Dr. ... ** CGM.U.M13Uſs Mjºjºſº Q1. Wy JQURNG11. Vol. X, JULY, 1891, No. 1. J. F. BALDWIN, M. D. - - - - - - EDITOR. * J E. BROWN, M.D., - tº Associate Editor. C. R. CORNELL, —, , – - Business Manager. 48 PAGES READ/WG MATTER, PUBLISHED MONTHLY. $1.00 PER YEAR. THE COLUMBUS MEDICAL PUBLISHING COMPANY, Publishers and Proprietors, 246 East Gay Street, Columbus, Ohio, Entered at Postoffice, Columbus, Ohio, as second-class mail matter. CH. MARCHAND’S ,, PEROXIDE OF HYDROGEN - º SOLD BY LEADING DRUGGISTS. Laboratory, 1O West Fourth Street, New York ## ( jºz (MEDICINAL) H2 O2 (ABSOLUTELY HARMLESS.) 㺠£2;sº Ž º º * e tº • tº *ś *3 Is rapidly growing in favor with the medical prºfession. It is the ºśãº S most powerful antiseptic iºnown, aimost tasteless, and odorless- º/ſº aſ à W. Can be talken internaliy or applied externally with perfect safety. its curative properties are positive, and its strength and purity can always be relied upon. This remedy is not a Nostrum. A REMEDY For DIPHTHERIA ; CROUP ; SORE THROAT, AND ALL IN FLAMMATORY DISEASES OF THE THROAT. OPINION OF THE PROFESSION, Dr. E. R. Squibb, of Brooklyn, writes as follows in an article headed “On the Medical Uses of Hydrogen Peroxide” (Gaillard's Medical Journal, March, 1889, p. 267), read before the Kings County Medical Association, February 5, 1889: “Throughout the discussion upon diphtheria very little has been Said of the use of the Peroxide Of Hydrogen, or hydrogen dioxide; yet it is perhaps the most powerful of all disinfectants and antiseptics, acting both chemically and mechanically upon all excretions and secretions, so as to thoroughly change Their character and reactions instantly. The few, physicians who have used it in such diseases as diph- theria, scariatina, small-pox, and upon all diseased surfaces, whether Qf skin or mucQus membrane, have uniformly spoken well of it so far as this writer knows, and perhaps the reason why it is not more used is that it is so little known and its nature and action so little understood. . . . . . . . . Now, if diphtheria be at first a local disease, and be auto-infectious; that is, if it be propagated to the general organism by a con- tagious virus located about the tonsils, and if this virus be, as it really is, an albuminoid substance, it lºy and will be destroyed by this agent upon a sufficient and a sufficiently repeated contagt. . . . . A child"S nostrils, pharynx and mouth may be fooded every two or three hours, or oftener, from a proper Spray apparatus with a two volume solution without force, and With Very little discomfort; and any solution which finds its way into the larynx or stomach is beneficial rather than harmful, and thus the effect of corrosive Sublimate is Obtained without its risks Or dangers. . .” Further on Dr. Squibb mentions that CHARLES MARCHAND is one of the oldest and best makers Of Peroxide of Hydrogen, and one who supplies it to all parts Of the Country. . . CAUTION.—By specifying in your prescriptions “Ch., Marchand's Peroxide of Hydrogen (Medicinal ).” .* sold only in 34-ib., 36-lb., and 1-lb. bottles, bearing my label and signature, you will never be imposed upon. Never sold In Olli K. PREPAIRED ONLY BY A book containing full explanations concerning the therapeutical applications of both CH. MARCHAND's PERoxIDE of HYDROGEN (Medicinal) and GLycozoNE, with opinions of the profession, will be mailed to physicians free of charge on application. ? Ǻ Mention this publication. Chemist and Graduate of the “Ecole Centrale des Arts et Manufac- _ twres de Paris” wº (France). STARLING MEDICAL COLLEGE, COLUMIIB U.S., OHIO. The Forty-third Sessiem will Open September 10, JS90, and continue six months. Thoroughly equipped Chemical and Physiological Laboratories, and especial attention paid to laboratory teaching. A large and well-appointed Hospital—St. Francis Hospital, of Starling Medical College, is in the same building, and under the exclusive control of the College Faculty. FEES:—Matriculation, $5.00. Tuition, $50.00. Laboratory, $5.00. Examination, $25.00. For further information, address T. C. HOOVER, M. D., Registrar, 229 East State St., Columbus, Ohio. COMMUNICATIONS. Case of Intubation, Tube Worn Forty Days— by S. L. M’Curdy, M. D., Dennison, O... 1–3 Asthma—by I. W. Chisholm, M. D., New Concord, O... . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 A. Curious Case of Vision Dependent on the Use of Both Eyes—by T. F. Bliss, M. D., $pringfield, O.... . . . . . . . . . . . . . . g º e º ºs e º 'º 3–5 in Surgery: The Use and Abuse of the & & #". § º Sºº-hy C. 6–10 Surgeon’s Probe; Nephritic Colic . . . . . . . . 28-35 . PerkinS, IM. L., San Clusky, U. . . . . . tº º $ tº - º * * * Scarlatina—M. Sevestre—translated by D. OBSTETRICS-Things to Unlearn about N. Kinsman, M. D., Columbus, O... . . . . . 10–16 Midwifery; A Case of Sterility and Dys- The Significance of Muscae Volitantes. . . . . . 16 menorrhea; Relief of Pelvic and Abdomi- nal Pain by Hot Colon Douches; Amputa- SELECTIONS. D tion of Breast. . . . . . . . . . . . . . . . . . . . . . . . . . . . 35–40 MED/CIAVAE– Angina Pectoris—a Debate ; y - frotracted Cass of Bright's Disease; Dif- ŽP/70/8/4/2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41–44 ferential Diagnosis Between Ulcer and As OOA AMOT/CES... . . . . . . . . . . . . . . . . . . . . . . . 45–48 ADVERTISERS. & The Maltine Mfg. Co., New York. . . . . . . . . . . . . . . 1 H. K. Mulford & Co., Philadelphia . . . . . . . . . . . . 14 Battle & Co., St. Louis. . . . . . . . . . . . . . . . . . . . . . . . 2 The Keeley Institute, Marysville, O... . . . . . . . . . 15 Dr. McMunn’s Elixir of Opium . . . . . . . . . . . . . . . 2 Beeman Chemical Co., Cleveland, O... . . . . . . . . 17 Harrison Coie, Columbus, O. . . . . . . . . . . . . . . . . . . 2 University of the City of New York . . . . . . . . . . 18 Paris Medicine Co., St. Louis, Mio. . . . . . . . . . . . . 3 Reed & Carnrick, New York . . . . . . . . . . . . . . . . . . 19 B. Keith & Co., New York. . . . . . . . . . . . . . . . . . . . 3 Cornell-Pheneger Chem. Company, Columbus, C. A. Frees, New York. . . . . . . . . . . . . . . . . . . . . . 4. io. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Julius Fehr, M. D., Hoboken, N. J. . . . . . . . . . . . 4 Cincinnati Sanitarium ... . . . . . . . . . . . . . . . . . . . . . . 21 Dios Chemical Co., St. Louis, Mo. . . . . . . . . . . . . !) Western Penn. Medical College, of Pittsburgh. 21 The Antikamnia Chemical Co., St. Louis, Mo. 6 Bowden Lithia Spring Co., Lithia Springs, Ga. 23 The “Yale” Surgical Chair . . . . . . . . . . . . . . . . . . . . * James I. Fellows, New York... . . . . . . . . . . . . . . . . 24 The Arlington Chemical Co., Yonkers, N. Y... 8 PREMI UM LIST FOR 1891 . . . . . . . . . . . . . . . . . . 7, 16, 22 Wm. R. Warner & Co. . . . . . . . - e s tº ſº $ tº e º & © e g g º żº Q Charles Marchand, New York...... lst page cover Mariani & Co., New York...... . . . . . . . . . . . . . T0 Starling Med. College, Columbus, O.2d “ & & Forbes’ Diastase, Cincinnati, O . . . . . . . . . . . . . . . 11 C. N. Crittenton, New York. . . . . . . . 3d “ $ & Eisner & Mendelson Co., New York. . . . . . . . . . . l2 Parke, Davis & Co., Detroit&N. Y.4th “ & & Lambert Pharmacal Co., St. Louis.. . . . . . . . . . . . 13 CONTENTS. Cancer of the Stomach ; Some Experimen- tal and Clinical Observations upon the Therapeutical Value of Salicyl-Bromanilid; Antikamnia..................... . . . . . . . . . . 17-27 SUAE GER Pi—Progress in Transplantation; The Treatment of Hypertrophied Tonsils by means of Ignipuncture ; Chloralamid r |f|| | An extract of Malted Barley, Wheat and Oats, is the most Concentrated and Efficient, and therefore the most Economical of all Malt Extracts. s l º º : MALINE!º FERMENTS, ExºMTS MauriNENEVERCONGEALs N Gastric Affections and Debilitating Diseases, so prevalent during the Summer, Maltine with Pepsin and Pancreatine, and Maltine with Phosphate Iron, Quinia and Strychnia will be found exceptionally valuable, their base being a powerful Reconstructive and Digestive. An eight ournce bottle of each will be sent upon application to any physician who will pay expressage. The Maltine Manufacturing Co. 19 Warren Street, New York. - - 2 IDREAMILESS SILEEP, About eighteen months ago a friend of mine from America told me of the wonderful effects of a medicine, much used in the States, called BROMIDIA, which is a combination of Chloral, Bromide Potass, Cannabis Indica and Hyoscyamus. I obtained some, and have ordered it regularly for over a year; and have found it excellent in the pain of rheumatism, pneumonia and cancer; also in the sleeplessness of scarlatina and alcoholism. It has never failed me in procuring sleep, without the disagreeable dreams and after effects of opium. The dose is 3ss. to gj. every hour until sleep is procured. I have also found it of much service in cases of tonsilitis, used as a gargle with glycerine and carbolic acid. Extract from recent article in Edinburgh Med. Journal, Vol. XXXI., No. X., by J. LINDSAY PORTEOUs, M. D., F. R. C. S. Ed. BATTLE & CO., Chemists' Corporation, ST. Louis, Mo., U. S. A. Branches : 76:NEW BOND STREET, LONDON, W. 5 RUE DE LA PAIX, PARIS, - - 9 AND 10 DALHOUSIE SQUARE, CALCUTTA. 80 MONTAGNE-DE-LA-COUR, BRUSSELS. 3. 28 NIEUWE HOOGSTRATT, AMSTERDAM. TXI Fr.. TM ICTM ITUTINTINT’s EI-IxIR OF OFIUTNT An Invaluable Discovery in the Preparation of Opium. 7"Ay/S ZS 7A/AE AOA&AE A/V/D AESSAEAV 7"ZAZ ZX7'A' A C 7' A'A’OM 7TAZAZ AVA 7/VE DA’ CVG. It contains all the Valuable medicinal properties Of Opium in natural combination, to the exclusion of all its noxious, deleterious, useless principles upon Which its bad effects depend. It possesses all the sedative, anodyne and antispasmodic powers of Opium: . To produce sleep * composure; to relieve pain and irritation, nervous excitement and morbid irritability of body and mind; to allay convulsive and Spasmodic actions, ete.; and being purifled from all the noxious and deleterious elements, its operation is attended by no sickness of the stomach, no vomiting, no costiveness, no headache, nor any derangement of the constitution or general health. Hence its high Superiority over . Laudanum, Paregoric, Black Drop, Denarcotized Laudanum, and every other Opiate preparation. E. FERRETT, Agent, 372 Pearl St., New York. HARRISON COLE, PRACTICAI. OPTIGIAN, All Defects of Vision, requiring Spherical Lenses, scientifically corrected. Special Lenses carefully adjusted to prescription. Optical and Scientific Goods of all kinds. Repairing of every description. Prescription Blanks Furnished Physicians on Application. 64 North High Street, Columbus, Ohio. | FEBRII,IISTE Tasteless Syrup of Quinine. Made from an alkaloid which remains in the bark after crystalizing the Quinine, com monly known as Amorphous Quinine. This preparation is nearly tasteless in the mouth, but perfectly soluble in the stomach, and equal to the Sulphate of Quinine in every respect, producing the same results as the Sulphate of Quinine in the same size doses. You will find this an elegant palatable prepara- tion which children will delight to take, and ladies will find it much preferable to any pill or capsule, as it never produces the nauseaating sensation which is produced by pills and capsules, and is much quicker in its action as it is much more soluble. No disguisers used in its preparation. JEFFERSoNTown, KY., Jan. 23, 1888. SIRS:—I used your Tasteless Quinine and find it all that is claimed for it. Children take it without the slightest resistance, take it as readily as if it was simple syrup, and its effect is just is satisfactory as the Quinine itself. I will use it always for children and sensitive stoma chs of adultS. S. N. MARSHALL, M. D. The Southern Practitioner, published at Nashville, Tenn., and edited by Drs. Deering J. Roberts and Duncan Eve, in the January number, 1888, says: “Febriline, or Tasteless Syrup of Amorphous Quinine, is one of the greatest boons yet con- ferred on the practitioner of medicine. The question naturally arises, what is it 2, Well, we can say from experience, having given it a thorough trial—yes, we mean by thoroughly trying it on our charity patients, using on them the sample left in our office, and its results were so good, that we have tried it time and again. On Our pay patients sending them to the nearest drug store With a formula, on which we did not hesitate to write over our signature, Febriline, and in these cases it has given us and Our patrons the greatest Satisfaction. Try it and you will use it again. MAINTU FA CTURED BY THE PARIS MEDIGINE COMPANY, Druggists and Chemists, FOR SALE BY 212 North Main Street, St. Louis, Mo. THE CORNELL-PHENEGER CHEMICAL CO., Columbus, O. IECIEHTTIEL’S GON. T.INC. AWENA SATIWA (FROM COMMON OATS.) A POWERFUL NERVE sti MULANT, Tonic, ETC. IS EMPLOYED IN THE TREATMENT OF Paralysis, Epilepsy, St. Vitus' Dance, the Morphia or Opium Habit, Chloral and Tobacco Habits, Sleeplessness, Nerve Exhaustion, Neuralgia, Alcoholism, Painful and Deficient Menstruation, Headache, Hysteria, Convulsions and Prostration from Fainting, and in the Convalescent Stage of all Acute Diseases. DOSE—From ten to thirty drops or more, as often as may be indicated to meet the urgency of the case. Ad- minister in hot water when q lick action is desired. "NW7-E INAR-A-TEE CINTIE Cºe"U"-A-T-ITTSZ CºriºuTsz - IECIEHTTIEEI’S ELIXIR DYSPEPSIA COMP. B. Hydrastin, } A Positive Remedy for the relief and cure of DYSPEPSIA, INDIGES- #. TION. HEARTBURN, FLATULENCY, SEASICKNESS, GASTRIC Avenin.” * } IRRITATION, ACIDITY OF STOMACH, Etc. DOSE—One teaspoonful in a wine glass of water immediately after each meal, or when indicated. For an acute attack, when prompt action is demanded, administer in hot water. "NW7"IE IN4:-A-TEB, CINTIE QUT-A-T-ITTSZT CINTILTSzº- Send for printed matter on CON. T.I.N.C. AVEN A SATIVA in the Morphia or Opium Habit, and certi- ficates from different members of the Medical Profession citing cases under their charge treated by it, also REVISED AND ENLARGED MANUAL, to B. KEITH & CO., Organic Chemists, - ESTABLISHED 1852. No. 75 William Street, New York. • C. A. Frees, º 781 Broadway, New York, as ES Manufacturer Of New Patent Artificial Limbs and Appliances Of the most Approved and Scientific Construction, LECS AND FEET, ARMS AND HAN DS, With duplex, lateral, and single ankle movements, With full finger, wrist and elbow movements Illustrated Calalogue sent free, upon receipt of description of case. Mention the Columbus Medical Journal. When you Write. tºº, jº An unparalleled list of awards has been made / ɺlº in favor of the Superiority of these artificial limbs including five international, and seventeen local ex I thibitionS. à First Premium at the Paris Exhibition in /889. Crutches and Elastic Stockings at Trade Prices. --- - Also, Appliances for shortened and deformed limbs. A New I’a Lelt Extension for Shortened limbs, with artificial toe joint, to take line place of cork soled shoes or iron Stirrups. Showing how neatly the extension Will dré SS The dotted lines show the position of the trou- sers, giving the foot a I erfectly natural appear- 3.In Ce. - A Showing how the Exten- sion is applied, giving uni- form bearing the Whole length of foot. º J. FEHR's º “Compound Taléum” #º “Baby Powder.” º # #: §ººl; “ Hygiernic Derrmal POvv der ’’ FOR INFANTS AND ADULTS. PROPERTIES:— Antiseptic, Antizymotic and Disinfectant. : COMPOSITION:–Silicate of Magnesia with Carbolic and Sali- cylic Acids. - USEF U L AS A GENERAL SPRINKLING POWDER, with positive Hygienic, Prophylactic, and Therapeutic properties. Good in all Affections of the Skim. Sold by the Drug Trade Wholesale and Retail generally. Per box, plain, 25c.; perfumed, 50c. Dozen “ $1.75; & & $3.50 THE MANUFACTURER: jº, Julius remis, M.D., | i * Ancient Pharmacist, ####|||}|A - HOBOKEN, N. J. Advertised only in Medical and Pharmaceutical publications. NEUTR osrn E1 A NE W AND POWERFUL NEURO TI • ANoDYNE AND HYPNOTic. - A most efficient and permanent preparation, REMARKABLE för its efficacy and THERA- PEUTIG EFFEGTS in the treatment of those NERV0US AFFECTIONS and morbid conditions of the System which so often tax the skill of the Physician. - A RELIABLE AND TRUSTWORTHY REMEDY FOR THE RELIEF OF Aſysteria, AEpilepsy, Meurasthenia, Mania, Chorea, Uterine Congestion, Migraine, Meuralgia, All Convulsive and Reflex Neuroses. The Remedy Par Aixcellence in Delirium and Restlessness of Pevers. - Is the result of an extended professional experi- ence, and is compounded in the most palatable form by a skilled pharmacist, the formula of which will commend itself to every Physician. FORMULA :—Each fluid-drachm contains 5 grains each, C. P. Bromides of Potassium, Sodium and Ammonium, I-8 gr. Bromide Zinc, I-64 gr. each of Ext. Belladonna and Canna- bis Indica, 4 grains Ext. Lupuli and 5 minims fluid Ext. Cascara Sagrada, with Aromatic Elixirs. DOSE:—From one teaspoonful to . a tablespoonful, in water, three or more times daily, as may be directed by the Physician. . FOR PURTHER INFORMATION AND SAMPLE BOTTLE SEE FOOT of this PAGE. UTERINE TONIC, ANTISPASMODIC AND anodyne. = i = -j A reliable and trustworthy remedy for the relief of Dysmenorahoea, Amenorrhoea, Menorrhagia, Leucorrhoea, Subinvolution, THREATENED ABORTION, Vomiting in Pregnancy and Chlorosis; directing its action to the entire uterine system as a general tonic and antispasmodic. This combination is the result of an extensive professional experience of years in which the constituent parts have been fully tested singly and in combination in various proportions, until perfection has been attained. - DIOVI BURNIA is prepared for prescribing exclusively, and the formula as given will commend itself to every intelligent physician. FORMULA :—Every ounce contains 3-4 dram each of the fluid extracts: Virburnum Prunifolium, Viburnum Opulus, Dioscorea Villosa, Aletris Farinosa, Helonias Dioica. Mitchella Repens, Caulophyllum Thalictroides, Scutellaria Lateriflora. DoSE :-For adults, a desertspoonful to a tablespoonful three times a day, after meals, In urgent cases, where there is much pain, dose may be given every hour or two, ALWAYS IN HOT water. L. Ch. Boisliniere, M.D., Professor of Obstet- rics, St. Louis Medical College. • * - . . St. Louis, June 18, 1888. . I have given DIOVIBURN1A a fair tral, and found it useful as an uterine tonic and anti- Jno. B. Johnson, M. D., Professor Of the Princi- ples and Practice of Medicine, St. Louis Medical COllege. St. Louis, June 20, 1888. I very cheerfully give my testimony to the Virtues of a combination of vegetable remedies prepared by a well known and able pharma- cist of this city, and known as I) IOVIBUR - NIA, the component parts of which are well known to any and all physicians Who desire to know the same, and, therefore, have no rela- tion to proprietary or quack remedies. I have employed this medicine in cases of dysmenor- rhoea, suppression of the catemania and in excessive leucorrhoea, and have been much pleased with its use. J do not think its claims (as set forth in the circular accompanying it) to be at all excessive. I recommend its trial to all who are willing to trust to its efficacy, be- lieving it will give satisfaction. Respectfully, Spasmodig, relieving the pains of dysmenor- rhoea, and regulator of the uterine functions. I feel authorized to give this recommendation of DIOVIBURN LA, as it is neither a patented nor a Secret medicine, the formula of which having been coln municated freely to the medi- Cal profession. : * ca. 3ers/o., et, no H. Tuholske, M.D., Professor Clinical surgery and Surgical Pathology, Missouri Medical College ; also Post-Gradutate School of St. LOuis. : . St. Louis, June 23, 1888. I have used DIOVIBURNIA quite a num- ber of times—sufficiently frequently to Satisfy myself of its merits. It is of unquestionable. benefit in painful dysmenorrhoea: it possesses antispasmodic properties which seem especi- ally...to be exerted on the uterus. - Aºz A. Z. To ally playsicia in uuacquailled with the mediciual effect of D10 V1BURNIA, and NEU- ROSINE, we will mail pamphlets containing full informatian, suggestions, commendalions of some of the most prominent professors in, the profession, and various methods of treatment : also a variety of valuable prescriptions that have been thoroughly, tested in an active prac. tice, or to physicians desiring to try our preparations, and who will pay express charges, we will send on application a bottle of each free. . . . bios chemical co., St. Louis, Mo. 6 1-OZ. PACKAGE, $1.00 EXTRACT FROM AN ARTICLE ON 0. A UNIQUE CASE OF STAB WOUND OF . PREPAID. THORAX AND ABDOMEN-RECOVERY.” 7, BY A. V. L. BROKAW, . M. D., ST. LOUIS, MO. Demonstrator of Anatomy and Surgery Mis souri Medical College; Junior Surgeon to St. John’s Hospital. “For the relief of pain, of which the É. complained, no opiates were given, ut as a substitute Antikamnia was admin- istered in 10 grain doses, with excellent effect.”—Courier of Medicine, Dec. 1890. Valuable in Neuralgia, Myalgia, Sciat- ica, Acute Rheumatism, Hemicrania and Typhoid Fever; also Headache and other t; Pes of Neuroses due to Irregularities of Menstru- ths S. .9°C, ation. Exhibited in Asthma, Hay Fever, *** °ries 3. %*D & & Q Q º Influenza, La Grippe and Allied Com Furtherinformation and A. Sh;W3. plaints, it secures the desired result. samples sent free on application. © ANTIKAMNIA CHEMICAL CO., St. Louis, MO. “YALE” SURGIGAL CHAIR. The “Yale” is the most complete Chair ever offered to the Surgeon, Gynae- cologist, Oculist or Aurist. Every posi- tion known to the profession is easily and quickly obtained. Has the largest range of movements. Can be firmly locked in any desired position, Does a . away with moving patient to get dorsal Vº position; secures the most desirable in- § clinations for the Sim's position; can be tilted backward to revive patients - from an asphyxiated condition....Can sº sºlº Rººs be raised, lowered, revolved or tilted Fig. IX.--Chloroform Narcosis Position. * lºag with patient in position to get the best Head of Patient at a Downward tº seaſº. lights. It is the strongest and most Fig.1—Normal Position. substantial Chair made. To THE PROFEssion. " sº It is fully protected by numerous Letters * Patent, thus giving us absolute control of many special features which make our Chairs so conspicuous... We will promptly enjoin y any one from using the said improvements. * † : * ~ * CAUTION:--Beware of unscrupulous agents, 6 º' S sº- representing themselves as selling for us. * agº. There is only one “Yale” Chair and one - º * : Canton Surgical and Dental Chair Co. at ** nºś Position. Canton, Ohio. Fig. XW--For Elevating the Hips. * Send for Illustrated Catalogue --- g : and full description with large *... ." - * * *. . . . . -- cuts, †: nine leading posi- a tions, from which an endless num- ber of modifications are obtained. Decidedly the best Chair on the market for the price. Manufactured only by THE CANTON SURGICAL AND DENTAL CHAIR CO., ºf Manufacturers of Canton and Yale sº Şa & *...*, * \º Surgical and Gould Dental Chairs, ... *s-, -º * =2...eº Fig. XVII---Dorsal Position. oANTON, ohio, U. S. A. Angle of 45 Deg. Fig. Wil-Horizontal Position--Elevated. * PREMIUM LIST NOTE THE LOW FIG URES. —O— FOUNTAIN PEN-Best Grade. (Paul E. Wirt—long or short, stub or regular.) With One Year Subscription to the Journal | (Above is the price of the pen alone.) | || Ask our editor. GAS BRACKET. ..]|| º | 3. A Fountain Pen when once used is never dispensed with. With Light Condenser, Mirror and Bar Complete. - (See cut below.) All Nickle Plated, and MEDICAL Journal, One Year . $20 oo Above can be arranged for oil lamp at an extra expense of about $1.00. Light Condenser and Mirror not including Bracket (see cut below) with Journal, One Year . . . . . . I2 OO Light Condenser without Mirror or Bar, not including * Ç. Bracket (see cut below) . . . . . . . . . . 8 OO Prices named are less than the regular prices on light condensers alone. Cash must accompany order to obtain these prices. * * * * * * *-* Rºſ -- º: . . . . . . * : - sº ºr ºf F# . . . . ; : I rººrºº # * : : atº" ada, ºft . .” ...; #ll # º º: .. A\; | yº," º:#. | * # # º * jº: |#. |#. |É * PEPTONOIDS BEEF (POWDER) BEEF, Sterilized MILK, Partially Peptonized. GLUTEN, THE MOST CONCENTRATED AND NUTRITIOUS FOOD IN THE MARKET Received the only GOLD MEDAL and Highest Award at the International Health Axhibition, Zondon, after a critical examination of all the Beef and Concentrated Pood Productions by a /ury composed of the best Chemists in Europe. There is no food preparation that compares with it in nutritive properties. It is partially prepared for assimilation, and, therefore, makes less demand upon the digestive powers of the gastric juice. Being in the form of a dry powder and sterilized, it will keep in any climate. It contains 95 per cent of nutritious matter. The use of BEEF PEPTONOIDS is indicated as follows: Convalescence from all diseases, Pulmonary Affections, Pneumonia, Phthisis ; Dyspepsia, Gastritis, and all Stomach Ailments; Fevers, Diarrhoea, Dysentery, and all Intestinal Diseases; Marasmus, Bright's Disease, Diabetes, and excessive use of Alco- holic Stimulents. Beef Pºptonoids may be given per rectum in all cases where the stomach cannot digest food, and in debility resulting from any cause. IEEETOINTOTTYS T_TGSTUTT) This preparation represents, Beef Peptoncids in the form of an elegant cordial, all constituents being entirely digested and ready for assimilation. Liquid Peptonoids is a nourishing peptogenic liquid stimulent with the albuminoids in a soluable state with only sufficient spirits added to preserve it. It contains the largest amount of albuminoid principles and the least amount of alcohol that is possible to use and to make a stable compound. Liquid Peptonoids will keep indefinitely; its flavor and palatability are such that many who have taken it liken it to a delicate cordial. It will readily be taken by patients who are unable to injest food in any other form (in these cases it has been found of the greatest service). In convalescence from fever and other diseases, in loss of appetite, weak digestion and gastritis, its effects are positive, and it will never fail to give perfect satisfaction. There is no preparation in the market that has been recommended so highly by physicians who have carefully tested it. 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Sº Ni, -- - .. * . * - . • , - * ... . ~. - /* * * * * ; : ... * , a * . .. - - * , ** - • . - ...” - - ' ' . . . '. ... ' MEDICAL JOURNAL A MONTHLY JOURNAL OF MEDICAL SCIENCE. VOL. 10. - JULY, 1891. No. 1. COMMUNICATIONS. CASAE OF INTUBA 77ON, 7 UBAE WORAW FORTY DAYS. BY S. L. M'CURDY, M. D., DENNISON, OHIO. Read before the Tuscarawas County Medical Society. - Mr. President and Gentlemen: I am able to report to you IOO per cent. of recoveries from intubation of the larynx for membranous croup. - At this point, however, it will be well to remind you that it might have been IOO per cent. of deaths, for this result is based upon a single case. Aside from the fact that my patient re- covered there are some very interesting features that should not be lost with this case. - - Dec. 14th, '90, I saw Gala M., aged 4, suffering with mem- branous croup, in consultation with Dr. M'Peck, of Bowerston, O. After confirming the diagnosis, I retired to where the parents were to advise them that intubation was the only hope. While there we were informed that if we wanted to see the pa- tient alive to come at once. - The parents consented to the introduction of the tube and without taking time, or rather, forgetting to thread the tube, I at once intubated. I am almost certain that the child would have been dead in an hour, and possibly a few minutes. After a little coughing, during which time considerable mucus tinged 2 COMMUNICATIONS. with blood was raised through the tube, the patient dropped into a sleep and continued to rest during the greater portion of the next three or four hours. - Dec. 16th. I again saw the patient, and owing to the accu- mulation of mucus in the tube it was removed, cleaned and re- placed. wº Dec. 17th and 19th. The tube was removed, and after remaining out for a half hour or so was necessary to replace, because of the closing up of the larynx. Dec. 22d. As this was the 8th day, the extreme orthodox limit for final removal of the tube, I of course expected to leave the tube out, but in this I was mistaken, for the larynx soon began to fill up and the tube had to again be introduced. The presence of the tube would give immediate relief. Again on Dec. 24th the tube was removed, and breathing was so free that after waiting about two hours, I started home congrat- ulating myself upon the fortunate termination of the case, but was overhauled before I got very far to hurry back and reintro- duce the tube, and I arrived in time to again keep the patient from dying. Dec. 26th and 29th, the same operation occurred. As I could find nothing written upon the feature that worried me in the case, I wrote to Dr. O'Dwyer for some light. He advised me to allow the tube to remain in just as long as there was no actual demand for its removal. Jan. 2d, the tube was removed and cleaned, but had to be replaced. I now decided to give Dr. O'Dwyer's advice full sway and did not disturb the tube until the 15th, or 13 days. Again the larynx began to fill and again the tube was necessary to save life. While we can usually expect the membranous deposit to either be cast off or slough off, from the 5th to the 8th day, and thereafter there is no further demand for the tube, unless there is reformation, or paralysis, my case demanded the tube from Dec. 14th to Jan. 23rd, or 40 days. During this time the tube was removed, and reintroduced 17 times. The patient took measles Jan. I6th, which no doubt prolonged the demand for the tube. - x - The long and continuous presence of the tube in the larynx and its presence against the vocal cords resulted in paralysis, and the patient had aphonia for about 6 weeks after the tube was finally removed, but the voice entirely returned. In conclusion please note the length of time the tube had to be worn, the number of times it was replaced, and the appar- y/ -- . 2. *-** %z’ º;…/ **, 4-3-#&- M'CURDy—Case of /n/ubation, Etc. 3 ent vitality of the membrane, as well as the fact that while the membrane was so thoroughly organized in the larynx it did not extend down into the trachea below the lower end of the tube, and thus destroy life. - ... • A.S. 7A//l/A. BY I. W. CHISHOLM, M. D., NEW CONCORD, OHIO. For the paroxysms attendant on asthma, I find nothing which affords such prompt relief as the hypodermic injection of morphia. For the continuous treatment I am now employ- ing “Peroxide of Hydrogen '' in a “Muriate Ammonia Inhaler,” and so far, have found nothing to equal it. Also in conjunction, I advise the use of strong coffee and plenty of it at meals and other portions of the day if the patient desires it. A CURIOUS CASE OF VISION DEPENDENT ON 7A/A, USA, OF APO 7A/ ZYES. - BY T. F. BLISS, M. D., SPRINGFIELD, OHIO. I hesitate in publishing this report of a case because it is unique and will at once suggest to eye specialists the probability of simulation or else an error in diagnosis. I cannot believe, however, that a child not yet nine year old could undergo the rigid examination of six sittings and not commit some error to show intent to deceive if such was the case, when there was no occasion or apparent desire to do so. - Edna S., a bright girl nearly nine years old, came to me December 13, 1890, for an examination of her eyes. She had trouble in school because she could not see well, and the teach- ers had often advised her to wear glasses. By reference to my notes of an examination of the eyes of 37OO children in the pub- lic schools of this city, two years before, I found that I had re- ported her as having hyperopia, and convergent strabismus. My recollection was that she did not then know the letters, and the test was comparative. At this time there was no muscular defect but the child showed symptoms of chorea, with a staring look in the eyes, that indicated very imperfect sight. I began the usual test for vision with Snellen's card, and as she did not admit 4 COMMUNICATIONS. vision=shº I covered the right eye and made my first record L. E. V.=sºn, the best that she could see after a long and tedious trial with test lenses, followed with only negative re- sults. As she went to the card several times and became familiar with the position of the letters, she occasionally would call one right but the next minute would not, and the lens seemed to make no difference. I then tried the right eye in the same way, with the same result. With the use of both eyes she read coarse print at six inches badly, and had not better than V.=sºo without glasses. I prescribed Atopia sulph., gr. IV., Aqua one ounce, for two days to dilate the pupils, when she came back for another trial. With the ophthalmoscope the fundus appeared normal and both eyes indicated a hyperopia of two dioptrics. I re- peated the trial with test lenses, but neither eye gave any ma- terial improvement, the only admission that she saw anything on the test card at fifteen feet being that she saw “scratches” on the card. Ignoring all tests I determined to trust the ophthalmoscope, and put on a pair of + 2.OO D lenses, intending that she should wear them a few weeks hoping for improvement in sight. To my surprise she at once read the test letters to #; and with + I.5o D she read #. If I covered one eye she saw nothing with the other more than before. I then recalled the fact, that in my examination I had tested each eye separately, seeking all the time for some definite error of refraction for a starting point and had found none in either eye. I gave her + I.5o D glasses, which she wore seven weeks, during which time I gave her four sittings and completed my examination and give this as the result: The eyes, as far as I can learn, are alike in every particu- lar. Right eye vision gº o ; cannot distinguish any print in 11ewspaper; counts fingers on temporal side in space one foot in diameter at fifteen feet, the remainder of field dark; does not distinguish colors. The left eye gives the same result. Neither eye was improved by any lens tried. All results were the same before and after using atropia. With the accommoda- tion relaxed, however, the eyes gave vision ; ; with a + 1.5o D lens when both eyes were used together, and this vision has im– proved in seven weeks to # and she reads diamond type easily. With the assistance of my friend, Dr. A. H. Vance, I made a very careful examination on this point to detect some decep- tion, but was unable to. Any change from this strength lens impaired vision and a material change in the power of the lens BLISS—A Curious Case of Vision, Etc. 5 over one eye made both eyes as helpless as either was alone. Every answer was prompt and consistent. A difference of one- fourth of a dioptry in either lens would confuse her answers, and one dioptry plus or minus added to either lens simply shut off the sight from both eyes. Since wearing the glasses there has been a marked im- provement in the choreic symptoms, and in her general appear- ance, but little if any change in the apparent sight of either eye when tested alone. In summing up this case we have this curious conflict of diag- nosis: Atropia and the ophthalmoscope say, simple hyperopia, which we correct with the proper lens and have all the condi- tions of normal eyes and perfect vision. A systematic examin- ation of each eye by objective tests and lenses give, amauro- sis, temporal hemiopia, color blindness, contracted field of vision, nyctalopia, and vision to count fingers at fifteen feet, in both eyes. These latter symptoms are not unusual" in a squinting eye that has long suppressed the image, and the universal tes- timony of authorities is, that the proper way to test for vision is to examine each eye separately, but in this case both eyes sup- press the image and make the separate test valueless. A friend of mine, of large experience, suggested astigmatism in oppo- site axes; but no lens or combination made the least difference in either eye, and the question in my mind is, is there some compensating relation between the two eyes, by which one sup- plies what the other lacks to complete vision. If she cannot see with either eye, how can she see with both 2 Where is the power that transforms two temporal and limited fields of vision with no idea of color, to an open field and perfect color sense 2 The fact that the strabismus that I noted two years ago has dis- appeared, indicates that binocular vision was a necessity to vis- ion, and the full correction of the hyperopia makes binocular vision normal. I have made this report as brief as possible, and submit it without further comment. I will keep the case under observa- tion, however, and hope to see definite improvement in monocu- lar vision as a result of wearing glasses. “A/OAZAVO//OS ’’ OA. TAZAZ AWASO-AA/AA’ YAVX. -**** BY C, E. PERKINS, M. D., SANDUSKY, OHIO. Read before the Bay City Medical Society, May 9th, 1891. The subject which I will present to you to-day, although it. may not interest you as some other might, I regard of great im- portance to us as general practitioners as well as to specialists in nose and throat diseases. In its normal condition the naso-pharynx contains a thick layer of lymphatic tissue which is covered by mucous membrane and greatly resembles the faucial tonsil, so that it has been, not. inappropriately, styled the pharyngeal tonsil. This tissue is most abundant in the roof and posterior wall of the naso-pharyn- geal space, where it is thrown into folds, as it were, and loosely attached to the underlying hard structures except in the median line where the attachment is rather firm. The function of this tissue is still a matter of discussion. The recital of the various theories here would be tedious; suffice it to say that its uses are very similar to those of the faucial tonsils; some effect in common with all lymphatic tissues on the blood, and to produce mucus to lubricate the pharynx and bolus. of food as it passes to the stomach. . . At times this tissue undergoes hypertrophy and gives rise to the disease under consideration. The lymphatic elements in- crease in size and number, and the depressions between the folds. are deepened, the one in the median line often becoming nearly a sac, by the sides growing over it. This gives rise to the con- dition described by Tornwaldt, and known as Tornwaldt's bursa. It probably has no real significance other than as being a result. of the general process. There is also some hypertrophy of the glandular structures but not to the same extent (as a rule) as in the lymphatic tissue. As to the causation of this disease, not much is known. It is preeminently a disease of youth, seldom originating after puberty; oftenest found in scrofulous and lymphatic children. It is sometimes congenital, and is often associated with enlarge- ment of the faucial tonsil, as in a case recently seen by me, in which the tonsils had been removed sometime before without benefit, this condition of the naso-pharynx being overlooked. PERKINS="Adenoids” of the AWaso-Pharynx. 7 These growths interfere with nasal respiration. The child is usually a mouth breather. He has a coated tongue and bad breath, especially in the morning, because he has breathed through his mouth all night. He snores for the same reason. Is apt to have high arched palate, thus increasing nasal obstruc- tion. He has a dull, lifeless look, continually going around with mouth open and staring sleepy expression. He has a peculiar dead voice, because one of the resonant cavities is filled with growths which act as a damper upon the sound vibration. For the same reason it is impossible for him to sing, the high notes especially. By prolonged use his voice becomes weak and hoarse. He is apt to be duller at his books than other children. Dull headaches are experienced at times. These growths varying, as they do, as to the relative amount of mucous and lymphatic tis- sue they contain vary also in the amount of mucus they secrete. It is unnaturally thick and tenacious and falling down into the pharynx causes an irritation and gives rise to the hawking which is too familiar in this climate. This is usually the most trouble- some symptom in adults, but I have seen children in whom there seemed to be no more abnormal amount of mucus pro- duced. Deafness and inflammations of the middle ear are often caused by these adenoids. How they produce these troubles is still “subjudice.” They are sometimes a prominent feature in the production of asthma. How they are concerned in this would take us beyond the limits of this paper. They often vary in size with changes in the atmosphere. On humid days they absorb moisture and are larger than on dry. This may lead to confusion in diagnosis. This condition is a cause of many of the transient colds with which we are so familiar. The diagnosis can usually be made by the looks of the patient, the dull, lifeless look, open mouth, dead voice, etc., being hard to mistake when once seen. But in all cases further examination should be made with rhinoscopie mirror if possible. They will appear in the naso-pharynx as a reddish gray, lobu- lated mass. The finger introduced behind the palate is often a good way to discover them. If neither of these ways seems practical the nose may be sprayed with a 6 per cent. solution of cocaine and after a few moments the cavernous tissue of the tur- binateds will have contracted sufficiently to permit a view through the nose. They appear a reddish gray, not at all like the normal throat reflex. */ If there is any nasal obstruction this will not be practical. If a spray of some of the liquid hydrocarbons of the petroleum series as zero-cosmolin be used, the spray directed into one 8 COMMUNICATIONS. nostril there will from the other, the nose and throat being nor- mal, be forced out a thick cloud of atomized fluid. If this does not take place or there is a small amount of mist, there is some obstruction, and having excluded the nose the throat will be at fault, and this is the usual condition. This is also a valuable means to determine the success of treatment. Prognosis as to cure of most of the troublesome symptoms is good if the growths are removed. Nasal respiration may become established and hearing be greatly benefitted in the majority of cases, especially in children and even in adults the cases of deaf- ness are far from hopeless. In a large number of these cases the growths become greatly reduced in size soon after puberty. Whether this is due as much to real atrophy as to the increase of the naso-pharyngeal space which takes place at that time, it is difficult to say. Very often then the symptoms become those of ordinary naso-pharyngeal catarrh, the obstruction be- coming of less importance. In this case the patient is relieved of many troublesome symptoms but not cured. On the whole, they should be removed as they may result in permanent disease. The treatment may be either constitutional or local. In strumous and debilitated subjects benefit is often obtain- ed by the use of cod liver oil and tonics, such as iodide of iron, phosphorus, arsenic, etc., and some of these preparations should be given if there exist indications, whether or not they are sub- jected to operative treatment. One of the functions of the pharyn- geal tonsils being as suggested connected with digestive system, one would look for disorder of stomach and bowels, and in some cases this does exist and aggravates the disease in the naso- pharynx and when corrected the symptoms become much more bearable. But we will be obliged to place our main reliance on local treatment. Generally the complete removal of these growths should be advised. When for any reason this becomes impossible, a great deal may be done by medicine, applied with sprays and applications. The naso-pharynx should be cleansed from mucus by means of spray or post nasal syringe with some alkaline wash, then some astringent should be applied by same device. This should be done daily by patient's parents, or friends. For cleansing purposes Dobell's solution is as good as any- thing, and for astringent I prefer solution of tannin, borax and glycerine. In conjunction with this treatment they should be cau- terized with nitrate of silver, or chromic acid crystals or by gal- vanic cautery. This may be done through the throat, or if the nasal passages are free, as I prefer, through the nose. After spraying the nose with cocaine solution the cautery point should I PERKINs—“Adenoids" of the Maso-Pharynac. 9 be introduced cold into the naso-pharnyx. It should then be pressed against the growths and the current turned on. It should be allowed to cool before being withdrawn. This should be done on both sides. An eschar will be formed and cast off in about a week and be followed by contraction. In five or six applications there will be great improvement. If the patient be timid and cauterizing in this manner be deemed inadvisable, electrolysis may be tried and is strongly advocated by some, but I have had no experience with it. We now come to consider their rapid removal. This, I may say, is generally advocated by specialists in this line. Operators differ as to the method which seems to them most simple and effective. Whether or not, an anesthetic should be administered depends upon the patient's age and disposition, the mode of oper- ating and the preference of the operator. I prefer to produce anesthesia in children, if at all nervous, as they usually are. In adults I generally get along well without it. Some writers use the finger, either alone or armed with a curette which fits the finger like a thimble. In this way the growths are partly scraped away and partly bruised, subsequent disintegration and absorption effecting their removal; several sittings are neces- sary. This process appeals to me as disagreeable and tedious. They may be removed by the forceps. I have found an Holbrook Curtis forceps to answer very well. They may be guided by the mirror in the throat, or if the patient is anesthetized, by the finger or the growths may be seized and removed, their position having been previously determined by the mirror. If the palate is forcibly retracted it may be caught and torn by the forceps if due care is not taken. This necessitates retraction of the palate or use of some other means. Forceps have been de- vised to cut antero-posteriorly, thus avoiding this difficulty, but with these it is impossible to remove that part of the growth On the posterior wall. I prefer in these cases to use the curette or snare After the curette is in position retching does no harm other than to embarrass the operator. With a little practice it can be inserted without difficulty, even in very irritable throats, and the growths scraped off. I prefer one that cuts from before backwards, as Bosworth's. It has been objected to the forceps and curette that they may cause injury to the eustachian tube. I have never had such a case, but must confess that I never operate without think- ing of the danger and worrying about it. As being free from this danger the snare would naturally suggest itself. I have used it in but three cases and was well pleased. I prefer to IO COMMUNICATIONS. use it through the nose; the snare is threaded with piano-wire and a loop of the required size left, this is bent down until a kink is made, the wire is drawn in until it will pass through the nose. It is passed into the naso-pharnyx and the loop en- larged to its first size, it is then placed into position and the wire slowly drawn home. By this manner the wire hugs the bony wall and removes the growths completely from one side. There is sharp bleeding for a few moments; the patient will generally blow the mass through his nose. The process should be repeated on the opposite side. This method is suggested by Bosworth as being the most thorough of all. The cautery snare is in no way superior to the cold wire snare and is more expen- sive and not so manageable. Following these operations there may be sore throat, pains. in the neck and headache, with some fever. These should be treated on general principles and local antisepsis. In conclusion I might say that many points that are very in- teresting have been necessarily omitted, for I feel that the patience of the society has been taxed in the extreme. But if these cases are looked for a great many more will be found than one would naturally suppose, and in view of the ofttimes. brilliant results obtained by proper treatment, they make a very Satisfactory class of cases to handle. SCAA’/LA 7/AVA. HOSPICE DES ENFANTS ASSISTES-M. SEVESTRE. (Translated from Progress Medical, by D. N. Kinsman, M. D., Columbus, Ohio.) Continued from /ume Issue. The etiology of scarlatina is obscure in many points, and from what I have already said you have learned that we are wholly ignorant of the nature and character of the microbes. We, however, assert that they do exist. We know positively. that Scarlatina does not arise spontaneously, or from common. causes, but that it always follows another case by more or less. direct transmission. It is, unfortunately, in a good number of cases impossible to trace the source of the contagion, and we are unable to turn. to account, an element of appreciation to which I attribute much importance in certain contagious diseases, and particu- larly in measles; I mean the knowledge of the precise length SEVESTRE–Scar/a/?na. I L of the period of incubation. We shall return to this, but for the present let us consider the results of attempts at inocula- tion. Stoll, having introduced the scales of the scarlatinous be- neath the skin of a healthy person, thought he had obtained a scarlatinous eruption, but other observers, and particularly Petit Radel, failed in similar trials. In 1865, Girard showed, by two positive facts, that scarlatina is communicable during the erup- tion. The observation of Cameron, Trousseau, Mabboux, men- tioned above, and my personal experiences prove it, and Rand- some has cited from cases in which the contagion seemed to have been transmitted from 12 to 20 hours before the exanthem. We may therefore consider it demonstrated it is communicable during the eruption and even previous to this, in the pre-erup- tive stage. When does it cease being contagious? This is difficult to determine with precision. If the contagion occurs at a late period, it is impossible to tell whether it is due to germs re- cently produced by the patient, or is due to old contagious ele- ments which have preserved their vitality. In Barthez case, a child separated from its brother and joined to him on the forty- fifth day of his disease, took scarlatina. In another similar case reported by him, the beginning of the disease was three months before. In Sanni's case, a young man fell sick at Se- dan, the 8th of January ; started in the campaign, Feb'y 20th ; March 23rd, seventy-three days after the outbreak, he came to Paris and infected a child. It is probable that in these cases, which occurred in 1865, the patients did not undergo any kind of disinfection. Spear saw a case, infect his young brother after three months. In the meantime his clothing had been com- pletely renewed, but in such a case I ask if the antisepsis of the body had been sufficient and if the virulence may not persist in the throat and mouth. In this way Bond explains the fol- lowing case: A young patient had left the hospital six weeks after the beginning of a case of mild scarlatina; she was put in the same bed with her sister and the latter had scarlatina at the end of five days as this little patient had no longer showed any traces of desquamation for a period of fifteen days, and more- over the clothing had been disinfected and herself bathed, it appears reasonable to admit the contagion from the throat. Miquel (de Amboise), by inoculating the blood of a plaque of scarlatinous exanthem, observed a redness around the point of inoculation, and as new trials on the same individual gave no results, he thought he had realized a vaccination ; but Leroy I 2 COMMUNICATIONS. d'Estelles produced upon himself in the same way a slight redness which he was able to reproduce many times. All these experiments have but little value. I shall mention the following case of Haarwood, of Cam- bridge, reported by Sanni : A man who lived with a scarlatin- ous patient cut his hand with a piece of glass. He at first had an intense inflammation of the wound, then he was attacked with a disease they called scarlatina, from which he died. We must demonstrate, in the beginning, that the redness which ac- companied the inflammation of the hand was not a septicemic exanthem, similar to that of Savard which I mentioned at my last lecture; and further, if it did really concern a scarlatina, the proximity of the patient sufficed amply to explain it. The inoculability of scarlatina is very doubtful. The cases cited do not serve to fix the duration of incubation, and we are forced to seek this in sufficiently clear clinical facts. These cases ought to fill the following conditions: The contact with the patient should be brief, and the separation should be imme- diate and complete, that no other source of contagion could be invoked. Here are some cases of this kind : A child, observed by Allison, came from Laneville, where an epidemic prevailed, and where it had remained several hours; five day after it pre- sented a scarlatinous eruption. In a case reported by Marchand of Berlin, a hospital attendant came, the 21st of November, to take a patient to a hospital; the 24th he complained of head- ache, then rapidly presented all the symptoms of Scarlatina; the incubation was three days. Cameron gives an example in which the incubation was still shorter: A girl of nine years, isolated nine weeks from her sister sick of scarlatina, at the end of this time came in contact with and slept with her sister. Two days after she had vomiting fever and the characteristic exanthem. They carried the patient to an aunt, who shared her bed with her; the next day, 24 hours later, the aunt fell sick in her turn. You have seen in Trousseau's lectures, the history of the young English woman who, lying in the same room with a scarlatin11, not having contact with her before, had scarlatina in her turn 24 hours later. This is not the extreme limit, the incubation may be shorter still. Thus, in a case reported by Dr. Mabboux, a sol- dier was admitted to a hospital at IO a. m., at 3 p. m. it was seen he had scarlatina and he was isolated; during the following night his neighbor had sore throat, the first symptom of a scar- latina which had an incubation of only I2 or I5 hours. SEVESTRE-Scarlatina. I 3 My personal observation confirm the preceding cases. A case I observed in Lariboisiere in 1879, and those presented at different times in this hospital, all go to show that the incuba- tion of scarlatina has a maximum of five or six days, but con- tact having been in these cases prolonged many days, it is possible that the contagion was not affective at the first mo- 1ment. “ On Monday morning a young girl complained of having Had a bad night; nevertheless arose, but some hours later was obliged to take her bed; being called to see her after midday, I found a vivid redness of the throat and the beginning of the eruption of scarlatina. The other children were sent to the country immediately, consequently none were infected, except on that Monday, but Saturday, five days after, one of her sisters presented symptoms of scarlatina. On the other hand, I closely observed a case in which the duration of the stage of incubation did not appear to have ex- ceeded 12 hours. A little girl of nine years was taken one night; at 5 a.m. there was vomiting and fever; at 7:30 there was a vivid redness of the throat. This was the beginning of a scarlatina otherwise benign. Seeking very carefully for the ori- gin of this case, I was unable to find any cause but the following: The day before the child had passed some hours in a house where, months before, I had seen a case of scarlatina. Disin- fection had been practiced six weeks before, but probably incom- pletely. Incubation in this case could not have been more than twelve hours. Therefore, we say, in conclusion, the incubation of scarla- tina is variable. I do not think it ever exceeds five or six days, often it is less, twenty-four hours or less. Cases are mentioned by Girard of Marseilles in which incubation was 16 or 17 days, but these are so different from the rest that I think we should take no account of them. [Hillier mentions two cases with an incubation of 51 and 54 days. K.] One may explain these cases by saying the contagion is for a time resting in store, be- fore being utilized by the subject, if you will allow the expres– S1O11. When is scarlatina contagious P For a long time, until the last few years, they thought it was only during desguamation. Contagion lasts as long as desquamation. Desquamation, so Cameron thinks, is rarely complete in England before the 8th weeks. It is frequently incomplete the Ioth and 12th weeks. But the point of special interest to determine is, when the pa- tient ceases to produce contagious elements, for we all know I4 COMMUNICATIONS. disinfection is valuless, and has no reason for its use, if the pro- duction of the contagion continues during its use. Peace thinks the secondary and tertiary scales are not contagious. Finally, although the fact does not rest upon absolutely positive observations, it may be conceded that at the end of five or six weeks, and a cleaning up practiced as I shall indicate further on, the patient ceases to be infectious. I come now to a study of the modes of transmission. Scar- latina arises, says Borsieri, a miasmate earterzove quod ºn aere volitat, auf contagzone et contactu susciºur. We may admit that the transmission may be direct, although it is not so easily demonstrated as for diphtheria. It is probable that inspired dust is the principal vehicle. It often occurs in- directly through a third person who remains free; Allison has published some examples: A woman coming from an infected village having patients in her family, came to the family of her son, a distance of I3 kilometers, and infected a child who slept in the same chamber with her. There had not been a case of scar- latina in this county for thirty years. A child sick with scarlatina was visited daily by its grandmother ; two brothers of the child lived with her, eighteen days after both were attacked in turn, without other source of contagion being obvious. Indirect transmission is not doubtful, but as Sanni says, that any one may transport the contagion they should have intimate and prolonged contact with the patient; thus we explain the rarity of infection by the physician. There are opposite exam- ples: Bernoulli cites the case of a physician who leaving a scarlatinous patient went to a woman in labor and performed version ; some days later she had scarlatina. Bezek infected one of his daughters after a half hour's sojourn with this patient who had scarlet fever. These cases, although rare, force us to con- clude we ought not to leave such patients without minute anti- septic precautions. On the contrary, there are abundant cases when objects used by the patients have conveyed the infection. This is easily understood since the microbe of scarlatina, like that of dipththeria, has great vitality. Beurdert mentions two children who contracted scarlatina in a chamber where two months before there was a death from the disease. Of the same order is Fink's case: In four days, with no epidemic, three children were seized with scarlatina, when some days before in their presence a trunk of clothing had teen opened, which had come from a sister who had had scarlatina SEVESTRE–Scar/a/272a. I5 in another town. If scarlatina may be carried by garments and linen, it may be conveyed by any objects whatever used by the patient, toys, books, etc. A woman living in Brittany, in a place free from scarlatina, received from Germany a letter from the old governess of her daughter, this person said she had just had scarlet fever, and was having a very abundant desguamation, so that while writing the letter she had to shake the paper many times to clear away the scales which fell in profusion ; some days after the mother and daughter were sized with scarlatina. Dr. Fox having seen three cases of scarlatina in one house was lead to suspect a book lent from a circulating library; an in- quiry indeed showed him that this book had been lent some time before to a family in which there had been a case of scarlet fever. He obtained an order from the sanitary authority that, thenceforth all persons attacked with contagious diseases, who should take books from the circulating library and disseminate diseases should be prosecuted. This same measure was doubtless justifiable, but I beg leave to remark how far this differs from the go-as-you-please policy which obtains in France in similar cases. You know that in England they believe certain diseases, and especially scarlatina, may be transported by milk. I allude now not only to the cases canvassed at Our last con- ference in which by faulty interpretation they had thought scarlatina to be of bovine origin, but more especially to those cases in which there is reason to think milk was the vehicle of contagion of human origin. In August, 1879, in a village near the city of Manchester, Amy saw 35 cases of scarlatina of which 24 began the 3d and 4th of August. All the infected families took milk from the same farm, while their neighbors who were supplied from another source remained free. Of three milkers employed upon this farm one lived with his son who had a child sick with scarlet fever. He carried the milk to a certain number of patrons, but as other persons served by the other milkers fell sick, it seems probable that this man carried upon his hand and clothes the germs of scarlatina with which he sowed the milk. Likewise, Foulis reports an epidemic of 234 cases, in a sin- gle week, in a population fed by many creameries, receiving milk from the same furnisher, having at his farm a woman with scar- let fever. These facts and others of the same order lead us to think milk may transport the contagion of scarlet fever, therefore, I6 COMMUNICATIONS. we conclude scarlatina is a transmissible disease, ever dependent upon a previous case; nevertheless, the etiological study would be incomplete, if we did not say something about the accessory causes which many modify the respectivity of the organism. Continued. THE SIGNIFICANCE OF MUSCAE VOLITANTES.—People are often frightened almost out of their wits by the sudden appear- ance of flying specks before their eyes; sometimes they are only one or two, but often thousands of them can be seen, partigularly when a person looks towards a white surface, as white clouds, white houses, white pavements, or towards water surface. These flying specks are mostly small points, con- nected one with another by fine lines, and the points often pre- sent a beaded appearance. At first, persons are likely to try to knock them away, thinking it is something before their eyes. They come usually in both eyes at the same time. They may diminish or increase in number at times, but they rarely ever disappear entirely. They usually have a fixed position in the field, but occasionally they "move or float about to a limited extent. They never interfere with vision by settling over objects looked at, They are invisible with the ophthalmoscope. Their nature is not well understood. The explanation usually given is that they are opaque points in the vitreous humor, which throw shadows upon the retina and thus become visible. Badly focused eyes are most likely to be troubled with muscae volitantes. They signify nothing serious so long as they are mere points, connected by fine lines, and do not interfere with the acuteness of vision. Treatment is more than useless. If the eyes are out of focus proper glasses should be selected. It is important that the patient should ignore their presence entirely; should avoid seeing them as much as possible and let them alone. Large floating masses before the eyes which swim. around and often obscure vision, are the result of serious disease and should be promptly looked after.—A. D. WILLIAMS, M. D., zn. St. Zouz's M. and S. /our. 9 & 26% *. Standard and 6fficinal Preparations for Physicians enly. Galenical Preparations MANUFACTURED BY |WILLIAM R. WARNER & Cſ), —o-Hº FOUNDED IS56.é=—o— PIL. SUM BUL. COM P. (WM. R. WARNER & CO.) (DR. GOODELL) R. Ext. Sumbul... I gr. Assafoetida .... 2 gr. Ferri Sulph. Ext. ...1 gr. Ac. Arsenious ... 1-40 gr. “I use this pill for nervous and hysterial women who need building up.” This pill is used with advantage in neurasthenic conjunction with War- ner & Co.'s Broino-Soda, one or two pills taken three times a day. PIL. Dic Estiva. (WM. R. WARNER & CO.) A VALUA BLE AID TO DIGESTION. R. Pepsin Conc't...l. gr. Gingerine....... 1-16 gr. Plv. Nux Vom.9% gr. Sulphur..........}% gr. In each pill. This combination is very useful in relieving vari- ous forms of Dyspepsia and Indigestion, and will afford permanent benefit in cases of enfeebled digestion, where the gastric juices are not properly secreted. As a dinner pill, Pil. Digestiva is unequalled, and may be taken in doses of a single pill either before or after eating. PIL. LADY WE BSTER. (WM. R. WARNER & CO.) R. Pulv. Aloes...2 grs. | Pulv. Rose Lvs.... }. gr. “ Mastic...}, gr. M. Ft. one pill. Lady Webster Dinner Pills. This is an excellent combination officially designated as Aloes and Mastich, U. S. P. We take very great pleasure in asking physicians to prescribe them more liberally, as they are very excellent as an aperient for persons of full habit or gouty tendency when given in doses of one’pill-after dinner. P I L. A NTISEPTIC. (WM. R. WARNER & CO.) Each pill contains: - Sulphite Soda ...... 1 gr. Ext. Nux Vomica .34 gr. Salicylic Acid...... 1 gr. Dose, 1 to 3 pills. Pil. Antiseptic is prescribed with great advantage in cases of Dyspepsia attended with acid stomach and enfeebled digestion, following excessive indul- gence in eating or drinking. It is used with advann tage in Rheumatism. PIL, CHALY BEATE- (WM. R. WARNER & CO.) Proto. Carb. of Iron, 3 grs. Dose, 1 to 3 pills. (WM. R. WARNER & Co.'s FERRUGINous PILLs.) Ferri Sulph. Fe SO4 }-É. Carb. Fe. CO3 Potass. Carb. K2 CO3 ſ TPotass. Sulph. K2 SO4 Pi - - ANTISEPTIC COMP. (WM. R. WARNER & CO) Each pill contains: Sulphite Soda...... 1 gr. Pwd. Capsicum.1-10 gr. Salicylic Acid...... 1 gr. Concent’d Pepsin ...1 gr. Ext. Nux. Vom ...}} gr. Dose, 1 to 3 pills. Pil. Antiseptic Comp. is prescribed with great advantages in cases of dyspepsia, Indigestion and Malassimilation of food. - PIL- CHALY BEATE CO M. P. (WM. R. WARNER & Co.) Same as Pil. Chalybeate with 3% gr. Ext. Nux Vomica added to each pill to increase the tonic effect. Dose, 1 to 3 pills. PIL. ALOIN, BE LLADO N N A A ND STRY CH N IN E, (WM. R. WARNER & CO.) R. Aloin........ 1-5 gr. Ext. Belladonna. ...}% gr Strychnine..2–60 gr, Dose, 1 to 2 pills. Medical Properties—Tonic, Laxative. Try this pill in Habitual Constipation. Please Specify (WARNER & CO.) and order in bottles of 100 to secure the full therapeutic effect and to avoid - the substitution of other brands. 1228 Market St., Philadelphia. . . . . - AGENTS IN COLUMBUS, OHIO : . . . 18 Liberty St., New York. . . . cornell, Praeneger Co.; Orr, Brown & Price ; Kauffman, Lattimer Co. y 1 JUST PUBLISHED Grippe and Its Treatmºn.” CYRUS EDSON, M. D., HEALTH DEPARTMENT, CITY OF NEW YORK. D. APPLETON & CO., Publishers, 1, 3, 5 Bond St., New York. Price, 25 Cents. See Part III, pp. 39, 40, 44, 45: . . . . In the great depression caused by the disease and in the Con- walescence, special attention is called to the walue of “Win Mariani.” This additional testimony again clearly demonstrates that the most effectual treatment in La Grippe and similar wasting diseases, is the strong, generous diffusible tonic, known as VIN MARIANI “The Standard Preparation of Erythroxylon Coca.” MONOGRAPH BY EUROPEAN AND AMERICAN OBSERVERS WILL BE FORWARDED 0N APPLICATION. IMA IA-I FRIA-INTI tº CO. | "I : Bd. US $9.3 ill lººs :::::::::::::::::. 52 West 15th Street, New York. MEDICINE. ANGINA PECTORIS-A DEBATE.—The Zancet, March 14th, says: The debate which has occupied three meetings of the Medi- cal Society, and has just been concluded, deserves attention, not only from the intrinsic interest of the subject—angina pectoris, —but in no small degree from the remarkable breadth of views taken by most of the speakers. For it is singular how re- stricted have been the opinions held in past time concerning an- gina pectoris, and how, in this respect, medicine has been apparently influenced by that feature which so strikes the popu- lar imagination—we mean the liability to sudden death. No one, however, who has followed this debate, can aver that Eng- 1ish physicians adhere to any such narrow conception, and many doubtless would agree with Dr. Mitchell Bruce in the desire that the term “angina pectoris” could be got rid of. That being impossible, the next best thing is to deprive it of its application to any single morbid state, and, if not adopting Sir Walter Fos- ter's notion of its being a “mode of death,” to at least employ the phrase in a merely clinical sense, as expressive of paroxys- mal precordial pain. Obviously, then, the sufferer does not die from the symp- tom itself; but from the cardiac conditions that underlie it—con- ditions that may be of organic origin, or of hardly less serious functional derangement. The mechanism of the circulation is suddenly disturbed, and the expression of the heart's difficulty to be found in the anguish experienced by the patient. With one notable exception, the speakers at this debate agreed with the opener of the debate, Dr. Douglas Powell, in attributing an- gina pectoris to some defect in the harmonious co-operation of the heart and vessels in the work of the circulation. At the same time there were certain divergencies of views as to the precise form of this derangement. All, however, concurred in including under the anginal seizure, attacks of the most varied kind, having the one feature of pain in common. The chief points of difference related to the question whether the cardiac condition during the attack was one of muscular spasm or of over-distension of the cavities, as to the precise share taken by the state of arterial blood-pressure in initiating the seizure, and 17 I8 SELECTIONS. as regards the integrity of the muscular substance. Dr. Douglas Powell, for instance, attributed many cases to a condition of un- due vaso-motor irritability, whereby under comparatively slight influences the arterial blood-pressure, previously in most cases unduly high, is increased, leading therefore to a sudden call for increased effort on the part of the heart. Such cases, he main- tained, were numerous, and though alarming in symptoms, were seldom fatal. In them the heart muscle was healthy, and they contrasted with the graver type associated with cardiac degener- ative changes. Dr. Lauder Brunton’s comparison of the heart with the bladder went further in explaining the rationale of the pain produced by over-distension, but he admitted a predispos- ing state of heart weakness, owing to which the increased arte- rial resistance, such as is produced in the first stages of mus- cular contraction, is sufficient to cause undue distension of the cavities. Sir Walter Foster lucidly and simply referred the immedi- ate cause of the attack to the over-distension of one or other of the cavities, although in many cases he recognized the heart was degenerate. Dr. Broadbent did not allow that heightened arterial tension was at all a constant feature; he laid stress on the dangers of a weakened heart, and candidly confessed that some cases afforded no reasonable explanation. Dr. Ord seemed willing to admit all factols, vascular and cardiac, as provocative of attacks, but distinguished two main groups, dependent upon whether exertion was or was not the exciting cause. Dr. Mitchell Bruce contended for an underlying weakness of the heart, which was generally enlarged, and declared that symp- toms of vaso-motor disturbance and increased arterial tension were generally wanting. Indeed, it was manifest that no single theory could explain the varied conditions under which an an- ginal seizure may arise. The “gouty heart” seemed to Dr. Bruce, to best describe the condition most often present. Professor Grainger Stewart was almost alone in pleading the neuralgic theory; and he would even extend angina to in- clude pain ascribed to aortitis apart from heart disease. The distinction he drew between muscle pain and nerve pain does not seem a very tenable one, and since all the conditions named by him as exciting are equally well explained on the muscular Hypothesis, it is somewhat difficult to see the reason for retain- ing the notion of cardiac neuralgia. The question whether the pain be due, as Dr. McVail argued, to excessive contraction, or, as Dr. Seymour Taylor held, to spasm of the heart, or to the SELECTIONs. I9 mechanical effects of over-distension, like that experienced in the bladder, on Dr. Brunton's analogy, is to a certain extent imma- terial, except that it emphasizes the notion that the condition of the muscular wall rather than that of the cardiac nerves, is the primary fact. Dr. McVail attempted to contrast the attacks of pain with the nerve-storms of epilepsy, and urged that the mode of onset and the character of the pain should be more carefully studied. The central fact of the whole discussion turned, however, less upon the character of the pain than upon the condition of the heart and blood-vessels; and we believe the views held by the majority of speakers, as to angina pectoris being an index of cardio-muscular difficulty, are those most in harmony with facts. The only ground for resorting to the neuralgic doctrine, advanced by Professor Grainger Stewart is that it forms, as it were, a loophole of escape from the difficulty which other theo- ries encounter in the fact that each of the several cardio vascu- lar conditions described, may exist apart from angina. Thus angina pectoris does not occur as a result of the heightened arterial tension of Bright's disease, nor usually from the distension of cavities due to valve defects, notably the mit- ral valve; whilst cardiac degeneration, with or without disease of coronary arteries, may most certainly exist, and lead to a fa- tal issue without ever being characterized by anginal seizures. Obviously there is much to learn yet concerning the nature and immediate causation of angina pectoris, but the association in fatal cases with manifest organic lesion of heart or blood-vessels and, in non-fatal attacks, with clinical evidence of defective cir- culation and heart enfeeblement, and the rarer event of breast pang—sometimes with fatal result—from sudden and violent exertion, seems to point conclusively to its origin in disordered mechanical conditions of the circulation, with consequent strain on the cardiac power. Therapeutically, there is general agreement as to the lines to be adopted in dealing with these cases, and the utility of the Initrites is admitted by all, as usually affording the most speedy and sure relief from the anginal pain. The prescribing of iodide of potassium and of eliminant measures; the due regula- tion of diet and exercise, proportioned, of course, to the degree of integrity of the heart, were also spoken of with more or less approval and unanimity.—Amer. Zanceſ. 2O SELECTIONS. PROTRACTED CASEs OF BRIGHT's DISEASE,-(Clifford Mitchell, M. D., Chicago, Ill., in Clinical Reporter.) Once it was thought that Bright's disease was necessarily fatal within a year and a half, or perhaps, in less time. This was due to the fact that no diagnosis of Bright's disease was established until the patient became dropsical or had such evi- dent symptoms as to attract even his own attention. Of late it has been proved beyond controversy, I think, that there are cases of Bright's disease which pursue a tardy course, often remaining stationary for years and requiring, for their full developement, from ten to twenty years or, possibly, more. Such cases, pathologically, are to be classified under the head- ing of chronic diffuse non-eazzda/zze nephritis. Now, in the chronic diffuse eacuda/zve cases, with rapid course, there is exu- dation of blood serum into the kidneys and we find plenty of albumen and casts in the urine. Not so in the slow, non-exu- dative cases. There may be no albumen at all, or but traces, and only occasionally a hyaline cast or two. Professor Francis Delafield, of New York, has classified the protracted cases as follows: I. Those in which there are absolutely no symptoms, at all, except the changes in the urine. 2. Those in which the patients have disturbances of di- gestion, loss of flesh and strength, increased arterial tension, headache and sleeplessness; they grow feeble and die. 3. Those in which, after years of no symptoms at all, there may be a sudden attack of acute uremia. Those in which there are no symptoms at all until the patient has had pneumonia or a pericarditis or suffers from an accident, and then renal symptoms are developed. In these very slow cases, albumen is either absent altogether or so small in amount that a hasty examination, of unaltered urine, fails to discover it. There may be no casts at all in the urine, but if repeated examinations be made, with the micro- scope, small hyaline casts will occasionally be found. It is very easy to see, therefore, why these slow cases of Bright's disease are not detected. One patient has no symptoms and his physician, even though the urine be tested in the rou- tine way, discovers no albumen. How then, is the diagnosis to to be established 2 Experience has shown that if a patient, of average weight and appetite, voids habitually, urine of specific gravity, IOI8, or below, in which urea, per fluid ounce, and phosphoric acid, per fluid ounce, are much below the normal average, if the volume of day urine is habitually less SELECTIONS. 2 I than twice the volume of night urine, when the patient does not drink largely during the evening, we are war- ranted in suspecting that the patient has Bright's disease. Before committing ourselves to a diagnosis, frequent examina- tions of the urine should be made, and if, at times, we find stray hyaline casts and now and then a trace of albumin, not due to dis- ease of the lower urinary organs, we should conclude, especially in patients over forty years of age, that there is a true renal lesion. It is not at all advisable to use the term “Bright's disease,” when speaking to the patient, for the latter, ten years later may laugh you to scorn, and feel some resentment at the fright you have cause him. It has been thought that these slow cases of Bright's disease occur only in adults, but I have record of a case in which the disease, apparently, lasted during the whoſe /?ſe of the patient, or at least from earliest childhood, the patient dying of uremia in her eighteenth year. From the earliest years, the patient urin- ated frequently and voided more urine in twenty-four hours than normal, and much at night. The urine was always below nor- mal in specific gravity, and of poor quality as regards solids. When about sixteen years old, I found a small quantity of albu- men, but carefully repeated examinations failed to find casts. About two years later, I found the specific gravity below IOIo, urea only seven grammes per liter, albumen over one-tenth, and one or two renal casts, one wide hyaline cast, dotted with renal epithelium, and one granular cast. The patient's face was now waxy and somewhat bloated, she complained of cramps and “dead" fingers. For a month or two, felt better, under admin- istration of various remedies; them after over-exertion and tak- ing cold, began to void less urine, had dyspnea, rapid pulse, and died from uremia in about a week. The last examination of urine made a week before death, showed the urine to be almost precisely the same in quality as for years, and no casts could be found. There was really no sediment at all. The practical value of establishing the diagnosis is as follows: I. Professional men are to be warned, that while, strictly speaking, there is no present danger, a sudden strain, an all night case or two, an exhausting journey or professional busi- ness, may bring on acute uremia. Disregard of medical advice is at the bottom of many of the sudden deaths. 2. Men in politics, about to enter on a long and exciting struggle, should be warned that it may cost them their lives, especially in the shock of defeat. 22 SELECTIONS. 3. Professional diners-out should be advised to become habitual suppers-in, and be told that gross feeding is quite as dangerous as drinking. Many men who pride themselves on their Spartan courage in refusing drinks, wear out their renal epithelium with excess of nitrogenous food. 4. All patients, with urine such as is described, should, when possible, seek non-malarial, dry localities, and keep away from large bodies of water in the spring of the year. 5. If, in addition to renal weakness, there is pulmonary dis- order, the case becomes more serious, since an attack of pneu- monia is likely to prove fatal. Such patients must avoid locali- ties where pneumonia is rife. In cases where the patient is obliged to remain in a cold, wet climate, he should remain in-doors, and preferably in bed, during cold, easterly storms, and, in any event, never get his feet wet, nor plow through snow. 7. Surgeons, who attend such patients, must not be sur- prised at unfavorable results from operation or injury. How are these protracted cases to be treated 2 Look after the general health, guard against uremia, and, if neessary, relieve arterial tension. In regard to the general health, give the following directions: the patient is to wear thick-soled shoes, or better, high boots, and never get wet. He is to wear complete suits of Jaeger underwear the year round, light in summer and the heaviest in winter. He is to have a ther- mometer outside his window, and wear his overcoat, according to temperature and not according to the month of the year, when- ever the temperature is below sixty degrees; a thick coat, with- out an overcoat from sixty to seventy degrees; then in warm weather, a coat of medium thickness; but the rule is imperative, that below sixty degrees, even if it be August first, a good warm overcoat is to be worn and buttoned up well over the chest, not flaring open. The patient is not to eat meat to excess, none at all at the night meal. He is to avoid draughts and yet have plenty of air. He must never be chilled not for so much as a minute or two. He is not to take cold baths at all, and, when bathing, is to dry one limb, or part, before washing another. He is to avoid stuffy rooms. He is not to sit, as I saw one of my pa- tients, three months before death, from uremia, in a stuffy office, in his shirt sleeves, smoking strong cigars, while working with his head, when perfectly well able to retire from business and bask in the sunshine of lower California or Egypt. In general, the treatment is what any sensible person ought to be willing to adopt, but how many seem to think it funny and original to SELECTIONS. 23 violate the physician's directions 2 And how many take better care of their money than of themselves 2 Late hours and all dissipation are strictly tabooed, but harmless recreation is of great value from a psychical standpoint. DIFFERENTIAL DIAGNOSIS BETWEEN ULCER AND CANCER OF THE STOMACH.—Kollman (Berlin A /zn. Woch.-C/mzzers. Med. Magazine,) says in the great majority of cases the diag- nosis between ulcer and cancer of the stomach is easily made, but that in not rare cases it may be difficult. In some cases the course of ulcer of the stomach is without striking symptoms, and the disease is perhaps first discovered at the autopsy, or makes its presence known by sudden profuse hematemesis, or by a peritonitis. Cancer of the stomach may also exceptionally exist with- out peculiar characteristic symptoms, the only symptoms being a steadily progressing marasmus and profound cachexia, with- out recognizable cause. Usually, however, pronounced digestive disturbances, pain in the region of the stomach, vomiting, with or without admixture of blood, point with certainty to serious disease of the stomach ; but whether it is ulcer or cancer must be determined by other considerations. The points to be considered in the differential diagnosis of the two diseases are: The age of the patient, the character of pain, the character of bleeding, the degree of acidity of the gas- tric juice, the duration of the disease, the condition of the nutrition of the patient, and the presence or absence in the gas- tric region of a palpable tumor. As regards age, gastric ulcer is most frequent between the ages of fifteen and twenty years; but it is not rare in old per- sons. Cancer of the stomach is most frequent between the fortieth and sixtieth years of life, eighty-two of Kollmar's one laundred and eighteen cases occurring during this period. Koll- mar’s statistics of one hundred and eighteen cases of cancer seen in the last twenty years at the medical clinic at Tubingen, give an average age of fifty years. Localized pains, “wound pain,” are characteristic of gastric ulcer, but they are not present in all cases, and are found in gastric cancer in the stage of ulceration. Diffuse pains, dys- peptic discomfort, and cardialgia, are common to both diseases. The pain in gastric cancer is usually less intense than that in gastric ulcer. & 24 SELECTIONS. Hematemesis varies greatly in character and quantity in both, but generally profuse hemorrhages are more frequent in ulcer. Absence of hydrochloric acid from the gastric juice is not an absolutely certain sign of the presence of cancer. A nega- tive reaction is obtained in some cases of amyloid degeneration of the gastric mucous membrane, in cancer of the duodenum and esophagus, and in poisoning with acids; and the reaction is frequently negative in gastric catarrh, in atrophy of the gas- tric mucous membrane, and in persistent fever. A temporary absence is not rare in gastric catarrh and dilatation of the stomach. In the latter diseases the reaction may be obtained by repeatedly washing out the stomach ; Kollmar reports a case of this kind. A decidedly positive reaction speaks with consid- erable but not absolute certainty against the diagnosis of gastric cancer, while a negative reaction, because it occurs in other dis- eases of the stomach, should at least not be regarded as charac- teristic of cancer. The duration of the disease is of great importance in the diagnosis. Gastric ulcer runs a very chronic course, frequently lasting years; it may get well and subsequently recur. The course of gastric cancer is different, as it is very exceptional for it to last longer than two years, and usually death occurs much sooner. A preceding history of stomach trouble lasting for years, getting well for a time and then relapsing, is against the diagnosis of cancer even in old persons. Cancer sometimes, but very rarely, develops in the scar of an old ulcer. Kollmar has been able to find only fourteen cases of this kind reported in the literature upon the subject. Details of cases by Dittrich, Meyer, Lebert, Heitler, Platow, Rosenheim, and Kulcke, are given. It is not reasonable, there- fore, to pay too much attention to these exceptional cases in the diagnosis. Both ulcer and cancer may both be present in one patient. An important diagnostic point is the condition of the pa- tient’s nutrition. Great and early emaciation and cachexia. occur in the great majority of cases of gastric cancer, whereas in ulcer the nutrition is often relatively good. But when the ulcer has persisted a long time, the stomach has become dilated, and frequent vomiting and hemorrhages occur, the picture of the diseass is very much like that of cancer. A sign, surpassing all others in diagnostic importance, is a palpable tumor in the stomach region, which is almost always present in cases of cancer. It may be simulated by scar tissue SELECTIONS. 25 about an ulcer, by a saculated peritoneal exudate, by an hyper- trophied pylorus, or by a tumor of a neighboring organ. In such cases watching for the growth of the tumor leads to a cor- rect decision, though in some cases increasing atrophy of the abdominal walls, by making the tumor more readily palpable, has made it appear to grow larger. Reinhard has collected six- teen cases of simple ulcer of the stomach with tumors. In six cases the tumor was caused by an hypertrophied pylorus from cicatricial stenosis; in six it was the result of adhesions be- tween the stomach and other organs, caused by the ulcer, and in part also by encroachment of the ulcer itself upon these organs; in three cases there were foreign bodies on the ulcer; and in one case an encapsulated abscess. All the sixteen pa- tients were of an age at which cancers are common ; thirteen were women and three men. A tumor of the head of the pan- creas may lead to error. In such cases as Reinhard's, the duration of the disease is a great aid in the diagnosis.—/Özd. SOME ExPERIMENTAL AND CLINICAL OBSERVATIONS UPON THE THERAPEUTICAL VALUE OF SALICYL-BROMANILID.—(C. S. Bradfute, M. D., Demonstrator of Therapeuties, Jeff. Med. Coll., Phil.) Among the new remedies lately introduced from Germany is one from Radlauer’s laboratory, a synthetical compound, to which he has given the name “antinervin,” or, with a view of indicating its chemical composition, “salicylbromanilid.” The former is its proprietary title. It is a combination of bromace- tanilid and salicylanilid, and is claimed to possess the virtues of anti-fibrin, bromine, and salicylic acid, without their unpleasant effects, and is, consequently, an antipyretic, an antineuralgic, and an antinervine. It is a white, crystalline powder, having a rather pleasant, slightly acid taste, feebly soluble in cold water, but freely in hot water, alcohol and ether. The dose is from three to ten grains and is best given in the form of compressed tablets or in simple powders. J. A glance at the physiological action of the three agents comprising salicyibromanilid, shows that they are essen- tially circulatory depressants. Salicylic acid acts directly on the heart muscle, lessening its electrocontractility, and, when administered in toxic doses, causing the organ to stop in dias- tole. After a preliminary period of stimulation, it depres- ses the vaso-motor centers. Antifebrin acts very similarly, though its effect upon the heart and vessels is more powerfu producing a rapid fall in the blood-pressure and a weak, irregu- 26 SELECTIONS. 1ar heart, Bromine, in addition to its impression upon the heart and vaso-motor nervous system, lowers the vital activity of the centers in the medu//a oblongata and interferes with the function of conscious cerebration in a way not yet clearly under- stood. In a series of experiments conducted in the therapeutical laboratory in the Jefferson Medical College, the writer found antinervin a profound depressant of the circulation, and a prompt antipyretic. The behavior of the heart in the experiments indicated the poisonous effect of the drug directly upon the organ. Guided by these experiments the writer concluded that sal- bromalid was best applicable to those affections characterized by functional disturbances of the circulatory system brought about by reflex impressions or too active stimulation, and acute in- flammatory conditions occurring in robust subjects. In the cases that fell in his hands he found this conclusion correct, and noted favorable results, and in some instances obtained curative effects when other remedies had failed, or acted unsatisfactorily. The following are a few of the cases in which he employed the remedy, and while they are not conclusive in establishing the therapeutical position of the drug, they may be accepted as indications for its administration. gº Case—Angina pectoris. Male, aged 36; laborer. Has at- tacks about twice a month. Ten grains of salbromalid caused relief of symptoms in about twenty minutes, and three grains every two hours afterwards prevented a recurrence of the par- Oxysm. The results were, of course, not permanent, as the patient still has attacks as frequently as ever, but the drug never fails to check a paroxysm. The writer enjoins a caution here in administering this drug in angina pectoris. It should not be given in asthenic cases, and there must always be at Hand ammonia and strychnine to combat a failure in the circu- lation. A thirtieth of a grain of the latter hypodermatically, if the heart shows signs of ceasing work, is the porper dose. # Case—Brachial neuralgia of two weeks’ duration. Female, aged 32 ; typewriter. Pain paroxysmal. Three grains of sal- bromalid, administered every three hours, caused the pain to disappear within twelve hours. This dosage was continued four days, and afterwards a course of arsenic and diet effected a permanent cure. This patient was robust, but of a neurotic temperament, and the neuralgic pain was evidently spasmodic in character. SELECTIONS. 27 The following case presented the converse condition and it will be noticed that the drug was ineffective. Case—Brachial neuralgia of three years' duration, probably rheumatic. Man, aged 41 ; engineer. In fair physical health, with a rather stolid, morose disposition. Suffers more or less continuous dull pains in left axillary and brachial regions, with occasional exacerbations. Ten grain doses of salbromalid de- pressed the circulation but exercised no appreciable control over the pain. It is seen from what has been stated, that salbromalid is most effective as a pain reliever and antinervine in those func- tional disturbances of the circulatory system which occur at the onset of acute diseases, and in some other conditions, manifested by an overacting heart and contraction of the arterioles, which lessens the total area of blood space, and that it is most effective in robust subjects. Its power to reduce the temperature is un- doubted, but owing to its action upon the heart it should be given carefully in states of hyperpyrexia, especially the low fevers.—AW. A. Med. Mo. ANTIKAMNIA.—Dr. G. C. Eggers, Jr., of Florisant, Mo., writes as follows to the Antikamnia Chemical Company, of St. Louis: “I have been using antikamnia for the past ten months, and up to within the past month uniformly obtained results which justified in every particular the claims made for your pro- duct. In fact, its usefulness to me was so completely established that I had come to regard it as an absolute Sene gua non in my practice. Within the past month I have had some inexplicable failures in cases where antikamnia never before disappointed. Upon carefully reviewing the subject, I find that during the entire period I purchased direct from you I had no failures to record; latterly, however, I have purchased from convenient retailers. Within the last two or three months I have noticed in various medical journals several alleged formulae for antikam- nia, varying so materially that their very disagreement suc- cessfully establishes their falsity. I am led to believe that some druggists are supplying a compound made according to One or the other of these formulae, and dispensing it as antikamnia. I wish you would look into this. When I prescribe antikamnia, I want antikamnia and nothing else.”—M. Y. Med. /our. SURGERY PROGRESS IN TRANSPLANTATION.—Dr. R. Haug, assistant at the Royal Surgical University-Policlinic of Munich, has pub- lished an “Experimental surgico-histological essay ” in which He demonstrates that the shell-membrane of a hen's egg is highly applicable to transplantation. On the strength of thorough ex- perimental researches he makes the following statements: The fresh shell-membrane of a hen's egg is perfectly capa- lole of organization and therefore eminently fit for transplanta- tion. It is only that side of the membrane which is turned towards the calcareous shell of the egg which can be used for the purpose of transplantation. It is not a mere agglutination that takes place in the case, though immigration of leucocytes from the neighboring tissues agglutination is gradually trans- formed into perfect assimilation. The intimate fusion of both tissues attains its climax in the appearance of an extensive vas- cularization. The latter causes the shell membrane to lose its specific properties and to be progressively transformed into con- junctive tissue. For this reason the membrane, as above stated, is eminently qualified to be used in all classes of granulating wounds, especially also for definite occlusion of tympanic canal. A successful transplantation of a dog's skin on an extensive wound caused by burning has been performed by Dr. Alexander Miles, in England. This case presents a twofold interest; first on account of the great frequency of such accidents, and then on account of the unusual therapeutic method made use of. The left leg of a 10 year old boy had been scalded up to the 1znee by accidental immersion in boiling hot, liquid cow food, and although he had succeeded in disengaging the leg immedi- ately, it was found that the cutis had been loosened from the middle of the patella down to the articulation of the foot, the foot itself having been protected by the leather shoe He was at first treated according to empirical methods and it was only after four weeks that a physician was called in. When the patient was admitted to the hospital, the whole lower part of the left leg was deprived of its cutis, with the exception of a small spot on the anterior side of the tibia, and the surface of ulcera- tion was in a large proportion covered with healthy granulations, only a few necrotic fragments having remained attached between 2S SELECTIONS. 29 them. The latter yielded soon to the application of boracic acid compresses and after their gradual expulsion a fortnight later the whole surface of ulceration presented a healthy field of granula- tion, without any vestige of cicatrization. The enormous ex- tent of the wound precluded all possibility of covering it with human skin and it was determined to use the skin of some ani- mal. Miles selected a young, smooth-skinned dog for the opera- tion. It was a week old and its color was black and white. After having killed it with chloroform, the whole ventral and crural portion of the skin was excised and a patch was formed consisting of the whole cutaneous tissue with the exception of the adipose layer. In the meantime the leg had been carefully cleaned and all blood had been removed from the granulations. The excised skin was divided into a number of strips, 4 inches long and 9% inch wide, and firmly pressed into the surface of ulceration, with smaller fragments of I square inch were used in filling up the gaps between the larger pieces. To a some- what larger spot on the inside of the knee a piece of smooth skin from the tail of the animal was applied. Then, the whole was covered with a protective bandage, over which gauze imbibed with diluted boracic acid was added, and humidity was further maintained by a layer of gum tissue, over which finally a thick layer of sublimate-wadding and a firm bandage were applied. On the third day the bandage was renewed for the first time, and with the exception of a small fragment which was ulcerating and was removed, all other pieces were found to be firmly attached and the cicatrization process beginning as well at the edge of the large ulceration as in the center. The healing process progressed rapidly, although some particles of the large strips were ulcerating; all the smaller fragments were well attached. After 3 weeks the spots remain- ing bare were filled up with human skin (taken from a boy) and all were cicatrized in a short time. Six weeks after beginning of the treatment the ulceration was completely healed, but the patient was kept in bed for another fortnight and then he was allowed gradually to set the extremity in motion. When the boy was seen again, 7 months later, there was absolutely no contraction to be noticed in the cicatrice with the only exception of a very slight contraction where the caudal skin had been implanted. The color of the whole skin was uniform and very similar to the normal color, nor was there any hair or secretion to be seen ; the sense of taction was not weaker than in the right leg and the temperature was the same. 3O SELECTIONS. In a case as the one related success depends principally on three elements: I. The general condition of the patient; 2. The character of the process of ulceration ; 3. The means employed for the purpose of accelerating the healing. In the case above stated the only favorable point in the general condition of the patient was his age. His general condition was very low : the favorable result was mainly due to the method of treatment. Although it could not be said that just a dog's skin is better approprial for transplantation than the skin of other animals, it presents at least the advantage of being always on hand and of furnishing sufficient material for most cases. A most important element is the age of the dog. During the first days after birth the animal grows very rapidly and by transplanting a large por- tion of young tissue, endowed with an energetic growing force it becomes possible to cover rapidly the whole surface of ulceration, this preventing contractions which always makes their appear- ance after extensive burning, if they heal without artificial inter- vention.—Deutsche Medizznal Zeitung.—Med, and Surg. A'eporter. THE TREATMENT OF HYPERTROPHIED TONSILS BY MEANS OF IGNIPUNCTURE, is highly recommended by I. Cullen, M. D., of Cincinnati, consulting laryngologist to Cincinnati Free Hos- pital for Women.—Cocaine is first applied to the tonsil, a solu- tion of from 4 to IO per cent. being used, The electrode should be inserted to the depth of the lacunae or follicle of the tonsil, and two or three punctures in close proximity should be made at one sitting, to be repeated in from three to six days, as the condition of the gland will warrant. The soft form of hypertrophied tonsils will yield the best results from this method of treatment. The degree of heat used is that of a moderate red, the knife being allowed neither to cool to a black heat before its re- moval from tissue, as pain and hemorrhage will result, nor to attain anything like a white heat, as in that case the pain will be more severe and the danger of injuring surrounding tissue greater. Lennox Browne recommends that the knife be used either at black heat or a dull red, and considers anything ap- proaching bright red or white heat as positively dangerous and to be avoided under all circumstances. The main indications for reduction of tonsils by galvano- cautery might be summarized as follows: I. When tonsils have ceased to perform their function by reason of interstitial thickening and occlusion of the lacunae. SELECTIONs. 3I II. That when a tonsil at short intervals becomes inflamed and gives rise to peritonsillar abscess. III. Where the tonsil is so situated that it is a matter of great difficulty as well as danger to use the tonsillotome, and from extensive adhesion of the pillars, likely to cause severe Hemorrhage by being cut. e IV. In all cases in which alarming hemorrhage is feared. V. When patients will not consent to the use of the knife and yet the demand for the removal of the gland is imperative. CHLORALAMID IN SURGERY.—Emory Lanphear, M. D., of Kansas City, in a Clinical Lecture, recommends that chlorala- mid be given in any case in which, after an operation it is neces- sary to give the patient something to quiet the nervous system and to produce sleep. Morphine is unjustifiable unless there be some indication for the anodyne effect of the opiate; this is markedly true in abdominal surgery; but in any case the mor- phine is objectionable because it is apt to produce vomiting, is certain to seriously interfere with the process of digestion, is sure to induce constipation, and nearly always to give rise to Headache, malaise, etc. Chloral depresses the heart to a dan- gerous degree, and therefore cannot be used in these cases. Bromides, with hyoscyamus, will sometimes answer the purpose admirably, but most stomachs rebel against this combination, so that it is hardly safe to try it. Chloralamid prepared acts very much like chloral and sul- phonal, but does not depress the heart like the former, and is much superior to the latter in that it is soluble, exerts no bad influence upon digestion, possesses no diuretic action, never causes pruritus, vertigo, diarrhea, or other bad spnmptoms which sometimes follow the administration of sulphonal—in fact, ex- perience is demonstrating the accuracy of REICHMANN’s obser- vation : from chloralamid no ill effects in the circulation or in the feelings of patients are to be noted; and besides, the cost is much less than that of sulphonal. T. LAUDER BRUNTON, in a recent report on the Relative Utility of Different Hypnotics, Highly commends it, and states that with reference to certainty of action and the question of tolerance chloralamid surpasses. It exerts its influence upon both the brain and spinal cord, producing sleep and reducing the motor excitement; it may be regarded as a pure hypnotic without anodyne properties, though some late reports would indicate that it has to some degree the power for partial abolition of pain. It is, then, the ideal seda- 32 SELECTIONS. tive, giving prompt and satisfactory action, reliable results and absolute freedom from evil side or after effect. Its dose is from fifteen to sixty grains. The proper method of exhibition is to give fifteen to thirty grains (according to the condition of the subject), repeating the dose in an hour if the first have not produced sleep; usually from ten to thirty grains give five to eight hours’ refreshing slumber. The best method of giving it is to dissolve the required amount in about a tea- spoonful of whiskey or brandy, or in a small glass of wine if the patient prefer. It may also be given in anything contain- ing alcohol in considerable quantities, as tincture cardamon compound, tincture of hyoscyamus, etc. If for any reason it cannot be given in this manner it may be taken in powder form, and wash down with cold water or cold tea. The direction of W. HALE WHITE, of London, is a good one; viz., tell the pa- tient to dissolve the powder in brandy, add water to his liking, and drink it shortly before going to bed; this combination with spirits is particularly good in our surgical cases where whiskey is usually indicated, at least in most major operations. If in any cases it be better to have the medicine in liquid form, this combination may be prescribed: B. Chloralamid. . . . . . . . . . . . . . . . . . . . . . . . 3 iſ Spts. frumenti. . . . . . . . . . . . . . . . . . . . fl. 3 i Misce bene ut ft. solut. et adde: Syrupum rubi idei. . . . . . . . . . . . . . . fl. 3 i Misce. Sig.: Dose, one tablespoonful, to be repeated in one hour if sleep is not produced. This makes a decidedly pleasant mixture of slightly acid taste and fruity aroma and flavor. THE USE AND ABUSE OF THE SURGEON's PROBE.—(Arch Dixon, M. D. in Am. Pract, aud Mews.)—There can be no ques- tion but that the probe is one of the most useful and most valu- able instruments in our armamentarium, but it is also one of the most dangerous. Employed almost daily and hourly by surgeons in exten- sive practice, it serves a good purpose in the exploration of fistu- lous tracks and sinuses, in detecting the presence of foreign bodies, dead bone, etc. It is also undoubtedly useful at times in determining the course and location of pistol ball. But it is to the indiscriminate, often times uncalled for and I might almost say criminal use of the probe in this connection that I wish to call attention. There seems to be a prevailing idea among the laity, and particularly is the idea engrafted in the minds of newspaper reporters, that in gunshot wounds of any character SELECTIONS. 33 the first duty of the surgeon is to probe for the ball. I am sorry to say that this idea is also deeply rooted in the minds of many of the medical profession. Scarcely a daily paper is picked up in which does not occur the publication of one or more cases of gunshot wounds in which the statement is made that the docter has probed for the ball, or that he is going to probe for the ball. Most of you re- member the celebrated case of President Garfield. How he was shot on the morning of July 2, 1881, at the Pennsyl- vania depot, how Dr. Bliss, without waiting for consultation, immediately upon his arrival proceeded to probe the wound with a view, as he expressed it, of ascertaining the course of the ball and the organs involved. It does not seem that Dr. Bliss ob- served any antiseptic precautions in the case, but without surgi- cal consultation he takes from his pocket case a Nelaton probe, which probably had not been sterilized, and passes it into the wound, “which was on the right side, four inches from the me- dian line of the spine and on a line with the eleventh rib, into what seemed to be a cavity.” That he did not ascertain the course of the ball and the organs involved is a matter of medical history; and it is further a matter of history that the ball was encysted and therefore Harmless, that pus sinuses formed and that President Garfield died of pyemia, in all probability due to the introduction of sep- tic matter on Dr. Bliss’ probe. Which of you can say that, had the wound in President Garfield's side been hermetically sealed with an antiseptic dress- ing without further interference, he might not to-day be a living man 2 I shall not occupy the time of the society by going into the details of this remarkable case, nor indeed into those of any other case, but shall content myself by mentioning a few instances which have fallen under my personal observation bear- ing upon this most important subject. Ben A., a negro man about twenty-five years of age, was shot by a police officer in attempt to escape arrest. The ball penetrated the left side, about two inches below and to the left of the scapula. The negro succeeded in making his escape, and was concealed for two days in a cabin on the river bank. He was here visited by a physician who examined the wound, which was completely sealed by a dry blood clot. His condition was fairly good, temperature almost normal, and appetite unim- paired. The blood clot was removed, and a probe taken from the pocket-case of the doctor, which had probably a short 34 SELECTIONS. time previously been inserted into a suppurating bubo, with- drawn and wiped off, was passed through the chest walls into the pleural cavity to discover the course and location of the ball. Result, metastatic septicemia and death. A man engaged in trying to quell an election row was shot in the abdomen an inch and a half below and to the left of the umbilicus. The ball did not enter the abdominal cavity, but the probe of the docter did. Result, fulminent peritonitis and death. The ball had passed through and underneath the abdominal mucles and was removed from the back after death. A man, either accidentally or with suicidal intent shot him- self in the forehead about an inch above the orbital process on the right side. Two physicians were called in to see him, and proceeded at once to probe the wound to ascertain the course and 1ocation of the ball (a No. 32). The patient who was conscious before the probing was done, immediately became comatose and promptly died. The physicians gravely announced that the probing revealed the fact that the ball had lodged in the base of the brain. A young man was leaning on a shotgun with the muzzle in the axilla when it was accidentally discharged. The load of squirrel shot passed, as a slug would have done, upward and backward, making its exit through the scapula, cutting in its course the long thoracic and other nutrient or circumflex branches of the sub-clavian and axillary arteries. Natural hemo- stasis had taken place, while the young man walked with assist- ance to a house half a mile away. Notwithstanding the fact that no hemorrhage was going on, and it was plain the charge had passed straight through, a physician passed a probe entirely through the wound and then broke up the clots with his finger, setting up a dangerous and almost uncontrollable hemorrhage. Septic trouble of course followed the busy probe and finger, but was fortunately controlled and recovery ensued. A young man became engaged in a quarrel at a dance and was shot three places, through the right arm, into the chest, and through the left thigh. I was telephoned to go and see him. On my arrival I found a young physician already on the ground and busily engaged in passing a probe into the wound in the thigh, which was slightly to the right of the lower angle of Scarpa's triangle. He informed me that the ball had pene- trated the abdominal cavity, having passed upward and under- neath Poupart's ligament. An examination revealed the fact SELECTIONs. 35 that the ball had gone entirely through the thigh, making its exit at a point almost exactly opposite to the point of entrance. The second ball had passed through the biceps muscle of the right arm and had penetrated the chest about an inch in front of the axillary line. These wounds escaped the probe owing to my timely arrival. I will do the young man the justice to say that he had sterilized his probe before using it. The chest wound was dressed antiseptically and the patient made a good recov- ery. Many other such cases eould be cited, but the only object of this paper is to protest against the indiscriminate and ridicu- lous habit of thrusting a probe into every gunshot wound which comes under observation. This especially applies to gunshot wounds of the chest, which in almost every instance should be cleansed with an antiseptic solution, dressed and sealed. with an antiseptic dressing, and severely let alone. ALLINGHAM's OINTMENT FOR HEMORRHOIDs: B.—Bismuth submit . . . . . . . . . . . . . . . . . . . . . . . . . 3.J. Hydrarg. Subchlorid . . . . . . . . . . . . . . . . . . . . § e Morphine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . grs. iij. Glycerini. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3ij. Vaselini . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3j. M.--Sig. Use in pile-pipe. NEPHRITIC Col.Ic.—Dr. R. O. Owen, of Lynchburg, Va., (Va. Med. Mo.) claims to have found that the passage of a catheter through the uretha, in cases of nephritic colic, causes “marked and immediate relief.” in a large majority of cases. He thinks the catheter, by reflect action, causes a violent con- traction, followed by great relaxation of the muscular coat of the ureter, and at the same time increased secretion of urine, by which the stone is rapidly forced through the now relaxed passage. OBSTETRICS. THINGS TO UNLEARN ABOUT MIDWIFERY.—E. B. Ward, M. D., Laingsburg, Mich., in Am. Zancet. - - First.—That child-bearing is anything but the natural, Health producing function of woman. - ºSecond—That interference of any kind in natural labor, is admissible. g 36 SELECTIONS. Having determined that the presentation is normal, the less the physician renders himself obnoxious to the patient by fre- quent examinations, or even by his presence in the sick room, the better. He is not her deliverer; she is competent to deliver herself, and with less liability to a ruptured perineum than if the various means devised to prevent such a catastrophy are employed. Let her quietly alone, and turn attention to induc- ing the attendants to observe quiet and cheerful decorum. There are many more children born without the aid of a doctor than with, and the world's population is increasing. Third—That the youngling should be fed immediately after being “dressed.” Some old mothers insist on putting a teaspoonful of cold water into the infant's mouth, and then as the buccal muscles normally contract and relax, they decide the “baby is hungry.” Now if they are prevented from giving the child anything after normal labor, except the maternal fount, a long step will have been made toward avoiding many of the ailments appertaining to early infancy. The breasts probably contain no milk proper, but they do hold what Nature provides for first introduction to the child's stomach. Further, if the milk does not appear for twenty-four or forty-eight hours, the babe can wait instead of having its alimentary canal cramped by the ingestion of unsuit- able and unnatural food. It will not starve, or if it does, the physician is not to blame, for he did not make mankind. If he had, as he grew in years and information, he would conclude the opossum's method of attaching its young to the nipple, an improvement on the way with woman. Fourth.—That traction is never to be made on the cord. The way to deliver a placenta is to hold the cord taut in the right hand (not pulling on it), while the left digits gently 1.nead the body of the womb until contraction is produced; then with a little assistance by the cord, delivery is attained. Aºifth-That it is any part of the obstetrician's duty by word, look, or insinuation, if any deviation from the normal is diagnosed, to divulge it to the patient or attendants, or even to the relatives, until the time comes for trouble and action to begin. He is not going to ride on a tidal wave into the affections of the family by prolonging their mental misery. Better in fact say nothing, if possible, until the trouble is remedied, and let explanations follow. Silence and circumspection are golden. Sixth-That absolute quiet in the recumbent position is imperative. SELECTIONs. 37 The Indian squaw will stop by the wayside, while on a march, and after completing the duties of maternity, pick up the result and follow along the trail. If the patient has ordinary discretion, let her use it unlimitedly in this respect. I am satis- fied that sub-involution and a variety of other distressing and troublesome difficulties, sometimes come from keeping the idea impressed on the patient's mind that now she is in a precarious condition, and her mind is concentrated on that thought, whereas, the fact is, she is in normal health. Mental impres- sions are powerful, especially in females, and more especially during maternity, and anything that can be said to throw off the brooding horror with which dress-deformed, civilized women contemplate motherhood, is a God-send. g Finally.—That it is the correct thing to always employ antiseptics in midwifery. s - Barring the possible fact that in hospitals, by inducing extraordinary cleanliness, antisepsis may be and probably is of benefit, I am as well satisfied that in ordinary practice, and in the hands of the new-made graduate of to-day, it is an instru- ment of death. Death/—understand I am as well convinced as of my own existence, that I have seen cases of pelvic peri- tonitis, cellulitis, and ultimate death, resulting solely from post partum vaginal injections of the bi-chloride. I mean just what I say ; and I honestly believe if the facts were known, the actual percentage of deaths due to confinement, in country practice, or wherever the plastic and unreasoning novice plies his profession and attempts to follow the teaching of men who gather their information from spontaneous speculation, is steadily on the increase. - Now, since the learned H. O. Martin has found, up to last accounts, twenty-seven different microbes in the human vagina, and is undoubtedly searching for more, I submit in all candor, if it is not about time to “let up ’’ on the idea of attempting to anticepticize a wound received per zzas maturales. It is prepos- terous ! It is absurd ; and I believe absolutely dangerous, as now practiced. Simple, careful cleanliness, and the following out of Nature's dictates, will lead any one who thinks for himself into the right way. In conclusion I beg leave to indicate that the deductions Herein advanced are not drawn altogether from the vagaries of a puerile imagination, nor yet from the solid rock of unreasoning intolerance, but are the result of upwards of a third of a centur in active practice, and in close careful observation. t 38 SELECTIONS. [Dr. Ward should have added an eighth thing to unlearn, viz.: That chloroform given in labor is dangerous. It is not dangerous, and should be given in the great majority of confine- ments, especially in primiparae.—Ed. Col. Med. Jour.] A CASE OF STERILITY AND DySMENORRHEA.—The dissect- ing-room was once the chief source of material on which discriminating observations upon visceral pathology could be made. An autopsy might afford an opportunity to witness ovarian conditions of a morbid character, yet the holder of the post mortem section rarely looked for anything beyond the pro- nounced cause of death. The dead-house of a large hospital furnishes valuable material for making pathological observations; yet autopsical dissections are too often little better than careless mutilations. The abdominotomist, on the other hand, has multiple opportunities to inspect the ovaries, and especially to examine them carefully when they are in pathological states. I have lately turned attention to the condition of the ovaries in sterile women, whether the disease calling for laparotomy have been of the uterine appendages or not. The first case that commanded my attention was that of Miss , who had been treated for dysmenorrhea till the woman’s patience was exhausted. By the advice of a council of physicians I had dilated the uterine cervix, the professional opinion being that stenosis, and not a neurosis, was the cause of the painful menstruations. I did the work thoroughly, even risking laceration of the uterine cervix ; and to the surprise of us all, the same old complaint was continued. Paroxysms of pain preceded and extended well up through each menstrual epoch. At length the young woman married; and we hoped and expected menstrual troubles would end in pregnancy. As she went to reside at a distance from her old home I lost sight of her; but after two years she returned on a visit, and again be- came a patient of her old doctor; and he called me in consulta- tion. She was rather thin of flesh, and anemic, as well as sterile. To get at the seat of the disease the operation of oophorectomy was decided upon, there being some evidence of salpingian enlargement on the left side. In fact the diagnosis was salpin- gitis, with probable pyo-salpynx. To my surprise, after opening the abdomen, I found no special disorder of the salpynges, and not a striking disorganization of the ovaries. At first I was about to close the abdomen, making the best retreat possible; but an indurated, somewhat enlarged condition of the ovaries led to a closer inspection of those organs. The outer envelope— SELECTIONS. 39 peritoneum and tunica albuginea—was dense, white, and smooth. There were few ovulatory cicatrices to be seen ; there was not a corpus luteum—true or false—to be found, except a few im- perfectly developed scars. The woman had menstruated regu- larly, but had not fully ovulated. For several years—four or five—no mature ovum had burst through the peritoneal envelope, the . woman was necessarily sterile. Ova had undoubtedly started from the interior recesses of the ovarian stroma, and pressed hard upon the surrounding wall, but could find no escape from the tough environment. Here, then, was a rational cause for the menstrual pains. There was no neurosis—no stenosis, as ordinarily understood, but a rubber-like impermea- bility of the ovarian husk. The evoluting egg could not burst through its enveloping case. Each menstrual mºsus developed thickening and toughness of the peritoneo-albuginean wrapper, till at length no ovulation occured; and the congestion resulted in dysmemorrhea. Here, then, was a new theory in regard to not uncommon pathological states. Sterility and dysmenorrha may come from indurated states of the ovaries, periodical inflam- mations and exudations being primary and secondary causes. It is possible there had been gonorrhea as specific source of irritation, but I have no reason to think so. Every surround- ing was contrary to such a theory. Possibly I am slow to think evil; but every indication of propriety was present in the patient. Tait's operation or oophorectomy was executed; and a speedy recovery followed. The menstruations were resumed after one interruption, and no pain attended them. The woman became plump and high-colored, so that she might be taken for the “picture of health.” She is sterile, of course; and so she was before the operation. She was cured of the dysmenorrhea— the objective incentive at the start. If the therapeutist can cure such apathological state without an operation, he has a right to censure the surgical procedure; but until he can he had better hold his peace. After getting new light on the pathological condition of dysmenorrhea in a certain per cent. of cases he may medicate understandingly. After a disease is comprehended it may be rationally assailed.—Prof. Howe, in Eclec. Med. /our. RELIEF OF PELVIC AND ABDOMINAL PAIN BY HOT COLON DOUCHES.—The writer has resorted to this procedure for various painful affections, such as renal colic, ovarian neuralgia, and inflammation of the broad ligament, severe pelvic pain, dys- menorrhea, and one case of what appeared to be hepatic colic. 4O SELECTIONs. The proper method of using the remedy is as follows: The patient is to lie on the left side, with the left arm under the back, legs partly drawn up, hips on a pillow or folded blanket, the chest low; in short, in the Sims' position. This position allows the patient to administer the injection by the use of the right hand. It is always better, however, to have an attendant administer the injection if possible. If an attendant gives it, the patient might better lie directly on the face, with a folded blanket or pillow under the thighs. The water is to be of a temperature not more than 112° F. nor less than IO6°F. From a pint to two quarts of the hot liquid should be slowly injected, and retained for a few minutes. If there are feces in the rectum, as is usually the case, the injection and the feces will be quickly ejected. Then at once have the patient lie down, and repeat the hot injection, using a larger quantity the second time. This will be retained longer, and will almost certainly relieve the pain. When this is expelled the patient should lie down again, and about a pint of hot water should be injected ; this will be retained if the patient lies quiet, and it will be discharged from the system through the kidneys. If the patient is at all weak, it is wise to administer a stimulant before giving the injections. W. E. Forest, M. D., in Med A’ecord. AMPUTATION OF BREAST.—Dr. Terrillon in a report of one hundred removals of the breast, arrives at the following con- clusions : I. The danger of the operation is about m2/. 2. A return of the disease seems to be the rule when the axillary glands have become implicated. 3. This relapse is most common during the first years after the operation ; this period rarely exceeds six or seven years. 4. All malignant tumors and the mixed tumors of the breast should be freely removed ; that is, the total ablation of the mammary gland is necessary. The same is true of the en- larged axillary glands when they exist. 5. A return of the disease may be operated upon one or several times, especially when it is possible to effect an immedi- ate reunion of the skin. This operation relieves the patient; removes for a certain time the ulcerations which sometime secrete a large quantity of liquid ; finally successive operations seem to exert a happy in- fluence on the progress of the malady.—Bulletºn de Thera- feutzgue. SIFIERIENTG-_ * . . That Springtime is the rejuvenating, season is a fact to which all Nature bears testimony, and that it should be such for the human family is a proposition in the form of a truism. The only question which can arise in this connection is involved in the consideration of the Means to the End. The rejuvenation of vegetable life takes place through the renewed activity of a true form of digestion, and it has been well said that the most Rational System of Medicine For animal life is that which aims at Medication through Alimentation. Hence, various forms of partly or wholly digested foods, etc., have come into vogue, which, however, neither in flavor or appearance are Calculated to Provoke an Appetite. The practitioner who has used Forbes’ Diastase Finds that his patients gain in weight, and that the general functions of the system rapidly assume a perfectly normal condition as the result of its influence upon Palatable Every-Day Wictuals, Absolutely compelling complete digestion, at the time and under the circumstances, Peculiar to Natural Processes, As evidenced by the condition of the excrements. Why P Simply because the FORBES’ DIASTASE is a Certain and Uniform Digestive Agent, Exercising upon ingested food the same triple influence which forms the basis of plant nourishment. Qº The Forbes’ Diastase IS CERTAIN because it exactly replaces those elements which are weak or deficient in The Natural Digestive Tract, IS UNIFORM because it is made so by controlling arrays which determine absolute value. The Standard. One grain of For BES’ DIASTASE will convert a jelly containing 60 grains Bermuda Arrowroot in two fluid ounces of water at a temperature of 140° to 150° F., into a thin watery solution of assimilable carbo-hydrates in 3 to 4 minutes. In 30 minutes, at the same tempera- ture, it will have formed between 4 and 4.25 grains of sugar, or four times its weight. Sample Bottle sent, charges paid, to any physician addressing THE FORBES DIASTASE Co. CINCIN NATI, OHIO. 12 JuliãIII is put up in this style only. "IOHANN HOFF'Sº MALIEXTRACT, MALT ExTRACT, imported by Eisner." Imported by “EISNER,” When ordering the Genuine Article. The Genuine has the signature of “Johann Hoff" and “Moritz Eisner” on the neck of every bottle. Sº Illinurſillāk leirinaxºº. Hºº ||º \º & The Genuine Imported Huff's MaſtExtraſt This has been the first Malt Ex- tract introduced to the Medical Pro- fession (1847). No preparation of Malt has been so long and exten- sively employed as a Medical FOOd Nutrient and Tonic. *- t § W | | -—---- The following is an abstract from the work on the Pul. monary Diseases published by Prof. PROSPER DE PIETRA SANTA, at Z2aris : **isiºn ºthillillº VUHANN HOFF l §# (tºl ºiſiſ. º º | l *ABRICKUNDERALERE INBE; ! MEUEWiittºs.send timuluimºan micrºss- “As a large number of patients lack the neces- sary power to digest solid food, and would through the use of stimulants be merely excited and weak- ened, therefore I regard it of immense value to the practitioner to bring to his aid a nutritious tonic and remedy like the Johann Hoff's Malt Extract, which will act not only as a tonic, but as a nutrient as well, and which is less exciting than T. tº wine as a stimulant." º mº w “I have, during the past eighteen months, made º a number of examinations of the principal forms myself that the Johann Hoff's Malt Extract, im- º ported by Eisner & Mendelson Co., is a genuine Hºl :* # Malt Extract, FREE FROM Salicylic Acid or other objectionable substances.” |ºil HENRY LEFFMANN, M.D., Phila. CAUTION: A preparation bottled in New York is being sold as “Hoff's" Malt Extract. To obtain the genuine, original article, please specify “JOHANN HOFF'S which will prevent substitution. EISNER & MENDELSON CO., Sole Agents for the U.S., 6 Barclay Street, New York. } EDITORIAL DEPARTMENT. J. F. BALDWIN, M. D., Columbus, - q- EDITOR. J. E. BROWN, M. D., Columbus, tº -: * * * - ASSOCIATE EDITOR. Communications, reports, etc., are solicited from all quarters. Authors desiring reprints, will receive fifty, fee of charge, 27°ozyżded the request for the same accom- panies the article. Subscribers changing their location, are requested to notify the Publishers promptly, that there may be no delay in receipt of the journal, stating both the new and the former post-office address. We have no authorized Collectors, except such as carry properly made out bills, countersigned &y the Pzzó/7shers. THE COLUMBUS MEDICAL PUBLISHING CO., COLUMBUs, OHIo. ANNUAL MEETING OF THE OHIO STATE MEDICAL SOCIETY.— The annual meeting of the State Society, held at Sandusky on the 17th, 18th and 19th ult., was enjoyable and successful. The attendance was fair and the programme unusually full. The papers appeared to be fully up to the average. We shall present most of them to our readers in a condensed form during coming 1SS1162.S. An important amendment to the by-laws was adopted by which every member of a county or district society will become, by virtue of that membership, a member of the State Society, and on payment of his dues entitled to a copy of the transac- tions. Delegates only will be entitled to vote on matters of legislation, but by special amendment all present members of the Society were included in the same privilege. Papers will be limited to twenty minutes hereafter. A series of resolutions, offered by Dr. McCurdy, of Youngs- town, was adopted, deploring the prostitution of the State benevolent institutions to the demands of political partisanship and asking all good citizens to join in petitioning for the enact- ment of such legislation as will place them on a non-partisan basis, and require a civil service examination of all officers and employes before they are permitted to take position in them. Cincinnati was selected as the place of the next meeting, and May 4th was the date selected. The following is a full list of the officers chosen : President—G. A. Collamore, M.D., Toledo. 1st Vice President—X. C. Scott, M. D., Cleveland. 2nd Vice President—A. J. Garone, M. D., Sandusky. 3rd Vice President—A. R. Baker, M.D., Cleveland. 4th Vice President—F. D. Bain, M. D., Kenton. Secretary—T. V. Fitzpatrick, M. D., Cincinnati. 4 I 42 EDITORIAL. Asst. Secretary—August Rhu, M. D., Marion. Treasurer and Zzórarian—T. W. Jones, M.D., Columbus. Member of Committee on Finance—H. J. Herrick, M. D., Cleveland. Member of Committee on Zegislation—S. S. Thorne, M. D., Toledo. Member of Committee on Publicaſion—E. S. McKee, M.D., Cincinnati. Member of Committee on Admissions and Medical Societzes— A. F. House, M. D., Cleveland. The session closed with a trip to Put-in-Bay and return, which, with the entertainment at Cedar Point, was furnished by the local profession. A SUPREME COURT DECISION OF INTEREST TO PHYSI- cIANs.-It is not often that the Supreme Court of the United States is called to pass upon a question of special interest to medical men as distinguished from other patriotic citizens, but such a one was decided not long ago. The ruling was on the right of a railway company, when sued by a person who has sustaimed injuries, to have such person examined by its own surgeon. A woman sued the Union Pacific Railroad Company, in the Circuit Court of Indiana, on account of an injury of the spine, which she claimed had resulted from the fall upon her of an upper berth in a sleeping car. Three days before the trial, the company asked the court for an order requiring the woman to submit to an examination by the company’s physioian, the examination to be made with as little exposure of the person as possible, and in the presence of the physiaian of the injured woman. The court overruled this motion on the sole ground that it had not the legal right to enforce such an order. The case came before the Supreme Court on the correctness of this ruling, and the latter sustained the lower court, saying such an examination is an invasion of the sanctity of the person to a degree that the law does not recognize, and that it is incon- sistent with the common law. Justices Brewer and Brown dissented from this ruling. That opinion may be good law, but it is not good sense. Such law is contrary to good morals, as it directly encourages malingering and all similar rascality. Supreme Court Judges are usually great sticklers for precedents, but even precedents 1must give way ultimately to good sense. EDITORIAL. 43 THE YANKEE MEDICAL STUDENT.—Our English contem- porary, the Hospital Gazette, states that the Yankee medical student has not very much to be thankful for. First of all, the medical “ diploma mills '' turn out their thousands of ill-trained and indifferently educated youths to take part in the professional struggle for existence, and then no kind legislature has inter- fered for the purposes of restricting the practice of medicine to native graduates. His woes, therefore, are tangible, but now Mr. McKinley has got passed a tariff, in virtue of which the tax on microscopes has been raised sixty per cent, so that an instrument which costs ninety dollars in Germany will, whole- sale, cost one hundred and fifty dollars in the States. This will hardly have for effect to stimulate microscopical work, and the cost will, of course, increase parz passu with the minuteness of the object to be magnified, seeing that the higher the power the greater the initial cost, and, therefore, the more crushing the protective duty.—St. Louis M. and S. Jour. THE State Board of Health of Kentucky at its recent meet- ing held in Louisville, “resolved that the Secretary be instructed to place upon the list of medical colleges whose diplomas are to be certified and endorsed for registration under the laws of this State, only such colleges as shall, after the session of 1891–2, exact of matriculates and graduates a minimum of requirements not less than those required by the American Medical College Association.” FORDYCE BARKER, M.D., LL.D.—America has lost one of Her best and noblest physicians by the death of Dr. Fordyce Barker, on Saturday, May 30th, from apoplexy, after an illness of two days. He was born in Maine, in May, 1818 and was therefore seventy-three years of age. He studied in Edinburgh. and Paris for some time after graduating in his own country, and on his return commenced to practise in Norwich, Conn. In 1850 he went to New York, where he resided for the remain- der of his life. He was well-known as an obstetrician, and his book on “Puerperal Diseases” has been read by physicians in all parts of the world. OUR readers will notice the change in style of advertisement of the Maltine Company. Their use of the Maltese cross is ingenious and by no means inappropriate. It was under the banner of this cross that the Crusaders of the middle ages van- 44 EDITORIAL. quished the followers of the Cresent, and this cross was adopted by the Hospitallers of the Order of the Knights of St. John of Jerusalem, who were among the first founders of institutions established to ameliorate the physical ills of mankind. After their occupation of the Island of Malta, which they held for centuries against the assaults of the Infidel, this symbol came to be known as the “Maltese Cross,” and is emblematical of the success of merit, of practical benefit to mankind and of ability to resist attack. THE AMERICAN SOCIETY OF MICROSCOPISTs, now in the thirteenth year of its existence, will hold its fourteenth annual meeting in Washington, D. C., August IO, and continue in session five days. Its roll of active members contains about three hundred and fifty names, embracing very nearly every person in the United States who is at all promient as a microscopist. Any further information concerning the Society or the approaching meeting may be obtained on addresssing Dr. Frank L. James, President, Box 568, St. Louis, Mo. DR. J. E. ANDERSON, of Lake Sulter, Fla., under date of June 6, 1891, writes as follows concerning Lacto-Preparata: “I have prescribed Reed & Carnrick's Food for years, and I thought perfection had been reached, but their Lacto-Preparata has surely crowned their efforts with complete success. It can not be improved. I have been prescribing their preparations for years, and shall continue to do so as long as they keep up to the present standard. I have not been solicited to write this by any one, but when I find such preparations as Reed & Carnrick's, I feel it my duty to assist them in placing them before our ‘brother doctors. APPRECIATION.—7%e Canada Med. Æecord, in its June issue, gives credit to the COL. MED. Jour. for twelve of its articles. Dr. A. L. HUMMEL, of Philadelphia, and Mr. Chas. Roome Parmele, of New York, have entered into a copartnership, under the name of Hummel and Parmele, in the business of Medical Journal Advertising. - 13 The Best Antiseptic for Both Internal and External Use. LISTERINE Antiseptic, Prophylactic, Deodorant, Non-Toxic, Non-Irritant, Non-Escharotic, . Absolutely Safe, Agreeable, Scientific and Strictly Professional. FORMUL.A.—Listerine is the essential antiseptic constituent of Thyme, Eucalyptus, Baptisia, Gautheria and Mentha Arvensis, in combination. Each fluid drachm also contains two grains of refined and purified Benzo-boracic Acid. DOSE,--Internally: One teaspoonful three or more times a day (as indicated), either full strength or diluted, as necessary for varied conditions. LISTERINE is a well-proven antiseptic agent—an antizymotic—especially adapted to internal use, and to make and maintain surgical cleanliness—asepsis—in the treatment of all parts of the human body, whether by spray, irrigation, atomization, or simple local application, and therefore characterized by its particular adaptability to the field of PREVENTIVE MEDICINE — INDIVIDUAL PROPHYLAXIS. Physicians interested in LISTERINE will please send us their address, and receive by return mail our new and complete pamphlet of 36 quarto pages, embodying:— A TABULATED EXHIBIT of the action of LISTERINE upon inert laboratory compounds. FULL AND EXHAUSTIVE REPORTS and Clinical observations from all sources, confirming the utility of LISTERINE as a general antiseptic for both internal and external use, etc. Diseases of the Uric Acid Diathesis. Vowocº. KIDNEY ALTERATIVE–ANTI-LITHIC. FORMUL.A.—Each fluid drachm of “Lithiated Hydrangea.” represents thirty grains of fresh Hydrangea and three grains of chemically pure Benzo-Salicylate of Lithia. Prepared by our improved process of osmosis, it is invariably of definite and uniform therapeutic strength, and hence can be depended upon in clinical practice. DOSE.-One or two teaspoonfuls four times a day (preferably between meals). Urinary Calculus, Gout, Rheumatism, Bright's Disease, Diabetes, Cystitis, Haematuria, AJ' and Vesical Irritations generally. We have had prepared for the convenience of physicians DIETETIC NOTES (sample of which is here with shown), GOUT. suggesting the articles of food to be allowed or prohibited in - several of these diseases. DIETETIC NOTE, - A mixed diet should be adopted, the nitro- A neatly bound book of these DIETETIC NOTES, each genous and saccharine articles be- note perforated for the convenience of physicians in detaching ing used in limited amounts. and distributing to their patients, mailed gratis upon request, Allowed.—Cooked fruits without together with the latest compilation of case reports and clin- much sugar; tea and coffee in mod- ical observations, bearing upon the treatment of this class of eration. Alcoholic stimulants, if diseases, used at all, should be in the form of light wines, or spirits well diluted. - The free ingestion of pure water is Lambert Pharmacal Co. lº sº - O Azºoid.—Pastry; malt liquors and sweet wines are veritable poisions ST. LOUIS, MO. º these patients. -** 14 Doctor, Tablets and Triturates. No. 2. Size, 7%x3%x% inches. All vials in this case are fitted with screw caps. Write for Complete List, mentioning this Journal. This Will Interest You ! That you may become acquainted with the merits of our preparations, we will furnish you for $3.00, with a handsome, double Morocco Pocket. Case, containing 24 vials, filed with the following complete assortment of Price, $3.00. We would call especial attention to our Tablets Hypophos, Quinia Comp. cum Creasote, which are superior to syrups and solutions, owing to absence of sugar and free acid. II. K. MULFORD & CO. Tr, aconite, 1-2 minim. Tr. belladonna, 2 minim Nitro Glycerine Comp. (M. & Co’s.) Cascara com.(M. & Co.) Ammon. Mlur. comp. Calomel, 1-10 grain. Calomel, 2 grains. Calomel, ipecac & soda bicarb, No. 1. Dover’s Powder, 2% gr. Fever (Dr. T. G. Davis) Hydrarg. Iodine Virid, 1-4 gr. Iron, Arsenic and Stry- chnia. Hvpophos Quinia comp. Creasote. * Acetanilid, 2 grains. y Morphia Sulph., 1-6 gr. 7 Zinc Sulpho-carb., 1 gr. Acid Arsenious, 1-60 gr. Hismuth et Cerii Oxalat Kermes Mineral comp. Paregoric, 10 minim. Strychnia, 1-60 grain. Quinia Sulph., 1 grain. Corros. Sublimate, 1-40 grain. Factors of Compressed Goods and Pharmaceutical Preparations, JP HII L.A.I.D E LIP H II [A. * …; º, - . . . . . " - * * * * .." - . . . * *. * , , , SOLUBLE =A CIM&l Trilliſt. A Nitro-Glycerin Comp. I TRITURATES (Mulford & Co.'s) Nitro Glycerin, I-100 gr., Tr. Digitalis, 2 min., Tr. Strophanthus, 2 min., Tr. Belladonna, 34 min. USEFUL IN ALL Heart Troubles A SPECIFIC IN ANGINA H. K. MULFORD & CO. Manufacturing Pharmacists 21:32 CDarket Street (3) PHILAn ELI pHIR 5OO of these Sent on receipt of $1.00 Send for Complete List B () () K N 0 T I C E S. PRACTICAL TREATISE ON ELECTRICITY IN GYNECOLOGY. By Egbert H. Grandin, M. D., Chairman Section on Obstetrics and Gynecology, New York Academy of Medicine; Obstetric Surgeon, New York Maternity Hospital; Obstetrician, New York Infant Asylum, etc., and Josephus H. Gunning, M. D., Instructor in Electro-Therapeutics, New York Post-Graduate Medical School and Hospital; Gynecologist to Riverview Rest for Women; Electro-Gynecologist, North-Eastern Dispensary, etc. Illustrated. Octavo, 180 pages. Muslin, $2.OO. New York: William Wood & Company. The authors look upon electricity as only “a valuable adjunct to routine therapeutic methods,” in diseases peculiar to women. The first 54 pages are taken up with general consider- ations and descriptions of batteries, electrodes, etc. Galvanism is regarded as contra-indicated in any acute process; but sub- acute inflammations may be very cautiously so treated. Faradism administered through a wagºnal bipolar electrode is regarded as only second to opium in its power of alleviating pain associated with an acute inflammatory process. They present strong testimony in support of galvanism for destruction of life in ectopic gestation, as preferable to laparotomy in the early stages. In the section on electrolysis, Dr. Gunning reports a remarkable case of cure of cancer of the cervix—after eminent practitioners had awarded the patient only a short while to live. Galvano- cautery in the treatment of malignant growths is deemed worthy of further use. In obstetric uterine inertia, in the second stage, the faradic stimulus is sometimes very valuable. As electrical appliances are coming more and more into general professional use, such works as this will be in demand. INTERNATIONAL CLINICs. A Quarterly of Clinical Lectures on Medicine, Surgery, Gynecology, Pediatrics, Neurology, Dermatology, Laryngology, Ophthalmology and Otology. By Professors and Lecturers in the Leading Medical Colleges of the United States, Great Britian and Canada. Cloth, pp. 357; Price, $2.75. Philadelphia. J. B. Lippin- cott Co.—I89I. 45 46 BOOK NOTICES. Although, from the well known character of the pub- lishers, we expected that these announced Clinics would be very desirable volumes, we must confess that we are agreeably surprised at the general appearance and value of this, the first, number of the series. It contains thirty-six clinical lectures by the ablest men in the profession of this country and Europe. The subjects are well selected, plainly and concisely stated, and of proper length to give the cream of the subject without being obscured by class-room oratory. The book is well bound in cloth, well indexed and printed on excellent paper with illustra- tions wherever needed. *FEVER : ITS PATHOLOGY AND TREATMENT BY ANTIPYRETIcs. g By Hobart Amory Hare, M. D., B. Sc., Clinical Professor of Diseases of Children and Demonstrator of Therapeutics in the University of Pennsylvania; etc. Phila. and London : F. A. Davis. I891. Price, $1.25. " . Dr. Hare's work on “Fever” is the essay to which the Boylston Prize of Harvard University for 1890 was awarded. It has very little to say upon the theory of fever, contrary to what would be expected from its title, but is devoted particularly to a study of the action of the new antipyretics. THE MODERN ANTIPYRETIcs—their Action in Health and Dis- ease. By Isaac Ott, M. D., Ex-Fellow in Biology, Johns Hopkins University; Consulting Physician to the Easton Hospital, etc. E. D. Vogel, Bookseller. Easton, Pa. 1891. Cloth. 8vo. Pp. 52. - Besides giving an account of the new coal-tar products, antifebrin, antipyrin, phenacetin, exalgin and the others of the group, the author also goes into the physiology of fever and its treatment. It is well written and presents the case fairly, with- out unduly exaggerating the merits of the particular class of drugs with which it deals principally. In the concluding section on the “Value of Antithermics in Typhoid Fever,” he strongly favors water baths. MEDICAL SYMBOLISM, IN CONNECTION witH HISTORICAL STUDIES IN THE ARTS OF HEALING AND HyGIENE. By Thomas S. Sozinskey, M. D., Ph. D., author of The Culture of Beauty, BOOK NOTICES. 47 The Care and Culture of Children, etc. Cloth, 12mo., 171 pp.; price, $1.OO. Philadelphia and London: F. A. Davis. This lastliterary effort, giving evidence of great research, was completed just before Dr. Sozinskey’s death. It is a treatise on medical symbolism in connection with studies, essentially, historical, in the art of healing and of hygiene. Medical unthology is treated of fully. The book contains a fund of information which deserves to be widely known. WOOD's MEDICAL AND SURGICAL MONOGRAPHS. Volume X, Nos. I and 2. April and May, 1891. New York: Will- iam Wood & Co. Price, $10.OO a year; single copies, $1.O.O. - This series of monographs seems to have struck a popu- lar vain in the esteem of the medical profession. The contents of the April No. are—Treatment of Syphilis of the Nervous System, by Julius Althaus, M. D., of London ; Railway Injuries, with special reference to those of the Back and Nervous System, in the Medico-Légal and Clinical Aspects, by Herbert N. Page, M. A., England; Causes and Prevention of Phthisis, by Arthur Ransome, M. D., For May we have:—Differentiation in Rheumatic Diseases (so called,) by Hugh Lane, L. R. C. P. Mental affections of Childhood and Youth, by J. Langdon Down, M. D. Cure of the Morphia Habit, by Oscar Jenning, M. D., and notes on the examination of the Spectum, Vomit, Feces and Urine, by Sidney Coupland, M. D. MATERIA MEDICA AND THERAPEUTICs—With especial reference to tha clinical application of drugs, by John N. Shoemaker, A. M., M. D., Professor of Materia Medica, Pharmacology, Therapeutics, and Clinical Medicine, and Clinical Professor of Diseases of the Skin in the Medico-Chirurgical College of Philadelphia, etc. etc. Being the second and last volume of a treatise on Materia Medica, Pharmacology, and Thera- peutics. An independent volume upon drugs. Pp. 675; Royal Octavo ; Cloth ; Price, $3.50. This is the long-looked-for second volume of Shoemaker's Materia Medica, Pharmacology, and Therapeutics. It is wholly taken up with the consideration of drugs, each remedy being studied from three points of view, viz.: the Preparations, or Materia Medica; the Physiology and Toxicology, or Pharma- cology; and, lastly, its Therapy. Dr. Shoemaker has finally brought the work to completion and now this second volume is 48 & BOOK NOTICES. ready for delivery. It is thoroughly abreast of the progress of Therapeutic Science, and is really an indispensable book to every student and practitioner of medicine. It is thoroughly and carefully indexed. Published by F. A. Davis, Medical Publisher and Bookseller, 1231 Filbert Street, Philadelphia. THE POcKET MATERIA MEDICA AND THERAPEUTICS; a Resume of the Action and Doses of all Officinal and AVon-officina/ Drugs Mow in Common Use. By C. Henri Leonard, A. M., M. D., Professor of Medical and Surgical Diseases of Women and Clinical Gynecology in the Detroit College of Medicine. Cloth, 12mo., 300 pages; price, postpaid $1.OO. The Illustrated Medical Journal Company, Publishers, Detroit. This volume, so the preface informs us, has been in prep- aration for the past four years. The drugs of as late introduc- tion as 1891 are to be found in its pages. The author claims to have incorporated everything of merit, whether officinal or non- officinal, that could be found either in standard works or from many manufacturers' catalogues. The scheme embraces the Pronunciation, Officinal or Non-officinal indication (shown by an”,) Genitive case ending, Common Name, Dose and Metric Dose. Then the Synonyms, English French and German. /f a Plant the part used, Habitat, Natural Order, and description of Plant and Flowers, with its Alkaloids if any. If a Mineral, its Chemical Symbol, Atomic Weight, looks, taste, and how found, and its peculiarities. Then the Action and Uses of the Drug, its Antagonists, Incompatible, Synergists and Antidotes. Then follow its Officinal and Non-Officinal preparations, with their Medium and Maximum Doses, based, so far as possible, upon the last U. S. Dispensatory. Altogether, it is a handy volume for either the Physician, Student or Druggist, and will be fre- quently appealed to if in one's possession. It is the most complete small book on this subject now issued. 15 DRUNKENNESS AND THE Opium, Cocaine, Chloral and Tobacco Habits, SUCCESSFU LLY TREATED AT THE KEELEY INSTITUTE MARYSVILLE, OHIO. Investigation as to methods and results cheerfully solicited. We refer by permission to Dr. Kinsman, Columbus, Ohio, and Dr. Geo. W. Boerstler, Lan- caster, Ohio. ADDRESS : The Keeley Institute, MARYSVILLE, O. Mrs. Briskie—“Johnny, did the doctor call while I was out?” Little Johnny (stopping his play)—“Yes. He felt my pulse an' looked at my tongue, and shook his head, and said it was a very serious case, and lie left this prescription and said he would call again be- fore night.” Mrs. Briskie— “Gracious me ! It wasn't you I sent him to see. It was the baby.” LIQUID FOR BRONZING-A fluid for bronzing paper, glass, leather, etc., is prepared as follows (Pharm. Zeitung ) : Diamond fuchsine IO parts, and methyl-violet 5 parts, are dissolved with the aid of heat in 95 per cent. alcohol. To the solution 5 parts of benzoic acid is added, and the whole is boiled from five to ten minutes, until its green color has changed to a lustrous golden bronze. This is very brilliant, durable and adherent, is easily laid on with a brush, and dries in a few minutes. To SMOOTH OUT A WRINK- LED DIPLOMA.—Apply a thin | coating of hot paraffin to the back of the diploma, and before it is entirely cold smooth out the wrinkles with a common smoothing iron, place diploma between two clean panes of glass larger than diploma and weight it down for several days before replacing in frame.— Meyer Bro. Druggist. DOCTOR (to patient)—“I do not wish to frighten you, but if you have no objection I’d like to call in a couple of my brother physicians. Irascible Patient— “All right! If you need any assistance in murdering me call in your accomplices.” LA W S O N T A IT says: “Where syphilis kills its tens, gonorrhea kills its thousands; and it would take the sufferings of a hundred cases of syphilis to make up for the long, weary years of agony of one case of gonorrheal pyosalpinx. — Mew York Medical /ournal. 16 OUIR, BEST PIEEMIUIMI IFOIR, 189 O Z A NEW WATCH FOR PHYSICANS. Look AT THE PRICEs. º $3%; % sº The two styles shown are different only in the dial ; the small knob to left of crown pulls out and stops the watch ; pushing in, it is started. THE PRICES OF THE WATCHES, POSTPAID, INCLUDING ON E YEAR’S SU BSCRIPTION TO º COLUMBUS MEDICAL JOUR- AL, The “D0Ctor's Quick Stop" OPEN - FACE, SWEEP - SECON ID MOVEMENT, With Stop Attachment. ºf SOLID NICKEL AND GOLD IFILLED CAISES. For C0 UNTING THE PULSE this watch is invaluable to Physicians. It is also an ex- cellent Time-Keeper, and warranted by the firm making it as equal to any Twenty-five Dollar watch for durability and keeping time. Any watch that does not give entire satisfaction can be returned at our expense. This is not on the “Cheap John” or Water- bury order, but a first-class watch, and after due consideration we are satisfied we can find nothing more acceptable to the Pro- fession as a premium. Solid Nickel Gase, - $6,50 This would retail in any jewelry store for $8.00 to $10.00. Gold Filled Case, - $12.50 Retailing for $20.00 to $25.00. REMEMBER above prices include a YEAR’S SU BSCRIPTION TO THE COLUM BUS MEDICAL JOURNAL, or we will send the Watches on receipt of above amounts. Every Physician should have one Every owner of a good horse should use them. Cash must accompany orders in all cases. Address, ThB (Dilmills Mºliſłl Pll, [0, 246 EAST GAY STREET, COLUMBUS, OHIO. W60ſ, | / #2 sº sº % S$ /A-. §§ % N $. # Se sº--> § tº- 9 §º º: 3. *%- N & 6 5 N Æ 2% sº 17 ICAI, GOMPANY'S *. §º jº', | !. º, ºr ºft . D S-> § . -] ! sº, vºsº/*, *, - *- Highest possible digestive strength. º 221. º: ** =#E=== Solubility unequaled. Has no disagreeable taste or odor. Especially adapted to making wines, elixirs, and saccharated Pepsin. We make no scale, crystal, saccharated or weak preparations. Price the lowest of any of its class in the market. - Liberal samples for trial forwarde” to Physicians and Druggists On application. Correspondence solicited." BEEMAN CHEMICAL CO. INo. 5 ECu Celid Avenue, CLEVELAND, OHIO. Also Manufacturers of Pure Pancreatine and Saturated Solution of Pepsin. THERE is an instructive lesson in the English mor- tality returns from tubercu- 1osis for the last forty years. In the ten years from 1851 to I86o the number of deaths from tuberculosis in persons from 15 to 45 years of age amounted to 3,943 in every million ; from 1861 to 1870 it had fallen to 3,711; from 1871 to 1880 it was 3,194; and from 1881 to 1887 it did not exceed 2,666. The decreased rate is more marked in the female than in the male sex. PRESERVATION OF HYDRO- GEN PEROXIDE. — For this purpose Kingzett recommends the addition of a small amount of ether. Experi- ments conducted by the author show that pure hydro- gen peroxide lost, in twenty- eight days, ten per cent. ; in ninety-eight days, 27.4 per cent. in two hundred days, thirty-nine per cent. ; and in four hundred and ninety days, 89.2 per cent. The addition of sulphuric acid reduced these figures to 9, 23, 27%, and 68.3, respectively. Alco- hol reduced them to I, 7, 4, 7.4, and 22.8, respectively, while ether still further re- duces them, showing a loss of the peroxide in the times mentioned of O, I.5, 2.3, and I5.9, respectively. 18 (INIVERSITY OF THE CITY OF NEW YORK, MEDICAL DEPARTMENT, 410 East Twenty-Siacth Street, opposite Bellevue Hospital, New York City. FIFTY-FIRST YEAR, 1891-92. IF_A_CTUTT. TTSZT OF IMCIEIDICINTIE, REV. HENRY M. MAcORACKEN, D. D., Chancellor of the University. Charles Inslee Pardee, M. D., Dean of the Faculty ; Professor of Otology. Alfred IL. I. oommis, M. D., H.L. ii., Pro- fessor of Pathology and Practice of Medi- cine: Physician to Bellevue H, spital. William H. Thompson, M. D. LL. D.. Professor of Materia Medica and Thera- peutics: Diseases of the Nervous System : Physician to Bellevue Hospital. Winn. Mecklenburg Poilz, M. D. Pro- fessor of Obstetrics and Gynaecology; Physician to Bellevue Hospital, and to Emergency Lying-in Hospital. Leyvis A. Stimson, M. D., Professor of Surgerv : Surgeon to Bellevue and New York Hospitals. Rudolph A. Witthaus, MI ID., Professor of Chemistry, Physics and Hygiene. W. Gilruana rhompson, M. D., Profess- or of Physiology; Physician to Presbyterian and New York Hospitals. Geo. Woolsey, Mr. Mo, Professor of Anat- Qmy and Clinical Surgery; Surgeon to Bellevue Hospital. Henry P. Loomis, M. D. , Professor of Pathological Anatomy. Stephen smith, M. D. , Emeritus Profess- or of Qlinical Surgery; Surgeon to Bellevue Hospital. E. Mac Donald, H.L. B., M. D. , Emeri- tus Professor of Medical Jurisprudence and Psychological Medicine; General Superin- tendent of the New York City Asylums for the Insane. Charles st edman Enni, M. D., Professor of Ophthalmology: Surgéon to the New York Eye and Ear Infirmary. A. Henry G. Piffard, M. D., Clinical Profess- or of Dermatology : Consulting Surgeon to Uharity Hospital. Joseph E. Winters, M. D., Clinical Pro- fessor of Diseases of Children. Prince A. Morrow, M. D., Clinical Pro- fessor of Venereal Diseases; Surgeon to Charity Hospital. William C. Jarvis, M. D., Clinical Pro- fessor of Laryngology. - Laurence Johnson, M. D., Clinical Pro- fessor of Medicine : Visiting Physician to Gouverneur Hospital. A. M. Mºhelps, M. D., Clinical Professor of Orthopoedic Surgery; Surgeon to Charity Hospital. Willis E. Ford, M. D., Lecturer on Electro- Therapeutics. Chas. E. Quimby, M. D., Adjunct Pro- fessor of Practice of Medicine. J. Clifton Edgar, M. D., Adjunct Professor Of Obstetrics. Fred'Ix W. Gwyer, M. D., Adjunct Pro- fessor of Surgery : Assistant Visiting Sur- geon to Bellevue Hospital. John B. Knapp, M. D., Adjunct Professor Of Materia, Med 1 Ga. Edward D. Fisher, M. D., Adjunct Pro- ſessor of Nervous 1)iseases; ºneurologist to Hospital for Incurables. B. T. Egbev 1 Le Fevre, M. D., Clinical Profess- Or Of Medicine. Ivinn sickles, M. D., Assist. Professor of Chemistry and Physics, Irving sº. Haymes, M. D., Demonstrator of Anatomy. The collegiate year consists of a SPRING TERM, which begins March 25th, 1891, and ends June 1st, 1891, and a WINTER TER VI which begins Wednesday, September 23d, 1891, and ends March 31st, 1892. An obligatory three years graded course has recently been established. The FIRST YEAR Com urine analysis, etc. prises recitations in the primary subjects, dissection, laboratory work, . The SECOND YEAR comprises lectures in the primary branches, recitations, laboratory work and clinics in general medicines and surgery. The THIRD YEAR comprises lectures in the general branches, clinics in general and special Subjects and instruction by Sections at the bedside in the wards of Bellevue Hospital, and attendance upon obstetric cases in out-door practice. The ample Lahoratory Dispensory and Hospital facilities at the disposal of the College enable the faculty to offer to each student unusual advantages for practical work and bedside instruction. For course of Lectures Matriculation Final Examination Fee e e s e s e a s a s s a s e e s s a e e º e s e a e e s a e e a s e s e e º e s • e º e º 'º e º 'º e º s e º º º e º 'º e • * * * * * * * * * * * * * * * * * * * * * * g e e s e o e w a e e a tº e º e s s s e e s e º e º e º 'º º e º 'º e º e º e º e º 'º tº e º º Demonstrator’s Fee, including material for dissection e e s e e s e e s a s e e s e e s e e º e o e s e e s e e s a e s a e º e º e o e < * * * * * * * * * * * * * * * * 5 00 For further particulars and circulars, address the Dean, Prof. Chas. Inslee Pardee, M. D., University Medical College, 410 East 26th St., New York City. ..::::::: §:::::::: *N } & :::::::: Ny. Yºs O & A QF Nº. ºff % 32. & * ... • * * * * ~ * * * * s:# $8. © , , , Yºº. & 23 4, &S © 4, 4X" | The following fac-simile is a sample of hundreds of communications which we are continually receiving from the Medical Profession in regard to the value of LACTO-PREPARATA in Infant Feeding. WE DO NOT SOLICIT TESTIMONIALS, NOR PUBLISH THEM WITHOUT PERMISSION. 2 N. C ºlºur? J. --~~~4 2: . Tº 77-6 ſº. 22. Żºłºść. I 7 㺠2.0 20 SEND FOR OUR PAMPHLET. N SIETHINT*T* I FIFRIETHIETH IT CONTAINS VALUABLE SUGGESTIONS AND FORMULAS OF MUCH USEFU LNESS. THE CORNELL-PHENEGER CHEMICAL CO. COrº'UºBU’s, O::::::O- --> §º †sº #º H Uſ) *3 - : §: # § Fº Asſiſſiºilii#ieſ) § #: ºft||| i # I ºft | # ; : Pl in Hºllº i |A || # § àº. p: # - # †† jī; w sº ##|- || i; #| ||il. Hºº ñºilº : （IIIº º #### #Tºº ºilſ p: - º tº-º- - Øs C p: A. N lºs & º rº. Šišº sº Fº º | º [. §§§ §§§ §§ :*: E- >erº-z-E º A PRIVATE HOSPITAL FOR MENTAL AND NERWOUS DISORDERS. COLLEC E HILL, OHIO. Eighteen Years Successful Operation. Oue Hundred and Fifty Patients admitted annually. Daily Average, Seventy. Cottages for Nervous Invalids, Opium Habit, etc. Location Salubrious. Surroundings Delightful. Appliances Ample. Charges Reasonable. Accessible by Rail; 6 Trains Daily; 30 min. from G. H. & D. Depot, Fifth and Hoadly Sts., Gincinnati. & For Particulars, Address ORPHEUS EVERTS, M. D., Sup’t, College Hill, Ohio. WESTERN PENNSYLVANIA MEDICAL COLLEGE, CITY OF PITTSBURGH. tº The REGULAR SESSION begins on the last Tuesday of September and continues six months. During this Session, in addition to four Didactic Lectures, two or thfee hours are daily allotted to Clinical Instructions. Attendance upon two Regular Courses of Lecture is requisite for graduation. A three years’ graded Course is also provided. The SPRING SESSION embraces Recitations, Clinical Lectures and Exercises, and Didac- tic Lectures on special subjects. This Session begins the Second Tuesday in April, and continues ten Weeks. The LABora ToBIES are open during the Collegiate Year for instructions in Chemistry, Microscopy, Practical Demonstrations in Medical and Surgical Pathology and Lessons in Normal Histology. iºtal importance attaches to the Superior Clinical Advantages possessed by this. College. - For particulars see Annual Announcement and Catalogue for which address the Sec- retary of Faculty, Dr. T. W. T. McKENNAN. Business communications should be sent to Prof. W. J. ASDALE, Sec'y Board of Trustees, 2108 PENN AVENUE, PITTSBURGH. CLUBBING LIST SPEG/AL PR/GE TO SUBSGRIBERS. g We will send any of the following publications including the CoLUMBUS MEDICAL JOURNAL, for One Year, at price in second column. CASH WITH ORDER. Regular Subscrip- - tion Price. Century Magazine . . . . . . . . . $4 OO $4 50 Scribner's Monthly . . . . . . . . 3 do 3 50 Popular Science, monthly . . . . . 5 OO 5 co North American Review, monthly . . 5 Oo 5 25 Forum, monthly . . . . . . . . . 5 OO 5 25 Cosmopolitan . . . . . . . . . . . 2 4O 3 I5 Nineteenth Century, Am. reprint . . 4 50 4 75 Harper's Monthly . . . . . . . . . 4 OO 4 25 & 4 Weekly . . . . . . . . . 4 OO 4, 25 4 ( Young People (Juvenile) . . 2 OO 2 50 Frank Leslie's Weekly . . . . . . . 4 OO 4 50 Scientific American . . . . . . . . . 3 OO 3 65 { % Supplement . . 5 OO 5 OO St. Nicholas (Juvenile) . . . . . . . 3 OO 3 50 . Youth's Companion (Juvenile) new sub- scriber . . . . . . . . . . . . I 75 2 35 Turf, Field and Farm, new subscriber 5 Oo 5 OO Peck's Sun . . . . . . . . . . . . 2 OO 2 50 Texas Siftings . . . . . . . . . . 4 OO 4 OO Judge . . . . . . . . . . . . . . 4 CO 4 OO Puck . . . . . . . . . . . . . . 5 OO 5 OO Life . . . . . . . . . . . . . . . 5 OO 5 OO Time . . . . . . . . . . . . . . . 4 OO 4 OO Ohio State Journal, Weekly . . . . I Oo I 50 If there is any publication you want, not in above list, write us for prices, we can save you money. 23 PROF. R. 0GDEN DOREMUS SAYS THAT BOWDEN LITHIA, WATER From G E O FRGIA, Contains 4,447 GRS. LITHIUM BI-CARB PIER, MMI PERIAIC, G-ALL ON. D0CTOR Do you know of any other Lithia Water in the market kº, which has been submitted to so critical and professional an analysis P * . It has a record unsurpassed for satisfactory results. We are prepared to submit the proofs in the following cases: Kidney TroubleS (of Every Kind), Caiarrh of Bladder (Acule or Chronic), Renal Or Uric Acid Calculi, Diabetes (Insipidus or Mellitus), Dysentery or Diarrhaºa Acute or Chronic), GyStiſis (Acule or Chronic), Rheumatism, Gouf, Acid or Afonic Dyspepsia. Ask us (on postal card) to send convincing proofs, and samples of water free. ...a •w * The elegant SWEET WATER PARK HOTEL, 500 guests (new), the Famous Bromine Lithia Vapor Baths (Hot Spring Method, but far superior) and a competent resident Physician. Any information cheerfully answered. Address Bowden Lithia Springs Co. LITH 1A SPRINCS, GA. Syr. Fº Cº., Fellows Contains the Essential Elements of the Animal Organization—Potash and Lime; The Oxidising 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 Slightlv Alkaline Reaction. It Differs in its Effects from all Analogous Preparations; and it possesses the important properties 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 deseases. Its Curative Power is largely attributable to its stimulant, tonic, and nutritive properties, by means of which the energy of the system is recruited. Its Aetion is Prompt; it stimulates the appetite and the digestion, it promotes assimilation, and it enters directly into the circulation with the food products. The prescribed dose produces a feeling of buoyancy, 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 per- sons 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 bottle (and the wrap- pers surrounding them) bear, can then be examined, and the genuineness—or otherwise—of the contents thereby proved. .7/edica! Zetlers may be addressed Zo - Mr. FELLOWS, 48 Vesey Street, New York. gº-ºh" only prominent Emulsion. of Cod-liver Oil introduced directly to the medical profession. It is advertised exclusively in medical journals. HYWY9| EINE. Produces rapid increase in Flesh and Strength. FORMIULA.—Each Dose contains : * |--— Eºs #º by NT IP verywhere. . 80 m. Soda . . . . . . . . .1-3 * Fºol º (drops) Šišić Acid -. #: Grains It is pleasant to the Taste and Soluble Pancreatin. 5 Grains Hyocholic Acid 1-20 “ acceptable to the most delicate Stomach. IT Is ECONOMICAL IN USE AND CERTAIN IN RESULTs. HYDROLEINE (Hydrated Oil) is not a simple alkaline emulsion of oleum morrhua, but a hydro-pancreated preparation, containing acids and a small percentage of soda Pancreatin is the digestive principle of fatty foods, and in the soluble form here used, readily converts the oleagunous material into assumulable matter, a change so necessary to the reparative process in all wasting diseases. | Lautenbach’s Researches on the functions of the liver would show the beautiful adjustment of therapeutics in preparation of Hydroleine, furnishing, as it does, the acid and soda necessary to prevent self- poisoning by re-absorption of morbid tubercular detritus and purulent matters into the general circulation, In Wasting Diseases the most prominent symptom is emaciation, the result of starvation of the fatty tissues of the body as well as the brain and nerves . This tendency to emaciation and loss of weight, is arrested by the regular use of Hydroleine, which may be discontinued when the usual average weight has been permanently regained. The following are some of the diseases in which HYDROLEINE is indicated : Phthisis, Tuberculosis, Bronchitis, Catarrh, Cough, Scrofula, Chlorosis, General Debility, etc. To Brain Workers of all classes, Hydroleine is invaluable, supplying as it does, the true, brain-food, and being more easily assimulated by the digestive organs than any other emulsion. The principles upon which this discovery is based have been described in a treatise on “The Digestion, and Assimilation of Fats un the Human Body,” by H C. BARTLETT, Ph D , F C. S, and the experiments which were made, together with cases illustrating the effect of Hydrated Oil in practice, are concisely stated in a treatise on “Consumption and Wasting Diseases,” by G. Over END DREwRY, M. D. COPIES OF THESE WORKS SENT FREE ON APPLICATION. - Sold by all Druggists at $1.OO per Bottle.- C. N. CRITTENTON, SOLE AGENT FOR THE UNITED STATES. 15 FULTON STREET, N. Y. A Sample of Hydroleine will be sent free upon application, to any physician (enclosing business card) in the U.S, PULMONARY consumption (THE TREATMENT BY THE SHURLY-GIBBES METHOD.) HE experiments and results, obtained by Heneage Gibbes, M. D., Professor of Pathology, Michigan University, and E. L. Shurly, M. D., Professor of Clinical Medicine and Laryn- gology at the Detroit College of Medicine, in the treatment of Pulmonary Consumption with solutions of chemically pure iodine and chloride of gold and sodium are already well known to the Medical Profession. * It is not claiming too much for this method to state that the results from its employment have been far more promising than those obtained from tuberculin, or from any method for the treatment of pulmonary consumption hitherto attempted. It gives us much pleasure therefore to announce that we are now prepared to Supply the necessary Solutions in any quantity desired (with the endorsement of Drs. Shurly and Gibbes), and to guarantee their purity and uniform quality. - Reprints of recorded methods of using these Solutions, With clinical reports, Will be mailed physicians on request. The solutions are put up in One-ounce bottles. Price per ounce of each Solution, $1.00. PARKE, DAVIS & CO., DETROIT AND NEW YORK. - A [.. º - # , ; , , !. © . () © © © ‘.... * . . . . ~ * EEſº ()): Vol. X, OCTOBER, 1891. No. 4, J. F, BALDWIN, M. D. - 4- - - - - ED ITOR. J E. BROWN, M. D., - - Associate Zºditor. C. R. CORN ELL, - - Azºsiness Manager. 48 PAGES READ/WG MATTER. PUBLISHED MOWTHLY. - $1.00 PER YEAR. THE COLUMBUS MEDICAL PUBLISHING COMPANY, Publishers and Proprietors, 246 East Gay Street, Columbus, Ohio. Entered at Postoffice, Columbus, Ohio, as second-class mail matter. amºa º mº * vº º vº- wn wºma vº wº, a wºº wº wº * * * * * * * *. w CH. MARCHAND'S , PEROXIDE OF HYDROGEN §4. (MEDICINAL) H2 O2 (ABSOLUTELY HARMLESS.) ãºsºsº. z - - s * - - - % ãº. Is rapidly growing in favor with the medical profession. It is the §: §§ most powerful antiseptic known, almost tasteless, and odorless. #ºſ º {{WN Çan be taken internally or applied externally with perfect safety. º §§§ ø Ş. Its curative properties are positive, and its strength and purity can always be relied upon. This remedy is not a Nostrum. & A REMEDY For DIPHTHERIA : CROUP ; SORE THROAT, AND ALL º IN FLAMMATORY DISEASES OF THE THROAT. OPWAV/OAV OF THE AROAPESS/ON. I) r. E. R. Squibb. of Brooklyn, writes as follows in an article headed “On the Medical Uses of Hydrogen Peroxide” (Gaillard's Medical Journal, March, 1889, p. 267), read before the Kings County Medical Association, February 5, 1889: “Throughout the discussion upon diphtheria very little has been said of the use of the Peroxide of Hydrogen, or hydrogen dioxide; yet it is perhaps the most powerful of all disinfectants and antiseptics, acting both chemically and mechanically upon all excretions and Secretions, so as to thoroughly change their character and reactions instantly. The few physicians who have used it in such diseases as diph- theria, Scarlatina, Small-pox, and upon all diseased Surfaces, whether of Skin Or mucous membrane, have uniformly spoken well of it so far as this writer knows, and perhaps the reason why it is not more used is that it is so ſittle known and its nature and action so little understood. . . . . . . Now, if diphtheria be at first a local disease, and be auto-infectious; that is, if it be propagated to the general organism by a con- tagious, virus located about the tonsils, and if this virus be, as it really is, an albuminoid substance, it may and will be destroyed by this agent upon a sufficient and a sufficiently repeated contact. . . . A child’s nostrils, pharynx and mouth may be flooded every two or three hours, or oftener, from a proper Spray apparatus with a two volume solution without force, and with very, little discomfort; and any solution which finds its way into the larynx or stomach is beneficial rather than harmful, and thus the effect of corrosive sublimate is obtained without its risks or dangers. . . . .” Further, on Dr. Squibb mentions that CHARLEs MARCHAND is one of the oldest and best makers of Peroxide of Hydrogen, and one who supplies it to all parts of the country. ..., CAUTION.—By specifying in your prescriptions “Ch., Marchand's Peroxide of Hydrogen (Medicina | 1.” .* sold only in 94-lb., 96-lb., and 1-lb. bottles, bearing my label and signature, you will never be imposed upon. Never sºld }I) Oll I K. PREPARED ONLY BY A book containing full explanations concerning the * + k, , , § 4. f therapeutical a #. ; both §º. of the “Ecole Centrate PEROXIDE OF HYDROGEN (Medicinal) and GLycozoNE, iſ tº º I tººl A des Arts et Monmº fac. with opinions of the profession, will be mailed to ſ ºr w º º - - , twºres de Pº ris ‘’ physicians free of charge on application. t - - º Ž" Mention this publication. SOLD BY LEADING DRUGGISTS. Laboratory, 10 West Fourth Street, New York º Chemist and Grſt duſtle Frry?) ce. STARLING MEDICAL COLLEGE, COLTU MIBTU.S., O HIO. The Forty-third Session will Open September 10, 1890, and continue six months. Thoroughly equipped Chemical and Physiological Laboratories, and especial attention paid to laboratory teaching. A large and well-appointed Hospital—St. Francis Hospital, of Starling Medical College, is in the same building, and under the exclusive control of the College Faculty. FEES:—Matriculation, $5.00. Tuition, $50.00. Laboratory, $5.00. Examination, $25,00. For further information, address T. C. HOOVER, MI. D., Registrar, - 229 East State St., Columbus, Ohio, CONTENTS. COMMIJNICATIONS. º tion of the Causes of Aortic Regurgita- Notes on the Examination of Applicants for tion; Tobacco, and Physical, Health; Pension and Life Insurance— by Charles Pilocarpine in Pneumonia; What is the H. Mertz, A M , M. D., Sandusky, O.... 145–151 Hest Nutritive Enema 2 Treatment of Case of Fracture and Dislocation of the Warts; W. R. Warner & Co.; Salicylate Spine, with Operation—by A.W. Ridenour, of Sodium in Pruritus; Worms; Gastric t M. D., Massillon, O. . . . . . . . . . . . . . . . . . . . . . 151-153 Ulcer . . . . . . . . . . . . . . . . * * * * * * * * * * * * * * * * * * * * 161-171 The Surgical Treatment of Chronic Catar- r • - rhal Kºhdiº" by R. Harvey Reed, SURGER) -The Supposed Curative Effect M. D., Mansfield, O... . . . . . . . . . . . . . . . . . . . . 154-159 of Operations Per Se; Premature Diag- Edema pulmonium!—by Dr. E. S. M'Kee, M. nosis and Premature Treatment of Syphi- D., Cincinnati, O. . . . . . . . . . . . . . . . . . . . . ... 159–160 lis; Fractures at the Elbow Joint......... 172-181 * *** r * O'BSTE TRICS –The Purse-String Operation SELECTIONS. for Cystocele .................. s - ptº e º a - .181–184 MED7C/AWE — Advertising Doctors; The Treatment of Pneumonia; A Plea for the A/2/70/8/4/. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185–188 More Liberal Use of Butter; How to Make a Cup of Coffee; What Shall be B OOA AMOT/CES ... . . . . . . . . . . . . . . . . . . . . . . 189–192 T) one for a Cold in the Head 2 Differentia- ADVERTISERS. The Maltine Mfg. Co., New York. . . . . . . . . . . . . . 1 Lambert Fharmacal Co., St. Louis.. . . . . . . . . . . . 13 Beeman Chemical Co., Cleveland, O... . . . . . . . . 2 H. K. Mulford & Co., Philadelphia . . . . . . . . . . . . 14 Dr. McMunn’s Elixir of Opium . . . . . . . . . . . . . . . 2 The Keeley Institute, Marysville, O............ 14 Harrison Cole, Columbus, O... . . . . . . . . . . . . . . . . 2 Columbus Medical College. . . . . . . . . . . . . . . . . . . . . 14 Paris Medicine Co., St. Louis, Mo. . . . . . . . . . . . . 3 Battle & Co., St. Louis . . . . . . . . . . . . . . . . . . . . . . 15 B. Keith & Co., New York. . . . . . . . . . . . . . . . . . . . 3 Western Penn. Medical College, of Pittsburgh. 15 Cincinnati Sanitarium . . . . . . . . . . . . . . . . . . . . . . . 4 Katharmon Chemical Co., St. Louis. . . . . . . . . . . . 16 Julius Fehr, M. D., Hoboken, N. J. . . . . . . . . . . . 4 Reed & Carnrick, New York . . . . . . . . . . . . . . . . . . 18 Dios Chemical Co., St Louis, Mo. . . . . . . . . . . . . 5 Bowden Lithia Spring Co., Lithua Springs, Ga. 20 The Antikamnia Chemical Co., St. Louis, Mo. {} Mellier Drug Company, St. Louis. . . . . . . . . . . . . 22 The “Yale” Surgical Chair . . . . . . . . . . . . . . . . . . . {j Renz & Henry, Louisville, Ky. . . . . . . . . . . . . . . . . 22 Cornell-Pheneger Chem. Company, Columbus, James I. Fellows, New York......... . . . . . . . . . . 24 Ohio. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '• * * * * * * * * 7 PREMI UM LIST FOR 1891 . . . . . . . . . ..... 17, 19, 21, 23 The New York Pharmacal Ass'n, N. Y. . . . . . . . & Charles Marchand, New York...... lst page cover. Wm. R. Warner & Co. . . . . . . . . . . . . . . . . . . . . . . 9 Starling Med. College, Columbus, O.2d “ & & Mariani & Co., New York . . . . . . . . . . . . . . . . . . . 1 () C. N. Crittenton, New York. . . . . . . .3d “ { % Forbes’ Diastase, Cincinnati, O. . . . . . . . . . . . . . . . 11 Parke, Davis & Co., Detroit & N.Y.4th “ & © Eisner & Mendelson Co., New York. . . . . . . . . . . 12 2. WITH coprivaron. A combination of the best Morwegian Cod Liver 0i/ with MALTIME, in which, by the vacuum process, rancidity is prevented and disagreeable-odor and taste of the oil removed. Base a Powerful Reconstructive Gontains No Inert Emulsifier lºs Ilisill lighlil II lilill Palilº Is an active Starch Digester and Tissue Builder. Produces rapid Improvement in Appetite. ls used where “Emulsions" cannot be tolerated, A complete list of the Maltine Preparations and their formulæ will be sent on application, THE MALTINE MANUFACTURING CO. (Please mention this Journal.) New York, N.Y.: BEEMAN CHEMICAL COMPANYs sº PURE Highest possible digestive strength. Solubility unequaled. Has no disagreeable taste or odor. Especially adapted to making wines, elixirs, and saccharated Pepsin. We make no-scale, crystal, saccharated or weak preparations. Price the lowest of any of its class in the market. Liberal samples for trial forwarded to Physicians and Druggists on application. Correspondence solicited. BEEMAN CHEMICAL CO. INo. 5 Euclid Avenue, CLEVELAND, O, HIO. Also Manufacturers of Pure Pancreatine and Saturated * , Solution of Pepsin. IDER. McIMIUINN’s I tº tº ſº. (Ft. Clº Cl An Invaluable Discovery in the Preparation of Opium. **º-ºº- 7A/AS IS THA. PURAF AAWD ESSENTIAL EXTRA C 7 AWA’OM 7TA/A AVA 7/VA: /) A UG, It contains all the valuable medicinal properties of Opium in natural combination, to the exclusion of all its noxious, deleterious, useless principles upon which its bad effects depend. It possesses all the sedative, anodyne and antispasmodic powers of Opium: To produce sleep and composure; to relieve pain and irritation, nervous excitement and morbid irritability of body and mind; to allay convulsive and spasmodic actions, ete.; and being purified from all the noxious and deleterious elements, its operation is attended by no sickness of the stomach, no vomiting, no costiveness, no headache, nor any derangement of the constitution or general health. Hence its high superiority over, Laudanum, Paregoric, Black Drop, Denarcotized Laudanum, and every other Opiate preparation. E. FERRETT, Agent, 372 Pearl St., New York. Tharrison COLE, RACTICAL OPTIGIAN, All Defects of Vision, requiring Spherical Lenses, scientifically corrected. Special - Lenses carefully adjusted to prescription. Optical and Scientific Goods of all kinds. Repairing of every description. Prescription Blanks Furnished Physicians on Application. 64 North High Street, Columbus, Ohio. EBRII.I.NE Tasteless Syrup of Quinine. Made ſrom an alkaloid which remains in the bark after crystalizing the Quinine, com- monly known as Amorphous Quinine. • ? t This preparation is nearly tasteless in the mouth, but perfectly soluble in the stomach, and equal to the Sulphate of Quinine in every respect, producing the same results as the Sulphate of Quinine in the same size doses. You will find this an elegant palatable prepara- tion, which children will delight to take, and ladies will find it much preferable to any pill or capsule, as it never produces the nauseaating sensation which is produced by pills and capsules, and is much quicker in its action as it is much more soluble. No disguisers used in its preparation. * JEFFERSoNTown, KY., Jan. 23, 1888. SIRS:-I used your Tasteless Quinine and find it all that is claimed for it. Children take it without the slightest resistance, take it as readily as if it was simple syrup, and its effect is just is Satisfactory as the Quinine itself. I will use it always for children and sensitive stoma chS Of adults. S. N. MARSHALL, M. D. The Southern Practitioner, published at Nashville, Tenn., and edited by Drs. Deering J. Roberts and Duncan Eve, in the January number, 1888, says: • “Febriline, or Tasteless Syrup of Amorphous Quinine, is one of the greatest boons yet con- ferred on the practitioner of medicine. The question naturally arises, what is it 2 Well, we can say from experience, having given it a thorough trial—yes, we mean by thoroughly trying it on our charity patients, using on them the sample left in our office, and its results were so good, that we have tried it time and again on our pay pattents sending them to the nearest drug store With a formula, on which we did not hesitate to write over our signature, Febriline, and in these cases it has given us and Our patrons the greatest satisfaction. Try it and you will use it again. MANU FACTURED BY TEIE PARIs MEDIGINE company, Druggists and Chemists, FOR SALE BY 212 North Main Street, St. Louis, Mo. THE CORNEEL-PHENEGER CHEMICAL CO., Columbus, O. IECTEHTTIEEI’S GON. T.INC. AWENA SATIWA (FROM COMMON OATS.) A Power FUL NERVE stimula NT, Tonic, ETC. i- IS EMPLOYED IN THE TREATMENT OF . . - “... Paralysis, Epilepsy, St. Vitus' Dance, the Morphia or Opium Habit, Chloral and Tobacco Habits, Sleeplessness, Nerve Exhaustion, Neuralgia, Alcoholism, Painful and Deficient Menstruation, Headache, Hysteria, Convulsions and Prostration from Fainting, and in the Convalescent Stage of all Actite Diseases. DOSE—From ten to thirty drops or more, as often as may be indicated to meet the urgency of the case. Ad- * & & minister in hot water when q lick action is desired. . . . . ; WNZTIE INAI-A--E-B, CINTIE QUT-A-I-ITTSZT CINTILTSzº- . . . ; * { - smº Elºi II LLILILºuiſitiº G. I. It is III: • . . Y., , , , x s: EEITHI’s . . s" - * * º, 3. ELIXIR DYSPEPSIA COMP. R. Hydrasting. A Positive Remedy for the relief and cure of DYSPEPsºn DIGES- Xanthoxylin, } TION, HEARTBURN, FIATULENCY, SEA-SICKNES; t º *:::: Bi-Carb, Soda, #ASTRIC Avenin. IRRITATION, ACIDITY OF STOMACH, Etc. . . . . DOSE—One teaspoonful in a wine glass of water immediately after each meal, or when indigătéd: attack, when prompt action is demanded, administer in hot water. . . . . . . . * via M.A.EE ciria ov.A.L.ETºr cirrºr- ". ...; send for printed matter on CON. T.INC. AVEN A SATIVA in the Morphia or Opium Hâbâ, and certi- ficates from different members of the Medical Profession citing cases under their charge treated by it, also REVISED AND ENLARGED MANUAL, to & . . . . . " B. KEITH & Co., Organic Chemists, ESTABLISHED 1852. No. 75 William Street, New York. *º §§§ º § § - §§§ : ºf . §H#. § # ſº º 'N *_Hjºº ill - º 7 ºº:: W §§§º: & W º º iſ - sº ºf ºilº. Wºº. a *. º. º º §: † § Nº. §§§§§ º Fºr ºt- ---- sºszººs *:::=º::::::". *-- - L.-- *** * * * º: gº-º-º: - - - - * Fº -º- S. tº as re-- ^N EASERWTCW, cINCINNA ti - san ITARIUMI. A PRIVATE HOSPITAL FOR MENTAL AND NERWOUS DISORDERS. COLLECE HILL, OHIO. Eighteen Years Successful Operation. Oue Hundred and Fifty Patients admitted annually. ... Daily Average, Seventy. Cottages for Nervous Invalids, Opium Habit, etc. Lozation Salubrious. Surroundings Delightful. Appliances Ample. Charges Reasonable. Accessible by Rail; 6 Trains Daily; 30 min. from G. H. & D. Depot, Fifth and Hoadly Sts., Gincinnati. For Particulars, Address ORPHEUS EVERTS, M. D., Sup’t, College Hill, Ohio. Rº: UT- IETIEHIELTER,”S #ſº "Compound Talcum" #: “Baby f'owder.” ** ****** “Hygienic Derrmal Fow der ’’ ! T I/TT FOR ; INFANTS AND ADULTS. RSN. *S. Srº. q ū, jºi Wºź COMPOSITION:–Silicate of PROPERTIES: — Antiseptic, * Magnesia with Carbolic and Sali- || Antizymotic and Disinfectant. §TG)\º: * ~ (7 cylic Acids. #2 Effº t USEF U L AS A §§§ GENERAL SPRINKLING POWDER, & it) º }}} with positive Hygienic, Prophylactic, and Therapeutic properties. § - - º GOOd in alſ. Affections of the Skim. crk } - ‘Al *ALMA iſ: Sold by the Drug Trade Per b lain, 25c.: f d. 50 º †º - Wholesale and Retail er box, p * C.; per me , 50c. Julius; º generally. Dozen $1.75; $3.50 §obok, TN. J 4. THE MANUFACTURER: 2^*e Zºkorr. #º, JULIUs FEHR, M. D.,. ºl Ancient Pharmacist, HOBOKEN, N. J. Advertised only in Medical and Pharmaceutical publications. i NEUrrtos rrrrr! A NEW AND PoWERFUL NEUROTIC, ANODYNE AND HYPNOTIC. A most efficient and permanent preparation, REMARKABLE for its efficacy and THERA- PEUTIC, EFFEGTS in the treatment of those NERWOUS AFFECTIONS and morbid conditions of the System which so often tax the skill of the Physician. A RELIABLE AND TRUSTWORTHY REMEDY FOR THE RELIEF OF Aysteria, Epilepsy, Meurasthenia, Mania, Chorea, Uterine Congestion, Migraine, Meuralgia, All Convulsive and Reflex Weuroses. The Remedy Par Axcellence in Delirium and Restlessness of Fevers. form by a skilled pharmacist, the formula of N E U RO S N E which will commend itself to every Physician. FORMULA :—Each fluid-drachm contains 5 grains each, C. P. Bromides of Potassium, Sodium and Ammonium, I 8 gr. Bromide Zinc, I-64 gr. each of Ext. Belladonna and Canna- bis Indica, 4 grains Ext. Lupuli and, 5 minims fluid Ext. Cascara Sagrada, with Aromatic Elixirs. DOSE:—From one teaspoonful to a tablespoonful, in water, three or more times daily, as may be directed by the Physician. Is the result of an extended professional experi- ence, and is compounded in the most palatable FOR FURTHER INFORMATION AND SAMPLE BOTTLE SEE FOOT OF THIS PAGE. UTERINE TONIC, ANTISPASMODIC AND ANODYNE. A reliable and trustworthy remedy for the relief of Dysmenorahoea, Amenorrhoea, Menorrhagia, Leucorrhoea, Subinvolution, THREATENED ABORTION, Vomiting in Pregnancy and Chlorosis; directing its action to the entire uterine system as a general tonic and antispasmodic. This combination is the result of an extensive professional experience of years in which the constituent parts have been fully tested singly and in combination in various proportions, until perfection has been attained. DIOVI BURNI A is prepared for prescribing exclusively, and the formula as - given will commend itself to every intelligent physician. FORMULA :—Every ounce contains 3-4 dram each of the fluid extracts : Virburnum Prunifolium, Viburnum Opulus, Dioscorea Villosa, Aletris Farinosa, Helonias Dioica. Mitchella Repens, Caulophyllum Thalictroides, Scutellaria Lateriflora. DoSE :-For adults, a desertspoonful to a tablespoonful three times a day, after meals, In urgent cases, where there is much pain, dose may be given every hour or two, ALWAYS IN HOT water. Jno. B. Johnson, M. D., Professor of the Princi- §: and Practice of Medicine, St. Louis edical College. St. Louis, June 20, 1888. I very cheerfully give my testimony to the Virtues of a combination of vegetable remedies prepared by a well known and able pharma- cist of this city, and known as DIOVIBUR- N1A, the component parts of which are well known to any and all physicians who desire to know the same, and,therefore, have no rela- tion to proprietary or quack remedies. I have employed this medicine in cases of dysmenor. rhoea, suppression of the catemania, and in excessive leucorrhoea, and have been much pleased with its use. J do not think its claims (as set forth in the circular accompanying it) to be at all excessive. I recommend its trial to all who are willing to trust to its efficacy, be- lieving it will give satisfaction. Respectfully, L. Ch. Boisliniere, M. D.. Professor of Obstet- rics, St. Louis Medical College. St. Louis, June 18, 1888. I have given DIOVIBURN1A a fair tral, and found it useful as an uterine tonic and anti- Spasmodic, relieving the pains of dysmenor- rhoea, and regulator Of the uterine functions. I feel authorized to give this recommendation of DIOVIBURN LA, as it is neither, a patented nor a Secret medicine, the formula of which having been communicated freely to the medi- cal profession. &” c/. %3oz s/n es e Že/O, H. Tuholske, M. D., Professor Clinical Surgery and Surgical Pathology, Missouri Medical College ; also Post-Gradutate School of St. LOuis. St. Louis, June 23, 1888. I have used DIOVIHURN IA quite a num- bcr of times—sufficiently frequently to satisfy myself of its merits. It is of unquestionable benefit in painful dysmenorrhoea ; it possesses antispasmodic properties which seem especi- ally to be exerted on the uterus. A’z A. Z.A., 4-6. To any physician unacquainted with the medicinal effect of DIOVIBURNIA, and NEU- ROSINE, we will mail pamphlets containing full informatian, suggestions, commendaiions of some of the most prominent professors in the profession, and Various methods of treatment : also a variety of valuable prescriptions that have been thoroughly, tested in an active prac- tice, or to physicians desiring to try our preparations, and Who will pay express charges, we Will send on application a bottle of each free. DIOS CHEMICAL CO., ST. LOUIS, MO. ** - - - 6 ~ sº = ~ 9 ~ irr c -- sºlºiſſºſ", *Nº. Resº juſtinatiºſºlk ~0 Allyſºlº N6 Šs Of Chirº DERVATIVES: sº OF THE O) º s §§ (àH2n-6. f fºlbº Nº jºisſiºsº NEURALGIA, RHEIſMaſsM, Tâ 96 –º --~ 5 S ºsſil Niñºsis) *T*_* < * A gº LAGRPPETANDALutºstuffs ºfsiriſ RISUtº The GENUINE is put up in two forms only:-‘‘POWDERED’’ AND “FIVE cral N TABLETs.” Samples of each, with full information, sent free on application to THE ANTIKAMNHA (CHEMICAHL CO., E- ST. LOUIS, MO. *YALEF SURGICAL CHAIR.T The “Yale’’ is the most complete Chair ever offered to the Surgeon, Gynae- cologist, Oculist or Aurist. Every posi- tion known to the profession is easily and quickly obtained. Has the largest range of movements. Can be firmly locked in any desired position. Does 265 away with moving patient to get dorsal". position ; Secures the most desirable in- clinations for the Sim's position, can be tilted backward to revive patients from an asphyxiated condition Can *º º ºw. *Sir be raised, lowered, revolved or tilted Fig. IX---Chloroform Narcosis Position. # = With patient in position to get the best Head of Patient at a Downward == ... lights. It is the strongest and most Angle of 46 Deg. Position. substantial Chair made, sº TO THE PROFESSION. It is fully protected by numerous Letters Patent, thus giving us absolute control of many special features which make our Chairs so conspicuous. . We will promptly enjoin any one from using the said improvements. CAUTION:--Beware of unscrupulous agents, representing, themselves as selling for us. There is only one “Yale’’ Chair and One - : -ºº::::: Canton Surgical and Dental Chair Co. at Fig XIII.:S Canton, Ohio. - 2. * Send for Illustrated Catalogue - and full description With large cuts, showing nine leading posi- tions, from which an endless num- ber of modifications are obtained. Decidedly the best Chair on the market for the price. = Manufactured only by THE CANTON SURGICAL AND DENTAL CHAIR CO., §: Manufacturers of Canton and Yale Surgical and Gould Dental Chairs, CANTON, OHIO, U. S. A. º º: !,”, “ .-- t . ; : . - | r SEND For OUR PAMPHLET. vº & | *- sIEIHINT*T* I FIFRIEHIET: IT CONTAINS VALUABLE SUGGESTIONS AND FORMULAS OF MUCH USEFULNESS. - THE CORNELL-PHENEGER CHEMICAL CO. corºlºr=Us, Ofºto- 8 -&#- º is a skiff{uſtº propazo& cowbiwottow of 9ſtoct-cowoozłºwg, ğat- cowcott. &** as cºmb Štazch-convozłing 9ſſatovicſe, acièiftob with the owcºſt propoztiow \º of Ölciès aſ ways prosowt in the hootthº otowoch. Jº is a woot vatuatºo bigooting agent, cºw8 SUPERIOR To PEPSIN_ALONE.”—Prof. ATTFIELD, Ph. D., F.R.S., &c., Arof. of Practical Chemistry to Pharmaceutical Society of Great Britain. Cº. LACTOPEPTINE. The most important Remedial Agent ever presented to the Profession for DYSPEPSIA, WomiTING IN PREGNANCY, CHOLERA INFANTUM, CoNSTIPATION, and all Diseases arising from Imperfect Nutrition. LACTOPEPTINE IN. CHOLERA INFANTUM. We desire to direct special attention to the great value of Lactopeptine in Choler- Infantum, and other intestinal troubles incident to the heated term. Send address for our Medical Almanac, containing valuable information. The New York Pharmacal Association, IP. O. Box 714. NEW YORK. COLUMBUS MEDICAL JOURNAL A MONTHLY JOURNAL OF MEDICAL scIENCE. VOL. 10. OCTOBER, 1897. No. 4. COMMUNICATIONS. AVO 7TES ON THE AEXAMINATION OF APPL/CAN 7S AſOA’ AAEAVS/OAV AAV/O ///7/2 //WSO/A’AAVCAE. BY CHARLES H. MERZ, A. M., M. D., SANDUSKY, OHIO. The following notes are offered to those engaged in making examinations of applicants for Life Insurance and Pensions. It is desired to give a concise outline of the main points to be ob- served in such examinations, and while they are not intended to form complete directions, they will serve as a guide to system- atic observation, and it is believed they will save the examiner much time and prove trustworthy aids to the memory. The writer was led to prepare them for his own use more than two years ago. Every one engaged in such work has, at times, felt the absence of a well outlined plan of procedure. A thorough and satisfactory examination can only be made by pursuing a systematic course, without the adoption of which the most ex- pert examiner will omit important points and lose sight of serious defects. - g - The following furniture and instruments are indispensable: a fixed measuring rod and slide, good scales, steel tape-measure, vision test cards, astigmatic chart, an operating table or lounge, I45 I46 COMMUNICATIONs. a set of steel sounds, an ophthalmoscope, a stethoscope, and urin- ary test apparatus. The applicant should be examined in the following order: Ascertain his height, weight, and age. Inspect the general physique, skin, Scalp, cranium, eyes, nose, ears, mouth, face, neck, and chest. Examine the heart and auscultate the lungs. Ex- amine for hernia and diseases of the genital organs. Examine the abdominal organs. Test the hearing and vision. Ahysique. Note whole form; general appearance and bear- ing, whether robust or debilitated. Observe curves of spine. Are the size and length of thorax, size and appearance of abdo- men, and upper and lower extremities well-proportioned 2 Ob- serve color, shape, and movements of face. Are height and weight balanced 2 Note the effects of disease and bad habits. Skin Yellowness indicative of jaundice; paleness, of anemia, scrofula, consumption, and cancer; dark violet, of ob- structed circulation; puffed and dingy hue, of organic heart dis- ease; sodden, waxy, dry, and rough, of kidney disease. All chronic, contagious and parasitic diseases, nevi and chronic ulcers. Sca/ . Examine for £2mea capitºs and alopecia. Papular eruption of syphilis. Cranzum : Abnormally large head. Deformities conse- quence of fractures. Lesions of skull result of complicated wounds. Caries and exfoliation of bone. Injury to cranial nerves. Here as elsewhere, locate all wounds and injuries. Are sears tender, adherent, or dragging 2 Ayes: Contraction of the pupil observed in inflammation of retina or brain or apoplectic effusion near the poms varoliz. Dilat- ation of pupil, seen in most cases of hydrocephalus and apo- plexy, in nerve blindness (amaurosis), glaucoma, cataract. In- activity of pupil (Argyle-Robertson) under changes of light com- mon in locomotor ataxia. Different states of the pupils show disorder, either ophthalmic or central in site. Arcus senz/as— sign of fatty degeneration. Range and extent of vision. Look for conjunctival affections, trachoma, entropion, opacity of cornea, pterygium, steatismus, conical cornea, cataract, ectropion, ptosis, abscess of orbits, nystagmus, myopia, hypermertopia, presbyo- pia, glaucoma, diplopia. Mose: Note deformities altering the voice and respiration, or disfiguring the face. Stenosis of nasal passages. Purulent or fetid discharges. Chronic rhinitis (ozema). Polypi. Evi- dence of syphilis. MERz—Moſes on the Earamzmatzon of Applicants, Etc. I47 Ears : Lobes full and glistening in gouty diathesis. Wrinkled in prolonged cachexia. Note deafness of one or both ears and all catarrhal and purulent forms of acute and chronic offitis media. Polypi. Perforation of drum. Degree of deafness by watch and voice. Malformations of external ear. Ulceration. Closure of external meatus. 77mmitus aurium suggestive of brain, nervous debility, quininization, or disease of ears. Amount and character of cerumen. Tumors, malignant disease, syphilitic eruptions. Mouth and Tongue: Tongue protruded with difficulty in apoplexy, cerebral paralysis (bulbar sclerosis, glosso-labio-phar- yngeal paralysis), or thrust to one side in hemiplegia. Pallid in anemia, red in glossitis, furred in indigestion, gastro-hepatic catarrh, bare of epithelium in advancing phthisis. Tender, smooth, shining and frequently covered with little ulcers, in chronic diarrhea. Abnormally clean, fissured, and red in dia- betes millitus. In constitutional syphilis, inflamed patches; often condylomata. Broad, pale, flabby, and indented by the teeth in atonic dyspepsia. Hypertrophy or atrophy. Adhesion to any part preventing free motion. Malignant disease, chronic ulceration. Loss of part of lip. Mutilation of lips from burns -or wounds. Anchylosis or deformity of either jaw. Gums : Scurvy indicated by swollen, spongy, easily bleed- ing state. Blue line in lead poisoning. Red line often noticed in phthisis. Teeth. Notched incisors, of inherited syphilis. Rapid decay in impairment of constitution. AVeck : Note glandular swellings or scars of superficial glands. Goitrous enlargements. Violent action of carotids as indicative of aortic regurgitation. Wry neck. Tracheal open- ings. Stricture of esophagus. Throat and voice: feeble from debility; hoarse from laryngeal inflammation and tumifaction ; thick from cerebral oppression. Aphonia in laryngitis and paralysis. Articulation altered in nervous diseases (monotonous scanning speech of cerebro-spinal sclerosis). Faucial inflamma- tions shown in redness and swelling, with or without enlarged tonsils. Relaxed and elongated uvula. Fetid discharge. Small red prominences. Distended ducts. Shining and dry Eusta- chian tubes in bold relief. Ulceration of idiopathic syphilitic or tuberculous nature. º Chest : Observe respiration. Normally about 18. Note dysp- nea as indicative of asthma, dilatation of heart; aneurism of . aorta, mediastinal cancer, pleuritic effusions, abdominal dropsy, I48 COMMUNICATIONS. etc. Sighing respiration of heart trouble. Cheyne-Stokes respi- ration from fatty degeneration of heart. Note any malforma- tions of chest. Fractures with deformity. Caries or necrosis of ribs. General shape, size and movements of chest. Inequality of the two sides. Capacity in expiration and inspiration. Look for general expansion or local bulging. Retraction or local de- pression. By percussion, note clearness or dullness of resonance; duration and special character. By auscultation, note normal vesicular murmur, prolonged expiratory sounds, harsh tubular blowing, bronchial cavernous and amphoric sounds. Note sibi- lant, sonorous or dry rales. Observe dyspnea as originating from hydrothorax and edema of the lung, or affections of mitral valves or Bright's disease. Hemoptysis—if from lungs, blood bright arterial hue, alkaline in reaction, full of air bubbles. May be from mouth, nares or stomach. Pulse : Examine as to (a) muscular force of heart walls ; (b) state of cardiac valves; (c) muscularity of arteries; (d) elas- ticity of arteries; (e) state of capillary circulation ; (/) qualities of blood; (g) condition of nervous system. Debility produces slow pulse. Feeble heart, feeble pulse. Observe irregularity connected with mitral insufficiency and jerking pulse (Corrigan) of aortic regurgitation. Deficient elasticity indicating atheroma, fatty or calcarious degeneration. Feel both wrists. Examine carotids. Notice temporal arteries, if tortuous and distended as indicative of gouty diathesis. Compare cardiac impulse with arterial pulsation. Any difference indicates trouble in aortic valves or in arterial system. Observe difference in standing and sitting as indicating nervous debility. Note relation between pulse and respiration——normally four pulsations to one respira- tion. Rapid heart and slow respiration indicate functional or or- ganic heart trouble. Acceleration of breathing, with little in- crease of pulse indicates disease of respiratory organs. Jerking pulse of aortic regurgitation. Intermittence may be nervous or twitching of heart muscle; persisting with feeble pulse, indicates dilatation. Radial intermittence Inay accompany regular beat— result of stenosis of aortic valvular outlet from left ventricle and fatty degeneration. Irregularity from derangement of rhythm is of serious import—mitral disease, dilatation, brain trouble (structural), or excessive use of tobacco. * A/eart: Locate. Note impulse. May be displaced by liver, pleuritic effusion, emphysema, deformity of spine, cancer of 1ungs, or aneurism. Depression suggests previous carditis; sometimes congenital. Locate valves. Pulmonary immediately MERZ—AVotes on the Examination of Applicants, Etc. I49 behind junction of third left costal cartilage with sternum. Aortic lies just below pulmonary, behind third intercostal space at left edge of sternum. Tricuspid behind middle of sternum on level with the fourth costal cartilage. Mitral valves are be- hind third intercostal space about one inch to the left of the sternum. Distinctive sounds of various valves heard best as follows: Pulmonary in second left intercostal space near ster- num; aortic in second right intercostal space near sternum; tricuspid at midsternum above ensiform cartilage; mitral imme- diately above the apex beat. Note sounds, first and second ; rhythm ; murmurs, endocardial or valvular; pericardial or fric- tion sound. In order of frequency—mitral regurgitation, aortic obstruction, aortic regurgitation, mitral obstruction, pulmonary obstruction, tricuspid regurgitation, tricuspid obstruction, pul- monary regurgitation. In hypertrophy of the heart, look for valvular lesions, aneurism, pericarditis with adhesions, Bright's disease, emphysema. In dilatation, look for obstruction from weakness of muscular walls of heart from fatty degeneration or malnutrition. - Abdomen ; Note any alteration in size or shape as caused by hernia, tympanites, ascites. Local tenderness on pressure. Enlargement or atrophy of liver or spleen. Note mesenteric dis- ease, cancer, aneurism, distension of bladder. Determine na- ture of any tumor found. Abdomen is retracted in emaciation, lead colic, and some cerebral diseases. Note tenderness, constant and limited to epigastrium, coated tongue, and vomiting of mucus or food in chronic gastritis. Dilatation of stomach by cancer. Explore rectum for piles. Note inflammation, bleed- ing, or ulceration, Engorgement of hemorrhoidal vessels. Tu- mors, size and number. External, or internal, bleeding, or ulcerated. Prolapse of rectum. Examine for hernia. Note size and kind. Reducible or irreducible. Direct or oblique. Size of abdominal rings. Impulse on coughing. Varicose veins, size, condition of integument, tending to rupture or ulceration. Note color of urine, odor, reaction, quantity (40-50 fluid ounces for a man in health weighing 150 lbs.). If abnormally small amount, suspect congestion of kidneys, cirrhosis of liver, acute or chronic catarrhal nephritis, or some affection of the heart. If abnormally large in quantity, suspect diabetes, organic degener- ation of kidneys, or hysteria. The specific gravity varies from IOI 5 to IO25. When below IOI 5, look for some exhausting in- flammatory disease. When above IO25, if pale and limpid, sus- pect sugar. If persistently above IO35, there is almost certain I5O COMMUNICATIONS. proof of diabetes mellitus. Test for albumen and sugar. Ex- amine for blood, bile, mucus, pus, urea, uric acid, urates, oxalate of lime, tube casts, epithelium. Note any acute affections of genital organs—gonorrhea and venereal sores, phimosis, stric- ture, hypertrophied prostate. Retractiqn or loss of testicles, hydrocele of tunic, or cord, atrophy of testicle, malformation, urinary fistula, stone in the bladder, cystitis. Mervous System : Observe movements of hands, incessant and jerking in chorea. Often in one arm and hand only in par- alysis agitans. With tremor seen in voluntary motions alone in multiple cerebro-spinal sclerosis. Often rhythmical opening and closing of hand successively in athetosis. Hemplegic patient will circumduct feeble limb after the other. In para- plegia shuffles along the floor. In hysterical paralysis, drags lame limb behind the other. The spinal spastic paralytic rises on the toes with legs close together. The shaking paralytic trots, stooping forward. In locomotor ataxia he lifts the feet and Ricks out forwards or sideways, bringing the heels down with a stamp. In locomotor ataxia the patellar reflex is abolished. In spastic spinal paralysis it is exaggerated. Note vertigo or spasms, convulsions, nausea, diplopia, if pupils are equal in size and normal. Examine retinal fluid. Note area and degree of loss of sensation with the esthesiometer. Measure loss of power with the dynamometer. Examine mental condition. ‘Look for paralysis of bladder and bowels, anesthesia or hyperes- thesia of skin. Stand on one foot with eyes closed. Observe gait with eyes open and closed. Note hiccough, dyspnea, sigh- ing, pain or difficulty in deglutition. Look carefully for evi- dences of syphilis, tobacco, alcoholic or venereal excesses. Zºmbs and /oints : Enlarged articulations may be gouty, scrofulous or rheumatic (rheumatoid arthritis) gradual swelling and stiffness, with but little inflammation. Gouty finger joints are swollen and distorted by carbonates and urates. Clubbed finger ends and incurbated nails are found in ordinary con- sumption. Nails are often striated after gout. Severe sprains, relaxation of ligaments or capsule of joints, badly united fractures, rickets, caries, necrosis, atrophy, paralysis, retraction or perma- ment contraction. Locate and describe scars—dimensions, whether adherent or tender. Note any loss of tissue. In rheum- atism look for want of power, tenderness, crepitation on motion, thickened ligaments, fibrous anchylosis, reflex spasm. Search for damage to cardiac structures. Duration an element. Diagnose locomotor ataxia and pains of hepatic origin. Note: MERz—AVotes on the Examznation of Applicants, AEtc. I5I condition of all joints, muscles and tendons. Extent to which stiffened, extent of atrophy, shown by comparative measure- ments. Note chronic diseases of joints, old or irreducible dislo- cations, or false joints, loss of a limb or any portion thereof, webbed fingers, anchylosis, loss of any finger, club foot, flat foot, webbed toes, overriding of toes, loss of any toe, “hammer toe,” anchylosis of any joint, extent and character, whether fibrous or bony anchylosis. Such is a general outline of the points to be examined and the order which is found most convenient. While not exhaust- ive nor complete, they will serve as handy reference notes. CASAE OF APRACTURAE AAV/O /D/S/LOCA 7TWOAV O/7 THE SP/WE, W/TH OPERATION. * By A. W. RIDENOUR, M. D., MASSILLON, OHIO. In view of the rarity of these cases with the almost invari- able result, I have thought proper to report a case that marks a new era, at least in my practice. We will remember at the start the severe trauma the cord underwent; the bones crushed, 1muscles and ligaments torn loose. December IIth, 1890, Martin Nye, aged twenty-eight, laborer, while driving through a shed on a load of lumber was caught between an over-head beam in such a manner as to crush the center of his back forwards at an acute angle, frightfully lacerating and crushing both hard and soft parts in that region. Within half an hour after the accident found the patient pulseless, skin cold and clammy, respiration sighing, very rest- less, jactitation, suffering frightful pain in back, sensation and . motion absent from injury down. Knee jerk absent, reflex ab- Sent. On inspection at seat of injury found depression of fully one inch corresponding to seventh dorsal vertebra, with absence of spinous process of eighth dorsal. This at once led me to inform the patient and friends of the exceeding gravity of the case, and that the only hope of life lay in a speedy operation. Consent was readily given and at once carried out. * This paper was prepared by its gifted and lamented author for the recent meet- #. of the Ohio State Medical Sociely, where it was read by title, while he lay on his eath bed. I52 COMMUNICATIONS. With the usual and necessary antiseptic preliminaries an incision about twelve inches long was made, commencing at the third and terminating at the ninth, dorsal, separating muscles from either side and exposing all bony-roof of cord from the sixth to and including the ninth dorsal. The muscles were crushed, soft, pulpy and mangled beyond recognition in region of injury. The lamina of the seventh dorsal was broken and separated from the body; transverse process either side of seventh, fractured, with facet for ribs torn completely off; ends of ribs stuck up in wound; the body of seventh vertebra was dislocated forwards fully one inch, nearly slipping out in front. Spinous process of seventh vertebra was split and crushed. The spinous process of the eighth dorsal was not only split, but actually inverted, penetrating the cord, crushing it. The lamina of eighth fractured ; the body of eighth fractured but not dislocated. The membranes were punctured and badly lacer- ated at different points with free hemorrhage in the arachnoid space. The cord was crushed at juncture of seventh with eighth by the inverted spinous process of eighth ; the cord was carried forward with the dislocated seventh vertebra ; compression at juncture with sixth and eighth. Altogether I cannot conceive a more frightful injury unless we might include cutting off the cord and immediate death of patient. - Did not use trephine; did not have to. Do not think it safe to trephine the spine. The bones being soft can be sepa- rated readily with safer bone instruments. Removed all bony roof from the middle of ninth dorsal to and including middle of sixth dorsal vertebra ; passing my finger between the body of seventh dorsal elevated it into position ; smoothed all rough or sharp bony prominences; removed all clots ; stopped all hemorrhage; replaced dislocated ribs as well as I could without any articular facets, and placed strands of catgut along bottom of wound in such a manner that the cord could not come in contact with them or, in fact, with anything, requiring some care here in the disposal of remaining bones and overlying muscles. Sutured muscles carefully on either side; sutured skin, applied dry dressing. The after treatment of this case was uneventful. The sen- sation returned at once in both lower extremities; motion per- ceptible in recti muscles at the end of fourth day. Compelled to use catheter to pass urine until the seventh day, when it passed normally. No control over sphincter ani until the end RIDENOUR—Case of Fracture and Dislocation, Etc. 153 of first week, restored. Knee jerk restored at the end of second week; could raise limb fron, bed at end of fifth week; can walk with crutches at end of three months. Applied plaster-of-Paris jacket for support at end of second week. The wound healed without any pus and with three dress- ings, primarily in one week. No fever at any time. Urine did not present any albumen or sugar; no casts or abnormal de- posits, sp.-gr. IO 20. - Patient suffered no pain after operation ; no atrophy of muscles of lower limbs since operation ; joints not thickened. Patient walks about with aid of cane, June 5, 1891. The patient is under care of Dr. Marchand, of Canton, and is at the Stark County Infirmary. The doctor reports the patient as rapidly recovering his bodily vigor, can get around readily, and that the plaster was removed during April. There is no deformity at all. I would have wished the plaster had remained on longer, but it seems no ill effects followed its re- moval. I was kindly assisted in the operation by Drs. Miller and Reed, of Massillon. The only plea I have to make in these cases where the diagnosis is made, is for an immediate, thorough and careful operation ; a few hours' delay, in my opinion, is sufficient to render the operation futile, and I have no hesitation in placing the cause of failure in so many of these operations to delay. Some eight years ago I reported a case to this society where I had made the operation three years after injury, with the result of complete failure, patient dying two weeks after of acute albuminuria. - But in doing this work the utmost care is required, not only in removing all bony or other foreign materiai from the vicinity of the cord, but that no possible chance for subsequent hemorrhage or pressure from exterior cause can occur, as even the pressure of superimposed muscle will be sufficient to deprive the cord of life, or a small shaving of bone will cause inflamma- tory softening and death. Slight hemorrhage will cause a clot that will act more rapidly than in the brain, in causing death ; but the operation can be done and should be made safe by care and without hurry, and I repeat without delay. No patient should be allowed to die without an attempt by an operation to save him. 7A/AE SOA’G/CA/, 7A’AºA 7TMAEAV7" OA’ CA/A&OAV/C CA 7TAA’- RHAL APPEND/C/7/s. By R. HARVEY REED, M., D., MANSFIELD, OHIO. A Paper read before the Ohio State Medical Society, June, 1891. (Condensed.) Whilst catarrh in the more limited sense of the word is in- tended to indicate a flow or discharge from a mucous surface, according to the older authors, yet by the most recent writers it has been given a wider scope, and consequently it has been applied to general inflammations of the mucous membranes, which, of course, may be either acute or chronic. Again, whilst catarrhal inflammations of the mucous mem- branes are usually accompanied by more or less discharge, yet we may have a chronic inflammation of a mucous membrane with little or no discharge, in which case there is usually an atrophic condition of the membrance. Usually, however, there is hypertrophy of this membrane with an excessive mucous or even muco-purulent discharge, which is not infrequently associ- ated with a circumscribed necrosis of the mucous membrane, which in chronic catarrhal appendicitis frequently extends to and may even involve the serous coat of the appendix, producing a complete perforation. The peculiar location of the appendix vermiformis, associ- ated with its anatomical construction and relations, predisposes this particular portion of the digestive tract to chronic catarrhal inflammation. Some one has said that the absorbent properties of this ru- dimentary attachment are greater in proportion to its size than any other portion of the alimentary tract; and hence the liquid portions of the contents of the intestine which find their way into the appendix are more rapidly absorbed and therefore leave a concrete mass which becomes a foreign body, and sets up an in- flammation of the mucous membrane. As to the truth of this statement, I am not prepared to give any opinion ; but it seems to me that owing to the small diam- eter of this appendage, which opens above the cecum, from which gravity alone will promptly supply it with both liquids and solids at all hours of the day or night, it is easy to account for I54 REED–7%e Surgical 77-eatment, Etc. I55, the formation of concretions. Under the circumstances there must be more or less stasis of the contents of the appendix ver- miformis, which ordinarily must be emptied of its contents by a sort of a vis a tergo process, which we must all concede is not very active. In addition to these concretions which are found so fre- quently in the appendix, it is liable to be invaded by cherry pits, grape seeds and the like, which have the same effect on it as the concretions, Again, we may have a chronic appendicitis following an at- tack of acute enteritis or even an attack of peritonitis, metritis, salpingitis or ovaritis, which often results in adhesions of the appendix to some of these parts. It is only a few weeks since I operated on a case, where I found the appendix firmly attached to the fundus of the uterus and which was greatly enlarged and thickened by chronic inflammation. Again, I have found it ad- herent to the broad ligament, the fimbriated extremity of the Fallopian tube, and even the ovary. The next important question is, how shall we determine the existence of chronic catarrhal appendicitis with practicable accuracy P & We must all admit that simple acute appendicitis, or sup- purative perityphlitis, is easily diagnosticated; but when it comes to making an accurate diagnosis of chronic catarrhal ap- pendicitis, it is much more difficult. It is true, that many cases of chronic catarrhal appendicitis fail to come under the notice of a surgeon until they are suffering from an exacerbation of their chronic trouble, or an acute attack of appendicitis which is threatening life. Yet, when these chronic cases do present them- selves to the surgeon during the intervals of their recurrent at- tacks of acute inflammation, then is the time for the surgeon to determine the exact nature of his case and follow it with prac- tical and timely advice, and not wait for an inflammatory erup- tion to occur before he decides what it is, or what he will do for it. The point was well taken by Fitz when he claimed that usually the primary causes of every perityphlitic abscess were the result of a perforative appendicitis (and, we might add, or a chronic inflammation of the appendix which so frequently re- sults in perforation sooner or later). This being true then, it is easy to see the importance of making a clear diagnosis as early as possible. In order to do this you will find it important to ascertain the condition of the bowels; for if you have constipation alternating with diarrhea I56 COMMUNICATIONS. and accompanied with circumscribed tenderness over the region of the right iliac fossa, it is well to be on the lookout for a case of chronic catarrhal appendicitis, and especially so if there is a History of an attack of acute perityphlitis. If the case is in a woman, you may be able to feel the thickened appendix by placing one of the index fingers well up in the right horn of the vagina whilst you palpate over the region of the appendix with the other, excepting in cases where the abdominal walls are very thick and firm. In this class of cases you can easily distinguish between the ovary and the appendix by remembering that when you Squeeze the ovary it produces a sickening sensation, whilst pressing on the inflamed appendix produces only pain without this peculiar sensation of nausea. w In the male, the very fact that you have a circumscribed tenderness over the region of the right iliac fossa is sufficient evi- dence, barring the bare possibility of hernia, to arouse your Susp1c10ns. If the irritation is very marked, you may have vomiting as well as constipation with all the symptoms of intestinal obstruc- tion. I have seen numerous cases of this character where there was every apparent evidence of obstruction to the intestinal tract, but which in reality was not obstructed at all only so far as the inflammation of the appendix extended to the muscular walls of the cecum and produced temporary paralysis. I recall one case in particular which I reported some years ago, in which there was a strangulated hernia of only the appendix, in which there was every symptom of occlusion of the bowel, which was relieved by an operation just as promptly as if we had had a real obstruc- tion of the intestines. I speak of this to show you that inflam- mation of the appendix will produce constipation and even ster- coraceous vomiting just the same as complete obstruction. In the severer forms of chronic catarrhal appendicitis the pain may occasionally be referred to the umbilical or epigastric region. Again, the patient, if a close observer, may notice mucous or muco-purulent discharges attached to his stools which, of course, might come from some other part of the intestinal tract, but if he has circumscribed tenderness over the region of the appendix and no marked tenderness elsewhere along the ali- mentary canal, it is reasonable to conclude that it is more prob- able that it comes from the appendix than elsewhere. Again, if a patient comes to you complaining of either gastric or intestinal indigestion, or both, accompanied with a circumscribed tenderness over the region of the right iliac fossa, look out for a case of chronic catarrhal appendicitis. REED–7%e Surgical Treatment, Etc. I57 In a patient where the abdominal wall is very thin and the appendix is very much thickened, you may be able to trace it by a careful digital examination associated with percussion. Rectal examinations are only beneficial for obtaining nega- tive results; for instance, a patient is having mucous and muco- purulent discharges associated with the stools, and it is a ques- tion whether the mucous comes from the rectum or higher up, then an examination may decide the question which previously may have been one of doubt. I have already spoken of attachments which may occur in the female between the appendix and the uterus or some of its appendages; of course in the male these can all be excluded, but we may have omental attachments, which are common to both. I remember holding a post-mortem a few years ago on a physician who died of rupture of the heart, who during life had frequently referred to a tumor in the right iliac fossa, and who had frequent attacks of gastric and intestinal indigestion, which the autopsy revealed to be undoubtedly the result of chronic ca- tarrhal appendicitis, as we found the appendix attached to a role of omentum, no doubt the sequel of chronic inflammation. Having fully decided that you have a case of chronic catar- rhal appendicitis, the important question that confronts you is, How shall we treat it 2 - Of course, the timid and uncertain doctor will always advise the expectant treatment, and is ever ready to “wait for some- thing to turn up,” which advice the unsuspecting patient is usually very ready and willing to accept. Arnica, poultices, liniments and blisters form the chief weapons of external “warfare” under these cireumstances, whilst “blood medicine,” “liver pills” and “tonics” are given to fortify- the inner man against the invasion of this subtle foe. The patient gets better and worse, alternately, from time to . time, until finally a crisis comes. By this time, however, the catarrhal inframmation has done, its work and a perforation has taken place, and the result is an attack of perityphlitis. Acute circumscribed, or even general, peritonitis has set in, and death is staring the patient in the face. A surgeon is sent for, but it is too late, and the undertaker completes the work of expectancy. If, however, nature comes to the rescue and throws up a fortifi- cation, so to speak, of plastic material around the perforation, and confines the escaping contents of the perforated appendix to a limited area, then you will most likely have a perityphlitic ab- scess, which the surgeon’s knife may relieve and permit your I58 COMMUNICATIONS. patient to get well, with a lot of peritoneal adhesions and gen- eral thickening around the end of the cecum, which may possi- bly involve the ileo-cecal valve, and lay the foundation for a case of intestinal stenosis at some time in the future. In illustration of the above I recall a case, to which I was called in counsel a few years ago of a young man whom I found dying from acute peritonitis, which I diagnosed as a result of a perforation somewhere in the region of the appendix. A post- mortem confirmed my opinion, and revealed a concretion in the appendix which had set up a chronic catarrhal appendicitis, fol- lowed with perforation, general peritonitis and death. I might go.on multiplying these cases, but that would only be occupying your time to no advantage, and would prove noth- ing more than I have already proven. - There is no question in my mind but that a timely amputa- tion of the appendix in these cases would save lives and secure health and comfort. It was my good fortune on one of my visits to Professor Senn's clinic, at the Milwaukee Hospital, to see him examine a case and diagnosticate chronic catarrhal appendicitis, and witness him operate on the same case and remove from a young man a thickened appendix, the resullt of chronic inflammation, the walls -of which had almost ulcerated through in several places, pro- .ducing a perforation which no doubt would have occurred in a short time. In answer then to my question, “How shall I treat these cases P” I will reply: By all means amputate the appendix just as soon as you are positive of the existence of chronic catarrhal inflammation of the same. Don't wait for something to turn up—those days are gone by ; be accurate and active, and don’t wait for the undertaker to come to your rescue and bury the re- sults of your procrastination beneath the sods of the valley. The operation is an easy one and not attended with any marked danger to life, if properly performed under strictly aseptic pre- cautions. In fact, the patient assumes more danger every day he lives harboring a difficulty of this character than he does in having it removed by an operation. Again, you have the satis- faction of knowing that, like a sheep’s tail, the appendix is neither useful nor ornamental, and the sooner it is cut off the better. In amputating the appendix, it is only necessary to make an incision over the region of the appendix parallel to Poupart's ligament just large enough to expose the end of the cecum and REED–The Sung zeal 77-eatmen/, AE/c. I59 its rudimentary attachment. Then ligate the appendix as close as possible to the cecum with an aseptic silk ligature, snip off the offending rudiment with a pair of scissors, cover the stum carefully with a hood of the omentum, which should be held in place with a few aseptic silk stitches, make your toilet carefully and close up the external wound and cover it with an antiseptic dressing; place your patient in bed and keep him there until the parts are thoroughly united and have regained strength enough to resist the tendency of ventral hernia. When this operation has been successfully performed, you have removed the ax, so to speak, which was hanging by a frail thread over the head of your patient and daily threatening his life. You have given him a new lease of life with an extended expectancy of the same, and made a patient who was once unin- surably a fit subject for insurance, saying nothing of the com- fort, both mental and physical, you have afforded him by the operation. Then, as Solomon says, “the conclusion of the whole mat- ter is :” §e Ist. That the appendix vermiformis is a useless rudiment of the cecum. 2d. That chronic catarrhal appendicitis is always dan- gerous and liable to be followed at any time with hazardous and even fatal results. 3d. That medical treatment is of little or no permanent value in this class of cases. 4th. That the only safe and reliable method of treating chronic catarrhal appendicitis, and the only treatment that will promise permanent relief to your patient, is prompt amputation of the appendix. AºA) EMA AU/LA/OAVU//. By DR. E. S. M'KEE, CINCINNATI, O. Grossmann' has made some remarkable experiments con- cerning edema of the lungs in Vienna. He has found that an acute pulmonary edema occurs in dogs, and not, as hitherto sup- posed, in rabbits alone, from obstruction of the left auricle and compression of the left ventricle. He has learned that transu- -dation plays but a secondary role in the causation of dyspnea, and that the most important obstruction to respiration is the in- I6O COMMUNICATIONS. flexibility of the lung on account of the edema. On account of the vascular engorgements there occurs an enlargement of the alveolar spaces, that is, an enlargement of the lungs. He con- siders transudation a factor of no importance in dyspnea. We not only have a congestion and edema through muscarin intoxi- cation, but also swelling and stiffness of the lungs and bronchial cramps. He thinks that his investigations prove the primary cause of congestion of the lungs to be the narrowing of the left side of the heart, contrary to the theory of Conberm-Welch, who considers it due to paralysis of the left side of the heart. Moyer, * contrary to his previous belief, has found pilocarpine to have a most happy effect on the treatment of pulmonary edema. 1 Medical News, Aug. 16, 1890. 2 Meñlical Standard, Sept., 1889. Medical News, Aug. 16, 1890. ADVICE TO A YOUNG DocTOR.—The following letter, written eighty years ago by Dr. Benjamin Rush, applies so well to present conditions and is so full of sound advice that we publish it here: (Med. A'ecord.) a. “PHILADELPHIA, April 21, 1812. “DEAR SIR : The faculty with which a medical education is acquired in our country has multiplied physicians to such a degree that I do not know of a spot in the United States in which you would fix yourself with more advantage than in the one you now occupy. Competition and slow pay are now the conditions of a medical life everywhere. My advice to you is to remain where you are; you will grow with the growth of the settlement. Purchase upon credit, if possible, a small farm ; a little debt will make you industrious and furnish you with an excuse to send in your bills as soon as your patients recover. Employ the leisure which a healthy season will give you, in agricultural labors; the more you will obtain in this way the more independent you will be of your patients, and, of course, the more you will be courted by them. Happiness does not con- sist in wealth. A competence, books, alternate 1abor and ease, to use the words of the poet Thompson, a good wife, a few friends, vicinity to a church, and conduct regulated by the principles of the Gospel constitute the sum total of all the happiness this world is capable of giving, and these may all be possesséd and enjoyed in your present situation. “From, dear Doctor, “Yours truly and affectionately, “BENJ. RUSH. “TO DR. PETRIKEN.” 9 I D Y S I Fº I H I Fº S I C JAL - Liquid PANGREoPEPSINE W.M. R. WARNER & CO.) A REMIEIDY I FOIR, INIDIG-IESTION. Containing Pancreatine, Pepsin, Lactic and Muriatic Acids, etc. The combined principles of Indigestion. To aid in digestion animal and vegetable cooked food, fatty and amylaceous substances. DoSE.—A tablespoonful, containing five grains Pepsin, after each meal, with an Aperient Pill taken occasionally. This preparation contains, in an agreeable form, the natural and assimilative principles of the digestive fluids of the stomach, comprising PANCREATINE, PEPSIN, LACTIC AND MURIATIC ACIDS. The best means of re-establishing digestion in enfeebled stomachs, where the power to assimilate and digest food is impaired, is to administer principles capable of communicating the elements necessary to convert food into nutriment. The value of LIQUOR PANCREOPEPSINE in this connection has been fully established, and we can recommend it with confidence to the profession as superior to pepsin alone. It aids in digesting animal and vegetable cooked food, fatty and amylaceous substances, and may be employed in all cases where from prolonged sickness or other causes, the alimentary processes are not in their normal condition. IERIH II EDTUTIMIATISM I. *Elixir Selic S7-lic -4-cid. Corºn-p- (WM. R. WARNER & CO.) This preparation combines in a pleasant and permanent form, each fluid drachm, the following B. Acid. Salicylic (Schering's,) grs. v. Potass. Iodid........................... grs. iss. Cimicifuga............... ..... grs. iś4. Tr. Gelsemium........................ gtt. i. So prepared as to form a permanent, potent and reliable remedy in RHIECUMLATIs M, GOUT, LUMEAGO, IETC. This preparation combines in a pleasant and agreeable form : Sali- cylic Acid, Cimicifugae, Gelsemium, Sodii Bi-Carb, and Potass. Iodid. so combined as to be more prompt and effective in the treatment of this class of diseases than either of the ingredients when administered alone. This remedy can be given without producing any of the unpleasant results which so often follow the giving of Salicylic Acid and Salicylate of Sodium, viz., gastric and intestinal irritation, nausea, delirium, deafness, nervous irritability, restlessness and rapid respiration; on the contrary, it gives prompt relief from pain, and quiets the nerves without the aid of opiates. Elixir Salicylic Acid Comp. has been extensively used in private practice for several years with almost unvarying success and better results than any other mode of treatment yet suggested. It is a matter of great satisfaction to us to be able to place before the medical profession a remedy so effectual in the cure of one of the most stubborn classes of disease. The dose is from a teaspoonful to a desertspoonful, and increased as necessary to meet the requirements of the case. Each teaspoonful con- tains five grains of Salicylic Acid. Elixir Salicylic Acid Gomp. is put up in 12-0Z. square bottles, and may be obtained from druggists everywhere. IPIERIE. PA REID ONLY EY Manufacturers of SOLUBLE COATED PILLS, 1228 Market St., Philadelphia. 18 Liberty St., New York, AGENTS IN COLUMBUS, OHIO : Cornell, Pheneger Co.; Orr, Brown & Price; Kauffman, Lattimer Co. G00A AS A GARDIAG TONIG. Professor Beverly Robinson in an article entitled “Heart Strain and Weak Heart,” states: “Among well known cardiac tonics and stimulants for obtaining temporary good effects, at least, I know of no drug quite equal to coca, Given in the form of wine of fluid extract, it does much at times to restore the heart muscle to its former tone. I have obtained the best effects from the use of “VIN MARIANI.” From personal information given me by this reliable pharmacist, these results are attributable to the excellent quality of the coca leaves and of the wine which he uses in its manufacture.” Referring to “VIN MARIANI,” Dr. Beverly Robinson adds: “In coca also we have a powerful stimulant to the economy that frequently will strengthen or give tone to the nerves in a rapid manner that no other drug with which I am familar can accomplish.” “I have repeatedly felt this effect of Mariani’s Wine of coca on myself when extremely fatigued from overwork or want of sleep. The wine of Mariani is, I believe, one of the best preparations, on account of the great care exercised by its maker.” e Dr. Henry Conkling, in the Brooklyn Medical Journal, Vol. V. No. 3, refers to the value of Coca Erythroxylon as a cardiac tonic. We extract the following: g “In cardiac irritability due to the irritation from the non-elimination of urin- ary products, as shown by the diminution of urea, coca erythroxylon given under the form of “VIN MARIANI” has been most successfully employed. The heart here is frequently in a condition of tremor cordis, and marked muscular debility often remains after the function of the kidneys has become more normal. ‘‘VIN MARIANI” has in our experience, proved most beneficial in restoring and saving muscular force, and thus furnishing a better organ upon which other drugs may act more favorably.” MONOGRAPH BY EUROPEAN AND AMERICAN 0BSERVERS WILL BE FORWARDED 0N APPLICATION. INA CALI RIA-INTT cºc CCD- Paris - 4 Bd. Haussmann. 52 West 15th Street, New York. London: 239 Oxford Street. * MEDICINE ADVERTISING DOCTORS.—There is, it seems to us, a grow- ing dissatisfaction on the part of not a few physicians with that rule of the code of medical ethics that forbids general advertis- ing—a dissatisfaction which many secular journals, foreseeing in the repeal or a general disregard of the rule a new source of income, endeavor to foster. “A dry goods merchant advertises, why should not a physician P” “The rule puts the ordinary physician at a disadvantage as compared with itinerant quacks and others who advertise.” “The rule is not fair, because, while it forbids direct advertising it permits indirect advertising to a favored few, by means of college connections, journal articles, etc.” “Many who pretend to adhere to the rule violate it with impunity by having themselves interviewed on medical topics by the reporters or reluctantly (?) giving them for publication the details of some great (?) surgical operation.” Such are some of the expressions which one may hear any day, from the rank and file of the profession, when the subject of professional adver- tising is broached. Let us examine these complaints as briefly as may be and see whether any of them furnish a ground for the repeal or disregard of a rule which has hitherto been considered both necessary and salutary. What does a merchant advertise ? His goods. What can a physician advertise 2 Himself. This broad distinction sepa- rates the two cases very widely. “Let another man praise thee, and not thine own mouth, a stranger and not thine own lips,” wrote Solomon of old, and the wisdom of the maxim has not been lessened by the lapse of years. The intrinsic impropriety of boastfulness, even if unaccompanied with the mendacity which is almost always united with it, the moral malodorousness of self-praise are too apparent to deserve a discussion or demand a demonstration at our hands. This malodorous impropriety is much increased in professional advertising addressed to the laity by the fact that those who are intended to be reached by it are •eonfessedly unable to judge of the truth or untruth of the state- ments made by and of the advertiser—they can not sample the goods offered nor compare them in either quality or price with those offered by others. These moral considerations ought alone to settle the question, but let us pass beyond and down into the I6I I62 SELECTIONS. lower level of utility. The rescinding of the rule or its general disregard would simply add to the physician’s expenses that of advertising bills. If Dr. A. is permitted to refer to himself as especially skilled, what is to prevent Dr. B. from occupying twice the space to tell in larger type and more magniloquent terms of his own pre-eminence, and so on ad unfinitum ? And what would that mean save the superadding to the loss of self- respect and professional dignity that of money 2 The advertis- ing quack thrives simply because the profession at large do not advertise. The remedy would therefore, seem to be not to repeal the rule of the code of ethics, but to embody in the statutes the idea that any physician or vender of secret nostrums who shall advertise in the public press to do certain things shall be held to guarantee the results promised, and for failure to accomplish. such results shall be liable criminally as for obtaining money under false pretenses. The matter of “advertising” through college connections and articles in journals is both exaggerated and misunderstood by those who claim to see in it an evasion of the code, at least in spirit—exaggerated as to results—the fact being that in the large majority of cases the time expended in teaching and writing is never compensated by the money results that come therefrom—misunderstood, because that sort of “advertising,” if such it may be called, is addressed, not to the general public, but to members of the same profession, who can judge. It further implies, in the matter of college connections, the passing upon the qualifications of the parties by a body of competent men, or board of trustees—and in the case of journals, the cen- sorship of an editor. As to those who modestly put themselves in the way of reporters, to whose wiles they fall unsuspecting victims (?), they are morally and professionally on a par with the woman of easy virtue who repels the “greeney’s” advances only to increase his eagerness. To such “the butt end of the law” should be vigorously applied by prompt expulsion from the societies to which they belong, and absolute subsequent iso- lation from and by the respectable members of the profession. We are not, of course, referring here to the discussion of the principles that may divide schools of practice, or the warning of the people against hygienic and other dangers, but to all refer- ences to one's alleged special skill or knowledge.—Clinical A'e- porter. SELECTIONS. I63 THE TREATMENT OF PNEUMONIA.—A recent number of The Zanceſ contains an important contribution to the treatment of pneumonia by Dr. W. S. Fenwick, of London. This paper is based on an analysis of one thousand cases of pneumonia treated in the London Hospital during the decade ending 1890. In the above list no case was included that had not been twenty-four Hours and upwards in the hospital before a crisis or death occurred. Dr. Fenwick divides his cases into two great groups—the sthenic and asthenic. The sthenic cases, five hundred and two in number, were treated according to the following methods: I. A certain number were treated with hot applications to the chest, combined with the administration of various expecto- rant and tonic remedies. 2. A number of cases where large doses of quinine was the only treatment. 3. Cases where the treatment was carried out by the em- ployment of general antipyretic measures. In the first two classes the mortality exceeded twenty per cent. In the third class various antipyretic measures were used. In twenty-six cases, where the treatment consisted of cold appli- cations to the chest, the mortality was about fifteen per cent. The cold pack was used in twenty-six cases with a like mortality. Cold sponging was used in sixty-five cases, with a mortality of about thirteen per cent. The ice cradle was made use of in forty-three cases, with a mortality of seven per cent. Taken altogether, there were one hundred and eight cases treated by the application of cold in various ways, with a mortality of ten per cent. The mortality by the other methods being more than double that by the cold treatment. With the latter treat- ment, it should be mentioned that stimulants were also usually given. In spite of the very considerable number of cases analyzed by the author, it would be unwise to place too much confidence in the apparent teachings. We know how fallacious the results of statistics may prove to be ; it is therefore wise to be very guarded in accepting broad and definite conclusions founded on this evidence. The success of the “cold” treatment of other febrile and infectious diseases—especially in typhoid fever— has been proven beyond all manner of doubt. There is nothing improbable, therefore, in the statement that cold applications is the best treatment for pneumonia. Death in pneumonia is nearly always brought about by heart failure, and in the treat- 1ment of this disease it is of paramount importance to keep this in I64 SELECTIONS. mind. We have always looked upon the treatment of pneumonia with cardiac depressants as being fundamentally wrong. In place of strengthening the citadel, we are by the employment of these agents undermining it. In a superficial, theoretical sense there is something cap- tivating in the idea that during the early stages of a pneu- monia cardiac depressants should be used, while in the ad- vanced stages these should be replaced by agents of an opposite class. When we, however, consider the stern fact that death is owing to heart failure, we should have abundant proof that car- diac depressants (tartar emetic, veratrum, aconite, etc.) have an indirect effect in limiting the extent and severity of the inflam- Imatory process. Have we undoubted proofs that they accom- plish this 2 We believe we have not. It appears to us that the true treatment of pneumonia consists, in the early stages, of measures which reduce the temperature, while at the same time there is no depressant effect on the heart. Of all antipyretics, cold is the most efficient. The employment of quinine, anti- pyrine, etc., is open to the same objection as are tartar emetic, aconite, etc. They act as cardiac depressants. In the final stages of the disease, the state of the pulse is the index for treatment. In many cases, camphor, digitalis and alcaholic stimulants are not required, but their judicious use in threat- ened heart failure is of the greatest importance. Dr. Fenwick shows that very particular dangers attend the period of crisis; it is, therefore, very necessary to guard the patient at this period by the use of those agents mentioned. A PLEA FOR THE MORE LIBERAL USE OF BUTTER.—No dietetic reform would, I believe, be more conducive to improved Health amongst children, and especially to the prevention of tuberculosis, than an increase in the consumption of butter. Our children are trained to take butter with great restraint, and are told that it is greedy and extravagant to eat much of it. It is regarded as a luxury, and as giving a relish to bread, rather than as in itself a most important article of food. Even in pri- vate families of the wealthier classes these rules prevail at table, and at schools and public boarding establishments they receive strong reinforcements from economical motives. Minute allow- ances of butter are served out to those who would gladly con- sume five times the quantity. Where the house-income makes this a matter of necessity, there is little more to be said than that it is often a costly economy. Enfeebled health may easily entail SELECTIONS. I65 a far heavier expense than a more liberal breakfast table would have done. Cod liver oil costs more than butter, and it is be- sides often not resorted to till too late. Instead of restricting a child’s consumption of butter, I would encourage it. Let the limit be the power of digestion and the tendency to biliousness. Most children may be allowed to follow their own inclinations, and will not take more than is good for them. The butter should be of the best and taken cold. Bread, dry toast, biscuits, potatoes and rice are good vehicles. Children well supplied with butter feel the cold less than others, and resist the influenza better. They do not “catch cold” so easily. In speaking of children I by no means intend to exclude other ages, especially young adults. Grown-up persons, however, take other animal fats more freely than most children do, and are besides al- lowed much freer selections as to both quality and quantity. It is not so necessary to raise any clamor for reform on their account. It may be out of place to remark that if a greatly in- creased demand for fresh butter should result from a change of custom such as that suggested, it could easily be met by those concerned. There need be no increase in the cost of the article, whilst at the same time a benefit would be conferred on our home farmers.-A/u/chinson's Archives of Surgery. How To MAKE A CUP OF COFFEE.—It is asserted by men of high professional ability that when the system needs a stimu- lant nothing equals a cup of fresh coffee. Those who desire to rescue the drunkard from his cups will find no better substitute for spirits than strong, new-made coffee, without milk or sugar. Two ounces of coffee to one pint of boiling water makes a first- class beverage, but the water must be boiling, not merely hot. Bitterness comes from boiling too long. If the coffee required for breakfrst be put in a granitized iron kettle over night, and a pint of cold water be poured over it, it can be heated to just the boiling point, and then set back to prevent further ebullition, it will be found that, while the strength is extracted, the delicate aroma is preserved. As our country consumes nearly ten pounds of coffee per capita, it is a pity not to have it made in the best manner. It is asserted by those who have tried it, that malaria and epidemics are avoided by those who drink a cup of hot coffee before venturing into the morning air. Burned on hot coals, it is a disinfectant for a sick room. By some physi- cians it is considered a specific in typhoid fever.—7%e Æðzcure. I66 SELECTIONS. WHAT SHALL BE DONE FOR A COLD IN THE HEAD 2–It Imay not be always possible to break up a cold. Sometimes during the congestive stage, anything which will allay irritation will suffice. The person who feels a cold coming on should in- stantly betake himself to bed, drink a cup of hot ginger-tea, and make use of a snuff like that which was proposed several years ago by Dr. Ferrier : B. Morph. Sulph . . . . . . . . . . . . . . . . . . . . . . . . . . . gr. j. Bismuth submit. . . . . . . . . . . . . . . . . . . . . . . . . . 3 iij. Pulv. acacia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 i. M The insufflation of a little morphine at the commencement of a cold in the head is sometimes attended with very happy re- sults. Quinine as an abortant in commencing cold is much in use; the dose should be somewhat large ; Dr. T. J. Maclagan says ten grains. Its efficiency is, however, rather problematical, Doubtless, menthol is one of the best local applications in the early stages of a coryza. It may be used in the form of an oint- ment (menthol one part, vaseline thirty parts), or as a spray with liquid albolene. A formula which may do good service is the following: menthol, one part, liquid albolene, thirty parts. A special spray atomizer, such as is sold by all the instrument makers, is needed for the effective use of this conubination. Menthol seems to limit congestion to the mucous membrane ; it is often followed by a profuse flow of nasal mucus, with little sneezing. Breathing through the nose and mouth the steam of hot camphor water, and the internal use of carbonate of ammo- nia, are also recommended, and there is often utility in the pro- duction of active diaphoresis. Many of late years have claimed decided benefit from full doses of antipyrin, acetanilid, phenace- tin, in the onset of colds; and, doubtless, these new remedies are more and more taking the place of the depressant diapho- retics.—Med. A'ecord. DIFFERENTIATION OF THE CAUSES OF AORTIC REGURGITA- TION.—In a clinical lecture Dr. Wm. H. Porter referred to the frequent occurrence of regurgitation murmurs from minute con- genital perforations of the valves. These apertures are sharply cut, as if punched out of the normal valve, and are not asso- ciated with any of the common evidences of endarteritis or en- docardial lesions involving the valve segments. Patients having them, showed during life an aortic regurgitation murmur, which was unattended by any discomfort. It is because of these congenital perforations that it has become a well-recognized fate SELECTIONS. 167 that while aortic regurgitation is the most fatal of all valvular lesions, some authors have claimed that an aortic regurgitation gives the greatest expectation of life. The differentiation of aortic regurgitation from incomplete closure of the aortic valve, from that due to congenital perforations becomes then a very important matter from the standpoint of prognosis, and can readily be accomplished by attention to the following points : Aortic regru.gitation from Incomplete Closure. Congenital Perforations, Physical signs always the same except Physical signs almost the same. marked cardiac enlargement. No uniform enlargement of the heart. Marked subclavian pulsation. No subclavian pulsation. Shot or bead like pulse. Pulse normal. Marked dyspnea. No dyspnea. Cardiac interstitial pneumonia. No brown induration of the 1ung. Cough with bloody sputum. No cough or sputum. May have pulmonary hemorrhages. No pulmonary hemorrhages. Dropsy usually marked. No dropsy. Great general discomfort. No general discomfort. May be improved by treatment. Not affected by treatment. The comparative studies of these two classes of cases show conclusively that we must not be governed exclusively by the loudness and intensity of the abnormal sounds in the prognosis and diagnosis, but we must carefully consider all the evidence presented before coming to a final conclusion. Above all things, never make a diagnosis or prognosis on a single examination, but insist upon placing the patient upon suitable treatment and several examinations, and then a wonderful degree of accuracy in diagnosis can be obtained.—Medica/AVews, May 30, 1891. TOBAcco AND PHYSICAL HEALTH–STATISTICS GATHERED FROM YALE STUDENTS.–Dr. J. W. Steaver, the College Physi- cian and Instructor in Athletics at Yale, has made a comparative study of the users and non-users of tobacco in the present Senior Class for the past four years, and from his measurements he forms the following table : Osers of AVom-users Average ſncrease in Tobacco. of Tobacco. Lung capacity, liters (Or an increase 66 per cent greater for non-users.) - - - . 15 .25 Inflated chest, meters (Or an increase IQ per cent. greater for non-users.) - - - .O3O4 .O364 Height, meters (Or an increase 20 per cent greater for non-users - - - - - - .OI69 .O2O2. Weight, kilogrammes (Or an increase 25 per cent. greater for non-users.) - - - .4 .5 With regard to the possible effect on scholarships these statistics were given : Of those who received Junior appoint- I68 SELECTIONS. ments above dissertations, 95 per cent have not used tobacco ; of those above colloquies, 87% per cent. have not used tobacco; of all who have received appointments, 84% per cent. have used tobacco; of the entire class, 70 per cent. have not used tobacco. Dr. Steaver says that these figures accord with statistics that he has kept for the past eight years, the greatest percentage of gain always being on the side of those who do not use tobacco. The greatest variation in the two years' widest part has not been more than 4 per cent. Some of the students who are classed among the non-users do smoke, but not oftener than once a week or at such long intervals that the tobacco is apt to have little or no effect on them. Dr. Steaver states that the prominent ath- letes do not smoke or otherwise use tobacco, as a rule, Calhoun being the only exception in college. All the candidates for the crew abstain from tobacco.—AVew York 77mes. PILOCARPINE IN PNEUMONIA.—(L. B. Tuckerman, M. D., of Cleveland, O., in Med. Æecord.)—Up to the present season the in- ternal treatment on which I have chiefly relied in pneumonia has been morphine, tartar emetic, and tincture of aconite (ºn to ºr gr. each of the two former, and to I minim of the latter hourly) during the earlier stages, and in the latter stages full doses of iodide of potassium—from one to two grains an hour—to promote resolution and support the flagging heart. The latter feature of this treatment was, I believe, first advocated by the late Professor Palmer, of Michigan University. Up to the present season I have been well satisfied with the results of this treatment. This year, however, in the pneumonia following grip patients have seemed to respond less promptly than formerly to it. Early last winter Dr. P. H. Sawyer, of this city, related a case to me where favorable results had immediately followed the hypo- dermatic injection of one-tenth grain of muriate of pilocarpine in a conjestion of the lungs suddenly supervening in typhoid fever, and which promised to be rapidly fatal. Prompt diaphoresis ensued, breathing became less labored, in a few hours all signs of the congestion had disappeared, and the patient had an unin- terrupted recovery. Profiting by his suggestion, I have been giving pilocarpine regularly for the last four months in connec- tion with the morphine, aconite and tartar emetic as above men- tioned, and find that it softens the cough, allays the dyspnea, and promotes resolution better than any drug I have heretofore tried. The doses used have been from one seventy-fifth to one- fiftieth of a grain hourly, or in urgent cases one-tenth ot one- fourth grain hypodermatically in combination with one-sixtieth SELECTIONS. I69 to one-thirtieth of a grain of strychnine to guard against too great a depressant action. The good result is probably attributa- ble not only to the prompt relief given to the congested viscera by the dilatation of the arterioles, but also to the fact that pilo- carpine powerfully stimulates the excretory functions of the . skin and liver, thus tending to free the system from certain toxic products of disease. Without its use I am confident that at least four of my cases which have recovered would have proved fatal. Though early employed, and with good results, in chronic bronchitis with athsma, I am not aware that it has hitherto been used to any extent in acute pneumonia. Of course, the limited number of cases occurring in the practice of a general practitioner can hardly be claimed to prove anything. The co-efficient of error is too large altogether, but the favorable results which have followed its use in pneumonia in the hands of more than one physician in this city certainly warrant a thorough test of its merits by the medical profession at large. WHAT IS THE BEST NUTRITIVE ENEMA 2—Nutritive enemata, though often indicated in cases of esophageal or gastric disease, are comparatively rarely used, because of the general skepticism as to their utility. Either they are of but little nutritive value, as in the case of bouillon, or they are difficult of absorption by the rectum, as in the case of milk. Leube suggested, in 1852, the use of pancreatized beef-pulp, and afterward Ewald proposed the peptones of meat and of cheese as offering suitable material for rectal feeding. There is no doubt that the substances recom- mended by these writers are, in part at least, absorbed by the rectum. Nevertheless, their use has never become general, be- cause of the difficulty of their preparation. Ewald, as a result of further experiments, found that eggs, even though not pepto- nized, were, to a considerable extent, absorbed by the rectal Imucous membrane. According to the Mercredi medical for April 1, 1891, M. Huber, of Zurich, has recently repeated Ewald's experiments in Professor Eichhorst’s clinic, and announces that the absorption of the raw eggs is greatly aided by the addition of common salt. The salt is well borne, and causes, as a rule, no irritation of the bowel. He considers that eggs beaten up with salt, in the proportion of fifteen grains to each egg, are the best form of nutritive enema. His method of procedure is as follows: Two or three eggs are taken and thirty to forty-five grains of salt are added to them. They are slowly injected by means of a soft-rubber tube carried 17O SELECTIONS. as high up into the bowel as possible. Three such enemata are given daily. An hour before each enema the rectum is cleared out by means of a large injection of warm water.—W. Y. Med. Jour. TREATMENT OF WARTs.—Cutting off warts or cauterizing them never prevents their return. Pullin recommended solutio Fowleri in doses of one to six drops daily, according to the patient's age. Others recommended tinct, iodii ten drops twice daily. Muehler witnessed the best effects from arsenical treat- ment, beginning in adults with two drops thrice daily, in chil- dren with half a drop thrice daily, and slightly increasing the dose every week. The warts crumble to pieces and disappear, especially when washing and drying the hands, so that the skin looks normal after two or three weeks. Relapses were never observed.—A//gem. Med. Centr. Zezłung 55, 1891. W. R. WARNER & Co. are evidently determined to keep in the van of therapeutic remedies. “Antalgic Saline” appeals to us to-day for recognition as a remedy for the relief of “head- ache,” also for influenza and neuralgia, and as an antidote of “la grippe” they issue the “Pil. Chalybeate Compound:” Composition carb. protoxide of iron, grs., 2%. Ext. nuc, vom., — — — — gr., 9% Sig.: One pill every four hours and increase to 2 pills three times a day. - Antalgic Saline, one dessertspoonful every four or five hours till relieved for headache. The same mode of administration precedes that of of the chalybeate pills for “la grippe.”—Weekly A/educa/ A'ezyzew. tºº-º-º-º-ºmºmº-º: - FOR the relief of pelvic and abdominal pain, Dr. W. E. Forest (Med. A'ecord) urges the use of the hot colon douche. He cites cases of renal colic, biliary colic, ovarian neuralgia, pelvic cellulitis, dysmenorrhea, etc., in which pain was relieved com- pletely when morphia hypodermically would relieve it only par- tially. He recommends a temperature of IIo° to II.2° F. for the injection, and has the patient take the Sims' position with the hips elevated. The injection should be given slowly, and re- tained as long as possible. After the rectum is freed from fecal matter, the injection should be repeated and retained as long as possible, using the second time about a pint of water. His ex- perience is that this will almost certainly relieve the pain. SELECTIONS. 17I THE successful treatment of that alarming and dangerous condition, spasm of the glottis, is oftentimes difficult and uncer- tain, but Sir Morell Mackenzie tells us that by setting up a rival reflex, the laryngeal spasm, itself a reflex usually due to peri- pheral irritation, may be overcome instanter. All one has to do is to get the sufferer to take a pinch of snuff or pepper, or failing either condiment, to excite sneezing by tickling the mucous membrane of the nares. The immediate result is a paroxysm of sneezing, after which the patient sinks quietly back to sleep breathing like a new-born infant. The treatment is logical as well as practical, and is well worth a trial.—Brief. SALICYLATE OF SODIUM IN PRURITUS.--Dr. Wertheimer reports the case of a woman suffering from universal cutaneous. pruritus of nervous origin, for the relief of which he tried salicy- late of sodium in fifteen-grain doses three times a day. After the third dose she enjoyed the first night's undisturbed sleep she had had for a long time, and by the fourth day all itching bad entirely ceased. Smaller doses were given for a few days longer, and she has since remained free from any return of the pruritus.--/ournal of the American Medical Association. AN asthmatic neighbor of mine gets so much relief from inhaling the smoke of a teaspoonful of the following combina- tion that he wants all chronic asthmatics to know about it: Stramonium leaves, } tº em *** - Green tea dust, 818, 3 iv.; Lobelia, 3 iss. Mix together and wet up with a saturated solution of nitrate of potassium. Dry thoroughly and keep in a close can or a well stoppered bottle.—W. T. Plant, M. D., ºn Am. Practit. WoRMS.–In a lecture at Jefferson, Dr. Oliver P. Rex said : Whenever you have a child over two years with a pallid face, unequal dilatation of pupils (which is said by one authority to be more common than equal), an appetite which varies, one day good and the next poor, restless at night, grinding its teeth in it sleep, etc., colicky pains and a distended abdomen, think of WOT111S. GASTRIC ULCER.—Prof. J. W. De Costa recommends, for this frequently intractable affection, an exclusive diet of ice- cream. A pleasant remedy, surely. SURGERY THE SUPPOSEDCURATIVE EFFECT OF OPERATIONS PER SE.- Under this title Dr. J. William White, of Philadelphia, con- tributes a paper to the Annals of Surgery for August, which, not only from its subject, but from the great number of authorities quoted and from the peculiarly rich experience of the writer, makes an article of unusual interest and importance to both sur- geon and physician. The author's attention was first directed to this subject by reason of his experience with the operation of trephining for so-called traumatic epilepsy. - g § During the past five years, with Dr. D. Hayes Agnew, he has trephined in fifteen cases of supposed traumatic epilepsy. All but one patient recovered from the operation. The one who perished was an imbecile and a confirmed drunkard as well as an epileptic. Death occurred from suppression of urine, prob- ably secondary to etherization. * - In one case a bullet was found imbedded in the brain sub- stance, in another an irregular portion of the internal table was dissected out from beneath the dura mater, to which it was at- tached by cicatricial adhesions. In another there were project- ing spicules of bone on the internal strface of the button removed and the adjacent portions of the skull. In two, marked sclerosis and thickening of the cranium were observed about the field of operation. In the remaining cases nothing abnormal was seen. Although this was the case, the patients were without exception notably improved by the trephining, in two instances even to the point of apparent cure, no return of the symptoms having been observed for eighteen months and for two years, respectively, after the operation. In the seven others the results were strik- ingly favorable, convulsions disappearing for weeks or months, although previously of more than daily occurrence. The author has, in so far as this is possible, classified the cases in which an operation seemed to be per se the main factor in bringing about a cure. These cases are divided into three groups in accordance with the anatomical seat of the symptoms or of the supposed disease. This brings them under the follow- ing heads: I. Operations for the relief of nervious phenomena, such as epilepsy, insanity, paralysis, etc. 2. Operations for ab- I72 SELECTIONS. I 73 dominal and pelvic disorders, such as peritonitis, tumors, etc. 3. Miscellaneous operations. 4 * * This classification is further carried out by grouping to- gether; (a) Those cases in which nothing whatever was found explanatory of the symptoms; (b) those in which some departure from Inormal condition was observed, but was so slight as to be apparently inadequate to explain the symptoms; (c) those in which an apparently grave and irremediable condition was dis- closed by an exploratory operation, but notably improved or alto- gether disappeared after mere inspection or handling, no further surgical interference having been thought justifiable. Under the heading of Operations for the Relief of Nervous Phenomena Dr. White has tabulated, including his own service, one hundred and fifty-four cases. Many of them are given in detail, and, coming as they do from recognized authorities are of exceeding great interest. • s . . . In fifty-six cases of trephining for epilepsy nothing abnor- mal was found to account for the symptoms. Twenty-five of these patients were reported as cured and eighteen as improved, and in three cases it was mentioned that a relapse occurred subse- quently. . . . . . In thirty cases of ligation of blood-vessels for epilepsy four- teen patients were reported as cured, fifteen as improved, and one as having died seven days after the operation. In the fatal case the right common carotid artery was tied. No fit occurred after the operation. * . . . } - t - In ten cases of castration for epilepsy all the patients were reported as cured. In nine cases of tracheotomy for epilepsy two patients were reported as cured, six as improved, and one as much improved, though death in this case followed in two months after the oper- ation. - In twenty-four cases of removal of the superior cervical ganglia of the sympathetic nerve six patients remained well at the end of three years, ten were improved, five remained unim- proved, and two died soon after the operation, but not from its direct effect. In six cases of incision of the scalp for epilepsy nothing was found to account for the symptoms. Three of these patients were reported as cured at the end of three months or less, one as cured at the end of a year, two as cured at the end of two years, and two others in almost similer cases as cured. f I74 SELECTIONs. Twelve patients with epilepsy were reported as cured by such operations as stretching of the sciatic nerve, excision of the musculocutaneous nerve, cauterization of the larynx, circum- cision, the application of a seton to the back of the neck, tenot- omy of the external recti muscles, burning of the scalp, puncture of the heart, etc. * Thirteen cases of spontaneous or accidental cures of epilepsy are also reported, at a time varying from two months to five years after the traumatism, which was a fall, a burn, a wound, an amputation for intercurrent injury or disease, etc. Passing from the cerebral to the spinal region, Dr. White cites an illustrative case of his own. A man, aged fifty-five, was attacked on December 25, 1887, with severe pains in his arms and shoulders. A few days later there was weakness of the thighs, spreading rapidly down the legs to the feet and upward on the body to the nipple line. In eight days there was absolute pa- ralysis of the parts involved, including both sphincters, while at the same time the paralyzed parts became the seat of profound anesthesia. Girdle pains developed, bed-sores made their ap- pearance, and percussion of the spine over the third and fourth vertebrae became painful. The reflexes were exaggerated, and light blows on the head in the direction of the spinal axis gave rise to frightful exacerbations of the girdle pains. In spite of every remedial measure these symptoms increased in severity for ten months. An exploratory operation was then undertaken. Dr. White removed the spines and laminae of the first five dorsal vertebrae, opened the slightly thickened dura, separated some firm adhesions to the subjacent pia, explored the cord, and, hav- ing failed to discover any serious pathological changes, closed the wounds in the dura and soft parts. The girdle pain had en- tirely disappeared by the following day, sensation began to re- turn in the feet on the day after, voluntary motion in the toes re- turned after the eighth day, and so one symptom after another disappeared until the patient completely recovered and is now earning his living by manual labor. In the list of abdominal and pelvic disorders apparently cured by operation per se a number of extraordinary cases are cited. The experience of Tait, who has more than once drawn attention to the astonishing disappearance of tumors, often of large size, after a mere exploratory incision, and the corroborative testimony of von Mosetig are cited at length. Konig's analysis of 131 cases of tubercular peritonitis treated by abdominal incis- ion is carefully discussed. SELECTIONS. I75 In response to letters of inquiry upon the subject Dr. White has received many communications from prominent operators, the great majority of them containing notes of cases not previ- ously published. Among the writers of these letters are to be found Goodell, Hirst, Battey, Roswell Park, Lusk, Cheever, Charles T. Parkes, Cabot, Hunter, McGuire, Nancrede, Weir, Stimson, and many others of equal note. Under the heading of miscellaneous operations the author has given several of very diverse character. First are quoted cases of osteomalacia cured, after weeks or months of confinement to bed, by either oophorectomy or Cesarean section. Passing to another subject, the question of graduated tenot- omy of the eye muscles for the relief of severe nervous symptoms is carefully discussed. The author freely acknowledges the value of tenotomies, both complete and graduated, in the restoration of equilibrium in badly balanced ocular muscles, but he is none the less convinced that in numbers of instances of reported cures of chronic chorea, petit ma/, and even delusional insanity, the effect of the operation per se is in large measure the potent cause of the supposed cure. This belief is founded not alone on theory, but upon the fact that in certain cases of reflex nervous troubles a cessation of the symptoms has followed the tenotomy, although this has not produced perfect equilibrium. Again, the relapses which may take place after a perfectly successful series of tenot- omies would indicate that the nervous phenomena attributed to the insufficiency, for the relief of which the operations were made, were not correctly so attributed, and that the temporary relief must be ascribed to some cause other than the correction of an imperfect balance of the external ocular muscles. In seeking for a reasonable explanation of the phenomena observed in such cases the author has formulated the conditions that are common to nearly all of them : I. Anesthesia. 2. Psychical influence, or so-called mental impression. 3. The relief of tension. 4. Reflex action, or the “reaction of traumatism.” These influences were operative in the majority of cases, although not one of them, ex- cept the last, applies to the whole list. - With the idea that it was conceivable that a disease of the nerve centers not reached by ordinary drugs might be affected by agents of such volatility and diffusability as ether and chloro- form, the author instituted a series of observations upon a num- ber of epileptics in various stages of the disease. All other treat- ment was discontinued, and ether was given to the production of full anesthesia at intervals of from forty-eight to seventy-two" 4. 176 SELECTIONS. hours. Either the results were entirely negative or, in conse- quence of the withdrawal of their bromides, the patients grew WOI-Se. } \ - Since in the great majority of cases upon which Dr. White bases his paper there were either undoubted symptoms such as are habitually associated with organic disease or demonstrable and unmistakable evidences of such disease, it is necessary to be- lieve, in considering the psychical influence of an operation, that . powerful impressions acting upon the emotional or intellectual nature may affect the organic processes of secretion, nutrition, etc., and may arrest pathological changes and bring about repar- ative or recuperative action. Cases are cited in which such in- fluences are clearly set forth. The author holds that the normal equilibrium which we witness between the cerebro-spinal and the sympathetic systems, as respects their influence upon the blood-vessels, is obviously more or less interfered with when the brain transmits a more than wonted impulse, allowing the unrestrained action of par- alyzing the influence of the sympathetic vaso-motor nerves. In this relation the author narrates some remarkable cases of hyp- notism and cites some striking examples of the effect of the cent- ral nervous system upon the body. # The belief is expressed that in many of the cases described there can be little doubt that relief of tension was an important factor in the amelioration or cure. If it is assumed that preter- natural tension exists in the cranial cavity, this would be reliev- ed to an extent by trephining, and there would be but few ex- ceptions to the rule that in each case something was done which lessened tension in a cavity or organ of the body. A diminution of the tension would manifestly alter the blood supply to any im- portant organ in the body, and with it the nutritive processes, local and general. Beyond this nothing definite can be said ex- cept as it applies to cases of ascites, in which, as in cases of . dropsy of a joint, one tapping may prove permanently curative because the original source of irritation and supersecretion has already disappeared. -- - Under the head of Reflex Action the author includes “reac- tion of traumatism” as well as the effects of revulsion and count- er-irritation. * Verneuil long since showed that very slight traumatism sometimes excited in the entire economy a general perturbation, and sometimes by selection of the weak point, sudden aggrava- tion of lesions that were only slight or had slumbered. This SELECTIONS. 177 same excitement, usually prejudicial, may occasionally be cura- tive. Dr. White believes that in the case of spinal surgery above detailed the local shock of the operation was promptly followed by a corresponding reaction in which the vitality of the tissues was raised sufficiently high to determine a return to the normal state. In this relation the reciprocal influence of one portion of the body on another is briefly discussed. In considering abdominal tumors, attention is called to the possibility of the spontaneous disappearance of such tumors, the relation of this disappearance to the operation being coincidental. Cases are cited in point. As to the cure or amelioration of growths thought to be malignant by merely exploratory opera- tion, a long search through the literature of the subject has met with but little success. The cure of tuberculosis of the peritoneum as the result of exploratory incision is explained on the ground that the removal of ascitic fluid allows the peritoneal surfaces to fall together and to acquire adhesions. The tubercles are then shut in between the coils of the intestine, the omentum, and the abdominal wall. They are thus surrounded by tissues in a high degree of activity which can now throw around them the limiting zone of young cells and eventually fibrous tissue which, if the tuberculous pro- cess is not too far advanced, may effectually resist it and may cause it to retrograde, the process being analagous to that which we see imperfectly going on around a cancerous growth. As a result of a study of the subject the author believes the following conclusions are warranted : - I. There are large numbers of cases of different grades of severity and varying character which seem to be benefited by an operation alone, some of them by almost any operation. 2. Those cases include chiefly epilepsy, certain abdominal tumors, and peritoneal effusions and tubercle, though the im- provement in the latter is, perhaps, to be explained on general principles. 3. Of the possible factors which, by reason of their constancy, must be considered, anesthesia seems least likely to have been effective. The three others—viz., psychical influence, relief of tension, and reflex action—may enter in varying degrees into the therapeutics of these cases, and, taken together, serve to ren- der the occurrence of occasional cures less mysterious. 4. The theory of accident or coincidence scarcely explains the facts satisfactorily.—N. Y. Med. Jour. 178 SELECTIONS. PREMATURE DIAGNOSIS AND PREMATURE TREATMENT OF SYPHILIS.—Considerable difference of opinion exists among physicians as to the proper time to commence specific treatment in early syphilis. The author is evidently one of the class which discountenance haste in this 1matter. The general tenor of his advice is as follows. He says: “I believe it is rather a disadvantage than a benefit to begin general treatment at once, and therefore, even when the diagnosis, of chancre is positive, I confine myself to local treatment, unless there are special and urgent reasons for pushing inunctions. or internal medication. In cases in which the chancre is mild I even do without mercury in any form locally. “Believing thus, I can see no occasion for hasty diagnosis, of syphilis, and still less for immediate general treatment, which prevents a rectification of a mistaken diagnosis. “Even when a chancre is correctly diagnosticated, general specific treatment is not in order. It has been said that mercury is to constitutional syphilis what iron is to anemia—a tonic par earcellence. This is true when the disease is generalized, not when it is local. Here the condition for which it is so whole- some is not yet present. Mercury is a poison, and the patient is so weakened and depressed by its premature use that he is less able to bear it when it is needed. Constitutional syphilis an- tagonizes the mercury; the local lesion does not decrease the susceptibility. The patient, in fact, enters upon the consti- tutional period of the disease in an enfeebled condition. “If the diagnosis of chancre be mistaken, the mercurials are injurious, and at the same time they forever mask the diag- nosis, and the patient can never feel safe. A cloud hangs over him ; he fears to marry; he imagines every pimple and every ache, some new manifestation of a disease he never had ; he is in fact often more miserable than the man who has had his early symptoms, and has been reassured by seeing the prompt effect of proper treatment. “Another point worthy of consideration at this time is the bearing of this diagnosis on life insurance, because some com- panies will not take risks until after a certain number of years, and some reject altogether those who have had syphilis. “How much better, then, to reserve a diagnosis until it can be made with certainty. Calm the patient’s anxiety and, per- haps, exaggerated fears; put him on a tonic treatment if he needs it, which will aid in the cure of the chancroid, if such it. be. If a constitutional disease be about to follow, this plan will. SELECTIONs. I79 put the patient in the best possible condition to bear the disease and its treatment. It may require the aid of the dentist to put the mouth in good condition.” My conclusions may be very briefly summarized : Ist. Never make a diagnosis of primary syphilis until it can be made with certainty. 2d. Never treat a case until the diagnosis is absolutely certain ; and then, unless there be a very special necessity, do not begin a general mercurial course until there are signs of the disease being systemic. In men the exanthems are very rarely missed. In women, it is true, the eruption may be very slight and be overlooked. But mucous patches about the genitals and about the mouth will almost always be found ; and as women in this country seldom smoke, these patches, when following a suspicious sore, will suffice for a positive diagnosis. They, as well as the eruption on the skin, constitute an indication for general treatment. H. C. Dembitz, M. D. An A/ed. AVews. FRACTURES AT THE ELBow Joint.—Dr. Thomas H. Manley publishes in the AVew York Medica/ /ourma/, June 27, 1891, a paper with the above title and a tabulated report of fifty one cases. The paper is so well considered and complete, such an excellent exposition of the generally accepted practice of sur- geons and of the teachings of standard authorities, discussed as they are from Dr. Manley's ripe experience, that it merits a careful and more extended review than we have space to give. We are tempted, however, to some editorial comments upon one part of the paper, because we believe that the views of Dr. Man- ley, agreeing as they do with “all standard authorities,” are wholly wrong and quite unworthy of such a progressive thinker as our author. He says: “I have never seen a case in which a fracture was definitely determined in the superior segment of the elbow joint recover without ankylosis, impaired action, or weakness, in vary- ing degrees, remaining after treatment; and I do not believe that any method known to science will ever wholly obviate them, when this sundering of the humeral head extends down through the condyles and implicates the synovial investment.” But he fails to recognize the explanation of this in the following : “Passive motion I invariably employ early and often with children, commencing any time after the first week, feeling my way cautiously at the beginning, steadying the joint with one I8O SELECTIONS. hand, while I use the forearm as a lever. With time, however, if the rigidity is rebellious, I do not hesitate to employ greater force until muscular or ligamentous resistance is wholly subdued.” From his careful clinical observations, however, he has received some valuable hints, but appears to have failed to grasp their full meaning, and to learn therefrom the secret of success in the treatment of unsound joints. He says: “For the man approaching or past the meridian of life little benefit will accrue from this early motion. The elements of the joint actively participate in this class, tume- faction is firm and voluminous, and the slightest movement is attended with terrible pain. “Here ether may be administered to aid diagnosis or liberate adhesions. But, when I have employed it, many times the ankylosis stubbornly resisted such force as was deemed com- patible with safety, and oftentimes, when any additional motion was gained by this plan, it was quickly lost, the limb assuming its former angle.” When a fracture occurs involving a joint, rigidity is first due to muscular spasm, and to effusion into the joint and surrounding tissues. Passive motion at this time increases the effusion both into the joint and surrounding tissues, the motion which it induces between the fragments augments the quantity of callusforming material, and as a result it tends to restrict the arc of motion from adhesions and from deposit of plastic mater- ial both within and without the joint. This ought to settle the question of early passive motion. Employed later, while any unsoundness of the joint remains it prolongs that unsound con- dition, and if sufficiently vigorous will increase the effusion and lead up to all the ill effects already pointed out. If judiciously employed and not carried beyond the point of producing pain, nothing is gained more than the patient would accomplish if left to himself; but if carried beyond the point of producing pain, either with or without anesthetic, as Dr. Manley has him- self observed, it “yields unsatisfactory results, and the distortion promptly returns.” Still later, when all unsoundness has passed away from the injured articulation, rigidity may remain, and be due : (1) to true bony synostisis; (2) to abnorma 1 bony prominences from displaced fragments or new bone; (3) to fibrous adhesions; and (4) to shortened muscles and ligaments. In the first condition, passive motion will, of course, effect noth- ing. One might as well attempt to establish a false joint in the shaft of a long bone after union had become perfect. In the SELECTIONs. I8 I second condition, passive manipulations will effect no more towards increasing the arc of motion, restricted by bony promi- nences, that it would toward establishing lateral motion at an antero-posterior hinge-joint. In the third and forth conditions, the voluntary use to which every active human being puts his joints will do all that passive motion can accomplish, not so rapidly perhaps, but much more safely. In a word the rule should be: Never employ passive motion in an unsound joint; in a sound joint it is not necessary. § Passive motion is a relic of barbarism, and should be classed with incantations, burning of incense, and amputations through the tarsus. It is nothing more nor less than a superstitious rite, which has been handed down from generation to generation of “standard authorities.” It has less to recommend it than the Faith Cure, for it may be actively, rather than passively, harmful. In tubercular arthritis and in acute synovitis unaccompanied by fracture, patients have refused to submit to passive motion, and it would have been to the credit of our profession if they had also refused to submit to its tortures in these cases. If there is any universal and well established law in surgery, it is that all inflammation should be treated by functional rest, and a joint injured by a fracture of its bony parts is no exception to this rule. Comparatively recently it has been conclusively demonstrated beyond question that immobilization of a joint never produces anchylosis, and it now only remains for us to accept that which is equally true and easy of demonstration, namely, that passive motion of an unsound joint never prevents anchylosis, and never increases its range of motion. Passive motion of an unsound joint never relieves, always prolongs, and often increases the unsound condition, and may even be the sole cause of a tubercular inflammation of the articulation. It is quite as important in surgery as in medicine to remember the axiom : Don’t treat your patient too much ; let him get well if he can, John Ridlon, M. D., in Epitome of Med. OBSTETRICS. THE PURSE-STRING OPERATION FOR CYSTOCELE.—(Henry D. Ingraham, M. D., Professor of Gynecology in the Medical Department of Niagara University, in Med. Mews.) Every practitioner of experience is well aware of the trouble and annoyance that a cystocele occasions, not only to the patient, but I82 SELECTIONs. to himself; of the many expedients to which it may be necessary to resort to keep the prolapsed parts in their normal position, and the want of success that often attends his most persistent and painstaking efforts. As yet no means of mechanical sup- port has been devised that, in a goodly number of the cases that come to us for treatment, permanently benefits or even tempo- rarily remedies the displacement with comfort to the patient. Neither has operative treatment accomplished all that was fondly hoped of it. The writer behieves that whenever a cystocele can be sup- ported with comfort “by any kind of pessary with the only inconvenience of an occasional removal of it, and the substitution for a week or so of astringent tampons to allow an erosion to heal, an operation is not necessary, even though the pessary must be worn continuously; nor in the case of young women, whose vaginae have not become over-distended throughout, and where a cure many be expected in a year or two, if the parts be properly supported ; also in old women past the menopause, whose tissues have become so relaxed and flabby from age and childbearing, and whose vaginal walls have lost all contractility, so that a cicatrix would be sure to stretch soon after the patient left her bed.” In cases like those referred to, an operation is not justifiable, because it is not necessary, or because there is no prospect of a cure; but in cases in which the woman objects to wearing a supporter, in which the tissues possess a fair degree of tone, in which the cystocele is too large to be cured by wear- ing a supporter, and in which there is rupture of the perineum that demands an operation, then anterior colporrhaphy is indi- cated and will usually be followed by a good result. During the first years of my operative experience I per- formed the Sims operation, or some modification of it—but in all cases the sutures, which were of silver wire, were passed as Sims recommended, z. e., transversely. The parts always healed, and for a time the operation appeared to be successful; but in a few months, in quite a large proportion of the cases, the parts began to stretch, and in a few months more the patient was in a condition similar to that existing before the operation. Another objection to this operation is the difficulty of removing the stitches, if the perineum is repaired at the same time, as it has been in all of my cases. Not satisfied with the results in these cases, about fifteen months ago I performed my first so-called purse-string or tobacco-pouch operation for cystocele, with very satisfactory results. SELECTIONs. 183 CASE I.—Mrs. B., thirty-eight years old ; born in Germany; married nineteen years; was the mother of eight children, the eldest eighteen years old, the youngest two years old. Her labors were always comparatively easy and rapid. For the pre- ceding ten years she had suffered from both rectocele and cystocele, the condition gradually growing worse. Doubtlessly, the perineum had been ruptured at the birth of the first child, although the patient did not know when the rupture occurred. Whenever she was on herfeet for any length of time, a prolapse of the anterior vaginal wall, as large as a medium-sized orange, would take place, and every pessary that was tried failed to keep the parts in place. Hence, it was decided to operate. The opera- tion was performed on March 6, 1890. She was placed in the lithotomy position, and the legs supported by Kelley's Bein- halter. Before the patient is completely anesthetized there is always retching or straining, so that the parts are usually protruded to their full extent. Beginning at a point about half an inch below the meatus, and passing around the protrusion, near its junction with the parts that were in normal position, I cut through the mucous membrane and made a complete sweep of the cystocele, returning to the point at which the incision began. In this case the cut was less than an inch in front of the cervix. Then, with a tenaculum catching the membrane, with a knife I carefully dissected off the entire mucous membrane included within the line of incision, care being taken not to cut too deeply, as the bladder is easily entered, and it unnecessarily weakens the parts to remove more tissue than is absolutely required. The membrane was removed in one piece, and the bleeding was slight. The denuded surface was two and three- quarters inches in its antero-posterior diameter, and about two and a half inches in the transverse. For sutures I used No. 7 braided silk that had been kept for six hours in melted wax one ounce, and carbolic acid and salicylic acid, of each half a drachm. Threading a piece, fifteen inches long, at each end with the needles that are used in operations upon the cervix, the first suture was pâssed nearest the cervix, on one side of the raw surface, in and out of the mucous membrane, about a third of an inch from the denuded edge, until the median line just below the meatus was reached. The same method was pursued on the other side with the other end of the suture. The wound was then cleansed, and with the point of a sound pressed in toward the bladder. The edges of the wound were brought closely together by crossing and pulling on the ends of the silk, in the same way as a purse or tobacco-pouch is closed. The 3: I84 SELECTIONS. suture was then tied. There was a little dimple in the center, but no raw surface was to be seen or felt. One end of the suture was cut short, and the other end brought out upon the thigh, and secured by adhesive plaster. A thick mass is formed on the anterior vaginal wall, the apposed raw surfaces of which adhere to one another without inconvenience, resulting in a firm support to the bladder. The perineum was repaired by Emmet's operation. The patient was put to bed, and treated in the manner usual after such operations. For the first twenty-four hours she had nothing but a swallow of hot water every hour or so. After that she was given beef-tea or broth, until on the third day her bowels were moved. This was insured by the administration of a grain of calomel every hour until three does had been taken, followed by a Seidlitz powder two and half hours later. The bowels were subsequently moved every second day. A light diet was given. The catheter was used but twice, the patient being allowed to urinate as soon as she was able to do so. After each urination the parts were cleansed with carbolized water from a fountain syringe. No vaginal douche was used. Ten days after the operation the suture was removed without difficulty, and union was found perfect. The sutures were removed from the perineum at the same time. The patient was kept in bed three weeks, when she was allowed to sit up, and a week later to walk about the house. This patient is obliged to work hard, and to be on her feet a good deal. At this writing, nearly fifteen months after the operation, the support is apparently as good as it was when she got out of bed. She has no cystocele, and suffers no incon- venience whatever from the effects of the previous injury. In addition to the foregoing case, I have performed the operation in four others, with apparent success, yet time enough has not elapsed to determine definitely what the results will be. I am convinced, however, that better results will be obtained from this operation than from any other, as it gives a thicker and firmer support that is less likely to stretch. One important point in this operation is to denude as large a surface as practicable—the cicatrix is the firmer, and the result is the more likely to be permanent. Another important element in securing a good result is to keep the patient in the recumbent position for some time, until union becomes secure and firm, so that stretching is not likely to occur. SEIFIERIINTG-. That Springtime is the rejuvenating season is a fact to which all Nature bears. testimony, and that it should be such for the human family is a proposition in the form of a truism. The only question which can arise in this connection is involved in the consideration of the Means to the End. The rejuvenation of vegetable life takes place through the renewed activity of a true form of digestion, and it has been well said that the most Rational System of Medicine For animal life is that which aims at Medication through Alimentation. Hence, various forms of partly or wholly digested foods, etc., have come into vogue, which, however, neither in flavor or appearance are Calculated to Provoke an Appetite. The practitioner who has used Forbes’ Diastase Finds that his patients gain in weight, and that the general functions of the system rapidly assume a perfectly normal condition as the result of its influence upon Palatable Every-Day Wictuals, Absolutely compelling complete digestion, at the time and under the circumstances, Peculiar to Natural Processes, As evidenced by the condition of the excrements. Why P Simply because the FORBES’ DIASTASE is a Certain and Uniform Digestive Agent, Exercising upon ingested food the same triple influence which forms the basis of plant nourishment. The Forbes’ Diastase IS CERTAIN because it exactly replaces those elements which are weak or deficient in The Natural Digestive Tract, IS UNIFORM because it is made so by controlling arrays which determine absolute value. The Standard. One grain of FORBES’ DIASTASE will convert a jelly containing 60 grains Bermuda. Arrowroot in two fluid ounces of water at a temperature of 140° to 150° F., into a thin watery solution of assimilable carbo-hydrates in 3 to 4 minutes. In 30 minutes, at the same tempera- ture, it will have formed between 4 and 4.25 grains of sugar, or four times its weight. Sample Bottle sent, charges paid, to any physician addressing THE For BES DIASTASE Co. CINCINNATI, OHIO. 12 b An Achievement of Modern Chemistry. C. TEP. G-T ITUTIEHINT. GREEK ENGLISH PollBoskosſº. GLUTEN Foom. BOSKOS—NOURISHING While there are various Gluten foods in the market, each and every one of them contains more or less starch (from 12 to 54 per cent.) Poluboskos contains only four-tenths of one per cent of starch. We can therefore justly say that it is practically free from starch, an achievement which has heretofore not been attained. The name “Polusboskos” was selected to distinguish it from other Gluten foods in the market. This name is not without its significance, it being a combination of two Greek words, polus, much, and boskos, nour- ishing. Pure Gluten with its congeners is the nitrogenous food principle of the vegetable kingdom, and is to be especially recommended because of its freedom from the poisonous ptomaines which are frequently found in many meat preparations which depend largely on the nitrogenous substances which they contain. Gluten is the element of the vegetable world which gives force and energy to animal life, and is the equivalent to the albumen of the animal kingdom. Poluboskos needs no special preparation ; it is ready at a moment's notice. Mixed with milk it makes the most nourishing, stimulating, and refreshing food and drink for convalescents and dyspeptic invalids; it is readily assimilated by the weakest stomach. Two teaspoonfuls of Poluboskos contain as much nourishment (nitro- genous matter) as one pound of meat. It supplies energy to muscles, nerves, and other organs. A laborer taking three doses of Poluboskos a day will be able to endure more fatigue than if fed upon a meat diet. The use of Poluboskos as an article of diet in diabetes will be at once recognized, as it is free from starch. We will be highly pleased if you will give this preparation your attention. We are prepared to furnish physicians with samples, and hope to be favored with your valued commands. Yours very respectfully, NEw York, EISNER & MENDELSON CO. EDITORIAL DEPARTMENT. J. F. BALDWIN, M. D., Columbus, - * * EDITOR- J. E. BROWN, M. D., Columbus, s * *sº * * - ASSOCIATE EDITOR. Communications, reports, etc., are solicited from all quarters. Authors desiring reprints, will receive fifty, free of charge, provided the request for the same accom- panies the article. Subscribers changing their location, are requested to notify the Publishers żromptly, that there may be no delay in receipt of the journal, stating both the new and the former post-office address. We have no authorized Collectors, except such as carry properly made out bills, countersigned by the Pub/2shers. THE COLUM BUS ME DICAL PUBLISHING CO., COLUMBUs, OHlo. THE RUSH MONUMENT.—The fund for this monument has thus far had a phenomenally slow growth. The profession at large has taken no interest in it whatever. Dr. Rush was, doubtless, an excellent physician in his day, as well as a fine gentleman and a good deal of a politician. That he ever made any specially valuable contributions to medical literature, is not apparent. Our library contains a volume of his lectures, but the lectures afford no proof that the author was a man of an special ability. Indeed, during the seven years that the matter of this fund has been before the profession, we have seen no valid reasons offered for thus honoring the memory of this par- ticular physician, and not only has it seemed to thus impress the profession generally, but even the physicians of Philadelphia, his own city, seem to be as lukewarm as the rest. Some months ago, the furid committee concluded to send “coin-cards” to physicians, so that each one could send by mail a fifty-cent piece. One of these “coin cards” was sent to each of seventeen hundred physicians in Philadelphia, and enclosed was a letter setting forth the object of the appeal, saying that the trial of this new method was made in Philadelphia since that was the home of Rush ; that upon the success of this final appeal would be based the decision of the Committee to approach other members of the profession in the same way, and begging each one to send a check, a dollar bill, a fifty cent piece, or a reply that he did not care to contribute. As a stamped and addressed envelope was enclosed, it was confidently hoped that answers would be received from all, but to the r,7OO letters sent there were but 16O replies. The cost of postage, coin-cards, folding, and addressing was $95, and the amount received was $155.50. The committee has worked hard, but the project lacks soul. Better discharge the committee, refund the money, and let the 111atter rest. I85 I86 EDITORIAL. THE “physiological salt solution” has been brought to the attention of the profession of late by the report of a larger than usual number of cases in which it has been used with apparently the happiest results, the patients being rescued from conditions in which death seemed imminent, showing immediate improve- ment, and convalescing favorably. The exact proportion of this solution is one part of sodium chloride to one hundred and thirty parts of water, which proportion is expressed in the prescription of one drachm to the pint. The cases in which it is indicated are those of shock and acute anemia from the loss of a large amount of blood, cases in which the action of both medulla and heart become almost nil from the sudden withdrawal of blood supply. This lack of blood supply means not only an absence of food for the vital centers, but likewise deprives them of the current which removes the waste products of their activity, the cells becoming poisoned in their own excretions. The physiological salt solution acts by replacing the bulk of the blood that has been lost. It flushes out the collapsed arterial system, carries away from the vital centers their effete products, and since it approaches in specific gravity and re-action the nor- mal blood fluid, is the best vehicle for taking in solution and carrying to these centers whatever of food matter may remain stored in other tissues. Obstetrical and surgical cases, complicated by enormous blood loss, or secondary hemorrhages, where the patient is un- able to rally from the second shock which these give, are the ones usually calling for this treatment. Little attention has been paid to any mode of administering this solution, save by intra- venous injection which is the ordinary method. Emergencies may arise in practice where the intravenous method for some reason may be contraindicated, or the physician has not the means at hand to perform the operation in such manner as safety demands. The report of a recent case tends to show that in such cases the solution can be thrown into the lower bowel, where, retained by compresses if necessary, it brings about, though to a less degree, the same reaction noted on its intraven- ouis use. The body impoverished of its fluids, greedily absorbs of the fluid from the distended bowel, while the warmth of the solution as injected has a beneficial effect, helping to sustain a temperature already subnormal. The range of cases in which it can be used is not a wide one, neither will it avert the fatal issue that is bound to be a part of the history of such cases, but if now and then it adds the EDITORIAL. 187 one saving chance which the patient may find among the many opposing ones, or if it stays the fatal issue for an hour or a day, it has not been resorted to in vain. J. E. B. DR. JAS. E. REEVES.—A writer in 7%e . Observer thus describes a visit which he made to Dr. Reeves, in his Chatta- nooga home : “I was met by a gentleman of manly presence and courteous manner, who, when I gave him my name and address, at once welcomed me and made me feel at home. The doctor invited me without ado or formality of any kind to examine some mounts of sputum, wherein were large numbers of B. tuberculosis. With an extra fine Bausch and Lomb one-sixth dry objective the bacilli were demonstrated in a remarkable manner. They were not quite as diagrammatic as Crookshank’s “nice” figures, but their specific features were plainly indicated, and were after the doctor's usual superb mounts. Dr. Reeves has a complete little room on the north side of his office, and adjoining it, where he keeps his magnificent microscopes and the fine array of objectives of which he is the happy possessor, and they are always ready for work. Here we saw every conven- ience in accessories and methods of microscopical work better arranged than it had ever before been our good fortune to wit- ness. Drawers, boxes, slides, covers, microtome—the Ryder with Dr. Reeves' improved attachments—reagents, etc., are right at hand, where a busy man could easily lay hold of them, and so utilize the spare five minutes which are so often thrown away |because the microscopist must first “get ready.” I might tell of Dr. Reeves' method of hardening, imbedding and section cutting, but as the doctor will explain all these matters in his “Hand-book of Microscopical Technique, etc.,” which he will publish in the fall, and do it so much more satisfactorily than I can, I will not even attempt to steal “his thunder.” To see Dr. Reeves' rapid and yet complete methods of cutting, staining, and mounting, is to marvel how easy is the whole process of making neat and perfect mounts when conducted by an expert. Every reader of The Observer should order in advance a copy of Dr. Reeves' book. If the reader receives only half the infor- mation which the doctor so freely and unselfishly gave me he will be amply repaid for his outlay.” IT has been decided by the Joint Committee appointed by the North Western, the North Eastern and the North Central Ohio Medical Societies, to hold a Union Meeting at Mansfield, O., on Thursday, Friday and Saturday, Nov. 5th, 6th and 7th. I88 EDITORIAL. On Thursday evening the Members will be entertained by a Reception given by the Hon. John Sherman, and on Friday evening by a Reception given by the Hon. M. D. Harter. Every arrangement has been made to make this meeting a pleasant and profitable one, and a full attendance is desired. Ample hotel accommodations will be arranged for; and an effort will be made to secure reduced rates on all the railroads of Ohio. The Committee of Arrangements consists of Drs. R. Har- vey Reed, J. W. Craig and Geo. Mitchell, all of Mansfield. SWEET OIL IN THE TREATMENT OF GALL-STONEs—A collec- tive investigation by the Therapeutic Section of the Philadelphia Polyclinic Medical Society, through its committee, Drs. Thomas J. Mays and Homer C. Bloom, has resulted in their strong recom- mendation of this line of treatment. It is claimed that 98 per cent. of the cases thus treated were cured or greatly benefited. The oil need not be pure ; cotton-seed oil is as good as any, and the dose need not be large ; a tablespoonful of the oil, every three or four hours, is ample. The committee is not positive as to the mode of action. It is proper to remark that at the meeting of the society at which this report was read, there was much adverse criticism as to the reliability of the supposed cases on which the report was based. WE have received the annual report of that sterling institu- tion, the Cincinnati Sanitarium. The report shows that the continued success of the methods of treatment and care adopted, has been such as to make additional accommodations almost a necessity. DR. J. S. PYLE, of Canton, O., has recently devised an ingenious self-retaining lid elevator, and also an improved fixation forceps. WE have received from Dr. R. Harvey Reed, health officer, his third annual report of the health department of the city of Mansfield, O. It is an unusually vigorous document. } 13 The Best Antiseptic for Both Internal and External Use. LISTERINE Antiseptic, Prophylactic, Deodorant, Non-Toxic, Non-Irritant, Non-Escharotic, Absolutely Safe, Agreeable, Scientific and Strictly Professional. FORMUL.A.—Listerime is the essential antiseptic constituent of Thyme, Eucalyptus, Baptisia, Gautheria and Mentha Arvensis, in combination. Each fluid drachm also contains two grains, of refined and purified Benzo-boracic Acid, - DOSE,--Internally: One teaspoonful three or more times a day (as indicated), either full strength or diluted, as necessary for varied conditions. - LISTERINE is a well-proven antiseptic agent—an antizymotic —especially adapted to internal use, and to make and maintain surgical cleanliness—asepsis—in the treatment of all parts of the human body, whether by spray, irrigation, atomization, or simple local application, and therefore characterized by its particular adaptability to the field of - PREVENTIVE MEDICINE – INDIVIDUAL PROPHYLAXIs. Physicians interested in ListERINE will please send us their address, and receive by return mail our new and complete pamphlet of 36 quarto pages, embodying:— A TABULATED EXHIBIT of the action of LISTERINE upon inert laboratory compounds. FULL AND EXHAUSTIVE REPORTS and Clinical observations from all sources, confirming the utility of LISTERINE as a general antiseptic for both internal and external use, etc. Diseases of the Uric Acid Diathesis. KIDNEY ALTERATIVE-ANTI-LITHIc. FORMUL.A.—Each fluid drachm of “Lithiated Hydrangea.” represents thirty grains of fresh Hydrangea and three grains of chemically pure Benzo-Salicylate of Lithia. Prepared by our improved process of osmosis, it is invariably of definite and uniform therapeutic strength, and hence can be depended upon in clinical practice. DOSE-One or two teaspoonfuls four times a day (preferably between meals). Urinary Calculus, Gout, Rheumatism, Bright’s Disease, Diabetes, Cystitis, Haematuria, AJ' and Vesical Irritations generally. We have had prepared for the convenience of physicians 4 DIET ETIC NOTES (sample of which is here with shown), GOUT. suggesting the articles of food to be allowed or prohibited in *-*. several of these diseases. DIETETIC NOT E. — A mixed diet should be adopted, the nitro- A neatly bound book of these DIETETIC NOTES, each genous and saccharine articles be- note perforated for the convenience of physicians in detaching ing used in limited amounts and distributing to their patients, mailed gratis upon request, Allowed.—Cooked fruits without together with the latest compilation of case reports and clin- much sugar; tea and coffee in mod- ical observations, bearing upon the treatment of this class of | eration. Alcoholic stimulants, if diseases. used at all, should he in the form of § light wines, or spirits well diluted. * The free ingestion of pure water is Lambert Pharmacal Co. ºt sº C. Azoid.—Pastry; malt liquors and . sweet wines are veritable poisions ST. LOUIS, MO. to these patients. Doctor, This Will Interest You ! That you may become acquainted with the merits of our preparations, we will furnish you for $3.00, with a handsome, double Morocco Pocket Case, containing 24 vials, filed with the following complete assortment of Tablets and Triturates. No. 2. Size, 7%x3%x% inches. Price, $3.00. º | Tr. aconite, 1-2 minim. Tr. belladonna, 2 minim Nitro Glycerine Comp. . . (M. & Co's.) Cascara com.(M. & Co.) Ammon. Mur. comp. Calomel, 1-10 grain. Calomel, 2 grains. Calomel, ipecac & soda bicarb, No. 1. miſſiº Dover’s Powder, 2% gr. W\ Fever (Dr. T. G. Davis) Hydrarg. Iodine Virid, 1-4 | º | ! º gr. |W | º Iron, Arsenic and Stry- ||||||||||||ſº chnia. Hvpophos Quinia.com.p. Creasote. Acetanilid, 2 grains. Morphia Sulph., 1-6 gr. Zinc Sulpho-carb., 1 gr. Acid Arsenious, 1-60 gr. Bismuth et Cerii Oxalat Kermes Mineral comp. Paregoric, 10 minim. Strychnia, 1-60 grain. J.T. All vials in this case are fitted with screw caps. We would call especial attention Quinia Sulph., 1 grain. to our Tablets Hypophos, Quinia Comp. cum Creasote, which are superior to syrups and Corros. Sublimate, 1-40 solutions, owing to absence of sugar and free acid. grain. H. K. MULFORD & CO. Factors of Gompressed Goods and Pharmaceutical Preparations, Write for Complete List, mentioning this Journal. DRUNKENNESS AND THE Opium, Cocaine, Chloral and Tobacco Habits, rt SUCCESSFU LLY TREATED AT THE KEELEY INSTITUTE MARYSWILLE, OHIO. Investigation as to methods and results cheerfully solicited. We refer by permission to Dr. Einsman, Columbus, Ohio, and Dr. Geo. W. Boerstler, Lan- caster, Ohio. ADDRESS : The Keeley Institute, MARYSVILLE, O. PIH [II L.A.I.D ELPHIA. COLUMBUS Medical College! The Seventeenth Annual Session will begin Sep. 9 and last three months. For full Information, see Annual Announcement. Address DR. J. W. HAMILTON, Dean, COLUMBUS, OHIO. B () () K N () TI C E S. A CLINICAL TExT-BOOK OF MEDICAL DIAGNOSIS FOR PHYSI- CIANS AND STUDENTs. By Oswald Vierordt, M. D., Profes- sor of Medicine at the University of Heidelberg, etc. Au- thorized translation from the second German edition, with additions, by Francis H. Stewart, A. M., M. D., member of the Medical Society of the County of Kings, New York, etc. With one hundred and seventy-eight illustrations. Phila- delphia: W. B. Saunders, 913 Walnut street. 1891. Oc- tavo, 700 pp.; cloth, $4.OO. - This is probably one of the best works ever published upon medical diagnosis. The author has been Lecturer on Diagnosis in the Medical Clinic at the University of Leipsic, and has combined in this valuable treatise an immense amount of information, under the view that normal and pathological anat- omy and physiology constitute the foundation of diagnosis. While he rejects no aids of chemistry or microscopy, he dis- tinctly announces in his paper that “a preparation or a chemical reaction is not enough for a diagnosis, but that the whole organ- ism must always be brought under consideration. In other words, in diagnosis as well as therapeutics, this rule is impera- tive: We must 2ndividualize the case.” The work is thorough and methodical. It embraces in- structions for microscopic examination of sputum, methods of staining, of distinguishing the various cardiac lesions, and of ex- amining the digestive, urinary and nervous systems. Indeed, nothing seems to have been omitted that might be of aid in mak- ing diagnosis. We would advise every physician to get the book, study it carefully, and consult it frequently. A correct diagnosis is the 1zey to successful therapeutics. ANNUAL OF THE UNIVERSAL MEDICAL SCIENCEs. A Yearly Re- port of the Progress of the General Sanitary Sciences throughout the World. Edited by Charles E. Sajous, M. D., and Seventy Associate Editors, assisted by over Two I89 - } I90 BOOK NOTICES. Hundred Corresponding Editors, Collaborators and Corres- pondents. Illustrated with chromo-lithographs, engravings and maps. Five volumes. Philadelphia : F. A. Davis. I89 I. - This is the fourth series of this valuable work. It ap- pears in its usual handsome form, and with all its accustomed excellence. - tg - Sickness and death in the editor's working corps have made the volumes later than usual in their appearance, but have not diminished their value. - - - The present volumes bear abundant evidence of the fore- sight of the projector of the Annual, which has now become a necessity for teachers, practitioners, writers and students. It has become a part of the periodical literature of medicine, and will continue to appear on much the same lines of practical utility as originally laid out by its able editor. The Annual de- serves and should receive most liberal support. - WooD's MEDICAL AND SURGICAL MONOGRAPHS. Published monthly. September, 1891. New York: Wm. Wood & Co. $1O.OO. $1.OO per part. i *. - This periodical contains the following: Foods and Dietaries: A Manual of Clinical Dietetics, by R. W. Burnett, M. D.; Stertor, Apoplexy, and the Management of the Apoplec- tic State, by Robert L. Bowles, M. D.; and the Index of Volume XI. *mºnºsºmºsº THE POPULAR SciENCE MONTHLY, for November, contains a number of interesting papers. Among them we notice one on the newest of important educational movements, Univer- sity Extension. The article is by Prof. C. Hanford Hen- derson, and, after sketching what has been done in Eng- land, it describes the beginning that has been made in this country, and tells the plans of the extension organizers for the future. g WITH a final paper on The Manufacture of Steel, in the November number, Mr. W. F. Durfee completes the account of the Besemer process, and proves that its chief feature was first developed by an American. . . º r t \, , Book NoTICEs. I9I PROF. FREDERICK STARR has a fruitful topic, Ornament. He has found that “the savage loves finery,” and the descriptions and pictures of the article will support this verdict. PRESIDENT GOODALE chose a very practical subject for his address to the American Association for the Advancement of Science, namely, Some of the Possibilities of Economic Botany, and has a great many interesting things to tell about it. The address is to be concluded in the December number. THE second of the Lessons From the Census, by Mr. Carroll D. Wright, points out some serious defects in our mode of enu- merating the people, and proposes definite measures for its im- provement. º - Prof. A. E. Dolbear contribute an essay on Metamorphoses in education. It is a thoughtful paper, and shows that, since education is a process of fitting men for their environment, a change in its character was necessitated by the change in the conditions of human life that has taken place in modern times. The rivalry of the high senses, by Prof. G. T. W. Patrick, and the second of Prof. Frederick Starr's articles on dress and adornment, are also leading articles. . THE GENUINE WORKS OF HIPPOCRATEs, translated from the Greek, with a Preliminary Discourse and Annotations, by Francis Adams, LL.D., Surgeon. Octavo, 766 pages, extra muslin, gilt top, price, $5.OO. New York, William Wood & Company. . As an introduction to this work, under the title of “Pre- 1iminary Discourse,” the author gives a most interesting chapter on The Origin of Grecian Medicine, the Life of Hippocrates, the Authenticity of the Treatises Attributed to Hippocrates, and the Physical Philosophy of the Ancients. Then follows the “Works” themselves, well translated. Of the sixty-one books attributed to Hippocrates, eighteen are presented as genuine by Dr. Adams, with copious annotations. There are a number of illustrations, some of which depict surgical instruments, which are curiously similar to some in use at the present day. One turns over the pages, at first, from mere idle curiosity; but soon the interest grows, and the reader soon learns that, although very many of the sayings of the great Hippocrates are now known to be value- less, many of them are not, and there is much good sense and quaint wisdom in these pages. .** I92 BOOK NOTICES. The book is valuable in itself, but especially so to any one who desires to keep informed in medical history. The book is excellently printed, and bound in classical form. *= smºmºmºsºmsºmºsºms “NEW ENGLAND MEDICAL MONTHLY.”—We have before us a souvenir copy of the New England Medical Monthly, issued to celebrate its tenth anniversary. It presents, in this issue, excel- lent photographs of many of the best known physicians and surgeons in this and other countries. We wish this journal the success which it so well deserves. A NEW BI-WEEKLy—THE FORT NIGHTLY M. D.—Dr. Bransford Lewis, of St. Louis, formerly editor of the Weekly Medica/ A'ezzew, announces the establishment, Jan. Ist, 1892, of a new medical journal under the title of “The Fortnightly M. ZD.,” $2.OO per anum. Dr. Lewis' attainments as a journalist are well known, and we await with interest the advent of his new journal. MADEMOISELLE GIRAUD, My WIFE. From the French of M. Adolphe Belot, with our introduction by Emile Zola; 8vo., pp. 395. Chicago. Laird & Lee, publishers, 1891. This book gives in vivid but chaste language, the trials of a newly married man, whose wife's liaison with a female friend, with whom she indulges in the illicit pleasure of Lesbian love— leads her to deny him all marital privileges, so that though his wife she is still a Mass. This sapphic attachment she had maintained since her first initiation into its mysteries while at a boarding school; and the apparent object of the book, so far as it has any object, is to warn mothers against exposing their daughters to the dangers and tempations existing in the “hot bed of vice.” The book and its numerous illustrations are all very Frenchy. BROMIDIA THE HYPNOTIC. FORMUL.A.—Every fluid drachm contains fifteen grains EACH of Pure Chloral Hydrat. and purified Brom. Pot. and one-eighth grain EACH of gen. im, ext. Cannabis Ind. and Hy, scyam. poºr hair to One fluid drachm in WATER or SYRUP every hour until sleep is produced. IN ſºlº A Tiº N.S.–Sleeplessness, Nervousness, Neuralgia, Headache, Convulsions, Colic, Mania, Epilepsy, Irritability, etc. In the restlessness and delirium of fevers it is absolutely invaluable. IT DOES NOT LOCK UP TEIE SECRETIONS. PAPINE T H E ANO D Y NE- Papine is the Anodyne or Pain-relieving Principle of Opium, the Narcotic and Convulsive Ele- ments being Eliminated. It has less tendency to cause Nausea,Vomiting, Constipation, etc. IN DIS ‘ATIONS. Same as Opium or Morphine. IPSPSE--ONE FLUID DRAUHM-(represents the Anodyne principle of one-eighth grain O D . A THE ALTERATIVE AND UTE RINE TONIC. F4DRWA UIL. A.—Iodia is a combinati on of active principles obtained from the Green Roots of Stillingia, Helonias, Saxifraga, Menispermum and Aromatics. Each fluid drachm also contains five grains Iod Potas., and three grains Phos. Iron. TD (DSE one or two fluid drachms (more or 1ess as indicated) three times a day, before YY) tº 8, 18. IND, ICATIONS —Syphilitic, Scrofulous and Cutaneous Diseases, Dysmenorrhea, Menor- rhagia, Leucorrhea, Amenorrhea, Impaired Vitality, Habitual Abortions and General Uterine Deblility. westERN PENNSYLVANIA MEDICAL COLLEGE, CITY OF PHTTSBURGH. SESSIONS OF 1891–92. The REGULAR SESSION begins on the last Tuesday of September and continues six months. During this Session, in addition to four Didactic Lectures, two or three hours are daily allotted to Clinical Instructions. Attendance upon three Regular Courses of Lectures is requisite for graduation. A three years’ graded Course is provided. The SPRING SESSION embraces Recitations, Clinical [Lectures and Exercises, and Didactic Lectures on special subjects. This Session begins the second Tuesday in April, and continues ten Weeks. The LABORATORIES are open during the Collegiate Year for Instructions in Chemistry, Microscopy, Practical Demonstrations in Medical and Surgical Pathology and Lessons in Normal Histology. & Special importance attaches to the Superior Clinical Advantages possessed by this College. For particulars see Annual Announcement and Catalogue, for which, address the Secretary of Faculty, PROF. T. W. T. McKENNAN, 810 Penn Avenue. Business correspondence should be addressed to PROF. W. J. ASDALE, 2107 Penn Avenue, Pittsburgh, Pa. 16 THE NAICCLELLAN & HITT COMBINATION PEMALE SYRINGE, ſº IN OPERATION. º . . . º \ © 2. L Cº. # * , sº Cº. # | & G | sº PAT' D APRIL 22, 1890. The above cut represents an improved female syringe. It is exceedingly simple in construction, and completely accomplishes the purpose for which it was designed. It con- sists of a long point or barrel, on which is a hard rubber bulb and three blades or arms for dilating the vagina. It can be taken apart, and is very easy to clean. The advantages claimed for this syringe are: FIRST. It is the only combination syringe that will dilate the parts well, so that the medicine comes in direct contact with all the diseased surface, thus insuring a speedy cure. SECOND. It is the only syringe throwing six jets of water, all in different directions. In this way no part escapes thorough washing and medication. THIRD. It is so simple in application that any woman can operate it. FourTH. There is no danger of injecting the fallopian tubes with this syringe. It is a practical, simple and common sense syringe, invaluable in the treatment of inflammatory and ulcerative conditions of the vagina and neck of the womb. It is a well known and accepted cardinal principal of sanitary law that preventive measures take pre- cedence of curative, and hence all means employed to this end will, in intelligent hands, overcome and eradicate many of the diseases known to womankind. & Through this instrument vigorous antiseptic agents can be efficiently and actively used. It is as far superior to the old style syringe as the electric light is to the tallow dip, and will in time supplant it. The syringe is put up in boxes for family use, and can be adjusted to any syringe. It meets and supplies a long-felt want, and can be safely and efficiently employed by all physicians. Prices to physicians: Hard Rubber Attachment Dilator . . . . . . . . . . . . . . . . . . . . . . $1 75 each. £ 6 & 4 6 & with soft rubber bulb. . . . . . . . . . 2 OO ‘ ‘ & 6 6 6 6 & “ 2-qt. soft rubber fountain... 2 75 “ Upon receipt of price it will be sent by express, charges prepaid, to any physician. KATHARMON CHEMICAL 00, 117 Washington Avenue, ST. LOUIS. CLUBBING LIST. SPECIAL PR/GE TO SUBSGRIBERS. We will send any of the following publications including the CoI.UMBUS MEDICAL Journal, for One Year, at price in Second column. CASH WITH ORDER. Regular Subscrip- tion Price. Century Magazine . . . . . . . . . $4 OO $4 50 Scribner's Monthly . . . . . . . . 3 OO 3 50 Popular Science, monthly . . . . . 5 OO 5 CO North American Review, monthly . . 5 od 5 25 Forum, monthly . . . . . . . . . 5 OO 5 25 Cosmopolitan . . . . . . . . . . . 2 4O 3 I5 Nineteenth Century, Am. reprint . . 4 50 4 75 Harper's Monthly . . . . . - - - 4 OO 4 25 6 & Weekly . . . . . . . . . 4 OO 4 25 6 & Young People (Juvenile) . . 2 oo 2 50 Frank Leslie's Weekly . . . . . . . 4 OO 4 50 Scientific American . . . . . . . . 3 OO 3 65 & 4 6 (; Supplement . . 5 OO 5 OO St. Nicholas (Juvenile) . . . . . . . 3 OO 3 50 Youth's Companion (Juvenile) new sub- scriber . . . . . . . . . . . . I 75 2 35 Turf, Field and Farm, new subscriber 5 Oo 5 OO Peck's Sun . . . . . . . . . . . . 2 OO 2 50 Texas Siftings . . . . . . . . . . 4 OO 4 OO Judge . . . . . . . . . . . . . . 4 OO 4 OO Puck . . . . . . . . . . . . . . 5 OO 5 OO Life . . . . . . . . . . . . . . . 5 OO 5 OO Time . . . . . . . . . . . . . . 4 OO 4 OO Ohio State Journal, Weekly . . . . I oo I 50 If there is any publication you want, not in above list, write us for prices, we can save you money. & * º % º: <} ** : Fº º SN • & ºr ſº * K) º Z.” \ * gº ºs e ºf N º & 23, '?” ſ/h ( ; , , , §§ $4. «» F., iſ/, /; §§ © & , º # |// # ; & % vº/* f : \, x, \, The ſollowing fac-simile is a sample of hundreds of communications which we are continually receiving from the Medical Profession in regard to the value of LACTO-PREPARATA in Infant Feeding. WE DO NOT SOLICIT TESTIMONIALS, NOR PUBLISH THEM WITHOUT PERMISSION. sº Chº? 71… ?” ==º £º. ſº 4a cº-J.--~~~~ | 19 OUIER, EIEST PIERIEMIUIM FOIR. Isso 1 : A NEW WATCH FOR PHYSICIANS. IL, O OIFK AT TI HIJE, PERICI Es. The “I)06tor's Quick Stop" OPEN - FACE, SWEEP - SECON ID MOVEMENT, With Stop Attachment. sº so III) Nick EL AND gold. JFILLED CAS E.S. For C0UNTING THE PULSE this watch is invaluable to Physicians. It is also an ex- cellent Time-Keeper, and warranted by the firm making it as equal to any Twenty-five Dollar watch for durability and keeping time. . Any watch that does not give entire. sºyacázoza can be returned at our expense. This is not on the “Cheap John” or Water- bury order, but a ſérst-class watch, and after due consideration we are satisfied we can find nothing more acceptable to the Pro- fession as a premium. No. 1. The two styles shown are different only in the dial; the small knob to left of crown pulls out and stops the watch ; pushing in, it is started. 'I HE PRICES OF THE WATCH ES, POSTPAID. INCLUDING ON E YEAR’S SU BSCRIPTION TO º COLUMBUS MEDICAL JOUR- AL, ->-> gº º: : gº A\| 60 \ § 2 º # : º§%. 3 Solid Nickel Gase, - $6.50 This would retail in any jewelry store for $8.00 to $10.00, Gold Filled Gage, - $12.50 Retailing for $20.00 to $25.00. REVIEMBER above prices include a YEAR'S SU BSCRIPTION TO THE I Sº 2% COLUM BUS MEDICAL J Olj RNAL, or | Š- * we will send the Watches on receipt of i. -à above amounts. § 9 Every Physician should have one Every owner of a good horse should use them. Cash mezesł accompany orders in all cases. Address, Th}(||m|| MºjiſlPll, CD, 246 EAST GAY STREET, COLUMBUS, OHIO. *. $ *- § ºg §s 4. ºsº šs 20 PROF. R. 0CDEN DOREMUS SAYS THAT BOWEEN LITHIA WATER I From GEORGIA, Contains < E.4 –4 ="7 GRS. LITHIUMI BI-CARB IPIEER, IMIPIECEIAIC, G-ALLON. D0CTOR Do you know of any other Lithia Water in the market which has been submitted to so critical and professional an analysis? It has a record unsurpassed for satisfactory results. We are prepared to submit the proofs in the following cases: º: Kidney Troubles (of Every Kind), Gaiarrh of Bladder (Acule or Chronic), Renal Or Uric Acid Calculi, Diabetes (Insipidus or Mellitus.) DySémiery or Diarrhaºa Acute or chronic), Cystitis (Acute or Chronic), Rheumatism, Gouf, Acid or Atomic Dyspepsia. Ask us (on postal card) to send convincing proofs, and samples of water free. The elegant SWEET WATER PARK HOTEL, 500 guests (new), the Famous Bromine Lithia Vapor Baths (Hot Spring Method, but far superior) and a competent resident Physician. Any information cheerfully answered. Address Bowden Lithia Springs Co. LITHIA SPRINCS, CA. PREMIUM LIST. O AWO TA. TAZAZ LOW F/G UA’A.S. O FOUNTAIN PEN–Best Grade. (Paul E. Wirt—long or short, stub or regular.) With One Year Subscription to the Journal . . . . . $2 50 (Above is the price of the pen alone.) A Fountain Pen when once used is never dispensed with. Ask our editor. GAS BRACKET. With Light Condenser, Mirror and Bar Complete. (See cut below.) All Nickle Plated, and MEDICAL Journal, One Year . $20 oo Above can be arranged for oil lamp at an extra expense of about $ I.OO. Light Condenser and Mirror not including Bracket (see cut below) with Journal, One Year . . . . . . I 2 OO Light Condenser without Mirror or Bar, not including Bracket (see cut below) . . . . . . . . . . 8 OO Prices named are less than the regular prices on light condensers alone. Cash must accompany order to obtain these prices. z::::::::: * --> º A º TONGALINE Possesses a peculiar affinity for viscid secretions, neutralizing and eliminating them through the natural channels. It is diaphoretic, laxative, anti-septic, anti-neuralgic, and anti-rheumatic, hence is |N|D|CATED IN NERWOUS HEADACHE, Rheumatism, Neuralgia, La Grippe, Sciatica, GOut. MELLIER DRUG COMPANY. , ºr, T. - < Mention this Journa ALTERATIVE TONIC, —- ELI x R or º ... " . . * , - - - - . w ſ' , º * , ; , ",".. " . . . . . - • . . , - - 5 * * & * - w . . . . ~ - - - d º ‘. . . . . . - - " º *. - W - - - c O : ; ; , - ~ * -- ~ º P . - " * * , d .5 - * - º " - - º " . sº - º - - a . . . . . º - . - - . . . - - * - ... º' º * . . * . . . . - " * . " . . . . v (FERR, hydrars Et Arsenicum) FORMUL.A.—Each fluid drachm contains: PHOTO. C.H.I.ORIDE IRON, one-eighth gr. BICHLORIDE MERCORY, one-hundred and twenty-eighth grain. CHLO RIDE ARSENIC, one two hundred and eightieth grain. With CALASAYA A LRCA LOIDS and ARO- MATICS. INDICATIONS.—Anemia, from any Cause, Struma, latent Syphilis, General Debility, \ - COn Stipate. Tuberculosis, Malaria, Loss of Appetite, Habitual Constipation, Chlorosis, Chorea, Chronic Uterine, Pelvic, Zymotic, Catarrhal and Dermatological Diseases. DOSE.—One or two fluid drachnas three Or more times a day, as directed by the physi- Cian. The prescribed dose of THREE CHLORIDES gives prompt action, produces a feeling of buoyancy, stimulating the appe- tite and the digestion, promoting assimila- tion ; is v ry pleasant to the taste, assimila- ted by the most delicate stomach : does not Wilſ not color the teeth, and is harmless under prolonged use. This prepa- ESTBD. ICFE TO Gº." TIMIIPOIFRT"IETFI FES : ILOUISVILLE,Dj KENTUCKY.". Fº ... ...To be; had of All Leading J O D bers. º: , º sº HEADACH E. “I prescribed Tongaline for a lady who has suffered exceedingly with Headache for Several years. The pain is mostly confined to the top of the head, and continues often for 24 hours, unless she is thoroughly narcotized by an Opiate. Ton- galine was taken in doses of a teaspoonful at intervals of an hour, and the third dose relieved her entirely. There was no malaise or bad feel- ings of any kind following its use. Other physi- cians here speak very highly of their experience with Tongaline.” THOMAS H. URQUHART, M.D., Hastings, Neb. IT CONTAINS Tonga, Ext. CIMICIFUGAE RaceMoss: AND THE SALI- CYLATES OF SODIUM, PILOCARPIN AND Colchicin. •S EN D FOR C L | NICA L REPORTS. Io9 & III Walnut Street, ST. LOUIS. ration has stood the test of time and experi- ence, is uniform, una] lerable and can be relied upon to produce results. Its use is Indicated in a Wide Range of Diseases. Physicians will please designate R. & H. Elixir Three Ch IOrides. Where a more specific alterative is need- ed, other than increasing the dose or bichloride, mercury. The physician may add without reservation any of the Soluable salts of iodine or its compounds. Dispensed in twelve ounce bottles: price, $1.00. MARION SIMS CoI, LEGE, ST. LOUIS, MO., Nſay 30, 1890. Turing the past six months I have pre- Scribed for the various conditions indicated by the component parts of the mixture of the “Elixir Three Chlorides” for more than three hundred recorded cases, and 1n no instance have I regretted it. I. N. LOVE, M. D., St. Louis. The Formula of this. Compound, will, immediately suggest itself to the thoughtful Physician. 1832. RENZ & HENRY, §§ § Iºwrººkfºr 3 . taxiaº anxtºniº Mºº-ºº- 23 IETER, EHIN/IITUTINZL IT IIST I LOOK I LOOK M THIS WILL SAVE YOU sº I - M ONEY. It is our intention to make the subscription list of our Journal larger and to give patrons benefit of WHOLESALE PRIt ES on everything we can get low figures on. We guarantee the quality of everything. A $12.00 Case for $8.50, with the <ºolwºmbus Medical Journal thrown ºn. No. 60 (MFFROYED BUGGY CASE. It is worthy of notice. Only Cases of this manufacture have the COMBINATION CORNER (see cut). The Foot or Button being in ONE PIECE with the corner, prevents them from coming off the Case. Note all improvements in No. 60 Case, and see its superiority to cheap imitations of the same. | : * | No. 60 Improved Buggy Case, each . . . . . . . . . Including one year's subscription to the Journal, $8. 5 O Space for powder papers, instruments, ete. Case made of Black Grained Russia leather, leather lined throughout, and mounted With German silver combination corners, nickel spring lock, with key, making the most substantial, complete and richest-looking Physician's Case ever placed on the market. It should be noted that the No. 60 Case is protected by German Silver combination corners; also nickel edge trimmings around the Center partition, which serves to protect from wear and to keep the partition in place. These improvements are found only in No. 60 Improved Buggy Case, it being the constant, aim of the manu- facturers to make this case as near perfect as skillful labor and carefully selected material Will make. - NOW Read this—a $12.00 Case and the Journal for $10.50. 66. SATCHEL CASE, 10 inch frame, contains 18 one ounce, 11 six, drabrms and 14 four drahm Corked Vials, ample loops for in- struments, box for sundries, plush lined. With a neat compartment # for Hypodermic Syringe. Size, É; 10x7-5. Price. With the COLUMB Uš # MEDICAL JOURNAL 1 year, $10.50. We think this the most conveni- ent Satchel Case sold. Can also furnish it with 7 two Oun Ce bottles instead of 9 of the One Ounce. This is the finest, and best, º Satchel Case on the market to-day. All of above prices include the CoI,UMBUSMEDICAL Journal for one year. Cash must accompany Order to Obtain above prices. Syr. Hypº: CO., Fellows Contains the Fssential Flements of the Animal Organization—Potash f and Lime; The Oxidising 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 Slightlv Alkaline Reaction. , It Differs in its Effects from all Analogous Preparations; and it possesses the important properties 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 deseases. Its Curative Power is largely attributable to its stimulant, tonic, and nutritive properties, by means of which the energy of the system is recruited. I*s Action is Promp"; it stimulates the appetite and the digestion, it promotes assimilation, and it enters directly into the circulation with the food products. The prescribed dose produces a feeling of buoyancy, 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—C&UTION. The success of Fellows' Syrup of Hypophosphites has tempted certain per- sons 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. -> º º 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 i the original bottles; the distinguishing marks which the bottle (and the wrap- pers surrounding them) bear, can then be examined, and the genuineness—or otherwise—of the contents thereby proved. } .7/edica! Zeilers may be addressed to - Mr. FELLOWS, 48 Vesey Street, New York. E ESTABLISHED |5 YEARS. Fiſhedf |MITATIONS. TREEDIENSIFIESIDEIHEITFEHFANDINENIEHILHHEEE ESSENTIALLY DIFFERENT FROM ALL OTHER BEEF TONICS. UNIVERSALLY ENDORSED BY LEADING PHYSICLANS. This preparation, consisting of the Extract of Beef (prepared by Baron Liebig’s process), the best Brandy obtainable, Soluble Citrate of Iron, Cinchona and Gentian is offered to the Medical Profession upon its own merits. It is of inestimable value in the treatment of all cases of Debility, Convalescenice frons Severe Illness, Anaemia, Malarial Fever, Chlorosis, Incipient Consumption, Nervous weakness, and maladies requiring a Tonic and Nutrient. . It is quickly absorbed by the Stomach and upper portion of the Alimentary Canal, and therefore finds its way into the circulation quite rapidly. COLDEN'S LIQUID BEEF TONIC appeals to the judgment of intelligent Physi- cians in the treatment of --All. Gases of General. Debility.<- It is essentially a Food Medicine which gives tone and strength in cases where other remedies have failed or been rejected. A single trial will convince any fair-minded Physician of the value of this preparation. By the urgent request of several eminent members of the medical profession, I have added to each wine. glassful of this preparation two grains of Soluble Citrate of Iron, and which is designated on the label, “With Iron, No. 1;” while the same preparation, Without Iron, is designated on the label as “No. 2.” gº. In order that Physicians unacquainted with * COLDEN'S LIQUID BEEE TONIC may become familiar with it, we will upon application send a sample bottle free (express charges paid), to any Physician in the United States. Please ask your Dispensing Druggist (if he has not already a supply) to order it. In prescribing this preparation physicians should be particular to mention “COLDEN’S,” viz., * Ext. Carmis F1. Cornp. (Colden).” It is put up in pint bottles, and can be had of Wholesale and Retail Druggists generally throughout the United States. c. INT. CERI*I*T*EIN TOINT, Ceneral Agent, [ _ tº- tº t-s tº- 1 5 FULTON STREET, NEW YORK. III.iiiIIIllilili Ilºilfillſifilillºtill III. I IIIllil IIIllil IIIHIM|| Illilill ||||||||||||||||||III | illili IIIIIIIillili IIIIIIIllllllllllllllllllllllllll) LENN’SE = ONSTANTINE’S = SULPHUR SOAP. PINE TAR SOAP. ... made. Has been on trial amon physicians know the great value of the local use of sulphur in the By far the Best Tar Soap ma © 818 - ; - physicians for very many years as a toilet soap and healing agent, an Treatment of Diseases of the Skin. Glenn's Sulphur Soap is - - w - ] eded in all cases where the Original and Best combination of its kind, and the one now its superior virtues have been unanimously conceded in a - erally in use. For sale by All ID te." the use of Tar is ind is ated. None genuine unless stamped A. As generally in use. e by ruggists, CONSTANTINE’s PERSIAN HEALINº PINR. |Bevvare of Counterfeits. TAR SOAP. For sale by All Druggists. wholesale Depot, C. N. CRITTENToN, 115 Fulton Street, New York. Samples of above Soaps SENT FREE, on application, to any Physician inclosing card, INSOMNIA. LEEP, poetically expressed, is “Life's nurse Sent from Heaven to create us anew from day to day.” It is, indeed, “Tired Nature's sweet restorer.” -. Insomnia may be dependent upon derangement of the nervous, circulatory, respiratory or urinary organs, the alimentary tract, the liver, or upon febrile or general disease. It may also be caused by unhygienic conditions of heating, lighting, ventilation, diet, occu- pation. Whatever its cause, which must be sought for and as far as possible removed, resort must often be had to medicinal agentS. Preparations of the Bromides, Chloral, Gelsemium, Opium and Henbane are most universally employed. We supply these in combination in two efficient formulae, under the name of CEREBRAL SEDATIVE COMPOUND (Formula A, with Opium; Formula B, with Henbane Substituted for Opium), the latter for cases in Which Opium is contra-indicated. p The following prescription is an eligible one for administration : B Cerebral Sedative Compound, Syr. Sarsaparilla Compound, aā 3 iv. P., D. & Co.'s. Sig: Dessertspoonful when indicated. Descriptive literature of our products Sent to physicians on request. - PARKE, DAVIS & CO., DETROIT AND NEW YORK. MEDICGL Vol. X. NO WEMBER, 1891. No. 5, J. F., BALD WIN, M. D. - - - - - - ED ITO R. J E. BROWN, M. I.). - - Associate Eºſitor. C. R. CORN ELL, - - JSzésiness Mazzager. 48 PAGES READ/WG MATTER, PUBLISHED MONTHLY. - $1.00 PFR YEAR. * THE COLUMBUS MEDICAL PUBLISHING COMPANY, Publishers and Proprietors, 246 East Gay Street, Columbus, Ohio, Fintered at Postoffice, Columbus, Ohio, as second-class mail matter. &ºva wawa ºvºvº Wawawa wavawawa w unwaviava wºn wº, tº wave ºn tº whº wº wºw.va wavº whº wave, wa ºn wavº wavºv wavºwavºwawawawa wavºnvavºvºvº cº-ºx.º.º.º.º. tatawa w a wawa wa wa wava wavava wava wawa wavºweva wavºvºvº CH. MARCHAND’S PEROXIDE OF HYDRO GEN. (MEDICINAL) H2O2 . ABSOLUTELY HARMLESS.) §§§ MOST POWERFUL BACTERICIDE AND PUS DESTROYER. zºº st: ãº: * ENDORSED BY THE MEDICAL PROFESSION. ...ºf astrº-º-º-ººr aſ--> " - " " - 㺠UNIFORM IN STRENGTH, PURITY, STABILITY. £. ºt º - zº } ~ * * * - -q •r - - fºr €º RETAINS GERM ICIDAL POWER FOR ANY LENGTH OF - § TINI E. TAKEN INTERNALLY OR A PPLIE I) EXTERNALLY WITH PERFECT SAFETY. Send for free book of 72 pages, giving articles by the following contributors: #ºrt DR. PA U L G : B | E R, Director of the New York Bacteriological and Pasteur Institute. ** Peroxide o Hydrogen and Ozone—Their Antiseptic Properties.” Medical Avezws of Philadelphia, Pa. - DR. C.E.O. B. HOPE, Surgeon Metropolitan Throat Hospital of New York. “Sonne Clinical Features of Diphtheria, arid the Treatment by Peroxide of Hydrogen.” Ayew Porã. Medica/ A’ecord. NOTE. –Avoid substitutes—in shape of the cornrnercial article bottled— unfit and unsafe to use as a nºnedicine. - Ch. Marchand’s Peroxide of Hydrogen (Medicinal) sold only in 4-Oz., 8-Oz., and 16-oz. bottles, bearing a blue label, white letters, red and gold border, with his signature. Never sold in bulk. PHYSICANS WILLING TO PAY EXPRESS CHARGES WILL RECEIVE FREE SAMPLE ON APPLICATION, |PREPARED ONLY BY * Tº Mention this publication. Chemist and Graduate of the “Acole Centrale des Arts et Manufactures de Paris” (Arance). leadinºgists. Laboratory, 10 West Fourth St., New York. contents. COMMUNICATIONS. *ś. #5: º; The * * . i arly Diagnosis of Diseases of the Spine in Anºsthetics in Labor-by Hugh Hendrixson,..., , Children ; The Present Status in Brain M. D., Columbus, O e is & e º e º is a e s e e s tº it is : .... 1 3–196 Surgery; Sterility of Pus in Abscess of the A Rare Case of Pelvic Dropsy—Operation- i Liver; Statistics of Breast Amputations; $ºy J. F. Baldwin, M. D., cºlumbº, 199 Rules for the Administration of Cocaine. .217-224 The Relations of impairment of fissue, Fyo. OBSTETRICS-Pregnancy after Conserva- genesis and Sepsis—by T)r. Robert Peter, i tive Ventral Fixation of Retroflexed Uteri; Canal Dover, O. . . . . . . . . . *... • * * * * * * * * * * * * * * * 200-203 Pediatric Aphorisms; The Proper Method . Malpractice...... . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 of Applying Obstetric Forceps; Painless and Unconsious Parturition; Drainage in Abdominal Surgery; On Plugging the SELECTIONS. Cervix Uteri Instead of Vagina in Uterine MED/CIAWE—Common Errors and Fallacies Hemorrhage; Two new, Methods for the tº € in the Treatment of Children; Treatment Closure of Recto-Vaginal Fistula. . . . . . . . . 224–230 of Angina Pectoris by Cocaine; Therapeu- - _2: tics; Simple Å. Hodgkin’s Disease; i E/9/7 OAJAZ. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231-238 Life Insurance and Syphilitic Risks. . . . . . . 205-217 | BOOK NOTICES...... . . . . . . . . . . . . . . . . . . . . 239–240 ADVERTISERS. - The Maltine Mfg. Co., New York. . . . . . . . . . . . . . 1 Eisner & Mendelson Co., New York. . . . . . . . . . . 12 Beeman Chemical Co., Cleveland, (), . . . . . . . . . . 2 Lambert Pharmacal Co., St. Louis. . . . . . . . . . . . . 13 Dr. McMunn’s Elixir of Opium . . . . . . . . . . . . . . . 2 H. K. Mulford & Co., Philadelphia . . . . . . . . . . . . 14 Harrison Cole, Columbus, O... . . . . . . . . . . . . . . . . 2 Battle & Co., St. Louis . . . . . . . . . . . . . . . . . . . . . . , 15 Health Restorative Co., N. Y. . . . . . . . . . . . . . . . . . ;3 Western Penn. Medical College, of Pittsburgh. 15 B. Keith & Co., New York. . . . . . . . . . . . . . . . . . . . 3 Katharmon Chemical Co., St. Louis. . . . . . . . . . . . 16 Cincinnati Sanitarium ....................... ... 4 Reed & Carnrick, New York ............. . . . . . 18 Julius Fehr, M. D., Hoboken, N. J. . . . . . . . . . . . 4 Bowden Lithia Spring Co., Lithia Springs, Ga. 20 Dios Chemical Co., St. Louis, Mo............. {} The Terraline Co., Washington, D. C. . . . . . . . . . 21 The Antikamnia Chemical Co., St. Louis, Mo... 6 Mellier Drug Company, St. Louis . . . . . . . . . . . . 22 The “Yale” Surgical Chair, Canton, O......... 6 Renz & Henry, Louisville, Ky. . . . . . . . . . . . . . . . . 22 Cornell-Pheneger Chem. Company, Columbus, James I. Fellows, New York... . . . . . . . . . . . . . . . . 24 2hio. . . . . . . . . . . . . . . . . . . tº e < e < e s a e s e e º 'º e º a tº s e 7 PREMIUM LIST FOR 1891 . . . . . . . . . . . . . . . . . 17, 19, 23 The Arlington Chemical Co., Yonkers, N. Y... 8 Charles Marchand, New York...... 1st page cover. Wm. R. Warner & Co., Phila, New York..... 9 Starling Med. College, Columbus, O.2d “ g ºf Mariani & Co., New York .......... . . . . . . . . . 1() C. N. Crittenton, New York. . . . . . . . 3d “ é & The Forbes’ Diastase, Co., Cincinnati, O... . . . 1 | Parke, Davis & Co., Detroit & N.Y.4th “ & & A combination of the best Morwegian Cod Liver 0i/ with MALTIME, in which, by the vacuum process, rancidity is prevented and disagreeablerodor and taste of the oil removed. Base a Powerful Reconstructive Contains no Inert Emulsifier lºs Ilişliſhligsillſ ill; Pālāl; is an active Starch Digester and Tissue Builder. Produces rapid improvement in Appetite. is used where “Emulsions” cannot be tolerated, A complete list of the Maltine Preparations and their formulæ will be sent on application. THE MALTINE MANUFACTURING CO. (Please mention this Journal.) New York, N.Y., BEEMAN CHEMICAL COMPANY’s sºlº | *. § &- :*::::::::: t PURE *º PEPSIN º Nºſ/ º, , .º. a = ſ/º. =) =J ºff. º Highest possible digestive strength. Solubility unequaled. Has no disagreeable taste or odor. Especially adapted to making wines, elixirs, and saccharated Pepsin. We make no scale, crystal, Saccharated or weak preparations. Price the lowest of any of its class in the market. * Liberal samples for trial forwarded to Physicians and Druggists on application. Correspondence solicited. BEEMAN CHEMICAL CO, No. 5 Euclid Avenue, CLEVELAND, O HIO. Also Manufacturers of Pure Pancreatine and Saturated Solution of Pepsin. *2. - TSFt. McIMITTINN’s E. L. ſcº (IFE OF O. Fºl ITU TIM t An Invaluable Discovery in the Preparation of Opium. 7"Ay/S IS 7"Aſ E PURA. AAVZ) ZSSAEAV 7"ZAZ AX7'A' A C 7' A'A’OM 7TAZE AWA 7TWVAE DA’ CVG, It contains all the valuable medicinal properties of Opium in natural combination, to the exclusion of all its noxious, deleterious, useless principles upon which its bad effects depend. It possesses all the sedative, anodyne and antispasmodic powers of Opium: , To produce sleep and composure; to relieve pain and irritation, nervous excitement and morbid irritability of body and mind; to allay convulsive and spasmodic actions, ete.; and being purified from all the noxious and deleterious elements, its Operation is attended by no sickness of the stomach, no vomiting, no costiveness, no headache, nor any derangement of the constitution or general health. Hence its high superiority over . Laudanum, Paregoric, Black Drop, Denarcotized Laudanum, and every other Opiate preparation. E. FERRETT, Agent, 372 Pearl St., New York. HARRISON COLE, PRACTICAI, OPTIGIAN, All Defects of Vision, requiring Spherical Lenses, scientifically corrected. Special Lenses carefully adjusted to prescription. Optical and Scientific Goods of all kinds. Repairing of every description. Prescription Blanks Furnished Physicians on Application. 64 North High Street, Columbus, Ohio. 3 “Febricide” will be found to be possessed of great curative R | D E power in Malarial Affections of any kind, and in all inflamma- * , tory diseases of which Fever is an accompaniment. For Neuralgia, Museular Palms, and Sick Headache, it is *=g a Specific. & tº Prof W.M. F. WAUGH, MI. D., of Philadelphia, writes: A Gomplete Antipyrelic, a In a case of persistent neuralgic headache, worse On awaken- ing, with a possibility of malaria, “Febricide” gave instant Restorative of the High- relief. BUFFALO, N. Y., February 13, 1890. est Order, and an Amodyne I have daily preseribed the FEBRICIDE PIR,LS all ſº • through our Epidemic of Influenza and Pneumonia, of Great Gurative Power. with capital results S. W. WETMORE, M. D. UAMP SPRINGS, M.D., February 3, 1890. The prevalence of “La Grippe” has enabled me to test x our FEBRICIDE and I. Consider it the most efficient remedy I have yet used in the pains of said malady. -- .3 JOHN L. WARING, M. D. - SPRINGVIEW, NEB., November 25, 1889. I have used your FEBRICIDE with excellent results in our Mountain Fevers (typhoid), reducing, in one case, the temperature from 104% with dry, brown furried tongue in ten minutes, to 99% with tougue cleaning promptly and moist, and rapid improvement dating therefrom. Have used Antipyrin in similar cases with no good results. ALBERT S. WARNER, M. D. FEBRICIDE IN PNEUMONIA. º.º.º.º. ricide Pills (one being given every four hours, as a rule), and with hot poultices externally ; dmitted. I ISIS. Admitted. Crisis. William Johnson, ...... June 1, 1889, June 8, 1889 Belle Smith . . . . . . . . . . . . Jan. 8, 1890, Jan. 12, 1890 Fanny Winnery ....... Dec. 29, 1889, Jan. 4, 1890 Wm. Payne ............ Jan. 2, 1890, Jan. 5, 1890 Wm. M. Johnson. . . . . . . Dec. 30, 1889, Jan. 5, 1890 Gustav Thoman . . . . . . . . Jan. 21, 1890, Jan. 23, 1890 All ended in recovery. These are all the cases of croupous or lobar pneumonia treated in the hospital during the influenza epidemic excepting of e case, which was admitted in a moribund condition, and ded before any treatment could be instituted. One case, which was apparently moribund when admitted, is included in the above list, and is at present recovering from an attack of femoral phlebitis. JOHN A. RAYBURN, M. D., Resident Physician. —Phila. Times and Register, Feb. 17. 1890. Samples sent free of charge to any Physician who mentions COLUMEBUS MEDICAI, JQURNAL, || || || "...º." ſº f * , . " º . . . . . . . . º - & ºf ſº * . º wº *...*.* 'By ºn, Usº or Ex- EE IC "Tº E L S → C O N - T - N C - A V E N A S A T L V A. FROM COMMON OATS. A POWERFUL NERVESTIMULANT, Tonic, ETC., Is also Employed in the Treatment of Paralysis, Epilepsy, St. Vitus' Dance, Chloral and Tobacco Habits, Sleeplessness, Nerve Exhaustion, Neuralgia, Alcoholism, Painful and Deficient Menstruation, Headache, Hysteria, Convulsions and Prostra- tion from Fainting, and in the Convalescent Stage of all Acute Diseases. DOSE,-From ten to thirty drops or more, as often as may be indicated to meet the urgency of the case. Administer in hot water when quick action is desired. Messrs. B. KEITH & CO –Gentlemen : - Melroy, Ind. I am giving the con. tr. avena sativa for the morphia habit, and I find it will cure, I believe, all cases, no matter how Zong they haze been the sdaze of this opium monster. I think this is the greatest discovery of Our age. F. M. POLLITT, M.D. Messrs. B. KEITH & CO.,-Gentlemen: Barnesville, Ga. The con. tinct. avena sativa has been more successful in the treatment of the opium habit than anything I have ever tried, and I have tried various other remedies, amongst them the advertised nostrums. º HOLLOWAY, M. [.. Messrs. B. KEITH & CO., Gentlemen : Idaho Springs; Col. I have tried a small amount of the con. tr. avena sativa and am more than plcased with it in the opium habit and several other cases, such as in female diseases and nervous conditions. CHAS. B. RICHMOND, M. D. Send for printed matter on Con. Tinc. Avena Sativa in the Morphine or Opium Habit, and certificates from different members of the Medical Profession citing cases under their charge treated by it, also Revised and Enlarged Manuel to IEE. E.E.EEI*T*EBI cºz CFO-s ORGANIC CHEMISTS, ESTA B L | SH E D : 852. No. 75 WILLIAM ST. 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The most important Remedial Agent ever presented to the Profession for DYSPEPSIA, WomITING IN PREGNANCY, CHOLERA INFANTUMI, CoNSTIPATION, and all Diseases arising from Imperfect Nutrition. LACTOPEPTINE IN CHOLERA INFANTUM. We desire to direct special attention to the great Value of Lactopeptine in Cholera Infantum, and other intestinal troubles incident to the heated term. - Send address for our Medical Almanac, containing Valuable information. The New York PharmaCal Association, P. O. Box 714. NEW YORK, •s's * 2 ...-saw” §:a j , f - * - }} . - { / º '... ".. ;:3. ~ * , ..". f 4”. ? .* “r p - * .** * 2 g * - & ^ COLT J M BUS MEDICAL JOURNAL A MONTHLY JOURNAL OF MEDICAL SCIENCE. VOL. 10. DAECEMBAER, 1897. No. 6. CO M M UNI CAT I () N.S. OAV 7///, //A/ OF O/7 /DA’A/AW/AWG 7///5 A/º/, ///S W/7A/ /LAA’ GAZ 7TO/A'AºS AAW/O /O/OOAOA’/l/ GA OZAZ" - S 7TA’//2S /AV CAS/2 O/7 A/LA2/2/O/AVG AAFTAEA /APAA’O 7 OAZY. By M. STAMM, M. D., FREMONT, OHIO. Read before the Ohiº, State Medical Society, June, 1891. For the last six years I have used the iodoform tampon in various cases of hemorrhage where I could not reach the blood vessels well enough to apply a ligature, and I can only say that it has relieved me of considerable annoyance and anxiety. Mikulicz, about five years ago, introduced his tobacco-pouch tampon in cases of pelvic operations to cover, as he called it, the dead spaces resulting from enucleation of large tumors which had no pedicle and where the peritoneum was not extensive enough to cover the enucleated surface. This was a very valua- ble addition to operative measures and encouraged surgeons to remove tumors which otherwise they would hardly have dared to touch. The only objection I found, in one case of laparotomy, was the difficulty of its removal. When, therefore, Walcher, of Stuttgart, described his method of draining the abdominal cav- ity in case of hemorrhage after laparotomy, which he had tried 24I 242 - COMMUNICATIONS. in seven cases with excellent results, I resolved to carry it out should a case come into my hands which would give the slight- est cause of apprehension in regard to after-bleeding. On February Ist, this year, I operated on a case of double Ovarian cancer in an advanced stage., The tumors were so wedged into the pelvic cavity that their pressure upon the blood vessels produced such enormous ascites as to threaten suffoca- tion. The ascitic fluid so pressed the tumors into the pelvis that the patient was frantic with pain in the small of her back. To give her relief I tapped her once, but in course of one week the fluid had reached the former volume and the excruciating pain in her back, as well as the signs of suffocation, returned with the same severity. The patient, who at first told me never to speak of an operation, now imperatively demanded to be re- lieved of her suffering in whatever way and at whatever cost. I only reluctantly yielded to her desire, the more so as I had noticed a nodule in the epigastric region at the time when I tapped her. On incision the right tumor was found to be mov- able and presented a pedicle, but the left one was adherent to the sigmoid flexure and pelvic wall so that I had to peel it off. There was considerable parenchymatous oozing, which did not cease after flushing the cavity and using pressure with sponges, so that I decided to use a large rubber tube about the thickness of a thumb and a strip of iodoform gauze about one and one-half yards long. The latter was pulled through the tube and the long end pressed against the bleeding parts, Douglas' pouch was filled by it and the tube kept the prèssure up. She recovered from the operation without any untoward symptom, but about four weeks later showed signs of pyloric obstruction, and at the end of six weeks she died from imanition. - I have since used it in another case of small ovarian cyst about the size of a fist, adhering to the posterior part of uterus and Douglas' pouch. Adhesions were very firm, so that the cyst burst and emptied its contents, a dark grumous mass, into the pelvic cavity. Considerable parenchymatous oozing induced me to use the drainage tube and gauze. Patient made a smooth and rapid recovery. Dr. Wm. Busch, of Genoa, O., called me to see Mrs. T., aged about thirty-three years, married for several years, no children. She had complained of pain in her right ovarian region for the last few years, but especially so since last July. On examina- tion I found a solid, not fully outlined, tumor, reaching nearly up to the umbilicus; it moved very little and with the uterus STAMM–On the l’alue of Dražnzing, Ætc. 243 only. At the operation, performed on March 25th, the tumor presented the size of a large child's head; adhesions were ex- tensive. An incision into the tumor brought to light a large quantity of soft, cheesy substance, with balls of long hair. As it was impossible to form a suitable pedicle, I peeled the tumor out of its peritoneal covering and then tied the remaining mass in four parts, but there was still some bleeding going on even after flushing the cavity and using pressure with the sponges. The light of the room was very unsatisfactory, and even after using Trendelenburg's position I could not find the bleeding point. Patient collapsed considerably, so that any further at- tempt to find the source of hemorrhage would have been fraught with danger. I therefore filled Douglas' pouch with iodoform gauze in the manner described in the first case. Patient rallied from the operation with a very feeble pulse, but her temperature did not exceed IOO". After forty-eight hours I removed the tube and gauze strip, and from that time on she made a rapid recovery. C I am well aware that some of our foremost German opera- tors are not in favor of drainage, even in the most complicated cases, and that in spite of this they have obtained excellent re- sults. A few, however, have returned to drainage, and Sanger especially advocates glass tubes with iodoform gauze (capillary drainage); he claims a smoother recovery for his cases and thinks that by this procedure the action of the blood ferments is neutralized. The majority of American and English sur- geons are greatly in favor of drainage, and the good results ob- tained thereby will probably not lead them soon to abandon this method. It is true, the splendid results obtained by Ohlshausen, Martin and others, without drainage, are apt to lend additional lustre to their operative skill; but as we cannot all reach such a height of perfection in operating or possess the marvelous dex- terity of a Tait, and as we are not all surrounded by a staff of well-trained assistants and nurses and other facilities which their hospitals afford, we often look about us for measures which will shorten and simplify our operations without lessening their safety. It is self-evident that the old surgical rule, to tie every bleeding vessel which will admit of ligation, should never be thrown overboard. Despite this rule, however, we often have cases which are in such a state of collapse that the shortening of the operation becomes imperative, and it is in such cases, especially in parenchymatous bleeding from the denuded sur- faces, that the packing of the pelvis serves us in good stead. 244 COMMUNICATIONS. Yes, it is really for the purpose of tamponade more than for drainage that we use this combination of gauze strips and large drainage tubes, since a healthy peritoneum generally serves already as an excellent drainage surface. Still in many cases the power of absorption of the peritoneum is very much im- paired, and it becomes desirable to rid the abdominal cavity as soon as possible from the blood and accumulated secretions. In such cases, where drainage is used, the recovery is avowedly less interrupted or eventful than where drainage is omitted. Walcher has used this method in four cases of tumors with vascular peri- toneal adhesions and in three cases of ectopic gestation with the best results; he did not even attempt to tie the bleeding vessels. He uses glass tubes with a lumen three-fourths to one inch and a length of five to eight inches. As I had no glass tube of such size on hand I used a rubber tube, but I think glass tubes pre- ferable; the drainage opening seems to unite better after using the latter. The iodoform gauze strip can be from one to three yards long; to exercise sufficient pressure upon the bleeding surface, you can pack the whole pelvis with it, and the tube will keep up the pressure and give ready outlet to the secretions. I ap- plied the sutures as if there had been no drainage tube inserted, and tied the thread near the tube in a noose so that after forty- eight hours, when the tube was removed, I could simply draw the edges of the opening together and make a permanent knot. In removing the tube you lift it slightly, and you can then read- ily pull the gauze strip out through it. Walcher found the wound healed completely in nine days. In my cases it took a few days longer to heal, which I attributed to the use of rubber instead of glass tubes. I covered the wound and tube with iodoform gauze and wood wool. Walcher had to resort in two cases after forty-eight hours again to the tamponade, as he met with fresh hemorrage, but could close the wound after the third or fourth day. He also found that, owing to the pressure of the tampon, two patients complained of retention of flatus ; this is, however, a small disadvantage in comparison to the great ad- vantages of the method in other respects. AO/AEA’/2/EA’A/L AAE I/ZA’. BY S. B. HINER, M. D , LIMA, OHIO. Read at Mansfield, O., Nov. 5th, '91. I shall not attempt any systematic discussion of my subject, nor go into the details in text book style, but shall endeavor to present a few points for your consideration, that I have gathered from experience and study, relating to the pathological phe- nomena met with from time to time in the parturient state. Pregnancy and parturition, being physiological processes, do not normally develop pathological conditions—yet we find as a sequence in a large percentage of cases some morbid action or process, which either terminates fatally, or entails months or years of ill-health upon the mother at a time which should be the happiest period of her life. The first point, then, for investigation is the primal cause, in a case or series of cases, of the departure fron, the normal procedure. Is there in all cases of febrile action, after parturi- tion, some germ received from some source without the body, which causes all the disease and deaths, or is there such a thing as self-infection independent of external influences P According to the radical wing of pathologists, there never need be any febrile action, after delivery, if the bacteria which generate septicemia are absolutely excluded. In other words, no lesion of organ or tissue, no matter how severe or extensive, can of itself become serious ; but that to this, must be added the necessary germ to poison the fluids. That there are febrile conditions occurring after labor which lack the essential features of a puerperal fever, is undoubtedly true. Even the almost discarded excuse of “catching cold” has been shown by Lusk to Have some foundation : he says that he has frequently in hospital practice been able to trace severe cases of cellulitis, pelvic peritonitis, and general peritonitis, occurring in the winter season, to the patient getting out of bed, when perspiring, and clad only in a night dress, and going thus over the bare floor to the water closet. He also states that, in certain cases, emotional causes produce puerperal disorders, “the nervous system furnish- ing the first impulse to the disturbed action.” 245 246 COMMUNICATIONS. That local lesions after tedious, difficult or instrumental labors are exceedingly frequent, is well known. I have seen the vulva so bruised, swollen and discolored, after an instru- mental delivery, as to make it very difficult to use the catheter, even with the advantage of inspection. Such contusions neces- sarily have some febrile action. These cases all have this one redeeming feature, that they do not infect other cases, even when in close proximity in the wards of a hospital, thus showing that the true puerperal fever, is an inflammation with the addition of an infective poison. In such cases there is also an absence of the symptoms of blood poisoning, or if present they only manifesting them- selves in a moderate degree. This has been explained by some, by “assuming that there is such a thing as an aseptic surgical fever due to the absorption of the products of physiological tissue changes, at the seat of the injury.” In army practice we had wounds which would inflame and suppurate without any special virulence, but add to such the infection of gangrene and a very different case would soon pre- sent itself. So I take it is the condition of the puerperal patient; she may have a variety of local inflammatory processes to a greater or less degree, without any special virulence, but if the infectious poison is introduced, and developed either primarily or secondarily, we then have true puerperal fever. According to Widal, the streptococcus of puerperal infection can not be distinguished from that of erysipelas. He also states that the various forms or varieties of puerperal fever are due to peculiarities of the organism, and not to any difference in the germs. Thus the same germs may cause suppuration, the pyemic form, or infiltration of tissues without histological reaction, the septicemic form ; it may lead to the formation of false membrane, the diphtheritic form, or cause fibrinous coagula in the veins, phlebitis. We know that we rarely find two cases presenting the same symptoms or lesions in our so called puerperal fevers. We do not know why one case is an acute general peritonitis, another a septicemia or a phlebitis, and so on. That there is an infectious materies morbi, introduced in some mysterious manner, has been admitted for many years. That there is a germ always associated with such cases, has been proven almost beyond a doubt. Now whether this germ is the active agent, or a carrier only of the infectious matter, or whether its own secre- tions produce the disease, is immaterial ; the indication is clearly HINER—Puerpera/ Pever. 247 to ensure our patients from any possibility of contamination, if in our power. The divisions of cases into antogenetic and heterogenetic, does not relieve us of responsibility in the so called self-infected cases. These are said to be due to absorption of the products of decomposed coagula, shreds of membrane, placenta, etc. But the radical wing of bacteriologists assert that no substance or tissue can decompose if all germs are excluded. If this be true, then there is no real difference, as to causation, in the two classes. Admitting the bacterial origin of puerperal fever, the next question is as to the means by which it is communicated from patient to patient. Since 1775, when Dr. Gordon clearly traced its communicability by the accoucheur or nurse, to the present, the authentic reports of numerous cases in the care of certain physicians, establish beyond a doubt that to the attending physician many a poor mother’s death can be attributed. It is a fearful responsibility, and demands of us greater precautions than are generally observed. When the laity come to fully understand this danger, the accoucheur in whose practice a case occurs, will find that his cases of expected labor will prudently seek some non-infected physician. But in the light of modern teaching, who can be said to be entirely free from infection ? All suppurations, such as abscesses or wounds, or decomposing animal matter of any kind or source, erysipelas, diphtheria, scarlatina, puerperal cases, post-mortems, etc., will not only infect the hands, but may also charge the clothing and the beard or hair with the morbific material. Eternal vigilance only can place the general practitioner in such an aseptic state as to permit him to enter the lying-in chamber of the expectant mother with safety. To what extent precautionary measures should be resorted to by the practitioner, is an undetermined question. He cannot avoid almost daily contact with some possible source of infection, and it would be extremely difficult to relinquish obstetrical work, except when the danger seemed more than ordinarily imminent. But to perfect cleanliness of person and clothing, the frequent use of active germicides, especially while attending a labor case, would seem to be the least measure of our bounden duty. The most remarkable record of Dr. Rutter, of Philadelphia, who had forty-five cases of puerperal septicemia in one year, while none of his neighbors' patients were attacked, is sufficient alone to establish the fact of personal infection. This fatality clung to him until, I believe, he entirely abandoned obstetrical 248 COMMUNICATIONS. practice, having had no less than ninety-five cases inside of five years. In his case it is claimed that a chronic Ozena, with which he was afflicted, was the nidus of the poison. - It is not necessary to go into details of cases, nor to Iminutely describe the treatment. The management of such cases should be of a two-fold character; first, the preventive, and second, the special or direct. Every case of labor should be treated as a possible case of septicemia. The conditions necessary to such development exist in every case; such as the retention of coagula, the presence of abrasions or tears, the denuded placental site with its sinuses occluded by clots, the temperature most favorable to decomposition, everything ready for the germ, which like a lighted match in a pile of tinder, start the combustion of tissue and fluids, that so frequently ends in an untimely death. The preventive treatment, however, need not, and indeed cannot, be carried out in private practice as among hospital patients. A preliminary vaginal injection of some germicidal solution, with bathing the external parts, should be generally advised. The accoucheur as aforesaid should wash his hands in a bichloride solution, and cleanse the finger nails before each examination. After delivery, the treatment should be governed by the condition of the patient. If labor has been difficult and 1acerations or abrasions have resulted, then the injection of some antiseptic solution should be used; otherwise I do not think it advisable or necessary. The free escape of lochia in ordinary quantity, I believe is sufficient to prevent the introduction of bacteria. But if that is scanty or absent, there is undoubtedly greater opportunity for their entrance. Nature soon attempts the repair of injuries, and the exudate forms a barrier to their lodgment in wounds. But if repair is delayed, or interrupted, the danger of inoculation is increased and this accounts for the 1ate development of some cases of septicemia after the third day. The use of antiseptic pads or clean cloth sprayed with carbolic acid, is preferable to such rags as are often furnished and supposed by the patient to be good enough for that purpose. But if, in spite of all precautions, you find that your patient shows the symptoms which mark the onset of disease, then in addition to the thorough use of the above measures, you may find it necessary to carefully curette the uterus, in order to remove any decomposing clots or shreds of placenta or membrane. This should always be preceded and followed by a thorough vaginal injection. This may be supplemented by a thorough HINER—Puerpera/ Fever. . 249 swabbing of the uterus with tincture of iodine. The propriety of using intra-uterine injections is questionable, and in my own experience has not been satisfactory; those cases in which they were used all dying, except one where I simply threw in a small quantity of a strong solution of compound tincture of iodine. The vulva and ostium vaginae should be inspected, and wounds treated by local application, just as such wounds should be if situated elsewhere, when unhealthy. * - The first indications to be met in general treatment, are the control of temperature and the relief of pain. The best anti- pyretic is quinia, which should be used freely at first, and more or less continuously during the case. Its supportive effect can be supplemented later in the disease by iron. In true septicemia it is doubtful if any other line of medication is so useful as this, as it keeps up life's forces, in the struggle against the lethal ac- tion of the absorbed poison. The relief of pain requires opiates in large quantities, although they act best in cases in which acute peritonitis is the prominent lesion. Since venesection has been abandoned, veratrum has been largely used in the inflam- matory type of cases, as an arterial sedative, and often with much benefit, but its depressing effect upon the heart’s action is liable to do more mischief than bleeding can be charged with. The use of internal antiseptics has not been productive of any decided benefit; and their use should be subordinate. Salicylate of soda, however, may be used, on account of its antipyretic, as well as antiseptic, effect. Authors differ as to its usefulness. The foregoing brief description gives the chief points of the method of treatment by recent authorities. We are cautioned in regard to the use of cathartics on account of the danger of ex- citing an uncontrollable diarrhea. I believe, however, that much good may be accomplished by assisting nature to eliminate the putrescent fluids from the system, through that great natural sewer, the intestinal canal. Nature points the way here by soon establishing a diarrhea which only becomes deleterious by the local irritation induced by the poison, and this, like the once dreaded diarrhea of typhoid fever, does not occur if the ex- crementitious materials are rapidly removed from the beginning. I am aware that this is debatable doctrine, and contrary to the present teaching. Dr. Clarke's method was to narcotize the patient and lock the bowels. Lusk and Playfair oppose cathar- tics; Schroeder and other German authors recommend them. Dr. Gordon, whose experience in 1795 was enormous, reports a total of seventy-seven cases with forty-nine recoveries. He 25O * COMMUNICATIONS. makes the strong statement that all the recoveries were cases in which he bled largely and purged freely and continuously. He asserts that purging is the outlet by which nature, when left to herself, attempts her own relief. He also makes the counter statement that the cases which died, had been bled lightly, or not at all, and no purging or but little had been secured. For many years the doctrine of narcotism, as promulgated by Alonzo Clark, held sway, and as a result the bowels were locked up completely. This treatment was also extended to all inflammations of the peritoneum, either idiopathic or traumatic. Opiates were pushed to absolutely arrest peristaltic action. Now the laparotomists discard opium almost entirely and keep the bowels soluble. Did you ever stop to think that if a natural or accidental discharge, from any part of the body, either its tissues, or its cavities, shows a putrid, offensive, or abnormal appearance, the proper course without exception is such as would favor the com- plete removal of it? Remember, now, that the convolutions of the intestine bring some part of its twenty-five feet in length, in contact with all of the walls of the abdominal cavity, and with every organ therein. And what other channel of elimination is there, so con- venient, so readily acted upon, and so little damaged by the pro- cess, as the intestinal canal 2 In Pepper's System of Medicine, in the article on surgical septicemia, it is said, that “The pro- fuse choleraic diarrhea which generally accompanies this dis- ease, may be regarded as an effort of nature to eliminate the septic poison,” yet the author advises that it be controlled by astringents, etc. It seems to me that if this irritating, putres- cent matter is not allowed to remain in the beginning, long enough to do harm, there would be no danger of prostration re- Sulting from an uncontrollable diarrhea. And here I desire to make a suggestion, germain to my subject, z. e., that we should not neglect to move the bowels freely immediately before, or very soon after, labor. Think of the condition of a patient of full habit and regular meals, al- lowed to go two or three days without an evacuation, at a time when the blood is loaded with the materials prepared to support and nourish an extra being ; and in addition taking up through the absorbents the waste of muscular tissue after a hard labor, as well as the products of retrograde metamorphosis in the uter- ine walls. We well know that when occasion arises for active cathar- sis, as in eclampsia, no harm results. A few years since, HINER—Puerpera/ Fever. 25 I we treated a case where during the coma subsequent to convul- sions, in a primipara, highly edematous, we had over fifty large stools within forty-eight hours, using elaterium and blue mass, and had a good recovery. I think that the experience of others will sustain me in this statement. A recent case of puerperal septicemia which I visited fre- quently in consultation from the beginning to convalescence, was treated by calomel purgatives at least every second or third day, with decided relief to the patient, as expressed by herself and shown in her symptoms. She was a primpaira, weighing nearly two hundred pounds. Labor had been tedious. During convalescence, small infarctions formed along the outer aspect of left thigh and over right scapula, which softened and were opened as early as possible. The attending physician stated to me recently that he believed her recovery was largely due to the attention given the bowels. The abandonment of venesection as a remedial agent in dis- ease of any kind seems so settled that it is with a good deal of hesitancy that I venture to mention it, in connection with this affection. We hold up our hands in holy horror at the idea of robbing the system of twenty, thirty or forty ounces of the vital fluid, yet we fail to see that the congestion and exudates of an extensive inflammation usually destroy an equivalent amount of blood, and also compel nature to expend an unmeasurable amount of force in the removal of the products of the inflamma- tion. That the immediate effect of a free venesection is bene- ficial, in the early stage of the inflammatory type of this disease, is admitted by some modern authors, but the fear of subsequent exhaustion prevents a resort to it. Yet in a post-partum hem- orrhage it is not unusual to meet with a loss of forty to sixty or more ounces without any serious consequences, after the pri- mary collapse. In fact, Dr. Gordon asserts that during the epi- demic, such patients as flooded profusely escaped the disease. My own recollection does not recall any instance of puerperal fever following a profuse hemorrhage. Dr. Harris, the Ameri- can editor of Playfair's Midwifery, edition of ’85, states in a foot- note as follows: “I believe that the entire abandonment of ven- esection has been a grand error, and that where there is early in the attack a high pulse, with great abdominal distension and tenderness, and a decided elevation of temperature, we ought to bleed the patient, sitting, at once, and to such a degree as to pro- duce a decided impression. One of the worst cases I ever saw was cured in this way. The woman was delivered at 3% P. M. 252 COMMUNICATIONS. of one day and the disease manifested itself in twenty hours. At nine the next morning she was apparently doing well; at One she was in great suffering, and could not bear her abdomen to be touched; vs. f 3 XVI. At 9 P. M., symptoms more grave; vs. f 3 XL in a sitting posture until she felt sick; at IO P. M., pulse I 50 ; in twenty-four hours from this, no fever and very little pain ; in three days regarded as out of danger.” Now the deduction which I desire to draw is, that the free flooding, or subsequent early catharsis, favors rapid action of the absorbent and excretory organs, and that an engorgement of vessels or alimentary canal retards it. And the same reasoning, I believe, holds good on the onset of the fever, z. e., that the treatment which can bring into active operation every one of life's processes for its maintenance and preservation is the best course to pursue. When you opiate a patient, you simply deaden and stagnate every organ and function, unless it be the skin. When you give veratrum heavily, you are paralyzing the cardiac muscle, by depressing the functions of the spinal cord, and les- sening its reflex activity. The large or continued use of the new antipyretics carries with it a dangerously depressing effect on innervation, which we are unable to measure or counteract successfully. Hence I am constrained to believe that bleeding and evacuants relieve obstructions of circulation and promote absorption and excretion more nearly in accord with nature's methods than any of the other potent remedies now relied upon. A&AE/2OA” 7" OAV /AV 7TO/AA 7TWOAV. BY S. L. McCurdy, M. D., DENNISON, OHIO. The greatest wonder to me in performing intubation is that I have been so successful in introducing the tube, so successful in removing it, and that I can report seventy-five per cent of recoveries. Since my experience has been confined to four cases, I may reasonably expect my per cent. of recoveries to be reduced ; and if the experience of my friends is any criterion, I must expect to fail sometime to find the tube, or possibly to introduce the same, even after repeated trials. THE COLUMBUs MEDICAL Journ AL of May, 1891, contains the following: “During the discussion of intubation at the recent meeting of the American Pediatric Society, Dr. Chas. W. Earle, of Chicago, said: ‘I have nothing to say in the direct line of the paper, for I am one of those who cannot, who cannot, McCURDy—A’effort on /m/ubaſzon. 253 intubate the larynx, and I am honest enough—and it does not take much courage either, to tell my professional friends in Chicago that I cannot do it. I think there are a good many of them who try to do it who should be as honest as I am, and acknowledge their inability. For while I believe this matter of intubating the larynx is one of the most brilliant things which have been brought before the profession in years, and I am as proud as anybody can be that American physicians have had more to do with it than those of any other nation, yet I say with a great deal of sorrow and shame that there are, I believe, though not in New York, Boston, nor Philadelphia, a certain number of people going around trying to intube the larynx, but killing the children. “‘I have seen some of the most barbarous, some of the most horrid surgery that has ever been attempted, it appears to me, attempted by some of these people who thought that in order to be in the current they must intube the larynx. I do not sup- pose it is possible to compute the number of the instruments sold to physicians in our locality, and yet we have but two physicians who do the operation nicely. I only commend the work of these gentlemen who have brought the operation to so perfect a state. “‘I think this society should take some action to prevent everybody from undertaking it. The greatest blunders are made in trying to take the tube out. I have seen men plunge and go through all sorts of motions trying to find the tube, and sometimes they have had to do tracheotomy in order to find it. In fact, I am strongly of the impression that a few of them have not been found to this day.’” I had a conversation recently with a friend—a resident of a neighboring city—who was called upon to intubate, and who, after making a number of failures, learned the operation by practice upon a dog; but, in spite of this, he utterly failed to get the tube in the larynx so as to stay. I know of a number of instances where failure has followed failure, and in one case, three very skillful surgeons tried to introduce the tube, but all failed. The foregoing is certainly very discouraging, and is a real drawback to an operation, which, in the hands of O'Dwyer, . Waxham and others, gave so much promise for the salvation of these little sufferers, for it is impossible for these experts to be obtained for such emergencies. 254 COMMUNICATIONS, I must confess, along with others, that the most difficult portion of the operation is the removal of the tube. In view of this difficulty, I have had a set of tubes changed as shown in the drawing. Upon the point of the upper lip of the extractor, I had a knob made, and at a corresponding point upon the posterior wall of the tube, as shown, I had a cavity burred out so as to receive the knob of the extractor. One difficulty in removing the tube, I think, has been to properly enter the beak of the extractor directly into the tube, 2. e., the true anatomy of the throat has not been thorougly understood. A natural conclu- sion would be, that to pass a tube into the trachea, it should be püshed downward on a line with the anterior wall or surface of the neck. Such is not the case; but, instead, in introducing the tube, its point should be directed forward, as though it was to make its exit through the anterior wall of the larynx. If this rule * –– is observed, there will be a less number of failures in introducing the tube. The change, as suggested, and shown in the accompanying drawing, I feel will reduce the difficulty of extracting to a minimum. Case 1. With Dr. McPeck of Bowerston. Patient, girl, aged four. (Reported in COLUMBUS MEDICAL JOURNAL, July, '91, page one.) The tube, in this case, was worn forty days, and after making a number of efforts to leave the tube out, upon the 18th day of the treatment the tube was allowed to remain undisturbed for thirteen days, as per advise of Dr. O'Dwyer. Recovery. Case 2. Courtesy of Dr. England, of Jewett. Diphtheritic croup, slight deposit on tonsils. Patient aged four years, in ad- vanced stage of the disease. Would apparently have died in a few hours. Tube introduced. Was hastily summoned thirty-six nours after and found case of capillary bronchitis. Temperature IO4°, respiration 60. No obstruction in air passage. Tube was entirely clear when removed post mortem. Death. McCURDy—A’eport of /w/uðation. 255 Case 3. Courtesy of Dr. Wilson, of this place. Patient aged two and one-half years. Male, suffering with every symp- tom of croup, but would likely have lived from eighteen to twenty-four hours. Tube introduced with relief of dyspnea. From this on, patient did well and the tube was removed on fourth day and left out. Recovery. Case /. Courtesy of Dr. Brannan, of Canal Dover, Ohio. Male, aged four years. Case was not in last hours of death, but would doubtless have lived eighteen to twenty-four hours. Tube introduced with relief of all symptoms of dyspnea. Case progressed favorably, and tube was removed after having remained in five days, eleven hours. Recovery. CONCLUSIONS: I am firmly convinced that intubation should be performed just as soon as the diagnosis is positively made out. Ist. Because the vitality of the patent is better, and there is less danger of pneumonia. 2d. If, when the tube is introduced, the lower end is beyond the lower margin of the membrane, the pressure upon the mucous membrane of the trachea destroys its membrane producing power. It is always best to use a tube a little large rather than too small. 7A7A: //E/D/CA/C 7TA’/2.4 7///º/V7 OA’ CVS 7/7/S. BY JAMES TYSON, M. D., PROF. OF CLINICAL MEDICINE UNIVERSITY OF PENNSYLVANIA. A paper read before the Philadelphia County Medical Society. The medical treatment of cystitis does not furnish a very satisfactory chapter in therapeutics. It includes such treatment as the physician is called upon to use supposing the exciting cause, such as a stone or obstruction in the urethra, to have been removed, wherever possible, I say when possible, because the enlarged prostate which is responsible for so many cases of cystitis is, in the vast majority of cases, not removable even in these days of brilliant surgical results. It must also include the treatment of a certain number of cases in which no remova- ble cause is ascertainable, as well as cases where, as with a long previous gonorrhea, the cause has long since been removed, but has left a deep-rooted tendency scarcely eradicable. 256 COMMUNICATIONS. It should be stated, too, at the outset, that the vast majority of cases of so-called cystitis are inflammations of the neck of the bladder and of that part of the urethra passing through the prostate. cuſe cys/2/2's is far less commonly met by the physician than the chronic form, while its treatment is far simpler, and, I may add, more satisfactory, at least so far as the removal of the acute symptoms is concerned. Rest in bed is a primary and essential condition. Leeches to the perineum should be applied more frequently than they are. A poultice to this same region and over the abdominal region is always useful, while a brisk saline cathartic should never be omitted. As the feverish state which always accompanies cystitis is more or less constantly associated with a scanty urine, concen- trated and irritating to the inflamed mucous membrane, it is desirable at once to increase the secretion, and thus dilute it. Copious libations of pure water, to which the citrate or acetate of potassium is added, in fifteen to twenty grain does for an adult, should be allowed. The ordinary spirits of nitric ether in two drachm doses every two hours is an admirable adjuvant, and may be combined with the officinal liquor potassii citratis, which contains about twenty grains of citrate of potassium to the half ounce. Formerly the mucilage of flaxseed or flaxseed tea was much used as a diluent menstruum for the diuretic alkalies indicated, but I am doubtful whether it is any more efficient than a like quantity of water. Where there is much pain and straining, as is often the case, especially where cantharides is the cause of the inflamma- tion, opium is indispensable, always in the shape of a supposi- tory, half a grain to a grain of the extract being thus administered, or a proportionate amount of morphine. Iced water injections into the rectum, or pieces of ice similarly applied, are very effi- cient in allaying the pain and irritation where additional measures are needed. & The successful treatment of chroſzzo cys/2/z's is a much more difficult task, for three evident reasons: Ist, the constant presence in the bladder of the urine with its irritating qualities, especially to an inflamed mucous membrane; 2d, the difficulty in getting remedies to reach the inflamed surface; and, 3d, the pent-up inflammatory products, which in their decomposition often make the urine still more irritating by exciting in it ammoniacal changes. There is no doubt that, if the urine could be kept from entering the bladder during the existence of an Tysox—7%e Medica/ 77-eatment of Cysłºſz's. 257 inflammation, the latter would rapidly heal; that cure would be facilitated by obtaining ready escape for the pus and mucus formed in the inflammatory process; while happier results might also be reasonably expected if we could secure readier access for remedies to the inflamed areas. None of these indications can be met entirely, hence the difficulty in attaining a cure. They remain, however, the conditions to be fulfilled, and while none can be thoroughly secured, they may be approximated in various degrees. To do this should be the object of treatment. First, the irritating qualities of the urine may be diminished by the use of diluents as already recommended in the treatment of acute cystitis. Almost any of the negative mineral waters, so highly recommended by their owners, are useful for this purpose. Just as good is pure spring water, or even Schuylkill water, and better is distilled water. From one to two quarts should be taken daily, If the kidneys are equal to their office, a large quantity of light-hued urine, of low specific gravity and relatively weak in solids, will be secreted. When it is proposed to go further and add to the efficiency of diluents, mistakes are often made. While one can scarcely go astray in adding alkalies to the fluid ingested in acute cystitis, it is very different with the chronic form. In this the urine is often alkaline, or ready to become so on the slightest addition of alkali to the blood. Such alkalinity of urine in turn favors decomposition, the effect of which is to convert the pus, if present, into a tenacious, glairy fluid which the bladder cannot evacuate. Notwithstanding this tendency, I have known liquor potassae and other alkalies to be administered under precisely these conditions—adding fuel to the flame. The indication under these circumstances is to render the urine acid, if possible, although this is very difficult to accomplish. Benzoic acid has the reputation of doing this, and it probably is true of it when administered in very large doses. It may be given in the shape of a five grain compressed pill, of which at least six must be given in a day to produce any effect. The same property has been assigned to citric acid, but this is a mistake, as all of the vegetable acids, when ingested, are eliminated as alkaline carbonates. f The second indication is to medicate the inflamed surface. Two ways, of course, suggest themselves: (a) by the internal administration of drugs; (b) by the injection of medicated liquids into the bladder. To carry out the first method, an enormous number of in- fusions, decoctions, and fluid extracts of vegetable substances have been suggested, the vast majority of which are absolutely useless, except as they serve by their quantity to act as diluents Among the best known of these are buchu, pareira brava, uva 258 * * COMMUNICATIONS. ursi, and triticum repens. I have never known any beneficial results from any of them, and have long ago ceased to prescribe them. - - The only class of remedies I have found of service in cystitis through their internal administration are the balsams. Of these, the balsam copaiba is practically unavailable, because not one stomach in a hundred will submit to its ingestion in sufficient doses or for long enough time to permit it to be of any use. On the other hand, I have found sandal-wood oil very useful, and it is about the only remedy of which I can say this for its direct effect upon the mucous membrane of the bladder. It is also comparatively well borne by the stomach, and is best administered in capsules containing ten minimus. I believe it Has heretofore been the usual custom to give these and like remedies after meals, but I have recently adopted the method of giving them on an empty stomach before meals. I believe they are as well, and even better, borne than when given after food, and they pass into the blood much more quickly. It is desirable to impregnate the blood and impart to the urine a balsam odor. This is scarcely possible with less than eight capsules a day— two before each meal and two at bedtime. I think I may say that I have found the so-called Santal-Medy capsules, which are, I believe, nothing but a very pure sandal-wood oil, better borne than the other specimens of the oil. I have given as many as twelve of these a day for considerable periods of time without deranging the stomach. Both boric acid and benzoic acid are useful adjuvants to the treatment of chronic cystitis through their antiseptic effect on the urine, each in five grain doses rapidly increased to ten. I have used resorcin in five to ten grain doses, and naphthaline in two grain doses for the same purpose. & The application of remedies to the bladder by injections can be conveniently considered in connection with the third indica- tion—the getting rid of the products of inflammation, the pus and mucus, and the compounds resulting from their decomposi- tion. The latter are, of course, not always present, but all who have had much experience with cystitis are familiar with the tenacious, glairy mucoid matter, which will not drop or rise up in a pipette, glistening with large crystals of triple phosphate, and exhaling a stinking ammoniacal odor which quickly con- taminates an entire apartment. There is only one way to get rid of this, and that is to wash out the bladder, and too often this is too long deferred. Tepid water should be first used, and the injection made through the soft catheter now so invariably adopted. Sir Henry Thompson is very emphatic in his direc- tions that no more than two ounces should be thrown in at a time, and that this should be allowed to run out, a like quantity Tyson—7%e Medical 77-eatment of Cystiſis. 259 again injected and allowed to run out, and this repeated until the water comes out as clear as it enters. In a very large ex- perience in washing out bladders, I have never met an instance in which the amount named by Sir Henry may not be doubled with advantage, so that I begin with four ounces. When this quantity is used, a much shorter time is necessary to cleanse the bladder thoroughly ; and after the capacity of the bladder has been determined I often throw in more, because it is sometimes useful to distend the viscus a little, for in this manner the depressions and inequalities between the muscular trabeculae, always present in advanced bladder inflammations, are thoroughly reached. These simple injections, practised once a day, or in severe cases twice a day, often result most happily. I have seen the pus reduced from large bulk to a mere trace, and micturition reduced from five or six times to once a night. Commonly, after a few injections with plain water, I add some medication. My favorite is the salicylate of sodium in the proportion of a drachm to the pint. Its disinfecting qualities are undoubted, and I have some reason to believe that the soothing effect claimed for it is not without foundation. I have used a good deal of Sir Henry Thompson's soothing solution—of biborate of sodium an ounce, glycerin two ounces, water two ounces, and of this mixture half an ounce to four ounces of tepid water—with about the same result. Boric acid, in the proportion of a drachm to the pint, is also very satisfactory. - Alum is an astringent which has been too much overlooked of late in suppurating processes in mucous membranes, and may be substituted for the salicylate with advantage where the pus does not diminish as rapidly as is desired. It should be more cautiously used than the salicylate of sodium. Sufficient of the powdered alum should be first added to a pint to give it a dis- tinctly astringent taste, when the bladder should be washed out as described, while a small quantity may be allowed to remain after the last injection. Where there is a foul odor present I use the bicloride of mercury in solution, but exceedingly dilute. It is almost in- credible how small a proportion of this salt is irritating to the bladder, and having learned by experience, I never begin with a solution stronger than 1:25,OOO, but gradually increase the strength if it is well borne. Carbolic acid may be substituted for the bichlorid of mercury, but it has not been so satisfactory in my hands. Other drugs are recommended to be similarly used, but I lave had little or no experience with them. One from which much may, with reason, be expected is the peroxide of hydrogen, one part to five, of water. In the single instance in which I have used this, the patient, who had previously been using 26O COMMUNICATIONS. the bichloride solution, returned of his own accord to the latter, because he thought it more satisfactory. Among other remedies recommended to be used the same way are acetate of lead, one grain to four ounces; dilute nitric acid, one or two minims to the ounce ; and nitrate of silver, one grain to four ounces; but I have had no experience with them. Anodynes are indispensable in many cases of cystitis to relieve the patient of extreme pain and the frequent desire to pass water, which are the result of the same cause. Opium and its alkaloids are the most efficient, and they are best introduced by the rectum. There appears to be no absorbing power for opium at least, and there is no use in attempting to use an- odynes by that channel. Cocaine, from which so much might reasonably be expected, has failed of its purpose in my hands. I have injected as much as two ounces of a two per cent. solution into the bladder with- out effect, except to produce some of the symptoms of cocaine poisoning. Most disappointing, too, has been the use of cocaine to remove the exquisite tenderness of the urethea which some- tinues attends this condition, and is a serious drawback to the use of the catheter. Where there is greatly enlarged prostate, catheterization is indispensable, and is attended often with the most happy results. It is often too long deferred because of the natural repugnance to the use of the instrument. Of course, the patient or his friends should be taught to use the catheter and to wash out the bladder. In these days of refined antisepticism it is scarcely necessary to say that the extremest precautions should be taken to cleanse the catheter after its use, in order to avoid sepsis. There is nothing better for this purpose than the bichloride solutions I: IOOO, in which the catheter should be allowed to lie for a short time after being cleansed with boiling hot water. How much can be accomplished by such treatment as the above described 2 That an absolute and total cure is ever obtained in chronic cystitis is exceedingly doubtful, Hence the statement at the beginning of my paper, that the medical treat- ment of cystitis does not furnish a very satisfactory chapter in therapeutics. On the other hand, that a life of suffering may be converted into one of comparative comfort is certainly true, and I have many times seen it. Nay, more; I have more than once seen a life prolonged half a dozen years in such comfort by care- ful attention to the bladder of the kind described, It occasionally happens, of course, that all treatment of this 1 Associate Editor. C. R. CORNELL, * - Business Manager. 48 PAGES READ/WG MATTER, PUBLISHED MOWTHLY. $1.00 PER YEAR. THE COLUMBUS MEDICAL PUBLISHING COMPANY, Publishers and Proprietors, 266 East Gay Street, Columbus, Ohio. Entered at Postoffice, Columbus, Ohio, as second-class mail matter. CH. 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Keith & Co., New York.................... 3 Renz & Henry, Louisville, Ky. . . . . . . . . . . . . . . . . 16 Cincinnati Sanitarium . . . . . . . . . . . . . . . . . . . . . . . . 4 Reed & Carnrick, New York . . . . . . . . . . . . . . . . . . 18 The Antikamnia Chemical Co., St. Louis, Mo. , 4 Bowden Lithia Spring Co., Lithia Springs, Ga. 20 Dios Chemical Co., St. Louis, Mo. . . . . . ....... 5 Columbus Medical Publishing Co. . . . . . . . . . . . . 21 I. O. Woodruff & Co., New York. . . . . . . . . . . . . . 6 Hall & McChesney, Syracuse, N. Y. . . . . . . . . . . 21 Cornell-Pheneger Chem. Company, Columbus, Katharmor, Chemical Co., St. Louis. . . . . . . . . . . . 22 io. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 James I. Fellows, New York................... 24 The Arlington Chem. Co , Yonkers, N. Y. . . . . . 8 PREMI UM LIST FOR 1892. . . . . . . . . . . . . . . . . . . 17, 19, 23 Eisner & Mendelson Co., New York. . . . . . . . . . . 9 Charles Marchand, New York...... 1st page cover. Lambert Pharmacal Co., St. Louis............. IBO C. N. Crittenton, New York. . . . . . . . 3d “ & & YWm. R. Warner & Co., Phila., New York..... 11 Parke, Davis & Co., Detroit & N.Y.4th “ & & Mariani & Co., New York . . . . . . . . . . . . . . . . . . . 12 - A combination of the best Worwegian Cod Liver 0i/ with MALTIME, in which, by the vacuum process, rancidity is prevented and disagreeable odor and taste of the oil removed. Base a Powerful Reconstructive Contains No Inert Emulsifier lº, Ill illiligsillſ ill; Pālāl; Is an active Starch Digester and Tissue Builder. Produces rapid Improvement in Appetite. is used where “Emulsions” cannot be tolerated, A complete list of the Maltine Preparations and their formulæ will be sent on application. THE MALTINE MANUFACTURING CO. (Please mention this Journal.) New York, N.Y.; 2 WESTERN PENNSYLVANIA MEDICAL COLLEGE, CITY OF PITTSIBURGH. SESSIONS OF 1891-'92. The RRGULAR SEssroN begins on the last Tuesday of September and continues six months. Paring this Session, in addition to four Didactic Lectures, two or three hours are daily allotted to Clinical Instructions. Attendance upon three Regular Courses of Lectures is requisite for graduation. A three years’ graded Course is provided. The SPRING SESSION embraces Recitations, Clinical Lectures and Exercises, and Didactic Lectures on special subjects. This Session begins the second Tuesday in April, and continues tºa weekg. The LABora TORIES are open during the Collegiate Year for instructions in Chemistry, Microscopy, Practical Demonstrations in Medical and Surgical Pathology and Lessons in Normal Riistology. Special importance attaches to the Superior Clinical Advantages possessed by this College. For particulars see Annual Announcement and Catalogue, for which, address the Secretary of Faculty. - PROF. T. W. T. McKENNAN, 810 Penn Avenue. Business correspondence should be addressed to PROF. W. J. ASDALE, 2107 Penn Avenue, Pittsburgh, Pa. IDER. MCCTMITUTINTINT’s I E tº […] [IF O. F. O. Fº Tºſ. M t An Invaluable Discovery in the Preparation of Opium. TAZAS IS 7"A+E PURA2 AAVID ESSAEAVTIA/, EXTRA C 7" FROM 7THE AWA 7TWVE DA’ UG. It contains all the valuable medicinal properties of Opium in natural combination, to the exclusion of all its noxious, deleterious, useless principles upon which its bad effects depend. It, Fºº. all the sedative, anodyne and antispasmodic powers of Opium: . To produce sleep and composure; to relieve pain and irritation, nervous excitement and morbid irritability of body and mind; to allay convulsive and spasmodic actions, ete.; and being purified from all the noxious and deleterious elements, its operation is attended by no sickness of the stomach, no vomiting, no costiveness, no headache, nor any derangement of the constitution or general health. Hence its high superiority over Laudanum, Paregoric, Black Drop, Denarcotized Laudanum, and every other Opiate preparation. E. FERRETT, Agent, 372 Pearl St., New York. HARRISON COLE, PRACTICAL OPTIOIAN, All Defects of Vision, requiring Spherical Lenses, scientifically corrected. Special t Lenses carefully adjusted to prescription. Optical and Scientific Goods of all kinds. Repairing of every description. Prescription Blanks Furnished Physicians on Application. 64 North High Street, Columbus, Ohio. JUsT on E worD to the Medical Profession as to the value of TERRALINE (or purified Petroleum) in Bronchial Pulmonary Catarrhal and other Diseases of the Throat and Lungs. In the first place it is not an emulsion, and does not deteriorate with age. In the second place it is tasteless and Odorless; the patient can continue its use without repugnance to the taste. It does not cause eructations Or nausea and the most delicate stomoch can tolerate it. It is pre- scribed by the leading physicians everywhere and the grand results from its use as reported to us . *. increditable. Read what a few of our leading city physicians say of it, as given in IAU6 r"W16WS. DR. JAMES T. YOUNG, 1836 New York Avenue—“Terraline has promptly relieved a number of cases of Chronic Bronchial Catarrh that would not yield to other remedies.” DR. J. O. STANTON, 1344 G. Street—“I have prescribed Terraline in a large number of cases of Laryngitis, Bronchitis aud. Incipient Phthisis, and am more than pleased with the result.” Dr. Z. T. SOWERS, 1320 New York Avenue—“I have prescribed Terraline in a number of Cases such as are usually given COd-Liver Oil, and as it has the double advantage of no odor or taste, can be given in those cases in which Cod-Liver Oii disagrees, with all the advantages of the latter, and with even increased benefit.” - DR. A. Y. P. GARNETT, 1317 New York Avenue—“Have prescribed Terraline as many as thirty times, and for almost as many forms of Bronchial and Pulmonary complaints, and fail to recall a single instance in which I did not see prompt and decided improvement in the patient.” DR. D. C. PATTERSON, 919 I Street—“I am of the opinion that in Terraline we have a most valuable agent in the treatment of the class of cases for which Cod-Juiver Oil is prescribed.” DR. P. J. MURPHY, Surgeon in charge of the Columbian Hospital—“I have prescribed Terra- line very often in the last year, both in and Out of the Hospital, with grand results, and while I never write a certificate for a medicine, however good, am free to say that I see in Terraline the #; remedy for the trestment of Bronchial and Pulmonary troubles ever brought to my attention.” We have hundreds of certificates from all parts of the United States which we will insert from time to time in the Medical Journals where they legitimately belong. B. —TERRALINE............................................. 3 xii. Sig.—One or two teaspoonfuls, three or four times daily, in sherry wine. The price of Terraline is One Dollar a bottle. A full size bottle for trial will be sent to any physician without expense except for express charges which he must pay on receipt of it. THE TERRALINE COMPANY., SOLE M'FRS. 1316 L STREET, N. W., WASHINGTON, D. G. CUREID IBY THE USE OF I tº E- I C * tº E C SES c o N. T. I N G. A.V.E N A S A T L V A. FROM COMMON OATS. A POWERFUL NERVE STIMULANT, TONIC, ETC., Is also Employed in the Treatment of Paralysis, Epilepsy, St. Vitus' Dance, Chloral and Tobacco Habits, Sleeplessness, Nerve Exhaustion, Neuralgia, Alcoholism, Painful and Deficient Menstruation, Headache, Hysteria, Convulsions and Prostra- tion from Fainting, and in the Convalescent Stage of all Acute Diseases. DOSE.-From ten to thirty drops or more, as often as may be indicated to meet the urgency of the case. º * Administer in hot water when quick action is desired. Messrs. B. KEITH & CO –Gentlemen : Melroy, Ind. I am giving the con, tr. avena sativa for the morékia haëit, and I, find it will cure, I believe, all cases, no matter how long they haze been the slave of this opium monster. I think this is the greatest discovery of Our age. F. M. TPOLLITT, M.D. Messrs. B. KEITH & CO.,-Gentlemen: Barnesville, Ga. The con. tinct. avena sativa has been more successful in the treatment of the opium habit than anything I have ever tried, and I have tried various other remedies, amongst them the advertised nostrums. - J. C. HOLLOWAY, M.I. Messrs. B. KEITH & CO., Gentlemen : Idaho Springs; Col. I have tried a small amount of the con. tr. avena sativa and am more than plcased with it in the of items haëzt and several other cases, such as in female diseases and nervous conditions. - CHAS. B. RICHMOND, M. D. Send for printed matter on Con, Tinc., Avena Sativa in the Morphine or Opium, Habit, and certificates from different members of the Medical Profession citing cases under their charge treated by it, also Revised and Enlarged Manuel to Es. EEEixº Go. unaanic CHEMists, ESTABLISHED | 852. No. 75 WILLIAM ST. NEW YORK. H LZ º p: ſº H 2. º Pl § Hºr p: Q4. C p: As fº º sº º º ſº § ſ gº." fº sº §§§ſº § sº § º - §§§ * º: º jº ſº łº §§ º Rºšº º º! (l #=# #º º § §§ *, ºr: ; §§ * ºśs - § §§ suº ~. ...: :*::=2x=== A PRIVATE HOSPITAL FGR MENTAL AND NERWOUS DI30RDERS. COLLEC E H E LL, OH ! O. Eighteen Years Successful Operation. Oue Hundred and Fifty Patients admitted annually. Daily Average, Seventy. Cottages for Nervous Invalids, Opium Habit, etc. Location Salubrious. Surroundings Delightful. Appliances Ample. Charges Reasonable. #; by Rail; 6 Trains Daily; 30 min. from G. H. & D. Depot, Fifth and Hoadly Sts., IIl Ginnati. mº, M *** *śaº * > ...º º - ºn: DURIijº LAST YEARS EßIDEAic THE EXHIBITION C F Žs/s/so G) @ 3) @ & G c. N/N/A zºº PA I Nº. º ANZNZN º secured THE DESIRED REsults sº AND IS AGAIN IRIDICATED BY TAE * , , , RETURN OF INFLUENZA G a AND liſs ALLIED COMPLAINTs. SP * FOR HISTORY & LITERATURE ADDREss. THE ANTIRAMNHA CHEMICAL CO., ST. LOUIS, MO., U. S. As W. W. ". : ; *... . - º . . ~ ." tº . . ...t. t " ºf º: "A Nº And O WERFUL NEUROTIC, I (INTI & I A N. O. Dº Y Nº ºf A N D H YP NOT. C. A most efficient and permanent preparation, REMARKABLE for its efficacy and THERA- PEUTIC, EFFEGTS in the treatment of those NERW'ſ US AFFECTIONS and morbid conditions of the System which so often tax the skill of the Physician. A RELIABLE AND TRUSTWORTHY REMEDY FOR THE RELIEF OF Aſysteria, Fºlepsy, AVeurasthenia, Mania, Chorea, Uterine Congestion, Migraine, Meuralgza, All Conz/u/szze and A’eſſex Avezzroses. . & - . . . . . * §: ; ) §§ º . . . . . . . 7 he ſeemedy Par Bºxcellence in Delirium and A’estlessness of Fezers. Is the result of an extended professional experi- ence, and is compounded in the most palatable form by a skilled pharmacist, the formula of which will commend itself to every Physician. FORMULA :—Each fluid-drachm contains 5 grains each, C. P. Bromides of Potassium, Sodium and Ammonium, I-8 gr. Bromide Zinc, I-64 gr. each of Ext Belladonna and Canna- bis Indica, 4 grains Ext. Lupuli and 5 minims fluid Ext. Cascara Sagrada, with Aromatic Elixirs. - daily, as may be directed by the Physician. DOSE:—From one teaspoonful to a tablespoonful, in water, three or more times FOR FURTHER INFORMATION AND 8AMPLE BOTTLE SEE FOOT OF THIS PAGE. ' ". . .”. J U.J. ºs. RNTIA UTERINE Tuniſ, ANTiSPASMODIG AND ANODYNE. A reliable and trustworthy remedy for the relief of Dysmenorahoea, Amenorrhoea, Menorrhagia, Leucorrhoea, Subinvolution, THREATENED ABORTION, Vomiting in Pregnancy and Chlorosis; directing its action to the entire uterine system as a general tonic and antispasmodic. This combination is the result of an extensive professional experience of years in which the constituent parts have been fully tested singly and in combination in various proportions, until perfection has been attained. . º .." 2. \, \! : wº FORMULA :—Every ounce contains 3-4 dram each of the fluid extracts: Prunifolium, Viburnum Opulus, Dioscorea Villosa, Aletris Farinosa, Mitchella Repens, Caulophyllum Thalictroides, Scutellaria Lateriflora. a desertspoonful to a tablespoonful three times a day, after meals, HA is prepared for prescribing exclusively, and the formula as given will commend itself to every intelligent physician. Virburnum Helonias Dioica. DOSE :-For adults, In urgent cases, where there is much pain, dose may be given every hour or two, ALWAYS IN HOT water. - Jno. B. Johnson, M. D., Professor of the Princi- ples and Practice of Medicine, St. Louis Medical College. St. Louis, June 20, 1888. I very cheerfully give my testimony to the Virtues Of a combination of vegetable remedies prepared by a well known and able pha} ma- cist of this city, and known as DIOVIBUIR- NIA, the component parts of which are well known to any and all physicians who desire to know the same, and, therefore, have no rela- tion to proprietary or quack remedies. I have employed this medicine in cases of dysmenor- rhCea, Suppression of the gatemania, and in excessive leucorrhoea, and have been much pleased with its use. J do not think its claims (as set forth in the circular accompanying it) to be at all excessive. I recommend its trial to all who are willing to trust to its efficacy, be- lieving it will give satisfaction. Respectfully, ~~! <^ CA. L. Ch. Boisliniere, M. D.. Professor of Obstet- rics, St. Louis Medical College. St. Louis, June 18, 1888. I have given DIOVIBURNIA a fair tral, and found it useful as an uterine tonic and anti- Spasmodic, relieving the pains of dysmenor- rhoea, and regulator of the uterine functions. I feel authorized to give this recommendation of DIOVIBURNIA, as it is neither a patented nor a secret medicine, the formula of which having been communicated freely to the medi- cal profession. 3ozs/n es e hºo. H. Tuholske, M. D., Professor Clinical Surgery and Surgical Pathology, Missouri Medical College ; also Post-Gradutate School of St. LOuis. St. Louis, June 23, 1888. I have used DIOVIBURNIA quite a num- bcr of times—sufficiently frequently to satisfy myself of its merits. It is of unquestionable benefit in painful dysmemorrhoea ; it possesses antispasmodic properties which seem especi- ally to be exerted on the uterus. A’z A. Z.A.-4-6. To any physician unacquainted with the medicinal effect of DIOVIBURNIA, and, NEU- ROSINE, we wiſ] mail pamphlets containing full informatian, suggestions, commendaiions of some of the most prominent professors in the profession, and Various methods of treatment ; also a variety of valuable prescriptions that have been thoroughly tested in an active prac- tice, or to physicians desiring to try our preparations, and who will pay express charges, we Will send on application a bottle of each free. DIOS CHEMICAL CO., ST. LOUIS, MO. FRELIGH’s TABLETs, & (Cough and Constituent), FOR THE PREVENTION AND GURE OF PULMoMARY PHTHISIS. IE"OIFR-IM ITUTI Lº Z ETH. e Cough Tablets. Constituent Tablets. EACH TABLET contains. ' s Each tablet contains. - Morph. Sulph. (; ; gr.), Atropiae Sulph. Arsenicum (ºn gr.), Precipitate Carb. (##0 gr.), Codeia (º, gr.), Antimony of Iron, Phos. Lime, Carb. Lime, Silica, Tart. (; gr.), Ipecac, Aconite, Pulsatil- and the other ultimate constituents, la, Dulcamara, Causticum, Graphite, according to physiological chemistry, Rhus-tox, and Lachesis, fractionally so (normally) in the human organism, arranged as to accomplish every indica- together with Caraccas, Cocoa, and tion in any form of cough. - Sugar. - PRice, THREE Dollahs PER Double Box. Containing sufficient Tablets of each kind to last from one to three months according to the condition of the patient. A Connecticut physician writes: “I am now using your Tablets, on a patient (young lady), who has had three, quite severe hemorrhages the week previous to the beginning of the same. She has taken one box only, has had no return of the hemorrhage, and has gained four (4) pounds since beginning treatment, besides all rational symptoms have improved wonderfully. I will add that I had tried Ol. Morrh., Syr. Hypophos. Co., etc., with no apparent benefit.” A Virginia physician writes : “Eºclosed find Postal Note for another double box Freligh’s Tablets. I used the sample box in three cases, with decided benefit in one, slight improvement in second, and while they did nºt improve the third case, it being in very advanced stage, there was an amelioration of the distress- ing symptoms.” - A Massachusetts physician, in practice 25 years, writes : -- - send me two double boxes Freligh's Tablets. I have tried the sample box with most excellent results.” A Michigan physician writes: “I am more than pleased with them. They have not disappointed me once. Dr. C. for whom I ordere i a box, writes me that he is much improved, and speaks in praise of them. He has geºuine Tuberculosis, and while I do not think he can recover, yet I firmly believe the Tablet S will prolong his life.” - sIEPIEHCIA-ILE CIE"I FI EHI FR-. While the above formulae has been in use, in private practice, over 30 years, and we could give testimonials from Well-known clergymen, lawyers and business men, we prefer to leave thern to the unbiased judgment of the profession with the following offer : On receipt of 50 cents, and card, letter head, bill head, or other proof that the applicant is a physician in active practice, We vil send, delivered, charges prepaid, one of the regular (double) boxes, (retail price, Three Ijóñar) containing sufficient of each kind of Tablets to test them three months (in the majority of cases) in some one case. Card, letter head, or some proof that the applicant is a physician in active practice, MUST accompany each application. Pamphlet with full particulars, price list, etc., on request. A PEBICsIF>EHICIERIZE CERE ERO-SPIN ANT. - (FRELIGH’S TONIC,) Our Special Offer is still open, to send to any physician, on receipt of 25 cents, and his card or letter head, half a dozen samples, delivered, charges prepaid. Each Sample is sufficient to test it for a week in Qne Case. - º * As we furnish no samples through the trade, wholesale or retail, for samples, directions, price Iists, etc., address T. C. WOODIER, UIETIE" &; CO- Manufacturers of Physicians’ Specialties, 38 MCA-IIDENT I. A-IN E, INTE! WZ ~ OIF.Ex. CITY". Orthopedial sm, Appliances. We are now manuſactur- ing everything in the way of º º::::::: º º tº Spinal, Weak Ankle or / \ | Bow Leg Braces **; º º & dip Splintst º ºis. % 2::: Everything in the ORTHOPEDIC T-irh-e- Write us before ordering or send your patient to us and we will take the measurement and guarantee a fit. We can make as good an APPLIANCE as can be had elsewhere ºf Te * > for LESS MONEY AND CAN FURNISH º sh º IT MUCH QUICKER. - |||ſ: º |##! t |illili º FULL INSTRUCTIONS SENT FOR MEASUREMENT WHERE PATIENT CANNOT BE SENT TO US. 25 JBI CBlt, DiSCOInt ******** from price to patient given Physician when order from Doctor is sent with patient . The Cornel-Pheneger Chemical Company, COLUMBUS, OHIO. PHYSICIANS" SUPPLIES OF ALL KINDS. PEPTONOIDS BEEF (POWDER) BEEF, + Sterilized MILK, Partially Peptonized. GLUTEN, THE MOST CONCENTRATED AND NUTRITIOUS FOOD IN THE MARKET A'eceived the only GOZ/2 MADAZ and Highest Azward at the International Health Azhabition, Zondon, after a critical examination of all the Beef and Concentrated Food A roductions by a /ury composed of the best Chemists in AEurope. There is no food preparation that compares with it in nutritive properties. It is partially prepared for assimilation, and, therefore, makes less demand upon the digestive powers of the gastric juice. - Being in the form of a dry powder and sterilized, it will keep in any climate. It contains 95 per cent of nutritious matter. ...” The use of BEEF PEPTO NOIDS is indicated as follows : Convalescence from all diseases, Pulmonary Affections, Pneumonia, Phthisis; Dyspepsia, Gastritis, and all Stomach Ailments; Fevers, Diarrhoea, Dysentery, and all Intestinal Diseases; Marasmus, Bright’s Disease, Diabetes, and excessive use of Alco- holic Stimulents. Beef Pep'onoids may be given per rectum in all cases where the stomach cannot digest food, and in debility resulting from any cause. IFIEFTCTTCTDs II ICUIT). This preparation represents, Beef Pep oncids in the form of an elegant cordial, all constituents being entirely digested and ready for assimilation. Liquid Peptonoids is a nourishing peptogenic liquid stimulent with the albuminoids in a soluable state with only sufficient spirits added to preserve it. It contains the largest amount of albuminoid principles and the least amount of alcohol that is possible to use and to make a stable compound. liquid Peptonoids will keep indefinitely; its flavor and palatability are such that many who have taken it liken it to a delicate cordial. It will readily be taken by patients who are unable to injest food in any other form (in these cases it has been found of the greatest service). In convalescence from fever and other diseases, in loss of appetite, weak digestion and gastritis, its effects are positive, and it will never fail to give perfect satisfaction. There is no preparation in the market that has been recommended so highly by physicians who have carefully tested it. D0SE,-For an adult, one tablespoonful three times to six time a day; children in proportion, PHOSPHO-CAFFEIN COMP. (GRANULAR EFFERVESCING...) A SEDATIVE NERVE AND BRAIN F000. - The most efficient and palatable preparation in Nervous and Sick Headache, Neuralgia, Insomnia, Neurasthenia, and General Nervous Irritability. . Caffein. *=e Acidi Phosphorici, aa grains, ss. Each dessertspoonful contains: { Antipyrin. Ext. Apii. Grav. Dulc. (Celery) aa grain j. Sodium Bromide, grains v. DOSE,-One or two heaping teaspoonfuls in a half tumbler of water. Put up in 4 oz. and 8 oz. Bottles. THE ARLINGTON CHEMICAL COMPANY, ! . for the above preparations.) TSZ OINTIEEE. S., INT- TY". COLUMBUS MEDICAL JOURNAL A MONTHLY JOURNAL OF MEDICAL SCIENCE. VOL. 10. JAAVOAA’Y, 1892. No. 7. COMMUNICATIONS. SOME FACTS EVERY PRAC7/7/ONER OUGA/7 7 O AAWOW AAPOO/7 SQU/AV7. & BY A. R. BAKER, M. D., CLEVELAND, O. Professor of Ophthalmology and Otology, and Clinical Professor of Diseases of the Eye, Ear and Throat, in the Medical Department of Wooster University. I meet doctors all over the country who do not know the difference between a hypermetropic and a myopic astigmatism— practitioners who do not possess an ophthalmoscope or trial lenses, and who would not know what to do with them if they had them, who say, “I make no pretensions to treat eye diseases, except those of the most trivial character, such as granular lids and szmple operatzon to cure s/rabzsmus.” - When I answer such remarks by saying that there are few subjects in the entire field of ophthalmology requiring so much judgment and such a wide knowledge of the anatomy and physi- ology of the eye, and so thorough a mastery of the intricate subjects of refraction and accommodation, as the treatment of squint, I generally lose, in the esteem of doctors of this class, the reputation I may have as an oculist. Two or three unsuc- cessful operations often serve to modify this unfavorable opinion very materially. As an illustration of the frequeney of the fail- ure of operations for squint, in the hands of surgeons not having 289 29O COMMUNICATIONS. a thorough knowledge of refraction and accommodation, and the optical principles involved in the treatment of these cases, I may quote the following statistics of consecutive cases, as re- vealed from my case-book in private practice: Advancement of the internal rectus has been performed thirty-two times, and thirteen of these were cases in which the surgeons had divided the internal recti too freely, and the case of simple convergent squint was changed into a marked diver- gent squint, leaving the patient in a much worse condition than if no operation had been performed. Several of these cases occurred at the hands of surgeons of undoubted skill. During the same period of time, eighty-four cases of convergent squint have been operated upon, and twenty-seven of these cases had been operated upon by other practitioners unsuccessfully. Some of them had been subjected to as many as eight to ten opera- tions. 1 One of the facts every practitioner should know about squint is, that no surgeon should perform an operation for cross- eyes who is not competent and prepared to make a careful scientific examination of the patient’s refraction, and prescribe spectacles accordingly. There are thousands of cases of squint scattered all over the country who have been operated upon unsuccessfully, or who have knowledge of unsuccessful opera- tions, and who go through life with this deformity uncorrected, because nearly every young graduate of medicine who has seen a few operations performed in the clinical amphitheatre, when a student, thinks himself competent to make the operation, and experiments on the first case he meets. It is not surprising that the operation has fallen into disrepute in the minds of the laity. - Another fact every practitioner ought to know about squint is, that the object to be gained by treatment is not only a cos- Inetic one, but to establish and preserve binocular vision. The person suffering from squint sooner or later becomes, to all intents and purposes, blind in one eye. He has a blind side. He, to a large measure, has lost the “perspective sense,” and cannot judge of distance. *- Is the amblyopia of the squinting eye the cause or the effect of the squint? The weight of opinion seems to be that the theory of Donders is in the main true. The squint depends upon hypermetropia and the interdependence of accommodation and convergence; the amblyopia is the result of disuse, psychi- cal exclusion, or suppression. The leader of the operation is BAKER—Some Facts Every Practitioner, Etc. 29I Schweiger, of Berlin. He thinks the amblyopia is monocular and congenital, or that it precedes, and is one of the—if not the sole—causes of the squint. Cuignet sadly misunderstands or misrepresents Donders' theory, and brings forward the strange theory that the child conceals the squinting eye beneath the in- ternal angle and under the shadows of the nose and brow because of photophobia. A “reflex” exercised by the defective eye is juggled with. he strongest argument brought against the views of Donders is, that all children are hypermetropic, and, conse- quently, the connection between hypermetropia and squint is not so evident as heretofore supposed. There are several answers to this observation. There is undoubtedly a difference in individuals in this respect. Some are able to exercise greater accommodation with less convergence than others. They have more “play” in this respect and are able to resist the tendency to squint. It has also been shown that the average amount of hypermetropia is much greater in squinting than in mon-squint- ing children. Mr. Frost finds in his own practice that hyper- metropia under I D., which is common in children, is seldom associated with squint. A majority of his strabismus cases had a refraction of over 2 or 3 D. of hypermetropia, and over IO per cent. had H. of over 6 D. .* Mr. Snell's cases of squint averaged over 4.25 D. of hyper- Imetropia. Landolt quotes the following conclusive experiment as proving that hypermetropia has a tendency to produce a squint: “If we possess binocular vision, let us fix a near object, cover one eye, the left for instance, and place a concave glass before the right. This eye will not change its direction, but will con- tinue to see clearly, but the effort of accommodation, which it is forced to make in order to neutralize the negative glass, imposes itself at the same time on the other eye, and provokes in the lat- ter a converging strabismus of a degree corresponding to the power of the concave glass. The existence of this strabismus may be easily established objectively, and manifests itself sub- jectively by a homonymous diplopia at the moment when the diaphragm is removed from in front of the left.” . It is certainly a matter of almost every day experience with practical ophthalmic surgeons, that the correction of the ametro- pia is frequently all that is necessary to cure the squint; the moment the glasses are laid aside, it reappears. Another fact every practitioner ought to know about squint is, that most cases can be cured without an operation. Of one 292 COMMUNICATIONS. Hundred and ninety-eight consecutive cases of convergent stra- bismus occurring in my private practice, one hundred and six, or Imore than one-half of the entire number, were cured without an operation. I say they were cured advisedly, because when I commenced using spectacles for the cure of strabismus, I found that when I charged fifty dollars for an operation for strabismus, patients paid it willingly, but when I charged fifty dollars for fitting spectacles, even though it required infinitely more skill and time than was required for the operation, strenuous objec- tion was made to paying so large a fee; so that to keep my patients, and at the same time secure a moderate fee, I fell into the habit of charging a stipulated amount, and if the spectacles did not effect a cure, I agreed to make the operation without additional cost to patient. In this way, with very few excep- tions, I have been enabled to follow my cases to complete recovery. A review of these cases has suggested a number of interesting questions. We may have determined accurately the refractive condition of each eye, and yet be at a loss to know what lenses to prescribe. The glasses that are theoretically correct may be absolutely refused by the patient. The number of changes made in these prescriptions is a painful attestation of this fact. Must the whole amount of the error of refraction be neutralized 2 If there is a difference in the refractive condition of the two eyes, shall both eyes be corrected fully 2 If one only, what is to be done with the other P Must the spectacles be worn all the time 2 When, and how long, should atropia be used ? When will two pairs of spectacles be needed ? What are the indications for decentering the lenses, and what for prisms ? The question of personal appearance also has to be taken in con- sideration, and will have a decided influence in rendering a ver- dict as to what style of frames shall be worn—eye-glasses or spectacles, which 2 These are problems that require the best judgment, and try the skill of the oculist. - Every case presents a problem to be solved. As a general rule, the nearer a full correction of the error of refraction is attained the better. In order to do this accurately the accom- modation should be paralyzed with atropia in every case. Spectacles should always be given in preference to eye-glasses. Treatment based upon these facts, viz., that the squint is due to the error of refraction, that binocular vision can be restored, and that squint can be cured without an operation has met with the most gratifying results. If cases are seen early and treated carefully it may be a question whether it is ever . e k Inecessary to make an operation. BAKER—Some Facts Every Practitioner, Æte. 293 Mothers are, as a rule, accurate observers of their children’s ailments, and I am constrained to put more confidence than formerly in the statements frequently made by mothers, such as the following: “My child's eyes were not crossed until he had an attack of the measles, or some other illness, or had a slight injury of one eye, and it was tied up for a few days; when the bandage was taken off the eyes were crossed ; or he imitated a cross-eyed playmate; or he amused his little sister by making eyes.” These children might have gone on through life with- out Squinting, but for the trifling incident that for a short time unbalanced the natural tendency there is in all cases to estab- lish and preserve binocular vision, but owing to the excessive 11ervous stimuli that are sent to the internal recti in all cases of hypermetropia the squint soon becomes permanent. The prac- tical application of this observation is that many cases of squint Imay be prevented by a little timely advice to the mother. While every case of hypermetropia does not squint, every case of squint is hypermetropic. The statement, that once hypermetropic always hypermetropic, is not true, as will be attested by any one who has kept cases under observation year after year. I have notes of a case, a boy six years of age, brought to me about seven years ago, with convergent strabis- mus; he had two dioptries of hypermetropia. I gave him a pair of spectacles correcting the error of refraction fully. The eyes soon became straight; about two years afterward he returned and said he could not see the letters on the blackboard at School with his spectacles. I found that he had only one D. of H., and changed his spectacles accordingly. In about another year he came back complaining about his spectacles, and said that he could see better without them. I found that his refrac- tion was normal, and ordered him to stop using spectacles. About a year ago he returned, complaining that he could not see the blackboard, and I found that he was becoming myopic, and at the present time he has about 2 D. of myopia. Here we have a typical case of squint with 2 D. of hypermetropia chang- ing to emmetropia and then to 2 D. of myopia in seven years. It is quite possible, that even though this boy had not been fitted with spectacles as the eyes changed to normal, the squint would gradually become less and finally disappear altogether. I have seen a number of such cases, but they are exceptions. Even though the refraction change to normal or even to myopia, the Squint almost always remains, because the one eye usually becomes blind before the refraction has changed to normal, and thèn no effort is made to establish binocular vision. 294 COMMUNICATIONS. This observation has a very decided bearing upon the treat- ment of these cases. If we can preserve the sight of the eye until such time as the eyeball changes its form and becomes emmetropic, or until the child is old enough to wear spectacles (which serves the same purpose as nature often accomplishes in changing hypermetropic eyes into normal ones), we treat our cases in accordance with scientific principles and secure perfect results. Fortunately this can be done very easily ; simply give the mother a solution of atropia, instruct her to watch the child; if it commences using one eye a// the ſºme, put a drop of atropia in the fixing eye. This paralyzes the accommodation and compels the child to use the other eye. Repeat the atropia once or twice a week until the child begins to use the other eye. It may be necessary after a time to use the atropia in the other eye as it often becomes the fixing eye. As long as the child some- times uses the right eye and sometimes the left, there need be no fear of the child becoming blind in one eye, and there is no necessity for using the atropia in this manner, although much benefit may be gained by using it in both eyes occasionally for a short time. Girls will usually wear spectacles satisfactorily at three and a half, and boys at four and a half years of age. In treating cases of squint, I have usually been governed by the following rules : I. If the squint is alternating and the vision fairly equal in both eyes, it is seldom necessary to operate. A full correc- tion of the ametropia will usually result in cure of the squint. f 2. If the squint is fixed in one eye, but the vision of the Squinting eye good, the same rule should be observed, excepting that atropia should be instilled into the working eye occasion- ally and possibly a patch kept over it, and orthopedic exercise indulged in as described by Landolt. 3. If the squint be fixed in one eye and the sight very defective, and no improvement after patient trial with lenses and covering good eye, only a cosmetic result can be obtained. The operation should be performed any time after the sixth year. 4. If the squint be fixed in one eye and the vision of this eye is slightly defective, it is possibly undergoing deterioration from disuse, and should be carefully exercised, watched and tested. If the deterioration of vision appears to be increasing, an operation should be performed at once. *g A PLEA FOR A MORE Ex7ENDED SUPERVISIOW OA” 7TAZAZ AAA’ 7TO/AC/A3 AWT WOA/AAV. BY D. R. SILVER, M. D., SIDNEY, OHIO. (Read before the Ohio State Medical Society, June, 1891.) In at least one-half of the cases of obstetrics which phy- sicians in the country and smaller towns are called upon to attend, responsibility for their proper management is coincident with the beginning of labor, and ends twenty-four hours after delivery. It is the practice of some to make no second visit. When an engagement is made by the prospective father, or other interested relative, it is not for the purpose of obtaining infor- mation or knowledge, but to secure service at a certain time; and the part taken by the doctor in this interview is to enter the item in his note-book. The matter then passes from his mind, only to be recalled, perhaps, by the arrival of an excited and impatient messenger, urging immediate attendance at the bed- side of the woman, who, some days, or perhaps two or three weeks, before the expected time for labor, has fallen in a fit. Then there is a time of hasty preparation on the part of the doctor. Whether a beginner or a veteran he knows what puer- peral eclampsia means, and he trembles to think of the probable outcome of his case. In the consultation which is almost sure to follow this hasty summons, everything is talked of except the one important matter, namely, how might this great calamity have been averted 2 It is not the province of this writer to discuss that question. It is taken as granted that much might have been done, but the golden opportúnity was lost when the engagement was made, if, indeed, it had not passed before. The answer to a single question propounded by the vigilant physician is often sufficient to show whether all is right or whether some- thing is wrong. And, unfortunately, the laity assume that every pregnant woman has certain symptoms which, while unpleasant, are not dangerous, and call for no treatment. Thus it is that in scores of instances the first intimation the physician has that pregnancy exists is when he is called to treat an eclamptic seizure. 295 296 COMMUNICATIONS, Prevention is better than cure, and it is scarcely questionable longer that proper management may avert a seizure which, untreated, might at its first onset produce fatal injury to the poisoned and oppressed brain. We know this, but the people, our patrons, do not know it. Who then is responsible 2 Mani- festly the profession has been, and is now, derelict in the per- formance of duty, by failure to inform the people that medical science is able, at least in some cases, to avert that fearful calamity, an attack of puerpera/ convulszons. From the physician's standpoint every pregnant woman should be regarded as in a pathological condition, or at least subject to certain maladies pertaining solely to that condition. Women should be taught to feel that for nine months before confinement, and certainly for as many weeks afterwards, they need the counsel and advice of a skillful, conscientious physician. When that happy day arrives, and it is sure to come, we shall have fewer broken-down and bedridden mothers, fewer cases of one-child sterility, and far less use for the abdominal surgeon. It is true that women who have not borne children are sub- ject to displacements of the uterus, ovarian tumors, and the various kinds of pelvic diseases—salpingitis, ovaritis, metritis, etc.—still, in the great majority of instances, such cases occur in those who have borne children, and can be traced to pregnancy and labor as causative factors. It were strange indeed if a pro- cess so complicated as that of labor, so straining upon the nerves and muscles, when both the mental and physical systems are wrought up to the highest pitch of excitement, should not be full of dangerous possibilities. Obstetric labor, the bringing of a human being into the world, endangers the integrity of parts of the physical system necessary to the continued health and comfort of the mother. Serious injuries are by no means uncommon. And yet, at the conclusion of labor, no one scarcely attempts to find other lesion than that perhaps of a lacerated perineum. Indeed, no one, however skillful, can de- termine at this time whether the parts will or will not assume their normal relations, position and condition. But we know that unless involution is perfect, not only of the uterus, but of every organ concerned in reproduction, good health for the unfortunate is impossible, That proposition is indisputable. And yet in obstetric practice responsibility ceases, and oversight and care cease for the physician, at the second visit, twenty-four hours after delivery. The result is just what we find, that a large percentage of mothers are invalids, and through no fault of their own, either. SILVER—A Plea for a More Extended, Etc. 297 Nine days in bed is well; nineteen were better. But rest nine months will not compensate for the lack of professional skill in restoring a displaced uterus or ovary, stitching up a lacer- ated cervix or perineum, or properly treating a tender and inflamed peritoneum injured in the throes of labor. At our second visit we cannot ascertain whether the uterus will or will not assume its proper position in the pelvis. The chances are against rather than in favor of it, and therefore, when a sufficient time has elapsed, say from nine to fifteen days, a third visit should be made, when it will be possible to make out the state of the involution, the position of the uterus, and the condition of the ovaries and pelvic organs. No woman having intra-pelvic disease should be allowed to pursue her ordinary vocations. No woman having such disease gets well without rest and treatment, and especially in case of displacement she must have the counsel and skillful personal care of the physician. Seventy-five per cent. of the cases of inflammatory pelvic disease which I have seen could be traced to labor or confinement as the predisposing cause, and I am quite well convinced that at least one-half of these might have been averted by taking such precautions as I have before indicated. Backward displacements of the uterus are especially liable to occur after confinement. The text-books speak of these, and mention tight bandaging as a cause. Of course, it is possible that an obstetric binder might be placed so that it would cause a retroversion; but, in fact, whether a binder be used or not, the enlarged heavy organ is very likely to remain in the position in which it is left by the attendants; all the parts are relaxed ; the fundus, even if properly placed, is liable to fall into the pelvic excavation, becoming retroverted, and will remain so. There is, indeed, nothing to pull it into position except the round liga- ments, and their power is very questionable indeed. i. Every woman arising from her bed of confinement with a displacement, or a pelvic inflammation, is a candidate for chronic invalidism—the cases on which quackery thrives. The lesion, easily amenable to treatment at its beginning, soon brings changes which cannot be remedied even by the skill of the most expert gynecologist. There is then a life of misery before the unfortunate patient. The question for us to seriously consider is, who is respons- ible, and what can we do to prevent the present large percentage of mortality from puerperal eclampsia 2 I would answer, that we are responsible, not our patrons. How should they know the danger signals 2 298 COMMUNICATIONS. Of course, I know there is and should be a certain delicacy in giving unasked advice. But I take it that we should educate our people, and that every mothef and every prospective one should be informed of the importance of receiving counsel and advice in the early months of pregnancy. By concert of effort by the profession in this direction the percentage of mortality could be largely cut down, and pregnancy robbed of one of its greatest terrors. The fear of maternity, of the pains of 1abor and of the results known so often to follow delivery, hangs like a pall over the lives of expectant mothers. This dread leads to the practice of all sorts of expedients to avoid motherhood; not because children are not wanted, but because pregnancy is feared ; not because they love children less, but because they prize life and comfort more. Thus it is that society, the nation and the world suffer. It is true that with anesthesia we have done much to lessen the dread which every sensitive soul has for the travail of childbirth. But observation teaches me that the mental suffer-- ing consequent upon the knowledge of the possible danger to life far outweighs the fear of physical suffering, and that with both in prospect it is not wonderful that motherhood is avoided when possible, or only accepted as a religious duty. The time has come when there is a demand for better obstetric service. Among the more intelligent and wealthy the day of the midwife is past, There is demand for skill, a demand for men with clean hands and pure lives, and we are beginning to feel as never before the responsibility of this demand. Among the younger men it is not unusual to hear this assertion : “If it were not for my family practice I would eschew obstetrics. It does not pay. To much responsibility.” To the scientist this is encouraging. It is only when men feel responsibility that duty will be well done. In conclusion, I would say: There is need of reform in obstetric practice. Its scope and limits have been before indi- cated. The time has fully come when there should be an advance all along the line, to the end that the price of mother- hood may be less than possible death or chronic invalidism. To accomplish this end it is not alone sufficient to give better train- ing to the young men just entering the profession, that they may skillfully use the forceps, deliver a retained placenta, con- trol a hemorrhage, or restore a lacerated perineum ; but it is necessary for all of us to recognize the fact that no amount of skill can avoid or prevent accidents whose consequences can only SILVER—A Plea for a More Extended, Ætc. 299 be seen long after the patient has passed out of our care, as is now the fashion on the third day after confinement. Every gynecologist knows the large part played by displacement of the uterus in the complaints of sick women. He knows too well, also, the great difficulty experienced in its restoration, and that the changes wrought by gestation afford the best hope for cure. But confinement will accomplish nothing unless the organ is held in place by mechanical support, if necessary, until involu- tion is accomplished and all the pelvic viscera have assumed their normal relations and positions. Impregnation of the dis- placed and diseased uterus does not often occur, and we can number these as causes of one-child sterility which is now so frequently observed. I would then plead that our care of the parturient woman should commence with the beginning of pregnancy, and only cease when we are fully satisfied by care- ful investigation that every organ concerned in the reproductive act is in its normal healthful condition. A. A.A.’ A 7T/7/S. BY DR. AUGUSTE RHU, MARION, OHIO, Member of the Amer. Med. Ass’n ; Nat. R. W. Surgeons' Ass’n ; Ohio State Med. Soc. ; Miss. Val. Med. Ass'n, etc. : Local Surgeon for the Big 4, C. C. C. & I., . Erie, C. & E., and C. H. V. & T. R’ys. (Read before the Northwestern Ohio Medical Association, Dec. II, 1891.) The inflammatory conditions of the cornea come largely under the care and observation of general practitioners, who, as a rule, are not able to treat them successfully, nor is the proper effort made to study these cases; a general professional temerity takes hold of the average doctor, when such cases present themselves, and a large per cent. of blindness can be traced to unskillful treatment, and a still larger per cent. of blurred and otherwise impaired and deformed vision, or sequelae, such as opacities, staphyloma, nebulae, maculae and leucomas. I contend that most cases can be treated more successfully if we but follow the plan to which I will call your attention, founded on my own clinical ex- perience. I trust you will pardon me if I epitomize the histol- ogy of the cornea. The cornea of man is composed of five layers : 7%e first layer, composed of corneal epithelium of several layers of very transparent stratified pavement epithelium, 3OO - COMMUNICATIONS. directly continuous with the conjunctival epithelium, only the conjunctival epithelium is less transparent. f 7%e second layer is the anterior basal membrane of Bowman (Reicherts), a homogeneous elastic membrane, a thin layer of very refractile tissue. & 7%e Zhºrd /ayer is the very important substantia propria, a dense mass of bundles of lamellae of fibrous connective tissue, united into the superimposed lamellae with a cement substance; between the fibrillae and within there are formed the Reckling- shausen juice canals. In these spaces the tissue juice, the fixed corneal corpuscles are found, consisting of protoplasm with a nucleus. These spaces and canals also contain the wandering cells, resembling the white blood leucocytes. It can thus be readily conceived that from a small focus the pus cells penetrate these spaces rapidly and cause a speedy general purulent infiltration, which can be observed with reflected light. Pus cells once in this layer generally prove a serious, condition to combat; for most cases of interstitial, diffuse, or parenchym- atous, keratitis make their destructive beginning in this layer. The etiological causative factor is generally a constitu- tional one, z. e. inherited syphilis. 7%e fourth layer is the posterior elastic membrane of Des- cemet, conspicuous by its thickness. It is as clear as glass, and very resisting to destructive processes. 7%e fifth layer is the lining on the posterior surface of Descemet's membrane, and consists of beautiful polygonal endothelial cells, each with an oval nucleus, which under stimuli Have the power of contracting. In the normal cornea, we find no blood vessels, but during the reparative process they frequently form. The lymphatics are represented as mentioned above, in the inter-communicating lymph-canalicular system, of the third layer, which contains the nucleated corneal corpuscles. In connection with this there are the lymph canaliculi, which are lined with a continuous endothelium, containing the nerve bundles. Descemet's membrane possesses great resisting power, especially to pyogenic destructive processes. Even though bathed in pus, anteriorly and posteriorly, as in hypopyon kera- titis, it requires considerable time to perforate the same. As long as we can prevent perforation of this membrane we may expect to obtain good results, and we frequently get excellent re- sults even though perforation actually takes place. The Iminute lymph canalicular spaces are in direct communication RRU—A eraſzłzs. 3OI with those of the sclera. These canaliculi and lacunae become crowded with leucocytes during the inflammatory process, and thus impair the transparency of the cornea, and, if not arrested, cause destructive and irreparable injury to the corneal tissue. Parallel to the corneo-scleral margin, and lying near the deep surface, is the canal of Schlemm, ovoid in section ; it is a lymph canal and may separate into smaller canaliculi, which reunite. The nutrition of the cornea is thus maintained by the lymph coming from the marginal vessels traversing the canaliculi of the tissue, and by diffusion from the aqueous. The entrance of the aqueous is greatly facilitated by the removal of the endothelium. While the nutrition of the cornea is thus secured, it is not easy for fluid to escape by filtration through the cornea. (Noyes' Diseases of the Eye.) Leber has shown that so long as the endothelium remains intact, the aqueous will not reach the surface even under extreme pressure ; the flow of fluid is maintained by the marginal blood vessels and by the canal of Schlemm. The nerve supply of the cornea comes from the ciliary, which having passed the ciliary body, form a plexus around the corneal limbus, both deep and superficial (Noyes). It is of importance to observe that on account of the ana- tomical structure of the anterior chamber, pus may exist with- out being detected, Great difference exists in the density of the hypopyon ; if it be of a thick and fibrinous kind it may not fall to the bottom of the chamber, but remain sticking to the ante- rior surface of the cornea (Berry), or a small amount may accumulate in the bottom of the anterior chamber without being seen above the clear line of the sclera (Ayres), therefore we should be very cautious in conducting the examination ; always examine with reflected light, in a dark room, and confirm this with the ophthalmoscopic mirror, and always remember when we have a hypopyon keratitis, that if it is of mycotic origin, and if the expectant plan is pursued the endothelium will soon be destroyed, when perforation is liable to occur at any time. Keratitis may be divided into superficial, interstitial and posterior, and due either to trauma or to constitutional causes. The symptoms are mostly conjunctival hyperemia, the peri- corneal injection gradually becoming more intense near the limbus cornea. If complicated with conjunctival disease, which is quite frequent, we have at the same time a muco-purulent discharge. Frequent complications with iritis and irido-clycli- tis are the rule. We have an almost constant epiphora and distressing photophobia and blepharospasm, accompanied with 3O2 COMMUNICATIONs. great pain, often circumorbital, and a sensation as if some foreign particle were in the eye, which generally ushers the patient before the doctor, when on careful inspection we find as a rule the case to be one of keratitis. If you now are familiar with the histology of the cornea, you will likely proceed cautiously, and can differentiate between a keratitis, iritis or conjunctivitis. Then you will be able to meet the indications successfully. Prescriptions are of value only when we thor- oughly comprehend pathology, and it may not be out of place to say right here, that many members of our leading ophthal- mological forezgin societies are not eye specialists per se, but are general practitioners, and eminent ones at that; they are highly esteemed and valuable clinical observers in the field of ophthal- mology ; Ordinarily, from the ranks of the general practitioner, the leaders of the various specialties must necessarily be selected. In phlyctenular keratitis, we find the favorite seat at the margin of the limbus corneae. Perhaps no form of keratitis is met with more frequently than this. It usually attacks children. In my own practice the ratio is about five girls to one boy. The subject is mostly of a strumous, weakly, ill-fed, delicate phy- sique, or one predisposed to eczema, rhinitis, adenoid vegeta- tions of the post-nasal space, or perhaps living in defective sanitary surroundings. I have already given the symptoms. The diagnosis is complete if we find slight lead-colored or yellowish elevations, or vesicles, the size of pin heads, which frequently are diffused all over the cornea. In such cases let the treatment be prompt, both local and constitutional ; but remember, first, second and lastly, to always regard it as a local disease. Let treatment begin as follows: Moisten an ordinary wooden toothpick in clean aseptic water, touch with the dampen- ed end a Wyeth’s ophthalmic disk of cocaine and place it directly on the cornea, or in the conjunctival sac ; in a few moments the same will be absorbed ; then, in the same manner, place a disk of atropine—this in turn will be followed by a sublimate disk, or if you prefer it, an ointment of the yellow oxide of mercury, grains ij to the drachm, of either liquid or solid alboline. Solutions can be used if the ophthalmic disks cannot be procured. It is well in all diseases of the eye requir- ing antiseptic washes, to have a solution of corrosive sublimate, I in iO,OOO, always on hand. Since most ulcers are of mycotic origin, the above solution is indispensable, and should be used in follicular conjunctivitis, as well as in trachoma, with excel- 1ent results. RHU—A eraſzłs. 3O3 (In my opinion the best and most reliable manner of using ophthalmic remedies is by means of Wyeth Brothers’ ophthal- mic disks; they make all that may be of value in the shape of flat absorbable disks, and since I have been able to procure these, I never think of using solutions.) In aggravated cases the eye curette should be used; in fact, in my practice, I use the curette as a rule in corneal ulcers. After curetting, I touch the base of the ulcer with a solution of silver. If complicated with hypopyon, I evacuate the same early. Since I have used the silver solution in touching the ulcer, I have had no occasion to use any other means; SO uniformly successful is this. The constitutional treatment consists of concentrated cod. liver oil (Wampole's), and occasionally iodine of iron. Correct the secretory and excretory functions and invigorate the system. We also find, following acute attacks of catarrhal inflamma- tion of the upper respiratory tract, herpes of the cornea, more frequently in the adult, followed by herpes on the lips, nose, face and eyelids. This variety yields promptly to well directed treatment. The nose, throat and pharynx must receive proper attention. The variety of pemphigus of the cornea, keratitis bullosa, Arlt's keratitis interstitialis consecutiva, keratitis vasculosa, or malarial keratitis, are met with quite frequently, Keratitis interstitialis diffusa parenchymatosa is a variety usually found in early life, and as a rule we find it a secondary complication of specific origin, attacking ordinarily only one eye at a time, or in succession. On account of its essential chronicity, it demands prompt and early recognition. In this we find the third layer, or substantia propria, chiefly attacked although all the layers are soon involved successively. One of the most dangerous cases I have ever treated came under my care some months ago. It had been treated as one of iritis, by a very competent physician and surgeon, for two months, the last treatment consisting of calomel powdered into the conjunctival sack. This caused the most extensive sloughing in the lower conjunctival sack I have ever witnessed; the cornea, also, was seemingly hopelessly destroyed. I saw the case was one of keratitis hypopyon, and at once powdered pure cocaine into the eye, curetted the ulcer, touched the same with silver solution, with a paracentesis needle evacuated the hypopyon, placed Wyeth's atropine disk in the conjunctival sack, in a few minutes inspergated finely powdered aristol and carefully bandaged the eye. The evacuation of pus quieted the pain and he slept well that night, which he had not 3O4. COMMUNICATIONS. been able to do for two months previous. This case, under sub- limate collyria locally and internally iodide of potash and mercury, passed on to an uneventful recovery. In such cases the doctor must be the master of the situation ; if he cannot control his patient, he had better send him away where this can be accomplished. It is always well to regard all ulcerative processes of the cornea (and you may call these by whatever name you please) as of mycotic origin ; primarily as a local infection, secondarily as due to constitutional causes. In cases where you find anesthesia of the cornea combined with a keratitis, you had better be on your guard; this holds good in cases of trauma to the corneal epithelium, for this class of cases are always of the severest kind in my ophthalmic practice, but usually are re- garded too trifling to need attention in their incipiency. In one case, a carpet tack had caused a slight abrasion of the corneal epithelium ; in another, a burdock burr had brushed across the cornea. These cases had been treated with cocaine and atropin, but no improvement following, they presented at my office. One of them wanted an imaginary foreign particle re- moved from the eye, but on careful examination I found it already a case of hypopyon keratitis. The frequency of such mistakes in diagnosis is a surprise to me, and I am sorry to say that in the libraries of most physicians a good work on the eye is wanting. A now quite celebrated ophthalmologist said, some years ago, that the successful doctor is one who can correctly differentiate between a case of conjunctivitis and one of iritis; and I would add that the coming successful one is he who can recognize a case of keratitis and meet the indications intelligently, and at the same time recognize a case of iritis, conjunctivitis, or one of irido-cylitis. A little more attention and less haste in examination would make the diagnosis a com- paratively easy One. In my opinion the beſe moºr of the various forms of keratitis is the one already alluded to, namely, hypopyon Kerazz/2s. Whether it begins as a stenic or astenic inflammation, it is equally destructive. As a rule it has its beginning in an injury causing abrasion of the corneal epithelium, frequently caused by chips of stone, metal, etc., flying into the eye. Should a hypopyon keratitis be complicated at the same time with a purulent dacryo-cystitis, it will add much to the gravity of the case, which will run a more or less protracted course. The presence of pus in the anterior chamber as well as in the corneal RHU—A eražzłs. 3O5 layers, must be recognized early ; the difficulty encountered in .recognizing this has been already described. When you find pus, evacuate it promptly. The evacuation of pus from the anterior chamber at once quiets the frightful pain and indirectly the photophobia. As a rule this disease is complicated with iritis; hence the use of atropin is to be advised, until you obtain the specific effect. Since these cases run a chronic course, perhaps due to a debilitated physique and a poorly working nervous system, they improve more rapidly if proper constitu- tional remedies are adopted. The treatment consists, as afore- said, in careful and thorough curetting of the ulcer, touching the same with the silver solution, or the cautery, evacuation of the hypopyon, and the sublimate solution to arrest the septic process. In cases requiring further antiseptic and absorbent treatment, I would advise finely powdered aristol or iodoform, and if indicated hot water fomentations. Should perforation of Descemet's membrane occur, use atropin and the antiseptic collyrium. In many cases you will get good results and useful vision even when perforation has occurred. SCARZA T/NA. HOSPICE DES ENFANTS ASSISTES-M. SEVESTRE. (Translated from Progress Medical, by D. N. Kinsman, M. D., Columbus, Ohio.) (Concluded from /uly Zssue.) Scarlatina affects all ages, and in England especially adults frequently are seized. In France it prevails most among chil- dren. It is rare in the first year, and it is common to see the nurse affected while the nursling is free. Bermoulli has seen it in a child of three weeks, and in another of two months. Ballon saw a case of congenital scarlatina. Potier published a case in the newly born, the mother having been attacked the day after delivery. The infant, who had been isolated, fell sick after some days and recovered, while the mother perished. I have observed that in all young children the disease (and I have seen many such) is usually benign and characterized by the fact that the throat is little involved, and there is slight exfolia- tion of the tongue. * Authors estimate the influence of the seasons diversely. It may be said, however, that while scarlatina may prevail in win- 3O6 COMMUNICATIONS. ter, it is most common in the spring and summer. According to Bertillon, scarlet fever is least common in November and most frequent in May and June, especially so in July and August. Scarlatina prevails in all climates, but it is most frequent and severe in England, while it is more favorable in France in both aspects. As to the causes of immunity from this disease, aside from the influence of age or a previous attack, we are ignorant. It will be difficult for you to explain the following case, which is characteristic, but far from being unique: Of three sisters living together and sleeping in the same room, one Has scarlet fever, the others escape contagion. Two years later the younger sister takes scarlet fever, the eldest remaining unaffected at this time, but is herself attacked eleven years later. Relapses in scarlatina are rare, and a first attack usu- ally protects in the future. There exist a certain number of cases which may, according to Koerner, be divided into three groups: a. False relapses, characterized by a new exanthem in the second or third week, while the fever still continues. 6. True relapses, marked by a second attack of scarlet fever with all the characteristic symptoms, with desquamation during the convalescence. c. Relapses which occur many months or years after, of which Koerner has collected seventy-nine cases, from various authors. The cases of Stoebel and Jahn, in which there were from four to seven relapses, seem unworthy of belief. In all cases, to authorize the relapse, the fact of the first attack should be beyond doubt, and for the second we must have perfect clearness of symptoms. I have now come to the examination of prophylactic measures of scarlet fever. Inoculation has been proposed, and some physicians have thought they had determined a true vacci- nation by this process, because scarlatina has spared subjects previously inoculated. This is not sufficient proof, for you know even in epidemics infection is not necessary, and if you will recall what I said at the beginning of this conference, you will conclude we cannot place reliance upon the efficiency of inoculation. It has been supposed a more positive result might be obtained by the use of medicines, given as a preventive to persons living in proximity to the patient" and thus more exposed to infection. For this purpose they have recommended yellow sulphuret of antimony, quinine, mercurials, and more recently the sulpho-phenique of soda ; but it is especially to preparations of belladonna they have had recourse. You know SEVESTRE-Scarlatina. - 3O7 belladonna in a certain dose will produce marked redness of the throat and a cutaneous eruption singularly like that of scarla- tina. On this basis, and according to the axiom Similia Similibus, Hahnemann prescribed belladonna as a prophylactic to scarlet fever. He has had many imitators, and although the efficiency of this means is very doubtful, many physicians do not think they can dispense with it, and have recourse to it at the solicitation of their patrons. According to some observers the results are marvelous. Huffeland had but three cases in 525 persons submitted to belladonna. The facts related by Stievenart, in the epidemic of 1843, are more wonderful. In a place of 800 or 900 inhabitants, there had been ninety-six cases of scarlatina with thirty deaths; Stievenart began the use of belladonna, and administered it to 250 persons, and had no case of contagion. On the contrary, of fifty who refused to take it, there were fourteen cases of scarlatina and four deaths. On the contrary, West cites an epidemic observed by Balfour, in which there were two cases of scarlatina among seventy-five children who took belladonna, and none among seventy-six who took nothing. Barthez and others have seen similar examples. I have met one case which strongly assails the value of bella- donna as a prophylactic. I saw in the city a little girl with whooping cough to whom I gave for many weeks atropine in strong dose. One of her sisters having been taken with scarlatina, she was, in her turn, after some days, seized with scarlet fever, although she had been for a long time under the influence of atropine. You cannot, therefore, trust greatly to the employ- ment of belladonna, and I think you had better leave it alone, but if the families insist upon it, you can give them this satis- faction on condition of employing small doses. In Germany, from five to twenty drops of the following solution is given, according to the age : B. —Ext, belladon . . . . . . . . . . . . . . . . . . . . . . . . . . . gr. iss; Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 iſ ; Water . . . . . . . . . . . . . . . . . . . . . . . . . . q. S. to 3 iſ M. Blache advises the following: B. —Ext. belladonna. . . . . . . . . . . . . . . . . . . . . . . . . gr: iss; Water cannella . . . . . . . . . . . . . . . . . . . . . . . . . 3.j M.—Two drops morning and evening, to children two years old, increasing one drop for each year, not passing twelve drops. When you prescribe belladonna, you need not even attain these doses. You will, moreover, at the same time practice the rigid prophylaxis to which I now come. - Serious, really efficacions, prophylaxis of scarlatina, is based upon the principles which I indicated in a previous lec- 3O8 COMMUNICATIONS. ture, and unite isolation and antisepsis. The isolation of the patient and his nurses should be as complete as possible. The patient should be placed in a special pavilion in the hospital; this will be sufficient as well as necessary. My study of the general prophylaxis of contagious diseases has given me strong convictions on this subject. I have already instructed you upon this point; I will not review them. When the disease is known or even suspicioned, the patient should be isolated, for you must remember scarlatina is contagious at all periods. Isolation should be continued rigidly during the disease, and after com- plete recovery. You cannot in the beginning fix its limits; it will vary decidedly as to the descuamation, whether more or less abundant, precocious or prolonged. They say in general terms isolation should continue for six weeks. This is true in general terms, but in some cases I have reduced the period ; perhaps in other cases it ought to extend to or beyond two months. In no case should you return the patient to freedom until he has been carefully disinfected. Antisepsis is of capital importance and should be scrupulously followed in all its details to its complete realization. Persons who have care of the patient, or are with him for a short time, will be compelled to wear a special garment, or at least a blouse, which they will remove when they leave the chamber. They will at this, and many other times, and during the disease, wash their hands and faces with anti- septic solutions. The disinfection of the patient should be made with the purpose of destroying the germs. The linen should not leave the chamber except to pass to the stove or be submitted to the action of boiling hot water. Fecal matter and the urine should be disinfected, but the throat and skin should especially be washed. You will frequently wash the mouth and throat with antiseptic lotions. This is one way of destroying the germs, while without this precaution more may be expelled and become sources of contagion. It is at the same time very useful for the patient, for whom it diminished greatly the danger and gravities of secondary infections. Annoint the skin with an antiseptic pomade ; thus you will facilitate desguamation and hinder the diffusion of the scales. Some authors have feared these unctions would disorder the functions of the skin. On the contrary, Johnson, who employs them in the early days of the disease, has never seen any disadvantages. It is certain that these unctions, besides their antiseptic functions, may prevent chilling of the skin. You will employ with this aim phenic oil as made in England, rather than the boric vaseline. You will SEVESTRE–Scarlatana. - 3O9 use these unctions especially on the days previous to returning the child to public life. At this time you will also use antisep- tic baths, with sublimate when it is possible, or at least with black soap, when you cannot use the sublimate. You can with a sponge wet with a sublimate solution, I-IOOO, wash off the whole body. These washings are particularly necessary upon the hairy scalp, of which antisepsis is too much neglected. For the rest you will, during the last week, make alternate use of baths, lotions and antiseptic unguents. After the last bath, which will be given, if possible, outside of the affected chamber, the patient will put on its clothes, and from this time will under no pretext enter the chamber again. Once the patient is clear from them, everything in use in the room during the scarlet fever should undergo complete disinfection by the means I have indicated. - * - It goes without saying that the isolation of suspects is as important for scarlatina as for other contagious diseases, and as the incubation does not exceed five or six days, as I have shown, a quarantine of seven days is enough, I add, this quar- antine ought to be preceded by a disinfection of the suspect and his clothing. The prolonged vitality of the germs justifies this precaution. These measures ought to be extended to the rules of schools and colleges; that is to say from all gatherings of children, doubtful and suspected should be excluded, even when circumstances would not justify a seven days’ quarantine, and a formal disinfection. Among suspects, I place the brothers and sisters of children sick with scarlatina, Unfor- tunately, nothing of this is done in Paris. In foreign countries, and especially in Germany, it is not thus, and certain villages of our country have adopted the same practice. Let us hope we shall finish by making it universal. SMA//, /OO.S.A.S.—GA2/P. BY W. W. KINKEAD, M. D., NASHVILLE, TENN, I wonder how many of the readers of the JOURNAL will try the suggestions of Dr. Somers, as published by you, page 121, in the September issue 2 Not many, I imagine, and yet every one that gives them a fair trial will certainly be convinced. Our school claims to be liberal, the truly eclectic, but most of us probably fall far short of our claim. In further proof of the very great benefit to be often derived from small doses often repeated, I would like the readers of the JOURNAL to try the 3IO COMMUNICATIONS. following prescription for colds, commencing bronchitis, tonsil- litis and like affections : B. Atropiae sulph. . . . . . . . . . . . . . . . . . . gr. I-60—I-IOO ; Morphiae sulph. . . . . . . . . . . . . . . . . . gr. SS ; Aq dest. . . . . . . . . . . . . . . s tº º e º g º Aº ‘e 3 ii. M. Sig. Take a teaspoonful every half hour. There was a time during the first epidemic of the grip when there was much uneasiness lest the supply of antipyrin should fail. I was not disturbed in the least for I was curing all the cases I met with this prescription. In proportion to my prac- tice I probably treated as many cases of the grip as any one and I don’t believe I had to try anything else in six cases, and I have never had a case of pneumonia or bronchitis following a case of grip. It is surprising how few doses will give relief in a great many cases. I was recently called to see a lady who was purging and vomiting, and who said that she felt like every bone in her body was aching, and that she had not slept for two nights. I gave her the above combination and her husband had to wake her up to give her the fourth dose. She slept all night and I did not have to give her any more medicine except a small dose of calomel and ipecac at bed time on the following night. As the years go by I have more and more reason to respect the effect of small doses of medicine often repeated. Z3oz Zzme Streeſ. POPULAR FAITH IN ALTERATIVES.—Since the nature of the action of this class of remedies is to some extent as yet undeter- mined and obscure, they are necessarily prescribed empiri- cally. To this fact is perhaps due the promiscuous use by the public, not infrequently with the endorsement of physicians, of a host of nostrums of no real medicinal value. Many of these have had an enormous sale—indicative not so much of their worth as of the general belief in the necessity for the use of what are popularly termed “blood purifiers.” Spring is the season when these are most generally resorted to, When we consider there is no condition of disease at some stage of which tonic alteratives are not indicated, it will be appreciated that next to agents such as opium and quinine, the action of which is specific, no class of remedies are more fre- quently demanded, Messrs. Parke, Davis & Co. supply under the name of Syrup Trifolium Compound an alterative formula containing red clover, stillingia, cascara amarga, burdock root, poke root, prickly ash bark, berberis aquifolium, all valuable vegetable alteratives, either with or without potassium iodide. This has been used by physicians with much success in all conditions requiring alterative treatment. 9 An Achievement of Modern Chemistry. CRYSTAL SPRINGS GLUTEN. GREEK ENGLISH PoluBOSKosºvº. GLUTEN Foom. BOSKOS—NOU RISHING While there are various Gluten foods in the market, each and every one of them contains more or less starch (from 12 to 54 per cent.) Poluboskos contains only four-tenths of one per cent of starch. We can therefore justly say that it is practically free from starch, an achievement which has heretofore not been attained. The name “Polusboskos” was selected to distinguish it from other Gluten foods in the market. This name is not without its significance, it being a combination of two Greek words, polus, much, and boskos, nour- ishing. Pure Gluten with its congeners is the nitrogenous food principle of the vegetable kingdom, and is to be especially recommended because of its freedom from the poisonous ptomaines which are frequently found in many meat preparations which depend largely on the nitrogenous substances which they contain. * Gluten is the element of the vegetable world which gives force and energy to animal life, and is the equivalent to the albumen of the animal kingdom. Poluboskos needs no special preparation ; it is ready at a moment's notice. Mixed with milk it makes the most nourishing, stimulating, and refreshing food and drink for convalescents and dyspeptic invalids ; it is readily assimilated by the weakest stomach. Two teaspoonfuls of Poluboskos contain as much nourishment (nitro- genous matter) as one pound of meat. It supplies energy to muscles, nerves, and other organs. A laborer taking three doses of Poluboskos a day will be able to endure more fatigue than if fed upon a meat diet. The use of Poluboskos as an article of diet in diabetes will be at once recognized, as it is free from starch. We will be highly pleased if you will give this preparation your attention. We are prepared to furnish physicians with samples, and hope to be favored with your valued commands. & Yours very respectfully, NEw York. EISNER & MENDELSON CO. 10 The Best Antiseptic for Both Internal and External Use. LISTERINE Antiseptic, Prophylactic, Deodorant, Non-Toxic, Non-Irritant, Non-Escharotic, Absolutely Safe, Agreeable, Scientific and Strictly Professional. FORMUL.A.—Listerine is the essential antiseptic constituent of Thyme, Eucalyptus, Paptisia, Gautheria and Mentha Arvensis, in combination. Each fluid drachm also contains two grains of refined and purified Benzo-boracic Acid. DOSE.-Internally: One teaspoonful three or more times a day (as indicated), either full strength or diluted, as necessary for varied conditions. LISTERIN E is a well-proven antiseptic agent—an antizymotic — especially adapted to internal use, and to make and maintain surgical cleanliness—asepsis—in the treatment of all parts of the human body, whether by spray, irrigation, atomization, or simple local application, and therefore characterized by its particular adaptability to the field of PREVENTIVE MEDICIN E — INDIVIDUAL PROPHYLAXIS. Physicians interested in LISTERINE will please send us their address, and receive by return mail our new and complete pamphlet of 36 quarto pages, embodying:— A TABULATED EXHIBIT of the action of LISTERINE upon inert laboratory compounds. FULL AND EXHAUSTIVE REPORTS and Clinical observations from all sources, confirming the utility of LISTERINE as a general antiseptic for both internal and external use, etc. Diseases of the Uric Acid Diathesis. KIDNEY ALTERATIVE-ANTI-LITHIC. FORMUL.A.—Each fluid drachm of “Lithiated Hydrangea’’, represents thirty grains of fresh Hydrangea and three grains of chemically pure Benzo-Salicylate of Lithia. Prepared by our improved process of osmosis, it is invariably of definite and uniform therapeutic strength, and hence can be depended upon in clinical practice. DOSE.—One or two teaspoonfuls four times a day (preferably between meals). Urinary Calculus, Gout, Rheumatism, Bright’s Disease, Diabetes, Cystitis, Haematuria, AJ' and Vesical Irritations generally. We have had prepared for the convenience of physicians Dí ET ETIC NOTES (sample of which is herewith shown), G OUT. suggesting the articles of food to be allowed or prohibited in — , several of these diseases. DIETE TIC NOTE. — A mixed diet should be adopted, the nitro- A neatly bound book of these DIETETIC NOTES, each genous and saccharine articles be- note perforated for the convenience of physicians in detaching ing used in limited amounts. and distributing to their patients, mailed gratis upon request, Allozved.—Cooked fruits without together with the latest compilation of case reports and clin- || much sugar; tea and coffee in mod- ical observations, bearing upon the treatment of this class of | eration. Alcoholic stimulants, if diseases. . used at all, should be in the form of light wines, or spirits well diluted. - - The free ingestion of pure water is Lambert Pharmacal Co. tº & * o Azoid.—Pastry; malt liquors and sweet wines are veritable poisions ST. LOUIS, MO. to these patients. ' º —- sº SURGERY A HUNDRED CASES OF ENTIRE ExcISION OF THE TONGUE.— A valuable paper by Whitehead, on excision of the tongue appears in the British Medica/ /ournal for May 2, 1891. In the last twenty years the writer has operated for cancer of the tongue in 139 cases. Of these IO4 were complete excis- ions, and 25 were partial operations, the mortality in the former being 19.21 per cent., while in the total number of cases it was 14.3 per cent. When the tongue alone was excised the death- rate was 4.5 per cent., and when glands and jaw were also re- moved it was 77 and 57 per cent. respectively. He has not selected his cases, and has never allowed the extent of the disease or the emaciated condition of the patient to deter him from operation when there was any prospect of either prolonging life, or of affording even but temporary relief. The essential details of Whitehead's operation are: 1. That complete anesthesia during the first stage of the operation, but afterward only partial insensibility, is to be maintained. 2. The mouth must be securely gagged, and kept fully open. 3. The head should be supported in such a position as will afford the best 1ight, and at the same time favor the gravitation of blood out of the mouth rather than into the pharynx. 4. A firm ligature must be passed through the tip of the tongue for the purpose of traction. 5. The division of the reflection of mucous membrane between the tongue and jaw and the anterior pillars of the fauces. 6. Rapid separation of the anterior portion of the tongue from the floor of the mouth. 7. Securing, if possible, the lingual arteries prior to division. 8. Passing a ligature through the glosso-epiglottidean fold, before finally separating the tongue. 9. The application of a mercurial solution to the floor of the mouth, followed by painting the surface with an iodoform styptic varnish. The cutting part of the operation is done entirely with SC1SSO1’S. The writer does not advocate preliminary tracheotomy, and believes that it is possible to guard against the entrance of blood into the lungs by means involving much less risk than either tracheotomy or laryngotomy. He thinks it important that the patients should be made to sit up from the first and not kept in 3II 3I2 SELECTIONS. bed. The average time of convalescence he has found, under these circumstances, to be seven days. In regard to the predisposing and exciting causes of the disease, it was found that in IO4 cases a family history of cancer could be definitely traced in but six, and in seven others it was doubtful. In sixteen instances the disease was attributed to injury; 61 of the patients were smokers, and in the majority of these the disease began on the side on which the pipe was habitually held. Irritation from teeth was the exciting cause in 33. One patient had never smoked, and had not possessed a tooth for twenty years. o As to the duration of life after the operation, information was obtainod in 61 cases. Fifteen lived for one year; four two years; two three years; four five years; one six years, and one patient survived the operation for fourteen years, although 62 years old at the time it was performed. In conclusion, Whitehead lays great stress on the im- portance of the removal of the disease at the earliest possible moment after its discovery.—CVnzy. Med. Mag. TECHNIQUE OF SUPRA-PUBIc CystotoMy.—In a paper read before the Phil. County Medical Society, Dr. Joseph Hoffman gives the details of this operation. Much has been written that tends to produce an impression that the steps are more or less complicated. No special instruments are needed. A bistoury and a few artery clips are all that is required—additional in- struments only being called for according to the conditions met after exploration. The injection and washing out of the blad- der are, I believe, all that the surgical aspect of the operation requires. The bladder can be easily reached both in the child and adult without packing the rectum. The relative size of the bladder in the adult and child is to be regarded, care being taken not to over-distend the viscus. The incision is made close down to the pubis, and two pairs of artery forceps used as retractors, as the incision is deepened, obviates all necessity for special instrument or additional procedure. The suprapelvic fat is pushed asunder with the finger, and the bladder comes into view or is easily felt at the bottom of the wound. The viscus is easily raised into the wound by the forceps applied again after the manner of using them to raise the peritoneum, and the incision is readily made. The forceps can still be retained in position or, if deemed expedient, a thread can be introduced by SELECTIONS. 3I 3 which control over the edges of the wound is maintained. The subsequent procedure is now dependent on the operation to be done. If drainage only is intended, a rubber tube is stitched into the wound or a hard drainage-tube retained by simple means. If a calculus is to be removed, the procedure is as simple as taking a seed from a cherry. The operations for tumor and prostatic disease are, of course, more extensive and dangerous, and these it is not the purpose of the paper to consider, but only to call attention to the fact that their removal by this operation becomes more a matter of surgery and less of experiment than by any other means whatsoever. Finally, for the operation all can be claimed that simplicity, accuracy, and safety can commend. The so-called statistics of the operation before it was fairly tried, or used for other than forlorn cases, cannot be used either to condemn or recommend it. Its results, as obtained at the present time by exact sur- geons, working thoroughly and entirely from an anatomical standpoint, give it a record unequalled by any other method of dealing with the surgical diseases of the bladder. INTESTINAL PERFORATION IN TYPHOID FEVER.—Intestinal perforation is the most alarming accident that occurs in the course of typhoid fever, as spontaneous recovery extremely seldom takes place. A few cases have been recorded where the patient has recovered, but from the well known difficulty in diag- nosing such a state, it is impossible to prove absolutely that recovery does take place. Practically, it may be said that in- testinal perforation in typhoid is a fatal event, unless prompt measures are taken to close the rent and wash out the abdominal cavity. In the Medica/ AVezº’s for November 21st, 1891, Dr. Weller van Hook of Chicago reports a successful laparotomy for perforation occurring on the seventh day of relapse in typhoid. The patient, a female, aged 31, was suddenly seized on the seventh day of a relapse with great pain in the ileo-cecal region, followed by the symptoms of collapse, distension of the abdomen, a very rapid pulse, and temperature of IO6°F. On opening the abdomen, nine and a half hours after the perforation occurred, more than a pint of feces and inflammatory matter escaped. The opening was quickly found. It was irregularly circular and about two millimetres in diameter. It was closed with three longitudinal rows of interrupted Lembert sutures. The ab- domen was thoroughly washed out, the temperature remained at IO3° for four or five days, but after this the symptoms of peri- 3I4. SELECTIONs. tonitis gradually disappeared and the patient made a perfect recovery. Dr. Hook reports two additional cases of perforation in typhoid where he performed laparotomy, but without success. Since 1884, the date of the first operation with this object in view, Dr. JHook was able to find an account of nineteen (inclusive of his own three) cases. There were fifteen deaths and four recoveries, but in two of the successful cases it was probable that the perforation followed an appendicitis, while in the third case the peritonitis preceding the rupture was localized by pre- vious adhesions. Excluding these three cases, then, Dr. Hook's was the only one where recovery followed the extrusion of the intestinal contents into the general peritoneal cavity. In an admirable paper read before the American Association of Physicians by Dr. Fitz, of Boston, the following conclusions are arrived at : Intestinal perforation occurs in about one per cent. Of all cases of typhoid fever. It is the cause of death in a little more than six per cent. of fatal cases. Most cases of recovery from symptoms of perforation are those in which an attack of appendicitis is closest simulated, while the great majority of the fatal cases are those in which other parts of the |bowel than the appendix are perforated. It is probable that the appendix is more often inflamed and perforated in typhoid fever than has hitherto been suspected. Dr. Fitz recommends that immediate laparotomy be employed for the relief of suspected intestinal perforation in typhoid fever only in the milder cases of this disease. In all others, evidence of a circumscribed peri- tonitis should be awaited, and may be expected in the course of a few days. Surgical relief of this condition should then be urged as soon as the patient’s strength will warrant. Had Dr. Hook followed the recommendations of Dr. Fitz He would not have been able to have recorded a successful case. When perforation occurs, and the contents of the intestines escape into the general peritoneal cavity, as happened in Dr. Hook's case, the only hope is in the quick performance of a laparotomy. The almost necessarily fatal ending should not deter us from resorting to this procedure. Unfortunately the diagnosis is often difficult, and not infrequently impossible. The classical symptoms of perforation detailed in text-books are as frequently absent as present. Although perforation is the most frequent cause of peritonitis, there are several others which lead to it, and, further, the symptoms may be entirely latent. All who have had an extensive experience with typhoid fever can confirm this statement.—Montrea/ Med. /our. SELECTIONs. 3 L5 MECHANICAL DRAINAGE FOR DROPSY.—Schilling (Mercred, Medica/,) proposes a modification of Southey's method of capil- lary drainage for the relief of dropsy. By means of a curved needle, threaded with silver wire of a thickness varying accord- ing to the needs of the case he passes a broad loop beneath the skin, completing this little operation by twisting the two ex- tremities of the wire tightly together, so as to keep the skin perforations open by the slight traction of the loop. The ends of the wire are covered with plaster or cotton to prevent catching in the clothing, and the ground of operation is dressed with a simple compress of cotton or antiseptic gauze. As the edema subsides the loops may need tightening from time to time. Two threads on the inner side of each thigh will give eight drainage punctures and will be sufficient for ordinary cases.—C/mzv. Med. A/ag. CIRCUMCISION.—In the Archives of Surgery Mr. Jonathan Hutchinson sums up his experience in regard to the sanitary advantages of the rite of circumcision. After premising that it is not needful to go on a search for any recondite motive for the origin of the practice, he says, “No one who has seen the su- perior cleanliness of a Hebrew penis can have avoided a very strong impression in favor of the removal of the foreskin. If not re- moved, it constitutes a harbor for filth, and is, in many persons, a constant source of irritation. It conduces to masturbation, and adds to the difficulties of sexual continence. It increases the risk of syphilis in early life and of cancer in the aged. I have never seen cancer of the penis in a Jew, and chances are rare.”— AV. Y. Med. /our. THE TREATMENT OF SENILE GANGRENE.—In a recent issue of the Deutsche Medicinzsche Wochenschrift, Prof. Haiden- hain presents his views on this subject, which are based on a careful study of twenty-five cases of senile gangrene of the lower extremity, the majority of which occurred in diabetics. It is a well known fact that this form of gangrene is characterized by especial severity, so that the author's rules for treatment are worthy of careful consideration. He advises that as long as the gangrene is confined to one or two toes we should abstain from surgical intervention, and wait for a line of demarkation to form. Local antiseptic measures and elevation of the limb are all that is required, and we are especially warned against the detach- ment of the gangrenous portions with the scissors and forceps, 316. SELECTIONS. which tends to increase the inflammation. If the gangrene spreads to the dorsum or sole of the foot, we should adopt Hutchinson's recommendation and amputate at the thigh, mak- ing as small skin flap as possible. An extensive experience has shown that amputation below the knee in these cases is apt to be followed by gangrene of the flaps, which, if it does not lead to a fatal termination, renders a second operation necessary. If High amputation is deferred until the development of fever and suppuration the prognosis becomes the more unfavorable. While it is true that a successful result has sometimes been obtained by amputation below the knee, the weight of testi- mony is decidedly in favor of the high operation.—/m/, /our of ..Surgery. STITEs’s TEST FOR CARCINOMA.—(John H. Brinton, M.D., Prof. Prac. of Surgery, Jeff. Med. Coll., Philadelphia, in Med. AVezws.) On October 17, at the surgical clinic, I removed for atrophic scirrhus the right breast of a female, aged sixty-one. In the presence of the class the tumor was immediately sub- jected by Dr. W. M. L. Coplin to the test of Mr. H. J. Stites, of Edinburgh. The method of examination was that furnished me by Professor Chiene, of Edinburgh, which I give in his own words :— I. Excise the mamma. 2. Wash thoroughly in water to remove blood. 3. Place in a 5 per cent. solution of nitric acid (B. P.) for ten minutes. 4. Wash in cold water for five minutes. By the time these procedures are executed the axilla is cleaned out and the vessels tied. The mamma is now examined ; the carcinomatous structure appears a dull white, like the eye of a boiled fish, the healty tissue translucent. When any such reaction is seen additional tissue should be removed at the corresponding point. In removing the carcinomatous breast, Professor Chiene directs that its relations to the circumferential tissues should be marked by the knife, so that after the test has been applied to the mass excised the situation of any outlying, unremoved diseased areas can be fixed. . In the case operated upon the foregoing directions were carefully followed by Dr. Coplin, who demonstrated to the class that the infected tissue became of the characteristic “dull white,” resembling egg-albumen, while the uninfected tissue appeared SELECTIONs. 3I 7 translucent and gelatinoid, affording a striking contrast to the carcinomatous structures. The reaction in the axillary glands seemed even more marked than that in the breast ; it therefore would, perhaps, be well always to retain one gland for com- parison with those treated with the acid. The test described by the distinguished Scottish surgeon as devised by his assistant, Mr. Stites, appears to be a most perfect one. It is to be hoped that future trial will show that it can be depended upon, and that it can really be accepted as a gauge of the thoroughness and sufficiency of removal of carcinomata, not only of the mamma, but also of other parts. THE best remedy for internal piles. Á R. Kennedy's Pinus Canadensis (dark). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I drachm Ol. Theobromae . . . . . . . . . . . . . . . . . . . I OZ. M. Rub together, and make 20 suppositories by using a cold mould. Sig. Insert suppository every night at bed hour. —AWorth Western Zancet. ALLINGHAM's OINTMENT FOR HEMORRHOIDS :— B. Bismuth, submit. . . . . . . . . . . . . . . . . . . . . . . . . . . 3.j Hydrarg. subchloride. . . . . . . . . . . . . . . . . . . . . . 9 iſ Morphinae, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . gr. iij Glycerini. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 iſ Vaselini. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 j. M. Sig.—Use in pile-pipe. TREPHINING FOR EPILEPsy.—Dr. C. H. Merz, of Sandusky, reports, in the Medica/ Age, a case of trephining for epilepsy in a patient aged eighteen years, the epilepsy following a depress- ed fracture of the skull received ten years before. Two months after the operation, there had been no return of the fits. A report two years later will be of interest. MEDICINE THE TREATMENT OF UREMIC COMA AND CONVULSIONs.— (Dr. John Ferguson, Demonstrator of Anatomy in Toronto Medical College, in Zherapeutic Gazette.) I. In cases of albuminuria of moderate amount, give the saturated solution of magnesium sulphate. 2. If the cases be more acute and urgent, put the patient in bed, with the head elevated. 3. If there be severe headache, any muscular twitchings, or tendency to coma, give at once a dose of calomel, croton oil, and 3.18 SELECTIONs. nitrate of potassium, and then maintain the action of the bowels by means of the salts. 4. Induce free perspiration by extra clothing, warm packs, hot drinks, and salicylates. 5. Allow no animal food but milk, and give liquids very freely. 6. If there be any convulsions, at once give a hypodermic injection of morphine, and follow it by the pilocarpine, if in the meantime sufficiently free diaphoresis has not been obtained. 7. In the case of pregnancy, if labor has not set in, and it is thought necessary to induce it prematurely, by all means push the above treatment vigorously, and try to obtain some considerable improvement in the patient’s condition, especially in the kidneys, before the labor is induced. In some cases, by the above treatment, the kidneys speedily regain their proper functions, and it becomes unnecessary to interfere forcibly with the course of gestation. Should such a recourse be ultimately unavoidable, the patient is in a better condition to stand the additional strain. 8. In all cases of albuminuria, and especially in those of pregnancy, there is a deficient action of the skin, as well as a marked reduction often in the quantity of urine passed per diem. To get the skin to act freely almost invariably increases the flow of urine. To remove the hard, tense pulse, cause free per- spiration, dissolve out of the system the excess of uric acid in it, due to the small urine flow, I would strongly advise the use of salicylate of potassium or sodium. A good deal has been said about these drugs irritating the kidneys. This, I think, is sometimes akin to the fear that too many have towards a quiet- ing dose of opium in the sleeplessness often found in cases of albuminuria. The salicylates, I contend, neutralize the uric acidemia, soften the pulse, permit, if they do not cause, free sweating, and carry from the blood a factor of great disturb- ance—uric acid. It is not necessary to continue their use long ; a few days at most will suffice, when the case may usually be safely left to the Epsom salts. With reference to opium, I have noticed the very hard, tense pulse of uremia become soft and full in half an hour after the administration of the morphine hypodermically. 9. In five case of uremic convulsions, where I have had an opportunity of examining the urine, there was an excess of uric acid in the urine, and consequently an excess in the blood. The importance of this is very great, as uric acid in the blood in ex- cess tends to cause convulsions. & SELECTIONS. . 3 IQ GOITRE-Two cases were shown in the Jefferson clinic on Oct. 19th, a middle-aged woman and her daughter, a girl I6 years of age. The girl had Erophtha/mac Gozłre, and the mother purely the Gozłre. There was a family history of the disease; the mother's sister, mother, and her maternal grandmother and maternal aunt had all had goitre. In the case of the mother the thyroid glands have been much enlarged for the past twenty years, the enlargement being first noticed shortly after the birth of her first child. There were no other symptoms, neither her eyes nor her heart being affected. In the daughter the disease had developed in the past nine months. The thyroid glands were very much enlarged and her eyes and heart were also very much affected. Another feature of the case was that the girl had never menstruated : Prof. DaCosta prescribed the following treatment: For the mother : B. Tinct, iodinii. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Bj Lanoline. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cosmoline. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . aa fåss. M. To be applied locally and well rubbed in. Also internally Lugol's solution of iodine, gtt. ij, three times a day. For the daughter, to bring on meustruation, half a grain of potassii permanganas, in pills, three times a day for a month ; and to quiet the heart: R. Tinct, strophanti. . . . . . . . . . . . . . . . . . . . . . . . . . gtt. v. Sodii bromidi. . . . . . . . . . . . . . . . . . . . . . . . . . . . . gr. X Syrup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Aquae. . . . . . . . . . . . . . . . . . . . . . . . . . . q. s. aa ad fºj. M. Sig.—Three times a day. The patients were also directed to rest as much as possible. —Col. Ó C/znze A’ecord. ON TAKING FLUID WITH MEALS.–A great deal of mis- apprehension is often found to exist in the popular mind in regard to matters of eating and drinking. The cause of this to some extent is to be traced to oldtime sayings, which have come down to us in the form of a concentrated infusion of some- body's opinion upon a subject of which he or she was woefully ignorant. One of these misapprehensions to which we may refer is as to the injuriousness of taking fluid with meals. One frequently hears it laid down as a maxim that “it is bad to drink with your meals; it dilutes the gastric juice.” By way of explanation we may remark that “it implies that the fluid taken is harmful.” Whence this sāgacious postulate originally came we cannot tell. It has quite the ring about it of an inconse- 32O SELECTIONS. quent deduction formed by a person whose presumption of knowledge was only exceeded by a lamentable ignorance of the subject. Medical men often find much difficulty in dealing with these museum specimens of antiquated science, for even edu- cated persons are disposed to cling to the absurdities of their youth. Upon this matter Mr. Hutchinson remarks in the last number of his Archives : “I observe with pleasure that the ver- dict of general experience and common sense has been confirmed by scientific experiment in the matter of taking fluid with meals. Dr: Tev. O. Stratievsky, of St. Petersburg, after elaborate trials, has found that fluids materially assist the assimilation of proteids, and announces the following conclusion, which it is to be hoped no future experiments will controvert: on the whole, the widely-spread custom of taking fluids during or just before one's meals proves to be rational and fully justified on strict scientific grounds. To take fluids with the meals is almost as important an adjunct to digestion as is the mastication of solid food pre- paratory to swallowing it.” It is obvious, however, that there is a limit to the amount of fluid one can swallow with impunity— not to speak of comfort—just as much with meals as at other times. It would be dangerous to create a general impression that fluid is good with food irrespective of quantity. It is, more- over, a well ascertained clinical fact that an excess of cupran- dial fluid does not retard digestion in certain people, and gives rise to discomfort in most. A little attention to one's sensations in such matters will far better fix the desirable limit than all the “data” in the world.—Med. Aress and Circular, 7%erap. Gazette. THE TREATMENT OF DISEASES OF THE KIDNEYS.—In the American /ournal of the Medical Sciences for October, 1891, DR. FRANCIS DELAFIELD publishes a paper on the classification of the various forms of kidney-disease, popularly called Bright's disease, which, in addition to many valuable facts bearing on the pathology of these diseases, contains numerous hints as to renal therapeutics. Dr. Delafield calls attention to the fact that acute congestion of the kidneys can be relieved by the application of heat to the surface of the body. Chronic congestion is best managed by the drugs which stimulate the heart and dilate the arteries. We evidently have no means at our command by which we can influence acute degeneration of the renal epithelium ; fortu- nately, the great majority of the cases of acute degeneration are Inot serious. SELECTIONS. 32 I Chronic degeneration also seems to be a condition which we are unable to treat. In acute exudative and in acute diffuse nephritis the main indications for treatment are to diminish the severity of the nephritis and to regulate the circulation. To diminish the severity of the 11ephritis, we employ cups over the lumbar region, heat over the lumbar region or over the entire body, and the internal use of calomel, sulphate of magnesium, Opium, aconite, or digitalis. The disturbances of the circulation are largely the causes of the cerebral symptoms and of the dropsy. With a laboring heart and contracted arteries we employ the drugs which dilate the arteries, chloral hydrate, opium, nitrite of amyl, and nitro- glycerin, or we diminish the quantity of the blood by venesec- tion, sweating, or purging. With a feeble heart and relaxed arteries we use the cardiac stimulants. In chronic nephritis, climate and mode of life constitute the important parts of the treatment; it is doubtful if drugs exert any effect on the nephritis. A warm, dry climate and an out-of- door life are of the greatest importance. Medical treatment can, flowever, be employed with advantage for the relief of the anemia, the dropsy, and the disturbances of circulation.— 7%erap. Gazette. SENDING INVALIDS Away FROM Home.—“Every health resort is filled with the graves of those who left their homes in the expectation of regaining health. Many of these went because of the popular reputation of the particular place for the cure of the particular disease which each suffered from. By far the larger number went because they were so advised by their physician. In the last analysis, the reputation of every health resort is made by the advice of physicians. Unquestionably, much good has resulted to multitudes thus advised. Is not this enough 2 inquires the reader. Certainly, if more could not be obtained. Can more be obtained 2 We think far better results could be had if physicians contemplating the sending of a patient to a particular place, would take the time and trouble to learn all that could be learned respecting this place as bear- ing upon the condition of the patient. Respecting nearly all Health resorts there has, at the present time, accumulated a very considerable amount of literature. Some one or more physi- cians are generally known as having given special study to each resort. We submit that, in justice to his patient, it is the phy- 322 SELECTIONS sician’s duty to master said literature, and interrogate said physiciall or physicians. It may be that, after all this, the question is still doubtful. In this instance it were better to keep the patient in his comfortable home. “Second, it is worse than cruel to send incurables away from home to suffer and die amid the privations incident to an abode among strangers. It is well understood that in most health resorts no provision is made for those seriously ill. Hotels and first-class boarding houses do not want them, and the accommodations of second and third-rate boarding houses are certainly unfavorable for their comfort in any respect. For those who cannot afford and obtain the best provision for their actual needs, the decent home in the worst climate is preferable to an abode such as we have in mind at the best climatic resort. The differences in the characteristics of the sexes must be remembered. The late Prof. Alonzo Clark used to say, referring to this matter, “Men and dogs can live in the woods, but women must have a home.’ He insisted that no woman should be sent away for her health unless a home could be provided for her in the desired climate. Any patient, man or woman, does better when located in comfortable quarters. Such quarters should be secured before the patient leaves home. “Third, it were wise to make the journey by easy stages toward the new climate or on the return homeward. To pass within twenty-four hours from a temperature of zero into one of 80° Fahr., is trying to any person, and should especially be avoided by the sick. In like manner, the return north should be gradual. Some one has said that it were best to follow the maturing of the strawberry, in a return from a residence in the south to a northern home.—AEditorial zn Amer. Zancet. THE PRODROMAL AND EARLY SYMPTOMs OF BRIGHT's DISEASE,--Dr. Charles F. Withington enumerates the following symptoms in the order of their priority, as determined through an analysis of seventy-five cases of chronic interstitial nephritis. I. Polyuria, with frequent micturition, and especially in- creased nocturnal micturition, was experienced by twenty-five persons, or thirty-three per cent. One had it twenty years before death, and four for two years and over. Eight persons, giving data on this point, showed an average of three and three- fourths years of polyuria before death. This average does not, as some others will be seen to do, require to be raised to repre- sent the true figure. & SELECTIONs. 323 2. Dyspnea was experienced by forty-seven, or sixty-four per cent., being the most frequent symptom. The longest case was forty years. The average of twenty-six persons, giving dates, was one hundred and eight weeks, or a little over two years. But this average requires to be materially raised, from the fact that it does not include four persons who had had dyspnea for “years” and one who had had it “always.” So that the true average date of dyspnea should be carried back nearer to that of polyuria. Edema, observed in thirty-eight cases, or fifty-one per cent. (This will be remembered in comparison with the eighty- four per cent. of edema in the mixed cases of chronic Bright's.) The longest cases were fifteen and twelve years. The average of twenty-nine persons was sixty-nine weeks, which requires to be slightly raised on account of a thirtieth person who had had it for “years.” 4. Cough occurred in forty-one persons, or fifty-six per cent. The longest ten years; two for five years. The average of thirty-two persons, forty-seven weeks, which is somewhat too low, as there were three others who had had it for “years.” 5. Palpitation, nineteen persons, or twenty five per cent. The average of nine persons had had it for twenty-six and a Half weeks, which is a little too low, as it does not include one person who had had it for “years.” Q 6. Headache, twenty persons, or twenty-seven per cent. Two had had it “always' and one for “years,” which should materially raise the average of eleven others who had had it for twenty-one weeks. The remaining symptoms average too near each other and are based on too small a number of cases to warrant an opinion on their relative priority. Nausea and vomiting present in thirty-seven patients, or forty-nine per cent. One had had vomiting “always,” one for “years,” and twenty-four others averaged nine and a half weeks before death. This average is probably too low. Amblyopia, in eleven persons, or fifteen per cent. One person had had it seven years. Including him in six cases giving dates, we should have an average of fifty-four weeks; omitting him, five cases give sixteen weeks, which is doubtless nearer right. Vertigo, in thirteen, or seventeen per cent. The earliest twenty-two weeks; the average of five, nine weeks. 324 SELECTIONS. Diarrhea, in sixteen, or twenty-one per cent. One had it for ten years. The average of ten others, 6.2 weeks. (Per contra, three record constipation.) Lumbar pain, in four persons, or five per cent. ; which shows the popular fallacy of backache as a symptom of Bright's at least in this form. - *. Cerebral hemorrhage occurred in ten persons, or thirteen per cent. The earliest was five years before death. Three had two attacks, and one had three. Six died from hemorrhage of brain or meninges. Other hemorrhages occurred as follows: of the nose, seven ; of the lungs, six ; bowels, two; stomach, one. Delirium occurred in fifteen, or twenty per cent. It was generally a late symptom, the earliest case being three months, and eleven cases appearing first within the last two weeks of life. Disorders of sleep are thus classed : insomnia or vigil in eleven ; drowsiness or sopor in four. Rather a late symptom. Convulsions, of course, occur late. They are recorded in only seven, or nine per cent. Coma, prior to the day of dissolu-, tion, in twenty-six. Cyanosis is spoken of in eleven cases; in at least five it was noted ten days or more before death. Of other symptoms, infrequent but of significance, the author. mentions: itching in two persons; other paresthesiae in three ; thirst in four; neuralgia in two; sore-throat in two ; Cheyne-Stokes respiration in three.—7%erap. Gazette. © COLD IN THE HEAD.—For cold in the head, while in the acute congestive stage, there is no better remedy than gelsemi- num. One good large dose, say IO minims of the fluid extract, taken upon going to bed, will effectually dispose of this trouble- some and uncomfortable affection. One dose is usually suffi- cient.—Medical Compend. THEMOSTPERFECTFORMOFDosimETRY IS AFFORD ED BY - The term Parvule, from Parvum (small), is applied to a new class of remedies (Warner & Co.'s) in the form of minute pills, containing minumum doses for frequent repeti- tion in cases of children and adults. It is claimed by some practitioners that small doses, given at short intervals, exert a more salutary effect. Sidney Ringer, M. D., in his recent works on Therapeutics, sustains this theory in a great variety of cases. Parvules of Calomei, 1-2O Med. Prop.–Alterative, Purgative. DOSE.-1 to 2 every hour. Two Parvules of Calomel, taken every hour, until five or six doses are administered (which will comprise but half a grain), produce an activity of the liver, which Will be followed by bilious dejections and beneficial effects, that twenty grains of Blue Mass or ten grains of Colomel rarely cause, and sickness of the stomach does not usually follow. Parvules of Calomel and Ipecac. B. Galomel, 1-10 gr. Ipecac, 1-10 gr. Med. Prop.–Alterative, Purgative. DOSE.—1 to 2 every hour. Two Parvules of Calomel and Ipecac, taken every hour until five or Six doses are administered (which will comprise but a grain of Calomel), produce an activity of the liver, which will be followed by bilious dejections and beneficial effects, that twenty grains of Blue Mass or ten grains of Calomel rarely cause, sickness of the stomach does not usually follow. E’arvules of Aloin, 1-10. Med. Prop.—A most desirable Cathartic. The most useful application cf this Parvule is in periodic irregularities—Dysmenorrhoe and Amenorrhoe. They should be given in doses of one or two every evening at and about the expected time. DOSE.-4 to 6 at once. This number of Parvules, taken at any time, will be found to exert an easy, prompt and ample Cathartic effect, unattended with nausea, and in all respects furnishing the most a perient and cathartic preparation in use. For habitual constipation, they replace When taken in single parvules the various medicated waters, avoiding the quantity required by the latter as a dose, which fills the stomach and deranges the digestive organs. Parvules of Podophyllin, 1-40. Med. Prop.–Cathartic, Cholagogue. r Two Parvules of Podophyllin, administered three times a day will re-establish and regu- late the peristaltic action and relieve habitual constipation, add tone to the liver, and invigorate the digestive functions. Parvules of Arsenit: Patash, 1-100. (WARNER & Co.) This Parvule will he of great use to physicians, as two Parvules represent the equivalent of one drop of Fowler’s Solution, so that physicians can regulate the dose by giving one or more Parvules every hour. º Parvules of Corrosive Sublimate, 1-100. (WARNER & co.) Dr. Ringer, in his treatise, lays great stress upon the efficacy of minimum doses of corrosive sublimate in the treatment of Diarrhoea, whether the stools contain blood or not. Parvules of Nux Womica, 1-50. (WARNER & Co.) Nux Vomica, according to Ringer, is possessed of real curative powers for sick headache, accompanied with acute gastric catarrh, whether due to error in diet, constipation, or no apparent cause. He regards it, administered in small and frequently repeated doses, as useful in many disturbances of the gastric functions. * - W. H. WARNER & CO., Philadelphia. I 2 AA’O/2//V/LACZYC A GA/AWS 7 “/LA GA’/PPE.” (MARE LAFFONT, M. D., PARIS, FRANCE.)* The epidemic which was such a cruel scourge last winter is again appearing. The symptoms of this complaint are manifested invariably by a functional depression, more or less marked, of the whole system, varying from simple lassitude stuffiness of the nose and slight gastric obstructions. In the late epidemic to these premonitory symptoms succeeded all the characteristic of grave typhoid infection; nausea, fever, muscular pains, delirium, pneumonia with tendency to suffocation and complete prostration. In the presence of Influenza in the stage when the patient was completely depressed, I found the most effectual treatment to be the administering of strong tonics such as generous wines, champagne, cognac, tonics physical and moral, preferably prepara- tions made from the fresh leaves of Erythroxylon Coca, such as “Vin Mariani’’ and “Elixir Mariani;” at the same time causing revulsion and administering repeated aperients. I advise as a rational treatment for Influenza and kindred affections: gentle purgatives; disphoretics and revulsives ; strong tonics. * Medical Press and Circular, London. 2- “THE TENSOR OF THE WOGAL CORDS.”—Gharles Fauvel, M. D. “THE REMEDY, PAR EXCELLENGE, AGAINST WORRY.”— J. Leonard Corning, M. D. “THE WINE FOR ATHLETES.”—E. B. Palmer, M. D. “THE GARDIAG TONIG GIVING BEST.EFFECTs.”—Beverley Robinson, M. D. * Monograph on Erythroxylon Cocoa Forwarded on Application. IM EA-I RIALINTI & CO- P E tº USS ſºlº Lºs :*: j Street, 52 West 15th Street, New York. EDITORIAL DEPARTMENT. J. F. BALDWIN, M. D., Columbus, - º e- EDITOR. J. E. BROWN, M. D., Columbus, tº-º º * -, * - ASSOCIATE EDITOR. Communications, reports, etc., are solicited from all quarters. Authors desiring reprints, will receive fifty, free of charge, frozºided the request for the same accom- panies the article. Subscribers changing their location, are requested to notify the Publishers Aromptly, that there may be no delay in receipt of the journal, stating both the new and the former post-office address. We have no authorized Collectors, except such as carry properly made out bills, countersigned &y the Auðlishers. THE COLUMBUS MEDICAL PUBLISHING CO., CoLUMBUs, OHIO. THE KEELEY CURE.—Dr. Edmund Andrews, of Chicago, thinks that this “cure" is very similar to that of Dr. J. L. Gray, of La Porte, Ind. He says: “When Dr. Gray receives a patient he sets into his room a bottle containiug a pint of good whisky, instructing the patient that he can take all he wishes. He immediately commences and gives him four hypodermic injections each day, each containing one-tenth of a grain of the chloride of gold and sodium and one-fortieth of a grain of nitrate of strychnine, and gives a mixture to be taken by the mouth containing the same with some atropine. The following is the formula for the mixture as given to me by Dr. Gray: Sodio-auric chloride. . . . . . . . . . . . . . . . . . . . grains I2 Ammonium chloride . . . . . . . . . . . . . . . . . . . & 8 Strychnine nitrate. . . . . . . . . . . . . . . . . . . . . . Atropine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F1. ext, cinchona compound. . . . . . . . . . . . OZ. F1 ext, coca . . . . . . . . . . . . . . . . . . . . . . . . . . . £ 6 Glycerine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . { { Mix and take a teaspoonful every two hours when awake. “He sees the patient four times a day and rapidly increases the gold and strychnine until the symptoms show that they are getting all that they will bear. The first day the patient drinks pretty heavily of the whisky in his room. The second day he begins to lose his desire for it. By the evening of the third day, or the morning of the fourth, he is totally sick of it and will not take any more. The treatment is carried on from three to six weeks.” Dr. Andrews is of opinion that the Keeley “cure” very closely resembles the above, judging from the similarity of symptoms produced in the patients, consisting in pupil dilatation i 325 326 EDITORIAL. with dimness of vision and uncertain gait (atropine); headache and muscle twitchings (strychnine); and finally an irritating erythema all over the body (gold) The effect of these agents on the nervous centers is to obliterate the desire for alcoholic stimulation. “ This,” Dr. Andrews continues, “breaks the tyranny of the habit and enables a man to start on a career of total abstinence without feeling a distress from the absence of His stimulant. Many men, therefore, are able to resist future temptation and to permanently maintain their sobriety, but if they begin to tipple they will gradually overcome their repug- nance and re-acquire the habit. In all probability the periodical drunkards accustomed to going on sprees at intervals of consid- erable time will be found most liable to fall back into their old liabits.” Dr. E. F. Wilson, of this city, has secured some excellent results from the use of a formula very similar to that above. He has had two analyses made of the medicine sent out by Keeley,and both agree very closely with the formula of Dr. Gray. COLUMBUS, O., DECEMBER 3, 1891. Pursuant to call issued by the Cincinnati College of Medi- cine and Surgery for a delegated convention of the medical colleges of the State of Ohio, to be held at Columbus, on the date above mentioned, representatives of the following faculties were present, viz: Starling Medical College, Toledo Medical College, Pulte Medical College, Columbus Medical College, Medical Department of the National Normal University, College of Physicians and Surgeons of Columbus, Woman's Medical College of Cincinnati and the Cincinnati College of Medicine and Surgery. * - On motion, Dr. Starling Loving was elected Chairman and Dr. Charles A. L. Reed, Secretary. On motion of Dr. C. E. Walton, representatives of the Physio-Medical Society of Ohio were admitted to a vote in the Convention. - º - Dr. Charles A. L. Reed presented the following: Resolved, By the Medical Colleges of Ohio, in Convention. assembled, that the Legislature be and is hereby requested to enact a law which shall embody the following features, viz.: 1. The creation of a board or boards of medical examiners in the composition of which equitable and just representation EDITORIAL. 327 shall be accorded to the various recognized denominations of medical practice. 2. The examination of all condidates for the practice of medicine holding diplomas hereafter issued by medical colleges which shall be deemed in good standing by the board. 3. Exemptions from examination to extend only to those who at the time of the enactment of this law shall be recognized as legal practitioners within the meaning of existing statutes ; but all legal practitioners shall be required to register. 4. A penal clause which shall secure the enforcement of the foregoing provisions. Dr. C. E. Walton on behalf of the Legislative Committee of Cincinnati presented the registration law approved and pro- mulgated by that committee. - On motion by Dr. Shockey, the resolutions presented by Dr. Reed were approved. * On motion by Dr. Kinsman, the secretary was directed to forward transcripts of these proceedings to each local medical society in Ohio, and to the medical press. On motion by Dr. Scoville a committee was appointed to confer with the Legislative Committee of Cincinnati for the pur- pose of securing such changes in the bill proposed by that com- mittee as to make it conform to the resolutions adopted by this convention. The chair appointed as such committee Drs. S. S. Scoville, T. C. Hoover, G. W. Mayhugh and Chas. A. L., Reed. r Adjourned. - CHARLEs A. L. REED, Secretary. STARLING LOVING, Chairman. ANNOUNCEMENT.—E. B. Treat, Pub., N. Y. ; has in press for early publication the 1892 “International Medical Annual,” being the tenth yearly issue of this deservedly popular work. Its corps of thirty-five Editors are specialists in their respec- . tive departments, and have been carefully selected from the brightest and best American, English and French authors. It is the embodiment of what is worth preserving of the current Medical Journals of the world for the year, and will con- tain over 6,OOO references to diseases and their remedies. The service rendered the profession by this Annual cannot 328 EDITORIAL. be over estimated, and it is an absolute necessity to every phy- sician who would keep abreast with the continuous progress of practical medical knowledge. This Index of New Remedies and Dictionary of New Treatment, epitomized in one ready reference volume at the low price of $2.75, make it a desirable investment for the busy practitioner, student and chemist. W. B. SAUNDERs, of Philadelphia, the publisher, announces the following important new medical works as now in prepara- tion, ready for delivery about June 1, 1892. They will be sold only by subscription : An American Zeacf Book of Surgery, by Professors Keen, White, Burnett, Conner, Dennis, Park, Nancrede, Pilcher, Senn, Shepherd, Stimson, Thompson and Warren. It is to form one handsome royal octavo volume of about I2OO pages (IOx7 inches), profusely illustrated with wood cuts in text, and chromo-litho- graphic plates. Price, cloth, $7.OO ; sheep, $8.O.O. An American Zerº Book of Zhe Practzze of Mediczne, accord- ing to American teachers, edited by William Pepper, M. D., LL. D., provost of the University of Pennsylvania. This is to appear in two handsome royal octavo volumes of about IOOO pages each, with illustrations to elucidate the text wherever necessary, Price per volume, cloth, $5.00; sheep, $6.O.O. He also announces a new Pronounczng /Jacázonary of Medz- cine, by John M. Keating, M. D., and Henry Hamilton, and a work on ZDiseases of the Æye, by G. E. de Schweintz, M. D., both to be ready in a few weeks. ass=sº sºººººººººººº. DEATH UNDER THE INFLUENCE OF “VITALIZED AIR.”—The Pittsburg Dispatch of Dec. 30, 1891, contains an account of a death in the dentist chair of a healthy man, aged 31, while under the influence of the Duret Compound known as “vitalized air.” We shall await the report of the Coroner on this case with deep interest. It will be remembered by those of our readers who were present at the meeting of the State Society, that Dr. J. C. Reeve of Dayton, spoke of this compound for inhalation which has been introduced into dental practice. From his examination of it he stated his belief that it was chloroform— nothing more nor less than diluted chloroform, and sounded a warning note as to its use. EDITORIAL. 329 THE vomiting attendant upon the use of chloroform anesthesia is at times annoying to a marked degree. If the patient has been properly prepared for the operation, the stomach being empty, the nausea which arises during anesthesia can generally be kept short of vomiting by pushing the chloro- form when the patient is seen to retch. In these cases however, as in others, there is liability of an amount of nausea and vomiting during the twelve hours following the operation which might not only be unpleasant, but the mechanical disturbance caused by it might seriously interfere with wound in operations where perfect rest was important. Dr. Lenewitsch (Centra/b/. fur Charungze, No. 21, 1891), has endeavored to find some re- liable preventive for this, and in six cases has succeeded in quickly quieting the vomiting by washing out the stomach with a one-half to two per cent. warm soda solution. As a stomach tube is generally found in the surgeon’s armament, it is a measure that can be easily tried, if the means usually resorted to are not quickly successful. J. E. B. GONORRHEAL OPHTHALMIA.—At a recent meeting of the N. E. O. Med. Society, Dr, X. C. Scott, of Cleveland, stated that gonorrheal, or purulent, ophthalmia could be always and promptly cured by the use of the following eye-drops, a state- ment which was corroborated by Dr. A. R. Baker, of the same city: * R.—Acid. borici, Hydrast. Sulph. . . . . . . . . . . . . . . . . . . . . . . . a a gr. v ; Tr. opii deod. . . . . . . . . . . . . . . . . . . . . . . . . . . . . j. M. Sig.—Eye-drops. Dr. Scott also stated that gonorrhea could be cured in three days by the same, used as an injection. We hope that all the above is true, but fear that Cleveland microbes possess less vitality than their confreres elsewhere. DR. FERDINAND KING, for a number of years editor of the Znternatzona/./ournal of Surgery, has terminated his connection with that periodical, which will hereafter be issued by the Inter- national Journal of Surgery Co. Dr. King will at once commence the issue of a journal of his own, to be called “The Doctor's Weekly.” Dr. King's well- 1 Mºtºº. Cº. SS º § 2. ſt- º so tº dº A\\\\\ 5 bī) . sº ſº ;: GP º 2, # Cºc tº- r −3 °º et. º. a * 5 p. sº d º H S.P. § 3 St © tº Kſ) arº G -: Z; E : O 3 : {*. {T} # 3.5 2. ## 8. º lº g § = 3 º º:::: ... : © No. 6o Improved Buggy Case, each . . . . . . . . Including one year's subscription to the Journal. $ 8. 5 O Space for powder papers, instruments, ete. Case made of Black Grained Russia leather, leather lined throughout, and mounted With German silver combination corners, nickel spring lock, with key, making the most substantial, complete and richest-looking Physician's Case ever placed on the market. It should be noted that the No. 60 Case is protected by German Silver combination Gorners; also nickel edge trimmings around the Center partition, which serves to protect from wear and to keep the partition in place. These improvements are found only in No. 60 Improved Buggy Case, it being the constant aim of the manu- facturers to make this case as near perfect as skillful labor and carefully selected material Will make. *. NOW Read this—a $12.00 Case and the Journal for $10.50. 66. SATCHEL CASE, 10 inch frame, contains 18 one ounce, 11 ãº. six drahms and 14 four drahm º, COrked vials, ample loops for in- 㺠= Struments, box for sundries, plush tº) * lined, With a neat compartment §§§ for Hypodermic Syringe. Size, ºf 10x7-5. Price, with the CoI,UMBU's #E MEDICAL JOURNAL 1 year, $10.50, We think this the most conveni- ent Satchel Case sold. Can also furnish it with 7 two Ounce bottles instead of 9 of the One Ounce. This is the finest and best made Satchel Case on the market to-day. All of above prices include the CoIUMBUSMEDICAL Journal, for one year. Cash must accompany order to obtain above prices. as Syr. Hyºph: Co., Fellows Contains the Essential Elements of the Animal Organization—Potash and Lime; The Oxidising 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 Slightlv Alkaline Reaction. It Differs in its Effects from all Analogous Preparations; and it possesses the important properties 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 deseases. Its Curative Power is largely attributable to its stimulant, 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 directly into the circulation with the food products. The prescribed dose produces a feeling of buoyancy, 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. INOTICE–C#.UTION. The success of Fellows' Syrup of Hypophosphites has tempted certain per- sons 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. º tºp º º 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 bottle (and the wrap- pers surrounding them) bear, can then be examined, and the genuineness—or otherwise—of the contents thereby proved. .7/educaſ, Zeffers may be addressed £o - Mr. FELLOWS, 48 Vesey Street, New York. gº-ºh" only prominent Emulsion. of Cod-Liver Oil introduced directly to t.e medical profession-º - It is advertised exclusively, in medical journals. YURQLEI (WA Produces rapid increase in . Flesh and Strength. FORMUL.A.—Each Dose contains : Pure Cod Liver Oil.80 m. (drops) || Soda........ . .... 1-3 Grains Distilled Water. . . . . 35 “ Salicylic Acid ... 1- 4 • Soluble Pancreatin. 5 Grains. Hyocholic Acid...1-20 “ - Recommended and Prescribed by ºf EMIN ENT PHYSICHANS Everywhere. º It is pleasant to the Taste and Fºrt acceptable to the most delicate Stomach. IT IS ECONOMICAL IN USE AND CERTAIN IN RESULTS, HYDR2.ÉINE (Hydrated Oil) is not a simple alkaline emulsion of oleum morrhua, but - a hydro-pancreated preparation, containing acids and a small percentage of soda. Pancreatin is the digestive principle of fatty foods, and in the soluble form here used, readily converts the oleaginous material into assimilable matter, a change so necessary to the reparative process in all wasting diseases. Lautenbach’s Researches on the functions of the liver would show the beautiful adjustment of therapeutics in preparation of Hydroleine, furnishing, as it does, the acid and soda necessary to prevent self- poisoning by re-absorption of morbid tubercular detritus and purulent matters into the general circulation. In Wasting Piseases the most prominent symptom is emaciation, the result of starvation of the fatty tissues of the body as well as the brain and nerves. This tendency to emaciation and loss of weight is arrested by the regular use of Hydroleine, which may be discontinued when the usual average weight. has been permanently regained. The following are some of the diseases in which HYDROLEINE is indicated : Phthisis, Tuberculosis, Bronchitis, Catarrh, Cough, Scrofula, Chlorosis, General Debility, etc. To Brain Workers of all classes, Hydroleine is invaluable, supplying as it does, the true brain-food, and being more easily assimilated by the digestive organs than any other emulsion. The principles upon which this discovery is based have been described in a treatise on “The Digestion and Assimilation of Fats in the Human Body,” by H. C. BART LETT, Ph. D., F. C. S, and the experiments which were made, together with cases illustrating the effect of Hydrated Oil in practice, are concisely stated in a treatise on “Consumption and Wasting Diseases,” by G. Over END DREw Ry, M. D. COPIES OF THESE WORKS SENT FREE ON APPLICATION. * Sold by all Druggists at $1.OO per Bottle. c. N. crittenton, S0LE AGENT FOR THE UNITED STATES. 1 15 FULTON STREET, N. Y., A Sample of Hydroleine will be sent free upon application, to any playsician (enclosing businosa card) in the U.S, TONICS, ANTIPERIODICS, EXPECTORANTS. We desire to mention the special advantages of a few eligible preparations which meet many indications in Tonic, Antiperiodic and Expectorant Treatment. ESENCIA DE CALISAYA. An agreeable, general tonic and stimulant, the equiva- lent of 40 grains Calisaya Bark in each ounce. As a palatable stimulant, antiperiodic and febrifuge, possess- all the medicinal virtues of Calisaya, it may be relied upon. Emulsion Of COD LIVER OIL With HYPOPHOSPHITES This is the perfection of an emulsion, pure, fluid, palatable. Each ſluidounce contains: Cod Liver Oil, 4 fluidrachms; Hypophosphite of Lime, 8 grains ; Hypo- phosphite of Soda, 4 grains ; Gum Arabic, Sugar, Glycerin, Water and Carminatives. º GRINDELIA ROBUSTA, QUEBRA- CHO, CHEKAN, YERBA SANTA, LIPPIA MEXICANA, ANODYNE PINE EXPECTORANT, BRONCHIAL SED- ATIVE, all have had their value proven in relieving respiratory affections. Among Compressed Troches for Throat and Bronchial Trouble, We may mention Ammonium Muriate, Borax, Potassium Bicarbonate, Potassium Bromide, Potassium Chlorate, Potassium Chlorate and Ammonia Muriate, Potassium Chlorate and Borax, Sodium Bicarbonate, Soda Mint. Descriptive Literature and all information regarding our products promptly furnished on request. PARKE, DAVIS & COMPANY., DETROIT, NEW YORK AND KANSAS CITY. GG)1: Uſ M13t'ſs * - - *- tº-a - - tº- tº- ºn -* wºm º ºsº wºn ºn wº wºn wº wºme wº * \º gº wº- wº wº- wn wº MEDICGL JGURNG11. vol. x. FEBruary, 1soe. Me, 8, z J. F. BALDVV IN, M. D. --> - - tº-e tº- - EDITOR. J E. BROWN, M. D., - e- Associate Editor. C. R. CORNELL, - - Business Manager. 48 PAGES READING MATTER. PUBLISHED #OWTHLY. $1.00 PER YEAR. THE columbus MEDICAL PUBLISHING company, Publishers and Proprietors, 266 East Gay Street, Columbus, Ohio. Entered at Postoffice, Columbus, Ohio, as second-class mail matter. CH. MARCHAND's , PEROXIDE OF HYDRO GEN. § gº tº: " . . *. § ºğg (MEDICINAL) H2O2 (ABSOLUTELY HARML Ess. º tº tº º § Most POWERFUL BACTERICIDE AND PUs DESTROYER. º º'ENDoRSED BY THE MEDICAL PROFESSION. sº. £3 UNIFORM IN STRENGTH, PURITY, STABILITY. º' RETAINS GERMICIDAL POWER FOR ANY LENGTH OF - TIME. - TAKEN INTERNALLY OR APPLIED EXTERNALLY WITH PERFECT SAFETY. Send for free book of 72 pages, giving articles by the following contributors: DR. J C H N AULDE, of Philadelphia, Pa. “Hydrogen Peroxide–Résumé.” Azar, Jork Mea'ical Gozerzaz. DR. E. CHAREST, of St. Cloud, Minn. “Peroxide of Hydrogen for Gonorrhoea.” Medical IP'orld of Philadelphia, Pa. - + NOTE.—Avoid substitutes—in shape of the corn nercial article bottled— unfit and unsafe to use as a medicine. Ch. March and’s Peroxide of Hydrogen (Medicinal) sold Only in 4-Oz., 8-Oz., and 16-oz. bottles, bearing a blue label, White letters, red and gold border, with his signature. Never sold in bulk. - PHYSICIANS WILLING TO PAY EXPRESS CHARGES WILL RECEIVE FREE SAMPLE ON APPLICATION, - PREPARED ONLY BY NY ; º [* Mention this publication. Chemist and Graduate of the “Acoſe Centrale des Arts et Manufactures de Paris '' (Arance). trasºaiers. Laboratory, No. 28 Prince Street. ~ contents. COMMUNICATIONS. A Possible Source of Contagion—by Charles . Merz, A. M., M. D., Sandusky, O.... .337-342 The Philosophy of Orificial Surgery—by C. * A. Howell, M. D., Columbus, O. . . . . . . . . .342–351 The Keeley Treatment of Alcoholism—by Jefferson C. Crossland, A.M., M.D., Zanes- ville, O............ * * * * * * * * * * * * * * * * * * * * * * * 35 t—354 SELECTIONS. MED/CINE–Modern Treatment of Head- aches; The Value of the Physical Signs at SURGER Pi—Treatment of Stricture ; Re- lation of Albuminuria to Surgical Opera. tions; Rupture of the Bladder; The Treatment of Varicose Ulcers; Excision of ‘Encysted Tumors of the Scalp; On the . Torsion of Arteries. . . . . . . . . . . . . . . . . . . . . . .362–370 OBSTE TRICS – Hyperemesis Gravidarum ; Cesarian Sectiºn and Porro's Operation ; Fetor of the Lochial Discharges; A Plea for Explorative Incision in Ascites in Women; Blood-letting in . U remic Convul- sions; Urethral Carunkle; Toilet Powder; ‘. . * s t sº *.x. the Apices of the Lungs in Supposed In- Enuresis, . . . . . . . . . . . . . . . . . . * - - - - - - - - - - - - - - ' 370 378 cipient Phthisis; A Prophylactic Against AºAX/Z'OA’/4/. . . . . 379 382 Influenza; Coca as a Cardiac Tonic ; scar- | ***** * ******** ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' let Fever; Sciatica.... . . . . . . . . . . . . . . . , ... .355-362 POOK MOT/CES, . . . . . . . . . . . . . . . . . . . . . . . . . 383–384 ..', f * -- Y. . . . . . . . . . ADVERTISERs The Maltime Mfg. Co., New York . . . . . . . . . . . . . . I Wm. R. Warner & Co., Phila. . . . . . . . . . . . . . . . . . | || Western Penn. Medical College, of Pittsburgh. 2 Mariani & Co., New York . . . . . . tº º & s sº t # * * * . . . 12 Dr. McMunn’s Elixir of () pium . . . . . . . . . . . . . . . 2 H. K. Mulford & Co., Philadelphia . . . . . . . . . . . . I 3 Harrison Coie, Columbus, O... . . . . . . . . . . . . . . . . 2 . . The Clerniana Chemical Co., Atlanta, Ga., . . . . . 1 | The Terraline Co., Washington, D. C. . . . . . . . . . 3 - Battle & Co., St. Louis . . . . . . . . . . . . . . . . . . . . . . ! 4 B. Keith & Co., New York. . . . . . . . . . . . . . . . . . . . 3 Mellier Drug Company, St. Louis. . . . . . . . . . . . . 15 Cincinnati Sanitarium . . . . . . . . . . . . . . . . . . . . . . ... 4 Renz & Henry, Louisville, Ky. . . . . . . . . . . . . . . . . } {} The Antikamnia Chemical Co., St. Louis, Mo... 4 PRE!!! Üß LST F08 l802 . . . . . . . . . . . . . . . . . . . . . . . I {} Dios Chemical Co., St Louis, Mo. . . . . . . . . . . . ... 5 Health Restorative Co., New York . . . . . . . . . . . 7 I. O. Woodruff & Co., New York. . . . . . . . . . . . . . 6 Reed & Carnrick, New York . . . . . . . . . . . . . . . . . . 18 Cornell-Pheneger Chem. Company, Columbus, Bowden Lithia Spring Co , Lithia Springs, Ga. 39 Ohio. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . James I. Fellows, New York. . . . . . . . . . . . . . . . . . . 20 New York Pharmacal Association. . . . . . . . . . . . . . S Charles Marchand. New York. . . . . . lst page cover, Eisner & Mendelson Co., New York. . . . . . . . . . . 4} C. N. Crittenton, New York. . . . . . . .3d “ 4 & 'Lambert Pharmacal Co., St. Louis.. . . . . . . . . . . . 1() Parke, Davis & Co., Detroit & N.Y.4th “ “ cod LIvºir ori. A combination of the best Worwegian Cod Liver 0i/ with MALTIME, in which, by the vacuum process, rancidity is prevented and disagreeabletodor and taste of the oil/removed. Base a Powerful Reconstructive Contains No Inert Emulsifier lºs Il islfilligsillſ ill; Pālāl; Is an active Starch Digester and Tissue Builder. Produces rapid Improvement in Appetite. ls’used where “Emulsions" cannot be tolerated, A complete list of the Maltine Preparations and their formulæ will be sent on application. THE MALTINE MANUFACTURING CO. {Please ºnention this Jenrnal.) New York, N. Y. \ 2 WESTERN PENNSYLVANIA MEDICAL COLLEGE, CITY OF PITTSIBURGH, SESSIONS OF 1891-'92. The REGULAR SESSION begins on the last Tuesday of September and continues six months. During this Session, in addition to four Didactic Lectures, two or three hours are daily allotted te Clinical Instructions. Attendance upon three Regular Courses of Lectures is requisite for graduation. A three years' graded Course is provided. The SPRING SESSION embraces Recitations, Clinical Lectures and Exercises, and Didactic Lectures on special subjects. This Session begins the second Tuesday in April, and continues ten Weeks. The LABORATORIES are open during the Collegiate Year for instructions in Chemistry, Microscopy, Practical Demonstrations in Medical and Surgical Pathology and Lessons in Normal Histology. Special importance attaches to the Superior Clinical Advantages possessed by this College. For particulars see Annual Announcement and Catalogue, for which, address the Secretary of Faculty, PROF. T. W. T. McKENNAN, 810 Penn Avenue. Business correspondence should be addressed to PROF. W. J. ASDALE, 2107 Penn Avenue, Pittsburgh, Pa. 1 DJ F.R.. TM IcTM ITUTINTINT*S I Gº tº ſº. [...] R. O. F. O. Fº Tºſ. Mºſ An Invaluable Discovery in the Preparation of Opium. THIS IS 7"HE FURE AAWD ESSEAVT/A/, EXTRA C7' A'ROM 7THE AWA 7TWVE DA’ UG. It contains all the valuable medicinal properties of Opium in natural combination, to the exclusion of all its noxious, deleterious, useless principles upon which its bad effects depend. It possesses all the sedative, anodyne and antispasmodic powers of Opium: . To produce sleep and composure; to relieve pain and irritation, nervous excitement and morbid irritability of body and mind; to allay convulsive and spasmodic actions, ete.; and being purified from all the noxious and deleterious elements, its operation is attended by no sickness of the stomach, no vomiting, no costiveness, no headache, nor any derangement of the constitution or general health. Hence its high superiority over. Laudanum, Paregoric, Black Drop, Denarcotized Laudanum, and every other Opiate preparation. E. FERRETT, Agent, 372 Pearl St., New York. HARRISON COLE, PRACTICAL OPTIOIAN, All Defects of Vision, requiring Spherical Lenses, scientifically corrected. Special Lenses carefully adjusted to prescription. Optical and Scientific Goods of all kinds. Repairing of every description. Prescription Blanks Furnished Physicians on Application. 64 North High Street, Columbus, Ohio. 3 -- #Tº ONE WORD JUs -] a-J ” *=s** to the Medical Profession as to the value of TERRALINE (or purified Petroleum) in Bronchial Pulmonary Catarrhal and other Diseases of the Throat and Lungs. . In the first place it is not an emulsion, and does not deteriorate with age. In the second lace it is tasteless and odorless; the patient can continue its use without repugnance to the taste. t does not cause eructations Or nausea, and the most delicate stomoch can tolerate it. It is pre- scribed by the leading physicians everywhere and the grand results from its use as reported to us *: *. increditable. Read what a few of our leading city physicians say of it, as given in InterViews. DR. JAMES T. YOUNG, 1336 New York Avenue—“Terraline has promptly relieved a number of cases of Chronic Bronchial Catarrh that would not yield to other remedies.” DR. J. O. STANTON, 1344 G. Street—“I have prescribed Terraline in a large number of cases of Laryngitis, Bronchitis and Incipient Phthisis, and am more than pleased with the result.” Dr. Z. T. SOWERS, 1320 New York Avenue—“I have prescribed Terraline in a number of Cases such as are usually given COd-Liver Oil, and as it has the double advantage Of no odor or taste, can be given in those cases in which Cod-Liver Oil disagrees, with all the advantages of the latter, and with even increased benefit.” DR. A. Y. P. GARNETT, 1317 New York Avenue—“Have prescribed Terraline as many as thirty times, and for almost as many forms of Bronchial and Pulmonary complaints, and fail to recall a single instance in which I did not see prompt and decided improvement in the patient.” DR. D. C. PATTERSON, 919 I Street—“I am of the opinion that in Terraline we have a most valuable agent in the treatment of the class of cases for which Cod-Juiver Oil is prescribed.” DR. P. J. MUR Y, Surgeon in charge of the Columbian Hospital—“I have prescribed Terra- line very often in the last year, both in and out of the Hospital, with grand results, and while I never write a certificate for a medicine, however good, am free to say that I see in Terraline the #; remedy for the trestment of Bronchial and Pulmonary troubles ever brought to my attention.” We have hundreds of certificates from all parts of the United States which we will insert from time to time in the Medical Journals where they legitimately belong. R. —TERRALINE................................... tº e º 'º ſº tº $ tº º . 3 xii. Sig.—One or two teaspoonfuls, three or four times daily, in sherry wine. The price of Terraline is One Dollar a bottle. A full size bottle for trial will be sent to any physician without expense except for express charges which he must pay on receipt of it. THE TERRALINE COMPANY., SOLE M'FRS 1. 9 º 1316 L STREET, N. W., WASHINGTON, D. G. "CUREDTBy THE USETOF I Eis. I E- I C "Tº E C S → f C O N → T | N C - A V E N A S A T L V A. FROM COMMON OATS, º A POWERFUL NERVE STIMULANT, TONIC, ETC., Is also Employed in the Treatment of Paralysis, Epilepsy, St. Vitus' Dance, Chloral and Tobacco Habits, Sleeplessness, Nerve Exhaustion, Neuralgia, Alcoholism, Painful and Deficient Menstruation, Headache, Hysteria, Convulsions and Prostra- tion from Fainting, and in the Convalescent Stage of all Acute Diseases. DOSE.-From ten to thirty drops or more, as often as may be indicated to meet the urgency of the case. Administer in hot water when quick action is desired. Messrs. B. KEITH & CO ,—Gentlemen : Melroy, Ind. I am giving the con. tr. avena sativa for the , meozºkia hać it, and I find it will cure, I believe, all cases, no meatter how long they have been the slave of this opium monster. I think this is the greatest discovery of Our age. F. M. "POLLITT, e - e. Messrs. B. KEITH & CO.,-Gentlemen: Barnesville, Ga. The con. tinct. avena sativa has been more successful in the treatment of the opium habit than anything I have ever tried, and I have tried various other remedies, amongst them the advertised nostrums. HOLLOWAY, M. L. Messrs. B. KEITH & CO., Gentlemen : Idaho Springs; Col. I have tried a small amount of the con. tr. avena sativa and am more than plcased with it in the ogizmi Aabit and several other cases, such as in female diseases and nervous conditions. CHAS. B. RICHMOND, M. D. Send for printed matter on Con. Tinc. Avena Sativa in the Morphine or Opium Habit, and certificates from different members of the Medical Profession citing cases under their charge treated by it, also Revised and Enlarged Manuel to - IEE. IEEEEI*T*EBC cºz CFO-s ORGANIC CHEMIST8, ESTABLISHED | 852. No. 75 WILLIAM ST. NEW YORK, º ºº § iº §§§ ºff. tº º === Bºeº. § tº ɺº. § Fº ź. º ޺ º £º sº-º §§ --- - §º zº %. W º ----- gº:=== tº: cINcINNA ti - sanitarium. A PRIVATE HOSPITAL FOR MENTAL AND NERVOUS DISORDERS. COLLEC E HILL, OHIO. Eighteen Years Successful Operation. Oue Hundred and Fifty Patients admitted annually. Daily Average, Seventy. Cottages for Nervous Invalids, Opium Habit, etc. Location Salubrious. Surroundings Delightful. Appliances Ample. Charges Reasonable. §: by Rail; 6 Trains Daily; 30 min. from C. H. & D. Depot, Fifth and Hoadly Sts., IIl Gillmati. For Particulars, Address ORPHEUS EVERTS, M. D., Sup’t, College Hill, Ohio. Asif YEARS EßIDEAlic as N ºw A ºr Wºrmºz sº ^º secured the desirepresvirgº s" AND IS AGAIN IRIDICATED BY iſſRE * , , e, RETURN OF INFLUENZA G O - AND ITS ALLIED COMPLAINTS. S. * FOR H 1 STORY & LITE RATURE ADDRESS, THE ANTIEAMNIA. CHEMICAL CO., ST. LOUIS, MO., U. S. A. INſ ETOſ R O şIINTE I A NEW AND POWERFUL NEUROTIC, A NODYNE AND HYPNOTIC. A most efficient and permanent preparation, REMARKABLE for its efficacy and THERA- FEUTIC, EFFEGTS in the treatment of those NERWUUS AFFEGTIONS and morbid conditions of the System which so often tax the skill of the Physician. - A RELIABLE AND TRUSTWORTHY REMEDY FOR THE RELIEF OF Hysteria, Epilepsy, Neurasthenia, Mania, Chorea, Uterine Congestion, Migraine, Neuralgia, All Conzulszze and Reflex AVeuroses. The Remedy Par Zºxcellence in Delirium and A’estlessness of Pevers. NEU ROSINE Is the result of an extended professional experi- ence, and is compounded in the most palatable form by a skilled pharmacist, the formula of which will commend itself to every Physician. ForMULA :—Each fluid-drachm contains 5 grains each, C. P. Bromides of Potassium, Sodium and Ammonium, 1.8 gr. Bromide Zinc, I-64 gr. each of Ext. Belladonna and Canna- bis Indica, 4 grains Ext. Lupuli and 5 minims fluid Ext. Cascara Sagrada, with Aromatic Elixirs. daily, as may be directed by the Physician. DOSE:—From one teaspoonful to a tablespoonful, in water, three or more times FOR FURTHER INFORMATION AND SAMPLE BOTTLE SEE F00T 0F THIS PAGE. RTOſ. RINT CA UTERINE TONIC, ANTISPASMODIC AND ANODYNE. A reliable and trustworthy remedy for the relief of Dysmenorahoea, Amenorrhoea, Menorrhagia, Leucorrhoea, Subinvolution, THREATENED ABORTION, Vomiting in Pregnancy and Chlorosis; directing its action to the entire uterine system as a general tonic and antispasmodic. This combination is the result of an extensive professional experience of years in which the constituent parts have been fully tested singly and in combination in various proportions, until perfection has been attained. DIOWIBURNIA..."...#. given will commend itself to every intelligent physician. FORMULA:—Every ounce contains 3-4 dram each of the fluid extracts: Prunifolium, Viburnum Opulus, Dioscorea Villosa, Aletris Farinosa, Mitchella Repens, Caulophyllum Thalictroides, Scutellaria Lateriflora. a desertspoonful to a tablespoonful three times a day, after meals, Virburnum Helonias Dioica. DOSE:—For adults, In urgent cases, where there is much pain, dose may be given every hour or two, ALWAYS IN HOT water. Jno. B. Johnson, M. D., Professor of the Princi- §: and Practice of Medicine, St. Louis edical College. St. Louis, June 20, 1888. I Very cheerfully give my testimony to the Virtues Of a combination of vegetable remedies prepared by a well known and able pharma- cist of this city, and known as DIOVIBUR- NIA, the component parts of which are well known to any and all physicians who desire to know the same, and,therefore, have no rela- tion to proprietary or quack remedies. I have employed this medicine in cases of dysmenor. rhoea, suppression of the catemania and in excessive leucorrhoea, and have been much pleased with its use. J do not think its claims (as Set forth in the circular accompanying it) to be at all excessive. I recommend its trial to all who are willing to trust to its efficacy, be-, lieving it will give satisfaction. Respectfully, L. Ch. BOisliniere, M. D.. Professor of Obstet- riCS, St. Louis Medical College. St. Louis, June 18, 1888. I have given DIOVIBURN1A a fair tral, and found it useful as an uterine tonic and anti- spasmodic, relieving the pains of dysmenor- rhoea, and regulator Of the uterine functions. I feel authorized to give this recommendation of DIOVIBURNIA, as it is neither a patented nor a secret medicine, the formula of which having been communicated freely to the medi- cal profession. sº c/. 3ors/n es e Pºz). H. Tuholske, M. D., P. of essor Cliuical Surgery and Surgical Pathology, Missouri Medical College ; also Post-Gradutate School of St. LOuis. St. Louis, June 23, 1888. I have used DIOVIBURNIA quite a num- bcr of times—sufficiently frequently to satisfy myself of its merits. It is of unquestionable benefit in painful dysmenorrhoea: it possesses antispasmodic properties which seem especi- ally to be exerted on the uterus. A’z A. Z.A.-4-6. To any physician unacquainted with the medicinal effect of DIQVIBURNIA, and, NEU- ROSINE, we will mail pamphlets containing full informatian, suggestions, commendaiions of some of the most prominent professors in the profession, and various methods of treatment ; also a variety of valuable prescriptions that have been thoroughly tested in an active prac- tice, or to physicians desiring to try our preparations, and who will pay express charges, we will send on application a bottle of each free. DIOS CHEMICAL CO., ST. 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A Connecticut physician writes: “I am now using your Tablets on a patient (young lady), who has had three quite severe hemorrhages the week previous to the beginning of the same. She has taken one box only, has had no return of the hemorrhage, and has gained four (4) pounds since beginning treatment, besides all rational symptoms have improved wonderfully. I will add that I had tried Ol. Morrh., Syr. Hypophos. Co., etc., with no apparent benefit.” A Virginia physician writes : “Enclosed find Postal Note for another double box Freligh's Tablets. I used the sample box in three cases, with decided benefit in one, slight improvement in second, and while they did not improve the third case. it being in very advanced stage, there was an amelioration of the distress- ing symptoms. - A Massachusetts physician, in practice 25 years, writes: • ‘Send me two double boxes Freligh’s Tablets. I have tried the sample box with most excellent results.” A Michigan physician writes: “I am more than pleased with them. They have not disappointed me once. Dr. C. for whom I ordered a box, writes me that he is much improved, and speaks in praise of them. He has genuine Tuberculosis, and while I do not think he can recover, yet I firmly believe the Tablets will prolong his life.” SIFIEHCI C.A.T.s CoIFI FI EHI E-. While the above formulae has been in use, in private practice, over 30 years, and we could give testimonials from well-known clergymen, lawyers and business men, we prefer to leave them to i.e. unbiased judgment of the profession with the following offer: . On receipt of 50 cents, and ... ietter head, bill head, or other proof that the applicant is a physician in active practice, we vºll 'send, delivered, charges prepaid, one of the regular, (double) boxes, , (retail price, Three I5ollars) containing sufficient of each kind of Tablets to test them three months (in the majority of cases) in some one case. Card, letter head, or some proof that the applicant is a physician in ...tive practice, MUST accompany each application. Pamphlet with full particulars, price list, etc., on request. A E-IEHICsIFIEHICIERIZEID CEREERO-SPIN ANT. (FRELICH'S TONIC.) Our special Offer is still open, to send to any physician, on receipt of 25 cents, and his card or letter head, half a dozen samples, delivered, charges prepaid. Each sample is sufficient to test it for a week in One case. ‘As we furnish no samples through the trade, wholesale or retail, for samples, directions, price lists, etc., address f T. O. 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PHYSICIANS" SUPPLIES OF ALL KINDS. 8 -º-, £º is a hiſłfwº propazoğ cow8iwatiow of ºſtect-cowoozłºwg, ºat- cowuez, gº T inq cºw8 Stavch-convezting ºſcºtoxicito, aciêiftwo with the owtaſt proportiow b. of &lot&s aſvuciº pzczowº in {{\o hocºthº otowºc.cf. &t is a woot vaſwatſo bigeotiwg agent, cºwb SUPERIOR To PEPSIN ALONE.”—Prof. ATTFIELD, Ph. D., F.R.S., &c., Prof. of Practical Chemistry to Pharmaceutical Society of Great Britain. º SY \ & S • * §§ º *... " M.S. §s § § § § §§ &:S wº, LACTOPEPTINE. The most important Remedial Agent ever presented to the Profession for DYSPEPsi A, WomiTING IN PREGNANCY, CHOLERA INFANTUMI, CoNSTIPATION, and all Diseases arising from Imperfect Nutrition. LACTOPEPTINE IN CHOLERA INFANTUM. We desire to direct special attention to the great value of Lactopeptine in Cholera Infantum, and other intestinal troubles incident to the heated term. Send address for our Medical Almanac, containing valuable information. The New York Pharmacal Association, IPs. O. Box 714. NEW YOI R, K. COLUMBUS MEDICAL JOURNAL A MONTHLY JOURNAL OF MEDICAL SCIENCE. Vol. 10. FEBRUARY, 1892. No. 8. COMMUNICATIONS. A POSS/BZE SOURCE OF COWTAGZON. BY CHARLES H. MERZ, A. M., M. D., SANDUSKY, OHIO. A Paper read before the Northern Ohio Medical Society at Fremont, O , Dec. 17, 1891. While feeling the deepest reverence for a custom that has become sacred through time and usage, the writer, after much careful thought on this same subject, was rejoiced to see the full fruition of an innovation, observed in the Scovil! Avenue M. E. Church, at Cleveland, Ohio, a Sunday or two ago, that of administering the holy communion in small individual glasses. This was done after careful deliberation and with the full consent of the pastor and laymen, and for excellent sanitary reasons. At this day, scientific investigation has proven beyond the possibility of a doubt, that nearly, if not all, of the diseases human flesh is heir to, are due to infection by germs. The time is approaching when it will be possible for us to say, with assurance, that infectious diseases are parasitic diseases—and the proof of our assertion will lie in the fact that bacteria are found on the surface of the human body, and in the interior organs in communication with the exterior. We are forced to account for their presence by two hypotheses, one, the spontane- ous production of these organisms in the interior of th; tissues; 337 338 COMMUNICATIONS. the other, their introduction through the membranes from without. The cutaneous surfaces are penetrated with difficulty by germs, though upon the mucous membrane there is little, if any, delay in their introduction into the system. Under what other circumstances than those of religious conviction could one of us be induced to drink from a cup that bad been brought into contact with several hundred lips, without any pretense of cleansing 2 Ordinarily the cups, used in communion, are of metal, and have edges that are more or less roughened, which form convenient hiding places for germs of disease. Think a moment of the importance of this question that now demands the attention of every physician, sanitarian, and scientific man, the role of bacteria in infectious disease. The unimpeachable nature of experimental proof in this-line, when investigation is carefully conducted, is at once made apparent. The germs once implanted, warmth and moisture are the most favorable adjuvants for their rapid development, in fact, are essential. No doubt, the germs pass into the blood after being introduced into the alimentary canal by food and drink. Their multiplication under favorable circumstances is rapid—almost beyond comprehension. Figures can convey but a vague idea of the rapidity of their growth. “Let us suppose,” says Cohn, “that a bacterium divides into two in the space of an Hour. Then in four, at the end of the second hour, in eight at the end of three hours, and in twenty-four hours the number will already amount to more than sixteen millions and a half, (16,777,22O). At the end of two days, this one bacterium will have multiplied to the incredible number of 281,500,000,000 ; at the end of three days, it will have furnished forty-seven trillions; and at the end of a week, a number which can only be represented by fifty-one figures.” 5% In order to render these numbers more comprehensible, let us seek the volume and weight which may result from the multiplication of a single bacterium. The individuals of the most common species of rod-bacteria present the form of a short cylinder, having a diameter of a thousandth of a millimeter in length. Let us represent to ourselves a cubic measure of a Imillimeter. This measure would contain, according to what we have just said, 663,OOO,OOO of rod-bacteria. Now, at the end of twenty-four hours, the bacteria coming from a single bacterium would occupy the fortieth part of a cubic millimeter; but at the end of the following day, they would fill a space equal to 442, 570 of these cubes, or about a half litre. Let us admit that the MERz—A Possible Source of Contagºon. 339 space occupied by the sea is equal to two-thirds of the terrestrial surface, and that its mean depth is a mile, the capacity of the ocean will be 928,OOO,OOO cubic miles. The multiplication being continued with the same conditions, the bacteria issuing from a single germ would fill the ocean in five days. Germ poisons remain active for a long time after their escape from the body. The fact that in some cases the germs are absorbed only through abraded membranes, and in others through the unbroken membrane, may be explained by the varying diameters of the particles. - Immunity from sources of infection even in the matter of Holy communion, can be attained only by scrupulous care and cleanliness. Surely it is not too sanguine a prediction that the next few years may see this custom which has so long prevailed, and about which so many sacred thoughts cluster, give way to a safer sanitary plan. - - The persistence of virulence of bacilli has been clearly shown by Klebs and others. A culture in bouillon kept six months from the light in a closed tube, gave strong healthy colonies of germs when inoculated in living animals. Sevestre, in “Etudes de Clinique Infantile,” cites cases tending to prove the extraordinary vitality of the contagion of diphtheria. Lapses of two and four years are not unusual periods for infection from dangerous sources. The subject is one of vital importance from the point of view of prophylaxis. Direct transmission from lip to lip, from sputum, from hands, clothing, and instruments, has been observed again and again. As showing the relative number of deaths from contagious diseases in Michigan in 1886, the following diagram accurately drawn to a scale will prove of interest. Consumption. Diphtheria. Typhoid. Scarlet fever. Whooping cough. Measles. We are striving to secure acts of Legislature that will limit the spread of seeds of disease and death. Physicians every- where for years past have petitioned the Legislature and urged, 34O * - COMMUNICATIONS. by all possible means in their power, the passage of laws that would protect us in a measure from contagious diseases. Yet this one source of contagion, the indiscriminate use of the communion cup, has largely escaped notice, and is sanctioned as a custom because supposed to have been so established by Holy Writ. Biblical authority at least does not specify the manner in which the custom is to be observed. We do not find that Christ's disciples partook from the same cup, at the first com- munion. According to Luke 22:17: “And he took the cup and gave thanks and said, take this and divide it among yourselves.” There is nothing to justify the inference that all drank from the one cup ; rather that each disciple had a smaller cup from which he partook of his portion. - In many of the more contagious diseases the main changes are found upon the mucous membranes of the lips, tongue, and mouth. This is especially true of one disease particularly virulent and loathsome in its manifestations. Food that has be- come lodged in the crevices of the teeth, aided by moisture and warmth, creates a perfect hot-bed for microbes, if indeed such matter itself is not directly poisonous. - There is a well known list of diseases that are contagious. Healthy persons receiving into their systems the germs emanat- ing from those ill with small-pox, scarlet fever, diphtheria, measles, etc., are familiar examples of disease by infection. The persons ill reproduce in their bodies the specific germs that made them sick, so that exposure to the presence of such is sufficient to reproduce the disease. Convalescent children and adults are often sent to school, Sunday school, and church, while they are active centers of contagion. Physicians through care- lessness, and often intentionally, conceal the fact, and are some- times partzceps crºmazmi's in such concealment. It is in this manner that maladies are allowed to work their fatal effects upon communities. The great trouble to contend with, however, is the nearly universal coincidence of opinion that so long as any one disease does not assume an overwhelming epidemic form, there is no occasion to attempt to limit its spread. Apathetic inaction speaks louder than words, and the responsi- ble parties must either acknowledge it or admit being negligent of the safety of the lives entrusted to them. Upon the same grounds—that of infection—promiscuous and indiscriminate kissing is to be condemned. The prevalent habit of every one in kissing children is to be seriously deprecated, and it is not at all to be questioned that much disease is trans- MERZ–4 Possible Source of Contagion. * 34: 1mitted in that way. It would be well if every mother would beed this warning. The skin and mucous membrane of infants are exceedingly delicate, and very susceptible to poisons that may zunconsciously be carried upon the lips of another. - Judge Arnold, of Philadelphia, has decided that it is not necessary for one to kiss a much-handled, and perhaps disease- germ bedecked, bible when taking oath in his court. He claims that it is a relic of idolatry that ought to be abolished; that it was established by the church to show humiliation of the people, before the first judges, who were clerics; and that the custom has been abolished in England. It is a relic of the age in which trial by fire took the place of trial by jury, when a man’s innocence or guilt depended upon his physical capacity to endure pain and torture. But its worst feature is the dirt and disease which is imparted to the book by the constant handling it receives by dirty witnesses. When the Duke of Fife took Inis oath at Stratford, he caused the Testament to be enveloped in clean white paper. - Medical works are replete with instances of infection from the mouth and lips. The man who sips from the cup preceding his brother communicant, may have a malignant sore throat, or be but just convalescent, or have some other infectious disease in its incipiency, that renders it unsafe for one to press his lips where that one's have been, - - The question is, “Has the church or the individual the right to cause the people to incur this risk at every communion ?” How this danger, by no means an imaginary one, can best be avoided, I do not pretend to even suggest, as that rests alone with the Pastor and his congregation. Various plans have been proposed, and in one or two instances at least, been tried without arousing anything but approbation. After all, it is not the form of our worship, but “the spirit that giveth life.” I can give in one word the secret of this question and that of the whole of hygiene—cleanliness. If cleanliness be next to Godliness, then certainly is there cause for careful consideration of this particu- lar subject. - - f In many different ways, the christian of to-day is a sanitarian. He recognizes the sacredness of the human body— God’s highest work. He recognizes the value of human life, that it too is a sacred thing, and that he must not commit murder. He is his brother's keeper and under sacred obligations to consider his welfare. His rule is the Golden Rule. He is a sanitarian in more indirect ways. He is building hospitals and º 342 COMMUNICATIONS. charitable institutions. He is combatting crime and degeneracy, and is waging war on disease that flourishes among the poorer classes. He is a sanitarian, in that he recognizes the depend- ence of body and soul, and he directly benefits the latter when he betters the condition of the former. He is emphatically a sanitarian in that he realizes that public morals and public sanitation are so closely related, have so definite an influence upon the purity of life, that whatever teaches the people public cleanliness and the principles of public health, directly advances the cause of the Christian religion. Yet in spite of all this, in view of the grounds he takes upon other subjects, he sanctions this custom of administering the wine in the Holy Communion, either from superstition or from a wilful blindness to the danger arising from it. I do not believe that anyone was ever made a sanitarian by fear, but rather only by conviction ; therefore, when I point out the possible peril to health and life that, beyond a doubt, exist in this christian custom as now observed, I do not do so with the idea of alarming anyone, but with the intention of familiar- izing everyone with the facts as they really exist. 7A/A A//// OSO/2//Y OF OR//7/C/A/L SOA'G/E/C V. BY C. A. HOWELL, M. D., COLUMBUS, OHIO. Thesis read before the Central Ohio Medical Society. Eight years ago, Dr. E. H. Pratt, of Chicago, heralded to the medical world the following statement: “In all pathologi- cal conditions, surgical or medical, which linger persistently in spite of all efforts at removal, from the delicate derangements of brain substance that induce insanity, and the various forms of 11eurasthenia, to the great variety of morbid changes repeatedly found in the coarser structures of the body, there will be found invariably more or less irritation of the rectum, or the orifices of the sexual system, or of both. In other words, all forms of chronic disease have one common predisposing cause, and that cause is a nerve waste occasioned by an irritation at the lower openings of the body.” Such, gentlemen, is the proposition Orificial Surgery teaches. . To those of you who hear such a broad assertion made for the first time, it will seem somewhat startling, and it is only after putting the above statement to the crucial test of practice, How ELL–7%e Philosophy of Orºficial Surgery. 343 will you believe it. All scientific principles must have some philosophy to back them up, and as time is short, with this brief introduction as to the object of Orificial Surgery, I shall at once plunge into the philosophy of the same. º, There is but one direct means by which man’s physical being is developed, by which it is maintained in a normal con- dition, and when broken down by disease by which it is restored to health ; hence, there is one chief thing to which the various measures employed for the relief of bodily ills should be directed. It matters not whether drug, electricity, massage, are the instru- ments used, all are directed to this one aim. I refer to the cir- culation of the blood. If the blood current is strong and free, health is assured ; if the circulation is sluggish, congestions oc- cur—pathological conditions appear. There is not a patholog- ical condition but has its beginning in blood stasis, the re- moval of which is the problem that demands solution in the treatment of chronic diseases. We all know that the activity of the circulation depends on nerve force; the proper supply of nerve force, means a good circulation. A waste of nerve force means an enfeebled circulation—it means disease. So far, then, I have tried to lay before you four tenets on which Orificial Surgery is based. First—that where there is a proper circulation, there is health. Second—that blood stasis means local congestion ; the initial lesion of all disease. Third—that a normal circulation is maintained by normal nerve force. Fourth—that congestions are all associated with nerve waste. The special nerve force which presides over the circulation is derived from the great vaso-motor system. This system is formed by the intermingling of fibres from both the cerebro- spinal and sympathetic system of nerves. As a vine twines itself around a tree, so is this arterial tree covered by tendrils from this gigantic vine of nerve filaments, until even the small capillary is net-worked by nerve tendrils; bearing in mind, therefore, that this figurative nerve vine is made up of both the cerebro-spinal and sympathetic nervous systems, you can at once see that the circulation is under a double influence. * Now, for one moment, let us see the respective functions of these two gigantic nerve systems : the cerebro-spinal furnishes the body with sensation of which we are conscious, and supplies the so-called voluntary muscles with motor power. The cerebro- spinal system furnishes the indwelling spirit, which plays sym- phonies of harmonies and discord upon the human body; “it laughs the body, it cries the body, it blushes and pales the body, 344 . COMMUNICATIONS. it sweats and dries the body, it rests and runs the body, it nau- seates and purges the body; in fact, it constitutes the body a ‘jumping jack,' which it uses and abuses at its will.” But the action of the cerebro-spinal system is spasmodic and not to be relied upon for the processes of nutrition. It goes to sleep every night, it is paralyzed under the influence of an anesthetic, and in every way it is unreliable as a steady provider of nerve force. The sympathetic nerve system, fortunately for us, is tireless in its activity; it sleeps but once, and that sleep is final; by night and day, in rest and toil, under all conditions and at all times the sympathetic system is maintaining the func- tions of animal life. Can’t you see the importance of this sys- tem to our welfare 2 I must not forget to mention that the afferent filaments from the sympathetic system supply sensa- tions to the mucous membrane of the body. The efferent nerves supply the involuntary muscles of the entire organism. The sexual system is also under its control. The various involun- tary activities of the body are carried on by tubular structures, namely: the arteries, veins, intestinal and respiratory tracts and glandular ducts. These, as you remember, are made up of long and circular fibres, which are non-striated, are involuntary, and therefore are under the influence of the sympathetic nervous sys- tem. Now these tubes through the peristaltic action they pos- sess, carry both solids and fluids along their course; thus is digestion, circulation and appropriation dependent on this same sympathetic system. When the sympathetic nerve force is abundant, all peristaltic actions are vigorous, all bodily activities are well accomplished, and a healthy human organism is placed at the disposal of the cerebro-spinal system for the accomplish- ment of its purposes. The problem of health is a problem of sympathetic nerve force, and the problem of disease is the prob- 1em of sympathetic nerve waste. The original supply in an in- dividual of sympathetic nerve force undoubtedly is a question of constitution ; the husbanding or squandering of this force, how- ever, is the all-important theme that concerns you as medical 1116211. I must now call your attention to the two lower orifices of the body. Each one of these openings is guarded by two dis- tinct sphincter muscles, an upper and a lower. The upper one, in each instance, is composed of involuntary muscular fibres, and is, consequently, supplied by the sympathetic nervous sys- tem. The lower sphincter is made up of voluntary muscular fibres, and is therefore under the control of the cerebro-spinal HoweLL–The Philosophy of Orificial Surgery. 345 nervous system. This is true of the rectum, and is also true of the male and female urethra. Since the sexual organs in both sexes take their nerve supply from the sympathetic nervous sys- tem, whatever wastes sexual power in either sex, causes a waste of sympathetic nervous power, and therefore lowers the nervous tone of the entire sympathetic system. Prolonged muscular action of either voluntary or involuntary muscular fibres involves a prodigal waste of nerve force, and is exhausting in its effects on either nervous system. Men who could be on their feet from morning until night without undue fatigue, if permitted fre- quently to change their position, as in walking and standing alternately, find it impossible to stay in a fixed position for more than a half an hour or an hour at a time. What is true of the cerebro-spinal system and voluntary muscles, is also true of the sympathetic system and involuntary muscles; alternate contrac- tºon and relaara!zon as merely eaterczse, and strengthens, but pro- /onged unremztling contractzons of any 2nzo/untary muscle, not only wearies the muscle, 64t fºres the entz're sympathe/2c nervous system, thereby undermūnâng the vigor of every peristaltic action in the body and laying the foundation for disordered functions and passzzle congestzons, which are the beganzezng of all pathology. With this brief resume of anatomical and physiological facts, we are prepared for consideration of some of the principles upon which orificial philosophy is based. If there is one thing I would impress upon your mind more indelibly than another, it is the first principle in orificial surgery—“the arrºtation of an organ begans at its mouth.” This is true even in inorganic life. The semblance of the human form can be seen in the construction of our great nation. The head of the national man will be at Washington; its arteries will be represented by railroads, rivers and canals; its nerves by telegraph and telephone wires; its various organs by its cities and towns. Take any of these cities and towns, single out the places where passing feet have worn their beaten tracks in the pavement by excessive use, and these spots will be found at the centres of traffic, at the orifices of the towns and cities, namely—ports and railway stations. This principle ap- plied to the microcosm—man, will at once point out the openings of the organs as the points of greatest friction ; therefore, I repeat, “the irritation of an organ starts at its mouth. Enlarge the proposition, and you have the thought that bodily nerve-waste in general begins at the openings of the body.” I think I hear the question, “1f orificial surgery be true, why narrow its limits to the lower orifices of the body alone?” Gentle- 346 - COMMUNICATIONS. men, orificial surgery is not limited ; the eye specialist, the ear specialist, the rectal specialist, in fact all specialists, would have you believe that the world revolves around their specialties. Orifi- cial surgery, while a specialty, is only an adjuvant to other methods of treatment. It includes every orifice of the body, but a special stress does it lay on the irritations found at the two lower open- ings of the body. The reason for this is, that organs having outlets at the upper part of the body, while they have important functions in the animal economy, are not so essential to the maintenance of the general health as are those which open be- low. Every organ of the body is continually undergoing more or less waste, from the disintegration and molecular death of its cellular structure. The main avenues of exit for this waste ter- minate below in two channels, whose passageways are perpetu- ally traveled by the waste products of the body. The gaseous waste of the system can escape through the skin, and by the breath, but the solid elements of waste congregate to form the steady streams of urine and feces, which require for the contin- uance of health a daily exit. So you see that the lower open- ings of the body with their guarding sphincters are not merely Žhe orifices of the rectum and urethra, but they are the universa/ gateways for the em/zre body, by which the dead cells that have been worn out in the service of an eye, an ear, a nose, a brain, a spinal cord, a lung, a mucous membrane, a liver, a heart, in fact any and every organ of the whole body, can pass out from the system. This is the reason why special stress is laid on the two lower organs. If an eye is inflamed, it can be bandaged; if an ear is diseased, it can be stopped ; if a nose presents pathologi- cal conditions, it can be protected from contact with the air; the mouth may remain closed should diseases attack this organ, and all this for an indefinite period, but not so the sphincter-guarded lower organs; feces and urine must pass, regardless of the con- dition of the orifices, and for this reason the lower openings of the body can never rest. - - As, therefore, blood stasis is the beginning of pathology, and as a weakened.peristaltic action is the beginning of blood stasis, and as the spent sympathetic nerve force is the predis- posing cause of a weakened peristaltic action, and as spasmodic action of involuntary muscles is the cause of a weakened nerve force, and as an irritable lining membrane is the cause of spas- modic action of involuntary muscles, and as the point where this universally occurs is at the lower openings of the body, therefore it seems a reasonable conclusion from this line of logic HoweLL–7%e Philosophy of Orificial Surgery, 347 that the proposition of orificial surgery formulated five years ago, is not without a substantial foundation in anatomical, physi- ological and pathological facts. I therefore repeat the statement I made at the beginning of my paper, which I believe in time will become historical. “/n all pathological conditions, surgical or med- ſcal, which linger persistently in spite of all efforts at remova/, from the delicate derangements of brain substance //a/ 2nduce insanez/y, and the various forms of neurasſhenza, ſo the great variety of morbid changes repeatedly found ºn the coarser structures of the body, there will 2nvariably be found more or less ºrrāţaſion of the rec- Żum, or the orifices of the searºa/ system, or both 2n other words, there is one predisposing cause for al/forms of chronic disease, and that is, a sympathetic nerve-waste occaszoned by orificia/ arrazatzon aſ the lower offenings of the body. These ºrrāţaſions induce a rigadity of the sphincters guarding the parts which e2/her com/?nºtes symphaſ/he/ically affecting the rest of the 2nzo/untary muscular system, and steadz/y drain?ng //e nervous flower f/a/ supp/zes 27, atm/2///he whoſe struggle fermezmaſes zn a rigor mor/z's, or /zrzng out Žn the hopeless grip it relates into the inertia of paralysis.” There is one point I wish to call your attention to; it is the re- flex effect of irritations in general. Reflex irritation is a more common occurrence than you would at first suppose. There is one characteristic which may always be observed, that wherever there as reflea irritation, there is also reflea congestion. As an exam- ple of what I mean let me cite tetanus; the inflammation having subsided at the point of injury can be found at the nerve centres at post-mortems; mumps is another example. Following in the same line, severe local lesions at the lower openings of the body sufficiently irritable to make the patient painfully conscious of their presence, are not liable to be accompanied by reflex troubles, and as soon as they are corrected, the patient is perfectly well. On the other hand, should the irritation and congestion of these parts have been transferred to some other part of the organism by nerve metastasis, so to speak, the patient is left fully unconscious of orificial irritation, and no amount of ques- tioning can elicit symptoms of local mischief. This accounts for two facts—first, why the physician is so often thrown off his guard, and thinks there is nothing abnormal at the lower orifices; and second, why the rectum has laid in oblivion for so many years. The orificial surgeon, then, cannot safely es/imate the amount of benefit that will result from his work by the amount of /ocal maschief present. It is only when he realizes the exhaust- ing effect of undue contraction of muscular fibres, that he will 348 r COMMUNICATIONS. begin to appreciate the necessity of relaxing all parts that are unduly contracted; it is only when he realizes what apparently insignificant causes will produce serious reflexes, that he will begin to appreciate the necessity of cleaning up rough- ened mucous membranes at the openings of the body, smoothing out wrinkled orifices, and of dilating contracted sphincters. While in this connection, I desire to call your attention to the close reflex relations existing between the rectum and the lungs. This is more important than many others, because the chest, in its action, resembles a great suction pump, and is the chief agent in drawing the blood from all parts of the body back to the center of circulation. Hence, any influence that affects the res- piration affects also the activity of the entire body, Under profound anesthesia no amount of surgical procedure seems to interfere in the least with the functions of respiration and circulation. A hand or foot may be amputated, a pleural, or peritoneal cavity may be opened, any of the major operations in surgery may be performed without materially affecting the depth of inspiration or the rapidity of the heart’s action, except when the operation is so severe as to threaten the extinction of life. In such cases respiration, of course, will be correspond- ingly slow, and the heart’s action more or less enfeebled. This, however, is the effect of severe shock in major operations. But in the weak and the strong, whether the lower orifices of the body are seriously affected, or present but slight evidence of disorder, the dilatation of circular fibers supplied by the sympathetic nerves will always produce more or less effect upon the respiration and the rapidity of the heart’s action. To prove that it is the sym- pathetic system, rather than the cerebro-spinal, that produces this profound impression, is very easily demonstrated. Place a patient under complete anesthesia, insert the thumbs into the rectum, dilate the lower sphincter, (remember this muscle is under the control of the cerebro-spinal nervous system,) and you will notice no effect on the respiration. Insert your thumbs further up the rectum, so that the upper sphincter is impinged on, (bear in mind this sphincter is under sympathetic influence) and the effect is instantaneous. The respiration will become slow, the heart's action rapid and feeble, and the patient will be placed in a position compromising his life. Another fact is re- vealed by this experiment; the capillaries of the system become instantaneously and universally flushed; hands and feet that have been cold for twenty years will become hot in less than twenty seconds. The pallid and sallow face will begin at once How ELL–7%e Philosophy of Orificial Surgery. 349; to glow with a new infusion of blood; and is it not reasonable to infer that what is going on externally is also taking place in the deeper structures of the body ? As a result of such an equalization of blood current, all local congestions subside. This dilatation of sphincters supplied by the sympathetic nerves has the remarkable effect of equalizing the capillary circulation ; flushing parts that are anemic, relieving parts that are congest- ed, and arousing the entire system to renewed activity. The dilatation of urethra, of uterus, or of vagina, will produce simi- lar effects, only not so marked. That the effect, however, is not entirely due to dilatation of the sphincters, but rather to the bruising and constant shocking of terminal nerve filaments of the sympathetic nerves, is shown by the fact that a similar effect can be produced by the severe pinching of a hymen ; the hood of a clitoris, the foreskin, or the mucous membrance covering the last inch of the bowel. But I will defy you to produce any effect on the respiration by pinching any part of the mucous membrane that is under the control of the cerebro-spinal system. About two years ago the lack of knowledge of the influence of rectal work upon the respiration was the cause of death in the following case, which is now so well known that many who listen to me will at once recognize the case. “An eminent sur- geon, while holding a college clinic, presented to the class a case of fistula. The man was placed under the influence of ether and the case was successfully operated upon and dis- missed. A year subsequently the same man presented himself to the same clinic for the same surgeon to operate upon him for hemorrhoids. The same assistants gave the man the same anes- thetic—ether—which he took as kindly as before. The surgeon proceeded to remove the piles by the Orthodox process of liga- tion, talking as he worked; but as soon as he tightened the liga- ture upon the first pile tumor, the assistant who was administer- ing the anesthetic called his attention to the general condition of, the patient. He had stopped breathing and was rapidly becom- ing cyanotic. The surgeon arose from his chair, observed that the man was not only breathless, but becoming rapidly pulse- less, and immediately began active measures for his resuscita- tion. Artificial respiration, practiced both with patient horizon- tal, and with head and shoulders dependent, the use of electricity, and all other measures which were employed, were wholly una- vailing, and the man's spirit went out. And neither the operat- ing surgeon, nor his assistant, nor any gentleman present, seemed to think far enough or to know enough to cut the string that # 35O COMMUNICATIONS, was all this time strangling the pile tumor, and constricting the terminal filaments of the sympathetic nerves. The case was thoroughly described in all its painful details in a prominent medical journal, and yet I have seen no comment upon the ig- norance manifested in this case concerning the disturbance to the respiration which follows injury to the rectal nerves.” A similar occurrence occurred to me when operating last Thanks- giving Day, on a prominent lady of this city, with only this ex- ception—that recognizing the cause of the fast approaching asphyxia, I removed the clamp from the hemorrhoids, and my patient was at once resuscitated. - “In conclusion, let me sum up the entire subject in a single sentence. Bring me an individual with clean lips and nostrils; a palate of proper length and unobtruding tonsils; a rectum that presents neither piles, prolapsus, fissure, ulcer, pockets nor pap- illae—an individual whose sexual orifices are smooth and free from all irritation ; if it be a man, his foreskin shall be free, the frenum of sufficient length, the urethral passage smooth and normal in size, especially in its prostate portion ; if a woman, her hymen must be pale and atrophied, her urethra devoid of caruncles and ulcerations, her internal and external ora uteri reasonably patulous, and without undue sensitiveness; bring such an individual, and I will point to the same person and show you a human being whose digestion is good, whose capillary circulation is superb, whose very existence is a constant source of uninterrupted delights. Such men and women maintain a steady poise of mind and body—they live to the fullness of time, and, unless removed by accident, their dissolution takes place on the principle of the “one-hoss shay”—they settle slowly and peacefully into their last sleep, just because their life's time-piece lias run down. On the other hand, introduce to me a mortal suffering with passive congestion in various parts, whose blood finds its lazy way back to the heart by slow stages because the peristaltic action of the arteries is tired out—a person whose vitality is low, and whose poor, enfeebled body begins to be the prey of inherited or acquired tendencies—consumption, scrofula, syphilis, organic derangements, of whatever form they may take—show me such an individual, and they are as numerous as withered leaves in autumn, and I will stake the reputation of this idea that I shall be able, without straining a point, to find 1egitimate fault with the condition of some one or more of the various orifices of the body.” . HoweLL–7%e Philosophy of Orificia/ Surgery. 35I Gentlemen, such is the philosophy of orificial surgery; it bas been presented to you in a clumsy and meagre style. I Hope, however, that enthusiasm may be spread amongst you, and from you carried to the suffering thousands around us. If you will carry out its true principles, you will be repaid, not only in dollars and cents, but those poor unfortunates, called chronics, will rise up and call you blessed. - 7A/A. A. Z.A./L/EY 7A. AEA 7TMZAV7 OA” A/L COAZO/L/S//. BY JEFFERSON C. CROSSLAND, A. M., M. D, ZANESVILLE, OHIO. Read before the Hildreth District Medical Association at Zanesville, Ohio. Dr. Keeley, of Dwight, Ill., claims to have discovered a cure for drunkenness and the drug habits. Contrary to medical ethics and without any well-grounded reason from a professional point of view, he has thus far in part kept his cure a secret. The basis of his formula, he alleges to be the double chloride of gold and sodium, and in this, it is claimed, the specifically curative properties reside. The bichloride is put up in liquid form in an unknown excipient. What therapeutic value is there in the remedy ? According to pharmaceutical teaching, the sodium is used to promote the solubility of the gold. It is claimed that the excipient is eliminative; that it enables the system to throw off any gold that may be administered in excess of that which may be necessary to correct the morbid nervous condi- tion. It is believed now that the pathological condition in alco- holism consists in a shrunken and degenerated condition of the nerve cells with hyperplasia of the neuroglia or nerve connect- ive tissue. In other words, a sclerosis of the nerve centres is supposed to exist. Whatever the condition may be, it is evi- dently not unremediable as restoration of functional integrity, from which we would infer structural integrity, often occurs with and without treatment. It is claimed by Keeley that gold effects its specific action on these diseased nerve centres. The therepeutic value of gold, after a pretty thorough test in the different neurotic, scrofulous and leuetic diseases, was thought to be almost nil, and, consequently, it had fallen into disuse. In recent years, however, its use has been revived. It seems to be used now chiefly in mind disorders characterized by depression. This precious product sent out from the Keeley 352 . COMMUNICATIONS. factory is put up in eight ounce bottles, and sold in pairs. At the Keeley Institute at Marysville, O., the remedy is admin- istered hypodermically and by the mouth. The double method, we infer, however, is not necessary, as it is claimed home treat- ment can be taken with equal success. Therefore, there seems to be no special skill required in carrying out the treatment. The same medicine is lauded with equal enthusiasm as a specific for alcoholism, the opium, chloral, cocaine and tobacco habits, and neurasthenia. The only difference in the remedy used in . the several instances, is in the grading—whatever that may mean —possibly a variation in the amount of gold used, as the price varies from five to ten dollars per pair of bottles, according to the habit for which it is used. These several conditions for which its specificness of action is claimed are sufficient to justify a suspicion of charlatanry. It is claimed for the remedy that it eliminates that element which has an affinity for alcoholic poison, and that it instills in the individual a repugnance, an antipathy for drink. This claim seems grossly unscientific. If the cure has this power, why not inoculate the youth by a course of treatment, and give them immunity from the disease, just as we inoculate against other diseases P Keeley, in his advertising literature, says no patient, cured by his treatment, will ever re- lapse. In another place, he evidences a little modesty by ac- knowledging that about five per cent. of relapses occur. Again, he acknowledges that the treatment of dipsomania is rather un- satisfactory. It is often necessary, he says, to renew the treat- ment with the recurrence of the appetite. His enthusiastic faith in his cure seems to be overcome by his avariciousness. How are we to harmonize these inconsistencies P A large per cent. of the cases treated at the Institute, are periodical drinkers, who come to the Institute in a state of intoxication. Who would be more likely to imagine himself cured, and more disposed to write a flaming testimonial, than a man recovering from a de- bauch 2 That gold is a specific for alcoholism seems extremely doubtful, and it is highly probable that no such specific exists. From a therapeutic standpoint, the treatment seems fraudulent. Upon what, then, does Dr. Keeley base a claim for public confi- dence in his cure ? In medicine, if a man of well-known ability, a scientist, announces a valuable discovery, his ability and rep- utation lend prestige to his claim. But the announcement by scientists of marvelous cures is not always sufficient to justify their acceptance by the profession without the most careful CROSSLAND–7%e A eeley Treatment of Alcoholzsma, 353 study, and cautious and patient trial. The totally valueless, and many times fatal regenerative treatment of Brown-Sequard, and the infinitely exaggerated Koch treatment for consumption which swept over the civilized world in colossal waves of epi- demic enthusiasm, are unforgotten illustrations. If, then, the productions of scientific geniuses are to be received with hes- itancy, startling discoveries and marvelous cures emanating from men of humble professional standing should be looked upon with tenfold more dubiousness. But the advocates of the Keeley cure claim that cures are effected and that these cures are per- manent. There seems to be considerable evidence to substan- tiate this claim. There are men who are known to have long been addicted to the excessive use of drink, in consequence of which they had become mental and physical wrecks, who seem to have abandoned the habit, and acquired a different appearance. Sufficient time, however, has not elapsed to justify the claim of permanence. Suppose some cures are effected. Is cure the rule or exception ? In the Keeley Hospital, as in all others of a pri- vate character, a special effort is made to inform the public of the successful cases, and to conceal from the public eye the un- successful ones. Testimonials as to the value of any new and fashionable treatment are easily obtained. Every worthless nostrum is bolstered up by ardent recommendations. The trouble with testimonials is, that most of them are written in glorious expectation of a cure, built up by earnest assurances of success, while the treatment is yet on trial and before an inglo- rious relapse. This is abundantly proven by the many, some of them quite well known, who have enthusiastically certified in be- half of the Keeley treatment, and who have since died from alcohol- ism, while the vast majority are fast re-entering their drink thraldom. Those with whom a treatment fails, never certify. To what, then, are the successful cases attributed 2 The will- power. Every physician realizes the value of a strong will- power in disease. You have all observed how speedily and easily despondent patients succumb to disease. On the other hand, you have all observed how an indomitable will has enabled patients to hold out against wasting and progressive disease and to triumph over what seemed almost necessarily fatal. The seemingly marvelous recoveries from hypochondriasis, and apparently hopeless conditions, simulating hysteria, which are supposed to be a visitation of Divine healing power in answer to prayer and faith, are unquestionably due solely to a restora- tion of will-power. The appetite for drink is either inherited or 354 CoMMUNICATIONs. acquired. In the majority of cases, it is acquired. Alcoholism is virtually a habit disease. The will-power is lost or impaired. This must be restored. A certain amount of medication may be necessary to sustain the vital forces, while the patient is men- tally and physically recuperating from his debilitated condition. But to restore will-power, there must be an effort on the part of the patient. There must be a firm determination, an ambition for restoration to former usefulness and position. Having re- stored the will-power, the cure will last so long as the will-power can be sustained. If, as we have seen, the will is so potent in actual bodily disease, it is as easy to believe that it can rescue patients from habit disease. When Cassius asked Caesar for a reason why he should not go to the Capital he replied, “The cause is in my will.” In cures from alcoholism, the cause is in the will. “Where there is a will, there is a way.” To make a more perfect application of this proverb, I would paraphrase it thus, “Where there is a will, there is a cure.” HYSTERICAL JOINTs.-Brodie makes the following state- ment, which Esmarch fully endorses : “I do not hesitate to declare that, among the higher classes of society, at least four- fifths of the female patients, who are commonly supposed to labor under disease of the joints, labor under hysterics and nothing else.” This statement seems rather remarkable, con- sidering the source from which it comes. Skey, from his experience in St. Bartholomew's Hospital, considers it very common in the lower classes. Dr. Shaffer says, “My experience convinces me that it occurs very frequently in both the upper and lower classes. In other words, I may say that many cases of simulated disease of the articulations are recognized as such, and it is a fair presumption that some, perhaps many, of the remarkable cases of which we hear now and then, have been cases, which, while presenting all, or at least the more sugges- tive symptoms of the lesion, were simply in a state of neuro- mimisis.” Dr. Gibney remarks, “that it is not limited to adolescence, but occurs very frequently in children. During my service as house surgeon in the N. Y. orthopedic hospital, it was not an unusual occurrence, for such cases, to be admitted into the wards, being considered true articular disease on their admission, and in many cases the diagnosis would not be changed until they had been under observation some time.” 9 An Achievement of Modern Chemistry. CRYSTAL sphings GLUTEN. GREEK ENGLISH PoluboSKosº. GLUTEN Foon. While there are various Gluten foods in the market, each and every one of them contains more or less starch (from 12 to 54 per cent.) Poluboskos contains only four-tenths of one per cent of starch. We can therefore justly say that it is practically free from starch, an achievement which has heretofore not been attained. . y The name “Polusboskos” was selected to distinguish it from other Gluten foods in the market. This name is not without its significance, it being a combination of two Greek words, polus, much, and boskos, nour- ishing. Pure Gluten with its congeners is the nitrogenous food principle of the vegetable kingdom, and is to be especially recommended because of its freedom from the poisonous ptomaines which are frequently found in many meat preparations which depend largely on the nitrogenous substances which they contain. - - Gluten is the element of the vegetable world which gives force and energy to animal life, and is the equivalent to the albumen of the animal kingdom. - Poluboskos needs no special preparation ; it is ready at a moment's notice. Mixed with milk it makes the most nourishing, stimulating, and refreshing food and drink for convalescents and dyspeptic invalids; it is readily assimilated by the weakest stomach. Two teaspoonfuls of Poluboskos contain as much nourishment (nitro- genous matter) as one pound of meat. It supplies energy to muscles, nerves, and other organs. A laborer taking three doses of Poluboskos a day will be able to endure more fatigue than if fed upon a meat diet. The use of Poluboskos as an article of diet in diabetes will be at once recognized, as it is free from starch. - We will be highly pleased if you will give this preparation your attention. -- * We are prepared to furnish physicians with samples, and hope to be favored with your valued commands. Yours very respectfully, NEW YORK, EISNER & MENDELSON CO. - 10 The Best Antiseptic for Both Internal and External Use. LISTERINE Antiseptic, Prophylactic, Deodorant, Non-Toxic, Non-Irritant, Non-Escharotic, Absolutely Safe, Agreeable, Scientific and Strictly Professional. FORMULA —Listerine is the essential antiseptic constituent of Thyme, Eucalyptus, Baptisia, Gautheria and Mentha Arvensis, in combination. Each fluid drachm also contains two grains of refined and purified Benzo-boracic Acid. DOSE,--Internally: One teaspoonful three or more times a day (as indicated), either full strength or diluted, as necessary for varied conditions. LISTER IN E is a well-proven antiseptic agent—an antizymotic — especially adapted to internal use, and to make and maintain surgical cleanliness—asepsis—in the treatment of all parts of the human body, whether by spray, irrigation, atomization, or simple local application, and therefore characterized by its particular adaptability to the field of PREVENTIVE MEDICINE — IN DIVIDUAL PRO PHYLAXIS. Physicians interested in LISTERINE will please send us their address, and receive by return mail our new and complete pamphlet of 36 quarto pages, embodying:— *. A TABULATED EXHIBIT of the action of LISTERINE upon inert laboratory compounds. FULL AND EXHAUSTIVE REPORTS and Clinical observations from all sources, confirming the utility of LISTERINE as a general antiseptic for both internal and external use, etc. Diseases of the Uric Acid Diathésis. KIDNEY ALTERATIVE-ANTI-LITHIC. FORMUL.A.—Each fluid drachm of “Lithiated Hydrangea’’ represents thirty grains of fresh Hydrangea and three grax, is of chemically pure Benzo-Salicylate of Lithia. Prepared by our improved process of osmosis, it is invariably of definite and uniform therapeutic strength, and hence can be depended upon in clinical practice. DOSE.-One or two teaspoonfuls four times a day (preferably between meals). Urinary Calculus, Gout, Rheºmatism, Bright's Disease, Diabetes, Cystitis, Haematuria, A]. and Vesical Irritations generally. We have had prepared for the convenience of physicians DIET ETIC NOTES (sample of which is herewith shown), G OUT. suggesting the articles of food to be allowed or prohibited in **** several of these diseases. DIETETIC NOTE, - A mixed e - diet should be adopted, the nitro- A neatly bound book of these DIETETIC NOTES, each genous and saccharine articles be- note perforated for the convenience of physicians in detaching ing used in limited amounts and distributing to their patients, mailed gratis upon request, Allozved.—Cooked fruits without together with the latest compilation of case reports and clin- much sugar; tea and coffee in mod- ical observations, bearing upon the treatment of this class of eration. ... Alcoholic stimulants, if diseases. used at all, should be in the form of - - light wines, or spirits well diluted. - \ The free ingestion of pure water is Lambert Pharmacal Co. ºf - Q Azºoid.--Pastry; malt liquors and sweet wines are veritable poisions ST. LOUIS, MO. .* to these patients. =s=sº-"º MEDICINE MODERN TREATMENT OF HEADACHES.—Allen McLane Hamilton has just written a brochure upon this subject (Physicians' Leisure Library, No. 6, Geo. S. Davis, publisher, Detroit). He classes all headaches under six groups, viz: - I. Congestive headaches. 2. Anemic headaches. 3. Organic headaches (due to structural cerebral changes). 4. Toxic headaches (e.g., lithemic, uremic, malarial, etc.). 5. Neuralgic headaches. 6. Neurasthenic headaches. sº. I. In the first variety he orders a brisk saline cathartic, followed by - B. Spt. ammonii aromatici. . . . . . . . . . . . . . . . . . . . . . f3ij Cocainae hydrochloratis. . . . . . . . . . . . . . . . . . . . . . 9ss Ammonii bromidi. . . . . . . . . . . . . . . . . . . . . . . . . . . 3iss Aquae campllorae. . . . . . . . . . . . . . . . . . . q. s, ad f 3iv Misce. Sig. : One teaspoonful (in ice water) every hour until pain is relieved. If due to overwork, regulate life and give tonics like strychnine, digitalis or phosphoric acid. In school-children bromides may control, given four times daily, the largest dose at bedtime. In any case constipation must be removed. 2. In anemic headaches, more pronounced early in the day, a cup of hot tea or ammonia in some form often gives relief. Bromides and chloral aggravate rather than diminish the suffer- ing. To cure he advises: * . B Ext. cannabis Indicae. . . . . . . . . . . . . . . . . . . . . . . gr:vj Ferri ammon. citratis. . . . . . . . . . . . . . . . . . . . . . . 9ijss M. et ft. pil. no. xxiv. Sig. : One thrice daily. If due to heart-weakness, a combination of strychnine, iron and digitalis will be found quite effective. When there is much depression with the headache, opium may be added. 3. For organic headaches little can be done unless the cause be of such character that it may be removed. (See book for differential diagnosis.) * 4. Of toxic headaches, perhaps the majority may be traced to lithemia. The treatment consists of restriction of meats eaten, as well as cheese or other nitrogenous food, wine and beer, etc.; all to be accompanied by plenty out-door exercise. Internally salicylate of sodium, iodide and acetate of potash and preparations of mercury do much good, as does also salol in 355 356 * * SELECTIONs. doses of five to ten grains. Some cases will only yield to colohicum and alkalies : B. Vini sem. colchici. . . . . . . . . . . . . . . . . . . . . . . . . . . f3ss Potassii acetatis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3v.j Tinct. cimicifugae. . . . . . . . . . . . . . . . . . . . . . . . . . f 3ss Aquae menth. pip. . . . . . . . . . . . . . . . . . . . . . . . ad f ;iv M. Sig.: Teaspoonful every four hours. Uremic headaches are also common. Hot air baths, diaphoretics and remedies directed to favor elimination remove the distress, but headache returns unless cause be removed. Tincture of the chloride of iron is usually indicated, an anemic condition commonly being also present; purgatives should also be employed. § Malarial headaches are frequent in some sections of the country. The usual anti-periodic treatment followed by iron, quinine and strychnine or arsenic will check and prevent 1ſec1111"e11Ce. - 5. The simpler cases of neuralgia due to cold, malaria or gastric derangements, are relieved by anodynes, and the local use of galvanism. There are, however, some drugs which have a decidedly specific action upon the trigemenus, the most important being aconite or its alkaloid, large amounts being necessary. Small amounts are useless ; a sufficient quantity to affect the disease will produce some prickling of the tongue and lips, shivering and a feeling of subjective coldness or even numbness of the extremities. Seguin’s prescription is: B. Aconitinae. . . . . . . . . . . . . . . . . . . . . . . . . . . . . gr. To ad & Glycerini. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Spt. vini rectif. . . . . . . . . . . . . . . . . . . . . aa fºj Aquae menth. pip. . . . . . . . . . . . . . . . . . ad f 3ij M. Sig. : Teaspoonful three times daily before meals, carefully increased. Chloral hydrate is of service in controlling the pain until the cause is removed ; and acetanilide is also good. Of course quinine, arsenic, etc., must be given as indicated. But some- times, after the etiological factor has been eliminated, the pain still persists; in such cases phosphorus is to be relied upon, because phosphorus in its pure form is one of the best regenera- tors of diseased nerves in existence, and in neuralgia of the fifth nerve is of prime excellence. This prescription is an admirable one, and produces little or no gastric disturbance: B. Phosphori . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . gr.j Alcohol. (absolute.) . . . . . . . . . . . . . . . . q. S. ut ft. Solut. Glycerini q S. . . . . . . . . . . . . s • * * * * * * * * * * * * * * ad f 3iv Spt. menth. viridis. . . . . . . . . . . . . . . . . . . . . . . . . . . f 3ss M. Sig.: One teaspoonful after eating, to be increased. External application are of service occasionally, as menthol, ointment of aconitine, belladonna or veratrine. An ointment that has proven good is : SELECTIONS. - 357 B. Chloral hydrat. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Camphorae. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . aa 3ij Petrolati. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3ss M. Sig.: Apply as needed. Morphine may be added if desired (but would have but little effect—ED ). In neuralgias of rheumatic origin, when there are painful points and tenderness which lasts for several days, the use of an ordinary wire hairbrush with connections with a Faradic battery, or light massage of the scalp (care being taken not to pull the hair) will be found to diminish the hyperesthesia. In sub- occipital headache Faradization is highly efficacious. 6. The “neurasthenic” group includes a long list of irregular headaches of obscure origin, but dependent more or less upon conditions of neural weakness; many are due to eye- strain, many to ovarian or uterine disorders, but in most cases no cause can be discovered. So recourse must be had to general measures. The bromide of caffeine [or bromosoda of Wm. R. Warner and Co.—AEditor] is often serviceable. The following formula is recommended : B. Ammonii carbonatis. . . . . . . . . . . . . . . . . . . . . . . . . . 3iij Tinct moschi. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f 3v.j Spts, lavandulae. . . . . . . . . . . . . . . . . . . . . . . . . . . . . f3.j Elix. ammonii valerianatis. . . . . . . . . . . q. S. ad fºvii; Misce. Sig.: Two teaspoonfuls at a dose in water. The most efficacious preparations for continuous treatment are those of the restorative class. A pill of arseniate of strych- nine, strophanthus and quinine may be tried with expectation of great benefit, thus: - B. Strychninae arseniat. . . . . . . . . . . . . . . . . . . . . . . . . gr. SS Sem, strophanth . . . . . . . . . . . . . . . . . . . . . . . . . . . . gr. v.j . Quininae sulph . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Bijss Misce et ft. pilulae no. xlviij. Sig.: One or two after each meal. Ethereal acetate of iron may be administered one hour after the meal with great advantage in many cases. A am. City Med Indear. THE VALUE OF THE PHYSICAL SIGNS AT THE APICES OF THE LUNGS IN SUPPOSED INCIPIENT PHTHISIS.—It is a fact well known to physicians generally that in health the percus- sion note at the apex of the right lung may occasionally be of higher pitch than that of the left apex. An examination of one hundred healthy symmetrical chests by Drs. Fussell and Adams, on the other hand, shows that, I. A normal condition at the right apex may be consid- ered a diseased condition. - 2. A diseased condition of the right apex may be consid- ered normal. 358 SELECTIONS. 3. The normal disparity in favor of the right apex may mask diseased conditions at the left apex. In the Unzversity Medical Magazine for June, 1891, these authors publish a tabulated list of one hundred cases, taken as they presented themselves at the dispensary of the University of Pennsylvania, the disease for which these cases were under treatment having no influence on the condition of the lungs. When it is taken into consideration that the usual site of tubercular infiltration is at the apex of the lung, and that among the first signs of consolidation of the lung are higher-pitched percussion note, increased tactile fremitus and vocal resonance, the importance of the determination of the value of these signs is at once apparent. Of course there are other signs of incipi- ent phthisis; one of which, prolonged expiratory effort, is very suspicious of approaching consolidation, and is a phenomenon which is seldom misleading. It is in those cases where these other signs are absent, masked, or very slight that these varia- tions spring into greater prominence. Again, undoubtedly, the higher-pitched note, when existing normally at the right apex, is perfectly resonant; it lacks the deadened quality noticed in commencing consolidation. Yet this difference in quality is hardest to distinguish in just those cases where the greatest doubt exists, so that practically this difference is of no use. It is of the utmost importance that signs which are perfectly nor- mal should not be mistaken for those of diseased conditions. On the other hand, it is equally important that we do not over- look diseased conditions at either apex, considering the signs as those of health. In the incipient stage of phthisis, so vital is the diagnosis for the future of the patient, and so slight are the symptoms and signs, that every straw adds weight to the con- ception of the case. A positive diagnosis is demanded by pa- tient and as eagerly sought by physician. The disease is pre- sented in its incipient stage oftener to the practitioner than any other disease, as its symptoms and results are so well known to the laity. Hence, in the majority of normal lungs, we have con- ditions which at once add suspicion to our conception of cases in which incipient phthisis is feared. In examining this table, consisting of the reports of the condition of fifty-eight men and forty-two women, we find that eleven, or eleven per cent., have the same percussion note at both apices; nineteen, or nineteen per cent., have slightly higher-pitched note at the right apex; and sixty-nine, or sixty-nine per cent., have markedly higher-pitched note at SELECTIONS. 359 the right apex, while one was higher pitched at the left apex. In the ninety-two cases where vocal resonance was taken, ten showed no difference at the apices; fourteen showed slight in- crease at the right apex, and sixty-eight marked increase. In ninety-three cases where the tactile fremitus was taken, no dif- ference was found in eleven cases, slight increase on the right side in twenty, while sixty showed marked difference. Two cases exhibited marked increase of fremitus at the left apex. In pursuing the examination, as far as posoible, the results were obtained separately by each observer, compared, and then obtained together. Many cases where slight variation occurred were verified in this manner. One observer percussed the chest, while the other listened in such a position as to be unable to tell which apex was being percussed. Any case in which there was any difference of opinion as to the existence of any varia- tion was put down in the list as equal on both sides. All the ordinary rules of percussion and auscultation were observed. There was no desire to force cases into one class or the other; the attitude was simply to endeavor to find the exact truth on the subject. • * Supposing a case to present itself with higher-pitched per- cussion note, increased tactile fremitus, and vocal resonance at the right apex, the question, of course, arises whether this is a diseased condition. One of three errors may be made;— I. A normal condition at the right apex may be considered a diseased condition. - - 2. A diseased condition at the right apex may be consid- ered normal. 3. The normal disparity in favor of the right apex may mask diseased conditions at the left apex. It is accepted by physical diagnosticians that the larger size of the right bronchus accounts for the increase of vocal reso. nance and tactile fremitus, both being due to the same cause— increased transmission of the voice-sounds. As to the reason of the higher-pitched percussion note at the right apex, there is less clear and united opinion. The note at the left apex ought, if anything, to be the higher pitched; the explanations of the contrary conditions existing are not satisfactory. One explana- tion is that the liver at the base of the right lung deadens the wave-sounds from the tissue above, while the hollow viscus, the stomach, serves more as a sounding-board for the left lung. The degree of tension of the thoracic parietes and of the lung-tissue itself may account for it, as the greater the tension the higher the pitch. 36O SELECTIONs. In conclusion, the authors affirm— - That higher-pitched percussion note, increased vocal reso- nance, and the tactile fremitus are normal at the apex of the right lung as compared with the left; that this normal condition can occur in such a number of cases and to such a degree as to cause in many instances a diagnosis of consolidation at the right apex ; that finally, in deciding doubtful cases, other signs be- sides these three are necessary to formulate a diagnosis; con- tinued observation of cases where other signs are lacking, being necessary to watch the possible development of actual disease. The authors report in detail three cases, which illustrate the existence of these three possibilities of error.—7%erapeutic Gazette. A PROPHYLACTIC AGAINST INFLUENZA.—Every indication points toward a return of a severe endemic of influenza. On the 24th of December, 1889, after numbering thousands of victims abroad, it suddenly appeared in the United States, and cost more lives than many epidemics of cholera. W The nature of the affection, the marked debility induced by it, and its sequelae, all point to a remarkable depression of the general system. During its presence in the country, the prevalence and severity of other acute diseases were largely in- creased and the mortality from all other causes augmented. This condition of affairs continued for some time after the subsidence of the epidemic. . The value of coca as a tonic to antagonize any tendency to adynamia is too well known to require elaboration here. Its therapeutical effects tend to build up precisely what influenza tends to destroy—a fact instanced by the use made of coca leaves by the natives of Bolivia and Peru, which renders them capable of undergoing the greatest possible physical strain, and that frequently with sparse nourishment. This remarkable tonic action of coca in medical therapeutics has further been attested by Brown-Sequard, Dujardin-Beaumetz, Ball, Bouchut, A. Mc Lane Hamilton, A. E. Madoman, H. M. Lyman, I. N. Danforth, P. S. Conner, and many other eminent physicians, too numerous to mention in the space at our disposal. . The coca wine made by Mr. Mariani, of Paris and termed Vin Mariani, is a preparation based on a scientific study of the individual virtues of the several varieties of the plant, conducted with a view to extract from them the most potent components, giving rise to tonic effect. The wine employed as an excipient SELECTIONS. 36 I is also selected with the same idea in mind, its fineness and purity giving the Vin Mariani the agreeable aroma which is peculiar to it. It is not only indicated as a prophylactic against influenza by the strongest inferences of experimental thera- peutics, but its use meets the approval of pure common sense. A wineglassful should be administered three times a day after meals, or about half an hour before each meal.—(Editorial by Charles E. Sajous, M. D., in Zhe Safe/lite. COCA As A CARDIAC TONIC.—Dr. Henry Conkling calls at- tention to the form under which this drug should be admin- istered, as follows: The official preparation of coca, the ex- tractum erythroxyli fluidum, may be given in doses from 3ss, 3ii. The use of this preparation is not always satisfactory. After employing the remedy, the thought has been suggested that perhaps the nature of its composition did not tend to de- velop the local sedative action of coca upon the mucous mem- brane of the stomach. A preparation made differently, con- taining more of an alcoholic principle, might, theoretically, overcome this difficulty. It is possible that the article famil- iarly known for many years as “Vin Mariani” has the requisite composition. It has been used, as noted in printed records, for diseases of the mouth, throat, stomach, general neurasthenia and pulmonary tuberculosis. Its use has been suggested in forms of cardiac diseasc. This note has been written to record the successful use of the preparation in cardaic irritability due to the irritation from the non-elimination of urinary products, as shown by diminution of urea. The heart here is frequently in a condition of tremor cordis, and marked muscular debility often remains after the function of the kidneys has become more normal. Vin Mariani has, in our experience, proved most ben- eficial in restoring and saving muscular force, and thus furn- ishing a better organ upon which other drugs may act more favorably. ScARLET FEVER.—Dr. Wilson, of Philadelphia, says that the treatment of this disease by the use of chloral has given him better results than any other; it seems to be almost a specific for the disease. From the beginning give chloral in doses of two to five grains, according to the age of the child, and at intervals sufficient to keep the patient constantly in a slightly somnolent condition. Give the chloral in syrup of lactucarium, and it will be taken very readily by the child,—Col. and C/im. Åecord. 362 - SELECTIONs. SCIATICA.—In a hospital case Dr. David D. Stewart gave a hypodermic injection of twenty minims of one per cent. solution of arsenious acid. The injection was made deeply into the gluteal region at the point of greatest tenderness, so as to get the solu- tion about the sheath of the nerve. This caused the patient intense pain for a few minutes, but when the pain of the injec- tion had passed away the sciatic pain had also gone with it. He said that he had had very good results from this treatment.— Co/, and C/zm. Adecord. SURGERY TREATMENT OF STRICTURE.-(G. Frank Lydston, M. D., in 77mes and A’egzster.)—The treatment of stricture of the urethra has given rise to more contention and more radically opposed views than almost any surgical disease that could be mentioned. One faction never cuts, another always cuts, and still another causes organic stricture to fade into the misty past by the use of “electrolysis” alone. As is usually the case under such circumstances of conten- tion, the philosophical surgeon will occupy the middle ground. The best reply that can be made to the extravagant claims of the urethrotomist and the still more extravagant claims of the elec- trolytic crank, is that, “there are strictures and strictures,” To some of the so-called conservatists, it would be foolish to reply— the differentiation of strictures is a matter beyond their compre- hension. They cling to the traditions of the past with a fatuity and obtuseness which an axe might possibly impress, but argu- ment, never. There is a vast difference between judicious con- servatism and the cowardice and ignorance that often masquer- ades as conservatism. - - It will be impossible for me to discuss the subject of treat- ment in a comprehensive manner, in this paper, but, with your kind indulgence, I will attempt to present a few practical points. * /22/a/ation of Stricture.—By dilatation we mean gradual and intermittent dilatation. Continuous dilatation, excepting with soft instruments as a preliminary to gradual dilatation, is out of date. w Selection of Cases.—I believe that every soft and tractable stricture should be treated by dilatation. Even admitting that urethrotomy is, in many cases, a radical cure, it is far better, in my opinion, for a man to be enslaved to the sound for the rest of SELECTIONs. 363 his days if by so doing he can avoid the dangers of an operation and at the same time receive satisfactory relief from his symp- tC 111S. - The majority of deep strictures will yield to dilatation, especially if all obstructions and points of friction and irritation be primarily removed from the pendulous portion of the canal. If such points exist, attempts at dilatation of the deep stricture only makes matters worse. - It has been my experience that strictures of the pendulous urethra are rarely soft and tractable. They are generally irrita- ble and resilient, and the more they are stretched the worse they get, and the more irritable the deep urethra—which is perhaps free from local disease—becomes. It is possible to distinguish on the first examination, as a rule, those strictures of the pendulous portion which are likely to yield to dilatation. These, unfortunately, are rare. The nearer the stricture is to the meatus the less likely is it to yield to dilatation. Points of relative inelasticity will never yield to dilatation. - A requency of /92/a/ation.—My experience goes to show that the majority of surgeons dilate at too frequent intervals. Here is a prime necessity for the selection of cases. Each stricture is a law unto itself. Some cases yield best to dilatation every third day. I have seen cases in which bi-weekly operations gave the best results. Many strictures are tortured into irritability and resiliency. A few weeks rest sometimes obviates the neces- sity of urethrotomy. It is hardly necessary to repeat the old maxim that gentleness is the key-note of success in the treatment by dilatation. f Orethrožomy.—Dilating urethrotomy is the operation of election in the majority of strictures of the pendulous urethra. It is required many times as a preliminary to deep dilatation. It is absurd to attempt to dilate a deep stricture without cutting a narrow meatus, or other firm bands which may exist in the anterior urethra. Dilatation, to be effective, must be carried to the extreme limit of distensibility of the urethra. It is impos- sible to satisfactorily dilate a No. 35 bulbo-membranous region via a No. 3O meatus or pendulous urethra. I have already called attention to friction as an important factor in stricture and gleet. A division of the inelastic and unyielding point is usually required for a cure. Oftentimes an obstruction will be due to a tender patch in the urethral mucous. membrane. This causes reflex contraction, and, as a conse- quence, the affected spot is never at rest. Urethrotomy, how- 364 - SELECTIONs. ever, affords the required rest, and the lesion disappears. Con- gested and granular plaques sometimes require the same treat- ment, and for similar reasons there is, in addition, the indica- tion for an alteration of nutrition at the diseased point. Urethrotomy should always be performed under strict anti- septic precautions. Instruments require as careful boiling as in the performance of a laparotomy. The urethra should beflushed out with a I in 2,000 bichloride solution as a preliminary Imeasure. - - ZDangers of Oreſ/ºrotomy.—In spite of the optimistic views of those who operate as a matter of routine, urethrotomy is at- tended by some inconveniences and possible dangers. I ac- 1All. §ases, off. It is essentially a Food Medicine which gives torne and streragtin. In cases where other remedies have failed or been rejected. A single trial will convince any fair-minded Physician of the value of this preparation. By the urgent request of several eminent members of the medical profession, I have added to each wine. glassful of this preparation two grains of Soluble Citrate of Iron, and which is designated on the label, “With Hron, No. x;” while the same preparation, Without Hrozh, is designated on the label as “No. 2.” §. F" In order that Physicians unacquainted with ** compens mauro asse Tonig may become familiar with it, we will upon application send a sample bottle free (express charges paid), to any Physician in the United States. Please ask your Dispensing Druggist (if he has not already a supply) to order it. In prescribing this preparation physicians should be particular to mention “COLADEN’S,” viz., “Ext. Carmis F1. Comp. (Colden).” It is put up in pint bottles, and can be had of Wholesale and Retail Druggists generally throughout the United States. c. rºſ. cIRI*T*E*ERINT*I*CSINT, General Agent, * , tºº tº º - 6 Fúy TQR. §TREET, RTÉW YOR. K. IIIIIHIIIHIHIIIHiſſiſſiſſiſſiſſiſſRTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTHIFTTTTTTTTTTTTTTTTTTTTTHIIIHilfilfilliſillililliſiiilliliğliſi mºmºmºmºraxxiºs fºo;NSTANT: NE'S = $ULPHUR SOAP. PINE TAR SOAP. ſ’hysicians know the great value of the local use of sulphur in the physicians 'or very many years as a toilet soap and healing agent, and By far the Best Tar soap made. Has been on trial among Treatinent of Diseases of the Skin. Glenn’s Sulphur Soap is - - - - * * h * . . - - - its superior virtues have been unanimously conceded in all cases where ..º.º. *::: º: of its kind, and the one now the use of Tar is indi, ated. None genuine unless stamped A• A• generaily . For sale by XPruggists, CoNSTANTINE’s PMERSHAN HEALIN"S PINE Beware of Counterfeits. TAR SOAP. For sale by All Druggists. Wholesale Depot, C. N. CRITTENTON, MI5 Fulton Street, New York. Samples of above Soaps SENT FREE, on application, to any Physician inclosing card. * t 4. * PULMONARY CONSUMPTION. INFLUENZA. Koch discovered the specific bacillus of tuberculosis, and it is announced his son-in-law, Dr. Pfeiffer, has identified the specific bacillus of influenza. Neither has yet made manifest the specific cure for either malady. Among remedial agents which may be considered to have stood the test of experi- ence in meeting the indications in these diseases for general and local treatment are the following: Cod Liver Oil and Creasote are employed by many eminent authorities, com- bining as they do the virtues of hyper-nutrition with the power of counteracting the extension of the tuberculous process. We supply SOLUBLE ELASTIC CAPSULES COD LIVER OIL, ten minims; CREASOTE, one minim. We will mail to physicians report on the cure of tuberculosis by Julius Summerbrodt, Prof. at the University of Breslau, who regards Creasote to be an unequaled remedy for countless sufferers from pulmonary tuberculosis. MOSQUERA'S BEEF MEAL, BEEF CACAO and BEEF JELLY are ideal nutrients for consumptives, and properly prepared, can be taken by the most sensitive patient. The indications for the treatment of influenza are three-fold: To control ner: vous hyperaesthesia, securing absolute rest; to prevent extension of inflammations of the respiratory tract; to guard against dangerous saquelae by heart tonics and proper nutrition. * CEREBRAL SEDATIVE COMPOUND fulfills the first indication, combining the bromides, chloral, gelsemium and opium. s ANODYNE PINE EXPECTORANT admirably meets the second indication, allaying bronchial irritation. It combines white pine bark, wild cherry bark, spike- nard root, balsam poplar buds, blood root, sarsaparilla bark, morphine acetate and chloroform. SYRUP OF IRON CHLORIDE and ESENCIA DE CALISAYA are red blood corpuscle makers par excellence, and may be combined with normal liquid digitalis, or fluid extract cactus grandiflorus, with stimulating, nutritious diet, to meet the third indication for treatment. Descriptive literature and all information desired concerning our products furn- ished on request. PARKE, DAVIS & COMPANY. Detroit, New York and Kansas City. EBICC 1. JGURNG11. Vol. X. MARCH, 1892. - No. 9, =&º, ſº J. F. BALDWIN, M. D. - - - - º * EDITOR. J E. BROWN, M. D., - - Associate Editor. C. R. CORNELL, - * Business Manager. 48 PAGES READING MATTER. PUBLISHED MONTHLY. $1.00 PER YEAR. THE COLUMBUS MEDICAL PUBLISHING COMPANY, Publishers and Proprietors, 266 East Gay Street, Columbus, Ohio. Entered at Postoffice, Columbus, Ohio, as second-class mail matter. % CH. MARCHAND’S sº. PEROXIDE of HYDROGEN: Rººs-ºſ. #sº #º (MEDICINAL) H2O2 (ABSOLUTELY HARMLESS.) º, Most Power FUL BACTERICIDE AND PUs DESTROYER; * ENDORSED BY THE MEDICAL PROFESSION. º i. t # É.-->3's WN) - > *- a -- º UNIFORM IN STRENGTH, PURITY, STABILITY. zºº RETAINs GERMICIDAL POWER FOR ANY LENGTH OF TAKEN INTERNALLY OR APPLIED EXTERNALLY WITH PERFECT SAFETY. send for free book of 72 pages, giving articles by the following contributors: DR. E. R. SQUIBB, of Brooklyn, N. Y. “On the Medicinal Uses of Hydrogen Peroxide.” Gaillard's Medical journal, N. Y. ; D R. ROBERT T. MORRIS, of New York. “The necessary Perox icle Of Hydro- gen.” journal of the American Medical Association, Chicago, Ill. NOTE.—Avoid substitutes—in shape of the eon mercial article bottled— unfit and unsafe to use as a medicine. - * t • * Ch. Marchand’s Peroxide of Hydrogen (Medicinal) sold Only in 4-Oz.; 8–oz., and 16-oz. bottles, bearing a blue label, White letters, red and gold border, with his signature. Never sold in bulk. PHYSICANS WILLING TO PAY EXPRESS CHARGES WILL RECEIVE FREE SAMPLE ON APPLICATION, PREPARED ONLY BY ~ | [. rº C޺ Mention this publication. S- Chemist and Graduate of the “Ecole Centrale des Arts et Manufactures de Paris ” (France) ...º.º. Laboratory, No. 28 Prince Street. º CONTENTS. COMMUNICATIONS. Hip Disease—Operative Treatment in Old and Neglected Cases—Sixteen Cases Re- Fº Wm. E. Wirt, A. M., M. D., h. D., Cleveland, O..................... 385–395 Chronic Endometritis—by J. M. Baldy, M. D., Philadelphia. . . . . . . . . ................ 396 - 400 Perplexing Singultus—by Robert Peter, M. D., Canal Dover, O....... ............... 400–404 SELECTIONS. MED/CINE–Course of Chronic Nephritis; The Obsolescence of Medical Terms; The Treatment of Phthisical Cough ; Prophy- The Odoriferous Principle of Asparagus in the Urine ; Cystitis . . . . . . . . . . . . . . . . . . . . 405–411 SURGER Pi—Relief from the Ills of Enlarged Prostrate; Colotomy ; Treatment of Alo- pecia Areata; Bone Wiring; The Dry Poultice in Epididymitis; Cocaine in Peri- tonitis; Chan-roids—Origin of... . . . . . . . . . 412–418 CORRESPONDENCE. An Appeal to the Medical Profession, from the Decision of the Trustees of the Colum- bus Medical College—by N. R. Coleman, laxis and Treatment of Influenza; Cod- M. D., Columbus, O... . . . . . . . . . . . . . . . . . . . 419–428 Liver Oil and Creasote in Consumption ; Æ/2/7 OAZAZ. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429.432 - ( ADWERTISERS. Health Restorative Co., New York . . . . . . . . . . . . 1. Mariani & Co., New York . . . . . . . . . . . . . . . . . . . 12 Western Penn. Medical College, of Pittsburgh. 2 H. K. Mulford & Co., Philadelphia . . . . . . . . . . . . 13 Dr. McMunn’s Elixir of Opium .......... as s e s • 2 James I. Fellows, New York... . . . . . . . . . . . . . . . . 14 Harrison Cole, Columbus, O................... 2 The Clemiana Chemical Co., Atlanta, Ga...... 15 The Terraline Co., Washington, D. C. . . . . . . . . ... 3 E. M. Hessler Surg. Instrument Co., Cleveland 15 B. Keith & Co., New York. . . . . . . . . . . . . . . . . . . . 3 H. H. Ballard, Pittsfield, Mass. . . . . . . . . . . . . . . . . 15 Cincinnati Sanitarium . . . . . . . . . . . . . . . . . . . . . . . . 4 Mellier Drug Company, St. Louis. . . . . . . . . . . . . 16 The Antikamnia Chemical Co., St. Louis, Mo. . 4 Renz & Henry, Louisville, Ky. . . . . . . . . . . . . . . . . | 6 Dios Chemical Co., St. Louis, Mo. . . . . . . . . . . . . 5 Theodore Metcalf Co., Boston . . . . . . . . . . . . . . . 17 I. O. Woodruff & Co., New York.... . . . . . . . . . . Battle & Co., St. Louis . . . . .. . . . . . . . . . . . . . . . . . . 17 Cornell-Pheneger Chem. Company, Columbus, Reed & Carnrick, New York . . . . . . . . . . . . . . . . . . 18 Ohio. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Bowden Lithia Spring Co., Lithia Springs, Ga. 19 The Arlington Chem. Co., Yonkers, N. Y. . . . . . 8 PREMUſ. LIST FOR 1892 . . . . . . . . . . . . . . . . . . . . . . . 20 Eisner & Mendelson Co., New York. . . . . . . . . . . 9 Charles Marchand, New York...... lst page cover. Lambert Pharmacal Co., St. Louis......... .... 10 C. N. Crittenton, New York. . . . . . . . 4 & § { Wm. R. Warner & Co., Phila. . . . . . . . . . . . . . . . . . 11 Parke, Davis & Co., Detroit & N.Y.4th “ & & *. | This WINE OF COCA is so prepared that it contains the active principle of the leaves in a perfectly pure form. - Q Moreover, it is absolutely free from all those foreign sub- C tora tive stances which all other wines of coca contain, and which interfere, to a great extent, with its curative influence. It is well known that the cocaine contained in the coca-leaves varies considerably in its proportion; hence, giving to the wines as ordinarily made, uncertain strength, and causing Q them to be unreliable in their action on the system. In the Wi C of oča RES I'ORATIVE WINE OF COCA the proportion of n - alkaloid is invariable, and the physician can therefore pre- scribe it with the certainty of obtaining uniform results. Prof. WyM. A. HAMMON D., M.D. says: FOR A wineglassful of this tonic, taken when one is exhausted * wº-ºººººººe and worn out, acts as a most excellent restorative; it gives a feeling of rest and relief, and there is no reaction Nervous Prostration, Brain Exhaus- and no subsequent depression. ... A general feeling of pleasantness is the result. I have discarded tion, Neurasthenia and all forms fºr Yºsanººse ºf º • *- º t produces also excellent results in cases of depression o of Mental and Physical Debility. spirits; in hysteria, headache, and in nervous troubles generally, it works admirably. It is a simple remedy, yet efficacious and remarkable in its results. - - "T" ºr tº /- EDI CA 32 ONLY COMPLET ravaETIC_*MATERIA MERICA THE SUSTAINS THE #. AN IPYR of THE Mºs is ºut gusº::::::::::- ' ' AJ(D" -ºš A Resºlve of the Highest order. Tº |NVALUABLE IN MALARIAL DISEA5E5. §º APOSITIVE REMEDY FOR NEURALGIA ANDRHEUMATISMN/ Prof. W.M. F. WAUGH, M. D , of Philadelphia, writes: In a case of persistent neuralgic headache, Worse on awakening, with a possibility of malaria, “Febricide” gave instant relief. BUFFAL (D, N. Y., February 13, 1890. - I have duly prescribed the FEBRICIDE PILLS all through our Epidemic of Influenza and Pneumonia, with capital results. S. W. WETMORE, MI. D. - SPRINGVIEW, NEB., November 25, 1889. I have used your FEBRICIDE with excellent results in our Mountain Fevers (typhoid), reducing, in one case, the temperature from 104% with dry, brown furried tongue in ten hours, to 99% with tongue cleaning promptly and moist, and rapid improvement dating therefrom. Have used Antipyrin in similar cases With no good results. ALBERT S. WARNER., M. D FEBRICIDE IN PNEUMONIA. º.º.º.º. ricide Pills (one being given every four hours, as a rule), and with hot poultices externally : . Admitted. Crisis. Admitted. Crisis. William Johnson, ...... June 1, 1889, une 8, 1889 Belle Smith ............Jan. 8, 1890, Jan. 12, 1890 Fanny Winnery ....... Dec. 19, 1889, an. 4, 1890 Wm. Payne ..... ... ....Jan. 2, 1890, Jan. 5, 1890 Wm. M. Johnson....... Dec. 30, 1889, Jan. 5, 1890 Gustav Thomam ........ Jan. 21, 1890, Jan. 23, 1890 All ended in recovery. These are all the cases of croupous or lobar pneumonia treated in the hospital during the influenza epidemic excepting O e case, which was admitted in a moribund condition, and died before any treatment could be instituted . . One case, which was apparently moribund when admitted, is included in the above list, and is at present recovering from an attack of femoral phlebitis. JOHN A. RAYBURN, M. D., Resident Physician. -Phila. Times and Register, Feb. 17. 1890. - Samples sent free of charge to any physician who mentions this JOURNAL. ISIES ALTII RESTORATIVES CO. 90 South Fifth Avenue, NEW YORK, 2 WESTERN PENNSYLVANIA MEDICAL COLLEGE, CITY OF PITTSBURGH, SESSIONS OF 1891-'92. The REGULAR SEssIon begins on the last Tuesday of September and continues six months. 15uring this Session, in addition to four Didactic Lectures, two or three hours are daily allotted to Clinical Instructions. Attendance upon three Regular Courses of Lectures is requisite for graduation. A three years’ graded Course is provided. The SPRING SESSION embraces Recitations, Clinical Lectures and Exercises, and Didactic Lectures on Special subjects. This Session begins the second Tuesday in April, and continues ten weeks. The LABORATORIES are open during the Collegiate Year for instructions in Chemistry, Microscopy, Practical Demonstrations in Medical and Surgical Pathology and Lessons in Normal Histology. - ſ Special importance attaches to the Superior Clinical Advantages possessed by this College. For particulars see Annual Announcement and Catalogue, for which, address the Secretary of Faculty, - - - PROF. T. W. T. McKENNAN, 810 Penn Avenue. Business correspondence should be addressed to & PROF. W. J. ASDALE, 2107 Penn Avenue, Pittsburgh, Pa. - - 1 DJ F.R.. INV [c TM ITUTINTINT’S Ex-rxIR or or rurrºr An Invaluable Discovery in the Preparation of Opium. It contains all the valuable medicinal properties of Opium in natural combination, to the exclusion of all its noxious, deleterious, useless principles upon which its bad effects depend. It possesses all the sedative, anodyne and antispasmodic powers of Opium: To produce sleep and composure; to relieve pain and irritation, nervous excitement and morbid irritability of body and mind ; to allay convulsive and spasmodic actions, etc.; and being purified from all the noxious and deleterious elements, its operation is attended by no sickness of the stomach, no Vomiting, no costiveness, no headache, nor any derangement of the constitution or general health. Hence its high superiority over . Laudanum, Paregoric, Black Drop, Denarcotized Laudanum, and every other Opiate preparation. - C.A.T.J. T.IOINT, On account of its large sale, 8purious qrticles are offered in, bulk. The genuine is sold only in vials of about 7 drachms, with yellow wrappers and signature of Jno. B. McMunn. - E. FERRETT, Agent, 372 Pearl St., New York. HARRISON COLE, tº # 6 º # a - PRACTICAI, OPTIOIAN, All Defects of Vision, requiring Spherical Lenses, scientifically corrected. Special Lenses carefully adjusted to prescription. Optical and Scientific Goods of all kinds. Repairing of every - description. Prescription Blanks Furnished Physicians on Application. 64 North High Street, Columbus, Ohio. 3 *::::: rea - - * **** JUsT on E worD -] -] = - to the Medical Profession as to the value of TERRA LiNE (or purified Petroleum) in Bronchial Pulmonary Catarrhal and other Diseases of the Throat and Lungs. - - In the first place it is not an emulsion, and does not deteriorate With age. In the second place it is tasteless and odorless; the patient can continue its use without repugnance to the taste. It does not cause eructations Or nausea, and the most delicate Stomoch can tolerate it. It is pre- scribed by the leading physicians everywhere and the grand results from its use as reported to us are almost increditable. Read What a few of our leading city physicians Say of it, as given in interviews. - DR. JAMES T. YOUNG, 1336 New York Avenue—“Terraline has promptly relieved a number of cases of Chronic Bronchial Catarrh that would not yield to other remedies.” DR. J. O. STANTON, 1344 G. Street—“I have prescribed Terraline in a large number of cases of Laºys, Bronchitis and Incipient Phthisis, and am more than pleased with the result.” R. Z. T. SOWERS, 1320 New York Avenue—“I have prescribed Terraline in a number of cases such as are usually given Cod-Liver Qil, and as it has the double advantage of no odor or taste, can be given in those cases in Which Cod-Liver Oil disagrees, with all the advantages of the latter, and with even increased benefit.” - - DR. A. Y. P. GARNETT, 1317 New York Avenue—“Have prescribed Terraline as many as thirty times, and for almost as many forms of Bronchial and Pulmonary complaints, and fail to recall a single instance in which I did not see prompt and decided improvement in the patient.” DR. D. C. PATTERSON, 919 I Street—“I am of the opinion that in Terra line we have a most valuable agent in the treatment of the class of cases for which Cod-Liver Oil is prescribed.” DR. P. J. MURPHY, Surgeon in charge of the Columbian Hospital—“I have prescribed Terra- line very often in the last year, both in and Out of the Hospital, with grand results, and while I never write a certificate for a medicine, however good, amº free to say that I see in Terraline the - #; remedy for the trestment of Bronchial and Pulmonary troubles ever brought to my attention.” - We have hundreds of certificates from all parts of the United States which we will insert from time to time in the Medical Journals Where they legitimately belong. - B. —TERRALINE............................................ . 3 xii. Sig.—One or two teaspoonfuls, three or four times daily, in sherry wine. The price of Terral ime is One Dollar a bottle. A full size bottle for trial will be sent to any physician without expense except for express charges which he must pay on receipt of it. THE TERRALINE COMPANY., SOLE M'FRS. 1316 L street, N. w., washington, D. c. CUREDTBy THE USE of - IEE IEE IC "E" EI s” co N. TI N G. A.M. EN A SAT I V A. FROM COMMON OATS. A PoweRFUL NERVESTIMULANT, TONIC, ETC, - Is also Employed in the Treatment of Paralysis, Epilepsy, St. Vitus' Dance, Chloral and Tobacco Habits, Sleeplessness, Nerve Exhaustion, Neuralgia, Alcoholism, Painful and Deficient Menstruation, Headache, Hysteria, Convulsions and Prostra- tion from Fainting, and in the Convalescent Stage of all Acute Diseases. DOSE,-From ten to thirty drops or more, as often as may be indicated to meet the urgency of the case. • - Administer in hot water when quick action is desired. Messrs. B. KEITH & CO –Gentlemen : Melroy, Ind. I am giving the con, tr. avena sativa for the meo2.Éhia habit, and I find it will cure, I believe, all cases, no matter how Zong they haze been the slaze of this opium monster. I think this is the greatest discovery of Our age. F. M. POLLITT, M.D. Messrs. B. KEITH & CO.,-Gentlemen: Barnesville, Ga. The con. tinct. avena sativa has been more successful in the treatment of the opium habit than anything I have ever tried, and I have tried various other remedies, amongst them the advertised nostrums. - HOLLOWAY, M.I. Messrs. B. KEITH & CO., -Gentlemen : Idaho Springs; Col. I have tried a small amount of the con. tr. avena sativa and am more than plcased with it in the of iu”. /*ašit and several other cases, such as in female diseases and nervous conditions. - CHAS. B. RICHMOND, M. D. Send for printed matter on Con. Tinc. Avena Sativa in the Morphine or Opium, Habit, and certificates from different members of the Medical Profession citing cases under their charge treated by it, also Revised and Enlarged Manuel to IEE. IEEE-II*T*EC cºz CF.C.s ORGANIC CHEMIST8, ESTA B L | SHED | 852. No. 75 W | LLIAM ST. NEw YORK. *.*.*.* * * 4 CINCIN.INATI - SAINITARIUM. A PRIVATE HOSPITAL FOR MENTAL AND NERWOUS DISORDERS, - COLLEC E H ILL, OHIO. Eighteen Years Successful Operation. Oue Hundred and Fifty Patients admitted annually. Daily Average, Seventy. Cottages for Nervous Invalids, Opium Habit, etc. Location Salubrious. Surroundings Delightful. Appliances Ample. Charges Reasonable. §: by Rail; 6 Trains Daily; 30 min. from G. H. & D. Depot, Fifth and Hoadly Sts., incinnati. For Particulars, Address ORPHEUS EVERTS. M. D., Sup’t, College Hill, Ohio. a DURIſſie LAST YEARS EßIDEAlc THE EXHIBITION OF } ^^^^ G G & 6 o'e , , , 2 . ºr %NZNZX^^^^^^^^^^^^^^^^^% * * * - . . . . . . . - . º . “. . . * > . . . * * - , º * * > . - ‘. - º --- - - - - - - - . . . . - in sº . . . - R * -º - prºseºnºr: ZNZNZNZNZ ſº º - º SECURED THE DESIRED RESULTS AN][) |S A@/A || |N| ||[N][D)||G|ATED BY TſIAE , a tº RETURN of INFLUENZA g o a AND ITS ALLIED COMPLAINT5. FOR H 1 STORY & LITE RATURE ADDRESS, THE ANTIRAMNIA CHEMICAL CO., ST. LOUIS, MO., U. S. A. S. 42 NEUrFR osrRE I A NEW AND POWERFUL NEUROTIC, ANODYNE AND HYPNOTIC- A most efficient and permanent preparation, REMARKABLE for its efficacy and THERA- PEUTIC, EFFEGTS in the treatment of those NERWUUS AFFEGTIONS and morbid conditions of the System which so often tax the skill of the Physician. A RELIABLE AND TRUSTWORTHY REMEDY FOR THE RELIEF OF Hysteria, Epilepsy, Meurasthenia, Mania, Chorea, Uterine Congestion, Migraine, Neuralgia, All Convulsive and Reflex Aveuroses. The Remedy Par Zºxcellence in Delirium and Restlessness of Fevers. . Is the result of an extended professional experi- ence, and is compounded in the most palatable N E U RO S | N E form by a skilled pharmacist, the formula of which will commend itself to every Physician. . For MULA :—Each fluid-drachm contains 5 grains each, C. P. Bromides of Potassium, Sodium and Ammonium, I-8 gr. Bromide Zinc, I-64 gr. each of Ext. Belladonna and Canna- bis Indica, 4 grains Ext. Lupuli and 5 minims fluid Ext. Cascara Sagrada, with Aromatic Elixirs. DOSE:—From one teaspoonful to a tablespoonful, in water, three or more times daily, as may be directed by the Physician. FOR FURTHER INFORMATION AND SAMPLE BOTTLE SEE FOOT OF THIS PAGE. Oil (OVI) ETOſ. R. N. (A UTERINE TONIC, ANTISPASMODIG AND ANODYNE. A reliable and trustworthy remedy for the relief of Dysmenorahoea, Amenorrhoea, Menorrhagia, Leucorrhoea, Subinvolution, THREATENED ABORTION, Vomiting in Pregnancy and Chlorosis; directing its action to the entire uterine system as a general tonic and antispasmodic. This combination is the result of an extensive professional experience of years in which the constituent parts have been fully tested singly and in combination in various proportions, until perfection has been attained. & DIOVI B UR N | A is prepared for prescribing exclusively, and the formula as given will commend itself to every intelligent physician. FORMULA :—Every ounce contains 3-4 dram each of the fluid extracts: Virburnum Prunifolium, Viburnum Opulus, Dioscorea Villosa, Aletris Farinosa, Helonias Dioica. Mitchella Repens, Caulophyllum Thalictroides, Scutellaria Lateriflora. DOSE:—For adults, a desertspoonful to a tablespoonful three times a day, after meals, In urgent cases, where there is much pain, dose may be given every hour or two, ALWAYS IN HOT WATER. Jno. B. Johnson, M. D., Professor Of the Princi- §: and Practice of Medicine, St. Louis edical College. St. Louis, June 20, 1888. I very cheerfully give my testimony to the virtues of a combination of vegetable remedies prepared by a well known and able pha] ma- cist of this city, and known as DIOVIBUR- NIA, the component parts of which are well known to any and all physicians who desire to know the Same, and,therefore, have no rela- tion to proprietary or quack remedies. I have employed this medicine in cases of dysmemor- rhoea, suppression of the catemania, and in excessive leucorrhoea, and have been much pleased with its use. I do not think its claims (as Set forth in the circular accompanying 1 t) to be at all excessive. I recommend its trial to all who are willing to trust to its efficacy, be- lieving it will give satisfaction. Respectfully, L. Ch. Boisliniere, M. D.. Professor of Obstet- rics, St. Louis Medical College. St. Louis, June 18, 1888. I have given DIOVIBURNIA a fair tra], and found it useful as an uterine tonic and anti- Spasmodic, relieving the pains of dysmenor- rhoea, and regulator Of the uterine functions. I feel authorized to give this recommendation of DIOVIBURNIA, as it is neither a patented nor a Secret medicine, the formula of which having been communicated freely to the medi- cal profession. - * c/. 3ozsſºn e & 4 Mºtº). H. Tuholske, M. D., Professor Clinical Surgery and Surgical Pathology, MissOuri Medical College ; also POst-Gradutate School of St. LOuis. St. Louis, June 23, 1888. I have used DIOVIBURNIA quite a num- ber of times—sufficiently frequently to satisfy myself of its merits. It is of unquestionable benefit in painful dysmenorrhoea; it possesses antispasmodic properties which seem especi- ally to be exerted on the uterus. A. A. Z.Z.4% To any physician unacquainted with the medicinal effect of DIUVIBU H.N.I.A., and, N EU- ROSINE, we will mail pamphlets containing full in formatian, Suggestions, commendaiions of some of the most prominent professors in the professlou, and Various methods of treatment ; also a variety of valuable prescriptions that have been thoroughly, tested in an active prac- tice, or to physicians desiring to try our preparations, and who will pay express charges, we will send on application a bottle of each free. DIOS CHEMICAL CO., ST. LOUIS, MO. - 6 * a FRELIGH’S TABLETS, (Cough and Constituent), FOR THE PREVENTION AND CURE OF PULM ONARY PHT HISIS. I FCI RIM ITUTI tº a Z ETH. Cough Tablets. EACH TABLET CONTAINS. Morph. Sulph. (sº gr.), Atropiae Sulph. (5%g gr.), Codeia (; gr.), Antimony Tart. (; gr.), Ipecac, Aconite, Pulsatil- la, Dulcamara, Causticum, Graphite, Rhus-tox, and Lachesis, fractionally so arranged as to accomplish every indica- tion in any form of cough. Constituent Tablets. EACH TABLET CONTAINS. Arsenicum (; ; gr.), Precipitate Carb. of Iron, Phos. Lime, Carb. Lime, Silica, and the other ultimate constituents, according to physiological chemistry, (normally) in the human organism, together with Caraccas, Cocoa, and Sugar. - PRICE, THREE DOLLIARS PER DOUBLE BOX. Containing sufficient Tablets of each kind to last from one to three months according to the condition of the patient. A Connecticut physician writes: “I am now using your Tablets on a patient (young lady), who has had three quite severe hemorrhages the week previous to the beginning of the same. She has taken one box Only, has had no return Of the hemorrhage, and has gained four (4) pounds since beginning treatment, besides all rational symptoms have improved wonderfully. I will add that I had tried Ol. Morrn., Syr. HypophOS. Co., etc., With no apparent benefit.” A Virginia physician writes: , “Enclosed find Postal Note for another double box. Freligh's Tablets. I used the sample box in three cases, with decided benefit in one, slight improvement in second, and while they did not improve the third case. it being in very advanced stage, there was an amelloration of the distress- ing symptoms. A Massachusétts physician, in practice 25 years, writes: “Send me two double buxes Freligh's Tablets. I have tried the sample box with most excellent results.” A Michigan physician writes: - “I am more than pleased with them. They have not disappointed me once. Dr. C for whom I ordere i a box, writes me that he is much improved, and speaks in praise of them. He has genuine Tuberculosis, and while I do not think he can recover, yet I firmly believe the Tablets will prolong his life.” SIF> E-CI CALLs Cº E-IFIEHER.. While the above formulae bas been in use, in private practice, Over 30 years, and we could give testimonials from well known clergy men, lawyers and to usiness men, We prefer to leave them to the unbiased judgment of the profession with the following offer: . On receipt of 50 cents, and card, letter head, oill head, or other proof that the applicant is a physician it, active practice, we will send, delivered, charges prepaid, one of the regular (dºuble) boxes, (retail price, Three Dollars) containing suffi ient of each kind of Tablets to test them three months (in the majority of cases) in some one case. Card, letter head, or some proof that the applicant is a physician in active practice, MUST accompany each application. Pamphlet with full particulars, price list, etc., on request. AL ENIEH COSIFIEHICPIFEI2:IEID CERE BRO—SPIN ANT. (FRELICH'S TONIC.) Our Special Offer is still open, to send to any physician, on receipt of 25 cents, and his card or letter head, half a dozen samples, delivered, charges prepaid. Each Sample is sufficient to test it for a week in One Case. • As we furnish no samples through the trade, wholesale or retail, for samples, directions, price lists, etc., address I. O. WTOOTDIER, UIETIET &; CO- Manufacturers of Physicians’ Specialties, 38 M.I.A.I.Llº, NJ L A-INTIE, INTEVV SZ colºrs: CITY. Orthopedial d Appliances. =] We are now manufactur- ing everything in the §. NY %) , º/ . . . * way of * Czº, § º Spina /, W. *W ºf ſ \ \ Weak Ankle or A. º Bow leg Braces, || & Hip Spins. º Everything in the ORTHOPEDIC T-irh-e- Write us before ordering or send your patient to us and we will take the measurement and guarantee a fit. We can make as good an APPLIANCE as can be had elsewhere for LESS MONEY AND CAN FURNISH FULL INSTRUCTIONS SENT FOR MEASUREMENT WHERE PATIENT CANNOT BE SENT TO US. 25 ||BI tºll. Distſ.It from price to patient given Physician when order from Doctor is sent with patient . . The Comel-Pheneger Chemical Company, COLUMBUS, OHIO. PHYSICIANS" SUPPLIES OF ALL KINDS. 8 s UCC ESSO R$ TO ś - REED & CAR N Rºl C K . ſº Fºº W - f ºf Ngſon) HEl:1|CAL | - ”. d - , º Fo R T H Est PRE PARATIQ NS S.S. rº sº Æ A. lºg - … Sº?: S: | |\º º, (G2), gº º $º The most efficient and palatable preparation Each dessertspoonful contains- tº * * Caffein, in Nervous and Sick Headache, Neuralgia, Acidi Phosphorici, aā grains, ss, Insomnia, Neurasthenia, and General Nerv- Antipyrin, •e & . . º e * - tº Ext. Apii. Grav. Dulc. (Celery), āā grain j, ous Irritability, Sodium Bromide, grains v. COLUMBUS MEDICAL JOURNAL A MONTHLY JOURNAL OF MEDICAL SCIENCE. VOL. 10. MARCH, 1892. NO. 9. COMMUNICATIONS. Aſ/A) /D/SAEASAE O/2EA’A 7/VAZ 7TA’AºA 7TMAEAV7 /AW O/C/D AAV/O AVEG/L/Z'CTAE/O C.A.S.A.S.–S/X7A2AAW CASA.S. AºA.AOA’ ZTE/O. By WM. E. WIRT, A. M., M. D., PH. D., CLEVELAND, O. Lecturer on Orthopedic Surgery in the Medical Department of the University of Wooster, Cleveland, O. Late House Surgeon Hospital for Ruptured and Crippled, N. Y. City. The fixation of the thigh in distorted positions is one of the common results of hip disease; and especially is this so in those cases improperly treated or that have been entirely neglected. During the early history of the disease the rectification of the deformity is an easy matter, but in the late stage, when the joint is nearly or quite ankylosed, the difficulties of correction become much greater; it is with this late period that this paper is concerned. The deformities requiring correction are flexion, abduction and adduction. These deformities produce an apparent short- ening of the limb, or as it is called “practical” shortening in contradistinction to real shortening, which latter may be quite small, while the former is considerable. In order to bring the foot down in the act of walking, in those cases where there is fixation at a moderate angle of flexion, motion must take place 385 386 COMMUNICATIONs. in the spine (flexion), thus producing lordosis; and where the angle of deformity is great it may be nearly or quite impossible to get the foot down. In these cases a practical lengthening of the leg is obtained by building up the shoe. In adduction, be- side shortening, there is tilting of the pelvis. With abduction there may be, early in the disease, an apparent lengthening, but at the late period with which this paper treats there is no length- en 111g. When the deformity is of such a grade as to seriously inter- fere with progression, surgery is called upon for relief from the condition. * - The operative measures to be considered are: I. Brisement Force, with or without myotomy, tenotomy, fasciotomy, &c. II: Osteoclasis. III. Osteotomy. - - The field of Brisement Force should be limited to those cases in which there is only fibrous ankylosis. If there is con- siderable shortening of the flexor or adductor muscles, or of the fascia, myotomy, tenotomy, &c., will relieve the tension and per- mit the more easy rectification of the limb. Frequently the cap- sule of the joint is found shortened, and in some cases requires an open incision down to the joint before the tissues will lengthen enough to allow the complete straightening of the limb. After the limb is straightened it should be fixed in a plaster of Paris spica, or by extension, the former being the writer's pref €1"eD Ce. t The second and third operations, osteoclasis and osteotomy, are reserved for those cases in which there is bony union, or a fibrous ankylosis of a very firm character. It is true that osteo- clasis is sometimes the result of brisement force, but this is ac- cidental, and not the intention of the operator. In performing osteoclasis, appliances are used to hold the pelvis and force is then exerted on the limb ; but the point of fracture is so uncertain and the operation as a whole lacks precision, and is so unscientific that it has been replaced by Osteotomy. Osteotomy is now considered to be the most satisfactory operation for the rectification of deformity in a bony ankylosed hip. This operation has been performed at different points near the head of the bone. Adams' operation was a division of the bone at the neck. Sayre and Barwell divided the bone be- tween the greater and lesser trochanters; while Gant performed osteotomy just below the trochanter minor. This latter opera- tion, now considered the best by all surgeons, is based on the WIRT-Hºp Disease, Ætc. 387 anatomical reasoning that the resistance of the psoas and iliacus being set free, a return of the deformity is not to be expected; also, that by operating at a lower point than had formerly been done, the operator is more likely to strike healthy bone and less likely to relight the old inflammation. GANT'S OPERATION.—The night before the operation, the thigh is encased in a dressing of soft soap, or soap liniment, with the proper outside bandages. By the next morning it will be found that the outer layers of epidermis are softened and will readily wash off. Then ether and alcohol may be used to re- move any oily or soapy substances remaining. This procedure makes the part as thoroughly clean and aseptic as can be done by human skill. The soft soap dressing is used at Roosevelt Hospital, N. Y. City, the soap liniment at Hospital for Rup- tured and Crippled. The best osteotome in use is that of Vance, of Louisville, Ky. It should be tempered to a hardness between that of a cold chisel and the carpenter's chisel. Its length is about 7 inches, width of cutting edge, 3% to 9% inch. The handle should be marked every half inch, to show the depth to which the instrument has penetrated. This is more than theo- retically indicated, for I have seen one of New York’s best sur- geons drive the Osteotome through the thigh and 1% inches into the sand bag. The patient under chloroform, he is placed on his side with a sand bag between the thighs. The trochanter minor having been marked out the osteotome is introduced at a point just below the level of this trochanter, on the outer aspect of the thigh. The blade is held in the same axis as the limb, and is made to penetrate the skin, fascia, muscles, periosteum down to the bone; the blade is then turned at right angles to the limb, and with the sharp blows of a mallet, preferably a wooden one, the osteotome is driven through the bone, being loosed and driven at different angles, after each two or three blows. When about 34 of the bone is cut, z. e., when only a shell remains, the osteotome is withdrawn and the fracture completed by manual force. The limb is then brought down parallel with its fellow, or as nearly so as possible, and fixed in position by a plaster of Paris spica. There is little or no bleeding ; the wound in the skin is very small, and is covered over by oiled silk or rubber gauze, and over this the antiseptic dressing and the plas- ter of Paris. The limb is left in the plaster spica for from four to six weeks, after which it is removed, the parts examined and measure taken for a convalescent walking splint (called a cali- per). By the time it is made and applied, the limb is strong 388 COMMUNICATIONS. enough to be used with the aid of the splint. The convalescent splint is worn from two to eight months—in a few cases longer. As a result of these operations we have a practical length- ening of the limb from two to four inches, the limb placed in the vertical plane of the body, and in walking the spine is held upright, instead of being lordosed, as is required in a flexed limb. t Below I report the results of operation in sixteen cases treated at the Hospital for Ruptured and Crippled, N. Y. City. The histories are taken from my note book of cases treated . during my service as an interne. I have merely given a sum- mary in most of the histories, omitting that which does not re- 1ate to the subject in hand. The diagnosis is given in the origi- nal history of many of the cases as “Deformity Resulting from Old Hip Disease.” I have not used this form, but the simpler one of R. H. D. (Right Hip Disease), L. H. D. (Left Hip Dis- ease), letting the history indicate whether the disease was qui- eSCent Or 110t. Case I. Wm. B., age 12. Left hip disease (L. H. D.), May 9, 1889. Fairly well nourished. When standing there is marked lordosis, all the weight of the body being supported by the right limb–the balls of the left toes just touching the floor. Has characteristic hip limp. Limb fixed at 125°. There is a small sinus just below trochanter major. Ra 27%, Ru 32, R. Th I4, Rk II V4, Rc IO, La 26%, Lu 28, L Th II, Lk 934, Lc 834. NotE.-R stands for right (leg), L for left (leg), Ra is the . distance from right inner malleolus to right anterior superior spine of ilium and represents the actual length of leg for com- parative purposes. Ru is the distance from right inner malleo- lus to umbilicus, and represents the practica/1ength for compara- tive purposes. R Th, Rk and Rc are the circumferences of the right thigh, knee and calf. On the left side these measurements are taken at the same points. May 28, '89. Patient under ether subcutaneous tenotomy of flexors and adductors performed. Finding that leg could not be brought down, femoral osteotomy (Gant's) was performed, using Vance's osteotome. Limb placed in line with the body. Plaster Paris spica applied. June 19. Patient up to-day in rolling chair, still wearing STO1Cal. p June 29. Patient allowed out of rolling chair for first time. July 27. Plaster spica removed to-day. Limb appears perfectly straight and in line with its fellow. - WIRT-Hºp Disease, Ætc. 389 Ra 30%, Ru 33, La 28, Lu 30%. Angle of greatest extension (A. G. E.) 165°. There is a small angle of motion. No tenderness about joint. Hip splint to be applied for present, then high shoe only. Sept. 4. Has been wearing high shoe only since Sept. 5. Walks well. Sept. 19. Discharged to-day to out-door department, wear- ing high shoe and walking well. REMARKS.–It will be seen that La was increased I}% inches, and that the practical length (Lu) was increased 2% inches by the operation. The angle of greatest extension (A. G. E.) was increased 40°, z. e., the thigh was straightened out 40°. I have given this history rather full, in order to show the manner of keeping records in the hospital. Case II. Margaret Mc., age 13. Right Hip Disease. (R. H. D.) Disease began at age of 2%. Treated in out-door de- partment of hospital for five years. Hip fixed at 135°. Con- siderable adduction. Ra 25%, Ru 25%, R Th I4, La 29%, Lu 33%, L Th 16%. June 5. Patient etherized. Gant's operation performed. July 2. Plaster Paris removed and to be left off. Ra 27, Ru 31%, La 29%, Lu 33%. - The child is to wear a snug spica bandage and the right shoe built up two inches. Ankylosis complete. - Sept. 5. Patient discharged to out-door department. Limb strong and unyielding. 8° adduction. - REMARKS.—By comparing above measurements it will be seen that Ra was increased 19% inches, while Ru, the practical length of the leg, was increased 6 inches. Case III. Pauline H., age 14, Left Hip Disease. (L. H. D.) Disease began at age of 2%. History relates a number of im- provements and relapses before coming to the hospital, June 17, 1889. Patient well nourished. Walks with de- cided hip limp ; touches floor with balls of toes left foot. Limb fixed at 155° (A. G. E), adducted, pelvis tilted upward one inch on left side. No tenderness, no signs of abscess. Ra 31%, Ru 36%, R. Th 19%, La 31, Lu 34%, L Th 17.” June 25. Gant’s operation performed, … July 5. Up for first time in rolling chair. Sept. 3. Seems to be a small amount of motion at hip. Dec. 31. Patient discharged. Union at thigh firm. Little or no motion at hip. Wears a caliper (convalescent brace). Ra 31%, Ru 35%, La 30%, Lu 35%, 39C) COMMUNICATIONS. - REMARKs.—This child remained in the hospital several months to cure a “hammer toe.” La is shortened, while Lu, the practical length, is increased I 34 inches. . Case IV. Willie F., age 6. Right Hip Disease (R. H. D). Disease began at age of 3. - June 17, '90. General condition of patient good. Thigh held fixed at 150°. No pain on manipulation, no peri-articular tenderness, no infiltration. Ra 20%, Ru 23, R. Th 8%, La 21, Lu 24, L. Th II. Walks with marked limp, as from a shortened limb; body inclined to right side. Comes in wearing hip splint. June 27. Patient under ether. ‘Osteotomy performed (Gant's). Deformity fully corrected. Limb put slightly in ab- duction. Plaster Paris spica applied. • - July 26. Plaster Paris removed; wound healed; union firm ; small callus; A. G. E. I65°; no motion, no pain, no infil- tration. Patient measured for a hip splint. Ra 20%, Ru 23, La 2034, Lu 23%. Aug. I. Hip splint applied. | Aug. I4. Condition same as above, A. G. E. I70°. Wear- ing hip splint and hip shoe. Discharged. REMARKS.—Angle of greatest extension (A. G. E.) was in- creased 20°. Ru is the same before and after operation ; Lu, the practical length of well leg, is given as less. Case V. Wm. J., age 8, R. H. D. Disease began at age of 4. Has been under treatment three years. * May 22, '90. General condition fair; limb held fixed at I45°. - } Ra 22%, Ru 25, R Th 8%, La 24, Lu 2634, LTh 934. No pain on manipulation. Comes in wearing long hip splint. May 27. Patient etherized. Gant's operation. Limb brought down parallel with other. Plaster spica applied. |} July 2. Plaster removed for first time; limbs parallel; thigh fixed at 170°. Bony union firm. 4° adduction. To have brace applied. . • Ra 23, Ru 25%, La 24, Lu 27%. - July 24. General condition good; bony union perfect; limbs apparently parallel; very small callus; no infiltration ; no joint or peri-articular tenderness; very slight range of mo- tion ; goes out wearing hip splint and high shoe. Discharged to out-door department. REMARKs.—The practical length (Ru) was increased 34 inch. Angle of greatest extension (A. G. E.) increased from I45° to I70°, z. e., 25°. WIRT-Hºp Disease, Etc. 39 I Case VI. George McG., age 9, R. H. D. Disease began at age of two. Wore Sayre's long hip splint for a year, begin- ning shortly after invasion. - May 7, '90. Patient rather enemic. Right limb very much atrophied. No joint or peri-articular tenderness on manip- ulation. Leg fixed at 130°. Walks with marked hip limp and as from a shortened limb. Standing, there is marked lordosis and lateral curvature of spine. * Ra 24%, Ru 28, R. Th IO%, La 25%, Lu 29, L Th I3. May 9. Patient etherized. Gant's operation. Limbs made parallel. Plaster spica applied. June II. Plaster spica removed. Bone well united. Limbs parallel. Measured for caliper brace. Ra 24, Ru 2834, La 26, Lu 29%. June 23. General condition excellent. Limbs about par- allel. Slight callus at seat of operation. No pain on manipula- tion. Slight motion at joint. Wearing caliper. Discharged to out-door department and to report every week. REMARKS.—Lu, the practical length, was increased about one half inch. * Case VII. Joseph W., age 7, R. H. D. Disease began when boy was less than a year old. Limped while learning to walk, Wore a plaster Paris spica for a year. - May 7, 1890. Right limb adducted so much that it crosses the left at knee. Pelvis very much tilted up on right side. Hip fixed at I2O’; no pain; 24° adduction. - * Ra 1934, Ru 214, R Th 8#, La 21, Lu 25, L Th IO34. May 9. Patient etherized. Adductors divided and an at- tempt made to correct deformity. Failed. So Gant’s operation performed. Limbs made parallel; fixed in plaster spica. June II. Plaster Paris removed for first time; union firm ; limbs parallel ; small range of motion at hip joint. There is a little tenderness of hip, but test not crowded. Ra 20%, Ru 23%, La 2I4, Lu 25. June 16. Long hip splint applied. June 23. General condition good ; union firm ; small cal- lus; no infiltration around hip; no pain on minipulation ; no peri-articular tenderness. Wearing hip splint without high shoe. Discharged to out-door department (O. D. D.). REMARKS.—Lu, practical length of the limb, was increased 134 inches. Case VIII. Miner Y., age I.O. R. H. D. Disease began at age of 4. Treated four years with ointment. Used crutches three; has walked without crutches for two years. 392 COMMUNICATIONS, May 27, 1890. Fairly well nourished. Marked lordosis. Thigh fixed at 130°. A sinus on inner and upper aspect of thigh discharges slightly. Ra 24%, Ru 2434, R Th IO;, La 25, Lu 28, LTh I2}. January 28. Gant's operation performed and limb brought down parallel with its fellow ; sinus scraped out and injected with iodoform glycerine and water; plaster spica applied. Feb. 26. Plaster removed. Union good ; trochanter moves as limb moves. Sinus is discharging. Plaster spica re-applied. Ra 23, Ru 26%, La 25%, Lu 28%. - - March 17. Plaster Paris removed and hip splint applied. Comfortable ; sinus discharging freely. April 29. Boy is active; good appetite. Fair amount of motion at hip. A. G. E. 175°. Slight discharge from sinus. wearing hip splint comfortably. Patient discharged. REMARKs.—Angle of greatest extension (A. G. E.) increased 45°. Practical length (Ru) increased I; inches. * Case IX. Lizzie C., age 5%. L. H. D. Disease began at age of 2+. Six months later came to hospital and has worn a walking brace ever since. May 21, '90. General condition good. Hip fixed (A. G. E.) at I 30°. No pain on minipulation. - Ra 17, Ru 20, R Th Iok, La 1634, Lu 194, LTh 9%. May 27. Gant's operation performed; limbs made parallel; plaster spica applied. June 30. Plaster Paris removed. Union firm ; A. G. E. I70°. Ra I7+, Ru 20%, La I7+, Lu 20. July 17. Hip brace applied. A moderate amount of callus. July 24. Walking with hip brace. Discharged to out-door department. , REMARKs.—Angle of greatest extension (A. G. E.) in- creased 46°. Practical length (Lu) increased one-half inch. Case X. Sarah B., age 16. L. H. D. Disease began when child was five years old. - Ra 33, Ru 38%, R Th 17, La 31, Lu 34, LTh I5. November 30, '89. Gant's operation performed. January 8, 1890, Ten days ago plaster spica removed. Limb found in good position; union firm. Convalescent splint (caliper) applied, which she wears with ease. Brace to be left off at night. A. G. I50°. & Ra 33, Ru 38, La 30%, Lu 35. Limb can be abducted over arc of I5°. . January 20, '90. Discharged, walking nicely on caliper. WIRT-Hºp Disease, Etc. *- 393 August 15, '90. For past few weeks has had occasional pain. Advised rest and the cautery. September 30. No relief from cautery. Has had much pain; walks badly. Ru 38%, Lu 36%. - November 30, '90, Walking with comfort ; no pain for two weeks. Discharged to O. D. D. REMARKS.—The practical length one month after the operation was increased one inch ; by September this practical length had increased two and one-half inches. This is one of the few cases where any trouble followed, and this coming on eight months after operation, indicates that it was probably due to other causes much more than to the operation. The amount of motion at hip following the operation was considerable. Case XI. Annie D., age 15. R. H. D. November 9, '89. Well nourished. Stands with thigh con- siderably flexed ; marked lordosis; hip fixed at (A. G. E.) I35°; no tenderness on motion or pressure. Ra 23%, Ru 25%, R Th II, La 2434, Lu 25%, L Th 13. November 12. Gant's operation performed. December 23, '89. Plaster removed; union firm, though parts seem tender on manipulation ; limbs parallel ; hip splint applied. - January I6, '90. Condition same as above, except no ten- derness. Ra 25, Ru 28}, La 26, Lu 28}. Can walk without support. To use a caliper still. Dis- charged to O. D. D. Case XII. Stella A., age 9, L. H. D. No motion at hip— fixed (A. G. E.) at 135°. Trochanter major one and one-half inches above proper location (above Nelaton's line.) Ra 24, Ru 27%, R. Th I 2, La 22, Lu 23%, L Th IO. April 9, '90. Gant’s operation performed. May 7. Plaster removed. Union firm ; considerable mo- tion at hip. A. G. E. 175°. Angle of greatest flexion 135°. [Thus showing 40° of motion.] Splint applied. Ra 24%, Ru 28, La 22%, Lu 25%. May 16. Walks well. Discharged. REMARKs.—Practical length (Lu) increased 2 inches. Angle of greatest extension (A. G. E.) increased 40°, z. e., the leg was straightened out 40°; also 40' of motion gained. Case XIII. Ruth J., age 14, R. H. D. Disease began when child was 3 years old. Was called cured after wearing a 394 COMMUNICATIONS. brace four years. Mild relapse began three months ago, due to a fall. May 24, 1890. General condition good. Right thigh fixed at 130°. Ra 28, Ru 32%, R. Th I4%, La 2934, Lu 34%, L Th 12. Comes in withont any apparatus and cannot walk. May 27, '90. Gant's operation performed. It was found necessary to divide the thigh flexors in order to bring the limb down parallel with the other. Plaster spica applied. - June 26. Plaster removed for first time. Union firm ; A. G. E. 170°. Ra 28%, Ru 33%, La 30, Lu 34%. She is to remain abed till brace is made and fitted. July I. Brace applied. © July 7. Condition excellent; A. G. E. 175°; no motion at hip. Discharged wearing hip brace, but no built up shoe. e REMARKS.—Angle of greatest extension (A. G. E.) in- creased 45°. Practical length (Ru) increased I inch. Case XIV. Annie O., age 6. L. H. D. º e October Io, 1890. General condition fair. Wearing ordi- nary hip splint. Limb fixed at 135°. Some muscular spasm. but no pain; no abcess. - Ra 20, Ru 22, R. Th II 34, La 1934, Lu 22, L Th 9. October 17. Gant's operation; limb brought down, &c., November 17. Plaster spica removed for first time. Union firm ; to wear hip splint for four weeks. - December II. Ra 21, Ru 22%, R. Th 12, La 29%, Lu 22%, L Th 9%. A. G. E. 176°. Limb fixed; no infiltration. Discharged to O. D. D. dº REMARKS.–Angle of greatest extension (A. E. G.) in- crersed 41°. Practical length (Lu) increased 34 of an inch. Case XV. Eva P., age 15. R. H. D. © - June 24, '90. Gant's osteotomy performed ; limb made par- allel with its fellow; plaster spica applied. July –. Ra 27, Ru 31, La 31, Lu 34%. e August 5. A. G. E. 172°. Wears hip splint with comfort; walks well; discharged to O. D. D. REMARKS.—Notes incomplete. 3. Case XVI, Lizzie P., age 14. L. H. D. :- April 4, 1890. General health quite good ; no pain or ten- derness about hip. Fixed (A. G. E.) at 140°. Marked hip limp. Ra 31, Ru 35, La 30, Lu 32%. WIRT-Hºp Disease, Ætc. + 395 April 8. Gant's femoral osteotomy performed; limb brought down parallel with its fellow ; fixed in plaster of Paris spica. May IO. Spica removed; union firm. Ra 31%, Ru 36, La 30, Lu 35%. A. G. E. I70°. June 22. Wearing hip splint with comfort. Gets around well. Discharged to out-door department. REMARKS.—Angle of greatest extension (A. G. E.) in- creased 30°. Practical length (Lu) increased 234 inches. SUMMARY.-The above is in brief the history of sixteen cases of hip disease in which Gant's femoral osteotomy was per- formed. I have omitted no case between the dates from which the histories are taken. All the cases were improved—some very much so—both in the walk and comfort of the patient. In no case was there any untoward symptoms following as a result of the operation. In only one case was there any difficulty whatever; in that case there was a slight return of the old hip trouble, but following nine months after the osteotomy it can hardly be said to be due to the operation. In several of the cases there was a certain amount of motion at the joint (not at the seat of operation) fol- lowing the operation. This is in no way detrimental to the patient, but rather of benefit. It might be argued, Why not break up adhesions and get motion without osteotomy 2 The answer is, that to gain 40° or more of extension at the hip would require a very considera- ble amount of disturbance in the joint; this frequently lights up the disease, the child then has to go through another siege of hip trouble, ending in more complete ankylosis than before. The prime idea of the osteotomy is not that of disturbing the joint, but rather to correct deformity without disturbing, and when motion is gained without trouble, then just so much is gained. In all cases before doing the osteotomy, enough force is used to determine that the adhesions in the joint are Osseous, or, at least, very firm. It must be conceded that this operation is of great use in these old and neglected cases of hip disease. CAE/A2O/V/C A/V/OOA/AF 7TA’/7/S. BY J. M. BALDY, M. D., PROFESSOR OF GYNEcoLOGY IN THE PHILADELPHIA POLYCLINIC ; SURGEON TO GYNE- CEAN HOSPITAL ; GYNECOLOGIST TO ST. AGNES' HOSPITAL. A Paper Read Before the Philadelphia County Medical Society, February 10, 1892. Of late years it has become the habit of gynecologists to consider almost all endometrical disease as symptomatic, and not an independent lesion. It is certainly true that many petvic diseases are accompanied by an unhealthy condition of the en- dometrium ; especially in inflammatory disorders the lining membrane of the uterus is so frequently affected as to have given rise to the supposition that it is either caused by the pelvic dis- ease, or rarely occurs independent of it. In fact, such assertions are frequently made in print and on the floors of our societies. The temptation is strong to accept this theory, which appears at first blush to be so plausible, but which is nevertheless most fal- lacious. My daily experience is teaching me that endometritis as an independent disease is quite a common disorder, and is at the bottom of many of the discomforts suffered by women. The causes giving rise to this disease are much the same as those which originate vaginitis, and particularly salpingitis—specific infection and post-puerperal sepsis being the most prolific, and giving rise to the bulk of the cases. Oftentimes the beginning of the trouble can easily be traced to a child-birth or to an abor- tion. The woman has had a slow get up, and will give the his- tory of some fever, or she has regained her usual health very slowly, and possibly not at all ; she will have complained of a vaginal discharge since her confinement, when previously she had been free from this annoyance. The history may be that of an attack of specific infection. Sometimes the history in such a case is clear—a sudden appearance of a yellowish vaginal dis- charge, with swelling of the labia and burning micturition. At other times the evidence of specific infection is not entirely satis- factory, but it is quite notorious that women often become con- taminated without giving it any particular attention, or the dis- comfort has been so slight as to be soon forgotton. In any event, if the disease be neglected and spreads to the cavity of the uterus, it soon spends its force and settles down to a chronic 396 BALDy—Chronze AEmdome/rzºzs. 397 condition. It may or may not extend into the Fallopian tubes and cause a salpingitis and peritonitis. Should it do so, as is often the case, the removal of the appendages will not necessa- rily bring about a cure of the patient. In fact, this is the secret of the failure of laparotomy in many of the cases which are going from one clinic to another for relief. Even if the disease is com- plicated by pelvic disorders of an inflammatory nature, especially if the two arise from the same cause, it is well to first turn our attention to the endometritis, in which case a laparotomy Imay at times be avoided. In other words, certain cases, embracing the two diseases, the symptoms from the endometritis may over- shadow those from the salpingitis; this is especially true of many instances in which the intra-peritoneal damage has not been very serious. In those cases where the intra-peritoneal in- flammation has subsided, and only its products remain, the treat- ment of the endometrial inflammation, which, under these cir- cumstances, is usually chronic, can be carried out with impunity if ordinary care be taken. Of course, in the event of there being an acute or even a subacute pelvic inflammatory condition pres- ent, great care must be taken not to interfere with the uterus in any way, else an already bad condition of affairs may be made much worse, and even serious. In many patients, in whom there exists post-puerperal septic endometritis or specific endo- metritis, the disease has stopped short of the tubes, and has not involved either them or the peritoneum. These cases are quite common, and are daily overlooked. The women wander from one doctor’s office to another, and finally, when their money is all gone, into the public clinics, seeking relief in vain. It is often a matter of surprise to me that many of them have never even had an examination made, but have been treated for months, and years with drugs, or have been advised to use an injection of hot water. The hot water injections, as usually given, are worse than useless. Just sufficient water at a moderate temper- ature is used to cause a congestion of the uterus and pelvis, which congestion is not relieved by the secondary effect of the hot water, viz: the contraction and consequent driving away of the blood from the parts. These women suffer from a continual uterine discharge more or less profuse; there is, perchance, a feel- ing of weight and heaviness in the pelvis, accompanied by back- ache; sometimes they feel weak and worn out. The menstrual function is disordered, being generally irregular and profuse; pain may or may not attend this function. These symptoms exist either alone or in various combinations, the only constant and reliable one being the uterine discharge. A local examina- 398 COMMUNICATIONS. tion discloses an enlarged and heavy uterus, from the cervical canal of which an unhealthy thickish discharge is oozing. Oftentimes the cervix is eroded, and the mucous membrane of the everted lips, if the lips be everted, bleeds on being touched with a piece of cotton or an instrument. This hemorrhagic con- dition is more apt to be present when the disease is still acute or subacute; but, nevertheless, it is at times seen in the chronic cases. In some instances the uterine body is comparatively normal to the touch so far as its consistency is concerned ; again, it may be either too soft, or, what is more common, extremely hard, and even almost fibrous in character. These changes in- dicate that the disease is not altogether confined to the endome- trium, but has invaded the structures comprising the uterine wall. It is no uncommon thing to see an endometritis and a metritis coexisting ; in fact, in chronic cases it is rather the rule than the exception. The disease is almost always primarily an endometritis, and treatment which will cure this affection will be followed by a cure of the metritis almost as a matter of course. So much is this the rule that I have gotten to look on these two diseases as very much one and the same. Where this condition of affairs exists—a large and abnor- mally heavy uterus—there is very apt to be a retro-displacement of the womb sooner or later. Whether or not all displacements which give rise to trouble are originally caused by uterine in- flammations, it is a curious fact that it is a very rare thing to find a troublesome retro-displacement without either uterine or pelvic inflammatory diseases complicating it. For the treatment of uncomplicated endometritis and metri- tis there are a variety of remedies, some of them quite effective, while many of them are useless, and are applied in a haphazard way. My own preference is to adopt the shortest and surest course of procedure. The woman is put under ether, the cervix is dilated, and the uterus thoroughly curetted; the uterine cav- ity is then washed out, and an application of Churchill's iodine made to its surface. If there is pretty free bleeding in conse- quence of these manipulations, the uterus is packed full of iodo- form gauze, which is removed in the course of a day or two, as circumstances demand. Ergot may or may not be given by the mouth, the indications for its use being hemorrhage or an en- 1arged heavy uterus. Usually, I give half a drachm of the fluid extract, three times a day for a short period, gradually reducing the quantity until it is dispensed with altogether within about a week. BALDy—Chronze AEndome/rzłęs. 399 As to the steps of the operation : The patient is placed in the dorsal position, the dilatation is made with the Goodell rapid dilators after careful antiseptic precautions. I dilate usually only sufficient to introduce and manipulate my instruments easily--from three quarters of an inch to an inch. Great care is taken to make the curettement a thorough one. All debris can be washed away, and the cavity cleansed by the use of the rectal nozzle of a Davidson syringe. The application of iodine follows immediately, it being applied with a long-nozzled uterine syringe. The patient is now returned to bed, and nothing more is done for a week or two, excepting to give absolute rest, hot water injections, and keep the bowels soluble, together with the ergot as indicated. I have not found occasion to place a lland rubber drain in the uterus, as Wylie does, nor to pack it with iodoform gauze for a prolonged period, as Polk proposes. I find, if my dilatation has been properly made, that the cervical canal remains sufficiently patulous for the necessary drainage. The uterus will resent in one way or another the presence of a foreign body, and these procedures can only result in just so much more irritation and consequent discharge. Some patients are cured altogether by this treatment; but, for the most part, in order to secure a thoroughly satisfactory result, treatment must be kept up for some little time after the woman is allowed to get out of bed. It is my habit, in these cases, to make an intra-uterine application of iodine about twice a week for a few weeks, then once a week, and finally to with- draw the treatment altogether; the hot water injection should be kept up twice a day throughout the whole course of treat- ment. It is not uncommon, where the endometrium has under- gone a fungoid change, for the disease to return, and the whole treatment has thus to be gone through with a second time. Many patients will not submit to this treatment, in which event it becomes necessary to resort to other methods of manage- ment. A prolonged course of intra-uterine treatment will, in many cases, eventually bring about the same result. I do not maintain that iodine is the only remedy to be used for this pur- pose, but I have come to use it routinely for the reason that I have found no other drug which would give better results. It is not advisable always to use it in full strength, in which case it may with advantage be diluted with glycerine in the required proportions. Ichthyol and all the similar substitutes have only proven disappointing. So much for the uncomplicated cases of endometritis. Where the disease is accompanied by a pelvic inflammatory con- 4OO COMMUNICATIONS. dition the first question to settle is whether or not an abdominal section is to be performed for the removal of the appendages. If they are not sufficiently affected to call for the operation, and if the uterine symptoms predominate, and are very annoy- ing, I have no hesitation in treating the uterine cavity. A long-nozzled uterine syringe may with safety be passed into the uterus, even in the presence of considerable pelvic disease, and a local application thus made. In these cases the strength of the material injected should be regulated by the amount of inflam- mation, as a strongly irritating fluid will be much more likely to cause trouble than the mere passage of the instrument itself. When the pelvic disease has been an old one and quiescent, I have not hesitated in gently dilating the cervix and curetting the cavity of the uterus, nor have I ever had any trouble follow such a procedure. In this class of patients there is an opportu- nity for the nicest kind of judgment, and if one be skillful and careful in selecting the proper cases, the treatment may be fol- lowed by the greatest benefit. I am perfectly well aware that this is contrary to the teachings of many gynecologists of the present day, but my own experience in these matters has opened my eyes to the fallacy of such ideas. If the gentlemen opposing the practice of intra-uterine treatment would try it on some of their cases who continue to have enlarged uteri and a vaginal discharge after the removal of the appendages, they would soon become convinced of its practical value, even in these cases. (In the ensuing discussion, Baldy stated distinctly that the treatment which he had recommended was for uncomplicated endometritis, and not appropriate for cases in which there were pelvic or abdominal complications; such cases should be treated as the conditions called for.) AAEA’A/LAX/AWG S/AWG U/C 7TUS, BY ROBERT PETER, M. D. CANAL DOVER, O. To stop and treat hiccough is like, in farming, to only cut away the tops of the weeds and let the other parts of the plants remain. Clear away the cause and you will cure the effect. The phenomenon of singultus is explained by an irregular, spasmodic action of the diaphragm. Irritation to the phrenic tract produces irregular diaphragmal action, synchronous action of the glottis is thereby broken, and the air rushing through the chink, under these abnormal circumstances, causes the “hic.” PETER—Perplexing Singulius. 4OI Irritation of the phrenic nerve may be conveyed from any one of the visceral organs, through the agencies of the solar plexus ;. or, for that, from any part of the body, through the same com- plex influence of the wonderful sympathetic system. Singultus may also be caused by ptomaines, which, in some way, may happen to have a selective action upon the phrenic tract. Wit- ness the following history of such an instance, interesting and very instructive: Mr. V. O. P., my brother, aged 31 years, druggist, and one of Shelby's (Ohio) brightest, most prominent and beloved citizens; always enjoyed good health, except that he had been an occasional sufferer of subacute articular rheuma- fism, and a few years prior to this sickness, had a spell of stub- born singultus lasting three days, which, however, was unac- companied by fever. The family history is good in every way. There is no history of an injury, nor is a broken surface per- ceptible over left ankle or anywhere else on the body. November 29, 1891, while doing Sunday morning duties at drug store, patient first complains of pain in left ankle and a short spell of hiccough. November 30, about IO a. m., begins obstinate spell of sin- gultus, lasting almost incessantly for five days and nights; hiccoughing sometimes from 15 to 25 times in a minute, or 900 to 1500 times per hour. There is a decided febrile movement. On this day thermometer indicates IO4° in the evening. Dr. Bricker is called, who employs lobelia as an emetic, cocaine and a number of other remedial measures against the singultus, but without avail. December I. Singultus continues the same. Pulse is still not much above the normal ; but the temperature fluctuates be- tween IO4° and Ios”. Dr. Sommers sees the case with Dr. Bricker at noon. By midnight patient has had a short intermis- sion of the singultus. Writer reaches bedside after midnight and examines patient in presence of Dr. Sommers. Ankle is found but slightly swollen ; skin is not discolored; there is little local heat and but slight tension ; patient is somewhat listless, and therefore cannot be interviewed. Temperature IO4°, and pulse 90. Lips, tongue and throat are moist. As stated, local appear- ances of ankle would seem comparatively n27, commanding little attention and entirely out of proportion to the general symptom complex. We are unable to account for high temperature, delirium and the general “rumpus,” from data at hand. We Rnow that patient has been subject to rheumatism, and think that probably the present condition be such an one. We pre- scribe:— 4O2 COMMUNICATIONS. B. Potas. bromide. Potas. bicarbonatis. Chloral hydrat... . . . . . . . . . . . . . . . . . . . . aa gr. c 1 x ; Morphia sulph . . . . . . . . . . . . . . . . . . . . . gr. iv. Ag: cinnamomi . . . . . . . . . . . . . . . . . . . 3 iv.; M Sig. 3 ii to be given every 4 hours. December 2. Patient is more quiet, but is still hiccough- ing; temperature still IO4°, pulse 90. Later on patient has his first sleep since his sickness, during which singultus continues just the same. Abdomen is for first time noticed to be tympan- itic, and singultus stops an hour. Near noon, Dr. Reed, of Mansfield, attending local physicians and myself are in consulta- tion. Speculations are indulged in and suggestions are made as to treatment. We all agree in the belief of rheumatism. The theory that the singultus is a nervous manifestation, due to con- stitutional disturbances produced by rheumatic poison, is ad- vanced by Dr. Reed. Mark, the temperature at this time of consultation is IO4.5° and in half an hour later, IOS.2°. The family restless and the attending physicians still not satisfied. Dr. Scott, of Cleveland, is called in the evening. On the doc- tor's arrival, about 8 P. M., temperature has declined to IO2.5°, and patient had ceased to hiccough for two hours. The doctor examines patient, concludes on subacute rheumatism, and states that the singultus is one of a nervous condition ; that the high temperature may be explained by some underlying fever; per- haps malarial or typhoid. He orders IO grains of quinine to be given ; which is done at once. The chloral and bromide mix- ture is advised to be continued. The hiccough returns to con- tinue, as before, long ere the doctor returns home to Cleveland at midnight. December 3. Temperature is subnormal in the morning, pulse 80. We have two intermissions of singultus; one lasting two hours, and the other, two and one-half hours. Temperature fluctuates and rises during the day, but never higher than Io2.5°. Delirium is wild and furious on this day; patient im- agines that he is pursued; that he is in a railroad wreck; and that he is before a court of justice, to defend his honor, and makes a long and eloquent plea in his defense. December 4. Temperature down in the morning to IOI.5°, pulse varying from 96 to Io8. A few intermissions of hiccongh, each lasting about an hour. The pulse in the afternoon same as morning. Temperature IO3°. The ankle is noticed on this day to be a little more tense, swollen and discolored. Iodine is ad- vised locally and the limb wrapped in cotton. Patient becomes violently delirious in the evening and remains so, despite an opiate, chloral and bromide until next day. t PETER—Perplewing Singulius. 4C3 º:December 5. Morning pulse roo, temperature Io2°. Patient is little more rational, complains of no pain, and seems comforta- ble. In the afternoon, has two voluntary stools, despite the opium he has taken. The abdomen is more distended and tense; pain and gurgling over ilio-cecal region elicited on pressure. A profuse rose-eruption is noticed all over the abdomen and over the trunk, some of which disappears on pressure. Sudamina are also noticed. Patient's nose bleeds. P. M. pulse I2O, tem- perature IO2.2°. Singultus still present, but not near so con- stant and frequent. Ankle is a little more swollen, but has not seemed to pain during the day, and therefore is left alone. The rose-rash, voluntary stools and nose-bleed all remind us of typhoid fever (but pyogenic sepsis never enters our minds ; blast it!). We are still groping in the dark ; but feel that some fearful reve- lation is soon in store for us. December 6. Strange as it may seem, we are still haunted |by the delusion of rheumatism, as the left fore-arm is now also somewhat swollen. And I will apologize, before going further, for the oversight in neglecting to examine the ankle joint now, at a time when we might have learned something. It seems that we are so constituted that at times we are most blind to opportune moments nearest to us, and our own interests. How: ever, let us state, nevertheless, that the morning pulse is III, and temperature IOI.5” on this very day. The delirium is less. Patient has slept some. The symptoms of hiccoughing and general restlessness are better. However, later in the day patient for the first time refuses nourishment and wets the bed. Abdo- men feels tense and is somewhat painful, especially over ilio- cecal region. Rose eruption and sudamina still exist. , Patient is put on three grains of salol every two hours. Evening tem- perature IO3°, and pulse IO8. - December 7. Left fore-arm found but very little more tense and is only noticed to hurt him when touched; the ankle seems comfortable. This A. M. pulse is Io2, temperature IOO.5°. Day uneventful, except that patient only once more wets the bed. Evening temperature IO3.2°. - A December 8. Now comes the day of revelation. A young man, bright and crisp from the medical centre of Switzerland, Berne, and a cousin of the writer, steps in at the opportune time and points out the now possible fluctuation. The case is only too clear. Chagºrzm is our desert. My welcome cousin, Dr. Rudolph Nydegger, now of Cleveland, takes charge of the case. Of course abscesses are opened, drained and dressed under strictly antiseptic precautions. The next morning tem- perature and pulse have dropped some and our patient seems better, 4O4 CoMMUNICATIONS. Henceforth our case progresses very slowly, as must be ex- pected, and nothing more eventful happens, except the singular condition, for ten to fourteen days, that, with an occasional febrile movement, we have the temperature normal, the pulse normal, but at the same time patient is de/zrzozas. Nothing else can be added that is of interest except that one more new operation had to be made at ankle, after first openings of ankle and fore-arm Had healed. - One thing further might be stated, that a great number of remedies were employed against the singultus; but they were all of no avail. This aggravating symptom gradually abated of its own accord, entirely ceasing on removing the cause. The trouble was, the singultus busied attendants only too match, that they failed to properly wade into a perplexing diagnosis, waiting for something to turn up. t There is no doubt but what, the primary focus of suppura- tion was subfascial. The surface in such case is at first apt to be comparatively pale in appearance, the edema deep-going and fluctuation late; which was the case here. Had the suppura- tion focus been primarily superficial, marked discoloration, ten- sion and fluctuation would have all been present very early, and could scarcely have been overlooked, nor even been mistaken. With such data and a misleading history to baffle one, under such cover subfascial abscesses located in the region of a joint where the fasciae are thick, strong and tense, it was not so dis- graceful to be misled in making an early and correct diagnosis; although true, it must be admitted, the use of exploring needle, which was overlooked at this stage, might have rendered some material assistance. Such a “rumpus” as was present, seemed out of proportion to the local appearances, detracting attention from diagnosis early desirable, so that early drainage might be possible. - - The history of this case is both interesting and instructive. I should like to enquire for the infection atrium. How was this patient infected 2 The history of the case does not reveal any- thing positive. sº This paper does not do this subject the full justice that it deserves. It is not so intended ; but it may be stated that it will receive this on some future occasion, as there are a number of useful points to be brought out, diagnostic, for instance, which should receive attention. Since writing the above, patient informs me that small par- ticles of bone have been discharged, and that the ankle is still swollen and stiff. It would thus seem that we most probably had primarily to deal with a bone abscess, or osteo-nyelitis circumscripta. True, no roughness of bone was noticed at the time of operation, but that such a breech of structure, howsoever small, may then have existed, seems plausible. 9 An Achievement of Modern Chemistry. * CRYSTAL SPRINGS GLUTEN. k GREEK ENGLISH PoluBoskosº, GLUTEN FooD. BOSKOS—NOURISHING While there are various Gluten foods in the market, each and every one of them contains more or less starch (from 12 to 54 per cent.) Poluboskos contains only four-tenths of one per cent of starch. We can therefore justly say that it is practically free from starch, an achievement which has heretofore not been attained. - The name “Polusboskos” was selected to distinguish it from other Gluten foods in the market. This name is not without its significance, it being a combination of two Greek words, polus, much, and boskos, nour- ishing. Pure Gluten with its congeners is the nitrogenous food principle of the vegetable kingdom, and is to be especially recommended because of its freedom from the poisonous ptomaines which are frequently found in many meat preparations which depend largely on the nitrogenous substances which they contain. Gluten is the element of the vegetable world which gives force and energy to animal life, and is the equivalent to the albumen of the animal kingdom. . Poluboskos needs no special preparation; it is ready at a moment's notice. Mixed with milk it makes the most nourishing, stimulating, and refreshing food and drink for convalescents and dyspeptic invalids; it is readily assimilated by the weakest stomach. Two teaspoonfuls of Poluboskos contain as much nourishment (nitro- genous matter) as one pound of meat. It supplies energy to muscles, nerves, and other organs. A laborer taking three doses of Poluboskos a day will be able to endure more fatigue than if fed upon a meat diet. The use of Poluboskos as an article of diet in diabetes will be at once recognized, as it is free from starch. We will be highly pleased if you will give this preparation your attention. Af We are prepared to furnish physicians with samples, and hope to be favored with your valued commands. Yours very respectfully, NEw York. EISNER & MENDELSON CO. «» 10 The Best Antiseptic for Both Internal and External Use. LISTERINE Antiseptic, Prophylactic, Deodorant, Non-Toxic, Non-Irritant, Non-Escharotic, Absolutely Safe, Agreeable, Scientific and Strictly Professional. FORMUL.A.—Listerine is the essential antiseptic constituent of Thyme, Eucalyptus, Baptisia, Gautheria and Mentha Arvensis, in combination. Each fluid drachm also contains two grains, of refined and purified Benzo-boracic Acid. DOSE,--Internally: One teaspoonful three or more times a day (as indicated), either full strength or diluted, as necessary for varied conditions. LISTERINE is a well-proven antiseptic agent—an antizymotic—especially adapted to internal use, and to make and maintain surgical cleanliness—asepsis—in the treatment of all parts of the human body, whether by spray, irrigation, atomization, or simple local application, and therefore. characterized by its particular adaptability to the field of PREVENTIVE MEDICINE — INDIVIDUAL PROPHYLAXIS. Physicians interested in LISTERINE will please send us their address, and receive by return. mail our new and complete pamphlet of 36 quarto pages, embodying:— A TABULATED EXHIBIT of the action of LISTERINE upon inert laboratory compounds. FULL AND EXHAUSTIVE REPORTS and Clinical observations from all sources, confirming the utility of LISTERINE as a general antiseptic for both internal and external use, etc.. Diseases of the Uric Acid Diathesis. - www. } 61 KIDNEY ALTERATIVE-ANTI-LITHIC. FORMUL.A.—Each fluid drachm of “Lithiated Hydrangea” represents thirty grains of fresh Hydrangea and three graſſ.s of chemically pure Benzo-Salicylate of Lithia. Prepared by our improved process of osmosis, it is invariably of definite and uniform therapeutic strength, and, hence can be depended upon in clinical practice. - DOSE-One or two teaspoonfuls four times a day (preferably between meals). Urinary Calculus, Gout, Rheumatism, Bright’s Disease, Diabetes, Cystitis, Haematuria, AJ' and Vesical Irritations generally. We have had prepared for the convenience of physicians == 4 T} i ET ETIC NOTES (sample of which is here with shown), GOUT. suggesting the articles of food to be allowed or prohibited in * - several of these diseases. DIETETIC NOTE. — A mixed." diet should be adopted, the nitro. A neatly bound book of these DIETETIC NOTES, each genous and saccharine articles be-- note perſorated for the convenience of physicians in detaching ing used in limited amounts. and distributing to their patients, mailed gratis upon request, Allowed.—Cooked fruits without. together with the latest compilation of case reports and clin- much sugar; tea and coffee in mod- ical observations, bearing upon the treatment of this class of eration. Alcoholic stimulants, if diseases. used at all, should be in the form of light wines, or spirits well diluted. The free ingestion of pure water is. Lambert Pharmacal Co. ºt tº . Q Avoid.—Pastry; malt liquors and sweet wines are veritable poisions. ST. LOUIS, MO. to these patients. - MEDICINE Course OF CHRONIC NEPHRITIS.—Dr. F. Delafield (Amer. Jour. Med. Science) says: There is hardly any limit to the variety of the disease, but the most constant symptoms are anemia, dropsy, and albumin in the urine. I. There are cases in which the symptoms are nearly con- tinuous, the patients get steadily worse and die within one or two years. The anemia, the dropsy, and the albumin are con- stantly present, and the patients die with dropsy or with chronic uremia. 2. There are cases in which the anemia, the dropsy, and the dyspnea come on in attacks which last for weeks or months. Between the attacks the patients are comparatively well, often able to work, although the urine always contains albumin. 3. There are cases in which a number of years before death the patient has an attack of dropsy, etc., from which he apparently recovers and goes on able to work, but with urine of low specific gravity, which sometimes contains albumin. After an interval of many years comes the fatal attack with all the characteristic symptoms. 4. There are cases which for years have no symptoms but pallor of the skin and urine of low specific gravity containing albumin. These patients often for a long time feel so well that they cannot understand that they have a serious disease. 5. There are cases in which the first symptom is the at- tack of spasmodic dyspnea, the patients otherwise feeling well. It may be months or years before the other symptoms are de- veloped. 6. There may be a history of chronic endocarditis lasting for years before the renal symptoms are developed. 7. There are cases which apparently recover from the dis- €3 Se. - º The prognosis is bad, but life may be prolonged for many years with but few symptoms, and recovery seems to be possible. TREATMENT.—Acute congestion of the kidneys can be re- lieved by the application of heat to the surface of the body. 4O5 4O6 - SELECTIONS. Chronic congestion is best managed by the drugs which stim- ulate the heart and dilate the arteries. * We evidently have no means at our command by which we can 1m fluence acute degeneration of the renal epithelium ; for- tunately the great majority of the cases of acute degeneration are not serious. . . . . . . . Chronic degeneration also seems to be a condition which we are unable to treat. In acute exudative and in acute diffuse nephritis the main indications for treatment are to diminish the severity of the nephritis and to regulate the circulation. To diminish the se- verity of the nephritis we employ cups over the lumbar region, heat over the lumbar region or over the entire body, and the in- ternal use of calomel, sulphate of magnesia, opium, aconite, or digitalis. - . The disturbances of the circulation are largely the causes of the cerebral symptoms and of the dropsy. With a laboring heart and contracted arteries we employ the drugs which dilate the arteries—chloral hydrate, opium, nitrate of amyl, and nitro- glycerin—or we diminish the quantity of the blood by venesec- tion, sweating, or purging. With a feeble heart and relaxed arteries we use the cardiac stimulants. . In chronic nephritis climate and mode of life constitute the important parts of the treatment; it is doubtful if drugs exert any effect on the nephritis. A warm, dry climate and an out-of- door life are of the greatest importance. Medical treatment can, However, be employed with advantage for the relief of the anemia, the dropsy, and the disturbances of circulation. THE OBSOLESCENCE OF MEDICAL TERMS.—The suggestion to abolish the use of the word phthisis, at least in its application to tuberculosis of the lungs, is both practical and progressive. First introduced to designate conditions attended with wasting, its application gradually became restricted to the commonest condition of which wasting is a most conspicuous manifestation, and for which phthisis then became a synonym—pulmonary tuberculosis. There are few dissentients to-day from the doc- trine of the unity of phthisis, and those few will have to adopt some more distinctive name if they decline to accept that in com- mon employ. There is no further need for the word phthisis, and as a useless term it should be rooted out of medical nomen- clature. SELECTIONS. 4O7 A somewhat analogous transformation is illustrated by the varying employment of the word apoplexy. First used to des- ignate the sudden loss of consciousness that results not only from cerebral hemorrhage, but also from thrombosis and embol- ism, it subsequently became synonymous with the most com- mon of these conditions—hemorrhage. Then its application was extended until hemorrhage into other viscera was also spoken of as apoplexy. Thus hemorrhage into the lungs became pulmonary apoplexy. There is now no further use for the word apoplexy, except as descriptive of a condition that is but sympto- matic. ; : There is one other word that is most opprobrious, and that should be relegated to the obscurity that gave it birth—the word cancer. There was a time when the histological structure of neoplasms was even less well understood than it is to-day. Then all malignant growths were considered cancerous—and we fear that even to-day the careless and the uninformed are indifferent in their designation of such growths. With the creation of the word carcinoma there is no further necessity for the word cancer. The one can never be misunderstood, the other is vague, and bespeaks lack of precision. - - Let us henceforth refrain from saying phthisis, apoplexy, and cancer, when we mean pulmonary tuberculosis, hemorrhage and carcinoma.—Med. AVews. - - THE TREATMENT OF PHTHISICAL COUGH.—The cough in phthisis is perhaps the most troublesome of all the symptoms we are called upon to treat. It cannot be said that all of the brilliant researches which have lately been made respecting the ‘etiology and treatment of this disease have advanced our knowl- edge regarding the management of this distressing symptom. We must still rely upon only clinical experience, and until the rational treatment recently proposed has shown itself of positive value, the symptomatic treatment will remain of chief practical value to practitioners of medicine. In nearly every case of con- sumption this symptom cough calls for treatment, and it is very often one of the gravest questions possible how it shall be prop- erly dealt with. Not only is it troublesome, annoying and pain- ful to the patient, but it causes vomiting, loss of sleep, hemop- tysis, pneumothorax and exhaustion when it is violent and pro- longed. For practical purposes the cough in phthisis may be divided into two kinds: (1) ineffectual and feeble; (2) excessive. The very feeble, ineffectual cough is always a grave symptom 408 - * SELECTIONs. when occurring in the later stages of consumption and associa- ted with exhaustion and general debility. J. Mitchell Bruce, M.A., M.D. L. R. C. P., who, from his large experience as a physician to Charing Cross Hospital, and to the Hospital for Consumption, Bromptom, is entitled to his high reputation as a teacher, has delivered an excellent lecture upon this important subject (International Clinics, April, 1891, p. 43), in which he discusses the treatment of cough, under headings referring to the time of its occurrence, as follows: (1) “Cough in the evening; (2) cough at bedtime; (3) cough during the night; (4) cough on waking, stirring, rising and dressing in the morning; (5) cough after meals; (6) exces- sive soughing any time, with or without abundant expectora- t1Orl. This division seems a practical and rational manner of dis- cussing the subject, and as a guide to the cause of the cough it commends itself as a routine method of thought. Cough in the evening may be due to the fatigue of the day and its consequent exhaustion, to over-heated rooms, tobacco smoke, bad air, or over-exertion on the part of the patient. The results are, as Bruce says, three-fold: “(I) Exhaustion; (2) rise of tempera- ture; (3) cough.” To prevent these and their bad effects upon the night's rest, the rational treatment of this symptom is to order such cases to retire early. Similarly, when cough at bedtime is a marked feature of any phthisical case it can very often be traced to sudden change of temperature, over-strain (going upstairs), etc., etc., and the most effective treatment will consist in the regulation of these bad conditions, and the strict avoidance of any of the causes which have been found to start the .coughing. Should all the care possible in getting the patient upstairs and to bed fail to prevent the attack, Bruce recommends the giving of a few drops of the spirits of chloro- form combined with a little lemon juice and simple mucilage, and if this fails, a small amount of morphine. . . In cough occurring during the night, which is usually due to an accumulation of secretion, reflex irritability of the nervous system from fever and general exhaustion, he directs the use of warm food and stimulants, and that morphine should be with- held unless simple measures prove powerless to arrest the pro- longed and useless attack; while for morning cough the indi- cations are to refresh the system, to assist expectoration and to avoid all narcotics. These should be met by an early breakfast, hot drinks, or nourishing broths, which, by stimulating the strength and increasing the secretions, assist expectoration. SELECTIONS. 4O9. In dealing with “cough after meal” Bruce confesses that for such paroxysms the only therapeutic indication is “to arrest the unhappy symptoms, an indication far too general to be of much service in the selection of a remedy.” Cough at this time is: very commonly attended by vomiting, and so nutrition rapidly. fails. The main thing is to avoid large or habitual doses of narcotic sedatives, which very soon have a disastrous effect on the digestive functions, and so hasten the end. Finally, Bruce discusses the control of violent cough occur- ring at any time, and advises the use of the following local meas- ures, viz.: Swallowing of pounded ice, menthol inhalations, warm alum spray, morphine insuffiations with double the quantity of powdered starch, inhalation of a few drops of chloroform on lint. For “obstinate cough,” Dr. Roland G. Curtin, of Philadel- phia, who may justly be considered an American authority upon diseases of the chest, has brought to the notice of the profession the oil of sandalwood (Phila. Hosp. Reports, Vol. 1, 1890). Dr. Curtin thus summarises his experience with this remedy in the wards of the Philadelphia Hospital and in private practice : “In the first stage of phthisis the remedy acted in a very satisfactory manner, giving comfort and great relief to the patients when the cough was very troublesome. Sleep was pro- longed and less disturbed and appetite was improved. In the second and third stages of phthisis, where the medicine was well received by the stomach, it added greatly to the comfort of the patient, greatly relieving the strain of coughing. “In the cough of catarrhal pneumonia, it not only acted as an immediate quietant of the cough, but also in a number of cases it seemed to have a curative effect, the improvement being prompt and very decided. The profuse tenacious secretion was changed by liquefying it, which relieved the distressing symp- toms, and it was finally diminished in quantity.” Dr. Curtin's claims regarding the value of sandalwood oil in: the treatment of phthisical cough are based upon its local and . general effects, as known to the profession all over the world in the treatment of urethritis, and the advantages which he points out from its use in preference to opiates are the immediate relief usually afforded, no impairment of appetite, unless it disagrees. with the stomach (as it sometimes does), no constipating tend- ency, nor does the dose have to be increased after awhile. ** But the cough of phthisis is one which can never be treated. by a set formula; each one must be dealt with according to the circumstances present. The value of hygenic measures cannot 4 IO SELECTIONs. be over-estimated, and the use of simple and rational means to the exclusion, as much as possible, of opiates, should always be adopted. In the future, it may be, we shall annihilate cough by directly attacking the cause of phthisis, but in the meantime we are dependent upon what bedside experience has taught us.- Med, and Surg. Æeporter. - PROPHYLAXIS AND TREATMENT OF INFLUENZA.—Cyrus Edson, of the Health Department of the City of New York, pub- lishes a monograph on /a grippe and its treatment. Three in- dications are to be fulfilled: (1) means must be taken to assist the system to rid itself of the poison to which the attack is due ; (2) pain must be relieved; and, (3) not the least important, de- pression must be counteracted. The first indication is obtained by means of castor oil or 2 compound rhubarb pills. Three or four 3-grain powders of phenacetin are usually sufficient to re- ‘lieve headache and muscular pains. Salol, two and one-half grains to each dose, may be added to the phenacetin with advan- tage. He deprecates antipyrin and its congeners, which serve to augment the depression, and recommends instead Hoffman's anodyne, which is diaphoretic, diuretic, and stimulant. To over- come depression during and after the disease, he recommends the free use of tonics. He repeats Professor Laffont's (of Lille) recommendation of coca preparations, those of Mariani being given the preference. During the disease a hot grog, one-third Mariani wine of cocoa and two-thirds sweetened water, is admin- istered, taken very hot, several times a day, the slight diaphore- sis induced being a valuable addition to the tonic action. (The editor, in the coming issue of the Annual, recommends the ex- hibition of cocoa in the early stages of the disease, with a view to counteract the impending asthenia and curtail the disease. Six grains of blue mass are first ordered, and, as soon as a couple of movements have been obtained, 2 tablespoonfuls of Mariani cocoa-wine are given every two hours; lozenges, each containing 2 grains of cocoa-leaves and I-12-grain of cocaine, con- tribute greatly to ward off the pharyngo-laryngeal complications. A 6-per cent. Solution of cocaine, applied occasionally to the nasal mucous membrane, directing the cotton-covered probe toward the roof of the nose and anteriorly, reduces markedly the pain caused by involvement of the frontal sinus. . He fully agrees with the author as regards the contra-indication of an- tipyrin.) Edson considers champagne, generous wines, tonic doses of quinine, iron and strychnia also of value. The catarrhal rritation of the air-passages are best allayed by inhalations SELECTIONs. 4II of compound tincture of benzoin. Chloroform liniment is recom- mended as a rubefacient; opium and carbonate of ammonia for the cough. The treatment of pneumonic grippe is essentially the same as that of uncomplicated pneumonia, the author em- phasizing the advisability of preserving the strength of the patient.—7%e Sa/e//zfe. COD-LIVER OIL AND CREASOTE IN CONSUMPTION.—Dr. Julius Summerbrodt, Professor at the University of Breslau, has recently published his experience in the use of creasote in con- sumption. He states: “After nine years' employment of crea- sote, in thousands of cases of consumptive patients, I have reached the conclusion that we can cure with creasote sufferers in the initial stages of lung tuberculosis, and not only the initial stages, but also longer seated and severer forms may be com- pletely and permanently cured. Creasote is for countless suffer- ers an excellent remedy, thus far unequalled by any other for tuberculosis of the lungs. I cousider the most desirable form for administering creasote to be the capsule, adding a readily- absorbable fat, as cod-liver oil or olive oil. Parke, Davis & Co. supply soluble elastic capsules, prepared from the finest French gelatin—cod-liver oil ten minims, crea- sote one minim—which offer a convenient and agreeable mode of administering these remedies, and will mail to those interested a reprint of Professor Summerbrodt's report of his experience with these remedies. THE ODoRIFEROUS PRINCIPLE OF ASPARAGUS IN THE URINE.—The peculiar characteristic odor of the urine of persons who have eaten asparagus is attributed by Nencki to the pres- ence of methyl-mercaptan, a substance produced in the fermenta- tion of albumin and gelatine, and forming one of the constituent gases of the intestine. The presence of this substance in the urine of asparagus-eaters is explained by the fact that asparagus contains an organic sulphur compound which is supposed to. undergo disintegration with the production of methyl-mercaptan during the germination of the plant.—Univ. Med. Måg. Cystitis.--Dr. A. W. Marsh (7%erap. Gazette) recommends oxalic acid. His formula is as follows: w B. Acid. Oxal. . . . . . . . . . . . . . . . . . . . . . . . gr. xvi; Syr. arrant. cort. . . . . . . . . . . . . . . . . . . 3 i ; * * g e º e º e s & e º e s is a tº º e s e º º ºs s a e º e º 'º q. S. ad 3 iv SURGERY RELIEF FROM THE ILLS OF ENLARGED PROSTATE.—It is to be admitted that there is no medical relief from the dangerous and tormenting conditions arising from enlarged prostate. To surgery, then, one must look for aid, and it is gratifying to know that such advances have of late been made as to render old age less full of terror to “prostatics”—for to-day prostatotomy and protatectomy are so developed as to promise great relief to the sufferer. Prof. Edward L. Keyes recently read a paper upon the subject before the New York Academy of Medicine (a synop- sis of which is here taken from the 7%erapeze/2c Gazette), in which he characterizes these operations as splendid additions to our resources in that class of grave vesical disorders found so often in the best ranks of the community late in life, in those who used their brains rather than their muscles, and led sed- entary lives. Yet the indications for these operations are not yet positively determined. The questions which admit of dis- cussion are: I. When is prostatectomy to be preferred to the suprapubic operation ? 2. What condition of prostate or vesical disease, or both, justifies a radical operation, and should it be done early or late? 3. How much of the prostate should be -taken away 2 Prostatotomy as an adjuvant to vesical drainage has been so generally recognized as a proper concomitant of the latter operation that its consideration need not be dwelt upon, nor yet that new form of operation—lateral prostatectomy—performed by dissecting off the rectum from the prostate and peripherally slicing away its lateral lobes without opening either the urethra or the bladder. This operation was suggested theoretically after cadaveric research by Dittle last year; but, aside from its mani- fest inability to cope with the median prostatic overgrowth, it has loeen tried and found wanting this year by Kuster. Keyes has recently operated in a series of cases, eleven in number, three perineal and eight suprapubic. The results in the suprapubic cases have been two deaths; one in a very promising case, the other in a very grave one. After the second case, all the remain- -ing patients took diuretin freely and salol, and in none was there any urinary fever, suppression or pyelitis. Antiseptic irriga- 4I 2 SELECTIONs. 4I 3- tions and the usual precautions were always followed. In age the patients averaged sixty-four. The cases were not selected, except that all mild ones were refused operation and no desper- ate case was denied the chance, and out of these several of the patients were so nearly dead when taken in hand that the opera- tion seemed more like the short horn of a dilemma than an operation of choice or expediency. Suprapubic prostatectomy in cases of this nature was of the first order in magnitude and grav- ity; in fact, it would seem that it far outranked nephrotomy, or even nephrectomy, in gravity. Even in the milder or seem- ingly milder cases it is a somewhat grave resource, and it is scarcely proper to attack cases early, when symptoms are not severe, with an operation the best statistics of which have yielded a mortality of 13.6 per cent. and where the well-known chances of life with the use of the catheter are so high. As to the power of re- storing contractility to the atonied orgau, the author’s statistics lacked value on account of the recent date of several of his opera- tions. In his eight suprapubic cases two patients died; in three of the others, although all were up and about, the wound was not quite healed. Of the remaining three, in Case I the operation was in- sufficient and the antony remained, although urination was natural and voluntary up to that point. Case II: The patient had had eight ounces of residum, and now empties his bladder completely. Case III: This patient has also entirely dispensed with the catheter and is functionally well. Whether the others would lose their atony and empty their bladders entirely without the catheter the author could not say at this time. Of the three perineal cases, two patients had emptied their bladders entirely after the operation. - An important lesson taught by these cases is the variety in texture of the enlarged prostate. In some instances it was found so tough as to make it impossible of removal by the use of the curved scissors, and then digging out with the fingers. This suggested the employment of the ronguer forceps, an in- strument found invaluable. A vertical cut is to be preferred to the transverse incision always, and in this operation, which re- sulted in so mnch hemorrhage, open dressings should be used. One or two buried sutures of catgut may be used to attach the recti muscles, the yellow fat below the peritoneum, and the blad- der wall above its incision into one firmly-knotted mass, one end of the silk loop on each side (which has been supporttng the bladder during the operation) being then carried through the rectus muscle on either side, and again knotted, and the two loops 4 I4. -- SELECTIONS. tied together under considerable tension with a string passed across the sacrum. This holds the loops between the pelvic crest and the great trochanter on either side. This loop goes in over the skin through the rectus, through the bladder, thence up over the skin on either side. The tension of the two keeps the wound constantly open. Continued irrigation can then be maintained. The author's conclusions are: I. Prostatectomy is justifiable and does what nothing else C3LT1. - 2. The perineal operation is less severe, but also decidedly less reliable than the suprapubic; it should rarely be preferred unless there are urethral complication. In very feeble old men it may still be the operation of election. 3. The operation is not justifiable with the present statis- tics if the patient can be comfortable in catheter life. 4. No physical condition of the parts or of the patient short of a practically moribund state contraindicates an operation. By it in desperate cases life is often actually saved, although the operation is a grave one and its mortality high. 5. With the rougeur, better than with any other instru- ment, the bladder outlet can be lowered and polypoid or inters- tial growths jutting into the prostatic sinus can be removed, and these points are more essential to a successful issue than the taking away of a large portion of the prostate bulk. The instru- ment next in value is the curved scissors; but the trained finger is the most important of all. 6. Diuretin is perhaps of value when the kidneys are de- ranged. It certainly does no harm. 7. Chloroform alone should be used as an anesthetic.—A . C. Med. Andear. COLOTOMY.—Charles B. Kelsey, M. D., Professor of Dis- eases of the Rectum, New York, Post-Graduate Medical School and Hospital, claims, in a very interesting lecture published in the Therapeutic Gazette, the following indications for the per- formance of colotomy: - I. In all cases of cancer which cannot be completely ex- tirpated, where the disease is liable to produce any degree of obstruction, or is broken down and discharging into the rectum which will cause no symptoms referable to the rectum, and hence furnish no indications for operation. SELECTIONS. - 4I 5 2. In all cases of incurable non-malignant ulceration where the disease is too extensive to admit of complete resection of the ulcer. - 3. In all cases of threatened obstruction where the obstruc- tion cannot be permanently overcome by attacking it directly; for example, the obstruction due to old pelvic cellulitis in WO]]16211. - 4. In all cases of recto-vesical fistula. 5. In all cases of congenital malformation where the rectal cuſ de-sac cannot be dissected out and brought down to the surface. Noticing these indications carefully, you will see that colot- omy is always advised with the one condition, where nothing else can be done—cancers that cannot be removed, extensive ulceration that can be cured in no other way, threatened obstruc- tion from any cause which cannot be relieved by attacking it directly, congenital malformations where a useful anus cannot be made if the perineum. In only one class of cases is there no proviso—the recto-vesical fistule. In other words, we do not rashly recommend this procedure to the exclusion of other things; and if we do it more frequently than others, it is be- cause we know how much relief it will give, and are anxious to afford that relief at the earliest possible moment. If colotomy will put thirty pounds of flesh on a cancerous patient, and cause such an amount of relief to his local symptoms as to make him believe himself entirely cured ; if by removing the chief cause of local irritation it will tend to retard the inevitable increase in growth ; and if the artificial anus is not a cause of mental or physical annoyance, why delay giving the patient the advantage of it at once P and why put off an operation, with less than one. per cent. mortality, until in the midst of itſtestinal obstruction the mortality becomes thirty-three or fifty per cent. One of the greatest advances in the surgery of the rectum, of late years, is the doing away with the idea that intestinal ob- struction is the only indication for colotomy. It is, in fact, only one of many indications for this operation.—Miss. Valley A/ed. Mo. TREATMENT OF ALOPECIA AREATA.—As is well known, the principle of treatment in alopecia areata is that of stimulation of a marked character. This method has been found to be suc- cessful and to be followed by a growth of hair on the bald spots. In a recent number of the /our. of Cut, and Gemzło-Or. Dzs., 4I6 SELECTIONs. Dr. L. Duncan Bulkley gives a procedure adopted by him which is simple, cleanly, and affective in his experience. It consists in applying pure carbolic acid to the affected areas. A piece of cot- ton is wound around a tooth-pick and the area is at first lightly touched with the cotton which has been saturated with ninety- five per cent. solution of carbolic acid. Then it is vigorously rubbed in for a few moments. Care should be taken not to apply it to a surface of more than two and one-half square inches at one sitting. One application is often sufficient. If there are no results seen in two or three weeks, another application is made and this is usually all that is required. Internal treat- ment, as a rule, is not necessary.—St. Zouz's M. and S. /our. BONE WIRING.—Dr. J. J. Buchanan, a warm advocate of this method (Pittsburg Med. Acev.), gives the following as the method of applying the wire suture: - I. Use strict antisepsis, not only on general principles, but with special reference to the fate of the wire loop, which will re- main harmless in the bone if asepsis be attained, but which will in all probability require subsequent removal in case of suppura- t1O11. 2. Make free incisions to expose the point of fracture. In many cases spicules of bone will be found to require removal or replacement, which through an insufficient opening might escape observation. Free exposure of the seat of fracture also makes the wiring easy and insures against leaving portions of soft tissue between the fragments to defeat union. 3. Regulate the size of the wire by the size of the bone and the amount of tension which it will probably have to endure. The perforations should, of course, correspond to the size of the wire, and may be made by a simple Brainard drill. I prefer, however, and always use the Hamilton drill. 4. Whenever aseptic conditions are present or can be at- tained, cut the wire short and turn the ends down between the ends of the bone. Under these circumstances no fear need be entertained that the wire will ever give trouble or make its presence manifest in any way. In case the situation of the bone is such that asepsis is impossible of attainment, as in compound fractures of the jaw, opening into the mouth, or in fractures already in a state of suppuration, it is better to leave the wires long and let the ends protrude from the wound. In such cases the subsequent removal of the wire will be facilitated if we count the number of twists to which it is subjected, for in the removal we will then know exactly when to stop untwisting it. • SELECTIONS. 4I7 He presumes that little objection will be made to the wiring of compound fractures, but it is difficult to secure the patient's consent to a resort to it in simple fractures. Nevertheless, he is convinced that the time is not far distant when a large propor- tion of these will be treated on the common-sense plan of free exposure, , accurate coaptation, suture of fragments and exact closure of wound. THE DRY POULTICE IN EPIDIDYMITIS.—Brewer, following the younger Langlebert, has employed in the Vanderbilt clinic. what he calls the dry poultice in some twenty-five or thirty cases of epididymitis, of both tubercular and gonorrheal origin. The dressing consists of a moderately thick layer of cotton wool applied over the testicle, covered by a layer of thin rubber pro- tective, so fashioned as to completely cover the diseased organ, and extend up onto the sound tissue, partially enclosing the sound side. This is secured by a snugly-applied bandage, and the whole held in place by a suspensory. Its results, as regards the absorption of the induration, are rapid and marked, a very considerable diminution being seen at each dressing, and the author adds that no other method of treatment has in his hands proved so satisfactory.—/our. Cutan. and l’en. ZX2 seases. COCAINE IN PERITONITIS.—The distressing pain and vomit- ing of peritonitis may be promptly checked by a suppository containing one grain each : extract of opium, cocaine hydro- chlorate, and iodoform. It will be safe to use one suppository per rectum four hours apart, if the patient is closely watched for toxic effects, which may be noted by cold extremities and en- feebled heart action. The writer was led to the employment of the above on the theory of the malignancy of the affection and reversed peristaltic action of the bowel in peritonitis, and the well-known anesthetic properties of cocaine on serous mem- branes. Alimentation should be temporarily suspended, and enema must be avoided until vomiting is checked. J. G. Kiefer, M. D., in A ansas City Med. Andear. CHANCROIDS—ORIGIN OF.—Dr. R. W. Taylor reports (//ed. AVews) the case of a healthy young man free from gonorrhea or syphilis, who consulted him for seven true chancroids in the balano-preputial sulcus. The woman with whom he had cohab- ited was free from any such trouble; and his examination of her showed nothing but a deep and highly ulcerated fissure of 418 SELECTIONs. the OS uteri, surrounded by an area of intense hyperemia. Brownish, gelatinous pus escaped profusely from this ulceration. On inquiry it was learned that since this woman had had a child, Seven years before, she had leucorrhea most of the time, and that four weeks before this examination she had been taken sick with what was called peritonitis. She remained three weeks in bed, and then, on getting up, indulged freely in sexual inter- course with this man, at the same time drinking large quantities of wine. The result was that he became affected with chan- croids, and she suffered greatly from pelvic pain. The AVew York Medical /ournal says : Here, then, is a case in which, in consequence of an acute attack of peritonitis, together with sex- ual excess, a discharge from a subacute inflammation becomes converted into a more active form of pus. The important clin- ical fact brought out by this case is in direct accord with the re- sults of inoculation experiments which have been made by various observers with pus from acne, ecthyma, impetigo, scab- ies, etc., in which lesions were produced in no way distinguish- able from chancroids. The lesson taught by this case is that it is easy to see how a physician, ignorant of the fact, might cruelly wrong innocent women. Syphilitic women who are en- tirely free from specific lesions of the genitals often have a puru- lent vaginal secretion which is rich in pyogenic microbes, and which is capable of producing chancroids in men ; while, on the other hand, it is not unusual for men to cohabit with impunity with women having an old and extinct chancre and chronic chancroids. There are not a few medical men who think that, because chancroid is classed as a venereal disease, it must of ne- cessity originate in sexual contact, yet in many cases this sup- position is not correct, for, says Dr. Taylor, chancroids may originate in some subjects de novo. In other words, chancroids may develop in men who have had no sexual intercourse what- ever, as a result of some diathetic condition or some contamina- tion of herpetic vesicles, chafes, abrasions, or fissures. This was pointed out by Dr. Lloyd some years ago. He found that a large number of penile discharges, though sexual in origin, were not specific. Many penile sores of sexual origin were neither chancres nor chancroids. Idiosyncrasy, in his opinion, played a great part in the contraction of venereal disease.-Med. Stand- ard. - - CORRESPONDENCE. AAV AAEAEAE A/L 7TO THE MEDICAL PROFESSION, AºA'OM 7TA/AE /OA: C/S/OAW OA’ 7A7A, 7A O.S 7TAZAZS OA’ CO/C OA/A O.S MAZZO/CA/L CO/C/A2 GAZ. BY N. R. COLEMAN, M. D., COLUMBUS, OHIO, Professor of Diseases of Women and Children, and of Physical Diagnosis, and Secretary of the Faculty of Columbus Medical College (Resigned). 7 o’ the Editor of COLUMBUS MEDICAL Journal : Has the board of trustees of a medical college a right to graduate candidates who have not been recommended by a majority of the faculty? Has the faculty of a “regular” college the right to graduate men whose preceptors are irregular and not recognized by the medical profession or entitled by its rules to professional standing or recognition, or who practice some “ism” in medicine 2 Is it to the best interests, honor and purity of the regular profession of medicine, to graduate men whose credentials are not up to the full requirement set forth in college catalogues and in accordance with the medical ethics of the profession ? - A recent occurrence in the Columbus Medical College, of this city, and many letters received by the writer in reference thereto, have suggested these interrogations. At a faculty meet- ing on February 27th, the work of voting on the passage of candidates went along smoothly until the name of a student from Illinois was reached. I, being the secretary, called the attention of the Faculty to the fact that said student’s creden- tials did not meet the requirements of the College, inasmuch as his previous course of lectures had been at an eclectic college, and that his preceptor was an eclectic, and that therefore, accord- ing to our requirement, which says that a candidate must have studied three years “under the direction of a regular practitioner of medicine,” the student was not eligible for graduation. Dr. Hyatt, of Delaware, Ohio, (Professor of Chair of Practice,) took the floor and urged that he be allowed to graduate, as his grades were up to the requirements of the College, and he had not been notified, but allowed to go on to the close of the term. s (I here want to state that, as Secretary of the Faculty, I had, about the first of February, prepared notifications for said student and another, informing them that they would not 4 IQ .42O CORRESPONDENCE. be eligible for graduation, and requested the Dean, Dr. J. W. Hamilton, to allow me to serve them, to which he would not consent. This request was made several times. I further want to call attention to the fact that before the holidays, there was a student discovered in the class who had been a practicing eclectic, and at a Faculty meeting on December 15th, I received a note from Dr. Charles S. Hamilton, Professor Chair of Surgery, re- questing me to call the attention of the Faculty to it. I did so ; the matter was thoroughly discussed, the candidate brought before the Faculty, we agreed that he was not eligible for graduation, and a motion was made that he be rejected, which 1motion was unanimously carried. On the 24th of December, there was another Faculty meeting, called by request of Dr. J. W. Hamilton, Dean, who was not present at the meeting on December 15. At this meeting, Dr. Hyatt at once brought up the matter of the rejection of the student above referred to, objecting thereto, and on motion, the action taken on December I5th was rescinded, and he was -allowed to go on with the graduating class, all the Faculty present voting to reinstate, except myself. I objected to this unjust procedure, claiming that it was to allow him to go on and finally to reject him, as he could not, according to our requirements, graduate. I simply introduce this to show the inconsistency of Dr. Hyatt's plea for previous notification, as I have always been opposed to de- ceiving men. A single word of explanation may be in order at this point: In our school—and I presume the same custom prevails everywhere — students matriculate in the office of the Dean, Dr. J. W. Hamilton, and he alone, if anyone, would know of any irregularities. “Credentials” are called for soon after the Holidays, and it was at this time that I, and I presume most or all of the other members of the Faculty (except perhaps the Dean), first became aware of the irregularities in the cases of said students. Candidates and their preceptors are supposed to understand the English language, and to know whether or not they comply with the College requirements.) After Dr. Hyatt had finished what he had to say, I called the Faculty’s attention to the violation of their own require- ments. The matter was then passed over without a vote being taken, and all went smoothly until the name of another student was reached. I then informed the Faculty that said student's credentials were not up to the requirements of the College, as his certificate of term of study was signed by his preceptor, who was “irregular ’’ in his practice, advertising in the daily papers, with CORRESPONDENCE. . 42 I a cut of himself in connection with his advertisement, all of which was in gross violation of the ethics of the profession. Dr. Hyatt again took the floor, and advocated the passage of the student, adducing as argument that his preceptor, bad graduated at a regular college, and he, the student, had read the regular text books and attended a regular college, and was not familiar with medical ethics; and further, that his preceptor was a member of the Central Ohio Medical Society, and the Faculty should have notified him, the student, before this that he was ineligible for graduation. He also stated that he feared the student could obtain his diploma by law, and that he was in favor of his graduation. - I took the floor and informed the faculty that his pre- ceptor was not a member of the Central Ohio Medical Society, as he had forfeited his membership by non-payment of dues, and that it was well understood that he would have been expelled, but for the fact that two members of the committee appointed to investigate his case thought it best to allow his membership to lapse rather than expel him, lest he would raise the cry of per- secution. I further stated that his preceptor had been engaged in what is termed “irregular practice” during the entire term of his studentship, and that we could not admit him to graduation without violating the very first sentence of the requirement in our catalogue; that if he did not understand medical ethics, he should understand the plain requirements in our catalogue, which are inserted for the enlightenment of persons seeking information upon that particular point. - - Dr. Hyatt had stated that we had graduated a man last year who had studied with, and whose certificate of time of study was signed by, an irregular or advertising quack, and that thus we had established a precedent. In reply to this, I said I was very sorry, and that it had occurred through the negligence of the one having in charge the credentials of the graduating class, who had failed to report it to the Faculty, as I for one knew nothing of it, and that the committing of one sin did not justify another, and that we should repent, ask forgiveness and sin no more. But in the case then under consideration, we all thor- oughly understood it, and there would be no excuse for our committing another wrong. . i In reference to the legal aspect, I said, let him go to law, and if he can obtain his diploma from that source, that will exonerate us and place us upon a firm basis in the line of the bet- ter medical colleges, I pledged myself to meet all the expenses 422 CORRESPONDENCE. that might arise in the course of such legal proceedings, to take charge of the trial, and to free the College from all danger or dam- age, if only they would not trample under foot what I believed to be 11ecessary to sustain our honor and integrity. (In reference to his not having been previously notified, the reader has only to refer back to the case of the student, where I cited the fact of his being rejected at one meeting of the Faculty, and that he was reinstated at another. So that plea is futile and unjust in the extreme. I also stated that if we graduated a man coming from an irregular source, as this student did, it would be better for us to do away with all requirements, and grant diplomas to all applicants. I urged that we should use extreme care not to violate our own requirements, and that it was not to the interest, the honor and the purity of the profession to graduate men who Had studied with irregular physicians. * During all this argument between Dr. Hyatt and myself, I was not aware how members of the Faculty were going to vote, but I implored them to stand by the honor of the profession and of the College. Finally the case came to a vote, restfiting as follows: Those voting in the affirmative, or to pass, were Drs. Hyatt and Pearce; those voting in the negative or to reject were Drs. W. D. Hamilton, Jewett, Barnhill, Eis, Blake, C. S. Hamilton and Coleman ; J. W. Hamilton, the Dean, did not vote. The chair declared the student rejected. There were two other men to whom I called the Faculty's attention, who had attended their only previous course of lectures at the Medical Department of the University of Wooster last summer. One failed to pass his examinations, but the other passed and was graduated. - We then returned to the case of the Illinois student, and after a brief discussion his case was put to a vote. Those voting in the affirmative, or to pass, were Drs. Hyatt and Pearce, and those voting in the negative, or to reject, were Prof. Eis, Drs. Barnhill, W. D. Hamilton, Jewett, Blake and Coleman. Dr. J. W. Hamilton, Dean, declared him rejected. - This closed the meeting. I was directed to call a Faculty meeting for Tuesday, March Ist, at IO A. M. When the Faculty convened, Dr. Hyatt introduced a protest signed by himself and Dr. Pearce, of Urbana, (Chair of Obstetrics,) protesting against the rejection of the student, as follows: PROTEST-This protest is in relation to the action of a majority of the Faculty in refusing to pass Mr. , On a claimed defect in the certificate of time of study given by his CORRESPONDENCE. 423 brother, a practicing physician, Columbus, Ohio. Said defect relates entirely to the party gºvzng the certzftcaſe, and not the candidate's time, based on the fact alone that the said Dr. — is now, and has been for some time, practicing quackery, and hence not a regular physician. Dr. —'s studies were regular, he graduated at a regular medical college, and is now a member of the Central Ohio Medical Association. The candi- date, Mr. —'s studies were regular, z. e., he studied the regularly recognized text books, and knew nothing in regard to the ethics of the profession, and did not know but that his brother’s certificate was all that was necessary covering the time of study. He has attended two courses of lectures in Columbus Medical college, and stands very high as a candidate in scholar- ship—his grades in all the departments much above the average —being one of the three of the whole class of fifty-nine, who re- ceived the grade of Zoo in practice of medicine. Moreover, nothing can be said justly against his moral character, the whole ground for rejection being based, therefore, on the fact that his brother (who gave the certificate of ſºme of study) is now practicing in an irregular way. Again, it has been known by the Faculty, or part of them, for two years past, that Mr. was studying with his brother, and at the commence- ment of the term now just closing, entered as a candidate for graduation (without remonstrance on the part of the Faculty), and now as he stands at the threshhold of the profession, well qualified to enter, the door is shut in his face. Shall he be made to answer for the sins of his brother ? - We therefore most earnestly enter our protest against the rejection of Mr. -— , by a part of the Faculty, on such a pre- text. We profesſ, secondly, because (in our judgment) it is an . act of injustice to the candidate, an injustice to the College, an to ourselves, individually, as teachers. . (Signed) E. H. HyATT, M. D., - e Chair of Practice of Medicine. H. C. PEARCE, M. D., - Chazr of Obs/e/rzcs. After readlºg his protest, Dr. Hyatt moved to have the vote rejecting Mr. … — reconsidered, but his motion was declared out of order as only one voting with the majority could move a reconsideration. Finally, after considerable discussion, Dr. Blake moved that Dr. Hyatt be allowed to have his protest spread upon the minutes. This motion resulted in a vote in 424 CORRESPONDENCE. the affirmative of all the members present, except myself. I then asked the privilege of having my protest spread on the minutes beneath that of Dr. Hyatt, which was granted. - Dr. Hyatt, having thus been defeated in every attempt, and by an overwhelming majority, to have the student graduated, then arose to his feet and declared his intention of taking the matter before the Board of Trustees. I told him that it was very unkind, unjust and cowardly to fortify himself behind the Board of Trustees, a body to which I did not belong, and where I could not have the privilege of defending my belief and con- victions in this case, and asked to be granted the privilege of being present at that meeting. This request was granted. I then inquired as to the hour the Trustees would meet, but could get no definite answer. On leaving the College, I requested Dr. W. D. Hamilton, who had stood by me during the entire struggle, to be with me at the Trustee meeting, that he might hear what was said. I returned to my office, and at about fifteen minutes to three o'clock, was informed by telephone that the Trustees were in session and waiting for me. I hurried to the College as rapidly as I could, When I entered, W. J. Clark, one of the Trustees, was on the floor, advocating the passage of the Illinois student. I supposed that they had just commenced their work, and when he got through, I requested the President of the Board of Trustees, Rev. Dr. Moore, to grant me the privi- lege of the floor, which he did. I then and there recited care- fully the dangers of graduating any man whose course of study had been with an irregular practitioner, and whose previous course of lectures had been at an irregular college, informing them that we were violating the very first requirement of our catalogue, as well as the code of ethics governing the American Medical Asso- 'ciation, and also the rules adopted by all well regulated Medical Colleges. I reminded them that ten years previous there had been an irregularity committed in the College, in the graduation of a West Virginia student, and that I hoped they would not do anything that would bring about as disastrous results as did that. I further stated before the Board of Trustees, that if they graduated this student from Illinois, it would, in my judgment, very seriously damage the standing of the Institution, and would render the diplomas of our graduates, in States where there are Boards of Health and where Medical Law is right, utterly worthless. I begged of them not to make any mistake of that kind. \ , , The Trustee opening the debate followed me; after him, Dr. W. D. Hamilton called the attention of the Trustees to the CORRESPONDENCE. 425 same things that I had recited, and most earnestly urged them to make no mistake in the action they were about to take, par- ticularly in graduating men who were not, in our judgment, eligible. - . When he sat down, the President of the Board, to my great surprise, stated that the motion before the house was the passage of both students. The question was called for, and by the votes of Drs. Hyatt, Pearce, and J. W. Hamilton, Dean, and Mr. W. J. Clark, was declared carried. (The Board of Trustees consists of seven members: Rev. Dr. Moore, President; Dr. J. W. Hamilton, Secretary; Drs. Hyatt and Pearce, and Messrs. Clark and Sessions and Rev. Dr. Gladden. They were all present except Messrs. Gladden and Sessions.) You can imagine my surprise, after having been promised by Dr. Hyatt, the privilege of being heard before the Board of Trustees on the case of the second student, at not being permitted to utter one word in behalf of the action of the Faculty. I arose, passed the Secretary’s book over to Dr. J. W. Hamilton, told the Trustees that I was extremely sorry that they should have taken such action as they did ; that the action, in my judgment, was most dangerous and serious in its nature, and that I feared the result of it. I then withdrew. On the day following, being March 2nd, the Board of Cen- sors having heard of the action of the Board of Trustees, called a session of their body and adopted the following significant preamble and resolution, which will speak and explain itself: “COLUMBUs, OHIO, March 2d, 1892. “At a meeting of the Censors of Columbus Medical College, held at the College, at above date, B. B. Leonard was elected President, and B. F. Hart appointed Secretary. The following preamble and resolution were adopted : - “WHEREAs, It has appeared to the Board of Censors that the Trustees of Columbus Medical College have overruled the Faculty of said College, in admitting to graduation — and —, whom the Faculty had rejected, therefore, A'eso/ved, That the Board of Censors protest against the action of said Trustees, and sustain the Faculty in their action on said and —. Moved by Dr. Battles and sec- onded by Dr. Bolan, that this resolution be adopted. Carried. B. B. Leonard, M. D., Pres’t, West Liberty, Ohio; B. F. Hart, M. D., Sec'y, Marietta, Ohio; W. K. Bolan, M. D., Cumberland, Ohio; H. F. McCoy, M. D., Nelsonville, Ohio; J. W. Comly, M. D., Harrisville, Ohio; W. S. Battles, M. D., Shreve, Ohio.” 426 CORRESPONDENCE. No attention whatever was paid by the Trustees to this action of the Censors, although the Censors are supposed “to guard the portals” of the profession, as witness the following, taken from the college catalogue: - “CENSORS.—Wishing to maintain the most intimate and cordial relations with the profession, and desirous of giving op- portunity for the most searching scrutiny of our work, especially in reference to conferring degrees, the Faculty have selected a Board of Censors, representing most parts of the State, who will be duly notified and requested to be present to witness examina- tions and join the Faculty in passing upon candidates. It is but simple justice that the profession itself, through intelligent and disinterested representatives, should have the opportunity of guarding its own portals against the admission of unworthy or incompetent persons.” - I did not sign the diplomas of the ineligible students, and I am informed that they were not signed by some other members of the Faculty. * - The question arises, have the Trustees the right or author- ity to graduate a candidate who has been rejected by a majority of the Faculty 2 I certainly think not. If they have, then we have reduced the entire system of graduation to a farce. We have simply converted it into nothing but a diploma mill. This case is unprecedented. So far as possible to learn, in all edu- cational institutions, either medical or otherwise, there is not such a case on record. • I contend that it is just as essential that a student’s creden- tials should come up to the full requirements of the College, as that his grade should. Even if the grades of the two students referred to were up to, or even above, the average, that is not sufficient. There are many other things that we take into con- sideration that are just as essential to prepare a man to practice his profession, as are his educational attainments. He must reach this point by a regular course, as prescribed by the rules of the College and the ethics of the profession, and not receive his instruction and education from one who is irregular, or who practices medicine in a way that the regular profession cannot sanction without self-stultification. How can we afford to de- nounce men as irregular in their practice and deny them recog- nition or standing in the medical profession, and then receive and graduate their students P Will not such a course, on the part of any medical college, make respectable that which we de- Inounce, and promote the evil we seek to eradicate 2 It is difficult CORRESPONDENCE. 427 to understand why the Board of Trustees pursued this arbitrary course, usurping power that was not vested in them, trampling under foot the will of the Faculty, prostituting the medical profession, and thereby endangering every diploma that has ever been issued by the Institution, in every State of the Union where there are proper Boards of Health. Dr. J. W. Hamilton owns a majority of the stock of the College, and by authority of law can elect the Trustees. The members of the Faculty opposed to the graduution of said students, entertained no unkind feelings toward them, but sought only the efficiency of the College and the good of our profession, and it is for the medical fraternity and the public to judge of the motives of those concerned in this matter. In an educational institution designed to qualify men for the great and important duties of our profession, those in charge should have no other motive in view than good results to our profession and safety to the lives and health of those who may entrust themselves to our care. t There is another serious question involved, and that is whether such a graduation is legal. Who ever heard of a Board of Trustees assuming to graduate a candidate who had not been recommended by the Faculty P In this case, both students were rejected by a majority of the Faculty, and by so rejecting them, they said these men are not eligible for graduation. Yet, in the face of all this, three Doctors and two laymen took it upon themselves to set aside the deliberate opinion and judgment of the Faculty, and grant diplomas, not on, but against, their rec- ommendation. Can the profession tolerate being dictated to by an arbitrary Board, without contending for its own rights and privileges 2 - I now ask the Medical Profession if the stand I have taken for its honor, dignity and purity is right 2 The facts have been faithfully placed before you; it is for you to judge if any Med- ical College can graduate men coming from irregular sources, and yet maintain its position and dignity as a reputable institu- tion of learning. If not, we hope you will be as bold, outspoken and determined as our noble Board of Censors, who have in their protest, in most emphatic 1anguage, declared against such irreg- ularities. It is for the medical profession to remedy such great evils, and take all necessary and legitimate measures to prevent a repetition of such conduct, no matter whether the same may come from selfish motives of men who have not the highest interest of the profession at heart, or from lax notions of discip- line and requirements, injurious to our profession and dangerous to the public. 428 - CORRESPONDENCE. SUMMARY. - 1st. Has the Board of Trustees of a Medical College the right to graduate candidates who have not been recommended by a majority of the Faculty P . 2nd. Has the Faculty of a regular College the right to graduate men who have studied under, and whose credentials are signed by, those who are ordinarily denominated irregular, or who practice some “ism” in medicine P - 3rd. Is it to the best interest, honor and purity of the regu- lar profession of medicine to recommend and urge the gradua- tion of men whose credentials are not up to the full requirement set forth in college catalogues, and in accordance with the ethics of the profession ? . 4th. Was the position taken by Drs. Hyatt and Pearce, and sustained in the Trustee meeting by Dr. J. W. Hamilton, in urging the graduation of men who were not eligible, according to the published requirements of their own catalogue, for the best interest of the College and the profession at large, and were they justifiable in taking such action ? 5th. The Board of Censors consists of medical men who are ripe in years of experience, and who stand in the front rank of their profession ; were they right in their thoughtful, determined, and conscientious act, in condemning, in clear and most emphatic language, the action taken by the Board of Trustees 2 6th. The position taken by me in this lamentable affair is purely one of principle and honor; if that position is correct, and for the best interests of the medical profession, let medical men give it their most earnest and sincere approval, and take such measures as their wisdom and judgment may suggest to prevent a recurrence of such an improper and unwarranted exercise of power. - º I have heretofore expressed the opinion that the action of said trustees was not authorized by custom or law; in support of my judgment and opinion in reference thereto, I here call attention to Section 3726 of the Revised Statutes of Ohio, as follows: “Sec. 3726. The Trustees of a College, University, or other institution of learn- ing, incorporated for the purpose of promoting education, religion, morality or the fine arts, which has acquired real or personal property of the value of five thousand dollars, and which has filed in the office of the Secretary of State, a schedule of the kind and value of such property, verified by the oaths of the Trustees, may appoint a President, Professors and Tutors and any other necessary agents and Officers and fix the compensa- tion of each, and may enact such By-laws, 11ot inconsistent with the Laws of this State, or of the United States, for the government of the institution and for conducting the affairs of the corporation as they may deem necessary ; and may, ON THE RECOMMENDA- pron OF THE FAcurry, confer all such degrees and honors as are conferred by Colleges and Universities of the United States, and such others having reference to the course of study and the accomplishments of the student, as they may deem proper.” THEMOSTPERFECTFORMOFDOSIMETRY IS AFFORDED EY The term Parvule, from Parvum (small), is applied to a new class of remedies ‘(Warner & Co.'s) in the form of minute pills, containing minumum doses for frequent repeti- tion in cases of children and adults. It is claimed by some practitioners. that small doses, given at short intervals, exert a more salutary effect. Sidney Ringer, M. D., in his recent works on Therapeutics, sustains this theory in a great variety of cases. Parvules of Calomet, 1-2O Med. Prop.–Alterative, Purgative. - DOSE.-1 to 2 every hour. Two Parvules of Calomel, taken every hour, until five or six doses are administered (which will comprise but half a grain), produce an activity of the liver, which will be followed by bilious dejections and beneficial effects, that twenty grains of Blue Mass or ten grains of Colomel rarely cause, and sickness of the stomach does not usually follow. Parvules of Calomel and Ipecac. R. Galomel, 1-10 gr. Ipecac, 1-10 gr. Med. Prop.–Alterative, Purgative. DOSE,-1 to 2 every hour. Two Parvules of Calomel and Ipecac, taken every hour until five “Or Six doses are administered (which will comprise but a grain of Calomel), produce an activity of the liver, which will be followed by bilious dejections and beneficial effects, that twenty grains of Blue Mass or ten grains of Calomel rarely cause, sickness of the stomach does not usually follow. T’arvules of Aloin, 1-10. Med. Prop.––A most desirable Cathartic. The most useful application cf this Parvule is in periodic irregularities—Dysmenorrhoe and Amenorrhoe. They should be given in doses of one or two every evening at and about the expected time. DOSE.-4 to 6 at once. This number of Parvules, taken at any time, will be found to exert an easy, prompt and ample Cathartić effect, unattended with nausea, and in all respects furnishing the most aperient and cathartic preparation in use. For habitual constipation, they replace When taken in single parvules the various medicated waters, avoiding the quantity required by ...the latter as a dose, which fills the stomach and deranges the digestive orgais. Parvules of Podophyllin, 1-40. Med. Prop.–Cathartic, Cholagogue. Two Parvules of Podophyllin, administered three times a day will re-establish and regu Tate the peristaltic action and relieve habitual constipation, add tone to the liver, and- invigorate the digestive functions. Parvules of Arsen it : Patash, 1-100. (WARNER & Co.) - - This Parvule will be of great use to physicians, as two Parvules represent the equivalent of one drop of Fowler’s Solution, so that physicians can regulate the dose by giving one or more Parvules every hour. Parvules of Corrosive Sublimate, 1-100. (WARNER & CO.) Dr. Ringer, in his treatise, lays great stress upon the efficacy of minimum doses o corrosive sublimate in the treatment of Diarrhoea, whether the stools contain blood or not. Parvules of Nux Vonnica, 1–50. (WARNER & Co.) Nux Vomica, according to Ringer, is possessed of real curative powers for sick headache, accompanied with acute gastric catarrh, whether due to error in diet, constipation, or no apparent cause. He regards it, administered in small and frequently repeated doses, as useful in many disturbances of the gastric functions. W. H. WARNER & Co., Philadelphia. 3 * ...?' ". .º *...* * × - - º º º: , , , ś ‘’’. tº º & ºrgº... : / *a********s - . ' ' That Springtime is the rejuvenating season is a fact to which all Nature bears testimony, and that it should be such for the human family is a proposition in the form of a truism. The only question which can arise in this connection is involved in the consideration of the * - Means to the End. The rejuvenation of vegetable life takes place through the renewed activity of a true form of digestion, and it has been well said that the most Rational System of Jºſedicine For animal life is that which aims at Medication through Alimentation. Hence, various forms of partly or wholly digested foods, etc., have come into vogue, which, however, neither in flavor or appearance are Calculated to Provoke an Appetite. The practitioner who has used Forbes’ Diastase Finds that his patients gain in weight, and that the general functions of the system rapidly assume a perfectly normal condition as the result of its influence upon Palatable Every-Day Victuals, Absolutely compelling complete digestion, at the time and under the circumstances, w Peculiar to Natural Processes, As evidenced by the 3 ndition of the excrements. Why P Simply because the FORBES’ DIASTASE is a Certain and Uniform Digestive Agent, Exercising upon ingested food the same triple influence which forms the basis of plant nourishment. - The Forbes’ Diastase IS CERTAIN because it exactly replaces those elements which are weak or deficient in The Natural Digestive Tract, IS UNIFORM because it is made so by controlling arrays which determine absolute value. The Standard. One grain of FORBES’ DIASTASE will convert a jelly containing 60 grains Bermuda Arrowroot in two fluid ounces of water at a temperature of 140° to 150°F., into a thin watery solution of assimilable carbo-hydrates in 3 to 4 minutes. In 30 minutes, at the same tempera- ture, it will have formed between 4 and 4.25 grains of sugar, or four times its weight. *ample Bottle sent, charges paid, to any physician addressing THE FORBES DIASTASE Co. CINCINNATI, OHIO. t EDITORIAL DEPARTMENT. J. F. BALDWIN, M. D., Columbus, - . - - - - - - EDITOR. J. E. BROWN, M. D., Columbus, - - - - - - ASSOCIATE EDITOR. Communications, reports, etc., are solicited from all quarters. • Authors desiring reprints, will receive fifty, free of charge, frozided the request for the same accom- panies the article. Subscribers changing their location, are requested to notify the Publishers Aromptly, that there may be no delay in receipt of the journal, stating both the mezy and the former post-office address. - We have no authorized Collectors, except such as carry properly made out bills, countersigned by the A'ublishers. t THE COLUMBUS MEDICAL PUBLISHING CO., - CoLUMBUs, OHIo. The Medical Bill which was introduced by Doctor Sterritt into the House, and afterwards modified by the Medical Socie- ties of Cincinnati, met with most disastrous defeat when brought to vote, as was anticipated by those of us who have been more or less connected with Medical Legislation during the last ten or fifteen years. The campaign was somewhat different this year from those of preceding years, as a number of influential papers throughout the state favored the Bill; notably, the Cincin- nati Enquirer, the Cleveland Leader, and the Cincinnati Times- Star. A number of papers opposed it, with their usual mendac- ity, notably, the Ohio State Journal, Cincinnati Commercial Ga- zette, Columbus Evening Dispatch, and Toledo Blade. It is quite generally understoºd that the newspaper publishers of Ohio have formed a combination, whose object is to defeat, if possible, legislation tending directly or indirectly, immediately or remotely, to limit, in any degree whatever, their advertising patronage, and although there is nothing in the bill this year related at all to the matter of advertising, the probability is the papers still thought they saw a cloud no larger than a man’s hand in the bill, and hence fought it. Those of us who have tried to present to the people the other side, through the col- umns of these papers, know that any communication in favor of these bills is immediately rejected, even if compensation is offered for the insertion of the same at full advertising rates, Any ignoramus or quack may insert any article that he pleases, no matter how full of falsehoods, with perfect freedom, but noth- ing on the opposite side, under any circumstances, can be pre- sented to the people. Of course all this is unfortunate for the profession, but the newspapers are slowly but surely, by just 429 430 g EDITORIAL. such methods, losing their influence with the people, and the time is surely coming when their opposition will no longer be of any avail. - The members of the legislature who were most obnoxious and insulting in their fight against the bill are, Price, of Hock- ing county, Doty, of Cleveland, James, of Wood county, Ely, of Fulton county, and Baird, of Ashland. It is to be hoped that the physicians living in the districts represented by these men will see to it that they are retired to private life at the first op- portunity. Legitimate opposition is not to be objected to, but the insulting attitude of these men places them beyond the pale of any courtesy. The officers of the Pan-American congress are pushing the affairs of the congress very actively. The officers chosen are Wm. Pepper, of Philadelphia, President, A. M. Owen, of Evans- ville, Treasurer, and, of course, Charles A. L. Reed, of Cincin- nati, Secretary General. The officers have recently had the Congress incorporated under the laws of the State of Ohio, and it is expected that Government will make a proper appropriation to meet the pecuniary needs of the Congress, at least in part. We understand that Senator Sherman has consented to intro- duce a bill for that purpose in the Senate. It is fortunate that Doctor Reed is at the head of affairs. We know of no man who possesses in a larger degree the necessary energy and ability for filling the most important office of Secretary General. Dr. C. Pancoast Gailey, who, with the writer, graduated from the Jefferson Medical college in 1874, and who is a rela- tive and former protege of the late Prof. Joseph Pancoast, of that institution, is visiting the various hospital clinics of Phila- delphia, exhibiting his remarkable powers as a physical diag- nostician. Dr. Gailey is entirely sightless, and depends exclu- sively upon auscultation, percussion and palpation, which signs He has cultivated to a wonderful degree. His diagnoses are ex- peditiously made and are very clear. Prof. Shoemaker of the Medico-Chirurgical college writes: “Dr. Gailey is able to de- tect the most difficult diseases of the lungs and heart, and at our clinics diagnosed and treated with great scientific precision the most intricate affections of the chest. His keen special senses and his thorough knowledge of pathology and therapeutics must assure those placing themselves under his treatment that they are in the hands of a skillful and scientific physican.” & 6 For Threatened Abortion Dysmenorrhoea \Anti-Spasmodic Rea. Vibur. Prun 0pul. ** Aletris Far, ** Helion, Dios. “ Mitch. Repens gr.9% Caulophyllin - gr. 1 gr. gr.9% gr.9% gr. 4 A. º YuTERINE" 13 TONIC COMP. TH. K. MULFORD COMPANY TABLET WIBURNUM C RELIABLE/ Philadelphia A Onvenient W Elegant Easily - Swallowed, For f AMENORRH(EA LEUCORRH(EA Anodyne 100 of these TABLETS sent on receipt of 65 CENTS Mention this Journal Doctor, This Will In - --~~~~ terest YOU1 That you may become acquainted with the merits of our preparations, we will furnish you for $3.00, with a handsome, double Morocco Pocket Case, containing 24 vials, filed with the following complete assortment of Tablets and Triturates. No. 2 § asſº ! - Size, 7%x3%x% inches. Price, $3.00. All vials in this case are fitted with screw caps. We would call especial attention to our Tablets Hypophos, Quinia Comp. cum Creasote, which are superior to syrups and solutions, owing to absence of sugar and free acid. JH. K. MULFORD & CO. Tr. aconite, 1-2 minim. Tr. belladonna, 2 minim Nitro Glycerine Comp. (M. & Co's.) Cascara com.(M. & Co.) Ammon. Mur. comp. Calomel, 1-10 grain. Calomel, 2 grains. Calomel, ipecac & soda bicarb, No. 1. Dover’s Powder, 2% gr. Fever (Dr. T. G. Davis) Hydrarg. Iodine Virid, 1-4 gr. Iron, Arsenic and Stry- chnia. Hv pophos Quinia comp. Creasote. Acetaliilid, 2 grains. Morphia Sulph., 1-6 gr. Zinc Sulpho-carb., 1 gr. Acid Arsenious, 1-60 gr. Bismuth et Cerii Oxalat Kermes Mineral comp. Paregoric, 10 minim. Strychnia, 1-60 grain. Quinia Sulph., 1 grain. Corros. Sublimate, 1-40 grain. Factors of Compressed Goods and Pharmaceutical Preparations, Write for Complete List, mentioning this Journal. PIH III, AI D EI LP). H II.A., Syr. Hyppº. CO., Fellows Contains the Essential Elements of the Animal Organization—Potash and Lime; - The Oxidisling 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 Slightlv Alkaline Reaction. It Differs in its Effects from all Analogous Preparations; and it possesses the important properties 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 deseases. Its Curative Power is largely attributable to its stimulant, 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 directly into the circulation with the food products. The prescribed dose produces a feeling of buoyancy, 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. INOTICE—Cºltſ'TION. The success of Fellows' Syrup of Hypophosphites has tempted certain per- sons 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 wrap- pers surrounding them) bear, can then be examined, and the genuineness—or otherwise—of the contents thereby proved. ./edica? Zellez's may be addressed £o Mr. FELLOWS, 48 Vesey Street, New York. EDITORIAL. 43 I EMINENT AMERICAN PHYSICIANS AND SURGEONs.—Dr. R. F. Stone, of Indianapolis, the well-known author of a work en- titled Elements of Medicine, has undertaken the publication of a book to contain brief biographical sketches of eminent American physicians. Our readers may recall the fact that a physician named Atkinson, of Philadelphia, issued a somewhat similar book a number of years ago. Dr. Stone's work is designed to be as complete as possible, and to embrace the entire territory of the United States. Such a book, if properly gotton up, and most judicially edited, will prove of value to the profession. At- kinson's book was gotten up to make money for its author, and from its appearance seems to have undergone no editorial super- vision whatever. It is filled with the most ridiculous fables and exaggerations. In a personal letter received from Dr. Stone, he assures us that he intends to exercise his editorial prerogative with great care, and from his standing in the profession, and his wide acquaintance with the eminent men of our profession,and the need that exists for such a book as he proposes, we predict for the book an eminent degree of success. It will be illustrated with photo engraved portraits of many of the men whose sketch- es will appear. — - EMBALMING FLUIDS.—The custom of embalming bodies before burial is becomiug more common, and the old fashioned ice-box is seldom used in cities. The fluids used for embalming purposes are usually strong solutions of arsenic or of corrosive sublimate, or of both. In ordinary cases, the use of embalming fluids is unobjectionable, but in some cases of death by poison- ing the use of such fluids would render detection and conviction of the criminal parties difficult, if not impossible. Even if the fluids are not injected into the blood vessels, but are simply placed in the cavities of the body, it is well known that within a few hours post-mortem diffusion occurs, and then the arsenic may be detected in all parts of the body, even as remote as the brain. & This point was emphasized in a case that recently occurred in Dayton, and in which the writer was subpenaed as an expert. The defendant was charged with murdering his wife by frequently repeated small doses of ammoniated mercury, white precipitate. No suspicions were aroused until after the death of the woman, and after her body had been embalmed by injecting into the brachial artery a fluid containing large amounts of arsenic and considerable quantities of corrosive sublimate. The chemical 432 EDITORIAL. analysis made by the State's chemist was wretchedly performed, so much so as to be absolutely worthless, or even worse than worthless. A second examination of the body, some weeks later, revealed white precipitate in the rectum and in the phar- ynx. All the abdominal viscera, and the rest of the intestinal 'canal, had been destroyed by the first chemist in making his so- called “examination,” hence the second chemist who was called into the case had to limit his examination to the portions named, and which had not been removed from the body at the first au- topsy. At the trial the question arose whether the corrosive sublimate known to have been injected could, during the process of mortification of the body, have become converted into the am- moniated mercury. Opinions differed somewhat at this point. The jury, however, brought in a verdict of manslaughter—an obviously absurd verdict, as the defendant was either innocent or else guilty of a most cool and deliberately planned murder. Some years ago, Keen, of Philadelphia, advised the use of a solution of chloral in the preservation of bodies desired for dis- section. If chloral will answer for the preservation of anatom- ical material, it would certainly answer admirably for the pres- ervation of bodies previous to burial. It would seem as though it would not be out of place to forbid by law the embalming of bodies, except under some special circumstances, by the use of any fluid containing either arsenic or corrosive sublimate. THE NECESSITY OF STATE MEDICAL ExAMINATIONs.—The salutary effects of State medical examinations are forcibly illus- trated in the report of the Medical Examing Board of the State of Washington. Of thirty applications for authority to engage in the practice of medicine, fifteen were rejected. The questions asked were of such a nature that only the incompetent could fail of the requisite average. The report is but a repetition of like re- ports that have emanated from other States. As a result of restric- tive medical legislation, not only is the number of successful ap- plicants reduced, but the actual number of original applicants is also diminished. It is the imperative duty of the State to afford the community adequate protection, from the devices and in- trigues of quacks and adventurers, with whom reputable men and women cannot compete.—Med. AVews, A WEGETABLE ALTERATIVE # TONIG AUSES THE ELIMINATION OF SPECIFIC BLOOD Poison, the repair of wasted and disorganized tissues, and the restoration of the vital forces to their normal activity. In the treatment of Syphilis it supercedes the use of both Mercury and Iodide of Potassium, and is a reliable remedy for the evil effects pro- duced by the excessive use of these drugs. It is also specially indicated in all Scrofuſbus Affections, and is invaluable in the treatment of Eczema and other Skin Diseases, in Chronic Rheumatism, Old Chronic Ulcers, etc. Formula—Verrhus Clemiana is a Compound Fluid Extract of Clematis Erecta, Prinos Verticillatus, Fraxinus Americana and Rhus Glabrum, with 9% of one per cent. of Venanatic Acid, C H2 O2. Dose –A teaspoonful in water, gradually increased to a tablespoonful, three or four times daily. Prepared Only by THE CLEMIANA, CHEMICAL COMPANY., ATLANTA, - - GEORGIA. Elastic Hosiery & Supporters sº Elăşti, RIlliBT, Bºší Šilk || Lillåll, *= TWO (2) NEW L00MS JUST PUT IN. Hereafter can make and fill Special orders day after receipt. Our motto will be QUALITY. E. M. HESSLER SURGICAL INSTRUMENT CO., 57 and 59 Euclid Avenue, GLEVEL" ND, OHIO. N. B.-The Manufacture and Fitting of Deformity Apparatus, Artificial Limbs and Trusses, a Specialty. Bind All Your Papers at DmCB, According to Robert Louis THE KLIP IS THE BEST BINDER. Stevenson, “there are men and Adopted by U. S. Government. Put classes of men that stand above on or offin ten sec. the common herd: the soldier, * *: gº.º.º. the sailor, and the shepherd not *", §" $5 per Ioo. Covers | . } * grºss 2 tº ºrder, any style. infrequently; the artist rarely; jºsº. Address rarer still the clergyman; the . H. BALLARD, 29, Pittsfield, Mass. physician almost as a rule. 16 “I believe that Ponca Compound has a more decided alterative action upon the uteruse and uterine mucous membranes than any known remedy. Under its internal administration I have seen long standing ulcerations heal, foul discharges cease, a spongy, inflamed and enlarged uterus reduced in size and become firm and healthy. In subinvolution it is invaluable, soon relieving such symptoms as headache, backache, sideache, bearing down feelings, bladder troubles, bloated abdomen, indigestion, constipation and many others that are a consequence of this condition.” R. M. HUTCHINS, M. D. FORMULA —-Ext. Ponca, 3 grs. ; Ext. Mitchella Repens, I gr. ; Caulophyllin, 5% gr. ; Helonin, 36 gr. ; Viburnin, Vágr. DOSE :-One Tablet four times a day. 1OO Tablets will be mailed upon receipt of $1.O.O. MELLER DRUG Cſ). 109 & III Walnut St., St. Louis. ALTERATIVE TONIC, THREE CH LORIDES Tafer, Hydrang ETArsenicum, Nº. º FOR.MUL.A.—Each fluid drachm contains: PHOTO-CHLORIDE IRON, one-eighth gr. BICHLORIDE MERCURY, one-hundred and twenty-eighth grain. CHLO RIDE ARSENIC, one two hundred and eightieth grain. - With CALASAYA A LKALOIDS and ARO- MATICS. INDICATIONS.—Anemia, from any Cause, Struma, latent Syphilis, General Debility, Tuberculosis, Malaria, LOSS of Appetite, Habitual Constipation, Chlorosis. Chorea, Chronic Uterine, Pelvic, Zymotic, Catarrhal and Dermatological Diseases. DOSE,--One or two fluid drachms three or more times a day, as directed by the physi- Cian. The prescribed dose of THREE CHLORIDES gives prompt action, produces a feeling of buoyancy, stimulating the appe- tite and the digestion, promoting assimila- tion ; is v ry pleasant to the taste, assimila- ted by the most delicate stomach ; does not constipate. Will not color the teeth, and is harmless under prolonged use. This prepa- ESTBD. ration has stood the test of time and experi- ence, is uniform, unalterable and can be relied upon to produce results. Its use is Indicated in a Wide Range of Diseases. Physicians will please designate 'R. & H. Elixir Three Chlorides. Where a more specific alterative is need- ed, other than increasing the dose Or bichloride, mercury. The physician may add without reservation any of the SOluable Salt8 of iodine or its compounds. Dispensed in twelve Ounce bottles: price, $1.00. MARIoM SIMS Colſ, EGE, ST. LOUIS, *} May 30, 1890. During the past six months I have pre- scribed for the various conditions indicated by the component parts of the mixture of the “Elixir Three Chlorides’’ for more than three hundred recorded cases, and in no instance have I regretted it. I. N. LOVE, M. D., St Louis. The Formula, of this. Compound, will, immediately suggest itself to the thoughtful Physician. 1832. IRENZ & HENRY, IDIFRTDſ G- IIM II FOIERT-IHIFRS LOUISVILLE, KENTUCKY. - To be had of All Leading Jobbers. - 17 Always Uniform — Therefore Always Reliable. and the Purest Wine. º RECOMMENDED FOR NEURALGIA, SLEEPLESSNESS, DESPONDENCY, ETG. FOR FAT!CUE OF MiN D as Or {} BODY. *RINGER recommends Coca T.EAVEs as of great value in % Febrile Disorders, by restrain- a/ "eº $4 #Zºº ing tissue metamorphosis, º: šº’ and for the same reason § in Phthisis. For their decided § Nº. º/ AND º-º-º: anodyne and anti-spasmodic qual- § ºf NWIGORATOR º - ities, they have been successfully §§§ ſº agº &e employed in Typhus, Scorbutus, º º ; * ſº It is £3: šº § Fº §§ ăș/ ſº } Gastralgia, Anaemia, Enteral- § . * . . g º ºs - §§§ gia, and to assist digestion. g #7A, º % § / ºf .6 & ; WINE OF COCA is probably Saft, alſ ſ: ſtain § /4 %; the most Valuable Tonic in the 8 i y º % ºar- * - § being ſº as Materia Medica when properly pre- gº Jºsiºd £% §§§ºpared. With Stimulating and anodyne 3. P. 1 sº # properties combined, WRETCAL F2s 600 CA. § ſº & ſº - § §§ ºſº *Aé ºft "utmost jºi §g a-a * * . ºs * * º º * * * te gº É% Aºndº; ſº WWNE acts without debilitating, being always § ''...}. º wniform and therefore absolutely reliable. For . ARCIIIB Jº — Al AQ QVC tº: & * º º º * “º. § and the flºº Athletes it is invaluable in imparting energy and § “Coca" increases energy, *A. fle ºt removes... drowsiness, enlivens ſº § § the spirits, and makes the con- º' obtain- resisting fatigue; Public Speakers and Singers find it indis- º l pensable as a “Voice Tonic,” because being a “tensor” of sumer to bear cold, wet, great, tº $. able. h l i e * bodily exertion and even want of 6. Yº the Vocal chords, it greatly strengthens and increases the º,§ degree, with QA ºff volume of voice; and to the elderly it is a dependable aphro- - *A Aff disiae, superior to any other drug. lºose of Metearf's, Coca \º Th90dore Metcalf. ESTABLISHED 1837. Frank A. Davidson. Wine.--One-half wineglassfull three . times daily, between meals. Physi- ſº ſ | eians’ sº ºy §§º º: iſºlº | y carriage prepaid, upon the receipt O Rae "zº Tº ollar. 3. - 39 Tremont Street, tº-3 BOSTON, MAss. THE HYPNOTIC. FORMIUR.A.—Every fluid drachm contains fifteen grains EACH oſ Pure Chloral Hydrat. and purified Brom. Pot. and one-eighth grain EACH of gen, ini. ext. Cannabis Ind. and Hyoscyam. - Dos E.-One-half to one fluid drachm in WATER or SYRUP every hour until sleep is roduced. HN isºrross-sleeplessness, Nervousness, Neuralgia, Headache, Convulsions, Colic, Mania, Epilepsy, Irritability, etc. In the restlessness and delirium of fewers it is absolutely invaluable. IT HD DES NOT LO CLK UP 'THE SECRETIONS. PAPINE THE ANODYNE- Papine is the Anodyne or Pain-relieving Principle of 0pium, the Narcotic and Convulsive Ele- ments being Eliminated. It has less tendency to cause Nausea,Vomiting, Constipation, etc. IN D H CATIONS.—Same as Opium or Morphine. tº º Dos E.-ONE FLUID DRACHM--(represents the Anodyne principle of one-eighth grain Morphia.) O D : A THE ALTERATIVE AND UTER INE TONI c. Fort MUL.A.-Iodia is a combination of active principles obtained from the Green Roots of Stillingia, Helonias, Saxifraga, Menispermum and Aromatics. Each fluid drachm also contains five grains Iod. Potas., and three grains. Phos. Iron. ... Dos E —One or two fluid drachms (more or less as indicated) three times a day, before meals. INDICATIONS.—Syphilitic, Scrofulous and Qutaneous Diseases, Dysmenorrhea, Menor- rhagia, Leucorrhea, Ameriorrhea, Impaired Vitality, Habitual Abortions and General Uterine Debility. * CARNRICK's A PRO DUCT OF PURE, SWEET Mi LK, PAE-ATABLE, NUTRET OUS, * EAsi LY Dices.TED, AND when pissolved in water Forms A DE Licious §: FF & RW = $62 tº NTT KU M. YSS.- (Zºzz aep 222 a.27°-22//ºz őožºes, 272 Zapo szzes, 372e £azzez' ſºo/ö/ø/20, s2/7czezzz Zab/ez's yoz' seveze fºye/ye-ozzzzce boſſ?/es, azed. Zhe szza!!er. &2/7tezezeź for 2%z’ee Zape/ve—ozzzzce 602??es of Åzemeyss.) THIS PREPARATION is presented to the Medical profession in the convenient form of Tablets, and will be found superior in every respect to ordinary Rumyss, Wine of Milk, Fermented TViilk, or any similar preparation. KUMYSGEN when prepared for use contains every constituent of a perfect Kumyss. KUWIYSGEN is made from fresh, sweet milk, and contains fully thirty per cent. of soluble casein, which is double the amount found in ordinary Kumyss preparations. KUMYSGEN being in Tablet form, will keep indefinitely, is easily and readily prepared, less expensive than the ordinary variable and perishable Kumyss, and its fermentative action may be regulated at will, thus rendering it available at all times and under all circumstances. Clinical tests gathered from every quarter of the globe attest its special value in all cases of Gastric and Intestinal Indigestion or Dyspep- sia, Pulmonary Consumption, Constipation, Gastric and Infestinal Catarrh, Fèvars, Anaemia, Chlorosis, Rickets, Scrofula, Vomiting in Pregnancy, Bright’s Disease, Intestinal Ailments of Infants, Cholera Infantum ; for young children and for convalescents from all diseases. The casein being finely subdivided, it is especially valuable for all who require an easily digested or a partially digested Food. RUMYSGEN is a delicious effervescent Food-Beverage, relished alike by the sick or well. EUMYS;GEN is tonic, stimulant, diuretic, highly nutritious, easily digested, perfectly palatable, and always permanent and uniform in strength. SAMPLE SENT ON REQUEST. MANUFACTURED BY ERE:ºp & C.A.F.Nº.1:Cº, New º'erle- 19 PROF. R. 0cDEN DOREHUs SAYS THAT From G-FCOIRG-I.A., Contains . . . * * m º ºſ ºn ºn tº ºn wºn tº mºre wºn amamºa ºn ammº sº. tº ºr . . . . d - * *-*. * . . . . . * * * º “ . ; : * > . . . . .'; … º.º. . . ." , *, * * - º * . . . . . . . . . * ** O WHICH THE ESPECIAL ATTENTION OF THE MEDICAL PROFESSION IS CALLED, ARE THOSE WHICH FOLLOW LA GRIPPE AND ITS ALLIED COMPLAINTS. A “BROCHURE” CONTAINING THE PATHOLOGICAL AND PHYSIOLOGICAL ACTION OF ANTIKAMNIA, ALSO ITS USE IN GENERAL PRACTICE, WITH SAMPLES IN POWDER AND TABLET FORM, SENT FREE ON APPLICATION. ADDRESS: THE ANTIKAMNIA CHEMICAL COM- PANY, ST. LOUIS, MO., U. S. A. WHEN PRESCRIB- ING ANTIKAMNIA, SEE THAT THE GENUINE is DISPENSED, INSURING THE DESIRED RESULTs. 5 UTERINE TONIC, ANTISPASMODIG AND ANODYNE. A reliable and trustworthy remedy for the relief of Dysmenorahoea, Amenorrhoea, Menorrhagia, Leucorrhoea, Subinvolution, THREATENED ABORTION, Vomiting in Pregnancy and Chlorosis; directing its action to the entire uterine system as a general tonic and antispasmodic. This combination is the result of an extensive professional experience of years in which the constituent parts have been fully tested singly and in combination in various proportions, until perfection has been attained. DIOWIBURNIA FORMULA:—Every ounce contains 3-4 dram each of the fluid extracts: Prunifolium, Viburnum Opulus, Dioscorea Villosa, Aletris Farinosa, Mitchella Repens, Caulophyllum Thalictroides, Scutellaria Lateriflora. a desertspoonful to a tablespoonful three times a day, after meals, is prepared for prescribing exclusively, and the formula as given will commend itself to every intelligent physician. Virburnum Helonias Dioica. DOSE :-For adults, In urgent cases, where there is much pain, dose may be given every hour or two, ALWAYS IN HOT water. Jno. B. Johnson, M. D., Professor of the Princi- ples and Practice of Medicine, St. Louis. Medical College. St. Louis, June 20, 1888. I very cheerfully give my testimony to the Virtues of a combination of vegetable remedies prepared by a well known and able pharma- cist of this city, and known as DIOVIBUR- NIA, the component parts of which are well known to any and all physicians who desire to know the same, and,therefore, have no rela- tion to proprietary or quack remedies. I have employed this medicine in cases of dysmenor- rhoea, Suppression of the catemania and in excessive leucorrhoea, and have been much pleased With its use. I do not think its claims (as set forth in the circular accompanying it) to be at all excessive. I recommend its trial to all who are Willing to trust to its efficacy, be- lieving it Will give satisfaction. Respectfully, L. Ch. BOisliniere, M. D.. Professor of Obstet- riCS, St. Louis Medical College. St. Louis, June 18, 1888. I have given DLOVIBURNIA a fair tra], and found it useful as an uterine tonic and anti- SpaSmodic, relieving the pains of dysmenor- rhCea, and regulator Of the uterine functions. I feel authorized to give this recommendation of DIOVIBURNIA, as it is neither a patented nor a Secret medicine, the formula of Which having been communicated freely to the medi- cal profession. - <^ CA, 732, s/n , et a haz). H. Tuholske, M. D., Professor Clinical Surgery and Surgical Pathology, Missouri Medical College ; also Post-Gradutate School of St. LOuis. St. Louis, June 23, 1888. I have used DIOVIBURNIA, quite a num- bCr of times—sufficiently frequently to satisfy myself of its merits. It is of unquestionable benefit in painful dySmemorrhoea, ; it possesses antispasmodic properties which seem especi- ally to be exerted on the uterus. A’z A. Z.A.-4-6. To any physician unacquainted with the medicinal effect of DIOVIBURNIA, desiring to try our preparations, and who will pay express charges, we will send on application a bottle free. D OS C H E M CAL CO., ST. LOUIS, M. O. WESTERN PENNSYLVANIA MEDICAL COLLEGE, CITY OF PITTSBURGH. SESSIONS OF 1591-'92. The REGULAR SESSION begins on the last Tuesday of September and continues six months. During this Session, in addition to four Didactic Lectures, two or three hours are daily allotted to Clinical Instructions. Attendance upon three Regular Courses of Lectures is requisite for graduation. A three years’ graded Course is provided. The SPRING SESSION embraces Recitations, Clinical Lectures and Exercises, and Didactic Lectures on special subjects. This Session begins the second Tuesday in April, and continues ten Weeks. The LABORATORIES are open during the Collegiate Year for instructions in Chemistry, Microscopy, Practical Demonstrations in Medical and Surgical Pathology and Lessons in Normal Histology. Special importance attaches to the Superior Clinical Advantages possessed by this College. For particulars see Annual Announcement and Catalogue, for which, address the Secretary of Faculty, PROF. T. W. T. McKENNAN, 810 Penn Avenue. Business correspondence should be addressed to PROF. W. J. ASDALE, 2107 Penn Avenue, Pittsburgh, Pa. FRELIGH’s TABLETs, - (Cough and Constituent), - FOR THE PREVENTION AND CURE OF PULM ONARY PH THISIS. I FCI ERIM CUT. L. Z. E-. Cough Tablets. EACH TABLET cond AINs. Morph. Sulph. (sº gr.), Atropiae Sulph. (5%0 gr.), Codeia (5%, gr.), Antimony Tart. (; gr.), Ipecac, Aconite, Pulsatil- la, Dulcamara, Causticum, Graphite, Rhus-tox, and Lachesis, fractionally so arranged as to accomplish every indica- tion in any form of cough. Constituent Tablets. EACH TABLET CONTAINS. Arsenicum (ºn gr.), Precipitate Carb. of Iron, Phos. Lime, Carb. Lime, Silica, and the other ultimate constituents, according to physiological chemistry, (normally) in the human organism, together with Caraccas, Cocoa, and Sugar. PRICE, THREE DOLLIARS PER DOUBLE BOX. Containing sufficient Tablets of each kind to last from one to three months according to the condition of the patient. A Connecticut physician writes: “I am now using your Tablets on a patient (young lady), who has had three quite Severe hemorrhages the week previous to the beginning of the same. She has taken one box only, has had no return of the hemorrhage, and has gained four (4) pounds, since beginning treatment, besides all rational symptoms have improved wonderfully. I will add that I had tried Ol. Morrh., Syr. HypophOS. Co., etc., with no apparent benefit.” - A Virginia physician writes: “Enclosed find Postal Note for another double box Freligh’s Tablets. I used the sample box in three cases, with decided benefit in one, slight improvement in second, and while they did not improve the third case, it being in very advanced stage, there was an amelioration of the distress- ing symptoms. A Massachusetts physician, in practice 25 years, writes: “Send me two double boxes Freligh's Tablets. I have tried the sample box with most excellent results.” - - A Michigan physician writes: “I am more than pleased with thern. They have not disappointed me once. Dr. C. for whom I ordered a box, writes me that he is much improved, and speaks in praise of them. He has genuine Tuberculosis, and while I do not think he can recover, yet I firmly believe the Tablets will prolong his life.” SIFIEE CIALI La CPIFIFI EHF.. While the above formulae bas been in use, in private practice, over 30 years, and we could give testimonials from well-known clergymen, lawyers and business men, we prefer to leave them to the unbiased judgment of the profession with the following offer : . On receipt of 50 cents, and card, letter head, bill head, or other proof that the applicant is a physician in active practice, we will send, delivered, charges prepaid, one of the regular (double) boxes, (retail price, Three Dollars) containing sufficient of each kind of Tablets to test them three months (in the majority of cases) in some One case. Card, letter head, or SOme proof that the applicant is a physician in active practice, MUST accompany each application. Pamphlet with full particulars, price list, etc., on request. AL PEICsIF>IEICIEEI2:IEID CERE BRO_SPIN ANT. (FRELICH'S TONIC,) Our special Offer is still open, to send to any physician, on receipt of 25 cents, and his card or letter head, half a dozen samples, delivered, charges prepaid. Each sample is sufficient to test it for a week in One Case. |As we furnish no samples through the trade, wholesale or retail, for Samples, directions, price lists, etc., address T. O. WTOOT) IER, UIETIET &; CO- Manufacturers of Physicians’ Specialties, 883 NAIA-ILEINT L.A.INTIE, INTIEW YOR.I.K. CITY". Orthopedial Appliances. We are now manufactur- ing everything in the way of |Spinal, \ Weak Ankle or Bow leg Braces | & Hip Splints. Everything in the ORTHOPEDIC T-irh-e- Write us before ordering or send your patient to us and we will take the measurement and guarantee a fit. We can make as good an APPLIANCE as can be had elsewhere Qºs for LESS MONEY AND CAN FURNISH y IT MUCH QUICKER. & º: Å,": . . * * *f t t- §§ & jº ſ | ". t || || - ===ſ 2. | | f ſ ſ | ſºil. º! l, | *… * * . . . d º }|| ſ º w ſº - º - lº. | jlill!!!… º | | t w Sº | f WA " * sº f FULL INSTRUCTIONS SENT FOR MEASUREMENT WHERE PATIENT CANNOT BE SENT TO US. 25 JBI Cºmt, DiSCOInt from price to patient given Physician when order from Doctor is sent with patient The Cornell-Pheneger Chemical Company, COLUMBUS, OHIO. PHYSICANS SUPPLIES OF ALL KINDS The most Important Remedial Agent in DYSPEPSIA, WOMITING IN PREGNANCY, CHOLERA INFANTUM, CONSTIPATION, And all Diseases arising from Imperfect Digestion. THE NEW YORK PHARMACAL ASSOCIATION P. O. Box 1574, NEW YORK. COLUMBUS MEDICAL JOURNAL A MONTHLY JOURNAL OF MYEDICAL SCIENCE. VOL. 10. APRIZ, 1892. No. 10. COMMUNICATIONS. THE PRESIDENT'S ADDRESS.—A FEW THOUGHTS O/V ///º/D/CA/, /7/O OCA 7TWOAV. By R. HARVEY REED, M. D. (UNIV. OF PENN.), MANSFIELD, O. Delivered before the Eleventh Annual Meeting of the North Central Ohio Medical . Society, held at Mansfield, March 25, 1892. . It is hard for us to realize that at the close of the last cen- tury there were but three medical colleges in the United States of America. The oldest of these was the University of Penn- sylvania, which dated from 1764. The King's College in New York, was opened in 1768, and Harvard was founded in 1783. Up to the close of the last century these three colleges together had only graduated less than 250 stu- dents. There was no fixed standard of qualification for students who were about to enter the field of practice. The average med- ical student of those days (not unlike many of the present age) was poor, and in the majority of instances was obliged to “pad- dle his own canoe” whilst attaining his medical education. There were no railroad facilities, and the country at this time, even in the New England states, was practically a dense wilder- ness, with poorly constructed roads, and in many instances only trails that lead through the forest from one town to another. In those days it required quite a considerable amount of self-denial on the part of the medical student to attend college, as it was no 433 434 COMMUNICATIONS. small task to leave his home, especially in the rural districts, and travel on foot, on horseback or by stage to either Boston, New York or Philadelphia, and in addition to this, it required no small sum of money for him to live on in these cities and pay his tuition and other expenses after his arrival. - Medical books were scarce and high ; it required six months to get a book after you had decided to make a purchase, as the only supply attainable had to be imported from Europe, with the exception of one work of any magnitude, and that was Smellie's Midwifery, which had been reprinted in Boston in 1786. Yet the physicians of our country were learned men of their day, when we take into consideration the many difficulties they llad to contend with in obtaining their education and in “keep- ing up with the times,” as we term it now days, by having at hand a ready supply of the latest literature. - The first medical society we have any knowledge of, was the Massachusetts Medical Society, which held its first meeting in 1782. Shortly after which, were organized the Medical Societies of New Jersey, Delaware and New Hampshire. Owing to many difficulties in the way of students attending college, the Massachusetts Medical Society inaugurated a sys- tem of issuing licenses, which were afterwards followed by many of the other societies of that day and later date, and even those that were organized many years afterwards. •. . It is true the war of the Revolution furnished the army sur- geon of that day special facilities for interchange of thought and opinions between the physicians and surgeons of the different parts of the country, whilst surgeons from abroad, who had been educated in continental Europe, came to this country and added to the common stock of medical knowledge. The end of the war, however, put a stop to this interchange of ideas, and the army surgeons returned to their native villages and were again isolated from each other as before. The strange ideas and dogmatic views, which had taken pos- session of many of the great surgeons of that age, are not to be wondered at, when we consider the sparse population, the difficul- ties of traveling, and thereby the almost complete isolation of one physician from another, and not only this, but the almost absolute absence of medical literature, except in the form of a few foreign works, which were imported from Europe. Circumstances compelled those who desired to study medicine. to read with preceptors, for more reasons than one: First, they could not afford to obtain the necessary books, neither could they REED–The President's A daress, AEtc. 435 afford to spend so much time in college, and consequently they adopted the cheapest, and then best plan of the age, by placing themselves under an experienced perceptor,learning from him by individual contact, not only anatomy and physiology, but ma- teria medica and therapeutics, the theory and practice of medi- cine, as well as the principles and practice of surgery. . . In those days the pharmacist was not abroad in our land, and most of the therapeutic remedies were gathered in the for- ests, swamps and fields, which were prepared by the practitioner in the form of infusions and decoctions. In this respect the stu- dent of those days had really better facilities for studying medi- cal botany than they have at the present time. Many of the medicines were obtained from native plants, and the students were usually required to gather them during the summer season, and thus familiarize themselves with their appearance, and their therapeutic properties, as well as to learn how to prepare them for administration to the patient. The facilities for anatomical study were very meagre, whilst those pertaining to physiology were equally poor. At the bed- side, however, of his preceptor's patients he learned to study the various diseases, as well as the practical treatment of the va- rious surgical cases that came within the scope of his preceptor's range of practice. *- . . . . *. After two or three years of this kind of study, he either made application to some medical society to practice as a licentiate, or attended two short sessions at one of the few medical colleges then in existence, in which he made a few dissections, listened to the Prof. of physiology deliver a scattered course of imperfect lectures, which were seldom, if ever, illustrated by practical dem- onstrations. Was told by the Prof. of Materia Medica and Therapeutics what he knew about drugs and their application in diseases. Listened to a few lectures on chemistry, and seldom, if ever, was in a chemical laboratory, and still more seldom ever made any chemical experiments himself. He was given a gen- eral description of a few of the diseases to which man is heir, by the Prof. of Theory and Practice of Medicine, and now and then was entertained by a clinical lecture; was taught how to diagnosticate and set a broken limb or amputate a mangled arm, and now and occasionally had these lectures demonstrated by some unfortunate fellow, who submitted himself for a clinical lecture. It is not our object to criticise the means and methods em- ployed for the education of our forefathers, who practiced over a century ago, for they were no doubt as far in advance of those 436 COMMUNICATIONS. who practiced a century previous to them, as we are now in ad- vance of those who practiced during the Revolution. But our object in rehearsing these means and methods is for the purpose of calling your attention to the fact that many of the customs which have originated, and were the outcome of circumstances, which governed our physicians a century ago, are no longer essential in obtaining a medical education, and hence we may truly say they are simply traditional fallacies, which it is our duty to discard. - To illustrate: The old flint-lock musket, which served the purpose of our forefathers in throwing off the iron rule of tyr- anny inflicted by Great Britain, is no longer a suitable weapon to protect the rights of the American citizen of the present; but because the old flint-lock did noble service in its time, is no rea- son why it should be continued in use as a means of defense and offense, instead of the Gatling gun and the repeating rifle. As in the military and commercial world, so in the medical field, the requirements of the present day have not only in- creased, but they have changed, and the necessity of the times demands still greater change, and the adoption of improved methods that must soon take the place of even our present sys- tem of medical education. Scarcely more than a century and a quarter ago, there were but three medical colleges in the United States, and less than 250 graduates, whilst to-day there are nearly 150 colleges, be- sides 26 legalized licensing bodies granting degrees to medical students, and investing them with the power to practice medi- cine and surgery; and instead of less that 250 graduates in the whole United States, there were 14,884 matriculates and gradu- ates in the United States at the close of the college year in 1890, of which in the same year, there was over 30 per cent of all the matriculates who graduated from the various medical schools of the United States; or in other words, there were over 4,000 medi- cal students, who graduated in this country in the spring of 1890. I believe it was Webster who once said that “whilst it is crowded below, there is always room above.” In glancing over the statistics of the number of medical colleges in this country, and their annual “output” of students, we cannot help saying that the present condition of affairs in regard to the present method of medical education is bound to keep it crowded below, both as to colleges and graduates. In the first place, many of our colleges still adhere to the old plan of two terms, of five or six months each, as being sufficiently ample to qualify the grad- REED–The President's Address, Etc. 437 uate to assume the responsibility of treating patients, whose lives depends upon his skill and knowledge. Why, gentlemen, how many of you would risk a blacksmith, who had only been an apprentice for ten months, to shoe your horses, or a shoemaker, with a similar amount of training, to make your shoes 2 And , yet our laws permit these colleges to grind out students by the hundreds and thousands, and clothe them with legal authority to practice medicine, who could not name the incompatibles that entered into the compounding of our simplest formulas. Ah but you say they have had three years training under a respon- sible preceptor. Very well, admitting they had, I will leave it to any honest physician to answer according to the dictates of his own conscience, as well as his own personal experience, as to how much real practical knowledge a student obtains by reading with the average preceptor. t As a rule he learns how to take care of his preceptor's horses, sweeps out the office, cleans the spittoons, dusts off his bottles, takes care of his surgical instruments, accompanies him in his drives around the city or to the country, and holds the Horse while he is looking after his patient’s health, waits on the patients when in the office, posts the Doctor's books, makes out His bills, now and then does some collecting, and between times, and when he has nothing else to do, ponders over the latin names of the bones and muscles in Gray’s anatomy, and after squandering one or two years of his precious time in this way, he receives a certificate from his preceptor for good behavior and moral conduct, and with that he enters the average college. In many instances he could not pass a common school examination in the simplest branches of the English language, saying noth- ing of the higher branches, which are taught in the average high school, but with this preliminary education he attends two courses of lectures, graduates, and becomes one of the crowd of the medical profession at large. Is it any wonder our profes- sion is ridiculed, when it is crowded and overcrowded with this class of material which, although it makes us blush to say so, constitutes a large majority in nearly every state and territory in the Union 2 - Turned loose upon the world without money, knowledge or experience, he is compelled to perforate terra firmá with his pro- boscis, or relinquish all claims to vitality, and as a result, he either resorts to empiricism and straightout quackery, or joins the army of abortionists, or if his conscience forbids these meth- ods of obtaining a livelihood, he squeezes out an existence by 438 CoMMUNICATIONs. reducing the average fees in order to make some inducement for the people to employ him, until by personal effort and practical knowledge he is able to command a larger practice and better fees, by which time he is often a middle-aged man, and ready to go down the decline of life, with little or nothing laid up for Himself or family, and usually (unless he happens to be fortu- nate enough to marry a rich wife) dies poor. - Some of you may think I have overdrawn this picture, yet I will leave it to yourselves to look around you and form your own judgment as to its correctness. There is not a county in the state of Ohio, in which these statements that I have just made, can not be fortified by practical examples. The question then confronts us as to how we shall improve this deplorable state of affairs 2 Is it by the legislature creating state boards of medical examiners, who shall decide on the quali- fication of every student who is to practice in our state, or shall we go beyond that and revise the laws under which medical col- leges obtain their charters? Whilst the former would no doubt be of great advantage, and afford a remedy for ready relief, yet I am firmly of the opinion that to reach the case most effectively, we should adopt the latter plan. Under our present laws it is the easiest thing in the world to obtain a charter for a medical college. No standard of edu- cation is required by our present state laws, of a college, to which they grant a charter. If these laws were revised, and 110 colleges granted a charter excepting they comply with a high standard of medical education, the foundation of which should at least be based on a diploma from a high school, or better, a reputable college; for generally there is nothing that strangles empiricism so quickly as a liberal education on the part of the physician. If properly educated, he will always find employ- ment, and his patients will be ready and willing to pay him fair living fees for his service. . . Again, the time has come when the preceptors should be discarded as not only obsolete, but absolutely useless. The medical student should not waste two or three years of his time under some preceptor—I care not how good he may be, but should at once select a college and place himself under its care and direction. • For a medical student to place himself under a preceptor, is just as foolish as it would be for a student, contem- plating a classical course, to place himself for two or three years under some graduate of some literary college preparatory to entering the same later on, rather than go to the college direct REED–The President’s Address, Etc. 439 and utilize the benefits that are afforded him professionally by experienced teachers. The time has also come when the old-fashion lecture course must go. When books were scarce and high, it was well enough to resort to lectures, but at present, better and improved methods are at hand, which sooner or later must take the place of the didactic lecture. The idea of a student listening to four or five lectures a day, of an hour each, day in and day out, from Monday morning till Saturday night, and retaining anything more than simply an impression on his mind of the subjects lect- ured upon, is entirely out of the question. If this is the best method of teaching, why do not literary colleges adopt the same plan 2 Why is it they resort to class-teachings and text- tº and the assignment of lessons, if the lecture plan is the est? Who would deny that the classical graduates who leave Harvard and the University of Pennsylvania to-day are not bet- ter students and more thoroughly educated in the branches that constitute the course they have taken, than the medical students who are graduated from, the same institutions 2 And yet these institutions stand the peer of any other medical colleges in the United States, if not in the world. And why is this 2 It is simply because in this classical course they teach by the recita- tion plan, assigning each scholar in each class a specified lesson, and they expect him to get that lesson, and recite it to his in- structor, with but very few mistakes, and upon his punctuality and the perfection of his recitations are based his grades for each day, the aggregate of which gives him his grade at the end of the term. On the other hand, in the same medical college, no record is made as to whether a student is present at every lecture each day in the week or not. It is practically optional with him as to whether he is examined on the lectures given from day to day in the various branches, or whether he is not, just so he passes the final examination at the end of each year. Can any person for a moment suppose that such methods will result in as high a grade of education as that adopted by the literary department of the same university ? On the other hand, it begets truancy and carelessness, for which they make up, at the final examination, by what is familiarly known among students as “cramming” In conclusion, I would recommend : 44O COMMUNICATIONS. Ist. That we seek to elevate and improve the methods and means practiced by our medical colleges for giving a medi- cal education, by a revision of our charter laws, which should make it more difficult to obtain a charter, and when one is ob- tained, that it be made obligatory upon the college to adopt a high grade of medical education, the standard of which shall be decided upon by a committee of the best physicians of the State. 2nd. That for present emergencies, and to serve until the charter laws are amended and put in operation, we would advise the creation of a state board of medical examiners. 3rd. We would recommend doing away with preceptors altogether, and that the standard of attainment for entering our 1medical colleges should be based upon the degree obtained from a reputable high school or college. 4th. We would recommend that the present method of in- structing the medical student by didactic lectures, be done away with, and that the class plan of teaching be adopted, and that the course should consist of at least three years (and better four) of nine months each, divided into three terms, of three months each, and that the students be divided the same as in literary colleges, into classes of freshmen, sophomores, juniors and seniors, and that final examinations be discarded, but that each student be examined daily, and graded with each daily examination. In addition to this, we would recommend not only the clini- cal lectures, which are so valuable at the present day, but that each student be given practical lessons at the bedside, in both medicine and surgery, in addition to a liberal course in practi- cal chemistry and pharmacy, and the general compounding of medicine. We are conscientious in our belief that if our col- leges required a higher standard of literary education, and would adopt the class or collegiate method of teaching medicine and surgery, and be as thorough in their medical course as our academies and universities are in their literary course, that it would only be a question of time until empiricism would practi- cally cease to exist, and that instead of the average physician being a “scape goat” for ridicule, he would be looked upon, as he should be, not only as a man of classical knowledge, but learned and skilled in his profession, and in the most comprehensive sense of the word, a Medical Doctor, in whose hands the life of his patient could be considered safe.. A&EPORT OF CASES OF AFF/A-X FROM NASAZ D/S- A.A.S.A.S. - *=1 BY CARL. H. VON KLEIN, A. M. M. D., CLEVELAND, OHIO. A Paper Read Before the Northern Ohio Medical Society, Dec. 17, 1891. No other organs in the human body have greater propen- sities to produce reflex disturbances than those of the nasal cav- ities, which not only effect the throat, ears and kindred organs of the head, but extend to the lower extremities. Several years of practice, devoted exclusively to the respiratory tract, have en- abled me to observe diseases of these organs, which would have been almost impossible in ordinary practice. During nineteen years of general practice, no such ideas have I entertained that frightful affections, such as “choking spells,” difficult swallowing, bronchial coughs, asphyxia, steno- sis and pains in various parts above and below the diaphragm, 1might be caused by diseases of the nose. However, many of those reflex diseases which may be traced to the upper respira- tory tract, are found sometimes so slight that the pathology of the membrane of the nose would be to an ordinary rhinoscopist almost entirely undetectable, and even defy many competent observers. The cases which I herewith report, will verify the accuracy of my assertions. Case I.-A school mistress, aged 28, who applied for treat- ment, related that she was examined by a physician, who pro- nounced her case laryngitis and pharyngitis, and that the said physician was absent from home. She claimed that the pain in her throat was so intense that she could not wait until his re- turn. I made a laryngoscopic examination ; to my surprise, I was unable to detect any disease whatever, either of the larynx or pharynx. I informed her that I could not make a diagnosis of her case, as I could detect no disease of the organs of which she spoke. I knew the physician to be a gentleman of medical culture, who could not be guilty of such mal-diagnosis. As I feared that my assertion might injure the standing and reputation of the physician, I contended with her that she evidently misun- derstood him; she became displeased at my declarations, and did § 44. I 442 COMMUNICATIONS. not return. About five months later, she again called on me and asked me what I could do for her. I re-examined her throat, with the same result as in my former examin- ation. I proposed to examine her nasal chambers, to which she consented. After a careful and tedious examination, I found an ulcer on the left side of the nostril, similar to a fissure, about half an inch in length and a quarter of an inch in width, just anterior to the entrance of the eustachian tube. I asked her whether she had pain about the ear; she stated that the whole throat pained her, beginning at the ear down to her lung. I be- gan treating her case accordingly, and in five weeks the ulcer was healed, and in two weeks later I discharged her—well. Case 2.-A male attendant of the Dayton Insane Asylum, age 46. I was called at midnight; found the patient sitting up. in a chair in an asthmatic paroxysm, unable to talk, lips blue, eyes dilated, head downwards, respiration 40, pulse I2O, strength completely given out. The messenger explained that the same paroxysm has lasted a fortnight, and that he had not been in bed for two or three months. I gave him a hypodermic injection of belladonna every fifteen minutes until the pupils. became largely dilated. I also gave him a large dose of iodide of potassium. I remained with him for three or four hours, but no relief was obtained whatever. The next morning I examined the upper respiratory chambers, and found both completely stuffed with foreign bodies. I removed three large polypi from the anterior part of the right nostril, and two from the left. There were visible farther obstructions, and after cleansing the cavities with absorbent cotton, I found the obstructions to be large turbinated bodies, which, after spraying with cocaine, I removed with electro-cautery. On examination of the post-na- sal cavities, I found on each side large polypi, which I removed at once with a snare, their weight being about two-thirds of an ounce. The cavities were then sprayed out with chlorinated iron to check bleeding. At my next visit—8 o'clock, P. M., I found the patient on a lounge fast asleep, respiration 24, pulse 91. Patient began to improve at once, and in five weeks was discharged, without the slightest inconvenience to his breathing. Case 3.—A barber, age 28, through the courtesy of Dr. J. L. McIllhenny, applied for treatment of a tickling sensation of the throat, with difficult breathing. On laryngoscopic exam- ination nothing could be found as the cause of the cough or tickling sensation. A rhinoscopic examination showed a high VoN KLEIN–Report of Cases of Reſea, Etc. 443. degree of post-nasal hypertrophic catarrh. Thirteen weeks treat- ment cured the post-nasal catarrh, when the difficult breathing and cough both disappeared. . Case 4.—Mrs. J , age 36, through the courtesy of Dr. Wm. Reich, of Canada; had been under treatment by specialists of Toronto and Buffalo. In appearance, she was a handsome brunette, intelligent and self-possessed, figure erect, mouth small, eyes dark, nose prominent, speech weak, and lips tremb- ling. The Doctor gave the following history of her case: At the age of 24, she aborted after three months gestation; he could not ascertain whether from instrumental or natural causes. Four years later she had another premature birth, 5 months ges- tation, caused by a fall on the ice. Since then no pregnancy occurred. About seven years ago he was summoned at night, and found her in a state of collapse. The distressed husband related that every time she became angry or in any way excited, she fell into this state. After working with her for several hours, he restored her by artificial respiration. Five weeks later he was summoned again, found the patient in the same state, and from a similar cause, and restored her by the same means as in the previous case. Her husband related that one paroxysm occurred during copulation. For a long time the Doctor attri- buted her trouble to a nervous difficulty, caused by her miscar- riage, until about two years ago, when he observed a contrac- tion of the nose to such an extent that it formed a suction of the inner walls and the septum in both nares, perfectly locked. Just as soon as the nares were dilated, she became restored. He sent. her to a specialist, who pronounced it paralysis of the schneiderian membrane. He treated her for quite awhile, and considered her cured. She returned home, and at her first act of copulation, the same result occurred as prior to treat- ment. They then wrote to me, and according to my advice she came to me. . On a rhinoscopic examination, nothing could be discovered as to disease of the nares. I concluded that it was a case of spasmodic contraction of the rhinal muscles. I accordingly divided the inner muscle on each inner side of the outer wall, about one-eighth inch deep, with a small scalpel, and intubated with silver tubes, one and a half-inch long, one-half inch diameter, one inch and three- eighths circumference, made purposely to suit her case. She remained with me 17 weeks, when I pronounced her cured. It is now 17 months; I hear from her occasionally, and the former difficulty has not re-occurred. 444 CoMMUNICATIONs. Case 5.-Mrs. Gwin, age 42, the wife of Dr. J. M. Gwin, came to me for treatment for impaired breathing. A rhino- scopic examination showed post-nasal turbinated hypertrophy, of which she knew nothing. I removed the hypertrophy with Iny post-nasal bone forceps, and after three weeks treatment she returned home perfectly sound. - Case 6.-A lady, aged 61, through the courtesy of Dr. Roms- pert, applied for treatment for difficulty in swallowing. A laryn- goscopic examination proved the throat to be inflamed on both sides of the larynx, extending to the thyroid muscles, ulcerated fauces and inflamed glottis. The pharynx was also involved clear back into the posterior nares. A rhinoscopic examination showed it to be a chronic case of ozaena; to such an extent that almost the entire nasal bone was necrosed. After the second treatment she did not return. I cannot say what became of the case. However, the difficulty commenced about the middle of the nasal chambers, and extended down to the thyroid glands. Case 7.—Mr. J , age 28, a ticket agent, applied for treatment of irritated throat. A laryngoscopic examination showed irritated fauces, with inflamed pharynx, caused by rhinal disease. On examination of the nose, I found the septum deviated in a zigzag manner. I ascertained from him that he had his nose broken at the age of 12, when he fell into a cellar. I concluded that the irritation of the throat was caused by the broken septum which obstructed the anterior part of the nares, causing the secretion to flow back unto the fauces and pharynx. . According to my request, he allowed me to rebreak and set his septum, which was done perfectly. In 8 weeks the septum was healed, and the secretions came anteriorly instead of posteri- orly. To the throat I did nothing, except occasionally sprayed it with a weak astringent prepared in vaseline, simply to allay the irritation. - Case 8.—Dr. E. C. Crum, applied for treatment of the res- piratory organs. Examination of the throat showed an inflam- mation of the pharynx and hypertrophic elongation of the uvula; post-nasal examination showed chronic post-nasal rhin- itis. I accordingly amputated the uvula and treated the rhin- itis. He did not attend to his case very regularly, and like other Doctors was a bad patient. I feel satisfied that the post- nasal treatment benefited the impaired state of the throat. Case 9.—A female attendant of the Asylum, through the courtesy of Dr. Pollack, applied for treatment for what she styled “a pain in the throat.” An examination showed acute VON KLEIN–Report of Cases of Æeffea, Ftc. \, 445. inflammation of the larynx and pharynx. Post-nasal examina- tion exhibited post-nasal catarrh. From the moment that the catarrh commenced to subside, the throat became better, and in four weeks the nasal catarrh had almost ceased, while the larynx and pharynx were both in the healthiest condition. Case IO-A music teacher, age 22, through the courtesy of Dr. B. Mills, came for treatment for loss of voice. She related that she gave vocal lessons and sang in church, and within the last year her voice began to fail, which placed her in such a condition that she became unfit for her occupation; she feared she had injured her voice by singing too high. A laryngo- scopic examination showed the throatin a healthy condition, with the exception of the vocal chords, which were slightly thick- ened. I took it for granted that her statement was correct, that lier throat was injured by singing. I treated the vocal chords three weeks, when she returned home, supposed to be sound. Two months later I received a letter from her, that she was in the same condition, if not worse, than previous to my treatment. She came once more, and after II days treatment she again returned, with as good a result as before. Three weeks later she again complained of the same difficulty. I examined her nasal chambers, and found ulcerated nares, with heavy flowing secretion. Bending her head backward, and contracting the soft palate, I could see the secretion drop into the throat. I applied nitric acid to the ulcers for several days, and sprayed her throat with a vaseline preparation of eucalyptol. After five weeks treatment she returned home sound and well, and has remained so ever since. - - Case II.—A school mistress, age 29, through the courtesy of Dr. E. O. Francis, applied for treatment of pain and weak- ness of the throat, almost crying on account of the great agony in her throat. A laryngoscopic examination proved nothing from which pain could be caused, with the exception that there was a slight checking in speech when the air was being ex- pelled through the bronchal tubes. The pharynx was slightly marbled at the edges. Post-nasal examination demonstrated a chronic case of naso-pharyngeal catarrh.. I treated the case accordingly. The pain in the throat would not yield to my treatment until about five or six weeks daily treatment of the post-nasal cavities, when the nasal cavity checked the unhealthy secretion, and the pain ceased. The patient improved rapidly. Case I2.—A merchant, aged 30, through the courtesy of Dr. W. J. Conklin, applied for treatment for what he termed 446 COMMUNICATIONS. “choking spells.” He related that during the night he would take such choking spells that life was almost a burden to him. An examination of the throat exhibited a deviated, elongated and hypertrophic uvula, pharynx was red, both nasal cavities were filled with hypertrophic tissue, with little space to breathe through. At the entrance of the anterior cavities the muscles were contracted, and at every respiration I could see a suction of the inner-nasal walls. The uvula being hypertrophic, undoubt- edly there was no other way to reduce it but by amputation. The hypertrophic tissues of the nose were removed, and the nasal entrance kept dilated by tubage. The case was treated with great difficulty, on account of the peculiar formation of false membrane; after one was removed but a few weeks another would form. During the intervals of removing the membrane and the formation of another, there was no impaired breath- 1119ſ. - g Case 13—Through the courtesy of Dr. A. Peskind, Mrs. B , age 42, applied for treatment for what she styled “chok- ing spells.” She related that about bed time she would take “choking spells,” which frightened her and her family. Upon a laryngoscopic examination, nothing could be detected but an elongation of the uvula, and thickening of the soft palate. Rhinoscopic examination showed heavy hypertrophic tissues at the edge of the post-nares. Accordingly, the hypertrophy was removed. The elongation of the uvula, and the inflammation of the soft palate have subsided, and so far no “choking spells” 11ave re-occurred. - Case I4.—Mr. S , age 28, a clarionetist, applied for treatment for disease of the ear. I referred him to Dr. X. C. Scott, as the treatment of the outer ear is outside of my specialty. Dr. Scott treated him for a short period, when he discovered that the trouble was caused by some obstruction in the nasal cavity, and referred him to me. After rhinoscopic examination, I found a large turbinated process extending from both sides of the mid- dle turbinate, closing both Eustachian tubes. The patient re- 1ated that he was unable to hear his own notes while blowing His instrument, and that he could hear the notes of other instru- ments better than his own. I removed the turbinated processes with my nasal bone forceps, and the wounds healed by granula- tion. He has fully recovered his hearing, but recently hyper- trophic tissue began to build on the parts where the turbinated processes were removed, and again there appears to be some im- pediment in his hearing, for which he is now in my treatment. VON KLEIN–Report of Cases of Reflear, Etc. 447 Case 15.—Through the courtesy of Dr. W. H. Humiston, Mr. M––, age 30, applied for treatment for defective voice and impaired breathing. The voice was somewhat feminine, and sounded eunuchal. Upon examination, I found a badly devia- ted septum, with chronic post-nasal catarrh. I straightened the septum and checked the catarrhal discharge, and the voice is much improved. Case 16.—Through the courtesy of Dr. A. Peskind, a young man, age 18, applied for treatment for difficulty of the nose and throat. Upon examination, I found deviation of the septum, post-nasal catarrh, elongation of the uvula, and a reflex bronchal catarrh. He complained mostly about a pain in the chest. Af- ter amputating the uvula and treating the post-nares, with very little constitutional treatment, the bronchal catarrh has subsided and the throat is looking well. The deviation of the septum has not yet been corrected. I fear unless the septum is straight- ened, that the reflex trouble of the bronchia will recur. Case I7.—Through the courtesy of Dr. F. E. Goetz, Miss B , age 30, amateur singer, applied for treatment for a defect in her voice. Upon examination of the larynx, nothing could loe detected. However, her voice was husky in the higher notes only, the lower notes without defect. Upon rhinoscopic exam- ination, I found a large turbinated process, extending to the outer side of the schneiderian membrane, closing the left nostril entirely. I removed the turbinate, with my bone forceps, suf- ficient to give her ample breathing and to allow the sound to pass through the cavity. After a short period of treatment, she became impatient with the period of treatment, and did not return, hence I am unable to give the outcome of the case. Case 18.—My friend, Dr. A. Eyer, consulted me in a case of sinus hypertrophy, which I removed from the left nostril, but the slightest touch of the irfner nose produced in him a reflex of pain not only of the kindred organs of the head, but also clear down to the lower extremities. Gentlemen, I have many such cases to report, but I do not wish to detain you any longer, as I have given enough proof, by my foregoing cases, that diseases of the entire respiratory tract, including the lungs, and even the extremities, may be cause by reflex of nasal disease. - No. 122 EUCLID AVENUE. 448 } SELECTIONS. THEY TOOK A RELAPSE-Disheartened Missionary (re- turning to his field after years of absence)—Oh, unhappy men, you have lapsed into error and darkness and paganism again. I Chief Heathen—(apologetically)—Well, you see, after you went away a Catholic missionary came along and told us the bad place was full of Methodists, and so he scared us into his com- munion ; then he went away and a Presbyterian came along and waked us up on regeneration, adoption, and election, and we joined his church ; then an Episcopalian came and we burned our Westminsters and stocked up on prayer-books; then he left and a Baptist landed and walked us into the water and baptized us right, and we’d just about got settled when a new Congrega- tionalist came over and told us that so long as we were heathen we had a dead sure thing of going to heaven; but if we became Christians we had to walk mighty straight or go to the everlast- ing bonfire. So we ate him up, burned our Bibles, and resumed business at the old stand. Boys, put the parson in the cage and fat him up for thanksgiving day.--Brooklyn Eagle, BEEF JUICE.-Where it is necessary to give an invalid just the juice of beef, broil say a half pound for just a moment over a quick fire, then score it thoroughly, put it in a lemon squeezer, and press the juice into a cup, add a grain of salt, stand the cup in hot water for a moment until the juice is warm and use it immediately. This is more tasty and appetizing than beef tea. - FOR TAN AND FRECKLES.—Dr. Chevasses' preparation for tan, freckles, pimples, etc: .. s B. Rose water. . . . . . . . . . . . . . . . . . . . . . 6 ounces. Glycerihe. . . . . . . . . . . . . . . . . . . . . . . % ounce. Bitter almond water. Tinct. benzoin . . . . . . . . . . . . . . . . . . . aa 2% drams. Borax . . . . . . . . . . . . . . . . . . . . . . . . . . I}% & 6 Rub the borax with the glycerine, gradually adding the rose and almond water; lastly add the tincture benzoin, agitating constantly. Apply night and morning. *. 9 The Best Antiseptic for Both Internal and External Use. LISTERINE Antiseptic, Prophylactic, Deodorant, Non-Toxic, Non-Irritant, Non-Escharotic, Absolutely Safe, Agreeable, Scientific and Strictly Professional. FORMUL.A.--Listerine is the essential antiseptic constituent of Thyme, Eucalyptus, Baptisia, Gautheria and Mentha Arvensis, in combination. Each fluid drachm also contains two grains of refined and purified Benzo-boracic Acid. - DOSE,--Internally: One teaspoonful three or more times a day (as indicated), either full strength or diluted, as necessary for varied conditions. LISTERINE is a well-proven antiseptic agent—an antizymotic — especially adapted to internal use, and to make and maintain surgical cleanliness—asepsis—in the treatment of all parts of the human body, whether by spray, irrigation, atomization, or simple local application, and therefore characterized by its particular adaptability to the field of PREventive MEDICINE – INDIVIDUAL PROPHYLAxis. Physicians interested in LISTERINE will please send us their address, and receive by return mail our new and complete pamphlet of 36 quarto pages, embodying:— - A TABULATED EXHIBIT of the action of LISTERINE upon inert laboratory compounds. FULL AND EXHAUSTIVE REPORTS and Clinical observations from all sources, confirming the utility of LISTERINE as a general antiseptic for both internal and external use, etc. Diseases of the Uric Acid Diathesis. flºranged Vowoc". KIDNEY ALTERATIVE-ANTI-LITHIC. FORMUL.A.—Each fluid drachm of “Lithiated Hydrangea’’, represents thirty grains of fresh Hydrangea and three grai,is of chemically pure Benzo-Salicylate of Lithia. Prepared by our improved process of osmosis, it is invariably of definite and uniform therapeutic strength, and hence can be depended upon in clinical practice. DOSE.-One or two teaspoonfuls four times a day (preferably between meals). Urinary Calculus, Gout, Rheumatism, Bright's Disease, Diabetes, Cystitis, Haematuria, AJ' and Vesical Irritations generally. We have had prepared for the convenience of physicians DIETETIC NOTES (sample of which is herewith shown), G OUT. suggesting the articles of food to be allowed or prohibited in *mº several of these diseases. DIETETIC NOTE. — A mixed diet should be adopted, the nitro- A neatly bound book of these DIETETIC NOTES, each genous and saccharine articles be- note perforated for the convenience of physicians in detaching ing used in limited amounts. and distributing to their patients, mailed gratis upon request, Allowed.—Cooked fruits without together with the latest compilation of case reports and clin- || much sugar; tea and coffee in mod- ical observations, bearing upon the treatment of this class of | eration. Alcoholic stimulants, if diseases. used at all, should be in the form of light wines, or spirits well diluted. The free ingestion of pure water is Lambert Pharmacal Co. "ºpistry. mait liquors and sweet wines are veritable poisions ST. LOUIS, MO. to these patients. THEmost PERFECTFORMOFDosimETRY IS AFFORDED BY The term Parvule, from Parzºum (small), is applied to a new class of remedies (Warner & Co.'s) in the form of minute pills, containing minumum doses for frequent repeti- tion in cases of children and adults. It is claimed by some practitioners that small doses, given at short intervals, exert a more salutary effect. Sidney Ringer, M. D., in his recent works on Therapeutics, sustains this theory in a great variety of cases. Parvules of Calomel, 1-20 Med. Prop.–Alterative, Purgative. DOSE.—l to 2 every hour. Two Parvules of Calomel, taken every heur, until five or six doses are administered (which will comprise but half a grain), produce an activity of the liver, which will be followed by bilious dejections and beneficial effects, that twenty grains of Blue Mass or ten grains of Colomel rarely cause, and sickness of the stomach does not usually follow. Parvules of Calomel and Ipecac. R. Galomel, 1-10 gr. Ipecac, 1-10 gr. Med. Prop.–Alterative, Purgative. DOSE.—1 to 2 every hour. Two Parvules of Calomel and Ipecac, taken every hour until five or six doses are administered (which will comprise but a grain of Calomel), produce an activity of the liver, which will be followed by bilious dejections and beneficial effects, that twenty grains of Blue Mass Or ten grains of Calomel rarely cause, sickness of the stomach does not usually follow. IParvules of Aloin, 1-10. Med. Prop.—A most desirable Cathartic. The most useful application cf this Parvule is in periodic irregularities—Dysmenorrhoe and Amenorrhoe. They should be given in doses of one or two every evening at and about the expected time. DOSE.—4 to 6 at once. This number of Parvules, taken at any time, will be found to exert an easy, prompt and ample Cathartic effect, unattended with nausea, and in all respects furnishing the most a perient and Cathartic preparation in use. For habitual constipation, they replace when taken in single parvules the various medicated waters, avoiding the quantity required by the latter as a dose, which fills the stomach and deranges the digestive organs. Parvules of Podophyllin, 1-40. Med. Prop.–Cathartic, Cholagogue. Two Parvules of Podophyllin, administered three times a day will re-establish and regu- late the peristaltic action and relieve habitual constipation, add tone to the liver, an invigorate the digestive functions. - Parvules of ( Arsen it : Patash, 1-100. WARNER & Co.) This Parvule will be of great use to physicians, as two Parvules represent the equivalent of one drop of Fowler’s Solution, so that physicians can regulate the dose by giving one or more Parvules every hour. Parvules of Corrosive Sublimate, 1-100. (WARNER & CO.) - Dr. Ringer, in his treatise, lays great stress upon the efficacy of minimum doses o corrosive sublimate in the treatment of Diarrhoea, whether the stools contain blood or not. Parvules of Nux Vonnica, 1–50. (WARNER & CO.) Nux Vomica, according to Ringer, is possessed of real curative powers for sick headache, accompanied with acute gastric catarrh, whether due to error in diet, constipation, or no apparent cause. He regards it, administered in small and frequently repeated doses, as useful in many disturbances of the gastric functions. W. H. WARNER & CO., Philadelphia. OBSTETRICS. To WHAT ExTENT IS THE DIAGNOSIS OF PREGNANCY POS- SIBLE IN THE EARLY MONTHs?—Charles Jewett, M. D., in Brooklyn Medical /ournal.—The most conclusive evidence of pregnancy in the first three months is to be found in the pelvis. Naturally, the earliest and the most significant effects of utero- gestation upon the maternal economy are to be looked for in the uterus itself. And it is of these that it is the principal object of this paper to speak, They begin with the fixation of the im- pregnated ovum, and are for the most part progressive through- out the entire period of gestation. The changes available for Our purpose are the changes in the size, shape, and consistence of the uterus. Size.—The uterus grows with the growing ovum, and prac- tically at a fixed rate throughout the nine months. It is well known, however, that at the time when the growth first becomes easily perceptible, notably in the second month, the enlargement of the uterus is chiefly in its lateral and antero-posterior diame- ters. The length at this time is but little increased. This is what would be naturally expected when we remember that in the non-gravid state the anterior and posterior walls lie in contact. The beginning development of the egg has the effect to lift the uterine walls apart and to round them out, the ordinary length of the cavity being sufficient to accommodate, the growth of the first few weeks. In course of the third month the growth begins to be an all-round growth. True, the enlargement of the uterus in the first and second months is not solely the mechanical ef- fect of the growing ovum; it is in part due to the increased physiological activity of the uterine structures. Shape.—The shape of the gravid uterus is practically that impressed upon it by the globular ovum growing within its cav- ity. The first change in shape, then, is a bellying of the ante- rior and posterior walls of the body of the uterus. To the touch the bellying is usually most accessible in front; it is most ap- preciable in front, for the further reason that the anterior surface of the non-gravid uterus, especially in the nullipara, is flattened, while the posterior surface is somewhat convex. The lateral borders also begin to be rounded out. In the non-gravid uterus, 449 45o 8 SELECTIONS. especially of the nullipara, the inferior segment—that part im- mediately above the cervix—will be found much narrower than the fundus above or the cervix below. Since it is in this part of the uterus that the ovum is lodged, the first effects of the devel- oping ovum upon the shape of the uterus are readily perceived in the lateral as well as the anterior expansion of the corpus uteri. The changes in contour are well developed in course of the second month, and the shape at this time is in notable con- trast with that of the healthy nulliparous organ. At the end of the eighth week, or soon after, a cross section of the uterine body, midway between the isthmus and the fundus, is almost a perfect circle. Consistence.—The uterine structures begin to soften from the date of conception. This softening is naturally most marked at first in that segment of the organ included between the cervix and the fundus, since this part is in most intimate physiological relation with the ovum. It is in most cases easily appreciable at the fourth week, certainly by the sixth, and is well developed at the eighth. But little experience is required to recognize the peculiar compressibility and resiliency of the uterus, which contains a living ovum in the latter part of the second month. I may mention here a practical point upon which I have been accustomed to rely for the recognition of this sign. In the healthy non-gravid condition the mesial section of the lower seg- ment of the uterine body is notably denser than the lateral sec- tions. . The softening which characterizes the gravid uterus is most readily detected in this median section. The median ridge disappears, and not only that, but this mesial section of the corpus uteri usually becomes less dense between the fourth and sixth week than the uterine structures on either side of it. The softening of this portion of the body of the uterus, at a point immediately above the cervix, is the essential fact in HEGAR's SIGN. Hegar's sign, which has become familiar to the profession within the last few years, may best be defined as the compressi- bility of the isthmus uteri. Its location is the inferior segment of the body at a point just above the cervix, and it is especially marked in the mesial section. To be evidence of pregnancy with a living ovum, this compressibility of the tissues must be accompanied with the normal elasticity, While the compressi- bility of the isthmus is not equally well. developed in all cases, it is always present in some degree during the second month, SELECTIONS. . 45I and when well made out is less liable to fallacy than most other signs of this period. It will be better understood in connection with Hegar's method, which will be described below. * ** Technique of Pelvic Examination.—Little need be said with reference to the method of examination for the pelvic signs of pregnancy. It is frequently impossible to fix and palpate the uterus satisfactorily with a single finger intra vaginam. With two fingers slightly separated the uterus may be readily bal- anced between them and the external hand, and may be ex- plored with ease. The surrounding structures, too, are thus brought within easier reach. - When the fundus cannot be readily tilted forward within the grasp of the outer hand, as is sometimes the case in posterior misplacements, the lower segment may be explored by pressing the external hand down against the uterus in front and carrying the internal fingers well up into the posterior fornix. Again, by the use of the index finger per vaganam, and the second in the rectum, the entire posterior surface of the uterus may be reached and explored, as late as the second month and later. In extreme cases, when the importance of the question is sufficient to justify it, the examination may be made under an anesthetic, when it is otherwise impracticable by reason of undue thickness or rigidity of the abdominal walls, or other dif- ficulties. Mere muscular rigidity, however, may frequently be overcome by requiring the patient to breathe rapidly, or by gentle manipulation of the abdomen for a few moments, with a view to disarming the reflexes. It may be objected that all this is a troublesome matter, but the best results in practice are sel- dom reached except by taking pains. - Hegar's method is as follows: The index finger is passed into the rectum and carried just above the utero-sacral ligaments to a point opposite the isthmus uteri. The thumb of the same hand, passed per vaganam, rests upon the corresponding point in front of the isthmus. The tissues thus intervening between the thumb and the finger may usually, at about the sixth week or a little latter, be compressed almost to the thinness of a visiting card. In difficult cases the rectum may first be distended with water to facilitate the introduction of the finger above the third sphincter, or the examination may be made with the aid of an anesthetic. This is Hegar's sign as obtained by his method. I have found no great difficulty, however, in most cases, in demonstra- ting to my satisfaction the compressibility of the lower uterine 452 - SELECTIONs. segment by the usual bimanual exploration. Forcing the uterus well backward and downward with the outer hand, the isthmus may be readily reached with the fingers of the other hand in the posterior vaginal fornix, and the compressibility or density of the lower segment easily appreciated. - . . The recto-vaginal modification of the bimanual above de- scribed serves the same purpose. The seat of Hegar's sign may thus be more easily explored—though, perhaps, not with the same precision—than by his manipulation. Or again, when the uterus is freely moveable, it may be gently drawn down with a volsella held by an assistant, and the isthmus thus brought within the reach of a finger of one hand in the anterior, and the corresponding finger of the other in the posterior vaginal cul- de-sac. - Causes of Fazlure.—In a small proportion of cases the diag- nosis is unfortunately beset with insurmountable difficulties. When all available means are utilized, however, failure can arise only from one or two classes of causes: - (I) Pathological conditions which may mask the preg- nancy. (2) Pathological conditions which simulate it. In the presence of uterine fibromata, for example, the recog- nition of pregnancy may be quite impossible in the first three months. The same thing may be true, at least in the second month, from other conditions of the uterus which retard the usual changes of density. * Among the morbid conditions which simulate utero-gesta- tion, especially in the second month, are chronic metritis, sub- involution, fluid accumulation in the uterus (hematometra or hydrometra), a flexed and hyperemic uterus, a soft submucous fibroid. - - In general, pathological growths are distinguished from gestation by the absence, for the most part, of the signs of preg- nancy and by the presence of the signs of disease; moreover, the rate of the growth in pregnancy is unlike that of any other pelvic tumor, and in neoplasms of other organs than the uterus, the latter may be differentiated from the tumor by the touch. Chronic metritis and subinvolution are distinguished by greater density. Fluid accumulations present the characters of a tense cyst. A uterus containing a soft submucous fibroid may usually be easily differentiated from that of gestation by the history. The same is true of a flexed and hyperemic uterus. The physical signs in the latter case are frequently misleading, SELECTIONS. - 453 especially the softening and thinning at the point of flexion, but there is a notable absence of the normal elasticity of the tissues. It may be remarked here that the gravid uterus of the early months is by some writers described as doughy. This, I think, is a mistake; resiliency or elasticity is a notable characteristic of the uterus of gestation, so long as the ovum is living. It will be observed that the morbid conditions which may mislead are not so commonly to be expected in first pregnancies. The diagnosis is less difficult, therefore, in women pregnant for the first time, and in healthy primiparae may be positively es- tablished in every case by the sixth or eighth week, frequently at a still earlier period. . - Actopic Pregnancy.—The possibility of diagnosis in ectopic pregnancy has been the subject of much acrimonious discussion. Great difference of opinion prevails. : It is now generally conceded that with very rare exceptions, all ectopic pregnancies are primarily tubal. The major part of them are seated in the free portion of the tube. Pregnancy in the free portion of the tube ruptures before the fourteenth week— in many cases during the second month. The signs on which we must rely, therefore, for the diagnosis of pregnancy before rupture, when the pregnancy is ectopic, include only those of the first three months. Usually only a portion of these are available, since the majority of cases rupture some weeks before the end of the third month. Furthermore, the uterine signs of normal gestation are not al! present in ectopic, and those which are found in misplaced pregnancy are not so fully developed as in normal cases at the same stage. Moreover, the occurrence of extra-uterine pregnancy always implies the existence of more or less pelvic disease, and the pathological conditions which have brought about the ectopic fetation in greater or less degree embarrass the diagnosis. Similar complications are compara- tively rare in normal gestation. Tubo-uterine pregnancy, pregnancy in the intra-mural portion of the tube, is more difficult of recognition than that which takes place in the free part of the tube, and for these reasons: If the ovum lodges at the inner end of the oviduct, close to the cavity of the uterus, the enlargement of the uterus is nearly symmetrical, and before rupture differentiation from ordinary pregnancy is extremely difficult or impossible. If the fruit sac is located in the outer segment of the intra-mural por- tion of the tube, that is, just within the wall of the uterus, at the cornu, the case is difficult to distinguish from pregnancy in the 454 SELECTIONs. rudimentary horn of a double uterus. Yet in the latter case the distinction is not important, since the treatment is much the same in both. - - - It must be granted that in extra-uterine fetation certain additional signs are engrafted upon those of normal pregnancy, but they are usually more or less masked by the results of pelvic disease. Again, it must not be forgotten that in a large propor- tion of cases the opportunity for diagnosis never presents before rupture. º After rupture, particularly if much hemorrhage has taken place, failure to recognize the state of affairs is rarely excusable. With a patient, however, who has suffered habitually from dysmenorrheal pains, and in whom the pelvic organs are mis- placed and matted together by adhesions, both the symptoms and physical signs may be extremely misleading, even after rupture, especially if the symptoms of internal hemorrhage and the usual collapse are nearly or wholly wanting. A'esume.—The diagnosis of pregnancy in the early months rests upon no one sign, but upon the collective evidence of all the signs. The most reliable evidence of normal gestation in the first three months is to be found in the changes which take place in the uterine tumor. - In the great majority of all cases of normal pregnancy the signs of the second month are sufficient to establish the diag- IlOS1S. In the absence of pelvic disease, pregnancy may be positively predicated in every case of utero-gestation between the eighth and twelfth weeks, often at an earlier period. - - A ruptured tubal pregnancy, with slight hemorrhage, may pass unrecognized, usually being followed by recovery. In ruptured tubal pregnancy, with free hemorrhage, the clinical picture is unmistakable. - While the diagnosis is more difficult in ectopic than in normal pregnancy, it is possible in a large percentage of cases. DISCUSSION. DR. SKENE.—While expressing my great appreciation of the contributions of the paper and the illustrations, I would like to call attention to three signs of pregnancy, which I think have not been alluded to, and which I consider of great value. First, in addition to the elasticity or softening of the uterus and its change of form, there comes with that a difficulty of SELECTIONS. 455 mapping out the uterus. It is exceedingly difficult to outline it in some cases, and that very fact is of great value, because any- thing else which is likely to simulaté pregnancy is more clearly defined, because denser, as a uterine fibroid, subinvolution, a distended Fallopian tube, or an ovarian cyst, for instance. More than that, in the early months of pregnancy the uterus grows out of proportion to its surroundings, and so its mobility, or the facility with which it can be displaced, is lessened. You will find it more difficult to raise a pregnant uterus up out of the pelvis, or towards the superior strait, than in any other condition, than in cases of most — not all — small fibroids which enlarge the uterus, or subinvolution, which does the same thing. This, partial fixation is rapidly overcome in the latter months of pregnancy, especially after the third month, when the function of development of the uterine ligaments is taken up and goes on rapidly. f The second sign which I would mention is the color of the mucous membrane of pregnancy, which is different from every- thing else — nothing simulates it. It is present in a lesser degree in ectopic gestation, but in normal gestation this color of the mucous membrane is not simulated by any marked condition that I know of. That peculiar bluish violet hue, if seen a few times, is easily recognized afterwards, and becomes of the great- est possible value, and I depend very largely upon it. Of course it requires a careful speculum examination in order to see it, but it is worth the trouble in doubtful cases. - The third sign is the peculiar secretion in the cervix. There is a difference between the secretion in the cervix of the pregnant uterus and that of any other pathological condition. In the pregnant uterus the cervical secretion has a whitish, opaque appearance, that at first sight is very much like the leucorrheal discharge in a case of muco-purulent cervical endo- metritis, but careful examination proves that it is not, because it contains pus, which gives the opaque appearance, while in preg- nancy opacity is due to the coagulation of the albumen by the secretions of the vagina. That is characteristic of pregnancy, and occurs in no pathological condition, and is almost always present. When I find that opaque secretion of the crevix, that peculiar hue of the cervix and vagina, and the other physical signs, I am more positive of the diagnosis in the early months of pregnancy than in the fourth or fifth month, when fetal mo- tion is present, but, on account of a fatty abdomen, is hard to distinguish. 456 SELECTIONs. I meant simply to emphasize the fact that the diagnosis can be made with some degree of positiveness,and if I have emphasized the importance of the diagnosis, then I have done what I most desired to do. * - - DR., JEWETT. — With regard to the points made by Dr. Skene, the fixation of the uterus and the difficulty in mapping it out, as signs of pregnancy, are new to me. The former, possibly, is hardly available in the period with which the paper deals. As to the color of the vagina and cervix in gestation, one of the best contributions we have had to that subject we owe to Dr. Chadwick. In a large number of observations he found this sign in about five-sixths of all cases at the end of the third month. º - w - There is reason, possibly, to assume that the dusky hue of pregnancy may be distinguished from that caused by morbid conditions, if Dr. Chadwick is right. He calls attention to the fact the peculiar coloration of pregnancy is most frequently present and most marked on the anterior wall of the vagina, immediately behind the meatus urethrae, and he considers it not due to mere venous engorgement, such as occurs in disease, but to hypertrophy of the cavernous structure of this region. Yet the appearances in pregnancy and disease are so nearly alike that the distinction is usually difficult. - I may say that the point for Hegar's test is the lower seg- ment of the uterus immediately above the cervix. CUPID’s BATTLE witH ADIPOSE.-Pharmacists are not in- frequently importuned by customers to give advice in cases of superabundance of adipose tissue, and hence the following ro- mantic episode may prove interesting to some of our readers. The story is told by Dr. Dio Lewis : A very fat young woman came to my office and asked to see me privately. When we were alone, she said: “I have called to consult you about the strangest thing in the world. I will tell you all. I am twenty-three years old. When I was nine- teen I weighed one hundred and twenty-two pounds; now I weigh two hundred and nine; I am filling up with fat. I can hardly breathe. The best young man that ever lives loved me, and has SELECTIONS. 457 been on point of asking me to marry him ; but, of course, he sees I. am growing worse all the time, and he don't dare to venture. I can't blame him. He is the noblest man in the world, and could marry any one he chooses. I don’t blame him for not wishing to unite himself to such a great tub as I am. Why, Doctor, you don't know how fat I am. I am a sight to behold. And now I have come to see if anything can be done. I know you have studied up all sorts of curious subjects, and I thought you might be able to tell me how to get rid of this dreadful curse.” & She had been talking faster and faster, and with more and more feeling (after the manner of fat women, who are always. emotional), until she broke down in hysterical sobs. I inquired about her habits—table and otherwise. She replied: “Oh, I starve myself; I don’t eat enough to keep a bird alive, and yet I grow fatter and fatter all the time. I wouldn’t mind for myself, but its just breaking his heart; if it wasn’t for him, I could be reconciled.” Then I asked her if she would be willing to follow a pre- scription I might give her. * “Willing 2 willing P’’ she cried, “I would be willing to go through fire, or to have my flesh cut off with red-hot knives. There is nothing I would not be willing to endure, if I could get rid of this horrible condition.” e I prepared a prescription for her, and arranged that she should call upon me once a week, that I might supervise her progress, and have frequent opportunities to encourage her. The first prescription which I prepared for her was this. First: For breakfast, eat a piece of beef or mutton as large as your hand, with a slice of white bread twice as large. For dinner, the same amount of meat, or, if preferred, fish or poultry, with the same amount of farinaceous or vegetable food in the form of bread or potato. For supper, nothing. Second : Drink only when greatly annoyed with thirst; then, a mouthful of strong lemon- ade without sugar. * Third : Take three times a week some form of bath in which there shall be immense perspiration. The Turk- ish bath is best. You must work, either in walking or some other way, several hours a day. “But, Doctor, I can’t walk; my feet are sore.” . - I thought that might be the case; but if the soles of your shoes are four inches broad, and are thick and strong, walking will not hurt your feet. You must walk or work until you per- spire freely, every day of the week. Of course you are in deli- cate health, with little endurance; but, as you have told me that 458 SELECTIONS. you are willing to do anything, you are to work hard at some- thing six or seven hours every day. Fourth : You must rise very early in the morning and re- tire late at night. Much sleep fattens people. Fifth : The ter- rible corset you have on, which compresses the center of the body making you look a great deal fatter than you really are, must be taken off, and you must have a corset which any dressmaker can fit to you—a corset for the lower part of the abdomen, which will raise the great mass and support it. This is all the advice I have to give you at present. At first you will lose half a pound a day. In three months you will lose from twenty to thirty pounds. In six months, forty pounds. You will constantly improve in health, get over this excessive emotion, and be much stronger. º I happened to be out of the city and did not see her until Ther second visit, two weeks from our first meeting. It was plain when she entered that already her system was being toned up; and when we were again in my private office, she said: “I have lost six and a half pounds; not quite as much as you told me, but I am delighted, though nearly starved. I have done exactly as you prescribed, and shall continue if it kills me. You must be careful not to make any mistakes, for I shall do just as you say. At first the thirst was dreadful; I thought I could not bear it. But now I have very little trouble with that.” About four months after our first meeting, this young woman brought a handsome young man with her, and after a pleasant chat, she said to me: “We are engaged; but I have told my friend that I shall not consent to become his wife until I have a decent shape. When I came to you I weighed two hun- dred and nine pounds; I now weigh one hundred and sixty-three pounds. I am ten times as strong, active and healthy as I was then, and I have made up my mind, for my friend has left it al- together to me, that when I have lost ten or fifteen pounds more we shall then send you the invitation.” As the wedding-day approached, she brought the figures one hundred and fifty-two on a card, and exclaimed, with her blue eyes running over : “I am the happiest girl in the world! and don’t you think I have honestly earned it 7”—Western Druggzst. INCESSANT HIccough RELIEVED BY LAVAGE OF THE STOM- ACH.-Reading in the daily press lately several accounts of a most persistent case of hiccough, which had lasted many days, and which was baffling the skill of the local medical fraternity, re- SELECTIONs. 459 calls to my mind a case of the same trouble which came under my care while a resident physician in Cook County Hospital, Chicago, of which case I find I have complete notes: S. S., a Russian peddler, aged 27, admitted to hospital April 30, 1888. Had always been in good health ; on admission com- plained only of a persistent and incessant hiccough, which con- tinued night and day; it had already lasted one week; he was thoroughly exhausted from loss of sleep and the pain and sore- ness produced by the constant contractions of the diaphragm; the usual remedies for these cases, such as morphine, bromide and chloral, ether, cannabis indica, bismuth, soda and atropine, were each tried, but with little or no effect; morphine in large doses would relieve for one or two hours and allow the patient Some sleep; electricity applied to the epigastrium and to the phrenic nerve was of no avail. On examination over the region of the stomach, that organ was found to be considerably dilated and to contain a large quan- tity of fluid ; there was no external signs of a tumor or other py- loric obstruction ; thinking that the dilation of the stomach and the retention of fermenting food might be a cause of the hic- cough, I introduced a siphon-tube into the stomach and thor- oughly washed out that organ ; at least two quarts more of fluid were removed than had been introduced through the tube, and that which was removed was in a high state of fermentation. After this operation the hiccough entirely ceased, and the patient had his first good night's sleep in sixteen days. He was dis- charged two days later, with no return of the trouble.——Medica/ A'ecord. CASTRATION As A SUBSTITUTE FOR CAPITAL PUNISHMENT.— Before the New York Society of Medical Jurisprudence, March I4th, William A. Hammond, M. D., of Washington, read a pa-. per entitled “A New Substitute for Capital Punishment and Means for Preventing the Propagation of Criminals.” He began by stating that the primary object of all punish- ment for crime is the protection of society. Punishment should be of such a character as to act as a deterrent to crime to the ut- most extent. Statistics, as well as the experience of all ages, show that the fear of the punishment of death has never pre- vented man from injuring society. Imprisonment for life has proven even less of a deterrent than death. This last form of punishment is not so terrifying to the criminal; there is always the hope of a chance to escape or of a pardon. The objects to be accomplished by punishment of crime are threefold: First, it 46O SELECTIONS. should act as an example to others. Second, by placing the per petrator in such a position that further infringement of the laws will be impossible. Third, by inflicting such an amount of men- tal and bodily suffering upon him that he will experience a lively sense of his crime; and hence, when he has incurred that pun- ishment, he will be less prone than before to repeat his offense. It is clear that to accomplish all the objects for which pun- ishment is intended, neither death nor life-imprisonment are satisfactory, and some other means must be sought for. This 1method, Dr. Hammond stated, we have a punishment which even in our own time and in this country has been occasionally em- ployed for certain crimes—namely, castration. From a very early period castration was inflicted for adultery and rape. It has been in vogue in certain European countries, and not many years ago several negroes in Missouri were punished in this way for committing rape upon a white girl. The speaker said he would only refer to castration as a punishment for murder, and that his object was simply to show that this form of punishment would prove more deterrent than capital punishment or impris- onment for life; that it would entirely remove the man from the criminal classes, and that it would prevent the propagation of criminals. I. Castration as a deterrent to crime. A man places great- er value on his generative powers than on his life. As a French writer has said, “the dignity of a man resides in his testicles.” When they are removed there is a marked change in the man. He cannot open his mouth without exposing his condition. The facial expression becomes altered. The man becomes cowardly and effeminate. It leaves a stain upon him worse than that placed upon Cain. Dr. Hammond stated that the three negroes who were castrated in Missouri uniformly expressed a prefer- ence for capital punishment. He has several times put the question to criminals under sentence of death, and they all said they would rather hang than be deprived of their testicles. Juries that now hesitate about inflicting capital punishment would be less squeamish about castration. It would be a continuous punishment. It is not the intenseness of pain that has its great- est effect, but its continuance, 2. Castration would have the effect of making the criminal of some use to society. A dead man is of no use to society, and a man in prison is almost as bad. There are many occupations that would be open to him ; he could occupy any position in which boldness or originality are not essential. Possibly he might make a good clergyman. He would not make a soldier, or a SELECTIONS. 46I sailor, or a policeman, but he could edit a mild newspaper or make an efficient member of the legislative body. The value of eunuchs as singers has long been known. They would make ex- cellent dry-nurses and safe type writers. 3. Castration is probably the most powerful agent we have that will so alter the physical characteristics of a man as to re- move him from the criminal classes. We can learn a great deal of the effects of the operation by performing it upon the lower animals. After it is done the fierce ram becomes mild and the cat ceases his nightly raids. So far as the human species is concerned, our observation is largely limited to the Orient, to those who have suffered from wounds or disease of the organs, and to those upon whom the operation has been performed for punishment. The universal testimony of persons who have trav- eled in Eastern countries is that the operation takes away all the dangerous elements that are present in the person ; they be- come mild and obedient; they delight in the care of young child- ren. It is true, however, that it causes a degradation of the moral as well as the physical qualities. Dr. Hammond said that ten cases of castration have come under his notice. Three were the negroes who were punished in that manner for rape; two had lost their testicles as the result of disease; one had them removed as a possible cure for epilepsy; one had mutilated himself during an attack of delirium tremens, and three had been shot in battle. All these men were materi- ally changed, and, what is more remarkable, all of them who were in the habit of taking alcoholic liquors lost their appetite for it. Castration probably produces a profound change in the brain- structure. As a reformatory agent, it stands unequalled by any other radical act we have. 4. As a means of preventing the propagation of criminals, it is as sure as death itself. If this form of punishment had been adopted a few hundred years ago, many thousand acts of crime would not have been committed. It is less cruel than capital punishment, more efficacious than imprisonment for life. Dr. Hammond concluded his paper by stating that he did not expect to see this measure adopted during his lifetime, or during that of any of his hearers. It is so radically different from the method that modern Society has seen fit to establish that its adoption will take a long time. It took thousands of years to abolish torture and make other changes in the laws, and he felt sure that the method of dealing with criminals he had advocated in his paper would be more humane and efficacious than the one now employed. 462 - SELECTIONs. In the discussion that followed the reading of Dr. Ham- mond's paper, Dr. Landon Carter Grey stated that the sugges- tion was so novel that he was rather taken aback. Any method that would prevent the propagation of the criminal class is cer- tainly worthy of attention. The point he wished to criticise in Dr. Hammond's paper was that it had not been shown conclu- sively that castrated males will not commit acts of violence. It is. reported that many crimes are committed in the harems in the East; what part the eunuchs played in these he did not know. In females ovariotomy has been done on an exceedingly liberal scale in late years, and it does not seem to eliminate their sexual characteristics.--Med. AVews. INFREQUENT PULSE (BRADYCARDIA.) IN RHEUMATISM.– This is an exceedingly rare phenomenon in rheumatism, and the text-books hardly mention it. (The writer has seen but one case; in that the pulse dropped finally to 32 per minute; recov- ery was slow, but uneventful. J. F. B.) Prof. J. E. Atkinson, of Baltimore, has been investigating the matter, and reaches the following conclusions (Va. Med. Mo.):— I. Bradycardia is observed rarely during the active stage of acute inflammatory rheumatism. It occurs with greater fre- quency during convalescence from this disease. 2. When it occurs during convalesence, in most cases, proba- bly, it is identical with bradycardia following acute febrile dis- eases of widely different nature, and directly the result of the febrile action itself upon the innervation or musculature of the heart. 3. When it occurs during the active stage of rheumatic fever, it probably depends upon endocarditis, or pericarditis, or myocarditis (primary or secondary, by extension), whereby the inhibitory nerves of the heart are implicated, and consequently stimulated. Even where the physical signs of cardiac inflamma- tion are absent, bradycardia occurring during the acute stage of rheumatism, may be secondary to undetected myocarditis stim- ulating the vagus nerve. 4. It is possible, but exceedingly improbable, that this symp- tom may follow the action of the rheumatic noza upon the car- diac muscle or nervous system directly. NON-CONTAGIOUSNESS OF LEPROSY.—Dr. L. Duncan Bulk- ley in a study of this disease, basing it on his own observations. and those of others, arrives at the following conclusions: SELECTIONs. 463 I. Leprosy is not in any proper sense of the word a conta- gious disease. 2. There is not the slightest warrant for public alarm con- cerning cases of leprosy. 3. It is not due to climatic or race conditions. 4. It originates from bacillus. 5. There is reason to believe that under certain conditions it can be inoculated. tº 6. There is considerable ground for the opinion that it is frequently caused by food and especially fish. 7. Heredity is a possible factor in its causation. 8. There is far greater warrant for the seclusion and regu- lation of syphilis and tuberculosis than of leprosy.—Weekly Al/ed. A'ezyzew. gººmººl ºf ºmº How TO ADMINISTER IRON.—It is generally conceded that the officinal tincture of chloride of iron is one of the most valu- able of the iron preparations therapeutically. The practical diffi- culties attending its administration for a length of time have been its disagreeably astringent taste, its corrosive action on the teeth, and its constipating action. Dr. G. W. Weld's extensive experience in the practice of dentistry led him to recognize the virtues of the tincture of the chloride of iron as a stimulant for patients after the strain of the dentist’s work. Repeated experi- ments to obtain a formula free from the objectionable features resulted in the preparation of a very highly pal- atable syrup with all the therapeutic efficacy preserved. This has been extensively tested and placed in the hands of Parke, Davis & Co. for manufacture, who strongly commend it to the medical profession for trial. Being prepared after Dr. Weld's formula, it is entitled Weld's Syrup of Iron Chloride (P., D. & Co.'s). It is believed it will effect a revolution in iron adminis- tration. mºsºmsºmº mºsºme HEART MURMURs.—It is sometimes difficult to distinguish between a functional and organic heart murmur. An organic murmur is increased by anything that increases the force of the muscular contraction of the heart. If you make the patient walk about the room, or up and down stairs, so as to throw a lit- tle additional work on the heart, then the murmur becomes more distinct. Another distinguishing feature is that organic mur- murs are more harsh than functional murmurs. The seat of an anemic blowing is to the left of the sternum, about the third 464 SELECTIONs. costal cartilage, or over the area of the pulmonary artery. It is a systolic murmur. In cases of marked anemia, there is a purr- ing, blowing murmur in the jugular vein, which is called the ðruit de diable. It is a purring sound, like that made by a cat. Its exact cause is not known, but it may be due to some altera- tion of the relation existing between the blood and the contain- ing vessel.—77mes and Register. LAWSUITS AGAINST DR. KEELEY.—The celebrated Keeley method of treating drunkenness must have some annoying draw- backs, as lawsuits seem to be multiplying about its originator. In one case, a prominent Chicago physician has brought suit be- cause his name was inserted as a reformed drunkard in a long list of patients of the Dwight Institute, while he says he never was a patient at all, and is a temperance man. In another case, a patient has brought a damage suit because he claims the treat- ment has injured him physically without accomplishing the re- sult claimed. At the same time, it must be remembered that there are hundreds and thousands who have been treated, and believe that they are absolutely free from the danger of a re- lapse.—Va. Med. Mo. * RUPTURE OF AN AORTIC VALVE FROM PHYSICAL ExER- TION.—--Tretzel has recorded the case of a large, muscular, hearty Iman, forty-one years old, who, while pushing a heavy cart, felt a severe pain in the chest. In the course of the day both the man and his wife observed a purring sound that emanated from the man's chest, and that occurred with the regularity of the pulse. Except for oppression of the chest and disturbance of sleep, the general condition was unaffected. On examination, a murmur could be heard at a distance of two or three yards from the pa- tient, and it was observed that the sound was produced subse- quently to the occurrence of the apex-beat. On palpation of the precordium, a tremor could be felt. Pulsation was detected in the epigastric region, in the carotids, and in the peripheral ves- sels. The area of cardiac percussion-dulness was already in- creased. On auscultation, a loud diastolic murmur was heard at and to the right of mid-sternum. A diagnosis of aortic insuf- ficiency, from rupture of a valve leaflet, was made. The patient was lost sight of for two years, when he was found cyanotic and anasarcous. The heart had become enormously enlarged. Its action was frequent and feeble. The diastolic murmur was not as loud as it had been at first, and could no longer be heard at a SELECTIONS. 465 distance from the chest. While under observation the patient died suddenly. At the autopsy the heart was found to be im- mensely dilated and hypertrophied. The first part of the aorta was dilated. The aortic orifice was incompetent. The right leaf- let at its anterior portion was torn from its attachment, and floated free in the opening. A linear cicatrix occupied the site of attachment of the valve. The remaining valves and orifices were normal.—Med. AVews. * =sº THE CAUSE OF THE INUTILITY OF ERGOT IN THE INTES- TINAL HEMORRHAGE OF ENTERIC FEVER.—As an addendum to the communication in 7%e Medical AVews of January 9th, relat- ing to the therapeusis of intestinal hemorrhage in enteric fever, I would like to state that the inutility of ergot in this condition has a source deeper and a significance wider than was noted by your correspondent. A hemorrhage of sufficient gravity in en- teric fever to demand a resort to specific measures to cause its cessation, usually emanates from an eroded vessel. Ergot here, as in the hematemesis of gastric ulcer—also commonly de- pendent upon the erosion of an artery—is not only useless, but absolutely harmful, since, from its constricting effects on the ves- sels being limited to the arterioles, and causing resistance a fronte, when a vessel larger than an arteriole is the source of Hemorrhage, the increased pressure results in augmentation of the bleeding. This fact, though of vast importance, is appar- ently known to few. It was pointed out some time ago by Dr. A. H. Smith, in a communication to 7%e Medical AVews relating to the hematemesis of gastric ulcer. The principle underlying it should govern the administration of ergot for the control of hemorrhage—to use in that produced by capillary oozing, to avoid in that resulting from rupture of a vessel larger than an arteriole. Still another important objection to the employment of er- got in the intestinal hemorrhage of enteric fever is the fact that active peristaltic movements are thereby produced, the effects of which would inevitably be to disturb the ulcerated bowel, to pro- voke more rapid separation of the sloughs, and to aggravate the tendency to bleeding.—/Dr. ZD. D. Stewart, ºn Medical AVews. SURGERY. HEMORRHAGE SURGICALLY TREATED.—Dr. Robert H. Daw- barn, of New York, (Medical A'ecord) urges upon the profession the treatment of hemorrhage, when the bleeding point cannot be reached (as in hemorrhage from the lungs, stomach or intes- times), the use of bandages placed around the limbs, and tight- ened by twisting with a stick, after the manner of the Spanish windlass, as figured in the text-books. The bandages should be twisted tight enough to prevent the return of blood, but not tight enough to prevent its flow in the arteries. In this way a greater or less amount of blood is retained in the limbs, and af. ter the hemorrhage has ceased, and time enough has elapsed, about an hour, for the clot to be formed firmly, the bandages can be removed, one at a time, and the blood restored to the circula- tion. He also advises in cases of collapse from hemorrhage, in- jection into the blood vessels of a solution of common salt. The solution should be prepared in the proportion of a heaping tea- spoonful of salt to a quart of water, as hot as the hand will bear. The water should first be boiled, for reasons of asepsis. The presence of the salt is of vital importance, as otherwise the in- jection would prove promptly fatal. The operation of injection involves no cutting whatever, or searching for a collapsed blood vessel. The instruments needed are three; an ordinary syringe, Davidson's syringe, or fountain syringe, a soft catheter or other rubber tube, and an ordinary hypodermic needle, large size preferred. The femoral artery is then located and the needle thrust in. As this artery is large, there is no difficulty in pierc- ing it with the needle. As soon as the presence of arterial blood through the needle shows that it is in proper place, the end of the rubber tube is slipped over it and connected with the syr- inge, care being taken to see that all air is excluded. The hot salt solution is then pumped in in sufficient quantity—a pint is usually a proper amount—requiring probably a half an hour for the injection. In order to prevent the possibility of air working through the valves, the entire syringe, together with the hand of the operator, should be inserted in the fluid, the heat of which should be maintained by keeping the vessel containing it in a larger one supplied with still hotter water. 466 SELECTIONs. 467 TREATMENT OF TUBERCULAR JOINTs BY THE INJECTION OF IODOFORM EMULSION.—The Ammals of Surgery for January, 1892, contains a monograph by Senn, giving an admirable account of this method of treatment in his hands. Prof. Senn's extensive acquaintance with surgical literature enables him to make a comparative review of all the substances used in this form of treatment—which have proven of value and have received atten- tion from the profession. His clear conception of experimental study and research also qualify him to present to the profession a concise statement of the results obtained by different experi- ments. For these reasons the paper is invaluable as a contribu- tion to modern surgery. tº EEE º ANOMALIES OF FORM AND POSITION OF THE KIDNEY.—De- viation from the normal shape and size or natural positions of the kidneys may be congenital or acquired at any period of life. It is probable that the affection is much more common than is generally supposed. Statistics given make a proportion of one in every 250 persons. These deviations are much more common in women than in men—in the proportion of seven to one. Dr. Gill Wylie has recently reported a case (AV. Y. Journal of Gyneco/- ogy) in which both kidneys were found upon the right side, one occupying its normal position and the other situated beneath the right broad ligament of the uterus. The misplacement in this case was considered unusually low. A NEW METHOD FOR REMOVAL OF EPITHELIOMA.—We are indebted to Dr. P. A. Morrow, of New York Charity Hospital, for some valuable suggestions respecting the removal of cutane- ous epithelioma. Following out the line of more recent experi- ments in skin-grafting, the doctor clearly demonstrated that the limitations in the size and depth of the grafts were fanciful, and that grafts of considerable size and .. so deep as to include the entire thickness of the skin, and in some cases a layer of sub-cutaneous tissue, would readily and perfectly unite, provided accurate co-aptation of the grafts or new material with the base and margins of the surrounding tissues be obtained. The method of procedure consists in removing, with an instrument which resembles an old-fashioned shotgun wad-cutter, and known as “Keys’ Cutaneous Purich,” buttons of healthy integument of required thickness and size, and immediately inserting the same into receptacles or beds previously made in the diseased territory by the same instrument. 468 SELECTIONS. While this method of treatment appears applicable to vari- ous forms of cutaneous disease, it is more especially indicated in “epithelioma of recent development, and of limited area,” and when the cancerous infiltration has not yet invaded the adjacent tissues. The healthy tissues taken from another part of the body do not so readily undergo degenerative changes, and for this reason Dr. Morrow believes the progress of the disease may be checked and the chances of a complete and permanent cure thereby materially strengthened. The method is worthy of care- ful trial and with certain modifications the range of its applica- tion may be increased. S., e The hypodermic use of a solution of cocaine will render the procedure painless.-Medica/Mirror. PADS OF ABSORBENT GAUZE As A SUBSTITUTE FOR SPONGES. —Ashton, M. D., in Med. AVews. The pads are made of the ordi- nary unsized absorbent gauze in use in all hospitals for surgical dressings. I employ two sizes: a large pad, nine inches square, which is used in abdominal work, and a small one, four and one half inches square, for pelvic cases. Each pad is composed of six- teen layers of gauze, folded together in such a manner that the edges cannot fray. The large pad is made as follows: A single layer of gauze a yard square is folded at each extremity upon it- self, so that the folds meet at the middle. This makes two layers of gauze, oblong in shape, the extremities of which are now folded over so that they meet in the middle. There are now four layers, and the shape of the pad is square. This is then folded upon it- self, making again an oblong pad, having eight layers. Folding it once more upon itself, the pad is then composed of sixteen lay- ers and measures nine inches square. To keep the pad in shape and the layers from becoming separated the edges are stitched together with ordinary sewing cotton. The small pad is made in a precisely similar manner, except that the piece of gauze 18 inches square is used. º The advantages of these pads over sponges are very great. Flat sponges are not only expensive, but it requires great care and trouble to render them aseptic. Again, they can be used only a few times, as the chemical process through which they must pass in cleaning after an operation renders them rotten and un- fit for use. Indeed, it is a serious question—one that for myself I have long since decided in the negative—if a sponge should ever be used a second time in abdominal work. Certainly, the best results are obtained in this branch of surgery by those SELECTIONS. 469 operators who are extravagant in the use of their materials and who never use ligatures or sponges left from a previous opera- tion. Finally, sponges necessarily swell when brought in contact with fluids, and consequently they do not remain well in the position in which they are placed. On the other hand, gauze pads are inexpensive, the material costing only 234 cents a yard; they are readily made, and easily rendered aseptic by simply placing them in a steam sterilizer for forty-five minutes prior to using them. Again, they remain well in place, as they retain their shape perfectly and are much easier to pack about the seat of operation than are sponges. ESOPHAGOTOMY FOR THE REMOVAL OF A SILVER DOLLAR.— Dr. J. T. Freeland reports the following case in the Medica/ A'ecord. While scuffling with some companions, a young man, holding a silver dollar in his mouth, accidentally swal- lowed it. It lodged in the esophagus about an inch above the sterno-clavicular articulation. When seen two hours after the accident, he was in intense pain, and making constant violent efforts at vomiting. The coin could not be reached with forceps nor with an improvised coin-catcher. The pa- tient was anesthetized, the head drawn back and to the right, making tense the muscles and fascia on the left side of the neck, and an incision three inches in length made along the anterior border of the sterno-mastoid muscle. The tissues were carefully divided with the blade and handle of the scalpel, until the blood- vessels came into view. These were drawn to one side, and the trachea to the other, and the incision continued until the coin could be felt through the wall of the esophagus, which bulged into the wound. An incision was made down on the edge of the dollar, and as soon as it could be seen it was grasped with a forceps and the opening enlarged, until the coin could be drawn out. The only hemorrhage was from a small artery near the esophagus, which was secured without difficulty. No sutures were taken in the esophagus, and the wound was packed with iodoform gauze, which was afterward changed daily. The in- ferior laryngeal nerve was divided. On the ninth day the pa- tient was able to swallow fluid while lying on his right side, on the fifteenth day could swallow in the upright position, and on the twenty-fifth day he returned to his ordinary diet. - [Several years ago, a young man was brought to my office, who had swallowed a silver dollar. He was a tramp who had 47O SELECTIONS. only a dollar in his possession, and for safety, as he was sleep- ing with other tramps, had placed it in his mouth. He waked up just as it was going down. It had lodged just above the stomach. Emetics failed to dislodge it. I succeeded in pushing it into the stomach by the use of a bougie. I tried to keep track of him, to see if the dollar passed on, but he passed from obser- vation, carrying with him my only hope for a fee. J. F. B.] *º THE OPERATIVE TREATMENT OF IRREDUCIBLE LUXA- TIONS OF THE THUMB.—Dr. Montez states that the operative treatment of this trouble has attracted but little attention, and some authorities have condemned surgical interference. Dr. Montez, however, thinks that these patients should enjoy the benefits of antiseptic surgery, for the sake of improving the ap- pearance of the thumb, even when its functions are not much interfered with. As regards the methods of operation, arthrot- omy is not of itself sufficient to effect reduction, and section of the lateral and capsular ligaments has proved of no service. Resection alone is of value. The incision should be anterior and made over the head of the metacarpal bone; the periosteum and capsular sheath are detached, and the head of the bone excised. If the patient is young the periosteum should be abraded to avoid periosteal proliferations and anchylosis. –Za 777bune Al/edica/e. *ssºmsºmºsºmºmº ETHER ANESTHESIA.—In New York chloroform is rarely used. In the administration of ether, what is known as the “blood storage” method is used, which is, briefly, as follows: An Esmarch's bandage is placed around the upper and lower extremities, near the body, just tight enough to prevent the re- turn of venous blood, but before commencing the ether the pres- sure is increased so as to shut off entirely or as near as possible the supply of arterial blood to the extremities. After the opera- tion the bandages are slowly loosened and the unetherized blood permitted gradually to return from the extremities and dilute the etherized. The advantages claimed are, less ether, less time, less danger and a much more rapid recovery from the anesthesia. The method is being tried at Roosevelt and Belleveue Hospitals.-- A/zss. Va/. A/ed. Mo. 11 AA’O/2//Y/LA CT/C A GA/AWS 7 “ſ. A GAC/APE.” sº-sº (MARE LAFFONT, M. D., PARIS, FRANCE.)* The epidemic which was such a cruel scourge last winter is again appearing. * The symptoms of this complaint are manifested invariably by a functional depression, more or less marked, of the whole system, varying from simple lassitude stuffiness of the nose and slight gastric obstructions. In the late epidemic to these premonitory symptoms succeeded all the characteristic of grave typhoid infection ; nausea, fever, muscular pains, delirium, pneumonia with tendency to suffocation and complete prostration. * In the presence of Influenza in the stage when the patient was completely depressed, I found the most effectual treatment to be the administering of strong tonics such as generous wines, champagne, cognac, tonics physical and moral, preferably prepara- tions made from the fresh leaves of Erythroxylon Coca, such as “Vin Mariani’’ and “Elixir Mariani;” at the same time causing revulsion and administering repeated aperients. I advise as a rational treatment for Influenza and kindred affections: gentle purgatives; disphoretics and revulsives ; strong tonics. Medical Press and Circular, London. * “THE TERIOR OF THE WO CAL CORDS.”—Charles Fauvel, M. D. “THE REMEDY, PAR EXCELLENCE, AGAINST WORRY.”— J. Leonard Corning, M. D. “THE WINE FOR ATHLETES.”—E. B. Palmer, M. D. “THE GARDIAG TONIG GIVING BEST EFFECTS.”—Beverley Robinson, M. D. Monograph on Erythroxylon Cocoa Forwarded on Application. INA/TA-I F& I-A-INTI cºc CC- Paris: 4 Bd. Haussmann. 52 West 15th Street, New York. London - 239 Oxford Street. 7 Convenient W Elegant A Easily Swallowed RELIABLE, Rea. Vibur. Prun gr. i Y “ “ 0pul. gr. 1 * Aletris Far. gr.9% ** Helion, Dios. gr.9% * Mitch. Repens gr.9% Cauſophyllin - gr.9% TABLET WIBURNUM \ COMP. For AMENORRH(EA LEUCORRHEA For 3- Threatened " Abortion Dysmenorrhoea Anti-Spasmodic / ) MULFORD \\ * | COMPANY ºr * \Philadelphia/ ) Anodyne 100 of these TABLET's sent on receipt of 65 CENTS Mention this Journal Doctor, This Will Interest You ! That you may become acquainted with the tº erits of our preparations we will furnish you for $3.00, with a handsome, double Morocco Pocket Case, containing 24 vials filed with the following complete assortment of Tablets and Tritu rates | | Tr, aconite, 1-2 minim. Tr. belladonna, 2 minim Nitro Glycerine Comp. (M. & Co’s.) Cascara om.(M. & Co.) A Timon. Mur. comp. Calomel, 1-10 grain. Calomel, 2 grains. Calomel, ipecac & soda bicarb, No 1. Dover's Powder, 2% gr. Fever ( Dr. T. G. Davis) H vararg. Iodine Virid, ſº | | º t Creasote. º Hypophos Quinia comp. W \\ Acetanilid, 2 grains. W. Morphia Sulph., 1-6 gr. ſ º \ | W Zinc Sulpho-carb., 1 gr. º Acid Arsenious, 1-60 gr. ſ Bismuth et Cerii Oxalat Kermes Mineral comp. – -- • 2 tº z → - Paregoric. 10 minim. No. 2 Size, 7%x3% x7% inches. Price, $3.00. §. 1-60 grain. All vials in this case are fitted with screw caps. We would call especial attention Quinia Sulph., 1 grain. to our Tablat's Hypophos, Quinia Comp. cum Creasote, which are superior to syrups and solutions, owing to absence of sugar and tree acid. grain. Write for Complete List, mention-ng this journal. H. R. M U L FOR D & CO Factors of Gomu, essed Got ds and Pharmaceutical Preparations, Corros. Sublimate, 1-40 12 H H H L A D HD H . PHIIA. EDITORIAL DEPARTMENT. J. F. BALDWIN, M. D., Columbus, - - - - - - - - EDITOR. J. E. BROWN, M. D., Columbus, sº * tº 4- sº- - ASSOCIATE EDITOR. Communications, reports, etc., are solicited from all quarters. Authors desiring reprints, will receive fifty, free of charge, Arovided the request for the same accom- panies the article. Subscribers changing their location, are requested to notify the Publishers żromptly, that there may be no delay in receipt of the journal, tating both the new and the former post-office address. We have no authorized Collectors, except such as carry properly made out bills, countersigned by the Publishers. THE COLUMB US ME DICAL PUBLISHING CO., CoLUM BUs, OHIo. WE have received several brief communications laudatory of the “Elixir of the Three Chlorides,” manufactured by Renz & Henry, of Louisville, Ky. *º-º-º-º PROF. D. HAYES AGNEw, America's greatest surgeon, died at his home in Philadelphia on March 22d, at the age of seventy- four. Dr. Agnew was born in 1818, in Lancaster county, Penn- sylvania, and graduated at the University of Pennsylvania. WHEN a member of the Faculty of a Medical College (and this time it is the Chattanooga Medical College) alludes to his colleagues in a published article as “my faculty,” the inference is almost inevitable that the school belongs to the vest-pocket variety. DR. JAMES M. MILLER, of Bloomington, Ill., has become violently insane. He was a prominent young physician, and a few weeks before his attack, he underwent a course of the Keeley treatment for alcoholism and the opium habit. Since then his health has been greatly impaired.— 77mes and A’egzster. WE have received a number of reprints of articles from Doctor Wm. E. Wirt, of Cleveland, Ohio. Among them are the following: Case of double club-foot, double club-hand and mul- tiple deformities; Congenital dislocation of the hip; Pott's dis- ease ; A Theoretical and Practical Demonstration of the Action and Tension of the Tendo-Achillis in Supporting the Body on Tiptoe. 47I 472 EDITORIAL. WE have received a brief communication from Dr. W. I. Riggs, of Pittsburgh, in which he speaks very highly of the use of the “Three Chlorides” in gynecological and obstetrical prac- tice. He claims for the remedy a specially valuable action in securing the absorption of pelvic deposits. THE Superintendent's report of the Cincinnati Sanitarium for 1891, has been received, and makes the usual flattering show- ing for the work of this excellent institution. The Superin- tendent makes a strong argument in favor of hospital treatment for the insane instead of home treatment, as being best in a great majority of cases. …” THE Medical Wews of Philadelphia, has at last yielded to the inevitable, and has decided to drop the digraphs “ae” and “Oe’ except in Caesarean, Naevus, Framboesia, Amoeba and Pharmacopoeia. The change is a commendable one, but the edi- tor should take the bull boldly by the horns and drop the digraphs in everything and forever in words that have become Anglicized. PATHOLOGY ExTRAORDINARY.-The Health Officer of a Tennessee town was recently called upon to investigate an epi- demic of typhoid fever in a farm house. He decided that the disease was due to the use of milk by the persons affected. The cow from which the milk was drawn had sore teats, and he thought that these sore teats were caused by the odor from a re- cently disturbed dung pile. MODERN MEDICAMENTS.—Before us is the latest list, just issued, of the extensive line of standard and pharmaceutical preparations, and modern medicaments manufactured by Parke, Davis & Co. A novel and attractive feature of their comprehensive and well arranged list is the representation, by forty engravings, of the home laboratories at Detroit, and the branches at New York, Kansas City, and Walkerville, Ontario. These engravings com- prise views of the exterior and interior of the laboratories, offices and sections of departments at Detroit, The cover is engraved, and altogether it is the most complete list ever published of the products of this well known house, and will be welcomed by their friends. To physicians interested, a copy of this list will be mailed on request. EDITORIAL. 473 “INGLUVIN.”—W. R. Warner & Co., of Philadelphia, de- site to send to any physician a sample of this remedy wherever he has a patient resisting all other treatment for sickness in gestation, marasmus, cholera infantum, for which it is found to be almost a specific. WE are in receipt of an interesting brochure from the Arlington Chemical Co., being their second series of “American Men of Eminence.” The pictures are interesting, and those who receive them should save the series carefully, as the company issuing them promise to bind them neatly when the series is completed, free of charge, for all who request it. This company is one of the most enterprising in the country, and its methods of advertising are strictly professional and legitimate. THOSE “West Virginia Resolutions,” concerning which a committee was appointed at the last meeting of the State Medi- cal Society, are handled without gloves in a paper by Dr. Webb J. Kelly, of Galion, read before the Northern Ohio Medical Societies at Mansfield, a few months ago. The paper should be carefully read by the members of the committee, and all others interested in this matter. It seems to us that the points made by Kelly are well taken, and that the railroad surgeon is with us and has come to stay. * PURE CHLOROFORM.–Professor Pictet, of Berlin, formerly Professor of Chemistry in the University of Geneva, has accom- plished the absolute purification of chloroform, by subjecting it to a very low temperature. The pure chloroform chrystalizes, and the part remaining liquid contains, or is supposed to con- tain, all the toxic impurities. Experiments made by Bois Ray- mond, as recently published in the British Medica/ /ournal, seem to indicate that chloroform thus purified is at least a much safer agent than the ordinary article. If Pictet's method shall prove to get rid of the dangerous element in chloroform, and render that agent a safe anesthetic, he will have conferred an inesti- mable boon upon humanity. JEFFERSON MEDICAL COLLEGE is at last waking up to the necessity of joining the ranks of progressive medical colleges. It has recently decided to put up new buildings on Broad Street at a cost of about half a million dollars; also to add a number of men to the faculty. The chair formerly occupied by Professor Y 474 EDITORIAL. Theophilus Parvin, of obstetrics and diseases of women, has been divided. Prof. Parvin retains obstetrics, and Dr. E. E. Mont- gomery, for many years connected with the Medico-Chirurgical College, has been elected to the chair of diseases of women—a full professorship. Four clinical professorships have been es- tablished, and filled as follows: Dr. F. X. Dercum, professor of nervous diseases; E. E. Graham, professor of children's diseases; H. Augustus Wilson, professor of orthopedic surgery, and H. W. Stelwagon, professor of skin diseases. No better appoint- ment than that of Doctor Montgomery could have been made. He is not only a fine operator, with wide reputation, but an ex- cellent teacher. A COMMENDABLE ENTERPRISE.-We learn with pleasure that Messrs. Charles Truax, Greene & Co., the well-known sur- gical instrument dealers of Chicago, will open a “Physicians’ Bureau of Service and Information” during the World's Fair. They will keep a register of all physicians calling, with their name, residence and location in the city; will forward to them telegrams or mail matter sent in their care; will keep a list of hotels and boarding houses for their accommodation, and will furnish them banking facilities; they also will furnish telephone and messenger service, and package room; will also have inter- preters of German, French, Spanish and other languages located in the building; in other words, they expect to make their “Bureau” a headquarters for all the physicians attending the exposition free of change. We hope that they will largely in- crease their already large number of friends and acquaintances, and will be thus paid (in part at least) for the service expended. Izanufactured of Hard Rubber, with Cover containing NEW INSTRUMENT.-We t Alcohol Lamp, tº # have received from The Physicians' Supply Manu- ºil facturing Co., of I4O Nas- *. º sau St., New York, a “Bart- fººt ºf \ . . . . . 'si ** 1ey” Pocket Test Case. It —H, s —s— is made of hard rubber with 1metal cap, and contains an alcohol lamp, test tube, test papers, urinometer, pipette, and powders for determination of sugar and albumen, The whole is a case which can be easily carried in the pocket. It constitutes a valuable addition to our means of bed- side diagnosis, and will prove especially valuable to a physician whose practice extends to considerable distances from his office. The price of the case is two dollars. y EDITORIAL. e 475 WE desire to call the attention of our readers to the new ad- vertisement of Reed & Carnrick. This firm have spared neither labor nor expense to perfect their Infant Foods in keeping qualities by sterilization and by placing them in hermetically sealed containers. They claim that Lacto Preparata, an all-Milk Food for young infants, and Carnrick’s Food, composed of half Lacto-Preparata and half dex- trinized wheat, for use after six months of age, have now prac- tically reached perfection in keeping qualities, and that they are the only Infant Foods in the market that will alone thoroughly nourish a child during the nursing period. Their Lacto-Pre- parata almost perfectly resembles human milk in character, com- position and taste. * UNDER the name of Annals of Ophthalmology and Otology there has been issued the first number of a quarterly magazine, to be devoted to eye, ear, nose and throat literature. It is published at Kansas City, Mo., with James P. Parker as its edi- tor, with whom will be associated Dr. B. E. Fryer, of the same city, Dr. C. A. Wood and T. M. Hardie, of Chicago, and Dr. M. D. Lederman, of New York. The first number contains articles from such men as Roosa, of New York, Jackson and Gould of Philadelphia, Chisolm, of Baltimore, and Gleitsmann, of New York, and if its standard is maintained in succeeding issues there will be no question of its popularity with that part of the profes- sion which takes any interest in the study and treatment of dis- eases of these parts. The Ammals will aim to occupy a practical field, and being published in the west should rally to its support the large body of special practitioners to be found in that sec- tion, the south and southwest. With Knapp's Archives it will not conflict, for that occupies the field of ophthalmological classics,devoting itself almost exclusively to technical literature, and compact reviews. And having included the department of Rhinology and Laryngology the Ammals will find a patronage which no other ophthalmological journal has as yet sought. J. E. B. * LEPROSY IN MINNESOTA.—We would call the attention of those health authorities whose notions of leprosy are apparently cotemporary with those of the first century of the Christian era to an article in the Zanceſ for March 26th, that has been indorsed 476 - Editorial. by the well-known secretary of the State Board of Health of Minnesota, Dr. Hewitt, and by that excellent sanitarian, Dr. Henry B. Baker, of the Michigan State Board of Health. The article in question is by Dr. Gronvald, of Minnesota, and de- scribes the experience of that State during the past forty years with the lepers among its Scandinavian population. It is stated that all leprous persons are registered and kept under observa- tion, and all suspicious persons are visited by inspectors of the State board. The only thing that the board requires is for the affected person to have his own bed and utensils. And yet, with so little interference with the freedom of the individual, there are but eighteen cases of leprosy in the State; in none of the de- scendants of lepers has there been any sign of the disease dis- covered; no leper has been born in Minnesota, and so no ground lias existed for the exhibition of officious zeal in declaring a patient to be an outcast and treating him as such.—AV. Y. Med. Journal. - The “notions” of the Ohio State Board of Health seem to be of the primitive character alluded to by our esteemed cotem- porary; for less than a year ago the Board re-promulgated a rule absolutely prohibiting, under any circumstances whatever, or with any precaution whatever, the transportation of bodies of those dying of leprosy. We sincerely hope that the members of this and other Boards will take pains to inform themselves of the real character of this disease, and then act more in accordance with modern ideas. *mºnº-ºsmºs PHYSIO-MEDICALISM--The editor of Samatzve Medicine, the organ of the so-called Physio-medical school of medicine, and published at Westerville, Ohio, dedicates to the editor of this Journal the following, as containing the history, principles and motto of his school:— - “HISTORY.-The Physio-Medical school of medicine had its founding in the teaching and practice of Samuel Thomson, and its development under the labor of Alva Curtis, A. M., M. D. (1805-85.) - “PRINCIPLES.—It holds to the following principles, believ- ing them to be the basis of the science of medicine. “Ist, The zygła/properties of the living matter of the human organzsm are definzie and faced, the same in the sick man as in the well man; hence, the fallacy of an agent being remedial in the first case and poisonous in the latter. 4. EDITORIAL. 477 “2nd, The relationship of agents to the living matter of the system is definite and fired, hence, the fallacy of quantity alter- ing quality; therefore “3rd, A gºven agent always produces essentza//y the same effect, due allowance being made for seeming exceptions as idio- syncrasy and repetition. “4th, Zhe relation of pozsons to the living matter of the system zs only deframental and never truly remedza!. “MOTTO.-Conditiones Medica Saniter.” From the above it will be seen, if we understand what the language means, that the only principle of this “school” is, that under no circumstances will its believers administer poisons. A definition of the word “poison” in this connection would be interesting, and also an interview with the druggists filling the prescriptions of Physio-Medicalists. We strongly suspect that their prescriptions would read very much like those of other physicians, including our Homeopathic brethren, who with scarcely an exception have long since abandoned their “princi- ples” of similia and infinitesimal doses. g It will be remembered that when the recent Medical Bill was under consideration by our legislature, the Physio-Medical- ists insisted, and we believe secured an amendment to that ef- fect, that their school should have one representative in the Board, although all the other physicians of the state were willing that no names of schools should be used at all, but that the mat- ter should be left in the hands of the Governor with the sole provision that not more than three of the seven members should belong to one school of medicine. The Physio-Medicalists were afraid to trust the Governor. Their impertinence in thus de- manding representation can only be appreciated when we consider that they have, in the State of Ohio, not a single med- ical college or hospital, and less than IOO who are nominally professors of that faith. From the report of the Commissioner of Education for the years 1888-9, we find the Physio-Medical school had but one college in the country, at that time, with a faculty of II teachers, with I5 students and 5 graduates. That a school of medicine that makes such a meagre showing as this should demand representation in a Board of Medical Examiners, is the height of the ridiculous, and we think that the demand for a representative for this school was made, not in the interest of justice, but as a means of defeating the Bill. We do not think they care to have their methods investigated, or their grad- uates examined. - 478 EDITORIAL. OAP/7'O/AA’ Y. smºsºm-º. DR. C. R. VANDERBURG. The following resolutions were adopted by the Central Ohio Medical Society, March 3d, 1892: Whereas, It has been the will of an all-wise Creator, that the Angel of Death should visit us and call from our midst, our brother physician, C. R. Vanderburg, of this city; therefore be it A'esolved, That we, the members of Central Ohio Medical So- ciety, while bowing in humble submission to the Divine will, hereby express our deep sorrow for the untimely death of our friend. Not only we, but the whole medical profession, have lost an honored friend and a faithful co-laborer, a man whose sim- plicity was child-like, and whose faithfulness to the cause had won for him the respect of the profession and the public. A'esolved, That while we recognize in him a model of integ- rity filled with an abiding faith, inflexible principle, and untiring in his labors to advance the knowledge of medicine, we trust that the light he has given to the profession, and the blessing he has conferred upon humanity by alleviating their suffering dur- ing his professional activity, and who attest the value of his ser. vices, and lament his removal from earth, that he has gained the approval of the one Great Physician, who doeth all things well. A'esolved, That we most respectfully tender to the bereaved wife and all relatives our heartfelt sympathy in this hour of their loneliness and sorrow, and be it further A'esolved, That a copy of these resolutions be sent to the family of the deceased; recorded by the Society, and published in the Columbus Medical /ournal and daily papers. JNO. A. LEEPER, GEO. M. CLOUSE, Committee. : J. C. LAWRENCE. Syr. Hyppº. Co., Fellows Contains the Essential Elements of the Animal Organization—Potash and Lime; The Oxidislng 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 Slightlv Alkaline Reaction. It Differs in its Effects from all Analogous Preparations; and it possesses the important properties 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 deseases. Its Curative Power is largely attributable to its stimulant, tonic, and nutritive properties, by means of which the energy of the system is recruited. I's Action is Promp"; it stimulates the appetite and the digestion, it promotes assimilation, and it enters directly into the circulation with the food products. The prescribed dose produces a feeling of buoyancy, 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 per- sons to offer imitations of it for sale. Mr. Fellows, who has examined samples of several of these, finds Lhat 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 wrap- pers surrounding them) bear, can then be examined, and the genuineness—or otherwise—of the contents thereby proved. .7%edicaſ Zeilers may be addressed £o Mr. FELLOWS, 48 Vesey Street, New York. 14 A WEGETABLE ALTERATIVE & TONIC AUSES THE ELIMINATION OF SPECIFIC BLOOD Poison, the repair of wasted and disorganized tissues, and the restoration of the vital forces to their normal activity. In the treatment of Syphilis it supercedes the use of both Mercury and Iodide of Potassium, and is a reliable remedy for the evil effects pro- duced by the excessive use of these drugs. It is also specially indicated in all Scrofulous Affections, and is invaluable in the treatment of Eczema and other Skin Diseases, in Chronic Rheumatism, Old Chronic Ulcers, etc. Formula-Verrhus Clemiana is a Compound Fluid Extract of Clematis Erecta, Prinos Verticillatus, Fraxinus Americana and Rhus Glabrum, with 9% of one per cent. of Venanatic Acid, C H2 O2. Dose.—A teaspoonful in water, gradually increased to a tablespoonful, three or four times daily. Prepared Only by THE CLEMIANA, CHEMICAL COMPANY., ATLANTA, - - GEORGIA. Elastic Hosiery & Supporters Flăşliſ RIlliBT, BBSí Silk || Lillºl, TWO (2) NEW L00Ms JUST PUT IN. Hereafter can make and fill Special orders day after receipt. Our motto will be QUALITY. E. M. HESSLER SURGICAL INSTRUMENT CO., 57 and 59 Euclid Avenue, GLEVELAND, OHIO. N. B.-The Manufacture and Fitting of Deformity Apparatus, Artificial Limbs and Trusses, a Specialty. Bind All Your Papers at Omeg, THEOLOGICAL PHYSIOLOGY..— THE KLIPIS THE BEST BINDER. If it had pleased God to so order, Adopted by U. S. Government. Put it would have been quite as easy on or off in ten sec- - ... . . . for an oyster to have swallowed $5 per IOO. Covers to order, any style. Jonah as for Jonah to have sº sº. Address swallowed an oyster.— Baptist BALLARD, 29, Pittsfield, Mass. Zeacher. - -: `` Tº §§§ § ºfs ºf §§ Sº H. H. B () () K N () TI C E S. BACTERIOLOGICAL DIAGNOSIs: Tabular aids for use in Practical Work, by James Eisenberg, M. D., Vienna. Translated and Augumented from the Second German Edition, by Nor- val H. Pierce, M. D., College of Physicians and Surgeons, Chicago. The F. A. Davis Co., Publishers, Philadelphia. The original purpose expressed in the preface by the learned author—namely, that of a guide to the student, and aid to the more advanced worker in bacteriological diagnosis—has been well carried out. The fact that the second edition was called for in but little more than a year from the appearance of the first, shows the value of the book. It is the most convenient sylla- bus of the one hundred and thirty-eight micro-organisms that have been described, and which possesses marked biological points of differentiation. It is a sufficient guarantee of the practical use- fulness of the work to say that it is employed in Professor Cohn's laboratory. REPORT ON CHOLERA IN EUROPE AND INDIA, by Edward O. Shakespeare, A. M., M. D., Ph. D., of Philadelphia, United States Commissioner. Washington, Government Printing Office, 1890. … This is a ponderous, four-to volume, of nearly a thousand pages. Dr. Shakespeare was appointed, by Pres. Cleveland, in October 1885, a Commissioner to visit Europe in order to learn all that he possibly could in regard to the Cholera, then existing in that part of the world. Dr. S. visited Europe, and transmitted his report a little over five years later We hope the book is a valuable one; it is large enough to be; but until the author, or some one else, furnishes a summary of his conclusions—if he has formulated any—the world is likely to know nothing about it. AN article of much grewsome interest, describing First Actions of Wounded Soldiers, is among the contents of The Popular Science Monthly for June. The writer, Mr. George L. Kilmer, gives his own experience, and other cases which he has seen on the battle-field, or has collected from various sources, and raises a number of interesting physiological queries concerning them. * 479 48O BOOK NoTICEs. SAUNDERS' POCKET MEDICAL FORMULARY, with an Appendix; containing Posological Table, Formulae, and doses for Hypo- dermic Medication, Poisons and their Antidotes, Diameters of Female Pelvis and Fetal Head, Diet List for Various Dis- eases, Obstetric Table, Materials and 'Drugs used in An- tiseptic Surgery. By William M. Powell, M. D., author of Essentials of Diseases of Children, etc. 261 pp. Price, $1.75, leather; $1.50, cloth. Philadelphia; W. B. Saunders. 1891. The 1734 formulae contained in this little volume are well selected, and embrace about everything prescribed and prescrib- able in the materia medica. The arrangement is alphabetical, with thumb-letter index, and blank pages are inserted for ad- ditions. CONSUMPTION: HOW TO PREVENT IT AND HOW TO LIVE WITH- OUT IT : Its Nature, its Causes, its Prevention, and the Mode of Life, Climate, Exercise, Food and Clothing Neces- sary for its Cure. By N. S. Davis, Jr., A. M., M. D., Pro- fessor of Principles and Practice of Medicine in the Chicago Medical College, etc. 8vo. pp. I43; cloth, 75 cents. Phila- delphia; F. A. Davis, Publisher, 1,231 Filbert Street. 1891. A little volume, gives us, in condensed space, some valua- ble suggestions in regard to the nature and treatment of this scourge. It will be read with interest, even if it contains noth- ing that is especially novel. - WOOD's MEDICAL AND SURGICAL MONOGRAPHS : Vol. XII. No. 3; December Contents; Modern Materia Medica, with Thera- peutic Notes. By Dr. Otto Roth. Index for Vol. XII. William Wood & Co., publishers, 56 and 58 Lafayette Place, New York. Price $1.00. The December issue of this series was delayed in going to press by the time required for its translation. Aside from the index, this number is wholly devoted to the subject of materia medica, with therapeutic notes, and will prove a useful adjunct to ones library. STRICTURE OF THE RECTUM. A Study of One Hundred and Thirty-eight Cases. By Charles B. Kelsey, M. D. Second edition. This is a brochure of 48 pages, presenting very com- pletely the author's views as to the treatment of rectal stricture. His wide experience enables him to speak with authority. 15 “I believe that Ponca Compound has a more decided alterative action upon the uterus and uterine mucous membranes than any known remedy. Under its internal administration I have seen long standing ulcerations heal, foul discharges cease, a spongy, inflamed and enlarged uterus reduced in size and become firm and healthy. In subinvolution it is invaluable, soon relieving such symptoms as headache, backache, sideache, bearing down feelings, bladder troubles, bloated abdomen, indigestion, constipation and many others that are a consequence of this condition.” } R. M. HUTCHINS, M. D. FORMULA —Ext. Ponca, 3 grs. ; Ext. Mitchella Repens, I gr. ; Caulophyllin, 5% gr.; Helonin, 36 gr. ; Viburnin, Vágr. DOSE:—One Tablet four times a day. - 1OO Tablets will be nailed upon receipt of $1.00. MELLIER DRUG CO., 109 & III Walnut St., St. Louis. ALTERATIVE TONIC, three Cºlºrides (FERRI, HYDRARG ET ARSENICUM.) FORMUL.A.—Each fluid drachm contains: PHOTO-CHLORIDE IRON, one-eighth gr. HICHLORIDE MERCURY, one-hundred and twenty-eighth grain. CHLO RIDE ARSENIC, one two hundred and eightieth grain. s With CALASAY A. A LRALOIDS and ARO- MATICS. - INDICATIONS.—Anemia from any cause, Struma, latent Syphilis, General Debility, Tuberculosis, Malaria, Loss of Appetite, Habitual Constipation, Chlorosis, Chorea, Chronic Uterine, Pelvic, Zymotic, Catarrhal and Dermatological Diseases. DOSE.-One or two fluid. drachnas three Or more times a day, as directed by the physi- Cian. The prescribed dose of THREE CH1,ORIDES gives prompt action, produces a feeling of buoyancy, stimulating the appe- tite and the digestion, promoting assimila- tion ; is v ry pleasant to the taste, assimila- ted by the most delicate stomach ; does not constipate. Will not color the teeth, and is harmless under prolonged use. This prepa- ESTBD. ration has stood the test. Of time and experi- ence, is uniform, unalterable and can be relied woon to produce results. Its use is Indicated in a Wide Range of Diseases. Physicians will please designate R. & H. Elixir Three Chlorides. Where a more specific alterative is need- ed, other than in creasing the dose or bichloride, mercury. The physician may add without reservation any of the Soluable salts of iodine or its compounds. Dispensed in twelve ounce bottles; price, $1.00. MARION SIMS Col, LEGE, ST. LOUIS, Mo., May 30, 1890. } Turing the past six months I have pre- Scribed for the Various conditions indicated by the component parts of the mixture of the “Elixir Three Chlorides’’ for more than three hundred recorded cases, and 1n no instance have I regretted it. 1. N. LOVE, M. D., St Louis. . The Formula, of this. Compound, will, immediately suggest itself to the thoughtful Physician. 1832. º: IRENZ & HENRY, DERUTC+ IIMIIPCERT-EERs LOUISVILLE, KENTUCKY. To be had of All Leading Jobbers, 16 Always Uniform — Therefore Always Reliable. - 2 º, Made from Fresh Coca Leaves M ETCALF S sº § and the Punest Wine. FOR FATICUE OF MIND A or 46 RECOMMENDED FOR 7 NEURAIGA, SIEEPLESSMEss, DESPONDENCY, ETG. PRINGER recommends CoCA LEAVES as of great value in 4% Febrile Disorders, by restrain- %roing tissue metamorphosis, *7 and for the same reason T in Phthisis. For their decided anodyne and anti-Spasmodic qual- sº ities, they have been successfully Wººs, employed in Typhus, Scorbutus, ºš Gastralgia, Anaemia, Enteral- : i º i | ſºº§ſº º \ fº # yº *ºº //i - % -%&: r º f Rºº. ſºft º e * g - Nà id: º § %iº gia, and to assist digestion. §( Agrºbable,º §§ & WINE OF g * * *** * . . Nº Ž%% § & ºš OF COCA is probably º Safe and Certain, §/4%— & the most valuable Tonic in the , , , ,º º #4% ºf Materia Medica, when properly pre- * * gº being Aº §º. * ºr “º . g º 'º A & º .,, ºft.*.*. §parºd & pared. With stimulating and anodyne ..., Jºe ſº . ſº l aſº/ * e º # Adeº the gº. properties combined, WIETCALF's Cod A gº sºlºr:#; Yº WINE acts without debilitating, being always *\º the Freshest º, wniform and therefore absolutely reliable. DR. ARCHIBALD SMITH- M. Coca Leaves Mºš f tº ſº tº se f s ſº y E'Or “Fºr UTA's in isºstates that wº and * Aº Athletes it is invaluable in imparting energy and “Coca" increases energy, \\,. & Pºst ſº resisti g ge g tº * A tº ºf 9 removes... drowsiness, en Kºns §§ jº º resisting fatigue; P ublic speakers and Singers find it indis- ** * §. * gºt º •º- pensable as a “Voice Tonic,” because being a “tensor” of §º ...; gº YM ºf the vocal chords, it greatly strengthens and increases the ood, to a surprising degree, W1 * 9. * tº tº gº º ease and impunity: “” Vº É volume of voice; and to the elderly it is a dependable aphro- - - *\ ºf disiac, Superior to any other drug. Dose or Metcair's coca Nº g yº-3; ººººº Yº Thèodore Metcalf.__ESTABLISHED 1837. Frank A. Davidson. times daily, between meals. Physi- º cians” * bottles, by express, G0. carriage prepaid, upon the receipt of One . y I Dollar. * 39 Tremont Street, ſº BOSTON, MASS. 3ROMiDA THE HYPNOTIC. FORMIUH, A.—Every fluid drachm contains fifteen grains EACH oſ Pure Chloral Hydrat. and purified Brorn. Pot. and one-eighth grain EACH of gen. im. ext. Cannabis Ind. and Hyoscyam. nºr-hair to one fluid drachm in WATER or SYRU P every hour until sleep is roduced. isłºrioss-sleeplessness, Nervousness, Neuralgia, Headache. Convulsions, Colic, Mania, Epilepsy, Irritability, etc. In the restlessness and delirium of fevers it is absolutely in Valuable. IT Ibo Fºs N G T ALO CR D EP 'H'EIE SECRETIONS. PAPINE T H E A R O DYNE- Papine is the Anodyne or Pain-relieving Principle of Opium, the Narcotic and Convulsive Ele- ments being Eliminated. It has less tendency to cause Nausea,Vomiting, Constipation, etc. HN MP H CATIONS.–Same as Opium or Morphine. ºn tPS E. –O N E FLUID DRACHM-—(represents the Anodyne principle of one-eighth grain M.Orphia.) * # C D : A TH E A LTE RATIVE AN ID UTE R N E TONIC, FORM UI, A.—Iodia, is a combination of active principles obtained from the Green Roots of Stillingia, Helonias, Saxifraga, Menispermum and Aromatics. Each fluid drachm also contains five grains IOd. POtas., and three grains PhOS. Iron. MDOSE —One or two fluid drachms (more or less as indicated) three times a day, before meals. INDICATIONS.—Syphilitic, Scrofulous and Cutaneous Diseases, Dysmemorrhea, Menor- rhagia, Leucorrhea, Amenorrhea, Impaired Vitality, Habitual Abortions and General Uterine Debility. To the Medical profession. During the past seven years we have been laboring assiduously to produce Infant Foods ready for use that would closely resemble healthy human milk. It has not been an easy task, as every physician knows who has taken a special interest in the subject. We have spared neither labor nor expense to accom- plish this object, which will be demonstrated to any physician who will visit our factory. We have met the more recent demand for a sterilized Food for Infants by an expensive change in our machinery under the supervision of the most eminent Bacteriologists in the country. This sterilization has been accom- plished without rendering the casein of the milk less digestible, as is invariably done with the patented sterilizers in use. It also insures with the hermetically sealed cans, their perfect keeping qualities We do not think it possible that any Infant Food will ever be prepared that will excel LACTO-PREPARATA (an all milk food) for the feeding of young infants and CARNRICK’S FOOD for their nourishment during the latter part of the nursing period. All other /m/ant Foods in the market are com- posed entirely of the cereals; or they contain so little milk (about 8 per cent.) that it is a misnomer to call them Milk Foods. If such foods are used alone, the child will not be properly nourished, its flesh will be flabby, and it will quickly succumb to disease, because they are deficient in albuminoid con- stituents. Send for circulars and samples. Mak0 YOur UWI. KUMYSS in Ong Minute, A Product of Pure, Sweet Milk. What is lºunaysgen P It is Kumyss in a dry form, containing all the constituents of the best Rumyss, and requires only the addition of water to produce an article superior in digestibility and palatability to the old form of Kumyss. It is the Zaeal Food in all cases where nutrition is an important factor, and digestion is feeble. - - When all other Foods fail try KUMYSGEN, but it is better to try it in the beginning and save time and strength. . EUMYSGEN is the only preparation of Kumyss that will keep. All liquid preparations of Kumyss will keep but a short time, and are constantly changing in the bottle, unless some deleterious preservative is used. Kumyss made from KUMYSGEN is far more palatable, easier digested and 35 per cent. less expensive than the old style Kumyss. - Öur Syphon Kumvsgen Bottles allows Kumyss to be drawn without loss of contents. One in every three bottles are Syphon, containing same quan- tity of KUMysGEN as the others. Send for samples and descriptive circulars. MANUFACTURED ONLY By rerºr & cartººroºs, New York- PREMIUM LIST. & T Nºwy . | * i. | l: ***-> º wº Wy # , ºft| | º |||}|" |. . º * - ||||| ill|| ... : :º)" i | º º | . & ; ºilſ.} º | - |; - jº lº...; . . .” III: | || | ". º º-º-ey--- ~ * * * º gº d Lazzzzzzzzz s | | -ºil *3 - ? MO TE THE LOW FIG UK’A.S. O FOUNTAIN PEN–Best Grade. (Paul E. Wirt—long or short, stub or regular.) With One Year Subscription to the Journal . . . . . $2 50 (Above is the price of the pen alone.) A Fountain Pen when once used is never dispensed with. Ask our editor. - GAS BRACKET. With Light Condenser, Mirror and Bar Complete. (See cut below.) All Nickle Plated, and MEDICAL Journal, One Year . $20 oo . | , , , , - . . . . . d "... iſ]|| . . . : º j|| º º | º ; | Above can be arranged for oil lamp at an extra expense of about $ I.OO. Light Condenser and Mirror not including Bracket (see cut below) with Journal, One Year . . . . . . I 2 OO Light Condenser without Mirror or Bar, not including Bracket (see cut below) . . . . . . . . . . 8 OO Prices named are less than the regular prices on light condensers alone. Cash must accompany order to obtain these prices. º “ a tººlſ li º :- ºrszºº : | 2: sº º 3. SWC º º | --> º § || #. º § | #! ſ | t | h º º º º ; 19 Dr. JULIUS FEHR'S § “Compound Talcum.” “BABY POWDER,” THE “Hygiernic Derrmal FOvv der ’’ & s º: FOR Żºłę2. o, & 4,'. INFANTS AND ADULTS. sº Introduced to the Medica1 and Parmaceutical Professions, by * } * º Sºses, Dr. Fehr, in the year 1873. ºj COMPOSITION:—Silicate of PROPERTIES: — Antiseptic, ſº Magnesia, with Carbolic and Sali- || Antizymotic and Disinfectant. § hilºſº cylic Acids. | N . 7& USEF U L AS A - †º #ſº GENERAL SPRINKLING POWDER, šijº i with positive Hygienic, Prophylactic, and Therapeutic properties. f - ####jºš l Good in all Affections of the Skinn. (33. §§s. Sold by the Drug Trade Generally : - § ; |W 12 4ſ; Per Box, plain, - - 25c. Per Box, perfumed, - 50c. }} | º ź. #. - Per Dozen “ — — $1.75. Per Dozen { % - $3.50. Julius; ºa. ; **ś i THE MANUFACTURER: - sº N.J 3. śg/ e3e Zi3}ox. *. JULIUS FEHR, M. D.,. | i *...* | Ancient Pharmacist, | * * HOBOKEN, N. J. f On 1 y advertised in Medical and Pharmaceutical Prints. Cheap at Last! $º MAGNIFYING FRONT CLINICAL THERMOMETERS. THE COLUMBUS MEDICAL PUBLISHING 00. Rubber Case, $2.oo (formerly $2.50). Chain Case, $3.oo (formerly (3.5o). And the Columbus MEDICAL Journal with it for one year FREE. Think of it! Thermometer and Journal less than the former price of Thermometer alone. Sent by mail free, in safety case, on receipt of $2.1o or $2.60. Thermometers Fully Guaranteed. COLUMBUS, OHIO. 20 IFIERIETMLITUTIMI I IST I LOOK I ILOOK W THIS wºye You It is our intention to make the subscription list of Our Journal larger and to give patrons benefit of WHOLESALE PRICES on everything we can get low figures on. We guarantee the quality of everything. A $12.00 Case for $8.50, with the Columbus Medical Journal thrown in. No. 60 IMPROYED BUGGY CASE. It is worthy of notice. Only Cases of this manufacture have the COMBINATION CORNER (see cut). The Foot or Button being in ONE PIECE with the corner, prevents them from coming off the Case. Note all improvements in No. 60' Case, and see its superiority to cheap imitations of the same. sº W #ºW W ºssº : šº ..º.º. - : o. 60 Improved Buggy Case, each . . . . . . . . . $8.50 Including one year's subscription to the Journal. N Space for powder papers, instruments, ete. Case made of Black Grained Russia. leather, leather lined throughout, and mounted with German silver combination corners, nickel spring lock, With key, making the most Substantial, complete and richest-looking Physician's Case ever placed on the market. It should be noted that the No. 60 Case is protected by German Silver combination corners; also nickel edge trimmings around the center partition, which serves to . protect from wear and to keep the partition in place. These improvements are found only in No. 60 Improved Buggy Case, it being the constant aim of the manu- facturers to make this case as near perfect as skillful labor and carefully selected material Will make. NOW Read this—a $12.00. Case and the Journal for $10.50. 66. SATCHEL CASE, 10 inch frame, contains 18 One Ounce, 11 six drahms and 14 four drahm corked vials, ample loops for in- struments, box for sundries, plush §§ # lined, with a neat compartment §§ for Hypodermic Syringe. Size, º; 10x7-5. Price, with the CoEUMBUS - # MEDICAL JOURNAL 1 year, $10.50. We think this the most, COnveni- É ent Satchel Case sold. É Can also furnish it with 7 two Ounce bottles instead Of 9 Of the One Ounce. This is the finest and best made Satchel Case On the . market to-day. All of above prices include the CoI,UMBUSMEDICAL JOURNAL for one year. Cash must accompany order to obtain above prices. * HYD R O L E |N|E (HYDRATED OIL) Is prescribed and used in the following Hospi- tals in New York and Brooklyn: NEW YORK CITY : Bellevue Hospital of Medical and Surgical Relief for the Out-Door Poor. St. Luke's Hospital. St. Vincent's Hospital. St. Francis Hospital. Presbyterian Hospital, The New York Post-Graduate Medi- cal School and Hospital. The New York Polyclinic Hospital and Dispensary. Roosevelt Hospital, Out-patient De- partment. Mount Sinai Hospital. The French Hospital. Hospital of the New York Society for Relief of the Ruptured and Crippled. New York Infirmary for Women and Children. Manhattan Eye and Ear Hospital. New York Eye and Ear Infirmary. St. Joseph's Hospital. Gouverneur Hospital. New York Foundling Hospital. Nursery and Child's Hospital. The Hahnemann Hospital. The Harlem Hospital. New York Infant Asylum. University Medical College Dispen- Sary. Demilt Dispensary. New York Dispensary. Northwestern Dispensary. Eastern Dispensary. Northeastern Dispensary. Harlem Hospital Dispensary. | | Yorkville Dispensary and Hospital. Sunnyside Nursery. Bloomingdale Clinic. Infant's Hospital. Homeopathic Hospital. Almshouse Hospital. Workhouse Hospital. BROOKLYN, N. Y. : St. Mary's General Hospital. Long Island College Hospital. Brooklyn Hospital. \,. The Brooklyn Home for Consump- tives. St. Peters’ Hospital. St. John's Hospital. St. Mary's Maternity and Infant's Home. Brooklyn Eye and Ear Hospital. St. Catharine's Hospital. Kings County Hospital. Homeopathic Hospital. Memorial Hospital. St. John's Home. Brooklyn Orphan Asylum. Brooklyn Throat Hospital. The Baptist Home. The Chinese Hospital. The Norwegian Hospital. Brooklyn (E. D.) Dispensary and Hospital. The Brooklyn Central Dispensary. Brooklyn City Dispensary. Bushwick and East Brooklyn Dis- pensary. The Southern Dispensary and Hos- pital. Bedford Dispensary. REVOLUTION IRON ADMINISTRATION A HIGHLY PALATABLE PREPARATION OF IRON CHLORIDE. RON is easily chief among Haematinics. According to T. Lauder Brunton, M.D., D.Sc., F.R.S., it increases the number of blood. corpuscles; the percentage of haemaglobin in them, and functional activity of all the vital organs; as a vascular tonic classes with digitalis. and Strychnine, and in its alterative qualities with arsenic. The tincture of Chloride of Iron has long been recognized as the most efficient of iron preparations, the objections to its continued administration, its highly astringent taste, its corrosive action on the teeth, and constipating action have, however, been hitherto insurmountable. We have succeeded in preparing an entirely palatable syrup of officinal Tincture Iron Chloride combining all its virtues with none of f its drawbacks. It is prepared after the formula of Dr. G. W. Weld, and is entitled: “WELD'S SYRUP OF IRON CHLORIDE.” (P., D. & CO.’S) We earnestly recommend its trial to all the profession, believing it to be the most acceptable preparation of Iron ever devised. Samples will be sent on receipt of request to physicians who indicate their willingness to pay express charges. PARKE, DAVIS & CO., Detroit, New York and Kansas City. Dr. we w w x- COLUMBU's Alſſºſcell. JGURNG11. Wol, 2C, MAY, 1892, No. 11, J. F, BALDWIN, M. D. - - Cº- 4- cº- º EDITOR. J E. BROWN, M. D., - - Associate Editor. C. R. CORNELL, i- * Business Manager. 48 PAGES READING MATTER. PUBLISHED MONTHLY. $1.00 PER YEAR. THE COLUMBUS MEDICAL PUBLISHING COMPANY, Publishers and Proprietors, 266 East Gay Street, Columbus, Ohio. Entered at Postoffice, Columbus, Ohio, as second-class mail matter. \\ - CH. MARCHAND’S - § | Q - - §º º, PEROXIDE of HYDROGEN. ſ º sº āşş § WNYS (MEDICINAL) H2O2 (ABSOLUTELY HARMLESS.) %\}|...º. § MOST POWERFUL BACTERICIDE AND PUS DESTROYER. END ORSED BY THE MEDICAL PROFESSION. UNIFORM IN STRENGTH, PURITY, STABILITY. -e-ºff RETAINS GERMICIDAL POWER FOR ANY LENGTH OF º TIME. \-> TAKEN INTERNALLY OR APPLIED EXTERNALLY WITH PERFECT SAFETY. Send for free book of 72 pages, giving articles by the following contributors: DR. ROBERT T. MORRIS, of New York. “The necessary Peroxide of Hydro- gen.” Journal of the American Medical Association, Chicago, Ill. DR. S. POTTS EAC LETON, Resident Physician in the Children's Hospital of Philadelphia. ** Résumé – Hydrogen Peroxide in Surgical Affections.” Medical and Surgical Weforter, Philadelphia, Pa. . NOTE.-Avoid substitutes—in shape of the connnereial article bottled— unfit and unsafe to use as a rºledicine. - Ch. Marehand's Peroxide of Hydrogen (Medicinal) sold only in 4-oz., 8-Oz., and 16—oz. bottles, bearing a blue label, VV hite letters, red and gold border, with his signature. Never sold in bulk. PHYSICANS WILLING TO PAY EXPRESS CHARGES WILL RECEIVE FREE SAMPLE ON APPLICATION, PREPARED ONLY BY - ſº Mention this publication. Chemist and Graduate of the “Acoſe Cen/ra/e des Arts et Manufactures de Paris” (Arance). teacºasts. Laboratory, No. 28 Prince Street. ~ ContFNTs. -- COMMUNICATIONS. The Binder in Obstetrics — by W. V. Hayetis, M. D., Columbus, O............481–487 Alcohol, from a Medical Standpoint—by . . . . A. B. Walker, M. D. Canton, Ö......... 487–490 - Functions of the Kidneys, with Sugges- : tions as to Treatment of Uremia—by . D. N. Kinsman, M. D., Columbus, O...491–496 New York Letter on 9thºpedig Star- gery—by Stewart LeRoy M’Curdy, M. P. Dennison, O.......................... 497–501 -Aligina Pectoris a Sequel of Typhoid Fever, by H. L. Rosenberry, M. D ſº Menominee, Mich. ........ gº tº e º ºs e º 'º º º º ſº º ...s01-502 #. Breast; *:::::::: ‘g. #. Hºn. - - reatment of Foreign Bodies in the SELECTIONS. # rain; The Surgical º: Of MED/CINE–Plain Talks to Physicians; uberculosis Cervical Glands; Treat- Processes Which Result in #. Arrest ment of Hydrocele; Pruritus Ani...... : or Cure of Phthisis; The Diagnosis of e e º e º 'º - © tº 521–524 Pneumonia in Chil dhood and in fancy; EDITORIAA. . . . . . . . . . . . . . . . . . . . . . . . . . . Biccough Cured by Compression of BOOK MOTICES........................ . .525-528 ADVERTISERS. o Health Restorative Co., New York......... ... 1 H. K. Mulford & Co., Philadelphia .......... 12 Dios Chemical Co., St. Louis, Mo...... * * * * * * * Fellows, New York. . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Western Pennsylvania Medical College..... 2 The Clemiana Chem. Co., Atlanta, Ga. . . . . . . 14 Julius Fehr, M.D., Hoboken, N. J. .......... 3 E. M. Hessler Surgical Instrument Corn- B. Keith & Co., New York.................... 3 pany, Cleveland, O. . . . . . . . . . . . . . . . . . . . . . . . . e Cincinnati Sanitarium............... . . . . . . . . . 4. H. H. Ballard, Pittsfield, Mass. . . . . . . . . . . . . . . 14 The Antikamnia Chem. Co., St. Louis, Mo... 4 Columbus Medical Publishing Co..... . . . . . . . 15 Od Chemical Co., New York.................. 5 Mellier Drug Company, St. Louis........ . . . . 16 Dr. McMurin’s Elixir of Opium.......... ‘. . . . 5 Renz & Henry, Louisville Ky.. . . . . . . . . . . . . . 16 Harrison Cole, Columbus, 8 & e º ſº º q + c 0 - © • * * * * * * 5 Theodore Metcalf Co., Bostoni............ . . . . 17 I. O. Woodruff & Co., New York City ... . . . . 6 Battle & Co., St. Louis, Mo..... tº º dº º e - © tº º º e º . . 17 The Corne11-Pheneger Chemical Company, Feed & Carnrick, New York ......... tº e - e - ... 18 Columbus, O... . . . . . . . . . . . . . . . . . . . . . . . . e - e º a tº Premium Lists for 1892 . . . . . . . . ............19–20. The Arlington Chem. Co., Yonkers, N. Y... 8 Charles Marchand, New York... 1st page cover Lambert Pharmacal Co., St. Louis, Mo...... 9 C. N. Crittenton, New York ..... .3d. “ 64 W. R. Warner & Co., Philadelphia .......... 10 IMariani & Co., New York ......... . . . . . . . . . . . 11 the Phrenic Nerve; A Remedy for Chronic Rheumatic Arthritis; Treat- ment for Itch;, Pie-P1ant and Hema- turia . . . . . . . . . . . . . . º e º & © e º e • a s s a e e s - e º 'º ...503–507 OBSTE TRICS –Sexual Perversion; The Bright’s Disease of Pregnancy; Der- moid Cysts; Extraction of Arms Ex- tended Over Head in Breech Labor; An Ideal Dressing for Abdominal Wounds; Tamponade of the Uterus; Mixed Narcosis in Gynecological Sur- £ery . . . . . . . . . . “. . . . . . . . . . . . . . . . . . . . . . . . . .508—516 SURGERP-Recurrence of Carcinoma of Parke, Davis & Co., Detroit ..... ith “ {{. l This WINE OF COCA is so prepared that it contains the active principle of the leaves in a perfectly pure form. 9 Moreover it is absolutely free from ali those foreign sub- C torative stances which all other wines of coca contain, and which interfere, to a great extent, with its curative influence. It is well known that the cocaine contained in the coca-leaves varies considerably in its proportion ; hence, giving to the wines as ordinarily made, uncertain strength, and causing - v them to be unreliable in their action on the system. In the Wi C of oca RES TORATIVE WINE OF COCA the proportion of T alkaloid is in variable, and the physician can therefore pre- scribe it with the certainty of obtaining uniform results. Prof. W.M. A. HAMIMOND., M. D. says: FOR A wineglassful of this tonic, taken when one is exhausted *ºs e-ºº-º-º-º: and worn out, acts as a most excellent restorative ; it gives a feeling of rest and relief, and there is no reaction Nervous Prostrat ion, Brain Exhaus- and no subsequent depression. A general feeling of iº gº pleasantness is the result. I have discarded tion, Neurasthenia and all forms flººr wines **** ** UIS (e his ºº:: tº * * * t produces also excellent results in cases of depression o of Mental and Physical Debility. spirits; in hysteria, headache, and in nervous troubles generally, it works admirably. It is a simple remedy, yet efficacious and remarkable in its results. % § JE ONLY COMPLET ripyretic "warERIA MEPISA’’ THE BUSTAIN5 #. AN pyr : THE MA finists ºut ts::::::::::::= AREsitrºve OFTHE HIGHEST ORDER. |NVALUABLE IN MALARIAL DISEA5E5. ÅAft APOSITIVE REMEDY FOR NEURALGIA ANDRHEUMATISMNº. Prof. W.M. F. WAUGH, M. D., of Philadelphia, writes: In a case of persistent neuralgic headache, worse on awakening, with a possibility of malaria, “Febricide” gave instant relief. BUFFALO, N. Y., February 13, 1890. I have duly prescribed the FEBRICIDE PILLS all 1 hrough our Epidemic of Influenza and Pneumonia, with capital results. S. W. WETMORE, M. D. - SPRINGVIEW, NEB., November 25, 1889. I have used your FEBRICIDE with excellent results in our Mountain Fevers (typhoid), reducing, in one case, the temperature from 104% with dry, brown furried tongue in ten hours, to 99% with tougue cleaning promptly and moist, and rapid improvement dating therefrom. Have used Antipyrin in similar cases with no good results. ALBERT S. WARNER., M. D. FEBRICIDE IN PNEUMONIA. º.º.º.º.º. ricide Pills (one being given every four hours, as a rule), and with hot poultices externally : Admitted. Crisis. Admitted. Crisis. William Johnson,...... June 1, 1889, June 8, 1889 Belle Smith . . . . . . . . . . . . Jan. 8, 1890, Jan. 12, 1890 Fanny Winnery ....... Dec. 19, 1889, Jan. 4, 1890 Wm. Payne . . . . . . . . . . . . Jan. 2, 1890, Jan. 5, 1890 Wm. M. Johnson....... Dec. 30, 1889, Jan. 5, 1890 Gustav Thoman . . . . . . . . Jan. 21, 1890, Jan. 23, 1890 All ended in recovery. These are all the cases of croupous or lobar pneumonia treated in the hospital during the influenza epidemic excepting one case, which was admitted in a moribund condition, and died before any treatment could be instituted. One case, which was apparently moribund when admitted, is included in the above list, and is at present recovering from an attack of femoral phlebitis. JOHN A. RAYBURN, M. D., Regident Physician. -Phila. Times and Register, Feb. 17. 1890. Samples sent free of charge to any physician who mentions this JOURNAL. ISIEALTFI FESTORATIVE CO. 90 South Fifth Aveuue, NEW YORK, UTERINE TONIC, ANTISPASMODIC AND ANODYNE. A reliable and trustworthy remedy for the relief of Dysmenorahoea, Amenorrhoea, Menorrhagia, Leucorrhoea, Subinvolution, THREATENED ABORTION, Vomiting in Pregnancy and Chlorosis; directing its action to the entire uterine system as a general tonic and antispasmodic. This combination is the result of an extensive professional experience of years in which the constituent parts have been fully tested singly and in combination in various proportions, until perfection has been attained. DIOWIBURNIA is prepared for prescribing exclusively, and the formula as given will commend itself to every intelligent physician. FORMULA :—Every ounce contains 3-4 dram each of the fluid extracts: Prunifolium, Viburnum Opulus, Dioscorea Villosa, Aletris Farinosa, Mitchella Repens, Caulophyllum Thalictroides, Scutellaria Lateriflora. a desertspoonful to a tablespoonful three times a day, after meals, Virburnum Helonias Dioica. DOSE :-For adults, In urgent cases, where there is much pain, dose may be given every hour or two, ALways IN HOT water. Jno. B. Johnson, M. D., Professor of the Princi- §: and Practice of Medicine, St. Louis edical College. St. Louis, June 20, 1888. I very cheerfully give my testimony to the Virtues Of a COmbination of vegetable remedies prepared by a well known and able pharma- cist of this city, and known as DIOVIBUR- NIA, the component parts of which are well known to any and all physicians who desire to know the same, and, therefore, have no rela- tion to proprietary or quack remedies. I have employed this medicine in cases of dysmemor- rhoea, suppression of the Catemania and in excessive leucorrhoea, and have been much pleased with its use. J do not think its claims (as set forth in the circular accompanying it) to be at all excessive. I recommend its trial to all who are Willing to trust to its efficacy, be- lieving it will give satisfaction. Respectfully, L. Ch. Boisliniere, M. D.. Professor of Obstet- rics, St. Louis Medical College. St. LOuis, June 18, 1888. I have given DIOVIBURN1A a fair tral, and found it useful as an uterine tonic and anti- Spasmodic, relieving the pains of dysmenor- rhoea, and regulator Of the uterine functions. I feel authorized to give this recommendation of DIOVIBURNIA, as it is neither a patented nor a Secret medicine, the formula of which having been communicated freely to the medi- cal profession. - e.” cº, Že, s/n 4 et , AºA). H. Tuholske, M.D., Professor Clinical Surgery and Surgical Pathology, Missouri Medical College ; also Post-Gradutate School of St. LOuis. St. Louis, June 23, 1888. I have used DIOVIBURNIA quite a num- bcr of times—sufficiently frequently to satisfy myself of its merits. It is of unquestionable benefit in painful dysmenorrhoea ; it possesses antispasmodic properties which seem especi- ally to be exerted on the uterus. A’z A. Z.A.-4-6. To any physician unacquainted with the medicinal effect of DIOVIBURNIA, desiring to try Our preparations, and Who will pay express charges, WeWill send on application a bottle free. DIOS CHEMICAL CO., ST. LOUIS, MO. WESTERN PENNSYLVANIA MEDICAL COLLEGE, CITY OF PITTSIBURGH. SESSIONS OF 1391–92. The REGULAR SESSION begins on the last Tuesday of September and continues six months. Buring this Session, in addition to four Didactic Lectures, two or three hours are daily allotted to Clinical Instructions. Attendance upon three Regular Courses of Lectures is requisite for graduation. A three years’ graded Course is provided. The SPRING SESSION embraces Recitations, Clinical Lectures and Exercises, and Didactic Lectures on Special Subjects. ten Weeks. This Session begins the Second Tuesday in April, and continues The LABoratoRIES are open during the Collegiate Year for instructions in Chemistry, Microscopy, Practical Demonstrations in Medical and Surgical Pathology and Lessons in Normal Histology. Special importance attaches to the Superior Clinical Advantages possessed by this College. For particulars see Annual Announcement and Catalogue, for which, address the Secretary of Faculty, PROF. T. W. T. McKENNAN, 810 Penn Avenue. Business correspondence should be addressed to PROF. W. J. ASDALE, 2107 Penn Avenue, Pittsburgh, Pa. - * 3 Dr. JULIUS FEHR'S 㺠“Compound Taicum” ºr “BABY POWDER,” # THE s “Hygienic Derrmal Povv der ’’ §§ FOR %fºHíſº §§kºſ' X- ſ §§ {: INFANTS AND ADULTS. ºf ºilº Lº Introduced to the Medical and Parmaceutical Professions, by § ë. Fººfs: Dr. Fehr, in the year 1873. Ǻ 4%. }.5% ź. COMPOSITION:-Silicate of PROPERTIES: — Antiseptic, ºśī. Magnesia with Carbolic and Sali- || Antizymotic and Disinfectant. § ſi Aº cylic Acids. sº * . - 'ſ R v § .# P. USEF U L AS A A. GENERAL SPRINIKLING POWDER §§ -- - Q - 3. & f - with positive Hygienic, Prophylactic, and Therapeutic properties. l Njºtº. § £º º #2; M! %; Good in all Affections of the Skinn. $º § §§§ ºft Sold by the Drug Trade Generally: * §§Aij jºlºff Per Box, plain, - - 25c. Per Box, perfumed, - 50c. - # º #}#}} Per Dozen “ - – $1.75. Per Dozen % (, - $3.50. - #ſºliº; 1}}|º f §§ºftºjšº THE MANUFACTURER: - § §§ $ºzº wº - - | Nº - JULIUS FEHR, M. D.,. #Pººh: Ancient Pharmacist, i. '#4] HOBOKEN, N. J. |#####|ſſº'ſ On 1y advertised ill Medical and Pharmaceutical Priuts. THE MORPHINE HABIT CURED BY THE USE OF . Jºs. E- J. C. "Tº E iſ sº * . . C O N – T | N. C. 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The con. tinct. avena sativa has been more successful in the treatment of the opium habit than anything I have ever tried, and I have tried various other remedies, amongst them the advertised nostrums. t HOLLOWAY, M.I., Messrs. B. KEITH & CO.,-Gentlemen : Idaho Springs; Col. I have tried a smali amount of the con. tr. ayena sativa and am more than plcased with it in the ozºize” habit and several other cases, such as in female diseases and nervous conditions. CHAS. B. RICHMOND, M. D. Send for printed matter on Con, Tinc., Avena Sativa in the Morphine or Opium Habit, and certificates from different ºr embers of the Medical Profession citing cases under their charge treated by it, also Revised and Enlarged Manuel to E. Ex-E-Isrººr sºcio-, organic CHEMists, ESTABLISHED 852. NO. 75 WILLIAM ST. NEW YORK. k Fºº! º º ##| || # º 3}} || | f i Şeº. § º º §§ Nikº } º º ſ - º º º #ſº ########### * Nºt ºw. 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Wº sº I wºn tº ºr ºr ºf ºm mm mm mass ºn ** - - * * * * * * * * * * * . . . . . . . . . * : * * * * * * * * * * * * ***** * * * < x ntains all the valuable medicinal properties of Opium in natural combination, to the exclusion of all its noxious, deleterious, useless principles upon which its bad effects depend, It possesses all the sedative, anodyne and antispasmodic powers of Opium: , To produce sleep and composure; to relieve pain and irritation, nervous excitement and morbid irritability of body and mind ; to allay convulsive and spasmodic actions, etc.; and being purified from all the noxious and deleterious elements, its operation is attended by no sickness of the stomach, no vomiting, no costiveness, no headache, nor any derangement of the constitution or general heaſth. Hence its high superiority over . Laudanum, Paregoric, Black Drop, Denarcotized Laudanum, and every other Opiate preparation. - C.A.T.J. T.IOINT. On account of its large sale, spurious articles are offered in, bulk. The genuine is sold only in vials of about 7 drachms, with yellow wrappers and signature of Jno. B. McMunn. E. FERRETT, Agent, 372 Pearl St., New York. HARRISON COLE, PRACTICAI. OPTIGIAN, All Defects of Vision, requiring Spherical Lenses, scientifically corrected. Special Lenses carefully adjusted to prescription. Optical and Scientific Goods of all kinds. Repairing of every description. - Prescription Blanks Furnished Physicians on Application. 64 North High Street, Columbus, Ohio. . - 6 FRELICH’S TAB LETS, wº (Cough and Constituent), FOR THE PREVENTION AND CURE OF ONARY PHT HISIS. FCIFE IMITTI, ZEE. Cough Tablets EACH TABLET CONTAINS. Morph. Sulph, (ºr gr.), Atropiae Sulph. (sºn gr.), Codeia (; gr.), Antimony Tart. (; gr.), Ipecac, Aconite, Pulsatil- Constituent Tablets *-* EACH TABLET CONTAINS. Arsenicum (; gr.), Precipitate Carb. of Iron, Phos. Lime, Carb. Lime, Silica, and the other ultimate constituents, la, Dulcamara, Causticum, Graphite, according to physiological chemistry, Rhus-tox, and Lachesis, fractionally so (normally) in the human organism, arranged as to accomplish every indica- together with Caraccas, Cocoa, and tion in any form of cough. Sugar. . PRice, THREE DOLLARS PER Double Box. Containing sufficient Tablets of each kind to last from one to three months according to the - condition of the patient. A Connecticut physician writes: “I am now using your Tablets on a patient (young lady), who has had three quite severe hemorrhages the week previous to the beginning of the same. She has taken one box Only, has had no return of the hemorrhage, and has gained four (4) pounds, since beginning treatment, besides all rational symptoms have improved wonderfully. I will add that I had tried Ol. Morrh., Syr. HypophOS. Co., etc., with no apparent benefit.” A Virginia physician writes: - “Enclosed find Postal Note for another double box. Freligh's Tablets. I used the sample box in three cases, with decided benefit in one, slight improvement in second, and while they did not improve the third case. it being in very advanced stage, there was an amelioration of the distress- ing Symptoms, A Massachusetts physician, in practice 25 years, writes : ~. “Send ºne two double boxes Freligh’s Tablets. I have tried the sample box with most excellent results.” - A Michigan physician writes: - “I am more than pleased with them. They have not disappointed me once. Dr. C for whom I ordered a box, writes me that he is much improved, and speaks in praise of them. He has gettuine Tuberculosis, and while I do not think he can recover, yet I firmly believe the Tablets will prolong his life.” sIF ºr CIT_º_I_m ºf E*IET"IEHFºl. While the above formulae has been in use, in private practice, over 30 years, and we could give testimonials from well-known clergymen, lawyers and business men, we prefer to leave them to the unbiased judgment of the profession with the following offer : . On receipt of 50 cents, and card, letter head, bill head, or other proof that the applicant is a physician its active practice, We will send, delivered, charges prepaid, one of the regular (double) boxes, (retail price, Three Dollars) containing suffleient of each kind of Tablets to test them three months (in the majority of cases) in some one case. Card, letter head, or some proof that the applicant is a physician in active practice, MUST accompany each application. Pamphlet with full particulars, price list, etc., on request. - § º: § º CERE BRO-SPIN ANT. (FRELIGH’S TONIC,) Our Special Offer is still open, to send to any physician, on receipt of 25 cents, and his card or letter head, half a dozen särnples, delivered, charges prepaid. Each sample is sufficient to test it for a Week in Orle CaSe. : - As we furnish no samples through the trade, wholesale or retail, for samples, directions, price lists, etc., address - I. O. WCOTYERUIFF & Co. Manufacturers of Physicians’ Specialties, 88 NAIA-II) EINT L A-IN E, INTE WZT TY OF. Iº CITY". Orthopedial Appliances. We are now manuſactur- ing everything in the §§§ { way of |\º Spinal. . \ Weak Ankle or Bow leg Braces | & Hip Splintst Everything in the ORTHOPEDIC T-irºn-e. Write us before ordering or send your patient to us and we will take the measurement and guarantee a fit. We can make as good an APPLIANCE as can be had elsewhere * . . for LESS MONEY AND CAN FURNISH f irº IT MUCH QUICKER. FULL INSTRUCTIONS SENT FOR MEASUREMENT WHERE PATIENT CANNOT BE SENT TO US. 25 ºr ºil. Distint from price to patient given Physician when order from Doctor is sent with patient . The Cornell-Pheneger Chemical Company, COLUMBUS, OHIO. PHYSICIANS SUPPLIES OF ALL KINDS 8 succ Esso R S TO REED & CARN RICK º *ś - Fo R THESE PRE PARATIONS Aſºlº NSTON | § CHEMICAL: ) | k = §32s s . The most efficient and palatable preparation Eachºtspoonful contains— afteln, in Nervous and Sick Headache, Neuralgia, Acidi Phosphorici, aā grains, ss, Insomnia, Neurasthenia, and General Nerv- Antipyrin, g • - - - -- ~ * ~ * jº tº º Ext. Apii, Grav. Dulc. (Celery), āā grain J, ous Irritability. Sodium Bromide, grains V. COLUMBUS MEDICALJOURNAL A MONTHLY JOURNAL OF MEDICAL SCIENCE. Vol. 10. MAY, 1892. No. 11. COMMUNICATIONS. THE BINDER IN OBS7E7R/CS. BY W. V. HAVENS M. D., COLUMBUS O. Read Before the Central Ohio Medical Society, Oct. 1, 1891. In the May number of the Columbus Medical /ourma/, of 1890, is an article under the above heading, taken from the Med. A'ecord, which says: “To bind or not to bind the par- turient female, is a question with which the obstetrician still al- lows his mind to wrestle. At a recent meeting of the Obstetrical Society of London, it was concluded, in effect, that the doctor had better do as the patient felt inclined. The matter ought not to be left in such a doubtful state. Kingdoms rise and fall, great nations disappear, cyclonic storms and volcanic fires change the face of nature, but babies continue to be born, and the mother in- sists on having a binder or knowing the reason why. The Ob- stetrical Society of London should not trifle with topics of such eternal moment. - “For our part, we say, do not bind. The alleged com- fort secured is imaginary, the idea that the binder can restore the figure is unscientific and unphysiological, its supposed power in helping involution is purely hypothetical, and the whole conception of a binder is unnatural and abhorrent to common sense. The binder is a relic, not of barbarism, for 481 482 - COMMUNICATIONS, the barbarians are too sensible to bind, but of a half enlightenment that is worse than ignorance. “The physician who binds now-a-days, does it out of a meek complaisance to an imperious mother-in-law or officious nurse. He should, out of respect to his art, rise above such trammels to His medical skill and his intellectual independence.” Says an experienced practitioner: “I have never been an advocate of the bandage, but have used it to keep peace in the family. It is often hard to convince a patient that she will not have a large abdomen if she does not have a bandage applied so tight that she is uncomfortable. The belief that a bandage is the only thing that will ever make her presentable is handed down from her grandmother. I find, on looking over my list, that in every case where the bandage was not used, the result was most satisfactory. On the other hand, in the cases where the bandage was used, I met with symptoms not so pleasant. There were more after-pains, the patient was more restless, and the uterus did not go back to its proper size and place so quickly. “Now, what are the conditions 2 Here is a womb out of posi- tion, having been pressed down with the superincumbent weight in and upon it for months ; the broad ligaments have become in- ert, soft, flabby and refuse to do their duty (of holding the uterus in position); there is often a tendency to prolapsus, there may be flexion or version. What does a bandage do? It helps to hold that uterus in its mal-position, it prevents nature from doing her work, and adds to the discomfort of the patient. . “Is there any danger from the binder P There certainly is. It is very apt to be drawn too tight, and very often by the direc- tion of the patient herself. She, anxious to preserve her form, will insist ‘the bandage is too loose,’ till the doctor (if he be young) or the nurse will tighten it, till the pressure thus brought to bear on the uterus will light up an inflammation that may end in death. This has been done. I claim that any abdom- inal binder that will answer the purpose for which they are in- tended, will do a great deal more injury than good. They act on the principle of a ligature around the abdomen. They flatten the uterus, which at the time of child-birth is large and the tis- sues are loose and engorged with blood. The uterine sinuses are all wonderfully increased in size. Is it not easily seen that an abdominal binder, even though moderately tight, would compress and flatten the uterus and would, as a result, prevent the process of ‘involution.’ Just for a moment, think of a greatly enlarged uterus incarcerated between the spinal column behind and a ban- dage in front. - * HAVENS.–7%e Azīzder 27, Obstetrzcs. 483 “I certainly believe that a very great majority of female ‘weaknesses of American women are due, in part, to the use of the abdominal binder after confinement. Involution is inter- fered with by the use of the binders, and, as an almost certain result, subinvolution and procidentia uteri will afflict the woman the remainder of her life. “That the binder gives support and comfort is purely imagin- ary, or nearly so. Take almost any patient who has left the binder off and she will want no bandage. “How often have you applied the binder with the greatest care, and, when you called next day and asked ‘How does the bandage feel ?’ received the answer: “Very well, indeed,” and when you looked to see if it were all right, found it under the arms ” What we want is to know which is right, binder or no binder. All works on obstetrics, so far as I know, recommend it. Lusk says the application of the binder after delivery is one of those points in practice about which men of large experience en- tertain a difference of opinion. “In my student days, in the Hopital des Cliniques in Paris, the binder was dispensed with, A folded sheet was, however, laid across the abdomen, it having been found that a certain amount of pressure was necessary for the comfort of the patient. This plan compelled her to lie upon her back, and thus had the disadvantage of restricting freedom of movement. Careful observation has failed, however, to show me a single good reason why the binder should be discarded. When properly applied it adds greatly to the woman's comfort, and enables her to turn at will upon her side. Many place a compress made of a folded towel above the symphysis pubis. This addition usually serves no better purpose than to displace the uterus to one side.” Says Playfair: “When we are satisfied that the uterus is permanently contracted, we may apply the binder ; but this should rarely be done until at least half an hour after the birth of the child. The soiled clothes should be gently withdrawn from under the patient, moving her as little as possible, and the binder should be at the same time slipped under the body, taking care that it is passed well below the hips, so as to secure a firm hold. No kind of bandage is better than a piece of stout jean of sufficient breadth to extend from the trochanters to the ensiform cartilage; a jack towel or bolster-slip answers the purpose very well. These are preferable, at any rate at first, to the shaped 484 COMMUNICATIONS. binders that are often used. One or two folded napkins are gen- erally placed over the uterus, so as to form a pad to keep up pressure. Once in position, the binder is pulled tight and fast- ened by pins. The utility of careful bandaging after delivery, can scarcely be doubted, although some years ago it became the fashion to dispense with it. It gives a comfortable support to the lax abdominal walls, keeps up a certain amount of pressure on the uterus, and tends to restore the figure of the patient.” Cazeau and Tarnier say : “A binder applied with moderate firmness and reaching from about the tenth rib to below the trochanters, is a source of much comfort to the patient, and is of benefit by supporting the relaxed abdominal walls, and by main- taining a certain increased amount of intra-abdominal pressure assisting the contraction of the heavy uterus. The binder usu- ally should not be worn more than eight or nine days.” Hirst says: “The good effects claimed for the binder when properly adjusted and fastened, are the preservation of the figure, compression of the abdomen, restoration of intra-abdominal pres- sure, compression and fixation of the uterus, prevention of relaxa- tion of the uterus and consequent hemorrhage, and promotion of involution. A pad made of a folded towel, or any convenient and clean material, should be placed over the fundus of the uterus and the bandage drawn tightly and secured with safety- pins, beginning at the lower margin, and placed sufficiently close to secure smoothness and equable pressure.” Says Churchill : “I do not know that we consider the binder absolutely necessary. Dr. Davis states that he has not used one for fifteen or twenty years, except in cases of flooding ; it is, however, very useful at first in maintaining a certain de- gree of contraction of the uterus and giving support to the abdo- men, and afterwards in promoting a return to the natural condi- tion of the uterine and abdominal parietes, for which reason I think it deserving of rather more attention than is usually paid to it, at least after the first day or two. I believe that if it be duly applied during the time the patient keeps her bed, she will avoid that loose state of the integuments which gives rise to what is called ‘pendulous belly.’” * Leishman says: “There is considerable difference of opin- ion among American accoucheurs in regard to the use of the binder. During the past ten years some appear to be disposed to discard it. The truth appears to be between the extremes in this, as in many other things. Patients generally prefer to have a well-applied binder. It gives them comfort, but unless properly HAVENS-The B2nder the Obstetrzcs. 485 adjusted it does more harm than good. The benefits which fol- 1ow its application are obtainable during the first few hours af. ter delivery; at this time it acts in precisely the same manner that the bandage used in the operation of paracentesis abdominis does. After the woman has become accustomed to the changes produced by the discharge of the uterine contents, the bandage has done its work and may be removed. The widespread opinion among women that it aids in restoring the original outlines of the figure, does not call for its continued use. As a rule, com- presses had better not be employed, and the bandage should be thin enough to allow the uterus to be felt through it.” The principal object which the bandage serves, Rams- botham says, is to brace the bowels, and give an artificial sup- port in lieu of that which they have lost through the laxity of the abdominal muscles, and to prevent the faintness frequently attendant on the sudden removal of a certain degree of pressure. It may to some extent, indeed, stimulate the uterus to more perfect contraction, but if that organ be unnaturally flaccid it would be wrong to rely on compression by a bandage to insure its more powerful action or prevent its cavity becoming distended with blood. In such a case, the only safe means of exerting suf- ficient external pressure is by the grasp of the hand, steadily and for some time unremittingly applied. A German surgeon attributes the shapeliness of the Eng- lish married ladies to the use of the obstetric binder after labors, a practice ignored in Germany, in consequence of which, Ger- man matrons mostly are disfigured by relaxed and pendulous abdominal walls. ... • What we want to arrive at is: Does the proper use of the bandage induce unfavorable results? Are we certain that cases of retroversion, prolapsus, etc., occurring when bandages are properly used, are attributable to the bandages 2 All remedies and appliances that are potent for good are equally potent for harm when not properly used. In bandaging a fractured arm, some skill must be used, as a too loose application allows crepitus and large callus, while too tight strangulates the circulation, causing gangrene. So it is with the post partum bandage; if too loose, it gives no support, and if drawn like the girth of a saddle, it may bind the uterus to the backbone. If I used the bandage because it was expected that I should do so, and by omitting it would risk the displeasure of the pa- tient and her family, I should consider that I used it improperly. 486 COMMUNICATIONS. If, on the contrary, I used it because I knew what I desired to ac- complish by its use, and had so far always succeeded, I think I use it properly. I never use a remedy or appliance that I have no faith in. I use it because the authorities advocate it, because my experience Has never taught me that it was harmful, or that my success would be better without it. All my patients expect it, and have faith in its utility, and are always better satisfied with its use. On the contrary, if the bandage is not used, and hemorrhage, prolapsus, or any other bad results follow the confinement, it is always laid to the absence of the bandage, and the physician is blamed. - - That some physicians never use it, and are successful, does not convince me that I should abandon it. - I think that the post-partum bandage, when sufficiently wide and reasonably tight, is a real comfort and support to the patient, and favors restoration of the abdominal walls to their Original condition. ; I believe that, as ordinarily put on, the bandage is simply a nuisance. I refer to the strip of muslin, six inches wide, which is put around the waist and never stays there, but gets in the way, until either nurse or patient quietly slips it off. But I set great store on my own particular hobby in bandages. I use a plain strip of muslin or flannel, wide enough to reach from the breast to the knees. This is pinned tightly, and can not slip up or down, as the hips are wider than the waist above or the thighs below. Thus applied, the bandage is highly appreciated by the patient, and renders her comfortable. It need not be worn for more than three days. I have yet to see a case which would willingly do without it. t How a binder applied in this way can be a “fruitful sourc of mischief to the patient,” “flatten the uterus,” or act like a liga- ature, is a puzzler, and I fail to see much of the “old granny” about such a process, either. The advantages can be briefly stated ; a good moral effect; without it there is an incompleteness about the treatment; the woman realizes that the struggle is over, and feels safer and more satisfied that something has been done for her; it prevents hemorrhage, relaxation of the womb and all “goneness” (what- ever that means—incipient syncope, I suppose); acts as a gentle excitant to the uterine contractions, till the exhausted, paralyzed abdominal muscles regain their normal tension, and like a brace or splint supports the back and all those parts of the body that are suffering from the shock. HAVENs—Zhe Binder in Obstetrics. 487 I disclaim using the bandage on account of its antiquity; at the same time because it has been used for so long a time is not a reason why it should now become obsolete. I find, on the completion of labor, the parts greatly distended and relaxed. I consider the indications are for rest. I desire to assist nature in contracting and restoring the parts to their nor- mal size. I adjust the bandage with this end in view, in no sense as a “binder,” but as a support, a help. In doing this we act only as an aid to nature, and this, I believe, to be the true func- tion of a physician. - Since writing the above, I have attended a lady in natural labor, and while applying the bandage I remarked to her that there was a great round of argument for and against using the binder. She replied, “If those who oppose it could only experi- ence the feeling of goneness and faintness that always follows delivery, and then experience the relief, comfort and support a well applied bandage gives, they never would oppose it after- wards.” Gentlemen, can we discuss this question fairly if we leave the woman’s feelings out of consideration ? AZ.CO//OZ, FROM A MED/CAZ S7AAV/DPO/NZ. BY A. B. WALKER, M. D., OF CANTON, O. A Lecture Delivered Before the 83d Meeting of the N. E. O. Medical Association. This is one of the most important subjects that demands the attention of our American people to-day. A question of vastly more interest than protection, free trade or reciprocity. To the medical profession, it is of special interest, since so much respon. sibility rests upon it. It has a moral bearing, that we as Physi- cians are bound to respect, for by the great army of temperance workers, we are held amenable for the habit of intemperance being formed in many. A reformation is dawning upon us, and we, as medical advisers and counselors to the sick and afflicted, have a heavy responsibility, and the question to-day for us to decide is: Is there any condition, physiological or pathological, requiring the use of alcohol as a therapeutic measure ? And if so, what are the conditions and when should it be used ? Through the influence of one of our great men, one of the founders of the American Medical Association, Dr. N. S. Davis, the American Medical Temperance Association was organized 488 COMMUNICATIONS. at Washington, D. C., May 7, 1891, and sixty-one physicians were enrolled as original members. The object of this associa- tion is to advance the practice of total abstinence in and through the medical profession, and to promote investigation as to the action of alcohol in health and disease ; and it aims at being a bond of union among medical abstainers, scattered all over our country. No pledge is required to be signed, but the members are expected to be total abstainers. The liberty of members to prescribe alcohol is entirely uncontrolled. In England a similar society has been in existence for many years. - Associations like these mean something, and will cer- tainly be productive of much good; for there is no doubt but that alcohol has been, and is, recklessly prescribed and used, and that we as physicians are held accountable for many cases of in- ebriety. There are many noted physicians, as Davis, Chenery, Quinby, Taft, Mullen and others, who claim that there are no conditions, either in health or disease, where alcohol in any form should be used. “The popular belief,” says Dr. Mullen, “that beer and other alcoholic drinks are strengthening, is a mistake, a de- lusion, a mere superstition, which receives no support from science.” - - Between two extremes, there is always a common mean. While we as regular physicians have no confidence in homeo- pathy, we cannot help admitting that it has done much to make our medicines more palatable, and has changed our views in many respects regarding the physiological action of drugs. So it is and will be with these radical views regarding the use of alcohol. They will cause us to be more careful in prescribing it and set us to thinking and investigating, and as a result a great refor- mation in its use will follow. My own belief at the present time is, that alcohol does de- serve a place in our materia medica, and is, under certain patho- logical conditions, a proper therapeutic measure; but when pre- scribed its physiological action should be as carefully studied and watched as when morphia, chloral, atropine or cocaine are given. I do not believe alcohol should ever be used in perfect health, and believe it should be classed among the poisons and kept in a special case with the rest of the poisons, as is the cus- tom with the druggists in Germany with their poisons. It should be labeled with the skull and cross-bones, not to be dispensed un- WALKER—Alcohol, from a Medical Standpoint. 489 less by the prescription of a responsible physician. Then, and not until then, will the temperance millennium be reached, when this country will prosper as no other country has ever prospered ; if we as physicians would lend our influence, it would come to TO2.SS. Professor Bartholow claims that “alcohol is within certain 1imits a food, and that the organism may subsist, for a variable period, on it exclusively, and that the weight of authority and the deductions of experiment are in favor of the view that an ounce to an ounce and a half a day of alcohol is oxidized and de- stroyed in the organism, and yields up force, which is applied as nervous, muscular and gland force.” Dr. W. H. Ford, in his most interesting experiments, found a small quantity of alcohol in normal blood, resulting, according to his views, from decomposition of the hydrocarbons. As there seems to be no doubt but that alcohol is oxidized when taken into the system, and that it normally exists in healthy blood, it is certainly the remedy when the hydrocarbons cannot be digested and assimilated, as is the case in all fevers, when by the administration of alcohol we are really using the hydrocarbons in a form in which they may be immediately oxi- dized, requiring no preparation by digestion. We simply supply material to meet the excessive waste. - Professor Austin Flint, Jr., in his address at Washington, D. C., Ninth International Congress, “claimed that alcohol is promptly taken up by the blood, and is oxidized even more readily in fever than in health, but in no case of disease, except perhaps in certain instances of poisoning by animal venoms, should alcohol be administered to a point where the slightest de- gree of alcohol intoxication is apparent.” Professor Wilson says, “In cases of typhoid fever, for a weak failing heart, there is no better remedy than alcohol, and when there are marked nervous symptoms and abdominal complica- tions, it is also indicated.” - Alcohol in small doses increases the action of the heart, and raises the body temperature, but has a depressing effect when taken in large doses. In the early stages of fever, alcohol should be cautiously and sparingly administered, but when the temperature is high with symptoms of delirium and prostration, alcohol is indicated and should be given in large doses, as half an ounce to an ounce every one or two hours for a day or so. During this time, the temperature should be carefully watched, and as soon as it begins to fall the amount should be diminished, 490 COMMUNICATIONS. but continued in smaller doses. There is no danger whatever from a large dose as long as the temperature is high. I do not believe in the use of alcohol to reduce the tempera- ture when it is high, for we have other and safer means, as the tepid or cold sponge bath, &c. . . . Many cases of feeble digestion are benefited by small doses of alcohol in some form, after meals, but I question the propriety of using it in these cases, on account of the great danger incident to the habit being formed. - In shock, where alcohol has not been a factor in its cause, small doses often repeated, but carefully guarded, seem to have a good effect, but I would not depend on it alone, for there are ammonia, atropine, strychnia, caffeine and other remedies, that we know will raise the body temperature by sustaining the heart's action, as well as small doses of alcohol. In wakefulness, due to cerebral anemia, a dose of alcohol in some form will produce sleep, but a cup of hot beef tea or even hot water will answer as well, and with no danger of the habit being formed. w - - When an anesthetic is to be given, it is a very good plan to give from one-half to one ounce of brandy or whisky, one hour before. The patient takes the anesthetic better, and I be- lieve there is less danger from heart failure. But in chloroform or ether narcosis, alcohol should not be given, for it will only add to the existing trouble. e Alcohol taken after exposure to cold, prevents congestion, and thereby attacks of pneumonia, pleurisy, &c., are doubtless many times avoided, but I question but that some hot drink wonld do just as well. Alcohol should not be given in bilious cases, cirrhosis of the liver, gout, Bright's disease and diabetes, and it should be dis- continued in all cases when the secretions become less active, as indicated by a dry tongue, higher temperature, or increased pulse rate. It is not the habit of intemperance alone that we are to fear from prescribing alcohol, but the pathological conditions result- ing from it when taken into the system, as the cirrhotic changes which are known to take place in the stomach, liver, kidneys, brain, spinal cord, and vascular system, by this active and pow- erful agent. These changes, in many instances, are permanent, and many a promising brain has been forever eclipsed by this seductive agent. - - - FUWCTIONS OF 7//E A/DNAEY'S, W/7// SUGGAES- 7TWOAVS AS 7 O 7TRAEA 7TM/A. AVT OA' UA’Aº/l//.4. BY D. N. KINSMAN, M. D., COLUMBUS, OHIO, PROFESSOR OF DIS- EASES OF THE NERVOUS SYSTEM, STARLING TMEDICAL COLLEGE. Read Before the Columbus Academy of Medicine. The kidneys are composed of vessels, nerves and tubules, all of which are supported by a connective tissue which has very intimate connection with the capsule of the kidney, a dense fibrous membrane surrounding the organ. The tubules vary in diameter and direction, and kind of epithelial lining. They begin with an expansion known as Bowman's capsule, which is lined with a single layer of flat epithelium. This capsule contains the glomerulus, which is formed by the division of the afferent artery into five or eight branches. These branches unite and escape from the cap- sule as the efferent artery, which again breaks up into a fine cap- illary plexus, which surrounds the convoluted portions of the tubules. The proximal convoluted tube is lined with rod-like epithe- lium, first described by Heidenhain. The descending limb of the loop of Henle is lined with a clear flat epithelium ; the ascend- ing limb is lined with ad epithelium resembling that of the con- voluted tube. The distal convoluted portion of the tubule has an investment similar to that of the proximal portion, mentioned before. The collecting tubes are of larger calibre, and lined with cubical epithelium. The lining of Bowman's capsule, the covering of the glomerulus, and the lining of the descending limb and loop of Henle, are for protection only. The glandular epithelium of the other portions of the tubules is concerned in the excretion of urea, uric acid, extractives, and coloring matter, while the water and crystaloids escape through the glom- erule 2. The water comes in contact with the products of the epithelium lower down, and carries them into the pelvis of the kidney. wº The formation of the urine is a complex process of filtra- tion and excretion. The urine has no uniform characteristics, 49I 492 COMMUNICATIONS. but varies with every passing inflence in color, quantity and den- sity. It is always toxic, and its toxicity varies as much as any other factor. For much which follows I am indebted to Bouchard's lec- tures, delivered in 1885, which are too little known to the pro- fession, and to various other authorities whose work has been re- ported in the journals of the day. The leucomaines and ptomaines, both harmless and poison- ous, are found in the urine. They are formed in the processes of nutrition which are normal to organization, and by bacterial action. Ptomaines are also known as cadaveric poisons; the word is derived from the Greek word, signifying a corpse. The pois- onings caused by rotten eggs, putrid meat, sausages, fish, milk, cheese and decayed fruits are due to ptomaines. They are pro- duced by bacteria, which are the cause of decay. It has been shown by Schiff, and others, that the liver cells fix and destroy poisonous alkaloids, when the cells are normal. The kidneys eliminate the portions which pass the liver. When the kidneys are incompetent, either from their own functional disorder or from excess of the poison introduced or formed in the organism, the result is intoxication. Over forty ptomaines have been iso- lated. Not all have been found in the human body, but the list found therein is not short. The work of the kidneys may be suddenly and greatly increased by the production of these toxic elements in the body. The demand upon the kidneys for the elimination of the products of metamorphosis of the body, is in- creased by exercise and various kinds of food ingested, without regard to bacterial infection. Bouchard estimates that a man weighing 132 pounds, daily excretes two and a half pints of urine; twelve drachms of this urine will kill an animal weighing two pounds. Such a man, then, daily excretes poison enough to kill forty-eight pounds of animal, or in two days and one half, poison enough is formed by him to cause his death by autogenous in- toxication, if its excretion should be arrested. (Or, according to the metric system, each kilogram of the man forms enough actually to kill 4.64 grams of animal; hence the toxic co-efficient of the urine is 4.64.) This toxicity is greater during activity than during sleep, although the sp. gr. is less. As was said before, this toxicity varies with every changing condition ; a com- mon cold increases it; cholera produces a deadly urine, when it is introduced into the living animal. When the epithelial elements of the kidneys are diseased, the toxicity of the urine diminishes, while that of the blood serum increases, resulting in the condition known as uremia. KINSMAN–Functions of the Rºdneys, Etc. 493. What are the constituents of the urine which determine uremia 2 Bouchard has shown that it takes 91.31 grains of urea to kill two pounds of animal, and this must be injected at once. In this proportion it would take 6866 grains (Troy) to kill a man of 130 pounds. As a man excretes two and one-half grains per pound daily, the urea produced in nineteen days, in a single dose, would be necessary to produce fatal intoxication. The water necessary to hold the urea in solution if introduced into the veins suddenly would be as fatal. From this he concludes urea is not an active factor in producing uremic intoxication. In the same manner he excludes from a leading role, uric acid, crea: tine, etc. By filtering urine through charcoal, he found one-third of its toxic power was gone ; one sixth of the potash and all the alkaloids were removed. By concentration and extraction he was able to show, by physiological experiment, that the urine contains two convulsants, a narcotic, a sialagogue, an anti-ther- mic and a myotic. These facts show the reason for the different forms of uremic intoxication ; z. e., comatose or convulsive. The toxicity of urines differs even in conditions compatible with health. Bouchard says every man is in the daily act of suicide by autogenous poisoning. The liver and kidneys stand guard for his life. Physiologists have shown that the toxic power of the blood in the portal vein is double that in the hepatic veins. They have also shown that the liver cells have a specific power to destroy the vegetable alkaloids when they are rubbed together in a mortar. The toxic coefficient of the blood in the portal system can be reduced by one-half by disinfection of the intestines by the use of mercury, charcoal, the salicylates and naphthol. While an infant nurses its own mother's breast, there are but few bacteria in the intestines, and these do not cause putrefaction ; but when mixed feeding begins, there is bacterial invasion of the stomach and intestines, and the normal process of digestion is more or less modified by putrefaction. Sometimes putrefaction produces poisons to the extent of killing the child. Cholera infantum is an example of this process. Under all circumstances the fecal matter of the intestines of adults contains matter which, if isolated and injected into animals, will promptly cause death. The toxity of the blood of the por- tal system is caused by the absorption of these poisons from the intestines. The liver cells fix or destroy them in large part; the rest are removed by kidneys, as they are brought to them by the blood vessels. 494 COMMUNICATIONS. As the bacteria act on nitrogenous matter without, so they act in the intestines. It is generally assumed that indol, acetal, phenol, and the sulphur compounds found in the urine, are the results of the transformation of bacterial product, to a large extent. The indol reaction in the urine has been seized upon as one of the factors of diagnosis in obstruction of the bowels, in intussusceptions and internal strangulations. The mutiplication of putrefactive products in the intestines, is indicated by abdominal pains, vomiting, diarrhea, cold sweats, faintings, and fetid urine; an acute toxemia, Infectious diseases, according to the doctrines of modern pathology, are caused by microbic invasions, and the action of their products upon the organism. The deadly power of these products is translated by convulsions, coma, cardiac failure and collapse, in many cases before there is any gross lesion of any important organ, as in cholera infantum, cholera asphyxia, malignant scarlatina and diphtheria. As to some of these infections, the course has been worked out; as to others, it is still a matter of inference. The mechanical theory, as well as that accounting for their action by using up the oxygen of the blood, has been abandoned, and we rest now upon the theory that the bacteria produce poisonous albumoses, organic acids and alkaloids, which act as the agents in the lethal intoxication. Bacteria attack the protoplasm of the cells, and by a process of digestion produce an albumose suitable for their culture, as . well as either an organic base or acid. Both are alike poison, and by their absorption and diffusion they cause their own spe- cific lesions. The action of the albumoses, and the organic bases or acids, has been determined as to anthrax, cholera asphyxia, tuberculosis, scarlatina, diphtheria and glanders, by bacteriolog- ists who have been working on the subject of immunity arti- ficially induced. The alkaloid produced by the bacillus of scar- latina and diphtheria, has been found in the urine, and shown to be identical with that recovered from pure cultures of the bacilli of these diseases, by their physiological effects. None of these ptomaines are found in healthy urine. The etiological impor- tance of these investigations does not require to be urged. (For further information on this subject, see Vaughn and Novy, Ptomaines, etc., 1891 ; Brzºzsh Medzca/ /ourma/, 1891 and 1892; and Progres Medica/, 1891 and 1892.) Cummi found the toxic coefficient of the blood in eclampsia more than double that of persons in health. Roger observes KINSMAN–Fuzzcázons of Zhe Azdneys, Aïc. 495 } that the toxic power of the blood serum balances that of the urine in pneumonia. Enough has been said to show that in an enor- mous number of diseases, the kidney is called to the work of in- creased elimination. In many cases the material to be elimi- nated involves the epithelium and renders it incompetent to dis- charge its functions. On the other hand, the poisonous matter may overtax its power and, at the last reduction, death from infectious diseases results from uremia. Bouchard says: “Uremia is the intoxication produced by those poisons, normally introduced or formed in the organism, which should be eliminated by the kidneys, and are retained when that organ is impermeable.” Uremia, then, is not one, but a sum of many conditions. Of the many substances normally in the urine, potash is the only one which ever plays a leading role in uremia, aside from the alkaloids. PRACTICAL CONSIDERATIONS:—Stimulation of the functions of the skin may concentrate the blood, but it does not depurate it of any harmful constituent in cases of uremia. The elimina- tion of urea, chloride of sodium and water are the only constitu- ents which can be removed in the sweat by increasing the ex- cretion of the skin, and these are not active factors in producing uremia. Three quarts of Sweat do not contain more urea than one ounce of urine. Purgatives, which are so much in vogue, have scarcely any more value in relieving a condition of uremia. Bleeding is of decided value in the treatment of uremia of parturient women. On this point the testimony is uniform. It removes a portion of the poison with the abstracted blood and allows the dilution of the remainder by absorption of water. The standard treatment of uremia may be summed up in the punning couplet of Dr. I. Lettsom, of the 18th Century : “I physics, bleeds and sweats 'em ; Then if they die, I Lettsom.” Here, as in so many other conditions, preventive measures are worth infinitely more than curative. In the treatment of all infectious maladies the kidneys should be kept active by the use of large quantities of diluents. Milk and water for food and drink act best as diuretics. And yet I am compelled to utter a caution in respect to milk; it must be fresh, and unless the bowels are in a fairly aseptic condition, it may prove harmful. I am convinced I saw a typhoid fever case die, in a collapse, from intestinal putrefactions from want of care in giving milk, who seemed to be doing well up to three hours of his death. Milk had better be sterilized. Sterilization does not destroy poisons 496 COMMUNICATIONS. already formed; it only kills germs. Putrefactions must be pre- vented, in the intestines, by the use of mercurials, charcoal, the salicylates and naphthaline. Charcoal fixes the poisonous pro- ducts, and will disinfect as well as deodorize the contents of the bowels. All meat extracts, teas of beef, mutton, chicken and bouillon must be forbidden. They are of no value as nutrients or tissue formers, and they increase the work of the kidneys use- lessly and dangerously by increasing the extractives and potash salts which must be removed. When the patient vomits, water may be given by cold enemata. The clothing should be warm to prevent congestion of the kidneys, not to increase the func- tion of the skin. By following out these indications we may indefinitely pro- long the lives of persons who have incompetency. Scarcely any one lives to middle life without impaired kidneys. Nature gave us more kidney capacity than we need, for our living, just as we have more lung and liver capacity than is absolutely essential, but this redundancy is for our protection. By care in feeding, by avoiding and correcting intestinal putrefactions, the life of those with impaired kidneys will not be incompatible with use- fulness and enjoyment. As to the use of drugs, I have little to offer. Iron with excess of chloride of sodium keeps up the blood condition. When there is fibrosis of the arteries, I have derived much benefit from trinitrin. In convulsions of uremia, I know of no drug the equal of morphine—used hypodermically. DUBLIN JOKE.—The ordinary meeting of the “Mutual Medi- cal Titillation Society” was held last evening. T. R. Umpet Bloer was in the chair. The following papers were read: Dr. Cooley-Wabbles on “The Cure of Chronic Diarrhea by Ligature of the Transverse Colon, Staffordshire Knot,’” (Why not ?—Ed.) Dr. Strait Vest : “Case of Homicidal Mania in a Child Five Days Old,” and on “The Painless Removal of a Pair of Trousers from a Dangerous Lunatic, Who had Attempted Suicide with Same.” An interesring discussion ensued. Dr. Bid-A-Wee: “Fatal Result from the Expectant Treatment of Post-Partum Hem- orrhage.” The following papers were promised for next meeting, . to be read by Secretary, on “A New Patent Foramen-Ovale,” and “The Treatment of Spina Bifida by the Taxis and Violent Per- cussion,” by Von Homboog; and on “The Value of Massage in the Treatment of Ingrowing Toenail, by Professor Footsore Limpi. Von Schuckhardt on “A Case of Exophthalmic Goitre in a Kitten benefited by Traction on Caudal Extremity.”— 72mes and A’egzster. AVEW VOA’A /A277AA’ OAV OA’7 HOAAE/D/C SUA’GAEA’Y. By STEwART LEROY M'CURDY, M. D., DENNISON, O. Professor of Orthopedic and Clinical Surgery, Ohio Medical University, Columbus, O.; Lecturer on Topographical Anatomy and Landmarks, Western Penn. Medical College, Pittsburg, Penn.; Surgeon P., C., C. & St. L. Ry. GENERAL ORTHOPEDICS.—New York affords vast opportu- nities for studying any branch of medicine and surgery. Es- pecially is this true of Orthopedic surgery. During a service of some weeks, with the privileges of every orthopedic hospital and clinic in the city, I was afforded an opportunity to examine an average of about one hundred cases daily. The orthopedic ser- vice at the Vanderbilt clinic, is open from IO to I2 daily, and has a daily average of about 15 cases. Dr. John Ridlon is ortho- pedic surgeon here, and I had the pleasure of serving as his as- sistant. One has an opportunity here to see the methods of Dr. Hugh Owen Thomas, of Liverpool, England, practiced, as is done no- where else in the United States. Dr. Ridlon, it appears, is es- pecially commissioned to champion the methods of Thomas, and indeed, I may say, no doubt feels himself under the spiritual guidance of the departed sage of Liverpool. The most commendable feature of all of Thomas’ braces, etc., is their simplicity. His hip and knee braces, and all of his ap- pliances, can be made cheaper than any other braces now in use, and, withal, they are most efficient. Dr. Ridlon had special instruction under Dr. Thomas, and is thoroughly acquainted with his methods, and I must say I have seen some very fine results obtained from their adoption. The Institute for Ruptured and Crippled has probably the largest out-door attendance of any institution of the kind in this country. It is not uncommon for them to have fifty cases daily. Prof. V. P. Gibney is surgeon-in-chief, and he is ably seconded by Dr. W. R. Townsend, who had charge during the early part of my service there. Their clinic is held from 1 to 3 daily. Dr. Royal Whitman has charge of the out-door department. Dr. Wm. F. Bull is attending surgeon to the hernia department. This institution was established by the late Dr. Knight, who had in operation many plans of treatment by devices and braces, the 497 498 COMMUNICATIONS. majority of which have long since been discarded. Either Dr. Gibney or Dr. Townsend operates Tuesday and Friday mornings at 8:30. The in-door department has an average of 180 patients, which affords quite a variety of operations, and the surgeons are very nice operators. Drs. Gibney and Townsend also do the orthopedic work at the Polyclinic, and here there is ample material for one to study the subject pretty thoroughly. The N. Y. Orthopedic Hospital, of which Dr. Shaffer is sur- geon-in-chief, has an average daily clinic of about thirty cases. Through the kindness of Dr. T. Halsted Myers and Dr. Sam’l Ketch, I was privileged to examine cases here. It is the aim of this institution to use the knife as little as possible, and allow the mechanical treatment to have unbounded sway. Dr. Shaffer is one of the first orthopedists of the country, and has probably as remunerative a private practice as any one practicing othoped- ics exclusively. Dr. A. M. Phelps, professor of orthopedic surgery at the New York Post-Graduate Medical School and Hospital, lectures on Wednesdays and Fridays at 4:30, and his clinics are full, averaging IO to I5. Dr. Phelps differs somewhat from the other orthopedic men in that he is an operator; 2. e., he operates upon every class of cases, at the same time carrying out the mechanical treatment Dr. A. B. Judson's clinic, at the New York hospital, is very interesting, from the fact that the average number of cases is about 5 to 8,and one has an opportunity to study the cases. The Doctor is a most genial gentleman. His knowledge of practical mechanics makes it possible for him to do a great deal of the putting to- gether and repairing of braces, which very materially leads to His success in the management of all forms of deformity. The clinic of R. H. Sayre, at Bellevue out-door depart- ment, held on Mondays, Wednesdays and Fridays, from three to five p. m., is very interesting, from the fact that Sayre the younger, carries out the principles of his father, besides embody- ing more modern methods. I believe that R. H. Sayre does the most beautiful plaster work of anyone in this country. His jackets are models of perfection in fit and workmanship. At the Bellevue clinic there is an average of about twenty cases. The senior Sayre is so afflicted and deformed with rheuma- tism that active work is out of the question. Strange, indeed, that one who has done so much for the deformed, should be tor- tured by a similar affliction. M'CURDY—AVew York Zetter on Orthopedic Surgery. 499 I shall never forget the very kind treatment received at the bands of Dr. Sayre in his office where I was privileged to ex- amine his private cases. My purpose in these letters is to present the methods of practice in the different clinics and hospitals, illustrating the brace or appliance used by a cut when possible, so that a com- parison can be made, and if I should catch myself comparing, criticising or finding fault, I would have you remember that I do not want to influence my readers, but am only expressing my opinion. º The opportunities afforded for the study of this class of cases are beyond comprehension, and as a matter of fact, entirely too much material is presented to make a critical study of cases or class of cases. The most interesting table of statistics imaginable might be furnished the profession by following these clinics for years, and then making a comparative table. As it is, the only statistics furnished us are given by individuals, and generally from pri- vate or selected cases. Dr. Sayre, a few weeks ago, reported over 4OO cases of hip disease, with six deaths, and with, I believe, about 20 per cent. of practically perfect recoveries. Such figures may be found in private practice, but never at a clinic under pres- ent methods of treatment. In private practice, the patients are more intelligent, and carry out the surgeon’s desires more faith- fully; besides, they are able to buy comforts that are not fur- nished dispensary patients. It is most frightful to parents to have you tell them that their child has a hip or a Pott's disease, or a tubercular knee or elbow, and that it will likely have to be under active treatment for two, three or four years, and under observation for ten or twelve years, but such is the case in clinical practice. While orthopedic surgery should be considered a sufficiently limited specialty, I find that men are given to making still further subdivisions; 2. e., in one clinic better results are obtained in hip disease; another excels in club-foot, and another empha- sises Pott's, or lateral curvature. Now this is not intentional, lout rather accidental; or it may not exist at all ; but in my rounds, I have been struck with the results in hip treatment at one place, and I get better points in the management of club-foot at another, etc. The question of when to operate and when to depend upon mechanical appliances, is of considerable moment to the patient, but not at all agreed upon by different surgeons. 500 COMMUNICATIONS, An orthopedic surgeon, considered in its broadest sense, is , one who not only does all orthopedic operations, from excisions down to tenotomies, but who is also able to execute in detail the mechanical treatment. Not all of the orthopedic surgeons operate, and some who consider themselves orthopedic surgeons Have no mechanical knowledge or ideas. The one who has in flis “make up” both of these qualities, must be considered the safest man. To illustrate—I saw a child with hip disease, who presented every indication for a tenotomy of the adductors and tensor wagºnae femorz's considered from an operator's standpoint; but, under an anesthetic, the muscles completely yielded, and no operation was necessary. I also saw two other cases, upon which an operator had decided to do a Gant operation (osteot- omy of femur below trochanter major for anchylosis of hip), but, under ether, the anchylosis did not exist, and tenotomy re- stored the limb to normal position. The orthopedic mechanic would doubtless have waited in all these cases, but the operator became impatient. The handling of tubercular abscesses following Pott's and hip diseases, is under discussion. This subject I will discuss at length in another paper, and I desire at this time to say that opinions differ from one extreme of opening every abscess that comes, to the non-interference in any case, preferring to allow them to open spontaneously. In practice one is frequently asked what brace one uses in hip cases, or what jacket one used, or what would you recom- mend as the best brace for lateral curvature, or what club- foot shoe do you use, etc. Those who have not made mechani- cal orthopedics a study, are too often inclined to think that a |brace, if made and used for hip-joint disease, is good for all cases, without variation. Especially is this true with doctors without natural mechanical ingenuity. But, as we never find two cases of typhoid just alike, so do no two cases of hip disease run exactly the same course. The same must be said of all orthopedic practice. For instance, while the Judson club-foot shoe is pretty generally used here, it is not applicable to all cases. A surgeon must treat symptoms, as is done in typhoid, and if he does not understand the symptoms and the remedy for the same, it is useless to try to treat the condition. What will 1 $º tion. As seen in the small cut, the yoke can be folded up into very small space for transportation. The broad leather-shoulder straps make it exceedingly easy for the patient. The price of the yoke and irrigator complete is $7. wº- º º DISCRIMINATING AGAINST Two-YEAR COLLEGES.—The - Oregon state board of health has adopted a rule defining a medi- cal institution in good standing to be one requiring three regular sessions of six months each, covering three years time. A Dr. T. Barwood was rejected on the ground that the school from which he graduated does not have such a three years course. He brought the case before the circuit court, which rendered a decision adverse to the power of the state board to make such distinction. On appeal to the Supreme court the decision was overruled and the authority of the state board sustained. ,” 524. EDITORIAL. THE TERM “REGULAR” DEFINED.—The Surgeon General of the United States rendered a decision last fall, which, coming from so high an authority, ought to satisfy the most exacting for a definition of the word “regular.” & In the army regulations there is a paragraph which specifies concerning the qualification of the physician being admitted, and says he must be a graduate of a regular medical college. A member of Iowa homeopathic Medical Society wrote a letter to the Surgeon General, asking him to state definitely what was meant by the word “regular.” The answer was as follows: “The term regular as used in paragraph 1544 Army Regulations, is used in its most compre- hensive sense, as indicating a college well equipped and prepared to cover the whole ground of the science and art of medicine in its teachings, and requires not less than a three years' course of study to secure its diploma.” P. BLAKISTON, SON & Co., announce a new text-book on Materia Medica, Pharmacy, Pharmacology, and Therapeutics, by Wm. Hale White, M. D., F. R. C. P., etc., Physician to and Lecturer on Materia Medica at Guy’s Hospital; Examiner in Materia Medica, Royal College of Physicians and Royal College of Surgeons, etc.; edited by Reynold W. Wilcox, M. A., M. D., Professor of Clinical Medicine at the New York Post-Graduate Medical School and Hospital, Assistant Visiting Physician Bellevue Hospital, etc. ºº: Eº-º-º-º: t WE have received from the Dios Chemical Co., of St. Louis, a colored lithograph of cerebral localization. Such a lithograph will be found many times convenient for showing to patients, and a copy will be sent free to any of our subscribers who ask for it. WE notice that the injunction of Battle & Co. against Fin- lay and Brunswig, of Louisiana, in regard to the use by the .1atter firm of the trade mark “Bromidia,” has been made per- petual by the United States Circuit Court. THE twenty-eighth annual meeting of the Ohio State Eclectic Medical Association, will be held at Youngstown, O., Thursday and Friday, June 9 and Io, 1892. A full programme is presented. Syr. .º 1. "ws: ºº pºph: Co., Fellows Contains the Essential Elements of the Animal Organization—Potash and Lime; The Oxidising 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 properties 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 deseases. Its Curative Power is largely attributable to its stimulant, 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 directly into the circulation with the food products. The prescribed dose produces a feeling of buoyancy, 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 per- sons 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 wrap- pers surrounding them) bear, can then be examined, and the genuineness—or otherwise—of the contents thereby proved. .7%edecaſ Zeffers weaſy %e addressed £o Mr. FELLOWS, 48 Vesey Street, New York. A WEGETABLE ALTERATIVE & TONIG AUSES THE ELIMINATION OF SPECIFIC BLOOD Poison, the repair of wasted and disorganized tissues, and the restoration of the vital forces to their normal activity. In the treatment of Syphilis it supercedes the use of both Mercury and Iodide of Potassium, and is a reliable remedy for the evil effects pro- duced by the excessive use of these drugs. It is also specially indicated in all Scrofulous Affections, and is invaluable in the treatment of Eczema and other Skin Diseases, in Chronic Rheumatism, Old Chronic Ulcers, etc. Formula.-Verrhus Clemiana is a Compound Fluid Extract of Clematis Erecta, Prinos Verticillatus, Fraxinus Americana and Rhus Glabrum, with 96 of one per cent. of Venanatic Acid, C H2 O2. Dose.—A teaspoonful in water, gradually increased to a tablespoonful, three or four times daily. Prepared Only by THE CLEMIA.N.A, CHEMICAL COMPANY., ATLANTA, - - GEORGIA. Elastic Hosiery & Supporters Flästiſ Rūlī, Bºst Silk || Lillºl, TWO (2) NEW L00Ms JUST PUT IN. Hereafter can make and fill Special orders day after receipt. Our motto will be QUALITY. E. M. HESSLER SURGICAL INSTRUMENT CO., 57 and 59 Euclid Avenue, GLEVELAND, OHIO. N. B.-The Manufacture and Fitting of Deformity Apparatus, º Artificial Limbs and Trusses, a Specialty. Bind All Your Papers at Omeg, URINE FOR INSECT STINGS.— THE KLIPIS THE BEST BINDER. Dr. Terry, in Dietetic Gazette, ----- Tº ſº... . Adopted by U. S. º tº- Government. Put says that fresh urine, freely ap- ºãº *:::::::::::: plied, is the best remedy for is P. º.º.º stings of hornets, bees, and other to order, any style. y s Address insects. Wet cloths with it and LLARD, 29, Pittsfield, Mass. apply until the pain ceases. º: Qºş: • **- rºš - B () () K N 0 TICES. THE PRINCIPLES AND PRACTICE OF MEDICINE–Designed for the Use of Practitioners and Students of Medicine. By William Osler, M. D., Fellow of the Royal College of Physicians? London ; Professor of Medicine in the Johns Hopkins Uni- versity and Physician-in-Chief to the Johns Hopkins Hos- pital, Baltimore; formerly Professor of the Institutes of Medicine, McGill University, Montreal; and Professor of Clinical Medicine in the University of Pennsylvania, Phila- delphia, Sold only by subscription. Price, cloth, $5.50; sheep, $6.50; half Morocco, $7. D. Appleton & Co, Pub- lishers, Bond Street, New York. • The appearance of this work has been anticipated for some time by the profession, who had become already familiar with Dr. Osler through his contributions to the medical jour- nals. The book embraces the most progressive views in regard to the practice of medicine, and indicates thorough study and exhaustive research by the author. Dr. Osler is by no means a therapeutic nihilist, neither is he an enthusiast in drug giving. He chooses the golden mean, and to exhibit these characteristics we can do no better than take up his treatment of typhoid fever. In the treatment of this fever he recommends most highly the use of cold water, as introduced first by Currie, of Liverpool, but more recently advocated by Brand, of Stettin. The results of this treatment have been so excellent as to almost compel its use in hospital practice, but the difficulties attending its manipulation are such as to render its use in private practice “scarcely feasible.” Medicinal antipyretics are not recommended, unless it be in rare cases antifebrin. The author places no dependence on antiseptics, including carbolic acid, iodine and naphthol, although he thinks they do no harm and serve to amuse the patient. For abdominal pain and tympanites, turpentine stupes are recom- mended, but the internal administration of turpentine the author states is a useless practice, “for the perpetuation of which, in this generation, H. C. Wood is largely responsible.” Opiates should be used for diarrhea. For constipation an injection is best, or a mineral water laxative. Hemorrhage should be treated by full doses of acetate of lead and opium, and absolute quiet. For peritonitis, morphia should be given ; if perforation 525 526 BOOK NOTICEs. occurs late in the disease, laparotomy may give the patient a chance. For heart failure, alcohol is our main stay, and strych- nine is most useful. Digitalis is of doubtful value. Where ner- vous symptoms exist,the cold water pack should be employed, with an ice cap to the head if necessary, and morphine internally. A return to solid food should not be allowed until the temperature has been dormal for ten days, ſº We notice a few typographical and verbal errors, which will doubtless be corrected in a succeeding edition, but the book as it stands is one of the most valuable additions to medical litera- ture that has appeared for many months past. THE CHINESE: THEIR PRESENT AND FUTURE ; MEDICAL, POLITICAL, AND SOCIAL, by Robert Coltman, Jr., M. D., Surgeon in Charge of the Presbyterian Hospital and Dis- pensary at Teng Chow Fu ; Consulting Physician of the American Southern Baptist Mission Society; Examiner in Surgery and Diseases of the Eye for the Shantung Medical Class; Consulting Physician to the English Bap- tist Missions, etc. Illustrated with Fifteen Photo-Engrav- ings of persons, places and objects characteristic of China. In one handsome Royal Octavo Volume, 22O pages. Extra . Cloth, price, $1.75, net. Philadelphia: The F. A. Davis Co., Publishers, 1231 Filbert street. This very interesting little work is the result of Dr. Colt- man’s experience while in China as a 1medical missionary, and contains much valuable information on topics not directly medi- cal. The author states that digestive disorders are very frequent among the Chinese, due to their lack of proper food, hygienic surroundings, etc. An interesting point is made concerning leprosy, which is said to have existed for thousands of years, with- out any material increase in the number of cases, lepers mixing freely among the people. Dr. Coltman expresses his belief that the disease is hereditary and also that syphilis acts as a predis- s posing cause. § HvDRIATIC TREATMENT OF TypHOID FEVER. By Chr. Sihler, M. D., Ph. D., Professor of Histology, Medical Department of Western Reserve University, etc. Published by Chr. Sihler, 832 Scranton Ave., Cleveland, O. 12mo. Pp. 340. Cloth, $1.50. The author has been compelled to publish this book at his own expense, as publishing houses had refused to undertake the enterprise. It is to be hoped that his enthusiasm will be BOOK NOTICEs. 527 rewarded by a large sale of the book, at least sufficiently large to reimburse him for his outlay. ar - The book is divided into four chapters. The first chapter give the results of the cold water treatment, showing a reduction in the death rate of from one-half to two-thirds. In the second chapter the author treats of the effects of the treatment on the various functions of the body, and symptoms of the disease. In chapter three he describes the method of carrying out the treat- ment, and in the next chapter gives details of twenty-four cases treated according to this method. Although the results that have been obtained by the use of this treatment are such as to convince one of its great usefulness, and Qf the advantages of resorting to it in typhoid fever, nevertheless, in private practice the obstacles seem to be almost insuperable, so that we are com- pelled to feel with Osler that the method is hardly “feasible” outside of hospitals. — TREATISE ON GYNECOLOGY, MEDICAL AND SURGICAL. By S. Pozzi, M. D., Professor Agrege a la Faculte de Medicine; Chirurgien de l’Hospital Lourcine-Pascal, Paris; Honorary Fellow of the American Gynecological Society. Trans- 1ated from the French edition under the supervision and with additions by Brooks H. Wells, M. D., Lecturer on Gyne- cology at the New York Polyclinic; Fellow of the New York Obstetrical Society and the New York Academy of Medi- cine. Volume I. With 365 Wood Engravings and Six Full- page Plates in Colors. New York: William Wood & Com- pany. I89I. Although only the first volume of this exhaustive work is before us, we feel safe in saying that when completed it will exceed in practical usefulness any similar work with which we are acquainted. * , As chief of a hospital service at Lourcine, devoted solely to diseases of women, and as a careful observer at the leading gynecological clinics in England, Germany and Austria, the author has well qualified himself for the preparation of his book. Although a Frenchman, and proud of the work done in his own country, he is broadly cosmopolitan in his views, and gladly recognizes good work wherever done. This volume covers 560 large pages, is illustrated with three hundred and five wood engravings and six full-page chromo- lithographic plates. Many of the illustrations are original. The subjects treated are: Antisepsis, anesthesia, control of hem- orrhage and closure of wounds, drains and tampons, examina- 528 * Book NoTICEs. tion of patient; metritis ; fibroma of uterus; cancer of uterus; uterine displacements; deformities of the cervix, atresia, stenosis, atrophy and hypertrophy; and disorders of menstruation. COMPLETE MEDICAL POCKET FORMULARY AND PHYSICIANS VADE-MECUM. Collated for the Use of Practitioners. By J. C. Wilson, A. M., M. D., Physician to German Hospital, etc. Philadelphia: J. B. Lippincott Co. 1892. Pages 262. Leather tuck and pocket. Price, $2. This book contains “upwards of 2,500 prescriptions, col- lected from the practice of physicians and surgeons of experience, American and foreign, arranged for ready reference under an alphabetical list of diseases; also a special list of new drugs, with their dosage, solubilities, and therapeutic applications;” together with tables of formulae for suppositories, hypodermic medication, of drugs for inhalation, poisons with their antidotes, a posological table; a list of incompatibilities; metric equivalents; a brief account of external antipyretics, disinfectants, medical thermometry, the urinary tests, and much other useful infor- mation required in emergencies, etc. It contains blank inter- leaved pages, on which one can add such notes of new drugs, combinations, etc., as he may wish. & OHIO MEDICAL UNIVERSITY.-We understand that the affairs of the Ohio Medical University, of this city, are getting into excellent shape. The faculties of Medicine and Surgery, Pharmacy and Dentistry, are thoroughly organized. A lot 50 feet wide by 180 feet deep has been purchased on Park street, opposite Goodale Park. This location is in the very heart of the city. It is one square from High street, but owing to the pres- ence of the park, is so retired that the work of the school will not be interfered with by street noises. The plans have been drawn and accepted for an elegant three-story building, to cover the entire lot, furnishing a large number of recitation rooms, besides a large amphitheater, and rooms for the hospital depart- 111ent. A From 19tters received from physicians and students, it is evident that the proposed method of teaching by assigned lessons and recitations is destined to prove very popular. We have no doubt that this is the true method of imparting instruction. The announcement will be ready for mailing in due time. It is expected that the building will be completed in time for the opening of the session in September. Cheap at Last! MAGNIFYING FRONT CLINICAL THERMOMETERS. Rubber Case, $2.oo (formerly $2.5o). Chain Case, $3.oo (formerly (3.5o). And the Columbus Medical Journ AL with it for one year FREE. Think of it! Thermometer and Journal less than the former price of Thermometer alone. Sent by mail free, in safety case, on receipt of $2. Io or $2.60. Thermometers Fully Guaranteed. The Columbus MEDICAL PUBLISHING Co. COLUMBUS, OHIO. “WE GET THERE JUST THE SAME.”— Our lip we can’t help curlin’ At the medical profesh : Sure, there’s Dr. Quack, of Berlin, Always finding something fresh To prevent mankind from croaking, And to load himself with fame. This is not a theme for joking, But—we get there just the same. Here’s a man has struck a plan, sirs— So the daily papers say— w To prevent the growth of cancers, . And we only hope he may ; All the things they’ll soon be healing To which one can put a name— Yet we’re haunted by a feeling º That we’ll get there just the same. . Oh, confound all foreign “masters” With a secret to disclose ! We believe in mustard-plasters, And put tallow on our nose. Let the savants of Vienna Spin there narratives so lame— If we stick to salts and senna We get there just the same. —Hospital Gazette. he was doing. * A young M. D. who was trying to establish bimself in a community, met an old lady who had interested herself in the young doctor's behalf, whereupon she inquired how “I was called out three times last night,” said the young doctor. “Why, 1a me!” said the old lady, “I was affected just that way myself the other night, and Dr. S. gave me some powders that stopped the diarrhea at once. Here try one of them.” “No wonder me darlin’ is cross-eyed,” Said love-sick young Pat to his mother, “For both of her eyes are so pretty That each wants to look at the other.” " —Arunonzam. Possesses a peculiar affinity for viscid secretions, neutralizing and eliminating them through the natural channels. It is diaphoretic, laxative, anti-septic, anti-neuralgic, and anti-rheumatic, hence is HEAD ACH. E. |N|D|SATED |N “I prescribed Tongaline for a lady who has § suffered exceedingly with Headache for several NEğW{}}S #AğHE , years. The pain is mostly confined to the top of g the head, and continues often for 24 hours, unless * * * * * - she is thoroughly narcotized by an Opiate. Ton- Rheumatistii, ºisºn *.*.*.*. galine was taken in doses of a teaspoonful a Meu rai ia intervals of an hour, and the third dose relieved § her entirely. There was no rmalaise or bad feel- £. ings of any kind following its use. Other physi- La Grippe, cians here speak very highly of their experience º ſº With Tongaline. y 7 Sciatica, THOMAS H. URQUHART, M.D., G t Hastings, Neb. IT CONTAINS TongA, Ext. CIMICIFUGAE RACEMOSAE AND THE SALE- CYLATES OF SODIUM, PILocarp1N AND Colchic IN. sEND For clinic AL REPORTs. MELLIER DRUG COMPANY. Iog & III Walnut Street, ST. LOUIS. co I. -3% . . . . . . FOR. M U L.A.—Each fluid drachm contain S : PHOTO-CHLORIDE IRON, one-eighth gr. BICHLORIDE MERCURY, one-hundred and twenty-eighth grain. CHILO HIDE ARSENIC, one two hundred and-eightieth grain. With CALASAYA A LRALOIDS and ARO- MATICS. INDICATIONS.—Anemia from any cause, Struma, latent Syphilis, General Debility, Tuberculosis, Malaria, Loss of Appetite, Habitual Constipation, Chlorosis, Chorea, Chronic Uterine, Pelvic, Zymotic, Catarrhal and Derrmatological Diseases. DOSE.-One or two fluid drachins three or more times a day, as directed by the physi- Cian. The prescribed dose of THREE CHLORIDES gives prompt action, produces a feeling of buoyancy, stimulating the appe- tite and the digestion, promoting aSSimila- tion ; is v ry pleasant to the taste, assimila- ted by the most delicate stomach ; does not constipate. Will not color the teeth, and is harmless under prolonged use. This prepa- EST3D. * * : * º -- * * * "Sº - 'º \,{} º º º ºr ºr Louisvili, KENTU ration has stood the test of time and experi- ence, is uniform, unalterable and can be relied woon to produce results. Its use is Indicated in a Wide Range of Diseases. Physicians will please designate R. & H. Elixir Three Chlorides. Where a more specific alterative is need- ed, other than in creasing the dose Or bichloride, mercury. The physician may add without reservation any of the soluable Salts of iodine or its compounds. Dispensed in twelve Ounce bottles; price, $1.00. MARION SIMS COLLEGE, ST. LOUIS, *} May 30, 1890. During the past six months I have pre- scribed for the various conditions indicated by the component parts of the mixture of the “Elixir Three Chlorides’’ for more than three hundred recorded cases, and in no in stance have I regretted it. t * 1. N. LOVE, M.D., St Louis. The Formula, of this. Compound, wilſ, immediately suggest itself to the thoughtful Physician. 1832. To be had of All Leading Jobbers, 17 > * º - £º, $º ſº. A ſº º % NS - º º ſ wº w [. Always Uniform — Therefore Always Reliable. METCALF's tº ſº.” RECOMMENDED FOR 'NEURALGA, SIEEPLESSMEss, FOR FATICUE OF DESPONDENCY, ETG. MIND BODY. a Or Aſº *º ) § ºRINGER - recommends CoCA LEAVES as of great value in ſº Febrile Disorders, by restrain- &ºeing tissue metamorphosis, #7 and for the same reason in Phthisis. For their decided anodyne and anti-spasmodic qual- ities, they have been successfully &s employed in Typhus, Scorbutus, º! & P § Gastralgia, Anaemia, Enteral- **:: ºº / §§7. W % gia, and to assist digestion. W % §/ Ǻ WINE OF COCA is probably Nº. § % % % o - . Yº Safe alſ G § % = % the most valuable Tonic in the º” A2 sº #&# Materia Medica when properly pre- * §§Mºš: §§§ aſſº; C-3' º §º pared. With stimulating and anodyne º 㺠9a ºš most ski 2.3% (, properties combined, MIETCAHLF2s CoCA º *AYºğs-T, u ill "Čº: º - *- - - 3 º' - ğ tº and precision from 4º WINE acts without debilitating, being always DR. ARCHIBALD S Vº '..."; 4% wniform and therefore absolutely reliable. For - ...” MITH- Wº A ſº º is s - - - • - tº: As ºf isºstates that wº º flºº Athletes it is invaluable in imparting energy and * Coca," increases energy, *A. A., Pº ſº sº ocs c ++ - e - º * : * * * removes, drowsiness, iºns º § j resisting fatigue; Public Speakers and Singers find it indis- the spirits, and makes the con- º °º- pensable as a “Voice Tonic,” because being a “tensor’’ of the Vocal chords, it greatly strengthens and increases the sumer to bear cold, wet, great, ſº b bodily exertion and even want of ſº Yº º: *§ degree, with § # volume of voice; and to the elderly it is a dependable aphro- - § | disiac, superior to any other drug. Pºe ºr Metcair's eace \# Theodore Metcalf. ESTABLISHED 1837. Frank A. Davidson. Wine:- One-half wineglassfull three º times daily, between meals. Physi- º - ciams’ sample bottles, by express, K. ALF G0 carriage prepaid, upon the receipt of One ºf sy ID ollar. # 39 Tremont street, tº BOSTON, MAss. - BROMIDEA THE HYPNOTIC. FoRMHUMLA.—Every fluid drachm contains fifteen grains EACH of Pure Chloral Hydrat. and purified Brom. Pot. and one-eighth grain EACH of gen. im. ext. Cannabis Ind. and Hyoséyam. pººf-hair to one fluid drachm in WATER or SYRUP every hour until sleep is produced. IN ºf UATA PNS.—Sleeplessness, Nervousness, Neuralgia, Headache, Convulsions, Colic, Mania, Epilepsy, Irritability, etc. In the restlessness and delirium of fewers it is absolutely in Valuable. KT DoE’s Notr Łock UF THE secKETKorss. º T H E ANO DYN. :- Papine is the Anodyne or Pain-relieving Principle of Opium, the Narcotic and Convuisive Ele- ments being Eliminated. It has less tendency to cause Nausea,Vomiting, Constipation, etc. HN D10ATRIONS.—Same as Opium or Morphine. - HP0s E.-ONE FLUID DRACHM-(represents the Anodyne principle of one-eighth grain M.Orphia.) O D : A THE ALTERATIVE AND UTER IN E TO NIC. FORMIUIL.A.—Iodia is a combination of active principles Obtained from the Green Roots of Stillingia, Helonias, Saxifraga, Menispermum and Aromatics. Each fluid drachm also contains five grains IOd. Potas., and three grains PhOS. Iron. DOSE —One or two fluid drachms (more Or less as indicated) three times a day, before meals. INMRICATIONS.–Syphilitic, Scrofulous and Qutaneous Diseases, Dysmenorrhea, Menor- rhagia, Leucorrhea, Amenorrhea, Impaired Vitality, Habitual Abortions and General |Uterine Debility. - To the Medical f'rofession. During the past seven years we have been laboring assiduously to produce Zºant Foods ready for use that would closely resemble healthy human milk. It has not been an easy task, as every physician knows who has taken a special interest in the subject. We have spared neither labor nor expense to accom- plish this object, which will be demonstrated to any physician who will visit our factory. We have met the more recent demand for a sterilized Food for Infants by an expensive change in our machinery under the supervision of the most eminent Bacteriologists in the country. This sterilization has been accom- plished without rendering the casein of the milk less digestible, as is invariably done with the patented sterilizers in use. It also insures with the hermetically sealed cans, their perfect keeping qualities ... We do not think it possible that any Infant Food will ever be prepared that will excel LACTO-PREPARATA (an all milk food) for the feeding of young infants and CARNRICK’S FOOD for their nourishment during the latter part of the nursing period. All other Infant Foods in the market are com- posed entirely of the cereals; or they contain so little milk (about 8 per cent.) that it is a misnomer to call them Milk Foods. If such foods are used alone, the child will not be properly nourished, its flesh will be flabby, and it will quickly succumb to disease, because they are deficient in albuminoid con- Stituents. Send for circulars and samples. Make Your Own KMYSS in One Minute. A Product of Pure, Sweet Milk, What is P&Cunnysgen P It is Kumyss in a dry form, containing all the constituents of the best Áumyss, and requires only the addition of water to produce an artigle superior in digestibility and palatability to the old form of Áumyss. It is the Zaeal Food in all cases where nutrition is an important factor, and digestion is feeble. When all other Foods fail try KUMYSGEN, but it is better to try it in the beginning and save time and strength. * RUIMYSGEN is the only preparation of Kumyss that will keep. All . liquid preparations of Kumyss will keep but a short time, and are constantly changing in the bottle, unless some deleterious preservative is used. Rumyss made from KUMYSGEN is far more palatable, easier digested and 35 per cent. less expensive than the old style KumySS. Our Syphon Kumysgen. Bottles allows Æumyss to be drawn without loss of contents. One in every three bottles are Syphon, containing same quan- tity of KUMysgen as the others. Send for samples and descriptive circulars. MANUFACTURED ONLY BY fºr) & CAERINTERECº, New º'erle- | PREMIUM LIST O - | | NOTE THE LOW FIGURES º — H. FountAIN PEN-Best Grade. º 4 tº win–ºranº - º with One Year Subscription to the Journal . . . . . . $2 50 º (Above is the price of the pen alone.) | A Fountain Pen when once used is never dispensed with. Ask our editor. GAS BRACKET. With Light Condenser, Mirror and Bar Complete. (See cut below.) All Nickle Plated, and MEDICAL Journal, One Year . $20 oo Above can be arranged for oil lamp at an extra expense of about $1.OO. Light Condenser and Mirror not including Bracket (see - cut below) with Journal, One Year . . . . . . I 2 OO Light Condenser without Mirror or Bar, not including Bracket (see cut below) . . . . . . . . , - 8 OO Prices flamed are less than the regular prices on light condensers alone. - Cash must accompany order to obtain these prices. 20 FREMIUIM. IIST I Look! Look! This wºve You It is our intention to make the subscription list of Our Journal larger and to give patrons benefit of WHOLESALE PRICES on everything we can get low figures on. We guarantee the quality of everything. A $12.00 Case for '$8.50, with the Columbus Medical Journal thrown in. t No. Go IMPHowed BUGGY case. It is worthy of notice. Only Cases of this manufacture have the COMBINATION CORNER (see cut). The Foot or Button being in ONE PIECE with the corner, prevents, them from coming off the Case. Note all improvements in No. 60 Case, and see its superiority to cheap irrhitations of the same. º Fº §§§ºsºsº. §:º sºj §§ §§§§§ sº º § º ºf º § sº º - \\ § #. Yºğ : # : ******s: No. 6o Improved Buggy Case, each . . . . . . . . Including one year's subscription to the Journal. $ 8. 5 O raaterial will make. * NOW Read this—a $12.00 Case and the Journal for $10.50. Space for powder papers, instruments, ete. Case made of Black Grained Russia leather, leather lined throughout, and mounted with German silver combination corners, nickel spring lock, with key, making the most Substantial, complete and richest-looking Physician’s Case ever placed on the market. It should be noted that the No. 60 Case is protected by German Silver combination corners; also nickel edge trimmings around the center partition, which serves to protect from wear and to keep the partition in plage. These improvements are found only in No. 60 Improved Buggy Case, it being the constant aim of the manu- facturers to make this case as near perfect as skillful labor and carefully selected 66. SATCHEL CASE, 10 inch frame, contains 18 one ounce, 11 six drahms and 14 four drahm ; Corked vials, ample loops for in- ##, struments, box for sundries, plush NH lined, with a neat compartment *# for Hypodermic Syringe. Size, ãº; 10x7-5. Price, with the CoIUMBUS 㺠MEDICAL Journ AL 1 year, $10.50. ºº:: # We think this the most conveni- # ent Satchel Case sold. Can also furnish it. With 7 two Ounce bottles instead Of 9 Of the É One Ounce. This is the finest and *º-º-º-º-º-º-º-º-º-º best made Satchel Case On the :::::::::::::===s*** market to-day. All of above prices include the Columſ BUSMEDICAL Journal for one year. Cash must accompany Order to Obtain above prices. E FWAREDF |MITATIONS. ESTABLISHED [6 YEARS. Fºr DES IIEBIG'Slſ||D EXTRACT OF BEEFAND TONI[. Mäläiſä-Lºir- ESSENTIALLY DIFFERENT FROM ALL OTHER BEEF TONICS. UNIVERSALLY ENDORSED BY LEAD ING PHYSICLANS. This preparation, consisting of the Extract of Beef (prepared by Baron Liebig's process), the best Brandy obtainable, Soluble Citrate of Iron, Cinchona and Gentian is offered to the Medical Profession upon its own merits. It is of inestimable value in the treatment of all cases of Debility, Convalescence fronn Severe Illness, Anaemia, Malarial Fever, Chlorosis, Incipient Consumption, Nervous weakness, and maladies requiring a Tonic and Nutrient. . It is quickly absorbed by the Stomach and upper portion of the Alimentary Canal, and therefore finds its way into the circulation quite rapidly. COLDEN'S LIQUID BEEF TONIC appeals to the judgment of intelligent Physi- cians in the treatment of --All. Gases of General. Debility.<- It is essentially a Food Medicine which gives tone and strength in cases where other remedies have failed or been rejected. A single trial will convince any ſaur-minded Physician of the value of this preparation. By the urgent request of several eminent members of the medical profession, I have added to each wine. glassful of this preparation two grains of Soluble Citrate of Iron, and which is designated on the label, “With Iron, No. x;” while the same preparation, Without Iron, is designated on the label as “No. 2.” g| F. In order that Physicians unacquainted with COLDEN'S LIQUID BEEE TONIC, may become familiar with it, we will upon application send a sample bottle free (express charges paid), to any Physician in the United States. Please ask your Dispensing Druggist (if he has not already a supply) to order it. In prescribing this preparation physicians should be particular to mention “COLDEN’S,” viz., * Ext. Carnis F1. Comp. (Coſden).” It is put up in pint bottles, and can be had of Wholesale and Retail Druggists generally throughout the United States. c. INT. cIRI*I*T*E=N*E*CINT, General Agent, º ſº a º º sº 1 : 5 FULTON STREET, NEW YORK- --------------- sº-º-º-º-º-º-º-º-º-----------º-º-º-º-º-º-º-º-º-º-º-º: filliſilliſilliſillilililllllllllllliiliſilliſſiſſiſſiſſiſſiſſiſſiſſiſſiſſiſſiſſiſſilſiliiliiliſillililillilililililillilililililililihiliſillililillililililliliiliiliiliiliiliilililililliſillilililililllllllllllllllllllllllllllliſº LENN’S= = ONSTANTINE’S = SULPHUR SOAP. PINE TAR SOAP. By far the Best Tar Soap made. Has been on trial among f’hysicians know the great value of the local use of sulphur in the physicians for very many years as a toilet soap and healing agent, and its superior virtues have been unanimously conceded in all cases where the use of Tar is ind is ated. None genuine unless stamped A• A- corss'TANTINE’s PERSIAN HEALIN"S PIN E. TAR SOAP. For sale by All Druggists. Treatinent of Diseases of the Skin. Glenn’s Suluhur Soap is the Original and Best combination of its kind, and the one now generally in use. For sale by All Druggists. Bevy are of Counterfeits. wholesale Depot, C. N. critteNToN, 115 Fulton Street, New York. Samples of above Soaps SENT FREE, on application, to any Physician inclosing card, AN IDEAL PEPSIN: PHYSICIANS PRESCRIBE P., D. & Co.'s ASEPTIC PEPSIN. Pepsins as heretofore known have left very much to be desired, most of them indicating by their odor the putrescent mucus and other objectionable constituents which must necessarily prove irritating, especially to the delicate Stomach of an infant, invalid or dyspeptic. * We now supply a new and improved Pepsin Product (ASEPTIC PEPSIN, I to 4000, P., D. & Co.'s), in the full con- fidence that it Will at once recommend itself to the favor- able attention of the Medical Profession. It is twice as active as any other pepsin now on the market, and by the process of manufacture which we pur- Sue, is deprived Of all Septic constituents. This process. renders it very palatable So that the most fastidious palate could not possibly object to its taste. Samples and literature will gladly be supplied upon application. MANUFACTURED ONLY BY PARKE, DAVIS & COMPANY, DETROIT, NEW YORK AND KANSAS CITY. ÇG)). UM13t'ſs MiſſE!CG11: JGURNG11. Vol. X, JUNE, 1892. Me, 12, J. F, BALDWIN, M. D. - *- wº 4- - — EDITOR. J E. BROWN, M. D. - - Associate Editor. C. R. CoRNELL, - - Business Manager. 48 PAGES READ/WG MATTER, PUBLISHED MONTHLY. $1.00 PER YEAR. THE COLUMBUS MEDICAL PUBLISHING COMPANY, Publishers and Proprietors, 266 East Gay Street, Columbus, Ohio. Entered at Postoffice, Columbus, Ohio, as second-class mail matter. wº - * K . . . . .” ~ sºs º ºr ºf a | l E PREVENTS FERMENTATION OF FOOD IN THE STOMACH. MOST POWERFUL REMEDY FOR HEALING PURPOSES. CURES : DYSPEPSIA, GASTRITIS, ULCER OF THE STOMACH, HEART-BURN. Send for free book of 80 pages giving articles by contributors to medical literature. PHYSICIANS WILLING TO PAY EXPRESS CHARGES WILL RECEIVE FREE SAMPLE ON APPLICATION. Glycozone is sold only in 4 ounce, 8 ounce, and Xó ounce bottles. Never sold in bulk. PREPARED ONLY BY tº Mention this publication. Chemist and Graduate of the “ Ecole Centrale des Arts et Manufactures de Paris " (France). leadinºgists. Laboratory, 28 Prince St., New York CONTENTS. COMMUNICATIONS Sepsis—with a Narration of a Few Inter- esting and Instructive Cases—by Rob- ert Peter, M. D., Canal Dover, O. . . . . . . 529–537 The Cause and Cure of Asthma and Kid- dred Diseases—by F. E. Young, M. D., Canton, O.......... ............ . . . . . . . . . 537–542 Constipation—Its Causes, Consequences and Treatment—by Geo. P. Sattler, M. D., Pavonia, O... .................... 542–547 Physio-Medicalism.—A Reply—by G. H. Mayhugh, M. D., Westerviile, Ó...... .547-550 New York Letter, on Orthopedic Sur- gery-Hip Joint Splints now in Use in the Various Hospitals—by Stewart L. Address; Some Points in the Syn1p- tomatology of General Paralysis of the Insane; The Pepsin Standard Advanc- ed; Pin Sensation in the Throat. . . . . . . 557–564 O BSTE TRICS – Gynecological Opera- tions, Catgut In; Pregnancy at the Age of Fifty-nine; One Thousand Cases of Labor Without a Death; Menstruation and Lactation: New Iodine Bottles: Menthol in Vomiting of Pregnancy ...564–568 SURGER Pi—Posture in the Reduction of Hernia; The Removal of the Crystal- 1ine Lens in High Degrees of Myopia .568-570 M’Curdy, M. D., Dennison, O .......... 550–556 A.D/7”OR/4/. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 571–572 SELECTIONS. D ºº::::::::::::: • e s s s e e º s p- MED/CINE–Lectures Versus Recitations BOOA NOT/CES. . . . . . . . . . . . . . . . . . . . . . . . . 573–576 in Medical Colleges: A Remarkable ADWERTISERS. Health Restorative Co.; New York. . . . . . . . . . . 1. Mariani & Co., New York . . . . . . . . . . . . . . . . . . . . 11 Rios Chemical Co., St. Louis, Mo... . . . . . . . . . . 2 H. K. Mulford & Co., Philadelphia. . . . . . . . . . . 12 Western Pennsylvania Medical College..... 2 Fellows, New York. . . . . . . . . . . . . . . . . . . . . . . . . . . 13 #"; Fehr, M. D., Hoboken, N. J. . . . . . . . . . . 3 The C1emiana Chem. Co., Atlanta, Ga. . . . . . . 14 : Keith & Co., New York. . . . . . . . . . . . . . . . . . . . 3 E. M. Hessler Surgical Instrum1ent Com- Sincinnati Sanitarium . . . . . . . . . . . . . . . . . . . . . . . 4. pany, Cleveland, O . . . . . . . . . . . . tº e º e º is e º e º 0 & ... 1 º: Antikamnia Chem. Co., St. Louis, Mo... 4 Cölumbus Medical Publishing Co. . . . . . . . . . . . 15 §: Qºlical Cº. New York. . . . . . . . . . . . . . . . . . 5 Renz & Henry, Louisville, Ky., . . . . . . . . . . . . . 15 #. McMunn's Elixir of Opium.............. 5 Theodore Metcalf Co., Boston . . . . . . . . . . . . . . . . 16 I º: Cole, Columbus, O....... : . . . . . . . . . . 5 Battle & Co., St. Louis, MO. . . . . . & © tº e º º v ... . . . 16 . O. Woodruff & Co., New York City ....... 6 Reed & Carnrick, New York . . . . . . . . . . . . . . . . . 17 The Corne11-Pheneger Chemical Company, Premium Lists for 1892 . . . . . . . . . . . . . ... 18–19—20. Tº"; O. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cl1arles Marchand, New York... 1st page cover he New York Pharm1acal Ass’n, N. Y. . . . . . S C. N. Crittenton, New York . . . . . .3d “ 6 & Lambert Pharmacal Co., St. Louis, Mo...... Q Parke, Davis & Co., Detroit ... . . 4th “ & G W. R. Warner & Co., Philadelphia .......... 10 Jolumbus 21iebical Yournal Baſitor—J. F. BALDw1N, M. D. Associate Editor—J. E. BROWN, M. D. Azusiness Manager—C. R. CORNELL. V O L U M E X. COLUMBUS, OHIO : COLUMBUS MEDICAL PUBLISHING CO, 1892, CONTENTS. PAGE Abortion, treatment of... . . . . . . . . . . . I 29 Abdominal wounds, ideal dressing. . 512 Abscess, to detect. . . . . . . . . . . . . . . . . . 89 A. C. E. Mixture . . . . . . . . . ... • * * * * * * * 97 Adenoids of naso-pharynx. . . . . . . . . . 6 Adipose, to reduce. . . . . . . . . . . . . . . . . 456 Adulteration . . . . . . . . . . . . . . . . . . Sept. 14 Advertising doctors . . . . . . . . . . . . . I6 I, 556 Age of Animals, Huidekoper. . . . . . . 383 Agnew D. Hayes, death of . . . . . . ... . . . 47 I Albuminuria and operations. . . . . . . . 367 Alcohol. . . . . . . . . . . . . . . . . . . . . . . . . . . . 487 ALLIS, O. H., problems in Surgery. . 49 Alopecia areata. . . . . . . . . . . . . . . . . . . . 4. I 5 Alteratives. . . . . . . . . . . . . . . . . . . . . . . . . 3 IO American Medical Association . . . . . . 57I Amputation, point of election . . . . . . . 50 Amylene hydrate. . . . . . . . . . . . . . . . . . . 2I4 Anatomy, Nancrede. . . . . . . . . . . . . . . . 24O Anatomy, Benning. . . . . . . . . . . . . . . . . 333 Anatomist, Leonard. . . . . . . . . . . . . . . . 239 Anesthetics in labor. . . . . . . . . . . . . . . . I93 Aneurism, tracheal tugging. . . . . . . . . 71 Angina pectoris. . . . . . . . . . . . . I7, 2I3, 272 after typhoid fever. . . . . . . . . . . . . 5OI Annals of ophthalmology. . . . . . . . . . . 475 Annals of Surgery. . . . . . . . . . . . . . . . . . 33O Annual of the Medical Sciences, Sa- OuS - . . . . . . . . . . . . . . . . . . . . . . . . . . . I89 Antikamnia... . . . . . . . . . . . . . . . . . . . . . . 27 Antipyretics, Ott. . . . . . . . . . . . . . . . . . . 46 Antisepsis for the hands. . . . . . . . . . . . 517 Antiseptic midwifery. . . . . . . . . . . . 277, 281 Anus, imperforate. . . . . . . . . . . . . . . . . . I36 Aortic regurgitation . . . . . . . . . . . . . . ... 166 Aortic valve, rupture by exertion. . . . 464 Aphorisms, pediatric. . . . . . . . . . . . . . . 226 Aphrodisiac . . . . . . . . . . . . . . . . . . . . . . . 75 Appeal to the medical profession. . . . 419 Appendicitis, chronic . . . . . . . . . . . . . . I54 in children . . . . . . . . . . . . . . . . . . . . 283 Appendix, early operation . . . . . . . . . . I34 Arkansas medical bill. . . . . . . . . . . . . . . 381 Arms, extraction of, in breech labor. 51 I Arsenic in skin diseases . . . . . . . . . . . . 276 Artificial drums. . . . . . . . . . . . . . & s • * * * 9I Ascites, explorative incision. . . . . . . . 373 Asparagus. . . . . . . . . . . . . . . . . . . . . . . . . . 4II Asthma. . . . . . . . . . . . . . . . . . . . . . 3, I?I, 537 Autopsies in America. . . . . . . . . . . . . . . II9 Bacſeriology, Ball. . . . . . . . . . . . . . . . . . 334 Bacteriological Diagnosis, Eisen - berg. . . . . . . . . . . . . . . . . . . . . . . . . . . PAGE BAKER, A. R., facts about Squint. . . 289 BALDWIN, J. F., pelvic dropsy. . . . . . I97 9 BALDY, J. M., chronic endometritis. 396 BARBER, T, L., cure of drunkenness. 62 Barker, Fordyce . . . . . . . . . . . . . . . . . . . 43 Barriers disappearing. . . . . . . . . . . . . . . 52 I Bartley test case . . . . . . . . . . . .* * * * * * * ~ * 474 Bauduy, Merz'ous ZXiseases. . . . . . . . . . 574 Beef juice. . . . . . . . . . . . . . . . . . . . . . . . . . 448 Bile in peritoneal cavity. . . . . . . . . . . . I3 I Binder in obstetrics . . . . . . . . . . . . . . . . 48I Births, report of to health office...95, 237 Bladder, rupture of. . . . . . . . . . . . . . . . . 368 BLISS, T. F., strange defect of vision. 3 Blood and fecal stains . . . . . . . . . . . . . . 75 Board of Health, report of births. .95, 237 6 Bone wiring . . . . . . . . . . . . . . . . . . . . . . . 4 I Boulton’s Solution . . . . . . . . . . . . . . . . . . I3 Bowditch, Henry I., death of . . . . . . . . 382 Bradycardia. . . . . . . . . . . . . . . . . . . . . . . 462 Brain, foreign bodies in . . . . . . . . . . . . . 518 Brain surgery. . . . . . . . . . . . . . . . . . . . . . 22O Brandy for infants. . . . . . ‘. . . . . . . . . . . . 284 Breast, amputation of . . . . . . . . . . . . . . 4O statistics . . . . . . . . . . . . . . . . . . . . . . . 222 cancer of . . . . . . . . . . . . . . . . . . . . . 284 cancer of, recurrence of... . . . . . . . 5I6 Breech presentation, extraction of a TIT1S . . . . . . . . , - - - - - - - - - • . . . . . . . . . 5II Bright’s disease . . . . . . . . . . . . . . . . . . . . 32O chronic. . . . . . . . . . . . . . . . . . . . . . . . 405 and operation . . . . . . . . . . . * - - - - - - 367 early symptoms. . . . . . . . . . . . . . . . 322 of pregnancy . . . . . . . . . . . . . . . . . . 5O9 protracted. . . . . . . . . . . . . . . . . . . ... 2O treatment. . . . . . . . . . . . . . . . . . . . . . 505 Bronchitis, chronic. . . . . . . . . . . . . . . . . 287 Bronzing. . . . . . . . . . . . . . . . . . . . . . July, I5 Butter, free use of. . . . . . . . . . . . . . . . . . I64 Cystotomy, supra-pubic . . . . . . . . . . . . 3I2 Cancer or ulcer of the stomach . . . ... 23 Cancer, Stite's test for . . . . . . . . . . . . . . 316 Cannabis indica. . . . . . . . . . . . . . . . . . . 274 Capital punishment, castration for... 459 Castration, effect of . . . . . . . . . . . . . . . . I26 Castration instead of capital punish- Iment 459 Cat Gut in gynecological operations. 564 Celluloid plates after trephining. . . . . . 92 * * * * * * * * * * * * * * * * * * * * * * * * * * Cerebral abscess. . . . . . . . . . . . . . . . . . . 53 Cerebral surgery. . . . . . . . . . . . . . . . . . . 22O Cervical glands, treatment of... . . . . . . 519 Cesarian section . . . . . . . . . . . . . . . . I3O, 37I ! s: : * : ‘. . 1 V CONTENTS, - PAGE PAGE Chancroids, origin of . . . . . . . . . . . . . . 4I7 Drainage in abdominal surgery. . . . . 228 “Childbirth made easy” . . . . . . . . . . ‘. . I28 || Dropsy, explorative incision . . . . . . . . 373 Childhood, headaches of . . . . . . . . . . . . 282 Drums, artificial. . . . . . . . . . . . . . . . - . . 91 Children, errors in treatment. . . . . . . 2O5 || Drunkenness, cure of. . . . . . . . . . . . . 62 Quinine to. . . . . . . . . . . . . . . . . . . . . I24 | Dublin joke. . . . . . . . . . . . . . . . . . . . . . . 496 Chinese, Coltman . . . . . . . . . . . . . . . . . . 526 Dysmenorrhea, peculiar case . . . . . . . 38 CHISHOLM, I. W. asthma, . . . . . . . . . . 3 || Aar, Roosa. . . . . . . . . . . . . . . . . . . . . . . . 336 Chloral is e = * g e s = e s = < * * * * * * * * * * * * * * * 2 I3 Edema of lungs s & e = < e < * * * * * * * * * * * * * I59 Chloralamid . . . . . . . . . . . . . . . . . . . . 3I, 2I4 Education, medical . . . . . . . . . . . . . . . . 269 Chloroform death. . . . . . . . . . . . . . . 96, 379 | Elbow Joint fracture. . . . . . . . . . . . . . . I79 in labor. . . . . . . . ., - - - - - - - - - - - II4, I93 Electricity, Beard and Rockwell . . . . 240 |Nitrite of Amyl. . . . . . . . . . . . . . . . 93 in gynecology.. . . . . . . . . . . . . . . . . I28 Pure . . . . . . . . ... e. g. s is e. e. e. e. e s e a tº a s “ 473 Stewart . . . . . . . . . . . . . . . . . . . . . . . 384 Vomiting * * * * g tº & & & e º is tº e º º ſº e º $ $ & 329 Embalming fluids . . . . . . . . . . . . . . . . . 43 I Cholera, Shakespeare. . . . . . . . . . . . . . 479 | Endometritis, chronic . . . . . . . . . . . . . . 396 Cholera Infantum . . . . . . . . . . . . . . . . . . 88 | Enema, nutritive. . . . . . . . . . . . . . . . . . . I69 Circumcision . . . . . . . . . . . . . . . . . . . . . . 3I5 Purgative • e < e < e < e < e s a e = e º 'º e < * * * I 23 Circumcision, Remondino. . . . . . . . . . 332 | Enuresis. . . . . . . . . . . . . . . . . . . . ... .277, 378 Climate for invalids. . . . . . . . . . . . . . . . 32I | Epididymitis . . . . . . . . . . . . . . . . . . . . 4 I? Cocaine, to administer. . . . . . . . . . . . . 223 Epilepsy, trephining. . . . . . . . . . . . . . . 317 Cocaine . . . . . . . . . . . . . . . . . . . . . . . . . . . 286 Epithelioma, to remove . . . . . . . . . . . . 467 Discs. e e º ºs º e º $ tº s tº - - - - - - - - - - - - - - I4O Ergot, uselessness of in intestinal * Coca . . . . . . . . . . . . . . . * g º & © tº e g º º s & ſº e tº 36I hemorrhage. . . . . . . . . . . . . . . . . . . . 465 Cod Liver Oil in consumption. . . . . . 4II | Erysipelas . . . . . . . . . . . . . . . . . . . . . . . . . 78 Coffee, to make . . . . . . . . . . . . . . . . . . . . I65 | Ether anesthesia. . . . . . . . . . . . . . . . . . 47O Cold in the head. . . . . . . . . . . 74, 166, 324 || Examination for insurance. . . . . . . . .... I45 CoLEMAN, N. R., Appeal to the Explorative incision in dropsy. . . . . . 373 Medical prosession . . . . . a s g g g g º ºs 4I9. | Fat, to reduce. . . . . . . . 'e , s , , a e < * * * * * 456 College convention. . . . . . . . . . . . . . . . . 326 Fecal and blood stains. . . . . . . . . . . . . . 75. Colles's Fracture. . . . . . . . . . . . . . . . . . . I36 | Fees, basis of... . . . . . . . . . . . . . . . . . . . . II 7 Colotomy. . . . . . . . . . . . . . . . . . . . . . . . . . 4I4 | Felons. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217 Columbus Medical College . . . . . . . . . 4I9 | Femur, fracture, results. . . . . . . . . . . . 26 I Common sense in Medicine. . . . . . . . . 38O fracture of, in old people. . . . . . . . 51 Compensation, basis of. . . . . . . . . . . . . II7 | Fenwick, Diagnosis. . . . . . . . . . . . . . . . 573 Constipation. . . . . . . . . . . . . . . . . . . . . . . 542 | Fever, Hare. . . . . . . . . . . . . . . . . . . . . . . . 46 infantile. . . . . . . . . . . . . . . . . . . . . . . 209 | Fissured nipple. . . . . . . . . . . . . . . . . . . . 276 treatment . . . . . . . . . . . . . . . . . . . . . 27I | Fluids with meals. . . . . . . . . . . . . . . . . . 3I9 Consumption, arrest of. . . . . . . . . . . . , 594 | Forceps, to apply. . . . . . . . . . . . . . . . . . . 227 Davis. . . . . . . . . . . . . . . s = • * * * * * * * * 480 . Fortnightly M. D. . . . . . . . . . . ". . . . . . . . I92 Incipient. . . . . . . . . . . . . . . . . . . . . . 357 | Fracture of leg, non-union . . . . . . . . . 52 Contagion, source of. . . . . . . . . . . . . . . 337 | Frank Leslie. . . . . . . . . . . . . . . . . . . . . . . 33ſ Corpulency, sudden death. . . . . . . . . . I2O | Freckles. . . . . . . . . . . . . . . . . . . . . . . . . . . 448 Cough of consumption. . . . . . . . . . . . . 407 | Free dispensary. . . . . . . . . . . . . . . . . . . . 287 Country Doctor, King . . . . . . . . . . . . . I44 Free trade. . . . . . . . '• • - - - - - - - - - - - - - - - I4 I Creasote in consumption . . . . . . . . . . . 4II | Functions of the kidneys. . . . . . . . . . . 49 I Crude petroleum . . . . . . . . . . . . . . . . . . . 288 || Gailey, C. P. . . . . . . . . . . . . . . . . . . . . . . 43O Crossland, J. C., Keeley Cure. . . . . . . 35I Gall stones. . . . . . . . . . . . . . . . . . . . . . . . . II5 Crystal coating. . . . . . . . . . . . . . . . . Aug., I5 | Sweet oil . . . . . . . . . . . . . . . . . . . . . . . . . . I88 Curative effect of operation . . . . . . . . . 172 | Gangrene, senile. . . . . . . . . . . . . . . . . . . 3I5 Cystitis. . . . . . . . . . . . . . . . . . . . . . . . 255, 4TI | Gastric ulcer. . . . . . . . . . . . . . . . . . . . . . . I71 Cystocele, operation • e º e o e s is e º 'º e o 'º e I8I Gauze, absorbent, instead of Sponge. 468 Dermoid Cysts. . . . . . . . . . . . . . . . . . . . . 5Io General paralysis of the insane. . . . . . 56I Detection of fecal stains. . . . . . . . . . . . 75 | Glands cervical, treatment of... . . . . . 5I9 Aiagnosis, Vierordt * * * g e º e º e < * * * * * * I89 GOFF, E. L, phymosis • * * * e º a s e tº $ tº º & IO6 Diarrhea, infantile. . . . . . . . . . . . . . . . . 207 | Goitre . . . . . . . . . . . . . . . . . . . . . . . . ... 74, 3I9 Dictionary, Funk and Wagnall’s. . . . I39 Gonorrhea, fatality of. . . . . . . ... July, I5 Diphtheria, local treatment. . . . . II6, 2I2 Gonorrheal ophthalmia. . . . . . . . . . . . . 329 Diploma, to smooth. . . . . . . . . . . July, 15 Grave's Printed Index. . . . . . . . . . . . . . 33O Doctors, young, advice to. . . . . . . . . . I6o Gymnastics, Nizzen. . . . . . . . . . . . . . . . 383 Dollar, silver, esophagotomy for. . . . 469 Gynecology, Grandin . . . . . . . . . . . . . . . . 45 Doses, small. . . . . . . . . . . . . . . . . . . . . . . I2I Pozzi. . . . . . . . . . . . . . . . . . . . . . . . . . 527 CoNTENTs. . V. •PAGE Gynecological operations. . . . . . . . . . . 564 Hammond, castration . . . . . . . . . . . . . . 459 Hands, autisepsis for. . . . . . . . . . . . . . . 5 I? HAvRNs, W. B., binder in obstetrics. 481 Head, cold in . . . . . . . . . . . . . . . . 74, I66, 324 Headaches in children . . . . . . . . . . . . . . 282 Headaches, treatment . . . . . . . . . . . . . . 355 Heart murmurs . . . . . . . . . . . . . . . . . . . . 463 Hegar’s sign. . . . . . . . . . . . . . . . . . . . . . . 450 Hemorrhage surgically treated. . . . . . 466 Hemorrhoids . . . . . . . . . . . . . . . . . . . ‘. . . 3 I 7 HENDRIXON,. HUGH, anesthetics in labor. . . . . . . . . . . . . . . . . . . . . . . . . . 193 Hernia in children, trusses . . . . . . . . . 8O Hernia, posture in . . . . . . . . . . . . . . . . . . 568 § radical operation... . . . . . . . . . . 56, 94 Hewitt, death of . . . . . . . . . . . . . . . . . . . I 4O Hiccough. . . . . . . . . . . . . . . . . . . . . . 458, 506 case of. . . . . . . . . . . . .. . . . . . . . . . . . . . 4OO High temperatures. . . . . . . . . . . . . . . . . 23.I HINER, S. B., puerperal fever. . . . . . . 245 Hip disease. . . . . . . . . . . . . . . . . . . . . . . . 385 Hippocrates, Adams. . . . . . . . . . . . . . . . I9 I Hodgkin’s disease. . . . . . . . . . . . . . . . . . 2I5 Hoff's Malt Extract. . . . . . . . . . . . . . . . 72 Homeopaths. . . . . . . . . . . . . . . . . . . . . . . 236 Howe, A. J., death of... . . . . . . . . . . . . . 33O How ELL, C. A., orificial surgery. . . . .342 Pſydriatic Treatment, Sihler. . . . . . . 526 Hydro-salpinx. . . . . . . . . . . . . . . . . . . . . 82 Hydrocele . . . . . . . . . . . . . . . . . . . . . . . . . 52O Hyoscine . . . . . . . . . . . . . . . . . . . . . . . . . . 2I4 A/ypodermic Medication, Bartholow. 33 Hysterectomy. . . . . . . . . . . . . . . . . . . . . 86 Hysterical joints. . . . . . . . . . . . . . . . . . . 354 Ideal dressing for wounds. . . . . . . . . . 5I2 Incipient consumption . . . . . . . . . . . . . 357 Incontinence of tirine. . . . . . . . . . . 277, 378 Indianapolis, chloroform death at... 379 Infant feeding. . . . . . . . . . . . . . . . . . . . . . 2O5 Infantile constipation . . . . . . . . . . . . . . 2O9 Influenza, prevention and treatment. 410 prophylactic against. . . . . . . . . . . . 360 Injections, hot, for colic. . . . . . . . . . . . 39 purgative. . . . . . . . . . . . . . . . . . . . . . I23 Insane, general paralysis of . . . . . . . . 56I Ansomnia, Macfarland. . . . . . . . . . . . . . I44 Anternational Clinics. . . . . . . . . . . . . . . 45 International Medical Annual. . . . . . . 327 Intestinal perforation in typhoid fever . . . . . . . . . . . . . . . . . . . . . . . . . . 3I3 Intubation, tube worn 40 days. . . . . . I Intubation . . . . . . . . . . . . . . . . . . . . . . . . . 252 Intussusception . . . . . . . . . . . . . . . . . . . . I32 Invalids, sending away from home. .. 321 Iodine bottles. . . . . . . . . . . . . . . . . . . . . . 568 Iodide in diagnosis of consumption.. I2I Iron, how to administer. . . . . . . . . . . . . 463 Itch . . . . . . . . . . . . . . . . . . . . . , ºn e º gº & G & © e 507 Jack the Ripper. . . . . . . . . . . . . . . . . . . . 75 Jefferson Medical College. . . . . . . . . . . 473 - * PAGE Johnston, Christopher, death of. . . . . 238 Journal of Medical Philosophy and Practice . . . . . . . . . . . . . . . . . . . . . . . 523 Keeley Cure. . . . . . . . . . 351, 325, 471, 464 Kellar, Dr. George . . . . . . . . . . . . . . . . . 572 Kentucky Medical Law. . . . . . . . . . . . ... 43 Keratitis. . . . . . . . . . . . . . . . . . . . . . . . . . 299 KINKEAD, W. W., small doses . . . . . 3O9 Kidneys position of . . . . . . . . . . . . . . . 467 RINSMAN, D. N., uremia . . . . . . . . . . . 49 I KLEIN, C. H. VON, nasal reflexes. . . 44 I Koch and the code. . . . . ' - - - - - - - - - - - 73 Lactation and menstruation . . . . . . . . Laparotomy statistics. . . . . . . . . . . . . . LARIMORE, F. G. , hernia. . . . . . . . . . . 56 Lectures vs. recitations. . . . . . . . . . . . 557 Leprosy, contagiousness of . . . . . . . . . 475 in Minnesota . . . . . . . . . . . . . . . . . . 475 non-contagiousness of . . . . . . . . . 462 Leucorrhea . . . . . . . . . . * - - - - - - - - - - - - - 75 Life insurance examinations. . . . . . . . I45 and syphilis . . . . . . . . . . . . . . . . . . . 2I6 Ligatures ... . . . . . . . . . . . . . . . . . . . . . . . 5 I Liver, pus of . . . . . . . . . . . . . . . . . . . . . . 222 Lochial discharge, fetor of . . . . . . . . . 372 Locomotor atax1a. . . . . . . . . . . . . . . . . . 74 Low grade schools. . . . . . . . . . . . . . . . . I4O Lusk, Z/?dzwifery . . . . . . . . . . . . . . . . . . 573 Mademoiselle Giraud, Belot. . . . . . . . I92 Malpractice. . . . . . . . . . . . . . . . . . . . . . . . 2O4. Maltine . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Materia Medica, Leonard . . . . . . . . . . 48 Shoemaker . . . . . . . . . . . . . . . . . . . . MAYHUGH, G. H., Physio-Medical- 1Sin . . . . . . . . . . . . . . . . . . . . . . . . . . . 547 McBride-Packard yoke. . . . . . . . . & . . . 523 MCCURDY, S. L., case of intubation. I intubation . . . . . . . . . . . . . . . . . . . . . 252 New York Letter . . . . . . . . . . . . . . 497 Orthopedic surgery . . . . . . • s we & tº gº 55O spinal supports . . . . . . . . . . . . . . . . IO8 McMillen, J. W., death of. . . . . . . . . . I42 Meals, water with . . . . . . . . . . . . . . . . . . 3I9 Medical education. . . . . . . . . . . . . . 269, 433 Medical monographs. . . . . . . . . . . . . . . 335 Medical Physics, Brockway. . . . . . . . . 384 Medical AWezes, and digraphs. . . . . . . 472 Medical society, membership in....77, 79 Medical union . . . . . . . . . . . . . . . 77, 79, 559 Medicine, º::::::::::::::7: 79. : Meningitis, diagnosis. . . . . . . . . . . . . . . I34 Menstruation, effect of . . . . . . . . . . . . . I37 in high altitudes. . . . . . . . . . . . . . . 87 and lactation . . . . . . . . . . . . . . . . . : 567 Menthol in vomiting. . . . . . . . . . . . . . . 568 MERZ, C. H., life insurance examina- tione . . . . . . . . . . . . . . . . . . . . . . . . . . I45 Source of contagion . . . . . . . . . . . . 337 Microscopists, American society. . . . 44. Midwifery, antiseptic. . . . . . . . . . .277, 281 hypothetical case. . . . . . . . . . . . . . 6o V1 CoNTENTs. PAGE Midwifery, things to unlearn . . . . . . . 65 Milk sickness. . . . . . . . . . . . . . . . . . . . . . 35 Missionary, dishearterled. . . . . . . . . . . 448 Mistress same as wife . . . . . . . . . . . . .‘. 556 Mixed Narcosis. . . . . . . . . . . . . . . . . . . . 515 M'PGEE, pulmonary edema. . . . . . . . . . I59 Modern medicaments . . . . . . . . . . . . . . 472 Morphia. . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I 3 Muscae Volitantes . . . . . . . . . . . . . . . . . . I 6 “My Faculty ". . . . . . . . . . . . . . . . . . . . . 47 I Myopia, removal of lens in . . . . . . . . . 569 Nasal reflexes. . . . . . . . . . . . . . . . . . . . . . 44 I Nephritis, chronic. . . . . . . . . . . . . . . . . . 4O5 Nephritic colic . . . . . . . . . . . . . . . . . . . . 35 AVerzozºs /Xiseases, Shaw. . . . . . . . . . . . 333 AWezey Fºngland Monthly. . . . . . . . . . . . I 92 New York Medical Law. . . . . . . . . . . . I22 Night terrors . . . . . . . . . . . . . . . . . . . . . . 2 IO Nipple, fissured. . . . . . . . . . . . . . . . . . . . 276 Nitrite of Amy1 in chloroform . . . . . . 93 Non-union fractures. . . . . . . . . . . . . . . . 52 Nusbaum's Narcosis. . . . . . . . . . . . . . . . 5IS Nutmeg poisoning. . . . . . . . . . . . . . . . . 284 Nutritive enema . . . . . . . . . . . . . . . . . . . -I69 Obsolescence of medical terms. . . . . 4O6 Obstetrics, things to unlearn . . . . . . . . 35 Obstetrical Lectures, Morris. . . . . . . . I43 Ohio Medical University. . . . . . . . . . . 528 State Medical Society. . . . . . . . . . 4 I State University. . . . . . . . . . . . . . . 237 One thousand cases of labor . . . . . . . . 566 Operation, curative effect. . . . . . . . . . . I72 and shock. . . . . . .* * * * * * * * * * * * * ~ * 49 Orificial surgery . . . . . . . . . . . . . . . . . . . 342 Orthopedic surgery . . . . . . . . . . . . 497, 550 Ovarianº cysts, mammoth. . . . . . . . . . 28I Sclerosis. . . . . . . . . . . . . . . . . . . . . . . . . . 338 Ovariotomy, effect Of... . . . . . . . . . . . . . I26 Painless parturition. . . . . . . . . . . . . . . . 228 Pan-American congress. . . . . . . . . . . . 43O Paraldehyde. . . . . . . . . . . . . . . . . . . . . . . 2I4. Parsnip poisoning. . . . . . . . . . . . . . . . . . I38 Parturient woman, supervision of... 295 Passive motion. . . . . . . . . . . . . . . . . . . . . I79 Pathology, extraordinary. . . . . . . . . . . 472 Pediatric aphorisms. . . . . . . . . . . . . . . . 226 Drainage. . . . . . . . . . . . . . . . . . . . . . . . 24I Dropsy . . . . . . . . . . . . . . . . . . . . . . . . I97, 288 Pepsin standard. . . . . . . . . . . . . . . . . . . . 564 Perityphlitis in children. . . . . . . . . . . . 283 Peritonitis, cocaine in . . . . . . . . . . . . . . 4 I? PERKINs, C. E., Adenoids of phar- ynx . . . . . . . . . . . . . . . . . . . . . . . . . . . Perplexing singultus. . . . . . . . . . . . . . . 4OO PETER, ROBERT, relation of impair- ment, &c. . . . . . . . . . . . . . . . . . . . . . 2OO Sepsis. . . . . . . . . . . . . . . . . . . . .. . . . . 529 Singultus. . . . . . - - - - - - - - - - - - - - - - 4OO Phymosis . . . . . . . . . . . . . . . . . . . . . . . . . IO6 Physician as a business man, Taylor. 335 Physicians and Surgeons of the tº PAGE (V. S. . . . . . . . . . . . . . . . . . . . . . . . . . . 431 A hysiology, Foster. . . . . . . . . . . . . . . . . 334 Physiological salt solution. . . . . . . . . . 186 Physio-medicalism . . . . . . . . . . . . . 476, 547 Pie-plant and hematuria. . . . . . . . . . . . 507 Piles. . . . . . . . . . . . . . . . . . . . . . . . . . . . 35, 3I7 Pilocarpine in pneumonia. . . . . . . . . . I 68 Pin sensation in throat. . . . . . . . . . . . . 564 Plain talk to physicians. . . . . . . . . . . . 503 Pneumonia, diagnosis in infancy. . . . 506 pilocarpine . . . . . . . . . . . . . . . . . . . . I68 treatment of . . . . . . . . . . . . . . . . . . . I63 Pocket Formulary, Wilson... . . . . . . . . 528 Popular ScienceMonthly. I90,331,383, 574 Porro’s operation . . . . . . . . . . . . . ... . 37 I Possible source of contagion . . . . . . . . 337 Potter, F. H., death of . . . . . . . . . . . . . I42 Pott’s disease, diagnosis. . . . . . . . . . . . 2 I 8 Pozzi, Surgical Gynecology . . . . . . . . 574 Pregnancy, Bright’s Disease. . . . . . . . 509 Powder for children . . . . . . . . . . . . . . . . 378 Pregnancy at 59 . . . . . . . . . . . . . . . . . . . 566 early symptoms of . . . . . . . . . . . . . 449 prolonged . . . . . . . . . . . . . . . . . . . . . 127 after ventral fixation of womb. . . 224 vomiting of. . . . . . . . . . . . . . . . . . . . . 37O Probe, abuse of... . . . . . . . . . . . . . . . . 32 Prostate, enlarged . . . . . . . . . . . . . . . . . 4I2 Protection or free trade. . . . . . . . . . . . . I4I Pruritus . . . . . . . . . . . . . . . . . . . . . . . I7I, 52O Puerperal fever. . . . . . . . . . . . . . . . . . . . 245 Pulmonary edema. . . . . . . . . . . . . . . . . . I59 Pulse, infrequent. . . . . . . . . * * * * * * * * * * * 462 Purse string operation for cystocele... 181 Pus in abscess of liver. . . . . . . . . . . . . . 222 Pyogenesis and sepsis. . . . . . . . . . . . . . 2OO Pyo-salpinx . . . . . . . . . . . - - - - - - - - - - - - 82 Quacks. . . . . . . . . . . . . . . . . . . . . . . . I61, 556 Quinine to children. . . . . . . . . . . , - - - - - I24 Quiz-compends... . . . . . . . . . . . . . . . 96, 196 Recitations vs. lectures. . . . . . . . . . . . 557 Recto-vaginal fistula, closure... . . . . . 230 A'ectum, Kelsey. . . . . . . . . . . . . . . . . . . . 48O REED, R. Harvey, appendicitis... . . . I54 medical education. . . . . . . . . . . . . . 433 REEVE, J. C., mixed narcosis. . . . . . . 5I5 A. C. E., mixture. . . . . . . . . . . . . . 97 pelvic dropsy. . . . . . . . . . . . . . . . . . 288 Reeves, James E. . . . . . . . . . . . . . . . . . . 187 chronic bronchitis. . . . . . . . . . . . . . 287 Reflexes from nasal diseases. . . . . . . . 44 I “Regular” defined . . . . . . . . . . . . . . . . . 524 Regurgitation, aortic. . . . . . . . . . . . . . . I66 Relapse, religious. . . . . . . . . . . . . . . . . . 448 Relations of impairment of tissue, &c 200 Remarkable address. . . . . . . . . . . . . . . . 559 Removal of lens in myopia. . . . . . . . . 569 Reports of births. . . . . . . . . . . . . . . . 95, 237 Retroflexion. . . . . . . . . . . . . . . . . . . . . . . 279 Rheumatic arthritis . . . . . . . . . . . . . . . . 507 RHU, AUGUSTE, Keratitis. . . . . . . . . . . 299 CONTENTS. V11 - PAGE PAGE Ribs, resection in abscess. . . . . . . . . . . 55 | Thigh, cancer of . . . . . . . . . . . . . . . . . . . 92 Rickets. . . . . . . . . * e e º e s tº a e º 'º e º e º e s e a e 2 II | Thumb, luxations of . . . . . . . . . . . . . . . 47O RIDENOUR, A. W., death of . . . . . . . . . 238 || Tobacco and health. . . . . . t • * * * * * * * , 167 fracture of spine. . . . . . . . . . . . . . . . I5I Toilet powder . . . . . . . . . . . . . . . . . . . . . 37 I Roberts, remarkable address. . . . . . . . 559 || Tongue, excision of, , . . . . . . . . . . . . . . .318 ROSENBERRY, H. L., angina pectoris 501 || Tonsilitis. . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Rush's advice to doctors. . . . . . . . . . . . I60 || Tonsils, enlarged, by ignipuncture, 30 Rush monument . . . . . . . . . . . . . . . . .. . . I85 || Torsion of arteries... . . . . . . . . . . . . . . . 369 Salicyl-bromanilid. . . . . . . . . . . . . . . . . . 25 || Township trustees . . . . . . . . . . . . . . . . . 285 Sanctity of the person. . . . . . . . . . . . . . 42 | Tracheal tugging in aneurism. . . . . . . 71 Sarcoma of thigh. . . . . . . . . . . . . . . . . . . 92 | Transfusion, salt solution. . . . . . . . . . . I86 SATTLER, GEORGE P., case of mid- Transplantation . . . . . . . . . . . . . . . . . , 28 wifery. . . . . . . . . . . . . . . . . . . . . . . . . 60 | Trephining for epilepsy. . . . . . . . . . . . 3I7 constipation. . . . . . . . . . . . . . . . . . . . 542 | Truax & Co. . . . . . . . . . . . . . . . . . . . . . . . 474 Saunders' announcement. . . . . . . . . . . 328 Trusses for children . . . . . . . . . . . . . . . . 8O Compends. . . . . . . . . . . . . . . . . . . . ... 239 Tubercular joints, iodoform in . . . . . . 467 Formulary. . . . . . . . . . . . . . . . . . . . . 480 Tumors of the scalp. . . . . . . . . . . . . . . . . 369 Scanzoni, death of. . . . . . . . . . . . . . . . . . I42 | Two-year colleges. . . . . . . . . . . . . . . . . . 523 Scarlatina . . . . . . . . . . . . . . . . . . Io, 305, 361 | Typhoid fever, intestinal perforation 313 Schools of medicine . . . . . . . . . . . . . . . 52I Typhoid ſever, Sihler. . . . . . . . . . . . . . 526 Sciatica. . . . . . . . . . . . . . . . . . . . . . . . . . . . 362 | Ulcer of stomach. . . . . . . . . . . . . . . . . . . 17 I Scientific American . . . . . . . . . . . . . . . . 331 | Ulcer or cancer of stomach, diagno- Sepsis. . . . . . . ". . . . . . . . . . . . . . . . . . . . . , 529 sis . . . . . . . . * * * * * * * * * * g e - * * * * * * * 23 Sexual frigidity . . . . . . . . . . . . . . . . . . . . 75 | Ulcers, varicose. . . . . . . . . . . . . . . . . . . . 368 perversion . . . . . . . . . . . . . . . . . . . . . 508 Uremia. . . . . . . . . . . . . . . . . . . . . . . . . ... . . 491 Shock, operation during. . . . . . . . . . . . 49 blood letting. . . . . . . . . . . . . . . . . . . 376 Shurly–Gibbes formula . . . . . . . . . . . . 7 I treatment . . . . . * - - - - - - - - - - - - - - , 3 I7 SILVER, D. R., the parturient woman 295 | Urine, incontinence of. . . . . . . . . .378, 277 Small doses . . . . . . . . . . . . . . . . . . . . 121, 309 | Ureters injured during labor. . . . . . . . I25 Spinal supports. . . . . . . . . . . . . . . . . . . . Io8 || Urethral caruncle. . . . . . . . . . . . . . . . . . 377 disease, diagnosis . . . . . . . . . . . . ... 218 Urethrotomy . . . . . . . . . . . . . . . . . . . . . . 364 Spine, dislocation and operation . . . . I5I Uterine hemorrhage, plugging cer- Squint. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289 vix. . . . . . . . . . . . . . . . . . . . . . . . . . . . 229 STAMM, M., pelvic drainage. . . . . . . . 24I | Uterus, tamponade. . . . . . . . . . . . . . . . . 5I3 State Board of Examiners. . .286, 429, 432 || Uterus, ventral fixation, pregnancy. 224 Statistics, laparotomy. . . . . . . . . . . . . . I27 | Vaccination . . . . . . . . . . . . . . . . . . . . . . . I23 Steno's duct, fistula. . . . . . . . . . . . . . . . 90 || Vanderburg, C. R., death of... . . . . . 478 Sterility. . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 || Varicose ulcers. . . . . . . * * * - - - - e - - - - e. 368 . peculiar case. . . . . . . . . . . . . . . . . . . 38 || Vas deferens, how to proceed when Strabismus. . . . . . . . . . . . . . . . . . . . . . . . . 289 cut. . . . . . . . . . . . . . . . . . . . . . . . . . 53 Stricture, treatment of. . . . . . . . . . . . . . 362 Ventral fixation of womb, pregnancy 224 Strontium . . . . . . . . . . . . . . . . . . . . . . . . . 572 | Vick's Floral Guide. . . . . . . . . . . . . . . . 384 Substitution . . . . . . . . . . . . . . . . . . . . . . . . 268 Viuolia soap . . . . . . . . . . . . . . . . . . . . . . . 38I Sulphonal . . . . . . . . . . . . . . . . . . . . . . . . . 2I4 || Vision dependent on both eyes. . . . . 3 Supervision of parturient woman. ... 295 || Vitalized air, death from . . . . . . . . . . . 328 Supra-pubic cystotomy. . . . . . . . . . . . . 312 Vomiting of pregnancy. . . . . . . . . . . . . 370 Supreme Court decision. . . . . . . . . . . . 42 WALKER, A. B., alcohol. . . . . . . . . . . . 487 Surgery, problems in . . . . . . . . . . . . . . . 49 Warts . . . . . . . . . . . . . . . . . . . . . . . . . I35, IZO Sykes, R. D., milk sickness. . . . . . . . . 65 Weaning of infants. . . . . . . . . . * * * * * * 2O5 Symbolism, Sozinskey. . . . . . . . . . . . . . 46 Wells of Scalp. . . . . . . . . . . . . . . . . . . . . 369 Syphilis, fatality of . . . . . . . . . . . . July, I5 West Virginia resolutions. . . . . . . . . . 473 w premature treatment . . . . . . . . . . . I78 WIRT, WM. E., hip disease. . . . . . . . . . 385 and life insurance. . . . . . . . . . . . . . 216 || WISE, S. P., malpractice suit. . . . . . . 287 Tamponade of the uterus. . . . . . . . . . . 513 || Wood’s Monograph . . . .47, 143, 190, 480 Tan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 448 || Worms. . . . . . . . . . . . . . . . . . . . . . . . . . . . I7I Tariff, the . . . . . . . . . . . . . . . . . . . . . . . . . 138 Wounds of intestimes, Martin . . . . . . . I43 Temperatures, high. . . . . . . . . . . . . . . . 231 Yankee medical student. . . . . . . . . . . . 43 Tendo Achillis, suture. . . . . . . . . . . . . . 2O4 || YOUNG, F. E., asthma. . . . . . . . . . . . . 537 Texas University. . . . . . . . . . . . . . . . . . . I4I | Youth and age. . . . . . . . . . . . . . . . . . . . . II 4 Thacker, J. A., death of. . . . . . . . . . . . 330 | Youth's Companion ... . . . . . . . . . . . . . 237 Therapeutics, Wood. . . . . . . . . . . . . . . . 239 ZENNER, paralysis of insane... . . . . . 56 I l This WINE OF COCA is so prepared that it contains the active principle of the leaves in a perfectly pure form. Q - Moreover it is absolutely free from all those foreign sub- C to rativ C stances which all other wines of coca contain, and which interfere, to a great extent, with its curative influence. It is well known that the cocaine contained in the coca-leaves varies considerably in its proportion; hence, giving to the wines as ordinarily made, uncertain strength, and causing 0. them to be unreliable in their action on the system. In the Wi C of oca RESTORATIVE WINE OF COCA the proportion of T] alkaloid is invariable, and the physician can therefore pre- ſ scribe it with the certainty of obtaining uniform results. Ps of W.M. A. HAMMOND., M. D. says: A wineglassful of this tonic, taken when one is exhausted — FOR — and worn out, acts as a most excellent restorative ; it gives. . - a feeling of rest and relief, and there is no reaction Nervous Prostrat ion, Brain Exhaus- and no subsequent depression. ... A general feeling of \ 4 s e pleasantness is the result. I have discarded tion, Neurasthenia and all forms flººr xilies **** ** TISGe º: ºº:: tº weia. hil it t produces also excellent results in cases of depression o of Mental and Physical I){ bility. spirits; in hysteria, headache, and in nervous troubles - generally, it works admirably. It is a simple remedy, yet efficacious and remarkable in its results. He ONLY COMPLETE annovaETIG-water A *BSA" THE BUSTAINS THE #. An pyrº THE MA REDUCES tºut is bººt # * 35 pºt - *V. EVER % a. YºA , º, A RE5 ſt §§ INVALUABLE IN MALARIAL DISEAEEE. º. APOSITIVE REMEDY FOR NEURALGIA ANDRHEMATSN/ SProf. W.M. F. WAUGH, MI. D., of Philadelphia, writes: In a case of persistent neuralgic headache, worse on awakening, with a possibility of malaria, “Febricide” gave instant relief. -- * * BUFFALo, N. Y., February 13, 1890. I have duly prescribed the FEBRICIDE PILLS all through eur Epidemic. 6 Influenza and Pneumonia, with capital results. S. W. WETMORE, M. D. - SPRINGVIEW, NEB., November 25, 1889. I have used your FEBRICIDE with excellent results in our Mountain Fevers (typhoid), reducing, in one case, the temperature from 104% with dry, brown furried tongue in ten hours, to 99% with tougue cleaning promptly and moist, and rapid fººt ating therefrom. Have used Antipyrin in similar cases with no good results. ALBERT S. WARNER, M. D. FEBRICIDE IN PNEUMONIA. º.º.º.º. ricide Pills (one being 3. every four hours, as a rule), and with hot poultices externally : - mitted. Crisis. - Admitted. “ Crisis. William Johnson, . . . . . . June 1, 1889, June 8, 1889 Belle Smith . . . . . . . . . . . . Jan. 8, 1890, Jan. 12, 1890 Fanny Winnery ....... Dec. 19, 1889, Jan. 4, 1890 Wm. Payne . . . . . . . . . . . . Jan. 2, 1890, Jan. 5, 1890 Wm. M. Johnson. . . . . . . Dec. 30, 1889, Jan. 5, 1890 Gustav Thoman . . . . . . . . Jan. 21, 1890, Jan. 23, 1890 All ended in recovery. These are all the cases of croupous or lobar pneumonia treated in the hospital during the influenza epidemic excepting or e case, which was admitted in a moribund condition, and died before any treatment could be instituted. One case, which was apparently moribund when admitted, is included in the above list, and is at present recovering from an attack Of femoral phlebitis. JOHN A. RAYBURN, M. D., Resident Physician. —Phila. Times and Register, Feb. 17. 1890. - Samples sent free of charge to any physician who mentions this JOURNAL. FIES ALTII RESTORATIVE CO. so south Fifth Aveuue, NEw York. UTERINE TONIC, ANTISPASMODIG AND ANODYNE. A reliable and trustworthy remedy for the relief of Dysmenorahoea, Amenorrhoea, Menorrhagia, Leucorrhoea, Subinvolution, THREATENED ABORTION, Vomiting in Pregnancy and Chlorosis; directing its action to the entire uterine system as a general tonic and antispasmodic. ForULA:—Every ounce contains 3-4 dram each of the fluid extracts: Viburnum Prunifolium, Viburnum Opulus, Dioscorea Villosa, Aletris Farinosa, Helonias Dioica, Mitchella Repens, Caulo- phyllum Thalictroides, Scutellaria Lateriflora. spoonful three times a day, after meals. given every hour or two, ALWAYS IN HOT WATER. Dos E:—For adults, a desertspoonful to a table- In urgent cases, where there is much pain, dose may be Jno. B. Johnson, M.D., Professor of the Princi- §: and Practice of Medicine, St. Louis edical College. St. Louis, June 20, 1888. I very cheerfully give my testimony to the virtues of a combination of vegetable remedies prepared by a well known and able pharma- cist of this city, and known as DIOVIBUR- N1A, the component parts of which are, Well known to any and all physicians who desire to know the same, and,therefore, have no rela- tion to proprietary or quack remedies. I have employed this medicine in cases of dysmenor- rhoea, suppression of the catemania and in excessive leucorrhoea, and have been much pleased with its use. J do not think its claims (as set forth in the circular accompanying: it) to be at all excessive. I recommend its trial to all who are willing to trust to its efficacy, be- lieving it will give satisfaction. Respectfully. L. Ch. Boisliniere, M. D., Professor of Obstet- rics, St. Louis Medical College. St. Louis, June 18, 1888. I have given DIOVIBURNIA a fair tral, and found it useful as an uterine tonic and anti- spasmodic, relieving the pains of dysmenor- rhoea, and regulator Of the uterine functions. I feel authorized to give this recommendation of DIOVIBURNIA, as it is neither a patented nor a secret medicine, the formula of which having been communicated freely to the medi- cal profession. * ca. Z3ors/n , et a hºo. H. Tuholske, M. D., Professor Clinical Surgery and Surgical Pathology, Missouri Medical College ; , also Post-Gradutate School of St. Louis. ; St. Louis, June 23, 1888. I have used DIOVIBURNIA quite a num- ber of times—sufficiently frequently to satisfy myself of its merits. It is of unquestionable benefit in painful dysmenorrhoea ; it possesses antispasmodic properties, which seem especi- ally to be exerted on the uterus. " A’z A. Z.A.-4-6. To any physician unacquainted with the medicinal effect of DIOVIBURN IA, and Who will pay express charges, we will send on application a bottle free. - Dios chemicAL co., ST. Louis, Mo. westERN PENNSYLVANIA MEDICAL COLLEGE, cITY of PITTSBURGH. SESSIONS OF 1891–92. The REGULAR SESSION begins on the last Tuesday of September and continues six months. During this Session, in addition to four Didactic Lectures, two or three hours are daily allotted to Clinical Instructions. Attendance upon three Regular Courses of Lectures is requisite for graduation. A three years’ graded Course is provided. - The SPRING SESSION embraces Recitations, Clinical Lectures and Exercises, and Didactic Lectures on special subjects. tea weeks. This Session begins the Second Tuesday in April, and continues * The LABoratorTEs are open during the Collegiate Year for instructions in Chemistry, Microscopy, Practical Demonstrations in Medical and Surgical Pathology and Lessons in Normal Histology. Special importance attaches to the Superior Clinical Advantages possessed by this College. For particulars see Annual Announcement and Catalogue, for which, address the Secretary PROF. T. W. T. McKENNAN, 810 Penn Avenue. of Faculty, , Business correspondence should be addressed to PROF. W. J. ASDALE, 2107 Penn Avenue, Pittsburgh, Pa. 3 º §§ º ſ Dr. JULIUS FEHR's eº; s “Compound Taicum” ºl --- * ºś ####|ºſºft º | V V *** §§ •, - 9 • *** - § [[[III]ºº: #!!! | º THE . . |$º ††; “Hygienic Derrmal Powder ’’ jºš. |NFANTS AND ADULTS. §ºliºsºft Introduced to the Medical and Parmaceutical Professions, by iſºl. Sº Dr. Fellr, in the year 1873. .#|ſº COMPOSITION:-Silicate of PROPERTIES: — Antiseptic, ºº::N Magnesia with Carbolic and Sali- || Antizymotic and Disinfectant. cylic Acids. - . t | º GENERAL SPRINKLING PowDER, with positive Hygienic, Prophylactic, and Therapeutic properties. ;- iiº: $i :2-3. ( } ſ § t Good in all Afree ions or the skin. Sold by the Drug Trade Generally: . *.. ºſ Per Box, plain, - - 25c. Per Box, perfumed, - 50c. Per Dozen “ - - $1.75. Per Dozen “ – $3.50. *: § : THE MANUFACTURER: §§§ - M. º. ** . ########## # } JULIUS FEHR, M. D.,. º Ancient Pharmacist, - - ; ń. - # ||||}|† : . §§ºtº |||}}#ij}} Q # § HOBOKEN, N. J. &####!º Only advertised in Medical and Pharmaceutica1 Prints. THE MORPHINE HABIT . I tº EE I C * tº I H C SE * o on. T INº. AVENA’s AT 1 v A. A POWERFUL NERVE STIMULANT, TONIC, ETC., - ... " • ‘ Is also Employed in the Treatment of Paralysis, Epilepsy, St. Viñº Dance, Chloral and Tobacco Habits, Sleeplessness, Nerve Exhaustion, Neuralgia, Alcoholism, Painful and Deficient Menstruation, Headache, Hysteria, Convulsions and Prostra- tion from Fainting, and in the Convalescent Stage of all Acute Diseases. DOSE,-From ten to thirty drops or more, as often as may be indicated to meet the urgency of the case. Administer in hot water when quick action is desired. Messrs. B. KEITH & CO ,—Gentlemen : . - Melroy, Ind. . I am giving the con. tr. avena sativa for the , mergh ia haëit, and I find it will cure, I believe, all cases, no matter how Zong they haze been the slave of this opium monster. I think this is the greatest discovery of Our age. - - . M. POLLITT, M.D. Messrs. B. KEITH & CO.,-Gentlemen: . Barnesville, Ga. The con. tinct. avena sativa has been more successful in the treatment of the opium habit than anything. I have ever tried, and I have tried various other remedies, amongst them the advertised nostrums. t HOLLOWAY, M.D., Messrs. B. KEITH & CO., Gentlemen : * . Idaho Springs; Col. I have tried a small amount of the con. tr. avena sativa and am more than plcased with it in the of ium habit and several other cases, such as in female diseases and nervous conditions. - - - . - CHAS. B. RICHMOND, M. D. Send for printed matter on Con, Tinc., Avena Sativa in the Morphine or Opium, Habit, and certificates from different pembers of the Medical Profession citing cases under their charge treated by it, - also Revised and Enlarged Manuel to - - E: **Exºr sº ºrganiſ GHEMISTs, ESTABLISHED . . . 852. No. 75 WILLIAM ST. NEW YORK, (A : ; 3. ſº ſº H ſº tº ź º K! * ... ºff-ºf- 2. jº O ; tº . gº : - #sºft * 'º §§ g º ºil C m! §N.3% S § ; }|º (/) - ºutrit Z Ú) © - *4 ſº 3 As P SW2" ɺ § sºłº \ NS y 5 MWA ſº CINC as, M. A PRIVATE HOSPITAL FOR MENTAL AND NERWOUS DISORDERS. COLLEC E H ILL, OHIO. Eighteen Years Successful Operation. Oue Hundred and Fifty Patients admitted annually. Daily Average, Seventy. Cottages for Nervous Invalids, Opium Habit, etc. Location Salubrious. Surroundings Delightful. Appliances Ample. Charges Reasonable. §: by Rail; 6 Trains Daily; 30 min. from G. H. & D. Depot, Fifth and Hoadly Sts., IIIGillmati. - For Particulars, Address ORPHEUS EVERTS, M. D., Sup’t, College Hill, Ohio. TO WHICH THE ESPECIAL ATTENTION OF THE MEDICAL PROFESSION IS CALLED, ARE THOSE WHICH FOLLOW LA GRIPPE AND ITS ALLIED COMPLAINTS. A “BROCHURE” CONTAINING THE PATHOLOGICAL AND PHYSIOLOGICAL ACTION OF ANTIKAMNIA, ALSO ITS USE IN GENERAL PRACTICE, WITH SAMPLES IN POWDER AND TABLET FORM, SENT FREE ON APPLICATION. ADDRESS: THE ANTIKAMNIA CHEMICAL COM- PANY, ST. LOUIS, MO., U. S. A. WHEN PRESCRIB- ING ANTIKAMNIA, SEE THAT THE GENUINE IS DISPENSED, INSURING THE DESIRED RESULTS, 5 y PRE-SENILITY - - or premature old age is a too early de- PRE-SEN | LITY cline of the virile and physical powers, v * . . . . . . . . . . . . . .'; ' ', " " ... W. sººn manifested by a commencing deca- dence of the reproductive giands— such as, a wasting or atrophy of either the Prostate, Teates, Mammae or Ovaries — caused by masturbation, sexual excesses or sedentary habits. º , , • * * • ſº * > - A. º º, . . . º nº . "... . . . . . . | \ Wº ſº º: "º . . . . * - º * w v º, E º º, c. "..." § º 'º's ſº ºw ..., . . ºw ' ' 'º','!'}; ºn of the reproduc- vºyºmºnºnº. GENITHRINARY IFISE secretory activity. Its continued True Santal and Palmetto, Ø is the indicated remedy, as it is unexcelled as a vitalizing tonic to the withered glands and regular use for some weeks pro" in a pleasant aromaticſ. duces results which are satisfac- 'º'; - >121ſ tory to both physician and patient. ſº 1. UP = ". . . . is a true Tonic, lººſ VJ. SPECIAL not a stimulant, *INº PRE-SENILITY, tº- Ayº’ Prostatic Trouble as to the reproduc 21RRITAsie áll Abbéré. mucous surfaces, ºurethraſinºammation. hence, its use for a sufficient period 00 GHEM, G0, NEW YORK restores their norma, ºnction. - J -: IDER. McIMITTININ’s O. FITUTIMI An Invaluable Discovery in the Preparation of Opium. It contains all the valuable medicinal properties of Opium in natural combination, to the exclusion of all its noxious, deleterious, useless principles upon which its bad effects depend It possesses all the sedative, anodyne and antispasmodic powers of Opium: . To produce sleep and composure; to relieve pain and irritation, nervous excitement aud morbid irritability of body and mind; to allay convulsive and spasmodic actions, etc.; and being purified from all the noxious and deleterious elements, its operation is attended by no kickness of the stomach, no vomiting, no costiveness, no headache, nor any derangement of the constitution or general health. Hence its high Superiority Over Laudanum, Paregoric, Black Drop, Denarcotized Laudanum, and every Other Opiate preparation. C.A.T.J. T.IO INT. On account of its large sale, spurious articles are offered in, bulk. The genuine is sold only in vials of about 7 drachms, with yellow wrappers and signature of Jno. B. McMunn. E. FERRETT, Agent, 372 Pearl St., New York. HARRISON COLE, PRACTICAL OPTIGIAN, All Defects of Vision, requiring Spherical Lenses, scientifically corrected. Special Lenses carefully adjusted to prescription. Optical and Scientific Goods of all kinds. Repairing of every description. Prescription Blanks Furnished Physicians on Application. 64 North High Street, Columbus, Ohio. - - 6 FRELIGH’S TABLETS, - (Cough and Constituent), Fort THE PREVENTion AND cure o PULMONARY PH THISIs. IF"OIFE IM CUI ºr Z H-. Cough Tablets Constituent Tablets . EACH TABLET contains. - Each tablet contains. Morph. Sulph. (sº gr.), Atrop’ae Sulph. Arsenicum (sº gr.), Precipitate Carb, (5%0 gr.), Codeia (#6 gr.), Antimony of Iron, Phos. Lime, Carb. Lime, Silica, Tart. (; gr.), Ipecac, Aconite, Pulsatil- and the other ultimate constituents, la, Dulcamara, Causticum, Graphite, according to physiological chemistry, Rhus-tox, and Lachesis, fractionally so . (normally) in the human organism, arranged as to accomplish every indica- together with Caraccas, Cocoa, and tion in any form of cough. º Sugar. PRice, THREE Dollah's PER double Box. Containing sufficient Tablets of each kind to last from one to three months according to the condition of the patient. A Connecticut physician writes: “I am now using your Tablets, on a patient (young lady), who has had three quite severe hemorrhages the week previous to the beginning of the same. She has taken one box only, has had no return. Of the hemorrhage, and has gained four (4) pounds since beginning treatment, besides all rational symptoms have improved wonderfully. I will add that I had tried Ol. Morrh., Syr. Hypophos. Co, etc., with no apparent benefit.” A Virginia physician writes: - “Enclosed find Postal Note for another double box. Freligh’s Tablets. I used the sample box in three cases, with decided benefit in one, slight improvement in second, and while they did not improve the third case. it being in very advance i stage, there was an amelioration of the distress- ing symptoms. - - - A Massachusetts physician, in practice 25 years, wri'es: “Send me two double b xes Freligh's Tablets. I have tried the sample box with most excellent results.” - A Michigan physician writes: - - “I am more than pleased with them. They have not disappointed me once. Dr. C. for whom I ordered a box, writes me that he is much improved, and speaks in praise of them. He has genuine Tuberculosis, and while I do not think he can recover, yet I firmly believe the Tablets will prolong his life.” t SIFIEE CIALIC a CºIF"I FIETHER.. While the above formulae has been in use, in private practice, over 30 years, and we could give testimonials from well-known clergymen, lawyers and business men, we prefer to leave them to the unbiased judgment of the profession with the following offer : . On receipt of 50 cents, and care, letter head, bill head, or other proof that the applicant is a physician in active practice, We will send, delivered, charges prepaid, one of the regular (double) boxes, (retail price, Three Dollars) containing sufficient of each kind of Tablets to test them three months (in the majority of cases) in some one case. Card, letter head, or some proof that the applicant is a physician in active practice, MUST accompany each application. Pamphlet with full particulars, price list, etc., on request. - A. FIEIC's EEBIOERIzºlº D CERE BRO–SPIN ANT. (FRELIGH’S TONIC, ) Our Special Offer is still open, to send to any physician, on receint of 25 cents, and his card or letter head, half a dozen s imples, delivered, charges prepaid. Each Sample is sufficient to test it for a week in One C4Se. As we furnish no samples through the trade, wholesale Or retail, for Samples, directions, price lists, etc., address - I. O. WOODIER, UIFE & CO- Manufacturers of Physicians’ Specialties, 33 IMCA-IIDIEINT L.A.INTIE, INTIE Wr Yor.I.E CITY - Orthopedial *] * App We are now manufactur-, ºr --> S > as ſº A " Sºº R. º -: , ; /2.25 SS *>, ...?' & F.S. º **.* ºf SSS , % ºy SN º * {{{ſº} \}. Sº º) 'º %)ºº is \ R. º , W. " N ing everything in the § way of º º º sº g - º ź s º Ż - - º º Ž, . |Spina/ &s &S ºšº y & Nº. & "º غ \º § s' - § ºss • X." W º: 6(IR AMK/6 0Y *** **, ºcºtº ºx, Bow leg Braces ". & Hip Splintst. :ºx .*.* º:-. •º ſº." Everything in the ORTHOPEDIC T-ir-e- Write us before ordering or send your patient to us and we will take the measurement and guarantee a fit. We can make as good an APPLIANCE as can be had elsewhere , for LESS MONEY AND CAN FURNISH 9 IT MUCH QUICKER. Jº ºf w | v. .*.*. º " | º （ ſº ºf | Us: - ; : SSS |]] |# FULL INSTRUCTIONS SENT FOR MEASUREMENT WHERE PATIENT CANNOT BE SENT TO US. 25 ||BT Cºmt, DiSCOInt '' * * > º from price to patient given Physician when ſº ſº. sº º tº 3. . order from Doctor is sent with patient . The Cornell-Pheneger Chemical Company, COLUMBUS, OHIO. PHYSICIANS" SUPPLIES OF ALL KINDS. The most Important Remedial Agent in DYSPEPSIA, WOMITING IN PREGNANCY, CHOLERA INFANTUM, CONSTIPATION, And all Diseases arising from Imperfect Digestion. THE NEW YORK PHARMACAL ASSOCIATION P. O. BOX 1574, NEW YORK. COLUMBUS MEDICALJOURNAL A MONTHLY JOURNAL OF MEDICAL SCIENCE. Vol. 10. JUAVE, 1892. No. 12. comMUNICATIONS SEPS/S-W/7H A AVAA’AºA 7TWOAV OA' A' A' A DV /AV7'AºA'- ESTING AND INSTRUCTIVE CASES. BY ROBERT PETER, M. D., CANAL DOVER, OHIO. Read before Ohio State Medical Society at Cincinnati, 1892. In these blessed days of anti-sepsis, thanks to Pasteur, Lis- ter and Koch, we are at least permitted to come to our patients with clean hands and a clear conscience. These sanitary precepts are founded upon the dire lessons of sepsis. This dread process is the dispenser of admonition—“Let another man’s shipwreck be your sea-mark.” And yet, how little is its intimate nature understood. It would seem that this were still largely an unex- plored field in which much work need be done. - . Our theme, therefore, is not so easy to define. A septic process is so complicated that a number of complex factors must necessarily enter to produce it. That stage in our knowledge is not yet at hand that we can fully appreciate all these factors so curiously interwoven in their relations to each other, as they are concerned in sepsis. However, it may be briefly defined as infec- tion and intoxication, which arise when specific, pathogenic germs gain access to the body, and finding conditions favorable, they grow and multiply therein, and in so doing elaborate a chemical poison which induces characteristic effects. These + - 529 \ * 53O COMMUNICATIONS. effects are sometimes only local, or both local and systemic; this will often only depend upon the kind of germ, or both upon the kind of germ and the kind of host. It is in physical life just as it is in social life; the lower grade is striving to oppose the higher. Instaðz/ity of organized structure and function during life, as well as of organic material after death, makes bacterial life possible. Under these circum- stances organized form falls prey to bacterial life's action, by which means it is returned to its primary or organic state, from whence it was taken. In this process the transzºzon products mec- essary to sep/zczzz!oarzcatzon are given. In a scientific way this fact was first proven by Panum, in 1856. He showed that poisons comparable to venom of serpents, curare and nicotine, and not to be destroyed by either boiling or evaporation, are formed during decomposition of animal matter. Since his time, Brieger deserves credit for isolating a number of , these putrefaction ptomaines; and what is still more important, he was the first one to demonstrate the fact that certain poisons are also formed within the living body, by certain germs, causing infectious diseases. Hence, it is evident, that every germ which causes disease in man, does so by virtue of its chemical products. These poisons may result first from the secretion by some of the bacterial cells themselves; secondly, from the spitting up of complex compounds of organic source, by the activity of bac- terial life. Ever mindful in her conservatism, nature provides a restora- tive process to regenerate tissues impaired by traumatism and disease. It resembles in every respect the physiological process of growth of tissues, just as is observed during development of the body; and, like in other developmental processes, more or less heat is evolved. Embryonal cells promptly undergo trans- formation into tissues which correspond to the anatomical seat of lesion. Unmolested, this process ſeezer proves destructive, but always construcázve ; and it ever promptly attains its end. How-. ever molested by bacterial life, a process never constructive, but a/ways destrucázzle, is inaugurated, and abnormal heat is generally evolved. Embryonal cells are not promptly, and more often not at al/, transformed into tissues corresponding to the seat of 1esion ; but are broken down and appropriated to the formation of poisons which are utilized in intoxication. This complicated pro- cess never promptly attains a salutary end, but only too often destroys the host. AWarratzve AVo Z.—Somewhat uniquely illustrates viru- 1ence--an old and only too oft-told story: Mrs. — is on a PETER—Sepsis, Etc. 53 I journey of several hundred miles; while on the train she is seized with pain and flooding, and, as she puts it, “something drops while in the water-closet.” After reaching her destina- tion, flooding still continues for about one week. Loath to seek advice, failing strength and offensive discharge finally constrain her to do so. On examination the doctor finds os uſer, tightly puckered up; forcibly dilating it, he removes a small amount of debris. Three days thereafter, patient takes a violent chill, fol- 1owed by progressive inflammation of the surrounding tissues and involving the pelvic peritoneum. For three days the patient is entirely unconscious, pulse and temperature fluctuate, at times the former ranging over 16O beats per minute and the latter Ios’. Writer is called per telegram ; on my arrival patient has regained consciousness and is somewhat better. I tell the doc- tor and his associate, who together are now attending, that the trouble evidently is septic ; but this they are not inclined to telieve. But, very soon there are thirty-five inoculated puerperae in that community; out of which number Mrs. is the only one who survives. Even one of the physicians becomes inocu- lated from some one of his patients, and has a very serious time to recover. Mrs. —, after four years, suffers since from chronic pelvic abscesses. It is, of course, assumed that infection is always from without. Germs may be conveyed into the body in many dif- ferent ways. Into mucous channels, for example, they may find their way by inhalation or by being swallowed with the food. True, the hydrochloric acid contained in the gastric juice, serves often to protect the digestive tract from infection ; but under cer- tain circumstances these invaders acquire such an unusual amount of resistance, that they can withstand the action of the stomach's acid secretion, as well as can the spores. After alight- ing on a mucous or cutaneous surface, the infecting germ furthers its journey into the tissues through a solution of continuity of structure, be it ever so insignificant. It is a noted fact that infection is more likely to occur through a merely slightly broken surface that does not bleed, than through a bleeding one; because, in the one case, the infecting agent is readily taken up by the absorbents, while in the other it may be washed away. Germs always follow the avenue of /east reszstance. Some forms find in the blood, others in the 1ymph spaces and vessels, the conditions most favorable for their proliferation. And even after , they do gain access to the body, the same kinds of infecting agents do not always produce like effects on different hosts. 532 COMMUNICATIONS. Sometimes, in one instance, it may prove only a local process, while in another it may prove both local and systemic. It is be- lieved that this will generally largely depend upon the number in which the invaders are present—i.e. the size of dose—upon the varying virulence, which the same species under different cir- cumstances possesses, as well as the varying capacity of the host’s resistance to ingress of the germs. AWarration AVo2.-Albert K., aged 5 years, gets his right hand into a pulley, which tears away distal phalanges of the little and third fingers and more or less crushes the whole hand. His wounds are treated with iodoform dressings, yet parts suppurate freely; however, the boy suffers no systemic effects. On a very busy day the father brings his boy to my office to obtain new dressing ; to gain time, I request the father to proceed first in removing the old one. In doing so, the father runs the tip of his right thumb over the point of a dressing pin and barely nicks it. Three days after he has a decided chill, followed by a high fever, and is a very sick man. The thumb is very painful and swollen, and progressive destructive inflammation sets in, involving the entire hand and forearm. Three incisions are made to drain off the pus—one into the thumb and one each into the Hand and forearm respectively. Despite our treatment, the entire belly of flexors of the thumb sloughs away, and the father but very slowly recovers, while the son’s wounds promptly Heal and he is at the same time enjoying the best of health. This narrative first shows the difference of havoc produced upon the son and father respectively, by the same kind of pyogenic micro-organism ; further, it shows in the father's case the apti- tude of infection through an insignificant portal. Both character and degree of infection and intoxication will first depend upon the kind and competency of the infecting agent on the 9ne hand, and upon the kind and susceptibility of the host on the other hand. These are problems towards which the complex factors of the microbe's individual equation as well as the complex factors of the host’s individual equation, must respectively contribute to solve. Diverse tissue metabolism resulting from the whims of fluctuating nutrition and waste, both during health and disease, must no doubt variously affect the parasite's environment, and, therefore, also its capability as well as the host's response to bacterial reaction. With such variable conditions, chemism and concomitant symptoms must therefore often and wzale/y differ. Marrative AVo. 3.−Mr. E. C. M., aged 60 years, is afflicted with erysiplas, involving the face, ears and parts of the neck PETER—Sepsis, Etc. 533 and scalp, which is accompanied by uncontrolable nausea and vomiting. From Sunday to Thursday the temperature ranges between IOO.5° and IO3.5°; pulse, between 86 and 96. On Thurs day the temperature drops to 97° and the pulse to 66, and at the same tzme nausea and vomiting cease, but the local conditions remain about the same. This shows that chemism radically changed on Thursday, and with it did all of the systemic mani- festations, while local appearances are seemingly not much changed. AWarrative. A/o 4.—Mrs. J. F., aged about 35 years of age, gets pregnant in August, and her pregnancy is accompanied by uncontrolable vomiting, so that she rapidly emaciates and fails in health. It so continues until one week before Christmas, when she aborts. The family physician is called. Patient appears to him rather large for the length of time of pregnancy. An abdominal effusion is noticed by him. The puerperal state in itself passes by uneventfully, only vomiting will not cease. Writer is called in consultation, and the patient is found eartremely emaciated and enfeebled, with a pulse of I44, and a remarkably wacz/latzng febrile movement, fluctuating within two hours first from IOO.5° to 97.5°, and then to IOI*. The tongue shows two large necrotic patches. The stomach is very irrita- ble, rejecting everything, and is distended with gas. Spleen is considerably enlarged, and, as already stated, there is some abdominal effusion. Close inquiry elicits the fact that patient had fever for some time before the miscarriage. Vomiting not ceasing, we know that now its cause is not pregnancy, and from the other data at hand, it appears that our patient suffers from sepsis. The infection must be traced to the prima via and no doubt prior to puerperſum. This would illustrate predisposing influences of mal-nutrition and temperature vacillation character- istic of some forms of sepsis. The entrance of the different bacteria into the body, their residence there and their means of support, result in different processes. Some of these processes are always local and never more, as in gonorrhea (?), infectious ophthalmia, etc. There are some in which local evidence is almost nil, while the sys- temic manifestations are alarming; as in tetanus, la grippe, etc. These are no doubt constant biological stipulations. While again, we have to deal with some bacterial processes which are not constant in their behavior; at one time they are only local, while at another, both local and systemic, as in pyogenesis, etc. These, as we have seen, are mainly governed by the host's own 534 COMMUNICATIONS. resisting powers. Then we may have mixed processes known in bacteriology as symbiosis, as may be found with diphtheria, typhoid fever, tuberculosis, etc. Progress of infection and intoxication is encouraged by nega- tive response of the host's immunity-giving agencies. When bacteria are brought into contact with living tissue, certain wan- dering cells come to its rescue, devouring and peptonizing these offenders. This is the doctrine of phagocytosis, first demon- strated by Metschnikoff. Phagocytosis depends upon the char- acter of “chemiotaxis.” By this is meant the attraction (“posi- tive chemiotaxis”) or repulsion (“negative chemiotaxis”) of phagocytes. Prudden and Hodenpyl believe that the phenomenon “chemiotaxis” is due to chemical action of bacterio-pro- tein. The infecting agents must also meet the germicidal proteids of the blood; these may prove negative, and hence conducive to the inroads of infection. Finally, when bac- terial products are not rendered inert by metabolism going on within and their elimination is ineffectual, then results progresszze zìzłoaczcatzon. The local changes resulting from bacterial action, are due to the toxic “irritation which the sympathetic nerves receive, and this leads to afflux of blood to the irritated part, owing to the dilatation of innervated capillaries. The congestion, the stasis, the altered local diffusion and nutrient phenomena, are the natural consequences of the local irritation.” Further morphological changes will depend upon the different nature of poisons. For instance, many bacteria form peptic ferments which break down and dissolve the infested tissues; in other words, the tissues are converted into a condition of disintegra- tion or necrosis of one sort or another. Then, again, in some way not yet known to us, very peculiar and characteristic inflammatory changes may be brought about which result in the formation of new tissues of various kinds. As examples, we may cite tuberculosis, syphilis, etc. tº We have seen that when pathogenic germs find a locus mzzzzorz's reszsőem/za, how they may enter the living organism and there can produce their various toxic effects. True, the chemical products have not yet all been severally isolated, that must be formed in these different processes. Yet enough work has been done in this direction to prove that this is the right path of research to follow in pursuit of the essence of truth. But the living body is such a complicated structure of unstable com- ponent parts and functions, that it is an easy matter to under- PETER—Sepsis, Etc. 535 stand how manifold is its versatility of metabolic processes in health, how much more so in disease, and especially so 2n Septzc diseases, Therefore, never forget that we have to deal with the 2ndividual, as well as with the materzes moróz, in our diagnosis making. The symptoms of the different septic processes may manifest themselves in such a variety of perplexing ways that it peremptorily behooves us to be on our guard. It would be a blessing if there were some unswerving pathognomonic guide to direct attention. The nearest that one may come to this is, adopt the eccentric, but never unsafe, philosophy of the pangerm- ist, to always look for sepsis. So varyingly do these different septic processes manifest themselves, therefore always think of them. It is easy to diagnose an advanced tuberculosis, a septi- cemia in the puerperal state, or a pyemia when the local evidences are apparent; but not so, when such land-marks are not plainly manifest. The bacterial poisons all more or less affect the central ner- vous system. This fact is variously expressed in the different septic processes. For instance, some may be especially depress- ing in their action upon the heart, even morphine and veratrine- like, or they may induce atropine and digitaline-like and other peculiar effects resembling those of other vegetable alkaloids. Others, no doubt, have a perverting influence upon trophic nerve-functions, while all of them at different times manifest a predominant or selective action upon certain individual nerve- tracts. This may prove a source of perplexing annoyances, well calculated to overshadow other symptoms, and to mislead in diagnosis. To illustrate, let me refer to a case of pyemia reported by me in the Columbus Medica//ournal of March, 1892, in which is shown the selective action upon the phrenic nerve. It is the case of my own brother, who for five days and five nights almost incessantly hiccoughed; sometimes from 900 to 1,500 times per hour, both while awake and asleep. There was a sup- puration of the left ankle, from which a metastatic pus-localiza- tion formed in the interosseous space of the left forearm, just below the elbow. The patient recovered, but very slowly and conditionally. Symptoms of elimination and different types of fever often render signal service in diagnosing the different septic processes. Yet, even these may prove inconstant: e.g. who has not seen constipation in typhoid fever, or the type of this fever widely deviate from its form of continuousness, or even seen it drop by times below the normal 2 “A combination or succession of º -- t 536 COMMUNICATIONs. hyperthermic and hypothermic phenomena may become mani- fest according to the combination or alteration of poisoning by the deleterious physiological products or their antagonistic action.” Inconstancy and fluctuation are therefore often char- acteristic of septic processes; especially is this true of pyemia. No doubt explanation must be largely sought in difference of chemism. But this is as yet a very hazy theme; notwith- standing the remarkably broad statement made by Dr. A. M. Brown and quoted by Aitken : “(I) Poisoning by the “Extract- ives’ is attended by hyperthermia. (2) Poisoning by the ‘Ani- mal Alkaloids’ is accompanied by hypothermia,” etc. To this, in a letter to me, Prof. Vaughan says: “The statement is very unfortunate and is not true. The term ‘Extractives’ is too indefinite to discuss. That ‘Animal Alkaloids' are charac- terized by the production of hypothermia is not true, is shown by a number of facts entertained in our work on Ptomaines,” etc. (As illustrations see the work of Vaughan and Navy, pages 121, I23 and I40, I41, 2d Edition.) However, this has no practical bearing with us. After all, we must have recourse to discrete symptomatology; it alone can guide us in each particular septic process. Hence, we must always carefully but promptly con- sider every single diagnostic detail, since so much depends upon a proper and early diagnosis. The advancement of bacteri- ology and physiological chemistry, which go hand in hand, will finally triumph and do a vast deal to elucidate and eventually lead us to a correct and satisfactory conception of sepsis. The treatment of septic processes may be told in one word—it is antisepsis. This means that we should strive to over- power these pathogenic invaders. This is not so easy in prac- tice as it would seem in theory. After pathogenic microbes Have gained entrance into the body, it is more difficult to destroy them than when only in a wound. We are generally able to prevent wound diseases by an antiseptic and aseptic operation and by antiseptic dressings, since in that way we shut off the natural and only mode of entrance into the wound ; but, it is quite otherwise when we have once to deal with systemic infec- tion and intoxication, as no drug has yet been suggested in any one of the septic processes that proves at all time fully efficient as well as harmless—internal use of bactericide agents being very unreliable and occasionally injurious to the body. Our present knowledge of the intimate nature of sepsia and of the doctrines of immunity would seem to suggest, that so far our chief reliance must depend upon cleanliness, cheerful hygienic PETER—Sepsis, Etc. 537 surroundings; upon proper nutrition, to reinforce the tissues in their defensive powers; and upon elimination; to drain the various toxines from the system through the different emunc- tories. Hence, since within favorable environment every specific germ produces its own characteristic poison, its own char- acteristic effect, it is very important and desirable that stand- ard vitality of structure and adequacy of function, not only of larger organs, but of every solid and fluid tis- sue, of every individual component cell and its proto- plasm, be well maintained. On these conditions depends our safety; because within them is vested the power to check invasion and the progress of micro-organisms. 7A/A2 CA O.S.A. AAV/D COA’A. O.A. A.S. 7A/A/A AAV/O A //W- A)A2A2/O /O/SAEASA.S. BY F. E. YOUNG, M. D., CANTON, O. In the limited space allotted to this paper, it is evidently. impossible for me to treat so vast and difficult a subject as asthma 'exhaustively, or even to mention the vast quantity of literature upon the subject. Suffice to say, then, that I had been a great sufferer from this distressing malady for twenty-two years, and that I have been entirely cured. I was gradually becoming worse and worse, from year to year—always worse in the fall and winter, until last October. I had got down so low and seemed to have so little vitality left, that I despaired and thought I could not live through the winter. I was only a gaunted up, stooped- shouldered, gasping, wheezing invalid, with almost an incessant cough, spitting at least a pint of clear, tough, stringy mucus, and had to burn a stramonium remedy from three to five times every night and several times during the day to get relief. My hands and feet were always cold, my digestion poor, had bilious spells or sick headache, every few weeks, and had alarming attacks of palpitation of the heart. All the flexor muscles of the body seemed contracted, so that I could not straighten out my fingers or throw the shoulders back. I had consulted hundreds of physi- cians, read everything on the subject that I could get, used all known remedies, and yet with it all I was still a hopeless invalid and had not learned what caused the disease. I had long thought that it was reflex and tried to find the cause, but owing f* 538 COMMUNICATIONS. to the fact that I was never conscious of local rectal symptoms, never mistrusted that the rectum was the seat of the trouble. When my stomach was bad, and that was often, I tried by dieting and remedies to correct it. Then again I thought it was from nasal irritation, and had a specialist remove the pharyngeal tonsil and turbinated bodies, break down the septum and straighten it up, saw, bore, burn and spray throat and nose for months, and still had asthma all the time. Rectal irritation as the cause of my asthma was never even hinted at until I consulted Dr. Pratt, and even when he assumed that to be the cause and wanted to examine, I demurred, saying that I had never had any rectal disease—no piles, pain, constipa- tion or discomfort at all, and thought my bowels the best part of me. He asked if pregnant women vomiting in the morning,. complained of their uterus 2 I replied not necessarily, and he said so a man with asthma from rectal irritation would not neces- sarily complain of rectal symptoms. He examined, found what he predicted, and operated on me under an anesthetic. I went to sleep during a bad attack of asthma and got awake without it, and have never had it since. I recovered from the operation in two weeks, and have kept right on improving every week since, until now I have gained twenty-six pounds; have never missed a meal or a night's sleep ; my entire form and gait have changed, hands and feet are warm. I can straighten my fingers as far as ever, and on waking stretch like a growing child; my step has become more elastic, and I have a buoyancy of spirits that I never had before. The antiquated idea that in order to have rectal irritation account for these serious reflex disorders, we must find very marked local diseases, and the patient be conscious of local suf- fering in the rectum, is very strongly disproved by my own as well as numerous other cases that have come under my observation and until we learn to look by the eye of experience below an apparently healthy mucous membrance and see the diseased sym- pathetic terminal nerve fibers, crying out in their distress by reflex disturbances of other organs, we cannot avail ourselves fully of the wonderful benefits to be derived from “orificial sur- gery” in the treatment of chronic disease. Owing to this fact not being understood, hundreds of invalids are suffering from day to day without a proper understanding of the cause of the trouble, and we go on treating the symptoms or effects, trying to relieve now this symptom, now that, until we have become discour- aged and our patient disgusted, and he abandons himself to a YOUNG—7%e Cause and Cure of Asſ/ima, A. (c. 539 life of invalidism, or goes the rounds of patent medicines or quack doctors, only to find after awhile that none of them can cure his case. But if we fully understand the great sympathetic nerve and its functions and diseases, we can go right for the prime cause, and its removal places nature in condition to cure the case. A local examination, estimated by the ordinary standards of pathology, discloses a remarkably healthy looking rectum. A careful scrutiny, however, of the last inch may disclose a few scattering pockets, a few diminutive papillae, and perhaps neither of these approaching a condition of excoriation, the mucous mem- brane simply appearing atrophied and presenting around the entire circumference of the gut a slightly congested appearance. One would think that such a slight form of trouble could do no serious damage to the general health, but the surgeon should remember that this membrane contains terminal nerve-fibres; that they too are atropied and in more or less of an irritable con- dition, and that the irritation present is sufficient to cause a con- tinuous abnormal contraction of the internal sphincter. And the surgeon should also reflect that this continuous pinching of dis- eased terminal nerve-fibres must weaken to a tremendous degree peristaltic actions, thereby interfering with the circulation of all the solids and liquids of the body. We live by tubes | All the activities of the body, from the sweat-glands of the skin to the alimentary canal, are conducted by tubular structures. The food and drink of the body pass into a tube; the juices which act upon it are conveyed along tubes; the blood flows through tubes; the lymph, the chyle, the bile, the urine, the very air we breathe all accomplish their pur- poses and seek their destination through tubular structures. Every one of these tubular structures has a muscular coat upon whose action the service of the tube depends. The muscles which compose these coats are all involuntary muscles, and are supplied universally by the sympathetic nerve. The health of the body depends upon the vigor of the vermicular motions thus provided for, and these in turn are entirely dependent on sym- pathetic nerve-force. Sympathetic nerve-force, then, is the steam which propels the enginery of the body, and the study of health, and also of repair necessarily involves the study of the supply of this waste and nerve-force. You will remember, now, that the sympathetic supplies the sexual system, and that the study of the condition of the sexual organs is essential, and that the sexual systems of such patients 54O COMMUNICATIONS. either present an abnormal degree of excitability, or have passed on to the opposite condition of enervation, which is still more serious. The local condition found is apparently so insignificant as in years gone by to have entirely escaped the attention of the medical profession, and in cases where it has been examined has been pronounced normal. The patient is conscious of no local inconvenience whatsoever, and may possibly object even to an examination being made; claiming regularity of the habit of the bowels, and entire freedom from all forms of local sensations. The weakened peristaltic actions of the body, however, have told seriously upon the general health, and the individual idiosyn- crasies have begun to develop. With some patients it may be a tendency to spinal and brain troubles. The brain may be either over-active to a point of insomnia, or may be dormant to the point of stupidity. The spinal cord may be congested and irritable, or it may have passed beyond this stage to molecular death of large numbers of its cells and the patient begins to suffer the pains of ataxia or the helplessness of paralysis. If the individual weakness be that of the lungs, tubercular tendencies may be inaugurated, or the patient develop asthmatic or other bronchial difficulties. In other cases the heart’s action may be irregular or painful. In still other there may be manifested kidney, liver or intestinal troubles. In yet others the outer skin may take on any of the forms of cutaneous degeneration. In fact, whatever the inherited or acquired weaknesses of the individual may be, they may begin to manifest themselves. One topic more, however, is worthy of mention in this con- nection, viz: The stupidity of the sympathetic nerve. It does not discriminate between the tissues it supplies and a foreign substance, and it is fully as liable to squeeze its own membrane, if it is out of repair, as it is to propel a foreign body along one of its canals. If its throat is swollen it will try to swallow its own membrane as readily as it would a bolus of food. If the urethra is inflamed it will make as strenuous efforts to expel it, although there is no urine to pass. If its rectum is acutely inflamed it will exert itself in a hopeless endeavor to strain it out of the body as earnestly and honestly as though it were trying to pass a quantity of fecal matter. In consequence of this lack of dis- crimination on the part of the sympathetic nerve a stricture can be induced in any canal of the body by simply inducing an inflammation of the membrane, lining it at any point. And when you stop to think that tonic spasms of muscular fibres are extremely exhaustive of nerve-force, it begins to dawn upon one YOUNG—7%e Cause and Cure of Asthma, AEtc. 54I. how an irritation at one of the openings of the body, by induc- ing undue spasms of the muscles guarding it, can be extravagant of the nerve-force upon which the actiyity of the muscles depends. The human house which such a patient inhabits has been wasting faster than repairing, and the incidents and accidents of time are disintegrating the mansion until, perchance, it has become so poor an abiding place that the spirit is seriously ques- tioning the propriety of taking its departure. In such cases the fires of life have burned low, the sounds of the world are grow- ing faint, the heart's desires are pretty well consumed, and the things of this earth are less tempting, and extreme measures are necessary to arouse the sleeping organism to throw off the leth- argy of approaching dissolution. The peristalses of such a suf- ferer are exceedingly feeble. Not a tube in the entire body has sufficient impetus to properly fulfil its use. The solids and liquids are no longer freely propelled along their channels. The commerce of the organism becomes locally and generally obstructed, and nothing but some general measure that shall. have power to re-establish vigorous peristaltic actions throughout the entire body will be effective in starting once more the machin- ery of life in successful operation. Prescribe medicines, but the organism is too sleepy to respond to them. Give baths and Imassage, but the reactive powers are too poor to profit by the exercise. For such an ‘individual perfectly regardless of what. part of his human machinery is so badly clogged as to threaten death, there is a sovereign remedy of more power to rouse the latent energies of the system and re-establish bodily activities than all others combined. In the treatment, then, of the chronically sick, whatever may be the nature of their complaints, employ any and all of the resources of the profession which may be at your command. The most scientific and grandest of all is the application of inter- nal medication. If you can tune the harp of life into rhythmic action once more by the use of drugs, it is your. duty as an Honest physician to do so. But if you fail there are at your command various other measures which may serve your purpose satisfactorily. Massage, baths, electricity, plasters, ointments, heat and cold, dieting, artificial and natural waters, changes in relations and surroundings, mental therapeutics and numerous other valuable adjuvants omitted from this list. But when these measures too have been of no avail, and the patient still contin- ues to suffer, there is another resource still left you, more pow- 542 • COMMUNICATIONS. erful, certain and permanent in its action than all other meas- ures combined. This resource is orificial surgery. By its aid the capillaries of the entire body can be instantaneously flushed; the sleeping energies of the patient aroused and the activities of life again renewed. tº * In employing orificial methods always be guided by the same conservative policy which induced you first to prescribe for your patient before resorting to other measures. Use the simplest means first. Mere dilatation, the use of heat and cold, and if pruning is absolutely essential, do as little of it as pos- sible. When you come to use orificial work upon the rectum, as in all other surgical work, it is better to save than to destroy. If there are pockets and papillae, excise them with as little destruc- tion of the mucus membrane as possible. If there is a fistula, lay it open, dissect out the tract and stitch it up again. If there are hemorrhoids, try to remove them with the fewest incisions and with the least possible destruction of normal tissue by which you can accomplish your work. But when this, too; has been done, and the result is still unsatisfactory, do not forget that there is a last appeal which you can make to the latent energies of the system, whose power transcends all others, and will crown your labors with success if there is still sufficient life left in the tissues to respond to ady appeal. That appeal is the American operation. CONST/PA 77ON.—ſ TS CA USAES, CONSEQUEWCAES AAV/O 7TA&AEA 7///º/V7. BY GEO. P. SATTLER, M. D., PAVONIA, O. & In presenting this subject to you to day, I do not lay claim to much that is either new or startling. We get quite enough of the novel, the wonderful and the extraordinary in the domain of the specialist, but of matter that pertains to the daily interest of the general practitioner, there is generally a stinted supply in our conferences, and this lamentable fact must plead my excuse for introducing a topic so ordinary and commonplace. The causes of habitual constipation are of the most varied and diversified character, and it is not always possible in an individual case to point out the original or primary one. But disguise the fact as we may, it is undoubtedly mainly due to the baneful effects of our newer and more refined civilization. SATTLER—Constºpatzon, Ætc. ix. * 543 We find it mostly prevalent in the artificially fed infant, in the female during her period of maternity, and in old age, and the causes in all are mainly dietetic. To be more explicit, allow me to add, that if there is one factor more than another that plays a conspicuous part in the cause, cure or prevention of chronze constipatzon, it is found in alimentation. A correct and common sense system of dietetics is indispensible to perform a *CUl1 e. It is with its prophylaxis, and treatment that we as physi- cians are chiefly concerned, and it is likely to tax our utmost skill, and ofttimes exhaust all our resources and all our patience to remedy the evil or achieve a moderate amount of success. As this topic is too vast and complex to view in all its dif- ferent phases, we will chiefly confine ourselves to the considera- tion of the dietary errors of the aforesaid periods—infancy, maternity and old age. When an infant is deprived of that food which nature had intended for its sustenance, either by some unavoidable calamity, or by the mother, who reasons that her own ease and the claims of society are paramount to her own offspring, a train of evils will most certainly follow, for no true or exact substitute for mother's milk has yet been discovered. It may differ in ten- perature or in the mode of administration, but mostly chemically and microscopically. Right here opens a wonderful field for inventive genius; for the person who propounds an exact substi- tute will deserve everlasting gratitude, and will confer a great boon on the entire human family. The various and multiplied proprietary articles on the market can not be depended upon in many cases, though some will often serve a useful purpose. Experience here is our only safe guide. As the digestive and assimilative powers vary in different children, and owing to age and individual peculiarities sometimes in the same child, the food ought to be changed in quantity and quality correspondingly, which can be done here by varying the amount of water added to cow’s milk, which is the nearest substitute with us. Barley water and lime-water are useful additions in the majority of C2S62.S. Many writers recommend cold water enemas. This is an admirable method, providing the fault lies in the lower bowel; otherwise it is only palliative. It is my honest conviction that we err oftener in not adding enough water than too much to the milk. Where but a smail quantity of water is added, it is quickly taken up by the absorb- 544 & COMMUNICATIONS. ent vessels, leaving the more solid portions of the milk to be acted upon by the digestive fluids. The question often confronts us whether we should at once resort to medicine, or remedy the constipated bowels in some other way. We are sometimes constrained to yield against our better judgment, on account of the importunities of parents and nurses, for what is more natural than to exhibit an apperient in such cases, and then it is so convenient. However, if the stools are found to be pale, hard, and sometimes fetid, a powder composed of calomel, soda bicarbonate, and some bitter vegetable cathartic, like podophyllin, will bring about good results. This is to be given in divided doses, and may be continued for several days with the happiest results. Calcined magnesia is another remedy much in favor; it has. the advantage of being comparatively harmless and tasteless, and when an antacid is indicated it will subserve a double pur- OSé. t p With the use of water and the preceding powder, a case may be tided over until the patient is old enough and has the proper strength to make the desired changes in the diet. There is a period in the lifetime of most women that is fraught with many ailments, and chief among them is a func- tional derangement of the bowels, and the period is that of child- bearing. We have to deal here with several physiological fac- tors—pressure of the gravid uterus, and functional activity in the uterine organs and mammary glands. In the two latter functions the fluids of the body are largely appropriated, and at the expense of the bowels. Among other causes may be men- tioned a want of proper exercise by seeking seclusion from an innate delicacy. Mental anxiety, deranged nerve function, and too often a faulty diet, will cap the climax. How are the difficult, and sometimes disastrous conditions to be met P The greatest difficulty here lies in the fact that the trusted and tried family physician is often not consulted until the mischief is done. In this class of cases, as in many others, an ounce of prevention is worth a pound of cure. The methods practiced by some old mid-wives in thelong ago, were not without some benefit, although they may have been in error as to their therapeutic effect. It consisted in giving the mother, a few weeks prior to her confinement, an ample supply of tea ; either linseed, marshmallow or bran tea. These amylaceous arid mucilaginous drinks were supposed to impart to certain mucous membranes like properties, and thus facilitate labor. I am far SATTLER—Constipation, Etc. 545 from condemning this old-time practice, and sincerely wish it was employed oftener at the present time. It certainly was a stride in the right direction, for it would obviate constipation, and thus relieve the patient from a train of evils which not infre- quently laid the foundation of a life of misery. Dr. Ward, in the Medical Indear, says: “Constipated bowels is a factor of no little importance in causing diseases of women. My observation has led me to believe that women who have uniform regularity of their bowels are seldom invalids; and nearly all invalids have a history of constipation or irregularity of their bowels. It would be entirely consistent with modern teaching to recommend a diet in such cases, vastly different from that too often indulged in by the patient. A diet which is based on common sense as well as on scientific principles, is the one which will give us the great- est measure of success. * Whenever the American people come to a realization of the fact that health is far more to be desired than wealth, and that no person was ever intellectually great unless physically strong, then, and not till then, will the subject of dietetics receive the attention it so much deserves. But we are hopeful that it will receive due recognition in the not far distant future. We see clearly the tracks of the sturdy pioneers, “The first low wash of waves Where soon will roll a human sea.” Chronze constipation, as found in advanced life, differs materi- ally from the preceding, as the causes operating are dissimilar. The principal causes are loss of vital energy, change of habits and a greater susceptibility to morbid or pathological changes. Many have led an industrious and abstemious life, through the springtime and harvest, and now as the autumn of life is approaching—the time of “the sear and yellow leaf,” they inau- gurate a change. They propose now to live a life of ease, and quietly enjoy the fruits of their labor. But ere long, indigestion, mal-assimilation and constipation will manifest themselves, and if they persist in their mode of living, the concomitant evils, con- gestions, fistulas, ulcerations and hemorrhoids will follow. There is yet another great evil which I must not fail to mention in this connection : By far too many resort to quacks and patent-medicine vendors for relief. But the “Spring Medi- cines,” the “Great System Renovators,” and the “Peristaltic Persuaders” will not effect a cure. But too often “melancholy will mark them for her own,” if perchance theirs is a lesser fate than that of the sear and yellow leaf. W 546 COMMUNICATIONS. What is the proper remedy, you may ask? The first in importance is the diet; the next, exercise, and the last medicinal means. Choose such a diet as will bring about of itself the desired result without the aid of medicine, if this is possible. Our object should be to impart vigor to the sluggish bowels, and to . place the fecal mass in the best possible condition for its onward progress. Succulent fruits and vegetables, and such other arti- cles as will leave a greater amount of residue in the bowel. I would especially recommend bread made from coarse flour or meal. If patients have no regular calling or improper vocations, enjoin systematic outdoor exercise, together with frequent tepid baths, massage and cold enemata. Also insist on a liberal amount of cold water as a drink, immediately before retiring in the evening, and in obstinate cases, again in the morning before the breakfast hour. Certain mineral waters are excellent for this purpose. They should have a regular hour to relieve them- selves. Tell them to be for once methodical and persistent. But a doctor must also prescribe medicine, for that would seem quite natural, besides the inexorable law of fate so decrees it. Medicines which increase peristalsis, give tone and energy to muscles and glands, and increased flow of mucus are some- times indicated. For this purpose cascara sagrada, aloes, podophylin, belladonna and strychnia may be exhibited. To unload the portal vessels and free the liver, are also indications to be met. Preparations of soda, such as the sulphite and bicarbonate, are useful and can be combined with the above. Before dismissing this subject, allow me to refer, in a more general way, to some of the difficulties to be overcome in the management of chonze constipatzon. I am fully persuaded that a faulty diet is the fruitful source of the many chronic ailments which we daily meet in our practice. Sir Henry Thompson, the noted English physician, says that more than one-half of all dis- eases come from errors in diet, and, strange as it may seem, the greatest error is to be found in our “staff of life,” and this, too, in a land of universal plenty, and in an age of miraculous inven- tion and discoveries; and among a people superlatively educated and refined. With us the staff of life should be the pearl of greatest price. The good book commands us not to cast our pearls before swine, but this is exactly what a great many people are doing every day, for the bread made from the finest grades of the “Patent Roller Process” flour, contains scarcely anything else but starch granules. The gluten and the inorganic com- 49 SATTLER—Constipation, Etc. 547 pounds, the most nutritious and health-imparting principles, are separated from the central portions of the wheat grains and fed to swine. Pure starch alone will not support animal life any 1ength of time. By actual experiments dogs have been starved to death when fed exclusively on this substance. A lady once observing an officer in the army toasting a piece of bread on the end of his sword, made the significant remark: “Why, my dear sºr, you are holding the staff of life on the point of death.” Should it ever be said of us that our staff of life, when partaken too exclusively, will bring us to the point of death P Solomon, when full of years and wisdom, declared : “There is no new thing under the sun.” He certainly did not then have in his mind's eye our bread, which is above all things else new, and by far too fresh to be digestible; the process of its manu- facture decidedly too new and refined to be nutritious. God, the creator and dispenser of all good, evidently did not intend to have His precious gifts so transformed and maltreated. The result of this practice is apparent and inevitable, and as long as individuals will indulge in this unwholesome and unnatural food, so long will chronic constipation be in our wake. AH/YS/O-ME/D/CA/L/S//.—A A&AEAE/. Y. BY G. H. MAYHUGH, M. D., WESTERVILLE, OHIO. Through the courtesy of the editor of this Journal, I am permitted to lay before its readers a brief reply to the editorial contained in the April issue, relating to physio-medicalism. I beg to premise my remarks with the statement that when I was solicited by the editor to formulate the principles of the physio- medical school of medicine, I did not understand that it was to be used as a basis for a public criticism of our school and of our posi- tion touching recently attempted medical legislation in Ohio; and further, having seen so much harm and no good come from sec- tarian medical discussion, I am decidedly opposed to such busi- ness. Hence, by this reply, I do not mean to seek further discus- 'sion. It is my belief that medical men can best serve humanity and best advance their respective schools, by devoting their time to investigation in the legitimate fields of physiological and thera- peutical research ; and that this done, they will have little time for sectarian bickerings. But the editorial above mentioned is so markedly out of the way, that I feel in duty bound to ask the privilege of replying. § WN 548 COMMUNICATIONS. I. “The only principle of this school is, that under no cir- cumstances will its believers administer poisons.” Physio-medi- calism has a broader foundation than one idea. Our rejection of poisons is but a conclusion to which our premises (principles) lead us. Physio-medicalism teaches that medicine is a science, not a bundle of empiricisms; that the basis of therapeutics is physi- ology, not pathology; that the body is maintained in health and restored to health when diseased, by an inherent vital force; and that the conservation of this vital energy is the highest duty of the physician. º \, 2. “A definition of the word poison would be interesting.” Physios have no purposely-devised definition. Personally, this one from Gardner suits me well enough : “That which, when applied externally, or taken into the human body, uniformly effects such a derangement in the animal economy as to produce disease.” 3. The inference, that the prescriptions of Physios, if examined, would show "that they, like the Homeos, have “aban- doned their principles, is wholly unjust. We doubt not there are some among us who pretend one thing and practice another; |but that, as a class, we are guilty of hypocrisy, we emphatically deny. And we submit the opinion that it is unbecoming and ungenerous, to say the least, in any medical man to make such insinuation regarding medical men. Suppose we paraphrase the motto of the Knights of the Garter, making it read: “Evil 272 him who evil thinks.” & 4. The editor is mistaken when he asserts that Physios were afraid to trust the governor, and that they sought to have representation by name in the board. We were just as generous as members of other schools, and we did not desire that names of schools should be used. We desired that the bill be made to read: “There shall be representation on said board of at least four schools of medicine,” instead of three, and the amendment we secured made that change, and that only. We did not seek to have our school name inserted, after it was agreed to drop all names of schools; and we did not ask for the amendment because we were afraid to trust our honored governor, but because it was our right to have recognition 272 //he Zaw, recognition stated and not implied, merely. We resent the charge that it was “impertinence ’’ and the “height of the ridiculous” on our part to ask for represen- tation ; and we assert that, though we have only a comparatively few practitioners in the State, and no college or hospital at pres- SATTLER—Constipation, Etc. 549 ent, we have as much intrinsic right to this representation as though we had a hundred thousand of each. We are one of the four recognized schools of medicine, having our own text-books and colleges. Our patrons in Ohio number many thousands of Ohio's best and most intelligent people. Few in numbers ? Yes, but do numbers alone give respectability and ability to prac- tice medicine P Shall the question of numbers dominate the set- tlement of a question of right and justice P “Taxation without representation” because few in numbers ? Suppose that in some - State of the United States a board was to be created, there being no regular college or hospital in the State, and only about one hundred practitioners of that school, would you think it just to Reep these “regulars” out of the board 2 No, you would make “Rome howl” if such a thing were attempted. Pity profound that men can not rise to a higher argument—cannot show reason worthy the conclusion sought. 6. Referring to the statement that the report of the com- missioner of education for 1888-9, shows that the physio-medical school had but one college in the country at that time, we must say that the man who gathered those statistics was not capable, or else intentionally perverted the truth. At that time there were two colleges of our school, one at Indianapolis, the other at Chicago. These colleges are both giving instruction on a par with that given in any medical college in the land, and both require three terms of six months each before graduation, with one previous year under a preceptor. # 7. That Physios demanded representation on the board, “not in the interest of justice, but as a means of defeating the bill,” is an imputation on our honor as unjust as it is unfounded, and is an utterance unworthy the high moral standing of him who makes it. Physios, standing as they do before the intel- 1ectual people of Ohio, and making honorable claim to recogni- tion as scientific medical men, would have been basely false to the trust imposed upon them and their consciences, had they failed to make open and manly claim, as we did, for recognition on the board whose creation was sought. Having made this claim, we firmly insist that our motives in doing so be not mis- represented. 8. “We do not think they care to have their methods investigated nor their graduates examined.” This statement is on a par with that last noticed, and has, in part, the same answer. Further, we would say, physio-medicalists have no “unwriten work,” no secret methods. And one thing is certain, 550 COMMUNICATIONS. they do not bind the spirit of their practitioners by any Hippo- cratic oath, thereby fettering their liberty of conscience, though they do follow Hippocrates very closely, in that they say, with him, “I will give no person any poison;” and whenever the law demands of our graduates, along with the graduates of other schools, an examination, we will take our place cheerfully, and carry off as high a grade as those of other schools. But we will ever insist that, when any examining board is created, we have at least one representative in that board ; and this will we do, even though superficial reasoning show us to be “impertinent” " and “ridiculous.” We trust that our friend, the editor, will get upon a higher plane, if he should ever again have occasion to refer to his numerically weak, yet sincere, fellow-laborers in the medical field. AVA. W. YOACA /A2 7TZTAEA’ OAM OA” 7TA/OAAE/O/C SOA’GAZA’Y_ A/P /O/WZ SPL/NZS WOW IN USA. IN THE VAA’/O OVS. ATOS/2/7TA/L,S. BY STEWART L. M'CURDY, DENNISON, OHIO. Professor of Orthopedic and Clinical Surgery, Ohio Medical University, Columbus, O.; Lecturer on Topographical Anatomy and Landmarks, Western Penn. Medical College, Pittsburg, Penn.; Surgeon P., C., C. & St. L. Ry. * Sayre did a remarkable thing when he developed the prin- ciple of the ratchet and key traction in the treatment of hip dis- eases. He made a second stride when he began the use of plaster-of-Paris. Taylor made another wonderful stride when he extended the traction brace below the foot, serving as a support for the body in walking. r Thomas made another wonderful stride when he devised his splint, which immobilizes the joint. Phelps did a more wonderful thing when he developed his splint, which is a happy combination of Sayre, the Taylor and Thomas ideas, and in addition to all these he adds lateral trac- tion. In looking over the history of hip splints, I find very little variation in the practice during the past thirty years, except dur- ing the past few years what is known as the “American Hip Splint” ” was described by Dr. Henry G. Davis and Dr. Lewis *Dr. A. B. Judson, N. Y. Transactions, 9th International Medical Congress. £ M’CURDY—AVew York Zetter on Orthopedic Surgery. 551 A. Sayre, both in the same issue of the American Medical Monthly, in 1860. In these articles two points, viz.: Ischiatic or perineal support, with extension by means of adhesive straps from the leg, were described in both papers. In the many modi- fications that have been made up to this time, these two points flave been the prominent features. To Dr. Edmund Andrews, of Chicago, and Dr. C. Fayette Taylor, of New York, is due the credit of extending the splint beyond the foot so as to take the weight of the body from the dis- eased joint. Dr. Taylor describes the ratchet and key method of extension in his monograph, published in 1873. The splints used in the various hospitals in New York City in the treatment of hip joint diseases at the present time, are described and illustrated in the following pages. What is known as the Polyclinic splint is the most universally used brace in the treatment of hip joint disease. As is shown in the cut (No. 1) it is No. 1. (Polyclinic.) § composed of a long external upright bar, extending above from a pelvic band to two or three inches below the foot. The pelvic band is secured at right angle to the upright and passes around the pelvis in front and back to a point half way from the median line to anterzor superior spine. In this brace two perineal bands are used and are secured to the pelvic band by buckles. Just above the knee is a band of iron to hold the leg parallel with the brace. At the lower end the brace is bent across under the foot, and after being covered with sole-leather, serves to walk on. Trac- tion is made by adhesive straps along the outer and inner sides of the leg, allowing them to extend from just above the shoe-top to near the perineum. A strap running from the foot piece is secured in buckles attached to the lower ends of the adhesive straps. The leg is held in the brace by two straps, one above the knee and one at the shoe top. This brace is and has been used at the Institution for Ruptured and Crippled almost uni- versally. It is also used at the Polyclinic. I have been unable to get any one to father this brace, but it is no doubt a modifica- tion of Dr. Judson's brace. This brace produces traction, and in a measure, secures the limb. It does not hold the hip quiet, # 552 COMMUNICATIONS. neither does it prevent angular deformity. I had opportunity to examine a great number of cases using the Polyclinic splint under Dr. Whitman, and the results obtained in many cases are very satisfactory. In order to prevent angular deformity, a minature, or short Thomas is used along with the Polyclinic. This combination it seems to me, is a most desirable one, and secures: I, Traction, 2, Immobilization, to my mind the essentials in the successful management of these troubles. A cork sole is worn on the well foot in order to make the diseased member pendant. In the Clinic I saw in one day four new cases of hip disease in babies under one year, with the disease in its earliest possible stage, and it is not unusual to have IO to I5 hip cases daily. Dr. A. B. Judson, of the New York Hospital, has a splint in some respects similar to the Polyclinic splint. It differs, how- ever, in that he has but one perineal band and he does not use buckles to secure the perineal strap to the pelvic band. This is done so that the patient has less chance to loosen buckles and thus diminish the desired amount of traction. The pelvic bands are made of hard rubber and are interchangeable. Through the courtesy of Dr. Judson, I had the privileges of his clinics and was enabled to make careful examination of his cases, and his results were very good, indeed. In one case that was passing through the experimental period in view of discarding the brace, there was no angular deformity, with very fair motion. This case had abscesses which made a voluntary opening. To my mind the greatest advance made in the treatment of hip disease in a dozen years, is the introduction into this country of the splint devised and used by Dr. Hugh Owen Thomas, of No. 2. (Thomas Single.) Liverpool, England, and which bears his name. The Thomas splint has a champion in Dr. John Ridlon, who believes not only in the hip splint of Thomas, but in all other of the innumerable original methods of this mechanical surgeon. The Thomas splint, as shown in figures 2 and 3, completely immobilizes the joint. It prevents angular deformity, but it does not produce ** M’CURDy—Mew York Zetter on Orthopedic Surgery. 553 traction, and those who believe in traction in the treatment of ‘hip disease, are either slow to adopt the brace, or if they desire No. 3. (Thomas Double.) the immobilization feature, are found to extend the bar below the foot in order to make traction. This improvement has been made by Bradford and others. Dr. Thomas advises the use of a patten on the well foot about two inches high, with the use of crutches. During my service of some weeks with Dr. Ridlon, I did not see one case in which he used the patten or crutches. This is rather experimental on the part of Dr. Ridlon, and apparently tempting Providence. Nevertheless, he is getting good results. The Thomas splint in the hands of Dr. Ridlon certainly does good work. He is able to prevent flexion, or if flexion exists when treatment is begun, the splint is bent almost to the angle of flexion, and gradually brought down to complete extension. In cases of adduction or abduction, a band is thrown around the side of the body from the upright, and this deform- ity can be controlled. If rotation exists, Dr. Ridlon extends the upright bar down around the heel and foot to the toes, and a shoe over this controls this deformity. For those who desire to immobilize the joint in these cases, the Thomas splint is un- doubtedly the best. Dr. A. M. Phelps, Prof. of Orthopedic Surgery at the New York Post-graduate School and Hospital, has succeeded in making a combination of the leading features of all the hip splints. His splint immobilizes as does the Thomas, but in my opinion not as effectually, because his upright bar is along the outside of the trochanter and body instead of posteriorly as in the Thomas. Phelps' splint makes traction in about the same manner as does the Polyclinic, the Judson, the splint used by Dr. Shaffer. All of these have the extension beyond the foot, and require either crutches or a patten. r 554 COMMUNICATIONS. Cut 4 shows the Phelps splint with external upright and lateral traction band. No. 5 shows the same applied except the upright bar is on the inside of the leg instead of the outside, Riº | | jº º * No. 4. (Phelps.) V No. 5. (Phelps.) Dr. Shaffer, who is surgeon-in-chief to the N. Y. Orthopedic Hospital, and Orthopedic Surgeon to St. Luke's, uses a splint which is constructed very much after the style of the Judson. It has a ratchet-and-key extension, as has the Sayre and the Judson. Dr. T. Halstead Myers, Dr. Shaffer's assistant, is using a spiral spring to produce traction in addition to the ratchet traction. This, to my mind, is a step in the right direction. Drs. Gibney and Townsend use exclusively the Polyclinic splint in advanced cases, and the plaster-of-Paris 'spica in early cases. They treat more hip cases than any one else in this country, and while the Polyclinic splint , is generally used, other methods of treatment are seen at the Clinic. - M’CURDY—AWew York Zetter on Orthopedic Surgery. 555 / The Sayre brace, known to every one in this country and many foreign lands, is not used outside of the Bellevue Clinic. . The principle of traction is afforded by the use of this splint, No. 6. (Sayre.) with articular motion, and is the only one of the many splints. used in New York that does allow free motion of the joint, and this is one of the principles of the splint, which, as you will observe, is not desirable in the use of other methods, but objectionable. * One of the best orthopedic surgeons said to me in talking about “his” splint, that a professor of Orthopedic surgery in a western medical college, after having examined into the merits of the various appliances devised for the same purpose, said: “You may send me your splint for I want to use it in my prac- tice. It suits me exactly.”. This, if taken literally, is to my notion evidence of a lack of mechanical ingenuity on the part of the western professor. I am inclined to think that no one can practice orthopedic surgery successfully and adopt any stereotyped method, any more than can a general surgeon do two abdominal sections exactly alike. No two cases are exactly alike, and hence they must be treated as individual cases with the varying symptoms. I do not mean to say that one must devise a new splint for every case treated, but I do say that unless the case is studied per se, the best results cannot be expected. The question of the proper time to discard a hip brace is one that requires more consideration than to make a diagnosis. If the brace is removed too soon, the old trouble, possibly latent, and which under the continued use of a brace, would go on to recovery, will return and the same course of abeesses, etc. will continue for months or years. The only brief rule is 556 COMMUNICATIONS. to remove the brace and make daily examinations of the limb. If angular deformity does not increase, the case may be pro- nounced cured. If, however, angular deformity does increase, the brace should be re-applied. - (To be Contzmued.) :* THE newspaper advocacy of the advertising “doctor” as a Iman of “progressive” ideas sounds exceedingly strange to the . student of newspaper evolution, who has seen in the earlier English newspapers the familiar puffs of quacks of modern mewspapers. In the eighteenth century more than one satirist 1ashed the practice. Even the gentle Oliver Goldsmith used these “enterprising” medical men as the following extreme comparison for contempt: *. | As puffing quacks some caitiff wretch procure, To swear the drop or pill had wrought a cure. In his Chinese Letters Goldsmith satirizes even more severely quack advertisements of his day as mendacious as in ours. Crabbe in the “Borough,” thus applied the lash to the use of “cured and grateful patients:”. But now our quacks are gamesters, and they play With craft and skill to ruin and betray, With monstrous promise they delude the mind, And thrive on all that tortures humankind. Void of all honor, avaricious, rash. And twenty names of cubblers turned to squires Aid the bold language of these brushless liars : And then in many a paper through the year, Must cures and cases, oaths and proofs appear; Men snatched from graves as they were dropping in. —Med. Standard. THE PAYMENT FOR MEDICAL SERVICEs.-The following points were recently decided in a California case : A physician called by a man to attend a woman, supposed to be his wife, can recover for his services from the person summoning him, although the parties are not, in fact, legally married. One who calls a physician to attend a person whom he represents to be his wife, is estopped to deny that fact in an action for his ser- vices rendered on the faith of such representation. A’OA&M ULA—Listerine is the essential Antiseptic constituent of Thyme, Eucalyptus, Baptisia, Gaultheria and Mentha Arvensis, in combination. Æach fluid drachm. also contains two grains of refined and purified Benzo-boracic Acid. - DOSE.-/nternally: One teaspoonful three or more times a day (as indicated) either full strength or diluted zwith zvater, or in combination zvițh other drugs. As a local application to ulcers, zºoznds and abscesses, or as a gargle, mouth-zºash, inhalamt or injection, it can be used ad libitum, diluted as necessary for zaried conditions. LISTERINE is a non-toxic, non-irritating and non-escharotic antiseptic, composed of ozoniferous essences, vegetable antiseptics and benzo-boracic acid; miscible with water in any proportion and in agreeable strength sufficiently powerful to make and maintain surgical cleanliness in the treatment of all parts of the human body, and particularly adapted to the field of preventive medi- cine—personal prophylaxis. - l In the treatment of catarrhal conditions of the mucous membranes, of every locality, LISTERINE occupies an important position on account of its free- dom from possibility of poisonous effect, its efficacy, its detergent and antiphlo- gistic properties and the cooling and refreshing after-effect which its use imparts to the tissues, These properties have won for LISTERINE a first place in the lying in room, and in the treatment of uterine and vaginal diseases. In those forms of dyspepsia which are associated with the formation of gases, acid eructations and fermentative action in the contents of the stomach, LISTERINE has proven most valuable. In many cases, the LISTERINE. alone in teaspoonful doses, or diluted with one or two parts water or glycerine, will give entire relief. . e The gratefully stimulating properties of LISTERINE assist in the effec- tive anti-fermentative and antiseptic influence which this preparation exerts upon the stomach and duodenum, and will aid in a remarkable degree in over- coming the distressing symptoms of that class of disorders produced by the fermentation of food, the decomposition of organic matter, the endo-development of fetid gases, and the presence or attack of low forms of microzoic life. Descriptive Literature, Embodying a Treatise upon the Summer Gomplaints of Infants and Ghildren, MAILED GRATIS UPON REQUEST. LAMBERT PHARMACAL CO, St. Louis, Mo. FOREIGN DEPOTS : W. Lloyd Wood, Toronto. Geo. Baumann, Dresden. Wilanowa Hermanos y Cia., Barcalona. S. Maw, Son & Thompson, London, E. C. Roberts & Co., Paris. A. B. Zanetta, Matanzas, Cuba. THEmostPERFECTFORMOFDosimETRY IS AFFORDED BY The term Parvule, from Parvum (small), is applied to a new class of remedies (Warner & Co.'s) in the form of minute pills, containing minumum doses for frequent repeti- tion in cases of children and adults. It is claimed by some practitioners that small doses, given at short intervals, exert a more salutary effect. Sidney Ringer, M. D., in his recent works on Therapeutics, sustains this theory in a great variety of cases. Parvules of Calomel, 1-20 Med. Prop.—Alterative, Purgative. DOSE.—1 to 2 every hour. Two Parvules of Calomel, taken every hour, until five or six doses are administered (which will comprise but half a grain), produce an activity of the liver, which will be followed by bilious dejections and beneficial effects, that twenty grains of Blue Mass or ten grains of Colomel rarely cause, and sickness of the stomach does not usually follow. Parvules of Calomel and Ipecac. R. Galomel, 1-10 gr. Ipecac, 1-10 gr. Med. Prop.–Alterative, Purgative. DOSE.-1 to 2 every hour. Two Parvules of Calomel and Ipecac, taken every hour until five or six doses are administered (which will comprise but a grain of Calomel), produce an activity of the liver, which will be followed by bilious dejections and beneficial effects, that twenty grains of Blue Mass or ten grains of Calomel rarely cause, sickness of the stomach does not usually follow. Tarvules of Aloin, 1-10. Med. Prop.—A most desirable Cathartic. The most useful application of this Parvule is in periodic irregularities—Dysmenorrhoe and Amenorrhoe. They should be given in doses of one or two every evening at and about the expected time. e DOSE.—4 to 6 at once. This number of Parvules, take at any time, will be found to exert an easy, prompt and ample Cathartic effect, unattended with nausea, and in all respects furnishing the most a perient and cathartic preparation in use. For habitual constipation, they replace when taken in single parvules the various medicated waters, avoiding the quantity required by the latter as a dose, which fills the stomach and deranges the digestive Orgau.S. Parvules of Podophyllin, 1-40. Med. Prop.–Cathartic, Cholagogue. Two Parvules of Podophyllin, administered three times a day will re-establish and regu- 1ate the peristaltic action and relieve habitual constipation, add tone to the liver, and invigorate the digestive functions. Parvules of Arsen it : Patash, 1-100. WARNER & CO.) This Parvule will he of great use to physicians, as two Parvules represent the equivalent of one drop of Fowler's Solution, so that physicians can regulate the dose by giving one or more Parvules every hour. Parvules of Corrosive Sublimate, 1-100. (WARNER & CO.) Dr. Ringer, in his treatise, lays great stress upon the efficacy of minimum doses o corrosive sublimate in the treatment of Diarrhoea, whether the stools contain blood or not. Parvules of Nux Womica, 1-50. (WARNER & CO.) Nux Vomica, according to Ringer, is possessed of real curative powers for sick headache, accompanied with acute gastric catarrh, whether due to error in diet, constipation, or no apparent cause. He regards it, administered in small and frequently repeated doses, as useful in many disturbances of the gastric functions. W. H. WARNER & CO., Philadelphia. * MEDICINE LECTURES VERSUS RECITATIONS IN MEDICAL COLLEGES.— Benry Bixby Hemenway, A. M., M. D., of Evanston, Ill., in Med. AVews. According to an ancient custom, adopted in every regular and well-governed college for medical instruction in this country, most of the didactic teaching is by lectures. Is it wise to adhere to the old system 2 The lecture was originally the means used for all education. With the progress in the art of printing and with the advances made in the science of pedagogy in non-professional schools, the lecture has largely given place to the use of text-books. Even in some professional schools— theologic, for example—the lecture is of far less importance than the daily examination from a prescribed text-book. - Is it not strange that the disciples of Esculapius so long continue to use llis methods of instruction ? In favor of the lecture-system it must be admitted that when the professor can speak at all fluently, he can make a good impression with less study. He can cover up his own lack of reading, and with a very superficial knowledge of his subject occupy his hour in a pleasing manner. Some time since I Beard a didactic lecture upon a subject in materia medica. The speaker spoke easily and occupied his entire time, but he said practically nothing. He told the origin of the drug, and the fact that it had been used in medicine from very early times. He did not tell the composition, method of preparation, dose, or exact physiologic action. He did give a few of the gross effects of the drug, and named some diseases in which it is used, but failed to give the exact indications for its administration. It would be unjust to regard such teaching as representative of the work of our schools, but similar lectures are given more or less frequently in most of them. When we say that the lecture was the original form of instruction, we do not necessarily mean that questions were excluded, as they are in modern lectures. On the contrary, that prince of teachers, Socrates, made his lectures far more inter- esting and effective by frequent interrogations. It has been claimed for the pure lecture-system that it gives a better opportunity for the teacher to impress his individuality 557 558 SELECTIONs. npon the student, but I feel that this is not the truth. The lec- turer gives his ideas, and the student absorbs what he can, but is not prepared to recognize what ideas are original. Everyone who has a broad acquaintance with the professional schools must recognize the fact that the best students come, as a rule, from those institutions in which the quiz is a special feature; and, probably, he will further note that he remembers most viv- idly the instructions received from his quiz-master. The lecture system tends to narrow the student's mind. The student rarely knows of what the next lecture is to treat, and so cannot, if he would, look up the ideas of others. After the lecture he is inclined to learn all that he can of the profes- sor’s lecture rather than spend his time in reading his text-books. In fact, some professors give their students to distinctly under- stand that they must take their professor's ideas, and not those of other authorities. It is only a small man who would thus give his pse dºrzt. It frequently happens that a lecturer is misunderstood, when both the speaker and the hearer suppose that there is a perfect understanding. The error is seldom discovered except by the l112. Cl The present method does not at all prepare the student for his life-work. He may practically go to sleep while listening to a dull lecture, or he may be spell-bound by the eloquent speaker. At best, there is a decided feeling of exhaustion after listening to 1ectures for a few weeks. Original thought or reasoning is reduced to a minimum. º Against the quiz method of instruction it is often urged that it takes too long to get around a large class to devote much time to that method. True it does take time, but, so far as I know, in our professional schools the quiz is not generally utilized in the most profitable manner. A few hurried questions are occasionally asked in regard to the subject of past lectures only. I would suggest that in our didactic teaching the text-book be more generally used. I remember having provided myself, during my first year at college, with several text-books recom- mended in the catalogue. In pathology, for example, it was so absolutely impossible to follow the professor with the text- book that the student has never yet been able to wade through the pages of his German author. Having been unable to com- prehend the work when studying the subject, he is now afflicted with mental dyspepsia and nausea whenever he reads a few pages of that particular book. The teacher should be a leader, SELECTIONS. 559 or he is a crammer instead of an educator. He should instruct the student how to read. A poor book as a text, thoroughly mastered, is far better than a good book glanced at. When one text-book on a subject is understood by the student, others can be more easily comprehended. What is the object of the ordinary lecture on anatomy 2 It is practically only a recital of a few pages from Gray, and gen- erally less accurate. In histology, chemistry, anatomy, and to some degree in pathology and materia medica, the most profitable work can be done in the laboratory. The student will learn more in less time, and with less fatigue. In other cases, even including as far as possible clinical teaching, an assigned lesson should be given out beforehand. As far as possible, the teacher should make his remarks explanatory and supplementary to the answers of the students. In that way the student is practically obliged to study, and he soon learns to read different authors with discrimination. + If it is a fact that the student remembers most vividly the instructions in the quiz-class ; if in the quiz-class the student can most clearly comprehend the ideas of the teacher, is it not a foolish custom to assign the quiz-classes to assistants, sometimes undergraduates ? There was a time when the primary school was assigned to the poorest teacher. To-day the best school-boards regard the primary teacher's place as the most difficult to fill. It is to be hoped that a like change will soon be noticed in the gen- eral opinion relative to the quiz-master. *.* We would not entirely abolish the lecture system, but rather revive the method of Socrates, and adapt it to the present time. By the use of text-books the student may be prepared for the questioner, and the lecture should be limited to discussing with the class disputed points, or emphasizing important subjects. A REMARKABLE ADDRESS.—Dr. John B. Roberts, in his presidential address, made use of the following remarkable state- InentS : “The Philadelphia County Medical Society should be lib- eral enough in its policy to accept as a member any physician whose education and personal character make him a fit associate for intelligent men. Let the test be not the school or college from which he received his diploma, but an education enabling him to understand and appreciate the science of medicine, coupled with an honest purpose to treat his patients by all means or methods which experience, investigation and research 56o $ELECTIONS. show to be serviceable. His political, religious and social beliefs or affiliations should not disqualify him ; nor should his opin- ion that in similars the physician will sometimes find a remedy of value in the treatment of disease. “There are those who believe that, in ‘like cures like' is found the only and the universal law of therapeutics, but their number is increasingly small. Those in this city who practice only in accordance with this exclusive dogma can probably be counted on one's fingers. A pretty extensive study of the litera- ture of sectarian medicine has convinced me that the time has come when we should say to all educated and honorable physi- cians of this city, even to those who have graduated from sec- tarian medical itstitutions, ‘The Philadelphia County Medical Society is open to you to become members, if your beliefs do not necessitate the “rejection of the accumulated experience of the profession and of the aids actually furnished by anatomy, physi- ology, pathology and organic chemistry.’” Q “I know that this has always been the unspoken attitude of this society’s law; but it needs be said loudly and openly. Church unity is the aim of the religious sects of the day; medi- cal unity should be the aim of professional societies. “It is unreasonable to expect the physicians whose boyhood and early professional life have been spent in the atmosphere of sectarianism to make a formal public recantation. Acquiesence iu the results of scientific therapeutics is all that should be demanded of them.” $ & If Dr. Roberts is supported by his society, the beginning of the end has been reached. The Times has been urging for a long time that an overture should come from the dominant scool, and it has The invitation could not have emanated from a better source than from conservative old Philadelphia, nor from one more unexpected ! Dr. Robert's proposition is honorable and magnanimous, and should be accepted by all who do not reject the accumulated experience of the profession and of the aids actually furnished by anatomy, physiology, pathology and organic chemistry. We do not know of one in the so-called homeopathic school who does reject these experiences and agencies, and Dr. Roberts' overture should be received graciously and with appreciation, in the spirit in which it is offered, by those to whom it comes. No formal recantation is asked, no creed to be subscribed to, all is open and above-board, humanitarian and brotherly Dr. Roberts proposes that the invitation to medical unity shall be heralded upon the house-tops—“ loudly and openly!” It SELECTIONs. 56I is not necessary for us to say that these are the sentiments we have been urging for many years, it is well known, and now that the climax has come from such a source, we are truly thankful. Now let our Medical Society of the County of New York take a similar step. This society some years since started loravely in this direction, but soon was frightened into a back- track which resulted in an unfortunate by-law requiring “recan- fation” of all candidates to membership who had ever practiced sectarian medicine, and not a candidate has appeared to make the recantation This by-law effectually closed the door to many who would otherwise have sought membership, and medical unity received a set-back. " Wipe out this bigoted by-law and accept the policy proposed by Dr. Roberts, and sectarian medicine will receive a great shock in this vicinity. Who will make the motion to rescind the obnoxious by-law P The next move should be for the homeopathic societis to drop the sectarian name, and change their by-laws to agree therewith. Then there need be no disbanding of societies, and those who see fit could continue membership with their friends and acquain- tances, and confine their discussions, if they want to, to the appli- cation of the rule of similars in medicine, or anything else they choose. They would then really become a “specialty” in medi- cine, as proposed by Dr. Conrad Wesselheft some time ago.—AV. Y. Med. 77mes (Homeopathic). SOME POINTS IN THE SYMPTOMATOLOGY OF GENERAL PAR- ALYSIs OF THE INSANE.—(Philip Zenner, A. M., M. D., Clinical Lecturer on Diseases of the Nervous System in the Medical Col- 1ege of Ohio, in Zance/-C/inzc.) The early recognition of this disease is of highest consequence, for it may avert financial or worse calamities, and it is only then, if ever, that anything can be hoped from therapeutical measures. The symptoms are mainly of a mental or motor character. There is a progressive failure of mental powers, first of the pow- •ers of attention and mental concentration, then of judgment, memory, will-power, and of the affections and emotions, this fail- ure being attended by the presence of delusions, most commonly the delirium of grandeur. At the same time motor phenomena become manifest; first tremor of the lips and tongue, then pare. sis of the facial muscles and some difficulties of speech. The latter is a sort of stumbling articulation ; Syllables are not enun- p 562 SELECTIONs. ciated distinctly, run into one another, or are left out altogether. The peculiarity of these paralyses is that they are only partial— do not become complete, because they are of cortical origin. But other paralytic manifestations more, decided in character often appear. These are, the paraplegia, or spastic or ataxic gait, due to changes in the spinal cord. The disease has an average duration of three years. Usually there is a gradual progress from bad to worse, though periods of improvement, which may give rise to false hopes and bitter disappointment, sometimes occur. The course of the disease is, also, not infrequently complicated by periods of maniacal excite- ment and paroxysmal seizures of an apoplectic or epileptic character. & The earliest symptoms are mental ones, and come on so insidiously that they are scarcely recognized at the time, though they may be afterwards recalled. First there is a falling off in the power of attention, of concentration of mind or mental vigor and endurance, and, with these, of niceness of discrimination and judgment, as well as quickness of comprehension. If these changes are not obseryed in the ordinary routine of daily life, they become apparent when high demands are made upon the intellect, when new undertakings call for special or original thought, etc. The memory, also, begins to fail. This is, at first, true only of recent occurrences, the events of the day, etc., while old recollections remain long unimpaired. One frequently observes, after the disease has made some progress, that in a conversation revealing a remarkable recollection of incidents in times long past, the same statements may be unwittingly repeated more than once, thus bringing into striking contrast the forgetfulness of the present and recollection of the past. With these changes in purely intellectual qualities, atten- tion, judgment and understanding, there will be found changes in the affective life. The patient takes less interest in his busi- ness and other relations. His affections are less strong; illness or death in his family affect him less than formerly. At the same time he appears in some respects more emotional ; he becomes more irritable, laughs or cries easily, though these emotions are far less deep than would be normal to him. He gradually |becomes careless in personal and business methods, indifferent in His own affairs, regardless of the feelings of others, and may mani- fest a tendency to indecent words or actions. Such changes, especially whilst slightly marked, may escape attention a long time, or, at least, not be supposed to have any SELECTIONS. 563 pathological significance. Even if the patient falls into the hands of a physician, and the suspicions of the latter be aroused, he may fail to obtain any history of mental symptoms, and it may require long and patient observation on his own part to detect such manifestations. But while these early mental symp- toms so easily elude observation, or when observed, may be difficult to interpret, fortunately for the diagnosis, certain objec- tive symptoms are usually manifested at the same time, which, when related to the mental condition, have a high diagnostic import. These symptoms are inequality of the pupils, tremor of the lips and tongue, slight facial paralysis, and slight speech disturbances. But these symptons, also, may be so slightly marked that they must be carefully sought, if not to be over- looked. * As before stated, maniacal periods often occur in the course of the disease. If such a state occurs early, before the disease has yet been recognized, it is said to usher in the disease. Errors of this kind are not infrequent. I have seen a number of cases in which the disease was supposed to have begun abruptly, as a sort of explosion, in which a careful investigation revealed a prior change, a slow, insidious beginning. I dwell specially upon this point, to emphasize the importance of looking for early symptoms. In such cases the ocular symptoms, the condition of the pupils, may direct attention to the true condition. Ocular symptoms are of such high diagnostic import, and so frequently found at an early stage of the disease, that they should always be sought for. The most common of these is inequality in the size of the pupils. Also, very commonly one or both pupils respond to light very sluggishly or not at all. In some instances there is what is termed spinal myosis: the pupils are quite small, do not respond to light, but become smaller on convergence of the eyes. Some years ago, in a paper read before the American Medical Association, I called attention to the importance of this symptom, in conjunction with loss of the knee-jerk, in helping to a diagnosis of general paralysis. The paper was based upon the examination of a large number of cases, and it was found that this combination of symptoms was found in a larger pro- portion of the cases of general paralysis, and in very few of the other forms of insanity. j I must again emphasize the importance of seeking objective symptoms in cases where suspicious metal symptoms are found. sº 564 SELECTIONs. THE PEPSIN STANDARD ADVANCED.—There are many varie- ties of pepsin in market, differing widely in purity, activity and adaptability for therapeutic use. Whether pepsin be prescribed with success or failure de- pends on its quality. The physician prescribing pepsin should demand in his prescription a pepsin product which he has con- vinced himself is pure and active and can be relied upon. By prolonged investigation of digestive ferments the stan- dard has been again and again advanced. It is announced by Parke, Davis & Co., that they have succeeded in making a pepsin , capable of digesting 4,000 times its weight of coagulated egg albumen under the conditions of the pharmacopeial test. This product is prepared by a new and original process. which renders it aseptic, free from odor, agreeable in taste to the most sensitive palate, and superior to any pepsin product hith- erto made. In these days, when novices and pork-packers are flooding the market with pepsins, it behooves the careful physician to see that his prescriptions are filled by the product of some reputable manufacturing chemist. PIN SENSATION IN THE THROAT.—Dr. John Dunn, of Rich- mond, Virginia, reports, in the AV. Y. Med, /ournal five cases of pin sensation in the throat, in all of which he was able to find, on investigating the throat with a probe, a point of hyperemia or granulation, on touching which the patient exclaimed : “That is the point.” This point was found invariably about two inches above the point at which the patient located the sensation, by pressure upon the outside. It is not uncommon for physicians to meet with these cases, usually where the patient imagines that he or she has swallowed a pin or fragment of bone, or other similar material. On touching the point with caustic, the sensa- tion disappeared. OBSTETRICS GYNECOLOGICAL OPERATIONS, Calgut 2m. — Dr. Wm. Goodell (Therapeutical Gazette) says: The objections urged by surgeons against the use of catgut are: the difficulty of steri- lizing dead animal tissue, the liability of its knots to untie, and its short life. These traditional fears regarding its use I have shared in common with the great majority of English-speaking SELECTIONS. 565 surgeons. But very recent experience has proved to me that they are in a great measure groundless, and that we have in catgut a most valuable agent—one which cannot be replaced by anything else. Having had several ventral herniae after abdominal operations, I have brought the tissues together with deep sutures placed four to the inch, inclosing a liberal amount of tissue, and re-enforcing these with several series of continu- ous catgut sutures, approximating similar tissues on opposite sides of the wound, and have not had a single case of hernia since. An advantage in using catgut in enteric surgery is that the serous surfaces quickly adhere, and if by chance the needle perforates the lumen of the bowel, the catgut quickly swells, corking the needle hole, and prevents fecal leakage. In operations upon the vagina, the radical cure of hernia and of anal fistula, the removal of the coccyx, the extirpation of vulvo-vaginal glands, and of labial cysts and tumors, and the amputation of hypertrophied and prolapsed cervix uteri, catgut sutures will be found to answer admirably. The ability of uniting, by an absorbable and buried suture, layer after layer of a deep wound, in such a loose and vascular tissue as that of the labia, takes away the dangers of hemorrhage, of abscess, and of sloughing. Mere surface sutures of catgut are too short lived and cannot be depended on, hence I have never used them in recto-vaginal and vesico-vaginal fistulae and in 1acerations of the cervix. Neither should they be used in complete lacerations of the perineum, unless re-enforced by deep sutures of silver wire or of silk-worm gut. I have never used catgut in ligating a large vessel until after seeing, in Berlin, Drs. Martin, Mackenrodt, and Winter fearlessly using it in tying pedicles of ovarian tumors, and ligating the broad ligaments in sections in both vaginal and abdominal hysterectomies. Since then I have been ligating with catgut only, the broad ligaments and all the vessels both large and small, nor has the number of these ligations ever made me feel anxious. In tying the pedicle of a large ovarian tumor, one should not trust to a single ligature of catgut, as with silk in the Staffordshire knot, but successively, the outer, the inner, and the middle third with a separate No. 3 or No. 4 German gut ligature. In cases where I have used catgut in vaginal hysterectomies, the patients could turn about from side to side and move about in bed with freedom denied to patients after abdominal section. Moreover, as they are absorbed and drop off spontaneously, the patients are saved the annoyance of 566 *-. SELECTIONs. repeated speculum examinations and tugs on ends of the ligatures to remove them, The mode of preparation of catgut which I have adopted is as follows: The unprepared gut comes in greasy coils of a dark amber color. To dissolve out the fat, these are placed in com- mercial ether for from twenty-four to forty-eight hours, according to the size of the gut ; and if the gut is of the larger sizes, the ether is changed once. The gut is now immersed for forty-eight hours in a I-IOOO alcoholic solution of corrosive sublimate. It is then wound on glass spools by surgically clean hands and Rept permanently for use in a mixture of two parts of oil of juniper to one of alcohol, which is occasionally changed. When needed for an operation, I transfer the requisite number of spools to a mixture of one part of glycerine, which has been sterilized by heat, to nine of alcohol. This gives the gut greater smooth- ness and pliability. Thus prepared, it will last in the tissues of the body from a week to ten days. PREGNANCY AT THE AGE OF FIFTY-NINE.—Dr. E. Derasse (Gazette Medica/e de Ziege, October 1st, 1891,) saw in his con- sulting room in August, 1889, a lady with a swelling of the abdomen. She was 59 years of age, and had been a widow for twenty years. The tumor was taken, by one of her medical attendants, for a uterine fibroid, and by another for a cyst. Arrangement had even been made for an operation. Dr. Derasse, on examining the tumor, which was uniform with the uterus, noticed a sensation as though something was moving inside it. On auscultation fetal heart sounds could be heard; ballotement was also clear. The breasts were already well developed and heavy. After careful investigation of the case it transpired that the elderly patient had a young lover. On December 21st, 1889, she was delivered of a fine boy. She was then aged 59 years and 5 months, Dr. Derasse having succeeded in obtaining her birth certificate. She suckled her child well, and weaned it up- on her sixtieth birthday. She stated that she had ceased to menstruate at 50 and she had a married daughter 40 years old. Dr. Derasse refers to the Dictionnaire Encyclopedigue where several cases are recorded where mothers suckled their children at the age of 60, or even later.—Brzt. Med. /öur. ONE THOUSAND CASES OF LABOR WITHOUT A "DEATH.— This is the result obtained at the Preston Retreat, by Dr. Joseph Price. There had been one death in the building, but that occurred in a case picked up by the patrol and brought to the SELECTIONS. 567 institution in convulsions and completely comatose. No urine could be found in the bladder. The patient died shortly after admission and it was thought that this case could be properly omitted. Dr. Price attributes the good results to refinement in detail which is practiced, and to the application to these cases of the principles of abdominal surgery. The woman, during and for a period after labor, is a wounded woman. In this series of one thousand cases a number of compli- cated labors were dealt with successfully, both as regards the mother and child. Many feeble and impoverished subjects were treated. The patients are admitted two weeks before labor and remain four weeks after labor. The toilet begins on admission, with a bath, a laxative, and clean clothing. Until the occur- rence of labor, the woman takes two soap baths a week, the bowels are kept soluble and the kidneys are watched. When the premonitory symptoms of labor appear, a thorough bath is given, superintended by a careful nurse, an enema is adminis- tered and the vagina douched with I-2OOO solution of bichloride of mercury and the woman is given clean clothing and placed in a clean delivery room. The nurse makes a toilet and the physi- cian makes a toilet before and after entering the room. As a rule, only one examination is made. For some six years there has been no meddlesome midwifery. It is only in complicated labors that repeated examinations are made. But two vaginal douches are given, one before and the other after labor. It has never been necessary to repeat the douches. After the final douching, a pint or so of the fluid is poured over the thighs and external genitals and the pad is applied. This is changed four to six times a day, for the first four days. There is never a per- ceptible odor. The mothers nurse their children without excep- tion, and the mortality among the infants is very low. After labor the bowels are kept soluble. The patients are well fed before and after labor. They remain in bed usually eleven days, and then go to the convalescent ward. MENSTRUATION AND LACTATION.—It is a generally received view that the supervention of menstruation during the period of lactation is prejudicial to the quality of the maternal milk supply, and therefore detrimental to the nutrition of the child. Most practitioners will probably state as a matter of observation that menstruation unfits the mother as nurse by reducing the quantity of the milk in addition to rendering it more “watery.” 568 SELECTIONS. In order to ascertain the real effect of menstruation on the quality of the milk, Dr. Schlicter has made a series of analyses which seem to show that the current belief is founded on défec- tive observation. In addition to careful examination of the com- position of the milk during and after menstruation, he had the child weighed and its general condition noted at and after the same period. He reports that in respect both of casein and fat, the milk secreted during menstruation compared favorably with that furnished prior to that date. The differences observed, moreover, in no case equalled those which occur in the milk of the normal healthy female at the various periods of the same . day; hence he declines to attach any importance to them. NEW IODINE BOTTLES.-Physicians who have occasion to: carry liquid iodine have, doubtless, many times had occasion to regret a spilling of the contents of the bottle into their medicine cases. George E. Abbott, in the Medical A'ecord, recommends that the iodine be carried in a bottle filled with cotton to the point of saturation, so that on inverting the bottle none will run out, but on passing an applicator into the bottle it will take up all the iodine necessary. There are other liquids that could be carried in the same way with advantage, and the idea is a good O1162. | MENTHOL IN VOMITING OF PREGNANcy is highly recom- mended by several writers, on authority of its success in most obstinate cases. It is administered hourly in grain doses—sus- pended in a solution of alcohol and syrup. SURGERY. POSTURE IN THE REDUCTION OF HERNIA.—I had, on Saturday last, a case which well illustrated the principles set forth in Dr. George H. Taylor's article, published in the Journal for April 25th. About seven o'clock of the evening aforesaid I was called to see Mrs. R., who that evening had been digging in the garden. An hour or an hour and a half before my arrival she had developed a right, direct inguinal hernia. I found her with a hernia half as large as my fist, hard, tense, and painful; with great pain in the bowels and vomiting. After careful manipulation, finding that it would be impossible to reduce the Hernia by taxis, I gave her repeated hypodermics of morphine SELECTIONS. 569 sulphate to relieve the pain, subdue peristalsis, and prevent tympanites; elevated the hips on a board ; applied ice to the tumor; and made repeated pressure, or “pulls,” upon the bowels toward the diaphragm. A few minutes sufficed to produce a somewhat lessened tension in the tumor, and I felt that it would only be a question of time when reduction could be affected. Gradual diminution took place, and, finally, at IO.30, spontane- ous reduction of the bowel took place, a portion of the sac still remaining down, but the latter was easily returned. I feel confi- dent that this case could not have been relieved by taxis in the ordinary way, but a combination of taxis, posture, anodyne, and antiphlogistic easily effected a cure. It is quite likely that many other cases, such as we have heretofore been accustomed to operate upon, might be relieved in the same way. There is, of course, nothing new in the postural treatment of hernia, e. g., the hanging a man by his legs over the shoulders of another man—and then taxis. It is only in the application of the principle; the combination of gravity, atmospheric pressure, reversed rhythmical respiratory action ; external abdominal pressure with the operator's hand, and persistent, patient waiting.—Dr. Thomas A. Elder, in the AV. Y. Med. /our. THE REMOVAL OF THE CRYSTALLINE LENS IN HIGH DEGREES OF MYOPIA.—(Arthur D. Mansfield, M. D., Assistant Surgeon at the Presbyterian Eye, Ear and Throat Charity Hos- pital of Baltimore, in Med, and Surg. Æeporter.) It is not a new idea, it is not an original idea, but it is a novel idea as well as an old one. Remove the lens in a healthy eye? Produce cataract and its risks that we may obtain benefit? Shall we convert a myope into a hyperope P , That is exactly the question. What shall be done for an eye that is progressing, as is seen in all cases of high degree of myopia 2 Shall we allow it to progress and be unable to stay its course 2 By no means—I think the proper thing to do when the indications are clear, is to remove the lens and stay the progression of the refractive error and check the anatomical changes in the eye which is bound to affect it more or less permanently. \ The originator of this ingenious device by means of which a dangerous myopic eye can be changed into a comparatively harmless hyperopic eye I do not know, but Dr. Fukala, of Pilsen- Karlsbad has within the past few years, experimented on some 19 Ca,SeS. 57O SELECTIONS. In these cases he clearly demonstrates that good results have been obtained in many cases, the improvement ranging in many from four fold to twelve fold, with a medium or average improvement of seven fold. How should the lens be removed 2 Dr. Fulkala recom- mends in all cases an iridectomy upwards, lessening thus the danger from intra-ocular tension consequent upon the discission of the lens, the iridectomy also preventing any occurrence of iritis or choroiditis. The lens should be removed by discission and not by extraction—secondary cataract should always be guarded against. The only objection to the iridectomy is the disfigurement, but the presence of the coloboma as a disfigure- ment is infinitely outweighed as aprecautionary measure. The advantage resulting from the aphakia are summed up briefly : * I. Distinct vision for the eye is obtained. 2. Retinal images are very much enlarged which in itself is a marked advance and benefit. t 3. Visual acuity is improved. 4. When using the eyes normally for distance the myope uses his accommodation, thus the relaxation of the accommodation is marked and complete in many cases, the accommodation being impaired, which latter condition cannot be called strictly an improvement, yet it is an advantage when com- pared with the previous condition present in the eye previous to the operation. 5. Often in high degrees of myopia the binocular vision is at fault, especially when the degree of myopia in the two eyes is far apart as to quantity and degree, binocular vision for near work is restored by this removal of the lens. it. 6. The work at the punctum proximum is held at proper dis- tance from the eyes and not at the myopic distance which varies with the degree of refractive error. 7. Spasms of the accommodation and all disturbing ele- ments disappear in this method of treatment; this is of a neces- sity so, as the accommodation is greatly impaired. 8. The myope is converted into an hyperope which is not progressive and ceases to be a form of annoyance as soon as the eyes are properly adjusted with glasses. . The subject is an important one, I take it, and hope it will call forth the expression of views from any who may have had, experience with the subject as presented. 11 Before the Medical Profession almost 30 years, and invariably gives. uniform satisfaction. 3. - i r º We respectfully ask thorough testing, strictly UPON ITS own MERITS, to prove the exceptionally high reputation it holds, Owing to correspondence on the subject, we regret being compelled to. caution, that inferior Coca preparations are frequently substituted upon patients, and as we do not advertise to the public, physicians will kindly be - particular to insist on * a , . As- • A *: “VIN MARIANI” is the concentrated extractive of the FORM - L A • , , , fresh leaf Erythroxylon Coca, blended with a special quality ... * , £º of . Bordeaux Wine. Each half-litre bottle contains the . . medicinal properties of two ounces of selected leaves. , , - ... º. º. - ** :, . . . . . . . . . . ; - - ‘. . v * x - * * * * , - . ." *. ** A " " . . . • '... : :" ‘‘ re; ; , ; g # * six . . Usually a wine-glassful three times a day, half an hour * . . . ." . . . . . , , , before meals or immediately after. Increased or diminished, º, , , . . . . . . .” at discretion.'of the physician. . - As a pleasant, mild stimulant, without unpleasant reaction ; with especial good effect on the digestive and respiratory organs; convalescence and enfeebled conditions. Effect is ſº) ſº - * . . Extensively used in Hospitals, Cliniques and private prac- . . ** • . tice, its merits are recorded by the medical press of Europe - O and America. Uniform excellence and recognized efficacy . . R who subjected it to test, and it may be affirmed that wherever Coca is indicated “Vin Mariana” invariably re- * . . . º: º IN |)|C ! \ | E. } *"a diffusible fonic ; a strengthener of the nervous system, ** immediate and lasting. - - won the absolute confidence and esteem of every physician ceives the preference. .The continual increasing demand is a clear proof of the reliance placed in “Vin Mariani” by the Medical Profession, through whom it has been popularized. - . . WE WILL BE HAPPY TO FORWARD, POST-PAID, TO ANY PHYSICIAN MENTIONING THIS JOURNAL, A HANDSOMELY BOUND BOOK, DETAILING FORMULAE, DOSE, PHYSIOLOGICAL EFFECTS AND THERAPEUTIC INDICATIONS of COCA, AS ALSO OTHER INTERESTING READING MATTER CONNECTED witH THE SUBJECT BY EUROPEAN .AND AMERICAN OBSERVERS. MARIANI se co- 52 West 15th Street, New York. ... ſ 41 Bd. Haussmann; PARHS = Laboratory, neuiily s/Seine. LONDON = 239 Oxford Street. . uTERINEN - TONIC \ RELIABLEA ºf Convenient W Elegant" Easily f Swallowed A Ret. Vibur. Prun gr. i \ “ “ 0pul. gr. 1 * Aletris Far, gr.9% ** Helion. Dios. gr.% “ Mitch. Repens gr.9% {Caulophyllin - gr.9% TABLET WIBURNUM COMP. For Threatened Abortion Dysmenorrhoea Anti-Spasmodic// AMENORRHGEA LEUCORRH(EAI H. K. MULFORD COMPANY APhiladelphia/ Anodyne 100 of these TABLETs sent on receipt of 65 GENTs Mention this Journal Doctor, This Will Interest You ! That you may become acquainted with the merits of our preparations , we will furnish you for $3.00, with a handsome, double Morocco Pocket Case, containing 24 vials filed with the following complete assortment of Tablets and Triturates. Tr. aconite, 1-2 minim. Tr. belladonna, 2 minim Nitro Glycerine Comp. (M. & Co’s.) Cascara Lom.(M. & Co.) Ammon. Mur. comp. Calomel, 1-10 grain. Calomel, 2 grains. Calomel, ipecac & soda bicarb, No. 1. Dover’s Powder, 2% gr. Fever (Dr. T. G. Davis) Hydrarg. Iodine Virid, 1-4 gr. Iron, Arsenic and Stry- chnia. Hv pophos Quinia comp. º Creasote. W \\ Acetanilid, 2 grains. * Morphia Sulph., 1-6 gr. W W. Zinc Sulpho-carb., 1. gr. |\pº- Acid Arsenious, 1-60 gr. tº |# j|| iſſiſſiſſ º ; |º -* * t º- #$3 Wºr Hismuth et Cerii Oxalat - - - Kermes Mineral comp. - - - gº - Paregoric, 10 minim. No. 2. Size, 7%x3%x% inches. Price, $3.00. Strychniº, 1-60 grain. All vials in this case are fitted with screw caps. We would call especial attention Quinia Sulph., 1 grain. to our Tablets Hypophos, Quinia Comp. cum Creasote, which are superior to syrups and Corros. Sublimate, 1-40 solutions, owing to absence of sugar and free acid. graln. H. K. MULFORD & CO. Factors of Gompressed Goods and Pharmaceutical Preparations, PIH III LA ID #CILIPFH iſ A . Write for Cosaplete List, naentioning this Journal. EDITORIAL DEPARTMENT. J. F. BALDWIN, M. D., Columbus, - * - - * tº - tº- cº- EDITOR. J. E. BROWN, M. D., Columbus, - * - - - - ASSOCIATE EDITOR. Communications, reports, etc., are solicited from all quarters. Authors desiring reprints, will receive fifty, free of charge, Arovided the request for the same accom- panies the article. - Subscribers changing their location, are requested to notify the Publishers Aromptly, that there may be no -delay in receipt of the journal, stating both the new and the formeer post-office address. We have no authorized Collectors, except such as carry properly made out bills, countersigned by the Aztólishers. THE COLUMBUS MEDICAL PUBLISHING CO., f CoLUMBUs, OHIo. WITH this issue the Journal, completes its tenth volume, and the editor completes his sixteenth consecutive year of editorial work. We look back over the sixteen volumes which represent this work, with a feeling of pardonable pride at the character of the work done. We think we may say, with strict truthfulness, that among journals of its class none have pre- sented a greater variety of matter during this period, or more valuable. The yearly indexes have been made up with great care, so as to be full and complete, making the bound volumes a valuable storehouse of easily accessible information. The editor has aimed to act as a collaborator, rather than to present any special views of his own, and hence the remarks that have been made apply to the character of the matter furnished by others, and not to that which appears under the editorial Heading. The large number of subscribers that grace our sub- scription list, gives evidence of the appreciation of our labor by the lprofession, and we can only promise that in the future as in the past we shall endeavor to present to our readers a journal as valuable as our efforts can make it. THE AMERICAN MEDICAL ASSOCIATION.—The Detroit meet- ing of this association seems to have been one of unusual impor- tance, both in the quantity and character of the work done. The profession and citizens of Detroit distinguished themselves by the generosity of the entertainment furnished the visiting members and their wives. Those who attended the meeting have been profuse in their praises of the entertainment. Aside from the scientific work done, one of the most important matters was the adoption of a resolution directing the trustees of the Journal of the Association to refuse all advertisements of any 57 I 572 EDITORIAL. so-called “proprietary” medicines. The course of the /ournal, which is the Organ of the Association and the oracle of its Code of Ethics, in heretofore publishing these advertisements, has been extremely obnoxious to the great majority of the members of the Association, and the action taken is but the natural out- come of this feeling. It is to be hoped that the other leading medical journals of the country will unite in an effort to exclude from their pages, so far as possible, all this class of objectionable advertising. It would seem as though the Medical Journal Association could in some way secure united action of this char- acter, which would result in a decided elevation of American journalism ; but so long as the Journal of the British Medical Association, and the other foreign journals, and the other lead- ing journals of this country, continue to insert such advertise- ments, it is to be feared that the action taken at Detroit will result merely in curtailing the resources of the Association Journal without accomplishing any especial good. STRONTIUM.–We have received from a Mr. F. S. Mason, of , New York, an article on the strontium salts. The language of the article is very similar to that of a number of others which have graced the pages of some of our exchanges, and as the writer is entirely unknown to us, personally and by reputation, and does not seem to be even a physician, we suspect that his article is an attempt to foist upon the medical public, through this journal, a shrewdly worded advertisement of a preparation which is soon to be forced upon the market, from the laboratory of a French “professor.” We decline to have our reading pages thus used, and refer Mr. Mason most respectfully to the busi- ness manager of the journal. IN a note received from Dr. George Kellar, of Bucyrus, he assures us that he is not an Eclectic, and has never practiced Eclecticism, although he holds a diploma from the Eclectic Medi- cal Institute at Cincinnati. He thinks that Eclectics should be called “Exclusives.” He is a believer in “rational medicine.” Syr. Hypºphi. CO., Fellows Contains the Essential Elements of the Animal Organization—Potash and Lime; The Oxidising 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 properties 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 deseases. Its Curative Power is largely attributable to its stimulant, 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 directly into the circulation with the food products. The prescribed dose produces a feeling of buoyancy, 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–C#.UTION, The success of Fellows' Syrup of Hypophosphites has tempted certain per- sons 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 wrap- pers surrounding them) bear, can then be examined, and the genuineness—or otherwise—of the contents thereby proved. .7%edecaº Zeffers may 6e addressed £o Mr. FELLOWS, 48 Vesey Street, New York. A VEGETABLE ALTERATIVE & TONIG AUSES THE ELIMINATION OF SPECIFIC BLOOD POISON, the repair of wasted and disorganized tissues, and the restoration of the vital forces to their normal activity. In the treatment of Syphilis it supercedes the use of both Mercury and Iodide of Potassium, and is a reliable remedy for the evil effects pro- duced by the excessive use of these drugs. It is also specially indicated in all Scrofulous Affections, and is invaluable in the treatment of Eczema and other Skin Diseases, in Chronic Rheumatism, Old Chronic Ulcers, etc. Formula—Verrhus Clemiana is a Compound Fluid Extract of Clematis Erecta, Prinos Verticillatus, Fraxinus Americana and Rhus Glabrum, with 96 of one per cent. of Venanatic Acid, C H2 O2. Dose –A teaspoonful in water, gradually increased to a tablespoonful, three or four times daily. Prepared ºnly by ATLANTA, gºs º GEtºilfa. § §§ §§§ * §§§ §§§ S$ $ º: > 57 and 59 Euclid Avenue, Flästiſ Rilliff, Elastic Hosiery & Supporters *-> Bºší Silk [] illill, *- TWO (2) NEW L00MS JUST PUT IN. Hereafter can make arid fill Special orders day after receipt. Our motto will be QUALITY. ICAL INSTRUMENT CO., GLEVELAND, OHIO. N. B.-The Manufacture and Fitting of Deformity Apparatus, º Artificial Limbs and Trusses, a Specialty. * *** * > *w * -w-s- www.wqºrk- THE KICKER.—“I admire the kicker. I admire him even when he theoretically kicks Ime. I have long held that the man who undertakes to walk through this world with meek and humble spirit will get regularly flattened out and broken in two at least once a month. On the contrary, who ever saw a chronic kicker who didn’t live on the fat of the land and have a front seat everywhere 2–Eacchange. BO OK NOTICES. - 574 - BOOK NOTICES. of our work in this field, and gives portraits of seventeen of the prominent workers. This number contains also the fifteenth article in the illustrated series on the Development of American Industries since Columbus. It deals with Leather-making, and points out the advances that American tanners have made i BOOK NOTICES. e 575 Uterine Adnexa and Ligaments; Genital Tuberculosis, Intra and Extra-peritoneal Pelvic Hematocele are treated in four chapters; Diseases of the Vulva five chapters; Diseases of the Vagina four chapters; malformations of the Genital Organs, three chapters, and Diseases of the Urinary Tract, Rectum and Pelvis, two chapters. This work is not an exposition of any one system or school, nor of the methods of any one man or one nationality, but it is a most complete digest of the best and most important writ- ings on Gynecology in France, Germany, England, and America, and as an epitome of the best literature of the subject to date, is an invaluable and necessary book. A PRACTICAL MANUAL OF DISEASES OF THE SKIN. By George H. Rohe, M. D., formerly Professor of Dermatology in the College of Physicians and Surgeons, Baltimore; assisted by J. Williams Lord, A. B., M. D., Lecturer on Dermatology in the College of Physicians and Surgeons; Assistant Physi- cian to the Skin Department in the Dispensary of Johns Hop- lºins Hospital. No. 13 in the Physicians’ and Students' Ready Reference Series. In one neat I2mo volume, 303 pp. Extra cloth, price $1.25, net. Philadelphia: The F. A. Davis Co., 1231 Filbert street. This adds another to the already numerous hand-books. We think there is a demand for a brief work of reference on the skin, and this book meets it. DISEASES OF THE NERVOUS SYSTEM. By Jerome K. Bauduy, M. D., L.L. D., Professor of Diseases of the Mind and Ner- vous System and of Medical Jurisprudence, Missouri Medi- cal College, St. Louis, etc., etc. Second edition. Philadel- phia: J. B. Lippincott Company, 1892. Cloth : 8 vo.; pp. 352 : Price, $3. This work is a complete revision of a volume of clinical lectures on diseases of the nervous system published in 1876, and long out of print. The author's style is excellent, and so lucid that it is not surprising that his former pupils have requested a republication. A number of the lectures are devoted to the subject of insanity, and into these the author has suc- ceeded in compressing a large amount of valuable information. 576 BOOK NOTICES. INTERNATIONAL CLINICs. Edited by John M. Keating, M. D., J. P. Crosier Griffith, M. D., J. Mitchell Bruce, M. D., F. R. C. P., and David W. Finlay, M. D., F. R. C. P. July, 1891. This is the second of the quarterly issues of this work and contains lectures by Pepper, Tyson, N. S. Davis, Roswell Park, Gerster, Gill Wylie, Skene, Starr, Rockwell, Duhring and others. It is well illustrated with plates and figures, and as an innovation contains a biographical sketch of Dr. Joseph Leidy, with a portrait. MEDICAL DIAGNOSIs, by Samuel Fenwick, M. D., Fellow of the Royal College of Physicians, &c. Seventh Edition, Revised and Enlarged. P. Blakiston, Son & Co., Publishers, Phila- delphia. I2 mo, 352 pages. Cloth. This handy little volume belongs to the Student's Guide Series, issued by this house. The work is quite thoroughly illustrated with small but distinct cuts, and covers quite thor- oughly the field of medical diagnosis. For a volume for quick reference by a student or young practitioner it will prove valuable. We have noted the previous editions of this work as they have appeared from time to time. SYPHILIS IN ANCIENT AND PREHISTORIC TIMEs. By Dr. F. Buret, Paris, France. Translated from the French, with notes, by A. H. Ohmann - Dumesnil, M. D., Professor of Dermatology and Syphilology in the St. Louis College of Physicians and Surgeons; Consulting Dermatologist to the St. Louis City Hospital; Physician for Cutaneous Diseases to the Alexian Brothers’ Hospital; Dermatologist to St. Margaret's Hospital, etc. In Three Volumes. Volume I. Philadelphia and London : F. A. Davis, Publisher. 1891. $1.25. This book will prove valuable to all interested in venereal diseases. The author endeavors to prove, by references to the writings of all ages, that syphilis is as old as man, and as evidence of the author's extensive reading and marked erudition, the book is remarkable. Dr. Dumesnil has given us a most faithful translation. Cheap at Last! t #AGNIFYING FRONT CLINICAL THERMOMETERs. Rubber Case, $2.oo (formerly $2.50). - Chain Case, $3.oo (formerly (350). º'E::::3%) - sº - º ... . . . . . . . . " . ." sº is tºº?/7'-. º * . º - P º;;.... ...: 2 Llullllllllllllllllllllllllllllllllſº iſld ãºttº ſº- --tº c º arº - ſº ºzº ſº: ºšº ###########itº:::::::::::::::::::::: *::::: 2:::: . . . . . . . . . . . .s: . . " ' - - º - - - - * * * * *- - * - º - - -- ºt-º'- ſ a. * * - -- * - wº - - ś Fº º fºLullllllllllllllll º £º ºº:: i. ### mº 'ºz * : * * st == º + 4. :*Allºti: - - ! º:::::: :::… º. ººº- | #: t f And the Columbus MEDICAL Journal with it for one year FREE. Think of Thermometer and Journal less than the former price of Thermometer alone. Sent by mail free, in safety case, on receipt of $2.1 o or $3. Io. Thermomete S Fully Guaranteed. THE COLUMBUS MEDICAL PUBLISHING CO. COLUMBUS, OHIO. ALTERATIVE TONIC, FOR.MUL.A.—Each fluid drachm contain S: PHOTO-CHLQRIDE IRON, one-eighth gr. BICHLORIDE MERCURY, one-hundred and twenty-eighth grain. CHILO RIDE ARSENIC, one two hundred and eightieth grain. With CALASAYA A LPKA LOIDS and ARO - MATICS. INDICATIONS.—Anemia from, any cause, Struma, latent Syphilis, General Debility, Tuberculosis, Malaria, Loss of Appetite, Habitual Constipation, Chlorosis, Chorea, Chronic Uterine, Pelvic, Zymotic, Catarrhal and Dermatological Diseases. DOSE.-One Or two fluid drachnas three Or more times a day, as directed by the #### Cian. The prescribed dose of THREE CHLORIDES gives prompt action, produces a feeling of buoyancy, Stimulating the appe- tite and the digestion, promoting assimila- tion; is V ry pleasant to the taste, assimila- ted by the most delicate stomach ; does not constipate. Will not color the teeth, and is harmless under prolonged use. This prepa- EstEI). ration has stood the test of time and experi- ence, is uniform, unal t erable and can be relied upon to produce results. Its use is Indicated in a Wide Range of Diseases. . { Physicians will please designate R. & Eſ. Elixir Three Chlorides. Where a more specific alterative is need- ed, other than increasing the dose or bichloride, mercury. The physician may add . without reservation any of the Soluable salts of iodine or its compounds. Dispensed in twelve Ounce bottles; price, $1.00. MARION SIMS COLLEGE, ST. LOUIS, *} - May 30, 1890. During the past six months I have pre- scribed for the Various conditions indicated by the component parts of the mixture of the “Elixir Three Chlorides” for more than three hundred recorded cases, and in no instance have I regretted it. I. N. LOVE, M. D., St. Louis. The Formula, of this. Compound, will, immediately suggest itself to the thoughtful Physician. 1832. IRENZ & HENRY, *R*T*ETHIERS LOUISVILLE, KENTUCKY. 3. To be had of All Leading Jobbers, 16 Always Uniform — Therefore Always Reliable. METCALF's Yº ſº.” FOR FATICUE OF º ſº. 4 MIND. Or zº Ya & Yºkº , ; RECOMMENDED FOR º/NEURALGIA, SLEEPLESSMEss, DESPONDENCY, ETG. RINGER recommends CooA LEAVES as of great value in 4% Febrile Disorders, by restrain- Bºing tissue metamorphosis, and for the same reason in Phthisis. For their decided anodyne and anti-spasmodic qual- ities, they have been successfully employed in Typhus, Scorbutus, Gastralgia, Anaemia, Enteral- gia, and to assist digestion. WWINE OF COCA is probably 7 the most valuable Tonic in the Gertain, being * … . s Materia Medica when properly pre- Jºurd ſº 57 pared. With stimulating and anodyne Ø ** the ºf properties combined, MIETCALF2s CoCA º, º utmost skill "A", . º and prision from § WINE acts without debilitating, being always DR. ARCHIBALD SMITH- '..."; z → z wniform and therefore absolutely reliable. For #. As Iris"-statesthat \\ d the ºf Athletes it is invaluable in imparting energy and º: s ãº". Fºns º º, j / resisting fatigue; Public Speakers and Singers find it indis- the spirits, and makes the con- & sº obtain- ensable as a “Voi Hz, 32 - & 6 32 sumer to bear cold, wet, great.º, able. / #. S 1 ch y ce Tonic,” because being a tensor’’ Of bodily exertion and eyen wäntgfúſ NºN the Vocal chords, it greatly strengthens and increases the ::*ºdºvia * *- 'Volume of voice; and to the elderly it is a dependable aphro- V / / disiac, Superior to any other drug. IPose or Metcalf's coca Nº & yº: Sºtº. Y 1 Theodore Metcalf.__ESTABLISHED 1837. Frank A. Davidson. times daily, between meals. IPhysi- w ciams’ sample bottles, by express, R ETGALF G0 carriage prepaid, upon the recéipt of One sy I Dollar. 39 Tremont Street, -> BOSTON, MAss. BROMIDIA THE HYPNOTIC. FORMUL.A.—Every fiuid drachm contains fifteen grains EACH of Pure Chloral Hydrat. and purified Brom. Pot, and one-eighth grain EACH of gen. im. ext. Cannabis Ind. and Hyoscyam. - DOSE. –One-half to one fluid drachum in WATER or SYRUP every hour until sleep is r - INDICATIONS.—Sleeplessness, Nervousness, Neuralgia, Headache, Convulsions, Colic, Mania, Epilepsy, Irritability, etc. In the restlessness and delirium of fevers it is absolutely invaluable. IT DOES NOT LOCK UP TEIE SECRETIONS. PAPINE THE ANODYNE- Papine is the Anodyne or Pain-relieving Principle of Opium, the Narcotic and Convulsive Ele- ments being Eliminated. It has less tendency to cause Nausea,Vomiting, Constipation, etc. IN IPICATIONS.–Same as Opium or Morphine. a IPOSE.-ONE FLUID DRACHM-—(represents the Anodyne principle of one-eighth grain O D : A THE ALTERATIVE AND UTE RINE TO NIC. FORMUL.A.—Iodia is a combination of active principles obtained from the Green Roots of Stillingia, Helonias, Saxifraga, Menispermum and Aromatics. Each fluid drachm also contains five grains Iod. Potas., and three grains Phos. Iron. DOSE —One or two fluid drachms (more or 1ess as indicated) three times a day, before Id e3, IS. INDICATIONS.—Syphilitic, Scrofulous and Cutaneous Diseases, Dysmemorrhea, Menor- rhagia, Leucorrhea, Amenorrhea, Impaired Vitality, Habitual Abortions and General Uterine Debility. - To the Medical Profession. During the past seven years we have been laboring assiduously to produce Infant Foods ready for use that would closely resemble healthy human milk. It has not been an easy task, as every physician knows who has taken a special interest in the subject. We have spared neither labor nor expense to accom- plish this object, which will be demonstrated to any physician who will visit our factory. We have met the more recent demand for a sterilized Food for Infants by an expensive change in our machinery under the supervision of the most eminent Bacteriologists in the country. This sterilization has been accom- plished without rendering the casein of the milk less digestible, as is invariably done with the patented sterilizers in use. It also insures with the hermetically sealed cans, their perfect keeping qualities *. We do not think it possible that any /nfant Food will ever be prepared that will excel LACTO-PREPARATA (an all milk food) for the feeding of young infants and CARNRICK’S FOOD for their nourishment during the latter part of the nursing period. All other Infant Foods in the market are com- posed entirely of the cereals; or they contain so little milk (about 8 per cent.) that it is a misnomer to call them Milk Foods. If such foods are used alone, the child will not be properly nourished, its flesh will be flabby, and it will quickly succumb to disease, because they are deficient in albuminoid con- stituents. - - Send for circulars and samples. Mak0 YOur Own KUMYSS in Ong Milute, A Product of Pure, Sweet Milk What is IXunnysgen P It is Kumyss in a dry form, containing all the constituents of the best Aumyss, and requires only the addition of water to produce an article superior in digestibility and palatability to the old form of Kumyss. - It is the /deal Food in all cases where nutrition is an important factor, and digestion is feeble. - When all other Foods fail try KUMYSGEN, but it is better to try it in the beginning and save time and strength. k RUMYSGEN is the only preparation of Kumyss that will keep. All liquid preparations of Áumyss will keep but a short time, and are constantly changing in the bottle, unless some deleterious preservative is used. Rumyss made from KUMYSGEN is far more palatable, easier digested and 35 per cent, less expensive than the old style Kumyss. | Our Syphon Kumysgen. Bottles allows Kumyss to be drawn without loss of contents. One in every three bottles are Syphon, containing same quan- tity of KUMYSGEN as the others. Send for samples and descriptive circulars. MANUFACTURED ONLY By F.E.Er.) & CAERINT*EC:, Nºevºr ºorle- PREMIUM LIST. l | § º N wº N º º ſº | - | wº N I , s sº w jº | - | | SN | O NOTE THE LOW FIGURES. & - O FOUNTAIN PEN–Best Grade. (Paul E. Wirt—long or short, stub or regular.) t With One Year Subscription to the Journal . . . . . . $2 50 (Above is the price of the pen alone.) A Fountain Pen when once used is never dispensed with. Ask our editor. GAS BRACKET. With Light Condenser, Mirror and Bar Complete. (See cut below.) All Nickle Plated, and MEDICAL Journal, One Year . $20 oo 7.2% T | || || U. Above can be arranged for oil lamp at an extra expense of about $ I.O.O. Light Condenser and Mirror not including Bracket (see cut below) with Journal, One Year . . . . . . 12 OO Light Condenser without Mirror or Bar, not including Bracket (see cut below) . . . . . . . . . . 8 OO Prices named are less than the regular prices on light condensers alone. Cash must accompany order to obtain these prices. 19 FREMIUIM LIST I LOOK I LOOK I THIS WILL SAVE YOU M ONEY. It is our intention to make the subscription list of our Journal larger and to give patrons benefit of WHOLESALE PRICES on everything we can get low figures on. We guarantee the quality of everything. A $12.00 Case for $8.50, with the Colwmbus Medical Journal thrown in. RIO, GO IRWIFFROYED BUGGY CASE. it is worthy of notice. Only Cases of this manufacture have the COMBINATION CORNER (see cut). The Foot or Button being in ONE PIECE with the corner, prevents them from coming off the Case. Note all improvements in No. 60 Case, and see its Superiority to cheap imitations of the same. : $/lº. Şsº : sº :--------- - 5 G) No. 60 Improved Buggy Case, each . . . . . . . . . $8. Including one year's subscription to the Journal. Space for powder papers, instruments, ete. Case made of Black Grained Russia leather, leather lined throughout, and mounted with German silver combination ‘corners, nickel spring lock, with key, making the most substantial, complete and richest-looking Physician’s Case ever placed on the market. It should be noted that the No. 60 Case is protected by German Silver combination corners; also nickel edge trimmings around the center partition, which serves to protect from wear and to keep the partition in place. These improvements are found Only in No. 60 Improved Buggy Case, it being the constant aim Of the manu- facturers to make this case as near perfect as skillful labor and carefully selected material Will make. NOW Read this—a $12.00 Case and the Journal for $10.50. 66. SATCHEL CASE, 10 inch t º/ºt. frame, COntains 18 One Ounce, 11 # / tº issº É. Six drahms and 14 four drahm #|. § º º #, corked vials, ample loops for in- d º §º º %iº Struments, box for Sundries, plush gº=#| lined, with a neat compartment ºã for Hypodermic Syringe. Size, 32.É 10x7-5. Price, With the COLUMBUS l MEDICAL JOURNAL 1 year, $10.50. É We think this the most conveni- ent Satchel Case SOld. Can also furnish it with 7 two Ounce bottles instead Of 9 Of the One Ounce. This is the finest and |best made Satchel Case On the market to-day. All of above prices include the COLUMBUSMEDICAL Journ AL for one year. Cash must accompany Order to obtain above prices, 20 OUIR BEs.T PEREMIUNI FOR is 9. 1 : A NEW WATCH FOR PHYSICANs. I, Cº (O K. A.T GT1H E P H H CIES. The “I)06tor's Quick Stop" OPEN - FACE, sweep-second MOVEMENT, With Stop Attachment. & The two styles shown are different only in the dial ; the small knob to left of crown pulls out and stops the watch ; pushing in, it is started. THE PRICES OF THE WATCHES, POSTPAID, INCLUDING ONE YEAR’S SU BSCRIPTION TO º COLUMBUS MEDICAL JOUR- NAL, Solid Nickel Gase, - $6.50, This would retail in any jewelry store for $8.00 to $10.00. - Gold Filled Gase, - $12.50 | Retailing for $20.00 to $25.00. REMEMBER above prices include a YEAR’S SU BSCRIPTION TO THE COLUM BUS MEDICAL JOURNAL, or we will send the Watches on receipt of above amounts. Everv Physician should have one. Every -- Lº a good horse should use them. Cash mazesł accompany orders in all cases. Address, |}(ſ)||||||IS MElliſ fll Pll, [0, 246 EAST GAY STREET, COLUMBUS, OHIO. $33.5° S O L II) N J C R. E. J., A NID G O L D FILLED CASEs. . For CGU NT ING THE PU LSE this watch is invaluable to Physicians. It is also an ex- cellent Time-Keeper, and warranted by the firm making it as equal to any Twenty-five Dollar watch for durability and keeping time. Any watch that does not give entire sačis/action can be returned at our expense. This is not on the “Cheap John” or Water- bury order, but a ſizrst-class watch, and after due consideration we are satisfied we can find nothing more acceptable to the Pro- fession as a premium. - % § tŠ%: gſºººwtº “.. 0º §: 9 H.- à. 8 4. S^3 N § §s i\º 2: Sºº-ºº: -- ty It is advertised exclusively in medical journals. HYWY9| EINE. Produces rapid increase in Flesh and Strength. gº F-the only prominent Emulsion. of Cod-Liver Oil introduced directly to the medical prºtº-on-ºº: —a Recommended and Prescribed by EMIN ENT PHYSICIANS Everywhere. It is pleasant to the Taste and acceptable to the most delicate Stomach. FORMUL.A.-Each Dose contains : Soda........ ... ... 1-3 Grains, Salicylic Acid ... 1-4 “ Hyocholic Acid ...1-20 “ Pure Cod Liver Oil.80 m. (drops) Distilled Water..... 35 “ Soluble Pancreatin. 5 Grains. IT IS ECONOMICAL IN USE AND CERTAIN IN RESULTS, HYDROLEINE (Hydrated Oil) is not a simple alkaline emulsion of oleum morrhuae, but a hydro-pancreated preparation, containing acids and a small percentage of soda. Pancreatin is the digestive principle of fatty foods, and in the soluble form. There used, readily converts the oleaginous material into assimilable matter, a change so necessary to the Teparative process in all wasting diseases. Lautenbach’s Researches on the functions of the liver would show the beautiful adjustment of therapeutics in preparation of Hydroleine, furnishing, as it does, the acid and soda necessary to prevent self- poisoning by re-absorption of morbid tubercular detritus and purulent matters into the general circulation. In Wasting Diseases the most prominent symptom is emaciation, the result of starvation of the fatty tissues of the body as well as the brain and nerves This tendency to emaciation and loss of weight is arrested by the regular use of Hydroleine, which may be discontinued when the usual average weight has been permanently regained. The following are some of the diseases in which HYDROLEINE is indicated : Phthisis, Tuberculosis, Bronchitis, Catarrh, Cough, Scrofula, Chlorosis, General Debility, etc. "To Brain Workers of all classes, Hydroleine is invaluable, supplying as it does, the true) prain-food, and being more easily assimilated by the digestive organs than any other emulsion. The principles upon which this discovery is based have been described in a treatise on “The Digestion and Assimilation of Fats un the Human Body,” by H. C. BARTLETT, Ph. D, F C. S, and the experiments which were made, together with cases illustrating the effect of Hydrated Oil in practice, are concisely stated in a treatise on “Consumption and Wasting Diseases,” by G. Overend DREw Ry, M. D. COPIES OF THESE WORKS SENT FREE ON APPLICATION. - Sold by all Druggists at $1.OO per Bottle = C. N. CRITTENTON, :S0LE AGENT FOR THE UNITED STATES. 1 15 FULTON STREET, N. Y. * A Sample of Hydroleine will be sent free upon application, to any playsician (enclosing business card) in the U. S. AN IDEAL PEPSIN 1 PHYSICIANS PRESCRIBE P., D., & CO.'S ASEPT I C P E PSIN. Pepsins as heretofore known have left very much to be desired, most of them indicating by their Odor the putrescent mucus and other objectionable constituents which Imust necessarily prove irritating, especially to the delicate Stomach of an infant, invalid or dyspeptic. We now supply a new and improved Pepsin Product (ASEPTIC PEPSIN, I to 4000, P., D. & Co.'s), in the full con- fidence that it Will at Once recommend itself to the favor- able attention of the Medical Profession. It is twice as active as any other pepsin now on the market, and by the process of manufacture which we pur- Sue, is deprived of all Septic constituents. This process renders it very palatable So that the most fastidious palate could not possibly object to its taste. Samples and literature will gladly be supplied upon application. MANUFACTURED ONLY BY PARKE, DAVIS & COMPANY., DETROIT, NEW YORK AND KANSAS CITY.