GUNFORD

To be used dry for regulating the

COUNT

TO PHYSICIANS.

HORSFORD'S

ACID PHOSPHATE

[LIQUID]

Is a preparation of the phosphates of lime, mag

occult forces of the body

Professional Notices.

DR. J. P. BANCROFT,

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

llas removed to 39 Marlborough St., Boston.

nesia, potash, and iron with free phosphoric acid; DR. WALTER CHANNING

and extended experience proves that it is in such form as to be readily assimilated by the system.

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 appointment only.

It is not a secret or quack medicine, but is made in accordance with well-known scientific principles, under the personal supervision of the well-known Professor Horsford, who has made DR. C. H. COBB

the subject of the phosphates a life study.

It should not be confounded with the dilute

Will receive a few Lying-In Cases at 358 Columbus Avenue. Office Hours: Before 9 A. M., 2 to 4 and 6 to 7 P. M. Telephone No. 4882.

phosphoric acid of the pharmacopoeia, or with DR. NORTON FOLSOM any acid phosphate compounded in the labora

tory.

Dilute phosphoric acid is simply phosphoric acid and water without any base.

In this preparation of Acid Phosphate a portion of the phosphoric acid is combined with lime, iron, potash, etc. It is not made by compounding these articles together in the laboratory, but is obtained in the form in which it

exisis in the animal system.

It has been noted by some physicians that while in certain cases dilute phosphoric acid interfered with digestion, this preparation of Acid Phosphate not only caused no trouble with the digestive organs, but promoted in a marked degree their healthful action.

New Disinfectant,

ANTISEPTIC,

AND

DEODORIZER.

INSTANTANEOUS AND ODORLESS.

It is well understood that "phosphorus," as nch, is not found in the human body, but that phosphoric acid in combination with lime, iron, and other bases, i. e., the phosphates, is found in the bones, blood, brain, and muscles. In the brain is also found phosphoric acid not combined with any base. It is the phosphates and not the simple phosphoric acid that is found in the urine after severe mental and physical exertion, or during wasting disease. Thus the re- Price 50 Cents per Bottle. searches of chemists and physiologists would seem to prove that it is a phosphate, with an excess of phosphoric acid, i. e., an acid phosphate, that will better meet the requirements of the system than either phosphoric acid or a simple phosphate, and this theory has been proven beyond a doubt, by practice, iu a great variety of cases.

We have received a very large number of letters from physicians of the highest standing. in all parts of the country, relating their expe rience with the Acid Phosphate and speaking of it in high terins of commendation.

Pamphlet giving further details mailed frec on application to the manufacturers.

Physicians who have not used Horsford's Acid Phosphate, and who wish to test it, will be furnished with a sample without expense, except express charges.

RUMFORD CHEMICAL WORKS,

PROVIDENCE, R. I.

ONE BOTTLE makes

"WO GALLONS.

DR. GEO. B. TWITCHELL,

President of the Board of Trustees, N. II. Asylum for the Insane, will receive into his family a few cases of MENTAL or NERVOUS DISEASES.

P. O. address, KEENE, N. H

A PHYSICIAN,

Obliged to change climates, offers his house and a $3,500 practice for sale. No competition; the only phosician in town. Will give easy terms for payment if sired. Address "MEDICUS," Office Boston Medical Journa

HOME-MADE BEEF TEA,

Put up in glass jars, at 50 cents per pint, may be ordered at the Women's Exchange of Indus tries, 74 Boylston St., Boston. This opportunity will be found a great convenience, especially to those board ing. Refer by permission to Dr. JOHN P. REYNOLDS. DE CHARLES P. PUTNAM, Dr. ARTHUR II. NICHOLS

F. M. LORING, PHARMACIST,

655 Tremont Street, Boston. DISPENSING PHYSICIANS PRESCRIPTIONS A SPECIALTY. All the preparations of the New Pharmacopoeia, and r liable foreign and domestic remedies, constantly on hand.

STATE ASSAYER AND CHEMIST

FOR MASSACHUSETTS. Analysis, Expert Testi mony and Investigation, Sanitary Research. W. FRENCH SMITII, Pu. D., 235 Washington Street, (P. O. Box 3126), BOSTON (Correspondence invited.)

MASSACHUSETTS

HOSPITAL.

GENERAL

Warren Triennial Prize, $450. "On some subject in Physiology, Surgery, or Pathe logical Anatomy." Dissertations to be forwarded on of before February 1, 1886. For further particulars adress J. H. WHITTEMORE, M.D BOSTON, May, 1883. Resident Physician

This preparation is Hof chlorides produced, the strongest solution

and as a

GERMICIDE,

ANTISEPTIC,

and

DEODORIZER

it cannot be equaled.

MANUFACTURED BY THE

Egyptian Chemical Co.

15 Foster's Wharf,

BOSTON.

Original Articles.

TWO CASES OF INJURY TO THE BACK1

BY CHARLES F. FOLSOM, M. D., Physician to Out-Patients with Diseases of the Nervous System, Boston City Hospital.

AMONG the cases in my note-books I find quite a considerable number where injuries, especially falls, producing quite severe blows upon the back alone, upon the head, or upon the back and head together, have been the apparent cause of grave symptoms, involving the mind or the general nervous system, or both. I find that the gravity of the resulting disease does not depend upon the severity of the primary injury, nor upon the intensity of the pain and other indications of mischief immediately following. The character of the disorder, whether spinal, cerebral, or general, has not in these cases depended upon the locality of the original disturbance, whether of the head or of the back. Of two cases of delusional mental disease, one, which resulted in recovery, was, I think, the direct outcome of a fall in a skating-rink, whereby the back of the head. received a sharp blow not causing even momentary unconsciousness. The second was slowly developed through slight mental confusion, irritability, hardly distinguishable change of character, suspicion, jealousy, and fear of personal injury into delusional mental disease, remaining now, in the fifth year, an incurable insanity, which originated in a succession of violent blows to the back, but no injury to the head, from falling down stairs.

A large number of cases of epilepsy and a few cases of general paralysis of the insane were thought to have been the direct consequence of blows or other injuries, for the most part of the head, but to a less extent of the back. Chorea, too, and the group of symptoms classed under the head of spinal irritation, neurasthenia, and now and then hebephrenia, had their origin associated with the same immediate cause.

I learn from the notes that in the majority of cases in the individuals in whom concussion (not using the word in its technical sense) of the brain or spinal cord, or both, in my judgment, produced symptoms which would be commonly called mental or nervous, there was a hereditary predisposition to the neuroses or psychoneuroses, or that there was a developed instability of the nervous organization; but that fact does not by any means universally hold true. There is a vast preponderance of females over males, but the most difficult case to care for, and the longest to get well under what I thought to be judicious treatment from the beginning, was in a strong, able-bodied, intelligent man, who had been vigorous enough to frustrate an attempt to garotte him, but who, in the process, fell backwards, striking his head, neck, and shoulders on not very hard ground. This man had the greatest variety of manifestations of general disorder which I have ever seen classed under the heads of hysteria, railway spine, etc., and he was two years in regaining sufficient health to go to work, although he had the stimulus of the necessities of his wife and children to make him do so, and although any possible litigation upon the subject was so early decided that there was every inducement to him to recover. His cure has seemed a thorough one for now over a year. I have been long convinced 1 Read before the Boston Society for Medical Improvement, Jan

uary 14, 1884.

that many of these patients were suffering quite as much from disease affecting the brain as from anything which could with propriety be named hysterical, or spinal, or nervous, and many of them wholly from such disease.

The cases which I shall report to-night are two, in which quite similar injuries, producing nearly identical primary indications, resulted in widely different pathological conditions calling for directly opposite methods of treatment. Miss sixteen years old, a bright, very large, robust looking girl, brought up in a country town, came to me with her sister, giving the following history: She belonged to a family in which there were several members considered nervous, but in which no case of the neuroses or psychoses had appeared. She had never had any severe illness, and had always been healthy and strong until three months previous to consulting me, when she fell very heavily, striking her back on a level with the upper lumbar vertebra. She became somewhat dizzy, but not strikingly so, although feeling weaker than usual for a few days. The pain was disagreeable, and increased by moving about much, so that she was compelled to keep quiet for several weeks. After that time she was told that she had spinal disease, and her parents were informed that she must be treated as an invalid the rest of her life, the tenderness and pain at the seat of the injury still persisting. She was told that she must lie down much of the time, but that she might come to Boston to attend school, provided she did not walk or stand or study very much. I ascertained that the lungs, heart, and kidneys were free from evidence of disease. The patient began to menstruate in her fourteenth year, and the function had gone on without any indication for interference. The appetite was moderate. Digestion was well performed, barring an habitual constipation, which was readily overcome by careful regulation of food and habits. There were absolutely no indications of disordered function, except the pain and tenderness already referred to, a sense of weariness, and backache for the greater part of the day, a slight loss of flesh, and a progressively increasing loss of strength. The patient's sister had been directed not to allow her to sit long, to dance at all, to walk more than a very little, or to take part in the usual gymnastic exercises of the school. In fact, she was in the process of being trained to become an invalid of the neurasthenic type.

After the usual examination I felt satisfied that there was no real injury to the spine or brain, that there had been only a bruise, and that the treatment called for was not unlike that found most successful in a sprained ankle, when the acute symptoms had gone by. The sister was directed to follow out a course of treatment of which this is the outline:

A dash of cold water the whole length of the spine, followed directly by a sponge bath every morning. General massage once a week, and rubbing of the muscles of the back, shoulders, and abdomen every evening. To begin gymnastics with a view to strengthening and giving tone to the muscles supporting the weight of her heavy body at the end of a week, and in two weeks to take up dancing, at first very moderately. She was to practice at the piano, of which she was foud, a half hour each day, with a full support to her back, and she was to lie down for half an hour fifteen minutes after her back began to ache, but never to continue work with an aching back.

The sister was directed to inform me as to the progress of the treatment, the inmates of the house were recommended to look upon the young girl as in no way an invalid, and the patient was told not to come and see me again for a month, thereby getting additional assurance from my statement that there was no serious trouble with her. In a little over three months she has become quite well, she walks, dances, and seems quite like the other girls in the school.

The second case belongs to a class much more difficult to deal with.

Miss, aged twenty-six, an intelligent, healthylooking, high-school taught Irish American, with a comfortable home in one of the suburbs, where she kept house for her father and sister. She did not know of any mental or nervous disorder or any socalled nervousness in any of the branches of her family. She has been told that at the age of six or seven years she had pleurisy, and when fourteen slow fever. Otherwise she has been quite well and strong, and the picture of physical health. She began to menstruate at the age of fourteen, and has from the beginning suffered from intense dysmenorrhea. During the previous winter she had been up late and early, and her sisters thought that she had been overworking. She was not herself conscious of any weariness or feeling of effort. Her mind had been quite at rest. She had no anxiety, and had not lost flesh, and she was quite contented with her lot in life. She seemed to me exceptionally fortunate as regards the complicated circumstances combining to affect her general health. Last February she fell, striking her sacrum on the ice. The pain and discomfort from the blow were not great, so that she walked home and did not find it necessary to in any way diminish the labor of her daily life. For three weeks there was decided tenderness when lying on her back, and only slight pain at other times, which then disappeared. She noticed, however, that her daily work wearied her, and so she had walked out less than usual. Four weeks after the accident, in trying to walk a distance to which she had formerly been accustomed, she remarked a dull ache through the right thigh with decided weakness, and finally difficulty in walking. This symptom remained without abatement until August, when attempting to walk, the weakness of the leg rather increasing than diminishing, so that she then went to the sea-shore for a fortnight without benefit. Upon her return the leg began to ache in its whole length if used, so that she walked about only a little, and sat sewing much of the time. Then the arm began to ache and to feel weak. There was also about the same time a steady uncomfortable feeling in the head, always disagreeable, never severe.

She came to the out-patient department of the City Hospital September 19th, asking for the room for the treatment of nervous diseases. She was well formed, healthy looking. Her father had taken her to the horse-cars, and she found great difficulty in getting from Washington Street to the hospital, a distance of, perhaps, three hundred yards. The heart, lungs, and kidneys were ascertained to be healthy; the appetite was fair; bowels constipated; and there had been a slow but progressing loss of flesh, in all amounting to about five pounds. She slept poorly. There was a constant feeling as if the brain had been bruised, which was not much increased by mental effort, but any work requiring thought or planning produced a sense of general fatigue over the whole body. The emotional

state was much exalted. The patient could not sit long in the waiting-room without excessive fatigue and great increase in the pain affecting the extremities. She thought her mind was weakened, as she could not bear things at home with her customary equanimity. I could not find anything abnormal from an examination of the head, ears, or eyes. The ophthalmoscope was not used. The patient complained of a great ache, rather than pain, throughout the right arm and leg, and in the right side of the chest. The whole fore-arm sometimes felt as if encased in ice. A severe pain appeared at different times in different spots of the upper arm and thigh, and there was a feeling of numbness at the seat of the injury, sometimes very troublesome, oftener hardly noticeable. Between the shoulders, over a space ten inches in diameter, quite nearly symmetrical, and involving both sides, was an area of burning-heat sensation, varying in intensity under conditions for which I could not find any approach to a law. Sensation was slightly impaired pretty much throughout the right side, but there was at no time any marked anesthesia. The arm could scarcely be used in any of the ordinary duties of life, and the leg was exhausted after quite moderate efforts. There had been a sense of muscular spasm without any visible movement as observed by the patient in both legs, much less in the left, but also in the right arm.

In such a case as this healthy occupation and diversion for the mind are of the first importance, so that isolation and the rest cure were not to be thought of. A feeling of introspection and self-consciousness was particularly to be avoided, so that a hospital was distinctly contra-indicated on account of the danger of establishing a chronic invalidism. I saw no reason for removal from home except for convenience of treatment, and that could not be afforded, and yet the home was not a favorable place for the care of a sick person. I doubted whether massage would be of use, and my experience of other similar cases led me to question whether it might not do harm. At all events it was not procurable.

She was directed to walk only as much as was necessary to get to the hospital three times a week, her father driving her to the horse-cars; to use the arm only a couple of minutes at a time, at long intervals, and then for no fine movements. She was not to read or do anything involving mental effort except in a general way to direct her sister about the management of the house. She was to be taken out of herself as much as possible. From week to week she was allowed to gradually increase the amount of physical and mental work as she found she could bear it, and I soon ascertained that she was better those days when she came to the hospital than when she remained quietly at home. The faradic brush was used over the arm of a strength just beyond what could be comfortably borne for a month. At the end of a month's time all the most disagreeable symptoms in the arm had disappeared, and in a month more it was quite well except that it had still to be used carefully. The leg remained stationary, or, if anything, getting worse for a month, while the arm was improving, so that the patient was directed to apply the faradic brush to the whole length of the leg, since which time improvement has begun. With malt, cod-liver oil, and hypophosphite of lime four times a day the general condition improved, there was a slight but continuous gain in

flesh, the sleeplessness disappeared, and in a month and a half the uncomfortable feeling about the head had gone, to return only for a short time at considerable intervals. I dare say that the daily cold affusions to the back helped to improve the general condition, and had something to do with the rapid subsidence of the dyspnoea, panting breath, sensation of constriction about the chest, tightness about the heart, and parasthesias. As soon as the head began to feel well iron was given, at first in very small doses, and later the acid phosphates and arsenic. The constipation has been regulated by diet and mild laxatives.

At the present time the mental state has returned to the normal. The arm is quite well but not fully strong, the head does not cause any trouble or uneasiness, the abnormal sensations have gone except the pain in the thigh, although that has improved, and the strength of the leg is constantly mending. I confidently expect a full cure within three to six months. But the element of time seems to me extremely important in these cases, and I think that careful treatment should be insisted upon for at least six months after apparent recovery, to enable the system to entirely regain its tone. I know of no way in which the physician can form an opinion as to the extent of the damage done by injuries to the back and head except by reserving his prognosis for quite a time in order to see which set of symptoms appears. There probably will be a difference of opinion among equally qualified men with large opportunities for observation, as to the extent to which rest should form an important part of the immediate treatment of even seemingly trivial accidents causing a physical shock to the brain or the spine. Doubtless evil results happen less often than others. But serious trouble comes not seldom, and incurable, almost life-long, suffering is not uncommon in cases where there will always be at least a doubt whether sufficient care in the beginning might not have averted a tragedy. Whether in the first of these two cases the severe pain necessitated the rest which saved the young girl from the development of more serious disorder, and whether, in the second, the mildness of the initial symptoms encouraged the activity which prevented a speedy cure are questions of interest to the physician, and of importance to the patient. My own experience leads me to treat all similar cases with great caution from the beginning.

THE USE OF TOBACCO BY BOYS.1

BY EDWARD O. OTIS, M. D. (HARV.) ONE might deem an apology almost necessary for adverting again to the trite subject of the use of tobacco, a subject which has been discussed almost from time immemorial, and of which so much true and false has been said. Still it is a fact that tobacco-using among boys is common, and, further, most medical men, I think, will admit that the use of tobacco by boys, either moderately or immoderately, is injurious. So long, then, as this is the state of things it may not be amiss to raise one's voice from time to time against the abuse. Although not much that is new upon the

1 Read before the Section for Clinical Medicine, Pathology, and Hygiene of the Suffolk District Medical Society, December 12,

1883.

matter may be presented, every agitation against an evil does something towards eradicating it.

I propose to leave out entirely any discussion of the effects of tobacco, injurious or otherwise, upon adults, and refer only to its use by boys.

My attention was especially directed to this subject while in practice at Exeter, N. H., where I met with many of the students of the Phillips Exeter Academy, and noted the effect of tobacco upon them. I became still more interested by reading through the kindness of the late principal, Dr. A. C. Perkins-a large number of letters sent by parents, teachers, and others in response to a circular letter of the principal asking their opinion regarding the use of tobacco by boys in the school. To the circular and letters I shall refer later on.

As to the exact percentage of boys who use tobacco there do not seem to be any very accurate statistics. At the academy above referred to I should say that at least one half of the students used it. The statement was made some time ago, I believe in a secular paper, that seventy-five per cent. of school-boys over twelve or thirteen years old smoke cigarettes. I am inclined to believe that this is too high. At the Boston Latin School, of those in the upper classes from fourteen to eighteen years of age, the head master stated last year that probably about half used tobacco to some extent. The principal of another school stated that since his connection with it the number of smokers had nearly doubled. This is enough to show that the evil prevails extensively, and gives good reason for serious apprehension.

Whatever injurious effects the excessive and constant use of the drug may have upon adults, these are more marked and intensified in the case of the youthful user of tobacco; and, moreover, the youth are more inclined to its use to excess, for theirs is an age of immoderation. For example, a young student, from fifteen to seventeen years of age, I should think, told me he was smoking about a bunch of cigarettes a day, and although promised a trip to Europe if he would abandon the habit, said he did not think he could do it even for that prize. It is a time of rapid change, physically and mentally, with them; there is a constant development going on, and although I am not aware that any careful series of observations have been made, still I am sure that the general observation of all is to the effect that tobacco interferes with and retards the proper symmetrical development both of mind and body. Of course there are exceptionally robust and strong boys who, although they use tobacco, mature into sturdy men with good minds, but it is in spite of the tobacco. The especial deleterious effects of tobacco upon the young are pretty well known from all the discussion and much exaggeration that has been rife about them. I will briefly mention some of them.

There is the so-called "tobacco heart," an irregular, irritable heart. Dr. Gihon, in his report on the United States Naval Academy, says, "The annual examination of cadets reveals a large number of irritable hearts among the boys who had no such trouble when they entered the school." This was before tobacco was prohibited at that institution.

Another effect is defective muscular coördination, as shown in the tremulousness of the hand in manipulating a pencil or pen, and inability to draw a perfectly straight line. The professor of drawing at the Naval Academy said that he could invariably recognize a