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PAGE
Abortion, Self-produced, and its Consequences 178
Abscess, Mammary ' 91
"Advance," Cincinnati Medical .....115
Advertising, Medical .135
Advice to Students about to Graduate 31
Agassiz, Prof. . . . . . 196
Alcoholic Stimulants . 73
Alcohol, Dr. Lionel S. Beale on the Action of 166
Allopath, An Astonished , 58
Allopathic Courtesy 255
Allopathy vs. Homoeopathy , 133
American Cyclopedia 236
Amputations, Lines of Incision for Rapid. ......... 131
Anaesthesia, Inventor of 252
Anaesthetics, History of , 135
Anatomy, Physiology and Hygiene 96
Aneurism, Galvano- Acupuncture for Aortic 58
Animation, Suspended, Treated with Dry Heat 90
Antidote to Opium, Atropine as an 215
Anti-Dysenteric, New 210
An ti- Periodic, New 144
Antiquities 24
Anus, Imperforate 191
Arteries of the Tegument in Fever, Condition of. . . .215
Arteries, Torsion of 94
Artery, Ligature of the Femoral 131
Asphyxia in Breech Presentations. 131
Association., Alumni, of the College of Physicians and
Surgeons ... 108
Association, American, for the Advancement of Science 216
Association, Medical Science 21, 69, 93
Association, Public Health 22
Asylum, California Insane 47
Asylum, N. Y. State Homoeopathic Insane, 157, 159,
[251, 254
Asylum, Oldest Lunatic, in America 240
Asylum, Southern Ohio Lunatic 47
Asylum, Ward's Island Insane 47
Atmosphere , 236
Atmospheric Wave 23
Atropine . 129
Attenuations, Vitality of High . , 202
Aural Catarrh 138
Bacon, Dr 168
Barker, Dr. Fordyce . . 47
Beakley, Dr. Jacob 24
Berlin, A Letter from 183
Bladder, Fibroid Tumor of, Treated by Muriate of
"Ammonia 10
Bladder of a Female, A Wax Candle in the ........ 288
Bladder, Treatment of Chronic Diseases of 237
Boils, How to Arrest the Development of 58
Burns . . 264
Brain Disease 123, 158
Breast, Adenoma of 'the 89
Bright' s Disease, Chronic 94
Buchner, Prof. 144
G PAGE
California: For Health, Pleasure and Residence ... 18
Cancer, Diagnosis of 224
Cancer, How to Distinguish from Innocent Growths, 143
Cancer of the Skin, Development of 191
Cancerous Sores, Local Employment of Chlorate of
Potash in 252
Cancrum Oris Successfully Treated by a Saturated
Solution of Iodine 264
Case, A Practical 196
Case, The Most Dangerous . 240
Cerebral Hyperaemia, Hamamelis in Secondary. . : . . .245
Cerebro-Spinal Affections, Gelseminum in 175
Cervix Uteri, Enlargement of, during Pregnancy. . . . 132 Chancroid and Chancre, Diagnostic Characters of. . .117
Charity Students : 63
Chemosis, Case of, Cured by Guaraea . . 272
Chloroform Intoxication . . . t 252
Cholera 145
Cholera in Nashville 193
Cholera in Russia 47
Cholera Reports, Inaccurate 231
Cholera, Temperature Observations in 240
Cholera, Transfusion in 263
Cimex Lectularius , 180
Circulation of Frogs, Experiments in the 95
Climatology, Minnesota 55, 97
Clinical Contributions 124
Cod- Liver Oil Pills 151
Cold -Taking : Its Nature, Cause, Prevention and Cure . 283 Colles' Fracture, Observations on the Treatment for. .246
Cole, Dr. H. B 24
College, Bellevue Hospital Medical 70
College of Pharmacy, Tenn 47
College of Physicians and Surgeons 71
College, New England Female Medical. , 47
College, N. Y. Homoeopathic Medical 71
Colleges, Homoeopathic Medical 118
College, University Medical 71
Conium 168
Conjunctivitis, Chronic , 144
Constipation, A Case of Obstinate 156
Constipation, Arsenic in 168
Contagion 24
Consumption, Nutrition of Lung-Tissue in 116
Convulsions, Epileptiform 1 1
Convulsions, Puerperal 241
Corns, Tincture of the Chloride of Iron for. 57
Cotton Wadding, French Method of Dressing Wounds
by 165
Crannel, John, Letter from. 11, 83, 130
Crime, Influence of Sex in 159
Croup, Membranous, A Case of, in an Adult 272
Cystitis, Sub-Acute and Chronic, Treatment of 99
Czermak, Prof. 288
D
Daltonism 288
Daremberg, Dr 47
Death, Diagnosis of, by the Pupil 94
11.
Index.
PAGE
Death from Swallowing an Artificial Tooth with Rub- ber Plate Attached 264
Death-rate in New York for 1872 40
Deformities of the Extremities, Pathology of Certain . 269
Degrees, Medical 71
Depilatory 45
Development, Physical , 85
Development, Unilateral 288
Diabetes 158
Diabetes Cured by Lactic Acid 252
Diabetes M'ellitus, Cure for ... . 116
Diabetes Mellitus, New Cause of 45
Diseases of Women, Lectures on 16
Disinfectant, Chloride of Calcium as a 167
Disinfectants 24
Dislocation of the Head of the Femur, in an Aged
Patient 88
Dispensary, Albany City 71
Dispensary, Bond Street Homoeopathic 211
Dispensary, Cases from Practice 102
Dispensary, Western Homoeopathic 48, 192
Dysmenorrhcea, Dilatation of the Cervix Uteri in. . .252
Dyspepsia, Anaemia and Chlorosis, Functional 59
Dyspepsia, Treatment of, Without Medicine 169
E
Echises Scholaris and the Garcinia Mangostana. . . .287
Eczema Treated with Concentrated Petroleum 60
Education, American Medical 112
Education, Elevation of the Standard of Medical, . . 184
Education, Medical ... 205
Egypt, Khedive of , 288
Electro Therapeutics, Practical 21
Embalming, The Burnette Process of .' . . 287
Emperor of Austria 95
Empress of Austria 47
Epilepsy, Chloride of Potassium in 232
Eruptive Diseases, Blood in , 45
Essays, Prize 168
Eustachius, A Proposed Monument to 288
Excretine and What it Suggests 79
Extracts, Elegant 206
Eye, Encephaloid and Scirrhus Cancer of 90
F
Fees, Large "... 47
Fever, Intermittent 24
Fibrin, Artificial, from the White of Egg 287
Flint, Dr. Austin 47
Franklin, Prof. E. C 47
Future, The 253
G
Gastrotomy, Placenta in 132
Gegenbauer, Prof ". .240
German Language, Ahn's Rudiments of 214
Glue, Liquid " ... 57
Glycerine 45
Gonhorrhcea 144
Gonhorrhcea, Treatment of, byTanno- Glycerine Paste 286 Guernsey, Dr. Wm. A 24
H
Hahnemann, Brooklyn's Monuments in Memory of . . 61
Hahnemann, Widow of 144
Health, Annual Report of the Board of 20
Hemorrhoids in Parturient Women 272
Hemorrhage, Terebinth in 60
Flemorrhoids, Urethral 180
Hercules' Help 277
Hermaphrodism, A Curious Case of 80
Hering's Analytical Therapeutics 238
PAGE
Hernia, Hemorrhoidal 88
Hip-Joint, Anchylosis of the 46
Holloway 47
Home for the Friendless , . 120 I
Homoeopathic Congress, British 24
Homoeopathic Literature, Annual Record, 1873.. ..285 Homoeopathic Physicians and Surgeons, Cleave' s
Biographical Cyclopedia of 211
Homoeopathic Visiting List 281
Homoeopathic Recognition 45
Homoeopathic Therapia, Bonninghau sen's 235
Homoeopathy, American Institute of no, 120, 139
Homoeopathy, Appropriation of, by the Old School. . . 81
Homoeopathy in Jamaica . 48
Homoeopathy, Science of 97 .
Homoeopathy, St. Louis Academy of 47
Hospitals 134
Hospital, Albany City Homoeopathic 95
Hospital and Lying-in Asylum, Columbia 212
Hospital Attendance, Importance of 5&
Hospital, Bellevue » 71
Hospital, 'Brooklyn Homoeopathic 24, 72, 134, 201
Hospital, Chicago Homoeopathic 7°
Hospital, Guy's, Garotting at ... 23
Hospital, Harrisburg 216
Hospital, Hahnemann 24
Hospital, N. Y. Ophthalmic 24
Hospital of Chicago, Scammon 7°
Hospital, Philadelphia Jewish 4&
Hospital, The Woman's 7r
Houghton, Dr. T : 258
Huxley, Prof , 264
Hydrophobia, A Few Remarks on 155
Hygiene 7°
Hygiene, Mental , 284
I
Infancy, Oreide of Zinc in the Diarrhoeas of 214
Infancy, Perils of ■. 121
Infancy, Podophylline in the Diarrhoeas of 215
Infants in the Manufacturing Districts of England,
Death-rate of 287
Infirmary, Clinic of the Brooklyn Homoeopathic Eye
and Ear 151
Influenza, Causes of Horse ."•• 95
Inhalation, Use of Spiritus Terebinthinse by 273
Injections, Nutritious . , 288
Insanity 86
Ingrowing Toe-nail. 46
Intermittent Fevers, A New Method of Treating. . . . 144
International Scientific Series 17
Iodoform, Topical Action of. 217
Journals, New . . • • 48
Journal of Flomceopathy, N. Y . 115
Journal, Our 109
Juniper Tar-Soap 57
L
Labor, Case of 9&
Lactation, Fatty Liver during 57
Lamp Shades, Paper 45
Laryngitis, Syphilitic , 226
Laryngoscopy, Clinical 1 1 A 129
Lead-Poisoning 144
Lebarre, M ' 240
Legislation, Medical in
Leprosy, Curing , 252
Leprosy in the Sandwich Islands 257
Lesson of the Hour 230 |
Ligature, New *92
Light, Artificial 238
Index.
in.
PAGE
Lipomata, Cure of, by Alcoholic Injections 192
Liquor Sodse Chlorinatse ........ . , 276
Lithotomy, First Operation of , ,263
Liver, Abscess of the, Opening into the Ascending
Cava , 264
Liver, Cysts, in Childhood 46
Local Diseases, Relations of, to the Nature of the Soil . 46
Longevity 33
Longevity, Human 236
Longevity of Married and Single Life, Comparative. .214
M
Madeira as a Health Resort -. , 238
Mania 60
Mania, Acute, Treated by the Wet Pack 59
Marvels of Nature, Science and Art 17
Materia Medica, Characteristic 263
Maternitie, Brooklyn . . . .24, 118
Maternitie, Glasgow ....118
Maxilla, Bisection of Inferior 6
Maxilla, Giant Celled Sarcoma of the Inferior 89
Maxilla, Mercurial Necrosis of the Inferior 42
Medical Congress at Vienna 240
Medical Congress, International 239
Medical Hand-Book for Mothers . . , 236
Medical Register and Directory of the U. S 256
Medical Union I, 37
Medical Union Clinic - 258
Medicine, Future of 61
Medicine, Music as 265
Medicine, Schools of 197
Meningitis, Cerebro-Spinal 2
Menstruation, Physiology of 213
Mercury in the Excretions 191
Microscope and Microscopic Technology , 163
Midwifery, Manual of. 260
Morbus Brighti 91
Mortality among Clergymen 288
Mortality of Boston • 70
Mortuary Report in New York 96
Mott, Widow of the late Valentine 168
Muriate of Ammonia 46
Museum, American, of Natural History 288
N
Napoleon III, Post-Mortem of 41, 47
National Medical Library 48
Nelaton, Dr. Auguste 240, 264
Newly-Born Children, The Resuscitation of 167
Nose, Building up a . , 59
Notice, Editorial 13
Nurseries 106
Nurses, N. Y. State School for Training .216, 249
Nursery, Brooklyn 96
Obermier, Dr. Otto 240
Obituary , ... 24
Observatory, The Central Park 258
Ophidians 211
Obstetrics, Guernsey's 281
Obstetrics, Theory and Practice of . . 285
Ophthalmia, Epidemic 43
Ophthalmological Congress, International 47
Ophthalmoscopic Investigations 136
Opium Poisoning, Atropia in 239
Ossicles of the Ear, Mechanism of 211
Ovarian Fluid, Microscopical Appearances of 263
Ovarian Tumors, Diagnosis of 18
Ovariotomy 30
Ovariotomy followed by Twin Pregnancy 132
Ovariotomy, Observations on 150
Oxygen 264
PAGE
Ozone, by a New Process 55
Ozonizing the Air of Sick-Rooms 287
P
Paine, Dr. H. M 24, 161
Papaya 288
Paralysis, Facial 42
Paronychia, Palmaris 43
Periodicals, Medical 95
Peritonitis, Puerperal, Veratrum Viride in 42
Petroleum, Its Origin and Relation to Medicine. . .25, 49
Pharmacy, Chinese , 168
Phlegmasia Alba Dolens ... . 131
Phthisis, Chinese Use of Shad in 129
Phthisis, Laryngeal 9
Phthisis Pulmonalis, Curability of 286
Physician, Voltaire's Definition of 240
Physiology at Edinburgh, Chair of 204
Phytolacca Decandra 44
Plants in Sleeping- Rooms 264
Plaster of Paris Bandages, Removal of 143
Pleurisy, Secondary 1 76
Pleuro-Pneumonia , ... 42
Poisoning, Apomorphia in Cases of 46
Poisoning by Strychnine Treated by Chloral 101
Polypus, Fibrous, Removed from the Uterus by Elastic
Ligature 112
Poppy, Cultivation of 47
Post-Mortem Examinations 1 14
Practice, Cases from 103
Practice, Clinical Notes from 174
Practice, Two Cases from 158
Prayer Test, Substitute for 39
Pregnancy, Extra Uterine 58
Pregnancy in Primiparae of Advanced Age 173
Pregnancy in the Aged 287
Pregnancy with Imperforate Hymen 1 73
Prevention of Disease, Duty of the State in the 27
Profession, The, and the Medical Colleges 229
Prolapsus Uteri 132, 222
Pseudo-Pregnancy, A Case of 199
Pulsations, Foetal 118
Pultee, Dr 144
Q
Quinine, Action of 228
R
Rain-fall, The Effects of Forests upon 237
Rectum, Exploration of 238
Remedies, Characteristics of New 115
Re-Menstruation by the Breasts at Advanced Age. . . 130
Respiration, Researches in Regard to the. 273
Re-Vaccination, The Necessity of 144
Ring- Worm, Oleate of Mercury in 252
Rockwith, Dr. F. A .144
Romberg, Prof. 216
Salutatory 13
Sanitarian, The 7°, 163
Sanitary Legislation ' 62
Sanitary Reform in the Cooper Union 135
Sanitary Works 20
Scribner, Welford and Armstrong, Catalogue 285
Sea-Sickness , 192
Sea-Sickness, Chloral in ... » 24
Sea Water, Gold in 10
Septicaemia 64
Silphium Laciniation 168
Skin, Absorbing Power of the Human 143
Skin Diseases, Treatment of, Surgically Considered . . 76 Skin Diseases, Cases of , 103
IV.
Index.
PAGE
Skin Grafting 1 16
Smith, Dr. Wm. Tyler 216
Snake-Bites, Ammonia in .287
Society, Albany County Homoeopathic Medical . 143, 160
Society, British Homoeopathic .' 119
Society, Connecticut (Allopathic) Medical 268
Society, Homoeopathic Medical, of Penn . 48
Society, Mass. Medical vs. the Homoeopaths 84
Society, Medico-Legal 160
Society, N. Y. Co. Homoeopathic Medical, 210, 234, 259 Society, N. Y. State Homoeopathic Medical, 48, 62,
[66, 70, 144, 207
Society, The Royal Humane 71
Solar, Envelope, Liquid 204
Sore Mouth, Nursing , . . . 95
Spina-Bifida • .... 94
Spleen, Functions of 191
Sponge Tents 94
Starch, Digestion of 237
State Board of Examiners 181
Stricture of the Urethra, New Means of Dilatation in 237
Subcutaneous Injections 248
Sulphitus in Disease . 154
Sultan, Physician to the -. 156
Sumner, Dr. Albert E „ . . 24
Surgery, A System of 283
Surgery, Clinical 126, 152
Surgery, Science and Art of : 137
Surgical Diagnosis, Principle Causes of Error in. . .219
Surgical Operations without Assistance 1 79
Syphilis, Dr. Ricord on 34
Talmudic Gleanings .- 58
Telegraph Co., American District. . . '. 88
Temperature of the Sexes ; 287
Thomas, Dr. T. Gaillard -....* 47
Tic-Douloureux 130
Tobacco Poisoning , 227
Tongueless Speech 215
Tonsillitis, Cured by Baryta Carbonica 287
Tracheotomy, Precautions against Venous Hemorr- hage in , 192
Tracheotomy Tubes, Substitute for 125
Transfusion 206
Transfusion, A Case of 45
Transfusion of Blood 51' 94
Transplantation of Portions of Skin, Gynecological
Employment of 57
Treitz, Dr 47
Typhoid Fever , 143
Typhoid Fever, Water as a Cause of 144
Typhus Fever, Hydropathic Treatment of . . . 106
u
Ulcer, Chloral as an Application in Fetid : . . 204
Ulcers, Chloral in Venereal 46
PAGE
Ulcers, Chronic 264
Ulcers, New Method of Treatment 23
University, Albany Union 48
University of Berlin 96
University, Boston 96, 232
University, Leipsic 216
University of Michigan 87, 120, 240
University of New York, Med. Dep 48, 71
University of the State of N. Y 192, 232
Urine, Retention of 116
Uterine Diseases, Some Thoughts on 82
Uterine Polypus, Removed from a Child eight years
of age 128
Uterus, A Rapid and Complete Cure of Neuralgia of
the . 199
Uterus, Fibro-Cystic Tumors Treated with Muriate of
Ammonia 10
Uterus, Large Fibrous Tumor of, Treated by Elec- trolysis 248
Uterus, Treatment of Fibrous Tumors of, by Subcu- taneous Injections 46
V
Vacations for Doctors 85
Vaccination, Poisonous 91
Variola, Oleum Sinapis Nigri (Sulphi-Cyanalyl) in . . 59
Variola, Perchloride of Iron in 168
Variola, To Prevent Pitting in 120
Vegetable Perfumes, Effects upon Health 132
Veins, Varicose .- . ■ 94
Venereal Affections, Iodoform in . . 116
Verdi, Dr. Tullio S , 115
Verona, Dr .' 24
Veterinary Practice, Homoeopathic Manual of 91
Vienna, A Letter from 32, 107, 159
Vital Statistics from the Ninth Census 105
Von Graefe, Albrecht 202
w
War and Insanity 45
Water, Density of 168
Water, Pure 263
Whooping-Cough, Quinine in 95
Winona, Minn > 55
Woman's Employment 254
World Moves, The 38
Y
Yellow Fever . . ■ .240
z
Zurich, Women Students at 47
Zymotic Diseases, Impure Milk as a Source of 227
THE MEDICAL UNION
A MONTHLY JOURNAL Of Medicine, Surgery5 and the Collateral Sciences.
EGBERT GUERNSEY, M. D. JOHN C. MINOR, M. D.
> EDITORS. J
CHAS. E. BLUMENTHAL, M. D. ALBERT E. SUMNER, M. D.
Vol. I.
NEW YORK, JANUARY, 1873.
No. 1
iDriginai Articles.
MEDICAL UNION.
By A. K. Gardner, M. D.
Is it necessary for me, in commencing an article in the initial number of a new magazine, one of whose aims is to re-unite the profession, and to con- tribute to whose columns I have the honor of being invited — is it necessary for me to say to my friends, the profession and the community, that I am un- changed in belief and practice, differing in no respect from what I was when a member of the New York Academy of Medicine, unchanged save in tolera- tion? What the Christians of Catholic Rome — what the Protestants of more recent days — what the Pil- grim Fathers, even, never learned, — respect for the honest opinions of those who differ; this I have learned.
Hahnemann and his followers, I believe, looked only at one side of the shield and saw it to be silver, while the rest of the profession, from the opposite stand-point of their fathers, saw it to be golden ; both were right, but the wrong existed in the want of re- spect, each for the opinions of the other.
I have not attempted to accurately examine the claims of homoeopathy, for several reasons. First, one does not easily, starting with a prejudice, see or learn new things, and especially at my age, com- mencing a new half century. Next, it would not be honest to hold opinions not acted upon, or politic to change professions, when it might be thought that such a change was forced, or considered desirable under the pressure of circumstances. I have there- fore remained where I was, with my views unchanged — except in the estimate which I have of those pro- fessing and practicing homoeopathy. I am free to confess that the "regulars" do not possess in New York men of more honesty, respectability, literary and scientific culture, than are found in the ranks of the homceopathists, nor can I believe any meaner, smaller, or more ignorant, can be found among the "homoeopaths" than among the members of the New York Academy of Medicine; and I cordially endorse the professions of the editors of this jour- nal, whose aim is to unite the factions, and hereafter to know but one class of men — physicians — edu- cated, honest and faithful to their duty to heal the ills of mankind in the best manner that they can.
It seems to me, that in no way can we help this movement better than by carefully — so far as oppor-
tunities offer — examining and recognizing the dis- cordant views of the diverse parties. Now, the statement of Siinilia Similibus Curantur has been held as an exclusive dogma, and, till quite recently, has been sustained as the only principle of practice ; but to-day the advanced and progressive homceo- pathists hold this not as an exclusive dogma, but as a fact holding good in many instances.
Till lately, the
"regulars" have denied in toto it no place in their theories.
this claim, giving
propose to show that this much-quoted saying has some instances of truth, observed in my own expe- rience. The meaning of this axiom is, that a medi- cine which, taken in large (or poisonous) doses, will produce certain symptoms, when taken in much smaller and appropriate doses, will cure like symp- toms of disease. For instance, it is observed by the homoeopathic practitioners that corrosive sublimate in large doses causes large, bloody, slimy stools, and they say that under this law corrosive sublimate in small doses is the appropriate theoretical remedy for dysentery, and that, practically, it is a curative one. Of this statement I know nothing ; but I have some similar facts of a nature to corroborate these views, one of which I will briefly give.
Some years ago I had for a patient a woman en- gaged in house-cleaning, some three to six months pregnant. While engaged in whitewashing, she so strained herself that she brought on uterine haem- orrhage, and a miscarriage was imminent. I ordered rest, administered some morphine, etc. This checked all pains and flowing, so long as under their influ- ence, but they recommenced immediately upon their being omitted. After some days the woman said that she could not lay abed any longer, for it was starvation for her children, and thinking that further attempt to arrest its coming was useless, I gave her Tinct. Secale Cornut., in half tea-spoonful doses, to further stimulate the uterus to expel the ovum. But what was my surprise to find, with every dose, greater amelioration of the pains and flow soon entirely ceasing, so that she went on to full time.
Since that date I have had repeated floodings, ap- parently threatening abortion, entirely checked by small doses of the remedy.
Some fifteen years ago, I was called as expert wit- ness by the defence. A man had been sued for damages to mother and deformity to child, caused by his kicking a woman when four months preg- nant, and in defence he set up that the injury (some deformity and general debility) was owing to the mal-administration of ergot by the attending phy- sician, who had found that the tonic influence of this
The Medical Union.
drug, in small doses, had warded off a threatening miscarriage, and had enabled her to carry the child until full time. The defence was not sustained, but the ergot was deemed properly applied, and its ben- efit was markedly evident.
EPIDEMIC CEREBROSPINAL MENINGITIS.
By William N. Guernsey, M. D.
Epidemic Cerebro-Spinal Meningitis has been recognized as a distinct disease during the past century. Some authors claim that there were epi- demics of this disease in the preceding one, and a few endeavor to prove that it prevailed even in the remote period of the fourteenth century. These had only imperfect histories of symptoms to base their statements upon ; and as at that period various infectious diseases were often confounded with Meningitis Cerebralis, and when we remember that in more modern times typhus fever was not shown to be a distinct disease from typhoid until 1836, we cannot place much credence in their re- searches.
In the present century there have been four pe- riods of epidemics. The first commenced in 1805, and terminated in 18 16; the second occurred be- tween 1837 and 1850; the third, from 1856 to 1866; and the last commenced in the winter of 1871 and extends to the present time.
The first epidemic was of eleven years' duration, and prevailed in Prussia, Holland, Rhenish Ger- many, Bavaria and the eastern portions of France. It was the most extensive in the latter country, and to the French authors we are indebted for the ear- liest histories of this disease. In 1806, one year la- ter than the commencement of the European epi- demic, cases were first reported in America at Med- field, Mass. Thence it spread throughout New England and Canada, and a few cases also occurred at the South and West.
The second epidemic commenced in 1837, and lasted about thirteen years. It was severer and far more extensive than the previous one. For the first two years it was limited to France, and then ex- tended to Italy and Algeria, and until 1850 these countries were not free from it In 1849 it visited Spain.
Also, the disease designated and described by Dr. Robert Mayne as Cerebro-Spinal Arachnitis, which broke out in the work-houses in Dublin, in 1 846, was probably identical with the epidemic prevailing on the Continent.
In 1842, it broke out in the south-western States of the Union, and afterwards prevailed simultane- ously in isolated places there, at the West, and in Pennsylvania and New York.
From 1850 to 1854 this disease ceased to be heard of, when suddenly the third epidemic commenced with unusual severity in the south of Scandinavia, and during the next six years it extended to the northern portion. In i860 it broke out in Holland, and in 1863 in Northern Germany, which had hitherto almost completely escaped this epidemic. Here it spread very widely, and lasted until 1866. About the same time cases were reported in Rus- sia, in Ireland, and a few isolated ones in England — although in the latter country it has never pre- vailed epidemically.
In our own country it first manifested itself at this period in the winter of 1861-62, amongst our troops, stationed in Virginia and in Missouri. It recurred the three succeeding winters at portions of the South, and in some of the hospitals at the North.
About the beginning of the present year it broke out epidemically for the first time in New York, although isolated cases of spotted fever were re- ported in 1 87 1. It prevailed quite extensively during the winter and spring, and also in sections of this State and in Pennsylvania.
The first series of recognized cases reported to our Metropolitan Board of Health were on the 6th of January. From then to May 31st, there were 632 cases reported to the City Sanitary Inspector, and 469 deaths to the Bureau of Records. Un- doubtedly, many more cases occurred which failed of being reported, as many physicians were at first not familiar with the disease, nor cognizant of the necessity of reporting cases to the Health Board.
The most common synonyme of this disease is spotted fever, which was given to it by the physi- cians of this country during the first epidemic here. Another is petechial fever. North, in 1809, desig- nated it the malignant spotted fever, and Lyons, the black fever, which is still a popular name for it in some localities. All of these seem quite inap- propriate, as the eruption is often wanting, and they convey no idea of the nature of the disease.
Little is known of the kind of the poison from whose pernicious influences emanated these epi- demics that usually occurred simultaneously in lo- calities far remote from one another. That there is not simply an idiopathic inflammation of the cerebro-spinal membranes, the anatomical appear- ances clearly prove, as in the suddenly fatal cases often but little pathological changes are apparent. Many writers have endeavored to trace the cause to excessive cold, as most epidemics have occurred in the winter season. Mannkopf, of Berlin, how- ever, says that the average temperature of the months in which the epidemic prevailed, was not below that of corresponding ones in many preced- ing years.
That it may be dependent upon a miasmatic poison, is suggested from the extension of the epi- demic to places not contiguous to each other. Yet, the localities themselves have afforded no clue to the nature of the poison.
The mountains, the plains, the dry, arid spots, the well-watered verdant valleys, and the humid marshes, are all alike frequented by this disease.
It visits city as well as country, and stalks alike in palatial residences, and dirt-begrimed hovels. Salubrious mountain villages are often as severely stricken as the badly-drained, filth-reeking portions of some of our cities.
In our recent epidemic, a very large proportion of the cases have been reported, however, from the poorer wards of the city, and our Health officer says, in his report, that wherever the ■ local condi- tions have been carefully examined, it has been found that the drainage of the premises has been faulty, or that the immediate surroundings have presented such conditions as must necessarily give rise to some form of disease. He deduces from his observations that there can be no doubt that, overcrowding, with its attendant evils, accumula- tions of ordure, refuse, and various kinds of filth,
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absence of a proper supply of pure, fresh air, and personal neglect, invite and aggravate certain epi- demic tendencies ; and consequently we find, on examination of a map indicating the localities where cerebro-spinal meningitis has prevailed, that the largest proportion is to be found where these con- ditions obtain.
Yet, in many of the European epidemics, no intimate relation existed between filth, poverty, immorality and absence of good hygienic condi- tions, and the outbreak or extension of this disease. Viesseaux says, that in Geneva it attacked, equally, all ranks, both rich and poor; those in narrow, dirty and crowded rooms, and dwellers in man- sions, who were sole occupants of spacious and airy chambers. Mannkopf observed the same conditions in the epidemic in Berlin. The French speak of its greater prevalence amongst the well nourished, and those living under favorable sanitary condi- tions.
Although from reviewing the histories of past epidemics, cold, want, dissipation and vice cannot be classed together as exciting causes, yet they undoubtedly prepare a fertile ground for the recep- tion of the seeds of this as of other epidemic dis- eases.
During the past winter, small-pox was epidemic here and throughout the Middle States. It spread widely, and was unusually fatal. Also typhoid fever was rife, and typhoid symptoms complicated nearly every inflammatory condition. Malignant scarlet fever and pneumonia, of an asthenic type, were unusually prevalent.
The winter was very severe, and there was only a slight fall of snow.
Although the disease is not directly traceable to atmospheric or telluric influences as exciting causes, yet its concomitance with other epidemics of an adynamic character, leads us to suppose that the specific poison of the disease is only engendered at those periods when zymotic diseases are widely prevalent and highly fatal. To what derangement of the vital stimulants are due these depressing periods ?
Dr. Knapp, of Mexico, has recently brought for- ward the theory that the periodical increase of planetary attraction, which occurs when the supe- rior planets make their perihelion circuits, is the cause direct and indirect of the inauguration of epidemics, or recurrence of the so-called pestilential periods.
He writes, if the sun and moon disturb earth, ocean and atmosphere, by their force of attraction, elevating immense tidal waves thereon, with in- crease of gravity in the atmosphere appreciable by the barometer, and if the mass of Jupiter is by far the most influential element in the planetary system after that of the sun, and Saturn the next, surely Jupiter's and Saturn's periodical approaches in making their perihelion circuits must affect the earth and the organized existences on its surface to a considerable extent or degree, by their increased attraction of gravitation and disturbance of its at- mosphere, and the natural vital stimulants of all organized life.
The blights in vegetation, which invariably pre- cede and accompany epidemics, he attributes to the derangement of the usual supply of the stimu- lus furnished by gravity, and asserts that the pesti- lential periods are always coincident with the
perihelia of the large superior planets, especially of Jupiter and Saturn.
According to his illustrations, the gravity of the first epidemic coincided with the perihelion of Ju- piter in 1809 ; that of the second, with the com- mensurate perihelia of Jupiter and Saturn, which coincided also with the ship fever epidemic of the Irish famine years, from 1845 to 1849, when they culminated in cholera. Our last epidemic would have coincided with the perihelion passage of Ju- piter in 1868, and as he is about six years in making his perihelion circuit, his influence would be dis- tributed over that time.
In giving Dr. Knapp's theory, I would not infer that I fully subscribe to it, but think it quite plausi- ble ; and as we have hitherto confined our almost fruitless researches for the causes of pestilential periods to objects around us, it would be well to study the effect of planetary attraction upon the growth and welfare of terrestrial organisms.
The disease usually strikes the robust and strong in preference to the effeminate and sickly. Males are generally more liable to it than females ; in Massachusetts and in France the percentage of the former, who were attacked, was fifty greater than the latter. In some epidemics the majority of the sufferers were children, in others both children and adults were affected.
It is met both in civic and military life ; in some countries having been limited almost exclusively to the army, and in others, again, the civic classes have been the only sufferers.
Post-mortem: — In recent cases there is no emacia- tion of the body, and rarely cadaveric rigidity of the muscles. Suggilations are absent, and, ex- cepting the remnants of herpetic or petechial eruptions, there is rarely any discoloration of the skin. In protracted cases emaciation is extreme, and the skin is dry and scaly.
The scalp is vascular, and the cranial bones are often injected. The dura mater cerebri is injected, and sometimes tensely stretched. The longitudinal sinus is filled with dark fluid blood. The dura mater of the spine is also generally vas- cular, more often tense than that of the brain, and its sack frequently contains a serous effusion. Sel- dom is purulent matter found mixed with it. Fre- quently the dura mater is adherent to the pia, either in points or over a considerable extent. But the pia mater of both the brain and the cord is the seat of the most extensive changes. It is always hyperaemic, sometimes dry, and is the seat of an exudation, which forms the most prominent and characteristic pathological condition.
This exudation takes place principally at the base of the brain, and on the posterior surface of the cord. It does not cover the latter uniformly alike, but is greatest either at the cervical portion or on the canda equina. In the earlier stages of the lighter forms there is subarachnoideal serous effu- sion containing flocculi of lymph and pus cells. In severer cases, the exudation is cloudy, grayish, and of a gelatinous consistence. In the severest forms, pus is freely poured out, and forms thick masses of firm consistence, and although most abundant at the base, the whole surface of the brain participates in the inflammation, presenting in its different parts all the various stages.
Thus, when at the base, the changes are such as were last described ; the sides are clouded or of a
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light yellowish color, and the convexity is dry and hyperaemic. The exudation penetrates into the fossa sylvii, and is very abundant about the chiasm.
It is present also on the anterior surface of the spinal cord, although to a much less degree than on the posterior. In long protracted cases there is comparatively little purulent exudation ; but the pia is relaxed and greatly thickened. The exuda- tion is midway in nature between the pure purulent exudation of simple meningitis and the sero-puru- lent of the tubercular form.
Most authors say that the purulent exudation is always present at the basis cerebri in rapidly fatal cases; the meningite fondroyante. It has been de- nied by a few, and they claimed its absence denoted an intensely powerful infectious poisoning of the system.
Microscopical examination shows a proliferation of the connective tissue cells in the pia, and in the tunica adventitia of the arteries.
The brain substance and the spinal cord are hyperaemic — in the former both gray and white substance are highly vascular, and the white por- tion is dotted with points of injection, and fre- quently of red softening. The lateral ventricles are frequently distended with a reddish colored serum. The roots of the nerves are surrounded by the infiltration, and on microscopical examin- ation, we find in the surrounding connective tissue an extensive growth of cells, which penetrate be- tween the bundles of nerve fibres separating them from each other.
The muscles are of a dark brown red color. The heart is relaxed, often of a grayish yellow color, and sometimes shows, microscopically, fatty degen- eration. The lungs are commonly hyperaemic, and evidences of cedema or broncho-pneumonia are often present.
Most writers speak also of a hyperaemic condi- tion of the intestinal canal, especially of the peye- rian patches ; but as calomel and other cathartics were generally liberally given during the course of the disease, it was probably induced by the treatment adopted. The liver and spleen are often softened, and the latter is frequently enlarged. In all cases the kidney is injected, and its cells clouded.
In no other disease, perhaps, do the single cases present such varied and strongly contrasting pic- tures of symptoms which often confuse the physi- cian, and, as in the Ketchum poisoning case, place them unfavorably before the laity. Many authors have made many divisions and subdivisions of the disease ; but I prefer simply three, classifying the very acute cases under meningite fondroyante, and the lightest under the abortive.
The disease is ushered in by a chill and a violent headache, which is frequently accompanied with vomiting.
The chill is of variable duration, often repeated, and followed by a fever of moderate intensity. The headache is persistent, and the pain soon extends to the neck and spinal column. The spine becomes exceedingly sensitive to pressure. Early the head is drawn backwards, the muscles of the neck be- come stiff, and frequently opisthotonos occurs. The mind is ordinarily clear until now, when it gives way to delirium, which, in severe cases, soon yields to coma.
The pulse is frequent, but not so rapid as in the infectious diseases. The temperature is only slightly
elevated, never rising higher than 1030, Fahrenheit. There is slight increase of thirst, and at first loss of appetite. The eyes are occasionally suffused, and the pupils generally contracted. Deafness of a variable degree is quite common. The face is usually slightly suffused, and presents an apathetic or anxious look. Slight bronchial catarrh is gen- erally concomitant. The abdomen is sunken, and in grave cases its surface has a canoe-shaped ap- pearance. Obstinate constipation is almost always present ; and, as the derangement of the sensorium occurs, the urine is retained or involuntarily emitted.
Severe neuralgic pains are common in the ex- tremities and are due to the irritated condition of the posterior roots of the spinal nerves. Herpetic or petechial eruptions frequently appear — the for- mer around the mouth, on the cheeks or on the ears, and the latter upon the trunk.
The symptoms increase in severity until the acme of the disease is reached, and after a variable period of time convalescence commences, which is slow, protracted, and liable to many variations. Relapses are frequent, and often terminate fatally. The disease has no day of crisis, and is variable in du- ration. In meningite fondroyante they die within the first two days, and frequently within a few hours. In these rapid cases many of the objective symp- toms are wanting; the tetanic spasms may be absent, as the patient dies from general paralysis. In cases of moderate intensity, there is frequently an abatement of the severity of the symptoms at the end of the first week or during the second ; but convalescence may be protracted.
Authors speak of an intermitting form. In our last epidemic it occurred frequently either in the first stages or during convalescence. In the for- mer variety it generally assumes a quotidian type, the symptoms persisting more or less clearly during the greater portion of the day, yet are followed by complete remissions. After continuing thus a few days the remissions cease, and the disease becomes more violent. Quotidian exacerbations of variable severity occasionally occur during convalescence, prolonging the disease greatly. Death usually re- sults in the early stages either from asphyxia or general paralysis, and in the protracted cases from marasmus.
In order to present a more complete history of the symptoms, I will speak of them singly, and mention their chief peculiarities.
The headache is the most prominent and dis- tressing symptom. It is always present, excepting in the fondroyante form, where the disease suddenly overwhelms the patient, and he passes off in coma. Patients speak of it as a boring, throbbing pain, extending over the whole head, but most severe in the occipital region. Even in coma it is probably present, for the patient, with an anxious, suffering look, tosses his arms, and points and strikes con- tinually at his head.
The delirium is variable. Frequently it is low and muttering, at other times the patient talks excitedly, and in an incoherent manner. During the day the intellect is often clouded, the patient only answering questions when aroused, and re- lapsing immediately afterward into a stupid condi- tion. At night this yields commonly to delirium. Another common symptom is the pain in the spinal column. Patients complain of a full, tense feeling, and a burning pain in the cervical portion, and fre-
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quently, also, in the lumbar region. It does not usually appear until the second or third day of the disease. It is increased by pressure upon the spine, and aggravated by motion of it. The nodding of the head is especially painful, and even in the lightest forms the patient refrains from it.
Hyperassthesia of the skin is often present in the early stages. The sensitiveness of the patient to being touched or handled, affords an important diagnostic sign in differentiating this from infec- tious diseases. Anaesthesia occurs rarely while the intellect is unclouded. It is supposed to arise from the loss of sensibility of the posterior roots of the nerves as a result of the inflammatory changes.
Groups of muscles are commonly highly sensi- tive also in the first stages of the disease. The muscles of the neck and back are most frequently affected, and often those of the extremities.
The tetanoid phenomena are generally present in all cases, and occur early in the disease. Al- though indicating inflammation of the spinal men- inges, their absence is no proof that inflamma- tory changes do not exist. The head is firmly drawn back upon the neck, and the back is curved, producing marked opisthotonos. The patient lies, in consequence, upon the side, or frequently, in marked cases, upon the abdomen. Clonic spasms are some- times present. Paralysis of some of the muscles of the eye occasionally occur, but rarely the ex- tremities are affected. The obstinate constipation which is universally present, and the frequently oc- curring retention or incontinence of the urine are due to disturbances of the motor nerves.
Patients not unfrequently become blind from purulent choroiditis, probably arising from metas- tasis. Dr. Knapp says this affection begins usually in the first week of the disease, and that the sight is generally lost.
Deafness is remarkably frequent, and arises, in all probability, from a purulent inflammation of the labyrinth, by which the membranes of the inner ear are destroyed in a similar way as the membranes of the eye, by the purulent choroiditis.
The symptoms presented by the digestive organs are not prominently marked. The tongue is com- monly covered with a creamy-like fur, and is some- times reddened at the edges. Sordes never form to any extent. The appetite is commonly wanting at first, but later on there is often an unnatural craving for food. Vomiting occurs at the out- break of the malady, and frequently during the latter stages. It arises from the disturbed condition of the brain, and is excited rather by motion of the body than by presence of food.
The urine is variable in quantity, usually less than normal, and often contains traces of albumen and a few epithelial casts. In some cases, the joints are swollen and inflamed, the knee being most fre- quently affected.
As a consequence of the bronchial catarrh, the breathing is labored and rapid, and when the te- tanic symptoms are strongly marked, the respira- tion is much oppressed.
The eruption is not always present. European authors speak only of its occasional occurrence. American writers vary as to the ratio of cases in which it appears. Stille, of Philadelphia, says that 62 per cent, of the cases under his observation had eruptions of some sort.
In our recent epidemic it was frequently present, but not in the majority of the cases.
I have met with the herpetic and petechial varie- ties only ; but in previous epidemics the exanthema- tous and urticarial were also frequently seen.
The fever varies greatly in intensity and duration. The temperature is generally only slightly elevated, and presents no regular curves as in the infectious diseases. Generally it ranges from 990 to 1020, and in fatal cases it may reach 103^. The pulse is weak, feeble and thready, and does not correspond to the temperature in frequency. Often, it is re- tarded, and sometimes falls below its normal con- dition. When convalescence occurs it does not approach the healthy standard so rapidly as the temperature.
This disease has often been confounded with typhus and malarial fevers. If the difference of the anatomical appearances of cerebro-spinal me- ningitis and of typhus is kept distinctly in view, the symptoms of inflammation of the meninges will be rarely confounded with those of the latter disease.
In cerebro-spinal meningitis there is the severe, throbbing darting headache, characteristic of me- ningeal inflammation; in typhus it is dull and heavy. In the former disease, delirium, when present, occurs early ; in the latter, not until the headache commences to subside, and rarely before the end of the first week. In the first disease the eruptions are not constant, and appear on the first or second day ; in typhus, not until between the fifth and seventh. The meningitis is not conta- gious, the typhus highly so.
Cerebro-spinal meningitis occurs in all ages, but more frequently in children, while typhus is almost exclusively limited to adults. In one, we have a moist tongue, persistent vomiting, tetanic spasms and hyperassthesia. In the other, the sordes, trem- ulousness and blunted sensibility are characteristic. The pulse, temperature, course and duration of the two diseases vary greatly.
Between epidemic cerebro-spinal meningitis and malarial fever, the vomiting, the low temperature, the hyperassthesia, the eruption, the pain along the spinal column, and the utter failure of quinine in arresting the intermittent symptoms will differen- tiate the former disease from the latter.
The prognosis varies according to the type of the epidemic, and with the period of each. At the commencement, the meningite fondroyante is frequent ; in the latter part, the abortive.
In the epidemic of Germany from 1862 to 1866, the mortality ranged from 40 to 55 per cent., and in some of the earlier ones it reached as high as 80 per cent. In our city hospitals 30 per cent, have died. It is difficult to foretell the result of any case, as many commencing with light symptoms often end fatally, while those ushered in with all the graver phe- nomena frequently recover. After convalescence seems well established, there are frequently fatal relapses. We may consider as unfavorable symp- toms, great depression, sudden coma, jactation, re- appearance of protracted vomiting, and the pe- techial eruptions. Cases occurring among chil- dren and the effeminate, afford a better prognosis than those among the strong and robust.
I now enter, with pleasure, upon the consideration of the treatment of this disease. We have seen that under allopathic treatment the ratio of deaths has
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never been less than 30 per cent. I have taken much pains to obtain statistics of the mortality of this disease under homoeopathic treatment, and the result of my researches shows that less than 1.0 per cent, of our cases end fatally.
Our allopathic brethren rely principally upon cold applications to the head and spine, and opium in massive doses to quiet the delirium, relieve the headache and remove coma. Some use, recently, bromide of potassium instead of opium. Calomel and iodide of potassium are frequently given.
Our treatment has been in the forming stage, cold applications to the head and nape of the neck, and the administration of gelseminum alone or with belladonna internally. If the disease assumes a sthenic, inflammatory type, we have substituted aconite for the gelseminum. As soon as the spinal symptoms appear, we alternate secale with gelse- minum. To relieve the coma, we rely upon opium. Even our allopathic friends regard opium as their sheet anchor, and have gone so far as to call it a specific for this disease. They speak of it " as a most powerful agent in removing the deepest comas which were not absolutely irrecoverable," and recognizing its efficiency in the treatment of one symptom, give it empirically for all. Conium acts favorably in relieving jactation. For promot- ing absorption, mercurius biniodide is deservedly a favorite remedy.
In the long protracted cases, where emaciation is extreme, phosphorus and nux are serviceable. In these cases inunctions of cod liver oil are highly beneficial. The purulent choroiditis and the deaf- ness are irremediable.
No. 18 West 23^ Street, N. Y.
RESECTION OF THE INFERIOR MAXILLA,
FOLLOWED BY COMPLETE*REPRODUC-
TION OF THE BONE.
A CASE OF ACUTE NECROSIS FOLLOWING THE USE OF ARSENIOUS ACID FOR DENTAL PURPOSES — MERCURIAL SALIVATION PRODUCED BY AN AMALGAM FILLING.
By John C. Minor, M. D.
On the 10th of February, 1871, I was called to attend the case of Mrs. B. She was 27 years old, a widow, and her health, prior to her present illness, had always been excellent. The most careful ex- amination showed her to be entirely free from scrof- ulous or syphilitic diseases, either hereditary or acquired. I found her in bed too much prostrated to sit up, her complexion sallow, expression anx- ious, pulse 120 and weak, the perspiration stand- ing out in great beads on her forehead, her face swelled and her body emaciated. She was pro- fusely salivated, her breath was horribly offensive, and an attendant was constantly occupied in wiping away the secretion that streamed from her mouth. An examination of the mouth revealed necrosis of nearly the entire lower jaw. Nearly all the teeth had fallen out or been removed ; the tissues around the jaw were thickened and vascular ; the parts ad- jacent were bathed in foetid pus that constantly exuded from the sockets, and a probing of the bone revealed an extension of the necrosis from the articu- lation on the left side to a point within an inch-and-
a-half4 of the articulation on the right side. Her strength was rapidly failing and her condition a most unfavorable one for the success of any operation ; but I nevertheless advised an immediate removal of the bone as the only chance of saving her life, and this opinion was concurred in by the attending phy- sicians. Accordingly, upon the following day, Feb- ruary nth, 1871, I removed the jaw. Drs. T. F. Allen, F. E. Doughty, Belden, Jernegan, Allan and Fitch were present, and rendered valuable assist- ance.
Operation. — The patient was placed in an occu- list's chair and chloroform administered. When she was fully under its influence, I drew the tissues for- ward from the neck upon the bone, so that the re- sulting scar should be hidden behind the folds of the cheek and chin, and then, with a few rapid strokes of the knife, I divided the tissues down to the bone. This first incision began about half an inch in front of the articulation on the left side, and then followed the inferior border of the bone to the symphysis menti. The hemorrhage was controlled by pressure alone, the facial artery being of such small size that no ligature was required. My second incision was simply a prolongation of the first, extending it, as be- fore, along the inferior border of the bone to a point an inch below the articulation on the right side. At this point the knife struck a smoother surface of bone and I stopped my incision where the disease seemed to have terminated. The right facial artery was now seized and tied, and I proceeded to separate the dead bone from the periosteum and surrounding tis- sues. This was done, as far as possible, on both sides before the muscular attachments of the tongue to the symphysis were disturbed. A ligature was now passed through the tip of the tongue and given in charge of an assistant, and the muscles of the tongue divided at their point of attachment to the bone. A chain saw was immediately passed around the bone, and section made through the middle of the symphysis. A considerable quantity of foetid, grumous pus immediately followed this section, pour- ing out of the dental canal which had been filled with the matter.
Grasping the left half of the bone with the lion forceps and using the handle of my knife, the bone was readily enucleated from its investing periosteum, and a slight twist disarticulated it so that the liga- ments were easily divided by the blunt scissors, and the bone removed. The coronoid process broke off, however, during these manipulations and immedi- ately retracted. I seized its lower border, removed all I could get away with the gouging forceps and allowed the rest to remain. The right side of the jaw was now attacked in the same manner ; the ra- mus divided with the chain saw, an inch-and-a-half below the articulation, and all below the point of division brought away. A considerable collection of pus was detected in the left side of the neck, bur- rowing its way down behind the platysena ; this was evacuated by a free incision from without. The wound was now carefully cleaned, and an examina- tion showed the periosteum to have been most care- fully preserved. Silver sutures were used to unite the edges of the wound, and a hare-lip pin was in- serted so as to hold the muscular attachments of the tongue in position. A dressing of soft tow was ap- plied ; this was supported in position by a bandage passing around the patient's head, and she was then placed in bed with a trusty nurse stationed beside
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her in charge of the ligature that held the tongue forward in its position.
Subsequent History. — In twenty-four hours the ligature through the tongue was removed, the adhe- sions having become sufficiently strong to hold the part in position. The patient did not rally well. For several days she was more or less delirious. The forehead was constantly bathed in perspiration, her pulse continued about 120 and very weak, and there was no immediate abatement of the feverish symp- toms. The urine was scanty but not albuminous. The ptyalism continued as before the operation. Her condition seemed rather worse than before the operation, for the same general symptoms were pres- ent, and surgical shock was superadded to these. I gave her large inhalations of pure oxygen gas. Dis- carding the bags ordinarily used for the purpose, I attached one end of the tube directly to the receiver of compressed gas, and placing the other end in her mouth, I turned on the gas so that a gentle stream should flow through the tube. These inhalations were repeated every two or three hours, and the tube was allowed to remain in situ for half an hour at a time. In addition to this, chlorate of potash was administered internally, and used as a wash for the mouth. The patient was carefully nourished and moderately stimulated. At the end of a week there was a decided improvement in her condition. The mind became clear, the skin more natural in color, and the hectic fever subsided. Most of the sutures were removed on the sixth day, the incision having healed, for the most part, by first intention. During the second week the ligature around the facial artery came away and the remaining silver sutures were removed. The inhalations of oxygen gas had been gradually diminished in frequency, and were now discontinued.' Syrup of the hypophosphite of lime was alternated twice a day with small doses of chlor- ate of potash. During the third week I passed a probe through a small fistula on the right side, and detected necrosis of the free extremity of the ramus. I therefore dilated the fistula so that I could seize the dead portion with forceps, and as it was perfectly detached, I brought it easily away. It proved to be an exfoliation of the free extremity of the right ra- mus, about half an inch long, resembling the thim- ble-shaped exfoliations occasionally met with after amputations. After this the patient steadily recov- ered her health and strength, and a new jaw began to form, appearing at first as a cartilaginous deposit shaping itself into the form of the old jaw. This new formation became gradually harder, and as it increased in firmness the muscles began to exercise their control over it. Finally, after a period of six months, the new jaw became dense and solid, com- pletely under muscular control, perfect in its shape, free and natural in its motions, and differing from the old jaw in containing no teeth and in being somewhat smaller in its dimensions. The last traces of the ptyalism disappeared about two months after the operation. A few weeks ago she called upon me, and I was surprised to find how few traces had been left of the operation. The scar was completely hidden from view, and even a critical examination failed to detect the extent of the incision, so perfect was the union of the parts. The chin was some- what retracted, owing to the new jaw being smaller than its predecessor ; but this retraction was not to such a degree as to produce deformity. On opening the mouth a full set of teeth appeared — artificial
ones — that had been fitted to the new jaw by Dr. N. W. Kingsley. To the ordinary observer, there was no evidence that this patient had ever lost her jaw, so completely had nature and art repaired her loss.
Previous History. — The previous history of this case is, in some respects, more remarkable than the operative results, and suggests some questions of peculiar pathological interest. This bone which I removed, on the nth of February, was apparently sound on the 1st of January, and even on the 7th or 8th of January it was not supposed to be seriously threatened. And yet on the 27th of January the bone was dead, and had probably been so for some time. It is safe to say that this extensive necrosis of the bone occurred within a period of two weeks, an exceptionally rapid progress even for acute necrosis to make. The application of arsenious acid for the purpose of killing the nerve, upon the 27th of De- cember, was followed by an exfoliation of bone in front of the tooth that was recognized on the 7th of January, and on this latter date another application of arsenic was made, and in less than two weeks the jaw was dead. Now, a slight exfoliation of bone, re- sulting from the use of arsenious acid, is not an uncommon occurrence in dental practice, — most dentists, at least, have seen such cases, — nor is it usually considered of much importance, but in this case it acquires a remarkable interest, because the question at once arises whether the action of the arsenic stopped there; — whether, in fact, the agent employed to kill the nerve did not also kill the jaw. This question becomes more significant when we find so careful an observer, and so weighty an au- thority as Dr. J. Mason Warren, of Boston, record- ing two similar cases of extensive necrosis of the jaw produced by the use of arsenious acid for dental purposes. We find again that, on the 8th or 9th of January, while the parts around the tooth were in- flamed and vascular, an amalgam filling was inserted into its cavity, and in less than ten days the patient was salivated to such a degree that the ptyalism continued for more than two months afterwards. Let us now examine the record of this case prior to the operation :
Dec. 29, 1870. — Mrs. B. had a decayed tooth, the second molar on the left side of the lower jaw, that had given her occasional pain. On the 29th of December, while suffering from tooth-ache, she called upon her dentist in Poughkeepsie, where she lived, and desired him to kill the nerve and fill the tooth. The dentist, after examining the tooth, ad- vised its extraction, but finally deferred to the wishes of his patient and applied a minute quantity of arsenic to the nerve in the usual manner.
Dec. 30. — The pain still continued but not se- verely. The dentist removed the arsenic, made an application of kreasote to the cavity and directed the patient to call again the next day.
[Had she followed the instructions of the dentist, there would have been no trouble. His first advice was sound, and he was perfectly competent to treat even the subsequent exfoliation that occurred. In- stead of calling again the next day, as she had been directed, the patient resolved to come to the city and spend the holidays. She accordingly came to the city and received calls on New Year's Day, although she was suffering at the time from "severe toothache. "]
Jan. 4, 1 87 1. — The pain in the tooth continued without any material change since the last date.
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On the night of January 4, while returning from the opera, the patient was for a short time exposed to the weather, so that she became wet and chilled.
[I mention this exposure to wet and cold because it is one possible cause of necrosis. At the same time I do not hesitate to exclude it as one of the possible causes of this necrosis. In reviewing a pretty extensive experience of this disease, I have yet to meet with the first case of necrosis from this cause except where the disease has been located in the bones of the lower extremity; and, furthermore, I have thus far failed to discover a recorded case of any bone higher up than the humerus, whose death can be attributed to exposure to wet and cold, unless the patient had been at the time of exposure under the influence of mercurials, a condition which was wanting in this case* Markoe gives the gen- eral experience of surgeons in this particular when he says: " The bones most liable to suffer are those most liable to direct exposure to the injurious cause, as the bones of the feet and the shaft of the tibia. It would seem, also, that the exposure must be pro- longed, in order to produce its effect, * * * suffi- ciently to act as an exhauster of the general power of resistance, as well as a depressor of the local circulation of the part about to be affected." — {Dis- eases of the Bones, p. 122.]
Jan. 7th. — The pain in the tooth had now in- creased to such a degree that the patient concluded to have it out. She accordingly called upon a den- tist in this city, who found, on examination, that a portion of the anterior wall of the socket had exfo- liated, and he informed the patient of that fact. He did not consider the trouble as of serious import- ance, and persuaded the patient to have the tooth filled. As the nerve in the anterior fang of the tooth was still alive, he reapplied arsenic in order to de- stroy it. The part was very sensitive to press- ure. .
[The total necrosis had not yet begun. The slight exfoliation discovered on the 7th inst. was probably due to the arsenic applied on the 29th of December. Its extent, however, was not so great as to prevent another dentist from making the same application in order to destroy the remaining por- tion of the nerve. The persistence and severity of the pain points, however, to a deeper seated trouble than mere tooth-ache or a superficial exfoliation of bone, and there can be no doubt that the symptoms were those of periostitis attacking the membrane lining the socket of the tooth, or at least confined to the immediate locality of the tooth. We may as- sume, then, on sound pathological grounds, that this patient was, on the 7th of January, suffering from an inflammation of the periosteal membrane, in the immediate vicinity of the second molar tooth on the left side of the lower jaw, that had not yet arrived at the stage of suppuration, but was in a state of hy- peremia, just balancing between resolution on the one hand and an extension of the disease on the other. Had the tooth been extracted then, it is probable that a complete subsidence of the symp- toms would have resulted. A slight irritation of the part, however, would be adding fuel to the fire, and must inevitably turn the scale the wrong way. The tooth was not extracted. Arsenic was inserted into its anterior fang. Now, if one kind of violence will inflame a part, the same violence repeated will kill it; if a chemical agent, an escharotic, for instance, like arsenious acid, will produce severe inflamma-
tion, the same repeated will destroy the part. This is true of all external exciting causes of inflamma- tion, because the repetition of the irritation is made to an affected part whose vital forces are already de- pressed.]
Jan. Sth. — The parts immediately around the tooth had now become exquisitely tender and pain- ful. The dead nerve was removed, and the cavity filled temporarily with cotton and sandrac varn- ish.
Jan. gth. — The tooth was filled with amalgam. "I never suffered such intense agony," said the pa- tient to me when relating her case, "as that pro- duced by the filling of my tooth. It was hor- rible."
A period of intense suffering now began that was terminated by the removal of the jaw. So great was the pain, and to such an extent were the mind and body of the patient prostrated, that I could never get from her a clear account of the case dur- ing this eventful period. I have ascertained, how- ever, that the tissues surrounding the bone became rapidly swollen, hot, and always painful. Hectic fever set in, and the patient became profusely sali- vated. A physician was called in (Jan. 17 th), who applied hot poultices to the face and administered saline cathartics. The teeth now became loose, and pus began to ooze from their sockets. The patient was prostrated with fever; her appetite and strength rapidly failed, and she was at times delirious. The attending physician was dismissed, and Dr. T. F. Allen called to the case (Jan. 27th). The doctor called in the services of a competent dentist, and after lifting out some of the teeth — no forceps were required — the parts were thoroughly syringed, and an examination made of the condition of the jaw. It was found to be extensively necrosed, the necro- sis involving the whole thickness of the bone and nearly its whole extent. Under Dr. Allen's care every effort was made to support the failing strength of the patient and favor the separation of the dead bone from the living; tissues. But the thing was im- possible. The patient's strength was so far exhaust- ed that she failed to respond to the means employed. It became at last a question as to what should be done to save her life, for it was evident that septi- caemia would bring the case to a speedy and fatal termination, unless some more radical treatment should succeed. Under these circumstances I was called to the case, and removed the dead bone, as al- ready described.
The history of this case prior to the operation is remarkable for three things — First, the cause of the necrosis; secondly, the rapidity of the disease; thirdly, the occurrence of mercurial salivation. The case demands a fuller investigation, because its re- lation to the ordinary practice of dentists, as regards the use of arsenious acid for killing the nerves and amalgam for filling the cavities of the teeth, is of the utmost importance.
I shall therefore consider the pathology of this case in a more thorough manner in a future article, merely premising that consideration with the state- ment that there was no history or evidence that my patient ever suffered from any form of scrofulous or syphilitic disease, and that there was no mercury ad- ministered to the patient except in the shape of an amalgam filling.
10 East \\si Street, N. Y.
The Medical Union.
LARYNGEAL PHTHISIS.
By E. J. Whitney, M. D.
In no direction, perhaps, has the application of Laryngoscopy been of greater service than in the di- agnosis of those conditions of the larynx which, al- though manifesting themselves during the course of Pulmonary Tuberculosis, may, or may not have any connection with it. Until a comparatively short period, it was generally believed that all morbid laryngeal conditions in Tuberculous subjects were identified with, or bore a direct relation to, the dis- eased condition of the lungs, and extended by the same pathical process over the mucous membrane and sub-mucous tissue of the larynx and trachea. Laryngoscopy has done much towards forming an exact diagnosis, in laryngeal complications, with Tu- berculosis, showing most conclusively, that other morbid conditions (differing from Laryngeal Phthisis), each distinctive in its symptoms and peculiarities, may co-exist with Tuberculosis ; and in view of this, it is proposed to devote this article to the considera- tion of this morbid condition, and the differential diagnosis between it and other affections of the lar- ynx. While this disease is commonly secondary to a tuberculous condition of the lungs more or less extensive, it is not generally known that the affec- tion of the larynx, primarily, is sometimes the only indication of the commencement of Tuberculosis, so marked and prominent in its nature, that the cough and wasting appear to spring from it rather than from the chest, to which point the attention had not been directed ; and while nothing is more rare than the existence of the disease under consideration, in- dependent of Pulmonary Phthisis, it is equally true that it may precede this condition. I cannot, there- fore, but regard the usefulness of Laryngoscopy demonstrated beyond cavil, when by its means an exact diagnosis may be obtained of Laryngeal Phthi- sis, even in its earliest stages, and before any tuber- culous deposit can be found in the lungs, by a most careful and thorough physical examination. The importance of this fact cannot be overestimated, for by means of the mirror, the physician is not only warned of the approach of Tuberculosis by its fore- runner, Laryngeal Phthisis, but the knowledge thus gained may, through proper hygienic and precau- tionary measures, prolong the life of his patient for many years. The symptoms and laryngoscopic ap- pearances of the three diseases of the larynx most likely to be confounded with each other, viz. : I, Laryngeal Phthisis ; 2, Chronic Laryngitis ; 3, Syph- ilitic Laryngitis — will be described seriatim, with the further remark in passing, that the title under which the first named is spoken of is adopted in preference to that of Tuberculous Laryngitis, inas- much as the question, as to whether true tuberculous deposits are ever found in the mucous membrane of the larynx, is held negatively, by prominent laryn- goscopists.
The parts most favorable to the invasion of this malady are the ary-epiglottic folds, and the epiglot- tis, although in the progression of the disease, the ventricular bands and vocal chords are frequently involved. The earliest subjective symptom is pain in swallowing, and a laryngoscopic examination reveals swelling of the cartilage of Wrisberg and of Santorini, which, as the tumefaction increases, as- sume a pyriform shape, and projecting on the carti-
lages, obscures the interior of the larynx. This in- flammation is diffused, and its outlines fall into the adjacent parts without showing any especial line of demarcation.
The characteristic color of the parts just men- tioned is pale and aenemic ; but when the vocal chords are involved, they appear rough and thick- ened, and of a dark red, or purplish color. There is noticeable more or less hoarseness in the earlier stages, terminating in Aphonia, as the vocal chords and ventricular bands become involved. The parts present a puffy, cedematous appearance ; the secre- tion is thin, glary and tenacious ; and as the epiglot- tis becomes affected, and assumes a thickened and "turban-like" appearance, dysphagia is a marked and distressing symptom. Cough, although some- times wanting, is generally present, and is distinc- tive and peculiar, having a stridulous, metallic sound, which is quite characteristic of the conditions just described. Another, and equally marked char- acteristic, is the slowness of these tumefied parts to ulcerate, and although the inflammation and swelling may be very great, and the parts distorted almost be- yond recognition, there is an indisposition to ulcera- tion which is in marked contrast with another laryn- geal affection yet to be mentioned. When, how- ever, this process is established, the ulcerations are small and superficial, partaking more of the charac- ter of an erosion. The fauces present generally, a pale, colorless appearance, accompanied at times with such a degree of irritability and intolerance of contact, with the mirror, as to render an examina- tion a matter of considerable difficulty. Having thus briefly described the symptoms and pathological changes of Laryngeal Phthisis, it will be well to enu- merate its distinctive points of diagnosis, before pro- ceeding to the consideration of the other diseases already mentioned. 1st, Pain in swallowing; 2d, Location and character of the swellings ; 3d, Its color and that of the surrounding tissues, and 4th, Slowness to ulcerate. Chronic Laryngitis is not an uncommon affection in our Northern sea-board cities, and is more prevalent during cold, wintry weather. The parts most subject to an attack are the vocal chords and ventricular bands, then the epiglottis, and lastly, and more rarely, the arytenoid cartilages. This condition, depending as it does upon more or less capillary engorgement, is dis- tinctively hyperaemic in its nature, and the vocal chords, ventricular bands, and surrounding mucous tissue, are consequently bright red in color, varying in intensity according to the activity of the disease. There is usually but a slight degree of thickening or tumefaction; the supervening ulcerations are shallow, and when this process is extended to the vocal chords, numerous bright, glistening points are to be seen, caused by destruction of the lining mem- brane, which exposes the fibrous structure beneath. Aphonia, more or less marked, and fatigue in vocal- ization are ordinarily present, but no pain usually in swallowing, and seldom cough, but when it exists it is irritative in character. There is rarely any em- barrassment in respiration, and but little constitu- tional disturbance. The pharynx is generally con- gested, the uvula and soft parts relaxed, yet not- withstanding this hyperaemic condition the parts lack the exquisite sensitiveness of Laryngeal Phthisis, and a view of them can in most cases be readily ob- tained.
In Syphilitic Laryngitis, the epiglottis is most
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commonly the first affected ; following in frequency of attack are the vocal chords and laryngeal cavity, and more rarely the arytenoid cartilages. Ulcera- tion, which is developed in the earliest stages of this disease — unlike that process pertaining to the two diseased conditions just considered — is rapid and de- structive in its course ; the ulcerations, deep and ir- regular in form, with edges raised and prominent, are covered with a dirty yellow, or apthous secretion, which reveals upon removal a hyperaemic base, prone to bleed. The activity of this process causes considerable surrounding tumefaction, which, how- ever, is nearly always a sequel of ulceration, and rarely precedes it. Cicatrization, which follows the subsiding ulceration, affords distinctive characteris- tics no less marked and important than those of the ulcerative stage itself, consisting of radiating fibrous bands so dense and contractile in their formation as to frequently occasion both narrowing and displace- ment of the larynx, and, according to Tobold, are often "covered with abundant papillary growths." This last observation, however, my experience has failed to confirm. If, on the other hand, the ulcera- tive process continues, the soft parts may be des- troyed, Perichondritis induced, and the cartilaginous framework of the larynx displaced. The symptoms and appearances just enumerated obtain only in the tertiary forms of Syphilis ; those conditions arising from the Secondary type being mostly of an erythematous nature, which either disappear spon- taneously or yield quickly to treatment.
From a summary of the foregoing observations it will be noticed that morbid changes as reflected in the laryngeal mirror, afford positive means of diag- nosis. In Laryngeal Phthisis, the ary-epiglottic folds are most commonly the seat of attack ; and the pyriform swelling of the cartilages, the peculiarly tumefied epiglottis, as well as paleness of color, and indisposition to ulceration are, each and all, char- acteristic of this disease. It will also have been observed, that while more or less swelling is usually present in each of the diseases herein described, it may be laid down as a rule, from which there is rarely any deviation, that swelling in Laryngeal Ph- thisis precedes ulceration. The cough — stridulous and metallic — is also of value as a diagnostic symp- tom, while pain in swallowing, which is usually pres- ent, inasmuch as it accompanies in a greater or less degree, all inflammatory conditions of the epiglottis and inter-arytenoid folds, is not wholly reliable. In Chronic Laryngitis there is little or no constitutional disturbance; the interior of the larynx — the vocal chords and ventricular bands — are markedly affected, and, together with absence of cough and embarrass- ment of respiration, form important and distinctive differentiae. Syphilitic Laryngitis differs from either of the preceding diseases, through the early develop- ment of a destructive form of ulceration not pre- ceded by any tumefaction, in connection with its preference for the epiglottis, as its part of location. The depth and irregularity of these ulcerations, the rapidity of their course, together with the peculiarity of cicatrization, may be regarded as typical.
ioo Lafayette Avenue, Brooklyn.
THE MEDICAL UNION CLINIC.
i . Fibro- Cystic Tumor of the Uterus, treated with Muriate of Ammonia. In September, 1871, a young lady was placed under my care with fibro- cystic tumor of the uterus. The tumor was about the size of a child's head at full term, and had been growing for several years. During the last year it had increased rapidly in size, and occasioned much distress by its pressure on the pelvic organs. Flatu- lence, constipation and inability to stand or walk for any length of time were some of the concomitants of the tumor. Being somewhat doubtful as to the exact nature of the tumor, I had the patient exam- ined by Drs. Marion Sims, T. G. Thomas, A. K. Gardner, Washington L. Altee and others. Their diagnosis was uniformly the same — fibro-cystic tumor of the uterus. No encouragement was held out as to any cure by medicines. I placed her on muriate of ammonia, from three to six grains three times a day, dissolved in a large quantity of water, and kept her on that treatment for ten months. At the end of that time the tumor was decreased to such small dimensions that it could only be detected with difficulty. The other troubles disappeared also, so that, with the exception of a tendency to flatulent distension of the intestines, she is now apparently restored to perfect health. I have for a long time used the muriate of ammonia in preference to the iodide of potassium as an absorbent, and consider it superior to any other remedy for that purpose. I have never seen any bad symptoms arising from its use other than an occasional dyspepsia that was easily remedied by slightly diminishing the dose, or omitting it altogether for a day or two. The use of the muriate must be persisted in for months ; there must be a slow saturation of the system with the remedy in order to see its beneficial results.
I believe that the absorbent powers of muriate of ammonia were illustrated in this case. The remedy deserves a trial in similar cases, where absorption is the only hope of cure, the nature or location of the tumor forbidding operation.
John C. Minor, M. D.
Gold in Sea Water. — Sonstadt demonstrated the presence of gold in sea water, held in solution by the action of the iodate of calcium. He estimates the proportion to be less than one grain per ton of water.
2. Fibroid Tumor of the Bladder, treated with Muriate of Ammonia. In June last, a gentleman, well known in the literary community, applied to me for relief from a trouble which he said was mak- ing his life miserable. I found him weak, emaci- ated, with a sallow face and a distressed look. His age was about sixty. For years he had suffered from a severe trouble in the bladder, which had gradually been getting worse and worse. He was hardly ever able to go more than a half hour with- out an attempt to void water. The attempt was often unsuccessful even after five or ten minutes' trial, but on going back to his work the water would not unfrequently commence flowing without warn- ing, discharging itself into his pantaloons. Every night he was obliged to get out of bed as often as every half hour to void urine. A careful examina- tion with the sound revealed a tumor in the lower part of the bladder, somewhat in shape and nearly the size of a small hen's egg. The cause of all his trouble was apparent. An operation, at his age, with his strength broken down with long suffering, was only to be thought of as a last resort. I ordered him to take ten grains of muriate of ammonia three times a day. In a few days he informed me
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the drug severely purged him and deranged the stomach. I reduced the quantity to five grains to be taken in a wine-glass of water. In a short time marked improvement was apparent. He has re- gained his usual strength and color, and says he feels that he is a well man. He now passes water but two or three times a day, and is not called up at night. Under the action of the muriate of am- monia the tumor has become entirely absorbed, and every unpleasant symptom removed.
Egbert Guernsey, M. D.
3. Epileptiform Convulsions treated with Cedron. Mrs. E., aged twenty-five years, native of England, married, one child, always delicate. Four years ago, for the first time had an epileptic fit caused by fright. Since that time has had well marked epi- leptic attacks on an average once every two weeks.
Dec. 3, P. M. — I was called to attend her. I found her in bed, lying on left side, suffering from violent pain extending from the spine around the right side nearly to the mediaro line in front, and from about the first dorsal to the last lumbar verte- brae, attended with great sensitiveness to the touch ; frontal headache, nausea and vomiting, thirst ; pulse and temperature normal. This condition had ex- isted for three days* during which time she has had no sleep, nor been able to keep any food on the stomach. No fit for two weeks. Prescribed.
Dec. 4, A. M. — Condition about the same as yesterday. No sleep; temperature 100; pulse 80; Ignatia Oj in water. P. M. — After taking two doses of the remedy, pain in back and side relieved very much, but is returning. Has "fainted" two or three times ; otherwise about the same. Continued remedy.
Dec. $, A. M. — No change in previous symptoms. Has had seven or eight "fainting" fits since day- break ; during my visit had two which I recognized as Petit Mai. While lying quiet, without any per- ceptible change in her appearance, she became perfectly unconscious, respiration and heart's action remaining natural. This condition lasted for three minutes, when consciousness returned, with some chilliness and thirst. The intervals between the attacks varied from five minutes to two hours. Prescribed Ars. 1st dry. Met Dr. Henry Paine in consultation toward night, up to which time the patient's condition remained the same. We decid- ed to give Hyos. tinct. a trial, and should that fail, then Cedron.
Dec. 6. — No change for the better. Gave Cedron 1st grs. xx, in a third of a glass of water, tea-spoon- ful every hour till four doses had been taken, then every two hours.
Dec. 7. — Patient had some sleep, the first in six days ; was also able to retain some food on stomach ; pain much relieved ; no more attacks of the Mai. Gave Cedron 1st in powders of grs. v each, every two hours.
Dec. 8. — Found patient sitting up, nearly free from all pain ; had quite a good night's rest ; some appetite, and no difficulty in retaining food. Im- provement continued under this remedy in de- creased doses, and patient discharged.
Francis E. Doughty, M. D.
itorrespcmbence.
A LETTER FROM JOHN CRANNELL. My dear Union:
You want some of my studies for publication? Well, you know that an artist's work is always a finished pro- duction, while his studies are like mine — never done. An artist's studio presents not only the finished work, but also the chips and tools, the models and sketches from which the complete creation has sprung. If the work is on exhibition, the odd sketches and litter are stowed away in some corner to escape the eye, which appreciates only results accomplished, and has no time or inclination for a study of the process of construction. To the artist, however, these rough drafts — the dashes of color, the odd pencilings and memoranda out of which his work grew slowly and harmoniously — are of peculiar value ; and while the critics are ushered in silence to the presence of the completed work, he takes a friend aside to look over those queer and curious scraps that have lightened the burden of work and forced him to laugh when it was decidedly his business to weep. In like manner I find myself surrounded with a litter of precious chips which I have no disposition to burn up. Notes and pencilings on many quaint ideas and curious customs lumber up my desk. They have accumulated while I pursued some curious studies ; but now they are in my way and I must either burn them or print them, and so, my dear Union, you see me in print.
There is a peculiar fascination about the researches into the history of old surgical operations which invests them with a charm unusual to medical topics. We are led back through the musty pages of medical history, and in our studies we contemplate the relics of former systems with a curiosity which is often repaid by the recognition of old remedies and old instruments which, under new names, are known in our day as evidences of modern progress. As we pass along in our search we see rival schools and systems of medicine lying dead and buried side by side, with the mould of centuries quietly enshrouding all alike, and we pause to think that we too, with our wordy strife and all the rivalry between our various schools, must at last find similar resting places together, with every folly embalmed and every virtue gone; for every sect and school will take its stand when dead according to the measure of its weakest part when living. If one school becomes contemptible on account of intolerance and bigotry, and another school becomes absurd from the ignorance and credulity of its members, those facts will become eternal when all that was good in either has been long forgotten. It is merely a ques- tion of time which will make "our school," whatever that school may be, a thing of the past, and in view of this fact, he takes the safest course who uses his own judgment in all professional matters, and exercises that charity which refuses to recognize any school of medi- cine as entirely right to the exclusion of any other as entirely wrong. For what seems true to-day may be proved false to-morrow, and the birth of a new idea is sure to be the death of a dozen old ones. (The doctor of divinity says that his opponent is "heterodox," and the assertion is generally more profound than the proof. The doctor of medicine overwhelms his rival by calling him an "irregular," which signifies a medical heretic. Now, Heterodoxy is another man's doxy — whereas Or- thodoxy is a man's own doxy. This definition is an old
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one, but it might be difficult to give a new one which should be more accurate or more applicable to the case in hand. )
We fall into these digressions as naturally as one wan- ders off into the side alcoves of a museum, while the first and final purpose of his visit draws him toward the study of some antiquity at the remote end of the gal- lery.
In tracing the history of an old operation, we some- times find it associated and connected with the theories of the times in which we regard it. The study of any medical topic to-day requires a consideration of its rela tion to the vital theory or the physical theory of disease, because it is necessary to measure every practice pro- posed by the line of every theory extant until something fits ; since no matter what may be the success of the practice, it requires a theory to cover and protect it, just as a man requires a good suit of clothes before he can be admitted into fashionable society. We must examine our subject in the light of pathological knowledge, and compare it with other measures used to accomplish simi- lar results. In like manner we find that years ago medical and surgical proceedings were associated with the theories of the day, and were sometimes proposed as one of the methods to perpetuate the period of youth. Pathology was an unknown science then, and the vital and physical theories of disease were unheard of. The crucible of the alchemist, the tales of the traveler and the records of tradition, were then the sources of knowl- edge. Medicine was mingled with superstition, and surgery was surrounded by a thousand horrors. Science lay buried in a swamp of superstition, from which arose a miasm which was apt to give men the shakes. It may not be uninteresting, since our subject has led us into these old times, to give a little attention to some of the investigations which then occupied the minds of the learned.
We are led back to the time of the old alchemists who sought not only the power of transmuting baser metals into gold, but toiled as well to discover the fountain of youth, or to produce an elixir vitae which should obviate the necessity of dying and render mortality immortal. The measures proposed were generally of the most absurd character, and when some foolish visionary dis- covered what he supposed to be the secret of prolonging life indefinitely, he was apt to die before he reached three-score years and ten — a sufficient commentary on the efficacy of his secret. With the details of these profit- less labors we have little or nothing to do, but looking beyond them we find that they occupied the attention of curious and speculative minds in all ages, and we find traces of this search for life scattered throughout the literature of all countries, and where records fail us we hear the story over again in the traditions of the people. To some of these tales we now turn, not from mere curiosity alone, but because it seems probable, from the evidence of their construction, that the alchemists, in seeking the elixir vitse and the fountain of youth, were drawn on in their search by the mystic beauty of that old story of Eden and the Tree of Life, and that, not recognizing the antiquity and source of these old legends, they blindly groped for that which is forever guarded by the " cherubims and a flaming sword which turned every way to keep the way of the tree of life." Herodotus (Herodotus, Book III, Chap. 23) reports the existence of a magic fountain in Ethiopia in the following words : " When the Icthyopagi showed wonder at the number of years, he [the king of Ethiopia] led them to a fountain,
where, when they had washed, they found their flesh all glossy and sleek, as if they had bathed in oil — and a scent came from the spring like that of violets." * * * " If their account of this tradition be true, it would be their con- stant use of the water from the fountain which makes them so long lived." And here we have part of an old twelfth century rhyme (Fabliaux of the Twelfth and Thirteenth Centuries, selected by Legrand, translated by Way. Ellis's Edition, Vol. II, p. 195) which locates the fountain in the troubadour's paradise, "The wondrous land that hight Cokaigne :"
* * " But the chiefest, choicest treasure In that land of peerless pleasure Was a well to saine the sooth, Cleped the living well of youth. There had numb and feeble age Cross'd you in your pilgrimage ; In those wondrous waters pure, Laved awhile, you found a cure. Lustihed and youth appears, Numb'ring now but twenty years."
One of the most exquisite tales comes from Hawaii (Robertson's History of America) in the shape of a tradition concerning a voyage which certain natives of that island made, to a land where the inhabitants enjoyed perpetual youth and beauty — where the fountain of life removed every disease and every deformity, and where misery and death were unknown ; but, alas ! they had beheld that which was forbidden to mortal eye, and they all died shortly after their return to Hawaii. A similar tradition prevailed among the natives of Porto Rico, who located the fountain in one of the Lucayo islands, and, incited by the hope of finding it, Ponce de Leon roved from island to island till he discovered not the fountain, but Florida. Sir John Mandeville, that quaint old traveler of the fourteenth century, " who, on the day of St. Michael, in the year of our Lord 1322, passed the sea and went the way to Hierusalem and to be- hold the mervayles of Inde," discovered, among other "mervayles," a fountain on the banks of the Indus which possessed healing and rejuvenating powers, and Sir John not only describes the magical effects of its waters on the inhabitants of the country, but gives us his personal experience of its use. The old knight came back, after more than thirty years absence "in strange countrie," afflicted with gout and rheumatism which the magic fountain had failed to ward off, but as the Pope decreed that all that Sir John Mandeville had related, "and much more" was veracious, we, who are fallible, cannot dispute the point.
Roger Bacon was a firm believer in the elixir vitse and the philosopher's stone, and has left many curious works (De Secretis Artis et Naturae; De Prolongatione Vitse; De Secretis Operibus, etc., etc.) which show not only a fertile imagination and childish credulity, but, incongruous as it may seem, at the same time a brilliant power of analysis which enabled him to detect the errors of others while blind to his own.
But enough of these old stories for the present — the ancient idea of perpetual youth has faded away, and its place in science is now taken by researches as fascinating as any of old. We will come to our modern times soon enough, however, and there are some things yet to be looked at before we leave our book-shelves, and so in my next letter you will pardon the antiquarian proclivi- ties of
John Crannell.
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The Medical Union
A MONTHLY JOURNAL
Of Medicine, Surgery, and the Collateral Sciences.
Editors : EGBERT GUERNSEY, M.D. CHARLES E. BLUMENTHAL, M.D.LL.D. JOHN C. MINOR, M.D. ALBERT E. SUMNER, M,D.
Published on the First of each Month, by
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NEW YORK, JANUARY 1, 187S.
EDITORIAL NOTICE.
The editors of .the Medical Union invite the co-operation of the profession in making their jour- nal a valuable medium of scientific intelligence, and a record of the freshest news in the medical world. They trust the medical profession will look upon the journal as, in a measure, their own, and freely use its pages for the interchange of practical thought. Every thoughtful mind can add some- thing of suggestion and experience to the general store of knowledge. We wish to bring together, within our pages, the experience and investigations of the great army of workers now laboring in the broad field of medical progress. So far as this journal is concerned, the editors occupy the posi- tion of collectors of scientific intelligence and gen- eral news more particularly relating to the medical profession. They, of course, must exercise some discretion in the discharge of their duties, and se- lect for publication only that material which they think will be of interest to the medical world. While they aim to publish nothing which will re- tard the progress of scientific medicine, they will give a broad range to scientific discussion — always conducted in a spirit of courtesy — holding that each man must be alone responsible for the senti- ments he advances. Secretaries of medical socie- ties are earnestly requested to forward a rec- ord of the proceedings of their societies. Very much is brought out in the off-hand discussions of these associations by men who are too busy to write long articles, which will be of great practical value. Records of cases and little incidents in the daily round of professional work may thus be brought together from every part of our vast country, form- ing an immense treasury of knowledge. We trust these reports will be made as full as possible. Our reviews of new books will be in the interest of no publisher, but of the general reader. We shall strive to deal fairly and impartially with all. In this way only can reviews be of any real value.
Again, we ask our brethren in the profession to look upon this journal as in a great measure their own, and by their contributions make it second to
none in the medical world. The publisher desires us to say that its publication for one year is assured by the pledge of sufficient funds to cover its entire expense for that time, even if not a single copy is sold.
SALUTATORY.
The great object of the physican is, not only to cure, but to guard against the inroads of disease. His chief study should be, how to relieve suffering, prolong life, eradicate the causes of disease, and thereby elevate the human race, and increase the sum of human happiness.
To do this, he should ever stand in the vanguard of progress. His mind, carefully trained, thoroughly disciplined, should be able to discriminate between crude speculations, however beautiful the theories, and the logic of facts. The broad field of science, with its wonderful developments and the startling truths every day revealed, should find in him a pa- tient worker and an honest, earnest searcher after its mysteries. The questions which should ever ring in his ears should be, " What is truth ? How can I best bring the teachings of nature to subserve the interests of humanity ?" Honest in his own con- victions, earnest in his purposes, fearless in his investigations, he respects the intelligent opinions of others, though they may differ from his own. He subjects their ideas and their facts to the careful analysis of his own mind, that, if he may not wholly approve and indorse, he may, at least, gather from their investigations some grains of truth — some new thought — which may aid him in his own daily com- bat with disease. In every thus earnest worker he recognizes a friend and brother, a co-worker in the same great field, actuated by the same pur- pose, striving for the same end.
In coming before the public with a new journal, for its approval, we come not wedded to old ideas, not bound hand and foot to any philosophy, but culling facts from the experience of the past, from the investigations of earnest minds in all ages, we appropriate them to our use, and not only continue our investigations in the rich veins they have opened, but patiently watching day by day the developments of science, listening to its teachings, earnestly search for some new fact, some new mine of wealth from which we can draw more potent weapons to cleanse the current of life, and combat with the causes of disease and death.
In the way which seems to us most likely to be rich in practical results, we shall pursue our in- vestigations ; and if at any time we can be shown a better way, a more reasonable philosophy, more in accordance with the teachings of science, we shall willingly and gladly walk therein. Extending the hand of fellowship to all honest, intelligent workers
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in the great field of scientific research, we shall work earnestly for that time when the party walls, which never would have been reared except from persecution, shall be leveled, and all sectarian names merged in the broader name of Physician. Intolerance, bigotry and persecution commenced, and have kept alive the feeling of sect. Standing in the ranks of the so-called Homoeopathic school, we say to that part of the profession who claim to be the only regular school of medicine, if we are a sect you have made us one. We have been obliged to assume a distinct name and build a home for ourselves, because we have been driven from your ranks by the bitterest persecution and the most un- sparing abuse.
We deny that there is anything schismatic in our doctrines, our spirit, or our manner of practice. The principles upon which are based the doctrines of the Homoeopathic school were promulgated with- in the ranks of the dominant school by one of their own most accomplished and learned physicians. His very position as a man of science should have entitled his views to a fair hearing and an impar- tial investigation. Had this been done, the Homoeo- pathic school, as a distinct school, would never have existed. If we claimed not merely a therapeutics, but a physiology and pathology of our own, and were responsible for every theory and every infer- ence drawn from the law of Similia either by Hahn- emann, or any of those who have accepted that law, and taught that disease could only be successfully treated by the extreme high potencies, the case would be entirely different. But these extreme views have ever been the exception rather than the rule in our school. Homoeopathy is no more respon- sible for them than for anything else which may be placed upon its shoulders. They are the views and practices of individual men, for which they alone should be responsible. What we as homoeopaths claim as cardinal principles, are, first, the law of Similia, or the treatment of disease by medicines whose effects, tested upon the living, healthy or- ganism, are similar to the symptoms present in diseases. We do not claim this principle as uni- versal and exclusive. We claim that it is a principle of great value, and one which, carefully considered and correctly applied, gives us, when indicated, the most satisfactory results. We ask, in all fairness, that in no case should prejudice act against its fair consideration.
We claim, secondly, that as the law of Similia demands an intimate knowledge of the effects of the drug, the importance of proving each drug on the healthy organism. In this way can its real ac- tion be ascertained, and we no longer be compelled to depend on the chance-provings given in acci- dental cases of poisoning.
If our Symptomen Codex contains much that is unreliable, give us something better, but at least confess we are on the right track, and that in this way lies the true channel of investigation.
We are quite willing that the subject of dose be left to the individual experience and judgment of the practitioner. We find that a greatly reduced dose gives us the most satisfactory results, when the remedy is given in direct accordance with the law of " Similia." What the precise dose shall be, must depend on the condition of the patient and the idiosyncrasies of his constitution.
We do not claim these principles as exclusive, notwithstanding we believe they have simplified the treatment of disease, and opened to us a vast field of remedial agents, the limits of which we have as yet by no means reached. They have unlocked the hidden virtues of plants and minerals scattered about us in rich profusion, and have taught us there is no disease for which we may not hope to find, in the rich store-house of nature, some antidote.
Whenever we think them needed, we use drugs which do not act in accordance with the principle of Similia, and in such doses as we think will produce the desired results. We admit that, notwithstand- ing the discoveries and experience of each year are adding to the strength and scope of this principle, still it is not universal. Remedies are often re- quired for their chemical action, often as nutrients, supplying some deficiency in the organism, and often for their mechanical action. All that we ask of the physician is a careful discrimination of how, and in accordance with what principle, the remedy should be given. We ask for the homoeopathic law, that it be recognized and its proper value al- lowed.
Is there anything schismatic in the position we have assumed, anything to justify the bitterness with which we have been assailed, anything to warrant the treatment we have received from a school which prides itself upon its antiquity, its learning and skill ? The argument will not hold good that our physicians, as a class, are ignorant, without cul- ture, without scientific attainments, and with no social position — for in all these they are fully their equals. Our patrons, too, are found among the cultivated and refined — among people who reason, and who, when suffering, seek for help where they think it can best be found.
Gentlemen of the so-called school, Allopathic, or as you prefer calling yourselves, " the regular school of medicine," if you wish for reconciliation we are quite willing to meet you half way. We admit that / in the past there have been sharp words on both sides. To your sneers and your ridicule we have replied by an array of facts, and challenged you to disprove them. We have let the sunlight of truth
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into much that was unscientific in your practice. We have at all times been willing and eager to investigate carefully whatever we have found in medical literature, derived either from experience or scientific reasoning, and have honestly appro- priated what we considered truth, from whatever school it may have emanated. We have at all times been willing to communicate our ideas to others, either in the sick-room or in our medical journals ; and while we have always been ready to treat others with the respect and courtesy which should ever exist between members of a learned profession, we have not received the same courtesy from you. You have tried to crush us out of existence by your bitter opposition; your refusal to recognize us as physicians ; your closing the doors of hospital and asylum boards against us ; your determination that we shall occupy no places on the army and navy surgical and medical staff, and the prompt expul- sion, or suspension of all members of your societies who have the independence to meet us in council. In fact, gentlemen, you have shown a fixed deter- mination to throw every obstacle in your power in the way of a fair representation of our views and practice.
Has the result been entirely satisfactory ? Have you read the world's history so poorly as not to know that persecution such as you have shown has never succeeded in accomplishing its purpose ? that it always aids the cause it seeks to destroy ? In all this, the public are rapidly answering the question which they deem the more schismatic, and whose code of ethics to their unprejudiced eyes seems most in accordance with gentlemanly courtesy, and that broad charity which should ever be found in the heart of the man of science and the true physician. Look abroad upon the medical world with a fair and impartial eye, and compare the present with twenty years ago. No longer weak in numbers and influence, our colleges, our asylums, our hospitals, our dispensaries are scattered all over the land, and statistics which cannot be disproved, tell largely in our favor. Deprived of all fair representation in your medical journals, shut out persistently from hospitals, asylums and dispensaries established for the public good, and supported by our money as well as yours, we have been compelled to establish them of our own. We have called our literature and in- stitutions "Homoeopathic," not because we claim an exclusive devotion to that creed, not because we believe the law of Similia covers the whole range of the remedial action of drugs, but because here the Jj Homoeopathic creed is recognized and allowed its proper value.
Because you have compelled us to adopt this course, you now taunt us with being sectarian and adherents of an exclusive dogma.
What would be the result, gentlemen, of a little common fairness in this matter — of a little of that frank and sensible treatment which we ought to ex- pect from the members of a great profession, work- ing for the relief of suffering humanity? Compare your own teachings and practice now, with those of a quarter of a century ago, and tell us why the line of demarcation between the more conservative of the two schools is daily becoming less apparent. Why is it that your ablest writers on Materia Medica admit that the best way to get at the action of drugs, and the surest guide to their curative properties, is by proving them on the healthy organism ? Why is it every day you are treating your patients more and more in accordance with the law of Similia? Is it not because the influence of the Homoeopathic school has been quietly producing its beneficial re- sults upon the whole medical world, and even you are convinced there is a better way than that of the past?
We have none of us as yet, by any means, reached the limit of human knowledge, so far as remedial agents are concerned. We have all much to learn. We are convinced there are many things you can learn from us, and there is much we can learn from you. We are all striving for the same great end. Is your armory so well supplied with wea- pons to combat with disease that you have no oc- casion for others ? If statistics show the percentage of deaths to be less in our hospitals and dispensaries than in yours, is it not reasonable to suppose that we may have some weapons which would prove beneficial to you, and that you might with advan- tage make our creed part of your own ? We do not hold our creed responsible for many of the inanities which have been put forth in its name, any more than we hold your own profession responsible for some of the vagaries of its members.
Supposing you should throw open the pages of your medical journals to a fair and honest considera- tion of the doctrines which form our creed; suppos- ing you should give up this exclusive sectarian spirit, and throw open the gates of your hospitals, and asy- lums, and dispensaries to educated Homoeopathic physicians, allowing them the same privileges in the wards as yourselves ; and supposing, too, in the lecture rooms of your colleges a fair and just expo- sition of our doctrines should be given, what would be the result?
The name " Homoeopathic " would disappear from our literature, from our colleges, our dispen- saries and our hospitals, as you claim that of Allo- pathic is not recognized in yours. Standing high above all sectarian names, would be the glorious title of Physician. With united strength we could work in harmony and with a power never exerted before.
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You have it in your power to terminate this war- fare of bigotry and intolerance, unworthy of an en- lightened age and of the true spirit of science. You have only to step out from your shell upon the broad catholic platform of equal rights and equal justice to all. Until you are willing to take this course, this contest will go on until we obtain our just rights in the army, the navy, and in all the hospi- tals and asylums built by the public money (by our money as well as yours), for the public good. In the cities of New York and Brooklyn, at least one- half the taxes are paid by those who use homoeo- pathic treatment themselves and in their families, and yet their physicians are persistently excluded from the hospitals and have no voice in the man- agement of the sick poor within their walls.
While we are willing and ready at all times to meet scientifically educated physicians and work with them earnestly for the public good, no matter to what school they may belong, or whether they are male or female, white or black, we wish it dis- tinctly understood we have no apologies to offer for the past, no favors to ask for the future. We simply demand our rights, and insist that the sec- tarian dogmatic spirit which has so long sought to dictate medical ethics to the medical world, and which has built up party walls and engendered all the bitterness of party feeling shall cease. That spirit is already being shorn of its power — its an- athemas cease to terrify and its thunderbolts fall harmless at the feet. Earnest, truthful men are everywhere rising above the dictates of party, and in the catholic spirit of true science, are working heartily for the common good The time is not far distant when all true men in our noble profession will indignantly spurn the trammels of sect with its petty spites and narrow-minded prejudices, and the only contest will be, who shall do the most to pre- vent disease and relieve suffering humanity. For that time we shall earnestly work.
Reuieuis of Boohs.
Lectures, Clinical and Didactic, on the Diseases of Women. By R. Ludlam, M. D. Chicago : C. S. Halsey. Second Edition.
The appearance of this volume prepossesses us in its favor. It is mechanically a very neat work, and highly creditable to the typographical art of Chica- go. This, however, perhaps is partially owing to the fact that so much old type and poor book mate- rial was destroyed by the recent conflagration.
As to the work itself, we confess to have read it with no little interest. It is fresh, readable, agree- able in style, easy, and fluent, while, at the same time, it is not a little rambling, discursive, and incom- plete. Of this we could not complain, if it were not that it will be apt to be considered a complete treatise on female complaints, which it is very far from be-
ing. It is, as it calls itself, a series of lectures — clin- ical lectures, indeed — unstudied, except in some af- ter filling up, desultory, irregular, heterogeneous, and incomplete. Scarcely a single disease, or feature, or treatment of any complaint is exhausted, although touched upon in many places. As an index of the mind and character of the writer himself, the pages throughout are all sufficient. It evinces him to be a well-read, thinking, practical man, one not bound down by the theories of days of intellectual dark- ness, but fully imbued with the light of the present day and age. The practitioner of medicine will gladly meet the writer and learn from his evident abundant knowledge of this subject, both at the bed- side of the patient and in reading these pages. But for the learner, the work is not the one for his careful study. The writer has made a place for himself on the book-shelf by the side of Meigs and Thomas, but the student needs more didactic instruction as con- veyed in the sententious and carefully weighed words of Gooch, Dewees, Churchill, Byford, and, more than all of the incomparable and exhaustive treatise of Scanzoni, a writer, by the by, that we see too rarely alluded to by the erudite writer now before us.
We are glad to note as signs of the progressive writer, that he unites in the reprobation which the leading gynecologists of the world now give to the abomination of all abominations, the pessary in every form. Their constant use by any physician evinces him as a man of little observation of the causes of disease and less appreciation of a proper method of cure.
The writer, too, "is sound" upon the question of uterine therapeutics, and justly says that the more showy operations of the modern specialists have driven out to a very great degree that internal — we might say constitutional — medication which has a very great, if generally neglected or forgotten, in- fluence over such complaints. Did uterine diseases all commence from mechanical causes, then local and topical applications might suffice for their re- lief ; but it is true that many, if not most, of them originate from constitutional disturbances, aggra- vated indeed by excessive coition, abortions, and like local irritants unnecessary to enlarge upon here ; and in such cases, the axe laid at the root will be the ap- propriate internal remedy for a general cachexia, a constitutional disturbance, or frequently if most often unrecognized, and imperfectly understood, ner- vous sympathy, an influence subtle, unseen, but which will be more generally appreciated when by superior education and enlarged study the nervous system and its part in the human economy is better understood.
Scanzoni pointed out, and perhaps proved, that cancer in some cases originated in sorrow, mental disquietude and suffering. It, not unlikely, requires but time for the mental and moral causes of many physical diseases to be discovered and recognized.
Another step in this direction is the recognizing that hysteria and uterine irritation are coincident; perhaps the future may show that the uterine diffi- culty may be either primary or secondary.
In addition to what the author has said, had he lived in New York he might have added that some of / the most noted of these specialists have forgotten ^ something of the Hippocratic oath, and taken in its place maxims from the Tweed and the political "rings" of the day. They perform useless and even injurious operations simply for the exorbitant
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fees they charge. It is easy to "slit open an os," h and then it is easier to charge $500 or $1,000 from a confiding and credulous wife or her affectionate hus- band. Imaginary polypi and tumors are treated, and simple complaints are baptized with new Ger- man names, and extraordinary and equally as un- called-for sums are extracted from the credulous. Quackery of the most unblushing character is now not practiced by the ignorant seventh son of a sev- enth son, but is in the academies of medicine and the halls of science all over the land.
In the therapeutics we would be better pleased were the author more explicit in his indications on the quantity and strength of his preparations and the frequency of their administration. For example, upon page 195, under the head of "Treatment for the Ovarian Symptoms," is "Apis mellifica, cal- carea carbonica, platina, belladonna, colocynth, lachesis, thuja, kali jodatum, mercurius or hama- melis may be appropriately and successfully em- ployed." Some of these are quite powerful, and it might be very important how and when they should be employed, more especially when there is nothing in the work to indicate whether the writer is "of the most straitest sect a Pharisee," or whether his motto is "that liberality I to others show, that liberality show to me." Sold by C. T. Hurlburt. Price, $7.5o.
Marvels of Nature, Science and Art. i. The Moon. II. Electricity, ill. Water. Scrib- NER, Armstrong & Co., Publishers, New York.
On our book table we find the three works indicated above, forming a part of the admirable series of sci- entific works now going through the press, and re- cently published by Scribner, Armstrong & Co., un- der the general head of "Marvels of Nature, Sci- ence and Art"
The advances of science during the past few years have been so great, the revelations in the world of nature so startling, that the mind can scarcely keep pace with the new ideas and new truths which are being developed in such rapid succession. There is a vast number in this working world who have no time to follow the minute details, often painfully la- borious, by which the grand problems of science are worked out, and yet who are eager to learn the re- sult, and who feel their souls expanded and their minds strengthened for their daily toil as they con- template the great truths and the beautiful les- sons of nature, unlocked from its store house by the patient investigation and laborious research of others. It is for this class of minds this series of works are intended. They contain the results of the latest re- searches in the world of science and art, told in lan- guage easily understood, and will prove of vast inter- est to those who have no time to follow the laborious steps of investigation.
1. The Moon : with illustrations of its vast moun- tains and deep valleys, and its various phases and changes, by Amedee Guillemin, edited by Maria Mitchell, of Vassar College. The editor says in her preface, " This work is adapted to that large class of
^ persons, who, in an age which tends very decidedly to physical research, wish to know something of sci- entific facts j those whose occupations do not afford them time for study, or who from defects in their early training believe themselves incapable of math- ematics. From the first page to the last there is not
a problem ; not a triangle is drawn. Although as- tronomy and the laws cif motion cannot be studied without the highest mathematics, the facts which ob- servation and theory combine to make known can be gathered together and made attractive to the gen- eral reader, so that the narrow boundaries of ordi- nary daily life may be extended by a conception of the expansion of space and the cycles of time. "
11. Electricity, by T Baile : edited by Dr. John W. Armstrong, President of the New York State Normal School, gives a very clear description of the electric telegraph, inductive machine, electric light and its uses, and electro-plating. - ill. Water, by Gaston Tissandier : edited by Schill de Vere, D. D., LL. D., with sixty-four illus- trations. We are told, in exceedingly graphic lan- guage, of the wonders of the ocean ; the system of circulation of water in its solid, liquid, and gaseous forms ; its action upon continents ; its physical and chemical properties and uses. Much of valuable in- formation is found here even for the scientific reader, and for the general reader the work is full of instruc- tion and interest.
The International Scientific Series. D. Appleton & Co., Publishers, New York.
From the author's preface we copy the plan of the intended series. "The rapid development of sci- ence in the present age, and the increasing public interest in its results, make it desirable that the most efficient measures should be adopted to elevate the character of its popular literature. The ten- dency of careless book-makers to cast their crude productions upon the public has hitherto been so strong as to bring discredit upon the idea of popular science. It is intended to counteract this tendency by publishing a series of popular scientific books, prepared by the leading thinkers of different coun- tries, and known as the International Scientific Series."
The publishers have been fortunate in securing the services of the great English scientist, Prof. Tyndal, to prepare the initial volume of the series. He has chosen for his subject " The Forms of Water in Clouds and Rivers, Ice and Glaciers,'''' and it is handled with his usual clearness and skill. There is a great charm in Tyndal's style, and the reader is carried along by the great master mind by easy stages, until, almost before he is aware of it, he is master of the subject. His description of the wave theory of light is exceedingly beautiful, and his illustrations, in which he sifts the sunbeam so as to intercept the light waves and allow the dark, or heat waves, to pass unimpeded, and vice versa, are very simple and telling. He shows that the heat waves may exist in a perfectly dark room sufficient to fuse metal, while the light waves contain no heat, and thus shows that it is not only the sun's fire which produces evaporation, but a particular con- stituent of that fire, the dark waves. It is these lightless waves which, falling on the glaciers, melt the ice, the light waves not having power to melt the most delicate hoar-frost. And so the reader is led along, step by step, from one point of interest to another, each point amply illustrated. He sees the causes of oceanic distillation, of tropical rains, and how the mountains act as condensers, and the formation of the beautiful crystals of ice and snow, showing how each particle of water floating
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in the atmosphere has its attractive and repellant poles, such as we see in the magnet. The beautiful crystaline forms and the fairy architecture which we see in the snow and ice are explained.
Want of space forbids our following out the writer's train of thought. The work is a thoroughly scien- tific treatise, without the dry detail of the text-book, and gives the reader, in language and illustrations easily understood, the result of the latest investiga- tions upon the subject of which it treats.
The works of Prof. Tyndal will possess an addi- tional charm to the thousands who will have the plea- sure of listening to his lectures during his present visit to this country. It speaks well for the growing taste of our community for scientific culture when we see the eighteen hundred seats of the Hall in Cooper In- stitute filled night after night by a thoroughly appre- ciative audience to listen to lectures upon science. Among the audience are seen not alone the profes- sional scientific investigator, but merchants, and lawyers, and doctors, and divines, and artisans. Men of all grades and all positions, from the judge to the simple mechanic, meeting here on common ground, drinking in the same great lessons of truth, and learning more and more of the beautiful harmony of the divine mind as displayed in all his works. Science, after all, is the great democracy, the leveler of all distinctions. The more we study the laws of nature, the more our minds become attuned to the great law of beauty and harmony, which runs, like a beam of light from the divine mind, through all his works.
California; for Health, Pleasure, and Residence. By Charles Nordhoff. New York: Harper & Brothers, Publishers.
Mr. Nordhoff has been so long and favorably known to the reading public, in connection with the great publishing house of Harper & Brothers, as the managing editor of the Evening Post, as a bril- liant essayist and charming writer of books, that any work coming from his pen will be read with more than ordinary interest. It is no longer essential in good society that a person should have made a trip to Europe, have tramped over the Alps, and have floated in the gondolas of Venice, along her canals, and visited every picture gallery and ruin in Rome. The tide of pleasure travel along our eastern sea-board is rapidly turning westward, and we are learning that our own country possesses grander scenery, more beautiful landscapes, and brighter skies than anything of which Europe can boast.
Mr. Nordhoff's book, to the traveler seeking after pleasure or health, is- packed full of just such infor- mation as he needs, told in the most graphic and charming manner. We are taken leisurely over the mountains and along the plains, stopping at points of interest, and making detours into the mountains to visit lakes, and springs, and natural curiosities, such as can be seen in such grandeur and beauty no- where else in the world.
The greatness of California, its beauty, and wealth, and grandeur, its fertility of soil, its immense agri- cultural and mineral resources, its wonderful fruits, and delicious wines, all seem to appear before us as if produced by the wand of an enchanter. As he de- scribes the bright skies and the air full of life and strength, of some favored spot, we involuntarily ask why should our invalids, the worn-out men of busi- ness, the consumptive, the dyspeptic, seek a foreign
clime when one so much more genial can be found in our own land ?
The physician will find one of the most interesting chapters in the book, that devoted to climate. He often hesitates in recommending his patients to go abroad, when in doing so he knows he is putting a stormy ocean of three thousand miles between them and their homes. Now, a few days' ride, in a com- fortable car, furnished with almost every luxury and comfort to be desired in traveling, takes one away from our chill winds into a bright and genial clime. He says: "Southern California presents a most gloriously invigorating, tonic and stimulating climate, very much superior to anything I know of, the air is so pure and so much drier than at Mentona or else- where ; and although it has those properties, it has the most soothing influence on the mucous mem- brane, even more than the climate of Florida, and without its enervating effect. It is quite as stimu- lating as Minnesota, without its intense cold.
"All the leading physicians in the world agree that a tonic, stimulating, dry climate is the best for the great majority of cases suffering from pulmonary disease, or from a lowered vitality. The patient needs a climate in which he can spend most of the day out of doors. In Mentona and in the towns of the Rivere, the doctors always advise the patients to be in the house one hour before sundown, the changes are so great, and not to go beyond pre- scribed limits, because the winds are so cold and the draughts severe. In California I have con- stantly been out evenings. During the past winter, out of one hundred and fourteen days, I have spent one hundred and six in the open air. This was part of November, December, January, and February.
"Italy is generally a poor climate for invalids, and the pure blue Italian skies are not to be compared to ours; at least, with anything west of the Missis- sippi. One can come to California and spend the winter as cheaply as at Vevay, Clarens or Mon- treux — and those places are the cheapest winter re- sorts in Europe. For instance, at Santa Barbara or at Hortons, in San Diego, one can board by the winter at $48 a month."
We append a short extract from meteorological tables given at the end of the book. At San Ber- nardino, during the month of January, there was but one rainy day, and but one day when the wind was very strong. The average temperature was $8°. In February there were two rainy days, and no day when the wind was very strong. The average tem- perature was 62°. In March there were no rainy- days and no strong wind. The average tempera- ture was 640.
In Santa Barbara the average of the daily ob- servations were: In December, 52. 120; January, 54.5 1°; February, 53.35°; March, 58. 420. The air is clear and dry.
In conclusion, we have only to add, the work is beautifully illustrated, some of the engravings being gems of art.
General and Differential Diagnosis of Ovarian Tumors, &c. By Washington L. Atlee, M. D. 8vo, pp. 482. Philadelphia : J. B. Lippincott & Co. 1873. • (
THIS work of Dr. Atlee's is unquestionably one of the ablest that has ever been issued from the med- ical press of this country. It possesses not only the merit of ability, but is remarkable also for original-
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ity and for the most perfect candor. Dr. Atlee seems to take us at once into his confidence, and in the most genial and unassuming manner goes with us over the subject in hand, explaining the steps he took in attaining a position, second to none, as an accurate diagnostician. " The reader, in perusing this volume," says our author in his preface, " will notice that, while the text carefully indicates the particular points of diagnosis, the illustrative cases frequently reveal errors committed by the author. He has purposely drawn from his early experience, at a time when he was most liable to err, in order to illustrate, step by step, the pro- gressive advancement of knowledge in the diag- nosis of abdominal tumors, and to show that the observer in this, as in other forms of disease, must necessarily be educated by repeated observations before he can be qualified as an expert. He has written only for those who have not traveled over so large a field as himself, and who, warned by his mistakes, may thus be guarded against the quick- sands which he encountered in his earlier professional career. Mistakes teach most valuable lessons, and when discovered are not likely to be repeated. Hence, in medicine, they should be recorded for the benefit both of science and humanity. It is on this account that the author has not shielded him- self from his own criticism and has been free in the acknowledgment of his own faults in diagnosis. Having commenced the study of this subject at a period when not only the literature of the profession was greatly deficient, but when the whole medical world denounced and opposed ovariotomy, he had little else than the book of nature before him and the consciousness of right to sustain him. He greatly needed just such written clinical instruction as is herein presented to the profession. Had his pathway been illuminated by a similar beacon, he is satisfied that humanity would have been the gainer, and that his own record would have been better." Having thus indicated the method he proposes to adopt, the author plunges at once in medias res. There is a natural surprise on the part of the reader, because he is led directly at the subject in hand without any preliminary discussion about the pathology of ovarian tumors. The reader will also be agreeably disappointed in miss- ing the customary repetition of the time-worn ex- periences and opinions of others. Dr. Atlee de- pends on his own ripe experience and draws from his own ample resources. He starts out with the expressed intention of teaching the general and differential diagnosis of ovarian tumors ; he keeps steadily, thoroughly, and exhaustively to his subject, and when the end of the volume is reached we feel that there is nothing more to be said. We select, almost at random, some passages illustrating the author's views on various points and giving an idea of his style :
u Tapping. — One of the most important means of diagnosis in ovarian tumors is tapping. It gen- erally affords us undoubted information of the pres- ence or absence of ovarian disease, aids us in detect- ing adhesions, and in deciding upon the true char- acter of the tumor. As a means of diagnosis, how- ever, tapping should not be performed in the early period of the disease, unless it be done in reference to the propriety of ovariotomy, yet it would not be improper to tap at any period with a view of relieving urgent symptoms not amenable to ordinary med-
ication. On the other hand, ovariotomy ought never to be attempted by the inexperienced sur- geon, should he not be able to avail himself of enlightened counsel, without previously resorting to tapping as a means of diagnosis. Several cases of ovariotomy have been attempted where no tumor was found. Had these proceedings been premised by tapping, these patients might have been saved a hazardous operation, their surgeons extreme morti- fication, and the charge of ' difficulty of diagnosis ' — as an argument against ovariotomy — to this ex- tent at least, could not have been maintained. The only two operations in this city where ' no tumor ■ was found were performed by two very respectable surgeons, — one of them quite dis- tinguished,— and in neither case, as I have been informed, did they avail themselves, in their very limited experience in the treatment of ovarian dis- eases, of this indispensable means of diagnosis."
The value of tapping as a means of diagnosis be- comes more apparent when we consider the use of the microscope in revealing the nature of the fluid. Dr. Atlee gives special prominence to the fact that a free, delicate granular cell is characteristic of ovarian fluid, and in no disease can the microscope be of more assistance than when used according to our author's directions for the diagnosis of ovarian tumors. Four cases of cysts of the broad ligament are given in detailing the diagnostic steps to be taken in that disease, and then our author con- tinues :
" Now, after having detailed these four interest- ing cases, let me recur to the question, How can we distinguish an ovarian cyst from this form of cystic dropsy ? The answer is, By the character of the fluid.
" In recording the first case I made this memoran- dum : I took from the patient a large bucketful of beautifully clear, transparent fluid, which did not coagulate either by heat or nitric acid. The fluid was so clear and transparent that ^the fibrous structure of the boards forming the bottom of the bucket could be readily seen and appeared to be mag- nified.
" In the second case the record is : Eighteen pints of clear, transparent, crystal-like fluid, very thin, free from any tinge in bulk. It gave no reaction with litmus-paper, and did not coagulate by heat. Placed in a wineglass and examined by trans- mitted light, it exhibited a slight opalescent tinge.
"In the third case: Thirty-five pints of trans- parent fluid, as clear as spring-water. The fibres of the wooden bottom of the tub could be distinctly seen through it. It did not coagulate by heat, but when boiled, exhaled an osmazome or soup odor.
"And in the fourth case: Fifty-one pints of se- rous, transparent fluid having, in the sun's rays, a slightly bluish tint and quite free from albu- men. * * *
"Here I will digress a moment to observe that up to this period of my experience I had supposed that medication, after tapping, was necessary in or- der to complete the cure of this form of dropsy. Further observation, however, has satisfied me that tapping alone will sometimes be followed by a dis- appearance of the disease, particularly when the operation is performed by a large trocar. If the opening through the thin cyst remains patulous, so that the fluid, as fast as it is generated, can escape into the cavity of the peritoneum, the accumulation
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will not recur. The fluid, in these cases, unlike ovarian fluid, is absorbable by the free surface of the peritoneum, and if the absorbents are sufficient- ly active it will be readily taken up. Sometimes the opening in the cyst closes up and the accumu- lation of "fluid recurs: Hence, to meet these contingencies, I have originated the operation, to be hereafter referred to, of making a small opening in the linea alba, tapping the cyst, and afterwards drawing out and excising a portion of it, and re- turning the remainder, so that closure of the open- ing cannot thereafter possibly take place."
As illustrating the importance of tapping for diagnostic purposes in doubtful cases we give an abstract of one of Dr. Atlee's cases (case xxvin) with the author's remarks. This case was consid- ered as one of ascites coexisting with ovarian tumor and was so reported by Dr. T. Gaillard Thomas in his paper on the " Diagnosis of Malignant Dis- eases of the Ovaries."
"Case xxvin. — A multilocular ovarian tumor mistaken for a case of ' ascites, complicated with ovarian tumor;'' tapped six times, ovariotomy. April 13th, 1 87 1, Dr. W. K. Brown, of Brooklyn, New York, called at my office to consult me about a case of abdominal tumor. From the very intelli- gent account rendered by him, I inferred that it was a case of multilocular ovarian tumor, and re- quested him, when the case was again tapped, to send me, by express, a specimen of the fluid. * * During my absence the patient was tapped, a portion of the fluid was received and examined by Dr. Drysdale, and decided to be ovarian. On my return from California on the 3d of June, I found a letter from Dr. Brown, urging me to visit Brooklyn, to operate on his patient. Dr. Thomas had seen the case Nov. 20th, 1870, and tapped her the same day, removing four gallons of dark-green, syrup- like fluid. She was tapped again — -six times in all. After each tapping, a solid tumor could be detected occupying the right side, circumscribed, movable, and not tender on pressure. Dr. Atlee's diagnosis was ; ' a multilocular ovarian tumor, with one large cyst occupying nearly the whole cavity of the abdo- men.' The operation confirmed the diagnosis. ' The fluid was contained in one large, thin-walled, ovarian cyst, which was adherent to the walls of the abdomen. A large multilocular mass occupied the right side of the abdominal cavity.' There was no ascites."
Dr. Atlee's remarks on this case are well directed. " I have not presented the above case with the most remote idea of criticising the valuable paper of Dr. Thomas, but merely to show how so astute and ac- curate an observer may be led into error, as well as to call attention to one or two methods by which such an error might have been avoided. So far as I can comprehend Dr. Thomas' opinion it is this : that a large accumulation of ascitic fluid with a compara- tively small ovarian tumor is indicative of malig- nant disease of the ovary. In confirmation of this opinion he cites five cases of dropsy, one of which is the case above reported. With regard to this case he says : ' When I saw her, this accumulation was so immense as to cause her great pain and in- convenience from distension. Dyspnoea from pres- sure against the diaphragm was especially marked. In this case, as in case fourth, I was struck by the fact that in dorsal decubitus no point of resonance could be discovered upon percussion over the abdo-
men, which I attributed to the excessive amount of effusion. To make more certain a diagnosis at which I had even now partially arrived, I obtained Dr. B's consent to paracentesis, and drew off seve- ral large pailfuls of straw-colored serum.' It is just at this point that I wish to make an observa- tion regarding the diagnosis in this case and in all other cases where i the fluid is suspected of accu- mulating in such large amounts as to force aside the super-natent intestines, and produce dullness in place of resonance on percussion in dorsal decubi- tus.' Now, the object of the tapping, in such cases, is 'to make more certain the diagnosis,' and there are two methods by which this can be satisfactorily accomplished: First, by continuing to percuss the abdomen as the fluid is escaping. As the fluid diminishes in amount, if contained in the peritoneal cavity, the intestines will sooner or later float upon it unless bound down by adhesions, and a resonant percussion sound will be returned which will be manifested in the most elevated points on every change in the position of the body ; but if the fluid is encysted, the resonant sound will be stationary. * * * Second, the diagnosis can be made more certain by the physical and microscopical character of the fluid. Sometimes the physical character alone will decide the question, but when it is a ' straw-colored serum,' resembling ordinary ascitic fluid, the examination by the microscope will determine its real nature and its true source, by detecting or not detecting the peculiar ovarian granular cell."
Our space is too limited for further extracts. We commend the work in the highest terms as the best on the subject, and one that should occupy a place in the library of every physician.
The Annual Report of the Board of Health, of the Health Department of the City of New York, for the year ending March 30th, 1872, long delayed by unavoidable circumstances, is now passing through the press. One hundred pages had been printed, but were burned in the fire which recently destroyed the Express office. It will form a volume of some 400 pages, octavo ; and, besides the usual official reports of the several bureaus, will contain certain appendices of great in- terest to the medical profession, and to sanitarians. Among these we may mention an interesting report on "The Cerebro-Spinal Meningitis Epidemic" of 1872, by Morean Morris, M. D., late City Sanitary Inspector ; illustrated with map and engravings ; a report on " The Small-Pox Epidemic of 187 1-2," by a Committee of the Sanitary Inspectors, giving some of the results and statistics of the work of the department in the management of that disease ; a paper, by Commissioner Stephen Smith, M. D., on " Movements of Tenement-House Populations" (elsewhere referred to), and another, by the same gentleman, on " Summer Mortalities," fully illus- trated by charts, etc.
Several sanitary works are in course of prepa- ration, and will probably be published in the early part of the present year. Among them will be a / little monograph on " House Drainage, Sewerage and Water Supply," by Henry R. Stiles, M. D., and James Ingram, both of whom are attached to the Board of Health ; the former as Health Inspec- tor, the latter as Assistant Engineer. The work,
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which is very practical in its character, will treat of the nature, construction, and structural defects of the many domestic appliances common to the dwellings of the present day, such as water-closets, soil-pipes, sinks, privies, etc., etc. ; and is designed to show especially the intimate relation between such defects and many forms of disease. The expe- rience of the authors and official opportunities which they enjoy of examining into this subject, can scarcely fail to render the book of great value and practical interest to both laymen and professional men.
Another monograph on the Ventilation, Heating, and Interior Sanitary Construction of Houses, may also be expected from the pen of another of the City Sanitary Inspectors.
Dr. Hamilton has in preparation a practical work entitled "Practical Electro Therapeutics" Dr. Hamilton is at the head of the State Hospital for the treatment of nervous diseases in this city, and his work is a record of personal experience such as cannot fail to be of great service to those of his professional brethren, who have less opportunity for practical acquaintance with this remedial agent.
{Transactions of Societies,
THE MEDICAL SCIENCE ASSOCIATION.
[Abstract of Minutes, Dec. ioth, 1872.]
The President, Dr. Egbert Guernsey, called the meeting to order.
Intermittent Fever. — The experience of Dr. Blu- menthal in the use of beberine as a remedy for this disease had been very satisfactory. He had used it in the ordinary allopathic doses, and had also given it in the homoeopathic attenuations, his best and quickest results being obtained from the sixth attenuation. While residing in New Jersey he treated a number of cases of intermittent fever. His attention was at one time called officially, as chairman of a committee from the State Society, to the practice of a physician who was said to be very successful in their treatment, but was charged with using "secret remedies."
The charge proved to be unfounded. The treatment was as follows : The patient was treated with quinine and tartar-emetic powders, each pow- der containing half a grain of quinine and an eighth of a grain of tartar-emetic. These powders were taken three times a day until the intermittent fever subsided, and then, for ten days afterward, a daily powder of arsenicum 1st was given. Dr. Blumen- THALhad used this prescription himself and thought well of it, although he preferred smaller doses and single remedies.
Dr. Minor thought the proportion of tartar- emetic was too large, and that troublesome nausea and vomiting would be produced in a majority of cases by the administration of an eighth of a grain three times a day.
Dr. Egbert Guernsey relied principally upon quinine. He does not consider the objections of some to the use of quinine, on the ground that patients so treated do not " stay cured," are well founded.
In his experience, quinine cures were as radical cures as any others. He has known those who were reported cured by the potencies to relapse again,
and a certain proportion of relapses may be ex- pected under'any treatment ; but no remedy has, in his hands, produced such quick, permanent and satisfactory results as quinine.
Dr. Hallock cured a case, several years ago, with natrum mur., 200. He was called in consul- tation to the case by Dr. J. G, Baldwin, The low potencies had been already used unsuccessfully, and it was concluded to try the high potencies. Natrum mur. was indicated, and one dose of the 200th po- tency given. The patient never had another chill. The doctor mentioned this case not as illustrating his practice — for he rarely uses the high potencies — - but as an interesting cure that astonished both pa- tient and physician.
THE QUESTION OF DOSE.
Dr. Doughty related some cases of syphilitic periostitis, in which the pain and cachexia had been removed by large doses of iodide of potassium, from twenty to sixty grains three times a day.
The question was raised whether this treatment was homoeopathic.
Dr. Brown, in reply to the question, considered the treatment just related as strictly homoeopathic. The provings of iodide of potassium show that ca- chexia, articular swellings, pains in the bones, and many of the symptoms peculiar to the secondary and tertiary forms of syphilis, are produced by this drug. When the drug cures or relieves those symp- toms, it does so in accordance with the homoeopathic law, no matter what the dose maybe. "Similia similibus curantur" is a law of cure, and not a law of dose; the question of dose is a matter for indi- vidual experience to determine.
MERCURIAL POISONING IN DENTAL PRACTICE.
Dr. Minor presented to the Pathological collec- tion of the Association an inferior maxillary bone which he had excised. The case was one of necro- sis following the application of arsenic for the pur- pose of killing the nerve. The point, however, to which the attention of the Association was directed, was the occurrence of salivation, produced by the insertion of an amalgam filling into a tooth when the surrounding parts were inflamed and vascular. He asked the experience of the members as to the effects observed from amalgam fillings, and from the use of artificial teeth supported by rubber plates.
Dr. W. N. Guernsey knew of three reported cases of salivation produced by amalgam fillings.
Dr. Blumenthal had seen three cases in his own practice where the use of artificial teeth with rub- ber plates had produced symptoms of mercurial poisoning.
Dr. Rickaby had met with one case like those mentioned by Dr. Blumenthal.
Dr. E. Guernsey could refer to six cases where the rubber plates had been the cause of trouble to the wearer on account of the mercury contained in the plates.
THE ACTION OF QUININE AND ERGOT ON THE UTERUS.
Dr. W. N. Guernsey reported the following case : Recently he saw, in consultation, a woman, aged 37, the mother of ten children, the youngest of whom was two years old, who sought medical aid for a swelling at the seat of an old ventral hernia. It had not attracted her attention until three weeks
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previously. She had noticed none of the usual signs of pregnancy ; there was no discoloration of the areola around the nipple, no abnormal sensation in the breasts, and her menses had been perfectly reg- ular until the last, which commenced three weeks before, and had not ceased to flow.
There was noticeable a round, prominent tumor in the subumbilical region, which was movable, and the hand could be pressed below it against the spinal column.
Conjoining a vaginal examination with the ab- dominal palpation, the tumor was diagnosed to be an impregnated womb, which probably contained a foetus of three and a half months. As the haemor- rhage was profuse, and the os internum considerably dilated, secale cornutum was advised to be given in frequently repeated doses.
The physician in charge reported three days afterward no change in the symptoms. Dr. Guern- sey then recommended quinine in grain doses. In one half hour after the administration of the first dose, strong uterine pains commenced, and within three hours the foetus and placenta were expelled, both of which showed evidences of commencing decomposition. The secale used was.Squibb's fluid Extract.
There were three points of interest : the delusive history, the preternatural mobility of the uterus, and the prompt and effective action of quinine as a uterine stimulant.
During the past year, the attention of the profes- sion has been occasionally called to the usefulness of quinine in promoting uterine contractions. One writer has spoken highly of its use in parturition, considering it more reliable than ergot.
Dr. E. Guernsey had often seen good results obtained by quinine in menorrhagia arising from an atonic condition of the uterus.
Dr. W. N. Guernsey referred to the use of ergot in arresting threatened abortion. He narrated a case reported by Dr. A. K. Gardner where abortion seemed imminent ; and opium, subacetate of lead, and absolute rest had been of no avail in arresting the pain and haemorrhage. As the haemorrhage was profuse, and life seemed at stake, secale was given with the intent of emptying the uterine cavity. To his astonishment, pain and haemorrhage ceased, and at full term the mother gave birth to a healthy child.
In reply to the question asked by Dr. Blumenthal, if secale in large doses acted in these cases under the law of " similia similibus curantur," Dr. E. Guernsey mentioned several instances of its arrest- ing uterine contractions. He said it acted quickly either to excite or to arrest them. Dr. Hallock said his experience with the drug coincided with that of Dr. Guernsey.
Public Health Association of New York. — A series of informal meetings held during the summer months of 1872 resulted in the organiza- tion of an association of individuals interested in sanitary studies. The following gentlemen took part in these preliminary meetings and became members of the organization, viz.: Charles F. Chandler, Ph. D.; Carl PfeifTer, Augustus Viele, M. D.; Elisha Harris, M. D.; Stephen Smith, M. D.; Edward H. Janes, M. D.; Chas. P. Russel, M. D.; Henry R. Stiles, M. D.; Nicholas L. Camp- bell, M. D.; Admiram Judson, M. D. On the 15th of August, 1872, this association was formally
organized by the adoption of a constitution and the election of the following officers : President, Stephen Smith, M. D.; Vice-President, Chas. F. Chandler, Ph. D.; Recording Secretary, A. B. Judson, M. D.; Corresponding Secretary, Carl Pfeiffer ; Treasurer, E. H. Janes, M. D.; Chair- man of Executive Committee, Elisha Harris, M. D. The objects of the association are " the advance- ment of sanitary science and the promotion of organizations and measures for the practical appli- cation of public hygiene ;" its membership is open to all, of whatever profession or calling, who have an " interest in or devotion to sanitary studies, and allied sciences, and to the practical application of the same."
September 20th, at the society's first regular scientific meeting, an exceedingly interesting paper was read by the President, Dr. Stephen Smith, on " The Movements of Tenement-House Populations in New York City, with suggestions as to methods of preventing overcrowding and of providing the laboring-classes with improved dwellings." The reading of the paper (which, we understand, is to be published in an enlarged form in the forthcom- ing report of the New York Board of Health) was followed by an exceedingly interesting description by Mr. Lorin Blodgett, of Philadelphia, of the system of building small and cheap homes for the working-classes in that city ; and also by some re- marks on English tenement-houses by Mr. W. E. Worthen. Miss Dr. Mary C. Putnam and Dr. H. R. Stiles also contributed to the discussion of the subject.
October 30th, at a regular meeting, a paper was read by the President on " Sanitary Legislation, Organization and Work in the City of New York. "
At a public meeting held in the Chapel of the Reformed Church, corner of Fifth avenue and Twenty-ninth street, on the evening of December 7th, an elaborate and thoughtful paper was read by Dorman B. Eaton, Esq., former Counsel to the Metropolitan Board of Health, on " Sanitary Legislation in England and New York." Mr. Eaton was the framer, in a great measure, of the Met- ropolitan Health Law, virtually the same as the present law ; and his intimate acquaintance with the subject, enlarged by careful study of English and foreign health legislation during his recent pro- longed absence abroad, rendered the paper one of great interest and value. It will probably be pub- lished in full by the association. Mr. George W. Hastings, general secretary of the British Social Science Association, gave a detailed and graphic statement of the nature and operation of the "Con- tagious Diseases Act" in England. His earnest and forcible presentation of its results, as derived from his personal experience as one of the Royal Commission appointed to investigate the workings of the act, was listened to with the deepest interest by the large audience assembled, among whom we noticed many of the leading sanitarians, health- officials, &c, of New York and Brooklyn.
December 12th, regular meeting. The evening was well occupied in the discussion of current san- itary topics.
The association now numbers twenty-four resi- v dent members, embracing gentlemen of various professions, such as lawyers, doctors, architects, scientific students, &c, and bids fair to enjoy the success which its object so greatly demands.
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We are pleased to see that the claims of sanitary science and public hygiene have been recognized by the Faculty of the New York Homoeopathic Col- lege, who have provided for a course of special lec- tures on those subjects in the current^session of the college. Dr. Henry R. Stiles, one of the Health Inspectors of the city (and formerly connected with the old Metropolitan Board in Brooklyn), has been lecturing to the students on sanitary topics, with marked success.
Scientific Cleanings,
Garotting at Guy's Hospital. — We read in the Guy's Hospital Gazette, of a class of cases which in the opinion and according to the practice of the writer, "are benefited by being garotted." " One night," this gentleman relates, " going round the wards I found a girl in a hysterical fit; she fought and struggled vigorously with her nurses. Hating all rows, I grasped her throat and held it firmly till the astonished girl gasped out, ' You are choking me ! ' I then relaxed my" hold and prom- ised her a repetition of the performance. She was thoroughly cowed after having two more fits, and, being twice nearly choked, her alarm was so great that, though every night previously she had had fits, she desisted, and in a month afterwards her mother told me with joy of her complete recovery. A few days later Mr. Stocker, whose experience is immense, told me how beneficial this plan was, and said, ' You may remain for hours fighting with a screaming girl, but carefully choke them and they immediately subside — it is unpleasant for them, it frightens theni.'" The italics tare those of the ac- complished proficient in the art of choking. It is a great pity that this valuable contribution to medi- cal science is not entirely complete. In case the par- oxysm is not controlled by the patient being "nearly choked," we would naturally infer, and it is indeed very reasonable to suppose, that success would crown our efforts if we carried the treatment a little farther and quite"\ choked the patient. The muscular doctor will be glad to know that the same principle has been lately carried out in the New York Hospital, where the approved method was to tear off the clothes of the patient, prick her with lancets, drag her around the room and beat her. The case treated thus in the New York Hospital also recovered, but her mother did not come back "with joy" to tell about it, although the treatment was, no doubt, "unpleasant." In the Lunatic Asylum, on Ward's Island, the same treatment has been carried out even more thoroughly. The cases permanently cured have all been buried, and those under treatment are doing as well as could be expected. We suggest to the Governors of the New York Hospital, and to the Commissioners of Charity, that a professional garotter be added to the medical staff of all our hospitals, and that Mr. Stocker, "whose experience is immense," be in- duced to communicate his views to the profession at large as to the best methods of quieting nervous excitement.
A New Method of Treating Ulcers is de- scribed by Mr. Cowan in The Lancet. " Knowing as we do," says the author, " that an ulcer has the power of absorbing matters applied to its surface
(any one can try the experiment with black- wash to a moderate sized ulcer for a few days, when mercu- rial salivation will begin), it occurred to me to avail myself of so excellent a property by applying locally matters having nutritive powers, so that the skin might be nourished locally at the weakened and degenerate spots, to enable the skin to take up such material as would nourish its weakness, and convert its brittle state into a plastic and healing one. The natural secretion of an ulcer, the so- called laudable pus, may it not be a nourishing juice specially thrown out to feed the young grow- ing granulations ? If so can we not add to this by artificial manuring?
Such is the theory, and accordingly the doctor puts his famished ulcers on a nourishing diet as follows :
"Flour, four ounces; powder of acacia, one ounce ; powder of tragacanth, half an ounce ; one egg; chalk, two drachms; cold water, one pint." These ingredients are to be thoroughly mixed and placed in a saucepan over the fire. As soon as it boils, or a minute or two after, it is to be removed from the fire. It must be thin enough to spread over the ulcer on a brush, and thick enough to remain on the ulcer. If the directions given yield too thick a paste, a little boiling water may be used to thin it. Each patient is provided with a small bottle and brush, and is directed to paint his ulcer all over three or four times a day, and keep it cov- ered with a soft piece of rag. No other treatment is required. The patient should come for a fresh supply of the paste every day, and the bottle and brush should be washed out daily in order to keep them fresh and sweet. This treatment has the merit of being simple, rational and painless, and, according to the author, is more efficacious than the usual methods. A number of cases are given show- ing that in its author's hands this method succeeded in some cases of long standing after the failure of other means, skin-grafting included.
Atmospheric Wave. — By a careful examina- tion of the reports as received from the signal stations located on or near the Pacific coast, it appears that on the 12th of November, an atmos- pheric wave, similar to that which makes its annual appearance on the coast of England and Western Europe, began to break over the shores of Oregon and British Columbia. By the evening of the 12th it had spread over nearly the Pacific States and Territories, and at midnight was passing through the gorges of the Rocky Mountains, descending in turn, upon Colorado, Nebraska, Kansas and the Indian Territory. On Friday, the 15th, its eastern limit marked a course from Washington Territory on the north to the Lower Mississippi Valley on the south. Should this wave of air, which in the date and method of its approach so closely resembles the English one, continue, like that, in a series of successive undulations for several months, its presence will serve to account for our American winter storms, showing that they have their origin in the Rocky Mountains, where the moist air from the coast encounters and is condensed by the cold dry atmosphere of the mountain sum- mits, the result being those overwhelming snow storms that are the dread of the Western traveler. This would seem to prove the correctness of the theory that our cold weather comes from the West instead of the North.
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Disinfectants. — In the Central Chemical De- partment of Public Health at Dresden, numerous researches have been recently made with various disinfectants. The value of chloride of lime and sulphuric acid, which form the most effectual dis- infecting material, is here given by ioo, while the remaining numbers show the value of the other materials as compared with this standard :
Chloride of lime, with sulphuric acid ioo
" " sulphate of iron 99.0
Luder and liedloff powder 92.0
Slaked lime 84.6
Carbolic acid, disinfecting powder 85.6
Alum 80.4
Sulphate of iron 76.7
Chloralum 74.0
Sulphate magnesia 57.1
Termany fat with sulph. acid 51.0
Contagion. — M. Kletzinsky, noticing that per- sons sick with small-pox were often visited by flies, placed near an open window of the hospital, a saucer filled with glycerine. The flies gathered about it and were caught like birds with glue. In endeavoring to free themselves, the foreign matter adhering to them was left in the glycerine, which was carefully examined by the microscope. The glycerine was found to be full of strange cells, simi- lar to those seen by persons attacked with small- pox, but never found on the fly. This discovery shows that flies can be a very dangerous means of spreading contagious disease.
The annual meeting of the British Homoeopathic Congress was held at York, on the 4th of Septem- ber. In addition to the president's address, papers were read : " In what way is the action of drugs to be discovered? " by Dr. Sharpe ; "On the plan and value ofbaptisia in the treatment of typhoid fever " by Dr. Hughes; and, u On the physiological action of serpent poison," by Dr. Tybner. We have not space for the report of the discussions, or these papers, which were full and interesting.
Intermittent Fever. — Dr. Dujardio Beau- metz speaks highly of carbozotate of ammonia in the treatment of intermittent fever, from one-third to two-thirds of a grain daily being sufficient to sup- press the paroxysms. Like quinine, it diminishes the strength of the pulse and induces languor, cephalgia and even delirium, and finally is eliminat- ed from the kidneys. In many cases where quinine had failed, the drug worked a speedy cure.
Chloral in Sea-Sickness. — Dr. Ogilvie Will says, in a severe voyage across the Atlantic he gave chloral in eighteen cases of sea-sickness, and in only one did the drug fail to produce relief. He gives thirty grains in sweetened water, directing the dose to be repeated if relief does not follow in twenty minutes. He advises a little light, easily-digested food to be taken before sailing, and directs the choral to be taken and the patient to lie down on the first symptoms of the sickness presenting them- selves.
Antiquities. — In Egypt, mummies have been found with teeth filled with gold, and in Quito a skeleton has been found with false teeth secured to the cheek bone by a gold wire.
In the museum at Naples, among some of the surgical instruments discovered at Pompeii, there is a fac simile of Sims' speculum.
Hews 3tem$>
The Brooklyn LYiNG-In Asylum is negoti- ating for a new building. The lady managers pro- pose establishing, in connection with this institution, a nursery, a dispensary for the treatment of diseases of women, and a school for nurses.
The Hahnemann Hospital of New York has broken ground for its new building. This hospital will cover ten lots (half a block) on Fourth avenue, between Sixty-eighth and Sixty-ninth streets.
Dr. Albert E. Sumner has recently been ap- pointed a member of the Brooklyn Board of Exam- ining Surgeons for Pensions, and has been elected Secretary of the Board.
Dr. H. M. Paine, of Albany, writes : " We are about starting a homoeopathic hospital here; one has just been organized in Buffalo."
The Brooklyn Homoeopathic Hospital will be formally opened about the first of January, 1873.
Dr. William M. Guernsey has been appointed Physician to the Home for the Friendless, in place of Dr. C. T. Liebold, resigned.
Dr. Verona has received the appointment of Resident Physician of the Brooklyn Lying-In Asylum.
Dr. H. B. Cole is expected to return soon from Vienna to take the position of House Surgeon in the Brooklyn Homoeopathic Hospital.
The New York Ophthalmic Hospital was formally opened Dec. 16th, 1872.
iDbituary*
Dr. Jacob Beakley, the founder of the New York Homoeopathic Medical College, and until the past two years its Professor of Surgery and Dean of the Faculty, died at the residence of his brother, Dr. Henry Beakley, at Peekskill, in September last, in the 61st year of his age. Dr. Beakley was one of the earliest homoeopaths in this city, embracing its doctrines and advocating them with zeal at a time when it required some courage to enter the ranks of a school comparatively new, and with but few adherents, exposing himself to the ridicule and sneers of old friends and professional associates. In a short time he obtained a lucrative practice. This he afterward relinquished in accepting the position of Professor of Surgery in the Homoeopathic Col- lege but recently established in Philadelphia. In a few years he dissolved his connection with this school, and by his own energy, and in a great measure at his own private expense, started the college in New York. His students, now scattered all over the country and doing good service in the ranks of our profession, and in nobly upholding the standard of medical reform, will remember him / only with feelings of tenderness. The good he has done lives after him. The seed he has sown has already ripened into a rich harvest. Who is there, remembering his own fallibility, will cast a stone on the new-made grave ?
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iDriginal Articles.
PETROLEUM-ITS ORIGIN AND RELATION TO MEDICINE.
By Robert A. Chesebrough.
Petroleum is one of the most curious, as well as one of the most interesting, of the spontaneous pro- ductions of the earth. It seems to have been well known to the ancient Greeks and Romans, and to have been used by them for various purposes; Tacitus, Pliny and Vitruvius mention it, and Herodo- tus refers to a spring of bituminous liquid flowing in Zacinthus, one of the Ionian islands, two thousand years ago, and it is probable the spring had existed for a long period before his time. Bakoo, on the borders of the Caspian Sea, and the Ragoon dis- trict on the Irrawaddy, are remarkable for their large yield of petroleum from ancient times. From the latter source the Burman Empire and India have been furnished with vast supplies of oil for an un- known period, amounting at one time, it is said by Symes (Embassy to Ava), to an annual yield of 400, 000 hogsheads from some 500 wells. It seems to have been principally used in a crude state in lamps for lighting, for preserving timber against insects, and as a medicine. Large supplies have been more re- cently obtained in Italy, in Southern Russia, and the history of its discovery and the enormous yield obtained in the United States are too recent and well known to need repetition here. The origin of petroleum seems to be exceedingly obscure, and no satisfactory solution of its formation has as yet been given to the world. While some authorities have considered it as of volcanic origin, basing this opinion on its being found in volcanic districts, others have deemed it to be a drainage, as it were, from the cannel and bituminous coal measures, which coal yields on distillation an oil similar in character and elements to the natural earth oil. Near Vesu- vius a spring of petroleum rises up through the sea, and around the volcanic isles of Cape Verd it is seen floating on the water. But although petroleum is obtained in proximity to the coal measures, it is also found in geological formations where coal does not exist, in fact it is oftener so found; and again, where the most prolific of oil-yielding coals in the world have been found, viz: the Boghead of Scotland and the Albert of New Brunswick, no trace of petro- leum has been discovered. In Canada West, bor- dering the Lakes, large deposits of petroleum occur lying near the surface, and this in a district outside of the coal limits. It has also been main- tained that petroleum was the result of vegetable organic decay, but the main basis for this theory is the accepted starting point that it emanates from coal ; but if we discard this source of production, as the proofs would seem to oblige us to do, this theory is left without support. Certainly, petroleum pre- sents in itself no evidence of being of vegetable origin, its characteristics and elements are entirely different, and though we allow that the distillates of cannel coal are similar, there is much more reason to deny that cannel coal results from organic decay than to admit that origin for petroleum.
Petroleum is composed of hydrogen and carbon, the proportions of which differ according to its den- sity or body, the heavier oil containing the most car-
bon. It will not absorb oxygen, and does not, there- fore, as do all known oils or animal substances, oxy- dize or decompose in time or from exposure.
In the deep wells of Pennsylvania the crude oil found is exceedingly light in body, is highly inflam- mable, and of a spirit-like nature, showing a large excess of hydrogen, while the oil obtained in West Virginia from shallow wells possesses a far greater viscidity, is not at all inflammable, and shows an ex- cess of carbon. By boring deep wells in the same re- gion, light oil is obtained similar to the Pennsylvania, and it holds good as a rule all over the world, that the heavy oil is found near to the surface, while the light oil is obtained at a considerably greater distance be- low ; and when found on the surface it becomes by exposure, bitumen or asphaltum, having parted, by evaporation, with nearly all its hydrogen. Now, there can be no doubt, and it is universally con- ceded, that these oils of different density were originally the same, all proceeding from the oil of light gravity, distilled down, as it were, by the nat- ural heat of the earth, or from exposure on the sur- face. As a proof of this fact, if we take a large kettle of light gravity petroleum, place fire under- neath and slowly evaporate it, the oil in the kettle gradually becomes denser and assumes the character and appearance of the heavy crude oil ; then as the process is continued, it appears like bitumen, then it becomes a lustrous solid asphaltum, and finally when evaporated to perfect dryness, the residuum bears a striking resemblance to cannel coal.
It is with extreme diffidence and caution that we venture to uphold a theory greatly at variance with the teachings of modern geology, but when in defence of these teachings the proof offered is chiefly negative and the reasoning abstract, and on the other hand the proof seems direct, and, to us, the reasoning con- clusive, it is in the interest of true science that the merits of both should be investigated. We are taught by the geologist that coal has been formed in the earth from vegetable decay, that vast forests swept down by time and the convulsions of nature have left their remains congealed and compressed in the shape of coal deposits. By what chemical process organic fibrous matter has been changed into compact masses of hydrogen and carbon is not explained, nor why coal lies in veins and drawn out seams, rather than in vast tracts or huge pockets as it would seem natural it should do, were this theory the true one, we are not told. Undoubtedly, peat is the result of vegetable decay ; it bears every evi- dence of its origin. It lies as the forests fell, in large tracts, never running out into seams or lines as do the coal measures, is dissimilar in all respects to coal, and is not found in the coal districts. It has been held that coal was the ultimate result of peat, but there is an absence of all proof to sustain this, and the accepted theory of the coal formations suf- ficiently refutes such a conclusion. The geological formation necessary to the production of coal is ab- sent in the peat deposits, and underlying the coal deposits is found the sandstone formation, which is wanting under the peat beds. In fact, the appear- ance, localities, products and characteristics of the two substances show an entire dissimilarity. Geolo- gists agree in classing the different varieties of coal, viz : the cannel, bituminous, and anthracite as one series, of identical origin, only evaporated down by heat and time to different degrees of dryness ; and there can be no doubt but that this is true. On the
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James River, near Richmond, Va. , there is a natural bed of coke, underlying which and interspersed with trap rock and apparently baked fire-clay is a layer of coal, under this a deposit of half-coked coal, and still farther down a layer of bituminous coal. By subjecting bituminous coal to artificial heat we have, as an ultimate result, coke, but by subjecting peat to artificial heat we have, as an ultimate result, char- coal, similar in structure to wood charcoal, thus clearly showing its organic parentage, and indicat- ing the contrary for coal. Now, if coal is not a de- posit of organic matter, what is it ? We answer, we believe it to be solidified petroleum, and claim that the proofs to sustain this belief seem direct and conclusive, while we can discover no evidence in contradiction. Let us look for a moment at a few of these proofs, as we call them.
First : Petroleum evidently runs in veins or streams in the earth, filling up the chinks and cracks in the sandstone formation, in which it is found, which seems to be necessary to its retention, and from which it is extracted by wells of varying depth. The striking of one well contiguous to another has often resulted in drawing off the supply of oil from its neighbor, thus proving that the two wells tapped the same stream. Originally, nearly all the wells yielding oil of light gravity in Pennsylvania were at first flowing wells. Now a flowing well is a great exception, and the reason is obvious. The district is honeycombed with well-holes, and the pent up gas which forced the oil to the surface has escaped, thus clearly dem- onstrating that the supply below runs in communi- cating streams, branching off in different courses. A glance at the coal seams will exhibit identical features. These seams or veins wind through the earth like small streams, here and there branching off from the main artery and ending in small pockets, and sometimes returning to it in uncertain and wayward courses, just as though these streams had originally been liquid and had forced their way wherever they could find vent. Underneath these seams lies the same sandstone which retains the pe- troleum, forming now the bed of the coal. As the petroleum veins lie at varying depths, being forced up by the pressure beneath into the cracks and breaks of the sandstone, so likewise lie the coal veins, some near to the surface, others far beneath it. To account for the meandering veins of coal on the assumption that they were once liquid seems easy, while to account for the mystery of vegetable deposits being (in the instance of coal alone) drawn out into long, thin sinuous lines, with no traces of these remains on either side of these lines, seems difficult indeed.
Second : The great and principal strength of the vegetable theory, we may say its very groundwork, is the fact that organic remains have been found imbedded in the coal measures. Large stems of the calamites occur frequently in the sandstone. Club mosses and ferns in endless variety are found in the coal, preserving their original shape as though moulded and hardened in clay, their vegetable origin being plainly apparent. But this fact, to our mind, is a weakness of the vegetable theory, and a confirmation rather than a refutation of our argu- ment. Why should the process which converted organic remains into a solid mass of coal have spared some of these remains from this great change ? The law which was good as to the great mass was good as to the whole, unless some exceptionable con-
dition overruling this law, as to these unchanged parts, can be shown. On our theory, the explana- tion of their occurrence is easy. The streams of petroleum in their courses through the crevices of the rock carried with them plants and trees im- mersed in their liquid, the bulk of which vegetable matter probably became in time dissolved and ab- sorbed into the body of the bitumen itself, while some of it became petrified as the fluid hardened into a solid, and was thus preserved in the shape these remains present to-day. In the great up- heavals which the earth's crust has been subjected to through the past ages, it could not be expected that these then half liquid streams of bitumen should remain pure and unmixed with vegetable matter. On the contrary, it seems strange that they are so pure and uncontaminated, and their lines and courses so plainly marked.
Third: Coal, like petroleum, is composed of hy- drogen and carbon, the cannel and bituminous series presenting on distillation similar products to those of petroleum, while vegetable structures do not yield analogous products, either in their original condition or through their undisputed remains in the shape of peat.
Fourth : If it is true, as is universally conceded, that anthracite coal was formerly bituminous, baked to dryness in the earth, and the bituminous was originally cannel similarly evaporated, we accom- plish a vast stride in our theory, for the step from bitumen to cannel coal is a slight one, and it is equally well established that bitumen, or asphaltum, is evaporated petroleum. We have then but to establish the connection between bitumen and can- nel coal and the chain becomes complete. Twice has this identical question been the subject of im- portant law suits. In 1853 a case was tried in Edinburgh, involving the right to mine the Boghead beds, which were leased as coal. On the trial the most eminent authorities, in their testimony, differed as to whether the substance was coal or bitumen. A similar case was subsequently tried in New Bruns- wick, involving the title to the Albert mine, the question turning on the same issue In both cases the deposits were held to be coal, but the opposite was strongly maintained by experts of high charac- ter, who classed them as bitumens. That the equity of the proceedings lay with the holders of the leases, rather than with the contestants who sought to in- validate them on technical grounds, may have had much to do with the verdicts of the juries, seems probable. At all events, the distinction between coal and bitumen was found to be so narrow as to involve much uncertainty, and had at that time pe- troleum been known to the Western world as an article of commerce, as it is to-day, and the origin of bitumen itself been as well understood as it now is, the two substances in contest might have been held to be identical.
Fifth : We shall close our proofs by pointing to an instance of the occurrence of bitumen and coal in one deposit. In the island of Trinidad, West Indies, is a lake of petroleum bitumen about a mile and a half in circumference, which is underlaid by a bed of coal. The bitumen on the surface is hard and dry, being baked by the hot sun of a tropical clime, but underneath it is soft and oily, showing its petro- leum origin.
To sum up our theory succinctly, we claim that petroleum of the lightest density is the parent of
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the coal measures, and from it proceeds, in regular gradation, heavy petroleum bitumen and asphaltum, then the coals, cannel, bituminous and anthracite, and then coke. On the other hand, we claim that peat is the result of organic decay, and its ultimate result is charcoal.
Now, it is in no wise necessary to the support of our theory that we should show what petroleum is, and of what formed, if it is not, as claimed, the re- sult of organic decay ; for the secret of its forma- tion might remain forever an unsolved mystery, without detracting anything from our argument. We may suppose, if we will, that it is an original substance, existing in vast supply in the earth's inte- rior ; or we may more reasonably assume that by some mysterious process, hydrogen eliminated from water, acting on and combining with the carbon of the rock, aided by heat and pressure, forms petroleum, and that this process is going on continually, and has been going on forever in the great laboratory of the earth. We have here the two constituents of petro- leum, hydrogen and carbon, both existing in unlim- ited extent in the water and rock. We know that by the aid of heat water can be decomposed and its hydrogen set free, and we have therefore but to suppose this liberated hydrogen as dissolving and combining with the carbon of certain rocks to rea- sonably account for petroleum. Certainly this latter part of the process is mysterious, but nature is full of mysteries far more wonderful and inexplicable than this, and we submit that this chemical combi- nation would be less wonderful than the production of either coal or petroleum from organic remains.
[Lack of space obliges us to transfer the consid- eration of the Medical Properties of Petroleum to another number of the Union.]
THE DUTY OF THE STATE IN THE PREVEN- TION OF DISEASE.
By Egbert Guernsey, M. D.
In studying the future of our country, two points are strongly impressed upon our mind. First, the decrease in the ratio of births in our population ; and, second, the enormous percentage of deaths under five years of age. Both of these points are matters for grave consideration.
To establish the first, we have only to look at the census returns since the establishment of our na- tional government. We find by the census of 1 830 the number of white children in the United States under fifteen years of age to every one thousand females between the ages of fifteen and fifty were, in Alabama, 2,591 ; in 1840, 2,508; in 1850, 2,071, and 1,973 in i860. There were in Massachusetts 1,368 in 1830; in 1840, 1,258; in 1850, 1,143, and in i860, 1,123. In. New York there were in 1830, 1,837; in 1840, 1,580; in 1850, 1,364, and in i860, 1,327. In Kentucky there were in 1830, 2,279; m 1840, 2,201 ; in 1850, 2,003, and in i860, 1,906. In Illinois in 1830 there were 2,580; in 1840, 2,280; in 1850, 2,035, and in i860, 1,822. These States, taken at random from the different parts of the Union, fairly represent the general decrease in the percentage of births. Were this decrease in the percentage of births counterbalanced by a corres- ponding decrease of deaths in infancy and early
childhood, showing an increase of vigor and vitality during that period, it might be a question if the nation and humanity were not gainers by the change. But this is not the case. It is a reproach to our profession that with all its boasted resources, with all its wealth of means, which an all-wise Providence has placed within its reach, in a land where but few are poor, and where all, with but little exertion, unless stricken down by sickness, can easily obtain a comfortable livelihood, that death should reap its richest harvest from infancy and early childhood. It is a reproach to the statesman having the interest of the nation at heart, that he has forgotten that the real wealth of a nation con- sists not in its forts bristling with cannon, not in its armed ships floating on every sea, but in the phys- ical and intellectual strength of the people, their freedom from disease, and their power to people the land with a strong and vigorous growth. It is a reproach to the Christian and philanthropist that they have not struck boldly and with a strong hand at the great social evils of the day, and have learned the all-important fact that, as a rule, to have pure and noble lives, they must have healthy physical organizations.
Crime is often the result of disease. The un- harmonious, nervous and mental organizations which fill our prisons and scaffolds, are often produced by disobedience of hygienic laws, which causes the stream of life to flow on tainted and tainting from generation to generation. These errors and violations of Nature's laws cause not only much of the crime which fills the land, but that terrible mortality in childhood through which nearly one-half born into the world perish before they reach the age of five years.
Of the 393,606 deaths recorded as occurring in the United States for the year ending June 1st, i860, 168,852, nearly one-half, occurred under five years of age ; and nearly one-fourth of the whole num- ber under one year. In 1870, of the 481,243 deaths which occurred in the United States, 203,213 died before they reached the age of five years. In 1872, in the city of New York, 50 per cent, of the total mortality was in children less than five years old.
At the close of the sixteenth century, according to Marshall's tables, one-half of all children born perished under five years of age, and the average length of life of the whole population was eighteen years. Notwithstanding the average expectation of life at birth has been increased to about forty-eight, the decrease in the mortality of children under five years, as will be seen by the figures already given, has been very slight. In Boston, in 1870, the deaths of children under five years of age reached forty- three per cent, of the whole mortality. In 1871, the percentage of deaths under one year was, in Boston, 27; in Baltimore, 28.90; Brooklyn, 25. 25 ; New York (1869), 20.42 ; Philadelphia, 24.85 ; Washington, 28.30. According to Wappaens, in Europe, 33.66 per cent, of the entire population are below fifteen years of age, thus being consumers only, and contributing nothing directly to the pub- lic wealth. A sound political economy, viewing it from no higher stand-point, demands that infancy and childhood shall be so far protected and sur- rounded by safeguards, that the large majority shall not only pass the period of helplessness until they can become producers as well as consumers, but that they shall be well protected so that they may
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come upon the stage of action with healthy physical development.
There is a greater loss to the community than from the fcdeath of consumers before they reach the productive age. It is from that vast stream of diseased and vicious humanity which is con- stantly flowing into society from the fountain of childhood, too often tainted and corrupt, breathing its malarious poison wherever it goes. Incompe- tent nursing, scanty feeding, a vitiated atmosphere, give rise often, if they pass the period of childhood, to feeble and crippled men and women, who become more or less a weight upon society all their lives. Money spent in educating children into strong and healthy men and women is more than saved in hospitals and prisons.
The attention of the State, then, should be in- telligently and earnestly directed, as a matter of political economy, looking to the strength, stability, and physical and intellectual wealth of the nation, to the means of prolonging the lives of that vast throng which^swells the tide of death in early child- hood ; and not only in prolonging their lives, but so protecting them and surrounding them with such safeguards in education and judicious nourishment that they step out upon the stage of action with a physical and mental development which will enable them to do^their part intelligently and well in the greatToattle of life.
In large cities the mortality is, of course, im- mensely greater among the poor — among those who live in cellars, in single rooms and in small apartments, in closely confined tenement houses. From these quarters the death list is the heaviest, and the hospitals and nurseries draw their principal supply. , Some are driven to these quarters by mis- fortune, but in their apartments you will find, how- ever poor they may be, however barren their rooms may be of comfort, an attempt at least at cleanli- ness. But in the great majority the finer feelings of nature seem to have been blotted out by their con- tact, year after year, with that filth and misery in which often they and their fathers have lived gener- ation after generation. Here into these nurseries of vice, and crime, and sickness, and death, society should step — that society which shines in silks and diamonds at charity balls — that society which rears our marble churches^and weeps over the destitution of the heathen in foreign lands, and sends its gold m liberal supply for their conversion. These efforts are all noble in themselves, and we would not draw one drop from that broad and thirsty stream of liv- ing charity which has done and is doing so much for ^humanity. But let this society step in with its strong voice, nts Vealth, its intellect, its refinement, well directed and guarded by that comprehensive wisdom which in other matters has done so much for .humanity, so much for the wealth and prosperity of the nation. Let it, through proper authorities, control and direct sanitary affairs, not with a spas- modic,'feverishjimpulse, wrought up almost to frenzy by some glaring wrong which has forced itself upon its notice, but with a broad, comprehensive policy well matured, in which the resources of science shall be brought to its^aid, and the whole entrusted to able and honest men, willing to carry out its commands in their spirit and integrity — men whom no desire for pecuniary gain can swerve from their high sense of duty. More than this, let them be held to a strict account for the manner in which they perform then-
work. Let the street-cleaning contractor, the rail- road corporations, with their ill-ventilated and over- crowded cars, know that they are amenable to law, and that the law means the protection and safety of the public. Let every tenement house be so erected as to give light, fresh air and the means of cleanli- ness to all, and through sanitary officers compel the observance of sanitary rules. There are hundreds and thousands in large cities who, unless they are prevented by the strong hand of the law, will herd together and live like swine. It is not enough to require by law physicians to report contagious cases of disease. This, as far as it goes, is right, and is undoubtedly the means of preventing a large amount of sickness. But what we want is a law, properly executed, which will compel the erection of houses where it is possible for people to live without being poisoned by foul air. It is true, an attempt has been made to carry out some of these provisions ; but go among some of the lower class of tenement popu- lation and see whether it has been anything more than an attempt.
We have adverted to the lack or non-enforcement of the necessary sanitary regulations in the erection of tenements for the poor, and in the absence of sufficient care to compel an observance of proper hygienic rules as a fruitful cause of the immense fatality among children, and in the diseased and feeble constitutions among adults of that class in our large cities. If we pass to the public hospitals, we find the same lack of care, the same system of crowding, and the absence of that broad system of Christian benevolence which should characterize the management of public institutions. The idea seems to be, here are only paupers, who should be thank- ful if a great city, with untold wealth, should give them a place to die, and dole out its food and warmth to them in the smallest proportions. When from twelve to fifteen hundred poor lunatics are crowded within a space only intended for five hun- dred, as has often been the case on BlackwelPs Island, what can physicians do, however skillful and willing to perform their whole duty ? What is the use of their theorizing about nourishing food and careful attendance, and warm and well ventilated rooms, when, if the city authorities do not econo- mize in these minor matters, there will not be suffi- k cient money to fill the pockets of the Tweeds and " Sweeneys, and all those noble men who, for years past, have done so much for the honor of our city. On that sunny slope on Ward's Island there is a broad field, seamed with deep trenches, into which are cast by hundreds and thousands the nameless paupers. Hurry them out of sight.
" Rattle their bones over the stones, They are only paupers, whom nobody owns."
And a day's support is an item to the great city. And the little children,
" Who are weary ere they run,
Who have never seen the sunshine nor the glory, Which is brighter than the sun,"
find these trenches the gateway to greener fields, where there is no hunger and no tears.
Are we too strong in our language ? Will the facts be denied, that in the charity hospitals and asylums and nurseries on the Island, including Bellevue Hospital, there is a lack of that care and attention which the suffering poor and helpless
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children have a right to expect at our hands ? The public have not forgotten how in the new Insane Asylum, but a few months since, helpless lunatics were abused and kicked and trampled upon by beastly and brutal nurses. They have not for- gotten, either, that the physician at the head of the institution, who would not cover up this bru- tality, who would not wink at this wholesale torture and murder, is found to be in the way, and loses his place in the institution. He knows too much, and, poor man, his conscience is too tender. He has not yet forgotten the obligations of his oath, that grand old Hippocratic oath.
The whole system of nurses is wrong. Men and women are selected as attendants upon the sick and helpless, not for any qualification they may pos- sess for the work, but because political friends wish to find places for them ; and so, ignorant, brutal at- tendants fill the places where should only be found the skilled and the trained. These abuses exist not alone in our institutions in New York, but all over the country ; in almost every city and town where the poor are cared for at the public expense, there is more or less the same lack of care, the same in- competency in attendance, the same desire to spend money in costly buildings, and save in the care of the inmates. Do our profession suppose they have fulfilled their duties to society in simply prescribing for the sick when called upon, and in closing their eyes to glaring abuses ? They have been baptized to a work second only in importance to the care of souls, the care of the public health. It is their duty not only to lift the warning voice against abuses wherever found, but to search them out and suggest the remedy. It is their duty to demand of the public authorities that the positions of attend- ants upon the poor, the sick and helpless, be given, not as reward for political services, but to trained and skillful nurses.
To the Christian, the philanthropist, the states- man, to good citizens everywhere, the question de- mands attention, " How shall this terrible tide of disease and death in childhood be stayed ?"
We are in the midst now of a whirlwind of po- litical reform. Political rings have been broken up, and unjust judges deposed. Is it too much to ask of our legislators to look into this question which so vitally affects the future of our country ?
We need more stringent enactments, in reference to the sanitary affairs of large cities. A law, placed in proper hands for execution, which shall prevent the erection of unhealthy dwellings, and which shall compel due observation of sanitary laws.
We need a training school for nurses of both sexes, and the absolute necessity of every appointee in our public institutions having received some pre- liminary instruction, proved by careful examination, before entering upon his duties. Every medical college should have a department for the careful instruction of nurses. If our female medical col- leges would direct more attention to this one de- partment, sending out skillfully trained nurses, and giving their certificates only to those of good moral character, thousands of children might be saved, and they would receive the thanks of mothers every- where. Break up the medical rings in our public institutions, which are often more arbitrary and ty- rannical than the worst and most corrupt political rings, giving the appointment of the medical and surgical staff to the Mayor, to be chosen from those,
in his judgment, best qualified for the position. Let no school be ostracized, and scientific attain- ment and fitness for the position be the test, rather than adherence to any particular medical dogma. Let the assistant surgeons and physicians be selected from those students of the highest rank in scholar- ship, on a fair examination, without compelling them to show a diploma from some sectarian allo- pathic college. Let the nurses also be appointed only after a careful examination, without regard to political favoritism ; and all, steward, superintend- ent, assistant physicians, and nurses, be subject to the direction of the medical and surgical staff. Let it be distinctly understood that our hospitals are for the benefit of the sick, that they are sent there to be relieved, and, if possible, cured, not to be mur- dered, that a few students may become better posted in diagnosis. It is perfectly right that the immense clinical material in our hospitals should contribute to the instruction of our profession, but this only should be done judiciously, and without endanger- ing the lives of the patients.
In these times of reform, we call upon our legis- lators to look earnestly at this question of the waste of human life, and devise some means by which this useless expenditure can be saved. Let each State look carefully at its sanitary regulations, and see that they are made in the interest of no sect and no class, but only of the public good.
But we need something more than this, we need a national sanitary system, whose influence shall penetrate and be felt in every city and town and hamlet through the length and breadth of the land, from ocean to ocean. Let there be a body of men appointed by the President, selected solely with re- gard to fitness for the position, without regard to party or sect, selected from the ablest and most practical scientists in the land, not mere theorists, but men who are capable of devising and putting in force a grand and comprehensive sanitary sys- tem. Earnest men all over the country would come to their aid with valuable information and useful suggestions. The Signal Service Bureau is already in telegraphic correspondence with every section of the country, and so admirably is the system ar- ranged that atmospheric disturbance, not only on the land, but on the sea, can be predicted with al- most unerring certainty, and the track of storms, or damp and chilly winds marked out. Connect this information, thus easily obtained, with the development of diseases in different localities, the structure of the soil, the drainage, the vegetable productions, and geological formation, and all local causes of sickness so far as can be obtained, and we should have a mass of information brought together where it could be systematized, the proper deductions drawn, and rules and directions given, by means of which not only epidemics could be checked in their march of death, but informa- tion given as it regards the food and clothing and early care of children, which would yearly preserve thousands of lives.
If the appointment of this organization were made by the President, and to it by act of Congress given the necessary authority to carry out a broad and comprehensive plan, it would be placed above party or sectarian influence, and work solely for the pub- <