formance of a couple of operations on the cadaver, and, lastly, a public viva voce examination lasting from an hour and a half to two hours, with special reference to the cases seen. The questions, however, are by no means limited to the cases in hand, but extend over a wide range, touching on pathology, therapeutics, theory and practice, surgery, gynecology, obstetrics, and prescription writing. when suddenly respiration ceased. With artificial respiration the patient shortly cried, and began to breathe. The removal of the carious bone being desired, the chloroform was again applied, as previously, on Esmarch's wire and gauze apparatus, though cautiously. The pulse was good, aspect and breathing natural, but being administered very slowly the patient did not readily succumb to its influence. As soon as the conjunctival reflex ceased I reported being ready for the operation, but immediately the respiration again ceased. The patient was placed on the side of the table, head hanging down, tongue withdrawn, and artificial respiration performed for some minutes without effect. The battery was then procured and applied, and we had the satisfaction of witnessing the return of the rhythmical abdominal and thoracic movements. The operation was continued without further anæsthetic, one fourth of a grain of morphia being injected subcutaneously. The hospital where patients were seen and examined is one devoted entirely to men. It was founded in 1542 by Pedro Valdivia, Pizarro's lieutenant, who in 1541 chose one of the most fertile and beautiful valleys of the country for the site of Santiago. The hospital is built in squares, which have broad balconies running all around the inside, so that patients during convalescence have no lack of out-door life, which can be enjoyed almost the whole year round. In its sanitary arrangements, the quality of food, the nursing of patients, the use of temperature charts, and keeping of records there is much advance yet to be made; but the general ar- From the woman's ward we proceeded to the soldiers' rangement of the institution is good, and well suited quarters on the hill to witness a resection of the tibia. for the clinical instruction given. In one way this is This case, too, had been operated on before, and with advantageously conducted, and that is that students are chloroform, when a section of bone four inches long assigned cases, and have to study them and give their had been removed. A couple of sinuses had remained results before the class and instructor, at the bedside. open, and now the probe touched loose necrosed bone. In one ward I saw two cases of an affection but rare The patient was apparently taking the chloroform well, in the United States, namely, abscess of the liver. It and was soon limp. Remembering the morning's is quite prevalent here, as one frequently hears of the events, one of the attending surgeons advised the withaspiration of such cases. As a rule it appears as a drawal of the anaesthetic. It was done, but at that sequel to dysentery, which also prevails, and is sup- moment a peculiar pallor came over the patient's face, posed to be due often to the eating of a preparation of and all respiratory movements ceased. The operator pork, with about an equal quantity of red pepper. had been watching the pulse, and just moved to When this active irritant is followed by the favorite the foot of the bed. I stepped forward, and, taking popular spirit aguardiente, fire water, it is thought suf- the wrist, could not assure myself of any pulse. The ficient explanation of attacks of sporadic dysentery. head was immediately lowered, tongue withdrawn, abIn fact, popular tradition warns the people to refrain domen and chest slapped with a wet towel, ammonia from piling Pelion on Ossa in this way. Some day I injected subcutaneously, artificial respiration continued hope to be able to report some cases of this disease. for twenty minutes, and the battery used to stimulate the phrenic nerve, but without avail. There was no pulse or cardiac impulse at any time after noting the sudden change in the patient's condition, and respiration could not be restored. In the first case, both times, the respiratory movements ceased without any warning, while the cardiac contractions continued. In this case artificial respiration, performed according to Sylvester's method, and stimulation of the phrenic nerve restored breathing; whereas in the second case, again without any warning, the aspect betokened syncope, and both cardiac and respiratory contractions ceased together, and in this nothing availed to save life. The one word which is said to characterize these South American people is "mañana," to-morrow. In attempting to be received here one is made painfully aware of this procrastination. Much patience is needed, and one may count himself fortunate if he has a day assigned him within six weeks of his first making application. Some claim that the theory of protection is here extended to shield native medical talent. This I do not believe, but rather recognize the merit of a system which seeks to prevent ignorance from clothing itself in a title, and bringing discredit on the profession and injury to the public. Certainly there was no evident intention of excluding one whose education had been obtained abroad. The examination, of course, is in Spanish. It was calculated to test one's theoretical and practical knowledge, but while rigid was perfectly square and straightforward. During the oral examination I was struck by hearing quite a hum, among the students present, when, speaking of rapid dilatation for organic stricture, I spoke of administering ether. Here ether is practically unknown, the only anesthetic used or spoken of being chloroform. My morning's experience at the Charity Hospital of this city, where I was present and assisted in a couple of operations, may not be without interest. One was a young woman with caries of a metatarsal and cuneiform bone, to whom I administered chloroform. The patient had previously been operated upon and taken the anesthetic nicely. This time all went well for a few minutes, aspect, breathing, and pulse good, At the Boston City Hospital an almost daily experience with ether for twelve months showed that it had dangers, but fortunately they gave warning of their approach, and could be guarded against, beginning stertorous breathing or lividity warning one to desist, and never did I see any unfortunate result. Since settling here I have probably seen fifteen or twenty operations with chloroform, and in two of those have witnessed sudden collapse, which proved fatal in one. The United States mau-of-war Shenandoah auchored in our harbor a few days ago, and the daily papers reported her having yellow fever on board, but as her boats can be seen going to the landing the rumor must have been false. JOHN TRUMBULL, M. D. P. S. May 8th. At an autopsy of the case reported no abnormality about the heart or its valves was detected; and examining the woman the area of cardiac dullness and heart sounds were found normal. Miscellany. A CASE OF EXTRA - UTERINE GESTATION. THE following unusual case was recently reported to the Obstetrical Society of London by Dr. Mathieson, of Ontario. In spite of the success of the operation in this particular instance, the general opinion of the Society was strongly against the vaginal operation, compared with abdominal section in such cases: — The patient was aged thirty, the mother of five children. In November, 1880, menstruation (which had been regular, though scanty for two months) ceased, and abdominal pain began. In December, 1880, a lump was noticed low down in the left inguinal region. She was first seen by the author in March, 1881, when she had a tumor rising to the level of the navel, filling the left vaginal region and extending two inches to the right of the middle line. The uterus could not be mapped out. The sound passed three and a half inches, slightly to the right side and in front of the tumor. There was occasional pain in the tumor, tenderness, and a feeling" like jelly moving" which made her feel sick; painful micturition, irregularity of bowels. The tumor continued to enlarge, foetal movements became stronger, and the pain more severe. On April 12th she had an attack of pain and nausea, with pulse 146, temperature 103.6° F., cold extremities and cold sweat; relieved by morphia. A similar attack occurred on April 23d, another on May 2d, and another about May 18th. On June 2d a somewhat similar attack was accompanied by pretty regular labor-like pains, independently of foetal movements, and accompanied by a red discharge. The tumor continued to grow, and the most rapidly growing part was always the most painful. On June 13th occurred another attack like the last, but the pains were bearing down, though no bulging during them could be felt per vaginam. On June 28th she had a very severe attack of pain during micturition, followed by attacks of syncope. The roof of the vagina was filled with a doughy mass, solid on deeper pressure. Operation per vaginam was at once decided on, and performed without chloroform at the patient's request, by cutting with a knife and tearing with the finger nail. The face of the child was found presenting, and was delivered by forceps easily. It was stillborn, but soon revived. The placenta was at the posterior and left side of the cavity, its lower border some two inches from the vaginal roof. It was easily peeled off, a sponge soaked in perchloride of iron following it up. There was very little bleeding. The clots were removed from the cavity, its walls were touched with perchloride, and the operation ended. Much exhaustion followed the operation. The child weighed eight pounds seven and a half ounces, and appeared mature. The placenta was three-lobed, but was destroyed before a careful examination could be made. The after-treatment consisted in washing out the cavity autiseptically. The opening healed in three months. Severe pain in the side lasted for nearly two years after the operation. She was seen in August, 1883, in excellent health, had no pain except after great fatigue; had menstruated normally for six months. The child was healthy, the largest, and a great deal the heaviest, of the family. 1 Medical Times, May 31st. THE COURSE OF THE FEVER IN ACUTE a SILVESTRINI 2 dwells upon the somewhat neglected irregularity of the fever in acute pneumonia. The temperature, he thinks, practically does not, as a rule, adapt itself to the classical three periods of the disease. There are cases of pneumonia which run their course in three days, others in much more; and the temperature follows in its behavior the various phases of the morbid process. The temperature-curve is irregular even in cases of frank pneumonia following a typical course; if the temperature be taken every two hours, oscillations are noticed which escape observation if the thermometer be only used twice a day. The author records cases in which objective examination and consideration of the thermic curve showed that rise of temperature always coincided with the appearance of new pneumonic nucleus, and diminution or cessation of fever with the appearance of the signs of hepatization. At this moment, when the exudation coagulates, a compression is produced between alveolus and alveolus, and arrest of the blood and lymphatic circulation, and hence absorption of the pyrogenic products of inflammation is prevented. Fever only accompanies the period of exudation, during which the absorption of the pyrogenic products is facilitated; every elevation of temperature corresponds to a new invasion of the process, the pneumonia being considered as the union of so many pneumonic processes, which succeed one another with greater or less rapidity in different cases; and this succession of accesses goes pari passu with the oscillations of the thermic curve. The duration of the morbid process is short, the succession of anatomo-pathological periods rapid; but the nature of the process is to diffuse itself in other territories, where the same phenomena are developed, capable of producing the same manifestations. If the invasion take place quickly, there will be almost continuous fever; if slowly and interruptedly, the fever will have a more or less regularly intermittent type. If the pneumonia invade one tract only of the lung, and be arrested there, it will give rise to symptoms only lasting one day or two; if the process invade gradually all parts of a lung, there will be fever of long duration. The diffusion of the morbid process is by the bronchi, and not by lymphatic absorption or contiguity. If the diffusion took place by contiguity, those cases in which the process invades irregularly various zones of the lung could not be explained. BIPOLAR VERSION IN PLACENTA PREVIA. THE Medical Times and Gazette (May 24th) quotes with approval as being in agreement with the practice of some of the best English accoucheurs an article in a recent number of the Zeitschrift für Geburtshülfe und Gynäcologie, by Dr. C. Behm, of Berlin. It is based on cases observed in the clinic of Professor Gusserow. The author's experience of placenta prævia consists of fifty-three cases, of which the first thirteen were treated by plugging, rupture of the membranes, and version by the old "internal method. They comprised five cases, in which the placenta was completely prævia ; five partial or "lateral" (to use Dr. Belm's word), and three marginal. Of the thirteen, four mothers 2 Revista Clinica, November, 1883. London Medical Record, February 15, 1884. died, that is 30.8 per cent., and of the nine who survived, four suffered from febrile illness during the lying-in. The children were fourteen in number, and ten of them died during or soon after birth, a mortality of 71.4 per cent. These percentages Dr. Behm compares with the statistical statements of other writers, and finds that they represent about an average mortality. The principle of treatment adopted by Dr. Behm, in his latter forty cases, was that of bimanual version, after the method of Braxton Hicks, as early as possible, one foot being brought down through the os, and the labor then left to be gradually completed by the natural efforts, the pressure of the breech on the cervix being trusted to restrain hæmorrhage. The result was, that he lost not a single mother out of the forty. The infantile mortality was 77.5 per cent. Hofmeier, out of thirty-seven cases, treated in a similar way, only lost one mother, but of the children sixty-three per cent. In Dr. Behm's series of forty cases, he performed early bipolar version thirty times. In seven the membranes ruptured early, so that ver sion had to be longer delayed, and three were cases of head presentation, in which delivery was left to Nature. The advantages of this plan of treatment, Dr. Behm points out, are these: (1.) The necessary intervention is effected early, as soon as the os will admit two fingers, before the mother has lost much blood, or become exhausted. (2.) The breech, drawn down upon the os by slight pressure, forms a perfect tampon. (3.) As delivery is effected slowly, shock is avoided. As to the technique of the operation, Dr. Behm remarks that two fingers should be introduced through the os. If the cervix will not admit two fingers, it should be dilated with water bags. If the presentation of the placenta be complete, it will be found that it separates most easily on the side nearest to its edge; if the edge cannot be reached, it is best to perforate the placenta. After the breech has been brought into the os uteri, expulsion is best left to Nature. The accoucheur's motto in these cases should be, "haste with patience (Eile mit Weile), haste in turning, patience in extrac tion. nine, puerperal fever nine, erysipelas seven, typhus fever two. From scarlet fever, Chicago 11, New York 10, Boston five, Baltimore and Milwaukee two each, Brooklyn, Cincinnati, Pittsburg, Woburn, and Chelsea one each. From typhoid fever, New York, seven, Chicago four, Baltimore three, Cincinnati, New Orleans, Spencer, and Charleston two each, Brooklyn, Pittsburg, and Lynn one each. From whooping-cough, New York five, Brooklyn, Baltimore and New Orleans three each, Chicago, Boston, and Somerville two each. From malarial fevers, New Orleans six, Brooklyn four, New York three, Chicago and Charleston two each, Baltimore and Cincinnati one each. From cerebro-spinal meningitis, New York three, Chicago two, Cincinnati, New Orleans, Nashville, Lowell, Worcester, Fall River, and Chicopee one each. From small-pox, New Orleans seven, Pittsburg and Nashville one each. From puerperal fever, New York, BrookFrom erylyn, Chicago, and Cincinnati two each, Boston one. sipelas, New York, Brooklyn, and New Haven two each, New Orleans one. From typhus fever, New York and Chicago one | population of 1,343,037 (estimated population of the State 1,955,104), the total death-rate for the week was 14.40 against 16.31 and 16.50 for the previous two weeks. In the 28 greater towns of England and Wales, with an esti mated population of 8,762,354, for the week ending May Deaths reported 3354: acute 31st, the death-rate was 20. diseases of the respiratory organs (London) 261, measles 150, whooping-cough 133, scarlet fever 65, diarrhoea 44, small-pox (London 36, Liverpool three, Sheffield, Sunderland, and Cardiff one each) 42, fever 39, diphtheria 27. The death-rates ranged from 11.3 in Derby to 29.3 in Wolverhampton; Birkenhead 17.2; Nottingham 17.3; London 19.2; Birmingham 20.6; Leeds 20.6; Sunderland 22; Liverpool 22.4; Manchester 23; Leices ter 23.6; Sheffield 24.1. In Edinburgh 23.1; Glasgow 24; Dublin 22.3. For the week ending May 31st, in the Swiss towns, there were 29 deaths from consumption, lung diseases 20, typhoid fever 18, diarrhoeal diseases 12, diphtheria and croup four, whooping-cough two, erysipelas two. The death-rates were, at Geneva 19.4; Zurich 17.7; Basle 13.2; Berne 25.6. The meteorological record for the week ending June 14th, in Boston, was as follows, according to observations furnished by Sergeant O. B. Cole, of the U. S. Signal Corps: Direction of Wind. 1 O., cloudy; C., clear; F., fair; G., fog; H., hazy; S., smoky; R., rain; T., threatening. OFFICIAL LIST OF CHANGES IN THE STATIONS AND DUTIES OF OFFICERS SERVING IN THE MEDICAL DEPARTMENT UNITED STATES ARMY FROM JUNE 14, 1884, TO JUNE 20, 1884. Granted leave J. C. G., major and surgeon. CHANGES IN DEPARTMENT OF TEXAS. PORTER, J. Y., captain and assistant surgeon. From Fort Ringgold, Texas, to Fort Brown, Texas, as post surgeon. MADDOX, T. J. C., first lieutenant and assistant surgeon. From Fort Clark, Texas, to Fort Ringgold, Texas, as post surgeon. BLACK, C. S., first lieutenant and assistant surgeon. From | Fort Concho, Texas, to Fort Clark, Texas. S. O. 73, headquarters Department of Texas, June 9, 1884. LIST OF OFFICIAL CHANGES IN THE MEDICAL CORPS OF THE NAVY DURING THE WEEK ENDING JUNE 21, 1884. KNIGHT, J. S., surgeon, ordered before Retiring Board. HERNDON, C. G., passed assistant surgeon, detached from the Albatross, ordered to attend officers of Navy and Marine Corps in Washington. FLINT, J. M., surgeon, detached from Smithsonian Institute, ordered to Fish Commission steamer Albatross. LEACH, P., assistant surgeon, ordered for examination preliminary to promotion. GARDENER, J. E., passed assistant surgeon, detached from U. S. S. Lancaster, ordered to U. S. S. Powhatan. BRAIN AND NERVE FOOD. CROSBY'S VITALIZED PHOS-PHITES, From the Nerve-Giving Principles of the Ox-Brain and the Embryo of the Wheat and Oat, s a standard preparation with all Physicians who treat Nervous or Mental Disorders. Formula on every label. It is useful in all forms of Imaired Vitality, Mental Exhaustion, or Nervous Indigestion. It aids in the bodily and wonderfully in the mental growth of children. As it is a ood to the nerves, the teeth become sounder, the hair more glossy, the skin finer and smoother, the nails more handsome and less brittle. BRAIN WORKERS NEED BRAIN FOOD. Bv Druggists or Mail, $1.00. F. CROSBY CO., 56 West 25th Street, New York City. PELLETIER'S CAPSULES OF SULPHATE OF QUININE. Prepared by MESSRS. ARMET DE LISLE & CIE., successors of PELLETIER, DELONDRE & LEVAILLANT, with heir renowned " QUININE DES TROIS CACHETS." These Capsules are very thin, transparent, and dissolve asily in the stomach; they contain each 10 centigrammes (over 1 grain English) of the pure Sulphate of Quinine in silky rystals, and are capable of indefinite preservation. SOLD IN BOTTLES OF TEN OR TWENTY CAPSULES. General Depot: PARIS, RIGAUD & DUSART, 8 Rue Vivienne. New York: E. FOUGERA & CO., Importing Pharmacists. STRADLING, J. M., & Co.. 8 HOUGHTON, MIFFLIN & Co.. Vaccine Virus 12 .Solution for Diabetes 23 Tamar Indien 12 Medical Department 24 6 ........... Publishers, 2, 13 Listerine 18 Agents Wanted 2 Medical Department 12 THURBER, WHYLAND & Co........ Natrolithic Water 18 TWITCHELL, DR. GEO. B... Private Home, Mental Disease 2 TWITCHELL, DR. G. P... ..Card 2 12 LEACH & GREENE......... Surgical Instruments, etc. 7 NGLO-SWISS COND. MILK Co... Anglo-Swiss Milk Food 23 OWDOIN COLLEGE.. Medical Department 12 ODMAN & SHURTLEFF....Gynecological Instru'ts, etc. 17 "ELLOWS, JAMES I...... ISK & ARNOLD........ ..... OUGERA, E., & Co.....Imp'g Pharmacists, 4, 14, 15, 23 MALTINE MANUFACTURING CO 12 MCARTHUR, DR.........Comp. Syrup Hypophosphites 2 MEDICAL SCHOOLS.............. METCALF, THEODORE, & Co. 6 UNIVERSITY OF THE CITY OF NEW YORK.. Medical Dep't 22 DIABETES. The attention of the profession is called to a new remedy for the successful treatment and permanent cure of Diabetes Mellitus, GILLIFORD'S SOLUTION, an aqueous solution of a combination of Bromine and Arsenious Acid. This remedy has also proved very useful in a variety of nervous affections. Manufactured and sold by R. II. GILLIFORD, M. D., Allegheny, Pa. In half-pint bottles, $1 exp'd, on receipt of price. ANGLO-SWISS MILK FOOD. MILK-MAID BRAND. MADE AT CHAM, SWITZERLAND, BY THE ANGLO-SWISS COND. MILK CO. My analysis perfectly agrees with the analysis given on their labels, and bears witness to the excellent and rational manner in which this food is compounded.-DR. E. GEISSLER, Dresden, April 10, 1880. I have used Anglo-Swiss Milk Food in my practice, and commend it with confidence to those who may need it for infants or invalids. The introduction of the Anglo-Swiss Milk Food into America is a great blessing to sick children, weary mothers, and almost discouraged physicians, for medicine will not take the place of food.-E. A. JENNINGS, M. D., Provident Dispensary, 62 W. 14th Street, New York. Used in New York Infant Asylum.-J. LEWIS SMITH, M. D. Has yielded most favorable results.-J. C. GUERNSEY, M. D., Philadelphia. The Diarrhoea had been persistent for four months in spite of the use of other foods. After using two days the evacuations became normal, and the puny child is now plump and healthy. - GEO. M. OCKFORD, M. D., Vincennes, Ind. Used in our Sea-side Nursery. It nourishes and strengthens every child to whom it is given. - JOHN W. KRAMER, M. D., Master of St. John's Guild. Our little ones love it. It regulates and strengthens the bowels.- SISTERS OF CHARITY, St. Vincent's Home, Philadelphia. Address ANGLO-SWISS COND. MILK CO., P. O. Box 3773, New York. |