Halstead Wickes Combi 102 Manual Dexterity

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Full text of ' No. Boston Medical Library, 19 BOYLSTON PLACE. Digitized by the Internet Archive in 2012 with funding from Open Knowledge Commons and the National Endowment for the Humanities THE NEW ENGLAND MEDICAL GAZETTE% 3©ontl)ip journal OF HOMOEOPATHIC MEDICINE 'Die milde Macht is t gross.' VOLUME XXXIV.

BOSTON: OTIS CLAPP & SON, 10 PARK SQUARE. I NDEX Memorial to the Late Dr. Tisdale Talbot 541 COMMUNICATIONS. Address of the President of the Massachusetts Homoeopathic Medical Soci- ety. By Herbert C.

Clapp, M.D 193 Arsenicum Iodide vs. By Carl Crisand, M.D 220 Baths in the Gymnasium. Allen 145 Case of Hysterical Contractures, A. By De Ette Brownell, M.D 421 Cholera Infantum, its Pathology and Treatment. Hodgdon, M.D 213 Construction of a Scientific Materia Medica, The. By Pemberton Dudley, M.D.

355 Convulsions due to Disturbances Located in the Brain and Spinal Cord. Piper, M.D 307 Convulsions from Causes External to the Brain.

Wood, M.D 459 Curative Action of Certain Remedies in Diseases of the Upper Respiratory Tract, The. Rice, M.D 1 Dermatitis Herpetiformis.

Coffin, M.D 70 Differential Diagnosis between Appendicitis and Inflammations of Right Ovary and Tubes, The. Perkins, M.D 507 Discussion of Dr. Talbot's Theory of Vision.

Wells, M.D 449 Electricity in Strictures of the ^Esophagus. Rice, M.D 451 Electro-Traumatism.

Richardson, M.D 495 Expert Testimony. By Alice Parker Lessing 49 Hygienic Treatment of Phthisis at the State Hospital at Rutland, Mass. By Herbert C. -, 397 Ilio-colitis. Van der Burgh, M.D 362 Importance of Correctly Diagnosing Injuries to the Head, The. Louis Hartman, M.D. 498 Initial Lesion of Syphilis and its Treatment, The.

Powers, M.D.. 16 Interesting Symptom, An. Bellows, M.D 1 1 Is Venesection with Saline Transfusion ever Justifiable in the Treatment of Eclampsia? Southwick, M.D 163 Location for a State Homoeopathic Hospital, The. Emmons Paine, A.M., M.D 364 Medical Cases Treated at the Massachusetts Homoeopathic Hospital from April 1 to June 30, 1899. Reported by Edward E. Allen, M.D 349 Mercurials in Diseases of the Nose and Throat, The.

Strong, A.M., M.D 65 Notes on Apomorphia. Hornby, M.D 20 Occipital Posterior Presentations. Worcester, M.D 250 Ocular Indications for Suggestive Therapeutics. Wells, M.D 255 Old Dislocation of the Elbow, An. Tower, M.D 169 Old Friends versus New Acquaintances. Colby, M.D 13 One Year's Work-in Abdominal Surgery.

By Nathaniel W. Emerson, M.D. 60 On the Use of Electrolysis in Facial Blemishes.

Coffin, M.D... 457 Operation for Hemorrhoids, An. By Nathaniel W. Emerson, M.D 303 Peculiar Case of Ectopic Gestation.

By Charles W. Morse, M.D 453 Phenomenon Observed in the Blood of Morphinomaniacs, A. Fuller, M.D 241 Physician and the Public Schools, The. Bennett, M.D 118 4 The New England Medical Gazette. Physiology of Vision, The — A Theory. Talbot, M.D 445 Practical Points in the Practice of Midwifery.

Southwick, M.D • 300 Prevention of Premature Baldness, The. Coffin, M.D 493 Professional Etiquette and Medical Courtesy. By Charles Sturtevant, M.D.

404 Relation of Syphilis to Nervous Diseases, The. Colby, M.D 54 Relation of the Pharmacopoeia to the Question of Potency. Clapp, M.D 105 Saving the Twenty-four Hours' Urine.

Batchelder, M.D 23 Should Physicians Use Therapeutic Suggestion? By Charles J. Douglass, M.D. 297 Some Experiences with the Normal Salt Solution. Wesselhoeft, M.D 410 Some of the Oral Manifestations of Syphilis. Coffin, M.D 260 Some Points in Regard to Hemorrhage.

Powers, M.D 417 Surgical Diseases of the Faucial Tonsils. Strong, A.M., M.D 313 Therapeutic and Sanitary Uses of Bromine Vapor, The. By Dwight Warren, M.D 97 Three Cases of Insanity Complicated with Degenerative Disease of the Kid- neys. Klopp, M.D 155 Treatment of Conjunctivitis and Phlyctaenular Keratitis. Suffa, M.D in Use of Rubber Gloves in Surgery, The.

By Horace Packard, M.D 202 EDITORIAL. Action Taken by the Consulting Board of Westboro Insane Hospital upon the Death of Dr. Talbot 377 Concerning the Medical School *. 426 Consolidation of the Dispensary with the Massachusetts Homoeopathic Hos- pital 267 Death of Dr.

Talbot 324 Dr. Mary Mosher's Letter - 268 Hahnemann Monument Association 176 Intemperate Legislation 173 Ladies' Hahnemann Association 1 74 Late Dr. Talbot, The 464 Meeting and Membership of the Institute 224 New Hospital at Westboro, The 75 New Laboratory of Otis Clapp & Son, The 466 Opening of the New Building at Westboro Hospital 175 Our Duty to Our Medical Schools 25 Report of Committee of American Institute on Death of Dr. 465 Resignation of Prof. Rockwell * 323 Semi- Annual Meeting of the State Society, The ~.

517 Special Meeting of Boston University School of Medicine 378 State Sanitarium at Rutland, The 126 Tribute to the Late Dr. 374 EDITORIAL NOTES AND COMMENTS. Abuse of Public Charity, The 326 American Electro-Therapeutic Association, The 427 American Subscribers 27 Ann Arbor Homoeopathic Hospital 178 Boston Food Fair, The 470 Brooklyn Homoeopathic Hospital 1 78 Diabetes 1 30 Do Physicians and Pharmacists Live on the Misfortunes of Humanity? Dwight Warren 1 78 Index. Henry Houghton 76 Dr. Hunter 76 Dr.

Bennett 178 Homoeopathic Hospital to be Built in Ann Arbor 429 International Congresses at the Exposition of 1900 469 International Homoeopathic Congress, 1900 129 Meeting of the Illinois Homoeopathic Medical Association 237 National Medical College of Chicago 521 New Homoeopathic Pamphlet Series, A 518 Northwestern University Woman's Medical School 1 78 Notice of Gerrish's ' Anatomy by American Authors ' 236 Obituary of Dr. Briry 427 Obituary: William C. Cutler, M.D., Laura Maxwell Porter, M.D 269-271 Report of the Action of the House of Representatives on the 'Hahnemann Monument Bill 227 SOCIETIES. American Homoeopathic Ophthalmological, Otological, and Laryngological Society 389 Boston Homoeopathic Medical Society, 28-34, 78, 131, 179, 272-281, 327, 522, 570 Boston University School of Medicine 340 Hahnemann Medical College 187 Massachusetts Homoeopathic Medical Society 524 Massachusetts Surgical and Gynaecological Society 336 National Society of Electro-Therapeutists 432, 471 New York Academy of Medicine 186 Report of American Institute of Homoeopathy 380 Western Massachusetts Homoeopathic Medical Society 84, 184, 473, 577 Worcester County Homoeopathic Medical Society 430 OBITUARY.

Houghton 95 Dr. Sanders 48 Gleanings and Translations. 34-38, 90-94, 134-140, 293, 390-392, 436-443, 474-489, 527-533.

Reviews and Notices of Books 39-46, 141-144, 189-191, 237, 238, 289- 293, 345-347, 392-395, 433'435, 489-491, 533S3%, 5 8 °-5 8 3- Reprints and Monographs Received 46, 94, 191, 294, 395, 436, 491, 538, 583. Personal and News Items. 47, 96, 144, 192, 239, 295, 348, 395, 444, 492, 539, 584 sti T HE NEW ENGLAND MEDICAL GAZETTE No. JANUARY, 1899. THE CURATIVE ACTION OF CERTAIN REHEDIES IN DISEASES OF THE UPPER RESPIRATORY TRACT. RICE, M.D., BOSTON, MASS. [Read before the Massachusetts Homoeopathic Medical Society, October 8, i8qj.] Those who are trained for special work, who devote their thought and action toward treating diseases of certain definite parts of the body, take upon themselves responsibil- ities toward the medical profession, and particularly the homoeopathic medical profession.

One of these responsi- bilities I believe to be the study of remedies as affecting healthy and pathological states of these certain parts, their influence on the healthy tissues and their power in curing diseased conditions. Accuracy in first diagnosis, accuracy in after observation, and care in selecting those cases for internal remedial treatment which come within the scope of cure are of course essential.

Clinical evidence is not always reliable, but when the curative effect of a drug has been repeatedly clinically verified by capable observers one is surely justified in attributing to this remedy curative powers. I give nothing original here, but can, I hope, add to the con- fidence reposed in a few of our homoeopathic remedies, as exerting a restorative influence over diseases of the upper respiratory tract. For the sake of brevity, I will take up single diseased conditions rather than single drugs, giving a group of the remedies which have proven themselves reliable in those conditions with their several indications.

I 2 The New England Medical Gazette. Other remedies than those I have clinically proven effective may be indicated of course, but frequently the symptoms one finds are localized and constantly met, and those I may give here. I have chosen for consideration the symptom naso- pharyngeal catarrh because, although not a disease, it is a symptom of a variety of diseased conditions, and because the causes behind this symptom when recognized present a certain variety of pathological states, not all of them I believe curable by the internal indicated remedy alone.

Perhaps we are most frequently called upon to prescribe for this symptom as found in children between the ages of three and sixteen years. In these cases, although the parent complains that the child has catarrh, further questioning will frequently develop these additional symptoms: mouth breathing, snoring, difficulty in articulation, slight deafness. Objectively, we find the patient rather pale in appearance, with a short upper lip, open mouth, and pinched look of the nose. An examination of the throat shows the tonsils to be more or less hypertrophied, enlarged follicles on the pos- terior wall of the pharynx, while the use of the rhinoscope or finger reveals an enlargement of Luschka's tonsil; this hypertrophy may be in the nature of a soft mass nearly fill- ing the nasopharynx, or partially obstructing the posterior nasal passages and Eustachian orifices, or it may be fibrous in character presenting numerous crypts and depressions. After cleansing away the collected mucus the surface is seen to be reddened and irritated or perhaps pale and puffy.

In many such cases I believe that surgical or other local measures must supplement or precede the internal remedy. Particularly is this necessary when mouth breathing is a prominent symptom; but even in this case the remedy is of importance, and a permanent cure without its use cannot be accomplished. I shall mention but three remedies for this condition, namely, calcaria carbonica, calcaria phosphorica, and calcaria iodata. These remedies I have proven as effica- cious over and over again. The calcaria carbonica patients with fair complexion, flabby muscles, excess of adipose 1899* Th e Curative Action of Certain Remedies. 3 tissue, and of scrofulous diathesis are well known to every student of materia medica, but there are certain finer dis- tinctions to which I wish to call your attention as indica- tions for its use. The tonsils if hypertrophied are very much so; they are pale in color and soft to the feel.

The Luschka tonsil is also soft. It bleeds easily on the slightest touch of probe or finger, the turbinated bodies are pale and puffy. The discharge, nasopharyngeal alone if the nares are obstructed, both nasopharyngeal and anterior nasal if the obstruction is not complete, is mucopurulent in character, at times streaked with blood. This latter symptom is par- ticularly prominent if there is an anterior nasal discharge. It is at times profuse, but often scanty with sense of dry- ness in the nose and nasopharynx.

The teeth are late in appearing and after their appearance decay quickly. The calcaria phosphorica patient is also of the scrofulous type, but of dark complexion, of thinness in flesh, and of firmer fibre. The tonsils, if hypertrophied, are smaller and offer greater resistance to the probe.

The enlarged Luschka tonsil is also more resisting, and both the faucial and pharyngeal tonsil are of a more natural color than is found in the calcaria carbonica patient. The nasopharyngeal dis- charge is not as profuse and is more tenacious, but the larynx and bronchi are much more likely to be affected than in the preceding remedy. The patient almost invariably has either a slight cough or is continually clearing the throat to rid the larynx of its viscid secretion. Excitement arouses the patient to unwonted activity of mind and body, which condition quickly gives way to languor and depression of spirits. Both types take cold easily, the calcaria carbonica patient being most subject to nose and nasopharyngeal inflammations, the catarrh being greatly aggravated, while the second type of patient is mostly affected by a cold, either in the faucial tonsils, the pharynx, the larynx, or the bronchi, the nasopharyngeal discharge not being altered to any great extent. We find in the third remedy mentioned, calcaria iodata, many of the iodine characteristics, namely, the thin- ness of flesh, the tendency to glandular swellings, the 4 The New England Medical Gazette.

January, diathesis, scrofulous or syphilitic, the latter condition being a strong indication for the use of the remedy. This patient also takes cold readily, but the colds take the form of a vaso- motor rhinitis, that is, swelling of the erectile tissue, while itching, heat, watery discharge, etc., or asthma or croup may make manifest the onset of the cold. Beebe, of Chi- cago, recommends this remedy above all others in croup, whether it takes the diphtheritic form or of membranous croup. He regards it as a specific if given early in the dis- ease and continued persistently.

The tonsils, though en- larged, present a ragged appearance from the numerous crypts and diseased follicles which indent their surface. Luschka's tonsil may be very greatly hypertrophied. It is firm, unlike the calcaria carbonica condition where it is enlarged but soft, unlike also the calcaria phosphorica condi- tion, hard and small. The discharge is mucopurulent in character, like the calcaria carbonica discharge, rather pro- fuse posteriorly, scanty anteriorly, whether the post-nasal obstruction be complete or the contrary. Persistent hoarse- ness is a common symptom; the calcaria phosphorica patient has a cough but is not hoarse, at least not persist- ently so. The first two of these remedies I have used in the third and sixth decimal trituration, the latter in the second and third.

When I have once chosen the remedy I give it three or four times daily, persisting in its use for weeks or months. In my experience the curative action of these remedies is slow, but in the end extremely gratifying. I wish now to consider an entirely distinct class of cases, not as common as the foregoing, but still frequently met. They also have the symptom post-nasal catarrh, but it is from an entirely different cause, the origin not being consti- tutional and secondarily localized in the nasopharynx, but constitutional or traumatic and localized in the nasal pas- sages.

This form of the disease is not confined to any class or age. Allow me to present a typical case. B., age thirty-nine, occupation teacher, consulted me February 27, 1894, for a postnasal catarrh which had existed to a greater or lesser extent for ten years. The Curative Action of Certain Remedies. 5 patient complained of great accumulation of mucus in the nasal pharynx, causing much irritation in this region and giving rise to constant efforts of clearing.

Particularly was this the case at night, so that in consequence her sleep was much broken. There was a sense of fulness and dryness in the nose, though little anterior nasal discharge.

Family history good, and but for a worn look of the face with pallor the patient seemed to be in fairly good condition. Could discover no digestive disturbances. Devia- tion of the cartilaginous septum towards the right. Marked tumefaction of both middle turbinated bodies, each in con- tact with the septum. Inferior turbinated bodies and sep- tum reddened and dried in appearance.

The vault of the pharynx was so covered with tenacious yellow mucus that its condition could not at first be determined, but after cleans- ing away this accumulation the parts were seen to be greatly inflamed. The oropharynx was in places atrophied and again covered with enlarged follicles. A mild form of laryngitis was present. Here was a case and a not unusual one where constitutional symptoms were in a degree lacking, and where the indications for the remedy must be found in the nose rather than in the post-nasal space, although it was of a nasopharyngeal discharge that the patient complained. To be sure we had symptoms in the nasopharynx, namely, dryness, irritation, and much stringy yellow mucus; but these conditions in this case could be directly traced to the nasal condition, that is, the inability of the nose to perform its function, that of purifying and warming the inspired air. This case is illustrative of the nasal cause of a persistent and extremely troublesome symptom. The nasal obstruc- tion is hardly ever the same, but some form of hypertrophic rhinitis like the above is, however, frequently present.

The origin of this might have been from the constitutional tend- ency to attacks of acute coryza, these attacks in time pro- ducing permanent tissue changes in the nose, or as before suggested, traumatism might originate the condition. If the nasopharyngeal disease is from the latter cause, the nasal obstruction will be primarily from a defected septum, from 6 The New England Medical Gazette. January, the irritation of a septal spur, or from something of a similar nature. Here, of course, the internal remedy can do no good unless preceded by surgical measures.

It will be seen therefore how necessary a correct diagnosis becomes before the prescription is properly made. In the first class of cases also surgical measures may become necessary in the reduction of the hypertrophied tissue, but many cures can be performed by cleansing applications and the indicated remedy. The array of remedies for a hypertrophic rhinitis is small, particularly if one is unaided by constitutional symptoms, but the following have served me well: lobelia cerulia, a remedy to which my attention was called by Dr. Teets, of New York, kali bichromicum, mercurius, and hydrastis. The indications for the first remedy mentioned, lobelia, are, and I give Dr.

Teets' indications, depression of spirits, pain in the left side of the head and over the nose, itching and tingling in the nose, followed by frequent sneez- ing and discharge of thick mucus from the nostrils, with sensitiveness to inspired air or dust; additional indications for the remedy are found in the objective symptoms follic- ular pharyngitis and inflammation of the nasopharynx. Teets' symptoms cease, but I am able to add the following: the hypertrophy of the turbinateds is not pale and puffy such as is found in vasomotor rhinitis which the symptoms would indicate as existing, but the tissues are reddened, and after removing the secretion, which is thick, the membranes are left dry with a glazed look, particularly on the cartilaginous septum; this same glazed appearance can also be seen on the posterior walls of the pharynx. The remedy kali bichromicum would be thought of in the clinical case just described, but the tenacious discharge complained of is not a sufficient indication for the drug, and if it is pre- scribed on this indication alone, disappointment in its effects will quite likely result. It is not often mentioned in the text-books as one of the remedies likely to be called for in hypertrophic rhinitis, but bearing in mind the indication so frequently seen in its symptomatology, the ropy, stringy character of the secretion, and finding it sometimes curative 1 899. The Curative Action of Certain Remedies.

7 and sometimes not, an attempt has been made to more exactly differentiate its objective nasal indications, hoping in this manner to intelligently prescribe the drug in naso- pharyngeal catarrh. The nasal symptoms for which I pre- scribe it are sense of fulness, stuffiness in the nose with constant desire to blow it or to remove the supposed obstruc- tion by other means. The discharge is glutinous and is expelled with difficulty. On examining the nasal fossae this mucus can be seen stringing from the septum to the turbi- nated bodies. The septum appears dry, as in the first remedy mentioned, but there is a marked tendency of the septal membrane to break down, showing excoriations. The nose bleeds easily if the concretion covering the excoriation be removed. The patient's effort to keep the nose free results in an ulcerative process, at the point which was originally an excoriation.

I do not believe that the ulceration of the septum narium, named in the books, is a direct symptom, but that it is the result of the inflammation and dryness, aided by the mechanical irritation of the patient's finger nail. This ulcerative process may become so well established as to involve the cartilage and produce perforation.

This perfora- tion is very different in cause and appearance, however, from that found in syphilitic disease of the nose, and when syphilis is present I do not prescribe the remedy. Further indications for the remedy are huskiness, constant desire to clear the throat, and unreliable voice. When this stringy mucus is found only in the naso- pharynx and not in the nose or elsewhere, I attribute the localized condition mainly to physical causes, and do not, as a rule, prescribe this remedy. Mercurius has a nasopharyngeal discharge, tenacious if the nasal function is impaired to a sufficient extent, profuse, but the naso- and oropharynx feel dry. The familiar subjective symptoms, such as pain and ful- ness over the frontal sinuses, soreness of the nasal bones to external pressure, with much discharge from the nose of thick, yellow, bloody mucus, are, I believe, reliable. 8 The New England Medical Gazette.

January, The objective symptoms, again not considering those of the syphilitic patient, are swelling of the turbinated bodies, not the dry and reddened appearance mentioned in the two preceding remedies, but swelling of the soft parts which are covered with yellow or yellowish green mucus. The tissues seemed to have lost their integrity, for although the mucous glands are overactive, yet the absorbent powers are inactive as in the iodine cases. Small ulcerative processes may develop, particularly if the tissues are injured in the process of examination or by the patient's efforts to clean the nose. Blowing the nose violently and pinching and rubbing the alae against the septum may be sufficient to set up an ulcer- ative process, which might end in perforation.

The nasopharynx after being cleansed of its accumulated discharge is reddened, but presents the same unhealthy color, while the posterior of middle and inferior turbinateds are hypertrophied and of a white or slightly bluish white color. I will only briefly mention the last remedy named in the group. Hydrastis has many symptoms similar to kali bichro- micum. The appearance of the membrane is like. The inflamed membrane is also prone to excoriation and ulcera- tive processes are easily started. The mucous discharge is also tenacious. It is more pro- fuse, however, and there is more frequently associated with the nasal hypertrophies and the nasopharyngeal inflamma- tion a follicular pharyngitis, while digestive disturbances usually manifest themselves by an all-gone sensation in the stomach and by persistent constipation.

The internal action of both of these drugs is aided by using the one indicated locally as well as internally. Kali bichromicum I use in the third decimal for internal medication, and for local use a three-grain tablet of the first decimal trituration dissolved in an ounce of water. Hydrastis I give internally, a tablet containing four minims of the tincture, and for local use one grain of the muriate dissolved in an ounce of water. 1899* Th e Curative Action of Certain Remedies.

9 It is important to remember, in using these local remedies for the nose and throat, that the tissues must first be cleansed of their accumulated secretions before the local medicament can be properly applied. One other class of cases I would mention. These patients also complain of catarrh. They will tell you that the dis- charge is considerable, that there is an accumulation in the throat, particularly on waking in the morning, of thick, greenish yellow lumps, that the throat is dry much of the time,, that the sense of smell is impaired, and that their friends tell them that the breath is offensive. A case from practice will best illustrate this form of dis- ease, which from these symptoms has probably already been recognized by you as atrophic rhinitis or non-syphilitic ozsena. Miss S., age thirty-seven, consulted me October 10, 1893, complaining of the above symptoms. The trouble had existed to a greater or lesser extent since childhood, but an attack of la grippe two years ago produced aggravation of the symptoms.

Her general health was not good. Loss of sleep, an irritable stomach, and the consciousness that she was disagreeable to others on account of the offensive odor from the nose had caused a condition of debility. On examining the nose there was found an accumulation of greenish masses exceedingly offensive and hiding the tissues from view. On removing the accumulation the posterior wall of the nasopharynx could be plainly seen through the anterior nasal fossa. The inferior turbinated body and the anterior portion of the middle turbinated body, including the bony tissue of the left fossa, were completely destroyed.

The destructive process had only just begun in the right side. Oropharynx dry and glazed. On its upper portion could be seen the same kind of greenish collection observed in the left nasal passage. For- tunately this disease is not very common. Its origin need not be discussed in this paper other than that it is still a matter of opinion whether the disease results from an io The New England Medical Gazette. January, hypertrophied rhinitis or whether a scrofulous or tuberculous diathesis must be established. A specific bacillus peculiar to this disease has been dis- covered, and the fact of its being capable of producing a form of rhinitis in animals by inoculation established.

The question now arises, Can it be cured by the indicated homoeopathic remedy alone? I personally most emphatic- ally believe not. The indicated remedy may, and undoubtedly does, aid in curing the disease, but local cleansing and antisepsis are of primary importance.

To insure the best results the cleansing process must be carried out daily for a number of weeks by the physician. Spraying and douching are not sufficient. The parts must be well illuminated and cleansed with forceps, cotton, and spray. It frequently takes an hour to do this thoroughly in a recent case. In this way, aided by the internal remedy, the catarrh can be controlled, but when this cannot be thoroughly carried out only partial relief can be obtained.

This fact has often been illustrated in the dispensary clinic where biweekly treatment only can be made against those who can come to the office for daily treatment. In each case the apparently indicated remedy is given, but one class receives but temporary benefit, while the other practically recovers.

The disagreeable odor totally disappears. The loss of function from the destroyed tissue is in a measure restored, and the patient soon enabled to care for the nose properly without the aid of the physician. I will not weary you with indications for remedies in this disease, for I cannot recommend one above another from personal observation. The remedies for study are aurum met., arsenicum iod., silicia, sepia, argentum nit., kali bich., and sulphur. 1899- An Interesting Symptom. 11 AN INTERESTING SYflPTOM.

BELLOWS, M.D., BOSTON, MASS. March 3, 1897, a young man called at my office complain- ing of a distressing tinnitus in the left ear. It developed two weeks previous to his visit to me and had been an in- creasing annoyance ever since. There was no pain in the ear, nor any sensation of heat or of throbbing. The hear- ing power was practically unaffected.

But when the rim of the ear was brushed by the hand it gave rise to an unnatural 'woodeny' feeling in the ear; and a more decided touch of the hand or the contact of the coat collar occasioned a noise within the ear which my patient very graphically lik- ened to ' the bending of a piece of cloth which had been frozen.' A rumbling sound, and to again quote the patient's words, 'a sort of rasping noise,' was produced within the ear by simply walking across the room. The examination of this patient's ear revealed the cause of the annoyance at sight.

Held firmly embedded in a coat- ing of wax upon the anterior wall of the meatus, near the isthmus, was one end of a cut hair, which was about one half an inch in length, and the other end of the hair was held thus in constant contact with the superior posterior quadrant of the tympanic membrane. The tinnitus was occasioned by actual movements of the free end of the hair against the surface of the drumhead. After inquiry I learned that the patient's hair had been cut about the time the noise de- veloped, and this bit of hair had probably been blown into the ear by the barber. Its removal by a pair of delicate forceps stopped the whole difficulty immediately. This may seem like a trivial case to report before a meet- ing of our State society, but I present it simply as a text. The sermdn will not be long, but the application, I hope, will be very obvious.

Does not the symptom, as presented by this patient, 'a noise in the left ear like the bending of a piece of cloth which had been frozen,' sound like many another symptom 1 2 The New England Medical Gazette. January, in our expanded and complex materia medica? Does it not remind us, for instance, of that other symptom which we find under eupatoreum purpureum — 'crackling, like burn- ing of birch-bark; very much increased upon swallowing anything '? Suppose that, either led by this similarity in the character of the noise or through lack of any better choice of remedy, I had simply administered eupatoreum internally to this patient, in any potency whatever, and sent him away with the assurance that in a few days the annoy- ance would cease. The prediction in that case would have proven perfectly true, for within a few days more, by the natural process of growth of the cutaneous lining of the external meatus from within outwards, the hair would have been sufficiently withdrawn to no. Longer touch the drum- head.

What a chance then for a real clinical verification! We might thus have had one more 'verified symptom ' in our materia medica. It is not necessary for me to dwell upon this lesson. Its meaning is sufficiently plain. It means that every physician in the practice of medicine should have in his possession a suitable mirror and three or four specula for the examina- tion of at least the external canal and the drumhead of his patients' ears. And furthermore, it means that the advan- tage of this will accrue not only to the patients themselves, but to the accuracy of our materia medica, of which we are so proud in spite of occasional errors and rambling prolixity. Then, and not till then, shall we understand in our prov- ings, with scientific accuracy, the meaning of symptoms like 'crackling in the ears when moving jaws,' 'crackling in ears when reading aloud,' ' crackling in ears when eating,' and 'crackling in ears when chewing,' symptoms which we find at present in the provings of seven different remedies, and which may or may not be of any useful significance whatever.

— Besides the administration of arsenic and strychnia, the use of hot baths followed by cold douches has been very effective in cases of chlorosis. A complete cure has been reported in many cases. 1899- Old Friends versus New Acquaintances. 13 OLD FRIENDS VERSUS NEW ACQUAINTANCES. COLBY, M.D., BOSTON, MASS. The spirit of the age and the spirit of the nation are con- stantly urging us to experiment and to discovery.

It is this combination which results in progress. The outcome has been evident to even the most superficial observer. We have in our brief lives seen steam take the place of manual transmission of power, and at the present time we can see electricity and other agents supplanting steam; and who can doubt that mankind has been the gainer by such change? The accumulation of experiences in the manufactures and arts necessitates the abandonment of old methods and the substitution of newer ones from motives of economy. Every year thousands upon thousands of dollars are sacrificed in machinery because competition and advance have rendered it unremunerative. This spirit of progress has invaded every walk of life, not excepting that of our own conservative pro- fession.

The temptation to travel in newer and more royal roads is quite beyond resistance, and thus we welcome each new remedy or appliance, having a preformed belief that it must be more successful than the old. We are naturally prone to adopt that which is novel, either in theory or in appearance. To a certain extent this is praiseworthy, for without such animating spirit the methods inculcated by Hahnemann would still lie inoperative.

But there is a limit beyond which it is not profitable to advance. Every new theory or method requires a period of sedimentation during which the new discovery can be perfected and consolidated, during which. The various early data can be arranged and justified. This very process, analytical in its nature, may equal in value the original observations, and be more profitable than new excursions for fresh material.

In the earlier days of our school, when the enthusiasm of the revo- lution animated the efforts of its disciples, they all made most minute and patient provings of drugs upon the persons of themselves and all their willing friends. All symptoms 14 The New England Medical Gazette. January, were carefully noted, and most of them in chronological order. These records form the material for our study to the present day. Undoubtedly much which is inconsequential is recorded, but in so far as they have presented us with an orderly narrative, we can make reliable selection as truly and readily as they could who observed very likely more critically; and just reflect upon what a mine of wealth is left us, even after the most careful sifting.

These records were not very much modified by previous notions of pathology, but on the whole were quite unsophisticated. The remedies tried were comparatively few, so that several individuals could work upon the same drug.

This course was pursued for several years and the results turned in to the common treasury. Then there followed years of trial, during which the induced symptoms were practically verified in treating disease, and so we finally have presented to us the story told from two different standpoints. This is the pathogenic his- tory of nearly all drugs of the first fifty years of our materia medica. These provings are truly our old friends and tried friends; in number not large, yet sufficient to cure a large percentage of curable diseases, and potent enough to com- mand the fealty of many thinking, honest men, and finally women. In due course of time the number of those who were attracted to our method increased, for access to the ranks was much more easy than in the olden time, and the painstaking enthusiasm perceptibly waned. People were ambitious to extend the novelty, but no longer were they animated by the same self-denying spirit. New drugs were largely and rapidly admitted from various sources, chiefly clinical, and symptomatology was much more frequently made up from the curative effects of remedies upon the sick, and the original methods of proving became less prominent.

Provings upon the healthy were made in smaller series when offered for acceptance, and very likely the provings were made hoping to verify the clinical results rather than vice versa. For some reason the physician ceased to have among his friends those who would consent to prove a drug ' to the limit.' It became the mode to select a shorter and 1 899. Old Friends versus New Acquaintances. 15 easier road to the knowledge of drug action. With this somewhat informal introduction we cordially welcomed our new acquaintances.

Cheerful and well enough behaved indeed, as far as it went, but somewhat lacking in that use- fulness under trying circumstances to which our old friends had habituated our expectations. I readily acknowledge that several remedies like gelsemium, cimicifuga, and a few others bear the proper earmarks, but this does not invalidate the criticism upon the mass of our new remedies. Per- haps, even probably, there will not again prevail the same enthusiasm which existed seventy-five or more years ago, and we cannot count upon the same methods and results; but we should remember and be thankful that our archives still contain the records in as great purity as when the prov- ings were made, and to these narratives as preserved in the original journals and translated and published in an authori- tative way I would beg to direct the attention of all, but more particularly of those who have but recently entered our guild. Our predecessors were never satisfied to limit the use of aconite to those cases which exhibited a rapid pulse and high temperature, but found it equally the similium in many chronic diseases.

Nitric acid was found beneficial in cases which did not possess visible hepatic disturbance nor weakening sweats, but had finer and more involved symptoms, simulating actual diseases, — pathological conditions, either with or without a name in our nosology. Did time at my disposal permit, the list of examples might be extended through scores of instances, but the object of these few words is to awaken discussion, and time must be allowed for that purpose. The use of the provings is at our disposal. They were made in a truthful and orderly way. We can proceed by analysis or synthesis, according to our individual beliefs, but whatever way we use them, they are valuable. They are old and tried friends, ready to lend themselves to our service if we are only willing.

Let us not therefore neglect them. Our newer acquaintances need not be rejected.

We can entertain them hospitably, but not to the point of turning the cold shoulder to our old friends. It is time to fly to salve 1 6 The New England Medical Gazette.

January, and wintergreen oil when our well-tried rhus and sulphur, with their comrades, have been found wanting, and so on to the end of the honorable list. The argument prevails that the provings were not conducted in the light of modern science. Who is to blame for that? We can extend these very provings directed by the brightest light of the present day and we shall but add to, not take from, the record of these old friends of three generations. It is our manifest duty, and to avoid this duty betokens selfish ingratitude.

To possess the faculty and the opportunity and not use them is to submit to the commercial spirit, foreign to our self-sacrificing profession. Finally, it is proper to again call attention to a statement made in the text of this article, namely, ' These records were not very much modified by previous notions of pathology,' etc. You will find this to be practically true. Excepting some expressions adopted from the old and expiring humoral theory, but merely as expressions, the state- ment is correct. That there were theories attached to the new school we all know. As, for instance, the belief in the psoric and sycotic origin of chronic disorders, this was almost a matter of religion with Hahnemann, and fully adopted by his colaborers. You will, however, readily see that this was an application, an afterthought, and does not to a modifying extent appear in the proving.

We can apply or reject the theory as we choose from the very same data which existed then. We can cut the diamond according to our taste, but the inherent lustre is still there. THE INITIAL LESION OF SYPHILIS AND ITS TREATMENT. POWERS, M.D., BOSTON, MASS. There is hardly a more important disease than syphilis. The years which are liable to pass ere a radical cure is estab- lished, and the insidious attacks on any or all the tissues of the body, make it a topic of prime importance; and though 1899- Th e Initial Lesion of Syphilis and its Treatment, 17 little if anything new can be said, yet the discussion of some features of the initial lesion may prove of profit. When the syphilitic virus comes in contact with the absorb- ents of the body of a person who is not immune, that person is infected with syphilis, and the manifestation at the point where the virus enters the body is called the initial lesion.

This initial lesion is present as soon as there is a break in the skin or mucous membrane, and the syphilitic virus comes in contact with the lesion and infects it; but there elapses a varying time before it is distinguishable as a chancre, and in some cases it is said to never become noticeable. The length of time from infection to the presence of a recognizable lesion varies, as you have so many times heard, from three to eighty or ninety days. This is the period of primary in- cubation.

The much more common period of this primary incubation is from ten to thirty days, and yet we must remember that at times cases are seen at either extreme of the limit, and thus it is that we may need to be guarded in our diagnosis. After the infection has occurred then grad- ually appears a round cell infiltration about the vesicle, and this infiltration extends involving all the structures till there comes to be the indurated lesion which, has so often been called the hard chancre. This infiltration may depend on the location of the lesion and the mechanical irritation to which the lesion is subjected. This induration is probably never absent, but it may be so slight that it is not recog- nizable to the touch. Often, however, there is such indura- tion that the mass seems like a bit of wood or cartilage in the skin or mucous membrane.

There is besides this induration an excoriation or ulcera tion of the tissue at the point of infection, and this may extend to an area of considerable size and lead to marked scarring and possibly some deformity which is permanent. As a rule, however, the initial lesion leaves slight or no lesion relics behind when it heals, and the old suggestion to look for relics of the initial lesion on the genitals in case of suspected syphilis is valuable only when a positive distinctive scar is found and is not exclusive when absent.

1 8 The New England Medical Gazette. January, There is a form of initial lesion which has slight induration and yet there is often marked loss of tissue, and there is, at times, considerable swelling and local oedema.

I refer to the so-called mixed infection. When the same point is in- fected with syphilis and pus germs there often appears a lesion which has many of the characteristics of the 'soft' chancre, and there is often considerable discharge and quite likely multiple lesions appear. The acute inflammation from the pus germs overshadow the effects of the syphilitic virus, and these cases when seen and treated are often considered simple sores till the later symptoms make the diagnosis clear. There may be relapses of this ulcer occurring when nearly healed and this may be repeated one or more times, thus constituting the relapsing chancre. It has been assumed that the soft chancre or chancroid is caused by the ordinary pus germs, but candor compels the admission that this is a question on which there is much difference of opinion.

The simplest form of lesion is that of the papula, which may be small, dry, flat, large, or moist. This simple lesion may be and often is unnoticed by patient, and may even fail to attract the attention of the attending physician. Already I have intimated that an initial lesion may occur on any part of the body, and conservative estimates place seventy-seven per cent on the extra-genital parts of the body.

This leads one to think that syphilis may frequently be ac- quired innocently, and we cannot assume that all genital lesions are prima facie evidence of debased morals. The truth is that from five to ten per cent of cases of syphilis are innocently acquired. The topic of the distribution on the body of the initial lesion is too great to speak exhaust- ively upon in a paper like this, and in passing attention is called to the frequency with which it is found about the mouth, and here the angles and the tonsils are seemingly favorite locations. The initial lesion is more rarely seen in women than in men because it is within the vulva and causes no pain, and a slight discharge is not thought to be of much importance. There is one location, namely, on the breast of 1 899. Ine Initial Lesion of Syphilis and its Treatment. 19 women, where I think it will be seen less frequently than in the past, since there are few wet nurses employed at present, and hence the danger of infection from syphilitics' children is lessened.

Coincident with the growth of the initial lesion there appears another condition, a part of the same disease, to which attention must be called. This is the involvement of the neighboring lymphatic glands. Here we find not a single enlarged gland as often occurs in gonorrhoea, but a chain or group of them; and these are usually small, hard, and freely movable under the finger, and not the boggy mass which may be found in glands infected from suppurating lesions. Ab- scess is quite rare in the glands infiltrated from the initial lesion, and I believe when an abscess does occur it is usually if not always in those cases of mixed infection, and the ab- scess is caused by the pus germs rather than by the syphilis. This involvement of the lymphatics is a most constant symp- tom and a great aid in diagnosis.

The initial lesion may be mistaken for an epithelioma or a simple chancre. Epithelioma does not usually occur before forty years of age and the lymphatics are involved very late. The duration of the lesion is also a point in differentiation.

In simple chancre the induration is wanting and the glandu- lar infiltration is of one, two, or three large soft glands liable to open from the retained pus. Secondary or tertiary syphi- litic lesions may simulate the initial lesion, but the indura- tion is not usually so distinct and the lesions are not often solitary and there may be no glandular enlargement. A history of other lesions or the presence of lesions or lesion relics will help to exclude the initial lesion. With herpes progenitalis there is no induration, no glandular in- volvement, and there are multiple lesions often occurring in successive crops. The treatment of the initial lesion is a much-mooted point.

There is an almost unanimous testimony that mercury ad- ministered internally causes the induration to pass away and hastens the healing of the lesion. That this is desirable is doubted by so able a syphilographer as Dr.

Taylor, 20 The New England Medical Gazette. January, and he cites a number of equally noted men as favoring his idea.

He would use all the time from the discovery of the initial lesion to the eruption of the secondary lesions in building up the general health of the patient, preparing his stomach for the ordeal which it must undergo, and making his teeth healthy and the gums firm. Those of us who be- lieve in the more minute dose are not as liable to encounter gastric rebellion and spongy gums later in the case. For my part, I think that mere, biniodide or the bichloride can be used with benefit, and on these two forms of mercury I place most of my dependence. Locally the lesion should be kept aseptic if possible, and the first decimal trituration of calomel serves as one of the best dressings.

Wash the lesion clean with a sterile normal salt solution, dry it carefully, and apply a liberal dusting of the trituration and cover with a bit of absorbent cotton. In some cases aristol has served me well.

Once in a while a sluggish ulcer may be hastened in its healing by touching it with acid nitrate of mercury. With these simple means the initial lesion may be well cared for and the patient prepared for further lesions when they occur. NOTES ON APOMORPHIA. HORNBY, M.D., DORCHESTER, MASS. In the spring of 1893 rny attention was first called to the use of apomorphia in hysteria, by a physician who stumbled upon its use, having given it to an hysterical patient to control vomiting, and thereby curing a severe form of hysteria. This is the only authority I have for the use of the drug in the following case: — On May 4, 1894, I was called to see Miss S., age doubt- ful, probably from forty to forty-two, tall, slim, sallow complexion, dark hair and eyes, nervous temperament, con- stipated habit, inveterate coffee drinker, occupation that of a clerk.

Family history showed tuberculosis on the maternal side, paternal side negative. I was called to relieve the patient of an attack of hysteria, which expressed itself in that familiar form of uncontrolled 1899- Notes on Apomorphia. 21 laughter followed by weeping.

I mixed twenty drops of nux mos. 3 x in one third of a glass of water, ordered two teaspoonfuls every fifteen minutes until relieved, then once in two hours. In an hour's time she was out calling on some friends, where I had an opportunity to observe her through the remainder of the afternoon and evening. Though the outward expression of the hysteria was subdued, I saw that she was suffering from some intense nervous tension.

I could not gain her confidence, except that she was worried about some home affairs, and had not been eating for several days, but drinking black coffee. I discontinued the nux mos., and gave several doses of nux vom. She retired late. It was about midnight when I heard a loud, sobbing sound coming from her room. I pushed open the door, and saw her half seated, half falling from a chair; her head thrown slightly back and to the side; eyelids partly closed, with the eyes rolled back; mouth partly open; the right hand grasping the neck of the nightdress, the left hanging listlessly at the side; respiration short and very shallow, with this peculiar sobbing sound that one sometimes hears in very severe attacks of asthma. Later I noticed that the muscles of the chest were drawn in, as in extreme expiration, and remained in that spasmodic condition, relaxing only sufficiently to allow her to take a very short inspiration. The face was livid, the pulse full and slightly accelerated.

I threw the window open near which she sat, bathed her hands and face with spirits of camphor, and held it to her nostrils. In a few moments she recovered, perfectly conscious, smiling and saying, ' Thank you, I 'm better now,' and immediately relapsed into the same condition.

In a lucid moment I helped her to the side of the bed, where she sat from twelve to three o'clock without falling, her body inclining to the right and swaying in that direction. In each attack her right hand grasped the throat, as though she were smothered; the left hung at the side. I gave a tablet of moschus 2 x every twenty minutes until two o'clock, with the result of seeing the faint grow more profound and last longer. I had asked for counsel and been refused on the 22 The New England Medical Gazette. January, plea of not wanting people to know. I felt positive that this was a phase of hysteria.

I remembered the doctor's experi- ence with apomorphia and determined to try it. I gave one twentieth of a grain tablet, by the mouth, once in twenty minutes, with a marked improvement in half an hour. A new symptom appeared, that of, eructations of gas, so violent and prolonged as to cause exhaustion and severe pain in the left side. These attacks always terminated in this way. At half-past three the nerve wave had passed over, and though exhausted, the patient was bright and willing to talk about her condition. At four she fell asleep, sleeping soundly until seven, when she went to her work, looking and feeling as though nothing had happened. She had had an attack on the night previous to this, but had had no assistance.

I advised a tablet of apomorphia night and morning, but was obliged to discontinue it after the first day, owing to the extreme diaphoresis it produced, and I was finally obliged to control it with jaborandi. In 1895 and 1897 she had two attacks which were controlled within an hour with apomorphia, with the same diaphoretic result following. The patient has been thus afflicted since childhood, the attacks coming on about midnight and passing off between five and six in the morning.

She knows when they are coming, and can hold them in abeyance for a time, but they finally overpower her. She has a stepsister and cousin similarly afflicted. I will call your attention to two other uses of the drug that I have had an opportunity to verify. These are as an emetic, and its opposite, to prevent emesis.

The first was employed in the case of a child five years old, who had eaten the thorn apple, stramonium. One twentieth of a grain was given hypodermically, and emesis followed in ten minutes. The second was also employed in the case of a child who was suffering from an attack of gastritis, when ipecac and nux vom. Made no impression upon the nausea and vomiting.

One twentieth of a grain of apomorphia on the tongue re- lieved the vomiting almost immediately, and nux and arsen- icum completed the cure. 1899* Saving the Twenty-four Hours' Urine. 23 SAVING THE TWENTY-FOUR HOURS' URINE. BATCHELDER, M.D., BOSTON, MASS. If the past be any criterion, the importance of examining a portion of the mixed and measured twenty-four hours' urine is very slightly appreciated.

It is not sufficient to simply make a few chemical tests, take the specific gravity, and draw conclusions therefrom when one takes a sample of urine indiscriminately from a patient. Again, it is not enough that one should simply search far enough to decide whether our patient has nephritis or diabetes, or not. We must know from time to time the actual daily work done by the kidneys, in order to intelli- gently watch and guide our patient and know the approach of danger. The years of life are made up of an aggregation of daily or twenty-four hour cycles, each, from the physiological view point, somewhat closely resembling its fellows.

All extended studies of renal activity have been made in view of this fact, and all general and special averages governed thereby; hence in taking present physiological standards as our bases, conformity to the general principles upon which these have been constructed is imperative. The experiences one meets, where the patient receives no specific instructions as to saving the twenty-four hours' urine, partake both of the humorous and the uncertain.

A typical experience of the writer was as follows: He simply instructed his intelligent patient to bring him the twenty-four hours' urine, carefully saved in a thoroughly cleansed bottle. In due time the whole of the specimen was brought to the office.

The patient had saved the urine as follows: — Reckoning began in the morning on rising. The urine passed then was saved, and all voided from that time till and including what was passed on rising the following morning, at the same hour. On interrogation it was found that no urine was voided after retiring the night before the first por- 24 The New England Medical Gazette.

January, tion was saved. Therefore the bottle contained the renal secretion of about thirty-two hours, and all conclusions based thereon would be inaccurate when compared with normal standards. Repeated tests have led me to place in the hands of my patients and some of my colleagues specific instructions, such as the following: — DIRECTIONS FOR SAVING THE TWENTY-FOUR HOURS' URINE. Commence the reckoning at a specified hour (6 or 7 a.m., for example).

Pass urine then, and throw it away. Starting thus with the bladder empty, save all urine passed from that time onward, including that passed at exactly the same hour the following morning, thus ending the twenty-four hours by emptying the bladder. In order that none be lost, always pass urine separately just before going to stool. Mix well the twenty-four hours' urine thus saved, and bring the whole for examination, or let your physician measure it very carefully with a glass graduate, noting the exact total quantity. Send without delay 8 fl. (one half pint) of the mixed and measured urine for examination.

With this send a slip bearing the following information: — Name. Twenty-four hours' amount of urine as measured (in fl. Date and hour when you began and ended saving the urine. State kinds and quantities of food eaten during this period, and if possible for the preceding twenty-four hours. Kinds and quantities of fluids drank during same periods. State how much exercise you are taking.

Number of urinations. In special cases concise directions must be given to bring day and night urines in separate bottles, that the ratio of one to the other may be accurately determined. Clean sterile receptacles at all stages will greatly enhance the final results. 1899- Editorial. 25 EDITORIAL.

Contributions of original articles, correspondence, etc., should be sent to the publishers, Otis Clapp & Son, Boston, Mass. Articles accepted with the understanding that they appear only in the Gazette.

They should be typewritten if possible. To obtain insertion the following month, reports of societies and personal items must be received by the ijth of the month preceding. OUR DUTY TO OUR MEDICAL SCHOOLS. The beginning of the new year finds the affairs of the homoeopathic branch of the profession in an encouraging and prosperous condition. The past year has been not unevent- ful in many respects, and the steady advance in public esti- mation and confidence is exceedingly gratifying.

This con- fidence is amply shown by the continued munificent bequests to the hospital; by the generous donation which made our new nurses' home possible; by the recognition of our school in the establishment and management of the new hospital for the tuberculous at Rutland; and by the cessation of persist- ent and unwarrantable criticism on the part of some public officials of the management of the Westboro Insane Hospi- tal, and the recognition of the good work done there, as is shown by appropriations for increased buildings and facil- ities. We should not lose sight, however, of the fact that these evidences of increased public favor and trust carry in them- selves increased responsibilities, and place upon us the task of seeing to it that the direction and management and con- duct of all these institutions intrusted to our care are brought to such a degree of excellence and perfection that against them can be aimed no cavil.

In close touch with this whole question of the management of these public institutions and vital to it is the question of the conduct of the medical school, for upon it the character of the work there done and the quality and ability of the graduates therefrom will the future integrity of these insti- tutions as homoeopathic institutions largely depend. While the medical school has ever taken a foremost rank and sometimes the lead in advancing the cause of higher 26 The New England Medical Gazette.

January, medical education, it is by no means sufficient that we should rest even a little on our laurels, or stop to pat ourselves on the back; for while we may be laying this ' flattering unc- tion to our souls ' the world moves on, and we shall find our- selves trying to catch up with the procession instead of being in the lead. The country is overrun, as it were, with medical schools, the profession surcharged with practitioners. The only rem- edy that will ever remedy will be the natural working of that immutable law, ' the survival of the fittest.' Let us see to it, then, that we are of ' the fittest.' There is but one way to make and maintain a successful and influential and powerful institution of learning of any kind, and that is by offering the best and then seeing that the offers are scrupulously fulfilled. Already the handwriting on the wall indicates clearly to those who read that the present high standard must be pushed still higher, the requirements for admission to the study of medicine must be much more exacting, and should comprise such previous training as obtains the degree of A.B.

Or its full equivalent, the continuance of the present compulsory four years' course, with an option of five years, which, we believe, would in the not far distant future also become compulsory. That the taking of so radical a step might be accompanied with financial embarrassment in an institution dependent for the most part upon its students for its income may be possi- ble, but in our opinion it would be transient and not permanent.

Eventually the school with the highest standard and most rigid and difficult requirements not only attracts the best qual- ity of students, but also those best able to pay liberally. The capable, sincere student with abundant means is going to have the best, and for that he is willing and able to pay. It is good business then to furnish the best and thus attract students of this caliber. ' But it is by no means the richest student who makes the best doctor,' we hear some one say, and it is very true. For just that reason the medical school should be liberally endowed, if not with sufficient means for its entire support, 1899* Editorial Notes and Comments.

27 with at least sufficient to furnish aid in the form of scholar- ships to those needy students whose ability and conscien- tiousness in work warrant such financial assistance. The chief reason the medical school is not so endowed is that the public is not alive to its necessities. It does not realize the needs and the vast expenditure necessary to the maintenance of a medical school of the first class, and further to fignorance of the fact that in the present case the in- come for a greater part of its expenses comes from tuition fees, and that the services of the professors and instructors are for the most part entirely gratuitous. The enlightenment of the public to this necessity must come principally through the efforts of the practitioner, and just herein is the opportunity for the alumni of the school to do good work. Let each and every one, quietly and modestly but persistently, spread these necessities abroad and empha- size constantly the fact that the future success of our insti- tutions which have been so well established and so gener- ously supported depends upon the ability, the education, and the scientific training of those in whose charge they are placed; that such training must be obtained in the medical school; that the medical school needs money in order to furnish such proper scientific education; in short, that the medical school must be permanently and liberally endowed. These facts once generally known, the money will be forthcoming, for rarely has a worthy public or quasi-pubHc institution in our good old Commonwealth asked for help and asked in vain. EDITORIAL NOTES AND COMMENTS.

American Subscribers. — The American subscribers to the International Monument Fund for the restoration of Hahnemann's tomb have contributed nearly $270.

The greater part of this sum has been sent to Dr. Cartier, Paris, through Dr. James, of Philadelphia, who will receive further amounts. We are requested to print the following list of contributors: — 28 The New England Medical Gazette. $100.00 Massachusetts Surgical and Gynaecological So- ciety.......... Wetmore 25.00 Dr. James 20.00 Alumnae Association of the New York Medical College and Hospital for Women...

12.00 Dunham Medical Club of Hartford, Conn... Dennis 5.00 Dr. Walter Wesselhoeft 5.00 Dr. Thomas Shearer 5.00 Dr. Shearer 5.00 Drs. Martin 5.00 Dr.

Fiske 5.00 Summit County (Ohio) Clinical Society... James Harwood Closson 3.00 Dr. H.C.Allen 2.00 Dr. Orme 1.00 Dr. Hayward 1.00 Miss I.

Florence Himmelwright 1.00 $261.00 January, Dr. Tisdale Talbot (paid direct to Dr. Norton Francs. 1316.60 20.00 20.00 SOCIETIES. BOSTON HOMCEOPATHIC flEDICAL SOCIETY. The regular meeting of the Boston Homoeopathic Medical Society was held at the College Building, East Concord Street, Thursday, December 1, 1898, at 7.45 p.m., Vice-Pres- ident Sarah S. Windsor, M.D., in the chair.

The records of the last meeting were read and approved. The following physicians were proposed for membership: Charles Tilden Howard, Wesley Terence Lee, Lucille A. James, and S. Elizabeth Slagle, all of Boston. Johnson, M.D., Wollaston, Catherine Elizabeth McGovern, M.D., Dorchester, and Mary A.

Pearce, M.D., of Dedham, were elected members of the society. The following amendment to Article V of the Constitu- tion, proposed at the November meeting, was adopted by the society, namely: ' At the December meeting the President shall appoint a committee of three to nominate officers of the society for the ensuing year. Said committee shall nominate two candidates for each office and send their report to the General Secretary not later than December 21. A copy of this report shall be sent to each member of the society, with the program of the annual meeting.' The following committee was appointed by the chairman to nominate officers for the ensuing year: George H. Earl, M.D., Frederick P.

Batchelder, M.D., and Emma J. The Obituary Committee presented through its chairman, Dr. Colby, the following resolutions on the death of Dr. Heber Smith: — Whereas, It has been in accordance with the inscrutable plans of an all-wise Providence to remove from our fellowship our dearly be- loved friend and colleague, Dr. Heber Smith: Therefore, we, the members of the Boston Homoeopathic Medical Society, do Resolve, That in his translation to a more exalted field of duty, we are deprived of the comfort and usefulness of his valued presence.

In times of adversity he was a staff upon which we could lean. In times of success he was always a cheerful and acceptable partici- pator. His absence from our midst leaves a void in our hearts which can be but imperfectly filled by pleasant memories. Resolved, That we tender to his bereaved family our sympathy in their great loss.

Colby, Conrad Wesselhoeft, Fred B. Percy, Committee. The chair appointed Drs. Sylvester, H. E^ Spalding, and Howard P. Bellows an Obituary Committee to 30 The New England Medical Gazette.

January, draw up resolutions on the death of Dr. Sanders, of Boston. The resignation of Dr.

Harvey, of Cambridge, was read by the Secretary and accepted by the society. On the motion of Dr. Sutherland, it was voted that a committee of six be appointed to consider the matter of the publication of the valuable paper read at the November meeting by Dr. Wilkinson Clapp on ' The Present Status of the Pharmacopeia,' and if they deem wise publish the same as a tract from the Boston Homoeopathic Medical So- ciety and distribute it to all homoeopathic physicians through- out the country.

The following constitute the committee as appointed: — John P. Sutherland, M.D., I.

Tisdale Talbot, M.D., Alonzo Boothby, M.D., H. Spalding, M.D., H.

Clapp, M.D., and Fred B. Batchelder, Chairman of the Section of Sanitary Science and Public Health, suggested that the rules be sus- pended at the next meeting, and the section be allowed to eport at an adjourned meeting, say January 19, instead of the annual meeting. By such an arrangement the Bureau would be able to make a complete report. REPORT OF THE SECTION OF OPHTHALMOLOGY, OTOLOGY, AND LARYNGOLOGY. Sylvester, M.D., Chairman; Marion Coon, M.D., Secretary; T. Strong, M.D., Treasurer. The following were appointed to nominate sectional officers for the ensuing year: George E.

Rice, M.D., T. Strong, M.D., and Frank L.

Newton, M.D., who reported as follows: — George H. Talbot, M.D., Chairman; Emma J. Peasly, M.D., Secretary; and J. Miller Hinson, M.D., Treasurer; and they were duly elected by the society. The Treatment of Conjunctivitis and Phlyctenular Ker- atitis. Discussion opened by J.

Miller Hinson, M.D. 1899* Societies. The Treatment of Aural Neuralgia. Bel- lows, M.D.

Discussion opened by August A. Do Sprays, Local Applications, and Nebulized Medical ments interfere with the Curative Action of the Homceo- pathically Indicated Remedy? Dis- cussion opened by George H.

The Use of Mercurials in Throat Affections. Discussion opened by N. Houghton, M.D.

Keratometry and Astigmatism. Discussion opened by George A. In discussing Dr. Suffa's paper, Dr. Hinson said: Under the head of 'Catarrhal Conjunctivitis ' we find pink eye as the typical form. It is due to a specific bacillus, the bacillus of Weeks, first noted by Koch in Egypt in 1883.

Pink eye is classed among the epidemic rather than the endemic dis- eases. Personally I use hot or cold compresses, according as to which is more grateful to patient. Aconite and Pulsa- tilla, in simple form, are usually found efficient remedies.

In pink eye, bell, and rhus tox. With atrophine may be needed. The larger per cent of ophthalmia neonatorum occurring in practice of students I think is due to the careless, un- cleanly class of patients they reach rather than to lack of instruction or care. Again, the student reports these cases, while the practitioner may treat them personally and we do not hear from them. The microscopical examination of vaginal discharges, as suggested by Dr. Suffa, seems to me not only impracticable, but superfluous, if Crede's method is carried out in each case.

We must bear in mind that an ophthalmia equal in virulency and destructiveness to a gonorrhceal ophthalmia may be caused by microbes other than the gonococcus of Neisser (1879), namely, the staphylococcus pyogenes aurens and alba, the streptococcus pyogenes and the pneumococcus. We all probably use boric acid as a matter of routine. I find, however, that equally good results are claimed for the use of sterilized or distilled water as a cleanser. So far as I 32 The New England Medical Gazette. January, can learn, boric acid has no germicidal effect upon the gono- coccus. Burnett champions formalin 1-2000 as an anti- septic. He also uses nitrate of silver; the use of the stronger solutions being followed by salt solution and cold compresses to prevent undue reaction.

When nitrate of silver is needed it should be used twice in twenty-four hours. In the beginning of ophthalmia neonatorum I prefer aco- nite. Later, if I have occasion to change the remedy, I have recourse to remedies mentioned by Dr.

I am under the impression that an opacity centrally located, provided it does not entirely fill the pupillary area, causes less annoyance than one situated at periphery of pupillary space. There appears to be a diversity of opinion as to use of eserine. Personally I know one prominent ophthalmic surgeon who uses it to the exclusion of atrophine in keratitis. Is not the iritis coincident with, rather than resultant from, use of eserine?

As to the conjoined use of eserine and atrophine, I should like to inquire of Dr. Suffa whether the atrophine is used for its mechanical or medicinal effect. I wish to emphasize the reference made to the care of the teeth.

I know of one case of persistent keratitis which yielded immediately after extraction of a decayed tooth. As to remedies for phlyctenular keratitis, if one is to be pre- ferred before another, I think rhus is that remedy. In the treatment of keratitis and corneal ulcer the text-books advise some form of mercury locally. In such local use of mercury there is one thing to be avoided, namely, the giving of potas.

Iodide internally at the same time, as there is formed a caustic mercuric iodide which is highly irritating to the eye. Newton: I think, if I had a word to say here, it would be in defence of the dispensary patient re- specting his uncleanliness. I do not know as a physician finds any more uncleanliness here than among other patients. I do not know that in my somewhat extended experience I have found them objecting to soap and water. I scarcely feel that we should so often refer to the uncleanliness of dispensary patients. This disease is not necessarily con 1899- Societies.

3 3 tracted by the uncleanliness of the patient, for if it is in the secretion which comes from the vaginal canal, I cannot see how the patient is responsible. Suffa: Eserine has caused a good deal of irritation and pain. It is a remedy to be used with caution.

I have failed to see a case where it has acted favorably, and would not advise a general practitioner to use it. Boric acid has no germicidal effect, but it has a very beneficial effect on the eye, and is decidedly better than pure water. I cannot recommend nitrate of silver twice a day. I use it once in two days, depending upon the amount of secretion. I have carried many cases through without nitrate of silver.

Hinson: In the majority of dispensary cases the patients are careless and will not carry out the directions of the physicians. I refer particularly to the application of compresses and other local applications. Bellows next read his interesting paper on 'The Treatment of Aural Neuralgia.' Hinson: I consider Dr. Bellows' paper a very excel- lent and practical one, not only to the specialist but to the general practitioner, and suggest that it be printed. Klein: I do not advise the use of cocaine or chloro- form for the earache, but prefer moist heat.

In inflamma- tory cases I have found spraying the ear with tincture of aconite and ether beneficial in checking the pain for the time being. I think internal remedies should be given also, but first stop the pain. The next paper, ' Do Sprays, Local Applications, and Nebulized Medicaments interfere with the Curative Action of the homceopathically indicated Remedy?' Was read by Dr.

Talbot: I regret that for the sake of dis- cussion I cannot disagree with Dr. Rice in his very practical paper. In reality it opens the old question, but to my mind there is no doubt that a large number of cases of catarrhal inflammation are cured by external treatment. Hahnemann holds that the indicated drug offers the only means of cure, and that there is a special use and a special kind of action 34 The New England Medical Gazette. January, for each drug. If we can admit that in the application of local treatment we never use the internally indicated drug, that its dynamic effect does not enter into the question, we may then be able to decide whether local cure is a mere sup- pression or whether the cure is due to the dynamic force of the internally indicated drug. While I believe we appreciate the great service he has done for homoeopathy, we should not lose sight of the fact that Hahnemann was fond of theo- rizing, and his theories should be received with caution.

Bellows: Local applications which have a violent stringent action I consider objectionable, but those which are chosen for their medicinal effect are similar to those which are selected for their internal action. It seems to me that the objection which can be offered for the use of local remedies is very slight. Klein: I think if Hahnemann had lived in our time he would have used local remedies to destroy bacteria. I claim that remedies for local application are just as necessary as internal remedies. I use a good many external remedies as antiseptics. Strong next read an interesting paper on ' The Use of Mercurials in Throat Affections.'

Owing to the lateness of the hour Dr. Strong's paper was not discussed. Wells then read a paper on ' Keratom- etry and Astigmatism.'

The meeting adjourned at 10.30 p.m. Allard, Secretaiy. GLEANINGS AND TRANSLATIONS. An Antidote to the Rhus Poison. — In the Medical Record 'for April 16, 1898, is an article on Rhus toxicoden- dron, by Dr. Frank, of Milwaukee, Wis.

The author speaks of many remedies but gives no preference to any. This probably is no oversight, for I find such is the general tone of authors on the subject. A few years ago my son put a Chinaman to clearing a piece 1899- Gleanings and Translations, 35 of ground which was infested with a thick growth of poison oak, Rhus diversiloba, which had to be handled and burned. After one day's work the Chinaman reported sick, with hands and face swollen and painful. Remedies from the nearest doctor were obtained and applied. A carpenter who was working about the place was afflicted also.

His eyes were closed and very painful. The medicine at hand was used on both patients for several days with no relief. My son then sent to me, a hundred miles distant, for treatment. I ordered muriate of ammonium, one ounce, to be dissolved in two quarts of warm water. This solution was to be applied with cloth or absorbent cotton, covered with oil silk or rubber tissue.

Relief followed quickly and in two days the sufferers were well or able to work. Ten days later my son, after working a day with the shrub, found at night that his hands were swelling and inflamed. He applied the remedy at once, and by the next morning there was positive arrest of the malady. By frequent wash- ing with the solution he and the others were not troubled thereafter. Dermatitis venenata is usually self-limited, although the limit may be twenty-four hours or as many days; hence the long list of uncertain remedies. Any medicine which will relieve pain and arrest morbid progress promptly is a remedy much needed. The above cases and a history of many others might be cited to show that this drug, hydrochlorate of ammonium, is a pleasant and efficient curative and prophylactic.

Hudson, in Medical Record. The Menopause. — A vaginal examination should be ad- vised in all cases as often as every three months, to be sure that no disease of the pelvic organs exists. The return of the menses after a period of several years is to be taken as a warning of some serious condition existing, and great care should be used in examining to find the cause.

The treat- ment of patients at time of menopause depends upon the conditions and characteristics of individual cases, climate, $6. The New England Medical Gazelle. January, marital and home life, and constitutional dyscrasias and idio- syncrasies. The following are a few hints applicable to all: — As little waste of nervous energy as possible. As few cares and responsibilities as possible.

A cheerful home and companionship. Moderate and daily exercise, but not to exhaustion. Frequent bathing to free the pores of poisonous accumu- lations. All excretions should be free and regular. Massage where vitality is low and no exhausting hemor- rhages have occurred. Change of climate or scene where there are unhappy home surroundings. Medicines should be selected for each case, as different symptoms appear.

Dake, in Homoeopathic Journal of Obstetrics. The Bacteriology of Cirrhosis of the Liver. Adami states that experiments on animals show that alcohol at most produces the fatty liver with a slight amount of fibroid change in the portal areas, and nothing at all resembling the deposit met in hobnailed liver. More- over, extreme cirrhosis may attack children and adults who have never taken a particle of alcohol. As the result of numerous bacteriological researches he concludes, (i) That in at least a very large number of well-marked cases of pro- gressive cirrhosis in man a bacterium is to be found in the liver cells.

(2) That in the infective cirrhosis of cattle a similar organism occurs. (3) That the organism may occur in other organs. If these observations are confirmed, cir- rhosis of the liver assumes an entirely new aspect. A num- ber of phenomena are satisfactorily explained, such as en- largement of the spleen before there are any signs of portal obstruction, and the frequency of right-sided pleurisy.

The presence of jaundice in some cases and ascites in others perhaps depends upon whether the organism more especially affects the liver cells and bile ducts, or sets up a low inflam- mation of the peritoneum. Gleanings and Translations. 37 What the Student should be Taught.

— He should be taught, from the inception of his medical course to its very end, that there is a totality of the organism as well as a totality of symptoms; that there is no organ of the body independent of its fellow or fellows; that all are connected anatomically and physiologically, and that disease or lesion of any one may, and frequently does, disturb other and dis- tant organs. Besides, he should become thoroughly imbued with the idea that the mission of the physician is, first, to prevent disease; and, second, to cure disease which he can- not prevent in the easiest and safest possible manner, by in- ternal medication if possible, by other methods if necessary. He should be given an abiding faith in therapeutics; but he should likewise be taught the limitations of the internal remedy, so that each case which presents itself for treat- ment will be studied from a diagnostic and pathologic as well as a therapeutic standpoint. If he be thus equipped, there is little danger of his becoming either an extremist in thera- peutics or a pure localist.

He will be a true physician in the highest sense of the term — a safe man to intrust with the lives of his fellow men. Wood, in The Hahne- mannian Monthly.

Saline Injections after Flooding. — Amillet (L'Ob- stetrique) insists that after grave hemorrhage in pregnancy or labor a saline intravenous injection is the best method for encountering acute anemia. A one per cent solution of chloride of sodium is the only available mixture which has no evil influence on the corpuscles. At least 1,500 to 2,000 grams must be injected. In less serious cases two hundred grams can be injected under the skin; more than one dose may be required.

Amillet recommends an intravenous saline injection or a subcutaneous injection before any obstetrical operation is performed on a woman exhausted by loss of blood. When the patient has clearly been revived by these means, she must, in any case, be closely warched, as some- times the good effects do not last. The injections must be repeated, if necessary, till all danger has passed away. — British Medical Journal. 38 The New England Medical Gazette. January, A Vegetarian Hospital. — The treatment of the sick in the Oriotel Hospital at Loughton, in Essex, England, is carried out according to the strictest laws of vegetarianism.

There is room for twenty patients. The really poor are received free of cost; others pay from half a sovereign to three guineas a week for their treatment. Since the open- ing of the hospital it has been constantly full, and has never run into debt. Eggs, milk, and butter are allowed, but the ordinary dietary consists of porridge, bread and butter, some form of stewed fruit, and cocoa for breakfast, a savory, as macaroni, cheese, fresh vegetables, and pudding for dinner, and fresh fruit, bread and butter for supper.

Twice a week tea is allowed, oaten water and cocoa being on other days served in the afternoon. It is said that upward of five hun- drend patients have passed through the wards. — The Amer- ican Practitioner and News.

Cold Atr as an Appetizer. — Cold air, it would seem, possesses great possibilities as a medicine. A Russian phy- sician has had some very satisfactory experiences with it. He placed a dog in a room with the temperature lowered, states the London Engineering, to 100 degrees below zero. After ten hours the dog was taken out alive, and with an enormous appetite. The physician tried the test himself. After ten hours' confinement in an atmosphere of still, dry cold, his system was intensely stimulated.

So much com- bustion had been required to keep warm that an intense appetite was created. The process was continued on the man and the dog, and both grew speedily fat and vigorous. It was like a visit to a bracing northern climate. — The Die- tetic and Hygie?iic Monthly.

Vedder, of Christiana, Sweden, reports the results of examination of 310 married women who had never been pregnant, though married at least one year. In fifty of these cases he was able to examine the husband also.

He draws the* conclusion that in seventy per cent of these cases the husband is to blame for the sterility, either through impotence or through infecting his wife with gonorrhoea. — Norsk Magaziii, fer Lagevid. 1899* Reviews and Notices of Books. 39 REVIEWS AND NOTICES OF BOOKS. Diseases of the Stomach. By William W.

Van Valzah, A.M. A., M.D., and J. Douglas Nisbet, M.D.

Philadelphia: W. Price, cloth, $3.50 net. The subject matter of this exhaustive treatise on the diseases of the stomach is presented in six sections: namely, I. Introduction and Classification; II. Diagnosis and Diagnostic Methods; III. General Medication; IV. The Dynamic Affections of the Stomach; V.

The Anatomical Diseases of the Stomach; VI. The Vicious Circles of the Stomach. Each section is subdivided into chapters, treating the various conditions and diseases included in that section. The whole work comprises twenty-five chapters and is contained within six hundred and seventy-five pages.

The physical signs of diseases of the stomach and the instruction for the use and introduction of the stomach tube are full and explicit. The chapters on diet and the diet suitable to the various diseased conditions of the stomach, together with the admirable tables giving the amounts of albumins, carbohydrates, and fats in the various articles of food, are especially to be commended. The object of the authors is stated to be ' to make this book simple, clear, practical, and complete in useful information.' It certainly is clear and complete but hardly simple, except to one who has given much thought and study to the subject.

To the specialist it is eminently practical; to the general practitioner there is much in the work which is too technical and strictly scientific, requiring more knowledge and experience in practical organic chemistry than falls to the lot of most physicians. An admirable index, however, enables such a one to select what is available for his own needs. The make- up of the book is, as usual from the hands of this firm, excellent.

A Text-Book upon the -Pathogenic Bacteria for Students of Medicine and Physicians, By Joseph McFarland, M.D. With 134 illustrations. Second edition, revised and enlarged.

Phila- delphia: W. Price $2.50 net. The second edition of this work brings it thoroughly up to date. The book is in two parts. Part I, General Considerations, gives an 40 The New England Medical Gazette. January, interesting introduction to the study, and a short but comprehensive history of bacteriology. In this part is also given the methods and apparatus used in this line of work, the best media for growing bac- teria, and practical instructions based upon a wide experience which cannot fail to be of value.

In most works of this kind there are usually so many methods given, many of which are of questionable value, that quite frequently the student is confused, and one cannot fail to be impressed with the lack of superfluous matter in this book, which as a manual for the student or physician will be quite an accessory to his armamentarium. Part II, Specific Diseases and their Bacteria, is subdivided into A, The Phlogistic Diseases, acute-inflammatory and chronic-inflam- matory diseases; B, The Toxic Diseases; C, The Septic Diseases; and D, Miscellaneous.

Under A, the article on tuberculosis is deserving of the most care- ful perusal. In view of the ravages of this disease one cannot know too much of it, and the author has collected and presented the best views on trie subject as well as the best methods for its observation and experimental study.

Under B, the whole topic is well written, diphtheria deserving special mention. Under C, the articles on yellow fever and typhoid fever are worthy of note, especially in con- sideration of the part those two diseases alone have already played in the army and from climatic and unhygienic conditions are apt to, the importance of a thorough knowledge of their etiology, mor- phology, cultural peculiarities of their specific micro-organisms and their prevention is very evident. Of the application of the science of bacteriology and its bene- ficial effect upon everyday life, and especially upon cattle and other live stock, the author does not fail to call attention to Jn a very effectual manner. The book, on the whole, is well written and a valuable contribution to the methods of observation on those small and low forms of life which very materially and quite too frequently affect in a deleterious manner many individuals of the highest forms of life. Ophthalmic Diseases and Therapeutics.

Norton, M.D., Professor of Ophthalmology in the College of the New York Ophthalmic Hospital, etc. Second edition, revised and enlarged. Philadelphia: Boericke & Tafel. The classic of Dr. Norton, ' Ophthalmic Therapeutics,' 1899- Reviews and Notices of Books. 41 formed the basis of the first edition, which was the result of the joint labors of Drs. Norton, the death of the former leaving the completion of the work to the latter.

The popularity and extended adoption of the first edition by the leading homoeo- pathic medical schools insure a ready sale for the new work, with its many improvements and valuable additions. Methods of exami- nation, direct and indirect ophthalmoscopy, and sciascopy are well illustrated by some excellent photographs. The essentials of refrac- tion are well stated by Dr.

Worthy of especial notice is a chapter by Dr. Linnell, giving a tabulated list of ninety-three general diseases with their characteristic eye symptoms; this ready reference will undoubtedly be often consulted. Three hundred and eighty pages are devoted to diseases of the eyes, giving ' concisely all the essential features,' commencing each chapter with ' sufficient anatomy to enable one to understand the pathological processes.'

Local treatment is first stated, the indicated operation described, with illustration where necessary, and finally remedies with their indications given in the order of their importance, instead of the alphabetical arrangement of the earlier edition. Differential diag- noses arranged in parallel columns is another important innovation. Part II, ' Ophthalmic Therapeutics,' occupies 140 pages. Drugs are arranged in alphabetical order, and symptoms are given under the rubrics, objective, subjective, vision, and clinical. Beside the usual chromolithographs of the fundus, there are six very good reproductions of external appearance of chalazion iritis, follicular conjunctivitis, trachoma with pannus, hypopyon keratitis, and keratitis parenchymatosa.

The style of the anthor is so clear and the matter so readable that the work will be especially valuable to the student and general practitioner. King's American Dispensatory. By Harvey Wickes Felter, M.D., and John Uri Lloyd, Phr.M., Ph.D. Entirely rewritten and en- larged.

Eighteenth edition. Third revision.

In two volumes. Cincinnati: The Ohio Valley Company. Price, cloth, $4.50, sheep $5.00, per volume, postpaid. It seems to us a misfortune that so excellent a work as the above in its present revised, rewritten, and enlarged form should not have been printed on at least a fair quality of paper. Cheap, thin, glazed paper is an abomination, and good type loses its distinctive char- acteristics when associated with it. The text of this dispensatory, 42 The New England Medical Gazette. January, however, though prepared especially for eclectics, will give great sat- isfaction to students of all schools.

To be sure we have as yet only the first volume of the new edition, but this shows uniform merit and the painstaking care which has been lavished to insure accurate and unbiased statements. More than this, the pharmaceutical and chemical sections have been practically rewritten largely through the efforts of Professor Lloyd, who is particularly well fitted to bring such labors to a suc- cessful conclusion. Felter has rearranged, revised, and added to the material in- cluded under botanical sources, history, description, etc., and ad- ditionally has compiled and edited the entire medical section.

In this latter portion he has judiciously retained such teachings as the eclectics have proved to be valuable, at the same time modernizing the therapy of the whole, emphasizing the specific indications and uses of each remedy, deprecating excessive doses, and adding such new remedies as seemed worthily to demand recognition. Pro- prietary compounds and patented chemicals are to a certain extent included, but are not unreservedly indorsed. Remedies are arranged alphabetically and the first volume com- pletes those appearing under F. We may reasonably expect that the second volume will evidence as much care and intelligent prepara- tion as the first. Together they will find a place on professional bookshelves beside the Pharmacopeia of the American Institute of Homoeopathy, the Pharmacopeia of the United States, and the United States Dispensatory. Diseases of Women. A Manual of Gynecology.

Designed espe- cially for the use of Students and General Practitioners. Davenport, A.B., M.D., Assistant Professor in Gynecology, Harvard Medical School, etc. Third edition, revised and enlarged, with 156 illustrations.

Philadelphia and New York: Lea Bros. Price, cloth, $1.75 net. No better evidence of the value of this attractive manual can be asked for than that another edition has been demanded by the pro- fession. The book has been thoroughly revised and enlarged, and will be welcomed by the student and general practitioner alike, as now furnishing the surgical as well as the non-surgical methods of treatment.

The present volume contains 388 pages, and the series of illustrations has been correspondingly increased. The methods of examination and the various manipulations neces- 1899- Reviews and Notices of Books.

43 sary in the diagnosis and treatment are marked by their common sense and absence of useless detail. The chapter on dislocations and lacerations of the vagina is well illustrated and is to be especially commended. The section treating of uterine displacements and the adjustment of supports contains much definite information which one looks for in vain in many of the larger text-books. Disorders of menstruation, diseases of the ovaries and tubes, pelvic peritonitis and cellulitis are well dwelt upon.

A chapter on diseases of the urinary organs concludes the manual. The book has been written in a pleasing style and with sufficient detail to render it invaluable to the general practitioner. Every student would do well to possess it as a preface to his course of study. A Country Doctor. Shastid, M.D. Battle Creek, Mich.: Published by the Author. There can be no greater inspiration to the doing of worthy work than the record of such work, sympathetically presented and thoughtfully read.

Since McLaren's now immortal record of the life work of Weelum McClure, no more moving and inspiring presentation of a physician worthy that great name has been given for the example and comfort of the would-be physician than this very simple and touching picture of the life and character of a country doctor by that country doctor's son. It is true that as few men are heroes to their children as to their valets de chambre.

No more eloquent testimony to the character of the man here pre- sented to our affection could be offered than that he stands to his son, himself a physician, as 'The' physician; so far the model of his profession that the author closes with the quaintly and sweetly filial saying that he cannot doubt there are many men in the profes- sion 'almost' as good as his father! It is a very simple life that is here pictured: a life of soldierly devotion to duty; of selfhood conquered for the love of something nobler than self; of danger greater than has won many an 'honorable mention' for gallantry faced day by day, and as a matter of course, in the doing of daily duty through storm and shine, through failure and ingratitude; and for simple duty's sake, where no gain was. It is a record of the sympathy ' which,' in the noble phrase of the great Dr.

Brown, 'has outgrown emotion and passed upward to action'; in a word, it is the record of the life and character of a true physician, and as such, an inspiration to all who would become true physicians and 44 The New England Medical Gazette. January, do all that one life may do to raise their noble profession above the mean levels of a trade for personal gains. As has been said, the little record breathes sympathy and simple truth in every line. The author has done more than give us a picture of his father: he has given us the picture of a man whom every honest physician has, in the old word of sweet privilege, the right to claim as a ' father in God.' An American Text-Book of the Diseases of Children. Includ- ing Special Chapters on Essential Surgical Subjects, Orthopaedics, Diseases of the Eye, Ear, Nose, and Throat, Diseases of the Skin, and on the Diet, Hygiene, and General Management of Children. By American Teachers.

Edited by Louis Starr, M.D. Assisted by Thompson S. Westcott, M.D. Second edition, revised. Phila- delphia: W. Saunders, 925 Walnut Street.

Price, cloth, $7.00; sheep or half morocco, $8.00. For sale by subscription only. The clear, concise manner in which this book is written, emphasiz- ing points that are often overlooked by the general practitioner and giving him a fair knowledge of the more obscure diseases often treated by the specialist, particularly commends this work. The editor's object, as stated in the Preface, ' has not been to add unnecessarily to the number of encyclopaedias already existing, but to present to the profession a working text-book which shall be closely limited to, while completely covering, the field of pediatrics.' Starr's efforts have been successful is very apparent, the book containing much valuable and important matter deservedly demand- ing the attention of every practitioner. The present is an enlarged and revised edition of that issued in 1894, is divided into fourteen parts, and numbers 1244 pages. The work as it now stands is fully abreast of the times, for many of the original contributions have been amended, others have been entirely rewritten, while still others, such as ' Modified Milk and Percentage Milk Mixtures,' ' Lithemia,' and a section on ' Or- thopaedics,' are wholly new.

Chapters which are worthy of especial note are those upon ' Diseases of the Skin,' ' Eye, Ear, Nose, and Throat,' ' Ortho- paedics,' and those which deal with ' Diet,' ' Hygiene,' and the ' General Management of Children.' The illustrations are numerous and good, those in colors success- fully demonstrating how closely art can imitate nature. B.,1899- Reviews and Notices of Books. 45 The Care of the Baby.

A Manual for Mothers and Nurses con- taining Practical Directions for the Management of Infancy and Childhood in Health and in Disease. Crozer Griffith, M.D. Second edition, revised. Philadelphia: W B. Price, $1.50. While this little book is designed especially for mothers and nurses, it contains much valuable advice which the busy practitioner can well ponder upon.

The first chapter discusses the hygiene of pregnancy, the method of calculating the date of confinement, and similar data. The characteristics of a healthy baby are considered in the second chapter, and the growth of its mind and body in the succeeding one.

The chapters which follow relate to the methods of bathing, dressing, and feeding children of different ages, to the hoars for sleeping, to physical and mental exercise and training, and to the proper qualities of the children's various nurses and rooms. The chapter upon the baby's diseases has been written particularly for those mothers who, through various circumstances, are unable to have a physician constantly within a moment's call. It contains a description of the symptoms by which we may know that disease is present; a consideration of the nursing of sick children; a concise resume of the commonest diseases of infancy and childhood; and directions for the management of various accidents, including among others drowning and the swallowing of poisons. This work is to be highly commended and should be in every home where there are children. Key Notes and Characteristics with Comparisons of some of the Leading Remedies of the Materia Medica. Philadelphia and Chicago: Boericke & Tafel.

Price $1.25 net. The compiler of these key notes has sifted out good wheat from much chaff, and we think this monograph as a whole will serve as an excellent little helper in the oftentimes puzzling work of selecting the true similimum.

A few more remedies could have been added to advantage, but nothing given could well have been omitted. The most prominent characteristics of the remedies included are strongly emphasized, and the individuality of each clearly defined.

Comparisons are made which simplify selection and fix in one's mind more permanently important and guiding symptoms. The voluminous symptomatology of our materia medica must still 46 The New England Medical Gazette. January, be studied long and faithfully; but there is no good reason, never- theless, why one should not take advantage of such practical assist- ance as Dr. Allen offers in his comprehensive little work. A Primer of Psychology and Mental Disease for Use in Training- Schools for Attendants and Nurses and in Medical Classes. Second edition, thoroughly revised. Phila- delphia: The F.

Price, $1.00 net. This little work was written for the instruction of nurses in hos- pitals for the insane. The first edition has been adopted as one of the text-books in several of the training schools.

It having now reached a second edition shows that it has proved useful. For elementary instruction it will be found well adapted to medical students, and even the established practitioner will find many points in mental diseases made clearer by its perusal.

It is not always that so much information is obtained at so small an expense. Middletown, Ohio. Price, $1.00. To show that soli-lunar and planetary influences dominate the sex and exercise a controlling power over man's life in health and dis- ease, and from the cradle to the grave, is the author's object. His desire is, additionally, to show how a recognition of the influ- ence of natural law in the physical world may be of practical value to the physician, aiding him in mitigating suffering and in prolonging and saving human life.

How well the author accomplishes his aim is best left to the indi- vidual reader to decide. Those who are of a speculative and theosophical turn of mind may be interested, to follow out his argu- ments and consider the principles he presents.

REPRINTS AND MONOGRAPHS RECEIVED. The Advantage of Physical Education as a Prevention of Disease. By Charles Denison, A.M., M.D. Reprinted from Bulletin of the American Academy of Medicine, Vol. The Aseptic Animal Suture: Its Place in Surgery.

Marcy, A.M., M.D., LL.D. Reprinted from The Journal of the American Medical Association. The Dangers of Specialism in Medicine. Duncan Bulkley, 1899* Personal and News Items. 47 A.M., M.D. Reprinted from Bulletin of the American Academy of Medicine, Vol.

Manifestations of Syphilis in the Mouth. Duncan Bulkley, A.M., M.D. Reprinted from the Dental Cosmos. The Surgical Treatment of Uterine Myomata. Marcy, A.M., M.D., LL.D.

Reprinted from the Journal of the American Medical Association. The Abuse and Dangers of Cocain. Scheppegrell, A.M., M.D. Reprinted from the Medical News. Modern Treatment of Tuberculosis. By Charles Denison, A.M., M.D. Reprinted from the Journal of the American Medical Association.

Further Observations Regarding the Use of the Bone-Clamp in Ununited Fractures, etc. By Clayton Parkhill, M.D. Transillumination of the Stomach with Demonstration on the Per- son.

By Charles D. Reprinted from The Medical Age. Chronic Catarrh of the Stomach.

By Charles D. Reprinted from the Pharmacologist. By Charles D. Reprinted from the Journal of the American Medical Association. Intestinal Auto-Intoxication. By Charles D. PERSONAL AND NEWS ITEMS.

Percy, of Brookline, is now a member of the faculty of Boston University School of Medicine, filling the vacancy made by the recent death of Dr. Stowell has removed from South Dennis and opened an office at 283 Ashmont Street, Ashmont.

Corr, who has been practising in Boston, is now located in Attleboro. Allard, Secretary of the Boston Homoeo- pathic Medical Society, has recently been elected Medical Director of the Boston Mutual Life Insurance Company of Boston. 48 The New England Medical Gazette. January, 1899. Sanders died at his home, 511 Columbus Avenue, Boston, Mass., November 20, 1898, of senility.

He had been in constant practice up to within eight weeks of his demise. Sanders was born in Epsom, N. H., September 24, 1820.

He studied medicine in the Castleton Medical Col- lege, Vermont, graduating in 1843. He also attended Dart- mouth College, from which he received an honorary degree in 1886. He established himself first in Effingham.

A year and a half later, in the autumn of 1849, ne came to Boston, where he had since remained. He was associated for a year and a half with Dr. Samuel Gregg, from whom he took his first lessons in homoeopathy, and then went into private practice at 1 1 Bowdoin Street. Here he lived for twenty-one years, when he moved into his late residence on Columbus Avenue. Sanders was one of the three seniors belonging to the homoeopathic medical profession in Boston, and the community, as well as his school, recognized him as one of its most successful members.

He was a member of the Massachusetts Homoeopathic Medical Society (of which he had been president), the American Institute of Homoe- opathy, the Hahnemann Club, and the Boston Physiological Society, and had contributed largely to the medical journals. For two years he was a member of the Boston school com- mittee. He was a large contributor to many charities. He con- ceived the plan for and subscribed $5,000 toward founding the Little Wanderers' Home. He was a 32d degree Mason, A.

R., and had passed all the honorary positions in that body. He had always been a constant church sup- porter, and had given largely to the Union Congregational Church, of which he was a member. He leaves a widow. T HE NEW ENGLAND MEDICAL GAZETTE No. FEBRUARY, 1899. EXPERT TESTIMONY. BY ALICE PARKER LESSING.

[Read bffore the Boston Homoeopathic Society '.] Your society has honored me by assigning to me a subject for discussion, the extent of which far exceeds the possibil- ities of a short discourse. At the outset I must announce that until yesterday morning I was not aware of the subject as had been printed in your notices and I had intended a more indefinite talk chosen for me, and I have been able to give to it but a cursory thought and concentrate upon it a few disconnected ideas. As a lawyer I was naturally expected to direct myself to the legal field of medicine, but considering the immense acreage of this field you must not expect me to sow and bring home a full harvest. Perhaps it is well to remind you of an early biblical law whereby the gleanings of the field were not to be taken home, but were to be left to the poor.

So as one of the great army of the poor, I will pick up a few gleanings. The ' three learned professions,' as they were called, have always appeared to the world as possessing all the brains and practical ability to take care of the world.

In fact one of them, our sister Theology, has assumed to take care of the next world also. But primarily this trinity of professions controls the moral, the physical, and the social condition of humanity. Each in its sphere requires the assistance of the other. 49 50 The New England Medical Gazette. February, Theology with medicine combined — Mens sana in corpore sano — is the old Latin maxim, which in its broader idea means to us that the good morals of the community are dependent on the physical and sanitary conditions of the individuals.

But both combined without the enforcing and subjecting arm of the law would be powerless; and the reverse of this principle holds good as well. The law may be ever so powerful and its enforcing power ever so strong, without the application of the progressive medical and moral sci- ences its power to operate upon the individual would be vastly diminished. The law comes in dail y ■ con tact with its two sisters; it should never come.- iq to conflict, vWhltsthem. Leaving out the theologians fro^ri these refnarks ^TScrpr AttJ^ The first application is to your profession, and medicine comes to the aid of the physical wrong which has been caused by the accident.

But beyond this a legal wrong has been committed which caused the injury. The law is invoked to redress this wrong and the remedy is provided by the body politic to cure the injury. Now the two have combined to restore the individual injured to the financial and physical health which he enjoyed before, and if this is not attainable so far as the physical injury goes, the law remedy requires a greater financial restoration. This medicine is called damages.

Medicine cannot procure this latter remedy; the only apothecary who can fill the prescription is the law. But medicine must help to determine, in the first place, the extent of the injury, the prospective cure, the prognosis, without the knowledge of which the law cannot apply its curative power. Here appears one of the unfortunate conflicts which may 1 899. Expert Testimony. 51 be observed any day by a visit to one of the courts where damage cases are being continually tried. The physician who was called to cure the body is not allowed to be the sole arbiter as to the physical condition and prospects of his patients, and he is met with conflicting interests of the parties to the lawsuit. So you apply to the legal case the opinions of the medical experts who are to determine the conflict, which they gen- erally do by creating new conflicts.

Expert testimony of medical men determining on the extent of injury should be without conflict. The honest and unbiased opinion of a dozen medical experts should not be conflicting, but every attendant and observer on these cases knows that the contrary is the invariable rule. Is this the result of a difference of opinion honestly arrived at by studying the subject, or is it not rather the result of employment of the medical expert by one of the two parties to the damage case? This subject has occupied much attention of law and med- ical writers, of social reformers and students.

Each one has come to the same conclusion that the con- flict of medical expert opinion is much to be regretted and that some remedy is required to cure the expert fever. Of course it is easy to account for an honest difference of opinion on expert matters because different studies of the particular subject may reach different results.

The same thing happens in the opinions of lawyers and judges, each one honestly believing himself right; and we all know how great the difference of opinion is among the theologians, where each one knows himself so positively right that he knows every one else to be positively wrong, often even to the extent of condemning him to everlasting punishment. But because these same differences exist in the other pro- fessions is no reason why the legal field of medicine shall not be sown with a better seed and bring a better crop. A number of attempts have been made by various legis- latures and courts to remedy the evil; they all start from the 5 2 The New England Medical Gazette.

February, point that medical expert testimony has fallen into disrepute, and that this disrepute arises from the fact that the partic- ular expert is employed on a particular side of the case to testify on behalf and for the benefit of that side, that the fee he receives is paid him for that purpose, and unless he can give an opinion on the side which calls him — which means the side which employs him — he will not be em- ployed as an expert witness. No doubt, then, that studies of the subject thus prepared and opinions given under such circumstances cannot be of great value in helping us to arrive at the truth. So in a few instances law or rules of court have provided that no expert shall be called by either party, but that the judge shall appoint medical experts from among physicians of repute to study and give opinions on each case as it occurs, and this only under the direction of the court, neither of the parties having anything to do with paying the fee. The objections made to this system are many. It is claimed that it deprives the litigant of the right to call such witnesses as he pleases to prove his case. But why should he have that.right?

He has not the right to call what judge he pleases to hear his case nor to call what jurors he pleases to try his case. Again it is claimed that such a system creates a court of expert physicians who will be controlled by the rich corpor- ations so largely interested in the cases. This is indeed a serious objection when we consider the corruption in office. But will it be more so than the possibility of corruption of judges? Certainly it would be an unmerited insult to the medical profession to say of them that they can be corrupted any more easily than lawyers. And we know that the most prejudiced, one-sided lawyer loses his one-sided prejudice when he is elevated to the bench.

And the physician is at least as honest in public and private life as is the average good intelligent citizen in every sphere of life. A court of medical judges appointed to examine cases and determine a fact submitted to them should be and would be i8oq« Expert Testimony. 53 as high as a court of jurisprudents appointed to examine and determine the law in a given case. The objection of expense in maintaining such a court so as to maintain the standard of probity should not count for anything in a country where resources prove inexhaustible. We have lately under an act of the legislature of 1898 established a court of land registration which shall deter- mine and register the titles to land so as to make individuals more secure in their titles and land holdings. No suggestion of expense for maintaining three judges and a clerk and the necessary machinery has been urged, and no one has thought that the corruptibility of office holders would affect this new branch of our judiciary. A greater objection is that medicine is a speculative sci- ence, while law is an exact one.

No doubt this is so; the opinions of medical men differ and are based largely on speculation. The accepted science of a century ago is not even the non-expert opinion on the same subject to-day. Progress has shown as unquestioned error what was ac- cepted as a scientific fact. But even this objection must not weigh.

If you should examine the opinions of the United States Supreme Court you would find but very few on which the full bench is unanimous, and this with the exact science of law. From the very nature of the cases which come before that tribunal a conflict of opinion is expected, and human tribunal can only be expected to apply human ftniteness to its judgments. Whether in law or medicine, that judge who, with all the light which he can reach, will endeavor to do justice between man and man without fear or favor comes nearest to fulfilling the divine mission of a human judge.

No doubt such a medical judiciary would commit errors, but what human tribunal has not done so? This is a legal field of medicine still unexplored, and the efforts in this direction made by a few States have only been partial. The furthest of these go to the point of appoint- ing experts for each case and treating them as witnesses whose opinions are to be considered like other evidence in a 54 The New England Medical Gazette. February, case, the only object being to do away with individual expert calling, while the fees must be paid by the parties who are, or one of whom generally is, made to pay.

I have gone further in my idea by giving you the outline of a tribunal in character like the land registration court lately established, and to which I have already referred. So to this tribunal would be submitted each case where medical expert testimony is required, and it would determine, not the amount of damage, but the condition, past, present, and future, of the party injured; or in cases involving insan- ity, the mental condition of a testator or of a person charged with crime, and perhaps in the latter case the prospects of recovery, etc. I cannot go into details; I can only begin to agitate a reform in the legal field of medicine, so that others may dis- cuss it and bring forth a system. The novelty of the idea should not deter us in a great State like ours, which is always in the vanguard of every great reform tending toward truth and justice. And now once more in closing I beg to apologize for this treatment of the broad subject which you laid out for me, and to thank you for the opportunity I have had of leading you into a new legal field of medicine.

THE RELATION OF SYPHILIS TO NERVOUS DISEASES. The more one studies either syphilology or nervous dis- eases, the more strongly does the impression become fixed that the infection exerts a marked influence upon the nerv- ous system. It is second only to its effect upon the skin, and it is but natural that these results should be numerically related, both tissues being developed from the same embry- onic layer, and such kinship is not without its physical rela- tion. In the meantime we must bear in mind that it makes no trifling difference whether we pursue the study from the point of view of syphilitic nervous diseases or from that of 1899- The Relation of Syphilis to Nervous Diseases. 55 nervous diseases in syphilitic subjects, and there exists no small amount of confusion among authors upon this very in- teresting division. We all recognize the existence of such a condition as ' nervous syphilis,' with definite and unmistakable specific lesions, occurring at no very distant times from other syphilitic manifestations, that is, within a very few months or years.

On the other hand, there are several degenerative nervous diseases in which a very large percentage of cases present a previous history of specific infection. If these dis- eases occurred only in patients with such history there would be some ground upon which to class them as syphilitic, but unfortunately for such theory these same affections occur in a very respectable percentage of patients who present no such history, and where in fact there is every reason to exclude the probability of infection. To establish a diagno- sis of syphilis, patients should present some marked symp- toms by which the nature can be differentiated, something by which we can identify a specific from a non-specific case. In these late manifestations such stigmata do not exist, and we can only argue from the history of the case. One patient who has many years before had a primary specific lesion finally develops, for instance, ataxic paraplegia. Another person who has no suspicion of such affection is attacked by the same disease, and between the two there is nothing but the verbal history to show the slightest differ- ence.

In reality there may be a greater parallelism than in two syphilitic subjects. In several of the degenerative nerv- ous disorders it is claimed — and probably truthfully — that there is a percentage all the way from 50 to 80 of specific antecedents. To be conclusive, there should be no break save that of incorrect or doubtful history; in other words, there should be 100 per cent. The argument that if the whole family record could be known we should find inherited syphilis is not tenable in this country to any great extent, and it is remarkably singular that a robust child should grow up to robust manhood tainted with such dyscrasia and not show one specific indication until the third or fourth decade of life. Some other charac- 56 The New England Medical Gazette.

February, teristic symptom should crop out previous to the appearance of the nervous affection. It is a significant fact that most of our statistics upon this subject are from countries with large standing armies, composed mostly of single men, and con- stantly exposed to decidedly immoral influences, and syphilis is so common a holding that it would be difficult to select any chronic disease for study which would not furnish a large percentage of syphilis in its personal history. Another method of estimate has been suggested but never adopted. Not how many ataxics or paretics had had specific disease, but how large a proportion of syphilitics have these disorders. Such a census would make a very interesting study, and possibly it might be profitable. True syphilis of the nervous system is not so very frequently encountered, and when it does occur it is a comparatively early feature.

Most of the cases develop within two years of the last somatic lesion, and a large proportion within the first year. Its most common forms are meningitis, the char- acteristic disease of the cerebral and spinal arteries, and gumma. Of the vascular nervous supply the cerebral is most frequently attacked, and gummatous growths seem to prefer this area to all other central tissue. The symptoms are by no means uniform, but depend upon the locality involved; thus we get local paralysis, which may be multiple. If there be local palsies multiple in number, and not in correlated areas, occurring in a syphilitic subject, we may confidently expect that the lesion causing such palsies is specific in its nature.

Buzzard, who is a careful student with abundant opportu- nities for observation, calls attention to one feature which he seems to consider characteristic; it is the profound somno- lence. But care should be exercised not. To confound this with the somnolent form of hysteria, a rare condition occur- ring in markedly hysterical subjects, who are free from syphilitic taint. If there is gumma in the brain it is quite likely to cause optic neuritis. The endarteritis of syphilis cannot easily be differentiated from that of other causes, except that it occurs in younger subjects and is, like the 1 899. The Relation of Syphilis to Nervous Disorders.

57 other specific lesions, amenable to the administration of iodide of potash or mercury, and often a case which does not yield to the potash will improve under the administration of mercurius. Paretic dementia is without doubt an occasional occur- rence, but lately attention has been directed by an author to two assumed facts: that syphilitic paresis occurs within two to five years after the initial lesion, while true paresis does not often occur before ten or more years. Also that in true paresis the psychic symptoms predominate over the somatic, while in cerebral syphilis the somatic symptoms pre- cede and dominate the psychic failure. Attention has been called to the use of. Iodide of potash and mercury not alone for their curative power, but also as diagnostic agents.

Now it is a generally accepted opinion among neurologists that in post-syphilitic degenerative diseases these drugs do but little if any good. In true specific disease there is a cachexia for which the drugs have a selective affinity, while in the non-specific class the primary disease has acted as do many other factors, to disturb the equilibrium and render the patient subject to morbid action. There is nothing here upon which the drugs can act selectively. Again, the true syphilitical lesion is to a certain extent exudative, while in the other and late malady the lesion is strictly degenerative. Many syphilologists and pathologists claim to have demonstrated that in true specific lesions of the nervous system there is an infiltration of small, round celled characters similar to that which is found in gumma; this even in endarteritis and specific meningitis.

No such infiltration has been found in the late lesions like paresis and cord disease. The theory prevails to a great extent to-day that the original germ leaves a toxine which predisposes to degenerative action. This may be true, but it is singular that it should not in some way manifest its morbific influence until so many years have elapsed. The latency would be truly remarkable. Fournier has termed this condition para- syphilitic. Syphilitic, meningitis cannot be readily differentiated from 58 The New England Medical Gazette.

February, chronic meningitis of other origin. It is more likely to be more locally defined, and in a large number of cases it is only an extension of an underlying gumma. When it occurs over an extended area it is less likely than the non-specific variety to cause optic neuritis. Non-specific meningitis run- ning a more or less chronic course and not the result of trauma or alcoholism is not common. Septic meningitis is almost invariably acute. In estimating the time following syphilis to establish the value of the terms, early and late, it must be borne in mind that we cannot always count from the initial lesion.

A series of secondary lesions has a ten- dency to extend the time, and would make a late lesion — in point of time — early in reference to the specific history. Syphilographers tell us that such instances are not rare. Authority is about equally divided on the question of whether thorough treatment in the early days of the disease has any effect in averting post-syphilitic degenerative disease, and both sides present a large array of illustrative cases. There now presents itself to us a momentous question: Can medication in accordance with our accepted method be of any benefit?

While there is a very general opinion that the syphilitic virus is an entity which demands appreciable dosage and for a long time, yet there is a great probabil- ity that the post-syphilitic condition is one in which minute doses of remedies appropriate to the total symptoms may be of great benefit. This is on the same principle that we would use properly chosen remedies for their constitutional effect after an injury or any non-specific disease. As previously noted, syphilis is one of the disturbing causes, and being of considerable duration it most profoundly weakens the resist- ing power of the whole economy against morbid tendencies. We must constantly bear in mind that pathological processes are only physiological workings ' gone wrong,' and the causes which can initiate this error are innumerable. There is good reason to believe that we are no more helpless in facing this enemy than many others which we are constantly combating. But there is a period beyond which our efforts will be futile.

If we wait until nervous lesions of a degener- 1899* The Relation of Syphilis to Nervous Disorders. 59 ative nature are well established we have lost much valuable time, and it is doubtful if the lost ground can be regained.

These diseases, being degenerative, are consequently progres- sive, and the primary lesions carry with them other second- ary results. Central nervous tissue has but little recuper- ative function, and at best we can only hope to arrest, but not to repair. The disorder is to a greater extent in con- ducting tracts than in ganglionic tissue, which does not add hopefulness to the case. I do therefore most firmly believe that a course of carefully conducted constitutional treatment should follow the specific medication, as preventing non- specific, but consequent, disease. Occasionally, but not often, we read of one of these late cases being relieved by specific treatment.

There is no rule by which the post- infectious state can be treated save the important one to study carefully the symptoms. Another question is of importance to us: Does the con- tinued heroic treatment to which the early disease is sub- jected have any influence upon the development of late disease?

We all know that continued administration of mer- curial compounds to the non-syphilitic affects the constitu- tional habit most profoundly, and that many of the symptoms thus produced are almost identical with those caused by the specific infection, and unless we can argue that the virus uses up the mercury, so to speak, the whole economy must be saturated by it and its effects. Nor is there any method of deciding without doubt whether a large portion of late lesions may not bear disagreeable relationship to the primary treatment.

The very uncertainty as to the ultimate value of early and thorough treatment would be an argument in favor of the unreliability of such treatment. And yet how few of us would have the courage or temerity to withhold the use of such measures as are known to cause the dis- appearance of a majority of true secondary lesions? The extended use of mercury since the true nature of the disease was first recorded gives us but a small number of cases from which we can study the results of pure and unmodified disease. 60 The New England Medical Gazette. February, We are actually placed ' between the devil and the deep sea,' and must make our selection as to which horn of the dilemma shall impale us.

In one instance we must risk our good reputation and fly in the face of recognized authority; in the other we must bear the imputation of having added an unnecessary danger to the life and happiness of our patient. One thing is certain, we cannot carry our patient through the secondary stage of the disease in a way which will save us from criticism with simply imponderable agents. The secondary stage left to itself is not entirely free from danger. ONE YEAR'S WORK IN ABDOMINAL SURGERY. BY NATHANIEL W. EMERSON, M.D. [Presented to the Massachusetts Homeopathic Medical Society, Ja7uiary n, i8qqS What follows is a review of abdominal work done between January I, 1898, and December 31, 1898, and includes every case of operation which opened the abdominal cavity.

As tabulated the cases are reported in the order in which they were operated. It is desired to call attention to two or three special points as illustrated by the year's work. More and more is the writer convinced that the best surgery upon the appendages removes only those parts which are actually dis- eased. In cases of pyo-salpingitis, if a portion of either ovary seems normal and the patient is a woman under thirty- two or thirty-three years of age, effort is made to conserve the healthy portion of that ovary. Again in degenerate condi- tion o!

The ovaries, a resection rather than an extirpation of the ovary is undertaken if there is the least encouragement that any normal ovarian tissue is present. This statement is intended to be merely suggestive, however, as my experience is not sufficiently extended, either as to number of cases or lapse of time after operation, to draw exact definite conclu- sions.

As I see it now, I believe these conservative cases have a less tumultuous convalescence by reason of the ab- sence of a precipitated menopause. If only a portion of either of the ovaries is left behind, it seems to me that the 1899- One Year's Work in Abdominal Surgery. 61 resulting nervous condition is very much more satisfactory than when both ovaries are extirpated.

I would not have it understood by this that too great risks are taken in leaving behind pathological tissue; rather that a studied discrimina- tion is made with the hope of avoiding an unnecessary sacri- fice of normal tissue. In the past, where ovariotomy has been performed for tubal or ovarian disease, it is recognized that the after condition has not always been entirely satisfactory by reason of the imperfectly supported uterus which is left behind. As is well known, this has led to the advocacy by some operators of making a total hysterectomy where it is necessary to per- form a double tubo-ovariotomy. This has always seemed an unnecessary mutilation to some who sincerely believe that the old surgical rule of sacrificing no unnecessary tissue is as sound to-day as it ever was, and. I myself believe the sub- sequent life of the woman is more satisfactory and natural if the uterus is left behind, providing it is not pathological and providing it can be properly supported. I wish, therefore, to bring up the subject of ventro-suspension and ventro-fixa- tion, and suggest a possible extension of the utility of both these operations. First of all I wish to clearly differentiate the difference between the two terms as used here.

By a ventro-fixation is meant an actual fixation of the uterus to the abdominal wall proper, or, to be even more particular, to the recti muscles. This very proposition carries with it certain limitations, and its field of usefulness is therefore restricted. From the many cases recorded in the last few years, it is, or should be, accepted that ventro-fixation during the child-bearing period should not be resorted to if there is the slightest probability of subsequent pregnancy. This, then, reverts the operation to conditions which are developed subsequent to the menopause, natural or artificial as the case may be. In my own personal experience, it is limited to cases of complete procidentia. You are all familiar with the various old-time plastic vaginal operations in these cases, and are also familiar with their very frequent failure.

Vag- inal hysterectomy followed by plastic vaginal work was an 62 The New England Medical Gazette. February, improvement over the vaginal work alone, but it has not been by any means the success that was expected of it, and a large percentage of failures have resulted. After observing the very small uterus which is removed in many of these cases of prolapsus, one must question the part played by the uterus in establishing such a condition, especially so when within six months of its removal we have a complete pro- lapse of the vagina itself. I have, therefore, during the last year, approached this problem from above rather than from below, and have looked upon the atrophied and practically functionless uterus as a means of suspending all the relaxed tissues involved in a condition of complete procidentia. A small opening having been made above the pubes, the fundus of the uterus is brought up between the recti muscles and there firmly secured directly to the muscles themselves. The peritoneum is closed around the body of the uterus, and the whole wound is closed so as to obtain union by first inten- tion.

After complete closure, the parts are arranged as if the fundus of the uterus had been forcibly thrust up between the recti muscles perforating the peritoneum. This consti- tutes a true ventro-fixation. To one who has not seen the result of this manipulation, I am sure it will be a surprise. Instead of a wide and prolapsing vagina of very shallow depth, we find it narrowed and elongated and the lax pro- lapsing tissues seem to have largely disappeared. If now, following the abdominal operation and at the same sitting is undertaken whatever plastic work upon the vagina seems indicated, the mechanical results must be more satisfactory than by any other method heretofore advised for this annoy- ing condition. What the ultimate result will be in any given case I cannot say, since sufficient time has not elapsed for me to have determined this question from my own operations.

The immediate result has certainly been more satisfactory than that obtained by any other method I have heretofore employed, and no relapses have as yet reported. The only objection to this operation, which former experience has sug- gested, is that a loop of intestine may pass between the uterus and the bladder or abdominal wall and become stran- 1 899. One Year's Work i?i Abdominal Surgery. 65 gulated, and to obviate the possibility of this, a variation upon the present method in both ventro-fixation and ventro- suspension will be suggested and discussed later on. Ventro-suspension is applicable to a very much more extensive class of cases and variety of conditions, many of which are post-operative.

In cases of backward displace- ment, where Alexander's operation has failed or is not indi- cated, to my mind it offers the best solution to a very difficult problem. If properly done, it is safe in young women who afterwards become pregnant, and I myself have had one case where pregnancy following the operation caused absolutely no discomfort, and delivery was normal. The operation, moreover, permanently relieved the displacement. For dis- placement, the abdomen is opened in the middle line and the fundus brought up to the abdominal opening.

Two silkworm stitches are then passed through the anterior portion of the fundus and upper part of the anterior wall of the uterus in such a way that they are firmly buried in the uterus for about three quarters of an inch, and are about three quarters of an inch apart. The sutures are next passed directly through the abdominal wall upon their respective sides and about one inch from each other, and then firmly tied on either side upon pads of gauze. The fundus of the uterus where it is in contact with the peritoneum is previously scarified, after which the peritoneum is entirely closed with a very fine catgut suture, so that it lies between the fundus and the muscles. The incision is then closed in the usual way. These silkworm sutures are removed in from twelve to eighteen days, by which time firm union between the peritoneal surfaces in apposition has taken place. The final result of this is that the uterus is suspended not im- mediately behind the abdominal wall, but at a varying dis- tance from it by a cordlike elongation of the peritoneum, and this has relieved the displacement and all the accom- panying ill conditions. A marked disadvantage in this con- dition, however, has been the fact that occasionally a loop of intestine has slipped between the uterus and the abdominal wall and become strangulated, of course causing a very seri- 64 The New England Medical Gazette, February, ous state of affairs.

To obviate the possibility of this acci- dent, it occurred to me that a union between the peritoneum on the anterior surface of the uterus and the adjacent fundus of the bladder and anterior abdominal wall would obviate the possibility of the occurrence of this difficulty. This has been done in a number of cases with only beneficial results so far as observed.

The peritoneum over the lower portion of the abdominal wall and the bladder is very lax and adap- tive. After the uterus is suspended, with a fine catgut a line of suturing is applied beginning at the lowest point in the sulcus created in front of the uterus and carried directly up in the middle line, uniting the lax peritoneum over the blad- der to the more fixed peritoneum on the anterior surface of the uterus, until the point of suspension at the fundus is reached. This causes absolutely no discomfort to the pa- tient. The result is the formation of practically a third and anterior broad ligament which serves the function as well of a suspensory ligament.

It maintains the uterus in support in an almost perfectly natural position, and the strain of suspension is extensively and equably distributed. It also prevents the possibility of strangulation of the bowels, and as actually practised no objection to the employment of this method has been developed. While it is here spoken of in connection with a retroverted uterus I fancy its most ex- tended application will be found, provided it stands the test of experience, in cases of double salpingectomy or double tubo-ovariotomy where a practically normal uterus is left behind. I have used it in a number of these cases with most gratifying results so far, but again must call attention to the fact that sufficient time has not elapsed to draw defi- nite conclusions as to permanent results. The application of this same modification to cases of ventro-fixation for pro- cidentia makes them absolutely safe from the possibility of future accident. This report is made on 134 abdominal sections performed on 133 patients between January 1, 1898, and December 31, 1898, as follows: — TABLE OF CASES.. Indirect inguinal hernia.

Iki l-il.r.,.. ■ 1 1T''S i v-n._ ->Tubal >r Anpun.li i ['. Men 1 Cllumk r ' 'v,, (1.,n ■ Hernia, l l r ).i I Feeal list l Fibroma k,:ll..,,trd s «,p t z.!,= Fe j appendicectomy A very large appendix had prolapsed inti Appendix rem.-vi'il Urn nyli inttrn.d riny. Requiring a second operation. I, being full of pus, fr ase, and she appendix bad prolapse Cyst had partially emptied itself through the irregular slough of ii required practically a r Died from hemorrhage.

The abdomen was opened I Probably due to syphiliti S removed; also iy>^ ill- lllist.-ll,,;,,, ayin.' Sia based upon inijluaih g informatio ««'*»» removed fr.un j»,i!l bladder. Thu.umcwas.lmc,,,o idly buried i idul in • SUMMARY OF CASES. 6 j a - >H- ».»«.= Ap P.di^,o„,,.4 i., suppurative ',', ', cholelithiasis'' '.' Appendicectomy; cholecystotomy 6 t-l.k-lubl.,MS SlSSr, resection 'of OvarV '.

■ SSST- >• » 1 appendicectomy Dilatoiion of stomach Fecal listula l-ibroi.Mi., uteri Hernia Exploratory incision.*!..' Ahd,nal action Hysterectomy 18 1 „; appendicitis lh.:rL a; pendicitis Iiiie-iin.il adhesions „; appendicectomy Tubo-ovariolomy; jgmjl In uterectomy Y.^i 1,0 abdominal hysterectomy Abdominal section i ■ Pregnancy Procidentia uteri Vaginal hysterectomy Tubo-ovariectomv; ventral sun.

Abdominal section Vaginal exploration. Exploratory incision, 1 l'>o--alpingitis Kupture of vein, portal system Thickening of bases nf broad ltgs Coiial pregnancy Tubeftulusis of hvet 3; Total: 133 Cases. 134 Operations. Death rate 3%. TABLE OF CASES.

McC 22 Miss J. Cyst of left ovary Ovariotomy 1 Cholelithiasis Cholecystotomy 1 Metritis, chronic [inguinal Vaginal hysterectomy 1 Appendicitis, intercurrent; hernia, indirect Appendicectomy, herniotomy Jan. „, acute » Metritis, chronic; cysts of ovaries Vaginal hysterectomy Appendicitis, acute Appendicectomy Fibromata uteri Vagino-abdominal hysterectomy Appendicitis, acute I Appendicectomy „, intercurrent! » Metritis, chronic Vaginal hysterectomy Appendicitis, intercurrent ' S >a. S 5 a s 14 23 6 2 I 3 2 1 pp y ' Abdominal section drainaee Appendicectomy; cholecystotomy.,,, „; ventral suspension.

■ 5 „ „; appendicectomy.. Miss Miss Miss Mrs.

23 19 28 32 40 58 49 35 28 33 48 45 25 27 -5 29 26 38 JS 33 43 5° '7 5° 54 I Abscess, intra-abdominal I Appendicitis, acute I Pyo-salpingitis; ovarian cystomata 1 Dilatation of stomach 1 Sarcoma of mesenteric glands. — 1 Tubercular peritonitis 1 Appendicitis, acute „, intercurrent „, suppurative Hernia, ind. Ing., double it. Appendicitis, intercurrent,,, acute, „, intercurrent Salpingitis, rt.; ovarian cystomata 1 Ovarian cystoma, 1.; retroflexion uteri. I Appendicitis, intercurrent „, suppurative I Salpingitis, rt.; appendicitis I Chronic metritis; ovarian cystomata. 1 Hvdro-salpingitis, l.j appendicitis 1 Appendicitis, acute 1 Ovarian cystomata 1 Procidentia uteri; ovarian cystomata.

1 Thickening of bases of broad ligaments 1 Fibroma uteri 1 Cystic ovary, 1.; retro-flexion uteri I „ ovaries; salpingitis 1 ' Appendicitis, intercurrent 1 Umbilical hernia 1 Metritis, chronic I Carcinoma uteri 1 Appendicitis, intercurrent 1 Cyst of ovary, 1.; fibroma uteri 1 Ovarian cystoma, 1 1 Appendicitis, intercurrent I „, acute 1 1 Ovarian cystoma, 1 I Appendicitis, acute; cholelithiasis Abdominal section Appendicectomy Tubo-ovariotomy, double; ventral suspension Exploratory Abdominal section; drainage. Appendicectomy Herniotomy, double (Bassini). „ (Bassini) Appendicectomy Tubo-ovariotomy, rt. Resection of ovary; Appendicectomy...

Resection of ovary, left. Entral suspension Tubo-ovariotomy; appendicectomy Vaginal hysterectomy Tubo-ovariotomy, 1.; appendicectomy Appendicectomy; closure of bowel Tubo-ovariotomy, l.j resection of ovary, right „, double; ventral fixation. Vaginal exploratory incision Vagino-abdominal hysterectomy Tubo-ovariotomy, 1.; ventral suspension „ „; ventral suspension Appendicectomy I Ierniotomy, Vaginal hysterectomy Appendicectomy Tubo-ovariotomy; myomectomy Ovariotomy Appendicectomy Ovariotomy Appendicectomy; cholecystotomy. I Fibromata uteri Vagino-abdominal hysterectomy. I 'Abscess, peritoneal Abdominal section. [Appendicitis, acute I Hernia, ind.

Inguinal ^Appendicitis, intercurrent I Fibromata uteri Appendicitis, intercurrent Fibroma uteri Appendicitis, intercurrent; umbilical hernia „, acute „, intercurrent Carcinoma uteri Appendicitis, intercurrent. Intestinal adhesions I Ovarian cyst I Pregnancy I j Appendicitis, intercurrent. [Cholelithiasis 1 ' Fibromata uteri Appendicectomy Herniotomy (Bassini) Appendicectomy Abdominal hysterectomy Appendicectomy Abdominal hysterectomy Appendicectomy; herniotomy. I 'Appendicitis, intercurrent I „ suppurative 1 Ovarian cystomata, rt I j „ libro-cystomata, rt 1 Fibroma uteri, epithelioma uteri 1 Tubal pregnancy, ruptured, rt.; appendicitis 1 Fibromata uteri I Tuberculosis of liver, ascites.

I.Appendicitis, intercurrent....Cholelithiasis I I Appendicitis, acute Purulent peritonitis Appendicitis, suppurative... Vagino-abdominal hysterectomy Appendicectomy Exploratory incision Tubo-ovariotomy Exploratory incision Appendicectomy Cholecystotomy Abdominal hysterectomy Vagino-abdominal hysterectomy Abdominal hysterectomy Appendicectomy Abdominal section, drainage Ovariotomy I Pyo-salpingitis, double; appendicitis. I T u bal pregnancy, rt. Rupt 1 Pyo-salpingitis, double 1 Fibromata uteri April May June July Aug. Vaginal hysterectomy Tubo-ovariectomy; appendicectomy. Vagino-abdominal hysterectomy Exploratory incision Appendicectomy Cholecystotomy Appendicectomy Abdominal exploration Appendicectomy „ [appendicectomy Tubo-ovariectomy, left; salpingectomy, rt.; Tubo-ovariectomy Sept. Vagino-abdominal hysterectomy Yes No No No No Yes No No Yes No No No No No No No No Yes No No No No No No No No No No No No No No No No No No No No Yes No Yes No No No No No No No No No No No No No No No No Yes No No Yes No No No No No No No Yes No Yes Yes No Yes No Yes No A double operation.

Probably due to syphilitic infection. DC An acute attack of appendicitis complicated an already existing con- dition of gallstones with distended gall bladder. The appendix was about to become gangrenous and was removed; also 136 gall- stones. „; appendicitis „; fibroma uteri Dilatation of stomach Fecal fistula Fibromata uteri Hernia „; appendicitis Hydro-salpingitis; appendicitis. Intestinal adhesions Metritis, chronic Ovarian cystomata Peritonitis, purulent.. „, tubercular.

Pregnancy - Procidentia uteri 11 11; ventral suspension. - „ 1,; appendicectomy. 11 „; myomectomy Exploratory incision Abdominal section Hysterectomy. Herniotomy „; appendicectomy Tubo-ovariotomy; „ Exploratory incision Vaginal hysterectomy Ovariotomy 10 Vagino-abdominal hysterectomy... Abdominal section Pyo-salpingitis Rupture of vein, portal system... Sarcoma of mesenteric glands....

Thickening of bases of broad ligs. Tubal pregnancy Tuberculosis of liver Total: 133 Cases. 134 Operations. Death rate 3%. Vaginal hysterectomy Ventral fixation Tubo-ovariectomy; ventral suspension Abdominal section, Vaginal exploration.

Tubo-ovariectomy.., Exploratory incision A mistaken diagnosis based upon misleading information. 21 gallstones removed from gall bladder. A critical case. The tumor was almost solidly buried in abdominal and pelvic adhesions, g The ruptured tube had caused an acute appendicitis, by drawing appendix into adherent mass. A neglected case.

' ■ I - ■ • • • •: ■ 1899- The Mercurials in Diseases of the Nose and Throat. 65 THE MERCURIALS IN DISEASES OF THE NOSE AND THROAT.

STRONG, A.M., M.D. In presenting this paper we give nothing new, but only a grouping of the clinical results of the application of mercury to a set. Of diseases of one-part of the human body. Hence it is incomplete in so far that the conditions to be mentioned are frequently accompanied by general effects which serve to make a well-recognized simillimum for mercurius. We hope, however, that even this incomplete review may help to give renewed interest in this drug, to which we owe very much, and also to our>homoeopathic therapy as a whole. For a paper like this we must draw upon many writers in medical literature and text-books, and only this general acknowledgment to those writers can be given.

There are many preparations of mercury referred to in our writings, but clinical application has reduced this num- ber to a very few. Mercurius corrosivus and solubilis are the two forms which, through poisonings and provings, have furnished the fullest details of pathogenetic effects. All have more or less similar characteristics, and a well- defined differentiation is at least difficult. Speaking then in a general sense the mercurius solubilis is more frequently used in syphilitic, while the mercurius vivus seems to have a better action in connection with catarrhal affections. Mercurius cyanuret differs only in the peculiarity and in- tensity of the mouth and throat symptoms; it is the one form in which ' deposit of false membrane ' seems to have a certain degree of uniformity.

Mercurius corrosivus is useful in syphilitic ulcerations of a deeper grade than the solubilis, while the iodides have a greater affinity for the glandular system. The well-known action of mercurius as a tissue irritant makes it an important remedy in our special subject. Mercurius solubilis, or vivus, for they are largely inter- 66 The New England Medical Gazette. February, changeable, has proven curative in so-called catarrhal head- aches, characterized by a sensation of a band about the head, with pressure in the temples from within outwards; head feels heavy and neck stiff; with these there are the signs of nasal catarrh, sneezing, mucous discharge, lachrymation, and chilliness. It is also serviceable in congestions of the mucous mem- brane of the nose going on to inflammation, thickening, and ulceration, with formation of scurfs and frequent hemor- rhages, while the discharges are foul smelling, yellow, muco- purulent, irritant; especially of value when following a catarrhal origin, and serviceable if a scrofulous dyscrasis accompanies.

In the catarrhs of the nose and throat this remedy is of use when they have been provoked by damp, chilly weather, or by damp, cool evening air. There is the beginning coryza, with sneezing and slight mucous discharge, following, per- haps, the failure of aconite or camphor, or when seen too late in the attack for these to be of service. Stuffy feeling in the nostrils, relieved in the open air and aggravated in a warm room, with an irritative cough. Also in hypertrophic or chronic rhinitis, where there is an acute exacerbation.

In these catarrhal states there is very little, if any, differ- entiation to be made between the preparations as to the discharges, frontal pains, soreness of the nostrils, fetid smell, dullness of hearing, post-nasal dropping and hawking, and the general aggravation from cold and dampness, and the amelioration from warmth. In the iodides, perhaps, there is the greater tendency to thickening of the discharge and the formation of plugs or scurfs. It has also been stated, as the result of observation, that mercurius corrosivus seems best adapted for males, and the solubilis for females and children. Mercurius iodatus is ser- viceable in syphilitic and scrofulous children with induration and swelling of the glands; nasal bones inflamed, nostrils sore and crusty, profuse, long-lasting, acrid discharges, ex- coriating nostrils and upper lip.

There is a tendency for the disease to extend into the throat and the discharge to 1899- The Mercurials in Diseases of the Nose and Throat. 67 become tough and thick, forming chiefly about the pos- terior nares and post-nasal space; also when extending into the lachrymal duct and sac, especially when occurring among children. The solubilis is of service in ozena when occurring in scrofulous subjects or in acquired syphilis; the corrosivus when the discharge is glue-like often drying in the naso- pharynx, and the nasal fossae raw and smarting; also in per- forating ulcer of the septum, or phagedenic ulcers, associated with burning pains and acrid fetid discharge. The stomatitis occurring in mecurial poisonings, and espe- cially with those who work with the mineral, is a classic picture set forth in every text-book on materia medica. It runs through all degrees of inflammation to membranous exudate and phlegmon, and when unchecked to ulceration, suppuration, or even mortification of the soft parts and necro- sis of the maxillae, accompanied with excessive ptyalism.

Fortunately the extreme picture is rarely, if ever, seen to- day, but the minor degrees of stomatitis are not infrequent; and in these cases mercurius is invaluable, whether the attack is inflammatory or pseudo-membranous in character. The preparations called for, as a rule, will be the solubilis, if a constitutional taint is present; the cyanuret, if the ten- dency to membranous formation is marked; or, if more se- vere in form, the corrosivus, which acts, as we know, with destructive force upon the mucous lining of the mouth, oesophagus, and stomach, causing softening and gangrenous disorganization of this membrane. In the solubilis, again, we find sore throat with dryness and sticking pains; lancinating pains extending to the ears during deglutition; swallowing difficult on account of aching pains; constant desire to swallow, with raw, sore feeling in the vault of the pharynx, worse at night; on attempting to swallow, liquids pass back into the posterior nares; pharynx dull-red, streaked in dirty, yellow bands; uvula elongated, brightly congested; tongue thickly coated, white, with im- print of teeth; free flow of saliva.

These conditions may give way as a more or less severe pharyngitis, or may run on 68 The New England Medical Gazette. February, to an attack of tonsillitis or peritonsillar trouble, and in that event we would probably receive more aid from the iodide combinations. In mercurius biniodide we find, in connection with pharyn- gitis, a white follicular point with red areola, on left posterior pillar; sensation of a sore spot with or without the fore- going; swallowing saliva more difficult than liquids or food, a frequent symptom with the mercurials; of value for those who have been in attendance upon diphtheria, among whom attacks of pharyngitis are not uncommon.

This remedy has a special affinity for the follicles of the pharynx. Mercurius cyanuret has proven serviceable in chronic or hereditary syphilitic ulcerations of the nasopharynx or phar- ynx, in the latter located upon the arch, with inverted edges, uneven and callous; excessive bad odor. In chronic nasopharyngitis the corrosivus has tinnitus aurium and impaired hearing, with complaints of obstruction, fulness, and tingling in the Eustachian tubes, together with hypertrophy of the general tissues. In tonsillitis, when belladona has failed to remove the acute congestive stage, mercury often occupies the second place in the treatment. When, in addition to the pharyngeal symptoms already mentioned, which are present to a greater or less degree, we have the tonsils inflamed and swollen, with acute pain on swallowing, muffled voice, and local tenderness on external pressure, with a probability that the trouble will go on to suppuration, the solubilis will often check the entire process. If, on the other hand, the follicular form is more promi- nent, we will have better results from the iodides; the pro- toiodide favoring a right side invasion, with a free secretion, and a heavily coated furred tongue, and a tendency to a pseudo-membranous exudate.

The biniodide rather for the left side, with the membrane of the tonsils and fauces of a deeper red and angrier appearance; the tongue thickly coated in the center, with red edges, or dry tongue with constant desire to wet the mouth. Some writers recommend apis and ignatia in these conditions, claiming that the use of the iodides has become routine practice.

The Mercurials in Diseases of the Nose and Throat. 69 In the chronic form of enlarged and indurated tonsils and cervical glands, with thickened pharyngeal tissues and in- filtrated follicles, the iodides are still serviceable. A general point of differentiation between the two forms in these conditions seems to be somewhat as follows, that as the symptoms are largely catarrhal, thus approaching the solu- bilis or vivus, the protoiodide will be efficient; and, on the other hand, as they are of an inflammatory or irritative form, suggesting iodine, the biniodide will be of use. The cyanuret seems the best indicated in diphtheria of any of the forms of mercury, and may involve the mouth, fauces, pharynx, or larynx, with tendency to putrescence; membrane grayish and tough, with profuse salivation; rat- tling and whistling in the throat; dry, hot skin; scanty urination; stringy, thick expectoration; marked swelling of the glands (also the iodides); great prostration, even at the beginning of the attack, out of proportion to the objective symptoms. This drug has also been used in severe forms of follicular tonsillitis with ulceration, pseudo-membrane, and constitutional symptoms in accord. The iodides have also been used in diphtheria and much has been credited to them, although some authorities allow them scant praise and others deny their efficiency altogether, claiming that in diphtheria there is neither ulceration nor gangrene, but a false membrane formed upon an unbroken surface, and no proof that mercury can cause this patho- logical process. On whom shall fall the burden of proof?

In acute laryngitis where mercurius solubilis is useful, we have chilliness and great sensitiveness to cold, with frequent paroxysms of dry, burning heat, alternating with copious perspiration, without relief; larynx sore, with hoarseness, but no loss of voice, aggravated towards evening and after reading or exposure to dampness. If persistent we may have aphonia, which is not painful, however, although the mucous membrane of pharynx and larynx feels dry.

A sud- den onset following exposure to dampness is an additional characteristic. Conditions like these naturally lead to cough, and we have paroxysms characterized by various 70 The New England Medical Gazette.

February, kinds of pain and expectoration. The cough may be dry and hacking, often produced by sensation of tickling in larynx and trachea, especially low down, or it may be spas- modic, oftentimes incessant, even to suffocation, relieved sometimes by drinking freely of cold water. Or the cough may be tearing in character, coming from the chest with great soreness and suffering, aggravated at night.

Expecto- ration saltish or sweet, sometimes bloody, from violence of paroxyms, occasionally purulent. In strumous or syphilitic laryngitis where there is dark purplish swelling of the parts, with pain, hoarseness, and aphonia, in mercurius solubilis the discharge is viscid or muco-purulent, while in the iodide it is thin and offensive, with swelling of the glands. Where secondary ulceration supervenes, with increased secretion and inflamed areola, the corrosivus may do better service. In tubercular laryngitis the iodides are the best when a form of mercury seems indicated. DERMATITIS HERPETIFORMIS. Previous to the year 1884 the student in dermatology was not a little perplexed by the study of a class of diseases pre- senting erythemato-bullous lesions, and which were described under various titles.

It remained for Dr. Duhring in that year to recognize a more or less constant relation between the cutaneous lesions of these variously _ described diseases, and he presented to the profession a brochure under the title of 'Dermatitis Herpetiformis,' in which he included the. Various conditions mentioned above and maintained that all these conditions were but different manifestations of one disease. His contention at that time has since been ac- cepted by almost the entire profession, and to-day dermatitis herpetiformis seems to be an established fact.

The disease is thus defined in Dr. Duhring's own words:- — ' Dermatitis herpetiformis is an inflammatory, superficially seated, multiform, herpetiform eruption, characterized mainly 1899* Dermatitis Herpetiformis. 71 by erythematous, vesicular, pustular, and bullous lesions, occurring usually in varied combinations, accompanied by burning and itching, pursuing usually a chronic course, with a tendency to relapse and to recur.'

These may in their onset be sudden or ex- tend over from a week to ten days. When severe more or less prodromata are experienced, such as chilliness, malaise, constipation, fever and great itchiness of the skin with- out lesion. Following this the eruption appears, consisting of erythematous patches, groups of vesicles, papulo-vesicles, papules, pustules, or blebs, or a combination of any or all of these lesions on various parts of the body, occurring in groups. Although multiformity is the rule in the lesions of this disease, it is by no means constant. Not infrequently the lesions are all erythematous or all vesicular or pustular; neither does the predominance of one type during any attack guarantee similar lesions in the next or any succeeding seiz- ure. Different attacks may present types similar in char- acter or so unlike in appearance as to make it appear like a distinct and entirely different disease. According, however, to the predominance of the character of the lesion in any given case, we recognize for convenience of description five varieties, namely: the erythematous, vesicular, bullous, pus- tular, and multiform or mixed.

The erythematous variety presents itself for the most part in reddened patches, like some of the forms of the exudative erythema. Urticarial elements are not uncommonly associ- ated with this form and patches either discrete or confluent resembling erythema multiforme. The color may be any of the various shades of red common in cutaneous affections, tinged with yellow or brown and vanishing with various degrees of pigmentation. The vesicular variety is the most frequent, the eruption occurring in small, pinhead to pea-sized vesicles, occurring in groups, generally without areola. The shape of the vesicles is often irregular, and when close together tend to coalesce, forming small blebs, irregular, sometimes stellate in shape. 1 Cutaneous Medicine, Part II, page 440.

72 The New England Medical Gazette. February, The vesicle wall is quite firm, and on being broken by scratch- ing does not excoriate, but tends to refill. Itching in this form is most persistent and intractable, often occurring with intolerable energy before the appearance of the lesion and persisting with almost unabated fury throughout.

The itch- ing is often entirely out of proportion to the amount of cutaneous damage present. The bullous form presents typi- cal bullae, tense or flaccid, irregular in shape, with or without areolae, and the groups are often surrounded by small pustules or vesicles. In the pustular variety the lesions are for the most part pustules from the start; they are from pinhead to large pea size, grouped, and not infrequently have a few vesicles in proximity to each group. The smallest pustules are flat, not much above the surrounding level; the larger are raised, con- ical, or acuminate or puckered. According to Duhring, this variety is more apt to repeat itself in subsequent attacks than any other variety. The papular variety is the rarest, as it constantly tends to merge into the papulo-vesicular. It does, however, sometimes occur over limited areas and presents the mildest form of the complaint.

The multiform or mixed variety is polymorphous in all respects, the various forms above described being generally mixed upon the surface of the body, showing erythematous patches covered with vesicles, papules, and blebs of varying sizes, shapes, and colors. Grouping of lesions is still prom- inent, the itching severe, and most cases at some time during their course present this type. Lesions have been observed in the buccal, laryngeal, and tracheal mucous membrane, 1 and in one fatal case supposed to have existed within the intestinal canal. 2 The course of the disease is essentially chronic, occurring in relapses, with from a few weeks' to a few months' interval and covering a period of several years. The etiology is obscure. While it sometimes occurs in peo- ple of apparent good health, there seems to be a consensus 1 Stelwagon's cases, Jour. And Genito-Urinary, February, 1890.

2 Lancet, July 11, 1896. 1899- Dermatitis Herpetiformis. 73 of opinion among those having had the largest experience in this complaint that mental shock, such as anger or fright and nervous debility due to anxiety and worry, are the most com- mon causes. Duhring, Elliot, Crocker, Vidal, Brocq, and the author 2 have cited cases in which this cause was present. Winfield 3 and Sherwell 4 report four cases in which glucosuria following mental shock existed, and J.

Fordyce 5 a case complicated with albumen and casts in the urine. That this disease is for the most part either a nervous reflex or a tropho-neurosis seems to be fairly well established.

It may occur at any age, but is most common between the ages of thirty and sixty. The pathology has been exhaustively studied by several authors, prominent among whom are Leredde and Perrin. According to them the diseased process consists in a very acute inflammation of the papillary layer of the corium, with oedema and the pouring out into the tissues of a vast num- ber of polynuclear leucocytes and eosiniphile cells. Their researches have been confirmed by Davier 6 and by Dr. 7 This abundance of eosiniphile cells in the exudation has been thought by some to be somewhat pathognomonic of this disease, but as it also occurs in urticaria, pellagra, and pemphigus, it cannot be so considered. According to Neus- ser, it is an evidence of a phycosis and of marked vaso- motor disturbance.

The diagnoses from cases of eczema, erythema, multiforme urticaria, and pemphigus are frequently made with difficulty* and is only possible by the contemplation, not of any single attack, but of the disease as a whole as it occurs in its various relapses and recurrences. The special diagnostic points are itchiness, very severe, especially before the appear- 1 New England Medical Gazette, December, 1895. 2 Cutaneous Medicine, Part II, p. And Genito-Urinary, November, 1893. And Genito-Urinary, April, 1888.

And Genito-Urinary, November, 1897. 6 Annals de Derm, et Syph., t. And Genito-Urinary, November, 1897, 74 The New England Medical Gazette. February, ance of any lesions, the grouping of lesions, which consti- tutes its herpetiform feature, its tendency to relapse, its chronicity, and its capriciousness. The treatment of all cases reported has been far from satisfactory. Nothing so far seems to be able to prevent recurrences, which sometimes extend over a period of years with varying intervals. During an attack arsenic has accom- plished the most in affording relief and shortening the dura- tion of the attack.

On account of its probable neurotic origin it would seem that the arsenite of strychnia would offer even better results. As regards the local treatment, literature on the subject teems with a multitude of remedies, which is in itself a sufficient guarantee that but little suc- cess has attended their application. During the acute stage soothing lotions and dusting powders seem to have afforded the greatest relief, while later Duhring claims the best results from vigorous inunctions with sulphur ointment. Examination of Sputum. — Your case of incipient lung trouble brings a specimen of sputum.

With the platinum wire spatula a small particle of the thickest portion is picked out, placed on the end of a glass slide, and spread out well by another slide pressed down on it and pulled apart. Both are put aside for two or three minutes to dry in the air; then passed quickly through the flame three times. Hold- ing the slide by the free end with a hemostat, put on the spread a few drops of Ziehl's solution of fuchsin, hold over the flame until it bubbles, wash off in water, add a few drops of a solution of methylene blue in a 25 per cent solution of sulphuric acid; let it remain for thirty seconds, wash off with water, dry with filter paper, put on a drop of cedar oil, and examine with a one-twelfth oil emersion lens. If tubercle bacilli are present, they will be brought out as a distinct red against a blue background; and a positive diag- nosis is made in time to give the patient a chance for life in a suitable climate.

— The Virginia Medical Semi-Monthly. 1899* Editorial. 75 EDITORIAL.

Contributions of original articles, correspondence, etc., should be sent to the publishers, Otis Clapp & Son, Boston, Mass. Articles accepted with the understanding that they appear only in the Gazette. They should be typewritten if possible. To obtain insertion the following month, reports of societies and personal items must be received by the fjth of the month preceding. THE NEW BUILDING AT WESTBORO- The new building at the Westboro Hospital is very nearly completed, and will no doubt be occupied by patients before our next issue. The location is unsurpassed. Situated upon a knoll to the east of the main building, across the old high- way, which has now become entirely a private road belonging to the hospital, facing south and commanding a superb view of the distant town with Lake Chauncy in the immediate foreground, the building stands.

The structure itself is an oblong quadrilateral in shape, one hundred and sixty-six feet long and nearly seventy-three wide, and being adapted for both male and female patients, is divided into two sections, one the counterpart of the other. Beginning with the basement we find a kitchen with store- room, and the arrangements for heating, lighting, and venti- lation, the power for all being furnished in the original plant and carried into the new building by means of underground conduits. On the first floor on either side is a large day room, fifty by twenty-eight feet, with a southerly exposure, lighted by ten large windows.

On the side opposite the windows is a fine large brick fireplace, affording excellent ventilation. Leading out of this room is a semi-circular sun room or solarium, the walls and roof being entirely of heavy glass, where convalescents may have the advantage of thor- ough sun-baths.

Beside this day room are situated upon this floor four small rooms for single patients, and two three-bed dormitories connecting immediately with the day room, an examining room, a sewing room, a drying room for towels, mops, etc., a linen room, two rooms for subordinate officers, a toilet room and Turkish bath, with appurtenances, so ar- ranged as to be accessible from either side of the building. 76 The New England Medical Gazette. February, On the second floor on either side is a large dormitory, the same size and shape as the day room beneath, and in ad- dition four small single rooms, dining room, sewing room, bath with both tub and the modern spray, apartments for resident physician, and toilet room. On the third or attic floor is the apparatus for ventilating the building by the suction draft method, which can be rein- forced if necessary by forced draft from the cellar. In structure the building is of red brick with white trim- mings.

It has brick partition walls and salamander floors beneath the top floor of maple. The finish other than the floors is of oak and ash. The cost exclusive of finishing is about fifty thousand dollars, and the building is without doubt in accord with the most modern ideas of adaptability for the treatment of the acute insane. It is a matter of just pride and gratification to the mem- bers of the homoeopathic branch of the profession that the whole conduct of the institution and the beneficent results of its treatment have been such as to inspire general con- fidence, and thus enabled this much-needed addition to be cheerfully made by the Commonwealth. EDITORIAL NOTES AND COMMENTS. Hunter, of Lowell, a Senior in the State Society, died in Lowell, Mass., on January 11, 1899.

We append the following from the Lowell Mail of January 11: — Horatio M. Hunter was born September 29, 1830, in Lyndon, Vt., the son of James and Lucy Hunter. He first read medicine at Lyndon in the office of C.

Darling, M.D., who was the pioneer homoeopath of northern Vermont. After receiving an academic education Dr. Hunter went to Dartmouth Medical College, and afterwards to the Hahnemann Medical College of Philadelphia, from which he was graduated in the class of 1857. After leaving college he first practised medicine at Concord, Vt., from which place he later went to St.

Johnsbury, Vt. He left the latter place in 1870 and came to Lowell, where he has since been in practice.

Few, if any, physicians now here were then in practice in this city. Editorial Notes and Comments. 77 In all these years Dr. Hunter was never known to shirk a duty, be it ever so difficult or trying.

He had the respect of all who knew him; enemies he had none, for his sunny, peaceful nature would not per- mit him to make them. He had always been a hard worker, fond of his books and well acquainted with their contents; always keeping well abreast of the times, he gave to his patients the best there was in him.

Hunter was married in i860 to Miss Susan M. Chase, of Con- cord, Vt. She, with one daughter, Mrs.

Forrest Martin, and three brothers and one sister residing in Vermont, survive him. Hunter was a member of the Lowell Hahnemann Club, and was its first president. He was also an active member of the staff of the Lowell General Hospital, and had served upon its advisory board ever since the hospital has been opened. He was a Senior in the Massachusetts Homoeopathic State Society and one of the founders of the Massachusetts Surgical and Gynecological Society. He had also been a member of the American Institute of Homoe- opathy for many years. During his residence in Lowell he was a constant attendant at the First Universalist Church. A special meeting of the Lowell Hahnemann Club was held Thursday afternoon in the office of Dr.

Packer, to take action on the death of Dr. The following resolutions were presented and adopted: — ' Whereas, An all wise Providence, he who does all things well, has decreed that our friend and colleague, Dr. Hunter, shall be taken away, therefore we, the members of the Lowell Hahnemann Club, have met in special cession to give expression to our feelings of sorrow at this sad occurrence. In the death of Dr. Hunter our society has a vacancy created which no one man can ever fill, for there were in him a diversity of manly and noble traits combined with the greatest of skill, the utmost devotion to his work, and the broadest views of his duty, which made him indeed the true physi- cian. He went about doing good. ' Where others would have held back because of the sufferings and infirmities which he fought in later years, he never withheld his services, but went about his work day after day, when he was more in need of a physician than many of those to whom he administered.

' He knew no rich, no poor. He never complained of his cares, but cheerfully endeavored to lighten the burden of others. His one 78 The New England Medical Gazette. February, aim was duty, and he always performed it. He was one of nature's truest noblemen, God's noblest work.

The community at large, and especially that large portion which has always looked to him for counsel and advice, has met with an irreparable loss. Hunter cannot come back to us, but his memory will always be an incentive to us to do our duty.

To his stricken family we extend our deepest, sincerest sympathy.' On motion, it was ordered that the resolution be spread upon the records of the society and a copy sent to the family. It was also voted that the club attend the funeral in a body and that reports of the meeting be furnished the Lowell papers, the New England Medical Gazette, and the Philadelphia Hahnemannian. Van Deursen, M.D., Secretary. It is our painful privilege to chronicle with this issue the deaths of two more of our older and best known physi- cians, Dr. Hunter, of Lowell, and Dr.

Henry Houghton, of Boston. By rather a remarkable coincidence they were born in the same town, Lyndon, Vt., and died within a few days of each other. Atma Bodha Tamil Pdf Google here. They were both widely known and beloved, were both very successful practitioners, and were both filled with that divine spirit which placed professional honor and duty ever in front. They were both men of the older type, daily becoming less in number.

Have we those who in character and devotion to duty can hope to fill their places? God grant that we may ever keep the memory of such noble lives before us 'lest we forget, lest we forget.' BOSTON HOriCEOPATHIC 1TEDICAL SOCIETY. The Annual Meeting of the society was held at the Boston University School of Medicine, Thursday evening, January 5, 1899, at 7.45 o'clock, President John L.

Coffin in the chair. The records of the last meeting were read and approved. The following names were proposed for membership: Thomas R. Griffith, M.D., Cambridge, Lillian B. Neale, M.D., 1899- Societies.

79 Boston, Lena Hess Diemar, M.D., Cambridge, and Granville E. Hoffses, M.D., Boston. Howard, M.D., Wesley T. Lee, M.D., Lucille A.

James, M.D., and S. Elizabeth Slagle, M.D., were elected to membership. The reports of the Secretary, Treasurer, and Auditor for 1898 were read and accepted. On motion of Dr.

Windsor, it was unanimously voted that the society, through the Secretary, extend to Drs. Winn and William L. Jackson, former presidents of the society (who were too ill to be present), the season's greetings and best wishes for their recovery. On motion of Dr. Turner, it was voted that the Secretary be instructed to request of Dr. Bellows the privilege of publishing in the year book for 1898 his paper entitled ' Treatment of Aural Neuralgia,' which was read before the society at the November meeting.

The Obituary Committee, appointed at the November meet- ing, reported the following resolutions on the death of Dr. Sanders: — Whereas, The hand of Providence has removed from his field of labor and from our presence Orren S. Sanders, M.D., we, the mem- bers of the Boston Homoeopathic Medical Society, Resolve, That we hold in kindly remembrance the many noble qualities, as man and physician, of our late colleague. That we sympathize with the large number of patrons who had learned from long experience to look upon him as their worthy and beloved physician. That especially do we sympathize with her who mourns the loss of a devoted husband. Resolved, That these resolutions be placed on the records of the society, and that a copy be sent to the family.

Sylvester, H. Bellows, Committee. A petition signed by a sufficient number of members, ask- ing for the establishment of a new bureau to be known as the 80 The New England Medical Gazette. February, Section of Anatomy and Physiology, was presented.

On motion of Dr. Boothby, it was voted that this new section be instituted.

Ellen Hutchinson Gay, a corresponding member, hav- ing returned to Boston, was by vote of the society placed on the list of active members. The resignation of Alice E. Rowe, M.D., of Springfield, was read and accepted. The following Obituary Committee was appointed by the President to draw up resolutions on the death of Dr. Harris, one of the original members of the society: Alonzo Boothby, M.D., John -P. Sutherland, M.D., and Alonzo G.

Batchelder called the attention of the society to the efforts made by the Ladies' Hahnemann Monument Society to raise funds for the completion of the Hahnemann monument, and suggested that this would be an opportune time for the society to take some action in the matter. After considerable discussion by different members, it was voted that a committee of four be appointed to solicit funds for this purpose, which would represent the contribution of the Boston Homoeopathic Medical Society. The following physicians constitute the committee: A. Baker-Flint, Ada- line B. Church, Lucy Appleton, and Sarah S. The President appointed Drs. Sutherland, N.

Batchelder, and J. Hinson tellers, and the society proceeded to ballot for officers for the ensuing year, which resulted as follows: President, Sarah S. Windsor, M.D. >First Vice-President, Frederick W.

Halsey, M.D.; Second Vice-President, Kate G. Mudge, M.D.; General Secretary, Frank E. Allard, M.D.; Associate Secretary, Edward E. Allen, M.D.; Treasurer, Maurice W. Turner, M.D.; Auditor, N.

Perkins, M.D. Censors: John L. Coffin, M.D., Helen S. Childs, M.D., and T. The society voted to suspend the rules and allow the Sec- tion of Sanitary Science and Public Health to report at an adjourned meeting to be held January 19. Following the report of the tellers, Dr. Coffin, the 1899- Societies.

81 retiring President,' delivered a stirring address on the present status of homoeopathy, which was listened to with marked attention. At 9.15 the society adjourned to the Physiological Lab- oratory, where refreshments were served and a social time enjoyed. Music was furnished by the Euterpe Banjo and Harp Club, and the excellent selections, skilfully rendered, added much to the pleasure of the evening. A large number were present. Allard, Secretary.

The meeting of the society, adjourned from January 5, was held at the Boston University School of Medicine, Thursday evening, January 19, 1899, at 7.45 o'clock, Presi- dent, Sarah S. Windsor, M.D., in the chair. The records of the previous meeting were read and approved. The name of Frank A. Davis, M.D., was proposed for membership. Norcross, who was placed on the list of mem- bers retired for non-payment of dues in 1896, was reinstated by vote of the society, having paid all dues to date.

The resignation of Dr. Gleason, Wareham, was read and accepted. The following Obituary Committee was appointed by the President to draw up resolutions on the death of Henry A. Houghton, M.D.; I. Tisdale Talbot, M.D., Frederick W. Halsey, M.D., and Herbert C.

Report of the Section of Sanitary Science and Public Health. BATCHELDER, M.D., Chairman; MARY B. CURRIER, M.D., Secretary; ALONZO G. HOWARD, Treasurer. Talbot, M.D., N.

Perkins, M.D., and Helen S. Childs, M.D., who were appointed a committee to nominate officers for this section for the ensuing year, reported as fol- lows: Chairman, John A.

Rockwell, M.D., Secretary, Mary 82 The New England Medical Gazette. Lakeman, M.D., and Treasurer, Carroll C. Burpee, M.D., who were duly elected by the society. Subject: Baths and Bathing. Boston's Public Baths. Illustrated with Stereopticon Views.

Josiah Quincy, Mayor. Baths in the Gymnasium. Allen, of the Allen Gymnasium. Clinical Application of Baths. Sutherland, M.D. Discussion will be opened by H. Spalding, M.D., and H.

Allen gave an interesting description of baths as applied in the Allen Gymnasium. In her experi- ence cool baths after exercise had proved very beneficial and a preventive against colds, as well as a general tonic to the system. She also corrected the erroneous idea that turkish baths were enervating, and stated that such baths, properly administered and modified to suit individual cases, could be taken once a week with excellent results. Josiah Quincy spoke informally, outlining the present system of public baths in the city of Boston, and followed his remarks with stereopticon views, showing the location and construction of the baths and gymnasia throughout the city. During the past season the attendance at these baths had doubled; 1,900,000 baths had been taken at an expense of $38,000, a cost of two cents per bather.

The city has also provided free bathing suits for boys and girls,- and fur- nished a clean towel for one cent. The enormous increase in attendance at the public baths was largely to be accounted for by the fact that the baths had been established in nearly every ward in the city, thus bringing them within easy reach of the masses. He stated that the moral benefits, as well as the sanitary and physical, are obvious, for cleanliness is one condition of self respect, and certainly a clean body has an influence upon the person who takes the bath, there being a close relation between physical dirt and moral degradation. If our present 1899- Societies.

83 system of free public baths be maintained and developed for a term of years, the effect produced upon the community and upon its moral well being will be obvious. The Mayor also alluded to the beginning which has already been made for the establishment of winter baths, and showed stereopticon views of the Dover Street winter bathhouse, and hoped that next season others would be established at convenient locations about the city. Views were also shown of the different free gymnasia, which have been opened to the public. During the past season classes have been es- tablished in which free instruction has been given to a large number of boys and girls, the summer bathing suits being utilized for the gymnasium.

But a small beginning has been made in this line, but the practical utility of the work has been demonstrated. A new gymnasium will soon be com- pleted, built by the city at public expense, and will be main- tained as a part of the municipal expenses.

In closing views were displayed showing ancient and mod- ern baths in different parts of the world, from which it was evident that many European cities are far in advance of American cities in the development and establishment of free public baths and gymnasia. On motion of Dr. Boothby, it was voted that the society wholly endorses the speaker's efforts in this direction to furnish not only public baths but free gymnasia.

On motion of Dr. Colby, it was voted to extend to Mayor Quincy a vote of thanks for his scholarly and pains- taking address and that the same be placed on the records of this society. Sutherland, M.D., next spoke on the ' Clini- cal Application of Baths,' and stated that the subject of baths was an extensive one, the details of which he had no time to enter into. He was of the opinion that too much bathing was not beneficial to some people; that the rubbing or friction of the skin was more essential in removing the corneous layer of the cuticle and aiding in desquamation. Physiologically speaking, the skin was not designed for an organ of absorption and in its normal condition would not 84 The New England Medical Gazette.

February, absorb, thus very little dirt would naturally find its way into the circulation through the skin. Many persons, who bathe frequently, especially those who make use of strong alkaline soaps, were apt to do injury to the skin, causing it to become dry and hardened. In such cases, he recommended the patient to discontinue all bathing with water, and substituted cocoanut oil. He endorced the statement made by Miss Allen as to the benefit and efficacy of cold baths, and be- lieved that they should be used for their tonic effect. He believed that in our eagerness to secure absolute cleanliness externally we should not forget to bathe internally, and ad- vocated the free use of drinking water for that purpose. At the close of Dr.

Sutherland's remarks, a vote of thanks was tendered Miss Mary E. Allen for her courtesy in pre- senting a paper before the society. Spalding opened the discussion and endorsed the use of cocoanut oil as recommended by Dr. He also believed in the external application of warm water as a means of relief in a large number of diseased condi- tions. He had discontinued the use of cold water packs for two reasons: first, because he had been unable to obtain fav- orable results; second, because the patient was not satisfied. Clapp, when called upon to close the discussion, said we could well spend a whole evening in the further consider- ation of this interesting subject, but owing to the lateness of the hour, he thought it advisable not to further discuss the question at this time. The meeting adjourned at 10.

Allard, Secretary. WESTERN MASSACHUSETTS HOMCEOPATHIC MEDI= ICAL SOCIETY.

Springfield, Mass., December 21, 1898. The regular quarterly meeting of this society was held at Cooley's Hotel, Springfield, Mass., Wednesday, December 21, 1898, at 11.30 a.m., President W.

Wentworth, M.D., in the chair. 1899- Societies.

85 The records of the last meeting were read by the Secretary. And accepted.

Lane, M.D., of. Great Barrington, Margaret G. Darby, M.D., and Edward A. Darby, M.D., of Northampton, having been recommended by the Board of Censors, were elected, to membership in the society. Letters were read from Dr. Henry Tucker, of Brattleboro, Vt, and Dr. Rand, of Worcester.

Copeland, M.D., O. Roberts, M.D., and G.

Wilkins, M.D., were appointed an Obituary Commit- tee by the chair to draw up resolutions on the death of Dr. Remarks were made by a number of the physicians rela- tive to the great loss which we had sustained as a society in the death of our colleague, Dr. The resignation of J. Emmons Briggs, M.D., was read and accepted.

Scientific Session. Bureau: Gynecology, Medical Electricity, Ophthal- mology.

Carmichael, M.D., Chairman. Sanity and Therapeutic Value of Bromine Vapor. Dwight Warren, M.D., Winsted, Conn. Warren, after ten years' experience with bromine vapor, could most confidently recommend its therapeutic uses in croup, diphtheria, influenza, chronic laryngitis, catarrhal colds, hoarseness, and all affections of the air passages; also used for the prevention of scarlet fever and diphtheria. It has great use as a deodorant, chemically uniting with and destroying noisome odors. The Crede Method. Rhoads, M.D., Springfield.

This method, which was originated by Professor Crede in 1882, and has since been practised by him in his maternity hospital in Leipzig, consists of applying to the eyes of the newborn, for the prevention of ophthalmia neonatorum, a two per cent solution of nitrate of silver, one drop in each eye, every two hours. The result (with Professor Crede) was a s,uiv 86 The New England Medical Gazette. February, prising decrease in the disease, and the practice was adopted by, and is now used, in all the large hospitals in Europe. The doctor felt that in the fact that in the private practice of most physicians the disease is seldom encountered lay the danger of being off one's guard when a case did appear; and he recommended that in every case where therew as a suspicious vaginal discharge this method of practice should be used. Several Gynaecological Cases Treated by Galvanism. Parsons, M.D., Springfield. The Homoeopathic Treatment of Diseases Peculiar to Women.

Cushing, M.D., Springfield. In most of these cases no examination of the parts is nec- essary, but a careful selection of the appropriate homoeo- pathic remedy would insure a cure. The more chronic the case, the higher the potency to be given if results are to be gained.

In the discussion which followed, the voice of the society was in favor of vaginal examinations, in addition to the selection of the remedy. The tendency of the homoeo- pathic school at the present time was to give too little time to the study of materia medica, and too much time to surgery and gynaecology. We, as a society, should know more of materia medica and give a more prominent place to internal remedies, carefully studying our materia medica before selecting the drug. About twenty physicians were present, a number of the regular attendants being absent on account of the prevalence of the grip in Springfield and some of the surrounding towns. The Obituary Committee, through its chairman, Dr.

Copeland, presented the following resolutions on the death of Dr. Rand: — We, the members of the Homoeopathic Medical Society of West- ern Massachusetts, desire to honor the memory of our departed brother, Dr. Rand, and to testify to his skill as a physician, to his worth as a man, and to his integrity and fidelity as a member of the profession. His was a genial, kindly nature, expressing itself in love for bird and wayside blossom, in kindness to beast and burden-bearer, and in a large charity to all mankind. 1899- Gleanings and Translations. 87 In the realm of thought and letters he was an earnest student, ever seeking new light, ever receptive of the truth, ever enthusiastic in his research — a thinker and a scholar.

He was a poet, yet an eminently practical man, adapting himself with ever- ready tact to the circumstance and condition in which he was placed. He was an ideal doctor. His breadth of intellect, shrewd insight into human nature, and pleasing courtesy of manner placed him high in the ranks of his contemporaries. More than many another, he had the skill to read in his rides among the hills the stories nature has written in rock, tree, and flower, and he had a heart to respond to and to breathe inspiration from his surroundings, and, above all, the happy gift of imparting this inspiration to the hearts and lives about him.

To many a bedside he brought the wisdom of the physician, the skill of the surgeon, and the tender touch of the nurse, — a rare combination, endowed by nature, but developed by his surroundings. In the midst of his busy practice he still had time for family and friends; never too busy to give a suggestion, to lend a helping hand, free, generous to a fault, ever ready to help a worthy cause or a deserving person. Cheerful in the most trying circumstances, cool in the most perplexing, untiring, resourceful — a most interesting and lovable man. To his brother, sisters, and orphan children we extend the hand and heart of sympathy in this their great bereavement, the depth of which we may in some measure realize. Copeland, Oscar W. Roberts, Geo. Wilkins, For the Society.

The meeting adjourned at 4 p.m. Rowe, Secretary. GLEANINGS AND TRANSLATIONS.

Treatment of Sciatica. — Absolute rest in the recum- bent position is of the first and most vital importance, as without this other therapeutic measures amount to nothing. Weir Mitchell even goes so far, after putting the patient to 88 The New England Medical Gazette. February, bed, as to apply a long splint to the affected side, just as a surgeon does in fracture of the hip. He claims that he has cured some of the most obstinate cases, after all other measures have failed. I have never used it or seen it used, though some who have say they have known it to relieve, and some cases to be entirely cured by it. This would be an excellent mode of treatment in an institution, but I hardly believe it would be feasible in the majority of cases in private practice....

Local applications are often of great benefit — heat, ironing the thigh along the course of the nerve, firing along the course of the nerve, with the hammer made hot by boiling; the thermo-cautery; blisters over the nerve or most painful spots; iodine, preferably the corap. Or Churchill tincture, applied repeatedly until vesication takes place; deep injections along the course of the nerve or at its point of exit from the pelvis, repeated p. Acupuncture is a very popular mode of giving relief to patients suffering from sciatic neuralgia. It consists of introducing fine, round steel needles (which have been ster- ilized) to various depths from one to two inches over the course of the nerve.

From one to six are used. Professor Osier speaks highly of this mode, both in lum- bago and sciatica.... An operation by cutting down upon and opening the sheath of the nerve and breaking up any adhesions, in some obstinate cases, gives relief. Also by removing a section of the inflamed nerve.

Deaver, of Philadelphia, cured a case of long standing, which had resisted most active treatment of various kinds, by stretching the nerve. Electricity is recommended by some, but by many reliable authorities is not favored, being looked upon as an uncertain remedy. I have used it in one case, but the patient felt worse after than before. Cold applied over the course of the nerve by means of ice bag is advocated by Mitchell, Jacobi, Hammond, and others. In the majority of cases it is of doubtful utility.

Massage in conjunction with other treatment is advisable in cases where the inflammation of 1 899. Gleanings and Translations. 89 the nerve sheath is not too active, and it often does a great deal of good. There may be a syphilitic taint back of the trouble, when the use of potassium iodide or the corrosive chloride of mercury, singly or combined, may bring about a cure. Leech, The Maryland Medical Journal.

Electricity in Chronic Articular Rheumatism. — I have tried many of the famous prescriptions, but have failed to cure the disease with medicine — that is, satisfactorily.

I know electricity will do more in a case of chronic articular rheumatism than any drug. Before using electricity one must familiarize himself with the different currents — their applications, length of application, also strength of current to give, etc. I have found the best method to be that of the electro-thermal vapor bath, for this reason: the dry skin is practically a non-conductor of electricity, having a resistance of about one hundred thousand ohms.

This apparatus is for the purpose of overcoming, as far as pos- sible, this resistance. This can only be accomplished through heat and moisture. We overcome the resistance of the skin and the tissues beneath it, and can localize the cur- rent upon any desired portion of the body in a way that is impossible in the water bath. The pores are filled with perspiration, and through this moisture electricity will penetrate much more deeply than in any other method.

The improvement in the condition of a patient suffering from some chronic disease is ordinarily due to some of the many changes occurring in the process of nutrition. The effects of the electro-thermal treatments upon the organs and tissues of the body are mechanical, physical, chem- ical, and physiological. These results aid in nutrition by hastening the chemical changes which are ordinarily going on in the body. It is unreasonable to expect an immediate cure in a case of chronic trouble; chronic cases require chronic treatments.

Also it is unreasonable to expect elec- trical treatment to promptly and entirely remove deposits from the joints and cure a case of ankylosis; but I do say 90 The New England Medical Gazette. February, that electricity properly applied, with reasonable discrimina- tion in the selection of cases, will secure better results in the treatment of rheumatism than any other measure with which I am acquainted. This disease being constitutional, treatment in a large majority of cases, particularly of muscular rheumatism, will give better results by the use of general faradization given in the electro-thermal bath than in any other method. In the treatment of chronic articular rheumatism the current should be passed transversely through the joint. I prefer the galvanic because of its superior penetrating power, al- though alternation with faradic is very successful. In case you have callosities, ankylosis, or effusions, the galvanic current is much more efficient than the faradic. The nega- tive pole is also to be preferred where it is desired to cause absorption.

Where there is much pain, or the parts sensi- tive to pressure or exercise, the use of the positive pole over the seat of trouble usually affords prompt relief. The treatments should be as often as every day until the disease begins to subside; then every other day until pa- tient is dismissed. La Salle, in The Electro- Therapeutist. REVIEWS AND NOTICES OF BOOKS. Practical Urinalysis and Urinary Diagnosis. A Manual for the Use of Physicians and Students. By Charles W.

Fourth revised edition. Philadelphia, New York, Chi- cago: The F.

Davis Company, Publishers. While it has been for some time considered of importance to have made a thorough analysis of the urine in most diseased conditions, it is only comparatively recently that physicians generally are begin- ning to use this as a great aid in diagnosis. Indeed, to neglect it in certain conditions is not, to say the least, just to the patient, as the differentiation of certain types of disease is sometimes only possible through a thorough analysis of the urine.

Its influence on the treat- ment and ultimate results of the case is therefore great. The author of this very practical work has out of his large expe- 1899- Reviews and Notices of Books. 91 rience given to the profession very trustworthy methods for urinaly- sis. The reagents for the various tests he has selected with care and especially emphasized those which are the most trustworthy and less likely to be reduced by any other substance than what is being tested for.

In the section on ' Centrifugal Analysis ' he gives a ready method for determining approximately the amount of chlorides, phosphates, sulphates, and albumen in a given specimen of 10 c. By estimating their bulk percentages.

This is done by means of conically shaped centrifugal tubes of 15 c. Capacity and especially graduated, 10 c. Of urine being used and 5 c.

The tubes are then revolved at a speed of 1,000 revolutions a minute for three minutes. The arms of the centrifuge must be of such length that the tips of the tubes will describe on revolution a circle exactly thirteen inches in diameter.

From many analyses of normal urines by this method the author has constructed a standard scale with which the results of the centrifugal analysis of the urine in diseased states must be compared. The method in our experience gives fairly accurate results. For rapid comparative results on the same cases from day to day, as, for instance, in estimating the chlorides in pneumonia, we have a good means of determining the progress of a case by this method of centrifugal analysis. We cannot accept the confidence which he places in the Daland Haematokrit as a ready means of determining the number of red and white blood corpuscles per cubic meter.

The degree with which both white and red cells vary in size in health and in certain diseased states is often quite marked, so that 5,000,000 small cells would make a much shorter column than 5,000,000 large cells in the tubes of the haematokrit. However, for precipitating bacteria in the urine it may be of some use as the author has suggested. The section on ' Diseases of the Urinary Organs and Urinary Disorders ' appeals perhaps most strongly to the practitioner. In this section the author has very nicely differentiated the various forms of nephritis by not only giving the leading urinary symptoms, but also the most prominent of the other clinical symptoms. In this section he treats also in a similar manner amyloid disease of the kidney, renal tuberculosis, cystic disease of kidney, renal embo- lism, rsnal calculus, uraemia, haemoglobinuria, chyluria, diabetes insipidus and mellitus, pyonephrosis, hydronephrosis, surgical kid- ney, movable kidney, cystitis, vesical tuberculosis, stone and cancer. On the whole the work fulfils its object as ' A Guide to Practical 92 The New England Medical Gazette. February, Urinalysis.'

That it is in its fourth edition in so short a period as three years is a sufficient testimonial of its excellence. The typography and binding are good. We are in receipt of the following notice from the well- known publishers, Messrs. Lea Brothers & Co., which will be of interest to all our readers: — Messrs. Lea Brothers & Co. Announce for publication in March, 1899, the first volume of Progressive Medicine, a new annual which will be issued in four handsome octavo, cloth bound, and richly illustrated volumes of about 400 pages each.

The several volumes will appear at intervals of three months. In this age of unusual progress, so rapid is the advance in all departments of medical and surgical science that the need for condensed summaries which shall keep the practitioner up to date at the least possible expenditure of valuable time has become imperative. To insure completeness of material and harmony of statement, each narrative will receive the careful supervision of the General Editor, Dr. Hobart Amory Hare, whose reputation will everywhere be acknowledged as insuring practical utility in a high degree. Those associated with Dr. Hare in the production of Progressive Medicine include a brilliant gathering of the younger element of the profession, well representing the class which is so energetically con- tributing to make modern medical history. With the appreciation of the self-evident utility of such a work to all practitioners, the publishers are enabled to ask the very moderate subscription price of ten dollars for the four volumes.

The publishers offer to send full descriptive circulars and sample pages to those applying for them. A Text-Book of Obstetrics. By Barton Cooke Hirst, M.D., Pro- fessor of Obstetrics in the University of Pennsylvania. With 653 illustrations.

Philadelphia: W. Price, cloth, $5.00 net; sheep or half morocco, $6.00 net. Twelve years given exclusively to obstetrics and gynecic surgery, and to service as gynecologist and obstetrician in eight of the principal hospitals of Philadelphia, may well fit a man to write a book on obstetrics. When that gynecologist and obstetrician is also a teacher of long experience, he may feel justified in claiming that his work should have a place among text-books. Such a place we sincerely hope Dr.

Reviews and Notices of Books. 93 Hirst's volume on obstetrics may at once occupy. It may be adopted with advantage in place of works which have passed through several editions practically unchanged. Hirst's book is thoroughly up to date, readable, careful in its statements, comprehensive, yet not diffuse. Even in this day of copious illustrating this volume is unique, and the illustrations are excellent and pertinent to the text. The work is divided into seven parts: Pregnancy, The Physiology and Management of Labor and of the Puerperium, The Mechanism of Labor, The Pathology of Labor, Pathology of the Puerperium, Obstetric Operations, The Newborn Infant. The title of Part I, that is, Pregnancy, is perhaps the only one which does not convey the full scope of its section.

This portion includes chapters on anatomy, menstruation, ovulation, fertilization, etc., the development of the embryo and fetus, the physiology of pregnancy, and the pathology of the pregnant woman. Other titles are sufficiently explanatory.

Without prejudice to other portions of the work, we especially commend the section on 'The Physiology and Management of Labor and of the Puerpe- rium,' and the clear explanations and directions given in Part VI concerning the use and application of forceps. The illustrations in the latter sections will be very helpful, especially to students. We predict that Dr. Hirst's work will be received with much favor by instructors and practitioners. The Phonendoscope and its Practical Application.

Aurelio Bianchi. American edition. Philadelphia: George P. Pilling & Son. Price, 50 cents. That the phonendoscope is an improvement on the stethoscope we think few will dispute. Doubtless, however, there are some who are not fully conversant with the most approved methods of making use of the newer and better instrument.

The above-mentioned monograph will therefore prove serviceable to the many physicians who have discarded the old-fashioned stethoscope. Its five chapters seemingly cover all the practical points, a knowl- edge of which is essential to intelligent phonendoscopy. The origin, scope, and application of the phonendoscope are set forth, and the results obtainable by its use summarized; diagrams and charts show in connection with the text methods of outlining the organs of the body. It is claimed that not only their location, but also their movements 94 The New England Medical Gazette. February, and any alterations of position, whether caused by their functional activity or through the action of gravitation, can be determined by means of the phonendoscope. It is certainly a useful and easily applied little instrument, and this book of instruction should make it of still greater practical value.

Atlas of Syphilis and the Venereal Diseases, Including a Brief Treatise on the Pathology and Treatment. Franz Mracek. Bolton Bangs, M.D. Philadelphia: VV. Price, $3.50 net. This is the volume in the series of Medical Hand-Atlases, being published by Mr. Saunders, which, as the title shows, treats of syphilis?

The venereal ulcer, and gonorrhoea. We have_ had occasion to re- mark to such a degree on the excellence of the other hand-atlases in this series that it would be difficult to say anything new about this. There are seventy-one colored plates which are superb examples of the degree of perfection to which the art of illustration as applied to medicine has arrived.

The selection of cases is most happy, as it presents with great truthfulness the ordinary appearances of the dis- ease as well as some of the more exceptional. These plates are a practical help often in the deciding of a doubtful diagnosis.

The descriptive text is a brief history of each case with treatment (largely mercurial inunction) and results. The didactic text is brief, but practical and to the point.

Altogether this book is one of the best yet issued. REPRINTS AND MONOGRAPHS RECEIVED. The Manual of Massotherapy. The Use of Massage Rollers and Muscle Beaters.

Forest, B.S., M.D. New York: The Health Culture Co. Price, 25 cents.

Mechanical and Surgical Treatment of Fractures of the Neck of the Femur. Gillette, M.D.

Reprinted' from North- western Lancet. The Early Diagnosis of Cancer of the Stomach. By Charles D. Reprinted from The Journal of the American Medi- cal Association. Three Years of Serum Theraphy in Tuberculosis. Reprinted from New York Medical Journal for May 14, 1898.

1899- Obituary. 95 Christian Science.

A Sociological Study. By Charles A.

Reed, A.M., M.D. Cincinnati: McClelland & Co. Price, 10 cents.

Are Complete Castrates Capable of Procreation? Sturgis, M.D. Reprinted from Medical News of October 8, 1898. Some Remarks about the Study of Medicine in Germany. By Emil Ausberg, M.D. Reprinted from The Leucocyte. Caries of the Teeth and Diseases of the Stomach.

By Charles D. Reprinted from The Charlotte Medical Journal. Victoria Hdd Test Free Download. Diarrhoea and Bacteria. By Charles D. Reprinted from The New York Medical Journal. The Porcelain Painter's Son.

By Samuel Arthur Jones, M.D. Boericke & Tafel. Climacteric Insanity. Henry Arvin Houghton, M.D., after a brief illness, died at his home, 136 Marlboro Street, Boston, January 15, and so ended a life of rare activity, fidelity, and usefulness. Houghton was born in Linden, Vt., Dec.

After an academic training he entered the medical school in Philadelphia and graduated in 1852. The same year he married Sarah D. Johnsbury, and commenced his professional work in his native town. He soon removed to Keeseville, N. Y., where he found a larger field which he faithfully cultivated till 1876, when he came to Charlestown. Here his ability and the value of his services were soon rec- ognized and he entered upon a large and successful practice, which he continued until within a few days of his death.

In 1890 his wife, who had made his home life beautiful, died. In 1894 he was married to Mrs.

Willard, of Keese- ville, N. About this time he moved to the Marlboro Street home, where he died. Three sons survive him — Harry, of Boston, Edmund K., of Lexington, and Silas A.

Houghton, M.D., of Brookline. G6 The New England Medical Gazette. His memory will be long and tenderly cherished in many homes and in many hearts. He was, in very truth, a ' be- loved physician.'

To a deeply affectionate and sympathetic nature he joined in large degree close and accurate observa- tion and sound judgment. His lovable spirit and sterling character will make him long remembered by all who knew him. No one ever met him but recognized one of God's real noblemen. He loved and honored his profession and was devoted to his work. A veritable MacLure of Drumtochty, no ride was too long, no weather too severe, no home too humble, if so be he could serve the sick and relieve suffering. When in late years it was suggested that he should leave ' charity work ' to younger and less busy men, he replied, ' My service is at the disposal of any who need it and ask for it.' Modern schools may furnish fuller courses and ampler facilities than those of his time afforded.

They will be for- tunate indeed if they give to the community men as true and noble. He has finished his work and entered upon his rest and reward. ' Come, ye blessed of my Father; I was sick and ye visited me.' PERSONAL AND NEWS ITEMS.

New York Homoeopathic Medical College and Hos- pital. — Every graduate is requested to send his name and present address to the Corresponding Secretary of the Alumni Association, in order that the new list of all gradu- ates may be complete. Munson, Corresponding Secretary. 16 West 45th Street, New York. — A homoeopathic physician of ten years' expe- rience would like information regarding a good location in eastern Massachusetts. Would be willing to assist an estab- lished physician or purchase an established practice.

W.,' care of Otis Clapp & Son, 10 Park Square. T HE NEW ENGLAND MEDICAL GAZETTE No. THE THERAPEUTIC AND SANITARY USES OF BROMINE VAPOR. [Read before the Western Massachusetts Homoeopathic Society J Ten years ago I began to give myself to the experimental study of bromine vapor, and while the time has been pass- ing since then, my experiments with this much-misunder- stood but interesting drug have been greatly multiplied and repeated in a great variety of ways. I have tested this vapor extensively upon my own person, and have secured the cooperative and unconscious provings of a goodly num- ber of the old and young of both sexes, and have prescribed it in numerous instances empirically, at a venture, in order to obtain its prophylactic as well as its remedial effects. I have hardly had leisure to compile a definite and numer- ical statement of the many cases which have proved this drug under my personal observation, but by gathering together these tests and putting them beside my own experiments have produced ample data from which may be obtained a fair knowledge of the real therapeutic and sanitary value of bromine gas. Therefore, by a careful examination and analysis of this mass of experimental tests, I find that some very marked results are produced by bromine vapor when it is inhaled by a healthy person.

When the fumes of bromine are breathed into the air passages of a healthy person its primary action will be anaesthesia of the throat and larynx, but within two or three minutes there will follow an exces- sive irritation of the eyes, nose, throat, and bronchial tubes, VOL. 97 98 The New England Medical Gazette. March, producing in succession smarting of the eyes with a profuse secretion of tears, sneezing, and copious defluxion from the nostrils, and an intense pungent, pricking, scraping sensa- tion in the throat and larynx, with hoarseness and feeling of dryness, which is attended with more or less strangulation, paroxysms of coughing, and tightness of chest. The pulse will be slightly quickened and the urinary secretion some- what increased.

In a few instances headache is produced, and with rare exceptions sickness of the stomach. All these symptoms soon begin to gradually subside and an increased secretion of mucus and of the salivary glands take place. The throat and air passages feel easier, the voice becomes clearer, a decided exhilaration of the system is experienced, and an improved condition of the whole organism results.

Should the inhalation of the strong gas be prolonged or fre- quently repeated a superficial inflammation of the throat and tonsils will be caused, attended with a white exudate upon the mucous membrane. This bromine inflammation, however, is rapidly recovered from, its exudation is easily de- tached from the membrane, and its inflammatory action does not reckon among its events suppuration, loss of substance, nor any impairment of the nervous sensibility. In fact, even the diluted vapor produces local stimulation of the tissues, and when it is taken in small quantities a number of times daily for four or five weeks, increase of tone and strength with a laying on of flesh will ensue. In truth, when these fumes are taken in such a degree of strength as to cause great irritability so as to endanger asphyxia through spasm of the glotis, it never leaves behind it any lesion of sur- face.

I make this statement because it is backed up by the fact that I have taken the strong gas in startling doses hundreds of times even to temporary asphyxia, and to such an extent as to produce a coating upon the throat which was in truth a false membrane; and besides, I have given it out indiscriminately to many persons, who have used it at their own discretion, and it has proved to be perfectly congenial in its permanent effects upon each and every individual who has tested it. 1899- The Therapeutic and Sanitary Uses of Bromine Vapor. 99 That bromine in its common form is hazardous, unsafe, and unmanageable goes without saying, but I have used it without risk or dread of perilous consequences, for the reason that I had made the discovery of a compound where- with the vapor could be managed and used with perfect safety, by even the most inexperienced.

On this account my facilities for experimentation with this energetic sub- stance have been rare and unprecedented; and I have come to know that among physicians the therapeutic knowledge of bromine is for the most part an unknown quantity. When we consider the fact that bromine vapor has the quality and power to excite inflammation of and exudation upon the mucous membranes, we are led at once to the conclusion that it is homceopathically indicated for croup, if not diphtheria; and we have clinical facts in ample abun- dance, which go to establish its remedial value for these dis- eases. At one of the annual meetings of the New York State Homoeopathic Medical Society, many cases of croup were reported by different physicians as having been promptly re- lieved by bromine after other means of cure had been ex- hausted, and many eminent practitioners as well as professors of medicine concurred in the opinion that it was almost an unfailing remedy for membranous croup, as well as other forms of the same disease that had no membrane.

It will doubtless be remembered that Dr. Bracelin, a West- ern physician, practically demonstrated at Chicago some two years ago that chlorine gas would effect the cure of diph- theria where antitoxin had failed, and many other physicians have also reported remarkable recoveries that were treated by the same agent. Now bromine is a perfect analogue of chlorine, and is therefore equally as good a specific for diphtheria as chlorine; but chlorine acts with great violence upon the air passages, producing in them dangerous inflam- mation. The action of bromine upon the mucous tissues is always congenial, and because it is intermediate in its chem- ical affinities between chlorine and iodine it is the most avail- able remedy among the halogen vapors for affections of the throat and lungs. High authorities in the alopathic profes- ioo The New England Medical Gazette.

March, sion also claim that bromine is a sovereign remedy for diph- theria. And when the numerous provings and tests of bro- mine vapor that have come under my personal observation are critically examined, the inference which they evoke is direct and inevitable that it is a preventive of both diphtheria and scarlet fever; and more than this, it will protect the mucous membranes of the throat, glands, and air passages against all forms of atmospheric vicissitudes, as well as from the action of specific disease germs. Its employment is also invaluable to persons who are unusually liable to take cold, for I can report cases who have got rid of the tendency to catch cold by the habitual use of this vapor. Again, it may be taken with good effect as a defense from hay fever; and it will afford marked relief to those who have persistent coughs, and who suffer with catarrhal troubles of the nose, throat, and bronchial tubes, for it promotes expectoration from the air passages, and defluxion from the nasal cavities where they are clogged with viscid mucus. Now as nothing can be introduced into the lungs with safety and escape therefrom except it be in a gaseous form, it is absolutely essential that all local applications to the mucous lining of the bronchial tubes should be some kind of vapor; and it can never be claimed that much permanent good has ever been attained by the atomization of liquids or spray pro- ducers when used for lung treatment. But bromine being very volatile and its chemical affinities is of such a nature that it is peculiarly adapted to act as a remedial vapor for the air passages. Another point worthy of especial notice con- cerning the use of bromine gas is the fact that most persons rather like to inhale it.

That this unique substance, which chemists claim to have the worst of all odors, and which, when inspired, produces such a powerfully pungent effect upon the mucous tissues, should prove to be a favorite remedy with people for the most part who use it, even though they be refined and fastidious, is a very curious fea- ture, but this fact may be accounted for on the ground that its unpleasant primary effects soon cease, and its palliative and remedial agency continues. 1899- The Therapeutic and Sanitary Uses of Bromine Vapor. 101 As has been stated, I have made a very extensive use of bromine gas, and have also employed it in order to receive the benefit of its remedial effects upon my own person. Right here, therefore, I will give a brief recital of what I know personally about the bromine vapor treatment. For many years whenever I took cold, or any form of influ- enza, a very distressing cough would ensue, and it was a cough that always came to stay.

In summer the cough would abate, in winter it would recur again, and each suc- cessive return of cold weather would bring on with increas- ing severity the dread cough with expectoration. At length the affection was productive of such violent fits of coughing and wasting of flesh that bronchial consumption was fairly established. After the cough and expectoration had been continuous for two years I was induced to go to Colorado to seek relief by change of climate; in two weeks after I reached that State the cough ceased, but it came on every winter while I lived in the West, yet it was less severe. As the water in that country was strongly alkaline I was taken with a persistent chronic diarrhoea and was compelled to return East.

The second winter after I came back the cough reappeared with its old-time violence. As my system seemed to have no power of resistance against the rigor of our New England winters I was constrained to again seek a more congenial clime. As I had learned by experimenta- tion that bromine vapor was remedial in its effects upon the larynx and bronchial tubes, and could be freely used with perfect safety, I had recourse to its systematic employment, and soon discovered that it was a most potent agent of de- fense against those atmospheric elements and influences that produce such harmful effects upon the mucous membranes of the air passages. And now whenever I feel a tickling in the trachea, which is invariably a precursor of a protracted bronchial complaint, I resort at once to the use of bromine gas, and the mucus is rapidly loosened, the cough quickly disappears, and recovery takes place. Now I have been a strict observer of the laws of hygiene for many years, and yet the predisposition of the mucousmembranes to be easily 102 The New England Medical Gazette. March, injured by adverse atmospheric influences seemed to aug- ment rather than decrease. Hence I can attribute my im- munity from cough and constant good health for the last two years to no other means but the liberal use of bromine vapor.

The points of therapeutic value of bromine vapor may now be summed up: as a remedial agent and palliative for membranous and all other kinds of croup, diphtheria, grip, influenzas, chronic pharyngitis, laryngitis, and bronchitis, catarrhal colds, hoarseness, coughs, and asthma; for the prevention of scarlet fever, diphtheria, hay asthma, and all affections of the air passages produced by climatic changes of the weather or by disease germs. The sanitary value and advantages of bromine vapor next require consideration. As a deodorant it is unsurpassed; it searches out and destroys offensive odors in the atmosphere, and is endowed with the peculiar property of chemically uniting with and decomposing noisome smells, and at the same time its own odor is proportionately removed.

It de- composes sulphurated hydrogen gas, phosphorated hydrogen gas, and all other gaseous compounds which are liberated by putrifying animal and vegetable matter. Its fumes are rapidly diffusive, penetrating every crevice and secret cranny, and they also act with intense energy upon all organic materials. Numerous instances can be cited where it has conspicuously displayed its superior deodorizing power, as, for instance, after the terrible Johnstown flood, where it was found that no other deodorant would destroy the fearful smell that pro- ceeded from the dead bodies that were covered with debris but bromine, and six thousand pounds of it were used for that purpose. Again in New York when a large number of old sewers were opened for repairs, which being replete with unbearable stenches and deadly gases no workmen would enter them; and after all the well-known deodorants had been tried, and tried in vain, the city chemist recommended that bromine be used, which when applied destroyed all the noisome smells at once. And time would fail me to tell of the many rooms where the air was so pervaded with offen- 1 899.

The Therapeutic and Sanitary Uses of Bromine Vapor. 103 sive odors as to fairly sicken persons who entered them, and the same apartments were rendered perfectly sweet and wholesome by liberating within them a small amount of bromine gas. But bromine vapor is not only a powerful aerial deodorant: it is also a thorough atmospheric purifier. If we place a bottle of bromine with the stopper removed in a close and badly ventilated room, and allow it to remain there over night, in the morning its atmosphere will be pure and wholesome as the open air. The purifying properties of bromine gas are doubtless due to the fact that it carries with it so much oxidizing power.

Some of our later text- books teach that the halogens are powerful oxidizers, and the formation of an acid is not dependent on oxygen, and that the haloid acids H. Contain no acids; they, however, possess all the properties of acids, and oxida- tion is not only induced by free oxygen or substances rich in it, but is also produced by the halogens.

The agency of an impure atmosphere towards producing depression of the vital forces is well known. It therefore becomes a matter of necessity for persons who are seriously ill that their rooms should be kept constantly oxidized or replenished with pure air. It often happens that patients stricken with malignant diseases have to pass their illness in close, pent-up rooms and are compelled to inflate their lungs day after day with a gas-laden atmosphere, replete with impurities, infections, microbes, and insufferable smells which are the inevitable concomitants of putrid diseases; and it will therefore greatly enhance the chances of recovery of persons ill with such pestilential complaints to keep the air of their rooms charged with the fumes of bromine. But bromine gas is not only a powerful atmospheric deodorant and purifier: it ranks as being one of the most effectual of germicides. Official tests which have been made by the most eminent bacteriologists in order to determine the action of this drug upon micro life prove it to be one of the surest germicides known to science. The celebrated Dr. Koch, of Berlin, reports that according to his own tests of many disinfectants the only certain germicides are bromine, chlorine, iodine, and corro- 104 The New England Medical Gazette.

March, sive sublimate, and that bromine as concerns rapidity of action is superior to either chlorine or iodine. The sanitary uses of bromine vapor may now be summed up. It should be employed for oxidation and purification of unventilated sick rooms, the decomposition of pernicious gases, and for rooms of persons having communicable dis- eases, where effluvia or diseased virus is constantly thrown off from the bodies of the sick, besides the dry dust and other impurities of such an atmosphere; the secretions and excretions of patients and sickening odors of persons who are ill with smallpox, malignant diphtheria, scarlet fever, cancerous and gangrenous sores. The vapor is produced by a combination of the following drugs: — Bromide of potassium, 6 oz. Permanganate of potassium, 4 oz. Sulphate of aluminum, 2 oz.

And prepared as follows: — The permanganate of potassium should be used in the crystal form. The bromide of potassium and sulphate of aluminum may be ground to a coarse powder. Mix these three ingredients together and the mixture will be a com- pound powder that can be kept indefinitely in a wooden or paper box so long as it remains in a dry place. When this powder is dissolved in either hot or cold water, a decomposi- tion will ensue, and free bromine will be evolved. In order to produce the vapor in a form convenient for inhalation, one tablespoonful of the powder maybe put into a one or two ounce bottle, to which should be added one half a dram of cold water, and after the bottle has been corked and well shaken, the vapor will be ready for use.

When using the gas for remedial purposes it may be breathed into the air passages through the open mouth, as well as through the nostrils, directly from the bottle. The bottle thus pre- pared can be carried in the pocket and the vapor may be inhaled from it many times a day, taking five or six moder- ately weak inhalations at a time.

Whenever it is desirable to render the elimination of the 1 899. Pharmacopoeia in Relation to Potency. 105 vapor gradual and continuous in a volume that can be safely employed in rooms occupied by the sick, two tablespoonfuls of the powder may be put into an earthen or glass vessel, and two drams of cold water turned upon it; and after the powder has been thoroughly stirred it may be placed in the room, and by often stirring, the vapor will be slowly and con- stantly evolved.

Sometimes it will be requisite to keep three or more receptacles of the moistened powder standing in the room, for the vapor should be used thoroughly and freely enough to preserve the atmosphere fresh and whole- some and thus constantly keep the abnormal replaced with normal air. RELATION OF THE PHARMACOPOEIA TO THE QUES= TION OF POTENCY. [Read before the Hughes Medical Club.} An effort is being made to prejudice the minds of physi- cians who use the higher dilutions against the new Pharma- copoeia, for the reason that it fails to include rules for the preparation of dilutions from triturations of insoluble sub- stances.

It should be understood that the potency question is entirely foreign to the pharmacopoeia. This work deals with drugs and their conversion into medicines.

It considers their value only as pharmaceutical products. When we study their value as therapeutic agents we go outside the province of pharmacy. The Pharmacopoeia gives rules for the preparation of attenuations which, if followed, will insure accuracy, but it in no way limits the degree of extension. Dilutions made of what are regarded as insoluble sub- stances were omitted from the new Pharmacopoeia because they are not well-defined pharmaceutical products; in other words, they are not what they are claimed to be or what the labels indicate. Hahnemann, when he introduced these dilutions, considered that after triturating a metal or other insoluble substance up to the third centesimal attenuation, 106 The New England Medical Gazette. March, the particles reached such an infinitesimal (incredible) degree of fineness as to become soluble. Improved methods of examination by aid of the microscope have clearly and unmistakably demonstrated that his conclusions were incor- rect; that while the process of trituration will yield particles of a minute degree of fineness, still there is a limit of divisibility by this method of grinding.

The results are not sufficient to cause solubility, or even to admit of the parti- cles being held in suspension for any great length of time. It may be said, however, that this does not prove that such substances are entirely insoluble.- On the contrary, it is claimed that reliable authorities now consider that many metals heretofore regarded as entirely insoluble are to a limited degree soluble, and evidence of the fact is cited, such as the presence of gold in sea water, and the effect of the presence of metallic copper in water containing certain forms of algae as reported by Nageli and others. But these proofs are not by any means conclusive, as they fail to demonstrate that metals are soluble in their metallic form; in fact, the weight of evidence shows that they must undergo chemical change before being taken up in solution.

While gold is undoubtedly present in sea water, it has not as yet been found as metallic gold, but always in combination with iodine, bromine, or chlorine. The experiments of Nageli and others with pure copper immersed in a jar of water containing spirogyra resulting in the destruction of the algae is of great interest, but it should be remembered that further examination of the solution has demonstrated that the copper was taken up as an oxide and not as metallic copper.

As water contains more or less of free oxygen, the resulting oxide is not difficult to explain, and the further presence of free carbonic oxide found in most water may in other cases account for the presence of metals supposed to be insoluble. It must be accepted that the question of solubility of gold, copper, and other metals is still a disputed one, with the weight of evidence in favor of a necessary change into a soluble salt before solution can take place.

Even if we 1899* Pharmacopoeia in Relation to Potency. 107 should admit that all metals and, in fact, all substances are to a certain degree soluble in water or alcohol, it would appear reasonable that we should first ascertain the degree of solubility before we officially recognize such solutions. If not, we disregard one of the fundamental objects of a pharmacopoeia, which is to give official recognition to such drugs and drug preparations only as are well defined and of known drug strength. Doubtless it will be argued that these dilutions were introduced by Hahnemann and have been in use by most homoeopathic physicians since his day, and that they have become a recognized form of attenuation.

While it is true that in the past most, if not all, of the homoeopathic profession have used dilutions made from insoluble metals, it can be safely stated that to-day not more than fifteen per cent of the homoeopathic physicians of this country employ them. It should be taken into considera- tion also that Hahnemann never contributed to our literature any work in the nature of a pharmacopoeia. His directions for the preparation of medicines were given to us in the form of hints and rules of action, and are found scattered throughout his writings. Accuracy in every detail should be the invariable require- ment in everything pertaining to homoeopathic pharmacy, not only in the preparation of tinctures and attenuations, but also in the denomination of strength. The method of prep- aration should be demonstrably true, that is, based on scientific methods, and the indicating mark should tell the exact truth. This, at least, should be the rule applied to preparations recognized as officinal in our pharmacopoeia.

Attenuations in the form of dilutions made from insoluble substances by Hahnemann's method cannot be brought within this rule; consequently no matter how high a thera- peutic value we may place upon them as medicines, we should be content to regard them as non-officinal prepara- tions, at least until such time as we have determined their composition and strength. To obtain a clear idea of the question at issue, let us by 108 The New England Medical Gazette. March., way of illustration consider the method of preparing a dilu- tion of metallic copper and study the results obtained. Hahnemann directed that one grain of the third centesi- mal trituration of the metal be dissolved in 50 minims of water, then that 50 minims of alcohol be added. This would make the 4c dilution, the 5c being made by adding 99 minims of alcohol to 1 minum of the 4c dilution.

Let us first consider for a moment with what a minute- quantity of drug we have to deal in the 3c trituration. This single grain contains but 1/1,000,000 part copper, and if all the particles were brought together in one aggregation they would take up less than 1/10 millimeter in space; in other words, its diameter would be less than 1/250 of an inch. A minute point or mark made with a pen or pencil point would indicate its size, and yet this quantity of metal is minutely divided and diffused throughout the grain of trituration. Now as to the actual size of these drug particles.