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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) - - - - - - -</pre> - - -<div class='tnotes covernote'> - -<p class='c000'><strong>Transcriber's Note:</strong></p> - -<p class='c000'>The cover image was created by the transcriber and is placed in the public domain.</p> - -</div> - -<div> - <span class='pageno' id='Page_97'>97</span> - <h1 class='c001'><span class='xlarge'>THE</span> Cleveland Medical Gazette</h1> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='33%' /> -<col width='33%' /> -<col width='33%' /> -</colgroup> - <tr> - <td class='c002'><em>VOL. I.</em></td> - <td class='c003'><em>JANUARY, 1886.</em></td> - <td class='c004'><em>No. 3.</em></td> - </tr> -</table> - -<div class='chapter'> - <h2 class='c005'>ORIGINAL ARTICLES.</h2> -</div> - -<h3 class='c001'>A HISTORY OF MEDICINE.</h3> - -<div class='nf-center-c1'> -<div class='nf-center c006'> - <div>BY JOHN BENNITT, M. D.,</div> - <div class='c006'>Professor of Principles and Practice of Medicine in the Medical Department of the Western Reserve University, Cleveland, Ohio.</div> - </div> -</div> - -<p class='c007'>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.</p> - -<p class='c000'>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 -<span class='pageno' id='Page_98'>98</span>methodically digested and arranged so as to become attainable -by one.”</p> - -<p class='c000'>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.</p> - -<p class='c000'>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.”</p> - -<p class='c000'>There is good reason for the belief that Egypt was the -country in which the <em>art</em> 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.</p> - -<p class='c000'>Chiron, the Centaur, is said to have introduced the art of -medicine amongst the Greeks, but the early history of the <em>art</em> -is entirely legendary. Æsculapius appears in Homer as an -excellent physician of <em>human</em> 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 -<span class='pageno' id='Page_99'>99</span>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>Hippocrates was born in the island of Cos (more anciently -Meropis), an island of the Grecian archipelago of about one -<span class='pageno' id='Page_100'>100</span>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 <em>not</em> well -authenticated.</p> - -<p class='c000'>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>His treatment of disease was cautious and what we now -term expectant, <em>i. e.</em>, 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.</p> - -<p class='c000'><span class='pageno' id='Page_101'>101</span>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>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 <i><span lang="la" xml:lang="la">vis medicatrix naturae</span></i>.</p> - -<p class='c000'>Herophilus, born in Chalcedon, in Bythinia, flourished in the -latter part of the fourth and the beginning of the third century -<span class='pageno' id='Page_102'>102</span>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>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 -<span class='pageno' id='Page_103'>103</span>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>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 <em>native</em> Roman physician -whose name has come down to us.</p> - -<p class='c000'>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.</p> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div>[<em>To be Continued.</em>]</div> - </div> -</div> - -<div> - <span class='pageno' id='Page_104'>104</span> - <h3 class='c001'>REPORT OF A CASE OF EXTRA-UTERINE PREGNANCY.</h3> -</div> - -<div class='nf-center-c1'> -<div class='nf-center c006'> - <div>BY H. J. LEE, M. D., CLEVELAND, OHIO.</div> - </div> -</div> - -<p class='c007'>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 -<span class='pageno' id='Page_105'>105</span>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.</p> - -<p class='c000'>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 -<span class='pageno' id='Page_106'>106</span>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>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 -<span class='pageno' id='Page_107'>107</span>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.</p> - -<p class='c000'>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 -<span class='pageno' id='Page_108'>108</span>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>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.</p> - -<h3 class='c001'>STAMMERING, STUTTERING.</h3> - -<div class='nf-center-c1'> -<div class='nf-center c006'> - <div><span class='sc'>By Prof. G. Delon, late of Paris, France.</span></div> - </div> -</div> - -<p class='c007'>Here is an universal and very strange infirmity, impeding -speech, the origin of which must be anterior to the formation -of languages. Hippocrates, the “<span lang="fr" xml:lang="fr">Père de la Médecine</span>,” 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 -<span class='pageno' id='Page_109'>109</span>French, for instance, “<span lang="fr" xml:lang="fr">Bégaiement</span>” 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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>Stammering proper, when organic, might be called stammering -<span class='pageno' id='Page_110'>110</span>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>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:</p> - -<p class='c000'>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<a id='p110'></a>, general -debility or weakness, chorea, incomplete cerebral action, imperfect -will-power, want of harmony between thought and -<span class='pageno' id='Page_111'>111</span>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>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 -<span class='pageno' id='Page_112'>112</span>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>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 -<span class='pageno' id='Page_113'>113</span>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.</p> - -<h3 class='c001'>HOMELY FACTS.</h3> - -<div class='nf-center-c1'> -<div class='nf-center c006'> - <div>BY F. STEWART, CLEVELAND, O.</div> - </div> -</div> - -<p class='c007'>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 <em>incompatibles</em> 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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>A physician once told an apothecary that he prescribed fluid -<span class='pageno' id='Page_114'>114</span>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>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 -<span class='pageno' id='Page_115'>115</span>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>Having no time to continue this rehearsal, I close with a <em>plea -for more science, more investigation</em>, 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.</p> - -<p class='c000'>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.)</p> - -<div> - <span class='pageno' id='Page_116'>116</span> - <h3 class='c001'>BREUS' OBSTETRIC FORCEPS.</h3> -</div> - -<div class='nf-center-c1'> -<div class='nf-center c006'> - <div>BY C. B. PARKER, M. D.,</div> - <div class='c006'>Professor of Physiology and Lecturer on Gynæcology in the Medical Department of Western Reserve University, Cleveland, O.</div> - </div> -</div> - -<p class='c007'>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.<a id='r1' /><a href='#f1' class='c008'><sup>[1]</sup></a></p> - -<div class='footnote' id='f1'> -<p class='c000'><span class='label'><a href='#r1'>1</a>. </span>Archiv für Gynäcologie XX Band 2 Heft.</p> -</div> - -<p class='c000'>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.</p> - -<div class='figcenter id001'> -<img src='images/i020.jpg' alt='' class='ig001' /> -<div class='ic001'> -<p>Fig. 1.</p> -</div> -</div> - -<p class='c000'>Unlike the ordinary forceps, however, it is constructed with a -hinge-joint (<em>a</em> 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 (<em>b</em>), 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 -<span class='pageno' id='Page_117'>117</span>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.</p> - -<div class='figcenter id001'> -<img src='images/i021.jpg' alt='' class='ig001' /> -<div class='ic001'> -<p>Fig. 2.</p> -</div> -</div> - -<p class='c000'>The principal advantages secured by these forceps are:</p> - -<p class='c000'>1. That they are best adapted to draw in the pelvic axis.</p> - -<p class='c000'>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 <cite>British -Medical Journal</cite>, 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 -<span class='pageno' id='Page_118'>118</span>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.</p> - -<p class='c000'>2. These forceps give the greatest permissible freedom of -movement to the head during traction.</p> - -<p class='c000'>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.</p> - -<p class='c000'>3. An index is supplied by the arms and pin, which serves -to indicate the advance and position of the head.</p> - -<p class='c000'>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>Breus' forceps, after being tested successfully in all possible -<span class='pageno' id='Page_119'>119</span>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.</p> - -<div class='chapter'> - <h2 class='c005'>CORRESPONDENCE.</h2> -</div> - -<h3 class='c001'>BALTIMORE NOTES.</h3> - -<div class='nf-center-c1'> -<div class='nf-center c006'> - <div>BY SPENCER M. FREE, A. M., M. D.,</div> - <div class='c006'>Professor of Diseases of Children in the Baltimore Polyclinic, Baltimore, Md.</div> - </div> -</div> - -<p class='c007'>It is said of Baltimore that socially it is different from other -large cities in the <em>freedom</em> 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.</p> - -<p class='c000'>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 -<span class='pageno' id='Page_120'>120</span>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.</p> - -<p class='c000'>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.”</p> - -<p class='c000'>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.</p> - -<p class='c000'>One physician noted <em>insomnia</em> 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 <em>consciousness</em> of having a -convulsion, while in the latter such consciousness is very clear, -at least at the beginning of the spasm.</p> - -<p class='c000'>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 -<span class='pageno' id='Page_121'>121</span>of diagnosis. He noticed that the younger surgeons favored -the operation, but the older ones were more conservative.</p> - -<p class='c000'>A member reported one of those peculiarly (excruciatingly, -I ought to say) interesting cases of labor, in which, by <em>great</em> -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.)</p> - -<p class='c000'>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.</p> - -<p class='c000'>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 <em>not</em> 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.</p> - -<p class='c000'>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 -<span class='pageno' id='Page_122'>122</span>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.</p> - -<div class='chapter'> - <h2 class='c005'>NOTES AND COMMENTS.</h2> -</div> - -<p class='c007'>If “K.” will send name, we will take pleasure in publishing -his article in our next number.</p> - -<hr class='c009' /> - -<p class='c000'>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.</p> - -<hr class='c009' /> - -<p class='c000'>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 -<span class='pageno' id='Page_123'>123</span>it will be so far completed as to be used for commencement -exercises the last week in February.</p> - -<hr class='c009' /> - -<p class='c000'>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.</p> - -<hr class='c009' /> - -<p class='c000'>“<em>No Children Allowed.</em>”—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.—<em>Sanitarian for November, 1885.</em></p> - -<div><span class='pageno' id='Page_124'>124</span></div> -<div class='ph1'> - -<div class='nf-center-c1'> -<div class='nf-center c010'> - <div>The Cleveland Medical Gazette.</div> - </div> -</div> - -</div> - -<div class='nf-center-c1'> -<div class='nf-center c011'> - <div><em>A MONTHLY JOURNAL OF MEDICINE AND SURGERY.</em></div> - <div class='c006'><span class='sc'>One Dollar per Annum in Advance.</span></div> - <div class='c006'>All letters and communications should be addressed to the <span class='sc'>Cleveland Medical Gazette</span>, No. 5 Euclid Avenue, <span class='sc'>Cleveland, Ohio</span>.</div> - </div> -</div> - -<table class='table1' summary=''> -<colgroup> -<col width='41%' /> -<col width='58%' /> -</colgroup> - <tr> - <td class='c002'>A. R. BAKER, M. D., <em>Editor</em>.</td> - <td class='c004'>S. W. KELLEY, M. D., <em>Associate Editor</em>.</td> - </tr> -</table> - -<div class='chapter'> - <h2 class='c005'>EDITORIAL.</h2> -</div> - -<p class='c007'>Original communications, reports of cases and local news -of general medical interest are solicited.</p> - -<p class='c000'>All communications should be accompanied by the name of -the writer, not necessarily for publication.</p> - -<p class='c000'>Our subscription price remains at one dollar per annum in -advance. Vol. I begins with November, 1885. Subscriptions -can begin at any time.</p> - -<p class='c000'>Remittances when made by postal order or registered letter, -are at the risk of the publishers.</p> - -<h3 class='c012'>THE FASHIONABLE HOBBY.</h3> - -<p class='c013'>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.</p> - -<p class='c000'>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 -<span class='pageno' id='Page_125'>125</span>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.</p> - -<p class='c000'>Some of the best fellows we know ride hobbies, but let those -who now bestride the bacillus beware where the creature carries -them.</p> - -<h3 class='c012'>OLEOMARGARINE.</h3> - -<p class='c013'>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.</p> - -<p class='c000'>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 <i><span lang="la" xml:lang="la">azua pura</span></i> 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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>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.</p> - -<div> - <span class='pageno' id='Page_126'>126</span> - <h3 class='c012'>MEDICAL DEFENCE ASSOCIATION.</h3> -</div> - -<p class='c013'>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.</p> - -<p class='c000'>“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 -<span class='pageno' id='Page_127'>127</span>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.”</p> - -<p class='c000'>“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.”</p> - -<p class='c000'>“Another suit of a blackmailing character has been brought -against Dr. E. Williams and partners of Cincinnati, O. According -to the Cincinnati <cite>Medical News</cite>, 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 -<span class='pageno' id='Page_128'>128</span>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.”</p> - -<p class='c000'>“The Boston correspondent of <cite>The Northwestern Lancet</cite> -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.'”</p> - -<p class='c000'>The case of Drs. Reed and Ford of Norwalk, Ohio, will be -remembered by many Cleveland physicians. Miss Pierce, a -<span class='pageno' id='Page_129'>129</span>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?</p> - -<p class='c000'>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 -<span class='pageno' id='Page_130'>130</span>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.</p> - -<p class='c000'>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.</p> - -<h3 class='c012'>PRELIMINARY EDUCATION OF MEDICAL STUDENTS.</h3> - -<p class='c013'>Dr. John J. King, secretary of Trumbull County, O., Medical -Society, saw our article in the last number of the <span class='sc'>Gazette</span>, -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 -<span class='pageno' id='Page_131'>131</span>adopted by the Pennsylvania State Society at their annual -meeting in Norristown, Pa., May, 1883:</p> - -<p class='c000'>TO REGULATE THE STUDY OF MEDICINE.</p> - -<p class='c014'><span class='sc'>Resolved, I.</span>—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.</p> - -<p class='c014'><span class='sc'>Resolved, II.</span>—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:</p> - -<table class='table1' summary=''> -<colgroup> -<col width='8%' /> -<col width='20%' /> -<col width='71%' /> -</colgroup> - <tr> - <td class='c015'>“I.—</td> - <td class='c016' colspan='2'>A written statement, previously prepared, setting forth the candidate's course of study.</td> - </tr> - <tr><td> </td></tr> - <tr> - <td class='c015'>II.—</td> - <td class='c016' colspan='2'>An essay.</td> - </tr> - <tr><td> </td></tr> - <tr> - <td class='c015'>III.—</td> - <td class='c016' colspan='2'>Writing from dictation.</td> - </tr> - <tr><td> </td></tr> - <tr> - <td class='c015'>IV.—</td> - <td class='c016' colspan='2'>Spelling—Oral and Written.</td> - </tr> - <tr><td> </td></tr> - <tr> - <td class='c015'>V.—</td> - <td class='c016' colspan='2'>Reading.</td> - </tr> - <tr><td> </td></tr> - <tr> - <td class='c015'>VI.—</td> - <td class='c016' colspan='2'>Geography—Descriptive, Physical.</td> - </tr> - <tr><td> </td></tr> - <tr> - <td class='c015'>VII.—</td> - <td class='c016' colspan='2'>Political Economy.</td> - </tr> - <tr><td> </td></tr> - <tr> - <td class='c015'>VIII.—</td> - <td class='c016' colspan='2'>History—Ancient, Modern.</td> - </tr> - <tr><td> </td></tr> - <tr> - <td class='c015'>IX.—</td> - <td class='c016' colspan='2'>Geology.</td> - </tr> - <tr><td> </td></tr> - <tr> - <td class='c015'>X.—</td> - <td class='c016' colspan='2'>Botany.</td> - </tr> - <tr><td> </td></tr> - <tr> - <td class='c015'>XI.—</td> - <td class='c016' colspan='2'>Chemistry.</td> - </tr> - <tr><td> </td></tr> - <tr> - <td class='c015'>XII.—</td> - <td class='c016' colspan='2'>Natural Philosophy.</td> - </tr> - <tr><td> </td></tr> - <tr> - <td class='c015'>XIII.—</td> - <td class='c016'>Mathematics—</td> - <td class='c017'>Arithmetic complete;</td> - </tr> - <tr><td> </td></tr> - <tr> - <td class='c015'> </td> - <td class='c016'> </td> - <td class='c017'>Algebra, through quadratic equations;</td> - </tr> - <tr><td> </td></tr> - <tr> - <td class='c015'> </td> - <td class='c016'> </td> - <td class='c017'>Geometry, through plane geometry.</td> - </tr> - <tr><td> </td></tr> - <tr> - <td class='c015'>XIV.—</td> - <td class='c016'>Languages—</td> - <td class='c017'>English, standard school edition of English Grammar;</td> - </tr> - <tr><td> </td></tr> - <tr> - <td class='c015'> </td> - <td class='c016'> </td> - <td class='c017'>Latin, Cæsar's Com., 4; Virgil, 4; Cicero's Orations, 2.</td> - </tr> - <tr><td> </td></tr> - <tr> - <td class='c015'> </td> - <td class='c016'> </td> - <td class='c017'>Greek, the Reader; Gospels; Xenophon's Anabasis, 2.”</td> - </tr> -</table> - -<p class='c014'>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, -<span class='pageno' id='Page_132'>132</span>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.</p> - -<p class='c014'><span class='sc'>Resolved, III.</span>—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.</p> - -<p class='c014'><span class='sc'>Resolved, IV.</span>—The time of study required by members of -this society shall be five (5) years, including lectures.</p> - -<p class='c014'><span class='sc'>Resolved, V.</span>—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.</p> - -<p class='c014'><span class='sc'>Resolved, VI.</span>—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.</p> - -<p class='c014'><span class='sc'>Resolved, VII.</span>—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.</p> - -<hr class='c009' /> - -<p class='c000'>“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.</p> - -<div class='chapter'> - <span class='pageno' id='Page_133'>133</span> - <h2 class='c005'>SOCIETY PROCEEDINGS.</h2> -</div> - -<h3 class='c001'>PROCEEDINGS OF NORTH CENTRAL OHIO MEDICAL SOCIETY.</h3> - -<div class='nf-center-c1'> -<div class='nf-center c006'> - <div>TWENTIETH QUARTERLY SESSION.</div> - </div> -</div> - -<div class='lg-container-r c011'> - <div class='linegroup'> - <div class='group'> - <div class='line'><span class='sc'>Galion, Ohio</span>, December 18, 1885.</div> - </div> - </div> -</div> - -<p class='c000'>The president, Dr. <span class='sc'>Mitchell</span> 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.</p> - -<p class='c000'>Dr. <span class='sc'>R. Harvey Reed</span> 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.</p> - -<p class='c000'>He referred to the elaborate experiments of Dr. Watson of -Jersey City, which showed the following mortality on rabbits:</p> - -<table class='table1' summary=''> -<colgroup> -<col width='91%' /> -<col width='8%' /> -</colgroup> - <tr> - <td class='c016'>Sulphuric ether,</td> - <td class='c004'>16.66</td> - </tr> - <tr> - <td class='c016'>Chloroform,</td> - <td class='c004'>62.50</td> - </tr> - <tr> - <td class='c016'>Bromide of ethyl,</td> - <td class='c004'>50.00</td> - </tr> - <tr> - <td class='c016'>Alcohol, chloroform and ether,</td> - <td class='c004'>75.00</td> - </tr> - <tr> - <td class='c016'>Alcohol, chloroform and ethyl,</td> - <td class='c004'>66.66</td> - </tr> -</table> - -<p class='c000'>And on dogs:</p> -<table class='table1' summary=''> -<colgroup> -<col width='91%' /> -<col width='8%' /> -</colgroup> - <tr> - <td class='c016'>Sulphuric ether,</td> - <td class='c004'>00.00</td> - </tr> - <tr> - <td class='c016'>Chloroform,</td> - <td class='c004'>00.00</td> - </tr> - <tr> - <td class='c016'>Bromide of ethyl,</td> - <td class='c004'>100.00</td> - </tr> - <tr> - <td class='c016'>Alcohol, chloroform and ether,</td> - <td class='c004'>60.00</td> - </tr> - <tr> - <td class='c016'>Alcohol, chloroform and ethyl,</td> - <td class='c004'>80.00</td> - </tr> -</table> - -<p class='c000'>In these experiments the doctor found it necessary to resort -to artificial respiration on dogs as follows:</p> - -<table class='table1' summary=''> -<colgroup> -<col width='91%' /> -<col width='8%' /> -</colgroup> - <tr> - <td class='c016'>Sulphuric ether,</td> - <td class='c004'>None at all.</td> - </tr> - <tr> - <td class='c016'>Chloroform,</td> - <td class='c004'>2 times.</td> - </tr> - <tr> - <td class='c016'><span class='pageno' id='Page_134'>134</span>Alcohol, chloroform and ether,</td> - <td class='c004'>3 times.</td> - </tr> - <tr> - <td class='c016'>Alcohol, chloroform and ethyl,</td> - <td class='c004'>5 times.</td> - </tr> -</table> - -<p class='c000'>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.</p> - -<p class='c000'>In repeated experiments, he said, he had found the use of -electricity unreliable in resuscitating the heart under these circumstances.</p> - -<p class='c000'>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.”</p> - -<p class='c000'>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.”</p> - -<p class='c000'>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>In closing the author said: “From the brief review of the -anæsthetics most familiar to the profession from a practical -<span class='pageno' id='Page_135'>135</span>standpoint we have arrived at the following conclusions:”</p> - -<p class='c000'><em>First</em>—Of all general anæsthetics known pure sulphuric ether -stands at the head for safety, efficiency and every day practical -use.</p> - -<p class='c000'><em>Second</em>—Hydrochlorate of cocaine stands at the head of all -known local anæsthetics.</p> - -<p class='c000'><em>Third</em>—Ethidene promises to rival ether and merits a more -general and extended trial.</p> - -<p class='c000'><em>Fourth</em>—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.</p> - -<p class='c000'><em>Fifth</em>—No person should be entrusted with the administration -of any anæsthetic who is not thoroughly familiar with its physiological -action and practical administration.</p> - -<p class='c000'><em>Sixth</em>—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 -<i><span lang="la" xml:lang="la">ad libitum</span></i> whenever they may deem it necessary.</p> - -<p class='c000'><em>Seventh</em>—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.</p> - -<p class='c000'><span class='sc'>Dr. J. Campbell</span> 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.</p> - -<p class='c000'><span class='sc'>Dr. N. B. Ridgway</span> 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.</p> - -<p class='c000'><span class='sc'>Dr. Kelley</span> presented a clinical case of blindness in right eye -<span class='pageno' id='Page_136'>136</span>of a girl, from the concussion of a snow ball striking the arch -of the orbit.</p> - -<p class='c000'>The society adjourned to meet in Mansfield March 25, 1886.</p> - -<div class='lg-container-r'> - <div class='linegroup'> - <div class='group'> - <div class='line'><span class='sc'>J. F. Markel</span>, Secretary.</div> - </div> - </div> -</div> - -<h3 class='c012'>THE AMERICAN PUBLIC HEALTH ASSOCIATION.</h3> - -<div class='nf-center-c1'> -<div class='nf-center c006'> - <div>ANNUAL MEETING HELD AT WASHINGTON, D. C., DEC. 8-12, 1885.</div> - <div class='c006'>[By G. C. Ashmun, M. D., Health Officer, Cleveland, O.]</div> - </div> -</div> - -<p class='c000'>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'><span class='pageno' id='Page_137'>137</span>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.</p> - -<p class='c000'>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:</p> - -<p class='c000'>1. “Healthy homes and food for the working classes.”</p> - -<p class='c000'>2. “The sanitary conditions and necessities of school-houses -and school life.”</p> - -<p class='c000'>3. On “Disinfection and individual prophylaxis against -infectious diseases.”</p> - -<p class='c000'>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.”</p> - -<p class='c000'>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 -<span class='pageno' id='Page_138'>138</span>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.</p> - -<h3 class='c012'>CUYAHOGA COUNTY MEDICAL SOCIETY—ADJOURNED MEETING, OCTOBER 15<sup>TH.</sup></h3> - -<h4 class='c018'>REPORTED BY L. B. TUCKERMAN, COR. SEC.</h4> - -<p class='c013'><span class='sc'>Dr. Himes</span> presided.</p> - -<p class='c000'><span class='sc'>Dr. Powell</span> gave a verbal report on the progress of obstetrics -and diseases of children as follows:</p> - -<h4 class='c018'>OBSTETRICS.</h4> - -<p class='c013'>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>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 -<span class='pageno' id='Page_139'>139</span>present tendency of professional opinion is to favor an immediate -operation.</p> - -<p class='c000'>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.</p> - -<p class='c000'>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.</p> - -<p class='c000'>Hicks' bimanual method of treating placenta previa is gaining -ground.</p> - -<p class='c000'>In connection with post partum fever, a larger number of -cases of diphtheritic complications is noted than formerly.</p> - -<h4 class='c018'>DISEASES OF CHILDREN.</h4> - -<p class='c013'>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.</p> - -<p class='c000'>Cassels of Berlin, after an exhaustive investigation, claims -that no remedies are so reliable in <em>pertussis</em> as belladonna and -quinia.</p> - -<p class='c000'>In the treatment of <em>diphtheria</em>, 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.</p> - -<p class='c000'><span class='sc'>Dr. Allen</span> 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.</p> - -<p class='c000'><span class='sc'>Dr. Sihler</span> 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 -<span class='pageno' id='Page_140'>140</span>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.</p> - -<p class='c000'><span class='sc'>Dr. Allen</span> 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.</p> - -<p class='c000'><span class='sc'>Dr. Sihler</span> said that in his case the gall bladder was not so -very much enlarged.</p> - -<p class='c000'><span class='sc'>Dr. Tuckerman</span> 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.</p> - -<p class='c000'><span class='sc'>Dr. Vance</span> 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.</p> - -<p class='c000'><span class='sc'>Dr. Linhart</span> 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.</p> - -<div class='chapter'> - <span class='pageno' id='Page_141'>141</span> - <h2 class='c005'>NEW BOOKS.</h2> -</div> - -<p class='c019'>'<span class='sc'><span lang="fr" xml:lang="fr">Traite Pratique Des Maladies De La Peau; Diagnostic -et Traitement.</span></span>' Par M. Le Docteur E. Guibot, Medecin -De L' Hopital Saint Louis, Paris, etc.</p> - -<p class='c000'>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 <i><span lang="de" xml:lang="de">Krankenhaus -in Wien.</span></i> 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 <em>Diatheses</em>, 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 -<span class='pageno' id='Page_142'>142</span>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.”</p> - -<p class='c000'>After establishing, as he says, “the principles upon which the -scrofulous diathesis is founded,” he proceeds to enumerate the -different <em>scrofulides</em> of the skin as follows: 1, Erythematous; -2, Phlegmonous; 3, Pustulo-crustaciæ; 4, Tuburcular; 5, -Rupiform; 6, Ulcero-gumatous.</p> - -<p class='c000'><span class='sc'>The herpetic diatheses.</span>—“The distinctive feature of prime -import in herpetic lesions (<em>herpidites</em>) is their duration. In the -two diathesis we have just considered we have said that the -<em>scrofulides</em> are continuous in their duration; they present no interruption, -no intermittance; whereas the <em>syphilides</em> 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.</p> - -<p class='c000'>“The <em>herpidites</em> 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 <em>herpidites</em> 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.</p> - -<p class='c000'><span class='sc'>Symptomatic affections of the skin</span>, arising from pathological, -physiological and psychological disturbances are probably of -more interest than any other group, because here one finds so -<span class='pageno' id='Page_143'>143</span>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.</p> - -<p class='c000'>“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.</p> - -<p class='c000'>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.”</p> - -<p class='c000'>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.</p> - -<div class='lg-container-r'> - <div class='linegroup'> - <div class='group'> - <div class='line'><span class='sc'>W. T. Corlett.</span></div> - </div> - </div> -</div> - -<hr class='c009' /> - -<p class='c000'>“<span class='sc'>Official Formulæ of American Hospitals</span>” is the title of a -16-mo manual of 238 pages, published by the <cite>Medical World</cite> -of Philadelphia. It contains the formulæ of some twenty-nine -American hospitals, collected and arranged by C. F. Taylor, -M. D. Price $1.00.</p> - -<hr class='c009' /> - -<p class='c000'>“<span class='sc'>Organic Materia Medica and Therapeutics</span>,” 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.</p> - -<div> - <span class='pageno' id='Page_144'>144</span> - <h3 class='c012'>THE ASTRONOMIC DOCTOR.</h3> -</div> - -<p class='c013'>By request we take pleasure in reprinting this poem from -the <span class='sc'>Cleveland Medical Gazette</span> 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).</p> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div>I.</div> - </div> -</div> - -<div class='lg-container-b c020'> - <div class='linegroup'> - <div class='group'> - <div class='line'>To grace the brow of savans</div> - <div class='line in2'>Astronomy has twined the crown,</div> - <div class='line'>The trumpet sounds their giant deeds,</div> - <div class='line in2'>And celebrates their high renown.</div> - <div class='line'>But from the shrouded face of night</div> - <div class='line in2'>A doctor draws the veil, and first</div> - <div class='line'>Upon his modest, upturned sight,</div> - <div class='line in2'>The splendors of a planet burst.</div> - </div> - </div> -</div> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div>II.</div> - </div> -</div> - -<div class='lg-container-b c020'> - <div class='linegroup'> - <div class='group'> - <div class='line'>His country rounds he still pursues,</div> - <div class='line in2'>The storm he bears, and winter's cold;</div> - <div class='line'>Nor does his simple heart refuse</div> - <div class='line in2'>Creation's wonders to behold,</div> - <div class='line'>But Lescarbault with lifted eyes,</div> - <div class='line in2'>And hand upon his earnest heart,</div> - <div class='line'>Slow walks, to view the stars, but flies,</div> - <div class='line in2'>Relief from suffering to impart.</div> - </div> - </div> -</div> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div>III.</div> - </div> -</div> - -<div class='lg-container-b c020'> - <div class='linegroup'> - <div class='group'> - <div class='line'>Upon the doctor's humble life</div> - <div class='line in2'>Simplicity her graces sheds,</div> - <div class='line'>From grandeur far, and envious strife,</div> - <div class='line in2'>Goodness to diligence he weds.</div> - <div class='line'>His coat of serge he wears content,</div> - <div class='line in2'>Nor e'er for gilded splendor sighs,</div> - <div class='line'>But when he scans the firmament</div> - <div class='line in2'>He sees his “star of honor” rise.</div> - </div> - </div> -</div> - -<div class='nf-center-c1'> - <div class='nf-center'> - <div>IV.</div> - </div> -</div> - -<div class='lg-container-b c020'> - <div class='linegroup'> - <div class='group'> - <div class='line'>On history's page enshrine his fame,</div> - <div class='line in2'>Yet other glories claim our song;</div> - <div class='line'>Friends, collegues, share another's name!</div> - <div class='line in2'>To Laennec too our toasts belong,</div> - <div class='line'>An echo to his ear betrays</div> - <div class='line in2'>The seat of misery's hidden dart—</div> - <div class='line'>'Tis well on stony worlds to gaze—</div> - <div class='line in2'>'Tis nobler far to read the heart.</div> - </div> - </div> -</div> - -<p class='c000'>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.</p> - -<div class='tnotes'> - -<div class='chapter'> - <h2 class='c005'>TRANSCRIBER'S NOTES</h2> -</div> - <ol class='ol_1 c011'> - <li>Corrected nevrosis to necrosis (or might be neurosis) on p. <a href='#p110'>110</a>. - - </li> - <li>Silently corrected typographical errors. - - </li> - <li>Retained anachronistic and non-standard spellings as printed. - </li> - </ol> - -</div> - - - - - - - - -<pre> - - - - - -End of the Project Gutenberg EBook of The Cleveland Medical Gazette, Vol. I. -No. 3., January 1886, by A. R. Baker and S. W. 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