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-The Project Gutenberg EBook of The Cleveland Medical Gazette, Vol. I. No.
-3., January 1886, by A. R. Baker and S. W. Kelley and Various
-
-This eBook is for the use of anyone anywhere in the United States and most
-other parts of the world at no cost and with almost no restrictions
-whatsoever.  You may copy it, give it away or re-use it under the terms of
-the Project Gutenberg License included with this eBook or online at
-www.gutenberg.org.  If you are not located in the United States, you'll have
-to check the laws of the country where you are located before using this ebook.
-
-
-
-Title: The Cleveland Medical Gazette, Vol. I. No. 3., January 1886
-
-Author: A. R. Baker
-        S. W. Kelley
-        Various
-
-Release Date: August 22, 2016 [EBook #52874]
-
-Language: English
-
-Character set encoding: UTF-8
-
-*** START OF THIS PROJECT GUTENBERG EBOOK THE CLEVELAND MEDICAL ***
-
-
-
-
-Produced by Richard Tonsing, The Online Distributed
-Proofreading Team at http://www.pgdp.net (This file was
-produced from images generously made available by The
-Internet Archive)
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-
-
-                     THE Cleveland Medical Gazette
-
- _VOL. I._                  _JANUARY, 1886._                    _No. 3._
-
-
-
-
-                           ORIGINAL ARTICLES.
-
-
-
-
-                         A HISTORY OF MEDICINE.
-
-                        BY JOHN BENNITT, M. D.,
-
-    Professor of Principles and Practice of Medicine in the Medical
-     Department of the Western Reserve University, Cleveland, Ohio.
-
-
-It may not be inappropriate to give in your journal a brief sketch of
-the history of medicine, by the consideration of which we may come to a
-better appreciation of our present standpoint as medical men. We may
-also the better understand how much we, as medical men, and the world at
-large, are indebted to the methodical, plodding workers of the past in
-the field of inquiry pertaining to the nature and cure of disease. Such
-review may have the effect of stimulating medical men to more careful
-observation and the recording the results of observations that they may
-be given to others for mutual benefit.
-
-Science may be defined as “classified knowledge.” But all our knowledge
-is based on experience and observation. Medical science, like other
-sciences, taking the definition of Sir John Herschel, is “the knowledge
-of many, orderly and methodically digested and arranged so as to become
-attainable by one.”
-
-In all cases art and observation precede and beget science, and give
-origin to its gradual construction. But soon science, so built up,
-begins to reflect new light upon its parents—observation and art—helps
-them onward, expands the range of vision, corrects their errors,
-improves their methods and suggests new ones. The stars were mapped out
-and counted by the shepherds watching their flocks by night, long before
-astronomy assumed any scientific form.
-
-From the earliest ages the pains and disorders of the human body must
-have arrested men's anxious attention and claimed their succor. The
-facts observed, both as to hurts and diseases, and as to their attempted
-remedying, were handed down by tradition or by record from generation to
-generation in continually increasing abundance, and out of the repeated
-survey and comparison of these has grown the recognition of certain laws
-of events and rules of action, which together constitute “medical
-science.”
-
-There is good reason for the belief that Egypt was the country in which
-the _art_ of medicine, as well as the other arts of civilized life, was
-first cultivated with any degree of success, the offices of the priest
-and the physician being probably combined in the same person. In the
-writings of Moses there are various allusions to the practice of
-medicine amongst the Jews, especially with reference to the diagnosis
-and treatment of leprosy. The priests were the physicians, and their
-treatment mainly aimed at promoting cleanliness and preventing
-contagion. The same practice is approved by the light of latest science.
-
-Chiron, the Centaur, is said to have introduced the art of medicine
-amongst the Greeks, but the early history of the _art_ is entirely
-legendary. Æsculapius appears in Homer as an excellent physician of
-_human_ origin; in the later legends he becomes the god of the healing
-art. His genealogy is obscure and altogether fabulous. He, however, soon
-surpassed his teacher, Chiron, and succeeded so far as to restore the
-dead to life (as the story goes). This offended Hades, who began to fear
-that his realm would not be sufficiently peopled; complained to Zeus
-(Jove) of the innovation, and Jove slew Æsculapius by a flash of
-lightning. After this he was deified by the gratitude of mankind, and
-was especially worshiped at Epidaurus, where a temple and a grove were
-consecrated to him. His statue in this temple was formed of gold and
-ivory, and represents him as a god seated on a throne, and holding in
-one hand a staff with a snake coiled around it, the other hand resting
-on the head of a snake; a dog, as an emblem of watchfulness, at his feet
-(an intimation very appropriate for the medical profession). The
-Asclepiades, the followers of Æsculapius, inherited and kept the secrets
-of the healing art; or, assuming that Æsculapius was merely a divine
-symbol, the Asclepiades must be regarded as a medical, priestly caste,
-who preserved as mysteries the doctrine of medicine. The members of the
-caste were bound by an oath—the Hippocratis jusjurandum—not to divulge
-the secrets of their profession.
-
-In Rome, in the year 292 B. C., a pestilence (probably malarial fever)
-prevailed. The Sibyline books directed that Æsculapius (statue!) must be
-brought from Epidaurus. Accordingly, an embassy was sent to this place,
-and when they had made their request, a snake crept out of the temple
-into the ship. Regarding this as the god Æsculapius, they sailed to
-Italy, and as they entered the Tiber the snake sprang out upon an
-island, where afterwards a temple was erected to Æsculapius and a
-company of priests appointed to take charge of the service and practice
-the art of medicine. The name Æsculapius, then, is only an impersonation
-of medicine in the remote ages, or early ages of Grecian history.
-
-Hippocrates is the first writer of medicine whose works have come down
-to us with anything like authority other than fable. Indeed, he was the
-most celebrated physician of antiquity. He was the son of Heracleides,
-also a physician, and belonged to the family of the Asclepiades, said to
-be about eighteen generations from Æsculapius. His mother was said to be
-descended from Hercules.
-
-Hippocrates was born in the island of Cos (more anciently Meropis), an
-island of the Grecian archipelago of about one hundred square miles,
-probably about the year 460 B. C. Instructed in medicine by his father
-and other contemporary medical men, he traveled in various parts of
-Greece and Asia minor. He finally settled and practiced his profession
-at Cos, but died in Thessaly at the age of one hundred and four years
-(B. C. 357). Little is known of his personal history, other than that he
-was highly esteemed as a physician and an author, and that he raised the
-reputation of the medical school of Cos to a high degree. His works were
-studied and quoted by Plato. He was famous in his own time, and his
-works, some sixty in number, have in them many things that are not
-unworthy of consideration even after the lapse of twenty-two hundred
-years. Many of the works ascribed to Hippocrates are _not_ well
-authenticated.
-
-He divided the causes of diseases into two principal classes—the first
-consisting of the influence of seasons, climates, water, situations,
-etc.; the second of more personal causes, such as the food and exercise
-of the individual patient. His belief in the influence which different
-climates exert on the human constitution is very strongly expressed. He
-ascribes to this influence both the conformation of the body and the
-disposition of the mind, and hence accounts for the difference between
-the hardy Greek and the Asiatic.
-
-The four humors of the body (blood, phlegm, yellow bile and black bile)
-were regarded by him as the primary seats of disease; health was the
-result of the due combination (or crasis) of these humors, and illness
-was the consequence of a disturbance of this crasis. When a disease was
-progressing favorably these humors underwent a certain change (coction),
-which was the sign of returning health, as preparing the way for the
-expulsion of morbid matters, or crisis, these crises having a tendency
-to occur at definite periods, which were hence called critical days.
-
-His treatment of disease was cautious and what we now term expectant,
-_i. e._, it consisted chiefly, often solely, in attention to diet and
-regimen; and he was sometimes reproached with letting his patients die
-by doing nothing to keep them alive.
-
-His works written in Greek were at an early period translated into
-Arabic. They were first printed in Latin in 1525, at Rome. A complete
-edition in Greek bears a date a year later.
-
-Several editions in Latin and other languages have appeared from time to
-time. An English translation of 'The Genuine Works of Hippocrates,' was
-published by the Sydenham society in 1848, in 2 vols., by Dr. Adams. The
-advance which Hippocrates made in the practice of medicine was so great
-that no attempts were made for some centuries to improve upon his views
-and precepts. His sons, Thessalus and Draco, and his son-in-law,
-Polybius, are regarded as the founders of the medical sect which was
-called the Hippocratean or Dogmatic school, because it professed to set
-out with certain theoretical principles, which were derived from the
-generalization of facts and observations, and to make these principles
-the basis of practice. The next epoch in the history of medicine is the
-establishment of the school at Alexandria, which was effected by the
-munificence of the Ptolemies, about B. C. 300. Indeed the whole race of
-Ptolemies (from Ptolemy I. to Ptolemy VII. B. C. 323 to 117) seem to
-have been patrons of learning and learned men. (Less so Ptolemy VIII. to
-XIII., B. C. 117 to 43. Ptolemy II., Philadelphius, was born in Cos
-about 150 years after Hippocrates.) It was by the patronage of these
-kings of Egypt that learning flourished in Alexandria during their
-reign.
-
-In some of them this seems to have been the only redeeming feature of
-their character. Otherwise vicious, cruel, bloodthirsty in an extreme
-degree, they uniformly encouraged learning and learned men. (It seems to
-have been a hereditary trait.) Amongst the most famous of the medical
-professors of the School of Alexandria are Erasistratus and Herophilus.
-
-The former of these was a pupil of Chrysippus, and probably imbibed from
-his master his prejudice against bleeding and against the use of active
-remedies, preferring to trust mainly to diet and to the _vis medicatrix
-naturae_.
-
-Herophilus, born in Chalcedon, in Bythinia, flourished in the latter
-part of the fourth and the beginning of the third century B. C., and
-settled in Alexandria, especially was distinguished by his devotion to
-the study of anatomy. He is said to have pursued this to such an extent
-as to have dissected criminals alive. Several names which he gave to
-different parts of the body are still in use, as the torcular Herophili,
-calamus scriptorius, and duodenum. He located the seat of the soul in
-the ventricles of the brain. Only a few fragments remain of what he
-wrote.
-
-About this time the Empirics formed themselves into a distinct sect and
-became the declared opponents of the Dogmatists. The controversy really
-consisted in the question, “How far we are to suffer theory to influence
-over practice.” While the Dogmatists, or as they were sometimes styled,
-the Rationalists, asserted that before attempting to treat any disease
-we ought to make ourselves fully acquainted with the structure and
-functions of the body generally, with the operation of medicinal agents
-upon it, and with the changes which it undergoes when under the
-operation of any morbid cause, the Empirics, on the contrary, contended
-that this knowledge is impossible to be obtained and if possible is not
-necessary; that our sole guide must be experience and that if we step
-beyond this, either as learned from our own observations or that of
-others on whose testimony we can rely, we are always liable to fall into
-dangerous and often fatal errors. According to Celsus, the founder of
-the Empirics was Serapion, who was said to be a pupil of Herophilus. At
-this period, and for some centuries later, all physicians were included
-in one or the other of these rival sects, and from the evidence of
-history the two sects or schools were about equal. From Phiny, who wrote
-about the middle and sixth, seventh and eighth decades of the first
-century, we learn that medicine was introduced into Rome at a later
-period than the other arts and sciences.
-
-The first person who seems to have made it a distinct profession,
-separate from priestcraft, was Archagathus, a Peloponnesian, who settled
-at Rome about B. C. 200. His treatment of his patients was so severe and
-unsuccessful that he was finally banished, and no other mention is made
-of a physician at Rome for about a century, when Asclepiades of
-Bythinia, acquired a great reputation. His popularity depended upon his
-allowing his patients a liberal use of wine, and of their favorite
-dishes, and in all respects consulting their inclinations and flattering
-their prejudices; and hence it is easy to understand the eminence at
-which he arrived, for we see even in our own time men building up great
-reputations by similar practices.
-
-This man with a long name—Archagathus—was succeeded by his pupil,
-Themison of Laodicea, the founder of a sect called Methodics, who
-adopted a middle course between the Dogmatists and Empirics. During the
-greater part of the first two centuries of our era the Methodics were
-the preponderating medical sect, and they included in their ranks C.
-Aurelianus, some of whose writings have come down to us.
-
-They soon broke into various sects of which the chief were the
-Pneumatics, represented by Aretaeus of Cappadocia, whose works are still
-extant; and the Eclectics, who claimed as do the Eclectics of to-day, to
-select the best from all the other systems and to reject the hurtful.
-The most remarkable writer of this age is Celsus (about A. D.), whose
-work (De Medicina) gives a sketch of the history of medicine up to that
-time and the state in which it then was. He is remarkable in being the
-first _native_ Roman physician whose name has come down to us.
-
-Dioscorides of Cilicia flourished about the end of the first century. He
-accompanied the Roman army in their campaign through many countries and
-gathered a great store of information and observations on plants. In his
-great work 'De Materia Medica,' he treats of all the then known
-medicinal substances and their properties, real or reputed, on the
-principles of the so-called humoral pathology. Two other works are
-ascribed to him but their genuineness is questionable. For fifteen
-centuries the authority of Dioscorides, in botany and materia medica,
-was undisputed, and still holds among the Turks and Moors.
-
-                          [_To be Continued._]
-
-
-
-
-              REPORT OF A CASE OF EXTRA-UTERINE PREGNANCY.
-
-                 BY H. J. LEE, M. D., CLEVELAND, OHIO.
-
-
-The following case came under my care during my term of service in the
-wards of Charity Hospital in this city. Mrs. D., age thirty-five,
-married, one child two years of age, was admitted to the hospital July
-14, 1885, with the following history: She had always enjoyed good
-health, and there was no history of uterine disease. She menstruated
-about the first of April, 1885, did not menstruate in May, and supposed
-herself pregnant, as she had always been regular before, and during the
-latter part of May she had considerable nausea and other symptoms of
-pregnancy. About the first of June, while in church, she was taken with
-a severe hemorrhage. She was taken home and a physician called, who
-examined her and decided from the symptoms and history that she had had
-a miscarriage. There was very little hemorrhage after she arrived home,
-in fact very little at any subsequent time, but she did not recover
-well, had some pains in the abdomen, and she said had some fever all the
-time. Not getting on well, as she and her friends thought, it was
-decided to change physicians, which was done. The second physician
-concurred in the diagnosis of the first, and treated her evidently on
-the expectant plan, as any one would be compelled to do, owing to the
-difficulty of making a correct diagnosis at such an early stage. After a
-time, there being no improvement, she decided to go to the hospital. On
-admission she was quite emaciated and had an anaemic appearance; her
-temperature was about 99° to 100° in the morning and 100° to 102° in the
-evening. There was considerable tenderness in the right iliac region,
-extending into the hypogastric region. Uterus was not felt to be at all
-enlarged, but the os was patulous. There was an enlargement to the right
-of the uterus. This could be felt both externally and through the
-vagina; was of an irregular outline, and quite tense and tender upon
-pressure. A sound was introduced into the uterus and passed in about
-three inches and was deflected to the left quite perceptibly. It did not
-appear quite certain that there was nothing in the uterus, and in view
-of the history of the case it seemed justifiable to explore the cavity.
-Accordingly a good sized sponge tent was introduced and allowed to
-remain twenty-four hours, when it was removed and the uterine cavity
-explored with purely negative results. The patient had now been under
-observation over a week, and attempts made to improve her general
-condition with tonics and nutritious diet, but without success. Her
-temperature continued about 101° most of the time. A positive diagnosis
-had not been made, though it seemed that about everything could be
-excluded except extra-uterine pregnancy. At this juncture Dr. W. J.
-Scott was asked to see the patient. He did so and made a very careful
-examination, and gave it as his opinion the case was one of
-extra-uterine pregnancy. The next day Dr. Dudley P. Allen was called in
-consultation with Dr. Scott and myself. Dr. Allen's examination was
-careful and exhaustive, and at its close he gave it as his opinion that
-while there were some obscure points, the most probable conclusion was
-that the case was one of extra-uterine fœtation.
-
-Having all arrived at this conclusion, independently of each other, it
-was agreed that as there was some obscurity in the case, and also that
-in the event of there being a fœtus outside of the uterus it had now
-advanced to about the fourth month of gestation; consequently the most
-favorable time for the employment of the electric current had passed. In
-view of these facts, and also of the fact that exploratory incisions are
-attended with comparatively little danger, it was decided to make an
-exploratory incision and determine what was the condition of things. If
-a fœtus was found remove it if possible. If the trouble was something
-that could not be removed, the incision could be closed and the patient
-probably in no wise injured. Dr. Allen was asked to operate, and on the
-sixth of August the operation was performed. There were present, Dr.
-Allen, Dr. Scott, Dr. Millikin and the house staff. The anæsthetic was
-administered, and before commencing the operation an aspirator needle of
-good size was introduced into the tumor through the vagina. Upon
-exhausting the air no fluid was obtained, but upon partially withdrawing
-the needle about a drachm of clear serum was obtained, which was thought
-to be peritoneal fluid. It was then decided to proceed with the
-operation. An incision was made about an inch above and parallel to
-Poupart's ligament, commencing at the anterior superior spinous process
-of the ilium, and terminating at the outer margin of the rectus muscle.
-
-On opening the abdomen an adherent mass was found closely attached to
-the coecum. Strong bands also passed from the mass toward the symphysis
-pubis. In order to reach the mass more fully, and also the annexes of
-the uterus, the adhesions to the pubis were divided between ligatures.
-This having been done, it was still found to be impossible to detach the
-intestines which were closely adherent to the coecum, and nothing
-abnormal could be found in connection with the uterus. Failing to
-discover the cause of the adhesions about the coecum from the abdominal
-cavity, it was thought this might be accomplished by separating the
-peritoneum from the iliac fossa, and reaching the coecum from the outer
-and posterior side. This separation was continued until it could be
-carried no further without great danger of wounding the external iliac
-vessels, which were exposed for several inches. Although nothing further
-than a closely adherent mass of intestines had been found, an attempt to
-separate which had been carried to the limit of safety, and the cause of
-the malady had not been demonstrated with entire satisfaction, it was
-deemed best to close the abdominal incision, which was accordingly done.
-
-The subsequent history of the cure was as favorable as could be desired.
-The wound united very readily. The temperature never rose above 103°,
-and was only at that point for a few hours; most of the time was 100° to
-101.5°. Two weeks after the operation temperature was normal, a point it
-had not reached since her admission, and probably not for some time
-previous.
-
-Patient was examined September 8; the tumor was found to be considerably
-diminished in size, and tenderness almost entirely disappeared. She had
-apparently gained in weight, and expressed herself as feeling well. She
-was discharged from the hospital September 9. On the tenth of October
-she again presented herself, according to agreement, and was examined by
-Dr. Scott, Dr. Allen and myself. The tumor had entirely disappeared,
-only a slight thickening of the tissues remaining, the uterus had
-resumed its normal position, and the patient, to all appearances, was as
-well as ever.
-
-I have reported this case as one of extra-uterine pregnancy, and yet it
-will be seen by the report that the existence of that condition was not
-demonstrated at the operation, but it seems to me that the history of
-the case, both prior and subsequent to the operation, demonstrates
-pretty conclusively that it could be nothing else. Both the gentlemen
-who saw the case before operation were of the opinion that everything
-could be excluded except a collection of fluid, disease of the coecum
-and extra-uterine pregnancy, and to my mind (and the gentlemen who were
-called in consultation have expressed themselves in the same manner) the
-operation and the result of it excludes everything except the last
-mentioned condition. It may be said that in the treatment of the case
-less severe measures should first have been tried; that the electric
-current should have been employed before resorting to an operation. This
-subject was fully discussed, and the decision against the employment of
-electricity was unanimous, from the fact that the most favorable time
-for its employment had passed and the time had arrived when any further
-delay was dangerous. Then the danger from an exploratory incision is so
-small that it seemed to be more than counterbalanced by the knowledge
-that would be obtained by it. If an exploratory incision was made we
-would then be better able to tell what we had to deal with, and would
-also be in a position to deal with whatever was found in the most
-effectual manner, and it was thought that the most certain means of cure
-should be employed first and the patient not be subjected to the danger
-of delay in order that less certain methods might first be tried; also
-the high temperature seemed to render any delay more dangerous. The
-incision described was employed because it seemed that the tumor could
-be more easily reached and removed by means of it than by means of the
-central one. When, however, the mass was reached it was found to be so
-firmly attached to the cœcum by strong adhesions that it was absolutely
-immoveable. Under these circumstances it was decided that it would be
-unwise to attempt its removal, consequently the wound was closed and the
-operation desisted from. The subsequent history was all that could be
-desired, or could, under any circumstances, have been expected.
-
-I think the most probable explanation of the disappearance of the tumor
-is this: The case was one of extra-uterine pregnancy of the abdominal
-variety, the ovum became attached to the peritoneum and a connective
-tissue proliferation was set up which surrounded it with a vascular
-sack, the walls of which kept pace with the growth of the ovum, and as
-they extended into the abdominal cavity formed adhesions to the cœcum,
-intestines, and other parts in the vicinity. During the operation these
-adhesions were ligated and divided, and in consequence the nutrition of
-the ovum was entirely cut off, and death and absorption was the result.
-
-Since writing the report of this case the patient has been seen and
-examined. She seems to be in perfect health, and says she never felt
-better. There is not a vestige of the tumor remaining, except two or
-three small indurated spots that can be felt through the vagina.
-
-
-
-
-                        STAMMERING, STUTTERING.
-
-               BY PROF. G. DELON, LATE OF PARIS, FRANCE.
-
-
-Here is an universal and very strange infirmity, impeding speech, the
-origin of which must be anterior to the formation of languages.
-Hippocrates, the “Père de la Médecine,” Galen and Aristotle attributed
-it to an abnormal moisture of the brain and tongue and to a defective
-construction of the tongue, and their theories have been revived by
-modern writers. We find in Aristotle a double definition that stammering
-is an inability of articulating a certain letter, and stuttering an
-inability of joining one syllable to another. Notwithstanding the
-difference between the causes, the characteristics and the effects of
-both defects, several languages have but one word to express it; in
-French, for instance, “Bégaiement” means either stammering or
-stuttering. American dictionaries give the same definition for both; and
-in common talk no distinction is made, all stoppages in speech being
-called indiscriminately stammering or stuttering.
-
-Speech being a combination of separate sounds produced by the expired
-air, it is certain that the first condition required for natural and
-correct speech is an undisturbed and normal action of the breathing
-apparatus.
-
-The movements performed by the respiratory organs for the modification
-of the currents of air being produced by muscles owing their activity to
-nerves—motor and sensory—and the vocal organs being, like all parts of
-the organism, provided with nerves, it becomes evident that a general
-excitation of the nervous system, or any unusual excitement of the
-motor-nerves in action, will affect the muscles, cause irritation and
-create disturbances in inspiration, expiration and speech.
-
-Normal inspiration is produced by a regular contraction of the
-diaphragm, and expiration is due to the elasticity of the tissue of the
-lungs. A spasmodic inspiration, during which a prolonged contracted
-spasm of the diaphragm takes place, produces stammering; such a
-convulsive contraction of the diaphragm can take place without
-attempting to speak, but any attempt to utter sounds during the spasm
-will result in stammering. At the end of the spasm, the air is then
-quickly expelled from the lungs. I have noticed stammering children that
-I have treated subject to frequent attacks of hiccough; in hiccough the
-expiration is quiet: an irritation of the nerves of the diaphragm brings
-about, with a violent inspiration, an attenuated convulsive contraction
-of the diaphragm, as in stammering.
-
-In stuttering which is characterized by the presence of some spasm, in
-all articulations, labial, lingual, dental and guttural, although
-respiration is irregular and the respiratory organs do not work well,
-the inability to form and join the sounds comes from other sources than
-a spasmodic contraction of the diaphragm.
-
-Stammering proper, when organic, might be called stammering of the
-diaphragm, and that distinction would be quite logical, as other organs
-wholly unconnected with speech show that peculiarity of being affected
-with stammering.
-
-The influence exercised on the voice and speech by the respiratory
-mechanism is so considerable that a variety of theories on respiration
-have been advanced and discussed by physicians and specialists, not only
-with reference to speech impediments but specially for singing,
-elocution, acting and public speaking, and also in reference to general
-health. Writers and professors advocating exclusively so-called
-diaphragmatic, or costal, or abdominal respiration, are incorrect and
-perfectly deceived. The diaphragm, the ribs, and the muscles of the
-abdomen must all do more or less their special work, in order to carry
-on a normal and healthy respiratory act. An eminent physician, Dr. Ed.
-Fournié of Paris, says: “He who respires exclusively by one or the other
-of these alone (diaphragm, ribs or abdomen) must be indeed a sick man.”
-Costal or side-breathing is due to the elevation and depression of the
-ribs simultaneously with the contraction of the diaphragm. Abdominal
-breathing, the method taught to singers, is performed by the pressure of
-the abdominal muscles upon the anterior and lateral walls of the
-abdomen, forcing up the diaphragm, and thus expiring almost completely
-the air in the lungs.
-
-Medical and scientific investigations concerning speech defects have
-been as considerable as it is contradictory. The observations of
-prominent doctors and specialists, some of them being afflicted
-themselves, have in the most argumentative thesis attributed
-stammering-stuttering to numerous and varied causes, the enumeration of
-which has a real historical and pathological interest:
-
-Faulty action of the tongue, disorders of tongue-muscles, spasms of the
-glottis and epiglottis, troubles located in the larynx and in the
-hyoid-bone, abnormal depth of the palate, affections of the muscles of
-the lower jaw, spasm of the lips, abnormal dryness or moisture, or
-lesion of brain, nerves, muscles or tongue, nervous affection,
-intermittent necrosis, general debility or weakness, chorea, incomplete
-cerebral action, imperfect will-power, want of harmony between thought
-and speech, imitation and habit.—Such is the nomenclature of the
-principal ingenious theories exposed and upheld by those who have made a
-study or a business of the cure of speech defects. But some mistaken
-innovators, not satisfied with theories and investigations, gave to
-their ideas an experimental form. Forty and forty-five years ago a
-surgical craze, originating in Germany as a pretended cure of speech
-defects, was raging all over Europe. Stammerers and stutterers suffered
-a variety of operations, the horizontal section of the tongue, the
-division of the lingual muscles, the division of the genio-hyo-glossi
-muscles, the cutting of the tonsils and uvula, etc. Such suppression and
-mutilation of the vocal organs could not bring any cure, as it was
-proved, and some patients having died, the operating craze was put to an
-end forever. Since that it is by more gentle means that all attempts
-have been made to cure impediments of speech. The unfortunate stutterer
-has no longer to dread the misemployed zeal of surgical operators, and
-now it is even his own fault when he allows himself to fall into the
-hands of ignorant charlatans.
-
-Without lessening the value of former discoveries, I will say that the
-specialist of to-day must disagree with the most eminent authors and the
-most prominent works on that question, including Velpeau, Amussat,
-Becquerel, Lenbuscher, Bèclard, Bristowe, etc., and arrive at the
-conclusion that their testimony was one-sided, being confined to their
-own or few cases, and limited to mere theory and speculation. For the
-treatment of vices of speech, with the indispensable knowledge, long and
-practical experience alone will instruct what is the right method to
-pursue. The various theories on the nature and causes of that infirmity,
-and the enumeration of the different responsible organs may be, at the
-same time, partly false and partially true; but they have proved
-powerless to cure or relieve.
-
-In all varieties and forms of stammering-stuttering all the vocal organs
-can be blamed, and have, in each case, to be reformed and improved. In
-the majority of cases we find some traces of the organic peculiarities
-aimed at by authors, even if their influence is doubtful. Respiratory
-trouble is at the bottom of every case. The internal organs, and the
-tongue, the lips and jaws are to some extent in an abnormal condition,
-and suffer a convulsive spasm; they have to be treated, strengthened and
-made flexible. The nerve-function of the organs of speech is also
-disturbed. We notice in the majority of cases, to a certain degree,
-organic weakness, nervousness, lack of will-power, and above all,
-disregard of all natural rules and ignorance of the use and natural
-functions of the organs of speech.
-
-As to prognosis, I will say that all stoppages in speech, accompanied by
-spasms, sometimes hardly perceptible, and which are not the result of
-paralysis or lesion, may be classified as stammering-stuttering, and can
-always be cured, whatever may be their origin or cause, or their
-intensity, and that it is only a question of time and perseverance even
-for the most stubborn cases.
-
-The treatment of stammering-stuttering, which does not comport any
-operation nor drugs, is purely educational. It consists in remedying the
-defect and teaching properly the science of speech. Still, I think, that
-in many cases a strict attention ought to be paid to hygienic measures;
-some medical care and prescription would help the patient and the
-instructor. In the actual condition of things no regular practicing
-physician can afford to devote his ability and time to the treatment of
-speech defects. But doctors have to study the infirmity, to know that it
-can be cured, that it is an interesting and complex disease, in the
-treatment of which the progress of medical science can bring a
-revolution. Physicians the world over having wholly neglected to
-consider that question, the result has been to leave it in the hands of
-incompetent persons. In principle the question of speech impediments
-cannot be separated from medicine. Physicians cannot ignore an infirmity
-in which the organism itself is undoubtedly involved, at times in a very
-intricate manner and to a considerable extent. Every true physician
-feels that he has a sacred mission—to alleviate suffering; the tortures
-of a large class of people partially deprived of the faculty of speech
-are well worth his care and attention. Medical students ought to be
-provided with the means of becoming versed in an affection offering such
-a large field for study and work, where so much light is needed, and
-where the prospects of discovery and improvement from a scientific and
-medical standpoint are so legitimate. The family physician, often
-consulted, will do good work in advising his clients to try and get rid
-of such a terrible affliction, to be cured without delay, and in
-preventing them from falling into the hands of quacks.
-
-
-
-
-                             HOMELY FACTS.
-
-                      BY F. STEWART, CLEVELAND, O.
-
-
-Not long ago as a bottle was placed upon the counter of a pharmacist to
-be refilled, its inner walls were observed to be richly decorated with
-the active principles of the compound. A witch-hazel doctor standing by
-declared the decorated walls to be the secret of the patient's recovery,
-but upon inquiry it was found that the patient was no better. Still they
-had decided to try another bottle, and the apothecary was not the one to
-object. The investigation was carried no farther, but if it had been the
-same old story of _incompatibles_ would have been retold. To the aqueous
-solutions containing oleoresinous tinctures or extracts (such as
-cannabis indica, guaiac, benzoin, lupulin, ginger, myrrh, cubeb,
-eucalyptus, sumbul, and many others) a sufficient quantity of carbonate
-or calcined magnesia should be added. A few grains (say three to twenty)
-to the prescribed dose will suffice for a good suspension, and will be
-found in most cases unobjectionable of course in an acid mixture.
-
-There are many conflicting reports of this class of medicines, owing to
-unscientific prescribing as well as unreliable preparations. The
-activity of this class of medicines demands nothing short of strong
-alcohol for their extraction. Yet many weak and worthless preparations
-may be found in the market. If the unscientific observers would look
-more to the quality of their goods, these conflicting reports would
-begin to subside.
-
-A physician once told an apothecary that he prescribed fluid extracts
-because he found them more reliable than the tinctures. This was not
-true, and could not be proven. Upon investigation it was found that his
-prescribed dose of fluid extract of digitalis was equivalent to
-fifty-five drops of the tincture, a dose larger than he intended to
-prescribe. With such science the witch-hazel doctor will ride a high
-horse, and come in on the home stretch with flying colors. No singer can
-sing well who sings too many songs, and no beginner will prescribe well
-who prescribes too many medicines. This song has been sung much but not
-half enough, for it is not borne in mind. Many fail with a remedy simply
-because they have failed to master it.
-
-Mastering the few is said to be the key to success, and the writer
-believes it, for he has seen it proven. An eminent physician from New
-York was once called in consultation to a western city. His prescription
-was mercury iodide, potassium iodide, and infus. gentian. He stated (and
-the other physician said, “I see”) that the only object of the potassium
-was to dissolve the mercury iodide. But potassium's great affinity for
-iodide accepted it, at once dropped the free mercury to the bottom,
-likely to be taken all at the last dose, equal to fifteen or twenty
-grains of blue pill. He had failed to master this remedy.
-
-The witch-hazel doctor could not declare this time that the untaken
-medicine saved the patient's life, for he died before taking it. But he
-could smile at the prescription appropriately, were none of his own to
-be found on file.
-
-Another phase of fashion reminds one of the old saying “distance lends
-enchantment;” for there is just as good sense in going to New Brunswick
-to have a boil lanced as there is in bringing syrup hypophosphates from
-that place.
-
-The present pharmacopœia contains a splendid formula for this syrup—one,
-too, with which phosphoric acid, quinine and strychnine are perfectly
-compatible. A pharmacist that will not exert himself to furnish the very
-best article for a physician's prescription is not entitled to the
-physician's respect. But for a physician to expect a pharmacist to send
-all over town for some foreign preparation that might, in almost all
-cases, be better made at home, affords a weapon to retard medical
-science and advance the nostrum manufacturer. The more scientific
-physicians well know and admit that a good pharmacist can better judge
-of a compound than a physician, who seldom stops to test it, but
-prescribes it a few times and, in many cases, never thinks of it again,
-or, perhaps, not until he presents his bill and finds the patient's
-money all gone for semi-proprietary medicines that cost from fifty to
-one hundred per cent. more than would have paid for better compounds.
-Physicians will only have to examine these medicines after they have
-stood a year or two, and in many cases a much less time, to see the
-force of this argument.
-
-Among these nostrums are found numerous preparations we could mention,
-including many emulsions, elixirs, etc. It is comforting to see the
-better class of physicians giving these nostrums a “wide berth.” Others
-will follow their example if they investigate and master their remedies.
-
-Having no time to continue this rehearsal, I close with a _plea for more
-science, more investigation_, that we may not have to send to Buffalo
-for syrups of Dover powder or farther east, west or south for nostrums,
-but master the remedies we have, saving to the physician and patient
-from fifty to one hundred per cent., thus mitigating the popular cry of
-the high price of medicine. There should be a table of incompatibles in
-every medical college as prominent as the multiplication table in the
-schools, or pharmacists should be allowed more freedom to prepare
-medicines properly, instead of being held to the letter.
-
-The writer should not complain, for he has been liberally treated by the
-profession in this respect; but he does not feel at liberty to add
-magnesia to a mixture unless so ordered. A pharmacist did this at one
-time in a tar-and-water mixture, gaining great praise from the
-physician. (Making the tar quite thin with a little alcohol, then
-absorbing the whole with magnesia, and emulsifying by adding the water
-gradually.)
-
-
-
-
-                       BREUS' OBSTETRIC FORCEPS.
-
-                        BY C. B. PARKER, M. D.,
-
-   Professor of Physiology and Lecturer on Gynæcology in the Medical
-        Department of Western Reserve University, Cleveland, O.
-
-
-The accompanying wood-cuts represent the forceps recently introduced to
-the profession by Dr. Breus, formerly first assistant in the clinic of
-Prof. Carl Braun, Von Fernwald, in Vienna.[1]
-
-Footnote 1:
-
-  Archiv für Gynäcologie XX Band 2 Heft.
-
-It is the simplest in construction of the so-called axis traction
-forceps, and is specially designed for the extraction of the head
-presenting high above the pelvic brim. In size, shape, curves, handles,
-lock, etc., it is an exact model of the J. Y. Simpson forceps—the
-favorite instrument of the Vienna school.
-
-[Illustration: Fig. 1.]
-
-Unlike the ordinary forceps, however, it is constructed with a
-hinge-joint (_a_ Fig. 2) at the angle of the fenestrum with the shaft,
-which permits of a movement of the blades through an arc of about 40°.
-An elbow on the lower margin of the blade arrests the further movement
-in the downward direction, and a prolongation of the upper fenestrum of
-the blade, in the form of an arm (_b_), is continued backward parallel
-to the shafts. This arm turns at an angle of 100° in front of the lock
-and terminates in an eye, through which the split pin seen at the side
-of the instrument passes. The pin fits loosely in the eyes and
-restricts, while still permitting considerable latitude of movement to
-the blades. At the suggestion of several gentlemen to whom the
-instrument was shown, the shaft has been lengthened nearly one inch. In
-other respects the forceps is an exact counterpart of those now used in
-the lying-in department of the General Hospital in Vienna.
-
-[Illustration: Fig. 2.]
-
-The principal advantages secured by these forceps are:
-
-1. That they are best adapted to draw in the pelvic axis.
-
-This was the special claim set up by Aveling for his Sigmoid forceps.
-Tarnier also, in introducing his axis traction forceps to the profession
-in 1877 (for an account of which see _British Medical Journal_, May 26,
-1878), proves by means of diagrams and figures that, “in pulling on the
-classical forceps, it is impossible to make the traction exactly in the
-line of the pelvic curve,” and that two forces are actually exerted—one
-in the direction of the inferior straight, and the other at right angles
-to this in the direction of the pubes, while the head tends downward in
-the pelvic curve—the resultant of these two forces. This “vicious
-pressure” upon the pubes represents not only so much force lost, but
-also tends to injure the maternal soft parts, and can only be overcome
-by using the axis traction forceps. As the head descends, the pelvic
-curves of the blades become less and less, until, as the head arrives on
-the floor of the pelvis, the forceps are nearly straight. At the moment
-the head sweeps over the perineum the blades are still further
-deflected, until they form an angle with the shafts, as shown in the
-dotted lines of Fig. 1, thus forming the perineal curve of Herman's,
-Aveling's and Tarnier's forceps.
-
-2. These forceps give the greatest permissible freedom of movement to
-the head during traction.
-
-By the loose connection of the blades each possess a degree of
-independent movement, but always in a plane parallel to the other, so
-that the head may rotate during traction. The carrying out of this
-important principle is the chief advantage of this instrument over all
-other axis traction forceps.
-
-3. An index is supplied by the arms and pin, which serves to indicate
-the advance and position of the head.
-
-The application of Breus' forceps is in no wise more difficult than that
-of the ordinary instrument. Having disinfected, warmed and lubricated
-the blades, and the patient being prepared by an irrigation of a
-solution of bichloride, one part in 2,000, and placed in the lithotomy
-position, the handle of the left blade is taken up by the thumb and
-three fingers of the left hand (as one would hold a fiddle bow), the
-index finger pressing the projecting arm firmly against the shaft, as
-the thumb of the right hand guides the blade forward in the groove
-between the index and middle fingers introduced into the vagina. The
-right blade is then introduced in a similar manner and locked, and the
-pin inserted in the eyes of the projecting arms. The traction is made
-upon the handles in the axis of the brim, without changing its direction
-until the head presses on the perineum. Prof. Braun prefers, at this
-point, to remove the forceps and complete the delivery in the ordinary
-way.
-
-The same precautions are necessary in using the axis traction as the
-ordinary forceps. Especially must it be remembered that, as the force is
-exerted directly in the axis of the pelvic curve, and none being lost,
-much less is required, and generally the force of one hand is quite
-sufficient. To avoid too great compression of the head, the compressing
-force should be removed by opening the lock in the interval of each
-traction.
-
-Breus' forceps, after being tested successfully in all possible
-difficult cases—in many where the operator had failed with the ordinary
-forceps, as I myself have seen—is now recognized as the instrument best
-adapted to those cases where the head presents high above the pelvic
-brim.
-
-
-
-
-                            CORRESPONDENCE.
-
-
-
-
-                            BALTIMORE NOTES.
-
-                   BY SPENCER M. FREE, A. M., M. D.,
-
-     Professor of Diseases of Children in the Baltimore Polyclinic,
-                             Baltimore, Md.
-
-
-It is said of Baltimore that socially it is different from other large
-cities in the _freedom_ as well as the cordiality with which it extends
-its hospitality. The business men and their clerks are polite and
-attentive. They do not display the trait, so common in the metropolis,
-of incognizance—even to rudeness—if one chances to be on a tour of
-inspection instead of purchase. The impression is at once made, and very
-forcibly, that a Baltimorean has plenty of time, that he is not hurried.
-He will stop on the street and direct a discomfited stranger, and has
-been frequently known to turn aside from his duties and accompany the
-lost one to where he could take care of himself. This is a natural
-element in the entire populace, and is very prominent in the medical
-profession. A stranger is welcomed so heartily that he feels at home
-immediately, and can settle down among friends.
-
-It occurs to me that this easy-going feeling has had much to do in
-keeping our city from occupying the prominent position in education and
-authorship that her opportunities, and conditions in general, would lead
-us to expect. I am glad to say that she is arousing from her lethargy,
-and recently her pen has been busy. Several works have emanated from the
-profession here which have attracted much attention, and have been quite
-extensively read. Notably among them is a 'Text-book of Hygiene,' by Dr.
-Rohe, and 'The Physician Himself,' by Dr. Cathell, which has reached a
-fifth edition and a sale of over fifteen thousand copies. I should like
-to say, concerning these two works, that no physician, especially if he
-be under thirty-five years of age, should be without them. Two other
-works, 'A Manual on Nervous Diseases,' by Dr. A. B. Arnold, an old,
-experienced and able teacher, and one on 'Practical Chemistry,' by Dr.
-Simon, have been much studied and commented upon. They are limited to
-special subjects and will not naturally obtain a large class of readers.
-These, like the long-delayed blade of corn, which pushes its emerald tip
-heavenward and bears upon its face the sparkling matin dew, give promise
-of a fertile soil and of abundant fruitage.
-
-At the last meeting of the Medical and Surgical Society—which we had the
-pleasure of attending—there was an interesting discussion on cerebral
-troubles of syphilitic origin. A number of cases were related. The
-various symptoms of these maladies are familiar to your readers. The
-treatment which was successful in all but one of the cases here
-reported, was mercury and iodide of potassium. The plan preferred for
-the administration of mercury is by inunction. All the debaters insisted
-upon the full constitutional effects of the drugs. As one gentleman put
-it, “the system must be saturated before a cure is assured.”
-
-I might mention among the symptoms, that those manifested by the eye
-were not regarded as reliable. In one case the only manifestation was a
-persistent and severe supra-orbital and occipital neuralgia, and for
-some time the man was in consequence wrongly treated.
-
-One physician noted _insomnia_ as a distinct and always present symptom.
-Also as a point of differential diagnosis between the convulsions of
-epilepsy and those of local lesion of the brain, that in the former
-there is no _consciousness_ of having a convulsion, while in the latter
-such consciousness is very clear, at least at the beginning of the
-spasm.
-
-A case of pelvic peritonitis of the chronic form, reported by the
-president of the society, elicited much discussion, especially upon the
-subject of exploratory abdominal incision as a means of diagnosis. He
-noticed that the younger surgeons favored the operation, but the older
-ones were more conservative.
-
-A member reported one of those peculiarly (excruciatingly, I ought to
-say) interesting cases of labor, in which, by _great_ exertion on his
-part, and the assistance of two physicians and three (I think is the
-number) midwifes or old ladies, he managed “to save the old man,” though
-the other parties concerned passed on into the mysterious future. (The
-society is expected to laugh a good deal just here, and of course we
-expect the readers to do the same.)
-
-At a recent meeting of the Baltimore Medical Association a member
-related the following experience: In a family of three children, the
-oldest, who had scarlatina four years ago, contracted diphtheria; in a
-few days a younger one became ill with the same disease, but accompanied
-in forty-eight hours with a distinct eruption of scarlatina. A few days
-later the youngest was stricken with scarlatina, but had no symptom of
-the diphtheritic trouble.
-
-The report brought out the thought of most of the members present. The
-two questions of “the identity of pseudomembranous croup and
-diphtheria,” and of “diphtheria a local or a constitutional disease”
-were again argued, and, as usual, no opinions were changed. Like the
-Scotchman, each was willing to be convinced, but he could not find any
-one able to convince him. Two points were fully agreed upon, namely,
-that the presence of membrane in the fauces, and of sequellæ, are not of
-importance in diagnosis; also that nearly all of the cases in which the
-posterior nares becomes seriously implicated are fatal. One gentleman
-advanced the opinion, supported by “statistics” (as accommodating a
-friend as “facts”), that when the submaxillary glands were enlarged in
-this disease recovery took place; when they were _not_ enlarged, death
-occurred. The doctor did not say that death occurred at once or within a
-few days, so we shall be charitable and suppose that he meant sometime
-during the succeeding hundred years.
-
-Notes of two very interesting cases of myelitis, followed by spastic
-paraplegia, were read and discussed. The author made special mention of
-the exaggerated tendon-reflex being always present in disease of the
-lateral tract of the cord, and that this symptom is diagnostic—if
-hysteria be first excluded. He also noted in these cases that the
-condition of the muscles of the posterior portion of the legs (lower)
-was very tense, producing an impression on grasping them similar to that
-noticed on grasping a piece of iron. Neither of these men were able to
-place the heel upon the floor when standing erect. No amount of effort
-on their part could enable them to accomplish it. Neither of them were
-improved by the use of the iodides.
-
-
-
-
-                          NOTES AND COMMENTS.
-
-If “K.” will send name, we will take pleasure in publishing his article
-in our next number.
-
-                  *       *       *       *       *
-
-White physicians in Oriental countries are asked almost daily whether
-they cannot prescribe for suffering women without seeing them. Oriental
-women, debarred by social custom from consulting male physicians, are
-the victims of great and unnecessary suffering. They are thus shut off
-from the aid of western medical skill, though they know its value and
-are desirous of availing themselves of it. The movement in China and
-Japan to introduce female physicians from Europe and America is
-conferring great benefit upon the women of those countries and making
-brilliant opportunities for skilled women who go there. The hospital for
-women recently opened at Shanghai, under the charge of American women,
-is already filled with patients. An association has also been formed in
-India for training native nurses.
-
-                  *       *       *       *       *
-
-The new college building of the Medical Department of the Western
-Reserve University is being pushed rapidly to completion. The stone-work
-is done and the roof is now being placed in position. When once
-inclosed, work upon the interior can proceed regardless of the weather.
-It is thought that it will be so far completed as to be used for
-commencement exercises the last week in February.
-
-                  *       *       *       *       *
-
-Four cases of trichiniasis were reported to the health officer of
-Cleveland, December 23d. All were members of one family and had partaken
-of the same uncooked ham. The physician reporting the cases, Dr. J. F.
-Armstrong, had his suspicions aroused by the symptoms presented, and at
-once examined the suspected meat. His fears were confirmed by finding
-trichinæ spirolis in the remaining portions of the ham, and his
-observations were verified by the health officer. None of those affected
-are as yet seriously ill. It appears necessary to sound a constant
-warning against eating uncooked pork.
-
-                  *       *       *       *       *
-
-“_No Children Allowed._”—The “Solid Comfort” will answer for the
-occasion to designate an elegant apartment house opened about two years
-ago in a suburb of Boston. It was finished with all modern conveniences
-and inconveniences. There were electric bells in a row at the door, so
-that the afternoon caller could ring up nine different and peaceful maid
-servants before getting into communication with the family she came to
-see; there were fire escapes and telephones, and elevators and speaking
-tubes; and, in all probability, safety valves and submarine cables. But
-the crowning joy of all was the fact that no children were allowed
-within its walls. It was built for the accommodation of childless
-couples, and to ten childless couples were the suites let. How great was
-the quiet and calm of that sheltered retreat, until one ill-starred
-morning, when the cry of an infant, shrilly and piteously, broke the
-stillness! Horror and indignation upon the part of nine guiltless
-couples! And yet, so weak is humanity, that before the end of the second
-year there were children in seven of the ten families. The childless
-young couples were childless no more; and when the owner of the building
-complained to his friends of the unfair treatment he had received at the
-hands of his tenants, they all laughed in his face and advised him to
-let his apartments to bachelors.—_Sanitarian for November, 1885._
-
-
-
-
-                     The Cleveland Medical Gazette.
-
-
-              _A MONTHLY JOURNAL OF MEDICINE AND SURGERY._
-
-                    ONE DOLLAR PER ANNUM IN ADVANCE.
-
-  All letters and communications should be addressed to the CLEVELAND
-         MEDICAL GAZETTE, No. 5 Euclid Avenue, CLEVELAND, OHIO.
-
- A. R. BAKER, M. D., _Editor_. S. W. KELLEY, M. D., _Associate Editor_.
-
-
-
-
-                               EDITORIAL.
-
-
-Original communications, reports of cases and local news of general
-medical interest are solicited.
-
-All communications should be accompanied by the name of the writer, not
-necessarily for publication.
-
-Our subscription price remains at one dollar per annum in advance. Vol.
-I begins with November, 1885. Subscriptions can begin at any time.
-
-Remittances when made by postal order or registered letter, are at the
-risk of the publishers.
-
-
-                         THE FASHIONABLE HOBBY.
-
-It is reported that a Dr. Sax, of France, has discovered in all forms of
-beverages containing alcohol a “bacillus potumaniæ;” and it is claimed
-that this bacillus multiplies in the system of the drinker and
-circulates in his blood, and that when he gets delirium tremens he is
-not the subject of hallucinations but sees the reptilian forms that are
-inhabiting his own brain and optic apparatus.
-
-While the microscopists and various ologists are discussing this, we
-will tell a story of a certain worthy practitioner of our acquaintance.
-The doctor's hobby was malaria. If a person came in with a headache it
-was “malarial headache;” backache, “malarial backache;” legs ache,
-“malaria.” One day a man came in with his arm hanging helpless. Our
-friend promptly began about malaria. The man said he had heard of
-break-bone fever, but that he had fallen off a street car and didn't
-think this was a malarial fracture.
-
-Some of the best fellows we know ride hobbies, but let those who now
-bestride the bacillus beware where the creature carries them.
-
-
-                             OLEOMARGARINE.
-
-The subject of artificial butter continues to agitate the public mind
-and stomach. There are involved a few plain principles which, if
-applied, will elucidate the whole matter.
-
-Good glycerine can be made from dogs or horse fat, sugar from rags; sea
-water or the most impure lake or river water can be changed to _azua
-pura_ by distillation; good suet or tallow can be so treated as to make
-a nutritious and harmless article of diet. Now, if old grease can be so
-manipulated and modified as to give a pure and edible result, cheaper
-than old-fashioned butter, the latter will have to go out of fashion.
-
-In that case, wrong would lie only in selling the article for what it is
-not, and not in the fact of its being also injurious to the user. Just
-as in many synthetically manufactured wines and cigars, which are not
-chemically essentially different from the article they imitate, but are
-fraudulent because they are sold as imported or genuine, which they are
-not.
-
-If the goods are good, let them be sold for what they really are; and if
-the old-fashioned butter is higher priced, let those of us who like pay
-the difference for our fastidiousness. The manufacturers of the new
-butter should expend their efforts and their money in perfecting their
-process, so as to give an innocent and useful food, and in proving that
-it is so, instead of opposing the action of the Board of Health. The
-verdict of the health authorities should be regarded as final by every
-individual of the public, and until the new article is pronounced at
-least harmless, no one should think of using or handling it any more
-than they would measly pork or spoilt fish.
-
-
-                      MEDICAL DEFENCE ASSOCIATION.
-
-We have selected a few recent cases of suits for malpractice with the
-object of calling the attention of physicians to the importance of
-adopting some plan looking toward the suppression of quackery and the
-protection of professional rights when assailed by hostile influences.
-
-“In April, 1884, Dr. Graves of Petaluma, California, was called to see
-Mrs. Winters, the wife of a laborer whose family he had attended
-gratuitously for nearly sixteen years. He found that the woman, who was
-fifty-eight years of age, had fallen from a height and injured her
-ankle. The limb was very much swollen, so as to interfere with
-examination, but no crepitus could be elicited, neither was there any
-displacement, or shortening; and as the swelling continued, the limb was
-placed in position and wrapped loosely in cloth saturated with anodyne
-lotions. The patient, we are told, received every attention from Dr.
-Graves, but there was left finally some stiffening of the joint and a
-very slight inversion of the foot. No complaints were made until a new
-doctor arrived in the town, who told the patient the limb had been badly
-treated and advised her to sue for malpractice. The case was examined by
-ten of the chief surgeons in the State, including Drs. Lane, McLean,
-Morse and Dennis, all of whom said that there might have been a sprain
-or an incomplete fracture of the external malleolus, but that the ends
-of the bones were in perfect apposition and never had been separated,
-and that the stiffening was probably due to inflammatory adhesions. Two
-other doctors, one of whom being he who advised the suit, testified that
-there was shortening of the limb, and that the lower fragment of the
-tibia had been driven up and behind the fibula. One of these would-be
-surgeons, Dr. Wells, is nearly eighty years of age, and had not read a
-work on surgery for thirty years; the other, Dr. Ivancovich, confessed
-he had no special experience in surgery. Their incompetence may be
-judged from the way they measured the patient's limb in court. This was
-done by taking a carpenter's rigid rectangular rule, and measuring the
-limb as she maintained the upright position. The result was that in the
-opinion of nine jurymen the testimony of two unknown, inexperienced
-general practitioners out-weighed that of ten specialists in surgery,
-all of whom possess a national reputation, so that a verdict was
-returned in favor of the plaintiff, awarding her eight thousand dollars
-damages.”
-
-“Some three years ago Dr. Purdy, a well-known and esteemed physician,
-gave notice to the health department of New York City, in accordance
-with a regulation of the sanitary code which makes it the duty of
-physicians to notify this department of cases of infectious diseases,
-that in his opinion a young woman who was under his treatment was
-suffering with smallpox. The department sent one of its medical officers
-to investigate the case. The diagnosis made by Dr. Purdy was then
-confirmed and by the authority of the board of health the patient was
-transferred to the smallpox hospital. After a day or two the patient was
-discharged. This patient immediately brought suit against Dr. Purdy for
-$10,000 damages, on the ground of injury to her business and of the
-false diagnosis upon the part of her medical attendance. The jury which
-tried this case gave a verdict of $500 against the defendant. The
-singular injustice of this verdict resides in the fact that damages
-should have been brought against Dr. Purdy, when, in point of fact, the
-injury to the plaintiff was inflicted by the health department, which
-not only affirmed the diagnosis of the attending physician, but caused
-the removal of the patient to be made to the smallpox hospital. It
-appears that Dr. Purdy's sole error in the case was in informing the
-health authorities of the possible existence of smallpox. In the
-discharge of a duty imposed upon him by a city ordinance he has been
-subjected to the expense and annoyance of a legal case, and has been
-mulcted by a jury to the extent of $500.”
-
-“Another suit of a blackmailing character has been brought against Dr.
-E. Williams and partners of Cincinnati, O. According to the Cincinnati
-_Medical News_, the charge was that they had permitted a small scale of
-iron, that had entered the eye of a boy, to remain, by which he
-eventually became blind—the sound eye becoming affected through sympathy
-with the injured one and losing the power of vision. It was proven on
-trial that the boy had visited the office of Dr. Williams but twice, and
-then had ceased calling because he was informed that, to preserve the
-sound eye and be saved from blindness, he must consent to have the eye
-that had been destroyed removed from its socket, to which his parents
-would not consent. For several months after declining the services of
-Dr. Williams and associates, he spent his time in going the rounds of
-the specialists of diseases of the eye, putting his case in charge, at
-different times, of both regular and homœopathic physicians. Every
-ophthalmologist by whom he was treated informed him that the only way by
-which he could avoid becoming blind was to have the injured eye removed.
-Finally, after losing sight in both eyes, he brought suit. The medical
-testimony, we are told, was uniformly in favor of Dr. Williams, but the
-jury disagreed.”
-
-“The Boston correspondent of _The Northwestern Lancet_ writes: 'Dr. A.,
-a reputable practitioner living in a New England city, attended Mr. B.
-for a fractured thigh. The case did well, and the patient recovered
-without deformity. No measurements were recorded by the attending
-surgeon, but he was able to swear that the result was to him perfectly
-satisfactory. A year or two later the patient entered suit against Dr.
-A. for malpractice, and exhibited a leg considerably shortened and
-deformed. A jury at once found a verdict for the plaintiff, and awarded
-damages in some six or seven thousand dollars, a sum which seriously
-crippled the physician. He devoted his energies thereafter to
-discovering what he believed to be a fraud, and finally obtained
-evidence that B. had, subsequently to his recovery under A.'s
-attendance, again fractured the same thigh while in the Adirondack
-wilderness, and had, on that occasion, had no surgical attendance
-whatever. The physician was able to recover his money, but was at the
-expense of his detectives' and lawyers' fees, to say nothing of years of
-anxiety and of damage to his professional reputation.'”
-
-The case of Drs. Reed and Ford of Norwalk, Ohio, will be remembered by
-many Cleveland physicians. Miss Pierce, a comely young lady, sustained a
-Colles fracture, and was attended by Drs. Reed and Ford. Suit was
-brought twice in county court and dismissed because plaintiff did not
-desire to try the case. A few days before the case was outlawed, suit
-was brought in the United States Court at Cleveland. Many physicians
-were called on both sides, and the testimony of all the physicians, with
-probably one exception, was that the treatment was good and the result
-better than is usual with such fractures. Flexion extension, pronation
-and supination were perfect. She had, however, the power, when the arm
-was midway between pronation and supination, of bending the wrist toward
-the radius, and by making the head of the ulna prominent she was able to
-make an apparent deformity. Her case, then, was her ability to make an
-apparent deformity by twisting her wrist. (She could do the same with
-the unfractured wrist.) She was a good-looking woman, and therefore
-entitled to sympathy. She followed up the case persistently for six
-years, therefore there must be some merit in the case. The doctors all
-testified against her, so there was a combination of the doctors which
-must not be countenanced. Upon this strong case twelve intelligent
-jurors awarded thirteen hundred dollars damages. The judge subsequently
-reduced this to five hundred. Is it any wonder, when such things can be
-done in the State of Ohio, in the name of justice, that physicians like
-old Dr. Kirtland refused to attend cases of fracture under any
-circumstances? or that it is not unusual to hear surgeons of recognized
-ability say they dare not possess property for fear of suits for
-damages?
-
-Frequently physicians are accused of malpractice, and rather than
-undergo the expense and inconvenience of a suit they will submit to an
-extortion of money; or if a suit is lost in court through prejudice,
-unjust decisions, inability to secure good council or other unavoidable
-cause, rather than undertake to carry the case to a higher court, the
-physician will pay the damages, and thus establish a precedent which
-renders every physician under similar circumstances liable to a suit for
-damages. It is always observed whenever a large amount of damages is
-collected from a physician, numerous other suits on all sorts of cases
-are commenced. Such a condition of affairs ought not to exist.
-Physicians can not expect legislators to look after their interests
-until their grievances are made known. The testimony of physicians as
-individuals will not carry enough weight to accomplish anything. Moves
-have been made in this direction through the County and State societies
-and failed first, because the members of the societies are divided among
-themselves, second, because they represent only a fractional portion of
-the profession. Out of the thousands of physicians practicing in Ohio
-there are only about seven hundred members of the State society.
-
-We believe the object of county, state and national medical societies
-are intended for purely scientific work, and the less of medical
-politics brought into them the better. But when there is some definite
-end to be accomplished, some gross wrong to be righted, some persecuted
-physician defended, there ought to be some organization including
-physicians of all schools, independent of the medical societies as now
-organized. When a physician is sued for damages, if his case is worthy
-of being defended, the entire profession ought to lend him their moral
-as well as financial support, and this could be rendered in no way
-better than by means of some organization similar to the Medical Defense
-Association of England.
-
-
-               PRELIMINARY EDUCATION OF MEDICAL STUDENTS.
-
-Dr. John J. King, secretary of Trumbull County, O., Medical Society, saw
-our article in the last number of the GAZETTE, in which we urged the
-necessity of an elevation of the standard of preliminary education of
-medical students, and sends us the following resolutions which were
-unanimously adopted by the Trumbull County Medical Society, January 31,
-1884, and Drs. Julian Harmon, J. R. Woods and T. H. Stewart appointed
-medical examiners. The requirements are about the same as adopted by the
-Pennsylvania State Society at their annual meeting in Norristown, Pa.,
-May, 1883:
-
-TO REGULATE THE STUDY OF MEDICINE.
-
-  RESOLVED, I.—That this Medical Society shall annually elect a board
-    of medical examiners, to consist of three members, whose duty
-    shall be to examine applicants for admission to the study of
-    medicine.
-
-  RESOLVED, II.—All applicants for admission as students of medicine
-    under the tuition of members of this society shall present
-    themselves before the board of medical examiners and
-    satisfactorily pass examination in the following requirements:
-
-   “I.— A written statement, previously prepared, setting forth the
-          candidate's course of study.
-
-   II.— An essay.
-
-  III.— Writing from dictation.
-
-   IV.— Spelling—Oral and Written.
-
-    V.— Reading.
-
-   VI.— Geography—Descriptive, Physical.
-
-  VII.— Political Economy.
-
- VIII.— History—Ancient, Modern.
-
-   IX.— Geology.
-
-    X.— Botany.
-
-   XI.— Chemistry.
-
-  XII.— Natural Philosophy.
-
- XIII.— Mathematics—   Arithmetic complete;
-
-                       Algebra, through quadratic equations;
-
-                       Geometry, through plane geometry.
-
-  XIV.— Languages—     English, standard school edition of English
-                         Grammar;
-
-                       Latin, Cæsar's Com., 4; Virgil, 4; Cicero's
-                         Orations, 2.
-
-                       Greek, the Reader; Gospels; Xenophon's Anabasis,
-                         2.”
-
-  Candidates for examination may elect in French, Keetle's Collegiate
-    Course in French, Composition, Translation and Reading, and
-    Lacomb's History of the French People, instead of Cæsar's Com.,
-    Virgil and Cicero's Orations; and in German, Whitney's German
-    Grammar, Composition, Translation and Reading, Schiller's Willheim
-    Tell and Goethe's Faust, but such elementary knowledge of Latin
-    and Greek will be required as to enable the candidate to
-    intelligently comprehend the etymology of medical terms derived
-    therefrom.
-
-  RESOLVED, III.—No member of this society shall receive any person as
-    a student of medicine unless he present a favorable certificate
-    from the board of medical examiners.
-
-  RESOLVED, IV.—The time of study required by members of this society
-    shall be five (5) years, including lectures.
-
-  RESOLVED, V.—Members of this society shall recommend their students
-    to attend only such medical colleges as either require an
-    examination for admission similar to the one required by this
-    society, or make the full three-years' graded course of study
-    obligatory for graduation therefrom, and otherwise endeavor to
-    elevate the standard of medical education.
-
-  RESOLVED, VI.—That this society requests the Ohio State Medical
-    society to adopt the foregoing schedule of requirements and to use
-    its influence to secure legislation making the same obligatory
-    upon persons entering their names as students of medicine in the
-    State of Ohio.
-
-  RESOLVED, VII.—That these resolutions be printed and a copy sent to
-    each medical society in this State with the request that they
-    early report their action thereon.
-
-                  *       *       *       *       *
-
-“Pioneer Medicine on the Western Reserve” is the title of a series of
-articles which began in the November (1885) number of the Magazine of
-Western History (Williams & Co., Cleveland). They are written by Dr.
-Dudley P. Allen, which insures a warm interest in the subject as well as
-a capable handling of it. The series is historical and biographical, and
-the publisher promises several portraits before the last chapter in
-March or April. Probably none of the Magazine's various serials will be
-of more interest to the public, as well as to medical men generally. In
-the opening chapters we enjoyed the author's skillful joining into
-readable continuity of the broken facts that have been gathered from so
-long ago.
-
-
-
-
-                          SOCIETY PROCEEDINGS.
-
-
-
-
-           PROCEEDINGS OF NORTH CENTRAL OHIO MEDICAL SOCIETY.
-
-                      TWENTIETH QUARTERLY SESSION.
-
-
-                                        GALION, OHIO, December 18, 1885.
-
-The president, Dr. MITCHELL of Mansfield, called the meeting to order,
-and owing to the number of papers to be presented and the brief time for
-the session, ordered the omission of reading of minutes of last meeting
-and all miscellaneous business. E. H. Hyatt of Delaware, was first
-called, and excused on the ground that he could not do justice to his
-subject, “The Use and Abuse of Alcohol from a Professional Standpoint,”
-in so short a time.
-
-Dr. R. HARVEY REED of Mansfield, the appointed lecturer, read a paper on
-Anæsthetics, in which he gave a brief review of the different general
-and local anæsthetics in use and the different compounds of the same.
-
-He referred to the elaborate experiments of Dr. Watson of Jersey City,
-which showed the following mortality on rabbits:
-
- Sulphuric ether,                                                  16.66
- Chloroform,                                                       62.50
- Bromide of ethyl,                                                 50.00
- Alcohol, chloroform and ether,                                    75.00
- Alcohol, chloroform and ethyl,                                    66.66
-
-And on dogs:
-
- Sulphuric ether,                                                  00.00
- Chloroform,                                                       00.00
- Bromide of ethyl,                                                100.00
- Alcohol, chloroform and ether,                                    60.00
- Alcohol, chloroform and ethyl,                                    80.00
-
-In these experiments the doctor found it necessary to resort to
-artificial respiration on dogs as follows:
-
- Sulphuric ether,                                                   None
-                                                                      at
-                                                                    all.
-
- Chloroform,                                                           2
-                                                                  times.
-
- Alcohol, chloroform and ether,                                        3
-                                                                  times.
-
- Alcohol, chloroform and ethyl,                                        5
-                                                                  times.
-
-The author referred to a number of experiments he had made on frogs, in
-which vivisection was made, and the heart exposed and chloroform applied
-direct, from which they died in from ten to twenty minutes, and when
-bromide of ethyl was used in fifteen to thirty minutes, but when ether
-was used, and even much freer than either of the others, they did not
-die at all.
-
-In repeated experiments, he said, he had found the use of electricity
-unreliable in resuscitating the heart under these circumstances.
-
-After referring to the mortality reports which showed 405 deaths from
-chloroform against seventeen from ether, he said: “I feel that every
-time I use chloroform as an anæsthetic I am trifling with a dangerous
-compound, and that it will only require time and perseverance in its use
-until I will share the fate of many others, whose misfortunes ought to
-be a timely warning to us against its dangerous effects; and if not
-heeded an accident will be all the more inexcusable.”
-
-He condemned the use of so-called “vitalized air” as being an uncertain
-and unstable compound: being one of the nitro-oxygen series mixed with
-chloroform, its effects were uncertain and often very injurious, which,
-he said, “should be reason enough to deter any conscientious physician
-from using it or even recommending it.”
-
-For administering anæsthetics the author recommended a clean folded
-towel as being more preferable than anything else, as it was just as
-efficient and decidedly better from a sanitary standpoint.
-
-He recommended watching the pulse closely while administering
-chloroform, and the respirations when ether was administered, lest in
-the former the cardiac ganglia become affected and suddenly arrest the
-heart's action, or in the latter the nerve cells of the medulla from its
-toxic effects abruptly interfere with the breathing.
-
-In closing the author said: “From the brief review of the anæsthetics
-most familiar to the profession from a practical standpoint we have
-arrived at the following conclusions:”
-
-_First_—Of all general anæsthetics known pure sulphuric ether stands at
-the head for safety, efficiency and every day practical use.
-
-_Second_—Hydrochlorate of cocaine stands at the head of all known local
-anæsthetics.
-
-_Third_—Ethidene promises to rival ether and merits a more general and
-extended trial.
-
-_Fourth_—No surgeon should give any anæsthetics without being prepared
-to resuscitate the patient on the shortest possible notice if necessary,
-among which preparations nitrite of amyl stands preëminent.
-
-_Fifth_—No person should be entrusted with the administration of any
-anæsthetic who is not thoroughly familiar with its physiological action
-and practical administration.
-
-_Sixth_—The indiscriminate use of anæsthetics should be strenuously
-guarded against, and especially the practice of leaving such dangerous
-compounds in the hands of the laity to be given _ad libitum_ whenever
-they may deem it necessary.
-
-_Seventh_—The judicious use of anæsthetics under all necessary
-circumstances should never be omitted, for when properly used by skilled
-hands they are a glorious haven of peace in the midst of a stormy sea.
-
-DR. J. CAMPBELL of Galion reported a case of embolism, in which the
-diagnosis was uncertain, the symptoms grave and the disturbance of the
-circulation extremely severe, distinguished physicians differing widely
-as to the pathological conditions, and the autopsy revealed adhesions of
-the right lung and of the pericardum. Left lung compressed, left heart
-hypetrophied and stenosis of aortic orifice. On motion the case was
-referred to the committee on publication, and Drs. Hackendorn, Ridgway
-and Mitchell, who had seen the patient, were requested to give their
-views.
-
-DR. N. B. RIDGWAY reported a case of laceration of perinæum with
-operation within an hour, with complete success, on which remarks were
-made by Drs. Reed, Larimore and Kelley.
-
-DR. KELLEY presented a clinical case of blindness in right eye of a
-girl, from the concussion of a snow ball striking the arch of the orbit.
-
-The society adjourned to meet in Mansfield March 25, 1886.
-
-                                                J. F. MARKEL, Secretary.
-
-
-                THE AMERICAN PUBLIC HEALTH ASSOCIATION.
-
-       ANNUAL MEETING HELD AT WASHINGTON, D. C., DEC. 8-12, 1885.
-
-        [By G. C. Ashmun, M. D., Health Officer, Cleveland, O.]
-
-In the summer of 1873 a few gentlemen met at Long Branch, New Jersey,
-and organized as the “American Public Health Association.” At that time
-there were but few state boards of health, and local boards were not
-generally efficient; and it was one of the chief objects of the American
-Public Health Association to aid in the establishment of health and
-sanitary organizations throughout the country. Prominent among the
-original members of the association were gentlemen from the Mississippi
-valley. For a long time the cities and towns of that valley had suffered
-from visitations of yellow fever, and men had become somewhat
-enlightened by the good results obtained from the course pursued by
-certain officers during the war. Especially was this true in New
-Orleans, and the question was fairly raised whether local conditions
-were not responsible for the disastrous outbreaks which had occurred so
-frequently.
-
-From 1873 to the present time, there have been annual meetings of the
-association, with a greatly enlarged membership. A large result of the
-efforts of the association and its members is seen in the national,
-state and local boards of health, and other sanitary organizations
-throughout the country. But three of the states are now without state
-organizations. The recent meeting in Washington was its “thirteenth
-annual,” and was as well attended and its members as enthusiastic as at
-any. The members were “welcomed” on behalf the medical fraternity of
-Washington by the venerable Dr. J. M. Toner, and by the district
-authorities through the President of the Board of Commissioners, Judge
-Edmonds. These remarks were followed by the usual address by the
-president of the association, Dr. Reeves of West Virginia.
-
-The chief point, perhaps, of Dr. Reeves' address, and the one calling
-out most expressions of approval, was the arraignment of Congress for
-its failure to provide means for the support of the National Board of
-Health. He cited the liberality shown to care for domestic animals, the
-fisheries, the Indians, and, indeed, almost every conceivable object,
-but Congress was unwilling to grant even a sum sufficient for gathering
-and publishing the reports from local boards. He expressed a strong
-feeling against the attempt to have the work for which the National
-Board was created to perform, done by the Marine Hospital Service.
-
-A large part of the time of the meetings was taken up in hearing reports
-from committees appointed at the meeting in St. Louis, 1884. Among these
-reports were some of great interest. Prof. Sargent, of Harvard, gave a
-report upon “School Hygiene in American Schools and Colleges,” and this
-was enlarged by a paper from Dr. Hartwell, of John Hopkins University,
-on “The German System of Physical Education.” At this meeting prizes
-were to be awarded, in accordance with the wish of Mr. Lomb, of Baush &
-Lomb, Rochester. The subjects were:
-
-1. “Healthy homes and food for the working classes.”
-
-2. “The sanitary conditions and necessities of school-houses and school
-life.”
-
-3. On “Disinfection and individual prophylaxis against infectious
-diseases.”
-
-4. On “Preventable causes of disease, injury, and death in American
-manufactories and workshops, and the best means and appliances for
-preventing and avoiding them.”
-
-These prizes were in cash, and amounted to five hundred dollars each,
-the decision resting with a separate committee for each. Without taking
-more space, it may be said that these meetings are usually attended by
-about three hundred members, from all parts of the country. Canada sends
-representatives, and the meeting in 1886 is to be held in Toronto. Very
-diverse opinions are developed, and sharp discussions are the order. All
-shades of medical and lay topics and views are brought out, but all meet
-on the common ground of desire for improvement in health. The medical
-officers of the army and navy are always well represented by such men as
-Drs. Billings, Sternberg, Gihon, Turner and others, while Hon. Erastus
-Brooks of New York is a layman whose views have been and still are
-relied upon as representing a philanthropic sentiment which can be found
-in all communities.
-
-
-  CUYAHOGA COUNTY MEDICAL SOCIETY—ADJOURNED MEETING, OCTOBER 15^{TH.}
-
-
-                 REPORTED BY L. B. TUCKERMAN, COR. SEC.
-
-DR. HIMES presided.
-
-DR. POWELL gave a verbal report on the progress of obstetrics and
-diseases of children as follows:
-
-
-                              OBSTETRICS.
-
-In the department of obstetric literature, 'Barnes' Obstetrics' had just
-been published by Lea. It was encyclopædic in its character. Lusk had
-issued a new edition with several chapters added. Parvin's book was now
-in press, and is also issued by Lea. In the department of diseases of
-children, Eustace Smith's work is invaluable as regards symptomatology
-and clinical history, but is not so good in therapeutics. Goodhart's
-work, edited by Starr, is also of value.
-
-Axis traction forceps are coming more and more into favor, Lusk's
-modification of Sarnier's forceps being used. Simpson's axis traction
-forceps is also much used in this country and in Germany. The form used
-by Dr. Lusk's assistant and in use in Karl Braun's maternite in Vienna,
-with a hinge jaw where the blade joins the shaft and traction handles,
-allows more motion of the head and has a number of other advantages.
-
-Electricity is coming more and more in vogue as an oxystocic. It seems
-to hasten labor without increasing pain. Its use to destroy the life of
-the fœtus in fallopian pregnancy is more common in this country than in
-Europe.
-
-In the past two years Lawson Tait has operated five times for ruptured
-fœtal cyst, with four recoveries. There are no other cases on record so
-far as known to the reporter. The present tendency of professional
-opinion is to favor an immediate operation.
-
-Intra-uterine injections are not so freely used as formerly, and are
-restricted to cases where there is actual retention of putrid material
-in the uterine cavity, with fever. Bichloride of mercury is gaining
-ground as the antiseptic par excellence.
-
-Cocaine has been tried to relieve the pain during dilation of the os,
-but has not proved a success. It is, however, a success in relieving
-certain cases of obstinate vomiting of pregnancy, and also the pain of
-fissured nipples.
-
-Hicks' bimanual method of treating placenta previa is gaining ground.
-
-In connection with post partum fever, a larger number of cases of
-diphtheritic complications is noted than formerly.
-
-
-                         DISEASES OF CHILDREN.
-
-Crede claimed to be able to prevent ophthalmia neonatorum by instilling
-into each eye at birth two drops of a two per cent. solution of nitrate
-of silver.
-
-Cassels of Berlin, after an exhaustive investigation, claims that no
-remedies are so reliable in _pertussis_ as belladonna and quinia.
-
-In the treatment of _diphtheria_, Tr. Ferri and Potass. Chloras seem to
-stand as high as ever in the opinion of the profession. Calomel, which
-also has its admirers, seems to have lost no ground, as well as the use
-of the steam atomizer.
-
-DR. ALLEN presented a dermoid cyst of the left ovary, removed that
-forenoon from a nullipara aged twenty-seven. Six hours after the
-operation the patient's temperature was 99.6° Fahr., and there had been
-but little vomiting.
-
-DR. SIHLER showed a gall stone found at the autopsy of a woman
-forty-eight years old, whose symptoms had not been those which are usual
-in fatal cases of obstruction of the gall duct. There had been no
-jaundice, no bile in the urine and no previous attacks of pain. She
-complained one morning of sore throat, and was given one-eighth of a
-grain of morphia. In the evening there was pain in the stomach and the
-morphia was discontinued. This was on Saturday. By Sunday or Monday the
-pain had become located along the border of the liver. On Tuesday the
-free edge of the liver could be felt, and the temperature had risen to
-102° or 103°, pain and vomiting having also become very severe. The next
-week pain was less and swelling less, and in two weeks all symptoms were
-gone. She never before had symptoms of colic. Two weeks later, after she
-had been asleep about three hours, she had another attack. The next day
-the temperature rose again, and there was a larger region of
-sensitiveness than before. On Tuesday the fever subsided. On Wednesday
-collapse and vomiting ensued, ending in death. The autopsy disclosed
-adhesions of the liver, omentum and colon, an effusion of bile in the
-tissues, and this gall stone was found in the gall bladder.
-
-DR. ALLEN mentioned a case that he had seen in Keith's Clinic in
-Edinburgh, where an operation was undertaken for ovarian cyst, but when
-on opening the abdomen the tumor was found to be the gall bladder so
-enlarged as to fill the whole lower part of the abdomen.
-
-DR. SIHLER said that in his case the gall bladder was not so very much
-enlarged.
-
-DR. TUCKERMAN reported a case where a gall stone the size of a pigeon's
-egg was found post mortem, but which during life could sometimes be felt
-through the abdominal wall and sometimes not, and which gave rise to a
-bruit so distinct as to warrant a strong suspicion of aneurysm.
-
-DR. VANCE stated that according to his observation the passage of a gall
-stone into the intestine by ulceration was a common cause of intestinal
-obstruction. He also called attention to the value of the symptom of
-itching as pointing to the gall bladder as the seat of the difficulty.
-
-DR. LINHART reported a post mortem in a case of typhoid fever where
-eighty-five small stones were found in the gall bladder. The bladder was
-but little distended.
-
-
-
-
-                               NEW BOOKS.
-
-
-  'TRAITE PRATIQUE DES MALADIES DE LA PEAU; DIAGNOSTIC ET TRAITEMENT.'
-  Par M. Le Docteur E. Guibot, Medecin De L' Hopital Saint Louis,
-  Paris, etc.
-
-This, the fourth work which the author has written on dermatology, is
-intended to present, in a clear and concise way, a resumé of the more
-voluminous books which have preceded it. Unfortunately the dermatology
-of to-day, as it appears in the English language, is drawn largely from
-the precepts of the Vienna school. In fact, since the little volume of
-Robert Liveing, which appeared in London about eight years ago, there
-has been no truly English or American treatise on the subject; although
-books on diseases of the skin have appeared in quick succession, they
-have been vague echoes from the _Krankenhaus in Wien._ Do not think from
-this that I undervalue the original work done by the great teachers of
-local dermatology, for they have taken vast strides in the advancement
-of the science, but other lines of thought and investigation are needed
-to broaden the scope of the earnest student. The work before me, as its
-name implies, is a practical treatise on diseases of the skin, of about
-four hundred pages, with especial attention to diagnosis and treatment.
-To facilitate the former, the author has grouped cutaneous maladies
-which are alike in nature into what he calls _Diatheses_, of which the
-syphilitic, scrofulous, herpetic, cancerous and the congestive are dwelt
-upon. In differentiating the scrofulous from the syphilitic diatheses,
-the author says: “In the third stage of syphilis, as we have said, the
-work of destruction starts from within, attacking first the deeper
-structures, as the periostium cartilage and bone, whereas scrofula
-pursues the same destructive course inversely; that is to say, from the
-superficial to the deep parts. This consideration, upon which we cannot
-insist too strongly, is of the greatest importance in diagnosis. For
-example, if syphilis attacks the nose, the part first involved is the
-mucous membrane of the nasal fosæ, then the nasal bones and cartilages,
-which may become completely destroyed before the process subsides,
-leaving the nose flattened but the skin intact. In scrofula the work of
-disorganization begins in the superficial parts—the skin—and not until
-the part involved is completely destroyed does it proceed to those which
-are deeper, viz., the cartilage and bone. Again, it may be seen that the
-destruction is more complete in scrofula than in syphilis. This is
-especially true of the skin, for syphilis has at least a respect for
-this organ, which scrofula has not.”
-
-After establishing, as he says, “the principles upon which the
-scrofulous diathesis is founded,” he proceeds to enumerate the different
-_scrofulides_ of the skin as follows: 1, Erythematous; 2, Phlegmonous;
-3, Pustulo-crustaciæ; 4, Tuburcular; 5, Rupiform; 6, Ulcero-gumatous.
-
-THE HERPETIC DIATHESES.—“The distinctive feature of prime import in
-herpetic lesions (_herpidites_) is their duration. In the two diathesis
-we have just considered we have said that the _scrofulides_ are
-continuous in their duration; they present no interruption, no
-intermittance; whereas the _syphilides_ are essentially intermittent;
-they disappear spontaneously, or under the influence of treatment, and
-reappear without regularity or periodicity. Their intervals of latency
-are variable, often regulated by the change of season, especially liable
-to reappear in the springtime, and sometimes after many years of
-complete immunity.
-
-“The _herpidites_ combine in their evolution the two characters of
-intermittency and chronicity. At their commencement they are
-intermittent; in the second stage, which occurs after a certain though
-variable period, they assume the character of chronicity.” The author
-further divides the _herpidites_ into benign and malignant. Under the
-former are included herpes, impetigo, lichen, eczema and psoriasis; the
-latter includes pemphigus, cachectic rupia and prurigo senilis
-formicans. The cancerous and the congestive diatheses follow, after
-which the exanthemata and the cachectic diseases of the skin.
-
-SYMPTOMATIC AFFECTIONS OF THE SKIN, arising from pathological,
-physiological and psychological disturbances are probably of more
-interest than any other group, because here one finds so many things not
-even mentioned in most works on dermatology, and because this class of
-affections seems destined more and more to be a common inherent of
-American life.
-
-“These diseases, which are called diseases of the skin, are not so in
-reality. They belong more or less to the entire organism, revealing
-themselves upon the external integument with visible and palpable
-peculiarities which enable us to form an opinion as to their true
-nature. Considering the subject from this point of view, dermatology is
-therefore one of the most important branches of pathology; it is the
-torch which throws light on many morbid conditions which otherwise would
-remain obscure, vague and unsettled. But dermatology is more than this;
-it is the index, the external manifestation of disturbances which may be
-physiological or pathological, superficially or deeply seated. It is
-still more, for it is the visible expression of certain psychological
-emotions and moral states which are reflected upon the skin, there to be
-interpreted by the observing student.” This part of the work ends with a
-chapter on dermatoses of local origin, which includes parasitic
-affections.
-
-The book concludes by taking up the treatment of the different diseases
-one by one. In the treatment of syphilis the author says: “The
-preparation of mercury to which we give the preference is the proto
-iodide. It is less dangerous, more soluable in the stomach and more
-easily assimilated. It should never be given to exceed three
-centigrammes a day.”
-
-Time forbids further details. I will simply say the book is a good one,
-and will well repay careful study. Arrangements have been made with the
-author and his publishers to translate the work into English.
-
-                                                          W. T. CORLETT.
-
-                  *       *       *       *       *
-
-“OFFICIAL FORMULÆ OF AMERICAN HOSPITALS” is the title of a 16-mo manual
-of 238 pages, published by the _Medical World_ of Philadelphia. It
-contains the formulæ of some twenty-nine American hospitals, collected
-and arranged by C. F. Taylor, M. D. Price $1.00.
-
-                  *       *       *       *       *
-
-“ORGANIC MATERIA MEDICA AND THERAPEUTICS,” in accordance with the sixth
-revision of the United States Pharmacopœia. By James Young Simpson, M.
-D., of Orange, New Jersey. Book of 337 pages, well printed and very
-neatly bound. Published by J. H. Vail & Co., New York.
-
-
-                         THE ASTRONOMIC DOCTOR.
-
-By request we take pleasure in reprinting this poem from the CLEVELAND
-MEDICAL GAZETTE of April, 1860. A modest country practitioner discovered
-a planet. The medical and scientific world prepared to give him a public
-dinner at the “Hotel du Louvre.” But word was sent from the modest
-doctor he would rather “stay at home in his wooden shoes” (it is his own
-expression).
-
-                                   I.
-
-                 To grace the brow of savans
-                   Astronomy has twined the crown,
-                 The trumpet sounds their giant deeds,
-                   And celebrates their high renown.
-                 But from the shrouded face of night
-                   A doctor draws the veil, and first
-                 Upon his modest, upturned sight,
-                   The splendors of a planet burst.
-
-                                  II.
-
-               His country rounds he still pursues,
-                 The storm he bears, and winter's cold;
-               Nor does his simple heart refuse
-                 Creation's wonders to behold,
-               But Lescarbault with lifted eyes,
-                 And hand upon his earnest heart,
-               Slow walks, to view the stars, but flies,
-                 Relief from suffering to impart.
-
-                                  III.
-
-                 Upon the doctor's humble life
-                   Simplicity her graces sheds,
-                 From grandeur far, and envious strife,
-                   Goodness to diligence he weds.
-                 His coat of serge he wears content,
-                   Nor e'er for gilded splendor sighs,
-                 But when he scans the firmament
-                   He sees his “star of honor” rise.
-
-                                  IV.
-
-               On history's page enshrine his fame,
-                 Yet other glories claim our song;
-               Friends, collegues, share another's name!
-                 To Laennec too our toasts belong,
-               An echo to his ear betrays
-                 The seat of misery's hidden dart—
-               'Tis well on stony worlds to gaze—
-                 'Tis nobler far to read the heart.
-
-The above verses were written by Dr. Piory, one of the celebrated
-physicians of Paris, and were sung by Dr. Mayne at the annual dinner of
-the Medical Society of the Arrondisement of the Elysee. For the elegant
-and faithful translation which we have given, we are indebted to the
-kindness of a very accomplished young friend.
-
-
-
-
-                          TRANSCRIBER'S NOTES
-
-
- 1. Corrected nevrosis to necrosis (or might be neurosis) on p. 110.
- 2. Silently corrected typographical errors.
- 3. Retained anachronistic and non-standard spellings as printed.
- 4. Enclosed italics font in _underscores_.
- 5. Superscripts are denoted by a carat before a single superscript
-    character or a series of superscripted characters enclosed in curly
-    braces, e.g. M^r. or M^{ister}.
-
-
-
-
-
-End of the Project Gutenberg EBook of The Cleveland Medical Gazette, Vol. I.
-No. 3., January 1886, by A. R. Baker and S. W. Kelley and Various
-
-*** END OF THIS PROJECT GUTENBERG EBOOK THE CLEVELAND MEDICAL ***
-
-***** This file should be named 52874-0.txt or 52874-0.zip *****
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