diff options
Diffstat (limited to 'old/52874-0.txt')
| -rw-r--r-- | old/52874-0.txt | 2290 |
1 files changed, 0 insertions, 2290 deletions
diff --git a/old/52874-0.txt b/old/52874-0.txt deleted file mode 100644 index ab0f4fb..0000000 --- a/old/52874-0.txt +++ /dev/null @@ -1,2290 +0,0 @@ -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) - - - - - - - - - - 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 ***** -This and all associated files of various formats will be found in: - http://www.gutenberg.org/5/2/8/7/52874/ - -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) - - -Updated editions will replace the previous one--the old editions will -be renamed. - -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the United -States without permission and without paying copyright -royalties. Special rules, set forth in the General Terms of Use part -of this license, apply to copying and distributing Project -Gutenberg-tm electronic works to protect the PROJECT GUTENBERG-tm -concept and trademark. Project Gutenberg is a registered trademark, -and may not be used if you charge for the eBooks, unless you receive -specific permission. If you do not charge anything for copies of this -eBook, complying with the rules is very easy. You may use this eBook -for nearly any purpose such as creation of derivative works, reports, -performances and research. They may be modified and printed and given -away--you may do practically ANYTHING in the United States with eBooks -not protected by U.S. copyright law. Redistribution is subject to the -trademark license, especially commercial redistribution. - -START: FULL LICENSE - -THE FULL PROJECT GUTENBERG LICENSE -PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK - -To protect the Project Gutenberg-tm mission of promoting the free -distribution of electronic works, by using or distributing this work -(or any other work associated in any way with the phrase "Project -Gutenberg"), you agree to comply with all the terms of the Full -Project Gutenberg-tm License available with this file or online at -www.gutenberg.org/license. - -Section 1. General Terms of Use and Redistributing Project -Gutenberg-tm electronic works - -1.A. By reading or using any part of this Project Gutenberg-tm -electronic work, you indicate that you have read, understand, agree to -and accept all the terms of this license and intellectual property -(trademark/copyright) agreement. If you do not agree to abide by all -the terms of this agreement, you must cease using and return or -destroy all copies of Project Gutenberg-tm electronic works in your -possession. If you paid a fee for obtaining a copy of or access to a -Project Gutenberg-tm electronic work and you do not agree to be bound -by the terms of this agreement, you may obtain a refund from the -person or entity to whom you paid the fee as set forth in paragraph -1.E.8. - -1.B. "Project Gutenberg" is a registered trademark. It may only be -used on or associated in any way with an electronic work by people who -agree to be bound by the terms of this agreement. There are a few -things that you can do with most Project Gutenberg-tm electronic works -even without complying with the full terms of this agreement. See -paragraph 1.C below. There are a lot of things you can do with Project -Gutenberg-tm electronic works if you follow the terms of this -agreement and help preserve free future access to Project Gutenberg-tm -electronic works. See paragraph 1.E below. - -1.C. The Project Gutenberg Literary Archive Foundation ("the -Foundation" or PGLAF), owns a compilation copyright in the collection -of Project Gutenberg-tm electronic works. Nearly all the individual -works in the collection are in the public domain in the United -States. If an individual work is unprotected by copyright law in the -United States and you are located in the United States, we do not -claim a right to prevent you from copying, distributing, performing, -displaying or creating derivative works based on the work as long as -all references to Project Gutenberg are removed. Of course, we hope -that you will support the Project Gutenberg-tm mission of promoting -free access to electronic works by freely sharing Project Gutenberg-tm -works in compliance with the terms of this agreement for keeping the -Project Gutenberg-tm name associated with the work. You can easily -comply with the terms of this agreement by keeping this work in the -same format with its attached full Project Gutenberg-tm License when -you share it without charge with others. - -1.D. The copyright laws of the place where you are located also govern -what you can do with this work. Copyright laws in most countries are -in a constant state of change. If you are outside the United States, -check the laws of your country in addition to the terms of this -agreement before downloading, copying, displaying, performing, -distributing or creating derivative works based on this work or any -other Project Gutenberg-tm work. The Foundation makes no -representations concerning the copyright status of any work in any -country outside the United States. - -1.E. Unless you have removed all references to Project Gutenberg: - -1.E.1. The following sentence, with active links to, or other -immediate access to, the full Project Gutenberg-tm License must appear -prominently whenever any copy of a Project Gutenberg-tm work (any work -on which the phrase "Project Gutenberg" appears, or with which the -phrase "Project Gutenberg" is associated) is accessed, displayed, -performed, viewed, copied or distributed: - - 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. - -1.E.2. If an individual Project Gutenberg-tm electronic work is -derived from texts not protected by U.S. copyright law (does not -contain a notice indicating that it is posted with permission of the -copyright holder), the work can be copied and distributed to anyone in -the United States without paying any fees or charges. If you are -redistributing or providing access to a work with the phrase "Project -Gutenberg" associated with or appearing on the work, you must comply -either with the requirements of paragraphs 1.E.1 through 1.E.7 or -obtain permission for the use of the work and the Project Gutenberg-tm -trademark as set forth in paragraphs 1.E.8 or 1.E.9. - -1.E.3. If an individual Project Gutenberg-tm electronic work is posted -with the permission of the copyright holder, your use and distribution -must comply with both paragraphs 1.E.1 through 1.E.7 and any -additional terms imposed by the copyright holder. Additional terms -will be linked to the Project Gutenberg-tm License for all works -posted with the permission of the copyright holder found at the -beginning of this work. - -1.E.4. Do not unlink or detach or remove the full Project Gutenberg-tm -License terms from this work, or any files containing a part of this -work or any other work associated with Project Gutenberg-tm. - -1.E.5. Do not copy, display, perform, distribute or redistribute this -electronic work, or any part of this electronic work, without -prominently displaying the sentence set forth in paragraph 1.E.1 with -active links or immediate access to the full terms of the Project -Gutenberg-tm License. - -1.E.6. You may convert to and distribute this work in any binary, -compressed, marked up, nonproprietary or proprietary form, including -any word processing or hypertext form. However, if you provide access -to or distribute copies of a Project Gutenberg-tm work in a format -other than "Plain Vanilla ASCII" or other format used in the official -version posted on the official Project Gutenberg-tm web site -(www.gutenberg.org), you must, at no additional cost, fee or expense -to the user, provide a copy, a means of exporting a copy, or a means -of obtaining a copy upon request, of the work in its original "Plain -Vanilla ASCII" or other form. Any alternate format must include the -full Project Gutenberg-tm License as specified in paragraph 1.E.1. - -1.E.7. Do not charge a fee for access to, viewing, displaying, -performing, copying or distributing any Project Gutenberg-tm works -unless you comply with paragraph 1.E.8 or 1.E.9. - -1.E.8. You may charge a reasonable fee for copies of or providing -access to or distributing Project Gutenberg-tm electronic works -provided that - -* You pay a royalty fee of 20% of the gross profits you derive from - the use of Project Gutenberg-tm works calculated using the method - you already use to calculate your applicable taxes. The fee is owed - to the owner of the Project Gutenberg-tm trademark, but he has - agreed to donate royalties under this paragraph to the Project - Gutenberg Literary Archive Foundation. Royalty payments must be paid - within 60 days following each date on which you prepare (or are - legally required to prepare) your periodic tax returns. Royalty - payments should be clearly marked as such and sent to the Project - Gutenberg Literary Archive Foundation at the address specified in - Section 4, "Information about donations to the Project Gutenberg - Literary Archive Foundation." - -* You provide a full refund of any money paid by a user who notifies - you in writing (or by e-mail) within 30 days of receipt that s/he - does not agree to the terms of the full Project Gutenberg-tm - License. You must require such a user to return or destroy all - copies of the works possessed in a physical medium and discontinue - all use of and all access to other copies of Project Gutenberg-tm - works. - -* You provide, in accordance with paragraph 1.F.3, a full refund of - any money paid for a work or a replacement copy, if a defect in the - electronic work is discovered and reported to you within 90 days of - receipt of the work. - -* You comply with all other terms of this agreement for free - distribution of Project Gutenberg-tm works. - -1.E.9. If you wish to charge a fee or distribute a Project -Gutenberg-tm electronic work or group of works on different terms than -are set forth in this agreement, you must obtain permission in writing -from both the Project Gutenberg Literary Archive Foundation and The -Project Gutenberg Trademark LLC, the owner of the Project Gutenberg-tm -trademark. Contact the Foundation as set forth in Section 3 below. - -1.F. - -1.F.1. Project Gutenberg volunteers and employees expend considerable -effort to identify, do copyright research on, transcribe and proofread -works not protected by U.S. copyright law in creating the Project -Gutenberg-tm collection. Despite these efforts, Project Gutenberg-tm -electronic works, and the medium on which they may be stored, may -contain "Defects," such as, but not limited to, incomplete, inaccurate -or corrupt data, transcription errors, a copyright or other -intellectual property infringement, a defective or damaged disk or -other medium, a computer virus, or computer codes that damage or -cannot be read by your equipment. - -1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except for the "Right -of Replacement or Refund" described in paragraph 1.F.3, the Project -Gutenberg Literary Archive Foundation, the owner of the Project -Gutenberg-tm trademark, and any other party distributing a Project -Gutenberg-tm electronic work under this agreement, disclaim all -liability to you for damages, costs and expenses, including legal -fees. YOU AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT -LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE -PROVIDED IN PARAGRAPH 1.F.3. YOU AGREE THAT THE FOUNDATION, THE -TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE -LIABLE TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE OR -INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF THE POSSIBILITY OF SUCH -DAMAGE. - -1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you discover a -defect in this electronic work within 90 days of receiving it, you can -receive a refund of the money (if any) you paid for it by sending a -written explanation to the person you received the work from. If you -received the work on a physical medium, you must return the medium -with your written explanation. The person or entity that provided you -with the defective work may elect to provide a replacement copy in -lieu of a refund. If you received the work electronically, the person -or entity providing it to you may choose to give you a second -opportunity to receive the work electronically in lieu of a refund. If -the second copy is also defective, you may demand a refund in writing -without further opportunities to fix the problem. - -1.F.4. Except for the limited right of replacement or refund set forth -in paragraph 1.F.3, this work is provided to you 'AS-IS', WITH NO -OTHER WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT -LIMITED TO WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PURPOSE. - -1.F.5. Some states do not allow disclaimers of certain implied -warranties or the exclusion or limitation of certain types of -damages. If any disclaimer or limitation set forth in this agreement -violates the law of the state applicable to this agreement, the -agreement shall be interpreted to make the maximum disclaimer or -limitation permitted by the applicable state law. The invalidity or -unenforceability of any provision of this agreement shall not void the -remaining provisions. - -1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation, the -trademark owner, any agent or employee of the Foundation, anyone -providing copies of Project Gutenberg-tm electronic works in -accordance with this agreement, and any volunteers associated with the -production, promotion and distribution of Project Gutenberg-tm -electronic works, harmless from all liability, costs and expenses, -including legal fees, that arise directly or indirectly from any of -the following which you do or cause to occur: (a) distribution of this -or any Project Gutenberg-tm work, (b) alteration, modification, or -additions or deletions to any Project Gutenberg-tm work, and (c) any -Defect you cause. - -Section 2. Information about the Mission of Project Gutenberg-tm - -Project Gutenberg-tm is synonymous with the free distribution of -electronic works in formats readable by the widest variety of -computers including obsolete, old, middle-aged and new computers. It -exists because of the efforts of hundreds of volunteers and donations -from people in all walks of life. - -Volunteers and financial support to provide volunteers with the -assistance they need are critical to reaching Project Gutenberg-tm's -goals and ensuring that the Project Gutenberg-tm collection will -remain freely available for generations to come. In 2001, the Project -Gutenberg Literary Archive Foundation was created to provide a secure -and permanent future for Project Gutenberg-tm and future -generations. To learn more about the Project Gutenberg Literary -Archive Foundation and how your efforts and donations can help, see -Sections 3 and 4 and the Foundation information page at -www.gutenberg.org Section 3. Information about the Project Gutenberg -Literary Archive Foundation - -The Project Gutenberg Literary Archive Foundation is a non profit -501(c)(3) educational corporation organized under the laws of the -state of Mississippi and granted tax exempt status by the Internal -Revenue Service. The Foundation's EIN or federal tax identification -number is 64-6221541. Contributions to the Project Gutenberg Literary -Archive Foundation are tax deductible to the full extent permitted by -U.S. federal laws and your state's laws. - -The Foundation's principal office is in Fairbanks, Alaska, with the -mailing address: PO Box 750175, Fairbanks, AK 99775, but its -volunteers and employees are scattered throughout numerous -locations. Its business office is located at 809 North 1500 West, Salt -Lake City, UT 84116, (801) 596-1887. Email contact links and up to -date contact information can be found at the Foundation's web site and -official page at www.gutenberg.org/contact - -For additional contact information: - - Dr. Gregory B. Newby - Chief Executive and Director - gbnewby@pglaf.org - -Section 4. Information about Donations to the Project Gutenberg -Literary Archive Foundation - -Project Gutenberg-tm depends upon and cannot survive without wide -spread public support and donations to carry out its mission of -increasing the number of public domain and licensed works that can be -freely distributed in machine readable form accessible by the widest -array of equipment including outdated equipment. Many small donations -($1 to $5,000) are particularly important to maintaining tax exempt -status with the IRS. - -The Foundation is committed to complying with the laws regulating -charities and charitable donations in all 50 states of the United -States. Compliance requirements are not uniform and it takes a -considerable effort, much paperwork and many fees to meet and keep up -with these requirements. We do not solicit donations in locations -where we have not received written confirmation of compliance. To SEND -DONATIONS or determine the status of compliance for any particular -state visit www.gutenberg.org/donate - -While we cannot and do not solicit contributions from states where we -have not met the solicitation requirements, we know of no prohibition -against accepting unsolicited donations from donors in such states who -approach us with offers to donate. - -International donations are gratefully accepted, but we cannot make -any statements concerning tax treatment of donations received from -outside the United States. U.S. laws alone swamp our small staff. - -Please check the Project Gutenberg Web pages for current donation -methods and addresses. Donations are accepted in a number of other -ways including checks, online payments and credit card donations. To -donate, please visit: www.gutenberg.org/donate - -Section 5. General Information About Project Gutenberg-tm electronic works. - -Professor Michael S. Hart was the originator of the Project -Gutenberg-tm concept of a library of electronic works that could be -freely shared with anyone. For forty years, he produced and -distributed Project Gutenberg-tm eBooks with only a loose network of -volunteer support. - -Project Gutenberg-tm eBooks are often created from several printed -editions, all of which are confirmed as not protected by copyright in -the U.S. unless a copyright notice is included. Thus, we do not -necessarily keep eBooks in compliance with any particular paper -edition. - -Most people start at our Web site which has the main PG search -facility: www.gutenberg.org - -This Web site includes information about Project Gutenberg-tm, -including how to make donations to the Project Gutenberg Literary -Archive Foundation, how to help produce our new eBooks, and how to -subscribe to our email newsletter to hear about new eBooks. - |