Chapter II: Front Matter (2)

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

The Cleveland Medical Gazette.

_A MONTHLY JOURNAL OF MEDICINE AND SURGERY._

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MEDICAL GAZETTE, No. 5 Euclid Avenue, CLEVELAND, OHIO.

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

EDITORIAL.

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

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

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

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

THE FASHIONABLE HOBBY.

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

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

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

OLEOMARGARINE.

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

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

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

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

MEDICAL DEFENCE ASSOCIATION.

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

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

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

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

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

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

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

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

PRELIMINARY EDUCATION OF MEDICAL STUDENTS.

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

TO REGULATE THE STUDY OF MEDICINE.

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

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

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

II.— An essay.

III.— Writing from dictation.

IV.— Spelling—Oral and Written.

V.— Reading.

VI.— Geography—Descriptive, Physical.

VII.— Political Economy.

VIII.— History—Ancient, Modern.

IX.— Geology.

X.— Botany.

XI.— Chemistry.

XII.— Natural Philosophy.

XIII.— Mathematics— Arithmetic complete;

Algebra, through quadratic equations;

Geometry, through plane geometry.

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

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

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

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

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

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

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

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

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

* * * * *

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

SOCIETY PROCEEDINGS.

PROCEEDINGS OF NORTH CENTRAL OHIO MEDICAL SOCIETY.

TWENTIETH QUARTERLY SESSION.

GALION, OHIO, December 18, 1885.

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

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

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

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

And on dogs:

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

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

Sulphuric ether, None
at
all.

Chloroform, 2
times.

Alcohol, chloroform and ether, 3
times.

Alcohol, chloroform and ethyl, 5
times.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

J. F. MARKEL, Secretary.

THE AMERICAN PUBLIC HEALTH ASSOCIATION.

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

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

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

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

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

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

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

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

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

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

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

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

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

DR. HIMES presided.

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

OBSTETRICS.

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

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

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

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

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

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

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

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

DISEASES OF CHILDREN.

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

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

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

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

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

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

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

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

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

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

NEW BOOKS.

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

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

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

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

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

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

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

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

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

W. T. CORLETT.

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

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

THE ASTRONOMIC DOCTOR.

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