OL. CX., No. 3.] BOSTON MEDICAL AND SURGICAL JOURNAL. November 23, 1883. ASES OF PATIENTS AT THE MURDOCK LIQUID FOOD CO. FREE HOSPITAL, BOSTON, OF 70 BEDS, ORGANIZED MAY, 1883. ur First Death and its Cause. A Letter from the Physician who Attended Her. BOSTON, Oct. 22, 1883. DEAR SIR: Allow me to acknowledge the great favor aich I received at your hospital, indirectly, through e of my patients. The autopsy enables me to give a tter description of her case than I could in any other . From it we quote: It revealed a left ovarian cyst, ich was embedded at the base, and behind, in a canrous mass of the encephaloid variety and ulcerative ge. Recent and extensive inflammations had rendered @organs of the hypogastric and pelvic regions almost compact mass, so strong and extensive were the adhens. This condition accounted for the great suffering drapid change of the last few days of her life. fam satisfied that fully two months of comparative afort were added to her life by the use of your Liquid PEPSIN. E. SCHEFFER, LOUISVILLE, KY., Manufactures by his Improved Method SACCHARATED PEPSIN, Which has proven its superiority over other am using your Food, in a variety of cases, with great Pepsins by its stability, uniformity, and agreeaIn digestive strength it corresponds sfaction. Thanking you for all kindness to myself patient, I am Very respectfully yours, Mrs. S., born in 1841. Married; mother of two chil. While carrying the second child she was very ill the time, and had a very severe labor, causing lacera of the mouth of the womb, and other injuries inciat to such severe deliveries. Since that time she has ffered more or less from these injuries and other disses, which in turn have contributed to depress her rous system, and bring her into a state of great sufting, which has been long and tedious. To alleviate e sufferings opium was administered as the only medy that would give relief, until the opium habit was atracted. In this condition she came to the Murdock quid Food Gospital. Not able to walk or stand, weak restless, passing her nights in pain, vomiting her almost every meal, often deeply colored with fresh ood. Four weeks' treatment with Liquid Food cured the vomiting, overcame the opium habit, and now the tint sleeps well, eats well, and retains her food, and nined some ten pounds in flesh. Miss T., aged 24 years. In health weighed 140 lbs. December, 1830, was taken sick with pleurisy, which alted in an effusion of pus into the pleural sac. Sevaltimes pus was drawn by aspirating. At one time lo quarts were drawn. Finally the sac was opened, da drainage tube was put in, and the sac has continNto discharge until the present time. She was admitted to Murdock's Free Hospital, May 5, , weighing only 80 lbs., having lost 60 lbs. of flesh, ing unable to take and digest food enough to sustain esystem under such a drain, and has been badly conpted for three years, being obliged to take medicine ely for the same. On Liquid Food she gradually beto gain flesh and strength. The discharge from her diminished, tube reduced the same per cent, and been relieved of constipation. Her spirits revived, she improved and was able to ride and take short eks daily, until in August she received a severe mental ock, which upset her nervous system so that she resed food of all kinds for several weeks. She has finally covered her mind, and now takes food again, and is ning daily and able to ride out. Miss V., Oet, 1882, was blind, had both eyes operated , but without success. Other troubles followed ales, kidney trouble. Casts were found in the urine, the eft kidney being badly affected. Peritonitis and cystitis allowed. After being in a hospital three months, enred ours Oct. 5th, unable to retain food, vomiting insantly, and in a helpless condition. Has taken four aspoonfuls of Food daily. Retains her food, is able to around some, sitting up and working at what her Bightless eyes will allow, gradually improving in health, trength, and spirits. Mrs. 0. for four to five months was unable to retain Any food except four to five ounces of milk daily, with e water: her weight reduced in one year fifty-five Pounds; suffering from many complaints, she was obliged to take morphine daily in increasing quantities. She has been in the Hospital two months, has taken no morphine, and after the first week able to retain common food, and has gained seven pounds since, gaining one pound per week, and now discharged. Her last physician wrote us that she was incurable, and all the many that treated her gave the same opinion. Mrs. A. was for one year under treatment for uterine bemorrhages and extreme nervous debility, by the best physicians, with no beneficial results. She became completely prostrated by the disease. Her nervous system was so run down that she had no control of her nerves, passing the nights in a wakeful horror of some dreaded misfortune or death. Previous to this illness her weight had been one hundred and sixty pounds, but her sufferings soon brought her weight to one hundred and twenty pounds. She at last concluded to try what could be done for her at Murdock's Free Hospital, as she had taken medicine enough and thought she needed something to build her up. She entered in July, began taking one teaspoonful four times a day, and now, using her own words, is perfectly well both physically and mentally," und we are of her opinion, as she left us in September and is now in perfect health. Murdock Liquid Food is in general use at Infant Hospitals. ble taste. to the standard adopted by the Committee on the Sixth Revision of the U. S. Pharmacopoeia, which is as follows: One part dissolved in 500 parts of water, acidulated with 7.5 parts of hydrochloric acid, should digest at least 50 parts of hard-boiled Egg Albumen in 5 to 6 hours at 100 to 104° F. DRY PEPSIN, CONCENTRATED, Possessing 8 times the digestive strength of the above. Particularly recommended to manufacturers. Premiums were awarded to the above preparations at the International Exposition at Centennial AND THE Vienna, 1873, Exposition in SHADY Philadelphia. LAWN, Gothic Street, Northampton, Mass. A mental and general Sanitarium and Home for Invalids. Approaching close of its first decade of work. Chartered by State of Massachusetts to receive cases in lunacy. The inebrieties treated by original methods; diseases of women, with their surgery; senile dementia; defective or wayward mental development; a private and family institution; liberal living; an early pioneer in the "cottage plan;" the European languages spoken. Address SUPT. A. W. THOMPSON, A. B. (Harv., 1854), M. D., and A. M. (Harv., 1857), formerly of Northampton Lunatic Hospital. SUPPORTER Cup STEM DR. WADSWORTH'S Uterine Elevator. Made of India Rubber, without lead, is the most complete, the best adapted, affords more relief, gives better results, in cases of Prolapsus Uteri, and Displacements of the Womb, than all other Pessaries and Supporters combined. So say thousands of Physicians from Canada to Texas. Pamphlets describing the Instrument, also Price List, sent on application. II. II. BURRINGTON, Chemist & Druggist, Sole Proprietor, Providence, R. I. Also for sale by dealers in Surgical Instruments generally. N. B. The public are cautioned against using the above Trade Marks. FISK & ARNOLD, MANUFACTURERS OF ARTIFICIAL LIMBS, AND APPLIANCES FOR SHORTENED LIMBS, RESECTIONS, DEFORMITIES, ETC., AS A SPECIALTY. False Calves, Silk, Elastic, Wool, and Cotton Socks, to wear with Artificial Limbs. All cases will receive our personal attention, and from satisfaction to all under our care. our long experience we feel competent to give advice and No. 8 Hamilton Place, Boston, Officers and soldiers furnished on government account. 28 BOSTON MEDICAL AND SURGICAL JOURNAL. [JANUARY 17, 1884 HARVARD UNIVERSITY. MEDICAL DEPARTMENT, BOSTON, MASS. ONE HUNDRED AND FIRST ANNUAL ANNOUNCEMENT (1883-1884) CHARLES W. ELIOT, LL. D., President. HENRY P. BOWDITCH, M. D., Dean, and Professor of Physiology. FACULTY. OLIVER W. HOLMES, M. D., LL. D., Professor of Anatomy, Emeritus. HENRY J. BIGELOW, M. D., Professor of Surgery, Emeritus. FRANCIS MINOT, M. D., Hersey Professor of the Theory and Practice of Physic. CALVIN ELLIS, M. D., Jackson Professor of Clinical Medicine. HENRY W. WILLIAMS, M. D., Professor of Ophthalmology. DAVID W. CHEEVER, M. D., Professor of Surgery. JAMES C. WHITE, M. D., Professor of Dermatology, CHARLES F. FOLSOM, M. D., Assistant Professor of Mental Diseases. FREDERICK I. KNIGHT, M. D., Assistant Professor of Laryngology. J. COLLINS WARREN, M. D., Assistant Professor in Surgery. WILLIAM F. WHITNEY, M. D., Curator of the Anatomical Museum. OTHER INSTRUCTORS. SAMUEL H. DURGIN, M. D., Lecturer on Hygiene. GEORGE M. GARLAND, M. D., Assistant in Clinical Medicine. The following gentlemen will give special clinical instruction : — JOHN HOMANS, M. D., in the Diagnosis and Treatment of Ovarian Tumors. JOSEPH P. OLIVER, M. D., and THOMAS M. ROTCH, M. D., in Diseases of Chi SAMUEL G. WEBBER, M. D., and JAMES J. PUTNAM, M. D., in Diseases JAMES R. CHADWICK, M. D., in Gynærology. J. ORNE GREEN, M. D., and CLARENCE J. BLAKE, M. D., in Otology AMOS L. MASON, M. D., and FREDERICK C SHATTUCK, M. D., in Auscultation. A New Building has just been completed at a cost of more than a quarter of a million of dollars. Its numerous apartments are spacious, well lighted, and provided with carefully contrived apparatus for heating and ventilation. The comfort and convenience of the students have been constantly borne in mid a the arrangement of rooms, the construction of seats, and in the furnishing of the various laboratories, halls for lectures, and rooms for recitations, study, and conversation The building is devoted to laboratory instruction and didactic teaching, while the general and special clinics take place at the various hosp and dispensaries. Greatly enlarged and improved facilities are offered at the Massachusetts General Hospital and the Boston Dispensary, both of which is tutions have recently constructed buildings to meet the constantly increasing demands for their usefulness. Every candidate for admission not holding a degree in arts or science must pass a written examination on entrance to this School, in English, Latin, Phys and any one of the following subjects: French, German, Elements of Algebra or of Plane Geometry, Botany. The admission examination for 1884–85 wil held June 23d, at Boston, June 26th, at Exeter, Andover, New York, Philadelphia, Chicago, Cincinnati, St. Louis, and San Francisco; on September 221,■ Boston only. Instruction is given by lectures, recitations, clinical teaching, and practical exercises, distributed throughout the academic year. In the subjects of Anatomy Histology, Chemistry and, Pathological Anatomy, laboratory work is largely substituted for, or added to, the usual methods of instruction. The year bega September 25, 1884, and ends on the last Wednesday in June, 1885, and is divided into two equal terms. Students are divided into four classes, according to their time of study and proficiency, and during their last year will receive largely increased opportunitie for instruction in the special branches mentioned. Students who began their professional studies elsewhere may be admitted to advanced standing; but persons who apply for admission to the advanced classes must pass an examination in the branches already pursued by the class to which they seek admising Although the course of study recommended by the Faculty covers four years, until further notice the degree of Doctor of Medicine will continue to be give upon the completion of three years of study, to be as ample and full as heretofore. The degree of Doctor of Medicine cum laude will be given to candid who have pursued a complete four years' course, and obtained an average of 75 per cent. upon all the examinations of this course. In addition to the ord degree of Doctor of Medicine as hitherto obtained, a certificate of attendance on the studies of the fourth year will be given to such students desiring shall have attended the course, and have passed a satisfactory examination in the studies of the same. ORDER OF STUDIES. FOUR YEARS' COURSE. For the First Year. - Anatomy, Physiology, and General Chemistry. For the Second Year. — Practical and Topographical Anatomy, Medical Chemistry, Materia Medica, Pathological Anatomy, Clinical Medicine, Surgery For the First Year. Anatomy, Physiology, and General Chemistry. For the Second Year. - Practical and Topographical Anatomy, Medical Chemistry, Materia Medica, Pathological Anatomy, Clinical Medicine, and Clin ical Surgery. For the Third Year. Therapeutics, Obstetrics, Theory and Practice of Medicine, Clinical Medicine, Surgery, Clinical Surgery, Ophthalmology, Der matology, Syphilis, Otology, Laryngology, Mental Diseases, Diseases of the Nervous System, Diseases of Women, Diseases of Children, Forensic Medicine. ANNUAL EXAMINATIONS. At the end of the first year- Anatomy, Physiology, and General Chemistry. End of second year - Topographical Anatomy, Medical Chemistry, Materia Medica, and Pathological Anatomy. End of third year- Therapeutics, Obstetrics, Theory and Practice of Medicine, Surgery. (Students of the three years' course are also examined in Clinical Medicine and Clinical Surgery.) End of fourth year Ophthalmology, Otology, Dermatology, Syphilis, Laryngology, Mental Diseases, Diseases of the Nervous System, Diseases of Women, Diseases of Children, Obstetrics, Clinical and Operative Obstetrics, Clinical Medicine, Clinical and Operative Surgery, Forensic Medicine. Examinations in all subjects are also held before the opening of the School, beginning September 26th. REQUIREMENTS FOR A DEGREE. Every candidate must be twenty-one years of age; must have studied medicine three or four full years, have spent at least one continuous year at this School, have passed a written examination upon all the prescribed studies of the course taken, and have presented a thesis. For the purpose of affording to those already Graduates of Medicine additional facilities for pursuing clinical, laboratory, and other studies, the Faculty has established a course which comprises all of the special subjects of the fourth year in addition to private instruction in Histolo Physiology, Medical Chemistry, and Pathological Anatomy. Any or all branches may be pursued. If the full fee is paid, the privilege of attending any of the other exercises of the Medical School, the use of the laboratories and library, and all other rights accorded by the University will be granted. Graduates of other Medical Schools who may desire to obtain the degree of M. D. at this University will be admitted to examination for this degree after a year's study in the Graduates' Course. Examination on entrance not required. Course for GRADUATES. · -- FEES. For Matriculation, $5; for the year, $200; for one term alone, $120; for Graduation, $30. For Graduates' Course, the fee for one year is $200; for one Term, DR. H. P. BOW DITCH, Dean, Harvard Medical School, Boston, Mass. PATHOLOGICAL SOCIETY OF PHILADELPHIA. C. B. Nan- Fracture of the Base of the Skull. Necrosis of the PAGE PAGE BOSTON SOCIETY FOR MEDICAL OBSERVATION. Charles The Boston Medical and Surgical Journal is published weekly by Houghton, Mifflin & Co., 4 Park St., Boston, where subscriptions are received and single copies of the Journal are always for sale. TO THE MEDICAL PROFESSION. LACTOPEPTINE DEMONSTRATED SUPERIORITY OF LACTOPEPTINE AS A DIGESTIVE AGENT. Pharmaceutical Society of Great Britain. dered sugar of milk. The acids used at the factory lactic and hydrochloric-are LACTOPEPTINE having been prescribed for some of my friends during the past five the best to be met with, and are perfectly combined to form a permanent preparation; years-apparently with very satisfactory results its formula, which is stated on the the milk sugar is absolutely pure; the powder known as "diastase," or starch-digest bottles, and its general characters have become well known to me. But recently the ing (bread-, potato-, and pastry-digesting) material, as well as the pancreatine," or manufacturer of this article has asked me to witness its preparation on a large scale, fat-digesting ingredients, are as good as any I can prepare; while the pepsin is much to take samples of its ingredients from large bulks and examine them, and also mix superior to that ordinarily used in medicine. Indeed, as regards this chief ingredient. them myself, and to prepare LACTOPEPTINE from ingredients made under my own di- pepsin, I have only met with one European or American specimen equal to that made rection, doing all this with the object of certifying that LACTOPEPTINE is what its maker and used by the manufacturer of LACTOPEPTINE. A perfectly parallel series of experi professes it to be, and that its ingredients are in quality the best that can be obtained. ments showed that any given weight of acidified pepsin, alone, at first acts somewhat This I have done, and I now report that the almost inodorous and tasteless pulveru- more rapidly than LACTOPEPTINE containing the same weight of the same pepsin. Sooner lent substance termed LACTOPEPTINE is a mixture of the three chief agents which en- or later, however, the action of the LACTOPEPTINE overtakes and outstrips that of pepable ourselves and all animals to digest food. That is to say, LACTOPEPTINE is a skill- sin alone, due, no doubt, to the meat-digesting as well as the fat-digesting power of fully prepared combination of meat-converting, fat-converting, and starch-converting the pancreatine contained in the LACTOPEPTINE. My conclusion is that LACTOPEPTINE materials, acidified with those small proportions of acids that are always present in is a most valuable digesting agent, and superior to pepsin alone. the healthy stomach; all being disseminated in an appropriate vehicle, namely, powJOHN ATTFIELD. LACTOPEPTINE contains all the agents of digestion that act upon food, from mastication to its conversion into chyle, thus combining all the principles required to promote a Healthy Diges tion. One of its chief features (and the one which has gained it a preference over all digestive preparations) is that it precisely represents in composition the natural digestive juices of the stomach, pancreas, and salivary glands, and will therefore readily dissolve all foods necessary to the recuperation of the human organism. Sugar of Milk. FORMULA OF LACTOPEPTINE. .40 ounces. 8 ounces. 6 ounces. Ver. Ptyalin or Diastase.. .4 drachms. .5 fl. drachms. .5 fl. drachms. Pancreatine.. LACTOPEPTINE is sold entirely by Physicians' Prescriptions, and its almost universal adoption by physicians is the strongest guarantee we can give that its therapeutic value has been most thoroughly established. The undersigned, having tested LACTOPEPTINE, recommend it to the Profession. FAMUEL R. PERCY, M. D., Prof. Materia Medica, New York Medical College. F. LE ROY SATTERLEE, M. D., Ph. D., Prof. Chem., Mat. Med., and Therap. in N. Y. Col. JAS, AITKIN MEIGS, M. D., Philadelphia, Pa., Prof. of the Institutes of Med. and Med. Juris., W. W. DAWSON, M.D., Cincinnati, Ohio, Prof. Prin. and Prac. Surg., Med. Co. of Ohio; PROF. JOHN ATTFIELD, Ph. D., F. R. S., F. I. C., F. C. S., London, Eng., ALFRED F. A. KING, M. D., Washington, D. C., Prof. of Obstetrics, University of Vermont. D. W. YANDELL, M. D., Prof. of the Science and Art of Surg. and Clinical Surg., University of Louisville, Ky. L. P. YANDELL, M. D., Prof. of Clin. Med., Diseases of Children, and Dermatology, Univer- ROBT. BATTEY, M. D., Rome, Ga., Emeritus Prof. of Obstetrics, Atlanta Med. College, Ex- PROF. H. C. BARTLETT, Ph. D., F. C. S., London, England, For further particulars concerning Lactopeptine, the attention of the Profession is respectfully directed to our 32-page Pamphlet, which will be sent on application. THE NEW YORK PHARMACAL ASSOCIATION, Nos. 10 and 12 College Place, New York. P. O. BOX 1574. Entered at the Post Office at Boston as second-class matter. November 23, 1883. BOSTON, Oct. 22, 1883. DEAR SIR: Allow me to acknowledge the great favor which I received at your hospital, indirectly, through one of my patients. The autopsy enables me to give a better description of her case than I could in any other way. From it we quote: It revealed a left ovarian cyst, which was embedded at the base, and behind, in a cancerous mass of the encephaloid variety and ulcerative stage. Recent and extensive inflammations had rendered the organs of the hypogastric and pelvic regions almost a compact mass, so strong and extensive were the adhe sions. This condition accounted for the great suffering and rapid change of the last few days of her life. I am satisfied that fully two months of comparative comfort were added to her life by the use of your Liquid Food. the sick. 19:1882 occult forces of the body for the weak. A comfort by an automatic massage to the skin. Durably made of vegetable and animal fibre to meet the electrical needs of the body, it aids nerve force in all functional work. One will be sent by registered mail, with directions for use, on receipt of $3, or 6 for $16. For brush or circular apply to (Discount to Physicians.) G. F. WATERS, 8 Beacon Street, Boston, Mass. Professional Notices. DR. J. F. A. ADAMS, of Pittsfield, Mass., will pass the present winter and I am using your Food, in a variety of cases, with great DR. J. P. BANCROFT, satisfaction. Thanking you for all kindness to my self and patient, I am Very respectfully yours, Mrs. S., born in 1841. Married; mother of two children. While carrying the second child she was very ill all the time, and had a very severe labor, causing lacera. tion of the mouth of the womb, and other injuries incident to such severe deliveries. Since that time she has suffered more or less from these injuries and other dis eases, which in turn have contributed to depress her Lately Superintendent of the New Hampshire Asylun for the Insane, can be consulted in Diseases affecting the Mind, in Concord, N. H., or elsewhere by appointment. DR. BUCKMINSTER BROWN Ilas removed to 39 Marlborough St., Boston. DR. WALTER CHANNING will receive a few cases of Mental and Nervous Diseases at Brookline. P. O. address, Brookline, Mass. Office in Boston, 146 Boylston St. Office Hours, 12 to 1. From June 1st to October 1st, in Boston by appoint Probability of the Discovery of a ment only. nervous system, and bring her into a state of great suf- Will receive a few Lying-In Cases at 358 Colum- Miss T., aged 24 years. In health weighed 140 lbs. resulted in an effusion of pus into the pleural sac. Sev- She was admitted to Murdock's Free Hospital, May 5, llas removed, and will meet these desiring to consult him in cases of Mental Disease at No. 15 Pemberton Square, from 11 to 1 o'clock daily, or elsewhere by appointment. Residence, 19 Berkeley St., Cambridge. Telephone 7014. 1883, weighing only 80%1⁄2 lbs., having lost 60 lbs. of flesh, DR. CHARLES H. MALLETT, being unable to take and digest food enough to sustain the system under such a drain, and has been badly constipated for three years, being obliged to take medicine weekly for the same. Ou Liquid Food she gradually be gan to gain flesh and strength. The discharge from her Graduate of Harvard Medical School, eight months side diminished %. tube reduced the same per cent, and DR. IRA RUSSELL, has been relieved of constipation. Her spirits revived, and she improved and was able to ride and take short walks daily, until in August she received a severe mental shock, which upset her nervous system so that she refused food of all kinds for several weeks. She bas finally recovered her mind, and now takes food again, and is gaining daily and able to ride out. Miss V., Oct, 1882, was blind, had both eyes operated on, but without success. Other troubles followedpiles, kidney trouble. Casts were found in the urine, the left kidney being badly affected. Peritonitis and cystitis followed. After being in a hospital three months, entered ours Oct. 5th, unable to retain food, vomiting incessantly, and in a helpless condition. Has taken tour teaspoonfuls of Food daily. Retains her food, is able to go around some, sitting up and working at what her sightless eyes will allow, gradually improving in health, strength, and spirits. Mrs. O. for four to five months was unable to retain any food except four to five ounces of milk daily, with lime water; her weight reduced in one year fifty-five pounds; suffering from many complaints, she was obliged to take morphine daily in increasing quantities. She has been in the Hospital two months, has taken no morphine, and after the first week able to retain common food, and has gained seven pounds since, gaining one pound per week, and now discharged. Her last physician wrote us that she was incurable, and all the many that treated her gave the same opinion. Mrs. A. was for one year under treatment for uterine hemorrhages and extreme nervous debility, by the best physicians, with no beneficial results. She became completely prostrated by the disease. Her nervous system was so run down that she had no control of her nerves, passing the nights in a wakeful horror of some dreaded misfortune or death. Previous to this illness her weight had been one hundred and sixty pounds, but her sufferings soon brought her weight to one hundred and twenty pounds. She at last concluded to try what could be done for her at Murdock's Free Hospital, as she had taken medicine enough and thought she needed something to build her up. She entered in July, began taking one teaspoonful four times a day, and now, using her own words, "is perfectly well both physically and mentally," and we are of her opinion, as she left us in September and is now in perfect health. Murdock Liquid Food is in general use at MURDOCK LIQUID FOOD CO., Boston. Assisted by his son, DR. F. W. RUSSELL, receives patients into his "Family Home," WINCHENDON, MASS., for the treatment of Nervous and Mental Diseases. DR. GEO. B. TWITCHELL, President of the Board of Trustees, N. H. Asylum for the Insane, will receive into his family a few cases A GRADUATE Of the Boston Training School, with several years' experience in private nursing, would like to travel South or West, with an invalid lady. Is familiar with the overland route, can take all care of baggage, etc., and is ac Cure of Malignant Disease, and the Line of Study or Experi mentation likely to bring such a Cure to Light. And the undersigned was delegated to receive essays until December 1, 1883, and, with such assistance as he should select, to decide upon their merits. The undersigned hereby announces that six essays on the above subject were presented to him, and that, in the consideration of their merit, the aid of Dr. GEORGE B. SHATTUCK, Editor of the Boston Medical and Surgical Journal, was enlisted. The result of this consid eration is that no essay was deemed worthy of the prize. J. COLLINS WARREN, customed to hotel life. Inquire of Dr. BRIGHAM, Direc- HERBERT HALL, tory for Nurses, 19 Boylston Place, Boston. PHYSICIAN, Obliged to change climates, offers his house and a $3,500 practice for sale. No competition; the only physician in town. Will give easy terms for payment if desired Address" MEDICUS," Office Boston Medical Journal. FOR SALE. A strictly first-class Medical Practice, together with Real Estate, near Boston. There are several highly desirable features connected therewith, and the advertiser believes the opportunity unsurpassed for a physician desiring to establish himself. Full particulars can be ob349 Marlborough St., Boston, Mass. A Home for the Care and Treatment of Per sons afflicted with Mental Diseases. For Terms, etc., address MERRICK BEMIS, M. P., HERBERT HALL, WORCESTER, MASS. Town Office, 34 Pearl St., Worcester. Office hours, 10 to 12 A. M., 2 to 4 P. M. F. M. LORING, PHARMACIST, 655 Tremont Street, Boston. DISPENSING PHYSICIANS PRESCRIPTIONS A SPECIALTY. All the preparations of the New Pharmacopoeia, and re liable foreign and domestic remedies, constantly on hand. tained by calling on or addressing DR G. A. LELAND, STATE ASSAYER AND CHEMIST Original Articles. NEPHRECTOMY FOR THE REMOVAL OF CAN- BY JOHN HOMANS, M. D., IN the table of cases given below will be found only those where an operation was undertaken to remove a sarcomatous or cancerous kidney, or where the operation being undertaken on a different diagnosis eventuated in a nephrectomy for sarcoma or carcinoma. I have purposely excluded all cases of removal of the kidney for cystic disease, for floating kidney, for suppuration of the kidney filled with calcareous masses, or for any purpose other than that of removing a kidney affected with one of the two kinds of tumor mentioned above. At my request Dr. Howard Lombard has looked over the literature of the subject, and has found twenty-five cases of the kind mentioned above. If we add to these my own case, to be described later, we have twenty-six cases in the accompanying table. Dr. Lombard finds upwards of 130 reported cases of nephrectomy, and out of this number the operation has been done twenty-five times (with mine twenty-six times) for malignant disease, namely, for sarcoma twelve times, for carcinoma six times, for encephaloid four times, for adenoma once, and for doubtful tumors three times. In these twenty-six cases there have been eight recoveries, seventeen deaths, and one patient was under treatment at the time the case was reported. The causes of death were as follows: primary hæmorrhage, two; collapse, two; peritonitis, five; septic peritonitis, two; shock, two; pulmonary embolism, septicemia, return of disease, and cause unknown, one each. The incision was made in the lumbar region in seven cases, of which four recovered, two died, and one was under treatment when reported. In nineteen cases the incision was ventral, and fifteen died. The operation we have found reported fourteen times in Germany, six times in England, five times in the United States, and once in France. My own case, in which the fatal result is to be attributed more or less to want of skill, occurred in a man, twenty-nine years old, single, a sailor by occupa tion. He dated his abdominal trouble from the time he lifted a heavy stone, two years or more before. History when first seen. He discovered the tumor fifteen months ago, in the left hypochondrium. He has been growing thin, and has not worked any since the pain in his back began, two years ago, at which time he first noticed blood in his urine; this has appeared from time to time irregularly; sometimes his urethra has been plugged with clots so that he has drawn them out in long masses, and once as the plugs of coagulum could not be drawn out he was catheterized. He has more pain when his urine begins to be bloody. The pain in his back is what prevents him from working; when he jumps, or stumbles, or stubs his foot his back aches. He sleeps fairly well; his appetite is variable; his strength is failing. The tumor is a hard, flattened, oval mass, extending from the splenic region to the iliac region on the left side. It is about four and one half by nine inches in its diameters, and feels at first as if it were an hypertrophied spleen. At the same time it projects downwards into the anatomical site of the left kidney as well as upwards under the ribs. It is moved freely during respiration, and falls over towards the right side a little when the patient turns on his right side. It is uncertain whether it is within the peritoneum or whether it has pushed the peritoneum before it. About one third of the tumor lies under the ribs in the left hypochondriac and thoracic region. Dr. E. G. Cutler examined the blood, and found no increase in the number of white corpuscles, and no more albumen in the bloody urine than the blood would account for; no pus and no diminution in the amount of urea; he did find, however, blood casts from the tubules, from the ureter, and, perhaps, from the urethra. I found no stone in the bladder to account for the hæmorrhage. I reasoned somewhat in this way: If the tumor is an enlarged spleen it causes hæmorrhage by pressure on the renal vessels, or else the renal hæmorrhage is like the nose-bleed that accompanies an enlargement of the spleen. If the hemorrhage were caused by a calculus in the kidney there would be pus in the urine, and the urine would decompose. The tumor fills the left lumbar region, and seems to have grown from the lumbar rather than from the hypochondriac region. I was inclined to think the tumor one of the kidney, and very probably malignant. The man had come from a distance to have the tumor removed, and his decision was unchanged when the nature and possible result of the operation was explained to him. After delaying several weeks that the case might be thoroughly considered, and after consultations with competent advisers, an operation was decided upon, and was done at St. Margaret's Home on November 24, 1883. Operation one hour's duration; performed antiseptically under a spray of carbolic acid. An incision about five inches long was made through the linea semilunaris. After the peritoneum was opened it was seen that the descending colon had been pushed forward, and that an incision about half an inch long had been made in one wall. A director had been used, and the abdomen had been opened as carefully as usual. Probably it was owing to the thinness and great flattening of the colon squeezed between the tumor and the anterior abdominal wall that the wound was made. This cut was sewn up with a continuous suture of carbolized silk, and the operation was proceeded with. The incision was extended downwards near to the anterior-superior spine of the ilium and upwards through the cartilage of a rib. Another incision, about three and a half inches long, was made backwards at a right angle to the first incision. The tumor could now be seen gliding upwards and downwards beneath the peritoneum as the respiratory movements took place. The posterior wall of the peritonæum was now cut through, and an attempt made to peel out the lower extremity of the tumor, and raise it from its bed. This was accomplished with some slight hæmorrhage from the peritoneum near the hilus of the kiduey. The upper end of the tumor was now sought for, and pulled up very much as one would at an autopsy. The strain on the renal vein at this time was very great. When the tumor had been raised up at both ends the fold of peritonæum enveloping it was pushed back more or less, and the ureter and renal vessels were clamped in a large Spencer Wells's clamp. The pedicle was then tied with carbolized silk, and the clamp removed while the ligature was being tightened. |