1871. He attended thirty-six cases of confinement the last twenty years he had attended about nine hunwhile serving in the lying-in department, and there dred cases of confinement, including every variety of was not a single case of puerperal fever among them. complication, and had had but one death which was The only death that occurred was due to convulsions. preceded by febrile symptoms. Even this one was not He had observed the same measures in his private due to any septic influence. It was only since Dr. Wiley practice ever since, and had never had but one case in had read the paper before this Society to which referwhich there was a rise of temperature during the first ence had been made that he had tried the use of profew days after delivery. When there had been any phylactic vaginal injections, and he was sorry to say febrile movement it had occurred after the eighth day, that his experience with them had not been at all faand had been due to mastitis. He was in the habit of vorable. In no less than six cases, in all of which the washing out the vagina with a solution of carbolic acid women were faithfully syringed, he had seen fever which of the strength of one to fifty, or more often of one to was undoubtedly of septic character occurring in from thirty, and also of carbolizing the bed linen; while he five to eight days after delivery. He then went on to always insisted on having two sets of blankets and at say that there was a distinct reaction against the use least thirty-six napkins for the use of the patient. He of such injections now taking place in Germany, and would now try bichloride of mercury instead of the that they seemed to him to be objectionable on the carbolic acid. In conclusion, he said that he could not following grounds: (1.) He believed that the lyingagree with Dr. Murray in regard to there not being in patient ought to be kept as quiet as possible, and the same necessity for taking every precaution against the injections interfered with this. (2.) It was imposthe occurrence of infection in private practice. A sible to give them without subjecting the patient to a physician might have the most uninterrupted success certain amount of pain and exposure. (3.) Very few for a long time in his obstetric practice, and yet septi- nurses know how to give injections properly. (4.) cæmia at last make its appearance. They were liable to displace clots and thus open avenues for auto-infection. (5.) They might also loosen adhesions. In his opinion simple cleanliness before, during, and after labor was all that was necessary. DRS. F. V. WHITE, J. P. GARRISH, and J. C. PETERS then spoke, and DR. GARRIGUES brought the discussion to a close. In the course of his remarks he said that while one of the wards was new the others had been in constant use, and had previously contained many fever cases. There were three wards occupied by the lying-in patients in rapid alternation. The vulvar dressing had been devised with special reference to the shape and size of the parts to be covered by it, and he thought that if applied with proper skill it was efficient in excluding septic germs. DR. GILLETTE stated that he had been connected with the maternity service on Blackwell's Island for twelve years, and that he had sole charge of the lying-in wards of Charity Hospital when the obstetric patients were transferred from Bellevue Hospital. For years puerperal fever had been epidemic at Bellevue, and all efforts to break it up had proved futile. At last the mortality became so great that it was determined to discontinue the lying-in service there entirely, and, accordingly, forty women were removed to Charity Hospital. They were all saturated with the influences that had prevailed at Bellevue, but under the counteracting influence of extraordinary cleanliness only one case of puerperal fever occurred among them. Nothing was known of Listerism then, and no special antiseptic treatment was employed except carbolic acid baths. He thought there could be no question of the importance of all the suggestions which Dr. Garrigues had made, but there might be some discussion as PATHOLOGICAL SOCIETY OF PHILADELPHIA. to the methods which he proposed. The latest germicide to attract attention had been the bichloride of mercury, and so at the present time everybody was expected to bow down to it, although he was not as yet convinced that it was of more value than some other antiseptics. In regard to Dr. Garrigues' vulvar dressing, he could see theoretically how it might do good, but practically he did not believe it was of any service, for the simple reason that it could not be kept in absolute contact with the parts to which it was applied, and, consequently, there must be plenty of room for the entrance of any germs that might be in the air. The great secret of the success which had been reported he believed to be perfect cleanliness, and he was also disposed, like Dr. Murray, to attribute it in part, at least, to the fact that Dr. Garrigues had commenced in a new institution. DR. ALEXANDER T. HUNTER made some remarks, in the course of which he spoke of the superior advantages of the tube devised by Dr. George H. Lyman, of Boston, in cases where it was desirable to resort to intra-uterine injections; after which DR. BARUCH said that he was glad to hear the author of the paper speak against the use of prophylactic antiseptic injections after normal labor. For himself, he could only condemn them in the most unqualified manner. During C. B. NANCREDE, M. D., RECORDER. THURSDAY evening, December 13, 1883. DR. J. H. ENORMOUS HYPERTROPHY OF THE HEART (WEIGH- CHARLES W. DULLES, M. D., reported the case. His The patient from whom this specimen was obtained was a young man, eighteen years of age, who came under my care in February, 1882, in an attack of muscular rheumatism, principally affecting the shoulders. I found at that time great oppression of breathing, a heart dilated and hypertrophied, with a harsh, strong, mitral systolic and presystolic murmur. urine contained bile coloring matter, great excess of urates, great lack of chlorides and phosphates, and no albumen or sugar. In the sediments only amorphous urates were found. The treatment employed included the administration of infusion of digitalis, with iron and strychnia. At one time, believing it might benefit the violence I attributed to the real hypertrophy, I gave him veratrum viride. But it did no good. I did, however, get apparently good and prompt relief from some of the symptoms by the use of iodide of potash, in twenty-grain doses, thrice daily. After using this for a week, I noted in my case-book: "Sleeps well; eats well; feels well; cough very slight; urine clear; pulse better; cannot hear the old murmur (perhaps barely); both heart sounds audible and pretty clear; action of heart fair." (It had been very tumultuous.) After six weeks of doing well the patient had a new attack of uneasy stomach, dyspnoea, and more or less cyanosis. On the night of May 10th he had a frightful attack of dyspnoea; I gave him one fifth grain of muriate of pilocarpine hypodermically (in the left arm), under the influence of which he sweated, but had no salivation. The next day he had a large oedematous swelling of the left side of his neck, below the jaw, and reaching to the middle line in front. This increased up to the evening, and gradually subsided in three days. About this time fluid began to accumulate in the abdomen and thorax, and there was, of course, oedema of the feet and legs. There was also heard now a most beautiful water-hammer pulse over the femoral arteries below Poupart's ligament. The pulse here was intermittent and had a reduplicated sound like this. etc. Three weeks later another severe attack occurred, and again about three weeks after this. There were now in his urine considerable albumen and hyaline tube casts. When his attack came on, which was at night. I gave him one third grain of the muriate of pilocarpine hypodermically, which produced free sweating and brought out about two fluid ounces of saliva. His pulse came down from 140 to 100 in half an hour. But the dyspnoea abated only temporarily; the restlessness continued; the cyanosis increased; the respiration varied from 35 to 60 per minute; then his bowels moved involuntarily, his lungs seemed to fill up with oedema, and he died asphyxiated. The autopsy was made the next day, with the assistance of Dr. Formad and Dr. J. H. Musser. The points of interest were as follows: General edema of feet and legs; the face and neck and chest covered with purpura-like spots and patches. The abdomen contained about two quarts of clear serum; each pleural cavity nearly as much. The lungs were normal but small, and occupied the upper part of the chest. They were quite oedematous. The liver was slightly fatty, the spleen was of normal size, but very hard and tough. The kidneys were large, congenitally lobulated, and in a state of cyanotic hypertrophy. The heart was enormously hypertrophied, weighing, when all the adherent parts were removed, forty-eight ounces. The pericardium was so uniformly attached to it that it could not be removed, and there was absolutely no pericardial cavity. The right ventricle contained about six ounces of soft post-mortem clot. The left side contained about two ounces similar. After the heart had been opened and well washed it weighed forty ounces. All the valves and blood-vessels were healthy. The tricuspid and aortic valves were quite competent. The mitral orifice was enormous -measuring two and a half inches across. Every part of the heart was hypertrophied, and all to about the same degree. The whole organ, which I here show, was about the size of that of a bullock. systolic murmur; and the parotid swelling, following the hypodermic injection of pilocarpine in the arm of the same side. Dr. J. H. Musser remembered distinctly the case both before and after death. He had marked out on the chest the dimension of the heart and made it out as enormous, extending especially to the right. Furthermore, he thought that there was a double mitral murmur. The only apparent cause for the hypertrophy was the adherent pericardium. He would like to know what Dr. Henry thought of the correctness of this explanation. DR. F. P. HENRY said that the heart presented was remarkable not only for its enormous size but also for the absence of the usual causes of cardiac hypertrophy, there being neither valvular disease nor obstruction in any part of the circulation. During his student days he had seen some very large hearts in the collection which Prof. Alonzo Clarke was accustomed to show to his class, but would not trust his memory so far as to affirm that any one of them was as large as the one just shown. Dr. MACCONNELL had seen a case in a member of the Modjeska troupe where post-mortem examination showed an enormously hypertrophied heart with adherent pericardium and markedly granular kidneys. In this case the hypertrophy was clearly due to the kidney trouble. Dr. FORMAD thought that Dr. Dulles' case was unique as to size. Dr. Robinson, of New York, had recently reported a case of hypertrophied heart, weighing fifty-six ounces, but Dr. Dulles' specimen was weighed after removal of clots, etc. DR. MUSSER asked whether other members of his patient's family had not hypertrophied hearts without valvular lesions. If such was the case, taking into consideration the age of the patient, it would be well to consider the probability of the hypertrophy being in part secondary to the pericardial adhesions, in part idiopathic in origin. DR. DULLES said that there was a tendency to hypertrophy of the heart in one sister, and that the murmur at times was double. (To be continued.) - In the duty of the medical journalist to welcome the coming, speed the parting guest, it falls to our Laryngology, which we do with regret, and to anpart to chronicle the demise of the Archives of nounce the appearance of The Analectic, a new periodical designed to select and analyze the essential items of medical progress from the publications of this and foreign countries. It -The Archives of Medicine has also suspended publication after a satisfactory existence of five years. is to be regretted that this journal, which has filled a valuable place in supplying purely original material to its readers, is obliged by a combination of extraneous circumstances to retire from the field. -The Illustrite Monatsschrift der ärztlichen Polytechnik and the Centralblatt der orthopädeschen ChiThe points of interest in this case aside from therurgie will hereafter appear as one publication. curiousness of the specimen seem to me to be the comparative immunity of the kidneys; the absence of signs of adherent pericardium; the benefit derived from the use of iodide of potash; the temporary disappearance of the very strong mitral systolic and pre Mr. P. T. Barnum has been making a will, disposing, it is said, of some $10,000,000, and has called a number of physicians to give evidence of his mental soundness at the time of the execution of the instrument. Surgical Journal. Library of the Surgeon-General's office at Washing Medical and Surgical THURSDAY, JANUARY 3, 1884. ton with a fire-proof building. The medical societies of the different States will not allow the Index Medicus to become extinct. Massachusetts will restore, or will prepare to restore, her Board of Health to its existence as a separate A Journal of Medicine, Surgery, and Allied Sciences, published weekly by entity, and will simplify the organization of the HOUGHTON, MIFFLIN AND COMPANY, Boston. Price, 15 cents a number; $5.00 a year, including postage. complex body now known as the Board of Health, All communications for the Editors, and all books for review, should be Lunacy, and Charity. addressed to the Editors of the Boston Medical and Surgical Journal. Subscriptions received, and single copies always for sale, by the under There will be a sharp contest in her courts and signed, to whom remittances by mail should be sent by money-order, draft Legislature over the enforcement of the law to pre or registered letter. HOUGHTON, MIFFLIN AND COMPANY, No. 4 PARK STREET, BOSTON, MASS. ANNUS MEDICUS INCIPIENS. As last week brought the annual duty of summing up the medical events and results of the year which has just left us and contributing thus, it is to be hoped, to his euthanasia, so this week brings the no less periodical pleasure of wishing to our friends all they desire of good during the new year upon which we are all just entering. Hope, that best though delusive companion, is again starting trippingly on the journey as though she had never misled and even abandoned those who confided in her guidance; may vigor and perseverance be added to the company, enabling it to attack new questions and bring old ones to happy conclusions. There are plenty of dragons still to be slain, captives to be rescued, and rough places to be made smooth. Were not the spirit of prophecy such a dangerous one to imprison in print, we might outline the present medical year as we have the past, at least in so far as the one inherits from the other. Contributions will be made to the facts upon which the germ theory of disease is based, and the significance and scope of that theory will be somewhat more clearly defined. The Collective Investigation of Disease will be carried forward in England, on the Continent, perhaps in this country, and the methods by which the greatest advantage may be drawn from it will be gradually evolved. Both our own continent and that of Europe will be somewhat occupied next summer in guarding against any dangers from the relics of this year's epidemics of yellow fever and cholera, the present course of events in Egypt rendering a revival of cholera by no means improbable. Congress will discuss the value and functions of a national board of health, and, we will predict, while acknowledging the desirability of having a national board with a tolerably broad basis of representation, will leave the administration of maritime quarantine matters to the Treasury Department, assigning to a board of health the duty of pursuing and directing investigations of abstract hygienic problems which confront us as a nation and as individuals, and of making sanitary surveys. The possibilities and limitations of quarantine will probably in any case attract much discussion abroad as well as at home. Congress will in its wisdom make an appropriation to provide the Army Medical Museum and the Medical vent the adulteration of food and drugs, in which the rights of the public to be protected will eventually prevail over the desire of the manufacturers to be rich. The system of medical examiners obtaining in this State will receive favorable consideration in other States, warning the old coroners to withdraw. In the domain of therapeutics the synthetic process in the chemical laboratory may have surprises in store for us. We risk less in averring that medicine will again be robbed of some good followers, whose places will be taken by others now less known. In the above short paragraphs sufficient prophetic hostages have been given to fortune. Should some of them fail to be redeemed we shall shelter ourselves behind the wish, which perhaps was father to the thought; and laying aside the prophet's mantle we revert in closing to the agreeable and certainly safer function of wishing all who journey with us a happy and prosperous new year! LITERATURE IN MEDICINE. THE profession of medicine is making progress by means of the constant study done in the laboratory, at the bedside and in the library, by a series of trained students and observers. Laboratory work has accomplished so much for the good of the profession, and has assumed such importance in the eyes of educators, that there is danger lest work of other descriptions, not less important, should be under-estimated. "Original scientific work is in the present day too apt to be considered the only claim to distinction, and that phrase is held to mean, almost exclusively, work in the physiological or chemical laboratory, and clinical and literary labors are apt to be under-valued if not despised. The propriety of such an attitude toward these latter methods of study is discussed in an address on the Place of Literature in Medicine by Dr. C. J. Cullingworth, Lecturer on Medical Jurisprudence in Owens College, Manchester, England, before a students' society of that institution. He intimates that the term "original" is not always appropriate as applied to such laboratory work, which consists in the carrying out of a series of observations and experiments under the direction of a teacher to whom is not only due the suggestion of a subject for inquiry, but also the laying down of the lines of the inquiry itself. Unless originality of thought on the part of the worker himself is involved the phrase is open to objection. In the gentleman's opinion, while he is far from detracting from the value of researches which lead to even the slightest addition to exact knowledge, there is nothing in laboratory work itself as distinguished from clinical or literary work which gives it an exclusive right to be regarded as original and scientific. Literary work may be as deserving of the designation scientific as any other, and of immense value to practical medicine. Not every man who contributes an article to a medical journal can be described as literary. Unfortunately our journals too often contain limited personal experience and hasty generalizations recorded with complete ignorance of what has previously been written on the same subject, but it is one of the functions of the literary worker to rescue from oblivion the valuable facts scattered through the voluminous literature of medicine, and render them by comparison and collation useful to the profession. To bring together unusual cases, to elucidate a symptomatology from the collected histories, to put the practitioner on the watch in regard to such cases, and mark out lines of future inquiry which shall enable the next man who meets with a similar case to complete the story, what more profitable work can be found for the student? As a sample of such scientific literary work, the earlier editions of Bumstead's Venereal Diseases may be mentioned. The later editions were enriched more largely by his own observations, and deserve recognition for combined literary and clinical work, but of the first edition the author claimed only that he had collected into one volume, and thus rendered more accessible to the American reader, the investigations and results scattered through the pages of medical periodical literature in our own and foreign languages. This is an extreme example of such work; it is ordinarily done on smaller subjects, and is peculiarly fitted to men at the very commencement of their career, when their experience at the bedside is as yet too small to justify them in drawing materials from it alone for contributions to medical literature. As an assistant to such work Dr. Cullingworth speaks of the Index Medicus: "It is a remarkable example of American enterprise, and one can but feel deep regret that it has hitherto failed to obtain sufficient support to repay the cost of its publication. Recognizing the great loss it would be to medicine for such a publication to be discontinued, several of the medical societies in the United States have subscribed to a guarantee fund, from which the publisher, who for the first two or three years bore the entire risk, is for a short time to be recouped for any loss he may sustain by its continuance. I am glad to say that of all the towns in Great Britain, Manchester is the one which furnishes the longest list of subscribers in support of this enterprise." In attempting to collate the facts recorded by others one constantly finds the most important facts omitted and generalizations added in abundance. "The great ... obstacle to the development of a science of medicine is the difficulty in ascertaining what cases are sufficiently similar to be comparable, which difficulty is in its turn largely due to insufficient and erroneous records of the phenomena observed. . . . Very, very few are the men who can, by and for themselves, see and describe the things that are before them. . . . We had to wait long before the man came who could see the difference between measles and scarlatina, and still longer for the one who could distinguish between typhus and typhoid." We fear many cases are lost to the world which would prove not only of paramount interest but of great value to the profession, through the modesty of men who hesitate to publish cases because of their inability to explain every symptom which has appeared. "The report of a case," says Dr. Billings, whom we have just quoted above, "in which every symptom observed and the effect of every remedy given is fully accounted for, and in which no residual unexplained phenomena appear, is usually suspicious, for it implies either superficial observation or suppression or distortion of some of the facts." No one need despair, then, that laboratory experiment is not to their taste. The literary doctor bas his uses as well as the more strictly scientific, if only he will learn to use his literary ability for the service of his profession. Diversity in preliminary medical education is certainly an advantage to the profession, as furnishing a class of men who are able to profit by and make profitable to all the work of the observer and the experimenter. PERMISSIVE EUTHANASIA. AMONG the queries made by the Poet at the Breakfast Table of the man of the fortieth century A. d. is one whether the euthanasia has become a recognized branch of medical science. The JOURNAL has already noticed the assumption on the part of certain practitioners that a monstrosity should be put out of the way as soon as possible after birth, which proposal, though not (we are happy to say) generally "recognized," is in its measure a present realization of what the Poet thought a possible development of two millenniums. We now find in an exchange the frank confession of a physician on the frontier that he believes in and has acted on this principle in the treatment of an adult. The patient was a pauper, and was suffering from a serpiginous phagedæna which had destroyed the external genitals, and had spread into a large ulcer extending from the perinæum to the hypogastrium. He was alone, covered with filth and flies, dependent on the tender mercies of county commissioners, and apparently too weak to be moved to an almshouse. The reporter considered it his "duty as a conscientious physician," and in fulfillment of the "golden rule," to administer sol. Magendie 3i., which succeeded in fulfilling the indication for euthanasia, cito tuto et jucunde. Whatever the fortieth century may have in store for us, we believe that the profession is not quite pre pared for this teaching at present. We are not as yet ready to see the functions of Atropos added to those of Asklepios. But, on the other hand, though we would never become destroyers of life, we suspect few physicians have escaped the suggestion in a hopeless case of protracted suffering to adopt the policy of laisser aller, to stand aside passively and give over any further attempt to prolong a life which has become a torment to its owner. For instance, a woman has malignant disease advanced far beyond the chance of operative interference. The odor is horrible, and not to be suppressed. Pain is intense. refuses its work. Fatal hemorrhage momentarily threatens. For weeks the physician has combatted death at each of these points; has taxed to the utmost the art of the cook to appease the recalcitrant stomach; has crowded in food and stimulant by every channel, and all for what? to exhaust the strength and perhaps imperil the lives of the remainder of the household; to keep in their home a body which is repulsive to every sense and a mind which is no longer that of their The stomach friend, but which is overclouded if not maniacal; or, if the sufferer retains consciousness, to meet her bitter reproaches for prolonging her misery. Shall not a man under such circumstances give up the fight, take off the spur of the stimulant, and let exhausted nature sink to rest? a One of the most ghastly of Poe's tales is of a man whose soul was by some mesmeric influence kept in his body for weeks after the body was dead and decaying. The agony with which with swollen tongue and rattling voice he implores to be set free is vividly depicted, until at last the spell is taken off, and as the soul escapes the corpse collapses, loathsome, almost liquid mass of detestable putrescence." Even this emphatic language is hardly an exaggeration when applied to the bodies in which the physician sometimes fancies himself called upon to enchain for a little longer the struggling life. If the open upbraiding of the patient is wanting, the unspoken desire is often present to be delivered from this body of death. A garrison is brought face to face with inevitable surrender. The friendly general has not troops or supplies enough to relieve the besieged, and is perfectly aware of it. Shall he send in the pittance that can be introduced merely to prolong the garrison's suffering a few more days, when the surrender must inevitably be made? Perhaps logically it is difficult to justify a passive more than an active attempt at euthanasia; but certainly it is much less abhorrent to our feelings. To surrender to superior forces is not the same thing as to lead an attack of the enemy upon one's own friends. May there not come a time when it is a duty in the interest of the survivors to stop a fight which is only prolonging a useless and hopeless struggle? THE DECISION IN REGARD TO THE PRIZE FOR ESSAYS ON MALIGNANT DISEASE, ITS CURE, AND THE METHODS OF INVESTIGATION TO BE FOLLOWED. In our advertising columns will be found the decision of the judges concerning essays on the subject of Cancer presented in accordance with an announcement made in March, 1882. The result is to be regretted. The subject, it must be admitted, was a difficult one, but so much the more surprising is the lack of serious and painstaking endeavor noticeable in the majority of the essays offered. We must confess, too, to some surprise at the absence of other than writers in the English language, for the announcement concerning the prize offer was extensively published in France, Germany, and Austria, permission being given English language. to employ the French or the German as well as the The amount of the prize offered one thousand dollars was certainly sufficiently large to act as a spur to scientific zeal, and to have called forth a keener competition than is represented by the six essays which it is announced were received. Nineteen or twenty months was, moreover, time enough for serious preparation. There is no doubt that the benevolent proposer of the prize is not the least disappointed of those concerned. MEDICAL NOTES. The Naval Advisory Commission has recommended the sale of the whole or the larger part of the Naval Hospital grounds at Chelsea, Mass. The cause is that the grounds are unnecessarily large, that they form an obstacle to public travel, and that they are too valuable to be kept longer from the market. milk of the cocoa-nut is found in a daily contemporary. -A story illustrating the nutritiousness of the It seems that a vessel left San Francisco with four hundred passengers for Sydney, and, in consequence of running short of stores, put in at Samoa, where a large quantity of cocoa-nuts were obtained. The weather became so severe that the remainder of the passage consumed eight days, so that men, women, and children were reduced entirely to a cocoa-nut diet, and were obliged to be contented at last with but one per diem for each adult. "Notwithstanding this diet," says the report, "not a life was lost, and not a single case of sickness occurred, all the passengers landing in a healthy and well-nourished condition." -The attorney-general of New York has begun suit at New York against the Eclectic Medical College of that city to annul its charter and dissolve the corporation. The attorney-general charges that the college has violated the provisions of its charter by issuing its diplomas in blank to enable persons not properly qualified to insert their names and illegally practice medicine. Dr. Robert T. Davis, member of Congress from Fall River, has been appointed on the Committee for Public Health. Dr. Davis's long experience on the |