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Title: The Cleveland Medical Gazette, Vol. I. No. 3., January 1886
Author: Kelley, S. W., Various, Baker, A. R.
Language: English
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                     THE Cleveland Medical Gazette

 _VOL. I._                  _JANUARY, 1886._                    _No. 3._



                         A HISTORY OF MEDICINE.

                        BY JOHN BENNITT, M. D.,

    Professor of Principles and Practice of Medicine in the Medical
     Department of the Western Reserve University, Cleveland, Ohio.


It may not be inappropriate to give in your journal a brief sketch of
the history of medicine, by the consideration of which we may come to a
better appreciation of our present standpoint as medical men. We may
also the better understand how much we, as medical men, and the world at
large, are indebted to the methodical, plodding workers of the past in
the field of inquiry pertaining to the nature and cure of disease. Such
review may have the effect of stimulating medical men to more careful
observation and the recording the results of observations that they may
be given to others for mutual benefit.

Science may be defined as “classified knowledge.” But all our knowledge
is based on experience and observation. Medical science, like other
sciences, taking the definition of Sir John Herschel, is “the knowledge
of many, orderly and methodically digested and arranged so as to become
attainable by one.”

In all cases art and observation precede and beget science, and give
origin to its gradual construction. But soon science, so built up,
begins to reflect new light upon its parents—observation and art—helps
them onward, expands the range of vision, corrects their errors,
improves their methods and suggests new ones. The stars were mapped out
and counted by the shepherds watching their flocks by night, long before
astronomy assumed any scientific form.

From the earliest ages the pains and disorders of the human body must
have arrested men's anxious attention and claimed their succor. The
facts observed, both as to hurts and diseases, and as to their attempted
remedying, were handed down by tradition or by record from generation to
generation in continually increasing abundance, and out of the repeated
survey and comparison of these has grown the recognition of certain laws
of events and rules of action, which together constitute “medical
science.”

There is good reason for the belief that Egypt was the country in which
the _art_ of medicine, as well as the other arts of civilized life, was
first cultivated with any degree of success, the offices of the priest
and the physician being probably combined in the same person. In the
writings of Moses there are various allusions to the practice of
medicine amongst the Jews, especially with reference to the diagnosis
and treatment of leprosy. The priests were the physicians, and their
treatment mainly aimed at promoting cleanliness and preventing
contagion. The same practice is approved by the light of latest science.

Chiron, the Centaur, is said to have introduced the art of medicine
amongst the Greeks, but the early history of the _art_ is entirely
legendary. Æsculapius appears in Homer as an excellent physician of
_human_ origin; in the later legends he becomes the god of the healing
art. His genealogy is obscure and altogether fabulous. He, however, soon
surpassed his teacher, Chiron, and succeeded so far as to restore the
dead to life (as the story goes). This offended Hades, who began to fear
that his realm would not be sufficiently peopled; complained to Zeus
(Jove) of the innovation, and Jove slew Æsculapius by a flash of
lightning. After this he was deified by the gratitude of mankind, and
was especially worshiped at Epidaurus, where a temple and a grove were
consecrated to him. His statue in this temple was formed of gold and
ivory, and represents him as a god seated on a throne, and holding in
one hand a staff with a snake coiled around it, the other hand resting
on the head of a snake; a dog, as an emblem of watchfulness, at his feet
(an intimation very appropriate for the medical profession). The
Asclepiades, the followers of Æsculapius, inherited and kept the secrets
of the healing art; or, assuming that Æsculapius was merely a divine
symbol, the Asclepiades must be regarded as a medical, priestly caste,
who preserved as mysteries the doctrine of medicine. The members of the
caste were bound by an oath—the Hippocratis jusjurandum—not to divulge
the secrets of their profession.

In Rome, in the year 292 B. C., a pestilence (probably malarial fever)
prevailed. The Sibyline books directed that Æsculapius (statue!) must be
brought from Epidaurus. Accordingly, an embassy was sent to this place,
and when they had made their request, a snake crept out of the temple
into the ship. Regarding this as the god Æsculapius, they sailed to
Italy, and as they entered the Tiber the snake sprang out upon an
island, where afterwards a temple was erected to Æsculapius and a
company of priests appointed to take charge of the service and practice
the art of medicine. The name Æsculapius, then, is only an impersonation
of medicine in the remote ages, or early ages of Grecian history.

Hippocrates is the first writer of medicine whose works have come down
to us with anything like authority other than fable. Indeed, he was the
most celebrated physician of antiquity. He was the son of Heracleides,
also a physician, and belonged to the family of the Asclepiades, said to
be about eighteen generations from Æsculapius. His mother was said to be
descended from Hercules.

Hippocrates was born in the island of Cos (more anciently Meropis), an
island of the Grecian archipelago of about one hundred square miles,
probably about the year 460 B. C. Instructed in medicine by his father
and other contemporary medical men, he traveled in various parts of
Greece and Asia minor. He finally settled and practiced his profession
at Cos, but died in Thessaly at the age of one hundred and four years
(B. C. 357). Little is known of his personal history, other than that he
was highly esteemed as a physician and an author, and that he raised the
reputation of the medical school of Cos to a high degree. His works were
studied and quoted by Plato. He was famous in his own time, and his
works, some sixty in number, have in them many things that are not
unworthy of consideration even after the lapse of twenty-two hundred
years. Many of the works ascribed to Hippocrates are _not_ well
authenticated.

He divided the causes of diseases into two principal classes—the first
consisting of the influence of seasons, climates, water, situations,
etc.; the second of more personal causes, such as the food and exercise
of the individual patient. His belief in the influence which different
climates exert on the human constitution is very strongly expressed. He
ascribes to this influence both the conformation of the body and the
disposition of the mind, and hence accounts for the difference between
the hardy Greek and the Asiatic.

The four humors of the body (blood, phlegm, yellow bile and black bile)
were regarded by him as the primary seats of disease; health was the
result of the due combination (or crasis) of these humors, and illness
was the consequence of a disturbance of this crasis. When a disease was
progressing favorably these humors underwent a certain change (coction),
which was the sign of returning health, as preparing the way for the
expulsion of morbid matters, or crisis, these crises having a tendency
to occur at definite periods, which were hence called critical days.

His treatment of disease was cautious and what we now term expectant,
_i. e._, it consisted chiefly, often solely, in attention to diet and
regimen; and he was sometimes reproached with letting his patients die
by doing nothing to keep them alive.

His works written in Greek were at an early period translated into
Arabic. They were first printed in Latin in 1525, at Rome. A complete
edition in Greek bears a date a year later.

Several editions in Latin and other languages have appeared from time to
time. An English translation of 'The Genuine Works of Hippocrates,' was
published by the Sydenham society in 1848, in 2 vols., by Dr. Adams. The
advance which Hippocrates made in the practice of medicine was so great
that no attempts were made for some centuries to improve upon his views
and precepts. His sons, Thessalus and Draco, and his son-in-law,
Polybius, are regarded as the founders of the medical sect which was
called the Hippocratean or Dogmatic school, because it professed to set
out with certain theoretical principles, which were derived from the
generalization of facts and observations, and to make these principles
the basis of practice. The next epoch in the history of medicine is the
establishment of the school at Alexandria, which was effected by the
munificence of the Ptolemies, about B. C. 300. Indeed the whole race of
Ptolemies (from Ptolemy I. to Ptolemy VII. B. C. 323 to 117) seem to
have been patrons of learning and learned men. (Less so Ptolemy VIII. to
XIII., B. C. 117 to 43. Ptolemy II., Philadelphius, was born in Cos
about 150 years after Hippocrates.) It was by the patronage of these
kings of Egypt that learning flourished in Alexandria during their
reign.

In some of them this seems to have been the only redeeming feature of
their character. Otherwise vicious, cruel, bloodthirsty in an extreme
degree, they uniformly encouraged learning and learned men. (It seems to
have been a hereditary trait.) Amongst the most famous of the medical
professors of the School of Alexandria are Erasistratus and Herophilus.

The former of these was a pupil of Chrysippus, and probably imbibed from
his master his prejudice against bleeding and against the use of active
remedies, preferring to trust mainly to diet and to the _vis medicatrix
naturae_.

Herophilus, born in Chalcedon, in Bythinia, flourished in the latter
part of the fourth and the beginning of the third century B. C., and
settled in Alexandria, especially was distinguished by his devotion to
the study of anatomy. He is said to have pursued this to such an extent
as to have dissected criminals alive. Several names which he gave to
different parts of the body are still in use, as the torcular Herophili,
calamus scriptorius, and duodenum. He located the seat of the soul in
the ventricles of the brain. Only a few fragments remain of what he
wrote.

About this time the Empirics formed themselves into a distinct sect and
became the declared opponents of the Dogmatists. The controversy really
consisted in the question, “How far we are to suffer theory to influence
over practice.” While the Dogmatists, or as they were sometimes styled,
the Rationalists, asserted that before attempting to treat any disease
we ought to make ourselves fully acquainted with the structure and
functions of the body generally, with the operation of medicinal agents
upon it, and with the changes which it undergoes when under the
operation of any morbid cause, the Empirics, on the contrary, contended
that this knowledge is impossible to be obtained and if possible is not
necessary; that our sole guide must be experience and that if we step
beyond this, either as learned from our own observations or that of
others on whose testimony we can rely, we are always liable to fall into
dangerous and often fatal errors. According to Celsus, the founder of
the Empirics was Serapion, who was said to be a pupil of Herophilus. At
this period, and for some centuries later, all physicians were included
in one or the other of these rival sects, and from the evidence of
history the two sects or schools were about equal. From Phiny, who wrote
about the middle and sixth, seventh and eighth decades of the first
century, we learn that medicine was introduced into Rome at a later
period than the other arts and sciences.

The first person who seems to have made it a distinct profession,
separate from priestcraft, was Archagathus, a Peloponnesian, who settled
at Rome about B. C. 200. His treatment of his patients was so severe and
unsuccessful that he was finally banished, and no other mention is made
of a physician at Rome for about a century, when Asclepiades of
Bythinia, acquired a great reputation. His popularity depended upon his
allowing his patients a liberal use of wine, and of their favorite
dishes, and in all respects consulting their inclinations and flattering
their prejudices; and hence it is easy to understand the eminence at
which he arrived, for we see even in our own time men building up great
reputations by similar practices.

This man with a long name—Archagathus—was succeeded by his pupil,
Themison of Laodicea, the founder of a sect called Methodics, who
adopted a middle course between the Dogmatists and Empirics. During the
greater part of the first two centuries of our era the Methodics were
the preponderating medical sect, and they included in their ranks C.
Aurelianus, some of whose writings have come down to us.

They soon broke into various sects of which the chief were the
Pneumatics, represented by Aretaeus of Cappadocia, whose works are still
extant; and the Eclectics, who claimed as do the Eclectics of to-day, to
select the best from all the other systems and to reject the hurtful.
The most remarkable writer of this age is Celsus (about A. D.), whose
work (De Medicina) gives a sketch of the history of medicine up to that
time and the state in which it then was. He is remarkable in being the
first _native_ Roman physician whose name has come down to us.

Dioscorides of Cilicia flourished about the end of the first century. He
accompanied the Roman army in their campaign through many countries and
gathered a great store of information and observations on plants. In his
great work 'De Materia Medica,' he treats of all the then known
medicinal substances and their properties, real or reputed, on the
principles of the so-called humoral pathology. Two other works are
ascribed to him but their genuineness is questionable. For fifteen
centuries the authority of Dioscorides, in botany and materia medica,
was undisputed, and still holds among the Turks and Moors.

                          [_To be Continued._]



              REPORT OF A CASE OF EXTRA-UTERINE PREGNANCY.

                 BY H. J. LEE, M. D., CLEVELAND, OHIO.


The following case came under my care during my term of service in the
wards of Charity Hospital in this city. Mrs. D., age thirty-five,
married, one child two years of age, was admitted to the hospital July
14, 1885, with the following history: She had always enjoyed good
health, and there was no history of uterine disease. She menstruated
about the first of April, 1885, did not menstruate in May, and supposed
herself pregnant, as she had always been regular before, and during the
latter part of May she had considerable nausea and other symptoms of
pregnancy. About the first of June, while in church, she was taken with
a severe hemorrhage. She was taken home and a physician called, who
examined her and decided from the symptoms and history that she had had
a miscarriage. There was very little hemorrhage after she arrived home,
in fact very little at any subsequent time, but she did not recover
well, had some pains in the abdomen, and she said had some fever all the
time. Not getting on well, as she and her friends thought, it was
decided to change physicians, which was done. The second physician
concurred in the diagnosis of the first, and treated her evidently on
the expectant plan, as any one would be compelled to do, owing to the
difficulty of making a correct diagnosis at such an early stage. After a
time, there being no improvement, she decided to go to the hospital. On
admission she was quite emaciated and had an anaemic appearance; her
temperature was about 99° to 100° in the morning and 100° to 102° in the
evening. There was considerable tenderness in the right iliac region,
extending into the hypogastric region. Uterus was not felt to be at all
enlarged, but the os was patulous. There was an enlargement to the right
of the uterus. This could be felt both externally and through the
vagina; was of an irregular outline, and quite tense and tender upon
pressure. A sound was introduced into the uterus and passed in about
three inches and was deflected to the left quite perceptibly. It did not
appear quite certain that there was nothing in the uterus, and in view
of the history of the case it seemed justifiable to explore the cavity.
Accordingly a good sized sponge tent was introduced and allowed to
remain twenty-four hours, when it was removed and the uterine cavity
explored with purely negative results. The patient had now been under
observation over a week, and attempts made to improve her general
condition with tonics and nutritious diet, but without success. Her
temperature continued about 101° most of the time. A positive diagnosis
had not been made, though it seemed that about everything could be
excluded except extra-uterine pregnancy. At this juncture Dr. W. J.
Scott was asked to see the patient. He did so and made a very careful
examination, and gave it as his opinion the case was one of
extra-uterine pregnancy. The next day Dr. Dudley P. Allen was called in
consultation with Dr. Scott and myself. Dr. Allen's examination was
careful and exhaustive, and at its close he gave it as his opinion that
while there were some obscure points, the most probable conclusion was
that the case was one of extra-uterine fœtation.

Having all arrived at this conclusion, independently of each other, it
was agreed that as there was some obscurity in the case, and also that
in the event of there being a fœtus outside of the uterus it had now
advanced to about the fourth month of gestation; consequently the most
favorable time for the employment of the electric current had passed. In
view of these facts, and also of the fact that exploratory incisions are
attended with comparatively little danger, it was decided to make an
exploratory incision and determine what was the condition of things. If
a fœtus was found remove it if possible. If the trouble was something
that could not be removed, the incision could be closed and the patient
probably in no wise injured. Dr. Allen was asked to operate, and on the
sixth of August the operation was performed. There were present, Dr.
Allen, Dr. Scott, Dr. Millikin and the house staff. The anæsthetic was
administered, and before commencing the operation an aspirator needle of
good size was introduced into the tumor through the vagina. Upon
exhausting the air no fluid was obtained, but upon partially withdrawing
the needle about a drachm of clear serum was obtained, which was thought
to be peritoneal fluid. It was then decided to proceed with the
operation. An incision was made about an inch above and parallel to
Poupart's ligament, commencing at the anterior superior spinous process
of the ilium, and terminating at the outer margin of the rectus muscle.

On opening the abdomen an adherent mass was found closely attached to
the coecum. Strong bands also passed from the mass toward the symphysis
pubis. In order to reach the mass more fully, and also the annexes of
the uterus, the adhesions to the pubis were divided between ligatures.
This having been done, it was still found to be impossible to detach the
intestines which were closely adherent to the coecum, and nothing
abnormal could be found in connection with the uterus. Failing to
discover the cause of the adhesions about the coecum from the abdominal
cavity, it was thought this might be accomplished by separating the
peritoneum from the iliac fossa, and reaching the coecum from the outer
and posterior side. This separation was continued until it could be
carried no further without great danger of wounding the external iliac
vessels, which were exposed for several inches. Although nothing further
than a closely adherent mass of intestines had been found, an attempt to
separate which had been carried to the limit of safety, and the cause of
the malady had not been demonstrated with entire satisfaction, it was
deemed best to close the abdominal incision, which was accordingly done.

The subsequent history of the cure was as favorable as could be desired.
The wound united very readily. The temperature never rose above 103°,
and was only at that point for a few hours; most of the time was 100° to
101.5°. Two weeks after the operation temperature was normal, a point it
had not reached since her admission, and probably not for some time
previous.

Patient was examined September 8; the tumor was found to be considerably
diminished in size, and tenderness almost entirely disappeared. She had
apparently gained in weight, and expressed herself as feeling well. She
was discharged from the hospital September 9. On the tenth of October
she again presented herself, according to agreement, and was examined by
Dr. Scott, Dr. Allen and myself. The tumor had entirely disappeared,
only a slight thickening of the tissues remaining, the uterus had
resumed its normal position, and the patient, to all appearances, was as
well as ever.

I have reported this case as one of extra-uterine pregnancy, and yet it
will be seen by the report that the existence of that condition was not
demonstrated at the operation, but it seems to me that the history of
the case, both prior and subsequent to the operation, demonstrates
pretty conclusively that it could be nothing else. Both the gentlemen
who saw the case before operation were of the opinion that everything
could be excluded except a collection of fluid, disease of the coecum
and extra-uterine pregnancy, and to my mind (and the gentlemen who were
called in consultation have expressed themselves in the same manner) the
operation and the result of it excludes everything except the last
mentioned condition. It may be said that in the treatment of the case
less severe measures should first have been tried; that the electric
current should have been employed before resorting to an operation. This
subject was fully discussed, and the decision against the employment of
electricity was unanimous, from the fact that the most favorable time
for its employment had passed and the time had arrived when any further
delay was dangerous. Then the danger from an exploratory incision is so
small that it seemed to be more than counterbalanced by the knowledge
that would be obtained by it. If an exploratory incision was made we
would then be better able to tell what we had to deal with, and would
also be in a position to deal with whatever was found in the most
effectual manner, and it was thought that the most certain means of cure
should be employed first and the patient not be subjected to the danger
of delay in order that less certain methods might first be tried; also
the high temperature seemed to render any delay more dangerous. The
incision described was employed because it seemed that the tumor could
be more easily reached and removed by means of it than by means of the
central one. When, however, the mass was reached it was found to be so
firmly attached to the cœcum by strong adhesions that it was absolutely
immoveable. Under these circumstances it was decided that it would be
unwise to attempt its removal, consequently the wound was closed and the
operation desisted from. The subsequent history was all that could be
desired, or could, under any circumstances, have been expected.

I think the most probable explanation of the disappearance of the tumor
is this: The case was one of extra-uterine pregnancy of the abdominal
variety, the ovum became attached to the peritoneum and a connective
tissue proliferation was set up which surrounded it with a vascular
sack, the walls of which kept pace with the growth of the ovum, and as
they extended into the abdominal cavity formed adhesions to the cœcum,
intestines, and other parts in the vicinity. During the operation these
adhesions were ligated and divided, and in consequence the nutrition of
the ovum was entirely cut off, and death and absorption was the result.

Since writing the report of this case the patient has been seen and
examined. She seems to be in perfect health, and says she never felt
better. There is not a vestige of the tumor remaining, except two or
three small indurated spots that can be felt through the vagina.



                        STAMMERING, STUTTERING.

               BY PROF. G. DELON, LATE OF PARIS, FRANCE.


Here is an universal and very strange infirmity, impeding speech, the
origin of which must be anterior to the formation of languages.
Hippocrates, the “Père de la Médecine,” Galen and Aristotle attributed
it to an abnormal moisture of the brain and tongue and to a defective
construction of the tongue, and their theories have been revived by
modern writers. We find in Aristotle a double definition that stammering
is an inability of articulating a certain letter, and stuttering an
inability of joining one syllable to another. Notwithstanding the
difference between the causes, the characteristics and the effects of
both defects, several languages have but one word to express it; in
French, for instance, “Bégaiement” means either stammering or
stuttering. American dictionaries give the same definition for both; and
in common talk no distinction is made, all stoppages in speech being
called indiscriminately stammering or stuttering.

Speech being a combination of separate sounds produced by the expired
air, it is certain that the first condition required for natural and
correct speech is an undisturbed and normal action of the breathing
apparatus.

The movements performed by the respiratory organs for the modification
of the currents of air being produced by muscles owing their activity to
nerves—motor and sensory—and the vocal organs being, like all parts of
the organism, provided with nerves, it becomes evident that a general
excitation of the nervous system, or any unusual excitement of the
motor-nerves in action, will affect the muscles, cause irritation and
create disturbances in inspiration, expiration and speech.

Normal inspiration is produced by a regular contraction of the
diaphragm, and expiration is due to the elasticity of the tissue of the
lungs. A spasmodic inspiration, during which a prolonged contracted
spasm of the diaphragm takes place, produces stammering; such a
convulsive contraction of the diaphragm can take place without
attempting to speak, but any attempt to utter sounds during the spasm
will result in stammering. At the end of the spasm, the air is then
quickly expelled from the lungs. I have noticed stammering children that
I have treated subject to frequent attacks of hiccough; in hiccough the
expiration is quiet: an irritation of the nerves of the diaphragm brings
about, with a violent inspiration, an attenuated convulsive contraction
of the diaphragm, as in stammering.

In stuttering which is characterized by the presence of some spasm, in
all articulations, labial, lingual, dental and guttural, although
respiration is irregular and the respiratory organs do not work well,
the inability to form and join the sounds comes from other sources than
a spasmodic contraction of the diaphragm.

Stammering proper, when organic, might be called stammering of the
diaphragm, and that distinction would be quite logical, as other organs
wholly unconnected with speech show that peculiarity of being affected
with stammering.

The influence exercised on the voice and speech by the respiratory
mechanism is so considerable that a variety of theories on respiration
have been advanced and discussed by physicians and specialists, not only
with reference to speech impediments but specially for singing,
elocution, acting and public speaking, and also in reference to general
health. Writers and professors advocating exclusively so-called
diaphragmatic, or costal, or abdominal respiration, are incorrect and
perfectly deceived. The diaphragm, the ribs, and the muscles of the
abdomen must all do more or less their special work, in order to carry
on a normal and healthy respiratory act. An eminent physician, Dr. Ed.
Fournié of Paris, says: “He who respires exclusively by one or the other
of these alone (diaphragm, ribs or abdomen) must be indeed a sick man.”
Costal or side-breathing is due to the elevation and depression of the
ribs simultaneously with the contraction of the diaphragm. Abdominal
breathing, the method taught to singers, is performed by the pressure of
the abdominal muscles upon the anterior and lateral walls of the
abdomen, forcing up the diaphragm, and thus expiring almost completely
the air in the lungs.

Medical and scientific investigations concerning speech defects have
been as considerable as it is contradictory. The observations of
prominent doctors and specialists, some of them being afflicted
themselves, have in the most argumentative thesis attributed
stammering-stuttering to numerous and varied causes, the enumeration of
which has a real historical and pathological interest:

Faulty action of the tongue, disorders of tongue-muscles, spasms of the
glottis and epiglottis, troubles located in the larynx and in the
hyoid-bone, abnormal depth of the palate, affections of the muscles of
the lower jaw, spasm of the lips, abnormal dryness or moisture, or
lesion of brain, nerves, muscles or tongue, nervous affection,
intermittent necrosis, general debility or weakness, chorea, incomplete
cerebral action, imperfect will-power, want of harmony between thought
and speech, imitation and habit.—Such is the nomenclature of the
principal ingenious theories exposed and upheld by those who have made a
study or a business of the cure of speech defects. But some mistaken
innovators, not satisfied with theories and investigations, gave to
their ideas an experimental form. Forty and forty-five years ago a
surgical craze, originating in Germany as a pretended cure of speech
defects, was raging all over Europe. Stammerers and stutterers suffered
a variety of operations, the horizontal section of the tongue, the
division of the lingual muscles, the division of the genio-hyo-glossi
muscles, the cutting of the tonsils and uvula, etc. Such suppression and
mutilation of the vocal organs could not bring any cure, as it was
proved, and some patients having died, the operating craze was put to an
end forever. Since that it is by more gentle means that all attempts
have been made to cure impediments of speech. The unfortunate stutterer
has no longer to dread the misemployed zeal of surgical operators, and
now it is even his own fault when he allows himself to fall into the
hands of ignorant charlatans.

Without lessening the value of former discoveries, I will say that the
specialist of to-day must disagree with the most eminent authors and the
most prominent works on that question, including Velpeau, Amussat,
Becquerel, Lenbuscher, Bèclard, Bristowe, etc., and arrive at the
conclusion that their testimony was one-sided, being confined to their
own or few cases, and limited to mere theory and speculation. For the
treatment of vices of speech, with the indispensable knowledge, long and
practical experience alone will instruct what is the right method to
pursue. The various theories on the nature and causes of that infirmity,
and the enumeration of the different responsible organs may be, at the
same time, partly false and partially true; but they have proved
powerless to cure or relieve.

In all varieties and forms of stammering-stuttering all the vocal organs
can be blamed, and have, in each case, to be reformed and improved. In
the majority of cases we find some traces of the organic peculiarities
aimed at by authors, even if their influence is doubtful. Respiratory
trouble is at the bottom of every case. The internal organs, and the
tongue, the lips and jaws are to some extent in an abnormal condition,
and suffer a convulsive spasm; they have to be treated, strengthened and
made flexible. The nerve-function of the organs of speech is also
disturbed. We notice in the majority of cases, to a certain degree,
organic weakness, nervousness, lack of will-power, and above all,
disregard of all natural rules and ignorance of the use and natural
functions of the organs of speech.

As to prognosis, I will say that all stoppages in speech, accompanied by
spasms, sometimes hardly perceptible, and which are not the result of
paralysis or lesion, may be classified as stammering-stuttering, and can
always be cured, whatever may be their origin or cause, or their
intensity, and that it is only a question of time and perseverance even
for the most stubborn cases.

The treatment of stammering-stuttering, which does not comport any
operation nor drugs, is purely educational. It consists in remedying the
defect and teaching properly the science of speech. Still, I think, that
in many cases a strict attention ought to be paid to hygienic measures;
some medical care and prescription would help the patient and the
instructor. In the actual condition of things no regular practicing
physician can afford to devote his ability and time to the treatment of
speech defects. But doctors have to study the infirmity, to know that it
can be cured, that it is an interesting and complex disease, in the
treatment of which the progress of medical science can bring a
revolution. Physicians the world over having wholly neglected to
consider that question, the result has been to leave it in the hands of
incompetent persons. In principle the question of speech impediments
cannot be separated from medicine. Physicians cannot ignore an infirmity
in which the organism itself is undoubtedly involved, at times in a very
intricate manner and to a considerable extent. Every true physician
feels that he has a sacred mission—to alleviate suffering; the tortures
of a large class of people partially deprived of the faculty of speech
are well worth his care and attention. Medical students ought to be
provided with the means of becoming versed in an affection offering such
a large field for study and work, where so much light is needed, and
where the prospects of discovery and improvement from a scientific and
medical standpoint are so legitimate. The family physician, often
consulted, will do good work in advising his clients to try and get rid
of such a terrible affliction, to be cured without delay, and in
preventing them from falling into the hands of quacks.



                             HOMELY FACTS.

                      BY F. STEWART, CLEVELAND, O.


Not long ago as a bottle was placed upon the counter of a pharmacist to
be refilled, its inner walls were observed to be richly decorated with
the active principles of the compound. A witch-hazel doctor standing by
declared the decorated walls to be the secret of the patient's recovery,
but upon inquiry it was found that the patient was no better. Still they
had decided to try another bottle, and the apothecary was not the one to
object. The investigation was carried no farther, but if it had been the
same old story of _incompatibles_ would have been retold. To the aqueous
solutions containing oleoresinous tinctures or extracts (such as
cannabis indica, guaiac, benzoin, lupulin, ginger, myrrh, cubeb,
eucalyptus, sumbul, and many others) a sufficient quantity of carbonate
or calcined magnesia should be added. A few grains (say three to twenty)
to the prescribed dose will suffice for a good suspension, and will be
found in most cases unobjectionable of course in an acid mixture.

There are many conflicting reports of this class of medicines, owing to
unscientific prescribing as well as unreliable preparations. The
activity of this class of medicines demands nothing short of strong
alcohol for their extraction. Yet many weak and worthless preparations
may be found in the market. If the unscientific observers would look
more to the quality of their goods, these conflicting reports would
begin to subside.

A physician once told an apothecary that he prescribed fluid extracts
because he found them more reliable than the tinctures. This was not
true, and could not be proven. Upon investigation it was found that his
prescribed dose of fluid extract of digitalis was equivalent to
fifty-five drops of the tincture, a dose larger than he intended to
prescribe. With such science the witch-hazel doctor will ride a high
horse, and come in on the home stretch with flying colors. No singer can
sing well who sings too many songs, and no beginner will prescribe well
who prescribes too many medicines. This song has been sung much but not
half enough, for it is not borne in mind. Many fail with a remedy simply
because they have failed to master it.

Mastering the few is said to be the key to success, and the writer
believes it, for he has seen it proven. An eminent physician from New
York was once called in consultation to a western city. His prescription
was mercury iodide, potassium iodide, and infus. gentian. He stated (and
the other physician said, “I see”) that the only object of the potassium
was to dissolve the mercury iodide. But potassium's great affinity for
iodide accepted it, at once dropped the free mercury to the bottom,
likely to be taken all at the last dose, equal to fifteen or twenty
grains of blue pill. He had failed to master this remedy.

The witch-hazel doctor could not declare this time that the untaken
medicine saved the patient's life, for he died before taking it. But he
could smile at the prescription appropriately, were none of his own to
be found on file.

Another phase of fashion reminds one of the old saying “distance lends
enchantment;” for there is just as good sense in going to New Brunswick
to have a boil lanced as there is in bringing syrup hypophosphates from
that place.

The present pharmacopœia contains a splendid formula for this syrup—one,
too, with which phosphoric acid, quinine and strychnine are perfectly
compatible. A pharmacist that will not exert himself to furnish the very
best article for a physician's prescription is not entitled to the
physician's respect. But for a physician to expect a pharmacist to send
all over town for some foreign preparation that might, in almost all
cases, be better made at home, affords a weapon to retard medical
science and advance the nostrum manufacturer. The more scientific
physicians well know and admit that a good pharmacist can better judge
of a compound than a physician, who seldom stops to test it, but
prescribes it a few times and, in many cases, never thinks of it again,
or, perhaps, not until he presents his bill and finds the patient's
money all gone for semi-proprietary medicines that cost from fifty to
one hundred per cent. more than would have paid for better compounds.
Physicians will only have to examine these medicines after they have
stood a year or two, and in many cases a much less time, to see the
force of this argument.

Among these nostrums are found numerous preparations we could mention,
including many emulsions, elixirs, etc. It is comforting to see the
better class of physicians giving these nostrums a “wide berth.” Others
will follow their example if they investigate and master their remedies.

Having no time to continue this rehearsal, I close with a _plea for more
science, more investigation_, that we may not have to send to Buffalo
for syrups of Dover powder or farther east, west or south for nostrums,
but master the remedies we have, saving to the physician and patient
from fifty to one hundred per cent., thus mitigating the popular cry of
the high price of medicine. There should be a table of incompatibles in
every medical college as prominent as the multiplication table in the
schools, or pharmacists should be allowed more freedom to prepare
medicines properly, instead of being held to the letter.

The writer should not complain, for he has been liberally treated by the
profession in this respect; but he does not feel at liberty to add
magnesia to a mixture unless so ordered. A pharmacist did this at one
time in a tar-and-water mixture, gaining great praise from the
physician. (Making the tar quite thin with a little alcohol, then
absorbing the whole with magnesia, and emulsifying by adding the water
gradually.)



                       BREUS' OBSTETRIC FORCEPS.

                        BY C. B. PARKER, M. D.,

   Professor of Physiology and Lecturer on Gynæcology in the Medical
        Department of Western Reserve University, Cleveland, O.


The accompanying wood-cuts represent the forceps recently introduced to
the profession by Dr. Breus, formerly first assistant in the clinic of
Prof. Carl Braun, Von Fernwald, in Vienna.[1]

Footnote 1:

  Archiv für Gynäcologie XX Band 2 Heft.

It is the simplest in construction of the so-called axis traction
forceps, and is specially designed for the extraction of the head
presenting high above the pelvic brim. In size, shape, curves, handles,
lock, etc., it is an exact model of the J. Y. Simpson forceps—the
favorite instrument of the Vienna school.

[Illustration: Fig. 1.]

Unlike the ordinary forceps, however, it is constructed with a
hinge-joint (_a_ Fig. 2) at the angle of the fenestrum with the shaft,
which permits of a movement of the blades through an arc of about 40°.
An elbow on the lower margin of the blade arrests the further movement
in the downward direction, and a prolongation of the upper fenestrum of
the blade, in the form of an arm (_b_), is continued backward parallel
to the shafts. This arm turns at an angle of 100° in front of the lock
and terminates in an eye, through which the split pin seen at the side
of the instrument passes. The pin fits loosely in the eyes and
restricts, while still permitting considerable latitude of movement to
the blades. At the suggestion of several gentlemen to whom the
instrument was shown, the shaft has been lengthened nearly one inch. In
other respects the forceps is an exact counterpart of those now used in
the lying-in department of the General Hospital in Vienna.

[Illustration: Fig. 2.]

The principal advantages secured by these forceps are:

1. That they are best adapted to draw in the pelvic axis.

This was the special claim set up by Aveling for his Sigmoid forceps.
Tarnier also, in introducing his axis traction forceps to the profession
in 1877 (for an account of which see _British Medical Journal_, May 26,
1878), proves by means of diagrams and figures that, “in pulling on the
classical forceps, it is impossible to make the traction exactly in the
line of the pelvic curve,” and that two forces are actually exerted—one
in the direction of the inferior straight, and the other at right angles
to this in the direction of the pubes, while the head tends downward in
the pelvic curve—the resultant of these two forces. This “vicious
pressure” upon the pubes represents not only so much force lost, but
also tends to injure the maternal soft parts, and can only be overcome
by using the axis traction forceps. As the head descends, the pelvic
curves of the blades become less and less, until, as the head arrives on
the floor of the pelvis, the forceps are nearly straight. At the moment
the head sweeps over the perineum the blades are still further
deflected, until they form an angle with the shafts, as shown in the
dotted lines of Fig. 1, thus forming the perineal curve of Herman's,
Aveling's and Tarnier's forceps.

2. These forceps give the greatest permissible freedom of movement to
the head during traction.

By the loose connection of the blades each possess a degree of
independent movement, but always in a plane parallel to the other, so
that the head may rotate during traction. The carrying out of this
important principle is the chief advantage of this instrument over all
other axis traction forceps.

3. An index is supplied by the arms and pin, which serves to indicate
the advance and position of the head.

The application of Breus' forceps is in no wise more difficult than that
of the ordinary instrument. Having disinfected, warmed and lubricated
the blades, and the patient being prepared by an irrigation of a
solution of bichloride, one part in 2,000, and placed in the lithotomy
position, the handle of the left blade is taken up by the thumb and
three fingers of the left hand (as one would hold a fiddle bow), the
index finger pressing the projecting arm firmly against the shaft, as
the thumb of the right hand guides the blade forward in the groove
between the index and middle fingers introduced into the vagina. The
right blade is then introduced in a similar manner and locked, and the
pin inserted in the eyes of the projecting arms. The traction is made
upon the handles in the axis of the brim, without changing its direction
until the head presses on the perineum. Prof. Braun prefers, at this
point, to remove the forceps and complete the delivery in the ordinary
way.

The same precautions are necessary in using the axis traction as the
ordinary forceps. Especially must it be remembered that, as the force is
exerted directly in the axis of the pelvic curve, and none being lost,
much less is required, and generally the force of one hand is quite
sufficient. To avoid too great compression of the head, the compressing
force should be removed by opening the lock in the interval of each
traction.

Breus' forceps, after being tested successfully in all possible
difficult cases—in many where the operator had failed with the ordinary
forceps, as I myself have seen—is now recognized as the instrument best
adapted to those cases where the head presents high above the pelvic
brim.



                            CORRESPONDENCE.



                            BALTIMORE NOTES.

                   BY SPENCER M. FREE, A. M., M. D.,

     Professor of Diseases of Children in the Baltimore Polyclinic,
                             Baltimore, Md.


It is said of Baltimore that socially it is different from other large
cities in the _freedom_ as well as the cordiality with which it extends
its hospitality. The business men and their clerks are polite and
attentive. They do not display the trait, so common in the metropolis,
of incognizance—even to rudeness—if one chances to be on a tour of
inspection instead of purchase. The impression is at once made, and very
forcibly, that a Baltimorean has plenty of time, that he is not hurried.
He will stop on the street and direct a discomfited stranger, and has
been frequently known to turn aside from his duties and accompany the
lost one to where he could take care of himself. This is a natural
element in the entire populace, and is very prominent in the medical
profession. A stranger is welcomed so heartily that he feels at home
immediately, and can settle down among friends.

It occurs to me that this easy-going feeling has had much to do in
keeping our city from occupying the prominent position in education and
authorship that her opportunities, and conditions in general, would lead
us to expect. I am glad to say that she is arousing from her lethargy,
and recently her pen has been busy. Several works have emanated from the
profession here which have attracted much attention, and have been quite
extensively read. Notably among them is a 'Text-book of Hygiene,' by Dr.
Rohe, and 'The Physician Himself,' by Dr. Cathell, which has reached a
fifth edition and a sale of over fifteen thousand copies. I should like
to say, concerning these two works, that no physician, especially if he
be under thirty-five years of age, should be without them. Two other
works, 'A Manual on Nervous Diseases,' by Dr. A. B. Arnold, an old,
experienced and able teacher, and one on 'Practical Chemistry,' by Dr.
Simon, have been much studied and commented upon. They are limited to
special subjects and will not naturally obtain a large class of readers.
These, like the long-delayed blade of corn, which pushes its emerald tip
heavenward and bears upon its face the sparkling matin dew, give promise
of a fertile soil and of abundant fruitage.

At the last meeting of the Medical and Surgical Society—which we had the
pleasure of attending—there was an interesting discussion on cerebral
troubles of syphilitic origin. A number of cases were related. The
various symptoms of these maladies are familiar to your readers. The
treatment which was successful in all but one of the cases here
reported, was mercury and iodide of potassium. The plan preferred for
the administration of mercury is by inunction. All the debaters insisted
upon the full constitutional effects of the drugs. As one gentleman put
it, “the system must be saturated before a cure is assured.”

I might mention among the symptoms, that those manifested by the eye
were not regarded as reliable. In one case the only manifestation was a
persistent and severe supra-orbital and occipital neuralgia, and for
some time the man was in consequence wrongly treated.

One physician noted _insomnia_ as a distinct and always present symptom.
Also as a point of differential diagnosis between the convulsions of
epilepsy and those of local lesion of the brain, that in the former
there is no _consciousness_ of having a convulsion, while in the latter
such consciousness is very clear, at least at the beginning of the
spasm.

A case of pelvic peritonitis of the chronic form, reported by the
president of the society, elicited much discussion, especially upon the
subject of exploratory abdominal incision as a means of diagnosis. He
noticed that the younger surgeons favored the operation, but the older
ones were more conservative.

A member reported one of those peculiarly (excruciatingly, I ought to
say) interesting cases of labor, in which, by _great_ exertion on his
part, and the assistance of two physicians and three (I think is the
number) midwifes or old ladies, he managed “to save the old man,” though
the other parties concerned passed on into the mysterious future. (The
society is expected to laugh a good deal just here, and of course we
expect the readers to do the same.)

At a recent meeting of the Baltimore Medical Association a member
related the following experience: In a family of three children, the
oldest, who had scarlatina four years ago, contracted diphtheria; in a
few days a younger one became ill with the same disease, but accompanied
in forty-eight hours with a distinct eruption of scarlatina. A few days
later the youngest was stricken with scarlatina, but had no symptom of
the diphtheritic trouble.

The report brought out the thought of most of the members present. The
two questions of “the identity of pseudomembranous croup and
diphtheria,” and of “diphtheria a local or a constitutional disease”
were again argued, and, as usual, no opinions were changed. Like the
Scotchman, each was willing to be convinced, but he could not find any
one able to convince him. Two points were fully agreed upon, namely,
that the presence of membrane in the fauces, and of sequellæ, are not of
importance in diagnosis; also that nearly all of the cases in which the
posterior nares becomes seriously implicated are fatal. One gentleman
advanced the opinion, supported by “statistics” (as accommodating a
friend as “facts”), that when the submaxillary glands were enlarged in
this disease recovery took place; when they were _not_ enlarged, death
occurred. The doctor did not say that death occurred at once or within a
few days, so we shall be charitable and suppose that he meant sometime
during the succeeding hundred years.

Notes of two very interesting cases of myelitis, followed by spastic
paraplegia, were read and discussed. The author made special mention of
the exaggerated tendon-reflex being always present in disease of the
lateral tract of the cord, and that this symptom is diagnostic—if
hysteria be first excluded. He also noted in these cases that the
condition of the muscles of the posterior portion of the legs (lower)
was very tense, producing an impression on grasping them similar to that
noticed on grasping a piece of iron. Neither of these men were able to
place the heel upon the floor when standing erect. No amount of effort
on their part could enable them to accomplish it. Neither of them were
improved by the use of the iodides.



                          NOTES AND COMMENTS.

If “K.” will send name, we will take pleasure in publishing his article
in our next number.

                  *       *       *       *       *

White physicians in Oriental countries are asked almost daily whether
they cannot prescribe for suffering women without seeing them. Oriental
women, debarred by social custom from consulting male physicians, are
the victims of great and unnecessary suffering. They are thus shut off
from the aid of western medical skill, though they know its value and
are desirous of availing themselves of it. The movement in China and
Japan to introduce female physicians from Europe and America is
conferring great benefit upon the women of those countries and making
brilliant opportunities for skilled women who go there. The hospital for
women recently opened at Shanghai, under the charge of American women,
is already filled with patients. An association has also been formed in
India for training native nurses.

                  *       *       *       *       *

The new college building of the Medical Department of the Western
Reserve University is being pushed rapidly to completion. The stone-work
is done and the roof is now being placed in position. When once
inclosed, work upon the interior can proceed regardless of the weather.
It is thought that it will be so far completed as to be used for
commencement exercises the last week in February.

                  *       *       *       *       *

Four cases of trichiniasis were reported to the health officer of
Cleveland, December 23d. All were members of one family and had partaken
of the same uncooked ham. The physician reporting the cases, Dr. J. F.
Armstrong, had his suspicions aroused by the symptoms presented, and at
once examined the suspected meat. His fears were confirmed by finding
trichinæ spirolis in the remaining portions of the ham, and his
observations were verified by the health officer. None of those affected
are as yet seriously ill. It appears necessary to sound a constant
warning against eating uncooked pork.

                  *       *       *       *       *

“_No Children Allowed._”—The “Solid Comfort” will answer for the
occasion to designate an elegant apartment house opened about two years
ago in a suburb of Boston. It was finished with all modern conveniences
and inconveniences. There were electric bells in a row at the door, so
that the afternoon caller could ring up nine different and peaceful maid
servants before getting into communication with the family she came to
see; there were fire escapes and telephones, and elevators and speaking
tubes; and, in all probability, safety valves and submarine cables. But
the crowning joy of all was the fact that no children were allowed
within its walls. It was built for the accommodation of childless
couples, and to ten childless couples were the suites let. How great was
the quiet and calm of that sheltered retreat, until one ill-starred
morning, when the cry of an infant, shrilly and piteously, broke the
stillness! Horror and indignation upon the part of nine guiltless
couples! And yet, so weak is humanity, that before the end of the second
year there were children in seven of the ten families. The childless
young couples were childless no more; and when the owner of the building
complained to his friends of the unfair treatment he had received at the
hands of his tenants, they all laughed in his face and advised him to
let his apartments to bachelors.—_Sanitarian for November, 1885._



                     The Cleveland Medical Gazette.


              _A MONTHLY JOURNAL OF MEDICINE AND SURGERY._

                    ONE DOLLAR PER ANNUM IN ADVANCE.

  All letters and communications should be addressed to the CLEVELAND
         MEDICAL GAZETTE, No. 5 Euclid Avenue, CLEVELAND, OHIO.

 A. R. BAKER, M. D., _Editor_. S. W. KELLEY, M. D., _Associate Editor_.



                               EDITORIAL.


Original communications, reports of cases and local news of general
medical interest are solicited.

All communications should be accompanied by the name of the writer, not
necessarily for publication.

Our subscription price remains at one dollar per annum in advance. Vol.
I begins with November, 1885. Subscriptions can begin at any time.

Remittances when made by postal order or registered letter, are at the
risk of the publishers.


                         THE FASHIONABLE HOBBY.

It is reported that a Dr. Sax, of France, has discovered in all forms of
beverages containing alcohol a “bacillus potumaniæ;” and it is claimed
that this bacillus multiplies in the system of the drinker and
circulates in his blood, and that when he gets delirium tremens he is
not the subject of hallucinations but sees the reptilian forms that are
inhabiting his own brain and optic apparatus.

While the microscopists and various ologists are discussing this, we
will tell a story of a certain worthy practitioner of our acquaintance.
The doctor's hobby was malaria. If a person came in with a headache it
was “malarial headache;” backache, “malarial backache;” legs ache,
“malaria.” One day a man came in with his arm hanging helpless. Our
friend promptly began about malaria. The man said he had heard of
break-bone fever, but that he had fallen off a street car and didn't
think this was a malarial fracture.

Some of the best fellows we know ride hobbies, but let those who now
bestride the bacillus beware where the creature carries them.


                             OLEOMARGARINE.

The subject of artificial butter continues to agitate the public mind
and stomach. There are involved a few plain principles which, if
applied, will elucidate the whole matter.

Good glycerine can be made from dogs or horse fat, sugar from rags; sea
water or the most impure lake or river water can be changed to _azua
pura_ by distillation; good suet or tallow can be so treated as to make
a nutritious and harmless article of diet. Now, if old grease can be so
manipulated and modified as to give a pure and edible result, cheaper
than old-fashioned butter, the latter will have to go out of fashion.

In that case, wrong would lie only in selling the article for what it is
not, and not in the fact of its being also injurious to the user. Just
as in many synthetically manufactured wines and cigars, which are not
chemically essentially different from the article they imitate, but are
fraudulent because they are sold as imported or genuine, which they are
not.

If the goods are good, let them be sold for what they really are; and if
the old-fashioned butter is higher priced, let those of us who like pay
the difference for our fastidiousness. The manufacturers of the new
butter should expend their efforts and their money in perfecting their
process, so as to give an innocent and useful food, and in proving that
it is so, instead of opposing the action of the Board of Health. The
verdict of the health authorities should be regarded as final by every
individual of the public, and until the new article is pronounced at
least harmless, no one should think of using or handling it any more
than they would measly pork or spoilt fish.


                      MEDICAL DEFENCE ASSOCIATION.

We have selected a few recent cases of suits for malpractice with the
object of calling the attention of physicians to the importance of
adopting some plan looking toward the suppression of quackery and the
protection of professional rights when assailed by hostile influences.

“In April, 1884, Dr. Graves of Petaluma, California, was called to see
Mrs. Winters, the wife of a laborer whose family he had attended
gratuitously for nearly sixteen years. He found that the woman, who was
fifty-eight years of age, had fallen from a height and injured her
ankle. The limb was very much swollen, so as to interfere with
examination, but no crepitus could be elicited, neither was there any
displacement, or shortening; and as the swelling continued, the limb was
placed in position and wrapped loosely in cloth saturated with anodyne
lotions. The patient, we are told, received every attention from Dr.
Graves, but there was left finally some stiffening of the joint and a
very slight inversion of the foot. No complaints were made until a new
doctor arrived in the town, who told the patient the limb had been badly
treated and advised her to sue for malpractice. The case was examined by
ten of the chief surgeons in the State, including Drs. Lane, McLean,
Morse and Dennis, all of whom said that there might have been a sprain
or an incomplete fracture of the external malleolus, but that the ends
of the bones were in perfect apposition and never had been separated,
and that the stiffening was probably due to inflammatory adhesions. Two
other doctors, one of whom being he who advised the suit, testified that
there was shortening of the limb, and that the lower fragment of the
tibia had been driven up and behind the fibula. One of these would-be
surgeons, Dr. Wells, is nearly eighty years of age, and had not read a
work on surgery for thirty years; the other, Dr. Ivancovich, confessed
he had no special experience in surgery. Their incompetence may be
judged from the way they measured the patient's limb in court. This was
done by taking a carpenter's rigid rectangular rule, and measuring the
limb as she maintained the upright position. The result was that in the
opinion of nine jurymen the testimony of two unknown, inexperienced
general practitioners out-weighed that of ten specialists in surgery,
all of whom possess a national reputation, so that a verdict was
returned in favor of the plaintiff, awarding her eight thousand dollars
damages.”

“Some three years ago Dr. Purdy, a well-known and esteemed physician,
gave notice to the health department of New York City, in accordance
with a regulation of the sanitary code which makes it the duty of
physicians to notify this department of cases of infectious diseases,
that in his opinion a young woman who was under his treatment was
suffering with smallpox. The department sent one of its medical officers
to investigate the case. The diagnosis made by Dr. Purdy was then
confirmed and by the authority of the board of health the patient was
transferred to the smallpox hospital. After a day or two the patient was
discharged. This patient immediately brought suit against Dr. Purdy for
$10,000 damages, on the ground of injury to her business and of the
false diagnosis upon the part of her medical attendance. The jury which
tried this case gave a verdict of $500 against the defendant. The
singular injustice of this verdict resides in the fact that damages
should have been brought against Dr. Purdy, when, in point of fact, the
injury to the plaintiff was inflicted by the health department, which
not only affirmed the diagnosis of the attending physician, but caused
the removal of the patient to be made to the smallpox hospital. It
appears that Dr. Purdy's sole error in the case was in informing the
health authorities of the possible existence of smallpox. In the
discharge of a duty imposed upon him by a city ordinance he has been
subjected to the expense and annoyance of a legal case, and has been
mulcted by a jury to the extent of $500.”

“Another suit of a blackmailing character has been brought against Dr.
E. Williams and partners of Cincinnati, O. According to the Cincinnati
_Medical News_, the charge was that they had permitted a small scale of
iron, that had entered the eye of a boy, to remain, by which he
eventually became blind—the sound eye becoming affected through sympathy
with the injured one and losing the power of vision. It was proven on
trial that the boy had visited the office of Dr. Williams but twice, and
then had ceased calling because he was informed that, to preserve the
sound eye and be saved from blindness, he must consent to have the eye
that had been destroyed removed from its socket, to which his parents
would not consent. For several months after declining the services of
Dr. Williams and associates, he spent his time in going the rounds of
the specialists of diseases of the eye, putting his case in charge, at
different times, of both regular and homœopathic physicians. Every
ophthalmologist by whom he was treated informed him that the only way by
which he could avoid becoming blind was to have the injured eye removed.
Finally, after losing sight in both eyes, he brought suit. The medical
testimony, we are told, was uniformly in favor of Dr. Williams, but the
jury disagreed.”

“The Boston correspondent of _The Northwestern Lancet_ writes: 'Dr. A.,
a reputable practitioner living in a New England city, attended Mr. B.
for a fractured thigh. The case did well, and the patient recovered
without deformity. No measurements were recorded by the attending
surgeon, but he was able to swear that the result was to him perfectly
satisfactory. A year or two later the patient entered suit against Dr.
A. for malpractice, and exhibited a leg considerably shortened and
deformed. A jury at once found a verdict for the plaintiff, and awarded
damages in some six or seven thousand dollars, a sum which seriously
crippled the physician. He devoted his energies thereafter to
discovering what he believed to be a fraud, and finally obtained
evidence that B. had, subsequently to his recovery under A.'s
attendance, again fractured the same thigh while in the Adirondack
wilderness, and had, on that occasion, had no surgical attendance
whatever. The physician was able to recover his money, but was at the
expense of his detectives' and lawyers' fees, to say nothing of years of
anxiety and of damage to his professional reputation.'”

The case of Drs. Reed and Ford of Norwalk, Ohio, will be remembered by
many Cleveland physicians. Miss Pierce, a comely young lady, sustained a
Colles fracture, and was attended by Drs. Reed and Ford. Suit was
brought twice in county court and dismissed because plaintiff did not
desire to try the case. A few days before the case was outlawed, suit
was brought in the United States Court at Cleveland. Many physicians
were called on both sides, and the testimony of all the physicians, with
probably one exception, was that the treatment was good and the result
better than is usual with such fractures. Flexion extension, pronation
and supination were perfect. She had, however, the power, when the arm
was midway between pronation and supination, of bending the wrist toward
the radius, and by making the head of the ulna prominent she was able to
make an apparent deformity. Her case, then, was her ability to make an
apparent deformity by twisting her wrist. (She could do the same with
the unfractured wrist.) She was a good-looking woman, and therefore
entitled to sympathy. She followed up the case persistently for six
years, therefore there must be some merit in the case. The doctors all
testified against her, so there was a combination of the doctors which
must not be countenanced. Upon this strong case twelve intelligent
jurors awarded thirteen hundred dollars damages. The judge subsequently
reduced this to five hundred. Is it any wonder, when such things can be
done in the State of Ohio, in the name of justice, that physicians like
old Dr. Kirtland refused to attend cases of fracture under any
circumstances? or that it is not unusual to hear surgeons of recognized
ability say they dare not possess property for fear of suits for
damages?

Frequently physicians are accused of malpractice, and rather than
undergo the expense and inconvenience of a suit they will submit to an
extortion of money; or if a suit is lost in court through prejudice,
unjust decisions, inability to secure good council or other unavoidable
cause, rather than undertake to carry the case to a higher court, the
physician will pay the damages, and thus establish a precedent which
renders every physician under similar circumstances liable to a suit for
damages. It is always observed whenever a large amount of damages is
collected from a physician, numerous other suits on all sorts of cases
are commenced. Such a condition of affairs ought not to exist.
Physicians can not expect legislators to look after their interests
until their grievances are made known. The testimony of physicians as
individuals will not carry enough weight to accomplish anything. Moves
have been made in this direction through the County and State societies
and failed first, because the members of the societies are divided among
themselves, second, because they represent only a fractional portion of
the profession. Out of the thousands of physicians practicing in Ohio
there are only about seven hundred members of the State society.

We believe the object of county, state and national medical societies
are intended for purely scientific work, and the less of medical
politics brought into them the better. But when there is some definite
end to be accomplished, some gross wrong to be righted, some persecuted
physician defended, there ought to be some organization including
physicians of all schools, independent of the medical societies as now
organized. When a physician is sued for damages, if his case is worthy
of being defended, the entire profession ought to lend him their moral
as well as financial support, and this could be rendered in no way
better than by means of some organization similar to the Medical Defense
Association of England.


               PRELIMINARY EDUCATION OF MEDICAL STUDENTS.

Dr. John J. King, secretary of Trumbull County, O., Medical Society, saw
our article in the last number of the GAZETTE, in which we urged the
necessity of an elevation of the standard of preliminary education of
medical students, and sends us the following resolutions which were
unanimously adopted by the Trumbull County Medical Society, January 31,
1884, and Drs. Julian Harmon, J. R. Woods and T. H. Stewart appointed
medical examiners. The requirements are about the same as adopted by the
Pennsylvania State Society at their annual meeting in Norristown, Pa.,
May, 1883:

TO REGULATE THE STUDY OF MEDICINE.

  RESOLVED, I.—That this Medical Society shall annually elect a board
    of medical examiners, to consist of three members, whose duty
    shall be to examine applicants for admission to the study of
    medicine.

  RESOLVED, II.—All applicants for admission as students of medicine
    under the tuition of members of this society shall present
    themselves before the board of medical examiners and
    satisfactorily pass examination in the following requirements:

   “I.— A written statement, previously prepared, setting forth the
          candidate's course of study.

   II.— An essay.

  III.— Writing from dictation.

   IV.— Spelling—Oral and Written.

    V.— Reading.

   VI.— Geography—Descriptive, Physical.

  VII.— Political Economy.

 VIII.— History—Ancient, Modern.

   IX.— Geology.

    X.— Botany.

   XI.— Chemistry.

  XII.— Natural Philosophy.

 XIII.— Mathematics—   Arithmetic complete;

                       Algebra, through quadratic equations;

                       Geometry, through plane geometry.

  XIV.— Languages—     English, standard school edition of English
                         Grammar;

                       Latin, Cæsar's Com., 4; Virgil, 4; Cicero's
                         Orations, 2.

                       Greek, the Reader; Gospels; Xenophon's Anabasis,
                         2.”

  Candidates for examination may elect in French, Keetle's Collegiate
    Course in French, Composition, Translation and Reading, and
    Lacomb's History of the French People, instead of Cæsar's Com.,
    Virgil and Cicero's Orations; and in German, Whitney's German
    Grammar, Composition, Translation and Reading, Schiller's Willheim
    Tell and Goethe's Faust, but such elementary knowledge of Latin
    and Greek will be required as to enable the candidate to
    intelligently comprehend the etymology of medical terms derived
    therefrom.

  RESOLVED, III.—No member of this society shall receive any person as
    a student of medicine unless he present a favorable certificate
    from the board of medical examiners.

  RESOLVED, IV.—The time of study required by members of this society
    shall be five (5) years, including lectures.

  RESOLVED, V.—Members of this society shall recommend their students
    to attend only such medical colleges as either require an
    examination for admission similar to the one required by this
    society, or make the full three-years' graded course of study
    obligatory for graduation therefrom, and otherwise endeavor to
    elevate the standard of medical education.

  RESOLVED, VI.—That this society requests the Ohio State Medical
    society to adopt the foregoing schedule of requirements and to use
    its influence to secure legislation making the same obligatory
    upon persons entering their names as students of medicine in the
    State of Ohio.

  RESOLVED, VII.—That these resolutions be printed and a copy sent to
    each medical society in this State with the request that they
    early report their action thereon.

                  *       *       *       *       *

“Pioneer Medicine on the Western Reserve” is the title of a series of
articles which began in the November (1885) number of the Magazine of
Western History (Williams & Co., Cleveland). They are written by Dr.
Dudley P. Allen, which insures a warm interest in the subject as well as
a capable handling of it. The series is historical and biographical, and
the publisher promises several portraits before the last chapter in
March or April. Probably none of the Magazine's various serials will be
of more interest to the public, as well as to medical men generally. In
the opening chapters we enjoyed the author's skillful joining into
readable continuity of the broken facts that have been gathered from so
long ago.



                          SOCIETY PROCEEDINGS.



           PROCEEDINGS OF NORTH CENTRAL OHIO MEDICAL SOCIETY.

                      TWENTIETH QUARTERLY SESSION.


                                        GALION, OHIO, December 18, 1885.

The president, Dr. MITCHELL of Mansfield, called the meeting to order,
and owing to the number of papers to be presented and the brief time for
the session, ordered the omission of reading of minutes of last meeting
and all miscellaneous business. E. H. Hyatt of Delaware, was first
called, and excused on the ground that he could not do justice to his
subject, “The Use and Abuse of Alcohol from a Professional Standpoint,”
in so short a time.

Dr. R. HARVEY REED of Mansfield, the appointed lecturer, read a paper on
Anæsthetics, in which he gave a brief review of the different general
and local anæsthetics in use and the different compounds of the same.

He referred to the elaborate experiments of Dr. Watson of Jersey City,
which showed the following mortality on rabbits:

 Sulphuric ether,                                                  16.66
 Chloroform,                                                       62.50
 Bromide of ethyl,                                                 50.00
 Alcohol, chloroform and ether,                                    75.00
 Alcohol, chloroform and ethyl,                                    66.66

And on dogs:

 Sulphuric ether,                                                  00.00
 Chloroform,                                                       00.00
 Bromide of ethyl,                                                100.00
 Alcohol, chloroform and ether,                                    60.00
 Alcohol, chloroform and ethyl,                                    80.00

In these experiments the doctor found it necessary to resort to
artificial respiration on dogs as follows:

 Sulphuric ether,                                                   None
                                                                      at
                                                                    all.

 Chloroform,                                                           2
                                                                  times.

 Alcohol, chloroform and ether,                                        3
                                                                  times.

 Alcohol, chloroform and ethyl,                                        5
                                                                  times.

The author referred to a number of experiments he had made on frogs, in
which vivisection was made, and the heart exposed and chloroform applied
direct, from which they died in from ten to twenty minutes, and when
bromide of ethyl was used in fifteen to thirty minutes, but when ether
was used, and even much freer than either of the others, they did not
die at all.

In repeated experiments, he said, he had found the use of electricity
unreliable in resuscitating the heart under these circumstances.

After referring to the mortality reports which showed 405 deaths from
chloroform against seventeen from ether, he said: “I feel that every
time I use chloroform as an anæsthetic I am trifling with a dangerous
compound, and that it will only require time and perseverance in its use
until I will share the fate of many others, whose misfortunes ought to
be a timely warning to us against its dangerous effects; and if not
heeded an accident will be all the more inexcusable.”

He condemned the use of so-called “vitalized air” as being an uncertain
and unstable compound: being one of the nitro-oxygen series mixed with
chloroform, its effects were uncertain and often very injurious, which,
he said, “should be reason enough to deter any conscientious physician
from using it or even recommending it.”

For administering anæsthetics the author recommended a clean folded
towel as being more preferable than anything else, as it was just as
efficient and decidedly better from a sanitary standpoint.

He recommended watching the pulse closely while administering
chloroform, and the respirations when ether was administered, lest in
the former the cardiac ganglia become affected and suddenly arrest the
heart's action, or in the latter the nerve cells of the medulla from its
toxic effects abruptly interfere with the breathing.

In closing the author said: “From the brief review of the anæsthetics
most familiar to the profession from a practical standpoint we have
arrived at the following conclusions:”

_First_—Of all general anæsthetics known pure sulphuric ether stands at
the head for safety, efficiency and every day practical use.

_Second_—Hydrochlorate of cocaine stands at the head of all known local
anæsthetics.

_Third_—Ethidene promises to rival ether and merits a more general and
extended trial.

_Fourth_—No surgeon should give any anæsthetics without being prepared
to resuscitate the patient on the shortest possible notice if necessary,
among which preparations nitrite of amyl stands preëminent.

_Fifth_—No person should be entrusted with the administration of any
anæsthetic who is not thoroughly familiar with its physiological action
and practical administration.

_Sixth_—The indiscriminate use of anæsthetics should be strenuously
guarded against, and especially the practice of leaving such dangerous
compounds in the hands of the laity to be given _ad libitum_ whenever
they may deem it necessary.

_Seventh_—The judicious use of anæsthetics under all necessary
circumstances should never be omitted, for when properly used by skilled
hands they are a glorious haven of peace in the midst of a stormy sea.

DR. J. CAMPBELL of Galion reported a case of embolism, in which the
diagnosis was uncertain, the symptoms grave and the disturbance of the
circulation extremely severe, distinguished physicians differing widely
as to the pathological conditions, and the autopsy revealed adhesions of
the right lung and of the pericardum. Left lung compressed, left heart
hypetrophied and stenosis of aortic orifice. On motion the case was
referred to the committee on publication, and Drs. Hackendorn, Ridgway
and Mitchell, who had seen the patient, were requested to give their
views.

DR. N. B. RIDGWAY reported a case of laceration of perinæum with
operation within an hour, with complete success, on which remarks were
made by Drs. Reed, Larimore and Kelley.

DR. KELLEY presented a clinical case of blindness in right eye of a
girl, from the concussion of a snow ball striking the arch of the orbit.

The society adjourned to meet in Mansfield March 25, 1886.

                                                J. F. MARKEL, Secretary.


                THE AMERICAN PUBLIC HEALTH ASSOCIATION.

       ANNUAL MEETING HELD AT WASHINGTON, D. C., DEC. 8-12, 1885.

        [By G. C. Ashmun, M. D., Health Officer, Cleveland, O.]

In the summer of 1873 a few gentlemen met at Long Branch, New Jersey,
and organized as the “American Public Health Association.” At that time
there were but few state boards of health, and local boards were not
generally efficient; and it was one of the chief objects of the American
Public Health Association to aid in the establishment of health and
sanitary organizations throughout the country. Prominent among the
original members of the association were gentlemen from the Mississippi
valley. For a long time the cities and towns of that valley had suffered
from visitations of yellow fever, and men had become somewhat
enlightened by the good results obtained from the course pursued by
certain officers during the war. Especially was this true in New
Orleans, and the question was fairly raised whether local conditions
were not responsible for the disastrous outbreaks which had occurred so
frequently.

From 1873 to the present time, there have been annual meetings of the
association, with a greatly enlarged membership. A large result of the
efforts of the association and its members is seen in the national,
state and local boards of health, and other sanitary organizations
throughout the country. But three of the states are now without state
organizations. The recent meeting in Washington was its “thirteenth
annual,” and was as well attended and its members as enthusiastic as at
any. The members were “welcomed” on behalf the medical fraternity of
Washington by the venerable Dr. J. M. Toner, and by the district
authorities through the President of the Board of Commissioners, Judge
Edmonds. These remarks were followed by the usual address by the
president of the association, Dr. Reeves of West Virginia.

The chief point, perhaps, of Dr. Reeves' address, and the one calling
out most expressions of approval, was the arraignment of Congress for
its failure to provide means for the support of the National Board of
Health. He cited the liberality shown to care for domestic animals, the
fisheries, the Indians, and, indeed, almost every conceivable object,
but Congress was unwilling to grant even a sum sufficient for gathering
and publishing the reports from local boards. He expressed a strong
feeling against the attempt to have the work for which the National
Board was created to perform, done by the Marine Hospital Service.

A large part of the time of the meetings was taken up in hearing reports
from committees appointed at the meeting in St. Louis, 1884. Among these
reports were some of great interest. Prof. Sargent, of Harvard, gave a
report upon “School Hygiene in American Schools and Colleges,” and this
was enlarged by a paper from Dr. Hartwell, of John Hopkins University,
on “The German System of Physical Education.” At this meeting prizes
were to be awarded, in accordance with the wish of Mr. Lomb, of Baush &
Lomb, Rochester. The subjects were:

1. “Healthy homes and food for the working classes.”

2. “The sanitary conditions and necessities of school-houses and school
life.”

3. On “Disinfection and individual prophylaxis against infectious
diseases.”

4. On “Preventable causes of disease, injury, and death in American
manufactories and workshops, and the best means and appliances for
preventing and avoiding them.”

These prizes were in cash, and amounted to five hundred dollars each,
the decision resting with a separate committee for each. Without taking
more space, it may be said that these meetings are usually attended by
about three hundred members, from all parts of the country. Canada sends
representatives, and the meeting in 1886 is to be held in Toronto. Very
diverse opinions are developed, and sharp discussions are the order. All
shades of medical and lay topics and views are brought out, but all meet
on the common ground of desire for improvement in health. The medical
officers of the army and navy are always well represented by such men as
Drs. Billings, Sternberg, Gihon, Turner and others, while Hon. Erastus
Brooks of New York is a layman whose views have been and still are
relied upon as representing a philanthropic sentiment which can be found
in all communities.


  CUYAHOGA COUNTY MEDICAL SOCIETY—ADJOURNED MEETING, OCTOBER 15^{TH.}


                 REPORTED BY L. B. TUCKERMAN, COR. SEC.

DR. HIMES presided.

DR. POWELL gave a verbal report on the progress of obstetrics and
diseases of children as follows:


                              OBSTETRICS.

In the department of obstetric literature, 'Barnes' Obstetrics' had just
been published by Lea. It was encyclopædic in its character. Lusk had
issued a new edition with several chapters added. Parvin's book was now
in press, and is also issued by Lea. In the department of diseases of
children, Eustace Smith's work is invaluable as regards symptomatology
and clinical history, but is not so good in therapeutics. Goodhart's
work, edited by Starr, is also of value.

Axis traction forceps are coming more and more into favor, Lusk's
modification of Sarnier's forceps being used. Simpson's axis traction
forceps is also much used in this country and in Germany. The form used
by Dr. Lusk's assistant and in use in Karl Braun's maternite in Vienna,
with a hinge jaw where the blade joins the shaft and traction handles,
allows more motion of the head and has a number of other advantages.

Electricity is coming more and more in vogue as an oxystocic. It seems
to hasten labor without increasing pain. Its use to destroy the life of
the fœtus in fallopian pregnancy is more common in this country than in
Europe.

In the past two years Lawson Tait has operated five times for ruptured
fœtal cyst, with four recoveries. There are no other cases on record so
far as known to the reporter. The present tendency of professional
opinion is to favor an immediate operation.

Intra-uterine injections are not so freely used as formerly, and are
restricted to cases where there is actual retention of putrid material
in the uterine cavity, with fever. Bichloride of mercury is gaining
ground as the antiseptic par excellence.

Cocaine has been tried to relieve the pain during dilation of the os,
but has not proved a success. It is, however, a success in relieving
certain cases of obstinate vomiting of pregnancy, and also the pain of
fissured nipples.

Hicks' bimanual method of treating placenta previa is gaining ground.

In connection with post partum fever, a larger number of cases of
diphtheritic complications is noted than formerly.


                         DISEASES OF CHILDREN.

Crede claimed to be able to prevent ophthalmia neonatorum by instilling
into each eye at birth two drops of a two per cent. solution of nitrate
of silver.

Cassels of Berlin, after an exhaustive investigation, claims that no
remedies are so reliable in _pertussis_ as belladonna and quinia.

In the treatment of _diphtheria_, Tr. Ferri and Potass. Chloras seem to
stand as high as ever in the opinion of the profession. Calomel, which
also has its admirers, seems to have lost no ground, as well as the use
of the steam atomizer.

DR. ALLEN presented a dermoid cyst of the left ovary, removed that
forenoon from a nullipara aged twenty-seven. Six hours after the
operation the patient's temperature was 99.6° Fahr., and there had been
but little vomiting.

DR. SIHLER showed a gall stone found at the autopsy of a woman
forty-eight years old, whose symptoms had not been those which are usual
in fatal cases of obstruction of the gall duct. There had been no
jaundice, no bile in the urine and no previous attacks of pain. She
complained one morning of sore throat, and was given one-eighth of a
grain of morphia. In the evening there was pain in the stomach and the
morphia was discontinued. This was on Saturday. By Sunday or Monday the
pain had become located along the border of the liver. On Tuesday the
free edge of the liver could be felt, and the temperature had risen to
102° or 103°, pain and vomiting having also become very severe. The next
week pain was less and swelling less, and in two weeks all symptoms were
gone. She never before had symptoms of colic. Two weeks later, after she
had been asleep about three hours, she had another attack. The next day
the temperature rose again, and there was a larger region of
sensitiveness than before. On Tuesday the fever subsided. On Wednesday
collapse and vomiting ensued, ending in death. The autopsy disclosed
adhesions of the liver, omentum and colon, an effusion of bile in the
tissues, and this gall stone was found in the gall bladder.

DR. ALLEN mentioned a case that he had seen in Keith's Clinic in
Edinburgh, where an operation was undertaken for ovarian cyst, but when
on opening the abdomen the tumor was found to be the gall bladder so
enlarged as to fill the whole lower part of the abdomen.

DR. SIHLER said that in his case the gall bladder was not so very much
enlarged.

DR. TUCKERMAN reported a case where a gall stone the size of a pigeon's
egg was found post mortem, but which during life could sometimes be felt
through the abdominal wall and sometimes not, and which gave rise to a
bruit so distinct as to warrant a strong suspicion of aneurysm.

DR. VANCE stated that according to his observation the passage of a gall
stone into the intestine by ulceration was a common cause of intestinal
obstruction. He also called attention to the value of the symptom of
itching as pointing to the gall bladder as the seat of the difficulty.

DR. LINHART reported a post mortem in a case of typhoid fever where
eighty-five small stones were found in the gall bladder. The bladder was
but little distended.



                               NEW BOOKS.


  'TRAITE PRATIQUE DES MALADIES DE LA PEAU; DIAGNOSTIC ET TRAITEMENT.'
  Par M. Le Docteur E. Guibot, Medecin De L' Hopital Saint Louis,
  Paris, etc.

This, the fourth work which the author has written on dermatology, is
intended to present, in a clear and concise way, a resumé of the more
voluminous books which have preceded it. Unfortunately the dermatology
of to-day, as it appears in the English language, is drawn largely from
the precepts of the Vienna school. In fact, since the little volume of
Robert Liveing, which appeared in London about eight years ago, there
has been no truly English or American treatise on the subject; although
books on diseases of the skin have appeared in quick succession, they
have been vague echoes from the _Krankenhaus in Wien._ Do not think from
this that I undervalue the original work done by the great teachers of
local dermatology, for they have taken vast strides in the advancement
of the science, but other lines of thought and investigation are needed
to broaden the scope of the earnest student. The work before me, as its
name implies, is a practical treatise on diseases of the skin, of about
four hundred pages, with especial attention to diagnosis and treatment.
To facilitate the former, the author has grouped cutaneous maladies
which are alike in nature into what he calls _Diatheses_, of which the
syphilitic, scrofulous, herpetic, cancerous and the congestive are dwelt
upon. In differentiating the scrofulous from the syphilitic diatheses,
the author says: “In the third stage of syphilis, as we have said, the
work of destruction starts from within, attacking first the deeper
structures, as the periostium cartilage and bone, whereas scrofula
pursues the same destructive course inversely; that is to say, from the
superficial to the deep parts. This consideration, upon which we cannot
insist too strongly, is of the greatest importance in diagnosis. For
example, if syphilis attacks the nose, the part first involved is the
mucous membrane of the nasal fosæ, then the nasal bones and cartilages,
which may become completely destroyed before the process subsides,
leaving the nose flattened but the skin intact. In scrofula the work of
disorganization begins in the superficial parts—the skin—and not until
the part involved is completely destroyed does it proceed to those which
are deeper, viz., the cartilage and bone. Again, it may be seen that the
destruction is more complete in scrofula than in syphilis. This is
especially true of the skin, for syphilis has at least a respect for
this organ, which scrofula has not.”

After establishing, as he says, “the principles upon which the
scrofulous diathesis is founded,” he proceeds to enumerate the different
_scrofulides_ of the skin as follows: 1, Erythematous; 2, Phlegmonous;
3, Pustulo-crustaciæ; 4, Tuburcular; 5, Rupiform; 6, Ulcero-gumatous.

THE HERPETIC DIATHESES.—“The distinctive feature of prime import in
herpetic lesions (_herpidites_) is their duration. In the two diathesis
we have just considered we have said that the _scrofulides_ are
continuous in their duration; they present no interruption, no
intermittance; whereas the _syphilides_ are essentially intermittent;
they disappear spontaneously, or under the influence of treatment, and
reappear without regularity or periodicity. Their intervals of latency
are variable, often regulated by the change of season, especially liable
to reappear in the springtime, and sometimes after many years of
complete immunity.

“The _herpidites_ combine in their evolution the two characters of
intermittency and chronicity. At their commencement they are
intermittent; in the second stage, which occurs after a certain though
variable period, they assume the character of chronicity.” The author
further divides the _herpidites_ into benign and malignant. Under the
former are included herpes, impetigo, lichen, eczema and psoriasis; the
latter includes pemphigus, cachectic rupia and prurigo senilis
formicans. The cancerous and the congestive diatheses follow, after
which the exanthemata and the cachectic diseases of the skin.

SYMPTOMATIC AFFECTIONS OF THE SKIN, arising from pathological,
physiological and psychological disturbances are probably of more
interest than any other group, because here one finds so many things not
even mentioned in most works on dermatology, and because this class of
affections seems destined more and more to be a common inherent of
American life.

“These diseases, which are called diseases of the skin, are not so in
reality. They belong more or less to the entire organism, revealing
themselves upon the external integument with visible and palpable
peculiarities which enable us to form an opinion as to their true
nature. Considering the subject from this point of view, dermatology is
therefore one of the most important branches of pathology; it is the
torch which throws light on many morbid conditions which otherwise would
remain obscure, vague and unsettled. But dermatology is more than this;
it is the index, the external manifestation of disturbances which may be
physiological or pathological, superficially or deeply seated. It is
still more, for it is the visible expression of certain psychological
emotions and moral states which are reflected upon the skin, there to be
interpreted by the observing student.” This part of the work ends with a
chapter on dermatoses of local origin, which includes parasitic
affections.

The book concludes by taking up the treatment of the different diseases
one by one. In the treatment of syphilis the author says: “The
preparation of mercury to which we give the preference is the proto
iodide. It is less dangerous, more soluable in the stomach and more
easily assimilated. It should never be given to exceed three
centigrammes a day.”

Time forbids further details. I will simply say the book is a good one,
and will well repay careful study. Arrangements have been made with the
author and his publishers to translate the work into English.

                                                          W. T. CORLETT.

                  *       *       *       *       *

“OFFICIAL FORMULÆ OF AMERICAN HOSPITALS” is the title of a 16-mo manual
of 238 pages, published by the _Medical World_ of Philadelphia. It
contains the formulæ of some twenty-nine American hospitals, collected
and arranged by C. F. Taylor, M. D. Price $1.00.

                  *       *       *       *       *

“ORGANIC MATERIA MEDICA AND THERAPEUTICS,” in accordance with the sixth
revision of the United States Pharmacopœia. By James Young Simpson, M.
D., of Orange, New Jersey. Book of 337 pages, well printed and very
neatly bound. Published by J. H. Vail & Co., New York.


                         THE ASTRONOMIC DOCTOR.

By request we take pleasure in reprinting this poem from the CLEVELAND
MEDICAL GAZETTE of April, 1860. A modest country practitioner discovered
a planet. The medical and scientific world prepared to give him a public
dinner at the “Hotel du Louvre.” But word was sent from the modest
doctor he would rather “stay at home in his wooden shoes” (it is his own
expression).

                                   I.

                 To grace the brow of savans
                   Astronomy has twined the crown,
                 The trumpet sounds their giant deeds,
                   And celebrates their high renown.
                 But from the shrouded face of night
                   A doctor draws the veil, and first
                 Upon his modest, upturned sight,
                   The splendors of a planet burst.

                                  II.

               His country rounds he still pursues,
                 The storm he bears, and winter's cold;
               Nor does his simple heart refuse
                 Creation's wonders to behold,
               But Lescarbault with lifted eyes,
                 And hand upon his earnest heart,
               Slow walks, to view the stars, but flies,
                 Relief from suffering to impart.

                                  III.

                 Upon the doctor's humble life
                   Simplicity her graces sheds,
                 From grandeur far, and envious strife,
                   Goodness to diligence he weds.
                 His coat of serge he wears content,
                   Nor e'er for gilded splendor sighs,
                 But when he scans the firmament
                   He sees his “star of honor” rise.

                                  IV.

               On history's page enshrine his fame,
                 Yet other glories claim our song;
               Friends, collegues, share another's name!
                 To Laennec too our toasts belong,
               An echo to his ear betrays
                 The seat of misery's hidden dart—
               'Tis well on stony worlds to gaze—
                 'Tis nobler far to read the heart.

The above verses were written by Dr. Piory, one of the celebrated
physicians of Paris, and were sung by Dr. Mayne at the annual dinner of
the Medical Society of the Arrondisement of the Elysee. For the elegant
and faithful translation which we have given, we are indebted to the
kindness of a very accomplished young friend.



                          TRANSCRIBER'S NOTES


 1. Corrected nevrosis to necrosis (or might be neurosis) on p. 110.
 2. Silently corrected typographical errors.
 3. Retained anachronistic and non-standard spellings as printed.
 4. Enclosed italics font in _underscores_.
 5. Superscripts are denoted by a carat before a single superscript
    character or a series of superscripted characters enclosed in curly
    braces, e.g. M^r. or M^{ister}.





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