(e. orſ DICAL DIAL A Monthly Record of Medicine and Surgery. vol.I. == § { - MINNEAPOLIS, DECEMBER 1898. § {...". CONTENTs. ORIG IN FAL FARTIC.L.E.S. open Air or Hygienic Treatment of PEIDIATRICS. - Consumption. • ** - - - - - - - - - - - - 14 Importance Of al Special Stud f - { - e - - ** . . Study of the chronic Valvular, Lesions—A Clinical Results of Treatment in Private Sanato- Conditions which Surround Infancy . Jºecture Delivered at the Minneapolis - and Childhood 23 City Hospital, by John W. Bell, M. D. T1a . . . . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . . . ~~ Illustrated - - Rise, Progress and Present Needs of © º e º º ſº tº $ tº * * * * * * 1. s Y ºr w y º - Mod d --- - y” surgery. Pediatrics . . . . . . . . . . . . . . . 23 - # :* º g Inflammation, by Knut 5 I,ung Surgery . . . . . . . . . . . . . . 16 || Inanition Fever in the New-Born . . . . 24 9 *** * *-* * * * * * > . . . . . . . . . * | Amputation for Senile Gangrene . . . . 16 NEUROLOGY AND PSYCHIATRY. What are the Proper Limitations in Alex- Thyroidectomy in “Graves’ ” I)isease. . 16 ander's Operation ? . . 20 º Recent Literature on the Subiect . . . . . 25. p - Movable Kidney . . . . . . . . . . . . . . . 16 L J ED ITO RI RAL, S. Gunshot Wounds by Modern Missiles . . 17 ISYE, EAR, NOSE AND THROAT. S The X-Ray in Forensic Medicine. . . . . 17 | A New Treatment for Tracoma . . . . . 27 - ALUTATORY . . . . . . . . . . . . . . . . 10 (, YNECOLOGY. The Use of Formaldehyde in Atrophic THE SUB-CONSCIOUs MIND–SUBLIMINAL * º q e Rhinitis . . . . . . . . . . . . . . . . . 27 CONSCIOUSNESs . . . . . . . . . . . . . 10 A Case of Utero vesical Fistula with The Treatment of Entropion of the Uncommon Etiology . . . . . . . . . . . 19 I,ower I,id with Caustic Potash 27 THE THERAPEUTIC Uses oF THE SUPRA- Total Inversion of the Uterus . . . . . . . 19 ~. -f e s a to RENAL GLAND . . . . . . . . . . . . . . . 12 Foreign Bodies in the Uterus . . . . . . . 20 CLINICAL, MICROSCO I?Y THE TRUE AIMS OF A MEDICAL Journ AL, 13 - OBSTETRICS. Washed-Out Red Blood Corpuscles in the ETHERION. TI NIEW ATMOSPFIERIC Urine as an Aid in the Diagnosis of "Č.” THE New ATMospheric a Treatment of Puerperal Sepsis . . . . . . 21 Renal Calculus . . . . . . . . . . . . . 27 . . . . . . . . . . . . . . . . . . . . Symphysiotomy . . . . . . . . . . . . . 21 | The Clinical Value of the Widal Test . . . 28 PRO G. RESS OF ME DIC IN E. Effect of Symphysiotomy on a Subse- FIOSPITAL CL.INICS. quent Labor . . . . . . . . . . . . . . . 21 e - MEI) ICIN E. The Relation of the Blades of the Forceps Asbury Hospital, Fracture of the Pelvic to the Axis of the Fetal Head . . . . . 21 | Bones with Rupture of the . Bladder. Congenital Genesis of Tub losis. . , 1.3 ‘. . I . W. ld, F. R. C. S. . . . . g … uperculosis 1 Clinical Report of the Rotunda (Dublin) 3y J Macdonald, F. R. C. S 30 ... Oxygen in Morphine Poisoning . . . . . 1.3 Lying-In Hospital for Three Years . . 22 sº º Hºpiºiºmoral Hernia, 31 7+ º- * + , , g ~ * v K1) ut Hoegll, M. 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For terms, address ; T H E SANATO RIU M. THE MEDICAL DIAL A Monthly Record of Medicine and Surgery. MI Original Hrticles. chronic valvular LESIONS. Clinical Lecture, Delivered at the Minneapolis City Hospital, BY JOHN W. BELL, M. D., Professor of Physical Diagnosis and Clinical Medicine in the University of Minnesota. - Gentlemen: The cases I shall bring before you this morning will serve to emphasize cer- tain important points connected with the diag- nosis and management of chronic valvular le- sions. The first case is one of fully compensated valvular disease, having as its principal point of clinical interest a systolic musical murmur of un- usual intensity and duration the origin of which has given rise to much discussion and great di- versity of opinion among clinicians. Case I. J. M., male, Russian, Aet. 33. Fam- ily history negative. Denies gonorrheal and syphiletic infection, claims nevel to have had rheumatism. Had typhus fever in 1893. Dur- ing convalescence noticed slight dyspnoea, which continued thereafter, especially on exertion. Fol- lowing prolonged exposure during the winter of 1894, in the city of New York, he became quite ill, was admitted to St. Luke's hospital, where he was informed that he had organic valv- ular disease. He remained in the hospital three months; discharged improved, but still suffered from dyspnoee and praaecordial distress, espe- cially on exertion ; later gradual improvement. Status praesens. Inspection—You will observe that he is well nourished ; facial expression and color of skin those of apparent health except a slight cyanotic tinge of lips and nails. You observe there ex- ists a small scar over apex, the result of a sabre thrust. Note the forcible diffused impulse in fifth interspace two centimeters to left of left mammillary line, also slight epigastric impulse and marked pulsations of corotids and tempor- als. NEAPOLIS, DECEMBER, 1898. Palpation—On palpation I find a forcible but diffused apex beat; pulse full, regular, but collapsing in character. Percussion—On outlining the relative deep cardiac dullness, the all important one, you ob- serve it extends at level of third rib four centi- meters to the right of sternum and seven to the left. At the level of upper border of fifth rib it extends transversely from a point four centime- ters to the right of sternum to ten centimeters Topographical Outline of Deep Cardiac Dulness, Case 1. to the left. Veltical (lullness from the center of the second space to the center of sixth rib. The somewhat square outline suggests general en- largement of all the chambers; hepatic dullness slightly increased downward. Auscultation–In the elucidation of this case auscultation becomes the highest court of ap- peal. In the clinical investigation of cardiac murmurs, the following essential points should be observed : 1st, The rhythm ; 2nd, Point of differential maximum intensity; 3rd, Area of Transmission ; 4th, Its sound characteristics. Placing my stethoscope over the apex, I dis- cover a loud systolic musical murmur, having its maximum point of intensity at the level of the fifth interspace in left sternal line—audible with diminishing intensity to the left as far as the scapular line—to the right as far as the right mammillary line, above 2 THE MEDICAL DIAL. as far as the second rib. On listening, one is impressed with the musical character and marked intensity of the murmur. Its musical character has caused its possessor to be desig- nated as “the man with the musical heart.” We have before us the problem of locating the origin of this systolic murmur. You will ob- serve that it corresponds to the characteristics of the murmur of mitral insufficiency, except that its point of maximum intensity is over the usual site of tricuspid insufficiency. In spite of the above fact we are fully justified in excluding tri- cuspid insufficiency for the following reasons: 1st. The intensity and pitch of the murmur as well as its large area of transmission, speak against its tricuspid origin. 2nd. Absence of direct jugular pulse. 3rd, Absence of hepatic engorgement or pulsation. Musical murmurs are not uncom- mon, yet we seldom meet with one having the intensity and purity of the one under consider- ation. If we had time we might speculate at length as to the cause of this peculiar musical sound. A slit in one of the mitral curtains, a vegetation attached to a leaflet swinging back and forth, in the blood stream may be responsible. We can only definitely say that the audible vibrations giving rise to such a sound must be free and unhampered to give us the pure musical tone present. Why has this musical murmur its greatest intensity over the tricuspid area? The explanation is to be found, I believe, in the relation the ventricles sustain to the anterior chest wall, the marked en- largement of the right ventricle having caused the left ventricle to recede from the chest wall, hence sounds originating at the mitral must of necessity find their way to the anterior chest wall by way of the interventricular septum and right ventricle. Tracing of Right Radial of Case 1. Placing my stethoscope over the aortic area, I discover a short, soft churning diastolic mur- mur of feeble intensity, having its point of max- imum intensity over the aortic area, feebly trans- mitted downward in the direction of the apex, evidently due to aortic insufficiency. In addi- tion to the diastolic murmur we have a short, somewhat harsh systolic murmur, transmitted along the course of the aorta, heard distinctly at supresternal notch and over both carotids. You will recall the fact that the apex systolic musical murmur was not audible above the second rib and not conveyed by the vessels at the base. This murmur corre- sponds to the characteristics of the murmur of Posterior view of Case 2. aortic stenosis, due, probably, to slight stenosis or slight dilatation of the root of the aorta, a fre- quent cause of faint systolic murmur over this area. An analysis of the accompanying pulse- tracing of the right radial tends to confirm the diagnosis, at least, of aortic insufficiency. The discussion of the prognosis and treatment of this case we will defer until we have examined the Inext case. Case 2. W. W. Aet. 20. single, student. Family history, negative. Personal history, measles at the age of three years, diphtheria at eleven, never has had rheumatism. General health good until the age of eleven, then noticed slight shortness of breath and tendency to fre- quent attacks of bronchitis. In 1893 noticed prominence of praecordial region, which grad- THE MEDICAL DIAL. 3. ually increased until marked bulging of the low- er left half of the thorax, accompanied by no- ticeable curvature of spine occurred. This pa- tient came under my care in June, 1894, suffer- ing from dyspnoea, orthnopnoea, præcordia dis- tress, palpitation, general venous engorgement, with slight edema of the lower extremities, the usual signs of advanced cardiac insufficiency. Status praesens. Inspection—Well nourished, skin normal in color except a faint cyanotic tinge of finger tips and nails. Directing our attention to the thorax we find a marked deformity, consisting of a sharp lateral curvature of the dorsal portion of the spine with an abrupt jutting forward and to the left of the ribs and cartilages below the third, causing pronounced prominence of the left mam- mary, inframammary and axillary regions. From a careful study of this case extending over a period of several years I have no hesi- tancy in saying to you that I believe the deform- ity present entirely due to the great enlargement ºf this young man's heart, occurring as it has during the period of rapid growth. The deform- ity is fairly well shown in the accompanying pho- tographs. - On directing our attention to the visible apex beat we find it displaced downward and outward, the diffused and forcible impulse extending from the fourth rib downward, being most pronounc- ed in the midaxillary line in the seventh inter- space. You observe the marked pulsation in the arteries of the neck, also the pronounced ex- cursions of the superficial arteries, brachials, ra- dials, etc. - - Palpation—The apex is felt most distinct- ly in the mid axillary line at the lower part of the seventh interspace, being forcible but slight- ly irregular in rhythm. The pulse is irregular and intermittent, as you will observe by this puse tracing of the right radial. | - Tracing of Right Radial of Case 2. Percussion—The outline of relative or deep dullness, you observe, is almost square, extend- ing from the center of the second space to the upper border of the eighth rib in the mid axillary line. At the level of the sixth rib we find the transverse dullness extending from a point two inches to the right of the sternum to within a short distance of the left mid axillary line, indi- cating the existence of extreme enlargement of the heart (cor bovinum). The topographical outline of deep dullness is well shown in the ac- companying photograph. Auscultation–I find on listening over the aortic area a well marked diastolic murmur, dis- placing the second sound and continuing well toward the end of diastole, transmitted toward the apex. Placing the instrument over the apex, I detect a soft, blowing, systolic murmur trans- mitted to the left, corresponding to the charac- teristics of the murmur of mitral insufficiency, Topographical Outline of Deep Cardiac Dulness, Case 2. probably due to relative insufficiency of the mi- tral curtains, owing to the extreme enlargement of left ventricle. Diagnosis—Aortic and mitral insufficiency with unusual enlargement of all the chambers of the heart, causing deformity of chest, dating back to his attack of diphtheria. I find I have consumed so much time in the examination of these two cases that it will be impossible to do more than direct your attention 1st. Every healthy individual starts on life's journey with a considerable balance to the credit of his heart, the extent varying in differ- ent individuals. This balance we designate as reserve compensatory force, the value of which is well shown in the perfect compensatory hy- pertrophy present, especially in case one, and in a lesser degree in case two. 2nd. That the accurate diagnosis and ration- al treatment of valvular lesions is only possible when based on a correct anatomic and physiolo- 4 THE MEDICAL DIAL. gic, as well as mechanical understanding of the heart and vessels, hence it is essential that we keep constantly in mind the fact that the heart is not merely a mechanical pump, but that it is also a vital muscular pump, presenting problems partly mechanical and partly vital. 3rd. In the management of chronic valvular lesions we should keep constantly in mind the fact that they are permanent and hence incur- able, and as such are losses of principal which can never be fully repaid. However, if we can make our patients realize this important fact and have them govern themselves accordingly they may live as long as if their hearts were normal. 4th. Hence all medication should be direct- ed toward bringing the patient's general nutri- tion, as well as that of the heart muscle, up to the highest possible point and maintaining it. In other words, we ignore the incurable valve lesion and treat the individual suffering from cardiac insufficiency. The patient's condition should be frankly ex- plained to him. He must be made to understand why he must follow instructions explicitly, and that if he transgresses, his sin will manifest itself in attacks of praecordial distress, palpitation, gas- tro-intestinal catarrh and renal congestion. We should carefully regulate his diet, exercise and habits. He should be advised to lead a tem- perate, quiet, orderly life, as free from worry and excitement as compatible with our present mod- ern civilization. Case one, representing compensated valvu- lar disease, may be dismissed with the above ad- vice. - * Case two received the following treatment on coming under my care in the early part of 1894, suffering from advanced cardiac insuffi- ciency. He was placed in bed and kept abso- lutely quiet. Digitalin, nitroglycerin and Strych. were given in generous doses subcutaneously. The bowels were opened freely daily with salines; general massage daily. After a fortnight of rest under above treatment on a light but nutritious diet, the condition of the heart and circulation having improved markedly, he was given a course of saline baths, still continuing the sub- cutaneous use of strych. and digitalin. At the end of four weeks movements of resistance were added in addition to general massage. At the end of six weeks he was permitted to move slowly around the room for short periods three times daily, spending the remainder of his time recumbent ; later graduated exercise in the open air in the form of short walks, continuing the use of digitalis and strych. per orem. This young man owes his life to the faithful- ness with which he carried out minutely and in- telligently every detail of treatment. During the past three years his general health has been ex- cellent. Compensation is not so perfect in this case as in case one, perhaps never will be, yet in 'spite of the broken rythm, as indicated by the pulse and pulse tracing, the functions of the heart are performed quite normally, an occasion- al slight gastric catarrh being the only evidence of unbalanced circulation. In closing I desire to again emphasize, as I have so often in the past, the efficiency of the sub-cutaneous method of treating cardiac insuf- ficiency. * THE NEW ATMOSPHERIC GAS. That subtle fluid which pervades all solid and liquid bodies and occupies the boundless space between the stars will probably soon be under- stood. Previously to the year 1879, three states of matter were recognized, solid, liquid and gas- eous. Michael Faraday expressed his belief that there existed a state of matter in which the mole- cules were relatively as far apart as compared with those of a gas as the molecules of a gas were compared with those of a liquid. What Faraday suggested was demonstrated by Crookes in 1879 when with the aid of the tubes which bear his name, he proved the existence of a radiant or fourth state of matter. To produce this fourth state the air of the tube must be exhausted to one millionth of an atmosphere, the condition neces— sary for the production of the X rays. New light will perhaps be thrown upon this interesting subject in the discovery by Prof. Chas. E. Brush of a new element in the atmosphere to which he gives the name “Etherion.” In a pre- liminary paper before the American Association Prof. Brush states that he discovered this new atmospheric gas while examining glass for oc- cluded hydrogen. Its chief characteristic is en- ormous heat conductivity at low pressure. This heat conductivity is one hundred times that of hydrogen and the mean molecular velocity of the gas is estimated at more than a hundred miles a second. Its density is only a thousandth part that of hydrogen, while its specific heat is six thousand times greater than that of hydrogen. While the heavier gases of the atmosphere lie near the earth's surface this newly discovered gas extends far beyond and probably is identical with the ether “in which the stars swim.” ETHERION, THE NAEDICAL DIAL. 5 MODERN IDEAS OF INFLAMMATION. BY KNUT HOEGH, M D., Professor of the Principles of Surgery and of Clinical Surgery in Hamline University. In the higher animals, and in its full develop- ment, inflammation is characterized by the four cardinal symptoms of redness, swelling heat and pain. Lately we have added impaired function. It seems that we might have been more logical in saying simply changed function. However correct this description may be it does not give us any insight into what inflamma- tion really is, and none of the explanations given for the appearance of those symptoms suffices to indicate the essence of inflammation, and tells what really takes place in the organism during this complicated process. Many have been the efforts made to explain the mechanism of the process, and as each of the modern Ones has made our view more comprehensive, it will be necessary briefly to indicate a few of the most important. - Virchow held that the essence of inflamma- tion was the action of the tissue cells; acted upon by some, not yet understood irritation, they be- gan to proliferate or multiply by division, there- by producing new material. Cohnheim went a step further and observed under the microscope what took place in the in- flamed mesentery of a frog; he was struck by the changes in the circulation; he observed the dila- tation of the blood vessels, the initial acceleration of the blood, followed by its slowing up, the mural implantation of the leucocytes in the veins and capillaries, the transmigration (or diapedesis) of the leucocytes. He looked upon the vascular system as the prime factor, and thought that a molecular change in the vessel walls was the chief cause of inflammation. The adhesion of the white corpuscles (leucocytes) to the venous and capillary walls was explained by a greater adhesion, a sort of sticky condition; the slowing up of the current made the lighter leucocytes congregate at the walls, while the specifically heavier red corpuscles continued to swim in the middle; through a molecular change in the for- merly impervious walls, they became able to let not only a greater amount of plasma transude, but also to allow the formed elements to go through by a peculiar process, and without mak- ing a hole in the vessel wall. Recklinghausen and Thoma also consid- ered the change in the circulating apparatus as the main element in the production of inflamma- tion, but went a step farther in the causation by ascribing it to the vasometer nerve centres in the inflamed territory. * , All of these theories had an element of truth in them, but erred in being too exclusive. Vir- chow's theory in looking too exclusively at the tissue cells; v. Recklinghausen and Thoma, as well as Cohnheim in considering the vascular system alone as the chief seat of the inflamma- tory process; for organisms that have no vascu- lar system also react against noxious influences. To understand the reaction of animal organ- isms against them, Metschnikoff began to study the lower organisms as subjects of irritation. He did not have to descend in the scale of ani- mals lower than the frog to see that one of the cardinal elements of inflammation was lacking; in the frog there is no increase of heat. But he went lower down, to the very lowest organisms that we recognize as animal, and began with the study of the ameba. The ameba is the most simply built of all animals; it consists in fact of one single cell, a mere mass of living protoplasm, with a nucleus, and without even an enveloping membrane. If an ameba is cut in two, the part that retains the nucleus regenerates itself and the lost part grows out. If the ameba meets a bacterium, it throws out jelly-like prolongations, that embrace the enemy and that gradually coalesce with the mass of the animal, whereby the bacterium Soon finds itself enclosed within the ameba; a contest be- gins, in which the bacterium by its toxines, se- creted by its metabolism, impairs the vital func- tions of the host; if this is strong enough to re- sist action of the toxines, the ameba disintegrates the bacterium, in the cell substance of which we see small granular masses, that finally fall apart, and the bacterium is destroyed; its remnants are then gradually expelled, and the ameba goes on living. If, on the other hand, the bacterium pre- vails, the ameba dies under the formation vacuo- les, and the bacterium growing on its substance, lives on and multiplies. Reaction against noxious influences in the anneba consists then, first in regeneration, Sec- ond, digestion, third expulsion. We shall see that this type is followed by all animals, but that the process becomes more complicated as we ascend higher in the scale of Organisms. 6° d THE MEDICAL DIAL. The gastrula is much more highly organ- ized. It consists of an aggregation of cells that have become differentiated into layers, an ekto- derm, an entoderm and a mesoderm. The whole animal forms a sac with an open mouth. If a foreign body comes in contact with a gastrula inside of the sac, in other words, if it is swal- lowed by the gastrula, the fixed entoderm cells incorporate it, and transport it into the body substance; then we see the mesoderm cells that are more movable, and in a way floating, collect around it; they incorporate and digest the for- eign body, and this is again taken in hand by the cells of the ektoderm, by means of which the useless particles are expelled. This is the same process as in the ameba, but the cells being dif- ferentiated into layers with different physiolog- ical properties, the work is divided between them to accomplish the same result. In some of these lower animals we see a new feature. Some of the cells of the mesoderm coalesce and form a great cell or plasmodium that possesses greater digestive properties than the original cells. It may be said that these processes in animals without a vascular system are very different from the reaction that takes place in the higher ani- mals, and you may deny them the dignity of the name of inflammation. We shall, however, see that there is a gradual transition, and it is by studying the process in the simplest forms that we get an insight into the highest. Even in some animals with a vascular system the process of inflammation takes place without any participation of the blood vessels. In the class “vermes” or worms, a foreign body is di- gested and expelled without any change in the blood vessels; it is the phagocytes of the peri- vascular fluid and the endothelia of the perito- neal cavity that surround and digest the foreign body. So far, we have seen the reaction of an animal organism, the process that forms the prototype of inflammation, go on without any action of the vascular system whatever. It is only when we ascend another step in the ranks of animals, when we come to the ar- thropods and the mollusks, that we see the de- fensive process acting mainly in the vascular sys- tem. Blood vessels do not in these animals yet form a continuous system of communicating tubes, as in the vertebrates, but they empty into the general body cavity. Their blood consists of a number of white corpuscles with one nucleus leucocytes, and these leucocytes develop strong phagocytic (or digestive) properties. In these animals is also found a curious gland, the use of which in health has so far been undetermined; Kowalewski has, however, found that it is pos- sessed of strong phagocytic properties; it thus shows itself to be a rudimentary spleen. When microbes enter a molusk or an arthropode, the white corpuscles of the blood, and further the rudimentary spleen develop their phagocytic ac- tion, and destroy the microbes, or if they are worsted in the encounter, the animal dies. So we see that in this class of animals, the blood- cells play a very important part in the reaction of the organism; but the bloodvessels show no change. In all these lower animals we find that the defensive process consists in the incorpor- ation of the approaching microbes, their diges– tion by certain cells, that Metschnikoff calls phagocytes (eating cells) and the final expulsion of the invader. The vascular system is not yet developed in this evolutionary state, and when we meet its first rudiments it takes no part in the process. d * It is only when we come to the vertebrates that we find the vascular system taking a con- spicuous part in the defense, and when we re- member that this system is developed from the Imesoderm, and further that it is the mesoderm cells that furnish the phagocytes in those ani- mals where a differentiation of the original cells into the three fundamental layers takes place, our view is enlarged to take in that essential unity of life action, that we can follow in ob- serving the evolution of organic life. Already in the amphibia, the lowest of the vertebrates, we find that the circulatory appara- tus plays a conspicuous part in the reaction. While in the ameba the whole animal reacted, while in the gastrula the floating cells of the mesoderm developed phagócytic properties, while in molusks the circulating mesoderm cells of the vessels took up the battle against the mi- crobes, we find that in the higher organized ver- tebrates the reaction mainly takes place in the vascular system, a highly developed evolution of the mesoderm. But we shall see that this re- action is not limited to the vascular system, and that a theory of inflammation that does not look further is essentially defective. The connective tissue cells perform a very important function, So do the lymph glands, the liver and the spleen, THE MEDICAL DIAL. 7 all organs that are wholly or partly derived from the mesoderm. - The most conspicuous change in an inflamed territory of the higher vertebrates, is the change in the vascular system, so beautifully demon- strated by Cohnheim in the mesentery of the curarized frog. Most striking is the dilation of the vessels, and the increased velocity of the cur- rent followed by retardation, that soon allows each blood corpuscle to be seen, especially in the veins and capillaries, where the well known phenomenon of the separation of the three formed elements takes place. The bloodplates and the leucocytes sticking to the walls—munal implantation, and the red corpuscles floating in the middle of the current. Then comes the dia- pedesis, or the transmigration of the corpuscles through the intact wall, increased flow of plasm through the wall, whereby the neighborhood be- comes soaked with this exudate, as the inter- cellular spaces, the radicles of the lymphatics, are not equal to the task of carrying the exudate away quickly enough. All these well known processes do not by far represent the reaction of the organism, for just as important changes take place outside the vessels. In the first place we observe that there is a destructive process going on in the immediate Ineighborhood of an inflammatory focus, its de- gree and extent in proportion to the inherent virulence of the invading bacteria, and the im- paired vitality of the surrounding tissue cell. This reaction consists in death (necrosis) of the connective tissue cells. In their fibres we see first small highly refractive globules or spheres: the protoplasm of the cells show vacuoles, that is, hollow spaces indicating dissolution; soon the cells swell and become translucent; the cell nuclei that are enveloped in a double membran consists of two different constituents, first-chromatin, ar- ranged in threads that look like a collection of loops or a net; second, the acromatin, a sub- stance that fills the meshes of this net. The chromatin substance becomes granular, and soon disappears, indicating destruction of nucleus and consecutive death of the cell. The process of death is often that of so-called coagulation Inecrosis, a process whereby the protoplasm of the cells, containing albumen, becomes coagu- lated (like boiled) and soaked in the tissue juices or exuded plasma. This death of neighboring connective tissue cells is primary, the result of the poisoning by the toxic secretion of the bacteria; it is usually minimal in extent and followed by peptonizing of the dead cells, that is a process by which the albumen is changed to pepton, a lifeless but soluble form, that may be resorbed and carried away by the lymphatics. At a certain distance from the bacteria, that is, from the inflammatory focus, where the effect of their toxines is insufficient to produce death of the cells, we find the connective tissue cells re- act in a conspicuous manner. These cells multiply, proliferate, partly as Virchow showed by direct fission or segmentation; the nucleus dividing in two, and the cell protoplasm becom- ing constricted in the middle and finally separat- ing into two, each with its own nucleus; partly by the process that is known as karyokinesis or mitosis; as this seems to be the more common and important process, it must be briefly de- scribed. There are first formed two distinct poles in the protoplasm of the cell by the ag- gregation in the cell substance of two heaps of granules in diametrically opposite parts of its body. Soon changes take place also in the nu- cleus; the chromatin threads become thicker and more convoluted, the inner layer of the nuclear membrance is incorporated in the chromatin net- work, while the outer layer seems to continue with the achromatin of the necleus. The achro- matin forms fine threads that connect the two poles forming an elongated mass, considerably wider in the centre, and thus having a fusiform or spindle shape; in the next stage the chromatin threads from a star-shaped mass with elongated loops, running out from a common achromatic centre somewhat like the spokes from the hub of a wheel. This chroniatin mass Occupies the equatorial region equidistant from the poles and is soon seen to cleave into two masses, which arrange themselves in such a manner, that the angles of the loops point towards the respective poles, while the limbs point toward the equator, obliquely or perpendicularly. There is thus dif- ferentiated an equatorial disc, from which the threads are separated; these gradually contract- ing towards the poles arrange themselves finally as a wreath around each pole and the formation of two cells out of the original one is completed by the formation of a nuclear membrane around each wreath, and the separation of the two halves at the equator; this takes place gradually, beginning as a constriction which becomes so far advanced that soon only a few achromatin 8 THE MEDICAL DIAL. threads connect the two daughter cells which finally are separated by the complete disappear- ance of these threads, At the same time as we observe the necrosis of the cells immediately exposed to the toxines of the inflammatory focus, and proliferation of the cells as described in the more remote neigh- borhood, we see an immigration of leucocytes into the infected area. These cells are partly derived from the blood vessels by emigration, partly from the fixed connective tissue cells, that under ordinary circumstances remain in the stro- ma, but stimulated by the irritation of the in- flammation, return to their embryological phase and assume ameba-like properties, (Ranviers Clasmatocytes also called plasma cells by Wal- deier.) Many of these immigated cells die from the bacterial toxines, and their nuclei undergo what is called fragmentation; that is, a process whereby the nuclear chromatin substance is bro- ken up into fragments that remain inside the cell body; such broken up chromatin substance is incapable of karyokinesis, and therefore unfit to contribute to the building up of new tissues. It is mainly leucocytes that undergo this frag- mentation; their destination may perhaps be to serve as nutriment for the other cells that pro- liferate and participate in the process of regener- ation. It is known that the blood contains sev- eral kinds of leucocytes endowed with special qualities, and we do not believe that they all per- form the same functions in the process of inflam- mation. We recognize at least four different kinds of leucocytes that distinguish themselves partly by their size and the number of their nuc- lei, but more conspicuously by their power of absorbing anilin colors; their nuclei take the nuclein stains, but their protoplasm reacts dif- ferently according to the basic or acid condition of the stain. I. The greatest number of leucocytes (70 per cent.) have one lobated or several nuclei (they are polynucear) of many different forms, their protoplasm is granular and is only colored by nearly neutral or faintly acid mixtures of basic and acid colors. They do not take purely acid stains nor basic ones. Another variety is called eosinophil leucocy- tes; their protoplasm is colored by acid stains (eosin) and their nuclei are also rather large: usually one or two nuclei. Their nuclei have different forms, the protoplasm is coarsely gran- ular, and seems loosely connected with the nuc- leus. A third kind is the Socalled lymphocytes, presumably derived from the lymph glands; they are smaller, have only one nucleus, and take only basic stains; they are further charac- terized by having a very small protoplasmic body surrounding the nucleus. The fourth species are also mononuclear (with One nucleus) and take both acid and basic colors; they are relatively of large size. All these cells have ameboid movements, but the lymph- ocytes less than the others; the eosinophiles rather more; these are not phagocytes, while the neutrophile multinuclear cells, and mononuclear cells are in high degree endowed with phagocytic properties. In the further process of inflammation, say from the second to the third day, there is an in- creasing immigration of leucocytes; many of the cells, especially the large mononuclear cells show marked phagocytosis; they penetrate to the focus of inflammation and are seen to incorporate the bacteria, which soon show signs of degeneration. Other leucocytes do not reach the inflammatory focus, but form a wall around it, whereby it be- comes in a certain way incapsulated; in this wall are probably also the cells that are derived from the fixed tissue cells, and that have strong phag- ocytic properties; the phagocytosis in the inflam- matory focus goes on increasing, the large mon- Onuclear cells and the polynuclear neutrophile cells playing the most important part. But not all leucocytes prevail; some of them succumb, undergo fragmentation of their nuclei, and be- come pus corpustles. Thus an abscess cavity is formed, surrounded by a granulation wall rich in new formed blood vessles; the abscess cavity gradually enlarges; the surrounding membrane becomes thinner, as part of it degenerates into pus, and finally it reaches a surface, where it breaks open. In the remaining part of the wall appear giant cells by coalescense of several cells-plasmodium—a form of cell life that is characterized by strong phagocytosis. These giant cells contribute largely to the destruction of the dead material in so far as it is not elimi- nated by expulsion through the abscess open- ing. After this comes organization of the scar and final healing. - - How are we to look upon this process? Are We to consider inflammation as a mischievous ac- tion of the organism that we ought to oppose? Or ought we to look upon it as a salutary re- action that indicates the defensive lines upon which the organism meets and fights injurious THE NAEDICAL DIAL. 9 intruders and thus gives us a hint how we shall shape our actions so that we support nature's efforts? • . There are certain irritants that Owing to their inherent qualities produce less local reac- tion than others, that in other words are accom- panied by less local inflammation. As an in- stance the streptococcus may be named. In many cases this bacterium produces in healthy tissue very little swelling, and very little pain, in short but a very slight inflammation. But at the same time it kills the cellular elements and pro- duces rather extensive necrosis; untrammeled by reaction from the side of the blood vessels, it a finds but little opposition by emigrated leucocy- tes; only a slight degree of phagocytosis takes place, and but few of the connective tissue cells return to their embryological condition to ex- hibit their amebalike properties. Under such circumstances the streptococcus colony rapidly increases in number, the cocci spread into the intercellular spaces, get into the lymphatics and the lymph glands, producing their toxins; they soon poison the blood and a serious general con- dition becomes manifest. The local inflamma- tory processes are comparatively unimportant; but the very existence of the individual is threat- ened by the toxemic condition of the blood . An- other instance is gathered from experimental pathology. The bacillus pyocyaneus is patho- genic for rabbits. Injected it produces but slight local reaction, but becomes dangerous from general blood poisoning. If on the other hand the animal has been made comparatively immune, the injection produces a strong inflam- matory action in the injected territory, but the animal is not killed by toxemia. We must therefore consider local inflamma- tion as nature's protective reaction against infec- tion. If we look upon the process as it takes place through the whole series of animal organisms, we find that phagocytosis, the incorporation and digestion by living cells, is the fundamental pro- cess that developes in every animal from the one celled ameba to the highest vertebrate. In the second place we notice incapsulation and finally expulsion, processes, that in the higher animals are mainly carried on by the aid of the blood vessels, where we also find the most conspicuous changes, such as above mentioned. How does this process originate? Must we assume that there is an outside influence that im– mediately directs it, that there is a vital force which consciously steers the cell to the infected focus and calls the slumbering cells to new life, to appear On the arena as champions of the threatened organism? Shall we endow the leu- cocytes and the plasma cells and the endothelia with will and purpose? The first assumption is entirely contrary to our well founded and uni- versally accepted natural philosophy; the “vis medicatrix naturae” and similar teleological con- ceptions are long ago exiled to the lumber room of exploded hypotheses; the second theory is so phantastic that we hardly need to consider it. We can explain the process without invok- ing the aid of any of these unreasonable theories; we can arrange them under the general chemical and physiological laws; we can in this process recognize certain inherent qualities in living matter that shows us, that it is an expression of animal bio-chemical laws, that no more need the appeal to a separate, extraneous force, dis- associated from matter, than the chemist has to believe in a force outside of matter when he sees two elements combine. The question is answered by considering the properties of living tissue, particularly that form of it that has ameba like characteristics. They have, like elements in chemistry, affinities that draw them towards, or on the other hand re- pulsive qualities that push them away from cer- tain other forms of matter. The toxines produced by bacteria, as well as the proteins existing in their bodies have at- tractive qualities for the leucocytes, and vice versa; SO that the leucocytes in their chemical organization have forces that compel them to unite with the bacterial toxines or proteines, just as atoms of oxygen and hydrogen are com- pelled to unite to form molecules of water. This process of attraction and union is called chemo- taxis, and is just as comprehensible, or rather just as incomprehensible as the chemical affini- ties, that we have mentioned. Although this ex- planation of the emigration of leucocytes only Suffices for One phase of the process, and al- though much in it remains unexplained, we See that part of the process at least finds its counterpart in other actions of matter, with which we are familiar, and although the under. standing of the ultimate cause is, and probably always will be, incomprehensible to us, we recog- nize it as analagous to other processes in the Imaterial world. (To be continued.) 10 THE NAEDICAL DIAL. THE MEDICAL DIAL A Monthly Record of Medicine and Surgery. Issued on the First of every Month at Minneapolis, Minn. Editor, J. W. MACDONALD, M. D., F. R. C. S. E. Associate Editor, C. K. BARTLETT, M. D. Business Manager, E. E. GRISWOLD. . . . . COLLABORATORS . . . . A. W. ABBOTT, M. D. G. D. HEAD, B. S., M. D. R. O. BEARD, M. D. RNUT HOLeGH, M. D. J. W. BELL, M. D C. H. HuntER, A. M., M. D. J. FRANK CoRBET't, M, D. W. A. Jon Es, M. D. J. W. DUDLEY, A. M., M. D. J. H. RISHMILLER, M. D. J. H. DUNN, M. D J. D. SIMPson, M. D. F. A. DUNSMOOR, M. D. J. H. STUART, A. M., M. D. W. A. HALL, M. D. H. B. Sweets ER, M. 19. DAVID Owen THOMAS, B. A., M. D., M. R. C. S. This Journal will not be responsible for any of the opinions expressed by correspondents. Annual Subscription, in advance, - - - Single Copies, - = - * - sº - Advertising Rates made known on application. $1.00 ... 10 ADDRESS ALL COMMUNICATIONS TO THE MEDICAL DIAL, MINNEAPOLIS, MINN. MASONIC TEMPLE. *. DECEMBER, 1898. SALUTATORY. The City of Minneapolis, with a population of two hundred and fifteen thousand people, and three hundred and fifty practising physicians, the seat of two prosperous medical colleges, six gen- eral hospitals and five dispensaries, and the med- ical center of a vast territory has no journal to voice the interests of the regular medi- cal profession. To supply this open field The Medical Dial makes its appearance. It will be the constant aim of its pro- moters to make it all that a first class med- ical journal should be. Nor should this be a difficult task, for in the hospitals of this state is a vast amount of clinical material, both medical and surgical, from which valuable practical knowledge can be drawn. Throughout the Northwest are bright, progressive, and ambitious men whose writings from time to time will adorn its pages. An efficient corps of collaborators has been secured who will keep its readers abreast with the world’s literature in the various de- partments of Medicine and Surgery. These gen- tlemen are widely and favorably known. To the profession at large, and especially to our fellow workers in the Northwest, we shall devote ourselves with the determination that this journal shall be free from partisanship, and conducted in the interest of no clique or faction. To do justice to every one, to uphold the honor and best interests of the hard-working practi- tioner, to record faithfully the progress of medi- cine and surgery in the tersest and most prac- tical manner will be our endeavor; and in all these efforts we shall strive to be: “True as the needle to the pole Or the dial to the Sun.” THE SUB-CONSCIOUS MIND. SUB-LIM- INAL CONSCIOUSNESS. It was said that the late Rufus Choate, during his arguments before the courts and jur- ies, would illustrate and enforce his brilliant ef- forts with apt quotations of prose and poetry, while he was really collecting his thoughts on the next point to be presented. It was also re- lated by one of the most expert stenographers in our courts, that he could take the speeches of two lawyers talking at the same time; but when the judge joined in the debate it was liable to confuse him. By such facts and experiences it would seem that some minds, at least, are capa- ble of carrying on two or more processes of thought at the same time, and that this faculty is susceptible of cultivation and improvement by exercise; it is probably true that one current is predominant and will attach itself to the mem- Ory, while the others will not make any perma- nent impression on the sensorium, being carried on, apparently, by their own momentum when Once started ; and, as Dr. T. D. Crothers, of Hartford, Conn., says, “The mind acts indepen- dent of reasoning and sense impressions, one phase of which is where the person is controlled by a dominant idea, so that all recognition of surroundings and time are lost, although he ap- parently acts in harmony with them.” These mental conditions, it seems, may properly be classed as sub-conscious, or sub-liminal as one may prefer, meaning that they are under, over, or about the margin of the real current of men- tal action. These terms, “sub-conscious mind,” and “sub-liminal consciousness,” have been used quite frequently, and have not been well defined by any authority, or recognized by lexicograph- ers. In order to bring the subject before the THE MEDICAL DIAL. 11 “International Medico-Legal Congress” for dis- cussion, Clark Bell, secretary of the Medico- Legal Society of New York, addressed a letter of inquiry to several eminent Psychologists for their opinions as to these terms; he simply asked for a brief statement which might be classed as a definition and a contrast between the two expressions. To this letter he received a large number of replies. Prof. W. X. Sudduth, of Chicago, writes, “Sub-conscious relates to that part of our nature, that operates beneath, or beyond the threshold of consciousness, and only comes above the threshold at special and peculiar times. The term “subliminal self,” as far as I know, originated with and has been mostly used in the reports of the Society of Psychical Research, and has reached little further. Certain it is that it lias not come into common use in general psy- chological literature. Mind is the intelligence within man, natural and acquired, that makes him what he is intellectually, morally and physi- cally. The “natural” mind is an inheritance and operates beneath the threshold of consciousness as consciousness only comes through knowledge based upon comparison of sense relationships. Subconscious mental activity is in operation at all times, however, and from the very inception of being, while objective or “acquired” mental activity only comes with age and understanding. The term age, as here used, relates to maturing processes, not to maturity. The objective mind or acquired intelligence is the result of the sum total of sense experience has its seat in the sensorium where different centers for the several senses have been definitely located. The sub- jective or natural intelligence has no special seat but permeates all portions of the body, and con- trols the so-called unconscious functional activi- ties, while the objective mind directs the con- scious or acquired functions. Subliminal con- sciousness is a state of the natural or subjective mind and as such is to be clearly differentiated from objective and super-conscious mind.” Prof. William James, of Cambridge, Mass., writes that “Both terms, “sub-conscious mind.” and “subliminal consciousness” seem to me to be vague and denotive, rather than positively defining. They designate the source of acts, whatever it was, which seem positive and intelli- gent, (as involving perception or caprition) and which nevertheless do not spring from the usual clear consciousness with memory attached. I think the term sub is unlucky, since some of the phenomena seem super in respect of the cogni- tive powers displayed in them. I have been in the habit of talking of “extra marginal con- sciousness” as this seems to escape the narrow- ing implications of “sub.” Dr. James R. Cocke, a writer of note, sums up his explanation as follows, viz.: “This ‘sub- liminal consciousness’ of which we hear so much is probably the product of the lower centers of the nervous system, which during active con- scious life we are ordinarily not aware of, owing to cerebral inhibition, for the time, in abeyance, . the lower centers of the nervous system trained ordinarily to a form of automatism, taking up and carrying on the ordinary functions of the mind.” Prof. Harlow Gale, of the University of Min- nesota, says, “Although ‘subliminal conscious- ness’ is strictly a contradiction, an increasing number of phenomena above and below the threshold of consciousness make some term for their classification necessary, and for their pur- pose ‘subliminal consciousness’ implies much less in the way of personification into a meta- physical unity than ‘sub-conscious mind.’” Prof. J. McK. Cattell, of Columbia Univers- ity, New York, says, “I do not myself make use of the term sub-conscious mind. ‘Subliminal consciousness’ I should define as consciousness which is so indistinct that it is known only through its influence on the course of mental life. The term was, I believe, invented by Mr. F. W. H. Myers. It does not seem to me to be any better than the older and synonymous term sub- consciousness.” Prof. J. T. Eskridge, of Denver, Colorado, writes, “Sub-conscious mind or sub-conscious- ness is generally employed to define that state in which the mind is, or may be by suggestion, the active possessor of all passed acquired knowl- edge. Such a state is found in some cases of somnambulism and in the state of hypnosis of some persons. Consciousness, as we ordinarily understand it, is a condition of mind in which we have a summary of passed experiences, and are able to correllate this, with the impressions * made upon our sensorium at the time to which our mind is actively directed. Sub-conscious- ness means less than consciousness, but it seems to me that ‘subjective consciousness' as used by Hudson in his work entitled ‘The Law of Psy- chic Phenomena,' better expresses the mental 12 • THE MEDICAL DIAL. state commonly designated ‘sub-conscious mind,” or ‘sub-consciousness.’ ‘Subliminal Con- sciousness’ has seemed to me a pompous OF stilt- ed definition for ‘subjective consciousness.’” Thomas J. Hudson, author, etc., writes: “The sub-conscious mind is the Source of that intelligence which is manifested, when the func= tions of the cortex are wholly or partially inhibi- ted, as when one is in a state of somnambulism, either spontaneous or artificially induced, as in hypnotism. Subliminal consciousness’ is a term coined by F. W. H. Myers to express precisely the same mental phenomena, and I give his defi- nition in his own words: 'Subliminal; Of thoughts, feelings, etc., lying beneath the ordi- nary threshold (limen) of consciousness, as Op- posed to supraliminal, lying above the threshold.’ His definition is rather non-committal, as Was doubtless intended, in regard to anything, but the bare fact that the operations of that intelli– gence lie below the threshold of our everyday normal consciousness.” Several other distinguished psychologists re- plied to the inquiry of Mr. Bell, without, how- ever, much change of expression from the brief quotations given above. No argument was ad- vanced to prove the duality of the mind as Some psychologists have attempted to maintain. Some remarkable instances of physical impressions and premonitions are related and ascribed to the action of the subliminal sense, by R. Osgood Mason, Neurologist and Author; also by Dr. Crothers. The former relates how a mother, who had sent her child out to play, was in- pressed with the idea that something dreadful was about to happen to it, and sent for her to re- turn. When the child was asked where she was intending to go, said “to a place where she and her brother had found a pleasant spot on some rocks by the railroad the Sunday before.” There was an accident there which killed several peo- ple at the very time the child would have been there if she had not been called back; and the latter, Dr. Crothers, reports the case of Prof. Martin, of London, who, after careful study and preparation, decided to go to India in a certain official capacity; but at the last moment he was impressed that it was a fatal mistake to go; and the sequel proved the correctness of the impres– S1C)11. Two-thirds of mankind have tuberculosis, either latent or apparent; one-third die of the disease THE THERAPEUTIC USES OF THE SU- PRARENAL GLAND. The employment of animal extracts was brought prominently before the profession when Brown Sequard announced to the world that he had renewed his youth by the repeated hypoder- mic injections of a fluid extract obtained from the testicles of lambs. The fad had its day. Many other animal extracts have been tried and for the most part found wanting; but there is one gland which probably has not received the attention to which it is entitled. Dr. W. H. Bates (Medical Record, Oct. 8th, 1898) after a series of experiments on the ductless glands, be- gan in 1894 to use the aqueous extract of the suprarenal capsule in diseases of the eye. Its value in inflammation of the mucous membranes of the eyes, ear, nose and throat led him to believe that it would have a similar ac- tion in inflammatory conditions of other mucous membranes. He was also led to the belief that the extract was a valuable heart tonic from a study of its physiological action and the effects observed in a few cases in which evi- dent symptoms of heart disease were relieved by its installation into the eye. The extract must be freshly prepared when needed, for it is incompatible with preservatives and is weakened by heat. He prepares the fluid extract by mixing ten grains of the dried extract with two drachms of water and filtering. The filtrate is a one per cent solution of the extract. It is the most powerful astringent known. When a drop of a one per cent solution is instilled into the eye, the conjunctiva of the globe and lids is whitened in from forty seconds to two minutes. The pupil is not contracted or dilated, nor is a tolerance established by its use. It has no anti- septic or anaesthetic properties. In stricture of the nasal duct its use has given good results. When the duct is closed by swell- ing of its lining mucous membrane the extract syringed into the punctum lessens the conges– tion, and the duct becomes open immediately, SO that water may be made to pass through it free- ly. It often succeeds where cocaine fails. The success attending its use in stricture of the nasal duct has suggested its employment in stricture of the urethra, oesophagus, pylorus, etc. Dr. J. M. Otto used it in urethral stricture and found that it relieved the congestion of the parts suffi- ciently to allow the passage of a larger sound. An internal urethrotomy was painless and with- THE MEDICAL DIAL. - 13 out hemorrhage. Velich employed it in skin diseases and found that it produced local anemia When applied to the skin with or without a breach of continuity. Applied to a burn it turned the surface white, and prevented blister- ing. It whitened eczematous patches, and caused the hyperaemia of intertrigo to disappear. In small pox it has been used to prevent vesicu- lation and consequent disfigurament of the face. In pernicious anemia Dr. Douglas Stanley found in one case that the freshly prepared aque- Otis extract produced a marked increase in the number of red blood corpuscles. In heart dis- ease the suprarenal extract is much more power- ful than digitalis or ergot. Oliver and Schafer have proved it to be a tonic of the heart muscle. The tension can be increased enormously by in- travenous injection, less markedly by its subcu- taneous use; but its action is very uncertain when given by the mouth. Exophthalmic goitre has been materially affected by this remedy. Dr. George W. Crosby observed a decided improve- ment in the action of the heart and in the gen- eral muscular strength. The goitre had almost entirely disappeared, though the tumor was not very marked and the patient had gained consid- erably in flesh. One tablet of the extract repre- senting eight grains was given three times a day. The best way to administer the gland is to place a few drops of the aqueous extract on the tongue. Dr. Bates sums up his conclusions as follows: “As a pure astringent in all inflammations, as a hemostatic, and as a tonic—I might almost say food—to all muscle fibres, especially the heart, no therapeutic agent has been employed which can compare with the extract of the suprarenal gland.” * THE TRUE AIMS OF A MEDICAL JOURNAL. It should have a high standard of excellence in all matters pertaining to medicine and sur- gery. It should not be only a gleaner in the fields of literature on the subjects discussed, but seek Original theses of practical importance from the best authorities on diseases with which each is most familiar. It should criticise with knowl- edge and judgment, giving credit or blame just- ly with the reasons for the opinions expressed. In every respect it should have the six qualities of the ideal physician, viz.: “Bold when sure; cautious in danger; kind to the sick; friendly with fellow-workers; constant in duty; not greedy of gain.” Pr0SrcSS Oſ II?&dicine. MEDICINE. UNDER THE CHARGE OF J. W. BELL, M. D., C. H. HUNTER, A. M., M. D. J. H. STUART, A. M., M. D. DAVID Owen THOMAS, B. A., M. D., M. R. C. S. CONGENITAL GENESIS OF TUBER- CULOSIS. º Dr. James Nevins Hyde, in his presidential address before the American Dermatological As- sociation (Journal of Cutaneous and Genito- urinary Diseases, September, 1898) in speaking of the medical progress of the year, said: “While the doctrines once held on the subject of the heredity of lepra have been greatly shaken by acceptance of the bacillary origin of the disease, it is noteworthy that in the last year the inheri- tance, or more properly speaking, the congenital genesis of tuberculosis seems to be securing a broad foundation. Tubercle bacilli have been discovered in the testes of tuberculous patients without other urogenital symptoms; artificial tu- berculization of the placenta of guinea-pigs has resulted in the birth of tuberculous offspring. Congenital tuberculosis may be, in fact, set down as on the verge of actual demonstration.” Dr. Hyde adds, that notwithstanding none of the several forms of tuberculosis affecting the skin are seen at birth, it is probable that the latent bacilli demonstrated in lymph-glands, etc., would become active disseminators of the disease later in life. In this light, he regards the origin of lupus vulgaris in children, in some instances, to be by congenital genesis rather than by con- tagion. OXYGEN IN MORPHINE POISONING, A very interesting case of poisoning by mor- phine is reported by Dr. D. T. Playfair (Lancet, Aug. 27th, 1898). The patient was a strong woman, thirty-seven years of age, who swallowed a solution of morphine acetate containing about 30 grains. When the patient was found at Io:40 a. m. symptoms of profound morphine poisoning were established, and she passed rapidly into coma. Steps towards resuscitation were begun at once. Ether was used hypodermically, the faradaic current applied, and the stomach washed out first with water and then with a solu- tion of permanganate of potash. Afterwards a pint of strong coffee with one ounce of brandy was introduced. The faradaism failing to elicit any response hypodermics of atropia and strych- nia were employed. Artificial respiration was practiced but produced no effect on the pulse or cyanosis. An enema of coffee and brandy was given and mustard applied to the cardiac region and the feet. At I2 :45 p. m. oxygen by inhala- tion was commenced, which was continued with- Out any sign of natural respiration until 6 p.m., 14 THE MEDICAL DIAL, when the patient began to make slight inspira- tory effort—about one per minute. The Oxygen was continued until IO p. m. and the life of the patient was dependent upon it during the period of its' employment. Dr. Playfair asserts that “nothing but oxygen was apparently of any value.” He is inclined to believe that oxygen acts not only as a heart stimulant, but also pos- sesses some direct oxidizing effect on the poison. VIRCHOW ON HEREDITY. The authorities of Charing Cross Hospital, London, where Prof. Huxley received his med- ical education, have honored his memory by an annual lecture. The first was delivered a year ago by Prof. M. Foster, who was the most com- petent witness of Huxley's early work and also of the development of biology, the special field of his activity. This year the “Huxley Lecture” was delivered in English by Prof. Rudolf Vir- chow, of Berlin, on the “Recent Advances in Science.” The memory of Huxley, the pioneer biologist, and the fame of Virchow, the leading pathologist, conduced to make the occasion a memorable event in London medical circles. The social feature of the event culminated in a complimentary dinner to Prof. Virchow at the Hôtel Métropole where the representative mem- bers of the profession in Great Britain and Ire- land were assembled. Lord Lister presided and acted as toast-master. * In the course of his lecture Prof. Virchow said (Lancet, Oct. 8th, 1898): “It is the custom to describe as hereditary all diseases which reap- pear in different generations of the same families. Thus, one speaks of hereditary tuberculosis and hereditary cancer. It is, in fact, not difficult to produce genealogical tables which demonstrate the recurrence of paternal maladies in children and grandchildren. Much trouble has been de- voted—in my opinion without result—to the seeking of the germs of such diseases in the ovum or the semen. One is compelled to pass on to generations of cells which took origin after conception. As we pass from the time of con- ception the more numerous do we find the alter- ations in the formation of cells and in the forma- tion of embryonic tissue. At the same time there is a greater possibility of the alteration having arisen after the formation of the first cells and hence that the existing cause may have com- menced to act at that time. If we set aside this possibility nothing else remains but to assume that from conception from the organs which produce the disease a predisposition is transmit- ted which is already present in the earliest cells, even if it cannot be recognized in them.” THE ARREST OF PULIMONARY HEM- ORRFIA GE. Dr. Walker Schell reports (New York Med- ical Journal, Oct. I, 1898) the case of a woman in the advanced stage of consumption who was troubled with frequent and severe hemorrhages. Believing that the blood escaped from an eroded vessel in a cavity in the apex of the right lung he injected (“early in August”) 85 cubic inches of nitrogen gas into the right pleural cavity to com- press and immoblize the lung, according to the Murphy plan. - 4. The introduction of the nitrogen at once ar- rested the haemoptysis which did not recur to the time of his writing, Sept. 17th, 1898. D. O. T. OPEN AIR OR HYGIENIC TREATMENT OF CONSUMPTION. The British Medical Journal of Oct. Ist, 1898, contains a discussion before the British Medical Association on the open air, or hygienic treatment of consumption, which is strikingly interesting because of the advanced views set forth in some of the papers in the line of what is rapidly becoming the common concensus of the profession, as well as for the utter disregard of some of our cherished hygienic rules. Dr. Caverhill's paper on Sanatoria for Phthis— ical Patients is full of interest. The sympos- ium contains papers on the treatment of this dis- ease in South Africa, in New South Wales, in Australia, in the Riviera, in England, in farm houses, and at the sea side in properly con– structed verandas. Dr. Caverhill and Dr. Mander Smyth give us an insight into the management of patients in the Nordrach Sanatorium in the Baden Black Forest, and their papers are worthy of special consideration. The results are as wonderful as the method is startling. The Nordrach is situated in the Black Forest, miles away from town and sta- tion, I,300 feet high, surrounded by hills 1,500 feet high, so steep and rugged that only the stronger can make their way through or over them. The isolation of the place is held to be One of its chief merits, because patients are pro- tected from the multitude of evils attending the crowded and frequented resorts. “The environ- ment is considered of much more importance than the meteorological conditions.” The climate, as described, might be called “nasty,” but then “climate and weather have but little to do with results.” “The summers are hotter and the winters are colder than in Eng- land, the weather is changeable and the rain-fall is abundant.” It has been proved by Dr. Felix Blumenfeld “that neither fogs, mists, cold, ex- cessive rainfall, nor changes in barometic pres– sure had any appreciable influence on the health of consumptives” at the Sanitorium at Falkens- lºin. “The patients usually spend from seven to eleven hours daily in the open air, in spite of rain, fog, Snow, and a temperature often as low as 12° F. below freezing point.” Dr. Caverhill says, “Much was formerly made of frictions and cold douches in hardening the skin, and increas- ing resistance to colds and catarrhs; but the use of the latter has ben largely given up, and now lmot or cold douches are given indifferently for THE NAEDICAL DIAL. - - 15 purposes of cleanliness. It is remarkable how quickly the hardening process is brought about, and in a few weeks, sometimes even in a few days, patients can rest and sit about till bed- time with wet boots, stockings, and trousers or skirts. At Nordrach in the Black Forrest, 1,300 feet high, clothes and boots are seldom changed, even if damp, after the morning walk. Patients of both sexes sit at meals and lie down for the prescribed periods of rest, and only remove their wet garments on going to bed.” But to render such a course of treatment possible, and to be able “To withstand the cold and exposure to draughts and stormy weather, and to oppose the enfeeblement and wasting in- duced by the disease, it is necessary to eat large- ly, first, of fats, usually butter; secondly, of Sweets, farinaceous foods and vegetables; and, thirdly, of nitrogenous foods. If there be repug- riance of food it is the duty of the physician to Overcome it, and to stimulate the stomach which has become weakened by a too limited dietary both in quantity and variety.” The main features of the treatment, then, are mental and bodily rest, regulated exrcise (walk- ing or hill-climbing), overfeeding (or what to the patient seems overfeeding), principally with fats, vegetables and farinaceous foods, and finally abundant fresh air.” If a patient on admission is much reduced in body with febrile symptoms, he is kept in bed, but with his windows in the room wide open, (or partially open if the weather is stormy); the room is thus flooded with fresh air, winter and Summer, by day and night. “When his temper- ature has been normal for a week, he is allowed to be outside in verandas and pavilions, and when short walks are not followed by undue ele- vation of temperature, he gradually increases the distance to eight or nine miles, in which stiff hill climbing is often included. Walking must be slow, with frequent rests, and five hours a day are usually passed in this way.” - RESULTS OF TREATMENT IN PRIVATE - SANATORIA. Knopf, from collected results of treatment in Sanatoria in various countries, found, Out of 4,500 patients, after an average of three months' treat- ment, that 630 were absolutely cured, 630 were relatively cured, i. e. made able to work with only slight signs of disease remaining; 1890 were improved, while 1350 were either not improved or had died. * , . Dr. Brehmer, founder of Sanatorium treat- ment, in a total of 5,OOO cases, reports even more favorable results. Thus it is stated that by this Imethod, of the well-to-do class fully one in four of consumptive patients has been “completely cured, or cured sufficiently to return to work with every apparance of good health.” “CHILLS” AND “TAKING COLD.” Dr. Mander Smyth, speaking of the “la- mentable timidity of some writers in regard to 3 y 3 'fresh air,’” says, “It is indeed greatly to the credit of Dr. Walther (of Nordrach) that he has been the first to teach the absolute unimportance of the weather however bad, in the production of common cold, which he believes to be due to an infection somewhat similar to influenza, and also with regard to the state known as ‘chill,’ which in consumptives, in nine cases out of ten, means a relapse due to over exertion; this over exertion ‘chill' or relapse rarely happens at Nor- drach, and fresh acute cold or catarrh is never seen there, because the isolation and the open-air life render the chance of direct infection prac- tically impossible. When occasionally a cold is taken, it is transmitted from a visitor or some member of the Staff, and can be traced to the village or station below.” “Patients are at once encouraged to discard Overcoats, macintoshes, and all heavy clothing, in walking, whatever the season of the year, though for the sake of comfort they may wrap up as much as they like while at rest, but with open windows. No regard is paid to wearing sound boots or keeping the feet or clothes dry, nor even to wearing flannel next the skin; the patient's comfort being his guide in such mat- ters.” Sandals or thin canvass shoes are worn, winter and summer, and these are often soaked through in the first puddle. Dr. Smyth states, that while a patient in the Nordrach Sanator- ium, on purpose to test the infection theory of ‘taking cold,” he had worn wet shoes for days to- gether, sat by open windows for hours in draughts when the temperature of the room was at freezing point, waded in ice cold water, etc., and that he failed as did the school boy who tried similar means to get a ‘bad cold’ that he might play truant. APPLICATION OF THE METHOD, Dr. Caverhill says, “It is indispensable in the first place that the patient be informed of the nature of his disease. With the improvement in his symptoms, which is usually rapid, he loses his depression and is soon thoroughly con- vinced that his only hope of safety lies in the most strict adherence to all its requirements. The physician regulates the supply of nourish- 1ment and sees that it is consumed. He pre- scribes daily the amount of exercise and repose, and he keeps a close watch on the temperature and circulation. His rule must be absolute and his authority unquestioned.” TREATMENT OF CONSUMPTION IN DE- PENDENTLY OF THE SANATORIA. Dr. Calwell: “It is noticeable that the ani- Innals that suffer most from this affection are free when in the wild state. I refer to 1man and the milch or dairy cow; it is when they are herd- ed together in close quarters that they suffer. * * * Tuberculosis is a disease of the transition period in which we are at present. A transition period from the open air life of the savage to that ideal hygiene of the future. It is this open air 16 - THE NAEDICAL DIAL. life of the savage, combined with the hygienic comforts of our own age, and systematized with military precision, that the Continental Sanatoria compel the patient to live, and such is the specific treatment of consumption.” J. H. S. SURGERY. UNDER THE CHARGE OF J. H. DUNN, M. D., KNUT HoFGH, M. D. LUNG SURGERY. One of the most striking recent surgical pa- pers is that of Dr. J. B. Murphy, read before the American Medical Association (Journal Ann. Med. Association, July 23rd and 30th, Aug. 6th and I3th, 1898). It is a masterly analysis and summary of the “Surgery of the Lung,” togeth- er with some original investigation upon the treatment of certain cases of pulmonary tuber- culosis by intra plural injections of nitrogen gas for the purpose of securing collapse and qui- escence of the diseased lung. Murphy main- tains that immobilization and physiologic rest of the lung favor the healing of tubercular foci and cavities. If further experience should favor this basic proposition, his work will prove truly epoch making. His interesting experiments ap- pear to have brilliantly established the practica- bility and safety of the technique and it only re- mains for time to decide how curative this me- chanical quiescence shall prove. The author has issued this valuable paper in a reprint of 144 pages. AMPUTATION FOR SENILE GANGRENE. Dr. Stephen Smith, in a paper read before the New York Medical Association, advocates a modification of his well known joint amputa- tion for application to senile gangrene of the foot. preserve the blood supply of this region. In senile gangrene amputation above the knee has usually been advocated as more likely to get above the obstructed vessel and secure healthy and well nourished flaps, than amputations through the leg. Smith contends that the struc- tures about the knee are more largely supplied with blood than any of the leg tissues, and if amputation be performed so as to preserve the eight arterial branches, the flaps will be well nourished. - His directions are to make a straight incision beginning two inches above the upper border of the patella, and carry it down from the center of that bone to the tuberosity of the tibia; from here two curved incisions having their convex- ities downward, one in the direction of the ex- ternal, the other in the direction of the internal borders of the limb. These are joined posterior- ly in the said incisions across the upper border of the calf. The flaps are dissected up from the bones of the leg, the patella is removed and the W. A. HAL.I., M. D., The object of the modification is to better leg disarticulated. While there is probably no doubt of the general proposition that it is safer to amputate at or above the knee in Senile gan- grene, than through the leg, yet, the reviewer has, in a typical case with complete mortification of nearly the whole foot and the most striking arterial sclerosis, had very excellent healing of the stump made at the junction of the middle with the upper third of the leg. In this incident, the arteries were at once examined and the point of obliteration found below the point of amputa- tion, otherwise, with the intention to reampu- tate immediately at the knee. THY ROIDECTOMY IN GRAVES EASE. s In the Medical Record of August 2nd, Dr. Arthur Booth reports his results obtained by thyroidectomy in eight cases of Graves’ disease. The operation was followed by cure in five of the eight cases, one death, one improved and One not improved. There seems to be considerable surgical tes- timony in favor of, and an increasing tendency to resort to partial thyroidectomy in this dis- ease, especially in those cases in which the thy- roid enlargement is marked and precedes the tachycardia. It is worthy of notice that Booth says “One has been improved, and in this case it is worthy of notice that the operation was performed only six months ago, so that we may expect still further improvement and perhaps a cure, for the longer the period after operation, the better appear to be the results. As profound a clinician as Hilton Fagge, after Summing up the prognosis in Graves' disease, long ago, said: “The only possible inference seems to be, that most cases end in recovery.” The reviewer has observed several very troublesome cases which recovered in from eight months to two and a half years, upon hygienic and various modes of treatment. Hence until the results of surgical treatment of this af- fection are more decided than they yet appear, some suspicion must be entertained that the re- sults are largely coincidents. MOVABLE KIDNEY. In “The Record” of August 13th, Max Ein- horn writes entertainingly on movable kidney. He opposes nephrorrhaphy, except in rare instance, preferring a treatment of the gastric and intestinal disturbances by modern methods, and promoting nutrition and proper bandaging. The digestive disturbances are by no means en- tirely due to the movable kidney. In fact, such disturbances are not more markedly frequent in subjects with movable kidney than in others with normally fixed kidneys. He has not found the results of nephrorrhaphy in any respect better than those of modern medical treatment. In- deed in some instances after nephrorrhaphy, the symptoms have been worse. He advises that only when a connection between the symptoms and the renal movability appears to be proven in DIS- THE MEDICAL DIAL 17 a high degree, and after dietetic-mechanical treatment has failed, should nephrorrhaphy be resorted to. - - The views of E’ though possibly leaning a little heavily to a medical extreme, appear to the reviewer much nearer the truth than the ex- treme surgical views of Edibolds and many oth- ers. Nephrorrhaphy is a most useful proced- ure in certain cases—in a few even a necessary One, but anything like a routine application of it to every movable kidney, is productive of not very unequal parts of good, no-good and harm. GUNSHOT WOUNDS BY MODERN MIS- SILES. The brief war with Spain has revived the ever fascinating topic of gunshot wounds. the many recent articles upon the subject, that of Dr. Roswell Park (Buffalo Med. Journal, Aug. 1898), “Gunshot Wounds Made by Modern Mis- siles and their Treatment,” is especially enter- taining. As to the effect of the new ball on par- ticular tissues, he says: “In the skin, under or- dinary circumstances, there will be little or no difference between the wounds of entrance and exit. If such a ball pass through a blood ves- sel of the larger class, the edges of the wound will be so clean cut that no retraction of the in- ner coat can take place; consequently, no spon- taneous cessation of bleeding can occur. In Other words, a wound of a large vessel will be quickly fatal unless bleeding be promptly checked. In the muscles the explosive action of these bullets will be least marked, unless the lbone be also shattered. In the bones the ex- plosive effects will be most marked at short range, for reasons which I have already alluded to. Beyond 400 yards’ range they will be less So, while, again, at long range there will ordi- Tarily be less shattering and comminution than the old balls used to produce, and a clean pene- tration will be the rule unless the nodal point is struck. In the joints themselves the small bul- 1et rarely makes a severe injury, save by shatter- ing the bone. In the skull up to 1,200 to 1,500 yards complete shattering of the bone and dis- ruption of the brain will take place. At short Tanges the destruction will be even more terrific, and the head so struck will lose all resemblance to a human skull. In the chest clean perforation of the lungs will ordinarily take place, unless pieces of bone are driven in. What may occur in the heart has been already alluded to. Ten- dons, unless struck squarely, are pushed aside by the bullet. The abdomen may be perforated even at the longest effective range of a weapon, and multiple perforations of the intestines, with often complete destruction, may take place. The soft organs, like the liver, spleen and even the 1 . . . . . . . . . . . 46 Huntington S chorea. a p = & ſº e .. sº tº e Puerperal Mortality * * * * 63. 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Original Hrticles. MODERN IDEAS OF INFLAMMATION. KNUT G. HOEGH, M. D., Professor of the Principles of Surgery and of Clinical Surgery in Hamline Unive.sity. (Continued from page 9.) A description of inflammation that only con- siders the local process is defective, for the Or- ganism reacts in several ways, and in several localities against the onset of the bacteria; it has like a fortified castle several lines of defense. Have the bacteria prevailed at the point of in- fection, and have they broken through the first line of the surrounding granulation wall, they may spread through the lymphatics to the glands. There follows then a lymphangitis or a lymphadenitis; the battle is then renewed, and usually under these circumstances, successfully for the organism. For in the lymph vessels and the glands the conditions are very much the same as in the original point of infection ; when the bacteria reach the lymph sinus in the glands they meet numerous and active lymphocytes that have originated there; the enlargement of the lymph glands under these circumstances, which is the universal rule, indicates sufficiently the new formation of the defensive elements. If also these glands prove insufficient to destroy or at least retain and incapsulate the bacteria; the same process is continued into the next series of lymph vessels and glands by the process we call infection by continuity; this constitutes the second line of defense. But it may happen that the infective agents pass by the lymphatics and either through the broken down capillaries or greater vessels enter the general circulation. The organization is also here able to offer powerful resistance, which constitutes the third line of defense. We have seen that in the mollusk is found an undetermined gland endowed with strong pha- gocytic properties. This is in a way to be con- sidered as the prototype of the spleen, which in the higher animals by its increase in volume indicates its participation in the reaction of the organism against the bacteria or their toxines; in the higher animals this phagocytic effect is not limited to the spleen; the bone marrow and the endothelia of the bloodvessels assist in the process; partly by direct local phagocytosis, and partly by increased production of new leucocy- tosis, the so-called inflammatory hyperleucocyto- sis. l It has been experimentally proved that this byperleucocytosis is the direct result of toxin resorption; in most diseases its presence is of good prognosis, it shows that the Organism re- acts; in some diseases—for instance pneumonia, its absence forebodes a speedily fatal result. In other diseases, however, it only shows an ex- tensive toxin resorption, that in itself may prove fatal from its intensity, and in spite of the hyper- leucocytosis; we see that in diptheria this very pronounced increase of leucocytes usually in- dicates a fatal toxinaemia. But even this process is not the last effort of the organism to resist the bacteria and to neu- tralize their toxines; as perhaps the strongest line of defense, we must indicate the body juices themselves. In normal blood and lymph are found protective substances that have bactericide properties. These substances, that are called alexines are soluble albuminates, probably de- rived from leucocytes; they are easily destroyed when brought in contact with bacterial toxines, and on the other hand act as antidotes against them in neutralizing these chemical compounds. lºurther more, the excretions of the body, the urine, the feces, the perspiration, as well as the bile, the saliva, and the milk, absorb and expel from the organism toxines, which can be dem- onstrated in them by chemical analysis. These processes are of course of great im– portance in the battle against all kinds of bac- terial invasion, but they are further reinforced by a more remarkable process. When an indi- vidual becomes infected by a bacterial poison, there is produced in its blood certain substances which we call anti-toxines, and which have a 34 THE NAEDICAL DIAL. destructive influence upon the bacteria or their poisons. The manner in which these antidotes are produced is unknown; possibly some chem- ical reaction takes place between the bacterial toxines and the blood plasma; the result is that the organism becomes an unsuitable soil for the bacteria, or that it becomes able to resist the action of their poisons. somewhat loosely called immunity, which may be temporary or permanent. If during infective diseases, bacteria could multiply indefinitely, and if there was no other limit to their growth than the exhaustion of the nutrient material, it is difficult to see, how anybody could ever recover from an infective disease, that has broken through the primary local reaction focus. If for instance, the local reaction against the pneu- moncoccus is insufficient to neutralize the effects in the attatcked lobe of a lung, and the bacteria go on multiplying, they must certainly Over- whelm the organism by their toxines, if no fur- ther defensive mechanism is put in action. The usual clinical picture of the disease seems to jus- tify such an assumption. The patient lies in a very precarious condition, the condensation of the affectetd lobe of the lung shows no signs of resolution; the nervous system, the heart, the kidneys, are nearly exhausted. The patient is apparently in the greatest danger of death, and in fact in weak individuals it takes place with sufficient frequency; but in a majority of robust patients a sudden improvement appears, so that the patient at once passes from a most critical condition to one of convalescence. This is supposed to be due to an anti-toxin in the blood. The same with nearly al the self limiting infective diseases. In several of them the experimental pathologists have been able to isolate the chemical substance; in some they have used the serums of infected animals, and have produced cures by injecting them in the patient's body. Behring's anti-toxine for diph- theria is an instance of the therapeutic value of this treatment; and there are many facts that seem to indicate that we in the future shall be able to cure infective diseases by similar meas- 111’éS. . Reports are already coming in of the cure of pneumonia, tetanus, and typhoid fever by this treatment; they are as yet few and scattering, as our technique is imperfect; but the way is indicated, and the day is perhaps not distant when the general treatment by this and similar This is the condition methods will be as certain and effective, as the local or surgical treatment, which now enjoys such a prestige in the popular estimate. It must also be remembered in reviewing the process of healing infections, that the bac- teria themselves produce metabolic substances, that are detrimental to them ; that the bacteria thus may be destroyed by their own products, just as human beings occasionally die from re- tention of their secretions in uremia and acet- onemia, when the cutaneous perspiration is abol- ished, etc. This process can, however, not prop- erly be considered as a link in the chain of the organic reactions, as the invaded organism takes no part in it. In considering the above enumer- ated facts, we are led to the conclusion already above indicated, that the organism possesses other means of resistance against infection than the mere local ones, and that however great the importance is that we ascribe to Metschnikoff's theory of phagocytosis, this alone does not com- prise the whole truth. As most of the inflammations that interest the physician result from infection with bacteria, it seems proper to consider this process some- what in detail. - All bacteria that can produce disease are called pathogenic. They act in two different ways, and must, therefore, be separated in two c..., erent groups; one possesses the ability to en- ter the body and develop there; the other pro- duces its poison outside of the body; under cer- tain circumstances these poisons may be ab- Sorbed by the organism and interfere with its healthy functions. The first process is called in- fection, the second intoxication. We call the first group of bacteria, infective bacteria; and the second group saprophytes, that is, bacteria living on dead material. The infective bacteria do not act by their mechanical effects, but by their ability to secrete poisons; as an illustration we will name the anthrax bacteria, about which formerly the erroneous belief was current, that they acted mechanically by their mere presence, by depriving the Organism of necessary material, for instance its oxygen; we know now that they produce their destructive effects by the prepar- ation of poisons as a result of their metabolism. As a representative of the second group we will take the saprophytic bacteria that live in the intestinal canal: they live upon the dead con- tents of this canal, and are in health harmless; they are outside of the body, for the intestinal THE MEDICAL DIAL. 35 canal may be considered as a tube that perforates the body, and is outside of it. The products of these bacteria are not ab- sorbed by the healthy intestinal canal, but are passed out of the body with the excrements. But if a loop of intestine is cut off from its nor- mal blood supply by a constriction, or by being Squeezed into a hernial opening, the intestinal wall loses its vitality and becomes permeable to the poisons Secreted by the saprophytes and dis- solved in the fluids contained in the diseased loop. These poisons may speedily overwhelm the organism that succumbs, often without fever, very much in the same way as an organism is l:illed by a fatal dose of morphine or digatilin. The saprophytes or parasites live, not on the dead tissues of the body, but on the intestinal contents; a dead and foreign substance, that tem- porarily is enclosed within its walls. It is evident that the anthrax bacillus pro- duces its poisons by an endogenous process; that is, the poison is prepared within the infected organism, while the saprophytes produce their poison ektogenously, that is by a process that takes place outside the body. It is of importance to distinguish between these two mechanisms, as our porphylaxis and treatment must be differ- ent in the two cases. In the first case we must, as well as we can, prevent the entrance of bac- teria and make the tissues unfit for their habit- ation. The process of making the organism un- fit for the bacteria to live in, is called immun- izing, and an animal that does not offer a bac- terium a fit soil, is said to be immune against such a bacterium. The opposite of immune is susceptible or disposed. We know from expe- rience that many individuals are immune against bacteria that are pathogenic for other individ- uals; we know that there are tissues that are immune, at the same time as other tissues in the same individual are susceptible. The gen- occus for instance, thrives on the young pave- ment epithelium of mucous membranes, but not on older epithelium, nor on epidermis. Old rats are immune against anthrax, young are suscept- ible. ilis; it is doubtful if any animal but man is sus- ºceptible; adult men are immune against whoop- ing- cough, children susceptible; dogs and chick- ens are immune against the tetanus bacillus, etc. Immunity does not only vary with the animal species, but also with the age of the individual and with the condition of general nutrition, so Most animals are immune against syph- that there may be a temporary disposition, or a temporary immunity, according to such con- ditions as hunger, exhaustion or cold. We can not only make an organism unfit to support a given bacterium ; it is also possible to make it able to resist the poison of a bacterium, without interfering with its growth in the body. When we enable an Organism to resist or neutralize a bacterial poison, we say that we make it poison- proof. (Kochs: Giftfestigung.) The serum cure in diphtheria and tetanus aims at making the body poison-proof. Therefrom the name anti- toxin, which means an antidote. The serum cure in typhoid and cholera has for its object to make the Organism immune, that is to endow it with properties that render it unfit as a suit- able soil for the respective bacteria. The genuine intoxication diseases are not very frequent in actual life, but their product is common enough in the pathological laboratories, where animals are poisoned by fluids that by a Chamberlain filter have been separated from the bacteria, and only contains the poisons secreted by them. But the study of intoxication is very important, as even in infective diseases the local poison effects are overshadowed by the effects of the absorption into the circulation of the poi- sonous substance from the bacteria. \ The infective diseases, and the mechanism by which they are brought about, demand, there- fore, the closest study, which also has been given them in recent years. As our ideas become wider and our insight clearer, we feel the neces- sity of new terms, that more closely represent our conceptions, than the older names that often have been used in a loose and misleading man- 11er. - Infection can take place on the body surface, the external and the internal, by direct implan- tation; for instance when a pus microbe gains access to the organism by an abrasion of the skin, or when tubercle bacilli enter the lung through a solution of the continuity of the ves- icular epithelium, or when streptococci enter the testicle by emigration from the deeper urethra along the spermatic cord. But also organs that have no direct communication with the external world become infected; for instance, joints, the thyroid gland, the pleura; these organs are reached either through the blood current, or through the gradual invasion from neighboring organs; consequently indirectly; its chief im- portance is that it serves as carrier or dissemina- 36 THE MEDICAL DIAL. tor of infection. We therefore distinguish be- tween evogenous infection, where the infection comes more or less directly from the outside, and hematogenous infection, where the infect- ing material is carried to a particular territory through the blood current. The entrance into the body may either be a simple resorption, or an active immigration, and its place is designated as the atrium or port of infection; if the bacteria multiply in a place, we designate that place as a focus. This focus is not necessarily the same as the port of entrance, for the bacteria may there be absorbed and carried for instance by the lymph current to a more or less remote part, where a focus may develop at the same time as the orig- inal place of entrance heals without visible reaction. Take as an illustration the common case of a prick with an infected pin or needle. The original wound is the atrium or port of en- trance which often, even usually, heals without leaving a scar; the staphylococcus for instance that was lodged on the pin is carried into the lymphatics, is lodged there, and multiplies; from this focus proceed then lymphangitis, lymph- odenitis, and suppuration. Such a process would be called an exogenous infection by re- sorption. If in our instance the staphylococcus by arroding a capillary that is not thrombosed enters the blood current, and an infection of an internal organ takes place in this manner, then we have an hematogenous infection by resorp- tion. It does not often happen in the human species that the blood itself serves as a culture soil for the bacteria; but it happens often enough in animals; for instance in anthrax, in mouse septicemia, in erysipelas; such an infection of the blood should be designated as bacteriemia. The name septicemia has been used for this purpose, and Kotch uses it in that manner; but the name has also been given to other processes that ought to be distinguished from it; notably the poisoning of the blood by bacterial products, for which the name toxinemia ought to be used. As septicemia has been used in more than one sense it would seem better to abolish its use en- tirely, so much the more so, as the name literally means decomposition of the blood, a process that does not take place in the cases thus desig- nated. It must however be remembered that cases of pure toxinemia, of poisoning of the blood by bacterial products with entire absence of bacteria are not very common; they are prob- ably in most cases present for a short time, and in Small quantities. An infection may lead to one single focus, or there may be several; it may then happen that some of these have arisen from the first and orig- inal one; we speak therefor of primary and sec- ondary foci. If the infection from the primary focus spreads through the intercellular spaces, through the lymphradides we call this localiza- tion, infection by continuity. If on the other hand the secondary infection takes place through the blood current, and consequently shows itself in more distant regions, we call it metastasis. An infection of a gland in case of lymphangitis is an instance of infection by continuity; the various pus-localizations and infarcts in pyemia illustrate metastasis. - An infection is not necessarily produced by Only one kind of bacterium. Two or more kinds 1may at the same time effect an entrance in the same atrium, and may localize from that in sec- ondary foci, where we find the same bacteria as in the original focus. - Virchow calls this infection homologous infec- tion. But an infective focus in which a certain kind of bacterium has settled may become sec- Ondarily infected by another kind of bacterium, and this process is by Virchow called heterolo- gous infection, by others deuter-opathic infection. As an illustration of a heterologous, or deu- ter-opathic infection can be taken the infection of a tuberculous fistula by a staphylococcus inva- Sion. A homologous infection by two kinds of bac- teria, for instance by the tetanus bacillus and a pus-coccus (at the same time and at the same place) is sometimes called a mixed infection : this name might also be used of a heterologous or deuteropathic infection, wherefore the French school reject this name, and use the more logical designation of polymicrobic or monomicrobic in- fection. - It is known that there is a reciprocal action be— tween the various bacteria when they at the same time infect the organism. Such co-operation usually produces a higher degreee of virulence and a more severe type of illness; in some cases bacteria that are harmless (not pathogenic), when present alone, may produce disease by their com- bined action. - The products of bacterial metabolism that poi- son the organism are of two different kinds— Ist, the ptomaines, that are well defined chemical THE MEDICAL DIAL. 37 bodies; we call them toxines, if they have poi- sonous properties, which they usually have:– 2nd, the ferments, of which some are poisonous and designed as toxalbuminoids; many of the ferments are not poisonous, but have peptoniz- ing, fermentative, or color producing effects. The toxines act rather rapidly; immediately upon their resorption the symptoms of poison- ing appear; when they are expelled, their effects ‘CC & SC. which is to be expected from their fermentative action, but their effects last longer. There are of course yet a great many unsolved questions in the pathology of infection, and it may be that some of our present ideas will under- go modification. There is now no longer much disputet about Metschnikoff's theory of phago- cytosis, but it may be that it is not so prominent a factor in the mechanism of the organic reac- tion, as its discoverer originally thought. It is with this theory as with every new one, that it is apt to engross our attention too much and too exclusively in the first enthusiasm of its disciples. But in this it does not differ from other great theories that have made their appearance within the memory of living men, for instance Darwin's evolution theory and Pasteur's discov- ery of the microbic world, and the various theor- ies based upon it. Just as these theories have been modified, in some respects restricted, in others enlarged, so our modern theories of in- flammation must be prepared for the same fate. But just as these two theories have revolution- ized our conception of nature, so it is believed that the modern theories of inflammation will form the basis for new conceptions of disease,and a new theraputic era. CHLORINE IN THE TREATMENT OF DIPHTHERIA TESTED IN A BROOK- LYN HOSPITAL. On March 5th this journal published a letter from Dr. P. M. Bracelin, of Iowa, on the value of chlorine, specially prepared, in the treatment of diphtheria. Since that time the board of health has taken the matter up and has made a test of its value. While we have not yet received the official report, we are informed that in the King- ston Avenue Contagious Disease Hospital of Brooklyn, out of twenty-five cases treated by this method, there was but one death, and this case had received antitoxine in connection with the chlorine treatment. This one death occurred from cardiac failure. These tests show a death- rate of about four per cent., which is a remark- able reduction from the average.—New York Medical Journal, October 29th, 1898. The toxalbuminoids take longer time, . *Read before the Hennepin THE SECOND STAGE OF LABOR AND SOME INJURIES TO THE PARTU- RIENT CANAL.” By R. E. CUTTS, M. D., Minneapolis. There is probably no subject more familiar to the profession than that of the second stage of labor; and it might be considered by some to be a waste of time to bring it up for discussion. However when we consider the great number of gynecological cases one meets in his practice…... . and upon inquiry we learn that a large percent- age of them date from a confinement, this alone is surely sufficient reason for investigating the accouchment to ascertain if possible the cause of the trouble. . It is our purpose to consider the second stage of labor only in its relation to the mother; and as this stage is the most important part of labor and as it will afford sufficient material for dis- cussion for our limited time this evening the other stages will not be considered. But a short time ago while speaking with one of the younger members of our society about obstetrics and in particular about the small fee received for that work here, he remarked that was all it was worth as 99 cases out of IOO would deliver themselves in time if left alone and no skill was necessary in these cases. - How many physicians treat confinement cases this way? If such is the belief we might better turn this work over to the midwife for surely five or ten dollars is sufficient compensation for such services. o - During the second stage of labor the physician should remain constantly by the patient, care- fully noting the progress of the presenting part, the tension of the maternal soft parts and the condition of the foetus. Granting that the first stage of labor is com- pleted, the contractions strong but the head not decending, also granting that the pelvic, as well as the foetal, measurements are normal, likewise the position of the presenting part, examination reveals the sac of water, bulging during the pains, through the cervix. Hydramnios may be present and if such is the case we may expect to have uterine inertia. Sometimes there is so little amniotic fluid as to cause no separation of am- niotic membrane from the foetal scalp and in this County Medical Society. 38 - THE MEDICAL DIAL. condition the membrane is very hard to recog- nize. In any event the membrane may be so tough. as to prevent the descent of the head for hours thereby causing the exhaustion of both mother and foetus, which may be avoided by the recog- nition and ſhe rupture of the membrane. I men- tion this simply because I have known of pa- tients going for hours with an unruptured mem- brane when, by its rupture, labor was speedily terminated. Let us suppose our patient is a nervous hy- sterical primipara, well along in years, who has been made much more nervous by the necessary pain in the first stage, that the head has passed through the cervix and descended to a point where the vertex begins to appear at the vulva, the perinetim is beginning to be put upon the stretch, the pain is increasing due to the in- creased tension of the soft parts and the nar- rowed condition of the vaginal outlet and our pa- tient has only one thought or desire, that is to force everything through and have it over with. We have here a body—the perineum—upon the protection and preservation of which depends our patient's future health. With it intact she is soon to regain her former health, with it rup- tured she is liable to have retroversion, retro- flexion, prolapsus—incomplete or complete, prolapsed ovaries to say nothing of the results of a complete rupture of the perineum involving the rectum. The symptoms and suffering from these conditions need not be mentioned here but let us see what may happen to the structures involved in this accident. In the first place the occiput in coming under the subpubic ligament forces the brow and face posteriorly, putting the levator ani muscle on ex- treme tension. As this is a point where the pro- gress is apt to be arrested sometimes for hours, ‘unless assistance is given, the fibers of the 1e- vator ani muscle are apt to become separated or ruptured in the median line or so greatly stretched by the prolonged and severe tension as to very greatly weaken their contractile power. Remembering that we have a fasciculus of the levator ani muscle rising from the inner surface of each half of the body of the pubis passing around the vagina on each side to be inserted in a median raphe and sphincter muscle of the anus and also remembering that we have another Source of origin from the spines of the ischia and the white line extending from this point toward the pubis the muscle then passing down encircl- ing the rectum to be inserted on the coccyx, in the median raphe and inner sphincter of the 3.1111S. With the separation of the fibers on the anter- ior wall of the rectum the upper support to the cervix is lost; in time the rectal wall bulges drag- ging the vagina with it and the uterus is permit- ted to descend to just the extent of the separa- tion of the levator ani. By the loss of support to the cervix it is permitted to fall downward and forward thereby changing the position of the uterus from a nearly transverse position in the pelvis to one of the perpendicular, or approach- ing the axis of the vagina. From this condition of retroversion we soon get retroflexion simply due to the change in force of abdominal pressure on the uterus. To be sure we find this muscle varying in size a... strength in its original condition in different women just as much as we find the biceps vary- ing in different individuals. In one case we find upon examination the vagina enlarged, the tis- sues relaxed with no sphincter action except in the lower half inch while in another the posterior vaginal wall is held up taut nearly its entire length and a contraction of the vaginal muscles shows sphincter action for two and one-half inches. Some contend it is the levator fascia that gives support which is true to a certain ex- tent; however we find the fascia varying in strength in direct ratio to that of the muscle. Supplementing this action of the levator ani muscle and fascia we have the other muscles of the perineum of which the transverse perinei are the most important. The perineal body is made up of the union of the different muscles in the median raphe. And it is especially to the pro- tection of this body that I wish to call your at- tention to-night. Some authorities tell us the fourchette will be ruptured in sixty per cent of primiparae and that the perineum will also be lacerated in thirty- five to forty per cent while ten per cent multi- parae will suffer from laceration. Tears of the fourchette and minor lacerations of the perineum are in themselves of slight importance unless they are associated with general relaxation of the vaginal outlet. But the deeper tears of the perineum and the prolonged tension of these structures interfer- THE MEDICAL DIAL. 39 ing with the circulation, producing relaxation of the vaginal outlet are almost certain to permit some of the uterine displacements. To a large degree these conditions are avoidable and before describing the protection of the perineum let us consider the methods used by some of our lead- ing authors. Lusk recommends the method of Hohl and quoting from an article by A. D. Wilkinson in the Western Medical Review who gives the methods better than I have been able to obtain from other sources: He says; “Hohl advises the application of resistance to the head by pres- sing the thumb against the occiput above and the index and middle fingers posteriorly against that portion of the head nearest the fourchette: he claims absolute control may be 1mad over the advancing head.” - “Fastbender places the patient on the left side, stands behind her and applies the index fingers of the right hand to the occiput, while he inserts the thumb as far up into the rectum as possible. The movements of the head are thus under his control. During a pain it may be retarded, and in the interval it may be helped onward. He also applies the forceps in order to control the ad- vance of the head, holding back at the height of a pain and gently assisting downward in the in- tervals.” “Goodell's method of effecting a re- laxation of the perineum is done by pressing the thumb of the left hand against the occiput, while the middle and index fingers of the same hand are inserted into the rectum, and caused to drag forward and upward the distended perineum dur- ing a pain.” 1 layfair places the thumb and forefinger of the right hand on either side of the head upon the distended perineum and the lat- ter is gently pushed forward over the head dur- ing a pain.” “Merkerttschiantz places his patient in the dorsal position, the thumb and fingers of both hands are pressed against the distended perineum on both sides, and during a pain the tissues thus grasped are pushed toward the cen- tral line; as the head begins to emerge the left hand is placed above with the ulnar border in apposition with the mons veneris and the middle and index fingers about an inch from the thin border, pressing the upper portion of the per- ineum toward the medium line.” “Episiotomy is recommended, which consists in making a lateral incision of the vulva for the purpose of relieving vulvar and perineal tension. This is done during the height of a pain upon the mucosa just within the vulvar opening, about one-half inch upon the vaginal walls on both sides alike. They should be from one-half to three-fourths of an inch long and not more than one-fourth of an inch deep, and should be closed immediately after labor.” “Ritgen in his efforts to elevate the head 15laces the tips of the fingers of the right hand upon the perineum back of the anus and close to the point of the coccyx and makes pressure upward and forwards between pains, upon the frontal bone of the fetal head.” “Olshausen places the index and middle fin- gers of the right hand into the rectum and pushes through the recto-vaginal septum into the mouth or beneath the chin of the child, and presses Out-ward and forward between pains.’ ” The method I wish to describe is one I learned from Dr. H. Mc. M. Painter, of the attending staff of the Lying-in-Hospital of the city of New York during my service there as member of the resident staff in ’94. The method is practically this; When the vertex begins to present at the vulva the patient is turned on her left side, brought near the right side of the bed, her knees are flexed, a folded pillow or quilt is placed be- tween them to hold them slightly separated, she is entirely covered with a sheet or some light spread, excepting the lower part of the buttock thus exposing the perineum to view. The light from a window or lamp should be such as to give the best view of the parts at all times. Then seat- ing yourself on the edge of the bed at the pa- tient's back and placing your left hand between her thighs the fingers are allowed to rest on the presenting occiput; the elbow presses on the fundus uteri, while your right hand is free to aid expulsion of head when indicated. When the head has descended enough to reach the orbital ridge of the frontal bone at the point Inearest the coccyx with the thumb of your right hand you have complete control of the situation; and this occurs before laceration of the perineum can take place. The patient should now be given sufficient chloroform to allow of complete relaxa- tion of parts. The uterine muscle will continue to contract after the relaxation of the striated Imuscles; however with your patient in the posi- tion already described the descent of the head can be easily controlled by making pressure pos- teriorly with the tips of the fingers of your left hand resting upon the foetal occiput. The de- livery of the head, to be performed between the 40 THE MEDICAL DIAL. uterine contractions, is accomplished thus: With the thumb of your right hand resting on the Or- bital ridge of the frontal bone you make pressure anteriorly or to cause extension of the head, thus putting the perineum on the stretch until the margin begins to look white, which is an indica- tion that it has reached its limit of stretching, then with the tips of the fingers of your left hand crowd the head back so as to relax the perineum but not so far as to lose the hold on the orbital ridge with your right thumb; by this relaxtion of the perineum, which should be continued for a few minutes at a time, the blood is allowed to circulate through the tissues restoring them to their normal condition. Then repeating the pressure with your right thumb on the brow, putting the perineum on the stretch as before you find that the occiput will protrude some-what more than the previous time before the margin of the perineum becomes white showing the ne- cessity of its relaxation. By repeating this pro- cess until the eminences of the frontal bone ap- pear at the margin of the perineum the brow and the face may be allowed to slip out over the perineum between pains without fear of any serious damage to that body, thus delivery of the head is practically accomplished by a change from flexion to extension with but very little de- scent. With the head delivered there should be no further difficulty in delivering the rest of the Perinei supposedly torn by the foetal foetus. shoulder are in most instances torn in delivering the head but not recognized until after complete delivery of the babe the accoucheur believes it to lmave been done by the shoulder. The perineum beginning to tear at the margin and kept on the stretch by the head is almost unrecognizable; in fact it is entirely so, unless you have good light on the perineum and are close enough to make minute observation. The tension of the parts due to the pressure of the head prevents bleeding from the torn margin and unless the head is crowded back as in the described process of delivery it is not recognized during the delivery of the head and consequently the shoulder gets the blame. The advantages of this method are: You have your patient on her side thus bring- ing the perineum into the best of view which could not be done on her back without unneces- sary exposure; in fact the patient does not realize any exposure, to speak of, in this position. With the left elbow Over fundus of the uterus *; one can make strong pressure when needed or by slight friction with it excite uterine contractions. By using the right thumb on orbital ridge of the frontal bone one has as complete control as if two fingers were in the rectum which must be- come septic and which is unsurgical to say the least. By working the head back and forth in the process of Stretching the perineum the blood is permitted to circulate through all parts at fre- quent intervals thus preventing injury and allow- ing greater elasticity. The process should con- Sume about an hour in the ordinary primipara. CE REBRO-SPINAL MENINGITIS WITH CASES ILLUSTRATING THE VALUE OF LUMBAR PUNCTURE. By C. H. HUNTER, M. A., M. D., Professor of the Practice of Medicine in the University of Minne- SOta. - The purpose of this paper is a review of some Tecent cases, Occurring in our midst, of menin- gitis, in the light of the monograph by Council- man. This booklet is the result of the combined labors of Drs. Councilman, Mallory and Wright of the Harvard Laboratory. It is published and distributed by the Mass. Board of Health as one of its reports, the cost being paid out of the state funds. While none of its conclusions may be called strictly original, its analysis of the devel- opment of the literature of meningitis is so full, the marshalling of the evidence that Weichels- baun's bacillus intra-cellularis meningitidis is the real cause of epidemic cerebro-spinal meningitis, is carried out with such wealth and accuracy of de- tail,and withal,SO convincingly,and the diagnostic value of Quincke's procedure of lumbar punc- ture is so clearly demonstrated, that the booklet is a real and masterly contribution to medical literature. From any point of view, its publica- tion by a state board of health, with popular ap- proval, can be viewed with the livliest satisfac- tion. I have secured three copies for the library. They are now on the table for your inspection. The new methods of study have certainly been as satisfactory, applied to this disease, as they have been in other quarters. It may now be considered settled that inflam- mation of the brain and cord (meningitis) is al- Ways of bacterial Origin. These tissues are fav- Orable soil for the growth of first, the tubercle bacillus, tubercular meningitis, second, for the THE MEDICAL DIAL. 11 streptococcus, meningitis following trauma or extension from infected cranial bones and cavi- ties, third, for the meningococcus—epidemic cere- bro-spinal memingitis. Indeed these tissues seem the natural habitat of this germ. When found elsewhere in the body they cause accidental or complicating lesions, as the peculiar pneumonitis nephritis, etc. This disease thus constitutes a true cerebro-spinal fever, as it were. Fourth, for the pneumococcus of lung fever. Certainly is this true in sporadic cases. It may be considered yet undetermined that it grows epidemically. The merlinges furnish also, but much more rarely, a crop of the secretive but ubiquitous gonococcus, occasionally of the typhoid bacil- lus, and indeed, of all of the germs of infectious diseases. There seems some reason to suppose ...at they furnish favorable soil for the numerous intestinal germs developed during a gastro-en- terocolitis, though it is well to remember in this connection, the dictum of Stokes, quoted by Os– ler, that “there is no single nervous symptom which may not and does not occur independent of any appreciable lesion of the brain, nerves, or spinal cord.” This was said, I believe, before the introduction of searching microscopical and cul, ture methods. On this point, case XII of the series reported, has an interesting bearing. Epidemic cerebro-spinal meningitis is spoken of in the text books, for the most part, as easy of diagnosis. This may be true when the epi- demic is in full course and the attendant is on the alert. However, it has occured to me to be in doubt, and justly, I think. In our health reports too many cases have been reported in the prac- tices of a few, for them to have been always cor- rect. While ordinarily, a diagnosis of meningitis being present, (inferred from the symptoms) may a11SW €1" fairly well, it must have happened to a good many, desiring accuracy and demonstration in diagnosis, to wish for something more. This brings us to the cases I have been able to collect in town, through the kind co-opera- tion of a number of physicians, and to a consid- eration of those diagnostic methods that seen l.,e most feasible. No. 1. G. W. 24 years old. City Hospital. Symptoms. Onset sudden, headache, backache, rigidity and vomiting, speech involved, uncon- ciousness. Result, death in 25 days. Post Mor- tem, pus at base of brain. - - No. 2. R. K. I O years old. City Hospital. symptoms: onset sudden, headache, rigidity, Opisthotonos, temperature, 98 to IO5., herpes, semi-conscious. Result: Recovery in five weeks. No. 3. M. S. Age 14 years. City Hospital. Symptoms. Onset Sudden, Convulsions, uncon- Sciousness, headache, backache, rigidity not well marked, herpes. Result: Death in II days. No. 4. S. Age I4 years. Dr. King. Symptoms Complained two days of headache. Walked down town. Convulsions, vomiting, unconsciousness, and semi-unconsciousness, headache, herpes, rigidity. Wild. Result: Death in 11 days. No. 5. N. B. Age 8 years. Dr. Beard. Symp- tims: Gastro-enteritis. Gradual. Headache, rigidity, fixed strabismus, unequal pupils, un- consciousness. Result: Death in 7 days. No. 6. S. 9 years old. Dr. Roberts. Symp- tons. Abrupt, while at play. Headache, stupor, chill, temperature IO4. Petechiae over chest. Result. Death in 16 hours. Post Mor- tem. Congestion of the lung. Subsequent case led to diagnosis of epidemic cerebro-Spinal men- ingitis. - No. 7. Age two years. Dr. Roberts. Symp- toms. (Two weeks after No. 6.) Abrupt. Chill, temp. IO4, general pain, rigidity, general rashes. Result: recovery in six weeks. • * * No. 8. Age 4. Feeble minded. Dr. Roberts. Symptoms. (Four weeks After No. 6.) Abrupt, chill, opisthotonos, general rashes. Result: Re- covery in six weeks. - No. 9. Agnes M. 22 years. Dr. C. A. Smith and C. H. Hunter. Symptoms. Began gradually, like typhoid, severe backache, opisthotonos after a few weeks. Double vision. Result: Death in six weeks. Lumbar puncture with cocaine in the 3d week pneumococcus from the turbid Se1-111]]. No. 10. Harry S. 22 years. City Hospital. Symptoms. Chill, delirium, headache, backache, rigidity, herpes and offensive breath. Result: Death in 16 days. º - No. 11. Clara T. 17 years. City Hospital. Symptoms. Severe headache. Second day, rig- id neck and pain in back. Stupor, herpes, pupils immovable and typical rashes. Result: death in 3 days. Albumen in urine. No. 12. Willie D. Four years. Dr. C. H. Hunter. Scar in lip from dog bite two months before. Knee was resected at two. Symptoms. Abrupt attack, emesis, tonsillitis. Was out in three days. Acted strangely with throat. Fourth day delirious. Consultation fifth day, but no diagnosis fixed. Seventh day, my first visit. 42 THE NAEDICAL DIAL. Fever IO2, delirium, vacant look, unable to drink from convulsive movements of throat, extending to body. Rigid neck, dilated pupils responding to light. Eighth day could be aroused for a time, sat up in bed. Same convulsive movement of the throat extending gradually to entire body on attempting to drink, ending in unconscious- ness. Bowels loose and foul. Widal reaction absent. Blood count, I80OO. Lumbar puncture failed to obtain any fluid. Opisthotonos at one time. Last two days relaxation except during convulsions, stupor, coma and death on the 9th day. Nothing microscopically abnormal was noticed at the autopsy, save possibly, signs of entero-colitis. Pneumococcus and streptococcus cultivated by Dr. Wilson. Exudate on menin- gitis could be demonstrated microscopically. No. 13. Hackett. Four years. C. H. Hunter. Symptoms. Pharyngitis, bronchitis, gastro-en- teritis, lymphangitis, widal reaction present. Diagnosis—typhoid fever probably. Seventh day headache, neck rigid, gradual increase of men- ingeal symptoms. Extensive rigidity and con- tractures, delirium, stupor and death on the 12th day. Lumbar puncture on 8th day secured an opalescent fluid which was sterile. Blood count on 8th day, 23,OOO. An earlier blood count could have excluded the idea of typhoid. No. 14. M. P. Age 22 years. C. H. Hunter. Symptoms. Came intô office Thursday com- plaining of severe headache; fever, foul tongue. Sent to bed. Put on milk diet. Friday, better, still headache at night. Saturday in bed. Sun- day morning, violent headache and vomiting. Rigid neck. Suspected meningitis but was not prepared to make lumbar puncture. Relapsed into sleep and remained in stupor all day Sun- day. Aroused in the evening. Was dull, had headache. Walked to buggy and rode ten blocks Monday morning. Temperature IOO. Breath foul. Complained Tuesday a. m. Of Se- vere headache during the previous night. Other- wise better. Found him dead at I 2 Tuesday. Temperature Io8. Post mortem, lumbar punc- ture gave purulent serum, containing meningo- coccus (Dr. Corbett). No. 15. M. G. Eight years. Dr. LaLiberte. Symptoms. Onset sudden, pain, rigidity. Wast- ing remarkable. Bed sores. Result—death in 6 weeks. Lumbar puncture in the 5th week Se- cured a sterile opalescent fluid. t No. 16. Child. Dr. Head. tack of headache, rigidity and fever. Sudden at- Death prompt. Pneumococcus in miningeal pus found post-morten. Nos 17 and 18. Two cases. Dr. Matchan. Long course of irregular fever, pain, rig- idity and contractures ending in recovery. In this series of 18 cases, five or 28 per cent recovered—about as in other epidemics. In case 9 the development was that of Ty- phoid fever. As the diagnosis was settled so promptly by Lumbar puncture in the third week, it is probable that it might also have been arrived at earlier. Case 12 exhibited no effusion at p. m. The meningitis was proven only by microscopical examination of tissues. Case 3. An earlier blood count showing leu- cocytosis would have discredited the diagnosis of Typhoid if the meninges had given leucocyto- sis. There seemed no occasion for lumbar punc- ture earlier than the eighth day, the date of the first appearance of head symptoms. In case 16 lumbar puncture on Sunday a. m. the first moment of cervical rigidity would have led to a correct diagnosis, and safer prog- nosis. Lumbar puncture is easily done, is not pain- ful and almost certainly will put us in possession of correct knowledge as to the very essence of the disease with which we may be dealing. A good description of the procedure in lumbar puncture and discussion of its value is to be found on p. 439 of Vierordt's Medical Diagno- sis, ed. 1898. Coverslide examinations of cultures at the State Laboratory will settle the diagnosis. Operation for Lumbar Puncture. The patient lies upon the side—the back bent. A hypodermic needle with lumen calibre of No. 24 wire will do. Boil the needle, wash the skin with alcohol. Press the finger of the left hand at the side of the spine into an intervertebral lumbar space. With the right hand force the needle in parallel to a spinous process and until the point of the needle is felt to be in the spinal canal. The fluid follows the piston. The University of Genoa has given its M. D. to Miss E. Bonomi, which is said to be the first time the degree has been given to a woman by an Italian university.—Boston Medical and Sur- gical Journal, Sept, 22nd, 1898. THE MEDICAL DIAL. 43 REFLEX COUGH. A. V. McINTYRE, M. D., Hudson, Wis. Strictly speaking, all cough is reflex and of nervous origin. The term “Reflex Cough” is, however, commonly used to denote that which occurs without any evidence of disease of the larynx, trachea, bronchi, lungs or pleura. The profession recognize two kinds of cough, , ‘One, the expectorant cough, the purpose of which is to drain and expel secretions from the lower air passages, the result of inflammation of the lining mucous membrane; the other, the non expectorant, or, as I shall designate the “Reflex or Nervous Cough,” due to numerous reflex causes, such as gastric irritation, ear disorder, aneurysmal, glandular or other pressure on the pneumogastric, Superior laryngeal or sympa- thetic nerves. This cough may also be due to an elongated uvula, enlarged tonsils, a granular state of the pharyngeal or laryngeal mucous- membranes, polypi, or hypertrophic rhinitis, for- eign bodies in the larynx, trachea or external auditory meatus; undue dryness, hyperaemia, alteration in the quality or quantity of the provis- ional secretions. Cough is not a disease to be treated, but a symptom to be traced to its source. An inspec- tion of the pharynx and larynx, and a physical examination of the chest will generally suffice to detect the kind of cough with which you have to deal. To illustrate the cough in question I will relate the histories of a few cases. Case I.—In February, 1895, I was called to a child three years old with the following brief history. The mother stated that since early fall her daughter had had a dry, hacking cough, Imuch worse at night and often accompanied with night Sweats; poor appetite and emaciated; ev- erything had been tried for the child, but she was gradually getting worse. I found on examina- tion of her nose and throat that she had hyper- trophic nasal catarrh, enlarged tonsils and glands on both sides of the neck above and below the clavicle, bronchial breathing, a slight fever, and a constant hacking cough. The cough was at- tended with no expectoration. The family his- tory gave no evidence of consumption, nor did any of the family have enlarged glands or ton- sils (showing that their condition is not always hereditary, as is Supposed by some). I consid- ered this a case of purely reflex origin, due to the mouth-breathing, and pressure of some en- larged lymphatic glands, pressing upon either the Superior laryngal nerve, or some branches of the sympathetic nerves or both. I prescribed Syrup of hydriodic acid in drachm doses after each meal. In one month the cough was entirely gone, the enlarged glands in the neck had dis- appeared, the tonsils perceptibly decreased, and upon removal of the hypertrophied membranes of the nose, the case was discharged practically cured. - Case II-A child four years old. History of case. Child had a cough for a year, breathed entirely through the mouth, and had often said that it had a nail in its nose. I noticed that the child's nose was swollen and closed, and sus- pected some foreign substance in it, and that it must have been there for a long time, and the cause of the bad odor and the cough. On exam- ination of the chest I found no bronchial or lung trouble, and was convinced that the cough was due either to the occluded nostrils or to the mouth-breathing, or both. I irrigated the nose thoroughly and on examination found a foreign body in one nostril and the other completely filled by hypertrophied membrane. I removed the foreign body, which proved to be a small screw that had probably been there for a year; then cut away the superfluous membrane from the other nostril, and without further treatment the cough and catarrh were cured. Case III.-A man thirty-five years old came with a cough and inability to breathe at night. He had a hacking cough, constant irritation in the upper part of the pharynx. On examination of the nose and vault of the pharynx I found it completely filled with polypi and swollen mucous membranes. I removed three polypi at three different sittings, and treated him for the catarrh thereby restoring his nose breathing and curing his cough. Case IV-A man with a dry, spasmodic cough ; said he could not “raise” nor sleep well at night. There was no loss of flesh and he seemed well in every way. Examination of his chest gave negative results; nor did his family history give any light on his case. But inspec- tion of the pharynx showed both tonsils some- what enlarged and the uvala very long, and pen- dulous, the lower end resting on the base of the tongue. I removed a quarter of an inch of the uvala, and waited for results. The cough dis- appeared. - 44 THE MEDICAL DIAL. These cases are not common in infants, but frequent in older children. In nearly all the varieties the cough is worse at night and is often confined to that time. The general health may not be affected except from disturbance of sleep or from pain. The precise cause in any given case is discovered only by a careful examination of the ear, nose, pharynx, heart, stomach, lungs, liver, and the patient's general condition. En- larged bronchial glands may be suspected in patients of scrofulous, or tuberculous parents. Adenoids in the vault of the pharynx or perfora- tions in the drum of the ear should be sought for when called upon to treat a cough. Do not prescribe “The best cough mixture” you know; but examine his lungs first and if you find no trouble there, look for some reflex cause such as I have described. Remove the cause and you will cure the patient. If the cough appears to be purely nervous in origin, the best results will follow the use of the bromides, or iodide of pot- assium during the day, and a dose of antipyrene at night. - THE HUMAN BRAIN. A German biologist has calculated that the human brain contains 3OO,OOO,OOO nerve cells, 5,OOO,OOO of which die and are succeeded by new ones every day. At this rate, assuming the cor- rectness of the German's guess, we get an entire- ly new brain every sixty days.-Boston Medical and Surgical Journal; Sept. 22nd, 1898. THE CASE OF MIRS. MAYBRICK. Mrs. Maybrick has now been confined in an English prison for ten years, having been con- victed of the alleged murder of her husband by the administration of arsenic. It is generally be- lieved by those most competent to form opinions on the case that she was convicted on very inde- finite not to say contradictory testimony, and, unless there are facts unpublished and unknown, except to those in authority, it looks as though Mrs. Maybrick is held for punishment for some crime for which she has never been tried. It is well known that the Home Secretary has refused the appeals of societies, individuals, and the al- most universal demand of the people of England and America for her release, and even the re- quest of our President endorsed by the recom- mendation of the Lord High Chief Justice of England himself . Edison called the man who thought his patents were now free “A Himalayan Andesian jackass.” That was piling Ossa on Pelion. this case is Von Hippel's. A TRANSPLANTATION OF THE COR- NEA. t By C. H. KOHLER, M. D., Minneapolis. It was not intended to report this case until there was something definite and satisfactory to say of the result, but the misleading and inaccur- ate accounts which appeared prematurely in the public press make it desirable to give the profes- sion a more exact and lucid statement through the proper channel. One would glean from these reports that complete restoration of the sight is now practically certain, and that in the opera- tion the entire anterior part of the eye was ex- cised, when in reality only a small circle about the size of the ordinary pupil was removed. Then, too, the operation has been done very frequently in Europe and also a number of times by New York and Chicago physicians. The re- ports of the results, however, have been very conflicting. In this country it has never been successful enough to warrant further experi- mentation, while I am informed by an oculist who just returned from Vienna, that the opera- tion is being done as frequently in Europe as ever. In this country preference seems to be given to Van Milligan's operation, in which a cap of transparent celluloid or glass, shaped like an artificial eye, is used in place of the graft of the rabbit's cornea. The operation performed in The patient was a woman of 21 years, totally blind in the right eye for 3 years and in the left for 8 years. Blindness was result of dense corneal opacities due to tra– choma. The disease began when she was 8 years of age and continued until the lids were denuded of mucous membrane, she being where she could not or did not receive proper attention. Two years ago she came to this city and was treated for some time, and later, at divers times, had iridectomies performed. The last was 6 months ago and like the others did not favorably alter the condition of the vision to any perceptible extent. This was the last effort to do anything until about three weeks ago when she came to Ime. The case was absolutely hopeless with the exception of the faint possibility of some such operation as was done and she, being determined. to make one more effort, a transplantation was decided upon. A corneal trephine, an instru- ment especially made for these operations, was obtained through the courtesy of Dr. Casey Wood of Chicago and a good sized, healthy rab- bit procured for the work. Complete steriliza- tion of the eye of the patient and that of the rab- lit was necessary without the aid of any but the mildest antiseptic solutions. In the former this was done in the usual way, but with the latter it was much more difficult. We began by wrap- ping the rabbit in bichloride towels and Sponging the head thoroughly with soap and water, and then trimming the hair about the eye as short as possible and again Sponging the eye freely. This was followed by applying THE MEDICAL DIAL. 45 a wet bichloride bandage about the head, Which left nothing but the eye in sight. The eye and conjunctiva were then sponged and irrigated with a I to Io,000 bichlo- ride Solution and later, by repeated irrigation with a slightly saline solution. A 4 per cent so- lution, of cocaine was the only anesthetic used. It was instilled several times in the eye of the patient, but only once in the eye of the rabbit, and that just a short time before the piece was removed. In the operative procedure the lids were held back with a speculum and an assistant firmly held the eye with a long rat tooth forceps. The trephine was placed over what ap- peared to be the clearest part of the cornea, which was a trifle below the exact center, and a circle cut down through the anterior layers to Decemet's membrane and the disk carefully ex- sected, leaving only the posterior layer above the aqueous. As quickly as possible a similar piece was cut from the rabbit's eye, held in a warm salt Solution until properly unfolded (this tissue immediately curls up) and then placed in the patient's eye. The lid was closed over it, the eye dressed and not disturbed until the fifth day. By this time complete and perfect union had taken place . The piece transferred was clear, but be- Ineath it could be seen some opacity in the mem- brane left. Operated on in the same manner, except that the entire thickness of the cornea was removed and with it a part of the iris which was adherent to it. The loss of the aqueous greatly complicated matters, the eye collapsing so that the cornea appeared as much concave as it is normally con- vex. It was very difficult to fit in the piece from the rabbit, and this was hardly satisfactorily done at once. But, after waiting 15 minutes for it to fill up it assumed a more normal condition and a better adjustment was affected. After 36 hours the eye was opened and the piece found in perfect position, the aqueous chamber filled and sealed so perfectly that the eye was in nor- Imal shape. Nothing was necessary to hold the graft in position owing to the short time neces- sary for the plastic exudate with the aid of the upper lid,to effectually seal the anterior chamber, And thus the aqueous fluid soon served as a splint below while the lid was sufficient above to maintain perfect apposition. - At this writing both grafts appear perfectly united and retain good transparency except as stated in the left. In the right eye the iris from which all evidence of normal or artificial pupil has been obliterated, can clearly be seen through the transplantation and iridectomy must remove 1,...s before sight can be restored. Some time must elapse, however, before this is attempted and then only if the piece still retains its trans- lucency. The union of the piece is so perfect that it seems now almost a part of the eye and this would lead to much hope if the iris were not in such bad condition. As it now appears the On the tenth day the other eye was question of sight is a decidedly uncertain quan- tity. - REMOVAL OF TRANSVERSE COLON AND PAR.' TIAL RESECTION OF PANCREAS · AND LARGE CURVATURE OF STOMACH, WITH LATERAL SUTURE OF BOTH MESENTERIC VEINS.* -*. By A. SCHWYZER, St. Paul, Minn. The case, which seems to be the only one reported of entire removal of the transverse co- lon and also unique for its lesion and lateral su- ture of the mesenteric veins, was as follows: A carcinoma involving the whole transverse colon, and including the gastrocolic ligament, as well as reaching to the base of the meso-colon, was removed. In dividing the base of the meso- colon, the inferior mesenteric vein was laterally opened to the left of the duodeno-jejuneal valve and Sewed up laterally. The superior mesen- teric vein was also laterally opened to the extent of over one cm. at a point just before emerging under the head of the pancreas. Tremendous hemorrhage, though immediate and effective Compression was made. - The tumor, which went close to the stomach, necessitated resection of the large curvature of the stomach for a distance of seven cms. In re- moving the deepest part of the tumor, the divi- Sion line had to go partly through the superficial layers of the pancreas. In and under the head of the pancreas a small area of infiltrated tissue had to be left behind and was sewed over. He- patic flexure of the colon was united to the Splenic flexure by an end-to-end anastomosis with silk suture. - The carcinoma, which was double the size of a man's fist, was of the type of the carcinoma simplex. No signs of the adenomatous type were found. With the tumor a large piece of healthy colon had to be removed on account of the tumor growing into the mesocolon. The whole omentum had to be sacrificed also. The operation was made on October 16th at St. Joseph’s Hospital. After a somewhat event- ful time of recovery, though not on account of his bowels, the patient left the hospital on No- vember 29th in a very much improved condition, having a very good appetite, feeling stronger every day and having gained eleven pounds since the operation. - - December 18th : It might be added that the patient returned to his home in Havre, Montana, last week after gaining six additional pounds during the last two weeks. He has absolutely no pain whatever and is exceedingly satisfied with the result of the operation. *Abstract of a paper read before the Min- nesota Academy of Medicine, December 7, 1898. 46 THE MEDICAL DIAL. THE MEDICAL DIAL A Monthly Record of Medicine and Surgery. Issued on the First of every Month at Minneapolis, Minn. Editor, J. W. MACDONALD, M. D., F. R. C. S. E. Associate Editor, C. K. BARTLETT, M. D. Business Manager, E. E. GRISWOLD. . . . . COLLABORATORS . . . . G. D. HEAD, B. S., M. D. KNUT Hoeg II, M. D. C. H. HuntER, A. M., M. D. W. A. Jones, M. D. J. H. RISHMILLER, M. D. J. D, SIMPson, M. D. - F. A. DUNSMOOR, M. D. J. H. STUART, A. M., M. D. W. A. HALL, M. D. H. B. SweetSER, M. D. DAVID Ow EN THOMAS, M. D., M. R. C. S. A. W. ABBOTT, M. D. R. O. BEARD, M. D. J. W. BELL, M. D. J. FRANK Corbett, M, D. J. W. DUDLEY, A. M., M. D. J. H. DUNN, M. D. —ſ This Journal will not be responsible for any of the opinions expressed by correspondents. $1.00 ... 10 Annual Subscription, in advance, - - - Single Copies, - - - - - - - Advertising Rates made known on application. ADDRESS AL. COMMUNICATIONS TO THE MEDICAL DIAL, MINNEAPOLIS, MINN. MASONIC TEMPLE. JANUARY, 1899. > IS IT GRIP? The Medical News of Dec. 24th has an edi- torial on grip, in which our esteemed contem- porary seems to indicate that it believes the pres- ent widespread epidemic commonly supposed to be grip is not that disease. Its reasons for that belief appear to be that the disease has been somewhat irregular and atypical, and that the Pfeiffer influenza bacillus has not been demon- strated in the cases examined. We think the disease is grip, and will briefly give our reasons. No practitioner of some years’ standing, will probably deny that there appeared about Seven years ago a new disease, character- ized by Sudden onset, severe aching, deep-seated pains in various parts of the body, prostration and usually an inflammation of the respiratory, and sometimes of the digestive systems. Some- times the disease seemed to confine itslf to the nervous system. It was furthermore character- ized by its short duration, rather dispropor- tionate to its severity, by the extreme weakness that it left behind, by the number of its sequelae, and by its intense con– tagiousness. Older practitioners recognized it as a disease that under the name of grip or influ- enza had prevailed some years previously and then disappeared. ſº It seems to us that the present epidemic is of a somewhat milder form than the one that ap- peared about seven years ago, but sufficiently resembling it to indicate that we have to do with the same pathological entity. Like ordinary colds, the disease is presumably an infective dis-, ease. As the Pfeiffer bacillus in pure cultures has not communicated the disease to animals, we cannot prove that it is the etiological factor, but if it is not one micro-organism it is another, and it is immaterial for the diagnosis of the present epidemic, whether Pfeiffer's bacillus is the cause of grip, or not. e The present epidemic is different from or— dinary cold, by the above enumerated Symptoms. namely, its suddenness and severity, the pros- tration, the intensity of the malaise, and the marked and certain contagiousness. - If we should deny ourselves the right to give a disease a proper name, and recognize it as a pathological entity before we had made sure of its etiological factor, our nomenclature would be Very limited. Clinical symptoms differentiate Our present epidemic from those diseases that we by perhaps an unfortunate collective name have called colds, and in spite of the high authority of our Eastern colleague, we shall not consent to call it “a cold,” but will maintain that it is sub- stantially identical with the grip. THE SPITTING NUISANCE. The ladies of the Improvement League of this city are making a strong and praiseworthy ef- fort to have an ordinance passed by the City Council for the prevention of spitting in hall- Ways and stairways of public buildings and upon the sidewalks of streets or avenues. The habit of expectorating, with or without the adjunct of tobacco juice, is not only a disgusting nuis- ance but a menace to the public health. The more We study tuberculosis the more we are con- Vinced of its prevalence either apparent or lat- ent. Schlenker examined 100 bodies of adults and children giving special attention to the lungs, the mesenteric, bronchial and cervical glands; of the total number 66 were found to be tuber- culous and of these, tuberculosis was the cause of death in 53 per cent, was of great importance in THE MEDICAL DIAL. 47 6 per cent., and was latent in 41 per cent. Had a microscopical examination been made it is prob- able the figures would be still more startling. Tuberculin is the most accurate test for tubercu- losis and the results obtained by Kossel are full of significance. He tested, under Koch’s special direction, 2459 children in Berlin and found that they reacted to the old tuberculin. In only four of these was tuberculosis apparent; in all other cases it was latent. Rossel estimated that 40 per cent of city children secrete the tubercle bacillus from some part of the body. It is generally a- greed that tuberculosis is present in two-thirds of mankind. Another point which bears directly upon the question at issue is that the disease is chiefly con- veyed by the dried and disseminated sputum. The "sputum of a phthisical subject is practically a pure culture of the tubercle bacillus. Diluted I :4OO,OOO times it is still capable of propagating the disease in the bodies of rabbits and guinea pigs. The experiments of Corvet are very in- structive. He collected the dust of walls, ceilings furniture, etc., and observing every precaution succeeded in propagating the disease in two third of the animals into whose bodies the cultures from the dust were injected. Railway sleeping cars, steamboat staterooms and the cells of pris- ons are almost sure to be infected with the tu- bercle bacilli. The criminal who receives a life sentence is thereby practically condemned to die of tuberculosis. The sputum which is thrown upon the floors and stairways of public buildings, or upon the sidewalks of streets soon becomes dry and is disseminated in the form of dust and at once becomes a source of danger; and since two out of every three persons who commit this nuisance are the subjects of tuberculosis, either apparent or latent, the risk is by no means a trifling one. The great problem of the incoming century will be the stamping out of tuberculosis and every effort directed against the deadly bacilli will count towards the solution of this problem. The ordinance asked for by the Improvement League is not an innovation. A similar ordi- nance has for some time been operative in Los Angeles, California, Salt Lake City, Utah, and Rochester, New York, and so far as can be learned the results are gratifying. Since the above was written the ordinance has been passed by the Minneapolis City Council. EXPERT TESTIMONY. Expert testimony, and especially medical testi- mony, has fallen into disrepute, and justly so in many instances on account of the way it has been sometimes procured and used in the courts; and yet it has been the desire of all right minded and competent men to free testimony from bias and all other difficulties as much as possible. Many suggestions have been made for legal en- actments that, in some manner, might promote justice and save such testimony from the farcical results not unfrequently witnessed in trials of cases both civil and criminal. But on investiga- tion difficulties are met in these efforts to frame laws touching such matters that appear well nigh insurmountable when the rights of all par- ties concerned must be protected. As a result of a discussion on these matters before the Inter- national Medico-Legal Congress in New York, the following draft of a proposed law was pre- pared by Regent Foster, Esq., of New York city, in conference with Judge L. A. Emery, of Maine, and has been submitted for criticism. AN ACT IN RELATION TO EXPERT TESTIMONY:—Section Ist. “When in any civil or criminal proceeding it appears that the testimony of skilled experts may aid in determin- ing any issues of fact, any justice, of the Court in which proceeding is pending may upon appli- cation of either party and after reasonable notice and hearing, appoint one or more skilled ex- perts and make such reasonable examinations and tests in relation to the personal thing or sub- ject matter involved as either party may request.” Section 2d. “Such expert may be examined as a witness at the trial by either party or by the Court, and shall receive for his services and for his attendance at court a reasonable sum to be fixed by the Court and paid by the party making the application and be taxed in his costs if he recovers.” To the suggestion in the above law there will be the objection that the judge in any case should be made a party to either side in the trial, or to be involved in any way except as a presiding justice: and it is not desirable that such additional responsibilities as the selecting of ex- perts be thrust upon his honor, even if such a law could be made constitutional under our present organizations as states. If the Opposing counsel could agree with the judge as to the experts to be called it would be well; but under such circum- 48 THE NAEDICAL DIAL, stances a legal enactment would not be neces- sary. - It has also been suggested that a certain num- ber of qualified experts be appointed by the governor, or designated by some other legislative power, to act in that capacity both in civil and criminal cases, who should be called upon by parties seeking such services. This would con- fine litigants to certain individuals alone for tes- timony and advice which would be a restraint on liberty of choice hardly compatible with our ideas of freedom and fairness, even if such a law could be framed and held as constitutional. If expert witnesses could be summoned by both parties to testify on questions in litigation, as they have been in some instances in criminal cases, it would free them from all suspicion of bias, and then the slight differences of opinion would not be magnified as they now are by coun- sel to sustain the merits of their views and dis- parage those of their opponents. Experts, the most experienced of them, can honestly differ in their opinions as to the interpretation of facts concerning which time alone may determine which is correct; and why should such disagree- ments create any surprise, or reflect in any way on their truthfulness or integrity? The most enlinent lawyers differ in their interpretation of points of law which are often decided by the number of precedents only. In imitation of such decisions juries have sometimes decided cases, apparently, by a preponderance of numbers of witnesses without regard to their natural ability, qualifications, or previous training in the mat- ters concernng which they are called to testify. The second section of the above draft of a law is one of very great importance, and would go far to simplify the trial of all of this class of cases. It would place all expert witnesses on the same level as to any bias on account of pecuniary com- pensation and would have a good effect on the Iminds of the jury on that account. The force and bearing of such a law may be aptly illustra- ted by a scene in court when the late distin- guished expert, Dr. John P. Gray, was a witness and under cross-examination. The lawyer, think- ing to belittle or weaken the testimony of the doctor, assuming his fiercest manner, asked him, “How much have you been paid for giving this testimony?” The Doctor calmly replied, “I have not been paid anything; but I expect to be paid what the court allows me.” The baffled counsel- lor asked again, -"Do you mean to say you have not been paid five hundred dollars for your ser- vices in this case?” The still undisturbed doctor quietly said, “I mean to state just what I said be- fore, that I have not yet been paid anything; but expect to be paid what the Court allows me.” Such arrangements between counsel and wit- nesses, and known to be established by law, would have a salutary effect upon the minds of the juries, and all parties interested in the cases. REPORTS OF SOCIETIES. Hennepin County Medical Society. The semi-annual meeting of the Hennepin County Medical Society was held at the Public Library in Minneapolis on Monday evening, Dec. 5th–the president, Dr. Nippert, in the chair. Dr. Cutts, vice president of the society, de- livered the semi-annual address on “The Second Stage of Labor and Some of the Injuries to the Parturient Canal”—See page 37. Discussion.—Dr. A. B. Cates considered the method of Painter, recommended by the author of the paper the best means of saving the per- ineum. The lateral position with the left arm of the operator between the thighs and the parts in full view gave almost complete control of the head, and thus prevented its too constant of forcible pressure upon the perineum. Chloro- form was necessary as it relaxes the tissues, and keeps the patient from bearing down during the pains. This method however does not apply to forceps cases. In this country the dorsal posi- tion is chosen and the forceps are removed as soon as the perinium is stretched. The finger should then be passed into the rectum until the chin of the fetus is felt while the thumb controls the head. The finger should be covered with a rubber cot. In spite of all these methods a large number of lacerations will occur. . When he saw that a tear was inevitable he thought it much better surgery to divide the perineum in the mid- dle line, with a curved probe-pointed bistoury, thus making a clean incision which is much more likely to heal by first intention than a lacerated wound. Dr. C. G. Weston had been in the habit of using the method, but had not been so fortunate as the author of the paper. He could not be- lieve that laceration was avoidable in all cases, nor could he agree with the statement that there was no danger until the operator could get his finger behind the orbital ridge and draw the head forward. -- Dr. W. A. Hall thought the whole secret of Success lay in preventing over distention. With the fingers Over the occiput the head could be held back during the pains until by gradual dilation the outlet became large enough to allow the head to pass through without producing a THE MEDICAL D.A.L. 49 tear. He approved the plan of delivering the head with as little distension as possible. Dr. H. B. Sweetser believed a combination of circumstances acted as a safeguard to the per- ineum. Chloroform was a powerful factor. The head receded greatly during the intervals be- tween pains thus allowing the circulation to re- turn to the parts which suffered pressure. In primiparae the danger is largely due to the great power of the uterus in pushing the fetus onward. He has never felt that his hand was strong en- Ough to get absolute control over the fetal head. Ordinarily the laceration did not extend into the rectum and could be easily repaired, but in the abnormal position, of the occipito-posterior pre- Sentation the matter was more serious on ac- count of the sloughing which was almost sure to follow, and sloughing might occur even when there was no visible tear. Dr. A. W. Abbott said it was not the strong Imuscular woman who suffered rupture but the relaxed and non-muscular. Of late years he Imade no vaginal examinations, avoided interfer- ence with the perineum and applied forceps with- Out introducing his fingers into the vagina. He believed if statistics were available they would show that such methods as are employed to pro- tect the perineum are not only useless but harm- ful, as they only produce irritation and bring on pains. If the Almighty had intended to have the assistance of a doctor in this emergency He would have arranged in some way to have one there every time. An examination should be made a month before confinement and the ac- coucheur would thus be prepared for any emer- gency. Dr. Benjamin did not think the management Of the case had so much to do with the result as the disposition of the patient. Some are con- tented and patiently allow the labor to take its course; others are nervous and anxious to get rid of their sufferings; the latter are the most liable to rupture. If time is allowed, chloroform Wisely given and nothing else done, he believed few lacerations would take place. Dr. Chapman was surprised at the inference that laceration is the fault of the attending physi- cian and that the public would become educated to this belief. In the earlier years of his practice he congratulated himself that he had avoided tears, but now he believed it was due rather to the strength of the women than to his efforts. Dr. J. W. Dudley wished to correct the state- filent that the lateral position usually adopted in parturition, is the same as the Sim's position. The entrance of air into the uterus may account for some cases of sudden death. To prevent the possibility of such an accident the hand of the accoucheur should be placed over the fundus literi as Soon as the fetal head is delivered. The routine treatment in Boston is to hold the hand in that position for three quarters of an hour. Dr. Mary Whetstone avoided chloroform on account of its predisposing to post-partum hem- orrhage. She thought the dorsal position the natural one and superior to the left lateral. Dr. Cockburn preferred the dorsal position. He did not depend much upon chloroform. If anesthesia is not complete the expulsive power is increased, and the patient partially relieved of pain makes more vigorous efforts which increase the risk of laceration. He regretted that lacera- tion of the cervix did not find a place in the paper. Dr. Cotton had often been called too late to control the case, had observed the worst tears in muscular women who were unruly and would not obey instructions not to strain. Dr. Nippert, the president, thought that chlo- roform to its full extent is most effectual in pre- venting laceration. He would advise the use of an ointment to the perineum for months before confinement, Lanoline one ounce and Borax grains ten. In closing the discussion Dr. Cutts did not think all lacerations could be prevented, but in- stead of having 30 or 40 per cent. it would be reasonable to expect the ratio to be reduced to Io per cent. Pressure upon the perineum is to be condemned for it shuts off the circulation; pushing back the fetal head is a different mat- ter. He does not approve of episiotomy. Dr. Woodard read a paper on the “Medical Treatment of Dysmennorrhea.” For giving temporary relief the author con- demned the use of opiates. Chloral and the bromides were useful under proper restriction. In plethoric subjects viburnum prunifolium was recommended in one drachm doses for five days before and during the menstrual period. When chlorosis is present iron, arsenic, and strychnine are the best remedies. In the rheumatic, phen- acetine or acetanelid is indicated. He found apiol in five grain capsules night and morning of es- pecial value. In using the galvanic current he recommended placing the negative electrode in contact with the cervix, and the positive over the sacrum ; or the negative might be used intraute- rine and the positive over the epigastrium. Par- ticular attention should be given to hygienic measures and a sea voyage was highly com- mended. Discussion : Dr. Staples advises rest in bed and saline cathartics, and sends patients to the sea-shore where he employs sea-bathing with success. Calisthenics are valuable. Dr. Hirschfield had never seen a cure by ex- clusively medical treatment: he thought vibur- num almost a specific in nervous cases. Dr. Whetstone had been very successful in nervous cases by changing the patient's habits. She prescribes the bicycle. Dr. Cates thought dress the most important factor in the production of dysmennorrhea ; skirts must not hang from the waist and the in- testines must not be forced down upon the womb. * . . . • a 50 THE MEDICAL DIAL Dr. Abbott said the subject is not well treated in books. We do not know the pathology of ab- normal menstruation. The difficulty of research is too great and the pathology will not soon be understood. Stenosis and anteflexion are not responsible. Inflammatory cases are not troubled with dysmennorrhea. The symptoms vary widely, in 3OOO case records, as to nature and lo- cation of pain. Looseness of bowels and fre- quency of micturition and other reflex symptoms are frequent. Treatment must be systematic but cannot be scientific without a basis of scien- tific knowledge. Surgical treatment is often use- less and will in future be much less often resorted to. As to membranous dysmennorrhea, he had made microscopical examination of every case occuring in his practice and found the supposed membrane to be a clot in every instance. In certain cases due to lack of development he had found ovarian substance very useful. Dr. Benjamin said the early care of girls is important. They should be watched and in- structed ; dress is an important factor. Corsets and constricting bands should be discarded. Dr. Thomas remarked that, in the anaemic, pain is more severely felt than in others; general improvement of health is followed by relief of menstrual symptoms. One case treated by mas- sage improved rapidly. Mathews Duncan uses guaiac with success. Spasmodic dysmennorrhea is possible. Dr. Haggard said those who believe in spas- modic and obstructive dysmennorrhea have made viburnum popular. congestive cases. . Dr. Woodard in closing did not claim radical cures from medical treatment; but as many can be cured by medicine as by surgery. Dress is especially important. Spasmodic contractions cause the pain in many cases, and may be reliev- ed by the viburnum compounds. . GRIP IN THE EAST. While Minneapolis is passing through a mild epidemic of Grip, the eastern cities are suffering severely. The figures for Dec. 21st are as fol- lows: City. Cases New York. . . . . . . . . . . . . . . . . . . . . . . . 125,000 Philadelphia. . . . . . . . . . . . . . . . . . . . . . . . 50,000 • Baltimore. . . . . . . . . . . . . . . . . . . . . . . . . . 40,000 Dayton, O. . . . . . ... • * *, * * * * * * * * * * * * * * * * * * 5,000 New Haven. . . . . . . . . . . . . . . . . . . . . . . . . 5,000 Yale College. . . . . . . . . . . . . . . . . . . . . . . . . . 400 Total. . . . . . . . . . . . . . . . . . . . . . . 225,400 - BACTERIA. If bacteria are roaming about at kissing time a sufficient number might be collected at the Hobson receptions to satisfy One Lawson Tait, who wanted enough to make a poultice as a dressing for a wound. FROM AN ANCIENT WRITING. “Quod ali cibus est, Aliis fuat acre venenum.” Caulophyllum allays pain in Prosress of Inedicine. MEDICINE. UN DER THE CHARGE OF J. W. BEI.I., M. D., C. H. HuntER, A. M., M. D. J. H. STUART, A. M., M. D. DAVID Owen THOMAs, M. D., M. R. C. S. HOW MALARIA IS CONTRACTED. There has been considerable controversy dur- ing this decade as to the special vehicle of ma- larial infection. After giving an interesting re- sume of the prevailing theories (London Lancet Dec 3d, 1898) Dr. Amico Bignami, of Rome reports a successful inoculation of malaria with mosquitos. He says that until lately malaria was supposed to be contracted through the ag- ency of water and air; but it has been shown that drinking water could not be the vehicle of infection because Celli and other observers dem- onstrated that malaria was contracted on the Roman Campagna where the drinking-water was as pure as that of non-malarial neighborhoods. It has been more difficult to disprove the in- strumentality of air in the transmission of ma– laria. The air and soil have been considered as the sources of the infection by many Epidem- iologists. Dr. Bignami had previously dealt with the hypothesis that the malarial hematozoon ex- ists in a free state and resists dessication and pointed out that “Malaria does not comport it- self in the least degree like a disease due to in- halation of dust.” He showed that the theory of the passage of the malarial germs from the moist earth to the ground air encounters inex- plicable difficulties. If the air were a source of infection then we would expect malaria to be transported by the wind beyond the malarious region, and the malarious load carried by the atmosphere should not vary notably at different hours of the day. The unsatisfactory character of these hypoth- eses led the Dr. to consider the possibility of malaria being due to inoculation by Mosquitoes. If this theory were correct it was at once plain why malaria is not diffused by the wind, and why the disease is more easily contracted morning and evening, and that it does not prevail in high altitudes, but often manifests itself after sleeping in a malarious locality. It had been previously surmised by different observers that mosquitoes might be connected with the life history of the malarial parasite, but until lately it was thought that their agency was the same as in filaria dis– ease and not by inoculation. After recounting many difficulties in the experimentation with mosquitoes the Doctor states that in August of this year three persons submitted themselves voluntarily for the experiment. They were placed in specially prepared rooms (having THE MEDICAL DIAL. 51. gauze-covered windows) and exposed during the night to adult mosquitoes brought from ma- larial districts. The days were passed in a hos- pital ward. Thus making the experiment sim- ilar to successive night exposure in a malarious region. The experiment was successful but the details of the inoculation are reserved for another paper. D. O. T. THE TREATMENT OF WHOOPING COUGH. Dr. G. Arbour Stephens reports some start- ling results in the treatment of Whooping-cough (London Lancet, Dec. 3d, 1898.) He states that having an attack of pharyngitis he found that tickling his own external auditory meatus pro- duced a cough with the characteristic “whoop.” This led him to examine the ears of whooping- cough patients and he found almost invaribly that their ears were tender and that owing to ti.e pain their mothers were not allowed to wash tne organs, or there was a semi-fluid discharge present which in some cases had existed for some time. This induced him to institute the following local treatment. The ears were syr- inged out night and morning with lukewarm bo- ric lotion, or warm water. Then the meatus and tympanum were painted with the following: Cocaine Hydrochlo gr. XXIII Glycerine drachms III Hydrarg. Perchlor. Sol. m—XX Aqua. g. s. Ounce I, Misce. In every case the patient was benefitted and the whooping-cough ceased. However the bronchitis, laryngitis, and pharyngitis, accom- panying the disease did not disappear. He Ob- serves that whooping-cough frequently follows in the wake of measles, and that the ears fre- quently discharge. He reported eight cases treated and cured in three to six days. As a basis for the treatment he says, “As an expla– nation of the pathology of these cases I consider that there is a small local inflammation in the meatus starting independently of or succeeding to an attack of measles, and that this inflamma- tion irritates the nerve filaments which are con- nected with the root ganglion of the vagus, and so stimulates the vagus itself in some or all of its branches.” D. O. T. COMMON ERRORS IN THE MANAGE- MENT OF TUBERCULAR PATIENTS. The papers read, and the discussions had on the subject of Tuberculosis at the late meeting of the American Climatological Association held last fall in the White Mountains, as reported in the Boston Medical and Surgical Journal, Nov. 17, 1898, are of great interest and importance. Dr. Frederick I. Knight, of Boston, read a paper on the “Common Errors of General Practitioners in Dealing with Cases of Pulmonary Tubercu- losis.” I. The first error noted is the failure to make an early diagnosis. This is not usually difficult Since the discovery of the tubercle bacillus. A failure to make it may be very serious because it is especially true of this disease that the earlier its presence is discovered, the more amenable it is to treatment, whereas if there is delay and sec- Ondary infections have taken place there is not much chance of restoring the patient's health. . The most striking results of treatment of this disease in the great open health resorts and also in sanitaria are patients who have really never appeared as invalids. One reason of this error is that the patient naturally makes light of his first symptoms, and contents himself perhaps with asking the doctor on the street for a prescription for a cough which he regards as trifling, and thus an examination is not had until the patient looks and feels sick. Another reason, the physician himself, for ob- vious reasons, may shrink from the knowledge of the results of a careful physical examination. On the other hand any cough should necessi- tate frequent examination of the chest and fever tests, especially if there be hemoptysis. 2. A second error is the failure to admit the gravity of the situation the moment it is dis- covered, and to put the patient at once in the best possible condition for recovery. It is better as a rule, that the patient also should be fully in- formed of the gravity of the situation, as in this way only will he give thorough co-operation in the effort for his recovery. Of course he should be fully impressed with the hope of recovery if the proper course is pursued. 3. A third error is, while temporizing, in recommending treatment not only useless, but positively injurious—giving medicines which take away the appetite and interfere other- wise with digestion, does a great deal of mischief. Cough syrups, cod-liver oil and creosote do a large share in hastening the decline of patients. I do not mean to say that cod-liver oil never does good, for there are pa- tients who can take and assimilate it with ease, and greatly to their benefit, but it is cruel to pre- Scribe it in a routine way without selecting cases and watching effects. Who has not many times seen patients with thickly coated tongues swal- lowing large doses of oil faithfully three times a day, eructating it all the time, and capable of assimilating neither that nor any other food? Neither do I deny that creosote does good in Some cases in modifying the bronchial secretion and mproving digestion; but I believe that large doses as a rule take away the appetite and do imore harm than good. Both it and cod-liver oil should be administered tentatively. Another unfortunate mistake is a general un- restricted order to “drink whiskey” as a pre- ventative. The injudicious use of alcoholics de- presses the vital forces, makes the patient irri- table and dissatisfied with himself and everybody else and seriously interferes with his recovery. 52 e THE NAEDICAL DIAL. Patients are also injured by being told to ex- ercise when they should be quiet, as when the fever is on. ! - 4. A grievous error is often committed in the matter of sending patients away from home. Pa- tients who have only a few weeks or months to live, in almost every case would be better off at home. Others are advised to change climate who cannot possibly afford to remain away from home enough to do any good. º They go away, live in miserable quarters, on poor food, and having spent all their money in a short time are obliged to return. They would have spent their little money to much better ad- Vantage at home. Insufficient care is excercised in advising patients who are able and fit to make a change, as to the selection of climate. Too often the advice is simply to “go south” or “go west.” In such cases the patient flits about from One climate condition to another, without stay- ing long enough to fully experience the modify- ing effect of any one, perhaps till the chance for beneficial action is past. 5. The error, a very grave one, to which I shall call attention, is allowing the patient to go without sufficient medical supervision. This dis- ease requires constant watchfulness. A physician skilled in treating such cases is often better than the general practitioner whose attention is ab- sorbed in critical acute cases. Dr. Hart, of Colorado Springs in discussing this subject said: We have a great many patients sent to Col- orado who undoubtedly would be better if left at home. They arrive there after a long journey, with high temperature, sweating and so on, with every indication of advanced trouble, and in a number of instances I have found cavities, and it is a very difficult matter for the physician at the health resort to manage those cases. They do not understand why they should be sent back Inome because of this hopeless condition, which it invariably is.” There is another class of cases which are sent out and advised to rough it, ride horse back and have a good time generally and keep away from doctors. They soon fall into the doctors hands, and having taken a wrong course there is great trouble in the management of them. Neither should the patient try to keep himself under the management of his family physician after going away. Dr. Beverly Robin- son, of New York said : “With regard to the question of climate I am particularly opposed to sending a patient far away if I can find condi- tions near at home which will probably suit those patients about as well. I have a very doubtful mind as to the merits, in regard to curative in- fluence, of any particular climate as opposed to any other particular climate. All the conditions involved in the selection of a particular place must be estimated and it is important to have a good physician there. The drainage of the house and the food are quite as important as the ques- tion of climate. I do not believe it is a good thing to send people so far away from home in the secondary stages.” Dr. Knight said: “The physician should ap- preciate the possibility of cure if he does all that is possible for his patient by an early diagnosis.” J. H. S. SURGERY. UNDER THE CHARGE OF J. H. DUNN, M. D., W. A. HAL.I., M. D., KNUT HOEGH, M. D. The Operative Surgery of Malignant Diseases. Halstead, in an excellent article in Nov. “An- nals of Surgery,” reports the results of his opera- tion for Breast Cancer from 1889 to 1898 at the Johns Hopkins Hospital; there were 133 cases operated on, 76 of them more than three years ago. There have been 9 per cent of local and 16 per cent of regionary recurrences. Of the 76 opera- ted upon three or more years ago, 31 (or 41 per cent) are living without signs of local or metas- tatic recurrence. IO died more than three years after, only one of the ten having local recurrence. Thus 40 (more than 52 per cent) have survived more than three years without signs of local or regionary recurrence. This is certainly a most remarkable showing. Many of the most exper- ienced surgeons of the last generation doubted whether carcinoma of the breast was ever cured by operation, or life even much prolonged. How- ever, Butlin, in his work—“The operative Sur- gery of Malignant Disease,” published in 1887, after a careful canvass of the subject says: “I am therefore, confident that we may regard ope- rations for the removal of mammary cancer as successful in effecting a complete cure in rather more than IO per cent of all cases treated.” This view at that time was fully as optimistic as the facts would justify. Most surgeons have only too often reason to feel discouraged with operations for malignant disease in general and with cancer of the breast in particular. The result of Halstead's work gives the most cheering tidings for the subjects of malignant disease yet received—to have raised the percen- age of cures in breast cancer, from IO per cent to 50 per cent in a decade, is certainly rapid ad- vancement. Of the two great factors in the suc- cess of operative cure of malignant disease, viz: early interference, and completeness of removal, the former may have played some part, but it is evident chiefly to the latter that Halstead's suc- cess must be attributed, since many of his cases were far advanced, and he makes a special plea for earlier recognition and prompt action, by 1medical attendants. - - - It is notable that Butlin, who believed that IO per cent could be cured, opposed removal of the THE MEDICAL DIAL. 53 whole breast including the uninvolved skin, and especially a routine opening of the axilla—while Halstead not only adheres to his extensive ope- ration which sacrifices not only the whole breast and its skin, but the pectoral muscles, and the axillary glands and connective tissue en masse, but has extended it now so as to clean out and strip the supra clavicular fossa as a routine. For the present he says “Operate on the neck in every case, and remove the minor as well as the major pectoral muscles.” In our present light, great responsibilities rest upon the general practitioner, viz: to early rec- Ognize and to advise prompt action, but a still greater is placed upon the surgeon who attempts this operation, viz: that of skillfully making a sufficiently radical removal. Such operations re- quire a high degree of experience and knowledge Until recently, as a rule, the diagnosis has been made only after the disease has developed the grossest secondary changes, and then but par- tially removed—at first barely the tumor, then the whole breast, but leaving the skin, not visably involved. It is scarcely more than a dozen years since anything like a routine clearing of the ax- illa came into general vogue. Today it is demon- strated that the whole breast, its overlaying skin, axilla, pectoral muscles and supra clavicular fos- sa must be removed in the most careful and me- thodical manner, without incision or peace meal excision of the infected territory if we hope to give the patient any great prospect of cure. Only when these conditions have been most skillfully fulfilled, can the patient be said to have been given much chance of cure. According to Hal- stead, scientific surgery now offers the victim of mammary cancer something like even chances of being cured. In practice, between tardy diagnosis, and inefficient surgery, the general results are still, we fear, less than one cure in ten. It is sincerely to be hoped that the profes- sion will bestir itself to make the possibilities shown by Halstead, a general actuality. >k >; “Observations upon the Operative Treatment of . Hernia, at the Hospital for Ruptured and Crippled,” by Drs. Bull and Coley, (Nov. Annals of Surgery), is a valuable report. Modern Surgical Literature is somewhat open to the ac- cusation of short sight—more deeply interested in the “successful operation” than how the sub- ject fared ever afterward. It is, therefore, re- freshing to meet with articles which deal some- what with final results. In this case the material is large, the authors distinguished, and their ob- servation on their face temperate. From 1890 to 1898 there were treated at the Hospital 34,272 cases of rupture as folows:– Inguinal, male 248To; female 4082–28892 Femoral, male 558; female I369— Ig27 Umbilical, male Io'78; female I717– 2795 Ventral, male 229; female 429–– 658 - mere were 340 ventral herniae, due to lapara- tomy: 61 followed appendectomy; 25 followed Organs. Alexander operations. The histories indicated that most of these cases had healed by granula- tion, and emphasize the importance of primary healing in hernia operations. Of 917 cases submitted to operation for radical curé there were five deaths (two-fifths of one per cent–486 Were well, upwards of I year; 296 were traced and found free of recurrence for periods of from tWO to Seven years. Various methods were used in different series of cases, but that of Bassini gave the best results—12 known relapses in 618 cases. They regard the free cutting of the inter- nal oblique in Halstead's operation as a serious objection to that method. In Coley's last series of cases (531) primary union was secured in 95.5 per cent. The authors conclude among other things that hernia can be secured for a consid- erable period at least by operation. The propor- tion of permanent cures cannot as yet be set be- yond which relapse may not take place, but their studies of 360 relapsed cases throw considerable light upon the question. 80 per cent of the re- lapses occurred within one year and 64.5 per cent during the first eight months following ope- ration, while less than 12 per cent occurred after two years had elapsed. Hence if a hernia is Sound one year after operation, there is reason- able prospect of permanent cure, while if it re- mains well for two years, the chances of relapse are very small, though possible as late as 20 years after operation. J. H. D. GYNECOLOGY. UN DER THE CHARGE OF A. W. ABBOTT, M. D., F. A. DUNSMOOR, MI. D., J. H. RISHM II, I, ER, M. D. GESTATION FOLLOWING TRANSPLAN- TATION OF THE OVARIES. Dr. Grigorieff (Cent fur Gyn. No. 22, 1897) prolixly reports some unique experiments with rabbits in which he excised the ovaries and then transplanted them either near the uterine cornua in the broad ligaments or even at distant sites in pockets formed in the peritoneum. The rabbits, were killed six months later after they had be- come pregnant. Accurate studies were made of the gross and microscopal anatomy of the pelvic His observations conclusively demon- strate in each case that no Ovarian tissue re- mained at the site of the original implantation of the ovary. The author arrived at the following conclusions: First—The favorable results obtained are largely to be attributed to the scrupulous aseptic technique observed during the experiments. Second—The ovary continues to develop at the site of implantation and any part of the pelvic peritoneum may be selected for the transplanta- t1O11. 54 THE NAEDICAL DIAL, Third—The follicles undergo the usual course of development such as observed in the normally situated ovary. Fourth—Single follicles mature and rupture while the corpora lutea are formed in a perfectly normal manner, - Fifth–After transplantation of the ovary ges- tation may occur and continue to full term. MYOMATA OF THE LARGE INTESTINE. Pfanneustiel (Cent fur Gyn. No. 30, 1898) details the clinical history of a patient who entered the hospital on account of progressive emaciation and incontinence of urine. The author found the pelvis filled by a smooth, hard and firmly adherent neoplasm which dislocated the uterus and bladder upwards. A similar tumor, the size of a child's head, lay above and to the right of the Symphysis. After distending the rectum with gas he was able to make out that the tumor was retro-intestinal. He performed coeliotomy and found the upper enlargement to lie behind the descending colon which he enucleated by split- ting the mesentary. The neoplasm was firmly attached to the posterior surface of the colon by a fleshy pedicle which was then ligated and sev- ered with the Paquelin cautery. The peritoneum was sutured over the stump. The intra-pelvic neoplasm was removed with greater difficulty. After incising the posterior layer of the left broad 11gament, the pararectal tissue was divided with the cautery. The growth was then seized with a volsella and forcibly drawn upwards, being enucleated partly with the finger and partly with the cautery. The cavity thus created was drained per vaginum. The uterus and rectum were su- tured together and in this manner shut off from tue abdominal cavity. Microscopic examinations demonstrated that the removed neoplasms were myomata and re- vealed no trace of saraomatous degeneration. The writer summarizes that the neoplasms must have developed from the mucous membranes of the intestine. SEPARATION OF ABDOMINAL WOUND AFTER COELIOTOMY. Dr. Oscar Beuttner (Cent, fur Gyn. No. 22, I897) reports an interesting case illustrating the disadvantages of catgut sutures. The patient was a multipara, 35 years old; he performed coeliotomy for fibromyoma complicating gesta- tion-advanced to five months. The incision was in the alba and the muscles much atrophied. The peritoneum, muscles, facia and skin were closed separately with continuous catgut sutures. Ad- ditional catgut sutures were passed through the entire thickness of the abdominal walls. On the ninth day after the operation the deep sutures were removed and prima intentio observed. Soon after the patient was seized with a parox- ysm of coughing which finallly burst open the apdominal wound to the extent of 8-IO cm. This permitted the escape of the coils of intestine which were found adherent to one another and to the parietes by recent bands. The intestines were irrigated with a saline solution and retur- ned to the cavity. The coeliotomy wound, after refreshing the edges, was closed with ten through and through silk sutures. The patient then made an uneventful recovery. PEDIATRICS. UNDER THE CHARGE OF H. B. SWEETSER, M. D. HEREDITARY SYPHILIS. L. Duncan Bulkley, (Jour. Am. Med. Ass., Nov. 5, 1898), has written an interesting article on this subject. - The period at wheh symptoms manifest them- selves in children born apparently healthy varies from a few hours to several months after birth, the exact distal limit being as yet a “mooted question.” Most writers believe that one year is the outside possible limit at which the first symptoms appear, and that it is more than likely that, in cases where the initial symptoms ap- peared only after several years, the earlier mani- festations had been overlooked. At any rate in over three-quarters of the cases, the disease as- serts itself within the first three months of life; while beyond six months the proportion is ex- ceedingly small. Yet it is never safe to give an absolutely favorable prognosis as to escape of the child until after one year old. In consider- ing the relations of syphilitic children to the rest of the community, the author has this comment: The oft quoted saying of Fournier that “nothing is so dangerous to its surroundings as a syphi- litic child,” should always be borne in mind in connection with every case of hereditary syphilis. Hundreds and thousands of cases of syphilis have had their origin in innocent babes, and too great care can hardly be exercised. A child of parents with recent syphilis, even if apparently healthy, should never be wet-nursed, because there is no certainty that at some time mucous patches in the mouth may not develo and thus infect the nurse. - Not only the immediate attendant but every- one who comes in contact with the syphilitic child is in more or less danger of infection, de- pendent on the amount of care exercised. It must be especially remembered that the glairy secretion from the softened papules on the skin and the secretion from the mucous patches in the mouth are very highly contagious, and that thereby danger may arise from the nursing bot- tles, dishes, cooking utensils, cloths, etc. The Treatment of Hereditary Syphilis is dealt with it by Dr. Chas. S. Shaw. (Jour. Am. Med. Ass., Nov. 5, 1898.) t THE MEDICAL DIAL. 55 He states that in the infant we are, as a rule, called upon to treat only the secondary stage, for the reason that the teritary stage is rarely reached because of the slight resisting powers which lead to death from malnutrition. In mak. ing a prognosis he is justly and chiefly influenced by the child's capacity to assimilate nourishment. Concerning the treatment he says: “Whereas the value of mercury in adult syphilis does not admit of question, in infantile syphilis it is unique, it is the only drug. The iodides, arsenic and iron, so valuable in the treatment of the sequelae in the adult, have little place with infants, because with them this stage is seldom reached. Mer- cury in some form is a sine qua non. It is a question, therefore, only of choice of preparation and method of administration.” Of the four ways of giving mercury—by mouth, by hypoder- Imic injection, by vaporization and by inunction —he very strongly urges the method by inunci tion in infants, because of the importance of con- Serving the feeble digestive and assimilative ca- Tacity. Under certain urgent conditions, when it is necessray to quickly and powerfully im- press the system, he admits it may be advisable to have temporary recourse to the other three methods, but for persistent, systematic treatment The lays down the following axiom: There are two ways of treating infantile syphilis, a right way and a wrong way; the right way is by mer- curial inunction, the wrong way is any other way. . The eligible preparations are the unguentum Hydrargyri and the IO per cent, oleate (both officinal), diluted one-half with lard, lanoline, etc, to prevent irritation of skin. The method is simple: Spread about one drachm of ointment on a piece of cloth, lay on abdomen, and cover with binder; every second day bathe child and reapply. TETANY IN INFANCY. John Lovett Morse, (Jour. Amer. Med. Ass., Nov. 5, 1898), gives his views on the treatment of tetany in infants. Since all the available evidence as to the ori- gin and nature of tetany seems to show that the disease is due to toxic poisoning of some sort, treatment may be directed to the prevention of the formation of toxic substances and to their elimination if already formed. It is probable that Imany of these toxins are absorbed from the alimentary tract and some from the respiratory. Others may be the resultof abnormal metabol- ism. Regulation of the diet is probably the most important method of preventive treatment, al- though intestinal antiseptics may be of some value and deserve a trial. The formation and absorption of respiratory toxins can be best pre- vented by a liberal supply of fresh air and sun- light. Anything which tends to improve the hy. gienic surroundings is of use. Elimination is sought through the intestinal tract, and to a less extent through the kidneys and skin. Emetics, purgatives, and lavage of stomach and colon tend to favor elimination and prevent absorption. A liberal supply of water will keep the kidneys active. The skin may be stimulated by proper hygienic measures. - Symptomatic treatment is also important, and consists largely in the avoidance of excitants to spasm and in the employment of antispasmodics, as bromides, chloral, belladonna, opium, etc. AXIOMS IN INFANT FEEDING. I. The food must contain all the constituents and in the same proportion as found in mother's milk. - tº 2. It must be administered in a form suitable to the physiological requirements of infant di- gestion. 3. The total quantity in 24 hours must be such as to represent the nutritive value of one to three pints of human milk, according to age. 4. It must not be purely vegetable, but must contain a large proportion of animal mat- ter. 5. It must be free from taint of decomposi- tion or pathogenic organisms. CYCLING AND THE ACTION OF THE HEART. > Dr. M. Mendelsohn, Pediatrics, Sept. 15, 1898, in the Berlin Medical Society made the following note-worthy statement upon this sub- ject: The effect which wheeling may have on the blood pressure and thereby on the heart itself is of the greatest importance. In his own prac- tice, as well as that of Professor Oertel’s, a large number of observations were made in which an unfavorable influence on the heart was caused by wheeling. The relaxation and functional de- bility of the cardiac muscle was easily demon- strated, and the number of sudden deaths during wheeling is increasing, due to cardiac strain. As another warning against the excessive use of the wheel, especially in childhood, we Imay mention the observations in France during the yearly enlistment of recruits. It was found that a large percentage of those recruits who were expert wheelmen, had to be declared unfit for military duty on account of morbid changes in the heart muscle, or from the occurrence of marked changes in the spinal column, thorax, etc. [The above, of course, can only be true of the abuse of bicycling, but should warn us that, especially in children, careful supervision is necessary, as to correct position, speed and dis- tan Ce. Deaths from serpent bites, in India, are year- ly decreasing, and yet the statistics for 1806 show that I, I32 persons died from the effects of snake bites, while 291 were killed by tigers and other wild animals. 56 THE MEDICAL DIAL Neurology and Psychiatry. UNDER THE CHARGE OF R. O. BEARD, M. D., W. A. Jon Es, M. D. NEUROLOGY. The December issue of the Journal of Nervous and Mental Diseases has an interesting article by Dr. Frank Hallock entitled “A case of Hunt- ington’s Chorea” with remarks upon the propri- ety of naming the disease “Dementia Choreica.” The chief interest of the case lies in the care- fully given history showing that the mental symptoms preceded by several years the Onset of the chorea. These symptoms began with mild depression and lack of confidence in herself, accompanied by mental confusion and bewilder- ment, and increased to the point of childishness in her interest and pleasure in little matters. TO- gether with the beginning mental change ap- peared a rythmical movement of the thumbs. The first decided choreaform movements began fully five years after the mental change, and progressed steadily until two later they involved all the muscles of the body, including eyeball, tongue, pharynx, larynx, and diaphragm. Hal- lock compares this case with those of convulsive tic, and urges, first, that the motor activity is the outward expression of the state of the motor centres; secondly, that these centres are inti- mately connected by association fibres with those of higher consciousness and therefore, there is good reason to believe that whenever we find distinct and permanent motor disturbance of the cerebral organ, we may also expect to meet a certain grade of mental deficiency or impairment This same magazine also contains two arti- cles showing the difficulty which may sometimes arise in differentiating between cerebral symp- toms due to anaemia or chlorosis and those due to brain tumor. The first is on chrorosis and retino-papillitis, by Dr. H. M. Bannister, and gives the case of a young woman twenty-one years of age who was suddenly attacked with severe headache on the right side, accompanied by nausea and vomiting of cerebral type and by pronounced photophobia. Her family history was good and she had always been well until two weeks previously, when she had found herself rather more easily fatigued than usual. A care- ful examination showed all organs to be normal, but the blood count gave the red corpuscles three million two hundred and forty-four thou- sand, and haemoglobin forty-five per cent. The patient later developed regino-papillitis, but under treatment of arsenic and iron made a good recovery. - The second paper on this subject is by Dr. Hugh Patrick, entitled “Brain Tumor Simulated by Anaemia,” the case of anaemia was apparently one of tumor, the case of tumor apparently one of anaemia. The first was a domestic twenty-One years of hemorrhage. age who for six weeks had been suffering front constant and severe headache of greatest inten- sity in the left temple and supra-orbital regions. With this she had been troubled with numerous momentary attacks of blindness and complained of dizziness. There was also present intense double choked disk, with some small retinal Vision was reduced to 20-60 in either eye and the visual fields were notably, though not markedly, contracted. This patient also made a good recovery on iron and arsenic. The second case was that of a married woman of thirty-two, who for three or four years had been disabled from pelvic inflammation, but was finally fully relieved by an operation. About this time she began to suffer greatly from almost constant headaches, to which was soon added oc- casional vomiting, and left internal strasbismus. Four weeks later when first seen, she was very pale, thin and weak, but examination of the blood showed it to be practically normal, and there was nothing to indicate disease of the thor- acic or abdominal organs. The intense cepha- lalgia, pronounced paresis (almost paralysis) of the left abducens, typical choked disk, dizziness, a history of two abortive or atypical fits, slight difference in the knee jerks and the patient's complaint of a weakness in one leg, pointed to the existence of a brain tumor. Dr. Marlsham Sterritt and Dr. James Stewart, (British Medical Journal, October 1st) describe a sleep of fifty days which occurred in a lad of seventeen years. There was nothing in any way suggestive of catalepsy and the sleep was at no time so profound but that he could be aroused to take food. At the end of two months his weight began to increase with slow but steady improvement. Four months from the time the sleep ended he was somewhat unsteady in gait, ºut there is no evidence of mental impairment. W. A. J. Eye, Ear, Nose and Throat. UNIDER THE CHARGE OF J. D. SIMPSON, M. D. and recounts two cases, of which THE OPERATIVE TREATMENT OF PHARYNGEAL ADENOIDS. Dr. H. V. Wurdemann (The Laryngoscope, November, 1898), after having operated upon 189 cases for the removal of Pharyngial Adeno- ids, arrives at the following conclusions: “The results of these operations are usually immediate. The pernicious habit of mouth- breathing is rapidly overcome and the benefit of free nasal respiration and drainage is soon evinced by improvement of facial appearance, the dull, stupid look disappearing and the chil– dren becoming bright looking and more intelli– gent. The air being warm and purified, the ten- dency towards colds and catarrhal affections is THE MEDICAL DIAL. 57 lessened, and, as it is known that many infectious diseases in children are acquired through the up- per air passages, the liability to infection is less- ened and many attacks of sickness are escaped. If the deformity of chicken-breast has already been established, it is soon corrected through the proper breathing obtained. The respiration be- ing deepened, the blood and tissues are more thoroughly oxygenated, and the children rapidly gain in health and weight. “One of the principal reasons why the aurist is consulted in children having this condition is On acocunt of deafness. This is due to obstruc- tion of the Eustachian tubes. Subacute and chronic aural catarrh, with deafness, tinnitus, earache and vertigo in children is most common- ly caused by obstruction of the Eustachian tubes, due to adenoid disease in the upper part of the pharynx, and is rapidly cured by removal of the obstruction and a few subsquent inflations wtih the Politzer bag. Many cases of acute and chronic suppurative disease of the middle ear, with perforation of the drum-head, have their Origin in the infection from obstruction by pharyngeal adenoids, and a cure cannot be ob- tained by local ear treatment without removal of the cause. “There are few children of tender years who Thave nasal catarrh. The so-called catarrh is generally in the naso-pharynx and is due to ade- noids, which after removal in very young chil- dren need no further attention; but in older per- sons subsequent treatment is necessary. “I have had no unpleasant complications. There have been no cases of suppurative otitis media following any of my operations. I have seen and subsequently treated two such cases Occurring after operation by other men whose standing, however, should allow of no criticism. In a small percentage of cases there has been slight fever for one or two days after the opera- tion due to slight infection, and in these there has been delayed healing ; but in no case has there been any unpleasant symptoms after a week. As far as can be ascertained there have been only those instances where the growth has been sufficiently removed, or in which it has oc- curred in an amount large enough to warrant further operation. I have seldom made a sec- ondary operation in cases which had previously been operated upon by others. “The results achieved by removal of naso- pharyngeal obstruction due to adenoid growths are so brilliant, and the risks are so slight, that when indicated and properly done, there is no nore successful and immediately satisfactory surgical procedure.” THE MONUMENT TO DF. HANS WIL- HELM MEYER. The beautiful monument erected in honor of the late Dr. Wilhelm Meyer, the discoverer of “adenoid vegetations,” was unveiled at Copen- hagen Oct. 25th, 1898. Sir Felix Semon, M.D., who delivered the address, after referring to the very rare Occasions upon which physicians have been “immortalized by the sculptor's art in bronze or marble in a public place,” proceeded as follows:— “What, then, has been the conspicuous merit of Hans Wilhelm Meyer, that he should have been singled out for so unusual an honor as the One which is going to be paid to his memory to-day? The answer is easily given. It is now just thirty years since he was one day consulted by a girl, aged twenty, who suffered from deaf- ness, whose voice was most peculiar, and the ex- pression of whose face was almost idiotic. Treat- ment directed to the ears and to the throat failed, and it was not until the puzzled observer one day introduced his finger into the space between the nose and throat that an unexpected solution was met with. Instead of penetrating into an Open cavity, the finger was arrested by a large, Soft, easily bleeding mass, a condition the ex- istence of which in those days formed terra in- cognita. Meyer succeeded in removing this mass by Operation, with the result that the deafness was materially improved, the voice became nat- ural, and the idiotic expression of the face dis- appeared. Gratifying as this result was in itself, it was, however, only then that Meyer's real Imerit commenced. Schopenhauer has truly said that not he is finder of a thing who lifts it from the ground and drops it again, but he who, rec- Ognizing its value, takes it up and keeps it. If Meyer had regarded his experience in the light of a mere pathological curiosity, again years and years might have passed before the importance of the subject was realized. But with the true instinct of the scientific observer who develops what is ultimately to become an impor- tant truth from small beginnings, Meyer did not drop the clue which a casual observation had placed in his hands. He began studying the subject in all its bearings; he examined the masses he had removed with regard to their structure; he investigated the results which ob- struction of the space between the nose and throat exercised upon hearing, articulation, facial expression, general, mental and bodily develop- nent; he examined 2,OOO Copenhagen school children with regard to the frequency of this affection; he made himself the apostle of his own teaching by proclaiming it not only in his own country, but also in scientific publications abroad. In one word, to such an extent did he realize the true significance of his discovery that he left to his successors merely the addition of more or less important details, whilst the foundation of the edifice erected by him has remained un- changed from the time of his own first publica- tion of the subject. Nevertheless, it cannot be said that this teaching at first made very rapid headway. When in 1881 he introduced a discussion on the sub- ject at the International Medical Congress of 58 THE MEDICAL DIAL. London it came almost—I well remember— as a novelty to many of his audience, although that was mainly composed of specialists, and it was only in the next decade that the true importance of the subject was realized throughout the world. It was at first not easy to convince the bulk of the medical profession, the parents of the mostly juvenile patients, and the schoolmasters, that a discovery had been made which, like few others in medicine, was of the utmost practical impor- tance concerning the development of a healthy mind in a healthy body of the rising generation, and it needed the irrefutable proof of the sur- prising improvement seen in the subjects of suc- cessful Operations to make this conviction a uni- versal one. But truth, though slowly, ever forces its onward way, and when Meyer three years ago closed his eyes he had the satisfaction of knowing that the value of his discovery had at last been universally recognized. Already, then, the number of those who, through the timely removal of the obstructing glands, had been saved from lifelong deafness or from the lasting results of obstructed nasal respiration amounted to many thousands, and the benefits achieved through Meyer's merits will continue to accrue in future times to hundreds of thousands and millions.” THE THY ROID TREATMENT OF MID- DLE-EAR DISEASES. In view of the fact that a number of men, some of considerable prominence, have of late her- alded thyroid extract as having decided curative properties in the treatment of sclerosis and some other diseased conditions of the middle-ear, Dr. Macleod Yearsley (The Journal of Laryngology, Rhinology and Ototlogy, London, November 1898) was induced to try thyroid in twenty one cases, in all of which the results from treatment were negative. After following out the recom- mendations and directions of those who had ad- vocated the treatment, “even spoken eulogis- tically of it,” and not observing the slightest improvement in a single case he writes thus;– “The natural anxiety which animates all of us in the endeavor to be conversant with the latest methods of treatment predisposes rather to an attitude of mental credulity, which is inimical to an impartial and scientific judgment. The frequency with which new methods of treatment, from which we had fondly hoped to have arrived at something like finality, although sponsored by persons of unimpeachable scientific respecta- bility, prove on impartial investigation to fall far short of the expectations which had been legitimately raised regarding them, should lead us to adopt a scepticism which, while open to conviction, will not readily yield to mere plaus- able reasoning.” THE PROPER USE OF THE WORD CAT- is ARACT. The following is an extract from a paper pre- sented to the section of opthalmology at the last meeting of the American Medical Associa- tion by Dr. Edward Jackson. (The Journal of the American Medical Association, Sept. 24th, 1898.) “Anhong IO,OOO patients attending my clinical services at the Philadelphia Polyclinic and the Wills' Eye Hospital, all of whom were examined opthalmoscopically, except those in whom the use of the opthalmoscope was impos- sible by reason of opaque media, or closure of the lids, there were 1544 over 50 years of age. Arranging these by five-year periods I find re- Sults as follows:— Lens Some lens Clear. Opacity. 50 to 55 . . . . . . . . . . . . 460 . . . . . . . . . . . . 8I 55 to 60 . . . . . . . . . . . . 260 . . . . . . . . . . . . 50 60 to 65 . . . . . . . . . . . . 196 . . . . . . . . . . . . 85 65 to 70 . . . . . . . . . . . . 99 . . . . . . . . . . . . 83 70 to 75 . . . . . . . . . . . . 60 . . . . . . . . . . . . 7 I Above 75 . . . . . . . . . . 23 . . . . . . . . . . . . 77 Totals Io98 449 Gould's Dictionary gives as the definition of cataract: “Diminished transparency or opacity of the crystalline lens, or of its capsule.” This is substantially the definition given in other works of reference. But cataract, to the general public, means a disease of the eye leading to blindness, and only curable by a capital Opera- tion. So long as this condition was not discover- able until it had caused great impairment of vis- ion, and was perhaps approaching the proper period for operation, the discrepancy was not great; but now that we recognize the first begin- ings of opacity in the crystalline lens, the use of the term “cataract” to indicate slight opacities, when it will be understood to mean early and complete blindness is seriously misleading. The introduction of the phrase “incipient cataract” is doubtless intended to meet this difficulty, but it does it very imperfectly, as must any phrase that retains the objectionable word. Many people have been rendered skeptics as to the honesty of the surgeon by a diagnosis of “cataract” which has not, after many years, been followed by blindness or any serious impairment of vision. Many have been made extremely unhappy by dread of blindness from which they were never ...ely to suffer. There has even been some con- fusion of thought in the profession upon the sub- ject. I once heard a surgeon announce in a state imedical society that he favored operation on cat- aract in all cases where the vision fell to */o. I have known a surgeon of respectable antecedents to propose and urge such an operation for a pa- tient who had some lens opacity but who could still see to do fine sewing and read ordinary type with either eye. If the question of the significance of slight opacities of the lens were rarely of practical im- portance, this subject might not be worth dis- cussing; but when it arises in more than three- fourths of our patients who have reached the age of 75 years, it is of great practical importance. My own custom has been not to use the word THE NAEDICAL DIAL. 59 “cataract” unless the opacity was causing serious impairment of vision, or likely to require opera- tion. In the other cases I have informed the patient of the existence of “lens opacity,” and have explained its probable significance, only speaking of “cataract” in response to some di- rect inquiry as to whether it or anything like it was present. I believe that such a course gives patients a far truer idea of their condition than One which calls all lens opacities “cataracts.” It seems likely that some such distinction of terms will in time arise. It is probably useless to at- tempt by recommendation or resolution to intro- duce such a term ; but if the need for it is clearly recognized and appreciated on the part of the profession, the differentiation of language will naturally follow.” CLINICAL MICROSCOPY. UNDER THE CHARGE OF J. FRANK CORBETT, M. D., G. D. HEAD, M. D. Leucocytosis in Diphtheria. In the May number of the Annals de L’In- stitut Pasteur 1898, Dr. Besredka contributes an article upon Leucocytosis in Diphtheria. His conclusions are as follows: First, “when massive doses of diphtheria tox- ine are injected into rabbits the polynuclear leucocytes describe a parabolic curve reaching its maximum I2 to 16 hours after the injection; beyond this time polynuclear leucocytes decrease rapidly till death. Second, in slow intoxication, killing in several days, the polynuclear leucocytes are always in- creased. Third, in the course of immunization process a leucocytosis is manifested especially in the early hours after the injection. Fourth, children recovering from diphtheria exhibit leucocytosis which lasts from 12 to 15 days until complete recovery. Fifth, children who do not recover in spite of the serum treatment present in the blood only a small degree of polynuclear hyperleucocytosis. Sixth, the degree of increase or decrease in the number of polynuclear leucocytes constitutes one of the surest elements of prognosis in diph- theria.” - A criticism might be made upon conclusions one, two and three as arrived at by Besredka. In each instance the conclusion was drawn from leucocyte counts made only upon one rabbit, with no statement as to whether other rabbits were experimented with or not. The author also fails to give his method of securing the blood. If as most probable the veins of the ear were used, the enormous and repeated punctures which almost of necessity had been made in order to have secured so many counts would of ation. themselves have caused a local inflammatory leucocytosis as great as that recorded by the author, and would throw considerable doubt up- on his conclusions. In the Berliner Klin. Wocheuschrift 1898, page 809, Pappenheim announces the finding of the smegma bacillus in sputum from human air passages. He stained a specimen of Sputum after Gabbet's method and found on microscopical examination a large number of red colored bacilli which so closely resembled those of tu- berculosis that this diagnosis was made. The case came to post-mortem ; no tubercular lesions were found. Cover glass smears from the lung lalveoli, the mucous of the bronchi, trachea, and larynx all showed these same red staining bac- illi as well as the stain which they took in sections washed in alcohol, Pappenheim comes to the conclusion that he was dealing with the smegma bacillus. No cultures were made. As a result of his study the author offers a new staining process for differentiating between the smegma and tubercle bacillus. First, stain in Carbol fuchsin heated to boiling. Second, pour off the stain in the following solution : Absalc IOO parts; Corallin I part; Methylene blue to saturation; Glycerine 20 parts. Fourth, wash in water. The smegma bacillus is by this method decolorized. In connection with the findings of Pappen- heim, Fraenkel in the Berliner Klin. Wochen- schnft, 1898, page 880, states that he has repeat- edly observed in cases of lung Gangrene the so- called Psendo tubercle bacillus in the expector- At first these findings had led hiſm into error in diagnosis; but more recently he has looked upon these bacilli as harmless Sapro- phytes belonging to the group of Smegma bacilli. These observations of Pappenheim and Fraenkel reopen the subject of a specific stain for the tubercle bacillus. Formerly it was taught that by washing the preparation in alcohol the smegma bacillus was decolorized while the tu- bercle bacillus was not; and this fact was given as a means of differential diagnosis between the two bacteria. But there seems to exist a grow- ing skepticism concerning the value of this pro- cedure. Without doubt the most certain means of differentiating between the smegma and tu- bercle bacillus is by animal innoculation. G. W. H. A medical professor quizzing his class of stu- dents on the doses of medicine to be given, one student gave the number of grains of a powerful drug for a dose, which was very excessive for the safety limit; the professor said nothing and went on with his questions; but later the student hav- ing collected his thoughts, asked leave to cor- rect his statement as to the dose. The professor taking out his watch said, “It is now, too late, the patient has been dead 14 minutes.” 6() THE MEDICAL DIAL. 50Spital Clinic.S. ST. BARNABAS HOSPITAL. Clinic by A. W. ABBOTT, M. D. Two recent cases have been so instructive to me that I hope to interest you by a brief account of them, as follows: - vase I. Mrs. A., 27, married three years, never pregnant, menses regular, but painful; several severe falls, but no traumatism for six years; as well as usual, and attending to all duties up to three weeks ago. At that time had a red eruption in blotches; next morning, pain in left pelvis, which has not increased. About two weeks ago, a mass suddenly appeared in the left pelvis, which has not increased in size, but the tenderness is a little greater. Never had abortion, leucorrhoea or treatment of any kind for uterus or vagina; in fact, never had an examination. Temperature for last week, 99 to IO2% F. Bowels, consti- pated, painful, with mucous discharges. Physical examination. Mass in pelvis, filling Douglas' sac and extending to half as high as umbilicus. Uterus normal in size, but pushed up to pubis, with fundus to the right; fluctuation and some tenderness. Case 2. Mrs. B., 37, widow five years, never pregnant, menses regular, not painful. Perito- Initis six years ago; said to have enlarged ovary five years ago. Eleven weeks ago began to be lame across bowels. Case was diagnosed as ap- pendicitis by her physician (not a regular prac- titioner). Has been confined to bed ever since. Temperature nearly normal, 99% F. Pulse IOO. Bowels constipated, and movements painful with mucous discharges. Patient weak and nervous, and could give a very poor account of her case. The above was all that I elicited from the pa- tient ‘before operation. Afterward, and when she was more composed, she stated, on being particularly questioned, that about three weeks after bowels became sore, she had a sudden aw– ful pain, while at stool, from which she fainted; at this time, she began to flow, and flowed for six weeks, with discharge of a few clots; that she informed her physician also that there was a possibility of pregnancy, but the diagnosis of ap- pendicitis remained unchanged, and she was told that she would soon be better. Physical examination. Deep, fluctuating mass in left pelvis, extending from Douglas’ sac to half way to umbilicus, not very tender. Uterine fundus pushed to right, normal in size; cervix normal; whole organ crowded toward pubis. After ten weeks of suffering, she came under the intelligent care of a regular practitioner who promptly made a diagnosis of some kind of a cyst. I saw her a day or two after, and con- firmed the doctor's opinion. Not having the benefit of the history obtained after the operat- tion, the diagnosis was probably as complete as it well could be. The sudden terrific pain, with collapse and subsequent long-continued flow, with a tender mass which must have existed in the left pelvis for at least six weeks after the pain in bowels began, together with the admission of the patient that she might be pregnant should have made the diagnosis easy for the physician who had the case in charge at first. It will be seen that these two cases were ex- actly similar as to physical conditions, that the pain and tenderness were about the same, and the only marked difference in the histories, as obtainable at the time, were the presence of a medium high temperature in the first case, with a normal temperature in the second ; and yet the Operation proved that the first was an inflama- tory Serous sac, enveloping a pus tube, while the Second was a ruptured tubal pregnancy, just be- ginning to be septic. In both cases, the operation consisted in a wide posterior vaginal incision. In the first, several smail abscesses were evacuated after the serous sac had been opened, and finally the tube opened and three ounces of pus evacuated, iodo- form gauze drain for all the abscesses, as well as the tube. In the second case, after the peritoneum was opened, there was a gush of bloody serum; the finger then came upon a placental clot, on Sepa- rating which, the bleeding became profuse; the finger was then pushed through the clot and this two and one-half's months foetus extracted. As it was then certain that the rupture had been primarily into the broad ligament, and adhesions had formed sufficient to make a firm wall, the placenta was rapidly torn off and the cavity packed with iodoform gauze. Both patients are doing well. These two cases illustrate how nearly the symptoms of two dis- tinctly different pathological conditions may agree. . - The second case suggests that we should al- ways bear in mind the possibility of an extra- uterine pregnancy, even when we have the least apparent reason to expect it. Had this been prominent in my mind, I might have gotten the history before, that I did after, the operation. Fortunately, I was prepared for what I found; otherwise, the hemorrhage would very likely have been fatal. - CLINIC AT ST. BARNABAS HOSPITAL BY DR. K. H.O.E.G.H. Gallstone operation—Phlegmon of hand. November 21st. Mrs. M. C. 30 years old, mar- ried several years, never pregnant. Complains of attacks of severe colicky pains in abdomen, felt strongest in epigastrium, and in both hypochondria, the pains have nearly always come on in the evening, after the patient has gone to bed, and without any assignable cause, such as indigestion, fatigue, or mental emotion. They have sometimes been first felt in the right THE MEDICAL DIAL. 61 hypochondrium, whence they soon have spread over the whole abdomen, reaching great inten- sity, producing vomiting of bile, and other stom- ach contents. They are accompanied by a fre- quent desire to urinate; at times there have been spasmodic contractions of the thumbs and fin- gers. The pains have been yery severe for per- haps half an hour, then they have abated to some extent, often only for a short time: they have some times lasted two or three days, at other times only a few hours, they have usually been followed by a mild diarrhoea. - She has never been jaundiced, nor has any swelling in abdomen been observed. It is a couple of years since she became subject to these at- tacks, which gradually have become more fre- quent, and more severe. At first her health was perfect in the intervals; lately she has suffered, from oppression in cardia; of late she observes that she cannot digest rich food very well. Her previous health has always been good, but she has not menstrated except a few times during her 25th year. She is very short and very fat, and has the ap- pearance of perfect health. A physical examina- tion of the whole body is made: Except prom- inence of abdomen, and a somewhat Scanty de- velopment of pubes and the external genitals, nothing abnormal is observed, particularly no tu- mor, nor any increased tenderness at the re- gion of the gallbladder; nor any trace of albu- min in urine, in which no pus is found. The in- ternal genital organs are apparently normal. The patient has been under observation for a couple of weeks, during which time she had an attack of moderate severity, which I did not see, but in which the absence of a consecutive jaundice, and of abdominal tenderness after the attack was proved by personal observation. e What could these attacks be? They were evi- dently not inflammatory or febrile, for they were of too short duration, they came on too suddenly and ceased too suddenly without leaving any sign. They could thus not well proceed from a gastric ulcer, nor from appendicitis; the absence of pain, and the perfect digestion at the intervals enabled us furthermore to exclude an ulcer; so did her accumulation and retension of fat; for gastric ulcer leads always in my experience to at least temporary emaciation. s A recurrent appendicitis would leave a thick- ening or fulness in the iliac fossa; it would not be of so short duration when it was SO intense as she described. Nor could it well be a case of Oophoritis or salpingitis. e Attacks of pain from an incipient yet latent tit- bercular osteitis of the spinal column would probably be more continuous; the pains might come on in the night upon turning in bed, but we should expect stiffness of the back, even if de- formity and local tenderness were absent. The localization of pain might well be the same as in this case, for a patient is usually not able to in- dicate the seat of any deep pain with any accur- of gall-stone colic. acy. But the disease has already lasted a couple of years, in that time the local symptoms of Potts disease would have been manifest, particularly as tue pain had become more severe of late. Could these attacks be of renal origin? She had during them frequent desire to pass urine; but there was never found albumen by any chem- ical test, nor pus-corpuscles in the microscopic field; nor was there any tenderness in either renal region. Might not the attacks be purely gastric or intestinal spasms? If so, there must have been anatomical causes, especially adhesions, and they again would presuppose previous peritonitis, the presence of which there was no reason to Suspect, as there was no history pointing to it. Could the attacks be hysterical? The patient is a woman disappointed in the hope of moth- erhood, and considers herself as being sexually defective. The attacks are also accompanied by nervous symptoms, the tonic spasms of the fin- gers, the frequent desire to urinate. But she shows no other sign of lack of nervous balance, and has usually a very placid appearance. . Still the possibility of hysteria cannot be excluded with absolute certainty. - - On the other hand, all the symptoms can be explained by the assumption that this is a case The suddenness of the at- tacks, the apparent absence of a proximate cause, the intensity, the perfect health in the intervals. that lately has given way to slight gastric dis- turbances, the patient’s fatness—all these con- siderations point to the presence of biliary cal- culi. You might ask, if we ought not to feel a Swelling or at least a tenderness at the point of the IOth right rib, and if we ought not to have jaundice. The absence of swelling does not count for much, when we consider the thick layer of fat covering the gall-bladder, which would make it impossible to detect it even if it were present. But enlargement of the gall-bladder is not even common in gallstone disease; and stones have only rarely been felt through the ab- dominal wall. The presence of icterus is only found where the stones in some way obstruct the common duct, either by blocking it mechan- ically, or by injuring the mucous lining in their passage through the canal, thereby producing a temporary Swelling of it. - -- - If this be a case of gall-stone colic, the stone must either be in the gall bladder and too large to engage in the duct, or there may be very small stones that pass through the duct without giving rise to an obstructing catarrh of its mucous 1membrane. Her stools have not been examined for gall- stones, as she was not seen immediately after she had the attack here in the city. The case being explained to the patient as accurately as I was able to do it, she and her husband gave their consent to an operation. 62 THE MEDICAL DIAL. Consequently an operation was made in the presence of the class, after the usual preliminary treatment of rest in bed upon fluid diet, and the thorough disinfection of the skin by scrubbing and an antiseptic formalin pad. Owing to the thickness of the fat the incision had to be made somewhat long, perhaps 3% inches. It ran through the right rectus muscle, the fibres of which were separated by the handle of the scal- el. After the bleeding had been stopped the peri- toneum was opened. Omentum was uncom- comonly fat, and protruded in the opening mak- ing the search for the gallbladder difficult. When it was found, it appeared very small : it was sit- uated very deep in the wound and looked like the tip of a glove finger, and about the same size: it could be followed for quite a distance inwards, upwards and backwards. - My intention was to dissect out a peritoneal flap from each side, sew them to the free part of the gallbladder, and only to open it after adhes- ions had taken place in IO to I2 days. But it was found too difficult owing to the great depth, and the small size of the presenting part of the bladder. I had to perform the operation in one stage. Before I opened the gallbladder I had felt the stones through its walls. I packed the space as well as I could with sterile gauze sponges and opened the bladder; healthy look- ing bile came out, and with it a great number of stones, probably over a hundred; four of them were larger than a pea, others much smal- ler. A finger introduced through the opening made sure of the removal of all. The gallbladder was sewed up with fine silk in a double row of sutures, whereby the first row was turned in. Suture by catgut in layers and finally of the skin and subcutaneous tissue by silk-worm gut completed the operation. The later history was as follows: In 56 hours there developed pain and a temperature of IO2-2, and a pulse of IOO. Two wormgut sutures in the middle of the wound were removed, a closed dressing forceps introduced to the bottom of the wound, came into the peritoneal cavity; upon its with-drawal a few drops of dark blood followed. & wet antiseptic dressing was applied. The next morning the pain had disappeared very largely, and the temperature had gone down to IOO, the pulse was 90, the tongue was moist. After this the dressing was changed every day, as Suppera- tion developed in the fistula. In two days more, the temperature became 99 and the pulse 84, as at present, 16 days after the operation. The fever symptoms have been absolutely absent for about ten days, and her general condition most sat- isfactory; but there is yet suppuration along the track of the fistula. I do not anticipate a hernia, as the opening is very small, not over one-third of an inch, and the rest of the line of incision seems to be free from infection. IMPORTANCE OF PERSONAL CHARACTER IN THE PROFES- SION OF MEDICINE. “It is now a good many years since Sir James Paget published in the St. Bartholomew's Hos- pital Reports a short paper embodying the re- sults of an inquiry as to what became of a thou- THE Sand of his pupils within fifteen years of their entrance at St. Bartholomew's hospital. Of the 1,000, 23 had achieved distinguished Success; 66 had achieved considerable success; 507 had achieved fair success; 124 had achieved yery limited success; 56 had failed entirely; 96 had left the profession; 87 had died within twelve years of commencing practice (21 of them from diseases incurred in the exercise of their profesional duties); and 41 died during their pu- pilage (17 of them from phthisis.)” It may be explained that in this summary “distinguished success' means that those classed under this heading had gained leading practices in counties or very large towns, or held important public offices, or had become medical officers of large hospitals, or teachers in great schools. Those are stated to have attained ‘considebable success’ who had gained and still held at the time the paper was written, ‘high positions in the public services or leading practices in good districts,’ or who had already retired on their earnings, or who had won for themselves “much more than ordinary esteem and influence in society.’ The rest of those who could be said to have achieved any Sort of real success constituted the third class. This class, which might be called the moderaters embraced more than half of the total number of those whose histories were known. Of the other classes I need not here speak in detail beyond calling attention to the large num- ber that left the profession, nearly 1o per cent. of the whole. Most of those who are classed under this heading discarded the medical profession for other pursuits—the church, the army, the stage, Commerce, and agreulture. It was the conclud- ing portion of the paper, however, which made at the time the strongest impression on my mind and which has induced me, even after this lapse of years, to bring it before you today. ‘Of course,’ says Sir James Paget, ‘in watching and reflecting on the careers of my pupils I have come to some strong beliefs on subjects of Imedical education, but this is not the place for publishing them. Only one will I set down, which may be of use to future pupils and is justi- fied by some hundreds of personal recollections. In remembering those with whim I was year after year associated, and whom it was my duty to study, nothing appears more certain than that the personal character, the very nature, the will of each student had far greater force in determin- ing his career than any helps or hindrances whatever. ‘All my recollections,’ he continues, ‘would lead me to say that every student may THE NAEDICAL DIAL. 63 likely forecast his life in practice, for it will de- pend on himself a hundredfold more than on circumstances. The time and the place, the work to be done, and its responsibilities will change but the man will be the same except in so far as he may change himself.' “It may be said that this was all very well thirty years ago, but that times have changed and that whereas it may have been, and, no doubt, was then possible for a man with charac- ter and perseverance by sheer force of good be- Thavior and steady plodding to come eventually to the front, no man could do so today unless he also possesses a more than average share of in- telligence. For the general standard of knowl- edge in our profession has been raised and the , range of knowledge greatly widened, so that much now is required both in quantity and qual- ity even of the ordinary pass man, to say nothing of the honored men and prize-winners. This way of putting the matter sounds exceedingly plaus- ible, but it leaves out of view the fact that entrance into the profession is now guarded in a way in which it was not protected during the period of which Sir James Paget was writing, and that whereas a man could then enter upon his course of medical study without having given any proof of having received a fairly liberal educa- tion, it is impossible for him to do so now. The preliminary examination in general education which must be passed before a student can reg- ister, though not a severe test, is quite severe enough to keep back the hopelessly ill-educated man whatever good qualities he may possess. Hence the struggle is not, as might be supposed, between the man who has character without in- tellectual training, and the man who has charac- ter with it, but between the man who has intellec- tual training with character and the man who Thas intellectual training without. In such a struggle victory rests in the end with the man who, to his intellectual attainments, adds char- acter. As Sir James Paget says, “The time and the place, the work to be done, and its responsi- Bilities may change, but the personal character of the student remains now as then the chief factor in determining his ultimate career.’” (Dr. Cullingworth in the Lancet, Oct. 8th, 1898) AN ESTIMATE OF PUERPERAL MOR- TALITY BASED UPON OVER ELEVEN THOUSAND CASES. Dr. E. Garrett Anderson (Brit. Med. Journal, Sept. 17th, 1898) quotes the records of births and maternal deaths in six London maternity hos- pitals during the years 1895-6-7, showing a ma- ternal death rate of I in 483 cases. The death rate in nine other British maternity hospitals, during the same period, was I in 464, the total number of deliveries for the year being II, I22 with a total maternal death rate of I in 47I. This is lowered to I in 5,636 when certain cases dying from causes not connected with the puer- peral state are deducted. This remarkably low mortality is not accepted as a correct estimate in one of the leading articles in the same issue. Here it is set down as something more than I in 2OO, the previous low maternity report having been taken largely from the out-patient depart- ments, where all the fatal cases are not reported because they frequently pass into the hands of other physicians before recovery is complete. The conclusion here arrived at is that the real puerperal mortality is very much what it was thirty years ago. J. W. D. “LA FRIGOTHERAPIE.” Raoul Pictet, the famous Swiss savant, Chev- alier of the Legion of Honor, discoverer of the liquefaction of Oxygen, and member of more than forty Scientific societies in France and Germany, has come to America to demonstrate to phys- icians and scientists here what he is convinced is a cure for diseases of the lungs, stomach, the circulation and the kidneys. La Frigotherapie, the name of his new discovery, may perhaps be roughly translated into English as the “freezing cure.” The necessary machinery consists of a well of metal lined with thick furs, in which the patient descends, the depth being about five feet. This well is surrounded by an outer shell, while the cavity between the outer and inner walls is filled with a combination of sulphurous and carbonic acids known to the scientific world as “liquide pictet,” after its discoverer. This gas is kept in a liquid state at I ſo degrees below zero, and is continually forced into the cavity by pumps. M. Pictet says the patient, surrounded by the furs and the icy liquid, has no impression of cold whatever, and in fact his temperature rises after three seconds' treatment, increasing from one- half to One degree in five minutes. A period of treatment ranging from five to fifteen minutes is always sufficient for the time being, the num- ber of needful repetitions varying in each indi- vidual case. . . M. Pictet says he himself, after fifteen years of illness, was cured after eight descents into “the well.” The prince of Servia, he said, was absolutely cured by six descents, after twenty years of con- tinuous ill health.-N. Y. Herald. Charlotte de Baviere, the German Princess, Second wife of the Duc d’Orleans, brother of 1.ouis I4th of France, in her autobiography, says, “She always wanted to be a boy, and hav- ing heard that Marie Germain became one by jumping, I used to take such fearful leaps that it is a miracle I did not break my neck a thou- sand times,” A happy, prosperous, and contented New Year to all readers of the Medical Dial. 64 - THE MEDICAL DIAL. HOSPITAL CLINICS BULLETIN. Minneapolis City Hospital. MONDAY-1 to 3 p. m.—MEDICINE, Drs. Glenn and Williams. TUESDAY-9 to 11 a. m.—PHYSICAL DIAGNO- SIs, Dr. C. F. Nootmage1. ‘‘ 11 to 12 a.m.—PHYSICAL DIAGNO- sIs, Dr. J. W. Bell. . . ‘‘ 10 to 12 a. m.—GYNECOLOGY, Dr. W. J. Byrnes. “ 2 to 3 p. m.—MENTAL & NERVOUS DISEASEs, Dr. W. A. Jones. “ 3 to 4 p. m.—DERMATOLOGY, Dr. M. P. Vander Horck. WEDNESDAY-9 to 11 a. m.—SURGERY, Dr. W. A. Hall. THURSDAY-9 to 11 a.m.—GYNECOLOGY, Dr. A. W. Abbott. FRIDAY-9 to 11 a.m.—MEDICINE, Dr. J. H. Stuart. ‘‘ 4 to 5 p.m.—MENTAL & NERVOUS DISEASEs, Dr. Leo M. Crafts. SATURDAY-9 to 11 a. m.—SURGERY, Dr. W. A. Hall. ‘‘ 11 to 12 a. m.—PEDIATRICS, Dr. H. B. Sweetser. ‘‘ 1:30 to 2:30 p.m.—MEDICINE, Dr. H. L. Staples. ‘‘ 2:30 to 4:30 p.m.—MEDICINE, Drs. Haggard and Head. St. Barnabas' Hospital. MONDAY-9 to 10 a. m.—SURGERY--Dr. - J. W. MacDonald. ‘‘ 10 to 11 a. m.—SURGERY, Dr. - Knut Hoegh. ... SATURDAY-11 to 12 a. m.—SURGERY--Dr. J. E. Moore. ‘‘ 1 to 2 p. in.-MEDICINE, Dr. C. H. Hunter. St. Mary's Hospital. SATURDAY-9 to 11 a. m.–SURGERY, Dr. J. H. Dunn. Asbury Methodist Hospital. THURSDAY-9 to 11 a. m.—GYNECOLOGY, Dr. F. A. Dunsmoor. - ‘‘ 11 to 12 a. m.—OPHTHALMOLOGY, Dr. F. C. Todd. FRIDAY-9 to 11 a.m.—SURGERY, Dr. F. A. Dunsmoor. CORRESPONDENCE. Minneapolis, Minn., Dec. 16, '98. To the Editor of the Medical Dial : Dear Sir : It is with more than ordinary pleasure that I take the liberty of sending you these beautiful “Lines to a Skeleton” that they may be presented to the profession through the “Dial.” It is, per- haps, not unlikely that many are already famil- iar with them. Even though this be true, it seems. yet not inappropriate that they be presented 2116 W. $ From a clipping made by me some fifteen years ago we learn, relative to this poem that, Fifty years ago the London Morning Chronicle published a poem entitled “Lines to a Skeleton,” . which excited much attention. Every effort, even to the offering of a reward of fifty guineas, was vainly made to discover the author. All that ever transpired was that the poem, in a fair, clear hand, was found near a skeleton of re- markable beauty of form and color, in the Mus- eum of the Royal College of Surgeons, Lincoln's Inn, London, and that the curator of the mus- eum had sent them to Mr. Perry, editor and proprietor of the Morning Chronicle. Fraternally, Howard McI. Morton. LINES TO A SKELETON. Behold this ruin! 'Twas a skull, Once of ethereal spirit full; This narrow cell was life’s retreat, This space was thought's mysterious seat, What beauteous vision filled this spot! What dreams of pleasure long forgot! Nor love, nor joy, nor hope, nor fear, Have left one trace of record here. Beneath this smouldering canopy Once shone the bright and busy eye; But start not at the dismal void— If social love that eye employed, If with no lawless fire it gleamed, But through the dew of kindness beamed, That eye shall be forever bright, When stars and suns have lost their light. Within this hollow cavern hung The ready, swift and tuneful tongue. If falsehood’s honey it disdained, And where it could not praise, was chained; If bold in virtue's cause it spoke, Yet gentle concord never broke; This silent tongue shall plead for thee When time unveils eternity. Say, did those fingers delve the mine? Or with its envied rubies shine? To hew the rock or wear the gen Can little now avail to them. But if the page of truth they sought, Or comfort to the mourner brought, These hands a richer mead shall claim Than all that wait on wealth or fame. Avails it whether, bare or shod, These feet the path of duty trod? If from the halls of ease they fled To seek affliction's humble shed? If Grandeur's guilty bribe they spurn'd, And home to virtue's cot return'd, These feet with angel's wings shall vie, And tread the palace of the sky. THE MEDICAL DIAL. iii P-TO-DATE THE ALLISON OPERATING TABLE enameled interior. cians everywhere. Has no superior. attached. 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NAasonic Tennple Building, E-i NWINNEAPOLIS, MINN, º The only Exclusive Physicians' Supply House in the Northwest §i - § BºğB3 DOCTOR, Do Not Give A Up that Case of E: C. 2. E NA WITHOUT TRYING - . . . NOITOL., . . . Now recognized as an almost Infallible Remedy in all forms of Skin Diseases. s Avv. FALN/ ET TO CO. Nyl F. FOR GEN ITO-UR 1 NARY AFFEcºTI C N s. Contains Saw Palmetto, Santal and Corn Silk in an agreeable vehicle. Invaluable in Prostatic Troubles—Ovarian Pains— irritable Bladder—Pre-Senility—Difficult Micturition. - Samples of above sent on application to wh;ELER CHEMICAL works, - - - 15s Lake st., chicago, III. Manufacturers of a general line of Pharmaceutical Preparations. - ===º- -o-º- ~~~~<><> P. & S.A. |gºsºsºsºsºsº º { 47O TEM FLE COURT, M / N M EA POL/S. ! C 6 67 S - { Organized for the Protection of Physicians and Surgeons $ Q Q0. (> QI'QI' & and Collection of Accounts anywhere in the U. S. { SiSil CO. 22 washinston Hut. South, WE COLLECT WHERE OTHS. RS FAI L. TRY U.S. : -º-, -º- *-* *º--e- -º-e Surgical Instruments, Trusses, Surgical Braces, e II?inneapolis. - Manufactured to Order and Repaired. * We have a finely equipped shop º sº machinery for PbysiciallS and SurS&OilS SiSIIS above purposes. Many physicians have ideas for improvements * * * * - and changes in the construction of Speculums, Forceps, Douches, One of our Specialties, etc., or special braces for all parts of anatomy. 1 ti inst s’ Out of town physicians can express or mail their instruments & * with instructions attached or send in details for new work. Please mention this paper. BAUM'S BRASS AND MODEL WORKS, Yº, 2-wºº.ºwn". Gºº W E ALso Do ALL KINDS OF BRASS AND MAC H ! NIST WO R. K. (, 10.S. MST ID 5 –4– THE EDICAL DIAL A Monthly Record of Medicine and Surgery. Vol. I. No. 4. MINNEAPOLIS, MARCH, 1899. $1.00 per Annum. Single Copies 1 Oc. CONTENTS. ORIGI INRA L. R. RTIC.L.E.S. Skin Grafting—Dislocation of Shoulder. A clinical lecture delivered at the Min- neapolis City Hospital, by J. H. DUNN, M. D. . . . . . . . . . . . . . . . . . . 97 Sinus from Infected Ligature. A clinical lecture delivered at St. Barnabas Hos- pital, by A. W. AbBOTT, M. D. . . . . . 100 Conservatism in Medicine and Its Effects Upon the Practice of To-day, by J. C. FARMER, M. D. . . . . . . . . . . . . . 102 Case of Caesarean Section and Complete Hysterectomy, by F. A. DUNSMooR, M. D. . . . . . . . . . . . . . . . . . . 105 ED ITO RI EA L. S. THE CASE OF MARTIN vs. CourTNEY . 106 THE PASSING OF THE HORSE As A SANI- TARY ADVANTAGE TO OUR CITIES . . . 107 PROG RESS OF NAEDIC.INE. MEDICINE. Diabetes Mellitus. . . . . . . . . . . . . 108 Treatment of Consumption . . . . . . . 108 The Stonnach Tube. . . . . . . . . . . . 109 Position of Patients after Feeding . . . . 109 Diphtheria and Antitoxin . . . . . . . . 110 SURGERY. - The Murphy Button at Heidelberg. . . . 111 Treatment of Fractures by Weight Ex- 1. tension . . . . . . . . . . . . . . . . . 11 Catherization of the Ureters . . . . . . . 111 External Urethrotomy . . . . . . . . . . 111 The After Treatment of Gastrostomy . . 112 GYNECOLOGY. Abdominal vs. Vaginal Section in Pelvic Surgery Complete Incontinence of Urine . . . . Conservative Treatment of the Piseased, * * * * * * * * * * * * * g º is e PEDIATRICS. Some Preventatives . . . . . . . . . . . 114 NEUROLOGY AND PSYCHIATRY. The Ocular Evidence of Hysteria . . . . 117 Sub-Acute Combined Sclerosis of the Spi- nal Cord, and its Relation to Anemia and Toxemia . . . . . . . . . . . . . . 117 OBSTETRICS. The Relief of Suffering in Obstetrical Practice. . . . . . . . . . . . . . . . . 118 A New Method of Inducing Premature Labor. . . . . . . . . . . . . . . . . . 118 Dry Labor . . . . . . . . . . . y • * * * * * * 119 A Case of Inversion of the Uterus . . . . 119 Breech Presentation . . . . . . . . . . . 119 The Practical Application of Asepsis in Normal Labor . . . . . . . . . . . . . 119 CLINICAL MICRoscopy. Leucocylosis in Labor and the Puerpe- - 1. tº u q e is a s 4 ~ * * * * * * * * * the crowth of the Typhoid Bacilius in the Soil . . . . . . . . . . . . . . . . . 120 *FA WONG T H E J O CIR Nº L S. The American Journal of Insanity . . . . 121 BOOHO NOTIC.E.S. The American Year Book of Medicine and Surgery. Edited by GEORGE M. GOULD, M. D. 122 The Sexual Instinct, by JAMES FOSTER Scott, B.A. (Yale), M. D., C. M. (Edin) 122 Lectures on Appendicitis and Notes on other subjects, by ROBERT T. MORRIS, A. M., M. D. . . . . . . . . . . . . . . 12 Ueber Traumatische Entstehung Innerer Krankheiten. The Traumatic Origin of Internal Disesases, by DR. RICHARD STERN, Breslau. . . . . . . . . . . . . 123 Three Thousand Questions on Medical Subjects. Second edition enlarged. P. Blakiston's Son & Co. . . . . . . . . . 123 Record of Urinary Examinations. ranged by HARRY MORELL, M. D., C. M., Toronto . . . . . . . . . . . . . . . . . 123 International Medical Annual for 1899 . 123 MISC. E. L. L. R. N.Y. Medical Worthies, No. 2, AMBROSE PARE.124 Treatment of Angina Pectoris . . . . . . 125 Foreign Body in the Ear . . . . . . . . . 126 | Mortality Statistics of Havana . . . . . . 126 The Pathogenic Role of Dust . . . . . . 126 To Produce Distaste for Liquors . . . . . 126 gºes-º-º-º-º-º-º-º-º: PHYSICIANS liberal terms. § §§§ºğ NWasonic Term ple Building, tº- WILL FIND OUR STOCK OF INSTRUMENTS, HOSPITAL SUPPLIES, STAPLE PHARMACEUTICAL PREPARATIONS, FINE CHEMICALS, GAUZES, DRESSINGS, Etc., Complete in every department, and Doctors favoring us with their patronage will be supplied at TRADE PRICES and on the most No charge for boxing and cartage. Write us for terms, discounts and freight concessions. Soliciting your favors, we are, Yours very respectfully, CROLIUS, TUCKER & ALLEN CO., Wholesale Physicians’ Supplies and Surgical Instruments, NWINNEAPOLIS, NWINN. The only Exclusive Physicians' Supply House in the Northwest Číð º §§§ i i THE NAEDICAL DIAL. šš §§ ºš Sº *Nº ZN ZN *: On this space. §§ §§ §§ §§ : 3 § Keep | We will show our tº in the next issue. 3. * p > : > r tº p º § # In the meantime write us for our 19th edition $º catalogue, which will be ready for distribution & § about March 15th. It will prove a revelation to §§ # you in electro-therapeutical apparatus. § § Direct, MCINTOSH BATTERY & OPTICAL CO, ; ſ §§ § 521-533 Wabash Ave., CHICAGO. § ić Mention this Journal. > Q * TYREE's ANTiSEPTIc PowdeR ºf The New York Folyclinic, A Monthly Journal of Progressive Medicine and Surgery, edited with the co-operation of the Faculty of the New York Polyclinic Medical School and Hospital, says— l ſ “We believe that, as a rule, leucorrhea is not well treated, therefore we make no apology for alluding to the treatment of so common an affection. . Unless the vaginal flow be of intra-uterine origin, we know of no other means so simple and yet so effectual as the use of Pulv. Anti- septic Comp., Tyree's. It is in every way preferable to all the usual remedies used, many of which stain and are otherwise objectionable. The quality of endorsements given to this preparation are such as to stamp it as an article of unquestionable merit, for the various forms of leucorrhea. Scarcely an article on this subject is being written or discussed in the medical societies but what reference is made to this preparation. Surely this is a commendable sign.” FORMULA—Parts, sod. bor., 50; alumen, 50; ac. carbol, 5; glycerine, 5; the cryst. principles of thyme, 5; eucalyptus, 5; gaultheria, 5; and mentha, 5. Packages containing eight ounces (sufficient to make eight gallons of Standard Antiseptie Solution), 80c., obtainable from C. H. CIR KL-ER, Druggist, and Physicians' Supply House, Minneapolis, and from druggists generally, or direct from this office, carriage prepaid, on receipt of price. ſh J. S. TYREE, Chemist, Washington, D. C. Hº F-T:T-Tº | THE NAEDICAL DIAL. i i i FORMULA: THERAPY: w Each fluid drachm H E N. R Y y S Tonic, Stomachic, Anti-Scor- contains: - butic, Haematinic and Altera- 1-8 gr. Proto-Chloride Iron, T H R E E C H LO R DE S L Iºwa in Anaemias, chloro- 1-128 gr. Bichlor. Mercury, - . g - * g º º _* º * —Liq. Ferri ” s— sis, and as a reconstructive in 1-280 gr. Chloride Arsenic, q. Ferrisenic Henry's convalescence from any cause. Calisaya Alkaloidal. Cordial. Adjuvant to lodides. . THE GLANDULAR STIMULANT MAPKES QUAWT/7"Y AWD — - QUALITY OF BLOOD. 12 ounce bottle, $1.00. and CHALYBEATE TONIC. DOSE—1 or 2 drachms. THERAPY: * FORMUL.A.: In Lymphatic and Visceral H E N R Y ’S Colchicin, 1-20 gr. Disturbances a Uric Acid Sol- gº." grain. vent and a Reliable Eliminant - Solanin, 1-3 gr. in all Diathetic Diseases. T R | O D D E S L Sodium Salicylate, 10 grs. One or two fluid drachms in — i - ’s – Iodic Acid (equal to 7-32 gr: water exercises a synergistic Liq. Sali-iodide Henry's of Iodine in two fluid effect over the entire - - } Anti-Rheumatic drachms of Aromatic Cor- range of the ALTERATIVE, } Anti-Sy. y dial). Salicy ſates and lodides. - 8 ounce bottle, $1.00 In genito-urinary Diseases. MAIZO-LITHIUM. "...º.º.º.º.º. Cystitis, Incipient Diabetes, —with Lithium, resulting in Lithaemia, Urethritis, and all A POSITIVE DIURETIC MAIZENATE LITHIUM. Inflamed Conditions requiring - AND 2 grs. to drachm. Non-Irritati Diureti DOSE—1 to 2 drachms. a Non-Irritat1ng D1uretic. GENITO-URINARY SEDATIVE. 8 ounce bottle, $1.00. Invalid's Dietary on application. HENRY PHARMACAL COMPANY, - Louisville, Ky. gº----~~~~~~~~~~~~~~~~~~~~~~~~~~ gº * ... [. SN 4\" - - NW) * WHEN THE ACTIVE PRINCIPLES § Ä • g g g N} /N are taken from Cod Liver Oil, only the grease remains, and Ö Ä that is of no more value than other grease. W % The virtue of Cod Liver Oil lies in its curative principles, § º which are separable from the grease. These active princi- NW Ä ples (taken from pure, fresh Cod Liver Oil), are employed N) (\ in the manufacture of W (\ : HAGEE'S CORDIAL OF COD LIVER OIL with § %. HYPOPHOSPHITES OF LIME AND SODA. § º Your patients get the grease in the form of palatable food fats. § /N tº a ge º CORD. OL. MORRHUAE COMP. (Hagee) º - % is dispensed in 16-oz. bottles by all druggists. § & Made only by KATHARMON CHEMICAL CO., St. Louis, Mo. º tº 2-2-2-2-2-2-22-222s22s22s22s 2-2-2-2. N Sesºsºsºsºsºsºsºsºsºsºsºsºsºsºsºsºsºsºsºsºsºsºsºsºsºsºsºsºsºsºsºs: iV THE NAEDICAL DIAL. ST, PAUL ARTIFICIAL LIMB HOUSE, 27 E. Seventh Street, INVENTORS AND MANUFACTURERS OF Artificial Limbs. We are positively the only manufac- turer in the Northwest that does not employ soliciting agents. . . . . ESTABLISHED 1877. |§sº | We are the Doctors’ Workmen. We prefer to deal direct with physi- cians, as they know the wants of their patients. i% S. i All Surgical Appliances in the line of Orthopedic work done at reasonable prices, s . iC)W #iº& We respectfully solicit your patronage. JOHN McGUIRE, ''AcopyRIGHTED º * §§ § } MANAGER. sº. sº Telephone 1498-4. Goodyear Rubber Co., JAMES SUYDAM, Manager, 92, 94, 96, 98, too and 102 E. Seventh St., ST. PAUL, MINN. Manufacturers of the GOld Séal Rapid Flow | S|| Best quality bag and tubing; reversible rectal and infant pipes; eye spray; ear and nasal tubes; bent and irrigating vaginal pipes. Sizes: 2, 3 and 4 Quarts. NorthWestern Distributers Of Dr. L. WILHOFT’S (ORIGINAL) LADY'S SYRINGE Made of one piece of soft rubber and constructed on the only correct principle, viz: injection and suc- tion. It is the best vaginal Syringe made. Send for Descriptive Circulars, WE ARE MANUFACTURERS OF High Grade Vehicles FOR PHYSICIANS” Send for Catalogue Showing Different Styles. If requested, we will also send addresses of a large number of well known medical men, who are tº using our work, and also what they say about it. i. H. A. MUCKLE MFG. CO., º Office and Factory at Minnesota Transfer, between the Twin Cities. §§ Kºgº.gººgº.gººgº.gººgº.g à § §§ USE. § § } S 2. §§ 2. W St. Paul, NWinn. i. \\º. THE NAEDICAL DIAL. V A RE PUTATION MAKER! - THE KELLEY HOT AIR and WAPOR BATH - Every physician knows that heat scientifically applied is necessary - - to the successful treatment of a great range of cases. BATH No. 1. The modern method of applying Dry Hot Air or Medicated Vapor to any part of the body. The Absorbent Pad absorbs the moisture during heat exposure which admits of the patient taking much higher temperature than by any other method. The heat is perfectly distributed and regulated within an aluminum cham- ber, flexible, especially adapted to fit any part of the body, either sitting or reclining. The burner (either gas or alcohol) inclosed in heater. Patient always has control of regulated heat up to 400 Fahr. Weight of outfit fifty-one pounds; packed in convenient case for carrying. A Wide Departure from the Expensive, Cumbersome Machines on the Market. One test on a single case of Rheumatism, Gout, Inflamation, Congestion, Neuralgia, Spinal or Joint trouble will convince any physician it is a necessary adjunct to his practice. If it does not double discount any other Method, or prove entirely satisfactory after thirty days' trial, return it in good condition and money refunded. Send for circulars. PRICE, BATH No. 1, COMPLETE, $5.OO SAM E w IT H A R M A N D Leºsºv. Enr, $8.OO st ERILIZING THERMOMETER, $1.OO F. C. B. C. H. CAGO - I. W. KELLEY & Co., 6|| Dearborn Street, CHICAGO, ILL. - BATTNº. 2. BATH No. 1. MEDICAL BOOKS A&P - gº º Ellſ&Kā Mºhillilºſ Published in 1897 and 1898, º º' Mounted on 4-sawed oak Table ſ Pºž Air-receiver of seam- PERTAINING TO DISEASES OF WOMEN. El Cºſº less steel slº 10x80 in. tested to 500 !. º: Byford, H.T.-Manual of Gynecology. Second edition, 12 º |\, º Hi,". mo. 596 pages with 341 illustrations. Net . . . . . . . $3.00 Vºl. Willy" useful and practical ad- Currier. A. T.-The Menopause. 12mo, 309 pages . . . . . 2.00 - º mratus eyer offered !, *Davenport on Diseases of Women-Third edition. 12mo. - §) "A physicians for the -k .. º º º Net . . . . . . . . . . . .f 1.75 *** * S - | T t t Dudley, E. C.—A Treatise on the Principles and Practice o ºs Gynecology. 652 ºji with 422 engravings of which º M § |Bºlā ſº º 47 are colored, and 2 full page plates in colors and mono- º of Chronic Bron- chrome. Net, cloth, $5.00; leather . . . . . . . . . . . . 6.00 '..." *Garrigue, H. J. A. Text-Book of the Diseases of Women. |''''''''''" f Second edition. 357 engravings. Net . . . . . . . . . . 4.00 all Catarrhal air- - A fections of the * Head, Throat and Lungs. *Herman, G. F.—Diseases of Women. A Clinical Guide to Their Diagnosis and Treatment. 8vo, 886 pages, pro- fusely illustrated. Net . . . . . . . . . . . . " ' ". . . . Jones-McNaughton–Diseases of Women and Uterine Thera- eutics. 12mo. 909 pages with 565 illustrations. Net . 4.00 5.00 N Nº. *Pºe º H. A.-Operative Gynecology, 2 vols. 8vo, with N 24 plates and 550 original illustrations. Net . . . . . . 15.00 N N ſº Landau, Leopold—History and Technique of the Vaginal Rad- N Nº E ical Operation. 8vo. Illustrated. Net . . . . . . . . . . 2.00 N N -- *Massey, G. B.-Conservative Gynecology and Electro Thera- N N - peutics. 8vo. 394 pages. Illustrated in black and N N || || Fº colors. Net . . . . . . . . . . . . . . . . . . . . . . . . 3.50 Sº º 5 Martin, F. H.-Fibroid Tumors of the Uterus, 12mo. Net. 1.00 º Nº|| || | N. *Penrose, C. B.-A Text-Book of Diseases of Women. Second N º s. edition. 8vo. 529 pages. 217 illustrations. Net . . . . 3.50 - - *Shield–Clinical Treatise on Diseases of the Breast. 8vo. S tº . º 510 pages. Net . . . . . . . . . . . . . . . . . . . . . 5.00 sº sº - - Skene, A. J. C.—Diseases of Women. Third edition. 8v. Net 5.00 ſº- - - 2. Sutton, J. Bland and Giles, A. E.-The Diseases of Women. | C E. ~. 12mo, 436 pages with 115 illustrations. Net . . . . . . 2.50 #1-s | W. 3 Tait, Lawson-Perineal Operations by W. J. Stewart McKay. º º - 12mo, 69 pages. Illustrated. Net . . . . . . . . . . . 1.00 i º *Webster, J. C.—Diseases of Women, 12mo, 688 pages. Net 3.50 | - *Includes books published in 1898. & Wºo L- - º º Complete List of New Books on Application. Write /or Literature. ºf º E. H. COLEGROVE, Agt, MEDICAL BOOKS, 0, Q. HOLMAN, G8II'l Agt, La Grangº, Ill. 96 Washington St., Chicago, Ill. THE MEDICAL DIAL. mentation. not constipate. * Gray's GlycerineTonic Comp. (Glycerine, Sherry Wine, Gentian, Taraxacum, Phosphoric Acid, Carminatives.) Formula DR. JOHN P. GiFAY. Neutralizes Acidity of the stomach and checks fer- Promotes appetite, increases assimilation and does Indicated in Malnutrition, Anaemia, Melancholia, Nervous Prostration, Phthisis, Bronchitis, Catarrhal Conditions, Convalescence, General Malaise. THE PURDUE FREDERick co., No. 15 Murray Street, New York. The Hollem Portable A- Hygienic Bath. Made on Strictly $333333333333333333333% Scientific Princi. ? •. § 4\ § ples a n d Fully Å § Guaranteed. º f There has never been an accident with our Bath, and one is impossible. With , the he at shut off it becomes a perfect cooling room, avoiding any shock to the sys- tem by contact with the outside cold air. Unlike all other : baths, ours has an 4. adjustable cover, 3e éééesee which can be washed clean each week if desired, thus preventing the gathering of disease germs and microbes. Our strongest testimonials are from the leading Min- neapolis physicians. - - - frº-m-4-dº Free Bath book. Call or address | || !. i º - a. * *: { - t \\ y | | | |\ !||34 3 2 ( THE SINITARY MFG. CO., 406 Phoenix Building, MIN NEAPOLIS, MIN N. THE SANATORIUM. HUDSON, WIS. C sº º ºś #ſºft ºf jº º ** a §: }º & - § $ºf º **ś º § 5: § ſº A. 5 * >,\,'º', }\}_º||º *Sº ſº Jº . . :: *śRºſſ; § º º: §§§ { # ; §§ º ºº::#ffff:ffºliºſińſºlºiſſºil; #. º [...] "A -t: Q-Tºſ. # = ºf - Rºſſ Q #|{{!}{ º #TE:[[ECL): D º | §: s&===xº-ºº::::::::A; :::::::::::::::: - tº- -** AN INSTITUTION FOR THE SCIENTIFIC TREATMENT O F N ON - CONTAGIOUS DISEASE S. gº §§ Every Appliance and Method used which is $3 § recognized in Legitimate Medici including & Sº gnized in Legitimate ed1c1ne, 1ncluding §3. Turkish, Roman, Electric, Medicated and Thermal $3 § Baths—also every form of Electricity, as well as Sº §3 Massage and Swedish Movements, etc. All under §§ § the supervision of Experienced Physicians and § § Trained Nurses. § * * * * - Sº SºśćSºśćSºSºSøSºSºlºškºlºlºsſºsºsºsºsº!! Sº Sºść The institution is delightfully located, with a long, wide veranda, inclosed in the winter season in glass, and is equipped with mod- ern conveniences, as Elevator, Electric Light and Electric Bells, Large Parlors. For terms, address T H E SANATO RI U M. THE MEDICAL DIAL A Monthly Record of Medicine and Surgery. Vol. I. MINNEAPOLIS, MARCH, 1899. No. 4. Orisinal Hrticles. A CLINICAL LECTURE DELIVERED AT THE MINNEAPOLIS CITY HOSPITAL. By J. H. DUNN, M. D. Professor of Genito-Urinary Diseases and of Clinical Surgery in the University of Minnesota. SKIN GRAFTING—DISLOCATION OF SHOULDER. Gentlemen —This case might very profitably serve as a text for a whole morning's study. The young man is now 23 years of age. When four years old he was severely burned upon the right hip and thigh. After 12 years we have this large surface, still unhealed. The ulcerating surface is at present more than two-thirds the original size and presents an area of 40 sq. inches. The fail- ure to heal during this long period, is due to sev- eral causes. Ist, the great difficulty—almost im– possibility of healing such large losses of skin without skin-grafting. 2nd, the foolishness of the patient and his parents in failing to allow a continued, proper management of the case. Such cases are a great trial to all concerned and re- quire great patience and skill, perseveringly fol- lowed. The mother tells me that while the boy was small the father could not bear to have him hurt, and if the child refused to be dressed he would send the doctor away. This large scar Over the opposite trochanter is the result of ulceration from the pressure of long lying uncared for, the bad doctor being kept at a distance by the fond parent. The young man has profited but little by his long and sad experience, for three weeks ago when this surface had been gotten into prime condition for skin-grafting, he ran away on the first mention of an operation, and tramped to Wisconsin to find refuge with an uncle. His relation had the good sense to send him back, and he re-entered a week ago with the ulcer in a filthy, sloughing condition. After a week's treatment with hot antiseptic fomentatives, we have succeeded in getting it fairly clean, but still far from the satisfactory condition which existed before this foolish escapade. 3rd, we learn that the surface has been several times nearly healed— reduced once or twice to the size of a silver dol- lar, but before the healing was complete, the thin, ill-nourished scar tissue would break down or ul- cerate away. This is a very common occurrence in vast scars which have healed with such diffi- culty and chronicity. Before the discovery of skin-grafting and modern management of such vast losses of skin, it was next to impossible to heal them. Of coure the element of infection is always present until the whole surface is well healed. On the advent of any unfavorable con- ditions local or general, the feeble scar tissue melts away before the infection, and this waver- ing advance and retreat in the struggle between the enfeebled cells and the micro-organisms con- tinues. Even should the connective tissue and epidermis completely win the fight and thinly heal the wide area over, there is danger that some slight injury or irritation would give other bacteria entrance to resume the struggle. Hence the importance of healing such large losses of skin as promptly as possible, and with a mini- mum of contracting connective tissue, a result best achieved by skin-grafting. If you will ex- amine this ulcer carefully, you will find the edges bordered by a dense indolent scar tissue with poor circulation, while the ulcer presents an un- even, Warty or papillary appearance in places, very suggestive of a vast ulcerating epithelioma. Indeed these years and decade-long ulcers do not rarely end in malignant degeneration, i.e., carcin- Oma. At this moment I can remember at least four such instances falling under my own ob- servation. Probably the youth of the patient has thus far protected him from this well recognized tendency of the conditions here noted. Now, I think I may say, that it is practically impossible to heal this ulcer so that it will be likely to remain healed, by any measure short of 98 THE NAEDICAL DIAL, operation. Though the principles underlying skin-grafting are few and simple, yet in practice a considerable variety and choice of technique may be employed. The grafting may be large or small, thick or thin ; taken from the patient him- self, donated by another or reclaimed from the amputated member of some other unfortunate; or the epidermis of animals may be employed. Sometimes choice, sometimes necessity decides these matters. Then again the grafts may be ap- plied to the granulating surface, or the surface may be completely scraped, freshened and pre- pared for their reception. These matters are worthy of careful consideration and should be decided upon the merits of each case, because circumstances alter cases. We must confine our attention chiefly to this particular case. With this thick, uneven coat of warty granulation— many places higher than the normal surface— and callous, indolent, poorly vascularized edges, it is perfectly clear that the surface should be thoroughly scraped off to the healthy connective tissue below. This I rapidly do with a large cur- ette, or even with a dull knife blade used as a scraper. I also cut out this callous border which is choking out all thewessels from the adjacent normal skin. The bleeding which is not great, is now checked by applying large compresses wrung out of hot normal salt solution, and left on while we cut the strips of skin. The opposite thigh having been thoroughly cleansed with soap and water, shaved, washed with ether and bandaged with antiseptic gauze, we remove the dressings, re-wash with saline so- lutions, steadying the skin thus with the left hand this razor, ground flat on one side, is taken with the right, and by a rapid sawing movement, strips of skin from 34 to 1% inches wide, and from 2 to 6 inches long, are rapidly stripped off. The blade should not go too deep, first, because thin graftings are quite as good and in general even more likely to take; but second, and more important, if the whole thickness is removed you are largely “robbing Peter to pay Paul,” and a troublesome sore is left on the other leg, while if the skin is simply split, and the bleeding, but not wholly skinned surface be properly treated, no ulcer and its following cicatrix results. There is left a mark—a peculiar scar, if you please, but it is not the contracting, adherent structure with- out glands or hair, such as results from the loss of skin. I have gone a little deeper at some points than I would wish but at no place clear through the skin. If you keep these surfaces clean they will rapidly heal in a few days. These strips have been deposited in a basin of warm normal salt solution, and now comes the most tedious part of the process, viz; to care- fully spread them upon our prepared surface. On removing our compresses, we find the bleeding all checked, and proceed to carefully cover it with the strips of skin, being careful that they are accurately and clearly applied right side up. I find a large blunt needle, aided by a fine pinch forceps, as good instruments as any in adapting these pieces. With the forceps, a strip is laid on the surface, spread out as well as possible, but the thin edges persist in curling under; by a patient sliding back and forth, and hither and thither with the needle, while the nurse plays a very gentle stream of salt solution upon the piece, we soon succeed in spreading out and closely adapting the skin to the raw surface. Having covered the whole surface thus, we next cover it with lattice work of thin strips or rub- ber tissue to hold the grafts in place and to pre- vent the absorbent dressings from sticking to or disturbing them, the inter-spaces allowing any Oozing or discharge to escape into the sterile gauze, which we now apply in several thicknes- ses; over this a rubber bandage is applied, and to Secure further protection and prevent movement, in this case it will be best to apply a light plaster CaSt. r The place from which we removed the skin, is now treated in the same general manner. These dressings will not be disturbed for two days, and then only the outer ones, i.e., down to the rubber protective; those strips are not changed for four or five days. You will also ob- serve that the dressing is wholly sterile, no an- tiseptics being used. (Note:-Nov. 19. We will first dress the case of skin grafting of last Saturday.) These outer dressings have been changed every other day, but the strips of rubber protec- tive have not been changed. There is but very little suppuration and nearly all the grafts have taken well so that the large surface is nearly covered; only at a few points between the strips of transplanted skin a granulating surface may be seen, and this ulcer bids fair to be quite healed in two or three weeks. The place on the oppo- site calf from which the strips were cut, has prac- tically healed without infection and hence with- out pain. The place upon the thigh from which THE MEDICAL DIAL. 99 the rest were removed, has not healed quite so kindly. Here the razor went a little too deep at one point, and the wound has got slightly in- fected, hence it has been a little painful, and there is some secretion of pus. - After the class left last week, we placed the few remaining pieces of skin left over, upon the leg-ulcer of this man. The ulcer was about I in. by 2% inches. It was healing and healing quite rapidly from the edges at the time, hence the strips of skin were placed upon the granulation without scraping. They have, as you observe, grown well and practically healed the ulcer. Some of the class present at my operations at St. Mary’s Hospital last week, will remember the extensive burns which I grafted with skin taken from the leg amputated at the hip joint. That was the case of a woman who was exten- sively burned IO months ago. When she came under my notice two months ago, all the skin on the left thigh from the knee to the hip joint, excepting only a narrower strip I inch wide, was destroyed. The skin of the right thigh was about half as extensively destroyed. Her general con- dition was bad, from months of confinement, suppuration and pain. She had a hectic fever, poor appetite and was depressed. In short, her condition was such that it did not seem best to give an anaesthetic or cut strips of skin from her already much skinned surface. I therefore, kept the vast ulcers in as good a condition as possible and waited an opportunity of getting skin else- where. Last Monday, having to amputate a limb at the hip, skin in abundance presented, and we covered the granulating surfaces, which were not in very good condition, with strips shaved from the amputated member. The result has been most striking. Amid so much infection, of course Imany of the grafts have been destroyed, but vast areas have taken. The right leg will, I think, be almost healed in a couple of weeks. The other leg will be more than half clothed with skin, and the despairing woman has improved in mind, in appetite, and in every way, almost magically, in a week. I mention this case to illustrate some of the varieties of technique in this procedure. 4 Skin-grafting is surely one of the great dis- coveries of modern surgery. A great conven- ience and recourse in smaller losses of skin, it rises to a life saving remedy in such cases as the one just mentioned, where healing is impossible without its aid. The principle was discovered and aplied by Reverdin in 1869, and since then the technique has been amplified and perfected by many surgeons, especially Thiersch. As car- ried out in Our first case, the method is known as Thiersch's. In the Reverdin method little bits of skin lifted with the needle were nipped out with Scissors, or better, with a razor, and applied to the granulations at intervals. The method of the last case mentioned might be termed “mixed.” As I have stated, while the Thiersch method is the ideal one, in practice we find it necessary or convenient to resort to various methods according to the conditions and exi- gencies of the case in hand. CASE II. Here is a young man of 20 who was thrown from a horse five weeks ago, and has pain and loss of function in his left arm and shoulder ever since. As you observe his shoulders, it is at once apparent that the point of the left one is flattened. The left elbow is on a lower plane than the right and stands out from the body. He is unable to elevate the arm to a level with the shoulder. I think you will be able to make a diagnosis from inspection alone. Your reply—“dislocation of the shoulder,” is evidently quite right, but it may be best to confirm appearances by a little pal- pation. We are able to thrust the fingers almost under the acromion and coracoid processes, in- dicating an absence of the head from its normal position. Thrusting them deeply into the axilla and rotating the arm, the head of the humerus may be distinctly felt, dislocated downwards and forwards. We have then a dislocation, of over a months standing. We will give the boy an anaesthetic and see if we can put it in. I have rarely found much dif- ficulty in reducing a recent dislocation of the shoulder. Indeed, I can remember several in- stances, in which, after an anaesthetic was given, gently raising the arm sufficed to reduce the luxation—in two or three instances, quite unin- tentionally. Under complete anaesthesia, proper manipulation practically always succeeds with- out force. However, old dislocations are quite another story. The capsule closes about the bone, adhesions form, and ultimately, changes in the articular surfaces take place, so that replace- ment becomes difficult, if not impossible. As a general rule it is advisable to attempt reduction up to a year or two, after which changes in the socket render most cases of questionable utility, even if successful. I succeeded in reducing a 100 THE MEDICAL DIAL. six months old dislocation in a woman of 70 years last spring. In her case, I promised to make an attempt, with the proviso that I should not use too much or too prolonged force in so old a subject, and hence might not unlikely fail. Fortunately only a moderate amount of force was necessary to break up the firm adhesions and replace the bone, with a decided relief of pain and increase of function in the member. I men- tion this, as I think some physicians incline to over-estimate the difficulties and advise against attempts at reduction in elderly persons, when the reduction might be made with benefit to the patient. Having etherized this patient, we shall loos- en up the adhesions by rotating the humerus. Now elevating the arm forcibly while an assist- ant pushes the head upwards in the axilla, we bring the elbow quickly to the side thus, and the contour of the shoulder is at once restored. We have succeeded much more readily than I should have dared to hope. We will bandage the arm to the side and not allow the elbow to be raised far from the side for two or three weeks until the capsule is well healed. Failure to sufficiently immobilize the joint may be a cause of those cases occasionally observed, in which luxation occurs every time the arm is carried above the head. I have a coachman whose shoulder I have to set three or four times a year, as it nearly al- ways slips out when he unguardedly raises the arm into a certain position. Some years ago I had a patient whose shoulder I have reduced twice in one week, though by great care he was usually able to avoid luxation for two or three 1months at a time. He told me that for ten years it had been slipping out every little while when- ever he chanced to get his arm too high. Our time is up, but I shall continue the dress- ings in the next room and any of you having the time, may come in and observe several instruct- ive cases. Operations are but a small part of surgery after all. Operative technique is of course important, and necessarily the most pre- sentable to the student, but if he learns nothing more, he will not have learned much—only the apex of the great pyramid of surgical knowl- edge, while it is the broad and heavy base that is most needed and most difficult to construct. When the late Henry W. Longfellow was once introduced to a person by the name of Longworth, he wittily remarked that “Worth makes the man, the want of it the fellow.” A CLINICAL LECTURE DELIVERED AT ST. BARNABAS HOSPITAL. By A. W. ABBOTT, M. D. * *-m- Clinical Professor of Diseases of Women, in the University of Minnesota. SINUS FROM INFECTED LIGATURE. This patient is 28 years old. Had one child 7 years ago. Three years ago, had a laparotomy, for some inflammatory condition in the left pel- vis. Following the operation, she states that she had a fever, and that her pulse ranged from 140 to 160 for three weeks. The abdominal wound became infected, and suppurated freely. The 11pper part closed slowly, but the lower end never healed. From this has resulted this fistulous Opening. These abdominal fistulae are the result of na- ture's effort to keep up an avenue of escape for discharges which would be fatal, were they re- tained. They generally traverse some portion of the peritoneal cavity. The walls of the portion passing through or into the peritoneum consist, at first, of adhesive lymph, becoming poorly or- ganized, and finally developing into fibrous tubes of low vitality. Externally, they remain open, if the discharges are profuse or constant. Under Other conditions, they may close temporarily, but frequently reopen, and are a source of great annoyance to the patient. Their inner extremities with, 1st. The cavity of some organ, the bowel, bladder, Fallopian tube, gall bladder, kidney or 111-eter. 2nd. The cavity of a suppurating dermoid or other tumor, or extrauterine foetation. 3rd. An abscess resulting from and adjacent to a deep-seated carcinoma. 4th. A tubular abscess, and, 5th. A foreign substance which lies in a septic cavity; for example, kidney, gall or pan- creatic calculi; enteroliths which have ulcerated may communicate ...through the bowel; gauze, sponge, or instru- ments which have been carlessly left in the abdo men, non-absorbable ligatures, etc. The history of the case, palpation of organs, position of the fistula, character of the discharge, and careful use of the probe, will generally afford a very complete idea of the origin, anatomical relations and pathology of these fistulous tracts, THE NAEDICAL DIAL. 101 and will also indicate the proper line of treat- In e1.ht. If pure bile, is discharged, we know the source. is the gall bladder, or a gall duct; if urine, that the fistula communicates with the kidney, ureter or bladder, and its position will determine which ; if thin, yellow fecal matter, irritating to the skin, that the fistula is in communication with the small intestine above the lower third of the ile- um ; if distinctly fecal, and partly solid, that the bowel lower down is involved; if tubercle bacilli are found in the discharge, that a tubercular cav- ity is at the bottom of the sinus, and so on. The cystoscope and rectal speculum may be import- ant aids to diagnosis, for rarely a fistula may unite the cavities of the bowel and bladder, or the bladder and pelvic abscess, and not have an external Opening, or some of these hidden fis- tulae may complicate an ordinary external sinus. In this case, the history indicates that some- thing was removed from the left pelvis; that sep- sis followed, that at no time was there any fecal Odor or appearance to the discharge. No urine has exuded. The temperature has been general- ly only slightly above normal, except when pre- ceded by pain and followed by an increased dis- charge of pus (not tubercular). A bimanual examination shows that the ute- rus is in fairly good position, but that it is fixed, and that there is a decided thickening on each side of it. This probe passes to the right side, when introduced into the external opening, and I can pass it deep down in the pelvis. I also find another sinus leading down in front and to the right of the bladder. I do not find a passage down into the left pelvis, which was the seat of the Original operation. This need not deter us from expecting to find the source of the trouble On the left side, as we know that these sinuses are Often tortuous and have a course very wide of a straight line. From all these facts, we may be pretty sure that the cause of the fistula’s remain- ing Open, is that there is a piece of infected non- absorbable ligature where the ligation was made. An incision will now be made to enlarge the opening. This we will do very carefully, to avoid injuring the bowel or bladder. It will now ad- mit my finger freely, and I find quite a large pus cavity on the right and covering the uteruš. At the bottom of this cavity is an opening, which will not admit my finger, but through which I can pass this bent probe, which passes behind the uterus, under bowel and adhesions, around to the left side of the pelvis. - I also find another cavity, more in the median line, and just over the bladder. These cavities are lined with a soft, semi-solid substance, filled with little yellow particles, and which, on scrap- ing off, are accompanied with a free oozing. With this dull curette, we will scrape off all of this substance from the walls of both covities, and wash out all the debris. Turning now to the left side, I find a small opening to a sinus, which, as shown by the probe extends directly down into the deep left pelvis. I dilate this opening cautiously, pass my finger to the bottom, and can distinctly feel the knot of a ligature. With a pair of forceps, I reach down and remove this strong silk ligature, which has two loops, and was evidently used to tie off the left broad ligament. As the peritoneal cav- ity was broken into by my finger, I wall off the sinus with iodoform gauze, and carry also two pieces of gauze down to the bottom of the other cavities. The ends are cut off at the margin of the wound. This is covered with sterile gauze and cotton, and the patient bandaged. The gauze drains will be removed and the cavities repacked in three days. Thecavities will probably fill up and the wound heal in ten or twelve days. We were fortunate in finding the ligature so readily. It may often happen that a much more extensive dissection is needed, with careful sep- aration of adhesions, loosening adherent boweſ and omentum with especial provision against soiling the peritoneum. Abscesses from these infected ligatures, at times, though rarely, open into the bowel, and even less commonly, into the bladder. In such cases the closure of these visceral openings is very difficult. Sometimes these sinuses are so numerous, the pelvic organs so matted together and surrounded by pus pockets, that a vaginal hysterectomy is imperative, in order to afford complete drainage. . The following case is an illustration of com- plicated fistula. Mrs. B., age 38, no children, married I5 years. About 6 years ago had Ovaries and tubes removed through an abdominal incis- ion, on account of suppurative inflammation, by a very skillful surgeon. About a year after, he removed the uterus by the vaginia. Some six months after the hysterectomy an abscess formed in the pelvis which discharged in the lower part of the abdominal incession. Soon after a large amount of fecal matter began to pass through the vagina and, later, fecal matter occasionally passed by the abdominal fistula. About a year 102 THE NAEDICAL DIAL. after this the patient was in a desperate condition from partial obstruction of the bowels. I opened the abdomen again and found a sinus leading down to a foul Smelling abscess which communi- cated with the ileum by a small opening. In the abscess were several small pieces of heavy silk, knotted together. The upper end of the va- gina, opened almost directly by another sinus into the sigmoid flexture of the colon. After remov- ing the ligatures and cleaning out the abscess as well as possible, I separated the twisted adherent coils of small intestine which caused the Ob- struction, closed the openings into the ileum and sigmoid with fine cat gut, closed the abdom- inal opening and drained through the vagina. The case did not do well at first. There was extensive suppuration and reopening of the sin- uses. She was however relieved of the obstruc- tion. The bowels acting naturally. The patient has gained about 20 pounds in weight. The ab- dominal sinus has lately closed and the vaginal fistula is so far healed that a very small amount of fecal matter comes that way and only at inter- vals of four or five days. A case which I operated upon two or three days ago is also very instructive. Miss D. 17 years old was operated upon in the northern part of the state a year ago for ap- pendicitis which had gone on to extensive sup- puration. After the operation an abscess formed deep in the loin which the surgeon opened through the original incision. The latter opening never healed and although discharging but a drop or two of thin pus daily could not be made to close by stimulating applications or packing. Her pulse has been for, the last two months from IOO to I2O and her temperature from 99 to 103° F. quite regularly high in the afternoon. She is emaciated and very pale. On opening the abdomen I found at the bottom of the sinus a piece of fine silk about 2 inches long, which I re- moved. On Separating a portion of the bowel which had adhered to the line of the original in- cision I found that the peritoneum was covered with small, hard nodules varying in size from a mustard seed to a pea, some yellowish, but most of them grey and showing the characteristic ap- pearance of tubercular peritonitis, since verified by the microscope. I enlarged the opening ad- mitting the air freely to the peritoneum and then closed with silk worm gut leaving a very small slip of gauze for drain. This was removed on the second day; The union is apparently perfect as far as the sutures were placed ; there is not a CONSERVATISM drop of pus, and I think it would have been as well, if not better, had I left no drain but closed the entire wound. She will be put upon a tea- spoonful of whiskey before each meal and cod liver oil and peptonate of iron after meals with nourishing diet. Before operating upon a fistula, where you sus- pect a ligature is the cause, it is well to see if you cannot fish it out with a small hook like that of a crochet needle. I have several times suc- ceeded in this way. Since cat gut or other absorbable ligatures have been used instead of silk these cases are very much less common than when silk was univer- sally used. Sterile cat gut will never give rise to a fistula. You may also be perfectly sure that if you have used silk and have a fistula following you will never cure it without removing the silk. IN MEDICINE AND ITS EFFECTS UPON THE PRAC- TICE OF TODAY. By J. C. FARMER, M. D., MINNEAPOLIS. The old Orthodox conception of a doctor of medicine was much the same as the orthodox Opinions of most every other occupation or pro- fession which existed during the old puritanic period. That their conservatism colored all things (during the early history of our country) was but natural and consistent with the character and belief of the old colonial ancestors. The physician was a man of secretive methods, a rather mysterious and wonderful being, quite secluded from the public except in a strictly pro- fessional capacity; a very conventional and con- servative man in keeping with the beliefs of the times. - Custom then demanded of the physicians that the compounding and administration of pill or potion was about the only legitimate function they might properly indulge in ; that their sole duty towards the public consisted in the diag- nosis of disease and the administration of the remedy. And, custom decreed that any further services toward the public, in any capacity, not strictly immediate care of the sick,--was com- promising the dignity of the profession. Eti- quette was so strict as to forbid thought or ac- tion along any line not directly pertaining to the sick chamber. To-day the standard of judging the physi- cian's duties has greatly changed, but the effects THE MEDICAL DIAL. 103 of the old customs and practices, to a consider- able extent, still remain. The present laws and customs, forming the etiquette of to-day, still have clinging to them much of the narrowness of the past beliefs. The standard in all things pertaining to the practice and science of medicine has greatly ad- vanced, but like the ghost of the murdered fath- er of the immortal Hamlet, tinctures of former bigotry come stalking back to remind us of the misguided and not forgotten past. To-day the field of usefulness of the physi- cian has been greatly enlarged and extended— his public services as well as private action are not the limited function of the early Puritan doc- tor. The tendency of to-day is expansion, open- ing to the physician a broader field of public use- ..fulness, and placing him in positions of public responsibility and trust never dreamed of by our colonial ancestors. Yet there are many things in practice, it seems to the writer, that the physician has still to eliminate, and new and more favorable condi- tions to be created which will be of inestimable value in giving the profession a standard more in keeping with the important position which the practitioner holds to-day. The conditions do not exist, which, the writer believes are neces- sary, to give the physician the power for public good, which his education and social influence would naturally demand. These needs are of a very practical nature, and refer more to a busi- ness or social relation than to those of a purely professional or scientific character. Practical, in the respect that they demand a more important recognition by the public through their legislative and executive depart- ments. That they demand for the practice of medicine, better protection by the laws of the commonwealth. That they demand of the pro- fession a more united and determined stand against fraud and chicanery as now practiced. These needs are practical in the respect that they demand discrimination by the public be- tween legitimate and illegitimate practice of medicine. They demand protection from the dishonest men and women who rely upon news- paper advertisement for a practice instead of a medical education. Practical in that they demand better compen- sation for honest effort and worth among the legitimate practitioners. The social phase of these necessary condi- tions appears in the respect of closer relation- ship among physicians themselves, and the de- mand which they make for wider acquaintance of doctors in business circles; better knowledge of legislation and executive methods, and the ac- quaintance and friendship with the officials of these offices, who have so frequently duties to- wards the practice of medicine to perform. The lack of these conditions which seem to the writer to be so vitally important to the successful prac- tice of the profession, is but a natural step in the evolution of medical advancement, yet much can be accomplished towards recognition by candid effort to assist the natural plans for improve- Iment. One of the existing conditions which seems pre-eminently fundamental, in the writer's opin- ion, as causing many of the foregoing com- plaints, is that human attribute, selfishness. The past tendency of physicians, to be secretive and mysterious has its appearance in the physician of to-day as independence. It creates the tendency to egotism, and the tendency among practition- ers of keeping aloof from one another. It has begotten uncongeneality and marks the profes- sion to-day as one among the members of which little harmony of thought and action exists. This factor has caused much of the disfavor into which medicine has fallen of late years among some classes of laity. The feelings, the distrust, and the lack of good fellowship existing among many of the members of our profession goes far to cause much of the lack of confidence and dis- trust which characterize the public opinion to- ward medicine at the present time. That undue selfishness is greater in doctors than members of the bar or any other profession or Occupation, is not true, nor have any of the foregoing re- marks intended to convey this meaning, but, that great inharmony and disunion do exist, and the writer wishes to emphasize, in his opinion, this is the chief cause why these unfavorable conditions exist which have so marked an effect upon practice at the present day. This incongruity and lack of harmony among doctors as a class, greatly deters united effort towards improvement in the practice of medi- cine, prevents combined action for better legis- lation, and enactment of laws governing the medical instruction and practice. It handicaps all effectual attempts to inhibit deception and dishonesty of the unscrupulous element of the profession. 104 THE NAEDICAL DIAL. This selfishness and professional jealously permits the most criminal carelessness and inten- tional frauds to be perpetrated upon the public under the disguise of, “doctor.” Men and women who have neither the right nor qualification to incur the responsibilities of a physician, engage openly in active operation as doctors of medicine, and the profession suffers the ignominy and disrepute of the results of such practice. The distrust with which so many of our calling regard their brother practitioners can not but affect the general public's opinion, to the great detriment of the profession. The tendency not to recognize all physicians who have thoroughly qualified and equipped them- selves as brothers and equals (in the opinion of the writer) has been, and is today an unpardon- able offense to the dignity and honor of medi- cine, and will ever be an obstacle, as well as a reproach to the profession of medicine. Intolerance is the mill stone around the neck of the medical profession. The lack of public spirit and enterprise among physicians is an– other important fault of omission, which is di- rectly a detriment and should not exist among a class of men and women whose education and training amply qualify them for thought and action along lines connected with the general welfare of the public. Questions of public health, as well as affairs of city and state which call for logical thought, scientific methods, or reasoning, which every doctor has continually to put in practice, demand solution. The care of our city and county poor, the building of hospitals and asylums, the erec- tion and completion of our own unfinished city hospital should claim the attention and earnest effort of every physician in the city. The local medical publications of our city must rely upon every physician here for their suc- C6-SS. What, then, is the remedy, and the conduct apparent to every true disciple of Esculapius, that these needs may be supplied and our pro- fession have the rank which the importance of its duties to humanity demand for it. In the opinion of the writer not a few exist- ing evils are, as stated, the results of lack of pro- fessional conduct; a lack of interest in the wel- fare and practice of medicine, and neglect in the zeal for its improvement. Let our interest, whether we are of the old school, new School, or what not, be one and the same, inseparable. We have a common sacred duty towards life and humanity which partakes of our Christ charac- ter a degree sufficient to eliminate all dogmas and creeds. - To see but one object in view, the quickest and safest route to health and happiness, To maintain the dignity and honor of our profession. To hold inviolable the professional relation- ships and trusts. To extend to all members of the profession alike the right hand of good fellowship. To recognize in our brother practitioners the right to differences of opinion and not lose sight of the fact that we are all human, therefore we all have that prerogative. t - Our bigotry and intolerance do not consis- tently follow our claims to broad and scientific learning in our professional education, and therefore have no place in our minds. Our conduct between one another must not be the loop hole through which distrust from without finds a foot-hold in the minds of the laity. Every physician must be as diligent in guarding his brother's name and reputation, as lmis own, from public calumny and dishonor. It is by uniting in closer fellowship, and firm- er bonds sf union, and exerting greater zeal for the general welfare of medicine, that the coridi- tions more favorable for progress and advance- ment can be made possible. United effort must exist towards the dis- couragement of fraudulent practice and dishon- esty in medicine, before it can be possible to eliminate it. It is by concerted action alone that we can create the proper opposition to advertis- ing, quackery and the criminal ignorance and incapacity. These blotches of dishonor upon the professional character can not exist, if discoun- tenanced by the profession, unanimously. Thought and action along lines of public health and sanitary administration must always be in the province of the medical man, and the time must come when such affairs will be his rightful prerogative to administer. The time has arrived when our profession should stand behind the present effort to improve legislation in behalf of medical education and practice, and all phy- sicians should be together in their attempt to bring to our state statutes measures which will comprise a much needed law for the welfare of Imedicine. The past has proven the insincerity of the physicians to accomplish the enactment of such needed laws, and now this present attempt should prove the fallacy of the general belief that THE NAEDICAL DIAL. 105 doctors can not stand together for their own good as well as that of the public. - Let us all, then, as devoted disciples of the art and science whose name we are all proud to do homage to, and whose best interest we are ever zealous to defend, give unanimous and hearty support to the measures herein presented, which are necessary for the vital and best inter- est of our honored profession. Let our conduct towards the profession and every member in it, of whatever school, be of that sort of united fellowship which is akin to that sacred comradeship existing between the aged veterans, whose companionship through years of mutual dangers and suffering, has wel- ded inseparably their life long union. And not unlike this devoted comradeship will the beloved and honored profession, through the aid of all powerful science and united army of Esculapian disciples, march on to greater triumphs Over disease. CASE OF CAESAREAN SECTION AND COMPLETE HYSTERECTOMY. By F. A. DUNSMOOR, M. D. Professor of Operative and Clinical Surgery in the Uni- versity of Minnesota. On the evening of Jan. I2th, I was called by a midwife to see a Mrs. F , age 36, in labor at term, (she had two abortions, one three and one six years previous,) the midwife report- ing “that the vagina was blocked by tumors that obstructed the process of labor.” Upon examination, I found the entire lower segment of the uterus a carcinomatous mass, and SO rigid as to prevent even the passing of One finger through the cervix, although the waters had es- caped the night previous. The vaginal tissues were infiltrated, posteriorly to the rectum and anteriorly to the bladder. I sent the patient to Asbury Hospital, and on Friday A. M., Jan. I3th with the assistance of Drs. Dunn and Little, I made the Caesarian section, delivering a living male child in the shortest possible time. We decided, as the mother was hopelessly doomed if the parts were not wholly removed, to proceed to complete extirpation of the uterus and all the parts involved. In order to expedite matters, Dr. Dunn incised an outline in the vagina, going wide of all indurated parts; while, with Dr. Little's assistance, I proceeded to dissect out from above the entire uterus and both broad liga- ments, with the exception of the peritoneal en- velope. Every gland in the neighborhood show- ing the least enlargement was carefully removed. The patient made an uninterrupted recovery and was sent to her home on Washington and Fifth Avenues, South, on the 21st day, the child in perfect health and the mother supplying abun- dant nutrition for it. * The case presents some points of interest, One being that with such extensive cancerous developments, there should have been no dis- turbance of the process of gestation; and second, the question which came up as to the best meth- od of delivery of the child. The method advised by some , to incise the cervix and deliver by for- ceps, we believe, in this case, would have been impossible without such damage to the mother as must have resulted in either rupture of the bladder or such laceration of the adjacent parts, as would probably produce fatal results. Some German operators recommend such division of the cervix and then follow the delivery of the child by vaginal hysterectomy. In our case, it would have seemed impossible to have removed all the diseased tissue through this outlet. In- deed, Dr. Howard Kelly of Baltmore recom- mends the plan we adopted in all cases where the cervix is involved so as to obstruct labor. THE INFLUENCE OF THE SOIL ON DENTAL CARIES. C. Ross (Deutch Zeit. f. Chir. Band».2Iv., Hefte 5 und 6, 1897) has examined the teeth of 2O,OOO recruits, and has noted the influence of drinking water on them. The harder the water, the richer the soil in lime and magnesia, the freer were the teeth from caries; and conversely, the softer the water, the poorer the soil in lime and magnesia, the more liable were the teeth to be invaded by caries.—Am. Year Book of Med. and Sug. 1899, p. 672. INFLUENZA AND DRY FEET. Recently a correspondent, who stated that he was “something of an authority on grip” sent a communication to the Times saying that the only sure way to avoid taking the disease was to keep the feet dry. In corroboration of the point he mentioned that since he had been careful to do this he had not had it, while before observing the precaution he had had it four years in succes- sion, and got it “every time through his feet.” Whereupon another correspondent comes out with the staggering statement that he knows a man “who has had grip five years in succession, and he has two wooden legs.”—Boston Medical and Surgical Journal. 106 THE MEDICAL DIAL. THE MEDICAL DIAL A Monthly Record of Medicine and Surgery. (Entered at Post Office at Minneapolis as Second Class Matter ) Issued on the First of every Month at Minneapolis, Minn. Editor, J. W. MACDONALD, M. D., F. R. C. S. E. Associate. Editor, C. K. BARTLETT, M. D. Business Manager, E. E. GRISWOLD. . . . . COLLABORATORS . . . . . W. ABBOTT, M. D. W. A. HALL, M. D. . P. BARBER, M. D. G. D. HEAD, B. S., M. D. . O. BEAR.D., M. D. KNUT HOEG II, M. D. . W. BELL, M. D. C. H. HUNTER, A. M., M. D. B. CATES, A. M., M. D. W. A. JONES, M. D. . FRANK Corbett, M, D. J. H. RISHMILLER, M. D. . E. CUTTs, B. S., M. D. J. D. SIMPson, M. D. H. DUNN, M. D. J. H. STUART, A. M., M. D. A. DUNSMooR, M. D. H. B. SweBTSER, M. L. DAvid Owen THOMAs, M. D., M. R. C. S. i . The publishers will not be responsible, under any circumstances, for the opinions expressed or statements made º correspondents. Contributors will be furnished, gratis, with sample copies contain- ing their articles, under an agreement to distribute at once to physicians in actual practice. To avoid duplication, publishers should be informed of the field to be covered. Reprints, giving The Medical Dial full credit, may be obtained at actual cost. Annual Subscription, in advance, - - * $1.00 Single Copies, tº-sº tº º * * * tº ... 10 Advertising Rates made known on application. ADDRESS ALI, COMMUNICATIONS TO THE MEDICAL DIAL, MINNEAPOLIS, MINN. MASONIC TEMPLE. MARCH, 1899. THE CASE OF MARTIN vs. COURTNEY. A decision of great importance to the medical profession was rendered January 12th, 1899, by Judge Mitchell of the Supreme Court of Minne- sota. Dr. W. Courtney, of Brainerd, had been found guilty of malpractice and a verdict had been rendered against him in the District Court, Crow Wing County, and a motion for a new trial denied. A patient, who had a suppurating focus in “ the foot” after a severe contusion followed by surgical removal of injured parts, had been al- lowed to go about with the stump protected by a gauze dressing applied outside a collodion ap- plication. As the suppuration continued, and some redness of the parts gave evidence of in- flammatory action about the suppurating focus, amputation was performed of an additional “quarter of an inch” of the foot. This was fol- lowed by sepsis and death. The doctor was sued for malpractice, it be- ing alleged that in the first place the stump was not properly protected when the doctor allowed the patient to walk about on it; and in the sec- ond place that the amputation was made in the inflamed territory and thus led to sepsis. The Supreme Court does not enter upon the merits of the case from a medical standpoint; that is outside its province, the court and the jury having decided that part of the controversy. What the Supreme Court undertakes to do is to pass upon the question, whether the defendant had a proper trial; and it finds he had not. In the first place a Homeopathist was allowed to testify as to the treatment employed by an ad- herent of the rational school of scientific medi- cine, (so-called Allopathist or Regular.) The Supreme Court finds that the inferior court erred in allowing the Homeopathist to ap- pear as an expert to decide upon treatment by a practitioner of another school. To the lay mind nothing seems more rational than the view of the Supreme Court; for otherwise the so-called reg- ulars would be liable to give expert opinions Stigmatizing all treatement by honjeopathists as negligent, and the homeopathists to declare the treatment of other schools faulty. It seems evi- dent that the dispute between the various med- ical Schools is not a legitimate object for adju- dication by the legal courts. The objection, made in this case, that while homeopathists and regulars differed in medical treatment, they were guided by the same principles in surgical cases, and that the homeopathist therefore ought to be allowed to appear as an expert, falls to the ground when it is considered that the distinction between medicine and surgery is entirely arti- ficial, that they naturally overlap each other, and that no single case of localized disease (the spec- ial province of surgery) is without its influence On the general status of the organism. But the Supreme Court also decided that a new trial should have been granted by the infer- ior court because the verdict was not justified by the evidence. The main grounds for the deci- sion seem to have been that the homeopathist had not seen the case; that he gave his opinion based only on the statements made by lay men; furthermore that he was a comparatively young man without any large experience. Upon the other hand the defendant and his associate had been in constant attendance and had from their own daily inspection a good idea of the condition of the injured foot; and there were three other disinterested medical experts who were men of more mature experience, one of whom had seen the case. All these experts in their opinions, acquitted the defendant of the THE NAEDICAL DIAL. 107 charge of malpractice. Here in this case was the evidence of those three or five men of mature experience stood against the one who was com- paratively inexperienced, and who had not even seen the case. The Supreme Court finds that the jury gave a verdict against the preponderating evidence of the experts, and that it was error to deny a new trial. This part of the decision seems to be of great importance, and the more so to those who from personal experience know something about the inner history of most malpractice suits. Phys- icians are not apt to commit malpractice; they may, like other people, be careless, and “trust to luck” a little too much ; but gener- ally, when they treat a case, do what in their judgment is the best, for their personal interests are identical with those of the patient. The state (Minnesota) by giving them a license to practice after an examination conducted by its own agents stamped them, each one individually, as fit to practice medicine in all its branches, as far as knowledge and technical skill is concerned. Is there under such circum- stances any reason for allowing a single man's testimony to outweigh the testimony of the main body of the local profession? Malpractice suits are usually brought about by people who want to get some of a doctor's money, not because he has injured them in a pecuniary way, but because they think they can get the money under the form of law. Some- times they are instigated by other doctors, who in this way try to besmirch the reputations of dangerous competitors. It is usually not difficult in any community to find some young man who is willing to appear as the champion of the com- mon people against the trade interest of the pro- fessional labor union ; it gives him a certain pro- fessional and social prestige. It is against this class of experts that Judge Mitchell's able Opin- ion is directed. Well may he say that if a man can be found guilty of malpractice upon such evidence it would be unsafe to practice medicine or -surgery. We are glad that the old Pennsylvania doc- trine that it takes thirteen men to steal a farm, is expanded in Minnesota; the process has to be approved by our Supreme Court. “There are so many perils between the cradle and grave that it is a wonder that a man ever gets from one to the other,” said an Irishman. THE PASSING OF THE HORSE ASA SAN- ITARY ADVANTAGE TO OVR CITIES. The Commissioner of Police in London, Sir Edward Bradford, in commenting on the increase of motor carriages, as reported in Public Health, sees in that change a solution of the problem of congestion to street travel, and by the diminu- tion of the number of horses a sanitary advantage of no small account. As motor carriages occupy only one half the space of wagons drawn by horses the great relief they would afford for the crowded Streets of traffic is apparent; and the ease and promptness with which they can be con- trolled are advantages not to be overlooked or underrated, not to mention the accidents that may be escaped from runaway teams and excited animals. º But the sanitary advantages will not be all derived from the mere absence of the animals for traction; with electric or compressed air forces at command, we can have smooth clean streets, free from dust and foul odors, now, too much given up to filth and all kinds of litter scattered broadcast and in profusion. If in addition to the removal of the dumb animals the active “spitter” could be eliminated, still better conditions for health and comfort would be secured. It is not impossible that an ideal city might be realized— where the noise of wheels, the clattering of the iron shod feet of horses, the clanging of bells, the useless shouting of drivers and venders of mer- chandise, the abuse of overloaded and otherwise ill-treated animals are absent, and automobiles and bicycles are the means of locomotion for business or pleasure. Such a city might seem dead to a bustling, noise-loving person; but when thoroughly investigated and understood the quiet might be found not on account, neces- sarily, of lack of business, as the grandest forces of nature are silent in their processes and accom- plish their results at their appointed times. A city of this character would afford an earthly par- adise for the sick, the sleepless business man, the delicate, highly organized, intellectual worker, and the exhausted nervous woman. The passing of the horse; yes let him leave the city; but his usefulness will not then end. In the country, with more freedom and harmless as to sanitary conditions in his surroundings, he will still command our respect for his beauty and strength, and for his intelligence and assistance in contributing to our work or our recreating pleasures. 108 DIAL. THE NAEDICAL Prosress Of II?&dicine. - MEDICINE. UN DER THE CHARGE OF J. W. BELL, M. D., C. H. HUNTER, A. M., M. D J. H. STUART, A. M., M. D. DAVID Owen THOMAs, M. D., M. R. C. S. DIABETES MELLITUS. Diabetes Mellitus in children and young adults as a rule pursues a rapidly fatal course. Any plan of treatment is unsatisfactory and futile in the majority of cases. But in elderly people the disease is less acute and more amenable to treatment. Even if a cure is impossible, it may be possible to modify the severity of the disease and prolong the life of the patient. This is ac- complished more often by dieting than by med- ical remedies alone. In my experience the exclusive use of nitrogneous food for four or five weeks accompanied with small doses of alcohol, or sometimes without it, has given the best re- sult. During this period all carbohydrates are carefully withheld, and under this treatment urinalysis shows that the sugar reaction disap- pears or is reduced to a trace. A tolerably robust patient can be encouraged to pursue this treat- ment, and will not suffer any ill effects from it. When the exclusively nitrogenous plan is aban- doned, the patient is allowed to fall back grad- ually on a modified diet, containing as little starchy food as possible. In course of a few months if the specific gravity of the urine and percentage of sugar become extreme the patient again returns to a course of absolutely nitrogen- ous food. Should any complication arise requir- ing a surgical operation, it would be advisable to keep a diabetic patient on an exclusively meat diet for three or four weeks before any surgical Operation is undertaken. In emphasizing the utility of the diet treatment I do not oppose the use of any medical remedies indicated, such as Carlsbad salts, mineral waters, pancreatic ex- tracts, codein, etc. But in my opinion they hold a secondary place and should be administered symptomatically. T. THE TREATMENT OF CONSUMPTION. In discussing the treatment of consumption (phthisis) from the standpoint which aims to be fully in accord with the most advanced teaching, it is of the utmost importance to keep in mind at least two fundamental considerations; (1) An early diagnosis or a recognition of the signs that indicate the first deviation from the standard of health, and (2) the physical condition of the pa- tient together with his environment. An early appreciation of the patient's peril cannot be too strongly insisted upon, because the golden period for rendering effectual aid will most likely have been passed when the disease has so far progressed that he feels the manifest discomforts of its inroads, and when his friends take the alarm. Both the laity and the profes- sion should be educated to more alertness in Imarking the signs of its insidious beginnings. It is not sufficient to be satisfied to wait until the educated ear by skillful percussion is able to detect areas of thickening and consolidation to say nothing of small cavities or by means of the stethoscope to detect the catchy respiration or the mucous click. We must note the failing appetite, the imperfect digestion, the mal-assim- ilation, the slight hack or two in lying down at night, which is apt to ante-date the morning cough, the condition of the skin, the feel of the Imuscles and other tissues, the conformation of the chest or thorax, the catarrhal phenomena, the diminished elasticity and vigor and loss of energy; which things on being once noted are easily observed by the friends if not by the pa- tient himself. Signs such as are here mentioned, and these are not all, Occrring in an individual with omi- nous family connections or associations or her- dity are of enough significance to require that the patient put himself or be placed under the examination and observation of a physician who appreciates their import. This regime is very different from that which Inow commonly prevails under which the patient does not seek the physician's advice until his cough has perhaps become an annoyance to him- self or to his friends, or until he feels he can no longer discharge his accustomed duties. Now briefly concerning the pathology of this initial stage: It is not the purpose here to con- sider at length the so-called “tubercular dia- thesis” or the “inherited tendencies” or the “ready soil,” of the existence of which there is no lack of clinical evidence and from which the dis- covery of the bacilli has unfortunately somewhat diverted attention. But it shall suffice to call attention to what has been appropriately called the “pretubercular stage” of consumption. “Tuberculosis is always produced by the bacilli, but all phthisis is not tu- bercular in all its stages.” “Tuberculosis is an incident in the course of the disease and not the primary cause of pulmonary phthisis.” “The tubercle bacilli may be found in the air passages of perfectly healthy individuals. It is not com- monly found until after considerable organic change has taken place in the pulmonary struc- ture. . It (the bacillus) cannot then be rightly considered as the cause of phthisis” (McLean in Jour. Am. Med., February, '98.) Jaccoud says: “Multiple and varied elements are the true cause of the disease. The microbe is only the incidental agent.” Barton says: “Back of the bacillus are causes which are operating to produce mal-nutrition and a lowered vitality.” THE MEDICAL DIAL. 109 Jacobus says: “The tubercle bacillus never attacks healthy tissues.” The following are a few sentences from Nie- meyer written before the discovery of the tub. bacillus. They were written from the standpoint of the clinician and it is notable how they accord with the sentences above quoted. “The greatest danger” says Niemeyer, “for the majority of consumptives is that they are apt to become tuberculous.” “The majority of the cases of consumption are not the result of neo- plasm (the bacilli?) but of inflammation, and when tuberculosis exists it is almost always pre- ceeded by a pneumonic process which prepared the soil for the growth of tubercle.” In cropous pneumonia such result is rare. In chronic catarrhal it is almost the rule” He believed the “tubercle” to be a caseous metamor- phosis of the pneumonic product.” In the light of the discovery of the tubercle bacillus the above author's pathology has been set aside as antiquated, but it will be observed how clinically correct it is in the judgement of good clinicians and pathologists of this day. The trouble has been that the discovery of the mi- crobe has diverted the attention from most im- portant phenomena connected with the clinical history of this disease. I say important because of their relation to the wise and successful man- agement of the patient. Unless the trend of the discussion of this subject, the acknowledged inability of drugs and the results of successful treatment by later and more rational methods are misleading, the cor- rectness of the views here quoted will become generally acknowledged. As to the use of drug medication in this dis- ease little need be said here beyond the statement that by far the greater part of it is not only value- less, but that much of it is positively harmful; and further, that of the few drugs that continue in use, under which the patient seems to do well, it may be questioned whether the improvement is not in spite of them. - It has been no doubt truthfully said “when lodgment of bacilli is found in tissues no drug however administered can reach or destroy them. It can only counteract (in a measure) their tox- ins and increase resisting power of tissues against encroachments.” The thing to be at- tacked is not so much the lesion in the lung di- rectly as the lowered vitality of the body and the difficiencies of appetite, and drugs directed to a conquering of the bacillus in situ are not to be compared with measures which enable the or- ganism itself to acquire strength to overcome the disease” (C. L. Minor, N. Y. Med. Jöur. I-I4–99.) As to the real value belonging to serum med- ication, before it can be accurately determined we must have further data. It may be authoritatively stated that advan- ced cases of tuberculosis of the lungs are almost in every instance irremediable under any circum- Stan CeS. . . . . . . That even in the incipient stages, the patient remaining in the same environment, regime and habits, there will be no improvement of conse- quence where reliance is placed solely in drug medication, and no permanent improvement even under good hygienic management. - But there is abundant evidence, and it is rap- idly accumulating that consumption is curable under proper management. This subject will re- ceive further consideration in next issue of the Dial. J. H. S. THE STOMACH TUBE. The closing years of the nineteenth century witness an increasing interest in the study, inves- tigation and treatment of diseases of the stomach. Herschell in an able address before the British Medical Association (British Med. Journal, Oct. 29th, 1898,) reviews the subject of gastric the- rapy, emphasizing the efficiency especially of lavage, massage, and electricity. As to the relative merits of lavage, massage and electricity, much difference of opinion ex- ists in the minds of medical men. Gastric lavage in the form of the improved douche and spray is fast emerging from the just oblivion into which it was plunged by reckless and indiscriminate use. In the judgment of the writer, the stomach tube should never be used until after an accurate his- tory of the case has been secured and a careful examination made. The more important contra-indications are as follows: Ist. Advanced cardiac disease. 2nd. Aneurism of the larger arteries. 3rd. Advanced pulmonary tuberculosis or pulmonary disease of any form. 4th. Apoplexy and cerebral hyperemia. 5th. Advanced cachectic states. 6th. Recent hemorrhages of all kinds. 7th. Gastric ulcer with recent hematemesis. 8th. Advanced gastric carcinoma with vom- iting of blood. - 9th. Stomach or intestinal acute fever. Ioth. Pregnancy, as a rule. The more important indications for the use of the tube are briefly as follows. - Ist. For diagnostic purposes. - 2nd. Where the exit of the chyme from the stomach is hindered or retarded from either me— chanical obstruction or muscular insufficiency. 3rd. For the removal of foreign or irritating collections interfering with digestion. The above should not be considered inflex- ible rules, much depending on the individual judgment of the physician. J. W. B. troubles with POSITION OF PATIENTS AFTER FEED- ING. After meals patients, if bedfast, or, if feeble, should be directed to lie on the right side, turned well to-wards the front, with the limbs extended and then to take deep and slow inspirations. This 110 THE NAEDICAL DIAL. to facilitate the flow of the food as rapidly as may be through the pylorus into the intestine where the digestion and absorption is for the most part to take place. The tension of the abdominal muscles and the forcible movements of the dia- phragm bring about the prompt onward move- 1Tlent. It is reasonable to expect that the proper Order is that the process of digestion follow the intaking of food as promptly as possible, for this is the natural stimulus of all the agencies in the process and there should be no disappointment or halting by allowing the food to “puddle” in the stomach as it is liable to do if feeding is followed by a quiet decubitus without any aid to its es- cape from the pouch of the stomach except the action of its muscular fibres which in a weakened or dilated condition must be more or less inef- fectual. In this way I have no doubt is brought about bad conditions of the stomach and a rise of temperature especially in Typhoids from a kind of auto-infection. If any one doubts the force of this suggestion let him, after partaking of a full meal assume this position, breath as above and drop to sleep for not to exceed fifteen minutes, and then rise up to wonder where the “full feeling” has gone. J. H. S. DIPHTHERIA AND ANTITOXIN. The adversaries of antitoxin have tried to make it responsible for diptheritic paralysis, with out any reason. It is true that there are many cases of paralysis occuring in children previously treated with antitoxin but it has always appeared to me that the number was swelled by some of those who would have succumbed without anti- toxin long before the period of paralysis was due. Apparently mild cases of diphtheria are followed by paralysis; it is certainly true that many a case is changed into a mild one by antitoxin. It is after all better to have a paralytic child with the great probability of a final recovery than a corpse without even a chance of paralysis. Moreover, I cannot imagine a more difficult task than to calculate statistics on totally absent bases. The average number of paralyses varies according to the cases, the severity of the epidemics, and prob- ably to the treatment also. And finally, large numbers of cases, like those of Baginsky, appear to prove the contrary of what has been alleged. Among 993 patients before serum therapy was introduced there were 68 cases of paralysis, or 6.8 per cent. ; among 525 in the antitoxin period there were 27, or 5.14 per cent. Schmidt Rim- pler feels certain that his patients with accom- modation paralysis recovered more speedily under the use of antitoxin than without it. Sudden deaths have occured after the injec- tion of anti-toxin,the dose being in Some instances quite small. The case of the Langernans child in Berlin, who died after having received an in- jection of antitoxin, is not explained in spite or because of loud vituperations and vilifications. Most reporters of cases have been satisfied with admitting they know of no explanation. Berlin publishes one of the latest cases, and admits that death cannot positively be attributed to the in- fluence of the serum. Nifong (Medical Review, May 7th, 1898,) gave a boy of fifteen years, of slight build and with feeble circulation, fifteen hundred units. After ten minutes there were pal- lor, numbness of the extremities, cyanosis, Swel- ling of the face, and vomiting. Death occured in thirty-five minutes. Two girls received the same dose of the same serum from the city chem- ist of St. Louis without a bad result. Rauschenbusch observed on his four-year-old daughter, who had taken three times the dose while sick with diphtheria two years previously, pruritus, urticaria, vomiting, Sopor, and heart failure after two hundred units injected for the purpose of immunization. It does not appear that a connection between heart failure and sud- den death on the one hand and antitoxin on the other has been established in any case, and ven- tureSome and generalizing speculations are not able to shed light on obscure subjects. At all events, a single finding, a suggestion, Or a sus- picion of vomiting and aspiration of a solid body into the air passages, or of the injection of air into a vein, or excitement and fright, or a lym- phatic State, or a large thymus, if at all applic- able to an individual case, does not permit of a universal interpretation. After all, we can well agree with the conclus- ions of Dieudonne when he says that the treat- ment of diphtheria with serum is an essential ad- vance in theapeutics, that its effect is more fre- quently favorable than that of former methods, and that accessory consequences do not out- weigh the useful effects. H. Biggs recapitulates many of his previous writings in a paper read before the Society of the Alumni of Bellevue Hospital, as follows: “Since the introduction of antitoxin treatment the mor- tality of diphtheria is reduced to one-half, its course is shorter and milder; an injection made within the first two days reduces the mortality to five per cent. ; the earlier it is made the bet- ter the result. Small quantities of concentrated serum are tolerated by the very youngest babies. If antitoxin is not a specific it is certainly the best remedy in our possession against diphtheria. The genuine (that is, uncomplicated bacillary) cases are more amenable to its favorable influ- ence than mixed infections. It has no secondary effects on heart, kidneys, or nerves. Heart fail- ure and paralysis whenever observed are caused by diphtheria, not by antitoxin.”—Twentieth Céntury Practice, Vol. XVI, P. 116. Advice lately given to a class of newly made doctors —“Take as greeting for your future, this four-square rule in your life of service—I, clean living ; 2, just thinking; 3, hard work; and lastly, carefully weighed, straightly dealt, when there is need of it, English from the shoulder. —Clin. Rev. THE NAEDICAL DIAL. 111 SURGERY. UNDER THE CHARGE OF J. H. DUNN, M. D., W. A. HALL, M. D. KNUT HOEGH, M. D. THE MURPHY BUTTON AT HEIDEL- BERG. - M. Jordan reports (Gaz des Hop., Paris, 29th Oct., '98) that in Czerny’s clinic at Heidelberg, recourse was had to the Murphy button on every possible occasion. In recent years they had abandoned the button when dealing with the large intestine, but in other cases they had used the button on more than IOO cases without a Single disaster. The button may be passed as early as the 7th or 8th day, but more often as late as the third week. TREATMENT OF FRACTURES BY WEIGHT EXTENSION. Bardenhauer (Centralbl. f. Chir. Leipzig— No. 46, '98) maintains that the weights employed for extensions in fracture are usually insufficient. He recommends 30 pounds for the femur, 15 to 2O for the leg and I5 for the maleoli. In the lat- ter he rejects the stirrup and applies a plaster Over the maleolar projections, claiming that this keeps the foot in better position. He lays great weight upon the necessity for carrying the plaster far above the fracture; for fractures below the knee, he applies them up to the middle of the thigh, and for fractures of the femur, they are to extend to the trochanters. He also applies ad- ditional strips encircling the limb at right angles to the usual longitudinal strips. The sooner after fracturing, the extension is applied, the bet- ter the results. In 1837 fractures treated during the five years past at the Cologne City Hospital, there was no case of non-union. He claims that by the proper use of extension the amount of calus is lessened, and passive movements of the joint are carried on more freely. Of IO6 frac- tures of the maleoli, 75 per cent were able to return to work within 13 weeks. In 61 fractures of the 1eg, 60 per cent were fit for work within a like period. - - CATHERIZATION OF THE URETERS, Was leisted der Ureterkatheterismus der Nierenchurirgie? Under this caption J. Israel, in the “Berliner Klin. Wochenschr, no. 2, 1899,” contributes a long and interesting critique on the extreme claims of the diagnostic and therapeutic value of urethral catheterization as advocated by Caspar. Very briefly summarized, he concludes: First; catherization of the ureter alone can not answer the weighty question—what will be the degree of functional power in the remaining kidney after nephrectomy? Second ; The demonstration by this method, of disease in the second kidney, is not necessarily sufficient to contra indicate nephrectomy. Third ; The absence of abnormal composition in the sample of urine taken from the second kid- ney proves nothing for its soundness; gives no guarantee for its sufficient functional ability to withstand nephrectomy. Fourth ; Neither the health nor disease of a kidney in the anatomical sense may be demon- strated in every case with certainty by catheriza- tion of the ureters. - Fifth : The demonstration of the normal or of the abnormal composition of a specimen of urine drawn by ureteral catherization is not suf- ficient proof of the competent or incompetent functional power of the second kidney after neph- 1ectomy. Sixth ; Sounding of the ureters gives no con- clusive proof as to the presence or nature of the obstruction. - • Seventh ; In the specimen of urine drawn by Catherization of the ureters, it is not clear whether blood corpuscles come from the kidney or from injury to the ureter. Eighth ; Neither catheterization of the ure- ters nor of the renal pelves, are free from the dan– gers of infection. It has always seemed to the writer that it is safer for the practitioner to know less, than to know so much that is not so. I have always been inclined to believe that the extremists who would reduce renal surgery to an exact science by means of the urethral catheter, are on the whole, about as liable to fall down as the clinician who depends more on careful observation and his de- ductive reasoning, and less upon collecting and examining the two "urines.” Of course in ex- ceptional cases urethral catheterization is un- doubtedly very useful, but it is far from being a certain road to infallible diagnosis, and one often more attractive as a feat of skill than beneficial to the patient. J., H D. EXTERNAL URETHROTOMY. Hayden, (Am. Jour. Med. Sciences, Feb., 1899,) contributes an article on external urethro- tomy. The author holds that such conditions as re- currence of the stricture, perineal abscess or fis– tula and uncured urethro-cystitis, are not uncom- monly observed after this operation, and can in great measure be avoided by carefully following out certain details of technique in operation and after care, among which the following appear to be the chief: Ist, by dividing all the stricture, inot only on the floor, but also on the roof of the canal. 2nd, by digital dilation of the posterior urethra to prevent post operative tenesmus, and giving the prostate and bladder a much needed rest. 3rd. A proper drainage of the bladder by a large soft rubber perineal tube accurately placed so as to perfectly drain the bladder, and secured by silk suture through the tube and both edges of 112 THE MEDICAL DIAL. the wound, the latter being lightly packed around with gauze and the suture tied over it. The blad- der is then irrigated and partly filled with warm boric acid solution, and the tube clamped, until the patient is put to bed when it is connected with the usual syphon apparatus. The receptacle is to be placed only slightly lower than the blad- der, that undue suction on the tube may not ir– ritate the bladder. In two to four days the tube is taken out, washed and replaced, and removed permanently on the 5th to the 7th day, after which the patient is allowed to be up and about, passing the urine by both wound and meatus, pressing a pad of gauze against the wound as he does so. In the majority of cases all the urine passes by the urethra in a week after removing the tube. 4th, proper post operative dilatation. When the tube is removed on the second to fourth day, a medium sized sound is passed to the bladder and held for a minute. This is repeated every second or third day until the perineal wound is cicatrized, and the urethra takes a 28 or 3o French sound, with ease. Then the interval may be made longer. The perineal wound should be inspected daily in a good light, and made to heal solidly from the bottom and not to bridge over in places. This may be prevented by running the finger through the wound from end to end. Lastly when the wound is properly healed, the patient must be made to understand that his stricture is not cured, but that he must continue to have sounds passed at long intervals for the remainder of his life. Also that he must not stop bladder or urethral medication until the urethra is normal, and the urine practically free from tissue elements. THE AFTER TREATMENT OF GASTROS- - TOMY. R. H. Lucy, (Edinb. Med. Jour., Jan., '99.) contributes a brief paper upon the after treatment of cases of gastrostomy. The author states that the essentials in any method of establishing a permanent opening in the stomach, are: first, the operation should be simple and capable of rapid performance; second, the resulting fistula should be a long one, and preferably, take an angular course; third, it should pass through muscular fibre capable of a sphincter like action. He thinks this best fulfilled by Albert's operation. Fourth, most patients submit themselves for gas- trostomy, only when reduced in strength from starvation and toxaemia, hence the main indica- tion in after treatment is to apply, Ist, fluids for working the vascular system, kidneys and bowels. 2nd, stimulants. 3rd, food. The gastric functions having been long in abeyance, fluids predigested must be given, frequently, and in small quantities at first. During the first 24 hours, 5 oz. of peptonized milk, IOO Fahr. and % oz. brandy may be given every three hours. If thirst be urgent, an enema of a pint of tepid water may be given by syphon tube. On the second day, provided there is no vomiting, IO Oz. of peptonized milk and water—equal parts, may be given at similar intervals. As cough and te- nacious phlegm trouble the patient and prevent sleep in nearly all cases (a true “stomach cough”) especially in those whose stricture is high up, a 5 minum dose of nepenthe or laudanum should be included in the evening feed, and acts like a charm. On the third day, dilute hot broth may be alternated with milk. On the 4th day milk half peptonized and half plain may be used, giv- ing the gastric function a chance of resuming work. If any discomfort ensues, the former may be gradually replaced by the latter. Pepper and salt should be added to all foods to stimulate di- gestion. Benjor's food, thin gruel, beaten up eggs, and various farinaceous preparation may be added, and when the large sized tubes come to be worn, minced meat and vegetables may be passed down a large bore glass funnel by aid of a glass rod Or plunger, at least once a day, with Or without previous mastication by the patient. The bowels are relieved at first by simple or tur- pentine enema, and later by an aperient, given with the evening food. Any attempt to swallow, even liquids, should be forbidden. If the fistula rapidly enlarges and requires constant increase in the size of the tubes, leaving it out between meals allows of a rapid diminution. J. H. D. GYNECOLOGY. UNDER THE CHARGE OF A. W. ABBOTT, M. D., F. A. DUNSMOOR, M. D. J. H. RISHMILLER, M. D ABDOMINAL VERSUS VAGINAL SEC. TION IN PELVIC SURGERY. Joseph Price (Am. Gyn. and Obst. Jour. Vol. XIII No. VI.) staunchly promulgates abdominal coeliotomy and as vigorously condemns vaginal section with a ring of dogmatic prejudice. The Operators who oppose the vaginal route are in- fluenced by the logic of their experience and by purely surgical and pathological reasons. The Supra-pubic is the operation of their choice be- cause it affords more satisfactory results, is fol- lowed by less dangerous or annoying sequelae and lessens the risk of repeated operations. The difference between the advocates of the abdominal method and those who criticize it, is that the advo- cate of the supra-pubic route speaks according to his knowledge and experience, while the critic according to his failures and prejudices. The one has uniform success, the other humiliating fail- ures. The author states that the successful op- erators, American, English and German have practiced both methods for years adopting the Supra-pubic for tubal and ovarian diseases and the vaginal for malignancy. We are slow to abandon a procedure which we have found to be safe, and strongly indisposed to believe that there is a better way. An opera- THE MEDICAL DIAL. 113 tor cannot lay down dogmatically any procedure from which he ought not to depart. The most skillful operator never knows until he enters the abdomen the exact and entire condition which he will encounter. When signs and symptoms are not positive the supra-pubic route is the safest. The fault, with imperfect and incomplete sur- gery by the abdominal route, lies not in the pro- cedure but in the operator. Whatever the pro- cedure, the lack of discreet courage and sound surgical judgment is responsible for many fail- ures. Complications inoperable from above make them likewise from below. Pathological condi- tions are easier removed from above because the structures are clearly defined by palpation and sight. The operation can be made with mathe- matical certainty in its limits and it enables the operator to free omental and intestinal adhesions and repair all disorganized parts. The most disappointing post-operative symp- tom is the pain due to the leaving of omental and intestinal adhesions. Badly selected ligating ma- terial has been responsible for much post-opera- tive sequelae. Ligating with coarse and heavy ligatures makes insecure work. It is difficult to tie a surgical knot tightly and securely with coarse material and such ligation often is followed by hemorrhage. Commercial articles are never safe and the operator should prepare his own suturing material. He claims that it is meddlesome and dan- gerous surgery to extirpate a septic uterus. Like- wise he is amazed to observe experienced sur- geons deliberately extirpate the little healthy ut- erus and pass by pathological lesions and compli- cations constituting the real and only source of trouble. “In presence of chronic disease of the appendages he was a wise man who refrained from active interference with the uterus.”—Ban- tock. Prominent operators by the vaginal route urge the removal of the uterus because of its numerous lesions; this is an error, the lesions are commonly found to be of viscera and surrounding organs. In ectopic gestation the fruit Sac is fre- quently found adherent to the uterus but is easily stripped from it by the abdominal route and 1eaves a healthy uterus. In extra-uterine preg- nancy therefore the removal of the offending side leaves a healthy child-bearing woman. - J. H. R. COMPLETE INCONTINENCE OF URINE. L. Grant Baldwin, Brooklyn (Am. Gyn. and Obst. Jour. Vol. XIV, No. II.) reports some unique cases with gratifying results. The class of cases which he considers are those due to in- jury to the anterior vaginal wall causing a pro- lapse of the upper one third of the urethra and to a certain degree the neck of the bladder. In his cases the urethra was not dilated and he states incontinence does not follow as long as the ure- thra was not loosened from its fascial attach- ments. The author believed that the muscular coats of the bladder and urethra in incontinence are less involved than their fascial attachments. Patients with the least demonstrable lesion of the urethra and bladder will suffer often times more from incontinence than others with extensive la- cerations. He cites, as causes, child-birth and Ob- stinate constipation. As the head passes into the true pelvis the anterior lip of the cervix can be pushed up over the occiput and later, as the head comes down to the pelvic floor, it can be carried up behind the symphysis pubis. . If this point would be observed fewer cases of cystocele and urethrocele with partial or complete incontinence of urine would come under the gynaecologist's, observation. «'. Case I —Mrs. H., aged 64 years, four chil- dren, youngest 20 years old, no miscarriages; menopause at 46. Labors had been normal. Pa- tient had been suffering from incontinence of urine when on her feet for the past six years. In the sitting position she had partial control. Bowels regular. Urine normal. Upon close ex- amination of the urethra it was found to be pro- lapsed at its upper third. A small and short Emmet hard-rubber pessary gave immediate and permanent relief. The author is unable to explain why the incontinence should date back only six years—her period of widowhood—in- stead of 20 or more years to the birth of One of her children. - Case 2.—Miss X (sister of charity), aged 30 years. Obstinate constipation had existed from childhood, and she would sometimes pass a week without having a movement of the bowels. She had no control over her urine either sitting or standing and only to a certain extent when in bed. On rising in the morning she had to empty lmer bladder at once, or else the urine escaped until the bladder was completely empty. The uterus was found to be of normal size and in proper position. Urine normal. The author states that “The urethra was torn from its moor- ings back of and underneath the arch of the pubis.” Her constant worrying over her distress- ing condition had made severe inroads on her general health. The writer tried an Emmet pes- sary as in Case One, but of no avail. During the succeeding two months he tried various mod- ifications of the ordinary pessaries without ben- efit. Finally he tried a round ball of the ordinary white rubber—purchased from the toy store, which afforded complete relief. Afterwards he substituted one made of pure rubber. They were 134 inches in diameter, and the patient has worn the last unconsciously and with perfect relief for the past six months. J. H. Rishmiller. CONSERVATIVE TREATMENT OF THE DISEASED OVARY. J. T. Johnson, Washington, D. C. (Am. Gyn. and Obst. Jour., vol. XIV, No. 1), presents a judicious and discriminating plea against sac- rificial surgery of the adnexa. He states that the 114 THE NAEDICAL DIAL. difference between the radical and conservative treatment of the diseased ovary is difficult to define, as the most radical treatment is sometimes the most conservative. Likewise under some cir- cumstances the most conservative treatment would be the most radical. The fear of opening and manipulating within the abdominal cavity has disappeared, but the chief object in mind is how to close it so as to prevent hernia. We nowadays frequently flood the abdominal cavity with quarts of normal salt solution, thus warming up the somewhat cooled abdominal viscera, and at the same time per- forming an actual transfusion. The author states that real conservatism is gaining ground to such an extent over real radicalism that an Operator who presents adnexiae and uterine fibromata in a modern medical society has, in order to escape criticism and censure, to give good reasons why these important organs were sacrificed. The Op- erative mortality at present for the removal of fibroid tumors, in a surgically clean environment, averages better results than formerly its sister operation of ovariotomy. - By the more conservative method in enucleat- ing fibroids the patient is freed from the burden of her neoplasm and at the same time escapes being mutilated and blighted. For a score of years Battey, Heger, and Tait set the pace for radical operation. When a laporotomy was per- formed for the removal of an ovarion cystoma the appendages on the other side were likewise often removed, provided they showed any sign of be- ing even slightly diseased, with the apology that some day they might become diseased. It re- quires a higher degree of skill to save a diseased member than it does to ablate it. The writer emphasizes the disagreable Symp- toms accompanying the artificial menopause as being rather stormy and protracted and in some instances resulting in actual insanity. Menstrua- tion is generally not interrupted by Saving a portion of one ovary and sexual feelings undergo none of those peculiar revulsions which unfortu- nately follow total ablation of both Ovaries and tubes. Dr. Dudley, of New York, reported at the last meeting of the American Gynoecological Society, a brilliant series of IO3 conservative Op- erations, without a death. He did not hesitate to cut away the diseased portion of the tube and suture the healthy end to the healthy ovary. In some cases he irrigated the remaining portion of the tube with an antiseptic fluid and Stitched the tube to the ovary. In other cases where one ovary and tube had been removed on account of a neoplasm or abscess, and the other adnexia was found somewhat involved, the diseased por- tions were resected and the healthy portions stitched together. Gestation occured subse- quently in several such cases. The author mentions that menstruation is looked upon by most patients as a curse or a great inconvenience although very few welcome its disappearance. Some women believe that ar- tificial menopause is the beginning of old age which they dread, and the feeling that they are So "different from other women” carries with it an undefinable abhorence. In tubo-ovarian abscesses life-saving results have been effected by making a vaginal section and draining the pus-cavity per vaginam. Thus in many instances unexpected symptomatic, practical and permanent cures have been effected. If a surgeon follows ironclad rules and separates firm and numerous intestinal adhesions until he reaches the pus-cavity, he runs many more chances of Operating his patients to death than if he had made a conservative vaginal section, re- moved nothing but the life-destroying pus, irri- gated and drained the pus-cavity and put the patient to bed within ten minutes without shock and hemorrhage. J. H. Rishmiller. PEDIATRICS. UNDER THE CHARGE OF H. B. SWEETSER, M. D. J. P. BARBER, M. D. SOME PREVENTATIVES. Dr. A. Jacobi, (The Philadelphia Medical Journal, Dec. IOth, 17th and 24th, 1898) in his usual vigorous style touches with a master hand upon several very interesting and important sub- Jects. - Seasons and climates, race, city or country, soil and dwelling, precocious marriages, financial circumstances, the price of dress goods, the prev- alence of endemics and epidemics, of alcoholism and Syphilis, the ignorance of the people and of medical men, are among the most influential causes of excessive infant-mortality. Many of them could be prevented by social improvements, which have to go beyond the puny efforts of floating hospitals and fresh air piers. * * * As the principal mortality of the first year is due to disorders of the digestive, and that of the following period to those of the respiratory or— gans, the preventative measures to be taken ap- pear to be self-evident. Infant feeding has been made relatively safe by the methods calculated to destroy pathogenous germs; he says patho- genous, for the presence of others in the milk of women, and in the meconium, and in the stom- ach of the newly born as early as a few hours after birth, is either indifferent or beneficial. By rendering infant food germ-free, a number of dis- eases and deaths are prevented; mainly, the army Of infectious intestinal disorders, with consecutive renal, meningeal, encephalic, and respiratory troubles, not to speak of chronic marasmus that Swells the death lists often without an appreci- able anatomical cause. Beyond the means of prevention furnished by bacteriology, we have not advanced much these scores of years. The same questions belonging to the chemistry of milk, and of the composition THE NAEDICAL DIAL. 115 of infant food, are answered differently in differ- ent quarters with equal assurance. A famous au– thor, in spite of the physiological fact known these 30 years, that there is saliva and pancrea- tive juice in the infant economy, has only lately been converted to a faith in farinaceous foods, and is experimenting with other than milk sugar, and he comes to the conclusion, based on many sleepless nights, that the feeding on woman's milk may be carried on too long. Many begin also to find out that cows milk may be done to death by inconsiderate cooking, and the latter is not rendered more sacred or more wilolesome by calling it sterilization. The belief that infants and children require much food is correct. They require material not Only for reproduction but also for increase. In Order to gain 25 grains daily during the first half- year, they require daily from 8 to Io grains of proteid, 2.6 of which are demanded in the inter- est of growth. But over alimentation during a normal condition has its serious drawbacks which should be prevented: dilatation of the stomach, and diarrhoeal disease, rickets, adiposity, diseases of the skin, convulsions, biliary and renal colic, and myasthenia and myalgia depending upon the accumulation of phosphates, and lactates in the muscular tissue. Over-alimentation may lead to atrophy in different ways, so that the diagnosti- cian of a case of atrophy has not to look for star- vation in intestinal diseases only. When the stom- ach is too full the gut does not digest. A few months ago, before the Moscow congress, Von Mering detailed the following experiment: He cut the duodenum and sewed the two ends to the abdominal wall. When the stomach was full, and the intestine was full, the function of the stomach ceased. When the intestine was empty the stom- ach would work and discharge its contents. Until then, no normal secretion of hydrochloric acid would take place, but decomposition only. In this way stuffing leads to illness and atrophy. This may happen besides, for reasons that we should be anxious to discover. a sufficient amount of food, and when the stom- ach and the intestines and the feces appear to be quite normal, so that there is no sugar, and but little albumen and fat left in the feces, even the bowels were found sterile in such cases. The only changes discoverable were in the middle-ear, in the bladder and the pelvis of the kidneys, which may have been infected from the intestinal tract. These infants suffer from pain and sleeplessness furunculosis, phlegmons and gangrenes. This is one of the many classes of disorders in which the ubiquitous claims of bacteriology are not sus- tained. We have to return to organic chemistry to fathom the most occult mysteries of nature. “In a short evening the problems of infant feeding cannot be solved. Permit me only to add a few fragmentory axioms that I look upon as best fitted to improve the infants health and to prevent disease; Cow's milk can never be made like woman’s milk. Their physical and chemical compositions differ; mere dilutions do not When there is change the abnormal character of cow's casein. Farinaceous decoctions protect the infant against the abnormal casein better than water. Milk- sugar, though contained in milk, is not always the best sugar to be added to artificial foods. Plenty of water in the food of infants prevents many forms of dyspepsia, and secures normal function of the kidneys and of the liver. Infarctions of uric acid are frequent, and those of a hemorrhagic and pigmentous nature are not infrequent, and calcareous deposits are at least of occasional occurrence in the kidneys of the newly born. Gravel and stone are frequent in infancy. All these foreign masses lead to dis- integration of the endothelia, to hemorrhage, and to inflammation. Moreover, the rapid destruc- tion of the red blood cells in the normal newly born, and the transformation of hematine into hematoidin, which is identical with bilirubin and biliverdin, lead to obstructions and thromboses. It is a large supply of water that should be given to every newly born as a matter of course, while the milk supply is absent or scanty, that will pre- vent many of the dangerous ailments of the first weeks of life. - An exclusive cow's-milk diet is a mistake, no matter whether pasteurized or sterilized ; it may cause one-sided over-alimentation, such as has been described, and occasionally it produces, or aids in producing, scurvy. Cow's milk and fari- nacea require an ample supply of salt, Patented artificial foods are modern achieve- ments markedly beneficial. Like the compound pills of the wholesale druggist which are dumped on your office tables, and the medley of compº- site sweatshop productions of the wholesale book-manufacturers, artificial foods produce horses and carriages, town-mansions and coun- try villas, bonds, stocks, and bank-directorships. The treatment of the intestinal tract is partly dietetic, partly mechanical, and partly medicinal, as of most diseases of other Organs Or Systems. Disorders of the bowels, which could have been removed, lead to disturbance of the temperament and of the mind, to night terrors and convulsions, to rachitis, to intestinal absorption with fever and erythema and other skin diseases, not quite rare- ly to peritonitis, to cystitis from the immigration of intestinal bacteria, and to toxic nephitis; in other not uncommon cases to visceral abscesses. Most of what has been mentioned is preventable by medicinal and dietetic treatment; and the old physicians, with their maxim, “qui bene purgat, i.ene curat,” hit the nail quite frequently. What is meant by prevention—prevention of death—in acute febrile diseases may find a brief illustration in the roborant and stimulant treat- ment of pneumonia. During health, the innerya- tion and force of the heart are not easily dis- turbed, but every pulmonary disease taxes its powers. There is no pneumonia that may not require cardiac stimulation sometime or other, for the heart is sure to suffer within a few days from dilation, first of the right side. To what ex- tent this occurs cannot be foreseen. The princi- 116 THE NAEDICAL DIAL. ple of waiting for symptoms to turn up is a bad one. If medication were injurious by itself, that would be an excuse for not resorting to it. When heartfailure or collapse, however, has once set in, our remedies are mostly too late. Then to busy ourselves with our subcutaneous, medicinal or rectal hot-water injections or a perfunctory dose of digitalis, not “ut aliquid fias” but “ut aliquid fieri videatur” is preposterous. The weakness of the heart is by no means physical only, viz: the result of the over exertion caused by the difficulty met by their blood in its passage through the lungs, but it is dynamic and physiologic. Like all other infectious fevers, pneumonia acts probably by its toxin on the functions of the heart-structure and by impeded circulation the heart is certainly injured in its own nutrition. As far as the facilitation of pul- monary circulation is concerned it is not improb- able that strophanthus acts even better than di- gitalis; at least physiologists like Cushing tell us so. The inference is that whenever we require an improvement of the pulmonary circulation for the purpose of oxygenation and of the aortic cir- culation in behalf of nutrition, and of the rapidity of circulation in order to facilitate the elimination of toxines, we shall do well to use strophanthus and digitalis in combination. Who is it that made the rule that a prescrip- tion must contain one drug only, not two, nor three. though they chemically be ever so com- patible, if not the nihilists who preach that there is nothing in medicine but autopsies, and that medicine is a science, not an art; or, perhaps it . was only exaggerated antagonism to the yard- long theriacs of the Middle Ages. If there is in illness an uncomplicated condition, give an un- complicated drug; but be sure that the organ to which you direct your remedy is also simple and uncomplicated. Is there such a thing? Let me again take the examples of the heart. When we speak of heartfailure, or of a debilitated heart, does not that mean more than the flabbiness or over extension of an India-rubber bag? A heart is composed of muscular, intercellular, fatty, elas- tic tissues; it supplies all the organs with blood, and is itself thus supplied. Its circulation is pul- monary and nutrient. Its blood-vessels are ex- posed to all the anomolies of all the other blood- vessels. tic ganglia and fibers; there is the pneumogas- tric, there are fibers coming from the medulla, and in the medulla there is the head-center of the cir- culation. Its normal innervation is that of the contracting muscle and of inhibition besides. If this compound body fails in its cooperative ac- tion, is it probable that a single drug will restore it in all instances? In some, certainly, for the strengthening of inhibitory power is often suffi- cient to gradually restore the equillibrium, but in many cases the circumstances are not so sim- ple. Digitalis acts in many ways; according to Traube the slowing of the heart's contraction is its main effect; but aconite has a similar effect without any muscular influence. Digitalis in- In its nerve supply there are sympathe- creases arterial pressure, so does strychnine; di- gitalis causes diuresis by raising tension in the renal arteries; it has that effect in a lesser degree than strophanthus, which influences the arterioles less markedly. Digitalis also raises the blood- pressure, and thereby inproves the nutrition of all the tissues, that of the heart included. To its action on the heart and also on the arteries, is due the rapidity of the circulation; when, how- ever, its contracting influence on the small arter- ies is too intense, that rapidity is stopped. To restore it nitrites are employed. Strychnine in- creases arterial pressure without an inhibitory effect. That is why when only a moderate amount of inhibition, but competent pressure is required, small doses of digitalis should be com- bined with good doses of strychnine. Inhibition is paralyzed by atropine; that is why larger doses of digitalis are both tolerated and beneficial when combined with atropine. Spartein has little direct action on the heart muscle and depresses the inhibiting pneumogastric; that is why digital- is, when its muscle effect is demanded, is borne when combined with spartein, in fair doses, for a long time in succession. Such combina- tions are not only permissable; they are requisite. Such combinations, say of 4 decig. daily of di- gitalis or its equivalent with half the amount of spartein may be given for six weeks with perfect safety without going to see the patient and with no cumulative effect; the latter can not always be avoided when digitalis is given alone. Combina- tions of so-called heart stimulants may be much more various. Like Strychnine, ergot effects the medulla and the spinal-cord centers. Caffein, camphor, and ammonia stimulate both the heart and the vaso-motor centers; hydrastis both the vaso-motor centers and the peripheral vaso-mo- tors. Adonis appears to be almost identical with digitalis in its cardiac and arterial effects; stro- phanthus, with its modified action on the heart and principally on the arteries, finds its associates in convallaria and apocynum. - Statistics are said to prove that pneumonia will get well without medication. Which pneu- monia, and whose? It should be a great satisfac- tion to a man dying of pneumonia to learn that his neighbor got well without medication, if stim- ulation in time, perhaps venesection, might have saved his own individual life. It is the duty of the physician to judge of and to treat his indi- vidual case, and not the pneumonia of Louis, and of Deitl, and of other statisticians. Treat the Iman who is sick and not a Greek name. J. P. B. To overcome longing for drink, due to ir- ritation of gastric nerve supply:- B. Chlorinated water, 2 drachms, Decoction of Athaea 5 ounces, cane sugar 2 drachms. M. Sig. A tablespoonful every two or three hours. Zdekauer.—La Med. Mod. Jan. I2, '95. Disgusting an inebriate of alcoholic in- toxicants is not to cure the disease of inebriety, or narcomania.-Sajous’ Annual, Vol. I, p. 224. THE NAEDICAL DIAL. 117 Neurology and Psychiatry. UNIDER THE CHARGE OF - R. O. BEARD, M. D., W. A. Jon Es, M. D. THE OCULAR EVIDENCES OF HY- STERIA. Casey A. Wood (Amer. Jour. of Med. Sci.). The author's conclusions are, that: I. Most cases of hysteria present well-marked easily detected eye-signs and symptoms. 2. A few Ocular symptoms, such as rever- sal of the relation of the color-fields and the field for white, the tonic form of blepharospasm, spasm of accommodation and convergence, and pseudo-paralytic ptosis, may be regarded as pathognomonic of hysteria. 3. Defects of vision (in the absence of refrac- tive errors, accomodative anomalies, and fundus lesions) are, generally speaking, hysterical if ac- companied by photophobia and any form of blepharo-Spasm. . 4. No examination of a patient for ligeteria should be regarded as complete without consid- ering the condition of his ocular apparatus. 5. Where there is no conclusive external evi- dence of the neurosis present, the perimeter should be carefully used, the range of accommo- dation noted, and the opthalmoscope employed. 6. It should be remembered that ocular hy- Steria is common in children and in men. 7. Organic disease (traumatism especially) of the eye may accompany purely functional dis- turbances of that organ. - An editorial in the Journal of the American Medical Association of Jan. 21st, makes an inter- esting suggestion regarding epileptics under the title “The Convulsive Face.” It says; “We fre- quently see in children, and even in adult epilep- tics, the convulsive hand, consisting of a flexing grasp of the fingers in the palm over the flexed thumb. And often, after a sever epileptic fit, the patient remains as in a mold fashioned by the convulsion. Nowhere in the physique is this phenomena more plainly seen than in the facial features. For days after the convulsion the facial muscles are incapable of acting in unison in emo- tional and purposeful acts. The lips have an un- certain tremulous movement in speech, from which action alone epileptologists are often able to declare that a seizure has occurred. To the casual observer the face in this disease may give no impression beyond a possible One of prema- ture aging or a dulling of the facial appearance in those most afflicted, but experienced observa- tion will disclose a peculiar sharpening of the naso-labial fold, persisting most in action, a lack of unity of expression about eye and mouth, in which probably the most signal failure lies in the discord of cerebral impulses. For years the speech of the epileptic has been known to be highly diagnostic, due for the most part to its arythmic character. We might describe the epileptic face best if we were allowed to say that the arythmia of sound in speech finds counter- part in the disordered play of expression of the face.” W. A. J. SUB-ACUTE COMBINED SCLEROSIS OF THE SPINAL CORD, AND ITS RELATION TO ANEMIA AND TOXEMIA. Charles L. Dana (Jour. Nerv. and Ment. Dis.), claims that there is a group of cases show- ing ataxic paralysis with sub-acute course, which should be recognized as a distinct clinical type. He reviews briefly the literature, and then gives an account of a typical case including the his- tological examination of the cord. The initial symptom is a persistent paresthe- sia usually of the feet, associated with some weakness of the part and followed by consider- able ataxia. There is at first an increase of knee-jerks, and sometimes ankle-clonus and rigidity, but later the spasticity decreases and the knee-jerks disappear. Tactile, thermic and pain anasthesia are not marked until late in the disease, but the patient often has severe pains in the back and legs. The arms are involved later, or the first signs of trouble may begin in them. An anemia which may be of the pernicious type, but is usually secondary is present. The course is short requiring from six months to a year to reach its height. Control of bladder and rectum is finally lost, and paralysis and contracture of the lower limbs are present. The author con- siders the disease as of toxic origin, and Sug- gests that as it belongs to the degenerative per- iod of life it may be due to a premature senility of the bloodmaking organs. It is not likely that the change in the spinal cord is primary. The microscopical examination showed that the posterior columns of the spinal cord are first involved, and that the disease appears to start in certain foci in the lower dorsal or cervical cord,and later to spread throughout the entire length of the columns. The lateral columns and especially the crossed pyramidal tracts are se- verely affected. - The disease is distinguished from locomotor ataxia by the absence of syphilitic history, the rapid onset, the anemia, the motor weakness, the absence of ocular symptoms and of lightning pains. From multiple neuritis it is distinguish- able by the slow onset, the marked ataxia, the ab- sence of muscular wasting, tenderness, and pain, and by the development of bladder and rectal symptoms. The existence of marked anemia, and especially of pernicious anemia, is, taken with ataxia, paralysis and rapid course pathog- Inomonic. W. A. J. 118 THE MEDICAL DIAL. A CASE OF ERYTHROMELAGIA, WITH MICROSCOPICAI, EXAMINATION OF THE TISSUE FROM AN AM- PUTATED TOE. S. Weir Mitchell and William G. Spiller (Amer. Jour. of Med. Sciences). I he pure type of the disease is seen in the younger adults. In these the foot while held in a horizontal position may show no flush, and there may be no pain, although when the foot is lowered the arteries throb, the temperature rises, and the redness be- comes intense. The present case occurred in a man of sixty- five, and showed some variations from the type. In July 1897 the patient began to have limited areas of savage pain in the right foot, which varied in location but were accompanied with tenderness and extensive flushing. While the fourth and fifth toes were involved, a small, deep and painful ulcer developed on the outside of the fourth toe which healed slowly. Finally the trouble became localized in the great toe and a small ulcer formed under the nail. The heart was very feeble, the arteries were soft, the urine negative; the affected limb was not wasted but the right knee-jerk was increased, the ankle jerks were excessive though no clonus was pres– ent, and sensation was normal. As the pain was intense and could not be relieved, amputation of the toe was performed. A slough formed in the lower part of the wound, and it healed but slow- ly. Pain has occurred at times in other parts of the foot since operation and the authors doubt whether the patient will receive any permanent benefit. The microscopical findings are most irterest- ing. The nerves show intense degeneration. The bundles are composed wholly of connective tissue, with only here and there a nerve fibre appearing, and even in these occurs irregulat segmentation of the myelin. The vessels show equally marked change. The media is thickened, and the intima is intensely proliferated, so much so that in some cases it nearly closes the lumen. The veins show thickening. The bones also are 1arger than in the normal adult skeleton. No opinion is expressed as to the seat of the primary lesion in this case, and attention is drawn to the fact that arterio-sclerosis is com— mon at this age, while erythromelgia is rare. The preservation of sensation in the great toe, the nerves of which were so greatly degenerated indicates that sensation may obey different laws from those governing motion. W. A. J. VELOCITY OF SOUND. The latest calculation of the rate at which sound waves travel through air has been made by W. A. Leduc (Comptes Rendus, Dec. 26, 1898,) who finds that the rapidity of propagation of sound waves in a dry atmosphere at 22 de- grees F. is 1088.58 feet per second. OBSTETRICS. A. B. CATES, A. M., M. D. R. E. CUTTS, B. S., M. D. THE RELIEF OF SUFFERING IN OB- STETRICAL PRACTICE. Dr. Fothergill (Lancet, Jan. 28th, 1899,) in a paper delivered before the Clinical Society of Manchester, England, “On the relief of suffer- ing in obstetrical practice” held that the first duty of the obstetrician was to relieve suffering. This was to be secured, firstly—by careful at- tention to a number of details, secondly—by the use of chloroform during the second stage. Of the first, minor methods were such as hot bath. and suggested the bath room as the most com- fortable place to pass the greater part of the first stage. In dry labor Dr. Ribe's bag or manual dilatation was recommended to shorten the first stage while a short administration of chloroform was recommended in colicky uterine action and in spasmodic rigidity of the cervix. Quinine and cocaine were also useful in this stage. In the second stage a few whiffs of chloroform may be given during every pain, to be increased to deep- er anaesthesia during the last few minutes prev- jous to delivery. Chloroform did not increase bleeding nor was the babe injured; and should labor be prolonged it could be contpleted by the judicious use of the forceps. In operative cases chloroform should always be given. Dr. Fother- gill further says, “It is to be regretted that in that district forceps extractions, turning, craniotomy and removal of adherent placentae were fre- quently done without anaesthesia. R. E. C. A NEW METHOD OF INDUCING PRE- MATURE LABOR. Spinelli described at the Congress of Ob- stetricians and Gynecologists in Turin, a new method of inducing premature labor which con- sisted in introducing the index finger into the cervical canal then passing beyond the internal orifice, (in primiparae the canal should be prev- iously dilated) the inferior portion of the mem- branes is gently torn with the hooked finger and by the guidance of the finger a strip of gauze impregnated with glycerolate of ichthyol is in- serted which should be placed between the rup- tured membranes and the uterine wall; this operation can be performed best by drawing down the uterus by means of a forceps applied to the posterior cervical lip. The vaginal canal is then packed with sterilized gauze ; labor us- ually occurs in about ten hours. The author des- cribes ten cases treated by this method.—N. Y. Med. Jour., Jany. 7th, 1899. - (In cases of miscarriage with only partial emptying of the uterine contents, and in which the contractions fail to develop sufficiently to THE NAEDICAL DIAL. 119 complete the process, packing the lower segment of the uterus and cervical canal with 5 per cent. iodoform gauze and supported by packing the vagina with sterilized gauze soon causes soft- ening of the cervix and development of uterine contractions sufficient to accomplish the desired result.) R. E. C. DRY LABOR. Broadhead (Univ. Med. Mag. Dec., 1898,) Says in I5 per cent of labor cases the membranes rupture prior to or during the first pains. In such cases the foetal dangers are asphyxia and 1meningeal hemorrhage while the maternal dan- gers are lacération of soft parts, oedema, pres- Sure, necrosis, hemorrhage, sepsis, slow conval- escence and uterine rupture. He advises to begin the labor as soon as possible after the rupture of the membranes by giving a full dose of castor oil in glycerine followed in a short time by ten grains of Sulph. of quinine. The latter to be re- peated every three hours. Strych. Sulph. gr. I/30 should be given every two hours up to the physiological limit. Thorough asepsis by soap and scrubbing should be carried out. This was to be followed by douching with bichloride I/2OOO or a lysol solution every six hours. The forceps should be used in the second stage if prolonged. R. E. C. A CASE OF INVERSION OF THE UT- ERU.S. Dr. C. J. Ringnell reported at the Hennepin Co. Medical Society, Feb. 6th, 1899, a case of inversion of the uterus following confinement. The patient had been delivered by a midwife and as the placenta did not come away readily she introduced her hand into the uterus—directly, seized the afterbirth and removed it by direct traction. After removing the placenta she found the vagina filled with something which she sup- posed had to come away and kept manipulating it with that end in view until Dr. Ringnell saw the case several hours after delivery. There had been a constant loss of blood from the surface of the placental attachment, and the patient was so exsanguined that she lived but a short time, dying before replacement could be affected. Dr. Ringnell exhibited some splendid photographs of the specimen. R. E. C. BREECH PRIESENTATION. Dr. Edward A. Ayers, of New York, in the first of a series of articles on “Physical Diagno- sis in Obstetrics,” published in his new journal, “Obstetrics,” has the following concerning breech presentation. “The average infant mortality in head presen- tations occiput auterior, is estimated at from two to six per cent. In breech deliveries it is from 20 to 25 per cent. Not all cases of breech pre- sentation can be corrected before labor unless seen early in pregnancy—the seventh month. Many such cases will correct themselves. Some that are corrected will return to a breech. The following rules apply: Do not interfere with a breech presentation in cases of placenta praevia, marked pelvic contraction, abnormal growths in or around the pelvic portion of the uterus, twins, when mobility of the foetus is too slight to render external version easily; when mobility is too great to render it likely that the foetus will remain in a head presentation or after the breech has become inpacted in labor. Per- form external cephalic version when in the last four weeks of pregnancy the position in breech is becoming established and when no special reasons exist for a breech delivery provided such version is not difficult. Do not put the foetus in greater danger than from breech delivery. Choose if the conditions allow, (the last two weeks of pregnancy for doing version.” (The per cent. of mortality represented by the figures given above is twice as large as is generally conceded. A premature non-viable child and a dead foetus should be added as con- traindications to cephalic version.) - A. B. C. THE PRACTICAL APPLICATION OF AS- EPSIS IN NORMAL LABOR. Dr. J. Clifton Edgar in an address at the University of Pennsylvania on “The Practical Application of Asepsis in Normal Labor,” pub- lished in the Medical Record of Feby. I I, 1899, says, “The microbes which are known to cause puerperal infection do not exist in the healthy vagina at all or are in a state of innocuousness. The gonococcus is occasionally found in the va- ginal secretions. When pyogenic cocci are found in the puerperal uterus they have been intro- duced from without (Williams). As the vagina does not contain pyogenic cocci, auto-infection with them is impossible (Williams). Pyogenic cocci do not exist in a state of activity on the vulva and in the vulval canal.” After thorough cleansing of the vulva the separation of the labia with the thumb and middle finger of left hand is recommended while the finger of the right hand is inserted into the vagina, avoiding con- tact with the labia and hymen or its remains, as far as possible. A VERY SMALL BABY. There is at present a female infant at Govern- eur Hospital, New York, said to be perfect in its development in every respect except as regards size; at the age of two months she weighs but 3234 ounces. When born her weight was only I6 ounces.—(Boston Medical and Surgical Jour- nal.) *-* * AIR-EMBOLISM. Begouin has investigated the mechanism of death for air-embolism, and finds that the rapid- ity of death depends rather upon the amount of air in the right ventricle and on the rapidity or 120 THE NAEDICAL DIAL. force with which the air is introduced. These factors determine whether the asphyxia shall be rapid or slow. On the postmortem examination the author found the right ventricle greatly dis- tended with frothy blood. If a fine trocar was passed into the right ventricle after the ad- mission of air by the veins and aspiration was performed, death did not take place, but the ani- mal recovered after a short time. He concludes, therefore: I. That death is due to distension of the right ventricle by air, and, secondarily, to right-sided asystole. 2. That removal of the air by aspiration allows the ventricle to react.— Am. Year Book of Med. and Surg. p. 657. *- CLINICAL MICROSCOPY. UNDER THE CHARGE OF J. FRANK CORBETT, M. D., G. D. HEAD, M. D. LEUCO CYTOSIS IN LABOR AND THE PUBRPERIUM. In the Journal of Experimental Medicine Vol. 3, No. 6, Hibbard and White contribute an article giving the results of their work upon the examination and enumeration of the white cells of the blood in 55 cases of women in labor or the puerperium. They arrive at the following conclusions: I. A leucocytosis was present in over three fourths of their cases being more frequent and higher in primiparae. 2. During convalescence the count falls at first rapidly, later more gradually. * 3. Leucocytosis is higher in younger women regardless of the number of pregnancies. 4. Patients farthest advanced in pregnancy have the highest counts, 5. Leucocytosis present at the time of labor is due to an increase of the polymorphonuclear cells. Of the cases counted four were complicated ly inflammation of the breast. All these showed at the time of the febrile attack a leucocytosis (II-I6OOO.) The authors raise the question whether a white count in these cases would be of any value in detecting the presence of pus. In answer to this query it might be suggested that the height to which the count might rise would serve to differentiate between suppurative and the non-suppurative breast inflammation. The white counts made by the writer in these cases of breast abscess range between 25–32,OOO white cells to the C. M. M. BLOOD IN THE URINE. Rules for determining the location of the hemorrhage by microscopical study. I. If the blood corpuscles occur in casts the source of the hemorrhage is the kidney. 2. If the blood corpuscles appear as pale del- icate, rings in the urine (blood shadows), the source of the hemorrhage is the kidney, the pel- vis of the kidney, or the ureter urine. Caution : The blood must be examined fresh. Normal red blood corpuscles will become washed out if allowed to stand for 48 hours in an alkaline urine. (a) If the hemorrhage originates in the kid- ney, casts and real epithelium usually accompany the washed out red cells. (b) If the hemorrhage is from the pelvis of the kidney or the ureter, no casts are present. Pus cells and round, branched, or spindle epi- thelium may or may not be seen in the urine. 3. If the blood is from the bladder, the cor- puscles are usually increased in amount; they retain their normal color. May be crenated swol- len or normal in appearance, and usually asso- ciated with large numbers of pus cells, squamous and large, round epithelial cells, and masses of bacteria. 4. Blood from the urethra shows the corpus- cles normal in color and appearance and occur- ring only in the first part of the urine passed. 5. In some cases of acute congestion of the kidneys with suppression of urine, the first urine passed will contain an enormous number of red blood corpuscles, normal in color and appear- ance, without any accompanying cellular ele- mentS. - 6. In some cases of renal calculus, during the passage of a stone down the ureter both washed out and normal red blood cells will be seen without other cellular elements. Geo. Douglas Head, THE GROWTH OF THE TYPHOID BA- CILI_US IN THE SOIL. Having observed a number of outbreaks of typhoid fever in what appeared to be a typhoid area, John Robinson concluded that the source of infection was in the soil; but a bacteriologic examination of 30 samples of soil was negative. He then inoculated soil with typhoid germs, and from time to time took samples for investigation. He found that the typhoid bacilli were able to grow in certain soils, and that they could, under certain conditions, survive from one summer to another; the rains of spring and autumn and the frosts and snow of winter did not kill them. The part of the soil exposed to the sun showed no typhoid bacilli; but by scraping down one six- teenth in. from the surface the organisms were found to be present. Cultures of the bacilli planted at a depth of 18 in, grew to the surface, and others inoculated on the surface extended to a depth of 3 in. It is possible that this down- ward growth may have been assisted by mechan- icál means, as rain and artificial watering. No lateral spread could be ascertained. Vegetation was detrimental to the healthy growth of the organisms.-Am. Year Book of Med. and Surg. THE MEDICAL DIAL. 121 Amons the Journals. In the January number of the American Journal of Insanity, Dr. Ales Hrdlicka reaches the conclusions that while insanity sometimes stimulates such of its victims as possess the ability to write at all, into writing more volum- inously than when in health, the composition is at the same time lowered from its former level both in manner and matter; and that the same is true of picture drawing. The artistic and literary instinct is sometimes very strong in the insane and with the loss of judgement and a weakened self control these instincts assert themselves, the pictorial and lit- erary efforts resulting, always reflecting the men- tal states and power of the brain in which they were conceived. The value of Dr. Hrdlicka's contribution lies in its well selected illustration and comparisons of instances of the above generalization and might be made still more valuable perhaps had it been possible to collect examples of similar ef- forts by the same persons in health for compari- Sons in that direction. The article is confined wholly to a cansidera– tion of the literary and artistic work of patients in public institutions. There is an opportunity in this connection for some patient investigator to make an analysis of the work of some writers Outside asylum walls. Our decadent literature is full of eroticism. The irruption into literature of the cynic, pessimist, and other partial degen- erates, has resulted in chocking the pressess with a mass of morbid exhalations which may take years in falling into deserved oblivion and leav- ing that which is clean, sane and wholesome in its proper place of permanancy as the true lit- erary product of this century. Our forefathers used to take cynics and pes- simists and duck them in the nearest horse pond under the generic designation of “scolds;”—a proceeding which effectually dampened any am- bition to a wider exploitation of individual men- tal obliquities. Dr. Hrdlicka's line of investigation is of value also as affording a basis for the erection of cer- tain kinds of symptoms into a scheme for the differential classification of some of the more subtle grades of mental degeneracy as well as for the analysis and study of delusions. Dr. Irwin H. Neff contributes a paper on “The Tuberculin Test.” The reaction to the tuberculin exhibition is generally admitted to be of great diagnostic value and yet, Neff sounds a wise note of warning aginst its indiscriminate 11se in quoting Kelbs who admits that cases have been recorded in which tubercular foci were re- vealed in individuals who did not suffer any ill effects from the disease until the wholly latent and inactive foci were lighted up by the test. It is probably a question to be determined by collateral facts and conditions in each case whether the test shall or shall not be used and the existence of an element of danger in this as in chloroform and many another accepted good should not militate against it. The particular value of the test is emphasized as being applicable to the insane who are un- satisfactory subjects sometimes for physical ex- ploration and who can give no intelligent aid to the examiner. Further application of this test would seem to be advisable in hospitals for the insane along lines laid down by Dr. Neff in his excellent paper. Dr. Neff also presents a paper read before the sixth meeting of the Association of Assistant Physicians of Hospitals for Insane at Kankakee on the subject of “Factors in the Prognosis and Duration of the Acute Insanities,” in which he deduces from several tables of statistics the dict- tim that recoveries from the acute psychoses are more frequent than they are according to the commonly accepted percentage allowances, and that heredity does not exercise so baneful an influence in determining chronicity and dementia as is generally believed ; nor does it preclude recovery or, of necessity, determine relapse. Ac- ute melancholia occurs twice to One case of acute mania and the recovery rate is higher in the lat- ter, while improved cases of theformer fre- quently recover after discharge. He attributes the earlier recovery of acute mania to the fact that the cases are earlier sent to the hospital. The tables are clear and have a bearing on the question treated, a statement that cannot al- ways be made of the confusing complications presented with some of the ill digested articles which appear in medical journals. An article containing many statistical tables must be an- notated in a way that will enable the reader to get the milk out of the cocoanut with little effort if it is to attract interest or even be read at all by the busy practitioner; and this Dr. Neff has done. Dr. Richard H. Hutchins goes into some of the technical minutiae of chemical analysis of the ptomaines and auto-elaborated bodily pois- ons, laying stress on the value of physiological chemistry in searching for some of the more Ob- scure etiological factors of insanity. This line of investigation is passing through a stage of evo- lution. We have long passed the point where it was claimed that all cases of insanity were trace- able, in part, at least, to a defective renal action, a decaying lung or an intestinal insufficiency." The growing understanding of the relation be- tween nutrition and nerve action must naturally lead to more and more general application in the hospitals, of the methods elucidated by Dr. Hutchins to the study of all those things which can in any way affect the metabolic changes in the nerve cell; and that understanding will also lead to final abandonment of the extreme ideas of enthusiasts who elevate a single truth into a fad and distort all things to fit the preconceived notion. 122 THE MEDICAL DIAL. There are several other papers of merit and interest particularly that of Dr. Kirchoff, of Neu- stadt in Holstein, on “Recent Views as to the Topical Basis of Mental Disorders” and a thoughful contribution to the study of the re- lations between “Brain Anatomy and Psycho- logy” along somewhat similar lines. Altogether the number is unusually valuable in practical suggestion to the alienist and of in- terest to the psychologist. E. N. Flint. BOOk I’Oſic&S. THE AMERICAN YEAR-BOOK OF MEDICINE AND SUR- GERY, being a Yearly Digest of Scientific Progress and Authoritative Opinion in all branches of Medi- cine and Surgery. Drawn from Journals, Mono- graphs, and Text-Books of the Leading American and Foreign Authors and Investigators, collected and arranged with Critical Editorial Comments by Twenty-eight of the Leading Specialists and writers of the Country, under the General Editorial Charge of George M. Gould, M. D. Illustrated. Price, cloth, $6.50; half morocco, $7.50. For sale by subscription. Philadelphia W. B. Saunders, 925 Walnut street, 1899. The year book for 1899 maintains the high standard of excellence so apparent in the pre- ceding volumes. Dr. Gould and his collegues do for the reader what he could not without super- human labor do for himself. The medical litera- ture of all nations is carefully culled, all that is practical and useful is preserved while the chaff is allowed to fly away with the wind. The editor and the collaborations have improved by the ex- perience of past years and their notes and crit- iques are of especial value to the reader. We predict for this years’ annual a wider field than ever, those who have taken the previous num- bers will wish to continue, while those who take it for the first time will feel that the volume is complete in itself and affords them a ready ref- erence to the latest and most trustworthy know- ledge on any medical or surgical subject. On Other pages of this journal will be found extracts from this valuable work. & “ THE SEXUAL INSTINCT-ITs USES AND DANGERS As AFFECTING HEREDITY AND MORALS, ESSENTIAL TO THE WELFARE OF THE INDIVIDUAL AND WEL- FARE OF THE RACE, by James Foster Scott, B. A., (Yale) M. D., C. M., (Edinburgh University). Late Obstetrician to Columbia Hospital for Women, and Lying-in Asylum, Washington, D. C. Late Vice- President of the Medical Association of the District of Columbia, etc., etc., Octavo 436 pages, cloth $2. New York. E. B. Treat & Co. 1899. The subject with which this volume deals is of a very delicate nature, and has not been an 1nviting field for the scientific writer. At the same time the necessity for such information as the title implies, and the eagerness with which such knowledge is sought after have called forth a constant flood of quack literature. A work like the one before us, written by a scientific phy- sician, and containing the knowledge which lay- men ought to possess should meet with a cordial reception. The work is free from technical terms and is intended for men, not women or boys. The writer adopts a high moral tone and regards purity as the crown of all real manliness He deals with the physiology of the sexual life, the consequences of impurity, perversion of the sex- ual life, the regulation of prostitution, etc. The chapter on “Woman and the unmanliness of degrading her,” appeals to the best instincts of human nature, and is a powerful denunciation of the libertine. The author makes some very strong and timely assertions on the question of criminal abortion. When it is considered that for every one hundred pregnancies there come to the knowledge of the profession seventeen abortions, and that in all probability an equal number remain unknown to the physicians, the question is one requiring serious consideration. The text is well written, clear and forcible, and the publishers are to be congratulated on the ex- cellent appearance of the book. - I.ECTURES ON AIPPENDICITIS AND NOTES ON OTHER SUBJECTs, by Robert T. Morris, A. M., M. D., Adjunct Professor of Surgery in the New York Post Graduate Medical School and Hospital; Fellow of the New York Academy of Medicine, American Asso- ciation of Obstetricians and Gynecologists, American Medical Association, Member of the New York State and County Medical Societies, Society of Alumni of Bellevue Hospital, Linnean Society of Natural His- tory, etc. Third edition, revised and enlarged, with illustrations by Henry Macdonald, M. D. G. P. Put- nam’s Sons, New York, 27 West Twenty-ninth St. Lond., 24 Bedford St. Strand. The subject of appendicitis has been receiv- ing so much attention in the proceedings of so- cieties and in the columns of medical journals that probably its literature for the past decade is more voluminous than that of any other medical or surgical subject. The pathology of appendi- citis is now thoroughly understood and thanks to the efforts of Dr. Morris, the practitioner, by the perusal of these lectures obtains all the know- ledge necessary for the diagnosis and treatment of these important and ever occurring cases, In this the third edition of the book the au– thor adopts the blunt dissection of McBurney for entering the abdominal cavity, and the read- er cannot but be led to the belief that the des– cription of the technique of the inch-and-a-half incision with its indispensable “guy-line” is as near perfection as possible. Valuable statistics have been added to show that his brilliant results are due to the dropping out of his practice, little by little, of the methods which had a death rate of their own. Although he may at first be a trifle disagree- ably impressed by the egotism of the author, the THE MEDICAL DIAL. 123 reader on a close acquaintance feels that he is in the hands of a safe and trusty guide and is ready to follow. This is one of the books which no practi- tioner, who realizes his responsibility to his pa- tients or his duty to himself, can afford to be without. e RECORD OF URINARY EXAMINATIONS. A convenient, Practical Method for keeping Records of Urinary Ex- aminations for Future Reference in Hospital or Gen." eral practice. Arranged by Harry Morell, M. D., C. M., Trinity University, Toronto. Hartford, Conn., U S. A. J. B. Burr and Company. 1898. This is a book of charts, octavo size, neatly bound and affording space for chemical analysis, physiologic constitutients in solution, pathologic constitutients in Solution, microscopic examina- tion, bacteria and general remarks. By the aid of carbon paper a copy of each report can be made and separating it from the sheet at the per- forations, the copy can be sent to the ward or given to the patient or his physician, while the original retained by the analyst. Since one ex- amination of urine is rarely sufficient for a diag- nosis the practitioner will find these charts in- valuable for reference during the progress of a C3.S.C. UEBER TRAUMATISCHE ENTSTEHUNG INNERER KRANK- HEITEN. The Traumatic Origin of Internal Diseases. First Part, Diseases of the Heart and Lungs, Pages 193. Dr. Richard Stern. Breslau, Fischer Jena, 1896. Owing largely to litigant interest a good deal of medical literature has accumulated on injuries and resulting diseases appertaining to the nervous system—it must be confessed, with not well defined results. Meagreness of infor- mation about the results of trauma on the struc- ture and function of visceral organs is the rule in our text-books. The results of trauma are left largely to surgeons who have hitherto set too little store by the pathological development of the disease they are about to attack. “However, it appears more and more that in the etiology of organic internal disease the role of trauma is still by far not enough consid- ered and explained.” The policy of governmental insurance in Germany demands an accurate knowledge of etiology not obtainable in the text-books. Dr. Stern's bronchure fills this want very acceptably. The details of cases are given, in- cluding an account of the nature of the accident, the subsequent history as it develops and the post mortem finds. A basis is thus formed for critical comment. Part I, now published, concerns itself with heart and aortic diseases, endocarditis from sud- den strain and like accidents, muscular and nervous disturbances of the heart and aneurism of the arch. Y Chapter II. shows how and what lung affec- tions follow trauma, as pleurisy, tuberculosis and the various pneumonias. The book is of special value to the teacher or one likely to have to do with traumatic cases Or one summoned often into court. H. THREE THOUSAND QUESTIONS ON MEDICAL SUBJECTs, Arranged for Self-examination, with the Proper Refer- ences to Standard Works in which the Correct Replies will be found. Second edition enlarged. Price, 10 cents, Philadelphia. P. Blakiston's Son & Co., 1012 Walnut St. 1899. This little book can be carried in the vest pocket and used during spare moments for self examination. The questions are practical and so comprehensive as to cover the whole field of medical practice. At the end of each question numbers indicate the volume and page in which the answer can be found. No student could form a better resolution than to study these questions until he can answer them all; if he succeeds, no college or examining board can turn him down. E. B. Treat & Co., New York, will publish shortly the International Medical Annual for I899. This will be the 17th issue of the Annual and among its special articles will be found the following: - “Practical X-Ray Work,” by R. Norris Wol- fenden, M.D., B.A.; “Advances in Skull Surg- ery,” by Seneca D. Tubby, M.S., M.B. These ar- ticles will be freely illustrated, chiefly by repro- ductions from photographs. “Climatic Treat- ment of Consumption,” by F. de Havilland Hall, M.D., F.R.C.P. An article on “Legal Decisions Affecting Medical Men,” by William A. Purring- ton, A.B., LL.D., will be found interesting and pertinent. In response to the request of many Subscribers there will be found an article on “The Chief Pathogenic Bacteria in the Human Subject,” with descriptions of their morphology and methods of microscopical examination, by S. G. Shattock, F.R.C.S., the Pathological Cu- rator of the Museum of the Royal College of Surgeons, London, illustrated by a series of fine- ly colored plates. ALEXINS. Alexins are products obtained from cultures . of pathogenic microorganisms—the bacillus of tuberculosis, for instance—which, when injected are credited with the power of conferring im- munity against the disease which the organisms are supposed to represent. In a series of experiments, detailed in a re- port to the Scientific Grants Committee of the British Medical Association, in 1892, E. H. Han- kin showed that a few electric sparks of high po- tential are capable of robbing a pure alexin solu- tion of its power of killing bacteria. How elec- tricity acts in these instances is not satisfactorily explained.—Sajons’ Annual Ency., vol.I., pa. 231. 124 THE NAEDICAL DIAL. II?iSC&llany). MEDICAL WORTHIES. * 2. AMBROISE PARE. By the Editor. Few names in the history of medicine are more interesting and inspiring than that of Am- broise Pare. His works are as facinating as a romance and his personal history reads like a fairy tale. He was the son of a barber and was born at Laval, in Maine, in I509. His early edu- cation was acquired under many discourage- ments, for his parents were too poor to send him to school and so he was placed as a foot boy in the house of the Cure of the village. The priest's mule was committed to young Par’s care, and the grooming of this animal and other menial duties took up so much of his time that study was out of the question. Later he was apprenticed to a barber surgeon (and promptly showed a taste for minor surgery). The eminent lithotomist Colot visited Laval about this time for the purpose of operating upon a friend of the priest, who suffered from stone in the bladder. Pare was deeply interested in the performance and was highly elated when the great man invited him to assist in the operation by holding the patients legs. The skill and dex- terity of Colot came as a revelation to Pare and he at once resolved to proceed to Paris where he might perfect himself in the Art of Surgery, for which he already showed a special aptitude. The Hotel Dieu was even at that early day a famous hospital and he had the good fortune to become One of its house surgeons, a position which he filled for three years. His conduct and his apt- ness so attracted the attention of Gonpil the chief Surgeon, that he trusted him with the patients which he himself could not find time to attend. At the age of twenty seven he received an ap- pointment as surgeon in the French Army and served under Montmorenci in Piedmont. For more than thirty years he served his country as a military surgeon and during , a period when wars were almost constant. The treatment of gun shot wounds was crude and barbarous. Un- der the belief that the missles caused poisoning of the wound, it was thought necessary to pour into such wounds boiling oil of elders; hem- orrhage was arested by searing with a red hot iron and when amputation was resorted to a red hot knife was employed. On one occasion Pare ran short of boiling oil and instituted a new pro- cedure. - - Let us read the account of this fortunate oc- curence in his own quaint language: "I took courage to doe as they did. At last I wanted oyle, and was constrained in steed thereof, to apply a digestive of yolkes of egg S, oyle of roses, and turpentine. In the night I could not sleepe in quiet, fearing some default in not cauterizing, that I should finde those to whom I had not used burning oyle dead impoy- soned; which made me rise very early to visit them, where beyond my expectation I found those to whom I had applied my digestive med- icine, to feele little paine, and their wounds with- out inflammation or tumor, having rested reas- onable well in the night: the other to whom was used the sayd burning ayle, I found them fev- erish, with great paine and tumor about the edges of their wounds. An then I resolved with myselfe never so cruelly to burne poore men Wounded with gunshot. Being at Thurin I found a chirurgion, who had the fame above all others, for the curing of wounds of gunshot, into whose favour I found meanes to insinuate my selfe, to have the receipt of his balme, as he called it, wherewith he dressed wounds of that kind, and hee held me off the space of two years, before I could possible draw the receipt fºom him. In the ends by gifts and presents he gave it to me which was this, to boyle young whelpes 11 CW pupped, in Oyle of lillies, prepared with earth Worms, with turpentine of Venice. Then was I joyfull and my heart made glad, that I had un- derstood his remedy, which was like to that which I had obtained by great chance. See then how I learned to dresse wounds made with gun- shot, not by books.” - Pare's name has come down and will live in history in connection with his use of the liga- ture. He had not discovered it, although he be- lieved that its employment was original with him. Had he been better instructed in his youth he would probably have read that Celsus, Avicenna Albucasus and other ancient writers had recom- mended, if they had not actually adopted this method of arresting hemorrhage. It is certain however that the ligature was not in use in Pare's day, and his adoption of it marked an epoch in Surgery. Like many other progressive men he met with personal abuse and one writer Gourmelen, called him a blood-thirsty and cruel rascal. Pare was a voluminous writer and his THE NAEDICAL DIAL. 125. works form a folio volume of more than a thou- Sand pages. His disposition was kind and he was beloved by the soldiers. It was his custom to take his leave of the wounded by saying (Je vous pansai, dieu guerera) I have dressed you may God cure you. If we were to consider his faults we must say that his egotism was remarkable. In one of his writings he speaks of himself as follows, “and if there were four hurt I had alwayes three of them, and if there were question of cutting off an arme Or a legge, or to trepan, or to reduce a fracture or dislocation, I brought it well to passe.”—“and when wee had resolved to doe any serious worke of chirurgery, twas Ambrose Parey that put his hand therto, where I did it promptly and with dexterity, and with a great assurance, in SO much that the sayd physician ad- mired me, to see me so ready in the operation of chirurgery seeing the small age which I had.” He was the first to repair laceration of the perineum bp sutures, and the first to extricate loose cartilages from the knee joint. The later years of his life were spent in study, in self improvement, in piety and in good deeds. He held the position of physician, chief surgeon and member of the privy council in the reigns of Henry II, Francis II, Charles IX, and Henry III. * He was a Protestant and would have fallen a victim in the terrible massacre of St. Bartho- limew but for the personal friendship of Charles IX. Brantome thus discribes the king's rescue of Pare on that eventful night. “He sent to fetch him, and to remain during the night in his cham- ber and ward-robe commanding him not to stir, and saying that it was not reasonable that a man who had preserved the lives of so many people should himself be massacred.” Pare died in Paris, December 20, 1590, full of age and honors. - TREATMENT OF ANGINA PECTORIS. During a paroxysm the first remedies to em- ploy are such as will dilate the arterioles. Ni- trite of amyl is the best because it acts with the greatest repidity. A “pearl” of this drug may be crushed in a handkerchief or in cotton placed in the bottom of a glass tumbler, and inhaled. Nitroglycerine may be injected subcutaneously (I-IOO to 1-50 grain), or a tablet of this substance may be masticated. It is readily absorbed from the mouth and acts almost as quickly as when given hypodermically. - - Relief by these means is often immediate; but if not, ether should be inhaled. Chloroform is also advised by excellent authorities. Flint thinks it not without danger, if the heart is weak; ether, on the other hand, is a stimulant. Morphine, subcutaneously, is a valuable and some times an indespensable remedy. Whittaker suggests that is be given with caution in a condition which may anyway terminate in sudden death. The imorphine (% grain) may be guarded by atro- pin I-I50 grain), and in case of alarm also by Strychnine (I-30 to I-2O grain). Electricity has also been recommended. Hot and stimulating applications over the praecordia, such as a strong mustard poultice, are appropriate, as are also heat and friction for the extremities. Sometimes an icebag is put over the heart. Alcohol and aromatic spirit of ammonia are of benefit in case the cardiac action is feeble. Syncope demands such drugs as digit- aline, digitalis, saffeine, Strychnine, and camphor, employed hypodermically. I have known Oxy- gen to contribute to a favorable result in col- lopse due to chronic myocarditis with dilatation. of the left ventricle, and cannot see why it might not be well for a subject of angina pectoris to keep some ready in his house. - - Between attacks, it is of vital importance to avoid the predisposing and exciting causes. Rest and moderation are demanded. As for drugs, nitro-glycerine, taken after meals in doses just short of causing headache, has a distinct inhibi- tory effect upon the paroxysms. In some instan- ces it might be better to order it every three hours, as its influence is not long continued. Ni- trite of sodium (2 to 5 grains) may replace nitro- glycerine. A new remedy is erythrol-tetranitrate in grain doses four times in the twenty-four hours. If this drug is given in spirit and water (I grain in I drachm of alcohol and 7 drachms of water) the tension begins to fall in two or three minutes; if given in a pill, the time is twenty to forty minutes; if given in tabloid form and chewed, the time lies somewhere between the two. The drug was not introduced to replace amynitrite and nitro-glycerine in cutting short attacks, but only to replace them in preventing the onset of the attacks. J. B. Bradbury thinks the tablet undoubtedly the best form of administration. The persistent use of potassia iodide is very effective. Ten or 15 grains may be given thrice daily before meals in half a glass of water; or 2O grains three times a day for twenty days, fol- lowed by nitro-glycerine for ten days. The iodide is believed to dilate the arterioles and to promote arterial nutrition. See supposed that also by enlarging the calibre of the coronary arteries it invigorated the myocardium. Arsenic in small doses also tends to avert the paroxysms. In case of fatty degenration of the heart it would be contra-indicated. Quinine and methylene-blue have also been recommended. The treatment by saline baths and by the Schott method of excerises has a most potent effect in improving the condition of the cardiac 126 THE MEDICAL DIAL. muscle and vessels, and appears to have a direct effect in making the attacks less numerous and severe, and even in causing them to cease during a period of months or years. The movements must be made with especial care and caution in these cases, and the resistance at the Onset must be at a minimum. The artificial saline baths should contain from 1 to 3 per cent of salt, and from 4 to 1 per cent. of chloride of calcium, and should gradually be strengthened by the addition of carbonic acid. Sajous’ Annual and Ency, Vol. I, p. 347. FOREIGN BODY IN THE EAR. Dr. R. Haug (Deutche Med. Wochenschrift, Feb. 3rd, 1898) reports a case which should im- press upon the minds of all, that with few ex- ceptions the easiest, safest and best method for removing a foreign body from the ear is by Syr. inging warm water into the external canal, and that the dangerous practice of trying to remove it with forceps or hooks should be avoided if possible. The case was sent to Haug, on the ninth day. He found the auditory canal highly inflamed, the auricle and surrounding parts swol- len, and the cutis of the Osseous part of the canal torn out by the manipulations of an unskillful surgeon, so that the periosteum was exposed. The foreign body, a bean, could not be seen, but by means of a probe passed through the swollen and closed canal could be felt firmly embedded. As pain in the ear and mastoid increased, and headache, vertigo, neausea, and fever set in, and as it was not possible to remove the bean through the narrowed meatus, the auricle was detached behind and thrown forward. It was then found that the bean had been pushed through the membrani tympani into the middle ear, where it was found swollen by the constant bath of pus in which it lay, and firmly wedged in the drum cavity, from which it was removed only after chiselling off a portion of the Osseous canal. Entire recovery in about two months. THE MORTALITY STATISTICS OF HA- VANA. Toward the close of December, Sanitary In- spector W. F. Brunner, of the Marine-Hospital Service, rendered to Major-General Francis V. Greene, then in command in Havana, a tabulated report of the mortality of the city for the period embraced between the Ist of January and the 22d of December, 1898. By the courtesy of General Greene we have been enabled to exam- ine Dr. Brunner's report. The table shows 19,271 deaths from all causes. The population of Ha- vana is about 200,000, so that the total number of deaths makes a mortality rate of nearly ten per cent. In round numbers, this is five times as high as the rate for the city of New York, and that, too, for a year in which there were fewer than the usual number of deaths from yellow fever. The figures are as follows: Yellow fever, I36; typhoid fever, 1,030; pernicious fever, 529; malarial fever, I,373; dysentery, I,359; enteritis, 3,149; diphtheria, 21 ; small-pox, I86; beri-beri, 9; glanders, 8; starvation, 215; pneumonia, 317; tuberculosis, 2,819. The decrease in the number of deaths from yellow fever is accounted for by Dr. Brunner by the fact that during the year 1898 but few Span- ish troops were brought to Cuba. Beginning in April, 1896, he says, an epidemic of Small-pox swept Havana, and by the close of the year 1897 it had caused nearly 2.500 deaths, almost exclusi- ively among the natives. Practically, he adds, small-pox has now disappeared from Havana, but is still epidemic in several parts of Cuba. “The enormous death-rate from tuberculo- sis,” says Dr. Brunner, “is a result of bad hygienic surroundings, meaning bad food, bad homes and bad morals.” The great number of deaths from dysentery and enteritis he attributes to a scant and bad food supply. With 215 deaths attribu- ted to starvation alone, the conclusion can hardly be avoided that insufficient and unwholesome food played no inconsiderable part in the mortal- ity from other disease than dysentery and enter- itis. It becomes more and more evident that we have a tremendous duty to perform in Havana in the way of sanitation. It is to be hoped that the government will take the matter in hand promptly and push the work forward with all the speed that may be compatible with thorough- ness-New York Medical Journal. THE PATHOGENIC ROLE OF DUST. Kelsch and Simonin call attention to the disease-producing properties of the dust of streets and human habitations, and cite the cases of two soldiers who, in consequence of a wound on the foot, developed tuberculous lymphangitis, followed by general tuberculosis. Both were strong men without family-taint. The authors refer to two circumscribed outbreaks of typhoid fever manifestly arising from contamination of the dust of the floor. They then describe the technic of bacteriologic analysis of dust. From the dust on the floor of one hospital they were able to isolate staphylococcus pyogenes albus and aureus, bacillus procyaneus, the pneumo- baccillus of Friedlander, and the bacillus coli communis.--Am. Year Book of Med. and Surg. TO PRODUCE DISTASTE FOR LIQUORS Time, patience, control, and study of indivi- dual peculiarities are required. Strychnine, sometimes atropine, judiciously employed, are at times useful; but there is no specific. Small doses of Atropine less than I-IOO grain hypodermically, three or four times a day, pro- duce distaste in from one to five days.--Carter Med. News, Mar., '95. The same effect is produced by ipecac, 20 minims of the fluid extract used as an hypnotic. —Waugh Med. Age., '95. THE NAEDICAL DIAL. * * Vii &xxxx xxxxx xxxx xxxxxxxx xxxxxxxxxxxx - OAKLAND . . . . HYDROGEN DIOXIDE, U. S. P. “THE KIND THAT KEEPs.” A positive and harmless antiseptic and germicide for in- ternal and external use. - Highly recommended in the treatment of diphthería, scarlet fever, and other contagious diseases. - As a prophylactic in preventive medicine it is without a peer, and may be used lavishly or sparingly according to indications without a suspicion of harm resulting from its use in any application. THE OAKLAND COMPANY., 465 Broadway, NEW YORK CITY, N. Y. ;:;§|º sNZſi3.;Z. : & : * --- * *----------- - - - - --------------Yº -------> -ºs ------ - - - - - - - - - - - ---º-º-º: -ºr-º . ~~-y . -- ----- ----- - - - - – w OQ->O2 STPQ->O2 STDC-O2STDQC-O2STDC-O-STDC-O2STDQ->OASTD DOCTOR |\\\\\\\\\ -E=1 | S N E L T H E R = - FRENCHF GERMAN It is AMERICAN MADE IN AMERICA For AMERICANs re-ºr-e-ºr-e-Prº-e-Prº-e-Prº-e-Prº-e- º : : viii THE MEDICAL DIAL. Elºiſ-Medital and ElBºiſ-SIgital ISImEllis, Manufactural D BY The Waite & Bartlett Manufacturing Co. 108 E. Twenty-Third St., NEW YORK. The Hall||By Wimshurst Hºltz Státil. Mathing Is the most powerful made, therefore, for X-Ray examinations and for a wide range of therapeutic effect, it stands unequalled. Used in the College of Physicians and Surgeons, Society of the New York Hospital, Post-Graduate Medical School and Hospital, Bellevue Medical College and Hospital, Battle Creek Sanitarium, and more by Physicians, Hospitals and Sanitariums than any other. SEND FOR ILLUSTRATED CATALOGUE. NOYES BROS. & CUTLER, Agents, SAINT PAUL, MIN N N Esota. EC 2. ENAA DOCTOR, Do Not Give Up that Case of WITHOUT TRYING . . . NOITOL., . . . Now recognized as an almost Infallible Remedy in all forms of Skin Diseases. s a vav PALM ET TO C ~ Nºn F. FC R G E N I TO-U R NARY AFF EcºTI C rºus- contains saw Palmetto, Santal and Corn Silk in an agreeable vehicle. Invaluable in Prostatic Troubles—ovarian Pains – irritable Bladder–Pre-Senility–Difficult Micturition. Samples of above sent on application to WHEELE R C H E M I CAL VORKS, - - - 158 Lake St., Chicago, Ill. Manufacturers of a general line of Pharmaceutical Preparations. BAZZI-BLAN C H I PHONENDOSCOPE Velvet-Lined case, & 4.00. Beware of Infringements. wºc, N E R Mica - Platz Statiſ, Madhinés Have no tendency to collect moisture; keep dry under conditions impossible to glass; can be depended on in damp weather, and can be run at extreme speed without danger of breakage which so increases the generating ca- pacity that we will guarantee our 4 plate, MICA, machine to do better work than any 12 plate, glass machine hav- All genuine have our name on instrument. from your dealer, or, if not in stock, from us direct. GEORGE P. PILLING & SCN, 1229 Callouhill St., Philadelphia, Sole Agents for U. S. A. Buy MARSHALLSCUMVERIBLE HUSS CSEM).3% changes into Saddle Bug (is both in º Finest, best durable leather finish outside and in (lined). Con- ing no larger discs. The arrangement of induc- tors and collecting combs makes this machine free from leakage. Its X-Ray work is unexcelled. - We make 4, 8, 12 and 16 plate. Send for Catalogue. R. V. WAGNER & CO., teuts. 14 1-oz, rubber 18 6-ºr. cork S.–total 32 bottles, with spaces between rows for pow- der napers, 2 sundºv spaces, one under each * lid. 714:29:43:234. Delivered, privilege of examination, C. 1)., bal. $8.50, or ex- press paid $9.00 if you remit s1 00 earn- Patented. em ſee. We sell Saddle Bºgs low as $475. 24 bottle, with 2 sºe. $5.50. Best Leader Buggy Casº, 26.8-dr., 26 6-dr. i 3–02, hottles in springs, 1 sundry space, $3.75. We mail full line prices and illustrations it asked for. 52-54 state street, - - CHICAGO, ILL. Address W. S. MARSHALL, Care of Exchange Bank. CENTRALIA, Lºs THE MEDICAL DIAL. ix THE ALLISON PHYSICIANS TABLE. 1899 NAO DEL. Have you seen it? This style, No. 34, our latest production, surpasses in beauty, convenience and practical utility anything of the kind ever seen. The unique design, compact and harmonious, adjustable stirrups and leg crutches, glass trays in the revolving cabinets, detachable leg rests, the simple and ingenious mechanism—rendering it noiseless in its movements and easy of manipulation—are the secrets of its popularity. It is used in the Post Graduate Schools of New York and Chicago and heartily endorsed by faculty and students—a distinction no other table enjoys. The ALLISON CHAIR has been a leader for years, and is one of the most practical and convenient chairs made. Our COMBINATION CABINET No. 61, As shown in the cut, is a marvel, uniting in a single and handsome article of furtiture an instrument cabinet, aseptic and dust proof, a medicine cabinet with swinging racks for bottles, a writing desk, drawers for bandages, and compartment for wash basin. Our revolving Instrument Cabinets, thoroughly aseptic and proof against dust and dampness, are deservedly pºpular. The ALLISDN Wall Cabinet is in great demand. Catalogue Free. W. D. ALLISON CO., Manfrs., 133 E. South Street, INDIANAPOLIS, IND. f P. & S. PA. Seeley's 41o TEMPLE COURT, MIN NEA POLIS. Organized for the Protection of Physicians and Surgeons H ard= Rubber ! and Collection of Accounts anywhere in the U. S. { T we col-LECT wh-ERE oths. Rs FAIL. traw us. | I"L1SSC - _ _ _ _ _ - == º vºv A. NT CO L-U-U M N. Se: DVERTISEMENTS will be inserted in this column at the rate - of two cents a word, with a minimum charge of twenty-five cents, cash in advance. | Dº", APPLIANCES.—A private party has for sale a num- ber of medical electric appliances in every way as good as new, State what is wanted. Address Electric, The Medical Dial. Mº: EXCHANGE.-Have you anything to sell? Do you 1. want to buy anything? Do you seek a location? Do you want an associate 2 If you do, advertise in this column. PUBLISHERS’ DEPARTMENT. Elsewhere will be found a complete list of medical books on dis- eases of women which may be ordered direct from E. H. Colegrove, 94 Washington street, Chicago. Any medical work may be had from this house at lowest net rates. Mr. Colegrove is thoroughly well posted in his line of trade and pºlysicians may rest assured they will be well-treated when wanting anything in his line. AN EMULSION. Dunglison's Medical Directory defines Emulsions as follows: “Pharmaceutical preparations of a milky-white, opaque appearance, composed of oil divided and held in suspension in water by means of mucilage.” Worcester says: “A medicinal preparation of milky appearance composed of a fixed oil divided and held suspended in water by means of mucilage. There seems to be a very general agreement that mucilage is the essential part of oil emulsions. When the physician prescribes an emulsion of fat, he attempts to present fat to the absorbing vessels of the bowels ready for immediate a bsorption. Gum Arabic and Hold the Record for Cures Our Specialty is mailing “ready to wear” trusses with directions to physicians for their private patients. A postal will bring you our Catalogue and “Mechanical Treatment of Hernia," showing too styles, also life plates. CHESTERMAN & STREETER Successors to I, B, SEELEY & CO, 25 So. 11th St. Philadelphia Gum Tragacanth (the latter generally used, and which is insoluble Wºº-º-º-º-º-º-º-º: in water), are not foods. But when emulsions are prescribed, you are compelled to give not less than fifty per cent. of these sub- compelled, in order to reach the oil, to dissolve the envelope of stances, which are known to be inert and which increase the diffi- I gum. culties of absorption. In an emulsion each oil globule receives an Hagee's Cordial Cod-liver Comp. is not an emulsion, but an ele- envelope or coating of gum, consequently the digestive fluids are gantly aromatized cordial containing all the active principles of not only compelled to break up the globules anew, but are first cod-liver Oil taken from Cod-liver Oil, without grease. i SYR.HYPOPHOS, CD, FELLOWS Contains the Essential Elements of the Animal Organization—Potash and Lime; g f t | | The Oxidizing Agents—Iron and Manganese ; The Tonics—Quinine and Strychnine ; And the Vitalizing Constituent—Phosphorus; the whole combined in the form of a Syrup with a { Slightly Alkaline Reaction. It Differs in Its Effects from all Analogous Preparations; and it possesses the importalt prop- erties of being pleasant to the taste, easily borne by the stomach and harmless under prolonged use. It has Gained a Wide Reputation, particularly in the treatment of Pulmonary Tuberculosis, Chronic Bronchitis and other affections of the respiratory organs. It has also been employed With much success in various nervous and debilitating diseases. . Its Curative Power is largely attributable to its stimulent tonic and nutritive properties, by means of which the energy of the System is recruited. 2. Its Action is Prompt; it stimulates the appetite and the digestion, it promotes assimilation and it i enters directiy into the circulation with the food products. | The prescribed dose produces a feeling of bouyancy, and removes depression and melancholy ; hence the preparation is of great value in the treatment of mental and nervous affections. From the fact, also, that it exerts a double tonic influence and induces a healthy flow of the Secretions, its use is indicated in a wide range of diseases. . - NOTICE–CAUTION. - The success of Fellows' Syrup of Hypophosphites has tempted certain persons to offer imitations of it for sale. Mr. Fellows, who has examined samples of several of these, finds that no two of them are identical, and that all of them differ from the original in composition, in freedom from acid reaction, in susceptibility to the effects of oxygen when exposed to light or heat, in the property of retaining the strychnine in solution, and in the medicinal effects. - As these cheap and inefficient substitutes are frequently dispensed instead of the genuine preparation, physicians are earnestly requested, when prescribing the Syrup, to write “Syr. Hypophos. Fellows.” r As a further precaution, it is advisable that the Syrup should be ordered in the original bottles; the distinguishing marks which the bottles (and the wrappers surround- ing them) bear, can then be examined, and the genuineness—or otherwise—of the con- tents thereby proved. - Medical Letters may be Addressed to: Mr. FELLOWS, 48 Vesey Street, New York. MEDICAL DIAL THE A Monthly Record of Medicine and Surgery. Vol. I. No. 5. MINNEAPOLIS, APRIL, 1899. $1.00 per Annum. Single Copies 10c. CONTENTS. ORIG IN FAL FARTIC. L. E. S. Paranoia—Notes from a lecture before the Senior Class of Hamline University, by C. K. BARTLETT, M. D. . . . . . . . 127 Uterine Displacements, by A. E. BEN- JAMIN, M. D. . . . . . . . . . . . . . 131 The Value of Urinary Analyses, by Roß- ERT A. CAMIPBELL, M. D. . . . . . . 135 ED ITO RI EA L. S. IS APPENDICITIS A FAID 2 . . . . . . . . 138 AN UNJUST CONclusion THE NEw EDITor of THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIA- TION . . . . . . . . . . . . . . . . . . 139 THE NEW HOSPITAL AT WINONA . . . 139 PROGRBss of MEDicine. MEDICINE. Treatment of Consumption . . . . . . . 140 Treatment of Acute Gonorrhoea . . . . . 141 Goitre . . . . . . . . . . . . . . . . . 142 SURGERY. Fracture of the Internal Condyle of the Humerus . . . . . . . . . . . . . . . . 143 Schlatter's Case of Removal of the Stom- ach . . . . . . . . . . . . . . . . . . . 1. “Electro-Haemostasis in Surgery” . OBSTETRICS. Measurement of Foetal Head in Utero . . 145 The Treatment of Normal I, abor . . . . 145 Painless Treatment of Fissures in the Nipples. . . . . . . . . . . . . . . . . 145 PEDIATRICS. Ophthalmia Neonatorum . . . . . . . . 146 Chorea . . . . . . . . . . . . . . . . . . 147 Enema Rash in Children . . . . . . . . . 147 EYE, EAR, NOSE AND THROAT. Eye Lesions in Some Diseases of the Kidneys . . . . . . . . . . . . . . . . 147 Suprarenal Capsule in Eye, Ear, Nose and 'Throat Work 1. CLINICAL, MICROSCOPY. Bacteriology of Diphtheria tº $ tº $ tº e e º 'º s HOS PITFA L. C.L.INI C. S. Asbury Methodist Hospital. Ventral Her- nia—Vesico Vaginal Fistula–Ulcer on Leg—Cancer on Head—Ovarian Tumor —Displaced Uterus—Trachelorrhaphy —Ventral Suspension—Removal of the Coccyx—Muscular Anchylosis, by F. A. DUNSMOOR, M. D. . . . . . . . . . . . 150 St. Barnabas Hospital. All Intraliga- mentous Ovarian Cyst, by A. W. AB- BOTT, M. D. . . . . . . . . . . . . . . 154 BOOH NOTIC.E.S. Annual and Analytical Cyclopedia of Practical Medicine, by CIIARLES E, DE M. SAJous, M. D., and One Hundred Associate Editors. . . . . . . . . . . . 15 Nervous and Mental Diseases, by ARCHI- BALD CHURCH, M. D. and FREDERICK PETERSON, M. D. . . . . . . . . . . . 155 C.ORRESPONDENC. E. The Symptoms of Renal and Vesical Cal- culi, as the Patient Knows Them, by Rev. PERCY M. CLARENDON . . . . . . 15 Miscellany . . . . . . . . . . . . . . . . 158 Publisher's Department . . . . . . . . . 8 ſThe Geo. J. Sherer Sign Co., -*—a. -*- ~º- -ºr- ~r 22 WASHINGTON AVE. S., MINNEAFOLIS, * *. *—a-—-dº. -*—º- —-º- *. -*- -*- -º-e -º- -—w—sº- ºr-----sº- ~g- tº -º- -*- -*- & -*. *. -*- ~----- -wºr- -º- ~~ ~~ ~~ -sº- Physicians' and Surgeons' Signs PLEASE MENTION THIS PAPER A—-º- -*. i ONE OF OUR SPECIALTI ES. - g º-º--> -º- -º- ~g- º-e- -º ~g- <> &?????????????????????????????& PHYSICIANS § liberal terms. WILL FIND OUR STOCK OF INSTRUMENTS, HOSPITAL SUPPLIES, STAPLE PHARMACEUTICAL PREPARATIONS, FINE CHEMICALS, GAUZES, DRESSINGS, Etc., Complete in every department, and Doctors favoring us with their patronage will be supplied at TRADE PRICES and on the most No charge for boxing and Cartage. Write us for terms, discounts and freight concessions. 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The New York Polyclinic, A Monthly Journal of Progressive Medicine and Surgery, edited with the co-operation of the Faculty of the New York Polyclinic Medical School and Hospital, says– ºº “We believe that, as a rule, leucorrhea is not well treated, therefore we make no apology for alluding to the treatment of so common an affection. Unless the vaginal flow be of intra-uterine origin, we know of no other means so simple and yet so effectual as the use of Pulv. Anti- septic Comp., Tyree's. It is in every way preferable to all the usual remedies used, many of which stain and are otherwise objectionable. The quality of endorsements given to this preparation are such as to stamp it as an article of unquestionable merit for the various forms of leucorrhea. Scarcely an article on this subject is being written or discussed in the medical societies but what reference is made to this preparation. Surely this is a commendable sign.” - FORMULA—Parts, sod, bor., 50; alumen, 50; ac, carbol, 5; glycerine, 5; the cryst, principles of thyme, 5; eucalyptus, 5; gaultheria, 5; and mentha, 5. Packages containing eight ounces (sufficient to make eight gallons of Standard Antiseptie Solution), 80c., obtainable from C. H. CIR KLER, Druggist, and Physicians' Supply House, Minneapolis, and from druggists generally, or direct from this office, carriage prepaid, on receipt of price. J. S. TYREE, Chemist, Washington, D. C. MN º *~~ns. º *(ºre-3/2> º- THE MEDICAL DIAL. iii A RE PUTATION MAKER! - THE KELLEY Hot AIRandvapor BATH = Every physician knows that heat scientifically applied is necessary to the successful treatment of a great range of cases. BATH No. 1. The modern method of applying Dry Hot Air or Medicated Vapor to any part of the body. The Absorbent Pad absorbs the moisture during heat exposure which admits of the patient taking much higher temperature than by any other method. The heat is perfectſy distributed and regulated within an aluminum cham- ber, flexible, especially adapted to fit any part of the body, either sitting or reclining. The burner (either gas or alcohol) inclosed in heater. Patient always has control of regulated heat up to 400 Fahr. Weight of outfit fifty-one pounds; packed in convenient case for carrying. A Wide Departure from the Expensive, Cumbersome Machines on the Market. One test on a single case of Rheumatism, Gout, Inflamation, Congestion, Neuralgia, Spinal or Joint trouble will convince any physician it is a necessary adjunct to his practice. If it does not double discount any other Method, or prove entirely satisfactory after thirty days' trial, return it in good condition and money refunded. Send for circulars. PRICE, BATH No. 1, COMPLETE, $5.OO SAM E. W. T H ARM AND Lºsºv. Enr, $8.OO stERILIZING THERMoMETER, $1.OO F. O. B. C. H. CAGO - I. W. KELLEY & Co., 6|| Dearborn Street, CHICAGO, ILL. BATH No. 2. BATH No. 1. gº d º | Willº tº Act". "Nºrts § º are taken from Cod Liver Oil, only the grease remains, and º that is of no more value than other grease. W % The virtue of Cod Liver Oil lies in its curative principles, º % Å which are separable from the grease. These active princi- |\ ples (taken from pure, fresh Cod Liver Oil), are employed W. in the manufacture of * HAGEE'S CORDIAL OF COD LIVER OIL with § HYPOPHOSPHITES OF LIME AND SODA. º º Your patients get the grease in the form of palatable food fats. § (\ W º CORD. OL. MORRHUAE COMP. (Hagee) % is dispensed in 16-oz. bottles by all druggists. * Made only by KATHARMON CHEMICAL CO., St. Louis, Mo. * \ 2). Nºëéééééééééééééééééééééééééééééé iv THE MEDICAL DIAL. MALTINE is a highly concentrated extract - MALT EXTRACTS, which are thinner than of barley, wheat and oats. Barley alone - MALTINE, are thinner for the simple is employed in the manufacture of all other malt reason that they contain more water—are not extracts, and not one of them is as highly concen- concentrated as MALTINE is and therefore are trated as MALTINE. less nutritious and more costly. line Mal TINE is rendered particularly delicious MAL TINE, aside from its great nutritive Go) and refreshing if administered with any of value, is so rich in Tiastase that a dose the aerated waters, milk or wine of spirits. readily digests all the starchy food, such as Thus a pleasing change is afforded to capricious bread, potatoes and cake, which the aberage or fastidious invalids. - adult eats at a single meal. ić WE ARE MANUFACTURERS OF - High Grade Vehicle # § } É FOR PHYSICANS USE. * Send for Catalogue Showing Different Styles. § ; If requested, we will also send addresses of a § O § ; using our work, and also what they say about it. É e H. A. MUCKLE MFG. CO., ić St. Paul, Minn. Office and Factory at Minnesota Transfer, between the Twin Cities. S/2: *ALSºM*ALSºžūºlºg2\\\**AZ$2\\\*($72.5//º/1/SºV**ALSſ2\\\**ALSſ2\\\*AL #&#&#&#{{º}}:{{º}}:{{º}}:{{º}}:{{ large number of well known medical men, who are {} O i * g >, THE MEDICAL DIAL. V. ST. PAUL ARTIFICIAL LIMB HOUSE, 27 E. Seventh Street, INVENTORS...AND MANUFACTURERS OF * Artificial 24 Limbs. We are positively the only manufac- turer in the Northwest that does not employ soliciting agents. . We are the Doctors’ Workmen. We prefer to deal direct with physi- cians, as they know the wants of their patients. § 3 ; All Surgical Appliances ; : in the line of Orthopedic work done § 1, § at reasonable prices, § ºf Z § $5 § 2 . We respectfullyſºsolicit your ë, § patronage. / § * & A JOHN McGUIRE, #. ^ COPYRIGHTEO MANAGER. S$ §. :- **s $ R$ O SS :S & Aſºº * **ss. T; Telephone 1498-4. Goodyear Rubber Co., JAMES SUYDAM, Manager, z 92, 94, 96, 98, 100 and 102 E. Seventh St., S.T. PAUL, MIN N. GOld Séal — ` Rapid Flow | | Best quality bag and tubing; reversible rectal and infant pipes; eye spray; ear and nasal tubes; bent and irrigating vaginal pipes. Manufacturers of the Sizes: 2, 3 and 4 Quarts. NorthWestern Distributers of Dr. L. WILHOFT'S (ORIGINAL LADY'S SYRINGE Made of one piece of soft rubber and constructed on the only correct principle, viz: injection and suc- tion. It is the best vaginal Syringe made. Send for Destriptive Circulars, A @ - * M @º Eureka Nahliler '' º Mounted on 34-Sawed Oak Table º > :* . . . Rºsſ. . Air-receiver of Seam- less steel, Size 10x30 in. tested to 500 lbs. Fin- ished in nickle plate for Oxidized. The most useful and practical ap- paratus ever offered to physicians for the Spétial Treatment of Chronic Bron- chitis, Incipient Consumption & all Catarrhal af. § fections of the iº Head, Throat and Lungs. Slºt tº •º º' i a | 2:… . ; * . . . . . .”.” %Kº .s . . Ǻ} Eºs º |Write for Literature. . HOLMAN, ºr ºl, la mº, Ill. º [], 0. MEDICAL BOOKS Published in 1897 and 1898. STOMACH AND INTESTINES. Ewald, C. A.—The Diseases of the Stomach. Second edition. 8vo, 602 pages. Illustrated. Net . . . . . . . . . . . . *Einhorn, Max, M. D.— Diseases of the Stomach. Second revised edition. Complete in one volume of 502 pages, post-Octavo, muslin. Net . . . . . . . . . . . . . . . . . 3.25 Hemmeter, J. C. — The Diseases of the Stomach. 8vo, 788 pages. Illustrated. Net . . . . . . . . . . . . . . . . . . . . 6.00 Illoway, H.-Constipation in Adults and Children. 8vo, 495 pages. Illustrated. Net . . . . . . . . . . . . . . . . 4.00 *Van Valzah. Diseases of the Stomach. 8vo, 675 pages. Illustrated. Net . . . . . . . . . . . . . . . . . . . . . 3.50 URINARY, RENAL AND VENEREAL DISEASES AND URINARY ANALYSIS. Kelynack.—Renal Growths. 8vo, 269 pages. Net . . . . . $4.00 *Moullin, C. W. Mansell.—Inflammation of the Bladder and Urinary Fever, 156 pages, cloth. Net . . . . . . . . . . 1.50 *Mracek.—Atlas of Syphilis and the Venereal Diseases. With 71 colored plates. Net . . . . . . . . . . . . . . . . . . . 3.50 *Purdy, C. W.-Practical Urinalysis and Urinary Diagnosis. Fourth edition. 8vo, 380 pages, illustrated. Net . . . . 2.50 Saundby, R.—I,ectures on Renal and Urinary Diseases. Sec- ond edition. 12mo, 434 pages, illustrated. Net . . . . 2.50 Senn, N.—Tuberculosis of the Genito-Urinary Organs, Male and Female. 8vo, 317 pages, illustrated Net . . . . . 3.00 Taylor, R. W.-A Practical Treatise on Sexual Disorders of of the Male and Female. 8vo, 451 pages, with 73 illus- trations and 8 plates in color and monotone. Net. . . , 3.00 White, J. W. and Martin, E.-Genito-Urinary Surgery and Venereal Diseases, 8vo, 1061 pages, with 243 engrav- ings and 7 colored plates. Net, cloth, $6.00; sheep . . . , 7.00 *Williamson. —Diabetes Mellitus and its Treatment. 8vo, 417 pages. Net . . . . . . . . . . . . . . . . . . . . . . 4.50 *Includes books published in 1898. Complete List of New Books on Application. E. H. COLEGROVE, Agt., MEDICAL BOOKS, 96 Washington St., Chicago, Ill. vi THE MEDICAL DIAL. . . mentation. not constipate. |Gi ray's GlycerineTonic Comp. (Glycerine, Sherry Wine, Gentian, Taraxacum, Phosphoric Acid, Carminatives.) . Formula DR. JOHN P. GRAY. - | Neutralizes Acidity of the stomach and checks fer= Promotes appetite, increases assimilation and does | Indicated in Malnutrition, Anaemia, Melancholia, Nervous Prostration, Phthisis, Bronchitis, Catarrhal Conditions, Convalescence, General Malaise. THE PURDUE FREDERICK CO., No. 15 Murray Street, New York. The Hollem Portable A= Hygienic Bath. Made on Strictly $333333333333333333333% Scientific Princi- % º ples a n d Fully . ~sº Guaranteed. *W* **ś There has never been an accident with our Bath, and one is impossible. 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THE MEDICAL DIAL A Monthly Record of Medicine and Surgery. Vol. I. MINNEAPOLIS, APRIL, 1899. No. 5. Original Hrticles. PARANOIA. Notes from a Lecture before the Senior Medical Class of Hamline University. By C. K. BARTLETT, M. D., Professor of Psychological Medicine. Paranoia, the subject of the lecture today, is the modern term for “monomania” of the earlier writers, or the “reasoning madness” so-called, sometimes, because the reasoning powers do not appear disordered ; and on this account it is safe to state that more persons have been judicially condemned and punished for crimes for which they were really innocent by reason of mental irresponsibility, a great many more than have been cleared, when really guilty, by the legal acumen of their counsel, or on the plea of “Mania Transitoria.” On no other form of mental disease are ex- perts in psychology so liable to differ in their opinions as to the responsibility for crimes com- mitted as in that of paranoia; and certainly no other form has given the lawyers so much lati- tude for argument, or vexed the courts with so great difficulties; and no other has led to so much confusion in legal decisions. It is not so great a cause for wonder at these differences when we consider the conditions of the persons suffering from this form of mental disease. The subject may be in his usual state of general health, and doing business with his customary sagacity, or working at his trade with others, treating his customers or his associates in his ordinary manner, and in no way attracting the attention of strangers, or those casually meet- ing him; while at the same time, and under the cover of all this apparent rational conduct, he may entertain some delusion, and so hold it for months and even years before it becomes known to the public. While doing business away from home he may seem perfectly rational, and in no way create suspicion of his real condition; but at home, and among his own family, he is very apt to show some symptoms of his malady, and will not always be able to control his feelings and conceal his peculiar mental obliquities; in fact at home is usually where he or she makes the most trouble; it is here that suspicion on the part of husband or wife begins, and misun- derstandings and wranglings continue without, perhaps, any real grounds for complaint, neither party knowing just what the causes for the dif- ficulties are. * With this state of things in a family, if it is the husband having the delusion, he is inclined to leave home without apparent cause or neces- sity, and seek work or business in different places; he may return occasionally, and seem all right for a time; but the propensity to rove about will continue, and rather increase; he will make shorter stops with his family, and in any one place, and if an unmarried man, he will become more and more indifferent towards his associ- ates; he will take less and less interest in work, and become careless as to the wants of his family if he has one, and perhaps cease to make any provision for its support; and at the same time he may not have any bad habits upon which to squander his funds, or what he may occasionally €211-11. | But the disease grows worse, and the delusion Imore prominent, and sooner or later is liable to end in some violent outbreak, or assault on some one whom he may believe the cause of his troubles. If it is the wife who is afflicted with this form of disease, although she may conceal her delu- sions for a while, they are liable to find expres- Sion, usually in accusations against her husband or some neighbor, which will gain credence until the nature of her real infirmity is fully under- stood. • *, * . ! *- * - 4 - " . º - f - s * ++ ‘. t - delusions, and usually of persecution. * * . . - Paranoia is, therefore, that form of insanity that has some conspicuous idea or delusion which dominates the mental faculties and controls the persons’ actions to a greater or lesser extent. In Greek the word means foolishness, silliness, or madness; in English the meaning is well express- ed by the term “crankiness;” and, although we may not be prepared or justified in calling all cranks crazy, still, as a class, they furnish many individual cases, if not themselves in their de- scendants, for our hospitals for insane. The dis- ease may therefore be defined as a chronic form of insanity, either acquired or inherited from a neuro-degenerative taint, characterized by fixed It differs from other forms of mental disease by not gen- erally terminating in recovery, incoherence, or dementia, at least for a long time, the patient retaining for years the ability to think and speak logically. The symptoms of paranoia differ entirely from those of our previous subject—paresis; in that form, so far as the patient himself is con- cerned, he never makes the slightest attempt to conceal his feelings or thoughts; he talks openly and at all times, expressing every thought appar- ently as it comes into his mind; but with the paranoiac it is just the opposite; he talks very little, and seldom exposes his “inner conscious- ness” as we may term it, especially in the earlier stages of the disease, even to his intimate friends; but later on he will give indications of his thoughts occasionally. - When these cases have arrived at that point in their mental condition their friends cannot bear with their abuse and accusations, perhaps threats of violence any longer, and have them committed to the hospital as insane, then follows the excitement of the relatives and acquaintances who believe the commitment unnecessary and cruel, and they will show with apparent triumph the well written, and coherently expressed let- ters of the patient, explaining all his or her con- duct and with great ingenuity and plausibility, and accusing those concerned in their commit- ment as being conspirators to gain some advant- age of property, or to, in Sonne way, further their own schemes to injure or punish them ; they will write long letters to their acquaintances, casual perhaps, to the newspapers, to the governor and other state officials, and to lawyers, seeking their aid in obtaining their release from the hospital, exaggerating their confinement as to the great hardships to which they are exposed, and the THE MEDICAL DIAL. $ cruelty of being deprived of their liberty, and the abuse to which they are subjected from brutal 11tirSes, etc., etc. To ordinary readers these letters will appear perfectly sane and proper, and to their minds seem to be such cases as should be investigated by the authoritics. Committees will be appoint- ed who will personally examine the patient with- out discovering any delusion, perhaps, unless in- structed and guided by some one familiar with the disease and the patient, and the committees may recommend the discharge of the persons, Only to return home or elsewhere to continue their usual course of irritation among those with whom they are associated. These letters, as I have mentioned, that ap- pear to ordinary readers so clear and truthful, to one accustomed to peruse the correspondence of insane persons will appear in a very different light; in them the expert in mental diseases will See an undercurrent of abnormal thought, easy enough to understand, but difficult to explain, even if he is not acquainted with the writer; he will discover this in the composition and the ar- "angement of ideas. Paranoiacs are prone to be in trouble and become involved in lawsuits, and the Germans. have a special name for these subjects—meaning “Insanity with a tendency to litigation.” They are inclined to be quarrelsome and obstinate, im– patient of contradiction, and in the advanced Stages of the disease, to interfere with the affairs of others through jealousy, or their delusions of conspiracy and persecution. IKrafft-Ebing says, “These patients are de- fective in their ethical qualities; their alleged possession of a sense of right, which they empha- size on all Occasions, is in reality reducible to a tremendous egotism which allows them to recog- nize in law only a means to their personal ends.” And Spitzka says, “They will buy law books, and even become well versed in the details of that Science; they will haunt the courts, and if defeat- ed in one will appeal to another, and if finally beaten, will become infuriated at their failures, and convinced that the judges are bribed, or are under the advice of secret societies, and they will resort to invectives and libels, and send lengthy documents to the press, or even make personal assaults on their supposed opponents and their agents.” Guiteau was a typical example of a crank, and in my opinion a paranoiac. Although the world can well spare such a man, still his trial THE MEDICAL DIAL. 129 f is thought by many to have been not only a mistake, but his conduct on the scaffold at the time of his execution a disgrace to our courts and the country. He should have been legally restrained long before he made the deadly assault on President Garfield; his father was undoubt- edly insane, and early in life the son exhibited unmistakable signs of inheriting a neurotic de- generation; he was excessively egotistical, and al- ways attempting to do something for which he had made no sufficient preparation, and always failing in everything he undertook, except in his effort on the life of the president. This case will be referred to again. Pendergast, who shot Mayor Harrison, of Chicago, was also a paranoiac, and should have been confined long before he killed the mayor. He was well known to be insane on the single subject of office, but his acquaintances considered him harmless; they trusted him too long. It is proper to make some distinction be- tween the harmless and the dangerous delusions of individuals, although it may be impossible to always know when a man with any delusion and appearing harmless, how long he may so con- tinue; but we know that many persons holding some kind of delusions go through life, doing their work well, and without attracting particular and public attention on account of their abnor- mal mental condition. There was an example of this in the case of a prominent judge in this coun- try, who held court, and, so far as his legal opin- ions and decisions were concerned, was consid- ered competent and reliable, but all the time cherished the delusion that his dead wife return- ed to him frequently and sat by his side in the evening and conversed with him. Dr. Clouston, superintendent of the Morning- side hospital, near Edinburgh, Scotland, Speaks of the celebrated case of Mr. Wild, who held an important government office and did his work well all his life, and yet had labored under the delusion of grandeur, believing that he was a son of George the Fourth, and left all his money to the town of Brighton, because that monarch Thad been fond of that place; he was held to be insane as to his will-making but Sane as to all his other actions; and the doctor adds that he 1“ . | 3 * . f \ ; CASE 3–CANCER ON HEAD. My patient, here on this table, as you see, is an elderly man, over 60 years of age, book agent. * This growth above his left ear has been increas- ing, slowly for four months. Two months ago a physician in the country lanced it, saying, “It is an abscess;” but nothing more than a little bloody serum escaped from it. Ten days ago, he called upon another physician, who told him, “You have delayed longer than you should ; it is an abscess and should be opened at once.” He made a deep incision in the tumor from above downwards, as you see by the scar, with no better results. The reason these physicians Secured no pus at the time of their incisions is because there was none there, and it is evident- ly a sarcomatous growth. The discharge which constantly flows from his left nostril indicates that this communicates with the ethmoidal cells, - either by pressure or the extension of the dis- ease to those parts. First, we shave the scalp for a distance of two inches beyond the tumor. We make an in- cision four inches in length with the center over the most prominent part of the growth. The skin flaps are separated quickly and I pass my finger down close to the skull in order to lift the growth from its bed, and we find that all Of the skull is gone, to the distance of three in- ches in length perpendicularly, and two inches in breadth, directly back from the auditory Imeatus. The lowest portion involves the mas- toid cells, which we scoop out with sharp bone curette down to tip of the mastoid process. Now, we carefully separate the mass from above down- wards close to the dura mater, snipping part of the way with the Scissors, and part of the way separating with the dry dissector. Just as we finish the dura gives way from the sinus, and as you see a terrific hemorrhage which gushes forth demonstrating that we can proceed no fur- ther in this direction. We, therefore, pack the sinus so as to control the hemorrhage, with iodo- form gauze, since there is no opportunity to se- cure any bleeding vessel. This effectually con- trols the hemorrhage, and now we go carefully over the surface of the dura with a sharp curette to be certain there is no bit of the disease left. Next cover the whole wound with sterile gauze, and apply the ordinary bandages for the reten- tion of the dressing. There is extreme probability of recurrence in such cases, although at this time it appears as if we were beyond the tissure affected by the Ca1) Cer. CASE 4–OVARIAN TUMCR. The patient who is coming in at this moment, Mrs. G , housewife, age 30, married, one child, age 6, and one miscarriage 3 years ago, has an ovarian tumor four inches in diameter in the right side. A growth of this sort is so readily removed per vaginum, and there is so much less THE MEDICAL DIAL. 151 P - w probability of contamination of the abdominal cavity, and also escape wholly the possibility of a ventral hernia, we have selected the former meth- od for its removal. With a broad retractor, I pull back the perineum and with the volsella, grasp the neck of the uterus which is drawn well forward, and with this long knife make an in- cision clear across the vagina in the Douglass Pouch, cutting through to the peritoneum. I now pick this peritoneum up with a pair of artery forceps, and one-half inch further along with an- other pair, which I hand to the assistant to hold. Drawing these apart, I snip with the point of the Scissors an opening between these two forceps; now introducing my finger through this open- ing, I cut with the scissors, the finger protecting the parts behind, until the opening in the peri- toneum is sufficiently large for me to pass two or three fingers as far as is desirable. You no- tice the blue color of the tumor which imme- diately fills the space. I reach in with a pair of volsella forceps and grasp this blue wall which immediately begins to collapse from the escape of the clear fluid which it contains. I make the rent considerable larger with a knife and pull the sack down as rapidly as possible and spear through with a needle armed with number fourteen cat gut, tie off the sack, cut the pedicle off the tu- mor, and present you the specimen. We fill the vagina loosely with gauze and the patient is im- mediately ready to be sent to the bed in the ward. CASE 5–DISPLACED UTERUS. Mrs. M., age 30, Jewess, sterile, menstruation painful, markedly in the groins, with a history of the flow stopping several times between the first and second day, patient suffering great pain before it starts. She has the neurotic symptoms of Supraorbital head–ache, dizziness, and nausea, associated with the menstrual period. Upon ex- amination we find a two-thirds normal sized ute- rus high up in the vagina, very sharply anti- flexed, conical cervix, the tip pointing upward behind the pubes. * Our treatment will consist in dilating the ca- nal thoroughly with this uterine dilator, at the same time forcibly straightening the uterus; but as we are sure that within two days after the in- fluence of the anesthetic is passed off, it would resume its ordinary shape, we introduce this glass plug which completely fills the canal and is one-third inclu in diameter. This last is acocmplished with some little dif- ficulty and is indeed the most tedious part of the operation. Pushing the cervix as far back as possible toward the Douglass Sack, we fill the vagina sufficiently with iodoform gauze to hold it in this position. We find that there is difficulty in retaining the glass stem within the canal a sufficient time to establish a complete correction of this flexion. I have ordered glass stems that have upon either side of their shoulders perfora- tions which will permit the introduction of a * - , ' , a * suture which may be stitched to the outer side of the lip of the uterus, thus retaining the pessary within the uterine canal as long as we desire. I have never yet had an infection from this ‘procedure and have had better results following the wearing of these plugs until after the next menstrual flow, than I have by any other manip- ulation for the relief of this condition. Mrs. M., housewife, age 24, married 7 years, CASE 6–FIRST OPERATION-TRACH- { ELORRHAPHY. Mrs. M., housewife, age 24, married years, one child 6 years old, one miscarriage, present trouble commenced with birth of child. Has great pain in pelvis at menstrual periods, which are regular, and during micturation has lucor- rhea and bregmatic headache; appetite good. We find upon examination a bilateral tear in the cervix extending to the vaginal junction, hypertrophy of each lip, which is studded with distended mucus follicles, and a plug of thick mucus protruding from the canal as an evidence of the existing cervical catarrh, and we premise in addition, that the inflammation extends to the upper part of the uterine canal as well. We also find the uterine body extremely retroflexed and the fundus firmly fixed in Douglas cul de sac. We make a dilation of the internal os, and with a sharp spoon, curette the entire surface of the uterine cavity, immediately applying full strength compound tincture of iodine. We now denude the area of the laceration on each side of the cervical canal, making Emmet's operation which has been given the title of Trachelorr- haphy by Dr. E. C. Dudley, who was Dr. Em- met’s student at the time Dr. Emmet was de- Scribing this operation for the relief of condi- tions like these present. We introduce cat gut stitches instead of silk worm gut at this time since we do not wish to disturb the uterus at the time it would be neces- sary to do So if stitches were used which would not become absorbed in the course of a month. This on account of the operation which is to im- mediately follow, known as ventral suspension. The vagina now is cleansed by 94 of I per cent. Solution of lysol. CASE 6, SECOND OPERATION VEN- TRAL SUSPENSION. While the interne is making the usual pre- parations for the abdominal operation, we recite the reasons which make us select the opera- tion for ventral suspension instead of Alexan- der's operation of shortening the round liga- ments. ... The latter operation, in my opinion, is especially adapted to those cases where there is a retroversion instead of a retroflexion, and where the uterus can be readily replaced, and easily maintained in the correct position by the use of THE MEDICAL DIAL. a properly fitted pessary. As I have stated be- fore, this is a case of severe retroflexion and there are adhesions posteriorly which do not permit returning the uterine body to its normal posi- tion, but which I am sure can be readily divided as soon as we have opened the abdomen. i It is a fact that a hernia follows the opera- tion of shortening the round ligaments through the inguinal region, oftener than when the oper- ation for suspension is made in the median line. Now, our patient is ready. Two strokes of a sharp scalpel expose the white line known as Linea Alba which we divide by the next move- ment; two fingers introduced into this incision separate the muscles to the extent of 1% inches, and expose the peritoneum, My assistant picks up the peritoneum upon the opposite side with Pean forceps, while I do the same upon this side, pinching that part of the peritoneum between the fingers to be sure that the intestine has not immediately followed it. The peritoneum is opened and the index finger of the right hand, is introduced immediately into the pelvis and be- gins the process of raising the fundus to its nor- mal position. The adhesions are sufficiently firm to make it better to introduce the second finger alongside of the index finger, and the two to- gether separate the adhesions which have caused the uterus to maintain its flexed position. Now that the womb is perfectly free, it is forced into its normal position. We select a point on its anterior surface about one-half inch from the juncture with the bladder, and scarify a place as large as a little finger nail at its point; now introduce one cat gut suture through the mural peritoneum, then taking one-third of the uterine structure under the lower half of this point just scarified. The needle is next made to penetrate the peritoneum on the opposite side and the suture is held by the assistant. The next stitch is silk worm gut which is introduced through the skin, fascia, muscle, and peritoneum, then into the uterus, there bur- ied for nearly one-half inch under the upper half of the scarified surface upon the uterus, and now enters the peritoneum upon the opposite side, the Imuscle, fascia, and skin coming out exactly op- posite the point of entrance at the lower part of the external incision. These two stitches will be all that is necessary to attach to the uterus. They do not in any way wedge the uterine body into the line of the incision which is made for the purpose of this operation; but simply agglutin- ates this little scarified spot on the anterior sur- face of the uterus to an area of similar extent in the peritoneum of the anterior wall, sufficient- . ly long to make an adhesion certain, and also insure that the uterus cannot escape from its Tiew position until this adhesion has become what we term a ligament, which, in time, will grow in length sufficiently to allow all the motion neces- sary for the movement of the uterus in the pel- vis. This ligament is low enough down on the surface of the womb so that it shall not inter- THE MEDICAL DIAL. . This grotesque deformity which results in , * - - .* * r * * * w .’ { - 3. . . " - - • & * * + . ~ ** . . - - ... * - HF, tº + * , º, ^, * * , * * - * fere in any way with the progress of gestation should the patient become pregnant. - In the earlier, operations the uterus was usu- ally sufficiently antiflexed to allow the stitches which maintained it in its position, to be intro- duced upon its posterior surface; as you can readily see or imagine from this description, when such a fixation or suspension was present and pregnancy occurred, there was a decided pathological condition present as a result of the operation, and in more than one case it was necessary to produce a Porro operation. The stitches necessary to close this abdominal in- cision having been introduced and the binder ap- plied, the patient is put upon a stretcher and sent to bed. - CASES 7 AND 8–REMOVAL OF THE COCCYX. The two cases which next appear require the same operation, although one is a male, age 28, carpenter, a hard working man—the other a lady of leisure. The man has excessive pain in the region of the coccyx as soon as he lies down after a day's work, and from description, it is characteristic of neuralgia, affecting the nerves in the vicinity of the terminal spine, or coccyx. The lady is 40 years of age, fleshy, housewife, multipara, has had a ventral suspension, and now has coccygodynia, which is most excruciating when in a sitting posture. The operation for the relief of this condition is exactly the same in each case, and consists in the removal of the coccyx and a portion of the first segment of the sacrum, necessarily dividing all of the nerves which would be involved upon bending the coccyx in either direction. The depth at which the tip of the coccyx is found makes it usually necessary that a drainage tube be introduced, even if the skin is brought to- gether at the uppermost portion of the wound, since there is such an opportunity for contamina- tion of the stitches from the proximity of the wound to the anus. In this case, however, we will try by buried cat gut sutures to sufficiently approminate the deepest portion of the wound, and if a good union takes place at Once, we shall avoid a sinus which usually persists for some time after this operation is made. CASE 9.—MUSCULAR ANCHYLOSIS. Mrs. S., housewife, age 19, family history negative, one child two years old, has had scar- let fever two years ago, perfect recovery, later an attack of the measles from which she never recovered. Six months ago she had the first men- strual period since the attack of the measles, limbs began to contract two years ago. She has great pain in the region of the left hip beginning some seven months ago, since which time she has progressively lost flesh until as you see, she appears little more than a skeleton covered with skin. - the flexion of both thighs tightly against the ab- domen and crowded so that the right knee is at the left of the left thigh, and each leg presses tightly down upon the posterior surface of the thigh, and each foot has the characteristic de- formity known as Equinus. Now that the pa- tient is asleep, we see that although there is suf- ficient ridgity so that we can lift her from the table, using the feet as a handle, the ankylosis is false, or due to the contracting of the muscles and tendons, and there is no true or bony anky- losis present. - We make a subcutaneous division of the fascia below the anterior spine of the ilium, and divide the tendons or each ham string, and then, by gradually extending the limbs, we find, after considerable force is applied that each leg can be brought down to a line with the body; although the knees are still crowded together by the con- traction of the adductor muscles of the thigh, and the feet show the characteristic droop incidental to paralysis of the extensor muscles of the leg. There is a scar upon the posterior surface of the 1eft hip where there has been a discharge from a psoas abscess or a bed-sore. The history which comes with her is so meagre that we could not say which ; but all of the conditions of the patient indicate that there was probably tuber- cular disease in the region of the psoas and iliacus muscles, probably at the sacro-iliac synchon- drosis. So this patient will be put upon remedies to try to cure a disease which has produced these conditions; that is to say, we will give nuclein, the syrup of hydriodic acid, chalybeates, and “stuff” her with the best nourishments which can be procured for her. Meanwhile we apply adhesive strappings which reach to the upper third of the thigh, these secured by the appliance of a roller bandage throughout the entire length of each limb. A weight of four or five pounds. will be attached to the cord which runs through the pulley and is fastened to a block inside the strapping and below the foot. As soon as this patient is put to bed and she recovers from the effect of the anaesthetic, on the return of pain, she will try to flex the limbs as far as possible to overcome the pain, which is incidental to our manipulations. We shall, of course, be obliged to continue the effect of mor- phine, to the use of which she has become ad- dicted during her illness, until after the pain, which must necessarily result from this opera- tion, has ceased, afterward the dose of opiate will be gradually reduced; and within ten days I will warrant that we shall withdraw the drug alto- gether. We shall furnish massage and passive motion daily so that there may be no further tendency to anklylosis. Yet the probability is not great for full restoration of the function of the limbs owing to the tubercular disease now ap- parently localized at the sacro-iliac juncture. Although I have kept you an hour beyond the allotted time I am sure it has been to our mutual interest. * , , , , . . " - *. * y -> ST BARNABAS HOSPITAL surger Clinic by A. W. ABBOTT, M. D. Clinical Professor of Diseases of Women in the Uni- versity of Minnesota. AN INTRALIGAMENTOUS OVARIAN CYST. This patient is 24 years old ; married three years, but never had a living child. She had a miscarriage about two years ago. This was fol- lowed by inflammation in the pelvis from which she was confined to the bed nearly a month. Since then she has had an increasing pain in both sides of the pelvis, more marked upon the right side. She is unable to work, as being on her feet brings on sharp pains and faintness. She has menstruated regularly and without much pain. The flow has been normal in amount. She is not emaciated and pulse and temperature are normal. As she is now under the anaesthetic we will make a thorough examination bimanually. I find the uterus mormal in size and position. It is somewhat fixed and upon the right side I find a globular mass as large as a lemon evidently fluctuating, immovable, with its upper limit at about the level of the horn of the uterus. I can- not feel anything like an ovary distinct from the tumor. On the left side the tube is swollen, does not fluctuate and seems to be continuous with the Ovary which I can just make out. The ovary is fixed and about opposite the middle of the uterus. What is the character of the mass upon the right of the uterus? As it fluctuates, we know that the contents are fluid ; from its posi- tion we infer it to be tubal or ovarian ; and from its globular shape that it is ovarian, and finally from its fixedness that it is either bound down by adhesions or that it is intraligamentous. This we cannot positively determine until we have opened the abdomen. The mass upon the left is evidently an inflamed tube and ovary fixed by adhesions. I make the usual median incision, and having opened the peritoneum find the omentum adherent all around the rim of the pel- vis. This I carefully separate and passing two fingers into the pelvis, find the conditions sub- stantially as indicated by the previous examina- t1On. Reginning on the left side I separate all the adhesions of the tube and ovary until I bring them up freely into the wound. You can see that the tube is twice its natural size, and that the fimbriated extremity is entirely closed and rounded. Freeing the adhesions on the right side I find that the tube lies upon the tumor, is about normal in size, but that the tumor itself seems to lie for the most part inside the broad ligament. We will now elevate the patient into Trendelenburg's position and pushing back the intestines carefully pack gauze in front of them THE MEDICAL DIAL. so as to wall off the pelvis from the rest of the abdominal cavity. Evaporation and cooling are thus prevented and if we find pus in the tubes or tumor, it will be kept from contaminating the rest of the peritoneum. On lifting the abdominal wall with a retractor we find that the tumor is a thin-walled cyst, that it is entirely ovarian and that the greater part of it is covered by broad ligament, both in front and behind. It is there- fore what we call an intraligamentous Ovarian cyst. We first tie off the ovarian artery and then put a ligature on the uterine end of the tube. We now dissect off the broad ligament in front and behind and ligate the base of the tumor which is close to the ligature of the ovarian artery which we have just applied. I now cut through the pedicle and the tumor comes away without hem- orrhage. The edges of the broad ligament are now folded together and a single stitch of cat gut will hold them in place. Having cut the tube just outside of the ligature on the tube, and having dissected the broad ligament in front of the tube, and the dissection of the broad ligament behind being begun low down, the tube was re- leased with the tumor. Upon the left side the ovary being quite healthy, we shall try to retain this organ and put the tube in as normal a condition as possible. I mow open the clubbed end of the tube with scis- sors and with this probe find that it is patulous throughout. If we should leave this tube simply opened, it would soon close again. I therefore turn the edges over and stitch them back with fine catgut. • The patient is now lowered to the horizontal position, the gauze removed, the bowels allowed to resume their natural position and the omen- tum nicely replaced and smoothed out. The per- jtoneum we sew with a running catgut suture. The rest of the abdominal wall we will close by figure-of-eight silk gut sutures. I forgot who first described this suture, but I think it is alto- gether the best yet devised. The silk gut being prepared with needles at both ends, we intro- duce one so as to include first a part of the muscle and about one centimetre of the theoa on One side. With the Other needle the Other side is treated in the same way. The sutures are now crossed and the needles carried through the fat and skin opposite to the side on which they were first introduced. The muscle and theoa is therefore included in the lower loop and the fat and skin in the upper. This insures a perfect coaptation of the muscle and especially the theca, and this latter we generally reinforce with two or three catgut sutures cut short and buried. The First International Otological Congress was held in New York City in October, 1876, and the sixth congress is announced to be held in London from August 8th to the 12th, this year. The coming session promises to be both inter- esting and instructive to the profession. THE MEDICAL DIAL. ~ :- ANNUAL ANd ANALYTICAL CycLOPEDIA OF PRACTICAL MEDICINE. By Charles E. de M. Sajous, M. D., and One Hundred Associate Editors, Collaborators and Correspondents. Illustrated with Cromo-Lith- ographs, Engravings and Maps. Philadelphia, New York and Chicago. The F. A. Davis Company, Publishers. Price, Cloth $5.00; Half Morocco $6.00. - - The first volume of the above named cyclo- paedia begins with Abdominal Injuries” and ends with “Bright's Disease.” It gives clear and prac- tical information with many illustrative cases of abdominal lesions, beginning with contusions which may frequently produce grave results, while the apparent and external effects may be slight; all these cases calling for careful inves- tigation and a reserved judgment as to a prog- nosis. Quotations from the literature of reported cases are abundant, and well adapted to throw light upon such points as will prove of the high- est advantage to the physician seeking guidance in any given case that may present itself for treat- ment. Indeed, from the numerous cases cited it would seem possible to find a duplicate for al- most any accident that could occur. Modern surgery, with prompt treatment, has saved many lives after very serious internal injuries to the abdominal organs. º - The literature concerning wounds, penetrat- ing and non-penetrating, is liberally quoted and analyzed. Wounds from military arms of mod- ern construction are fully described, and con- servative treatment advised. It has been dem- onstrated that wounds from these missiles are much less dangerous and heal much quicker than the lacerations made by the old Springfield and other rifles of earlier date. The symptoms and management of cases of abortion are thoroughly described, and the via- bility of the foetus noted. Formerly it was thought that the seventh month was the clinical age of viability; but the use of the incubator and artificial feeding has saved children born during the sixth month, and that is now considered clin- ically and legally the viable age. - Considerable space, as the interest of the sub- ject warrants, is given to the animal extracts, and especially to those of the ductless glands, “whose functions are now known to be intimately asso- ciated with metabolism, and have taken the lead over all other portions of the animal organism utilized.” - Appendicitis has received such attention as the disease rightly demands, on account of the great number of cases now diagnosed and saved by timely surgical treatment; such cases as for- merly often succumbed and deaths were report- ed under various forms of internal inflammation. Physicians will find in this volume the latest and most reliable information on the subjects *_ treated, condensed to its useful and practicaſ form. NERVOUS AND MENTAL DISEASEs. By Archibald Medical Jurisprudence in the Northwestern Uni- versity Medical School, Chicago (the Chicago Medi- cal College), Chicago; and Frederick Peterson, M. D., Clinical Professor of Mental Diseases in the Woman's Medical College, New York; Chief of Clinic, Nervous Department, College of Physicians. and Surgeons, New York. Philadelphia. W. B. Saunders, 925 Walnut Street. 1899. Price, Cloth. $5.00, net; Half Morocco $6.00. This work, is written by two authors separ- .” Church, M. D., Professor of Mental Diseases and W ately, although on subjects closely related; in fact the diseases of the nervous system and men- tal diseases are so intimately connected as to make any distinction sometimes difficult. In the opening chapters on nervous diseases, Dr. Church gives minute and practical sugges- tions concerning the systematic preliminary ex- aminations of patients as to their mental states and physical systems; physicians, following these instructions, and aided by such instruments as Science has provided, cannot fail to thoroughly ascertain all the information of the real condi. tions for the proper foundation of successful treatment. - The chapters on brain diseases and localiza- tion are full, and well describe the different con- ditions according to the most recent knowledge of these several matters. There are now so. many competent observers studying the brain and Spinal cord, that new views and new discoveries are constantly being advanced, established by ex- periments and aided by such light as disease oc- casionally exhibits. In brain tumors skiagraphy has assisted the author, Dr. Church, in the diag- nosis, and this new element in examinations may prove of greater aid in the future. IDr. Frederick Peterson, in his portion of the work, has successfully carried out his design in bringing together such matter in relation to the definition, classification, Symptomology, and treatment of insanity as to be a ready reference and of practical value to. the medical student and general practºtioner. In the classification, the author has followed that recommended by the statistical committee of the Medico-Psycological association of Great Britain for use by the medical superintendents of asylums, and also that made for the state hos- pitals for insane in New York by the state com- mission in lunacy; but he has divided the thir- teen chapters of the book among eight different topics, which has greatly simplified the arrange- 111 ent. tobiography of a paranoiac to make prominent the symptoms of that sometimes obscure and troublesome form of mental disease. . The combined work is a credit to the authors and publisher, the text being well prepared, and etiology, pathology, The author has quoted liberally from the au- .* 3 * \ ‘. . * . . the printing and the 305 illustrations clear and expressive. Students and general practitioners will be fully compensated by Owning and read- ing carefully this up-to-date treatise on nervous diseases and insanity. . —r- COrr &SpOild&IIC&. THE SYMPTOMS OF RENAL AND VES- 'ICAL CALCALI AS THE PATIENT KNOWS THEM. To the Editor of the Medical Dial:—For a layman to contribute to a journal almost exclu- sively read by the medical profession is like car- rying coals to Newcastle; it is said, however, that an ounce of experience is worth a pound of theory. | In 1883 I became aware of some impending trouble in my left kidney, from the following symptoms: A burning pain with a kind of gyrat- ing movement, i. e., winding, twisting, grinding as if determined to bore a hole through either the kidney or the body. This burning, grind- ing pain would continue sometimes for 3, 5, IO, -or more days, then it would pass away—prob- ably, for as many days. - A year later, however, the grinding, burning pain became more intense, and the intervals of cessation gradually less. I found the urine ex- tremely acid (determined by litmus paper), with large deposits of mucus and blood. At this stage I had numberless attacks of renal colic, i. e., vom- iting, purging, and increased pains in the lower part of the abdomen, immediately above the pubes. On these occasions the abdomen would be drawn in, forming a kind of a cavity about 4 inches in diameter and in the center about two inches deep—saucer form; the testicles being tightly drawn up and the tension extremely pain- ful. The last attack lasted about four nights, i. e., the attacks would begin about 7 or 8 p. m. and last to about 4 or 5 a. m., the colic ceasing dur- ing the day. After the fourth day the calculus dropped from the kidney into the bladder, from which it was voided the 3rd day thereafter. It proved to be an uric-acid calculits about the size and shape of a coffee bean. About 18 months later I again began to mic- turate more frequently, reducing the intervals from 2 to 3 hours, to 20 or 3O minutes, or even less time; and each micturition becoming more and more painful. The symptoms I experienced from the pres- ence of the first calculus appeared again, Only in redoubled form. The renal colic appeared more severe and continued longer. On former at- tacks I was, at times, much relieved by applying lmot formentations; now they seemed inadequate to allay the severity of the pain. The muscles of THE MEDICAL DIAL. extreme i } the scrotum became, if possible, more rigid; the tension, being communicated to the kidneys, hence more painful. x At this time I consulted Dr. Hurry Fenwick, F. R. C. S., 14 Saville Row, London W., who prescribed colchicum, lithium, etc., and advised me to drink daily two and one-half bottles of krönen Quelle Wasser (Crown Springs water of Germany), which I continued to do for about eighteen months. During this period of Crown Spring water, lithium, calchicum, etc., drinking (eighteen months), I voided seven uric-acid cal- culi—all formed in and voided from the kidney —yet each one voided was accompanied by sim- ilar painful symptoms and effects. For the next two years I was free from stone, and trusted I should remain so, but it was not to be, for I soon (in two years) began to feel those peculiar symptoms which once felt are never forgotten. I thought I had suffered the limits of human endurance—vain thoughts! The severity of the new and later pains were increased seven-fold. The last eigh- teen days previous to voiding this one, I suf- fered from renal colic every night, and several times I had a slight attack during the daytime, which latter I had never experienced from any of the others. I consulted Sir Henry Thompson of the Uni- versity College, London, who prescribed hot fo– mentations, home-constructed vapor baths, lithi- um, etc., however, after eighteen days of terrible sufferings, physically and mentaly, I voided a brown mulberry stone, almost circular in form, about a quarter of an inch in diameter, and an eighth of an inch in thickness; the peaks of the mulberry being much like a prickly burr. It is these sharp, thorny, prickly peaks which tear and Scratch and cause such terrible agony to the suf- ferer. It is a well known fact that a mulberry will take many times more days to “pass” than any other kind of calculi, on account of its prick- ly, thorny, sharp-edged points and edges, which Stick fast into the flesh in its passage, only mov- ing on when forced by the urine, or muscular ac- tion of the body, when it tears itself away only to fasten itself, Octopus like, onto another part, probably only half an inch further on, to begin again its cruel torch of fire and torturing but half told. - I questioned Sir Henry as to the probable cause of the rapid and frequent formation of stone in the kidneys. He replied that a person, who was indulging in such a bad habit as to grow a calculus every few months, ought to avoid all kinds of sugar-sweetened articles of diet, all red meats, all fats, butter, cheese, milk, strawberries, figs, plumbs, grapes, beer, wines, etc., in fact, avoid sugar and alcohol in any or every form, take plenty of out-door exercise, frequent bath- ings, etc. Well, most of “these things have I ob- served from my youth up”—namely:—I am a life abstainer from alcohol and tobacco. I do not drink a quart of coffee or tea in a year; for THE MEDICAL DIAL. 157 seven years I abstained from all meats, during the period of renal calculi. - For Sweetening cocoa I have always used sac- charin. For the past twenty years I have taken a Turkish or Russian bath once a month, and in the intervals a fresh water bath; I have several hours of out-door exercise every day, hence, the solidification of uric-acid and phosphates must owe its cause to some other source. To refute the diet theory Dr. F. J. Freyer, M. Ch., 46 Harley St., London W., told me that He successfully operated, for stone in the bladder, on a male child only nine months of age, the 1mother of which never had calculi troubles. Again, he told me that stone was much more fre- quently met with in India than in Europe. However, I desired to insure myself, if pos- sible, against having another caculus. I now consulted Dr. Reginald Harrison, F. R. C. S., 6 Berkeley St., London W., who, among other remedies, advised me to try Piperazine, Imade in Berlin; so, for the next eighteen months I took about twenty-five grains daily, in water; and of lithia tabloids about twenty grains daily. The latter I have now used for the past ten years, but with what success I know not except that for the next two years, after voiding the last stone, I was free from pains, and was congratu- lating myself for having overcome the awful ten- dency of biennially forming a stone. However, I had scarcely passed the two year limit, when I again felt the warning symptoms, in connection with micturition. The first inti- Imation I had was that the flow would sometimes Suddenly cease, which caused intense pain. I Soon discovered that the cause was the stone blocking up the entrance to the urethra. Here, then, was a new and sadly painful experience—a desire to micturate, yet, at times, an utter in- ability to respond. As the stone grew in size the blockage became more frequent, with the result that the inner meatus ultimately became inflamed and sore, by reason of the rough edges of the Stone being pressed against the tender flesh, and thus cutting and bruising it more and Imore, as the frequency of desire to void the urine increased, until the stone became too large to be moved or swayed by the action of the water, when it would lie on the floor of the bladder. Of other painful sensations I will add that riding in an omnibus or jolting street car, or any sudden movement, became the cause of greatly increased pain and suffering; also lying on one side or the other, whilst in bed, had to be con- tinued on the side first chosen, for as the body turned SO would the stone turn and roll, and in its rolling around in the bladder would cause untold suffering. One would think these painful experiences, marrated in the foregoing, were about as much as One could bear, but not so; for there is still a imore painful one than heretofore described, namely:-at the end of micurition the meatus would burn as if hot scalding water or acid were passing, and, as if there had been red hot needles pricking the meatus. Now, surely this is the limit of human suffering! Vain thought—turn the screw yet another thread, says this merciless stone evil; for it frequently happens, especially in phosphatic formation, that a small fragment will break off, varying in size from a pin-head to that of a pea, and slowly wind its way through the urethra, often getting stuck in its passage, and taking from five to fifty hours in passing Out; and in its passage cutting, tearing and lac- erating tender and bruised flesh. Of these small pieces of salt-like fragments, I have voided perhaps over one hundred. . . . After thus suffering for about two years I consulted Dr. F. Swinford Edwards, 55 Harley St., London W., who advised an immediate op- eration by lithotrity—Dr. Bigelow's process. This stone crushed in the bladder, was an uric nucleus with a phosphatic covering, weighing nearly 700 grains. In this operation Dr. Ed- wards was ably assisted by Dr. Hurry Fenwick, of I4 Saville Row, London W. \ About a year later I was operated on a sec- ond time for another stone in the bladder. Dr. Edwards, with the eminent assistance of Dr. Reginald Harrison, of 6 Lower Berkeley St. W., London, performed this second operation. A year later I was operated on again for a third cal- culus, this time by Dr. Arthur Dean Bevan, of Chicago; and about 6 months later for a fourth, again by Dr. Bevan, and two days later Dr. Be- van discovered two more phosphatic stones, which he crushed and extracted by the litho- tritic operation. Four months later, February 9th, 1899, I underwent in Minneapolis my sixth operation under the care of Dr. J. W. Macdonald, F. R. C. S., assisted by Drs. Hoegh and Dewar, and up to the present time I am free from symp- toms of recurrence. I am sincerely yours, (Revd) Percy M. Clarendon, Minneapolis. It is said that cider effectually exterminates the typhoid fever bacilli. “Dr. Blank is a specialist, is he not? What’s his specialty?” “He has two—consultation and fees.” In September, 1899, it is planned to hold an international conference for the prophilaxis of syphilis and venereal diseases, in the city of Brus- sels, Belgium. i St. Louis now has a medical library of which the physicians there are proud. The member- ship is divided into three classes, viz.: (1) life, on payment of $100; (2) active, on payment of $25 the first year, and $5 annually; and (3) associate. on payment of $5 for the use of the library. The last have no voice in the conduct of the business of the association, There are already about seventy-five members or more. - z' - - . . . . ; “ - * , * * --- xxx. * * * ; : . 158 * t - .* - * * > . . .” • $ ‘2:... . . * * * < Iniscellany. sº THE MEDICAL THE MICROBE. * A. Since the fall of man we've dosed our kith and kin, boil’d Our herbs as potions for their } ills; We've striven to get the upperhand of sin, With infusions, and with tinctures and with pills; But we've kept a-dying younger all the time, The av'rage limit's now three score and ten; Methuselah roll’d up his hundreds nine, But the microbe wasn’t down to business then. Here's to you, little microbel and your chum— } - the bacillus; We are “on to you,” but ages you have been “a-doin’ us.” Here's to you little microbe in your secret hab- itats, Whilst you’ve been absorb’d in business, we've t been “talking thro’ Our hats.” We’ve No! He never thought of danger in the least, He thought he knew enough to save him whole; He mingled with the rev’ler at the feast, And enjoy'd the fairy function heart and soul. He went into the spirit of the toast, And got into the body of the guest; He was always very partial to the host, For he'd entertain with zeal nor ever rest. Here's to you, little microbel and the cocci and the spore, You’re a microscopic robber, that's kill'd lots and’s after more ; Here's to you little microbe you Frenchman epileptic, We have Waterloo'd you squarely with the Lis- ter antiseptic. He was dipping in our victuals constantly And a bathing in the water of the well; It was dangerous to eat and drink you see, And to tell the truth 'twas hardly safe to smell; For he'd float upon the breezes we'd inhale; Yes! he'd ride upon the cushions of Our bug - He was happy as a prisoner out of jail, In his palanquin upon the chubby pug. Here's to you, little microbe with your confi- dential style; We couldn’t navigate you 'till we had your chart on file; Here's to you, little microbe you are no ac- quatic sport, - In the antiseptic ocean you can never get to port. There's no doubt you have a sphere legitimate, But the colon we maintain is sacred ground : ſ DIAL & \ { And we're going for our antiseptic kit, Every time we know that you're a-fooling round. We don't want you in our stomach or our chest; - • ' || We won't have you in our liver or our spleen, / Get into our pancreas, if you think best, But remember that our antiseptic's keen. A Here's to you, little microbel you're no sluggard in a fight, You used to be a slugger, and a wrestler out of sight; - Here's to you, little microbe we can box and twist you now. With the Lister antiseptic you're “not in it,” in 2. TOW. And here's to you, little microbe I tho' your star is on the wane * And you’ll never be the aggressive social poten- tate again. Here's to you, little microbe for your death we’ve cast the die, Tho' we still must hold your mem'ry blazon'd on Sarcophagi. —(Maritime Medical News.) M. H. A. The Ninth International Congress of Oph- thamology will be held in Utrecht, August 14th to 18th, inclusive. The English, German and French languages will all be official at this gath- ering. It is announced that a very large exhibit, for the examination of the physicians in attendance, will be made at the meeting of the American Medical Association at Columbus. The manu- facturers and agents of preparations and medi- cal appliances are, it is said, making more effort this year than ever before to show the respective merits of their goods. The Mississippi Valley Medical Association will hold its twenty-fifth annual meeting at Chi- cago, September 12th to I5th, inclusive. An elaborate program has been prepared for the occasion and it is anticipated that it will be a notable gathering of well-known disciples of Es- culapius. Dr. Henry E. Tuley of Louisville, is the secretary, to whom titles of papers should be sent early to secure places on the pragram. The following medical societies of Minnesota are entitled to representation in the American Medical Association : The Minnesota State, Cross River Valley, Fillmore County, Hennepin County, Interurban, Olmstead County, Ramsey County, Southern Minnesota, South-Western, St. Louis County, Wabasha County, Winona County, medical societies; the Minnesota Acad- emy of Medicine, and the Minnesota Valley Medical Association. It is to be hoped that all these organizations will be well represented in the meeting in Columbus, Ohio, which convenes June 6. the MEDICAL DAL vi saxxx xxxxxxxxx xxxx i OAKLAND HYDROGEN DIOXIDE, U. S. P. “THE KIND THAT KEEPs.” & *& s Né} *t A positive and harmless antiseptic and germicide for in- ternal and external use. Highly recommended in the treatment of diphthería, scarlet fever, and other contagious diseases. As a prophylactic in preventive medicine it is without a peer, and may be used lavishly or sparingly according to indications without a suspicion of harm resulting from its use in any application. - THE OAKLAND COMPANY., 465 Broadway, NEW YORK CITY, N. Y. | & DOCTOR Mwawa * Tº S N E ITH ER = - : FRENCH* GERMAN * It is AMERI cAN MADE in AMERICA For AMERICANs| Gº-Osº. DCſ-Ost DGſ-Ost DGſ-Ost DGº-Osº. DCſ >O< DGſ-Osº : : 2 : S . . ." * , - - \ f * * * - - * * viii. * , * # PUBLISHER'S DEPARTMENT. RHEUMATISM. Dr. George White, of Chicago, in a recent article on rheumatism, has shown that the pro- fession stands largely in the dark as to the na- ture and true cause of the affection. In many cases which were capable of being diagnosed as rheumatism, he found clinical his– tories which were wholly incapable of scientific grouping. He regards the affection, as it is com- monly seen, as due in the largest number of in- stances to an excess of uric acid in the blood, or to syphilis, and in some cases all the symp- toms seemed to Owe their existence to the stru- mous diatheses. In the treatment of the disease the particular causes are, of course, zealously sought and treated, and relief from pain guaranteed. The best constitutional remedy Dr. White has found to be Henry's Tri-iodides, which is justly con- sidered, not only by him but by other observers also, as the efficient alterative. The Pulvola Chemical Co., New York, have opened up a new era in the therapeutics of exter- nal medication. Their little brochure on “Dolo- mol Compounds in Dermatology Syphelography etc.;'' is a dignified, scientific presentation of the subject of dry treatment of diseases of the skin and its therapeutic index is a comprehensive guide to the solution of many vexed questions in the treatment of many cases that come to the attention of the general practitioner. They al- so are sending out half tone illustrations of photomicrographs contrasting the crystaline tal- cum with the truly impalpable Pulvola. Consul Skinner announces that an eminent physician, Dr. Calmette, of the Pasteur Insti- tute of Lille, has discovered an antivenomous serum, that is effective at any time within four hours after the bite. THE MEDICAL DIAL. | THE PROPER TREATMENT OF HEAD- º ACHES. J. Stewart Norwell, M. B., C. M., B. Sc., House. Surgeon in Royal Infirmary, Edinburgh, Scotland, in an original article written especially for Medical Reprints, London, Eng., reports a number of cases of headache successfully treated, and terminates his article in the following lan- guage : “One could multiply similar cases, but these will suffice to illustrate the effects of antikamnia in the treatment of various headaches, and to warrant the following conclusions I have reached with regard to its use, viz.: - (a) It is a specific for almost every kind of headache. - - (b) It acts with wonderful rapidity. (c) The dosage is small. (d) The dangerous after-effects so common- ly attendant on the use of many other analgesics are entirely absent. - (e) It can therefore, be safely put into the hands of patients for use without personal super- vision. (f) It can be very easily taken, being prac- tically tasteless.” Advertising rates in The Medical Dial made known on application. gºggººgéºgègeºgéºgège; LOWERS... BEAUTIFUL ROSES CARNATIONS LILIES and a11 the flowers in their season. Easter flowers in abundance. Funerals a specialty. Telegraph orders for funerals and parties promptly filled. Seeds and other florist supplies. Send for Catalogue. - M En DEN HALL GREEN Houses, First Ave. S. and 18th St., or City Store, 414 Nicollet Ave., Minneapolis, sº Minnesota. # § § #S āşäriääriääriääriääriääriääriääriäää LEADING DRUGGISTS OF NAINNEAPOLIS. §§§§§:SAS:S:S:S:S^2\}|S:S:S:SãS:S:SãS:S:S:S:S:S:S:S º w - 3S 3S c4ccuracy and Quality Guaranteed. §§ # WANOUs PHARMACY. § MAIL ORDERS SOLICITED. §§ §§ - §§ à Miss Wanous, 2d Floor, 521 Nicollet Ave., Tel. 1228. à ŽSãSžSžS: S: S: S: S:[S; S:S:S: S: S:[S; S: S: S:[S:S:S:S: S: S: S:[S:S { } Iſº- O PHX N A LIL NIG E HT, *{{! : # WEBSTER & CHACIRCHILL, ! : The V 14 B D C : { g g i. º i: Under Nicollet House, Minneapolis, Minn. # # PREscription DRUGGists. * ! * . .” - . .” - -2- -------> -->~ ! : 2 and 4 WASHINGTON A.V. E. S., COR. HENNE PIN. : # Careful attention given to Physicians’ Prescriptions. | t We carry the nost º º: ºriºus in the Northwest. : Mau Urqers Promptly ruled. - |-- -Q- -º-º- *::: = @-e- ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~4 A THE MEDICAL DIAL. - ix. - James V. Tabor, M. D., Hodgſon, Me, writes: It affords me great pleasure to speak of Cord. Ol Morrhuac Comp. (Hagee) as ahead of all Cod-liver Oils and Emulsions that I have ever prescribed. It is really a cordial for young and old; and from the happy combination of its ther- apeutic properties, it imparts benefit in every case for which it is recommended. Mºva N.T. cº L-L M. N. D VERTISEMENTS will be inserted in this column at the rate of two cents a word, with a minimum charge of twenty-five cents, cash in advance. | Dº", APPLIANCES.-Aprivate party has for sale a num- ber of medical electric appliances, in every way as good as new. State what is wanted. Address Electric, The Medical Dial. EDICAL, EXCHANGE.-Have you anything to sell? Do you want to buy anything? Do you seek a location? Do you want an associate? If you do, advertise in this column. *~~~~~~~~~~~~~~ “STEVENS FAVORITE” IERI FILTE. _ It “Takes Down.” * 22-inch barrel, weight 44 pounds. Q () Carefully bored and tested. For 22, .25 and .32 rim-fire cartridges. No. 1 7. Plain Open Sights, $6.00 No. 18. - Ask your dealer for the “FAVO- RITE.” If he doesn't keep it we º price. Send stamp for complete cata- O º Target Sights, $8.50 will send, prepaid, on receipt of logue showing our full line, with val- uable information regarding rifles and ammunition in general. J. STEVENS ARMSMNI)'''[[]], [[], _º P. O. Box 91.6 CHICOPEE FALLS, MASS. eeley’s Hard= Rubber Trusses fºr-º-º-º: S m Tº indicate THE GREATEST GOOD to the (iPEATEST NUMBER Individuality must not be overlook- ed—each sufferer requires particular consideration. Our successful “truss by mail” system is the fruition of 30 years’ experience. Life Plates and catalogue mailed on request. Chesterman & Streeter Successors to I. B. SEELEY & CO. 25 S. 11th St. º ºvº º Aºyººyº ElBºiſ-Mºſlical Allſ. ElBºiſ-SIgital listillmºlis, Aſ Manufacturae o E-Y The Waite & Bartlett Manufacturing Co. 108 E. Twenty-Third St., NEW YORK. sº º | : º- The Hallºy Wimshlſst Hºlt, salt Mathis NOYES BROS. & CUTLER, Is the most powerful made, therefore, for X-Ray examinations and for a wide range of therapeutic effect, it stands unequalled. Used in the College of Physicians and Surgeons, Society of the New York Hospital, Post-Graduate Medical School and Hospital, Bellevue Medical College and Hospital, Battle Creek Sanitarium, and more by Physicians, Hospitals and Sanitariums than any other. SEND FOR, ILLUSTRATED CATALOGUE. Agents, SAINT PAUL, MIN N N Esota. the Medical diAL. *_*-*-******** ****** ALWAYS RELIABLE. NO DETRIMENTAL AFTER-EFFECTS. --- - IT HAS BEEN PROVEN BY CHENAICAL TESTS THAT } * N E U ROS IN E : : is the most effective and Safest Hypnotic yet known to the profession, and whereas it con’ſ AINS NO MORPHINE, CHLORAL OR OPIUM, there can be no detrimental after-effects. Always of the same consistency, therefore may be relied upon to produce the same results under similar conditions. It is only necessary for physicians to give NEUROS! N E a trial and they will be con- vinced that it is the standard remedy in the treatment of all forms of nervous disturbances. In Uterine troubles it should be combined with DIOVIEURNIA. Beware of substitution. When prescribing, signify (Dros.) Dos E: One teaspoonful to a tablespoonful three or more times a day, as indicated. Our new illustrated booklet, “Treatise on Neurasthenia,” mailed on application. DIOS CHAEMICAL CO., St. Louis, Mo. J-ºr-º-º-º-º-º-º-º-º-º-º-º-º-º-º-º-º-º-º-º-º-º-º-º-º-º-º--A M D Stands for ‘Doctor of &Medicine. Col FAX IMAINERAL WATER - º - - A natural Spring Water, Carbonated or Still. Stands for 3/Medical Dial. 1. One of the BEST REMEDIES on the market “ United we stand; divided we fall.” FOR cases of CONSTIPATION, Etc. - - - - - bscribe – one Do11 - - *A*.*.*sº& *"º". º †. *" THE GLEN wo OD-INGLE wooD co., Minneapolis, Minn. N. W. AGENTS, 303 Hennepin Ave., Minneapolis. Statiſ, Machines Velvet-Lined case, &4.00. Beware of infri ts. Have no tendency to collect ew ringements - - All genuine have our name on instrument. Buy moisture - keep dry under from your dealer, or, if not in stock, conditions impossible to from us direct. lass; can be depended on § damp weather, . can be GEORGE P. PILLING & SON, run at extreme speed without | 1229 Callouhill St., Philadelphia, Sole Agents for U. S. H. danger of breakage which so increases the generating ca- y pacity that we will guarantee MARSHALL S [[]NVERTIBLE BUGGY [ASE N0. 3? our 4 plate, MICA, machine º changes into Saddle to do better work than any ºf 2-º Bag (is both in one). 12 plate, glass, machine hav- fº ºn". ing no larger discs. The arrangement of induc- tors and collecting combs makes this machine free from leakage. Its X-Ray work is unexcelled. We make 4, 8, 12 and 16 plate. Send for Catalogue. 32 bottles, with spaces between rows for pow- der papers, 2 sundr spaces, one under eac * lid, 7%x2%x2%. Delivered, privilege of examination, C. O. D., bal. $8.50, or ex- press paid. º,00 in **.*... sº";"º"..."; - sell Saddle Bags low as 5, 24 bottle8 w tº "...º.º. ººr. R V R - , $3.75. W A. G N E & ( O 4. *ś º ºflºo. # asked for. - - - --> Address W. S. MARSHALL, 52-54 state Street, - - CHICAGO, IL.L. Care of Exchange Bank. CENTRALIA, Lºs THE MEDICAL DIAL. xi THE ALLISON PHYSICIANS TABLE. - 1899 NAODEL. Have you seen it? This style, No. 34, our latest production, surpasses in beauty, convenience and practical utility anything of the kind ever seen. The unique design, compact and harmonious, adjustable stirrups and leg crutches, glass trays in the revolving cabinets, detachable leg rests, the simple and ingenious mechanism—rendering it noiseless in its movements and easy of manipulation—are the secrets of its popularity. It is used in the Post Graduate Schools of New York and Chicago and heartily endorsed by faculty and students—a distinction no other table enjoys. The ALLISON CHAIR has been a leader for years, and is one of the most practical and convenient chairs made. Our COMBINATION CABINET No. 61, As shown in the cut, is a marvel, uniting in a single and handsome article of furtiture an instrument cabinet, aseptic and dust proof, a medicine cabinet with swinging racks for bottles, a writing desk, drawers for bandages, and compartment for wash basin. Our revolving Instrument Cabinets, thoroughly aseptic and proof against dust and dampness, are deservedly popular. - The ALLISDN Wall Cabinet is in great demand. Catalogue Free, W. D. ALLISON CO., Manfrs., 133 E. South Street, INDIANA POLIS, IND. A. C. DICE, Dist. M ngr., 816 Dayton Blog., Minneapolis. FORMUL.A.: THERAPY: Each fluid drachm - H E N R Y "S Tonic, Stomachic, Anti-Scor- contains: butic, Haematinic and Altera- 1-8 gr. Proto-Chloride Iron, T H R E E C H LO R DE S tive. - * Indicated in Anaemias, Chloro- 1-128 gr. Bichlor. Mercury, - * -- ***. 1-280 : Chloride Arsenic, –Liq. Ferrisenic Henry's— S1S, and as a. reconstructive 111 Calisaya Alkaloidal Cordial. convalescence from any cause. Adjuvant to lodides. THE GLANDULAR STIMULANT Makes Quarv Tu-TY Awd QL/AL/TY of ELoop. 12 ounce bottle, $1.00. and CHALYBEATE TONIC. DoSE—1 or 2 drachms. THERAPY: FORMUL.A.: In Lymphatic and Visceral H E N R Y "S Colchicin, 1-20 gr. Disturbances a Uric Acid Sol- Decandrin, 1-10 grain. vent and a Reliable Eliminant - Solanin, 1-3 gr. in a11 Diathetic Diseases. T R |- O D D E S. Sodium Salicylate, 10 grs. One or two fluid drachms in - * -- Iodic Acid (ºgual to 7-32 gr. water exercises a synergistic Liq. Sali-iodide Henry's of Ioding in two fluid effect over the entire drachins romatic Cor- Anti-Rheumatic range of the ALTERATIVE, ſ :- ****** Salicy ſates and lodides. | Anti-Syphilitic. of Maizenic * Corn Sº resulting in IN Genito - Urinary Diseases, M Al Z O - L|T H |U|M|. The . Cystitis, Incipient Diabetes, Lithaemia, Urethritis, and all A POSITIVE DIURETIC Inflamed Conditions requiring AND a Non-Irritating Diuretic. GENITO-URINARY SEDATIVE. Invalid's Dietary on application. HENRY PHARMACAL COMPANY., uisville, Ky. xii THE MEDICAL DIAL. N. º SYR.HYPOPHOS, CD, FELLOWS Contains the Essential Elements of the Animal Organization—Potash and Lime; \ The Oxidizing Agents—Iron and Manganese ; t } The Tonics—Quinine and Strychnine ; And the Vitalizing Constituent—Phosphorus; the whole combined in the form of a syrup with a Slightly Alkaline Reaction. It Differs in Its Effects from all Analogous Preparations; and it possesses the important prop- erties of being pleasant to the taste, easily borne by the stomach and harmless under prolonged use. It has Gained a Wide Reputation, particularly in the treatment of Pulmonary Tuberculosis, Chronic Bronchitis and other affections of the respiratory organs. It has also been employed with much Success in various nervous and debilitating diseases. Its Curative Power is largely attributable to its stimulent tonic and nutritive properties, by means of which the energy of the system is recruited. Its Action is Prompt; it stimulates the appetite and the digestion, it promotes assimilation and it enters directiy into the circulation with the food products. The prescribed dose produces a feeling of bouyancy, and removes depression and melancholy ; hence the preparation is of great value in the treatment of mental and nervous affections. From the fact, also, that it exerts a double tonic influence and induces a healthy flow of the Secretions, its use is indicated in a wide range of diseases. \ NOTICE—CAUTION. The success of Fellows' Syrup of Hypophosphites has tempted certain persons to offer imitations of it for sale. Mr. Fellows, who has examined samples of several of these, finds that no two of them are identical, and that all of them differ from the Original in composition, in freedom from acid reaction, in susceptibility to the effects of Oxygen whº exposed to light or heat, in the property of retaining the Strychnine in solution, aſ Ain the medicinal effects. As th: *leap and inefficient substitutes are frequently dispensed instead of the genuine pſ `, physicians are earnestly requested, when prescribing the Syrup, to noS. Fellows.” precaution, it is advisable that the Syrup should be ordered in the distinguishing marks which the bottles (and the wrappers surround- then be examined, and the genuineness—or otherwise—of the con- d. Medical Lettº ; may be Addressed to: Mr. FELLOWS, 48 Vesey Street, New York, tº MEDICAL DIAL THE A Monthly Record of Medicine and Surgery. Vol. I. No. 6. MINNEAPOLIS, MAY, 1899. $1.00 per Annum. Single Copies 10c. CONTENTS. ORIG INTFA. L. R. RTIC.L.E.S. Gall-Stone Surgery, by KNUT Hoeg H, BFHRENS, M. D., . . . . . . . . . . . 168 ED ITO RIYEAL. S. - THE COMING LIGHT, . . . . . . . . . . 170 DISEASES OF THE AGED, . . . . . . . . 170 REPORTS OF SOCIETIES. The Hennepin County Medical Society, . 172 American Medical Association—Program of the June Meeting, . . . . . . . . . . 173 PROGRESS OF NAEDIC INE. SURGERY. The Use of Calcined Bone in Bone Repair —A Fatal Intestinal Obstruction—Tor- sion of the Mesentery, GYNECOLOGY. Suprapubic Hysterectomy with Intraperi- toneal Treatment of the stump in Preg- nancy at Term for Obstructed Labor, . 174 OBSTETRICS. On the Occurrance and Significance of Post-Natal Transfusion — Eclampsia— Treatment of Post-Partum Hemor- rhage, . . . . . . . . . . . . . . . . . 175 PEDIATRICS. The Management of the Fever of Pneu- monia, . . . . . . . . . . . . . . . . . 176 NEUROLOGY AND PSYCHIATRY. Biological Conditions of the Parents of Epileptics — A case of Lisseminated Schlerosis with Unilateral Tremor— Motor Paths in the Brain and Cord of the Monkey — The Toxicity of the Blood in Epilepsy, . . . . . . . . . . . .177 CLINICAL, MICROSCOPY. Results of a Blood Study of Trichinosis— Influenza Bacillus, . . . . . . . . . . . 181 HOS PITYFAL. C.L.INI.C.S. Surgical Clinic by A. W. ABBOTT, M. D., at Asbury Methodist Hospital. Alex- ander's Operation—Double Vulvo-Vagi- nal Cysts — Conservative Surgery of the Adnexae, . . . . . . . . . . . . . . 182 BOOK NOTIC.E.S. The International Medical Annual and Practitioner's Index, . . . . . . . . . . 185. IDL E MONAER.T.S. Blunders Made by People in Trying to Use Medical Terms, by A. T. Conley, M. D., Publisher's Department, . . . . . . . . . X. fihe Geo.J. Sherer Sign Co., ! 22 WAsHINGTON AVE. S., MINNEA POLIS, -º-e gº MIN N. ... Pºsicians'anisms. Sims Physicians' and Surgeons' Signs ONE OF OUR SPECIALTIES. f PLEASE MENTION THIS PAPER. f -º-º- -º-º-º-º-º-º-º- $22%22%22%22%22%22%22%22%23.22%22%22%22%22%22%22%22%22%3 PHYSICIANS liberal terms. § § § § § § § § WILL FIND OUR STOCK OF INSTRUMENTS, HOSPITAL SUPPLIES, STAPLE PHARMACEUTICAL PREPARATIONS, FINE CHEMICALS, GAUZES, DRESSINGS, Etc., Complete in every department, and Doctors favoring us with their patronage will be supplied at TRADE PRICES and on the most No charge for boxing and cartage. Write us for terms, discounts and freight concessions. Soliciting your favors, we are, Yours very respectfully, CROLIUS, TUCKER & ALLEN CO., Wholesale Physicians’ Supplies and Surgical Instruments, NWasonic Tennple Building, 3-3 The only Exclusive Physicians' Supply House in the Northwest º NWINNEAPOLIS, NWINN. ii THE NAEDICAL DIAL. . . . THE NAME. . . MCIN TOSH IS A GUARANTEE, M*INTESH CHILADD]. LOOK AT THIS FROM TEN TO FIFTY PER CENT R EDUCTION. X-Ray Apparatus, STATIC MACHINES, OFFICE TABLE PLATES, PORTABLE BATTERIES, ELECTRODES OF EVERY DESCRIPTION. our 19th edition Catalogue, just issued, contains new REDuced prices, new literature, and gives cuts and descriptions of the very newest and improved electro-medical apparatus. This Catalogue will be mailed to physicians upon request, Post PAID, witHout cHARGE. Write for it. McINIOSH BATTERY AND OPTICAL CO., *****!º **** | Tyree's ANTiSEptic Powder ºf / The New York Polyclinic, A. º Journal of Progressive Medicine and Surgery, edited with the co-operation of the Faculty of the New York Polyclinic Medical School and Hospital, says– “We believe that, as a rule, leucorrhea is not well treated, therefore we make no apology for alluding to the treatment of so common an \ affection. Unless the vaginal flow be of intra-uterine origin, we know of no other means so simple and yet so effectual as the use of Pulv. Anti- septic Comp., Tyree's. It is in every way preferable to all the usual remedies used, many of which stain and are otherwise objectionable. The quality of endorsements given to this preparation are such as to stamp it as an article of unquestionable merit for the various forms of / leucorrhea. Scarcely an article on this subject is being written or discussed in the medical societies but what reference is made to this preparation. 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Trained Nurses. §: 406 Phoenix Building, MIN NEAPOLIS, MINN. #|| º Eºſ i The institution is delightfully located, with a 10ng, wide veranda, inclosed in the winter season in glass, and is equipped with mod- ern conveniences, as Elevator, Electric Light and Electric Bells, Large Parlors. y For terms, address TH E san ATO RIU M. THE MEDICAL DIAL A Monthly Record of Medicine and Surgery. Vol. I. MINNEAPOLIS, MAY, 1899. No. 6. Original Hrticles. * GALL-STONE SURGERY. By KNUT HOEGH, M. D. Professor of the Principles of Surgery and of Clinical Surgery in Hamline University. There is a certain analogy between diseases of the biliary system and those of the urinary system. There are the physiological excretion of normally aseptic ſluids, which by infection may become septic, a tendency to formation of concrements, painful crises of a colicky nature, a liability to inflammations of the canals with danger of extension in continuity of tissue, a chronic impairment of health, a difficulty of diagnosis—in fact, a number of conditions that produce similarity. At the same time there are great differences, mainly owing to the fact that while the urinary system is only partly covered by peritoneum, the whole gall-produçing ap- paratus is intraperitoneal. As a consequence of this difference, surgeons have boldly at- tacked urinary stones from remote antiquity, while the surgery of the gall apparatus has been allowed to lie fallow, until a couple of decades ago. While the presence of stones is the most common indication for operations on the bil- iary system, it is not the only one. Traumatism with subcutaneous rupture of the bladder or ducts, followed by effusion of bile into the peritoneal cavity, demands prompt surgical in- terference; as soon as the presence of bile in the peritoneum is established by the demon- stration of an intra-abdominal fluid, after a severe contusion in the region of the right hypochondrium, evacuation of the bile becomes imperative. The bile may be found free in the lower part of the abdomen, or it may form a swelling in the right hypochondrium; symp- toms of shock will necessarily be present; --- * Read before the Hennepin County Medical Society. some degree of peritonitis with distension of the abdomen; icterus (from resorption of bile by peritoneum), occasional absence of bile in feces—these will be the leading symptoms. The injury is of course very often fatal, but quite a number of cases have recovered. How- ever, no case is known to have got well except when the bile has been removed by puncture or incision followed by drainage. In the reported cases the puncture was usually performed to relieve the patient from the enormous disten- sion which seriously interfered with respira- tion; in some cases it had to be repeated sev- eral times. Effusion of normal bile into the peritoneum is, consequently, not by itself a very dangerous incident; it does not lead to suppurative peritonitis, but rather to a sero- fibrinous one, with formations of adhesions. Its proper treatment is aspiration, if necessary, repeated; if there are adhesions, then incision with drainage. It will always be difficult to diagnosticate the seat of the rupture; if it is the gall-bladder, it would seem to be good surgery to perform laparatomy and extirpate the gall-bladder. The most common cause of disease in the biliary system is connected with the produc- tion of stones. There have been various the- ories as to the origin of stones. Mr. Waring in his “Diseases of the Liver” concludes that Stones usually depend upon some obstruction to the flow of the bile. Naunyn in his “Klinik der Cholelithiasis” mentions the effect of micro- Organisms. It is probable that these two causes are in a certain way mutually depend- ent upon each other, and that they are the leading etiological factors. The gall-bladder is a reservoir that is only occasionally emptied; if it cannot completely Void its contents, Owing to some obstruction or to muscular inefficiency, micro-organisms find an almost ideal breeding place where all condi. tions favor formation of concrements. * . . . . . . * . -- ", . º. 3; * * , - -> Not all gall-bladders are possessed of the same degree of expulsive power. In this rela- tion attention should be directed to a peculiar feature in the history of gallstones. It is well known that they are more common in females, and in the aged. .* Why is this? May it not be that it is be- cause the gall-bladder in these two classes is more apt to have its muscular and expulsive strength impaired? In women laxity of the abdominal wall is apt to follow from repeated childbirths, from obesity, and from a congen- itally less developed muscular system. When the intestines lose their normal support of the abdominal muscles, they are apt to fall for- ward; they are thus unduly dilated, and circu- lation in them is then impaired. This is fol- lowed by venous stasis, poor nutrition of the intestinal muscle layer, diminished peristalsis, flatulence, heartburn, constipation, autoinfec- tion from resorption of intestinal products, all resulting in a weak general nutrition, and slug- gishness in the portal circulation. The drag- ging of the pendent viscera upon their mesen- teries, and the general fatty degeneration and the abdominal liposis must necessarily inter- fere with the muscular contractibility of the walls of the gall-bladder. Of perhaps equal importance is the vicious mode of dressing pre- Vailing amongst the female sex, whereby the liver becomes distorted and displaced. In these conditions we see cause enough why women should be more liable to have gallstones than I(16I1. - The prevalence of gallstones in the aged Strengthens the supposition that loss of con- tractibility is a factor in the production of these concrements, for it is precisely the impairment of muscular force that is the most common evi- dence of senility. We believe that stones are produced by bacteria, and that these bacteria find their most suitable soil in the stagnating bile; that faulty nutrition of the body at large has at best a very remote connection with the formation of gallstones. There is every reason to believe that gall. stones are formed mainly in the gall-bladder; and that those which are found in the cystic and common ducts have originally come from the gall-bladder and have been arrested in the narrower Canals. The stones that are occasion- ally found in the liver are always connected with disease in the biliary ducts, and secondary to gall-bladder disorders. THE MEDICAL DIAL Whatever may be the cause, the effects of stones are certain enough; they are all kinds of inflammations in the biliary system and its neighboring organs, catarrhs, suppurations, ulcerations, peritonitis of the covering of the adjacent organs, general peritonitis, strictures, twists, and adhesions leading to great disturb- ance of physiological action. Furthermore, we See the concurrence of stones and cancer so Often that we are constrained to believe that there is a certain causal relation between them. Thus Czerny found thirty cases of carcinoma in 162 cases operated on for stones. This is too great a proportion to be a mere coincidence. There is in fact nothing in our accepted ideas of cancer to make such a supposition improb- abel; long continued irritation is often associ- ated with the production of cancer in other or- gans, So that we have come to look upon it as a predisposing, if not the efficient, cause. Among the more immediate effects of stones are the colics that are so striking in the in- tensity of their pain, that they have been looked upon as by far the most serious effects of Stones. It was supposed that stones were harmless as long as they were quiet, that their chief danger was colics, and that these were brought about when the stones tried to escape from the bladder. We must admit that qui- escent Stones often give no symptoms what- ever, that many a stone has been found post- mortem in people who have exhibited no symp- toms of disease of their biliary system. But then we have much evidence to prove that quiet Stones are by no means harmless. We will upon inquiry find that the greatest number of persons who suffer from gallstone colic have previously suffered from other symptoms refer- able to the biliary system. It is common to have the patients state that they for a longer or shorter time have had some slight discom- fort in the right hypochondrium; this was fol- lowed by various forms of obstinate dyspepsia. The patients were unable to digest food well and easily; they would suffer from cardiac op- pression, flatulence, nausea, pain after meals; others would suffer from constipation; others again from biliary vomitings. The patients. had been thoroughly examined by competent men, and nothing had been found that could explain why the dyspeptic symptoms refused to yield to ordinary treatment. Finally the pa- tient had an unmistakable attack of biliary THE MEDICAL DIAL. 161 colic, and the explanation of the long-continued dyspepsia was found in the presence of gall- Stones in the bladder. The effects of gallstone disease upon the biliary organs are usually quite injurious. We often see a catarrh that spreads from the bil- iary ducts to the liver, through all the ducts, leading to secondary formation of stones in the liver, and inflammatory disease of this organ, phlebitis, local cirrhosis and hypertrophy of Certain lobes. Riedel has drawn attention to a localized hypertrophy that leads to the forma- tion of a thin flat lobe hanging over and con- cealing the gall-bladder. & The gall-bladder itself may become the seat of an accumulation of pus, serum, bile or mucous; or it may shrink to a degree that nearly or quite obliterates its lumen. Similar changes may take place in the ducts. Hardly less injurious for the patient's health may be adhesions to neighboring organs. Fibrinous peritonitis with following adhesions is the most common sequel of gallstone dis- ease. Such adhesions may take place between any of the adjacent organs. Sometimes there will be ulcerations from gallstones, and if no protective peritonitis encapsulates these parts of the peritoneal cavity, fulminant peritonitis may supervene. But usually adhesions have taken place, and gallstones find their way into many unsuspected places. They have been known to be evacuated through a bronchus, through the stomach by vomiting, through the skin; gallstones have even been found in the pelvis of kidney (Mayo-Robson). It will not surprise us to learn that they have found their way into the liver, the pancreas, or into the bowel. It has even been claimed that they have descended into the pelvic organs of women, but Curvoisier, who copies the case from the orig- inal report, does not admit the validity of the author’s conclusions. It is hardly necessary to point out that the possibility of ulcerations into other organs gives an additional indication for operative interference, when the diagnosis of gallstone is made, and the medicinal treatment shows itself futile. There is a certain analogy between the de- Velopment of our knowledge of diseases con- nected with the Vermiform process and those of the gall-bladder. It was only after we had begun to open the abdomen during attacks of inflammation in the iliac region, that we got an insight into the pathology of all these dis- eases near the cecum, and became enabled to consider them in one comprehensive view. So it is with the diseases of the biliary system; we did not, and could not, have a clear percep- tion of their nature, mode of progress, compli- cations and final effects before we, so to speak, by laparatomies, had surprised nature in her work. We have been enabled to see the effects of stones as inflammations and ulcerations in and around the gall-bladder; we have learned that the attack of colic is only an incident in the history of gallstone disease. That the slow action on the bladder and the adjacent organs by the daily increments produces far greater results than the more cataclysmal attacks of colic. Painful as such an attack is, it rarely kills, while the inflammatory processes lead to adhesions, twists, strictures and ulcerations that are more dangerous to life, because they interfere with the physiological functions of vital organs. ' The diagnosis of stone in the bladder is sometimes comparatively easy, at other times extremely difficult. When a person has the classical symptoms of biliary colic, followed by jaundice, when a tumor can be felt in the re- gion of the gall-bladder, when that region is markedly tender upon pressure, then the diag- nosis may be considered as reasonably certain. Has there besides passed stones by rectum, or have they by ulcerating found their way to other organs, or out through the abdominal wall, the diagnosis may seem absolute. But often there is none of these symptoms present, and yet the bladder may be the receptacle of Stones. Indeed as long as the stones remain quiet in the gall-bladder there is neither colic, jaundice nor swelling; as indicated, there is sometimes absolutely no symptom of illness, at other times Vague sensations that may come from disease in any part of the digestive system. Even when the sufferings become more marked We may be in the greatest doubt, whether we face a case of cholelithiasis, or, for instance, Some gastric disorder, or some disease in kid- neys, vertebrae or abdomen. The most common group of such deceptive Cases are probably those of stones in the kid- ney. It is said that the urine will give the de- sired information and that the absence of mor- bid products from the kidney in the urine ex- cludes renal calculi. But this is not so; I have 162 THE MEDICAL DIAL. had two cases where there were characteristic attacks with tenderness in the right hypochon- drium, where the urine was normal and where there were no gallstones, but kidney stones. In one of these cases stones could be felt through the emaciated abdominal walls. There Was a Stony-hard tumor in which I even suc- ceeded in eliciting crepitus. An accomplished medical friend saw the case with me, and con- curred in the diagnosis of gallstone. Great was my astonishment to find upon operation that the mass of stones was in the kidney; the urine Was normal because all of it was secreted from the healthy kidney. The other case was one seen with a prom- inent physician from Iowa. In this case re- peated examination both chemically and by the microscope failed to discover any anomaly of the urine. There had been several attacks of colic, and the whole complex of symptoms pointed to cholelithiasis. No stone was found in the bladder, but some months after the oper. ation the patient had a new attack of colic pre- ceded and accompanied by frequent desire to urinate. I do not know if morbid products were found in the urine at that time, but I sup- pose that the attacks were owing to renal cal- Culi. Nearly every condition in the abdomen that produces colic may mimic gallstone disease. Gastric ulcers give rise to pains that often are severe and protracted enough to suggest bil- iary colic; the differential points will largely be the tenderness on point pressure in the re. gion of the stomach, the association of the in- crease of pain with taking of food, the rapid emaciation; if hematemesis takes place, the diagnosis is, of course, clear. Gastric ulcers will most commonly be found on the left side of the median line, the gall- bladder on the right; but both may be on the Opposite of the usual one. The colic produced by a stricture of the bowel must be remembered in making the differential diagnosis; such strictures may be owing to infiltrating tumors in the intestinal wall, or to adhesions from pre- Vious peritonitis. In many of these it will be possible to see the peristaltic wave above the point of constriction; the history will usually help in establishing a diagnosis. Subphrenic abscesses, diseases of the pancreas, colic from indigestion must be remembered, as well as neuroses—all these conditions may be con- founded with biliary colic. Perhaps one of the commonest mistakes is to confound inflammation of the vermiform appendix with biliary colic. It is said that the locality of tenderness is decisive; but the gall- bladder may be displaced downwards, or the inflammation produced by the appendix may concentrate itself upwards. The history of the case will give valuable information. It is cer- tainly very rare that the severe pain of appen- dicitis lasts as long as an attack of biliary colic, and if it does it will produce a more gen- eral peritonitis. Another condition that may lead to severe colics is the presence of omental hernia in the linea alba. These ruptures are usually small and apt to be overlooked by physicians who are not familiar with them and who fail to recog- nize the connection between the colics and these small protrusions. Conditions outside of the abdomen may also be misleading. It is a well known fact that tuberculous inflammation of the vertebrae may occasion very severe pain that comes in attacks of great severity, apparently without external cause; there will in the beginning of such a disease be no deformity, no pain on pressure, no stiffness of the back. To make the similar- ity yet more deceptive, these attacks may come on in the night, just as gallstone colic is apt to do; probably from some change of position in bed, while the patient is asleep. When the disease has progressed further and the charac- teristic symptoms of tuberculous spondylitis have appeared the diagnosis is simple enough; but in the earlier stages it may be very difficult. Suppose we have progressed far enough in our diagnosis to have fixed the responsibility for the symptoms upon the biliary passages; We have yet to decide whether we have to do With concrements or other diseases. Occasionally we meet with phlegmonous in- flammation of the gall-bladder; this disease is usually speedily fatal, but may terminate in an encapsulated pus collection in the gall-bladder, and around it. If the case is seen early, before a general peritonitis has developed, it can be diagnosticated from appendicitis by its local- ity; the point of tenderness will be at the tip of the tenth rib, but when general peritonitis has set in it may be impossible to distinguish it from appendicitis, rupture of the gall-bladder from a stone, or from the results of a perforat- ing duodenal ulcer. Rare as the disease just mentioned is, it will probably often be misin- - - * * • ** --- THE MEDICAL DIAL. terpreted; a previous infectious disease should lead us to consider its possibility, as it always is the result of septic embolism. Much more common will be the confusion of stone with malignant disease of the biliary passages; in fact we often find a combination of the two conditions as above indicated. Even after opening the abdomen the sur- geon may be misled. It has twice happened to me that inflammations from stones have pro- duced such hard adhesions around the biliary passages that I did not dare to go through from fear that I had a malignant neoplasm, and coll- tented myself with loosening other adhesions that interfered with the free action of neigh- boring viscera. In both cases the patients re- covered, although the concrements that prob- ably were present were not removed. One of the patients was a man past fifty, who, besides attacks of colic, had suffered from the symp- toms of dilatation of the stomach, demon- strated by physical examination and the re- moval of large masses of fermenting stomach contents by means of the stomach tube. At the operation there were found adhesions of the pyloric portion of the stomach, with the liver; these were separated, but an indurated mass of almost stony hardness was found over the region of the common duct. This man lives yet, four years after the operation, and enjoys good health. It is somewhat humiliat- ing to make such mistakes, but fortunately in these two cases they had no evil results for the patients. After the diagnosis of gallstones is made, it becomes of importance to decide where the stones are. If there has been no jaundice, the stones are most apt to be in the gall-bladder, ov in the cystic duct. Iłut if jaundice has fol. lowed an attack, it may be difficult to decide whether the jaundice is due to the temporary passage of a stone through the common duct, to the permanent lodgment of a stone there, or to an Obstructive catarrh. If the jaundice is deep, protracted and re- peats itself, it is fairly certain that we have to do with a stone in the common duct; as Dr. Fenger of Chicago has demonstrated, gall- stones in the common duct are apt to have a somewhat dilated portion of the duct behind them; the stone acts as a ball valve and leads to obstruction; after a while it settles back in the dilated portion, and the occlusion, is tem- porarily overcome. If the jaundice is slight - º . . . . . . . %, ^- .* and of short duration, it may have been pro- duced by a catarrh accompanying the colic, and making the common duct impervious, as we see in catarrhal obstruction of the Ilose from a so-called cold. In other cases again the passage of a small stone through the common duct may block it . for a while, either by its mechanical presence before it has passed through the papilla, or by setting up an inflammation in the duct, with swelling of its mucous membrane. * It is evident that the obstruction of the common duct by a neighboring tumor, an en- larged gland, a carcinoma at the papilla, Will give rise to a jaundice that may be difficult to distinguish from that produced by a fixed stone. The age of the individual, the history of the case, and the amount of the cachexia pres- ent, may be valuable points in the diagnosis. But in many cases I suspect that even the most skillful diagnostician will have to be con- tent with the diagnosis of simple biliary Ob- struction, without being able to say what its cause is. The indications for various operations upon the biliary system are determined by the spe- cial condition, and the prognosis of the surgical interference depends upon the special form of the gallstone disease in the very highest de- gree. Concrements that are confined to the gall-bladder ought to be removed almost with- out a death, while interference with the deeper portions will entail a mortality that is quite serious. A carcinoma gives, of course, an absolutely fatal prognosis, and operations in cancerous individuals should not be performed. Tor at most a brief relief may be obtained; usually the issue is fatal. This is not only bad for the case in hand, but the impression spreads among the public, and even the physicians, that surgical interference with the biliary system is very dangerous; the effect of this is to deprive people from availing themselves of the bless- ings of the operation in the earlier stages of gallstone disease, where there is no practical danger. I wish therefore to protest against opera- tions in individuals suffering from cancer in the biliary system. Persons subject to obesity, or far advanced in years, or suffering from complications with phthisis, heart disease, nephritis or arterio-sclerosis, should not be considered as fit subjects for operation. Let THE MEDICAL DIAL. them stay under the care of their family physi- cians, let them go to springs or be treated medicinally in other Ways. Our diagnosis must not rest with the de- cision that gallstones are present, We must dis- tinguish between at least four different con- ditions: (1) Stones in gall-bladder with open cystic ducts. In such cases we are most apt to make mistakes, but such cases are just the ones where operations are most beneficial and least dan- gerous, and therefore most certainly indicated. (2) Inflammation of the gall-bladder, em- pyema, hydrops. Here the diagnosis will not be very difficult. (3) Adhesions and interference with the functions of neighboring organs. A very diffi- cult diagnosis. (4) Obstruction of the common duct. Only in the last group of cases, can we ex- pect jaundice; but it is not even present in all these cases. When the diagnosis of stones in the gall-bladder is made, it would seem the most natural procedure to open the gall-blad- der, remove the stones, sew up the wound, and drop the gall-bladder into the abdomen. This operation, cystendysis, has been performed a number of times, but in spite of its obvious simplicity, it was not the first operation elm- ployed for the removal of stones, nor has it become very popular with experienced opera- tors. It suffers from three very manifest de- fects, either of which must prevent its employ- ment, except in cases where no other operation is feasible. The first objection is, that even after opening the gall-bladder and removing stones, nobody can tell if they are all removed, especially from the cystic duct. The inex- perienced might think it an easy matter to de- termine whether all stones are removed or not, but this is not the case. Let it be enough to quote the statement of Dr. Hans Kehr of Hal. berstadt, Germany, who has probably more ex- perience than anybody else in gallstone sur. gery: “No surgeon, no matter how skillful as an operator, or how accurate an examiner he may be, can be absolutely sure that he has removed all Stones.” The second objection to this operation is that the gall-bladder is left without drainage and that the diseased condition of its mucous membrane is left without any treatment, while if drainage is established, this process is in itself curative of the various disorders. The third objection is of less weight than the two previous ones, because it may be over- come by technical skill. enough; that is, the possibility of bursting of the suture or of contamination of peritoneum. In fact I know from published records of five cases in which this took place. We see thus that this cystem dysis, or Open- ing, suturing and dropping the gall-bladder, an operation comparable to the modern ovari- otamy with intraperitoneal dropping of the pedicle, is an operation that has many weak points. Should it consequently be abandoned? Is it unnecessary for the operator to be ac- quainted with it? Has it no justification in any case? So seems indeed to be the opinion of some of the most prominent operators, but there may be cases where it perhaps should be chosen as the least of evils. When the small size of the gall-bladder, or its depth, or its situation deep in the abdomen behind an overlapping lobe of the liver makes it impossible to perform cystostomy, or where inflammatory adhesions to the liver make cystectomy dangerous, cystem dysis, or Opening and removal of stones followed by suture of the wound in the bladder and dropping, may be considered justifiable. The first operation by which gallstones Were removed was not the outcome of a skill- fully planned and executed surgical process, but the result of a mistaken diagnosis. In this case the walls of the gall-bladder were sewed into the wound of the abdomen, after it had been opened and a few dozen gallstones had been removed. The patient recovered, but it took about ten years before any surgeon acted upon the suggestion of this case, and started out with the definite plan of creating a fist- ulous opening between the gall-bladder and the surface of the body. This operation has got the name of cystostomy, and must be consid- ered as the standard operation for stones in the bladder or cystic duct. Two methods have been used; one con- sists in first producing an adhesion of the gall-bladder to the peritoneum, awaiting the establishment of firm adhesions, and then opening the gall-bladder, removing the stones, and establishing a biliary fistula. This opera- tion, called cystostomy in two stages, has found its main advocate in Riedel of Jena, who But still it is serious & * : THE MEDICAL DIAL. 165 has performed it many times and never lost a patient from it. Great as his success has been, and widely as his fame has spread, he has met a formidable rival in Dr. Hans Kehr, whom I have already mentioned. Dr. Kehr also con- siders cystostomy the best operation for stones in the gall-bladder in ordinary cases, but per- forms the operation in one session. He does not admit the greater safety of Riedel's opera- tion, and his results are just as good. If they would be just as good in the hands of the average operator may, however, be question- able. Before criticising these competing Opera- tions it may be well to discuss the operation of cystostomy in its general bearings. The advantages gained by sewing the wound of the bladder in the lips of the peri- toneal wound are manifest. In the first place, it puts the gall-bladder outside of the perito- neal cavity. Whatever comes out of the gall-bladder is by an accurate and trustworthy suture pre- vented from getting into the peritoneal cavity. The impossibility of ever being certain that all stones, including cystic ones, are really re- moved, seems to condemn every operation that does not leave an Outlet for Overlooked concre- ments. Furthermore, the mucous membrane of a gall-bladder that harbors a stone is never healthy, and we know of no more certain cure than drainage. The objection has been raised that the fistula may be permanent and the patient thus may become burdened by a lasting defect. There are two reasons for the permanence of the fistula. One is a technical mistake—that of putting the gall-bladder on the stretch by a too low opening. A proper location of the fistula will sufficiently prevent this accident. The Other cause is some obstruction in the cystic or common duct. In this case the fistula is far from being a detriment, it is a safety valve. It seems perfectly clear that the ob- jections to a temporary fistula are invalid. If a fistula should refuse to close, secondary oper- ations, such as removal of deepseated stones, the correction of twists or removal of adhe- sions, have in Dr. Kehr's hands always accom- plished final closure. What are the grounds upon which Dr. Kehr rejects the apparently safer operation in two stages? He claims, and as it seems with perfect reason, that the operation in two stages prevents a careful examination of the whole • * * gall apparatus; he lays the greatest stress upon the necessity of carefully examining the cystic duct, the choledochous, and the head of the pancreas. He empties the gall-bladder by means of an aspirator, and makes very long incision in the gall-bladder, and is thus enabled to examine the cystic duct as well as the other ducts. Nobody can deny the great importance of this examination, whereby it becomes possible to perform a complete removal of all stones in many cases, where otherwise a stone would be left. With great care and the necessary technical Skill the operation is not more dangerous than the operation in two stages. The operation for gallstones will never be. come the common property of every doctor; it is too full of unexpected complications, and in many cases too difficult for surgeons without Special experience in this special branch. In experienced and skillful hands the operation in One stage is as safé as in two, and it ought not to be intrusted to others. The operative method in all cases of cyst- Ostomy seems now to have become tolerably uniform. The incision is preferably made in the vertical axis of the body, through the right rectus muscle. Lawson Tait, who was one of the earliest operators and who has performed a large number of cystostomies, seems to have chosen the outside of the rectus muscle; Mr. Tait's reports suffer, however, all from a cer- tain incompleteness, which detracts somewhat from their usefulness. The French operators have followed the same practice. The Ger- mans have usually made the opening through the muscle, separating the fibres longitudinally and by blunt dissection. Mayo Robson says, “As a rule the aponeu- rosis in the semilunar line is divided, but if the rectus be wide, its fibres may be separated.” He seems to think that a scar through muscle is less resistant than one through fibrous tis- sue. This is not so; a hernia is more apt to develop through the linea alba or semilunaris than through the rectus muscle. After reaching the gall-bladder, those who Operate in two stages have, after as careful palpation as possible, sewed the bladder to the detached and reflected peritoneal and fascial flaps; the suture material is now mostly silk; catgut is not quite substantial enough; one § . . . . . . . * * * * * , - * ,” ‘ ‘, sº 2%. , “. - ". . ... " & , , , , * x • * > * . . *** ... • 3 - 3 x2 tº is, " - - ºr - f T +. • *** -> . . . . as , x~~ * - • * * • *- operator used silver suture with a result which *36 sº . ~.… . . . . . might have been foreseen. Mayo Robson uses chromic catgut. This is in so far an advantage, as silk sutures have frequently formed the nucleus for secondary stones (Dr. Kehr; Sammlung Kl. Vortr. No. 225, p. 14), but with proper care the sutures can all be removed, so that this danger ought to be eliminated. The immediate opening and suturing of the gall-bladder demands great care in preventing the escape of bladder contents into the peri- toneal cavity; this is done by Kehr by aspi- rating before incision, and by all operators by packing the cavity with aseptic gauze sponges. It will usually be found that the gall-blad- der has contracted adhesions with neighboring organs. These adhesions must be carefully separated; they are often the immediate cause of the patient’s illhealth, and in two of my own cases, where I did not dare to complete the Operation, the loosening of the adhesions re- lieved the patients from their sufferings. The process producing adhesions around the blad- der, the pericystitis, is a continuation of the inflammation in the bladder, of the mucous membrane primarily, then of the deeper layers of the Wall, leading to various pathological changes of the bladder, such as ulcerations and Contractions. The gall-bladder is sometimes shriveled up to such an extent that the opera- tion of cystostomy becomes impossible, and yet Stones may be present in the shrunken organ. It has been suggested in such cases to open the bladder and unite it with a bowel, cysto- enterostomy. This operation enables the bile to get into the bowel, and prevents a biliary fistula. There may be cases, where it has to be performed, when a cystostomy is impossible, and where removal of the gall-bladder by Lang- enbuch's operation, cystectomy, See Inns too (laun- gerous. The operation of cystectomy will first call for Our consideration. Langenbuch performed the first operation in 1882; it was successful, and Was repeated by its author four times be- fore he found any imitators in this apparently audacious operation. In the beginning the surgeons of Germany looked upon it somewhat suspiciously; Riedel and Kehr did not like it; but lately the tide has turned and Kehr is a strong advocate of it. The gall-bladder is an organ which can be removed without serious injury to the indi- THE MEDICAL DIAL. vidual, a fact that seemed probable from its absence in many animals. That it could be re- moved from animals was proved by experi- ments before Langenbuch showed that men could live without a gall-bladder. The opera- tion may, however, be very difficult of execu- tion, namely on account of firm adhesions to the liver. In dissection serious hemorrhage may be met with ; every operator knows what that means in such a deep locality. The hemorrhages have been controlled in Various ways, by continuous pressure with aseptic sponges, by the use of the thermo- . cautery, or by buried sutures. Another diffi- Culty in the operation may be in getting at a free part of the cystic duct; this must of course be carefully ligated, and perhaps sutured, for a leakage of bile would otherwise take place into the peritoneal cavity. It seems that the danger from this source is real, as even Kehr has lost a case through failure of the ligature of the duct. And yet Kehr, who originally was one of the adversaries of the operation, has become an enthusiastic convert to it, having at last report performed it sixty-nine times with three deaths. The indications for cystetomy become daily broader, and although I have never performed the operation, I am certain that I ought to have done so in a case I lost, because of the poor condition of the wall of the gall-bladder, that prevented absolute firmness of the suture. The next time that I meet a case where I suspect that the peritoneal suture may be de- fective, I shall not hesitate to excise the gall- bladder if feasible. The method of operation does not differ from that of other operations on the biliary System. The incision in the abdominal wall may have to be somewhat larger; a transverse incision may have to be added to the longi- tudinal One, otherwise no modification is neces. sary. The isolation of the cystic duct may be diffi. cult, and the ligature must be made with great Care. I should like to turn the ends of the Stump in, and sew the serous membrane over the stump; if the stump is long enough, it ought to be fixed in the abdominal wound, but usually I suppose that it will be too short and have to be dropped. The under surface of the liver must be lined with sterile gauze, which must be led out, above the stump. This is apt to produce a large and yielding scar, and to be THE MEDICAL DIAL. 167 followed by a hernia; to offset this possible dis- advantage relapses are excluded, as the stone- forming organ is removed. It is a significant fact that cystectomy is gaining in favor, and that the most prominent operators perform it oftener now than formerly. Where the problem presented to the opera- tor is to provide an outlet for bile, that cannot pass the common duct, it can be met in two ways: either by establishing an opening be- tween gall-bladder and skin, whereby a per- manent bile fistula is created, or by connecting the gall-bladder with the bowel. If the obstruction in the choledochous duct is a stone, it ought to be removed; if it is a tumor, the operation can be only palliative, and the less risky operation would seem the pref- erable one. Among the indications established by Dr. Murphy of Chicago for cysto-enterostomy, are the following: 1. When it is desirable to drain the gall- bladder for accumulations. * 2. When the choledochous duct is closed. 3. When the bladder is inflamed, drainage of the gall-bladder by a cystostomy looks more rational, as there is danger of infection of the bladder from the bowel; when the choledoch- ous duct is closed, it ought to be made patent by operation, if a concrement is the cause of obstruction; if a malignant tumor is the cause, the mortality of the operation has been so high in every other operator's hands that its justi- fiability is questionable. (Mayo Robson.) If after a cystostomy a permanent fistula remains from stricture or obstruction of the choledochous duct, and this cannot otherwise be relieved, then the operation of cysto-enter- ostomy is indicated. After having considered the operations on the gall-bladder, it remains to describe and criticise the operations on the ducts. Stones in the cystic duct can usually be pressed back into the bladder; sometimes they can be caught by a scoop, sometimes squeezed; in other cases their removal is impossible by these means. If the bladder is large, it is often possible to reach the duct, and to incise it; Kehr advises under such circumstances to sew it to the peritoneal flaps, to perform cysti- costomy. I have never seen this operation per- formed; with a shrunken gall-bladder, the depth in which the operation will have to be done must often make it impossible; if it is pos- sible it is indicated; with the establishment of drainage the inflammation of the cystic duct Will become more open and the stone may finally find its way out. Several such cases have been reported by Riedel. If the stones are in the choledochous duct they may be removed by choledochotomy. This operation has been carefully studied and described by Fenger. I have performed two successful operations myself. The great dan- ger of the operation does not consist in the diffi- culty of accurate suturing; with due exercise of patience and skill that can be done safely; but the operation is dangerous from the risk of Wounding important bloodvessels. It would carry this paper too far if the anatomy of the common duct were considered in detail; only this much must be stated, that the portal vein is to the right of the duct, and that branches to it cross its upper and middle portion; incision must therefore be made in its lower portion. Dr. Kehr gives the very important direction that operations on the common duct should not ordinarily be performed during an acute attack of inflammation in it. Under such circumstances a stone may have passed from the bladder, and as it must be of moderate size, there is a hope that it may pass. The gall- bladder contains usually a number of stones and is in a condition of severe inflammation. If cystostomy is performed, the bile will flow out of the fistula and the stones remain in the Common duct. On the other hand, repeated attacks of icterus that indicate a floating stone in the duct, as Fenger has demonstrated, demand surgical interference. The same holds good if the acute attack becomes complicated by rig- ors, high fever, rapid pulse and tenderness of the liver; then we may conclude that we have a beginning cholangeitis, and a drainage of the hepatic duct is the only method that holds out any hope. As far as I know Kehr is the only One who has undertaken it. While most of the operations on the gall- bladder are simple, and cystostomy practically devoid of danger, the operations on the ducts are both complicated and difficult. As they usually are demanded in cases of long standing, where the inflammatory processes have involv. ed the neighboring organs, we may have to per- form other operations at the same time, thus exposing the peritoneal cavity more than by a wº. - 2 . " •- .s - ... * *. --- - * **** - , , ; *...* - " -- * * * ... - - ..º.º.-: * , - . . . . . . . . . . . * * “s , . . . - x * ~ X, ºr ** , " .. . i *...** ... < * -- - *...*** * , * - * + - . * * - - - * . . * * - . . - .*, * * > . * - • ?" • # , * > . . » A-ºl * * r & & shorter operation, and also increasing the dan- ger of the narcosis. From these conditions it is very evident that we ought to discriminate between the various kinds of gallstone, Opera- tions. - It is of the greatest importance for the sufferers from gallstones that they should be operated early before the concrements have descended into the ducts, and before they have produced destructive inflammations in adja- cent organs. To accomplish this the following conditions must be fulfilled: 1. Physicians must learn to diagnosticate gallstone disease. That the knowledge of this disease is not as extensive and accurate as it might be, is among other things deducible from the fact that many doctors believe that colics are not from gallstones, except when accom- panied by jaundice; while the fact is that only a relatively small percentage show this dis- coloration. 2. The public must be educated to secure early Operative relief, and to understand the difference between the simple and the compli- cated cases. 3. Surgeons must as far as possible ex- clude malignant cases from their operating list. The deaths following them will by doctors and the public be charged to the general account of Operations on the gall-system, instead of to the account of operations on malignant tumors. 4. Operations on the biliary system should only be undertaken by surgeons who have made special studies of the subject. LOCOMOTOR ATAXIA. A decided improvement in a case of loco- motor ataxia is noted by James C. Wilson (Int. Med. Mag., N.Y., March), where the patient was administered the double chlorid of gold and Sodium, together with rest. One-twentieth of a grain of the mixture was given three times a day. The case was a sailor thirty-three years old, With no important family history, and had been under observation for about a year and a half. Some ten or twelve years ago the patient had shooting pains in the thighs, and also gir- dle pains. These pains continued until he came under notice, though treated several times for rheumatism. As a result of the treatment he felt better and is encouraged; his Sensations, his gait, and certain functions are on the gain. The doctor thinks it quite worth while to try treatment of the kind, especially with the drug mentioned, particularly in the early stages of the disease. - THE MEDICAL DIAL. FIBROID OF THE LEFT VOCAL BAND. By B. M. BEHRENS, M. D., Minneapolis, Minn. J. M. S., 32 years of age, School teacher, noticed about two years ago a beginning hoarseness, which became specially aggra- wating after taking “cold.” The patient is of robust health with no family history. Has always been well and but for this increasing hoarseness, which now has assumed such proportions that he is compelled to give up school work, complains of nothing except a disposition to take cold easily. Also, as instructor in singing, his larynx is overtaxed every day and in the evening he is quite worn out and scarcely able to talk above a whisper. The cause of this is illustrated in the ac- companying cut, which shows a fibroid occupy- ing the middle part of the left vocal band on a broad basis and white as the band itself. The general injection of the whole larynx head gives also to the tumor and the vocal band a flush of redness particularly conspicuous at its base and very marked after the least exertion of the larynx muscles. The nostrils, naso- pharynx and pharynx in a state of congestion, but nowhere hypertrophies to any appreciable extent. - The improvement of these parts under treatment did not benefit the condition of the larynx, and the galvano-cautery was resorted to in order to thoroughly remove the tumor, which was effected in three sittings. On ac- count of the irritability of the fauces the pre- liminary manipulation with the larynx probe had to be practiced more than a week daily, and even then I had often to shut off the cur- rent, When just on the point, on account of reflex spasms that would entirely remove from View both the tumor and the cautery point. Under such difficulties it affords us some conso- lation to know that a general improvement of THE NAEDICAL DIAL. 169 the whole upper air tract at least will effect a cessation of the growth, if not a reduction of it, what possibly might have taken place also in this case if left to itself. With the assurance that he would recover his voice entirely, the patient was permitted to go home—Wisconsin—before the vocal band had healed up again, and a few days later I received a letter in which he told me that the voice was entirely gone. As the patient could not or would not come back to Minneapolis for an examination, I had to await developments. Only after six weeks did the patient present himself fully recovered and voice perfect. The reason for my reporting this case is that complete aphonia set in, although the trauma, which caused paralysis of the adductor muscles, was one-sided, the rule being that the unaffected side partly makes up for this, and the voice is preserved to some extent. As I did not get the opportunity of examining the case in its aphonic state nor could convince myself of the extent of the aphonia, which patients often are apt to exaggerate, it stands to reason, that the trauma to twigs of the re- current nerve has caused a complete paralysis Of the adductor muscles on the left side. TO ABORT. A. COLD. Max Nassauer asserts that an incipient cold in the head can be checked every time if the nose is thoroughly rinsed out with a weak so- lution of potassium permanganate, which seems to have a specific action upon the germs causing the trouble. He claims that the pub- lic will have a higher respect for the profession when it is proved that colds can be success- fully aborted by following the physician’s di- rections. He checks colds in the first hour Or so, and thus escapes all the catarrhal and bronchial annoyance that follows in their train. He has a strong solution of potassium permanganate on hand: about what can be taken up on the tip of a small knife, to half a liter water. A few drops of this strong solu- tion are added to warm water until it is colored a pale pink. After blowing the nose vigorous- ly, both nostrils are rinsed out well with this weak solution, allowing the fluid to run out through the other nostril and through the mouth. Each nostril is then wiped out with cotton on the finger to mechanically remove all remaining germs. A small dry plug of cotton is then pushed well up into each nostril and the nostrils filled with the weak solution, with the head held back, allowing the cotton to Soak it up. The cotton is left undisturbed for about an hour, for the warmth and moisture to pro- duce their effects, when the plugs are expelled by blowing the nose. Even an established cold is favorably influenced by this treatment, but is most effective when the sneezing, tick- ling and increased secretions announce the advent of the cold, which he considers a highly contagious infection.—(Klin. Therap. Woch., January.)—Jour. Miss. Med. Ass’n. TREATMENT OF ACUTE COCAINE - IPOISONING. - If the poison has been swallowed the stom- ach syphon-tube should be at once applied and the contents of the organ evacuated. The patient should be placed in the horizontal position on his back. Tannic acid, iodine, or charcoal may be given as possible chemical antidotes. Stallard advises the Stimulation of respiration and circulation by flicking the chest and face with hot and cold towels, as in opium poisoning; but I cannot say that I have seen benefit from this practice unless it has been done lightly and occasionally for a minute or two. Ammonia or ether, inhaled, drunk by the mouth, or introduced into the rectum, or ad- ministered hypodermically, is useful, as also is the administration of Caffeine Or coffee. The addition of small quantities of alcohol, in the form of five to ten-drop doses of tincturae carda- mom, comp., spirit of chloroform, or tincturae lavandulae comp. (separate or combined), is sometimes serviceable when coffee cannot be easily taken. Chloroform may be inhaled to relieve the spasm. Strychnine, "in minute doses, 1/100 grain, with or without a couple of drops or so of tincture of digitalis, is also of value. Some authors report apparent benefit from intravenous injection of normal saline solution; but I think caution is requisite, owing to the risk of embolism in the lungs. When the blood-pressure has been raised or there is alarming respiratory spasm, a drop- dose of nitroglycerin, at intervals of half an hour if required, sometimes acts excellently. Clifford Allbutt says that the inhalation of oxygen and artificial respiration against the asphyxia may be indicated. I have found sips of hot water, and, where this could not be taken by the mouth on account of insensibility or collapse, hot water enemata, of three to four ounces, of substantial aid. External ap- plications, as hot as can be borne, such as a bottle, or jar, or tin filled with hot water and covered with flannel to protect the skin, I make it a rule always to apply, especially in un- consciousness, and, indeed, almost from the first.—Sajous’ Annual and Analytical Cyclo- pedia of Practical Medicine, Vol. II., Page 324. At quiz in senior chemistry: Dr. Morris:– “From what source is gallic acid obtained?” Matlock, promptly:—“From gall stones, Professor.”—University Medical, Galveston. THE MEDICAL DIAL. THE MEDICAL DIAL A Monthly Record of Medicine and Surgery. (Entered at Post Office at Minneapolis as Second Class Matter.) Issued on the First of every Month at Minneapolis, Minn. Editor, J. W. MACDONALD, M. D., F. R. C. S. E. Associate Editor, C. K. BART LETT, M. D. Business Manager, E. E. GRISWOLD. . . . . COLLABORATORS . . . . A. W. ABBOTT, M. D. W. A. HALL, M. D. J. P. BARBER, M. D. G. D. HEAD, B. S., M. D. R. O. BEARD, M. D. KNUT Hoeg H., M. D. J. W. BELL, M. D. C. H. HUNTER, A. M., M. D. A. B. CATES, A. M., M. D. W. A. Jon Es, M. D. J. FRANK Corbett, M, D. J. H. RISHMILLER, M. D. R. E. CUTTS, B. S., M. D. J. D. SIMPson, M. D. J. H. DUNN, M. D. J. H. STUART, A. M., M. D. F. A. DUNSMooR, M. D H. B. SweetSER, M. D. IDAVID owes THoMAs, M. D., M. R. C. S The publishers will not be responsible, under any circumstances, for the opinions expressed or statements made by correspondents. Contributors will be furnished, gratis, with sample copies contain- ing their articles, under an agreement to distribute at once to physicians in actual practice. To avoid duplication, publishers should be informed of the field to be covered. Reprints, giving The Medical Dial full credit, may be obtained at actual cost. $1.00 .10 Annual Subscription, in advance, - - * Single Copies, tº º sº gº º ºs tº- Advertising Rates made known on application. ADDRESS ALL COMMUNICATIONS TO | THE MEDICAL DIAL, MINNEAPOLIS, MINN. MASONIC TEMPLE. MAY, 1899. THE COMING LIGEIT. To Nikola Tesla the World seems indebted for the latest improvement in artificial light. From the burning pine pitch-knot to the “tal- low dip” was an immense stride in safety, con- venience and quality and quantity of illu- mination, and from the tallow dip to the gas from coal conveyed through the streets and buildings in pipes ready for instant use at all times was a still greater achievement; but when the electric cur- rent was arrested in its course by a slender carbon filament, and made to glow with the in- tensity of sunlight, the height of our ambition in lighting was thought to have been reached. But now comes the Tesla method in furnishing “artificial daylight,” which certainly claims our admiration for its present and prospective usefulness. If the cost can be kept within reasonable limits it will indeed prove the “coming light” for all purposes of illumination. Tesla calls it “vacuum tube lighting by high frequency currents”; he explains the process as follows: “The tubes (glass) have had all the air pumped out, but, of course, are full of ether. The passage of this special current sets the ether in motion, forming light waves. The light differs from arc illumination in that it has no particular centre; the whole tube glows and sheds a radiance like daylight all around.” The tubes can be made of any length of less than a yard, and when lighted do not dazzle the eyes by their brilliancy or sputter and vibrate in waves of light like the burning carbon pencils of the arc light. The tubes do not heat up with the light, one great advantage over the present electric incandescent globe, and they do not burn out and become useless as those with filaments often do, thus requiring renewal at considerable expense. The wiring for this light is essentially the same as that used at present for incandescent lamps, and the fix- tures already in place will answer; but a differ- ent dynamo has been prepared for economy. Already this process has passed the experi- mental stage, and contracts have been made with New York business houses for lighting them with this latest triumph of science in arti- ficial illumination; and so far as we can now judge it appears to meet every demand for a Satisfactory light. This is the third addition to our recent scientific knowledge, which seems to be already equipped for practical usefulness. With liquid air for refrigerating our beef for the army, a telephone without connecting Wires, and artificial daylight, we may rest for a while without anxiously asking what next? DISEASES OF THE A GED. One of the saddest commentaries on the medicine of the past can truthfully be said to be the neglect of the aged—for we are to-day Without a single comprehensive treatise on the changes peculiar to age, much less the diseases of advanced life. Indeed it was not until the dawn of the present century that old age re- ceived the slightest scientific consideration. Prior to the beginning of the century those who Wrote upon the subject wrote like Cicero from a contemplative literary standpoint. Our Surprise increases as we scan the litera- ture of the profession to find volume after vol- ume and journal after journal devoted to dis- eases of children, while scarcely a systematic treatise on the diseases of old age is to be found. The past want of interest as indicated by the scanty and fragmentary character of the …” * ... wº- ; : . THE MEDICAL DIAL. literature on the subject is largely responsible for the present apathy in the profession as well as in our medical schools. The medical student passes the college cur- riculum hearing scarcely a reference made to the changes peculiar to age, and having little opportunity to become familiar with the mal- adies to which old people are subject. ~ The writer scarcely recalls a reference to old age, during his college days, unless Sug- gested in mitigation of the failure of some bril- liantly planned but misguided operation or equally ill-timed drug treatment. Of late increasing interest is being shown in this much neglected subject. Dr. W. A. Hollis, in an able article in the London Lancet, Jan. 21st, 1899, entitled, “Do We Age More Rapidly than Our Forbears,” presents some interest- ing facts. Dr. J. Althaus, in the same journal, under the title of “Old Age and Rejuvenescence,” offers food for reflection. In commendation of the “Twentieth Cent- ury Practice of Medicine,” be it remembered that it was the first of our many excellent Works on practice to add a chapter on old age and its diseases. Has not the time arrived for a decided revo- lution in medical teaching in the direction of Special instruction in the changes and diseases Of advanced life? The writer would not urge the addition of another distinct course to the already over- crowded college curriculum, but would suggest that the necessary instruction be given by the chair of Paediatrics—the student having first received from the chairs of Anatomy and Physiology the necessary primary instruction bearing on the normal changes peculiar to age. The importance of this knowledge to the general practitioner in his daily work is so vital that further delay on the part of the medical colleges in supplying the necessary didactic and clinical instruction would seem unwarranted. J. W. B. No doubt many of the physicians of the Northwest are making preparations to attend the meeting of the American Medical Associa- tion, which convenes in the city of Columbus, Ohio, on June 6, and continues for four days. Many interesting orations have already been announced for the occasion, but it is safe to say that there are others that have not as yet . . • * . . . . is z f * , ; 171 f * g been mentioned in print that will be received. as heartily as those already mentioned. It will undoubtedly be the most interesting con- gress of physicians that has ever gathered since the organization of the association, and every physician who can should attend, and thus ob- tain a pleasing respite from the ever arduous labors of a continuous practice, and at the same time gather from the social contact and from the formal session such choice crumbs as will hereafter be of service. - A recent attempt to fasten the tentacles of Osteopathy upon the state of Nebraska met With defeat at the hands of the state senate. There was an even dozen in that august body who allied their forces with the osteopaths and Voted to amend the laws to allow them to practice in the state, while there were sixteen stalwarts who gave the proposition their un- Qualified disapproval. From the New York Medical Journal it is noted that Dr. Prince A. Morrow, of 66 West Fortieth street, New York City, wishes to ob- tain complete statistics of leprosy in this coun- try, to be incorporated in a report on the sub- ject. He respectfully requests any physician Who has personal knowledge of a case or cases to communicate the facts to him within thirty days. Such information will be duly credited, and, if desired, the name and any circumstan- ces which might lead to the identity of the leper will be strictly confidential. The profession at large, especially of the West, have lost a valued and respected co- laborer in the death of Dr. John H. Etheridge, secretary and one of the inspiring spirits of Rush Medical College, Chicago. The Doctor was well known throughout the country, and much was expected of him, and much was al- Ways given, whenever the occasion demanded that he should act or that his voice should be heard. - A fifty-thousand-dollar addition to the Win- nipeg General Hospital will be erected soon, and the necessary funds have already been raised. The citizens of that enterprising city are pleased to style the new building the “jubi. lee addition.” Thirty-five instructors have already been selected for the Cornell University summer medical courses in New York city, which begin the season May 1 and close August 1. ** **, *.,...; * * * • - * Reports of Societies. der Diseases. THE HENNEPIN COUNTY MEDICAL SO- CIETY - Held its monthly meeting at the Public Libra. ry, Minneapolis, April 3, 1899, Dr. Nippert, President, in the chair; Dr. Knights, Secretary. Dr. Lester W. Day was proposed for mem- bership. Dr. Sweetser exhibited an appendix which had been removed after the fifth attack, and which was the seat of an ulcer that had ad- vanced almost to perforation. - Dr. Knut Hoegh read a paper on Gall Blad- See page 159, The Medical Dial. DISCUSSION. Dr. J. W. Macdonald considered the paper a scientific and very practical one. The diffi- culties in diagonsis were almost insurmount- able. The classical symptoms of gall stones were in some cases readily interpreted, in oth- ers they were very misleading. For instance, pain was often referred to a distant part of the body, and he referred to a case in which all pain was referred to the region of the spleen. The patient gave a history of severe attacks of vomiting with the formation of a painful tumor on the left side. After a few days of suffering and the vomiting of large quantities of what was supposed to be pus, the tumor subsided. There was no pain over the gall bladder when the patient came under observation, but great tenderness and enlargement of the spleen. The history of the case led to the belief that the dis- ease was an abscess of the spleen opening by Way of the gastro-splenic omentum into the Stomach. On operating, however, the spleen was found to be healthy, but the gall bladder Contained three calculi. Jaundice was an indication that a stone was blocking up the hepatic or common duct, While the absence of jaundice was evidence that the stone was in the gall bladder or the cystic duct. There was one exception to this rule, and that was when a stone in the cystic duct pressed upon the common or hepatic duct With Sufficient force to cause obstruction. times it was exceedingly difficult to distinguish between gall stones and stone in the kidneys, or even between an enlarged gall bladder and a floating kidney. There were cases again in which all symp. toms of gall stones were manifested, but on Operating, adhesions around the gall bladder Were numerous, while no stones could be found in the gall bladder or the ducts. The presence of adhesions, however, was evidence that the gall bladder had at one time contained stones, and the breaking up of the adhesions generally resulted in a cure. At THE MEDICAL DIAL. Dr. J. E. Moore believed it more reasonable to consider cancer as the cause of gall stones, instead of gall stones the cause of cancer. The operation of dropping the sutured bladder into the abdomen is the ideal one, but he thought it safer to close the bladder, stitching it into the abdominal wound. Black silk suture, he considered the best. It should be left long for ease of removal. The difference of diagnosis, was illustrated in a case which came under his observation and was supposed to be floating kidney. There was no biliary colic, the tem- perature was 99, and examination under anaes- thesia had not given positive evidence. The gall bladder was surrounded by adherent omen- tum containing twelve large stones and fifteen smaller Ones. -- Dr. Dunsmoor thought the paper an Orig- inal One. He believed that fistula does not always depend on the way in which the gall bladder is stitched to the wound. Eſe had crushed stones in situ and did not stitch the gall bladder to the wound. He thought stones were generally formed in the liver and cited a case in support of this belief. Old people are not promising cases, but should not be denied operation. He thought the operation could be done in one stage, if carefully performed. He had fair results with Lembert Sutures. The nozzle of a syringe is useful in washing out stones from the ducts. Dr. Weston thought that palpation of the ducts for stones was not always possible. An incision parallel to the ribs gave the best view of the parts and was not liable to be followed by hernia. A sand-bag under the back of the patient is of great aid in securing a better View. Adhesions around the gall bladder are often found without stones being present and freeing these adhesions produces cure. He cited the case of a lady 68 years of age. For the last eight months before March she had no trouble. She then had attacks of pain with jaundice, but the operation was deferred. Chills and vomiting came on, and the operation Was undertaken; the gall bladder was inflamed and obliterated. There was an abscess cavity which was walled off by peritoneal adhesions, and One stone was found which had facets. The patient died. Dr. Dunn was convinced that carcinoma contraindicated operation. He considered cys. tostomy the best operation; as a rule he does not see any reason for the operation in two Stages, as nothing is gained and much lost. Errors in diagnosis are common. Stones are probably formed in the gall bladder in most cases. He had used the Murphy button in two cases of cholecystenterostomy; one was sue- cessful, the other partly so. Dr. Hunter drew attention to cases in which there was contraction of the gall bladder and adhesions from chronic gall-stone diseases, and stated the possibility of making a diagnosis of cases in which the gall stone had disapeared, * .* ~ * ~ * * * * - - - THE MEDICAL DIAL leaving the adhesions only. He mentioned the fact that certain localities furnished a large number of cases of gall stone. Strasburg is such a place, and he cited this as an argument against the theory, that the disease is of bac: terial origin. The question of how early and bow late we may operate he considered of great importance and had seen it somewhere stated we should not operate on a case in which the time of coagulability of the blood was beyond six minutes. Dr. Hoegh closed the discussion. AMERICAN MEDICAL ASSOCIATION. Office of the Permanent Secretary, 1400 Pine St., Philadelphia. The fiftieth annual session will be held in Columbus, Ohio, on Tuesday, Wednesday, Thursday and Friday, June 6, 7, 8 and 9, com- mencing on Tuesday, at 11 a. m. “The delegates shall receive their appoint- ment from permanently organized State Medi- cal Societies, and such County and District Medical Societies as are recognized by repre- sentation in their respective State Societies, and from the Medical Departments of the Army, Navy and Marine-Hospital Service of the United States. “Each State, County and District Medical Society entitled to representation shall have the privilege of sending to the Association one delegate for every ten of its regular resident members, and one for every additional frac- tion of more than half, that number: Pro- vided, however, that the number of delegates for any particular state, territory, county, city or town shall not exceed the ratio of one in ten of the resident physicians who may have signed the Code of Ethics of the Association.” - Members by Application.—Members by ap- plication shall consist of such members of the State, County and District Medical Societies entitled to representation in this Association, as shall make application in writing to the Treasurer, and accompany said application with a certificate of good standing, signed by the President and Secretary of the Society of which they are members, and the amount of the annual membership fee, $5.00. They shall have their names upon the roll, and have all the rights and privileges accorded to perma- nent members, and shall retain their member- ship upon the same terms. At a recent meeting of this Association, the following was unanimously adopted: Whereas, The American Medical Associa- tion did, at Detroit, in 1892, unanimously re- solve to demand of all the medical colleges of the United States the adoption and observance of a standard of requirements of all candidates for the degree of doctor of medicine which should in no manner fall below the minimum standard of the Association of American Medi- cal Colleges; and - -> *. - t ... * * * : -, -ś - *t → • * - . * *. • * • * * , , - **, w - - i. - - * * - 1 l 3 . . * - - - & * > * : • . - * * Whereas, This demand was sent officially . . by the Permanent Secretary to the deans of every medical college in the United States and to every medical journal in the United States, now, therefore, the American Medical Associa- tion gives notice that hereafter no professor or Other teacher in, nor any graduate of, any medical college in the United States, which shall, after January 1, 1899, confer the degree of doctor of medicine or receive such degree on any conditions below the published standard Of the Association of American Medical Col- leges, will be allowed to register as either dele- gate Or permanent member of his Association. ORATIONS. On Medicine—James C. Wilson, Philadel. Phº, Surgery.—Floyd W. McRae, Atlanta, Gºo, State Medicine.—Daniel R. Brower, Chi- "hairman Committee of Arrangements.- Starling Loving, Columbus. - OFFICERS OF SECTIONS. Practice of Medicine.—Frank Billings, Chi- cago, Chairman; Carroll E. Edson, Denver, Secretary. Surgery and Anatomy.—W. J. Mayo, Ro- chester, Minn., Chairman; M. L. Harris, Chi- cago, Secretary. * - Obstetrics and Diseases of Women.——A. H. Cordier, Kansas City, Mo., Chairman; W. D. Haggard, Jr., Nashville, Tenn., Secretary. Materia Medica, Pharmacy and Therapeu- tics.-Thomas H. Stucky, Louisville, Ky., Chairman; Leon L. Solomon, Louisville, Ky., Secretary. Ophthalmology.—Casey A. Wood, Chicago, Chairman; Charles H. Williams, Boston, Secre- tary. Laryngology and Otology.—Emil Mayer, New York, Chairman; Christian R. Holmes, Cincinnati, Secretary. Diseases of Children.—Henry E. Tuley, Louisville, Ky., Chairman; L. D. Boogher, St. Louis, Secretary. Physiology and Dietetics.-J. Weir, Jr., Owensboro, Ky., Chairman; Lee Kahn, Lead- ville, Colo., Secretary. Neurology and Medical Jurisprudence.— Frederick Peterson, New York, Chairman; Hugh T. Patrick, Chicago, Secretary. . Cutaneous Medicine and Surgery.—W. T. Corlett, Cleveland, Ohio, Chairman; J. M. Blaine, Denver, Colo., Secretary. State Medicine.—Arthur R. Reynolds, Chi- cago, Chairman; W. P. Munn, Denver, Colo., Secretary. - Stomatology.—George V. I. Brown, Mil. waukee, Wis., Chairman; Eugene S. Talbot, Chicago, Secretary. Wm. B. Atkinson, Permanent Secretary. - THE MEDICAL DIAL. Prosress of Inedicine. GYNECOLOGY. SURGERY. , UNDER THE CHARGE OF J. H. DUNN, M. D., W. A. HALL, M. D. KNUT HoFGH, M. D. THE USE OF CALCINED BONE IN BONE * REPAIR. Martini (Il., Policlinico, Aug. 15, 1898) com- pares the results of his experiments with cal- cined and decalcified bone in repairing bone cavities. The former material was prepared by calcining in a crucible pieces of the epiphysis of the heifer’s tibia, the latter by treating sim- ilar pieces of bone by 10 per cent hydrochloric acid. Both materials were then preserved in alcoholic solutions, 1 to 500 corrosive subli- mate. The author concludes from his evidently careful experiments on rabbits with both mate- rials, that calcined bone is much the best mate- rial for the repair of bone cavities. 1–It sup- plies salts of lime to the osteogenetic tissue; 2—it is easily prepared, preserved and ren- dered sterile by heat; 3—it is easily adapted to the cavity and its porosity favors bony inva- Sion. J. H. D. Iuys (Bulletins de la Société Anat. de Paris) reports a fatal intestinal obstruction from a large uterine fibroid which had become twisted on its pedicle and pressed upon and flattened out the sigmoid flexure. The patient was a woman aged 57, who entered the hospital with great abdominal distension and symptoms of intestinal obstruction, but died while prepara- tions for opening the abdomen were under way. At the autopsy no other cause of obstruction or death could be found. J. H. D. Faber (These de Lyon) asserts that intes- tinal obstruction from torsion of the mesentery is exceedingly uncommon. He finds but nine cases in medical literature, including the case reported. The accident as a rule involves a double strangulation. It may be partial, i. e. when a coil of the small intestine is isolated, but in total torsion of the mesentery the whole jejunum and ilium is isolated and changed to a closed cavity; hence, there is ascitic effusion, absence of faecal vomiting and circumscribed distension about the umbilicus. When partial mesenteric torsion takes place the coil involved is usually high up the jejunum, and the abdo- men is retracted. Obstruction from mesenteric torsion is one of the deadliest of its class, the eight cases which Faber finds in the literature having been all fatal. The abdomen should be early opened and the twist unrolled. Enter- ostomy is absolutely useless. In partial torsion the strangulated coil must be resected if sloughing. J. H. D. A. W. ABBOTT, M. D., F. A. DUNSMOOR, M. D. J. H. RISHMILLER, M. D SUPRAPUBIC HYSTERECTOMY WITH INTRAPERITONEAL TREATMENT OF THE STUMP IN PREG. NANCY AT TERM EOR OBSTRUCTED LABOR. W. M. Polk (Medical Record, March 4th, 1899) discusses this subject, making the reader conscious, as usual, of his accurate and minute observations. Leopold's latest statistics place Caesarean section within the limit of safe op- erations. Porro's operation, like hysterec- tomy for fibroids, was originally executed so as to leave the cervical portion of the uterus fixed in the lower angle of the abdominal in- cision. At present, like other suprapubic hysteroctomies, the stump can be treated in- traperitoneally. If we learn to regard the pregnant uterus as a tumor requiring excision and banish the thought that pregnancy adds to the mortality of operations, we have no ob- stacles in accepting to treat the stump from Porro's operation intraperitoneally. One of the most interesting chapters of modern surgery relates to this conquest. For example: A patient after the birth of the seventh child developed a cystic kidney on the right side. The kidney and enlarging uterus Caused so much pain in a subsequent gestation that the kidney was removed at the sixth month. The kidney neoplasm was as large as the uterus, and crowded well up beneath the floating ribs, and in turn crowded the uterus downward and to the left. The operation, the convalescence from it, the subsequent course of the case of labor, labor itself, and its con- valescence, were uneventful. The offspring is now two years old and suffered no harm. The second instance was a young married Woman, sterile, and who insisted on relief. An ovarian tumor, three and one-half inches in diameter, had a bearing upon the issue; there- fore, its removal by the abdominal section was suggested. While considering this advice the patient nullified it by becoming pregnant. Now another phase of the situation presented itself, the possible influence of the tumor caus- ing abortion; or its probable interference with delivery. Removal was again advised. This suggestion was accepted and a dermoid cyst rid the patient of a dangerous growth. The patient made a good recovery from the opera- tion and finally was delivered with untoward complications. The Porro operation is presented to us as a necessary measure or as one of election. As a measure of necessity the author states that THE MEDICAL DIAL. 175. We are faced by dire complications, such as Osteomalacia, a ruptured uterus, a septic uterus, uncontrollable hemorrhage and exten- sive uterine fibroma, especially of the lower uterine segment, and large enough to en- Croach upon the line of delivery. In all these conditions extirpation is the proper remedy. Caesarean section and symphyseotomy may be presented as alternatives. The point favoring Caesarean section is the avoidance of mutila- tion. It is more dangerous than extirpation, because the operation deals with a surface more fragile and more liable to sepsis. Leak- age of virulent poison into the peritoneal cav- ity generally means death. Time consumed in Operating and the amount of shock involved are practically the same. The question, then, is narrowed down to mutilation versus safety, and the less skillful the operator the greater the preponderance of safety on the side of ex- tirpation. In comparison with symphyseotomy the contrast can only apply to those greater de- grees of contraction to which symphyseotomy , is adapted. The author casts his vote for ex- tirpation and with all the greater alacrity the poorer the operator. It requires more skill to properly and successfully perform symphyse- otomy, eviscerate and remove a child from such a pelvis than it does to deliver a living child and extirpate the uterus from above. DETAILS OF OPERATION. There are present conditions which give the operator joy, such as elongation of the vagina which places the uterus well out of the pelvis and affords easy access for amputation. Likewise in pregnancy the vessels are enlarged and can be readily reached; the peritoneum is loosely attached and can easily be separated while the ureters, though drawn upwards, are proportionally less so than the cervix. The uterus is emptied after it has been turned out- side the abdominal cavity. Time is saved by tearing asunder the uterus, first cutting an opening to admit two or three fingers, choos- ing for the incision the median line commenc- ing at the fundus. Any troublesome hemor- rhage is checked at once by an elastic ligature thrown about the uterus below the rent. Then the uterus is removed. After ligating the ute- rine vessels and cutting away the uterine superstructure it is easy to invert the stump and from the direction of the vagina seize and draw down the stump and with T-shaped clamps, or ordinary hapmostatic forceps con- trol all bleeding. This secures a clean perito- neal cavity and enables the operator to close the coeliotomy wound. Case 1. Emergency hospital. The condition demanding the operation was a deformed pel- vis (osteomalacia). Deformity affected mainly the right half of the pelvis; there were nar- rowing of the arch and an encroachment of the acetabulum upon the pelvic cavity. Transverse diameter midway the canal meas. ured two and one-half inches; antero-posterior, three inches. When operated upon the patient had been in labor seventy-two hours. Child Weighed five and three-quarters pounds. Mother and child made excellent recoveries. Case 2. J. V., aged twenty-nine years; had been pregnant once before, and delivery was accomplished by means of embryotomy per- formed at term. Cervix was almost Obliterat- ed, and what remained appeared to be com- posed chiefly of cicatricial tissue. Free inci. Sion of the extensive cicatricial cervix being essential to such a delivery, the author deter. mined in favor of abdominal section. The Vagina was so greatly elongated as to place the utero-vaginal juncture well above the pel- Vis so that all that remained of the cervix was removed along with the body of the uterus. Recovery was somewhat slow, due to the de- Velopment of inflammatory exudate about the ligature controlling the vessels on the right side. This finally disappeared, and the patient left the hospital in excellent condition. The child thrived well, although fed artificially. J. EI. R. OBSTETRICS. A. B. CATES, A. M., M. D. R. E. CUTTS, B. S., M. D. ON THE OCCURRENCE AND SIGNIFI- CANCE OF POST-NATAL TRANS- FUSION. Rudolf Köstling (Brit. Gyn. Jr., Feb., '99) understands by post-natal transfusion that it is the blood which passes from the placenta to the foetus after birth. Köstling reports his OWn investigations and also collected the lit. erature on the subject. These researches were in regard to the change in weight of the child from the time it was born until the cord was cut and also determining the amount of blood Which flowed away when the cord was imme. diately severed. This increase in weight in primipara, when the cord was allowed to re- main until pulsations ceased, varied from 0 to 130 g. in primipara and from 0 to 80 in multi- para. If the cord was severed immediately after delivery he collected from it weights Varying from 10 to 152 g. in primipara and from 5 to 115 g. in multipara. As to the cause of post- natal transfusion he ascribes the contractions of the uterus which force the blood from it into the placenta and so leads to transfusion. He cannot confirm the statement that children Whose cords are cut early have an inferior ap- pearance and general condition; however, he thinks that children whose cords are severed :* - - - - ~ - ... - - *: - T. ... ...is; " - -ºw ** * : * > * > * > * * * - - A - Sº * ... . .-...- -- *.*, *, * .' * - - - s& *, ... • -* - ... . . . j *- ‘. . . .” * It * * • * . * j , . { - * : *- - late have a decided advantage. He considers that pulsation should have ceased in the cord before division, but thinks that Crede's grip, the elevation of the placenta and the stroking down of the cord, are superfluous. R. E. C. ECLAMPSIA. M. Bar (Univ. Med. Mag., Vol. XI, No. 6) proposes to call puerperal eclampsia without convulsions by the name of eclampism. In eclampsia convulsions greatly aggravate the prognosis of the preconvulsive condition, but the author contends that there are many cases which have no convulsions, but, instead, may have intense neuralgia, nausea, diarrhoea, albumen, oadema, and other symptoms of eclampsia; such cases may prove speedily fatal. Cases are reported which had prodromes of eclampsia, but no convulsions which quickly terminated by death. Autopsy revealed char- acteristic lesions of kidneys and ecchymotic spots. Patients may be in a true state of eclampsia • from self-intoxication without having a convul- sive attack. Bar wishes to emphasize the fact that while, generally spoºking, convulsions are characteristic of eclampsia, they are simply one of the many symptoms and may, like...any other symptom, be absent in self-intoxication. R. E. C. TREATMENT OF POST-PARTUM HEMOR. RELAGE. Bastian (Brit. Med. Journal No. 1992) advo- cates a method of plugging the Vagina, which he considers effective in all cases. The cervix is seized with forceps and pulled down as far as for any gynecological operation. Hermetic closure of the cervical canal by One or more pairs of strong pressure forceps closing the external os is good practice. Both these proce- dures have the great disadvantage of being applicable to cases of inertia only and are useless in post-partum hemorrhage from such causes as deep lacerations of the vagina or cer- vix or ruptured varicose veins. Plugging the vagina, as usually practiced without assist- ance, is useless. In Bastian’s method a Cusco bivalve specu- lum is introduced into the vagina, the blades, which should be about five and one-half inches long, are opened as widely as possible, thus bringing the cervix plainly into view. Steril- ized or iodoform gauze is then introduced, great care being taken to pack firmly against the cervix and cul-de-sac. The uterus is car- ried into the abdomen by the packing, and the plugging is continued until the vagina is filled. The speculum is left in position for 12 hours and the packing for 24 hours. The author thinks the woman is so safe as to require no special attention after the packing is per- formed. The mechanism is complex. If the THE MEDICAL DIAL. hemorrhage is vaginal, one of the valves of the speculum will compress the bleeding part, and the stretching of the vaginal wall is an indirect aid. If the hemorrhage is from the cervix the direct pressure from the packing will check it; also check it indirectly by pressure on the ute. rine arteries in the base of the broad ligaments and also due to the stretching of the parts by elevating the uterus. If from inertia the last named mechanism is equally effective closing the cervix as well as forceps. An intra-uterine clot then forms and causes the uterus to con- tract. R. E. C. PEDIATRICS. UNDER THE CHARGE OF H. B. SWEETSER, M. D. J. P. BARBER, M. D. THE MANAGEMENT OF THE FEVER OF PNEUMONIA. A very useful and practical debate on this Subject has recently been held in the Section of Pediatrics of the New York Academy of Medicine, and is reported in the Medical News of November 19, 1898. * Chapin thinks that in our management of hyperpyrexia the first point is to avoid any measures that will secondarily have a bad ef- fect, and thus hinder future chances of recov- ery. All depressing remedies come under this head, as, for example, most of the coal-tar de- rivatives. The only exception to this rule is the Occasional administration of small doses of phenacetine in sthenic cases where there is pain and nervous restlessness. Cardiac stim- ulants, such as caffiene or camphor, are al- ways added. When very high temperature keeps recurring, however, this remedy is not to be continued. Antipyrin, and especially acetanilid, should not be given under any cir- cumstances. It is sometimes a great tempta- tion to give these preparations, as they are easily taken and usually have a prompt if only temporary effect. The application of water is on the whole the safest and most satisfactory method of controlling dangerous hyperpyrexia. Much may be accomplished by a thorough applica- tion of cold to the head. This not only re- duces the temperature, but relieves to a cer- tain extent its deleterious effect on the brain and nervous system. In order to be effectual the cold to the head must be thoroughly and continuously applied. The ordinary method of applying cool cloths is not sufficient. Fine- ly cracked ice placed in bladders, from which the surplus air is expelled, may be molded around the head, especially at the vertex and occiput. Chapin has found ice poultices, made by mixing finely cracked ice with flax- seed meal in oiled silk, placed around and On top of the head, to be most valuable. By this . . . . . . . . . . . . . THE MEDICAL DIAL. means a Steady application of cold can be con- Veniently applied. If this is not accom- plished, the next resource is the application of compresses directly to the chest. * The child is stripped, wrapped in a blanket, and placed upon a table. A stimulant is given and the feet are placed in contact with hot bottles. A compress sufficiently large to Surround the chest is plunged into water at a temperature of from 70 degrees to 95 degrees F., and applied to the chest. This is changed eVery ten or fifteen minutes until the desired result is obtained. In order to disturb the child as little as possible, the nurse is directed to apply the compress from the front, tucking in the ends until they meet in the back, in this Way avoiding much movement or inconven- ience to the child. The exact temperature of the Water in a given case must be determined by the condition of the child, and the tempera- ture to be combated. A needless amount of cold is often employed. - If the temperature is 105 degrees F., the water may be 95 degrees F., or even warmer, at the start. A frequent application of the compresses will often produce results at this comparatively high temperature. presses are allowed to remain unchanged, they become warm and the effect is lost. If the temperature does not yield, the tem- perature of the water can be lowered until it reaches 70 degrees F., 60 degrees F., or even lower. It requires some careful watching to determine exactly how low the temperature of the water may be kept. The addition of about One-fourth part of alcohol sometimes increases the value of these compresses. This was well exemplified in a case recently under the au- thor’s care. An infant fifteen months old, with an extensive bronchopneumonia had a temperature ranging from 104 degrees F., to 105 degrees F. As the symptoms were some- what urgent, the infant twitching as in begin- ning convulsions, a compress at 60 degrees F. was applied about the chest. The child be- came slightly cyanotic under the compress, without much reduction of temperature. It was then removed and stimulants given. The following day compresses at 70 degrees F., with the addition of one-fourth alcohol, were applied, and the child reacted well to this treatment. The temperature soon dropped to 102 degrees F. So long as the feet and hands are kept warm the cool compresses may be applied, but chilliness of these parts is a contraindication to cold. When the temperature is reduced to 102 degrees or 103 degrees F., the compresses should not be renewed, but are kept in posi- tion in case the temperature ascends again to an unsafe degree. In the meantime they act in the same way as a cotton-batting jacket. Chapin has sometimes kept a child in this po- sition for several days, applying cold when indicated by a hyperpyrexia which tends to re- If the Com- . . . . . . . . . .- : | -- - . - * ~ * * ~ * { • > * > . - - - '. - 17 l - - r º cur. This clinical fact is probably explained by a mixed infection, and not the pneumococ- cus alone, being responsible for the disease. Wide variations in the temperature point to the former condition. - The deepened respirations ensuing upon the application of the compresses have a fav- orable effect upon the pneumonic circulation. As a rule children do not object to the com- presses when applied in the manner here sug- gested, the principal point being to avoid too great a degree of cold and to apply the com- presses with as little disturbance as possible . to the child, keeping the extremities warm. Although Chapin has occasionally em- ployed the tub, he rarely uses this method now in combating hyperpyrexia. The fright of the child and the exhaustion which accom- panies the tubbing contraindicate is use, He believes that all the good effects which may be obtained by the use of the tub may be had by a proper use of cool compresses. In case of cyanotic children, with prostra- tion and hyperpyrexia, he has employed the warm bath (100 degrees F.) with friction of the surface with good results. Continuing the debate, Holt spoke of the treatment of pneumonia in very young child- ren. By way of summary, he lays stress upon the following points in the treatment of pneu- monia in this class of patients: No depleting measures are ever admissible. Hygienic treatment, including fresh air, proper feeding and intelligent care, is of the utmost importance. No unnecessary medication should be per- mitted. Many annoying symptoms may be relieved by local treatment, such as the cough by inha- lations, pain by counter-irritation, restlessness by the ice-cap or sponging. Stimulants should be deferred until de- manded by the condition of the pulse. High temperature is much more safely and effectively controlled by the use of cold than by drugs. Greater caution is necessary in the use of powerful stimulants than is generally ob- served. Rest is quite as important as in other seri- Ous diseases. Dr. Simon Baruch next discussed the Value of hydrotherapy in the pneumonia of children. He said that the short time at his disposal would not permit him to offer more than a general outline of the hydriatic procedures which he had found useful, and to inculcate the necessity of using each with due regard to its rationale. In children under three years, the tub bath with continuous friction is most useful. If the body temperature is between 101 degrees and 103 degrees F. a tub is placed upon two chairs, near the bed, and half filled with water at 95 degrees F.; and the child is we ºº ... . :...” * . . . . . . . is wº. 3: ... 3 *: , <-- . . . . . . . ~~ * * x: . . . . . . " ‘’’. .,,. tº - - * *. f * - * * - r - * * . . - * . 4. * * gently submerged and held by pressing the fingers upon one shoulder (not upon the chest), Ice water is now added, without being allowed to touch the child’s body, until 85 degrees F. is reached; friction over the entire body is maintained for five minutes. This is a good initiatory procedure; it may be repeated every four to six hours with ad- Vantage So long as the temperature does not fall below 101 degrees F. When the body is above 103 degrees F. the water bath may be reduced to 80 degrees F., very rarely lower, and never so low as some bath temperatures mentioned. The duration should be prolonged to eight minutes; in this event it requires rep- etition every four hours. In the intervals be- tween the baths a compress, covering the entire anterior part of the trunk (the entire trunk is better) consisting of three folds of old linen or a towel (without fringes) wrung more or less out of water at 70 degrees F., and secured by a flannel bandage placed around the body, may be applied with advantage every hour When the patient is not asleep. This proced- ure not only fulfils every indication, but it also renders the demand for bathing less fre- quent. When delirium and stupor are present, When cyanosis is pronounced, and cardiac ac- tion embarrassed, when the bronchi are clogged with secretions, increasing dyspnea, in these conditions, which are so frequent in bronchopneumonia of children, the full bath may be changed to dips into water at 80 de- grees F. or less for a few seconds, repeated two or three times in rapid succession every hour, the temperature, duration, and fre- Quency being in accord with existing condi- tions. An excellent procedure in these des- perate cases is the affusion with basins of wa- ter at 60 degrees F. or less, poured over the head and shoulders of the patient, who is held semi-recumbent in a tub containing water at 100 degrees F. Rapid drying and friction are demanded after these procedures, because the patient’s reactive capacity is below par. Body temper- ature is not an index for the cold affusion, which should be given in these desperate cases even if the temperature is low. We aim to stimulate the central nervous system and thereby improve the circulation, respiration and expectoration. When the child is restless an occasional full bath at 95 degrees F., pro- longed for ten minutes, will prove soothing. In most children over three years of age full baths are too disturbing. A younger child will become quiet as soon as it experi- ences relief and comfort, while the older child will continue to struggle and scream. When- ever the child is tractable he prefers the full bath, but he insists upon it in every case when other treatment proves inadequate. Having observed that the toxines of pneumonia en- dow the patient with less resistance to cool- THE MEDICAL DIAL. ing procedures than do the toxines of typhoid fever, he avoids full baths colder than 75 de- grees and longer than eight minutes in the former disease. . In the management of pneu- monia patients larger reductions of the body temperature are not the prime object. In most children above three years of age the chest compress consisting of three folds of old linen so arranged by slits in the axillary portion as to fit Snugly around the chest down to the navel and held in position by a flannel binder, is the most useful procedure. The linen is Wrung out of water at 65 degrees to 70 degrees F., more or less thoroughly, according to the temperature and general condition, and the flannel bandage is pinned over it. (Oiled silk, which the nurse will recommend for pro- tection of the bed, counteracts the object of this compress and converts it into a poultice.) It is repeated every hour and discontinued when the temperature reaches 100 degrees F. These are the simplest and most useful hy- driatic procedures in the pneumonia of child- ren. The time limit precludes their more de- tailed description. Baruch concluded with a few words of warning to the effect that spontaneous reac- tion must always be provided for by friction during the bath so that there should be no need for warmth and friction after the bath. Whenever the patient becomes very chilly, with chattering teeth and cyanosed face, we may conclude that the procedure has been faulty and must be modified. A few nights ago Baruch saw a case in consultation with a well-informed practitioner who feared water- treatment because the patient had become cold and cyanotic under a wet pack. Inquiry elicited the fact that the patient had been sim- ply wrapped in a cold, wet sheet (no definite temperature). She was not covered snugly by blankets, as is demanded by the technique of the wet pack in order to promote reaction. This incident illustrates the importance of correct technique. Reaction is always fur- thered by rubbing during the procedure, or by protection against evaporation. It may be enhanced, also, by modifying the temperature of the water, not, as is often erroneously done, by elevating it, but by lowering it within rea- sonable limits, and shortening the procedure. It is a law of hydrotherapeutics that low Wa- ter temperature, strong mechanical impact, and brief duration, promote reaction. Higher bath temperatures are more agreeable and, if the procedure be prolonged, afford greater temperature reduction, but do not produce the stimulating, antifebrile effect of a correctly adapted cold procedure. J. P. B. MINISTERIAL HUMOR. At the close of the forenoon session of a ministerial conference, in announcing the Open- ing subject for the afternoon session, the pre- & - Af > THE MEDICAL DIAL. siding officer stated that Elder H- would pre- sent a paper on “The Devil,” and added: “Please be prompt in attendance, for brother H— has a carefully prepared paper, and is full of his subject.” Imagine his chagrin when an uproar of laughter reminded him of the un- happy witticism he had blundered into.—Homi- letic Review. Neurology and Psychiatry. UNDER THE CHARGE OF R. O. BEARD, M. D., W. A. Jon Es, M. D. BIOLOGICAL CONDITIONS OF THE PAR- ENTS OF EPILEPTICS. The author (Dr. Gaston Bechet, Archives de Neurologie, March, '99) investigated the family history of forty epileptic patients, and com- pared their statistics with the figures given for normal families in a similar investigation carried on by Ball and Regis. The results are tabulated under four heads: I. LONGEVITY. In the grandparents the length of life was rather greater than that for normal families, showing an average of sixty-nine years for epi- leptic families against sixty-five years for nor- mal. Of the parents thirty-seven were still liv- ing, and the average at death for the remaining forty-two was fifty years. This is well below the average age given for normal families, which is fifty-seven years. II. FECUNDITY. The number of children born to the grand- parents was considerably larger than for nor- mal families, showing an average of seven and sixty-two one-hundredths to each epileptic fam- ily as against four and thirty-eight for the nor- mal. The children born to the parents aver- aged six and twelve one-hundredths; the num- ber for normal families is not given. Of these forty epileptics twenty-six were married, and their children showed an average of one and sixteen one-hundredths per family as against a normal average of two and sev- enty-three one-hundredths. III, VITALITY. The vitality of the parents of the epileptics compared favorably with that of normal indi- viduals: Dead. Living. Parents of epileptics. . . . . . . . . 53.16% 46.83% Parents of normal . . . . . . . . . . . 57.5 % 42.5 % Of the brothers and sisters of the epileptics forty-two per cent had died. The age at which these deaths occurred showed a marked varia- tion from the normal, since eighty-six sixty-five one-hundredths per cent occurred under the * ...” •. , , , *. x- - , i. - * * * , * age of twenty years, while in normal families but sixty-six sixty-seven one-hundredths per cent of the deaths occur below this age. IV. DISEASE. The causes of the 411 deaths which had OC- curred in the four generations were as follows: ° a. Respiratory diseases, 136 (Phthisis, 53, occurring mainly in the ascendants.) b. Old age, 98 c. Cerebral and spinal diseases, 84 d. Neuroses and insanity, 11 This last figure is in contradiction to the figures of Ball and Regis, who place the fre- quency of nervous affections next to that of the pulmonary. The author draws the sions: 1. The longevity among the ascendants is less than that of normal families. 2. The average of births for the families is greater than the normal, but among the indi- viduals epilepsy tends to sterility. 3. The vitality is less in epileptic families, a much larger proportion dying in early years than in normal families. 4. The frequency of the different diseases presents very marked characteristics. Pulmo- nary troubles (phthisis in particular) are very common among the ascendants; cerebral trou- bles (meningitis in particular) occur frequently among the descendants. The neuroses and in- sanity are, according to these investigations, remarkably rare in the families of epileptics. These results confirm the well known opinion of Laseque that epilepsy is not hereditary. 2. W. A. J. following conclu. A CASE OF DISSEMINATED SCIEROSIS WITH UNILATERAL TREMOR. Tremor more marked on one side (Dr. Paul Remlinger, Revue de Medicine, March, '99) is often seen in Disseminated Sclerosis, but strict- ly unilateral tremor is exceptional. In fact it is generally admitted that unilateral tremor is hysterical in origin. As an exception to this rule the author records the following case: The patient, a well developed man, and a tailor by trade, first noticed a feeling of fullness and formication in the right upper extremity, which was followed later by steadily increasing tremor. The right lower extremity became in- volved in the same order, and a year or two later the lower lip showed similar symptoms. The tremor was intentional, and entirely dis- appeared on rest. While plainly marked on the right side, there was absolutely no tremor even on fatigue on the left side. Careful measure- ments and tests showed entire absence of atrophy, muscular weakness, or disorder of sensation on the affected side. Hysteria was absolutely excluded after failure to find any of *;--> **** * * * * * * *: ... . " • ... - . . . . . ; * - . .* - -* r * - -- *, *, * ~ * - -- : ..r. : ** * ~ * - * , * - - * - ir `-- w w - .* •, r the ordinary stigmata. Other symptoms pres- ent were exaggeration of the tendon reflexes on both sides, but more markedly so on the right; considerable diminution of the keenness of vision, due to optic neuritis; and a very slow, drawling and monotonous speech. When last seen, nearly six years after the beginning of the trouble, the patient was beginning to com- plain of a sense of fullness in the left arm, and it is possible that tremor will eventually ap- pear on the left side. W. A. J. MOTOR PATEIS IN THE BRAIN AND CORD OF TEIE MONICEY. Minute portions of the cortex were removed by Dr. Linden Mellus (Nerv. and Ment. Dis., April, '99) from the motor areas of the brain, after which the animals were allowed to live from ten to forty days. The movement con- trolled by the portion removed was, in each case, determined by faradic excitation. In most cases the removal of so small a portion of the cortex, generally from 2 to 4 mm. Square, was followed by no apparent disturb- ance of function, but the resulting degenera- tion was in some cases surprisingly large. Al- though an effort was made to have the area removed always of about the same size, the number of degenerated fibers varied largely in the different animals. The largest fibers were found following lesions in the highest portion of the brain, in the part governing movements of the great toe, and the finest fibers in the portion just anterior to the lower extremity of the fissure of Ro- lando, where is situated the center for laryn- geal movements. This gradual decrease in the Size of the axis cylinders from above down- Ward would seem to correspond to a similar decrease in the size of the pyramidal cells, as well as to bear some relation to the length of the axones. The degeneration of what may be called association fibers following all these lesions Was Very considerable. They were all subcor- tical, as it was impossible to trace any degen- eration within the substance of the cortex. In many Cases, especially when the lesion was near the fissure of Rolando, these subcortical association fibers were particularly numerous passing under that fissure, connecting the cor- tex of the ascending frontal with that of the ascending parietal convolution. Lesions of the ascending frontal convolu- tion were very likely to give rise to some degen. eration in the frontal gyri. Occasionally evi. dences of slight degeneration were found in the temporo-Sphenoidal lobe and in the convolu- tions of the internal surface, but never in the occipital lobe. In all cases scattered degener. ated fibers crossed in the middle third of the Corpus callosum to be distributed to the con- Volutions of the opposite hemisphere. THE MEDICAL DIAL. Proceeding inward or downward from the lesion, there was in each case a tract of black- ened fibers consisting sometimes of both coarse and fine fibers, and sometimes of only very fine fibers. In passing through the centrum ovale on the way to the internal capsule these fibers became more or less scattered, and Were not again found as a distinct and separate bundle, but were always more or less mixed in with the healthy fibers. In the upper levels of the internal capsule, fibers coming from the lesions in the upper portions of the convexity, as leg and upper arm areas, were found in the posterior half, while fibers from lesions lower down on the convex- ity, as hand or facial areas, were in the anterior half. On the other hand, in the lower levels of the internal capsule all the degenerated pyr- amidal fibers coming from lesions in this series of experiments, facial as well as lower limb fibers, were found well within the limits of the middle third of the posterior limb. If this ar- rangement holds good in the human brain, damage to fibers in the anterior portion of the capsule or about the genu, if in the upper lev- els would give rise to facial paresis; while small lesions a few mm. lower would be quite as likely to affect the upper or lower limb. A large proportion of the finer fibers com- ing from these lesions passed from the poste- rior limb of the internal capsule into the thala- mus, into which many of them could be fol- lowed for some distance. That these fibers are not collaterals given off by the pyramidal fibers as they passed through the capsule is shown by the fact that the fine degeneration in the capsule disappeared in proportion to the amount of degeneration passing into the thala- IIll IS. After lesion of the hallux center the tract of degeneration was considerably diminished by the passage of fibers, mostly fine, into the Optic thalamus. In the crus the remaining de- generated fibers were situated in the middle third. Here many passed from the dorsal bor- der into the substantia nigra, where they short- ly disappeared. The remaining fibers passed on through the pons and medulla, scattered over the entire cross-section of the left pyramidal tract. At the decussation of the pyramids the tract clearly divided, the majority of the degen- erated fibers crossing to the lateral column of the same side. Some blackened fibers clearly remained in the left anterior columns. None Of these fibers were observed to decussate. Occasional fibers could be traced for some dis- tance toward the anterior horn cells. Through- Out the lumbar enlargement fine fibers were found leaving the crossed tract, and they could be followed across the middle line into the gray matter of the opposite side. - The degeneration after lesion of the thumb center was always less than of the hallux cem- ter, and consisted of finer fibers. In the crus they lay to the outer third, and the passage of ~. - - . . * ~ : - . . THE NAEDICAL DIAL. Case V. White cells, 14,000; eosinophiles, 22–36%. - fibers to the substantia nigra was much more extensive, and in Some cases complete, so that below the crus no degenerated fibers could be found. In those cases in which degeneration could be traced on through the pons and me- dulla, the numbers of these fibers grew con- stantly less, and although single blackened fibers could be found leaving the pyramidal tract, they soon disappeared and their destina- tion could not be demonstrated. In considera- tion of the proximity of the facial area to these lesions, it is altogether probable that some cells connected with the facial nucleus were destroyed. After lesions of the facial center the distri- bution of degenerated fibers to the large cells of the pons was most noteworthy. In no case could a blackened fiber be shown to run into the nucleus or to come in contact with a motor cell. This of course would be impossible unless the fiber retained its medullary sheath to its termination. W. A. J. THE TO XICITY OF TELE BLOOD IN EPI- LEPSY. The author (Dr. P. Cololian, Archives de Neurologie, March, '99) gives an account of sev- enteen experiments made upon mice and rab- bits with the blood from epileptics, taken both before the attack, immediately after it and dur- ing the intermission. These observations lead the author to the conclusion that the blood of epileptics is always somewhat more toxic than that of a normal person, but is more markedly so immediately after the attack. These results are in direct opposition to the similar experiments made by Mariet and Vires, who decided that the blood of epileptics was less toxic than that of normal people. Cololian reasserts the long-acknowledged fact that the cerebral predisposition, whether hereditary or acquired, is the determining fac- tor, without which the toxicity would be pow- erless to cause the convulsions. W. A. J. CLINICAL MICROSCOPY. UNDER THE CHARGE OF J. FRANK CORBETT, M. D., G. D. HEAD, M. D. Osler, in the March number of the Am. Jour. of Med. Sciences, gives the results of a blood study of five cases of Trichinosis as fol- lows: • Case I. White cells, 17,000; eosinophiles, º II. White cells, 13,000; eosinophiles, º III. White cells, 34,000; eosinophiles, º IV. White cells, 18,000; eosinophiles, x- a . - ** ~ *k. * * * - - . . . . . . . . . . - * - , , , w *.* • j 81 A × - , - In every case a microscopical study of portions of muscle revealed the presence of trichinae. * It is a rather significant fact that in all the cases, except case I., the white blood count and the high percentage of eosinophiles directed the clinician to the correct diagnosis. In two cases typhoid fever was suspected, but the pronounced leucocytosis contra-indi- cated this diagnosis, and upon further investi- gation the true nature of the disease was dis- COvered. In one case malarial fever seemed the most probable diagnosis in the beginning, but the absence of the amoeba in the blood, the pres- ence of leucocytosis, and the large percentage of eosinophiles, pointed the way to a correct Conclusion. The high percentage of eosinophile leuco- cytes in the blood of all the cases is most re- markable. A larger series of cases of Trichinosis with records of white blood counts and eosinophile estimations is much to be desired. G. D. H. INFLUENZA BACILLUS. Bacterioſogical examination of a case sup- posed to be one of pneumococcus infection re- Vealed the fact that about ninety-five per cent. of the micro-organisms in the smears were in- fluenza bacilli. This is interesting when con- trasted with two other cases giving symptoms of influenza, in one of which streptococci were found and in the other pneumococci, but no in- fluenza bacilli. The latter were easily obtained from the infected lungs by streaking an agar plate first with blood from the rabbit and then with the exudate. From the sputa it is more difficult, and at least half a dozen plates should be made. The colonies are about half the size of those of the pneumococcus and were exceed- ingly faint. These bacilli grow in haemoglobin or blood and occasionally make threads. They grow only at fairly high temperatures, and do not produce septicaemia in animals. They were not stained by Gram. As a rule, these bacilli do not grow at all secondarily without blood, and never to any extent. A fair guess at the identity can be made from the large number of small bacilli present rather than from the grouping. No observer could absolutely distinguish the influenza ba- cilli in the sputum alone. These bacilli grow best in pigeon’s or rabbit's blood, and very little haemoglobin was required. Sterilized horse's blood had also given fair results.-(Dr. W. H. Park, N. Y. Path. Soc.)—Am. Micro- scopical Journal. A three-year-old boy referred to his baby brother as “the boy what eats mama.” THE MEDICAL DIAL. . . . bospital clinics. ST. BARNABAS HOSPITAL. Gynecological Clinic by A. W. ABBOTT, M. D. ALEXANDER'S OPERATION. Miss F., 28. Anaemic, weak, nervous. lost flesh for one and a half years. quite thin. Constipated, sacral pains and leucorrhea quite profuse, and a constant, severe pain under the left breast, which was immediately relieved by the replacement of the uterus a year or more ago. The relief was uninterrupted for six months, when on re- moval of the pessary, the pain returned and Has IS in OW has since persisted. Examining bimanually, we find that the uterus is completely retroflexed. It can be fully replaced and there are apparently no ad- hesions. The ovaries are prolapsed and be- hind the fundus. Cases like this give the most pronounced symptoms, because the ovaries are compressed between the hard body of the uterus and the sacrum. When in their normal position, the ovaries are compressed only by the broad ligament and the bowels, both soft and yielding structures. Out of the many operations devised for retrodisplacement of the uterus, there are two which have met with the most favor. These are ventro-suspension and shortening of the round ligaments by way of the inguinal canal, called “Alexander’s” operation, from the sur- geon who devised it. In Ventro-suspension the peritoneum cover- ing the upper part of the fundus is made to adhere to the parietal peritoneum. In Alexander's operation the round liga- ments are sought in the inguinal canal and drawn out enough to hold the uterus forward, and then fastened in the canal. The advocates of each method have found fault with the other, hernia and interference With pregnancy and labor being the chief ob- jections. In regard to hernia, if either opera- tion is properly done, the danger is practically nil. Theoretically there is less danger in the Alexander operation, because the internal ring and the posterior wall of the canal are not dis. turbed and the anterior wall is left at least as Strong as before operation. In ventral sus- pension the abdominal wall being divided clear through, a failure of perfect coaptation and union endangers the strength of the wall at that point. Practically, however, the objec- tion does not stand good for either operation if Well done. In regard to the method of suspension, the best authorities differ, many insisting that the interference with labor is due to the attach- ment being made upon the posterior surface of the uterus, and claiming that all trouble is avoided by making the anterior surface of the uterus the point of suture; while Kelly and . others, equally insist that precisely the op- posite is true and that the posterior surface of . the womb should be attached low down upon the abdominal peritoneum. In view of the unsettled state of opinion among good operators, it must be considered that the best way of doing a suspension is still unknown, and as, from the different points of view, each faction of eminent men regards the other as radically wrong, we must admit that possibly both may be in error. Personally, I regard the shortening of the round ligaments as preferable to any form of ventral suspen- sion, because it approaches more nearly the natural anatomical conditions. The operation is unquestionably more difficult in the majority of cases than suspension. Still as it is at least as safe as the other, this should not stand in the way. Rather we ought to educate our- selves so that we can do it successfully. After a wide experience with this operation, I can strongly recommend it as being safe, not too difficult and above all of accomplishing what We Want. It is universally admitted that it does not interfere with pregnancy or parturition. What I have said applies to cases of retrodis- placement, uncomplicated by adhesions, tubal and ovarian disease, tuberculosis and tumors. When there are simply adhesions, these may be broken up after an opening is made into the peritoneal cavity by an anterior abdominal or posterior vaginal incision. If the anterior abdominal incision is chosen, you are certainly in a very convenient position to complete the operation by a suspension. If any of the other complications exist, I would advise you not to undertake the case, unless you have had a suf- ficient personal observation of their manage- ment to feel confident that you can conduct them successfully. We now find the spine of the pubis, cut out- Ward, and a little above Pourpart’s ligament, two and one-half to three inches, down to the glistening fibres of the external oblique mus- cles, clamping the branches of the superficial epigastric and external pudic arteries. The ex- ternal ring now appears as a long narrow tri- angle, with the apex outward. This we open by dividing the intercolumnar fibres for an inch. We now see the small inguinal branch of the ilio-inguinal nerve and the larger genital branch of the genito-crural. These we push to One side, grasp the contents of the canal be- tween the thumb and forefinger, and in the mass see the White glistening beginning of the ligament. This we carefully separate from the fat and muscle fibres, and with only a little traction find that it begins to run out. We now find that there seems to be a sheath which stops its further progress. This we peel off, letting the cord come out an inch and a half more. This sheath is the peritoneal invest- ment, and as we strip it off, we grasp it with THE MEDICAL DIAL. * forceps, so as not to lose it in case the liga- ment should break. We now introduce a curved needle, threaded with worm gut, through the peritoneal sheath as low as pos- sible, then the ligament; then, while the assist- ant makes sure that the nerves are not in- cluded, the needle is passed through the tendon of the external oblique, fat and skin. With another needle on the other end of the Worm gut, we pass through the tendon, fat and skin, of the other side. The ligament has not been cut, and as we tie the sutures, with narrow for- ceps we push the redundant loop of the liga- ment into the fat of the mons veneris. The other side we treat in just the same way. I prefer to suture in this way for two reasons: 1st, the nerves are better seen and avoided; 2nd, there is, I am quite certain, less danger of stitch abscess, as in this way the contents of the large hair follicles are not carried down into the track of the needle. The sutures will be left for twelve to four- teen days, if there is no suppuration. DOLIBILE VULVO—VAGINAL CYSTS. Mrs. M. Thirty-eight years old. Three children. Two years ago had inflammation in right vulva; six months later the same in the other side. Since then each side has inflamed at intervals up to last fall, when she had an acute inflammation of the right side. This was opened and apparently cured. Since then both sides have increased in size. She has Soreness after coitus, frequent Smarting and burning in vagina and a constant unpleasant sensation in the parts. With this patient in the lithotomy position, you can see an unusual protrusion toward the vulval cleft on each side, as if a couple of pig- eon eggs had been placed under the skin of the labia. They are not tender, fluctuate but are not very tense. They are cysts of the vulvo- vaginal glands, true retention cysts and con- tain a glairy, mucoid fluid, and result from the inflammatory closure of their ducts with con- tinued secretion from the gland walls. Each cyst is usually single, but sometimes they are divided by partitions. This case is very unique in that both glands are cystic. Cysts of one side alone or abscess of one or both sides are common enough, but the present condition is so rare that Kelly in his recent work, states that he has seen it only once. The vulvo-vaginal glands are normally about the size of a white bean, situated op- posite the vaginal opening and between the sphincter vaginae and compressor urethrae muscles. The duct is about one-half inch in length and opens between the hymen and nympha on each side at about the lower margin of the hymen by an orifice that is too small to be seen by the naked eye. They are said to be the analogues of Cowper's glands in the male. * - - “. ... . . . .”. . . .”. - “. & z º. --- - * * - . • a sº. ** .. - -** *.xx * * *s ~ : * * * :: - * • 2 . " • *, *. ^ - - - - , , * * * ^- 3- * . . ~ * , t - .g.” There are two methods of treatment—one by incision and cauterizing with iodine or cal- bolic acid the inner surface. The other, which is the best, is by complete enucleation and closure of the wound by suture. We Will adopt the latter operation. Pushing the Cyst outward by a finger in the vagina, I make an incision one inch long down to the cyst and then work around the sides, so as to entirely enucleate it. This we do easily until We COme to where the vessels enter, i. e. at the upper and back portion. This we cut across and pinch the little artery that supplies the gland. We now close the wound from below up With two rows of cat gut, the first buried, and cover the whole with iodoform collodion. The same operation we repeat on the other side. If there is no suppuration, the patient can Walk about with comfort in a week. If it sup- purates, it will also heal, but take a longer time. CONSERVATIVE SURGERY OF THE ADNEXAE. Mrs. S. Twenty-one years old. No chil: dren. Miscarriage three years ago. Had gonorrhoea seven years ago; three months ago pelvic peritonitis. Has acrtic obstructive and mitral regurgitant murmurs. Heart not en- larged. Urine is normal. Menstruation nor- mal. She wishes relief from an acute pain in the region of the ovaries upon the slightest exer- cise. She is nervous, weak and anaemic, but in fairly good flesh. Examining bimanually we find the uterus longer than usual, and not very movable. On the right side there is a mass as large as a hen's egg, immovable, and studded with nodules. It is elastic, but not fluctuating. The tube is large, feels solid and seems to come out of the mass as though a part of it. The mass is probably a large cystic ovary and the tube one whose walls have been thickened by repeated inflammations. We shall find extensive ad- hesions. On the left side the tube can hardly be made out, while the ovary is not so large as the right, and is fairly smooth, and not very dense, but is almost as immovable as the right one. We infer therefore that this ovary with the tube is nearly normal, but that it is plas: tered, as it were, to the broad ligament by ad- hesions which may also extend back to the sigmoid and rectum. This patient is in the child-bearing period and married, and while she insists on relief from pain she still, as she expresses it, “wishes to be left a woman.” To lay out a plan of treatment we must have clearly in mind the pathological condi- tions as we would expect to find them if the abdomen were opened for inspection. We have decided that we have a cystic ovary on the right side. What does a cystic ovary look like and how does it differ from the normal? Instead of being a pinkish grey, and smooth, * > . . . . . . . .# s' .. - … -- # , - - * - r * w > * : *.*.*.*.*.*.* . - ** < • §º.º. 3. '', - - º: "…as " …. , - " " - -- - - * & - - - : ~s • * & •. -. .* * ... . . * 3. ** -- * * * -i º 3- -- ** * * - x- s": * it would be white and studded all over with the projecting distended Graffian follicles. The white color is caused by the condensa- tion of the outer surface by inflammatory de- posits (chronic ovaritis), and the follicles are large and distended because they cannot read- ily burst through this covering and discharge the ovum and blood as happens in the normal ovary. If we cut such an ovary open we find it fairly honeycombed with these retention cysts. If we make a microscopic section through such an ovary we find a good deal of condensed connective tissue throughout the ovary between the follicles as well as on the surface. The little arteries we would find also with thickened walls and reduced calibre. The tube on the same side we have found large, solid and adherent to the ovary. If we could look at this we should find, in- stead of an open tube with fimbriae, which can be lifted free from the ovary, a closed ostium, no fimbriae, and the tube and ovary so cement- ed that quite a little force is needed to separate them. We might find the tube rounded and Clubbed at the end or flattened down on the ovary. If we stretch such a tube longitudinally, we cannot unfold the convolutions or bends, be- cause they are glued together by adhesions on the peritoneal surfaces. If we now cut across this tube we might find the lumen actually wider than normal but the walls very much thickened. A microscopic section would find the plicae very much flat- tened or thickened or almost absent, but, con- trary to what you will often read, the epi- thelium, though often shortened by compres- sion, is very rarely absent. Contrary also to what is generally understood the lumen of the tubes in chronic salpingitis is almost never obliterated except at the very outer end. A cross section of the wall also shows an increase of connective tissue between the muscular layers with more or less of round cell infiltration. The adhesions are in strings, sheets or plaques of varying thickness and strength. In some of them blood vessels can be demonstrated. In accordance with our diagnosis we should find the ovary and tube of the left side normal in color, thickness and density, the tube ad- herent to the ovary and the ovary adherent be- low the mesovarian to the broad ligament and its upper surface adherent to the bowel behind. The tube will not be thickened, and if we should separate the adhesion to the ovary, the fimbriated extremity would be found open and we could pass a probe clear through to the uterine end. With this picture before us we are prepared to consider the treatment intelligently. Twen- ty years ago these cases were treated by opi- ates, iodide of potassium, iodine and glycerine applications to the vagina, hot douches and THE MEDICAL DIAL even later by massage and electricity. They were never cured, and only temporarily re- lieved. Experience has taught us therefore that these measures are worse than useless. The following surgical operations have been adopted for the relief of these cases: 1st. Through an anterior abdominal in- cision. - a. Removal of the tubes and Ovaries. b. Removal of the uterus, together with the tubes and Ovaries. c. Removal of only the diseased por- tions of the ovaries or tubes and insuring the potency of the tubes. 2nd. Through a posterior or anterior Va- ginal incision, the same procedures have been carried out. Which of the above courses shall we select for this case? Several points have to be taken into consideration. 1st. Can she take an anaesthetic? Al- though she has a double heart murmur, the heart action and pulse are good. There is no oedema and the urine is normal. It will there- fore probably be safe to give either chloroform Or ether. 2nd. While we wish to relieve her of her suffering, we wish to save all organs or parts of organs not hopelessly diseased, provided their retention will not probably lead to future trouble. - 3rd. To do this we must operate in a Way that will give us the best chance for a thorough inspection of the parts. 4th. We must avoid all possible danger to the patient. & In accordance with our diagnosis we will hope to save all organs, except the right tube and ovary. We may therefore eliminate all of the surgical procedures which contemplate the removal of all of the organs or of both tubes and ovaries, and this brings us to the simple questions: How can we best remove the right ovary and tube, separate all adhesions and re- store the left ovary and tube as far as possible to their normal conditions? Which route will be the best, the vaginal or the anterior abdomi- nal 2 The vaginal operation is safer from sepsis, less liable to subsequent hernia, and more rapid, but it has the great objection of not giving us a clear field for inspection and thorough, complete technique. This so far overshadows the advantages of the vaginal operation that in my judgment we should un- hesitatingly accept the anterior abdominal route in this case. Having made a three-inch incision low down in the linea alba, we place the patient in the Trendelenberg position, wall off the in- testines with gauze, lift up the abdominal wall with a retractor, and find in the first place the adhesions much more dense than we expected. These we carefully separate from below up- where the finger can be worked down to Doug- THE MEDICAL DIAL. las’ sac. We now find the right ovary, a dead white in color, studded with cysts varying in wards, having found a place behind the uterus size from a pea to a hazelnut, and the ovary , about three times as large as normal. The tube is thick and solid, and the end clubbed and adherent. The broad ligament is also thickened close to the ovary. We ligate across the broad ligament in sections with cat gut, and remove the ovary and tube. The left ovary is nearly normal in size and color, and the tube apparently healthy, except that the firmbriae are plastered down to the ovary. We free these adhesions and turn back a cuff on the tube, fastening with a couple of cat gut sutures. We now mop up the little blood that has oozed into the pelvic cavity, bring the patient to the horizontal position, close the peritoneum with cat gut and the rest of the abdominal wall with worm gut, figure of eight sutures. book notices. THE INTERNATIONAL MEDICAL ANNU- AL AND PRACTITIONER'S INDEX. A Work of Reference for Medical Practition- €I’S. Contributors: Prof. A. H. Carter, M. D., F. R. C. P.; Prof. H. D. Chapin, M. A., M. D.; C. W. Daniels, M. B., M. R. C. S.; E. Hurry Fenwick, F. R. C. S.; W. Soltae Fenwick, M. D., M. R. C. P.; T. Colcott Fox, B. A., F. R. C. P.; H. Bellamy Gardner, M. R. C. S., L. R. C. P.; A. E. Giles, B. Sc., M. D., F. R. C. S.; J. Dundas Grant, M. A., M. D.; F. de EIavilland Hall, M. D., F. R. C. P.; Prof. G. M. Hammond, A. M., M. D.; David Hardie, M. D.; Robert Jones, F. R. C. S.; Prof. Chas. Boyd IXelsey, M. D.; Richard Lake, F. R. C. S.; Priestley Leech, M. D., F. R. C. S.; Keith W. Monsarrat, F. R. C. S.; Prof. W. Oliver Moore, M. D.; Wm. Murrell, M. D., F. R. C. P.; Stephen Paget, M. A., F. R. C. S.; Prof. Seneca D. Powell, M. D.; Jos. Priestley, B. A., M. D., D. P. H.; Wm. A. Purrington, A. B., L. L. M.; Prof. A. W. Mayo Robson, F. R. C. S.; A. D. Rockwell, A. M., M. D.; Prof. Robt. Saundby, M. D., F. R. C. P.; Wm. Thorburn, B. Sc., F. R. C. S.; A. H. Tub- by, M. S., M. B.; R. Norris Wolfenden, B. A., M. D.; Eugene S. Yonge, M. D., C. M.; Samuel G. Shattock, F. R. C. S.; Prof. W. Gilman Thompson, M. D. 1899. Seventeenth year. New York. E. B. Treat & Co., 241–243 W. 23d street; Chicago, 199 Clark street. Price, extra cloth, $3.00. Treat's Medical Annual has been before the profession for sixteen years, and has been steadily growing in favor. This, the seven- teenth volume, is by no means behind its pre- decessors. Every department of Medicine and Surgery has been covered, and the progress of the past year is presented in a condensed form which is invaluable as a work of handy reference. The staff of contributors has been selected from men of eminence in all parts of the world, the literary style is of a high order, and the book is copiously illustrated. A presentation of the newest and most ap- proved methods of treatment is a strong fea- ture in the book, consequently, it is eminently practical, while its moderate cost places it Within the reach of all. BACTERIOLOGICAL RESEARCHES UPON WHOOPING COUGH. Dr. Otto Zusch observed tWenty-five cases of Whooping cough. The micro-organism he found and described is a short bacilius. It did not show any evidence of agglutination in the presence even of undiluted serum from Whoop- lºg cough cases. While he does not believe that the bacterium he describes can be ac- cepted as the specific etiologic factor, he does not hesitate to offer the following conclusions ... Support of its specific pathogenic nature: The apparent uniform occurrence of the bac. teria in the sputum of Whooping cough cases and their non-observance in Sputa of a large Series of cases of other affections. The pec- ular correspondence of the bacteriological findings with the clinical course. Further. more, the experience that the greatest danger of transmission of the disease lies in the ºa. tarrhal stadium, i. e., in a stage in which the bacteria are found in the purest State and largest numbers.--Am. Microscopical Journal. The National Confederation of State Medi- £al Examining and Licensing Boards will hold its next meeting at Columbus, Ohio, June 5, 1899, beginning at 10 o’clock a. m. The follow. ing are the officers for the present year: Presi- dent, William Warren Potter, Buffalo, N. Y.; Vice-presidents, E. L. B. Godfrey, Camden, N. J.; William Bailey, Louisville, IXy.; secretary- treasurer, A. Walter Suiter, Herkimer, N. Y. Executive Council—Chairman, Wm. S. Foster, Pittsburg, Pa.; Joseph M. Mathews, Louisville, Ky.; Hugh M. Taylor, Richmond, Va.; W. H. Sanders, Montgomery, Ala.; Charles K. Cole, Helena, Mont. Committee on Minimum Stand. ard of Requirements—Chairman, N. R. Cole. lman, Columbus, Ohio; Gardner T. Swarts, Providence, R.I.; T. J. Happel, Trenton, Tenn.; Augustus Korndoerfer, Philadelphia, Pa.; W. R. Tipton, Las Vegas, N. M.–Western Med. Review. A PROPER PROPORTION. “In Berlin there's one bicycle to every twen- ty-five persons.” “That’s all right; any kind of a rider can easily run over twenty-five persons.”—Chicago Record. - * * * *- : * . . . . . * : **, rº • ‘T.’ ... . . . . ; *...* 3: - - , - * ~ * : - - - , , - . . . . * * tº a w i * p. - - - , . 185 * - * - * º 3. * THE MEDICAL DIAL. blood | Idle II?oments. One of the most common sources of humor for the doctor is the blunders made by people in trying to use medical terms. Every now and then some one tries to let the doctor know how smart he is and how well he is posted on medical subjects. I have an old friend of this sort who likes to be called “Doctor” and im: agines he knows a great deal about medicine— in fact he often tells me so. Though a pretty loyal friend of mine, he yet has one trait of character that more learned doctors are often accused of having. About some special dis- eases he thinks he has made new discoveries and knows more about them than any other man living; believing this, he naturally wants the world to know it. Some time ago, during a severe epidemic of diphtheria, I accidentally overheard him haranguing a little crowd, and this is a sample of what he was saying: “Now, my friends, these doctors don’t seem to understand this ‘dipthera’ at all. I can give you the facts about it. My friends, it is in the Now then, in the first place, the blood becomes mallerous, and then the whole system gets vicated. Now is the time for action. You must apply your external remedies ex- ternally and your internal remedies internally. But, my friends, if it ever settles down onto the mid riff, they are gone as sure as the d–l!” This same old fellow told me one day when I enquired after his health, that he was feeling a good deal “dilapricated,” that he had been suffering with a cold and cough, but he had been doctoring himself and he was now ex- postulating freely and was feeling better. I have noticed since that some of my own pa- tients get relief in the same way. A few days ago I was enquiring after a con- sumptive patient who lives in the country. The man I enquired of is a neighbor of the con- sumptive. “Oh!” said he, “they say he is doing real well now since he got that incubator thing. It cleans his pipes out splendid.” bator thing” was an atomizer. Cannon Falls, Minn. A. T. Conley. DIAGNOSIS OF UTERINE CARCINOMA. (All writers emphasize the importance from a diagnostic point of view, of the occurence of hem- orrhage.) L. G. Baldwin Says that the one sign of mal- ignant disease of the uterus which should always be investigated, and especially when it occurs at or near the menopause, is hemorrhage. In some cases the bleeding is caused by coition at a per- iod earlier than that at which any derangement of the menstrual flow is noticed. This is es- pecially true when the disease has its origin in the cervix. Another comparatively early symp- tom is an inter-menstrual, watery, irritating dis- * charge, not necessarily foul-smelling. The “incu- E. J. Ill says that early diagnosis from sub- jective symptoms belongs to the difficult prob- lems. Exhaustive playsical examination is nec- essary to confirm the suspicion. The ulcerating epithelioma of the cervix is easily known by its distinct, hard edges, the hardness extending somewhat beyond the ulcerating portion. The bottom of the ulcer is remarkably hard, but so friable that a curet will easily remove a large piece. A tenaculum will take no hold in it. Through the speculum it appears as covered by a dirty grayish matter. The ordinary erosion, On the contrary, appears of a red color, has no in- filtration of its edges(and is smooth and velvety to the touch. The curet will make little impres- Sion on it, except to remove a very superficial layer. The syphilitic ulcer will be recognized by its general symptoms. Carcinoma of the body cannot be diagnosed in its earlier stages by palpation. When carcinoma of the cervical canal exists it will be seen only when the cervix is di- lated and the curret removes the friable masses. By palpation the cervix is found enlarged, and hard, deep-seated nodules are felt.—Am. Year Book of Med. and Surgery p. 581. Delafield divides inflammation of the colon into five forms: the acute catarrhal variety, in which there is an increased production of mucus and Serum, but no grave symptoms, and which is of short and favorable course in all except children; the acute purulent form, in which there are signs of Septic poisoning and the prognosis is commonly bad; the acute productive, necrotic variety, which is a severe form, the most marked effect being upon the glandular layer of the in- testinal wall (this also the last form); the fourth form in which there are patches of false mem- brane, sometimes with necrosis of the whole wall; and, finally, the amobic form, which is due to infection of the connective-tissue layer by the Amoeba coli. The latter form is often associated with abscess of the liver. In treatment, if the desease is low down, it is best managed by local irrigations; but if high up, it must be treated by drugs by the mouth. Sometimes the two meth- ods are well combined. For irrigation Delafield often uses an infusion of flaxseed, if there is no necrosis; if there is necrosis, he uses I :IO,OOO bichlorid, chlorid of zinc, or formalin. In cases situated higher up he uses bismuth and opium, and in persistent cases ipecac in large doses, with small doses of castor oil, silver nitrate, salol, or naphtholin.—Am. Year Book of Med. and Sur- gery, 1899, p. 191. The Journal of Tuberculosis, a quarterly, published by A. H. McQuilkin at Ashville, N. C., has made its appearance. Karl Von Ruck is the editor of the new venture. It “is a beginning to- ward what is hoped to be the gradual establish- ment of a representative publication of American endeavor and progress in dealing with the pre- vention and cure of tuberculosis,” says their salutatory. THE MEDICAL DIAL. ix. & OAKLAND HYDROGEN DIOXIDE, U. S. P. “THE KIND THAT KEEPS.” ZººZºº §§ 3% º º A positive and harmless antiseptic and germicide for in- ternal and external use. Highly recommended in the treatment of diphthería, scarlet fever, and other contagious diseases. As a prophylactic in preventive medicine it is without a peer, and may be used lavishly or sparingly according to indications without a suspicion of harm resulting from its use in any application. THE OAKLAND CHEMICAL CO., 465-467 West Broadway, §§ NEW YORK CITY, N. Y. º º } |S º º w … | … º Z. - OQ --O2-sºº. ºOºººº-º-Oºººº-º-Oºººº-º-Gº-Oºººº-º-Ozºº PURITY “ºbat Gentier on the 5pirit Lieg, ºbam (Lir"o Eyelios on Cit'0 Eyes” cAMPLEs on APPLIcarrow ro The AnwrikAM wra chemicAL co., ST. Lou's, U. S. A. ºses: Per-Ost Dº-Osº pºsosº Dº-Osº lººſ-Ost Dº-Osº : & - Sº - Nºrººººººººººººººººººººººººººººººº. Nºvº --- |ººlººlººlºº º - º gº. 7. *... . . . " -X- * - º * ...:: * *** * ... ºr $...'...' * * ºx THE MEDICAL DIAL PUBLISHER'S DEPARTMENT. TEIE KELLEY HOT AIR AND WAPOR EATH. We have had the Kelley Hot Air and Vapor Bath apparatus in use and have been well pleased with its convenience, economy and effectiveness for the purposes for which it is designed. The simplicity and safety of its operation are conspicuous features in its con- struction, and the patient, if not too ill and feeble, can control the administration of the treatment without the assistance of a nurse. There is no waste of time in preparing it for use, as by simply lighting a lamp the full effect of the heat is in operation in a few minutes. We can recommend the apparatus as Worthy of a trial in the treatment of such cases as it has been especially designed to benefit. This apparatus weighs but five pounds and is fully illustrated and described in an adver- tisement on another page. WWELEN PAIN IS DOMINANT. “A number of years ago, in a conversation with my old friend, Professor Stucky of Louis- ville, he told me that he used far less morphine now than formerl yand that he was able to combat the factor of pain as successfully in the majority of cases without it as he did with it. He urged me to give antikamnia to my pa- tients who had neuralgia, la grippe, rheuma- tism, locomotor ataxia and dysmenorrhoea, in- stead of using morphine. I acted on his sug- gestion and have been able to relieve this class of patients as effectively and without produc- ing the evils that result from the exhibition of opium or its alkaloids. Antikamnia possesses anodyne, antipyretic and analgesic virtues and has been thoroughly tried by able therapeut- ists. Prof. Shoemaker of Philadelphia has found it very valuable in rheumatism, mi- graine or neuralgic headache and many other nervous affections.” Readers will notice the Dial list of leading druggists of Minneapolis. Out-of-town physi- cians who may wish to have special work done in the way of filling prescriptions, which can- not be done at home satisfactorily, would find that any firm named in the list will attend to anything entrusted to them with despatch and in a satisfactory manner. They all have facili- ties and the goods to suit the wants of any physician. Extract from a lecture delivered at the Michigan College of Medicine and Surgery, by Dr. J. F. Bennett, Professor of Dietetics: Maltine is a pure extract of malted barley, wheat and oats (instead of being made from Only one of the cereals), containing all of the nutritive properties of these three grains, in addition to the valuable digestive agent dias- tase. You will find it particularly valuable where you wish to get a bone-producing and fat-making substance combined with the di- gestive agent diastase. I use it daily in my practice, both alone and with the various ton- ics and reconstructives with which it is com- bined, with very satisfactory results. A copy has been received by the Medical Dial of “The Antikamnia. FOetation and Partu- rition Chart,” published by the ever enterpris- ing, the Antikamnia Chemical Company, of St. Louis, Mo. It is a beautiful combination of three sheets of heavy Bristol containing nearly two dozen handsome colored engravings show- ing all the genital organs with descriptions, and the different periods of gestation from the beginning week. But on the main card is the Parturition Table, which is very convenient as showing the approximate date of delivery from any day in the year. The Medical Dial is in receipt of a beautiful lithographed pamphlet from the ever enterpris- ing Mr. Henry of Louisville, who in a letter says he is now principal owner of the cele- brated French Lick Springs of Indiana, which has a capacity for 500 guests. The famous Spa Pluto, America’s aperient and a product of these springs, he will introduce at once through the medical press as the most saline hydra- gogue eliminant and intestinal antiseptic, akin to Carlsbad, without the accompanying nausea and thirst. Through an unfortunate error in the adver- tisement of I. W. Kelley & Co., of Chicago, the “Kelley Hot Air and Vapor Bath” has been misrepresented. During the three months it has appeared in the Dial the weight of the out- fit has been stated to be “fifty-one” pounds. It should have appeared “FIVE” pounds. This bath is becoming celebrated, for it is everything that is claimed for it, and for many treatments is indispensable. - The Seeley Hard-Rubber Trusses, manufac- tured by Chesterman & Streeter, 25 South Eleventh street, Philadelphia, are about as per- fect as is possible to make trusses. They fit accurately and the wearing of them is un- conscious to the wearers. They hold the parts Snugly in place where they belong, creating a tendency on the part of the separated muscles to heal, thus allowing nature to do her royal Work. The Eureka Nebulizer, shown on another page, is everything claimed for it, and for special treatments, for which it is intended, there is no better on the market. Full descrip- tions will be sent on application to O. Q. Hol- man, LaGrange, Illinois, the general agent. THE MEDICAL DIAL. xi John W. Vaughan, M. D., Professor of Orthopedic and Clinical Surgery, Barnes’ Med- ical College, St. Louis, Mo., writes: The re- sults of Hagee's Cordial of Cod-liver Oil Com- pound have been most remarkable. For sub- acute and chronic bronchial and pulmonary troubles it is the ideal compound. As a recon- structive to the tissues and nerve tonic I have found nothing to equal it. It is non-irritating to the stomach and freely absorbed and assimi- lated. ~~~~Oººº-º-Oººº-º-º-O “STEVENSFAVORITE”; IETIETILTE. O it ºtakes Down.” :*:::: . . *** > -º * f. © 22-inch barrel, weight 4 pounds. () Carefully bored and tested. NO. I3 Target Sights, $8.50 Ask your dealer for the “FAVO- TITE.” If he doesn’t keep it we will send, prepaid, on receipt of price. Send stamp for complete cata- logue showing our full line, with val- uable information regarding rifles and ammunition in general. O For .22, .25 and .32 rim-fire cartridges. No. 1 7. Plain Open Sights, $6.00 : () O J. STEVENS ARMS AND'''[[]], [0, _mºſ P. O. Box 9 16 CHICOPEE FALLS, MASS. ©º-º-º-º-º-º-º-º-º-º-O VA/A NT COLU N/ N. DVERTISEMENTS will be inserted in this column at the rate of two cents a word, with a minimum charge of twenty-five cents, cash in advance. LECTRIC APPLIANCES.—A private party has for sale a num- ber of medical electric appliances, in every way as good as new. State what is wanted. Address Electric, The Medical Dial. EDICAL, EXCHANGE.-Have you anything to sell? Do you want to buy anything? Do you seek a location? Do you want all associate? If you do, advertise in this column. Goodyear Rubber Co., JAMES SUYDAM, Manager, 92, 94, 96, 98, 100 and 102 E. Seventh St., ST. PAUL, MIN N. Manufacturers of the GOld Séal O O Rapid Flow | Best quality bag and tubing; reversible rectal and infant pipes; eye spray; ear and nasal tubes; bent and irrigating vaginal pipes. sizes: 2, 3 and 4 Quarts. NorthWestern Distributers Of Dr. L. WILHOFT’S (ORIGINAL) JADY'S SYRINGE Made of one piece of soft rubber and constructed on the only correct principle, viz: injection and suc- tion. It is the best vaginal Syriuge made. Send for DBSCriptive Circulars, Leading Druggists of Minneapolis. : ############ ************** c4ccuracy and Quality Guaranteed. §§ wANOUs PHARMACY. § § ŽS MAIL ORDERS SOLICITED. ŽS 2|S Miss Wanous, 2d Floor, 521 Nicollet Ave., Tel. 1228. § ŽS:SãS:S:S:S:S:S:S; S:S; S:S; S:S:S:Sāśāş; S:[S2ISASAS25%SãS *grºgeºgrx-grºgrgrºgrgrºgrgrºg grºgrºg, ºr grgrºgrgrºgrºgrgrºgrgrºgrººrººrºº: www.x. Ağ- O PIE N A LIL N IG. H.T., “R& The Voegelí Bros. Drug Co., PRESCRIPTION DRUGG1 STS- 2 and 4 WASHINGTON Av E. S., COR. HENNEPIN. Mail Orders Promptly Filled. t We carry the most complete stock of Drugs and Chemicals in the Northwest. #wessºr Se CHACIPC, HILL, i !; PHAR MAC I STS, ! # Under Nicollet House, Minneapolis, Minn. i # Careful attention given to Physicians' Prescriptions. | *—a dº— -º-º-º-a -º-º-º-º-º: ~...~~~ -*— - º ſº º ~f_*- --dº. *. *- sº-------------------—u—w- -—-ºr wº- - ------ —sº-w-u- ~~ ~g- Stands for ‘Doctor of &Medicine. * * Stands for &Medical Dial. “TJ nite Cl XXze stand; divided Yve fall.” Now is the especial time to subscribe-One Dollar per annum. Address, THE MEDICAI, DIAL, 513 Masonic Temple, Minneapolis, Minn. THE MEDICAL DIAL. Physicians Know the Injurious Effects ... of the jolts and jars and shocks received : in riding the ordinary bicycles, with rigid frames. .* *. * * ; - * They also know (who have tried them) the luxury of riding a Cushion frame, KONNARK YARNELL MADE BY US SINCE 1896. This IS OUR FOURTH SEASON, and hundreds of delighted riders are our advertisers. Dr. EITEL bought the first Cushion frame wheel which we made and has declared since that $1,000 would not purchase it if he could not get another one like it. Among the other prominent physicians riding the KONNARK or YARNELL are the following: *. - DR. WM. A. HALLOWELL, DR, J. T. MooRE, DR. ADA PECK, DR. C. H. TASKER, DR, HAMILTON, DR. MARION A. MEAD, DR, R. M. PETERs, DR. M. P. VANDERHORCK, DR. J. W. MACDONALD. DR. L. A. NIPPERT. DR. T. S. ROBERTs, DR. F. R. WRIGHT. Send for Catalogue.—Prices, $40 to $70 for Cushion Frames. MOORE CARVING MACHINE COMPANY., Corner Seventh Street and First Avenue So., MIN NEAPOLIS, MIN N. ALWAYS RELIABLE. NO DETRIMENTAL AFTER-EFFECTS. Jºvºv-2^^_^_^^_^_^_^ N-zº-ºº-Yº N-2 x-zº-/~~/ > /*N-a-v-2 \-ZTN-2 S-2' > /*N-Zºx-º-ºx_^ ; ; : IT HAS BEEN PROVEN EY CHENAICAL TESTS THAT : : is the most effective and Safest Hypnotic yet known to the profession, and : whereas it CONTAINS NO MORPHINE, CHLORAL OR OPIUM, there can be no detrimental after-effects. Always of the same consistency, therefore may be relied upon to produce the same results under similar conditions. It is only necessary for physicians to give NEUROS IN E a trial and they will be con- : vinced that it is the standard remedy in the treatment of all forms of : J- -A nervous disturbances. In Uterine troubles it should be combined with DIOVIEURNIA. Beware of substitution. When prescribing, signify (DIOS.) DOSE: One teaspoonful to a tablespoonful three or more times a day, as indicated. Our new illustrated booklet, “Treatise on Neurasthenia,” mailed on application. DIOS CHEMICAL CO., St. Louis, Mo. ~~~~~~/Nº-º-º-º-º-º-º/Nº-º-º/Nº-º-º-º/Nº-º-º-º/Nº-º-e-ves/Nes-º-º-º- * THE MEDICAL DIAL. X. i º * TLOWERS... &\; BEAUTIFUL ROSES CARNATIONS LILIES and all the flowers in their season. "Funerals a spec- ialty. Telegraph orders for funerals and parties º filled. Seeds and other florist supplies. Send or Catalogue. MENDEN HALL GREEN Hous Es, First Ave. S. and 18th St., or City Store, 414 Nicollet Ave., Minneapolis, - - Minnesota. * fººtagºas. - fºr-º- Seeley's Hard= Rubber Trusses (Um silical Truss) indicate THE GREATEST GOOD to the CireATEST NUMBER Individuality must not be overlook- ed—each sufferer requires particular consideration. Our successful “truss by mail” system is the fruition of 39 years’ experience. Life Plates and catalogue mailed on request. Chesterman & Streeter successors to I. B. SEELEY & Co. 25 S. 11th St. Philadelphia. º ^^^^^^ -ºººººy MARSHALL'S CONVERTIBLEBUGBY GASEN),3% º - º Ellſtºkā Mºhilliºſ º on 4-Sawed Oak Table º º, Air-receiver of seam- less steel size 10x30 in. | \ iſ tested to 500 ibs in ished in nickle plate º or oxidized. The most useful and practical ". paratus ever offered to physicians for the ºr Special Treatment | of Chronic Bron- chitis, Incipient Consumption & all Catarrhal af. -- A ſections ºf the * Head, Throat and Lungs. - - Write for Literature. º- [], []. HOLMAN, G8I'l Agt, La Grangº, Ill. st pull intrºl III, Hols; 27 E. Seventh Street, INVENTORS AND MANUFACTURERS OF * Artificial Limbs. We are positively the only manufac- turer in the Northwest that does not employ soliciting agents. We are the Doctors’ Workmen. We prefer to deal direct with P. cians, as they know the wants of their patients. All Surgical Appliances in the line of Orthopedic work done at reasonable prices. We respectfully solicit your patronage. JOHN McGUIRE, changes into Saddle Bag (is both in one). Finest, best durable leather finish outside and in (lined). Con- tents: 14 1-oz. rubber 18 6-dr. cork S.–total 32 bottles, with spaces between rows for pow- der papers, 2 sundr ſº one under eac * lid, 7%x2%x2%. Delivered, privilege of examination, - D., bal. $8.50, or ex- press paid. § 00 i. *...*... sº";"º".º." - sell Saddle Bags low as 5. otties w º Best iº *::::::" 3-dr., 26 6-dr. ----- s in springs, 1 Bundry space, º.º. - 3 º º º º and illustrations if asked for. Address W. S. MARSHALL, Care of Exchange Bank. CENTRALIA, Lºs copy Rich T-d MANAGER. | xiv. THE MEDICAL DIAL. Elºiſ-Mºſlical Allſ Elºiſ-Silgital |||siſ|mºnts, Manufacturat o B- The Waite & Bartlett Manufacturing Co. 108 E. Twenty-Third St., NEW YORK. The Häſſley Wimshurst Hillſ. Statiſ Mathillº Is the most powerful made, therefore, for X-Ray examinations and for a wide range of therapeutic effect, it stands unequalled. Used in the College of Physicians and Surgeons, Society of the New York Hospital, Post-Graduate Medical School and Hospital, Bellevue Medical College and Hospital, Battle Creek Sanitarium, and more by Physicians, Hospitals and Sanitariums than any other. SEND FOR ILLUSTRATED CATALOGUE. NOYES BROS. & CUTLER, Agents, SAINT PAu L, MIN N N Esota. LEWIS A. MARTIN, (successor to F. J. SALFINGER) WATc. Franker & Jewel ER 704 PHOENIX. But LD 1 N. G. Watches, Clocks and Jewelry Repairing. Clocks Called For and Delivered Free of Charge. CoLFAX MINERAL \ºv ATER A natural Spring Water, Carbonated or Still. One of the BEST REMEDIES on the market FOR cases of CONSTIPATION, Etc. THE GLEN WOOD-INGLEVA/OOD CO., M. W. AGENTS, 303 Hennepin Ave., Minneapolis. "Did You Ever See Anything Like It?” THAE Manhattan Typewriter. QUALITY HIGHEST, PRICE LOWEST. Typewriters Sold, Exchanged, Rented. SUPPLIES FOR ALL TYPEWRITERs. MAXFIELD & OLIVER, 17 So. 4TH STREET, MIN NEAPOLIS, MINN. Telephone 146-2. BAZZI-BIAN CHI A Singer Sewing Machine || THE BEST INVESTMENT ON EARTH, earning more in proportion, to cost than any other purchase possible. IHREE DIFFERENT KINDS, either lock-stitch or chain-stitch. BUILT LIKE A WATCH, - N at the largest and best equipped factory in the world, where every machine is carefully tested - on practical stitching. §§§ Sold only by §§§§ _º ihe singer MANUFACTURING company ºf Pllſ||19||5|| Velvet-Lined case, $4.00. Beware of infringements. All genuine have our name on instru ment. Buy from your dealer, or, if not in stock, from us direct. GEORGE P. PILLING & SON, 1229 Callouhill St., Philadelphia, Sole Agents for U. S. H. THE MEDICAL DIAL. XV THE ALLISON PHYSICIANS TABLE. 1899 NAODEL. Have you seen it? This style, No. 34, our latest production, surpasses in beauty, convenience and practical utility anything of the kind ever seen. The unique design, compact and harmonious, adjustable stirrups and leg crutches, glass trays in the revolving cabinets, detachable leg rests, the simple and ingenious mechanism—rendering it noiseless in its movements and easy of manipulation—are the secrets of its popularity. It is used in the Post Graduate Schools of New York and Chicago and heartily endorsed by faculty and students—a distinction no other table enjoys. The ALLISON CHAIR has been a leader for years, and is one of the most practical and convenient chairs made. Our COMBINATION CABINET No. 61, As shown in the cut, is a marvel, uniting in a single and handsome article of furtiture an instrument cabinet, aseptic and dust proof, a medicine cabinet with swinging racks for bottles, a writing desk, drawers for bandages, and compartment for wash basin. Our revolving Instrument Cabinets, thoroughly aseptic and proof against dust and dampness, are deservedly popular. The ALLISDN Wall Cabinet is in great demand. Catalogue Free. W. D. ALLISON CO., Manfrs., 133 E. South Street, INDIANA POLIS, IND. A. C. DICE, Dist. M ngr., 816 Dayton Blog., Minneapolis. Liquor LITHIUM MAIZENATE. |MAIZO-LITHIUM -----nºr re-in-r- ---AT-v- D-1 ura-Tri-- Liquor sal-I-Odd Es. TRI-IODIDES H E N RY’s --n-acaw or -o-n - and ------------ A powerful alterative and resolvent, glandular and hepatic stimulant, and succedaneum to the iodides. Indicated in all conditions dependent upon perverted tissue metabolism; in lymphatic engorgements and functional visceral distur- bances; in lingering rheumatic pains which are “worse at night.” Bone, periosteal and visceral symptoms of late syphilis; for the removal of all inflammatory, plastic and gouty deposits A remedy in sciatica, megrim, neuralgias, lum- bago and muscular pains; the gouty and rheu- matic diatheses; acute and chronic rheumatism and gout; chronic eczema and psoriasis, and all dermic disorders in which there is an underlying blood taint. Tri-iodides enter into the composition of in- flammatory and gummatous º promoting disintegration and absorption of the feebly organ- ized tissues. In Arterial sclerosis they check or modify the degenerative process when this is due to a syphi- litic, gouty or rheumatic taint thus acting directly as a prophylactic against cerebral apoplexy. In A genito-urinary sedative, an active diuretic; solvent and flush indicated for the relief and pre- vention of renal colic; a sedative in the acute stages of gonorrhoea, cystitis and º in dropsical effusions due to enfeebled heart or to renal diseases. As a solvent in the varied mani- festations of gout, goutiness and neurotic lithemia, periodical migrainous headache, epigastric oppres- sion, cardiac palpitation, irregular, weak or inter- mittent pulse; irritability, moodiness, insomnia and other nervous symptoms of uric-acidemia. Decidedly better, more economical, extensive in ac- tion and definite in results than mineral zuaters. In LITHEMIA by reason of the neutralizing T. CT power of Lithium in combination with Maizenic acid, the superior diuretic. In RENAL COLIC as a solvent and eliminant - - of uric acid, and prophylac- tic against future attacks. In as a urine alkalinizer, and on URETHRITIS account of the remarkable se- dative action of corn silk upon inflamed genito- urinary mucous membrane. In OEDEI 1A resulting from cardiac or a renal dis- ease the pulse becomes regular and strong ; there occurs marked diuresis and increas- ed proportion of urinary solids. Those cases of irritable heart, irregular or in- termittent pulse so frequently met with by insur- ance examiners and found to be due to excess of uric acid are special indication for Maizo-Lithum. Wascent Chemic Union of Maizenic Indolent lymphatic enlargements Tri-iodides have a marked deobstruent effect and are specially indicated. Tri-iodides are diagnostic in dermic disorders in which unrecognized syphilis is the underlying cause. An hepatic stimulant increasing the quantity and fluidity of the bile. Relieves hepatic and intestinal torpor; does not cause the unpleasant gastric symptoms of potassium iodide. Colchicºn, tºo grain. Decandºn, 1-rogram. Solanºn, 1-3 grain. Soda Acid-from Green Corn Silk—with --v-L-- to------- Salicylate, no grains, ſodic Acid, Lºthium, forming Maizenate-Lith- -- ------------- (equal to 7-32 grain ſodine , 4 romaſ- ºum. Two grains to drachm. Dose H. En R Y PHARMACAL co- ºc Cordia/, /dose, to 2 drams in 1 to 2 drachms, 8 oz. bottle, ºr, oo. LOUISVILLE, KY- water, 8-oz. Bottle, Sr.o.o. | * *; , ; *g **,” * *- *: .** * THE MEDICAL DIAL. SYR.HYPOPHOS, CO, FELLOWS Contains the Essential Elements of the Animal Organization—Potash and Lime; *- The Oxidizing Agents—Iron and Manganese; * The Tonics—Quinine and Strychnine ; And the Vitalizing Constituent—Phosphorus; the whole combined in the form of a Syrup with a Slightly Alkaline Reaction. It Differs in Its Effects from all Analogous Preparations; and it possesses the important prop- erties of being pleasant to the taste, easily borne by the Stomach and harmless under prolonged use. It has Gained a Wide Reputation, particularly in the treatment of Pulmonary Tuberculosis, Chronic Bronchitis and other affections of the respiratory organs. It has also been employed with much Success in various nervous and debilitating diseases. Its Curative Power is largely attributable to its stimulent tonic and nutritive properties, by means of which the energy of the system is recruited. Its Action is Prompt; it stimulates the appetite and the digestion, it promotes assimilation and it enters directiy into the circulation with the food products. The prescribed dose produces a feeling of bouyancy, and removes depression and melancholy ; hence the preparation is of great value in the treatment of mental and nervous affections. From the fact, also, that it exerts a double tonic influence and induces a healthy flow of the secretions, its use is indicated in a wide range of diseases. NOTICE—CAUTION. The success of Fellows' Syrup of Hypophosphites has tempted certain persons to offer imitations of it for sale. Mr. Fellows, who has examined samples of several of these, finds that no two of them are identical, and that all of them differ from the original in composition, in freedom from acid reaction, in susceptibility to the effects of oxygen when exposed to light or heat, in the property of retaining the Strychnine in solution, and in the medicinal effects. As these cheap and inefficient substitutes are frequently dispensed instead of the genuine preparation, physicians are earnestly requested, when prescribing the Syrup, to write “Syr. Hypophos. Fellows.” As a further precaution, it is advisable that the Syrup should be ordered in the original bottles; the distinguishing marks which the bottles (and the wrappers surround- ing them) bear, can then be examined, and the genuineness—or otherwise—of the con- tents thereby proved. Medical Letters may be Addressed to : Mr. FELLOWS, 48 Vesey Street, New York. THE * MEDICAL DIAL A Monthly Record of Medicine and Surgery. Vol. I. $1.00 per Annum. No. 7. MINNEAPOLIS, JUNE, 1899. Single Copies 1 Oc. CONTENTS PROG, RESS OF NAEDIC.INE. C.O. R RESPO N DERNC. E. OBSTETRICS. A Unique Piece of “Medical” Literature, 214 ORIGI IN A L. FART | C.L.E. S. Antenatal Therapeutics . . . . . . . . 210 The Need of Sanatoria for the Treatment of Pulmonary Tuberculosis, by J. H. NEUROLOGY AND PSYCIIIATR Y. NAIS C. E. L. Lº N E O CIS's STUART, A. M., M. D. . . . . . . . . . 1ST tº s ºf ſº lus of the Hume in Epileps A Description of the Climate of New Phoconnelus of the Humerus in Epilepsy g º r * * & & & º as a Stigma of Degeneration—Congeni- Verses in Praise of a Physician, in Latin, Mexico, by DR. FRAssis CRosson, of tal Atrophy of the Cerrebellum—Po- with translation . . . . . . . . . . . . 192 Albuquerque, N. M., (illustrated) . . . 193 tº 2 tº g e £ g -- The American Medical Association—An- º sition of Sleep; a principle in Neurolo Alcoholism and Alcohol, by G. D. HAG- gical Therapy 212 nouncernell t . . . . . . . . . . . . . . 192 GARP, M. D * * * * * * * * * * * * * * * 198 A Bone-Setting Story. . . . . . . . . . . 192 Electricity in the Treatment of Sonne The Chicago Free Dental Dispensaries . 192 Diseases of the Digestive System, by BO O HQ NOT I C. E. S. Typhoid Bacillus in Milk . . . . . . . . 208 I, AFAYETTE W. CASE, M. D. . . . . . 20 ! HC Spoke T Diseases of the Ear, Nose and Throat, Hºmº º * * * * * * * * * * * * ; e *. ities, by Seth * --> ----- . . . . . . . . . . . . . ED ITO RI EA L. S. and their Accessory Cavities, by Set The Mississippi Valley Medical Associa- THE INSANE IN THE ANTILLEs . . . . 206 Scott Bishop, M. D., D. C. I. L. L. D. . 212 tion . . . . . . . . . . . . . . . . . . . 211 MOSQUITOES AS TRANSMITTERS OF DIS- An Epitome of the History of Medicine, Joſht Meeting of the Medical Editors and BASE . . . . . . . . . . . . . . . . . . 208 by Roswell Park, A. M., M. D. . . . . . 213 Publishers in Columbus . . . . . . . . 213 REPORTS OF SOCIETIES g The American Flectro-Therapeutic Asso- tº Saunders' Medical Hand Atlases. Atlas ciation Meeting in Washington . . . . 213 May Meeting of the Hennepin County of the Diseases of the Skin, by Prof. Medical Society . . . . . . . . . . . . 209 || Dr. Franz Mracek, of Vienna . . . . . 213 | PUBLISIILR'S DEPARTMENT . . . . . . . xii -º-º---º-º-º-º-º-º- -e-º-e-º-º-º-e—e O Torºa º sº. fihe Geo. J. Sherer Sign Co., ºn ! 22 WASHINGTON AVE. S., -º-º-º-º-º-º-º- MIN N E A POLIS, gº M IN N. PLEASE MENTION THIS PAPER. #83 53 O Q O O O # The Winkley Artificial Limb Co. 5 } (Incorporated under the Laws of the State of Minnesota ) $ Largest Manufacturers of Artificial Legs in the World. H. C. PIERCE, Ld tast Improved Hutchinson, Minn. Patent Adjustable -º-º-º-º: zºſ)” MINNEAPOLIS, MINN. 㺠§::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: construction. 3. $3 3. #3 × $3 3& ge L3 53 § Double-Slip Socket #3 $3 × F Warranted not to Chafe the Stump #. $3 3. or . . in Hottest, Weather. 5 nº HU #83 amputation : $. po T' ×3 six inches Guaranteed from Casts #5 T 3, $3 and Measure ments 5 § b; 3 S 3 * * PERFECT FIT ... is $4.4 B 1 THE NAEDICAL DIAL. iii Satisfaction Guaranteed. sº Floyd Valley Stock Farm, Good References Given. Le Mars, Iowa. TELEPHONE No. 4-3 CALL E. A. Y. WEIR & CO, Twin Gity Berse 6xchange. $ $ $ $ Breeders and Shippers of fine Carriage Horses, Cobs, MIDWAY, Gentlemen's Drivers, and º Speedy Road Horses. St. Paul, Minn. In writing, kindly give us an idea of the class of horse, or pair, you want, and we will try and give you thorough satisfaction. £f »eeeeeeeeeeeeeee º, & . Wy 3 when the cºvernºrs § % are taken from Cod Liver Oil, only the grease remains, and : that is of no more value than other grease. The virtue of Cod Liver Oil lies in its curative principles, which are separable from the grease. These active princi- ples (taken from pure, fresh Cod Liver Oil), are employed in the manufacture of e HAGEE'S CORDIAL OF COD LIVER OIL with HYPOPHOSPHITES OF LIME AND SODA. Your patients get the grease in the form of palatable food fats. CORD. OL. MORRHUAE COMP. (Hagee) is dispensed in 16-oz, bottles by all druggists. Made only by KATHARMON CHEMICAL CO., St. Louis, Mo. º:gs (ſ:tº | §tº !}} Ş. $2,2,2,2,2,2,2,2,2,2,2,2,2,2,2,2,2,2s22s22s22s ;34°33°343 gº {º Sesºs.sºs: sº sºsºsºsºsºsºsºsºsºsºsºsºsºsºsºsºs: S-S-S-S-S-S-S-S-S-SS: iv - THE MEDICAL DIAL. ſ § NOTARY PUBLIC. (INCORPORATED.) TELEPHONE 778. Reference, Hennepin County Savings Bank. Attorneys and Agents in all parts of the Country. •ºgº * * * * * *. * * ----- :-. º, * . * * > * *... . . . . *- :. ... * * **** * * : I - -- . . . * * > *. * 3. * * ... . . . . . * * * ... • * r * , ...'... . . . * * * , 3. * - * . Ş * . ... .”.' " .. , , § f * * * * # * , § º * - & * * *. {|: } ** §3. * * * , x , t ºf, ºr: & ºf * * * … . • ?: - * x* * • * ~ * . . .” - . * , • * * * §. ', • ..., ". . . . . " " : . as ... * - * • . . ." . . . . . . . . ." . . . . . . . . . , the * ~ * * —" ** ** ºr...º.º. ". . . . . .” . . . . . *.*.*. * - - -> - - - -- * *** - : *. ? - : ...:" • * * - : º, * * infº . • 32. x.". **: - • * ***, , º' : . . . . …..*.* * ‘. . . . . . . . . s. sº. & ss ºr , ~ --- . . ." º: * : * * > * 3- * * “. . Jºs'.” , *,” - - t : & ºr - 2. ' w º . . . … ...: ... • . . ." sº - > * * * - * . . . . . º º 4- * . . * *& - --- . * * *. w - *-* - § 2. - - ** - jº - <3 - - sº a . . * * * ; : §3 º ż. ºs * , , , , - " ; • * * * - - - , *-*. * * * • * s * . . ** at F. A • * * - • . ** - & . .” - + sk" . . . . . . . . (, , § ' … - { }} } ( A Special Physicians' and Surgeons' Department which is guaranteed to give good servive. ! : You have past due accounts that we can collect. Write for terms, etc. | | Office: 613-614 THE PHOENIX. MINNEAPOLIS, MINN. i- ALWAYS RELIABLE. NO DETRIMENTAL AFTER-EFFECTS. IT HAS BEEN PROVEN BY CHENAICAL TESTS THAT NEUROS IN E is the most effective and Safest Hypnotic yet known to the profession, and whereas it contAINS NO MORPHINE, CHLORAL OR OPIUM, there can be no detrimental after-effects. Always of the same consistency, therefore may be relied upon to produce the same results under similar conditions. It is only necessary for physicians to give NEUROS IN E a trial and they will be con- vinced that it is the standard remedy in the treatment of all forms of nervous disturbances. In Uterine troubles it should be combined with : DIOVIBURNIA. Beware of substitution. When prescribing, signify (DIOS.) : A- -\ DOSE: One teaspoonful to a tablespoonful three or more times a day, as indicated. To physicians unacquainted with NEUROSINE we will send trial bottle with literature containing formula free, they paying express charges. Our new illustrated booklet, “Treatise on Neurasthenia,” mailed on application. DIOS C. H. EMAICAL CO., ST. LocIIs, Mo. THE MEDICAL DIAL. v ADoctor: * O Did you ever think of the extremely important part which the Hypophosphites of Lime and Soda play in the process of animal nutrition? There is absolutely no complete life without them. . They enter into the composition of muscle, bone, cartilage, connective tissue, nerve tissue, and, in fact, every important tissue of the human body. Besides this, the soda salt takes the lactic acid, which is such a constant product of a faulty assimilation, and breaks it up into carbonic acid gas and water, in which forms it is at once harmless and is readily discharged from the system. When the entire system is in a healthy condition, with every organ working properly, and supplied with the proper variety of food, they are found in sufficient quantities at all times. But when the organs of digestion and assimilation get out of order, or foci of inflammation are estab- lished in various parts of the body, causing rapid destruction of tissue, they cannot then be supplied naturally in due proportion, and hence must be artificially supplied or the system suffers and the disease progresses to its fatal termination. * In McArthur's Syrup you will find the most agreeable and reliable means of artificially sup plying these important elements. It increases the appetite, giving tone and a feeling of buoyancy and vigor to the entire sys- tem. The flesh increases and becomes firm, the cheeks take on the hue of health, and the patient feels completely restored. - The diseases in which these results are produced are Consumption and all Chronic Diseases of the Throat and Lungs, Scrofula, the various forms of Nervous and Mental Debility, and Perversions of Nutrition, as Fibroids, etc. Send for a valuable treatise on “The Curability and Treatment of Consumption,” and a bottle of McArthur's Syrup, free, if you will pay express charges; or sample bottle by mail, free. THE McARTHUR HYPOPHOSPHITE CO., ANSONIA, CONN. Physicians Know the Injurious Effects of the jolts and jars and shocks received in riding the ordinary bicycles, with rigid frames. They also know (who have tried them) the luxury of riding a Cushion frame, KONNARK YARNELL MADE BY Us SINCE 1896, ºil | W% º 32 HIS IS OUR FOURTH SEASON, and hundreds of delighted riders are our advertisers. Dr. EITEL bought the first Cushion frame wheel which we made and has declared since that $1,000 would not purchase it if he could not get another one like it. Among the other prominent physicians riding the KONNARK or YARNELL are the following: DR. W.M. A. HALLOWELL, DR. J. T. MOORE, DR. ADA PECK, DR. C. H. TASKER, DR. HAMILTON, DR. MARION A. MEAD, DR, R. M. PETERS, DR. M. P. VANDEREIORCK, DR. J. W. MACDONALD. DR. L. A. NIPIPERT. DR. T. S. ROBERTS, DR. F. R. WRIGHT. Send for Catalogue.—Prices, $40 to $70 for Cushion Frames. MOORE CARVING MACHINE COMPANY., corner Seventh Street and First Avenue So., MIN NEAPOLIS, MINN. THE MEDICAL DIAI, Sº S Sº º S. sº sº Sº HRays WITH |\ica Platº's Show these Cardinal Virtues. As used on our Static inachines, Mica Plates make the most perfect appliance used in X-Ray and Therapeutic work. They are even more reliable than the best Induction coils, rain or shine; produce a perfectly constant discharge of cur- rent: illuminate the highest vacuum tubes (which have the greatest power of penetration) with practically no induction around the tube, thus en- tirely eliminating the possibility of X-Ray burns. The great speed at which they can be run makes it possi- ble to generate sufficient current for all practical purposes, with a compara- tively inexpensive machine. CATALOG ON APPLICATION R. V. WAGNER & Co., Inc. 308 DEARBORN ST., CHICAGO -- ºf sº ſº: =: -> j | - HALF-TONE, | As ZINC ETCHING, s/º- wood EngFAvincº DESIGNING. 293-2°C 0NEIDA B10CK MiNNEApolls. THE MEDICAL DIAL. vii TALTINE is a highly concentrated extract of barley, wheat and oats. Barley alone is employed in the manufacture of all other malt extracts, and not one of them is as highly concen- trated as MALTINE. TALTINE is rendered particularly delicious and refreshing if administered with any of the aerated waters, milk, wine or spirits. Thus a pleasing change is afforded to capricious or fastidious invalids. MALT EXTRACTS, which are thinner than MALTINE, are thinner for the simple reason that they contain more water—are not concentrated as MALTINE is and therefore are less nutritious and more costly. line MALTINE, aside from its great nutritive - value, is so rich in Díastase that a dose readily digests all the starchy food, such as bread, potatoes and cake, which the aberage adult eats at a single meal. 3.4% ºf Aſſoo U 2|S WE HAVE A LINE OF 77 iſſºſ. Tºš77. Nº 2| W §§ W 7 º e DESIGNED AND BUILT FOR PHYSICIANS USE. § §§ Ö i O Our Agents are our Vehicles in service. Ö Ö Ö S § § i. i. * The Users are our #s É Medical men, Business men and Livery men of the Twin Cities and surrounding Towns, who are using our work, and their kind words of praise about its Quality, Style and Wear. § ź ði ś (U& arc Iſlanufacturers. H. A. MUCKLE MFG. CO., vºn . , , , º * St. Paul, NWinn. S/2: Nºvºzzº-sºvºzzº Mºrziºrzºzzº-º-º-º/Z §:{{º}}:{{º}}:{{º}}:{{º}}º:{{j}}:{{º}}:{{º}}:{{º}}:{{5}: Notice at the Hub, between tlle Twin Cities, is located the Minnesota Transfer, with ten § Ö ; 2. friends. They preach the merits of our work, because they tell the ºš é sº * : truth. Upon request, we send the addresses of a large number of §§ §: Railroads and Muckle's great Vehicle Plant, all on the Inter- urban Electric street car line. *AL THE MEDICAL DIAL. - * ** "Tº "ſº "ſº : º - - - - - - sº_.º: - -- 5. application. | - The Dr. C. E. Sawyer Sanatorium, Marion, Ohio. For the treatment of Chronic Diseases, Cripples and Deformities. Correspondence solicited. Professional inspection invited. Catalogues furnished on Visitors welcome. MEDICAL BOOKS Published in 1897 and 1898. CLIMATOLOGY. SOLLY, S. EDWIN. A. Handbook of Medical climatology. Svo., 462 pages with illustrations and 11 full page plates, five of which are colored . . . . . . . . . . . . . . . . . . $4. * THE MEDICAL NEWS POCKET FORMULARY FOR 1899. containing over one thousand prescriptions, representing the latest and most approved methods of administering reme- dial agents. By E. Quin Thornton, M. D. In one wallet- shaped volume, strongly bound in 1eather, pocket and pencil. Net . . . . . . . . . . . . . . . . . . . . . . . . 1.50 HYGIENE. - *EGBERT'S Hygiene and Sanitation. 12mo, 368 pages, fully illustrated. Net . . . . . . . . . . . . . . . . . . . $2.25 PARKES, L. C. Hygiene and Public Health, 5th edition, 12 mo, 551 pages, illustrated. Net . . . . . . . . . . . . - *WILSON, George Handbook of Hygiene. Sth edition, 37 - illustrations, 798 pages. Net . . . . . . . . . . . . . . . $3.00 BACTERIOLOGY. ABBOTT. A. C. The Principles of Bacteriology, 4th edi- tion, 12mo, 543 pages, with 100 illustrations of which 19 are colored . . . . . . . . . . . . . . . . . . . . . . . . $2.75 * IEWLETT, R. T. Manual of Bacteriology. 12mo, 75 illustrations, 439 pages. Net, cloth . . . . . . . . . . . . $3.00 LELIMANN & N EU MAN Atlas and Essentials of Bacteri- ology. 12 mo, 204 pages, with 53 chromo-lithographic plates, comprising 558 figures and numerous engravings. Net $3.00 A Textbook upon the Pathogenic Bac- *McFARLAND, J. teria. 8vo, 500 pages, handsomely illustrated. Cloth. Net . . . . . . . . . . . . . . . . . . . . . . . . . . . . $2.50 *WILLIAMS, H. U. Manual of Bacteriology. 78 illustra- 263 pages. Net . . . . . . . . . . . . . . . . . . . . . . $1.50 MULR & RITCH.I.E. A. Manual of Bacteriology. 12mo, 519 pages, with 108 illustrations. Net . . . . . . . . . . . . $3.25 ºncºdes books published in 1898. Complete List of New Books on Application. E. H. COLEGROVE, Agt, MEDICAL BOOKS, 96 Washington St., Chicago, Ill. The Waterloo Electric Cure ESTABLISHED IN 1887 Is a sanitorium for the treatment of chronic diseases, elec tricity being the principal means employed, though any other remedies that will afford more relief are freely used. The institution is fully equipped with the best of mod- ern electrical apparatus and every form of electrical curent is used. Among the apparatus in use here are two static machines—one a powerful eight-plate machine, two sinu- soidal machines, four large cabinet batteries, an electric bath-tub, an electro-vapor cabinet-bath, and electrodes for conveying electricity to nearly every part of the body, external and internal. Five thoroughly trained men and women attendants assist in giving the treatment under the physician's direction. Among the diseases most succesſfully treated by elec- tricity are diseases of the nervous systern, diseases of women, diseases of the digestive system, diabetes, Bright's disease, diseases of the liver, catarrh of the nose and throat, etc. No insane or objectional patients are received. Waterloo is a beautiful and thriving city of more than 10,000 population, and may be reached by the Illinois Cen- tral, the Chicago Great Western, and the Burlington, Cedar Rapids & Northern railroads. Patients arriving in the day time are advised to come di- rectly to the Waterloo Electric Cure. Carriages and hacks are in waiting at all the railroad stations. If arriving at night, patients are advised to go to the Irving, Central or A merican hotels, all being located near the Waterloo Electric Cure. Patients are not boarded in the institution, but are assisted in procuring pleasant boarding places in private fan ilies or hotels at from $3.50 to $500 or in ore per week. The present proprietor is Dr. Lafayette W. Case, a graduate of Rush Medical College in 1870, and for many years a lecturer in that institution. He refers by permis- sion to Profs. H. M. Lyman, M. D. E. Fletcher Ingals, M. D. and G. Frank Lydston, M. D., of Chicago. For full particulars, address DR. LAFAYETTE. W. CASE, 210 and 212 W. Fourth Street, WATERLOO, IOW.A. THE MEDICAL DIAL. ix. The “Hy-ven” Mattress embraces all the essential features of the best hair mattress, and is SELF-VENTILATING. It is furnished as a combination box spring bed, or as a mattress alone, to be used on any spring bed. The upholstering on mattress part is of good thickness, mounted on high grade spiral springs which support it, and make it very soft and easy. The springs stand in a considerable air space, the sides and bottom of which are air tight. Any pressure on the mattress forces the air upward THROUGH THE MATTRESS, a vent being supplied by tubes at the tufting points. IT IS COOL ; IT IS HYGIENIC. Air is forced to all parts of the mattress equally. Invaluable Mattress for the Hospital, the Sanatorium, the sick-room. A boon to the bed-ridden. SE INT ON TRIAL TO ANY A.D. D. R. E. S.S. “Hy-ven” Office Chair Cushions are the coolest cushions made, and are unequalled for comfort. Write for prices and further particulars. THE HYGIENIC VIATTRESS CO., 15 So, Fourth Street, MINNEAPOLIS, MINN, x THE MEDICAL DIAL. NATURE's FORTRESS is the stomach: the human organism’s power of disease resistance and recuperation depend upon its normal, unimpaired physiologic functions Gray's Cilycerine Tonic Comp. is impaired nature’s armament and ammunition. It restores and : : KEEPS THE STOMACH RIGHT NATURE DOES THE REST in malnutrition, anaemia, convalescence and all chronic conditions associated with depraved vitality THE PURDUE FREDERICK CO. No. 15 Murray street, New York The Hollem Portable A= Hygienic Bath. Made on Strictly $333333333333333333333% Scientific Princi- G ples a n d Fully . Guaranteed. sº There has never been an accident with our Bath, and one is impossible. With the he at shut off it becomes a perfect cooling room, avoiding any shock to the sys- tem by contact with the outside cold air. Unlike all other baths, ours has an º adjustable cover, which can be washed clean each week if desired, thus preventing the gathering of disease germs and microbes. Our strongest testimonials are from the leading Min- neapolis physicians. | N Free Bath book. Call or address THE SANITARY MFG. (0., | THE SANATORIUM, HUDSON, WIS. § 9 #4 º £- §ºtiº ºr ſº * - - ºlºis § | gºea. . ºs-jºº'ſ i †† Rºw §§ ziº º: lić sººt.; º, sº." He, . . & "º ºſs Fºx nº º º ºxº ... " º r" ºf 'º 'ºf * Sp *** fº ſº º * * %. s", } Sºgº ºv, *.* sº | AN INSTITUTION FOR THE SCIENTIFIC TREATMENT 0 F N 0 M-CONTAGIOUS DISEASES. §§§§§§§§§§§§§§§§§45%.Søş4S4S4S4Sks!!NºSk § Every Appliance and Method used which is §§ § recognized in Legitimate Medicine, including § Turkish, Roman, Electric, Medicated and Thermal § § Baths—also every form of Electricity, as well as # Sø S # §3 §3 Massage and Swedish Movements, etc. All under § § the supervision of Experienced Physicians and §: Trained Nurses. Sø g waſ º 406 Phoenix Building, MIN NEAPOLIS, MINN. t | || | lik, Đ it. . The institution is delightfully located, with a long, wide veranda, inclosed in the winter season in glass, and is equipped with mod! ern conveniences, as Elevator, Electric Light and Electric Bells, Large Parlors. For terms, address THE SANATO RIUM. THE MEDICAL DIAL A Monthly Record of Medicine and Surgery. Vol. I. f Original Hrticles. THE NEED OF SANATORIA FOR THE EXCLUSIVE TREATMENT OF PUL- MONARY TUBERCULOSIS. By J. H. STUART, A. M., M. D., Minneapolis, Minn. Those who have read the contributions of Dr. S. A. Knopf of New York to the medical journals during the past four or five years have doubtless observed that the Writer has had one prominent and distinct purpose run- ning through what he has written; and further, that his scholarship, his knowledge of his sub- ject, his earnestness, and his clear, strong way of putting the matter, carry conviction of the truth and importance of what he has to say. We are apparently on the eve of a change in the management of consumptive patients. Pulmonary tuberculosis is both preventable and curable. Active and efficient measures are being instituted, and the appalling death rate of this life destroyer is being materially less- ened, and the economic savings to the World from this source will be correspondingly great. At a conservative estimate fully one-seventh of the human race perish from this disease, and since its ravages are greatest during the pro- ductive period of life, and because this disease is a lingering one, detailing, as it were, like the wounded soldier on the battlefield, one or two other lives for the care of each stricken One, it can be readily seen how profitable it will be to save and restore a few of this class to produc- tive labor. Many philanthropic men and women are investing their means in this work, more, perhaps, for the sake of their love for their fellows than for the profit likely to ac- crue, but for municipalities and states it might well be a consideration of savings and gain. MINNEAPOLIS, JUNE, 1899. No. 7. Dr. Knopf is a strenuous advocate of the es- tablishment of sanatoria in connection With Or adjacent to our larger cities for the exclusive use of pulmonary tubercular patients—closed against all other diseases. Reasons for this are based upon the well recognized nature of this disease. (1) That it is an infectious disease, commu- nicable from one person to another; not, how- ever, by contact, as is smallpox, measles, etc., inscription in “Inferno”: “Let him abandon hope who enters here.” The question naturally arises: Do Sana- toria” contribute materially to the advantage of the patient in the way of cure, or material but by the entrance of the microbes into the air passages through the atmosphere or into the alimentary canal in connection with some form of food, most commonly milk or meat. (2) Along with a sort of quarantine there should be a systematic and persevering treat- ment for the patient’s benefit. (3) A large number of our general hospi- tals supported by private charity absolutely refuse to admit tubercular patients, and (4) Our general municipal hospitals avoid, very naturally, crowding the wards With phthisical patients. There are several reasons for this reluctance. In the first place, there is the risk to which the other patients are thus necessarily exposed, and there is the unfavor- able and hurtful effect that the presence of an advanced case of phthisis unavoidably has upon the other occupants of the Ward. But there are other reasons that render the case of the poor phthisical patient more piti. able than even the above. His needs as to Ven- tilation, fresh air, and temperature are by no means the same as those of other patients in +sanatoria is plural of sanatorium though Dr. Knopf more fre quently writes sanatoriums. He rightly prefers the spelling Sana torium to sanatarium for reasons based upon the derevation of the wo words. 188 THE MEDICAL DIAL. the ward, and he often suffers in this Way; again, the kind of treatment or lack of treat- ment he there receives does him little or no good. He is looked upon as being there only to be in a way cared for until the inevitable end comes. The matter of his nourishment, so im- portant in the care of this wasting disease, cannot at all be attended to here as it ought to be. There is written too plainly about the gen- eral hospital for the phthisical patient Dante's improvement of his condition? Have the re- sults of work already done in institutions de- voted to this service, established their practical Value? Dr. Knopf answers these questions strong- ly in the affirmative and brings cumulative evi- dence in proof of it. He has made extensive study of this work in Europe as also in this country. He was physician at the sanatorium at Falkenstein under Prof. Dettweiler, the pu- pil of Dr. Brehmer, founder of that institution. He visited and examined all the principal Sana- toria abroad, spending one year exclusively in that way. His thesis before the faculty of Paris for his Doctor's degree was on “Sanato- riums for the Treatment and Prophylaxis of Pulmonary Tuberculosis,” an abstract of which may be found in the New York Medical Jour- nal for 1895, LXVII, pp. 419,460. At Falkenstein the mortality was reduced from 18.9 per cent to 11.9 per cent. The statistics gathered for the author's work on tuberculosis show that in England, where hospitals for the exclusive treatment of consumptives have been in Operation for many years, the mortality from tuberculosis has been reduced from twenty-four hundred and ten in a million inhabitants in 1870, to fourteen hun- dred and sixty-eight in 1893. In Adirondack Cottage Sanatorium at Sara- nac Lake, New York, the least favorable re- sults were 14 per cent absolute cures, 14 per cent relative cures, and 42 per cent ameliora- tions. Other favorable results are reported, but they are not at this moment at hand. Our author does not pretend to claim that cures do not occur under Other circumstances than in these institutions, for the post mortem appearance of cicatrices in apices of the lungs and of encysted calcareous concretions, have a long time been accepted as evidence of recov- eries from tubercular attacks, but the percent- age of recoveries in special sanatoria is so pro- nounced as to form a most reasonable and per- suasive argument in their favor. Spontaneous cures may and do occur from change of occupation, or of hygienic surround- ings, or from change of climate, but it will not be pretended that such instances form any weight against the provision of special hospi- tals for this disease. The author admits the benefits of certain climates for certain patients, but he does not believe in sending patients to a favorable cli- matic region and leave them there to pursue their own sweet will in the pursuit of health and recreation. While beneficial results might follow, and often do, perhaps, yet most com- monly, they do not, and thus not only is a great expenditure of money and strength wasted, and lives are lost, but many other lives are exposed to infection and lost in consequence of the scat- tering of germs that should never be permitted. Inquiries at famous health resorts, such, for instance, as the Riviera, reveal the fact that in consequence of the resorting thither of mul- titudes of consumptives to roam about and ex- pectorate at their pleasure and convenience, the increase of consumption among the inhab- itants there where this disease was once rare has been enormous. For the reason, therefore, in the first place, that no patient ought to be permitted to be a source of infection to others, and for the addi- tional reason, in a second important particular, that recoveries of patients, even in most pro- pitious climates, are to a greater or less degree problematical if the patient be left to his own Volition and care without the authoritative ad- Vice of specially qualified physicians, patients Seeking health at climatic resorts should be under the same or similar exacting regime as those who seek refuge in sanatoria near their homes or in places less distant. In this view of the matter it would be both impolitic and unwise to permit any section of Our Country, however promising as a health resort for consumptives, to be overrun and con- taminated, without restriction or sanitary laws instead of establishing measures which would both preserve healthiness and at the same time insure far better results to the health seekers. It will be pretended by no one that all cases of consumption are curable. There are those who are curable, those who are relatively cur- able, those whose conditions are improvable, and, lastly, those who grow worse and die. r r - - . T - *, *. ..” w . THE MEDICAL DIAL. The first class includes those who, whether absolutely whole or not, are nevertheless prac- tically well. The second includes those who are put back to their best estate, or into a condition of, to them, relative health. Are Sanatoria for consumptives dangerous to neighborhoods in which they may be estab- lished? . Dr. Knopf (Med. Rec., Oct. 3, 1896) shows that they are not. The laity, and, I am sorry to say, some in our profession, have been fearful that such an institution Would scatter the seeds of disease amongst the inhabitants near by. There are no fears to be entertained on this account, because of the sanitary and aseptic management of the whole hospital. Not only are the physicians and attendants scrupulously clean, but they keep the building and patients in the same condition, and all sources of infection are removed. The author lays stress upon the educating influences of these sanatoria, maintaining that the patients themselves learn to observe the rules of the establishment, and that its influ- ence extends to the neighborhood, to the ex- tent that the villagers follow its example. In the villages of Goerbersdorf and Falkenstein tuberculosis has actually decreased among the people, being one-third less than previously. Patients with incipient phthisis, after a pe- riod of practical training, learn how to care for \ themselves, to avoid hurtful causes and acquire hygienic habits of great value to them. They become thereby an educating influence in them- Selves. The number of sanatoriums abroad has mul- tiplied rapidly, numbering perhaps at the pres- ent time not a great deal less than one hun- dred, one-half of them being for the poor. As far back as 1856 Dr. Brehmer began the work by establishing what has been called the graded promade and diet cure. His pupil, Dr. Dettweiler, added the rest cure in the open air. The methods in these sanatoriums are sui generis. The patients are classified, and meth- ods are adapted to each one. The regime is exacting, quite military in its application, the medical supervision being constant and the per- Sonal training of the patients scrupulous. “The physician presides at the table, directs the rest cure in the open air, the breathing ex- ercises, and graded walks, the hydro-therapeu- tic applications, and the many other curative and preventative measures, the ensemble of - - * Sº 2 “. . 4. * wº- w 18 * * t 2 which constitutes, the real treatment of pul: - monary phthisis.” - The expectoration, the saliva and other se. cretions are religiously cared for by spittoons, damp cloths and paper napkins which are pro- Vided. The napkins and table utensils are boiled and disinfected after each meal. The patients on entering the sanatorium are gradually brought by training into the meth- ods in Vogue. The leading ideas are graduated exercise, much time spent in the open air of low temperature in a state of rest, full feeding as the patient can bear, much attention being given to encouraging the patient to eat, and tempting his appetite. Bathing at least once Or twice a week in cold water. This of course has to be brought about gradually, by first ap- plying friction of the hand, then using a little alcohol, then a mixture of alcohol and water, and next putting about the patient wet cloths . and using over them rubbing to encourage sur- face warmth. Finally the patient is able to sit astride a chair holding to the back, and a pitcher or two of water at a temperature of 60 to 45 degrees Fahrenheit is poured over the shoulders, followed by friction. A close Watch is kept by the physician on the temperature, and exercise is not to be taken if it reaches 100, and at no time is exercise to be taken to produce perspiration, which, if it occurs, is to be met by rest and dry rubbing in bed. The patients are to sit in the open air, on wide verandas or in pavilions, well lighted, for ten or more hours in each twenty-four on cush- ioned Ocean Steamer chairs, or lounges, comfort- ably wrapped in soft, warm wraps or robes or furs, with temperature surprisingly low. They sleep in large, roomy chambers, with windows open and winds often blowing over them. At the Nordrach Sanatorium in the Black Forest, the patients usually spend from seven to eleven hours daily in the open air, in spite of rain, fog, snow, and a temperature often as low as 12 degrees (Fahr.) below the freezing point. Patients quickly become hardened, so they rest and sit about till bedtime with wet boots, Stockings or trousers or skirts. The clothes or boots are seldom changed, even if damp, after the morning walk. They sit at meals and lie down for the prescribed periods of rest, and only remove their wet garments on going to bed. , - . , , - - - - ya w -. w - - • . - **. - , - - - 190 º - The main features of the treatment are men- tal, and bodily rest, regulated exercise, abun- dant feeding, sunlight, when obtainable, fresh air, out-door life, and the total absence of close or crowded sleeping apartments. Dr. Walther of the Nordroch Sanatorium was the first to teach the absolute unimpor- tance of the weather, however bad, in the pro- duction of the common cold, which he believes due to an infection. The lung exercises or gymnastics are re- garded as of much importance. They appear to be a systematic use of the auxiliary muscles of respiration, by a synchronous use of the arms with the respiratory movement. - The patient first raises the arms from the side to a horizontal position, taking an inspi- ration at the same time, and while holding the arms in that position supplementing the inspi- ration by an additional short forcible move- ment. The arms are then let fall to their posi- tion at the same time with the expiration. This is repeated as prescribed by the physician. The next movement is to extend the arms horizon- tally in front with backs together, then sweep them round, touching the backs again in the rear, inspiring deeply at the same time. Re- verse the movement during the expiration after the manner above described. In a similar man- ner the arms are to be raised vertically above the head. - - These movements insure thorough dilata- tion of the air cells and a change of the resid- ual air in the lungs. By this means the blood in the lungs is well aerated, and the small tubes and vesicles are kept clean of catarrhal products which doubtless form good soil for the lodgment and development of phthisical microbes. This exercise without doubt consti- tutes the best possible prophylaxis next to the freedom from exposure to germs. Fewers, diar- rhoeas and night sweatings are controlled for the most part without resort to drug medica. tion. It is the presence in the system of strep. tococci and their products, doubtless, that give rise to the high temperatures, the diarrhoeas and the hyperidroses that are often so trouble- some in the destructive stages of pulmonary consumption. The great cleanliness, the abun- dant fresh air and the systematic lung exer- cises so carefully enforced in these sanatoria greatly diminish or remove the conditions on which these phenomena depend, and hence the THE MEDICAL DIAL. patient is wonderfully relieved of these dis- tressing symptoms without special medication. When diarrhoeas occur the alimentary canal is first cleansed and the feeding properly ad- justed to each case with enjoined rest. Sweat- ing is controlled, if excessive, by wrapping the upper portion of the trunk in cloths wrung out of cold water to be followed by dry friction. Coughing becomes a habit and by proper effort on the part of the patient may be con- trolled by his own will power. Dr. Knopf tells us that Dr. Dettweiler was in the habit of saying to his patients that it is ill-mannered to cough in public without cause. Coughing is scratching the throat, and to Scratch the throat is as bad as to scratch the head in public. The use of medicines must be left to the discretion of the physician in charge, but in the sanatoria for consumptives of the class which Dr. Knopf is commending to the profes- sion and to the people, the administration of drugs holds a very secondary place. To combine the natural advantages of cli- mate with the regime of the sanatorium would be to secure the largest per cent of cures and benefits, and this no doubt will be very exten- sively done, in this country, but the portion of our consumptive population able to go and remain in such localities is small and, for the most part, must either be provided for near home or be left unprovided for. Near every large city or the center of every large population the sanatoriums should be erected, if for the poor exclusively, at the pub- lic expense. The structure of the building, its inside finish, and its whole appointments, whether for the poor or the well-to-do, should be alike excellent. Dr. Knopf's ideal arrangement would con- sist of three structures, one to be built inside or near the city, known as a detention hospi- tal, in which the patients may remain until they can be classified. Those in the incipient or pretubercular stage are, at the end of their probation, to be sent to the main portion of the hospital, situated within four or five hours' ride from the large city on a site selected for its suitableness in every way. The third por- tion to be a home for the less favorable cases. In Europe the arrangements are for larger numbers in one institution, from Seventy to One hundred, while in this country something more on the cottage plan is in favor, with accommo- THE MEDICAL DIAL. 191 dations for from four to eight patients. Dr. Knopf suggests a structure of which the following is a rather imperfect description: Three two-story pavilions, each capable of ac- commodating twenty-five patients, united by covered galleries one hundred feet long, serving on rainy days as promenades. tral pavilion are the necessary structures for administrative, culinary and heating purposes. There should be an isolated building for recrea- tion, one for visitors and one for isolation cases. Each pavilion to be 135 feet long, con- taining well ventilated and well lighted rooms, with bathrooms, sitting-rooms, parlors, etc. A veranda is to run the entire length of the build- ing twelve feet wide, where patients can take the rest cure in the open air on comfortable chairs or lounges. These verandas can be used also for promenades. Attendants are to be constantly on hand to see that patients do not sleep too long, that they do not become uncov- ered, and to supply their wants. The daily expense per capita of maintaining patients in Sanatoriums will vary somewhat. In New York in seven of the most important hospitals it ranges from thirty-three cents to two dollars per day. In the Adirondack Cot- tage Sanatorium it is about one dollar each. In Europe I think it is somewhat cheaper. Among the poorer class a large expense necessarily falls upon the public charity, even where the consumptive passes through his de- cline at his home or in charity hospitals, be- cause not only of expense and loss of bread- winning power of the sick one, but also the loss occasioned by the necessary attention that must be given by others. Then there must be added to this total a contingent expense occa- sioned by the infection of others through the sick One. - Cities and states ought therefore, as a mat- ter of public economy, to provide for the treat- ment of consumptives, with the expectation of what might be termed a profitable per cent of recoveries, as above sugested. But the argu- ment from a philanthropic standpoint, together with that of prophylaxis, is even more weighty. Dr. Knopf’s earnest, persistent work of edu- cating and leading our profession and our peo- ple on to an appreciation of what may be done for the pitiable victims of this fell destroyer, will eventually be followed by an abundant fruitage I have no doubt. He sanguinely ex- Behind the cen- claims, “It must be done; our national welfare is at stake!” • It has already been shown that a growing per cent is being cured, and perhaps an equal number relatively cured, or restored to useful- ness in their avocations. It is not so easy to make an estimate of the saving of life by pre- vention through measures instituted and their educating effect upon communities. As has already been shown, the death rate has been greatly reduced in certain communities from this cause. The laity, as well as the profession, will be on the lookout for the first signs of the disease, and the patient will come early under skillful medical care when the probabilities are greatly in his favor, which circumstance, together with the buoyant hope inspired by results already achieved, become harbingers of great good to him. The North American Review, Feb., 1899, contains an article by our author on “The Tuberculosis Problem in the United States,” which, if it can but secure a very general read- ing will do good service in educating the peo- ple as well as the medical profession, for it cannot be denied that a little mission Work is needed in our own ranks. There is here appended an incomplete list of contributions by Dr. S. A. Knopf to medical journals on this subject, some of which have been consulted by the writer in the prepara- tion of this article: “The Communicability of Tuberculosis and Special Hospitals for Pulmonary Consump- tion.” N. Y. Med. Rec., 1894, LI., p. 502. “Aerotherapeutics and Hydrotherapeutics in the Treatment and Prevention of Pulmonary Tuberculosis.” N. Y. M. J., 1897, vol. XXIX., pp. 68, 74. “The Present State of Preventive Means against the Spread of Tuberculosis in the Vari- ous States of the Union Critically Reviewed.” J. Am. M. Assoc., 1897, vol. XXIX., pp. 875, SS0. “The Urgent Need of Sanatoriums for the Consumptive Poor in our Large Cities.” N. Y. Med. Rec., 1897, vol. LII., pp. 775–778. “Les Sanatoria: Traitement et Prophylaxie de la Phthisic Pulmonaire pour 1895.” G. Carre, pp. 206; 4 pt. Smo. “Sanatoriums for the Treatment and Pro- phylaxis of Pulmonary Phthisis.” N. Y. Med. Jour. 1895, vol. LXII., pp. 419–460 º ºigg THE MEDICAL DIAL. \ “The Hygienic, Educational and Sympto- matic Treatment of Pulmonary Phthisis, with * ... a Plan for All Sanatoriums for the Poor.” ºv. “The State and Muncipal Care of the Con- . sumptives.” Canada Lancet, Toronto, 1898–99, pp. 784–793; N. Y. Med. Rec., 1898, vol. LI., pp. 433–437. “The Tubercular Problem; a Critical Sug. gestion in Reply to Dr. Leland Cofer's Sugges. tion to Philanthropists.” N. Y. Med. Jour., 1898, vol. LXVIII., p. 198. Doctors Bowditch, Otis, Flick, Hinsdale, Lee, Hamilton and others have contributed val- uable papers on this subject. VERSES IN PRAISE OF A PHYSICIAN. The following verses, originally published in the Westminster Gazette, have been widely Quoted, and were published in the Lancet for March 4th. They are by Mr. James Rhoades, a translator of the AEneid. The Lancet for March 25th republishes them with the sub- joined Latin translation, in elegiac metre, by Dr. J. P. Steele, of Dublin: TO A CERTAIN DOCTOR. “I’m only a doctor,” is your cry, “Concerned with the body's ills and maims, But witless of art and poesy, And lost to the spirit's finer aims.” Ay, only a hand by hundreds blest, A heart that has ached for all, save self, A brain racked ever to find them rest, A soul whose riches are scorn of pelf. In vain We argue; the theme is old; Some men love horses, some singing birds; But e'en if the poet’s song ring gold, Shall deeds that are gold weigh less than Words? You waived the pleasure and wooed the strife, Of thorns, not roses, have made your bed; You longed for the lovely side of life, And fought with the terrible instead— Longed sore, but never had time to give, “Till now it is all too late,” you say. So be it. Why, man, the life you live Is One long poem from day to day. [Idem Latine Redditum.] MEDICO CUIDAM. “Sum medicus tantum qui Sanem vulnera laesi Corporis et morbos,” care Machaon, ais; “Quid mihi cum Musis cui surdo cantat Hom- erus, Cui profert caeco daedala signa Myron?” Sed tamen est' pergrata manus tua milibus aegris i In quibus es totus nec memor ipse tui; . Dumque feras aliis requiem tibi saepe negatam, Sæpe bonus renuis quas merearis opes. Cur remoramur in his? Sunt argumenta vetus- ta; Hunc sonipes, illum flens philomela juvat; Aurea sint Sapphis lyra et aurea verba, Machaon, - Aurea sunt per te facta magisque valent. Gaudia praeteriens optasti tristia vitae, Promption in spinis quam recubare rosis; Dilexti puer Aonidum nemus; arma Salutis Castraque te retinent Hippocratea senem; Otia et Aomidas defles nunc prorsus ademptas, Inter opes Graiae mentis et artis inops. Sed quorsum has lacrimae? Divini carminis instar Est quantum vitae cumque, Machaon, agis! J. P. S. —N. Y. Med. Jour. THE AMERICAN MEDICAL ASSOCIATION Will hold its fifty-second annual meeting in Columbus, Ohio, June 6 to 9, inclusive. The railroads are offering reduced rates to Colum- bus for the occasion, generally one fare for the round trip plus $2.00. A special train will be made up in Chicago over the Pan-Handle Mon- day evening, June 5th, and it would be well for physicians to take advantage of this oppor- tunity to go in a body from the west, on ac- count of the social features afforded, but other trains may be utilized. A BONE–SETTING STORY. A story of bone-setting is that of the Scotch laddie, Jock by name, who, after being carried by his mother, as an unwilling patient, to the bone man to get his leg set, was asked if the manipulation had hurt him. “No,” said Jock, “it didna hurt me.” “I told you it wadna be painful,” said his mother. “Ah,” replied Jock, “nae wonder. You see, mither, I just let him fumble wi' that sound leg!”—Medical Press and Circular. There should be no complaint coming from the poor of Chicago now. The Medical Record says: . The Bureau of Associated Charities of Chicago has arranged to open a dental dis- pensary in each of its ten district offices, for the exclusive use of the poor. The object is to furnish dental service to the poor at the lowest possible expense. The charge for ex- tracting teeth will be ten cents, for filling, fif- teen to twenty-five cents. The dentists Volun- teer their services, and the material used is fur- nished at COSt. THE MEDICAL DIAL. 193 A DESCRIPTION OF THE CLIMATE OF NEW MEXICO. By Dr. Francis Crosson, Albuqurque, New Mexico. The territory of New Mexico comprises an area of 123,000 square miles, 15,000,000 acres of which is tillable land. It has a population of 282,000, of which 26,000 is Indian. Its greatest length is 390 miles; its greatest breadth, 335 miles. The high interior of our Continent com- prised in the large table-land extending from the Great Divide in Colorado, through New Mexico, is not excelled anywhere in the world as a resort for consumptives. The altitude, the persons in general, who have “something to sell” in the shape of an “Eden” of one kind or another. The American Climatological Association has done much to correct this evil by collecting and distributing reliable statistics, and it is today doing conscientious work that will, in a short time, prove of great practical and per- manent value to every practitioner of medicine in the civilized world. The “chaft” is grad- ually being winnowed from the pure grains of truth, and the unfortunate sufferer from dis- ease, who is compelled to leave home, friends, and all that is most valued in life, and seek change of residence in a climate favorable to the perpetuation of health and life, will be the chief beneficiary. A SUMMER OUTING IN THE MOUNTAINs. companies, land colonization enterprises and dryness, the purity of atmosphere, and the large amount of ozone it contains, combine to create conditions very favorable to recovery from tuberculosis. . There is, perhaps, no subject in medical lit. erature upon which medical men in general possess less practical information than upon the subject of climate. This statement, which is based upon an observation of more than seven years, is not made in a spirit of criticism, nor is it in any manner intended as a reflection upon a class of scientific men so honest, con- scientious and intelligent, as the great body of medical practitioners in our country. For the most part the physicians in the east have been obliged to rely for their information on this subject almost entirely upon such representa- tions as are commonly made in the multitudin- ous mass of “write-ups” issued by railroad My residence in the territory of New Mex- ico extends over a period of more than five years, during which time I have had a very favorable opportunity of observing all that is most valuable bearing upon the subject of cli- matic conditions of this region. I am con- Vinced that, within the geographical bound- aries of this vast territory, climatic conditions exist superior in many respects to any other equal area on this continent. The climatic characteristics of the Territory of New Mexico embrace in an almost ideal condition those most sought and valued in the treatment of diseases of the lungs and respiratory system. An absolutely ideal climate is not to be found anywhere, and it is a waste of time to seek for conditions which exist only in the minds of visionary writers. What is claimed for this region is that it possesses in a remark. able degree the most desirable elements fur- | -- THE MEDICAL DIAL. - nished by nature's laboratory for the treat- ment of certain diseases. In writing of climatic conditions, it is im- possible to avoid allusion to a disease that has baffled our best scientific minds for centuries, and which remains with us today as it accom- panied the Jewish people in their wanderings through the desert, a scourge to the human race, a mighty destroyer of life, a “Banquo's ghost” that will not down–I mean tubercu- losis. The principle involved in the selection of a suitable climate for the treatment of persons afflicted with diseases of the lungs is one of chemistry rather than physiology, and in order that this fact may be made clear for the pur- pose of what follows, it may be well to dis- and Italy, because the climate in these places was soft and balmy. In our own country it was Florida and the Pacific coast towns in southern California. Only the temperature of these localities was considered; moisture and its congener, malaria, were seldom or never taken into account. Patients succumbed promptly to their disease, and it was a long time before the physicians living amidst these conditions awoke to a realization of the causes responsible for the many fatalities. Today the sea coast towns are almost abandoned by con- sumptives, and physicians inhabiting the very towns formerly advocated as health resorts for this class of invalids, are sounding trumpets of warning, and telling the afflicted to avoid these places as they would charnel houses. card a few antiquated and stubborn fallacies that have been too long insisted upon and clung to with unreasonable tenacity. There are medical men today—some of them teach- ers at that—who claim that there is not, nor can there be, anything in any climate that can be regarded scientifically as having a direct curative action upon disease. As we proceed we will see whether or not this declaration can be sustained in the light of practical demon- stration and observation. The leading writers and teachers of medical science today over the entire world are agreed that climate holds the first place in the treat- ment of pulmonary tuberculosis, and that any system of medical treatment ignoring the im- portance of this great factor is unworthy of much consideration by physicians. Only a few years ago patients afflicted with pulmonary tuberculosis were rushed to Southern France A TYPICAL NEW M Exico RANCH, - Recall, Photo. It is held and taught by the ablest medical authorities over the entire world today, that consumption is a curable disease. I do not mean by this that all consumptives get well even under the most favorable circumstances; the term consumption is with many people synonymous with death; this, however, is not the case; perhaps ninety per cent of all cases of beginning consumption, if the diagnosis be made sufficiently early and the patient placed in proper climatic and hygienic surroundings, have a good chance of recovery. The fact of the curability of this disease, a fact well known to all experienced physicians, leads us next to the consideration of the best means we have to obtain this result. The question of climate as a factor in the treatment of consumption of the lungs is re- ceiving vastly more attention and study today than any special plan of medical treatment ap- THE MEDICAL DIAL. 195 plied to this disease. Without entering upon a description of the changes which occur in the system before this dread disease is established, a glance at chemistry will enable us at once to perceive and appreciate the advantages which a properly selected climate presents to the suf- ferer, and demonstrate in a large percentage of cases, the superiority of nature's method of restoring deranged functions to the standard of normal health. Altitude forces the lungs to work, thus af. fording them excellent gymnastics. The rare ozonated air of this region permeates the lungs to their ultimate ramifications, preventing, as has been conclusively shown by Dr. Roland G. Curtain of Philadelphia, pulmonary hemor- rhage, and revivifying the tissues of the body - if regularly pursued in a favorable climate will obviate the imaginary necessity in the shape of a movable gymnasium with which so many in- valids hamper themselves. The “climate cure,” as it has been called, holds out, in my judgment, more encourage- ment and hope to the afflicted than all other methods of treatment combined. This is stat- ing the case strongly, but truth is truth, and it must stand. After extensive travels in all parts of the United States, including Florida, Texas, North Carolina, Colorado, Arizona, California, as well as Mexico, a trip through New Mexico settled my mind upon the subject of climate. Since coming to this territory I have been frequently confronted with what might be called “star THE SUBURBS OF ALBUQURRQUE by supplying them with an abundance of oxy- gen. There is no health resort in Europe, not excepting the much-lauded Riviera, that can show such a stable and equable range of heat and cold as can be found at the meteorological station at Santa Fé, New Mexico. Changes in temperature throughout the Ter- ritory are never sudden, hence the invalid and health seeker by a little attention to his cloth- ing can exercise daily in the open air, and have no fear of colds and inflammations of the air passages so trying upon invalids resident on the Atlantic and Pacific coasts. An altitude of at least five thousand feet is the best for most patients in the incipient stage of pulmo- nary tuberculosis, and a patient recovering from his disease should be made to understand that where he regains health that should be his permanent residence. Walking affords the most natural form of physical exercise, and cures,” many of them patients brought here in an ostensibly hopeless condition. I have taken pains to personally investigate the histories of many of these persons, and I can unhesitating- ly vouch for their accuracy. The fame of New Mexico as a sanitarium for persons suffering from, or threatened with, pulmonary disorders, has spread far beyond the limits of the United States. A committee traveling around the world under the auspices of the “Societé Medicale” of Paris, carried back to France the report that in the climate of New Mexico they found more beneficial characteris- tics and fewer drawbacks than in that of any other region of the world visited. It will take first place among the world's sanatoria for pul- monary consumptives in the near future. All the required characteristics are here: A dry aseptic air, a light atmospheric pressure, a dry, porous soil, a maximum of sunshine, a min- THE MEDICAL DIAL. imum of cloud, and a slight variation of tem- perature only between the extremes of heat and cold. New Mexico lies in the region of great- est dryness in the United States. The average relative humidity of the territory ranges from 20 to 43 per cent, according to locality. The average at Boston is 69.2 per cent; at Buffalo, 73.1 per cent; and at Olympia, Washington, 79.2 per cent. The rainfall for the entire terri- tory is, approximately, 10.2 inches. The climate of New Mexico is its greatest glory. It is a land of sunshine. Here extremes are unknown; in summer it is never uncom- fortably warm in the shade; in winter it is de- lightfully invigorating in the sun. The atmos- phere is practically free from moisture, and absorbs so little heat that in the extreme south- The following figures are taken from the records of the United States Weather Office at Santa Fé: 1892. Average temperature, degrees. . . . . . . . . 49. 1 Maximum temperature, degrees. . . . . . . 90.0 Minimum temperature, degrees... . . . . . 1.0 Average relative humidity, per cent. . . 43. Average velocity of wind, miles per hour. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.7 Total rainfall, inches. . . . . . . . . . . . . . . . . 11.62 Number of cloudless days. . . . . . . . . . . . . 248 Number of fair days... . . . . . . . . . . . . . . . 97 Number of cloudy days. . . . . . . . . . . . . . . 29 1893. Average temperature, degrees. . . . . . . . . 49.4 Maximum temperature, degrees. . . . . . . 89.0 Minimum temperature, degrees. . . . . . . . 5.0 ern part of the territory the direct rays of the sun in summer may be hot, but they are always accompanied by a deliciously cool breeze. The air has a crisp freshness, even in the “dog days,” that belongs to New Mexico alone. The dryness of the climate is not intermittent; it is constant. The equability of temperature is shown by the fact that in summer it is cooler at Santa Fé than at any other meteorological station in the same latitude, and that this ab- sence of summer heat is not counterbalanced by the drawback of extreme coldness in winter, the mean temperature there being the comfort. able and tonic figure of 28 degrees, Fahrenheit, during January, which is the coldest month in the year. This characteristic applies to the entire territory. In the southern half of New Mexico, both the summers and winters are nat. urally somewhat warmer. Bird's-eye view of sant a re. - º º Jacksn., Photo. Average relative humidity. . . . . . . . . . . . Average velocity of wind, miles per hour. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Total rainfall, inches. ... . . . . . . . . . . . . . - Number of cloudless days. . . . . . . . . . . . 235 Number of fair days. . . . . . . . . . . . . . . . . . Number of cloudy days. . . . . . . . . . . . . . . 1894. Average temperature, degrees. . . . . . . . . Maximum temperature, degrees. . . . . . . Minimum temperature, degrees. . . . . . . . Average relative humidity, per cent. . . . 41. Average velocity of wind, miles per hour. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Total rainfall, inches. . . . . . . . . . . . . . . . . - Number of cloudless days. . . . . . . . . . . . 213 Number of fair days. . . . . . . . . . . . . . . . . . 114 Number of cloudy days. . . . . . . . . . . . . . . The sunshine records of Las Cruces, in the extreme southern part of the territory, at an altitude of 3,000 feet, and at Las Vegas in the eastern part, at an altitude of 6,000 feet, are THE MEDICAL DIAL. 197 equally good. In fact, the weather records at Santa Fé are a general average for the whole territory, and the health-seeker has a wide range of choice as to locality. The exceeding dryness of the atmosphere is accounted for by the contour and position of the mountain ranges. Evidence is abundant that the mortality from pulmonary tuberculosis is no greater at the present day than it was hundreds of years ago. A recent article was published in one of our leading medical papers showing that in Jewish history, years before the Christian era, pulmonary tuberculosis was as rampant as now. This Would tend to refute the idea that this disease is at present on the increase, and at the same time indicate that we possess no cause of death in those who live in the open air. In Switzerland, of one thousand deaths occurring among out-door laborers and farm- ers, not more than one or two die of pulmonary tuberculosis. A similar number of deaths in Italy among shepherds and farmers show only from forty-four to forty-five deaths. In France the sanitary statistics gathered from six hun- dred and sixty-two towns show that the more the population is conglomerated, so in propor- tion are the inhabitants gravely affected with this disease. The vital statistics of New Mex- ico show the death rate from pulmonary tuber- culosis among the native population, Mexican and Indian, to be three in one thousand, the lowest known. This, of course, does not in- clude patients who come here from the states THE MINING CAMP OF KELLY, NEAR Socorro. better therapy for this affection now than did the ancients. The greatest number of deaths from con- sumption occurs in workers exposed to irritat- ing substances in the respired air. In Switzer- land, ten out of one hundred stone cutters die from pulmonary tuberculosis. In England, of one thousand deaths occurring in these work- ers, three hundred and forty were due to this disease. It makes cruel onslaught likewise in those individuals who habitually occupy a bent posture at their occupations, and in those who live sedentary and intellectual lives. Of one thousand deaths in Italy among students and seminarians, four hundred and fifty died of consumption—45 per cent. In England, of a similar number of deaths in printers, four hun- dred and thirty succumbed to this disease. On the other hand, statistics show that it is quite exceptional for this disease to be the and from abroad suffering from this disease. During the past five years public attention throughout the United States and Europe has been directed to this territory as a natural san- atorium to a greater extent than ever before. The American Health Resort Association has published a large number of reports on the subject, which are attracting invalids here from all parts of the world; and there is no doubt but that in the near future physicians informed upon climatological questions will unanimously pronounce this region one of the most valuable health resorts in our land. In order to derive all the possible benefit from such a climate as that of New Mexico, the health-seeker should live out of doors. He should not only take exercise in the open air, but he should sleep out of doors. If he has the strength to get about at all, the best he can do is to go into the pine forests and camp out. - | 198 DIAL. THE MEDICAL The nomadic life of the tent dweller is the best tuberculosis. It is often a grave mistake for an invalid to seek change of climate in a place where he has no friends, no occupation, nothing to distract his mind from himself and his mal- ady. In a few days he exhausts the possibili- ties of mere curious interest in unfamiliar sur- roundings, and then he strolls about alone, or with chance acquaintances, until he becomes weary of the town and the monotony of his ex- istence. Homesickness ensues, the mental dis- ease more than counterbalances the climatic benefit, and the health-seeker, in desperation, returns to his home, preferring the certainty of death among friends to the possibility of a pro- longed existence under unsupportable condi- possible treatment for incipient pulmonary ALCOHOLISM AND ALCOHOL.” By G. D. HAGGARD, M. D. The hoary age of this disease, the amazing swath of misery it has cut out of the life and happiness of centuries, the present social hold of alcohol, its increasing volume, commercial and political power, these combine to make it worthy of the careful consideration of the general and special student, the citizen and the statesman. A definition of this disease is accomplished only in a description of the acute and chronic forms and their stages, with their pathological changes, all of which are well set forth in Sajous’ Annual Cyclopedia of the Practice of tions. If such a health-seeker would procure a saddle-horse, pack animals and a camp outfit and go into the mountains with a good guide and agreeable companions, he would find no monotony and no homesickness, but would gain strength and buoyancy of spirit and never know a dull hour. A year out-door life in the dry, bracing air of New Mexico will, I believe, arrest any case of beginning pulmonary tuber- culosis if the sufferer has the necessary strength and vitality to begin such a course of treatment and take ordinary precautions against undue exposure and overexertion. NEW PUNCTUATION MARK. Teacher—“Can any of you children tell what an interrogation sentence is?” Patsy (confidentially)—“Please, mum, it’s one o’ them sentences you always put an ear after.” -- Business section of EAST LAS vec As. Medicine. Late and important additions to the pathology of the nervous system are cur- rent. Causative factors include:—The agent, al- cohol; the organism and its variations; the environment; society and government. Ethyl alcohol, and the heavier alcohols in smaller amount, with carbon dioxide, are pro- duced from suitable media in the presence of an enzyme accompanying the growth of yeast. A part of the media is consumed in the rapid growth of the yeast. The heavier alcohols, called fusel oils, are more rapidly poisonous. In root alcohols, and in fermented drinks, they bear no mean part in the injury of the drinker who is vastly drunker than if he had taken instead an equal propor- tion of rectified alcohol in dilution, such as the “made liquors.” *Read before the Hennepin County Medical Society, May, 1899. THE MEDICAL DIAL. 199 The growth of yeast is retarded by one part of alcohol in 100,000 of the media, and is Stopped by 14%. Any amount given to higher Vegetables is deleterious. In the weakest dilu- tions it slows the motion and shortens the life of the amoeba and of white cells of animals, making them granular and spherical. The in- jury to these organisms is positive and in- Creases with the strength of the alcohol—there is not stage of stimulation. They are not re- Stored by a true stimulant or relaxant. In the presence of a true stimulant, the cell life is not shortened and function is increased. This deleterious effect of alcohol is seen again in poor reparative force and lessened resistance to infection of the alcoholic subject. Cholera, yellow fever, sunstroke, attack alco- holics in preference to others. Alcohol administered to dogs decreases the progeny and lessens the growth. Applied to incubating eggs, it produces defectives and monstrosities. - Parkes' experiments on men and those of Beaumetz on lower animals determined that, a large amount caused acute poisoning. Half the amount gave a longer period of exhilera- tion, less subsequent stupor and less inco- ordination. When 1 to 1; ounces of alcohol was given diluted, in divided doses, in 24 hours, to a man of 144 pounds, undergoing full exercise, no perceptible disturbance arose and no excretion would yield alcohol. He con- cluded that it was oxidized as food and was probably useful. The only logical conclusion from the first and second observations of evil effect and an indifferent third Observation would be that probably it still works injury. Guided by the sensation of the drinker, all should harmonize quite with the defenders of the drug. But “one’s feelings under an anaes- thetic are insane.” - F. McD. Cosgrave reviews Ridge, Lauder Brunton, Parks, Wallowisc, B. W. Richardson, Martin, W. A. Hammond, Prout, Fife, Vierordt, Herver, St. Sayer, Smith, Perrin, and Lehman, and concludes: “It has been found contrary to what has been and still is believed, that alcohol is first narcotic rather than stimulant —all but Smith found less carbonic acid gas exhaled.” Vierordt, Prout, Snow, Ed. Smith, Lallemand, Perrin and Duroy contend that it is not Oxidized. Dr. Anstie scouts the tests made by these. Suppose it oxidized in the body, we have not proved that all bodies oxi- dized within the body, e.g. toxins of diseases— are useful and desirable. Alcohol does not effect production of heat, but accomplishes a dissipation of heat. Al- cohol is probably oxidized—producing heat, acting as a food. (Reichert.) “Alcohol is cumulative as are some salts of lead, copper and silver.” The behavior of alcohol toward the blood and toward albumen in solution implies a combination with blood and tissue elements whence it is dislodged with difficulty. It may thus escape oxidiza. tion. Thirty-three per cent of potass bromide is eliminated; is the 66% therefore oxidized, acting as a food—a generator of force? Upon digestion, Gluzenski found a retarda- tion for three hours, then an increase and pro- longed activity as regards amount and activity of gastric juice. This would presage a final failure which we know occurs. Mohilanski treated fifteen students, age 18 to 25 years, with two to five ounces of alcohol in 40% water dilution and found more as- Similation of nitrogen in the habitue and less in others. Chittenden and Mendel found no useful results from test-tube digestion. Alcohol decreases the oxygen-carrying power of the blood and is a vaso motor para- lyzant; the effect on thin walled distal struct- ures is earlier and On the heart later. Fuller pulse and surface moisture are evidences of this paralysis. “Even in moderate amounts (Glazier) it irritates the kidneys, producing an exudate of leucocytes and cylindroids. It either lessens the solvent power of urine or in- creases uric acid and oxalate crystals. The effect of a single dose lasts 36 hours—and re- peated is cumulative.” The apparent recovery is not real and damage results. But to co-ordinate these physiological find- ings and put them to a sufficient test, Dr. J. H. ICellogg has given to vigorous young men two ounces of whisky and has tested tactile re- action, temperature reaction, accommodation, and the strength of all important muscles. All functions were decreased and weakened, muscular work lost almost One-third. The test meal and various alcoholics in different amounts gave remarkable loss of digestive power in all cases. This would seem to answer the question of the action of alcohol on the human body. It would appear that we have also an an- swer to the legal question, When is a man THE MEDICAL DIAL. : drunk?—Just as soon as he has taken alcohol, his judgment is impaired. These results accord with experiences of Stanley, Greeley and Nansen; also with those of Wolseley, Roberts and Kitchener. Under these last three in the British army, the total abstinence men (almost half the Indian army) have less than one-tenth the sickness, disabil- ity and offenses of the other section. Sir H. Ritchener found that grog rations showed loss of endurance, health and morale in four days; a beer ration gave the same result a little later. The abstainers gained in desirable qualities daily. in the German army the Kaiser finds the beer drinking soldier 15% to 20% less effective than the abstainer. The loss of Specific weight, the increase of water and fat content of alcoholized tissues make them more Subject to exhaustion, infection and cold effects. In a six-day bicycle race in December, at New York, there were thirty-three entries. Twelve staid in the race—all who used alcohol dropped out. The one who had never touched it won the race, as he did the previous year; the second used none; the third drank Spar- ingly, had one-half tablespoon of brandy in training; the fourth takes a drink occasionally when he feels like it, in training had a little beer. Here is an inverse ratio between drink and victory. The latest English-American boat race gave similar results. But in fatigue has it not benefited? Al- cohol abolishes the sense of fatigue and allows the exhaustion to go farther. The period of recuperation is lengthened. In a bicycle race of the previous year, a very little champagne was given on the last day, and disaster ensued. We expect an agent to act somewhat in disease as in health, for example; broth, aloes, strychnia. However inconsistent the views of its friends, alcohol will be fairly consistent in its behavior in the sick as in the well. A fellow physician says: “When I find a patient fevered and delirious, with dry tongue, subsultus and running pulse, and see this poor picture brighten and moisture come to parched surfaces under alcoholic administration, this demonstration personally is worth to me all the statistics in the world.” What is this demonstration, except of the stage of Wet mouth and vasculur paralysis of the grandiose? It can be no other, for he gives that dose. But it takes figures to tell the later history of all such cases, and he who scouts them is not Wise. . Beale says alcohol may be of use in cases where cell proliferation is too rapid, as it kills many and retards others. F. P. Henry, in Hare's Therapeutics, says of typhoid patients, “Most are better without alcohol. The habitue requires decided doses increasingly larger. After 40 years of age, the temperate require three ounces of whisky daily. It is better when the skin is leaky, a low pres- sure pulse, delirium, subsultus and restless- ness.” Diakonoff gaye to seven fever patients one and three-fifth ounces of alcohol in 40% dilution in four doses, and found (1) lessened assimila- tion; (2) spoiled appetite; (3) increased stools; (4) lessened albuminous change in body; (5) patient feels better. Osler says alcohol may be given if the heart is feeble and first sound obscure, if there be muttering delirium subsultus and dry tongue. Give freely brandy or whisky; eight to twelve ounces is a moderate amount. Mr. Osler says, “It would be like ‘hoisting’ the abstainers ‘with their own petard’ to quote typhoid mortality of London Temper- ance Hospital of 16% to 20% for the past twenty years.” On the same page, he says the mortality of the Metropolitan hospital for ten years is 17% to 18.2%. Why did he say twenty years to one and ten years to the other? On the basis of any decade, the abstainers are ahead. An advocate of alcohol evidently car- ries a “petard” himself. Why discard that previous ten years of other hospitals? It was fatal to his insinuation. Again, to adjust and co-ordinate the mass of observations let us refer to hospitals. We do not want alone the treatment of emergen- cies and records of early subsequent observa- tions, but the total result. In the Boston City Hospital, 1,042 typhoids were treated with alcohol and the mortality was 386; 1,042 with- out alcohol, purely expectant, mortality 81. Dr. A. M. Lesser who made a low mortality record in the Red Cross Hospital of New York, by banishing alcohol, went before the Medical Association of Havana, before the war, and proposed the non-alcoholic treatment of the famine fever among reconcentrados—executed the plan and saved over 60%, while the others lost almost all. The Society acknowledged him justified and declared him a benefactor. The Temperance Hospital in the City of Chi- cago has made an unusually low mortality rec- ord. Six general hospitals in New York City THE MEDICAL DIAL. 201 have made mortalities forming an increasing Scale or series in direct proportion to per capita cost of liquors used therein. The higher mor- tality goes with largest prescription of the drug. It is the same in the soldiers homes. Dr. Geo. R. Achor says, “In Edinburgh Hos- pital, under the alcoholic treatment of delirium tremens, the mortality was 25%; this was aban- doned and 300 cases treated without mortal- ity.” The same is true of the Philadelphia and Chicago hospitals. In order to find the truth of these statements, I took at random, not knowing the contents, twelve hospital reports from various states. Eight of these had need- ed data. Their mortalities were from 12% to 6.9%. Those having 10% or over spent 30 to 45 cents per capita for liquors and alcohol; those having 9% or less spent 18 to 23 cents per cap- ita. > w- Some have contended that after the merid- ian of life it is useful because of failing nutri- tion and others because of the opposite; still others, that in asthenia of children’s diseases and in threatened prostration of summer heat (Jacobi), a little whisky is good. There is no strength here, but great weakness. “It is the climax of poisons that at once excites to ex- haustion and cuts out nutrition” (Crothers). The individual element in the causation of alcoholism depends somewhat on heredity, age, sex, temperament, race, and even soil. Yet it invades all classes, all grades of men. The capacity and desire for happiness or pleasure exists in normal man and, also in many the readiness to seek it unearned, borrowing from the future; even by an anaesthetic; and in a thousand ways, it seeks him—for pay. Of those who came for treatment, in One re- treat, there were: Collegians, 18; university graduates, 14; academics, 22; and from com- mon school, 26. A large list of men as able, as well rounded, as Chas. W. Dilke, who all but ruined his life by intoxication, would be easy to make. That the medical profession affords too large a quota points the same way. It is only in later times that public senti- ment and the known treachery of the drug have kept the gifted—Palmerston, Gladstone and Sherman—to such an age. Statesmen usu- ally failed at 40 or 45. Heredity is undoubtedly a cause. No immu- nity to alcohol is possible since the issue of the alcoholic have less resistance than the parent. Fifty per cent of children of drunkards have a decided tendency (Greiner) to alcoholism. The morbid impulse is worse when it dates from the conception state. - But many victims are the moderate drink- ers, those who fill the walks that defectives do not peach. The shortened lives of actuaries’ lists are selected, sturdy, industrious, reason- ably independent, classed as temperate lives. Poverty of food, as among the Swiss, where coffee and potatoes alone are eaten; the belief - in a restorative effect of brandy, and the pride of imitation, are causes of youthful alcoholism. (Demme and Bunge.) * f Nerve shock, grief, joy, sudden riches or losses, account for a considerable number of CaSéS. Into this field of mingled strength and weakness, of ignorance unorganized—this army of halt, maimed, and blind—marches a solid combine of the commercially strong and greedy, under government armor enlisting every known force to compel men, women and babes to drink and die. The most powerful lobby is the liquor lobby. Very lately a vote affecting this business was taken in the Senate. A Senator in the aisle stretched an arm Over either side, snapped his thumbs, saying, “All up!” A good majority arose as they sought to do in the case of the army grog-shop, which they endowed with $100,000 public money ten years ago. The people of Iceland, of Hawaii, of Mada- gascar, and others, have been forced by the sword from positions of political and personal abstinence to admit this evil. During the last year, this disease has been forced on five pro- hibition districts of our country by the general government. Soldiers have been made bar- tenders and court-martialed when they re- fused; the chaplains reprimanded and insulted for reporting the devastation of alcohol—one of their sworn duties. Why should alcohol not lord it somewhat? The government is its active, energetic part- ner, who gives free warehousing and exemp- tion from tax while making, ripening and ship- ping out and in. The Secretary of State is chief beer-drummer among the child races of the earth. And as to any estimate of public opinion to the contrary, who can make it or suspect it while the press advertises “The Doc- tor's Choice,” and is under the pay of “the trade” 2 202 THE MEDICAL DIAL. The social hold of this evil does not seem greatly less than in those days of grosser drink- ing when Napoleon thought it “better to leave the dining-room with the ladies.” The reck- lessly drunk are most sure to find that other vice beyond. But the respectable drinking puts the well poised in the grip of habit often in the gutter and makes him alway at once and at least the most obdurate enemy of any hearty prophy- laxis of this disease. - Very conservative estimates by medical men find the physician’s prescription respon- sible for from one-half to one per cent of alco- holism. Certainly his example is farther-reach- ing; he daily meets the “venerable supersti- tion” and withholds his warnings; tacitly al- lows its worse than useless indiscriminate ex- hibition; “smiles” a little himself even before children, and much of it not to offend his client. The first report I ever read of the American Medical Association which met at Washington gave 1,200 as the number of champagne bottles emptied at its banquet, and the orgies finished partly under the tables. Some have said that stress of life is a cause; but stress of life, longer hours, more constant care, and the added tax of child-bearing, have still left woman comparatively out of the toils of drink and tobacco. Above all these, the capital reason is the “open door,” whether by social pressure, by genteel unction, by congenital defect, or stress, or poverty, this monstrous cavalcade to the regions of the lost, stops when the door closes. Why do physicians furnish 40 per cent of opium habitues? their wives too great a num- ber, and the handlers of liquors too great a quota of alcoholics? It is the open door. The over-taxed, under-fed, short-of-sleep mothers have been farther from this open door, the easy bait, the salted meat, the extra salted crackers and salted beer. The saloons of St. Louis were closed one Sunday last month; and the central city dis- pensary had not one surgical case, where the average is twenty-five new ones. Alcoholism is usually neglected, so its inci- dence is unknown. There are 250,000 saloons; 25,000 men and boys become employees or pro- prietors yearly. The life of the temperate is shortened 10 years, but he does not die of alco- holism. The mortality of alcoholism is pos- sibly 5 per cent of the whole, but the mortality is in the list of other diseases which alcoholism fosters: Eighty per cent of heat-stroke, a severe infection, is due to alcohol. Combined actu- aries’ tables of England for thirteen years show the abstainers’ mortality 58.8 out of a possible 100; the moderate drinkers, 80.8; the Scottish tables, 15 years; abstainers, 47; moderate drinkers, 69. One-half the children of drunk- ards are defective; and there are said to be tWO and One-half million hard drinkers in the United States. There is a much larger number of alcoholics. Each class has its progeny of criminals and defectives, an increasing burden to every state. One-third of the insane in the Department of the Seine in France are due to alcohol; and the number is trebled in thirty years. When Dr. Ames returned, he had seen no drunkenness in France. When Kate Field was working for the government wine-house in Cal- ifornia at $3,000 a year, she could not find any, either. But Dr. La Borde, of the Academy, says, “If something is not done at once, in a very few years the whole working class will be drunkards.” The consumption of alcohol is the grade of damage done, and France uses the most. She rejects 50 per cent in the examina- tion for the army, like Switzerland and Ger- many, and lessens the required height of sol- diers every five years. All rulers, all govern- ments of Europe, are grappling with the prob- lem of alcoholic control. It has been said that “diseases due to im- proper diet and habits of eating appear equal to that considerable evil of alcoholic intempe- rance” (Thompson), and that Providence is as stern in his displeasure toward the former as the latter. No figures are given. Such a sus- picion does not arise at the workhouse. The judiciary have not thought it; they find 80 per cent of crimes due to alcohol, 6 per cent to heredity aside from alcohol. However scant or plentiful the table, men do not often rise in a frenzy to beat a wife, to butcher the babe, or to hang themselves. No villages of aborigines starve and freeze when pemmican and hard- tack are their fiercest stimulants. In the individual, as in the state, this con- dition is one of starvation and of degeneration. The withdrawal of the drug is imperative—no danger attends sudden withdrawal. If one should select his progenitors 200 years in advance he should withdraw this drug THE MEDICAL DIAL. 203 even earlier. By records of heredity, he could have neglected the first had he done the second. - Elimination of the drug and of tissue and other debris is best accomplished by internal lavage, by drinking water copiously, by emetics and by the stomach douche. The warm baths —massage and electricity—will, if repeatedly used, displace most of the sedatives. These promote nutrition which the sedatives do not. A cup of hot liquid food has often done what bromides and sulfonal had failed to do; yet these sedatives and hypnotics may be occasion- ally used. The hot broths may be well spiced with capsicum, and this drug may be given freely. I have given a dram of the tincture robbed of its alcohol, each two or three hours for several days, and the stomach remained unharmed. At Dr. Jones’ instance, a man in typhoid state of delirium tremens believed to be dying, tongue and jaws immobile, pulse fee- ble, breathing noisy and irregular, we forced into the stomach a 20-grain bolus of capsicum. There was marked improvement in two hours; then gave five grains in milk each two hours with recovery. The collapse of the doctor or nurse is sure to lead to the idea that “the hair of the dog that bit him” is the only resort. A treatment of alcoholism by true opposites was that used by Mr. Stocking of the City Mission upon a case that had resisted the Keeley and other cures. He took him home, coaxed him to bed, and soon read him to sleep with selections from the Bible. And here is also a moral: The patient yields to your measures when this hope of stim- ulants and narcotics vanishes definitely. A large number of cases are restored to useful state in seven to ten days. When the degenerations are severe, a longer time is need- ed even for the partial cure that is yet possible; for the tissue changes are permanent and often progressive. The information obtained in retreats as to causation and the success of treatment—30 per cent, indicates one source of relief applica- ble to very few. England has lately authorized state institutions; Canada anticipates the same. Illinois has authorized two asylums to be supported by tax upon the saloons. Ger- many has issued orders and established sana- toria for inebriated army officers. These re- treats, as in Switzerland, should be compul- sory to the victim. It is a very poor occupa- tion to stand behind this car of Juggernaut lence and famine.” picking up or entombing the wretched remains. We should at least be as wise as the aborigines of Madagascar, Hawaii and Iceland—adopt a true prophylaxis. To this end, education in the homes is needed. The full support of the family physician should be had by example and admonition. Mrs. Helen Hunt has, with the aid of the W. C. T. U., placed the series of twenty-three temperance text-books before 16,000,000 chil- dren in the schools of forty-one states and all the territories. But with pro-liquor executors, this law is often defeated and one needs the patience of Kepler, who said, “Since God wait- ed six thousand years for an observer, I can wait a hundred for a reader.” Whatever the view of causation, our obliga- tion and the avenues of relief are yet the Same. Suppose alcoholism is the symptom of a deeper malady (contrary to the belief of all labor leaders, all social reformers, many states- men and the United States Supreme Court), it is also a cause of other diseases and a stepping- stone to worse vices; “is worse than war, pesti- Do we hesitate to annul such a symptom because the disease is ill de- fined? In the treatment of the individual, his physician demands abstinence; he enacts pro- hibition or sends him to a retreat. The police court does the same. The workhouse is pro- hibition territory and has few crimes and mis- demeanors and a low mortality. The Greeks, Mohammedans, Ireland in years 800 to 1000; Iceland, Hawaii in 1835; Madagascar, and of late years some of our states and many parts of states—in fact, one-half the whole South- have adopted prohibition. The alienists of Germany have abolished alcohol from the asy- lums; all the long list of our generals except- ing Eagan gladly bid good-bye to the canteen. As a restraint, the license system is evaded. There are 466 blind pigs and 532 licensed places in the District of Columbia. Under this Sys- tem, the evil has inundated every civilized and most of the savage races, and the consumption of alcohol has steadily grown. England gets four million additional revenue yearly out of the increase; France used one and one-half quarts of alcohol per capita in 1850; in 1884 it was four quarts. The Emperor of Germany and the Czar of Russia, see the failure of re- strictive measures, so called, and are talking prohibition. The municipal trade societies of Scandinavia, who earn 125 per cent profit, pay _: º, " . . : , . ‘. . . . . . * * : *-*. s" . . . . . * * - ‘. . . . .", . . . " " ,- ** – 12- -- l - , * .*, * * - - - :* - * + - - * † 7 per cent to preferred stock, and the balance to charities, which again appeals to the avarice of the taxpayer and cripples his conscience. The earliest, the reasonable, the only, and the latest prophylaxis is banishment. Of course, “it won’t work.” The internal revenue office and the report of wholesale dealers showed a. loss of eleven-twelfths of liquor sales in Iowa for a certain period. The court calendars and jails were empty in half the counties. The burnt district was almost a minus quantity at the capitol city. The governor of Connecticut, when that state was under prohibition, said, “There’s scarcely a grog-shop in the state; jails fast emptying; there is a delightful air of security.” The next seven years of license compared to previous seven years, commit- ments increased 82 per cent; drink and drunk- enness, 111 per cent; breach of peace, 79 per cent; vagrancy, 129 per cent; and population, 12 1-3 per cent. Vermont has had this law forty-seven years and has less other law and need of law because of it. There are thirty-five police in the state; $11,600 is the total yearly cost of jails; there are but two houses of ill repute. Liquor causes immense loss elsewhere in prosecutions; Vermont gains $230,000 from prosecutions. There are more savings accounts in her banks than there are families in the state. The drummers say, “One can’t get much to drink, but one can sell goods up this Way, you bet!” The governor of North Dakota says, “We buy more pianos per capita than any other state; but best of all, our young people are strangers to the result of the drink traffic.” Alcoholism is not a disease of the few ; We see in it the collapse of nations. In the Wider sense abstinence is vain; we are not free Who abstain. Admiral Tryon, 800 seamen and a five-million-dollar ship lie at the bottom of the Mediterranean as a result of moderation on his part alone. The quest of science is the truth, and it is running alcohol to earth. Let us assign it to its proper place. Let the agent, alcohol, be removed from the home, the ways of trade, from the officers who carry more lives than Our engineers, let it go to the poison shelf of the chemist. We are warned that “worse evils will take its place.” Is there a deeper pit whence they could spring? No nightmare of a disordered and outraged world can ever compare with this horror. No such evil, newly heralded, could THE MEDICAL DIAL. share our tent, and, unmolested, bleed human- ity of life and happiness. It will not come, and until it does, we are its prospective opponents as we are the enemy of the present usurper— alcohol. ELECTRICITY IN THE TREATMENT OF SOME DISORDERS OF THE DIGESTIVE SYSTEM. By LAFAYETTE W. CASE, M. D., Waterloo, Iowa. Every physician of experience is aware of the fact that some of the most annoying cases he has to treat are those of the digestive sys- tem. He will therefore welcome any remedy Or plan of treatment that offers better results than are usually obtained. I shall speak of certain chronic and obsti- nate conditions that are frequently met with and which tax the skill and patience of the physician to the utmost. The chief symptoms in these cases are pain, acidity, nausea, vomiting, flatulence and con- stipation. Together with these there are gen- erally debility and a great variety of nervous symptoms which often seem to overshadow the digestive troubles. - Careful examination of the case will show that the symptoms mentioned above depend upon atony of the stomach, atrophy of the mus- cular fibres of the stomach, dilatation of the stomach, inaction of the glands of the stom- ach and intestines, or a condition approaching paralysis of some part of the alimentary canal. For many of these conditions, I have dur- ing the past two years been using electricity in various forms. As my practice is limited strict- ly to sanatorium work I naturally have many cases of the kind mentioned and have made, during the time mentioned, not fewer than four hundred applications of electricity in various ways for their relief. My experience, based upon so large a number of cases, convinces me that a greater number of the very severe cases can be more surely cured by electrical treat- ment than in any other way. In cases of atonic dyspepsia, dilatation of the stomach and similar conditions, I rely on internal application of electricity. The stomach should be empty, and it is therefore best to give the treatment several hours after a light meal. The patient is directed to drink a cup of warm water and a long, flexible stomach elec- * w - THE MEDICAL DIAL. trode with perforated hard-rubber bulb is passed into the stomach. This is connected usually with the negative pole of the battery, and a spongio-pilene electrode from four to eight inches square connected to the positive pole is placed on the skin over the stomach and upper abdomen. The external electrode may be placed over the seventh cervical vertebrae or over the subclavicular region, I generally use from three to five milliamperes of the gal- Vanic current for three to five minutes. In some cases I use the galvanic current for two or three minutes and follow it with a mild Sec- ondary faradic current for the same length of time, the same electrodes remaining in place and the same poles being used. In other cases I use the sinusoidal current, which contracts muscular fibres without much pain. This internal treatment is given every sec- ond day. On alternate days an external appli- cation is made, the positive pole being at the back of the neck and the negative over the stomach. If there is much pain the positive pole may be placed over the stomach or other painful part of the abdomen. In certain cases of vomiting which seem to be of a purely nervous character, cases in which there is no evidence of organic trouble and in which the stomach seems to be in a healthy condition except during these nervous attacks, electricity has been of very great Service. Some of these cases are purely hysterical, some are due to violent or too long physical exercise or to exhaustive mental efforts; SOme are due to the emotions, anger, joy, grief, anx- iety, sexual excesses, etc. In some cases the food is ejected immedi- ately after eating and without nausea. There is then no more trouble until the next meal when the same thing occurs again. Of course, if this continues long the patient soon begins to show the effects of innutrition. In other cases there is persistent nausea, frequent vomiting and the patient becomes rap- idly reduced by the strain of vomiting and lack of nutrition. - Nearly all these cases of nervous vomiting can be readily cured by electrical treatment. In many cases external treatment alone is suffi- cient. The faradic current may be used, plac- ing one electrode over the seventh cervical ver: tebrae and the other over the stomach. The former should be about four inches square, the ... • ... - ? - y - ... • .” w - - * f - * r * * latter six inches, square. A mild secondary Current is preferable. In severe cases better results are often obtained by using the flexible internal electrode with the faradic current alone, or both galvanic and faradic as de- Scribed above. - The physician may be assured that the rem- edy will reach the affected part and is almost Sure to produce beneficial results. This can- not always be said of drugs, for the mildest ones are often ejected immediately. In many cases of indigestion the chief symp- tom is pain. This may be in the stomach, in the region of the liver, or in various parts of . the middle and lower abdomen. It is not usu- ally of a severe character, but is present nearly all the time. In such cases I usually employ the galvanic current, applying a spongio-pilene pad from four to eight inches square over the affected part and giving from five to twenty milliamperes of the positive current for five to ten minutes. The negative electrode may be applied to the back of the neck or other region. If the pain is confined to the region of the liver it is probably due to passive congestion of that organ, a frequent condition. In such cases I often use the interrupted galvanic, negative over the liver, with the most satisfactory re- sults. Patients experience very agreeable sen- sations during the treatment and the benefits are usually permanent. The obstinate constipation, which is so com- mon in the chronic disorders of the digestive organs, as well as in chronic diseases generally, is often relieved by a sharp spray from a power- ful static machine, or, where greater stimula- tion is necessary, by sparks drawn from the iliac region, especially the left. The spray is usually sufficient and is used for five minutes daily. On several occasions I have in this way caused One or more movements of the bowels within a few minutes after the treatment was given. I formerly used for this purpose the faradic current, inserting a metallic electrode in the rectum and with a spongio-pilene electrode at- tached to the other pole applying massage Over the course of the colon for five or ten minutes daily. I have also used the sinusoidal cur- rent in the same way, and while both methods give very satisfactory results, the static method is preferable. Patients appreciate the advan- tage of not being obliged to disrobe. Naturally, during the treatment of any form of indigestion, whether due to organic disease or not, the patient should be placed upon a suitable diet. After a cure has been effected he should avoid the causes that have operated in the first place. Neither electricity nor any other remedy will keep a person from getting sick if he transgresses the laws of health. THE MEDICAL DIAL THE MEDICAL DIAL A Monthly Record of Medicine and Surgery. (Entered at Post Office at Minneapolis as Second Class Matter.) Issued on the First of every Month at Minneapolis, Minn. Editor, J. W. MACDONALD, M. D., F. R. C. S. E. ; Associate Editor, C. K. BARTLETT, M. D. Business Manager, E. E. GRISWOLD. . . . . COLLABORATORS . . . . A. W. ABBOTT, M. D. W. A. HALL, M. D. J. P. BARBER, M. D. G. D. HEAD, B. S., M. D. R. O. BEARD, M. D. KNUT Hoeg H., M. D. J. W. BELL, M. D. C. H. HUNTER, A. M., M. D. A. B. CATES, A. M., M. D. W. A. Jon Es, M. D. J. FRANK CoRBETT, M., D. J. H. RISHMILLER, M. D. . E. CUTTs, B. S., M. J. D. SIMPSON, M. D. # } J. H. STUART, A. M., M. D. . DUN's MooR, M. D. H. B. Sweets ER, M. D. DAvro Owen THOMAS, M. D., M. R. C. S. # D U N N M. ID $ . The publishers will not be responsible, under any circumstances, for the opinions expressed or statements made by correspondents. Contributors will be furnished, gratis, with sample copies contain- ing their articles, under an agreement to distribute at once to physicians in actual practice. To avoid duplication, publishers should be informed of the field to be covered. Reprints, giving The Medical Dial full credit, may be obtained at actual cost. No notice can be taken of anonymous contributions. The name (not necessarily for publication) must accompany every communi- cation to this journal. $1.00 .10 Annual Subscription, in advance, - - - Single Copies, - - - - - - - Advertising Rates made known on application. ADDRESS ALI, COMMUNICATIONS TO THE MEDICAI, DIAL, MINNEAPOLIS, MINN. MASONIC TEMPLE. JUNE, 1899. THE INSANE IN THE ANTILLES. Dr. G. Alden Blumer, superintendent of the hospital for insane at Utica, N. Y., relates in the April number of the American Journal of Insanity, of which he is one of the editors, his experience in a recent visit to the hospitals for insane in the Antilles. The first visit was made to the Orphan and Lunatic Asylum under the immediate control of a Roman Catholic sisterhood, at San Juan, Porto Rico. The mother superior rather re- luctantly, and with many apologies, “led the way into the men’s quarters.” The building is described as unlike anything of the kind the doctor had ever seen before. “The rooms open- ed in quadrangular fashion on to a spacious court, and on its four sides were arched corri- dors. A well occupied the central space. The rooms, with massive iron-bound doors, like those of a mediaeval castle, were dark, gloomy, and foul, without sanitary conveniences, or beds.” The doctor says: “The occupants of these rooms were naked, filthy, and the spectacle A sickening; but the mother superior expressed pity in Voice and gesture for these wretched creatures, and some of the women patients Seized alld kissed her hand in evident affection. The male attendant who accompanied appeared kind and distributed tobacco freely to both men and women while his supply lasted.” A few women were sewing in the corridors; but the men were apparently without employment. From a window there was a beautiful view of the harbor—when the shutters were Opened. The chapel was clean, and the drinking water was filtered. This is the only favorable criti- cism that the doctor could make of this noi- Some place, where fifty-six insane patients were literally confined. & In the Danish colony at Charlotte Amelia in St. Thomas, fourteen insane men and women were found in the barracks. No pretense seems to be made to care for them according to mod- ern methods. In the absence of the physician, the honors were done by “a kindly but conse- Quential negro, with a remarkable fondness for long words.” The insane were herded with sick folk—in a one-story wooden building, con- taining both male and female patients. The rooms had no furniture worthy the name, and the patients wore little clothing, or none at all. In some of the rooms there was a heavy ring in the middle of the floor, which the negro ex- plained was for punishment, adding, “You see, sah, the doctor has shown great partiality to these patients at times, and they have taken undue advantage of him, sah, so that it is some- times necessary to have recourse to hostili- ties.” The asylum at Bridgetown, Barbados, was visited, and here the experience was different. The superintendent, Dr. Field, was found read- ing Plato in the original Greek. This is not so much of a surprise when we are told that the Barbadoans are often highly educated, especial- ly as classical scholars; seven English bishops, at one time, having received their education at Codrington College, Barbados; and the profes- sor of Roman history in Basenose College, OX- ford, and the master of Exeter College—both being Barbadoans, educated in native schools. In this asylum there is intelligent care. There were 346 patients, equally divided as to sex. The rooms were spacious, with abun- dance of air, the floors of pine or cement, clean, and the walls whitewashed, the plumbing mod- ern, and good, the kitchen roomy and clean. THE MEDICAL DIAL. 207 seen, and few comforts that are usually found in modern asylums; but such articles or luxu. ries are not common in the households of the people there. Cases of paresis and paranoia are uncom- mon, but epileptics and idiots abound. Can- Vas stretched tightly on a frame is used for a bed, and covering is rarely necessary. The pa. tients, naturally lazy, do very little work. Dr. Field said: “If they do not choose to work, they are provided for.” Under such liberal and encouraging Barbadoan laws, it would seem that the country would be a paradise for tramps. All the medical work of this hospital is done by the superintendent himself, who pre- fers not “to bother with an assistant.” For the 346 patients he has thirty attendants and one head attendant. The women are paid from $7 to $10 per month; the men, $8 to $12; the head attendant’s salary $300; and the Stew- ard's, $500. For the evening meal they had ginger tea, and the food is largely fish and vegetables, such as rice, yams, squash, ochra. All patients are discharged upon a twelve months’ parole, and there is a requirement that a post-mortem shall be held by an out- sider in the case of every death, for which service the officiating physician gets a fee of three guineas. The final comment is, “that the patients looked well and appeared contented.” March 16, St. Pierre, Martinique, was vis- ited, and the so-called “Maison Coloniale de Santé” inspected. The Martinique blue book says of this place that nothing has been neg- lected to bring it abreast of the best institu- tions of France. On inspection of the premises the facts ap- peared quite otherwise. The senior visiting physician, Dr. Morestin, a general practitioner of St. Pierre, reported the owner of the estab- lishment to be one M. Delatouche, “propriétaire de la France.” The director is named by the local administration and paid by the proprie- tor. There were two visiting physicians in charge of the men and women, respectively. Private patients paid according to their means, and a fixed rate was charged for those main- tained at public expense. There were about 200 patients, of whom only eight were white. The visiting physician prepared Dr. Blumer for what he was to see the next morning, speak- ing of the restraint chair, and the infernal The furniture is plain. No pictures were to be. noises that might be heard, owing to the “elec- tricity of the air” or the “ozone” that excited them. Dr. Blumer says “that it seemed to him that in the island of Porto Rico the Iowest grade of care had been reached, but this so- called ‘house of health,’ to translate literally, the French euphemism for asylum, was infi- nitely worse in every particular. It is impos- sible to convey in words a picture of the horror of it all.” The structural arrangements were like those of the San Juan asylum, but in worse repair, and the number of patients in the most barbarous restraint, the doctor would not trust himself to estimate. In the damp, dark, vault. ed cells, with great, ponderous doors bolted, barred and locked, were chairs secured to the floors, in the seats of which were holes, and on these were pinioned naked patients with an iron rod through the arms of the chair in front of the patients, with spaces between the rods and the back of the chair sufficiently narrow to prevent movements of the body, but leaving . arms and legs free, unless, as sometimes hap- pens, camisoles are used as an additional pre- caution. The bodily cleanliness can be imag- ined. In some cells two planks from wall to Wall, supported on cleats, served as beds. “They all seemed to live a common life [those at liberty] with the animals about the place, pigs, dogs, poultry, men, all huddled together in the greatest confusion, with little oversight On the part of attendants. One woman was restrained to an iron bracket with what looked like a length of canvas fire-hose, because she pulled out the feathers of the chickens and ate their eggs.” But worse than all was the so- called Salle des douches. The patient, re- Strained in a chair, a stream of water an inch thick at high pressure is let fall on his head, While an attendant plays upon his body with a hose from another quarter of the room. The effect of this treatment when a patient is “michant” is said to be “all that is desired.” The Lunatic Asylum at Kingston, Jamaica, was found in refreshing contrast to the condi- tions above described. Dr. J. W. Plaxton, the superintendent, is an old West Riding as- sistant, and has also seen service in Ceylon, and Dr. Williams, one of his assistants, had been trained at Hanwell and other British asy- lums. There were 776 patients in accommoda- tions for 600; but a new building was nearly completed to care for the surplus. The patients’ Quarters were clean and the ventilation excel- Nº. 3. . . . . . . . . . . . s - - -. ' ºs- 4. * - , * - , * x , * * .* % - - * * *, * Z.A . - ... * lent, and everywhere an absence of odor. They have a good shower bath for patients, as well as other modern means of sanitation. There were many coolies, and they are said to show a tendency to insanity of melancholic bias, and their number is out of proportion to the num- ber in the colony, the explanation being that the men were of unstable brains when they left British India to engage in contract labor in Jamaica. A few cases of leprosy, several cases of leucoderma, and a number suffering from skin affections, involving chiefly the feet, were seen. Deaths from pulmonary disease were said to be numerous, isolation being difficult. There was one case of death last year from yellow fever. General paresis and paranoia are rare. The attendants are said to be of a low order of intelligence, and their ideas of morality of the “crudest kind, a woman being in disfavor with her sex, including herself, until she has demonstrated her capacity to reproduce the species.” One attendant, it was said, “who remained chaste was stigmatized by her fellows as a hermaphrodite, and so plagued by them that she was compelled to leave the service. The only advantage which the married relation appears to offer from the point of view of the Jamaică negro is that it permits the couple formally to join the church.” There were twenty-seven patients, thirteen men and fourteen women, at the quarters for insane, at new Providence, Nassau, when vis- ited. They form, part of a general hospital, so- called asylum, for the sick. “Little or nothing was done for the men, who were comparatively Quiet, cases apparently of dementia.” The col- ored man in charge showed his notes with evi- dent pride, from which the doctor learned that “Samuel Bowleg continues silly and worry- some,” and that “Shadrach Wemyss continues quiet and rational.” The accommodations for women were not in keeping with the others. Four were found in seclusion of the worst kind, “confined behind heavily barred and bolted doors, noisy, profane and obscene.” A new building for men had just been finished. From these reports of the condition of the insane in the Antilles, it would appear that an- other D. L. Dix is necessary to help them in their sufferings and instruct their keepers in the modern ways of treatment. TYPEIOID BACILLUS IN MILK. The germs being in milk before churning are found in butter three months later. They do not multiply in butter if the butter milk has been well removed, but if left in this furnishes an excellent medium for multiplication. In sterilized milk, typhoid bacteria can exist for upwards of four months. Inoculated into fresh- ly drawn milk they have been found after three months. Inoculated into sour milk they take complete possession thereof and become almost a pure culture.—Am. Microscopical Journal. THE MEDICAL DIAL. ~ MOSQUITOES AS TRANSMITTERS OF DISEASE. The probability of disease being carried by insects from sick to healthy human beings has been receiving considerable attention of late. On this question a contribution by Dr. Charles J. Finlay in the Medical Record for May 27 is of special interest. The biological conditions and the habits of mosquitoes have received spe- cial attention and this line of study has thrown light upon the important role which these troublesome insects play in the etiology and propagation of malarial infection. One of the essential conditions appears to be that the transmitting insect should itself experience a true infection, which may not endanger its life nor greatly disturb its physiological func- tions, but must always require, on the part of the insect, pathogenous susceptibility for the Specific germs which it is called upon to trans- mit. This perhaps explains why the same in- sect may transmit only certain germs and not Others; as also, that, among insects of the same kind, some species may possess that fac- ulty, while others do not. In 1892, Dr. Theobald Smith, chief of the division of animal pathology in the United States Bureau of Animal Industry, settled the question of the propagation of Texas fever in cattle. He proved that the germ of the disease is a blood parasite, and that it is propagated by the cattle tick. The germs sucked in with the blood of diseased cattle infect the eggs of the insect, and the new generation of ticks, developed from the infected eggs, caused the Texas fever in the sound cattle upon which they are applied. A tick is not supposed to attack a second animal after parting from its first host. The disease is only propagated through the second generation of ticks, that is, the offspring from the infected eggs. Koch repeated and confirmed, in eastern Africa, the experiments of Dr. Smith, and came to the conclusion that mosquitoes are so closely associated with the spread of malaria that they are responsible for the propagation of the ma- laria infection. He does not agree with the idea that malaria can be communicated simply by a mosquito first stinging a malaria patient and afterward a sound person. Dr. Finlay, from observations of mosquitos in Havana, says: “After an interval of two or more days, which they require to digest the blood and empty themselves, they are ready to sting the next victim that presents himself, and may do so as many as ten or twelve times, during the thirty or more days that I have been able to keep them alive. It is therefore quite admissi- ble that, when the mosquito becomes contami. nated, not only its eggs, but also its salivary glands may be invaded by the pathogenous germs, so that the latter may be discharged With the secretion of those glands along the THE MEDICAL DIAL. track of the wound and into the capillary vessel entered by the sting when the insect attacks its next victim. Indeed on some rare occasions I have seen mosquitoes die within twenty-four hours after they had stung a patient With Se- were yellow fever, without assignable cause, for they still retained some of the blood which they had sucked; whence it might be surmised that the yellow-fever germ is pathogenic for the Havana mosquitoes, though the infection seldom proves fatal for those insects.” While IKoch was ready to assert that “where there are no mosquitoes there is no malaria,” IFinlay thinks this assertion is altogether too absolute. In August last, during his stay in the field hospitals on the hills near Santiago, there were neither mosquitoes, mosquito eggs, nor larvae to be found in the encampments, and not a single case of yellow fever occurred among the one hundred and fifty men who came under his observation, notwithstanding the daily communications with the city. It was otherwise in regard to malaria, for this constituted the prevalent cause of sickness in all those camps. Dr. Finlay sums up the re- sults of his experiments on yellow-fever mos- quitoes as follows: 1. Reproduction of the disease, in a mild form, within five to twenty-five days after hav- ing applied contaminated mosquitoes to sus- ceptible subjects. 2. Partial or complete immunity against yellow fever, obtained even when no patho- genous manifestation had followed those inoc- ulations. 3. The coincidence of cultures made with the heads and proboscides of contaminated Imosquitoes giving the identical micrococcus in tetrads (M. tetragenus febris flavae; M. tetra- genus versatilis, Sternberg; teracoccus versa- tilis) previously discovered by him in collabora- tion with Dr. Delgado, in the blood and secre- tions of yellow-fever patients. If the mosquitoes and other insects are such enemies to man, is there any way by which we can protect Ourselves against these disease- bearing creatures? Roch suggested that the German colonies of eastern Africa might be freed from malaria by the construction of dwellings from which mosquitoes might be barred out. In this country no difficulty is ex- perienced in keeping mosquitoes and other flies Out of our dwellings, and what we do for sim- ple comfort the inhabitants of tropical coun- tries ought surely to do, since with them it might be a question of life or death. Dr. Fin- lay suggests that the mosquito larvae might be destroyed in swamps, pools, privies, sinks, street sewers and other stagnant waters, where they are bred, by a methodical use of potas. sium or other such substances, in order to lessen the abundance of mosquitoes; but above all, those insects must be prevented from reach- ing yellow-fever or malarial patients, and a - * * r : - . * - x * - w 20 .. • , 9 • * r’ proper disinfection of all suspicious discharges must be secured in order to forestall the con- tamination of these insects. Hospitals should be well ventilated and should Occupy high , grounds, With no stagnant waters nor marshes . in their Vieinity, the doors and windows pro- . **ted by mosquito-blinds, and there should be facilities for disinfecting all suspicious dischar. ges, and for destroying all mosquitoes and larvae from within the building. The sick should only occupy the upper stories, and none but, yellow-fever patients and such malarial Patients as are immune against yellow fever should be admitted. The examination for ad Imission should be carried on in a Separate building. With such hospitals, efficient boards Of health, and improved Sanitary conditions arºund cities, Dr. Finley sees no reason why yellow fever cannot be Stamped out of Cuba and Porto Rico. - Reports of Societies. Hennepin County Medical Society. - º º, monthly meeting of this society Was held at the Public Library, Min * , May 1st, 1899. y, Minneapolis, In the absence of the president, Dr. C. G. Weston took the chair. p y p The names of Dr. Mary Towers, Dr. L. W. Day and Dr. J. F. Corbett were reported favor- ably by the Board of Censors, and the name of º; R. D. Greenlee was presented for Imelmber- SIllp. Dr. G. D. Haggard of Minneapolis read a Paper on “Alcoholism, Its Causation and Treat. ment.” (See preceding pages.) DISCUSSION. . Dr. C. G. Slagel—Mr. Chairman: The paper is good, but more suited to a temperance meet- ing. It Would seem to advocate the banish- ment of alcohol from medicinal use. The Views and the statistics are biased, are one- sided and extreme. No man to-day knows the action of alcohol. I knew beforehand the author of the paper would quote Richardson and Kellogg. I do not know that Richardson is any authority. I know Kellogg personally; he is cranky on this subject as he is on that of meat eating. I am an abstainer when well or moderately sick. Alcohol is our best antidote for septicæmia diphtheria and in tuberculosis. Forty Years of practice confirms this opinion. If I had phthisis and were to select from a full pharmacy that flask by which to live longest, it would not be cod liver oil, it would be rye Whisky. All things venomous are found in Texas, yet rarely a death therefrom, because of the good, old remedies, whisky and turpentine. ". . . .” --- * ** - “. . . . . . . . . . . - % . . . . . . t r r w - , . . . - > * > * … - 2 . " - * ** . . * w Alcohol is indispensable in pneumonia. It has no place in health. Dr. Mary Whitstone—I wish to commend the paper. Some of my professors used alcohol personally yet their teaching and general voice decried its use in medicine, and one of those who had long used the drug said the World would be infinitely better off without it. It destroyed much more than it benefited. I do not use the agent. The phthisical should be allowed to die Sober. w Dr. Phillips—I am as old as Dr. Slagle and an abstainer and as good a judge of whisky. Have given to patients large quantities of alco. holics, a pint a day or more. Have used it in sepsis and diphtheria. Some did and some did not die. I can’t tell whether the disease or alcohol killed them. The drug has a stimulant stage easy to exceed and damage results. It is a two-edged sword. The government attitude is wrong. Dr. Greenlee (Minnesota Soldiers' Home)— I have been interested in this subject. I wish to commend the paper. In replacing alcohol by tincture of capsicum, more alcohol than capsicum is given. If the writer would be fine- haired he should give capsicum straight. Our unfortunate old soldiers afford a large experi- ence in the treatment of alcoholism, as alcohol is the most potent cause of their deplorable state. I have abandoned alcohol in our hospi- tal even with the habtiue, and have succeeded. It is a strong test. I have always doubted the stimulant property ascribed to alcohol. It is not as the public seems to think, needful, that the old soldier should have all the liquor his skin will hold. Since age comes and he must die, let him die sober and in a proper mind. In weakness use Strychnia. In shock alcohol is a damage, the surfaces get colder and more clam- my and the pulse weaker. I want to say to Dr. Slagle: The prolonga- tion of life he observes is due to stimulation by Minnesota air. I have years ago used alcohol in diphtheria on the doubtful ground that this dreaded poison should be met with its equal. Alcohol is of no use in septicaemia or heart failure. Medical men have done great harm through thsi drug. The sale of it in the army has caused more deaths than any other cause; beside those of drunkenness and vice, men were made careless, and this was a predispos- ing cause of the scourge of fevers. Many of the older army men are drunkards—this tells what the younger will be. The head of the government should stop it. HE SPORCE TOO LATE. Boarding-House Mistress (discussing Eagan) —“Well, that’s the end of the embalmed beef, anyway.” New Boarder (slightly deaf)—“No more, ma’am’ I was just going to ask for another plate.”—Judge. THE MEDICAL DIAL. ProSress of II?cdicine. OBSTETRICS. UNDER THE CHARGE OF A. B. CATES, A. M., M. D. R. E. cuTTs, B.S., M. D. ANTENATAL THERAPEUTICS. In speaking of the antenatal cause of mor- bid state, Ballantyne (Brit. Med. Jour., April 15, '99) insists that it is quite probable the Same causes are at work as in the post-natal epoch; that, in other words, the agencies which produce pathogenic and toxic effects when act. ing upon infantile and adult organisms lead to pathogenic and toxic effects when acting upon the foetus and to teratologic results when act. ing upon the embryo and germ. He also be. lieves that the morbid causes are many and that all the toxic and pathogenic agents which have a known effect on post-natal life may act before upon the developing organism. In this Way alcohol, lead, morphine, nicotine, etc., and the microbes and their toxine may be causa- tive factors in any antenatal morbid condition. The same cause may produce in one instance a foetal disease, in another an embryonic mon- strosity and in another a breaking of normal heredity in the development of a proneness to certain maladies of body or mind in later life. In some, this same cause may produce sterility, embryonic or foetal death, possibly twinning, and certainly abortion and premature labor. These protean effects are most frequently pro- duced by syphilis, tubercle and alcoholism. It is quite probable that the real causative factor is one of interference with nutrition; and that the modus operandi of the morbid causes must be considered as the arrestment of normal pro- CéSSéS. In speaking of the antenatal death roll, Ballantyne says mortality tables tell some- thing of the frequency of death during the early months of foetal life, and obstetricians know something about the number of prema- ture labors, still births and abortions, but he doubts if the most pessimistic has an adequate conception of the loss of life during the first three months of pregnancy. Registration of . still births is recommended, and this in time would necessitate necropsy, which would be of great value in ascertaining the causes of the intra-literine death. It is not only antenatal death which has to be considered, but the antenatally wounded, crippled and diseased. Taking all into consid- eration, there is certainly need for antenatal therapeutics. As to post-natal treatment of antenatal morbid conditions the results achiev- ed by the orthopedic surgeon are referred to in the treatment of deformities, while medicine has given great relief in syphilis and cretin- ISIY). THE MEDICAL DIAL. 211 . The post-natal treatment of idiocy by crani- ectomy is spoken of as unsatisfactory since, as Blane has said that, in primitive microcephaly, the arrest in brain development has occurred before the fourth month of foetal life, and that therefore the post-natal operation does not re- lieve the condition which developed early in uterine life. In cases developing the trouble later, the operation is more successful. By internatal treatment is meant the care and management of the infant during labor, both while in the uterus and in the vagina. The prophylactic vaginal douche during and before abor is suggested for the prevention of gonor- :hoeal, septic or syphilitic infection of the eyes, mouth or lungs. The value of the prophylactic louche has not been fully appreciated. Antenatal treatment is primarily maternal treatment. It must be so since it must pass through the placenta. The transmission of medicines by the placenta is imperfectly known; however, we do know of the beneficial effect upon the unborn when mercury is given to a syphilitic mother. Yet the mercury is en- tirely stored up in the placenta. Hence the benefit to the foetus is simply due to the fact that the mercury keeps the placenta healthy. Besides mercury, iodide of potassium, quinine, potassium-chlorate has been found of benefit in cases in which there has been a tendency to abort. ** Infectious diseases should be avoided by the pregnant woman, since it has been shown that such diseases as smallpox, scarlet fever, meas- les, erysipelas, etc., may not only be trans- mitted by the mother to the child in utero, but that she herself may be immune to the dis- ease and not take it, but that the foetus may become infected and afterwards born with the effects of the disease apparent. Further, the danger of deformities as well as death of the foetus resulting from the infectious diseases are pointed out. Likewise the effects of poisons, viz., tobacco, lead, copper, alcohol, etc. Under puericulture, the writer says, the better the hygienic conditions that exist during pregnan- cy the better developed and healthy will the offspring be. As to maternal impressions dur- ing pregnancy, it need only be said that it is inadvisable for the mother to be subjected to unpleasant emotions, and that she ought not to be allowed to brood over disgusting or terri- fying sights. R. E. C. INTERESTING RELICS. One hundred and ninety-nine different Sur- gical instruments have been found in the ruins of Pompeii, which are now preserved in the national museum at Naples.—Med. Bulletin. The Mississippi Valley Medical Association will meet in Chicago October 6 to 9, inclusive, instead of September 12 to 15, as heretofore announced. Neurology and Psychiatry. UNDER THE CHARGE OF R. O. BEARD, M. D., W. A. Jon Es, M. D. PEIOCOMELUS OF THE HUMERUS IN EPI. LEPSY AS A STIGMA OF DEGEN. ERATION. Under the above title, L. Pierce Clark, M. P. (N. Y.Med. Jour, May 13, 1899) discusses at length the use of the term phocomelus, and the few references in literature which refer to shortening of one humerus among epileptics. He then describes two cases in the care of the Craig Colony at Sonyea, N. Y. ..Case 1 is a girl of nineteen, who developed epilepsy at the age of four. Patient was a full. term child, delivered with instruments after a prolonged labor. She was injured on the left side (probably birth palsy) and had several con. vulsions after birth, as well as at the time of dentition. When about three or four years of *ge she had severe convulsions which ended in left-sided hemiplegia. Her attacks for many years were confined to the left side, and always began there. Her attacks are almost always preceded by epigastric aura, a fact fully re- corded by Gowers, namely, that hemiplegic epi- lectics may after a time develop aura similar in all Hespects to those occurring in idiopathics. In this case the right arm is in all respects nor- mal except in length, which shows a shortening of three and one-half inches as Compared with the º left side. ase 2 is a woman of twenty whose epileps began at the age of eighteen º à. jº Patient born at full term, labor not prolonged and terminated naturally. At two years of age right knee became painful, and after some time amputation just above the knee was performed. From the descriptions of the relatives this pro- cess was doubtless tubercular. The right arm Was noticed to be shorter at this time, but she had perfect use of the limb, which is still main- tºined. . Measurements made by Clark show the right humerus to be four and one-half inches shorter than the left. The condyles are much enlarged and protuberant, and the lines running from shaft to condyles were propor- tionately shortened. W. A. J. CONGENITAL ATROPHY OF THE CERE- HBELLUM. C. G. Hubbard, M. D. (Jour. of Amer. Med. Assoc., May 13, 1899): Mrs. M., 37 years of age, had previously borne six children, all but one of Which were delivered at the seventh month, The Seventh child, a female, was also born at the Seventh month, weighing five pounds and thirteen ounces, and well-formed in every part, except that from the lower part of the occipital bone there hung a sac three inches long, two ** \, , ºf 2. - - * -- : * : • * : ... " " - ". . , ” * * * * * - • - •r - 3. - * - - ºr- *- ** . . . * * * *. - * > 212 3. and three-quarters inches wide and one-half inch thick. The sac was filled with cerebro- ... spinal fluid and communicated with the cranial cavity through a nearly circular opening in the bone about one inch in diameter. The lower border of the opening just touched the foramen magnum, but there was no loss of substance of any part of the spine. The remainder of the head was well formed, but its bones were more movable than usual. - ... When the child was one week old the sac was aspirated, and six ounces of fluid with- drawn. After the sac was emptied there was found to be quite an absence of brain sub- stance. Fully one square inch of bone was lack- ing. The finger could be swept around under the bone within the cranial cavity, one-half inch beyond the margin of the opening in every direction except downward. The sac refilled and was retapped. After the third tapping the child lay in a semi-comatose state for two days, and later tappings showed a marked increase in the atrophy of the cerebellum. The seventh tapping caused so much irritation that their further use was abandoned, and shortly there- after the head began to enlarge and show the appearance of hydrocephalus. The child died at four and a half months, and a partial autopsy showed the presence of over two quarts of cerebro-spinal fluid. The opening in the occipital bone was centrally lo- cated directly over the foramen magnum, touching the latter at its upper margin. The cerebellum was so atrophied that its right hem- isphere was scarcely half an inch in diameter, the other hemisphere a trifle larger. The cere- brum was also atrophied, but not to So great a degree. , W. A. J. POSITION IN SLEEP; A PRINCIPLE IN NEUROLOGICAL TELERAPY. Dr. William Browning (N. Y. Med. Jour., May 6, 1899) divides people into three classes according to the position assumed by the head in sleep. 1. The medium class, who use an ordinary or thin pillow. 2. Those who sleep with the head higher than this standard. Some of these, who have been mentally oc- cupied just before retiring, begin the night with the head high, and end it with the head medium or low. In this class also belong cases of excitement, mental over-activity, mania; also a proportion of neurasthenics, epileptics, and nondescripts; besides many persons who present no nervous disturbance. Cases of Various diseases and conditions— such as valvular disease, etc., which cause the patient to rest with the head high—are of course to be excluded. 3. Those whose habit it is to sleep with the head lower than the average standard. In this class the sleep is usually profound, THE MEDICAL DIAL. and they grave an extra amount. They incline to Wake drowsy, tired and exhausted, and if inclined to headache, this is present and often most Severe on waking. With this class cold feet are not the great impediment to sleep that they are when present in class 2. The author suggests that when ill the third class are most benefited by remedies that are essentially or casually excitants and tonics, such as nux vomica, digitalis, the valerianates, increase of body fluids, alcoholic stimulants, iron, overfeeding and rest. On the other hand, depressants, whether hypnotic or otherwise, are of little value. - In class 2 all this is reversed, and depleting and depressing remedies are to be chosen, such as atropine, hyoscine, chloral, bromides, sul- phonal, Warm baths and sweat cures, diapho- retics, hard work, etc. But all excitants, stim- ulants and tonics are contraindicated. W. A. J. BOOk I’Oſic&S. DISEASES OF THE EAR, NOSE AND THRO AT AND THEIR ACCESSORY CAVITIES. By Seth Scott Bishop, M. D., D. C. L., L.L. D., Professor of Diseases of the Nose, Throat and Ear in the Illinois Medi- cal College; Professor in the Chicago Post- Graduate Medical School and Hospital; Surgeon in the Post-Graduate Hospital; Consulting Surgeon in the Mary Thompson Hospital, to the Illinois Masonic Orphans’ Home, and to the Silver Cross Hospital at Joliet; formerly Surgeon to the South-side Free Dispensary and to the West-side Free Dispensary; one of the Editors of the Ilaryngoscope, etc. Second Edition. Thor- oughly revised and enlarged. Illustrated with ninety-four colored lithographs and two hundred and sixteen additional illustra- tions. Philadelphia, New York and Chi- cago. The F. A. Davis Company. Dr Bishop's book is especially adapted to the use of general practitioners and students. It is well written and more than ordinarily well illustrated by lithographs and engravings. It is not encumbered by descriptive anatomy. Particular attention has been paid to details in the treatment of the various diseases. The chapters on the mastoid diseases cover thirty- four pages and are especially valuable. Prom- inence is given to the subject of hay fever, the opinions of thirty writers on the pathology of the disease having been gathered and present- ed. The author gives a description of the method of “Direct Laryngoscopy,” to which much attention has been directed during the past two years by the profession. This par- ticular edition is at least a fourth larger than the former edition, and the mechanical execu- tion of the work is excellent. -— THE MEDICAL DIAL. 213 AN EPITOME OF THE HISTORY OF MEDI- CINE. By Roswell Park, A. M., M. D., Professor of Surgery in the Medical Depart- ment of the University of Buffalo, etc. Based upon a course of lectures delivered in the University of Buffalo. Second Edi- tion. Illustrated with portraits and other engravings. Six and one-half by nine and one-half inches. Pages xiv.–370. Extra cloth, $2.00 net. The F. A. Davis Co., Pub- lishers, 1914–16 Cherry street, Philadelphia. This work is a shrewd compilation, giving in a condensed form the substance of many able works written in the eighteenth and nine- teenth centuries. For the student of medical history who has abundance of time, it would be better to travel patiently over wider fields and drink deeply at larger fountains; but as time is an element of the first consideration, a work like the one before us, with its 370 concise, yet forceful and ably edited pages, the vital spirit which animated the souls of many giant think- ers, is invaluable to the busy, up-to-date prac- titioner. SAUNDERS’ MEDICAL HAND ATIA SES. Atlas of the Diseases of the Skin, including an epitome of Pathology and Treatment, by Prof. Dr. Franz Mracek of Vienna, being an authorized translation from the German. Edited by Henry W. Stelwagon, M. D., Ph. D., Clinical Professor of Dermatology, Jef- ferson Medical College, Philadelphia; Physi- cian in the Department for Skin Diseases, Howard Hospital; Dermatologist to the Philadelphia Hospital, etc. With sixty- three colored plates and thirty-nine full- page halftone illustrations. Philadelphia: W. B. Saunders, 925 Walnut street. Price, cloth, $3.50 net. If the practitioner is in search of a book which gives skin diseases in a helpful and con- cise form he has it in this compact little vol. ume. In 191 pages of reading matter the vari- ous diseases are described in a clear and for- cible manner. Then follow sixty-three colored plates and thirty-nine full-page halftone illus- trations, presenting vivid and truthful pictures of cases as they occur in actual practice. So lifelike are these plates that it seems impossi- ble for any one to have any difficulty in recog- nizing the counterpart of each when seen on the human skin. The sale of this series of atlases has been phenomenal. Starting out with a contract for the sale of 100,000 copies, the calculations of the publishers have been so far exceeded that it now looks as if the sale would reach 200,000 copies. TEIE AMERICAN ELECTRO-TELERAPEU- TIC ASSOCIATION. The ninth annual meeting of the American Electro-Therapeutic Association will be held in Washington, D. C., on September 19th, 20th, and 21st, 1899, under the presidency of Dr. F. B. Bishop, of Washington. Quite a number of papers of great scientific value have been promised, and the committee of arrangements insures the members a very entertaining and pleasurable meeting. Aside form the sessions of the association, the com- mittee has completed arrangements for a trip to Mount Vernon, one to Arlington, and sev- eral other social features. - The headquarters of the association will be at Willard's Hotel, where special rates will be given to members and their families during the meeting. It is announced that the American Medical Editors' Association and the American Med: ical Publishers' Association will hold a joint session during the congress of physicians in Columbus, Ohio, June 6 to 9. - 214 THE MEDICAL DIAL. CORRESPONDENCE. To the Editor of the Medical Dial: Dear Sir-The following letter was ad- dressed to a strong, healthy, young married man, the father of one child. He suffers no disease excepting constipation, which he thinks due to some rectal trouble. I have never been able to find any trouble, and as he has been examined by a number of good physicians who have found no trouble with the rectum, I am inclined to think it entirely neurotic. With this explanation I present this as an unique piece of medical literature worthy the profound consideration of the profession. GEO. C. BARTON, M. D. Dear Sir:- Your letter enclosing Symptom Blank is at hand, which has been carefully examined by our physi- cians. We find that if you will act promptly and thor- oughly now, a cure can be effected; but delays are dangerous, as the trouble will rapidly grow worse if not rightly attended to. Your case is one which will in time assume a form which is past human aid, unless treated properly at once. It is apparent you lose the semen to a great ex- tent with the urine during the day, which you can easily find out for yourself if you choose to do so. VIEW OF MIT. FRANKLIN, EL PASO. Put a small quantity of the urine, which should be passed upon rising in the morning, into a bottle and allow it to stand for a day or so in a warm place. If you notice a misty or cloudy substance suspended in the urine, you may be sure that it is the semen, which you are thus losing daily, and there is nothing known which will wreck the health so soon, or which will cause as many serious consequences, as this ex- cessive and unnatural loss of the vital principle of the blood. - This is the sad condition in which we find the majority of sufferers from sexual weakness, and, al- though some are inclined to make light of such mat- ters, yet this is a subject to which should be given the most careful consideration. If neglected this trouble nearly always results in some fatal or dread disease, as “consumption,” “Bright's disease,” or worse still—"insanity.” We have in the above paragraphs attempted to portray the evils resulting from negligence and delay in cases as serious as yours. You yourself know better than we can tell you the causes which have reduced you to this unenviable condition. We shall now enter more minutely into your case and will tell you how you may be com- pletely restored to “perfect manhood.” As per your answers to the questions on our Symptom Blank, we find you are afflicted with the following troubles, viz.: “Spermatorrhoea,” includes losses of semen in the urine during the day, general nervous debility, etc., for which we prescribe Course “A.” “Involuntary discharge” is the unnatural loss of the seminal fluid, generally occurring at night, as the result of lewd or unholy dreams. Course “C” is out cure for this form of sexual weakness. * Varicocele” is a swollen, enlarged condition of the veins in the scrotum, and is successfully treated by our Course “E.” *Defective power” is a peculiar condition and one to which most men are subject. It is the inability to discharge at the proper time during intercourse. We prescribe Course “I” for this condition. “Atrophy” is a shrunken or undeveloped condi- tion of the sexual organs. It is, indeed, a humiliating condition, but one which is, however, very common. Our Course “H” is a perfect cure for this trouble. What you require, therefore, is a combination treatment composed of Courses A, C, E, F and H, which are all described fully in our book, which we have sent to you this day by mail under separate cover. The examination of the urine from the medicated paper constituted the most striking and characteristic feature in the diagnosis of your case. The character of the test slip of Litimus paper when it reached us Indicated an abnormal alkalinity of the above men- tioned fluid, due to an excess of carbonate of am- monia and sulphate of sodium. This led us to sus- pect some grave disorder of the bladder, which was verified when, upon application of heat, we discov- ered a dark coagulum of ropy mucus, which, when examined under the microscope, proved to be com- posed chiefly of pus, corpuscles, haemagloben and transitional epithelial scales. This savored strongly of chronic cystitis or catarrh of the bladder. Still we were convinced that even if this condition were present, it was a symptom of a far more important pathological process going on above, viz., in the kid- ney, and we made our test accordingly in that di- rection. By chemical analysis we discovered albumen in excess, together with many equally abnormal organic substances as globulin and various biliary acids, while hypo-xanthin, oxaluric acid, kreatinine, leucin. gaurin, etc., were markedly apparent. The above conditions, taken together with the subjective symp- toms on the sheet, strongly indicate an incipient degeneration of the genito-urinary tract. In preparing the treatment for your particular condition, we shall take all possible pains to include such ingredients as will effectually rid your system of the above very dangerous symptoms. “There are just as good sea serpents in the sea as have ever been seen.”—Puck. Jagging Jim—“’Ello, slumpy Wat's de matter wid yer face and hands? Got de hives?” Slumpy—“No-got de bees.”—Judge. THE MEDICAL DIAL. xi º º - - §§§ £3% 38.3% º - OAKLAND HYDROGEN DIOXIDE, U. S. P. “THE KIND THAT KEEPS.” 3& º º : º N A positive and harmless antiseptic and germicide for in- ternal and external use. Highly recommended in the treatment of diphthería, scarlet fever, and other contagious diseases. As a prophylactic in preventive medicine it is without a peer, and may be used lavishly or sparingly according to indications without a suspicion of harm resulting from its use in any application. THE OAKLAND CHEMICAL CO., 465-467 West Broadway, NEW YORK CITY, N. Y. w £3 3. §§ 3. : 33 - } § Zºw - º NººSºº KºKº. NºNº. Wºº º Sº ºSººſzººlººwº-NººSººn º º 333333333333333333333333333333333333 Sºlº/Sº S^2. &\º Sº S^2/\ºº/Sº Sºº/Sº Sºººººººººº. c-e-ºc-e-ºc ecºs e ºscºe-ºc-e-ºc eºs “ºbat Gentlier on the 5pirit Lies, (Iban Cit’o Eyelios on Cir'.) IEyes” sAMPLEs on APPLºcation. To The AnwrikAMN1A chemicAL Co., ST. Louis, U. S. A. rises prises per-es or es prºses prºses prºses a | º xii THE MEDICAL DIAL. PUBLISHER'S DEPARTMENT. FAMILIAR CLINICAL PICTURE. One of the most common Class of Cases is that in which there are no well defined Characteristic Symp- toms of organic disease, but in Which there are dis- turbances of practically all the functions of the body. This condition is variously termed general debility, Imalnutrition, general atomy, etc. The Symptom- group is an exceedingly complex and varied one, but the most striking disturbances are those connected with the processes of metabolism; the patient is un- able to replace by food the active waste occasioned by the physiologic functions. In consequence of this, nutrition Suffers, Vital force becomes diminished almd there is functional disturbance of practically all the organs of the body. The stomach and the processes of digestion become particularly enfeebled and as a consequence there arise the symptoms of atonic dys- pepsia, with lack of appetite and inability of the di- gestive organs to prepare the food for assimilation. The patient's Vital powers are at a low ebb and nature’s method of recuperation, that is, by assimila- tion of food, is effectually inhibited by inability of the organs to furnish the required properly prepared nourishment. Every physician has many times re- alized the absolute uselessness in these cases of the Ordinarily employed tonics, iron, arsenic and Strych- nine. It is soon apparent that the remedies are either not absorbed or if they do enter the system they fail absolutely to re-establish the proper ratio of metabolic waste and repair. It is now universally conceded by authorities that the first requisite in the treatment of this class of cases, is to foster the patient’s nutritive functions so that food will become assimilated and thus restore wasted tissue and im- paired Vital forces. The stomach is the Organ of prime importance and its normal functional activity must be re-established by remedies Which have a direct tonic alterative and stimulant influence upon its enfeebled, inactive mucous membrane. Stom- achics—gentian, taraxacum, phosphoric acid, etc.—are the agents of most service. When, however, these StomachiCS are COImbined in a certain manner with a remedy which, according to the highest medical authorities, is the best promoter of assimilation, the indications for treatment are completely met. Gray’s Glycerine Tonic Comp. Combats malnutrition upon the most rational Scientific basis, that is, it re-estab- lishes normal nutritive processes by its stimulant and alterative influence upon the digestive organs and also furnishes the where withal—glycerine—to cause the assimilation of food and medicines. It gives Inature the needed Chance to resume its normal Work of repairing exhausted vitality and wasted tissue. While primarily a stomachic Gray’s Glycerine Tonic Comp. is of greatest value in all conditions of sys- tematic depression or exhaustion occuring either in- dependently or as a consequence of severe organic diseases such as tuberculosis, Bright's disease, etc. It antagonizes depression by propping the natural functions of the body, by engendering appetite and ensuring the absorption and assimilation of food— nature’s method of repairing waste.—The Purdue Frederick Co., 15 Murray Street, New York. Abstract from “The Causation and Treatment of Consumption,” by John R. Kestell, Ph. C., M. D., De- troit, Mich. Read before the Wayne County Medical Society: “I have little faith in specifics in the treat- ment of tuberculosis. I believe it is entirely a disease of malnutrition, as a result of defective elimina- tion, and all therapeutic measures must be directed toward the improvement of the digestion and assim- ilation. Consequently I am explicit in my instruc- tions as to diet, forbidding absolutely the use of alcohol, Syrups, potatoes in any form, pork, Veal and all such dishes as are difficult of digestion and prone to fermentation. In many of these cases of alimen- tation I have found it beneficial to give Some good diastasic extract of malt, that known as Maltine proving most satisfactory for the reason that it 1S, the only malt extract known to me which gives generous proportions of nitrogenous and phosphatic matter, with a proper proportion of carbohydrates; being made, as it is, from wheat and oats, in conjunc- tion with barley, instead of barley alone. Tonics, stimulating the nervous system and digestive Organs and assisting in the reconstruction of blood and tissue, are important. Stimulating baths may be used with good results. It is, in my opinion, a mis- take to overwhelm the body with frequent injections of undetermined animal serum, thereby producing either a severe reaction or possible accumulative toxemia.” © I have prescribed “Maltine with Coca Wine” with great benefit as a general tonic and to counter- act the prostration incident to intestinal hemorrhage from severe internal piles. No Other preparation of many used has offered such relief as “Maltine With COCa, Wine.” - Louis W. Dunawan, M. D., Chicago. Nat. Wallis, M. D., Fitchburg, Mass., Writes: “I have examined Hagee's Cordial, and am perfectly satisfied with it. It is a very palatable and agreeable preparation, and is a valuable addition to Our thera- peutics. Hagee's Cordial Cod-liver Comp. fills ‘a long-felt want’ and will meet the requirements in cases where cod-liver oil is indicated, and being SO admirably combined with the hypophosphites, it can not be other than a good “tissue builder.’” ANALYTICAL TEST. Gentlemen:—I have used Neurosine, prepared by the Dios Chemical Co. of St. Louis, in my practice for a number of years in hundreds of cases Where the Bromides are indicated, with marked success. The preparation has always been uniform and is in my opinion the best combination of Bromides on the market. On request, I have made a chemical an- alysis of this preparation and can State conscien- tiously that it is entirely free of Opium, Morphine and Chloral. - Carl Orth, Ph. C., M. D., Analytical Chemist. 1437 Penrose St., St. Louis. ADMITTED TO THE IFRIENCEI MARIKETS. It is a matter of Some gratification to the manu- facturers of Oakland Hydrogen Dioxide to know that their Solution is admitted to the French marketS. The extravagant claims boldly set forth by some manufacturers of pharmaceutical products are fre- quently not found true when the contents of the packages are examined, and the French government has incorporated in its customs regulations a wise provision which prohibits from its markets all pro- prietary medicines which do not comply with the Statements made On the accompanying label, and With the pharmacopoeia requirements of the country Where the goods are manufactured. All imports are examined by expert chemists and those which fail to pass a rigid invistigation are prohibited. - The fact that Oakland Hydrogen Dioxide is ad- mitted is equivalent to a guarantee from the French government that the article is as represented and worthy of confidence. If Some similar regulations existed in our own Country the profession as well as the public would be protected from the assaults of unscrupulous man- ufacturers, and many of the conflicting clinical re- SultS SO Often obtained by the playsician would to a great eXtent cease. CLIN/LATE CURE. To sufferers from the various forms of lung and throat diseases, New Mexico offers climatic condi- tions of especial friendliness. Here are found a very dry and aseptic air, a light atmospheric pressure, maximum of sunshine and minimum of cloud, slight variations in temperature, and a porous, dry soil. This is the land of Sunshine and blue Skies. It is never uncomfortably warm in summer, when one is shaded from the sun's direct rays. There are no dis- comforts of winter blizzards and freezing winds; and the air has a crisp freshness. The dryness is per- petual, not intermittent. Naturally the invalid struggling with consump- tion, bronchitis, asthma, etc., has a better chance for recovery where external conditions are helpful, not hurtful. In many cases the chance becomes a cer- tainty, and rugged health succeeds chronic invalid- ism. The paramount value of “climate cure” is at- tested by the experience of thousands of able physi- cians, and the special advantages of New Mexico are becoming better known to the medical fraternity. The term New Mexico is a broad one, and compre- hends a variety of local conditions. The northern section is higher, drier and colder than the southern; the mountain districts and table-lands differ from the valley regions, but the general characteristics are Pine, pinon, cedar and spruce trees grow abundantly in the mountain districts, filling the air with balsamic odors. There is no malaria; hay fever is a stranger, and epidemics of acute intestinal diseases never occull". While New Mexico is pre-eminently a resort for consumptives, it also attracts those troubled with kidney and rheumatic diseases. Persons afflicted with inflammatory ailments and heart disease should avoid high altitudes here as elsewhere. The term “health resorts” should not be used in a restricted sense. It properly indicates any place where one's physical condition may be bettered by baths and medical treatment, or by merely being out in the open air, engaged in hunting, fishing, riding, walking, etc. With that interpretation in mind, the passenger department of the Santa Fe Route has published a pamphlet giving the accommodations at each town in New Mexico which comes within the broad meaning of health resort. To summarize: Sanatoriums and other special facilities for invalids are only found all the year round at Las Vegas Hot Springs, Las Vegas, Santa Fé, Ojo Caliente, Las Cruces, El Paso and Hudson Hot Springs. The others are either summer pleasure resorts, like Jemez Springs, Sulphur Springs and El Porvenir, or they are - º - GENERAL VIEW OF the same-plenty of sunshine and pure, dry, ratified all". New Mexico extends nearly as far south as the northern line of Florida. Its elevation above the sea. ranges from 4,000 to 7,000 feet, the average being 5,600. This means a temperature equivalent to that of the New England coast, other things being equal, because every 800 feet of elevation is climatically equivalent to a degree of latitude at sea level. But other things are not equal. As stated, New Mexico is a country of sparse rainfall, and there is only a slight humidity in the atmosphere. Fogs are un- known. The result is an unusually equable climate, little affected by summer heat or winter cold. There are few days in the year when it is unsafe for invalids to venture outdoors. In summer, the sun's rays, while ardent, are never harmful; in the shade and at night the air is always cool. When winter comes, though deep snow may cover the mountain tops, it rarely falls on the lower levels, and does not stay there long, but melts away rapidly in the genial warmth of the sun. Yet disagreeable rain and snow flurries sometimes come, though not so frequent nor so severe as in other less favored localities. Visitors should not be disturbed by them. It is impossible to live without some precipitation of moisture. Wait for the sun's long and glorious reign to begin again, and you will gladly stay indefinitely. C. C. CARPENTER 617 Guaranty Blog., - LAS VEGAS Hot SPRINGS. * - white Photo. cities and villages, some of which possess certain business advantages, and all of which have New Mexico's universal endowment of pure mountain air. There are many seekers after health who must make a living while they are getting well. For their guidance a few pages of the pamphlet referred to are devoted to data concerning the avocations open to invalids, who can perform light manual labor. This information will also be of value to still another class, who, after having been restored to good health by the climate of New Mexico, must remain in that region in order to avoid a relapse, and who eventually find it necessary or desirable to engage in business. The attention of physicians who may not have visited New Mexico is respectfully invited to the expert medical testimony which appears in the palm- phlet. Round-trip tickets at reduced rates are on sale from Chicago, St. Louis, IXansas City, Denver and other principal cities, every day in the year, to Las Vegas Hot Springs, and during the winter tourist season (November 1 to April 30), to Deming and El Paso. For detailed information respecting ticket rates, etc., address W. J. Black, G. P. A., A. T. & S. F. Ry. Topeka, Kan., C. A. Higgins, A. G. P. A., A. T. & S. F. Ry, Chicago, Ill.; or any representative of Santa I'é Ikoute; or - Passenger Agent, - Minneapolis, Minn | - | xiv. THE MEDICAL DIAL. AMERICAN TENT AND AWNING COMPANY., C. M. RAVITZER, NAAN AGE.R. - - Awnings, Tents, Flags, Umbrellas, Horse Covers, Wagon Covers, Cotton Duck, Paulins, Horse Blankets, Cotton Mops, Oiled Clothing. Feed Bags. - - - TE NITs F.C. R. R. E. N. T. - 125-127-129 First Ave. North. Telephone 226 o J. MINNEAPOLIS, MINN. Nºv. A N T ~~) L-L M. N. Dv H. RTISEMENTS will be inserted in this column at the rate of two cents a word, with a minimum charge of twenty-five -- -- cents, cash in advance. - - - Waukesha Springs Sanitariu ſm LECTRIC APPLIANCES.-Aprivate party has for sale a num- "a ber of medical electric appliances in every way as good as new. State what is wanted. Address Electric, The Medical Dial. - WAukesha, Wisconsin. A private institution for the treatment of nervous diseases. BYRON M. CAPELS, M. D., Superintendent. ----- Mº: EXCHANGE.-Have you anything to sell? Do you - want to buy anything? Do you seek a location? Do you want an associate? If you do, advertise in this column. --- H”. SALE – Any physician of the mountain districts, or any Tº other, requiring a leather saddle-bag medicine case, all com- plete with bottles, should write at once to THE MEDICAL DIAL. Sent direct from the factory. Case is neat and substantial, and at a moment's notice can be converted into a hand bag. A RE PUTATION MA K E R _º. THE KELLEY HOT AIR and WAPOR BATH º - - Every physician knows that heat scientifically applied is necessary to the successful treatment of a great range of cases. BATH No. 1. The modern method of applying Dry Hot Air or Medicated Vapor to any part of the body. The Absorbent Pad absorbs the moisture during heat exposure which admits of the patient taking much higher temperature than by any other method. The heat is perfectly distributed and regulated within an aluminum cham- ber, flexible, especially adapted to fit any part of the body, either sitting or reclining. The burner (either gas or alcohol) inclosed in heater. Patient always has control of regulated heat up to 400 Fahr. Weight of outfit five pounds; packed in convenient case for carrying. A Wide Departure from the Expensive, Cumbersome Machines on the Market. One test on a single case of Rheumatism, Gout, Inflamation, Congestion, Neuralgia, Spinal or Joint trouble will convince any physician it is a necessary adjunct to his practice. If it does not double discount any other Method, or prove entirely satisfactory after thirty days' trial, return it in good condition and money refunded. Send for circulars. PRICE, BATH No. 1, COMPLETE, $5.OO SAM E \ºv IT + A R v A. N. D. Leº ºn Err, $8. Oo st ERILIZING THERMoMETER, $1.O.O. F. C. E. C. H. I. CAGO w. KELLEY & co. __ 6ſ Dearborn Street, CHICAGO, ILL. T i --. $ JOHNTWYETHT&TEROTHERT |||}|||}||||||}} N EUTRAL. (Liquor Mangano-Ferri Peptonatus—Wyeth.) ANAEMIA, CHLOROSIS, SCROFULA, DEBILITY. The value of Iron and Manganese in the form of pep- tonates as offered in this preparation may be summarized from the latest scientific researches, as follows: (I) By association with peptone, the albuminates of iron and manganese become “digested,” or, in other words, much of the labor of the stomach and pancreas in this respect is saved. (2) Peptone is a body that is not provided abundantly by the stomach, even in health ; and hence, its artificial administration is, for weak digestion a desideratum. (3) It is a necessary adjunct of pancreatic digestion. (4) It is easily absorbed. (5) It increases peristaltic action. gº DoSE.—For an adult, one tablespoonful well diluted with water, milk or sweet wine, three or four times a day. Per Gallon, $5.00 Per Dozen 12-ounces, $9.50 Wyeth's Imid Mali Extradiº Containing all the Nutrient Properties of Malt, with the Least Possible Quantity of Alcohol. We claim that our LIQUID MALT EXTRACT will be ſound to contain all the nutrition of the best Malt Ziguors in a higher degree than any of the largely sold Liquid Malts with which we have compared it, having the marked advantage that it is free from the stimulating effect which invariably follows their administration. LOSS OF APPETITE.-A wineglassful taken half an hour before each meal and before retiring at night, will soon restore a healthy appetite. DYSPEPSIA.—Discontinue the use of ice-water, coffee, milk and all strong liquors, and use WYETH's LIQUID MALT as a regular beverage, especially with each meal or luncheon. A permanent cure will be the certain result. NURSING MOTHERS.—Should use WYETH's LIQUID MALT liberally at every meal and luncheon and as a beverage. Per Dozen Pints - tº $3.00 WINE OF (ODLIVEROILEXTRACT with Cherry and Hypophosphites. A NUTRITIVE TONIC. Each fluidounce represents one fourth its volume of Cod Liver Oil with Extract of Malt, Fluid Extract of Wild Cherry Bark, and the Hypophosphites of Lime, Sodium, Potassium, Iron, Manganese, Quinine and Strychnine. Adult dose, one tablespoonful three or four times daily. For a child, one to two teaspoonfuls. |Per Dozen Pights ſº º $3.09 Elixir Alli-DVS]ºpſiſ, This preparation will be found peculiarly efficacious in those derangements attended with flatulence, acid fer- mentation, eructation superinduced by eating rich food, pastry, starchy vegetables, excess in drinking spirituous liquors, and excessive smoking. It will prove equally valuable in almost every condition of weak and impaired or imperfect digestive powers, either due to catarrh of the mucous coat of the stomach or in those symptoms char- acterized by sensations of distress and uneasiness during digestion, usually termed Nervous Dyspepsia. Each dessertspoonful contains: Pepsin I grain, Pancreatin 2 grains, Casca a Sagrada I grain, Ipecac I-5 grain, Strychnine I-60 grain, with the active constituents of 30 minius Antiseptic Solution. DOSE for an adult is one to two dessertspoonfuls after each meal or when feeling oppressed, Inuch depending upon the severity or frequency of the attacks. $12.063 Épeg' ºozen Pints tº º º WY ETH'S Granular Eſtresſing Salts, Our list of GRANULAR EFFERVESCING SALTS embraces those in popular and general demand. For uniformity and fineness of granule, ready and complete solution, sparkling eſſervescence and general freshness, delicacy of flavor and charactCr, they are un- surpassed. They are prepared with scrupulous exactness as to strength and contents of each drachul or sixty grains. We ask file attention of the medical profession to Dr. Cathell's Essay on the use of Kissingen and Vichy for Reducing Over-Fatness, a copy of which we will furnish on application. with a Dose Glass. 9aw. - º º º w EffèFWGSGing S0ffilm Phºsphâté Each dessertspoonful contains 30 grs. Sodium Phosphate. A Wii LD, PLEASA NT AND TASTE LESS LAXATIVE A SPECIFIC IN constipATION CHILDREN's DIARRHCEA, OBESITY, JAUNDICE, RICKETS, ETC., ETC. Sodium Phosphate has long bren the favorite purga- tive, inasmuch as it acts gently but surely, has little or no taste, and is easily taken by children and delicate persons. In the present form—the effervescent—it is a delightful remedy, constituting a refreshing sparkling draught of bland action. Sodium Phosphate is a mild but certain hepatic stimulant, and relaxes the bowels both by promoting an excretion of bile and by acting directly upon the mucous membrane of the intestines. It does not cause “griping,” nor does it derange the stomach or excite nausea; unlike many other purgatives, it has a beneficial effect upon the digestion, stimulating the flow of gastric juice. These Salts are put up in 4-ounce Doubly Sealed Bottles. Each Bottle accompanied Also in Bulk 1-pound Bottles. PHILADELPHIA, PENNA. ~ xvi. THE NAEDICAL DIAL. Go Lo MEDAL. Fol-DING BATHTUB. This bathtub is made of very first quality of rubbered tº º duck; will last ten years—we guarantee it for two. Made in different sº. sº- sizes to suit our hospital tub is 6 feet long; other tubs are 5 feet long, -º- -------- and when folded weigh 16 pounds and are 5 feet long by 4 in. x 5 in. Strong enouth to support the heaviest person, and a pail of water makes a bath. Physicians are recommending them. We also manufacture the celebrated Gold Medal Folding Furniture. Cots, Settees and Chairs in great variety. Send for free catalogues. GOLD MEDAL CAMP FURNITURE MNFG. Co., Racine, Wis. Goodyear Rubber Co., JAMES SUYDAM, Mållager, 92, 94, 96, 98, too and 102 E. Seventh St., S.T. PAUL, MINN. Manufacturers of the GOld Seal Rapid Flow | | S | | Best quality bag and tubing; reversible rectal and infant pipes; eye spray; ear and nasal tubes; bent and irrigating vaginal pipes. sizes: 2, 3 and 4. Quarts. Northwestern Distributers of Dr. L. WILHOFT'S (ORIGINAL) LADY'S SYRINGE Made of one piece of soft rubber and constructed on the only correct principle, & º viz: injection and suc- | |REGISTERED) tion. It is the best vaginal \, 3/ Syriage made. &s sº Sºnd for Dºstriptivº Circulars. Physicians and other professional men may wisely see that the stationery used in their professional cor- respondence is of at= tractive and proper style. The Beard Art & Stationery Co. give particular attention to filling such orders, and will send samples and quote prices on request. Address 705 Nicollet avenue, Tlin= apolis; telephone 181. Leading Druggists of Minneapolis. : jº cAccuracy and Quality Guaranteed. * ŽS WANOUS PHARMACY. * Mail orders Solicited. * Miss Wanous, 2d Floor, 521 Nicollet Ave., Tel. 1228. * zºº ********* ****************** - ******** ſº- O PEN ALL NIGHT, ºn The Voegeli Bros. Drug Co., PRESCRIPTION DRUGGISTs. 2 and 4 W Ash INgrox Ave. S., Cor. HENNEPIN. : We carry the most complete stock of Drugs and Chemicals in the Northwest. Mail orders Promptly Filled. …~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ * -- ſweester & CFACIRCFAILL, ſ - . . . ] PHARMAC 1sts, Under Nicollet House, Minneapolis, Minn. | Stands for Doctor of 3/Medicine. - * Stands for 3/Medical Dial. “ United we stand: divided we fall.” Now is the especial time to subscribe-One Dollar per annum. careful attention given to Physicians' Prescriptions. - --- ----- - -- Address, THE MEDICAL DIAL, 513 Masonic Temple, - Minneapolis, Minn. THE MEDICAL DIAL. xvii §§§ 38,738,238,238,238,238,233,238.23 LOWERS... BEAUTIFUL ROSES CARNATIONS LILIES and all the flowers in their season. Funerals a spec- ialty. Telegraph orders for funerals and parties º filled. Seeds and other florist supplies. Send or Catalogue. M. END EN HALL GREEN HOUSEs, First Ave. S. and 18th St., or City Store, 414 Nicollet Ave., Minneapolis, - - Minnesota. §§§§§ :* oGººººººººººoºoººººoºº. Seeley Hard= Rubber Trusses º Inguinal French Truss Prove Right Incipient For all º's Ruptures Chronic We send the right one—it won't disap- point you or your patient. Ours are Com- fortuble Tºusses to hold, and improve each hernia; make a cure for many. Drop us a postal for Life Photos, Cata- logue. Chesterman & Streeter sucessors to 1. B. seeley & co. 25 So. 11th St. Philadelphia. --Oooºooºººººººººººooº- MARSHALLSCDNVERTELEBUGBY CASEM).3% - changes into Saddle Bag (is both in one). Finest, best durable leather finish outside and in (lined). Con- 18-6-dr. corks.-total 32 bottles, with spaces between rows for pow- der papers, 2 sundr º º º!" ea -- , 7%x2'4'x2%. Delivered, privilege of examination, C.O. D., bal. $8.50, or ex- press paid. ºùù in ou remit s1.00 earn- Patented. e en ree, we sell saddle Bags low as £475. 34 bottles with - -- §ºes"; ; Hºisºr Buggy Gagº 8-drº *** -º- ings, laundry space, 88.75. 4. *% º º and illustrations it asked for. Address W. S. MARSHALL, Care of Exchange Bank. CENTRALIA, Lºs Eurºka Nºbulilºr º Mounted on 4-Sawed 0ak Table Air-receiver of seam- tº less steel, size 10x80 in. tested to 500 lbs. … | ished in nickle plate lºor oxidized. The most - useful and practical ap- paratus ever offered to physicians for the Special Treatment of Chronic Bron- chitis, Incipient Consumption & all Catarrhalaf- A ſections of the tº Head, Throat and Lungs. Hºrize /or Literature. 0, 0, HOLMAN, Gem'. Agt, La Grangº, Ill. ST, PAUL ARTIFICIAL LIMB HOUSE, 27 E. Seventh Street, INVENTORS AND MANUFACTURERS OF * Artificial Limbs. We are positively the only manufac- turer in the Northwest that does not employ soliciting agents. We are the Doctors’ workmen. We prefer to deal direct with physi- cians, as they know the wants of their patients. . All Surgical Appliances in the line of Orthopedic work done at reasonable prices. We respectfully solicit your patronage. JOHN McGUIRE, MANAGER. Office, 1878-6. Residence, 439-4, xviii THE MEDICAL DIAL. ElBºiſ-Mºdical Allſ Elºiſ-Silgital Instillmºlis, Manuracrur- to BY The Waite & Bartlett Manufacturing Co. 108 E. Twenty-Third St., NEW YORK. Thº Ramſby WimshurstHill. Stăţi, Maſhing Is the most powerful made, therefore, for X-Ray examinations and for a wide range of therapeutic effect, it stands unequalled. Used in the College of Physicians and Surgeons, Society of the New York Hospital, Post-Graduate Medical School and Hospital, Bellevue Medical College and Hospital, Battle Creek Sanitarium, and more by Physicians, Hospitals and Sanitariums than any other. SEND FOR, ILLUSTRATED CATALOGUE. NOYES BROS. & CUTLER, Agents, SAINT PAUL, MIN N N Esota. LEWIS A. MARTIN, CoLFAX IMAINERAL \ºv ATER (Successor to F. J. SALFINGER) A natural Spring Water, Carbonated or Still. WATCHAMAker & JeweleR One of the BEST REMEDIES on the market 704 PHOENIX. But LD 1 NG. FOR cases of CONSTIPATION, Etc. Watches, Clocks and Jewelry Repairing. THE GLEN WOOD-INGLE woo D CO., Clocks Called For and Delivered Free of Charge. N. W. AGENTS, 303 Hennepin Ave., Minneapolis. ‘Did You Ever Sté Anything Like It?” THAE Manhattan Typewriter. QUALITY HIGHEST, PRICE LOWEST. Typewriters Sold, Exchanged, Rented. SUPPLIES FOR ALL TYPEWRITERs. MAxFIELD & Oliver, 17 So. 4TH STREET, Telephone 146-2. MIN NEAPOLIS, MINN. BAZZI-BIAN CHI Pllſ||19||1300|| A Singer Sewing Machine Velvet-Lined case, $4.00. Beware of infringements. THE BEST INVESTMENT ON EARTH, - earning more in proportion to cost than any other purchase possible. THREE DIFFERENT KINDS, either lock-stitch or chain-stitch. BUILT LIKE A WATCH, at the largest and best equipped factory in the world, where every machine is carefully tested All genuine have our name on instru- ment. Buy from your dealer, or, if not in stock, from us direct. § GEORGE P. PILLING & SON, on practical stitching. § §§§ S Sold only by §§§§ - 1229 Callouhill St., Philadelphia, THE SINGER MANUFACTURING COMPANY ºf Sole Agents for U. S. A. THE MEDICAL DIAL. xix. THE ALLISON PHYSICIANS TABLE. 1899 NAODEL. Have you seen it? This style, No. 34, our latest production, surpasses in beauty, convenience and practical utility anything of the kind ever seen. The unique design, compact and harmonious, adjustable stirrups and leg crutches, glass trays in the revolving cabinets, detachable leg rests, the simple and ingenious mechanism—rendering it noiseless in its movements and easy of manipulation—are the secrets of its popularity. It is used in the Post Graduate Schools of New York and Chicago and heartily endorsed by faculty and students—a distinction no other table enjoys. The ALLISON CHAIR has been a leader for years, and is one of the most practical and convenient chairs made. Our COMBINATION CABINET No. 61, As shown in the cut, is a marvel, uniting in a single and handsome article of furtiture an instrument cabinet, aseptic and dust proof, a medicine cabinet with swinging racks for bottles, a writing desk, drawers for bandages, and compartment for wash basin. Our revolving Instrument Cabinets, thoroughly aseptic and proof against dust and dampness, are deservedly popular. The ALLIS0N Wall cabinet is in great demand. Catalogue Free. W. D. ALLISON CO., Manfrs., 133 E. South Street, INDIANAPOLIS, IND. A. C. DICE, Dist. Mingr., 816 Dayton Bidg., Minneapolis. Liquor LITHIUM MAIZENATE. |MAIZO-LITHIUM ------T re--nºrs- Liquor renaisenic. THREE CHLORIDES HENRY's. --------> ---------- ------v- - -a-ºr--- --- ºr-- ----- A genito-urinary sedative, an active diuretic; - - solvent and flush indicated for the relief and pre- An ox *...; ferruginous preparation, vention of renal colic; a sedative in the acute suitable for prolonged treatment of children stages of gonorrhoea, cystitis and tºº. adults and the aged. Indicated in anemia an in dropsical effusions due to enfeebled heart or to bodily weakness, convalescence from acute dis- renal diseases. As a solvent in the varied mani- eases and surgical operations; boys and girls at T- festations of gout, goutiness and neurotic lithemia, the age of puberty, and the climacteric period in periodical migrainous headache, epigastric oppres- sign, cardiac palpitation, irregular, weak or inter- mittent pulse; irritability, moodiness, insomnia and other nervous symptoms of uric-acidemia. Decidedly better, more economical, extensive in ac- tion and definite in results than mineral waters. In LITHEMIA by reason of the neutralizing D - - - power of Lithium in combination with Maizenic acid, the superior diuretic. In RENAL COLIC as a solvent and eliminant - - of uric acid, and prophylac- tic against future attacks. - In as a urine alkalinizer, and on URETHRITIS account of the remarkable se- dative action of corn silk upon inflamed genito- urinary mucous membrane. In OEDEMA resulting from cardiac or a renal dis- ease the pulse becomes regular and strong ; there occurs marked diuresis and increas- ed proportion of urinary solids. women. In children with chorea, rickets or who are backward in development, or in whom there exists an aversion to meats and fats. Prolonged administration never causes “iron headache.” I 11 CONSTIPATION as a ferruginous laxative " " " " " ' " `` tonic it is effective by in- creasing the flow of gastric juice and the bile, exciting normal peristaltic movements. I 11 CH LOROSIS it stimulates the formation of " " "Yº iron-containing elements and removes intestinal auto-intoxication upon which the disease often depends, I 11 of all forms as a chalybeate tonic and ANEMIA carrier of oxygen it Fº digest- ion, aids assimilation of food and increases depos: ition of fat in the tissues; raises bodily vigor and warmth and has a favorable influence on the ner- vous system. A. s Those cases of irritable heart, irregular or in- termittent, pulse so frequently met with by insur- ance examiners and found to be due to excess of uric acid are special indication for Maizo-Lithum. Wascent Chemic Union of Maizenic Acid—from Green Corn Silk—with Lithium, forming Maizenate-Lith- tum. Two grains to drachm. Dose 1 to 2 drachms, 8 oz. bottle, gr.o.o. -------> --------- -n ------------ H. E.N. R.Y. P. H.A.R.M.A.C.A.L. -O. Louisvi L.L.E., KY. AN ADJUVANT for, potassium iodide, the undesirable manifestions known as iodism can be removed. - stimulant to the peptic and hydrochloric glan- dular system of the stomach, especially servicable in the impaired appetite, nauseau, vomiting and other gastric symptoms of alcoholic subjects. Each drachm contains Proto-Chlor. Iron, Agrº, Bi-Chlor. Mercury, I-128 gr, Chloride Arsenic, 1-280 gr, Cali- saya Cordial. Dose 1 to 2 drachms. 12 oz. bottle, $1,00. xx THE MEDICAL DIAL. SYR. HYPOPHOS. CO., FELLOWS Contains the Essential Elements of the Animal Organization—Potash and Lime; The Oxidizing Agents—Iron and Manganese; The Tonies—Quinine and Strychnine ; And the Vitalizing Constituent—Phosphorus; the whole combined in the form of a Syrup with a Slightly Alkaline Reaction. It Differs in Its Effects from all Analogous Preparations; and it possesses the important prop- erties of being pleasant to the taste, easily borne by the Stomach and harmless under prolonged use. It has Gained a Wide Reputation, particularly in the treatment of Pulmonary Tuberculosis, Chronic Bronchitis and other affections of the respiratory organs. It has also been employed with much success in various nervous and debilitating diseases. s: Its Curative Power is largely attributable to its stimulent tonic and nutritive properties, by means of which the energy of the system is recruited. Its Action is Prompt; it stimulates the appetite and the digestion, it promotes assimilation and it enters directiy into the circulation with the food products. The prescribed dose produces a feeling of bouyancy, and retuoves depression and melancholy ; hence the preparation is of great value in the treatment of mental and nervous affections. From the fact, also, that it exerts a double tonic influence and induces a healthy flow of the secretions, its use is indicated in a wide range of diseases. NOTICE—CAUTION. The success of Fellows' Syrup of Hypophosphites has tempted certain persons to offer imitations of it for sale. Mr. Fellows, who has examined samples of several of these, finds that no two of them are identical, and that all of them differ from the original in composition, in freedom from acid reaction, in susceptibility to the effects of oxygen when exposed to light or heat, in the property of retaining the Strychnine in solution, and in the medicinal effects. As these cheap and inefficient substitutes are frequently dispensed instead of the genuine preparation, physicians are earnestly requested, when prescribing the Syrup, to write “Syr. Hypophos. Fellows.” As a further precaution, it is advisable that the Syrup should be ordered in the original bottles; the distinguishing marks which the bottles (and the wrappers surround- ing them) bear, can then be examined, and the genuineness—or otherwise—of the con- tents thereby proved. Medical Letters may be Addressed to: Mr. FELLOWS, 48 Vesey Street, New York. o Mº Dº –THE– MEDICAL DIAL A Monthly Record of Medicine and Surgery. Vol. I. No. 8. MINNEAPOLIS, JULY, 1899. $1.00 per Annum. Single Copies 10c. CONTENTS. ORIGINAL ARTICLES. Diagnosis and Therapeutics of Diph- theria, an Address by L. A. Nip- pert, M. D., Retiring President of the Hennepin County Medical So- ciety . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215 The Physician from the Patient's Standpoint, an Address before the Medical Graduates of Hamline Uni- versity, by William E. Thompson, A. M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220 Extra-Uterine Pregnancy, a Paper read before the Hennepin County Medical Society, by Lester W. Day, M. D. - - - - - - - - - - - - - - - - - - - - - - - - - - - --- EDITORIAL. The Surgical Anatomy of the Gall Ducts . . . . . . . . . . . . . . . . . . . . . . . . . . . .228 The Medical Department of Hamline University REPORTS OF SOCIETIES. Hennepin County Medical Society, the June Meeting American Medical Annual Meeting The Mississippi Valley Medical Asso- ciation, Notice of Fall Meeting . . . .243 PROGRESS OF MEDICINE. - - - - - - - - - - - - - - - - - Association, the Medicine. Seed and Soil of Tuberculosis . . . . . .231 Concerning the Treatment of Con- sumption Obstetries. The Post-Partum Management of Uterine Displacements . . . . . . . . . . . 233 The Early Diagnosis of Pregnancy . .233 Pediatrics. Summer Complaint in Children . . . . . 284 Thigh Friction in Infants . . . . . . . . . . 234 “Isoplik's Buccal Rash in Measles”. .235 Neurology and Psychiatry. A Case of Neuralgia of the Joints . .235 Encephalitis of the Pons in Child- hood. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235 A New Syndrome following a Wound of the Spinal Cord Insanity Defined on the Basis of Dis- ease º A Case of Glioma of the Lower Cer- vical Region of the Spinal Cord . . .237 Clinical Microscopy. The Symptoms of Dumb and True Rabies BOOK NOTICES. Electro - Haemostasis in Operative Surgery, by Alexander J. C. Skene, M. D., L.L. D. . . . . . . . . . . . . . . . . . . . . 240 A Practical Materia Medica for Nurs- es, by Emily A. M. Stoney The Pathology and Treatment of Sex- ual Impotence, by Victor G. Wecki, M. D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240 INDEX MEDICU.S. Being a List of Original Articles ap- pearing in the June Editions of sev- eral Exchanges MISCELLANEOUS. Hour of Birth and Death . . . . . . . . . . 21. ing Power of the Skin . . . . . . . . . . . . 22) The Hamline Medical school com. mencement Exercises . . . . . . . . . . . . . 239 Treatment of Diseases of the con- junctiva . . . . . . . . . . . . . . . . . . . . . . . . . . 241. Notice on the Revision of the U. S. Pharmacopoeia Typographical Errors Edition . . . . . . . . . . . . . . . . . . . . . . . . . . . A New Symptom for the Early Diag- nosis of Pulmonary Tuberculosis .243 Small Pox in the United States . . . .243. Antitoxin Said to Immune for Nine. ty-Six Days PUBLISHERS’ DEPARTMENT. Exhibits at the Thirty-First Annual Meeting of the Minnesota State Medical Society Exhibit of Parke, Davis & Co. . . . . . . - Exhibit of D. Appleton and Company. Exhibit of Fairchild Bros. & Foster. … Exhibit of The H. K. Mulford Co. . . .x Exhibit of The Yawman & Erbe Man- ufacturing Co. . . . . . . . . . . . . . . . . . . . . XI Exhibit of Wm. H. Armstrong & Co.: in the June Exhibit of The Maltine Company ...x. Exhibit of W. D. Allison Co. . . . . . . . º Exhibit of Chas. H. Cirkler . . . . . . . . . - Exhibit of The Oakland Chemical Co. Exhibit of the New York Pharmacal Association, The Arlington Chemi- cal Co., and The Palisade Manufac- turing Co. - Exhibit of Noyes Bros. & Cutler . . . . The Physicians' and Surgeons' Asso- ciation Elºiſ-Medical and Harim-surgital insmans | || |\ . Mar-ur-cººr-º-º-º- E- The Waite & Bartlett Manufacturing Co. 108 E. Twenty-Third St., NEW YORK. - The Hallºy Wimshurst it. Statiº Mathing Is the most powerful made, therefore, for X-Ray examinations and for a wide range of therapeutic effect, it stands unequalled. Used in the College of Physicians and Surgeons, Society of the New York Hospital, Post-Graduate Medical School and Hospital, Bellevue Medical College and Hospital, Battle creek sanitarium, and more by Physicians, Hospitals and Sanitariums than any other. SEND FOR ILLUSTRATED CATALOGUE. THE MEDICAL DIAL. MºINTESH º . . . THE NAME. . . MCIN TO SH IS A GUARANTEE. LOOK AT THIS FROM TEN TO FIFTY PER CENT R EDUCTION. X-Ray Apparatus, STATIC MACHINES, OFFICE TABLE PLATES, PORTABLE BATTERIES, ELECTRODES OF EVERY DESCRIPTION. 521-531 wa bash Ave., cº- I CAGO. our 19th edition catalogue, just issued, contains new Repuced prices, new literature and gives cuts and descriptions of the very newest and *" electro-medical apparatus. This Catalogue will be mailed to physicians upon request, Post PAID, witHour charge. Write for it. - McINIOSH BATTERY AND OPTICAL CO., º ſº |\º GN º | | || ºº: Kºlº º ºğ| § Al Sºlº Wººl Sºlºlº H. 5%. STOCKING. A. B. CHOATE, Counsel. C. L. WRIGHT. Physicials and Slſg001S ASSOſiation, 410, 412 and 414 Temple Court, MINNEAPOLIS, MINN. LONG D.I.S.T.A.N.C.E TELEPHONE 23 15-J. - Bullºtills Maſlº Anywheſt in the United Slalºs, tributed by Subscribers. from imposing upon members. | | | | | || OBJECT.--—We Collect on Yearly Contract at lowest rates. We furnish up-to-date Reports, based on facts, con- We Check the irresponsible ºlºº º sºlº 6.- º & G. s : º º - | º THE MEDICAL DIAL. iii ADoctor: You find the hot weather very exhaustive to your consumptive patients, don't you? Have you ever thought of the reason why? It is simply because the salts of the tissues are wasted in excessive perspiration. How call you restore this waste? By administering quinine, iron, strychnine, man- ganese and all the range of exciting tonics? Not at all. That only increases the difficulty and hastens end. There is but one way to give permanent improvement, and that is to restore the waste to the tissues by administering the hypophosphites of lime and soda, chemically pure. This will not only restore the waste but will also check the most of it by restoring sufficient tone to the tissues to restrain the unnecessary perspiration. By this means you can make this a season of grateful refreshment to those afflicted ones, and, by taking advantage of the freedom from colds which the season brings, start them on the way to permanent recovery. These are clinical facts, not theory. McArthur's Syrup of Hypophosphites is the only one in the market consisting of the chemically pure hypophosphites of lime and soda. -* If there is any special indication for any other medical agent it can easily be added to the prescription. See that you get that which is absolutely pure and genuine; write your prescription thus: SYR. HYPOPHOS. COMP. MCARTHUR : ONE BOTTLE. A large bottle will be sent you free (excepting express charges) if you will send your professional card or letter head. Address, THE McARTHUR HYPO PHOSPHITE CO., ANSONIA, CONN. % º 4. WW) WHEN THE ACTIVE PRINCIPLES § are taken from Cod Liver Oil, only the grease remains, and that is of no more value than other grease. : : The virtue of Cod Liver Oil lies in its curative principles, which are separable from the grease. These active princi- ples (taken from pure, fresh Cod Liver Oil), are employed in the manufacture of HAGEE'S CORDIAL OF COD LIVER OIL with HYPOPHOSPHITES OF LIME AND SODA. Your patients get the grease in the form of palatable food fats. CORD. OL. MORRHUAE COMP. (Hagee) is dispensed in 16-oz. bottles by all druggists. Made only by KATHARMON CHEMICAL CO., St. Louis, Mo. %4 :(ſ| | N|\;º | :ºº ſ § 32-2-2s •2,2,2,2,2,2,2,2,222s2 2s2 2s2 2s •2. tº •2-2-2-2, © .* THE MEDICAL DIAI, º - <> Sº Sº S. N & º sºlºš S Sº X-Rays WITH |\ica Platº's Show these Cardinal Virtues. As used on our static machines, Mica Plates make the most perfect appliance used in X-Ray and Therapeutic work. They are even more reliable than the best Induction coils, rain or shine; produce a perfectly constant discharge of cur- rent: illuminate the highest vacuum tubes (which have the greatest power of penetration) with practically no induction around the tube, thus en- tirely eliminating the possibility of X-Ray burns. The great speed at which they can be run makes it possi- ble to generate sufficient current for all practical purposes, with a compara- tively inexpensive machine. CATALOG ON A PPLICATION R. V. WAGNER & Co., Inc. 308 DEARBORN ST., CHICAGO I HALF-TONE, - - - zinc ETCHING, A wood EngFAVINGº __DESIGNINº. | 295-290 0NEIDA B10CK MiNNEApolls. NOW READY. lſalline WITH CREOSOTE. A number of years ago, when the value of Creosote became fully demonstrated, we began the publication of a formula for the administration of Creosote in Maltine. This formula has been employed successfully by thousands of physicians, and we have been urged over and over again to place such a combination upon the hº in order that a uniform and properly prepared product could be had under all circumstances. • ‘MALTINE with CREOSOTE” is the most eligible and palatable form in which Creosote can be administered. The vehicle—Maltine Plain—is particularly indicated, by reason of its great food and digestive value, in all conditions in which Creosote is so universally employed. lt will give us pleasure to send, prepaid, samples of “IVIALTINE with CREOSOTE’” to any physician in good standing who wishes to satisfy himself of its therapeutic value and elegance. THE MALTINE COMPANY., Eighth Ave., 18th and 19th Sts., BROOKLYN, N Y. sº vi THE MEDICAL DIAL. Sºſnºgº | º - || - || º The Dr. C. E. Sawyer Sanatorium, Marion, Ohio. For the treatment of Chronic Diseases, Cripples and Deformities. Catalogues furnished on application. Correspondence solicited. Visitors welcome. Professional inspection invited. | º -- º L- º - jºjº * … º * - ſº #(º WE HAVE A LINE OF * * | * © Flº Vehicles * FOR PHYSICIANS USE. º 㺠S. º S. 2. Our Agents are our Vehicles in service. The Users are our Gé friends. They preach the merits of our work, because they tell the : truth. Upon request, we send the addresses of a large number of ſº Medical men, Business men and Livery men of the Twin Cities º and surrounding Towns, who are using our work, and their kind Sº words of praise about its Quality, Style and Wear. - - - (U& arc Iſlanufacturers. §§ º H - A. M U C K L E M FG. CO., i º Minnesota Transfer, with ten º §º *::::::: great § Vehicle Plant, all on the Inter- - S. 2. urban Electric street car line. St - Pau | º M 117 Iºn. s: - - - E-ZººZººZººZººZººZººZººZºº. º ######}}{{º}}:{{º}}:{{5}: º - © * ić º º jº THE MEDICAL DIAL. º * § +: 3. HAM LINE UNIVERSITY DEFARTN/ ENT OF NM EDIC IN E. (MIN NEAPOLIS COLLEGE OF PHYSICIANS AND SURGEON.S.) 7th Street and 6th Avenue South, MINNEAPOLIS, MINN. The eighteenth annual session of the College will open Qctober 2, 1899, and continue eight and a half months. The course of instruction is divided into a four-years fully graduated, curriculum. Graduates in science and arts, and students from other recognized medical schools, may take advanced standing. All laboratories are newly equipped with the best apparatus. gº The hospital facilities are the best in the Northwest. All branches are taught practically, clinical and bedside instruction given in all the hospitals of both the Twith Cities. • --- Geo. H. Bridgman, D. D., President. Ileo M. Crafts, B. L., M. D., Dean, Professor Of Nervous Diseases. J. T. Moore, M. D., C. M., M. C. P. S., Professor of Theory and Practice Of Medicine. Edwin Phillips, M. D., Professor Of Gynaecology. W. J. Byrnes, M. D., Professor of Surgical Anatomy and Clinical Gynaecology. Columbus G. Slagle, M. D., Professor of Paediatrics. Herbert E. Cary, B. A., M. D., Associate Professor of Gynaecol- Ogy. J. W. MacDonald, M. D., F. R. C. S. E., Professor of the Practice of Sur- gery and Clinical Surgery. William H. Hallowell, M. D., IProfessor of Obstetrics. William G. W. Tupper, M. D., IProfessor of Therapeutics. Hugh N. McDonald, M. D., Professor of Diseases of the Chest. C. K. Bartlett, M. D., Professor of Psychological cine. George C. Barton, M. D., I?rofessor of Physiology and Clini- cal Gynaecology. A. F. Irwin, M. D., Ph. D., Professor of Pathology and Bac- teriology. David Owen Thomas, B. A., M. D., M. R. C. S., I’rofessor of Dermatology and Gen- ito-Urinary Diseases. Charles J. Spratt, M. D., I’rofessor of Ophthalmology and Otology. Medi- FA C U L-T Y. — Charles W. Williams, M. D., Professor Of Materia Medica. J. D. Simpson, M. D., Professor of Clinical Ophthalmolo- gy and Otology. Knut Hoegh, M. D., I’rofessor of the Principles of Sur- gery and Clinical Surgery. Charles W. Drew, Ph. B., M. D., I’rofessor of Chemistry and Toxi- COlogy. Henry J. O’Brien, M. D., I’rofessor of Clinical Surgery. Charles E. Smith, M. D., IPTOfessor Of Clinical Med cine. Iºd Ward Boeckmann, M. D., Professor of Clinical Ophthalmol- Ogy. Anton Shimonek, M. D., Professor of Clinical Gynaecology. C. A. McCollom, M. D., I’rofessor of Preventive and Legal Medicine and Medical Insurance. Norman Dreisbach, M. D., I’rofessor of Anatomy. William Glenn, M. D., Professor of Physical and Clinical Medicine. OTHER INSTIRUCTORS. I”. M. Holl, M. D., Clinical Professor of Paediatrics. F. B. Kremer, D. D. S., Lecturer on Dental Pathology and Therapeutics. M. C. Johnston, M. D., Assistant Professor of Pathology. Arnold Schwyzer, M. D., Clinical Professor of Pathology. Gustav A. Renz, B. S., M. D., Ph. D., Clinical Professor of Genito-Uri- nary Diseases. Diagnosis For Catalogue and Information Address, LEO M. CRAFTS, M. D., Dean, 606 Masonic Temple, Minneapolis, Minn. Joseph W. Bettingen, M. D., Clinical Professor of Diseases of the Nose, Throat and Ear. Charles J. Meade, M. D., ASSOciate Professor Medicine. $ Charles F. Denny, M. D., Instructor in Clinical Medicine. J. Frank Corbett, B. S., M. D., Assistant Professor of Bacteriolo- gy and Curator of the Museums. Edgar M. Dunn, B. A., Assistant Professor of Chemistry. Will'am B. Murphy, M. D., Demonstrator of Anatomy and In- structor in Clinical Chemistry. Frederick Leavitt, M. D., Instructor in Clinical Obstetrics. F. A. Knights, M. D., Assistant Professor of Histology and Embryology. R. M. Peters, M. D., Demonstrator of Anatomy and In- Structor in Medicine. C. A. Donaldson, M. D., Assistant Demonstrator of Anato- Dhy. C. H. Bradley, M. D., Instructor in Clinical Obstetrics. UNIVERSITY SCHOLARS ASSISTING IN LABORATORY INSTRUCTION. R. M. Burlingame, In Therapeutics. A. G. Chadbourne, Ph. B., In Histology and Embryology. G. M. F. Rogers, In Bacteriology, Edward A. Rich, Ph. B., In Histology and Embryology. Of Chinical * zº.# : .* : s & & & s THE NAEDICAL DIAL. ammunition. NATURE'S FORTRESS is the stomach: the human organism's power of disease resistance and recuperation depend upon its normal, unimpaired physiologic functions Gray's GlycerineTonic Comp. is impaired nature’s armament and It restores and : : KEEPS THE STOMACH RIGHT NATURE DOES THE REST in malnutrition, anaemia, convalescence and all chronic conditions associated with depraved vitality THE PURDUE FREDERICK CO. No. 15 Murray Street, New York The Hollem Portable A= Hygienic Bath. Made on Strictly $999333333333333333333% Scientific Princi- § *A e ples a n d Fully Å Guaranteed. There has never been an accident with our Bath, and one is impossible. If With the he at shut off it becomes a perfect cooling room, avoiding any shock to the sys- tem by contact with the outside cold air. Unlike all other NS baths, ours has an āś WSºo Y adjustable cover, aeeeeeeeeeeeeeeeeeeeees which can be washed clean each week if desired, thus preventing the gathering of disease germs and microbes. Our strongest testimonials are from the leading Min- neapolis physicians. s &% Irº Rºº-º-º: §: |. &zzzzzzzz º-------- • tºº Free Bath book. Call or address THE SANITARY MFG. CO., 406 Phoenix Building, MIN NEAPOLIS, MINN. THE SANATORIUM, HUDSON, WIS. § ºf: º/8-" º º lº ſ §§ º º. º t §§ * §º.º. *iºc & * : * ğ É ºft º * $º. * * & ſº !" º, *:::: - - M º º º & §§ ſºft ºf Nº. Z º - §: * A \, \! V º, §§§ E º 's- " " - º' . . : tº ####|Tilºlºº § º º # gº 5 ; ; sº §f 1. § s ſ . *R*-ºſ.º. Bºº º º º & ſ º: \!. *|s|≤5. Pºša § ºf º ſº- F- sº U HTº º,”, . º *SE; |ſº ºf º ſº & 3 º º Sºś#. *"..." . . ." § º º ††† A. jº º º: § ::::: Jº ºśº lºſiºlº º: 5. # # = lf º *Nº ºt -> - * * * & º - Élſº º $º3. º: aſſº's "… Eº: *~ -º-dºº" AN INSTITUTION FOR THE SCIENTIFIC TREATMENT OF NON - CONTAGIOUS DISEASES. SºğSºSºftSºSºftSºSºftSºftSºSºSºftSºftSºSºftSºlº Every Appliance and Method used which is recognized in Legitimate Medicine, including : §: Turkish, Roman, Electric, Medicated and Thermal $3 § Baths—also every form of Electricity, as well as § Massage and Swedish Movements, etc. All under §§ § the supervision of Experienced Physicians and § §: Trained Nurses. * * * § : : Sº Sø º #aaaaaaassesses assassassississiº . The institution is delightfully located, with a long, wide veranda, inclosed in the winter season in glass, and is equipped with mod- ern conveniences, as Elevator, Electric Light and Electric Bells, Large Parlors. For terms, address THE SANATO RI U M. *** * THE MEDICAL DIAL ** *- A Monthly Record of Medicine and Surgery. Vo 1. I. MINNEAPOLIS, JULY, 1899. No. 8. Original HrticleS. DIAGNOSIS AND THERAPEU- TICS OF DIPHTHERIA. An Address Delivered Before the Hennepin County Medical Society, By L. A. NIPPERT, M. D., Retiring President. Ladies and Gentlemen of the Society: “Doctors don’t recognize smallpox when they see them,” read the sensational headlines of a morning paper in Cincinnati some years ago. The case occurred in a ladies’ school and was diagnosed as purpura hemorrhagica until the development of smallpox among the stu- dents revealed the true nature of the disease. There are, unfortunately, today many phy- sicians who are unable to promptly diagnose diphtheria, even though the throats of their patients show a clinically characteristic diph- theria. As the writer counts himself among their number he desires to -bring this subject before the society for discussion, and hopes to benefit by the opinion of others who have had greater opportunities to observe this scourge of mankind. An early diagnosis of any illness is desira- ble and necessary for rational treatment. The earliest possible recognition of diplitheria is imperative since serum treatment has been ac- cepted as the specific which operates most suc- cessfully when used timely. At the present date the diagnosis of diphtheria is based on the presence of the K. L. bacillus, together with clinical evidence of a general infection of the System and a local affection, catarrhal or mem- braneous, of the mucous surfaces of the mouth, throat, mose or larynx. The existence of the latter without characteristic micro-organisms eXcludes diphtheria, the presence of the for- mer without other evidence of a pathological process affecting the system cannot constitute a disease. The conditions for diagnosis being so simple why should there be difficulty in rec- ognizing true diphtheria at once. A. BACTERIOLOGICAL DIA GTNOSIS. 1. The characteristic bacilli may not be found, as they not infrequently disappear even after a few days, or they may not have involved as yet the regions from which a smear can be taken, as in primary laryngeal cases. 2. There are other bacilli, which in appear- ance, manner of staining and grouping, resem- ble the true K. L. bacillus to such a degree that even the most experienced observers cannot distinguish one from the other, and these psuedo-diphtheria bacilli are constantly found in the throats of healthy persons. Testing their virulence is the only known method of diſferentiation. But does death to the guinea pig always mean virulence in the human be- ing? I believe this is still an open question. 3. The specimen obtained may contain a large number of other bacilli or cocci, the growth of which obscure or obliterate the de- velopment of the K. L. bacillus. 4. Germicides employed may have disinte- grated the bacilli beyond recognition. Thus our bacteriological examination may give negative results and yet diphtheria exist or the bacillus found is to all appearances the true K. L. Organism and yet lacks virulence. Evidently bacteriology alone should not be the only factor to be relied upon as determining the nature of the disease. B. WHAT CAN CLINICAL EVIDENCES TEACH US 2 Diphtheria prevalent or present in the neighborhood, a history of exposure, the pa. tient a child between two and twelve years of age, taken sick with moderate fever; anorexia, Vomiting, Sore throat and swelling of the sub- maxillary glands are suspicious. Albumin in the urine, the appearance of a patch on a mu- 3: * º , g: $. 3. ; º ā- s:'s g * 316 *. THE MEDICAL DIAL. cous membrane, rather adherent, leaving a bleeding surface if detached, with irritating discharge from one nostril justifies the provis- ional diagnosis of diphtheria. The spreading of this membrane to fauces and uvula, the de- velopment of increasing laryngeal stenosis, marked prostration and progressive anemia fortifies our opinion, and yet we may be mis- taken unless the occurrence of paralysis of pal- ate or heart, or later voluntary muscle groups renders our diagnosis indisputable. None of the above mentioned symptoms except the last one are pathognomonic. The appearance of the membrane, its man- ner of extension and firmness of adhesion to the adjacent structures have been considered as clinically the most characteristic signs of the disease and we will therefore consider the affections which may produce a similar ap- pearance. 1. Membranous angina, with meshy exu- dation easily detached from an inflamed but not raw, bleeding surface. 2. The pultaceous deposit frequently seen in the first week of Scarlet fever. 3. IIerpetic tonsillitis, commencing as small vesicles which rupture, coalesce and form a yellowish covering of the tonsils. 4. Confluent aphthae of pharynx palate and buccal surface. 5. Ulcerations of pharynx with fibrinous deposits upon them from syphilis or tubercu- losis have been mistaken for diphtheria. 6. Trauma of the tonsils may result in the formation of a membrane upon the injured sur- face. Excepting in the last named all the constitutional symptoms, barring albuminuria, also adenitis, as in true diphtheria, may be present. The history of trauma of syphilis and tu- berculosis and in the latter two, the membrane being below the level of the surrounding swol- len mucous membrane, make diagnosis not dif- ficult. Aphthae are readily recognized if seen at first or if noticed upon the tongue. After confluence the microscope shows the charac- teristic spores. At the outset herpetic ton- silitis and pharyngitis show separate vesicles, at a later stage it may be impossible to dis- tinguish them from membraneous angina. The presence of scarlet fever generally ex- cludes true diphtheria during the first week. A membranous deposit occurring later in the course of the disease is to be considered as diphtheritic. The question of making a diag- nosis between membranous sore throat and diphtheria on the strength of the appearance of the diphtheria is best disposed of by quot- ing Northrup and Bovaird in Sajous’ Annual, in which they state: “It is evident that it is at times perfectly impossible to distinguish the one from the other by simple inspection,” nor I may add, by macroscopocial and microscopi- cal examination of the exudate. Clinical his- tory and observation alone are therefore not always sufficient to establish an indisputable and early diagnosis, yet, in the great majority of cases in which clinical signs show diph- theria, the K. L. bacillus is found and the diag- nosis confirmed. In those cases, and they are not infrequent, in which the positive result of bacteriological examination is at variance with the clinical symptoms and appearances as in so-called catarrhal diphtheria, repeated bacteriological examinations and tests of Viru- lence should be made before the case is pro- nounced and reported (I do not say treated) as diphtheria. On the contrary with negative bacteriological results and characteristic clini- cal symptoms the patient should be considered as suspicious until repeated examinations fail to discover the bacilli. Few general practitioners are in position to make their own bacteriological examina- tions and cultures and still less animal tests. Recognizing the importance of timely diag- nosis, not only in the interest of the patient, but to the community at large, most of the large cities of this country have established municipal laboratories for bacteriological work for the purpose of examining specimens sent. Our city also has a well conducted lab- oratory and the writer takes this opportunity to commend the promptness with which he receives his reports. In this connection it will perhaps not be amiss to call the attention of the society to, and possibly through it the con- sideration of the Department of Health, of some defects in the systems of collecting the smears and the manner of report of the result of the examinations made. 1. The boxes containing the smears are only obtainable at the laboratory or health office. They are not transmissible by mail, and as an express office is not always near by, nor a messenger at hand, and the physician f t * ...: * * * * "r ; : *k, 4. * THE MEDICAL DIAL. 217 himself being unable to adjust his time to de- liver the box at the laboratory at the proper hour, much unnecessary delay is involved. Would it not be an easy matter to have an ar- rangement with the proprietors of drug stores in different districts so that the boxes could be obtained and left there. The health inspector of the district can collect them at certain hours. 2. The notification from the laboratory to the physician should not be by telephone only, but also by a written note or printed blank (such as for example is used by the university) and signed by the examiner. Its value would be greatly increased by stating other bacilli or COcci found in the smear. 3. The card which the physician is re- quired to fill out should, after name, address, etc., of patient, give the diagnosis of the at- tendant and be signed by him, and below his signature the bacteriological diagnosis of the laboratory given. Such an arrangement would be of great value in statistics and re- lieve the practitioner of taking the responsi- bility of the bacteriological diagnosis upon his Own shoulders. THERAPEUTICS. A correct diagnosis to be verified by a post- mortem examination is not the ultimate pur- pose of the practice of the healing art. After all, the successful treatment of the patient, whose life is entrusted to his skill, is the crucial test of the physician’s ability. In these days of brilliant achievements of the labora- tory, With new discoveries of methods of in- Vestigation and treatment, the opening of un- dreamed of spheres of possibilities may lead us to greater enthusiasm, and through it to less critical readiness to accept as facts, ex- periments the results of which have not yet stood the test of time, and induce us to neglect the attention to the hygiene, nursing and feed- ing of Our patient, the skillful management of which will frequently turn the tide in his favor. The Italian saying: “Dove non va il sole va il medico” (where the sun does not go, the physician goes), expresses the popular and cor- rect appreciation of the stimulating and dis- infecting power of the sunlight. The sick room should be bright, airy and isolated, freed from all unnecessary draperies and furniture. A temperature of 70 degrees is agreeable to patient and attendant. Steam generated by a small boiler keeping the atmos- phere moist will help to decrease the discom- fort caused by dryness and obstruction of the respiratory passages. At night a candle is preferable to gas or lamp light, which con- sumes more oxygen. Sponging the body with alcohol and rubbing afterwards, reduces fever, stimulates cutaneous circulation and allays nervous irritation. Water should be admin- istered freely. The addition of lemon juice is agreeable and useful. The crowding of several patients into the same room should be avoided, as it renders the air more impure and may be the cause of re- infection of the convalescents by those in which the disease is active. For cleansing of nose and throat soft cloths, which should be burned after use, are to be employed. Flush- ing of the air passages by gargling, spraying or syringing with normal salt solution re- moves shreds of membranes and stimulates the mucous surfaces. Hot Water Compresses add greatly in relieving the pain from Swollen lymphatic glands. Of greatest importance is the feeding of septic patients who have repugnance to food. Milk, raw, boiled or peptonized, if not well borne by the stomach, whey, meat broths, or one of my favored preparations—a cold water extract of beef with a little brandy in it—the different meat preparations and milk substi- tutes on the market, offer a bill of fare from which one can select according to the tastes and conditions of digestion of the sick. If food is absolutely refused gavage (introducing the tube through mouth or nose) may have to be resorted to. Persistent vomiting necessi- tates rectal feeding. In few diseases a greater variety of medi- cines have been used, demonstrating the in- effectiveness of most of them. Innumerable specific treatments have been recommended, to be found valueless in other hands than those of their appraisers. The writer will not at- tempt their tedious enumeration but desires to briefly mention old standbys which have been of value in his experience. They are few. Al- ways at the beginning, and if required during the course of the disease, I administer calomel in one-tenth grain doses until mild catharsis is induced. It stimulates the kidneys and has slightly disinfecting qualities. It is followed by small doses of bichloride of mercury given frequently for four or five days, which causes *A* ºr & * sº * § §§ s’ “s & Å. , - *:::: 㺠Sºl I HE NAEDICAL DIAL • ?: ' . . :*. * t wº. * sº & ſº º, * * ** *; tº * # * * g :* , º, s s ğ.§ º i. º * ** chloride solution one to one thousand, or a so- ‘’’. ‘ * an increased secretion of the mucous glands, lution of boracic acid, is particularly helpful , thereby washing out the cryptae and recesses of the mucous membrane and assisting to loos- en existing membrane, removing bacteria and possibly resisting their growth by the germi- cidal qualities of the drug. As soon as exten- sion of the membrane ceases the remedy is dis- continued. About this time, the depression of the circulation, incident to the disease, will re. guire the administration of heart stimulants. Strychnia and digitalis, with preference for the former, are given. If symptoms of actual heart weakness occur alcohol in some form is used liberally. I believe alcohol to be the most powerful antidote which we possess in cases of septicaemia and it is surprising what quantities even the teetotaller, if septic, can consume without other effect than increased strength of heart action. In the form of wine, whiskey or brandy it is certainly an agreeable medicine and easily given to children. As anaemia begins to show, the administra- tion of iron is indicated. The Tr. ferri chloridi seems to be the choice of the majority of physi- cians; my preferences are the pyrophosphate and tartrate, preparations which are less ob- jectionable to taste, readily assimilated and are not so prone to disturb digestion. Local applications are year by year regarded as more harmful than useful in proportion to the amount of constraint necessary to apply them. If used in children who have to be held by force, they are never applied thoroughly and Cause excitement and fear which act as de- preSSants on the heart. In older children and adults a more thorough swabbing of the throat can be carried out. While as a rule the physi- cian should be sufficiently painstaking and educated to compose his prescriptions to suit the individual case, yet there are many val- uable formulae in the market. Among these is Löffler’s solution. A swab of absorbent cot. ton, the latter tied to a stick, is dipped into this solution, the excess removed, and the SWab firmly pressed against the exudate four to six times daily. As this preparation is somewhat styptic, some patients object. In these a bichloride solution of one to five thousand should be used. After use the swab is burned. Gargles of tr. myrrh or tr. cap. sic., in water or a solution of potass, chlorat., are of value in keeping the unaffected parts of mucous membrane clean. Syringing with bi- in nasal complications. Symptoms of croup are relieved by intro- ducing steam under a tent, built over the pa- tient. Advancing stenosis of the larynx, pre- venting full inflation of the lungs, as indicated by anxious look, whispered voice, feeble or ab- sent breathing over posterior lobes of the lungs, and by retraction of the epigastrium on inspiration, demands relief by intubation. This operation, which is not a difficult one, should be the property of the general practi- tioner, as it may be necessary to perform it at Once to save life. Although extension of the membrane into the bronchi or profound sepsis may render the case hopeless, yet the wonder- ful relief given by the introduction of the tube justifies its use even in extreme cases. The Writer at one time intubated a child, apparent- ly moribund, and only at the urgent request of the mother, resulting in the recovery of his patient. Among thirty-five to forty intuba- tions he has had no untoward results from the Operation except the swallowing of the tube in two cases. In each case the tube was passed three or four days afterwards. “Gentlemen look more to nature and less to Germany,” was the exclamation of an old doc- tor of the old school during one of his flights of oratory in a hospital lecture room in my stu- dent days. This protest against the tendency to let theory alone govern treatment was un- Cloubtedly a timely one. Yet had he lived to see the results of antitoxin treatment in diph- theria, as witnessed by the majority of us, he Would have added, “but in diphtheria assist nature by the use of the serum from Ger- many.” In August, 1896, the author for the first time used the serum. Until January 1, 1899, he treated sixty-eight cases, all verified by bacteriological examination or by the subse- quent development of other cases in the same family. In fifty-eight patients antitoxin was injected, among these two deaths, one a child seven years old, crippled since birth (probably an insufficient dosage was used), the other a young man, sick four days and thoroughly Septic before being seen, therefore not a case in Which serum treatment could be used with any expeciation of success. Of the ten not in- jected, five were adults, three were children THE NAEDICAL DIAL, with a very light form of the disease, and the other two were children suffering from a se- were form. In these latter two, who died, the parents objected to the remedy. In both fam- ilies there have been other cases (one laryn- geal) of diphtheria, and antitoxin was used with prompt recovery. It seems to be one of the disadvantages of the success of Serum treatment to create the impression among the ignorant that diphtheria is not a serious dis- £3 Sé. Without waiting for the report from the laboratory, a patient presenting symptoms of probable diphtheria should be injected at once. It is an established fact that the earlier the serum is used the greater its effect in con- trolling the disease. The initial dose of severe attacks should be one thousand units for chil- dren above three years of age, for laryngeal cases two thousand units, but in younger chil- dren and lighter forms of diphtheria half the dose is sufficient. Should there be no im- provement as shown by fall of temperature, decrease of pulse rate, disappearance of stupor and general better condition of the patient, with cessation of extension of the membrane within eighteen to twenty hours, a second in- jection should be given. The mammary region, abdomen, thighs and subscapular are selected as sites for puncture. My preference is the latter. With the patient turned on his face he can be controlled readily, cannot see the approach of the needle and the skin is not so sensitive as on the abdomen or thigh. As a matter of course the needle and syringe should be sterile and the point of in- jection rendered aseptic. With the exception of cutaneous manifestations, as erythema and urticaria, ill effects from antitoxin injection are rare and the cases of sudden death re- ported to have resulted from its use have not been proven to have been due to the antitoxin itself. They were caused probably by the methods of administration or the action of pre- servatives added to the serum. If chloroform were the only anaesthetic we possess would we deprive ourselves of its benefits because of oc- casional mishaps? I think not. Although the number of cases of diph- theria treated by the writer with antitoxin is but small, yet the recovery of fifty-seven cases out of fifty-eight, not selected, tonsilar, nasal and laryngeal, is a result which no other method of treatment has accomplished in his experience. As Bagnisky states it, “What I See I believe,” and I have seen patients suffer- ing from severe attacks of diphtheria recover so promptly after the use of antitoxin that I would have doubted the correctness of my diagnosis had it not been for the confirmation from the laboratory. And this experience is the same the world over and is recorded by men of almost unlimited opportunities of ob- servation, men known for their cautiousness, Conservatism and judgment. I am therefore convinced that in antitoxin we have a true Specific for diphtheria. Let us hope that the persevering researches and experiments to Which hundreds, yes thousands of earnest workers devote their lives, will result in the development of other specifics which will dull the sting of death in many a disease. HOUR OF BIRTEI AND OF DEATH. From an analysis of 36,515 births and 25,474 deaths, in which the time of day was accurate- ly noted, Dr. Rasovi (Klinischtherap. Wochen- Schrift, No. 43, 1898) concludes that the maxi- mum number of deaths occurs during the after- noon hours (between two and seven o’clock), and the minimum in the hours before midnight. The time of the maximum number of deaths corresponds to the hours during which, in the healthy person, the pulse frequency and the body temperature are at their height. He at- tributes the fact that the maximum number of births takes place in the early morning hours to tWO causes: (1) During these hours the accumulation of CO2 in the body reaches its height, because oxidation takes place slowly, and under the influence of bed-rest and warmth the CO, is slowly eliminated; and as a result of the diminished blood pressure at this time there is an accumulation of CO, in the uterine venous plexus. (2) The inhibitory action of the cerebral and spinal centers on the sympa- thetic system is less marked at night, so that the impulses of the latter are expended with greater effect. The inhibitory power of the central nervous system is at its height during the early afternoon hours, or at the time when births are least frequent. The writer also claims that the early morning frequency of asthmatic and epileptic attacks may be ascrib- ed to the diminished inhibitory action upon the sympathetic system at this time. The state of Texas is soon to have an epi- leptic asylum at Abilene, the last legislature having passed a bill to that effect. The same legislature also ordered an appropriation to greatly increase the capacity of the insane asylum. THE MEDICAL DIAL. THE PHYSICIAN FROM THE PATIENT'S STANDPOINT. An Address Delivered at the Graduating Exercises of the Medical Department of Hamline University, June 5, 1899, By WILLIAM E. THOMPSON, A. M., Professor of Latin Language and Literature. The medical students who are SOOn to re- ceive their diplomas have doubtless heard all the technical advice during their four years' course which they care to absorb. They have submitted to quiz after quiz from the various members of the medical faculty until they are Christian Scientists to the extent they are willing to try absent treat- ment for a while at least. It Will probably take the next twenty years for you to assimilate what you have not rejected and forgotten. So you will not be bored to- night by me with anything from a professional standpoint. Perhaps, however, you might be willing to submit to a snap shot or two of your learned and much instructed selves from the point of view of a prospective patient. No one knows better than yourselves that the day of short and superficial preparation has gone, and that a man who practices the healing art now must take something a good deal stiffer than two six months’ courses in lec- ture-room and laboratory and a short time in a practicing physician’s office. The man who is hunting for a snap is woefully mistaken, if he expects to find it in the courses of a reputa- ble medical college of any old and well-estab- lished school. Your alma mater and its sister across the river have foot by foot raised the bars until the requirements are now such that the advocates of short and easy methods are beginning to talk about a medical trust. They feel like the boy who was told by his father that mother and he had decided that their young hopeful needed a local application of birch-bark, a posteriori, to correct a very evideut derange- ment of the young man’s moral liver. The pre- cocious degenerate, fully inoculated with the virus of the anti-trust environment of the pres- ent hour, bitterly exclaimed, “Yes, you and maw always agrees when it Colmes to licking me. You and maw’s the whole thing. I don’t never have no show. This family's run by a ^. trust.” Whereupon the head of the trust be- gan to monopolize the anxious attention of the impertinent youth to the tune of several re- sounding Whacks. * Now, from the standpoint of the patient, whatever his opinion about other combina- tions, the medical trust (so-called) in Minne- Sota is doing an eminently proper thing in raising the standard of qualifications demand- ed of those aspiring to the vocation of a phy- sician, both when they enter and when they are graduated. The health of the patient is his capital and his life. Therefore any addition to the thoroughness of a young doctor’s preparation is a guarantee that he will be better fitted to care for the physical and mental welfare of the public for whose sanitary soundness he has become responsible. Young men who have dedicated their lives to the healing art are appreciating this fact and flocking to those schools where the stand- ard is high. They are actuated by at least two motives. They feel as the colored boy did who joined a mission school in the South, the need of adaptation to environment. As he very aptly, and picturesquely put it, his rea- son for Wanting a thorough education was, “Dis chile is dorgoned tired of wearing a two-dollar hat on a ten-cent head.” Now the courses that the medical college of Hamline University has laid down are not adapted to heads contented to remain ten-cent heads, and the medical profession is the last one for ten- Cent headed men to enter. But another reason for the young medic's longing for a sound and complete medical training is the very laudable ambition which he entertains of reaching a high place in his profession. He knows that the room at the top is more and more to be occupied by thor. oughly equipped students of the medical art. He does not expect to reach the dizzy altitude of that eminent specialist satirized in a late number of the Chicago Tribune. He had per- formed an operation for appendicitis. A med. ical student asked him if the operation was successful and received this reply: “No! We did not find any vermiform appendix and the patient recovered.” The ambitious young doc- tor would like to see his name in later years among such immortals as Jenner, Harvey, Morton, and Lister. ge ºf & ‘. g THE NAEDICAL DIAL. You want to realize, young doctors, that no one can be more intensely interested in your solemn and learned selves than the patient whose acquaintance you are so impatient to make. He is not waiting as impatiently for you as you are for him. But he demands cer- tain qualifications from the physician whom he is going to employ. Now, your patient is not always so unreasonable as you have been led sometimes to believe. He does not expect you to know it all at the start, and there is one kind of a young doctor that the patient has no earthly use for whatever i. e.—the one who knows it all de novo. If any neophyte at the shrine of Galen and Hippocrates starts in With too much of the “I am Sir Oracle” Smirk upon his visage, he will soon be without a case. This remark leads me to the first qualifica- tion which the patient asks from his physician: viz. modesty. I do not mean by modesty awk- ward bashfulness or “Uriah Heep” humility. I mean simply that unassuming confidence in one's ability which goes quietly along with its work without sounding a trumpet at every street corner or covering with advertisements the fences from Minneapolis to St. Paul. “Good wine needs no bush.” The genuinely competent physician is sooner or later found out and in demand. Modest worth may not al- ways find recognition; but in the long run pa- tients would rather trust themselves and their friends to the care of the man whose preten- tions are not too extravagant than rely upon the much-vaunted skill Of some Bombastes Furioso tramping about the country and mak. ing wonderful cures. The second quality which the patient ex- pects to find in his doctor is gentleness. This is closely connected with the first quality of modesty. I know that there have been many successful physicians, so far as professional emolument and ſame are concerned, who have seemed and often been really rough and boor- ish. But their success was due not to this Quality, but in spite of it; because they had other redeeming traits. There were a good many surgeons in the Civil War who had this reputation. When they came back to their home practice this trait seemed to stick by them; but how often have we heard patients say, “If Dr. N. were as gentle as he is skilful I should want him every time that I employed a physician, and not in extreme cases only.” ..” The doctor needs to have the same qualities which he insists upon in his nurses. If there is any quality which a patient appreciates more highly than any other in nurse or doctor it is tenderness. Of course this quality can be found only in a man of a naturally sympathetic heart. True tenderness and sympathy are never incomsistent with genuine manliness. “Drave as a lion and tender as a woman” has passed into a proverb with us. Sir Philip Sidney was no fitter, no nobler incarnation of those qualities than William McClure or many an unknown country or city doctor. Tact is another qualification which the pa- tient requires. If any one needs to be all things to all men in the true sense of the term it is the physician. He comes in daily contact with all classes, ages, conditions, and trades. He must know the best methods of approach to a thousand different persons often in a single year, even where he may not have pro- fessionally treated a hundred. Happy is the man who is born with a good deal of it. He needs to have his medicine-case full of it; but even a moderate amount may be vastly in- creased by cultivation. No man has more oc- casions on which he has to employ it, unless it be the teacher and the preacher. How often we hear it said of some bumptious young or even old doctor, “What a pity so bright a fel- low did not have a little more of the Savoir faire, the art of approaching people.” Of course tact, a proper self-repression, and discretion are three branches of that quality which has its trunk and roots in what we des- ignate by the homely Yankee phrase level- headedness. If ever a man needs to have equi- poise of all his powers, it is the physician; for in his hands often are the issues of life and death. An instant of self-demoralization or forgetfulness may cost him his professional reputation, and bring needless sorrow to a wide circle of his own and the patient's friends. The patient asks also from his medical ad- viser cheerfulness and hopefulness. Of course the young medic just beginning practice has many natural anxieties and perplexities to harass him. All of these for his own sake, as well as that of his patient, he must relegate to the rear, when he enters the sick-room. Like the pious Aeneas he must press his cares deep down in his breast and feign hope with his countenance. A merry laugh or a cheerful 221 *, ** 3. * s •. 3. §º: ‘–1. *** * -: § - 2) ºx, s: **. * * * + ~~ ~ *, + ** .* Smile often does more good than all the drugs of the pharmacopoeia. To have a genially radi- ant face one must have a sweet and Sunny dis- position. Serenity of soul gives this and se- renity of soul can be cultivated as well as any other virtue by a steadfast looking on the bright side of things. The doctor often preaches that doctrine to his patient. Let him take stiff doses of his own medicine of that kind, well-shaken, as often at least as every hour. That kind of treatment will often do as much good to a care-worn doctor as to the sick patient. It ought to do more sometimes. Ah! What a light seems to shine through the hospital as the sunny-souled and bright-faced doctor goes through his ward with a cheery word for each sick one, and how the patients feel toward him as the soldiers in the Crimean hospitals did about Florence Nightingale’s shadow, as though they would kiss it as she passed that way. Another quality which the normal patient asks for in his physician is sincerity. This is not inconsistent With what has been said be- fore about tact and cheerfulness. I do not mean by this that the patient expects to be told all that the physician thinks about his particular case or that of any other person. But he does Want to feel that he can trust his medical adviser as a genuine man in whose hands his case will receive fair and honest at- tention. He believes in a man who has strong convictions as to the merits of the particular school of medicine whose principles he has espoused and who will not change his treat- ment to suit the momentary caprice of a sick man. The normal patient hates nothing worse than Shams and mongrels, and when he has made up his mind as to the merits of a partic- ular School he expects that the man who is treating him according to the principles of that school is true to his medical belief. The pa. tient Who is seeking for such a man sticks to him. When he finds him. The true doctor must therefore be a true man in the broadest sense of the term, true to his patient, true to his principles, true to society, true to his own fam- ily, true to himself. The reasonable patient also asks of his doc- tor that he be a progressive man. We hear a good deal now about being strictly up-to-date. That does not mean that one should be ever- lastingly agog for the latest fad or freak. It THE MEDICAL DIAL. means simply that one should be conservative. ly progressive. He has to keep in touch through his medical journals with the latest well-authenticated discoveries and remedies in his chosen field. He has to be well-read also in matters of general interest and importance. He has all the time, while adding to his medi- cal knowledge and experience, to say to him- self and act as though he thoroughly believed it: “Be not the first by whom the new is tried, Nor yet the last to lay the old aside.” But if we should say nothing more than what the patient expects from his doctor, you might well think that this seems like all give and no take as far as the physician is con- cerned. It is all right for doctors to give medi- cines and advice, but when it comes to making all the concessions without any return, why, that is a different thing. Well! the doctor has his reasonable requirements and expectations. We have talked of doctor debtor to patients. Now let us look at the other side of the account and think about patient debtor to doctor. What concessions to his doctor does a sensible patient gladly make? First, he feels that he ought to place the fullest confidence in the professional integrity and manliness of the One whom he has called to treat and advise his family and himself. He cannot expect medical skill, advice, or rem- edies to do himself or his friends much good, unless he places implicit confidence in the man who is for the time the guardian of his health and his physical and mental savior. There is no tie outside of the family relation more ten- der and sacred than that which is often formed connecting the patient with “Luke, the be- loved physician.” We see it more frequently, it may be, in the country than in the city, more often in the older than in the newly settled portions of our land. The practitioner of long experience becomes the friend and the confi- dant of those whom he has watched from the Cradle to manhood and WOmanhood and some- times to the grave. Frequently three genera- tions of the same family employ him, first from necessity, and then from choice, as their counsellor and friend. He carries the whole countryside on his heart, and deserves and often receives undying gratitude, respect, and love. Now, into this honorable and beloved fra- THE NAEDICAL DIAL. 223 ternity you are to enter, and it is your priv- ilege to expect eventually to win your way to deserved confidence and esteem. You, of course, expect to hear all sorts of witticisms uttered at your expense; but you know that those who are most fond of associating you with undertakers and cemeteries instead of with Hygeia, the goddess of health, are the first to send for you, if they think that grim death is knocking at their portals, and then the rattle of your wheels or the sound of your voice is more welcome music than the rustle of an- gels’ pinions to waft them away from this world which they feel so reluctant to leave. But the confidence which the patient gives to his physician is not deserving of the name, unless it results in obedience. So this is the inalienable and undeniable right of the prac- titioner whose services have been engaged. He is the autocrat of the sick-room, and patient, nurses, and friends are in duty bound to carry out his instructions. The life of the patient is in his hands, and disobedience to plainly written or uttered instructions is un- fair, culpable, and sometimes even criminal. If the patient comes to the point where he will not or cannot follow directions, when he is in his right mind, then every right-minded and honorable doctor feels under no obligation to keep the case, and intimates that his services are no longer at the command of those who do not know the very first principles which should govern a sick man and his friends. ISut confidence and obedience are not the Only debts which the patient owes his doctor. Appreciation of services, sometimes inestima- ble, goes a good deal farther than this. Fault enough is often found with even the best phy- sicians, if things do not seem to go exactly right. He needs all the more genuine and Warm commendation when he has handled a difficult case skillfully and well. The patient too often takes too much for granted, and little thinks of the hours of watchfulness, anxiety, and care which the faithful doctor has spent upon his case. The considerate patient must take all these things into the account and show his high appreciation not only to the man who has saved him, but to all his friends and acquaintances by his loving advertisement and cordial commendation of the one who has been his great deliverer. How can he ever do too much for this man who has done so much for him 2 But confidence, obedience, and praise are not the only things that the patient owes his doctor. “Fine words butter no parsnips.” The physician cannot live even on such excel- lent things as trust, obedience, and commen- dation. There is no man living who trusts men longer or who has greater patience and Consideration than the kind-hearted doctor. If you could see the account books of some practitioners not a hundred miles from these two cities, and compare the services rendered with the compensation received, it would be an eye-opener to many who are always talking about the extortionate charges of professional men. The gratuitous work done by doctors for which they never think of charging is simply enormous. The poor and the unfortunate are again and again treated by them without the hope or the claim of any remuneration. They know the poor and the proud in their commun- ity, and in numberless delicate ways alleviate their miseries without ever charging a cent, and are as careful and skilful as though they were to receive a hundred or five hundred dol- lar fee. They are the good Samaritans of their community. Their voluntary unpaid bene- factions of time and skill are large, their ex- penses, professional, family, and social so great that the intelligent patient readily sees that sentiment alone will not support a phy- sician and keep him from bankruptcy. So he cheerfully receives the monthly statement of services rendered and promptly sends his check to the man who is, alas! too often the last one thought of in settling accounts. If all that a man has will he give for his life, why should he not gladly and liberally reward the man who so often saves, prolongs, and renders more endurable that life? So let the patient remember that while he often claims from his physician modesty, gen- tleness, tact, discretion, self-repression, cheer- fulness, hopefulness, sincerity, full profession- al equipment, in short every virtue under heaven, he in turn owes the debt at least of confidence, obedience, high appreciation, and liberal compensation. May you, graduates of the class of 1899, find patients who are willing to cordially con- cede your just claims, and may they find in you men who possess the qualifications which they s g_* , ... - " - * * * *. * sº. 3 - . * *** % * Aº ...& # h & 3. ". «- * * ask of their chosen doctors. Then you will have at least a partial recompense for the years of hard and honorable service to which your friends devoutly wish you may all attain. *EXTRA-UTERINE PREGNANCY. By LESTER W. DAY, M. D., Minneapolis, Minn. In looking for a subject for my paper this evening it occurred to me that a semi-historical account of the development of our views con- cerning extra-uterine pregnancy taken in con- nection with microscopic specimens would be of interest. My chief source of information are the lectures of Dr. J. Whitridge Williams, asso- ciate professor of obstetrics at the Johns Hop- kins University. I purposely touch lightly upon symptoms, diagnosis and treatment. Extra-uterine pregnancy was first described by Albucasis, an Arabian physician living in Spain during the eleventh century. Three hundred years later the wife of Jacob Nufer, a pig-stone cutter, came to child-bed, and, after suffering many hours, and having exhausted the arts of the barber surgeons and midwives, was given up to die. Nufer, who had been away from home, returned to find his wife in desperate straits, and with the courage of despair opened her abdomen, delivered his child, and saved the life of his wife. Caspar Baukin wrote an acount of this, thus giving us the first operated case reported. In 1604 Riolanus wrote the first description. of tubal pregnancy, and ten years later Mer- cerus gives us the first description of inter- stitial pregnancy. From then on to 1741 numerous individual cases were reported, when Bianchi collected them into one book. Josephi in 1803 attempted to classify the various forms of extra-uterine pregnancy; but the first clear conception was given us by Tait, in 1888. The ancients, because of their false notions concerning pregnancy, could not conceive how ectopic pregnancy could occur. Uutil the mid- dle of the seventeenth century it was believed that the ovaries corresponded to the testicles, and that they secreted the female semen. To three Hollanders, Van Horne, de Graaf and Schwammerdam, do we owe a refutation of this idea. #Read before the Hennepin County Medical Society. THE MEDICAL DIAL. De Graaf in 1672 said that ova existed in the female testicles before coitus; but what he described as ova were really follicles. He knew that the follicles ruptured; but it was not until just before he died that he discovered an ovum. De Barr was the first to discover an ovum. Following his discovery came the idea that Only under the influence of sexual intercourse would an ovum mature. They considered a Corpus luteum to be a sign of pregnancy, and upon the strength of this belief Denman Cooper gave evidence before an English court which resulted in the hanging of a man on trial for criminal assault. After rupture of a follicle the ovum normally passes down the tube; but how? In some animals a capsule surrounds the ovary and connects it with the tube, thus removing any possibility of escape for the ova into the abdominal cavity. In man there is a space, filled with fluid between the ovary and the finnbriated end of the tube. “Rouget” advanced the theory that the fim- bria become erectile and grasp the ovary at the place of rupture, thus endowing the tube with reason. Kehrer of Heidelberg supposed that the follicle ruptured with such force that the ovum was injected into the Fallopian tube. . The theory taught by Dr. Williams is that the cilia in the tubes produce a gentle current in the peritonitic fluid which draws any foreign particles in the vicinity of the tubes into them. Pinner has shown that if cinnabar be in- jected into the abdominal cavity a portion will find its way into the tubes and thence into the | | | | Lode used the eggs of the tapeworm in a similar way, and with similar results. In what other way can we explain external migration? It is generally stated that it takes about eight days for an ovum to make the trip from the ovary to the uterus; but the work of prov- ing this was done upon animals. Hyrtl found, however, an ovum in a girl’s tube five days after menstruation. In 1785 Spallanzani proved that semen was the agent of fertilization before which time it Was thought to be due to the aura seminales. How the spermatozoa get into the uterus is not definitely known. Sims supposed that the semen is collected into the posterior fornix and is thence sucked up into the cavity of the uterus. THE MEDICAL DIAL. 225 Rristeller believed that during the orgasm a plug of mucous is pushed down into the lake of semen and was later withdrawn with the adherent spermatozoa. Henle showed that spermatozoa move an inch and one-half in an hour, and so possibly they climb up (?). Tait in 1883 accepted the then common be- lief that the cilia in the uterus and in the tubes move in opposite directions; those in the tubes being directed downward toward the uterus while the waves in the uterus move upward toward the fundus. The purpose of this con- trary action he believed to be to direct the spermatozoa toward the ovum descending in the tubes, creating at their point of meeting a Quiet spot where the ovum may implant itself. Hofmeyer proved that this was only a the- oretical belief, and that normally the direction of the cilia wave, in both tubes and uterus, is toward the cervix. Tait further believed that the downward action of the cilia in the tubes prevented the entrance of spermatozoa into the tubes and that whenever they do gain access it is because of the destruction of the cilia by some inflam- matory process. A. Martin proved the fallacy of this idea. Spermatozoa may always be found in the lat- eral portion of the tubes of women constantly exposed to coitus. Dührssen found living spermatozoa three and one-half weeks after the last coitus in the tubes of a girl; while Bischof found large numbers of Spermatozoa, upon the surface of the Ovaries and in the tubes of animals killed shortly after coitus. Thus it seems reasonable to suppose that impregnation occurs normally in the tubes, and if for any cause the down- ward passage of fertilized ovum be obstructed extra-uterine pregnancy occurs. Such causes may be classified under three heads: 1. Obstacles within the lumen of the tube, by which its caliber is diminished or entirely Obliterated. 2. Diseases of the tubal walls and peculi- arities in its anatomy or form. 3. Factors acting externally to the tube, by which its lumen is encroached upon or ob- literated. The occurrence of tubal polypi, first de- scribed by Ahlfeld and Leopold, was the ex- planation that appealed most strongly to the early investigators, but the comparatively few cases reported in recent years leads us to be- lieve it an infrequent cause. Dr. Williams had an opportunity to de- scribe the following case of tubal obstruction: The left uterine tube was the seat of two extra- uterine pregnancies. At its uterine end was a Small sack containing the skeleton and calci- fied remains of a foetus which completely oc- cluded that portion of the tube, and from the satisfactory history obtained clearly represent- ed the remains of an extra-uterine pregnancy which had occurred twelve years previously. The lateral end of the tube contained the pla. Centa and the membranes of a four months’ pregnancy which had ruptured, allowing the escape of the foetus into the abdominal cavity, Where it was found alive at the operation. The left ovary was small and atrophic and present- ed absolutely no sign of a recent corpus lute- um. The right tube presented signs of peri- Salpingitis and endo-Salpingitis; but its fim- briated extremity was patent, and the right OVary contained a corpus luteum correspond- ing in size to the duration of the pregnancy. Dr. Williams has been able to demonstrate external migration of the ovum in five out of thirty cases of which he has accurate patholog- ical records. In all of them the fimbriated ex- tremity of one tube was completely occluded by old inflammatory processes, or the tube was Converted into a hydrosalpinx, while the other tube was the seat of the pregnancy, and pre- Sented a patent fimbriated extremity. In each case the ovary on the pregnant side presented absolutely no evidence of a corpus luteum, While the Ovary corresponding to the occluded tube contained a typical corpus luteum of pregnancy. In 1891 Dr. Williams found by cutting serial sections of the tubes that beginning at the horn of the uterus there are only from two to four simple folds of mucous membrane. Grad- ually as he passed away from the uterus' he found these folds to become more and more involuted and complex until at the ampulla every trace of the original simple structure is lost. Furthermore he occasionally found that Where the infolding occurred near the base of one of the original folds that instead of stop- ping at the muscular coat the invagination would penetrate it and then run parallel to the lumen in the wall of the tube, ending in a blind cul-de-sac. $ºtº -4° *- * • *** * * ~s ... -- *. * * .* 2-y 226 ~ : * Theoretically nothing could be simpler than for a fertilized ovum to be swept into one of these cul-de-sacs and there develop. Williams was able to demonstrate this mode of develop- ment in 16 per cent of his cases of extra-ute- rine pregnancy. Here owing to the thinness of the wall, the tube generally ruptures at a very early stage. Peritonic bands may produce an obstruction sufficient to prevent the down- ward passage of an ovum while permitting the tiny, wriggling spermatozoa to pass upward. W. A. Freund has pointed out that abnor- mal bending of a tube, as where the foetal type of tube persists, produces constriction of the lumen. A number of authors believe the tubes to be normally endowed with peristaltic action, and that this movement is an impor- tant factor in the downward propulsion of the ovum. There are two factors that may inter- fere with this movement, thickening of the tubal walls, due to salpingitis, and adhesions about the tube. It is to these causes that Dr. Williams attributes the large number of cases of extra-uterine pregnancy that Oc- cur in association with inflammatory af- fections of the tubes, and not to de- struction of the cilia, as Tait believed. Ca- tarrhal salpingitis never causes destruction of the cilia, and even in extreme grades of pyosal- pinx one may demonstrate them. In all of Wil- liams’ cases cilia were found, although a puru- lent salpingitis was present in three, and in another case a follicular salpingitis. Leopold reports a case where a myoma of the uterus so compresed a tube as to prevent the passing out of an Ovum. Kelly gives the following classification of extra-uterine pregnancy based upon the orig- inal point of implantation of the fertilized ovum. When it remains and develops where first arrested it is called primary extra-uterine pregnancy; upon changing its position by rup- ture or further development, it is designated as secondary. Of the primary forms we may have inter- stitial, isthmial, ampullar and infundibular; the latter becoming secondarily tubo-ovarian or tubo-abdominal. I will not attempt to discuss these varie- tież. The tube walls increase in size owing to the hypertrophy of the muscle cells, the devel- opment of a decidua Vera, and to the great in- crease and hypertrophy of blood vessels. We are not able to distinguish as clearly THE MEDICAL DIAL. between decidua vera, serotina and reflexa, as in ordinary pregnancy. The decidual cells come from the connective tissue cells of the mucosa being due to a hypertrophy of the ex- isting cells rather than to a new growth. Also We find a certain number of the decidual cells to be derived from the endothelium and peri- vascular connective tissue of the blood vessels. In a number of cases the entire mucosa of the tube is converted into decidua, and in one case Williams found not only the mucosa of the pregnant tube but that of the other also converted into decidua Vera. In all these cases we find changes in the uterus. For the first three months it grows as rapidly as though it contained an ovum, also developing a decidua Vera. After three months it ceases to grow. In rare cases this change in the uterus does not occur. As to the changes in the lumen of the tube no general remarks can be made as they vary in almost every case. Werth, of Kiel, pointed out that if serial sections of the tube be cut, we find that as we approach the sack the lumen becomes smaller and smaller until it is at last obliterated. Still in a number of cases the lumen of the tube is continuous with the sack of gestation. Again as we approach the sack the epithelial struc- ture gels smaller and smaller, and we have finally only a few epithelial slits correspond- ing to the high ciliated epithelium. (Speci- mens.) As to the outcome of tubal pregnancy, in a rare number of cases gestation goes on to the full term in the tube. Williams has seen two cases. In the vast majority, however, rup- ture occurs about the twelfth week; though it may occur at any time. Tait taught that rup- ture usually occurred into the broad ligament, the outcome being encapsulation of blood and haematoma in the broad ligament. Williams has only seen one case that conforms to Tait's law. When rupture occurs into the peritoneal cavity the woman may die of hemorrhage; if she does not die, the blood is either absorbed or a haematocele is formed in Douglass’ sack. The ovum may be expelled with membranes and placenta, or the placenta may remain in the tube. If the first occurs, and the mother lives, the probabilities are that the ovum will be absorbed. If the foetus escapes alone the conditions are more favorable for the child, and it may go on to full term. The placenta, \ THE MEDICAL DIAL. 227 On the other hand, may become attached to Other organs and the circulation be estab- lished. If the tube does not rupture the rule is that the pregnancy goes on for a few months only, and then the foetus dies and is gradually con- Verted into a blood mole. Again, infection may occur leading to pyo-salpinx (rare). The fluid may be simply absorbed and the foetus mummifies; calcification may occur and we have a lithopaedion formed, or, lastly, it may be converted into a fatty mass bearing a rela- tion to the ammonial soaps. Symptoms of Ectopic Gestation: Sometimes the Symptoms are the same as in nor- mal gestation, and the woman is not aware that anything is wrong. But more frequently a tumor appears to one side of the medium line, elastic and painful to touch, which grows from month to month, While the uterus itself enlarges to the size of a two or three months’ pregnancy. This may be associated with attacks of paroxysmal pain in the lower abdomen. The foetus may continue to develop in spite of several of these attacks. With the death of the foetus the decidua of the uterus is cast off, and the woman believes that she has had an abortion. If the pregnancy goes on to full term without rupture, the pa- tient suffers pains similar to the pains of mis- carriage or of true labor, and are called false labor pains. That contraction of both uterus and gestation sack occurs, has been postively proven. The pains may last several days and gradually die out. The child dies; the ſluid is absorbed and the child may remain in the abdomen for a long time without causing trou- ble. More commonly the tube ruptures and with this accident there is sudden intense pain in the lower abdomen. The patient becomes very anaemic and faint, and complains of hunger and thirst. The first accurate diagnosis before rupture was made by Johann Veit of Berlin in 1885. If we find a woman with the subjective signs of pregnancy and a soft mass on one side of the uterus, we are justified in making the diag- nosis of extra-uterine pregnancy. As the tu- mor grows the diagnosis becomes more posi- tive. In a number of cases ordinary preg- nancy may simulate extra-uterine pregnancy owing to displacement of the uterus. Upon putting the uterus in position the symptoms disappear. When the foetus dies the diagnosis is often very difficult. If we find an abdominal tumor and are unable to feel the outlines of the child it may be impossible to make the diag- nosis. If death occurs after spurious labor pains and the tumor decreases in size the Cause is quite evident. Some workers believe that it is justifiable to curett the uterus and remove enough of the membrane to examine under the micro- Scope. Dr. Abbott has recently pointed out that curetting should only be done when the Surroundings are such that an operation for removing the sack can be immediately done. Up to three or four years ago the treat- ment of these cases was a mooted question. At present operative treatment is the only thing advocated, Lawson Tait being the father of this movement. One of the earliest methods was to puncture the sack, draining off the fluid. Dangerous injection of morphia and other drugs into the sack have been tried in hope of killing the foetus. It has even been seriously suggested that the mother be syphilized. Electricity was next advised, and in this coun- try has had many adherents. At present it is employed by very few. The condition must be regarded as a very dangerous one or even as a malignant disease, as the entire tubal wall may be eaten out by the growth of the placenta. If the diagnosis is reasonably certain we should advise imme- diate operation; if on the other hand we are called in after rupture, we must try and in- crease her strength. If her condition will per- mit she should be operated immediately. If we come to a case that has gone on to full term, it is considered best to operate at once and not consider the life of the child, as it is usually poorly developed. In some cases it is practicable to remove the entire product of pregnancy; but in others to remove the pla- centa would be followed by uncontrollable hemorrhage. In these cases we should leave the placenta within the abdominal cavity, to take care of itself. When the physicians of Florida shall have induced the legislature of that state to prohibit the awful crime of kissing and that disgusting habit of expectorating in public places it is presumed that the tuberculosis bacilli will have to seek more salubrious climes for their unpleasant habitation, and not until then will the people of that flower-scented state rest at Gà Sé. º *::: * : .* * wº rº. * … -.” § - * 228 * * * * * . V. º * * --. e." ^{ - ! §§§s', ' '. ºx" £-ºs 3. *...* THE MEDICAL DIAL A Monthly Record of Medicine and Surgery. (Entered at Post Office at Minneapolis as Second Class Matter.) Issued on the First of every Month at Minneapolis, Minn. Editor, J. W. MACDONALD, M. D., F. R. C. S. E. Associate Editor, C. K. BARTLETT, M. D. Business Manager, E. E. GRISWOLD. . . . . COLLABORATORS.. . . . A. W. ABBOTT, M. D. W. A. HALL, M. D. J. P. BARBER, M. D. G. D. HEAD, B. S., M. D. R. O. BEARD, M. D. KNUT HOEGH, M. D. J. W. BELL, M. D. C. H. HuntER, A. M., M. D. A. B. CATES, A. M., M. D. W. A. Jon Es, M. D. J. FRANK CORBETT, M., D. . J. H. RISHMILLER, M. D. R. E. CUTTs, B. S., M. D. J. D. SIMPson, M. D. J. H. DUNN, M. D. J. H. STUART, A. M., M. D. F. A. DUNSMooR, M. D. H. B. Sweets ER, M. D. DAVID Owen THOMAS, M. D., M. R. C. S The publishers will not be responsible, under any circumstances, for the opinions expressed or statements made by correspondents. Contributors will be furnished, gratis, with º copies contain- ing their articles, under an agreement to distribute at once to physicians, in actual practice. To avoid duplication, publishers should be informed of the field to be covered. Reprints, giving The Medical Dial full credit, may be obtained at actual cost. No notice can be taken of anonymous contributions. The name (not necessarily for publication) must accompany every communi- cation to this journal. $1.00 .10 Annual Subscription, in advance, - - - Single Copies, †- - * - º tºº wº- Advertising Rates made known on application. ADDRESS ALL COMMUNICATIONS TO THE MEDICAL DIAL, MINNEAPOLIS, MINN. MASONIC TEMPLE. JULY, 1899. THE SURGICAL ANATOMY OF THE GALL DUCTS. The surgical literature of the gall bladder and ducts has recently been enriched by sever- al valuable papers. In our issue for May we published a paper by Dr. Knut Hoegh which deals in a very practical manner with the pres- ent status of the etiology, diagnosis and treat- ment of gall-stones. The gross anatomy of the gall ducts has been so well established by the work of so many able observers that little that is new can be expected in this diection. However, as the surgery of the cholopoictic system has advanced, the anatomy of these structures is studied with new interest, and several mod- ifications of our views must be admitted. Dr. George Emerson Brewer, of New York, gives a preliminary report in the Annals of Surgery for June, on “the Surgical Anatomy of the Gall Bladder and Ducts,” from an analysis of one hundred dissections. In nine cases the gall bladder was adherent to neighboring THE MEDICAL DIAL. • Viscera. So as to change the normal relations. In Seven of these, the gall bladder was found to be adherent to the first and second portions of the duodenum, and the traverse colon and the Omentum, rendering access to the ducts aud duodenum, for purposes of exploration or operation difficult, and only possible after con- siderable dissection. The average length of the gall bladder in the 100 cases was four and three-fourths inches, the smallest was one and one-half inches in length, while the largest measured six inches. Twelve of the 100 gall bladders contained calculi, the number vary- ing from one to 250. The length of the cystic duct varied from one-half to two and one-half inches. “In One instance it was one-half inch in length, in three instances it was three- fourths, in fifty it was one, in twenty-one in- stances it was one and one-fourth inches, in seventeen instances it was one and one-half inches, in three instances it was one and three- fourths, in four instances it was two, in one in- stance it was two and one-half, the average of the 100 cases being two and one-third inches.” The last figure in the foregoing quotation is evidently an error, as according to the figures the average of the measurements in the 100 cases is one and one-fifth inches. The length of the common duct varied from one and One- half inches to four and three-fourths, the aver- age being three inches. The practicability of passing a probe through the ducts was studied experimentally by Dr. Brewer. “The cystic duct, owing to the spiral valve formed by the mucous membrane, rarely permits the passage of a probe, while in the hepatic and common ducts, which possess no such valvular arrangement, probes even of large size pass in either direction with the greatest freedom.” “To test the frequency and ascertain if pos- sible, the conditions under which the cystic duet becomes so altered as to freely admit the passage of a probe, an attempt was made in ninety-seven subjects to pass a soft metal probe from the gall bladder through the cystic duct into the common duct. In only ten in- stances was this possible. Of the ten in which the probe passed freely five to fifty per cent. presented calculi in the gall bladder, while of the eighty-seven in which the probe could not be passed seven or only eight per cent. showed Calculi.” THE NAEDICAL DIAL. 229 THE MEDICAL DEPARTMENT OF HAM- LINE UNIVERSITY. In another column will be found the names of the recent graduates of this college, all of whom passed the State Board of Examiners with high credit. This department of Ham- line University, formerly known as the Minne- apolis College of Physicians and Surgeons, the advertisement of which appears in this jour- nal, continues to maintain the high reputation it has acquired for graduating classes of ex- cellent standing in the profession. By vote of the Board of Trustees a com- mittee has been appointed with authority to erect a suitable building for the accommoda- tion of the school for the coming season, and located near the city and other hospitals, the plans of which have been adopted. With new and excellent class rooms, and increased fa- cilities for giving instruction, the faculty can look confidently forward for the prosperity of this institution. The professors are compe- tent and enthusiastic in their work, and de- serve the confidence of the community and the Students seeking an entrance into the medical profession. A cut of the new building will appear in Our next issue. THE DISINFECTION AND THE DISIN- |FECTING POWER OF THE SRIN, Dr. R. Binaghi (“Centrb. f. Chirurg.”), as a result of many experiments, found that after an ordinary cleansing of the hands, followed by simple drying, the number of bacteria was invariably increased (due, doubtless, to the softening of the outer layers of epidermis). After Washing in soda solution and repeated rubbing with a dry, sterile towel, the number of bacteria was lessened; also after soaping and scrubbing; also after washing in alcohol or ether. As disinfectants, the following agents gave the best results: Corrosive subli- mate, 1 in 1,000; carbolic acid, 5 per cent; and potassium permanganate, 1 per cent. A sim- ple long-continued washing with any one of these solutions (without previous preparation) never sterilized the skin. For complete sterili- zation the author recommends the following procedure: 1. Wash and scrub in warm soap and water. 2. Wash in warm alkaline solution (soda or soda carbonate, 5 per cent). 3. Sterilized Water. 4. Rub With Sterile towel. 5. Alcohol or ether. 6. Warm sublimate solution, 1 in 1,000. This invariably produces sterility of the hands.--Tondon Health. Reports Of Societies. HENNEPIN CO. MEDICAL SOCIETY. The annual meeting of the Hennepin Coun- ty Medical Society was held at the Public Li- brary, Dr. L. R. Nippert presiding. The minutes of the last semi-annual meet- ing were approved as read. The report of the special committee on re- Vision of the fee bill, which was laid over from the last meeting, was taken up, and considera- tion thereof was, on motion, deferred till the next meeting, the report being placed on file. The Board of Censors having reported fav- orably on the names of Drs. Lester W. Day, J. Frank Corbett, Mary Towers and D. R. Green- lee, the same were duly elected to membership in the society. Dr. A. W. Abbott presented a sarcomatous ovary, removed by him, with history of the C:\S62. Dr. L. A. Nippert then delivered the annual address which was entitled “Diphtheria—Di- agnosis and Therapeutics.” (See preceding pages.) DISCUSSION. Dr. Sweetser agreed with the president that the antitoxin is a very valuable remedy, but thinks the possession of a specific may make us careless. The cause of death may be secondary infection or other complications. He cited a case in which the patient was dying rapidly of uraemia and recovered rapidly under appropriate treatment. Attention should be paid to the membrane. The disease is local, not constitutional. The habitat of the germ is beneath the membrane and We should avoid in- fection if possible. He had found most satis- faction in using a solution of papoid in glyc- erine, which usually dissolves the membrane in twonty-four hours. Dr. D. E. Smith advocated local treatment. He uses a steam atomizer with Sodium Hy- posulphate. He cited a case with long con- tinued anaemia, temperature and albuminuria, followed by post-diphtheritic paralysis. Dr. J. F. Corbett, speaking from the stand- point of the health officer, wished to refer to so-called “Catarrhal” Diphtheria. The degree of infection does not necessarily correspond to its virulence, but very close contact is usually necessary to contract the disease from the “catarrhal” cases. Diphtheria may be local- ized in other parts than the throat. He cited a case of discharge from ear in which Klebs- I/Oofiler bacilli were found which persisted un- der hydrogen peroxide, but disappeared under 1-1000 bichloride. Dr. Knights cited a case of infection of the navel in a girl of 12 years occurring a few days after the Klebs-I/Oeffler bacilli disappeared THE MEDICAL DIAL. AMERICAN MEDICAL Association. r , - º from the throat. In this case also hydrogen 4. peroxide did not discourage the bacilli. They were destroyed by # of 1% formaldehyde. He questioned whether the use of a swab with young children who struggle does not do harm by lacerating the mucous membrane. Gargles do not reach the parts affected. He would use the swab only when it can be very care- fully applied. Streptococcus infection occurs only through a lesion of the mucous membrane and is the especially dangerous complication, aside from laryngeal obstruction. Dr. Cotton cited a case requiring intuba- tion in which the tube, having been introduced twice, on account of dyspnoea, the last time al- lowed to remain a week, death immediately followed extraction, in spite of tracheotomy, and the cartilage of the larynx was found to be softened so as to allow the larynx to col- lapse. , Dr. Haggard cited an intubated case in which spasm of the glottis followed extraction of the tube, which was immediately reintro- duced. At the final extraction a solution Of eucaine was employed in the throat with the result that spasm did not occur. Dr. Nippert, in closing, said that in laryn- geal cases the use of the antitoxin often ren- dered the tube unnecessary, and when neces- sary it could be earlier removed. He referred to the necessity of always being ready to re- introduce the tube immediately. Dr. Mary Whetstone moved that a commit- tee be appointed to confer with the health of- ficer as to the carrying out of certain recom- mendations contained in the address. Motion carried. Drs. Whetstone, Sweetser and Wes- ton were appointed as such committee. The annual election resulted in the choice of the following gentlemen: Tº resident—Dr. H. B. Sweet Ser. Vice-President—Dr. Knut Hoegh. Secretary–Dr. F. A. Knights. Treasurer—Dr. R. E. Cutts. Ilibrarian—Dr. G. D. Head. Censors—Dr. C. G. Slagle, Dr. J. H. Stuart, Dr. R. J. Hill, Dr. G. D. Haggard, Dr. H. Cotton. Executive Committee—Dr. J. W. Little, Dr. R. E. Cutts, Dr. C. H. Hunter. On motion of Dr. Cotton the society voted that an order on the treasurer for the sum of $50 be drawn in favor of the Public Library. The society then adjourned to meet in Sep- tember. ONE ON THE SURGEON. A noted surgeon of London, who was called to attend the Queen just at his lecture hour at one of the large colleges, had written upon the bulletin board, “Dr. Will not lecture to- day. Gone to attend the Queen.” Some mis- creant wrote underneath the message “God Save the Queen.” (Reported by Fassett's Bureau of the Medical Press.) The semi-centennial year of this organiza- tion was celebrated at Columbus in true- “Buckeye” style. The meeting was character- ized by a large attendance, interesting papers and hot weather. The local profession, aided by the Columbus Board of Trade, combined to make the occasion a memorable One, and cer- tainly proved Columbus to be as hospitable a city as there is in the land. The Governor’s reception, at the Great Southern and the ball at the Columbus Auditorium were the events of the season. Those who were fortunate enough to be present will carry away pleasant recollections of the Capital City's fair ladies and gallant men. The scholarly address of the president, Dr. Joseph M. Mathews of Louisville, on “Our National Body; Its Purposes and Destiny,” contained many valuable suggestions. Dr. Mathews said: “I imagine that when the father of this association called around him a few devoted friends, accomplished physicians and surgeons, and effected an organization to be Rnown as the American Medical Associa- tion, their first thought was the unification of the profession which they loved so dearly. Sacrifices and great personal discomforts were endured by them to obtain the good, but the splendid results were evidenced in the as- sembled body. Some must be teachers or in- structors and others listeners; they each in their way contributed their mite. It frequent- ly happens that some member from a far-off and sparsely settled country had heard some truth that, in its application, might save a life, or in return he might give an experience which might prove of incalculable benefit to his more fortunate brother. This possibility should rule out class legislation.” Dr. Mathews urged that the association should admit all those who represented honesty, fair dealing, and who entertained an earnest desire to ele- vate the standard of the medical profession and of the association. He recommended Washington as the prop- er home of the association, adding that he thought the distinguished body gained no dig- nity by traveling about, to say nothing of the inconvenience and expense imposed upon a local profession. This suggestion, however, did not obtain the sanction of the committee. Dr. Mathews recommended as an easy solution of the heated annual discussion over the per- manent Secretaryship, that the editor of the Journal be made also the secretary. This matter was taken up later and the secretary- ship placed in the hands of Dr. Simmons, the editor. This relieves from duty Dr. Atkinson, who for twenty-five years has served the asso- ciation in the capacity of secretary. A goodly - - - : ' ". . ... THE MEDICAL DIAL. portion of the address was devoted to the con- sideration of tuberculosis, anti-vaccinationists, and syphilis. Dr. Mathews closed with an ap- peal to the politicians for harmony, saying in part, “Let me beg of you that this meeting be One of perfect harmony and peace. Let noth- ing of an acrimonious nature be indulged in, but rather let your deliberations be charac- terized by patience, love for each other, and a desire to ennoble the profession to which you belong.” The association unanimously adopted reso- lutions indorsing a public health bureau, with a cabinet officer at its head, and also to set aside a sum of money for the use of the legis- lative committee. Dr. J. C. Wilson of Philadelphia delivered a masterly address on Medicine, and Surgeon- General Sternberg showed a series of stereop- ticon views, illustrating the hospital ship and the camp as they existed in the Spanish-Ameri- CàI] W3. I’. The association adopted resolutions urging local boards of health to enact laws making vaccination compulsory. A resolution was also adopted calling for the appointment of a committee of five to consider the best means of treating tuberculosis and preventing its dissemination. The nominating committee made the fol- lowing selection of officers for the ensuing year: President, Dr. W. W. Keen of Philadelphia; First Vice-President, Dr. C. A. Wheaton of St. Paul; Second Vice-President, Dr. E. D. Fergu- son of Troy, N. Y.; Third Vice-President, Dr. G. M. Allen of Liberty, Mo.; Fourth Vice- President, Dr. W. E. D. Middleton Of Daven- port, Ia.; Secretary, Dr. George H. Simmons of Chicago; Assistant Secretary, Dr. J. A. Joy of Atlantic City, N. J.; Treasurer, Dr. H. P. New- man of Chicago; Judiciary Council, Dr. J. D. Griffith of Ransas City, Dr. J. E. Cook of Cleveland, Dr. J. H. Baillache of Washington, D. C., Dr. J. B. Lewis of Topeka, Dr. J. W. Irvin of I/Ouisville and Dr. Frederick Holme Wiggin of New York. The session of 1900 will be held at Atlantic City, N. J., and we venture to offer the sugges- tion that this meeting be held two weeks later, in order to secure full attendance of the doc- tors and their families. The schools in vari- ous parts of the country will be out by that time and a better opportunity afforded to give our wives, sons and daughters a pleasant out- ing at the seashore. C. W. F. Dr. F. S. Morris of McCook, Nebraska, utilizes the instinct of carrier , pigeons to in- form him of the condition of his patients who reside far away from his office. By leaving several pigeons at a patient’s home the family can send one or more messages as to the con- dition of the patient daily. properly the body the lungs begin to fail. Prosress of Inedicine. MEDICINE. UN DER THE CHARGE OF J. W. BELL, M. D., C. H. HUNTER, A. M., M. D. . J. H. STUART, A. M., M. D. DAVID Owen THOMAS, M. D., M. R. C. S. SEED AND SOIL OF TUBEROULOSIS Dr. McGillicuddy, of New York (Jour. Am. Med. Ass’n), points out the similarity of the physiology of man and plants. As the lungs are to man so are the leaves to plants. Earth, sap, plants: food, blood, body. If the earth fails to nourish the plant, the leaves begin to Wither and die. If food ceases to nourish The yellow sickly leaf has less resisting power than the green and vigorous one; in like manner the tubercular bacilli find favorable soil in a weak, unnourished and impoverished lung. This microbe is one of the germs of decline and de- cay, and it is in the lung and other parts af. fected that the bacilli, acting under the great and beneficent law of nature, which thus pro- vides for the disintegration and feturn to dust of that which has passed its usefulness and lost its vitality, begin and carry on their mis- sion. To check the deterioration is the first step in the restoration of health. J. H. S. CONCERNING THE TREATMENT OF CON- SUMDTION. Dr. A. B. Farnham (Boston Med. and Surg. Jour., April 13, 1899) gives a brief outline of an excellent method of treating consumptive patients according to the present trend of pro- fessional opinion. The patient should have plenty of fresh air, day and night, in all kinds of weather, and sun light when obtainable. He holds that winds are not harmful to patients, provided the back is turned to them and the patient does not sit improperly exposed. The patient should not talk when walking or exercising in the wind, and he should habitually breathe through the nose. Exposure to the weather is far prefer- able to being shut up in stuffy, ill-ventilated rooms. The patient should be warmly clad in light-weight Woolen garments. Careful attention should be paid to the stomach. It is not proper to force the eating, for if other matters are properly attended to the appetite will come all right. Keep the mouth, teeth, tonsils, throat and upper air passage clean by spray and other means. It often happens that through imperfect expec- toration bits of sputa cling to portions of the mouth and fauces and thereby impair the ap- - - * . * - - - - - ** "... • * ... .” w * : * ~ -: - - “. . . •. , ** *** , 4. "* *...* *4. ~ - c. * * * : - - - * → 2- *... - a -- - Sº sº. * * - - * ... • * yº * ~ * - * , , , - : ' ', * → - - - * * * - w -- •, ... ? - - ~3. ". . . . . º. * , ... " . . . . * * Aſ ºf * * **. - - - º: * * - * * * - ,” •º: + 4 ~ * lungs of the accumulations of the night, the patient lean over the side of the bed in the prone position, with head much lowered to fa- cilitate more perfect cleansing. The sputum is to be cared for after approved methods. Bathing should be practiced twice a week, rapidly bathing a part of the body at a time. with massage. Intelligent attention should be given to lung gymnastics with the view of dilating the lungs, distending the alveoli and clearing out the small tubes. Ilocal catarrhs make excel- lent soil for the development of the bacilli. Keep the good lung at work. The introduction of ozone and vapors are commended. For the latter the Writer favors a mixture of pine needle oil, creosote and eucalyptus. high tension battery, having for some time used the Lesla-Thompson instrument. For internal medication strych. Sulp., creo- sote and guiacol valerianat, hold the leading and well nigh exclusive place. The first men- tioned to be given in large doses as high as one- sixth of a grain and even higher if toleration be established. For the attendant fever (and presumably care is taken to keep a record of temperature) no special medication or treatment is resorted to beyond rest. The same is observed also with regard to sweating and cough. For the latter, when medicine is resorted to yerba santa is preferred. • The writer closes his paper with the re- mark that the best remedy for phthisis is brains, skill and honesty on the part of the physician in charge. - A pretty general survey of the current lit- erature on the management, treatment Or therapeutics of consumption indicates that whether in homes, hospitals or sanatoria the above or very similar methods are insisted upon. - Except as adjuvants for the purpose of im- proving the nutrition in the several ways by which this can be accomplished, the internal use of medicines seems to be less and less in- sisted upon. As a germicide it can hardly for a moment be maintained that creosote is of value, especially in the localities in which are usually the ravages of the bacilli. If it soothes the cough or lessens expectoration it is doubtless indirectly of value. Being an active antiseptic the value of its presence in the ali- mentary canal whose function is materially im- paired, can be appreciated not withstanding the obvious risks of continued large doses. The same may be said of its congeners. The case is somewhat different with strychnia, but it will require accumnlated testimony to estab- lish proof of its efficacy, independent of meas- ures in their very nature far more rational. THE MEDICAL DIAL. ‘. . . petency for food. The author recommends that during the morning cough, to clear the He also speaks favorably of the . Alcohol should without hesitation be avoid- ed, because of its harmful effects, and the use of cod liver oil is at best questionable, not only because of its liability to impair digestion, but also because of its affinity for oxygen it not unlikely interferes with the proper oxydation of the system. The Murphy method by compression of dis- eased lung by injections of nitrogen gas is yet in the stage of experimentation, but it is not at all unlikely that it will pass after the man- ner of the sulphuretted hydrogen gas and other similar suggestions. - Whatever else may be suggested or insisted upon it will remain to be true through it all that the term hygienic management in its broadest and best sense will embody the high- est hopes and best expectations of the pulmon- ary tubercular patient, whether it be pursued at the home, the sanatorium or in a selected climate. No ordinary hospital into which are admit- ted patients of other classes is at all suitable for the care and management of consumptive patients for various reasons. Special sanatoria ought to be established all over the country, on selected spots for the convenience of such as ought not, or cannot remain at home, or make a change of climate. This class no doubt constitutes the majority because of their limited means. This fact, to- gether with another consideration, viz: that cures are more likely to be more lasting if ef- fected in the climate in which the patient will most likely have to remain, makes it necessary that most consumptives must be treated near home or be left to ordinary inefficient meas- UII*GS. - Sanatoria erected in localities combining the several desiderata believed to be beneficial for this disease, such as light, dryness, suitable temperature, altitude, etc., will, for a while at least, be most sought after by those who can. Homes or sporadic living in most favorable climates, and individual engagement or occu- pation, by which each person can earn a living or secure the benefits of congenial pursuits, constitutes the ideal method of consumptive management. Out door work in the soil, such as farming, gardening, fruit raising, flower growing, and raising small beries by those, to whom these employments are congenial, stands at the head. In the arid regions of our continent, espe- cially where irrigation is feasible, are to be found ideal homes. The Pecos valley in New Mexico, Western Kansas and Nebraska, portions of Colorado and Arizona, offer such opportunities. Dr. W. S. Watson, Of Riverview Sanatarium on the Hudson (Jour. Am. Med. Ass’n) having been over the ground and looking up this mat- ter, makes some pertinent remarks, especially THE MEDICAL DIAL. with reference to the climate, etc., of Old as Well as of New Mexico. g The chief points of importance in climatic Conditions are those favorable to non-devel- opment, retardation and cure of consumption, which are dryness of air, freedom from micro- Organisms, irritants and noxious gases, the largest amount of sunlight practicable, dimin- ished barometric pressure, ozoniferous atmos- phere, and fitness for out door life during the greatest possible amount of time. altitudes in the regions above indicated includ- ing Old Mexico are the safest and most advan- tageous regions known. - The Republic of Mexico, with an elevation from 3,000 to 7,000 feet above sea level, offers even more and better advantages, perhaps, than the favored portions of our own Republic. He commends the Mexicans, especially the in- habitants of the City of Mexico—“The Rome of America”—as a liberal, hospitable, refined and cultured people, The above advantages of climate pertain to the early stages, before destructive changes oc- cur. After cavities are formed the advantages here are questionable, because of the dryness, the bare surface and frequent high winds, which give rise to frequent sand storms which well nigh suffocate the sound lungs, to say nothing of the bronchial irritation which at- tends consumption. In high altitudes there is an increase of blood circulating through the lungs, hence in- creased metabolism and tissue changes. Deep breathing tends to improve nutrition and glandular secretions, which are in turn accom- panied by delightful and stimulating effects upon the nervous system. J. H. S. Mr. Smith (bent into the shape of an inter- rogation point with hepatic colic)— Oh Doctor, dear Doctor—gee whizz! ouch! great Scott! My guts are tied up in a double bow knot! I’ll give all I’ve got in this world with delight, If you’ll help-O-oo-oo!—help me out of this plight! And the doctor soon eased him, and solved every doubt, And tenderly watched him, till about.” The doctor (one year later)— Mr. Smith, I am very hard up, would you care To pay me a little, if you have it to spare? Smith (in an injured tone)— Pay you? Ah yes, I remember it now, But I’m sure I’d got well just the same any- how ; You must wait till I've paid much importanter debts, Sech as club dues, and pew rent, and lost ’lection bets. “up and —Med. Gleaner. The high . OBSTETRICS. UNIDER THE CHARGE OF A. B. CATES, A. M., M. D. R. E. CUTTS, B. S., M. D. THE POST PARTUM MANAGEMENT OF |UTERINE DISPLACEMENTS. E. C. Savidge, in New York Medical Jour- nal, March 11th, 1899, considers post partum displacements due to enfeebled muscular pow- er, measures for the improvement of which should be applied early in pregnancy or even before conception. Over-stretching of the perineal muscles by prolonging the second stage of labor is to be avoided; a laceration im- mediately repaired, is to be preferred. Such muscles are virtually henceforth dilated . muscles and are incapable of performing their work just as much as a dilated heart. Trusting post partum cases to nature is condemned. During the puerperium, or until the uterus resumes its normal size, the patient should be under observation. When the puer- perium ends, which may be six weeks or three months, is a question of fact and not of dates. Until involution is complete some support should be used preferably in the form of a tampon to prevent stretching of ligaments and muscles. Engorgement of the tissues is to be relieved by medication of the tampon; lacera- tions of the perimeun are to be repaired, no matter how small, while those of the cervix will often heal spontaneously if proper local attention be given them post partum. R. E. C. THE EARLY DIAGNOSIS OF PREG- NANCY. I3raun-Fernwald, in the Brit. Med. J., May 6th, 1899, considers Hegar's sign the most re- liable for early diagnosis of pregnancy. This is produced by an abnormal thinness, softness and compressibility of the lower segment of the uterus, or that part above the insertion of sacro uterine ligaments, the bimanual examin- ation being carried out with one finger in the rectum. With this sign pregnancy can rarely be diagnosed before the end of the second month. The writer concludes from investigat- tions held in Braun's clinic, during the last five years, that the most important early sign of pregnancy is a change in the shape of the body of the uterus, as well as in the softness, one side being thicker than the other. Even as early as the end of the first month one side and horn of the uterus may be doubly as thick as the other. This horn is not only thicker, but softer, while the other may more nearly resemble the non-pregnant uterus. The soft and large horn and segment of the uterus en- croaches upon the other, even passing beyond ~ --- * *-*. ~ x * * * * * * • * , *- * : * : 3. 3,' ' . .” -- 3, . " . . . . 4 - *_ - Fº 2. º. ... . . . * % º * { ... : * ~ * *s ... . . . . . . º. - * * * . . . * * 3. ~. ^- * : * > $ the middle line and at the junction of the two there is a distinct longitudinal groove. The fundus may be saddle-shaped, due to the same Call ISQ. The probable explanation of the difference in size of the two parts of the uterus is that the OVum becomes fixed on the one side and en- larges with the ovum, while the sulcus in the uterus would indicate the margin of the ovum. The enlargement may be so striking that the larger horn may be mistaken, by one inex- perienced, for a small myoma. The earliest time in which diagnosis was made was three days after one period - had been missed. When hemorrhage has occurred, he claims that by this sign one can tell whether abortion has occurred. If the sign is positive the ovum is still there. Its absence, when other signs of pregnancy are present, would point to a probability of extra uterine pregnancy. - R. E. C. PEDIATRICS. UNDER THE CHARGE OF H. B. SWEETSER, M. D. J. P. BARBER, M. D SUMMER COMPLAINT IN CHILDREN. This trite, but at this season of the year, very important subject is considered by Fischer, in the Medical Record of June 17, 1899. Although he advances nothing new, still the paper is valuable in that he states facts in treatment, which should be matters of routine for all of us, but which, apparently, we are lia- ble to forget. In this disease nature's first effort is to empty the digestive tract of offending material by vomiting and diarrhoea. It is a wise plan to aid nature in this effort, and the safest means We have for accomplishing this is either castor oil or calomel. Calomel has the added advantage of being an intestinal antiseptic. Irrigation of stomach and bowel with salt solution is also of considerable value, not only cleansing the canal, but providing, by absorp- tion, a needed increased volume of blood. The stomach flushing should be done by the physi- Cian personally, to guard against the disaster of inadvertently flooding the lungs through the larynx—an accident which happened to a trained nurse with one of the author’s patients. The bowel douche should have a temperature of 110° F. and undue pressure is avoided by raising the syringe only two feet above the child’s body. Diet, however, plays the most important part in the management of a case of summer complaint, and, if faithfully carried out, will do more toward the completion of cure than al- most all medicinal treatment. The first point to be borne in mind is to discontinue all kinds THE MEDICAL DIAL. of food which were being given at the time of the attack, and this applies with especial em- phasis to milk, which, in hot weather, is so easi- ly contaminated, and therefore so difficult to obtain pure, and, moreover, which, even when given pure, readily decomposes in a stomach be- low the normal digestive capacity. Instead, give some food easy of digestion and assimila- tion, readily made and easily preserved. Thus may be given plain barley water, mutton or chicken broth thoroughly skimmed, expressed meat juice, or even plain water. The return to milk should be very cautious. Environment plays an important role. The child should be kept in a cool temperature if possible, and the clothing should be light and loose. A very important point is the enforce- ment of change of air. It is a well-known fact that a child suffering from summer complaint in the midst of a warm city will suddenly be- come almost constipated if given a sea voyage, or upon being removed to the country. Drugs, if the above dietetic and other rules be disregarded, are worse than useless. FI. I}. S. TELIGH FRICTION IN INFANTS. Griffith (Archives of Pediatrics, May, 1899) reports two cases, and Louis Fischer, in the same journal, another of masturbation in young infants by thigh friction. The practice began in two of the cases at the eighth or ninth month, and one at the twelfth. The symptoms are described by Griffith as follows: The child at first in the sitting posture, would throw her- hips down, usually place one foot upon the thighs down, usually place one foot upon the instep of the other, and make decided, al- though slight, friction of one thigh against the other. All this was done silently, the silence sometimes attracting the attention of the nurse or parents. If the motion was allowed to go on profuse perspiration would break out about the head. At times, when there was reason to believe that masturbation had been carried on for some time while unprevented, the child Would have a very exhausted appearance and be wet with perspiration, especially of the head; Occasionally the act appeared to have been performed during sleep. - It is believed that this trouble exists far more often than it is recognized, and that by careful questioning of parents and nurses some obscure cases of fretfulness, innutrition, exhaustion and wasting can be explained by it. All the cases re- ported, and there are only a few scat- tering ones, have been in female children. Griffiths says it is difficult to see how a thigh friction could be practiced by a male infant; although he is not prepared to say that it can- not be done. The treatment consists of the maintenance THE MEDICAL DIAL. 235 of the strictest cleanliness, the use of mild astringent washes and ointments, and especial- ly in constant watching. In Fischer’s case the prepuce of the clitoris was adherent and this was believed to be the cause of the trouble. After several months of medicinal treatment, by various methods, without improvement clitoridectomy was performed, and a perfect cure was the result. J. P. B. “ICOPLIEC’S BUCCAL RASH IN MEASLES.” Sobel (in the Medical Record of June 3, 1899) treats of the great value, from a diagnos- tic standpoint, of Koplik's buccal rash. He adds a series of thirty new cases, making sixty- five in all, in which a diagnosis of measles was made, even as early as seventy or even nine- ty-six hours before the appearance of the cu- taneous rash, and in no instance was there an error. On the other hand, during the invasive stage of various diseases, as la grippe, coryza, tonsilitis, German measles, bron- chitis, etc., and in many of the skin diseases, as eczema in its various forms, scabies, varicella, pediculosis, impetigo, ery- sipelas, erythema multiforme, etc., this phe- nomenon has been uniformly absent. The im- portance of this diagnostic test lies in its early appearance, and if further investigation shows it to be so uniformly and invariably present as its author claims, then it will go a long way in aiding to limit the spread of measles. H. B. S. Neurology and Psychiatry. UNIDER THE CHARGE OF R. O. BEARD, M. D., W. A. Jon Es, M. D. A CASE OF NEURALGIA OF THE JOINTS. (Ein Fall von Arthroneuralgic.) By Dr. Miecislaus V. Nartowski. Arthroneuralgia was "first described by Brodie in 1822, and is considered by most authors as a manifestation of Hysteria. The case described by Nartowski (Wein. Medicin. Wochenschrift, May 20, 299) bears out this opinion. The patient, Anna G., 32 years of age, com- plains of pain in the knees and a weakness in the feet, from which she has suffered for the past two years, since the occurrence of a fright. The family history is neurotic, and the patient herself as a child was irritable and intractable. She was married at 23 and has had three children, the youngest of whom is four years old. . She complains now of feeling often as if a ball rose from her abdomen to her throat. On examination the patient appeared to be well nourished, and all the bodily functions were in normal condition. The patellar reflex is increased, both knees are somewhat swollen, they are fixed in a position of extension and show hyperaesthesia to light touch, while deep pressure gives no pain. This hyperatesthesia is especially marked on the inner aspect of both knees and in the popliteal space; and there is also increased redness and temperature for 10 cm. above and 13 cm. below the joint. This latter condition is especially marked during menstruation, but there is also a daily varia- tion in temperature, the lower extremities be- ing cold in the morning and hot toward night. Both active and passive movement of the knees is painful. Treatment consisted in convincing the pa- tient of the possibility of a cure, then in mas- sage for five days until the swelling was re- duced, followed by three applications of the electric spark. The cure was complete, and has continued for six months, although there is certainly great likelihood that the trouble will at some time return. W. A. J. ENCEPHALITIS OF THE PONS IN CEIILD- EIOOD. (Zur Encephalitis pontis des Kindesalters, Zugleich ein Beitrag zur Symptomatologie der Facialis und Hypoglossus Lahmung.) By H. Oppenheim. The author describes (Berlin Klin. Wochen- schrift, May 8, 1899) the case of a young wom- an of 19 years, otherwise well nourished and vigorous in appearance, who asks for the re- lief of a facial defect of long standing. The history shows that at the age of one year she was taken ill with convulsions and loss of consciousness which continued several days, and that on recovery there was a paralysis of the left face, the eye being open and the mouth drawn to the right. This gradually improved until the eye could be closed, but there re- mained a twitching in the muscles of the left face and chin, a feeling as if the left upper lip were too thick, and some hindrance in speech. The examination showed a paralysis of the left frontal muscle, normal movement of the Or- bicularis palpebrarum, and lid reflex to touch and light normal. The left lip and chin show fibrillary twitchings which now and then re- semble those of convulsive tic. The raphe of the tongue shows serpentine deviation, first toward the left and then toward the right, the tip lying to the left. The left half is also smaller than the right. The movements are normal. Pharynx and larynx are also normal. The electrical examination is important. The left side shows some slight loss of excit- ability, and the Platysma myoides gives no re- action, even to strong currents, except in a $ºº-ºº:. . . . . . . . . . . . . *- *::: * * , -, - 1:... . . . . . * * * . **. º : , , | * # - “... . . . . AºS. - * { - » * * * - * narrow strip near the middle line. Of special interest is the observation, however, that stim- ulation of the right facial gives contraction in the left chin and lower lip muscles. This oc- curs with a current strength which produces even in the right side either no movement or a very weak one, and which applied directly to the left side gives absolutely no reaction. In the lower extremity it is noteworthy that the right patellar and Achilles reflex are some- what stronger than the left. - The author’s diagnosis is that the case is one of infantile paralysis; a pontine or bulbar infantile paralysis. In other words the pro- cess of Poliomyelitis or Encephalitis acuta has attacked the centers of the pons in this in- stance. The cross-sided reaction to electricity is explained by supposing that the collaterals from the right nerve are sent to the muscles near the middle line on the left side. Were it a reflex phenomenon through the brain the contraction on the left side would be a trifle slower in time than on the right, and this does not Occur. W. A. J. A NEW SYNIDROME FOLLOWING A. * WOUND OF TELE SPINAL CORD. (Nouveau Syndrome Consecutif a une Blessure ~ de la Moelle.) By L. Minola, Archives de Neurologie, May, 1899. * Julia Munoz, age 40 multipara, received June 10, 1896, a stab wound between the seventh and eighth ribs on the right side at a distance of 6 cm. from the apophysis of the dorsal vertebrae. This was followed immedi- ately by a complete flaccid paraplegia with dis- turbance of sensation. In the right lower limb there was a complete anaesthesia to all forms of sensation from the level of the hip joint to the tips of the toes. During the first week the following evidence of allochiria was noted: When a warm body was placed upon the right knee the patient pointed with her left hand to the left knee and referred the sen- sation of warmth to that point. The left low- er limb showed marked hypera-sthesia. At first also there was found a point on the back three finger breadths above the wound which was hyperasthetic; two weeks later a similar point developed in the right sacral region. The patellar reflex was absent on both sides and the plantar appeared only on the left. The rectum and bladder showed no abnor- mality. The subsequent course of the disease was as follows: Motion reappeared earlier in the right extremity than in the left, and in both motion appeared first in the proximal portions and later in the distal. Flexion was better performed than extension. By October, 1896, the right extremity was performing all the THE NAEDICAL DIAL. ordinary movements, while the left could only With difficulty perform flexion of the foot, and toes, and extension of these parts was impos- Sible. In the meanwhile it was observed that movements occurred in the left foot during sleep which were impossible in the waking state. Attempts at walking caused trembling of both extremities, but most marked in the left. This trembling finally disappeared en- tirely on the right side but increased on the left, where there also developed a contracture which placed the foot in forced extension so that the toes alone touched the ground. (Equino-varus.) By June 11th, 1898, this con- dition was already established, and note was made that the right patellar reflex was slightly increased and there was no clonus, while on the left there was marked exaggeration and clonus. No atrophy appeared in either ex- tremity. The anaesthesia of the right ex- tremity disappeared rapidly in certain regions, leaving, however, isolated areas which recov- ered much more slowly. By June 11th anaes- thesia still persisted over the great toe, along the inner side of the foot and over the internal malleolus. - The author shows that this case is in ac- Cord with the experiments of Mott on mon- keys, in which he demonstrated that hemisec- tion of the cord produced no changes on the Opposite side, but on the same side there oc- cured hemiparaplegia and hemianaesthesia ac- companied with allochiria. These experi- ments, as well as the present case, refute the theory of Brown-Sequard that the sensory nerves cross in the cord at the level of en- trance, and upheld the claim of Ramon y Cajal that the sensory fibres do not decussate but bifurcate, forming a Y, and continue up- Ward with the fibres of the posterior column to finally terminate by free aborization in the gray matter of the posterior horn. The symptoms in the case related can be eXplained by supposing that the instrument divided completely the right side of the cord and that its point injured the intero-lateral portion of the left half, which includes the pyramidal tract. The author does not discuss the question of why there should have been complete recovery On the side of the hemisection, and such marked secondary degeneration on the side of the less complete lesion. W. A. J. INSANITY DEFINED ON THE BASIS OF DISEASE. In a brief but very clear article by C. H. Hughes, M. D., under the above title in the Alienist and Neurologist of April, 1899, the author gives the following sentences. “We no longer beg the question. We understand that insanity stands on the same basis as all other diseases—plus another organ. Not exactly as THE MEDICAL DIAL 237 liver secretes bile in its physiological state does the brain secrete mind. We do not now express the formula in the exact phraseology of Cabanis, but we say, as the brain in good anatomical condition is necessary for the physiological expression of mind, so the mind when it expresses itself to the world in a pathological manner, obeys the laws of all other diseases. Its organ, the brain, is wrong either functionally or structurally, primarily or secondarily, either in the intimate structure Of the neurons or in their relation to each other in the cerebral cortex, or by reason of their abnormal blood supply, or by reason of changed conditions of nutrition of metabolism or whatever it may be. We need never be at sea before any court, before any jurist, in giv- ing our views of insanity as a disease, prima- rily or secondarily involving the brain of the individual so as to produce in him a change in the natural habits of thought, feeling or action —a change of his normal, natural, mental ex- pression by which, or by reason of the disease underlying all, he is placed out of harmony With his surroundings, with his natural self or his normal family type of mind.” W. A. J. A CASE OF GILIOMA OF THE LOWER CERVICAL REGION OF THE SPINAL CORD. Producing a Total Transverse Lesion, in Which There Was Spasticity of the Lower Limbs and Persistence of the Deep Re- flexes. The complete report, by W. H. Hudson, M. D., Lewellys F. Barker, M. D., Simon Flexner, M. D., of this very interesting case is pub- lished in the form of a monograph, but a re- sume illustrated with four very fine plates is given in the American Journal of Medical Sciences for June. º The patient when first seen by Dr. Hudson, in 1890, was a man of fifty, whose family and personal history was free from any record of either syphilis or tuberculosis. Six months previously he had been thrown from a horse, and to this injury he attributed his symptoms, which then consisted chiefly of pain along the spine from the dorsal regions downward and burning in the legs and feet. The knee-jerks were exaggerated; he swayed when standing with his eyes closed. He grew worse on specific treatment, his legs became almost en- tirely helpless in 1891, and completely so in 1895. By this time sensation had become lost as high as the nipple line. He had never had the excruciating pain common in spinal tumor, but there had been moderate pain along the spine and well marked girdle pain. The slightest irritation caused violent spasmodic contractions of the muscles of the legs. By December, 1896, his stomach was very unre- tentive, he was dyspnoeic, and his breathing was entirely diaphragmatic. His pupils were small and reacted imperfectly. Sensation in all parts was lost below the third rib in front and the spine of the scapula behind. Above this there was some hyperaesthesia. The legs were rigid and entirely paralyzed, but there was no atrophy except in the interossei of the hand. The skin reflex was present in the legs and feet; there was violent ankle clonus and Some exaggeration of the knee-jerk. The diag- nosis was an intradural tumor, which was probably intramedullary. On autopsy a tumor was found involving the substance of the cord, and extending from the level of the fourth cervical to that of the third dorsal vertebra. The upper five centi- meters of this consisted chiefly of a tumor reaching nearly throughout the whole lateral extent of the cord and ending above and below in two cone-like projections, one of these be- ing continued downward in the form of a cen- tral stem of what appeared to be gliomatosis. This stem was surrounded by softened cord. Microscopical examination showed that the tumor consisted of a very large number of much thickened blood vessels, many of which showed hyaline degeneration, of fibres, and of cells which were round, oval, or pyriform in shape. They were somewhat irregularly ar- ranged, but often appeared to radiate from the blood vessels. In many places there was blood extravasation. The stem of gliomatosis contained large numbers of peculiar bodies consisting of collections of waxy looking ma- terial, apparently the result of degeneration of the protoplasm. With the Weigert-Pal stain- ing method they appear black. Many cavities both large and small were present, some preformed and others due to softening. The preformed cavities were en- closed by a layer of fibres like that around the central canal of the cord, and upon this layer was a membrane lined with high epithelium. There have been hemorrhages into these cavi- ties, and there was granular material at the edges which looked like degenerated neuroglia. This case gives conclusive proof that the reflexes may remain when the cord is com- pletely severed if the lumbar enlargement is healthy, and therefore the cutting of the con- nection with the cerebellum is not the cause of loss of reflexes. W. A. J. The baby pickaninny changes in color somewhat as follows, so it is said, from the hour of birth: The negro baby comes into the world a tender pink; the second day it is lilac; ten days afterward it is the color of tanned leather; and at fifteen days it is chocolate. The coloring matter lies between the layers of epidermis. * * *~~uº, * * * * * ... • * * * ... ** - S.- ... - * ****-*: ... . .”... - * ... 3. 3.º.º.º.º.º. * ...'", -" - . * * 23, ... - * * º • - * § 28s CLINICAL MICROSCOPY. UNDER THE CHARGE OF J. FRANK CORBETT, M. D., G. D. HEAD, M. D. THE syMPTOMs of DUMB AND TRUE RABIES. The familiar picture of a dog frothing and foaming at the mouth, running through the streets and snapping at everything, is one that strikes terror to the hearts of all. Unfortu. nately, this is but one phase of rabies of which there are many more. The bite of a dog, that at the time seems only to be sick, may lead to a case of rabies on the part of the one bitten. This is due to the fact that dogs are capable of communicating rabies several days before any positive symptoms appear. There are two kinds, dumb rabies and true rabies, In dumb rabies the dog does not try to bite; in fact cannot, for the jaw is paralyzed as indicated by dripping saliva. The animal is reticent and hides away from observation and finally passes into paralysis and death. In typical rabies the dog passes from a. de- pressed nervous condition to mania, delirium and finally paralysis. It would seem that the dumb form is but the rabid form With some of its phases left out. This idea is strength. ened by the fact that in varying the Quantity of rabic material, experimentally inoculated, either of these forms may be produced from originally the same animal. The smaller quantity leading to acute rabies and the larger to dumb rabies. In the early stages of true rabies the dog’s entire nature seems changed, a cross dog becomes amiable and an amiable dog becomes cross; he is easily frightened, re- fuses food, or else attempts to eat it but Can- not swallow, or will eat all sorts of trash. Signs of incoördination begin to appear, also trembling; the eye is injected and there is a slight tendency to choke; the voice becomes hoarse and comes deep from the throat. The saliva of a dog in these stages is fully virulent but the symptoms as yet have nothing especial- ly to indicate hydrophobia, as many of these may be absent. The dog tries to doze, but its slumbers are broken; it turns about restlessly; it runs about and snaps in the air and seems to see imagined forms. The dog can still be controlled by speaking to it; it is thirsty and laps water but cannot swallow; it bites every- thing in reach; can still eat solid food. From this the animal passes to a state of delirious rage; it attacks all animals within reach, but does not bark as it is wont to do in fighting. It breaks out its teeth and tears its body without any pain. Foam does not drip from the mouth as yet. After the animal has exhausted itself, periods of exhaustion or par- oxysms occur. Paralysis of hind legs next THE MEDICAL DIAL. follow, the powers of incoördination are lost; the dog totters, gives a slight convulsion and dies. Duration of illness, five to ten days. Of this multitude of symptoms, any or many may be absent, but the points of special importance are the muffled bark, a tendency to snap up foreign material, and incoördination, with, finally, paralysis and death. A mad dog may be able to eat and even to swallow water at some stages, so it is no evi- dence of the lack of rabies. On the other hand, perfectly healthy dogs may act in a very peculiar manner; a nervous dog is often sub- ject to having peculiar spells of barking and acting in a crazy manner. There are certain pathological conditions in the dog which give rise to symptoms somewhat similar. Among these conditions are meningitis, intestinal par- asites and nephritis with uraemia. These are often mistaken by the laity for true cases of rabies. - In the rabbit, the incubation period is from twelve to fifteen days, and the disease from three to five days longer. Incoërdination in early stages, and, finally, paralysis, are the main symptoms. The animal tends to crouch in a corner of its box; if it attempts to walk, staggers, and if pushed quickly, rolls over and loses its balance; it cannot raise itself up by shoulder or pelvic muscles, but will kick its hind legs if lifted up, finally dies with paral- ysis of hind limbs. Incoördination may be supplanted by a somewhat excitive condition. Rabbits do not tend to snap and bite. The rabic horse tends to kick, bite and tear itself; at times will not eat and tends to fall down suddenly as if shot. This description covers all of the different forms of rabies in animals. Why they should give rise to such Varying phenomena, we cannot answer, except On theoretical grounds, but it is certain that this same virus that produces rabies in the dog, with above train of symptoms, will pro- duce the same disease in the rabbit, with dif- ferent symptoms. Furthermore, if we take the virus from a dead rabbit and inoculate it into the dog, it produces true canine rabies. We can partly explain this difference from the difference in nature, for in the fierce, carnivorous dog we get a furious madness; in the horse, an animal of considerable spirit, we obtain symptoms re- sembling these; and in the dumb rabbit we secure only symptoms of incoördination. This goes to show that rabies is a disturbance of the nervous system and is manifest in different ways. The immediate cause of rabies is unknown, probably some bacilli, cocci or similar organ- isms. Pasteur Once mistook the Micrococcus Tetragenous for the germ of rabies. Many claimants have recently brought forth their Own views. It has been claimed that a small thick bacillus with a clear ZOne Center is the - - A. THE MEDICAL DIAL. cause of rabies and that this disease has been produced by inoculating cultures of this germ. A Blastomycetes has also been obtained from rabid animals and inoculation with results which seem positive. The bipolar bacillus of rabit septicaemia was once a supposed cause. That the seat of rabies is in the nervous system is generally accepted as proven. Blood from rabid animals will not produce rabies. Possibly the virus gains admittance to nerve centers through lymphatics, as Pasteur has shown by the following experiments: He in- oculated the ear of a rabbit with rabic virus and immediately cut off the ear below site of inoculation with cautery and the animal died of rabies. He also cut off the cord of rabbit and inoculated below site of section; that por- tion of cord below cut was virulent and that portion above was not. This indicates that transmission is in nerve matter or in Struc- tures immediately connected with nerves. The virus of rabies seems to withstand cold better than heat, for when subjected to temperatures given below, give the following results: No degree for the period of one week, on inoculation, developed rabies. Thirty degrees for the period of eight days, on inoculation, developed rabies on the ninth day. Thirty-five degrees for the period of eight days, on inoculation, developed rabies on the eleventh day. Forty degrees for the period of eight days, on inoculation, developed only a few symp- toms. Fifty degrees for the period of eight days, on inoculation, developed only negative re- sults. Commencing putrifaction interferes with virus of hydrophobia, but advanced putrifac- tion does not. is also affected by drying. Cords that have been dried for a long time gradually lose viru- lence. Repeated inoculations in the series of susceptible animals shortens period of inocula- tion and increases virulence, and in a series of non-susceptible animals, lengthens inocula- tion period, and weakens virulence. For ex. ample, by repeated inoculation in rabbits we get a virus (the so-called fixed virus) that will kill in eight to ten days. On the other hand, a hen may die of rabies, but in doing so it destroys the virus. i The only positive point in diagnosis of rab- ies is transmission from one animal to another, generally accomplished by subdural inocula- tion. There is nothing pathognomonic in the post-mortem of a rabic dog. Pasteur claimed he could distinguish a brain of a rabic dog from a normal brain. He claimed some differ- ence between the fine granular matter found in brain substance of a rabic dog and that found The virulence of rabic material * , , riz - • * in normal brain, and further, that the granular matter, if normal, would disappear on being injected into virus of a rabbit dying with rab- ies, but if from a rabic animal, would not so disappear. - The greater number of animals submitted to the Minneapolis City Laboratory for exam- ination for suspected rabies, upon inoculation have not proven to be rabies, but the post- mortems have shown various conditions. One animal showed evidence of having had menin- gitis, and rabbits inoculated from the dog died in a few days with no symptoms of rabies, for the inoculation period of rabies is longer and this disease has some well marked symptoms which have been described above. People bit- ten by the dog, six in all, have remained healthy. A second dog presented a bad con- dition of kidneys, death being due to uraemia. No result followed inoculation from the me- dulla of this dog. In a third, the intestinal tract was found covered with pin worms. This case closely resembled rabies but no re- sults followed inoculation. A fourth gave negative results from inoculation and normal condition of tissue. A fifth gave rise to symp- toms of true rabies in rabbits. While we have the series of negative re- sults, on the other hand, a dog may have viru- lent saliva before he shows any symptoms of rabies and later any or all of these symptoms may be marked. J. Frank Corbett, M. D. THE HAMLINE MEDICAL SCHOOL COM- MENCEMENT EXERCISES. The graduating exercises of the medical de- partment of Hamline University took place at the Hennepin Avenue Methodist Church in this city on the evening of June 5th. Dr. A. F. Irwin of the medical faculty gave an address on “The Riddles of Science” and Prof. Wm. E. Thompson of the general faculty of the university delivered an address on “The Physician from the Patient’s Standpoint.” Both were well received. The following is the list of graduates: Graduating M. D., C. M., Cum Laude—R. M. Burlingame, Ernest G. Sasse, Miss Ellen E. A. Willis, George M. F. Rogers. Graduating M. D., C. M.–David J. Dona- hue, James Hynes, Robert J. James, James D. Jones, Adolph E. Loberg, Edward H. Kirk- hoff, Charles H. Mason, Fred C. Miller, Carl M. Oberg, Floyd J. Roberts, Daniel L. Scanlon. Course for Graduates—Titus C. Briggs, The American Medical Quarterly is a new publication, the first number, dated June, 1899, with publication office at 100 William street, New York City. THE MEDICAL DIAL. BOOk ROtiC&S. ELECTRO-HAEMOSTASIS IN OPERATIVE SURGERY. By Alexander J. C. Skene, M. D., LL. D., Professor of Gynecology in the Long Island College Hospital, Brook- lyn, N.Y.; formerly Professor of Gynecol- ogy in the New York IPost-Graduate Medi- cai School; Gynecologist to the Long Is: land College Hospital; President of the American Gynecological Society, 1887; Corresponding Member of the British, BOS- ton and Detroit Gynecological Societies, of the Royal Society of Medical and Natural sciences of Brussels, of the Obstetrical and Gynecological Society of Paris, and Of the Leipzig Obstetrical Society; Honorary Member of the Edinburgh Obstetrical So: ciety; Fellow of the New York Academy Of Medicine; ex-President of the Medical SO- ciety of the County of Kings; ex-President of the New York Obstetrical Society. New York: D. Appleton and Company. Price, cloth $2.50 net. º The discovery of the ligature was a long stride in the right direction, but the ligature is not a perfect means of arresting hemorrhage for it has its defects and failings When em- ployed in certain operations, and in some con- ditions catgut has answered so well the re- quirements of the surgeon that many have rest- ed satisfied that the ideal method had been at- tained. But catgut is difficult to sterilize, and, when sterilized, it is a difficult matter to keep it so. If applied to a vessel in a septic or necrosed tissue the ligature itself not only becomes septic, but fails to be absorbed. It thus remains as a foreign body preventing the process of repair, and adds of its own self to the culture field of the bacteria. Other objec- tions to eatgut are its crispness when dry and its tendency to stretch when soaked. Silk lig- atures have also their weak points which We need not specify in this place. The imperfections of ligatures led Dr. Skene to search for something better in surgi- cal hemostasis. Starting from Dr. Thomas Keith’s method of treating the pedicle in ovari- otomy by the clamp and cautery, the author had his attention called to the use of elec- tricity in heating laundry smoothing irons, and it occurred to him to adopt the same heating power to surgical instruments, such as the clamp and forceps. After describing the instruments required in electro-hemostasis, the author shows the ap- plication of his method to the various opera- tions, paying special attention to its use in ovariotomy, myomectomy, abdominal hysterec- tomy, ovario-salpingectomy, and appendec- tomy. The treatment of uterine carcinoma, belvic abscesses, tumors of the bladder, rectal hemorrhoids and neoplasms of the skin and mucous membranes is dealt with in an interest- ing manner and the adaptation of electro- hemostasis clearly shown. The work is well illustrated and the subject dealt with in the excellent style which has characterized the preceding Works of this well known author. The reader will be well paid by a study of Dr. Skene's excellent monograph, for the variety of the operations to which electro-hemostasis is adapted and the certainty of its results jus- tify us in predicting for the new method a wide adoption by the surgeons of the future. A PRACTICAL MATERIA MEDICA FOR NURSES. By Emily A. M. Stoney, “Au- thor of Practical Points in Nursing.” Philadelphia: W. B. Saunders. Price $1.50 net. We cannot agree with those who believe that the less a nurse knows of the treating and curing of diseased conditions, the more close- ly will she follow the directions of the physi- cian. In our experience the more extensive and accurate the training the better is the nurse qualified to fill the place assigned her by the advanced medical science of today. The work before us is not intended to supply a full knowledge of materia medica and thera- peutics, but in a condensed form it gives the nurse a general and practical knowledge of the drugs which are in common use. The chapter on poison emergencies is just what every nurse should be familiar with, while the dose list gives her a ready reference in a case of emer- gency where, in the absence of a physician, she is expected to act, and must act. We cor- dially endorse the work before us, and the physician who cannot place it in the hands of his nurse, lest she should be thus enabled to criticise his directions, had better take down his own books on materia medica and refresh his memory. THE PATHOLOGY AND TREATMENT OF SEXUAL IMPOTENCE. By Victor G. Vecki, M. D. From the author’s Second German Edition, revised and rewritten. W. B. Saunders, 925 Walnut St., Philadel- phia, 1899. Price $2.00 met. This work speaks the bare truth in dealing with a delicate subject. The first edition ap- peared seven years ago and met with a good deal of Opposition on acount of the liberal in- terpretation of some of the questions dealt with. Sexual impotence, besides being a seri- ous disease, is, also, of frequent occurrence, and productive as it is of much mental suffer- ing, a consideration of its pathology and treat- ment is a duty required of the practitioner. While some portions of the work are calcu- lated to pander to the depraved tastes of the sensual, the book deals in an exhaustive and - * * . . . -- - - THE MEDICAL DIAL. scientific manner with the anatomy and phys- iology of the sexual organs, the forms of im- potence, its etiology, diagnosis, prophylaxis and treatment. The work cannot fail to be helpful in the treatment of these difficult and perplexing cases which every physician of ex- perience is constantly meeting. While we cheerfully acknowledge the value of the treatment recommended by the author in most particulars, we must emphatically dis- approve of the sentiments expressed in the fol- lowing paragraph, p 727. “As marriage is a heroic and very danger- ous remedy not accessible to every one, and as a mistake in this affair is so difficult to cor- rect, many a convalescent patient will be com- pelled to have recourse to other connections than hymeneal in order to satisfy his sexual desire, if he does not want to become impotent again, or to be troubled again by morbid pol- lutions. He must satisfy this natural Want regularly, and the act cannot be called im: moral simply because it is accomplished out of wedlock. Such connections may be unknown to dried-up pedants who have never been young, but every man gifted with a heart and physical power is familiar with these liaisons in all their variations.” - TREATMENT OF DISEASES OF THE CON- JUNCTIVA—HYPERAEMIA. Treatment of the hyperaemia of the Con- junctiva resolves itself into the removal of this Cause. If of passive origin, the removal of the obstruction to the circulation will be followed by the rapid subsidence in the undue vascular- ity. If of active, the correction of any exist- ing anomaly or refraction or of muscle-balance, or the removal of any foreign body, Will accom- plish the same result. Dark glasses should be given to protect the eyes from irritating rays of light, and from dust and smoke, and a boric wash or some other mild antiseptic or astrin- gent lotion will, with cold compresses, be Suffi- cient to reduce the vessels to their normal size. CATARREIAL CONJUNCTIVITAS. Attention should be given to the general health. Any existing systemic disease, such as rheumatism, diabetes, or albuminuria, should be combatted, shorter working hours should be prescribed for professional men and more exercise recommended; the eyes must be prop- erly protected from the light, air, and dust with smoked glasses, and they should be kept clean from discharge by frequent washings. With boric-acid lotion; great relief may also be ob- tained from the application of ice compresses. These are best applied as follows: 1. Sev- eral pads of gauze of three or four thicknesses, about the size of a silver dollar, are laid on a block of ice. The ice should be suspended in a receptacle with perforations in its bOttom - - .* - - . . . A. ; * * * : * > . , , *, - - w w J ,' - + r .* ~~ & which will permit the water and any secretion from the compress to drain off into a jar be- neath it. An ordinary kitchen-collander and wash-basin will answer very well for this appa- ratus. One of the pads is taken from the ice as soon as it has been saturated and is applied to the closed lids, removed in a few moments, and a fresh one substituted for it. - 2. Compresses of absorbent cotton which have been soaked in ice water may also be em- ployed. They should be squeezed out sufficient- ly to prevent any of the water trickling over . the patient’s face and neck. 3. Cold may also be applied by means of the ordinary douche or by holding a small cake of ice directly to the eye; but these should be dis- carded for the compress, as they cam only be used intermittently. To avoid repetition it seems well at this place to give the indications which call for the employment of hot and cold compresses, not only in the treatment of catarrhal conjunctivi- tis, but also of the other forms of conjunctivitis as well. - In hyperamia of the conjunctiva, induced by ametropia or the presence of a foreign body, we have, in cold, a simple, but effective, means of restoring the membrane to its healthy condi- tion. In these cases the douche or the com- press may be applied over the closed lids, with the greatest advantage, for fifteen minutes at a time. The water employed should not be too cold, or excessive reaction may follow its use. Frequent washing of the eyelids and sur- rounding skin with warm water and castile soap is the most efficacious home treatment for catarrhal conjunctivitis. De Schweinitz (Phil- adelphia Polyclinic, April 7, 1894.) In the treatment of the milder form of Con- junctivitis the membrane may be sprayed with a solution of boric acid and salt, the good effects of this plan being probably due to the fact that the liquid thus applied penetrates the deeper tissues and correspondingly increases the extent of the contact and prolongs the ac- tion of the drug. De Schweinitz (Amer. Jour. of Opth., St. Louis, Jan., '94.) * FOLLICULAR CONJUNCTIVITIS. Treatment is the same as for catarrhal con- junctivitis, with the additional indication of bringing about the disappearance of the folli- cles. This is the best accomplished by insuf- flations of iodoform, aristol, or calomel. In stubborn cases excision or expression of the follicles has been recommended. The hygienic surroundings should be bettered, if need be, the health of the patient attended to, and all near work prohibited. All errors of refraction should be carefully corrected under atropine. VERNAL CONJUNCTIVITIS. The disease is incurable, and palliation of the acute symptoms represents all that can be * * * * * * * >< ... y \,, §3:...'...} * + -- i. * Gºº $ * **. s . . . . ~~~ : - ;...? sº tº 3- " " ? * * *- - "… ". . . * ** * * , * > - -, * w v- •' . . . . . . . . . yº º 3 •. . . & - ** * * * * done. Van Milligen, who has had excellent opportunities to study the disease in Constan- tinople, where it occurs more frequently than elsewhere, has employed a solution of acetic acid, one to twenty grains to the ounce, with marked benefit. I have obtained excellent re- sults from the same remedy. Spring catarrh is an attenuated form of trachoma, the affection of the conjunctiva of the lid being primary and the immediate cause of the hypertrophy of the limbus. Good results obtained from vigorous friction of the lid with mitigated nitrate-of-silver stick. Chibret (Re- Vue Gen. d’Ophtal., March, '93.)—Sajou’s An- nual and Analytical Cyclopedia of Practical Medicine, Vol. II., pages 341 to 344. TO ALL WHOM IT MAY CONCERN. In accordance with instructions given by resolutions passed at the National Convention for Revision of the Pharmacopoeia of the United States of America, held in Washing- ton, A. D., 1890, I here with give notice that a General Convention for the Revision of the Pharmacopoeia of the United States of Ameri- ca will be held in the city of Washington, D. C., beginning on the first Wednesday in May, 1900. It is requested that the several bodies represented in the convention of 1880 and 1890, and also such other incorporated state medical and pharmaceutical associations, and incorporated colleges of medicine and phar- macy, as shall have been in continuous opera- tion for at least five years immediately pre- ceding this notice, shall each elect delegates, not exceeding three in number; and that the Surgeon-General of the Army, the Surgeon- General of the Navy, and the Surgeon-General of the Marine Hospital Service shall appoint, each, not exceeding three medical officers to attend the aforesaid convention. It is desired that the several medical and pharmaceutical bodies and the Medical De- partments of the Army, Navy, and Marine Hospital Service shall transmit to me the names and residences of their respective dele- gates, as soon as said delegates shall have been appointed, so that a list of the delegates to the convention may be published in accord- ance with the resolutions passed at the 1890 Convention for the Revision of the Pharma- copoeia, in the newspapers and medical jour- nals in the month of March, 1900. Finally, it is further requested that the several medical and pharmaceutical bodies concerned, as well as the Medical Departments of the Army, Navy, and Marine Hospital Ser- vice, shall submit the present Pharmacopoeia to a careful revision, and that their delegates shall transmit the result of their labors to Dr. Frederick A. Castle, 51 West Fifty-eighth street, New York city, Secretary of the Com- mittee of Revision and Publication of the U. S. Pharmacopoeia, at least three months be- THE MEDICAL DIAL. fore May 2, 1900, the date fixed for the meet- . . ing of the convention. H. C. WOOD, President of the National Convention for Re- vising the U. S. Pharmacopoeia, held in Washington, D.C., A. D., 1890. M University of Pennsylvania, Philadelphia, Pa., May 1, 1899. TYPOGRAPHICAL ERRORS IN JUNE ISSUE. In Dr. Stuart's article, page 187, second column, the second paragraph, should have read as follows: - (1) That it is an infectious disease, com- municable from one person to another; not, however, by contact, as is smallpox, measles, etc., but by the entrance of microbes into the air passages through the atmosphere or into the alimentary canal in connection with some form of food, most commonly milk or meat. Third paragraph should have read: The question naturally arises: Do sana- toria” contribute materially to the advantage of the patient in the way of cure, or material improvement of his condition? Have the re- Sults of work already done in institutions de- voted to this service established their practical value? And page 188, first paragraph, commencing after the tenth line should have read: inscription in “Inferno”: “Det him abandon hope who enters here.” In Dr. Crosson’s article, page 193, first col- umn, the first line under cut belongs top sec- Ond column. EXPLANATION. Dr. A. T. Conley, of Cannon Falls, sends in the following letter from a patient, with in- terpretation, which will afford an excellent tomic to the weary physician who may have an idle moment on his hands: PROSPECTUS. Daer Sir yu Leickt to no how et es wet mer water Last Niet i gat a quit Dal pan ent Sens i got a gut rest Last Nit et was zum mater in et to pan in te siet es most goun mei tung es e bout te Sam nor te bouls i tuck kaster Oul Sent a botel Caster Oul Wet te Boe M. K — INTERPRETATION. Dear Sir.—You like to know how it is with my water. Last night I got a quite deal of pain and since I get a good rest. Last night it was some matter in it? the pain in the side is most gone, my tongue is about the same? nor the bowels. I took castor oil. Send a bottle castor oil with the boy. M. K — Bill Nye once said that a hot-water bag felt like a Mexican hairless dog. THE MEDICAL DIAL. ***** THE MISSISSIPPI VALLEY MEDICAL ASSOCIATION. This progressive society will hold its twen- ty-fifth annual meeting under the presidency of Dr. Duncan Eve, of Nashville, on October 3, 4, 5 and 6, in the city of Chicago. The com: mittee of arrangement confidently anticipates that this meeting will be a prominent feature in the history of the association, and advances the following reasons for this opinion: 1. The Autumn Fete, to be known as the American Festival, will be held from Septem- ber 25 to October 9, at which time the presi- dent and his cabinet will be the guests of the city during the laying of the corner stone of the new Federal building. 2. The railroad fare from all points to Chicago will be a flat one-fare rate for the round trip. 3. The post-graduate schools of the city Dropose to arrange for a series of clinics to be given during the festival period by the most eminent teachers in all the medical faculties of this great center, thus affording an extraor- dinary attraction. 4. Aside from the features mentioned above, there has been for several years past a desire on the part of the members to hold a meeting in Chicago. The accessibility of this city, and its splendid hotel facilities, make it an ideal convention place, and consequently the committee expect more than double the usual attendance at this meeting. Titles of papers should be sent in at once to the secretary, Dr. Henry E. Tuley, Louis- ville, Ky. The exhibit hall will be located on the seventeenth floor of the Masonic Temple. Ap- plications for space should be sent to Dr. J. Homer Cutler, 1010 Memorial Building, Chi- Cago. A NEW SYMPTOM FOR THE EARLY DIA G- NOSIS OF PULMONARY TUIBER- CUT OSIS. Dr. Murat (Gazette Hebdomadaire de Médi- cine et de Chirurgie, March 5) calls attention to a subjective symptom which he has found very frequently present in the subjects of incipient tuberculosis. It consists of a sensible vibration in the affected appex on loud speaking. Some- times the patient instinctively tries to dimin- ish this vibration by pressing the correspond. ing arm against the body. This symptom is a logical consequence of the induration of the lung tissue and is akin in its nature to broncho- phony, which it often precedes, however, as Dr. Murat is able to aver from his Own Observa- tions. If a patient in whom an early phthisical condition is suspected is instructed to make deep local expirations, and his attention is di- rected to this point, he will generally be able to recognize the vibration on the affected side, as though the tuberculous lung were in rela- tion with the larynx, while no such sensation is perceptible on the sound side. A thorough in- Vestigation of this point would, if it substanti- ates Dr. Murat’s opinion, place us in possession of a very valuable aid to the early diagnosis of pulmonary tuberculosis.-N. Y. Med. Jour. SMAILL POX IN TELE UNITED STATES. The following is the total number of small pox cases in the United States from December 31, 1898, to March 31, 1899, as reported to the Supervising Surgeon-General, United States Marine-Hospital Service: Alabama 127, 2 deaths; Arkansas 8, 1 death; California 82, 15 deaths; Colorado 121, 6 deaths; Connecticut 2; District of Columbia 58; Florida 18; Georgia 312; Illinois 38; In- diana 39; Indian Territory 45 deaths; Iowa 8, 1 death; Kansas 90, 7 deaths; Kentucky 259, 3. deaths; Louisiana 79; Maine 7; Maryland 10; Michigan 16, 1 death; Minnesota 1; Mississippi 17, 3 deaths; Missouri 58, 7 deaths; Montana 2; Nebraska 369, 3 deaths; New Jersey 6; New York 18, 3 deaths; North Carolina 33, 1 death; Ohio 311, 4 deaths; Oklahoma 37, 13 deaths; Pennsylvania 85; Porto Rico 403; Rhode Island 1; South Carolina 10; Tennessee 105; Texas 715, 116 deaths; Virginia 1,658, 14 deaths; Washington 3; Wisconsin 17, 2 deaths; Wy- Oming 4. It should be remembered that the above are the cases officially reported and due allowance should be made for errors and Omissions— principally the latter. Bob Burdette says: “Man that is married to a woman, is of many days and full of trouble. In the morning he draweth his sal- ary and in the evening behold it is gone. It is a tale that is told. It Vanisheth and no one knoweth whither it goeth. He riseth up, clothed in the chilly garments of night and seeketh somnambulent paregoric where with to soothe his infant posterity. He cometh forth as the horse or ox, and draweth the chariot of his offspring. He spendeth his shekels in the purchase of fine linen to cover the bosom of his family, yet himself is seen in the gates of the city with one suspender. Yea, he is altogether Wretched.” ANTITO XINE SAID TO IMMUNE FOR NINETY-SIX IDAYS. Dr. John M. Maury, in the Memphis Lancet, reports having administered 500 units of diph- theria antitoxine to a child of twelve years that had been exposed to a case of diphtheria in the same family but did not develop the disease until the ninety-sixth day thereafter. The boy was then given 2,000 units, with rapid recovery. THE MEDICAL DIAL. subDIME FAITH. A dermatologist began a paper on alopecia as follows: “Faith is usually pictured as a maiden clinging convulsively to the rock of ages. I think a more impressive representa- tion would be that of a bald-headed patient rubbing vigorously into his scalp the remedy prescribed by the bald-headed specialist in skin diseases.” * SHORT BUT SWEET. A doctor noted for his laconic style of expression sent the following terse and wit- ty note to a refractory patient who paid no at- tention to reiterated demands for the payment of his bill: “Sir, if you pay this bill you will oblige me. If you don’t I shall oblige you.”— N. Y. Lancet. A German scientist has analyzed the hu- man body into seven large nails, over six kilo- grams of candles, carbon to make sixty-five gross of lead pencils, phosphorus to make nearly a million matches, a large handful of . salt and enough sugar to sweeten fifty cups of coffee. All the above would fit nicely into 1,200 egg shells. And the genius of the age is not yet exhausted. A citizen of Minneapolis greatly amused the people on the street a few days ago by hav- ing a little pet pig which followed him around like a dog. This would remind one of Dr. Alexander Wood (“Lang Sandy Wood”), who treated Bobby Burns, the Scotch lyric com- poser, for a sprained knee, and had a pet sheep which followed him from place to place on his professional visits. * Eighteen trousers buttons, twenty-seven needles, several bits of nails and a buckle were swallowed by a German convict in the hopes of committing suicide, but failed, all the ar- ticles passing off in the usual way without in- Convenience. The new nurse, who had assisted the sur- geon in a simple operation and had heard some of the common expressions used, said of the condition of another patient that he urinated by first intention, because he did not hesitate. No foreign physician, who may be sojourn- ing in Italy, will be permitted to give first aid in any street accident without laying himself liable to prosecution and fine. This is one of the queer laws of untutored Italy. Adjutant-General Corbin has stated in his report that the following was the loss of life in the Spanish-American war from May 1, 1898, to February 28, 1899: Killed in action, 329; died of wounds, 125; died of disease, 5,277. Total, 5,731. LOCKJAW. Gelsemium has cured many cases of lock- jaw when all other remedies have failed. It must be given in large doses, and pushed to the extreme point of toleration.—Med. Sum- mary. HIS METHOD. “How do you pronounce the word “but terine’?” asked the customer. “The last syllable is silent,” stiffly replied the tradesman,—What to Eat. Index II?&dicuS. The following is a list of a few of the leading articles published in the June editions of some of the journals on our exchange list: NEW YORK MED. JOUR., JUNE 10th. President's Annual Address to the American AS-, sociation, by Joseph M. Matthews, M. D. Sanitary Lessons of the War, by George M. Sternberg, M. D., L.L. D., |U. S. A. The Voice in Diagnosis, by Alexander J. C. Skene, M. D. Vaginal Douches, Anti-partum and Post-partum, by N. Napoleon Boston, M. D. Pneumonectomy, the Future Treatment Of In- cipient Tuberculosis, by John S. Pyle, M. D., L.L. B. Medical Gynaecology, by Eugene Colenhall Savidge, M. D. NEW YORK MED. JOUR., JUNE 17th. Some Remarks upon Obstetrics in Private Pra C- tice, by J. Clifton Edgar, M. D. Quantitative Determination of Albumin in the Urine, by Charles W. Purdy, M. ID., L.L. D. A Severe Case of Puerperal Sepsis Treated by Antistreptococcus Serum and Uguentum Crede, by James D. Voorhees, A. M., M. D. The Use of Holocaine as a Local Anaesthetic in Eye, Dar, Nose and Throat Operations, by John Gut- mann, M. D. On a Compound Microscope for Viewing the Eye, by Lucien Howe, M. D. State of the Gastric Secretions in Organic Dis- ease of the Heart, by Frank H. Murdock, M. D. NEW YORK MED. JOUR., JUNE 24th. Some Critical and Desultory Remarks on Recent Laryngological and Rhinological Literature, by Jonathan Wright, M. D. (Ninth paper.) A Primary Polymorphous-cell Sarcoma of the Nose, with Universal Metastasis and Formation of a Free Sarcomatous Mass in the Right Ventricular Cavity, by Alfred Scott Warthin, M. D., Ph. D. How to Give Anaesthetics, by William S. Deutsch, M. D. The Inoculation Theory of Malaria, by Walter B. James, M. D. Surgical Operations during Hypnotic Sleep, by Arthur MacDonald. Rubber Gloves in Aseptic Abdominal Surgery, by C. H. Richardson, M. D. sº * THE MEDICAL DIAL. DENTAL DIGEST, CHICAGO. , - Conscientiousness in Our Daily Practice, by Dr. A. S. Sawyer. Painless Extirpation of Live Pulps without Cat- aphoresis, by Dr. P. M. Williams. SOUTH'N MED. JOUIR., LA GRANGE, N. C. Treatment of Urethral Stricture by Electrolysis, by Julius F. Lynch, M. D. New Methods Employed for the Relief of Im- paired Hearing, by Iouis J. Lautenbach, M. D., IPh. D. JOUR. OF MED. AND SCI., PORTLAND, ME. Passing of the Provincial Surgeon, by Franklin C. Thayer, M. D. -- Leucorrhoea and Its Renner, M. D. Development of Serum Therapy, by E. H. Jud- kills, M. D. - JOUR. OF MISS. MEI). ASS’N, BILOXI. A Study of Twelve Cases of Malarial Hematuria, Treatment, by Rob't C. Including Four Autopsies, by M. Goltman, M. D., and , MEDICAL RECORD, N. Y., JUNE 3d. Some of the Problems of the Alienist, by Fred- erick Peterson, M. D. Obscure Causes of Disease, by W. Stanton Glea- son, M. D. Rubeoliform Sobel, M. D. Remarks on the Midwifery Question, by Thomas J. Hillis, M. D. MEDICAL RECORD, N. Y., JUNE 10th. Remarks on the Incision at the Outer Border of the Rectus for Appendicitis, by Frederick [am- merer, M. D, Local Anaesthesia, by Alexander B. Johnson, M. D. - Diphtheritic Conjunctivitis Cured with Anti- toxin, by George Huston Bell, M. D. The Abortive Treatment of Gonorrheal Ophthal- mia, by a Cantholysis and the Thorough Application Of Nitrate Of Silver, Forty Grains to the Ounce, by H. D. Jamison, M. D. * MEDICAL RECORD, N. Y., JUNE 17th. Summer Complaints in Children, by Iouis Fisch- er, M. D. Reflections on the Nosology of the So-Called Functional Diseases, by Joseph Collins, M. D., and Joseph I'raenkel, M. D. - Traumatic Ruptures of the Heart, with a Case, by Richard Cole Newton, M. D. Congenital Cataract in the Rabbit, Obarrio, M. D. MEDICAL RECORI), N. Y., JUNE 24th. Subacute Ataxie Paralysis and Combined Schle- rosis, by Charles L. Dana, M. D. Military Tuberculosis of the Pleura without Other Tuberculosis Involvement of the Lung, by Eu- gene Hodenpyl, M. D. The Post-Febrile Insanities, by Allan McLane Hamilton, M. D. Fibrona of the Abdominal Wall, by C. Jeff Miller, M. D. and Other Eruptions, by Jacob by T. de PENN. MED. JOUR., PITTSBURG. Four Addresses of Welcome before the IPenn. Medical Society at Johnstown. - MERCIK'S ARCHIVES, N. Y. Ichthalbin in Pediatries, by Th. Homburger, M. D. The Therapy of Urotropin, with a Report of Some Personal Experiences, by Herman Schiller, M. D. A Contribution on the Therapeutic Action of Triphenin, by A. G. Servoss, M. D. The Treatment of Acute Enterocolitis, by Robert C. Kenner, A. M., M. D. Original Researches with the Salts of Strontium, by Leon II. Solomon, A. B., M. D. MED. IPORTNIGHTLY, ST. LOUIS. Hysteria Resulting from Severe Fright, by Prof. F. X. Dercum, M. D. Medical Inspection of School Children, by Frank Hinchey, M. D. Treatment of Septic Conditions Following La- bor, with the Injection of Anti-Streptococcic Serum, by A. G. Ellis, M. D. * Wrm. [raus, M. D. f MED. AND SURG. MONITOR, INDIANAPOLIS. Some Observations on Appendicitis, by E. I. Lar- kins, M. D. The Universal Symbolism of Medicine, by R. French Stone, M. D. Ophthalmia Neonatorum, by I. L. Firebaugh, MI. D. Perforations of the Hard and Soft Palate, by J. F. Barnhill, M. D. Diphtheria, by N. A. ISremer, M. D. Ilateral Curvature of the Spine, by J. A. Com- ingor, M. D. - GAZETTE MEDICALE I) E PARIS, 10 JUIN. Chronique Médicale: La Médicine aux Salons de 1899. Iles Epidemies manacantes: La Peste en Egypte. Les Banquets de la Sennaine: Le Banquet du D Eimly. THE POST-GRADUATE, N. Y. Etiology and Treatment of Chorea, by Joseph Collins, M. D. |Use of Oxygen with IEther for Anaesthesia, by Carter S. Cole, M. D. MARITIME MEDICAL NEWS, HALIFAX. Tuberculin—Its Value as an Aid in the Early Diagnosis of Tuberculosis, by D. A. Campbell, M. D. PAC, REC. OF MED. AND SURG., SAN FRAN. A Contribution to the Study of Antral Disease, by J. Dennis Arnold, MI. D. A Case of Melano-Sarcoma of the Conjunctive; Death, by Geo. C. Pardee, Ph. B., A. M., M. D. On Empyema of Sinus Frontalis, by F. Fehleisen, M. D. Ocular Neurasthemia, by E. J. Overend, M. D. Two New Instruments for Measuring the Monoe- ular Field of Fixation, by F. B. Eaton, M. D. Dietetics in Diseases Affecting Nutrition, by A J. Sanderson, MI. D. Hydatid Cysts, by Thos. G. Inman, MI. D. & * . . .” s" ºf ... §: * 5. ** * ..º. p.º. *...*.*, *. * **** * :* 4. Ż. . . . s." **** * * * , , º, . . .” 3. -- * * - - - -º .., x * 23 **. º*: º º * * * * : * -: *:: * ~ : * > . -: * { Nº ºx!'...ex ºf rx. * * , - * . 2. :6 $ ... r * . ... → * º X * --> - * * 4 # *. * - , # MEDICAL HERALD, ST. JOSEPH. The Use of Force for the Reduction of Fractures of the Iower End of the Radius, by D. Richardson, M. D. - Mitral Regurgitation and Aortic Stenosis, by Wm. N. Beggs, A. B., M. D. Chronic Nasal Catarrh, by P. I. Leonard, M. D. Remarks on Neurasthenia, by John Punton, M. D. INTERNAT’IL MED. MAG., N. Y. The Pathology of Gall-Stones, by Joseph Farland, M. D. Concerning Immunity and the Use of Normal Non-Immunized Serums, by W. Thornton Parker, M. D. * WIS. MED. RECORDER, JANESVILLE. Brain-Tire, by James Mills, M. S., M. D. Acute and Sudden Recurrent Appendicitis, by M. O. Terry, M. D. Ileucorrhoea, by Geo. S. Harnden, M. D. Ilocal Treatment for Gonorrhoea, by W. A. Cran- dall, M. D. NOI&TLIWESTEIRN LANCET, ST. PAUL, JUNE 1. I’ure Drinking Water, by Tomas Thams, M. D. Gonorrhoea in Women, by W. H. Bordenstab, M. I.). Observations in Anaesthesia, by Alice MagaW. What Are the IRespective Indications for the Ante- rior Abdominal and Vaginal Incisions for Pelvic DiS- ease, A. W. Abbott, M. D. NORTHWESTERN LANCET, ST. PAUL, JUNE 15. Hernia, by A. McLaren, M. D. On Subdivision of the Uterus, by F. J. Campbell, Ph. M., M. D. Some Abdominal Operations in Country Practice, by Thor Moeller, M. D. General Melanosis, by R. O. Beard, M. D. Alcohol, by Stuart Leech, M. D. MC- ST. PAUL MEDICAL J OljRNAIA. Etiology of Abcess of the Liver, by Henry Jach- son, M. D. The Osteopathic Delusion, M. D. Differential Diagnosis between Dietl's Crisis and Gall-Stone Colic, by Claarles L. Greene, M. D., and John T. Rogers, M. D. Myomectomy for Myoms of the Uterus, by J. L. Rothrock, M. D. Apparent Closure for the Eustachian Tubes, by B. M. Behrens, M. D. VIRGINIA MED. SEMI-MONTHLY, JUNE 9. Some Dropsies and Their Management, by J. C. by Arthur Sweeney, Wilson, M. D. Diagnosis of Bullet Wounds of the Intestines, by Hugh M. Taylor, M. D. The Antiseptic and Eliminative Treatment of Typhoid Fever, by T. Virgil Hubbard, M. D. Peritonitis from a Clinical Standpoint, by August Schachner, M. D. Specific Urethritis, by John W. Shaw, M. D. The Disinfection of Railway Coaches and Street Cars Operating in Ohio, by Frank Warner, M. T. THE MEDICAL DIAL. º • The Use of Chloroform in Labor, by Walker Bourne Gossett, M. D. Abdominal Surgery—Past and Present, Cases, by Franklin M. Brantley, M. D. The Eye in General Disease, by J. Wilkinson Jer- vey, M. D. - Some Points in Operating for Abscess of the Liver, by B. E. Hadra, M. D. The National Formulary, by M. D. Hoge, Jr., M. D. VIRGINIA MED. SEMI-MONTHLY, JUNE 23. A Case of Carcinoma of the Breast, by Elmer Sothoroln, M. D. w The Prevention and Treatment of Pelvic Inflam- mation in the IFemale by the General Practitioner, by R. R. Kime, M. D. Some Interesting Cases in Iłectal Surgery, by A. B. Cooke, A. M., M. D. Four Cases of Infantile Monstrosities in the Same Family, by William M. Hestle, M. D. I,acerated Wound of the Eye With Displaced Retina– I’reliminary Iridectomy in Incipient Cataract —Iridectomy for Atresiae Pupillae, by Dudley S. Reyn- Olds, A. M., M. D. The Continued I'evers of North Carolina, by Ben- jamin R. Hays, M. D. Treatment of Epileptics in Colony, by J. P. Edger- ly, M. D. Treatment of General Suppurative Peritonitis, by Stuart McGuire, M. D. Some Points in the Surgery of the Canal, by Floyd Willcox McRae, M. I.). The Medical Aspects of Crime, BrOWel', MI. D. Some Points in the Surgery of the Thumb, by Robert J. Iteed, M. D. The Materna—A New Device for the Home Modi- fication of Milk, by lienry E. Tuley, A. B., M. D. Treatment of Diabetes Mellitus, by J. M. Allen, A. M., M. D., L.L. D. Chronic Diarrhoea, by T. M. Greenwood, M. D. NEW YOIRIK IANCET. The Perineum) in First Ilabors, by J. W. Bullard, M. D. A Clinical Contribution to the Treatment Of Anaennia, by Geo. Taylor Stewart, M. I.). BTUFFALO MEDICAL JOURNAL, BUFFAI.O. Report of a Case of Acute Nephritis in an Infant —Probable Cause, Saccarin, by G. A. Himnaelsbach, M. I.). Impressions of Cuba and the Cubans, by Marshall Clinton, M. D. Hyperchlory dria, Including a Further Report on the Writer’s Effervescence Test, by A. L. Benedict, M. D. TJse Of Alcohol in the Treatment Of Nervous and Mental Diseases, by Sydney A. Dunham, M. D. GAILI/ARD’S MEDICAI, JOURNAL, N. Y. Proceedings of the American Medico-Psychologie- al Association. Puerperal Septicemia, by C. Prevost, M. D. Recollections of a Quarter of a Century, Stephen Smith Burt, M. A., M. D. Specialism in Medicine, by A. C. Corr, M. D. with Alillmentary by Daniel R. by THE MEDICAL DIAL. ix axxxxxxx ºxsassasssssssssss s - £33333 º OAKLAND : - HYDROGEN DIOXIDE, U. S. P. & - & “THE KIND THAT KEEPS.” * A positive and harmless antiseptic and germicide for in- º ternal and external use. - * & * . Highly recommended in the treatment of diphtheria, º º, scarlet, fever, and other contagious diseases. x As a prophylactic in preventive medicine it is without º & a peer, and may be used lavishly, or sparingly according to indications º: a suspicion of harm resulting from its use § in any application. . & THE OAKLAND CHEMICAL CO., 3.5 465-467 West Broadway, & NEW YORK CITY, N. Y. & §§ - - * sº * Q_*O2 TDC-02 Tºg º O ATPQ->O2 TDC-O2. TeG->O2. TSC-O-STDO §§ 3 : : - Q ºz. . . . . . 22 Nº. - I. Perceptional Center. II. Intellectual Center. III. Emotional Center. TV. Will Center. V. Motor Center; transmits the impulse to write ANTIKAMNIA TABLETs. Grises Per-Ost Per-Os: Der-Os: Deſ-Ost Deſ-Ost Dº Osº. D i : º:§: THE MEDICAL DIAL. #. i #.& .* * .º : 3. PUBLISHER'S DEPARTMENT. EXHIBIT AT THE THIRTY-FIRST ANNUAL MEETING OF THE MINNESOTA STATE MEDICAL SOCIETY, IN MINNEAPOLIS, JUNE 21 TO 23, 1809. The exhibitors were hardly satisfied with the facilities at their disposal at the West Ho- tel, at which hostelry the State Society held its Session this year, although the hotel man- agement did all they could to make matters pleasant for them. It was a poor place to hold sessions of such a large body at best, for the Simple reason that a hotel is never intended for such a purpose, and, besides, a national Order made the same hotel their stopping place at the same time, and the modest physicians did not have elbow room when in the lobby. There were fewer exhibits than WOuld have Otherwise been made had there been room, and the largest One had to seek Quarters in a vacant store opposite the hotel. The exhibitors were given one of the alcoves, usually used as a Writing room, and some other space in the lobby. However, those who had displays made the best of the OC- casion, distributing samples and literature and exer- cising their persuasive powers on the visitors. The following is a somewhat abbreviated account of the Several exhibits: PARIXE, DAVIS & CO., DETROIT. Represented by Mr. C. A. Robinson, of Minneapolis, Assisted by Mr. E. G. Basset, Mr. H. E. Harter and Mr. Harry Hazeltine, Northwestern Travel- ers for the House. It was impossible for the members of this firm to do justice to themselves by having their exhibit in the West hotel, consequently they secured a vacant store on the opposite side of Hennepin avenue and made the largest display while the Society was in Session. In one window they had several samples Of Sandal WOOd in its natural state, as well as bottles Containing the oil extracted from the wood, and preparations from the drug, while in the other win- dow were a number of guinea pigs, placed there simply to attract attention. Counters On either side displayed the numerous products placed on the mar- ket by this enterprising firm. A Cage held three roosters which were used to show the possibilities of ergot in discoloring the combs. To attempt to enumerate all the specialties of this well-known house here would be superfluous, but the representatives in charge of the exhibit took special pains to call attention to their septic vaccine whicle is pertinent to these small-pox times. Their vaccine is glycerinated and furnished in Capil- lary tubes with rubber bulbs for ejecting the fluid, One tube being required for each vaccination. It is claimed for this vaccine that inoculation is followed by a larger percentage of successful vaccinations than with any other on the market; that it is physi- ologically tested to insure activity; that it is bac- teriologically tested to secure entire absence of harm- ful micro-organisms, and that it is hermetically Sealed. Another equally important subject for Work among the physicians was the calling attention to their serums, of which this house makes One Of the largest varieties in the country. For instance, their anti-diphtheritic serum is supplied in bulbs contain- ing 500, 1,000, 1,500 and 2,000 units each, ready for instant use. Then there is their anti-StreptOCOCCiC serum, also in convenient bulbs, as well as their anti- tetanic serum. These serums are highly recom- mended as perfectly reliable, pure, and of full strength. Ergot aseptic is also supplied in the same form of bulb ready for use. A meat booklet, showing the good results from the use of Taka-Diastase, one of their preparations, 4. in indigestion and superdigestion, was handed out; also a reprint of an article by J. I. Dowling, M. D., of New York, on the “Nuclein Solution in the Treat- ment of Scrofula.”; also a circular ShoWing the use- fulness of Syrup Trifolium Compound, and a Com- plete catalogue of the firm's tablets, any of which will gladly be mailed on postal card request to the address of the firm in Detroit. - D. APPLETON & COMPANY, NEW YORK CITY. Represented by Mr. H. L. McCoy, 318 N. Y. Life Building, Minneapolis. This house is too well known to need but a pass- ing mention here, and their representative, Mr. H. L. McCoy, is also too well known in the northWest to require at our hands a biography, but it might per- haps be well to say something about both. Their mutual interests lie, of course, with the physicians, and while the former has a world-wide field that it covers in an eminently satisfactory manner, the lat- ter has probably the best section of the Country, in which to devote his time in filling the Wants of phy- sicians who constantly need the latest results of med- ical research and practice in permanent book form. Mr. McCoy does his work in a right royal man- ner, as was evidenced by the hearty hand-shake given him by many of the oldest practitioners of the state who were in attendance, and evidence Came from several of the younger members of the profes- sion, who said they were under a debt of gratitude to Mr. McCoy for courtesies extended to then. On their graduation from the medical department. Under these circumstances there is no wonder that the house of D. Appleton & Company prospers in the north- Western StateS. We are informed that Mr. McCoy has a COm- plete stock of all the medical works of the company at his rooms in the New York Life Building, in this city, and books will be sent on telegraphic, tele- phonic or chirographic order without a moment's . delay. FAIR CHILD BIROS. & FOSTER, NEW YORK CITY. Represented by Mr. F. G. Aldworth, of Minneapolis. This popular firm has been before the profession for many years with such valuable compounds that many physicians would find it inconvenient to practice without them. The firm’s representative, Mr. Aldworth, successfully presented the claims of “Panopepton” and had a large Supply of Samples On hand, which were freely distributed to members of the society. Ilarge claims are made for this prepa- ration, which were presented in convincing form in a booklet giving Clinical reports On the COmpound. “Panopepton” combines “the prime food ele- ments, albuminous and farinaceous, in a perfectly assimilable and agreeable solution. The beef and the bread, having been physiologically converted into the soluble and diffusible form absolutely essential to their appropriation by the system, are sterilized and concentrated and preserved in Sherry Wine.” I'airchild Bros. & Foster originated the idea of preparing Such a nutrient food and, Of Course, have made a special Study of the effects thereof and plen- ty of evidence that it will do just what they claim for it is adduced. Their “Peptogenic Milk Powder” for modify- ing COWS' milk was fully shown to visitors. It is claimed for this powder that it will convert cows' milk into a food for infants that is almost identical with human milk, which gives it an important place in the physician’s medicine cabinet. THE H. R. MULFORD CO., PHILADELPHIA. Represented by Mr. Edwin V. Clark, Minneapolis. If any citizen of Minneapolis or visitor at the hotel, Whether a physician of layman, had but re- THE MEDICAL DIAL. quested, he could have been inoculated with almost any contagious disease he might Select, from diph- theria to Asiatic cholera, for the above firrh had the germs of each in tubes properly labeled and Corked. Should one wish to see how each miscrobe looked under the microscope he had but to look at the del- icate reproductions from the micro-photographs, which were also in display. It so happened that no one requested to be inoculated, but there were many who examined the photographs and Wondered how the little mischief-makers could do such awful dam- age to the human body, or to any other animal Structure. There was also a fine display of antitoxines for the physician’s use as well as for the Veterinary Sur- geon. Their glycerinated vaccine lymph, of whiclı samples were at hand, attracted much attention. Other specialties were Granular Effervescent Salicylos, Soluble Effervescent Tablets Lithos, Cap- Sules Terebene and Sandal Comp., Bismuth Formic- iodide Comp., Glycerite of Ichthyol and Iodine Comp., Elixir Hydrangea and Lithium Comp., Capsules Methylene-Blue Comp. and Wild Cherry and Mor- I'hulaline COrdial. Mr. Clark was cordially greeted by numerous friends among the profession. THE YAWMAN & ERBE MANUFACTURING CO., SUCCESSORS TO THE OFFICE SIPECIALTY CO., I&OCHESTER, N. Y. Represented by Mr. Charles F. Meyer, of St. Paul. This house is One Of the largest in the Country in its line of business, manufacturing as it does many novel devices for the office, including letter files, bill files and indexes. One of the most COInvenient Of these for the physician, who cares at all for method, in his work, is the index file, where may be kept for instant reference, a literary index, or an index of Cases, giving history and progress and line of treat- ment for each individual who may come under his care. We have in mind a physician in this city who keeps a double index of Cases in such a way that he Can, in five seconds, look up the whole line of treat- ment Of any Case he has, Whether under his atten- tion for Only a few weeks or for several years, and his Cabinet and filing boxes are home-made and prob- ably cost him more than the Cabinets made by the above house, while they are not anywhere near so elegant or so compact. A letter addressed to the house or to the representative will secure a complete Catalogue from which selections may be made. Mr. Meyer was in evidence with samples and we are informed secured several good orders. WM. H. ARMSTRONG & CO., INDIANAPOLIS. Represented by Mr. A. C. Dice, District Manager, Minneapolis. This house, One of the best-known in the West, and One of the largest in the Country, manufactures a complete line of surgical instruments, deformity ap- paratus, trusses, crutches and elastic hosiery. In the line of instruments Mr. Dice had one of the most complete outfits on the floor, and considerable inter- "est was manifested in the examination Of the Several articles in the display. Several good orders were booked. THE MALTINE CO., BROOK.I.YN, NEW YORIK. Represented by Dr. Ward R. Ford, of Minneapolis. This company, one of the largest in the Coun- try, has but recently placed a new compound on the market—“Maltine with Creosote”—which Seems to be meeting the requirements for a combination of the lat- ter drug with something that would completely disguise its disagreeable taste, and at the same time remove the tendency Of Creosote to produce gastric irritation. Thorough and Sat- isfactory tests have been made With the compound, and the results so far have been eminently satisfactory to numerous distinguished practitioners in the 'East. For the various forms of tuberculosis it is highly recommended. A Very large number of samples were given away, together With the other and better known preparations. And in addition to the above a very pretty desk pad for blot- ting paper with “Maltine” advertising upon it was presented to nearly every physician. Dr. Ford was highly pleased with the reception, given the samples and souvenirs, and any outsider who might Witness the proceedings for a few minutes could observe that the gentleman's personality was a large factor in the pleasure of the professional gentlemen who carried to their homes the neat bundles presented to them. W. D. ALLISON CO., INDIANAPOLIS. Represented by Mr. A. C. Dige, District Manager, Minneapolis, 816 Dayton Building. Indianapolis is the center where a large num- ber of articles are manufactured in all trades, but there is probably no article that comes from that city, in any line, that gives more satisfaction to the users than the physicians’ table, made by the W. D. Allison Co. It is so simple in Construction, SO easy to manipulate, so convenient and practical, that it commends itself to the surgeon at a glance. This table is built in such a way that the body of the pa- tient may be readily placed in any of the technically- named positions, when the fastenings effectually lock, and there are no vibrations. The Allison combination cabinet, made by the same parties, is also enthusiastically received by the profession. It is aseptic and dust proof and Will hold all the instruments and medicine in bottles that any physician, with the largest practice, may need in his daily work. The same firm also makes an instrument Cabinet which is meat and artistic in alppearance and is Con- venient and practical. All of the good points of the above were shown in a persuasive and effective manner by Mr. Dice, and the missionary work done by him will no doubt result in many sales in the future. CHAS. H. CIRIKI,ER, MINNEAPOLIS. Represented by Mr. J. B. Murphy, of Minneapolis. Mr. Cirkler, the popular druggist and chemist, located in the Dayton building, this city, has well- nigh turned his place of business into a physicians' and hospital supply house, and is now holding the field in Minneapolis in this line of trade, and his only handicap is room to do his increasing business, which, however, we understand will be promptly overcome when the necessity becomes too urgent. He had an elegant display on the floor, under the charge of Mr. Murphy, of this city, who booked numerous Orders for immediate alld future delivery. There was a full line of surgical instruments, and physicians' and hospital supplies on exhibition, among them a couple of electric batteries which at- tracted attention and were tested by the visitors, creating amusement for the other exhibitors. Com- plete Catalogues of instrument Cases were given Out as well as of the Other goods handled by Mr. Cirkler. Parties living in the northwestern states will find it convenient to Send their Orders direct to this house and receive prompt service and the best goods made in the Country. THE OAKLAND CHEMICAL CO., NEW YORK - CITY. Represented by Mr. H. N. Timolat, of Minneapolis. “The Rind that Reeps,” is the motto for the prin- Cipal product of the above house, referring to their Oakland Hydrogen Dioxide. This compound is one of the best known antiseptics and germicides on the * - + * * *. * - e - “...,' * 4 i THE MEDICALDIAL. market for internal and external use, and it is claimed for it that it is one of the best for the treat- ment of diphtheria, scarlet fever and other Con- tagious diseases. The strongest point in its favor, aside from its effectiveness, is its harmlessness, for it may be used with lavishness or in Small quantities and there need be no fear that harm Will result. It may be used with confidence wherever an antiseptic is needed. Truly this is the age of antiseptics and warfare against the mysterious microbe, and it is very evident that Oakland Hydrogen Dioxide is one of the strongest weapons against that foe of man- kind. Mr. Timolat was busy giving Out Samples and monograms on the compound. For the administration of OXygen gas the above company has placed on the market a very convenient form of inhaling bottle, which is cheap and its utility is quite apparent when Once it is tried. THE NEW YORK PHARMACAL ASSOCIATION, THE ARLINGTON CHEMICAL COMPANY., . THE PALISADE MANUFACTURING CO., YONICERS, NEW YORK. Represented by E. R. Tarry, M. D., of Virginia. The above three establishments are One and the Same, and have the same management, the same fac- tory and the same general office. They had a con- spicuous location for their exhibit, under the charge of Dr. Tarry, who distributed samples of Lectopep- tine preparations, Liquid Peptonoids, Borolyptol, Rola, Cardinette and Hemaboloids, together with lit- erature fully describing each compound in detail. All these preparations are meeting with favor, and from talks with several physicians we were informed that they Were deserving of a still greater reputation in the profession. NOYES BROS. & CUTLER, ST. PAUL. Represented by Mr. William O. Wilson, of St. Paul. This well-known house had one of the largest displays on the floor, consisting of surgical instru- ments and appliances of all kinds. Mr. Wilson, the genial representative, is an ex- pert in the exhibition work, and made an impression upon the physicians who took the pains to examine the goods on disply. THE PHYSICIANS" AND SUIRGEONS' ASSO- CIATION. Among the new and promising enterprises in Min- neapolis is the Physicians' and Surgeons' Association, With Offices at 410, 412 and 414 Temple Court. The Object of the Association is to furnish infor- mation to its members concerning the standing of in- dividuals, or promptness or tardiness with which they meet their obligations to the profession; making col- lections of Outstanding accounts, etc., etc. The management of the Association is with Mr. H. M. Stocking and C. L. Wright, both of whom are gentlemen of Successful experience in their line. Business entrusted to their care will receive careful and prompt attention. Although beginning less than a year Since, they have already made a record for suc- CeSS and promptness which commends them to the profession, and any who are not yet members of the ASSOCiation, Would do well to confer with them. Dr. L. Lewis, Lewis Sanitorium, Auburn, N. Y., reports: I had a Mrs. R. upon Hagee's Cordial, and She improved every day. Her weight when she be- gan Was 101 pounds, and is now 145 pounds, after eight months’ use of the Cordial. She lºad night SWeats, hectic Cough, diarrhoea, and all the regular symptoms which are connected with Phthisis. It is seldom that you will find genuine. scientific advertising pages, yet if you will turn another page, . occupied by the McArthur Hypophosphite Co., of Ansonia, Conn., you will find it there Óf a Very in- Structing and interesting character. LBăſling DIIIggists ºf Millſ|Bā)0lis, Jºe O PEN A LIL NIGHT, *@% The Voegeli Bros. Drug Co., PRESCRIPTION DRUGG | STS- 2 and 4 WASHINGTON Ave. S., Cor. HENNEPIN. We carry the most complete stock of Drugs and Chemicals in the Northwest. Mail Orders Promptly Filled. *xºk ºk sºciº-ºxº, as a was a ſaxºkrº ºr * * * * * * *.xxºkiærk ºak-º-º-ºk jºkiºk ºk # weBSTER & CºurcKILL, : PHAR MAC I STS, () ; Under Nicollet House, Minneapolis, Minn. ! .*. *|| Careful attention given to Physicians' Prescriptions. | LEWIS A. NWARTIN, (Successor to F. J. SALFINGER) WATCH MAKER § JEWELER 704 PHOENIX BU LD 1 NG. Watches, Clocks and Jewelry Repairing. Clocks Called For and Delivered Free of Charge. Physicians and other profes- sional men may wisely see that the stationery used in their professional correspondence is of attractive and proper style. The Beard Art & Stationery Co. give particular attention to filling such orders, and will send samples and quote prices on request. Address 705 Nicollet avenue, Minneapolis; telephone 181. THE MEDICAL DIAL. i xii §§§3$38,238,238,238,238,238.23 Nº. LOWERS... BEAUTIFUL ROSES CARNATIONS LILIES W. and all the flowers in their season. Funerals a spec- * ialty. Telegraph orders for funerals and parties º filled. Seeds and other florist supplies. Send or Catalo City Store, 414 Nicollet Ave., Minneapolis, - - Minnesota. #3:3#3:3#33.3%.3%33.3 gue. MENDEN HALL GREEN Hous ES, First Ave. S. and 18th St., or ********; Seeley's Hard-Rubber Trusses - Double Inguinal Truss. Rupture Holders and Curers. i & ceives our personal attention. Our “ready to wear” trusses are always satisfactory. Full directions and plates Mail Orders a Specialty—each one re- i go with them. Catalogue shows too i patterns—send for life plates, etc. Chesterman & Streeter Successors to 1. B. SEELEY & Co. 25 So. 11th St. Philadelphia. •eeeeeeeeeeeºººººººººººe - - MARSHALL'S CONVERTIBLEBUGGY BASEM),3? - changes into saddle -º Bag (is both in one). Finest, best durable leather finish outside 32 bottles, with spaces between rows for pow- der papers, 2 sundr spaces, one under eac d, 7%x2%x2%. Delivered, privilege of examination, C. 0. , bal. $8.50, or ex- press paid. ºù0 it ou remit $1.00 earn- PATENTED. We sell Saddle Bags low as $475. 24 bottles "...” º $5.50 Best Leader Buggy Case, 26 3-dr., 26 6– nº bºttles in springs, laundry spaçº, $3.75. We mail full line prices and illustrations if asked for. Address W. S. MARSHALL, Care of Exchange Bank. CENTRALIA, Lºs º Eurºka Mºhillilºſ Mounted on 4-Sawed Oak Table * less steel, size 10x30 in. |A tested to 500 lbs. Fin- ished in nickle plate ºlor oxidized. The most useful and practical ". º paratus ever offered to physicians for the ºr Spºtial Treatmºſt ºss of Chronic Bron- m - - chitis, incipient - - Consumption & all Catarrhal af. A fections of the ºHead, Throat and Lungs. - - - N. s N ºs º - - tºº - º - Write /or Literature. º º, º Hºlm, ºn g, a gº, Ill. Goodyear Rubber Co., JAMES SUYDAM, Māmāgār, 92, 94, 96, 98, too and 102 E. Seventh St., S.T. PAUL, MINN. Manufacturers of the º, Flſ|S|| Best quality bag and tubing; reversible rectal and infant pipes; eye spray; ear and nasal tubes; bent and irrigating vaginal pipes. Sizes: 2, 3 and 4 Quarts. Northwestern Distributers of Dr. L. WILHOFT'S (ORIGINAL) LADY'S SYRINGE Made of one piece of soft rubber and constructed on the only correct principle, viz: injection and suc- tion. It is the best vaginal Syriuge made. Sºld fºr Destriptivº Circulars. xiv. THE MEDICAL DIAL. Physicians Know the Injurious Effects of the jolts and jars and shocks received º in riding the ordinary bicycles, with rigid - frames. They also know (who have tried them) the luxury of riding a Cushion frame, KONNARK YARNELL MADE BY US SINCE 1896. TH; IS OUR FOURTH SEASON, and hundreds of delighted riders are our advertisers. Dr. EITEL bought the first Cushion frame wheel which we made and has declared since that $1,000 would not purchase it if he could not get another one like it. Among the other prominent physicians riding the KONNARK or YARNELL are the following: DR, WM. A. HALLow ELL, DR. J. T. MooRE, DR. ADA PECK, DR. C. H. T.AskER, DR, HAMILTON, DR. MARION A. MEAD, DR. R. M. PETERs, DR. M. P. VANDERHORCK, DR. J. W. MAcDonal.D. DR. L. A. NIPPERT. DR. T. S. Rob ERTs, DR. F. R. WRIGHT. Send for Catalogue.—Prices, $40 to $70 for Cushion Frames. MOORE CARVING MACHINE COMPANY., corner Seventh Street and First Avenue So., MIN NEAPOLIS, MINN. Did You Ever Sée Anything Like It?” THAE : Manhattan Typewriter. QUALITY HIGHEST, PRICE LOWEST. Typewriters Sold, Exchanged, Rented. SUPPLIES FOR ALL TYPEWRITERs. º MAxFIELD & Oliver, Northwestern Dealers, 17 so. 4TH STRE T, telephone las-2. MIN NEAPOLIS, MINN. A Singer | s== BAZZI-BIAN CHI - - s:FE & º-º] Sewing Machine || | PhDIB|ISS|| THE BEST INVESTMENT ON EARTH, - F. || ||3: Velvet-Lined case, $4.00. earning more in proportion to cost - - Beware of infringements. than any other purchase possible. Tººlſ THREE DIFFERENT KINDS, º All genuine have our name on instru- either lock-stitch or chain-stitch. º! ment. Buy from your dealer, |/|\\ſ) if not in stock, BUILT LIKE A WATCH, |\{0}\) or, 11 not in Stoc at the largest and best equipped factory in the | |||}|{ from us direct. world, where every machine is carefully tested Rºſ V º º § on practical stitching. º NQ GEORGE P. PILLING & SON, Sold only by ºf: §§ == 1229 Callouhill St., Philadelphia, THE SINGER MANUFACTURING COMPANY ºf Sole Agents for U. S. A. THE MEDICAL DIAL. XV THE ALLISON PHYSICIANS TABLE. 1899 NAO DEL. Have you seen it? This style, No. 34, our latest production, surpasses in beauty, convenience and practical utility anything of the kind ever seen. The unique design, compact and harmonious, adjustable stirrups and leg crutches, glass trays in the revolving cabinets, detachable leg rests, the simple and ingenious mechanism—rendering it noiseless in its movements and easy of manipulation—are the secrets of its popularity. It is used in the Post Graduate Schools of New York and Chicago and heartily endorsed by faculty and students—a distinction no other table enjoys. The ALLISON CHAIR has been a leader for years, and is one of the most practical and convenient chairs made. Our COMBINATION CABINET No. 61, As shown in the cut, is a marvel, uniting in a single and handsome article of furtiture an instrument cabinet, aseptic and dust proof, a medicine cabinet with swinging racks for bottles, a writing desk, drawers for bandages, and compartment for wash basin. Our revolving Instrument Cabinets, thoroughly aseptic and proof against dust and dampness, are deservedly popular. The ALLISON Wall cabinet is in great demand. Catalogué Frè6. W. D. ALLISON CO., Manfrs., 133 E. South Street, INDIANAPOLIS, IND. A. C. DICE, Dist. M. ngr., 816 Dayton Bldg., Minneapolis. Liquor LITHIUM MAIZENATE. |MAIZO-LITHIUM ------- -------- -----rive di ura--- A genito-urinary sedative, an active diuretic; solvent and flush indicated for the relief and pre- vention of renal colic; a sedative in the acute stages of gonorrhoea, cystitis and epididymitis ; in dropsical effusions due to enfeebled heart or to renal diseases. As a solvent in the varied mani- festations of gout, goutiness and neurotic lithemia, periodical migrainous headache, epigastric oppres- sion, cardiac palpitation, irregular, weak or inter- mittent pulse; irritability, moodiness, insomnia and other nervous symptoms of uric-acidemia. Decidedly better, more economical, extensive in ac- tion and definite in results than mineral waters. In LITHEMIA by reason of the neutralizing - ower of Lithium in combination with Maizenic acid, the superior diuretic. In RENAL COLIC as a solvent and eliminant - of uric acid, and prophylac- tic against future attacks. In as a urine alkalinizer, and on URETHRITIS account of the remarkable se- dative action of corn silk upon inflamed genito- urinary mucous membrane. In OEDEMA resulting from cardiac or a renal dis- ease the pulse becomes regular and strong; there occurs marked diuresis and increas- ed proportion of urinary solids. Those cases of irritable heart, irregular or in- termittent pulse so frequently met ºš". insur- ance examiners and found to be due to excess of uric acid are special indication for Maizo-Lithum. Nascent Chemic Union of Maizenic Acid—from Green Corn Silk—with Lithium, forming Maizenate-Lith- tum Two grains to drachm. Dose 1 *o 2 drachms. 8 oz. bottle, gr.o.o. -------> ------- -n ------------ Liquor sali-iodides. TRI-IODIDES H E N RY'S ----R-Y -- ------ --> ------------ A powerful alterative and resolvent, glandular and hepatic stimulant, and succedaneum, “o the iodides. Indicated in all conditions dependent upon perverted tissue metabolism; in lymphatic engorgements and functional visceral distur- bances; in lingering rheumatic pains which are “worse at night.” Bone, periosteal and visceral symptoms of late syphilis; for the removal of all inflammatory, plastic and gouty deposits. A remedy in sciatica, megrim, neuralgias, lum- bago and muscular pains; the gouty and rheu- matic diatheses; acute and chronic rheumatism and gout; chronic eczema and psoriasis, * a11 dermic disorders in which there is an under ying blood taint. Tri-iodides enter into the composition of in- flammatory and gummatous º romoting disintegration and absorption of the feebly organ- ized tissues. In H. En RY PHARMACAL co- icº Cordial. Dose, 1 to ſº drawns in Louisvi L.L.E., KY- Arterial sclerosis they check or modify the degenerative process when this is due to a syphi- litic, gouty or rheumatic taint thus acting directly as a prophylactic against cerebral apoplexy. Indolent lymphatic enlargements Tri-iodides have a marked deobstruent effect and are specially indicated. Tri-iodides are diagnostic in dermic disorders in which unrecognized syphilis is the underlying cause. An hepatic stimulant increasing the quantity and fluidity of the bile. Relieves hepatic and intestinal torpor; does not cause the unpleasant gastric symptoms of potassium iodide. Colchicºn, 1-20 grain. Decandrºn, 1-to-grain. Solanin, 1-3 grain. Soda Salicylate, to grains ſodic Acid (equal to 7-32 grain Iodine , 4 romaſ- water. 8-02. Bottle, ºr oo. tºº *** *r- - §§§ tº ", " ". * ~ * * º ºf 2 ** * r $. -- * šºvi THE MEDICAL DIAL. • * * SWR. HYPOPHOS. CO., FELLOWS Contains the Essential Elements of the Animal Organization—Potash and Lime; wºm- The Oxidizing Agents—Iron and Manganese ; The TonicS—Quinine and Strychnine ; And the Vitalizing Constituent—Phosphorus; the whole combined in the form of a Syrup with a Slightly Alkaline Reaction. It Differs in Its Effects from all Analogous Preparations ; and it possesses the important prop- erties of being pleasant to the taste, easily borne by the Stomach and harmless under prolonged use. It has Gained a Wide Reputation, particularly in the treatment of Pulmonary Tuberculosis, Chronic Bronchitis and other affections of the respiratory organs. It has also been employed with much success in various nervous and debilitating diseases. Its Curative POWer is largely attributable to its stimulent tonic and nutritive properties, by means of which the energy of the system is recruited. Its Action is Prompt; it stimulates the appetite and the digestion, it promotes assimilation and it enters directiy into the circulation with the food products. The prescribed dose produces a feeling of bouyancy, and reluoVeS depression and melancholy ; hence the preparation is of great value in the treatment of mental and nervous affections. From the fact, also, that it exerts a double tonic influence and induces a healthy flow of the Secretions, its use is indicated in a wide range of diseases. NOTICE—CAUTION. The success of Fellows' Syrup of Hypophosphites has tempted certain persons to offer imitations of it for sale. Mr. Fellows, who has examined samples of several of these, finds that no two of them are identical, and that all of them differ from the original in composition, in freedom from acid reaction, in susceptibility to the effects of oxygen when exposed to light or heat, in the property of retaining the strychnine in solution, and in the medicinal effects. As these cheap and inefficient substitutes are frequently dispensed instead of the genuine preparation, physicians are earnestly requested, when prescribing the Syrup, to write “Syr. Hypophos. Fellows.” As a further precaution, it is advisable that the Syrup should be ordered in the original bottles; the distinguishing marks which the bottles (and the wrappers surround- ing them) bear, can then be examined, and the genuineness—or otherwise—of the con- tents thereby proved. Medical Letters may be Addressed to: Mr. FELLOWS, 48 Vesey Street, New York. Damp º . | N. (JCathºr Is the time to buy a Static Machine. One that works every day, rain or shine. (Jagher inica-Plate Static machine is this sort. It does not collect moisture. It can be run at a high rate of speed. It has the largest generating capacity. It is unexcelled for X-Ray work. It produces the most sedative current for relieving pain. It is the cheapest for what you get. A 4-Plate i. the work : ſºlate CHICAGO glass machine. CATALOG on APPLICATION R. V. WAGNER & Co., Inc. 30a D-A-Bonn strº-E-T º The island of ººloºliºu wondorº, native win and ruits. resort at which to enjoy your Summer's outinº. - THE HOTEL victory, ºut-in- Bºy Island, take ºrie, onio. The World's Largest and Most Charminº: Summer Hotel. - cºol, deliºttu air no sudden changes: pure water, absolutely no mosquitoes; fishing, boating, bathing. dancing: nata: ºrinº ºnºments innumerºle; large orchestra: ºl acres of lawn; service and cuisine unsurpassed; º' ºr ºntº, ºwº ºilºsºtric car Hines to the ºves and principal pºrts of the island 1// rººs centering at Cleveland, Sandusky, tº and Detrºit, make dirºt dº sº for Put-in-Bay Island and Hotel Victory. Open from June 22d tº Sºlºmber 15th. Rºtes tºo tº #5 per day; $10.50 to sº weekly: greatly reduced mºnthly rates. Children 10 years and under, and nurses, halt rate, º/wº ſº, etc., tº wº, tººs pºstº. Rate card on application. - ſ: - - - - - The Historical Battleground of Perry's Victºry. The ideal º º As ºne well-known man in public life writes: " It is a great place. It is a boºn tº the invalid, a Mºca to the tourist, a Paralise . tº whildren, Nature's ºnly spot; and considering it all-the clºan and cºntortable hotº the exºellent ºuisine, the Interesting soci º, the very ºeux wiris, the nuns admirable orchestra, the gravious landsºme the healthºut air and all the rºst of it 1 ºn woºl- ºntºusly sºy that nºvº in my lite betwºre lºve I received so ºwn a return upon my investment. The Hotel Victory should nº known vºw lºº. It is ºn annºtion of mºunturºny tº diſtus' this ºsmº of ºne ºnce " . - - - L. - - - ſº - - - - - - CTO ºr Y ( A tºrºs.: Hºº L \ . ºf: THE MEDICAL DIAL. vii. - - - º*_ ºf ſº N | º, *, 's- ºf ſº - - | | -- 293-200 0NEIDA B10CK MiNNEApolls. - - Aº * Ellſbºa Mºhillilºſ tº mounted on M-Sawed Oak Table Dºº ºa Air-receiver of seam- º º, less steel, size 10x30 in. | - tested to 500 lbs. Fin- | ished in nickle plate ºl | ºlor oxidized. The most | - useful and practical ". - paratus ever offered to physicians for the R Special Treatment º- of Chronic Bron- chitis, Incipient Consumption & all Catarrhalaf- A ſections of the ºhead, Throat and Lungs. - - - | º - tº ſº Write for Literature. - - [], []. HOLMAN, G8II'l Agt, La Grangº, Ill. Physicians and other profes- sional men may wisely see that the stationery used in their professional correspondence is of attractive and proper style. The Beard Art & Stationery Co. give particular attention to filling such orders, and will send samples and quote prices On request. Address 705 Nicollet avenue, Minneapolis; telephone 181. TJOHNTWYETHT&TEROTHER " |||}|||}||||||} N EUTRAL. (Liquor Mangano-Ferri Peptomatus— Wyeth.) ANAEMIA, CHLOROSIS, SCROFULA, DEBILITY. The value of Iron and Manganese in the form of pep- tonates as offered in this preparation may be summarized from the latest scientific researches, as follows: (I) By association with peptone, the albuminates of iron and manganese become “digested,” or, in other words, much of the labor of the stomach and pancreas in this respect is saved. (2) Peptone is a body that is not provided abundantly by the stomach, even in health ; and hence, its artificial administration is, for weak digestion a desideratum. (3) It is a necessary adjunct of pancreatic digestion. (4) It is easily absorbed. (5) It increases peristaltic action. DOSE.-For an adult, one tablespoonful well diluted with water, milk or sweet wine, three or four times a day. Per Gallon, $5.00 Per Dozen 12-ounces, $9.50 Wyeth's Liquid Malt Extraſt. Containing all the Nutrient Properties of Malt, with the Least Possible Quantity of Alcohol. We claim that our LIQUID MALT EXTRACZ zvill be found to contain all the nutrition of the best Malt Ziquors in a higher degree than any of the largely sold Liquid Malts with which zwe have compared it, having the marked advantage that it is free from the stimulating effect Zuhich inzariably follows their administration. LOSS OF APPETITE.-A wineglassful taken half an hour before each meal and before retiring at night, will soon restore a healthy appetite. DYSPEPSIA.—Discontinue the use of ice-water, coffee, milk and all strong liquors, and use WYETH's LIQUID MALT as a regular beverage, especially with each meal or luncheon. A permanent cure will be the certain result. NURSING, MOTHERS.—Should use WYETH's LIQUID MALT liberally at every meal and luncheon and as a beverage. Per Dozen Pints - sº $3.00 WINE OF (ODLIVEROILEXTRACT With Cherry and Hypophosphites. A NUTRITIVE TONIC. Each fluidounce represents one fourth its _volume of Cod Liver Oil with Extract of Malt, Fluid Extract of Wild Cherry Bark, and the Hypophosphites of Lime, Sodium, Potassium, Iron, Manganese, Quinine and Strychnine. Adult dose, one tablespoonful three or four times daily. For a child, one to two teaspoonfuls. Per Dozen Pints - ſº $9.00 Elixir Anti-DVS]ºpſiſ, ThisJ. will be found peculiarly efficacious in those derangements attended with flatulence, acid fer- mentation, eructation superinduced by eating rich food, pastry, starchy vegetables, excess in drinking spirituous liquors, and excessive smoking. It will prove equally valuable in almost every condition of weak and impaired or imperfect digestive powers, either due to catarrh of the mucous coat of the stomach or in those symptoms char- acterized by sensations of distress and uneasiness during digestion, usually termed Nervous Dyspepsia. Each dessertspoonful contains: Pepsin I grain, Pancreatin 2 grains, Cascara Sagrada I grain, Ipecac I-5 grain, Strychnine I-60 grain, with the active constituents of 30 minims Antiseptic Solution. DOSE for an adult is one to two dessertspoonfuls after each meal or when feeling oppressed, much depending upon the severity or frequency of the attacks. $12.00 Per Dozen Pints - tº WY ETH'S Granular Eſtresſing Salts. Our list of GRANULAR EFFERVESCING SALTS embraces those in popular and general demand. For uniformity and fineness of granule, ready and complete solution, sparkling effervescence and general freshness, delicacy of flavor and character, they are un- surpassed. They are prepared with scrupulous exactness as to strength and contents of each drachm or sixty grains. We ask the attention of the medical profession to Dr. Cathell’s Essay on the use of Kissingen and Vichy for Reducing Over-Fatness, a copy of which we will furnish on application. These Salts are put up in 4-ounce Doubly Sealed Bottles. with a Dose Glass. EſſºrWESGing S0ffilm PhOS)hâtº Each dessertspoonful contains 30 grs. Sodium Phosphate. A M I LD, PLEASANT AND TASTELESS LAXATIVE A SPECIFIC IN constipATION CHILDREN's DIARRHCEA, ‘OBESITY, JAUNDICE, RICKETs, ETC., ETC. Sodium Phosphate has long been the favorite purga- tive, inasmuch as it acts gently but surely, has little or no taste, and is easily taken by children and delicate persons. In the present form—the effervescent—it is a delightful remedy, constituting a refreshing sparkling draught of bland action. Sodium Phosphate is a mild but certain hepatic stimulant, and relaxes the bowels both by promoting an excretion of bile and by acting directly upon the mucous membrane of the intestines. It does not cause “griping,” nor does it derange the stomach or excite nausea; unlike many other purgatives, it has a beneficial effect upon the digestion, stimulating the flow of gastric juice. Each Bottle accompanied Also in Bulk 1-pound Bottles. PHILADELPHIA, PENNA. THE MEDICAL DIAL. FORGED Send for literature, “The stomach is the link in the vicious circle (neurasthenia and nervous exhaustion) which has to be FORGED anew.” - Prof. Clifford Allbutt, System of Medicine, Vol. ii. . This restoration of digestive functions and powers of assimilation is invariably accomplished by........ GRAY's GlyceriNEToNic CoMP. the PURDUE FREDERick co. No. 15 Murray Street, New York The Hollem Portable A= Hygienic Bath. Made on Strictly Scientific Princi- ples and Fully Guaranteed. There has never been an accident with our Bath, and one is impossible. With the he at shut off it becomes a perfect cooling room, avoiding any shock to the sys- tem by contact with the outside cold air. Unlike all other -- baths, ours has an ºl. *A* tº Zºº Aº, & Zºº adjustable cover, ºeeeeeeeeeee which can be washed clean each week if desired, thus preventing the gathering of disease germs and microbes. Our strongest testimonials are from the leading Min- neapolis physicians. i º ſimi; &AW Free Bath book. Call or address THE SMNITARY MFG, CO., º THE SANATORIUM, HUDSON, WIS. AN INSTITUTION FOR THE SCIENTIFIC TREATMENT OF NON-GO NTAGIOUS DISEASES. gº; # Every Appliance and Method used which is §§ § recognized in Legitimate Medicine, including : § Turkish, Roman, Electric, Medicated and Thermal §§ t Baths—also every form of Electricity, as well as §§ Massage and Swedish Movements, etc. All under ; the supervision of Experienced Physicians and §: Trained Nurses. §: 406 Phoenix Building, MIN NEAPOLIS, MINN. if | # | º # #|| . The institution is delightfully located, with a long, wide veranda, inclosed in the winter season in glass, and is equipped with mod! ern conveniences, as Elevator, Electric Light and Electric Bells, Large Parlors. For terms, address THE SANATO RIUM. THE MEDICAL DIAL A Monthly Record of Medicine and Surgery. Vol. I. MINNEAPOLIS, AUGUST, 1899. No. 9. OriSimal HrticleS. *SURGICAL TREATMENT OF THE URETHRA IN OLD MEN. By D. R. GREENLEE, M. D., Surgeon Minnesotn Soldiers Home, Minneapolis. Without attempting to present a scientific discussion of the geneto-urinary organs of the male, I desire to report one hundred cases of aged men, who have suffered from the various diseases common to men of advanced years, and that is difficult micturition, which is a great affliction, and causes directly or indirect- _ly more suffering than is usually supposed, and which is too often overlooked, unless absolute retention exists. Having had a great many men of this class to care for, it seemed necessary to resort to more radical treatment than mere palliative remedies; therefore all medical treatment was abandoned and stretching the urethra was commenced, which resulted in marked benefit, and most of the cases were permanently cured; of course stricture is the most common cause of obstruction, and many of these cases are extremely difficult to overcome, especially a severe stricture in the prostatic portion which is accompanied with hypertrophy of the pros- tate gland; fortunately however the cases are few which cannot be overcome by the skillful use of the sounds. As yet there have been no definite conclusions arrived at as to the causes by which this change—hypertrophy of the gland—is brought about. It is a well known fact however that hypertrophy takes place af. ter the age of fifty years and can not hardly be considered a pathological condition, as it may exist without any symptom whatever except as it may interfere with the flow of urine. It seems to be an overgrowth caused by a decline of the generative function; but we find an- other condition of the gland, that of conges- tion and inflammation, with a catarrhal condi- tion of the urethra, and the ducts emptying * Read before the Minnesota State Medical Society. into the region of the prostate; there is evi- dently a stasis in the blood circulation of this region. It is well known that it is upon nerve force alone that the circulation depends for its ac- tivity, hence a proper supply of nerve force means a good circulation; a waste of nerve force or a low tone of the nervous system means an unfeebled condition with its various forms of unfortunate sequences. The latter condition is frequently found in the aged, although the apparently robust are not exempt from a stasis of circulation in the urinary tract. Whatever wastes sexual pow- er causes a waste of sympathetic nervous power, and therefore lowers the nervous tone of the whole sympathetic system. i The various forms of neurosthenia may be traced to the irritation of the rectum or sexual system, or both. The practice of correcting reflex irritations and congestions, and institut- ing general nutritive changes throughout the body by the treatment of the two great excre- tory outlets of the human body, invites a great deal of study and investigation. It has been now about ten months since the dilating treatment by the use of graded sounds has been instituted at the Soldiers' Home, which has resulted in giving great relief, and, as I have said before, made many permanent cures. The history of these one hundred cases cannot be correctly reported; a long-forgotten gonorrhea is undoubtedly the cause of trouble with many who deny any possibility of such an occurrence; others admit promptly that such is the case. Duplay speaks of an idiopathic contracture of the urethra in the prostate and membranous portion which does not depend on any disease of the urinary organs. I suppose he means any specific disease. It matters lit- tle, however, what the direct cause is, the treatment must be the same. The patholog- ical conditions as found in these cases varies very much as well as the degree of severity. In the treatment of these cases no general an- esthetic was used; although many cases could have been dilated at once under anesthesia, the severe strictures with firm cicatricial tissue can not be forced without incurring a good deal of danger, whereas the slower process Softens the made tissue and excites absorbsion 248 THE MEDICAL DIAL. i after the first few efforts of dilatation. In cases of hyperasthesia of the canal a four per cent. solution of cacaine or a five per cent. eucaine renders good service. The technique of this minor surgical procedure is of as much importance as those of greater magnitude; hence a strict aseptic condition was observed in all cases. I will give the details of two cases which will explain the technique as we go along. J. G. P., age 72, admitted from a country town on October 22, 1898, with the following symptoms: Constant dribbling of urine; clothes wet to feet; oºdema of lower extremi- ties; quite anemic; loss of appetite; constipa- tion and pain in region of bladder, prostate gland and inside of thighs. TREATMENT. Patient was bathed and put to bed with dry clothes, and given a urinal to catch the urine; enough of this was obtained for a test, which was found to contain about twenty per cent. albumen. The next step was to learn the cause of retention of urine. The glands penis was thoroughly cleaned with chloride wash, and a sterilized Fowler’s sound smeared with soap-suds passed into the urethra; a moderate anterior stricture was discovered, which, by the use of eucaine, was dilated at Once. It was then discovered that an almost impervious stricture existed in the prostatic re- gion, and now came the tug of war, requiring patience, perseverance and a little skill. The smallest bougie and sounds were finally pas- sed, which resulted in an increased flow of urine. This dilating process was repeated every day until a number twelve American gauge was passed; after which the intervals were of longer duration, three or four days usually, until a number twenty American gauge passed freely without any resistance. Numbers eighteen, nineteen, and twenty were passed occasionally for three months, and in the mean time the urethra was washed out with warm boracic acid solution through Dur. ham’s back-flow tube, followed by an injection through a soft rubber catheter into the pros- tatic region of a one to two per cent. solution of protargol. bumen and oedema of extremities disappeared, prostate gland grew less in size and tender- ness; no medicines were used except a general tonic including iron. Case No. 2.-C. B., age 57; subject of epi- lepsy; body not well nourished, although he had a ravenous appetite. too frequent micturition, especially at night, and sometimes wetting the bed. Convulsions almost every night and sometimes during the day. Examination revealed phimosis with extremely long prepuce and hardened orifice, unable to expose meatus urinarious; prostate gland enlarged and tender. Circumcision was performed at once under the local effect of This man improved rapidly; al- He complained of eucaine injected under the skin of the parts to be removed, giving very little pain or incon- venience to the patient. One week later the sounds were used; a considerable constricture was found in the prostatic inch, but no diffi- culty in passing a number twelve A. G., al- though quite tender, and when sound was withdrawn a good deal of stringy mucous was adherent to the instrument; this was repeated several times to remove the mucous, after which a thorough washout in the same manner as in case No. 1. The patient improved rapid- ly by further stretching of the urethra every few days. The convulsions became very light and less frequent; he is still under the treat- ment with a fair prospect of complete recov- ery. These two cases are a sample of about fifty per cent. of all patients treated in this manner, and the balance of less severity, but all in the same line of trouble. It is not the object of this paper to attempt to instruct experienced surgeons how to man- age these cases, but simply to show what a persistent treatment will do by the use of the sounds alone; also, that the treatment does more than relieve the impediment to the flow of urine; it relieves many reflex troubles which add much to the relief of a man in his declin- ing years. It is not a difficult matter for a student to learn the anatomy of the urethra, and its re- lations in a normal condition, or to pass a catheter when there has been no pathological changes; but when he meets with a severe stricture, or an enlarged prostate pressing sharply upon the canal, he finds himself in difficulty of the most perplexing kind, requir- ing great patience and perseverance. It may not be out of place here to suggest to the young practitioner not to rely too much upon his patient’s statements, as it is very common for them to say their kidneys are affected, or there is something wrong with the bladder. Nine times out of ten the cause of trouble is between the meatus and the bladder. In referring back to the treatment of hy- pertrophy of the prostate gland, I wish to add my experience and observation of three cases of castration; two of them were performed a number of years ago without much relief, which I now believe had more or less of an inflammatory action of the urethra as a com- plication of the enlarged gland. The third case was performed on the 17th day of August, 1895, the record of which I have kept. J. R., age 64, lost the left testicle when a small boy by an accident which required the removal of the gland. He was admitted to the hospital for treatment of difficult micturition; a silver catheter could not be passed, owing to a lat- eral curvature of the urethra. A soft rubber was passed and drew off the urine in consider- able quantity. Examination through the rec- N THE MEDICAL DIAL. 249 tum revealed an extensive hypertrophy of the prostate gland on the right side, but the left side gland was quite small, the side from Which the testicle had been removed in early life. I explained his condition to him and sug. gested the removal of the remaining testicle, to Which he promptly consented, and it was removed on the day above mentioned. There Was nothing unusual about the operation, ex- cept the cord was secured by passing the two ends of the cat-gut ligature through the upper end of the wound forming the first stitch. The wound healed kindly in a few days; the prostate diminished in size and in two weeks he could pass his urine at will. The above case was unique in many re- Spects, and the only one claiming favorable results known to the writer, although the au- thor, Dr. J. D. White, of Philadelphia, claims many cures of the malady by means of castra- tion. The high estimated value of those or- gans has probably prevented any very ex- tensive experience in that line of treatment. CERTAIN LANDMARKS IN THE PROG_ RESS OF MODERN MEDICINE. By Franklin Staples, M. D., Winona, Minn. Chairman Minn. State Board of Health. The value of departures and developments in the arts and sciences is best esti- mated when seen in the retrospect. The abundance and newness of what is near may render discriminating observation difficult. As recently said by Osler:* “In the case of medicine the difficulties of observation are enormously increased by the extraordinary de- velopment which belongs to the history of the present century.” This author further ex- presses his estimate of the advance of modern medicine in words as follows: “The rate of progress has been too rapid for us to appre- ciate, and we stand bewildered, and, as it were, in a state of intellectual giddiness, when we attempt to obtain a broad, comprehensive view of the subject.” In reviewing the broad field of medicine and surgery, with the history of events for half a century or more, many important beginnings are counted; some of which, in their results and greater development, are now seen to be not only the essential ground-work, but im- portant elements in the science structure and in the practical advances of the present time. The following are, examples: *Address in medicine delivered before the British Medical Association at Montreal, I. ANAESTEIESIA—(AFTER FIFTY YEARS.) Shortly before the middle of the present Century the discovery of anaesthesia marked an epoch in the history of operative surgery. Of this, as now seen, it is believed that at the time of its advent no more important or bene- ficient discovery had been made. The use of sulphuric ether and chloroform, as the prin- cipal anaesthetic agents, soon became univers- al, and have so continued with constantly in- creasing advantage and importance to the present time. A word of practical bearing may be al- lowed here. An element in the increasing Success in the use of these anaesthetics has been the acquired purity of the drugs. This has been demanded by surgeons, and has been realized more ſully in late years than in for- mer times. t Some knowledge of the drug, and practical skill in administering the different anaesthet. ics are essential to the better success in their use. To illustrate: Sulphuric ether is a light liquid, evaporates rapidly in ordinary room temperatures, mingles readily with the air, and, being of less specific gravity, quickly rises in the atmosphere when allowed to evaporate. Chloroform, on the other hand, is heavy, both in liquid and vapor form, mingles slowly with the air, and when the vapor is set free it falls to the floor in a stream almost like a liquid. It necessarily follows that the two anaesthetics must be administered in different ways. In the use of ether the air should be excluded from the inhaler as far as possible. With the best efforts in this direction, with ordinary means of inhalation, the vapor will hardly fail to be sufficiently diluted with the air, and have a sufficient proportion of its elements to sup- port respiration. The opposite conditions are found in chloroform, and a different procedure in regard to the admission of air is required. Moreover, for reasons apparent, an attempt at a mixture of the two anaesthetics for inhala- tion is by no means admissible. Concerning the advantage of anaesthesia in surgery, it is not alone, nor is it, perhaps of chief importance, that by its use the patient is saved from suffering during an operation, but the greater good may be found in the fact, that there may not only be a better technique and more complete execution in all operations, but by these very means, far better results may be realized, not only in saving life, but in restoring to usefulness and comfort parts that would otherwise be lost or made subject to disease, disuse and suffering. The highest ex- cellence in surgical operation is no longer rapidity of execution; but carefulness, exact- ness, and intelligent direction in every move- ment have now become possible, and are of first importance. Operations and explora- 250 THE NAEDICAL DIAL. tions, not before practicable, are now made common procedures, both for diagnosis and for restorative treatment. Besides, it is now well known that the danger to life from surgical shock, or rather that the chances of the existence of shock, either from injury or capital operation, are far less when the nerve centers are protected by well directed anaes- thesia. Moreover, the same holds good in cer- tain medical cases: for instance, in puerperal eclampsia, in which life may terminate in re- flex convulsions. The advantage of anaes- thesia in this case is, that by it the suscepti- bility of the reflex centers is held in abeyance during the time of the irritative, septic influ- €Il Cé. This brief mention is not an enumeration, but may be taken as in part illustrative or suggestive of the great advantages gained by the discovery and application of anaesthesia in practical medicine and surgery. II. TELE DEVELOPMENT OF STATE MEDICINE. Public Hygiene—State Preventive Medi- cine—Authoritative Sanitation for the pre- vention of disease, has developed principally during the time of the present generation. It began in England in 1844, when the House of Commons became sufficiently interested to take the initiatory step in the movement which has developed into what at present ap- pears as the world’s great system of State Preventive Medicine. In the United States the first movement was made in the Legisla- ture of the State of Massachusetts in 1849, but it was twenty years later when the first State Board of Health was formed in this state, and the work of sanitation by govern- mental authority began in this country. From these beginnings at times within the observation of men now active in affairs, the wonderful development and extension of State Preventive Medicine in the principal countries of the world have taken place. What appears as the most significant and important fact in the existence and present magnitude of this department of science and law, is that it has resulted largely from the advance of education and practical knowledge and interest in this direction in the popular mind. Further accounts of this departure and growth may not now be given: the purpose here is to notice briefly some of the ways in which the development of state medicine, in its dif- ferent departments, has aided in the advance- ment of general medicine and science. In our centennial year, 1876, the eminent physician and first president of the Massa- chusetts State Board of Health, Dr. Henry I. Bowditch, in his memorable address before the International Medical Congress at Philadel- phia, spoke concerning the progress of medi- cine in the then past centennial period as fol- lows: “In its medical and social ideas, the past century easily divides itself into three unequal epochs, viz.: I. From 1776 to 1832, the era of theory and of dogmatism; II. 1832 to 1869, or that of strict observation, and of bold, often reckless, scepticism; III. From 1869 to 1876, which is destined to continue and progress while the nation itself lives, the no- blest and most beneficent of all, viz., that in which the profession joined heartily with the laity and, aided by the material and intellect- ual resources of great states, will study to un- ravel the primal causes of all disease with the object of preventing it. It is the epoch of State Preventive Medicine.” The broad view of this distinguished medical scientist and sanitarian, here expressed, as now seen in the retrospect after nearly a quarter of a century, was correctly prophetic of what in the higher science of medicine was then to come. The present outlook shows the fulfillment of this prediction in various ways. Among the more important advantages which have resulted from the advance of state medicine have been its effects in elevating the standard of medical education in the country. The position and work, first of the Illinois State Board of Health, then of other states by their examin- ing boards, in fixing a lawful standard of re- Quirements for admission to the practice of medicine in the states, have given character and position to the profession and to medical practice in this country, which under the pre- vious regime could not be realized. III. TEIE ADVENT OF BACTERIOLOGY. The most recent advances in medicine and surgery which have resulted from discoveries in bacteriology and the practical measures which have come from the same, have been the work of many minds in different countries, principally in the last quarter of a century. The results of work in this direction were es- pecially in the mind of Professor Osler, when he spoke to the British Association on the wonderful progress of medicine in recent times. While the burden of his message was the value of English culture in the history of modicine, all nationalities received their share of credit, and a general account of great achievements and suggestions concerning the distribution of prizes found expression in the following words: “Three among the greatest scientific movements of the century have come from Germany and France. Bichat, Laennec, and Touis laid the foundation of modern clinic- al medicine; Virchow and his pupils, of scien- tific pathology; while Pasteur and Koch have revolutionized the study of the causes of dis- ease; and yet the modern history of the art of medicine could almost be written to its fulness from the records of the Anglo-Saxon race. We can claim every practical advance of the very first rank—vaccination, anaesthesia, preventive THE MEDICAL DIAL. 251 medicine, and antiseptic surgery, the ‘captain jewels in the carcanet’ of the profession, be: sides which can be placed no others of equal lustre.” Since the days of ancient Greek medicine, it has been the aim of the higher order of Scientists to establish practical medicine upon a pathologic basis. Progress in this direction, however, was greatly impeded during the dark and middle ages and far into the modern period by the growth of false theories in medi- cine—pseudo-pathies, and medical delusions, the Wasting remains of some of which have continued to the present time. It now may be Safely said that nothing in all time has de- Veloped in the world of true science that com- pares in importance with what has lately come to light in the domain of bacteriology. As is now understood, it lies at the bottom of path- ologic anatomy, and explains much of the phe- nomena in disease action which could formerly be but partially understood. It has advanced the Science of medicine by showing the nature of causes, the existing living substances, Which, by their presence and action in the tissues, constitute the pathological conditions of the same; and by affording direction for management, based upon a knowledge of the nature and action of germ destroying agents Obtained by experimental work in laboratories and by clinical observation. This is an ad- vance over former methods of study, in that investigation is made by the use of instru- ments of precision, chemical and biological tests, the use of the microscope, thermometer, etc., rather than by superficial observation of Supposed symptoms of disease, with little un- derstanding of their significance and value. The former may be regarded as demonstrative, While the latter may result in misleading con- jecture. The practical relations of newly discovered facts in bacteriology to medicine and surgery, bearing upon the progress of the same, may be mentioned in part as follows: First, on medi- cal education:-Changes in methods and scope of study and teaching, which of late have come to Our advanced institutions, have resulted in the increase and improvement of laboratories for experimental and clinical work and demon- stration. The pathological laboratory is now a necessary department, and has a large place in all advanced schools of medicine. Its effect has been to extend the course, widen the scope, and to elevate the standard of medical instruc- tion. Besides, the time is now, when to the phy- sician thus educated, who is engaged in the practice of medicine or surgery, or both, comes the necessity of having his own private labora- tory, suitably furnished with instruments and apparatus for use in diagnosis and for study and demonstration in pathology. It is known that the microscope has recently been pro- moted from its old position of office ornament, \ and assigned to active duty in a new and im- portant department. In the matter of present place and import- ance of the science of bacteriology, the words of Professor Abbott of the University of Penn- Sylvania may be quoted. He says: “From the Very onset its history is inseparably con- nected with that of medicine; and as it now stands, its relation to hygiene and preventive medicine are of the utmost importance. It is, indeed, to a more intimate acquaintance with the biological activities of the unicellular, veg- etable micro-organisms, that modern hygiene OWes much of its value, and our knowledge of infectious diseases has reached the position it now occupies.” + The great advantage of a practical knowl- edge of the character of contagious diseases, depending as it does upon the behavior of different infections, the variety of methods of Communication, length of incubation, and of how the action of specific germs may be abort- ed, modified, or prevented, is shown in the present more intelligent and more successful management both for prevention and for cure. The different means and methods of preventing the passing of infection, for instance, in cases of typhoid fever, tuberculosis or diphtheria Will serve to illustrate. With the present higher education de- manded for practicing physicians, and the deeper insight into disease conditions now available, the far greater possibilities for good resulting from improved management, become apparent. With the advance of knowledge comes increased responsibility. It is to the Credit of advanced law and Order in the civil- ized world, that at the end of the nineteenth century men are held responsible for what they ought to know.—Journal of Medicine and Sci- ence, Portland, Maine, July, 1899. * Principles of Bacteriology (Introduction), Abbott. TEIE COLD PLUNGE. Dr. Hobart Emery Hare, Professor of Ther- apeutics, Jefferson Medical College, Philadel- phia (American Medical Quarterly for June), S3LWS : "buting the past three months I have had 64 cases of typhoid fever under my care. Every one of these has required hydrotherapy; in only two has the persistency of the fever necessitated the use of the cold plunge. “In the opinion of those who have the larg- est experience, hydrotherapy is needed in every case of typhoid, and with this view I most heartily concur. “When it comes to the question of dosage (in hydrotherapy) my point of view differs from that of some others. “As firmly as I believe that the cold plunge 252 THE NAEDICAL DIAL. is not for every one, so do I believe that in some cases it is the best and only thing which can be employed with advantage. “I believe that the mode of applying cold should be varied to the needs of the individual patient, and I have yet to see the case in which Í have regretted the employment of the modi- fied plunge bath. “What, then, are the modifications that I would suggest? First, the use of cold applied to the body of the patient who is stripped and who lies upon his bed, while the nurse gives him the necessary friction and massage. “It is of vital importance that the nurse who employs this modified bath treatment should be trained to his duties. “I am firmly of the belief that the active rubbing which accompanies the use of cold in the way that I have described, is of great ad- vantage to the patient, because I believe that a gentle massage given to patients suffering from typhoid fever and who are practically taking the rest cure, is an exceedingly useful thing for the maintenance of health. Second, because by these frictions we increase reac- tion; and third, as has been proved by Pop- ischil, friction increases the loss of heat 80 per cent., and, according to Weisroch, the loss of moisture through the skin 50 per cent. “Whenever a physician tells me that he is unable to lower the temperature by friction and cold without the plunge, I am confident that it is because the method has not been properly employed, for only rarely is the fever so persistent as to fail to drop. “Of course in the early stages of typhoid it is a well known fact that the fever is peculiar- ly resistant, not only to cold friction but also to the plunge itself.” PRACTICAL MIND HEALING. A Christian Scientist, whose time was fully occupied in thinking about the unreality of diseases at $2 per think, once treated a highly unappreciative man for a chronic nervous affection of a very painful character. After this man had depleted his purse by sending $40 thus without any improvement, he desired to know when he should begin to get better. Then the Christian Scientist waxed Wroth and said: “O you of little faith ! Know that you would already have been cured, if you had be. lieved me when I told you that your pain was not real. Pain and suffering do not exist; they are merely phantasms of the brain. There is no such thing as matter,” continued he with such emphasis that he rattled some silver dol- lars in his pocket, “none whatever; the only real thing is thought. All this is too subtile for your commonplace mind, and hence I can do nothing for you; you had better go and fill your coarse, unappreciative system with drugs.” Then a vision of $40 that had vanished, and of pain that had vanished not, came before the mind of that long suffering man, and he arose and took that Christian Scientiist and he mop- ped the floor with him, Smiting him sore upon the head and back so that, when he was through, congestion, abrasions, contusions, in- cipient ecchymoses and epistaxis were among the phenomena presented by his Christian COUIntenance. “There is no real suffering,” said the un- appreciative man, with scorn. “The bruises of your alleged head are entirely hypothetical; the choking I gave you was simply an idea of mine, and a devilish good idea, too; the pain which you feel is merely an intellectual phan- tasy, and your nose bleed is only one of the ideal conceptions of the cerebral mass. Be- lieve these things not to exist and they vanish. Good-day, sir.” And the patient departed.— The Medical Visitor. RESUSCITATION OF THE APPARENTLY DROWNED. The proper methods to be adopted for sav- ing the apparently drowned should be fa- miliar to every one, and as the present sea- son is sure to witness the usual number of such casualties, The Dial would draw the at- tention of its readers to the simple but ex- cellent rules published by the Michigan State Board of Health, as follows: Rule 1.—Remove all obstructions to breath- ing. Instantly loosen or cut apart all neck and waist bands; turn the patient on his face, with the head down hill; stand astride the hips with your face toward his head, and, locking your fingers together under his belly, raise the body as high as you can without lifting the forehead off the ground (Fig. 1), and give the body a smart jerk to remove mucus from the throat and water from the windpipe; hold the body suspended long enough to slowly count one, two, three, four, five, repeating the jerk more gently two or three times. Then act by Rule 2. Rule 2.--Keep the patient face downward and maintaining all the while your position astride the body, grasp the points of the shoulders by the clothing, or, if the body is naked, thrust your fingers into the armpits, clasping your thumbs over the points of the shoulders, and raise the chest as high as you can (Fig. 2) without lifting the head quite off the ground, and hold it long enough to slowly count one, two, three. Replace him on the ground with his forehead on his flexed arm, the neck straightened out, and the mouth and nose free. Place your elbows against your knees and your hands upon the sides of his chest (Fig. 3) over the lower ribs and press downward and inward with increasing force long enough to slowly count one, two. Then THE MEDICAL DIAL. 253 suddenly let go, grasp the shoulders as before and raise the chest (Fig. 2); then press upon the ribs, etc. (Fig. 3). These alternate move. ments should be repeated ten to fifteen times a minute for an hour at least, unless breathing is restored sooner. Use the same regularity as in natural breathing. Do not give up too soon. You are working for life. Any time within two hours you may be on the very threshold of success without there being any sign of it. Rule 3–After breathing has commenced, restore the animal heat. Wrap him in warm blankets, apply bottles of hot water, hot bricks, or anything to restore heat. Warm the head nearly as fast as the body, lest con- vulsions come on. Rubbing the body with warm cloths or the hand, and slapping the fleshy parts may assist to restore warmth, the circulation of the blood, and the breathing also. The rubbing of the limbs should always be from the extremities toward the body. If the patient can surely swallow, give hot coffee, tea, milk, or a little hot sling. Give spirits sparingly, less they produce depression. Place the patient in a warm bed, and give him plenty of fresh air; keep him quiet. Avoid delay. A moment may turn the scale for life or death. Dry ground, shelter, warmth, stimulants, etc., at this moment are nothing—artificial breathing is everything—is the one remedy—all others are secondary. Do not stop to remove wet clothing. Pre- cious time is wasted, and the patient may be fatally chilled by exposure of the naked body, even in summer. Give all your attention and effort to restore breathing by forcing air into, and out of, the lungs. If the breathing has just ceased, a smart slap on the face, or a vig- orous twist of the hair will sometimes start it again, and may be tried incidentally, as may also, pressing the finger upon the root of the tongue. Before natural breathing is fully restored do not let the patient lie on his back unless some person holds the tongue forward. The tongue by falling back may close the windpipe and cause fatal choking. If several persons are present, one may hold the head steady, keeping the neck nearly straight; others may remove wet clothing, re- placing at once clothing which is dry and warm; they may also chafe the limbs, rubbing toward the body, and thus promote the circu- lation. Prevent friends from crowding around the patient and excluding fresh air; also from try- ing to give stimulants before the patient can swallow. The first causes suffocation; the sec- ond, fatal choking. In suffocation by smoke or any poisonous gas, as also by hanging—proceed the same as for drowning, omitting effort to expel water and the like from windpipe. In suspended breathing from effects of chloroform, hydrate of chloral, electric shock, and the like, proceed by Rule 2, taking especial pains to keep the head very low, and preventing closure of the windpipe by the tongue falling back. A SEVERE CASE. Two weeks ago I was summoned to the bedside of Djoahnine Stitleometzhler. The involute and laby- rinthinate tangle of his symptoms made me suspect at first that he had absorbed his own name, but a further examination convinced me that he was a victim of typhomalariopneumophthisicotrychimoteta- noataxionephreticos penitis. Owing to the ubiquity of pathogenic bacilli, anti- septics are always indicated, so I exhibited calcium betanaptholalpha monolosulphonate. As the patient suffered from severe non-localized pain I gave ortho- oxyethlanamooobenzollamidoquinoline combined with salicylaldehydmethylphenylhydrazine. For his in- somnia I gave trichloraldehydphenyldimethlypyrazo- line. His wife asked me what ailed him and what I was giving him. I told her and she said “yes,” and turned very pale. Upon examining him on the next morning I be- came convinced that the vital forces had miscon- strued the remedies, and that a congerie of retroab- sorptions had resulted. I then wrote out the follow- ing prescription: Tetrahydrobetanaphthalamine, Sodium thioparatoluidinesulphonate, Orthosulphamidobenzoic anhydride, Amidoacetoparaphenetidine, . . . . . . . . . . . . aa 1 dim. M. Sig. A teaspoonful every hour. When the wife presented the prescription to the druggist he instantly dropped dead. The patient is up and about, but something is wrong with his Broca's convolution—he mutters in a multisyllabic lingo that is intelligible only to modern pharmacal chemists. I am in hiding where the spiral melody of the woodbine that twineth blendeth ever with the sweet, low, soothing, murmurous, quadrisyllabic, rythmic tune of the gentle polygonum punctatum.– Ex. 254 THE MEDICAL DIAL. THE MEDICAL DIAL A Monthly Record of Medicine and Surgery. (Entered at Post Office at Minneapolis as Second Class Matter.) Issued on the First of every Month at Minneapolis, Minn. Editor, J. W. MACDONALD, M. D., F. R. C. S. E. Associate Editor, C. K. BART LETT, M. D. Business Manager, E. E. GRISWOLD. . . . . COLLABORATORS . . . . A. W. ABBott, M. D. W. A. HALL, M. D. # P. BARBER, M. D. G. D. HEAD, B. S., M. D. . O. BEABD, M. D. KNUT Hoeg H., M. D. J. W. BELL, M. D. C. H. Hunt ER, A. M., M. D. A. B. CATEs, A. M., M. D. W. A. Jones, M. D. # FRANK CORBETT, M., D. J. H. RISHMILLER, M. D. . E. CUTTs, B. S., M. D. J. D. SIMPson, M. D. . J. H. DUNN, M. D. J. H. STUART, A. M., M. D. F. A. DUNSMOOR, M. D. H. B. Sweets ER, M. D. DAVID Owen THOMAS, M. D., M. R. C. S. The publishers will not be responsible, under any circumstances, for the opinions expressed or statements made }. correspondents. Contributors will be furnished, gratis, with sample copies contain- ing their articles, under an agreement to distribute at once to physicians in actual Fº: To avoid duplication, publishers should be informed of the field to be covered. Reprints, giving The Medical Dial full credit, may be obtained at actual cost. No notice can be taken of anonymous contributions. The name (not necessarily for publication) must accompany every communi- cation to this journal, Annual Subscription, in advance, - - - Single Copies, * gºs * *-* e- * * Advertising Rates made known on application. $1.00 .10 ADDRESS ALL COMMUNICATIONS TO THE MEDICAL DIAL, MINNEAPOLIS, MINN. MASONIC TEMPLE. AUGUST, 1899. LIQUID AIR IN MEDICINE AND SURGERY. The remarkable discovery of Prof. Charles E. Tripler, by which liquid air can be produced in large quantities and at small cost, is likely to prove of great value in medicine and sur- gery. Liquid air is a clear bluish fluid re- sembling the color of the atmosphere on a clear day. Its temperature is 312° F. below zero. It contains nitrogen and oxygen with a small but variable proportion of carbon diox- ide. As seen in an ordinary receptacle the liquid is boiling and gives off a white vapor which rapidly disappears, the intense cold causing the vapor to fall to the ground. It may be called a dry liquid for it leaves no moisture. Applied to the hand, it produces a sensation of burning or tingling, similar to the feeling produced by the faradic current. The hand can be put into the liquid without injury if it is immediately withdrawn. When a cup of liquid air is thrown upon the floor it behaves as a cup of water would do if thrown upon a hot stove, for the floor of a room at ordinary temperature is about 400° F. above that of liquid air. Possessing properties such as have just been stated, we would naturally expect a great deal from this new agency. One of the first applications to suggest itself would be the destruction of bacteria. If all forms of germ life are destroyed by a temperature of 160° F. above zero, we would naturally look for their destruction at 312° below. In this we are probably doomed to disappointment. In ex- periments made by Dr. A. Campbell White of New York (Medical Record, July 22, 1899) the effects of liquid air were tested on the germs of typhoid, anthrax, and diphtheria. To test the effect of extreme cold upon these germs without bringing them in direct contact with the liquid, pure cultures of virulent an- thrax, diphtheria, and typhoid bacilli were put into capillary tubes. These tubes were marked for identification, sealed at both ends and dropped into a glass of liquid air. The liquid was renewed at intervals, thus keeping the tubes at all times submerged. Some of the tubes were removed at the end of thirty min- utes, others in forty-five minutes, sixty min- utes, and ninety minutes. After removing the tubes from the liquid and breaking off the sealed ends, they were dropped into separate Culture tubes containing fresh sterilized bou- illon. The bouillon tubes were placed in in- cubators at a temperature of 38°C., where they were allowed to remain for 48 hours, when they were all examined and found to contain pure cultures of anthrax, typhoid, and diph- theria bacilli according as they had been in- Oculated. Dr. J. H. Huddleston tested the effect of liquid air on Vaccine virus, and found that ex- posure for fifteen minutes to liquid air had no effect whatever on the power of the virus to produce vaccination. So far, then, the application of liquid air to the destruction of bacteria has been disap- pointing. In the treatment of diseased conditions of the tissues, as cancer, abscess, boils, carbun- cles, etc., more encouraging results have been Obtained. The air can be applied to the tis- sues in the form of a spray and by means of a swab dipped into the fluid. When a spray of the liquid is directed against the skin, the part THE MEDICAL DIAL 255 at once becomes anemic and perfectly white or colorless. If the application only lasts a few seconds, the color as quickly comes back and for several minutes afterward the skin is COn- gested. Less than a minute suffices to freeze the part as hard as ice; but even then the circu- lation returns in a few minutes without any in- jury to the tissues. Dr. White began the use of liquid air in the local treatment of ulcers of the leg, chiefly varicose, many chancroids and some Specific ulcers. On this point he says: “So many of these cases have now been treated with liquid air that it can be said with positiveness that we have nothing at our disposal to-day which will so quickly, thoroughly, and with as little pain, clear up the edges and stimulate the Sur- face of an ulcer to granulations as liquid air does when properly applied. The application should not be made so frequently as to break down the new granulations as they form. Af- ter the first two applications to a varicose ulcer, one application a week is usually suffi- cient. To a chancroid, or mixed sore, one ap- plication pretty generously applied is suffi- cient. A “beefsteak” -chancre requires two or three applications, three or four days apart. All ulcerations treated with liquid air seem to do better when followed by a dry dressing, such as aristol, subgallate of bismuth or stear- ate of zinc, instead of any unguent.” In the treatment of lupus by liquid air most encouraging results have been obtained by Dr. White. Three cases have been under his care. One case of lupus erythematosis, in- volving the frontal region, both ears and one side of the face, has been under treatment two months. After the second application the affected areas entirely desguamated, leaving the derma in perfectly healthy condition, slightly red and no eschar. This had been a very obstinate case and resisted all other methods of treatment. The two other cases promise equally good results. Carci- noma has been vigorously attacked by experi- menters with liquid air and the unfortunate victims of this terrible disease are sure to fall a prey to the host of quacks and charlatans who are on the lookout for new and startling agen- cies. Dr. White cautiously expresses his opin- ion on this point, and although he has several cases under treatment and is very hopeful of results, he wisely refrains from drawing con- clusions until wider experience shall have af- forded more extended data. Professor Tripler, realizing the dangers of the indiscriminate use of liquid air, and the tendency of dishonest and ignorant persons to use it in order to impress the public, has wisely refrained from furnishing it promiscuously for experimental purposes. At the Roosevelt out patient department and the Vanderbilt Clinic, however, regular and liberal supplies are fur- nished, and as the experiments are conducted under the supervision of competent and up-to- date physicians, the profession may confidently expect to have something in the near future which will be a valuable addition to their armamentarium. PURE WATER. When we consider that the human body is composed of seven-tenths water it would ap- pear reasonable to expect that a decent regard for the Welfare of life would demand that the supply of this necessary fluid should be as free from impurities and injurious substances as careful investigation could secure; but obser- vation proves the fact that almost universal indifference prevails, as a rule, as to this mat- ter. Very few of our large cities are supplied with water free from contamination by sur- rounding surface impurities received from cul- tivated soil and drainage pollution; and when rivers and small streams are utilized to supply the wants of the public, the danger of disease from such sources is unavoidable. In our old geographies rivers were spoken of as “water- ing” the lands through which they flowed; but this statement can be true only to a very lim- ited extent as the evaporation can contribute slightly to dew; they are in fact drains and polluted by the cultivation of the lands through which they pass, and by the waste from the inhabitants living along their borders, and manufacturing establishments located in their vicinity; these latter being often of such a character as to deserve the name of nui- sances. All these filthy contributions are poured into the streams at greater or less (often very little) distance above the intake pipes supplying the people of our cities with their water for culinary and drinking pur- pOSes. Our “father of waters” may have been com- paratively pure before his shores above Min- 256 THE MEDICAL DIAL. ‘k. neapolis had become well settled and the drainage from them entered freely into his liquid to be diluted and drank by our thirsty citizens; but analysis now proves the poisons present of more than one agent of disease dan- gerous to health. Pure air is good; beautiful parks enjoyable; but pure water is indispen- sable for the preservation of the health of men and animals. The city of Minneapolis has spent its millions for public buildings and lux- urious quarters for municipal purposes, but has hesitated and delayed to expend the paltry sum of $150,000 for a filter to purify its water supply and maintain its excellent standard for health in the future. Boston has expended millions of dollars to secure an abundance of pure water, and guards the sources of supply and reservoirs with jeal- ous care to prevent contamination. New York has done likewise, and is still watching and at- tempting improvements and extensions. Chi- cago, some years ago, took its supply from the lake at a considerable distance from the shore; but while drawing its water from that source, it was pouring its drainage directly into the same water and pumping the mixture into the homes of the people. Favorable winds some- times kept the floating filth away from the in- take well; but quite as often unfavorable winds surrounded the source of supply with the float- ing refuse from the city. To remedy this state of things the intake pipes were carried farther out in the lake; but now a still better plan has been adopted by turning the drainage through a canal into the Illinois river, thence into the Mississippi river. This will help the city of Chicago; but what will the people do below? Already a vigorous protest is being made by St. Louis, who keeps a critical eye on all the ac- tions of her rival for western precedence. No lake is safe for a water supply when the drainage of the city is poured into the same Water. Duluth has had experience with the danger of this experiment. The intake pipes were supposed to be carried out beyond the limit of danger from sewerage; but the pipes became defective near the shore, and the city had an epidemic of typhoid fever of an alarm- ing magnitude. There is no city in the world so liberally supplied with pure water as the city of Rome, Italy. It fairly gushes out from numerous fountains in all parts of the city in the most profuse quantities. It comes from the Alban and Sabine hills, and from uncultivated fields uncontaminated by animal or soil pollutions. The ancients appreciated the importance of the pure article, and spared no expense or trouble to secure the best to be had. Their Water- works are the admiration of engineers at the present day. Paris derives its water supply from the Seine and the Marne, from the Ourcq Canal, from artesian wells, and from springs. The water from the artesian wells is the most pure; but these can contribute but a small propor- tion of the immense quantity consumed, and therefore much impure fluid must find its way into the stomachs of the gay citizens of the beautiful city. London is supplied with water from the Lea and Thames rivers, and from wells; the latter furnish the purest water when sunk in the sands to the chalk formation. As to the water from the Lea and the Thames Dr. Frank- land said, “Notwithstanding the most efficient possible filteration, it is becoming less and less fit for domestic use, on account of sewage pollution, about one-half of the water at pres- ent supplied being already grossly polluted, and a very large proportion of the remainder occasionally polluted.” He recommended that the supply be obtained from the springs before they entered the rivers. ! If the above is the best that has so far been accomplished by our large cities with un- limited powers and means, intelligent engi- neers and water commissioners, and the results are so far from furnishing pure water for fam- ily use, what can be expected of individual effort on farms throughout the country? Fort- unate circumstances and situations for some, who may still have the “old oaken bucket hang- ing in open wells,” may insure water of ex- cellent purity; but too often, and especially among recent settlers, only holes in the ground, or shallow wells where surface water is collected for family use are found; or, pos- sibly a pump in a well of deeper pretensions, but surrounding the same pools of standing and stagnant water, the waste from pumpings, which furnish convenient drinking supplies for animals and fowls, and where ducks and geese do congregate. The constant presence of this contaminated water filtering down through the soil cannot fail to reach the source from THE NAEDICAL DIAL. 257 which the family draws its supply. Then too, for convenience, the well is often located too near the stables where animals are housed, and the surrounding soil becomes, in time, thoroughly saturated with their excretions. There are three sources of supply that promise water in native purity. Living springs protected from the approach of ani- mals that may pollute the water, drive wells in selected localities free from surrounding soils liable to contaminate, and artesian wells of considerable depth, when large quantities are necessary. The latter afford the most avail- able source for cities, and are unquestionably the most exempt from impurities. They are expensive, and yet their cost cannot largely exceed that of other provisions for supplies that require settling basins and other ex- pensive means for purification. DOCTOR ROBERT LAWSON TAIT, F. R. C. S.—Died on the 13th of June last near Birmingham, England, suddenly, and we may say prematurely, being only 54 years of age. He will be long remembered for his valuable contributions to surgery, and especially of the abdominal region. With largely developed combative qualities he was conspicuous for controversy with his fellow practitioners, and always defended his views with vigor. His strict attention to cleanliness in all surgical Operations rather than anticeptic preparations gave him wide notoriety, and his success proved the fact that it is better to avoid poisonous germs than to admit them and then attempt their destruction by germicidal rem- edies. We call attention to the advertisement of Northern Steamship Company, in connection with their superb line of steamers between Du- luth and Buffalo. The accommodations are the admiration of all who have enjoyed the trip. Office of Commissioner of Health. City of Minneapolis. July 25, 1899. To the Editor Of The Medical Dial: Dear Sir:-According to your recent re- quest, I here with send you a few items that may be of interest to you in your work: Number of deaths for July to date. . . . . . . 119 Number of cases of measles to date. . . . . . 9 Number of cases of scarlet fever . . . . . . . . 8 Number of cases of diphtheria. . . . . . . . . . . 7 Number of cases of typhoid fever . . . . . . . . 19 Number of deaths from consumption. . . . 13 Number of deaths from typhoid fever. ... 4 Number of deaths from whooping cough. 4 Number of deaths from diphtheria. . . . . . . 1. 225,602 City’s estimated population. . . . . . . . . y City’s census population (U. S., 1890). 192,833 Respectfully, A. K. Norton, M. D., Edwina J. Peck, Commissioner. Clerk. Reports of Societics. SOUTHWESTERN MINNESOTA MEDICAL SOCIETY. ** . The annual meeting of the Southwestern Minnesota Medical Society was held at the Town Hall, Adrian, Minn., Thursday evening, July 20, 1899. The meeting was called to order at 6 D. Iml., Dr. E. King, president, in the chair. After the regular business the following Programme Was listened to and discussed: Paper, “The Physician of To-day as a Pre- Scriber of Medicine.” Dr. E. King, Fulda Minn. y 5 Paper, “Differential Diagnosis of Small Pox, Chicken Pox, and Measles,” Dr. G. R. Cur. ran, Worthington. The meeting then adjourned to attend the banquet at Hotel Slade. The society reassembled at 10 p. m., when the following papers were read: “Report of a Case of Arcromegaly,” Dr. H. A. Tomlinson, St. Peter. “A Report of a Peculiar Case,” Dr. H. Neill, Sibley, Iowa. “Report of an Obscure Case of Brain Dis. ease,” Dr. C. De Jong, Fulda, Minn. “The Latest Fad in the Treatment of Gon- orrhoea,” Dr. M. Sullivan, Adrian, Minn. The meeting then adjourned to the office of Dr. M. Sullivan, where a jolly good time was enjoyed till the wee sma' hours. THE AMERICAN ELECTRO-THERAPEU. TIC ASSOCIATION will hold its ninth annual meeting at Wash- ington, D. C., September 19, 20, 21. The fol. lowing is the Committee of Arrangements: Drs. D. Percy Hickling, chairman; Jos. Taber Johnson, G. Lloyd Magruder, Z. T. Sowers, Robert Reyburn, G. Betton Massey, Chas. R. Luce, Elmer Sothoron, Llewellyn Eliot, Clif. ton Mayfield. Willard's hotel has been chosen for the headquarters and special rates have been made. Many able papers have been promised and a very successful scientific meet- ing is assured. There will be a large and Varied exhibition of electro-therapeutic ap- paratus in Willard's hall, which is well adapt. ed for this purpose. The committee promises a very pleasant social program, including a reception by the president of the United States, an excursion to Mt. Vernon, Arlington and Alexandria—a buffet lunch to be served at Alexandria, and an evening visit to the Congressional Library to be viewed under elec. trical illumination. Provisions have also been made to visit the war, state, and navy depart. ment, the United States treasury and other public buildings. 258 THE NAEDICAL DIAL. AMERICAN ASSOCIATION OF OBSTETRICIANS AND GYNECOLOGISTS. The American Association of Obstetricians and Gynecologists will hold its twelfth annual meeting in the Denison House, Indianapolis, Ind., September 19, 20 and 21. The association will meet in executive session with closed doors September 19th, at 9.30 a. m., for the election of new Fellows. The open ses- Sion for the reading of papers Will begin at 10 o'clock. Recess for luncheon at 1 o’clock p. m. Af- ternoon session at 3 o'clock; evening Session at 7.30. The morning session will begin Wednesday at 10 o'clock for the reading of Scientific papers. After- noon session at 3 o'clock. At 6.30 p. m., Wednesday, the executive Session will Convene for the election of officers, and for other business. The morning ses- Sion will begin Thursday at 9.30 o'clock. The after- noon session will be called at 3 o'clock and at 7.30 o'clock p. m., Wednesday, the annual dinner will be Served. Ex-President Harrison and Senator BeV- eridge will probably make addresses at the dinner. Many papers have been promised. All members of the medical profession are invited to attend the Sci- entific Sessions. Pr0SrcSS Oſ II?&dicine. GYNECOLOGY. UNDER THE CHARGE OF A. W. ABBOTT, M. D., F. A. DUNSMOOR, M. D. J. H. RISHMILLER, M. D INFRAPUBIC ROUTE IN SURGERY OF TIII) UTER US AND ITS ADNEXA. Wm. H. Wathen (Am. Gyn. and Obs. Jour., July, 1899) believes that we are but a little nearer a con- sensus of opinion than we were four years ago When Jacobs reported his large amount of Surgery On the uterus per vaginam. The author does not claim that there are no diseases of the uterus that cannot be successfully treated by either the Supra. Or infra- pubic method but objections to the latter is lack of experience. He is surprised at surgeons who oppose the infra- pubic route because of their repeated insistence that by the abdominal route one can see the Structures, which is not so in the vaginal Imethod. Surgeons who have operated by both methods Will State that nearly every structure treated from below is brought within view before it is severed. In enucleation of pus-tubes and ovaries, if we bisect the uterus, the eye can guide the finger as well as by the Suprapubic route, and the finger can explore to the pelvic brim with its trained sense of touch. The Statement that we must necessarily wound the intestines more in the infrapubic than in the suprapubic Operations does not bear the test of intelligent experience. He has performed vaginal hysterectomy Since 1888, and the last few years has treated every pelvic disease by this route. During these eleven years he has never wounded the bowel or ureter, but has done so several times in performing Coeliotomy. EVery well-trained surgeon can attain the same degree of perfection if he will persist in his efforts. Seldom a retractor is needed and by dispensing with them the operation may be done more rapidly and with less danger of wounding adjacent Organs, for the fingers are the best retractors that can be used. If we bisect the uterus there is usually no difficulty in seeing the tissues before the knife or scissors is applied; but if we cannot the finger may be carried in advance Of the Cutting instrument and thereby prevent wounding the bladder, intestines, or ureterS. The author regards the vaginal method as more conservative. There is no danger of opening Doug- las’ pouch and bringing the tubes and ovaries within view, and, if not diseased, they may be returned without injury; but if not diseased enough to justify complete removal, they may be treated by any ap- proved method. The Suprapubic method would confine the pa- tient to bed for not less than two weeks, and require an abdominal Support for One year, While in the Vaginal method there is no danger of hernia, or post- Operative intestinal adhesions. The author has not done a Suprapubic Operation for ectopic gestation for four years but has performed about thirty through the vagina—all making an uninterrupted recovery. He admits that it would not be the correct procedure to attempt to complete an operation for extra-uterine pregnancy in intra-peritonacal rupture with an accu- mulation of blood in the abdominal cavity that could not be drained away. With extensive accumulation of pus the patient may symptomatically recover by simple incision and drainage, and he has observed cases who afterwards complained of no pelvic trouble. This is particularly applicable in accumulations of puS following abor- tion or labor. In Cases of local Sepsis the formation of pus may be prevented by early vaginal incision— opening the folds of the broad ligament, or separat- ing pelvic adhesions—and then lightly packing with iodoform gauze to keep the infected Surfaces sepa- rated. He leaves the gauze in for five or six days and removes it gradually—beginning on the third day. The writer has never observed that the length of the vagina has been altered or the Secretion espe- Cially interfered with. His main objection to the suprapubic route, therefore, are delayed convales- cence and the abdominal incision in COnsequence Of subsequent development of hernia. J. H. R. WHEAT A.S FOOD. Wheat is as perſect a food as any one article can be. There is perhaps no one substance which under long continued use meets the necessities of the body, but certainly wheat does if any one article can. Three classes of substances are required to nourish the body. First, the inorganic principles, such as salt, lime, potash, magnesia, iron, Sulphur—these are found in vegetable and animal products. Second, nitrogenous principles in which nitrogen forms the Chief element; and third, Carbonaceous, or those in which carbon predominates. These three classes fulfill the different functions in the process of nutri- tion. One is as necessary as the Other, though not needed in the same proportions. The inorganic sub- stances, the salt, lime, potash, etc., enter into the Or- ganization of plants and into flesh in various pro- portions. The foods best fitted to nourish the body contain about fifteen parts Of Carbon to three of nitrogen; for every grain of nitrogen which is needed to build up the tissues of the body, fifteen grains of carbon are required. The tissues are built out of tho Carbonaceous foods. These represent the fuel, so to speak, which is burnt under our boilers, out of which the force comes to drive the machinery. The true food then is that which Supplies about fifteen grains of carbon to one of nitrogen, together with some inorganic substance. Wheat represents the normal proportion much more Closely than lean meat, fat moat, Or butter. Eggs are a good type of organized food, as they contain both nitrogen and carbon. Milk is One of the perfoct foods. We do not mean to say that we need all through life the same kind of food that is needed during the period of development; still, a perfect food may fairly be rep- resented by milk and wheat, especially if the whole wheat is ground into meal.—London Health. THE NAEDICAL DIAL. 259 PEDIATRICS. UNDER THE CHARGE OF H. B. SWEETSER, M. D. J. P. BARBER, M. D *>= CEREBRO–SPINAL FEVER. Dr. Wm. Osler delivered the Cavendish Lec- ture in London (Phila. Med. Jour., July, '99), choosing this subject. He mentions the close relationship of this disease to pneumonia. Sporadic cases of both occur in intervals of epidemic prevalence, though in pneumonia they are much more numerous. Epidemics of both are most striking in barracks, jails and asylums. Even when not prevailing as an epidemic there may be remarkable house-epidemics of cerebro-spinal fever. The seasonal relations are the same in both, and the two diseases may prevail together. The abrupt onset, the great frequency of herpes in both, the leucocytosis, the almost identical character of the fibrino- purulent exudate in the two diseases, the fre- Quent complication of pneumonia in epidemic cerebro-spinal fever and of meningitis in pneu- monia are additional points of contact. The degree of contagion is about the same in both diseases and it has been claimed that the Or- ganism described in cerebro-spinal fever is only a variety or a degenerate form of the pneumococcus. On the other hand, pneumo- nia is a disease spread over the entire earth, there is no land immune from it. Epidemic meningitis is very rare, and in many countries is still unknown. Croupous pneumonia attacks every age, the disposition increasing somewhat with increas- ing age, epidemic meningitis is a disease which affects children and young people; beyond thir- ty-five there is slight disposition to it. Croup- ous pneumonia has a typical course and a crisis; epidemic meningitis has no crisis. The complications of the two diseases are dif- ferent, etc. Of the twenty-one cases which Osler has seen, lumbar puncture was made in sixteen. In two cases, both mild, the puncture was made, in one on the seventh day, in the other on the sixth day, but no organisms were found. Of the remaining fourteen cases, in thirteen the diplococcus intracellularis was present on cover slips and in cultures. In the remaining case its presence was doubtful on cover-slips, and the slaphylococcus grew in cul- ture. It is worthy of note that in two of the five cases which came to autopsy the diplo- coccus intracellularis was not found, although it was present in the fluid obtained by lumbar puncture sometime previous to death. In one of these a terminal infection of streptococcus and the bacillus colicommunis had taken place. Osler combats Netter's theory that cerebro- spinal fever may be caused either by the pneu- mococcus or the diplococcus intracellularis. He admits that a primary cerebro-spinal men- ingitis may be due to the pneumococcus, but says that both clinically and bacteriologically, this form can be distinguished from the dis- ease in question. He thinks it most unlikely that a remarkable specific affection like cere- bro-spinal fever should be caused by two dif- ferent organisms. “On the whole, then,” he says, “our observations support those of Weichselbaum, Jaeger, Huebner, Councilman and others, that in epidemic cerebro-spinal fever there is an organism with special cultu- ral peculiarities which may reasonably be re- garded as the exciting cause of the disease. Concerning the diagnosis he remarks that meningitis is not always easy to recognize clin- ically. Mortifying post-mortem disclosures are even more common with it than with peri- corditis. The unexpected meningitis of pneu- monia, of Bright's Disease, and of other chron- ic affections, teaches us how latent may be the process; on the other hand, who has not in typhoid fever and in pneumonia, made a posi- tive diagnosis of meningitis, and has found post-mortem the cerebro-spinal membranes perfectly free. Sooner or later the truth of Stokes dictum is brought home to each one of us: “There is no single nervous symptom which may not and does not occur independ- ently of any appreciable lesion of the brain, nerves or spinal chord.” After mentioning the contrast between the abrupt Onset of primary meningitis and the latency of secondary, he devotes considerable space and gives a number of charts to show the peculiar variability of the fever. Of his twenty-one cases thirteen had a skin eruption of some form. Herpes was present in eight cases. A diffuse erythema about the chest and abdomen and over the joints was present in four cases. Petechia were noticed in eight cases, extensive in only three. In three cases a very remarkable and peculiar rash was pres- ent in the neighborhood of the joints, partic- ularly Over the extensor surfaces of the knees and elbows and about the ankles. There was a diffuse, livid erythema of great intensity, on which purpuric herpes developed—a vesicular rash, the individual vesicles of which became filled with blood. As the erythema faded and the vesicles dried, they could be felt as little nodular hemispherical bodies, which could be felt for a week or ten days. A leucocytosis was present in every case. In four the first blood count was made on the third day, and the leucocytosis was 25900, 14500, 40800, and 32000 per c. m. The first count was made on the fourth day in four cases, and the leucocytosis was 26240, 31800, 19300 and 7600 per c. m. In four cases the 260 THE NAEDICAL DIAL. leucocytosis exceeded 40000 per c. m., the max- imum count was 47000 on the ninth day of a fatal case. The leucocytosis persists even in the most protracted cases. As a rule there was no special reduction in the number of red blood corpuscles. In one case the diplococcus intracellularis was isolated from the blood during life. He thinks leucocytosis has no special value in the differential diagnosis of the various forms of meningitis, although the leucocytosis seems not to be so high or so per- sistent as tuberculous meningitis. Arthritis was present in two of his cases. In one of these the disease began with arthritis, and in the other the diplococcus intracellularis was is- olated from the pus in the joints. Kernig's sign was present in every case in which it was sought for. Regarding lumbar puncture he says that during the past ten years no single measure of greater value in diagnosis has been introduced than Quincke's lumbar puncture. We are now able in a large number of cases to make a prompt decision as to the existence of men- ingitis, and are further enabled to recognize the form of the disease. It is a simple, quite harmless procedure, and in a majority of cases can be done without general anasthésia, or with the aid of a local freezing mixture. A dry tap is rare in cerebro-spinal fever; the needle may be plugged with fibrim, or a nerve root may come directly against the orifice. Puncture in the third or fourth interspace may be negative, while in the second a free flow is secured. In one of his cases in which no fluid was obtained, the autopsy showed an exudate as thick as butter. A first puncture in a case is very often negative. Very often at first a few drops of blood flow, then a clear or turbid fluid, either drop by drop, or sometimes in quite a strong stream. In a great majority of all cases when meningitis is present the fluid is turbid. In rare instances clear fluid may be obtained when meningitis exists, and in a protracted case the fluid may be turbid at one puncture and clear at the next. A clear fluid may be obtained from a puncture in the Sec- ond lumbar interspace, while lower down a turbid fluid may be withdrawn. Several ob- servers have noted that the fluid may become clear in the intermissions of the disease. Only once was clear fluid removed in an exacerba- tion; on several occasions bloody fluid was re- moved in case eighteen. In one case in which turbid fluid had been withdrawn at one punc- ture, at a subsequent one, before death, blood flowed from the needle and at post-mortem there was extensive meningitis and a rupture of the basilar artery with hemorrhachis. The number of organisms found bears no constant relation to the intensity of the symptoms. In acute cases they are present, as a rule, in large numbers. The later the dis- ease the less likelihood is there to find the dip- lococcus intracellularis in the fluid; but he has found them in the second, third, fourth, fifth, and seventh Weeks. As to the therapeutic value of lumbar punc- ture he seems undecided. He quotes Williams, of Boston, as saying he had seen beneficial ef- fects, and Wentworth, who has a large experi- ence, has not seen anything more than a tem- porary relief lasting a few hours. Netter claims that he has seen convulsions, that had lasted a long time without intermission, cease after the withdrawal of only two drams of fluid. He (Osler) has given this point his closest attention, and many times has perform- ed the puncture directly for its supposed ben- efit. It is to be regretted that he has given the result in only three cases, and in only one of them any more than the note of improve- ment after a single puncture. Case sixteen he reports fully giving chart. In all seventeen punctures were made between the twenty- ninth and the seventy-fifth day of the disease, of which fourteen were positive. A turbid pale yellow fluid was removed at each tapping. On five occasions 100 c. c. or more were Ob- tained, once 125 c. c. and once 126 c. c. Follow- ing the two first effective tappings the patient appeared better, the temperature dropped, and he seemed much brighter; but he soon be- came worse, and the fever rose. Following the sixth, seventh, eighth, and eleventh punc- tures the temperature fell 4.5°, 3.8° 4.2°, and 5.8°. There was no change in the general con- dition, though he sometimes was a little brighter, and the drop in fever followed so di- rectly that it seemed only natural to attribute the good results to the lumbar puncture. The thirteenth puncture, however, was negative, yet the temperature fell 5.1°, and after the fourteenth tapping the temperature rose 2.6°, He concludes, “Evidently not the withdrawal of the fluid, but the peculiar character of the disease, already spoken of, was responsible for the remissions.” There were no special drugs used in the treatment of his series of cases. Morphia was given freely to control the pain. Ice sponging was employed when the temperature rose above 102.5°. The mortality—nine of twenty- One cases—was considered low, as the cases Were as a rule quite severe. In two of the cases the spinal canal was opened, drained and irrigated. He says, so far as he knows, an ex- tensive lammectomy had not been done for acute spinal meningitis until his first case, Nov. 6th, 1898, in which the operation was sug- gested and performed by Dr. Harvey W. Cush- ing. The spinal canal was thoroughly irri- gated with salt solution and a quantity of purulent exudate washed out. No change fol- lowed in the existing paraplegia. The bladder and kidneys became infected, and he died about two months after the operation. The paraplegia persisted. At autopsy the spinal THE NAEDICAL DIAL. 261 meninges were smooth and looked perfectly normal. It was impossible to say where the dura mater had been incised, and there were neither adhesions nor areas of thickening on the pia-arachnoid. There were extensive changes in the cord itself and the nerve roots. In case twelve lammectomy was performed on the fourth day by Dr. Cushing. The patient was very ill, and the spinal symptoms were especially pronounced. A catheter was press- ed beneath the dura mater and the membranes drained and irrigated with salt solution. For several days he seemed much better. He de- veloped a hemorrhagic cystitis and pyelone- phritis, and died on the sixth day after the ope- ration. Osler thinks, on the principle of a desperate remedy for a desperate disease, the operation seems justifiable in certain sev, re cases, in which, as in his first case, the spinal symptoms are very marked. J. P. B. Two papers on Cerebro-Spinal Fever were read before the section of Practice of Medi- cine at the recent meeting of the Am. Med. Assn., at Columbus (Journal of the Am. Med. Assn., July 22, 1899), one by Dr. George Long- head Eyster, of Rock Island, Ill., and the other by Dr. T. N. Miller, of Rockford, Ill. Dr. Eyster reports two cases, one of which illustrates in a remarkable way the intermit- tency of the fever, and symptoms of the dis- ease. He isolated the diplococcus intracel- lularis from the spinal fluid and also from the nasal mucus in each case. In both cases there was a history of preceding coryza and a muco- purulent discharge from the nose was also present in each case. Dr. Miller’s paper is interesting principally On account of the discussion it elicited. Dr. J. C. Wilson, of Philadelphia, called at. tention to the value of Kernig's sign in diag- nosis, and to the contagiousness of the disease. He advocates such measures as isolation and disinfection until the question of transmissi- bility is finally settled. He also mentioned the value of full doses of opium in the treat- ment of the disease. Dr. J. H. Musser, of Philadelphia, spoke of the value of lumbar puncture as a diagnostic and therapeutic measure. He has no doubt that in some cases there is great relief. It is a relief to the headache and to the irritative symptoms that occur in the early period of the disease. He says withdrawal of fluid often re- lieves the stupor. He mentioned laminectomy and is satisfied it is a rational procedure when perfect asepsis can be maintained and where there is great pressure. Outside of mechan- ical procedures, he thinks opium is the only drug in the treatment of the disease. Dr. Scott, of Iowa, speaking of the con- tagiousness of the disorder said he believes that the origin of infectious diseases is decom- posing animal and vegetable matter. Dr. C. F. Wahrer, of Ft. Madison, Iowa, had a severe and unusually prolonged case follow- ing la grippe. He gave her gelsemium, Opium, belladonna, bromide, chloral and ergot, as well as several other things that the symptoms called for; made hot applications for pro- longed periods, which relieved her of pain, and when she had sufficiently recovered, sent her to New Mexico, when she returned splen- didly recovered. Dr. Bradwell, of St. Louis, demonstrated the diplococcus in thirty-three of thirty-four cases, but he seemed a little mixed on his technique. He found Kernig's sign present in all of the thirty-four cases. He mentioned one case of very great interest. “The case occurred in a woman who was in the hospital and was at the seventh month of pregnancy. She was sick two days; the disease was of the fulminent Order. The foetus was dead. The Woman lived one day. The autopsy showed a menin- gitis of both mother and child, which was con- firmed by bacteriological methods. The dip- lococcus was found in both mother and child.” Dr. J. M. Anders, of Philadelphia, men- tioned a case occurring in a tenement where a great many children, about thirty, had been ex- posed to it and no other case occurred in the building, and from this one case draws the re- markable conclusion that this shows it to be a non-contagious disease. J. P. B. THE PREVENTIVE TREATMENT OF PUER- PERAL ECLAMPSIA. Richard C. Norris, in July number of Am. Gyn. and Obs. Jr., Says the rational and efficacious treat- ment of eclampsia consists in prophylaxis. He as- Sumes that toxins of unknown Composition and from various origins are the underlying factors of puerperal eClampsia. - The healthy organism at best is a manufactory of poisons, and, quoting from Boufe, “Even the healthy body makes incessant attempts at suicide by intoxication.” However health is maintained by two sets of organs—the one to transform, the other to eliminate. During pregnancy these protecting Organs are put at a disadvantage and a break in the physi- ological equilibrium is the result; the blood contains an abnormal quantity of leucomains and the toxicity Of the urine is decreased, While that Of the blood Serum is increased; there are fower red blood Cor- puscles in the blood; the heart and lungs do extra work; while that of the kidneys and liver is also in- Creased. Too much stress cannot be laid upon the insuf- ficiency of the liver, as a number of complications of pregnancy depend directly upon the faulty action of the liver, the kidneys having a secondary role in their production. The more serious Complications are such as pty- alism, pruritis and incorrigible vomiting lasting after the fourth month, while milder toxemia produces the usual vomiting, dyspepsia and Constipation. The nervous System may suffer, likewise the skin producing herpes and bronzing. Thus the prophylaxis will necessarily be hygienic as well as medicinal and obstetric. The hygienic consists in good pulmonary ventilation and a diet of easily di- 262 THE NAEDICAL DIAL. gested, readily oxidized, nonconstipating and non- toxic food. Intoxication is first evidenced by Such symptoms as neuralgia, irritable temper, Vomiting, Salivation and hebetude. The urine is usually free from albu- men, but the area is diminished, While uric acid is increased. For practical purposes the percentage of urea, the specific gravity and the amount voided must be Kietermined. For the medicinal treatment of mild cases cal- Omel with regulation of diet is sufficient. Calomel not only acts favorably on the liver but also as a marked intestinal antiseptic. For graver cases complete rest in bed, the pa- tient assuming the genupectoral position at inter- vals, an exclusive milk diet, and in some cases the patient should be placed in the Trendelenburg post- ure and the colon daily flushed with two gallons of normal Salt Solution. In urgent cases hypodermo- clysis may be desirable. Hot air baths and hot pack should only be used in cases requiring the emptying of the uterus. Epsom Or Rochelle salts are Con- sidered best for the rapid elimination of Waste products. Diuretics, aside from copious drafts of water, are inadvisable since the overtaxed kidneys should not be Crowded. NO fixed rule Can be laid down for the termina- tion of pregnancy, but should the toxaemia Continue to increase steadily in spite of all treatment, this, more than any other Symptom, may justify the emptying of the uterus. J. P. B. THE AETIOLOGY OF ECTLAMPSIA AND THE DIAGNOSIS OF IMPENDING ECLAMPSIA. Edward P. Davis, in July number of American Gyn. Obs. Journal, mentions Some of the Various, theories that have been advanced, but sums up the situation by saying that at the present time the bulk of evidence goes to show that it is due to a profound toxemia. Originating in mother and foetus, but that the exact agent has not been isolated. Mention is made however of the experiment of Merletti with ammonium Carbonate in Solution, which produced eclampsia, and death in animals, and whose organs showed the same lesions as found in eclampsia. Cellular necrosis was the chief characteristic. Merletti declared a profound intoxication by the ex- cess of incomplete urea in the blood caused convul- Sions and death with parenchymatous degenerative Changes, with or without hacmorrhages. The urine of the eclampic patients produces but feebly toxic effects when injected into animals, while that of noneclamptic persons is often quite the reverse. “When, however, the blood Serum Of eclamptics was carefully studied and a microscopic study of the organs of eclamptic patients showed multiple emboli as a constant pathological change, it became evident that the toxines of eclampsia. Cause Convulsions, because they are absent from the urine and excretions and present in the serum of the blood and in the organs of the body. It is natural then to find the urine during eclampsia not highly toxic.” Serum albumen may be present in the urine, but, unless in CXCess, or it is accompanied by kidney debris, it is a symptom of importance. While convenient tests for toxinos are lacking, yet We have in Ulrea a clinical index of the metab- olism of the body which may be utilized to designate the lack Of assimilation. A diminished amount of urea excreted indicates that toxines are retained, while a normal amount indicates but little retained. The pregnant woman rarely excretes the normal amount, but less than 1.5 per cent. demands attention. Especial attention must be directed to the func- tions Of the liver and intestines. When close Scru- tiny indicates that the liver, kidneys, skin, bowels, and lungs are deficient in action, investigation of the nervous system will show that the patient is suffer- ing from retained toxines. J. P. B. Neurology and Psychiatry. UNIDER THE CHARGE OF R. O. BEARD, M.D., W. A. Jon ES, M. D. DISORDERS OF TELE NERVOUS SYSTEM A CCOMPANYING GYNECIC DIS- EASES. The author (R. S. Hill, M. D., Journal of the Amer. Med. Assn., July 15, 1899), describes eight cases of operation in gynecological cases in six of which acute mania occurred during the first ten days after the operation. One of the other two also died insane within a year. According to his own account all the patients were in an anaemic, exhausted and nervous condition before the operation, and not a few of the symptoms described as justifying opera- tion might fairly be laid to the general condi- tion. A large part of the paper is taken up in an elaborate description of the way in which the pelvic nerves might affect the brain. Such theories are doubtless good, but it might be even better to know enough to put one’s pa- tients in good condition before performing two or three operations on the pelvic viscera. Sure- ly an attack of acute mania lasting two or three weeks, even if finally recovery occurs, has injured the stability of the brain cells rather than improved them. Perhaps in Ala- bama surgery has made more rapid progress than neurology. Certainly Dr. Hill gives no evidence in his paper of the shadow of a doubt as to the propriety of the operations in view of the subsequent history. W. A. J. CONCERNING IKERNIG’S SIGN IN MEN- INGITIS. The author (James B. Herrick, M. D., Amer- ican Jour. Med. Sci., July, '99) recounts an in- vestigation to determine the value of Kernig's sign made in nineteen cases of meningitis and in one hundred other cases, twenty-five of which were normal. In 1884 Kernig, of Rus- sia, announced that if a patient with menin- gitis be made to sit up, as on the edge of the bed, the thigh therefore being at a right angle with the body, it is found extremely difficult to extend the leg because of the presence of a marked flexor contracture. The sign may also be obtained by bringing the thigh at right angles to the body as the patient lies in bed on the side or preferably on the back, and the leg then extended. The only requirement seems to be that the thigh should be placed at a right angle with the body before the attempt is made to extend the leg. Not infrequently in deliri- ous patients a little, gentle force must be used THE MEDICAL DIAL. 263 before the jerking and tense muscles yield. The same is true of some spastic conditions. But where Kernig’s contracture is present pa- tience and gentleness do not cause the muscles to yield, and the back of the patient can gen- erally be lifted from the bed without the knee giving way. Of course there must be exclud. ed those cases in which local causes could in- terfere with the proper extension of the leg, such as rheumatic or other forms of arthritis of the hip or knee, myositis, old contractures from nervous diseases, and sciatica. Astonishingly little attention has been giv- en to this sign, but last year Netter reported two series of cases, numbering seventy in all, in 90 per cent. of which the sign was present. Herrick’s series of cases gives an equally fa- vorable result. Of the nineteen cases of un- doubted meningitis examined, the sign was present in seventeen, or 89.4 per cent. of the cases. In the two cases in which it was ab- sent, both children, the single examination was made a short time before death, and it was noticed at the time that there was a general marked laxity of all the muscles. In eight of these cases the diagnosis was confirmed by autopsy. In one case of miliary tuberculosis the sign was absent at first, but later made its appearance at the same time with the other ev- idences of cerebral involvement—retraction and rigidity of neck, severe headache, paralysis of Ocular muscles. In some of the cases its presence was of distinct value in making the diagnosis. Netter records a case of great value. In a typhoid with typical symptoms and no clinical evidence of meningitis, Kernig's sign was marked. Autopsy showed typhoid, and also a cerebro-spinal meningitis due to the staphylo- coccus pyogenes and the bacillus typhosus. In the twenty-five normal persons and sev- enty-five cases of various diseases other than meningitis examined for this phenomenon it was absent in ninety-eight and present in two. Of these two one on autopsy proved to be sub- dural hemorrhage, and the other was a case of gonorrhoeal rheumatism who had lain for four weeks with the knees flexed, as this was the most comfortable position. TTerrick concludes that this sign is present in from 80 to 90 per cent. of cases of menin- gitis and is only exceptionally present in other diseases. W. A. J. ON ASTASIA—ABASIA, WITH A CASE. The author (J. C. Wilson, M. D., Amer. Jour. Mod. Sci., July, '99) gives the sixth case reported by American physicians of this syn- drome, and adds that but forty-three cases are On record in medical literature. The case was that of a young woman twen- ty-four years of age, of distinguished but high- ly neurotic family. On the paternal side there is an uncle epileptic and an aunt addicted to mor- phine; on the maternal, two uncles dipsomani- acs. Her father was very successful in busi- ness, had grandiose ideas, and lost a large for- tune: now is greatly absorbed in tracing gene- alogies. Her mother and one sister died of diphtheria, and an older sister who is in ex- cellent health is very excitable. The patient kept house for her father, was intelligent and cheerful, and in excellent health until a re- cent unsatisfactory love affair. Early in Jan- uary she began to have bath pruritus, and one night just at the close of menstruation she was aroused at midnight to receive an unimport- ant telegram. The next day on attempting to arise, she found it impossible to stand or walk. She described her condition in the following terms: “My left leg feels as if it were made of cotton”—an expression already recorded— and “I feel like a combination of a child learn- ing to Walk and a drunken woman.” Examination showed slight pallor, but oth- erwise all organs and functions were normal. Lying in bed or seated on a chair, the lower exll einities showed nothing abnormal; motor power, freedom and precision of movement, and the muscular senses were unimpaired; knee-jerks decidedly increased; ankle-clonus not present; the plantar reflex intact; electric- al reactions normal. There was no rigidity, ataxia, or paralysis. Sensation to touch, tem- perature and pain appeared to be unimpaired. She complains, however, of numbness and pricking throughout the left lower extremity, including the foot, leg and thigh, and also in the right foot, and outer surface of the right leg below the knee. Upon attempting to stand her legs bent under her, owing to abrupt move. ments of flexions of the knee followed by rapid extension. These contortions necessitate a com- pensatory movements of the upper extremities and head in order to maintain equilibrium. Upon attempting to walk with assistance these difficulties Were increased. Treatment consisted of rest in bed, Valeri- anate of zinc, one grain four times a day, mas- sage and faradism. At the end of four weeks the motor disturbance and paraesthesia had wholly disappeared, but about this time dis- tinct hysterical phenomena—vomiting, inter- mittent tremor of the hands, vertigo, sensa- tions of throbbing in the abdomen, emotional manifestations, weeping and excitement with- out apparent cause—manifested themselves. That astasia-abasia is not a nosological entity, but a syndrome, must be conceded. Church’s statement that it is due to a systema- tized amnesia embodies that theory which is generally accepted. In the foregoing case it was a symptom of hysteria. Many of the cases have occurred in connec- tion with organic disease but cases of organic disease of the nervous system are often asso- ciated with hysteria. W. A. J. 264 THE NAEDICAL DIAL. Book notices. THE DISEASES OF THE NERVOUS SYS- TEM, a Text-Book for Physicians and Stu- dents, by Dr. Ludwig Hirt, Professor at the University of Breslau; translated, with per- mission of the author, by August Hock, M. D., formerly Assistant Physician to the Johns Hopkins Hospital, now the McLean Hospital, Waverly, Mass.; assisted by Frank R. Smith, A. M. (Cantab.), M. D., In- structor in Medicine in the Johns Hopkins University; with an Introduction by Wm. Osler, M. D., F. R. C. P., F. R. S., Professor of Medicine in the Johns Hopkins Uni- versity, etc. With one hundred and eighty- One illustrations. New York: D. Appleton and Company, 1899. Price, $5.00 cloth; sheep $6.00. The above work takes its place in the “Medical Iibrary Series” of the Publishers, and will be widely read in its translation into English. The author is well known as a teach- er in nervous diseases, and the introduction to the English translation by Dr. William Osler, will add to its favorable reception by Ameri- can readers. Dr. Osler remarks that, “Where all is so good it is invidious to select, but the chapter on Tabes is an illustration of our author’s lucid, and, at the same time, thorough treatment of his subject.” The same state- ment would be true of the complete work; but the chapters on Aphasia and Parasites of the Brain are especially interesting. In regard to the former Dr. Hirt says, “The speech center, which is situated partly in the frontal, partly in the temporal lobe of the left hemisphere, is certainly of larger extent than is commonly supposed.” This fact is fully illustrated by descriptions and diagrams concerning the symptoms of diseases affecting the speech. As to the parasites found in the brain, cys- ticerci and the echinococci are described as the most important. The cysticerci are frequent- ly found at the autopsy when their existence during life was not suspected. Of the four cases observed in the author's clinic, only one was diagnosed during life, and “this one not not because it presented characteristic symp- toms, but owing to the history of the patient, from which we learned that he was in the habit of frequently eating raw pork.” We can recommend the work as a valuable addition to the literature on nervous diseases. We have much pleasure in drawing the at- tention of our readers to the following list of new books which will be published by W. B. Saunders, Philadelphia, on or before Septem- ber 1, 1899: The International Text-Book will present a complete treatise on the theory and practice of surgery in its most advanced aspects. There is a real need among practitioners and ad- vanced students for a work On Surgery, en- cyclopedic in scope, yet so condensed in style and arrangement that the matter usually dif- fused through four or five volumes shall be given in one-half the space and at a corres- pondingly moderate cost. In his Pelvic Inflammations, Dr. Pryor di- rects the attention of the general practitioner and specialist to a surgical treatment of the infectious pelvic diseases of women. The sub- ject is a most important one, insomuch as in: flammatory lesions constitute the majority of all pelvic diseases. Ryle on the Nose and Throat, Heisler's Em- bryology, and Jackson's Disease of the Eye are practical text-books for students, written by men of long and successful experience as teach- ers of these branches. Special features of Dr. Kyle's book are the logical classification of the diseases, the mod- ern pathology illustrated with new and orig- inal cuts, and the extended consideration given to details of treatment. DEATHS UNDER “CHRISTIAN SCIENCE.” Reports of deaths more or less due to “Christian Science” are coming in so rapidly from all parts of the country that the patience with which the country endures the crimes of the would-be exorcists is simply amazing. Notes of protest are, indeed, to be heard com- ing from various directions, but most of them are sounded by organizations of little influence or authority, like the Medico-legal Society of this city, or in courts of limited jurisdiction and unimpressive powers. The great medical associations, state and county, content them- selves with occasional ridicule of the “Scien- tists” and their dupes, but they do nothing effective, while the various legislatures ignore altogether this danger to the life and health of the whole population of the country and de- vote their energies to matters many of which are of much less public importance. Mean- while the high priestess of ignorant credulity intermits her propaganda only long enough to make affidavit that she is not yet dead, and, having demonstrated her continued existence, proceeds industriously with the appointment of new book agents and the acquisition of more wealth. All this is amusing enough in its way, but it is also humiliating and danger- ous. Every “Christian Scientist” is a poten- tial center of infection for bodies as well as minds, and that the victims of this infection are many is shown every day that passes.— New York Times. It is said that lactic acid and glycerin, equal parts, Will remove freckles. THE NAEDICAL DIAL. 265 Index II?&dicuS. Original Articles of last month. & & Figures indicate price for single copies. PENN. MED. JOUR., PITTSBURGH. (25) Pott's Disease and its Modern Treatment, Stew- art L. McCurdy, M. D., Pittsburgh. Report of a Case of Cerebellar Abscess, J. B. Crombie, M. D., Alleghany. The Treatment of Appendicitis, R. H. Gibbons, M. D., Scranton. Stricture of the Rectum, William M. Beach, M. D., Pittsburgh. To Make Clean the Hands, and the Field of Sur- gical Operation with a Job, W. S. Forbes, M. D., Phil- adelphia. Some Atypical Features of Certain of the More Common Nervous Diseases, Theodore Diller, M. D., Pittsburgh. The Importance of Early and Proper Attention to i. Ailments of the Eye, G. W. Allyn, M. D., Pitts- urgh. The Normal Movement of the Ocular Muscles, Joseph E. Willets, M. D., Pittsburgh. The Attitude of the Family Physician to His Pa- tients in Respect to Opticians, Louis J. Lautenbach, A. M., M. D., Ph. D., Philadelphia. MED. AND SURG. MONITOR, INDIANAPOLIS. (10) Cerebral Paralysis, Daniel R. Brower, M. D., Chi- Cago. The Role of Primary and Secondary Osteoplastic Surgery in the Treatment of the Extremities, Thomas H. Manley, M. D., New York. Physician and Patient—Legal Aspect of Profes- sional Secrets, Judge Charles E. Cox, Indianapolis. Treatment of Puerperal Septicemia, Luther P. Luckett, M. D., Terre Haute, Ind. -* N. W. LANCET, ST. PAUL (JULY 1). (10) Medical Federation, President’s Address Before the Minnesota State Medical Society, F. A. Duns- moor, M. D., Minneapolis. Abdominal Hysterectomy in the Treatment of Malignant Disease of the Uterus, J. L., Rothrock, M. ID., St. Paul. A Plea for Better Disinfection in Typhoid Fever, E. B. Miner, A. B., M. D., Gardner, N. D. Probing the Nasal Duct, J. H. Rinelaub, M. D., Fargo, N. D. N. W. LANCET (JULY 15). Modern Veterinary Practice, M. H. Reynolds, M. D., V. M., Minneapolis. Surgical Treatment of Strabismus and Heteropho- ria, with report of Sixty-seven Cases, H. A. Beau- doux, M. D., Fargo. Vetro-Suspension of the Uterus, Aug. Eggers, M. D., Grand Forks. Lights and Shades of Ilife Among the Insane, D. S. Moore, MI. D., Jamestown, N. D. N. Y. LANCET. (10) Abnormal Reaction of Stomach Contents Produc- ing Constipation and Diarrhea, John P. Sawyer, MI. D., Cleveland, Ohio. Painful IRheumatoid Arthritis of the Ileft Hip- Treated with Ice as a Local Application, W. EWart, M. D., New York. Eye Complications of the Acute Specific Fevers, Percy Fleming, MI. D., New York. Foreign Bodies in the I’harynx and Oesophagus, Robert Jones, M. D., Liverpool. A Case of Ear Cough, Mayo Collier, M. D., LOn- ClOn. A Note on Hemophilia, E. Mansel Sympson, M. A Note on X-Rays and Color-Blindness, Sidney Stephenson, M. B., F. R. C. S., Edinburgh. Picric Acid in Superſicial Burns, Ian Macdonald, M. D., Rio Tinto, Spain. Dilatation of the Stomach and Stricture of the Pylorus, A. W. Mayo Robson, M. D., New York. Erythrol Tetranitrate in Angina Pectoris, Bough- ton Addy, M. D., Southport. ST. L. MED. AND SURG. JOUR. (10) Experimental Study of Children, More Especially of Washington School Children, Arthur Macdonald, M. D., Washington, D. C. Chlorosis, S. A. Scher, M. D., Hamburg, Germany. MED. REGISTER, RICHMOND. (15) Mastoiditis: Diagnosis and Treatment, John P. Davidson, M. D., Richmond. The Evolution of Therapy, Simon Baruch, M. D., New York. Etiology and Treatment of Alveolar Hemorrhage, John H. Hartman, D. D. S., Richmond. Peculiar Case of Twin Birth, J. B. Fisher, M. D., Midlothian, Va. JOUR. OF SCIENTIFIC MED., CHICAGO. (10) Treatment Of Neurasthenia—with Clinical Re- ports, Milton P. Creel, M. D., Central City, Kan. Advantages of Dispensing Our Own Drugs, H. Stein, M. D., Altamont, Ill. MED. SUMMARY, PHILADELPHIA. (10) Cholera Infantum, William Hooker Vail, M. D., St. Louis. Treatment of Erysipelas, Charles E. Tucker, M. D., Joppa, Ill. Does Tobacco Cause Amblyopia? Wm. H. Morse, M. D., Westfield, N. J. Thermal Convulsions of Children, A. J. Mann, M. D., Luz, Ga. Chips from My Workshop, Joseph Adolphus, M. D., Atlanta, Ga. Medical Legislation, J. W. Lockhart, St. Joseph, Wash. Eth-Pharmal, Ben H. Brodnax, M. D., Brodnax, La. WESTERN CLINICAL RECORDER, CHICAGO. 10 The Rational Diagnosis, being the Annual Ad- dress before the Wisconsin State Medical Society, Henry B. Favill, M. D., Chicago. A Typical Pneumonia, following Grippe, A. T. Holbrook, S. B., M. D., Milwaukee. IReport of a Case of Probable Thrombosis of the Right Sigmoid Sinus, Arising from Acute Purulent Otitis Media; Recovery Without Operation, F. D. Brooks, M. D., and Thomas C. Phillips, B. S., M. D., Milwaukee. MEDICAL HERALD, ST. JOSEPH. (20) The Relation Between DOCtor and Dentist, Daniel Morton, M. D., St. Joseph. IReport of the Committee on Progress of Obstet- rics, C. C. Dunnaker, M. D., Kansas City. The Treatment of Gastric and Intestinal Diseases, Johann Landau, M. D., Heilkunde, MO. The Specialist, W. C. I'ulkerson, M. D., Blue Hill, Neb. The Treatment of Diabetes, C. H. Wallace, M. D., St. Joseph. WISCONSIN MEDICAL RECORDER, JANES- VIII.E. (10) Gastro-Intestinal Diseases of Children, Or Sum- lmer Complaints, Joseph Adolphus, M. D., South Atlanta, Ga. Gastro-Intestinal Troubles of Old People, Ralf St. J. Perry, MI. D., Farmington, Minn. Diarrhoea, F. H. Benedict, M. D., Weedsport, N. Y. Direct Massage in the Treatment of Glaucoma. (7th paper), J. A. Pratt, M. D., Aurora, Ill. MEDICAL SENTINEI, PORTLAND, ORE. (25) The Pathology and Therapy of Cancer—with Spe- Gial IReference to Cancer of the Stonnach, Augustus C. Bernays, MI. D., St. Louis. Acute Gastro-Intestinal Affections George M. Wells, Portland, Ore. in Children, 266 THE NAEDICAL DIAL. MERCIK'S ARCHIVES. (10) Importance of Internal Remedies in General Sur- gery, Thomas H. Manley, M. D., New York. The Thyroid Gland in Obesity, Horatio B. Wood, M. D. The Usefulness of Potassium Iodide in Cerebro- spinal Meningitis, H. A. Moody, M. D., Mobile. The United States Pharmacopoeia, John Forrest, M. D., South Carolina. JOUR. OF COMP. MED. AND VET. ARCHIVES, PHILADELPHIA. (30) Stock-Farm Veterinary Practice as a Post-Grad- uate Course, A. M. Lushington, W. M. D., Lynch- burg, Va. Cornstalk Disoases, A. Bostrom, D. W. S., Minden, Neb. Leukaemia, B. R. Raupp, D. W. S., Ransas City, MO. Serum as a Remedy... for Hog-Cholera, J. D. Sprague, V. S., David City, Neb. Synopsis of a Report on Osteoporosis, C. J. Mar- shall, W. M. D., Philadelphia. The Veterinarian as a Naturalist, W. H. Dal- rymple, M. R. C. V. S., Baton Rouge, La. IKINGSTON MED. QUAR., CANADA. Medical Associations (Editorial). Examination of the Prepuce in Cases of Deferred Diagnosis, A. E. Barber, M. D., South Bend, Ind. • Clinical Demonstration in Operative Gynecology, Isaac Wood, M. D. The Complications of Scarlet Fever and Their Treatment, J. W. Campbell, M. D., Kingston. Tuberculosis Prophylaxis, E. Ryan, M. D. Hay Fever, J. C. Connell, M. D. Faces and Their Examination, W. T. Connell, M. D. A Typical Operation for the Radical Cure of Ob- lique Inguinal Hernia, W. G. Anglin, M. D. ST. LOUIS MED. GAZETTE. (10) The Establishment of Sanatoria, and the Tuber- culosis Congress (Translated from the Berliner klinische Wochenschift by Sidney I. Schwab, M. D., St. Louis), Ferdinand Hueppe, Germany. Infantile Paralysis (3d Paper), Charles G. Chad- dock, M. D., Paris, France. Amputation at Lower End of Thigh for Gangrene —Patient Recovers, Dr. Julius E. Griswold, Port- land, Conn. AM. JOUR. OF SURG. AND GYN., ST. LOUIS, JUNE. Optbalmologic Surgery in the Country, With Spe- cial Reference to Acute Ulcer of the Cornea, John Fee, M. D., Oklamoma City, Okla. Successful Removal of a Piece of Wood Imbedded in the Brain Thirty-Two Years, Without Impairing the Cerebral Functions—Removal of a IKnife Blade in the Brain, Death, Z. H. Evans, M. D., Traverse City, Mich. Electricity in Gynecological Practice, J. A. GraC- ey, M. D., L. R. C. P., Waxahachie, Texas. Occlusion of Pošterior Nares, with Report of TWO Cases, J. Rule Fritts, M. D., Mexico, MO. Treatment of Congenital Talipes, Harriet E. Gar- rison, M. D., Dixon, Ill. That First “Hysterectomy,” R. E. Haughton, M. D., Richmond, Ind. “Division of the Fee,” from the Standpoint of the Country Doctor, Finis Purdue, M. D., Swinton, Mo. Trouble with Vulvar Papillomata, H. D. Fair, M. D., Powers, Ind. Three Abdominal Sections Of the Same Woman in Five Years, the Second being Caesarean Section, Mother and Child Both Living, Stewart W. Prior, M. D., Chester, S. C. Treatment of Carbuncles, Milton P. Creel, M. D., Central City, Ky. S. W. MED. REC. (JUNE), HOUSTON, TEX. (10) Summer Complaints of Children, W. H. Allen, M. D., Marlin, Tex. Diarrhoea of Infants, A. H. Schenk, M. D., Ken- ney, Texas. BROOKLYN MED. JOUR. (20) M º Mental Suggestion and Charlatanism, P. Scott, B Rºsis of Hip Disease, Charles D. Napier, A. ., M. D. The History of a Case of Cut Throat, Henry Wallace, M. D. Pelvic Abscess in Women, Alexander Rae, M. D. GAILLARD’S MED. JOUR., NEW YORK. (50) On the Care Of the Skin in Its Connection. With Physical Culture and Health, Dr. John Moir, L. R. C. P., L. R. C. S. (Edin.), London, Eng. Clinical Data Relating to Cancer of the Uterus, Andrew F. Currier, M. D., New York. A. Clinical Lecture in Neurology, Harold N. Moy- er, M. D., Chicago. Two Cases of Peliosis Rheumatica, Charles J. Aldrich, M. D., Cleveland, Ohio. Remarks on the Midwifery Question, Thomas J. Hillis, M. D., New York. The Doctor Outside of Medicine, William L. Stowell, M. D. MED. EXAM., NEW YORK. (20) The Technique for the Detection of the Tubercle Racillus in Sputum, as It Affects the Life Insurance Risk, Thomas C. Craig, M. D., Surgeon U. S. Navy (Retired), Brooklyn. A Plea, for Under-Graduate Instruction in Mak- ing Life Insurance Examinations, Brandreth Sym- Onds, A. M., M. D., New York. 9. The Relation of Build (i. e. Height and Weight) to Longevity, George R. Shepherd, M. D., Hartford, Conn. Selection, Appointment and Qualifications of Medical Examiners, Wm. B. Ribbey, M. D. POST-GRADUATE, NEW YORK. (30) The Diagnosis of Renal Tumors, Leonard Weber, M. D., New York. Some Remarks on Gastric Ulcer, Especially On Its Cicatrization, Achilles Rose, M. D., New York. MEMPHIS LANCET. (10) The Galvano-Caustic Radical Treatment of ProS- tatic Hypertrophy, F. IGreissl, M. D., Chicago. Vomiting in Pregnancy, G. G. Buford, M. D., Memphis. Surgery of Strabismus, Charles H. Beard, M. D., Chicago. Ludwig's Angina—with Report of Cases, Robert W. Tate, M. D., Bolivar, Tenn. Post Hoc, Propter Hoc, W. J. Chenoweth, MI. D., Decatur, Ill. A.M. JOUR. OF DERM. AND G.—U. DIS., ST. LOUIS. (25) Two Cases of Primary Carcinoma of the Prostate, L. Bolton Bangs, M. D., New York City. A Case of Ichthyosis Nigricans, A. H. Dumesnil, M. D., St. Louis. Gummata and Chancro Iłedux, Henry G. An- thony, M. D., Chicago. TJrethritis—GOnOrrhoea, M. D., Eddy, N. M. A Case of Dermatitis Pilaris Capillitii, Isadore Dyer, M. D., New Orleans. Combined Perineal and Suprapubic CyStotomy, Wm. P. Munn, M. D. The Bottini Operation for Enlargement of the Prostate Gland, with Report of Case, Andrew J. Downs, A. M., M. D., Philadelphia. A Few Remarks in Regard to the Treatment of Gonorrhoea, Edward J. Wynkoop, M. D., Syracuse, N. Y. Venereal Warts in Ano, A. B. Middleton, B. S., M. D., Pontiac, Ill. Treatment of Retention of Urine in Cases of En- larged Prostate, H. M. Christian, M. D., Philadelphia. Secondary Tuberculosis of the Skin, Walter U. ICennedy, M. D., St. Louis. TEXAS MEDICAL JOURNAL, AUSTIN. (10) Intestinal Perforations from Within by Foreign Bodies, by B. E. Hadra, M. D., San Antonio. Ohmann- F. G. Moehlau, THE MEDICAL DIAL. 267 ~f Some Tonsil Clippings, by R. S. Carroll, M. D., Calvert, Tex. MED. REVIEW OF REVIEWS, NEW YORK. (10) Gynaecological Surgery in Public Hospitals, Henry C. Coe, M. D., New York. MEDICAL COUNCIL, PHILADELPHIA. (15) Obstetrics and Gynecology in China, Charles E. Reed, M. D., Kang Hau, Canton, China. Hypertrophied Tonsils, J. T. Anderson, M. D., Cornelia, Mo. Surgery in the Region of the Western Plateau, H. A. Armstrong, M. D., East Las Vegas, N. M. On the Change of Life in Women, A. H. P. Leuf, M. D., Philadelphia. Some Experiments in the Use of Antitoxine in Diphtheria, W. S. Devine, M. D., Marshalltown, IOWa. Some Common Diseases of the Ear, John R. Baer, M. D., Philadelphia. R. C. MED. INDEX—LANCET. (10) Empiricism in Missouri and How to Suppress It, E. L. Priest, M. D., Nevada, MO. Vasoco-Vaginal and Vasico-Uterine Fistula, H. E. Pearse, M. D., Kansas City. MEDICAL MIRROR, ST. LOUIS. (10) The Vagilla, Byron Robinson, M. D., Chicago. Grip, O. D. Fitzgerald, M. D., Los Angeles, Cal. Report of a Case, Triplets, J. Louis Early, M. D., Iºnottsville, Ky. Report of a Case of Cerebro-Spinal Meningitis, L. C. ROyater, M. D., Henderson, Ky. Deviations of the Nasal Septum and Its Operative Treatment, Wm. B. Shields, M. D., St. Louis. Scarlatina, C. R. Day, M. D., MayView, MO. - BUFFALO MED. JOURNAL. (20) A Plea for the Unification of Medical Societies, Z. J. Lusk, M. D., Warsaw, N. Y. Prophylaxis in Obstetrical Practice, W. G. Tay- lor, M. D., Buffalo. Relative Death Rates from Cancer and Consump- tion, John H. Pryor, M. D., Buffalo. Relation of Medicine to Civilization, John O. Roe, M. D., Rochester, N. Y. N. Y. MED. JOURNAL. JUI.Y 1. (10). Three Steps in the Tuberculous Process in Chil- dren, David Boviard, Jr., M. D., N. Y. Shadowgraphs of the Intestinal Villus of the Cat, J. W. Hartigan, A. M., M. D., F. R. M. S. (London), Morgantown, W. Va. Comparative Test of Mixed-Fat Emulsion Cod-Liver Oil, W. J. Mersereau, M. D., N. Y. The Christian Scientists: What Shall We DO With Them 2 F. Julian Carroll, M. D., Summerville, S. C. Excision of the Right Superior Cervical Ganglion of the Sympathetic for Glaucoma, with Report of Case and Review of Literature Of the Surgery of the Cervical Ganglia, James Moore Ball, M. D., Edwin C. Renaud, M. D., and Willard Bartlett, A. M., all of St. LOUlis. N. Y. MED. JOURNAL, JULY 8 (10) Report of Three Cases of Multiple Pistol-Shot Wounds of the Intestine, George Woolsey, M. D., N. Y. A Clinical Study of Twenty-four Cases of Paraly- sis Agitans, Joseph Collins, M. D., and L. J. J. Mus- kens, M. D., both of N. Y. AEtiology of Texas Cattle Fever, with Special IReference to Recent Hypotheses Concerning the Transmission of Malaria, Theobald Smith, M. D., Boston. Eudoxine in Paediatric Practice, Gustavus M. Blech, A. B., M. D., Chicago. The Doctor as a Carrier of Disease, John T. How- ell, M. D., Newburgh, N. Y. N. Y. MEDICAL JOURNAL, JULY 15. (10) The Nature of the Xanthomata, S. Pollitzer, A. M., M. D., N. Y. The Relation of Ophthalmology to General Med- icine, G. Griffin Lewis, M. D., Syracuse, N. Y. Some Aspects of Chronic Malarial Infection and their Treatment, W. H. Thomson, M. D., L.L. D., N. Y. and Phthisis: Its Aetiology and Treatment, George D. Barney, M. D., Brooklyn. The Term Appendicitis, Utica, N. Y. Why Fumigation of Apartments Occupied by Tu- berculous Patients at Health Resorts Should be un- der Municipal Control, Charles F. McGahan, M. D., Aiken, S. C. N. Y. MEDICAL JOURNAL, JULY 22. (10) A Study of Delirium, William Hirsch, M. D., N. Y. The Importance of Early Diagnosis in Locomotor Ataxia, as Affected by the Newer Pathology, Wil- liam Broaddus Pritchard, M. D., N. Y. The Properties of Buffalo Lithia Water, John W. Shoemaker, M. D., L.L. D., Philadelphia. Remarks Based upon a Further Experience with Calomel in Diphtheria, L. D. Judd, M. D., Philadel- phia. The Administration of Atropine in Epilepsy, F. L. Wachenheim, M. D., N. Y. N. Y. MEDICAL JOURNAL, JULY 29. (10) Cerebral Abscess in a Child Three Months Old, Complicated by Erysipelas of the Head and Face— Operation—Recovery. Cursory Consideration of the Diagnostic Value of Symptoms, William J. Doyle, M. D., Philadelphia. Modern Therapy of the Tympanic Cavity, M. A. Goldstein, M. D., St. Louis. Anaesthesia: Nitrous Oxide; Ether; Chloroform, S. Ormond Goldan, M. D., N. Y. Old Types of Disease, F. Savary Pearce, M. D., Philadelphia. A Report of Two Cases of Typhoid Infection without any Intestinal Lesions, August Jerome Lar- tigau, M. D., Albany, N. Y. The Early Recognition and Management of Ma- lignant Disease of the Digestive System, Max Ein- horn, M. D., N. Y. MED. RECORD, N. Y., JULY 1. (10) Notes On the Treatment of Yellow Fever with the Blood-Serum of the Bacillus Icteroides, and its Preparation, Charles B. Fitzpatrick, M. D., N. Y. A. Further Contribution to Exclusion. Of the In- testine, Frederick Kammerer, M. D., N. Y. A Grooved Perineal Cannula to be Used as a Guide in Performing Perineal Sections in Cases of |Urethral Obstructions, Ramon GuiträS, M. D., N. Y. The Ill Effects of the Roentgen Rays as Demon- strated in a Case, Daisy M. Orleman, M. S., M. D., Peekskill, N. Y. Cystoscopy and Urethral Catherization in Women, Edward N. Liell, M. D., Jacksonville, Fla. IHow to Retain Your Grip on the Practice of Medicine, Sidney Davis, M. D., Milton, Pa. Foreign Bodies in the Throat, Herbert J. Hop- kins, M. D., C. M., Pittsburg. A Case of Acromegaly, A. Hymanson, M. D., New York. An Unique Case of Pityriasis Versicolor, William S. Gottheil, M. D., New York: MED. RECORD, NEW YORK, JULY 8. (10) Report of a Case of Alcoholic Multiple Neuritis, with Autopsy, J. H. Larkin, M. D., Ph. D., New York. Notes on the Induction of Premature Labor, Henry C. Coe, M. D., New York. Variations in Human Gait, E. H. Bradford, M. D. BOSton. MED, RECORD, NEW YORK, JULY 15. (10) Some Points in the Symptomatology, Pathology and Treatment of Diseases of the Sinuses Adjacent and Secondary to the Orbit, Charles Stedman Bull, A. M., M. D., New York. Some Remarks on Chronic Bright's Disease, Arthur R. Elliott, M. D., Chicago. Preparing for the Knife in European Hospitals, J. Preston Miller, M. D., Washington, D. C. The Relations Of Cardiac Murmurs to the EventS of the Normal Cardiac Cycle, Warren Coleman, M. D., New York. Treatment of a Supposed “Rissing Bug” Wound, etc., R. Ellis, M. D., 268 THE MEDICAL DIAL. followed by Prompt Recovery, F. A. Burrall, M. D., New York. SO. MED. JOUR., LA GRANGE, N. S. (10) Diagnosis of Bullet Wounds of the Intestines, Hugh M. Taylor, M. D., Richmoid. Etiologic Factors in Diseases Incident to the Second Summer of Childhood, and Treatment, R. H. Goodier, M. D., Hannibal, MO. DENTAL DIGEST, CHICAGO. (25) Permanence of Replanted Teeth, A. P. Nicholson, D. D. S., Edgerton, Wis. ST. PAUL MED. JOURNAL. (25) Some of the Problems of Professional Life and Their Relation to Success in Practice, H. A. Tomlin- son, M. D., St. Paul. Ectopic Pregnancy, A. McLaren, M. D., St. Paul. Catgut, Eduard Boeckmann, M. D., St. Paul. MEDICAL BRIEF, ST. LOUIS. (10) Senile Cataract, Gustavus Hartridge, F. R. C. S., London, Eng. Shall the Specialist Pay a Commission to the General Practitioner? Emory Ilanphear, M. D., Ph. D., L.L. D., St. Louis. Systemic Effects of Dentition, George M. Rice, M. D., Powersburg, ICy. Malaria and Its Treatment, H. B. Williams, M. D., IKaufman, Texas. Talipes Varus—Tarsectomy—Complete Recovery, with Full Correction of the Deformity, Wm. Davis Foster, M. D., Kansas City. Impotency, J. L. Gilbert, M. D., Kendallville, Ind. Antiseptic Obstetrical Practice, J. S. Leachman, M. D., Gallion, La. The Ureters, Byron S. Robinson, B. S., M. D., Chicago. º Carbolic Acid in Diphtheria, J. W. Lockhart, St. John, Wash. Epilepsy, T. A. Smurr, M. D., Ottawa, Ill. Pneumonia, H. A. Simpson, M. D., LoCust Spring, Tenn. OCCIDENTAL MED. TIMES, SAN FRANCISCO, CAL. (20) The Malarial Fevers of the Sacramento and San Joaquin Valleys, Phillip Ring Brown, M. D., San Francisco. Sinus — Thrombosis—Cure Without Opening the Sinus, IRobert Levy, M. D., Denver. Cerebro-Spinal Meningitis, Three Cases—Death— Autopsy, S. J. Hunkin, M. D., San Francisco. VA. MED. SEMI–MO., IRICHMOND, JULY 7. (10) Physiologic and Therapeutic Effects of Static Electricity, G. P. Edwards, M. D., Nashville, Tenn. Peculiarities in Heart Affections in Children, Phillip F. Barbour, M. D., ILouisville. Diagnosis, C. F. Ulrich, A. M., M. D., Wheeling. The Perineum—Its Injury and Repair, Edmond T. Baker, M. D., Richmond. The Prevention and Treatment Of Cancer Of the Uterus, A. Lapthorn Smith, B. A., M. D., M. R. C. S. (Eng.), Montreal. Permangate of Potassium Injections in the Treat- ment of Diarrhoea and Dysentery, together with In- ternal Antiseptics, Illucien Lofton, M. D., Emporia, Va. Laminectomy—A plea for Its Employment in Serious Spinal Injuries, IIugh G. Nicholson, M. D., Paint Creek, Va. VA. MED. SEMII–MO., RICIIMOND, JULY 21. (10) Quantitative Estimation of Albumin in the Urine, Chas. W. Purdy, M. D., Chicago. Multiple Neuritis, Paralysis Agitans, Epilepsy— A Clinical Ilecture, J, Allison Hodges, MI. D., Rich- mond. Surgical Complications of Typhoid Fever, Hugh M. Taylor, M. D., Richmond. Succedaneum to Digitalis, W. R. Inge Dalton, M. D., New York. Metaphysics, Henry C. Eyman, MI. D., Cleveland. Antitoxine in the Treatment of Diphtheria, Ed- win I. Morgan, M. D., Washington, D. C. S. W. MED. RECORD, HOUSTON, TEX. (10) Acute Bright's Disease, Superinduced by Preg- nancy, B. S. Ezell, M. D., ISOSse, Texas. Comatose Malaria, R. T. Morris, M. D., Houston. AMERICAN MED. QUARTERLY, NEW YORK, JUNE. (75) Disease in the Sygmoid Flexure, Mathews, M. D., L.L. D., Louisville. Some Facts Concerning the Treatment and Medi- cal Complications of Typhoid Fever, Hobart A. Hare, M. D., Philadelphia. © Experiences in Intestinal Surgery, Matthew D. Mann, M. D., Buffalo. Fat and I'ecundity, a Study of the Cause, Path- ology and Treatment of Sterility due to Obesity in Women, Charles A. I. Reed, M. D., Cincinnati. On the Close Relation Between the NaSal and Cranial Cavities as a Cause of Brain Disease, William C. Krauss, M. D., Buffalo. Hygiene of the Bedroom and Bedstead, Lawson Tait, E. R. C. S., M. D. (deceased). Ointments and Pastes, Ernest Wends, M. D., Buffalo. The Effects of Modern Small-Arm Projectiles, as Shown by the Wounded of the Fifth Army Corps During the Campaign in the Capture of Santiago de Cuba, Chas. B. Nancrede, A. M., M. D., LL. D., Ann Arbor, Mich. The Correction of Nasal Deformities by Subcu- taneous Operations, John O. Roe, M. D., Rochester, N. Y. JOSeph M. A Case of Elephantiasis of the Penis, George Henry Fox, M. D., New York. Tuberculosis of the Urinary Tract, a Study of Thirty-four Cases, Albert Vander Veer, M. D., and Willis G. Macdonald, M. D., both of New York. THE YOUNG GRADUATE. . . I’m the equal of any, Young “Saw-bones” proudly cried; The image of Paracelsus IS Stamped upon my Side: I am as apt and Cunning AS any doc. Can be— He needn’t put on any airs And think he’s Smart as me. I’m every bit as good as they, Young “Saw-bones” blustered loud; The old, gray-haired doctors, They needn’t feel so proud; For all their airs and graces I do not give a fig; My diploma is just as good as theirs, And half again as big. When this young man in the world Went out upon his way, Alas! the folks still held him cheap, Whatever he might say. The gray-haired doctor smiled. “You’ll find,” He said, “that par is par, It doesn’t matter how you boast, But what you really are!” —EX. There is an epidemic of measles in certain por- tions of England. In Liverpool twenty-three schools have been Closed, most Of them in the infant de- partment only, but two of them wholly. Not many deaths, however, have occurred. The disease is Said also to be quite prevalent in Manchester and Warrington. It is gratifying to know that the com- plaint is not of the virulent type. Further decay in children's teeth may be pre- vented by applying nitrate of silver solution. An in- Soluble lime salt is formed in the to Oth Structure. THE MEDICAL DIAL. xi & OAKLAND HYDROGEN DIOXIDE, U. S. P. “THE KIND THAT KEEPS.” A positive and harmless antiseptic and germicide for in- ternal and external use. Highly recommended in the treatment of diphthería, scarlet fever, and other contagious diseases. As a prophylactic in preventive medicine it is without a peer, and may be used lavishly or sparingly according to indications without a suspicion of harm resulting from its use in any application. THE OAKLAND CHEMICAL CO., 465-467 West Broadway, NEW YORK CITY, N. Y. 3& * -e-ºc-e-ºceans -e ºs -e ºs -e ºscºe ºne º | : : º “ºbat (Bentliet on the 5pirit Lies, (Iban Cit’o Egelios on Cit’o Eyes” saweles on APPLucArrow To The Anwrikamnia chemical co., ST. Louis, U. S. A. rºles ºr eº-oº-oº-oº or es ories a xii THE NAEDICALDIAL. PUBLISHER'S DEPARTMENT. Do you know the theory of reconstruction by the Hypophosphites of Lime and Soda.” If not, read the advertisement of the McArthur Hypophosphite Co. and send for a pamphlet. Dr. S. C. Martin, Professor of Dermatology and Hygiene, Barnes Medical College, St. Louis, Mo., WriteS: After having tested Hagee's Cordial Cod-liver Oil Comp. in my practice for a number of years, the re- sults have been so uniformly gratifying that I now rarely prescribe any other cod-liver oil preparation. The points in its favor are: 1st, the desired ingredi- ents; 2d, their combination in a palatable and assim- ilable form, which insures a sufficiently prolonged use to produce substantial results. UTRO-OVARIAN PAIN. Prompt relief, unaccompanied by habit or un- toward after-effect, is what the up-to-date practi. tioner desires most in these cases. If the pain is over the lower border of the liver, or lower part of the stomach, or, in short, be it headache, Sideache, backache or pain of any other description caused by suppressed or irregular menstruation, it Will yield to two five-grain tablets of Antikamnia. This dose may be repeated in an hour or two, if needed. For very prompt relief it is advisable to Črush the tab- lets and swallow them with a little Wine, diluted whisky or toddy.—Ohio Medical Journal. ANEMIA. e As a consequent of mumps, Dr. David L. Field, of Jeffersonville, Indiana, writes concerning several cases of anemia in children who had suffered from mumps: In these children, there Was no Orchitis, Or transiation of the disease to any other organ, but the cases were attended with extreme langour and high temperature range. Nothing in the usual iron rem: edies gave relief for the anemia. Which followed upon these cases, and Dr. Field put them upon Henry's Three-Chlorides, a remedy which has never disap- pointed him in the treatment of anemia, from any cause. In these children, the remedy proved most happy, and very prompt, in doses of one-half to one teaspoonful in water or milk after meals. WYETH's LIQUID EXTRACT OF MALT. . Liquid Extract of Malt which, although liquid, is intended to supply certain elements of nutrition and to aid the adaptability of food in increasing the bodily weight and strength, should not be a Stimu- lant, at least, not in an alcoholic sense. It Should be an indirect means, or auxiliary, in increasing the ef: ficacy of the ordinary food of our daily meals, or, that of a prescribed diet in invalidism. Wyeth's Liquid Extract of Malt may, therefore, be regarded as a food and as a beverage only in the grateful palatabil- ity of its taste, purposely rendered slightly, though agreeably, bitter, through which its tonic property is much increased. Another advantage the MeSSrS. Wyeth claim for their Malt is, its small percentage of spirit, less than 3 per cent, with fourteen or fifteen per cent of nutritious, extractive matter. SOLAR HEAT. Direct exposure to the sun’s rays; employment in or living in hot and poorly ventilated offices, work- shops or rooms, are among the most prolific causes of beadache in summertime, as well as of heat exhaus- tion and Sunstroke. For these headaches and for the nausea, which often accompanies them, antikamnia. will be found to afford prompt relief and can be Safe- ly given. Insomnia from solar heat is readily over- come by one or two five-grain antikamnia tablets at supper time, and again before retiring. If these con- ditions are partly dependent upon a disordered Stomach, two five-grain antikamnia, tablets with fif- teen or twenty drops of aromatic spirits of ammonia, Well diluted, are advisable. For the pain following Sun Or heat Stroke, antikamnia in doses of one or two tablets every two or three hours will produce the ease and rest necessary to complete recovery. As a preventive of and cure for nausea while traveling by railroad or Steamboat, and for genuine mal de mer or SeaSickness, antikamnia is unsurpassed and is recommended by the surgeons of the White Star, Cunard and American Steamship lines. HERNIA. Strangulated hernia in children is of far more frequent occurrence than generally supposed. There is an old-fashioned idea that a child under one year Should not Wear a truss—and this is the cause of numerous deaths. A pad should be fitted to every infantile rupture as soon as discovered. If this does not hold the gut back, a truss should be made as SOOn aS it is found the hernia. Will not remain re- duced. By a proper truss a large proportion of such hernia will be perfectly cured by the third year. Most cures are found to follow the use of Seeley's Hard Rubber Trusses. They hold the parts in their natural positions, assisting the natural development of the child to outgrow the rupture. The manufac- turers, Chesterman & Streeter, Philadelphia, are practical Skilled truss fitters, and will send cata- logue and life plates to those who write for them. MALTINE WITH CREOSOTE. Each fluid ounce contains four minims of pure Creosote. Among the more recent remedies Creosote has proven of the utmost Value in the treatment of tuberculosis in its various forms, especially pul- monary, and in Septic conditions of the alimentary canal as exhibited in different forms of diarrhoea. By its antiseptic properties it counteracts the tonic influence of tubercle bacilli, destroys bacilli of a less virulent type, and increases nutrition by stim- ulating metabolic activity. Its combination with Maltine has proved exceptionally Serviceable in Sup- plying a highly nutritious element, disguising the disagreeable taste, and completely removing the tendency of creosote to produce gastric irritation; in fact, PURE creosote, such as is used in this com- bination, causes little or no irritation in the alimen- tary canal even when taken alone. TEIE LARGEST IN THE WORLD. The attention of physicians and others is direct- ed to The Winkley Artificial Limb Company, whose advertisement appears on the front title page. We feel warranted in bespeaking for this company the confidence and patronage of all in need of their servi- ces, as manufacturers of artificial limbs. They have had years of experience and success. The growth of this company has been quite phenomenal, starting in business Some twelve years ago in a Small way, their business has increased from year to year until today the are the largest manufacturer of artificial limbs in the world, furnishing patrons not only throughout the United States, Canada and Mexico, but even aCrOSS the Water, and any one interested in the Sub- ject, upon application will be sent their large illus- trated descriptive catalogue, and any desired informa- tion upon the Subject will gladly be given. You will find this Company thoroughly responsible and reliable In every way. SIGHT-SEER’S HEAD ACHE. There are, no doubt, very many important uses for antikamnia, of which physicians as a rule may be uninformed. A five-grain antikamnia tablet pre- Scribed for patients before starting on an outing, and this includes tourists, picknickers, bicyclers, and in fact, anybody who is out in the sun and air all THE NAEDICAL DIAL. xiii in anaemic conditions associated with chlorosis when the catamenia are slow in asserting themselves or dysmenorrhea exists on account of a deficiency of red blood Corpuscles, or in cases of menorrhagia re- Quiring the use of a tonic, I have secured excellent results, and have seen patients rapidly relieved of unto Ward Symptoms, while in debilitated conditions following typhoid fever, when convalescence is Slow, the effects of the remedy are all that can be desired. During Convalescence from pneumonia, when resolu- tion is slow, and the normal respiratory murmur is not rapidly established, I know of no better remedy. I have used it satisfactorily with children, recovering from Summer diarrhoea, in connection with milk or Some of the most desirable baby foods upon the market. In the primary stages of phthisis pulmonalis I have confidence in its curative powers, while it has & day, will entirely prevent that demoralizing head- ache which frequently mars the pleasure of Such an occasion. This applies equally to Women on shop- ping tours, and especially to those who invariably come home cross and Out of Sorts, with a Wretched “sight-seer's headache.” The nervous headache and irritable condition of the busy business man is pre- Vented by the timely use of a ten-grain dose. Every bicycle rider, after a hard run, should take two five-grain tablets on going to bed. In the morn- ing he will awake minus the usual muscular pains, aches and Soreness. As a cure and preventive of the pains peculiar to Women at time of period, antikamnia is unequalled and unaccompanied by habit Or un- pleasant after-effect. If the pain is Over the lower border of the liver, or lower part of the stomach, or in Short, be it headache, Sideache, backache, Or pain of any other description caused by suppressed Or ir- regular menstruation, it will yield to two five-grain tablets. This dose may be repeated in an hour Or tWO, if needed. AN IMPORTANT OBSERVATION. Prof. Burney Yeo, of London, States in his latest work on Clinical Therapeutics, that many of the Common forms of diarrhoea are accompanied by ex- Cessive acidity of the intestinal Contents, and that they may be promptly cured by antacid remedies Without the use of astringents. These forms Of diarrhoea are a SSOCiated With the induce intestinal fermentation and consequent local growth and multiplication of micro-organisms which irritation from decomposing food products. The therapeutic indications in these cases are Clear, Viz: Check intestinal fermentation, neutralize acidity, and overcome the existing atonicity and ca- tarrhal inflammation of the intestinal mucous mem- brane. Lauder Brunton speaks highly of the use of glycerine as an intestinal antiseptic. In combination With digestive tonic alteratives and antacids, as it is in Gray's Glycerine Tonic Comp. it fulfils all the ex- isting indications and moreover promotes the diges- tion and assimilation of food so that the normal nu- tritive processes are speedily re-established. It is of particular value in diarrhoea occurring in people of impaired Vitality, as it not only cures the intestinal disturbances but it also restores tone to the enfeebled System. THE PURDUE FREDERICK CO., No. 15 Murray Street, New York. AN IDEAL TISSUE BUILDER. A great desideratum in the medical practice is an ideal tissue builder. The busy practitioner fre- quently finds himself at a loss to decide upon the most efficient remedy for a given case, in spite of the great variety of drugs from which he may select. This is especially true in cases where tissue changes and waste are Continuous, and where it is necessary to check the disintegration and repair and restore the waste of cellular tissue, resulting from established Cachexias. In these cases remedies are required both for their antidotal properties and their food Values. TJnder these circumstances that remedy which most nearly meets the requirements of the case is of most Value. I am rarely constrained to lend my indorsement to any proprietary remedy, though admitting, in a general way, that many of them are excellent for the treatment of diseases for which they are recom- mended. But I have found in the use of Cord. Ol. Morrhuac Comp. (Hagee) such marked benefit that I feel justified in calling the attention of the profession to its merits, both as a medicine and tissue builder. Its elegance and excellence as a pharmaceutical prod- uct, the ease with which it is assimilated, its re- tention by the most delicate Stomachs, all make it desirable for exhibition in Cases Where the principal indication is to guard the patient's Stomach. Used proved of advantage in my hands in all stages of the . disease. It is particularly in those cases when the Stomach becomes so rebellious and so intolerant of medication that I have found this remedy well borne and beneficial to the sufferer. I could cite many cases in which I have used the Cordial, but will only Subjoin One for the consideration of the profession: M. H., female, White, age 16, American, tall, Slim, slightly cachectic, poorly developed, general health below normal, suffers from amenorrhea, has Some Cough, mammary glands undeveloped, pulse 90, elevation of temperature one-half degree above nor- mal, no expectoration with cough, no sinking of tissues above Clavicle, slight dullness on percussion in apices of both lungs, auscultation reveals dry Valves in apices of both lungs, slight hoarseness. History shows that menses appeared at fourteen and were regular for three or four months, though scanty and painful, then ceased and had not reappeared up to present date. Prescribed Cord. Ol. Morrhuae Comp. (Hagee), teaspoonful four times per day, tinct. ferri chlorid ten drops three times per day, and oc- casional hot hip baths. The menstrual flow was re- established in two months and recovery was rapid and uneventful. At this time the patient is in ex- cellent health and has had no tendency to relapse to her former COIndition. N. M. Baskett, M. D. Moberly, Mo. THE NEW MALTINE COMBINATION. The study of infectious disease received a new impetus and was placed upon a new basis when the agency of bacteria in its production was discovered. The efforts of clinicians were then directed to the influence of remedies upon the parasitic and living causes of disease. The great desideratum was to find substances having the power either to destroy microbes Or to neutralize the noxious products which they elaborate. In the Course Of Such experimental Studies, however, we were led to realize more for- cibly than ever before the resistant powers of the human organism. It was learned that it is not the mere presence of bacteria within the body that is the most significant fact, but their germination, repro- duction, and Cultivation, and, above all, the poison- ous products by which the infection of blood and tissues is accomplished. Thereafter the fortification Of the Organism acquired fresh importance. The at- tention of physicians was directed not only to the destruction of micro-Organisms and the neutraliza- tion of their poisons, or toxins, but also to the assist- ance of the tissues in their struggle against the in- Vaders. As long as, by any and every means, general nutrition can be maintained at the normal standard there is little to be feared from the presence of path- ogenic bacteria. If, however, the general vitality be reduced by any cause, Our diminutive foes can then not Only enter, but can Contaminate the System. These discoveries have thrown new light upon the operation of many medicinal substances, and xiv THE NAEDICAL DIAL. have served to direct our energies to the Support Of the threatened organs and tissues. A nutritious principle which is SQ influential in promoting the digestion of one of the great food-groups—viz: the carbohydrates—has a Wide range of applicability. It adds to the nourishment of the feeble. It restores digestive power and physical energy to those Who have been notably reduced by a lingering illness. It promotes the healthy growth of muscular structures and strengthens the functions of Secreting glands. Accordingly, skillfully prepared and reliable preparations like those of The Maltine Company, flave long been favorably known to and beneficially employed by physicians in the large class of morbid conditions in which they are indicated. Several act- ive remedies or combination of remedies have from time to time been added to the plain Maltine in Order to adapt it to a wider field of usefulness. The lateSt of these excellent additions to a worthy line of prod- ucts is Maltine with Creosote. In the purely medicinal, as distinguished from the climatic treatment of tuberculosis, Creosote has approved itself as a remedy of the first rank. It un- doubtedly possesses a considerable inhibitory influ- ence over the development of the bacillus tubercu- losis. It relieves the prominent symptoms of phthi- sis more effectually than any other remedy. Creo- sote is often able to hold this destructive malady in abeyance for an indefinite period, or practically cure the disease. Therefore a combination of Maltine with Creosote appeals most powerfully to the medi- cal profession. So much of the physician’s work has to do with tuberculosis in its varied manifestations and localizations that a warm welcome Will doubt- less be extended to this new preparation. Its nutri- ent and antiseptic properties render it admirably adapted to fulfill many important indications. We are assured that the creosote contained in this prep- aration is perfectly pure, and We have learned by painful experience that there is a Vast difference be- tween pure and impure creosote. Each fluid Ounce of Maltine with Creosote contains 4 minims of pure creosote. Creosote is an efficient remedy in many morbid conditions of the intestinal tract, and this new combination will, consequently, be found of Sery- ice in many cases of chronic indigestion.—The Month- ly Cyclopædia of Practical Medicine, Philadelphia, June, 1899. Iodine stains may be removed with bicarbonate of soda. The burning pain of carbolic acid may also be eradicated by the same agent. Coffee will effectually disguise the iodides of potassium and Sodium. 1000 LABELS FREE. THE WIS. MEDICAL RECORDER IS NEEDED BY EVERY IPRACTICAL PEIY- SICIAN, BECAUSE AS DR. JAS. ADOL- PEIUS, OF ATLANTA, GA., SAYS: “IT IS FULL OF PRACTICAL AND INTEREST- ING MATTER THE BUSY DOCTOR FINDS USEFUL.” IT HAS ABLE CORRESPOND- ENTS IN ALL TEIE GREAT MEDICAL CENTERS AND A STAFF OF REGULAR CONTRIBUTORS, WHO ARE IN ACTIVE PRACTICE IN ALL PARTS OF THE COUNTRY AND FURNISEI LIVE ARTI- CLES. TO RAPIDLY INCREASE TEIE REC- ORDER'S CIRCULATION, FOLLOWING TRIAL OFFER IS MADE. EVERY PEIY- SICIAN SENDING 50G WILL RCEIVE THE RECORDER Every MonTH FoR six MONTHS AND 1000 LABELS WILL BE SENT FREE OF CHARGE. THESE LA- LBailing Diliggists ºf Millſ.Bāſūlis, xxxx rururºrerºr wrºxururururu'vurvurºrº wºw wºw ºr “w” Egy- O PEN ALL NIGHT. *ēſ, The Voegelt Bros. Drug Co., PRESCRIPTION DRUGGISTS. 2 and 4 WASHINGTon Ave. S., COR. HENNEPIN. We carry the most complete stock of Drugs and Chemicals in the Northwest, Mail Orders Promptly Filled. *.*.*.*.*.*.*.*, *, *, *, *, *.xºliº.ºkxº-º-º-º:ºxºkiºkºkºkº *, *, *, *, *, *.xºxiº. BELS ARE 14 NCHES SQUARE WITH YOUR NAME AND AIDDRESS PRINTED IN BLUE INEO. TELEY ARE MADE OF THE BEST IMPORTED GUMMED PAPER, AND ARE WORTEL MORE TEIAN TELE PRICE - - - º *- *- -*—a- - a- v-u- EBSTER & CHACIRCHILL, tº | PHARMAC I STS, | ? {} } } *—--dº. -a- ------- —dº- —º- ~ } | } Under Nicollet House, Minneapolis, Minn. -º-, -º-º-º-º-º: -*—----- -ā- -ā- sº-c- *— -*—a —dº- —iº- * -—--—u—ur - -º-º- OF TEIE SIX MONTEIS’ SUBSEIPTION. TEHIS OFFER WILL BE OPEN TO READ- ERS OF TELE DIAL FOR A SEHORT TIME ONLY. ( Careful attention given to Physicians' Prescriptions. ! -º-e- HALL & THRONE, PUBLISHERS, JANESVILLE, WIS. THE MEDICAL DIAL. º :. º*º- --- - : | The Dr. C. E. Sawyer Sanatorium, Marion, Ohio. For the treatment of Chronic Diseases, Cripples and Deformities. Catalogues furnished on application. Correspondence solicited. Visitors welcome. Professional inspection invited. Dººl Sºu"-ºzhuºzhºu"a ſºluºſº *A* #éºéºžičğº #:#5: WE HAVE A LINE OF * º Vehicles DESIGNED AND BUILT FOR PHYSICIANS USE. Our Agents are our Vehicles in service. The Users are our friends. They preach the merits of our work, because they tell the truth. Upon request, we send the addresses of a large number of Medical men, Business men and Livery men of the Twin Cities and surrounding Towns, who are using our work, and their kind words of praise about its Quality, Style and Wear. (Jø are iſlanufacturers. º H. A. MUCKLE MFG. CO., Minnesota Transfer, with ten Railroads and Muckle's great vehicle Plant, all on the Inter- - S 2. urban Electric street car line. St - Pau | . Mi In In. - - #&#&#º | - | tº it. º - cººl º- ºr º º ſ | | - }: {{. º º i § º i : º - § i. THE NMEDICAL DIAL. V NOW READY. § | : º 3% § § i. º § ſº # § §§ † : WITH : : º CREOSOTE ğ O § º § § # A number of years ago, when the value of Creosote became s: fully demonstrated, we began the publication of a formula for the ; administration of Creosote in Maltine. This formula has been § employed successfully by thousands of physicians, and we have ; been urged over and over again to place such a combination upon i the market in order that a uniform and properly prepared product # could be had under all circumstances. j § º : 92 s “MALTINE with CREOSOTE is the most eligible and palatable form in which Creosote can be administered. The vehicle–Maltine Plain—is particularly indicated, by reason of its great food and digestive value, in all conditions in which Creosote is so universally employed. i : º: i : lt will give us pleasure to send, prepaid, samples of “MALTINE with CREOSOTE” - to any physician in good standing who wishes to satisfy himself of its therapeutic value and elegance. * THE MALTINE COMPANY, Eighth Ave., 18th and 19th Sts., BROOKLYN, N Y. HAM LINE UNIVERsity 7 . . . . . DEFARTN/IENT OF NM EDIC IN E. (MIN MEAPOLIS COLLEGE OF PHYSICIANS AND surgeons.) 7th Street and 6th Avenue South, MINNEAPOLIS, MINN. The eighteenth annual session of the College will open October 2, 1899, and continue eight and a half months. The course of instruction is divided into a four-years fully graduated, curriculum. Graduates in Science and arts, and students from other recognized medical schools, may take advanced standing. All laboratories are newly equipped with the best apparatus. The hospital facilities are the best in the Northwest. All branches are taught practically, clinical and bedside instruction given in all the hospitals of both the Twith Cities. Geo. H. Bridgman, D. D., President. Leo M. Crafts, B. L., M. D., Dean, Professor Of Nervous Diseases. J. T. Moore, M. D., C. M., M. C. P. S., Professor of Theory and Practice Of Medicine. Edwin Phillips, M. D., Professor of Gynaecology. W. J. Byrnes, M. D., Professor of Surgical Anatomy and Clinical Gynaecology. Columbus G. Slagle, M. D., Professor of Paediatrics. Herbert E. Cary, B. A., M. D., Associate Professor of Gynaecol- Ogy. J. W. MacDonald, M. D., F. R. C. S. E., Professor of the Practice Of Sur- gery and Clinical Surgery. William H. Hallowell, M. D., Professor of Obstetrics. William G. W. Tupper, M. D., Professor of Therapeutics. Hugh N. McDonald, M. D., Professor of Diseases of the Chest. C. K. Bartlett, M. D., Professor of Psychological cine. George C. Barton, M. D., Professor of Physiology and Clini- cal Gynaecology. A. F. Irwin, M. D., Ph. D., Professor of Pathology and Bac- teriology. Pavid Owen Thomas, B. A., M. D., M. R. C. S., J’rofessor of Dermatology and Gen- ito-Urinary Diseases. Charles J. Spratt, M. D., Professor of Ophthalmology and Otology. Medi- FAC U LTY.— Charles W. Williams, M. D., Professor of Materia Medica. J. D. Simpson, M. D., Professor of Clinical Ophthalmolo- gy and Otology. Knut Hoegh, M. D., Professor of the Principles of Sur- gery and Clinical Surgery. Charles W. Drew, Ph. B., M. D., * Professor of Chemistry and Toxi- cology. Henry J. O’Brien, M. D., Professor of Clinical Surgery. Charles E. Smith, M. D., Professor of Clinical Medicine. Edward Boeckmann, M. D., - Professor of Clinical Ophthalmol- Ogy. Anton Shimonek, M. D., Professor of Clinical Gynaecology. C. A. McCollom, M. D., Professor of Preventive and Legal Medicine and Medical Insurance. Norman Dreisbach, M. D., Professor of Anatomy. William Glenn, M. D., Professor of Physical and Clinical Medicine. OTHER INSTRUCTORS. P. M. Holl, M. D., Clinical Professor of Paediatrics. F. B. Kremer, D. D. S., Lecturer on Dental Pathology and Therapeutics. M. C. Johnston, M. D., Assistant Professor of Pathology. Arnold Schwyzer, M. D., Clinical Professor of Pathology. Gustav A. Renz, B. S., M. D., Ph. D., Clinical Professor of Genito-Uri- nary Diseases. Diagnosis For Catalogue and Information Address, LEO M. CRAFTS, M. D., Dean, 606 Masonic Temple, Minneapo Joseph W. Bettingen, M. D., Clinical Professor Of Diseases of the Nose, Throat and Ear. Charles J. Meade, M. D., Associate Professor Medicine. Charles F. Denny, M. D., Instructor in Clinical Medicine. ... " J. Frank Corbett, B. S., M. D., Assistant Professor of Bacteriolo- . gy and Curator of the Museums. Edgar M. Dunn, B. A., Assistant Professor of Chemistry. . William B. Murphy, M. D., t W Of Clinical Demonstrator of Anatomy and In- structor in Clinical Chemistry. Frederick Leavitt, M. D., Instructor in Clinical Obstetrics. F. A. Knights, M. D., Assistant Professor and Embryology. R. M. Peters, M. D., * * Demonstrator of Anatomy and in- Structor in Medicine. C. A. Donaldson, M. D., Assistant Demonstrator of Anato- of Histology Imy. C. H. Bradley, M. D., Instructor in Clinical Obstetrics. UNIVERSITY SCHOLARS ASSISTING IN LABORATORY INSTRUCTION: It. M. Burlingame, In Therapeutics. A. G. Chadbourne, Ph. B., In Histology and Embryolog: G. M. F. Rogers, In Bacteriology. Edward A. Rich, Ph. B., In Histology and Embryology. THE MEDICAL DIAL. i i i ZDoctor: * . . . . . O How is that case of scrofula getting along? About the same old way it has for years, is it not? t You see by this time that the alteratives and general tonics give but temporary benefit. Sometimes, in fact, ''. they irritate and aggravate the case. - Did you ever think what is the real pathology of scrofula? - -, It is the deficiency or degeneration of the tissue walls. This allows extravasations of blood, and diapedesis of corpuscles, forming eruptions and suppuration. It is not “bad blood,” but bad tissues. Notice that rickety building over there. It is crumbling while those near it, much older, are still strong. What is the matter? Bad brick and mortar in the walls. It can be stayed awhile with props, but soon the radical change must come of tearing it down and building it over with good material. - - Now, Doctor, your scrofula patient is in the same condition, with this difference: Nature is constantly remov- ing the old material in his tissue walls, and replacing it with new. In seven years, without any cessation in his ex- istence, he will be composed of entirely new material. This gives you a golden opportunity to put in some extra good material. What shall it be? Shall it be iron, quinine, strychnine, arsenic and manganese? No. They only prove to be irritants. The only remedy is hypophosphites of lime and soda—the true reconstructives of the tissues. By using them faithfully and constantly you will gain gradual improvement at once and permanent cure in a few years. - You see the philosophy of it, don’t you? The only chemically pure preparation of these tissue foods is McARTHUR'S COMPOUND SYRUP OF THE Hy- *PHOSPHITES OF LIME AND SODA. All others contain, in addition, the irritant “tonics,” so delusive in their ults. Be sure that your patients is served with none other than McArthur's. You can add to it in the prescrip- any other remedy specially indicated at special times. Other diseases particularly requiring this remedy are Tuberculosis (twin brother of Scrofula), Rachitis, Chronic ſh, Chronic Bronchitis and Throath Affections, Chronic Alcoholism, Impotence, Nervousness, General Debility, ºrain Exhaustion, Loss of Memory, Chronic or Wasting Diarahoea, Suppurating Discharges and Sores, Uterine Fibroids, and all diseases characterized by waste or faulty nutrition. Write your prescription thus: \ SYR: HYPOPHOS: COMP: MCARTHUR: ONE BOTTLE. As it is made only for Physicians, there are no printed wrappers or other advertisements on the bottle. Our pamphlet on the “Curability and Treatment of Consumption.” sent free to physicians on application. We will send one bottle of McArthur's Syrup free to any physician who will pay the express charges. THE McARTHUR HYPOPHOSFHITE CO., BOSTON, MASS. WHEN THE ACTIVE PRINCIPLES N are taken from Cod Liver Oil, only the grease remains, and à that is of no more value than other grease. The virtue of Cod Liver Oil lies in its curative principles, / which are separable from the grease. These active princi- N ples (taken from pure, fresh Cod Liver Oil), are employed in the manufacture of * HAGEE's coRDIAL OF COD LIVER OIL with HYPOPHOSPHITES OF LIME AND SODA. Your patients get the grease in the form of palatable food fats. CORD. OL MORRHUAE COMP. (Hagee) is dispensed in 16-oz. bottles by all druggists. Made only by KATHARMON CHEMICAL CO., St. Louis, Mo. *2-2-2s Q teeeeeeeeeeeeeeee • o © *2s2 2s2 2. o éééééééééééééééééé :s#ééééééééééé THE MEDICAL DIAL. XV --~~ --- --- * = . || || ºf º º \| Elgºirſ-Mºſligal All ElBºiſ-Slſg The Waite & Bartlett Manufacturing Co. Băl |||siſ||||Bills, Manuracºrun-o E- 108 E. Twenty-Third St., NEW YORK. The Hallºy Wimshurst hit. Statiſ, Mathing Is the most powerful made, therefore, for X-Ray examinations and for a wide range of therapeutic effect, it stands unequalled. Used in the College of Physicians and Surgeons, Society of the New York Hospital, Post-Graduate Medical School and Hospital, Bellevue Medical College and Hospital, Battle Creek Sanitarium, and more by Physicians, Hospitals and Sanitariums than any other. SEND FOR, ILLUSTRATED CATALOGUE. NOYES BROS. & CUTLER, Agents, SAINT PAUL, MIN N N Esota. (Successor to F. J. SALFINGER) 704 PHOENIX BUILDING. LEWIS A. MARTIN, WATCHAMAker & Jewel ER Watches, Clocks and Jewelry Repairing. Clocks Called For and Delivered Free of Charge. M. D. “United we stand; Divided we fall.” Now is the especial time to subscribe-One Dollar per annum. Address, THE MEDICAL DIAL, 513 Masonic Temple, Stands for Doctor of 3/Medicine. Stands for 3/Medical Dial. Minneapolis, Minn. "Did You Ever See Anything Like It?" * Manhattan Typewriter. QUALITY HIGHEST, PRICE LOWEST. Typewriters Sold, Exchanged, Rented. suPPLIES FOR ALL TYPEWRITERS. MAXFIELD & OLIVER, Northwestern Dealers, 17 So. 4TH STREET, Telephone 146-2. THAE MIN NEAPOLIS, MINN. A Singer Sewing Machine || THE BEST INVESTMENT ON EARTH, earning more in proportion, to cost than any other purchase possible. THREE DIFFERENT KINDS, either lock-stitch or chain-stitch. BUILT LIKE A WATCH, at the largest and best equipped factory in the world, where every machine is carefully tested on practical stitching. - Sold only by THE SINGER MANUFACTURING COMPANY Nº. BAZZI-BIANCH, PhDIB|ISS|| Velvet-Lined case, $4.00. Beware of infringements. All genuine have our name on instru- ment. Buy from your dealer, or, if not in stock, from us direct. GEORGE P. PILLING & SON, 1229 callouhill St., Philadelphia, sole Agents for U. S. A. xvi THE MEDICAL DIAL. An Ocean Voyage On Fresh VVater. Duluth to Buffalo via “NORTH WEST" or “NORTH LAND,” the most magnificent fresh water steamships in the world, exclusively passenger. Sailing twice-a-week. Illustrated information from F. I. Whitney, Gen. Pass. Agent Great Northern Ry., St. Paul, Minn. LOWERS... BEAUTIFUL ROSES CARNATIONS LILIES and all the flowers in their season. Funerals a spec- ialty. Telegraph orders for funerals and parties £º. filled. Seeds and other florist supplies. Send or Catalogue. M. EN DEN HALL GREEN HOUSEs, First Ave. S. and 18th St., or City Store, 414 Nicollet Ave., Minneapolis, - - Minnesota. § §§§§§§§§ MARSHIII's CONVERTELEBUGBY CISEN.3, ;" “; eelev’s Sºlº’s. | Sºs: Sº º E.--- ->: Trusses =#º Essº sº:- 23, 2% --- - % zº º *-a-ºº: changes into Saddle Bag (is both in one). Finest, best , durable leather finish outside Ult& : º 18 6-dr. cork S.—total 32 bottles, with spaces between rows for pow- der papers, 2 sundry f #: § * each Fº 3 T 34X2% X23% . º Delivered, privilege of examination, C. D., bal. $8.50, or ex- press paid, .00 if º: 84 #" ; :dº." º; ſº sell Saddle Bags low as £4.75. Ottle8 W. §º"; Best #e. Buggy Case,_26 3-dr., 26 6-dr., * 3 oz. botties in springs, 1 bundry space, $3. º $ We ºil full line prices and illustrations if asked for. Address W. S. MARSHALL, -> Care of Exchange Bank. CENTRALIA, ille Fit Easy They don't “worry '' the fitted or the fitter. Rupture Comforts—our patrons call the m. Our specialty is physicians mail orders for private patients. Each truss is 2 guaranteed satisfactory. 5o styles shown in our catalogue—sent free—also life plates. i Chesterman & Streeter Successors to I. B. SEELEY & CO. 25 S. 11th St. Philadelphia. ÓðO ©OOOOOOOOOOOOOOOOOOOO.º. | i THE MEDICAL DIAL. XV THE ALLISON PHYSICIANS TABLE. 1899 NAO DEL. Have you seen it? This style, No. 34, our latest production, surpasses in beauty, convenience and practical utility anything of the kind ever seen. The unique design, compact and harmonious, adjustable stirrups and leg crutches, glass trays in the revolving cabinets, detachable leg rests, the simple and ingenious mechanism—rendering it noiseless in its movements and easy of manipulation—are the secrets of its popularity. It is used in the Post Graduate Schools of New York and Chicago and heartily endorsed by faculty and students—a distinction no other table enjoys. The ALLISON CHAIR has been a leader for years, and is one of the most practical and convenient chairs made. Our COMBINATION CABINET No. 61, As shown in the cut, is a marvel, uniting in a single and handsome article of furtiture an instrument cabinet, aseptic and dust proof, a medicine cabinet with swinging racks for bottles, a writing desk, drawers for bandages, and compartment for wash basin. Our revolving Instrument Cabinets, thoroughly aseptic and proof against dust and dampness, are deservedly popular. Catalogué Frè6. The ALLISDN Wall cabinet is in great demand. W. D. ALLISON CO., Manfrs., 133 E. South Street, INDIANAPOLIS, IND. A. C. DICE, Dist. M. ngr., 816 Dayton Blog., Minneapolis. Liquor LITHIUM Maizen ATE. MAIZO-LITHIUM ------- *-m-tº- -------- ---------- - A genito-urinary sedative, an active diuretic; solvent and flush indicated for the relief and pre- vention of renal colic; a sedative in the acute stages of gonorrhoea, cystitis and epididymitis : in dropsical effusions due to enfeebled heart or to renal diseases. As a solvent in the varied mani- festations of gout, goutiness and neurotic lithemia, periodical migrainous headache, epigastric oppres- sion, cardiac palpitation, irregular, weak or inter- mittent pulse; irritability, moodiness, insomnia and other nervous symptoms of uric-acidemia. Decidedly better, more economical, extensive in ac- tion and definite in results than mºneral zwaters. In LITHEMIA by reason of the neutralizing ower of Lithium in combination with Maizenic acid, the superior diuretic. In RENAL COLIC as a solvent and eliminant of uric acid, and prophylac- tic against future attacks. In Liquor FERRISENIC. THREE CHLORIDES HENRY's. --------> ---------- --- ºr--- ------ An oxygen-carrying ferruginous preparation, suitable º prolonged treatment of children adults and the aged. Indicated in anemia and bodily weakness, convalescence from acute dis- eases and surgical operations; boys and girls at the age of puberty, and the climacteric period in women. In children with chorea, rickets or who are backward in development, or in whom there exists an aversion to meats and fats. Prolonged administration never causes “iron headache.” I - as a ferruginous laxative CONSTIPATION tonic it is effective by in- creasing the flow of gastric juice and the bile, exciting normal peristaltic movements. CHLOROSIS it stimulates the formaſº as a urine alkalinizer, and on URETHRITIS account of the remarkable se- dative action of corn silk upon inflamed genito- urinary mucous membrane. In OEDET1A resulting from cardiac or a renal dis- TT T. ease the pulse becomes regular and strong ; there occurs marked diuresis and increas- ed proportion of urinary solids. Those cases of irritable heart, irregular or in- termittent pulse so frequently met with by insur- ance examiners and found to be due to excess of uric acid are special indication for Maizo-Lithum. Nascent Chemic Union of Maizenic Acid-from Green Corn Silk—with Lithium, forming Maizenate-Lith- ºum Two grains to drachm. Dose I to 2 drachms, 8 oz. bottle, ºr oo. " " ``'``'`` iron-containing elems removes intestinal auto-intoxication the disease often depends. ANEMIA of all forms assº carrier of oxv. ion, aids assimilation o ition of fat in the tis. warmth and has vous system. . . . . • * s . . .”. 3. * - ºr A., * w - . . . 3. º A ‘’ X º : = s. ‘. . .” -- * + = - - 3. :*--------> º-ººººººº- w sºº-ºº-ºº: ~ : - rºT THE MEDICAL DIAL. SWR. HYPOPHOS. CO., FELLO Contains the Essential Elements of the Animal Organization—Potash and Lime; The Oxidizing Agents—Iron and Manganese ; The Tonics—Quinine and Strychnine ; And the Vitalizing Constituent—Phosphorus; the whole combined in the form of a Syrup with a Slightly Alkaline Reaction. It Differs in Its Effects from all Analogous Preparations ; and it possesses the important prop- erties of being pleasant to the taste, easily borne by the Stomach and harmless under prolonged use. It has Gained a Wide Reputation, particularly in the treatment of Pulmonary Tuberculosis, Chronic Pronchitis and other affections of the respiratory organs. It has also been employed with much . Success in various nervous and debilitating diseases. Its Curative Power is largely attributable to its stimulent tonic and nutritive properties, by means of which the energy of the system is recruited. ts Action is Prompt; it stimulates the appetite and the digestion, it promotes assimilation and it enters directiy into the circulation with the food products. The prescribed dose produces a feeling of bouyancy, and removes depression and melancholy ; hence the preparation is of great value in the treatment of mental and nervous affections. From the fact, also, that it exerts a double tonic influence and induces a healthy flow of the Secretions, its use is indicated in a wide range of diseases. \ Notice—cAUTion. The success of Fellows' Syrup of Hypophosphites has tempted certain persons to offer imitations of it for sale. Mr. Fellows, who has examined samples of several of these, finds that no two of them are identical, and that all of them differ from the Rinal in composition, in freedom from acid reaction, in susceptibility to the effects of º When exposed to light or heat, in the property of retaining the strychnine in ld in the medicinal effects. - Reap and inefficient substitutes are frequently dispensed instead of the physicians are earnestly requested, when prescribing the Syrup, to ellows.” \it is advisable that the Syrup should be ordered in the \marks which the bottles (and the wrappers surround- hºl and the genuineness—or otherwise—of the con- ty Street, New York. ©u, ©es #. THE MEDICAL DIAL A Monthly Record of Medicine and Surgery. Vol. I. No. 1 1. MINNEAPOLIS, OCTOBER, 1899. $1.00 per Annum. Single Copies 10c. CONTENTS. ORIGI INº L. FARTIC.L.E.S. An Arm Saved After Being Run Over and Crushed by a Railway Locomotive, by S. L. Kilmer, M. D., South Bend, Ind. 301 Fibroma Molluscum (Illustrated), by F. J. Leviseur, New York City . . . . . . . 305 Myasthenia Gastrica, by John W. Bell, M. D., Minneapolis. . . . . . . . . . . 306 The Treatment of Cancer by the Cata- phoric Diffusion of the Oxychlorides of Mercury and Zinc–the Massey Method, by G. Betton Massey, M. D., Philadel- phia. . . . . . . . . . . . . . . . . . . 308 Tetanus and Tetanus Serum, Report of a Case, by Edward, Newton Flint, A. B., M. D., Minneapolis. . . . . . . . . . . 31() The Legal Responsibility of the Physici- an in Certain Cases, by F. F. Casse- day, Ph. B., M. D., Minneapolis . . . . 312 Modification of Bottini's Operation for Hypertrophy of the Prostate by Galva- no-Cautery, by Robert Newman, M. D., New York § * * * * * * * * * * * * * 314 The Differential Diagnosis of Small Pox, Chicken Pox and Measles, by G. R. Cur- ran, M. D., Worthington, Minn . . . . .315 t The Pathogenesis of Functional Nervous Diseases and their Prophylactic Indica- tions, by John Punton, M. D., Kansas City. . . . . . . . . . . . . . . . . . . 316 “Technic of Abnormal Hysterectomy,” by J. H. Carstens, M. D., Detroit. . . . .317 Two Cases of Dystogia due to Ventrofixa- tion, one Requiring Caesarian Section, Xavier C. Werder, M. D., Pittsburgh. .318 Report of a Case of Complete Hernia of the Pregnant Uterus, by W. V. Ander- son, M. D., Toledo . . . . . . . . . . . 3.18 EDITORI R L. S. SOME THOUGIITs ABOUT WAccINATION, by KNUT HOEGH . . . . . . . . . . . . 320 DEMISE OF GEORGE HENDRIcks, M. D. 321 PRO GI RESS OF MEDIC.I.N.E. OBSTETRICS. The Operative Treatment of Labor Com- plicated by Pelvic Deformities. . . . . 322 Notes on the Induction of Premature Labor. . . 32 tº ſº º º 'º - tº tº e º ſº º - © s Laryngospasm, Eclampsia and Tetany in Children. . . . . . . . . . . . . . . 322 NEUROLOGY AND PSYCHIATRY. A Case of Intrauterine Epidemic Cerebro- Spinal Meningitis . . . . . . . . . . . 32 Pachymeningitis Spinalis Externa—Re- covery Complete . . . . . . . . . . . . 325 BOOHO NOTIC.E.S., American Pocket Medical Dictionary, by W. A. Newman Dorland, A. M., M. D. 3 The Hygiene of Transmissible Diseases; Their Causation, Modes of Dissemina- tion and Methods of Prevention, by A. C. Abbott, M. D. . . . . . . . . . . . . 326 26 A Text-Book on Practical Obstetrics, by Egbert H. Grandin, M. D. . . . . . . . 32 Treatment of Pe1 vic Inflammations Through the Vagina, by William R. Pryor, M. D. . . . . . . . . . . . . . . 32 A Text-Book on the Diseases of the Nose and Throat, by D. Braken Kyle, M.D. 327 Hints on Practical Urinalysis, by Chas. C. Yarbrough, M. D. . . . . . . . . . 328 INDEX MEDIC.U.I.S. Recent Medical Journal Literature . . . .329. MISCELLANEOUIS. Tuberculosis Among the Queen's Cows. 306 9. Monstrous Obesity (Illustrated) . . . . . 31 Formaldehyde for Consumption. . . . . .319 “Remarkable Cure for Insanity.” . . . . 321. A Conundrum . . . . . . . . . . . . . . 321. Disguising the Taste of Naseous Drugs .. 326 Treatment of Acute Bronchitis. . . . . . .328 The Urine in Disease . . . . . . . . . . . 329 New Cure for Germ. Diseases. . . . . . . 332 PUIELISHERS DEPFART NAENT. Mellin’s Food Company . . . . . . . . . X. Katharmon Chemical Co . . . . . . . . . X. The Maltine Co. . . . . . . . . . . . . . X The Allison Table Endorsed. . . . . . . X. Peerless Battery Co. . . . . . . . . . . . A Pocket Day Book, Journal and Ledger Combined. . . . . . . . . . . . . . . X. McArthur Hypophosphite Co. . . . . . . x; Henry Pharmacal Co. . . . . . . . . . . xi. Antikamnia Chemical Co. . . . . . . . . xi. Purdue Frederick Co. . . . . . . . . . . xi. Incorporated under the laws of the State. #"The Winkley Artificial limb Co.: Lowell E. Jepson, M. S., President. Patent Adjustable DOuble Slip SOCket ARTIFICIAL LEG...º. ſ | §-* - -º-**º- || KS:º3. :- - º- ººi -ºº-.- * Rºz-A-3.r º gº ººsº ts º ; #ſºlº , is ſººj;| }, ... .ºgº . . . | | § I} | º:= =} # Wºz-Śll l -->SA | šll|| º ~s S. T. MINOR, Neodesha, Kas. Thousands of our Slip Socket Legs now being worn. INVENTORS AND MANUFACTURERS OF THE PERFECT FIT GUARANTEED from Casts and Measurements without 1eaving home. 0III large For amputation six inches below the knee, with illside socket thrown out of its proper position in order to show its construc- tion. Sent U. S. Government manufacturers. illustrated Catalogue Frºð, _* J. H. Jepson, Sec'y and Treas. WARRANTED NOT” H. C. PIERCE,.. Hutchinson, Minh, i i ; i ; i i *3 : Received the highest awards at the World’s Fair in '93, at the California International Exposition in '94, at the Atlanta International Exposition in ’95, and at the Omaha Exposition MIN NEAPOLIS, MIN NESOTA, U. S. A. in '98. * & 3. §y r †: sº ii THE MEDICAL DIAL. . . . THE NAME. . . MCIN TO SH IS A GUARANTEE, MºINTLISH LHDACD. LOOK AT THIS FROM TEN TO FIFTY PER CENT R EDUCTION. X-Ray Apparatus, STATIC MACHINES, OFFICE TABLE PLATES, PORTABLE BATTERIES, - - - - - - --- - ELECTRODES OF EVERY DESCRIPTION. - "lº- ºlº * our 19th equo, º sus, just s ºea, contal.s new Repuced prices, new literature, and gives cuts and descriptions of the very newest and improved electro-medical apparatus. This catalogue will be mailed to physicians upon request, Post PAID, witHour chance, write for it. McINIOSH BATTERY AND OPTICAL CO., *****!º **** An Ocean Voyage On Fresh VVater. Duluth to Buffalo via “NORTH WEST" or “NORTH LAND,” the most magnificent fresh water steamships in the world, exclusively passenger. Sailing twice-a-week. Illustrated information from F. I. Whitney, Gen. Pass. Agent Great Northern Ry, St. Paul, Minn. } * * 3. .* *-'s * : ** THE MEDICAL DIAL. . . . . iii 3. º- McArthur's SYRUP. (SYR: HYPOPHOS: COMP: C. P., McARTHUR.) Its use is indicated in Consumption and Tuberculosis, Diseases of the Chest, Chronic Cough Throat Affections, General Debility, Brain Exhaustion, Impotence and Loss of Memory. The point of primary importance in the use of the Hypophosphites is their Chemical purity, but, unfortunately they are too often adulterated. So little seems to be generally known, even among the medical profession, with regard to the chem- i. of the Hypophosphites, and the absolute necessity of CHEMICAL purity, that we call attention to this point. One of the first effects produced by the use of our CHEMICALLY PURE. Hypophosphites is a general increase of nervous energy, with a feeling of ease and comfort. The second effect is an increase of appetite; digestion is improved, and the bowels become regular in their action, the quantity and color of the blood is increased, respiration is controlled, a better expan- sion of the chest is observed, cough improves, easy expectoration is produced, night prespiration dimin- ishes, the face becomes fuller, the lips red, the nails and hair grow, and in children the teeth, showing t the importance of the Hypophosphites on the organ of nutrition. Bºphysicians when prescribing will please write thus: f B. SYR: HYPOPHos: CoMP: Mo ARTHUR. ONE BOTTLE. As it is made only for Physicians there are no printed wrappers or advertisements about the bottle. . . Our pamphlet on the Curability and Treatment of Consumption sent free to physicians upon application. We will send one bottle of McArthur's Syrup to any physician, without charge, who will pay the express charges on the same. Mention this Journal, ANSONIA, CONN. gº?” #3 * \ \ WHEN THE ACTIVE PRINCIPLES R W is dispensed in 16-oz. bottles by all druggists. W Made only by KATHARMON CHEMICAL CO., St. Louis, Mo. W & % are taken from Cod Liver Oil, only the grease remains, and Ö à i that is of no more value than other grease. § % % The virtue of Cod Liver Oil lies in its curative principles, § Ä which are separable from the grease. These active princi. Ú Ä ples (taken from pure, fresh Cod Liver Oil), are employed § % s in the manufacture of .* § º HAGEE'S CORDIAL OF COD LIVER OIL with § º HYPOPHOSPHITES OF LIME AND SODA. §§ § Your patients get the grease in the form of palatable food fats. º 3. CORD. OL. MORRHUAE COMP. (Hagee) § M\ º M\ M\\ •2.2.2.2.2.2.2.2s22s22s2:22:2:2:22:22:2: A. tº *S*S* Sº SºS’ Sº Sº S-S- S-S- Sº we Sº Sº Sº S. Sº Sº TH E M CARTHUR HYPOPHOSFH ITE CO., iv. THE MEDICAL DIAL. | | HAM LINE UNIVERSITY DEPARTMENT OF ME DIC IN E. (MIN MEAPOL1s col-LEGE of PHYSICIAMs AND surgeo N.S.) 7th Street and 6th Avenue South, MINNEAPOLIS, MINN. The eighteenth annual session of the College will open October 2, 1899, and continue tight and a half months. The course of instruction is divided into a four-years fully graduated curriculum. Graduates in science and arts, and students from other recognized medical schools, may take advanced standing. All laboratories are newly equipped with the best apparatus. The hospital facilities are the best in the Northwest. All branches are taught practically, clinical and bedside instruction given in all the hospitals of both the Twin Cities. Geo. H. Bridgman, D. D., President. Leo M. Crafts, B. L., M. D., Dean, Professor of Nervous Diseases. J. T. Moore, M. D., C. M., M. C. P. S., Professor of Theory and Practice of Medicine. Edwin Phillips, M. D., Professor of Gynaecology. W. J. Byrnes, M. D., Professor of Surgical Anatomy and Clinical Gynaecology. Columbus G. Slagle, M. D., Professor of Paediatrics. Berbert E. Cary, B. A., M. D., Associate Professor of Gynaecol- ogy. J. W. MacDonald, M. D., F. R. C. S. E., Professor of the Practice of Sur- gery and Clinical Surgery. William H. Hallowell, M. D., Professor of Obstetrics. William G. W. Tupper, M. D., Professor of Therapeutics. Hugh N. McDonald, M. D., Professor of Diseases of the Chest. C. K. Bartlett, M. D., Professor of Psychological Medi- cine. George C. Barton, M. D., Professor of Physiology and Clini- cal Gynaecology. A. F. Irwin, M. D., Ph. D., Professor of Pathology and Bac- teriology. David Owen Thomas, B. A., M. D., M. R. C. S., Professor of Dermatology and Gen- Ito-Urinary Diseases. Charles J. Spratt, M. D., Professor of Ophthalmology and Otology. For Catalogue and Information Address, LEO M. CRAFTS, M. D., Dean, 606 Masonic Temple, Minneapolis, Minn. Joseph W. Bettingen, M. D., Clinical Professor of Diseases of the Nose, Throat and Ear. Charles J. Meade, M. D., Associate Professor Medicine. Charles F. Denny, M. D., Instructor in Clinical Medicine. J. Frank Corbett, B. S., M. D., Assistant Professor of Bacteriolo- gy and Curator of the Museums. Edgar M. Dunn, B. A., Assistant Professor of Chemistry. William B. Murphy, M. D., - Demonstrator of Anatomy and In- structor in Clinical Chemistry. Frederick Leavitt, M. D., Instructor in Clinical Obstetrics. F. A. Knights, M. D., Assistant Professor of Histology and Embryology. R. M. Peters, M. D., Demonstrator of Anatomy and In- structor in Medicine. C. A. Donaldson, M. D., Assistant Demonstrator of Anato- of Clinical my. C. H. Bradley, M. D., Instructor in Clinical Obstetrics. UNIVERSITY SCHOLARS ASSISTING IN LABORATORY INSTRUCTION. R. M. Burlingame, In Therapeutics. A. G. Chadbourne, Ph. B., In Histology and Embryology. G. M. F. Rogers, In Bacteriology. Edward A. Rich, Ph. B., In Histology and Embryology. FA-L-L-T-Y-- Charles W. Williams, M. D., Professor of Materia Medica. J. D. Simpson, M. D., Professor of Clinical Ophthalmolo- gy and Otology. Knut Hoegh, M. D., Professor of the Principles of Sur- gery and Clinical Surgery. Charles W. Drew, Ph. B., M. D., Professor of Chemistry and Toxi- cology. Henry J. O'Brien, M. D., Professor of Clinical Surgery. Charles E. Smith, M. D., Professor of Clinical Medicine. Edward Boeckmann, M. D., Professor of Clinical Ophthalmol- ogy. Anton Shimonek, M. D., Professor of Clinical Gynaecology. C. A. McCollom, M. D., Professor of Preventive and Legal Medicine and Medical Insurance. Norman Dreisbach, M. D., Professor of Anatomy. William Glenn, M. D., Professor of Physical and Clinical Medicine. OTHER INSTRUCTORS. P. M. Holl, M. D., Clinical Professor of Paediatrics. F. B. Kremer, D. D. S., Lecturer on Dental Pathology and Therapeutics. M. C. Johnston, M. D., Assistant Professor of Pathology. Arnold Schwyzer, M. D., Clinical Professor of Pathology. Gustav A. Renz, B. S., M. D., Ph. D., Clinical Professor of Genito-Uri- nary Diseases. Diagnosis - º "Did You Ever See Anything Like It?” THAE Manhattan Typewriter. O'QUALITY HIGHEST, PRICE LOWEST. Typewriters Sold, Exchanged, Rented. suPPLIES FOR ALL TYPEWRITERS. * MAXFIELD & OLIVER, North-wester r -> ea Iers, 17 so. 4TH STREET, Telephone 146-2. MIN NEAPOLIS, MINN. *, + *::g y THE MEDICAL DIAL. § § § §§§§§ NOW READY. lſalline WITH CREOSOTE. A number of years ago, when the value of Creosote became fully demonstrated, we began the publication of a formula for the administration of Creosote in Maltíne. This formula has been employed successfully by thousands of physicians, and we have been urged over and over again to place such a combination upon the market in order that a uniform and properly prepared product could be had under all circumstances. • ‘MALTINE with CREOSOTE” is the most eligible and palatable form in which Creosote can be administered. The vehicle–Maltine Plain—is particularly indicated, by reason of its great food and digestive value, in all conditions in which Creosote is so universally employed. lt will give us pleasure to send, prepaid, samples of “IVIALTINE with CREOSOTE’” to any physician in good standing who wishes to satisfy himself of its therapeutic value and elegance. THE MALTINE COMPANY., Eighth Ave., 18th and 19th Sts., BROOKLYN, N Y. §§§§§§§§§§§§ # * * * ~ * : vi THE MEDICAL DIAL. --- |ººº -ſººº-ºººº-º ---.º º º|- ºº-- ſº ſº The Dr. C. E. Sawyer Sanatorium, Marion, Ohio. sº For the treatment of Chronic Diseases, Cripples and Deformities. Catalogues furnished on #º. application. Correspondence solicited. Visitors welcome. ſº -: Professional inspection invited. * . º 2^jº Harrison & Smith CO. Printers Binders CATALOGUES Lithographers Blank Book ſºirs. 257-259 First Ave. S., Minneapolis. JOHN WYETHT&TEROTHERT |||}|||}|||||||}} N EUTRAL. (Liquor Mangano-Ferri Peptomatus— Wyeth.) ANAEMIA, CHLOROSIS, SCROFULA, DEBILITY. The value of Iron and Manganese in the form of pep- tonates as offered in this preparation may be summarized from the latest scientific researches, as follows: º (1) By association with peptone, the albuminates of iron and manganese become “digested,” or, in other words, much of the labor of the stomach and pancreas in this respect is saved. (2) Peptone is a body that is not provided abundantly by the stomach, even in health ; and hence, its artificial administration is, for weak digestion a desideratum. (3) It is a necessary adjunct of pancreatic digestion. (4) It is easily absorbed. (5) It increases peristaltic action. DOSE.-For an adult, one tablespoonful well diluted with water, milk or sweet wine, three or four times a day. Per Gallon, $5.00 Per Dozen 12-ounces, $9.50 Wyeth's Liquid Malt Extraſt. i Containing all the Nutrient Properties of Malt, with the Least Possible Quantity of Alcohol. We claim that our LIQUID MALT EXTRACZ zvill be found to contain all the nutrition of the best Malt Ziguors in a higher degree than any of the largely sold : Liquid Malts with zwhich zvé have compared it, having the marked advantage that it is free from the stimulating effect which inzariably follows their administration. LOSS OF APPETITE.-A wineglassful taken half an hour before each meal and before retiring at night, will soon restore a healthy appetite. $. DYSPEPSIA.—Discontinue the use of ice-water, coffee, milk and all strong liquors, and use WYETH's LIQUID MALT as a regular beverage, especially with each meal or luncheon. A permanent cure will be the certain result. NURSING MOTHERS.—Should use WYETH's LIQUID MALT liberally at every meal and luncheon and as a beverage. Per Dozen Pints - º $3.00 WHINE OF (ODLIVEROILEXTRACT With Cherry and Hypophosphites. A NUTRITIVE TONIC. Each fluidounce represents one fourth its volume of Cod Liver Oil with Extract of Malt, Fluid Extract of Wild Cherry Bark, and the Hypophosphites of Lime, Sodium, Potassium, Iron, Manganese, Quinine and Strychnine. Adult dose, one tablespoonful three or four times daily. For a child, one to two teaspoonfuls. Per Dozen Pints - ſº $9.00 Elixir Anti-DySpºpſiſ, This preparation will be found peculiarly efficacious in those derangements attended with flatulence, acid fer- mentation, eructation superinduced by eating rich food, pastry, starchy vegetables, excess in drinking spirituous liquors, and excessive smoking. It will prove equally valuable in almost every condition of weak and impaired or imperfect digestive powers, either due to catarrh of the mucous coat of the stomach or in those symptoms char- acterized by sensations of distress and uneasiness during digestion, usually termed Nervous Dyspepsia. Each dessertspoonful contains : Pepsin I grain, Pancreatin 2 grains, Casca a Sagrada I grain, Ipecac I-5 grain, Strychnine I-60 grain, with the active constituents of 30 minims Antiseptic Solution. ! DOSE for an adult is one to two dessertspoonfuls after each meal or when feeling oppressed, much depending upon the severity or frequency of the attacks. $12.00 Per Dozen Pints - º WY ETH'S Granular Effºrts[ing Salts. Our list of GRANULAR EFFERVESCING SALTS embraces those in popular and general demand. For uniformity and fineness of granule, ready and complete solution, sparkling effervescence and general freshness, delicacy of flavor and character, they are un- surpassed. They are prepared with scrupulous exactness as to strength and contents of each drachm or sixty grains. We ask the attention of the medical profession to Dr. Cathell’s Essay on the use of Kissingen and Vichy for Reducing Over-Fatness, a copy of which we will furnish on application. EſſºrWESGing S0ffilm PhOSphâtº Each dessertspoonful contains 30 grs. Sodium Phosphate. A MILD, PLEASANT AND TASTELESS LAXATIVE A SPECIFIC IN constipATION CHILDREN's DIARRHCEA, OBESITY, JAUNDICE, RICKETs, ETC., ETC. Sodium Phosphate has long been the favorite purga- tive, inasmuch as it acts gently but surely, has little or no taste, and is easily taken by children and delicate persons. In the present form—the effervescent—it is a delightful remedy, constituting a refreshing sparkling draught of bland action. sº Sodium Phosphate is a mild but certain hepatic stimulant, and relaxes the bowels both by promoting an excretion of bile and by acting directly upon the mucous membrane of the intestines. It does not cause “griping,” nor does it derange the stomach or excite nausea; unlike many other purgatives, it has a beneficial effect upon the digestion, stimulating the flow of gastric juice. These Salts are put up in 4-ounce Doubly Sealed Bottles. Each Bottle accompanied with a Dose Glass. Also in Bulk 1-pound Bottles. *. PHILADELPHIA, PENNA. 2 - º, viii of nutrition in all cases of debility, nervous exhaustion, anaemia, malnutrition, is --- *, *. '... " THE MEDICAL DIAL. | GRAY'S GLYcERINE TONIC CoMP. neurasthenia, Regulates metabolism, Reconstructs wasted tissues Restores nervous force THE PURDUE FREDERICK CO. No. 15 Murray Street, New York The Hollem Portable A- Hygienic Bath. Made on Strictly $33,393 Scientific Princi- ples a n d Fully Guaranteed. There has never been an accident with our Bath, and one is impossible. With the he at shut off it becomes a perfect cooling room, avoiding any shock to the sys- tem by contact with the outside cold air. Unlike all other ºw baths, ours has an 4.j adjustašić ºve. ºeeeeeeeeeeeeee - which can be washed clean each week if desired, thus preventing the gathering of disease germs and microbes. Our strongest testimonials are from the leading Min- neapolis physicians. Free Batll book. Ca11 or address THE SMNITARY MFG, CO., | ſ º - | º | º THE SANATORIUM, HUDSON, WIS. - º,3 . º, ºf wººl. Aºitº º lº º, ºſº | - rº; º: º d º: ºš * , i. §§ t ºlº º ſº "º º - - tº "ºr [...] º AN INSTITUTION FOR THE SCIENTIFIC TREATMENT OF NON-CONTAGIOUS DISEASEs. gº º Every Appliance and Method used which is §§ recognized in Legitimate Medicine, including : § Turkish, Roman, Electric, Medicated and Thermal §§ § Baths—also every form of Electricity, as well as §§ § Massage and Swedish Movements, etc. All under § § the supervision of Experienced Physicians .# §3 Trained Nurses. wº Sº §: SºğS!!NºSºftNºSºftSºftNºSøSøSøSºSøNºSºftS2 406 Phoenix Building, MIN NEAPOLIS, MINN. º | The institution is delightfully located, with a long, wide veranda, inclosed in the winter season in glass, and is equipped with mod- ern conveniences, as Elevator, Electric Light and Electric Bells, Large Parlors. For terms, address THE SANATO RIUM. i THE MEDICAL DIAL A Monthly Record of Medicine and Surgery. Vol. I. MINNEAPOLIS, OCTOBER, 1899. No. 11. OriSimal Hrticles. *AN ARM SAVED AFTER BEING RUN OVER AND CRUSHED BY A. RAILWAY LOCOMOTIVE. By S. L. KILMER, M. D., South Bend, Ind. By way of introduction, permit me to say that the following case is not reported in con- sequence of its being in any sense new or re- markable, or as indicating any unusual skill, but because it shows what can be done by care and patience in cases that may at times seem almost hopeless in the matter of saving useful and serviceable limbs, and thus adding much to the comfort and happiness of the individual and his usefulness to the public, and reflecting credit upon the medical profession. It is of course always much easier and simpler to per- form an operation of amputation of a severe- ly injured limb than to save it, and the surgeon is much sooner through with his patient, but the patient is not so fortunate in being through with his affliction when thus maimed for life, for, unfortunately, when a limb is once removed by the surgeon, it remains off forever, and no other comes to take its place, and I contend, much as we esteem the ability of rapid and skillful, as well as successful amputations and operations generally, such ability is not so powerful an argument in fa- vor of the general qualifications of a surgeon, as will be demonstrated by saving, in a useful condition, a limb so seriously crushed as to appear hopeless. I admit that it requires greater knowledge and more self-assurance to decide in favor of attempting to save a man- gled limb than is required for its removal by amputation, but it is the surgeon's duty to be * Read at the 25th annual meeting of the Mississippi Val- ley Medical Association, Chicago, October 5th, 1899. possessed of judgment and discretion, indicat- ing when to withhold his hand, as much as ‘it is his duty to perform operations skillfully and dextrously. If the surgeon will put himself in his patient’s place, and then consider what he would wish to have done in his own case, simply observe the Golden Rule, he will not make frequent errors in this respect. I am aware of the fact that some will say a Stump is better than a deformed and useless member, and to this I assent, but not all de- formed members are useless, nor are all use- less members deformed, and the question of serviceableness depends upon their usefulness, and not on their perfection of form, or de- formity. The mere fact that at some time a Surgeon has succeeded in saving a limb or ex- tremity which afterwards proved useless to its possessor, should not cause him afterwards, when in doubt, always to amputate, for I bold- ly assert, but without of course the oppor- tunity of demonstration, that for every case of a useless member saved by conservative sur- gery, a score or more have been amputated, which might, by proper care and attention, have been saved to the great and lasting ben- efit of the possessors. The ease with which an amputation can be performed, the effect it has upon an unthinking public as an indication of skill on the part of the operator, thus tending to enhance his reputation, the flattering re- ports in many, if not most, localities, by the daily press, all conduce to operating and am- putating without discretion or consideration or discrimination, and thus, in time, there is a hardening of heart, and an involuntary am- putating instinct formed by the surgeon to such an extent that all that comes to his mill is amputating grist, and he runs in a single narrow channel or rut, which causes him to overlook entirely the grandest portion of his duties, viz., not only to preserve life but to so preserve the life and functions of an individual ãº, ºf £º: º, * §§ ** * * *302 THE MEDICAL DIAL. as to make him the most useful to himself, his family and the public. The title of this article may be thought- lessly considered as a misnomer, the forearm being crushed, but the crushing was practi- cally of the entire forearm, and when we cons sider the usual rule to always cut wide of the injured tissue in railway injuries, we will see that to follow this rule in amputation of a case of this kind, we would necessarily sacrifice the entire arm. It will be observed that the gen- eral tone of this article is a plea in favor of conservatism. Now to the case in question. About three o’clock in the morning, Octo- ber 26th, 1897, I was called to attend Mr. George Blue, American, age 27, height 5 feet 6 inches, weight 130 pounds, a yard switchman in the employ of the Lake Shore & Michigan Southern Railway at South Bend, Ind., who, in turning to step from the foot-board of the engine, slipped on the frost and fell in front of the engine, which at that moment started, the engineer and fireman not having observed the fall of Mr. Blue. The engine, in running over him, dragged him for some distance. Perhaps he caught hold of some part of the éngine to protect himself, but in any event he was dragged over the ties for some thirty or forty feet. His left forearm lay across the rail, and one or more of the wheels of the en- gine ran squarely over it, crushing the bones into short lengths and fragments, and man- gling and crushing the soft tissues in the usu- ally frightful manner in such cases. There was also a scalp wound of some four inches in length, extending to the skull. After a primary examination, he was re- moved to the Epworth Hospital; there, assist- ed by Dr. C. Stoltz, I made a more careful ex- amination of his arm, and found the above description not in the least exaggerated. My first impulse was of course to amputate the arm above the elbow, as being the proper course to pursue in consequence of the terribly mangled condition of the entire forearm. However, I remembered having read, not long prior, the results of a German surgeon, who had for some time made a specialty of en- deavoring to avoid amputations in all cases where it was possible to do so, leaving, practi- cally speaking, amputations to nature, under the opinion that nature was more conservative than art as practiced by the surgeon, and a better judge of the actual requirements than he; his method being simply to assist nature when it was evident that she was performing an amputation; and thus to ascertain whether it were not possible to save many cases which, under the usual practice, had been sacrificed, and his success had been so marvelous as to even astonish himself, saving many limbs that appeared hopeless, and of many others saving a generous portion of the limb to the great benefit of the patient. Having myself always been given to the practice of conservative surgery, although on a small scale, by means of which I had been enabled to save many entirely useful members, even without loss of motion in the joints which had been opened by the accident, or in the operation, I was the more easily inclined to believe that it would be perhaps justifiable to make the effort in this case to save the arm despite its almost hopeless outlook, inasmuch as the arteries had fortunately escaped sever- ing, as indicated by their continued pulsation, although it was feared the injury might cause them to slough and bring on secondary hem- Orrhage. The decision being made, I enlarged by in- cision one of the openings, from which pro- truded bones and mangled flesh, sufficiently to enable me to examine with the fingers care- fully the entire interior and removed with scissors a large amount of comminuted soft tissue; one section of the radius, two and three- Quarters indhes in length, which was entirely free from the soft tissues, was also removed, together with a number of fragments of bones of various sizes; a portion of the ulna, two and one-quarter inches in length, being still at- tached to some of the soft tissues, was per- mitted to remain, with the hope that it might perhaps receive a sufficient amount of nourish- ment to protect its vitality. After having thoroughly irrigated the vast cavity within the forearm, and trimmed off as much as possible everything that was beyond the possibility of reparative process, drainage being provided for, and the fragments of bone replaced in as natural a position as possible, the arm was extended and laid upon a straight posterior board splint, extending from the ax- illa beyond the finger tips, carefully packed in a gauze dressing, and light bandages applied. Strict asepsis was of course out of the question in this case, but the general principles of anti- THE MEDICAL DIAL. 303 septic treatment were complied with as closely as possible under the circumstances. The next day there was, as was to be ex- pected, a great deal of tumefaction, the swell- ing extending well up to the axilla, the skin over the forearm and extending some distance above the elbow much discolored, almost black, while the temperature was 101. On the following day the conditions were worse, and I began to fear that a great error had been made in the attempt to save the arm. How- ever, the condition remained, practically speaking, stationary for several days, and then began a profuse purulent discharge. There were large formations of pus at various places between the elbow and wrist; in fact, there was a generally suppurating condition of the entire forearm, necessitating the free use of the lance, so that the whole forearm resembled a sieve or bag, and upon irrigating with some little force, the fluid would discharge from half a dozen different openings. After a few weeks a splint was construct- ed, composed of longitudinal iron bars, curved so as to allow free access to the openings in the forearm, and at the ends of the bars leath- er straps and buckles, by which the splint was held in position; the bones being again ar- ranged as correctly as possible and free drain- age provided for, the limb could thus be handled and dressed without the removal of the splint. The discharge was very free for a period of probably two months, necessitating a change of dressing twice a day. Eventually, however, the swelling subsided greatly, and the discharge diminished, and the general ap- pearance of the arm improved. About this time he left the hospital for his home, coming to my office every day or two for treatment for several months longer. There was still a con- siderable discharge, and it was evident there was some necrosed bone remaining, and on the 9th of May, 1898, again assisted by Dr. Stoltz, I made an opening on the anterior or palmer surface of the forearm, near the wrist, and the portion of the ulna referred to above, as being left in the hope that it would survive, the en- tire diameter of the shaft of the ulna, and two and one-quarter inches in length, was easily removed, being found lying in a cavity of its own, entirely freed from all other tissues, and entirely dead. The periosteum had unfortunately failed to produce new bone, as was hoped, and appar. ently the contraction of the muscles had crowded out of position the portion of ne- Crosed ulna, approximating the extremities of the fragments of the bones, between which there was a ligamentous union only. The Wound was closed and speedily healed. The result is quite satisfactory, as the arm is quite useful, the patient having considerable power of flexion of the thumb and all of the fingers, Which enables him to hold a book or other ob- ject in his hand very comfortably; the liga- mentous union, although quite short, unfortu- nately still permits the hand to droop, so that the arm becomes decidedly curved. This can, however, be corrected by wearing a splint for a few days, which serves to correct the posi- tion of the bones, or did until some months since. There is, however, now a contraction of the muscles, slipping the extremities of the bones over each other, and a shortening of about three inches. The arm is entirely well at this time; that is to say, it is entirely healed and is painless. The ligamentous union and the natural weakness incident to the terrible injury to the soft tissues, makes it of course a very imperfect arm, but it is in a very much better condition, and much more serviceable than would have been any artificial arm that could have been put on the stump, had it been amputated. An important matter for consideration in this case is the question of the advisability of freshening up the extremities of the bones and wiring them together in the hope of procuring bony union; such result would doubtless add very much to the serviceableness of the arm, but should the effort result in failure, it is be- lieved that it would interfere to a certain ex- tent with its present usefulness. The result is indeed very gratifying, and demonstrates the justice of the attempt to save the arm, and I cannot refrain from the belief that very many limbs that are ordinarily sacrificed might be saved and made of more serviceability to their possessors by pursuing the course indicated above. It of course takes a long time, and a great deal of service and very much worry also, to produce a result of this character in a case of this description, and perhaps in some cases attempts might be made that would eventually prove to have been ill advised, and in which amputation might become necessary. Still, the results in this case have been so favorable, and my previ- * º * , ex” º: *º- * ... • *rs. * f * > * * ****, *, * , tº . . J. Ł, *** & #6 $4. ra” wer. * , ~~} “ . * - -ºš * * 304 ous results from the practice of conservative surgery have also been so satisfactory, that I feel not only justified in continuing along the same lines, but would feel that in many cases it would be reprehensible not to make the effort to save very seriously crushed members. I am of course not to be understood as ad- vocating the attempt to save all limbs that are crushed. There are many of them that it would be the greatest folly to make such an at- tempt upon, but if the result herein described can be produced in an arm crushed between the wheel of a railway locomotive and a solid T-rail beneath it, it is reasonable to assume that favorable results may be produced in a goodly number of injured limbs that are ordi- narily amputated because of a belief that it would be impossible to save them. I know of no definite rule by which the Surgeon’s practice in this respect should be guided; much indeed must depend upon the wisdom and judgment of the surgeon; but basing my opinion on the conditions and re- sults in the case reported herein, I should say that whenever the arteries are left intact, pro- viding a blood supply to the parts beyond the injury, it would be justifiable to make an effort to save the limb, however much the bones and soft tissues are crushed; especially so if the condition of the periosteum is such as to war- rant the belief in its vitality, and ability to re- store new bone. The Severed extremities of the muscles can sometimes be held in apposi- tion by sutures. The loose fragments of bone may be removed, the remainder put into the best possible apposition, the limb thoroughly cleansed, laid in as natural a position as pos- sible, kept clean and warm, and some depend- ence placed in nature, and she will produce results which will frequently astonish the surgeon by the way in which his art is ex- celled. I have not mentioned the nerves, for the reason that their fibrous character generally protects them from laceration in doubtful cas- es, and even if a nerve is severed, it is entirely practicable to unite the severed extremities by sutures with favorable anticipations of satis- factory results. Lest there should be some doubting Thom- as who would consider it impossible that a railway locomotive could thus pass squarely over an arm without crushing it beyond the power of nature with the surgeon’s assistance THE MEDICAL DIAL. to repair, and who would think, therefore, that an error had been made in the case here re- ported, pardon me for alluding to another case that occurred in my practice a few years ago, viz. April 21st, 1897, in Mr. E. P., height 6 feet, weight 170 pounds, 28 years old, an employe of the same railway company, who, in blocking a car that had no brake, was caught by the slip- ping of the stone used for blocking; the wheel caught his fingers, ran over them, and his hand and forearm to the elbow, and yet did not break a single bone. The force was so great and the shock so sudden that it caused him to turn a somersault. There was a vio- lent wrench or sprain of the elbow joint, and also of the shoulder, but, as above stated, not a bone was broken, not even in his hand or fingers, although the soft tissues were badly swollen and discolored for some time. This is, however, an exceptional case, oc- curring, no doubt, in an exceptional individu- al; exceptional, that is to say, from the stand- point of good fortune, as he has at another time since then, quite recently, viz. July 13th, 1899, again miraculously escaped serious or fa- tal injury, having been caught between the drawbars of two cars, but instead of being cut in two, as is usual in such cases, he was appar- ently forcibly squeezed and rotated out of the very jaws of death, and although laid up for several weeks from his injuries, he has now entirely recovered and is nearly as well as €WeI’. While on the subject of conservatism, I hope to be pardoned for referring to one more case, in which the usual rule for amputation or excision was violated, and in which the result demonstrated the justice of the violation, and is a confirmation of the correctness of the opin- ion and position of Reyher regarding gunshot wounds of the knee joint. In brief, the case was as follows: Isaac James, station agent of the Chicago & Grand Trunk Railway at Gran- ger, Ind., on the 27th day of October, 1895, ac- cidentally dropped from his hip pocket a large caliber revolver, which exploded, and the charge took effect upon his left knee, the ball entering on the inside of the joint, squarely between the femur and tibia, and passed di- rectly through the joint, plowing its way through the articular surfaces of both bones and lodged under the skin at the outside of the knee. The wound was probed and strips of gauze drawn through the course of the ball, THE MEDICAL DIAL. removing thus a number of fragments of bone. After thorough irrigation, the limb was put up in a plaster case, and although the knee joint was badly inflamed for several months the inflammation eventually subsided and he left the hospital in about three months after the injury with the limb almost well, and with the joint so good that a few months later there was only a very slight limp perceptible in his walk, the motion of the joint being almost per- fect. Other cases might be cited, but the above are sufficient to demonstrate the justice of con- servatism, in at least some cases that are generally considered outside of conservative boundaries. FIBROMA MOLLUSCUM. By Fred. J. Leviseur, M. D., New York City. Though this disease belongs to the rare cutaneous affections, its diagnosis is quite easy. It is impossible to mistake the large sessile or pedunculated round tumors, some hard, others giving the impression of an empty pouch (scrotum), for anything else than fibro- mata. The smaller nodes of hard consistency, imbedded in the skin, are also quite charac- teristic. There is, however, a third variety of lesions which at first may be somewhat puz- zling. They consist of small or larger soft spots of bluish tint. The examining finger sinks easily into the skin when pressing on these spots, and receives the impression as if there was an accumulation of fluid under- neath. Such is not the case, but these spots represent deeply-situated young tumors, the contents of which are gelatinous. Quite re- markable is the great number of tumors. Hashimosa, as quoted by Lesser, counted as many as 4,503 in one of his cases. This beats Ochterhony's record, who counted 2,033 small tumors (American Archives of Dermatology, July, 1875). Bergh has very appropriately called the disease, when occurring in such gen- eral distribution, “Fibromatosis.” - The proofs of direct heredity of the disease are not very convincing. There seems to exist, however, a certain individual or racial con- genital predisposition. The skin of the Negro and the Chinese is known to be specially prone to the formation of fibromata. Hebra, the elder, has stated that all his cases con- cerned individuals “stunted in bodily growth, and of more or less defective mental capacity.” The face of my patient, as shown in the au. companying picture, has certainly an idiotic expression, and in three other cases, which came under my observation, the same condi- tion was easily noticed. I cannot say, how- ever, that the patients were below par as re- gards their general health. The mental symp. toms consisted in slowness of thought, defect. ive memory, general irritability and head. aches. There were no delusions or hallucina. tions, nor a pronounced condition of dementia, as found in connection with myxedema. | * ? .* *: * 306 I will add here that a long-continued treat- ment with thyroid extract had no effect upon the patient’s mental and bodily condition. A course of arsenical medication was also tried in this patient without results. All that can be done in these cases, therefore, is to remove, by the knife or cautery, those tumors, which, by their size or weight, or by intercurrent in- flammatory changes, have become trouble- some. I have removed a considerable number of the smaller and more pedunculated ex- crescences by electrolysis. The tumors were transfixed at the base by the needle connected with the negative pole and the current closed by the patient touching the sponge electrode connected with the positive pole. Two to three milliamperes were sufficient in every case, twenty seconds was the length of time in which the current was allowed to act, and the needle was inserted four or five times. Electrolysis, or catelectrolysis, as I have called it, acts more in the manner of the in- jection of fluid into the tissues, and an anaes- thesia is soon produced. It is, therefore, ad- visable to wait about five minutes after the first application and the rest of the operation will be painless. Some of the tumors occa- sionally disappear by spontaneous involution, but this generally while others appear, and consequently no improvement results. TUBERCULOSIS AMONG THE QUEEN'S COWS. A tuberculin test was recently made at Windsor of a herd of forty shorthorn and Jer- sey cows belonging to the Queen, and most of them were found to react to the test. They were all apparently in good condition but as a result of the test, thirty-two cows appeared to be tuberculous, their temperature rising to 104 degrees F. or more; five cows appeared to be healthy, and three were doubtful. The whole herd was killed and the carcasses were exam- ined at the Royal Veterinary College. Of thirty-four animals whose temperature had risen above 104 degrees F., thirty-three were found to be tuberculous. The remaining ani- mal was not tuberculous, but had a diseased uterus. The rise in this case was sudden, and did not occur until after the twelfth hour. Of four cows which did not react, three were found to be free from tubercle, and the fourth had one small caseous gland in which tubercle bacilli were found. The two remaining cows which were classed as doubtful were both found to be tuberculous. In the formation of the new dairy herd at Windsor, all animals purchased for it will be tested, and admitted only when they do not react.—A m. Microscop- ical Journal, Washington. THE MEDICAL DIAL. --- MYASTHENIA. GASTRICA. By John W. Bell, M. D., Minneapolis. Professor of Physical Diagnosis and Clinical Medicine, University of Minnesota. Gastro-enterologists are fast becoming Con- vinced that the gastric muscle plays a very important part in gastric pathology; that mo- tility and not secretion is the all important factor. Clinically, motor insufficiency of the stomach manifests itself in One of three forms, depending on the degree of impaired motility present. For all practical purposes it may be divided as follows: 1St. MYASTHENIA WITH STAGNATION: Slight muscular insufficiency, characteriz- ed by diminished elasticity and strength of the muscular coat, as indicated by the inability of the stomach to empty itself within the normal period. 2nd. MYASTHENIA WITH RETENTION: Pronounced muscular insufficiency, charac- terized by marked impairment of motility and increase in size, as indicated by inability of the stomach to empty itself, even during the night, hence, constant retention of food with fermentation. 3rd. MYASTHENIA DUE TO OBSTRUCTION: Secondary motor insufficiency, due to pylo- ric obstruction, characterized by pronounced and progressive dilatation with constant re- tention, a surgical, rather than a medical prob- lem, as to treatment. The aim and object of the internalist should be an early and complete diagnosis. Having determined the existence of pyloric ob- struction and its nature, he should then call to his aid the skilled surgeon as he would in a case of appendicitis. The interest of the internalist naturally centres in the first and second forms of impaired motility, as observed in the clinical course of true motor insufficien- cy. The clinician, in order to determine changes in size and position, must have a cor- rect anatomic knowledge of the normal stom- ach. The adult stomach occupies an oblique position within the body, about four-fifths of the Organ being to the left, one-fifth to the right, of the median line. Its size, and, in a measure, its position, depends on the age, sex, individual, and degree of distention. The stomach is the dilated pear-shaped portion of the digestive tube situated between the esoph- agus and duodenum. It has two openings, two ends, two surfaces, two curvatures and two divisions of its cavity. The muscular coat, of especial interest to us at this time, consists of three kinds of fibers, longitudinal, circular and oblique—of the unstriped variety, arrang- ed in Such a manner as to favor the two im- portant movements of the stomach—churning THE NAEDICAL DIAL. 307 and evacuating. The cardiac orifice, the most fixed portion of the stomach, is situated be- hind the cartilage of the left seventh rib, one and one-fourth inches from its junction with the sternum, on a level with the spine of the ninth dorsal vertebra. The pylorus is freely movable, its usual habitat being at a point on a level with the spine of the twelfth dorsal ver- tebra and tip of the ensiform cartilage, in the right sternal line. It is something of a rover, and, as the result of disease, may be found very low and far to the right or left. - A topographical tracing of the moderately distended stomach gives the following outline: Superior limit, left parasternal line behind fifth rib; mammillary line, fifth interspace; an- terior axillary line, which is the farthest ex- tension of the stomach to the left, in the sev- enth interspace; lower limit, one inch above umbillicus in maies, slightly lower in females. ETIOLOGY: The predisposition to myasthenia gastrica may be inherited, and is frequent in the neu- rotic, arthritic and lithaemic. As a rule, how- ever, the myasthenic patient cannot pose as the victim of heredity. It frequently follows in the wake of severe acute diseases, typhoid, diphtheria, and influenza. Physicians should remember that during convalescence from ty- phoid and kindred conditions, the appetite rep- resents the needs of nutrition, rather than the functional power of the stomach, hence, pa- tients should not be permitted to overload the stomach, lest they develop myasthenia. My- asthenia is one of the most common forms of gastric disorder met with in the initial stage of pulmonary tuberculosis. It also complicates many diseases of the stomach. Its most fre- Quent cause is intemperance in eating and drinking; one of the most frequent being the use of large quantities of water at meal time. There can be no question as to the evil of large Quantities of fluid taken with meals. Water is not absorbed by the stomach, hence it must act to distend the organ and hamper the gastric muscle in its labo, . SYMPTOMIS. The symptoms of myasthenia with stagna- tion, follow the taking of food. Stomach feels full and heavy, eructation of gas, often fluid, headache, constipation, mental and moral de- pression. Physical Examination: Inspection and pal- pation, negative; percussion, with stomach moderately distended, gives slight increase of gastric tympany to the right, left and downward; gastric splashing, as develop- ed by percussion, especially if it linger beyond the normal period of digestion, is a val- uable sign. Myasthenia cannot be determined positively by inspection, palpation or percus- sion, hence the following procedure. (The de- gree of food stagnation measures exactly the degree of muscular weakness.) Following a very light Supper we give the patient for break- { fast one soft boiled egg. small piece of beef- steak, slice of bread and a cup of milk. Five hours later, we examine the stomach. If emp- ty on using the tube, marked stagnation does not exist. IDIAGNOSIS: The limitation of the symptoms to the pro- longed digestive period and their relation, to the quantity of food and fluid taken at a giv- en meal; the presence of gastric splashing, es- pecially beyond the normal period of diges- tion; the delayed evacuation of the flabby dis- tensible and slightly enlarged stomach, as de- termined by test meal and use of tube, render the diagnosis of myasthenia with stagnation positive. TREATMENT: 1st. Dietetic. 2nd. Medical. \ Digestive hygiene should begin with birth, for, verily, the history of the average Amer- ican stomach is a life-long story of insult and abuse. The diet in myasthenia with stagna- tion should be selected with great care after a careful examination of the stomach contents. The food should be nutritious, small in bulk and non-irritating, avoiding an excess of starches and sweets, little or no fluid being al- lowed with meals. I desire to dissent from the view expressed by Hemmeter in his valuable book, that these patients should eat frequently and but little at a time; on the contrary, the Stomach should be given time between meals to empty itself and have an interval of rest before introducing more food. The use of at least twelve ounces of hot water one hour be- fore meals should be insisted upon, with the view of flushing the stomach. Having selected a diet, so regulated as to support nutrition and lessen the mechanical labor of the stomach, we place the organ in the most favorable condi- tion to regain its lost muscular power. In addition, other means are necessary to Cure the disease. In the order of their relative value, I would place exercise, general and spe- cial, lavage in the form of the intragastric douche, massage, general and special, electri- city, hydrotherapy, Strychnine, etc. Exercise should be taken in the open air, walking, rid- ing or wheeling, never carrying it to the point of fatigue. Special exercises, tending to de- velop and strengthen the abdominal muscles, are especially valuable. Lavage in the form of the intragastric douche, used four or five hours after meals, or preferably at bedtime, using hot and cold water, alternating, medicated if indicated, thoroughly disinfects the gastric mucosa and stimulates and tones the muscu- laris, practically securing, as Suggested by Van Valza and Nisbet, in their eminently practical work, all the beneficent tonic effects, of an intragastric shower-bath. During the past few months I have secured excellent re- Sults in advanced cases of myasthenia with retention, associated with marked dilatation, by using every second or third Clay the com- & ºs-º" 5 i.; -- ſº * Jº ** • * * ** * . t .* * * i J * * 2. { 308 bined stomach tube and douche constructed for me by the Davidson Rubber Company. Massage, general and special, is an invalu- able aid, if judiciously directed by the phy- sician and systematically performed by a com- petent masseur. On the other hand, massage is capable of doing great harm if left to the caprice of the average masseur. Employed four or five hours after meals it improves the general nervous tone, aids in emptying the stomach, relieves associated intestinal torpor, strengthens the abdominal wall, and improves the abdominal circulation. My experience with electricity leads me to believe that its beneficial influence over motility and secretion has been overrated. It may be used internally or externally, galvanism or faradism, as indi- cated. Hydrotherapy, in the form of shower or salt water sponge baths, are useful, espe- cially with the neuresthenic class. The alter- nating hot and cold shower applied over the abdomen and to the spine exerts a beneficial influence in both forms of myasthenia gastrica. As to drugs, strychnine should be given in generous doses, combined with acids or al- kalies, as indicated by examination of stom- ach contents, aided by the use of gastric anti- septics if required to control fermentation. I find I shall have only time to briefly call attention to the more advanced forms of im- paired motility. MYASTHENIA WITH RETENTION Is the natural sequence of the milder or stag- nation form. When the myasthenia becomes so marked that the stomach never completely evacuates its contents, not even during the night, we have added the unfortunate symp- toms of retention, fermentation and auto-infec- tion. The symptoms common to the milder form become more severe; the appetite fails; flatulency becomes pronounced; nausea, and later vomiting, occurs; the functions of the in- testine become disordered by the foul ferment- ing chyme, finally, in part, delivered to the du- odenum; the urine becomes scanty; nutrition fails, as indicated by progressive emaciation. A physical examination reveals a flabby dilat- ed stomach, as indicated by enlarged percus- sion area, on distending the organ with gas. Gastric splashing in the morning before taking food is a valuable diagnostic sign. The one positive sign is the constant presence of food in the stomach in the morning after a test Supper. TREATMENT: Aim to improve the motor function, to con- trol fermentation, and to maintain the balance of nutrition, and to increase the power and efficiency of the gastric muscle. The same remedies used in myasthenia with stagnation are indicated, lavage, massage, electricity, hy- drotherapy, strychnine and resorcin. The diet should be highly nutritious, small in bulk, non- fermentative in character, consisting of finely THE NAEDICAL DIAL. divided particles, capable of utilization by the intestines. Sweets and all fats except butter should be excluded. Lavage should be per- formed daily in severe cases, at late bedtime or in the early morning, using a solution of boracic acid, salicylic acid or hyposulphite of soda. Massage should follow lavage, but new- er should be used indiscriminately to force the foul fermenting stomach contents into the in- testine. The large majority, even of advanced cases of myasthenia respond well to treatment, faith- fully and systematically carried out. The management of the third form of myasthenia, due to pyloric or duodenal obstruction aside from palliative treatment belongs to the sur- geon. * THE TREATMENT OF CANCER BY THE CATAPEIORIC DIFFUSION OF THE OXYCHLORIDES OF MERCURY AND ZINC–TEIE MASSEY METEIOD. By G. Betton Massey, M. D., Philadelphia. The electrolytic decomposition of mercury in contact with the gold anode of a galvanic current inserted into a malignant tumor, and the diffusion of the mercuric compounds thus forced through the diseased area by the cata- phoric action of the current, is a contribution to practical surgery for which the writer claims the credit of discovery and invention. It is evident that in this process we have a means of sterilizing any focus of germ growth or morbid cell life in any portion of the body that can be safely reached by the current, the principal essential condition to its use being the situation of the growth at a sufficient dis- tance from the vital centers, and the necessity for a drainage path for the escape of a portion at least of the devitalized structure. The process gives us a scientific method for the destruction, under ether, of the essential disease elements in early local cancerous growths in accessible situations, of all tuber- culous deposits in the body except within the skull, thoracic and abdominal cavities, and of such acute local infections as carbuncle, poi- soned wounds, etc. The pathologic fact underlying its use in Cancerous growths is that the various affec- tions grouped under the general name of can- cer are due to the presence of an abnormal cell life at the site of the disease, partaking of the nature of a foreign invasion of the body struct- *. Read at the meeting of the American Electro-Thera- peutic Association, at Washington, September 21st, 1899. THE MEDICAL DIAL. 309 ures, which, in its inception and early stages, is strictly limited in situation to the infected locality. In the present state of our knowl- edge it is impossible to decide whether these foci of abnormal cell life are made up of living integer, or extraneous, or of parasitic origin, as many now believe, or merely of errant in- trinsic cell units that have in some way changed their character and become cells of prey, as it were. Whichever of these hy- potheses is true, the fact remains that the in- terstitial diffusion of a protoplasmic poison in a nascent condition, into, through, and beyond these cells is a most efficient way of destroying the essential elements of cancer life, since in either case this life is the manifestation of Tocal protoplasmic bodies. In its application to cancer, the process must be of such a thorough nature that not one of the morbid cells or germs may escape in- filtration with the germicide. The massive dose required to secure this end results in the formation of two distinct zones of action; that nearest the active electrode being an area in which all vital cells are necrosed, the aseptic slough thus formed being limited by a subse- quently developed line of demarcation, and separating in from two to six weeks after the application. Beyond this line of demarcation, which limits the area in which the stroma of the affected organ is devitalized along with the morbid cells, the radiating stream of mercuric oxychlorides will be diffused to a considerable distance, depending in extent on the amount and duration of the current, and will produce a Zone of infiltration in which the cancer cells will succumb while the normal tissue cells are only irritated. It is this zone of infiltration-reaction, par- ticularly, which constitutes the chief value of the cataphoric treatment of cancer, for by it we may reach those outlying colonies of mor- bid germs that constitute the so-called roots of cancer, and which, in their latent condition, are apt to be missed by other methods of destruction or removal, where only what is seen can be removed. The failure to destroy these colonies is the reason for the recurrence of the growth after the use of the knife or caustics. It is best to make an effort to destroy all the germs at once when we are dealing with the more malignant varieties of carcinoma and sarcoma, since a mere wound of these colonies results in the attraction of added blood supply and more luxurious growth. To do this in a single application requires a current of from 200 to 1200 milliamperes, and necessitates placing the patient under a general anesthetic, The duration of such an application has varied in my cases from fifteen minutes to an hour and a half, the latter only in extensive growths situated near vital organs, as about the head and neck, where the effect of large currents on the respiration and circulation restricted the strength to 300 or 400 milliamperes only. The current supply is derived from two to three sulpho-chromic acid batteries connected in series, making a total of sixty or eighty cells, with a voltage of 120 to 160 volts, held in control by an efficient controller. This latter instrument I have been compelled to have made to order by the McIntosh Company, and where the large currents are used I have also employed a specially constructed Weston me- ter reading to the desired amounts. The portable acid batteries now generally in use are so flimsy and possess such small cells as to necessitate the construction of bat- teries with larger elements and cells for this work, which have been made for me by Wil- liams, Brown & Earle, of Philadelphia, under the name of the Massey Transportable Battery, in which the cells are of glass, and more con- venient arrangements for raising and lowering the elements by a worm screw and bevel gear has been added. The active electrode is a cannula made of 18 karat gold, lined with platinum for greater durability, when the pure mercuric catacho- resis is to be employed. The portion of the electrode to be inserted into the growth is free- ly amalgamated with mercury, and after its insertion an excess of the metallic mercury is injected through the tubular center of the in- strument by means of a glass syringe attached to it by a piece of rubber tubing. This excess of mercury is intended to surround the active end of the electrode within the growth to en- sure a full supply of this metal during the action of a powerful current, as otherwise the gold point will become bare of the material in a few moments. The shank of the instrument is insulated with shellac or fused hard rubber when the application is made within a natural cavity. 3. * * tº . fºr K., t **º º' ' ". . . . . . w --- * * * : * {3} + .. * " * * * * * * ***** §§ ****T, < - r . ." § 5 ºf 3 Y. an. * } * i *: k * * * In cases in which much tissue is to be de- stroyed, or where it is difficult to inject the mercury, I have used solid pointed electrodes of zinc freely amalgamated with mercury, which results in the formation and radiation of the mixed oxychlorides of mercury and zinc and the enlargement of the area of necrosis With the same current and duration. The indifferent, negative, electrode is made of a large plate of lead to which a suitable binding-post is attached, and over which is laid a thick pad made of eight or nine layers Of thick Cotton absorbent material well soaked in water. This plate and pad are fully as large as the entire back of the patient’s trunk, and on it the patient reclines during the appli- cation, the operating couch being preferably a spring cot covered with rubber cloth rather than a table, in order that this pad may re- main in uniform contact with the skin during the movements naturally made by a person under the influence of ether. The patient is placed on this couch and pad after all the apparatus has been arranged and tested. When thoroughly under ether the act- ive electrode is inserted into the center of the growth, the mercury injected, and the current turned on in a gradual manner, avoiding shock or sudden increase. The production of the area of necrosis may be seen to begin at once with an effective current, a drab-colored soft- ening spreading in all directions from the in- strument. At the end of a varying number of minutes the whole tumor becomes softened as this area increases, the brawny hardness of the malignant tissue changing to a doughy soft- ness, as though a cellular erectility had dis- appeared coincident with the loss of vitality in the malignant cells. The process should be kept up until the area of necrosis is co-term- inous with the apparent limits of the growth, the zone of infiltration being depended on to kill the outlying cells only. The eschar thus formed is painless and odorless, and separates in due time, the cavity left being allowed to fill with healthy granula- tions. Aside from the limitations to the use of this method mentioned at the beginning of this paper it should be stated that its effectiveness in accomplishing a permanent cure is in a di- rect relation to the earliness of the stage of the disease. A cure cannot be promised in an inoperable case, though its value as a pallia- tive in this stage is very great, and some in- THE MEDICAL DIAL. y & operable cases, as well as others very difficult to reach with the knife, have been cured. Primary growths and early local recurrences are best adapted to secure the best ultimate results, though several of my cases have been followed into the first gland of the axillary chain in breast cases, when this gland alone was affected. In these cases the gland was destroyed separately at the same operation, and the result in two instances has been the destruction of the infection in this situation also. A notable value of the method in certain cases is the possibility of destroying the can- cerous growth in an organ without destruction or removal of the unaffected portion of the organ. It is also a convenient form of opera- tion for cavities, such as the mouth, rectum, etc., as the instruments may be insulated to the point of attack. Finally, as the method is ab- solutely bloodless after the first prick in in- serting the electrode, by reason of the positive pole being used, it commends itself in the erad- ication of highly vascular sarcomas. In a paper read at the recent meeting of the American Medical Association in Colum- bus, Ohio, a number of successful cases were reported in detail, and the following summary of the total number of cases given. The sum- mary includes the initial experimental work, of course, some of the inoperative cases having been mere forlorn hopes: Operable Cases—Cured 8; probably cured, 1; failed to cure, 1.—Total, 10. Inoperable Cases—Cured, 2; probably cured, 1; failed to cure, 13.—Total, 16. Recapitulation—Cured or probably cured, 12 cases; failed to cure, 14 cases. TETANU'S AND TETANUS SERUM. REPORT OF A CASE. By Edward Newton Flint, A. B., M. D., Minneapolis. Tetanus is one of that peculiar class of diseases that, occurring most often in the spo- radic form, still develops at rare intervals many of the features of an epidemic. Whether it is to be counted as a thing beyond reason- able explanation that this is so, or whether an exact demonstration of the causes leading to such epidemics may be hoped for that shall enable us to conquer them by prophylactic measures, time only can tell. THE MEDICAL DIAL. 311 It is not improbable that in certain seasons and under favorable conditions of atmosphere and soil the bacillus of tetanus attains unusual and widespread virulence, placing it in posi- tion to attach itself effectively to any wound With which it comes in contact. Atmospheric conditions are beyond con- trol, even granting that a close examination of conditions should reveal to us the subtle influences of the air that are favorable to the growth of this particular bacillus. If, however, we are unable to quarantine ourselves against the baneful powers of mete- orological vicissitudes, it seems that in the de- velopment of serotherapy we have had at least. placed in our hands an agent that will combat the effects of the tetanus bacillus on the hu- man organism when once it has found lodge- ment there. None of us are likely to forget the remark- able and sudden development of an unusual number of cases of tetanus in this part of Minnesota, and more particularly within the confines of Minneapolis and St. Paul during the past summer. The epidemic—if such it may be called— seemed to develop first in a number of per- sons injured on the 4th of July in the variety of ways usual to that day. As near as I have been able to ascertain, eleven cases in all developed between July 4th and August 5th. Of these eleven cases, nine were taken to the various hospitals. Of this number, those who were treated with Parke, Davis & Co.'s Tetanus Serum, and subsequently died, were all brought to the hospital in the last stage of the disease. The three of which I am person- ally cognizant were all rigid in opisthotonos before receiving the first injection. One other case I know of also died outside the hospitals, but she received no serum until she also was rigid and the jaws had to be pried open with a spoon for the administration of nourishment. This would seem to demonstrate the neces- sity of early diagnosis and administration of serum if life is to be saved. And that life may be saved I am firmly convinced from my ex- perience in one case, though I am well aware of the small weight one case has in determin- ing the status of any remedy in the minds Of the profession at large. But even considering that small weight, I would fall short of my whole duty did I not throw it into the scales of experience and add it to our common store, First and foremost, the Tetanus Serum of Parke, Davis & Co. is perfectly harmless as regards local effects and after symptoms in doses of ten cubic centimeters, administered in a surgićally aseptic manner. This from my OWn experience, and I am assured that it is true of larger and continuous doses. I am reliably informed, however, that in giving continuous and large doses, covering Several days in time, a number of sores and abscesses appear on different parts of the body independent of the points of injection. How- ever, even if this be so and the patient live, the sores must heal up in time, and that is a distinct gain over death by tetanus, one of the most dreadful and agonizing paths to dissolu- tion. My case was as follows: Miss Cora H., aged 21, white, single, light complexion, brown hair, blue eyes, lymphatic temperament, rather pale and anaemic and frail though not in the least emaciated. Pre- vious health record good, save for the exanthe- mata of childhood, from which she made good recovery. Family history good, though singu- larly enough her maternal grandfather died of “lockjaw.” On Wednesday evening she stepped on a nail projecting through an old threshold which a carpenter had left in the hallway after mak- ing repairs. The nail pierced the thin shoe- sole and stocking and entered the flesh of the ball of the left foot just at the root of the third toe. The wound bled slightly and healed perfectly in three days without pain. The nail was rusted very slightly and the poison may have been in the shoe-sole, or it may have been on the nail. Monday evening, five days after the wound was received, I first saw the case. The wound was perfectly healed, the mother saying she had applied salt pork to it the first day. There was no redness, no local tenderness, but there was a perceptible swelling in that part of the plantar surface where the wound was located and around it for a space 2x1 inches. There was a dull aching pain along outer anterior aspect of tibia from ankle to knee. I advised hot antiseptic lotions and steeps to the foot and made a favorable prognosis. The entire family were extremely nervous, and because of her father’s death the girl’s : $º, * *-*. X- ‘. -a < $f º, > ... sº ), * * * mother was so worried as to exert a bad influ. ence over the nervous state of the patient. However, then and afterwards I endeavored conscientiously to separate the semi-hysterical Symptoms of the patient from those of tetanus, and While they pervaded the entire course of the symptoms, I will make no further refer. ence to them and only present such as I "be. lieved were truly tetanic. The following (Tuesday) morning I was notified not to call again as the patient “was all right.” Tuesday evening they came for me again but I was out. Wednesday morning I called and found the patient resting more comfortably, but I was told that on the previous evening she had spas. modic Cramps in the leg. On examination I found the swelling in the foot markedly in- creased and the pain extended up the entire leg to the hip, though there were no spas. modic signs and no soreness or stiffness of the jaws. I opened the foot at the site of the wound freely and swabbed it out with 95 per cent. carbolic acid. I then went to my down-town office and in about an hour and a half the mother tele- phoned me that the patient was rapidly grow- ing worse. I Secured three vials of 10 cubic centi- meters each of Parke, Davis & Co.'s Tetanus Serum and prepared to use it. I found the patient at about eleven o’clock Was indeed Worse. The foot was flexed and inverted. There were occasional slow cramps in the muscles of the thigh with great pain. There was a slight degree of pleurothotonus and the jaws sore and slow in opening, though the patient could still open her mouth and protrude her tongue. I at once gave her an injection of 10 cubic centimeters of the serum into the lower deltoid muscle. Here I took the temperature for the first time and found it 101°. Now I do not wish to seem too enthusias- tic or to be too insistent about the results in this one case, and yet I must say that the re- sult of the injection was most satisfactory in every way. At noon the patient broke out into a pro- fuse sweat. I returned in an hour and the worst feat- ures of the symptoms had already subsided. THE MEDICAL DIAL There was still pain in the leg and some Soreness of the muscles of the side, but the stiffness was gone from the jaws, and tempera- ture normal. In the course of the next forty-eight hours the unfavorable symptoms had all disap. peared, save a slight pain along the tibia, which persisted for some days. I gave no further treatment of any kind except to keep the foot wrapped in antiseptic dressings until it healed again. As I stated in the beginning, there were no untoward effects whatever locally or other- Wise as a result of the injection. . While the position of tetanus serum as a therapeutic agent in tetanus is still sub judice, personally I should feel in any future case that I had neglected a good chance to save life if I failed to use the serum. THE LEGAL RESPONSIBILITY OF TEIE PHYSICIAN IN CERTAIN CASES. By F. F. Casseday, Ph. B., M. D., Minneapolis. To relieve human suffering, the true phy- Sician ever stands ready. Oftentimes at the expense of his own health and purse, but, nev- ertheless, he responds with alacrity to the de- mands made upon his time, strength and skill. This Willingness to respond to the calls of the Suffering frequently makes the physician the object of imposition, and many times places his very life and liberty in jeopardy. A man of generous impulses may allow his sympathy to carry him beyond the limits of personal Safety in his desire to minister to others, and physicians are peculiarly prone to rashness in this regard, apparently losing sight of the duty which they owe themselves, their families and society. Our civilization is complex, and the relation of the physician to society is of the closest and most confidential nature, thus ne- cessitating a well-balanced judgment, and the exercise of the greatest caution on the part of the physician. Happy indeed is the practi- tioner whose skill is tempered with judgment and discretion, and in whom kindly sympathy does not beget rashness. The following cases are in point: I. Some years ago two colored men, S. and Mc., while in a saloon, got into an altercation, and S., who was a hack-driver, proposed to Mc. that they get into S.’s hack, drive out into the country, and fight it out. This they ac- \ cordingly did. During the fight Mc., true to the fighting instincts of the Southern negro, placed his fingers in S.’s right orbit, and at- tempted to gouge the eye out. He succeeded in destroying the eye. I was called in consul- tation, to see S., some days after the fight. The patient was in a pitiable condition, his eyeball being completely disorganized (pan- ophthalmitis), and he was unconscious, with muttering delirium; in short, his condition in- dicated serious involvement of the brain, and speedy dissolution. The family urged the re- moval of the eye. I refused. My reasons were, first, that the disease had progressed so far that removal of the eye would not check the inflammatory process, or save the man’s life; and, second, the man’s assailant was un- der arrest, pending recovery or death. If death occurred after an Operation to remove the eye, an attempt might be made to use this fact to hinder the administration of justice. S. died, and Mc. was convicted of manslaugh- ter in the third or fourth degree, with peniten- tiary sentence. II. Some fifteen years ago, while enjoying my summer vacation at the seashore, I spent a few days with an old friend, a physician, in Philadelphia. One night a sudden call came to my friend, and upon his invitation, I ac- companied him to the house. Upon arrival, we found a woman suffering from peritonitis, superinduced by an abortion. The woman was in an extremely critical condition. insisted she had done the job herself, unaided. Upon my suggestion, the doctor immediately summoned the coroner. It was a dramatic scene. The woman believing herself in the presence of death, solemnly made her ante- mortem statement setting forth the facts as stated above, and the statement was duly witnessed. Now, why was it necessary? Simply as a protection to my friend, and to comply with the law. The Pennsylvania law provides, or did at that time, that any phy- sician called to a case where abortion has been performed, shall immediately summon the coroner. Failing to comply with this law, the physician becomes an accessory after the fact, and the penalty is a term in the penitentiary. I am informed that a bright young physician, and an innocent man, served a prison term for violating this law. Ignorance of the law ex- cuses no man. This tale needs no moral. Railway officials, in their instructions to Ş, THE NAEDICAL DIAL. She trainmen, tell them, “In case of doubt, take the safe side.” This is a good rule in any line of action. III. Some twenty years ago, one of my personal friends and patrons, while working on a store building, was struck by a falling iron girder, carried down four stories to the basement, and pinioned under the wreckage. , I saw him within an hour after the accident. He had sustained a fracture of the skull, and no less than twelve separate and distinct fractures of the arms and legs, many of them being compound. The city police surgeon had applied tourniquets and rubber bandages to stop hemorrhage. Owing to the pressure from the fracture of the skull, the convulsive action was terrific, the efforts of three men being necessary to keep him on the table. To sat- isfy the family that everything possible should be done, I summoned Dr. J., a railroad surgeon, and One of God’s noblemen, who passed to his reward years ago, in consultation. It was apparent to any competent surgeon that noth- . ing could be done which promised any relief. I will never forget his remark in closing the conference. He said, “The man is beyond hu- man aid. An operation would do no good. He will die. If we operate, and he dies, the unthinking public will say we killed him.” We did our duty, and smoothed the patient’s path to the grave. The conditions confronting the physician and surgeon in this country embarrass and fre- quently prevent him from carrying out meas- ures for relief of the sick and injured, which his calm and unbiased judgment tell him are suited to the emergency, yet, if he applies these measures too frequently, he suffers un- just criticism and worse. This being true, he must adapt himself to the conditions as he finds them, always remembering not only the obligations he is under to give the patient the best skill at his command, but, also, the obli- gation he owes himself, his family, and society. A wealthy Russian engineer named Astro- koff, who recently died, left (1,000,000 rubles) $500,000 towards the foundation of a univer- sity for women in Moscow. The university is to comprise a mathematical, a scientific and a medical faculty. The municipal council of Moscow has voted an annual grant of (3,000 rubles) $1,500 to the institution.—Argonaut, July 24, 1899. 313, ; Y 4. *- º ſº # *.x -*. * 4 * y º § & f # '…' 3 * § *...*. 3. 5. x- * 4. gº ºr Tº 4. , * THE MEDICAL DIAL. s 'MoDIFICATIONs OF BOTTINI’S OPERA- º sº i. f (1). The instrument was clumsy, heavy and º; §3. #. * TION FOR FIYPERTROPHY OF THE PROSTATE BY GALVANO— CAUTERY. By Robert Newman, M. D., New York; Ex- President American Electro-Therapeutic As- Sociation, Consulting Surgeon Hackensack Hospital, Hóme in Yonkers; formerly Pro- sector, L. I. College Hospital, etc., etc. Bottini’s operation for the hypertrophied prostate consists in burning a passage through the enlarged gland by galvano-cautery with his instrument. It is more than twenty years since Dr. Bottini devised and practiced his Own Operation. Hypertrophy of the prostate differs from prostatitis in that it is a disease of advanced age, not painful as a rule. The cause is not an inflammation, and the enlargement troubles the patient most as a mechanical obstruction to the bladder, causing disease of the latter organ as cystitis, ureteritis, pyelitis and pyelonephritis. Bottini has reported at different times his successes, but the profession has only recently looked at that operation favorably. The au- thor of the paper has operated with an original Bottini instrument during the years 1882 and 1883, together with the late Dr. Guleke, but objected to different features of the instru- ment. This explains the incorrect statement of recent reports, that the Bottini operation has never been performed in this country until 1897. Not having had the expected result with Bottini’s instrument, Dr. Newman con- structed his galvano-cautery sound for the treatment of the hypertrophide prostate. His paper describing this instrument was pub- lished in the Journal of the American Medical Association August 28th, 1886. Then the in- strument was improved, and exhibited at the meeting of the International Medical Congress on September 8th, 1887, in Washington, D. C. The paper was published in the Transactions of the International Medical Congress and also in the New England Medical Monthly, December, 1887. The objections to Bottini’s operation were then : * Original abstract of a paper read at meeting of Am- erican Fiectro-Therapeutic Association, Washington, D. C., Sept. 19-21, 1899. unhandy. \ (2) The platinum burner was so thick that it got hot too slowly, and, when hot, lost its shape by bending, so that sometimes it would not move back into its beak. (3) The very large storage battery was too heavy for transportation, and a smaller instrument did not generate enough heat. (4) The instrument was very difficult to be introduced, and if the obstruction exceeded a certain size, was unintroducible. (5) The result of this operation was un- Certain. (6) The patient had to remain in bed for Weeks. (7) The operation was not free from differ- ent dangers and accidents. Other objections were made by Professor Bydygier in Wiener • Klinische Wochenschrift, January 5th, 1899. For those reasons the Galvano-Cautery Sound was devised and its utility proven by the report of cases. Its use is indicated in all cases of enlarged prostate, where urgent ne- cessity for immediate relief does not exist, and it is desirable to keep the patient perambulant. Some of the objections of Bottini’s old in- strument have been removed by modification made by Dr. Freudenberg, in regard to shape, handiness and electro-technical construction, and he added a cooling apparatus. In lieu of the platinum blade platino-irid- ium is used. The operation as modified by Freudenberg has lately become a favorite one with the profession. The writer of the paper, however, thinks that more improvements should be made, and suggests the following: (1) Omitting the water cooler, in order to make the mechanism of the instrument more simple. It has been questioned if it is better to dilate the bladder with water or air; each has advantages and objections, but it is better to prevent the heat than to injure the bladder, which may be accomplished by (2) The two conductors conveying the heat, each attached to either end of the burner, and each separately run and being insulated. This arrangement would heat the burner, and prevent the heating of other parts of the in- strument. (3) The end of the instrument conical and of a smaller size in order to pass the obstruc- tion and enter the bladder more easily. (4) A tunnel at the end for a filiform THE MEDICAL DIAL. 315 * guide, over which the instrument passes, to be used at the option of the operator. (5) The burner of platino-iridium smaller and stationary. * (6) Protector of burner to move, acting as a meter. (7) An endoscope would be desirable in order to observe the result of the operation. Messrs. George Tiemann & Co., New York, have made the new instrument with the alter- ations suggested, except the addition of the endoscope which was exhibited to the asso- ciation. * TEIE DIFFERENTIAL DIA GNOSIS OF SMALL POX, CHICKEN POX AND MEASLES. By G. R. Curran, M. D., Worthington, Minn. Diagnosing Small pox during an epidemic may be an easy matter. Given a case of vari- oloid, when there is no history of an exposure, or when there is no knowledge of any other case in the vicinity, it will tax the judgment of the best diagnostician. Small pox has broken out in our state, and, if we can read the signs of the times, it will not be stamped out until it becomes epidemic. Many physicians have never treated small pox; therefore, it is high time for us to familiarize Ourselves with the diseases with which it is often confounded. Measles is one of the diseases which is often confounded with small pox. In measles, the fever seldom reaches 102° F., but a case of the same severity of small pox will have a tem- perature of from 104° to 107° F. The eruption is muscular in measles and papular in small pox. The color of the eruption is a brighter red in small pox than in measles. The first signs of the eruption in small pox appear on the forehead on the second or third day; those of measles also appear on the forehead, but on the third or fourth day of the disease. The initial temperature in measles falls to normal at the end of the first day, to quickly rise, and does not fall again until the eruption is fully established. There is no prodromal fever in small pox, but, when the eruption is fully de- veloped, it falls to about normal, to rise again in the pustular stage. There is cough, coryza * Read before the South Western Minnesota Medical So- Ciety. * - - and photophobia in measles. None of these symptoms are prominent in the first stages of Small pox. As a rule, the early stages of Small pox are confounded with measles. There is greater confusion in differentiating between small pox and chicken pox. Mild cas. es of Small pox are frequently mistaken for chicken pox in the latter stages. The vesicles of Small pox are situated upon a papular base. This base describes a circle. The vesicle has no elevated base in chicken pox, and the form is more likely to be oval than circular; and in the early stages the spots disappear on pres- Sure, While those in the other disease do not. In the more fatal malady the vesicle is first pointed, then rounded, and, lastly, umbilicat. ed; while in the milder disease it maintains the rounded form only. In small pox the mu- cous membrane is involved, and the vesicles can be plainly seen in the throat, while in 'chicken pox this membrane is not involved at all; and in the former there is only one cavity in the vesicle which is hard to rupture, where- as in the latter it is separated into many cavi- ties, and is easily torn open. In variola the vesicle is situated in the true skin and leaves its characteristic scar, but in varicella the vesicle is located between the true skin and the epidermis and seldom leaves a scar. The "scab in small pox does not disintegrate, but falls off in mass; in chicken pox the scab grad- ually disappears in scales. Small pox has but one crop of vesicles, which follow an exact order in evolution; in chicken pox there may be several crops of vesicles, and they follow no exact order of development. It takes about twenty days for all the stages to be com- pleted in variola, but an ordinary case of vari- cella lasts but eight days; the former causes grave systemic disturbances, and is often fatal, while the latter makes little or no trouble, and is never fatal without complications. Small pox will go through a whole family, taking the oldest as well as the youngest; chicken pox is confined to only the younger members. Summing up, then, we have the following striking symptoms of the three diseases: I. Small Pox.—Headache, backache, vom- iting and fever. II. Measles.—Fever, coryza, photophobia and cough. III. Chicken Pox.—All symptoms slight, and aside from the inconvenience of the wesi- cles, the indisposition, mild. 316 THE NAEDICAL DIAL. *THE PATHOGENESIS OF FUNCTIONAL NERVOUS DISEASES AND THEIR PROPEIYLACTIC INDICATIONS. Dr. John Punton, M. D., Kansas City, Mo. Among other things the author said: “All authorities agree that heredity plays the chief role in the pathogeny of nervous diseases, con- sequently its study becomes of the highest im- portance. That a certain predisposition, or tendency to nervous disease, is transmitted from parent to child, all agree, and, in its in- cipient essence constitutes the nervous dia: thesis or constitution. This manifests itself by nervous irritability and defective inerva- tion of the organic functions, materially in- fluencing the normal development of the nery. ous system in the offspring, and makes itself felt by a constant tendency to degenerative changes in the nerve elements, rendering the subjects of it peculiarly liable to break down under stress of circumstances that would not affect another person inheriting a different constitution. “These abnormal conditions of inheritance. are largely the result of injudicious and un- physiologic modes of life of the parent, which, in their essence produce lesion of nutrition by contaminating the blood, producing metabolic changes in its constituents that materially in- fluence and lessen its vitalizing power of the nerve centers. What these special changes are—histologic, chemic, electric, toxic, or otherwise—may at present be difficult to satis- factorily explain, but, we all understand their effects on the somatic organism, and enough evidence can be produced to warrant the as- sumption that they underlie and form the ba- sis of the neurotic diathesis. This then be- comes one of the mightiest factors in the path- ogenesis of nervous affections, and experience warrants the assertion that it is purely a phys- ical defect, a lesion of nutrition, which can be remedied and even cured, and loses half its horror when this is fully realized and under- stood. This morbid inheritance that under- lies the so-called nervous constitution is not, therefore, a necessarily fatal heir-loom (cer- tain at some time or Other to Overwhelm its victim, as erronously supposed) but is subject, like all other impoverished blood states, to the laws and principles which govern the science of prophylaxis and therapeusis, and the im- portance of this fact cannot well afford to be slighted by the family physician in his dealing with children born of neurotic parentage. “In thus recognizing the blood as the nox- ious agent in the pathogeny of the various neuroses, it cannot be denied that environ- ment, education, occupation, habits, marriage, * Original abstract from a paper read at the meeting of the Mississippi Valley Medical Association, held in Chicago, October 3 to 6, 1899. physiologic crises, and general careers in life, are powerful adjuvants in favoring and pro- moting pathologic changes in the blood, which not only exaggerate the pernicious effects of the morbid inheritance, but react upon the nervous system in such a manner as to produce actual disease. But all such agents are usu- ally secondary to the primary cause, for it must be confessod that even in the acquired neuroses, much less the congenital, such fac- tors spend their force first upon the blood and its circulating medium, which again reacts. upon the nervous constitution of the individ- ual. That the blood is the chief factor in the production of the various functional neuroses is something more than a theory can be firmly supported by a four-fold proof: “1st. By analysis of the family history. “2nd. By actual demonstration in the pathologic laboratory. “3d. By clinical observation and experi- €Il Cé. “4th. By actual results in their treatment. “All authorities agree that the vast ma- jority of the functional neuroses are engrafted upon a neurotic constitution, which may be congenital or acquired, and it is known that it can be produced by changes in the blood in- cident to the causes already referred to. Re- cent experiment with human blood in the pathologic laboratory go to prove that in cer- tain forms of nervous disease the erythrocytes of the blood disintegrate, while the platelets undergo an abnormal multiplication in path- ologic changes that can easily be demon- strated, and, that these morbid products circu- lating in the blood have a very pernicious in- fluence on the elements favoring the produc- tion of neurotic disorders. Those of us who are brought in contact with the various forms of nervous disease cannot fail to be impressed with the large number of neurotics who pre- sent undoubted clinical evidence of malnutri- tion and impoverished blood states, which, in itself, suggests at least the blood as the chief pathogenic factor. Moreover, when the nutri- tion of such patients undergoes improvement by scientific methods of therapeutics and diet- ing, the nervous phenomena invariably give evidence of partial if not complete restoration. Even in those cases where the clinical evidence is not so apparent, the use of remedies that nourish the nerve elements and sustain their functional integrity is invariably rewarded by changes for the better. If, therefore, it can be demonstrated by reference to a large number of family histories that the great majority of the neuroses are based upon an inherited or acquired predisposition or neurotic constitu- tion, and that this again is recognized in the laboratory as a lesion of nutrition or change in the constituents of the blood, which receives further support, clinically, by the large num- ber of neurotics suffering from malnutrition, THE 317 NWEDICAL DIAL. and, that when these conditions are remedied, the nervous phenomena improve and often ºils. appear, it would suggest at least the validity of the argument set forth that the blood is largely the responsible pathogenic factor in the production of the various functional neu- I’OSCS. “The medical aspect of sociology as em- bodied in the clinical study of heredity, en- vironment, education, criminology, inte, per- ance, marriage, and the special relation these bear to the pathogenesis of nervous affections, should certainly claim our most earnest atten- tion. In poverty-stricken districts, where the parents are too poor to provide the necessary means to guard against the inevitable result of transmitted taints, or other injurious in- fluences, it is our business to appeal to the state legislature to make the necessary pro- vision for their proper care and protection. That we, as a profession, are not sufficiently engrossed with the all-important problems of prevention, as presented by our present soci- ologic studies, is clear to all, for, in the light of facts how can we sanction by our woeful indif- ference the continued abuse of certain influ- ences, which, by their very nature, tend to generate or develop a serious chronic neurot- ic invalidism that is well nigh incurable? The duty of every physician, who deals with his profession as a noble and humane science, is, rather to point out the methods of pre- venting occurrence of actual disease in la- tent constitutional defects or other vulner- able weakness, rather than confine his sole attention to the treatment of their more mature and active manifestations. The re- sponsibility of the medical profession in rela- tion to the coming manhood and womanhood of our race is too lightly regarded, and not until we as a unit arise from our lethargic in- difference, and deal positively with the med- ical sociologic problems that confront us in a more practical manner, can we ever hope to stem the ever increasing tide of neurotic dis- ease, and thus fulfill the true function of our mission as guardians and conservators of pub- lic health.” According to the Lancet for June 24th, the remains of Mr. Lawson Tait were cremated at Anfield, Lancashire, and the ashes removed in an urn to be deposited, in accordance with his testamentary wishes, in Gogarth’s Cave, an ancient Welsh burial ground at Llandudno, Wales. According to the Buffalo Medical Journal for July, George H. Kinter and James C. Saunders were recently committed for trial be- fore a United States jury on a charge of man- slaughter in the case of Rolfe Saunders, who died while under their care without medical aid being sought. *“TECHNIC OF ABDOMINAL HYSTEREC– TOMY.” By J. H. Carstens, M. D., Detroit, Mich. The usual careful aseptic preparations. The patient in Trendelenburg's position. Af- ter freeing adhesions, the uterus and growth is pulled out of the abdominal cavity with the aid of a cork screw. The intestines are kept in place by abdominal towels. Clamps placed on each broad ligament outside of the ovary. The broad ligament is cut one-quarter inch from the clamps down as far as the latter extend. f A cut across the uterus anteriorly from the point of one clamp to the other through the peritoneum and separation of the bladder from the uterus. Another pair of forceps are now placed on the broad ligament, down to the cervix and the balance of the broad ligament cut to the point of the clamps. The slight at- tachment to the vagina and anteriorly is now easily separated and the growth and uterus re- moved. We now have four clamps, two containing each ovarian artery and two containing the uterine arteries. Each artery is now separate- ly ligated with dry sterilized cat-gut. If the arteries of the round ligament are large as they sometimes are, they also require a liga- ture. The clamps are removed and the stumps and raw surfaces carefully covered with peri- toneum by a running suture of dry sterilized Cat-gut. If the cervix is removed a small open- ing is left for a temporary drain. If the cer- vix is left in no drainage is used except in septic cases when a puncture in the posterior cul-de-sac is made use of for a rubber drain. His conclusions are as follows: First. In abdominal hysterectomy, clamp. the broad ligaments and remove the growth and uterus. Second. Ligate the four blood vessels sep- arately. Third. Carefully cover all raw surfaces with peritoneum. Fourth. In cases without tears and healthy mucous membrane, leave in the cer- WIX. Fifth. Any diseased condition of the cer- vix and malignant growth perform total hys- terectomy. Dr. Mounier relates in France Noire that the natives of the French Soudan take rectal injections daily, the syringe a calabash with a pointed tip. The subject lies on his belly across the lap of a friend, who inserts the tip and blows into a small hole on top. The friend then takes his turn across the other’s lap. * Resume of paper read at the meeting of the Ameri. can Association of Obstetricians and Gynecologists, at In- dianapolis, September 19, 20 and 21, 1899. § * * ~< º & # § s: -5. * * * § #º * * $º. * > § 3: tºº. §§ ** ğ, r. * gº ºf8. ~ * *.x. 3. **, & * .. * *: * * *TWO CASES OF DYSTOCIA DUE TO VEN- TROFIXATION, ONE REQUIRING CAESARIAN SECTION. By Xavier C. Werder, M. D., Pittsburg, Penn. Dr. X. C. Werder, of Pittsburg, re- ported five cases of firm ventrofixation fol- lowed by delivery at term. In two cases dys- tocía followed this operation done for com- plete prolapse of the uterus with inversion of the vagina. One case terminated spontane- ously, the other required Caesarian section. he former case had been operated upon by imself, the latter by another surgeon. In both cases a series of operations was done at one sitting, including curettement, amputation of cervix, anterior colporrhaphy, ventrofixa- tion and perineorrhaphy. very firm fixation of fundus and posterior wall of uterus to abdominal wall was made in order to be sure of relieving prolapse. In the other case infection is said to have been the cause of broad attachment and firm fixation. He excludes from discussion other proced- ures intended to hold the uterus in anterior po- sition and defines the limits of ventrofixation as follows: It is the operation of preference in cases of complete prolapse of the pelvic organs, and in cases in which a very large heavy uterus, due to chronic metritis, is habitually retroverted or retroflexed and causes pronounced symp- toms. In these cases he thinks less rigid fixa- tion is ineffective. The fixation should be be- tween the anterior uterine wall; not the fun- dus or posterior wall; and lower angle of Wound. He attributes the serious after results to errors in technique rather than to the pro- cedure itself. Guerrant reports the case of primipara at full term who gave birth to a child with con- genital absence of both eyes. There was no trace of globe in either orbit. The orbital fissures were about one-fourth inch in length. There was no orbital enormity, and the fore- head was not high. In other ways the child was normally developed. The Medical Age for June 25 says, with reference to a case from the Archiv fur Laryn. golgie, ix, 1, 1899, of a woman who had applied for laryngolgic treatment, in whom Berthold noticed that the vocal cords had the appear- ance found only in the male adult, that the individual was a hermaphrodite, who eight years later returned for a certificate to allow the change of sex, having fallen in love with a WOIO & IT. THE MEDICAL DIAL. } In his Own case . *REPORT OF A CASE OF COMPLETE EIERNIA OF THE PREGINANT UTERUS. By W. V. Anderson, M. D., Toledo, Ohio. I present this report because the case is unique, so far as I have any knowledge: On the evening of March 9, 1894, I was called in consultation by Dr. Arne Zetlitz of our city, now of Sioux Falls, S. D. I found him in charge of a large well developed Polish woman, the mother of ten children. She had been in labor for 36 hours under the care of a midwife, before Dr. Zetlitz was called. We found upon examination that the abdominal muscles had been separated to such an extent that the uterus had passed out between the recti carrying the aponeurosis in front of it,' and now hung like a great pear suspended by its cervical attachments, the fundus reaching nearly to the knees. The uterus was freely movable and the os was found to be fully di- lated. The uterine contractions were good, Considering the length of time the woman had been in labor; but the position of the uterus rendered them ineffective; for at each con- traction of the uterus the patient would make vigorous effort to help herself, and though the uterus would rise until its long diameter stood at a right angle to the body, yet contraction and shortening of the abdominal muscles in- Stead of assisting delivery, acted somewhat as a draw-string at the mouth of a pouch, so that the greater the voluntary effort, the more it in- terfered with expulsion. We placed her under chloroform, and after inverting the uterus and having it steadied by an assistant, while Dr. Zetlitz attended to the anaesthetic, I applied forceps (the head pre- Senting O. L. A.) and delivered without dif- ficulty, a girl weighing 7 or 8 pounds. The birth canal was ample, and there was abso- lutely no cause of dystocia but the herniated uterus and consequent prohibitory effect of the Contractions of the abdominal muscles. We learn from the Journal of the American Medical Association for July 1 that the faith healer under whose treatment Dora Kraray, a child of Brooklyn, suffered from gangrene of the foot, making amputation necessary, has been sentenced to five years’ imprisonment. Fein, in old suppuration of the antrum, uses powdered nitrate of silver, which he ap- plies with a blower, designed to eject it in a fine cloud and cover the whole surface with a thin layer. A slight burning sensation fol. lows. The discharge diminishes and other Symptoms improvo. * Original abstract of a paper read at the meeting of the American Association of Obstetricians and Gynecologists held in Indianapolis, Sept. 19, 20 and 21, 1899. * Original abstract of a paper read at the mooting of the Mississippi Valley Medical Association held in Chicago, Oc- tober 3 to 6, 1899. THE MEDICAL DIAL. 319 MONSTRO US OBESITY. The illustrations shown here with are those of a strange case on the continent of Europe, shown in the August number of the Medical Review, London, from La Salpêtrière, May and June, page 216. The woman's age is 47, a wine-seller. Her father died at 61 from strangulation of a large umbilical hernia, and weighed 460 pounds. Her mother was not stout. An only sister died of phthisis at the age of 26, and one broth- er died at 19, probably from the same cause. Neither of the latter were abnormally stout. This woman was well formed and agile from the age of 12 to 16. At 15 she took a cold-foot bath during menstruation, when the flow was suspended for eleven months. At 16 has not extended to the face or superior part of the trunk, and apart from the two masses at- tached to the arms, it is the sub-diaphragmatic part of the body that is especially affected. The lower limbs present the appearance of elephantiasis, but, the writer says, they are not affected with that disease. Dr. Plan pro- posed to excise the most troublesome masses, but the woman declined to submit to the op- erations. - It is said that a London medical society has reserved a number of meetings in each year which will be devoted to a recital of unfavor- able cases and to a confession of errors in diag- nosis and treatment fallen into by members of the society. menstruation was very irregular, occurring only four or five times a year, and her weight at that time was 198 pounds. She married at 17. At 24 she weighed 242 pounds, and be: came pregnant for the first time, and the child is now a well-formed girl weighing 165 pounds. At 25 a boy was born, who three years ago was the largest conscript in France, weighing 330 pounds, and measuring fifty-nine inches around the waist and five feet and eight and one-half inches in height. An umbilical her- nia appeared during the latter months of the second pregnancy. Five years ago she weighed 495 pounds, but now weighs only 396 pounds. Her general health is good, but walking is difficult. In commenting on the case the Review says that heredity is evident both in the preceding and the succeeding generation. Probably the dark and confined habitation occupied in her early life, for her parents lived in a dark, ill- ventilated shop, increased the tendency to adi- pose tissue. It is noted that the hypertrophy Above cuts Reproduced from the Medical Review (London), originally in La Nouvelle Iconographie de la Salpêtrière. FORMALDEHYDE FOR CONSUMETION. Inhalation once or twice daily of com- pressed air made to bubble through a six per cent solution of formaldehyde will, it is said, benefit consumptives in any stage, the British Medical Journal says. Together with this treatment should be given two tablets of phag- ocytosin after each meal and at bed-time to create red blood corpuscles, and an improve- ment in the case will be seen in a week as a rule. New red blood corpuscles will be cre- ated, the appetite improved, cough and ex- pectoration will be lessened, night sweats sub- dued, and the patient, if not too far advanced, will be placed in a better position to regain health than by any other known treatment- Medical Examiner. Syphilis is said to be the most common dis. ease in Brazil, but malaria is by far the most prevalent in the Strait Settlements. - |- | THE NAEDICAL, DIAL. THE MEDICAL DIAL A Monthly Record of Medicine and Surgery. (Entered at Post Office at Minneapolis as Second Class Matter.) Issued on the First of every Month at Minneapolis, Minn. Editor, J. W. MACDONALD, M. D., F. R. C. S. E. * Associate Editor, C. K. BARTLETT, M. D. Business Manager, E. E. GRISWOLD. . . . . COLLABORATORS.... A. W. ABBOTT, M. D. W. A. HALL, M. D. # P. BARBER, M. D. G. D. HEAD, B. S., M. D. . O. BEARD, M. D. KNUT HOEGH, M. D. J. W. BELL, M. D. C. H. HuntER, A. M., M. D. A. B. CATES, A. M., M. D. W. A. JONES, M. D. J. FRANK Corbett, M, D. J. H. RISHMILLER, M. D. R. E. CUTTS, B. S., M. D. J. D. SIMPson, M. D. # H. DUNN, M. D. J. H. STUART, A. M., M. D. . A. DUNSMOOR, M. D. H. B. SweetSER, M. D. David Owen THOMAS, M. D., M. R. C. S. The publishers will not be responsible, under any circumstances, for the opinions expressed or statements made by correspondents. Contributors will be furnished, gratis, with sample copies contain- ing their articles, under an agreement to distribute at once to physicians in actual practice. To avoid duplication, publishers should be informed of the field to be covered. Reprints, giving The Medical Dial full credit, may be obtained at actual cost. No notice can be taken of anonymous contributions. The name (not necessarily for publication) must accompany every communi- cation to this journal. No advertisement will be changed in any issue unless notice be received by the 25th of the previous month. Annual Subscription, in advance, - &- *º- Single Copies, * Sº º ºs º º ºs Advertising Rates made known on application. $1.00 .10 ADDRESS ALL COMMUNICATIONS TO THE MEDICAL DIAL, MINNEAPOLIS, MINN. MASONIC TEMPLE. OCTOBER, 1899. SOME THOUGHTS ABOUT WACCINATION. In England and partly in this country, there is a good deal more opposition to vaccina- tion than in Germany and the northern Euro- pean states. As vaccination is compulsory in the last named countries, and as people usually do not like compulsory measures, it is some- What curious that vaccination is quite popular among them, while there is a strong agitation against it in England, and partly in America. Among the detractors of vaccination we find such names as that of Robert Wallace, the celebrated naturalist who became famous by anticipating Darwin’s evolution theory, and was the immediate cause of Darwin's publish- ing his natural philosophy. Mr. Wallace claims that vaccination is use- less and he seems to prove it by statistics, and yet we can hardly believe it. It seems that there must be a vast number of physicians, whose own personal experience proves its pro- tective influence; the bacteriologists and pa- thologists seem to be unanimous in their belief in it, and its action and effect seem to corres- pond so well with what we otherwise know about immunity, that there must be some other explanation of the poor results claimed by the anti-vaccinationists, and Mr. Wallace in par- ticular. In examining a large number of patients, I have been struck with the difference in the ap- pearance of the scars of a majority of English and Americans and of those on Germans and Scandinavians. By baring the arm of a person of foreign parentage, I can, as a rule, see whether he was vaccinated on the continent of Europe or in this country. In the first place, foreigners have several scars, usually three or more; while one scar is the rule here. Then the scars from foreign vaccination are small, consisting of minute dots of scar tissue, while the American scars are much larger and usu- ally show one smooth surface, evidently the result of a considerable loss of substance by ulceration. What I have seen of English Scars has reminded me of those produced in this country. Might there not be something in the method of vaccination pursued in various countries that might explain its popularity in One, as well as the opposition to it in others? In the first place, it is probable that a high- er degree of immunity is conferred by inoculat- ing several pustules than by confining oneself to one. In the second place, the use of fluid lymph secures a more uniform result than that of dried lymph, which, under no circumstances, can be mono-microbic. In the third place the method of inoculation advised in the printed di- rections in this country must expose the pa- tient to deuteropathic infection—for the scarf skin is either to be scraped off, or numerous small scarifications are advised. It is clear that in this way the numerous microbes that particularly nest in the hair follicles, the se- baceous and sudoriferous ducts get a chance to contaminate the little wound. Therefrom there is a homologous and polymicrobic infec- tion. This leads, therefore, to a considerable ulceration, followed by ugly scars; worse than this would it be if such a polymicrobic infection should have an attenuating effect upon the virus of vaccination. Nobody knows if this is so, but analogies from the bacteriological lab- oratory indicate that it may be so, and we have no right to put the effect of our operation in jeopardy by a defective method. The practical deductions I draw from these considerations are: (1) Only sterile lymph in capillaries should be used; (2) at least three pustules should be produced; (3) the inocula- tion should be made by inserting a minute quantity of the lymph on the point of a fine steel lancet in a little pocket or fold under the skin, almost in the same way as a hypodermic needle is introduced, but less deeply, only un- der the epidermis, and not to the corium; the * ' s & lancet or needle should not be introduced over One-eighth of an inch. In view of the return of our soldiers from the war, we may be prepared for smallpox epi- demics, and the above remarks are chiefly made to bring this important subject under discussion. BCNUT HOEGH. DEMISE OF GEORGE A. HENDRICKS, M. D. The medical profession has suffered a great loss in the death of Dr. George A. Hendricks, professor of anatomy in the medical depart- ment of the University of Minnesota. Dr. Hendricks died at St. Barnabas hospital, this city, at 8:35, Sunday evening, September 24th, from acute Bright’s disease. He had been afflicted with this malady for the past five years, but he was able to perform the ar- duous duties devolving upon him in connec- tion with his position at the University, and at the same time, to attend to his private practice, until the day previous to his death. Saturday morning he complained of the old “heavy” feeling, Sunday morning he became unconscious, and was removed from his home to the hospital, where he gradually sank to a comatose condition, although un- der the careful and close attention of sever- al of his faithful colleagues who did all they could to restore him to consciousness, until his last moment. Drs. G. G. Eitel, F. R. Wright and Charles Erdman were the attend- ing physicians. `" The deceased was known for his great per- sonal magnetism, and was popular at the University and among the profession. He was a leading physician, but his life work may be said to be the building up of an unique system of teaching anatomy, which he introduced in our University. He was recognized as one of the leading, if not the leading teacher of anat- omy in the country. For all these reasons his loss is greatly felt among the faculty and la- mented in the profession at large. The following brief sketch of his life, the substance of which appeared in the daily Times, will be found interesting: Dr. Hendricks was in his fiftieth year, having been born near Gettysburg, Pa., July 17, 1850. He was of Scotch descent On his father's Side and Scotch-Irish on his mother's, with an admixture of early Pennsylvania Dutch. His mother belongs to the Donavin family of Delaware, Ohio. He was the youngest of a family of three children. His brother, William Hendricks, the only one living at the present time, is editor of the Hummilstown Gazette of Hum- milstown, Pa. Beside this brother Dr. Hendricks leaves a wife, who was on the ocean on her way to Honolulu at the time of the death of her husband, and a mother, who is in Hummilstown. Dr. Hendricks was for a short time in his early life connected with his father's mercantile business as buyer; he graduated at a normal School and One of the Smaller colleges in Pennsylvania; studied for a year with a prominent physician near Philadelphia, THE NAEDICAL DIAL. and at twenty entered the medical school at Ann Arbor, taking his course in anatomy under the fa- mous Dr. Corydon Ford, becoming his assistant be- fore graduation, and continuing his work as assist. ant professor of anatomy for fifteen years after graduation, holding at the same time the chair of ºant professor of Surgery under Dr. Donald Mc- £LIlé. In 1889 he was called to the chair of professor of anatomy in the University of Minnesota, which he has held ever since. The department, which is ac- knowledged throughout the country to be one of the best in the United States, owes its entire existence to Dr. Hendricks. When he entered the department there was little material to work With, and the grad- ed Course in anatomy which Dr. Hendricks created, first in Michigan and afterward here in Minnesota, has been copied by all the prominent departments Of anatomy in the country. . Eight years ago Dr. Hendricks married Miss Ma- re D. Patterson, daughter of a Wealthy New York railroad man. They spent their summers in travel- ing, Mrs. Hendricks traveling also in Winter, till she had seen most of the civilized world. Three years ago they took up their permanent residence in Minne- apolis. And last Winter they visited the Hawaiian Islands, Where Mrs. Hendricks has built a handsome residence, where they eventually intended Spending the Severe months of the year and the rest of the time in Minneapolis. Mrs. Hendricks is now on her Way to Superintend the finishing of the new home. “REMARKABLE CURE FOR INSANITY.” A dispatch appeared in the secular press a few days ago, dated from Joliet, Illinois, With the above caption. It read as follows: “Irwin Fuller Bush, of this city, was sent to Kankakee asylum last March pronounced hopelessly insane. Yesterday, through treat- ment with lymph from glands of goats, Bush is home with his family, completely restored in mind and body, “The lymph was discovered by Dr. Roberts, an obscure physician of Green City, Mo. Its application for insane cases was demonstrated at a Chicago laboratory where Bush was taken last June. He was subjected to injections of the lymph, showing steady improvement until he was discharged last Tuesday, cured. The treatment is said to also arrest sensibility. “Roberts has gone to Europe to lay his discovery before Prof. Koch, of Berlin, and other foreign scientists, with a view of having them adopt it in insane asylums there.” CONUNDRUM. If neither common sense nor abundance of ridicule, a decent regard for general appear. ance, the approval of all male friends, the great peril of disease, the wanton waste of good clothing—if all these facts and argu- ments Will not prevail to shorten the skirts of Women while walking on the filthy streets, What power will persuade them to abandon the office of street sweeping? Give it up. It would be well for physicians to instruct their patients, who see black and red spots be: fore them, to quit playing poker. º: ****, **k sº ... * *, '1. *ś , **** §§§ * + *''', *A & # # * i * † *:::. *. * * *. '', 322 *...*&#: i zºº.º. * { rºx #. • * , a- t proSress oſ II?&dicine. OBSTETRICS. UNDER THE CHARGE OF A. B. CATES, A. M., M. D. R. E. CUTTS, B. S., M. D. º: THE OPERATIVE TREATMENT OF LA— BOR COMPLICATED BY PELVIC DEFORMITIES. (August Obstetrics.) Based upon a critical review of the first thousand patients delivered in the obstetrical department of the Johns Hopkins Hospital By George W. Dobbin. The conclusions arrived at are as follows: 1. In 131 cases of contracted pelves there was necessity for operative delivery 46 times, 35.11 per cent. © tº 2. The pelves most frequently requiring operation are the rachitic and irregular forms. The generally contracted pelvis, though very common in the negro race, is comparatively rarely sufficiently deformed to seriously ob- struct labor. 3. Pelves, in which the degree of contraC- tion is slight, and those in which the contrac- tion is very marked, are the easiest for treat- ment, as in both cases the indications are defi- nite, and should give the operator little trouble in deciding upon the treatment to be pursued. 4. On the other hand the pelves possessing a medium degree of contraction are the most perplexing, and call for the exercise of the greater skill and judgment. When proper ap- pliances are at hand, such cases are best treat- ed by tentative application of forceps, and this failing, immediate Caesarean section. 5. In general, forceps give a lower fetal mortality than version, but version done as a primary operation on a moveable head, in a slightly contracted pelvis, is a safer operation for the child than a difficult high forceps oper- ation. 6. Except in very exceptional cases, sym- physiotomy is not to be compared with Caesar- ean section, for the former operation, besides causing greater injury to the mother, is always an uncertain procedure. 7. Operations on contracted pelves are rarely uncomplicated. Among the commonest accidents may be mentioned premature rup- ture of the membranes and prolapse of the umbilical cord. 8. The only rational and scientific method of obtaining “corrected morbidity” statistics is by the bacteriological examination of the uterine lochia. for only in this way can we say definitely which infections are the result of operation. R. E. C. f * # THE MEDICAL DIAL. * NOTES ON THE INDUCTION OF PREMA- TURE LABOR. * * (By Henry C. Coe, M. D., New York. Rea at a meeting of the Harvard Medical Society, May 27, 1899.) There is such an apparent unanimity of opinion with regard to the technic of this operation that it would seem to admit of no argument. Students are led to infer from lec- tures and text-books that to excite artificial uterine contractions is easy and simple, while in actual practice they are surprised and dis- appointed at their inability to accomplish the desired result. Several cases are reported of operations upon and rough handling of the pregnant uterus without causing abortion. . Marked dilatation of the cervix for obstinate vomiting rarely causes but slight and tran- Sient uterine contractions. A recent text-book on obstetrics advocates the introduction of a bougie. This is consid- ered more or less uncertain and there is also considerable risk of rupturing the membranes, even in the hands of an expert. Preference is given to the method of dilat- ing the cervix and exciting uterine contrac- tions by means of the gauze tamponade within the uterus with or without the subsequent in- troduction of rubber bags. Cases are reported in which uterine action could not be brought about even by this method, and manual dilata- tion had to be resorted to. Where time per- mits, packing should always precede manual dilatation, since the packing softens the cervix and makes the further dilatation much more readily and effectively accomplished. It is rarely necessary to give an anaesthetic in order to introduce the gauze or bags. It would seem unnecessary to add that rigid asep- sis is indispensable in all these manipulations. R. E. C. PEDIATRICS. UNDER THE CHARGE OF H. B. SWEETSER, M. D. J. P. BARBER, M. D LARYNGOSPASM, ECLAMPSIA AND TETANY IN CEIILDREN. Professor Adolph Baginsky, in a classical clinical lecture (International Clinics, April, 1899) showed the connection of these three conditions, or symptoms, with one another, and also with rachitis. Almost without excep- tion laryngospasm develops in rickety chil- dren. In rare cases it may depend on some chronic cerebral trouble, as hydrocephalus, or cerebral intoxication from the presence of tox- ines of acute infectious ſevers. On the ground- work of a rachitis develops by preference the unstable nervous equilibrium which is upset by the slightest unusual irritation and leads to , \ *º THE NAEDICAL DIAL. . this characteristic nervous explosion in the delicate nerves of the larynx which constitutes laryngospasm. One of the four children which he present- ed had a mild attack during the clinic which he describes as follows: “There is a prelimi- nary stage of uneasy crying, almost moaning or whining; then a catch of the breath; then several catchy, cog-wheel respirations in suc- cession, while in the larynx a tone is produced that is high-pitched, crowing in character, whence the name stridulous; then the breath- ing stops completely for an instant and the child remains absolutely motionless; then fol- lows a deep, loud, long-drawn-out inspiration, and the child recovers as if from fright, to cry for some time, and after a while be completely itself again. “In severer cases the clinical picture of the affection is much more alarming. The cog- wheel respiration is followed by complete ces- sation of breathing. The mouth remains open, the alac nosi are drawn in, the facial muscles are in cramp-like contraction, the eyeballs start from their sockets, the look becomes an absolute glassy stare, the face gets red, becom- ing gradually darker and finally deeply cyanet- ic. The extremities, especially the upper ones, show spasmodic tremors. Then the pulse stops for a time and the child is unconscious, the cyanosis gives way to intense paleness, and the child sinks back into its mother’s arms as if dead, all vital functions in abeyance. “One such an attack is apt to follow a se- ries of general convulsions, which may last on- ~ ly for a few minutes, after which the child may appear almost perfectly well, as if nothing were the matter. Sometimes, however, every effort to restore the respiration is in vain, and the children die, despite every medical help possible. Taryngospasm is, in fact, the most frequent cause of sudden death in children.” One of the children was in a state of eclampsia following a severe attack, and after demonstrating the condition, he proceeded to show the connection between the two states. The connection between extremely mild at- tacks of laryngospasm and eclampsia is be- trayed by the gradation observed in the at- tacks themselves. It is not difficult to under- stand that a very severe local spasm might, by the reflexes awakened, go over into a series of general spasms. He thinks that laryngospasm by producing brain anaemia leads to eclamp- sia. He mentions Kussmal and Tenner's exper- iments showing that brain anaemia will in ani- mals cause convulsions. In laryngospasm as a result of the cessation of breathing there is an intense congestion of the lungs. The work thrown on the heart is sometimes so great that for a moment it stops entirely. This pro- duces great congestion of the brain, especially of the large and smaller venous trunks. They now occupy much more space than before, and } 323 an increase of intracranial pressure results, which drives the blood from the cortex. The anaemia thus produced causes the explosion of nerve force all along the motor tracts which we call convulsions or eclampsia. He mentions the fact that rachitis is closely associated with dyspepsia and that in both there are faults of nutrition that permit the en- trance into the circulation of higher and lower albumoses than those which the system can readily employ for metatolic purposes. These compounds act as toxines, and, as the infantile constitution is extremely susceptible to toxic influences, owing to the unstable equilibrium of the cellular life of the organism, not as yet fully developed, and ever using up its quantum of force for developmental purposes, its organ- ic functions are easily affected. Solltman has pointed out that, while in the brain develop- ment is extremely rapid, yet it is the inhibitory nervous mechanism which is longest incom. plete. As a result of this, irritations that in adults, and even in older children, have no ef. fect upon the central nervous system, lead in young children very easily to alarming explo- sions of nerve force. The irritants may act directly upon the nerve centres, as when the toxines of an in- fectious disease or of imperfect digestion are carried by the blood to the brain cells, but, be- sides this haematogenic irritation, there is a neurogenic irritation that leads, to explosions of nerve force and spasmodic seizures. This is especially true for irritation of any of the widely distributed branches of the vagus. Just where the center is from which these explosions of nerve force come is not so clear. Krause showed experimentally that there seemed to be a center for closure of the glottis in the cortical region of the gyrus praefron- talis. Semon and Harsley found, on the other hand, a center for involuntary closure of the glottis in the region of the calamus scrip- torius. In any case, it is much more the unde- veloped state of the children, still further em. phasized by that disturbance of nutritional and developmental processes which we call rachitis, that is responsible for the attack, than any disturbance of a natural reflex arc. IHe showed one of the patients in a condition of tetany and demonstrated the diagnosis as follows: “If I compress with this rubber tube the arm of this little child here, which had the moderately severe attack of laryngospasm, you notice at Once a change in the position of the hand. The fingers are pressed together in a slightly flexed position, the flexure occurring mainly at the metacarpophalongeal joints, and the thumb in adduction is pressed upon the fingers which partially cover it, the ac- coucheur position of the hand. Then come twitching of the muscles of the arm, in the in- tervals of which it can be noted that a state of spasm exists. This is Trousseau's phenom- *. * * * *r * , , , ** * 324 enon, and is pathognomonic of tetany. When the nerves or arteries leading to an extremity, in the heightened state of muscular reflex ac- tivity which exists in this disease, are pressed upon muscular twitchings accompanied by spasms, which sometimes become general, re- sult. If I tap the muscles of the jaw here, you see the slight contortion of the face which results; this is the facialis phenomena, Chvos- tek’s symptom, and is due to the hyperirrita- bility of the facialis nerve, though it is now known that this nervous hyperexcitability ex- ists in all nerves in tetany.” Enlargement of the thymus and the lym- phatic constitution, he says, have been put forward in the last two years as playing an etiologic role in laryngospasm. Not that either of them is now advanced for the first time, but they have once more been brought in- to prominence. There is no doubt that suffo- cative attacks, accompanied by quickened res- piration, cyanosis, venous swelling, dilatation of the pupils, general convulsions, asphyxia, and death may occur from enlargement of the thymus. These attacks are deceptively like laryngospasm, but are due more to mechani- cal pressure upon the larynx (or trachea) than to reflex nervous action, though this may some- times play a part too. That these sudden hy- peranaemic enlargements of the thymus are among the most prominent causes of sudden death in children, he says he has not the slight- est doubt. As to the differential diagnosis be- tween true laryngospasm and these attacks of suffocation due to an enlarged thymus, the pathognomonic symptom is the enlargement of the thymus. This is not so difficult to diag- nose as a rule. Sometimes palpation at the upper end of the sternum will help, while an area of dullness on percussion beneath man- ubrium sterni very seldom fails to indicate the true cause. As to the lymphatic constitution, here too is an old, well-known condition under a new name. Children affected by it are described as pale and delicate, often anaemic, with enlarg- ed tonsils, including the pharyngeal tonsil,- that is with so-called adenoid vegetations,— With polyadenitis or lymphatic glandular en- largement all over the body, especially in the cervical region, and often with enlarged thy- mus. In such children, it is said, the lymph follicles all along the intestinal tract and the mesenteric glands are on section found to be enlarged. Subjects of the lymphatic consti- tution are, he thinks, only selected cases of the most outspoken form of scrofula. They are extremely irresistant to infection: hence the enlarged glands and the enlargements of lymphatic tissue all over. They are irresistant to toxic as well as to bacterial action; hence the disturbance of their blood-making organs and their anaemia. That such patients should be more subject to laryngospasm or to spas- THE MEDICAL DIAL. --- modic attacks of any kind is clear from what has been said of rachitis and dyspeptic condi- tions as the favorite soil from which laryngo- spasm and eclampsia develop. Baginsky recommends phosphorus very highly in the treatment. He gives 1-20 to 1-30 gr. three times a day, and says it often works with marvelous rapidity. After the first or second spoonful the attacks disappear to recur no more. It is an excellent remedy for rachi- tis, but, he thinks, it acts not so much as a spe- cific for that disease as a soothing, strengthen- ing nervine. When phosphorus fails to inhibit the attacks, or after it has been used for some time and they recur despite its continuance, he has recourse to the bromides and musk. Any cause of local irritation must be diligently sought for and properly treated, especially any disorder in the region supplied by the vagus. When eclampsia develops or laryngospastic at- tacks follow closely on one another, he has found chloral the most useful remedy. He gives it per rectum in doses of 8 grs. to a child of two years old and fifteen or twenty grs. to one three or four years of age, to be repeated in two hours if necessary. With the zinc prep- arations, arsenic, or antipyrin he has never had any success either in laryngospasm or in eclampsia. He demonstrated the soothing effect of a continuous current of electricity on one of the patients with eclampsia. In Very severe cases he applies leeches over the mastoid, one for each year of the child's age, Or Where there seems to be imminent dan- ger of a fatal termination he opens a vein. He thinks he has seen life saved through the re- lief afforded to the congested venous circula- tion by removing two or three ounces of blood. It is difficult to discriminate in abstracting from a lecture of this kind where every sen. tence is pregnant with ideas, and the entire lecture is urgently recommended to the read- er interested in the subject. J. P. B. Operate in : (1) Ilocal or partial epilepsy (Jacksonian) when convulsions are limited to a particular group; (2) in epilepsy, general or partial, when the condition is followed, or was apparently caused by, traumatic depression ; (3) in many cases in which partial epilepsy has followed a head injury, even if there are no ex- ternal, indications, but in each signal symp- toms indicate the brain area affected.— Mc- Cosh. One per cent of common baking-soda put into the water in which the instruments are boiled, in order to sterilize them, will, to a great extent, if not totally, prevent rusting.— Massachusetts Medical Journal. Gluttony is the source of all our infirmities and the fountain of all our diseases. THE NAEDICAL DIAL. 325 / Neurology and Psychiatry. UNDER THE CHARGE OF R. O. BEARD, M. D., W. A. Jon ES, M. D. A CASE OF INTRAUTERINE EPIDEMIC CEREBRO–SPINAL MENINGITIS. By R. B. H. Gradwohl, M. D. —7- The author (Phil. Med. Jour. Sept. 2, 1899) reports the first case on record of epidemic meningitis in the foetus. L. L., age 31, married, of good family and personal history, was brought to the City Hospital, St. Louis, in February, 1899. At the time an epidemic of cerebro-spinal meningitis was in progress in the city. She was seven months pregnant at the time. Two days be- fore had had pain in ear, which did not im- prove, and when admitted to hospital she was in a comatose condition. On admission, respi- rations somewhat labored; pulse rapid and weak, 120; temperature 102; pupils unequal; Kernig’s sign present; hyperaesthesia and pho- tobia were present, and a petechial eruption existed on chest both anteriorly and posterior- ly. No fetal heart sounds could be heard. The patient grew steadily worse, urine the fol- lowing day showed both albumin and sugar, and death occurred in afternoon. Necropsy five hours after death. Cranial cavity of mother showed typical meningitis, with great injection of pia, and an abundant purulent exudation scattered here and there over the entire meningeal surfaces, especially marked at the base. The same condition was found upon the cord. An exact counterpart of the condition of the maternal meninges was found in the foetus, with perhaps more of a sero-purulent exudation than a purely puru- lent one as found in the mother. Bacteriological examination of fluid from both the maternal and fetal meninges revealed the presence of the diplococcus intracellularis meningitidis. The same micro-organism was also separated in pure culture from the left ear of the mother, where a small quantity of pus was found. Cultures taken from the lungs, blood, pla– centa and uterus were barren of growth. Dogs inoculated from both mother and foetus died in convulsions on the fifth and seventh days. 'The only similar case on record is one re- ported by Herwerden, in which the mother died of sporadic meningitis, and the child lived five days and died of meningitis compli- cated with pleurisy. In the meningeal exuda- tion of both mother and child, and also in their blood and liver, pneumococci Were §"; PACHYMENINGITIS SPINALIS EXTER- NA—RECOVERY COMPLETE. By F. W. Langdon, M. D., and Albert H. Frei- berg, M. D. The authors (Jour. of Amer. Med. Ass., Aug. 26, 1899) describe a very interesting case of quadriplegia which improved with exceed- ing rapidity under extension treatment and finally attained complete recovery. The arti- cle is well illustrated with charts showing With great clearness the extent and variation of both motor and sensory disturbances. J. X., age 19, Hebrew-American, had been troubled for six weeks with loss of power in arms and legs, and within past few days had developed fever and general malaise. Father died of consumption; mother and one sister are subject to rheumatism. Patient has been healthy; Syphilis can be positively excluded. Had gonorrhoea eight months ago followed in two weeks by pain and stiffness in the back of neck, which he called “rheumatism.” Next five months well. Onset of paralysis was gradual and was accompanied by some pain and rigidity in back of neck. Right arm was first affected. He had at no time pain in his limbs or any bladder or rectal defect. Tem- perature on admission evidently due to an in- tercurrent tonsiliitis and in no way connected with paralysis. General nutrition good; neck rigid, its tissues apparently infiltrated and indurated posteriorly, but without much tenderness on pressure or manipulation. Quadriplegia is present, practically complete below elbows and knees; the paralysis is moderately rigid, almost waxy in type; elbow-jerks present and equal; wrist-jerks present, active and equal; knee-jerks exaggerated and equal; rectal and ankle-clonus present and equal. A tuberculin test, with m. xv of a 1-250 solution was follow- ed in two hours by headache, and by chill and sweating in twenty-six hours. At the height of the process there was only very feeble mus- cular movement in any of the extremities, but electrical reaction was normal, except for par- tial R. D. in right hypothenar muscles. Dis- turbances of sensation consisted of marked diminution of temperature, sense over thorax, abdomen, and upper arm anteriorly, and on forearm and hands anteriorly and posteriorly. Analgesia developed later than the other dis- turbances and was confined to the anterior part of the thorax below the nipple line. As no improvement appeared, Dr. Freiberg was called in consultation, and he describes the condition of the neck as showing a consider- able, firm diffuse swelling immediately below the occiput and extending downward to the fourth cervical spine. Without any distinct boss it was sufficient to render indistinct to the touch the vertebral spine. There was con- siderable tenderness on pressure complained & ޺r ** ſº, sº *-*. & • * *: # * THE NAEDICAL DIAL. * , w- * *** *...* * * * -1 * , ... "…" #." 3. t **.* v -” 6 º: Y. W. “ \ t ** * * *- of in the whole swollen area. There was no torticollis, but rotation, movement of the head backward or to either side were interfered with, while the nodding movement was nor- mal. Extension was applied to the head while the weight of the body served for coun- ter-extension. The weight applied at first was three pounds, which was afterwards in- creased to twelve. Within twenty-four hours after application of the apparatus, it was diffi- cult to detect any sensory loss over thorax or abdomen, and, when found, it was too irreg- ularly distributed to be charted. Twelve days later the only sensory disturbance was loss of temperature sense on hands. Nine weeks af- ter beginning of extension, dynamometer showed right hand 50°; left 46°. Last May, examination showed the patient to be normal in all respects except that there was still slight induration about the spinal processes, and the movements of rotation and flexion forward were a trifle limited. The authors discuss the nine possibilities of diagnosis and conclude: “The symptoms indicated an in- creasing pressure of exudate with its incidence at the first and second cervical segments of the cord anteriorly, thus compressing the ascend- ing antero-lateral tract of Gowers (tempera- ture sense) and the pyramidal tracts before their complete passage into the lateral col- umns. Treatment in addition to the exten- sion consisted of potassium iodide and recon- Structives.” W. A. J. DISGUISING TEIE TASTE OF NAUSEOUS DRUGS. In his “Pocket Formulary of Diseases of Children” Dr. L. Fryberger has devoted con- siderable attention to the important question of how to disguise the taste of nauseous drugs. The following are from the list: Acetonilidum, gr. i., disguised by gr. iii. of white sugar; ammonii bromidum, gr. i., by m. V. Syr. aurantii; ammonii carbonas, gr. i., by m. v. Syr. aurantii or tolu; belladonnae tinct., m. ii., by m. ii., Syr. aurantii; calomel, gr. i., by gr. iv. Saccharum lactis; cascara sagrad., ex. v. fl. m. X., by m. V. Syr. Zingiberis and ext. liq- uiritiae fl.;chloral hydras., gr. i., by m. v. syr. aurantii or pruni virginianae with dr. i. aq. uiritiae fl.; chloral hydras., gr. i., by m. v. syr. aurantii; ferri chloridi., tinct. m. i., by m. v. Syr. aurantii or glycerinae; nucis vomicae tinct., m. i., by m. XX. Syr. aurantii; liq. potassii ar- Senitis, m. i., by dr. i. aq. cinnamonii or m. V. Syr. tolu; potassii acetas, gr. iii, by m. xv. syr. rubi idaei; potassii bromidum, gr. iii., by m. xv. Syr. aurantii; potassii iodidum, gr. i., by dr. ss. aq. menth. pip.; sodii salicylas, gr. iii., by m. v. Syr. Simplicis and gr. i. aq. cinnamonii.-Med- ical Record. Abuse your stomach and have headaches. * \ Book notices. AMERICAN POCKET MEDICAL DICTION- ARY. Edited by W. A. Newman Dorland, A. M., M. D., Assistant Obstetrician to the Hospital of the University of Pennsylvania; Fellow of the American Academy of Medi- cine, etc., containing the Pronunciation and Definition of over 26,000 of the Terms used in Medicine and the Kindred Sciences, along with over Sixty Extensive Tables. Second Edition. Philadelphia: W. B. Saunders, 925 Walnut Street. 1899. In Russia. Price, $1.25, net. Next to the office shears, this little volume is the handiest thing about the office of The Medical Dial. We recommend it as an au- thority on spelling and pronunciation, and it will be an invaluable addition to any phy- Sician’s Office. It is so condensed and so con- veniently arranged that any word or term may be found very quickly. The binding is abso- lutely perfect, with handy patent thumb index. In addition to giving the pronunciation and definition of 26,000 words, it contains several exceedingly valuable tables, the largest of which is a table of doses, in both apothecaries’ and the metric system. The fact that a large edition was quickly exhausted is substantial evidence that it is a practical and useful lexi- con. The present edition is up-to-date, and contains many new words. THE HYGIENE OF TRANSMISSIBILE DIS- EASES: THEIR CAUSATION, MODES OF DISSEMINATION AND METHODS OF PREVENTION. By A. C. Abbott, M. D., Professor of Hygiene and Bacteriology, and Director of the Laboratory of Hygiene, University of Pennsylvania. Three Hun- dred and Ten pages, Illustrated. Philadel- phia: W. B. Saunders, 925 Walnut street. Price, cloth, $2.00 net. Treventive medicine and sanitary science are too frequently neglected by the profession, much to their disadvantage, for there are con- ditions in every community, notably in the Smaller towns and villages, where the applica- tion of the principles of general hygiene by the resident physician would redound both to the Welfare of the community and to the credit of the practitioner. Diphtheria, typhoid fever, and other transmissible diseases, can usually be traced to causes easily removable by proper sanitary measures. Wells contaminated by barnyard drainage, and cesspools pouring sew- er gas into houses, are prolific causes of dis- ease in both city and country. Physicians, as Conservators of the public health, must take the lead in instituting sanitary measures. Dr. Abbott has placed before the profes- Sion in convenient form the accepted methods of the authorities on sanitary science the World Over. The work tells of the causation, THE MEDICAL DIAL. . 327 modes of dissemination and prevention of spe- cial diseases, such as typhoid fever, cholera, tuberculosis, influenza, venereal diseases, glanders, small pox, etc. Directions are given for prophylaxis in general against infectious diseases, such as vaccination, chemical mea- Sures, and special chemical disinfectants, heat and steam. Explicit directions are given in the care of stables, vaults, closets, cellars and cisterns. The book closes with the methods to be pursued in the management of commun- icable diseases and quarantine. The author has presented a practical up- to-date text book, which should be on the table of every physician, and frequently con- sulted. By acting upon the suggestions given in this latest work on the subject the physi- cian would do much to lighten his labors, and, at the same time, improve the environment of the community. F. F. C. A TEXT-BOOK ON PRACTICAL OBSTET- RICS. By Egbert H. Grandin, M. D., Gyn- ecologist to the Columbus Hospital; Con- sulting Gynecologist to the French Hospi- tal; late Consulting Obstetric and Obstet- ric Surgeon of the New York Maternity Hopsital; late Obstetrician of the New York Infant Asylum; Fellow of the Ameri- can Gynecological Society, of the New York Academy of Medicine, of the New York Obstetrical Society, etc. With the Collaboration of George W. Jarman, M. D., Gynecologist to the Cancer Hospital, Instructor in Gynecology in the Medical Department of Columbia University; late Obstetric Surgeon in the New York Mater- nity Hospital; Fellow of the American Gynecological Society, of the New York Academy of Medicine, of the New York Obstetrical Society, etc. Second edition, revised and enlarged. Illustrated with Six- ty-four full-page Photographic Plates and Eighty-six Illustrations in the Text. Phila- delphia, New York, Chicago: The F. A. Davis Company, 1898. 8 vo. Pp. xix—461. Extra Cloth, $4.00 net; Sheep, $4.75 net. The first edition of this excellent work was well received by the profession. In the second edition the author has thoroughly revised the work and has been most successful in his aim to maintain the position it has secured as the leading exemplifier of practical obstetrics from the modern standpoint. Several new plates and illustrations have been added, and altogether, the work is one which cannot well be spared from the general practitioner’s li- brary. In no department of medical practice is the physician thrown so entirely upon his own resources, as in the practice of obstetrics. While a large proportion of cases are natural and easily managed he is liable at any time to meet with difficulties in which he must act for himself, and act promptly. In surgical Operations he can generally choose a conven- ient time to operate, and if not confident in his OWn skill and dexterity, can get out of the difficulty by handing the patient over to a sur- geon. The obstetrician must be an operator, and must frequently operate under difficulties and with incompetent assistants. For all these reasons the contents of this book should be familiar to the up-to-date physician. TREATMENT OF PELVIC INFLAMMA- TIQNS THROUGH THE VAGINA. By William R. Pryor, M. D., Professor New York Polyclinic, etc. Two hundred and forty-eight pages. Philadelphia: W. B. Saunders, 925 Walnut Street. Price, cloth, $2.00, net. This is an especially valuable book to the general practitioner, as it is an elaboration of Professor Pryor's lectures at the New York Polyclinic, and gives in a practical manner the Hºment found most successful by the au- OI’. The author deserves especial commendation for going into minute detail in describing the line of treatment laid down for a given case. Many authors impair the usefulness of their books by the omission of just these things. The technique is familiar to the author and oftentimes its description seems unnecessary, but to the practitioner, who is not familiar With the procedure or operation, the technique is the essential portion. The book is a valu- able aid to every physician who treats diseases of Women, and we take especial pleasure in commending it to the profession generally. The Work is well illustrated with cuts showing both technique and instruments. F. F. C. A TEXT BOOK ON THE DISEASES OF THE NOSE AND THROAT. By D. Bra- den Kyle, M. D., Clinical Professor of Lar. Yngology and Rhinology, Jefferson Medical College, etc.; 646 pages, with one hundred and seventy-five illustrations, 23 of them in colors. Published by W. B. Saunders, 925 Walnut Street, Philadelphia. Price $4.00 lºoth; $5.00 in sheep or half morocco, Ilét. While Dr. Kyle has departed somewhat from the plan usually adopted by writers of text books, yet his arrangement is good, and his text is clear, and at the same time concise, tWO Very important points in a book intended primarily as a text book. Another point which has our hearty commendation is making each chapter complete in itself, even though it renders some repetition necessary. As the work is intended for general prac. titioners, as well as for the student, it enters into many details of a general nature, which &- %. < *. rv. x - & sº. * 328 t 3. sº Af $ assist in throwing light on the subject under consideration. This is an excellent feature, from the fact, patent to every specialist, that , there is a constant relation between the nose and throat, and many systemic diseases. The illustrations are made from the au- thor's own cases, some of the anatomical illus- trations being composite. The cuts of instru- ments are of those used for the most part by Dr. Kyle, and as a matter of course represent in each case only one of many adapted to the purpose mentioned. This is commendable, as the student needs definite and exact informa- tion as to instruments and their use. The author follows the same course in advising a line of treatment for the different diseased Con- ditions. He has endeavored to be as specific as possible, and the result is a most excellent book from every standpoint. The illustrations are superb, especially the colored ones, and show very clearly the condi- tion or organ under consideration, thus adding very materially to the value of the work to the student. The text and paper is all that could be desired, and the publisher, Mr. Saunders, is to be congratulated. F. F. C. A CONVENIENT BOOK. We are in receipt of a handy Brochure, “Hints on Practical Urinalysis,” by Chas. C. . Yarbrough, M. D., published by Frederick Stearns & Co., of Detroit, Mich. It is a very useful little book for physi- cians, who have analyses to make, as it gives a detailed description of reagents, apparatus required, solutions, how to make and use them, urinary tests, normal and abnormal constitu- ents of the urine, the different sediments found in the urine properly classified, Urinary Cal- culi, a model of recording urinary analyses, and the etiology and symptoms of some of the more important genito-urinary diseases. Erederick Stearns & Co will send a copy of this excellent book to any physician request- ing it, free of charge. F. F. TREATMENT OF ACUTE BRONCHITIS. The treatment of acute bronchitis varies somewhat with the age of the patient. A few general directions apply to all ages. Equal- ization of the circulation and stimulation of all lagging emunctories are important early measures. In all cases purity of air, equable room temperature (69 to 70 F.), and a slight excess of moisture in the air are essential. In young infants the child should be clad rather more warmly than ordinarily, a cot- ton or woolen jacket should be applied, and the chest should be rubbed twice daily with camphorated oil or a mixture of equal parts of oliveoil and amberoil or turpentine. A croup- kettle, to the water in which has been added THE MEDICAL DIAL. compound tincture of benzoin (one fluidrachm to one pint) should be employed for ten or fif- teen minutes every hour or two, and in winter a broad, shallow pan of water should be kept in front of the source of heat in order, by its evaporation, to moisten the air of the room. Ordinarily in the early stage a simple fever- mixture with the addition of a small quantity of ipecac will be all that is required. Of the febrifuges the citrate of potash with or with- out the addition of Small doses of tincture of aconite in accordance with the fever and car- diac excitement will be found useful and sim- ple. After the formation of mucus has start- ed and the fever has subsided the chloride of ammonium, in doses of one-fourth to one grain, should replace the fever-mixture. Ordinarily no further medication is requir- ed except for the use of mild laxatives to keep the bowels thoroughly opened. In removing the extra covering on the chest care is to be taken that the change be not made too rapidly, but that small portions should be taken away at a time. If at any time marked oppression Of breathing occurs from accumulation of mu- cus, the production of vomiting by a full dose of ipecac will cause prompt clearing of the tubes. In feeble children stimulants may be required, and where the heart’s action is weak the carbonate or aromatic spirit of ammonium . may, with advantage, be used instead of the chloride. In older children and adults a preliminary hot foot-bath, to equalize the circulation and start the emunctories, is of value. The appli- cation of mustard poultices or turpentine Stupes to the chest certainly gives relief and hastens cure. The use of a cotton or woolen jacket is not so important as in infants, but is of value. In those beyond the age of infancy ammonia salts can be used earlier in the dis- ease, the chloride acting especially well in combination with compound licorice mixture. Usually no other medicine, save possibly laxa- tives, is required unless the latter part of the attack is prolonged, in which case small and frequently repeated doses of the oil of euca- lyptus, gaultheria, or copaiba may be given in capsule. In the aged it is important to sustain the general strength and especially to watch the condition of the right heart. Stimulants are usually necessary; and it is important to change the patient’s position at short inter- Vals in order to facilitate expectoration and to avoid the effects of gravity in causing conges- tion or atelectasis of dependent parts of the lung. Many expectorant drugs other than those mentioned above are employed, but it is a question whether their action upon digestion does not offset any possible good effect upon the bronchitis-Sajous’ Annual and Analyti- cal Cyclopedia of Practical Medicine, Volume II., pages 23 to 25. THE MEDICAL DIAL. 329 * THE URINE IN DISEASE. Dr. Formad (Tri-State Medical Journal) Concludes an interesting article as follows: 1. Sediment in the urine has no signifi- cance unless deposited within twenty-four hours. 2. Albumin in the urine does not indicate kidney disease unless accompanied by tube- casts. The most fatal form of Bright's disease —contracted kidney—has little or no albu. IIllſl. 3. Every white crystal in urine, regardless of shape, is a phosphate, except the oxalate-of- lime crystal, which has its own peculiar form; urine, alkaline. 4. Every yellow crystal is uric acid if the urine is acid, or a urate if the urine is alkaline. 5. Mucous casts, pus, and epithelium sig- nify disease of the bladder (cystitis) or other parts of the urinary tract, as determined by variety of epithelium. 6. The urine from females can often be differentiated from the urine of males by find- ing in it the tessellated epithelium of the va. glna. 7. Hyaline casts (narrow) blood, and epi- thelial casts signify acute catarrhal nephritis. There is much albumin in this condition. 8. Broad hyaline casts and epithelial dark green granules and oil casts signify chronic catarrhal nephritis. At first, much albumin; later, less. 9. Hyaline and pale granular casts, and little or no albumin signify interstitial ne- phritis. 10. Broad casts are worse than narrow casts, for the former signify a chronic disease. 11. The urine should be fresh for micro- scopical examination, as the micrococci will change hyaline casts into granular casts, or devour them entirely in a short time. 12. Uric acid may, in Trommer's test for sugar, form a peroxide of copper, this often misleading the examiner into the belief that he has discovered sugar. Thus when urine shows only sugar, other methods of examination must be used—preferably the lead test. 13. The microscope gives us better ideas of the exact condition of affairs in examination of urine than the various chemical tests. Dr. Francis Crosson, author of “A Descrip- tion of the Climate of New Mexico,” which appeared in the June Dial, has returned to his permanent home in Albuquerque, after an extended sojourn in Minneapolis and other cities of the north and east. A man in Philadelphia has been awarded $1,500 damages for an attack of typhoid attrib- uted to contamination of his water supply by the overflow from a sewer left uncompleted by the city.—Sanitarian. “A indeX II?&dićllS. Enclosed figures indicate prices for single copies. MEDICAL REVIEW, London. (1 S. 6 p.). Au- gust: Notes, 10 pp.–Reviews, 27 pp.–Hospital re- ports, 8 pp.—Epitome current literature, 29 pp. MEDICAL REVIEW OF REVIEWS, New York City. (10). September: Some unusual cases of ap- pendicitis, with complications, A. Vanderveer, Al- bany. N. Y. MARITIME MEDICAL NEWS, Halifax. (10). August: Progress of medicine and Surgery during the last third of the nineteenth century, A. B. Ather- ton.—Disorders of the menopause, E. W. Cushing, Eoston.—The care of the tuberculous (ed.). MEDICAL FORTNIGHTLY, St. Louis. Sep- tember 1: Psychic element in disease and Sugges- tion, A. McDonald, Wash.-Physiology (chapter 12), A. L. Benedict, Buffalo.—Vertigo. P. Zenner, Cinnti. –September 15: Scattered leaves from a physician's diary (No. 9), A. Abrams, San Francisco. THE LARYNGOSCOPE, St. Louis. (20). Sep- tember: The offending middle turbinal (illustrated), Edwin Pinchon, Chicago.—Fibrinous rhinitis, D. J. Gibb, Wishart, Toronto.—Acute septic rhinitis of childhood, L. S. Somers, Phila.-Parasitic affections of the pharynx, E. O. Sisson, Keokuk, Ia. MEDICAL REGISTER, Richmond. (15). Au- gust: An interesting case of hereditary syphilitic dactylitis, L. C. Bosher, Richmond.—The relations of the coroner to the undertaker, W. H. Taylor, Rich- mond.—Summer diarrhea of infancy, Jesse Ewell, Ruckersville, Va.-Facial paralysis, W. S. Beazley, Richmond.—The germ of yellow fever (ed.). OCCIDENTAL MEDICAL TIMES, San Fran- cisco. (20). September: Address at commencement exercises of Cooper Medical College, R. J. Voorsan- ger.—Waledictory, C. N. Ellinwood ('99).-Resection of the rectum and bladder, colostomy, Cure of arti- ficial anus, recovery, demonstration of patient, C. G. Lewison, San Francisco.—Relation of the recuper- ative powers of nature to medical practice, G. L. Simmons, Sacramento.—A study of Caesarean Sec- tion, four cases, W. S. Thorne, San Francisco. INTERNATIONAL MEDICAL MAGAZINE, New York City. (20). September: On the practical aspects of dorsal percussion and in particular of the percussion of the spine, (illustrated), Wm. Ewart, London.—Bacteriology: its practical value to the general practitioner, W. W. Babcock, Phila.-Causes of urinary retention in the male: its treatment (clin- ical lecture), O. Horwitz, Phila.-Local treatment of corneal ulcer, W. L. Pyle, Phila.—Use and abuse of the douche, D. B. Kyle, Phila.--Some points in rela- tion to syphilis, J. D. Thomas, Pittsburg.—The prog- nosis and treatment of chronic sthenic gastritis (acid gastric catarrh), B. Reed, Phila. CHARLOTTE MEDICAI, JOURNAL, N. C. September: Relative efficacy of toxin and antitoxin in the treatment of tuberculosis, J. H. Williams, Asheville.—Strangulated inguinal hernia, F. T. Meri- wether, Asheville.—The use of the ophthalmoscope in internal medicine, L. W. Dean, Iowa.-Shall we Operate in every Case of appendicitis? V. Harrison, Richmond.—The preventability of typhoid fever, R. P. Smith, Sunnybrook, Md.—Iritis, R. S. Magee, To- peka, I\an.--The cure of epileptics, J. F. Edgerly, Oakboure, Pa.--Surgical procrastination, C. P. Tho- mas, Spokane.—Gonorrheal ophthalmia, J. B. Mc- Fatrick.-Abstracts of 100 of the leading articles of the month. tº Yº º:3- §. & sº- 3. ** * * tº . * 3. .x:" & * *. 3, #. 3. , * r; * “ A * * ... • $4. * , & Á- *. * NATIONAL MEDICAL REVIEW, Washington. (10). September: The physician and the Negro prob- lem (ed.). NEW YORK LANCET. (10). August Some acute pulmonary troubles, R. S. Michel, Chicago.— Rational treatment of Consumption, J. G. S. Coghill. —Case of toxaemia. With convulsions, C. L. Fraser. JOUR. OF COMPARATIVE MEDICINE AND VETERINARY ARCHIVES, Philadelphia. (30). August: Meat-inspection and milk-inspection, H. F. Palmer, Brooklyn. MEDICAL EXAMINER, New York City. (20). September: The life insurance examiner, G. D. Rohle.—Some practical hints regarding the making of examinations, Joseph ISucher. BROOKLYN MEDICAL JOURNAL. (20). Sep- tember: Prevention and modern treatment of tuber- culosis, Geo. W. Brush.-Metric System in prescrip- tions, E. H. Bartley.—Ovarian cyst with torsion of the pedicle, F. W. Wunderlich. DENTAL DIGEST, Chicago. (25). August: A. step in advance in the treatment of Riggs' disease, Alden Mills, New York.-Resume of the important changes that have taken place in dentistry during the last thirty-five years, J. N. Crouse, Chicago. JOUR. OF MISS. STATE MED. ASS’N, Biloxi. (10). September: Acute lymphadenitis, report of a case, L. F. Fox, Water Valley, Miss.-Prieumonia; or, commonly known as lung fever, W. W. Robertson, McComb City, Miss.-The mind in the presence of disease, L. M. Guess, Crystal Springs, Miss. MEDICAL MIRROR, St. Louis. (10). Septem- ber: Ununited fracture in Childhood, Edmund Owen, London.—Athletics in their relation to the male geni- to-urinary organs, G. F. Lydston, Chicago.—Faith, fraud and suggestion in therapeutics, T. F. Lock- wood, Butler, Mo.—A dozen dietetic dots, by the edi- tor, I. N. Love. JOURNAL OF SCIENTIFIC MEDICINE, Chi- cago. (10). August: The worthlessness of beef ex- tracts, Jno. Madden, Milwaukee.—Report of a case of eclampsia, V. F. Mueller, Milwaukee.—Alleged dangers of peroxide of hydrogen in surgery, G. M. Blech, Chicago.—First warnings of glaucoma, W. H. Pole, Detroit. *ºmºsºm-m-mºs WISCONSIN MEDICAL RECORDER, " Janes- ville. (10). August: Preparing for old age, Joseph Adolphus, South Atlanta, Ga.-Glaucoma (8th paper), J. A. Pratt, Aurora, Ill.—Observations on refraction, by the editor, J. P. Thorne.—Treatment of alopecia, with clinical reports, R. C. ICenner, Louisville.—Pure milk (ed.).-Protargol (ed.). MEDICAL BULLETIN, Philadelphia. (10). Sep- tember: The physiological and medical treatment of insomnia, by the editor, John V. Shoemaker.—Re- marks upon a case of pulmonary tuberculosis, George W. Pfromm, Philadelphia.— Masochism, sadism, and feticism, R. M. Niles, Pleasant Mount, Pa.-Sleep, sleeplessness, and hypnotics (ed.).-Hysterical ear (ed.). *º-ºº-ºº-smº JOURNAL OF MEDICINE AND SCIENCE, Portland, Maine. (10). September: Nasal catarrh; its surgical treatment, Arthur F. Sumner, Concord, N. H.-Extracts from the ancient history of medicine, F. J. Robinson, Fairfield, Me.—Extra uterine preg- nancy, W. G. Sawyer, Madison, Me.—Masso-therapeu- tics, E. H. Judkins (continued from August).--Pre- vention of consumption (ed.).-Is there a relation be- tween nervous prostration and hysteria (ed.). ' THE MEDICAL DIAL. RANSAS CITY MEDICAL LANCET-INDIEX. . (10). September: Some thoughts on various forms of infection, M. P. Overholser, Harrisonville, Mo.— Healing frauds and superstitions, a Sermon by Rev. C. M. Bishop, Nevada, Mo.—A woman and a tumor, and how they parted, H. E. Pearse, Kansas City.— The treatment of broken and deformed nasal Septa, Hal Foster, Kansas City. * MEDICAL HERALD, St. Joseph, Mo., August: Fibro-adenoma mammae. Enucleation, B. L. East- man, Ransas City.—Leucorrhea and its treatment, C. ICenner, Louisville.—Modern treatment of fractures, Edward A. Tracy, Boston.—The etiology of phthisis, a summary of scientific points involved in the Chur- chill theory, R. W. Gardner, New York City.—Some reflections on the principles of medicine (ed.). AMERICAN JOURNAL OF SURG. AND GYN., St. Louis. (10). August: Surgery and insanity, H. W. Coe, Portland, Oregon.—The gynecologist in rela- tion to the insane, Ernest Hall.—Vaginal hysterecto- my, incidents and complications, W. Lindley, LOS An- geles.—The sigmoid, some of its diseases, W. Burke, Los Angeles.—Abdominal pains, C. P. Thomas, Spo- kane.—An operation for cancer of the rectum Which did not cure, C. E. Case, Tacoma. OCCIDENTAL MEDICAL TIMES, San Francis- co. (20). August: Intravenous injections (bacilli) of mercury in the treatment of syphilis, Dudley Tait, San Francisco.—A case of foreign body in the heart, W. Ophuls, San Francisco.—A case of marked de- formity of the nails (onychogryphosis) in anesthetic leprosy, Douglass W. Montgomery, Cal.—Remarks on diagnosis and treatment of pulmonary tuberculosis, Geo. W. Cole, Los Angeles. JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, Chicago. (10). Sept. 9: A fallacy of the rest cure treatment, G. M. Gould, Phila.-Cata- phoric treatment of cancer, G. B. Massey, Phila.— Treatment of aneurisms by extirpation; With report of popliteal aneurism treated by this method, J. C. Oliver, Cincinnati.-Some complications resulting from rectal operations, W. M. Beach, Pittsburg.— Use of acetanilid in various combinations as a Substi-, tute for many proprietary drugs and mixtures, L. F. Bishop, N. Y. C.—Progress in serum therapy, G. W. Cox, Chicago.—Experiments with paraldehyde, C. C. Hersman, Pittsburg.—Accidental wounds of the fe- male bladder, F. H. Wiggin, N. Y. C.—Intestinal treatment of tuberculous peritonitis, H. T. Byford, Chicago.—Relative toxicity of cocain and eucain, A. H. Peck, Chicago. —Disease of the pancreas, F. E. Wallace, Monmouth, Ill.—The microbe of yellow fe- wer (ed.)—Nagging wives and nervous husbands (ed.).-The pathogenesis of Acromegalia (ed.).-Sept. 16: A profitable medical education, an address, H. O. Walker, Detroit.—Gall-stones, Consideration of their etiology, diagnosis and operative treatment, J. Ransohoff, Cincinnati.-Gall-Stones, Observations On their treatment, A. J. McCosh, N. Y. C.—Our tuber- cular patients, whom to send and where to send them, J. F. McConnell, Las Cruces, N. M.--Treatment of endrometritis by drainage and irrigation, A. H. Goelet, N. Y. C.—The importance of a knowledge of the development or evolution of the child in the pre- vention of children's diseases, E. Stuver, Fort Col- lins, Col.-Prognosis of laryngeal tuberculosis, R. Le- Vy, Denver.—Relation of uterine disease to Some of the insanities, C. C. Hersman, Pittsburg.—Treatment of chronic Group, E. Rosenthal, Philadelphia.--What are antitoxins? R. G. Eccles, Brooklyn.-Condensa- tion and preservation of milk by refrigeration, H. O. Marcy, Boston.—Non-malignant strictures of rectum, their surgical treatment, J. B. Bacon, Chicago.—Reed and Carroll’s reply to Sanarelli (ed.).-Zoëphilism and degeneracy (ed.). THE MEDICAL DIAL. 331 } SANITARY HOME, Fargo, N. D. (10). Oc- tober: Foods of colonial New England, H. D. Per- ky, Worcester, Mass.-A brain poultice, D. H. Reeder, Chicago.—Infant dietaries, by the editor, E. F. Ladd. —The meat problem (ed.).-Fermentation of tobacco (ed.). MEDICAI, COUNCIL, Philadelphia. (15). Sep- tember: The post-partum use of the abdominal bin- der, E. F. Tucker, Portland, Oregon.—Antistreptococ- cic serum in puerperal septicaemia, H. J. Rich- ardson, Canmore, Alberta, Canada.-Album OSes in dietetics, Jno. Zahorsky.—On the change of life in women (concluding article), A. H. P. Leuf, Phila- delphia.-Organic and functional diseases, incident to the menopause, treated by electricity and Cataphoric medication, with report of cases, G. W. Overall, St. Louis.-Rational therapeutics, a plea for the use of the active principles in medicine, G. E. Day, Millville, N. J.-Local treatment of a cold in the head (first paper), E. B. Gleason, Philadelphia. MEMPHIS LANCET. (10). August: Gunshot wounds in civil practice, W. L. Estes, South Beth- lehem, Pa.-Enuresis nocturna, in the female, Gustav Kolischer, Chicago.—A clinical study of chorea (Mem- phis Lancet $25.00 prize paper), Edwin Williams, Memphis.-Atypic malaria in children, with a case in point, Rosa, Engelmann, Chicago.—IS epidemic Cerebro-spinal meningitis a Communicable disease (ed.). September: The operative treatment of ex- ophthalmic goitre, Karl Doepfner, Chicago.—Differ- ential diagnosis of the continued fevers, M. Goltman, Memphis.-The continued fevers of the South, etiol- ogy and laboratory features, Wm. Krauss, Memphis. —Nature and art in the cure of disease, John M. Far- rington, Binghamton, N. Y.-Treatment of post-par- tum hemorrhage, Alfred Moore, Memphis.-Quinine in malarial hemoglobinuria (ed.). PENN. MEDICAL JOURNAL, Pittsburg. (25). August: Some injuries of parturition, especially of the perineum, F. P. Ball, Lock Haven.—The treat- ment of acute injuries of the brain, based on indica- tions of cerebral anaemia of engorgement, with re- port of Cases, J. H. Anderson, Pittsburg.—Remarks On nephrectomy, with a plea for the more certain and earlier diagnosis of conditions requiring it, C. P. Noble, Philadelphia.-A note on the employment of Solutions of toluidin-blue in the treatment of external inflammatory diseases of the eye, C. A. Veasey, Philadelphia.--Some of the legal results of advanced medical legislation, W. S. Foster, Pittsburg.—State Board of Health and antitoxin, T. D. Davis, Pitts- burg.—Observations on Nature and her methods, W. R. Hockenberry, Slippery Rock.-Revision of the U. S. pharmacopoeia (ed.). AMERICAN JOURNAL OF INSANITY, Balti- more, July: Some of the problems of the alienist, Frederick Peterson, New York.-The legal versus the scientific test of insanity in Criminal cases, Carlos F. Macdonald, New York City.—The care of the in- sane in farm dwellings, G. Alder Blumer, Utica.-The nature and principles of psychology, Boris Sidis, New York.-Our Work and its limitations, Edward C. Runge, St. Tollis.-The puerperal insanities, H. A. Tomlinson, St. Peter, Minn.—The role of wound in- fection as a factor in the Causation of insanity, A. T. Hobbs, London, Ont.—The desirability of close connection between the psychopathological laborato- ries and hospitals for the acute insane, Samuel B. Lyon, White Plains, N. Y. —Some difficulties in the retraction theory, W. L. Worcester, Danvers Insane Hospital.—Treatmont of the sick and insane in Per- sia, James P. Cochran, Urumia, Persia.-Progress in the clinical study of psychiatry, Edward Cowles, Wa- verly, Mass.-Clinical Cases, IV., pseudo-dementia. paralytica uraemica, Henry J. Berkley. JOURNAL OF TUBERCULOSIS, Asheville, N. C. (25). July: Some notes on the tuberculin test (1), E. O. Otis, Boston.—The diagnosis of early phthisis, L. P. Barbour, Boulder, Col.—The early diagnosis of pulmonary tuberculosis, C. F. Denny, St. Paul.—The diagnosis of joint tuberculosis, J. K. Young, Phila.- Report of twelve cases of tuberculosis, treated with watery extract of tubercle bacilli, J. Sutherland, Spo- kane.—The local treatment of lung diseases, B. F. Lyle, Cincinnati.-Use of protargol in diseases of the larynx and pharynx, H. J. Chapman, Asheville.—The prevention of tuberculosis (continued ed.). PENNSLYVANIA MEDICAL JOURNAL, Pitts- burg. (25). September: Address in medicine, J. C. Lange, Pittsburg.—Mechanical treatment of ptosis, (illustrated), E. B. Heckel, Pittsburg.—Some clinical Observations on diseases of the skin, J. V. Shoe- maker, Phila.-Four cases of carcinoma of the breast treated by the cataphoric method, G. B. Massey, Phila.—Puerperal septicaemia, G. W. Wagoner, Johnstown.—Intoxication from toxalbumins and Other toxins, Mary McD. Shick, Reading.—Diphtheria. in the Roselia foundling asylum and maternity hos- pital of Pittsburg; treatment with antitoxin, A. Roenig, Pittsburg.—A case of myxoedema, E. H. Small, Pittsburg.—Tuberculosis following typhoid fever, F. U. Ferguson, Gallitzin, Pa.—Relapse in typhoid fever, L. H. Mayer, Johnstown.—Diagnosis of mild cases of Small pox, W. D. Haight, Johnstown. VIRGINIA MED. SEMI—MONTHLY, Richmond. (10). August 25: Mr. Lawson Tait, the man and his work, J. Price, Philadelphia.—Life and work of Dr. John B. Hamilton, L. Eliot, Washington.—Rheu- atism, etiology, pathology and treatment, A. A. Young, Newark, N. Y.-The typhoid bacilli, a few facts concerning its favorable abiding place in the human System, and the most successful method by Which its poisonous toxine may be eliminated, J. J. McEvoy, Norfolk, Va.-Howard Kelly's proctoscope as a factor in the diagnosis and treatment of ulcer- ation of the rectum, L. Straus, St. Louis.-Thought as a correlative force, E. J. Bergen, Washington.— September 8: Colds, E. Cutter, N. Y. C.—Dangers which lurk in the schoolroom, how safeguards may be easily provided, W. B. Meany, Louisville.—The peritoneum and some of its morbid phenomena, W. L. Peple, Richmond.—Do patients recover from general peritonitis? I. S. Stone, Washington.--The use of toluidin-blue in external Ocular inflammations, C. A. Veasey, Philadelphia.-A case of brain abscess, with peculiar symptoms, G. K. Sims, Honolulu.-Pseudo- Catalepsy, W. M. Phelps, Colonial Beach, Va.-A case of tubal abortion, J. W. Boyee, Washington. MEDICAL RECORD, New York City. (10). Au- gust 26: The report of a case treated with yellow- fever serum, A. H. Doty, N. Y. C.—Bright's disease, or nephritis, W. S. Mills, N. Y. C.—Mucocele of the maxillary sinus, W. Scheppegrell, New Orleans.— The evils of the ritual practice of circumcision, A. Miller, N. Y. C.—Hernia of the vermiform appendix, L. L. Hill, Montgomery, Ala.—Labori’s wound and the question of bullet extraction (ed.).-The operative cure of ascitis due to cirrhosis of the liver (ed.).- The physical development of Japanese wrestlers (ed.).-September 2: Psychotreraphy; or, suggestion as a cause and Cure of disease, H. H. Seelye.—The etiology of scarlet fever, W. J. Class. Chicago.—A. preliminary report upon the use of carbolic acid in the treatment of mastoid wounds and chronic sup- puration of the middle ear, W. C. Phillips, N. Y. C. –An international language for scientific men, is it a possibility? R. Ellis, Utica, N. Y.—Overcrowded pro- fessions (ed.).-The clinical manifestations of ulcer- ative endocarditis (ed.).-A fatal case of benzine poisoning (ed.).-September 9: Reflex irritation, with Special reference to the eye strain, a factor in ner- 332 THE NAEDICAL DIAL. vous and mental disease, C. A. Drew, Bridgewater, Mass.-Scarlet fever reproduced by inoculation; some important points deduced therefrom, J. W. Stickler, Orange, N. J.-On Ozone and its generation by the static current for therapeutic use, J. M. Bleyer, N. Y. C.—The plague in Europe (ed.).-The work of the marine-hospital service for 1898 (ed.).-Atrophy of the optic nerve following profuse hemorrhage (ed.). —The coroner’s office and the daily press (ed.).-The treatment of Sinus-thrombosis of otitic origin (ed.). —September 16: Floating liver and its clinical sig- nificance, Max Einhorn, N. Y. C.—The practical treat- ment of typhoid fever, B. M. Taylor, Greensburg, Ky. —Facts and fallacies in uranalysis, T. W. Schaeffer. —Demonstration of two cases of extrophy of the - bladder, with suggestion for a new operation, J. H. Branth, N. Y. C.—Clinical course of gastric ulcer (ed.).--Smallpox and vaccination (ed.). GAILLARD’S MEDICAL JOURNAL, New York City. (50). September: Treatment of labor in ab- normal pelvis, Edwarl P. Davis, Philadelphia.--Sur- gical complications of typhoid fever, Hugh M. Tay- lor, Richmond.—How to treat boys and girls ap- proaching the age of puberty, Josephine M. Wetmore, Grinnell, Ia.-The death-dealing long-tube nursing bottle, Ernest Wende, Buffalo.—Jefferson and vac. cination, G. W. Drake, Hollins, Va. NEW ORLEANS MED. AND SURG. JOUR- NAL. (20). September: The importance of the early recognition and treatment of catarrhal diseases, W. Scheppegrell, New Orleans.—Some food impurities and chemical preservatives, Q. ISOhnke, N. O.-The lessons of the yellow fever in New Orleans in 1879, forty-One cases and nineteen deaths, crude scientific Sanitation and no quarantine, E. Souchon, N. O.- Christian (?) science (ed.).-Milk supply of N. O. (ed.). —Free public baths in N. O. (ed.). *-* BUFFALO MEDICAL JOURNAL. (20). Sep- tember: Importance of early diagnosis and surgical intervention in fractures of the skull, Marshall Clin- ton, Buffalo.—Neurasthenia from the standpoint of a general practitioner, C. W. Coulter, Oil City, Penn. —Experience, judgment and luck, Nelson W. Wilson, Buffalo.—What shall be the minimum stand- ard of requirements for admission to the study and practice of medicine? William Warren Potter, Buf- falo.—Oculist vs. optician, a protest, John J. Finerty, Buffalo. -*- NEW YORK MEDICAL JOURNAL. (10). Au- gust 26: The anthemion, Wallace Wood.—Subcuta- Ineous tenotomy, biographical notes, A. B. Judson.— Gunshot wounds of the chest in the Spanish-Ameri- Can War, H. S. Greenleaf.--The use of parotid-gland extract in the treatment of ovarian disease, E. P. Mallett.—Extradural Spinal meningeal hemorrhage, S. D. Hopkins, Denver.—The puerperal state and puerperal hemorrhage, derivation and classification, W. B. Gossett, Louisville.—The etiology of yellow fever (abstract of a marine-hospital report, a public document).-Report of six cases of pneumonia treat- ed with antipneumonic serum, Antonio Fanoni.-Sep- tember 2: The sphere of laryngology (an address), W. E. Casselberry, Chicago.—Is the so-called Ameri- can Voice due to catarrhal or other pathological Con- ditions of the nose? J. W. Farlow, Boston.—Obser- Vations on the treatment of hay fever, B. Douglass, N. Y. C.—Bovine tuberculosis in its relation to man, E. Moore, Albany.—The therapeutic Value of OXy- gen, W. L. Conklin, Rochester, N. Y.-Cerebral and meningeal syphilis treated by intramuscular injec- tions of insoluble salts of mercury. Some points in technique. J. C. Stinson, San Francisco.-Frac- ture of the lower end of the radius, C. Beck, N. Y. C. —A test-case for taste, N. T. Beers, Brooklyn.- Adeno-carcinoma of the nose, J. E. Newcomb, N. Y. C.—Traumatic neuropsychosis, C. E. Ide, Chicago.— Synechiotomy of the Stapes for improving the hear- ing in chronic suppurative otitis media residua, E. B. Dench, N. Y. C.—Dust in the etiology of tubercu- losis, M. Girdansky.—September 16: Atypical forms of pneumonia, a clinical study, E. Palier.—Hysteri- cal blindness, A. T. Muzzy, N. Y. C.—SeaSickness, J. C. De Vries.—Epiphyseal separation of the ends of the humerus, M. Lucid, Syracuse.—Clinical report of an epidemic of infantile diarrhea, I. J. Jones, Austin, Texas.-Epileptic eye strain, C. M. Capps, Knoxville, Tenn. NEW CURE FOR GERM DISEASES. Dr. Oscar Loew, one of the expert vegetable pathologists of the Agricultural Department at Washington, has developed to what he be- lieves to a point of practical use, a new treat- ment for germ diseases, which promises to su- persede the serum treatment now in use in diphtheria, fevers and many other diseases. The experiments have reached a stage where they can be tested in hospitals. The treatment is similar in some respects to the serum treatment, but depends on a dif- ferent principle, one basic idea being the pres- ence of a class of ferments known as enzymes, which are produced by the same bacteria that produce the disease. It is because of the production, or rather over-production, of a certain enzyme that a disease such as typhoid will “run its course” and die out of the system. The bacteria in this case, it is stated, are simply killed out by the ferment they produce. The object of the new treatment is to pro- duce a pure enzyme, which, introduced into the human system, will kill the disease germs with- out injuring the patient.—Gaillard's Medical Monthly. “Sare,” he cried, “you ar-r-re no Zhentle- man l’” The hot blood dyed the officer's brow. Sac-r-re!” he hissed; “do you know who eet ees zat you insult?” “Pouf!” cried the civilian; “I do not care.” “Do you veesh to fight?” “Yes. Now and at once.” “Do you not know zat I am one of ze best swor-rdsmen in Fr-r-rance?” “No. It makes no deeference.” “And do you want to die now?” “Yes. Right now.” There was a moment’s silence. “I would gladly keell you,” said the officer, “but eet ees not possible at Zee pr-r-resent mo- ment.” “Not possible. Why not?” “Because I will nevaire consent to fight wiz swor-r-rds zat are not pr-r-roperly r-r-rendered antiseptic. Bonjour, monsieur.”—Ex. An early symptom of locomotor ataxia, says Weiss of Vienna, is the inability of the patient to walk backward. THE MEDICAL DIAL. ix. A Perfect Anticeptic Should be Effective and Harmless OAKLAND HYDROGEN DIOXID is theoratically and practically effective and harmless; it contains only one active ingredient, OXYGEN, the preponderating element in the healthy living organism. It is indicated internally in all forms of dyspepsia and digestive disturbances, butryric fermentation, gastric catarrh, gastric ulcers, etc., externally as a local appli- cation in the treatment of specific inflammations of the mucous membrane, chronic inflammatory conditions characterized by fetid discharges and wherever morbid con- ditions characterized by fetid discharges and wherever morbid conditions or foul secretions exist. “THE KIND THAT KEEPS’’ Manufactured only by The Oakland Chemical Company, 465 West Brodway, - - - - NEW YORK. OQ --Ozºº-ºoºººº-º-O-ºº-º-Oººoº-º-Oººº-º-o-º-º-º-Ozºº PURITY “ºbat (5entliet on the 5pirit Lies, (Iban Cit'o Egelios on Cit'o lºves.” saweles on APPLycarrow To The Anwºrtramwfa chemicAL Co., ST. Louis, U. S. A. --Ost Pºsosº Dº-Osº. Dº-O--Dº-Osº lºº-Osºº Cº * PUBISHER'S DEPARTMENT. - * , - r 3. º, * * * * ... * * *- - - , - * * - §§ ; ºr: 4 * • , - * ~ * - - . •, : - N- k ‘. . -- * * f x - . . . *. - ga ºg # * # * * * : * , . # * *: 2 - ... " - * .. * , ‘. . ******* < - * * . . . . . . . . . ; : * ‘. . . . • - ** , , , . * * { \ . . . * * ... . . » : k *. - sº 3. * * * * § - * - * … • - - * & } a F $ \ - * * † , sº º , * * - - .." R - * # § * * * .* & . - *. * - * # - • * : - * * & * * * t - t # r” ... • & º +. . . It is said that a drowned man is always found floating with face down, while a woman floats with face up. The difference is probably due to the differ- ence in anatomical Construction. The recently adjourned congress of tuberculosis concluded that there is absolutely nothing, known that is practical about the cure of consumption, but the application of formaldehyde was mentioned with * Mr. Henry A. Snyder, of Boston, representing Mellin's Food Company, having spent several Weeks in the Twin Cities among the physicians, anticipates going to his Southern field soon, to pass the winter, after visiting several of the important towns of A northern Minnesota. He made the Dial office a pleas- * A ant visit during the past month. Decreased vitality from almost any cause is rem- edied by the administration of Hagee's Cordial, and the list of diseased conditions in which the Cordial is serviceable is a long one, and includes Consumption, Scrofula, Rickets, Skin Diseases, Rheumatism, Chronic Bronchitis, Epilepsy, Chronic Dysentery, Chlorosis, and all wasting diseases generally. Dr. J. K. Gailey, Clinical Professor of Surgery, Detroit College of Medicine, in giving his experience With “Maltine with Coca Wine” says, it is unques- tionably superior to anything he has ever tried as a galactagogue. In One case, particularly, the moth- er was enabled to nurse her child, Which she had not done with previous children. He considers it doubly efficacious in that it builds up the woman while stimulating the lacteal secretions. LNEQUALED FOR ITS UTILITY. Minneapolis, Sept. 27, 1899. A. C. Dice, District Manager, . W. D. Allison Co., 816 Dayton Bldg., Minneapolis. Dear Sir:—I have been using the Allison Physi- Cians’ Table for over three years, and I cannot en- dorse it too highly. Its construction and mechanism are perfect. For its utility it is not equalled by any Chair or table intended for a physician’s or surgeon’s use that I have ever Seen. C. M. FERRO, M. D. 404 Masonic Temple. (This table is illustrated on 3d page of cover.—Pub’r.) NO BETTER ON THE MARIKET. Candon, Ore., Aug. 18, 1899. Peerless Battery Co., Chicago, Ill. Gentlemen: Your battery is O. K. I have used it With most gratifying results in a case of para- plegia in a boy three years old; couldn’t stand alone, Ino, not eVen turn around in bed, when I commenced using your battery. Now, he can’t walk, but he can Stand alone, and crawls all over the place on hands and knees. And for headache and neuralgia it’s the thing par excellence. My list is off to the Peerless Battery Company for the best Faradic battery I ever Sa. W. - DR. S. R. LIMA. Dr. S. L. Rilmer, of South Bend, Indiana, who is the author of One of the original articles in this issue Of the Dial, is the publisher of a very compact and Serviceable pocket day book, journal and ledger, com- bined, which saves much time and labor. The price is $2.00 per copy. Should any physician reading this wish a descriptive circular, a postal card will bring One. At the same time request another Circular On “Dr. Rilmer’s Tracheotome,” an instrument that is # x * • * & • *. - * . " + % . . . . #, & . 3. ELECTRICITYT Up-To-Date= Instruments will bring great results. In Order to introduce our goods to the readers of this Journal, we will offer the following El G EAR GA! NS for the next 60 days. Faradic Battery, with 2. Dry Cells like above illustration with large Faradic Coil, Adjustâble Rheotome, Indicator and Elec- trodes, Cataloge Price $12.00. Price for his sale only $6 00: 24 Dry Gell Galvanic Battery, with Double cell Collector and pole Changer and Pole changer. All cells in this Battery being §º with springs. Price $20.00. Price for this sale only $14.75, Table Plate, in case with Bevel Plate Glass in top, with High Tension Coil, Galvanic Circle, with Double Cell Collectors, Milliampere Meter, Pole Cangér, etc. Price $43.00. Price for this sale only $32.50 gº Combined Table or Wall Plate, with Galvanic Circle and Faradic Coil, Pole Changer, etc. Price only $8.00. . Storag eCautery Battery for actual cautery work, with Rheo- Stat-, Price for this sale onls $13.50. * Send 3c. su stamps for our catalogue with full line of Faradiº Batteries. Galvanic Batterses, Cautery Batteries, Table and wall Plates, Illuminating instruments, Electrotudes, Static and X Ray Machines. ELECTRO MEDICAL_MAnufacturing Co., 350 Dearborn St., chicago, ILL. Physicians and other profes- sional men may wisely see that the stationery used in their professional correspondence is of attractive and proper style. The Beard Art & Stationery Co. give particular attention to filling such orders, and will send samples and quote prices On request. Address 705 Nicollet avenue, Minneapolis; telephone 181. THE MAEDICAL DIAL. º •Oºººººººoºººººººº- ******* Seeley Hard= Rubber Trusses - mous Cross-body Truss Ready to Wear We shape them to hold each rupture, fit each physique, relieve each case. Physicians' mail orders our specialty. Satisfactory ready to wear truss always sent. Drop us postal for Life Photos, Mechanical Treatment of Hernia. Catalogue, º i i : i Chesterman & Streeter successors to I. B. SEELEY & Co. 25 So. 11th St. Philadelphia. •oºººººººº-ººººººººººººººº. C) ur MARSHALLSC) NVERTIBLEBUGBY CASE Nº.3% -- changes into saddle º Bag (is both in one). - Finest, best durable leather finish outside and in (lined). Con- tents: 1+ 1-oz. rubber 18 6-dr. cork S.–total 32 bottles, with spaces between rows for pow- der papers, 2 sundr º one under lid, 734:294-294. Delivered, privilege of examination, C. 0. D., bal. .50, or ex- press paid. ºùù in I sº"; "º" ºf - 11 saddle Bags low as 5. otties wº tº "º.; ºr: * 3: º, bºttles in springs, 1 sundry space, $3.75. We ºil full line prices and illustrations it asked for. Address W. S. MARSHALL, Care of Exchange Bank. CENTRALIA, IL- eatenºred. º * TLOWERS... BEAUTIFUL ROSES CARNATIONS LILIES recommended for safe, easy, speedy and bloodless tracheotomy. This device makes the operation near- ly, if not quite as easy, as the ordinary hypodermic injection. In the treatment of Nervous Diseases and Gen- eral Debility, McArthur's Syrup Hypophosphites demonstrates its restorative powers. Here it is not the stimulating action of the remedies usually classed as tonics that is needed. The organic powers of the system are already taxed to their utmost ability to carry on the physiological processes of life. The Hypophosphites of lime and soda gives the much- needed effect in these conditions—not that of a stim- ulant by irritation, but that of a true nutriment to the starving tissues. Its tonic effects are permanent as they are the effects of a richer blood supply, bring- ing healthy food and oxygen to the tissues. Thus the patient is gradually brought up to his normal condi- tion. SECONDARY SYPHILLS. Dr. John J. Caldwell, of Baltimore, takes the position that those cases of syphilis which go on from bad to worse are those in which the patient will not take antisyphilic treatment regularly, or they are instances where mercury, or the iodides, do not agree with the patient. In cases of secondary syph- ilis, particularly those where mercury has been given for several months, Dr. Caldwell maintains that great assistance can be brought to the patient by giving him the iodides in a form that is readily assimilable—one that will not disagree with the stomach. No form of the iodides pleases Dr. Cald- well as much as Henry's Tri-Iodides. This he gives in doses of two drachms in water, forty minutes before each meal, and the last thing before retiring at night. Some cases are treated alone with the Tri-Iodides, but where the stomach is intolerant to mercury, he gets the best results from Henry's Tri- Iodides when no mercury at all is given. A WANT FELT AND FILLED. - If the doctor had never accomplished anything more definite in his life work than the relief of pain, than amelioration of human suffering, he would not have lived in vain. It is all very well to say that pain is physiological, that it is the cry of the nerve for more blood, yet its continuance cannot be borne by the patient, even by the most heroic Spartan. Long continued pain is dangerous, and while of course we never wish to obtund and remove it so completely as not to be able to ascertain its cause, and remove the same, yet, the best interest of our patient requires from time to time the administration of that which is opposed to pain. Remedies like opium, which relieve the pain and at the same time are exhilarating and alluring in their effects, are most ofttimes dangerous in the remote demoraliza- tion which they produce upon our patient. A remedy for the relief of pain which does not tie up the secre- tions, which carries with it no exaltation and no fascinations which tend in the direction of develop- ing drug habits, is a desideratum. Five-Grain Anti- kamnia Tablets certainly meet this necessity. Anti- kamnia is also more prompt and decided in its action in labor than opium, and has none of the unpleasant after-effects. It may be continued in smaller doses to control after-pains, and rather favors than inter- fores with the secretion of milk. A FAMOUS EXPRESSION. Professor Gibson, one of the pioneers in the de- velopment of scientific medical teaching in the United States, was asked, by one of his students at the Uni- versity of Pennsylvania, how to obtain a compre- hensive, accurate knowledge of medicine that would enable the physician to make a correct diagnosis, and and all the flowers in their season. ialty. Telegraph orders for funerals and parties romptly filled. Seeds and other florist supplies. Send or Catalogue. - MENDEN HALL GREEN HOUSES, First Ave. S. and 18th St., or City Store, 414 Nicollet Ave., Minneapolis, - - Minnesota. Funerals a spec- º WN £ºšššššāºšāºššº ºcii THE MEDICAL DIAI, | execute proper treatment. Dr. Gibson's reply has become inseparably connected with his name and memory. It was “Principles, principles, principles." By this, of course, was meant that, however varied were the manifestations of disease, they were to be comprehensively grasped only by a knowledge of the fundamental principles of physiology, pathology and therapeutics. The symptoms of disease, however manifold, could be intelligently interpreted only on this philosophic basis. Strictly consistent with this inexorable law is the fact that all conditions of de- pression and exhaustion of the system can be appro- priately and effectively treated only be re-awakening the dormant and torpid nutritive functions. The crying need of the emaciated tissues and impaired vital functions is for food, the natural restorative. In most cases, however, there is not only an indis- position to take food, but the digestive organs are so enfeebled that they cannot digest and assimilate food —their functions are suspended. The first indispensable step is to restore these functions. The ordinary tonics—iron, arsenic, strych- nine, hypophosphites, etc.—fail entirely to accomplish this object. Cod liver oil is the heaviest burden on even the strongest digestive powers to prepare for assimilation; on the atonic stomach it is an irritant— it aggravates the existing trouble. The digestive organs must be gradually coaxed into a condition of restored functions; they need stomachic alteratives, tonics and stimulants. The best of these, as proven by experience, is Gray's Glycerine Tonic Comp. It has a specific, se- lective action upon the atonic digestive organs; it not only enables them to digest food, but it invariably promotes assimilation, so that reconstruction of wasted tissues and nervous force is absolutely as- sured. For this reason Gray's Glycerine Tonic Comp. is the most rational, scientific and effective remedy in all conditions of malnutrition, anaemia and ner- vous exhaustion, occurring either independently as a consequence of organic disease, such as tuberculosis, Bright's disease, or as the result of acute infectious diseases. THE PURDUE FREDERICK CO., No. 15 Murray Street, New York. A NEW USE FOR THE MUSHROOM. We have hitherto been wont to regard the hum- ble mushroom only in the light of a fitting adjunct to beefsteaks, etc., but we now learn that tickling the palate is the meanest of roles which this succulent agaric is destined to play in the affairs of men, for M. Thisalix states that the juice of the mushroom has been employed by him in no less than two hun- dred experiments as vaccine – producing the same symptoms as the venom of viper bites. He prepares the vaccine in the following simple manner: Hav- ing cleaned the mushrooms as well as possible in several washings of water, he cuts them up into small pieces and macerates them in their own weight of chloroform water for twenty-four hours. The liquor is then drawn off and filtered through chemi- cally pure filter-paper. It has a neutral reaction, a pleasant and agreeable odor, and an insipid taste. In color it is at first brown, but quickly deepens until it finally assumes an inky blackness. It keeps well in stoppered bottles, if a drop of two of chloroform be added. Respecting its physiological action, the author assures us that it is not so offensive as one might believe a priori. A dose of ten cubic centi- metres inoculated under the skin of a guinea-pig's thigh produces an oedematous swelling which disap- pears in five or six days. At the same time the temperature rises from one-half to one degree. If a stronger dose (twenty to twenty-five cubic centi- metres) be employed, the local action becomes more pronounced, the oedema spreads to the abdomen, and sloughing sometimes supervenes. The temperature falls gradually (one or two de- 1000 LABELS FREE. THE WIS. MEDICAL RECORDER IS NEEDED BY EVERY PRACTICAL PEI.Y. SICIAN, BECAUSE AS DR. JAS, ADOL- PHUS, OF ATLANTA, GA., SAYS: “IT IS FULL OF PRACTICAL AND INTEREST- ING MATTER THE BUSY DOCTOR FINDS USEFUL.” IT HAS ABLE CORRESPOND- ENTS IN ALL THE GREAT MEDICAL CENTERS AND A STAFE OF REGULAR CONTRIBUTORS, WHO ARE IN ACTIVE PRACTICE IN ALL PARTS OF TELE COUNTRY AND FURNISEL LIVE ARTI- CLES. TO RAPIDLY INCREASE TELE REC- ORDER'S CIRCULATION, FOLLOWING TRIAL OFFER IS MADE, EVERY PEIY- SICIAN SENDING 500 WILL RCEIVE THE RECORDER EVERY MONTH FOR SIX MONTHS AND 1000 LABELS WILL BE SENT FREE OF CHARGE. TELESE LA- BELS ARE 14 NCHES SQUARE WITH YOUR NAME AND ADDRESS PRINTED IN BLUE INK, TELEY ARE MADE OF THE BEST IMPORTED GUMMED PAPER, AND ARE WORTH MORE THAN TELE PRICE OF THE SIX MONTELS’ SUBSRIPTION. TELIS OFFER WILL BE OPEN TO READ- ERS OF THE DIAL FOR A SELORT TIME ONLY. HALL & THRONE, PUBLISHERS, JANESVILLE, WIS. * Ellſbkā Mºhlizęſ º º - º on 34-Sawed Oak Table ºn Air-receiver of seam- less steel, size 10x30 in. | tested to 500 lbs. Fin- \\ ished in nickle plate ºjor ºxidized. The most useful and practical ". paratus ever offered to physicians for the ºr Spºtial Treatment of Chronic Bron- chitis, Incipient Consumption & all Catarrhalaf- A fections of the ºHead, Throat and Lungs. A - - -i. - | ſº - º - º - - - - Write for Literature. 0, 0, HOLMAN, G8I'l Agt, , La º |||. THE ME DICAL DIAL. grees), only to rise again rapidly. The general phe- nomena are more accentuated when the maceration is injected warm into the periosteum, the animal being often seized with nausea and falling on its hindquarters. The temperature falls four or five de- grees and remains so for twenty hours; the stomach is hard and sensitive to the touch. If, however, in- jected into the veins of a rabbit, the liquid produces, even while injecting it, violent shocks, which intensi- fy in proportion as the dose is increased. Generally fifteen to twenty cubic centimetres suffice to produce death. The animal falls on its flanks agitated by convulsions, and asphyxia ensues in a few seconds. If the thorax be at once opened, the heart will be found to be distended with blood, immobile, and all the veins swollen. The blood is black and coag- ulates rapidly. In the ventricles small clots are al- ready observed. Allowing a few minutes to elapse before making the autopsy, the coagulation will be completed in the vessels, and one can withdraw from the heart clots which reach into the aorta and pul- monary artery.—London Health. There is said to be an epidemic of rabies in Erie county, N. Y. It has afflicted not only men but also dogs, horses and cattle. . According to measurements made in Switz- erland, the tallest children are born in sum- Iller”. George J. Monroe, M. D., of Louisville, says of oatmeal that it has been used for centuries, and by millions of people. “It is considered a most excellent food. I believe, however, there are cases where it should not be used. A laboring man, who is most of the time out of doors, can, I believe, eat oatmeal with all propriety, even in large quantities, without harm. But take those of sedentary habits, or those who are nearly all of the time indoors, and I much doubt if they should eat very much oatmeal. I have noticed particularly that it produces constipation in the aged. My atten- tion has been called to this class of people more than it has to the young and middle-aged, because I have treated more aged people for constipation than I have young.” Lºlling Diliggists ºf Millbä00lis, ****** * * * * * * * * * * * --------- **** : tº OPEN ALL. NIGHT. º. : º - º : The Voegeli Bros. Drug Co., : PREscrl PTION DRUGGISTs. : * 2 and 4 WashingtoN Ave. S., CoR. HENNEPIN. : t We carry the most complete stock of Drugs and Chemicals in the Northwest. º Mail orders Promptly Filled. º: ---------------- aa. A ſº & CFACIRCFAILL, | ! PHARMAC 1sts, i. ; Under Nicollet House, Minneapolis, Minn. | | Careful attention given to Physicians' Prescriptions. | -- - --- - - -- - - 4. ºº- ºf - *\ºl º HALF-TONE, | , Zinc ETCHING, Lº- WooD ENGRAVINGº; ESIGNING. ºf º º: - º !. Vº - F *s | Zºº. ONEIDA B10Cſ. MiNNEApolls. Xiv THE MEDICAL DIAL. Elºiſ-Mºſlical and ElBºiſ-Siligital Iſsiſſimºſis, Mar-ur-ac-º-º-º- - The Waite & Bartlett Manufacturing Co. 108 E. Twenty-Third St., NEW YORK. ºs- º | ſº | - The Hall||B) Wimshus Hºli. Stăţi, Māºllinº Is the most powerful made, therefore, for X-Ray examinations and for a wide range of therapeutic effect, it stands unequalled. | | º ME = -ºº-ºº º - || º Used in the College of Physicians and Surgeons, Society of the New York Hospital, Post-Graduate Medical School and Hospital, Bellevue Medical College and Hospital, Battle Creek Sanitarium, and more by Physicians, Hospitals and Sanitariums than any other. SEND FOR, ILLUSTRATED CATALOGUE. NOYES BROS. & CUTLER, Agents, SAINT PAUL, MIN N N Esota. PEERLESS The LATEST and BEST - Faradic Battery Made. Highly endorsed by the Medical Profession as being the most Practical, Convenient, Economical and Simplest Apparatus made for the general Practitioner. ALWAYS READY for instant use. AUTOMATIC-you simply push the button. DIAL designating intensity of current applied. SIMPLE to operate. No switche to manipulate, no box to open. DURABLE –not liable to get out of order. ECONOMICAL–costs but 5c. a year to run. ATTRACTIVE Office Fixture. Regular price, $20; to introduce to Physicians only $15. Shipped promptly on receipt of price, fully warranted. AUTOMATIC-FARADIG PLEASEs ALL; Is SU RE TO PLEASE You. order direct, or of your dealer who will obtain for you, descriptive matter on application. BATTERY. PEERLESS BATTERY CO., 224 Fifth Ave., CHICAGO, ILL. BAZZI-BIAN CHI PhDIB|ISS|| A Singer Sewing Machine Velvet-Lined case, $4.o.o. Beware of infringements. THE BEST INVESTMENT ON EARTH, earning more in proportion to cost than any other purchase possible. THREE DIFFERENT KINDS, either lock-stitch or chain-stitch. BUILT LIKE A WATCH, at the largest and best equipped factory in the world, where every machine is carefully tested on practical stitching. All genuine have our name on instru- ment. Buy from your dealer, or, if not in stock, from us direct. GEORGE P. PILLING & SON, 1229 Callouhill St., Philadelphia, Sole Agents for U. S. A. Sold only by IHE SINGER MANUFACTURING COMPANY THE MEDICAL DIAL. E ALLISON physicians tº 1899 NAO DEL. Have you seen it? This style, No. 34, our latest production, surpasses in beauty, convenience and practical utility anything of the kind ever seen. The unique design, compact and harmonious, adjustable stirrups and leg crutches, glass trays in the revolving cabinets, detachable leg rests, the simple and ingenious mechanism—rendering it noiseless in its movements and easy of manipulation—are the secret ºf its popularity. It is used in the Post Graduate Schools of New York an and heartily endorsed by faculty and students—a distinctio table enjoys. The ALLISON CHAIR has been a leader for years, and is one of the most practical and convenient chairs made. Our COMBINATION CABINET No. 61, As shown in the cut, is a marvel, uniting in a single and handsome article of furtiture an instrument cabinet, aseptic and dust proof, a medicine cabinet with swinging racks for bottles, a writing desk, drawers for bandages, and compartment for wash basin. Our revolving Instrument Cabinets, thoroughly aseptic and proof against dust nd dampness, are deservedly popular. The ALLISDN Wall Cabinet is in great demand. Catalogue Free, W. D. ALLISON CO., Manfrs., 133 E. South Street, INDIANA POLIS, IND. A. C. DICE, Dist. M ngr., 816 Dayton Blog., Minneapolis. Liquor FERMI6ENI THREE CHL HENRY PR-L-N-ED T-REATMENT- Liquor LITHIUM MAZENATE. MAIZO-LITHIUM ------- ----Ts. --> AT-ve plura-Tri- A genito-urinary sedative, an active diuretic; - - solvent and flush indicated for the relief and pre- An ox. **'. fe. vention of renal colic; a sedative in the acute suitable for prolonge stages of gonorrhoea, cystitis and epididymitis ; adults and the aged. I in dropsical effusions due to enfeebled heart or to bodily weakness, conva renal diseases. As a solvent in the varied mani- eases and surgical oper festations of gout, goutiness and neurotic lithemia, the age of puberty, and periodical migrainous headache, epigastric oppres- women. In children w sign, cardiac palpitation, irregular, weak or inter- are backward in develſ mittent pulse; irritability, moodiness, insomnia exists an aversion to and tºº. symptoms of uric-acidemia. administration never Decidedly better, more economical, extensive in ac- tion º in results than mineral waters. CONSTIPATIO In creasing the flow o LITHEMIA by reason of the neutralizing exciting normal per ower of Lithium in combination CHLOROSIS; with Maizenic acid, the superior diuretic. removes intestinal the disease often q ANEMIA of a In RENAL COLIC as a solvent and eliminant - of uric acid, and prophylac- tic against future attacks. In ca.1 ion, aids assimi. ition of fat in warmth and he In vous system. 1ſting f di 1 dis- OEDET1A resulting from cardiac or a renal dis AN ADJU ease the pulse becomes regular and known as iodisi as a urine alkalinizer, and on URETHRITIS account of the remarkable se- dative action of corn silk upon inflamed genito- urinary mucous membrane. strong; there occurs marked diuresis and increas- ed proportion of urinary solids. Those cases of irritable heart, irregular or in- uittent pulse so frequently met with by insur- examiners and found to be due to excess of Rid are special indication for Maizo-Lithum. Chemic Union of Maizenic * Green Corn Sºlk-zºº/, ºrming Maizenate-Lith- aſºns to drachºn, Dose 8 oz. boºtle, ºr.o.o. inva-Li tº di ETARY -- ------------ H. E.N. R.Y. P. H.A.R.M.A.C.A.L. --O. º Louisvi L.L.E., KY. Stimulant to dular system of t in the impaired other gastric sy . 12 the MEDICAL DIAL. MſHypophosco,FEIO) —T- Contains the Essential Elements of the Animal Organization—Potash and Lime; The Oxidizing Agents—Iron and Manganese; Onies—Quinine and Strychnine : t N Vitalizing Constituent—Phosphorus; the whole combined in the form of a Syrup with a Whtly Alkaline Reaction. n Its Effects from all Analogous Preparations ; an it possesses the important prop- f being pleasant to the taste, easily borne by the Stomach and harmless under prolonged use. Rd a Wide Reputation, particularly in the treatment of Pulmonary Tuberculosis, Chronic \ and other affections of the respiratory organs. It has also been employed with much various nervous and debilitating diseases. - Wer is largely attributable to its stimulent tonic and nutritive properties, by mean energy of the system is recruited. pmpt; it stimulates the appetite and the digestion, it ‘promotes assimilation and it into the circulation with the food products. produces a feeling of bouyancy, and removes depression and melancholy ; hence thi great value in the treatment of mental and nervous affections. From the fact, also, double tonic influence and induces a healthy flow of the secretions, its use is de range of diseases. NOTICE–CAUTION. ws' Syrup of Hypophosphites has tempted certain persons to sale. Mr. Fellows, who has examined samples of several pf them are identical, and that all of them differ fro freedom from acid reaction, in susceptibility to the effects SS ight or heat, in the property of retaining the strychnine i hal effects. ºfficient substitutes are frequently dispensed instead of the W. ns are earnestly requested, when prescribing the Syrup, to t is advisable that the Syrup should be ordered in ding marks which the bottles (and the wrappers suſ. examined, and the genuineness—or otherwise—Of to t - Mr. FELLOWS, 48 Vesey Street —--- THE MEDICAL DIAL A Monthly Record of Medicine and Surgery. Vol. I. MINNEAPOLIS, NOVEMBER, 1899. No. 12 Original Hrticles. THE PART of THE STATE IN THE PROG. RESS OF MEDICINE AND SCIENCE. By Franklin Staples, M. D., Winona, Minn., President Minnesota State Board of Health. The important part in aid of the progress of science taken by different departments of the government of the United States and by the several states of the union has been recog- nized, and the results of the same are not un- known. The account here attempted must be mainly confined to work and results accom- plished in individual states rather than to what belongs especially to the nation, and this may be given only in brief outline—a few facts illustrative. A brief mention, however, of na- tional institutions and affairs may be made in passing. BY THE GENERAL GOVERNMENT. The Smithsonian Institution, in different departments of natural science, has had and continues to have its important place in the educational work of the government and its published reports constitute an important ele- ment in the present literature of science. The scientific work of the National Agri- cultural Department, in various ways in con- nection with diseases of grains and other agri- cultural products and with diseases of ani- mals, has a wide field of usefulness. It is not only in such lines of service of vast financial value to the country, but investigations and practical work in this department have been of great advantage in the study of diseases of man, and in practical ways have aided the work of preventive medicine. Another important division of the science work of the gove....11ent is that of the Weather Bureau. Observations in this department have advanced to such a degree of accuracy and completeness, as not only to be of great advantage to commerce on sea and land, direct- ing the movements of the same with a view to safety, but, as an aid in the study of climatic influences, atmospheric changes, temperatures, etc., have come to be of much scientific and practical value in the world of medicine. In preventive medicine and general Sanita- tion the work undertaken by the former Na- tional Board of Health is remembered, and the national and international work of Sanitary in- spection and control, now carried on by the Marine Hospital Service, has a practical value . which cannot be overestimated. Of late years the importance of a knowl- edge of the vital statistics of a country has been realized in connection with observations concerning disease prevalence and causes of death. State departments of health have pro- vided for the collection and have made Valu- able use of such statistics. This work has its place in the national service and is included in the present comprehensive work of the United States census. No mention of the works of the general government which relate to sanitary science should omit that of the War Department. Work in this department is especially directed to sanitary provisions for the army, but it is not limited to this alone. It has its part in the general public health service and its educa- tional influence is felt and acknowledged. Surgeon General Sternberg has been a leader in advanced work during the time of his ser- vice and his diligent labor has been in lines having place in the higher practice of the pres- ent time. His practical work in bacteriology is widely known and his publications have be- come the preferred text books of the schools. The army medical school has the advantage of instruction from this source. An able assis- tant, with others in the office of the surgeon general, is Deputy Surgeon General Charles Smart, who is known to sanitary scientists of the country in his works pertaining to practi- cal hygiene. In the advance of the times the co-operation of the schools of medicine and science of the country, with the departments of the national administration under the man- agement of such directors, has been most ad- vantageous and satisfactory. BY THE STATES. Management in different governments in Imatters pertaining to the progress of science necessarily varies. Ours is a confederation of States. It has been claimed that national rather than individual state administrations may more completely and efficiently exercise the function of sanitary investigation and con- • " ... . . . f ** - * , " " - ? .*.*... . .';*, * * * * - - 2 m : * * ***"...--rk. . . . . . . . . . * * * : . . . . ventive medicine has its appropriate place in departments both of state and nation. While the general government has long had its part in the advancement of science in various ways, the states, as such, have found their opportu- nities largely in what has come to light in the development of modern state medicine. - The province of preventive medicine is necessarily with preventable diseases. A word here will be allowed concerning the pres- ent field of operation and what has come to pass tending to render work therein more suc- cessful. Not only has the scope and extent of the great class of communicable diseases been more clearly defined than formerly in the ad- vance of modern science, but the nature of in- dividual diseases, their modes of propagation, the character and behavior of the different in- fective agents, are more definitely understood. The work of many scientists in different coun- tries has borne and is now bearing its fruit. The advance of knowledge in pathological anatomy, the advent and development of the Science of bacteriology and the consequent in- creased knowledge of the etiology and path- ology of many diseases have afforded definite direction for treatment and the use of preven- tive measures. Sanitary laws, state and national, are founded upon the principle of the right and obligation of government in the protection of the lives and property of citizens. The enact- ment of such laws and the formation of state executive organizations for service under the Same has characterized the action of the more advanced governments of the world, especially during the latter part of the present century. Recent great advances in departments of nat- ural Science relating to infectious diseases in man and animals have afforded valuable direc- tions and made the way possible for the effec- tive preventive work now undertaken by the state; and the state, in turn, while engaged in the field work of the public service, with the diligent use of means at hand, has provided means for promoting the further advance of Science in practical ways. Witness the estab- lishment of laboratories and the support of Working scientists for study and practical work in bacteriology and pathology. The warfare of sanitation against the forces of infection is both defensive and ag. gressive. The lines of advance have been in three principal directions, as follows: First, attack is made upon the sources and supplies of the invading forces. The places of origin and the conditions favorable to the production of infective germs are looked for and located. Houses and house surroundings are in spected With reference to garbage disposal. sewerage, ventilation, etc. Of not the least importance in reference to possible sources of typhoid fever and the infections of certain other dis- ; :* . . . . . . . .-2: . . . - , ". . . . - - - - ... . . . . . . . . pºra ºf Y \r-y Aſ T- Zºº A . . . ºr ' A T . . . . . . . . .. . . . . . . . . . . . . . . . . . . , , ; . . . . . - - ... } - - - º - º . . : . ". * * * l trol. It appears, however, that in this country the management of affairs pertaining to pre- many. ; : " . . . . . - , , ; ; ; ; ..." cases is the condition of public and private *... water supply and the quality of food products. Further, in the matter of looking for spe- cific causes of disease with reference to the removal of the same, we have the advantage of certain new or improved methods of diagnosis; for instance, the tuberculin test for determin- ing the existence of tuberculosis in animals and man, the serum diagnosis of typhoid fever by blood examination, bacteriological exam- ination to determine the presence of diph- theria, etc. These examples illustrate—the few for the Investigations in the etiology and pathology of infectious diseases, made by use of means and methods such as these, serve to render the biologic laboratory not only an in- stitution for practical work in preventive medi- cine, but also a school of instruction for medi- cal scientists. * Again, when the infective agent is found to exist, means are employed to prevent its pas- Sage and to diminish its opportunities for fur- ther invasion. This is done principally by authoritative isolation of the infected. Late developments in science relative to the nature and behavior of different infective germs have become valuable aids in determining the char- acter, extent and time limit of quarantine re- quired in different cases and the necessary dis- infection of persons and premises. A further and a most important means of preventing the progress of infection is that of Securing immunity of the individual to the ac- tion of specific infections. The forerunner of this method was the discovery of vaccination by Jenner near the close of the last century. Notwithstanding the influence of this example, nearly a century was required to secure fur. ther advancement along this line. But princi. pally within the last quarter of a century sci- entists in the leading countries of the world, by diligent and continuous study, have suc. ceeded in bringing to light much valuable and practical knowledge concerning the use of at- tenuated or modified virus of specific infec- tious diseases in safely securing immunity to further attacks. Managers of state and other laboratories are now actively engaged in the Preparation of material for this work in serum- therapy, so called, are affording instruction concerning the use and advantages of the same and by much experimental study are aiding the Work of further advancement. In the matter of recent advancement of the standard of medical education in this country, Which is now known as one of the most im: portant movements favoring the progress of Science in recent times, state enactments re- quiring higher qualifications for medical prac- titioners within the limits of the states are en- titled to principal credit. While the exten- Sion of departments of science pertaining to medicine, and the development of new lines of study, such as that belonging to the science of , ºr . . . º: THE NAEDICAL DIAL. bacteriology in late years, have had their place in making advance necessary, yet without the requirements of the state, opposing forces would likely have prevented the advance at present realized. As it is, the struggle with short-sighted and selfish interests has been considerable, but the interests of higher edu- cation have been able largely to gain the as- cendency, and the result is as we now see it. With the present state of medicine as it is, and in view of the part now assumed by the state in aid of the progress of medicine and science, there is occasion for rejoicing at what now ex- ists and for the hope of continued gain in the future. This brief mention is but an outline, and partial at that. Any account in detail, to be at all complete, would require a volume. This is as yet unwritten. Further facts may be ob- tained from various state and government re- ports and from observation in different de- partments of public works. * THE TREATMENT OF PULMONARY TU- BERCULOSIS BY THE INHALATION OF ANTISEPTIC NEBULAE. By Homer M. Thomas, A. M., M. D., Chicago. At the Louisville, Ky., meeting of the Mis- sissippi Valley Medical Association, I had the privilege of presenting microscopical proofs of the penetrability of vaporized medicaments into the pulmonary alveoli. Previous to that time all text-books on this subject stated that it was impossible for nebulae to reach beyond the Smaller bronchial tubes. A demonstration of the fact that nebulae do reach the pulmonary alveoli raises the question of their efficacy in the treatment of pulmonary phthisis. Work demonstrating the value of this form of medi- cation in the treatment of pulmonary tuber- eulosis has been going steadily on until the present time. It is the purpose of this address to present Such clinical facts as have been obtained through the use of this special form of medica- tion in the treatment of pulmonary phthisis. There is no specific treatment of this disease. Cures are reported upon every hand through the media of many agencies. The disease be- ing a complex one in its varied manifestations, each case should be treated upon such special lines as are individually indicated. The basis of all successful treatment is in the main- tenance of nutrition. As a corollary to this, is the influence of selected climate, judicious exercise, rest, baths, internal medication and all other collateral agencies which stimulate vital resistance. * Read before the Medical Section of the Mississippi Valley Medical Associatfon, at its Annual Meeting in Chi- cago, Oct. 4, 1899. 335 ANTISEPTIC NEBULAE IN THE ROLE OF CURE. Having surrounded each case with the es- sential conditions for repair of the pulmonary lesion, what relation does the inhalation of an- tiseptic nebulae bear in the role of cure? The answer to this query involves a consideration of the pathological basis upon which nebuliza- tion of antiseptic medication rests. It is proV- en beyond doubt that these nebulae penetrate through the ramifications of the respiratory tract wherever it is possible for air to go. The first question to determine, then, is, wheth- er the medicament can reach the origin of the disease; and will it prove effective when the origin of the disease has been reached, is the second problem. The air vesicle route is the rational One, since tubercle bacilli are discharged through the air, and are found in the sputum. The absence of general infection in curable cases shows that the possibility of connection with blood vessels is not large. All inflammatory areas are areas in which the mechanism of ex- tra vesicular interchange is materially inter- fered with. Large numbers of tubercle bacilli are discharged by the air vesicles. Few get into the blood or lymph current; therefore the air vesicles must be in closer touch with the tubercle bacilli. The presence of the large quantities of pigment from the air around tubercular areas shows that considerable ab- sorption through the lymphatics from air ves- icles is possible. A nebulized antiseptic hav- ing reached the area beyond the limit of cur- rent finds a greater probability of falling on the epithelial covering and of being absorbed from it than if it reached only to a zone of cur- rent, for in such an extra current area no force is operating save gravity. On reaching an ex- tra current zone nebulized antiseptics fall on squamous epithelium and encounter active phagocytic cells. In a zone of current they fall on ciliated epithelium and are wafted to the outside. These mechanical laws hold good whether the foreign body be tubercle bacilli, dust, or oils in suspension. Since this is true of healthy lungs, is it true when we speak of tubercular lungs? Neb- ulized antiseptics suspended in the air will reach the cavities and air vesicles of tubercular lungs just as well as if these lungs were healthy. But where there are considerable Zones in which the air vesicles are obliterated these areas are necessarily very difficult to ap- proach from the side of the air vesicle. Oil globules falling in the air vesicles of the neighborhood are picked up by the phagocytes, absorbed, and, finding their way into the lymph and into the blood, reach these masses of tubercular overgrowth with as much readi- ness as they can be reached in any other way. It is true that the presence of large areas with- out air makes success through air routes very difficult. Admitting that encapsulated tuber. .” .** 's ** * £ ... ', *4 * & . - 4. - • * - * , - ..º.º. . . . . * * *. * , . - *…* . . . . . . . ** * > . . - . … • *- $33. . *** . . . . * ~ *. . . . . . º, , , ... * * * * * - - - ** . ... ? -- * : - . " * … ** - * -- - - §: 3: • * , :4. - w .*-*ś. ' ' '.' * * ~ * - 3. * - •. ‘. . . . - w * , - - *** 3 - ~, - *** * **, *- * 2, 3, " ... ." - - º a? w . . , , - - *.* - * *. t cular foci, cannot be reached by nebulized medicaments, is there any known therapeutic agent which can reach them? None that I know of. Nature has walled off these encap- sulated tubercular foci by connective tissue barriers and in that way makes an effort to effect a cure. It therefore follows that the most rational way to treat locally these tuber- cular encapsulated foci is to attempt to render antiseptic their contiguous areas. - The pathologic conditions we have to deal With are those of lowered vital resistance in the lung tissue; development of tubercle ba- cilli; hyperplasia of fixed cells; formation of epithelioid cells; development of knot-like foci where the tubercular bacilli multiply; giant cell formation in which there is no new capil- lary formation; inflammation; degeneration of the blood vessels, lymphatics and air passages. In these areas, leucocytosis, further retrograde changes, mixed and secondary infection. That antiseptic nebulae have a beneficial in- fluence on the parts of the lung they reach there is no doubt. In such places the laws of Osmosis and dialysis unite to aid in the preven- tion of new invasion. That these antiseptic nebulae do not reach the encapsulated areas is no argument against the efficacy of this method of treatment, for neither can these areas be reached through the blood nor the lymphatics, by antitoxins or any method of hemotherapy, for no blood vessels or lymphatics reach these walled off foci. Therefore our therapeutic re- Sources are confined to persistent efforts to- Ward preventing an extension of the tuber- cular processes. SCOPE OF NEBUILIZATION. What is the scope of nebulization? 1. Con- trol of cough. 2. Relief of dyspnea. 3. Inti- mate contact of antiseptic nebulae upon 1400 Square feet of respiratory capacity. 4. In- hibition to the extension of tubercular foci. The advantage of controlling cough by in- halation, rather than internal medication, is self evident. By bringing to the inflammatory areas through direct contact specially adapted formulae of expectorant or anodyne combina- tions, you allay many or all of the distressing Symptoms from cough. The relief of dyspnea, incident to the block- ing of the larger or smaller tubes by catarrhal products, is often marked. By means of ex- pectorant types of nebulae this as a rule is readily accomplished. To properly use the antiseptic nebulae in the treatment of pulmonary phthisis it is es- Sential that an abundance of compressed air be Supplied at a steady pressure of from fifteen to thirty pounds to the square inch. The air should pass through a series of antiseptic chambers which entirely free it from all Tim- purities. When it is purified and then com- pressed a final measure of purification should THE MEDICAL DIAL. . . . be given by its passage through the oil of cloves. In cold weather it is better that the air should be heated to a temperature of 60° to . 70° F. before using for the purpose of produc- ing nebulae. Given an abundance of air that is properly prepared for use, a well devised and constructed nebulizer is placed at a point con- venient for the patient’s use. Into this neb- ulizer a variety of formulae can be used; the selection of the special combination suited to each case will depend largely upon one’s ex- perience in the use of this form of medication, and from a close study of the physical findings in the chest of each patient. Where it is de- sired to relieve cough a mixture containing the tr. of stillingia and beechwood creasote, with lavolin as a base, is quite often efficient. For the relief of the dyspnea, which so often arises from a catarrhal blocking of the tubes, both large and . Small, expectorant combinations with carbonate of ammonia, syrup of scillae, syrup of pruni virginae, with lavolin as a base, often give marked relief. one in which there are specially urgent symp- toms to relieve, and where there is general toxemia from the disease, recourse should be had to the use of the well known and tried antiseptics. Nebulization of eucalyptus, oil of cloves and beechwood creasote have been often effective. A mixture of ten per cent. iodoform in solution with sulphuric ether and lavolin has been found very valuable. Frequently the use of pure Ceylon cinnamon oil in solution, With lavolin as a base, in a preparation of about ten per cent., is an excellent stimulant for the bronchial mucous membrane. Whilst all of the foregoing are standard antiseptics, and have their range of usefulness in individual cases, it has been found that they do not inhibit the growth of culture media, hence nothing pathologically curative can be claimed for any of them. They are useful more for the relief of symptomatic conditions than for curative results. We have, however, at our command one antiseptic, a powerful * - - * * * , ; * Should the case be germicide, from which there is reason to feel hopeful that valuable results will be secured in cases of pulmonary phthisis. This antiseptic is formalin. It has been found by experiment that culture media placed in an atmosphere Saturated with a respirable solution of forma- lin are markedly inhibited, and, in some cases, entirely arrested in their development. With this fact, upon which to estimate the anti- septic value of formalin, we feel justified in claiming it to be our most valuable remedy in the treatment of pulmonary tuberculosis by inhalation. In using formalin I begin with a four per cent. Solution of the forty per cent. aqueous commercial solution in water. This is placed in the nebulizer and violently agitated by means of compressed air. I do not nebulize this solution, but favor evolution of the gas * - * , º, . - ^ through a mechanical mixture and agitation due to the pressure of compressed air. In a short time cases develop and acquire an in- creasing tolerance for the formalin mixture; and by degrees its strength can be increased ... from four per cent. up to twenty per cent. * One invariable rule should be observed in the use of this therapeutic agent, and it applies * * > .* i as soon as cough ensues. with equal force to those previously men- tioned, to instantly cease their administration By pursuing this plan the tolerance of the patient is readily se- cured and the time in which nebulization can be administered correspondingly lengthened. RESULTS AT THE COOK COUNTY HOSPITAL FoR consumPTIVES. There has within a year been established in this county a hospital devoted exclusively to the treatment of consumptives. This building is completely equipped with chemically pure compressed air, abundantly distributed, and the treatment of pulmonary phthisis by neb- ulization is there extensively used. I have rec- ords of a number of cases treated there since the 21st day of February, 1899, and desire to call your attention to some of the results Se- cured from the treatment. All of the cases were in the second and third stages of phthisis. They numbered fifty, all males. Of these we have a gain in weight among fifteen of the fifty averaging from two pounds to twelve pounds; a loss in weight among thirty-five, and in five cases there was neither loss nor gain in weight. When we reflect that the patients coming to this institution were in the worst possible condition of general health, all suffer- ing from advanced tubercular processes in their lungs, that the food supplied is of poor quality, and in every case inadequate to the proper nourishment of the patients, I feel that the showing made in the short time elapsing, from February 21st to August 15th, is a very creditable one. I am quite aware of the inac- curacies that statistical statements may lead ‘one into; I also appreciate the errors of deduc- tion that one may easily make from such a general aggregation of cases, but I feel war- ranted in asserting that a very large propor- tion of the improvement, forty per cent., ob- tained in the number of cases enumerated, has come from the persistent saturation of their respiratory passages with antiseptic nebulae. As far as the work has progressed it cer- tainly opens up a Vista of therapeutic possi- bilities. As I have already stated, a lung with a tubercular process shows an immense amount of newly formed connective tissue. This is an effort on the part of nature to wall off the pathological process. If nature is suc- cessful there is nothing left but scar tissue, the tubercular process is inclosed and the pa- tient recovers. If nature does not succeed, secondary mixed infection takes place, we have THE MEDICAL DIAL. sepsis, and the patient dies. There is only one . * * cure, that is by walling off the tubercular pro: cess by embryonal tissue. am led to conclude that medicated Vapors are of great value in favoring such a process. Neb- ulization always did, and always Will, occupy a secondary place in the treatment of this dis- ease; its function is that of a supportive role, rather than the development of curative prop- erties per se. We should remember that in ad- vancing infection with the tubercular bacillus it is the vital resistance of the cells and the possibility of the reproduction of embryonal tissue which we must strive to secure. How much any treatment assists these processes it is difficult to say, but only along the lines of such assistance can success be reached. The treatment is not necessarily an effort toward the extermination of tubercular germs, but the stimulation of the cellular structures of the system by which the patient may resist invas- ion of the germs as well as the toxins which are manufactured and thrown out by the germs themselves. THE MECHANICAL METHODS. There are many mechanical methods for the introduction of antiseptic nebulae into the res- piratory passages. A double glass tube, so constructed as to occlude the anterior nares, will enable the patient to inspire freely through the nasal passages. The nebulae can be admitted by a single glass tube held be- tween the lips slightly compressed, and in- halation will take place through the mouth as well as an admixture of atmospheric air through the nares. The preferable method is the use of a pure gum-rubber funnel top, such as is used for lavage of the stomach. This funnel top is readily adjusted to all the irregu- larities of the facial contour and very little of the nebulae escapes during its use. With this contrivance deep inspiratory efforts can be made simultaneously through the nares as well as the oral opening. The period of deep inhalation should be regulated by the easy tolerance of the patient to the nebulized med- icament. Cough is the only warning sign which should cause us to desist for a greater Or shorter length of time in the use of the nebulae. With increasing use on the part of the patient, the time of contact of the medi- cament with the respiratory passages can be greatly lengthened. Again, the nebulae can be respired directly from the exit opening of the nebulizer. This is a good way for those com- mencing the treatment, as the larger admixture of atmospheric air renders the deep inhalation of the nebulae less irritant. As a supersaturation of the respiratory passages With this nebulae is the desiderata aimed at, the whole atmosphere of the room in which the patient is placed should be com- pletely filled. Under these conditions every In my experience I - - - . . . . . - * -- - * * - - - • *. * * a ' ... ." ": f , “ . * * -. f - . s - * •, , - - -- * * - * *- . . - 2 : * * * *'', 2', \,” . . * * yº - * t . ** *, - - * . . . * .*, *s a * - . . .” - 7. * zºº. - “...i. *. *. * x # • * 43 §§ 3 : , is - : . . . . . . . . • • * : * , . . . *. - - - - ; : " ", •. 3. * * * * * t $. 3. r & wº 3. º, W ~. - - : . * * respiratory effort carries into the lungs a greater or less amount of nebulized medica- ment. So complete is the supersaturation at- tained that the expectoration of tubercular pa. tients often has the characteristic odor of the medicament nebulized. The perspiration from the skin will also have this odor, and the ammoniacal odor of the urine is frequently lost in the characteristic smell of the nebulized medicament. - *. The adaptability of this form of treatment for individual use of patients in their homes is very wide. A great deal of mechanical in- genuity has been shown in efforts made to eas- ily produce a large volume of compressed air for nebulization. Beginning with the Small hand bulb nebulization, is only secured in a very inefficient and interrupted way. Passing from that primitive form up to the use of pumps, an almost infinite variety of mechan- ism has been devised. There is the hand pump, which is tiresome, and at best, can only be operated for a comparatively short time. Then there has been an effort made to redupli- cate power by means of long lever pumps, ro- tary and circular. The most feasible and prac- tical means of obtaining compressed air for nebulization, in localities where there is water supply to the homes, is in the use of the mech- anism known as a compound pump. This pump is cylindrical in form. The water enters at the bottom and through a system of valves the pressure of the water operating upon the valves efficiently compresses the air and forces : it out through the opening from which it is conveyed into the reservoir for use. The usual water pressure is from sixteen to twenty-five pounds to the square inch. . By the use of com- pound pumps the pressure may be increased to thirty-five or forty pounds. & Should it be desired to take up nebulization to a considerable degree for the treatment of phthisical cases at home, facilities for the easy entrance of air into the pump are neces- sary. One of the first points to remember is to take the air from the highest point possible in the vicinity of the home so as to get it as free from surface contamination, odors and gases, as possible. In order to do this, after the pip- ing has been placed at the highest point, there is put at the outer end, two or three screens varying in increasing fineness, so that the air is put at the outer end two or three screens preventing the ingress of any dust or solid im- purities with the air. When the air is me- chanically filtered and compressed there should be placed an antiseptic chamber for the pur- pose of holding in suspension some antiseptic oil, as oil of cloves or oil of wintergreen. Af- ter this purification has been secured the air is then ready for piping to any portion of the home where its use is desired. The plumbing connections should be made at the point of en- trance of the water to the home, preferably in THE MEDICAL DIAL. the basement, for the higher you carry the pump from the basement the greater the cor- responding decrease in pressure. An appara- tus, such as I have described, can be placed for about $100. $Y - ge f While the inhalation of antiseptic vapor is not a specific for tuberculosis of the lungs, yet - it plays an important role as a supporting means to other methods of treatment. There can no longer be doubt of the penetrability of properly compounded and vaporized medica- ments. Their value in the treatment of pul- monary phthisis is largely determined by the medicament used and the amount respired. Clinical experience has proven their value. The weakness of this method of treatment lies in the therapeutic action of the medicaments at our command, rather than in the mechanics for vapor production. Chemical researches of the future, we hope, will yet bring to our aid more powerful antiseptics than those now available; powerful in their selective antag- onistic action upon the pathological conditions of pulmonary phthisis and yet harmless in their effect upon the healthy structures of the respiratory passages. We are strong in mech- anism, weak in therapeutic resources. A PLEA FOR THE ADOPTION OF THE INHAILA- TION METHOD. I believe the chances of successfully coping with pulmonary phthisis are greatly enhanced by the general adoption by the profession of the inhalation method. It makes possible the creation of a sterilized atmosphere for the res- piration by patients in their own homes. Too long have the profession been under the shrewd and often unscrupulous domination of those interested in the “commercialism of cli- mate.” In many instances incurable cases have been sent long distances from home, at great expense as well as bodily discomfort, al- lured by false hopes of the climatic cure of phthisis. Prominent specialists in localities, Supposed to have great virtue in the cure of this disease, have reaped great financial re- wards from the credulous faith of the incur- ably sick, and, when at last the fallacy of such hopes has been demonstrated, the excuse is given that they came “too late,” and, would they die at home, must return at once. No in- telligent physician can deny the value of alti- tude in the treatment of selected cases of phthi- sis, but the great rank and file of these suffer- ers leave the comforts of home to share the dis- comforts of a residence away, when their dis- ease is equally amenable to home treatment. I plead for greater discrimination in the selec- tion of cases that leave their home climate for Often an elusive hope of benefit in other alti- tudes. With our more intelligent apprecia- tion of the causative factor in the production of this disease, with the valuable curative agencies we can surround our patients with at their own firesides, and with the additional compensation that if cured at home they can forever remain there, we should use conscien- tious discrimination as to where and when We send our tubercular patients. While assidu- ously working to cure, by any means in our power, let us not neglect the broad field of the prevention of tuberculosis. - There is every probability that the absolute extinction of tuberculosis from the World is not far distant. It is inevitable that when the race becomes fully cognizant of the dangers from tuberculosis and the simple measures necessary to stamp it out of existence, they will arise and forever make this Scourge a thing of the past. Most hopeful is the outlook for the accomplishment of this great result. Not alone are the masses awakening to the needs of the hour, but those in high places, even royalty itself in England, is championing the cause of race emancipation from tubercu- losis. Innumerable societies are springing up in every village, hamlet and city throughout the land; prevention, like territorial expan- sion, is in the air, and so comprehensive is this reform in its scope that a great international conference for war on tuberculosis has re- cently held sessions in Berlin. Let us all do something to restrict this disease, so that with the dawn of the new century we may hope to see the tuberculosis problem solved by the most humanitarian methods, thanks to the combined efforts of physicians, health officers, statesmen, philanthropists and the good Will of an intelligent people. Marshall Field Building. COMPLICATED UMBII,ICAL HERNIA WITH FAECAL FISTULA A Clinical Lecture Delivered at St. Mary's Hospital, Minneapolis, by James H. Dunn, M. D., Professor of the Principles of Surgery, Medical Department, University of Minnesota, Gentlemen: We have here a very interest- ing and complicated condition. The patient, Mrs. “D,” is 45 years of age, and though of small stature weighs 240 pounds. She has a large umbilical hernia, which began during childbirth, eighteen years ago. During these years it has gradually increased in size, until it has reached the size of a man’s head, but has caused her, until lately, very little inconven- ience she having retained it to some extent by a bandage. *; About the 15th of January the tumor be- came painful and sensitive, and on the 18th severe vomiting, pain in the abdomen, and complete obstruction of the bowels, ensued. Hot applications were applied, and on January 25th the skin, which is said to have been red and fluctuating over this part of the hernial distant from the fistula. - - - - - - * * - * * - . . . . .” - , - * ... ' * -- . , ; } = 3:...*.*.*.*** - * - - * * ! . 4. - * * , ** * . - * : * : . * ; : . * ~ * : , º, . " : "... -33 - gº rº * - * . ." t - - • * - !. . . 3. • r * . . . * * *... : :"K, $2.5 : *"…ºw - * * * , t 1 * - • * - * * - - - " . - sº :- *** v - , t - • ‘ * - - * - w * & - * * * > - 3. - - – - * - •. 2 - * ,- - - - - - - r - - - - -- - y ºf 7 - -- - - - - - * t - * . sac, broke through and discharged some pus # '' { . and faeces. From the 18th to the 25th there had been complete obstruction of the bowels, vomiting, pain and abdominal tenderness. After ulceration through the skin, and dis- charge of faeces, all symptoms of obstruction subsided, but nothing has been discharged by the natural passage. This history obtained from the patient, in- dicates that the sac became inflamed, and the intestine attached wall. This loop probably became twisted on its axis, causing complete obstruction of the bowels, and the patient was relieved from im- pending death by spontaneous perforation of the abdominal wall. These old, large umbili- cal hernias have a considerable direct mortal- ity and a great tendency to relapse, even if the patient recovers. The subjects are very fat, the abdominal muscles much atrophied, and it is often extremely difficult to return the great mass of intestines and fatty omentum into the abdomen and bring the separated mus- cles anywhere near into apposition, at least without great tension. In this case we have the further unfavor. able conditions of extensive adhesions and a perforated intestine from the inside, while ex- ternally, as you see, the skin is extensively in- flamed, irritated and infected by the discharge of faeces. It is therefore impossible to render the field of operation anything like perfectly aseptic. We have devoted a great deal of at- tention to the skin and abdomen for the last five days, since the patient entered the hospi- tal, January 31, nevertheless there is an area of five or six square inches of skin very red and inflamed, and consequently septic. After the most thorough cleansing possible, of the ab- domen, I poke a small piece of gauze into the fistulous tract to prevent further discharge of faeces, and sew a piece of rubber tissue over this bad area of skin in order to keep our op- erative field as clean as possible. In removing the sac, it is often well to re- move a part of this redundant skin. This is usually done by a vertical ellipse, but in this case, on account of this bad area of skin, I shall make a transverse ellipse which will make a long scar in the skin across the ab- domen instead of up and down. Besides, I think, sometimes where the abdomen is very pendulous, this transverse skin incision is pre- ferable. Turning over the large flap of skin, we now Open the hernial sac on the left—the side most sac throughout its whole length, we break up the adhesions, except that of the intestine about the fistula. After the whole sac is cleared away down to this point, we pack gauze about this coil of intestine, separate it from the sac, and now the question arises whether to resect the intestine or simply suture itself to the abdominal After opening the the MEDICAL DIAL. the opening, which is frequently not very wide, and extends parallel with the intestine on its free border about three-quarters of an inch. I think there is not more than one-third of an inch in width gone. Freshening the edges slightly, I sew it with a fine silk, Lambert stitch. This, as you will see, reduces the lu- men of the intestine very considerably, not, however, so much as would appear, because the contraction of the muscular fibers, from the irritation of sewing, makes it look almost lead-pencil in size for the present. Were the contraction really as great as it appears, it would be certainly unsafe, and we would have to make a resection. I am quite sure, how- ever, that the decrease in the lumen of the bowel is not greater than one-third of an inch, therefore, I think I will not interfere with the action of the bowel. Now we clear away the rest of the sac and this large diamond shaped piece of skin, fat, etc., and we have the situation cleared up so far; but, as you will observe, I have not been able yet to reduce this mass of abdominal contents. I enlarge somewhat the opening in the median line, and with great difficulty we Succeed in getting the intestines and omentum back, but it would seem almost impossible to bring the widely separated rectus muscles to- gether. We loosen them up on each side, and with much attention and difficulty finally suc- ceed in getting them to nearly approximate. Under these circumstances we shall sew the muscular walls together with a silver wire, mattress stitch. The tension is altogether too great on these stitches in bringing the abdo- men together, but I see no way to further re- duce it, and while I fear there may be a re- currence of the hernia, under these circum- stances, I feel that this is the best that can be done with safety. - We next close the skin with interrupted silk Worm gut suture, and apply the usual ab- dominal dressings. Note.—The patient made a remarkably good recovery, without suppuration, disturb. ance of intestinal function, or relapse of the hernia. DOCTORS IN PERU. A correspondent of the Chicago Record says that in Peru, South America, American practitioners in both medicine and dentistry are much preferred by the populace, but the native practitioners, realizing this, make it as difficult as possible for foreigners to secure the right. No American diplomas are recognized, and the practitioners are required to speak the Spanish language. They are obliged too to pass a rigid technical examination, both writ- ten and oral. This is “protection,” and an ap- plication of the theory that is not relished by Americans who visit that country.—Peoria Med. Jour. * A RETRO-PERITONEAL CYST. By A. W. Abbott, M. D., Minneapolis. Clinical Professor of Diseases of Women, Medical Department, University of . Minnesota. Miss H., age 23 years; single; menses regu- lar. Pain in left pelvis for about a year. Five months ago first noticed swelling in left side, which has gradually increased. About this time felt sick and could not work, but got to work again in a week or two. One Week ago began to have fever, which has ranged from 99° to 101° F., with increased pain. The above history was furnished me by Dr. J. Hvoslef, with the diagnosis of probable ova- rian cyst. - Physical examination September 15, 1899. Patient thin, anaemic, confined to bed; pulse 100; temperature 100; chest, abdominal organs and urine normal. Extending from Douglas’ sac to one inch below left twelfth rib, and lat- * * ; º RELATION OF SIG MOI D TO TUM OR. a Sigmoid. b Incision in Broad Ligament. c Outline of tumor. d Bladder. erally from extreme left flank to two inches to the right of navel, with a decided projection in front, was a very tense, fluctuating tumor, to- tally immovable, and covering over the uterus, which was crowded backward and to the right. The uterus could only be outlined by rectal examination; ovaries and tubes could not be made out. Pressure produced pain. Diagnosis.--The fluctuation, immobility, tenseness, comparatively slow growth, and the fact that it developed from one side, suggested an ovarian cyst, probably intra-ligamentary. The tenderness and temperature indicated, in addition, an inflammation of the cyst wall. This diagnosis was by no means positive, as * Presented at the meeting of the Hennepin County Medical Society, October 9th, 1899. A. . . . . . . 4. * . . ... • , - . . . . w - * , * ~ * • w *. *.*, n * ...- … • w 's . ** * r - - . . * - - * * . . . - s- “. . . . . . . . " & 5: . . . . . . . . . . . . . . - - * - - -- - r - * - .."? . . . .* * - - . . . . . - : *, w - " . . . . * * * r * * , * - - - -- - º • ? - S. - * * - : - . . . - - ... - - - .* . * - - • * 1 * º - - - * * ' ' ' . - - 3. ~ * . . . . . . * - *, - . - . . . - i - . » - . . . * > . . . ,, . . . . . - t - - - - ~ 2. ... • * ; : { - - - * - * * f . . .” . . . . . ‘. * º ,-u ". - - - - - - - " . - r irs - - ... . . A f - ... • * 3 : -- - t º - r * * . * * , r * f -- * * - * - : * . - - d 4. • * º t the symptoms were also quite suggestive of tubercular peritonitis, septic hamatocele, Sup- purating fibro-cyst of the uterus, or even an ex- tensive pelvic abscess. The fixedness, tense- ness and unusually severe pain were the es- pecial features that indicated quite forcibly an intra-ligamentary cyst. - A median incision was therefore made, from the navel to the pubis. The turnor im- mediately presented. The color was, if any- thing, a little darker than that of an ordinary myoma. The vessels, especially the venous trunks, were much smaller (the largest being not larger than a straw), and I was struck with the fact that they did not seem to run in grooves, as is generally seen in myomata. The general direction of the vessels was longi- tudinal with the body. DI AGRAN OF VERTICAL SECTION OF THE TU fin OR. Open space between de and de shows line of incision through broad ligament and cyst wall. a Ovarian, b Uterine ligatures. c Sigmoid. d Wall of cyst. e Broad ligament. The sigmoid was now seen crossing over the upper part of the tumor. The peritoneum was very much elevated at the flank and left side of the pelvis, but not in the region of the bladder. The left tube could be felt, but not seen, passing over the extreme right but un- der portion of the tumor. The uterus could not be reached, the tumor so covered it over. On account of the stripping up of the peri- toneum and the distortion of the parts by the growth of the tumor, the position of the ovari- an and uterine arteries on eithér side could not even be guessed at. No part of the tumor projected through the broad ligament, which seemed much thickened. It will be seen that only one course of pro- cedure was available—that of enucleation, as suggested by Miner. A Tait's tube was pushed into the tumor, and a thin yellow fluid escaped. The tube, however, soon became clogged with a fibro-gelatinous greenish-yellow mass. An opening was made through the broad ligament and cyst sac, three inches long, parallel with the blood vessels, the hand intro- duced, and about a quart of the gelatinous mass and two quarts of fluid removed. The line of cleavage between broad ligament and true sac was not hard to find, but the enuclea-ºº: tion was very difficult, as 'will be appreciated gº by examining the specimen. t The Ovarian and uterine arteries were at last determined by the impossibility of going on with the enucleation at these points. They Were then ligated between the sac and broad ligament, These were the only ligatures required, al- though two clamps were placed on small branches, at the bottom of the cavity, in the pelvis. The bleeding was surprisingly small. The broad ligament was about one-eighth . of an inch thick over the tumor, and the true Sac Was about one-fourth inch thick. The in- ner Surface of the sac had a deep red color and bled easily. - f In removing the gelatinous mass, the hand seemed to break down extremely tenuous par, titions which apparently divided the cavity into loculi, but which were nowhere as thick or solid as the thinnest membrane. Fearing sepsis, on account of the previous temperature, the opening in the broad liga- ment was stitched to the peritoneum, a Miku- licz drain inserted, and the wound left open, except three stitches at the upper part. The patient has made an uneventful recov- ery. Temperature and pulse never above 100° F. and 112° F., respectively, and normal after first Week, by which time the gauze had been entirely removed. The microscopic appearance would indicate the oëphoron instead of the paroëphoron as the original focus of the disease; that is to say, the outer third of the sac seems to be made up of an exaggerated but closely woven connective tissue, sparsely interspersed with poorly de- Veloped Grafian follicles. The inner third is densely infiltrated with round cells. I was much surprised to find that the fibro- gelatinous mass was made up almost entirely of mono and polynuclear round cells, with only a Very Small amount of fibrinous threads. I have detailed the symptoms and physical appearance in this case for the reason that the subject is only slightly touched upon by our best and latest authors. WELL–PAID DOCTORS. Not long ago a surgeon in San Francisco Was paid $30,000 for performing a successful Operation for appendicitis. Dr. Howard A. Kelly, of Baltimore, is said to have been paid $21,000 for an operation and twenty-one days' attention upon a mine owner's wife. Dr. Tif. fany, of Baltimore, received $10,000 for a sin- gle Operation; Dr. Chambers, of same city, $5,000 for operating for a stab wound; Dr. Parks, of Chicago, received $10,500 for an op- eration, and Dr. Burnays, of St. Louis, $5,000 for a single operation. and the enucleation completed. 342 THE NAEDICAL DIAL. : -s A PLEA FOR INTERNAL MEDICINE. Ł By Florence C. Baier, B. L., A. M., M. D., Owa- tonna, Minn. The practice of medicine is beset with so many difficulties that the profession must reckon with patent medicines and high-handed quackery on the one hand, and on the other, with an army of negatives—homeopathy, osteopathy, faith cure, and the misnamed “Christian” science—whose fictitious claims are elaborately advertised, and in whose sup- port, greed and self-interest so cunningly inter- mingle the mysterious, the scientific and the divine, as to trick the ignorant and unwary, and appal the really devout. In curious con- tradiction, a denial of the value of medicine flaunts itself insolently and loguaciously and persistently in the very ranks of the profession itself. This is partly due to the overgrowth of the idea tending to the diminution of heroic dosage; partly to the rapid advancement of surgery, an exact science; partly to the icono- clastic spirit of the age; and partly to the large number of half-educated people in the profes- sion, who, not knowing what to do, do nothing, and then parade their “masterly inactivity.” To the actual employment of drugs there are many adjuvants, long recognized and used by physicians. Since when has not the regu- lar practitioner prescribed electricity, mas- sage, hydrotherapy, heat, cold, rest, exercise, and used “suggestion”? These are but a small part of his armamentorium. When a doctor trumpets to the world that he has found in any of these the sine qua non, he announces himself both a quack and a medical nihilist— for all else that mother nature has placed ready to our hand is as nothing to him. What would we think of the man who finds in Strychnine, for instance, an universal panacea? He is not more one-sided in theory, or not more incompetent as a medical adviser, than the man who sees in electricity, or “mechanical therapy,” or “suggestion,” our universal phys- ical redemption. Honesty compels the physi- cian to admit the claims of these medical ad- juncts to a place in therapeuties, but, at the same time, compels him to refuse them more than that, and to deny them the dignity of systems of medicine. The practitioner, with discriminating judgment, is not a medical skeptic, for he finds cases in which no med- icines are needed, and he has the courage of his convictions to prescribe these auxiliaries, though the act may result in the loss of money, his patient, and, possibly, his reputation; yet, he may be far away from the heroic dosage and Spoliative measures of earlier times—but he knows the value of internal remedies. Medicine may be regarded as a specialized food, needed at times in the animal economy to supply deficiencies, or make up a loss, or combat an infection, and when medical jour- nals, and when physicians themselves, advo- cate “throwing physic to the dogs” they argue not so much against medicine as against the ability of the practitioner. Therapeuties is the most important study in the practice of medicine, and in therapeutics the most important thing is internal medicine. A more careful study of drugs, of their action, and of their application in disease, is the surest corrective of such stuff as the following, which was clipped from a so-called medical journal: “Suggestive and mechanical therapy are the questions that confront the physician to- day. Medicines of all kinds, as remedial agents, are losing their former integrity, and aside from their suggestive powers, are of com- paratively little consequence. As science and mechanical therapy increase, the use of drugs decrease.” The therapeusis of the above is as faulty as the English. To rely upon one or two or a half dozen remedial agencies, to the exclusion of all others, is to be blind to nature’s own methods. In the light of history, however discredit- able, in many an epoch it is to mankind at large and to the profession’ in particular, and in the face of present medical knowledge, it is useless to decry medicine. No one would be more dismayed at the total disappearance of drugs i han the doctor who complacently in- forms you that the longer he practices the less medicine he gives, conveying the impression that he expects to continue his diminishing doses until they reach the vanishing point. The real fact is, however, that his experience and maturer judgment have taught him the use of, and not the abuse of, the powerful drugs at his command. The doctor who publicly, or in his private practice, minimizes the use of drugs, and lauds the exclusive use and universal efficacy of any One remedial agent, however excellent in it- self, simply and pathetically reveals his nar- rowing horizon, his vanishing ideals, the con- fusion of his thoughts, and his lack of diagnos- tic acumen. That drugs have done harm, and capable of it always, in unskilled hands, is no argument for their discontinuance. Like fire and water, they make “very good servants, but very poor masters.” Too many physicians have treated symp- toms, without removing the cause; have treated the disease, ignoring the personal fac- tor. Failure, under such a line of practice, was, of course, inevitable, and the disgusted practitioner, instead of finding the true cause of it in his own superficiality, has anathema- tized medicine in general. We need to more closely study the physi- ological processes of the body, both in health and disease; to more deeply inquire into ob- Order for Subscription to THE MEDICAL DIAL, Published Monthly at Minneapolis, Minn. 1899 | For DATE on LY] Publishers of THE MEDICAL DIAL; Please send THE MEDICAL DIAL to my address, given below, until ordered discontinued, for which I agree to pay One Dollar annually in advance. (Name) Paid $ in advance to (Street) [For last date (inclusive) covered by remittance.] ( P. O.) THE NAEDICAL DIAL. . . 343 .. scure causes of disease—in short, to make a better diagnosis—and we shall apply the rem- edy with more courage and confidence. It is not true that each disease has a “specific” drug, and some forms of bodily ailment are not curable by drugs or anything else. But in the vast majority of cases, the diseased body will more rapidly and surely be stimulated and quickened to resume its natural functions under the influence of drugs properly admin- istered than if left unassisted. Internal medicine is a great study, contin- ually varying with the advancement of science, and with the increasing knowledge of physio- logical processes. It is easier to decry its ef- ficacy than by patient research to possess its SecretS. *OVARIAN CYST WITH TWISTED PEDUNCLE. By A. W. Abbott, M. D., Minneapolis. Clinical Professor of Diseases of Women, Uni- versity of Minnesota. Mrs. D., 25 years of age, was delivered of her first child on July 27, 1899. The labor was normal. About the first of September she felt some pain in the left pelvis, which grad- ually increased until now, October 2nd, it is so severe that she gets very little rest. These pains radiate from the left ovarian region towards the back and left kidney. For a week she has not been able to lie down on account of a drawing pain in the hypogastric region. She first noticed a swelling in the left pelvis, about two weeks after the pain began, which has rapidly increased, so that now she meas- ures forty-two inches at the navel. She never regained her normal size after confinement, but Was told that no tumor existed. This was probably an error in diagnosis, but the tumor Imay have been so small that detection was im- possible. She had nausea and vomiting when she first felt the pain, but this soon ceased, although her appetite has remained very poor. She urinates frequently, but without pain, ex- cept an annoying pulling sensation just as the bladder empties. She has lost flesh. Her temperature is 99 F. and pulse 98 to 108. The uterus is in normal position. The right ovary can be made out and seems normal. The tu- mor is very prominent, dull with colon reson- ance above and on the sides, thinly fluctuating, and very tender. Diagnosis.-Ovarian mono-cyst of left side, with probable adhesions in region of bladder, with possible hamorrhage in the tumor. Abdomen opened October 5th. The pearly color of an ovarian cyst was manifest, but it had a greenish brown appearance, as if there was a subjacent haemorrhage. On inserting * Presented at the meeting of the Hennepin County TMedical Society, October 9, 1899. the Tait tube, about a gallon of thin coffee-col- ored fluid flowed out, indicating a previous slight bleeding into the cyst. The only ad- hesion was one recent attachment of the tu- mor to the abdominal wall, three inches below the navel and had evidently begun as an ad- hesion to the fundus of the bladder, as that organ was drawn up by the growth of the tumor and lay between the adhesion and sub- peritoneal fat with no intervening peritoneum; i. e., the bladder was pulled up by the adherent growing tumor, and drew up the peritoneum with it. There could, of course, be no more twisting after the adhesion took place, and from its position the stripping of the perito- neum must have followed, and the tumor must have grown largely after the twisting had ceased and adhesion taken place—all of which goes to prove that the tumor was small im- mediately after confinement, and to explain Why her accoucheur did not find it. On relieving the adhesion and drawing out the sac, the pedicle was found firmly twisted two full turns to the right. The fallopian tube of the same side was included in the twist, Which gave it the appearance of the tumor hav- ing rotated three times instead of twice. The arterial circulation of the sac was not much im- paired, but veins were very full, large, and con- tained solidified blood. The fimbriated end of the tube was swollen, red and very cellunatous. the tube was swollen, red and very oedematous. The tumor seems to be an oëphoritic cyst, as the tube is not stretched over it, nor is the ovary found upon it. The Status and development of this tumor are very easy to trace when we take the symp- toms and operative findings together. The tumor existed before confinement, was small and flacid immediately after. It then began to grow and rotate. It rotated slowly and brought on vomiting for a short time only and Some pain. After it had rotated twice, it be. Came attached to the fundus of the bladder. It then grew rapidly and gave her pain when She extended the body by the pressure of the abdominal muscles, and caused the frequent micturition by stretching the bladder. According to Bland Sutton, the following facts are about all that is definitely known of the axial rotation of pelvic tumors: 1. It may occur in any form of pediculated pelvic tumor. 2. It is most common in Dermoid's ovarian and parovarian cysts. 3. It occurs in about ten per cent of ova- rian and parovarian tumors and in these twenty-five per cent are associated with preg. nancy. 4. No satisfactory explanation of the cause of rotation has been offered. 5. The amount of torsion may be only half a turn and twelve complete turns have been reported. A 3. §: #º: :* º §- *…* * *. et .g. * * * §§§ 3, ſº . . . * * & ~ * ºrz " . * * § s” . * * * .* §: - * *3. R --- # * **. §3. & , x : 2. * & : $º * * º y " * 6. The rotation may be in either direction, but in a small majority it is toward the median , orrhage into the sac wall. line. 7. Rapid and firm twisting in a small tu- mor may lead to an error in diagnosis, as the agonizing pain, nausea and collapse, together with tenderness, are almost identical with the symptoms of ruptured tubal pregnancy. 8. Slow torsion is accompanied by more moderate pains, rapid increase in size of tumor but without collapse or much nausea. In this specimen can be well seen the livid color and thickening duc to the apparent haem- There also seems to be a number of large muscular bundles, but which, on section prove to be large veins with thickened walls, containing coagula and Sur- rounded by areas of increased connective tis- sue in their immediate vicinity. The whole wall takes a stain very poorly but best on the peritoneal side. * The remarkably certain and easy recovery attending operations on these cases goes to prove the truth of another observation by Sut- ton, that what is called gangrene is a loss of vitality but without odor or the presence of putrefactive germs. The lividity and the greenish color is due to the coagulation of blood. The condition is entirely different from that in a strangulated gut, the lumen of which is the matural habitat of putrefactive or- ganisms. * OBSTRUCTIVE GROWTHS OF THE PYLORUS, WITH REPORT OF A SUCCESSFUL CASE OF PYLORECTOMY. By J. E. Allaben, M. D., Surgeon to St. An- thony Hospital, Rockford, Illinois. Growths that may cause obstruction of the pyloric orifice of the stomach are: Carcino- ma, simple hypertrophic stenosis, cicatricial growths from ulcers produced by swallowing corrosive drugs, simple hypertrophy of the coats of the stomach at the pylorus, especially of the fibrous and muscular coats, mucous polypi, and rarely sarcomata, fibromata, myo- mata, lipomata and cysts. All of these, ex- cepting carcinoma and cicatricial contractions, are so seldom met with that they need not command attention only to speak of them in this paper. But cancer of the stomach and of Other organs is of such frequent occurrence and apparently so much on the increase that it should command Our most earnest consider- ation. In England and Wales during ten years (1860–1870) 81,699 died of carcinoma, a ratio of 1.29 (Senn). In New York the death rate from * Original abstract of paper read before the Surgical Section at the meeting of the Mississippi Valley Medical Association, held in Chicago, October 3-6, 1899. "THE NAEDICAL DIAL. cancer has increased in twenty years from 1.82 per cent. to 2.17 per cent. (Bryant). Heberlin states that in Switzerland gastric cancer is on the increase, being for 1,000 inhabitants in 1877 0.61 per cent. and in 1886 0.99 per cent. In England the death rate from cancer is about four times as great as it was fifty years ago. The mortality from gastric cancer is estimated from 0.6 per cent. to 3% per cent. In New York, in all cases of death, 1 in 100 is due to cancer of the stomach (Welch). In gastric cancer the pyloric region is involved in 60.8 per cent. of the cases. The cylindrical celled, or adenocarcinoma, is the form of Can- cer most frequently found in the stomach. The law regarding the prognosis of Opera- tion for cancer in general is especially appli- cable to cancer of the pylorus. The earlier the operation the better will be the results. To obtain more favorable results two things are imperative: first, the perfection of methods of diagnosis; and, second, the education of the public to understand the necessity of Operating as soon as a diagnosis is made. Chronic Stom- ach trouble in patients above forty years should be thoroughly studied with a view of detecting malignancy. Treatment of obstruction of the pylorus is limited to surgical procedure. The operations for relieving obstruction are: 1. Gastro-enterostomy, which is only a palliative measure. 2. Digital divulsion of the pylorus, or Lore- ta’s operation. 3. Pyloroplasty. 4. Pylorectomy or resection of the pylorus, of which there are three types: (a) typical, total or circular pylorectomy; (b) atypical py- lorectomy, which consists of a combination of pylorectomy with gastro-enterostomy; and (c) partial pylorectomy. The first pylorectomy was done by Peñn in 1879. One was performed by Rydygier in 1880, both cases dying. Billroth performed the first successful pylorectomy in January, 1881. The earlier operations for pylorectomy were attended with a great mortality. Ac- cording to Senn, in sixty-six cases collected from statistics fifty died; other authorities give the mortality as 57.4 per cent. to 75 per cent., but we believe that in the near future this mortality rate will be greatly re- duced. Already we see an improvement in this direction. From 1881 to 1885 the mortal- ity was 61.4 per cent.; from 1886 to 1892 it was 34.3 per cent. In 1882, of thirteen cases of re- section for carcinoma, all died; in 1893, of eight cases, all lived. Regarding remote re- Sults, the tables of Haberkant show that the cases recovering from the immediate results, died afterward from one and one-half months to eight years. At first thought, these statis- tics would not seem very favorable; but the remote results of operations of the breast for THE MEDICAL DIAL. . angle of the stomach with a Murphy button. ** The patient recovered rapidly from the opera- . . carcinoma are but little better. The average prolongation of life of those operated upon for cancer of the breast is from seven months to one year and nine months. Yet we do not hesitate to recommend the operation for it is the only hope of prolonging life. When we consider that it is only since the period of aseptic and antiseptic surgery that the ab- dominal cavity could be safely invaded; that the stomach is a vital organ in a comparatively inaccessible region, and that the operation is usually postponed until the patient is ex- hausted from the effects of obstruction, the wonder is, not that pylorectomy at the present time is a very fatal operation, but that it could be attended with success at all. º DIAGNOSIS. Besides the usual symptoms of gastric dis- order, emaciation, vomiting of food and matter resembling coffee-grounds, absence of free hy- drochloric acid and the presence of lactic acid in the gastric juice, the stomach when empty should be washed out, as suggested by Hem- meter, with normal saline solution, using a rubber stomach tube with a sharp chisel- shaped point around the lower opening to dis- lodge surface particles for microscopical ex- amination. As cancer cells do not multiply by direct division (fission), but by indirect di- vision (Karyokinesis), the presence of cells, undergoing this indirect division in the detri- tus of stomach washings, should suggest the presence of malignancy, even if the charac- teristic cancer cells are not found. REPORT OF A CASE OF PYLORECTOMY. The patient was a female aged 28 years, mother of two children; family history nega- tive. Was seen first June 10th, 1897, giving a history of ten months of intermittent pain, gastric disorder, loss of flesh, but not cachetic, with tumor in right hypochondriac region; the tumor finally becoming adherent under the umbilicus, and was the size, shape and hard- ness of a kidney. Exploratory incision was made September 1st, 1897, followed by total extirpation of one-third of the pyloric end of the stomach as follows: Incision four inches long, along outer border of right rectus muscle, the middle of the incision being opposite the umbilicus. Greater and lesser omentum cut off between two rows of strong cat-gut liga- tures. Duodenum was clamped and severed, and stomach amputated a little beyond the region of the neoplasm. The stomach was closed from above downward to within one inch of the lower angle by, 1st. Running–Lembert suture of strong silk in the mucous membrane; 2nd. Running Lembert suture of formal- ized cat-gut in serus and muscular coats; 3rd. Running Lembert suture of fine cat- gut over all embracing serous coat only. The duodenum was united to the lower tion, leaving the hospital on the fourteenth day, and continued well for nearly two months, when she suddenly developed peritonitis. Ce- liotomy was performed five days later—two Quarts of fluid and pus evacuated, but the pa- tient died two days later from exhaustion. * *,4_3% »ſ Y k 2. * @" * * * * * f as A- tº .3 & # :: * * , ; #2 * The post-mortem revealed two strictures in the transverse, colon, the Murphy button having lodged at the first stricture, causing a perfora- tion of the intestine. The union of the stom- ach coats and of the duodenum to the stomach was perfect. Microscopical examination of the tumor and stricture showed them to be carcinomatous. CONCLUSIONS. 1. Cancer is one of the most potent factors' in the causation of death, with a tendency to constantly increase in frequency of occurrence. 2. Gastric cancer occurs in about one-fifth of all primary cases. 3. In gastric cancer the pyloric region is affected in sixty per cent. of the cases. 4. The treatment of gastric cancer, direct- ed toward a permanent cure, is in the present state of our knowledge limited wholly to surgi- cal methods. 5. As early total extirpation of malignant growths, with the hope of permanent cure, is the goal toward which we are constantly striv- ing, and, as these growths in gastric cancer occur at the pyloric region in sixty per cent. of the cases, it would seem to follow as a nat- ural conclusion that pylorectomy would be the treatment most frequently prescribed for the cure of this malady. 6. Inasmuch as early diagnosis is the greatest requisite for directing proper radical treatment, the internist and the surgeon should turn their best efforts in this direction. 7. If the operation of pylorectomy were performed before obstructive symptoms mani- fest themselves, and before the occurrence of metastasis, the immediate results would be as favorable as in any other abdominal work, and the remote results as good as in extirpation of the breast for carcinoma. CARE OF THE MOUTH. Two drops of camphor on your tooth-brush will give your mouth the freshest, cleanest feel- ing imaginable, will make your gums rosy and absolutely prevent anything like cold sores or affections of your tongue. The gums, by the way, are barometers of our condition. If they are clear, bright and red we are in good health, while if our blood is thin and wanting in the mysterious red corpuscles that make us heal- thy the gums will be pale pink, or if we are in a very bad way indeed, and much in need of a course of dialized iron, they will be almost white.—Indian Lancet, THE MEDICAL DIAL *F *FURTHER observations on THE TREATMENT OF THE ABDOMINAL VISCERA TEIROUGH THE COLON. By Fenton B. Turck, M. D., Chicago, Ill. In a previous communication it was shown that small quantities of hot water (55 degrees Centigrade) introduced into the rectum pro- duced a marked effect on the heart and general circulation and especially on the abdominal organs. From these results it was evident that hot water introduced, at the temperature mentioned, into the colon, had a greatly bene- ficial effect upon the abdominal viscera. Air, hot or cold, forced through a double tube into the colon and allowed to escape, also acts not only as a powerful stimulant to the abdominal viscera, but also acts as a species of pneumatic gymnastics of the colon. In the introduction of hot water into the colon, the following technique is adopted: The patient is placed in a dorsal position upon a table specially devised for the purpose, which is so adjusted that the hips may be raised or lowered to any desired angle without discomfort. The solution em- ployed is usually a 9 per cent normal salt solu- tion when therapeutic effect of heat and cold are desired. For other purposes, mild anti- septic and medicated solutions may be em- ployed. A soft rubber tube, either single or double, with end and side openings, is intro- duced into the rectum as far as the sigmoid flexure. At first 200 to 300 cubic centimetres of water at a temperature of 50 degrees Centi- grade is introduced. This is allowed to return through a tube into a conveniently placed re- ceptacle and the procedure repeated. Every time the water is introduced its temperature is gradually raised until it reaches 55 degrees Centigrade; in all, from three to six litres are needed. The patient is then allowed to evacu- ate the bowels, after which he receives similar short treatment with water cooled 2 or 5 de- grees Centigrade. The amount of water in- troduced and withdrawn and the duration of the treatment depends upon the character of the case. For continuous irrigation, my double recur- rent tube or needle douche has answered the purpose best in the hands of gastro-enterolo- gists like Herschell, Treves, Gillespie and others. By continuous irrigation a somewhat different action is obtainable from that already referred to. It is indicated in impaction, acute gastro-enteritis and during the early stages of appendicitis. A strict observance of technique, judiciously varied in each case, gives the best results. The mucous membrane of the colon, like that of the throat, seems to be insensible to * Read at the meeting of the Mississippi Valley Medical Association in Chicago, October, 1899. comparatively high temperature. The sensa- tions within the colon as to heat or cold are not very definite. This may in part be due to the fact that the colon sensation has been so spe- cialized as to faecal pressure as to lose its heat and cold reaction. That the treatment through the colon influences not only the gen- eral circulation, but also stimulates the nerve actions of the abdominal viscera, and prevents the cerebral and spinal blood pressure, has long been known. The principle on which stimulant enemata have been employed in opium coma and allied conditions is significant evidence of this. The ano-genital center is notoriously the last to be affected in coma. Numerous instances have been reported where death from opium coma and anaesthesia have been prevented by its stimulation. Further- more, stimulation of the ganglia in the walls of the intestines cannot fail to produce effect on the spinal and cerebral centers. The in- creased action of kidneys, liver and other or- gans after the employment of colonic means is evidence in this direction. This is further- more shown by the fact that favorable results depend not upon the amount of water intro- duced, but upon the reaction between that and cold. Large quantities of water introduced at one time are detrimental. Small quantities, frequently repeated, have markedly beneficial effects. In colonic treatment by water or air, single or double recurrent tubes may be employed ac- Cording to the nature of the case. A tube with a single opening at the end is useless, however, for colonic lavage. One designed by me con- sists of a rubber tube (one metre long and with a calibre of 23 A or 35 F), tapered at the end to an opening with beveled edges. On either side are four small perforations opposite to each other in a row. Above this is a large side opening with edges so sunken as to pre- Vent irritation in introducing the tube. The distance from the end of the tube to the upper- most Opening is one and three-quarter inches. This tube ensures rapid return of the water in- jected and there is no danger of the suction of mucous membrane by siphonage. There is thus less danger of traumatism and of closure of the end of the tube by the mucous mem- brane or faeces. This tube ensures a more equable distribution of the fluid introduced, and is, therefore, of special value in topical ap- plications, or in introduction of food. The double recurrent tube or “needle douche” pre- viously described will be found of special value When prolonged irrigation of lavage is desired. It has been found particularly useful in ob- struction from whatever cause by Herschell and others. For the same reason it is of value in Colon atony or where hot or cold water is needed as a spray or needle douche. In some cases a tube capable of passing the sigmoid flexure may be needed. Most tubes now made THE MEDICAL DIAL. f 347 pass only to this flexure, but not beyond. The stiff tubes press upon and so bulge the walls as to give the false impression that the tube has passed through the flexure. The flexible tubes coil up and produce the same impression. My colonic sound and irrigator enables the physician to pass around the colon even as far as the caecum. It consists of a double curved metallic tube about sixteen inches in length, so made as to be passed through the Sigmoid flexure. The tube not only serves as a chan- nel for the return of fluids injected, but also as a sheath for the introduction of a flexible hol- low metallic cable. The distal end of the cable is surmounted by an olive shaped per- forated head. This serves as a guide for pass- ing the sound. As the cable is hollow, it may be employed for colonic distention. This, if secured during the passage of the sound, will ensure further introduction. The position of the cable tip may be determined by palpation, especially if the cable be rotated. Since the cable is metallic, it can be employed as an electrode. Food, by this instrument, may be distributed over a wide area. Great objection frequently exists to the introduction of water, especially hot water, into the colon. The hot water produces depression and even collapse at times. Warm water is particularly objection- able in this particular. Atony of the bowels from this cause, moreover, is very frequent. Distention of the bowels with water, subse- quently withdrawn, would be of value in bowel gymnastics, were it not for the fact that, since the water is slow to return and is not compres. sible, it causes undue distention. In treatment of the colon the object is, first, when atony exists, to secure heat; sec- ond, distention; third, contraction and peri- stalsis producing gymnastic exercise. For these purposes air often answers better than water. If heat be desired, the air can be heated by passing it from a compressed air tank through a bottle of water heated to the required temperature before passing it into the Colon. The method of treatment is useful in atony of the bowels, whether it exists alone or with obstruction or impaction. Compressed air is used with a double tube introduced into the colon. When the colon is distended, air is allowed to escape through the outlet tube. Air at 55 degrees Centigrade reaches as far as the colon. Nebulization of the colon may be employed; any of the nebulizing mixtures adapted to the colon being used. FOR FLATULENCE IN CHILDREN. R. Sodii sulphocarb . . . . . . grs. 4 to 8 Syr. aurantii. . . . . . . . . . . . . . m. 40 Aq. menthae pip . . . . . q. S. ad OZ. 1 M. Sig.—One teaspoonful three times a day for two days. * REPORT OF SIXTY-ONE CASES OF AP– PENDICITIS, THIRTY OF WHOM WERE OPERATED UPON, AND REPORTED IN DETAIL. By F. T. Meriwether, M. D., Asheville, N. C. While these cases are not large in number, they present features illustrative of the gen- erai characteristics of the disease. Thirty-one cases were treated medically, most of them being in consultation, in all of which he ad- vised operation, and, of the thirty-one, four died, a mortality rate of 13 per cent, and, if these cases are all traced, no doubt the mortal- ity would be greater. Of the operated cases, thirty in number, three died, a mortality of 10 per cent. But of those lost after operation, not by operation, as is so often said, none can by any means attribute the fatality to the opera- tion. In one case, the patient had been treated by a practitioner for five days after general peritonitis had developed, and the ope- ration was only done as a last resort; in an- other, the mother refused operation until the father could reach Asheville, and so his chances were thrown away, he having general peritonitis; and, in the third, death was caused by neglect of the neighboring negroes. They would not feed him or in any way take care of him. All three of these cases would in all probability have died for, in all of them, gen- eral peritonitis was present. All of the cases in whom a peritonitis was present, when medi- cally treated, died. The probability is that all of such cases will die unless operated upon, and most of them will die even if Operated upon, but it is the duty of the surgeon to offer the patient his only chance for life, even though the cause of surgery be damaged. We have all seen cases, not only of appendicitis, but of other serious diseases—for instance, rupture of the bladder, in which we could offer no real hope, and yet in which the patient re- covered. In two of the cases reported, no hope was offered to the family, but they were told it was their only possible chance, and, the family accepting, operation was done and the patients both go well. In ten cases concretions were found, in one of which the concretion was of a thick mucoid material, and in four there was only a single concretion. Except in the case of the mucoid mass, all of the concretions were composed of fecal matter, though in two a small amount of vegetable fibre was found imbedded in the mass. In One case the concretion was the ex- act shape and size of a cherry seed and it was only after division and examination that its real nature was discovered. * Original abstract of a paper read at the meeting of the Mississippi Valley Medic al Association, held in Chica- go, October 3 to 6, 1899. 348 THE MEDICAL DIAL. In only one case was vomiting marked, while in five cases there was no vomiting. In eight cases the bowels were loose, six of these being gangrenous cases. This looseness of the bowels was in nearly all the cases due, he thinks, to the giving of cathartics before and during the attacks, which looseness helped not a little to make the operation a success. Liver dulness was lost in all the pus cases, eight in number, and also in one case where pus was not present. In one of the cases the pus was thoroughly walled off. Sixteen of the cases were females, fourteen males. The average age was 23 2-5 years; there being sixteen cases 21 years old and under, twenty-four cases 30 years of age and under, twelve cases between 21 and 40 years of age and two over 40 years of age. The youngest case was 5 and the oldest 55 years old. In only ten cases could the appendix be felt before the operation, and in these cases the position and conditions determined by palpa- tion were verified by the operation. Whether this inability to palpate the appendix was due to a lack of skill or not, he does not know, but he thinks in many cases nothing but an in- definite resistance can be felt, particularly when the appendix points southwardly or lies outside the caecum. The rigidity of the oblique muscles and the distension of the cae. cum makes it nearly impossible to feel the appendix. One can often approximate the position of the appendix by the lines of re. sistance felt, but he doubts if in all cases an absolute diagnosis can be made of the condi. tions present. - An interesting feature about one of the cases reported was that, though there was no pus present, and only a small amount of serum, the infection was so virulent that the operator was infected upon the hand and was disabled for ten days. Within an hour after the Opera- tion a burning was noticed at one of the hair. follicles upon the little finger and in eighteen hours a vesicle had formed. Septic chills were had with quite a high temperature. Cultures from the vesicle showed the presence of the streptococci pyogenes, staphylococci Dyogenes aureus and one colony of the colon bacillus. A Very minute perforation was present near the tip of the appendix. In another case, a very Persistent cough, which the patient said was synchronous with the recurrences of the a D- pendicular trouble, was relieved. In a third case, one who had a history of typhoid fever ºccurring the year previous, the adhesions found at the time of the operation convince me that it must have been an appendicular trouble, for he had had no illness other than the supposed fever. In many cases the ap- pendix looked apparently normal, possibly only congested, but a thorough examination of its calibre and a microscopial examination of its walls always revealed disease. In all the cases the McBurney incision was used and in no case was difficulty had in reach. Through and through suturing was used in a great many of the cases, but at present he prefers layer su- turing with the sub-cuticular suture for the ing the site of the trouble. skin, all of catgut. In most of the cases the appendix was inverted and buried. He does not always advocate the opera- tion necessarily to save life, but in many cases to prevent suffering and loss of time from business. Many cases will get over their at- tacks, but, when we consider the low mortality of the interval operation and the high mor- tality of the delayed operation, the uncertainty of the exact condition of the appendix, or the outcome of the next attack, he thinks we are justified in advising early operation in every Case. A TYPICAL CASE OF VA COINELLA. The illustrations here with are from the Medical Record, September 23, reported by Dr. W. E. Fowler, of Huntsville, Texas. - - - - - - - A Typical Case of Vaccinella. The patient is a negro, age 30, came to hos- pital March 19, 1899, suffering with tertiary syphilis, but with no well-marked centres of at- tack. The subject had been vaccinated two weeks before and had a well-developed ulcer on the deltoid muscle of the left arm. In a few days a number of vesicles appeared about THE MEDICAL DIAL. 349 the primary sore, and the next day numerous papulae were observed about the neck, and from these they rapidly spread over the body. The vesicles were transformed into pitted pustules, similar to small-pox, and they had the charac: teristic odor. All the symptoms were those of small-pox, with the single exception of the ab: sence of pyrexia, there being absolutely no ele: vation of the temperature, save on two occa- sions, and it did not exceed 100°F. The photo- graph was taken April 24th, a few days after the appearance of active desquamation. The treatment was merely of a calmative and anti- septic nature, and the patient was soon meas: urably well, but is still under the specific treat- ment for the syphilis. The author comments as follows: “Now, it is a very well-known fact that one of the direct effects of vaccinal lymph in the system is to aggravate any cutaneous diseases present; this I know personally to be true, as it is clear- ly demonstrated in the cases of patients now under treatment here (at the penitentiary); and as many of the most marked manifestations of syphilis are of a cutaneous character, I have associated the progress of my case with that disease.” XIPHOPAGES, OR HUMAN DOUBLES. (Scientific American.) The first living double monster that we know much about was described by Isidore Geoffroy Saint-Hilaire, and consisted of the twin sisters Helene and Judith, who were born in Hungary in 1701 and died in 1723. The Siamese twins, Chang and Eng, attracted much attention in their time and were exhibit- ed in Europe and America. They were born in 1817, were married and had children, and died at an advanced age. These two brothers were connected by means of a ligamentous band passing from the epigastrium of one to that of the other. Later on, the two sisters, Millie and Christine, who were born in Colum- bia County, South Carolina, in 1851, were ex- hibited in Europe. These twins were connect- ed by the back. Recently, there have been presented to the Academy of Medicine of Rio Janeiro, Brazil, two sisters connected with each other in front and thus belonging to the category of what are now called Xiphopages. By this term are designated two well developed individuals with one umbilicus in common and connected from the lower extremity of the sternum to the navel. Such double monsters are curious. There are some that are provided with a thoracic cavity proper to each individ- ual. These are genuine Xiphopages. In oth- ers, the independence of the thorax is limited to the upper part of the thoracic cavity. M. Marcel Baudoin, who has made a special study of such monsters, designates these latter by the name of Thoracopages. The true Xiphopages are rare in science. In fact, the number of those born living and that have been observed does not appear to ex- ceed seven or eight, and several of these have not lived longer than a few days, or even a few hours. In 1892 there were exhibited in Europe the two sisters, Rodica and Doodica (Fig. 1), who were born in the English Indias in 1889. They were three years and some months old when they were exhibited in Brussels. In Fig. 2 are shown the two sisters, Rosa- lina and Maria, who have just been discovered in Brazil. These two girls are ten years of age and were born at Cachaeiro de Itapemerim. The parents were anxious to know whether or not they could be separated. That all depends upon the nature of the junction. Three Xipho- Fig. 1. The Sisters Rodica and Doodica. pages have already been operated upon, two of them with success, and all were of the female Sex Fig. 2. The Sisters Rosalina and Maria. With radiography, it will be easy to ascer- tain whether the two bodies are absolutely con- solidated or whether they are independent. If the latter is the case, a surgical operation might be performed with a considerable chance of success. For the above particulars and the illustra- tions, we are indebted to La Nature. The Journal of the American Medical As- sociation has the following to say in regard to one pair of the above twins: An unsuccessful attempt has been made to separate the six- year-old “Rosalina and Maria. Sisters.” Re- peated examinations in medical circles had convinced every one that the twins were dis. tinct and could easily be separated. Radio- graphs, after ingestion of bismuth, enabled the entire alimentary canal to be traced in each as in a normal subject, while the connecting band cast no shadow. But the incision revealed a peritoneum in common and a single continu- ous liver, forming a flattened lobe 4 cm. thick and 10 cm. wide occupying the second upper quarter of the connecting band. There were no indications of a septum of any kind, and in- tervention by operation was abandoned. In other respects the organs of each were found apparently independent. The twins move around easily, one walking backward, but can only lie on one side with comfort. 350 THE MEDICAL DIAL. THE MEDICAL DIAL A Monthly Record of Medicine and Surgery. (Entered at Post Office at Minneapolis as Second Class Matter.) Issued on the First of every Month at Minneapolis, Minn. Editor, J. W. MACDONALD, M. D., F. R. C. S. E. Associate Editor, C. K. BARTLETT, M. D. Business Manager, E. E. GRISWOLD. J. D. SIMPson, M. D. . . . . COLLABORATORS . . . . A. W. ABBOTT, M. D. W. A. HALL, M. D. # P. BARBER, M. D. G. D. HEAD, B. S., M. D. . O. BEARD, M. D. KNUT Hoeg H., M. D. J. W. BELL, M. D. C. H. HUNTER, A. M., M. D. A. B. CATEs, A. M., M. D. W. A. JONES, M. D. J. FRANK CORBETT, M., D. J. H. RISHMILLER, M. D. R. E. CUTTs, B. S., M. D. # H. e A. DUNN, M. D. J. H. STUART, A. M., M. D. DUNSMooR, M. D. H. B. SweetSER, M. D. DAVID Owen THOMAS, M. D., M. R. C. S. The publishers will not be responsible, under any circumstances, for the opinions expressed or statements made by correspondents. Contributors will be furnished, gratis, with º copies contain- ing their articles, under an agreement to distribute at once to physicians, in actual practice. To avoid duplication, publishers should be informed of the field to be covered. Reprints, giving The Medical Dial full credit, may be obtained at actual cost. No notice can be taken of anonymous contributions. The name (not necessarily tor publication) must accompany every communi- cation to this journal. SPEcIAL NoTIce.—Copy for the insertion or change of advertise- ments must be in hand by the 25th of the preceding month to insure attention. All changes or new work received after that date will be inserted only if convenient in the mechanical department. Notices for the Publishers’ Department should be at office of pub- lication by the 20th of the preceding month, and we cannot guar- antee insertion if received after that date. $1.00 .10 Annual Subscription, in advance, - - - Single Copies, - - - - - - - Advertising Rates made known on application. ADDRESS ALI, COMMUNICATIONS TO THE MEDICAL DIAL, MINNEAPOLIS, MINN. MASONIC TEMPLE. NOVEMBER, 1899. THE PROPOSED MINNESOTA NATIONAL PARK. We have long held the belief that for tu- bercular patients and those suffering from neu- rasthenia, no climate or location surpasses the pine forests of our own state. Time and again has the Writer sent young men showing signs of incipient phthisis to the lumber camps, some to earn their livelihood as time- keepers, others to pass the time in hunting and roughing it in the forest, and in every case With marked benefit. Dut the pine forests are disappearing and unless something is done to save them the “murmuring pines” will soon be among the things of the past, for in the past fifty years $100,000,000 worth of pine has been cut in Min- nesota alone, and the value of the standing pine which is cut down each year amounts to $5,000,000. The greater part of the pine which remains is in the hands of private parties, many of whom live in other states, who will cut it as fast as they can sell it. Much credit is due Col. John S. Cooper, of Chicago, Gen. C. C. Andrews, of St. Paul, and other gentlemen, for their efforts to preserve a large tract of primeval pine forest as a Nation- al park. Already the state of Minnesota owns the Itasca park, of less than a township at the source of the Mississippi river, but it is twenty- five miles from a railway and too small to an- swer the purposes of a health resort and a covert for game. To this it is proposed to add the Indian reservations of Cass lake, cre- ated in 1855, Leech lake and Winnebigoshish, comprising in all 611,592 acres of land and 218,470 acres of water surface. The project has been under consideration for three or four years, but has met with con- siderable opposition owing to the large area asked for. The requirements being now re- duced to reasonable bounds there is every probability that the scheme will be carried to a successful issue. The soil is dry and sandy; the landscape can hardly be surpassed for beauty. Here are lakes dotted with islands and these covered with magnificent groves of Norway and white pine, whose branchless trunks rise to an im- mense height, filling the air with a delicious aroma and allowing the sunlight to fall upon grass-covered glades, over which a carriage and pair could be driven with ease in any di- rection. - Black bass, pike, pickerel and muskallonge are caught in the lakes; wild ducks and geese abound; and game both large and small roam through the forest. Here is a veritable sports- man’s paradise, but, better than that, it is a natural sanatorium for the cure of the neuras- thenic, the overworked and the tuberculous. It was our privilege a few weeks ago to visit this delightful region, and as we lay in a tent and inhaled the delicious air laden with the Odor of the pine cones, the words of the Song came to remembrance: “I knew by the smoke that so gracefully curl’d Above the green trees that some cottage was near, And I ºnt if there's peace to be found in the World, A heart that is humble might look for it here.” THE CAUSE OF YELLOW FEVER. Before the war with Spain, or, to be more exact, on September 11, 1897, Surgeon—then Past Assistant Surgeon—Eugene Wasdin, be- gan his researches into the cause of yellow fever, Dr. Wasdin had made the first diag- nosis of yellow fever at Ocean Springs, Miss., Contracted the disease himself, and on his re- covery was directed by an order from the presi- dent to make an investigation into the cause of yellow fever as indicated by Sanarelli. He was furnished with a bacteriological outfit for the purpose, and on October 4th of the same year, was ordered to New Orleans, where the -- ; !; THE MEDICAL DIAL. opportunities for observation were greater than at Ocean Springs. On the 6th of Octo- ber, Past-Assistant Surgeon H. D. Geddings was ordered to New Orleans for the same pur- pose, the two investigators being directed to work together, or independently, as might be agreed between them. On the 1st of November they reported that they had carried their investigations to a point where it was desirable to continue them in some more favorable locality, and accordingly they were detailed for duty in Havana. They established their laboratory in the Cuban capi- tal in December, 1897, and continued their in- vestigations until March, 1898, when the threatened war with Spain caused their re- turn to the United States. In the following November they returned to Havana and took up the thread of their investigation where they had dropped, it before the war. In June of the present year, having arrived at definite conclusions they returned to Washington and reported to the bureau the following conclus- IOITS : First. That the micro-organism discovered by Prof. Guiseppe Sanarelli, of the University of Bologna, Italy, and by him named “bacillus icteroides,” is the cause of yellow fever. Second. That yellow fever is naturally in- fectious to certain animals, the degree vary- ing with the species; that in some of the ro- dents local infection is very quickly followed by blood infection, and that, while in dogs and rabbits there is no evidence of this subsequent invasion of the blood, monkeys react to the in- fection the same as man. Third. That infection takes place by way of the respiratory tract, the primary coloniza- tion in this tract giving rise to the earlier manifestations of the disease. Fourth. That in many cases of the disease, probably a majority, the primary infection or colonization in the lungs is followed by a “sec- ondary infection,” or a secondary colonization of this organism in the blood of the patient. This secondary infection may be complicated by the coinstantaneous passage of other or- ganisms into the blood, or this complication may arise during the last hours of life. Fifth. There is no evidence to support the theory advanced by Professor Sanarelli that this disease is primarily a septicaemia, inas- much as cases do occur in which the bacillus intestinal contents of normal animals and of organs in which it might be deposited there- from. Sixth. That there exists no causal rela- tionship between the bacillus “X” of Sternberg and this highly infectious disease; and that this bacillus, “X,” is frequently found in the intestinal content of normal animals and of man, as well as in the urine and the bronchial secretion. - Seventh. That, so far as your commission is aware, the bacillus icteroides has never been found in any body other than of one infected with yellow fever; and that whatever may be the cultural similarities between this and other micro-organisms, is characterized by a specificity which is distinctive. * Eighth. That the bacillus icteroides is very susceptible to the influences injurious to bac- terial life, and that its ready control by the processes of disinfection, chemical and me: chanical, is assured. * Ninth. That the bacillus icteroides pro- duces in vitro as well as in vita a toxin of the most marked potency; and that, from Our pres- ent knowledge, there exists a reasonable pos- sibility of the ultimate production of an anti- serum more potent than that of Professor Sanarelli. TRUE DIGNITY. True dignity must stand completely free Of haughtiness, for that is but a mask Oft worn to simulate the truly great, And hide a mind of smallest calibre. Lymſ AN W. DENTON, M. D., Minneapolis. ACTION OF DIPEITHERIA POISON ON TEIE EIEART. Dr. F. Rolly, first assistant to the chil- dren's clinic at Heidelberg, as the result of a series of experiments on animals with the diphtheria toxine (“Archiv fur experimentelle Pathologie u. Pharmakologie,” 42, 1899) con- cludes that: & (1) The fall in blood pressure induced by the poison of diphtheria is due to paralysis of the vasomotor centre, and also to the paralysis of the heart, which in spite of artificial respi- ration soon ceases to beat. (2) This action on the heart is direct and in warm-blooded animals is independent of the nervous system. (3) The paralysis of the heart develops af. ter a more or less definite latent period. Direct injection of the diphtherial poison or transfu- sion of lethal diphtherial blood interferes with the action of the isolated normal rabbit’s heart only after a certain latent period. (4) On the other hand, the action of the poison takes place at the same time, even if, before the appearance of poisonous symptoms or at the beginning of such toxic action, the heart is washed out with normal blood. (5) This property possessed by the diphthe- ria poison of action on the heart leads to the opinion that the poison gradually takes hold of the heart muscles, and is seemingly stored up there until its complete action is manifest; this further explains the continuance of func- tional heart disturbances after many of the acute infections. - ~ *** . . . . . f 3. * - * . & * … - -- -- * 351 ** * } *. *3 ºr * †, ”, * * * sº †. ‘. ‘S 3 CommunicationS. REGARDING THE SPECIFIC GRAVITY OF THE WAPOR OF SULPHURIC ETEIER. | Charleston, S. C., Oct. 9, 1899. To the Editor of the Medical Dial: Dear Sir: I have been absent from home since August 1st, and on my return found a sample copy of your journal awaiting me. Among much that was excellent I found in the article by Dr. Staples on “Certain Landmarks in the Progress of Modern Medicine” the fol- lowing statement, which is certainly contrary to all authority, and is dangerously mislead- ing. Perhaps you may have corrected it in the subsequent number, but at any rate it will do no harm to call your attention to it again. See page 249, August: “Sulphuric ether is a light liquid, evaporates rapidly in ordinary room temperatures, mingles readily with the air, and, being of less specific gravity, quickly rises in the atmosphere when allowed to evap- orate.” Against this read in Fowne's Chemis- try: “Although the substance itself is one of the lightest of liquids, its vapor is very heavy, having a density of 2,586, referred to the air.” Also notice the well-recognized rule for anaes- thesia (ether or chloroform), to keep the light elevated in case of operating at night, by gas or other open light. This is a mistake that is not unlikely to occur from the lightness of ether liquid, and too much care cannot be taken to prevent stu- dents making it. Hoping you will excuse any appearance of desiring to criticise on my part, I am Yours sincerely, JOHN FORREST, M. D. Professor of Materia Medica and Therapeutics, Medical College, State of South Carolina. DR. STAPLES’ REPLY. In answer to the criticism of Professor For- rest, Dr. Staples writes a word as follows: In reviewing the matter it appears that there is some reason for objection to a single point or expression in my mention concerning the physical and chemical properties of the yapor of sulphuric ether, relating especially to its Specific gravity compared with that of air. In admitting, however, the propriety of this correction, I wish to emphasize the fact, which, in my Writing concerning the use of ether and chloroform, I had principally in mind, viz., that the vapor of ether unites very readily with the air, and is quickly diffused in all directions. The fact that this vapor may of itself have a greater specific gravity than the air, does not prove that in combination with the latter it is THE MEDICAL DIAL. not found in the upper part of the room as Well as in the lower. My object in the Writing re. ferred to was mainly to show the importance of different management in the use of different anaesthetics; that in the use of ether the in- haler and its application should be such as not to allow its free escape into the air. Aside from the reason of its better effect as an anges: thetic when thus administered, it is evident that such procedure has another importance in preventing, if possible, the charging of the air with the other vapor sufficiently to render the combination explosive. This, together With an avoidance of confined air in the operating room, may at least equal in importance the plan of elevating the lights: Respectfully, FRANKLIN STAPLES, M. D. Winona, Minn. *=== NOTES FROM THE HUD BY THE ASSO- CIATE EDITOR. Boston, Mass., October 16, 1899. To the Editor of the Medical Dial: I send you here with a few lines, a brief his. tory of my movements since arriving in Boston. I made one visit to the City Hospital, Septem- ber 30, and was cordially received by the super: intendent, Dr. Rowe, and others of the hospital staff, and shown some interesting cases in one of the surgical wards for children. One young lad, by an accident, had his skull so completely crushed that the two parts were quite mov- able; but his head was relieved by trephining, and the removal of a considerable quantity of the fluid. The little fellow was up and around the ward apparently nearly recovered. An: other child, run over by a wagon, had a bad fracture of the lower jaw and some displace- ment of other bones of the face, but he too Was recovering. There were several others of more or less severity, but doing Well. I was just in time to see an operation for appendicitis by one of the surgeons, Dr. Lund. The case was a young woman about twenty years of age. After cutting through the peri- toneum, the operated parts were thoroughly walled off by the insertion of sterilized gauze, and on opening the abscess, a large quantity of pus was discharged. The appendix, though considerably decayed, was found and removed in several pieces. It appeared as a whole, longer than usually found. As I have not had an opportunity to visit the hospital since, I cannot report the result, but the operation was so skillfully made, and the patient appearing so comfortable at the end, I have no doubt of her recovery. Dr. Lund informed me that they averaged about one case a day, and on some days they had two. I asked about the use of liquid air and was told that they had not tried it. Dr. Lund said it appeared so far to be only a caustic, and having many others of the same THE NAEDICAL DIAL. 353. 4. nature, he had not yet experimented with it. It is a pleasure to visit an institution so complete in all its details for the treatment of the sick. The cleanly glass cases for instru- ments, and the means for sterilizing everything for use, are perfect, and beautifully arranged. I visited, also, the new McLean Asylum for the Insane, at Waverly. I was fortunate in finding Dr. Cowles, the superintendent, with whom I had some personal acquaintance, at Home. This institution is now on the Cottage plan, is located on high and beautiful grounds, from which the views are magnificent. The superintendent kindly conducted me over a considerable portion of the several buildings, where I found the accommodations and means of treatment for the patients are certainly not surpassed by any institution of the kind I have ever visited. I also called at a private hospital for in- valids conducted by Dr. Walter Channing, in Brookline. It has a charming elevation and accommodations for twenty patients. Dr. Channing was not at home, but Dr. Carter, his assistant, kindly took me through the rooms. In one apartment I found a patient that was under my care more than thirty years ago, and is now over eighty years old, and still in fair physical condition. While on a short visit at Keene, New Hampshire, Dr. Faulkner, one of the phy- sicians, took me through the local city hospital, so called, though under the management of a private association. They have accommoda- tions for about twenty cases, and are constant- ly filled with sick and surgical cases. It is well kept and in perfect order. The building, formerly a private house, with a considerable amount of ground for garden purposes, was presented by an individual, Mr. Eliott, and is located in the center of the city. Improve- ments are contemplated, such as elevator and a separate building for nurses. The hospital is a necessity, and the citizens now wonder how they have lived without one for so many years. Cordially yours, C. E. BARTLETT. - A SUGGESTED MODIFICATION IN TELE TECHNIQUE OF WACCINATION. Minneapolis, Minn., Oct. 17, 1899. To the Editor Of the Medical Dial : Dear Doctor: In Dr. Knut Hoegh's excel- lent article “Concerning Vaccination,” appear- ing in your October number, a very desirable and useful method is described. Please per- mit me to suggest a slight modification for con- venience sake. Fill the hypodermic syringe half full of sterile water; discharge all air; draw into the needle a minute droplet of vac- cine; insert the needle one-eighth of an inch horizontally under the epidermis; discharge enough to produce a small whitish spot at the end of the needle. As the needle is withdrawn keep the puncture closed with superimposed finger. The operation can be made painless by compression of the fold of skin. The incom- pressible column of water makes the deposit certain, and the method makes use of an ever- ready instrument. G. D. HAGGARD, M. D. SOcięty) R&pOrtS. HENNEPIN CO. MEDICAL SOCIETY. The stated meeting of the Hennepin County Medical Society was held at the Public Li- brary, Oct. 9th, Dr. H. B. Sweetser presiding. About thirty-five members were present, as was also Dr. H. W. Foster of Bozeman, Mon- tana, as Visitor. The special committee appointed to revise the fee bill made no further report and the bill as revised was adopted by the society and or- dered printed and distributed to the members by the secretary. The president made a brief verbal report for the executive committee, after which some discussion arose as to a change of our place of meeting and, on motion, the executive committee was empowered to se- cure other quarters, whenever a suitable place can be found. Dr. A. W. Abbott exhibited a retroperiton- eal cyst and also an ovarian cyst with twisted pedicle, with full reports of both cases. A paper entitled “Myasthenia Gastrica” was read by Dr. J. W. Bell, (see October num- ber of The Medical Dial), which was followed by a general and interesting discussion. Dr. A. W. Abbott inquired why patients suffering from this condition should not be al- lowed Water with meals. Dr. G. D. Head thought the rules for diag- nosis and treatment more clearly stated in the paper than in text books. Most of his cases had been in complication with other condi- tions. Wished to ask whether the protruding abdomens of children were to be supposed to be due to stomach atony. Mentioned use of Salol in diagnosis, and thought it valuable—to be taken by the mouth in capsules—and the urine examined one hour to one and one-half hours after. The diagnosis is difficult, even aside from the usual complications. Dr. L. A. Nippert suggested the value of at- tention to teeth and the habit of rapid eating, Thinks nothing but the test meal satisfactory in diagnosis. Dr. G. D. Haggard remarked that a small test meal often caused the stomach acid to be neutralized by saliva. Dr. E. S. Strout gave a sketch of the pro- cess of using salol. 354 THE NAEDICAL DIAL. # * \ , Dr. W. A. Jones meets disturbances of mo- tility often among neurasthenics, in whom motor insufficiency is often widely distributed. Many fermentative cases are due to nervous insufficiency. Direct treatment often disap- points. Many methods of treatment do good by bringing systemic health rather than by direct action. The mind should be diverted from the stomach as completely as possible. As to the drinking of water: The moral disci- pline of abstention may be salutary in some cases. Otherwise flhe free use of Water is positively beneficial. The stomach does absorb water—at least the water disappears. Anti- septic treatment is interesting and theoreti- cally correct, but no satisfactory stomach anti- septic has been found. Dr. Johnston wished to ask if the continued frequent use of hot water by the mouth might cause chronic congestion. Dr. Hoegh asked: “How about ice water?” Dr. Staples thought the name given to this condition fortunate. The condition may be brought on in convalescence from typhoid by distending the stomach with large quantities of fluid. Water in large quantities is injuri- ous. Whisky is beneficial in some cases, also bitter ale. Lavage has probably done more harm than good in the aggregate. The result- ing depression is injurious. It is of benefit in properly selected cases, but its use has been too promiscuous. Dr. Sweetser wished to ask if there were no way of estimating the rapidity of secretion. Dr. Bell, in closing: Water does injury when taken with meals. It is not absorbed by the stomach and distends and hampers it in its churning motion. Prefers to have it taken hot an hour or an hour and a quarter before meals. Has had no special experience with children, but thinks the enlargement of the , abdomen not due to size of stomach, at least, only partially. Has little experience with the salol test. It is not now very much used. The test meal is much more accurate and it must be large enough. The “test breakfast” is too small. The test dinner should be used and several observations made. Dr. Jones’ cases should be called neurasthenia gastrica, rather than myasthenia. The stomach is often the pivotal point with neurasthenics. Medical dyspeptics have disturbance of secretion rather than of motility. The fact of the abuse of lav- age must be admitted. The modern form of tube has more openings and gives a spray or douche. Distention is objectionable and adds to prolapse. Not more than one pint of fluid should be used. A double tube prevents dis- tention. Hot water may cause congestion if taken too hot. It should be taken one to one and one-quarter hours before meals. Dr. C. F. Nootnagle presented a paper en- titled “Secretory Diseases of the Stomach.” In discussion, Dr. Nippert asked how and when antacids should be used. Dr. Johnston asked why hydrochloric acid should not be given before meals? - Dr. Bell agrees that differential diagnosis between malignant disease and syphilis may be very diſficult and cited case. Hydrochloric acid is often absent in syphilitic disease of stomach. Did not agree that animal food alone caused hyperacidity. Thought egg-albu- men well borne and also some other proteids. Dr. Nootnagle, closing: Alkalies before meals do not produce any effect discoverable by tests. Alkalies after meals should only be taken to relieve pain. Did not restrict diet rigidly to carbohydrates, but allowed some pro- teids, meats finely divided, scraped beef being One of the best. Used silver nitrate solution in strength of 1-700 to 1-1,000. The application of Dr. W. B. Murphy for membership was read and referred to the board of censors. A letter from Noyes Bros. & Cutler, St. Paul, asking for the use of a room for two lectures on static electricity and X-ray work, was read and, on motion, the society voted to offer the use of the room. The matter of entertaining the Association of Railroad Surgeons was informally discussed, but no action taken. tº-º-º-º-º-º-º-º-º: WESTERN SURGICAL AND GYNECOLOG- ICAL ASSOCIATION. The ninth annual meeting of the Western Surgical and Gynecological Association will be held at Des Moines, Iowa, Dec. 27 and 28, 1899. Surgeons and gynecologists of the great West are cordially invited to affiliate them- selves with this Association. The secretary Will be glad to send application blanks on re- Quest. Titles of papers should be sent to the Secretary as soon as convenient, but not later than November 20 to insure a place on the pro- gram. H. C. CROWELL, Pres., IKansas City, Mo. GEORGE H. SIMMONS, Sec. and Treas., 61 Market St., Chicago. The theory that bacteria are indispensable to digestion has been laid to rest at last by Levin's research in the Arctic regions, report. ed in Hygiea, No. 2. He accompanied the Nathorst expedition and examined the intes- times of Various birds and animals killed. With the exception of one polar bear and two wal- ruses, the intestines were found absolutely sterile, and in these only a few specimens of the bacillus coli were discovered. Bacteria were found in the water, one colony to 1 c.c., the number increasing with the distance from the surface. The air was found absolutely Sterile. No colds nor catarrhs ever occurred among the men.—Jour. Am. Med. Ass'n. THE MEDICAL DIAL. 355 ProSress oſ II?&dicine. SURGERY. UNDER THE CHARGE OF W. J. H. DUNN, M. D., W. A. HALL., M. D. RNUT HOEGH, M. D. THE GROWTH AND EXTENSION OF CAR- CINOMA. (By William T. Councilman, Boston. Read before the Massachusetts Medical Society, June 13, 1899. Published in Boston Medical and Surgical Journal, Sept. 14, 1899.) [The modern operation in cancer cases is of necessity a careful dissection of wide ex- tent. It involves not only removal of the pri- mary growth and of all secondary growths, but also the removal of the entire lymphatic-bear- ing tissues between them, as thoroughly as can be done without involving the patient’s life. The pathological reason for this is very clearly demonstrated in Dr. Councilman’s paper.] The carcinoma is a tumor which arises from epithelial tissues, is characterized by unlimited growth locally, and by the formation of tu- mors of a similar structure in other parts of the body, Its microscopic structure shows two sorts of tissue, (1) epithelial cells arranged for the most part in solid masses, which vary in their size and form, growing in spaces which are called alveoli; (2) connective tissue which surrounds the alveoli and bears the blood Ves- sels for the nutrition of the cells in the alveoli. This connective tissue is called the stroma. Neither stroma nor blood vessels penetrate the masses of epithelium. If we take any normal epithelial structure and suppose that the cells at some point be- gin to multiply with unlimited activity and penetrate into the adjoining connective tissue, We have the structure of the carcinoma. It is not sufficient for the epithelium simply to pro- liferat. To explain the growth of the carci- noma, it will be necessary to consider for a moment the structure of the connective tissue. This is essentially formed of fibers, between which are colls. It carries the blood vessels everywhere, and in it lymphatics arise. In the tissue the cells lie in spaces which communi- cate with adjoining spaces and, from the en- largement and coalescence of these spaces, the lymphatics are formed. If we suppose that a carcinoma begins its formation by the epi- thelium growing outward into this tissue, then the growing cells of the tumor at once find their way into this system of communicating spaces and continue to grow in them. Every mass of epithelial cells is within such a lymph space of the tissue. The carcinoma not only tends to grow lo- cally in the way we have séen, but similar tumors are formed elsewhere. In carcinomas these secondary, or metastatic, tumors are found in those lymphatic glands which are con- nected with the primary tumor by lymphatic Vessels. In carcinomas of the alimentary Canal, the secondary growths are found not Only in the lymphatic glands, but in the liver, the connection being by the blood vessels of the portal system. The metastases repeat the structure of the primary tumor. Differences in the size and arrangement of the cells which characterize the primary tumor are found in the secondary. The same tendency to degen- erate, and the same form, are seen in the sec- Ondary. Something capable of producing the same growth must be carried from the primary tumor to form metastasis. By examining those lymphatic glands of the axilla, removed With a carcinoma of the breast, which, to the naked eye, present no enlargement or devia- tion from the normal, the beginning of the metastasis can be seen. It begins in the pe- riphery of the gland where the lymphatics, coming from the primary growth, enter. Cells of the same character as those in the primary growth are found in the lymph sinuses, and they grow here, the remainder of the gland forming the stroma. The growth advances along the lymphatics in two ways. Solid masses of cells, probably connected with the primary growth, may push their way along the lymphatic vessels. In car- cinoma of the stomach, it is not at all uncom- mon to find the lymphatics of the peritoneum Over the tumor, filled in this way with masses of cells. Secondly, by examining the tissue which is in the neighborhood of a carcinoma, and which is apparently not affected, we can Often find single epithelial cells within the lymphatics. In certain cases the tumor cells may push their way into blood vessels. In carcinoma of the alimentary tract, metastasis, both by the lymphatics and blood vessels, is the rule,_probably explained by the presence of Such numerous thin-walled veins in the tissue. The full recognition by surgeons of the inti- mate relation between the cells of the tumor and the lymphatics has led to those methods of operation which have so reduced the danger of recurrence. We know that no carcinoma can be found so recent in its development that the lymphatic glands belonging to the part may not be affected. Further, that the way of ex- tension is by the passage of cells from the primary tumor, or along the lymph vessels. It is of no use to remove the primary and sec- Ondary growth and leave a long street between the two which almost certainly contains strag. gling cells capable, each of them, of producing a new growth. Hence, tissue containing lymphatic vessels connecting primary growth 3- i ºv º * R. & * º, & - with lymphatic glands is removed as far as possible. Cells from the tumor, each capable of de- veloping a new tumor, may be implanted in the. tissues by the knife in the course of operation; hence the care exercised in avoiding incision into the tumor in the course of operation. [Not only is it bad surgery to cut into the tumor during the course of operation, but it is also poor surgery to cut across the lymphatics at any point between the tumor and the posi- tion of any possible secondary growth, as is evident from the statements made above.] A. T. MANN, M. D. GYNECOLOGY. UNDER THE CHARGE OF A. W. ABBOTT, M. D., F. A. DUNSMOOR, M. D. J. H. RISHMILLER, M. D TROPHIC DISTURBANCEs of BLADDER. FOLLOWING OPERATIONS. Mirabeau (Cent. für Gynae., 1899, No. 11) mentions the fact that the vesical irritation, frequently observed after an operation, is in- variably referred to infection or mechanical injury. Sometimes this irritation has been due to ligatures making their way through the walls of the bladder. The author cites two coeliotomies, with persistent vesical symptoms, in which cystoscopic examination revealed a general atrophy and anaemia of the mucous membrane. This circulatory disturbance was evidently due to the abnormally small arteries. He, therefore, inferred that the collateral cir- culation had not been established as usual after ligation of the vesical arteries. In just such patients treatment of the vesical per se may do more harm than benefit. Massage and tamponade, with the view of softening the ex- udate in the neighborhood of the organ, are prudently indicated. Prophylactically the op- erator should avoid mass-ligaturing, but li- gate the blood vessels separately, and, further- more, Sparing those as far as possible which supply the bladder. J. B. R. +-º-º-º-º-º-º- URETHRAL RESTORATION BY GERSUNG METHOD, Romm (Cent. für Gynae., 1899, No. 8) cites a case as follows: After protracted labor the urethra was destroyed in toto, with the excep- tion of the anterior wall. The orifice into the bladder was buried in cicatricial tissue. The writer restored the urethra by a flap operation, but disappointingly incontinence persisted. The Operation was repeated and the canal thus formed was subsequently twisted on its long axis from left to right 180 degrees and then THE MEDICAL DIAL. sutured. He then inserted into the bladder a silver catheter with a corresponding twist. Two weeks afterwards the patient could retain her urine from three to four hours. A month later the newly-formed urethra was dissected out as far as the bladder and given another twist of 180 degrees and sutured in such a manner and position that the external orifice was placed in the immediate proximity of the clitoris. A month hence the patient had en- tire control of her bladder. J. H. R. -* VAGINAL HYSTERECTOMY WITH DOYEN'S CLAMPS. Thrumin (Cent. für Gynae,. 1899, No. 5) re- ports 31 successive operations in which the broad ligaments were temporarily compressed with an instrument devised by the author sim- ilar to the angiatribe of Doyen and Tuffer. The operations were bloodless, and convales- cence was uncomplicated. The effect of pres- sure for two minutes before removal of the clamp—as disclosed by microscopical examina- tion—is to produce obliteration of the arteries by adhesion of the opposed endothelial sur- faces. The distal and proximal ends are plug- ged by thrombi; in other words, the tissues are mummified but not mortified. J. H. R. CARCINOMA OF UTERINE CERVIX FOL- LOWING SUPRAVAGINAL AMPU- TATION. Savor (Cent. für Gynae., 1898, No. 50) cites the case of a patient 52 years of age who had been operated upon four years before for fibro- ma. Of the uterus. The cervix was not re- moved. Convalescence was protracted on ac- count of a fistula communicating with the cervix. On examination the posterior lip of the cervix was found to be the seat of a cancer, involving the vaginal vault. The author ex- tirpated the carcinomatious extension with great difficulty, owing to the firm adhesion to the bladder and the obliteration or atrophy of Douglas’ pouch. The author refers to three other cases in Chrobak's clinic, in which the Stump subsequently became carcinomatious. He regards these cases as a strong argument in favor of pan-hysterectomy. J. H. R. THE CURE OF THE OPIUM HABIT. McLeod, of Shanghai, announcés that it is possible to cure the opium habit by means of bromide of sodium. He thinks that three Qūnces of the drug will suffice in most cases. He gives for the first two days doses of 2 drams in solution every two hours. On the third day 1 dram is given at each dose every two hours. —Western Med. Rev. Fasting is better than feasting. THE MEDICAL DIAL. OBSTETRICS. * UNDER THE chargE OF A. B. CATES, A. M., M. D. R. E. CUTTS, B. S., M. D. INVERSION OF THE UTERUS. W. M. McDonald (Am. Gyn. H. & Obs. Jr. Oct. 1899), in referring to the infrequency Of inversion of the uterus, says that in clinics Of Braun and Spaeth not a complete inversion QC. curred in 250,000 births, and in the Dublin RO- tunda it was observed but once in 191,000 de- liveries. While hospital reports show this to be a very rare occurrence, yet statistics from pri. vate practice indicate that inversion takes place more frequently; due, as the author thinks, to the fact that the physician in his haste to terminate labor oversteps the bounds of safety and as a result inversion, or some other complication, arises. It is suggested that possibly the practice of the Credé method of expulsion of the placenta and the abdominal massage, which is almost universally taught now, to prevent post partum haemorrhage, may be causative in producing inversion. The article closes with a report of a case occurring after forceps delivery, in a patient suffering from secondary syphilis. As the haemorrhage was severe, the placenta was de- livered by the combined method, although traction on the cord was very gentle. The haemorrhage continued after the delivery of the placenta, and upon examination the fundus uteri was found in the vagina. The fundus could be forced by the finger through the os, and then, with the nozzle of the fountain syr- inge and the pressure of the stream from the bag held at a height of eight feet, the inversion was completely reduced. Recovery unevent- ful. R. E. C. A CASE OF PUERPERAL SEPTICAEMIA IN WEIICEH ANTISTREPTOCOCCIC SERUM WAS USED WITH SUCCESS. (Dr. T. B. Grimsdale reports the case in the Lancet of Sept. 9, 1899.) Forty-eight hours after labor the patient had rigors. The uterus was douched twelve hours later, and a fall in temperature resulted. Temperature again returned, so curettement was finally performed. The fever continuing, on the ninth day ten cubic centimetres of anti- streptococcic serum were injected into the tissues of the abdominal wall. On the eleventh and twelfth days the serum injected was re- peated, but on the thirteenth day the injec- tions were discontinued, since the temperature of 104° and pulse of 120° had been restored to normal, with all other symptoms improved. tococci present. The temperature and pulse began to rise gradually, until three days latef the temperature became 103° and the pulse. 120°, with a return of the other unfavorable symptoms. Ten cubic centimetres of the Ser rum were again injected, and used daily for fourteen days, until it was found streptococci would not grow in the, blood serum of the patient. The injections were then discon- tinued, although the temperature was two or three degrees above normal; but it gradually fell and in the course of a week became slight- ly subnormal. Aside from small doses of quinine no other treatment was used. The patient was in the hospital seven and one-half Weeks. Dr. Grimsdale thinks the disease would have been greatly shortened had he not discon- tinued the use of the serum the first time. He considered it a mistake to take for granted, be- cause the temperature and pulse became nor- mal, that the blood was free from strepto: cocci, since they were shown to be present all the time by later examinations of cultures made at that time. After these injections the temperature became normal and remained so for twenty-four hours when it began to rise gradually for three days, showing that nearly all the streptococci were destroyed by these injections but that the few remaining multi- plied until the symptoms were reproduced. The immediate effects of the injections upon the patient were excellent. The headache, the fear of impending death, and the despondency were all removed when the injections were used. Toward the end of the course of treat- ment the patient suffered considerably from urticaria, and later complained of severe pains in the limbs and the muscles were painful upon pressure. Dr. Grimsdale feels certain that the pa- tient’s life was saved by the serum. E. E. C. INGROWING NAILS. I wish to call attention to a method of treatment for this painful affection, which I have used for many years, and I do not remem- ber a failure to promptly effect a cure. 1. Remove all pressure from the nail by cutting away a piece of the shoe. 2. Disinfect with hydrogen dioxide until no more “foam” appears. 3. Apply a drop of strong solution of co- caine in the base of the ulcer. 4. Apply a drop of Monsell’s solution to the ulcer, then cover loosely with gauze. Repeat this process every second day, until the edge of the nail is released, by the retraction of the hypertrophied tissue. The patient suffers no pain from the application, and all pain has dis- appeared the second day. The cure is effected in a week or two, without inconvenience or interference with business.--Dr. Kinsman, in Columbus Medical Journal. h 3. ~ * - * , r * : y : * P" " ..., º: i" * * ...I. ‘. .* 3% × * * .* * * ** * * * , f * » ** $º. --> * §§º.º. . . . šº, , , 1 ri * f = º:358:. . . . . ... " 3. 2 * * ~ * ~ * rt * : * * * ## * & *, $ 4 × gr * * º * * * THE MEDICAL DIAL. cause toxic effects? It is generally believed that the exanthematous diseases gain entrance & PEDIATRICS. —r- y UNDER THE CHARGE OF H. B. SWEETSER, M. D. J. P. BARBER, M. D ENIARGED GLANL)S IN CHILDREN. Schleich, in an article on this subject (Pedi- atrics, Oct. 1st, 1899), takes occasion to explain his theory of immunity in infectious diseases. He compares immunity of this kind to the drug habit. He has shown experimentally that morphine, cocaine, caffein, etc., may be given in ever-increasing dosage without intoxication, but that the initial dose introduced within the cranial cavity of the animal produces marked intoxication. He reasons from this that more and more of the drug must be used on account of the continual irritation of the lymph chan- nels, causing a narrowing of their caliber, so that only a limited portion of the drug can be absorbed and reach the brain. The balance of the drug remains within the lymphatic sys- tem, where it becomes chemically indifferent through oxidation, disoxidation, subdivision, etc. “There is, therefore,” he says, “originally only a local cellular immunity at the site of entry, restricted to a single division of the lym- phatic system, which is dependent upon orig- inal injury.” He refers to Pasteur’s anti-rabie inoculations and the fact that after an animal has been immunized by the injection of the virus of rabies under the meninges of the brain produces rabies and concludes from that, that “immunity is but a cellular local conception.” “The relative acquired immunity toward Scarlatina and measles may also be conceived as a closing up of the lymph radicals at the site of entry of the virus. Only in this man- ner can be explained the fact that children With acquired immunity to epidemic scarlatina may still contract surgical scarlatina. The or- dinary avenues of infection, whether respira- tory or digestive, have been rendered impervi- ous by obliteration of the lymphatics in these localities, but the virus may still gain the sys- tem by way of the cutaneous lymphatics—or, in other words, the entire body has not been rendered immune by the disease, but only a definite local territory.” It would seem that Schleich will have to answer several objections before his theory of immunity can be accepted. In the first place, if tolerance for a drug and immunity against infection is caused by a local obliteration of the lymph radicals, why does that not estab- lish tolerance for any other drug, or immunity against any other infection in the same Jo- cality? In the case of drugs, if repeated in- jection in a certain locality produces tolerance by obliterating the lymph radicals in that lo- cality, why does not the same drug taken into the stomach or injected in another locality where the lymph radicals were not obliterated into the system through the respiratory tract. If that is true, an attack of scarlet fever, ac- cording to Schleich’s theory, ought to im- munize the patient against every other infec- tion contracted by that route. The action of the various antitoxins would be very difficult to explain by this theory. It is hard to con- ceive how the antitoxin of diphtheria, for in- stance, injected in the thigh or back could ob- literate the lymphatic radicals of the throat. The practicăl part of the article is much better than the theoretical. He makes a strong plea for the strictest conservatism in the surgical treatment of the lymphatic glands of children, especially of those about the neck. Simple inflammatory enlargement with- out suppuration should never be treated surgi- cally. Local and constitutional treatment and removal of the source of irritation al- ways suffice. Simple suppuration is treat- ed by incision and packing. Suppuration with multiple foci are best treated by extirpa- tion without attempting to remove all of the capsule. Cheesy glands are always best treated by incision of the capsule and enuclea- tion of the contents with the curette, provided thorough constitutional treatment has not sue- ceeded in causing resolution. He thinks a syphilitic taint is behind caseous glands oftener than is supposed and advises specific medication before resorting to surgical meas- Ull’éS. J. P. B. BOOK IMOtiC&S. THIRTEEN DOLLARS FOR FOUR DOLLARS. w A book the price of which when originally published was twelve dollars alone and a year’s subscription to the New York Lancet (Address 156 Fifth Ave., New York) is offered for four dollars. The book is Flint’s “Encyclo- pedia of Medicine,” a work covering practically every subject in medicine. New, revised, 1898 edition; 1558 pages; 8vo; cloth. As has been aptly said, “A book for the desk and not for the shelf.” Thousands of endorsements have been re- ceived. “After several weeks of practical use I must say that I cannot see how you give so much for the money. I have a very good library, but When I want an idea quick I go to Flint's En- cyclopedia. It serves to review, and not rarely to give points not found elsewhere. I feel it my duty to thank you for such a book. “David Ralph Bowen, M. D.” The Medical News says: The text is brief, clear and explicit. As a volume for ready reference it occupies a field wholly by itself. , “tº $º- The Dominion Medical Monthly: Judging from the ability of the over two score leading English and American contributors, also from the scope and character of the work, one is compelled to acknowledge its great value as a book of reference. amº- MULTIPLE PISTOL SHOT WOUNDS. In an article in the New York Medical Jour- nal for July 8, 1899, Dr. George Woolsey, sur- geon to Bellevue Hospital, speaking of “Mul: tiple Pistol Shot Wounds of the Intestine,” says, “The necessity of operation is generally admitted. First, an enlargement and explora- tion of the wound to determine whether it has penetrated the abdominal wall; then a laparot: omy in such a position as to reach all parts of the peritoneal cavity, and especially those that lie in the track apparently taken by the bullet. The incision, as a rule, is best made in the middle line, through the rectus, an inch or so to one side of or through the semilunar line. As soon as the fact of perforation is known it is a mistake to confine ourselves to a small in- cision. The operation should also be done as soon as possible. On opening the abdomen in any case the first thing to do is to check hem- orrhage if it exists. Perforations of the in- testines should be closed by Lembert sutures. Two rows of continuous sutures are safer and more rapidly applied than a single row of in- terrupted sutures. It is safer to cleanse all parts thoroughly. If we are uncertain of the perfect closure of any perforation, if free se- rous exudation has begun from peritonitic irri- tation, due to infectious matter, or if more marked signs of peritonitis exist, most of us would prefer to drain. In cases of perforat- ing pistol shot wounds safety is the paramount consideration.” Surgeon Beck, of the Thirteenth Minne- sota, says that, “To the small-calibre bullet of the insurgents’ Mausers the wounded boys owe their lives and a continuance of their usual friendly association with good arms and legs. In the bony structure of the body the Mauser bores a clean little hole, rarely fracturing a limb; in the skull it takes a center shot to kill.” He says that he has knowledge of fully one hundred men shot through the chest cavity in every portion except the heart, who recovered. But while the injuries brought about by bul- lets from the army rifles of to-day are, on the whole, less severe than was formerly the case, abdominal wounds are as fatal, if not more so, than in former times.” Surgeon Beck further says: “Through the soft abdominal tissues the Mauser is always fatal. Wounds of the intestines, stomach and spleen always kill. Every operation for re- Section of wounded intestines resulted in death, and the operation is now entirely aban- doned.” THE MEDICAL DIAL. This is in line with the opinion of a large, number of army surgical authorities, although views differ considerably as to whether in pen- etrating wounds of the abdomen a radical or conservative treatment should be pursued. Dr. William Parker, of New Orleans, dis- cussing this point, records his belief that in abdominal wounds caused by the Small mod- ern bullet laparotomy should not be attempted in the field. Dr. Nicholas Plum lays down the dictum that laparotomy in penetrating gunshot wounds of the abdomen is indicated in all cases in which life is threatened by hem- orrhage of visceral wounds, and the general condition of the patient is such as to sustain the expectation that he will survive the im- mediate effects of the operation. Sir William McCormac advises, when pen- etration has been diagnosed, that abdominal section should be performed as quickly as pos- sible. The fact, however, may be noted here that the mortality which has up to the present fol- lowed penetrating wounds of the abdomen treated on the battlefield, or in war hospitals, has been extremely high. The French lost 91.7 per cent. of their cases in the Crimea, and the English 92.5 per cent. In the American war the death rate was 90 per cent.—Medical Record, July 8. -*. • INTOXICATION IN APPENDICITIS. Le Dentu, in a paper read before the Paris Academy of Medicine, accepts the view that appendicitis is toxic as well as infectious, and says that he has occasionally recorded marked evidences of intoxication. He gives two ex- amples: one of a toxic meningitis, and the other of a toxic icterus, which developed dur- ing the course of appendicitis. The icterus Was present throughout the course of a chronic appendicitis, promptly disappearing when the case was cured by operation. THE ALARMING INCREASE of CANCER. According to the Physician and Surgeon, Prof. Roswell Park makes the startling proph- eely that if for the next ten years the present relative death-rates are maintained, in 1909 there will be more deaths in the state of New York from cancer than from consumption, Smallpox, and typhoid fever combined. For a number of years back, the English Statisticians have been calling attention to the rapid increase of cancer in England. It has been almost universally noted that flesh eating and cancer are increasing at about the same ratio. The rice-eating natives of India are al- most Wholly free from cancer, which is found to be most frequent in occurrence among pork eaters and those who make free use of aniumal food. It is impossible for human beings to * * * * * * * * * ...? & £ w * * * * :- * * * * + ** * ** * * } **. § { Kº * -á .. *. *** ~ ;- .# * -: * R sº-ºx" * * * * * * *ś . A. *.4 . … ', " t * Š->' g V. * * \ ¥ º * -- * º make cemeteries.of their stomachs without suf- fering the natural consequences of polluting the vital, stream with the products of disease and putrefaction. This is the means whereby * - a fertile soil is prepared, not only for cancer, but for consumption and many other maladies. The Supreme Court of Iowa, Gambell, judge, in the case of Dr. George B. McClellan against J. F. Metzer, sheriff of Marion county, declared the medical practice law unconstitu- tional. CINNAMON AS AN INTERNAL ANTISEPTIC. Cinnamon is recommended as an internal antiseptic by Dr. C. G. Grant (British Medical Journal). When in Ceylon he discovered that persons working in cinnamon gardens seemed to be immune to malaria. On trial he found it valuable in gastro-enteritis, recurrent boils, and, he thinks, in typhoid fever. He was as- tonished by its wonderful influence in influen- za, and earnestly recommends its free use by Others. The reports of the Board of Health for the state of Massachusetts say that out of every 1,000 persons dying in the state between the ages of twenty and thirty, 597 (almost 60 per cent.) die of tuberculosis of the lungs. It is stated that Mrs. Mary Baker Eddy, of Christian Science fame, is being sued in amounts aggregating $500,000 by Mrs. Joseph- ine Curtis Woodbury, of Boston. Seven differ- ent suits are pending, all of which are for al- leged libelous remarks made by Mrs. Eddy at the First Church of Christ, Boston, Sunday, June 4.—Journal A. M. A. A form of malarial fever, which has for many years caused great ravages in certain parts of Central Asia, is on the increase, and is spreading over a large area, especially in the direction of the Steppes. The Russian medical • and sanitary staff in the affected districts are devoting themselves to the task of combating the disease wth ever-increasing energy.—Lon- ‘don (Eng.) Health. *º- Take two pounds of good prunes and water enough to make five pints; boil for fifteen or twenty minutes, and to this, when strained, add five pounds of Sugar and one pound each of modified nonbitter extracts of cascara sagrada and aqueous fluid extract of senna, and flavor with a few drops of oil of coriander and pep- permint. While this yields a good prepara- tion, it may be improved by adding one dram of Saccharin and enough simple syrup to make one and one-half gallons. This will be found an excellent laxative syrup.–Western Drug. gist. the MEDICAL DIAL. I do not consider traction on the tongue as being perfectly free from all danger; at least, I cannot imagine why muscle bundles should not be torn in the manipulations. By tickling the epiglottis nothing can be injured. We know by daily experience how anxiously we try to avoid touching the epiglottis in intra- laryngeal operations, even after thorough co- cainization. We are afraid of the reflex caused by the least sensation of tickling. Ought we not to learn by this experience? Therefore tickling the epiglottis might perhaps be tried as a means of resuscitation.—W. Freudenthal. The fifth Triennial Prize of Five Hundred Dollars, in deed of trust, will be awarded to the author of the best essay on “The Various Manifestations of Lithaemia in Infancy and Childhood, with the Etiology and Treatment.” The prize is open for competition to the whole world. The essay must be in English, type- written, distinguished by a motto, accompa- nied by a sealed envelope bearing the same motto, and containing the name and address of the writer. All essays in competition must be sent to Dr. Richard C. Norris, Chairman of the Prize Committee, College of Physicians of Philadelphia, Pa., and must be in his hands on or before January 1, 1901. The committee re- serves the right not to make an award if no essay submitted is considered worthy of a prize. Capitan (La Med. Moderne; Med. Rev. of Reviews) first mentions angina pectoris as a type of disease in which vaso-dilatation is indicated and then observes that our Stock remedies (amyl nitrite, nitroglycerine) are too transitory in their action. For a number of years substitutes have been sought for. Sev- eral good drugs have unpleasant collateral action (nitric ethers of the fatty-acid series, chlorhydrate of hydroxylamine), which have resulted in their abandonment. Recently the tetranitrate of erythol and hexamitrate of mannitol have been introduced. About an hour is required for them to reduce arterial pressure, but the result persists for six hours (dose, 6.5 mgm.). The indications for these remedies are angina pectoris, kidney diseases, aneurism, Raynaud’s disease, migraine, etc., etc. Dr. E. W. Scripture described before the American Association for the Advancement of Science the method of producting anaesthesia by the direct application of an electrical cur- rent without the application of drugs. An alterating current with equal positive and negative phases was made to traverse the nerve. At a proper frequency of about 5,000 complete periods in a second it can be made to cut off all sensatory communication by this nerve. Needles can be run into the part of the body supplied by this nerve without any pain being felt.—Scientific American. THE MEDICAL DIAL. jº *s i * Index II?&diCuS. Enclosed figures indicate prices for single copies. THE MEDICAL DIAL, Minneapolis, Minn. (10). September: The value of a leucocite COunt in appen- digitis, G. D. Head, Minneapolis.--Some abuses of na; sal surgery, W. S. Laton, Minneapolis–Surgical tuberculosis, G. G. Eitel, Minneapolis.--Suprarenal extract in ophthalmic aural and allied Surgery, A. G. Aldrich, Minneapolis.-Recurrent appendicitis, With report of a case, W. Z. Flower, Gibbon, Minn-Do we need iodoform, F. A. Dunsmoor, Minneapolis- The importance of the recognition of certain blood- changes, and especially toxaemia in...Our therapeu- tics, J. V. Shoemaker, Phildelphia–Tetanus in the light of modern research (ed.).-The Minnesota Na- tional Park (ed. by R. O. Beard).-Index-medicus, givi ing list of current original articles in the medical journals. º October: An arm saved after being run over and crushed by a railway locomotive, S. L. Kilmer, South Bend, Ind.—Fibroma molluscum (illustrated), Fred. J. Léviseur, N. Y. C.—Myasthenia gastrica, J. W. Bell, Minneapolis.--Tetanus and tetanus Serum, re. port of a case, E. W. Flint, Minneapolis.-The legal responsibility of physicians in certain cases, F. F. Casseday, Minneapolis.-The differential diagnosis Of small pox, chicken pox and measles, G. R. Curran, Worthington, Minn.—Some thoughts about Vaccina- tion (ed. by Knut Hoegh).--Demise of George Hen- dricks, M. D. (ed.).--The treatment of cancer by the cataphoric diffusion of the oxychlorides of mercury and zinc, the Massey treatment, G. Betton Massey, Phila.--Modifications of Bottini's operation for hy- pertrophy of the prostate by galvano-cautery, ROb- ert Newman, N. Y. C.—The pathogenesis of functional nervous diseases and their prophylactic indications, John Punton, Kansas City.—Technic of abdominal hysterectomy, J. H. Carstens, Detroit–Two cases Of dystocia due to ventrofixation, one requiring Caesa- rian section, X. C. Werder, Pittsburg.—Report of a case of complete hernia of the pregnant uterus, W. V. Anderson, Toledo.—Index-Medicus. * NEW YORK MEDICAL JOURNAL. (10). Sep- tember 23: Fractures of the lower end of the ra- dius, C. Beck, N. Y. C.—The physiological action and therapeutics of guaiamar, a derivative of guaiacol, G. F. Butler, Chicago.—The compulsory reporting of tuberculosis, S. A. Knoff, N. Y. C.—Exhibition of a case of stammering, with demonstration of the meth- ods employed in treatment, G. H. Makuen, Philadel- phia.-The early recognition of kidney disease, espe- cially in its reference to, life insurance, T. H. Rock- well.–Foreign bodies lodged within the eyeball, E. Jackson, Denver.—Pistol-shot wound of the abdomen perforating the stomach, recovery, J. N. LeConte, Jersey City. September 30: Displacements of the heart in lat- eral curvature, a study in therapeutics, T. E. Sat- terthwaite, N. Y. C.—Removal of a foreign body from the bronchial tube through the tracheal opening, re- port of a case, A. Coolidge, Jr., Boston.—A new series of therapeutic agents, K. Schwickerath.-The amoe- ba. ciliaria in disease, H. G. Graham, Chicago.—Ty- pho-malarial fever, C. R. Grandy, Norfolk, Va.—A. third report relating to the heated-blood treatment of croupous pneumonia, C. E. Elfstrom. October 7: A report of five cases of scoliosis and One case of flat foot treated by the Teschner meth- od, L. Erick, Baltimore.—Acute suppurative process- es in the faucial tonsils, J. L. GOOdale, Boston.—Ton- sillar and circumtonsillar abscess, G. A. Leland, Bos- ton.—Purpura rheumatica, remarks, two cases in the extremes of life, W. L. Johnson, St. Louis.-The pri- mary lesion of tuberculosis, how located, W. H. Weaver, Chicago. October 21: Very early rupture in an ectopic gestation in a tubal diverticulum, F. Henrotin, Chica- go.—A report of two cases of accessory thyroid gland at the base of the tongue, A. W. Watson, Philadel- phia.-The cause of death from industrial electric Currents, R. H. Cunningham (to be continued).--Sur- gical diseases of the kidneys, cases illustrating Some points in diagnosis and treatment, L. Freeman, Den- wer.—The effect of atmospheric changes on the hear- ing in chronic catarrhal otitis media, S. Oppenheimer. —A Clinical note on the Connection between asthma. and eczema, H. Taylor.—The treatment of follicular and Suppurative amygdalitis and the angina of Scar- let fever by the injection of a Solution of carbolic acid, H. J. Lipes. JOUR. OF THE AM. MED. ASS’N, Chicago. (10). September 23: Does the removal of the ovaries ex- ert beneficial influence on the subsequent progress Of malignant diseases, E. E. Montgomery, Philadel- phia.-Relations of headache to affections of the eye, S. D. Risley, Phila.-Headaches of gastro-intestinal disorders, F. Billings, Chicago.—Quantitative estima- tion of albumin in the urine, C. W. Purdy, Chicago.— Accidental or spurious albuminuria, C. G. Stockton, Buffalo.—Observations on tonsillectomy, J. H. Coul- ter, Chicago.—Diseases of the antrum of Highmore, a study of one hundred and fifty cases, L. C. Cline, Indianapolis.-Operation for undescended testicle and Congenital inguinal hernia, A. D. Bevan, Chicago.— Chloretone, a new hypnotic and anesthetic, T. B. Al- Čirich, Baltimore.—The douche, its rise and decline, but present restoration, F. A. Stahl, Chicago. October 7: Memorial address on the life and Clharacter of Lawson Tait, C. L. Reed, Cincinnati.-- Treatment of abdominal viscera through the colon, F. B. Turck, Chicago.—A further report on the use of “antiphthisic serum, T. R.” (Fisch) in tuberculosis, A. M. Holmes, Denver.—Walue of muscle training in treatment of Vocal defects, G. H. Makuen, Phila.-Re- lation of the nasal and accessory cavities and dental lesions, D. B. Kyle, Phila.-The semeology of the at- titude and motor state in children, S. W. Kelley, Cleveland.—Emergency surgery, with especial ref- erence to work in homes of the poor, R. C. Dugan, Eyota, Minn.—The proper place for proprietaries, J. F. Beery, Columbus.-Injuries to the eyes from elec- tric-light flash, W. H. Fox, Washington. October 14: Superiority of vaginal route over ab- dominal incision in surgical treatment of pelvic dis- ease in women, J. R. Goffe, N. Y. C.—Technique of Surgery of the uterus and adnexae per vaginum, W. H. Wathen, Louisville.—What becomes of patients. after Vaginal puncture and incision, F. Henrotin, Chi- cago-Constipation in infants, H. M. McClanahan, Omaha-Hysteria in children, E. E. Mayer, Pitts- burg.—Conveyance of infection through the medium of the ear syringe, a remedy, F. C. Todd, Minneapo- lis.-Automatic drainage of normal cavities, W. Jep- Son, Sioux City.—Anatomic variations of the nasal ghamber, and associated parts (illustrated), M. H. Cryer, Phila.-Report of cases of pulmonary tubercu- losis treated with intrapleural injections of nitrogen, With a consideration of the pathology of COmpression. of a tuberculous lung, A. F. Lumke, Chicago.—Pri- mary testicular mumps, L. B. Edwards, Richmond. ; hemorrhage and septicemia, T. H. Wagner, Ollét. October 21: Progress in medicine, and address, H. E. Tuley, Louisville.—Secretion and exudation. considered as a factor in diseases of the eye, J. W. Wright, Columbus.-Examination of the acuteness of Vision, Color perception and hearing of railway em- ployes, C. H. Williams, Boston.—Lipemia in diabetes mellitus, T. B. Futcher, Baltimore.—The Surgical sig- nificance of Certain anatomic, physiologic and patho- logic peculiarities of the peritoneum, H. D. Niles, Salt Lake City.—Three years experience with Vaginal Suturing of the round ligaments for retroversions and flexions of the uterus, H. N. Vineberg, N. Y. C.— *> q. * - r” * F-4 §º. 33%; i.” ". . . . . ." . " * ****.*.* * & ~ * .* * - 1? *ś - * * '... * * & * * * tº. sºr * Shock, its nature, cause and treatment, P. T. Nelson, Chicago.—The reconstruction of the pelvic structures '' incident to lesions of perineum, H. O. Marcy, Boston. 2. Case of urticaria pigmentosa following chicken pox, A. Woldert, Phila.-Report of cases of pulmonary tu- berculosis, treated with intrapleural injections of ni- trogen, with a considerable Of the pathology Of COm- pression of a tuberculous lung (continued from pre- vious number). SOUTHWESTERN MED. RECORD, Houston. (10). September: Hyper-medication, R. W. Knox, Houston.--"Auto-intoxication as the cause of fever,” some remarks on the treatment, F. B. King, Houston. SOUTHERN MED. JOURNAL, LaGrange, N. C. (10). September: Notes on the treatment Of Sup- purating bubo, H. A. Royster, Raleigh, N. C.—Treat- ment of acute dysentery, with report of cases, R. C. Kenner, Louis Ville. & *-*-* SOUTHERN MED. JOURNAL, LaGrange, N. C. (10). October: The human brain, an appeal to the general practitioner to give it more study, J. H. Hod- ges, Gainesville, Fla.--Whatever profit, there is in medicine belongs to doctors, H. O. Hyatt, Kingston, N. C.–Medical quackery of to-day (ed.).-Punishment of the rapist (ed.). WESTERN CLINICAL RECORDER, Chicago. (10). September: Anthrax affecting man, report of six cases (to be continued), F. J. Hogdes and W. T. Rinehart, Ashland, Wis.--The practical Value of the determination of indicanuria, H. G. Wells, Chicago. —Five hundred and fifty surgical operations Without alcohol, C. G. Davis, Chicago. THE LARYNGOSCOPE, St. Louis. (20). October: Endocranial complications of otic Origin. TWO cases of cerebral abscess. E. J. Moure, Bordeaux, France; translated by St. Clair Thompson, London, Eng.— Edeno-sarcoma of the nasal Septum, A. R. Baker, Cleveland.—Some consequences of singers' nodes, A. Rosenberg, Berlin.—An interesting case of fatal dyspnea in a child, S. E. Allen, Cincinnati.-Proceed- ings of International otological congress (Continued). ARCHIVES OF PEDIATRICS, N. Y. C. (25). October: Urticaria. Of the mucous membranes, es- pecially in connection with asthma, F. A. Packard, Phila.-The increase in Weight in infants fed artifici- ally, H. Koplik, N. Y. C.—Congenital cystic kidneys, with the report of a case, E. E. Graham, Phila.; with a pathological report, W. M. F. Coplin, Phila.-A case of porencephalus, G. N. Acker, Wash.-Report of a case of anuria, A. C. Cotton, Chicago.—Clinical diag- nosis Chart and record; a guide to bedside diagnosis for use in medical schools and in practice, A. Caille, N. Y. C.—Rickets (ed.).-Prognosis of physical ab- normalities of children (ed.).-Another advance in Se- curing pure milk for cities (ed.). VIRGINIA MED. SEMI—MO. (10). September 22: Remarks upon asthma as a Symptom Of uric acid Collaemia (second paper), J. Dunn, Richmond.—PhyS- ical examination for life insurance, A. H. Relch, Ilouisville.—Shall we operate in every case of appen- dicitis, V. Harrison, Richmond.—Rare result of gun shot injury to spine, W. H. Dial, Laurens, S. C. October 13: The treatment of pulmonary tuber- culosis by the inhalation of antiseptic nebulae, H. M. Thomas, Chicago.—Old age, and the modifications in the Course of the Ordinary diseases when they at- tack the aged, M. E. Nuckols, Richmond.—A form of the diplococcus scarlatinae not previously describ- ed., W. J. Class, Chicago.—An arm saved after being run over and Grushed by a railway locomotive, S. L. Kilmer, South Bend, Ind.—Appendicitis, report of twelve cases, C. G. Cannaday, Roanoke, Va.-Vesico- rectal anastomosis, J. Frank, Chicago. *362 THE. MEDICAL DIAL. MEDICAL REVIEW, London. (1s. 0d.). Sep: tember: Notes 14 pp.–Reviews of leading articles 25 pp.–Epitome of current medical literature 39 pp. MEDICAL MIRROR, St. Louis. (10). October: A profitable medical education, H. O. Walker, De- troit.—Treatment of tubercular and purulent joints with pure carbolic acid, A. M. Phelps, N. Y. C.— The forms and treatment of chronic rhinitis, R. C. Kenner, Louisville.—Sanguiferrin in chlorosis, W. C. Abbott, Chicago. JOUR. OF MED. AND SCIENCE, Portland, Me. (10). October: Mastoiditis, E. E. Holt, Portland.— Puímonary tuberculosis; a new idea of treatment by cutaneous inhalations of antiseptic and germicidal air, A. Walton, N. Y. C.—Relation of the physician to his co-worker, T. J. Stevens, Auburn.-The Janet treatment of gonorrhoea, G. A. Pudor, Portland. tºr MEMPHIS LANCET. (10). October: Clinical types of the uric acid diathesis, I. N. Danforth, Chi- cago.—A clinical study of Sunstroke, B. D. Mitchell, Memphis.—A case of peliosis rheumatica (Schoen- lein's disease), I. A. McSwain, Paris, Tenn.-A case of papilloma of the soft palate, R. McKinney, Mem- phis.--The study of the etiology of malaria (ed.). JOUR. OF THE MISS. STATE MED. ASS’N. Biloxi. (10). October: Arterio venous ancurism re- moved from scarpas triangle, M. J. Lowry, Meridian, Miss.--Circumcision, W. W. Robertson, McComb City, Miss.--Some facts about yellow fever, H. M. Folkes, Biloxi.-Irregular menstruation in young Women due to anaemic conditions, H. E. Lewis, Burlington, Vt. N. Y. LANCET. (10). Infectious jaundice, W. H. Washburn, Milwaukee.—Superficial treatment of deep diseases, W. H. Dickenson, N. Y. C.—The diag- nosis of Scarlet fever, F. F. Caiger, Stockwell.—A case of Strumpell’s paralysis combined with infantile paralysis, E. C. Williams, Bristol.—Operating for um- bilical hernia, whether for radical cure or when strangulation has occurred, H. Marsh, London.— Double pneumonia in the sixth month of pregnancy; miscarriage; relapse, recovery, T. Oliver, Newcastle- on-Tyne.—Extrauterine (one tubal and one ovarian) gestation in which rupture occurred before the end Of the first month, H. Gilford, Reading. AM. JOUR. OF DERM. AND GEN--URIN. DIS., St. Louis. (10). September: Climate as it affects the skin and its diseases, L. D. Bulkley, N. Y. C.— The effects of malformation and derangement of the genital Organs Of WOman. On her Sexual appetite, C. S. Bacon, Chicago.—CyStitis, J. H. Dowd, N. Y. C.— Cutaneous manifestations and intercurrent phenom- ena of Syphilis, S. C. Martin, St. Louis.-Rational treatment of gleet, J. M. Blaine, Denver.—Eye dis- eases due to syphilis, F. W. Hilcher, Spokane.—Dia- betes mellitus and its treatment, J. H. Reed, Battle Creek.—Treatment of acne (ed.).-A new dermato- * agent of Worth, A. H. Ohmann-Dumesnil, . LOUllS. BROOKLYN MEDICAL JOURNAL. (25). Oc- tober: Observations upon the organization and work of the medical department of the seventh army corps in the Spanish-American war, G. R. Fowler, late ma- jor and chief Surgeon U. S. W.-Remarks on the path- ology of the nasal Septum, J. Wright, Brooklyn.— Glycerinated vaccine virus and its preparation, H. Wallace, Brooklyn.—Incompleteness of the vaginal Speculum, J. E. Langstaff, Brooklyn.—Perforating gun-shot wound of the right thigh with injury to the femoral artery, F. W. Wunderlich, Brooklyn.— Notes On uterine hemorrhage, L. G. Langstaff, Brooklyn.— Prevention and modern treatment of tuberculosis (ed.).-Bacillus icteroides or bacillus cholerae Suis (ed.); full-page photo-cuts of: Samuel Boyd; Geo. I. Bennet. A. THE MEDICAL DIAL. # MED. EXAMINER, N. Y. C. (20). October: The universal blank for medical examinations (ed.).-The selection of lives for assurance, Mr. W. Hughes, Eng- land. The insurability of impaired lives, O. Embden, Brooklyn. =w-ºmsºmºsº MEDICAL SENTINEL, Portland, Oregon. (25). October: Some observations on the so-called spotted fever of Idaho, E. D. Maxey, Idaho.—Remarks on eti- ology of eclampsia, R. Kelly, Portland.—Headaches, especially those of ocular or nasal origin, J. A. IDOn O- van, Butte.—Headache, L. R. Markley, NeW What- com.—The so-called fever of Idaho (ed.). WISCONSIN MEDICAL RECORDER, JaneS- ville. (10). September: Cataract, R. B. Hopkins, Milton, Delaware.—A few points on therapeutics, A. V. Hinman, Youngstown, Ohio.—Emulsions as nutri- ents in medical appreciation, W. H. Morse, Westfield, N. J.-Case of interstitial nephtitis, W. B. Mann, Evansville, Ill.–Pilocarpine in rheumatism, A. A. Young, Newark, Ohio. MEDICAL HERALD, St. Joseph. September: The limitations of digestive practice, A. L. Benedict, Buffalo.—Typhoid fever, W. F. Mitchell, Lancaster, Mo.-Perspiration, night sweats, some thoughts, B. H. Brodnax, Brodnax, La.-A five-minute paper on in- flammation of the knee-joint, H. E. Pearse, Kansas City.—Some reflections on the principles of medicine (ed.).--An unsolved problem, the limitation of Off- spring (ed.). —The disease of inebriety (ed.). JOURNAL OF TUBERCULOSIS, Asheville, N. C. (25). October: The crusade against tuberculo- sis (ed.).-The Widal reaction in tuberculosis, S. H. von Ruck, Asheville.—Immunity as against heredity in tuberculosis, L. F. Frick, Phila.--Diagnosis of tu- berculosis, W. H. DeWitt, Cincinnati.-The tuberculo- sis Crusade and its problems, C. Denison, Denver.— Pulmonary consumption and tuberculosis (original translation), Ch. Baeumler, Freiburg, Germany. BUIL. OF THE AMI. ACAD. OF MED. Easton, Pa. (25). October: A profitable medical education, an address, H. O. Walker, Detroit–The elective sys- tem in medical education, J. M. Dodson, Chicago.— Report of the committee on the condition of medical education in the United States, presented to the as- Sociation of American Colleges, Columbus, June 5, ’99.-Medical education in the south, G. C. Savage, Nashville.—Report of meeting of the association of American Colleges. JOURNAL OF SCIENTIFIC MEDICINE, Chica- go. (10). September: A letter from Dr. Blackmer On medical instruction (with ed. Comment). —Some of the trials of a physician (with cut of author), H. Stein, Altamont, Ill.—The technique of intubation, E. Rosenthal, Phila.-A few remarks on emergency cases in general practice, by the editor, G. M. Blech. —Antistreptococcus serum therapy, J. Madden, Mil- waukee.—Pollutions and spermatorrhea, W. F. Muel- ler, Milwaukee. INTERNATIONAL MEDICAL MAGAZINE, N. Y. C. (20). October: Antitoxin in the light of sci- entific investigation, A. Robin, Newark, Del.—Herpes zoster, with especial reference to the supra-orbital type (illustrated), J. F. Schamberg, Phila.-High am- putation of the cervix and vaginal suture as a pre- liminary to abdominal hysterectomy, with the report of a case, W. W. Babcock, Phila.-Treatment of re- trodisplacements of the uterus, E. E. Montgomery, Phila.-Treatment of syphilis (to be continued), J. D. Thomas, Pittsburg.—The diagnosis and prognosis of chronic asthenic gastritis (ordinary chronic gastric catarrh), B. Reed, Phila.-Phantom tumors and their treatment, medical and surgical (ed.).--The treatment of diphtheria (ed.). er THE POST-GRADUATE, N. Y. C. (30). Oc- tober: The food value of Vitos compared with wheat bread, W. H. Porter, N. Y. C.—Surgical notes, T. * * , s:- * *- FA- , , ; 363, ºw *, * *f; #.” *; 5: g g : * *ś, º § # 3. * ;; : F--- : 4. * Dunham, N. Y. C.—Notes from the clinics, Drs. Torek, * Carter, Cole, Brodhead. INDIANAPOLIS POLYCLINIC. (15). October: A critical period in American history, Hon. E. A. Brown.—A few cases of obstetrics from my case book, N. D. Woodard, Indianapolis.-Prostatitis, R. A. Bryson, Indianapolis.-A definition of physio-med- + icalism, (ed.). MED. AND SURG. MONITOR, Indianapolis, (10). September : Varicocele, W. H. Link, Peters- burg, Ind.—Points in the treatment of typhoid fever, A. Maxwell, Indianapolis.-Brief facts about cathar- tics, S. E. Earp, Indianapolis.-Liquid air as a the- rapeutic agent (ed.). * THE PLEXUS, Chicago. (15). September: Lights and shades in the doctor's career (With cut of author), F. B. Earle, Chicago.—Some features in surgical progress, W. M. Harsha, Chicago.—Clinical report of four cases of abdominal section (With cut of author), S. H. Champlin, Chicago.—The passing of Dr. Sparrow (ed.). RANSAS CITY MED. INDEX—LANCET. (10). October: The clinical side of influenza, J. S. Triplett, Harrisonville, Mo.—Criminals and their characteris- tics, J. H. M'Cassy, Dayton, Ohio.—Treatment of dia- betes mellitus, M. P. Creel, Central City, Ky.—Elec- tricity as a therapeutic resource for the general prac- titioner, W. T. Herdman, Ann Arbor, Mich.-Is it un- ethical for medical men to use the lay press (ed.).- Mechanical restraint in the treatment of insanity (ed.). WESTERN MEDICAL REVIEW, Lincoln. (10). October: Diagnosis in neurotics, I. C. Philbrick, Lin- coln.—Aortic aneurism, with report of Cases and eX- hibition of specimens, J. N. Hall, Denver.—The treat- ment of pulmonary tuberculosis by the inhalation of antiseptic nebulae, H. M. Thomas, Chicago.—Upon cancer of the rectum, its treatment, C. C. Allison, Omaha.-Abortion (second paper), A. D. Wilkinson, Lincoln.—The plague (ed.).--The Victoria cross (ed.). —The present aspect of the tuberculosis question (ed.).-A New Yorker’s idea of the code of ethics (ed.). VERMONT MEDICAL MONTHY, Burlington. (15). September: The history of the medical de- partment of the University of Vermont (illustrated), H. E. Lewis, Burlington.—A new preparation of iron in the treatment of anaemia, H. P. Loomis, N. Y. C. —Some remarks on Catarrh, H. Thompson, St. Louis. —The treatment of the diseases of the uterus and vagina, R. A. Gunn, N. Y. C.—Proper feeding of infants and invalids (ed.).--This issue is a Souvenir edition, complimentary to the Vermont State Medical Society, and has full descriptions of the medical in- stitutions of the state (illustrated). MEDICINE, Detroit. (20). October: Drugs in cardiac insufficiency, O. T. Osborne, New Haven, Conn.—Penetrating wounds of the chest, J. B. Mur- free, Murfreesboro, Tenn.—A new departure in medi- cal Society work, the pathological department of the Indiana State medical society, F. B. Wynn, Indian- apolis.-Ectopic pregnancy, J. W. Long, Salisbury, N. C.–Etiology of eclampsia, C. B. Reed, Chicago.- Editorials: Treatment of diabetes mellitus; the Chi- Cago drainage canal; milk supply of cities; shall bul- lets be removed; a method of disseminating malarial poison; pachymeningitis; operative treatment of ap- pendicitis; change in type of general paralysis of the insane; contagion of cerebrospinal meningitis; Ker- nig's sign in meningitis and Frankel’s symptom in tabes; Obliteration of the bile duct; the preservation of fruits and fruit juices by Saccharin. THE MEDICAL DIAL. AMERICAN X-RAY JOURNAL, St. Louis. (20). October: Excitation of the Crooke's tube by the stat- 'ic machine, J. T. Pitkin, Buffalo. SANITARY HOME, Fargo, N. D. (10). Novem- ber: Hygienic adaptation in student-life, W. W. Hastings, Lincoln, Neb.-The educational work of Tuskegee, Booker T. Washington, Tuskegee, Ala- Vaccination evils, D. H. Reeder, LaPorte, Ind.—DiS- tilled water for city supply. E. C. Hargrave, Bay City, Mich.-Books on nature study (ed.).-Poison in potatoes (ed.). * BTIFFALO MEDICAL J O’DRNAL. (25). Octo- ber: Malaria complicating the puerperium, G. A. Himmelsbach, Buffalo.—Some medico-legal aspects of trauma in relation to diseased cerebral arteries, W. C. Krauss, Buffalo.—Edema, S. Y. Howell, Buffalo.— Rhynophyma, K. Wende, Buffalo.—Editorials: The medical directorship of the exposition; street noises and health; sanitation at the fair; the giving of cer- tificates. * NORTH AM. JOUR. OF DIAG. AND PRAC., St. Louis. (10). October: Feeding in acute dis- ease, with clinical reports, R. C. Kenner, Louisville.— The treatment of uncomplicated suppuration of the middle ear, H. A. Alderton, Brooklyn.—Report of four cases of sarcoma treated by injection of ery- Sipelas and prodigious toxins, C. M. Nicholson, St. Louis.-A contribution to the treatment of gonorrhea and simple urethritis, E. E. Holt, St. Louis. **º MEDICAL FORTNIGHTLY, St. Louis. (20). October 2: . On some structural varieties of the en- larged prostate relative to treatment, R. Harrison, London.—Nosophen and antinosine, a clinical lecture, W. A. Mann, Chicago. October 16: Aortitis and angina pectoris, Lan- cereaux, Paris.-The state vs. the child, M. V. Ball, Warren, Penn.-Physiology (19th paper), A. L. Bene- dict, Buffalo.—Scattered leaves from a physician’s di- ary (No. 10), A. Abrams, San Francisco. MEDICAL COUNCIL, Phila. (15). October: Blue babies, A. H. Leuf, Phila.—First report on a Case of chronic gastric ulcer in childhood, W. L. John- Son, St. Louis.-One woman’s obstetric history, S. M. Ward, Hampton, N. H.-Treatment of whooping Cough With bromoform, C. W. Ingraham, Bingham- ton, N. Y. —Immersion bottles, J. S. Arnold, Wash- ington.—A case of tetany, H. F. Smith, Pony, Mon- tana.-The diagnosis of scarlet fever, P. F. Barbour, Louisville.—Chronic malaria, A. G. Servoss, Havana, Ill.—Treatment of typhoid fever, J. J. Davis, Chicago. -Inspection of the nasal cavities, second paper, E. B. Gleason, Phila. N. W. LANCET, St. Paul. (10). August 15: The determination of sex, F. A. Dunsmoor, Minneapolis. The advance of medical education in the United States, F. Staples, Winona.--Diet in typhoid fever, E. J. Abbott, St. Paul.—Bronchial pneumonia, E. H. Bagley, Lake City. September 1: The lithaemic habit, F. C. Baier, Owatonna.-Constipation in infants and children, its cause, nature and management, C. G. Slagle, Minne- apolis.-The relation of pelvic disorders to Ile1"WOllS and mental diseases, C. E. Riggs, St. Paul.—Hygienic prophylaxis through legally enforced Vaccination etc., E. B. Bigelow, Owatomna.—Throat and nose dis. º º the presence of b. Cliphtheriae, J. H. alr, OWatonna.-Progress of medic in or & H. Yº. Roś cal diagnosis, H. September 15: Recent advance in gynaecolo e A. Stewart, pºinºjº.”. threatened rupture of the perineum, I. A. Fritsche New Ulm.—Observations of inguinal hernia, H. i. Staples, Minneapolis.--The policy of state sanitari- ums for consumptives, R. M. Phélps, Rochester, Minn.—Care of the new born, H. W. Bissell, St. Paul. —A report of a fatal case of embolism, With autop- sy, W.T. Adams, Elgin.-Neuroma of the median, re- moval and restoration of the function, A. W. Dun- ning, St. Paul.—The part of the operating room in modern surgery, F. Staples, Winona. October 1: Some observation upon the medical service of the late war with Spain from the Stand- point of the volunteer surgeon, T. C. Clark, Stillwa- ter.—A case of labor complicated with nephritis, T. L. Hatch, Owatonna.--Observations on the treatment of tuberculosis of bones and joints, C. H. Mayo, Rochester.—Some abuses in nasal Surgery, W. S. La- ton, Minneapolis.-The need of more Systematic in- struction in the diseases of advanced life, J. W. Bell. Minneapolis. \ MEDICAL RECORD, N. Y. C. (10). September 23: The legal versus the scientific test of insanity in criminal cases, C. F. MacDonald, N. Y. C.—The present status of appendicitis, with report of forty- five cases, F. L. Hupp, Wheeling, W. Va.--On the prevention of tuberculosis, C. Strueh, Chicago.—Re- moval of exostoses of the external auditory Canal by a hook, B. McAuliffe, N. Y. C.—Nephrorrhaphy and stripping of the appendix through a lumbar incision, for right floating kidney and painful appendix, J. C. Stinson, San Francisco.—An improvised Vaccine ex- peller, Boyer, United States army.—A typical case of vaccinella, W. E. Fowler, Huntsville, Texas.-A pipe- stem in utero, W. J. Greanelle, N. Y. C. September 30: A further view of the manage- ment of the deformity of hip disease, A. B. Judson, New York.—The neglect of sexual symptoms in the treatment of the male genito-urinary organs, Follen Cabot, N. Y. C.—The induction of premature labor in cases of albuminuria, Elizabeth Jarrett, N. Y. C.—The toxic Origin of certain neuroses and psychoses, G. W. McCaskey, Fort Wayne, Ind.—Dangers of headache powders; report of a case, with tests for the suspected ingredients, Sobel, N. Y. C.—A case of hereditary arthritis deformans terminating in fatal pernicious anaemia, J. S. Billings, N. Y. C.—Report of two cases of acute suppurative osteomyelitis, G. H. Grant, Rich- mond, Ind. October 7: On some important points regarding perfection of asepsis, C. Beck, N. Y. C.—The surgical treatment of gall Stones, F. C. Ferguson, Indianpis.- A new method of reducing old dislocations of the lower jaw, T. A. McGraw, Detroit.—Supplementary note On the etiology of scarlatina, W. J. Class, Chica- go.—The pulsatory hand and foot phenomena, W. Mo- ser, Brooklyn.—Anomaly of the long tendon of the bi- Ceps muscle of the arm, J. D. Craig, Albany.—A tack in the lung for seven years, A. V. Jova, Newburgh, N. Y. —Empyema, Sacculated between the heart and the lung, W. S. Dodd, Cesarea, Turkey in Asia.-A. Severe case of eclampsia complicated by a marked erythema multiforme, J. D. Voorhees, N. Y. C.— Excision of the hip, with skiagraph taken after five years, A. E. Isaacs, N. Y. C.—Bullet wounds of intes- time, Operation, recovery, G. Sherrill, Stamford Conn. —The dracunculus medinensis, John Patterson, Con- stantinople, Turkey.--Typhoid perforation in a case in Which the Widal reaction was absent, operation, Cleath, T. W. Jackson, Pinar del Rio, Cuba.--Wood pulp as a material for poultices and Surgical dress- ings, F. T. Gordon, United States navy. October 14: . A contribution to the study of the gastric crises of tabes, S. Basch, N. Y. C. Ventral fixation of the round ligaments for retroversion and prolapsus uteri, A. Monae Lesser, N. Y. C.—An inter- esting Case of hydrocephalus with pseudo-spastie Spinal paralysis, F. S. Kolle, Brooklyn. October 31: The early diagnosis of cancer of the stomach, J. C. Hemmeter, Baltimore.—The paralyses following general anaesthesia, W. M. Leszynky, N. Y. C.-A psychological study of jurors, T. D. Crothers, Hartford, Conn.-Renal casts—their significance and detection, J. H. Linsley, Burlington, Vt. * * j *. 3.3 A. : , *, *, 2. ... * * * * ******** sº * , #- § ſº # ---, * * THE NAEDICAL DIAL. ix A Perfect Antiseptic Should be Effective and Harmless t OAKLAND HYDROGEN DIOXID is theoretically and practically effective and harmless; it contains only one active ingredient, 0XYGEN, the preponderating element in the healthy living organism. • It is indicated internally in all forms of dyspepsia and digestive disturbances, butyric fermentation, gastric catarrh, gastric ulcers, etc., externally as a local appli- cation in the treatment of specific inflammations of the mucous membrane, chronic inflammatory conditions characterized by fetid discharges and wherever morbid con- ditions or foul secretions exist. * “THE KIND THAT KEEPs” Manufactured only by The Oakland Chemical Company, 465 West Broadway, a y tº tº tº NEW YORK. Liquor LITHIUM MAIZENATE. MAIZO-LITHIUM 5A Li ERIT PO 1 N T S • s E o ATIVE ºf U R ET 1 c = A genito-urinary sedative, an active diuretic; solvent and flush indicated for the relief and pre- vention of renal colic ; a sedative in the acute stages of gonorrhoea, cystitis and epididymitis ; in dropsical effusions due to enfeebled heart or to renal diseases. As a solvent in the varied mani- festations of gout, goutiness and neurotic lithemia, periodical migrainous headache, epigastric oppres- sion, cardiac palpitation, irregular, weak or inter- mittent pulse; irritability, moodiness, insomnia and other nervous symptoms of uric-acidemia. Decidedly better, more economical, extensive in ac- tion and definite in results than mineral zoaters. In LITHEMIA by reason of the neutralizing T. T.T.T.: T power of Lithium in combination with Maizenic acid, the superior diuretic. In RENAL COLIC as a solvent and eliminant ve * of uric acid, and prophylac- tic against future attacks In LIQUOR FERRISEN1C. THREE CHLORIDES HENRY'S. PRO Lo Nich ED ºr R EAT M. E. N. Ts FO R T H E E Lo Q ſo. An oxygen-carrying ferruginous preparation, suitable ź º; treatnient º §: adults and the aged. Indicated in anemia and bodily weakness, convalescence from acute dis- eases and surgical operations; boys and girls at the age of puberty, and the climacteric period in women. In children with chorea, rickets or who are backward in development, or in whom there exists an aversion to meats and fats. Prolonged administration never causes “iron headache.” I 11 CONSTIPATION as a ferruginous laxative tonic it is effective by in- creasing the flow of gastric juice and the bile, exciting normal peristaltic movements. In CHLOROSIS it stimulates the formation of Y" " "Y"> *** iron-containing elements and removes intestinal auto-intoxication upon which the disease often depends. I 11 of all forms as a chalybeate tonic and ANEMIA carrier of oxygen it #º: digest- ion, aids assimilation of-food and increases depos- ition of fat in the tissues; raises bodily vigor and warmth and has a favorable influence on the ner- vous system. T T as a urine alkalinizer, and on URE HRI IS account of the remarkable se- dative action of corn silk upon inflamed genito- urinary mucous membrane. In OEDEN1A resulting from cardiac or a renal dis; ease the pulse becomes regular and strong ; there occurs marked diuresis and increas- ed proportion of urinary solids. Those cases of irritable heart, irregular or in- termittent pulse so frequently met j". insur- ance examiners and found to be due to excess of uric acid are special indication for Maizo-Lithum. Wascent Chemic Union of Mazzenic Actd—from Green Corn Silk—with Itthium, forming Malzenate-Lith- tum Two grains to drachm. Dose I to 2 drachms. 8 oz. bottle, $1.00. NVA 1. o O L ETA R Y O N A PP 1.1 CAT I O N . H E N R Y PHAR MACA L CO. LOUISV L.L.E., KY. AN ADJUVANT for, potassium iodide &: undesirable manifestions known as iodism can be removed. Stimulant to the peptic and hydrochloric glan- dular system of the stomach, especially servicable in the impaired appetite, nauseau, vomiting and other gastric symptoms of alcoholic subjects. Each drachm contains Proto-Chlor. Iron, % gr, Bi-Chlor. Mercury, I-128 gr, Chloride Arsenac, I-280 gr, Calf- saya Cordial. Dose I to 2 drachms. 12 oz. bottle, $1.00. THE MEDICAL DIAL. ºf , ; * * * : . . . . .” * *: *:::::: ; is “,” “ , , *w { *. & PUBISHER'S DEPARTMENT. Two NEW ANTIKAMNIA TABLETs. * The Antikamnia. Chemical Company of St. Louis announces in their new page advertisement in this issue of The Dial that they are ready to Supply the trade and physicians with their two new tablets which have been thoroughly tested for the Work for which they are intended. From a perusal of the for- mulae the physician will readily see where these prep- arations will be indicated. The phenomenal Success of the tablets made by this well-known company in- sures the rapid use of the two new tablets. They are both laxative, the “Antikamnia Laxative Tablets” containing no quinine, while the “Antikamnia and Quinine Laxative Tablets” have this important anti- periodic. The former is nearly always indicated where pain and fever are present, and the latter is useful to reduce fever, quiet pain, and at the same time to administer a gentle laxative and tonic Com- bined. These preparations have a Wide range Of usefulness. Since their introduction the Hypophosphites have firmly maintained their hold on professional and popular confidence and to-day are prescribed alone and in combination by more physicians than any other remedy. This is strong testimony to their Su- perior worth, because of their fine tonic and consti- tutive properties which have been and will continue to be a means of relief and strength to thousands. McArthur's Syrup Hypophosphites (Lime and Soda) Comp. is a reliable preparation worthy of trial. If a stimulant is needed you may add it. It isn’t there when you do not need it as McArthur's Syrup is simply a tissue builder, a permanent tonic. M. A. Auerbach, M. D., New York: Mr. W. D., aged 23, residing with his parents on Madison street, a few blocks from my office, Called me in some weeks ago for treatment. I found the young man in bed and in a very bad Condition. He was not only suffering from a severe injury re- ceived whilst following his vocation, but also with a severe cough with copious “coffee-ground” expectora- tion, which, upon microscopical examination, proved to be tubercular. It is now about two Weeks Since I Started him on “Maltine With Creosote” and to my astonishment found upon my last examination that his cough and expectoration had both ceased. I find, upon palpation and phenendoscopic auSCultation, great improvement in his right lung as well as the apex of the left One. I can’t speak enough in favor of “Maltine with Creosote” and shall use it upon all my pulmonary patients hereafter. VALUE OF THE X-RAY. The value of the X-ray in the discovery of renal Calculi is now Occupying the attention of the sur- geons. Abbe has collected the records of twenty cases in which stones have been discovered by the radiograph. Regarding the technique he says: “Rub- ber tissue should be interposed between the patient and the plate to prevent perspiration. The fluoro- Scope is useless. The photographic plate must be placed Well up on the patient's back, including the last four ribs. A wet plate may show nothing, but When dry and held up before the light gives good ro- Sult. Photographs never show as well as a study of the negative itself. In all the cases reported subse- quent operation showed the correctness of the photo- graphic plate.”—The Clinic. A man SWallowed a dime and was hustled over to the doctor's office, who made him “cough up” two dollars..—Ex. Syrup Of raspberry makes a pleasant vehicle for bromide of potassium. Goodyear Rubber Co., JAMES SUYDAM, Manager, 92, 94, 96, 98, 100 and 102 E. Seventh St., ST. Paul, MINN. GOld Séal Manufacturers of the O l Rapid Flow | Best quality, bag and tubing; reversible rectal and infant pipes; eye spray; ear and nasal tubes; , bent and irrigating vaginal pipes. Sizes: 2, 3 and 4 Quarts. NorthWestern Distributers of Dr. L. WILHOFT'S (ORIGINAL) LADY'S SYRINGE Made of one piece of soft rubber and constructed on the only correct principle, viz: injection and suc- tion. It is the best vaginal Syriuge made. Sºnd for Descriptive Circulars, 1000 LABELS FREE. THE WIS. MEDICAL RECORDER IS NEEDED BY EVERY PRACTICAL PEI.Y. SICIAN, BECAUSE AS DR. JAS. ADOL- PHUS, OF ATLANTA, GA., SAYS: “IT IS FULL OF PRACTICAL AND INTEREST. ING MATTER THE BUSY DOCTOR FINDS USEFUL.” IT HAS ABLE CORRESPOND- ENTS IN ALL THE GREAT MEDICAL CENTERS AND A STAFF OF REGULAR CONTRIBUTORS, WHO ARE IN ACTIVE PRACTICE IN ALL PARTS OF THE gºrity AND FURNISH LIVE ARTI- TO RAPIDLY INCREASE THE REC- ORDER'S CIRCULATION, FOLLOWING TRIAL OFFER IS MADE. EVERY PEI.Y. SICIAN SENDING 50c WILL RCEIVE THE RECORDER EVERY MONTH FOR SIX MONTHS AND 1000 LABELS WILL BE SENT FREE OF CHARGE. THESE LA- BELS ARE 14 NCHES SQUARE WITH YOUR NAME AND AIDDRESS PRINTED IN BLUE INK. THEY ARE MADE OF THE BEST IMPORTED GUMMED PAPER, AND ARE WORTH MORE THAN THE PRICE OF THE SIX MONTHS SUBSRIPTION. THIS OFFER WILL BE OPEN TO READ- ERS OF THE DIAL FOR A SEIORT TIME ONLY. HALL & THRONE, PUBLISHERS, JANESVILLE, WIS. THE MEDICAL DIAL. Xi A RELIABLE HOUSE. The Waite & Bartlett Manufacturing Company, of 108 East 23d street, New York City, have one of the largest salesrooms in the United States, are cen- trally located in the metropolis, and carry one of the completest assortments of electro-medical and elec- tro-surgical instruments. Their static machines, in mechanical construction, convenience and perfectness of mechanical detail, are unsurpassed, and this is saying a great deal when there are so many good, bad and indifferent, on the market. Their cabinet combination batteries have the very latest improved devices. Their Faradic instruments with high ten- sion coils, their special accessories, and their well- known X-rays “up-to-date,” will be found as near perfection as the most painstaking practitioner will desire. A postal card will bring a catalogue by re- turn mail. Little Girl, “I wonder why the babies is always born in the night time.” Another Little Girl, “Don’t you know? It's cos they wants to make sure of finding their mothers at home.”–Harlem Life. Wife to Sick Husband: “Darling, has the moon come up yet?” Husband: tor. “It has if I swallowed it.”—The Doo- E. Lambert Yourex, M. D., Baltimore: I wish to speak of “Maltine cum Creosote,” hav- ing taken it myself for indigestion which attacked me some time ago and seemingly became persistent in spite of treatment. I was somewhat “run down” as to general health, and I believe the attack was much due to this circum- stance. of the starches. atonic condition. Knowing creosote to be indicated in such atonic condition and remembering I had a sample of “Malt- ine cum Creosote,” I decided to take it, which I did in small doses of a dram after meals. It began to do good work immediately and after taking the bottle I find myself almost cured. I am, therefore, pleased to state I have found a new indication for a combination which I consider one of the most valuable of the Maltime Preparations. Digestion was slow and imperfect, especially The stomach seemed to be in an HEREES AS A FORERUNNER OF CHANCRE. Andery (Berliner Klinische Wochenschrift, No. 15, 1899) has noted in a number of cases preputial herpes preceding the development of a chancre, and regards the outbreak of an eruption of this kind in a young man who has been exposed to the disease as highly suggestive of syphilitic infection.—Therapeutic Gazette. - The reason why Hagee's Cordial gives results is that it contains all the active constituents of Cod- liver Oil, derived from the liver of the Cod. It also contains Hypophosphites of Lime and Soda that pre- vent waste of tissue and promote constructive tissue metamorphosis. HOW TO MARE PAPER WATERPROOF. The sheet is coated on both sides with a solution consisting of one part gelatin, four parts water, and one part glycerin. When dry, the paper is immersed in a 10 per cent. solution of formalin. After this treatment the paper is said to become impervious even to steam. - I. N. Love, M. D., St. Louis: “Maltine with Creosote” is indeed excellent. It practically solves the problem of the proper adminis- tration of creosote. Creosote is a rank disturber of digestion, but when combined with that great digest- ive agent, Maltine, the thing is done. - Lºading DIIIggists ºf Millbändlis. - ------- - º ºr OPEN ALL. NIGHT, ºn The Voegel; Bros. Drug Co., PRESCRIPTION DRUGGIsrs. 2 and 4 Washington Ave. S., Cor. HENNEPrs. We carry the most complete stock of Drugs and chemicals in the Northwest. Mail orders Promptly Filled. - - - - - - - - - - - - - - - - - - - - - - - - - - -- -- - - - - |- - - - weaster & cºurcaill, PHARMAC 1sºrs, | Under Nicollet House, Minneapolis, Minn. | - | | Careful attention given to Physicians' Prescriptions. |- - - - - i #3.3.ºS.: Xii THE MEDICAL DIAL. A NEW PORTABLE ELECTRIC OUTFIT. By Gustavus M. Blech, A. B., M. D., Chicago. Electricity as a therapeutic agent, while quite popular with a few specialists and wealthy practi. tioners, is employed by the majority of general prac- titioners with no scientific precision, because of lack of suitable apparatus. The results are poor, for to obtain good results good apparatus is necessary. It is therefore for this reason that electricity is decried by many as a valueless agent, while in reality it is a very valuable means of curing a large number of among many practitioners that electricity can be ad- ministered scientifically only by means of large, sta- tionary and expensive “machines.” The price and impossibility of moving the batteries from the office to the bedside of the patient have proven objection- able features, preventing the general introduction and practice of electrotherapeutics. It is perhaps of interest to know that the most renowned specialists in Europe, for example Dr. Erb, who has become famous through his lectures and writings on electro- therapy, use, in their private practice, small portable batteries. Of course the term “small portable” is not to be confounded with the so-called family bat- teries, for self-treatment, which, as a rule, are not worth the material used on them. The erroneous idea that large liquid cells yield more electro-motive force and amperage than small dry cells has preju- diced the profession against anything but stationary cells. We know to-day that the size of the cell has nothing to do with its electro-motive force and that a small dry cell about as large as a vaginal speculum will do more for a longer period of time than, for ex- ample, a Laclede sal ammoniac cell. The cost of re- newing a dry cell is not larger than a refilling and keeping in good order of large acid cells. Knowing these facts, and to overcome the ob- jections mentioned, with the co-operation of the man- ager of the Electro-Medical Mfg. Co., I have devised a combination battery which, while cheap, admits of the scientific administration of galvanism, faradism. the practice of electrolysis, and the illumination of small lamps for diagnostic purpose. The following illustration gives a fair idea of its construction. The battery has twenty-four cells, connected to the galvanic circle, yielding 33 volts. The faradic cur- rent produced in the coil is even and smooth, but can also be regulated with Lindstrom's rheotome to from 100 to about 4000 interruptions per minute. There is a selecting switch for primary and secondary cur- rents. By means of a switch connection is made with a strongly built milliamperemeter for the meas. uring of the galvanic current. Four extra large cells are connected to a German silver wire rheostat for the purpose of running a small incandescent lamp (25 hours) for the illumination of cavities—throat, vagina, rectum, etc. The battery can be used for electrolytic work, such as the removal of superfluous hair, warts, moles, etc., and has for that purpose an electric needle and holder, epilation forceps and magnifying glass. To the battery are added several Sponge and metal electrodes, one roller electrode, one metallic brush and one interrupting handle, all which are fastened between strong clamps to the inner side of the Cover. ELECTRICITY Up-To-Date- Instruments will bring -> great results. ºs In order to introduce our goods to the readers of this Journal, we will offer the following EIG EAR GA! NS for the next 60 days. Faradic Battery, with 2 Dry cells like above illustration with large Faradic Coil, Adjustable Rheotome, Indicator and Elec- trodes. Cataloge Price $12.00. Price for his sale only $6.00. 24 Dry Gell Galvanic Battery, with Double cell collector and pole changer and Pole changer. All cells in this Battery being connected with springs. Price $20.00. Price for this sale only $14.75. - Table Plate, in case with Bevel Plate Glass in top, with High Tension Coil, Galvanic circle, with Double cell Collectors, Milliampere Meter, Pole Canger, etc. Price $43.00. Price for this sale only $32.50 - - - Combined Table or Wall Plate, with Galvanic Circle and Faradic coil, Pole changer, etc. Price only $8.00. Storag eCautery Battery for actual cautery work, with Rheo- stat- Price for this sale onls $13.50. - Send 3c. sn stamps for our catalogue with full line of Faradic Batteries. Galvanic Batterses, Cautery Batteries, Table and wall §§ Illuminating instruments, Electrotudes, Static and X Ray achines. ELECTRO MEDICAL MANUFACTURING CO., 350 Dearborn St., CHICAGO, ILL. Physicians and other profes- sional men may wisely see that the stationery used in their professional correspondence is of attractive and proper style. The Beard Art & Stationery Co. give particular attention to filling such orders, and will send samples and quote prices On request. Address 705 Nicollet avenue, Minneapolis; telephone 181. THE MEDICAL DIAL. } * WOULD NOT TAKE A HUNDRED DOLLARS. The manufacturers of the Peerless Automatic Battery are in receipt of a recent communication dat- ed October 13, 1899, from an Indiana doctor Which speaks for itself. * “Gentlemen:-I write to inform you that I am more than pleased with the Peerless Battery. I would not take $100 for it if I could not get another. —Dr. M. W. Yencer, Boston, Ind.” This Battery is made by the Peerless Battery Co., 224 Fifth Ave., Chicago. If you need a battery, if the old one you now have is not satisfactory Write them about the “Peerless.” *- A MECHANIC LAXATIVE BY THE MOUTH. Dr. Henry S. Upson, of Cleveland, O., in the Philadelphia Medical Journal, after condemning me- chanic irritants, as bran, oat-meal, seeds, etc., and chemic irritants, as acid fruits, drastics, etc., as all tending to be followed by a return of the constipated condition of the bowel, recommends liquid petrola- tum, a quarter to a half tumbler full (two to four •ounces). It is suitable alike to infants and adults. It is better than vegetable oils, as it does not become rancid. Orthoform is a new local anaesthetic Which is said to be non-poisonous, which lessens the amount of secretion in a wound, prevents putrefaction and stimulates the healing process. In burns of the third degree it is very valuable, also in painful ulcers, uSed as a dusting powder or ointment. In Cancer of the stomach it has been given internally, in daily doses of 5 to 15 grains. The ointment contains 10 per cent. of orthoform. Being non-poisonous it may be used in full strength as a dusting powder. * Bazz-blanch PhDIBIOSCOME velvet-lined case, ss.oo. Beware of Infringements. All genuine have our name on instru- 1ment. Buy from your dealer, or, if not in stock, from us direct. GEORGE P. PILLING & SON, 1229 Callouhill St., Philadelphia, Sole Hgents for U. S. H. 50 YEARs' EXPERIENCE ~ TRADE MARKS - DESIGN's CopyRIGHTs &c. Anyone sending a sketch and º Imay quickly ascertain our opinion free whether, an invention, is probably påtentable. Communica- tions strictly confidential. Handbook on Patents sent free. Oldest agency for securing patents. Patents taken through Munn & Co. receive special motice, without charge, in the Scientific Americall. gives uncertain results. LEARNING TO SEE AT FORTY. As reported Dr. Minor (N. Y. Med. Jour., Vol. XVIII., No. 19). The author reports a case of a male blind from birth, who, when the Cataract Was re- moved from each eye, could see and judge distance, color, and had binocular vision. The fields of Vision were normal. - The theory of the progressive development of both the optic nerves and a greater part of the Optic tract, occurring after birth, as a result of the func- tional activity of the eyes, meets With an exception in this case. He says, “It is probable that the per- ception of light possessed by my patient may have kept these parts intact, but it is difficult to under- stand how they were ready to assume Such perfect functional activity as was noted, if there is really as much in the theory of development being depend- ent upon functional activity as is currently SuppoS- ed.”—Post-Graduate. The tingling sensation in the arms and fingers ex- perienced by middle aged people on waking, especial- ly after falling asleep in the day time, is supposed to be due to a rheumatic taint; anyway, the iodide of ammonium is a valuable remedy in this Condi- tion given in doses of three grains or more every four houl'S. There are two reasons why gelsemium Sometimes (1) Because the preparation Obtained is of an inferior grade, (2) because the doses are administered too far apart. For instance, in facial and lumbar neuralgia ten to fifteen minims should be given each two hours until pain is relieved or a tonic effect Warrants its discontinuance. In protracted fevers a refreshing potion that will assist in allaying thirst and prevent nausea can A handsomely illustrated weekly. Ilargest cir- culation of any scientific journal. Terms, $3 a year; four months $1. Sold by all newsdealers. MUNN & Cº. MºWºrk Branch Office, 625 F St., Washington, be prepared by adding to a wineglassful of ice water 1 to 2 drachms of dilute phosphoric acid, and, if de- sired to render more palatable, include a Small quantity of Syrup of red raspberry. This is not to be used as a drink, but should be administered by frequent sippings, Only. - An easy and practical method may be adopted for the inhalation of Cologne, alcohol or ammonia dur- ing the process of fanning a patient, by covering the palm leaf fan with one thickness of roller bandage or attach a flat, thin Section Of Sponge to the Center of the fan. Either material will retain the liquid se- lected and the distance can be SO gauged that the in- halation of the stimulant will give no annoyance. The same method may be used to disguise the un- pleasant Odors in a sickroom. quick method of Saturating the atmosphere with a deodorizer, for instance a Solution of chloride of lime. Michigan has a law prohibiting the marriage of any perSon Suffering from gonorrhea, or syphilis. Vio- lation of this law is a felony punishable by a fine Of not less than $500 or more than $1,000, or impris- onment in the penitentiary for a term not exceeding five years, or both. Husband or wife may testify against the Other, and the privilege of medical se- Crecy is abrogated in such cases. A hot formentation that will not require to be changed frequently can be made by dipping a flat Section of Sponge in hot water. Apply to the part, and upon Sponge place a hot water bag. If desired, lººter in Which the Sponge is dipped may be med- ICàLéOl. It also provides a $ Xiv THE MEDICAL DIAL. º - ********************************************* VA POR MASSAGE Was introduced * the invention of . The Globe Multinebulizer. It is of the utmost value in the treatment of all diseases of the NOSE, THROAT, MIDDLE EAR, BRONCHIAL TUBES and LUNGS. CAN ONLY BE APPLIED with safety and scientific accuracy by means of the genuine, original device, which is patented. NO ONE CAN LAWFULLY make, sell or use a device of the same or similar nature in connection with any NEBULIZER, either multiple or single. Physicians and Others Are hereby warned against inferior and unlawful imi- tations which are being placed on the market. THE GLOBE MULTINEBULIZER is made in various styles and combinations with air receivers, tables, etc., and at prices to suit the purse of every purchaser. From $15 up. Write for circulars. combined a pump, sessive. THE GLOBE MANUFACTURING CO., and Multinebulizer. Price, $35. (Special Discount ºf Mention this ºournal.) Battle Creek, Mich., U. S. A. º º Cºſì - www.-- 2)" º, , - Eurºka Nºbulizer Mounted on 4-Sawed Oak Table ** Air-receiver of seam- * less steel, size 10x30 in. tested to 500 lbs. Fin- ished in nickle plate ºlor oxidized. The most useful and practical ". paratus ever offered to physicians for the ºr Spºtlal Treatment § of Chronic Bron- chitis, Incipient Consumption & all Catarrnal af. A ſections º º ëſ) *- >, ºld ºn - 5 lºº - ºHead, --0-1 c Tº $2.2 : º, ºn - and Lungs. ... 3 5:53: º 3. .# : - º º - º |-- - ºn C. ºn 2- . Tº # , ; £35 C - º an º ºſ º an º º § - E ºw- - - 3 -i- 3 3 & "3 - * "g #3"; E: 7 E* = º - - º - as º.º. h9 a 5 ; ex- 9 F * Fº 53 ºf 'º tº 3 Z. b)+ º cº- ºn tº c + no cy $- 7; 'º-c = 2 > 3’E - c.º. E 3-E. 5.5 tº C. c = Uſ) O - * - Tº. C. - on ºf a º - cº - º - Q -- E. : : - 5 gº º - ºn -- + 3 E 2 ºz.º. 3 #5 a tº 29 . * - - ºr 3.33 ± = ** † tº Cº 5 - - º a tº Eºº 3.35 5 E & 80% -- -- 5. 2 E & 22 ſ; 3 = O 3 : 3 3.5 &; “ $ - 5 § * ...5% *:::: ºº:: - - -- Lº- - º > * * g =###337; #3° 2 : ; ; º E * : * ~ 3 E 3- E =:: * * ºn 3 : 5 - -- - ºs º | E3 – - - - 12 - c. - Wºº- - - - -- º ºn. E E * = d. 3.35 ºn 5 ºf 5 º §º 3", £3 ºf º żºł3 * † : º ; : a 353 - 7:53: Eğ : - * - - LL ### *śrī ā *- - - * * 5 L & # , ºº 3-3 E - ºn ... ºu º E: sº ºn 3.5 o – c. 12 – º – Bºº.c dº º Pºs = - - - - (ſ) º: E. B. c : , E - 2.32 ± = * = - ºte for Literature. - Fººt: º3 : I <3.37 E- 5 -n. § 5* g. g.: +39 to § 3 = - 0, 0, HDLMAN, G8II'l Agt, , La Grangº, Ill - #3 ########5 § 0. | titl'i Agt, , |gº, Ill. º 3 = + £º: £ 3 E3 & -n º º L/ R. J. (Jagier & Zºº., Inc. 3O8 DEAR BORN ST., CHICAGO SEND FOR CATALOG. - - Cº-ºx: HAS revolutionized the application of / / Static Electricity. WITHOUT IT 300 revolutions per minute in large machines is the limit, thus: / Enormous machines are needed. patience patients lost over dead Static Machines. WITH IT? - The gre a test generating capacity. 2000 Revolutions. A machine sure to work under all atmospheric con- ditions. A thoroughly practical X-Ray and Therapeutic in- strument within the reach of every doctor. º - s Time a n d - s sº N •ºººººoºººººººººººººº. eeley’s Hard-Rubber Trusses º i i p.m...... c. Mail Orders a Specialty—each one re- ceives our personal attention. Our “ready to wear” trusses are always satisfactory. Full directions and plates go with them. Catalogue shows ico patterns—send for life plates, etc. Chesterman & Streeter Successors to 1. B. SEELEY & Co. : 25 So. 11th St. Philadelphia. MARSHALL'S CONVERTIBLEBUGBY CASEN),3% changes into Saddle - º Bag (is both in one). Finest, best durable leather finish outside and in (lined). Con- tents. 14 1-oz. rubber 18 6-dr. cork S.–total 32 bottles, with spaces between rows for pow- der papers, 2 sundr º º: º * E- Tºx2%x2%. Delivered, privilege of examination, D., bal. 38.50, or ex- press paid. 89.00 in *...*... sº".º: Saddle Bags low as 3475. 24 bottles...w º,"; Best i.e. Buggy Case, 26 3-dr, 26 6-dr. - - ings, 1 sundry space, $3.75. - 3 º: º º º and illustrations if asked for. Address W. S. MARSHALL. Care of Exchange Bank. CENTRALIA, LL- º LOWERS... NZ BEAUTIFUL ROSES CARNATIONS LILIES and all the flowers in their season. Funerals a spec- ialty. ... Telegraph orders for funerals and parties º filled. Seeds and other florist supplies send for Catalogue. MENDEN HALL GREEN Houses, First Ave. S. and 18th St., or City Store, 414 Nicollet Ave., Minneapolis, - - Minnesota. āşşäß. 4. -- - - - ** e * *. tº * 3t *, *. > * * , i. * *Jº r : * * • *} *-r * #, - $ * x º -** *, º " _* ** * - ***. *. * , § * * **, * i THE NAEDICAL DIAL. . . . . .38% * * ; ** º jº * - - - -º SYR. HYPOPHOS. CO., FELLOWS Contains the Essential Elements of the Animal Organization—Potash and Lime; *: * : * †. *. The Oxidizing Agents—Iron and Manganese; The Tonics—Quinine and Strychnine ; And the Vitalizing Constituent—Phosphorus; the whole combined in the form of a Syrup with a Slightly Alkaline Reaction. It Differs in Its Effects from all Analogous Preparations; and it possesses the important prop- * erties of being pleasant to the taste, easily borne by the stomach and harmless under prolonged use. It has Gained a Wide Reputation, particularly in the treatment of Pulmonary Tuberculosis, Chronic Bronchitis and other affections of the respiratory organs. It has also been employed with much Success in various nervous and debilitating diseases. Its Curative Power is largely attributable to its stimulent tonic and nutritive properties, by means of which the energy of the system is recruited. Its Action is Prompt; it stimulates the appetite and the digestion, it promotes assimilation and it enters directiy into the circulation with the food products. The prescribed dose produces a feeling of bouyancy, and removes depression and melancholy ; hence the preparation is of great value in the treatment of mental and nervous affections. From the fact, also, . that it exerts a double tonic influence and induces a healthy flow of the Secretions, its use is indicated in a wide range of diseases. NOTICE—CAUTION. The success of Fellows' Syrup of Hypophosphites has tempted certain persons to offer imitations of it for sale. Mr. Fellows, who has examined samples of several of these, finds that no two of them are identical, and that all of them differ from the original in composition, in freedom from acid reaction, in susceptibility to the effects of oxygen when exposed to light or heat, in the property of retaining the strychnine in solution, and in the medicinal effects. As these cheap and inefficient substitutes are frequently dispensed instead of the genuine preparation, physicians are earnestly requested, when prescribing the Syrup, to write “Syr. Hypophos. Fellows.” As a further precaution, it is advisable that the Syrup should be ordered in the original bottles; the distinguishing marks which the bottles (and the wrappers surround- ing them) bear, can then be examined, and the genuineness—or otherwise—of the con- tents thereby proved. Medical Letters may be Addressed to: Mr. FELLOWS, 48 Vesey Street, New York, • *, * 3. wº W . * * * * * * * C. * ...}. * t 㺠W., & & ! : ‘. . .” * º, r * , , * , 4 .# is * i-4 * s *. t * º -j - * *- Aſ s ** Tº- {r & º -** f - 3 : 2 s” F. : t * A .* { *. ¥ t # # * * r * t w .** ºs.' … “ º *. * º, } © ~ y, * { }, * # :*. * * * * * # ki. ºf f : ;: “ *sº 3. **, 3. §: #~ * y § #3. *:: .# * * * * * º: ‘. z #: º: £’º: º :- f ~ * *: ... * , . . . is i." ^ ' ', '.. • *, 9 * ..." *: * f C | O (SYR: HYPOPHOS: COMP: C. P., McARTHUR.) Its use is indicated in Consumption and Tuberculosis, Diseases of the Chest, Chronic Cough Throat Affections, General Debility, Brain Exhaustion, Impotence and Loss of Memory. The point of primary importance in the use of the Hypophosphites is their Chemical purity, but unfortunately they are too often adulterated. So little seems to be generally known, even among the medical profession, with regard to the chem- i. of the Hypophosphites, and the absolute necessity of cHEMICAL purity, that we call attention to this point. §. of the first effects produced by the use of our CHEMICALLY PURE Hypophosphites is a general increase of nervous energy, with a feeling of ease and comfort. The second effect is an increase of appetite; digestion is improved, and the bowels become regular in their action, the quantity and color of the blood is increased, respiration is controlled, a better expan- sion of the chest is observed, cough improves, easy expectoration is produced, night prespiration dimin- ishes, the face becomes fuller, the lips red, the nails and hair grow, and in children the teeth, showing the importance of the Hypophosphites on the organ of nutrition. Bay"Physicians when prescribing will please write thus: B. SYR: HYPOPHos: CoMP: Mo ARTHUR. ONE BOTTLE As it is made only for Physicians there are no printed wrappers or advertisements about the bottle. . . Our pamphlet on the Curability and Treatment of Consumption sent free to physicians upon application. We will send one bottle of McArthur's Syrup to any physician, without charge, who will pay the express charges on the same. Mention this Journal. THE MCARTHUR HYPOPHOSPH ITE CO., ANSONIA, CON N. S. >>>s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-s-3s2=Sº. seeeeeeeeeeeeeeeeeeeeeeeeeeeeeee, 2% º º ſ SN zz W WHEN THE ACTIVE PRINCIPLES W. § are taken from Cod Liver Oil, only the grease remains, and NW that is of no more value than other grease. § Ä The virtue of Cod Liver Oil lies in its curative principles, § Ä which are separable from the grease. These active princi- § ſº ples (taken from pure, fresh Cod Liver Oil), are employed W. § in the manufacture of § {\ O * A tº º HAGEE'S CORDIAL OF COD LIVER OIL with : º HYPOPHOSPHITES OF LIME AND SODA. § º Your patients get the grease in the form of palatable food fats. § % - V -> &- Ö). 3. CORD. OL. MORRHUAE COMP. (Hagee) W 3. is dispensed in 16-oz. bottles by all druggists. º A. Ö Made only by KATHARMON CHEMICAL CO., St. Louis, Mo. W (ſ e\ º %2 •2. e •2-2-2-2-2. *2.2.2.2s22s22s22s2; © eeeeeeeº <éééééééééééééééééééééééééé iv. THE MEDICAL DIAL. IN THE “LAND OF THE SKY.” ASHEVILLE, Eeauty Spot of the Great South! CHARMING OF SITUATION. BEAUTIFUL TO BEHOLD. THE *HAVEN OF REST.” . º - 3. Ø --- º: - º: º * † : * . º º - - ~~ *** --- - - - -v --> --~~~ --~~~~ - - - - Zºº’." -- , ºf º º, | - º º; º º ſº º º - an º- - - -- Zºº - º --~~~~ º --- -- --- - º º - Ž% º 3% º º º - º º I ºw. Lºcº H. Rºſſ iſ iſ iſºfº - -- * * * * m_J_nº_tº "ſiſ º - º º º º º H_1 = º --~~~ EEE --> --- - - --~~ Zºº. - Ž% 2% º 2^ Mºº - 2^2 + 2. º/ ſº Žº º - º º Twº Ż.º % º º º * - º º - - - - ---, ſº -- - º, º --- 2%. º º º º - º º º º --- º - c. º º - 2 º' º =>tºº - º º Žº º º --~~~~- - - - - ºº: º 'º-º-º-º-º-º-º-º-º-º: - BIRD’S EYE VIEW OF ASHEVILLE, N. C., ON LINE OF THE SOUTHERN RAILWAY. The wonderful Sanitarium for all classes of Health-Seekers, and the Over-Worked seeking Rest. Physicians will do well to advise their Patients who are suffering from any form of Head, Throat or Lung Trouble, or who are Debilitated from Advanced Years, to seek this celebrated resort, in the midst of the Mountain Peaks of Western North Carolina. SEE OF FOSITE PAGE. Fº * §º. THE MEDICAL DIAL. PEN Picture of Asheville. THE Queen of AMERICAN Mountain REsorts. As the Modern Traveler has said, the grand old state of North Carolina, which took her place so proudly in the line of the “Original Thirteen,” the “pitch, tar and turpentine state” of our geographies, a state that has given to the nation a long list of distinguished statesmen and patriots, offers to the tourist traveler great surprises and infinite delight even though he may have “scaled the Alps” and been “rocked in the cradle of the deep.” On her eastern border hangs the lace-like drapery of the ocean’s throbbing billows; her uplands bend beneath the great weight of the three great staples, tobacco, cotton and corn, while her western section rises grandly, in great billowy hills and towering peaks with charming valleys resting peacefully between, and mountain streams coursing joyously through vale and gorge, tossing their crystal waters in silvery cascades and deep-toned water falls. The fact is not generally known and here is one of the surprises, that in western North Carolina there are forty-three mountains more than 6,000 feet high, not bare, bald peaks of dismal rocks, but slope and summit are robed in the rich verdure of nature, a delight to the eye and affording beautiful and ever changing vistas. All these are higher than Mount Washington, and besides there are more than eighty which approximate 6,000 feet in alti- tude, and innumerable peaks exceeding 4,000 feet in height. Away up in the low hills of Canada this picturesque chain of mountains starts on its course, winding along through New Hamp- shire, Vermont, New York, Pennsylvania and Virginia, growing in majesty and grandeur as it stretches southward, and attaining in Caro- lina and Tennessee by far its greatest altitude and masciveness. Continuing its course in off- shoots into South Carolina, Georgia and Ala- bama, it sinks its heads, is merged into the ºnas and becomes lost to view near the gulf. In the very heart of those bold mountains of western North Calolina, a region abounding in nature's best efforts, full of picturesque ef. fects both fascinating to the eye and awe-in- spiring to the soul, stands the subject of this sketch, ASHEVILLE, “The Land of the Sky,” in a “Garden of the Gods,” where human health and human happiness are in sweet ac- cord, where crystal water gushes forth in in- numerable springs, from an untainted soil where malaria is unknown and where ideal climatic conditions make the place a delight- ful sanitarium for the invalid and a perfect home for the healthy and strong. On a plateau 2,500 feet above the sea level, sits this QUEEN OF AMERICAN MOUN- TAIN RESORTS for all seasons, surrounded by an amphitheater of tree-clad mountains, in the center of a circle embracing the territory bounded by the Mississippi river, the Gulf of Mexico, the Atlantic ocean and the great lakes. The entire region is picturesque, full of novelty and interest, an ideal resort for pleasure, recre- ation and health. The high altitude and low latitude insure cool summers and mild Winters, the latter shorn of their harshness, inducing to daily exercise in the open air in shooting, rid- ing, driving or short mountain excursions on foot. Neither in summer nor in Winter are there extremes in temperature, and the maps prepared by the government at Washington show this to be the ideal thermal belt of Amer- ica, formed by the peculiar topographical con- ditions existing on the Asheville plateau. That Asheville is the great Sanitarium par excellence for all classes of health-seekers, for those who suffer from exhaustion brought on by office work of long-continued heat, the suf- ferers from hay fever and all forms of head, throat and lung trouble, for those debilitated from advanced years who would withdraw from the tumult of business and city life to rest in the midst of mountain peaks, and in an atmosphere bracing, full of ozone and Sun- shine, is best attested in the words of many noted visitors of recent years. Just where the beautiful Swannanoa, “Nymph of Beauty,” one of the loveliest of mountain streams, whose course the train fol- lows, merges into the picturesque and historic French Broad, is Asheville. On a rugged plateau 2,500 feet above the level of the sea this “Queen Mountain City of the South” affords a haven for the residents of the heat stricken parts of the country. Though it is difficult to convince northern people that it is cooler 400 miles south of Chicago than it is in the Windy City, such is really the case. Seldom does the thermometer get above 90 de- grees Fahrenheit in the shade and for the per- son in ill health or the one on pleasure bent, there is no better place than Asheville. The Great Southern railway, than which there is none better equipped or more ably managed in the Union, traverses this entire Section of natural and historic interest. Its train service from every standpoint is unex- celled. From the west tourists connect with the Southern railway at Louisville, Ky., or at Cincinnati with the Queen & Crescent Route. Through sleeper is run daily from Cincinnati to Asheville without change. Only fortv hours from St. Paul or Minne. apolis to Asheville. For copy of “Land of the Sky” booklet or “Summer Homes” folder, or other information, write or call on Wm. H. Tayloe, A. G. P. A., Louisville, Ky., or J. C. Beam, Jr., N. W. P. A., 80 Adams street, Chicago, Ill. * f *. ; : § 3. 4 * sº % +. V * , ſ: ~ .# : #. sº º * * * .* . *; # s ". * “ t º §§ & º: º º ? §º.º.º. * < *- º & ºf s = * * * ~ * :º §º; º, r #2 º: R- ¥ § ºf . " §ºvi THE NAEDICAL DIAL tº º: ...” 1 : *. & ** # * §§ # Now READY. ſaline WITH CREOSOTE. | : i º : : .# A number of years ago, when the value of Creosote became ; fully demonstrated, we began the publication of a formula for the ; administration of Creosote in Maltine. This formula has been : employed successfully by thousands of physicians, and we have ă been urged over and over again to place such a combination upon ; the market in order that a uniform and properly prepared product # could be had under all circumstances. # << MALTINE with CREOSOTE” # is the most eligible and palatable form in which Creosote § can be administered. The vehicle—Maltine Plain—is particularly # indicated, by reason of its great food and digestive value, in all à conditions in which Creosote is so universally employed. lt will give us pleasure to send, prepaid, samples of “IVIALTINE with CREOSOTE’” to any physician in good standing who wishes to satisfy himself of its therapeutic value and elegance. THE MALTINE COMPANY., Eighth Ave., 18th and 19th Sts., BROOKLYN, N Y. THE MEDICAL DIAL. ... vii. º - º * , § sº 2. § . º, 9 gº º % § º %% º, º §§ % | (ALAXAHVEANAGESIcukNTPIRETIC) TS BACH TABLET CONTAINS: Antikamnia, - gr. 4%. Aloin, - - gr. 1-32 Cascarin, - - gr. 3% Ext. Belladonna, gr. 1-32 Podophyllin, - gr. 1-32 Specify “Antikamnia LAxATIVE Tablets.” We believe the profession will at once appreciate the uniqueness and usefulness of this combination. In all diseases and affections where pain and fever 3, I’6 º a laxative is almost invariably indi- cated. This is especially true in the beginning of the various fevers; in acute, throat, bronchial, and lung affections; and especially in the acute illnesses of early life. Attention is particularly called to the therapeutics of this tablet. One of its in- gredients acts especially by increasing in- testinal Secretion, another by increasing the flow of bile, another by Stimulating peristaltic action and still another by its especial power to unload the Colon. %2X2: % % ź gº sº g - sº o 3 s % º %% º HAVE YOUR DRUGGIST STOCK UP THROUGH / e HIS JOE E E R . . . . . . . * EACH TABLET CONTAINS: SAMPLES SENT GRATISYON Antikamnia, – gr. 3 Aloin, - – gr. 1-32 8. Bisulph, - gr. 1% Ext. Belladonna, gr. 1-32 ascarin, - - gr. 3% Podophyllin, - gr. 1-32 Specify “Antikamnia & Quinine LAXATIVE Tablets.” To reduce fever, quiet pain, and at the same time MADE O N LY BY ſ administer a gentle laxative and an excellent tonic s is to accomplish a great deal with a single tablet. - | | º W Among the many diseases and affections which ſº - call for such a combination, we might mention la grippe, influenza, coryza, Goughs and Golds, Chills and ST LO Ul S U S A º - fever, and malaria, with its general discomfort and "P - 2 - " - * * * * g great debility. RECEIPTOFPROFESSIONALCARD. & % We would especially call attention to the wide use of this tablet in chronic Or semi-chronic diseases. Its power to re- lieve pain, reduce fever, tone up the sys- tem, and restOre natural activ- ity to the bowels will, we feel Sure, make this tablet unusu- ally valuable. !%: sºŠºº%§ º Žwº& º:+%% º % Ž %º 2. §§ Š&g %&º s:sºtQ **SS -sg 3.&&*º º º º.º.º.º. S **** * * * * * * . . . . * * * * : *-.: . . . . ." - - : - - *:... . . . . . . . . . . . . . * : * > . . *... * sº sº: . . . . . . . . . . . ** .*.*, *, *** * * - . . . * . *... ." . . . . . V : ; - * : *- : * ~, " ; "“, : ..' . . . . - ... ',' . . . .”. W. A. - * * * *, *, ... " - - * * * * * W *... * * * - * - - - - ‘…. - - * - : ; : - ... * * *, Ak. THE MEDICAL DIAL. preventing the gathering of disease germs and microbes. . . . ; ‘. . | Foster MoTHER nervous exhaustion, of nutrition in all cases of debility, anaemia, malnutrition, is neurasthenia, Regulates metabolism, GRAY's GLYcERINE TONIC CoMP. Reconstructs wasted tissues \ Restores nervous force THE PURDUE FREDERICK CO. No. 15 Murray Street, New York The Hollem Portable - Zs- Hygienic Bath. Made on Strictly $333333333333333333333% Scientific Princi- % º *At ples a n d Fully § * - "r Guaranteed. ºfe There has never 4. been an accident º with our Bath, and . one is impossible. 4. ! With the he at shut off it becomes ; * º a perfect cooling º || || | | |Wii < #Tii * room, avoiding any - | *A A\ | #| || W ... ." § 3 }|\,\ tº tem by contact with |\\\ ºf ºil | the outside cold | W. JºA ºn W . 31F. } \ Žiž g y § Unlike all other § gº * > * * * : s baths, ours has an āś º Wºº S adjustable cover, which can be washed clean each week if desired, thus Our strongest testimonials are from the leading Min- neapolis physicians. º º | Free Bath book. Call or address THE SANITARY MFG. CO., 406 Phoenix Building, MIN NEAPOLIS, MINN. \, º º | - THE SANATORIUM, HUDSON, WIS. ‘’’, ſº-i º * | * a , \,\!\! \, E. X; ºs-rºx. *— * * * * * º ... iſ . º -] ºrm- ºc Sºl L-7 Nº. - º 㺺ms gºš Y] ſº ii.º.º.º.º.º.º. ... º.º.º. tººl º Fº::::::::::FF: Eº ºf Leº ºr EHIELT ###LFă. | * -ſſ- tºº º: º: *_º º -º-º-º: AN INSTITUTION FOR THE SCIENTIFIC TREATMENT OF NON-CONTAGIOUS DISEASES. S4S4S4S4S4S4S4S4S4S4S4NºS3 SlºžSøSºSºftSºftSºść Every Appliance and Method used which is § Sº recognized in Legitimate Medicine, including : Turkish, Roman, Electric, Medicated and Thermal $: § Baths—also every form of Electricity, as well as : § Massage and Swedish Movements, etc. All under §3. § the supervision of Experienced Physicians and : §3 Trained Nurses. **ºr & The institution is delightfully located, with a long, wide veranda, inclosed in the winter season in glass, and is equipped with mod- ern conveniences, as Elevator, Electric Light and Electric Bells, Large Parlors. For terms, address T H E SAN ATO RIU M.