though if it was not thoroughly performed it was of little use. He had also gone through the experience of Dr. Peabody with a portable bath-tub, but he had found the method extremely inconvenient, and also that, as a rule, all the advantages of the full bath could be obtained by sponging. In any case where sponging did not reduce the temperature as completely as was desired the end, he felt certain, could be attained by the use of the cold pack, the patient being wrapped in a sheet and kept thoroughly sprinkled. For several years he had pursued this plan with advantage in Bellevue Hospital, and consequently had long since dispensed with the cumbersome bath-tub. He agreed with Dr. Peabody in regard to the desirability of an early resort to the use of solid food, and thought that it was a good rule to allow the patient to have it as soon as he felt a desire for it. He did not believe that there was any specific for typhoid fever, and thought that each case ought to be treated according to the special characteristics which it manifested. In regard to the administration of alcohol, he said that he had passed through three different phases of opinion on the subject. When he first commenced the practice of medicine it was customary to starve fever patients as far as possible, and no alcohol whatever was allowed. Afterwards medical opinion went to the opposite extreme, and alcohol was given to excess, but still more recently there seemed to be a tendency, he thought, not to appreciate the advantages of the free use of alcohol in appropriate cases.

In bringing the discussion to a close DR. PEABODY said that there was an additional objection to the suggestion of Dr. Flint, Jr., and that was the difficulty that there would be in getting typhoid-fever patients to take sweet or greasy substances, since it was well known how hard it was to secure the taking of sufficient nourishment of a kind that was more agreeable to the sick. After replying to the criticisms of Dr. Janeway he remarked, in conclusion, that he did not doubt the efficacy of cold sponging if it was properly carried out, but the trouble was, according to his observation, that this was not done practically, as a rule, and hence he was still inclined to urge the use of the full cold bath as the most efficient means of reducing temperature in the average case of typhoid fever.

RHODE ISLAND MEDICAL SOCIETY.
QUARTERLY MEETING.

MARCH 20, 1884. Lyceum Hall, Providence.
DR. N. O'D. PARKS read a paper on

TOPICAL CARDIAC BLISTERING IN THE TREATMENT
OF ACUTE RHEUMATISM,

and recited several illustrative cases.

CASE I. Mr. B. was treated for acute rheumatism by the administration of salicin, in scruple doses, with five grains of ammonia carbonate every three hours. Under this treatment he rapidly improved, and in ten days appeared to be convalescent, and resumed his ordinary pursuits. In a few days, however, a relapse was threatened, indicated by pain and swelling of the knee and tarsal joints and an endocardial murmur. A blister, five by six inches, was applied over the heart, with the happy effect of aborting the threatened relapse, all symptoms of which, including the endocardial

murmur, quickly disappeared. Urine and saliva became alkaline. No return of the malady.

CASE II. An old lady who, every winter, is a victim to so-called "rheumatic gout," which usually attacks each great toe in succession. On this occasion most of the joints of each foot and some joints of the upper extremities, including the metacarpo-phalangeal and phalangeal joints of both hands, were involved, with the usual accompaniment of great pain, swelling, and high fever. A blister was ordered over the heart, and the affected joints anointed with ol. gaultheriæ, which was also exhibited internally, in fifteen-drop doses, every two hours. In three days she was able to sit up, and in less than a fortnight was out driving in her buggy, handling the reins herself. No symptom of relapse. CASE III. Mrs. M., aged forty. Right toe and ankle-joints swollen and painful. Urine and saliva highly acid. Ordered ten grains of salicin and two and a half grains of ammonia carbonate, to be repeated hourly. Fly blister, four by five inches, over the heart. On the next day the left foot was attacked. Ordered salicin, fifteen grains, aud ammonia carbonate, five grains, every two hours. Dressed the blistered surface with unguentum sabinæ. She did well for five days, when the right instep became swollen and painful. Blister over the heart repeated. The following day she felt much better. No pain. From this time convalescence was uninterrupted.

The history of several similar cases of acute rheumatism was given, the cure in each case being rapid and complete. The writer had tried all the modern methods of treating rheumatism, but none yielded such satisfactory results as followed the action of a blister over the heart combined with the administration of salicin or some of the salicyl compounds.

DR. ARIEL BALLOU had suffered from three attacks of rheumatic fever, and had found that a blister over the heart gave relief when the fever threatened to be high. He recommended the opium treatment in muscular rheumatism, as in his experience it tended to prevent a metastasis of the disease to the heart. The treatment of this disease has hitherto been largely empirical. The speaker had gathered eighty "sure cures" for rheumatism.

DR. HERBERT TERRY read a paper on

The

THE TREATMENT OF PUERPERAL FEVER, founded on personal observation of eleven cases. prevention of puerperal fever was briefly discussed. One of the most valuable prophylactic measures yet advocated is the production of a firm and continuous contraction of the uterus after the placenta is expelled. Ergot should be given in every case as soon as the after-birth is delivered, and for half an hour, at least, the hand should remain over the uterus, and any relaxation should be met by gently rubbing the uterus, cold to the abdomen, etc. After tonic contraction of the uterus is insured, and the patient thoroughly cleansed, a firm binder should be applied from the ensiform cartilage to the pubes. Ergot should be continued in smaller doses at least until the color has left the lochia.

Against vaginal douches during labor there is at least one theoretical objection. They wash away the mucus secreted during labor to aid in the passage of the head. A single injection, however, as labor begins may be advantageous.

Vaginal douches after confinement are unnecessary unless the lochia are offensive, — and then only for the

The indications for treatment in puerperal septicæmia are to keep the patient alive until the morbid process ends, and also to prevent any further absorption. For the latter purpose antiseptic intra-uterine douches are the most effectual means. When in doubt as to whether the disease is puerperal fever or milk fever, or as to the location of the point of absorption, it is a good rule to wash out the uterus without delay. If carefully done, the intra-uterine douche is as safe as the vaginal injection. The Davidson was preferred to the fountain syringe, because the direction and force of the stream are under more perfect control. The choice of a tube has to do with some of the dangers alleged against this treatment. It should be large enough to avoid entering a sinus or the Fallopian tubes, yet should not block up the os, and should be about twice the length of the ordinary vaginal nozzle. Some of the tubes used for this purpose are closed at the end, with several openings in the side directed outward and backward so that not only is the force of the stream diminished but it always flows towards the mouth of the womb. It seems important, however, that the fundus of the uterus as well as other portions should be well washed, and, to accomplish this, the hole in the end of the tube should be retained. As to antiseptics, carbolic acid may be employed in a strength of one to sixty, or even one to forty. A permaganate of potash solution of four grains to the ounce is valuable. Corrosive sublimate may be used in a solution of one to two thousand.

Alcohol, opium, quinine, digitalis, and the bromides are invaluable; but without the use of some germicide intra-uterine wash they do not promptly reduce the temperature or shorten the disease.

DR. H. G. MILLER read a brief paper on

BLEPHAROSPASM.

Although usually divided into three stages according to its degree, four varieties may more properly be recognized. The first is one of the slightest and least significant of the eye troubles for which patients seek advice. A simple spasmodic contraction of a few fibres of either the upper or lower portion of the orbicularis, and which the patient often refers to the eye-ball itself. It seems to occur most frequently in near-sighted per

sons.

The second form, nictitation, affects the muscles of both sides at the same time and consists in too frequent or too violent winking. This is most common in children, and is frequently thought to be a manifestation of chorea. Oftenest caused by hyperæmia of the lids or chronic papillary conjunctivitis. It seems to be frequently a reflex expression of fatigue, either of the eyes themselves or of some other portion of the organism. The excessive use of tea, coffee, and tobacco not unfrequently seem to be the exciting cause.

The third form is an exaggeration of the natural effort of the lids to protect the eyes from external in

form. What at first is a mere voluntary or instinctive effort to shield the eye from harm becomes a spasmodic contraction of surprising force and indefinite duration. It even aggravates and increases the original disease, as well as interferes seriously with its proper treatment. The practiced fingers of the surgeon can almost always successfully cope with it; but to the friends to whom the details of treatment must generally be confided it presents an almost insuperable obstacle. Even when the diseased condition causing it is cured, the palpebral opening for a longer or shorter period is left smaller and narrower than before.

The fourth form is spasm of the orbicularis, usually on one side only, clonic in its character, sometimes uncomplicated but often extending to all the muscles supplied by the facialis. In its slighter degrees, occurring frequently during conversation, it gives the patient the appearance of voluntarily adding a mysterious significance to his words, often mortifying to those so affected. In a higher degree the whole side of the face is drawn and distorted. This form is sometimes associated with tic douloureux and adds terror to an already terrible malady. Unlike the other forms which are reflex in character, this one may be of central origin. Cases were given illustrating each of the forms of the disease.

LOSS OF SIGHT FROM INJURY OF FACIAL NERVE.

DR. O'LEARY reported a case in which the sight of one eye was completely obliterated by injury of the facial nerve. The patient, while on picket duty, received a bullet wound over the eye, barely grazing the skin. DR. MILLER thought the loss of sight was a reflex effect from shock of the facialis.

DR. W. J. BURGE reported a case of

MALIGNANT DISEASE OF THE BLADDER,

and DR. CASWELL exhibited the specimen. There had been symptoms of vesical calculus, for which he was sounded without detecting a stone, though he passed a small one soon after leaving Dr. Caswell's office. The evacuating tube and a current of water would probably detect a stone in such a case better than an ordinary searcher. There was entire suppression of urine for four days before death. The growth extended across the bladder so as to close both ureters. The right kidney was atrophied, and the left with its ureter dilated. The tumor had the appearance of fibro-sarcoma.

EXHIBITION OF VARIOUS SPECIMENS.

DR. CASWELL exhibited six small calculi weighing together twenty-five grains, which he removed from the roof of a urinary fistula. They seemed to have formed in the passage.

DR. KEMP, of Lonsdale, exhibited a specimen of Aneurism of the Aorta with Cardiac Hypertrophy. DR. LLOYD MORTON reported a case of Oblique Fracture of the Femur through the trochanteric portion, and exhibited the specimen. There was only a ligamentous union, but the patient was able to walk.

DEATHS.

The President announced the death of DRS. T. W. PERRY and OTIS BULLOCK. A committee consisting

of Drs. W. E. Anthony, Ariel Ballou, and F. T. Caswell was appointed to prepare resolutions on the death of each of these venerable members.

ELECTION OF FELLOWS AND DELEGATES.

As recommended by the Board of Censors, Drs. George R. Smith, of Woonsocket, and William F. Morrison, of Providence, were elected Fellows. Delegates to the annual meeting of the American Medical Association were elected as follows: Ariel Ballou, G. P. Baker, P. E. Bishop, G. A. Brug, Herman Canfield, A. C. Dedrick, J. H. Eldredge, J. W. C. Ely, C. H. Fisher, S. W. Francis, James Hanaford, G. H. Kenyon, J. H. Morgan, S. O. Myers, N. O'D. Parks, A. A. Saunders, H. W. Stillman, H. E. Turner, and A. E. Tyng.

“The brain,”

lowed by arrest of cerebral growth. says Herbert Spencer, "which during early years is relatively large in mass, but imperfect in structure, will, if required to perform its functions with undue activity, undergo a structural advance greater than is appropriate to the age; but the ultimate effect will be a falling short of the size and power that would else have been attained. And this is a part cause — probably the chief cause why precocious children and youths who up to a certain time were carrying all before them so often stop short and disappoint the high hopes of their parents."

As regards the number of hours a day which may profitably be devoted to study there can be no fixed rule; age, temperament, sex, constitution, and state of health must be taken into account. Those of tender

THE HYGIENE OF STUDY. EX-SURGEON-GENERAL HAMMOND says that children should not be sent to school until they are ten or twelve years of age, ten at the earliest. Deferring for a moment the sanitary aspects of the question, the suggestion of Dr. Hammond as applicable to the great majority of children those especially of mechanics, artisans, operatives who require the services of their children at an early age would be impracticable. The Massachusetts law fixes the school age at from five to fifteen, and requires that all between those periods shall receive a certain number of weeks' instruction every year; every child must be in school for at least twenty weeks of the year from the time he is eight until he reaches the age of fourteen years. Among the wealthier classes, and those whose means enable them to give their children a longer term of education, there is less need of beginning school instruction till the organism is somewhat matured. As a question of the amount of learning which can be gained it is probable that it would not be much if at all diminished by retarding the time when children are sent to school. A healthy, bright boy of sixteen would get more from a book in a week than a child of six would in several months, and many parents who have kept their children from books until they were seven or eight years old have found that they have made progress in their studies rapid enough to compensate for the delay. In the earlier periods of life knowledge is chiefly gained, as in the earlier history of the race, by observation, and too rapid a stimulation of mental development is likely to be fol

growth, are less able to bear prolonged mental application than vigorous adults; nor, as before said, is it desirable to develop the juvenile brain at the expense of other organs. Those of the sanguine and nervous temperaments (if we may use terms which are becoming somewhat obsolete) are more restive, and suffer more under the restraint necessitated by study than those of other temperaments, and (other things being equal) they learn faster, owing to predominance of the circulatory and nervous energies. Females, as a rule, are capable of less continuous study than males, and those of strong constitutions in both sexes may bear, not only with impunity, but with profit, an amount of prolonged mental work which to weakly persons might be disastrous and even fatal. The same remark may be made apropos of states of health; hard and continuous exercise of the brain demanding, in order to be truly efficient, a sound condition of the organism. The truth is obvious enough, though needing frequent inculcation, that vigor of the circulation and integrity of the nutritive and other functions - a condition, in fact, of general bien être attended with a flow of spirits and absence of fatigue-should accompany the endeavors of the student, being essential to the successful grasp and assimilation of knowledge, while corporal inactivity, an enfeebled circulation, even a disordered viscus, entail depression or inhibition on the noblest of the cerebral activities.

To say then how much of the diurnal cycle should be devoted to study demands a knowledge of individual constitutions and capacities, and a decision can be arrived at only by an examination of particular cases. Here parents and teachers are called upon to exercise careful judgment. For the majority of children the ordinary five or six hours of daily schooling, with their recesses and interruptions, are probably not too much. Nor must it be taken for granted that these school hours are characterized by continuous application on the part of any but a very small minority, as any one observant of the habitual demeanor of juvenile pupils will testify. There are always some who learn their lessons with surprising quickness; these require to be kept back rather than urged forward, and should be allowed much play with their study. There are many more who are in no danger of ex

There are other aspects of the subject which we desire to take up. Mathematics, grammar, rhetoric, and other abstruse and difficult studies should be assigned to the morning hours, when the brain is fresh and vigorous; geography, history, reading, and writing, which demand less intense application, may more advantageously come up later in the day, when the mental powers are less keen. This Dr. Higgings has suggested in a late number of the Popular Science Monthly (Study Physiologically Considered).

Little need be said about the necessity, recognized by all institutions of learning, of bodily exercise, and it were better almost that the boy should grow up a dunce than a puny, feeble, sickly man. Even in young ladies it is now being generally conceded that a robust physique is a desirable thing, and seminaries for females are provided with play-grounds and places for gymnastic exercises.

With regard to diet we cannot too strongly insist on the need of good food as a condition of effective study. There is little danger of overfeeding in children; excess is rather the vice of adults than of the young, and the appetite is generally a safe guide. "How peremptory is the demand of the unfolding organism for materials is seen alike in that school-boy hunger which after life rarely parallels in intensity, and in the comparatively quick return of appetite." Herbert Spencer, in his treatise on Education, previously quoted from, makes some very practical suggestions under this head, which we shall do little more than condense. The degree of energy essentially depends on the nutritiousness of the food. Where energy as well as growth has to be maintained it can only be done by high feeding. Though a child of whom little is expected in the way of bodily or mental activity may thrive tolerably well on farinaceous substances, a child who is daily required not only to form the due amount of new tissue, but to supply the waste consequent on great muscular action, and the further waste consequent on hard exercise of brain, must live on substances containing a larger ratio of nutritive matter. And is it not an obvious corollary that denial of this better food will be at the expense either of growth or of bodily activity, or of mental activity, as constitution and circumstances may determine? We propose to return to this subject in a future

number.

DR. THOMAS TROTTER, PHYSICIAN TO THE FLEET.

It is always a pleasure to add to one's list of friends a man whose aims are upright and whose talents distinguish him above those with whom he is in daily contact, and who at the same time is genial, warmhearted, and well educated. That the man no longer walks the earth but lives only in his works does not necessarily diminish the pleasure in making his ac

Dr. Trotter's character is so charmingly set forth in Dr. Browne's essay and so illustrated by extracts from his writings, that we venture to say that its appearance has caused more than one copy of his books to be drawn from its dusty hiding place and that the charm of the Medicina Nautica has been found to exist equally in the other volumes.

There is a genuiness, a charming homeliness and simplicity in his mode of expression, that keeps the attention constantly alive. His devotion to duty, patient effort, pursuit of the practical, and true directness of purpose make his conclusions possessed of no other motive than fidelity to honest conviction.

New duties and responsibilities, which demanded independence of thought and self-reliance of character, were met and performed in a manner that made him an acknowledged authority. There are many evidences of his generosity, charity, philanthropy, and patriotism. Seemingly, he was a clever, ready, perceptive and receptive man, gifted with clear, strong, good sense; with an inquiring and studious habit of mind; genial, earnest, steadfast, sincere, and untiring—and his own nature was evidently of a gentle, charitable, and humane quality. Such is the description of the man drawn from his writings as summarized by Dr. Browne.

In addition one might say that he was a man of keen powers of observation, who could record facts as they existed without regard to existing theories and preconceived ideas. He saw with his own eyes and drew his own conclusions. He commenced early in his medical career to think for himself. He was very anxious, he tells us, that the subject of his Inaugural Dissertation when a candidate for the degree of Doctor of Medicine in the University of Edinburgh, in 1788, should be something that had never been noticed by any former graduate. This condition was fulfilled in his thesis De Ebrietate ejusque Effectibus in Corpus humanun. For this essay he received the thanks of the Royal Humane Society transmitted by Dr. Hawes, the illustrious founder of the institution, who observed that "the investigation of so important an inquiry, in a regular scientific manner, was never before thought of: it was a subject left, happily left, to be ingeniously executed and amplified by Dr. Trotter."