Chapter III: Part 3

Most men are discontented, and the want of contentment is just as querulous with the cosmopolitan reputation that unblushingly pockets a double eagle for a few raps on the thorax as with its suburban and obscure double that explores a whole chest half an hour for a dollar. The latter pays a shilling to the village blacksmith to reset a shoe, and the former hands over eight dollars every time the farrier looks at his team. Discontent goes with a misfit, and Depew told the Syracuse students that “misfits were everywhere and were always cheap.” It is doubtful if, upon the whole, there are in any walk in life such an unbroken line of splendid fits, the man to his duty and his clientage, as in the medical profession. It is not to be doubted that medical men, each to his location, his culture, his taste and his instincts, are better housed and clothed, more liberally supplied with the machinery of their technique, have greater demands on their purse in the interests of charity and reform which are duly met, have better educated families, have longer and more frequent opportunities for enjoyment which are not wasted, than can be counted item for item on the balance sheet of the average worker in any other profession or occupation. And these are the proofs of financial success, and they put aside the plaint that because the doctors do not “lay by at interest enough to live on” they are an ill-used class of men. The community pays liberally for being taken care of, and it ought to. The medical man’s entire time is taken up in acquiring the experience to exercise prompt judgment in emergencies, and this is precisely what the community pays for and is far from niggardly in the payment. Experience, needful to prompt judgment, is worth more than day’s wages or marginal profits, and this the community recognizes, and its estimate on the value of this experience is generally just. It may not be invariably accurate, but a doctor’s annual cash total is a very liberal estimate of what his individual experience is worth to the community. If the doctor does not “lay by at interest,” it is not because he does not receive enough, but because his relations to life make a free expenditure of money a necessity. He is at a certain disadvantage with a fair share of the people in being compelled to pay his debts. An excellent physician who is also a bohemian or with loose ideas as to honorable obligation, would be a nondescript. He is a fixture in the community with an open reputation, and it is proof of his liberal income that he is able to make and sustain that reputation.

THE OPEN STREET-CAR WHISTLE.

The open street car is in its mid-career for 1888, and the fiend of the whistler is on the vertex of successful practice. The stranglers of the Orient were an occasional incident in that sunburnt civilization as compared with the death-dealing, pestilential prevalence of the Brooklyn open street-car conductor, literally “armed to the teeth” with his offensive weapon, out of whose depths, impelled by æolic volumes from jerky and gigantic costo-diaphragmatic spasms, issue the ear-splitting and nerve-rending combination of fog-horn and prolonged rifle-crack. From stable to terminus and back, circulating along the outer step, holding on to the uprights with extended arms, facing forever the five-cent and helpless “fares,” two to four inches of potential reed or metal protruding from his embracing lips, like an ill-placed proboscis on a witless pachyderm, he summons the driver to screw up his brake and arrest his sportive team for a fare to unload, or to reverse the process for the temporary torture of more victims in hoisting in of other patrons of the line, and the shrill horror of his whistling signal, right in the faces of the passengers, is made more agonizing by the uncertainty of when and on whom it will discharge its blast, being forever ready for action, like the lance in rest of the jousting knight. It would be easy to aim this calliope at the curbstone or the empyrean, but this regard for the passengers’ tympanum disturbeth not the peaceful slumber of the tramway directory, whose shibboleth is the Vanderbilt curse of “the public be ——.” But sadder than the disregard of common-carriers for public comfort is the unearthed conspiracy of the otologists with the ill-paid conductors on the horse-cars. For some years this specialty throve on the otitis acquired at the bathing-houses at Rockaway and Coney Island, but the public discovered that a little cotton in the meatus was the needful prophylactic, and otitis, as a source of revenue, dwindled to the starvation point. Again, and for a time, the horn of plenty overflows in the otologist’s operating room, and his commissions to the car conductors promise to put them soon on a plane with the diamond-bedecked shirt-fronts of the average hotel clerk. It was said that so possessed was a certain London specialist with the operation of tonsillotomy that these amputated glands were each morning shoveled out of his office by the basketful. There are compensations all through life, and the hordes of cash boys, whose occupation vanished with the introduction of mechanical carriers into the great dry good bazaars, now find ample and continuous employment in sweeping out the heaped up fragments of shattered ear drums from the infirmaries of otological specialists. Verily, this deal among the ear men with the whistling open car conductors for the embezzlement of the community deserves the most summary and high-handed reprobation. There is but the faintest justification for such combination in the new code, but even that cannot fairly be pleaded when the integrity of the community’s ear is imperilled. A proper corps d’esprit would impel to the conservation of a professional brother’s prosperity, but even that laudable sentiment must have subordinate place when the profession at large, who are the conservators of society, see that society is likely to turn a deaf ear to the varied forms of human plaint, and all owing to the men who can neither stop or start an open car of a horse railroad without blowing out the ear drums of the community. The public is in peril and who shall be the Curtius to jump into the breach. The conductor cannot be appealed to. He is insensitive, and, besides, he is in authority. One cannot knock the beastly clarion from his lips’ embrace: there would be the claim for assault and ejection for disorder. The directors are a weak reed; they dread a strike. Municipal ordinance would be vainly sought: workingmen have a union and votes. The police, even the finest, are not open to bribery: they are at home in a brawl, and noise is their normal condition of repose. The profession must interfere. Henceforth let the cry be “boycott the whistle.” If it must exist, let the instruction be boldly posted at the starter’s office: “Conductors must aim their whistles at the curbstones and not in the ears of the passengers.”

PROMPT TELEPHONE SERVICE.

The telephone is too useful not to be treated properly. It is always an affair of two parties and each is in duty bound to be considerate of the other. The bell rings, it is answered promptly, and patience becomes well nigh exhausted before “central” succeeds in establishing the connection, and the time of the respondent is wasted. The reason for this rests on the thoughtlessness or selfishness of the one who makes the call. He rings and asks for a certain connection, and then hangs up his instrument, goes away to wait for a summons. In the meantime the respondent answers, stays by his instrument, “central” endeavors to call up the caller, perhaps through another office, the connection is often broken, and after much tribulation the connection is fully made. This is of very frequent occurrence and could be avoided, for the most part, by the caller staying by his instrument for the few seconds usually required to make the connection. There are occasional instances of bad management and some ugliness in the central office, but they are quite rare, and the service is very prompt. More delay and annoyance are caused by thoughtlessness of the users of the telephone than by any neglect of duty on the part of the operators at the central offices. One who is called up has a right to consider that he is wanted, and that promptly. It is the duty of the caller to be careful not to annoy the central office or waste the respondent’s time. Moral: When you call, stay by your instrument till the reply comes.

OFFICIAL ORTHOEPY.

The Mayor has made his appointments to the vacancies in the Board of Education. The proper assumption is that they are all good men and true, able to read, write and cipher. It would be worse than libelous to give houseroom to the rumor that any member of this responsible Board ever “made his mark.” One would be properly horrified at the audacity of the narrator of such a tale as the following: A member of a local committee entered the class-room as the teacher was conducting the recitation in spelling from the Reader. After listening for awhile, he intimated his desire “to give out a few words,” which desire was politely acceded to, and the book handed to him. A number of words were correctly and promptly spelled, and he gave out the word “Egg-pit.” One child after another was downed by the astute member until the teacher, in pity for her flock, suggested that the word was not in the lesson. Smiling disdainfully at her ignorance and presumption, he pointed his No. 11 forefinger to E-g-y-p-t. Tableau. The Directory for 1888 intimates that we live in a city of nearly 800,000 inhabitants.

_PROCEEDINGS OF SOCIETIES._

THE MEDICAL SOCIETY OF THE COUNTY OF KINGS.

A regular monthly meeting of the Medical Society of the County of Kings was held at the rooms of the Society, No. 356 Bridge Street, Brooklyn, on June 19, 1888.

The meeting was called to order at 8.30 P. M., with Dr. Wallace in the chair. There were eighty members present.

The minutes of the previous meeting were read, and on motion adopted as read.

The Council reported favorably on the names of the following gentlemen: Drs. Sidney Allen Fox, George H. Treadwell, Fred. L. Goddard, Stanton Allen, Horace B. Scott.

The following gentlemen were declared elected members of the Society: Drs. Chas. S. Fischer, James L. Carney, Eliot Gorton, Heber N. Hooper, Henry H. Morton, Geo. B. Rockwell, Lewis S. Meeker.

The following gentlemen were proposed for membership:

Dr. J. Le Roy Tettemore, 128 Rockaway Avenue; graduated at L. I. C. H., 1881, proposed by Dr. J. H. Hunt and seconded by Dr. W. B. Chase.

Dr. Stanton Allen, 114 Montague Street, graduated at College of Physicians and Surgeons, 1881, proposed by Dr. Richmond Lennox and seconded by Dr. J. S. Prout.

Dr. James W. E. Roby, 115 Lee Avenue, graduated at Medical Department, N. Y. University, 1887, proposed by Dr. D. Myerle, seconded by Dr. W. M. Hutchinson.

Dr. Charles G. Purdy, 56 Pulaski Street, graduated at the University of the City of New York, proposed by Dr. Chase and seconded by Dr. Little.

The Secretary stated that the name of Dr. Stanton Allen was among the propositions for membership presented at this meeting, and also among those reported favorably by the Council.

He said in explanation that Dr. Allen’s diploma had been sent to the Board of Censors and passed upon before his name had been proposed, in order that the diploma might not remain with the Censors till next September.

This was an infringement of the By-Laws upon admission of members, but if no objection was raised, the By-Laws would be waived in this case.

No objection was offered.

SCIENTIFIC BUSINESS.

The first paper of the evening, “On the Relation of the Bacillus Tuberculosis in Pulmonary Phthisis,” was read by Dr. I. H. Platt, of Lakewood, N. J., and discussed by Drs. G. R. Butler, J. M. Van Cott, J. H. H. Burge, P. H. Kretzschmar and G. A. Evans.

The next paper was “A Case of Dystocia and Double Phlegmasia-dolens,” by Dr. Lucy M. Hall. This was discussed by Drs. Dickinson, Thayer, Skene, Chase, Schenck and Harrigan.

A paper, entitled “Note on the Disinfection of Physicians’ Clothing,” by Dr. R. L. Dickinson, was then read and discussed.

REPORTS OF COMMITTEES.

The President called for the report of the Obituary Committees upon the late Drs. Chapman and Mitchell.

The obituary report of the late Dr. Chauncey L. Mitchell was then read by Dr. Burge, as follows:

Chauncey L. Mitchell, whose ancestors were of Puritan stock, coming to this country from Halifax, England, as early as 1635, was born in New Canaan, Connecticut, November 20, 1813. An excellent general education, obtained here and at Union College, Schenectady, was supplemented by a full course of study in the medical department of the University of the State of New York, better known as the College of Physicians and Surgeons, where he was graduated in 1836. The next twelve months were spent in the New York Hospital, and the succeeding two years on the continent of Europe. All who knew Dr. Mitchell intimately are so familiar with his studious habits that they need not be told that he never lost an opportunity for observation and improvement. This was true of him, not only during the period of his pupilage, but in all the fifty years of his active practice, five of which were in the City of New York. He came to Brooklyn in 1844, was admitted to membership in the Society of the County of Kings soon after, and was thrice honored by an election to its highest office. All the duties of his active life he performed with dignity and zeal. No one more than he enjoyed the uninterrupted confidence and affection of this community. Among his friends and patients were numbered the best of our citizens, and he is now equally missed in the profession, in the church and in the household. Dr. Mitchell was an earnest and devout believer in the Christian religion. His connection with the Church of the Pilgrims antedates the pastorate of the Rev. Dr. Storres, between whom and himself there was an intimate, personal and professional relationship for forty years.

Dr. Mitchell’s powers of observation and discrimination and his exactness of verbal expression were so excellent, that we regret that he did not give more time to authorship. An article on “The Effects of Ergot,” “Labor Complicated with Disease of the Heart,” and an occasional contribution to the journals, are all that we can find of his writings.

During the period of declining health, which occupied more than two years, Dr. Mitchell resigned many positions of responsibility, yet, at the time of his death, he was Sn. member of the Council of the Long Island College Hospital, member of the Amer. Med. Asso., Consulting Surgeon to St. John’s Hospital, to L. I. Coll. Hospital and to the Home for Aged Men, a member of the New York Academy of Medicine, New York Co. Med. Soc., and Kings Co. Med. Asso. He was also a life member and Corres. Sec’t’y of the L. I. Historical Society. It is matter of record that he was once a member of the Medical Staff of the Brooklyn City Hospital, and that he also filled with honor the Professorship of Obstetrics in the Castleton Medical College.

In 1843, Dr. Mitchell married _Caroline_, daughter of Hon. B. F. Langdon; in 1857, _Frances_, daughter of Hon. Benjamin Wright; in 1875, _Kate_, daughter of Hon. J. M. Van Cott, of this city.

Dr. Mitchell’s tastes were professional, literary, artistic and religious, but the centre of all was his own home. In the house which he had built more than forty years before, he died on the 8th of May, 1888, terminating a long career of untiring usefulness.

Mr. Chairman: In the preparation of this minute for the records of the Society, your committee have recognized the fact that they were appointed for this simple duty only. The pronouncing of a suitable eulogy belongs to other hands and to another occasion. We offer for your consideration the following:

_Whereas_, In obedience to the Divine Law the fully matured life of Chauncey L. Mitchell is ended on earth, and

_Whereas_, He was destined to fill a high position in the profession of medicine and as a citizen of this country, and

_Whereas_, He met all these requirements, fulfilled every duty, and discharged every obligation in such manner as only a highly cultivated, educated and honest man could, and

_Whereas_, When the end came, those who knew him best could truly say that he had left nothing undone to complete a noble, highly useful and honorable life;

_Therefore be it resolved_, That while paying this tribute to his memory we desire to express our high appreciation of his many virtues, and that while we deeply feel our loss, we also cherish his memory, and are grateful for the honor, dignity and advancement which his life’s work gave to this Society.

_Resolved_, That we offer our deepest sympathy to his bereaved family, and that a copy of these resolutions be conveyed to them as a humble tribute to his superior worth.

All of which is respectfully submitted by your committee.

J. H. HOBART BURGE, M.D.,
ALEX. J. C. SKENE, M.D.

The report of the Obituary Committee, as above, was accepted and committee discharged.

The Resolutions introduced by this committee were adopted as read.

NEW BUSINESS.

The Chairman read a communication from the Secretary of the Kings County Pharmaceutical Society, stating that the term of office of the two members of the Board of Pharmacy from this Society had expired, and asking that their places be filled.

THE PRESIDENT.—As I understand it, our elections take place only at the end of the year, and if this communication is to be acted upon, it will be necessary for the Society to pass a special resolution authorizing the election of these gentlemen. If it is the desire that the Society pass such a resolution, a motion will be in order.

A MEMBER.—I move that the By-Laws be suspended so that the election may be had this evening. Carried.

THE PRESIDENT.—Nominations are now in order. The present incumbents are Dr. J. H. Hunt and Dr. C. E. De La Vergne.

A MEMBER.—I move that the two present incumbents be continued in office, if it be the voice of this Society, until the annual meeting.

Seconded and carried.

There being no further business, the Society adjourned.

W. M. HUTCHINSON, M.D., _Secretary_.

_PROGRESS IN MEDICINE._

PREVENTIVE MEDICINE.

BY ELIAS H. BARTLEY, M.D.,

Professor of Chemistry and Toxicology, and Lecturer on Diseases of
Children, Long Island College Hospital, Brooklyn.

THE GERM THEORY A CENTURY AGO.

Under this caption the British Med. Journal for February 11, 1888, contains an editorial review of a pamphlet of 87 pages, published in 1788, and entitled: “_A Treatise on Fevers, wherein their Causes are exhibited in a new point of view, to prevent Contagion; and Putrid Sore Throat, Inflammatory Fluxes, Influenza, Consumptions, as well as the Low Nervous Fevers that terribly affect the Spirits, may be cured with ease_.”

The most remarkable part of the book is the speculative or explanatory part, consisting of an exceedingly ingenious argument, based upon the analogy of admitted facts, to prove that the cause of contagious fevers is some invisible noxious matter in the air. Of the intimate nature of this matter he says: Some consider it to be a sulphurous exhalation from the earth; but this cannot be, for, if so, acrid and sulphurous fumes would increase it, instead of checking or annihilating it. Another theory is that it is due to the products of putrefaction; but how can dead putrid matter ever get such activity as to work such astonishing results? It must therefore be something endowed with a more powerful activity than anything belonging to the mineral kingdom or simply putrefying matter, and must, therefore, be something “actually living.” He further concludes that these living organisms must have an existence independent of the body in which they are found. For this view, surprising and novel enough at first, loses some of its singularity, if we search for resemblances elsewhere. Now, just as it was well known that itch is due to the presence of acari, insects visible by the aid of the microscope, so close attention to these matters in numberless cases during many years, has proved beyond a doubt that the gaol distemper, putrid fever, plague, and infectious epidemics generally, proceed not from matter putrid in itself, but from invisible insects also, that, floating in the air at times, are lodged in the skin in immense quantities; feeding here in clusters, they produce pimples, pustules, etc.; for instance, the eruption of small-pox. He overlooks, or fails to mention, the possibility of their entering by the air passages or digestive system. “Medicines,” he says, “which poison insects without injuring the constitution have always proved specific.” These insects, which constitute contagion, are communicated by air, the raiment, as by contact. He admits that vegetables as well as animals suffer from the ravages of these animalcules. He believed that they originated from eggs and not _de novo_. He advises fumigations with sulphur and frankincense to destroy contagion in rooms, and shows that many diseases in lower animals are cured or prevented by the use of certain agents known to kill insects.

In summing up his theory, he says that, generally speaking, there are two sources of these animalcules. First, from subterranean sources, which operate in all sorts of weather and are accompanied by electrical phenomena. Second, from the surface of the earth, swamps, filthy lakes, stagnant ponds, etc. The eggs left on the soil develop in summer, and “the multitudes effluviate into air.”

The essay is interesting to us because of the very clear foreshowing of a theory that we are apt to regard as the creation of recent years. It is a good example of the power of attentive observation and inductive reasoning, which is so seldom met with even in scientific medical men of the present day.

ALBUMINURIA A FREQUENT RESULT OF SEWAGE POISONING.

Dr. George Johnson, in _Br. Med. Jour._ for March 3d, gives the histories of four cases of albuminuria which he believes were the result of breathing sewer air. In addition to other diseases, the result of drain poison, the author has met with several cases of albuminuria which he believes can and does under continued exposure to the sewer poison, result in incurable disorganization of the kidneys. He thinks that, in the absence of other probable exciting causes of albuminuria, the possibility of sewer poisoning should be constantly borne in mind. It is needless to dilate upon the importance of discovering the exciting cause of a disease so serious in its consequences as nephritis. In each of the four cases cited, albuminuria and casts were found in the urine, and blood in two of them. In each case defective drainage was proven, and in two of the four an immediate improvement occurred on removing this cause. One proved fatal from suppression of the urine.

The author suggests as an interesting point, that amongst the various diseases resulting from drain poison, diphtheria is in a very large proportion of cases associated with albuminuria.

It would be interesting to know whether a large proportion of cases of diphtheria occurring in houses having defective plumbing suffer with albuminuria, than in houses where no such defect exists. If these observations are confirmed, we may learn from them something of the cause of the great fatality of scarlet fever and diphtheria in houses which contain defective drains.

SEWER-AIR POISONING.

The question of sewer-air poisoning has received no inconsiderable attention at the hands of sanitarians within the past few years, some claiming that it is a carrier of many of the contagious diseases, including malarial affections, while others have denied its harmful action in these respects.

The last class, in substantiation of their claim, point to the assumed fact that plumbers and those who work in sewers are not, as a rule, especially subject to the diseases generally attributed to sewer air. That plumbers are not exempt from troubles of this kind is attested by numerous examples. According to _Science_, an inquest was recently held in Liverpool, Eng., on the body of a plumber’s apprentice who had been engaged in repairing pipes which connected with the sewer. Quantities of gas came through these pipes, and at the time the young man complained of pain and sickness, and died forty hours afterward. The jury rendered a verdict of poisoning by sewer air.

According to the _Sanitary News_, Dr. Vaughn, of the Michigan State Laboratory of Hygiene, claims to have found the specific germ of typhoid fever in the air of a soil pipe from the prison at Jackson, in that State, during an outbreak of typhoid fever.

The _Sanitary Inspector_ for February and March, reproduces from the _Medical News_ an article by Dr. Henry Hun upon this subject. Dr. Hun cites twenty-nine cases in support of his statements. The histories are those of non-contagious diseases, and therefore were probably cases of illness produced by non-infected sewers. He says: “In all of these twenty-nine cases there was an escape of a large amount of sewer gas into the air which the patients breathed; and at the time that the case was observed, it seemed extremely probable that the sewer gas was the cause of the disease.

“From the consideration of these twenty-nine cases, we may conclude that it is probable that the following conditions may result from sewer-air poisoning:

“1. Vomiting and purging, either separately or combined.

“2. A form of nephritis.

“3. General debility, in some cases of which the heart is especially involved.

“4. Fever, which is frequently accompanied by chills.

“5. Sore throat, which is frequently of a diphtheritic character.

“6. Neuralgia.

“These conditions may occur separately, but are frequently combined, and it is especially common for the fever to be associated with other symptoms of sewer-gas poisoning. Finally, in cases of sewer-gas poisoning, there is one group of symptoms which is almost always prominent, and these symptoms are: loss of appetite, drowsiness, extreme prostration, and a dull, unpleasant feeling in the head; and whenever this group of symptoms occurs, not as the result of an attack of acute disease, but as a chronic condition, we are justified in suspecting that the patient is exposed to sewer-gas infection.”

EFFECTS OF FOOD PRESERVATIVES ON THE ACTION OF DIASTASE, PANCREATIC
EXTRACT AND PEPSINE.

This subject has recently received experimental study at the hands of Dr. Henry Leffman and William Beam, the results being published in the _Analyst_ for June, 1888.

The antiseptics selected were those which have been known to be used to preserve articles of food and drink. They were salicylic acid, boric acid, sodium acid sulphite (sodium bisulphite), saccharine, beta-naphthol and alcohol.

In the following experiments a solution of arrow root starch, 30 grains to the litre, was used.

To 100 c.c. of this solution was added 0.5 c.c. of maltine diluted to 50 c.c. with water.

The figures give the proportion of antiseptic to the whole volume of liquid.

_Experiments with Maltine._

_Antiseptic used._ _Amount._ _Fehling’s Solution reduced by the Maltose formed._

None. None. 245 cc. Salicylic acid. 1 to 500. No sugar formed. Salicylic acid. 1 to 1,000. No sugar formed. Salicylic acid. 1 to 20,000. 245 cc. Boric acid. 1 to 1,000. 245 cc. Sodium bisulphite. 1 to 1,000. 245 cc. Saccharine. 1 to 1,000. 18.5 cc. Saccharine. 1 to 500. 5.6 cc. Beta-Naphthol. 1 to 1,000. 204 cc. Beta-Naphthol. 1 to 500. 174 cc. Alcohol. 1 to 25. 245 cc.

Experiments with varying amounts of diastase showed that one part of salicylic acid to 1,000 of liquid prevented the diastasic action completely. Saccharine in the proportion of 1 to 1,000 prevented the formation of sugar when the proportion of diastase was 1 to 1,000 of liquid. When the proportion of diastase was reduced to 1 in 2,000, salicylic in the proportion of 1 to 3,000 prevented the formation of sugar. It seems, then, that the weaker the diastasic solution, the more is its action hindered by salicylic acid, saccharine, etc. Sodium bisulphite has little if any power of hindering diastasic power.

_Experiments with Fairchild’s Pancreatic Extract._

_Antiseptic._ _Amount._ _Fehling’s Solution required._

None. None. 78 cc.
Salicylic acid. 1 to 1,000. No sugar formed.
Saccharine. 1 to 1,000. No sugar formed.
Beta-Naphthol. 1 to 1,000. 78 cc.
Boric acid. 1 to 1,000. 78 cc.
Sodium bisulphite. 1 to 1,000. 80 cc.

The tests were made with 0.2 grams of the extract.

It seems from these experiments that salicylic acid and saccharine, in the proportions used, entirely prevent the action of pancreatic ferment upon starch.

In similar experiments with saccharated pepsine with hydrochloric acid, except that the temperature was kept at 105° F., sodium bisulphite and boric acid were without effect.

Saccharine and salicylic acid had a slightly retarding action. Beta-naphthol almost entirely prevented the action.

With pancreatic digestion of albumen the results were practically the same, but the retarding action of the salicylic acid and saccharine was not quite so well marked.

From these experiments it will be seen that salicylic acid prevents the conversion of starch into sugar under the influence of either diastase or pancreatic extract, but does not seriously interfere with peptic or pancreatic digestion of albumen. Saccharine holds about the same relation as salicylic acid.

Sodium bisulphite and boric acid are practically without retarding effect.

Beta-naphthol decidedly interferes with the formation of sugar by diastase, but not with the action of pancreatic extract on starch.

It almost entirely prevents both peptic and pancreatic digestion of albumen.

The bearing of these experiments upon the sanitary question of permitting the use of these preservatives in foods, is self-evident. Prof. Leffman says: “Their use is scarcely allowable under any circumstances, and certainly only when the nature of the preservative and the amount is distinctly stated.” The use of saccharine as a sweetening agent must be looked upon as deleterious to health, and ought to be forbidden by sanitary authorities.

MILK AND SCARLATINA.

In a recent number of the JOURNAL, we published an abstract of the reported investigations of Mr. Power, Dr. Cameron and Dr. Klein of a disease among cows, which they believed had caused scarlatina among persons using the milk. The conclusions reached by these gentlemen seemed so startling that the Agricultural Department of the Privy Council began an investigation of the disease. The investigation was given into the hands of Dr. Cruikshank, whose reports are published in the _British Medical Journal_ of December 17, 1887, and January 21, 1888.

We have only space here to reproduce the conclusions reached by Dr. Cruikshank, which are as follows:

1. The nature of the contagium of scarlet fever is unknown.

2. The micro-organism regarded by Dr. Klein as this contagium is the _streptococcus pyogenes_.

3. _Streptococcus pyogenes_ is found sometimes in company with _staphylococcus pyogenes aureus_, as a secondary result in scarlet fever and many other diseases.

4. A streptococcus was first observed in scarlet fever by Crooke, later by Löffler, Huebner and Bahrdt; but its exact relation to scarlatina, and its undoubted identity with the streptococcus from pus and puerperal fever, was definitely established in 1885 by Frankel and Freudenberg.

5. Both the Wiltshire and Hendon cow diseases were called cow-pox by the people on the farms.

6. Both diseases correspond in their clinical history.

7. The ulcers on the teats correspond in naked eye and microscopical appearances, and the latter vividly recall the appearances of cow-pox.

8. Calves inoculated from the discharges of the ulcers are similarly affected.

9. _Post-mortem_ examination of such calves, or of calves inoculated with streptococci isolated from scarlet fever cases, show similar appearances.

10. The _post-mortem_ appearances in such inoculated calves are the result of septicæmia.

11. There are no specific visceral changes in cow-pox, apart from complications or coincident affections.

To the above criticism of Dr. Klein’s investigation of the Hendon cow disease, this gentleman claims that Dr. Cruikshank studied a different affection, and that the organisms were not the same. It is insisted upon by Dr. Klein, that Dr. Cruikshank’s conclusions were the result of studying cow-pox and not the peculiar disease he described as the Hendon cow disease.

THE CAUSE OF DEATH IN PHTHISIS.

Dr. R. W. Philip has made an experimental study to determine the cause of death in phthisis. The results of his study are published in the _Brit. Med. Jour._ of Jan. 28th, 1888.

His experiments were conducted with an extract prepared from fresh sputum from phthisical patients, as follows:

The sputum was treated with alcohol, put in a sterilizer, and heated to 37 to 40° C. for some time, filtered clear, and evaporated at a low temperature until the alcohol was expelled. This extract was used for subcutaneous injections in frogs, mice, and rabbits.

This extract was found to possess very marked toxic properties upon these animals, which manifested themselves by a depression of the higher nerve centres and of the heart. The depressant action upon the heart seemed to be exerted through the cardio-inhibitory mechanism, and is more or less completely antagonized by atropine.

The toxic principle he believes to be the result of the growth of the tubercular bacilli, and allied to the ptomaines. He found the quantity of the substance to be extracted from the sputum to be proportional to the abundance of the bacilli present in it. These observations are in accordance with the observations of various experimenters with other pathogenic organisms, and with the theory that seems to be gaining ground that immunity is the result of such by-products of the growth of these organisms.

SURGERY.

BY GEORGE R. FOWLER, M. D.,

Surgeon to St. Mary’s Hospital and to the Methodist Episcopal Hospital,
Brooklyn.

CONTRIBUTIONS TO THE STUDY OF MYXŒDEMA FOLLOWING TOTAL OR PARTIAL
EXTIRPATION OF THE THYROID BODY.

J. L. Reverdin (Congrès Francais de Chirurgie, 2 session, Paris, 1886.) This disease, following frequently in the after-history of cases of extirpation of the thyroid body, and called by Kocher, of Berne, cachexia stumpriva, was first described by Reverdin, and by him called “operative myxœdema.” His description of this disease coincides in general with the views now generally held, although we find some not unimportant deviations from Kocher’s conclusions; for instance, the latter observed the disease twenty-four times following thirty-four operations, it appearing to attack by preference those who had not attained their full development. On the other hand, R., basing his experience upon copious statistics, believes the disease is comparatively rare, following upon operations of the thyroid in only twenty-seven per cent. of cases. In his experience, it likewise preferably attacks children and young persons, but that it occasionally fails to occur after complete thyrotomy. Further, R. has observed a milder form of the disease, differing essentially from the graver type of the affection, which latter invariably tends progressively to a fatal termination. In the milder form, the disease is described as oscillating between relapses and improvement, lasting for years, cure sometimes resulting. Several cases are detailed supporting these observations. In two of these, it was supposed that the thyroid had been extirpated in toto, but it was subsequently discovered that a small portion of the gland had remained. Three cases are worthy of especial note. In these, after partial extirpation, in one the right lobe, and in two the left having been removed, an imperfect form of the disease made its appearance after several months. The characteristic signs, such as swelling of the face and limbs and hesitancy of speech and of muscular movements were absent; while the other symptoms, such as general weakness, pains in the limbs, chest, and head, greater or less loss of memory, chilly sensations, reminded one distinctly of the more complete form of the disease. In all these cases slow improvement followed. Another case is worthy of notice from the fact that, two months after the operation, the remaining lobe had so atrophied as to be scarcely distinguishable. Cases of this atrophy following partial extirpation have been observed both in Germany and in England.

UPON LUXATION OF THE HEAD OF THE RADIUS FORWARD.

Raestock (Deutsche Militärärztl. Zeitschrift, 1887, p. 331) has, by means of experiments upon the cadaver, shown that this accident occurs in forced pronation while the radius is resting upon the ulna at the point where the former crosses the latter, the ulna acting as a fulcrum. The head of the radius is pressed against its capsule and tears the latter. More rarely, the accident may occur in forced supination, by pressing the bone against the posterior edge of the ulna, the head of the radius being luxated through a rent made by a rupture of the external lateral ligament between the outer and inner sides; upon pronating the hand, this outward dislocation is converted into a forward one. The annular ligament is either torn or else the coronoid process of the ulna is broken. In either case the interposition of the annular ligament in the fold of the joint becomes an obstacle to reduction. In the experiments as detailed, great force was necessary in the production of the luxation.

Should active and passive movements, manipulation, etc., fail to remove the obstacles to reduction, the author advises a resort to secondary resection of the displaced head of the radius; this, with proper precautions, is certainly a most wise and rational procedure.

CHOLECYSTOTOMY, WITH LIGATURE OF THE CYSTIC DUCT.

Zielewicz (Centralblatt f. Chirurgie, No. 13, 1888,) proposes in addition to the so-called “ideal” method of Spencer Wells, that of suturing the gall bladder to the abdominal wound, to ligate the cystic duct, in order to insure the patient against the return of the biliary lithiasis. The only case in which he has tried it was one in which an attempt was being made to perform cholecystectomy, but the adhesions between the gall bladder and liver were so dense and unyielding as to render the removal impossible, on account of severe hæmorrhage. He therefore passed two ligatures around the cystic duct and divided the latter between them. The gall bladder was then fastened to the abdominal wound, incised and emptied of its contained calculus and biliary secretion. The patient made a good recovery, a fistula remaining, of which the writer says, that “after a time it was almost closed.”

The author claims for this operation the following advantages: 1st. Rapid healing without a resulting fistula. The gall bladder is practically removed from the organism. With appropriate after treatment, its secretion soon ceases, and it becomes obliterated. 2d. The operation is simple and less dangerous than cholecystectomy, and gives the same results.

In contrasting this operation with cholecystotomy, it may be said that the latter simply aims at removing the existing calculi, and makes no provision against the recurrence of the same. Where the “natural” method of Bernay is adopted, and the gall bladder dropped back into the abdominal cavity after suturing the incision made in its walls for the removal of its contents, in case of a recurrence of the disease, the entire operation must be repeated. In the “ideal” method of Spencer Wells, only an incision need be made, in such an emergency, at the site of the first operation. Troublesome fistulæ, however, are apt to remain.

In cholecystectomy, on the other hand, hæmorrhage from breaking down of adhesions between the gall bladder and the surface of the liver, it is claimed, is a frequent and troublesome complication. It is claimed by Thiriar, however (“De l’intervention chirurgicale dans certains cas de lithiase biliaire,” _Revue de chirurgie, 1886, No. 3_), that cholecystectomy is a less dangerous operation than simple cholecystotomy. Again, by Bardenheuer, that hæmorrhage from the liver can be readily arrested. The abstractor witnessed an operation in which the liver was accidentally wounded and the resulting hæmorrhage arrested by the thermo-cautery.

Hertin, a French naval surgeon, in 1767, after experiments made upon dogs, proposed, in wounds of the gall bladder, extirpation of the latter, after ligature of the cystic duct. In these experiments he demonstrated the feasibility of the operation of cholecystectomy upon the lower animals, at least.

Campaignac, in 1826, proposed ligature of the cystic duct, with partial resection of the gall bladder (Journ. hebdom. Bd. ii, 1829). K. Zagorski has recently attempted this latter procedure on dogs, with fatal results (Przegl. lekarski, 1887, No. 48). Nevertheless, to Zielewicz belongs the credit of being the first to demonstrate, by its successful performance, the feasibility of combining in man the two operations of ligature of the cystic duct and cholecystotomy with suture of the gall bladder to the abdominal wound. Upon further trial the operation may prove to be not only feasible, but to follow out a rational indication with relative safety.

SUPRA-PUBIC PROSTATECTOMY.

A. F. McGill, F.R.C.S. (_The Lancet_, February 4, 1888). The operation consists of two parts: (1) The opening and drainage of the bladder; and (2) The removal of the prostatic valve which prevents the egress of the urine. A full sized silver catheter, curved according to the nature of the case, is passed into the bladder, its contained urine withdrawn and its cavity washed out with a warm saturated solution of boracic acid till this is returned clean and unchanged. The usual rubber rectal bag is now introduced and filled with fourteen ounces of water. The bladder is now rendered prominent by injecting it with a sufficient amount of warm boracic acid solution. The catheter is retained in the bladder, and the fluid with which the latter has been distended, prevented from escaping. The usual median supra-pubic incision is now made, the bladder exposed and made to project into the abdominal wound by depressing the catheter. A large curved tenaculum is now passed transversely into the bladder, touching as it goes the point of the catheter. An incision is now made longitudinally through the bladder wall, the fluid being prevented from escaping by plugging the opening with the finger. The bladder is now seized with nibbed forceps, and applied on each side of the incision, the catheter is withdrawn from the urethra and the bag from the rectum, and the first part of the operation is complete. The interior of the bladder and its neck is now examined, in order to ascertain the exact nature of the prostate enlargement. A pedunculated middle lobe can be removed with the curved scissors, but in the case of a sessile middle lobe, this must be assisted with the finger and forceps. The “collar” enlargement is removed with greater difficulty. In order to insure the patency of the urethra, it is advised to pass the forefinger into the canal as far as the first joint. It is claimed that the hæmorrhage is not excessive. The operation completed, drainage is effected by passing a rubber tube out of the abdominal wound, the latter being partially closed by a point or two of suture. The tube is removed after forty-eight hours.

The author’s experience is limited to five cases, four of which have proved successful, while the fifth case is still under treatment. He claims that, in cases operated upon early, before diseased bladder or surgical kidney have developed, a radical cure may confidently be expected.

Two objections to this method occur to us: (1) Whoever has performed or witnessed supra-pubic cystotomy, either for the purposes of removal of a calculus or a neoplasm from the interior of the bladder, must have been struck by the difficulties in the way of a thorough appreciation of the condition of its posterior wall low down, or of the cystic neck. Unless specially devised instruments are available for each particular form of prostatic enlargement, it would seem to be a matter of great uncertainty as to just how much of the growth is removed. (2) Until satisfactory granulation of the wound surfaces has been accomplished, drainage, to be efficient, must be facilitated by placing the patient upon one or the other side, a position difficult to maintain, particularly in old people.

RESEARCHES UPON THE VAGINAL PROCESS OF THE PERITONEUM AS A PREDISPOSING
CAUSE OF TENDENCY TO EXTERNAL INGUINAL HERNIA.

H. Sachs (Archiv. f. Klinisch. Chirurgie, Band xxxv., p. 321–372) advocates quite decidedly the view, basing his opinions upon preparations of the spermatic cord examined and upon microscopic examinations of cross sections of the latter, particularly as to the relations of the vas deferens and the vessels to the vaginal process of the peritoneum, that the latter is formed before the beginning of the descent of the testicle rather than as a portion of the abdominal wall formed or dragged into position by the testicle in its descent. In proof, he alleges that he has always found, in cases of incomplete descent of the testicle, that organ upon the posterior wall of the vaginal process, and not on the floor of the same. In females, the formation of the canal of Nuck cannot be said to be due to any dragging.

The entrance to the opening of the vaginal process is found covered by a valve arrangement, and the same is particularly noticeable in the canal of Nuck. The opening of the vaginal process can be caused to gape through a spreading out of the mesentery attached to the ilium or that of the sigmoid flexure. The diameter of the opening is, in general, greater on the right side than on the left in boys, while in girls this difference is not observed. Further, the different forms of the incompletely obliterated opening of the vaginal process agrees with the most frequently occurring forms of the hernial sac in inguinal hernia. The relations of the vaginal process to the elementary parts of the spermatic cord are not constant. On the contrary, the relations which the smooth muscular structures of the cord bear to the vaginal process, in so far as their arrangement into bundles, and their positive relation to the posterior and lateral walls of the same are concerned, are quite constant, and almost form an integral part of the same. The obliteration of the vaginal process depends upon a granulating process, which begins in the middle third of the funnicular portion, and from thence proceeds more rapidly in a downward than in an upward direction. This granulation formation takes place essentially during the first ten to twenty days after birth; after this time it takes place more slowly. The canal of Nuck, on the contrary, is found to have almost entirely disappeared at the time of birth. They are both found to be more frequently open upon the right side.

From these observations it would appear that it is not essential to the production of inguinal hernia that a broad and short inguinal canal should be present. The only essential predisposing cause, in children at least, depends upon the condition of the vaginal process of the peritoneum itself.

The question of the legal responsibility of employers is an interesting one, in connection with this question. Hernia cannot be considered as an accident, in the surgical sense, according to Socin (Korrespondenzblatt f. Schweizer Aertze, 1887, No. 18), but is really a slowly occurring disease, to which certain well-defined anatomical peculiarities act as predisposing causes.

ACID SUBLIMATE SOLUTION IN SURGERY.

E. Laplace (Deutsche Med. Wochenschrift, No. 40, 1887), after repeated and careful examinations and experiments, became convinced that dressing materials consisting of wood-wool, made with sublimate in the usual manner, were far from being germless themselves, much less efficient as antiseptic applications. Gauze, however, showed much better results, but were far from realizing an idealistic asepsis. He likewise found that ordinary sublimate, in the presence of albuminous material, is quickly precipitated and becomes at once ineffective. L. experimented at first with hydrochloric acid as a means of preventing changes in the sublimate from occurring in the presence of organic matter, and particularly albuminous material. But, as hydrochloric acid itself was far from possessing the stability needful for the purpose of preparing dressings, he substituted for it, with the most gratifying results, tartaric acid. The proportions are as follows: sublimate, 1 part; tartaric acid, 5 parts; distilled water, 1,000 parts.

OPERATIVE TREATMENT OF PYOTHORAX.

E. Rochelt (Wiener med. Presse, No. 32 and 38, 1887). The expansion of the lung is greatly impeded after the usual operation for empyema by incision, by the free entrance of air in the pleural cavity. Mader, Subbolik and Immerman devised means for preventing this. R. operates by first resecting a rib, leaving the periosteum intact, and subsequently opening the pleural cavity by means of a trocar and canula. A drainage tube accurately filling the latter is now introduced, through which a disinfecting fluid is injected and its outer opening closed by means of a spring clamp. The tube is connected to an aspirating bottle, into which the pus is discharged. The tube is again clamped, and the bottle into which the pus has been aspirated removed, being replaced by another containing a sublimate solution, 1 to 500. Removal of the clamp and raising and lowering the bottle thoroughly irrigates the pleural cavity. This being accomplished, the patient holding his breath in expiration, and the clamp again applied, the irrigating bottle is removed, and a short hard rubber tube connected to the outer end of the drainage tube. This hard rubber tube has a soft rubber diaphragm which acts as a check valve, effectually preventing the ingress of air during inspiration, but in no wise interfering with the egress of fluid from the pleural cavity during expiration, fits of coughing, etc. For purposes of further irrigation the short rubber tube containing the valve may be removed after guarding against the entrance of air by clamping the drainage tube beyond, and the washing bottle reapplied. During the intervals of irrigation, absorbent antiseptic dressing are kept applied.

The abstractor would suggest the application of this method, particularly in recent cases and in children, without the previous resection of a rib. The increased support afforded the canula by the greater thickness of the thoracic walls would be a still greater safeguard against the entrance of air into the pleural cavity. A certain proportion of acute cases will recover without resection of a rib.

WOUND-HEALING UNDER THE DRY ASEPTIC SCAB.

Prof. Kuester (Centralblatt f. Chirurgue, March 17, 1888,) in reply to remarks made by Dr. Sonnenberg before the Association of Berlin Surgeons, January 9, who characterized K’s method of treating the wound after the operation for the radical cure of hernia as an “open method,” objects to this designation of his method, and takes occasion to more fully describe his method as follows: After the reduction of the contents of the sac, the latter is sutured and excised, and the ring is also closed by suturing. The wound cavity itself is now closed by several rows of buried sutures, so arranged as to bring together the edges of the several layers, tissue to like tissue. In congenital cases he does not loosen the sac, but sutures its opposing surfaces down to the point where the testicle lies free. The wound of the skin is now closed by a continuous silk suture, and an iodoform and collodion mixture brushed over the line of suturing until it is perfectly covered in and blood no longer oozes through. No drain is used, and no further dressing is deemed necessary. If, after two or three days, a split occurs in the scab or crust formed by the drying of the iodoform and collodion, the gap is quickly filled by a slight oozing from the deeper portions of the wound, which, upon drying, becomes a bar against infection.

There can be no doubt, if thorough asepsis is observed and obtained during the operation, the method of completely obliterating every space in which blood clot or serum could accumulate would do away with the necessity for drainage. This granted, it follows, as a natural sequence, that absorbent dressings are superfluous, simple protection of the line of suturing from atmospheric influences, infection, etc., being alone indicated. The iodoform and collodion compound would seem to fulfil this admirably. The method could scarcely find application in large or deep wounds, particularly if the latter invaded planes of dense connective tissue, fasciæ, etc. Here it would be manifestly best to provide drainage, etc.

In marked contrast to K’s method is that of McBurney, who, providing against infiltration by suturing the entire thickness of each edge of the wound together in such a manner as to render it practically but one layer, packs the wound cavity, and thus obliterates the inguinal canal, the latter filling up by granulation, a firm cicatricial plug taking its place.

THE TREATMENT OF CAROTID HÆMORRHAGE.