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ooh iUttres The Physiology and Pathology of the Mind. By Henry Maudsley, M.D., London; Physician to the West London Hospital; Honorary Member of the Medico-Psycological So- ciety of Paris; formerly Resident Physician to the Manches- ter Royal Lunatic Hospital, etc., etc. New York: D. Ap- pleton & Co., 443 and 445 Broadway. 1867. This is an elegantly published octavo volume of 442 pages. It is divided into two parts. The first part relates to the "Physiology of Mind," and embraces nine chapters, as follows: 1. On the Method of the Study of Mind. 2. The Mind and the Nervous System. 3. The Spinal Cord, or Tertiary Nervous Centres, as centres of reflex action. 4. Secondary Nervous Centres, or Sensory Ganglia. 5. Hemispherical Ganglia; Certical Cells of the Cerebral Hemisphere, etc. 6. The Emotions. 7. Volition. 8. Motor Nervous Centres, or Motorium Communi. 9. Memory and Imagination. Part Second treats of the "Pathology of the Mind;" and is divided into seven sections, as follows: 1. On the Causes of Insanity. * 2. On the Insanity of Early Life. 3. The Varieties of Insanity. 4. The Pathology of Insanity. 5. The Diagnosis of Insanity. 6. The Prognosis of Insanity. 7. The Treatment of Insanity. The author of this work has made a systematic attempt to elucidate the pathology and treatment of mental diseases, by the principles and facts of physiology. The general scope of the work is sufficiently indicated by the table of contents, which we have quoted. The author says, in his preface, "The aim which I have had in view throughout this work has been two- fold; first, to treat of mental phenomena from a physiological rather than from a metaphysical point of view; and, secondly, to bring the manifold instructive instances presented by the un- sound mind to bear upon the interpretation of the obscure pro- blems of mental science." We think every reader will find it an interesting and instruc- tive book. For sale by S. C. Griggs & Co., 39 and 41 Lake Street. Price, $4.00.

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Report on Epidemic Cholera. Circular No. 5. Surgeon Gen- erals Office, War Department, May 4th, 1867. This report is in pamphlet form, folio size, 65 pages; and contains a full account of the cholera as it affected the United States Army in 1866. It contains full statistical tables, and abstracts from official reports, of much value, in making up the statistics and history of this much dreaded disease.

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TRAINING, OR FORCED EXERCISE IN THE TREAT- MENT OF DIABETES. Professor Bouchardat, while admitting the efficacy of alimen- tary treatment in diabetes, considers it only as palliative, and he recommends the adoption of energetic exercise. This idea is not a novelty on his part, as in former writings he recom- mended, in the case of patients affected writh this complaint, the energetic action of their bodies and arms; and then he ascer- tained that labor in the open air always promotes the utilization of the feculent matters in diabetic patients. It is not sufficient in all cases to cause the disappearance of the sugar, but, all things being equal, in regard to the quantity of feculent mat- ters absorbed and other conditons, a diminution in the propor- tion of sugar contained in the urine always coincided with exer- cise in the open air. M. Bouchardat gives an instance of re- markable success in the treatment of diabetes attained by this treatment, the diet being carefully regulated and the urine being examined at intervals. Although the patient may at first be very weak, the adoption of exercise w'ill gradually give him strength. It is of the greatest importance, according to M. Bouchardat, to use the strength in proportion as it returns ; and daily exercise of the body, arms, and legs is indispensable. The greatest care must be taken to find some daily exercise which is agreeable to the patient; as, for instance, in the case of men, hunting, rowing, fencing, skating, billiards, cricket, etc., or any ordinary manual employment, as sawing, cleaving wood, turning, and the active work of gardening; and in women, all the active household employments, especially those "which re- quire the action of the legs rather than standing without walk- ing. Riding in a carriage is not to be adopted except when no other exercise is possible; but riding on horseback is a salutary kind of movement, although it cannot be substituted for all the others. Of all the modes of exercise, that wrhich is most convenient must be chosen; and it ought to be energetic, so as to produce a thorough sweating over the whole body; and then all necessary precaution should be taken to prevent the chance of chilling the system. M. Bouchardat relates several cases in which his system was successfully adopted in the treatment of diabetes; he considers the exercise of the gymnasium especially useful when such an establishment is well conducted, and he gives some rules to be followed by the patients. When the ex- ercise has been continued for about an hour, and all the body is bathed in sweat, the flannel should be changed, and the skin washed briskly with cloths soaked in cold water, then strongly rubbed w'ith coarse gloves or towels, or flesh-brushes. Then the body is to be struck and kneaded, so as to produce a complete reaction, which is sustained by a walk of a quarter of an hour at least, the body being protected by good woolen clothes. The skin should not be neglected while these exercises are used, and salt-water baths, either warm, or, what is better, cold, if they can be borne, are, according to M. Bouchardat, of almost inva- riable utility. During the treatment the diet must be carefully regulated, glycogenic substances being avoided while the urine is diabetic, and resumed only when the sugar has disappeared. The red wines of Bordeaux or Burgundy may be drunk; but sparkling wines, like champagne, should be avoided. Coffee and tea, without sugar, are sometimes suitable, but their em- ployment must be regulated by the condition of the urine after they are taken.--British and Foreign Medico-Chirurgical Re- view, Oct., 1866.

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(r) dit o na I. Duffield, Parke & Co.--On the last page of the cover will be found the advertisment of the above Drug and Chemical Manufacturing Company of Detroit, Michigan. We think it is one of the best and most reliable establishments in our country. Chicago Medical Society.--At the regular meeting of the Chicago Medical Society, held on the evening of August 23d, 1867, Dr. R. M. Lackey presented a report concerning the sanitary condition of the West Division of the city, and the prevalence of diseases. The report presented several items of interest, and led to a discussion, in which several members participated. Dr. Fenn, resident-physician, or interne, of the County Hospital, presented two pathological specimens, obtained from post mortems at the Hospital. The first, was the kidneys from a young woman, who died from pulmonary phthisis. For sev- eral weeks before her death the stomach had tolerated but little food, and rejected cod-liver oil. Her lower extremities had been oedematous; the urine scanty, and highly albuminous. The kidneys, as presented to the society, were about normal size. On peeling off the capsule, or external membrane, sev- eral small tubercular deposits were found between it and the kidney; the substance of the latter was somewhat softened, and the cortical part extensively changed by fatty degeneration. Several of the pyramidal bodies were so completely transformed into fatty tissue as to have lost their natural red and striated appearance, and a large part of the cortical substance had undergone the same change. The second, was a portion of the sigmoid flexure of the colon, from a boy who had died with dysentery. The boy had been in this country only a few weeks, and died after an illness of about ten days. His symptoms were those common to dysen- tery, accompanied by a strongly-marked typhoid condition of the system. In the section of the intestine presented, the mu- cous membrane was intensely red, with spots of dark brown; tnuch tumefied, partly by infiltration into the sub-mucous cellu- lar tissue, and distinctly ulcerated. The same changes were found to exist throughout the whole extent of the colon and rectum. Dr. A. Fisher announced to the Society the death of Dr. Orrin Smith, one of its oldest and most respected members, and moved the appointment of a committee to report resolutions expressive of the sentiments of the Society. The motion was adopted, and the Chair appointed Drs. Fisher, Davis, Paoli, Hamill, and Wickersham as such committee. Drs. Fisher and Ross stated to the Society the results of the post mortem examination of Dr. Smith. He had been in feeble health for many years, but continued in active practice until within a few weeks of his death. The pericardium was found closely adherent to the heart, throughout its whole extent; the heart much enlarged, with softening of its structure and dilata- tion of its cavities; the semilunar valves of the aorta and the mitral valve much thickened and of cartilaginous hardness; extensive pleuritic adhesions in the left side of the chest, and partial hepatization of the lower lobe of the lung. No mor- bid changes in other organs were noted. The pleuritic and pericardial adhesions had evidently existed many years. Dr. Fisher, from the committee, presented the following pre- amble and resolutions, which were unanimously adopted: Whereas, It has pleased the Supreme Ruler to remove from our midst, and take to Himself a prominent member of this Society, by the death of Dr. Orrin Smith; therefore, as a tri- bute of respect, we offer rhe following resolutions: Resolved, That, in the death of Dr. Smith, this Society has been deprived of an honorable member, the community of an experienced practitioner and a valued citizen. Resolved, That we recognize in our departed friend and brother, a man of great energy and perseverance, so entirely devoted to his profession and to the cause of humanity that, although advanced in life, and for many years a sufferer from organic disease of the heart, he continued to practice his pro- fession till a few weeks before his death. Resolved, That we tender to the afflicted family of the de- ceased our earnest sympathy in their sad bereavement and irreparable loss. Resolved, That the Secretary of this Society furnish a copy of these resolutions to the family of the deceased, to each of the daily papers of the city, to the Chicago Medical Journal, and the Medical Examiner. New Medical Journals.--We have received the first num- ber of the Leaveaworth Medical Herald, edited by C. A. Logan, M.D., and T. Links, M.D., and published at Leavenworth, Kansas. It presents every evidence of being worthy of the patronage of the profession. The Western Journal of Medi- cine and Surgery, published at Indianapolis, also comes regu- larly, filled with interesting matter. Medical Education in Chicago.--For many years a consid- erable number of Medical students residing in the North-western States, have resorted to the Medical Colleges in New York and Philadelphia, almost wholly on account of the supposed superior advantages for clinical study in the hospitals of these cities. However valid such an excuse may have been ten or fifteen years since, it is entirely groundless-at the present time. In the present number of the Examiner, we publish the Clinical arrangements of the Cook County or Almshouse Hospital of this city, and those of the Chicago Eye and Ear Infirmary; and if we add to these the advantages which have long been afforded in the Mercy Hospital, directly under the charge of the Faculty of the Chicago Medical College; and of the St. Luke's Hospi- tal, it will be seen that Chicago presents, to-day, as wide a field for clinical instruction and study, as can be occupied by any student or practitioner in the country. Indeed, we doubt "whether a more extensive and complete arrangement for instruction in all the departments of clinical study, can be found in any city in this country. The arrange- ment includes not only an ample field of practical surgery and practical medicine, but a special course in the Mercy Hospital on Diseases of the Heart and Respiratory organs, including physical diagnosis and the use of the Laryngoscope; special attention to post mortems and Pathological anatomy in the County hospital; and special courses of instruction on diseases of the Eye and Ear, by Dr. Hildreth, in the Eye wards of the County hospital, and by Dr. Holmes in the Eye and Ear Infir- mary, including the use of the Opthalmoscope and all other modern appliances in diagnosis. If we add to these ample facilities for clinical instruction and study, the full curriculum, the systematic order, and the lengthened lecture term of the Chicago Medical College, we shall have presented to the profession as complete an arrange- ment for affording a thorough education in all the departments of Medical science and practice, as can be found any where on this side of the Atlantic. We cordially invite every student and practitioner in the country, to visit our Medical Institutions, and satisfy themselves concerning the correctness of our statements. Deaths.--The last number of the Boston Medical and Sur- gical Journal, contains an account of the death of John Mason Warren, of that city; and the daily papers yesterday, an- nounced the death of James Jackson, of the same place, in the 89th year of his age. Thus have passed away two of the most distinguished members of our profession, members who have conferred honor upon the profession to which they belonged. COOK COUNTY HOSPITAL. The Cook County Hospital, is in fact the almshouse hospital for this city and county. It fills the same place here that Bel- levue does in New York. Its managers have exhibited both wisdom and liberality, in opening its wards for systematic and efficient clinical instruc- tion. Wisdom, because a public hospital constantly open for clinical instruction to students and practitioners, will always be more punctually and faithfully served by the attending physi- cians and surgeons, and the wants of the sick better cared for, than where no such instruction is given. Liberality, because, instead of making it the attache of any particular college, they have selected for the Medical and Surgical Board, some of the more active, enterprizing, and efficient members of the profes- sion who are not connected with either of the Medical Colleges in the city, but who will teach all students who seek its advan- tages and comply with its regulations. Dr. Edwin Powell, whose name appears in the list of attend- ing surgeons, has resigned his chair in Rush Medical College, for the express purpose of accepting the place of surgeon to the Hospital. As at present organized, we do not hesitate to as- sure students throughout the North-West, that the Cook County Hospital in this city, affords them just as good facilities for the Clinical study of disease, including Morbid Anatomy, as can be found in Bellevue, New York, the Pennsylvania Hospital at Philadelphia, or the Chaity Hospital in New-Orleans. We take pleasure in appending the following official cicular issued by the Medical Board of the Hospital:-- Cook County Hospital, City of Chicago.--Winter Term of Clinical Instruction.--1867-68. -- The Winter term of Clinical Instruction in the Cook County Hospital, will com- mence on the 1st of October, 1867, after the usual vacation of three months. The continued prosperity and growth of this Institution, with its large number of patients, representing every variety of disease, furnishes to the student an almost unlimited field for clinical study. The Annual Report for the year end- ing July 1st, 1867, shows that during the year one thousand and thirty-seven patients were treated in the Hospital. The number discharged during the year was nine hundred and twenty. During the year there were in the lying-in department sixty-six births. Thirty-one capital operations were performed in the surgical department. There were seventy-three autopsies, which afforded an excellent opportunity for the study of morbid anatomy. The field for the study of diseases of the chest is probably not excelled in any hospital in this country. In ad- dition, the out-door, or Dispensary department of the Hospital, furnishes a large number of interesting cases. This is in charge of the medical staff of the Hospital, and is in operation from 1 to 2 o'clock P.M. every day of the week, (Sunday excepted,) affording an excellent clinic. The Pathological Museum now contains many very interest- ing specimens, and is available for the study of morbid anatomy. It is the purpose of the medical staff to use and develop the immense resources of the Hospital for the promotion of medical education, and to add whatever is possible to the means and facilities for medical study attainable in Chicago. The object for which they will earnestly labor being an elevated standard of professional knowledge among the students, and such junior practitioners as may seek our city for these objects. There will be five clinics a week from October to July, and two a week during July, August and September. The clinical days are Tuesdays, Fridays and Saturdays, 1| o'clock P.M. The medical clinics will be given by Drs. Ross, Bevan, Jones and Lyman; the surgical by Drs. Powell, Bogue, Smith and Fitch. Dr. Hildreth will hold an opthalmic clinic every Satur- day. Special courses of instruction will be given during the winter on Auscultation and Percussion, by Dr. Ross; on Microscopy and Morbid Anatomy by Dr. Lyman; on Surgical Dressings by Dr. Bogue; on the Opthalmoscope by Dr. Hildreth. Fee for admission to the Hospital, $5.00. Graduate practi- tioners of medicine visiting th<' city, and desiring to follow the practice of the Hospital, are admitted without charge. MEDICAL ORGANIZATION IN CANADA. The following indicates a movement in the right direction among our Canadian neighbors.--Editor. Report.-- Whereas; By the "British North American Act, 1867." the union of the Provinces of Canada, Nova Scotia and New Brunswick is effected, and united Legislative and Execu- tive action is secured: and Whereas; Closer connection must necessarily take place in all the relations Of life; religious, moral, and social: and Whereas; "Uniformity of Laws in Ontario, Nova Scotia, and New Brunswick" is provided for in the said Act: and Whereas; Uniformity in the laws which regulate life and health, and especially those governing the exercise of the medi- cal profession, stand preeminent: Therefore: The Medical Society of Quebec,--the oldest city in the Dominion of Canada, deems it a duty to take action in the premises; and has come to the conclusion, that the most equitable, surest, and best means of attaining the desired end, will be by an union of the members of the medical profession of the Dominion of Canada in Conference, at as early a period as practicable after the consummation of the union of Canada takes place, under Her Most Gracious Majesty's proclamation. Wherefore: The following resolutions were unanimously adopted, and are now respectfully submitted to the considera- tion of the medical profession of Canada, for such action as may be agreed upon in Conference. Resolved, 1. That in the interest of the public, and the medical profession, it is desirable to adopt such means as will insure a uniform system of granting license to practice Medi- cine, Surgery, and Midwifery, throughout the Dominion of Canada. Resolved, 2. That in future, all medical degrees or diplomas, of Universities, Colleges, or Schools of Medicine, shall have an honorary value, and licences to practice Medicine, Surgery or Midwifery, in the Dominion of Canada, shall be granted by a Central Board of Examiners, in each Province, before whom all holders of Degrees in Medicine, or Diplomas for Surgery, or Midwifery, shall appear for examination. Resolved, 3. That a committee of seven members be named by the Medical Society, to confer with the various Universities, Colleges, and Medical Schools in Canada, on the subject of the establishment of a Central Board of Examiners, before which, all candidates for license to practice medicine in the Dominion of Canada, shall be examined. Resolved, 4- That the Quebec Medical Society recommends the calling of a Convention of Medical Delegates, from Univer- sities, Colleges, Schools, Medical Societies, etc., in the Domin- ion of Canada; to meet at the city of Quebec, on the second Wednesday in October, 1867, for the purpose of adopting some concerted action, on the subject of medical legislation, in con- formity with this report, and for the formation of a " Canadian Medical Society. " The whole respectfully submitted. Laval University. Quebec, 18th June, 1867. W. MAXWELL, M.D., Chairman. R. H. Russell, M.D., Secretary. NEW SYDENHAM SOCIETY. We call special attention to the following notice of this Society. 1116 Girard St., Philadelphia. Bear Sir,--As Honorary Secretary of the New Sydenham Society, I beg to bring its publications under your notice, and to invite you to enrol yourself as a member. The Society was instituted for the purpose of supplying cer- tain acknowledged deficiencies in the existing means of diffusing medical literature. Works of a practical character and of per- manent value are selected for publication. You can acquire the whole of the works issued by the Society from 1859 to 1867 (35 volumes, including 28 vols. handsomely bound in cloth, gilt, and 7 fasciculi of the Society's Atlas of Portraits of Skin Diseases, embracing more than 20 life-size colored plates, 18x24 inches), for Nine Guineas; or you can commence with either the past or the present year. The subscription is One Guinea per annum, payable in ad- vance. I undertake to receive your annual subscription, and to hand you the books as soon as they are issued. I am, Dear Sir, truly Yours, RICHARD J. DUNGLISON, M.D., Honorary Local Secretary. Series for 1866. I. Bernutz and Goupil on Diseases of Women. Vol. I; II. Fasciculus of Atlas of Portraits of Diseases of the Skin (three beautiful colored plates life size); III. Hebra on Diseases of the Skin. Vol. I; IV. Bernutz and Goupil on Diseases of Women. Vol. II. Series for 1867. I. Griesinger on Mental Diseases; II. Biennial Retrospect of Medicine and Surgery; in. Fasciculus of Atlas of Portraits of Disease of the Skin (colored plates); IV. Hebra on Diseases of the Skin. Vol. II. Annual Subscription $7.50, in advance, (the duty, etc. pay- able on arrival of the vols., amounting to about $2.50 addi- tional). Obituary.--Death of Dr. Orren Smith.--Another of our most useful and valuable citizens has departed this life. With deep sorrow, which will find an echo in the heart of every man who knew him, we announce the death of Dr. Orren Smith, which took place at his residence, No. 236 Illinois Street, on Monday evening. For years past the deceased had been troubled with heart disease. During all this time his life hung by a single thread, but by sheer force of will and tenacity of purpose, he clung to that life, which has been a real and substantial benefit to his fellow beings. It is only recently, and at the earnest solicitations of his friends, that he gave up an extensive and lucrative practice, to become himself a patient, and receive the kind offices from others which he himself had so often extended to suffering hu- manity. Dr. Smith was born in Washington County, Vermont, in July, 1806, and was consequently at the time of his death, sixty-one years of age. He graduated in 1830, as a medical student, at the University of Vermont, and practiced for upwards of twenty- five years at Montpelier and vicinity, where he was distin- guished for his skill as a physician, and whence he was ap- pointed in 1850 to the Professorship of Obstetrics and Diseases of women and children, in the University where he graduated, which position he filled with distinguished ability until 1857, when he resigned on account of ill-health, and left Vermont for a change of climate. After spending a year or two at the South, Dr. Smith finally, in December, 1857, settled in Chicago, where he continued in. the practice of his profession up to the very hour of his last prostration and sickness. New York Medical Socety on Consanguineous Marri- ages.--At the late meeting of the "Medical Society of the State of New York," it was resolved: " That a Committee be appointed to investigate and report upon the result of consan- guineous'marriages, etc." If such marriages come under your observation, you will confer a favor by answering the following questions, and trans- mitting such report, before November next, to the undersigned, one of the Committee appointed: 1. Name (initials) and age of Husband. 2. Nativity. 3. Age when married. 4. Constitution. 5. Health, deformities, peculiar diathesis. 6. Health of his family, hereditary diseases, deformities, etc. 7. Name (initials) and age of Wife. 8. Nativity. 9. Age when married. 10. Constitution. 11. Health, deformities, peculiar diathesis. 12. Health of her family, hereditary diseases, deformities, etc. 13. How' are the parties related to each other? 14. How long married ? 15. How many children, or sterility. 16. Abortions; cause; how many, and at what period? 17. Children died, at wThat ages and from what diseases? 18. The constitution, age and present health of living children, deformities, mental conditions, idiocy, cretinism, deaf, mute, blind, epilepsy, albinism, insane, etc. 19. Remarks and other information. Hoping to receive your valuable cooperation for the advance- ment of medical science, I remain yours, most respectfully, ROBERT NEWMAN, M.D. 118 W. Houston St., New York, July, 1867. Clinical Instruction at the Chicago Charitable Eye and Ear Infirmary.--During the winter courses of instruction at the medical colleges of Chicago, there will be regular clini- cal lectures on diseases of the eye at the Infirmary. This insti- tution offers the medical student and practicing physician unu- sual opportunities for the practical study of diseases of the eye and of their medical and surgical treatment. During the past year, five hundred and fifty-five patients were treated at the Infirmary, of which eighty-seven required impor- tant surgical operations. An aggregate of 3197 patients have received the benefits of the institution since its organization, nearly ten years since. There has been an average daily attendance of 26 patients at the infirmary during the past three months. Dr. Holmes will give special courses on the use of the oph- thalmoscope. The Legislature of the State of Illinois, at its last regular session, appropriated the sum of $10,000, for the support of the poor of the State, during treatment, at the Infirmary for dis- eases of the eye or ear. The Legislature of the State of Wisconsin recently appropri- ated the sum of $500, for the support of Wisconsin soldiers receiving treatment at the Infirmary for diseases of the eye, contracted in the army during the late war. Trustees--W. L. Newberry, President; P. Carpenter, Vice- President; S. Stone, Secretary; E. B. McCagg, Treasurer; W. II. Brown, William Barry, T. B. Bryan, C. G. Hammond, E. C. Larned, Wesley Munger, E. W. Blatchford, Daniel Good- win, Jr. Consulting Surgeons--Prof. J. W. Freer, M.D., Prof. H. A. Johnson, M.D. Attending Surgeons--E. L. Holmes, M.D., Prof. E. Powell, M.D. Superintendent--G. Davenport. Matron--Mrs. Davenport. CAUSES OF DEATH. Accidents,--------------------- 16 Anasarca,----------------------- 1 Apoplexy,----------------------- 2 " Cerebral,________________ 2 Brain Disease,__________________ 1 " Congestion of,____________ 6 " Softening of,_____________ 2 " Concussion of,____________ 2 " Inflammation of,__________ 4 Bright's Disease,_______________ 1 Bronchitis,_____________________ 3 Cancer Duodenum,________________ 2 Canker,------------------------- 1 Caries of Spine,________________ 1 Congestion of Lungs,____________ 3 Cholera,________________________ 3 Cholera-Morbus,_________________ 3 Cholera Infantum,______________177 Cirrhosis of Liver,_____________ 1 Convulsions,____________________33 Cyanosis,_______________________ 1 Disease of Chest,_______________ 1 Diabetes,_______________________ 1 Diarrhcea,_____________________ 25 Debility,_______________________ 7 Diphtheria,_____________________ 2 Dysentery,_____________________ 10 Delirium Tremens,_______________ 1 Dyspepsia,______________________ 2 Dropsy Abdominal,_________________ 1 Dropsy of Brain,---------------- 1 Encephalis,_____________________ 1 Enteritis,______________________ 6 Exhaustion,_____________________ 1 Erysipelas,_____________________ 1 Fever, Puerperal,_______________ 2 Fever, Typhoid,_________________ 9 Fever, Typhus,__________________ 2 Fever, Scarlet,_________________ 1 Fever, Intermittent,____________ 1 Fungus Hsematodes,______________ 1 Fracture, Compound, (leg,)______ 1 Gastritis,_______________________ 3 Gastro Enteritis,________________ 1 Gangrenous Sore-throat,__________ 1 Hydrocephalus,___________________17 Heart Disease,------------------- 2 Heart Disease, Valvular of,----- 2 Inflammation of Bowels,__________ 5 Inflammation of Liver,__________ 1 Inanition,_______________________ 4 Jaundice,________________________ 1 Lungs Atelectasis,______________ 1 Laryngitis,_____________________ 1 Measles,------------------------- 8 Meningitis,______________________ 5 Meningitis, Cerebro-Spinal,_____ 3 Mortification,__________________ 1 Old Age,_________________________ 2 Obstruction of Bowels,___________ 1 Over-exertion,___________________ 1 Paraplegia,_____________________ 1 Paralysis,_______________________ 3 Peritonitis,_____________________ 4 Pneumonia,______________________ 10 Phihisis Pulmonalis,_____________29 Premature Birth,________________ 13 Breast,_________________________ 1 Scirrhus Uterus,________________ 1 Small-Pox,_______________________ 6 Stillborn,---------------------- 12 Stricture Intestines,____________ 1 Suicide,_________________________ 2 Sunstroke,_______________________ 1 Suffocation,_____________________ 1 Tabes Mesenterica,_______________25 Teething,_______________________ 13 Tumor of Womb,__________________ 1 Whooping-Cough,_________________, 4 Worms,_________________________ 1 Ulceration of Stomach,__________ 2 Unknown,._______________________ 7 Total,_______________________________________________538 NATIVITIES Chicago,____________242 Illinois,------------ 7 Other parts U. S.,___84 Germany,_____________60 Ireland,-------------35 Bohemia,____________ 10 Austria,------------- 2 Holland______________ 2 England,_____________10 Norway,______________ 9 Sweden,______________12 Shetland Isles,_____ 1 Prussia,_____________ 3 Scotland,____________ 4 Canada,______________ 5 Denmark,------------- 1 On Sea,_____________ 1 Switzerland,________ 1 St. Helena,_________ 1 France, ____________ 1 Darnstadt,__________ 1 Unknown,____________46 Total,___________538 Ages of the Deceased. -- Under 5 years, 363; over 5 and under 10 years, 17; over 10 and under 20, 10; over 20 and under 30, 36; over 30 and under 40, 29; over 40 and under 50, 19; over 50 and under 60, 6; over 60 and under 70, 7: over 70 and under 80, 4; over 80 and under 90, 2; still born, 16; un- known, 29. Total, 538. Mosey Receipts from July 26th, to August 30th.--Drs. J. J. Fyke, Odin, Ill., $3; William B. Ilart. Greenwood, Ill., 3; W. J. Johnson. Chicago, Ill., 1.50; J. W. Ghrist, Ackley, Ill., 3; J. Y. Campbell, Paxton, Ill., 3; W. M. Burbank, Barrington, Ill., 3; J. H. & D. McDill, Biggsville, 111., 3; Wm. Martin, Chicago, Ill,, 2. To Physicians.--By request, Prof. Horatio R. Storer will deliver his second private course of twelve Lectures upon the Treatment of the Surgical Diseases of Women, during the first fortnight of December, at his rooms in Boston. Fee $50, and Diploma required to be shown. Certificates of attendance upon the course just completed have been issued to the following gentlemen: Dr. C. M. Carle- ton, Norwich, Ct.; Daniel Mann, Pelham, N.H.; G. E. Bullard, Blackstone, Mass.; J. A. McDonough, Boston, Mass.; M. C. Talbott, Warren, Pa.; II. Gerould, Erie, Pa.; E. F. Upham, West Randolph, Vt.; W. L. Wells, Howall, Mich.; and W. A. I. Case, Hamilton, C.W. , Hotel Pelham, Boston, 1st July, 1867.

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TREATMENT OF INCONTINENCE OF URINE. By ABBOTS SMITH, M.D, M.R.C.P, &c. Dr. Smith states in his interesting brochure On Diabetes; and on Enuresis arising from Irritability, Weakness, or Inflam- mation of the Bladder and Urinary Organs, that it should not be overlooked that a cure of enuresis will be greatly facilitated by certain moral and dietetic measures. For instance, any bad habit of not getting out of bed for the purpose of emptying the bladder at proper intervals should be counteracted. The quan- tity of fluids taken by the patient should be moderately re- stricted, particularly in the evening. This constitutes the real secret of the occasional success of the plan of treatment termed "Dietta Sicca," resorted to by some practitioners for the pur- pose of diminishing the excessive secretion. It consists in giv- ing thick soups, bread, roast, or baked meat, fish without sauce, and dried fruits; the amount of liquid nourishment is gradually lessened, and the patient's thirst is assuaged, by the use of baths. This plan, however, is useless when enuresis depends on actual disease of the bladder or kidneys. The usual diet should be selected chiefly from articles of food which, although nutritious, are unstimulating to the kidneys or to the bladder, and which are not difficult to digest. Of these, none is so well adapted as milk. Amongst the most objectionable articles of diet may be enumerated all liquids which are taken when hot, especially tea, spices, pastry, salted and preserved meats, and most compound dishes. The general remedial measures of sea- bathing, change of air, and exercise, will prove the most useful in atonic, strumous cases; but the patient should be cautioned with respect to riding on horseback, which is productive of the disorder in many persons of a delicate organization, and will, when excessively indulged in, frequently render the affection serious, and almost intractable to medical treatment.--Half- Yearly Abstract.

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J Chem Educ J Chem Educ ed jceda8 Journal of Chemical Education 0021-9584 1938-1328 American Chemical Society and Division of Chemical Education, Inc. 36920160 10.1021/acs.jchemed.2c00779 Activity Using PyMOL to Understand Why COVID-19 Vaccines Save Lives Maya Celia * Instituto de Investigaciones Quimicas (IIQ), Departamento de Quimica Inorganica and Centro de Innovacion en Quimica Avanzada (ORFEO-CINQA), Consejo Superior de Investigaciones Cientificas (CSIC), Avenida Americo Vespucio 49, 41092 Sevilla, Spain Facultad de Quimica, Universidad de Sevilla, Aptdo 1203, 41071 Sevilla, Spain * Email: [email protected]. 28 02 2023 14 03 2023 100 3 13511356 09 08 2022 15 02 2023 (c) 2023 The Author. Published by American Chemical Society and Division of Chemical Education, Inc. 2023 The Author and Division of Chemical Education, Inc. Permits the broadest form of re-use including for commercial purposes, provided that author attribution and integrity are maintained ). Chemistry and biochemistry instructors must help students to develop the ability to visualize and manipulate 3D biomolecular structures and critically analyze them and their relationship to their functions. To do this, representative systems must be strategically selected to stimulate students' motivation. Since the World Health Organization declared a global pandemic caused by a new beta-coronavirus, called SARS-CoV-2 in early 2020, huge efforts are being taken by researchers to learn in depth how this virus works and a lot of scientific results are continuously reported. Many of them focus on the structural features of the viral spike glycoprotein and their relation with the vaccine development. This paper presents a series of workouts that deep into the structural characteristics of the spike protein S SARS-CoV-2 virus and the structural features involved in its infection process, using free online resources such as the PDB and the computer program PyMOL. This type of activity is intended to engage structural biology students in examining these macromolecules and others to help establish procedures for controlling COVID-19 and other future infectious diseases. PyMOL session files and student activities are provided. COVID-19 Infection Process COVID-19 Vaccines Protein Structure PyMol Workshops Function-Structure Relationship Universidad de Sevilla 10.13039/100009042 NA European Regional Development Fund 10.13039/501100008530 US-1380849 document-id-old-9ed2c00779 document-id-new-14ed2c00779 ccc-price pmc1 Introduction Proteins and protein complexes are molecular machines that carry out a large number of essential functions in the cells.1 Protein functions are directly related to the structures of these proteins. Understanding how these molecules fold, how they assemble into complexes, and how they function could give us clues to answer questions such as why we have cancer, why we get sick, why we grow old, or how we can find cures for many diseases. Fundamental principles of protein folding and assembly, therefore, are an important part of most introductory-level biology and biochemistry courses. Many instructors use molecular visualization tools that allow their students to manipulate protein 3D structures and achieve a better understanding of the structure-function relationship. Advances in techniques for structure determination of biomolecules such as X-ray crystallography and nuclear magnetic resonance, and, in recent times, cryogenic electron microscopy, have allowed the resolution of more than 190,000 three-dimensional protein structures. All of them are freely available to be examined in the Protein Data Bank.2 On the other hand, numerous studies have reported that emotions play a crucial role in the human cognitive processes,3 including attention,4 learning and memory,5 reasoning, and problem-solving. That is why it is very important to select examples that students perceive as interesting and worth knowing, which occurs when learning is connected to students' interests, aspirations, and life experiences. Nowadays, learning facts about SARS-CoV-2, the coronavirus that causes COVID-19, is a very interesting topic for students. They look forward to understanding how this virus infects cells, how vaccines and antibodies work, or how the efforts of our research scientists can help end the current global health crisis. In the last two years, hundreds of structures of the SARS-CoV-2 spike protein have been reported. Their analysis has revealed aspects of its structural flexibility and how this protein interacts with the cellular receptor ACE2, revealing the way the immune system prevents its action by blocking it with neutralizing antibodies. Herein, a COVID-based learning activity is provided to train students in visualization and critical analysis of protein structures using PyMOL software.6 An example based on the CoV-2 spike glycoprotein and its interaction with ACE2 and different antibodies is provided. Simultaneously, they are educated in how scientific knowledge is achieved and how it helps to satisfy many basic human needs and improve living standards. Although targeted at college chemistry, biochemistry, and biophysics students, these activities may be appropriate at the high school level as well, particularly in biology or chemistry courses. 2 Methodology (Classroom Activities) The participants in these activities were 60 fourth-year university-level students from Chemistry and Chemistry & Material Sciences areas. They were separated into two groups that followed the same activities. During the sessions, the 30 subjects shared the same classroom and were instructed by the same teacher. A survey conducted at the beginning of the semester showed that none of them had any prior experience with PDB or PyMOL. The activities were divided into three 2 h class sessions.Session 1. The students were instructed in the basic skills of PDB and PyMOL software required to visualize and manipulate macromolecular structures. As an example for training, the spike protein of SARS-CoV-2 was employed. Session 2. PyMOL was used to manipulate and explain the structure of the ACE2 receptor cell, along with its complexes with the SARS-CoV-2 spike protein. Session 3. Structural analysis of several antibodies in complex with the spike protein were studied. Finally, students were able to answer the question: how is it explained chemically that vaccines save lives? At the end of this session, an anonymous survey was carried out in which the students were requested to assess different aspects of their experience. 2.1 Session 1: Learning What PDB Is, How PyMOL Software Works, and the Structural Features of the SARS-CoV-2 Spike Protein The instructor provided to the students a brief introduction to the most important features of the structure of SARS-CoV-2. The four major structural proteins are displayed: the envelope (E), membrane (M), nucleocapsid (N), and spike (S) proteins .7 Figure 1 Schematic structure of the SARS-CoV-2 virion. It is highlighted that spike protein (approximately 180-200 kDa) is the surface glycoprotein anchored to the viral membrane that plays an essential role when the infection process of SARS-CoV-2 takes place. This protein is a trimer of three identical protomers . Each protomer contains three segments: a short intracellular tail (IC), a transmembrane anchor (TM), and a large ectodomain that extends outward from the virus which is coated with sugar chains to hide the virus from the immune system8 and comprises S1 and S2 subunits. Figure 2 Schematic structure of the S protein protomer. Next, the students are invited to study the ectodomain by analyzing the requested structural features that they must observe manipulating PyMOL. Although hundreds of structures of this spike protein are already available in the Protein Data Bank, the one with the code 7DWY(9) has been selected and must be loaded in a PyMOL session. They are encouraged to distinguish the four different levels of the protein structures: primary, secondary, tertiary, and quaternary, changing the representation of the molecule from lines or wireframe to cartoon. They must learn how to select individual residues or different chains, how to change their colors, how to generate objects, how to show and hide different parts of the protein, how to measure distances and angles for bonds, and how to generate surfaces. They have to realize that the spike protein is a complex of three identical chains. A schematic illustration of the spike protein is given to the students, and they must recognize every single domain in the ectodomain, extracting them as different objects and coloring them in the suggested color. Figure 3 Schematic of SARS-CoV-2 spike protein primary structure. Different domains are shown by different colors. NTD, N-terminal domain; RBD, receptor-binding domain; FP, fusion peptide; HR1 and HR2, heptad region 1 and 2; TM, transmembrane domain; IC, intracellular tail. The S1 subunit has an N-terminal domain (NTD) and a receptor-binding domain (RBD) located in the C-terminal domain, which is implied in recognition and binding to the host cell receptor. S2 consists of the fusion peptide (FP), two heptad repeats 1 (HR1 and HR2) which operate the fusion of viral and host membranes, a transmembrane domain (TM), and a cytoplasmic tail (CT). When different species of coronavirus are compared, the S2 subunit is highly conserved, but the sequence of the S1 subunit varies greatly. S1 and S2 are connected to the S1/S2 cleavage site in which specific proteases act. The cleavage transforms the spike protein into a fusion competent form that suffers several conformational changes and allows it to anchor to the host membrane leading to the membrane fusion.10 2.2 Session 2: Structural Features of the Angiotensin-Converting Enzyme 2 (ACE2) and Conformations of the Spike RBD Domains The instructor explains the important role of the receptor-binding domains (RBD) responsible for recognition and binding to the host cell receptors. These receptors allow binding to angiotensin-converting enzyme 2 (ACE2) that is a transmembrane protein that activates angiotensin, a peptide hormone involved in the control of blood pressure. It was discovered that ACE2 is a functional receptor for the coronavirus responsible for severe acute respiratory syndrome (SARS),11 and it is found on the membrane of the lung, heart, kidney, and intestinal cells, which are the perfect targets for the infection by the virus. Hence, ACE2 behaves as a cellular entrance, and the virus binds to it like a key being inserted into a lock . Figure 4 Schematic RBD-ACE2 interaction. ACE2 is a homodimer with an extracellular domain and a small transmembrane domain:12 the catalytic peptidase domain (PD, residues from 19 to 615), the smaller neck domain (residues from 616 to 726), and the single-helix transmembrane (TM) domain (residues from 741 to 774). Figure 5 Left: monomer ACE2 domains. Right: ACE2-BOAT1 complex. The great flexibility of the TM helix made it impossible to determine the structure of the entire protein. However, since ACE2 also acts as the chaperone for membrane-bound amino acid transporter B0AT1, the structure of full-length ACE2 could be revealed by stabilization by B0AT1. The ACE2-B0AT1 complex (ID 6M1D(13)) was isolated as a dimer of heterodimers, but other additional data support that ACE2 is a homodimer even when is not bonded to B0AT1. Each dimeric ACE2 can bind with two S protein trimers. Students must load this complex in PyMOL and identify both monomers of ACE2 and B0AT1 and the three domains in the ACE2 chains. On the other hand, the RBD domains of the spike protein are quite flexible, and they can adopt two distinct conformations: "up" and "down". One, two, or three domains can be upward, but the "up" conformation is required to bind to receptors. This bending ability gives the virus its great infection capacity. Researchers have postulated that the most virulent SARS variants have more flexible RBD units, unlike the coronaviruses responsible for the ordinary cold, which are less aggressive because their RBD conformational motions are more hindered. In the PyMOL session named PyMOL-Session2.pse the students can now overlay the structures having PDB IDs 7DWY and 7DWZ,9 which present the spike in the closed and 1-up RBD conformation, respectively. The best way to visualize the different conformation of this single RBD domain is by displaying each chain of the spike protein in a different color (picking the C button in the panel and selecting "by chain" under "by chain") and showing both proteins in the surface mode . Figure 6 Spike protein in closed (left) and 1-up RBD (right) conformation. The students must compare both molecules and discuss the structural differences between them until concluding that one RBD domain is down or up according to the structure. Next, they will turn on the objects called RBD-2-up and RBD-3-up, extracted from structures 7DX8(9) and 7DX9,9 respectively, in which the second and the third RBD domains can also be observed in the up conformation . Next, students simultaneously turn on structures 7DWZ and 6M1D . They must be able to explain what they observe, that is, how the RBD domain of the spike protein interacts with the ACE2 receptor. Next, the structure with ID 7DX7(9) is turned on, and the students are asked to describe this new complex, to conclude that is the S protein of SARS-CoV-2 bound with PD of ACE2 in the called conformation 1 (1 up RBD and 1 PD bound). They consecutively turned on structures 7DX8 and 7V8A,14 to characterize by themselves conformation 2 (2 up RBD and 2 PD bound) and conformation 3 (3 up RBD and 3 PD bound), respectively, for the same complex . As the last exercise, the students must load the complex with ID 7DWX,9 analyze the structural features, and describe what they are visualizing as the structure of an S-ACE2-B0AT1 ternary complex, in which one ACE2 dimer binds two trimeric S proteins simultaneously . Ideally, students should know how to work with PyMOL, but to make the job easier the PyMOL-Session2.pse session is provided for session 2. 2.3 Session 3: Answering the Question: Why Do SARS-CoV-2 Vaccines Prevent Serious Illness and Save Hundreds of Thousands of Lives? Activity 3 starts with the instructor explaining that, after the interaction of the spike protein with the entry receptor ACE2, cleavage of the S1 domain is achieved by a protease. Proteolytic cleavage is followed by conformational changes in S2, which allows the fusion of the virus with the cellular membranes leading to the cytoplasmatic release of the viral genome into the host cell.15 Because the viral genome must access the cytoplasm, every step of this process is important. Understanding the foundations of these entry mechanisms allows researchers to design vaccines, antibodies, small molecule inhibitors, and other potential therapeutics targeting to prevent SARS-CoV-2 access into the host cell. A brief outline should be also provided to students about how the body fights illness and how vaccines work. So, they must know that after bacteria or viruses enter the human body they start to multiply, giving rise to infection and causing disease. Immediately, the immune system is activated and produces antibodies to fight off the infection, but this process requires a few days, which is why we have symptoms such as fever, headache, fatigue, or body aches. After the first infection, the immune system will recognize the germ and will already know how to defend the body. Vaccines contain attenuated or inactivated parts of a specific organism which provoke a mimicked infection in the body helping the immune system to create the specific antibodies. Of course, this simulated infection can cause some symptoms which are common while the body creates the new antibodies. Vaccines are the safest and most effective way of protecting people from infections. Of course, they are not perfect and a person can develop disease despite having been vaccinated, although they will be at a much lower risk of becoming seriously ill. Next, students load and overlay the structures with IDs: 7V2A,167TB8,177WPD,187CZP,197CZQ,19 and 7JZL(20) . All are complexes of the spike protein with antibodies or inhibitors bonded to the receptor binding domain (RBD). They must answer the following two questions: (1) why do SARS-CoV-2 vaccines prevent serious illness and save hundreds of thousands of lives? And based on what they have learned: (2) what could be the influence of virus variants on the efficacy of these antibodies, and why? At the end of these activities, most of the students made the connection between the observed structural features and the efficacy of vaccines, concluding by themselves that antibodies or inhibitors act by blocking the ACE2 binding of the spike protein and, as consequence, the viral entry into the host cells. During the sessions, the students explained to the instructors their respective answers to the questions and the instructors evaluated them. In addition, a quick assessment of the student's learning can be done using a short questionnaire as such the one provided in the SI. If desired, it can be carried out with Kahoot or similar tools. 3 Results and Discussion The Bioinorganic Chemistry course is a one-semester program offered to final-year graduation students in Chemistry and Chemistry & Material Sciences at the Chemistry Faculty of Sevilla University. The PyMOL class activities described herein have been carried out during the 2021/2022 second semester by 60 students separated into two laboratory sections. They were students of a Bioinorganic Chemistry course at a fourth-year university level from Chemistry and Chemistry & Material Sciences areas. After doing the proposed activities, the students completed a survey in which they stated their level of agreement to 20 given statements. Figure 7 shows the obtained results in 5 of these statements. A 5-point Likert scale was used (1 = Fully disagree, 5 = Fully Agree). The students answered the survey anonymously using a provided Google form which provides all the responses automatically. Figure 7 Based on this assessment, students judged these exercises help them develop their skills in handling and analysis of molecular structures (95.0%), overwhelmingly found the activity very interesting and motivating (99.4%), and helpful in understanding the impact of vaccination campaigns on reducing the incidence, hospitalizations, and deaths for COVID-19 (96.0%). In addition, students feel that they have learned how scientific knowledge is generated and shared (93.4%). Their enthusiasm can be also noticed in the students' notes. Some students commented in front of the entire class:"I find very motivating that the example used in this practice is related to the current COVID pandemic because it allows me to understand how infection takes place and what vaccines are for." "Now I can understand why COVID-19 vaccines prevent serious illness and death helping to stop the global pandemic." Students highly appreciated the efforts of their teachers who conducted the activity for them and considered the teamwork very helpful (97.0%). When asked how to implement improvements students said that they would like to learn in a similar way about other viruses and diseases. 4 Conclusions A series of engaging exercises are described in which students emulate the process that researchers have used to efficiently develop COVID-19 vaccines or rational drug design. Thanks to these activities, students can understand that the S protein plays a key role in the infection process of SARS-CoV-2 to human cells. They learn that the S protein contains three receptor-binding domains (RBD) which allow binding to the peptidase domain (PD) of the angiotensin-converting enzyme 2 (ACE2), a protein on the surface of many cell types. Hence, ACE2 acts as a cellular doorway--a receptor--and the virus binds to it like a key being inserted into a lock. While they discover about protein structure and protein-ligand interactions using the PyMOL software, through the process, the students also learn about infectious processes, computational drug design, and how scientific knowledge is constructed. Based on our assessment, students enjoy the exercises, understand the importance of the structural analysis of biomolecules, become more interested in science research, and demonstrate increased knowledge of content relevant to the topics. Supporting Information Available The Supporting Information is available at 1 instruction sheet (PDF) Session 2 instruction sheet (PDF) Session 3 instruction sheet (PDF) PDB IDs table (PDF) Figures S1-S5 (PDF, DOCX) Session 1 lab report (PDF, DOCX) Session 2 lab report (PDF, DOCX) Session 3 lab report (PDF, DOCX) Test/assessment (PDF, DOCX) PyMOL-Session2 (ZIP) Supplementary Material ed2c00779_si_001.pdf ed2c00779_si_002.pdf ed2c00779_si_003.pdf ed2c00779_si_004.pdf ed2c00779_si_005.pdf ed2c00779_si_006.docx ed2c00779_si_007.pdf ed2c00779_si_008.docx ed2c00779_si_009.pdf ed2c00779_si_010.docx ed2c00779_si_011.pdf ed2c00779_si_012.docx ed2c00779_si_013.pdf ed2c00779_si_014.docx ed2c00779_si_015.zip The author declares no competing financial interest. Acknowledgments We thank the University of Seville and the EU through the FEDER Operational Programme of Andalusia 2014-2020 programs for financial support: US/JUNTA/FEDER, UE (US-1380849). References Lesk A. M. 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ARTICLE XXXI. VALEDICTORY ADDRESS. By R. E. McVEY, M.D., President of the Morgan County Medical Society. Delivered at the Anniversary Meeting, May 9th, 1867. Gentlemen :--One year ago a few of us met in the court house in this place for the purpose of organizing a medical society, that the physicians of Morgan County might become workers in that great medical organization of our country which extends from the shores of the Atlantic to the Pacific, and from the great lakes to the Gulf of Mexico. What is the object of this vast organization, with its thou- sands of auxiliaries ? It is a philanthropic one, to minister to mankind in affliction, and that we may the better be enabled to do this, to collate and disseminate such information as each may acquire in his practice throughout the profession--to open new leads in the mines of science and extract unrevealcd virtues from the ores already dug. In this organization the man of limited attainments is per- mitted to share the ripe fruit gathered by the scientific research and experience of those of eminent culture, and I am proud to know that in this association we can point to some bright, par- ticular stars, whose lights wane not by the side of any in the medical firmament. Great, good, and learned men, whose in- fluence is not confined by professional boundaries, but per- meates society at large; and I hope it will not be regarded as an invidious allusion if I here mention the name of our own David, who has wrestled so successfully with the Goliahs of deformities. It is by the contact of mind with mind that our intellects are burnished, and the privilege we here enjoy of discussing the various medical questions of the day, may be instrumental in developing new theories, in enlarging the area of thought, and fit us to grapple with error in its many forms; and from the garners of the medical harvest aid us in separating the chaff from the wheat, that we may accept only that which is good, rejecting all that is bad. Here every man comes bring- ing his sheaves--some full of the brambles of dogmatism, others bristling with the thistles of crude and ill-digested the- ories, but still more heavy only with the golden grain of ripe experience. It is from these organizations that the materials are gathered for our medical journals. They are the carriers of our thoughts to the people, and should be found in the hands of every respectable practioner of medicine. The influence of our assosciations would be circumscribed indeed, were it not for those brethren of that profession, who hold in their hands tne lightnings of the press, that mighty engine of civilization without which science to-day would still wear the monk's garb of the dark ages, and be as powerless for good as Prometheus bound. Until the ingenious inventor of types opened the highway of thought throughout the world--mind chafed as a fretted pris- oner within cloister walls, and was manacled with the rusty chains of uncertain traditions--but now mounted upon a chariot as glorious as that of Ezekiel's vision, with the lightning as a servant and out-rider, it is moving grandly to the accomplish- ment of man's high destiny. To our profession and through us to the whole human family, this man of the press has come with healing in his wings, and it is but fitting that on all proper occasions we should acknowledge the obligation. Gentlemen, our profession has not yet reached the zenith of its glory. That is a goal situated on the outer boundaries of that promontory where human reason exhausted, shall lie down to slake its thirst in springs which have their source in another world than ours. But day by day, the great work advances, and by'the patient toil and combined efforts of the profession, we may, at least approximate that perfection which it is not given humanity to attain. To the studious and energetic, inquiry will continue to yield her trophies until the science of life shall be reduced to simple laws. But the labor before us is well calculated to discourage the most hopeful and enthusiastic practioner of medicine. We have not only the natural weaknesses and tendency of the body to decay to combat, for these we might provide with an accuracy and success almost equal to that with which the builder props and strengthens the crumbling edifice--but we have to contend with flames of consuming appetites, under- mining habits of luxury, and the thousand and one forms of vice with which the human frame is ever being assailed, and which have their origin in moral infirmities, which it is not our province to correct. Only at the millenium will the complications of our profes- sion be resolved into plain reasoning from purely natural causes to their effects. But if our work is endless, our record is nevertheless sure, and by every dictate of human sympathy we are impelled to increased exertion in behalf our fellow-man. Let us neglect, then, none of the means within our reach for the advancement of the profession which we have so nearly at heart, and the honor and fame of which we have voluntarily taken upon ourselves to sustain. Our responsibility is very great, and I should regard that physician recreant, indeed to the important trust, who should fail to contribute to the maintenance, usefulness and interests of these county associations. We are all satisfied that the short life of our society has been productive of much good, yet how much more prolific of beneficient results may it be made in the future. Will each member here to-day, commemorating its first annivesary, pledge himself to aid in extending its influence, that our next annual meeting may exhibit signs of prosperity even more marked than at present. In recalling the meetings of the past, I remember with plea- sure the spirit of harmony which ever prevailed, and doubt not the discussions have been quite as profitable to all as to myself; and I here take occasion to express my sense of gratitude to all who have participated in those meetings as essayists and speakers for suggestions which will not soon be forgotten. In vacating the chair I feel that I am making room for a more able occupant, one who will guide your deliberations with a more skillful hand. I have endeavored to discharge my duties faithfully, but I now feel that my experience in parlia- mentary rules but illy fitted me for the position. Your kind- ness in elevating me to the presidency, however, has been greatly exceeded by your manly forbearance with all my mis- takes. Is it necessary for me to thank you now for this courtesy ? I have mentally done so a thousand times while sitting as your presiding officer. I shall never cease to prize the honor which your votes have given me--that of being your first president. To Graduates of Chicago Medical College.--Those grad- uates of Chicago Medical College who have not received a copy of the Constitution and By-Laws of the Alumni Association, recently formed, will please send in their address to the Sec'y, s. a. McWilliams, 166 State Street, Chicago.

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Dr. C. Goodbrake, in behalf of the Nominating Committee, made the following recommendations of committees:-- For Local Secretary--Dr. J. Robbins, of Quincy. For Committee of Arrangements--Drs. Louis Watson, J. N. Ralston, and J. T. Wilson, of Quincy; M. Shepherd, of Pay- son ; and W. M. Landon, of Burton. For Committee on Necrology--Drs. J. H. Hollister, of Chi- cago; F. B. Haller, of Vandalia; and W. S. Edgar, of Jack- sonville. For Committee on Legislation--Drs. S. T. Trowbridge, of Decatur; H. A. Johnson, of Chicago; F. B. Haller, of Van- dalia; W. S. Edgar, of Jacksonville; and H. Noble, of Hey- worth. On Cholera-Infantum--Dr. DeLaskie Miller, of Chicago. On motion, the report was accepted, and its recommendations adopted. Dr. H. A. Johnson offered the following, which was adopted: Resolved, That the Committee on Legislation be instructed to prepare and present to the next regular session of the State Legislature, a bill legalizing human dissections, and that each member of this Society be requested to urge upon our legisla- tors the importance of such legal provisions, as a protection to public and private cemeteries, as well as for the promotion of medical and surgical education. Dr. D. W. Young moved that the thanks of the Society be tendered to Dr. J. Adams Allen, for his interesting public address last evening, and that he be requested to furnish a copy of the same to the Publication Committee, which motion was carried in the affirmative. Dr. P. Bailhache, Chairman of the Committee on Drugs and Medicines, presented an interesting report, which was accepted and referred to the Committee of Publication. Dr. David Prince read an abstract of his report on Plastic Surgery, which was accepted, and the report referred to the Committee of Publication. Dr. H. A. Johnson offered the following, which was adopted: Resolved, That Drs. J. W. Freer and Edmund Andrews be appointed by this Society, delegates to the International Con- gress, to be held in Paris, during the month of August next. Dr. E. L. Holmes, Special Committee on Ophthalmology, presented a brief report, which was accepted and referred to the Committee of Publication. Dr. T. D. Fitch, Chairman of the Committee on Specialties and Medical Advertising, presented a report, which was read by the Secretary and referred to the Committee of Publication. Dr. D. Prince, from the same committee, presented a minor- ity report, which was also referred to the Committee of Pub- lication. Dr. J. S. Hildreth read an interesting paper on Granular Conjunctivitis with Paniform Cornea, which was accepted and referred to the Committee of Publication. Dr. H. A. Johnson presented some interesting illustrations of the pulse lines, as written by the sphygmograph, together with the instrument. The communication was referred to the Publication Committee. Dr. N. S. Davis read a paper on the Physiological Effects of Alcoholic Drinks, which elicited an interesting discussion, and was referred to the Committee of Publication.

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ARTICLE XXX. CASE OF HEMORRHAGE AND ABORTION. By D. B. TRIMBLE, M.D., Chicago. I was called, on the night of March 18th, to attend a lady- on the West Side, and found her suffering from acute spasmodic action of the womb, accompanied by severe uterine hemorrhage. I was informed that she had had a convulsion, but this had passed away before my arrival. On the evening of the 13th, while sitting with her feet elevated on a stool or chair, writing, she had a sudden gush of blood from the uterus, unaccompanied by pain. The hemorrhage continued at intervals, and the pains increased, but, her husband being absent from the city, I was not sent for until the night above mentioned. In reply to the question whether her catamenia had been regular, I was as- sured that they had been. The discharge was very profuse, and her suffering, though abated, was severe. Her pulse, how- ever, was not much depressed. Prescribed the mineral acids, and a solution of morphine, and locally, a strong and cold solu- tion of Alum; the recumbent position, and perfect rest On the 19th, considerably relieved; hemorrhage lessened. 81st. So much better that I thought it unnecessary to see her again, and recommending a continuance of the recumbent posture, and, to some extent, the medicines, for a few days, I left her. On Saturday, the she took a walk, which brought on a return of the hemorrhage, and on Monday, 85th, I was again sent for, and found her suffering very acutely, and flooding severely. From her husband, who was now at home, I obtained a his- tory of the case. In December last, she had passed her regu- lar menstrual period by about ten days, when she became anxious about her condition, and wished the catamenia restored. She had had one child, and, by her own account, after a very difficult and dangerous labor, and therefore wished to avoid a recurrence of the same trouble. Her husband proposed send- ing for me, but she objected, on the ground that I would proba- bly not do for her what she desired (and this supposition was correct). She therefore sent for a neighboring homoeopath, who gave her a preparation of savin, which, in the course of a week, brought on severe hemorrhage and suffering, and she supposed she was relieved of her burthen. Every three weeks, subse- quently, until I saw her, she had a return of the menstrua in great and increasing abundance', and with increased suffering. This fact was a further confirmation of her views, that she was not pregnant, and this circumstance made me, also, incline to the same opinion; but, from the continued firmness of her pulse, the liquid character of the discharge and its abundance, and the severity of her pains, I was inclined to the opinion that, if not caused by pregnancy, there was probably a polypoid or other tumor in the womb. I therefore requested permission to make a tactile examination; but there was no evidence of any tumor; the os uteri was in a normal condition, closed, and not tender. This theory was, therefore, not confirmed, though not certainly disproved. On the 26th, under the above-mentioned and other remedies, she again appeared much relieved, and I did not see her again until the 28th, when she was still apparently improving. On the 29th, though the hemmorrhage still continued to some extent, she was comfortable; but on the night of the 29th, I was again called, when I found her deluged with blood; suffer- ing much; paler, but still with a pulse of much force. The heart's action, however, began to be affected, and, at times, there was considerable intermission in its pulsations. I now resorted to the tampon, saturated with alum water, which ap- peared to control the hemorrhage for that night and the next day. On the 30th, found her comfortable, cheerful, and without hemorrhage. In the course of this week, had given her a com- bination of alum and nutmeg (a favorite remedy of Dr. Chas. D. Meigs), fid. ext. ergot, etc. On the 31st, comparatively comfortable; but some return of hemorrhage. Removed the tampon, and introduced a very soft sponge, saturated with a solution of tannic acid. Hemorrhage continued, however, but the blood was now clotted- Upon re- examination, found the os more tumefied and tender, and the uterus itself enlarged and lower; and placing my hand over the pubic region, found the uterus considerably enlarged and firm. My diagnosis was still uncertain. Was the enlargement of the womb owing to pregnancy, to a tumor, or to coagulated blood accumulating in the womb, and retained by its rigid mouth? In my difficulty, I laid the case before an experienced medical friend, who thought, with me, that it was very improb- able she was pregnant, and suggested that, from the increasing tenderness and enlargement, it might be sub-acute hysteritis. April 1st and 2d. Quiet; hemorrhage and pain sometimes nearly ceasing, then returning, but not so freely. 3d. Took with me a strong sol. of ext. atrop. belladon., with the intention of applying it to the rigid os tincae, so as to pro- duce dilation; and when this was effected, it would probably enable me to determine the cause, whether from coagula, a tumor, or a foetus; and, if proper, I would then administer the ergot until the uterine contractions were sufficient to expel its contents. I called at 11 o'clock A.M., and found her so com- fortable, and enjoying the company uf a lady friend, that I delayed its application until my next visit. At 2 o'clock P.M., however, I was sent for in great haste, with the assertion that she was flooding to death. I found her in great pain, though intermitting; on examination per vagina, that there was but little hemorrhage, and that the os was slightly dilated. Satu- rated the sponge with sol. belladon. and reapplied it. Seeing the great anxiety of the husband, and, in fact, being anxious myself, I requested that Dr. Jones (of Peoria Street), who lived near by, should be sent for. By the time he had arrived, the os had become sufficiently dilated to admit the insertion of a finger, and, after a careful examination, Dr. Jones believed there was a foetus; and, after again examining her, I no longer felt any doubt. The doctor concurred in my proposal to use the belladonna and ergot, and left me. This was about 3| o'clock P.M. I at once administered f5ss. of the ergot, and reapplied the belladonna. Every half-hour, I administered the former, until she had taken f5 4 or 5. The pains became more regular and urgent; but still the os relaxed very slowly. It was a breech presentation, and after frequent and prolonged efforts, the body and limbs were born, but the head remained, and the pains ceased. After waiting ten or fifteen minutes, I made an effort to renew the contractions and bring away the head, but owing to the rigid condition of the os uteri, (which contracted around the neck,) I could introduce but one finger. I made gentle traction by the body, but very carefully, fearing a separation of the head. After a time, what I feared, actually occurred, and introducing my finger, found the head had re- ceded so that I could not reach it. I now introduced a pair of small abortion forceps, and though I could touch the head, could not grasp it. I then grasped the placenta, and, finding that it did not adhere, removed it entire. After again making efforts to get the head between the blades of the forceps, with- out success, I gradually dilated the os uteri until I could get two fingers into it, and passing them up until I reached the head, bent them over it, and brought it away. The patient recuperated more rapidly than I expected, and is now well. When we take into consideration the apparently successful effort to produce abortion in December; and the regular, though frequent and profuse return of the menstrua, up to March 13th; and the absence of the general signs of pregnancy (which had been apparent in her first); I think I am excusable in failing in my diagnosis. I have occasionally known persons to have a slight monthly discharge during pregnancy, sometimes to the period of parturition, but never before, so great a discharge, without destroying and dislodging the foetus.

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Dr. C. Goodbrake, Chairman of the Nominating Committee submitted the following report:-- For President--Dr. S. W. Noble, of Bloomington. For Vice-Presidents--Drs. D. W. Young, of Aurora, and 0. Q. Herrick, of Kansas. For Treasurer--Dr. J. H. Hollister, of Chicago. For Next Place of Meeting--Quincy. On motion of Dr. H. A. Johnson, the report of the Commit- tee was accepted, and the several candidates for office unani- mously elected. The President appointed Drs. Johnson, Miller, and Moore a committee to conduct the newly-elected officers to their places. Drs. Noble and Young, on being conducted to their places, thanked the Society for the honor conferred on them; and the retiring President, Dr. Haller, delivered a short, but appro- priate address. The annual assessment for the year 1867, was fixed at $3. Dr. H. A. Johnson then moved a reconsideration of the vote adopting the constitutional amendment relating to voting by permanent members. The motion was carried, and, after a brief discussion by Drs. Johnson, Watson, Moore, Niles, Young, Worrell, and Davis, the amendment was again adopted, by a unanimous vote of 49 ayes, 0 nays. On motion, the Society adjourned to 2 o'clock P.M. AFTERNOON SESSION. The Society was called to order at 2 o'clock P.M., Dr. S. W. Noble, President, in the chair. Dr. J. Robbins, of Quincy, moved to amend the minutes of the last annual meeting, by inserting the following in the place of the fifth paragraph from the bottom of page 5 of the printed transactions:-- "A paper was presented from the Adams County Medical Society, remonstrating against the admission of the Quincy Medical Society to representation in this Society, which was referred to a special committee, consisting of S. T. Trowbridge, H. Noble, and J. M. Steele. " The special committee, to whom was referred the communi- cation from the Adams County Medical Society, reported the following resolution, which was adopted:-- "Resolved, That the so-called Quincy Medical Society is not entitled to representation in the Illinois State Medical Society." After some discussion, the amendment proposed by Dr. Rob- bins was adopted, and the minutes, as amended, approved. The special order of business being the report of the Stand- ing Committee on Practical Medicine, Dr. J. A. Allen, Chair- man of that Committee, read a paper on the Prevalence of Cholera in Chicago during the year 1866, written by Dr. W. R. Marsh of Chicago. The report was founded almost exclu- sively on the records of the Health-Officer of Chicago, and after some discussion by Drs. N. S. Davis, H. A. Johnson, and D. Prince, it was, on motion of Dr. P. H. Bailhache, referred to the Committee of Publication. An invitation was received from the Mayor and city author- ities of Springfield, to visit Oak Ridge Cemetery at 4 o'clock P.M., which was accepted. Dr. J. Adams Allen presented the following resolution:-- Resolved, That the moderate use of ripe, but not stale or decaying, fruits is not objectionable as tending to produce chol- era, but, rather, conducive to the preservation of health during the hot season. This elicited a discussion, which was participated in by Drs. Edgar, Allen, Johnson, and Prince. While the latter was speaking, the hour fixed for the excursion to Oak Ridge arrived, and the further consideration of the subject was postponed until 9 o'clock Wednesday morning. Notice was given that a public lecture would be given in the Hall, by Dr. J. Adams Allen, of Chicago, at 8 o'clock that evening. The Society then adjourned to 9 o'clock A.M. of Wednesday. WEDNESDAY, JUNE 5TH. The Society was called to order at 9 o'clock A.M., Dr. S. W. Noble, President, in the chair. Dr. N. Wright, in behalf of the Committee of Arrangements, reported the following list of volunteer communications, with a recommendation that they be heard in order after the reports of committees. Tracings of the Pulse, and Shygmograph for making the same, prepared by II. A. Johnson, M.D., Prof. Chicago Med. College. Experimental Inquiries concerning the Physiological Effects of Alcoholic Drinks. By N. S. Davis, M.D., Prof. Chicago Med. College. Treatment of Paniform Cornea, occurring with Granular Eye- Lids. By Joseph S. Hildreth, M.D., Chicago. Pocket Obstetric Forceps, with a description of the same. By Addison Niles, M.D., of Quincy. A Case of Hydrophobia, with Treatment. By T. R. Hig- gins, M.D., of Vandalia. Deformities of the Spine treated by Mechanical Appliances. By F. 0. Earle, M.D., of Chicago. Dr. J. H. Hollister offered the two following resolutions, which were unanimously adopted.-- Resolved, That the Treasurer report to the Publishing Com- mittee, at the close of each annual meeting, the names of all those members who have been present at any one or more of the annual meetings during the five preceding years; or who have paid one or more annual assessments during that time; or have reported physical disability, preventing attendance at said meetings. And that only the names so reported be published in the Transactions for that year. Resolved, That the Treasurer be instructed to communicate each year with all the members whose names appear in the Transactions, who have not paid their annual dues, and solicit payment of the same. Dr. David Prince offered the following, which was adopted unanimously:-- Resolved, That it is with deep regret that the members of this Society contemplate the death of Daniel Brainard, M.D., Professor of Surgery in Rush Medical College; and that we unanimously accord to his memory the high appreciation due to the name of one who, by his talents and industry, has added to the sum of human knowledge, thus placing the world, as well as the profession, under obligations to perpetuate the memory of his contributions. Dr. T. F. Worrell moved that a committee of five be ap- pointed as a judicial committee to investigate the charges against Dr. Addison Niles, of Quincy. The motion was adopted, and the President appointed Drs. David Prince, E. W. Moore, DeLaskie Miller, 0. Q. Herrick, and L. T. Hewins as said committee. And at a subsequent stage of the proceedings, the names of Drs. H. A. Johnson and Edwin Powell were added to the committee. Dr. F. B. Haller, of Vandalia, offered the following reso- lution :-- Resolved, That we, the members of the State Medical Soci- ety, recommend that the several medical schools in this State adopt the plan of teaching recommended by the recent teachers' convention, in Cincinnati, as soon as practicable; and that we will send our pupils to the school or schools adopting such plan. Dr. J. Adams Allen moved that the consideration of the subject be postponed until the reports from standing and special committees had been received and disposed of. Which motion was adopted.

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SEVENTEENTH ANNUAL MEETING OF THE ILLI- NOIS STATE MEDICAL SOCIETY--SPRINGFIELD, JUNE 4th and 5th, 1867. The members of the Illinois State Medical Society assembled in Annual Session, in the Representatives' Hall, June 4th, 1867, at 10 o'clock A.M. Dr. F. B. Haller, of Vandalia, President, called the Society to order, and introduced the Rev. Albert Hale, who opened the exercises with prayer. Dr. N. Wright, Chairman of the Committee of Arrangements, then extended a cordial and appropriate welcome to the mem- bers of the Society; after which, the Assistant-Secretary, Dr. P. H. Bailhache, reported the following list of members and delegates as present:-- Drs. L. T. Hewins and T. N. Booe, of Loda, and D. L. Jewett, of Watseka, Iroquois Co. Dr. C. Goodbrake, Clinton, DeWitt C(r). Drs. H. II. Roman, H. C. Barrell, P. J. Wardner, Justus Townsend, B. F. Stephenson, A. Trapp, Lyman B. Slater, H. B. Buck, Geo. T. Allen, B. M. Griffith, P. H. Bailhache, and H. K. Palmer, of Springfield, and N. Wright, of Chatham, Sangamon Co. Dr. G. W. Albin, Neoga, Cumberland Co. Drs. A. Niles, Joseph Robbins, Louis Watson, and J. T, Wilson, of Quincy, Adams Co. Dr. F. II. VanEaton, Carrollton, Greene Co. " M. F. DeWitt, Whitehall, " " F. B. Haller, Vandalia, Fayette Co. Drs. E. W. Moore, S. T. Trowbridge, J. A. W. Hostetler, and A. McBride, of Decatur, and II. N. Clark, of Niantic, Macon Co. Dr. M. Reese, Abingdon, Knox Co. Drs. D. Prince, G. R. Bibb, and W. S. Edgar, of Jackson- ville, and John W. Craig, of Arcadia, Morgan Co. Dr. J. T. Frazer, Howard's Point, Fayette Co. Drs. D. W. Young and E. H. Gale, of Aurora, Kane Co. Dr. D. S. Jenks, Plano, Kendall Co. Drs. W. A. Knox, A. Fisher, N. S. Davis, H. A. Johnson, E. Powell, J. H. Hollister, J. Adams Allen, Moses Gunn, J. S. Hildreth, E. L. Holmes, R. N. Isham, F. 0. Earle, DeLaskie Miller, C. T. Fenn, E. Ingals, and Frank W. Rielly, Chicago, Cook Co. Dr. T. D. Washburn, Hillsboro, Montgomery Co. Drs. E. P. Cook and J. C. Corbus, Mendota, LaSalle Co. Dr. J. F. Potts, Peoria, Peoria Co. " J. Little, Leroy, McLean Co. " H. Noble, Heyworth, McLean Co. Drs. S. W. Noble, D. 0. Crist, D. L, Crist, and T. F. Wor- rell, Bloomington, McLean Co. Dr. S. B. McGlumphy, Lincoln, Logan Co. " J. S. Whitmire, Metamora, Woodford Co. " 0. Q. Herrick, Kansas, Edgar Co. " H. W. Davis, Paris, Edgar Co. Drs. J. 0. Hamilton, J. L. White, and G. C. Lyon, Jersey- ville, Jersey Co. Dr. Wm. Massie, Grandview, Edgar Co. " W. R. Fox, Wilmington, Will Co. Drs. W. H. Veatch and John Ewing, Pawnee, Sangamon Co. Dr. H. S. Hurd, Galesburg, Knox Co. " B. K. Shurtleff, Amboy, Lee Co.

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O i t u n a I. Illinois State Medical Society.--In the present number of the Examiner, will be found a full record of the proceedings of our State Medical Society, at its recent meeting in Spring- field. There was a larger number of members in attendance than at any previous meeting for eight or ten years. It was characterized by harmony, strict attention to appropriate busi- ness, and a spirit of active investigation. The reports and ^papers presented were more numerous and interesting than usual, but the time allowed for their investigation was too short. For the first time in several years, the Treasury was reported as not in debt, and money enough was received to ensure an early publication of the Transactions for 1867. We hope those members who presented reports or papers, which were referred to the Committee on Publication, and retained them in their own hands, will forward them to the Secretary without delay. By so doing, they will greatly facilitate an early publication. Medical Education.--We are gratified to observe that the proposed revision of our system of medical education, as adopted by the Convention of Medical College Delegates, recently held at Cincinnati, is receiving the cordial sanction of nearly all our exchanges. The editor of the Boston Medical and Surgical Journal, in a recent number, strongly endorses the action of the convention, but expresses regret that the "Elements of the Natural Sciences" should have been stricken out of the Section relating to Preliminary Education. Had he looked a little closer, he would have been spared this regret; for he would have discovered that though the words were stricken out at one stage of the meeting, they were restored again before the close of the session. That Section, as it was finally adopted, unani- mously, by the convention, is as follows:-- "That every student applying for matriculation in a medical college, shall be required to show, either by satisfactory certfi- cate, or by a direct examination by a committee of the Faculty, that he possesses a thorough knowledge of the common English branches of education, including the first series of Mathematics and the elements of the Natural Sciences, and a sufficient knowledge of Greek and Latin to understand the technical terms of the profession; and that the certificates presented or the results of the examination thus required, be regularly filed as a part of the records of each medical college." We hope to see the whole plan of revision, as recommended by the convention, practically adopted by the colleges and the profession in 1868. The Quarterly Journal of Psychological Medicine and Medical Jurisprudence.--It is announced that a new period- ical, with the above title, will be issued on the 1st of July, in the City of New York. It is to be edited by William A. Hammond, M.D. Obituary.--The daily papers have just announced the death of Geo. K. Amerman, M.D., of this city. He died at Marcel- lus, New York, whither he had gone on account of failing health. Dr. Amerman was well known in this city as an active and intelligent member of the profession, and his early death will be universally regretted. He died from consumption, in the 35th year of his age. Annual Announcement.--We have received the Ninth An- nual Announcement of Chicago Medical College for the Lec- ture Term of 1867-8 As the announcement will reach our readers at the same time with this number of the Examiner, we need do no more than call attention to it. We hope every physician and student into whose hands it may fall will give it a careful perusal. It contains not one word of false preten- sion, but represents an institution which, for completeness in its system of instruction, the number of its faculty, and its clinical advantages, has no superior in this country. Correspondents.--We have received, too late for insertion in the present number, the proceedings of the Morgan County Medical Society, the Adams County Medical Society, and some other papers. They will appear in our next issue. Dr. Baker Brown of London.--The celebrated Dr. Baker Brown has recently been expelled from the Obstetrical Society of London, for unprofessional conduct, in connection with his operations of clitoridectomy for the cure of epilepsy. Wanted.--Three copies of the Transactions of the Illinois State Medical Society for the years 1853 and 1855. These copies are wanted to complete the files kept for the use of the Society. Hence, any reader who may have, one or both of the above numbers on hand, and does not wish to keep a full record, *will confer a great favor by sending the same to the under- signed, Permanent Secretary of the Society. N. S. DAVIS, 166 State St., Chicago. Money Receipts from May 27th to June 26th.--Drs. B. Wilson, Cham- bersburg, $3; V. L. Hurlbut, Chicago, Ill., 3; P. S. Macdonald, Chicago, Ill., 3; J. T. Frazer, Howard's Point, Ill., 3; D. 0. Crist, Bloomington, Ill., 3; C. R. Parke, Bloomington, Ill., 3; T. Nicols, Peshtigo, Ill., 3; H. L. Smith, Or- land, Ind., 3 ; W. E. Peters, Nine Eagles, Iowa, 1 50. Mortality Report for the Month of May:-- CAUSES OF DEATH. Abscess,------------------------ 1 Accidents,--------------------- 11 Apoplexy,______________________ 2 . Croup,------------------------- 3 Cancer,_________________________ 3 ^.Consumption,--------------------32 _ Cholera Morbus,----------------- 1 -- Convulsions,_____________________39 Canker Sore Mouth,_____________ 1 Congestive Chills,_____________ 2 Congestion of Brain,____________ 2 -- Congestion of Bowels,___________ 2 -- Congestion of Lungs,____________ 2 Congestion,____________________ 1 ^Childbirth,______________________ 1 -- Colic,-------------------------- 1 /-Diphtheria,_____________________ 7 Drowned,_______________________ 6 Disease of Heart,______________ 5 -- Disease of Lungs,_______________ 3 . Disease of Brain,______________ 1 -- Disease of Liver,_______________ 1 Debility,______________________ 3 Dropsy,________________________ 7 -- Diabetes,_______________________ 2 -- Dysentery,______________________ 2 Decline,________________________ 1 Delirium Tremens,______________ 1 Epilepsy,---------------------- 1 Erysipelas,-------------------- 1 Fever, Typhoid,----------------- 5' Fever, Lungs,------------------ 6 Fever, Scarlet,________________ 5 * Fever, Ship,___________________ 1 Fever, Typhus,----------------- 2- Fever, Gall,------------------- 1 Fever, Nervous,________________ 1 Fever, Puerperal,______________ 1- Fever, Congestive,------------- 1 Inflammation of Lungs,______10 Inflammation of Brain,______ 1 Inflammation of Heart,______ 1 Measles,_______________________ 3- Nephritis,--------------------- 1 Old Age________________________ 5 Phthisis,______________________ 2. Poisoning,_____________________ 1 Pneumonia,_____________________ 1 Small-Pox,_____________________ 3 Stillborn,_____________________ 5 Spasms,________________________ 2 Suicide,_______________________ 1 Teething,______________________ 5 Whooping-Cough.----------------11 Unknown,_______________________21 Total,----------------------------------------------- 241 Total number last year for the month of May,--------- 275 Total number during the month of April,___________________ 278 Total number during the month of May,_____________________ 241 Decrease,__________________________________________________ 37 DIVISIONS OF THE CITY. North...... 56 | South,.... 83 | West.....Ill | Total,..._240 Unknown,-------------------------------------------------- 1 Ages of the Deceased.--Under 5 years, 108; over 5 and under 10 years, 9; over 10 and under 20, 9; over 20 and under 28, 35; over 30 and under 40, 30; over 40 and under 50, 17; over 50 and under 60, 13; over 60 and under 70, 12; over 70 and under 80, 5; over 80 and under 90, 3; over 90 and under 100, 1; unknown, 6. Total, 241. Chicago,-------------105 Austria,-------------- 1 United States,--------40 Canada, ______________ 4 England,______________ 7 France,______________ 1 Germany,_____________25 Ireland,_____________40 Isle of Man,_________ 1 Norway,-------------- 4 Sweden,___________ 6 Scotland,--------- 2 Unknown,---------- 2 Total,----241

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Dr. C. Goodbrake, in behalf of the Committee on Nomina- tions, reported the following as standing and special committees to report at the next annual meeting of the Society:-- Committee on Practical Medicine and Epidemics--Drs. IL A. Johnson, of Chicago; E. P. Cook, of Mendota; and Wm. Massey, of Grandview. Committee on Surgery--Drs. E. Powell, of Chicago; Geo. T. Allen of Springfield; and S. T. Trowbridge, of Decatur. Committee on Obstetrics--Drs. E. W. Moore, of Decatur; G. W. Albin, of Neoga; and W. A. Elder, of Bloomington. Committee on Drugs and Medicines--Drs. Henry Wing, of Collinsville; W. S. Edgar, of Jacksonville; and D. S. Jenks, of Plano. Committee on Ophthalmology--Drs. H. H. Roman, of Spring- field; Joseph S. Hildreth, and E. L. Holmes, of Chicago. Committee on the Causes, Pathology, and Treatment of Chol- era--Dr. N. S. Davis, of Chicago. Committee on the Language of the Pulse--Dr. J. H. Hollis- ter, of Chicago. Committee on Fracture of Lower End of Radius--Dr. David Prince, of Jacksonville. Committee on Conservatism in the use of Remedial Agents-- Dr. E. Ingals, of Chicago. On motion of Dr. II. A. Johnson, Quincy was designated as the place for holding the next annual meeting of the State Medical Society. On motion, the report of the Nominating Committee was adopted. The resolution offered by Dr. J. A. Allen, in relation to the use of fruit during seasons when cholera is prevalent, being the special order, was taken up; Dr. Prince having the floor. Dr. Prince advocated the resolution, and gave some interest- ing facts relating to the efforts to suppress the use of fruits in St. Louis during a former prevalence of cholera in that city. Dr. W. S. Edgar thought some fruits might be used safely, while others were dangerous. Hence, he moved to amend the resolution by inserting the W'ords "some fruits," which was lost. Dr. E. Ingals offered the following as a substitute for the resolution of Dr. Allen, but subsequently modified his motion, so as to make it an additional resolution:-- "Resolved, That the diet that is ordinarily most wholesome is the proper diet to be taken during an epidemic of cholera." After further discussion by Drs. T. F. Worrell, D. W. Young, and H. A. Johnson, Dr. N. S. Davis moved to amend the origi- nal resolution, by inserting after the word "fruits," the words "taken at the ordinary meals." He fully endorsed the posi- tion that good, ripe fruits not only did not predispose to attacks of cholera, but w'ere positively beneficial as articles of food. But, like all other articles of food, they should be taken only at proper intervals; and, as physicians, they should not adopt any resolution that might be so construed as to encourage the eat- ing of even ripe fruit at any and all hours of the day. The amendment was accepted without opposition. Dr. H. A. Johnson thought it injudicious to adopt any reso- lution on the subject, and moved to lay the resolutions on the table. The motion was lost, by 29 yeas, 34 nays. The resolution offered by Dr. Allen, and amended, was then adopted as follows:-- Resolved, That the moderate use of ripe, but not stale or decayed, fruits, taken at the ordinary meals, is not objectiona- ble, as tending to produce cholera, but, rather, conducive to the preservation of health during the hot season. The resolution offered by Dr. E. Ingals, was also adopted. Dr. J. H. Hollister offered the following resolution, which was adopted:-- Resoleed, That a special committee of three be appointed upon the subject of Necrology, having reference to the proper preservation of statistical and other memorial records of its deceased members. Dr. Hollister also proposed such an alteration of the Consti- tution as would make the Committee on Necrology a standing committee. Laid on the table until the next annual meeting. Dr. J. S. Whitmire offered the following, which was adopted: Resolved, That it now be made a permanent rule of this Society, that no member shall be permitted to speak a second time on any one subject, without the special permission of this Society. Dr. E. W. Moore moved that Art. 4 of the Constitution be so amended that the term of office of the President and Vice- Presidents shall commence at the opening of the next annual meeting after their election. Laid over, under the rules. The hearing of reports of standing committees was then resumed, and Dr. L. T. Hewins, one of the Committee on Prac- tical Medicine, read an interesting report, which was accepted and referred to the Committee on Publication. Dr. DeLaskie Miller, Chairman of the Committee on Obstet- rics, presented an abstract of his report, which, on motion, was accepted, and the report referred to the Committee on Publi- cation. Dr. H. W. Davis presented a lengthy report, embodying the results of his surgical practice during his recent service in ^he army; which was accepted without reading and referred to the Committee on Publication. Dr. Geo. T. Allen presented a short paper on the Radical Cure of Inguinal Hernia, with the instruments required for the operation. The paper was referred to the Committee on Publication. Dr. Trowbridge, Chairman of the Committee appointed at the last annual meeting, to urge the enactment of suitable laws by the State Legislature, reported as follows:--

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On motion of Dr. D. W. Young, the Society proceeded to elect the following members as delegates to the next annual meeting of the American Medical Association:-- Drs. T. F. Worrell, of Bloomington. J. H. Hollister, of Chicago. C. Goodbrake, of Clinton. Jos. Robbins, of Quincy. W. S. Edgar, of Jacksonville. H. B. Buck, of Springfield. F. B. Haller, of Vandalia. Moses Gunn, of Chicago. J. C. Corbus, of LaSalle. J. T. Wilson, of Quincy. H. Noble, of Heyworth. N. Wright, of Chatham. L. T. Hewins, of Loda. H. W. Davis, of Paris. B. K. Shurtleff, of Amboy. J. M. Steele of Grandview. E. H. Gale, of Aurora. Dr. P. H. Bailhache reported that the Treasurer's report has been examined by the Auditing Committee, and found correct. Dr. J. S. Hildreth offered the following, which was referred to the Committee on Legislation:-- Resolved, That a committee of three be appointed, to report at the next annual meeting of this Society, upon the necessity of an act of the Legislature defining the duties, responsibilities, and liabilities of Druggists and Pharmaceutists. On motion, the Society adjourned, until 7 o'clock P.M. EVENING SESSION--SECOND DAY. The Society was called to order by the President at 7 o'clock P.M. Dr. F. 0. Earle, of Chicago, read a paper on the Mechanical Treatment of Angular Curvature of the Spine, and exhibited apparatus. The paper was accepted and referred to the Com- mittee on Publication. Dr. Addison Niles presented a specimen of Pocket Midwifery Forceps, with a description of the same, which was referred to the Committee of Publication. Dr. Higgins, of Vandalia, presented the history of a Case of Hydrophobia, which was read by Dr. F. B. Haller, and elicited some discussion. The thanks of the Society were tendered to Dr. Higgins, with the request that the case be published in some medical journal. Dr. H. A. Johnson offered the following resolution, which was adopted:-- Resolved, That this Society urge upon the municipal author- ities of all our cities and larger towns the importance of a careful record of births, and a uniform registration of deaths and their causes, using for this purpose such necrological tables as have been generally adopted in this country and Europe. Dr. D. Prince offered the following, which was adopted:-- Resolved, That the Committee on Legislation be instructed to consider the propriety of urging upon the Legislature the passage of a law requiring railroad companies, and other incor- porated companies using machinery, to be responsible for the expense of board, nursing, medical supplies, and medical attend- ance necessary for their employees during the process of recov- ery, not exceeding six months, in cases of injuries received in the performance of their duties. The resolution relating to medical education, previously offered by Dr. F. B. Haller, and deferred until the reports of committees, etc., had been disposed of, was now taken up, and after some remarks by Dr. Haller, it was, on motion of Dr. J. S. Whitmire, referred to a committee of three, to report on the same at the next annual meeting of the Society. Drs. F. B. Haller, S. T. Trowbridge, and II. Noble were appointed said committee. The President also appointed the following committee to ex- amine and report on the status of the Quincy Medical Society: Drs. C. Goodbrake, E. L. Holmes, and D. 0. Crist. The following resolutions were unanimously adopted:-- Resolved, That the thanks of this Society be and are hereby tendered to the retiring officers, for their faithful performance of their respective duties. Resolved, That the thanks of this Society are hereby ten- dered to the profession, citizens, and authorities of Springfield, and also to the Committee of Arrangements, for the provision made for the accommodation and entertainment of the Society at this meeting. Resolved, That the thanks of the Society be tendered to Hon. Sharon Tyndale, the Hon. Secretary of State, for his courtesy in granting the use of the Hall of Representatives for the sessions of the State Medical Society. Resolved, That the thanks of the Society be tendered to the Superintendents of the Illinois Central R.R., the Chicago, Alton and St. Louis R.R., and the Toledo, Wabash, and Great West- ern R.R., for their favors of commutation tickets to members of the Society attending this meeting. On motion, the Society adjourned sine die. N. S. DAVIS, Permanent Secy. P. H. BAILHACHE, Asst-Secy.

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THE CHICAGO MEDICAL EXAMINER. N. S. DAVIS, M.D., Editor. VOL. VIII. JULY, 1867. NO. 7. Thriaittpt ARTICLE XXVIII. CONCENTRATED ORGANIC REMEDIES. By F. B. PAYNE, M.D., Marshall, Ill. Read before the Clark County Medical Association, April 3d, 1867. There is no branch of human knowledge so much indebted to chemistry for practical developments as that of medicine. The chemist, with his laboratory, is able to present to the profes- sion the active principles of plants, either combined or separate. It is, certainly, very desirable for the practitioner to possess the active principles of the vegetable kingdom in a concen- trated form. It is equally important that we secure these rem- edies in a durable form, and of uniform strength, containing all the medicinal principles of the plant. By this means, the stomach receives nothing but that which is necessary for the removal of disease. It has been demonstrated, by chemical analysis, that vegetables contain resinoids, neutrals, oils, and alkaloids, and in these elements reside the therapeutic proper- ties. It is the object of this paper to briefly speak of a few of the comparatively new remedies which have been prepared in powdered form, and represented as containing all the medicinal principles of the roots or plants from which they are obtained. The first to which we will refer, is the GELSEMIN. This a remedy derived from the bark of the root of the com- mon woodbine, or yellow jessamine, and contains three princi- ples, resinoid, neutral, and alkaloid. Its properties are febri- fuge, nervine, anti-spasmodic, relaxant, and some claim that it is alterative and ecbolic. If the remedy possesses all of these properties, it may, with every promise of success, be employed in the treatment of all febrile diseases, pneumonia, pleuritis, acute rheumatism, gonorrhoea, chorea, epilepsy, convulsions, in short, all inflammatory and nervous diseases. I cannot, by my limited experience in its use, testify to its value in this wide range of human maladies, but feel sure that it is one of the best arterial, sedatives known to the profession. It is a positive and active therapeutic agent, and by isolating the three princi- ples of the plant they are recombined and form a beautiful and durable powder, with a definite and uniform standard of strength. The average dose of gelsemin is one-half grain, but in some cases, owing to constitutional peculiarities, it may require two grains. If it is not given in sufficiently large doses to produce its constitutional effects, it will not fully accomplish the object for which it was administered. It must be given in doses that will cause slight dimness of vision and double-sight- edness, but in no case should the remedy be carried to com- plete prostration of the muscular system. Physicians who have used this remedy extensively state, that even when carried to complete exhaustion, no permanently injurious effects are pro- duced. The beneficial effects of this remedy are often mani- fested before constitutional symptoms are produced. When the dose is large enough to reduce the pulse to its normal standard it is not prudent to increase; but the remedy ought to be con- tinued for some time, in small doses, after the action of the heart is controlled. I have used this remedial agent in pneu- monia, typhoid fever, convulsions in children, produced by excessive febrile excitement, and, in fact, in all cases of fever where the pulse exceeds 100 per minute, and can testify to its value in these diseases. It is, undoubtedly, a valuable remedy, and it is in a convenient form, which is a very important con- sideration to the country physician, who is not only called upon to prescribe, but to dispense the medicines recommended. It is not a specific, but a positive and powerful agent, consequently not to be trifled with or incautiously used. When given at the proper time and in small doses, it is as harmless as any other potent drug in the materia medica. << CAULAPHYLLIN. This is the blue cohosh, or squaw root. It has two princi- ples, according to the analysis of B. Keith, consisting of a resinoid and neutral. It is claimed by some who use this rem- edy, that it is a valuable antispasmodic, alterative, tonic, ec- bolic, diaphoretic, diuretic, and vermifuge. The average dose is three grains. It is said that this dose may be repeated every hour or two with perfect safety, and even increased to five or ten grains. This remedy is highly extolled by Gr. Coe, M.D., and others, but we cannot testify to its value. We have used this preparation, prepared by Dr. F. D. Hill, Cincinnati, and feel confident that it is not entitled to the reputation claimed by this school of exclusive remedies. It is only a temporary remedial agent. If this preparation is a fair representative of the medicine, it is not entitled to the favorable consideration of the profession. We are willing to use all therapeutic agents which, by experience and proper test, proves to be valuable. We have used the remedy in combination with others, but do not regard it as even a good auxiliary remedial agent. LUPULIN. This is derived from the common hop. The part used is the strobiles, or cones, and is said to contain three principles, resin, resinoid, and neutral. Its properties are nervine, febrifuge, hypnotic, diuretic, and tonic. When it is employed, you may, with confidence, expect beneficial results. When given to small children, we have noticed that it frequently promotes diapho- resis and diuresis, and often succeeds in the production of re- freshing sleep. It is also a valuable tonic, mild in its opera- tion, and valuable in many forms of indigestion, and especially where there is a tendency to gastritis. It allays and soothes the irritability of the mucous tissues, and thus aids in the pro- cess of digestion. I have used this remedy, and feel confident that it is a valuable auxiliary remedial agent. The lupulin usu- ally found in commerce, is nothing more than the pollen of the flowers. The best preparation contains all the medicinal vir- tues of the hop, which reside not only in the pollen, but also in the parenchyma. The dose of true lupulin is from two to five grains. We have used it in febrile diseases in children, and if we have a genuiue preparation, it will in many cases produce hypnotic and febri- fuge effects. It is especially valuable in diseases of children, where "we desire an anodyne and cerebral excitement precludes the use of opium and its preparations. It also possesses other advantages as a substitute for opium, by not disturbing the stomach, or producing constipation. We have noticed that when this remedy fails to produce hypnotic or anodyne effects, it proves a valuable diuretic; I have frequently had patients say that it did not make them sleep, but caused a free flow of urine. The celebrity and value of common hop-beer, as a tonic, nervine, and diuretic, depends upon the lupulin it contains. The good or bad quality of the beer depends upon the quality and quantity of lupulin used in its preparation. We have used lupulin with good results in nervous headache, hysteria, chronic cough, and suppression of urine. It is highly recommended as a valuable remedy in spermatorrhoea, but we have not tested its virtues in this disease. It is certainly a good remedy for irritability of the mucous tissues. It is very important to get a genuine article, and not simply the pollen of the flowers. SANTONIN. This is a remedy obtained from the artemisia santonica, or mugmort. It is a peculiar, white, crystalline substance, soluble in ether or alcohol, and almost tasteless. It is a native of Europe, but is now being, cultivated in the United States. We also have the brown, or impure santonin, which is derived from the Aleppo wormseed. This is cheaper than the former. The properties of this valuable concentrated remedy are said to be tonic and narcotic, but its chief value consists in its anthelmin- tic virtues. I have used it extensively for the last six years, and feel warranted in stating that it is the best remedy known for the destruction of the acaris lumbricoides. It is an active and powerful remedial agent, but when properly administered it is not only perfectly safe but reliable. It may be administered alone, or in combinations with other agents. When children are troubled -with worms, the symp- toms of any disease with which they are attacked are aggra- vated by the presence of these intestinal parasites, and we can use the santonin in combination with the appropriate remedies for the disease. Our favorite mode of prescribing this medicine is as follows, for a child say three years old:-- 1^. Santonin,---------------------------- grs. iij. Hyd. cum creta,------------------------ " vi. Dover Powd,---------------------------- " ii. Mix, and make three powders. Give one every three hours, and four hours after last work off with oil castor and a few drops turpentine. This prescription will never fail to expel lumbricoides if they are in the intestines. We have frequently administered one or two doses of santonin alone, and often it has been followed by the expulsion of from six to twenty worms, and this result was accomplished without the subsequent use of a cathartic. For several years, we have almost invariably added santonin to the first cathartic powders given to children, in the treatment of any disease with which they have been attacked, and, often- times, where the existence of worms is not anticipated, large numbers will be expelled. We can, with perfect confidence, recommend santonin as one of the most convenient and reliable anthelmintics belonging to that list of remedies. When properly administered, no injurious effects can possi- bly result from its use. If given in large doses, it will produce some cerebral excitement, but, according to our observations, its specific action is fully obtained without the production of its constitutional effects. We earnestly recommend this remedy to all practitioners who have not yet used it. ASCLEPIN. This is the active principles of the asclepias tuberosa, or pleu- risy root. The part used is the root, and it contains two prin- ciples, resinoid and neutral. Its properties are said to be alterative, antispasmodic, carminative, diaphoretic, diuretic, expectorant, laxative, and tonic. If it possessed all these properties, it might, with every hope of success, be employed in all fevers, pneumonia, pleuritis, rheumatism, colic, colds, and inflammatory diseases, of whatever type. We have used this remedy in many cases, and feel sure that it is of but little, if any, value. We have never been able to notice any good effects result from the use of the preparation prepared by Dr. Hill. During the last six years, we have given it a fair and impartial trial, but have invariably been disappointed. If the article we used is a fair representative of the remedy, it is not even entitled to a place in the materia medica. PHYTOLACCIN. This is obtained from the root of the phytolacca decandria, or common poke root. It has two principles, resinoid and neu- tral, and its properties are alterative, deobstruent, and diuretic; in large doses, emetic and cathartic. It may, with every pros- pect of success, be employed in the treatment of rheumatism, glandular, and cutaneous diseases. We have found it a potent and reliable agent in the treat- ment of diseases where there is tardiness of action on the part of the secreting, absorbing, exhaling and eliminating vessels. It is a powerful remedy, and ought to be administered with great care. From one to two grains, three times a day, it proves a good, safe, and efficient resolvent, and manifests its influence in all the glands of the body. In the chronic form of rheumatism, it is a remedy of decided utility. We have used the following combination in cases of chronic rheumatism, with good effects:-- 1^. Phytolaccin,--------------------------- Podophillin,----------------------aa 3j. Grelsemin,--------------------------- grs. x. Mix, and make twenty powders, and give one every six hours. If this nauseates the stomach or acts too vigorously on the bowels, we diminish the dose of the two first and add grain morphine to each powder. We have never thoroughly tested the virtues of this remedy in any other disease, but feel confident that it might with pro- priety be used in enlargement of the spleen and hepatic torpor. It is highly recommended by some, as a valuable remedy in tuberculosis, gonorrhoea, leucorrhoea, and carcinomatous affec- tions, but in the latter it is used externally. In using these concentrated remedies, it is vastly important for the physician to procure genuine articles. Some chemists prepare them in such form that the doses above indicated are too large; at the same time, other preparations are not of suffi- cient strength. It is, therefore, left to the judgement of the practitioner to decide the propriety of quantity and repitition of the article used. It seems to be a fact, fully established, that compound vegetable substances which contain only a small number of elements and atoms are more durable than those more complicated. In proportion to the multitude of the atoms and principles that enter into the composition of organic com- pounds, we have an increased disposition to undergo transfor- mation and decomposition. This fact, is important to those who desire to procure the active medicinal principles of plants. It is hoped that we will soon be presented with the active princi- ples of the following crude remedy:-- POLYTRICHUM JUNIPERUM. This is the common hair-cap moss. It is an evergreen and indigenous plant, and there can be no doubt, with those who test its virtues, that it is a valuable diuretic. It grows on high, dry places, along the margin of woods and exposed places, and seems to prefer a poor, sandy soil. We have used it with decided benefit in many dropsical cases. The dose is about two fluid ounces of the effusion every half- hour. It is very highly recommended by some medical men, and we feel confident that it is a better, or at least more active diuretic than uva ursi or buchu leaves. Some physicians assert that they have, with this remedy, removed from dropsical pa- tients, in twenty-four hours, forty pounds of water. From what we know, by experience in the use of this agent, we can with confidence recommend it to the profession as a pleasant, safe, and reliable diuretic. It is hoped that, by the aid of chemical laboratories, we will soon be presented with the active principles of this plant in a concentrated form. Every country practitioner can readily realize the disadvan- tages of crude medicines. In this land of mud, it is very incon- venient to carry huge pill-bags, pregnant with crude roots and herbs; but this is a small matter, when compared to the incon- venience of patients swallowing pints and quarts of decoctions and infusions, in order to get the proper dose of a remedy.

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$t U r 110 <<$. CASE OF TREPHINING THE SPINE; DEATH FROM pyaemia; CLINICAL REMARKS. The following is one of very great surgical interest. The question of the advisability of trephining the spine after in- juries--an operation recently advocated by Dr. Brown Sequard --was largely discussed at a recent meeting of the Medical and Chirurgical Society, after the reading of a paper by Mr. Berk- ley Hill. (See American Journal of Medical Sciences, April, 1867, p. 538.) For the following report, we are indebted to Mr. Tracey: J. J., aged 28, -while somewhat tipsy, fell off a cart on his right buttock, and was unable to stand or move his lower ex- tremities from that moment. The case was first seen by Mr. Mauder on August 31, three days after the occurrence of the accident, vdien the patient exhibited more or less loss of sensa- tion below the level of the nipples, and loss of muscular power in the trunk and lower extremities, with constipation and retention of urine. The right buttock was bruised and exco- riated, as also was the integument over the angles of the right mid-dorsal region. On examining the spine, the spinous pro- cess of the seventh cervical vertebra appeared to be most unusually prominent, and the attempt to move this (though no mobility was appreciable,) gave pain in the region, and also along the back of the patient's right arm. The patient stated that this prominence had existed a long time, and had been caused by carrying bags of sand upon his neck. Respiration was performed chiefly by the diaphragm. The patient was placed upon a water-bed, and beyond attention to his bladder and to the bruise on the buttock, which was gradually converted into a sore, little in the shape of treatment was requisite; but the symptoms gradually changed--incontinence of feces and urine supervened, and the loss of sensation as high as the nipples became complete. He grew weak. On September 18 he was the subject of a severe cough, accompanied by difficult and copious expiration. He breathed more easily when lying over somewhat on his left side. The urine was highly ammoniacal, and loaded with muco-pus. Dr. Davies was consulted as to the condition of the chest, and ad- vised mist oleosa and brandy. Pulse intermittent. 19th.--After consultation with Dr. Ramskill and Mr. Little, Mr. Maunder determined to cut down upon the seat of and explore the injury. Insensibility and loss of volition existed as high as the nipple; the skin over the upper part of the right scapula and along the back of the right arm as far as the elbow, was tender on pressure, and an attempt to move the spine of the seventh cervical vertebra caused pain also. Irritating the feet caused reflex action. Incontinence of feces and of urine as before. The grasp of the right hand was weaker than that of the left, which was strong. At the operation Mr. Maunder said he was induced to inter- fere surgically for certain reasons--the physical condition of the spine led him to think that the seventh cervical vertebra, in part or entirely, had been displaced backwards and a little upwards, thus compressing the cord between its body and the laminae of the first doral. He thought that the cord had not been crushed beyond repair at the time of accident, because there was not from the first a total loss of sensation, but this had gradually become complete by reason of the continued pressure causing loss of temporary function. The operation which he proposed to perform did not, he thought, in itself, entail great risk to life, and was justified by the urgency of the symptoms. Operation.--The patient being on his face, and under the influence of chloroform, (which he bore well,) an incision about three inches in length in the mesian line exposed the spines of the first snd second dorsal vertebrae, and the knife kept close to these readily allowed the muscles to be separated, so as to expose the laminae also. The muscles were ecchymosed to some extedt. Free bleeding occurred, but no ligature was requisite. The spines of these vertebrae were now cut off at their bases, and the corresponding laminae were removed by the trephine and bone forceps. The bleeding having ceased, the sheath of the cord was seen at the bottom of the wound, but nothing abormal could be either seen or felt in it. On comparing the interval between the sheath of the cord opposite the laminae of the third dorsal vertebra, and between it and the laminae of the last cervical, the space was decidedly greater in the former than in the latter region; but this difference was not sufficient to induce the operator to remove the laminae of the seventh cervical. The wound was dressed with water-dressing, and the patient returned to bed. Half a grain of extract of belladona was ordered thrice daily. For some few hours after the operation the patient vomited, and when he had recovered from this, said his legs felt warmer than before the operation. Pain in the arm persisted for two or three days. Cough diminished greatly. On the fourth day subsequent to the operation, he was ordered one-twelfth of a grain of strychnine, thrice daily, and in a day or two reflex action was more readily excited in the lower extremities. On the 29th the cough again became very distressing, and he ex- pired suddenly on October 2. At a post mortem conducted by Dr. Sutton, the medulla spinalis w'as found more or less pulped opposite the lower border of the seventh cervical vertebra, and this, too, was displaced slightly forward, and its right transverse process was broken. There was not the least trace of inflammatory action in or about the cord and its membranes, but there was ample evidence of pyaemia in the great viscera. The bladder was quite healthy, a condition which Mr. Maunder believed to be due to the atten- tion bestowed upon that viscus by Mr. Salt, one of the dressers. Mr. Maunder suggested that the first attack of cough (before the operation) was also due to the blood-poisoning originating in the bed-sore.--Med. Times and Graz., Feb. 23, 1867 ; Med. News and Library, Philadelphia.

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Notes on the Origin, Nature, Prevention, and Treatment of Asiatic Cholera. By John C. Peters, M.D. Second Edi- tion, with an Appendix. New York: D. Van Nostrand, 192 Broadway. 1867. This is a neatly printed duodecimo volume of 200 pages. It is written in good style; and the title-page gives a good idea of the scope of its contents.

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ELECTION OF MEMBERS. The following were also elected permanent members, by unanimous vote:-- Drs. John M. West, Williamsville. Thos. Hickman, Vandalia, Fayette Co. B. H. Cheeny, Joliet, Will Co. Chas. Kerr, Pawnee, Sangamon Co. J. Sweeney, Normal, McLean Co. A. L. Kimber, Waverly, Morgan Co. J. P. Mathews, Carlinville, Macoupin Co.. C. L. Hart, Irving, Montgomery Co. John Walker, Berlin, Sangamon Co. Henry W. Boyd, Alton, Madison Co. J. L. Millier, Springfield, Sangamon Co. J. C. Ross, Lincoln, Logan Co. John W. Lawrence, Carbondale, Jackson Co. G. H. Peebles. Williamsville.

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To the Honorable President and Members of the Illinois State Medical Society:-- The committee, to whom was entrusted the draft for the afore-mentioned law, would beg leave to report:-- That prior to the session of the General Assembly, ending the current year, there was a correspondence opened with sev- eral legislators whose opinions were favorable to the scheme, and the draft submitted to this body one year ago, at Decatur, by the Macon County Medical Society, was sent to them. There was, therefore, a very favorable element in quite a num- ber of intelligent men of both brancues of the Legislature anx- ious for the passage of such an act. About ten days after the assembling of the Legislature, a quorum of this committee met in Springfield and consulted as to a plan of procedure, and determined that the bill should make its appearance in the Senate first. It was, therefore, presented to that body by its able and zealous friend, the Hon. W. H. Cheney, of McLean Co. We had a preference that it should be referred--because of its pertinence--to the Commit- tee on Education, which preference met the approval of the honorable senator presenting it. We consulted the members of the Committee on Education, in part, concerning the pros- pects of the passage of the bill, and found no opposition to it after they saw fully what it assumed to correct. Starting it thus in the Senate, and feeling favorably im- pressed with the encouraging assurances which we received from various influential senators, we next consulted with many members of the House of Representatives concerning its pas- sage through that body, should it succeed in passing through the Senate, and for a time felt sanguine of success, from the promises we received. But the golden pitcher was broken at the fountain. The Committee on Education tabled the bill in their room, and thus the thing was still-born, or rather still unborn, and so remained. Our honorable senator attempted to take it from the table that it might be recommitted, but it failed even in that. . There wras so determined a spirit in the House that some- thing of the kind should pass, that a bill was prosented to that body, bearing features widely differing from those which this committee was ordered to present, and considered by its friends as more conservative, which, although not killed in the commit- tee rooms, was in the House. It is, however, flattering, to reflect that the necessity of such a law was entertained by the Senate and House, by a larger number of men than any similar bill had ever been before. We therefore hope and expect that the intelligence of our law- makers will so grow that to pass a statute possessing the plain- faced merit of the one which we presented will, some day soon, be the accomplishment of our continued and persistent effort. We therefore recommend that the enterprise be continued, by the appointment of a more weighty and politically influential lobbying committee. S. T. TROWBRIDGE, M.D. GEO. T. ALLEN, M.D. P. II. BAILHACHE, M.D. Dr. W. S. Edgar offered the following, which was adopted:-- Resolved, That a committee of five be appointed, to report a memorial and law, to be presented to the Legislature at its next regular session, for the better regulation of the practice of medicine in the State; said committee to report the result of their labors at the next meeting of the Society.

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A recess of 10 minutes was taken, to enable the delegates from each county represented to seleot one of their own num- ber, to constitute a committee, for nominating officers and stand- ing committees for the ensuing year. On being called to order, the following members had been selected to constitute the Nom- inating Committee:-- Drs. W. S. Edgar, of Morgan Co. Louis Watson, of Adams Co. D. W. Young, of Kane Co. D. S. Jenks, of Kendall Co. J. C. Corbus, of LaSalle Co. C. Goodbrake, of DeWitt Co. J. F. Potts, of Peoria Co. J. T. Frazer, of Fayette Co. R. N. Isham, of Cook Co. J. S. Whitmire, of Woodford Co. M. Reese, of Knox Co. H. B. Buck, of Sangamon Co. S. T. Trowbridge, of Macon Co. T. F. Worrell, of McLean Co. G. W. Albin, of Cumberland Co. 0. Q. Herrick, of Edgar Co. D. L. Jewett, of Iroquois Co. S. B. McGlumphy, of Logan Co. T. D. Washburn, of Montgomery Co. J. L. White, of Jersey Co. H. W. Boyd, of Madison Co. F. H. VanEaton, of Greene Co. B. K. Shurtleff, of Lee Co. The Secretary read a letter from Dr. Taggert, of Cairo, explaining his inability to attend the present meeting. Also, a letter from Dr. R. G. Bogue, of Chicago, member of the Special Committee on Deformities of the Spine and Joints, explaining the non-appearance of a report by the Committee, and asking further time, with the addition of Dr. F. 0. Earle, of Chicago, to the Committee. On motion, the request of Dr. Bogue was granted, and the Committee continued another year. Dr. H. A. Johnson moved that the amendment to the Con- stitution, proposed last year, granting to permanent members the right to vote, the same as delegates, bo taken from the table and adopted. The motion was sustained by a vote of 24 yeas and 1 nay; the members of the Nominating Committee being absent from the room. Dr. DeLaskie Miller moved the adoption of a pending amend- ment to the Constitution, fixing the regular annual meetings of this Society on the Third Tuesday in May, in each year. The amendment was adopted by a vote of 32 yeas, 0 nays. Dr. J. Adams Allen, Chairman of the Standing Committee on Practical Medicine and Epidemic Diseases, stated that the report consisted chiefly of two papers; one on Cholera, as it prevailed in Chicago in the summer of 1866, written by Dr. Marsh, of Chicago; another on Diseases in the Interior of the. State, by Dr. L. T. Hewins, of Loda. The first of these papers was made the special order for con- sideration at 2 o'clock P.M.

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Dr. N. S. Davis, Permanent Secretary, in behalf of the Committee of Publication, presented the following report:-- When the undersigned commenced his term of office as Sec- retary, more than ten years since, the treasury of this Society was considerably in debt for the publication of the Transactions of the preceding year. And the receipts into the treasury have not been sufficient to liquidate the indebtedness and pay the full current expenses of publication. Hence, three alter- natives have recurred to your committee at each returning year, namely:--first, to omit the publication of the Transac- tions annually, for want of funds; second, to publish on the individual credit of the committee, with an annually increasing balance against the treasury, which by this time would have amounted to not less than $1000; or, third, to reduce the cost of publication to the amount actually in the treasury, or nearly so. The only possible mode of accomplishing the latter alter- native was, to first print the record of proceedings, reports, and papers constituting the Transactions, in the medical peri- odical under the control of the Secretary, and furnish extra sheets enough to make up the required number of volumes of Transactions for the use of the Society, at the cost of simple presswork, paper, and binding. In this way, from $100 to $150 could be saved to the treasury annually. Regarding the publication of the reports and papers read before the Society, in the medical periodicals as, in itself, a benefit, by giving them a wider circulatien in the profession, your committee did not hesitate to adopt the third alternative named. This course met the uniform approval of the Society until the meeting in Decatur, June, 1867. At that meeting, #which is the only one that your Secretary has failed to attend during his term of office, this subject was referred to a commit- tee, whose report stated that it was not desirable to have the Transactions published in the medical journals, and recom- mended that 100 copies be published, independently, for the members of the Society. This report was laid on the table, without any action by the Society. Hence, the Committee of Publication were left without either an approval of their past work, or any instructions for the future. As soon after the last meeting as the material for the Trans- actions had been placed in the hands of the committee, it was found that the independent publication of 100 copies of the Transactions would cost at least $260, while there was, at that time, a balance of only $100 in the treasury. In this dilemma, your committee resorted to the same practice as in preceding years, by which they reduced the cost of publication $111, dis- tributed copies of the Transactions to all members who had paid the annual assessment early in November, and left the treasury free from embarassment. It is to be hoped that the increased number of members in attendance on the present annual meet- ing will so increase the receipts of the Treasurer, that the Transactions of this meeting can be immediately sent to press, as an independent publication. But if, as has heretofore been the case, the amount should be found insufficient, your publica- tion committee should not be left in the embarassing position of having neither the positive approval nor the instructions of the Society. Immediately after the last annual meeting, the full record of proceedings was furnished for publication in both the medical journals published in our State. Subsequently, written notices were sent by the Secretary to the chairman of each committee charged with the duty of making a report at the next annual meeting. Certificates of appointment were also sent to each delegate appointed to attend the meeting of the American Medical Association for 1867. As the duties devolving on the Publication Committee de- pend, for their execution, mainly upon the Permanent Secre- tary, the undersigned would respectfully request the Society to appoint his successor whenever they deem it advisable to do so. Respectfully submitted, in behalf of the Com. of Publication. N. S. DAVIS, Permanent Secretary. The report was accepted, and a vote of thanks unanimously tendered to Dr. Davis, for his services in superintending the publication of the Transactions of the Society. Dr. J. II. Hollister presented the annual report of the Treas- urer, showing a.balance of $2 or $3 in the treasury. The report was accepted and referred to the Auditing Com- mittee. On motion, the Society adjourned to 2 o'clock P.M. AFTERNOON SESSION--SECOND DAY. The meeting was called to order at 2 o'clock P.M., Dr. S. W. Noble in the chair. Dr. D. Prince, Chairman of the Judicial Committee, made the following report, which was accepted and the committee discharged:-- Whereas, The claim of Dr. Addison Niles to membership in the Illinois State Medical Society rests upon the fact of his having been received as a delegate from a society which the Illinois State Medical Society has declared not entitled to representation; therefore, Resolved, That the charges are not regularly before the Society. The committee would further recommend, that inasmuch as the Quincy Medical Society was not heard in its defence last year, that the question of its right to representation be referred to a new committee, with instructions to report at the next meeting of this Society. DAVID PRINCE, \ DeLASKIE MILLER, ) II. A. JOHNSON, ( Committee. E. POWELL, \ E. W. MOORE, / Dr. J. Robbins, of Quincy, offered the following as an amendment to the report:-- Whereas, The claim of Dr. Addison Niles to membership in this Society rests alone on the fact that he was delegated thereto by a body (the so-called Quincy Medical Society) which this Society has declared not to be entitled to representation; therefore, Resolved, That the name of Dr. Addison Niles be stricken from the roll of members. On motion of Dr. II. Noble, the amendment, was laid on the table. The report of the Committee was adopted.

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Elements of Human Anatomy; General, Descriptive, and Prac- tical. By T. G. Richardson, M.D., Prof, of Anatomy in the Medical Department of the University of Louisania. Second Edition. Carefully Revised, and Illustrated by nearly 300 engravings. Philadelphia: J. B. Lippincott & Co. 1867. This is a full-sized octavo volume of 671 pages; published in excellent style. Its illustrations are well executed, and, as a whole, it constitutes one of the best text-books on anatomy that we have seen. For sale by S. C. Griggs & Co., 41 Lake Street, Chicago. Price $6.00.

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ARTICLE XXIX. ABBREVIATED REPORT ON OBSTETRICS. By HIRAM NANCE, M.D., Kewanee, Ill. Read before the M. T. Medical Society, Monmouth, Ill. In writing a report on the Practice of Midwifery, to be read to any medical association whose meetings last only one day, and whose members come from five populous counties, I would be doing injustice to its members in making it lengthy. Short and sweet should be the motto on such ocasions, and this shall characterize this essay. We are all familiar with the divisions of midwifery, or its more immediate conger, labor: into natural, or unnatural, or preternatural, rapid labor, tedious labor, instrumental labor, etc., etc. In writing this report, I may give my practice and experience in this branch of our profession, taking a retrospect, or a review, of my own personal past experience. The practice of midwifery is certainly reduced to a science amongst the more elevated portions of society--pity I could not say the same in regard to all classes. What I mean by this is, that, usually, the more intellectual and intelligent avail themselves of the services of physicians during the stage of parturition. And amongst this class, we find that the mortality originating from malpositions and puerperal diseases, of various kinds, is much less than among the less intellectual and poor. Does not this prove conclusively that the office of the physician is not a sinecure, or that his valuable services could not be dis- pensed with with impunity? It is true, that in many, if not in most cases of labor, our services could be dispensed with, and that any ordinary nurse or matronly lady could make gentle pressure over the uterine tumor during the immediate transit of the child from the mother into the world, thus preventing hemorrhage by the immediate contraction of the womb. Al- most any nurse ought, also, to be able and wise enough to examine for the umbilical cord, and ascertain if it is around the child's neck, or is being compressed in any w'ay that would endanger the life of the infant; she should also know enough to make the necessary efforts to resuscitate the child in case it is born asphyxiated, such as dashing cold water on it, Hall's ready method, performing the act of artificial breathing, etc., etc. These troubles occur in the simplest cases of labor, and if our nurse is destitute of this small amount of obstetrical knowledge, she is not a fit person to occupy the lying-in room without a superior, in the person of a physician, being placed over her, in every case of obstetrics. As I remarked before, this branch of our profession is a science, and none but scien- tific persons should take the weighty responsibility upon them- selves of engaging in its practice. One hour, fifteen minutes, yes, one minute, is sometimes enough to apply our skill and save a valuable life or lives. The obstetrician should be a wise man; one well and thor- oughly informed in his profession. He should know when to act and how to act, in all simple as well as difficult cases. In taking charge of an obstetrical case, the physician should, at a very early stage of labor, insist upon a digital examination. This, when accomplished, will not only allay your anxiety, but that of your patient, when you inform her that all is right. If the presentation is found to be natural, then you have but little to do but cheer your patient up, until the last stage of labor; but if you find a malpresentation, then you hold yourself ready to act when the proper time arrives--remain in the room or adjoining one, subject to call at any moment, and make fre- quent but not officious examinations, to know when the proper time arrives for your learned skill to be employed. Indiffer- ence and timidity, connected with ignorance, has caused the death of many a fond wife and loving mother. You are not a fit man to practice obstetrics, if you are not patient yet ener- getic, and wise enough to know the exact moment when to lend the necessary aid to assist your patient out of a trouble, the most painful and serious that befalls our gentler sex. By labor, we mean the delivery or the expulsion of the foetus and its appendages. Labor is the consequence of conception; and the time occupied in utero-gestation is nine calendar months, or from 270 to 274 days. When interrogated by a lady, to know at what time her accouchement will take place, I enquire when she had her last menstrual flow, and from this time add one or two days more, and, usually, in nine months from that time she will fall in labor. Some obstetricians count two weeks from the last menses, and then add nine months; but I think our prognosis will be much more likely to be filled if we calculate as I first mentioned. Labor is divided, with some degree of propriety, into four stages:--The first stage is known by a mucous or sanguineous discharge taking place from the vagina, from one to two or three days before true labor pains commence, also, we find at the same time, wandering pains about the back and loins, some- times extending down the thigh. The second stage is known by the pains increasing in frequency and efficiency, commenc- ing in the bowels and lumbar region and extending to the region of the womb, the dilatation of the os uteri, the protrusion of the bag of waters in the vagina, and the rupture of the same. When the liquor amnii has escaped without the interference of any external aid, and the presenting part of the child is in or or about entering the vagina, the second stage of labor is com- pleted. Then comes the third and important part, or the delivery of the foetus, known by the firm contractions of the abdominal muscles and the uterus, the head engages in the pel- vic cavity, the occiput generally being situate above the arch of the pubis or the left acetabulum, and the face opposite the sacrum of the mother. The head now, after some severe pains, presents itself at the vulva, powerfully distending the perineum; in a short time the head clears its confined state and is in the world; a minute or two elapses, and one or two severe pains accomplishes the delivery of the child. It now remains to sep- arate the child from the mother, which being done, in ten or fifteen minutes slight pains return. By making the necessary pressure on the uterine tumor and gentle traction on the cord, we have the pleasure of having delivered our patient of the secundines, which include not only the placenta, but the differ- ent membranes which envelope the foetus in utero; this delivery I would class as the fourth stage of labor. Some obstetricians class the last throes of labor, with the delivery of the placenta, as the fourth stage; but I prefer to call the fourth stage the removal of the appendages, indepen- dent of the removal of the foetus, for the reason that the deliv- ery is not completed until this is over; and we are not justified in leaving the bedside of our patient until this is entirely com- pleted, and we have ascertained, by examination, that the womb is firmly contracted. Immediately after, or just at the time the babe is being born, the hand should be applied over the hypogastric region, to ascertain if the womb is contracted; if it is not, no effort should be made to deliver the placenta, for if we do attempt it, a fatal hemorrhage might ensue. I was called in consultation, a few years ago, to see a patient, who, the messenger said was dying; when I arrived, I found it too true, it was really the case. I interrogated the attending physician: he said, that morning he was called to see her, found her in labor, (the labor was premature, being about the sixth month,) that she lingered from about 2 or 3 o'clock A.M. until the afternoon of the same day, that the afterbirth did not come away readily, and that he found it necessary to make slight traction on the cord and introduce two or three fingers to re- move it; that, in doing so, he accomplished it and left the room, and was in a very short time summoned to his patient, to find her very weak, pale, and faint. He immediately ordered carb, ammo., opii, brandy, etc., but finding reaction did not come on, he became alarmed and dispatched a messenger for me. When I arrived, she was really dying; pulse small and thready; countenance sunken and exsanguined; slow and diffi- cult breathing; very uneasy, rolling from side to side; yet the intellect was perfect. On applying my hand over the bowels, I found them as large, if not larger than before the accouche- ment--the story, to my mind, was immediately told, viz.:--con- cealed, or internal, uterine hemorrhage. My advice to you is, never leave a patient until the uterus is firmly contracted. , If you are an obstetrician, you practice for the good of your patient, and your own reputation; you should not leave your patient, even if everything has been favorable^ in less time than from 30 to 60 minutes. Had the attending physician in this case remained by the side of his patient, the consequences might have been different. The first symptom of the loss of blood, in nine cases in ten, is a desire for a drink of water; then, paleness, sickness, and fainting. These symptoms should rouse the fears of any physician, whether hemorrhage appears externally or not. What course of treatment will you adopt if, upon examina- tion, you find there is no hemorrhage externally? If there is no hemorrhage externally, and the symptoms that I have de- scribed are existing, your patient is flowing. How are you to know this? Apply your hand over the hypogastric region, and you will find that the uterus is not contracting, but that it may be nearly, if not quite, as large as it was before the birth of the child. If you now, under these urgent symptoms, pursue a dilly- dally course of treatment, your patient in a very short time will be in extremity, and you will reflect upon yourself, and feel very much chagrined that your treatment was not more active and directly addressed to her wants. In brief, I would urge that no time is to be lost; administer a portion of ergot, sit down by your patient, apply one hand over the hypogastric region and make firm pressure, in order to assist the uterus to contract. If, under this treatment, no contraction takes place, introduce the other hand in the uterus and press the knuckles or back part of the hand against the orifices of the bleeding vessels, at the same time keep making pressure on the outside; continue this treatment, and in a short time you will usually find the uterine tumor becoming harder and harder and the coagula coming away, and then the hemorrhage will cease. If this treatment does not succeed, you should also use cold water or water and vinegar injections in the womb, or pour iced water over the hypogastric region. The internal treatment should consist of tinct. opii, ergot, carb, ammo., brandy, etc., accord- ing to the best judgement of the practitioner. The treatment that I have described apply to cases where the placenta has been delivered. If the placenta is undelivered and retained, as in irregular or hour-glass contractions, of course it should be removed. In the summer of 1866, a man, residing six miles west, came to consult me in regard to his wife. He called upon me about 8J o'clock A.M. He said, about 5 o'clock that morning, his wife had been confined and delivered of a nice pair of twins, but the afterbirth did not come away; he wanted me to give him something to bring it away. He said a midwife was with her, and he thought that the case was not urgent, and she thought I could send something that would bring it away. I frankly told my friend of JErin that I was fearful the case was a serious one, and that I had better go out immediately; by so doing, I might save his wife much suffering, and, probably, her life. He squirmed and hesitated, and finally said, "they" told him to get some medicine. I informed him that I could send some medicine if he desired it, but that I was of the opinion that medicine would be of no avail, but that she would require the assistance of some physician to remove the placenta, if it had been retained four or five hours. After stating these things to him, the poor man was penurious and simple enough to leave me and go home without either taking medicine or engaging my services, and letting his wife lie in torment until about 2 o'clock P.M. of the same day. About this hour, a messenger came, in a great hurry, for me to go immediately and see Mrs. L., as they feared she would not live. When I arrived, I found the old midwife there. She was wise enough not to do any harm, but sat by the patient, consoling her that "all would soon be right, as the doctor had come." On examining the patient, I found her with a flushed face, full and rapid pulse, and a tendency to delirium; on applying the hand over the bowels, I found the uterine tumor hard and irregular; both umbilical cords were hanging out of the vagina, and, on digital examination, I could not find the placenta; I diagnosed irregular or hour-glass contraction of the womb, and the placenta in the upper chamber. I arranged the patient in a suitable position for operation for removal, administered chlo- roform, introduced my hand, found things as I had anticipated, grasped hold of the placenta, and, with the other hand applied externally over the placenta, gradually brought it away. It proved to be a large double placenta, firmly attached to each other. It being, delivered, I administered an opiate to my patient. When about leaving, I told them I would call the next day and see her, as I feared she would not get along well. He replied that, if any trouble occurred he would let me know; then grudgingly paid me my fee, after asking me to reduce it. Let me advise you, in like cases, to charge well for your ser- vices, and they will be better appreciated than when a mere nominal sum is demanded. During the last six years and nine months that I have re- sided in Kewanee, only twro cases of arm presentation have come under my immediate notice, and both of them were first under the care of midwives, secondly, under the care of other physi- cians, and, lastly, under my own care. The first case w'as a lady, about 40 years of age, with her sixth child. She was taken ill in the night and the midwife sent for, who encouraged her that she would soon get through. She continued giving this encouragement until about 3 o'clock of the next day, when, the lady not getting any better, the parties became restless and uneasy, and, having lost confidence in the midwife, proposed sending for me, and did so, but I was not at home. A homoeo- pathist was then obtained; he went, and found the arm in the vagina, with the hand out, the patient having very hard pains, forcing the arm out as far as the pelvis would permit. He manipulated with it in this condition for several hours. It seems that he had no correct idea how to deliver the poor woman; I think he must have pulled on the arm, hoping to pull it out in that way. After exhausting his strength and skill, all parties, and himself in particular, became satisfied that labor could not be accomplished without more skill than he possessed. He (the homoeopathist) advised them to go for me as soon as possible, and tell me to bring my instruments. I obeyed the summons, not as a consulting physician, but because I had first been sent for. When I arrived, I asked the "doc- tor" what the difficulty was. He said, an "arm presentation." I then said to him, "what do you want with instruments?" "Oh!" said he, "to amputate the arm." I mildly told him he had no authority for such interference, and explained, in brief, that turning was the only treatment in such cases, where the pelvis was ordinarily capacious. I then examined, and found the mother almost exhausted; constant pain; pulse 120; tenderness over the uterine region; and other symptoms of inflammation. On examination of the foetus, I found the arm out, and it perfectly black. I adminis- tered chloroform, and turned and delivered her in fifteen or twenty minutes. The poor woman seemed to rally some after it was through, but the pulse still remained quick and the bowels tender. The mischief had been done; the long-contin- ued pressure of the child in the pelvis and the arm in the vagina had set up an inflammation which spread to the perito- neum, and in six or seven days she died with puerperal fever, or metritis, connected with peritonitis. Had I been called at a proper time, I have no doubt but that I could have saved the life of this poor woman. It is humiliating to think that people will persist in employing such men, who do not understand even the first principles of midwifery, and thus sacrifice many valu- able lives. The second case of arm presentation was that of an Irish- woman, aged 33, with her fifth child. She was taken sick in the night and sent for an Irish midwife, who came and contin- ued with her until 3 o'clock P.M. of the next day. She then concluded that the woman could not get through without the aid of a physician. Dr. Scott, of this place, was called and found the arm entirely out and the patient in great pain, almost continually. As the pains were so severe and almost without remission, he saw it was useless to attempt turning without the assistance of some other physician, and he requested that I be sent for, which was readily agreed to. The doctor administered chloroform, and I proceeded to turn, which I did with but little trouble in tenor fifteen minutes time. The child was dead; the mother got along without an untoward symptom. I have not been fortunate enough in my practice to meet with an arm presentation at the proper time to turn, but have always found them in the situation of the two cases just related, viz.:--the arm forced down and the axilla resting on the brim of the pelvis; the waters all discharged; and the woman in al- most continued pain. Could I select the proper time to turn, in arm presentations, I would wait until the os uteri was suffi- ciently dilated, then introduce the hand corresponding with the position of the feet in utero, rupture the membranes, grasp the feet, or, if I could not reach both, bring down one, and deliver as I would an ordinary footling case. Feet and breech presentations occur so often, that it is hardly required that I should call the attention of the Society to them. They occur about every thirtieth labor. I have the satisfac- tion of stating to you that I never lost an infant in my practice that presented either head or breech. Some authors state that the mortality in these cases will average one-third of them. I manage them by letting them alone until the feet and breech are born, then ascertain if the cord is being compressed, if the pulsation is weak and feeble, I bring down a coil of it to pre- vent compression, then make traction on the infant by folding a towel around it and using gentle force; if the face is not coming down opposite the sacrum and perineum, I turn the child so it will, then, as soon as I can, I introduce my finger in the mouth and bring it into the world as soon as consistently practicable. I failed to mention that the arms should be brought down over the face, and in doing this great care should be used or we may fracture the humerus. An accident of this kind once occurred to me. Ramsbotham quotes several cases of this kind, and cautions us in regard to it, but, notwithstand- ing his caution, it occurred to me. I immediately dressed the little arm, and in ten davs it was as well as ever. Great excitement was caused in our village, a year or two ago, by a physician having care of a lady, who was so unfortu- nate as to have a footling case. It was stated that he let it hang by the neck, undelivered, half an hour, and in this posi- tion had to have counsel to help him out of the difficulty. Dif- ficulties may occur with any of us; but is an obstetrician justi- fied in such a case not to do better than this, where the lady is well formed and the child of ordinary size? I reiterate that no man nor woman should engage in the practice of midwifery until he or she has just and clear views of the process of parturition, and is freely prepared to act in all cases, either simple or complicated. And I believe it to be our bounden duty to expose all men or women who are not competent to take charge of such cases. If we attempt to practice a profession and are not well informed in it, we are responsible to our fellow-men and to our God--and shall we by our taciturnity become the accomplices, aiders, and abettors of their ignorance? I have seen but few cases of face presentation in my own practice, or in the practice of others. Eight or ten years ago, I met with a case, in consultation with Dr. Clark, of Galva. Our only treatment was nature and time, and the woman got along well, and, so far as I remember, had a living child. On the 29th Sept., last, I was sent for to see Mrs. B., resid- ing four miles from this place. I arrived about 9 o'clock A.M. She had been sick since 12 or 1 o'clock. On examination, I diagnosed face presentation, with the forehead presenting at the symphysis pubis, and the chin at the sacrum. The os was fully open, but no advancement was made, yet the woman had fre- quent and severe pains. It was the seventh labor, and she had always, but once, been confined and delivered without the as- sistance of a physician, and this time she had attempted the same, but the woman in attendance readily yielded the case when she came to the conclusion that the presentation was pre- ternatural. The uterus was so firmly contracted I could not make any change in its situation, and, therefore, was obliged to apply the forceps, which I did with great difficulty, but finally succeeded, and delivered her of a very large dead child. Had the child been reversed, with the forehead resting on the perineum and the chin at the pubis, I think it could have been born without instrumental interference, but as it was, it was an impossibility. Face presentations, as a general rule, should be left to nature, they only require, in the language of Dr. Gooch, "more time, more labor pains, and more patience than a natural presen- tation." By transverse or cross births, we mean when any other part presents except the head, feet, or breech. A peculiar presen- tation occurred to me during the month of April, of which I herewith hand you an ambrotype, taken from a plate in Rams- botaam's Process of Parturition, (plate No. 127.) The process of ambrotyping or photographing, as you all know, reverses the order of the picture, and instead of finding the vertex in the cavity of the left ilium it was in the right; instead of the foot being down in the vagina, as here represented, the toes, up to the instep, had fixed themselves over the arch of the pubis, while the heel alone presented in the vagina; while, at the same time, the vertex occupied the iliac fossa. The hand was pre- senting as you here see, and the umbilical cord likewise; but I did not give them time to protrude out of the pelvis. I was called to attend the case at 8 o'clock A.M. She had been taken in labor about 12 o'clock in the morning, the first symp- tom being a gush of the liquor amnii, and this continued drib- bling away until some time after my arrival. Cross births are usually characterized by irregular and defective pains, and in this case it was so. When first called, the uterus was but little open, and it was all I could do to reach the presenting part. I diagnosed presentation of the elbow. I remained with her several hours, pains very light indeed, and everything given to her to increase the pains and cause the opening of the os uteri sickened her so much that I ceased giving anything, and waited the natural dilatation, holding myself in readiness to act when the proper time arrived. About 5 P.M., the pains grew a little harder and the os was sufficiently open to introduce two or three fingers; then, I could prosecute my discoveries farther, and found it as first described. I found the umbilical cord was pulseless and, of course, the infant dead. I tried to reach the foot that did not present, but found it impossible. I then re- leased the foot from its engagement over the arch of the sym- physis pubis, and, by making intermittent tractions -with the hand hold of the foot, succeeded in making the head sweep around from the right ilium, then to the fundus, and down the sacrum, by turning the face in that position after I got hold of the second foot, and had delivered it as far as the umbilicus. Transverse presentations do not seem to be any more frequent among the poor than among those more pleasantly situated in life, and in affluent circumstances, though the contrary view has been advocated by some obstetricians. I know of no symp- toms that would lead us to suspect a transverse presentation before the commencement of labor, after this commences, then, upon examination, if we find the part protruding, like a small oval tumor in the shape of the fingers of a glove, we may sus- pect something wrong. Another prominent symptom is a ces- sation, or nearly so, of pains, after the discharge of the liquor amnii. Digital examination alone is the only symptom that positively tells us that we are having a preternatural presenta- tion to contend with. Now, should we be ignorant or incompe- tent, not knowing what to do, one of three things must happen: either the womb, by its continued action, would become rup- tured; or the woman would very soon sink from exhaustion; or, lastly, the child, if small and the pelvis of the woman suffi- ciently large, might be forced down in a doubled state, and the violence usually done in such a case would usually result in the death of the mother. No one, probably, condemns meddlesome midwifery more than I do; yet without the proper knowledge to know how to act and when to act, in this branch of our science, is criminal, and he who sticks his shingle up, advertising himself as a physician, should not only be an M.D. from some reputable school, but should possess good common sense, with a good tact for practic- ing this branch of our profession, for such troubles may present themselves to us at any time. I will notice, very briefly, a case or two of placenta praevia. Eight or ten years ago, a man consulted me in regard to his wife. Five or six months had elapsed since her conception, and she was occasionally having spells of flowing. I told him my opinion was that the placenta wras presenting, and the flow- ing would continue off and on until her confinement, and I im- pressed upon him the importance of having a physician in attendance at the first symptom she had of labor; but instead of complying with my instructions on this point, when the labor commenced they sent for her mother-in-law, who was an ignorant virago midwife. She officiated until she was entirely satisfied that she could accomplish nothing, and the woman would die from hemorrhage if undelivered. I was sent for in great haste, found the placenta presenting, and the umbilical cord prolapsed and out of the vagina ten or twelve inches. The child's belly was presenting, the head in the right and the feet in the left hypogastric region. She wras flowing quite profusely, and, as the placenta was nearly detached, I immediately delivered it. I then immediately introduced my hand, grasped the feet, and delivered her in ten minutes time. The hemorrhage was pro- fuse, though not sufficiently so to do any serious harm to the system, and she made a happy recovery. The child, of course, was dead, as I found the cord pulseless when I first entered the room. Another case of placenta praevia came under my care in Jan- uary, 1866. I was also consulted in this case, three or four months previous to her accouchement, in consequence of hemor- rhage occurring from time to time. I diagnosed the case cor- rectly, and told them frankly what they might expect, and enjoined them carefully to send for a physician at the first symptom of labor. They complied with my instructions, and I was sent for in good time. Every pain brought a gush of blood. I waited until the os uteri was dilated the size of a dollar. The parts were soft and quite dilatable; the placenta was immedi- ately over the os. I administered chloroform, then partly rup- tured the placenta and partly pushed it aside, introduced my hand in the womb, grasped the feet, and delivered my patient in fifteen or twenty minutes time of a dead infant. Not an unfavorable symptom presented after her accouchement, and on the first day of this month I delivered her of a fine, healthy boy, which came all right. It is a very easy matter to turn and deliver, if we can select the right time and the right patient; but we rarely have this choice. As one author states, it is as easy to turn a child in utero, as it is a fish in a pail of water; but, in order to do it, we must be master of our business, and have the right time and the right kind of a pelvis. Select the time, if possible, before there is serious hemorrhage; do not wait too long for dilatation of the os, for if you do, your patient will sink from the loss of blood. If we can operate before the membranes are ruptured, we will find very little difficulty; the arm will prevent the liquor amnii from passing off, and the hand in the womb will find the infant floating in the water, which can be turned with ease and facility. It is very rare, indeed, that both mother and child are saved in cases of placenta praevia; I have never had the good fortune to save both, neither have I ever had the misfortune to lose the mother, an occurrence which frequently happens to those poorly skilled in obstetrics, and occasionally to those who claim to be adepts in our profession. Abortions occur so often, and are so frequently perplexing to the physician, that I would not do justice, even in this short report, were I not to treat of them in brief. The division of abortion, as divided by authors, into two stages, calling it abor- tion if it occurs before the sixth month, and premature labor if after that time, is, in my opinion, superfluous, and should be disregarded. By criminal abortion, I mean where any drastic medicine is given to produce it, or where any instrument is introduced in os tincae, breaking down the membranes, and soon bringing on abortion or premature labor. This is certainly a crime of great magnitude, when not produced to save the life of a woman. We are not authorized to operate on any case, without it is known that the woman has a deformed or contracted pelvis, and cannot be delivered without the assistance of instruments, and the child delivered dead. Every woman aborting, either naturally or from instrumental aid, runs a heavy risk of losing her life; and yet, physicians, knowing this great danger, will, for a few paltry dollars, yield to the solicitations of the gentler sex, or be urged on by the seducer, to perform this unnatural and infernal crime; a crime not second to the greatest in the catalogue of medical jurisprudence, but equal with murder in its first degree. In a word, we, as members of a great and good profession, should openly proclaim to the public that we denounce this great evil, and plainly let those persons know, who seek our aid in such cases, that neither money, love, high and aristrocratic standing in society, or anything else can bribe us to commit this crime. It matters but little, whether a woman aborts from natural or unnatural causes, the danger is about equally great, without the abortionist has given some severe drastic emenagogue or cathartic, thereby setting up inflammatory action in the womb and bowels, producing metro-peritonitis; or has used some sharp, penetrating instrument, and done violence to the os uteri, thence extending into the womb, and setting up the same active symptoms. A physician who is a gentleman, a moralist, or a Christian, will not permit such a stain to tarnish his char- acter, whether known to the public, or alone to himself and his victim. Our treatment of abortion, in ordinary cases, is well known to you all. If there is little or no flowing, keep your patient quietly in bed, and administer a mild opiate; when the pains have ceased, give some mild laxative, such as ol. ricini, sul. mag., or citrate of mag. But if we are not so successful as to check the premature action of the womb, then it is our services may become urgently demanded; we may have to use all our skill to check inordinate flowing, subue inflammatory action, etc. The lives of all women are very much jeopardized in cases of abortions; oftentimes the placenta is left undelivered for days, and sometimes for wteeks, causing spells of hemor- rhage, reducing the system from day to day, until anaemia and death is the result. One case, in particular, I will call your attention to. It occurred in my practice in the fall of 1865. The lady aborted six weeks before the placenta was removed. No physician was with her at the time and she thought the afterbirth came at the same time the foetus did, but time proved the contrary. Hemorrhage continued from time to time, until it was delivered. I removed it with a pair of placenta forceps. My patient was perfectly anaemic, with a pulse of 140 to 150, and nearly unconscious at the the time I operated; but when I removed it, the bleeding ceased, and, under large doses of carb, ammo., quinine, and brandy, she rallied, and is now in good health. I was sent for to see a patient in Stark County, in the win- ter of 1863, who was, or rather had been, under the care of an eclectic physician. Her husband informed me that she had miscarried, and he said the doctor told him the "afterbirth had come away all right." When I sawt her, she seemed weak, pale, and excited, and had a pulse of 140; bowels tender and a little tympanitic. I made a digital examination, and found the placenta undelivered. I rendered the necessary aid, and soon my patient was convalescing. What do you think of a physician who tells his patient she is delivered, and leaves her in this situation to die? One or two more cases of abortion, and I am through. A few years ago, I was sent for, in consultation, to see a case in Knox County. When I examined my patient, the attending physician told me that she had aborted at two months. On applying my hand over the pubic and hypogastric regions, I found the uterine tumor as large as after an ordinary labor. Why this unusual enlargement after an abortion? In due time the womb assumed its natural size and the woman promptly recovered. Another very similar case I recently saw with Dr. Smiley, of this place. A very near friend of his was taken with men- orrhagia, which continued quite profuse from time to time, until the woman became anaemic and very prostrate. This condition lasted some two or three weeks. She was wakeful and irritable, and the doctor very properly became alarmed at her situation and requested me to call and see her. I did so, and on applying my hand to the bowels I found the uterine tumor filling the left hypogastric region full. The doctor thought she had not aborted at all, but considered it an unusual case of menorrhagia. If she had aborted, it could not have been more than from four to six weeks, as she had missed her menstrual flow but once. My first thought was that she had an ovarian tumor, and I interrogated the doctor closely in regard to its duration; he told me it could not possibly have existed more than two weeks. I then made a digital examina- tion, placed my finger at the os tincae as a guide, and intro- duced a bougie, fully four inches. In a day or two, she passed some membranous flakes, proving that she had aborted, as these were the membranes from around the foetus. Strict quietude, recumbent position, warm fomentations, detergent washes, mild #opiates, and tonics, were the means used for her restoration, and she is now able to sit up some, and the uterine tumor is rapidly diminishing. I consider these two cases as anomalous, and worthy a place in any report. I would do injustice to myself and this Society, were I not to touch upon puerperal peritonitis, especially if I am able to report anything favorable in its treatment. Puerperal fever, or more properly styled puerperal peritonitis, is the great ter- ror of the lying-in room. It is the disease at all times to be dreaded after ordinary, tedious, or instrumental labors. No physician performs his duty, in the lying-in chamber, after the labor is over, until he gives the patient and nurse strict and explicit orders in regard to her care, diet, etc. A little care- lessness in diet, or the admission of drafts of cold air, or pre- mature sitting up after delivery, may, at any time, develop this disease; especially will it do so when the malady is prevailing as an epidemic. The disease, or rather its treatment, has become the oppro- brium of medicine, and that, too, very properly. And why? Because, I think I can safely say, that nineteen patients out of every twenty, affected with genuine puerperal peritonitis, die in from two or three days to a fortnight after the attack. The old treatment of Armstrong, so highly insisted on by him, viz.: free and repeated venesection, does not succeed in my hands, and I think any of you who have had patients with this disease, and have tried the heroic plan of Armstrong, have come to the same conclusion that I have. This disease is so very fatal, that I think but very few patients recover under any treatment. I am of opinion that many cases reported as cured, especially in hospitals, are not genuine puerperal perito- nitis, but merely metritis, connected with a high grade of fever. When this disease is once well developed, as known by a pulse running up from 120 to 160; frequent vomitings of a greenish fluid; retention of urine; extreme tenderness over the uterus, extending over the bowaels; swelled and tympanitic state of the abdomen; lochia arid milk checked or entirely suppressed, then it is we know a case of puerperal peritonitis. In its treatment, I would place calomel and the other mercurials along with blood-letting, viz.:--lay them aside for the treatment of some other diseases, for they are certainly not demanded in this disease. I have the pleasure and gratification to communicate to you my treatment in two cases of well-marked puerperal peritonitis, during the present winter, both of whom recovered--one after a miscarriage of six months, the placenta being retained; and the other a natural primapara. Both cases had all the urgent symptoms I have mentioned, and my prognosis was, of course, unfavorable. My treatment was simple and, consequently, can be briefly stated:--It consisted in giving full portions of sub morphine every three hours, to quiet the system and also the pain, and Norwood's tinct. ver. viride in drops, four to seven every three hours, to quiet the excessive action of the heart; thus alternating the two remedies every hour and a-half. When the stomach was much disturbed, I gave aqua cinnamo- mum or the essence of cinnamon in water. To quench the thirst, gave ice in small pellicles, orange, and lemonade, etc. In the active stage, I moved the bowels every three or four days by enema; I disapprove of drastics any time in the dis- ease; and would only give ol. ricini and ol. terebinth, in the declining stage, and then when only imperatively demanded. Warm fomentations of hops should be constantly applied during the more active stage, to be succeeded in the stage of decline by a large epispastic, covering the whole abdomen. As soon as the stomach would retain nourishment, I gave milk, wine-whey, wine, etc., and at a still later period, I gave sugar-coated qui- nine pills as a tonic, every three or four hours. In the main, the above is my treatment, with very little variation, condensed in as few words as I am able to. All of which is respectfully submitted.

PMC9999967

THE CHICAGO MEDICAL EXAMINER. N. S. DAVIS, M.D., Editor. VOL. VIII. DECEMBER, 1867. NO. 12. Orininnt (PS a h t r i b u t i a u $. ARTICLE XLIX. WHY DO WE GIVE ALCOHOLIC STIMULANTS IN SHOCK? By D. W. YOUNG, M.D., Aurora, Ill. Read before the Fox River Valley Medical Association, October 7th, 1867. Mr. President and Gentlemen: The above is an important question, both to the profession and the public; is important from its moral as well as its phy- sical relations to society. However, I do not propose to con- stitute myself a reformer and treat of its immoral bearings upon society, I will leave that to those who make more pretensions in that direction; still, in my judgment, it behooves us all, as a profession, who should be conservators of public morals as well as public health, to study well the reasons that induce us, as a profession, to insist and persist in the sanction and recom- mendation of an article which is constantly producing such terribly degrading influences upon human society. I cannot help thinking that unless upon a thorough examination we, find it imperative, we are not justifiable in lending our influence and sanction to its so general use as a medicine. The opinion that alcoholic liquors afford to the human system a stimulus, which, if not absolutely necessary and essential to its well-being, is, nevertheless, beneficial, by promoting in the several organs a vigorous and healthful exercise of their respective functions, and by enabling them, thus, to resist more effectually the vari- ous disturbing agencies to which they are daily subjected, is one that has been long entertained, and of the correctness of which a large portion of the public still entertains a firm con- viction. Most undoubtedly, to the influence of this opinion may and must be ascribed much of the intemperance which has pre- vailed in the world; and it, even now, presents a formidable barrier to the success of every effort at reform, in respect to the use of intoxicating liquors as a beverage. We all know that the practice of giving alcoholic stimulants in all cases of shock, whether physical or mental, has become so common, that not only all physicians, but all the public, fly to the whiskey and brandy bottles as the elixir of life--the great restorers of health and animation. So long as this opin- ion prevails, every effort to stay the progress of intemperance, with its attendant evils, disease, poverty, insanity, and crime, will of necessity be unavailing. Is this practice in conformity with the best known medical facts--facts of undoubted observation and experience? Is it based upon scientific medical investigation; or is it simply cus- tom, handed down to us from the dark ages of the profession? To try and answer these questions is the object of this paper. To investigate this subject understanding^, it will be necessary to inquire what shock is; what the physical condition that pro- duces it; what the lesion to be remedied; also, what the known or supposed physiological action or effects of alcoholic stimu- lants are upon the human system. Prof. Dunglison says:--Shock is a "sudden or instantaneous depression of organic, nervous, or vital power, often with more or less perturbation of body and mind, passing either into reaction or into fatal sinking, occasioned by the nature, sever- ity, or extent of injury, or by an overwhelming moral calamity." Prof. Gross, in his system of surgery, says:--"Shock may be defined to be a depression of the vital powers, induced sud- denly by external injury, and essentially dependent upon a loss of innervation. It bears, in effect, the same relation to the ner- vous system, that syncope does to the vascular; in the one case, the result is caused by a diminution of blood; in the other, by a diminution of the nervous fluid; in both, the consequence is, more or less prostration, with perturbation of body and mind, extremely variable both as to intensity and duration. When nervous shock is severe, it may instantaneously terminate in death, as so often happens in falls and blows upon the head; more generally, however, after having continued an indefinite period, it passes into reaction, the powers of life gradually com- ing up as the different organs and the general system regain their nervous fluid. The most severe and fatal cases of shock are, generally, those that supervene upon direct injury to the great nervous-centres, as the brain and spinal cord. No less disastrous effects occasionally succeed blows upon the epigas- tric region, in consequence of the violence thus inflicted upon the solar plexus of nerves. The blood has long been known by physiologists, as the vital fluid, so necessary has its integrity always been regarded to the well-being of the system and main- tainance of healthy action. But, certainly, it is not the only fluid entitled to this distinction; the nervous fluid is both more subtle and more important as a life preserver. When the blood flows away in a mighty and overwhelming torrent, the person dies, and life is tnen said to be destroyed, as it certainly is, by the excessive sanguineous drainage. But in shock, the same thing may happen, and yet the body be literally surcharged with blood, not a single drop, perhaps, having been spilled in the accident causing the fatal result. Thus, of the two fluids, the nervous is in every respect the more important, because the more essential to life; and its disturbance is, therefore, a more frequent cause of death. "There is no sensible practitioner who has not occasion daily to lament, in the exercise of his profession, his want of knowl- edge of the functions of the nervous system, and I feel sure that cases of disease and accidents are constantly permitted to slip through our hands, simply because of our forgetfulness that there is such a thing as nervous fluid. No one is unmindful that a patient has blood, that a certain quantity of this fluid ia necessary to the maintainance of health and life, and that, like the solids, it is subject to a thousand diseases, often of them- selves sufficient to cause death. Unfortunately, we can never acquire any intimate knowledge of an agent so subtle as the nervous fluid; like the electric or galvanic, which it is supposed to resemble, we can know it only by its effects." Copeland defines shock to be a sudden sinking of vitality; vital depression; nervous shock; nervous depression; fatal sinking. He makes five divisions or classes: First. Where the shock may be altogether and simply a vital one, as where it is produced by a violent blow on the epi- gastrium, occasioning concussion of the solar ganglion. Second. Where it may be associated with various nervous phenomena, as when a large nerve, or joint, or limb, is lace- rated or severely injured, and the patient greatly alarmed. Third. Where it may be complicated with, or rather char- acterized by, comatose sinking, as when the contusion, concus- sion, or blow affects the intimate organization and circulation of the brain. Fourth. Where it may be so associated with the sinking, consequent upon losses of blood, as not to be distinguished from this cause, especially when the injury is such as occasions both shock and hemorrhage. Fifth. Where the alarm or shock may be entirely a mental one, or that consisting entirely of the sudden effects of ex- tremely depressing emotions on the action of the heart, or of the sudden and unexpected intelligence of distressing losses or events, whereby the nervous system is more or less shocked, the mental manifestations disturbed, and the functions of the heart and vital organs depressed and otherwise disordered. He adds:--"It will thus be perceived that the injuries or causes occasioning shock may be divided into five classes, and that the effects they produce may present five modified forms ; but although either of these may result from either class of causes, and although it is necessary to connect our observation of the phenomena, and our treatment of shock, with the partic- ular cause of it, it is still more important, especially as regards the treatment, to mark the particular form and modification requiring our aid." Erichsen says:--"The constitutional effects of shock consist in a disturbance of the functions of the circulatory, respiratory, and nervous systems, the harmony of the great organs of the body becoming disarranged. On the receipt of a severe injury, the sufferer becomes cold, faint, and trembling; the pulse small and fluttering; there is great mental depression and disquie- tude; the disturbed state of mind revealing itself in the coun- tenance, and in incoherence of speech and thought; the surface becomes covered by a cold sweat; there is nausea, perhaps vomiting, and relaxation of the sphincters. This condition lasts for a variable period, its duration depending on the severity of the injury, and on the nervous susceptibility of the patient. In extreme cases, the depression of power characterizing shock may be so great as to terminate in death. In the great major- ity of instances, however, reaction comes on, and the disturbed balance in the system is gradually restored. Is this state the result of fear and nervous susceptibility, or is it occasioned di- rectly by the physical lesion? In many cases, doubtless, the effect is entirely mental. Thus, persons have been frightened to death without any local injury or mischief. That there is a great difference in the mental fortitude of individuals, is notorious; some suffering excessive shock from the mere apprehension of >> injury, whilst others may be the subjects of the severest injury, and show but slight signs of suffering. If the injury be sudden and unexpected, the shock is usually greater. Where the feel- ings are roused, as in the heat of action, injuries often pass unnoticed by those who receive them. Hence, it is positively evident, that the state of mind at the time of the receipt of the injury materially influences its immediate effect on the constitu- tion. There can be little doubt, however, that different individ- uals manifest very different degrees of susceptibility to pain, some having more acute sensation than others." Thus, it will be seen that all these eminent surgeons and authors agree, and define shock to be a "sudden or instantane- ous diminution or depression of organic, nervous, or vital power." All agree that it varies in different cases and persons, accord- ing to the severity and extent of the cause or the injury, and the particular temperament, physical and mental condition of the patient at the time of the receipt of the cause or the injury. All these various conditions and circumstances are admitted to have a modifying or controlling influence upon the malady. Why this is so, we are unable to explain; because we do not know what life is--our present limited knowledge of the science of life does not enable us to give an exhaustive definition. Beale, Hunter, Harvey, Aristotle, Abernethy, Muller, Prout, Carpenter, HaiMMEr, and Virchow have all advanced extensive theories, have all written learnedly and guessed exten- sively, but the question still is, What is life? The symptoms of shock are very similar in all persons, and from all causes. One receives a blow upon the head; another upon the epigastrium; another, upon the back; another, falls a distance; another, receives sad news, such as the death of friends, or the loss of property; still another, simply witnesses a frightful accident. All reveal the same or similar symptoms. All fall to the ground; become suddenly cold; are bathed in a cold sweat; with deathly paleness; a sunken or collaped coun- tenance; irregular gasping and difficult breathing; are unable to move, speak, or think; frequently become convulsed; vomit; and, after a longer or shorter period, reaction or fatal sinking supervene, life either ceases, or healthy action is restored and life continues. This depressed condition of the organic, ner- vous, or vital powers we denominate shock, and the question now is, Are alcoholic stimulants the sine qua non to remedy this condition? Are we compelled to resort to this health, wealth, happiness, intellect, and life destroying agent to remedy the evil, to remove the shock ? Let us now carefully and candidly enquire what our own experience and the teachings and writings of our ablest and best physiologists and practitioners teach us upon this point. Learn from all this evidence, how well alcoholic stimulants are entitled to their present exalted position in the cure of this prostration. See if we must continue to sanction and recommend their use. Griffith says:--"In small quantities, there is mere excite- ment; in large doses, much excitement, with delirium, confu- sion of intellect, followed by somnolency, nausea, and vomiting, and even coma and apoplexy." Stille, in his Materia Medica, says, when speaking of its effects on animals:--"When the crural nerve of a frog is moistened with this liquid, the limb loses its power of motion; the same results, with depressed action of the heart, ensues when the whole limb is wet with alcohol. The pulsations of the heart soon cease under its application. Fish immediately lose their activity, in wyater containing but a small proportion of this liquid; and birds, according to Flourens, are deprived of sen- sation and voluntary motion, by a few drops of brandy. In- jected into the veins, alcohol always produces symptoms of prostration, proportioned to the quantity used and the purity of the article. "As early as 1679, Courten, Lanzani, and Baglivi, all showed that highly rectified spirits might prove instantly fatal, when employed in this manner, and that after death the blood was always found coagulated in the heart and lungs." Segalas "found that half an ounce, with four or five times its weight of water, injected into the crural or jugular vein of a dog, produced loss of motion, insensibility, abdominal respi- ration, and a scarcely perceptible pulse." Orfila "found that eight or ten drachms, injected into the cellular tissue of a dog, produced, first, vomiting of bilious mat- ters, and death in three hours. On dissection, the only lesion discoverable, was coagulation of the blood in the limb operated upon, and in the heart." Dunglison says:--"It need scarcely be said, that the case must be bad indeed, in which the hopes of the practitioner are placed on the excitement which alcohol is capable of inducing. It may be a question, indeed, whether it be not calculated to to exhaust the slight amount of excitability still existing in the system." Wood and Bache, in the United States Dispensatory, say: "As an article of daily use, alcoholic liquors produce the most deplorable consequences. Besides the moral degradation which they cause, their habitual use gives rise to dyspepsia, hypo- chondriasis, visceral obstructions, dropsy, paralysis, and, not unfrequently, mania." Copeland says:--"It should be recollected that the effects of spirits or other intoxicating liquors on the frame, will vary very much with the habits of the individual; with his state of body, especially as respects vascular plethora; and the existing condition of the stomach, chiefly as respects .the presence of alimentary matters. In the larger proportion of cases, how- ever, after a longer or shorter period of unusual mental vigor, nervous excitement, and increased action, varying according to the surrounding temperature, the brain becomes oppressed; the powers of voluntary motion, which are early impaired, fail entirely; the mental manifestations are suspended; and in the more severe cases, sensation is lost completely. In most cases and instances, this stage supervenes gradually; but any sudden exposure to cold will often induce it rapidly. The person feels drowsy, and appears to fall into a sound sleep; but it is dis- covered, when the attempt is made, that he cannot be aroused to consciousness by any effort, or, if it partially succeed, he is hardly sensible of surrounding objects, and immediately lapses into his former state, the limbs remain in whatever position they may be placed. The temperature of the head is generally above natural; but that of the extremities, and often of the surface generally, is considerably lowered, or but little altered or affected in the milder cases. The pulse, which was at first quick and excited, becomes feeble, small, and ultimately slow, and entirely wanting at the wrist. The respiration is usually infrequent, the separate acts of inspiration and expiration, par- ticularly the former, occupying a very short time, and is wholly or chiefly abdominal. The breathing is often laborious in the most advanced states, and in those, the respirations are convul- sive, the chest expanding by the rapid contractions of the asso- ciated muscles of respiration." Williams, in his Principles of Medicine, says:--"Nor can we wonder at the pernicious effects, when we consider the weak- ened state of the function and structure which stimulating drinks induce, especially in the organs which they most directly affect, the stomach, the liver, the kidneys, the blood, the heart, and the brain." All these eminent authors and teachers ascribe to alcohol, either as a primary or secondary effect, an enfeebled action of the heart and circulation. Besides these, we have the very valuable and interesting experiments and concise report of Prof. N. S. Davis, of Chicago, who called both the sphygmo- graph and thermometer to his aid. As his experiments are both very interesting and very instructive, I shall copy them entire: "On the 6th day of April, 1867, four hours after dinner, when the functions were supposed to be undisturbed by diges- tion, and the man in good health, the temperature of his body was carefully noted by a delicately graduated thermometer, inserted under the tongue, with the lips closed around it; the rate of the pulse and its qualities, as indicated by the sphyg- mograph, were recorded at the same time. Four ounces of bourbon whiskey was then administered, diluted with sweetened water. The same observations, in regard to temperature and condition of pulse, were made and recorded every half hour, until two full hours had passed. Another series of observa- tions, in all respects similar, were made on the 11th of April, except the whiskey, for which four ounces of sherry wine was substituted. "At the commencement of the experiment, at 10.20 o'clock P.M., the temperature of the mouth was 98|deg, pulse 83 per minute. Then he took the four ounces of whiskey. At 11 o'clock P.M., half an hour after he had taken the whiskey, the temperature of the mouth was 97fdeg, pulse 85 per minute. At 11.30 o'clock P.M., one hour after he had taken the whiskey, the temperature of his mouth was 97 J, pulse 89 per minute. At 12 o'clock P.M., one hour and a-half after the whiskey was taken, the temperature of his mouth was 97|deg, pulse 89 per minute. At 12.30 A.M., two hours after the whiskey had been administered, the temperature of his mouth was 971deg, pulse 85 perminute." Thus, it will be seen that in this experiment, when four ounces of bourbon whiskey were administered, the pulse in- creased from 83 to 89 beats per minute during the first hour, but decreased in number of beats per minute, from 89 to 85, during the second hour. The sphygmograph shows, most con- clusively, that, notwithstanding, while the number of pulsations were increased from 83 to 89 per minute during the first hour, the force of the heart and pulsations were weakened. The heart evidently had less power to propel the blood through the arte- ries, and a congestion of the venous radicles must ensue. The same thing often takes place during venesection, the number of pulsations are increased per minute, but the power of the heart is reduced. The second experiment made by Prof. Davis, differs but lit- tle from the first. It was instituted on the 11th day of April, 1867, and is as follows:--"At 10.15 o'clock P.M., three and a-half hours after dinner, the temperature of the mouth was tested with the thermometer, and found to be 97deg, pulse 78 beats per minute. At 10.30 o'clock P.M., four ounces of pure, clear sherry wine were administered. At 11 o'clock P.M., half an hour after the wine* was swallowed, the temperature of the mouth wras 96fdeg, pulse 75 per minute. At 11.30 o'clock P.M., one hour after the wine was taken, the temperature of the mouth was 96Jdeg, pulse 71 per minute. At 12.30, o'clock P.M., two hours after the wine had been drank, the temperature of the mouth was 96Jdeg, pulse 72 per minute." Thus, it will be seen that under the influence of four ounces of wine, the pulsa- tions were reduced in number per minute, from 78 to 72--lost six beats in two hours. The sphygmograph again shows dis- tinctly that the quality of the pulse was the same in kind in both experiments. The force of the heart's action was reduced under the influence of both the wine and the whiskey. Dr. Davis, in commenting upon the results of his experi- ments, says--"It will be seen that each pulse expands the artery to a greater extent and more suddenly than before the alcoholic liquid was taken, and that the commencement of the contraction is equally more sudden, while the whole line becomes more wavy or irregular; thereby much resembling the^wZse lines (as shown by the sphygmograph) when the arterial coats are weakened by fatty degeneration, or in such diseases as are accompanied by enfeebled capillary circulation, like typhus and typhoid fevers." Here, I desire to add that this fact was very forcibly and strikingly illustrated by comparing them with some fifteen or twenty plates presented to the Illinois State Medical Society, at Springfield, by Prof. II. A. Johnson, of Chicago, who also presented the results of his experiments with the sphygmograph, in a large number of cases and different diseases. Prof. John- son's plates showing the pulse lines, as recorded by the sphyg- mograph, in a number of cases of typhoid fever and chronic diarrhoea, were apparently identical with those presented by Prof. Davis, as recorded by the sphygmograph in his experi- ments with alcoholic stimulants. This fact was very apparent, and was noticed and commented upon by numerous and various members of the association. Both sets of plates showed, most unmist ale ably, enfeebled action of the heart, notwithstanding the one was recorded while the patient was laboring under the influence of four ounces of bourbon whiskey, and the other after the patient had suffered several weeks under the depress- ing influence of typhoid fever and chronic diarrhoea. Dr. Lionel Beale, Physician to King's College Hospital, in an article in Braithwaite, on Stimulation in Serious Cases of Acute Disease, says:--"I shall not discuss how stimulants, in very large quantity, influence disease, but shall, in conclusion, beg permission to direct attention to certain clinical facts which have been observed in many cases placed under the influence of large quantities of alcoholic stimulants (eig teen ounces of brandy and upwards in twenty four hours) the pulse was not increased, but diminished in frequency." Let us next inquire how alcoholic stimulants affect the tem- perature of the body. So far as I can learn, but few really systematic scientific investigations have been made in this direction, and the proofs relied upon as proving the heat-pro- ducing power of alcohol, rest chiefly upon the sensation arising from its ingestion, and on its chemical constitution, which latter is considered, by those who support Liebig's theory of animal heat, to furnish evidence of the effectiveness of alcoholic com- pounds as sources of heat, when introduced into the living organism. It has been, somewhat loosely and gratuitously, assumed that the agent in question exercises a powerful influence on the pro- duction of animal heat, this assumption being based principally on the sensation of warmth experienced in our own persons, after taking alcoholic liquors. We know, however, that our sensations are extremely fallacious guides in all matters pertaining to tem- perature, and that, therefore, in this case as in others, but little reliance can be placed on their indications. I am fully aware that the great majority of authorities are in favor of the opinion that alcohol is a powerful promoter of animal heat. Many patient, honest, intelligent, and competent experimenters, how- ever, deny this, and, in my judgment, give reasons and results which are at least entitled to our candid consideration. As one means of arriving at the truth on this point, we must exam- ine more particularly into the influence of the introduction of alcohol into the blood, upon the respiratory process. For our knowledge upon this point, we are largely indebted to the experiments of Dr. Prout and Dr. Vierordt. The former, states that alcohol and all liquors containing it, which he had tried, have the remarkable power of diminishing the quantity of carbonic acid gas in the expired air, much more than any- thing else which he had made the subject of experiments; this effect being most decided when the liquor was taken upon an empty stomach. Dr. Vierordt fully confirms Dr. Prout's observations; having found that in four experiments, the per- centage of carbonic acid fell, after from a half to a whole bottle of wine had been taken, from 4.54 to 4.01; and that this effect lasted between one and two hours. He further found, that when he drank wine with his dinner, the usual increase in the percentage of carbonic acid expired after a full meal did not take place. These facts are of great importance. Thus, then, there are clear indications that, when thus pre- sent in the blood with other materials which ought to be ex- creted, alcohol exerts an injurious influence, by retarding their combustion. This it will do in two ways:--first, by taking their place as the more readily combustible material; and, secondly, in virtue of the antiseptic influence which it exerts upon other substances, preventing or retarding chemical changes in them. That such is the case, we have at least strong proof, as appears from the experiments of Bouchardat, who found that, when alcohol is introduced into the system in excess, the blood in the arteries presents the aspect of venous blood, clearly showing that it has been prevented from undergoing the proper oxygen- ating process. The experiments of Dr. Prout afford strong additional sup- port to this conclusion; for he observed that no sooner had the effects of the alcohol passed off, than the amount of carbonic acid exhaled rises much above the natural standard, thus giving, it would seem, unequivocal evidence of the previous abnormal retention of carbonaceous matter in the system. 'From the foregoing considerations, then, we may conclude that the effects of alcohol as a heat-producing material, at best, could only be advantageously experienced when the blood does not contain a supply of other matters waiting for removal by the respiratory process. Is it not the case that in all cases of shock, the respiratory process is but imperfectly performed, and that, as a necessary consequence, there must be an excess of carbonic acid retained in the blood? If such is the fact, can it be a logical procedure to administer such articles as will still further increase the already sedative influence of an excess of venous blood? Dr. John Davy found that wine, so from increasing the temperature of his body, caused, on the contrary, a very visible diminution of its heat; and, moreover, that the diminution was proportioned to the quantity of wine taken--the greater the quantity, the more marked being the decrease of temperature. Dr. J. D. Hooker, who accompanied Sir James Ross in his Antarctic expedition, also denies the heat-producing properties of alcohol, and says, "that, even if it is capable of warming the central portions of the body, it is incapable of raising the temperature of the extremities." And Dr. Carpenter con- siders that, although alcoholic liquors may possibly produce a slight and transitory increase of heat, yet this is but momentary and followed by a depression that more than counterbalances the previous elevation. Dr. Edward Smith, of London, says:--"In a prolonged inquiry upon myself and another, we took the alcohol in mode- rate quantity, duly diluted, on an empty stomach, and we noticed most carefully the general effects and the moment of their occurrence. At first, there was a sense of dryness and heat, with fulness or swelling of the exposed parts. After about twenty to forty minutes, this sensation gave place to one of cold, which was first felt on the most sensitive part of the body, with regard to temperature, viz., between the shoulders, and, at length, notwithstanding the existence of a suitable degree of atmospheric temperature, it became distressing, and led even to shivering. This was sometimes so marked, and occurred so suddenly, that it gave rise to a shock." Dr. Sidney Ringer, Professor of Materia Medica, at Uni- versity College, and Dr. Walter Rickards, in an article in the London Lancet, give the results of numerous experiments instituted by them, in which they say:--"In their first experi- ment, they gave alcohol in large doses to three adults. In two, the temperature was greatly depressed--the depression amount- ing to 3deg Fahrenheit. In the third case, the temperature was but little influenced. The subject of this observation was a confirmed drunkard. Alcohol was also, by them, injected into the recti of two rabbits; in.both, the temperature was consider- ably depressed--the depression amounted to 15deg Fahrenheit. In a second experiment, they gave alcohol to eleven persons, in ordinary doses (an ounce of brandy). In eight, the temper- ature was depressed; in three cases, the temperature was unaf- fected. Two of these were confessed free drinkers. In con- ducting these observations, the following precautions were taken:--the persons were kept in bed; all the conditions were kept the same; the thermometer was kept the whole time in the axilla, and the temperature noted every few minutes." In 1848, MM. Dumereil and Dumarquay, in making numer- ous experiments on intoxicated dogs, always found their tem- perature uniformly reduced. Two years later, 1850, Prof. N. S. Davis, of Chicago, insti- tuted a series of experiments, the results of which showed unmistakably that the presence of only a few ounces of either fermented or distilled drinks, in the human system, was suffi- cient to produce a positive diminution of temperature. To still further verify these facts, Prof. Davis again, on the 6th and 11th days of April, 1867, instituted another series of experi- ments, which also produced the same results. He found that a strong healthy man, who took four ounces of bourbon whiskey diluted with sweetened water, suffered a depression in tempera- ture. The thermometer fell two degrees in an hour. In the second experiment, where he substituted four ounces of sherry wine for the bourbon whiskey, he found the temperature de- pressed also, but in a less degree. The depression amounted to one-half degree in one hour. I might continue, and present other authorities, introduce still more proof, but both time and space forbid; and it does seem to me that I have already presented enough to at least cause us to stop and consider the whys and wherefores before wTe, by example or sanction, fill every human stomach, whose unfortunate possessor is suffering from shock, with alcohol. I simply desire, in conclusion, to add my own views and experi- ence upon this subject. While I have never instituted any scientific investigations, nevertheless, I have had (during a very extensive surgical experience, both in the army and pri- vate practice) a pretty good opportunity of witnessing the effect of this agent upon persons laboring under shock. My experience has been, that alcoholic stimulants are very liable to produce extreme nausea, vomiting, and depression of the vital powers. I have thought that they retarded reaction and increased the depression. So marked have been these results, and so distressing their effects, that I have, long since, avoided their administration. I have substituted hot coffee, hot teas, and hot broth, when obtainable, and have been much better pleased with their effects. Understand me, I do not advocate the extreme touch not, taste not, and handle not principle, I still claim alcohol as a valuable remedial agent; I believe it well worthy of a place in our materia inedica--not as a stimulant, not as food, not as a tonic, but as an antiseptic; I believe that its great office is to prevent septimia, and, therefore, that it is a valuable remedy in the various zymotic and suppurative diseases. While I would have it retained in the materia medica, I would also have it labelled on every druggist's shelf as an acrid, irritant poison, to be used with much care, in extreme cases, never, under any circumstances, as a beverage, by a practitioner of medicine, AT LEAST.

PMC9999970

WEIMAR CHOLERA CONFERENCE. The following from a communication from Dr. Elisha Harris to the President of the New York Board of Health, has been long awaiting a place in our columns: Having been favored with an abstract of the discussions and concluding recommendations of the Cholera Conference that recently met at the city of Weimar, and having learned from Prof. Pettenkofer that the full stenographic report of the Conference will be published at Leipzic during the summer, I now lay before the Board of Health a synopsis of the discussions and their conclusions as given in this abstract. You will recollect the polite invitation that was extended to New York to be represented at that important meeting. It turned out to be precisely such a Conference as the interests of public hygiene required, for the most practical and comprehen- sive questions were discussed by the leading sanitary scholars of Europe, nearly 60 delegates being present. The following conclusions were adopted, and I beg leave to present them here before giving the synopsis of the debates of the Conference. CONCLUSIONS AND RECOMMENDATIONS. I. The Conference expresses as its deliberate conviction that the efforts to arrest and prevent cholera by disinfectants, should be continued in the most energetic manner. II. Disinfection will be entirely successful only where excre- mental matters are carefully gathered and kept from being cast about; when attention is given to the cleanliness and the means of health; and when the disinfection is performed by sanitary authorities in a compulsory manner. III. In places where the entire locality or district cannot at once be disinfected, it is advisable to disinfect throughout the places visited by the previous epidemics of cholera. IV. The general disinfection should be performed at the proper time, that is, before the epidemic is actually prevalent in town or place. Every house or spot that becomes infected or is suspected to be so, must be kept constantly under the influence of disinfection. V. In regard to the best substances as disinfectants, though the testing of various articles is not completed, there have been found, to the present time, no more effectual substances than sulphate of iron (copperas) and the carbolic acid; and, as expe- rience proves, we have no other disinfectants that can be em- ployed with greater facility. A combination of both these dis- infectants is therefore recommended. VI. The disinfection of clothing that has become infected by cholera excrement is especially an important matter. For that purpose the Conference recommends that all such clothing be disinfected by boiling in water, or by chemical treatment in a proper solution of "zinc vitrol" (sulphate or chloride of zinc), and the Conference also recommends that special arrangements be made by which disinfection can be employed in all places, and at any hour, among or for the poor. VII. For the disinfection of sewers and drains, the Confer- ence advises the trial of Mr. Sauvren's method. [The means used by Mr. Sauvren are not yet fully published, but they are believed to be similar to McDougall's--namely, combination of a carbolic or coal-tar preparations, in a cheap form.] VIII. If cholera infects any house or spot, it is recommend- ed that, if practicable, the houses so situated in an infected place, or being infected, should be vacated, and their inhabitants should be removed from the infected spot. IX. It is especially recommended that the ground-water (that is the water in the ground) about dwelling-houses, and all the grounds about habitations of every kind, should be preserved undefiled by any excremental matter of cholera; also, that all drinking water be undefiled and pure, and that where no pure water can be had that the water which must be used should be disinfected by boiling. Such were the final conclusions of the Conference in reference to the first duties of sanitary authorities, and the people of any town that is threatened by cholera. The discussions were based upon the experience and studies of the distinguished gentlemen who had thus agreed to meet and compare their views, and the results of their observations. The attendants at the conference were from various cities of Germany, Holland, Prussia, Austria, Hungary, and Russia. The history of cholera outbreaks among the troops in the war last year proved marvellously interest- ing, and conclusive on many points. Next in order of inter- est and importance was the history of infection by means of water contaminated by cholera excrement. Closely allied to the latter subject was the examination of evidence concerning the discoveries that have been made in regard to the particular means by which the cholera infection is transported and propa- gated. Lastly and most practically useful was the examination of evidences concerning the proper and best methods of disinfec- tion, and the relations of such means to the control and promo- tion of cholera epidemics. The chief medical officer to the Privy Council of Great Britain presented the history of the outbreaks of cholera in London in connection with the water of the East Lon- don Water Company, which, as Dr. Radcliffe has shown, was contaminated by cholera excrement. In the district where that water was used the epidemic burst forth as by explosion; while, subsequently, in other places it spread by the more usual meth- ods and in the more usual manner. Then again, there were other instances where the epidemic spared all persons in certain asylums and hospitals who used privies that were entirely uncon- taminated by cholera excrement, while the epidemic decimated the classes of inmates that used the latter. The Conference conceded that wells and reservoirs of drinking water were fre- quently contaminated by the cholera poison by soakage into them of the infectious element from the cholera stools; but Profs. Pettenkofer, Wanderlich, Simon, and others, agreed that drink- ing water was not the most universally common means of com- municating cholera to man. The influence of ground-moisture, or more precisely of the ordinary ground-water, while such water or moisture is receding by drying of the ground after a wet period, was proved by such who daily used the same well water, but who used different privies and frequented different and well separated yards, as we saw the same fact illustrated in two ad- jacent pavilions on Blackwell's Island, last summer. The influ- ence of different kinds of ground in receiving and propagating the epidemic virus of cholera was examined, and Dr. Pfeiffer, of Vienna, showed the curious course which the epidemic pursued in passing through the great forest country of Thuringen last year; while the delegates from Dresden and some other places showed what conditions of the earth had permitted and favored the spread of cholera on their soil, that covered certain granite rock districts. The outbreaks on Blackwell's Island and the rocky summit of Hudson City, fully bear out the conclusions of the Conference on the subject of cholera epidemics on rocky sur- faces, and do not disprove the agency of the surface soil in propagating the virus when planted in such places. Examining the great mass of facts presented by members of the Conference in regard to influence of the ground and its retentiveness of un- drained water or of being porous, and, at times saturated and again undergoing a course of drying by evaporation, the more important conclusions seem to be as follows: 1. That porous soils, and any kind of earth that retains and favors the ordinary kinds of fermenting filth, will readily retain and repropagate the virus of cholera when once the germinal virus has been introduced or planted by persons coming from infected places. That the mere altitude of a place is not the question that determines its susceptibility to cnolera; that the moisture (ground-water) and the fluctuations of that moisture of a soil by rising and receding (drying), favor the propagation of cholera; that a sewer or drain may become the chief source of infection to some places where there is no soil, or where the ground and everything except the sewers and drains have been disinfected. 2. That Prof. Pbttenkofer's use of the term ground-water should be understood, as he intended, to mean the standard of saturation by moisture in the soil, and that grounds which, upon their surface appear to be high and dry may, nevertheless, be saturated with moisture; that is, have an excess of ground-water (or high ground-water), and that the Sanitary drainage and drying which are necessary to protect a soil against repropagat- ing the planted virus or germs of cholera must be deep and thorough. The history and topography of the cholera fields of Halle, Berlin, Zwickeon, Thuringen, Helsingfors, and St. Peters- burg supplied admirable proofs of this great doctrine in sanitary drainage. 3. Good proofs were adduced that there are some kinds of soil that seem to be natural disinfectants of cholera virus, and upon which an epidemic cannot spread except in filthy houses, sewers, etc. We have not time to make the abstract of the facts that will illustrate the true theory of this kind of exemption. We can say, however, that it is plainly important that regard should be given to the kinds of earth and materials used for fill- ing up sunken lots, and that even the location of dwelling-places may sometimes be wisely a matter of choice as regards the nature of the soil. The facts concerning specific disinfection to destroy both the cholera virus and all susceptibility to material for its repropa- gation in a house or a district were well discussed in the Confer- ence. The negative facts were specially important, for they showed that in a few places, as in the great prison at Halle, the epidemic swept forward regardless of the previous and continued disinfection of the grounds and nuisances with sulphate of iron. But in those instances it was proved that the sewers and drains were not disinfected, and that not only were the infected spots particularly exposed to and connected with such drains and sew- ers, but that the copperas solution had been relied upon without admixture with carbolic acid, and the powerfnl antiseptic agents which coal-tar contains. In Berlin there was great success in the use of permanganate of soda, with sulphuric acid added-- that is, the success was achieved by the most rapid and power- ful oxidization, in the same manner as we last summer disin- fected the defiled clothing and bedding of the cholera sick by means of permanganate of potassa. The expensiveness of the method is the chief objection to it. Yet, for domestic and lim- ited applications, it is a perfect method for clothing and uphol- stery. The fact that with entire unanimity the Conference recommended that the main reliance for disinfection should be placed in the simpler and powerful agents--sulphate of iron and carbolic acid, which the Metropolitan Board unhesitatingly adopted at the beginning of the epidemic last year--will be am- ply warrant for out continuing to employ those cheap and effec- tual substances. The vital importance of perfect sanitary care of all persons sick or infected with cholera, was illustrated in the history of the epidemic in every city. Disinfection alone, especially the irregular and unsystematic or unenforced applications of disin- fection, did not always control the prevalence of cholera; indeed, such exclusive and unmethodical sanitary work often resulted in fatal disappointments. In some cities, as in Erfurth, even the carbolic acid was so freely used in some parts of the town (in privies), that the wells in the vicinity of privies flooded with that disinfectant, yielded water that tasted strongly of it; yet parts of Erfurth were neglected, and cholera was fearfully epidemic there. But it was conceded that in cities in which there was perfect, and systematic and well-regulated sanitary disinfection, combined with perfect care of the sick and of all suspected persons, as was the case in the city of Bristol and some other favorite cholera haunts, the epidemic was controlled, and, by like faithfulness and skill, that it could and should be generally controlled in all civilized cities. Professor Hirsch presented the arguments and studies that favor the discovery of the precise nature of the poison that pro- duces cholera, and the Conference commended and urged on the inquiries that have already, in the hands of Professors Klob and Thome, last year, resulted* in discovering a minute microscopi- cal growth that seems, thus far, to be exclusively produced in cholera excrements, and which obey all the tests for the destruc- tion as well as the propagations of the cholera. The spores of that little growth multiply with marvellous rapidity, and they are not destroyed by ordinary doses of chlorine or chloride of lime, but are killed by sulphate of iron and carbolic acid. The Conference recommend that scientific naturalists, like the men who are now at work on these questions, should continue their researches. It was also recommended that observers of cholera should carefully study the conditions under which the epidemic is transported from place to place, and also study the relations of grounds, moisture (ground-water), and other local conditions that determine the bounderies of epidemic fields. It will be observed by these notes, of a discussion that ap- pears to have been conducted with the single object to find out what is known, that there was a clear knowledge of the prac- tical wants of sanitary officers and governments. The nine propositions which the members of Conference have submitted as their unanimous conclusions and recommendations, I have placed at the beginning of this abstract, as being precisely the kind of information which a Board of Health most wishes to receive, and upon which it can base judicious practices. Fortu- nately for the good name of your Board as for the safety of the city last year, our practice was, from the first, based upon these doctrines, and the great minds that led in rhe Weimar Confer- ence were the men that had most aided us in former years to deal with epidemic and infectious diseases. I am happy to learn that the Leipzig report is to be fully illustrated by maps and charts to show precisely what course cholera has pursued in European cities. We may hope to receive copies next month. I regret that the Abstract forwarded by Professor Pettenkofer cannot be entirely translated and placed in your hands to-day. These pages contain the gist of the whole, but the debates touched upon a great many other points. We are a little sur- prised that some conclusion and recommendation on quarantine was not reached. But, since the fact has been demonstrated that persons who travel away from an infected district may themselves, W'hile yet journeying and not sick, spread cholera, by means of excremental evacuations, it is not surprising that little reliance should be placed upon quarantine regulations as a means of preventing cholera from spreading in Europe.-- Phila. Medical $ Surgical Reporter.

PMC9999973

WK IX 0 11 f e $ We have space, in the present number, only sufficient to acknowledge the reception of the following important works: The Practice of Medicine and Surgery Applied to the Diseases and Accidents Incident to Women. By Wm. H. Byford, A.M., M.D., Author of "A Treatise on the Chronic In- flammation and Displacements of the Unimpregnated Ute- rus," and Professor of Obstetrics and Diseases of Women and Children in the Chicago Medical College. Second edi- tion, enlarged. Pp. 616. Philadelphia: Lindsay & Bla- kiston. 1867. Price, $5.00. Studies in Pathology and Therapeutics. By Samuel Henry Dickson, M.D., LL.D., Professor of Practice of Physic in Jefferson Medical College, etc., etc. New Tork: Wm. Wood & Co. Publishers, 61 Walker Street. 1867. Duodecimo. Pp. 201. For sale by W. B. Keen & Co., 148 Lake Street. Headaches: Their Causes and their Cure. By Henry Gt. Wright. M.D., M.R.C.S.L., L.S.A., Member of Royal Col- lege of Physicians of England, etc., etc. From the Fourth London Edition. Duodecimo. Pp. 154. Philadelphia: Lindsay & Blakiston. 1867. Price, $1.25. Inhalation: Its Therapeutics and Practice. A Treatise on the Inhalation of Gases, Vapors, Nebulized Fluids, and Powders, including a description of the Apparatus employed, and a record of numerous experiments, Physiological and Patholog- ical, with cases. By J. Solis Cohen, M.D. Illustrated. Philadelphia: Lindsay & Blakiston. 1867. Price, $2.50. For sale by S. C. Griggs & Co., 39 and 41 Lake Street. Notes on the Origin, Nature, Prevention, and Treatment of Asiatic Cholera. By John C. Peters, M.D. Second Edi- tion, with Appendix. New York: D. Van Nostrand, 192 Broadway. 1867. Duodecimo, pp. 200. Epidemic Meningitis, or Cerebro-Spinal Meningitis. By Al- fred Stille, M.D., Prof, of Theory and Practice of Medi- cine, and of Clinical Medicine, in the University of Pennsyl- vania, etc., etc. Philadelphia: Lindsay & Blakiston. 1867. For sale by Cobb, Pritchard, & Co., 81 Lake St. Price, $2.00. Hufeland's Art of Prolonging Life. Edited by Erasmus Wil- son, F.R.S., Author of A System of Human Anatomy, etc., etc. Philadelphia: Lindsay & Blakiston. 1867. Pp. 298. Duodecimo. Price, $1.25. For sale by Cobb, Pritchard, & Co., 81 Lake Street. Biennial Retrospect of Medicine, Surgery, and Allied Sciences. Edited by Mr. H. Power, Dr. Anstie, Mr. Holmes, Mr. Tiiomas Windsor, Dr. Barnes, and Dr. C. Hilton Fagge, for the New Sydenham Society. Philadelphia: Lindsay & Blakiston. 1867. For sale by S. C. Griggs & Co., 39 and 41 Lake Street. Price, $3.50. Lectures on Diseases of Women. By Charles West, M.D., Fellow of the Royal College of Physicians, etc., etc., etc. Third American from the Third and Revised English Edition- Philadelphia: Henry C. Lea. 1867. For sale by W. B. Keen & Co. Price, $3.25.

PMC9999976

ACTION OF BELLADONNA IN DISEASE OF TITE CORNEA. By JOS.- S. HILDRETH, M.D., Chicago, 111. The use of belladonna, or other mydriatic, in some forms of corneal disease, is indispensable; while in others it becomes un- necessary, and often injurious. From the complex structure of the eye, rendering it suscep- tible to numerous pathological changes, arises this apparently diverse action. In the normal eye, the cornea is endowed with a delicate sen- sitiveness to the lightest touch; the pupil quickly responds to the influence of atropia, and its effects are quite persistent. This corneal sensitiveness remains, whether the pupil be dilated or contracted. But clinical observation has demonstrated a condition of the eye in which the nervous integrity of the cornea is so disturbed as to cause a peculiar state of anaesthesia; the dilatability of the pupil is correspondingly lessened, and the effects of atropia are of shorter duration. By gently touching the cornea with the point of a small camel's hair pencil, previously wet and stripped quite dry, or the point of a small roll of soft paper slightly moistened, the degree of anaesthesia is determined. By instilling one drop of a solutiou of atropia of definite strength* within the lids at intervals of fifteen minutes, the dilatability of the pupil can be estimated. These signs are pathognomonic of a condition which appears to be due to some defect of nervous action, which causes con- traction and congestion of the ciliary ring. The symptoms may be acute, with more or less congestion, or chronic without it. There is another distinct form of corneal anaesthesia, which occurs in all glaucomatous affections. It is invariably produced by intra-ocular tension, and with a pupil dilated or readily dila- table ; and, therefore, materially differs from that above de- scribed. As there is no intra-ocular tension, and dilatability of the pupil is invariably diminished in the former, I have designated it as anaesthesia of the cornea and radiating fibres of the iris without intra-ocular tension, in contradistinction to the latter. It is found that, as the depressed vitality of the cornea im- proves, normal dilatability of the pupil returns. To dilate and so maintain the pupil, relieves the anaesthetized cornea. Nov. 30, 1866. Mr. B--------, aged 35, bookkeeper. Slightly scrofulous and debilitated by overwork. Four months previous had an attack of iritis in left eye which lasted two weeks. It was uncomplicated ; no injury re- sulted; accommodation and vision were good. Was able to use both eyes without difficulty on the 28th. Felt trouble in the left eye the 29th, for which no cause can be assigned. An irregular transparent ulceration quite deep, three milli- metres wide, extends from lower margin of cornea four milli- metres towards the pupil. The adjoining parts appear slightly infiltrated. The cornea is anaesthetized, especially the inferior * Four grains of neutral sulphate of atropia to one ounce of water. three-fourths. The pupil, smaller than the opposite, feebly re- sponds to reflex movements and light. No other apparent dis- turbance of cornea or iris. Slight perikeratic injection. No inflammation or anaesthesia of conjunctiva, sclerotic, or lids. No evidence of paralysis of any part. Moderate photophobia and pain in central parts of globe. Three drops of atropia solution, instilled within the lids five times during one hour and a-half, produce dilation of the pupil, and diminish corneal anaesthesia. To apply two drops of same solution, within the lids, four times during the next twenty-four hours, and keep the eye well shaded. No other treatment. Dec. 1st. Pupil more dilated; corneal anaesthesia nearly re- moved. The ulceration is covered by a grayish exudation, and the re- mainder of the cornea is transparent. Perikeratic injection has nearly disappeared, and pain abated. Continue treatment. Dec. 2d. Pupil well dilated; cornea quite free from anaesthe- sia; reparative exudation augmented. Continue treatment. Dec. 4th. Pupil largely dilated, and no anaesthesia of cornea. Ulceration improving; no perikeratic injection or pain. To apply one drop of atropia solution twice daily. The tongue being coated, with sensation of dryness of the fauces, muriate of ammonia mixture ordered * * R.--Ammoniae Muriatiss,----------------------------- 1 dram; Potassae Chloratis,____________________________ss dram; Aquae Destillatae,----------------------------- 3 f oz. Syrupi Auranti,________________________________ 1 f oz.--M. Sig.--One teaspoonful from three to six times daily. Dec. 10th. Repair of cornea quite complete. A few delicate vessels pass from its border, a short distance upon the newly formed material. Cornea free from anaesthesia, and pupil largely dilated. Muriate of ammonia mixture, and atropia discontinued. Brown's citrine ointment to be applied three times weekly to the conjunctiva. To take a tonic mixture of bark and iodine. Dec. 28th. The ulceration has healed, leaving a slight bluish trace. The pupil free in its movements, responds to reflex movements and light. Cornea free from anaesthesia. Vision and accommodation good. In this case congestion and contraction of the ciliary ring produced anaesthesia of the cornea and radiating fibres of the iris. The patient being scrofulous and debilitated, keratic ulcer- ation speedily followed. Atropia, by relieving the congestion and contraction of the ciliary ring, restored the nervous integrity of the cornea, and allowed the reparative process to go on. Sept., 1866. W------, aged 18, printer. Constitution good, little debilitated. Cornea largely nebulous; the epithelium and parts immediately beneath being disturbed. Pupil par- tially dilates with free use of atropia. With contracted pupil, cornea anaesthetized; with dilated pupil, nearly free from anaesthesia. No other apparent disturb- ance in cornea or iris. No perikeratic injection, or inflamma- tion of sclerotic, conjunctiva, or lids. No evidence of paraly- sis of any part, or anaesthesia of conjunctiva, lids, or face. Pain in central parts of globe. This patient was under observation for over six months. Shortly after commencement, he took a small quantity of iodide of potassium. No other general treatment was employed. The pupil was dilated by atropia, and red precipitate oint- ment* applied within the lids once to three times weekly. To- wards the close, the yellow amorphous oxide of mercury, in ointment.! was substituted four times, at intervals of a week. * R.--Hydg. Oxyd. Rub.,----------------------8 grains; Hydg. Chid. Mite,____________________12 grains; ip-; Axungiae,_____________________________ 2 drams; Misce bene. Sig.--A piece the size of a grain of wheat within the lids, f R.--Hydg. Oxyd. flavi,______________________________ ss dram; (via humida parati) Axungiae,______________________________ ss oz. Misce bene. Sig.--To be used in the same manner as the red precipitate ointment. While the pupil was kept fully under the influence of atropia, progress on the part of the cornea, was very manifest; but as soon as the pupil was allowed to contract, the cornea made no improvement. This was frequently repeated, and, as in all similar cases, with the same result. April 13, 1867. Pupil normally dilatable ; reflx movements, vision, and accommodation are good. In this case, contraction of the ciliary ring, without apparent congestion, produced corneal anaesthesia and diminished dilata- bility of the pupil. The condition of the cornea indicated stimulation; but this could not take effect until the ciliary ring had been relaxed by belladonna, and the corneal nerves relieved. From numerous observations, the above cases have been se- lected as representing acute and chronic forms of anaesthesia of the cornea, and diminished dilatability of the pupil arising from those disturbances in the ciliary ring specially described, and illustrate the action of belladonna in this class of cases. Injurious results have not been observed to follow its pro- tracted use. But, when these conditions are absent, mydriatics are not requisite in uncomplicated keratic disease, and often become injurious, by producing atropinism of the eye. Hence, in affections of the cornea, occurring: a. With an- aesthesia and diminished dilatability of the pupil, belladonna is indicated, b. With normal dilatability of the pupil and absence of corneal anaesthesia, belladonna is not required. The conditions indicating the use of mydriatics frequently exist to a degree requiring surgical interference to enable the drug to take effect. Division of the ciliary ring is then often required. Inasmuch as more or less of the aqueous humor escapes during this operation, the beneficial results are attributed, by some, to diminished intra-ocular tension. By direct experiment it has been demonstrated that relief of corneal anaesthesia and diminished dilatability of the pupil, in these cases, are the result of a thorough division of the ciliary ring, and not due to evacu- ation of the aqueous humor. Paracentesis of the anterior chamber may in some cases of this class prove serviceable by diminishing congestion of the ciliary ring, but not otherwise. In one instance, contraction of the ciliary ring was found to co-exist with glaucoma. Iridectomy necessarily removed all intra-ocular tension, but failed to relieve the corneal anaesthesia. Division of the ciliary ring fifteen minutes afterwards at once accomplished that result. The length and title of this paper preclude anything further upon surgical treatment.--Trans, of Amer. Med. Association.

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$ e u r 11 a n $ CLINICAL PAPERS ON EAR DISEASE. By D. B. St. JOHN PvOOSA, M.D., Prof, in the University Medical College. NO. I.--INSPISSATED CERUMEN. It is intended, in the papers which are proposed under the above title, to present some of the practical results of an ex- perience in ear diseases, reaching over quite a large number of cases, in such a way that they may be useful as a guide to those who see comparatively little of the diseases of this organ. Among the laity, and even in the profession, hardening of the ear-wax is regarded as quite a common and harmless affection. All forms of deafness are ascribed to this cause, and the first treatment that many ear patients receive, is a vigorous syring- ing to see "if the wax be not hardened," and this often with- out any preliminary examination. Impacted cerumen is indeed quite a common occurrence, but it is by no means as simple an affair as has been generally supposed. I do not mean by this, that it is anything more, as a general thing, than a local affec- tion, but as such, it may produce results very detrimental to the function of hearing. It hardly seems to occur more fre- quently in persons with a soft skin than others, as has been suggested by some authors, for among the patients whom I have seen, careful examination has failed to detect any such origin. Persons with a dry and harsh skin have as often come to me with impacted cerumen, as the opposite class. A frequent cause is the too careful washing of the auditory canals with soap and water, which some over-clean persons delight in doing. This rinsing out the canal plugs the natural yellow wax, which is on its way out, down to the bottom of the canal, and being continued morning after morning, at last fills up the ear, and when the drum is once fairly covered, and pressed upon, and not till then, deafness results. It is somewhat remarkable how long persons may have the ears plugged up with hard wax without being aware of it. On examining persons who present themselves with impacted wax, only causing deafness on one side, we will nearly always find the same condition of things as to the wax, in the other ear. If the cerumen be very black and hard, and if it comes out in one large plug, we may con- clude that it has been there for years. I recall two cases in which, from definite accounts, we could safely conclude that five years had elapsed since the deafness occurred. In both of these cases, the hearing became normal after the wax was removed. Impacted wax sometimes causes serious inflamma- tion of the canal and drum. In one case, that of a young lady, suppuration of the drum resulted from hardened wax pressing upon it, and the wax was removed spontaneously like a shot from a pistol, and, as was stated, with almost as loud a report. This evacuation was preceded by the most intense pain. The removal of a plug three-fourths of an inch long from the other auditory canal, and which was wedged in very tightly, saved the patient from the inflammation which was so troublesome on the other side. In another case, still under treatment, what was supposed to be on first examination a plain case of inspissated cerumen, was found, after removal of the wax, to be one of inflammation of the integument which lines the canal. The removal of the hardened wax was, as it were, only the removal of a huge scab from an ulcerating surface. I have seen other cases like this. Inspissated cerumen causes many symptoms. The prominent ones are: 1. Sudden deafness. 2. Tinnitus aurium. 3. Vertigo. 4. Earache. Of course, an examination is the only method of clearing up the diagnosis. This examination should be undertaken with the ear mirror, (or otoscope, properly called,) and not with the syringe. In other words, it should be ocular, and not tactile. The trouble can hardly be confounded with any other affection. Wax which presses upon the drum is almost always black, not yellow, and nearly fills the canal. No decided prognosis can be given from seeing the wax, as to whether its removal will restore the hearing. Hardened cerumen very often forms over a perforated or ulcerated membrana tympani, and is then of course only a small part of the disease. It often results, also, from the dropping of oils into the ear for some therapeutical end seldom attained. The original disease for which the oils were used was then probably an affection of the cavity of the tympanum. The habit of examining the ear in all cases with head symp- toms, will sometimes assist materially in clearing up a diagnosis. I once cured a man from the effects of a supposed sun-stroke, by removing inspissated cerumen, who had been treated for two months in a hospital for cerebral disease. Patients who have once had impacted wax, are apt to suffer again from the same cause, at least I have seen quite a large proportion of cases in persons who have been affected in the same way before. Such may be advised to have their ears syringed with a solution of bicarbonate of soda and water, about once in two months. The removal of the hardened mass is very often a tedious affair. I once spent an hour a day for a week in removing a mass from the ear of a lady patient. In the interim, the best solvents, such as soda, were used. With pre- vious soaking the canal with a warm solution of soda, say a drachm to the half pint, ten minutes will generally suffice to remove the mass. A good india-rubber syringe, holding at least four ounces, should be used, and the auditory canal well straightened by holding up the auricle with the left hand, at the same time syringing with the right. The glass syringes are of no use. The stream sent in should be vigorous but steady, and care taken not to eject it with such force as to cause pain or dizziness. There should never be any pain caused in syringing the ear for any purpose. Where pain is produced, syringing will do harm. A thin bowl is held under the ear by the patient. No assistant is needed. No towel need be placed on the patient's neck, for, with careful manipulation, no water will be spilled. The ear may contain an astonishingly great quantity of hardened ear wax, and an examination should be made very frequently during the course of the syringing to determine when it is all removed. No after-treatment is necessary. If, however, sounds are oppressive, as they often are, after the removal of large quantities of ear wax, a little cotton may be worn in the meatus for a day or two. The membrana sympani always appears reddened immediately after the removal of the cerumen, and then dull. It will be some days before it regains its normal translucency. If the hearing be not improved im- mediately on removing the wax, the middle ear should be inflated by PolitZer's method. The drum is sometimes sunken in temporarily, and one or two passages of air through the eustachian tube will restore its position as well as the hearing. Professor Gross recommends the use of a pick for the removal of impacted wax. This does very well as an aid where the wax is very hard. If it be used, the surgeon should have a mirror on his forehead, and never put the pick in the canal, unless he can see just what he is doing. Painful and even destructive inflammation may be caused by this mining out process. The gen- eral practitioner, to whom ear cases come in only a small pro- portion in his daily rounds, had much better rely on the use of a syringe and warm water where possible, having previously moistened the canal with a warmed solution of soda, zinc, sulph., or with glycerine and water, sweet oil, etc. Inspissated cerumen rarely occurs in children. I suppose there is no dif- ference in the liability of the sexes, and I know of no well- established proximate cause, except the one given in the begin- ning of this article, z.e., packing the meatus by the frequent pouring in of water. Yet, we might say that it is common for hardened wax to collect about a foreign body in the ear, such as a raisin, introduced originally to relieve earache, a cherry- pit, etc., but here the inspissated cerumen is only a concomitant. It is hardly to be credited, although formerly generally believed, that a diathesis has anything to do with it, or that there is any disease of the ceruminous glands. The cause is probably in one way or another mechanical--that is, there is some interfer- ence with the normal and daily removal of the secretion.-- Medical Record.

PMC9999979

ARTICLE LIL. ON THE SOCIAL EVILS, WITH A PLAN FOR THEIR DIMINUTION, AND A PLEA FOR THE INNOCENT AND HELPLESS. By GEO. J. ZEIGLER, M.D. The subject of the limitation of prostitution with its dreadful concomitants, so ably treated of by Prof. Andrews, in the last number of your excellent journal, is one that appeals to every true philanthropist, and especially to the members of the medi- cal profession, who are, unfortunately, better practically ac- quainted with its terrible evils than any other class of men. But, while it is desirable to ameliorate the disorders of the body politic, induced by the illicit intercourse of the sexes, it is much more essential to remove the primary causes of such abnormi- ties, in order to prevent their occurrence and preserve the health and purity of society. This, however, can only be effected by acting in accordance with the natural laws for the development of life and the government of humanity. Among the many millions of human and other living beings existing in the world there is a certain degree of sexual activity for procreative and other purposes. This sexual instinct is so strong and energetic in the mass of mankind that it cannot be restrained, and in one way or another must be satisfied; for it is a well-known fact that, if these natural desires are not legitimately gratified, irregular indulgences and disorders of various kinds ensue, prominent among which are derangement of the brain, neryous system, genital apparatus, etc., with demoralization, unnatural habits, illicit intercourse, diseases of the sexual organs and general system, and premature destruction of life. Now, as these natural appetites cannot be repressed, they must be regulated, by so reorganizing society as to permit or compel a more regular flow of the sexual current and equable reunion of the sexes. Prostitution, with its attendant evils, is the more immediate result of a defective state of society, for, though dependent, pri- marily of course, upon the undue activity of the sexual appetite, it is always increased by the difficulty of legitimate association and the false ideas respecting marriage, in which woman is placed at a great disadvantage. The prevalence of prostitution cannot be wholly attributed to the inherent depravity of those who sink into it, but mainly to necessity and the extraneous force of circumstances, as it is most likely that woman is gen- erally influenced in her sexual relations more by the strength of her sympathies and the warmth of her affections, than the intensity of her animal desires; for, were it otherwise, the world would be sunk in the grossest licentiousness. , Now, as there are comparatively few women who voluntarily become prostitutes, some decided effort should be made to pre- vent this wholesale sacrifice of so many of the fairest and purest of our kind, for it is a lamentable fact that the majority of those who thus lapse from virtue are the healthiest and hand- somest of their sex, strength and beauty being powerful incen- tives to sensuality and essential elements for the successful pur- suit of a disreputable life. Besides, the necessity for some positive effort in this direction is the more imperative, as the evil is not limited to any .one class, but involves, to a greater or less extent, the whole human family, society being thus doubly outraged by the withdrawal of so much that is desirable for the legitimate relations of life, and the reactive injury to the body politic from the poison engendered therein by the vicious action of many of its most vigorous members of both sexes. But, for the requisite efficiency, such action must be based upon the fundamental principles of equity and justice, by fully recogniz- ing the correlative rights, duties, and obligations of the respect- ive sexes. That these are entirely too much disregarded at present, is apparent; for, as it now is, a man may corrupt and seduce a woman, debauch and disease her body, impregnate and beget her with child, and then discard her as a strumpet, he being comparatively free to leave her and repeat the fiendish act with others of her sex, with little risk from the law or loss of social caste. It is, however, quite the reverse with the mis- guided woman, for, on disclosure of her frailty, there is immedi- ate loss of social status, and her only alternative is either to seek personal or legal redress with the publication of her dishonor, or to remain quiescent and hide or endure her shame as best she can, or give herself up entirely to an abandoned life; and, when impregnated, to resort to abortion and commit child-murder in the wild effort to save her reputation, or submit to exposure and live the balance of her days under the ban of reproach as a degraded being--from which she may, perchance, be relieved by an acknowledged marriage, or, finally, as is so frequent, lapse into prostitution; while her innocent child is regarded as a waif, treated as an interloper in the human family, and branded with the ignominious titles of illegitimate, natural, bastard, etc. The same injustice is also manifested in the general action of society, in the difference between the penalty inflicted in a sim- ple breach of promise of marriage and seduction, for a man is apt to incur more social obloquy and greater legal punishment for the mere violation of a promise of marriage by word of mouth, than for the actual degradation of the woman by seduc- tive cohabitation, the injury to the female being comparatively slight in the former to that of the latter--attended, as it always is, with loss of virtue, often, also, character, and, frequently, utter ruin; yet, the latter is treated so generally as the lesser, and the former the greater crime. Now, this is obviously all wrong; yet, as a necessary result of the present imperfect social system, it is maintained as right, thus sanctioning evil and sustaining measures tending to the permanent degeneracy of the race, when by conforming more with the natural laws of life, such deterioration might readily be obviated. But to this end, as before intimated, there must be a radical change in the present views and customs of society respecting the natural affinities of the sexes, marriage, procrea- tion, the rights of children, and the relations of life in general. It is an acknowledged fact, that there are supreme natural laws governing the action of individuals and of the entire body politic, relating to the association of the sexes, births and deaths, as of everything else, and all issues in accordance therewith are necessarily legitimate, and cannot, without positive perversion, be regarded otherwise; hence, the usual conception of illegiti- macy is, it appears to me, altogether wrong, being based upon false premises. Indeed, the prevailing ideas respecting this subject of illegitimacy are so erroneous as to be a disgrace to the vaunted intelligence, Christianity, and civilization of the age. Thus, in the case of children, for instance, the very fact of their birth makes them legitimate in the natural order of things, the same as the production of the lower animals and other forms of life. But, even according to human estimate, there are very few children who could at all be considered oth- erwise than legitimate, and these only from the association of married men with single women or other men's wives, and single men with married women; all others are, unquestionably, enti- tled to immediate acknowledgement, and should be legitimatized by legal enactment recognizing the fact that cohabitation and marriage go together, the fact of sexual union being sufficient evidence of marital consent on the part of those thus indulging. This act of sexual conjugation being voluntary on the part of both male and female, and the essential element for procreation --the ultimate design of marriage--should be as conclusive of the marital union of men and women by the laws of man as they are by those of God; for, as generation occurs from sex- ual intercourse by the operation of the laws of life, without regard to human ordinances regulating the marital relation, it is, in reality, the only natural and true marriage physically considered, and, humanly, should be so acknowledged. Hence, as these so-called natural children are the fruit of a natural union of the sexes, and the product of natural marriage, by the operation of natural laws they have, ipso facto, the natural right to legitimacy, and should be legitimatized by human as they are by divine power, while their progenitors should be bound together by their marital tie, as well as obliged to recognize and provide for their offspring. Moreover, in those cases of forced conjunction, as in rape, the permanent association might also be made obligatory, if the injured female should decide that the union, thus involuntarily formed on her part, should be binding, although, even here, in the absence of such desire for its continuance, when impregnation occurred, justice would demand some provision for the legitimacy of the progeny, which might be effected by the application of the same rules as govern in divorce. Of course, if the decision of the woman be adverse to this coerced marriage, the ravisher should be severely punished, as usual. Furthermore, even in those appar- ently exceptional cases, arising from the intercourse of married men with single women or other men's wives, or single men with married women, the children should also be legitimatized by direct affiliation on the father. These views are necessarily based upon the idea of monogamy --or the union of one man with one woman--and limited, of course, to those thus first cohabiting; or, secondarily, only as at present, by the loss of the former companion, all other con- nections being polygamous and illegal, to be punished as bigamy. This plan is not, however, intended to interfere with the usual preliminary espousals, but designed rather to enlarge the sphere of legitimacy to its natural limits, in enforcing the recognition of an union contracted without preceding nuptial formalities, by legalizing marriages thus naturally consummated, and legit- imatizing children engendered and born out of ordinary wedlock, thereby lessening seduction and diminishing illicit intercourse with its attendant evils. The general adoption of this plan of legalizing marriages sex- ually consummated, would undoubtedly result in great good to all and harm to none, as, like the pledge by word of mouth, it would bind parties together only by their own act, force them to regard the sacred obligations thus incurred, and compel them to legitimatize and care for their progeny, the same as the more honorable always voluntarily do. To say nothing of the demor- alization of men and women from illicit association, it is the height of cruelty to allow innocent beings to be thrust into existence tainted with dishonor, which, in the present state of public opinion, can never be effaced. Society has no right thus to brand the innocent with infamy and debar them from the normal relationship of life, whatever it may do with their offend- ing parents. But, aside from the gross injustice of the act, and in view of the supremacy of the natural laws for the evolution of life, it is perfectly absurd to deny to children thus organized the claim to a legitimate birthright. It is just as foolish to thus proscribe these unfortunates, as it would be to reject the fruit from the tree because it had not grown in accordance with human ordinances, both being equally passive in their develop- ment within the great organism of life. Thus, by the legal recognition of the fact that the act of sex- ual conjugation constitutes marriage, and binds the cohabiting parties as closely together in the marital relation as extraneous nuptial ceremonies now do, all disgrace would disappear, mo- rality be promoted, weak women and innocent children pro- tected, seduction, abortion, child-murder, prostitution, degrada- tion, disease, and premature death diminished, and society be relieved of much of the evil which now so justly afflicts it, for permitting the present shameful state of things to exist. It is, hence, both inexpedient and unwise, as well as unjust, to tolerate a system at variance with the principles of physi- ology, morality, religion, civilization, and infinite justice, which entails so much misery upon innocent beings and humanity in general, when, by the adoption of a more perfect jurisprudence, relief could be so readily obtained and mankind so greatly benefited. Believing the preceding to be the true solution of a great social problem, and its practical application of inestimable value to humanity, it is the earnest hope of the writer that these few thoughts may enlist the sympathies and unite the efforts of all philanthropists to enact this suggestion into a rule of life, by proper education of society and suitable legislation on the sub- ject, thus bringing human jurisprudence in entire harmony with the natural laws. But as medical men are most familiar with the principles involved in this great question, and their influence is commen- surate with their knowledge, they are especially invited to give this proposition their serious consideration, with a hearty coop- eration, to insure the substantial realization of the proposed, or some better plan for thus benefiting their fellow-beings. Philadelphia, Nov. 1867.

PMC9999980

(n fl 11 o r 1 ii I Close of tjie Volume.--The present number closes the Eighth Volume of the Examiner. Severe sickness in our little family circle, prevents us from giving our intended clinical report and some editorial articles. We can, at present, only thank our patrons for their past favors, and express the hope that they may be continued. Transactions of the Illinois State Medical Society.-- The Transactions of our State Medical Society for 1867, are now ready for distribution to the members. The publication has been delayed, at least two months, by the late reception of the report on Plastic Surgery. Professional Appointments.--The following changes have been made in the Faculty of the Long Island College Hospital: Dr. C. L. Ford has accepted the Chair of Anatomy, and Dr. Foster Swift, that of Obstetrics and Diseases of Women and Children. Dr. Sam'l G. Armor has been transferred to the Chair of Principles and Practice of Medicine. Dr. Austin Flint retaining the Chair of Clinical Medicine. Notice.--Prof. Davis:--I am pained to announce the death of Jas. F. Spain, M.D., in Urbana, Ohio, on the morning of October 13th last. Dr. Spain was a man of superior mental and social qualities, and was known only to be loved. Dr. Spain graduated in Rush Medical College, in the spring of 1860, with honor to the school and himself. He died from an attack of apoplexv of the brain. D. B. WREN, M.D. REPORT ON THE SANITARY CONDITION AND PREVALENCE OF DISEASE IN CHICAGO DURING THE MONTHS OF JULY, AUGUST, AND SEPTEM- BER, 1867. By N. S. DAVIS, M.D., Member of the Sanitary Committee. Read to the Chicago Medical Society. In my previous report to this Society, ending June 30th, it was stated that the meteorological and sanitary conditions during the preceding three months, had been such as to favor a good condition of public health, and a low ratio of mortality.* The last week in June was represented as hot, oppressive, with south winds during each morning, but cool and bracing with west and north-west winds in the evenings. * See Med. Examiner, for August, 1867. The first day of July was clear, cool, and bracing, with a prevalence of north-west winds. The 2d, was ushered in with a hot, oppressive atmosphere, and south wind, which was contin- ued until 4 o'clock P.M., when it suddenly changed to the north- east, became boisterous, with clouds and thunder, but no rain. The 3d, was warm and cloudy, with slight rain in the morning, followed by west wind and copious showers of rain at evening. The morning of the 4th was hot, damp, and oppressive, with south wind. Early in the afternoon the wind changed to the north, the atmosphere became cooler, and the night was cool and clear. The 5th and 6th were moderately warm, sultry, with south and south-west wind, and a drizzling rain nearly all of both days. The 7th, was clear, dry, and cool, with northerly winds all day. The 8th, atmosphere clear, wrarm, and oppres- sive, with south wind during the morning. In the afternoon, rain fell, during which the wind changed to the north, bringing a cold, clear atmosphere in the evening; and which was con- tinued through the 9th. The morning of the 10th was ushered in with a strong south wind, hot and oppressive, with showers of rain at midnight. The 11th, was cloudy, damp, moderately warm, with wind, first south-west and then west. The 12th and 13th, mostly clear, dry, and cool, with light winds from the west and north. The 14th, was clear, hot, and oppressive, with south wind all day; but during the night, the wind changed to the north-west, bringing a cold, drizzling rain, which lasted until noon of the 15th, when the atmosphere became cool, clear, and dry, and continued so until the morning of the 17th. From the 17th to the 22d, the atmosphere was mostly clear, mode- rately hot, with cool nights, and very little wind from any quarter. There were clouds and slight rain on the 19th. The night of the 22d, like the day, was hot, clear, oppressive, with only slight wind from the south. These atmospheric conditions continued until the evening of the 24th, when there was slight rain, followed by thunder and slight rain on the morning of the 25th, with a continuance of high heat and dampness of atmosphere. In the evening, the wind changed to the north- west, bringing first light showers, and afterwards a cool, clear atmosphere, which continued until afternoon of the 26th, when the wind changed to the south, and the heat and dampness again became very oppressive, and continued so until the morn- ing of the 28th. From this date until the evening of the 30th, a strong west and north-west wind prevailed, with a cool, dry, and bracing atmosphere. During the night of the 30th, the wind changed to the south, bringing a copious warm shower at 4 o'clock A M. of the 31st. The heat and dampness continued until 3 o'clock P.M., when the wind suddenly changed to the north-west, accompanied by an active thunder shower, and fol- lowed by a temperature so low as to be very chilly. It is thus seen, that the prominent meteorological character- istics of July were, frequent changes in temperature, in atmos- pheric currents, and frequent light falls of rain, with a mean average temperature for the month about ordinary, it being several degrees lower than the mean temperature of July 1866; and slightly above that of the same month in 1865. In regard to local sanitary conditions, it may be said, that much greater efforts had been made to keep the streets and alleys free from garbage and decomposable materials, and to prevent the out-door privies from becoming full, than in previ- ous years. Yet these efforts on the part of the Board of Health were only partially successful, there being during all the month, in some populous portions of the city, unopened ditches, full privies, and other materials capable of decomposition under a July temperature. The gross mortality for the month was 538, being 168 less than for the same month in 1866, and 113 more than in July 1865. The increase over 1865, is mostly owing to the increase of population, while the excess in 1866 was the direct result of a prevailing epidemic influence, of a choleraic character. This is shown by the following comparison: Whole number of deaths from bowel-affections in 1865 1866 1867 July,_____________________ 163 299 236 More than 80 per cent of this large mortality from bowel- affections in July of each year, occurred in children under three years of age. The connection of this excessive infantile mor- tality with the first high temperature of every summer, is shown by comparing the mortality in July in each year with that of June. Thus: The mortality from bowel-affections in , 1865 1866 1867 June,__________________________ 20 45 21 July,_________________________ 163 299 236 A more detailed observation of facts, further shows that a large proportion of the attacks in children commence on partic- ular days, when the temperature of both day and night is high, with an excess of atmospheric moisture. Thus, of 73 attacks of cholera-infantum, diarrhoea, etc., coming under my own observation, during July, 1867, 56 were found to have com- menced on the following days, namely, 18 on the 3d and 4th; 10 on the 10th and 11th; 11 on the 13th and 14th; 7 on the 19th; and 10 on the 22d and 23d. By referring to the meteor- ological facts already given, it will be found that these are the days preeminently characterized by high temperature, oppres- sive south winds, and excessive moisture. The first case of well-marked, spasmodic cholera that came under my observation during the month, was a little girl, in the rear of 351 Illinois Street, who was attacked during the hot, sultry morning of the 4th, passed rapidly into collapse without medical treatment, and died on the morning of the 6th. The next was a man, in the rear of 124 South Jefferson Street, who was attacked with serous diarrhoea on the 11th, which culmi- nated in the full choleraic symptoms during the night of the 13th. Two cases occurred on the 20th: one was a woman in the rear of 331 Fourth Avenue; the other was a child, 2 years of age, in the rear of 24 West Harrison Street. Both these patients passed rapidly into collapse and died. The fifth case commenced on the 22d, in an intemperate man, living at 119 South Market Street. On the 23d, two cases occurred: one, a middle-aged woman, at 197 Van Buren Street; the other, also a female, about 30 years of age, residing at 70 West Indiana Street. Both these were violent cases, and had passed into collapse before I saw them. They died on the morning of the 25th. Another well-marked case occurred, in a woman in ad- vanced life, at 202 Sebor Street, on the night of the 24th. She was placed under treatment early, and recovered. During the same day, a man, at 342 West Kinzie Street, was attacked with cholera diarrhoea, which ended in the development of full chol- era symptoms, on the 25th; but he recovered. At 3 o clock A.M. of the 31st, a man was attacked with active cholera symptoms, at 54 Fourth Avenue, but he recovered. The cases here alluded to as cholera, were as well characterized in their symptoms as any cases that occurred during the summer and autumn of 1866, and they were, consequently, reported to the Board of Health. During the last week of the month, I saw many cases of dys- entery, in which the evacuations were bloody serum instead of mucus, accompanied by cool extremities, small pulse, and rapid prostration, constituting what has been called cholera dysentery. In making inquiries and noting carefully, from day to day, the exact commencement of cases of cholera-infantum, cholera- morbus, and spasmodic cholera, not only during the month now under consideration, but during the summer months of every year since 1849, I have fully satisfied myself that fifteen out of every twenty cases of these diseases have their first symptoms developed during days and nights when the atmosphere is hot, damp, and deficient in free electricity; or during the night time, in persons while sleeping in small, close, unventilated bedrooms. It is well known to every observing practitioner, who has seen much of cholera-infantum and epidemic cholera, that a large proportion of the attacks commence between mid- night and 6 o'clock A.M. And I have gathered sufficient data to show that the impure air of small or overcrowded and unven- tilated sleeping rooms, is one of the most potent exciting causes determining such results. August.--From the 1st of August to 11 o'clock A.M. of the 4th, the atmosphere was cool, dry, and nearly free from clouds, with a predominance of west and north-west winds. At 11 o'clock of the 4th, the atmosphere became still, or moved only by a slight breeze from the south, and hot and oppressive. It continued in the same condition until the afternoon of the 9th, when, suddenly, a brisk, cool wind came from the north, with flying clouds and slight rain. The 10th and 11th were cool and dry, with north winds. With the morning of the 12th came south wind and a hot, dry atmosphere, followed by copi- ous showers and sharp lightning in the evening. From the 13th to the 16th, the air was cool, dry, and pleasant, except about four hours of hot, oppressive atmosphere on the after- noon of the 14th. The 17th and 18th, were continuously hot and oppressive, with very slight wind from the south. The morning of the 19th was ushered in by a copious warm shower, speedily followed by a cool east, and, later, north-east wind, with a cool, rainy afternoon. From the 20th to the 25th, in- clusive, the atmosphere was cool and bracing, except two or three hours in the middle of each day, which were hot and oppressive. The wind veered each day from south-east in the morning, to north-west and north in the evening. Moderate showers fell in the evenings of the 21st and 22d, accompanied by fine displays of atmospheric electricity. With the morning of the 26th, came a warm shower, with south wind: hot and oppressive during the middle of the day, followed by copious showers and sharp lightning in the evening. From the 27th to the 30th, inclusive, the atmosphere was cool, dry, and pleasant, with chilly nights. The 31st was cold and rainy, with south- west wind. It is thus seen that the prominent meteorological character- istics of August were, a predominance of northerly winds, cool, bracing air, and a full average of atmospheric electricity. There were only eleven hot, oppressive days during the month, and only four of these were consecutive or continuous, one with another. Rain fell on seven different days, accompanied by thunder and lightning on four. During the first six days of the month, I met with no cases of either cholera-morbus or cholera-infantum, except such as had dated their commencement in July. But the continuous high temperature from the 4th to the 8th was accompanied by quite a number of new attacks on the 7th and 8th. During the warm days and cool nights from the 9th to the 16th, attacks of typhoid fever and dysentery became very frequent, especially among the laboring classes. Some new cases of cholera-infan- tum and diarrhaea occurred from the 17th to the 19th, and many old cases that had partially recovered were renewed. From this time to the end of the month, most of the new attacks of bowel-affections, both in children and adults, presented the form of dysentery; while typhoid fever continued to be of fre- quent occurrence. The only cases of cholera that came under my observation during the month, were the following:--A servant girl was attacked violently, during the hot, sultry night of the 4th, while sleeping in an overcrowded, unventilated room, in the alley in the rear of the.Opera House. She was placed under treatment early and recovered. A young man at 44 North Peoria Street, who had just returned from the country, was attacked during the latter part of the night of the 17th. He was placed under treatment almost immediately and recovered. The same morning (18th) I was called to an Irish laborer, at No. 48 Ohio Street, whom I found in a state of complete col- lapse, and he died during the same day. He had some diar- rhoea since the evening of the 14th, and all the symptoms of violent epidemic cholera supervened on the morning of the 17th. On the morning of the 19th, saw another Irish laborer in the same neighborhood, 77 Ontario Street, who commenced having diarrhaea at noon on the 18th, which developed into full and severe cholera during the latter part of the following night. Although passing to the very verge of collapse, he recovered. The local sanitary conditions in the neighborhood where these two cases occurred were bad. The drainage was very imperfect, several of the out-door privies were full to the surface, and a cow was stabled under the house No. 48 Ohio Street. On the 29th, I was called to see a man, at 645 State Street, who had been attacked with diarrhoea at Racine, about ten days previous. He was brought to the city on the 27th, when his symptoms assumed the character of severe spasmodic cholera. On the 29th, I found him with entire suppression of urine, pulseless, cold, very blue and corrugated on the surface, and all the phenomena of complete collapse. He died soon afterwards. It will be observed that all the foregoing cases, except the one brought from Racine, occurred on days or night3 when the atmospherPS was hot and oppressive, with south winds. The gross mortality for the month of August was 697, of which 340 were from bowel-affections, namely, cholera-infantum, 212; cholera-morbus, 7; cholera, 2; diarrhoea, 85; dysentery, 36. From personal observation, I am certain that a large majority of the fatal cases of cholera-infantum were such as hid their origin in July and had lingered in a chronic form until some time in August. And, on a strict diagnosis, a large proportion of them should have been classed as dysentery. Compared with the same month for 1865 and 1866, the result is as follows: 1865. 1866. 1867. Gross Mort. Bow.-Aff. Gr. Mort. Bow.-Aff. Cholera. Gr. Mort, Bow.-Aff. 464 208 940 376 139 697 340 We thus see, that while July and August of 1867 give a mor- tality much below the same months of 1866, it is so much above that of 1865 as to indicate a higher ratio in proportion to the population. We have occupied so much time and space with the meteoro- logical and other details concerning the months of July and August, that we will make only a brief allusion to September. It was characterized by no striking meteorological character- istics. The atmosphere was, a great part of the time, dry, warm in the middle of the day and cool during the night. The rainy days were few, and the amount of rain-fall below the average for this month in this locality. Bowel-affections in young children rapidly diminished, while dysentery and con- tinued fevers increased among adults. This is shown by the following comparison: Cholera-infantum. Dysentery. Typhoid. Typhus. July,__________________ 177 10 9 2 August,---------------- 212 37 13 5 September,-------------- 82 29 18 4 The total mortality for September was 507; being 232 less than in the same month of 1866, and 161 more than in Septem- ber 1865. I saw, during the month, only three well-marked cases of spasmodic cholera, one of which passed into fatal col- lapse in a few hours. The effect of local causes on the general mortality is strikingly illustrated, by comparing different sec- tions of the city. For instance, the total population of the 1st, 2d, 3d, 9th, and 10th Wards in 1866, was 63,747. The total deaths in the same Wards in August and September, 1867, was 190, or 1 to 335 of the population. The total population of 5th, 6th, 7th, 8th, 13th, and 14th Wards, was 69,670 The total deaths in the same Wards during August and September, 1867, was 555, or one to 125 of the population. The first series of Wards embraces the best drained and most substan- tially built portion of the-city, inhabited chiefly by the mercan- tile, professional, and business classes of the city; while the second series is the reverse, both in sewerage and building, and is inhabited chiefly by laboring classes of Irish and German nativity. The facts briefly, and perhaps imperfectly, set forth in this report, clearly establish two conclusions, of great etiological as well as sanitary importance:--The first is, that certain atmos- pheric or meteorological conditions are essential to the produc- tion of some of the most important endemic as well as epidemic forms of disease. The second is, that certain local sanitary conditions, relative to sewerage, house ventilation, privy accom- modations, cleanliness, and personal habits, are capable of increasing, in a three-fold degree, the injurious and fatal effects of the meteorological conditions alluded to. We cordially commend the following enterprise to the pat- ronage of our subscribers and readers.--[Ed. The Half-Yearly Compendium of Medical Science: Being A Synopsis of Practical Medicine, Surgery, and Medical Literature. The first part of this work will be issued from the office of the Medical and Surgical Reporter on the first of January, 1868. It will comprise about 300 pages royal octavo size, and will contain a well-prepared synopsis of the articles in the med- ical periodicals and monographs, and a general review of the medical literature of the preceding six months, both of this country and Europe. In the preparation of this work, we will be aided by many well-known writers, among whom are Drs. L. Elsburg, Samuel R. Percy, R. E. Van Gieson, F. I). Weisse, C. F. J. Lehlbach, S. W. Gross, George H. Napheys, J. E. Garretson, W. M. Tur- ner, A. Paul Turner, and others. The work will be systematically arranged under the following heads--subject to sueh modifications as time and experience may suggest--and supplied with a Copious Index of subjects and authors. I. ANATOMY AND PHYSIOLOGY. 1. Comparative Anatomy and Zoology; 2. General and Spe- cial Human Anatomy; 3. General and Special Physiology; 4. Embryology; 5. Pathological Anatomy and General Pathology. II. MEDICAL PHYSICS, BOTANY, CHEMISTRY, AND TOXICOLOGY. III. MATERIA MEDICA AND THERAPEUTICS. 1. Pharmacology; 2. General and Special Therapeutics; a. Electrotherapy; b. Hydrotherapy; c. Anaesthesia, etc. IV. GENERAL MEDICINE. 1. History of Medicine; 2. Statistical Medicine; 3. State Medicine--including Forensic Medicine, Hygiene Dietetics, and Preventive Medicine; 4. Epidemiology; 5. Animal and Vege- table Parasites; 6. Medical Bibliography. V. CLINICAL MEDICINE. 1. General and Constitutional Diseases; 2. Diseases of the Brain and Nervous System; 3. Blood Diseases; 4. Local Dis- eases, a. Respiratory Organs, b. Circulatory System, c. Organs of Deglutition and Digestion, d. Urinary and Male Genital Organs, e. Exanthematous Diseases. VI. OBSTETRICS AND DISEASES OF WOMEN AND CHILDREN. VII. SURGERY. 1. General Surgery--Tumors, etc.; 2. Mechanical Surgery; 3. Orthopaedics; 4. Military Surgery--Wounds, etc.; 5. Frac- tures and Dislocations; 6. Amputations and Resections; 7. Topographical Surgery, a. Head, Neck, and Breast, b. Eye and Ear, c. Nose, Mouth and Throat, d. Abdomen, e. Genital Organs; 8. Diseases of the Skin; 9. Gonorrhoea and Syphilis. VIII. VETERINARY MEDICINE. Terms of Subscription.--Subscriptions will now be received at the following rates: Compendium, per annum, two numbers,------------$3 00 " single number,-------------------- 2 00 " and Med. Surg. Reporter, per an.,- 7 00 S. W. BUTLER, M.D. \E D. G. BR1NTON, M.D. J ^(mors- 115 South Seventh St., Philadelphia. We earnestly hope that this national undertaking will be heartily supported by the profession. All who are willing to subscribe are requested to fill the following blank, and return to this office, before the 10th of December, as the size of the edition of the first number will be governed by the encourage- ment we receive. Money Receipts till November 25th, 1867.--Drs. J. Good, Warren, Ind., $3; R. M. Buchner, Aroma, Ill., 3; T. A. Bunnell, Chicago, 3,75; O. T. Maxon, Chicago, 6; John McHugh, Urbana, Ill., 2; Geo. W. Keener, Venice, Ill., 3; John Bell, Benton Harbor, Mich., 3; R. S. Lewis, Dubuque, Iowa, 3; B. Ragon, Roseville, Ill., 3; C. M. Spalding, Byron, Ill., 3; T. H. Bras, New Boston, Ill., 7; W. Stewart, Otumna, Iowa, 9. Mortality Report for the Month of October:-- The monthly report is as follows:-- CAUSES OF DEATH. Accidents,_____________________ Id Angina Menibanacea,------------- 2 Anaemia,------------------------ 1 Apoplexy,----------------------- 2 Asthma,------------------------- 1 Aseitics,----------------------- 1 Atrophy,------------------------ 2 Birth, premature________________ 9 " still_______________________26 " tedious-------------------- 1 - Brain Congestion of,---------- 5 _ " Dropsy,-------------------- 1 -- " Inflammation of,----------- 8 " Softening of,--------------- 2 --Bright's Disease,______________ 1 --Bronchitis,-------------------- 2 -Bowels, inflammation of_________ 5 'Bowels, obstruction of____j----- 1 -- Croup__________________________ 11 Cerebritis,_____________________ 1 Chills, congestive______________ 1 --Convulsions,_____________________42 Cholera-Morbus,_________________ 2 ^Cholera Infantine,---------------41 Cyomosis,_______________________ 1 Debility,----------------------- 7 Delirium Tremens,_______________ 1 -- Diarrhoea,_____________________ 11 -- Diphtheria,_____________________10 Dropsy,________________________ 1 -- Dysentery,_____________________ 13 -Ententes,_______________________ 8 Epilepsy,_______________________ 2 --Eucephalis,_____________________ 1 -- Fever, Bilious------------------ 1 Fever, Malignant--------------- 1 ---Fever, Termittent,______________ 1 Fever, Puerperal,--------------- 5 Fever, Scarlet,______________________ 3 - Fever, Typhoid,----------------------25 - Fever, Typhus,_______________________ 2 . Gastritis,------------------------- 1- Haematemesis,____________________ 1- Hepatitis, _____________________ 1*- Heart Disease,------------------- 4 Hydrocephalus,-------------------- 4-- Inanition,_______________________ 6 Jaundice,_________________________ 2- Laryngitis,______________________ 1 Liver, abscess of---------------- 1 -- Lungs, congestion of----------------- 1 ~ Measles,------------------------- 4 Meningitis,------------------------ 5- Meningitis, Cerebro Spinal,_________ 3 Meningitis, Tubercular-------------- 2 - Mortification,___________________ 1 Nephriles,___________________________ 1 -- Old Age,_________________________ 4 Opthalmia purulent,______________ 1 Paralysis,----------------------- 2 Consumption, _____________________25 # Peritonitis,________________________ 4 - Pneumonia,_________________________ 11 - Poison,__________________________ 1 Phelebitis, _____________________ 1 Scrofula, ----------------------- 2 Small-Pox,----------------------- 20" Suicide, ------------------------ 1 Stomach, cancer of_______________ 4 Tabes Mesenterica,________________13r" Teething,___________________________ 14 - Whooping-Cough.__________________ 2 Ulcers, malignant---------------- 1 Ulcers, cancer of________________ 3 Total,_____________________ _428 COMPARISON. Deaths in October, 1867,______________________________________ 428 Deaths in October, 1866,-------------------------------------1,170 Decrease,________________________________________________ 742 Deaths in September, 1867,____________________________________ 507 Decrease,__________________________________________________ 79 Ages of the Deceased. --Under 5 years, 326-; over 5 and under 10 years, 17; over 10 and under 20, 19; over 20 and under 30, 31; over 30 and under 40, 31; over 40 and under 50, 22; over 50 and under 60, 17; over 60 and under 70, 7: over 70 and under 80, 3; over 80 and under 90, 5; still born and prema- ture, 27; tedious births, 1; unknown, 9. Total, 428. - z / SEXES. Males,-----------230 | Females,-------198 | Total,_______428 COLOR. Colored,---------8 | White,-----------420 | Total,_______428 NATIVITIES. Chicago,___________224 Other parts U. S.,__65 Austria,____________ 1 Belgium, ----------- 1 Bohemia,____________ 4 Canada,_____________ 8 Denmark,____________ 1 England, ___________ 6 France,_____________ 1 Germany,____________42 Holland_____________ 7 Ireland,____________40 Norway,_____________ 7 Prussia,____________ 6 Scotland,___________ 2 Sweden,------------- 8 Switzerland,________ 2 Wales, _____________ 2 Unknown,____________ 1 Total,___________428 Chestnut Leaves in Pertussis.--In the Cincinnati Lan- cet and Observer, Dr. J. S. Unzicker, of Cincinnati, reports the use of a decoction of leaves of the chestnut, Castanea Visca, in hooping-cough. He says: I have given it a fair trial in about thirty cases, and feel sat- isfied in saying that at last a remedy is found to cope with this disease. In all of these cases it gave decided relief the first two weeks. The cough is cut short, and patients rest easier through nights, and the decline of all symptoms from that time on is very rapid. My method of using it is as follows: take from 5iij- to 3iv. of the leaves to the pint of water; let it come to a boil, then pour the whole into a teapot, without straining, and let them drink occasionally--either cold or warm--and as much as they will through the day and at bedtime. Childern, I find, like to drink it, even without sugar, which I consider best, and have that way administered it to infants, without the least diffi- culty. WINTER RETREAT FOR CONSUMPTIVES. A large house is being fitted up under the superintendence of Dr. Prince, in Jacksonville, heated by furnaces, so arranged as to admit of the purification and medication of the air of the house, producing an artificial climate, not only favorable for the most speedy recovery of patients undergoing surgical treat- ment, but also adapted to secure the best atmosphere for those affected or threatened with pulmonary complaints. It is expected that the repairs and alterations necessary for this purpose will be completed by the first of December. Address DAVID PRINCE, M.D., declt. Jacksonville, 111.

PMC9999981

DELIRIUM TREMENS SUCCESSFULLY TREATED WITH COFFEE. By WM. R. WHITEHEAD, M.D., New York. Recently, in a case of delirium tremens, I observed a pecu- liarly marked tranquillizing effect caused by strong coffee, and which produced prolonged and refreshing sleep, after the usual remedies had proved ineffectual. Mr. C., a merchant, visiting New York on business, who had been drinking very hard for several days, was taken with delir- ium tremens on the 13th of last March. His friends stated that they believed this to be his first attack. He was seen by a physician on the 15th, but did not receive further medical attention until the night of the 17th, when I was called to see him. He exhibited the usual symptoms, with the exception of a remarkable absence of muscular twitching on feeling the pulse. His hallucinations were at times very amusing; he was not disposed to be violent, but was quite tractable and easily controlled by his attendants. A mixture containing about a drachm of chloroform to the dose, was prescribed to be taken every few hours. The next morning, he was more quiet, having slept about two hours during the night, and for the first time since his illness. The condition of his bowels, his urinary and other secretions, were carefully observed. His tongue was large, white, and moist. Some pills of opium were substituted for a mixture con- taining chloroform and tincture of hops, ordered early in the day. A small quantity of ale was permitted, and some beef- tea and chicken-broth ordered. At night, he was very restless; his pulse at one time could not be felt; his extremities became cold and respiration labored. I gave him half a glass of whiskey. On the morning of the 19th, I was told that he slept an hour or two soon after drinking the whiskey; his skin was jaundiced, and he was costive. Twelve grains of blue mass were pre- scribed, which failed to produce the desired effect. At night, eight grains of calomel were given, to be followed in the morn- ing by a clyster. He vomited several times during the day, but retained the nourishment which he had taken. On the 20th, his bowels were slightly relieved, his skin was moist, and pulse good. I prescribed sulphate of morphia, in half-grain doses; he became quite restless during the day. The next day, there was no sensible abatement of the rest- lessness, and he was not free for any length of time from ludi- crous or disquieting hallucinations. At no time, however, was he violent, nor did he manifest great fright. The sulphate of morphia was repeated; he took some nourishment; his bowels were moved with a clyster. Complaining of soreness in the stomach; a blister was placed on the epigastrium. On the 22d, at the morning visit, being satisfied that the morphia had failed to afford relief; bromide of potassium was given, twenty grains at a dose, every two hours, in a suitable mixture. At the third dose, he became more restless and excited than he had previously been. The bromide was discon- tinued, and three subcutaneous injections of Magendie's solu- tion of morphia were made, of thirty drops each, at an interval of one hour between each injection. They failed to produce the slightest apparent effect. He drank half a glass of whiskey, which seemed to quiet him considerably. He took frequently during the day Tourtelot's beef-essence with much relish. On the morning of the 23d, I was told that after drinking the whiskey, he slept three hours, but I found him quite rest- less. Bromide of potassium was prescribed, in drachm doses, of which he took two, each at an interval of two hours. At half-past four P.M., he was much more quiet. lie asked for a cup of coffee, which he drank very gratefully, and at the same time ate a small piece of bread. Ninety grains of bromide of potassium were ordered at a dose, in which doses, I was reli- ably informed, it had been recently given successfully in delir- ium tremens at the New York Hospital. During the night, two doses of the bromide were administered. His urine was abundant and clear; pulse strong and full. He slept about an hour that night. The next day, his bowels were slightly moved with a clyster. The bromide of potassium was repeated twice, in doses of ninety grains, and produced at the second dose some anaesthesia of the skin. On the 25th, Prof. Willard Parker saw him with me, and observed the same absence of muscular twitching to which I have already alluded. It was decided that the patient should have his body and limbs well rubbed after being washed; that he should be permitted to have a cup of coffee, and as much nourishment as he could be induced to take. At night, a hot whiskey toddy was to be given to him, to be succeeded by inhalations of ether, but the ether was not given. At the morning visit the next day, I found that he had not slept during the night, and was very restless. The toddy seemed at first, as his nurse informed me, to make him more quiet; but he soon became much more restless after than before taking it. Chloroform, opium, brandy, and bromide of pot- assium had been each unsuccessfully essayed; the last of these substances in such doses as thoroughly to test its action. One prominent idea, however, governed my course throughout the treatment--it was properly to nourish the patient. I regarded the alcohol as a poison to be eliminated, but considered that the equilibrium of the nervous system should be gradually reestablished by suitable stimulants. Only temporary benefit resulted from the remedies used; and if at times they failed to produce any appreciable good, they, on the contrary, once or twice seemed to be productive of harm. When quiet and sleep did not immediately follow the use of brandy, the restlessness was much increased. Morphia appeared to be positively injuri- ous. The bromide of potassium, in doses of twenty grains, greatly excited the patient; increased to drachm doses, and then to doses of one drachm and a-half each, made him a little more quiet. I was not encouraged, however, to continue any longer these remedies, but disposed to discontinue further medical treatment, and rely upon the gradual assimilation of concen- trated and nutritious food, to allay the nervous excitement, and produce sufficient recuperative sleep. The patient had, several days before, expressed a wish for coffee, which he seemed to relish. It now occurred to me that coffee, acting as a food, containing nitrogenous principles, and also as a special nervous stimulant, might in this case, by its peculiar action, if given in sufficient quantities, produce a quieting effect, and induce sleep. Consequently, coffee was tried; and the issue of the experiment proved to be successful. At two o'clock P.M., about a pint of very strong coffee was prescribed, with a little cream, enough to make it palatable for him; and a broiled steak ordered, a part of which he ate. At eight o'clock P.M., I found that he had slept four hours. Tie drank again a large cup of coffee, and took fifteen grains of blue mass. ' On the 27th, at the morning visit, I found that he had slept nearly all night, but was then restless. His bowels had been moved, and his general condition was very much improved. Very strong coffee was again prescribed, and at half-past twelve o'clock P.M., I found him asleep. After this, the coffee was repeated a few times; he continued to improve, and soon recovered. Probably this nervous stimulant, by imparting an increased tone of a peculiar character to the general system, reestablished its equilibrium and caused sleep, when other stimulants, acting in a different manner, failed to produce this result. This, how- ever, is merely a conjecture, and may possibly be explained by others in a more satisfactory manner.--Medical Record.

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ARTICLE L. TRIAL OF TETRACHLORIDE OF CARBON AS AN ANAESTHETIC.--DANGEROUS EFFECTS. By E. ANDREWS, M.D., Prof, of Principles and Practice of Surgery, Chicago Medical College. In a letter written a few months ago, to the Examiner, I called attention to the new anaesthetic called tetrachloride of carbon, introduced by Dr. Protheroe Smith, of London. Dr. Smith had used the article in about one hundred cases; and was disposed to believe it safer than chloroform and far more agreeable than ether. On my return to this country, I brought a sample of it with me, from the same establishment which sup- plies it to Dr. Smith. I had a patient, upon whom it became necessary to perform the operation of resection of the hip-joint, and who had previously suffered so much nausea after the inha- lation of ether, that he very much disliked to take it a second time. As one of the chief advantages of the tetrachloride of carbon is its freedom from nauseating effects, I deemed it best to use it in this case. Having no such inhaler as is used by Dr. Smith, I employed a napkin, placed in a paper cone, and held a short distance from the face, as in giving chloroform. My friend, Dr. Sherman, whose experience in giving anaes- thetics amounts to some thousands of cases, took charge of the inhalation, and proceeded with rather more caution than he would with chloroform. Nothing remarkable occurred at first, but after the lapse of a few minutes, the assistant,, whose duty it was to watch the pulse, observed that it increased suddenly in frequency, so that in a short time he was unable to count it. At the same time, the patient, who was not yet unconscious, complained of a violent pain, as of cramp$ in the vicinity of the heart, and after a moment more, the pulse and respiration both suddenly ceased. The patient's head was spasmodically drawn backward, the countenance looked pale and deathly, and the pupils of the eyes dilated until the iris could scarcely be seen. Artificial respiration was at once commenced, and strong aqua ammoniae was rubbed in the nostrils, under which treat- ment, the patient revived again, although to all appearance almost dead. The anaesthesia was then completed by concen- trated sulphuric ether, -without further accident, and the carious bone excised in the usual manner. I do not think that there remained any prolonged unfavorable effect after the use of the tetrachloride, but the sudden advent of such urgent and dan- gerous symptoms made a strongly unfavorable impression on my mind, for the patient -was much nearer death than I ever saw one go under ether. I certainly shall not venture on the use of the article again, unless very extensive experience by others demonstrates its safety. It is proper to state that the patient was in a very exhausted and anaemic condition from the effects of disease, and was ope- rated on as a last, desperate resort, having no other hope of life. He rallied from the operation pretty well, without show- ing any signs of injury from the tetrachloride, but died, subse- quently, from exhaustion. 81 Monroe St., Chicago, Nov. 4, 1867.

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ARTICLE LI. A NEW ECRASEUR FORCEPS. By E. ANDREWS, M.D., Prof, of Principles and Practice of Surgery, Chicago Medical College. Nearly a year ago, I devised an instrument, intended as a substitute for the ecraseur, which I named the ecraseur forceps. I afterwards saw an instrument, invented by Dr. Smith, partly involving the same principle. The form which I had adopted was quite different from the other, and offerred several points of superiority over it. The subjoined wood-cut gives a correct .idea of its construction. It consists of a strong pair of forceps, of which the length of the jaws is to that of the handles as one to four. One jaw is thick, and has a slot through nearly its entire length; the other is thinner, and plays through the slot, as the chain of the ecra- seur plays through the opening in that instrument. The jaws are bent towards each other, in such a way that the beaks pass first, enclosing the tissue to be crushed in a diamond-shaped loop, which grows smaller in all directions as the jaws are pressed together. They act, therefore, very much like the chain of the ecraseur, in gathering all the tissue towards a com- mon centre, under a powerful compression, before they crush it asunder. The edges of the jaws, are rounded, t(c) prevent them from cutting like scissors. This instrument has many advantages over the chain ecra- seur, among which is, the ease of its application to almost all sorts of cases. For instance, in removing tumors from the side of the tongue. The chain of the ecraseur has to be drawn through the tongue by a needle and thread, from which the chain must then be detached and attached to the instrument, before the operator can proceed; but in the ecraseur forceps no such trouble is necessary. The surgeon simply applies his instrument to tho tongue, like a pair of scissors; the beaks sink through the organ, at the exact spot where they are placed; and the enclosed tissue is instantly under the gathering com- pression of the jaws. A second application, on the other side of the tumor, completes its removal. In removing piles, it operates admirably well. In case of a large tumor, whose ped- icle cannot be wholly grasped at once by the jaws, it is simply necessary to take it at two or three bites. A collateral advan- tage of these instruments is their cheapness. They are made by Tolle & Degenhardt, Chicago, for from three to four dollars, while a chain ecraseur costs from ten to twenty dollars, according to size. The only objection to it is this-Ecraseur work should always be done slowly. It is by the gradual compression that one makes sure of closing the vessels so as to avoid hemorrhage. The chain ecraseur tightens with a screw, whose turning re- quires time, and thus compels deliberation; while in the forceps form, it is in the power of a careless surgeon to grip the han- dles quickly together, and make the sundering of the tissues too sudden. In using it, the surgeon should compress the han- dles slowly and gradually, allowing about a minute to each act. of crushing.

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PS. o o : ii o 11 r jc Ths Science and Practice of Medicine. By William Aitken, M.D., Edin., Prof, of Pathology in the Army Medical School; Corresponding Mem- ber of the Royal Imperial Society of Physicians of Vienna, etc., etc., etc. In two yolumes. From the fourth London edition, with additions by Mer- edith Clymer, M.D., late Professor of the Institutes and Practice of Medi- cine in the University of New York, etc., etc. Philadelphia: Lindsay & Blakiston. 1866. We have received from the publishers, the first volume of this work, with a notice that the second volume will be through the press in a few days. We have only time and space now to say that the American publishers have issued the work in good style; and that it constitutes a very full and valuable treatise on practical medicine. All our readers who desire a very full summary of the present condition of practical medicine in Great Britain, will certainly find it in this work. When we have re- ceived the second volume, we will notice it more in detail. Price of complete work $12.00

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MILITARY TRACT ASSOCIATION. The Association met in semi-annual session, at Galesburg, on Tuesday, 11th day of December, 1866, at the hall of the Christian Association, A. H. Thompson, M.D., President, in the chair. The proceedings of the previous meeting were read and adopted, when the following physicians were presented for membership, and were elected:--Drs. Spalding, Hamilton, Phil- lips, Woodward, Burlingham, and H. M. Hurd, of Galesburg; Drs. Ewing, Webster, and Crawford, of Monmouth. It was voted that Dr. McClanahan, of Mercer County, be elected an honorary member, with all the privileges of the Association. Reading of essays being next in order, Dr. Crossley, of Princeton, read an article on Army Itch, or "Illinois Scratches," which elicited quite an animated discussion. Dr. Woodward gave a history of the disease, as it prevailed among the soldiers during the late war; and also exhibited some animalculae recently taken from a patient under his care. He considered the insect essentially different from the true acarus scabiei, but believed the disease amenable to the same treatment. The treatment used by him in the army was, iodide of arsenic internally, and ungt. hyd. oxid. nit. externally. Dr. Nance believed the disease to be caused by animalculae, and that the ungt. hyd. fortis, properly applied, was a certain cure. Dr. Spalding-recognized the disease as being identical with scabies; curable with the migt. sulphuris. Dr. Holton believed the disease to be caused by animalculae, but differing in the form of eruption produced by the acarus scabiei not infesting the spaces between the fingers and about the joints; both amenable to mercurial treatment; but the dif- ficulty of effecting a cure in the army, was the inability to observe cleanliness, also the frequently depressed physical vigor of the patient. Moved by Dr. Crossley, and carried, That the disease under consideration is animalcular in origin; and that mercury or sulphur is the treatment. Dr. Nance, of Kewanee, read an essay on the Endemic and Epidemic Diseases of Henry County, during 1866. Moved and carried, That the Association return a vote of thanks to Dr. Nance, for his very interesting essay. Dr. Holton, of Buda, read an interesting paper, entitled "Remarks on Different Subjects," being a detailed history of a variety of cases, of much interest, coming under his care during the past summer. REPORT OF CASES, AND PRESENTATION OF MORBID SPECIMENS. I)r. Woodward, of Galesburg, presented the calvaria of a boy, cut. 15, coming under his observation while in service in the army, who had been kicked by a horse over the right supra- orbital region four years prior; portions of the frontal bone having been removed by a physician in Madison, Wisconsin, the patient suffering with epilepsy. The peculiar features in tiie case were, that the convulsions could be produced at any time by pressure upon the cicatrix, and continued as long as the pressure was maintained; and, that during the eighty hours prior to his death, he had two hundred distinct convulsions. Dr. Nance, of Kewanee, presented a specimen of renal calcu- lus, of the mulberry variety, with a history of the case. Dr. H. S. Hurd, of Galesburg, reported an exceedingly in- teresting case of aneurism of the innominate artery, and right sub-clavian. Dr. Scott, of Kewanee, reported a case of anchylosis and caries of the right elbow-joint, occurring in a boy oet. 13, of scrofulous habit; after inflammation of the synovial membrane and cartilages of the joint. When the case came under the Doctor's care, it was of several months' duration. Amputation resulted in recovery. The morbid specimen was exhibited to the Association. Dr. Holton, Chairman of the Committee of Resolutions, in respect to Prof. Brainard, deceased, reported:-- Resolved, That, on account of a dispensation of Providence in removing our brother, Prof. D. Brainard, from our midst, we recognize the hand of Him who is the author of our being, and we desire to say, His will be done. Resolved, That our brother had acquired the reputation of being among the first as a teacher, and as an operator in sur- gery; and that his character and position for usefulness was world-wide; therefore, we deplore his loss as irreparable. Resolved, That in his life we see encouragement to persevere in our efforts to arrive at a position of distinction, and to im- prove our ability to alleviate the sufferings of humanity; and we regard him as a worthy example for the profession. Resolved, That w'e sincerely condole with the remaining members of the family. [Signed] * N. HOLTON, M.D., JOHN EWING, M.D., \ Committee. H. S. HURD, M.D., J Moved, by Dr. Holton, and carried, that a committee of five be appointed, to report on surgery, practice, obstetrics, materia medica, and therapeutics. Hie Chair reported the following gentlemen on said com- mittees :-- Surgery--Drs. Hamilton and Spalding, of Knox; Crossley, of Bureau; Secord, of Henry; Webster, of Warren. Practice--Drs. Latimer, of Bureau; Hume, of Henry; H. S. Hurd, of Knox; Crawford, of Warren; Boardman, of Stark. Obstetrics--Drs. Nance, of Henry; Holton, of Bureau; Web- ster, of Warren; Morse and Woodward, of Knox. Materia Medica and Therapeutics--Drs. Ewing, of Warren; Smiley, of Henry; II. M. Hurd, of Knox; Clark, of Henry; Breed, of Bureau. Moved, by Dr. Nance, and carried, that the President shall notify the committees one month before the meeting of the Association. The President appointed Drs. Burlingham, of Knox, and Webster, of Warren, on special essays. Moved, by Dr. Holton, and carried, that the President and Secretary be a committee on publication. Moved, by Dr. Crossley, and carried, that a vote of thanks be returned to the members of the profession in Galesburg, for their courtesy; also to the Christian Association, for the use of their hall. Moved, by Dr. Spalding, and carried, that we adjourn, to meet at 10 o'clock A.M., on the second Tuesday in May, 1867, at Monmouth. A. H. THOMPSON, Prest. Geo. II. Scott, Secy.

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x'rorrumiiis ui pannus CHICAGO MEDICAL SOCIETY. At the meeting of this Society on the evening of the 21st of December, 1866, Dr. Ira Hatch related a fatal case of cerebro- spinal meningitis, or spotted fever, that had occurred in his practice recently. During the discussion that followed the re- lation of the case, Dr. Orrin Smith referred to the efficacy of sulphuric acid in the treatment of erysipelas and small-pox, claiming that when given in efficient doses, its effects were more promptly curative than the tincture of chloride of iron. At the same meeting of the Society, Dr. Quales presented the uterus-of a female recently dead from puerperal or child- bed fever, in the County Hospital. It showed the usual appear- ances of severe inflammation. At the meeting on the evening of Dec. 28th, 1866, the ques- tion for discussion was as follows:--"In what class of cases, and when, are surgical operations justifiable, in the treatment of cancerous diseases?" Dr. Bogue, in opening the discussion, remarked that, as a general rule, the results of operative procedures for the removal of cancerous tumors were unsatisfactory. Epithelial cancers and scirrhus in its early stage, are the varieties most likely to be permanently benefited by extirpation. As a general or average result, thinks it doubtful whether life is prolonged by surgical interference. Regards operations sometimes justifiable for the purpose of giving the patient temporary relief from the great pain and offensiveness of the encephaloid cancerous growths in their advanced stage. When the disease affects one of the extremities, he regards amputation as preferable to the simple extirpation of the tumor. Dr. G. Paoli said he thought the profession divided in opin- ion, as to the value of surgical operations in cancerous diseases. Statistics appear to show that a large majority of cancerous patients die in from 12 to 18 months after surgical operations for their relief. He claimed that many cases of the epithelial variety of cancer, and some cases of scirrhus, were benefited by operations for their removal. But if the latter variety ex- isted in both breasts, or involved the neighboring glands, or the patient had attained an age beyond 55 or 60 years, no ope- rative procedures should be undertaken. Dr. Nelson related an interesting case of supposed cancerous tumor in the axilla of a soldier, which was extirpated in Boston, in 1862 or 1863, and up to this time the man remains well. Dr. E. L. Holmes remarked that the case related by Dr. Nelson, and others like it, certainly justified operations to some extent. He also thought an operation sometimes justifiable, simply to obtain temporary relief from severe suffering and annoyance. He thought, however, that the diagnosis of can- cerous tumors was in some cases extremely difficult; the results of microscopic examinations not affording a sufficient test. The discussion was further continued by Drs. N. S. Davis and II. M. Lyman, both of whom advocated the propriety and importance of paying more attention to the constitutional treat- ment of cancerous diseases. ELGIN MILK CONDENSING COMPANY. Dr. Hamill reported the observations made by himself and Dr. II. A. Johnson, during a visit to the "Elgin Milk Condens- ing Company," which were of a very satisfactory character. The whole process, from the delivery of the milk by the dairy- men, until it was prepared in its condensed form to be delivered to consumers, was exhibited to them. The integrity of the par- ties, the scrupulous care with which the milk is received, the cleanliness and sweetness of every vessel through which it passes, are guarantees to the public for its good qualities. It is recommended to the profession and the community for the following reasons:-- 1st. It is procured from healthy cows, that are not fed with slops from the distilleries, and are not kept, during any part of the year, in dark, close, and dirty barns. 2d. The process in no way deteriorates the quality of the milk, and its bulk is diminished, making its transportation easy. 3d. It is of uniform strength, requiring three parts of pure water to one part of condensed milk to bring it to the standard of good fresh milk. There is no drug or chemical used or mixed with it. And, lastly, it can be kept for a much longer time, at any season of the year, from becoming sour, if proper care is taken. It is the pecuniary interest of the company to use good milk for condensing, and none other; this furnishes an additional guard over the purity of the article. In consideration of these facts, it is especially adapted to the nourishment of infants who are deprived of a mother's care, or of good milk; if it supplies no other want, it will confer an unlimited blessing on this dependent class of human beings. The following letter from Prof. Johnson to Dr. II., will be read with interest by all, and needs no comment:-- Dr. IIamill--Dear Sir:--I received from Mr. Hinckley a specimen of the milk, condensed at Elgin in our presence, and have subjected it to an examination, for the purpose of ascer- taining what changes have taken place in its constitution. I added to one part of the "condensed milk " three parts of wa- ter, mixing well. The sp. grav. was then 1030, water being 1000. The casein did not differ, so far as I could judge, from that of good uncondensed milk. The amount of cream was within the range of good new milk. The corpuscles, as seen under the microscope, to a very limited extent, were broken, and in size, were somewhat more variable than those of good uncon- densed milk, the effect, I presume, of the mechanical agitation during the process of condensation. The taste of the milk, after condensation and dilution, as compared with specimens of the same milk before condensation, wras somewhat richer, giving the impression of more cream, due, I think, to the rupture, as previously stated, of the envelopes of some of the corpuscles. This, while it gives a richer taste, in no way impairs the quality of the milk. I used in my examination, as a standard of com- parison, the new milk from my own cow, a healthy animal, yielding, as wTe think, milk of an excellent quality. This pro- cess in no way injures the quality of the milk, while it dimin- ishes the bulk for transportation; is clean; is not likely to be adulterated, and may be kept without change for a much greater length of time. I take pleasure in saying that, in my judg- ment, the public may rely upon it implicitly, and I trust that the gentlemen interested may find sufficient encouragement to induce them to continue its preparation. In conclusion, I beg leave to suggest, that, as in all milk adulterated, whether with water alone, or with water and an admixture of other ingredients, the cream is invariably dimin- ished in relation to its bulk or quality, that the galactometer may be advantageously resorted to as a means of examination in cases of suspected falsification. This instrument consists of two glass tubes, of considerable size, connected by a smaller tube. This latter has a graduated scale attached. The instru- ment is filled with milk up to the small tube, a portion of acetic acid is added; the two well shaken together for a minute or two, when the butter, liberated by the acid, rises to the surface and fills the smaller tube. If gently warmed it will become limpid, and the amount will be indicated by the graduation of the smaller tube. If it be desirable to determine the propor- tion of cream to the whole amount of milk, the capacity of the instrument and the value of the divisions on the scale should be determined. If, for instance, the capacity of the larger tube be five times that of the smaller,'and the tube be divided into ten equal parts, it would be easy to determine, within a very small fraction, the relative proportions of cream in the milk with which the instrument is charged. This process djes not give, it is true, a scientific analysis of milk, but indicating, as it does, the amount of cream, its re- sults are sufficient for all practical purposes. Very truly, yours, H. A. Johnson. 611 Wabash Avenue, December 28th, 1866. After hearing the report of Dr. Hamill, the following resolu- tion was offered by Dr. N. S. Davis, and unanimously adopted: Resolved, That the great importance of having milk pure, uniform in quality, and capable of remaining sweet longer than that ordinarily distributed directly from the dairy, makes the condensed milk furnished by the Elgin Milk Condensing Com- pany an article of great value to the community, and one which we freely recommend for general use, and especially for use in feeding children.

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ARTICLE V. ESSAY ON CHOLERA. By N. WRIGHT, M.D., Chatham, Ill. Read before the Illinois State Medical Society, June 6, I860. The almost certain reappearance of that formidable disease, Asiatic Cholera, amongst us the ensuing year, should claim the especial attention of medical men, whose duty it is to gather around them all the information that is possible to be obtained concerning the various theories of its causes, pathology, and treatment. It would seem presumptuous in me to attempt to enlighten you, gentlemen, upon this already thread-bare theme; still the vast importance of the subject, and the intense interest that is manifested by the public mind, demand that the little we may know, or the theories we may entertain, should become the common property of the profession, as well as the community at large, whose protectors and guardians, in matters of health, we are. They look to us in "this the hour of their distress," and we should be prepared by our science and skill to calm the pub- lic fear, and thus remove one of the great, if not the greatest, predisposing causes of the frightful epidemic. We should in- vestigate the subject in all its various phases, and when we do meet the disease, meet it calmly, with a mind well prepared by sound pathology and therapeutics, early to battle with the monster and gain the victory, thus showing to the community that the confidence reposed in us, as conservators of the public weal, is not misplaced. Let us be no cowards, but, armed with science and experience, go forth and conquer even the fell destroyer cholera. I would define cholera, as a disease that is characterized by profound disorder of every vital function--of innervation, cir- culation, respiration, and secretion. It is attended with more or less prostration and lassitude; with a suspension of all the secretions; a feeling of cold; frightfully sensible to the touch; the breath and tongue of almost icy feel; a voice so peculiar as to entitle it to the sobriquet of "vox cholerica;" with a leaden color of the skin and mucous membranes, wherever perceptible; shrunken features and sodden extremities; cramps of the abdomen and extremities; a pulse quite small and feeble, often imperceptible; respiration accompanied with frequent sighing, and quite difficult--all of these attended with a profuse flux, both per orem et anum, of an enormous quantity of sero- alburninous fluid, deficient or entirely wanting in the normal secretions, heavily loaded with mucous epithelium, which has been mistaken for an altered secretion--all of these generally ending in death by asphyxia. The appearances presented upon dissection are all much the same, with perhaps more uniformity than in most other diseases. The only discrepancy can be easily accounted for, could we but know the particular stage of the disease in which the subject died. That discrepancy is found in the condition of the lungs, sometimes pale and exsanguious, and at others engorged and turgid with blood. The first, or anaemic condition, I have found when death took place in the early stage of collapse; and the hyperaemic condition, when the collapse has passed away and reaction, either in whole or part, has been established. The chief constant and conspicuous pathological phenomenon that is apparent in every case, is the changed condition of the blood, deprived of its serum, which has passed away in the enormous discharges and left a dark, coagulated mass accumulated in the right cavities of the heart, the vena cava, the portal and einul- gent veins. The arteries are, for the most part empty, as, also, is the left side of the heart. The blood thus found, coagulates entirely, without leaving a single drop of serum; heavily loaded with carbon and coloring matter; deficient in the saline ingre- dients ; without a particle of the free alkalies contained in healthy blood. Urea sometimes exists in the blood, where the secretion of urine has not been partially reestablished previous to death. The mucous surfaces are covered with a substance almost pre- cisely like the rice-water discharges vomited and purged during life. There is mucous epithelium still adherent to the surfaces of the membrane. The liver is filled to overflowing with dark blood, arising, no doubt, from both the obstruction of the cen- tral organ of circulation and the loss of fluidity of the blood itself. The bladder is invariably found empty and closed firmly upon itself, affording a diagnostic mark between cholera-morbus and cholera. The spleen is found often enormously distended, and, in fact, not a single abdominal or thoracic organ can be found unmarked with vascular rupture or turgescence of black blood. Let us, for a few' moments, contemplate the changes we find in the various organs from their normal condition, together with the offices they perform in the living machine, and I think we must all come to the conviction that the essence of the disease consists in morbid action of the secreting organs, produced by some poison, diffused throughout the blood, having a special direction and influence upon the nerves of organic life, or, in other words, upon the great sympathetic or ganglionic system of nerves whose duty it is to preside over the three great opera- tions of life, to wit:--circulation, respiration, and secretion. In the cold stage of our ordinary intermittent, in the rigor of congestive fever, and in the symptoms of some remittents, we have a few of the symptoms of this disease, though they are but in miniature and of the milder form. We also behold some of its phenomena in our ordinary endemic cholera-infantum--the same persistent nausea; the same albuminous discharge. And, still again, we meet with a closer resemblance in our intermit- tents, when they assume the malignant, or, as it is often called, the congestive form. I have seen, and, doubtless, most of you have seen, cases of malignant chills which were almost identical with cholera--the same coldness of the surface and sodden appearance of the ex- tremities; the same shrunken, pinched countenance; even the "vox cholerica," wTith the small and often imperceptible pulse; attended too, by vomiting, purging, and cramps. It was the close resemblance of one of these cases, years ago, when inter- mittents were of a more malignant character than now, that led me to investigate the relations that exist between cholera and miasmatic diseases; not that they are precisely alike, but there is a striking analogy between them in some of their symptoms, particularly the organs most affected. The locality too, which produces cholera in its most frightful forms, is identically the same as of miasmatic diseases. India, on the banks of the Ganges, the cradle of the scourge; the delta of the Nile; the valleys of the Mississippi and the Rio Grande; and, in short, wherever you find alluvial deposits and malarious regions, there you will find favorable localities for its propagation and foci from which it disseminates itself. I would not wish to be understood as classing cholera with diseases of miasmatic origin, simply because they are rife in the same regions that cholera has ravaged and still continues to devastate; nor yet from the strong resemblance that cholera has in some of its earlier symptoms to this class of diseases; but I do think that there is a strong family resemblance be- tween them, and that all the phenomena of the disease clearly indicate that both are of that class of disease which first shows itself in its effects by the derangement of the nerves of organic life. To elucidate, in part, the pathology of the disease, I would call your attention to the fact, that the bnus of the morbid im- pressions is first felt by the chylopoietic viscera, which are sup- plied with nerves from this system. When we consider the phy- siological purpose of the ganglionic system of nerves, and that all vital actions are produced through their influence; that they are distributed to the heart, lungs, liver, spleen, and kidneys, as well as to all the viscera contained in the thoracic and splanch- nic cavities, and that these organs feel the touch of the disease almost simultaneously, we are compelled to admit that it is upon these nerves that the disease is hurled. The doctrine that malarious diseases were derangements of the ganglionic system of nerves, is no new theory; but, until quite recently, the fact, as such I may now call it, has not been demonstrated. Prof. J. II. Salisbury, in his experiments, as related in the American Journal of Medical Sciences, shows that the essence of malarial poisoning consists of minute cells of an algid type, closely resembling palmella that are produced under favorable circumstances of heat and moisture, inhaled into the lungs, thence through the blood; and these affect the vital functions of the nerves of organic life; change the normal condition of the secreting organs, and thus produce malarial poisoning. Such may be, and quite likely is, the manner of the working of cholera, at least there is a striking resemblance between the operations of the two classes of poisons--affecting the same organs in much the same manner, through the same means, though with a different degree of intensity. From a careful survey of the various epidemics, as narrated by careful observers, and from no inconsiderable experience in the disease, I am fully satisfied that it can only be communi- cated through and by means of matter vomited or purged that may have an immediate effect upon systems prepared to receive them; or they may act remotely upon the putrid products of decay, made up of decomposing animal and vegetable matter, in our large cities; hence, the intensity and diffusion of cholera is in an inverse ratio to the sanitary condition of the place. Atmospheric causes have, doubtless, much to do, as remote agents, in spreading the disease, still they are unable to pro- duce it without the aid of local inoculation of existing filth and decomposing matter by cholera poison from some one having the disease. It travels no faster than it is carried, and strin- gent quarantine and strict sanitary measures will do much to avert,/if not to exclude, it from any place. If the foregoing views of the origin and pathology of this disease are correct, and the more I read and reason upon the subject, the more I am convinced they are, the plan of treat- ment must be simple and plain, but the means by which to accomplish it hoc opus, hie labor est. The obvious pathological changes, as we have previously stated, are in the blood, and an impaired or subverted innerva- tion of the ganglionic system of nerves presiding over the func- tions of organic life, that are distributed to the heart, lungs, and viscera contained in the abdomen. With these changes constantly in view, our efforts will be, first, to sustain the vital powers; then, to arouse and change the impaired action or non-acsion of the splanchnic nerves; then to arouse and restore the suspended secretions and con pel the various organs revocare gradum. All remedies may be, and indeed often are, abused or mis- used; and stimulants, in this our day, seem to be in some dan- ger of abuse, as it is the fashion to stimulate for everything. I would wish to use them so as to avoid Scylla on one side, and Charybdis on the other. The scripture tells us to "give strong drink to him that is ready to perish, and wine to him that is of feeble heart," and I know of no disease that "fills the bill" of the wise man so completely full as the one now under consider- ation. Active and diffusible stimulants must be freely used to overcome the extreme prostration and bring about the so much desired reaction. We must restore the lost equilibrium of the circulation and innervation, arouse the capillary circulation of the skin and mucous membranes, as well as the organs con- tained in the abdomen; reestablish the biliary and urinary secretions, and even when these are accomplished, our work is hardly begun. The vast quantities of effete matters that are retained in the blood, the result of suspended secretions, must be eliminated before we can feel assured that our patient super- asque evadere ad auras. When we look for a moment at the enormous amount of secretion in a healthy adult, the saliva, the gastric juice, the pancreatic fluid, the bile, the urine, the cuta- neous exhalations, and carbonic acid thrown off by the lungs and think that these are all retained in the system, why do we wonder tliAt death takes place so soon as it often does in chol- era? Why not rather wonder that the patient survives so long? One great point in the pathology of cholera, which has at- tracted more attention than all others, is the anaemic condition of the left side of the heart and arteries, and the excessive hy- peraemia of the right side of the heart and veins. Some late observers and writers have attributed this to spasm, or rather, as they have called it, tetanic spasm of the arteries and capillaries, particularly of the branches of the pulmonic arteries, that has closed these vessels and thus prevents the transmission of the blood through the lungs, and, consequently, no blood enters the lungs to be there oxygenated and passed to the left side of the heart, and again to pass its rounds in the system. At first view, there would seem to be some plausibility in this hypothesis. The success that blood-letting and nauseants, and even emetics, and, more recently, chloroform, have met with by their known powers of relaxing spasm, and thus (as is claimed by the sup- porters of this tetanic spasm theory) permitting the transmis- sion of the blood through these closed capillaries, I admit looks very reasonable, if the obstacle to the circulation be of the na- ture of tetanic spasm. But if, on the other hand, a want or absence of tone in the capillary vessels and branches of the pulmonic arteries, arising from deficient innervation of the nerves that govern the circulation be the cause that obstructs the blood and prevents its entrance into the lungs, there to receive the vivifying element that fits it for sustaining vital actions, if this be the cause, as I believe, it is evident that these means can afford but temporary relief and, in the end, but has- ten the fatal result. The reason that seems to me perfectly satisfactory for the stoppage of the blood in the right side of the heart and in the pulmonary artery, is a want of nervous power that should be imparted by the sympathetic, which sys- tem is overpowered or stricken down by the poison of the dis- ease. With this view of the causes that produce the unequal circulation, our attention should be directed to arousing the energies of the nervous system, particularly the ganglionic nerves. The best means to accomplish this with, in my hands, in many cases of malignant chills, has been large and oft-repeated dry cups applied to the epigastric region, for beneath this region lies the great epigastric or solar plexus of the sympa- thetic system, from which plexus radiates the nerves that supply nearly all the viscera in the abdomen. I need not enu- merate the various ganglia and their distribution, but if there is one point in the human body that is, or can be called, the centre of organic life, the solar plexus is that point. The shock imparted to the nervous system through the nerves radiating from this plexus by a large cup applied and repeated over this region, has saved patients of mine, suffering with malignant intermittents that I do not believe could have been saved by any other means in my power; the nervous system was aroused by this means, and stimulants and tonics completed the work. Strong rubefacients should be assiduously applied along the entire length of the spine while cramps or spasms continue, and friction with the hands and flour of mustard or capsicum where- ever they appear. External heat, in the form of hot baths, whenever they can be had, with mustard freely infused, must be used for the purpose of keeping up the temperature of the body and arousing the capillary circulation of the skin. An excellent, and in the country, in the absence of a bathing tub, a very convenient method of administering external heat is by means of cars of maize boiled for some time in water, and placed, while hot, around the patient in bed, or what is called a corn sweat; mustard sinapisms to the wrists and inside of the thighs and ankles; hot pediluvia, increased with red pepper or capsicum; and a flannel dipped out of hot water and sprinkled quickly with spts. terebinth., applied hot to the'abdomen; and injections of warm water per anum, as warm as you dare to use, to the amount of two or three pints, together with warm bed- clothing and the recumbent position. All of these should be persevered in as adjuvants to the medical treatment. I am well aware that treating symptoms is not a very sound or rational practice, but we have high authority for combating or avoiding the tendency to death, and we are justified in our efforts to alleviate the pain our patient is suffering while we are awaiting the action of medicines that may restore him to health. Vomiting is one of the symptoms that distress and harass the patient, and at the same time prevents the retention of medi- cines we may have administered to overcome the disease. Cold or ice-water is very grateful to the sufferer, and often it seems to check the vomiting. Ice-cold sparkling wines, as catawba or champaign, often are the best drinks that can be given out- patients. Creosote, in doses of three or four drops in a little cinnamon water, with about half an ounce of gum Arabic emul- sion, will sometimes check this distressing symptom. Mint juleps and the common effervescing soda-water, mixed with ice, is an excellent means for allaying the distressing vomiting, and at the same time it alleviates the tormenting thirst. Opium, we all know, in small doses, frequently administered, acts as a stimulant, and, at the same time, will allay the exces- sive irritability and pain that accompanies the early stages of the disease. It, however, is a remedy that must be used with great caution and carefully watched, that narcotism is not pro- duced, arid it should be altogether withdrawn when the consecu- tive fever stage springs up. Ipecachuana, in small doses, will be found of great assistance, by its effects upon the skin, and combined with camphor, which will do much to sustain the enfeebled nerves, and at the same will do all that we can do with medicine to relieve the frequent spasm. Calomel must not be forgotten, to arouse the dormant secre- tions, especially of the biliary organs; but the enormous doses that have been given in this disease are but a wanton waste of a useful medicine. The quantities of each will vary with the peculiar characteristics of the epidemic and with different cases of the same epidemic, as well as the intervals of time in which they should be administered. 1^. Hyd. Sub Murias,----------- grs.xvj. 3ij. G. Campli, pulv.,---------grs.xviij. 5ss. Pulv. Ipecach.,------------ grs.xij. grs.xviij. Pulv. Opii,---------------- grs.xij. grs.xiv. M. Divide into 2-1 pills. From the strong resemblance of many things in cholera to miasmatic diseases, and the well-established efficacy of quinine in the latter, it would seem well worthy a place among our remedies in this disease, and many have used it with much sat- isfaction. Oxygen gas, could it be easily obtained, would be a powerful assistant before the collapse stage of the disease. This is but an imperfect outline of the treatment I would propose for the early stage of the disease, and often the judi- cious treatment of this stage will obviate the necessity of treat- ing the more advanced stages and severer forms. But should the disease progress in spite of all our efforts, and bad cases generally will, and extreme collapse ensue, shall we give up in despair? Cold effusions, in the form of shower baths, applied so as to produce as great a nervous shock as possible, have been known to save the patient when in articulo mortis. Opiates can rarely be used now, and all our efforts must be used in every possible way to reanimate the almost dead body--dili- gent friction, after the cold shower bath; hot blankets and strong irritants more assiduously applied to the spine and ab- domen; and the stimulants, both alcoholic and diffusible, should now be carried almost to the heroic--these should be tried, but, I confess, with little hope of success in this stage of the disease. The consecutive fever that follows the recovery from cholera is often of as much importance as the disease itself. Local inflammation, arising from the suspended secretions in the vari- ous organs, will demand our attention, with appropriate means for their removal, which will best be understood by the appear- ance of the case itself. Local abstraction of blood, with coun- ter-irritants, and even blisters, together with appropriate reme- dies for restoring the secretions that have been suspended, these, with a light, nutritious diet, will generally restore our patients to health again. Resume.--1. Cholera very closely resembles diseases of miasmatic origin, as well in the choice of its location as in the identity and manner of the organs affected, and in the success that the same treatment has with both diseases. 2. That both miasmatic diseases and cholera are essentially manifested in derangement of all the secretions dependent upon deficient circulation of the blood, caused by want of innervation of the nerves of organic life belonging to the ganglionic system that are stricken down by the poison of the disease. 3. That the first and greatest object in the treatment of this disease, is to arouse the energy of these nerves by some sudden shock, so that they will supply the proper stimulus to the heart and arteries sufficient to keep up the circulation which may be much assisted by keeping the temperature of the body up to, or above, the normal condition. 4. That the proper and judicious use of stimulants, nervous, alcoholic, and diffusible, with other means mentioned above, to arouse the dormant secretions after the nervous system has been aroused, afford us much encouragement in the treatment of this disease.

PMC9999997

MORGAN COUNTY MEDICAL SOCIETY. Thursday, December 11th, 11 o'clock, A.M. Society met pursuant to adjournment. Dr. Wagely was elected to preside, in the absence of the President and Vice-President. The Secretary read the minutes of the last meeting, which were adopted. The President called for the report of committees. Committee on examination of credentials reported unani- mously in favor of Dr. Dutton for membership, who was im- mediately elected by unanimous vote. The committee on fee bill reported that they would be pre- pared to submit to the Society the result of their labors at the afternoon session. Dr. Prince exhibited several varieties of instruments for pro- ducing spray for medication of the air-passages, and for dead- ening the sensibilities of parts in order to lessen or prevent the pain attendant upon surgical or dental operations. He went briefly into a history of the introduction of the method of in- haling medical substances blown off in spray, as first practiced in France and Germany, and then explained the instrument in- vented by Dr. Richardson, of London, for the production of in- sensibility of parts by blowing upon them a spray of ether or rhigoline, which is capable of freezing in a few seconds by the tendency of rapid evaporation to produce cold. He exhibited an ingenious modification of the apparatus devised by Dr. Black for the purpose of shielding the lips and tongue from the spray while it is being blown upon the gums preparatory to extracting teeth. Dr. Prince referred to cases in which union by the first in- tention had occured under unfavorable circumstances after the application of the spray of ether to the cut surfaces. He thought this result was secured by the speedy arrest of the flow of blood from the minute vessels under the influence of cold. Dr. Edgar confirmed this view, by selecting cases occuring in connection with the battles at Vicksburg, in which union by the first intention had been secured by the application of ice to the wounds immediately after the amputation and before the final dressing. Dr. Black made some remarks explanatory of his employ- ment of the spray in extracting teeth, thinking the instrument a valuable means of lessening or destroying sensibility. In some cases he had found patients unable to bear the sudden re- duction of the temperature on account of the exposed and irrit- able condition of the nerve of the tooth. In some of these cases he had succeeded in employing the spray by first cover- ing the tooth with wax. On motion it was resolved that the thanks of the Society be tendered Dr. Black for his valuable contribution to dental sur- gery. The subject of local anaesthesia being under consideration, Dr. Edgar related a case of anchylosis of the elbow-joint of a young lady, treated with chloroform and olive oil to the joint, enclosed in oil silk to prevent evaporation, by which means all sensation was removed, the adhesions were broken up and the joint restored. Society adjourned to meet at 2 P.M. At 2 o'clock P.M., the Society met. The Vice-President in the chair. Dr. Warriner presented samples of his purified castor oil to the society for inspection and trial. Committee on fee bill, Drs. Askew, Fisher, and Prince, sub- mitted the following list of prices, for the establishment of a somewhat uniform rate of compensation for medical and surgi- cal practice in the county: For the purpose of a general guide in grading compensation for professional services, the following estimate is accepted by the members of the Morgan County Medical Society: The higher charges for services of a surgical nature do not imply greater attainments than are required for skilful medical practice, but they are considered necessary in view of the less frequency of the cases and the expense necessarily incurred in providing instruments and apparatus. Each member is still left to his full discretion to increase or diminish his own rate of compensation, in view of the pecuniary circumstances of his patients, or as a conscientious estimate of the value of his services, compared with those of members of greater or less attainments. Ordinary office advice, not consuming much time, and involving no unusual care in investigation, $1 00 Careful investigation in a physician's office or elsewhere, consuming considerable time, and often requiring the introduction of a sound or catheter, the employment of chemical tests, the introduction of an exploring needle, the em- ployment of a speculum, a stethescope, an ophthalmoscope, or a laryngoscope, by those skilled in these means of investigation,----- 5 00 to 25 00 Visit in town----------------------------------- 1 50 to 3 00 Subsequent visits same day without special call, 1 00 to 2 00 Night Visit,------------------------------------ 3 00 to 5 00 Extra patients in same family, each,------------ 1 00 Mileage--day,---------------------------------1 00 " --night,---------------------------------- 2 00 Obstetrics, uncomplicated, within three miles,-- 10 00 to 2500 Delivery, by turning, forceps, or perforation,--.- 25 00 to 5000 Subsequent visits in town for the first three days, to be in- cluded in the charge, unless fever, inflammation, or other com- plication render unusual attention necessary. Subsequent visits in the country, the same as in other cases. Attendance on small-pox, per visit, (mileage extra), ------------------------------------- 5 00 Consultations (mileage extra),------------------ 5 00 to 10 00 Gonorrhoea and syphilis, in advance,------------ 10 00 to 50 00 Minor surgical operations, like opening abscesses, dressing bruised fingers, bleeding, cupping, the formation of issues, and the introduction of setons,----------------------------------- 1 00 to 5 00 Dressing injuries of greater extent or danger, in- cluding fractures and dislocations, easily treat- ed, and the ligation or acupression of arteries in wounds of little importance, the amputation of toes and fingers, circumcision, the removal of the tonsils--the uvula, etc.,-------------- 5 00 to 25 00 Dressing large or dangerous wounds, requiring the closure of important arteries to arrest hem- orrhage, adjusting fractures and dislocations of greater magnitude or involving greater diffi- culties, the operation for hydrocele, for hair-lip, for strabismus, paracentesis, amputation of the breast, castration, the removal of tumors, not involving great difficulties, staphytorephy, lar- yngolemy, eridectomy, amputation, or extrac- of the eye,----------------------------------- 25 00 to 100 Capital operations, including the larger amputa- tions, resections, and exsections, and the re- moval of the paroted gland, trephining, ovari- otomy, herinotomy, Iithomy, the more difficult plastic operations, the reduction of disloca- tions which have resisted previous attempts, the adjustment of oblique fractures of the thigh and of those involving the neck of the femur, or of the knee-joint, compound and comminu- ted fractures of the larger bones and joints, extraction of cataract, and the formation of ar- tifical pupil,-------------------------------- 100 to 1,000 Subsequent attendance the same as in other cases. The President declared any remarks on the subject to be in order. Dr. Cassell thought a fee bill might be referred to as a gen- eral guide, but that great latitude must be allowed for varying circumstances, which the physican must respect. Drs. Craig, Askew, Reed, Fisher, Johnson, and others offer- ed remarks on the subject, when the list of prices, as submitted by the committee, was adopted by unanimous vote. The Vice-President reported a novel and interesting case of menstruation and escape of liquor amnii during eight months of pregnancy. Dr. Wagely moved the subject of puerperal fever be taken up. Dr. Prince apologized for the delay of his paper on that sub- ject, and promised it should be forthcoming at the next meet- ing. Dr. Edgar called attention to the liability of error in practice from failure to diagnose correctly the pathological condition in each case of puerperal fever, z.e., whether dependent on a true toxaemia, or on metritis, phlebitis, peritonitis or metroperitonitis. That the toxaemic condition being attended with an asthenic grade a fever indicated a supporting treatment while the purely inflammatory cases might be better treated by early free deple- tion and full exhibition of anodynes. The further consideration of the subject was postponed until the next meeting. On motion the Society adjourned to meet on the second Thursday of January, 1867, at 1 o'clock P.M. R. E. McVEY, M.D., Prest. C. T. WiLBUit, M.D., Secy.

PMC9999998

ARTICLE IV. WOUND OF THE INTESTINE--RECOVERY. Reported by Drs. MASON & WHITNEY, Prairie du Chien, Wis. Nov. 13thy 1866. John Fisher, a native of Sweden, light complexion, tall, spare, and of robust constitution, cet. 32, was stabbed, in an affray, on the evening of the above day. The instrument by which the injury was inflicted was probably a large dirk-knife. The knife entered the abdominal cavity about an inch below the umbilicus, and nearly over the median line, producing a diagonal wound nearly two inches in length. The corresponding wound in the transverse colon was also diag- onal, something over an inch in length, and was found to have divided a large branch of the mesenteric artery. When first examined, the larger portion of the intestines had escaped, including the wounded colon, and lay congested and cold upon the abdomen. There had been a good deal of hemorrhage from both ends of the severed artery, which was still bleeding. The pulse was feeble; surface cold and exsanguined; and the pa- tient quite insensible. A ligature was immediately placed on both ends of the di- vided artery and closely cut, the contents of the colon in the vicinity of the wound evacuated, the wound cleansed and closed accurately by the Glover's suture, care being taken to bring , the serous surfaces in contact. The entire mass of intestines were now carefully examined, when, no other injury being found, they were cleansed with warm water and returned, the small intestines first, and, lastly, the wounded colon. The long ends of the intestinal suture were now drawn up, bringing with them the entire gut, so that the intestinal wound should lie directly under that of the abdomen, to which it was closely applied and secured by fastening the sutures outside. The external wound was now closed by two points of suture and a few straps of adhesive plaster, a pledget of dry lint and com- press applied, and all secured by a broad bandage. The pa- tient was ordered to have a little stimulus and | grain of mor- phine every third hour. Nov. ll^th. Had passed a comfortable night; is well under the influence of morphia; pulse 108, quick; tongue a little red and dry; no tympanites, and very little pain. Ordered to con- tinue the morphia, and, for nourishment, oatmeal gruel; for drink, ice-cold toast-water. Nov. 15tli. Pulse 120; tongue red; some tympanitis; lies quiet; narcotism pretty well established. Continue treatment. Nov. 16th. Pulse 124; otherwise, same as yesterday; suf- fering no pain. Continue treatment. Nov. 17th. Same as yesterday. Continue treatment. Nov. 18th. Pulse 132, feeble; tongue very red and dry; tympanitis increased, and some pain. Continue treatment, and for nourishment, beef-tea. Nov. 19th. Removed external sutures; found wound united, except at lower angle, where intestinal sutures were brought out; pulse 138; tympanitis about as yesterday. To increase the doses morphia to | gr. every four hours, and 1 oz. whiskey alternately. Nov. 20. Pulse 132; tympanitis less; no pain. Continue treatment, and dress wound. Bowels moved a little to-day. Nov. 21st. Pneumonia developed in the right lung; cough troublesome; some dyspnoea. Continue morphia, and substi- tute Mindererus' spirit for the whiskey. Nov.22d. Patient improved; pulse 124; surface perspiring; considerable rusty expectoration. Continue treatment. Nov. 23d, 21/lh, 25th, and 26th. Improving; patient com- fortable ; intestinal suture coming away. Continue treatment. Nov. 28th. Intestinal suture brought away; bowels moved freely. From this date, the patient recovered gradually, hav- ing a moderate diarrhoea only, which was restrained by tr. opii camph. Dec. 10th. External wound about healed, and patient walk- ing about. It will be remarked that the morphia, pushed to moderate narcotism, "was steadily persevered in throughout the treatment. Of course it was withdrawn as soon as the tympanitis began to subside and the danger from inflammation had passed. During the process of repair, a red and raised ring was noticed around the wound where, probably, the intestine was glued to the -walls of the abdomen by plastic lymph.