Tetanus Treated with Antitoxin.-E. H. HOWLETT, F.R.C.S., reports (Med. Chronicle, vol. iv. p. 186) a case of tetanus in a lad of fourteen years, arising about two weeks after the receipt of gunshot-wounds in the legs. The repeated administration of antitetanic serum produced no immediate effect upon either the spasms or the general condition of the patient, but rapid improvement took place in the appearance of the wounds. Convalescence was established in twelve days. Why is the Abdomen Opened in the Middle Line ?-Dr. F. WINSON RAMSAY (Lancet, No. 3370, p. 1355) asks this pertinent question, and refers to the unanimity of operators in this selection. The usual reasons given for preference for the median incision are (1) less hemorrhage; (2) fewer important structures to encounter ; and (3) easy access to all parts of the cavity. These Dr. Ramsay considers imaginary and really points of disadvantage. In the first place, the matter of hemorrhage, there is no reason to fear troublesome bleeding in any part of the abdominal wall, and if slight in the linea alba, it shows a lower vitality there, and hence a delayed or imperfect union may result. Secondly, the whole depth of the incision being through fibrous or tendinous tissue the young operator may enter the cavity unexpectedly, injuring its contents, and in closing the wound he will find difficulty in readjusting the several layers as accurately as if they were distinctly separated by muscular tissue, etc. Thirdly, the greater facility afforded in exploring all parts of the cavity is overestimated, and more than outweighed by the presence of the umbilicus immediately in the way when it becomes necessary to extend the incision upward. To render the umbilicus strictly aseptic is a difficult, if not impossible, task. The writer suggests that abdominal section be made vertically through the rectus muscle on either side, and contends that here the operator will meet all of the advantages and encounter none of the disadvantages mentioned above. He has recently put it to a practical test in five operations, and is convinced that its advantages are not alone a matter of theory, but real. Some of the Immediate Results Produced by Castration in Cases of Enlargement of the Prostate.-DR. C. W. MUNSELL MOULLIN (Lancet, No. 3770, p. 1347) calls attention to an unexpected immediate effect following castration, to wit, the recovery of power to void the urine naturally ofttimes within the first few hours after the operation. Sometimes this has remained permanent, but usually there is a temporary relapse. He cites many cases illustrating this point, one of which was observed by Mr. Hunt, of Wolverhampton, wherein micturition was naturally performed two hours after the operation, and continued so for five days, when the use of the catheter had to be resumed. An item of especial interest in this case was a tonic spasm of the muscles about the anus, lasting for some time, quite the opposite having been their condition previous to the castration. Clearly this rather astonishing result cannot be explained upon the ground of atrophic changes in the gland, even though they appear after six or eight days. Nor will the feature of rest in bed, etc., be counted as a factor, for in most instances this is part of the preparatory treatment. Prof. White accounts for this by early changes in the median lobe of the body, which is so prone to act as a valvular obstruction; but this is obviously faulty, for time enough has not elapsed for any real diminution in its size, although atrophic changes are known to begin in the organs within a very few days; and, further, such decrease in size, did it occur so early, should be permanent, which will not explain the period of relapse so common in the progress of these cases. In the estimation of Dr. Moullin, the only reasonable explanation lies in the active stimulation produced by ligature of the spermatic plexus upon the vessel-walls, as well as the voluntary muscular tissue throughout the pelvis-as exemplified by Mr. Hunt's case cited above. The sudden and active stimulation of these nerve-trunks by ligation is certainly capable of producing just such results as have been observed, and their gradual subsidence will also coincide with the gradual adjustment of the injured nerves to the new conditions. tive was not curiosity nor mere recklessness, but the desire to be where the need for their services was greatest. Others were worn out by the strain and fatigue of hospital service. We all know something of the tax which is sometimes imposed by hospital service in civil life; what must it be in time of war, with a hundred imperious demands upon a doctor's time and force at once? Those men who underwent such trying experiences were not mentioned in the reports for special bravery, medals and distinctions were seldom distributed among them, neither did they seek or expect them. When we remember that at the close of the war there was scarcely a score of medical colleges in the country, that hospital experience prior to the war was limited to a mere handful of those who entered the service, that therapeutics, medical and surgical, was in its infancy compared with its present condition; when we consider, furthermore, the enormous numbers of sick and wounded successfully cared for, medical supplies obtained and distributed, and obstacles overcome in accomplishing these results, the magnitude of the work becomes apparent. To feel the touch of kinship with men of such achievements thrills one with joy and admiration. The war cloud has vanished; it is to be hoped it THE STATUS OF THE MEDICAL ARM OF THE will not again appear above the horizon; if it should, SERVICE IN CASE OF WAR. HAPPILY the war-cloud has blown over. We draw a sigh of relief as we think of the ills that threatened us for the moment which, for the present at least, have vanished. War may mean glory and renown and countless heroes; it may also mean defeat and disgrace; it always means desolation, sorrow, and horrors unspeakable. No one can have a keener conception of the force of these facts than the members of the medical profession, who, in their daily lives, see so much that requires nerve and patience and self-control. At the same time, should the country be imperilled and its existence threatened, there is no class of citizens which would be found more ready to make sacrifices, endure trials, and give their lives if necessary in its behalf. there need be no question as to the loyalty and devotion of the medical corps. But something more than these sentimental qualities would be required: skill in organizing hospitals, with their complicated equipment and supplies, profound knowledge of military hygiene, ability to organize means for the rapid and easy transportation of the sick and wounded, not alone to the field-hospital, but to the place where treatment, whatever its character may be, will be completed; in a word, all that pertains to the sanitary condition of marching and fighting men, or men in camp, usually grouped together in large bodies, are essential qualifications. That there should be skill and experience in the treatment of disease and injuries goes without saying. Nor is it to be forgotten that good sanitary regulations sometimes decide battles. How was it in the Civil War? The losses by How does the present medical situation compare death and disability in the medical corps were with that which confronted us in 1861? The marelatively greater than in any other arm of the ser- terial and intellectual development of the country vice. On the field of battle the surgeons, although during the past thirty years is an answer to the quesnon-combatants, pressed toward the front, regard- tion. Instead of a few medical colleges, none of them less of personal safety, and often lost their lives of the first rank as we now understand it, we have in the absorbing interest of the hour. The mo- | probably twenty which, as well-equipped centres of instruction, will compare favorably with similar institutions anywhere in the world. A very much larger number of lower grade colleges, while inferior in their opportunities and advantages, are serving a useful purpose as auxiliary to the others. Hospitals, where there was one at the close of the war there are now a hundred, and if there is anything of value in any hospital on earth that has not been tried in our principal hospitals East and South and West, it is because it has thus far been successfully concealed from inquisitive American eyes. With such colleges and hospitals, with opportunities for culture here ever broadening, and with opportunities for study abroad, of which thousands of the present generation of doctors have availed themselves, and with patriotism and loyalty to duty which are unquestionable, it is not to be doubted that with the first call to arms a medical corps could be quickly organized which would be ample as to quality and personnel for almost any conceivable requirement. Fortunately, too, the head of the medical department of the army at the present time not only reflects lustre upon the army and the country by his scientific achievements, but possesses executive capacity of a rare order, which would enable him to expand the service judiciously in case of need, and distribute to administrative posts the officers of tried experience, some of whom saw service in the Civil War. Of great assistance also would be the medical officers of the national guard, whose experience in the summer camp and whose systematic training of successive ambulance-corps have developed an organization of pronounced efficiency. The transfer of duties and relations from civil to military life, with its discipline, its subordination to authority, and the other conditions incidental to the life of a soldier, would be found difficult and trying to many men of excellent capacity and great usefulness, who nevertheless chafe under restraint and routine regulations. We would suggest that in the curriculum of our medical colleges a very distinct period be allotted to the study of military surgery and the special duties which pertain to the military surgeon. It would also be well if some extension of the military system were applied to our hospital management, at least in the larger cities, where the hospitals would at once be required for military purposes, and from which the higher medical officers would probably be promptly drawn. It may not be inappropriate to inquire as to the character of the work of the medical corps if war | should occur. An interesting article bearing upon this phase of the subject has recently appeared from the pen of Sir William MacCormac. He speaks of the greater velocity and smaller size of the missiles now in use as necessarily effecting a change in the character of the wounds which would be received and require treatment in war. There would be more penetrating, fewer lacerated and bruising and crushing wounds. The wounds produced by these small missiles, if not instantly fatal, would have small openings of entrance and exit, and would be relatively difficult to treat. There would be fewer coarse wounds of bayonet and sabre, there would certainly be fewer gangrenous wounds, because of antiseptic treatment immediately and universally applied. There would be fewer wounded by whatever means, there would be more killed outright. The improvements in our ambulance-system, the existence of railroads at almost any point in this country, or in any other in which battles are likely to be fought, will greatly simplify the question of transportation of the wounded. If the terrible effectiveness of modern firearms will tend to shorten a war between two great powers because of the losses which one or both would sustain, equally true is it that the resources of modern scientific medicine would permit a larger percentage of the sick and wounded to be quickly restored to duty and effectiveness than at any previous period of history. What a striking contrast these two facts afford, superlative destructiveness on the one hand, superlative beneficence on the other. WHAT DETERMINES THE LOCALIZATION OF DISEASE? THE accurate localization of disease has been the chief aim and study of the diagnostician during the last fifty years. And wonderful are the advances which its enthusiastic pursuit has led to. Such terms as "general debility," "asthenia," "phlogistic," "bilious," "sanguine," "lymphatic," "amaurosis," "rheum," "decline," etc., have almost disappeared from our vocabulary, and the gain both in clearness of our conceptions of disease and efficiency in combating it has been enormous. In our systems of medicine nowadays almost any disease, except the contagia and the diatheses, is referred to some special organ as the chief seat of its processes; but this wonderful progress has simply been gradually bringing us face to face with another problem behind all this, and of even Now, while it greater interest and practical importance, "What | for instance, are illustrative cases. is impossible to arrange all the organs of the human From the point of view of this school there is a strong and growing tendency to regard many forms of morbid action as reversion to processes which were normal or physical in these tissues at an earlier stage of their ancestral development. For instance, calcareous degeneration is a "dropping back" to the simpler and easier processes of the coral-polyp or chalk-animalcule (Globigerina) stage of our development, fibroid change a sinking on the part of the cells involved to the sponge-level, cancer a "rebellion" of the glandular epithelium, involving a return to the anarchistic "every-cell-for-himself" hydroid stage, gout a falling of the lever and muscle cells in the avian or reptilian stage, in which uric acid is their normal product, etc. According to this suggested theory, any prolonged lowering of the nutrition or vitality of a part or of the entire system, whether from local causes, such as fibrotic arteries, or from general, such as underfeeding, excessive exposure, insufficient supply of oxygen, senile changes, etc., may be sufficient to set up one of these reversionary degenerations and thus account for a large class of disease. But this cannot be further discussed here, as it is to another suggested factor in the causation or localization of disease we wish specially to call attention. And that is the "age," both embryonic and ancestral, of the organ attacked. It is an accepted rule in both biology and psychology that those parts or properties which are the last to appear in an organism are usually the first to disappear. The flowers of plants, the cells of the brain-cortex, the menstrual function in woman, the highest power of the intellect and imagination, and in a race the higher social virtues and graces, in famine or war, Conspicuous among these are the uterus and mammary glands of the female and the lungs in both sexes. The rudiments of a stomach appear in the amoeba, of a muscle-nerve apparatus in the hydra, and of a heart in the mollusc; but the whole invertebrate world with its myriad forms of life is traversed, and three or four of the widest strata of the vertebrate before the air-breathing lung appears in the amphibia. And the same order is followed in the embryo, even the gill-clefts, bars, and arteries putting in their appearance first as if to emphasize the thought what a mere parvenu the lung-sac is. The case of the uterus and milk-gland is even more marked, for the methods of parturition are such as to render both of them unnecessary right up to the very latest and smallest class of even the vertebrates, the mammalia. And by a singular coincidence all three of these organs are peculiarly subject to disease, and to a degree for which no adequate explanation has yet been advanced. Diseases of the lung, for instance, are responsible for one-fourth of the entire death-rate, more than double the proportion which can be attributed to any other single organ or even system, while the uterus and mammæ are the site of nearly 60 per cent. of all cases of cancer in the female. In the case of the lungs, part of this extraordinary susceptibility may unquestionably be explained by the strain to which they are subjected by the sudden and frequent changes in their special environment-the atmosphere; but this can account for only a minor part, as some 65 per cent. of the lung death-rate (45 per cent. of the entire rate) is due to a single specific process-tuberculosis—which can hardly be attributed to exposure. The same is trueof the uterus and mammæ, the overwhelming mass of whose fatality is caused by a special disease, carcinoma, in whose causation neither functional strain. nor traumatic injury can play more than the slenderest part, popular and even professional superstition to the contrary notwithstanding. Would not this peculiar morbidity of all three of these organs be best explained upon the principle of the general law already referred to, that late ap pearance means early decay, and that morphologic and ancestral weakness is usually accompanied or followed by premature functional senility? This, I think, can be almost demonstrated in the case of the uterus and mammæ, the vast majority of whose peculiar diseases develop only after their functional activity has ceased and they have become practically supernumerary organs, waste tissue in the body, which, like "dirt" elsewhere, is sure to breed dis ease. ECHOES AND NEWS. On the 15th of July last Dr. S. Moos, of Heidelberg · one of the founders and editors of the Archives of Otology, died on his sixty-fourth birthday. Rising from an obscure parentage, and battling with the most adverse circumstances and many difficulties, his heroic courage overcame all, and enabled him to write his name among the foremost scientists of his age. His specialty. In recognition of his merits his sovereign writings have greatly enriched the literature of his bestowed upon him the honorable title of counsellor. THE recent election at the New York Academy of Medicine resulted in the election of Egbert H. Grandin, Vice-President; Joseph E. Janvrin, Trustee; Herman L. Collyer, member of Committee on Library, to serve four years; B. Farquhar Curtis, member of Committee on Library, to serve five years; Robert A. Murray, VON BRUNN, professor of anatomy in the University member of Committee on Admissions; William S. Gotof Rostock, is dead. THE Lancet has despatched a special correspondent to the seat of war in West Africa. THE TWELFTH INTERNATIONAL MEDICAL CONGRESS will be held at Moscow from June 7 to 14, 1897. THE ALBERTO-LEVY Prize of 50,000 francs has been awarded by the Paris Academy of Sciences to Professors Roux and Behring in equal parts. DR. JOHN D. Ross, of Williamsburg, Blair County, Pa., has just completed the sixtieth year of a continuous subscription to the American Journal of the Medical Sciences and to The Medical News since its first issue. He is now in his ninetieth year, and still takes an active interest in medicine. LUDWIG TEISCHMANN, formerly professor of anatomy at the University of Cracow, died recently at the age of seventy-three years. His name was generally known in association with hemin-crystals, of which he was the discoverer, and which have such profound significance in medical jurisprudence. THE CHAMBER of Commerce has been occupying itself with a study of light and air with the intent to restrict the skyward aspiration of buildings. In Berlin the height of buildings is limited to the width of the street; in Paris to about 50 per cent. over such width; in Chicago to 130 feet, and in Boston to two and a half times the width of the street. THE explanation for the increase in the New York tax-rate, given by the Governor, shows that it was largely due to increased expenditures for new charitable purposes, including a very considerable item for the institutions ordered by the Legislature." new Perhaps if we would put some of the money that now goes into "homes and asylums into school-houses we might have fewer paupers and lunatics to support. If it were the custom to erect a monument to a man in his lifetime for services to humanity, Dr. Haftkine of all men deserves one. After inoculating forty thousand persons for cholera in India at considerable personal expense he is returning to Europe shattered in health. It is doubtful if he will ever be able to expel from his system the Assam malaria which brought his noble experiments to a close. His inoculations reduced the death-rate materially. theil, Reginald H. Sayre, Ralph L. Parsons, and Charles H. Richardson delegates to the Medical Society of the State of New York. FROM the returns of the last census from the city of Paris, compiled by Dr. Bertillon, it appears that there are 2922 medical men residing in the capital, and of this number 521, or upward of one-sixth, are foreigners. The total number of foreigners living in Paris being 181,000, there are, consequently, 2.87, or in round figures 3, foreign physicians to 1000 foreigners, whereas there is only 1 (exactly 1.07) French physician to 1000 French inhabitants. An examination of the table of professions shows that the practice of medicine attracts to the capital of France more foreigners than any other profession. THE NEXT MEETING OF THE MEDICAL SOCIETY OF THE STATE OF PENNSYLVANIA has been appointed at Harrisburg, Pa., beginning Tuesday, May 19, 1896, and continuing for three days. The Committee on Scientific Business have issued a circular requesting that all papers offered shall be so condensed that they may be read in ten minutes, and that each discussion shall be limited to five minutes. The programme will be arranged as usual in the order in which applications may be received. The titles should be furnished the Chairman of this Committee as soon as possible, and not later than March 19th. The Chairman of the Committee is Dr. F. LeMoyne, Pittsburg, Pa., to whom all communications should be addressed. THE Supreme Court of the German Empire has just pronounced sentence and ordered judgment in the following case: Dr. Max Böhm (Friedrichroda), a determined opponent of vaccination, some time ago was prosecuted for having certified to the successful vaccination by him of several children. The public prosecutor held that this vaccination was fictitious, inasmuch as a diluted lymph, incapable of conferring immunity, had been employed. The decision of the court at Gera, where the case was tried, was unfavorable to the defendant, but this judgment was reversed by the Supreme Court at Leipzig. But the health authorities, instead of acquiescing in their defeat, again brought him up before the court at Gera on the same charge in May last. The court sentenced the defendant to two months' imprisonment. An appeal was again taken to the Supreme Court, but this time the judgment was sustained. |