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Related post: due iirst, and in the vast majority of cases, to the negli-
gence of the obstetricians in omitting the plan recom-
mended by Crede; second, to the negligence of the
attendants in obtaining proper relief immediately; and
third, to the inability of the oculist in a certain very
email percentage of cases to prevent destruction of the
•eyes.
As to the first point, it is evident that by far the
most effectual method of preventing this disease is to
kill the germ which may have lodged beneath the lid
before that organism has a chance to develop. Futile
attempts had been made to accomplish this by different
methods, and an almost infinite variety of antiseptics
had been used in various strengths. Yet the results were
not specially satisfactory until Crede called attention
to the value of a two-per-cent. solution of nitrate of sil-
ver dropped into the eyes of children immediately after
birth.
The data were so conclusive, and the results so re-
markable, as practically to make a new era in the pre-
vention of this much-dreaded disease. The accumulated
experience now covers many thousands of cases. Vari-
ous comparative tables have been compiled to show the
advantages of Crede's plan. One of these, arranged by
Fuehs, I present. These data could be extended and in-
creased many times, if necessary, taking them from the
private or hospital practice of other observers. The
Tesiilts, however, are sufficiently constant to have this
table an exponent of all:
WITHOUT PRBCAUTI0N8.
TWO-PBR-CENT. SILVER NITRATE.
Author.
Total No.
of births.
Per cent.
Total No. of births.
Per cent.
Ohlshauscn
Croilc
550
2,897
1,092
1,266
1,887
1,106
12-5
10-8
4-8
7-3
4-3
12-3
1,160
1,250
703
S 1st period 3,000
"( 2(1 " 2,100
361
0-1
Konigstem
Knikeuberg
Felsenreieh
0-7
0-14
1-9
1-0
Total
8,798
'8-66
8,574
Average per cent.
0-656
This shows that while, without treatment, we find
that ophthalmia of infancy develops in over eight per
cent, of all the children born in institutions, on the other
hand, with this treatment, it occurs in only a little over
one half of one per cent. In other words, the number
of cases is about sixteen times as great without this pre-
caution as when it is used. On such a basis of calcula-
tion for the cases of blindness in this State from oph-
thalmia of infancy we would have about twenty-seven
instead of the four hundred and thirty-eight now prob-
ably existing. Of course this is not an. exact calculation,
but only an estimate based on the data before men-
tioned. The number would be greater or less than this
if other sets of statistics from other observers had been
selected. But about four hundred and eleven fewer
persons would have been blind here in New York State
alone had they received the benefit of the Crede pre-
ventive treatment. Will obstetricians permit that pro-
portionate amount of misery to be charged to their ac-
count now that there is a means to prevent it? It is be-
yond the scope of this paper to discuss the reasons for and
against Crede's method for the prevention of that dis-
ease. But, since the State pays such large sums each
year to support the victims of this disease, and since it has
surely as much right as an individual to demand the best
treatment for those whom it supports, if not for all citi-
zens, then why should it not have a law which makes
the Crede plan obligatory, at least in public institutions?
That, of course, would aft'ect obstetricians more than any
other class. To a certain extent it would increase their
responsibilities, and might annoy them otherwise.
But setting aside their evident duty, as indicated by
these data, in order to ascertain the opinion of a consider-
able number. I recently sent a letter to many prominent
obstetricians in this State, asking each one —
1. If Crede's method should be used invariably in
hospital practice.
'2. If it should be made obligatory there.
3. If it should l3e used invariably in private practice.
4. If it should be made obligatory there also.
The replies would furnish sufficient material for a
separate communication later. It is sufficient for our
present purpose, however, to state that when these replies
were tabulated it was found that the first question
was answered in the affirmative almost without excep-
tion.
June 26, IsaT.J
HOWE: BLINDNESS IN NEW YORK 6TATE.
871
As for the second, the opinion was about equally di-
vided.
About the third and fourth, however, the testimony
was strongly in the negative. Only two offered the least
objection to the method, and these objections were of a
nature easily answered by abundant testimony.
In a word, at least half of those most likely to oppose
such a law already beUeved in it for public institutions
if not for private practice.
But supposing that such a law existed, the figures
show that the disease would still develop in about one
half of one per cent, of all children born. And what is
to be done with these?
That brings us to the second point or second method
of preventing the resulting blindness, or to the duties
of nurses before mentioned, and the answer to this ques-
tion is to enforce the law which already exists in this
State relative to mirses and attendants. Every one knows
how important the element of time is in the treatment of
this disease.
Five years ago that subject was thoroughly discussed
in this society, and largely as the result of that discussion
a law was enacted which read as follows:
AX ACT FOE THE PBEVENTIOX OF BLINDNESS.
Section 1. — Should any midwife or nurse having
charge of an infant in this State, notice that one or both
eyes of such infant are inflamed or reddened at any time
within two weeks after its birth, it shall be the duty of
such midwife or nurse so having charge of such infant,
to report the fact in writing, within six hours, to the
health officer or some legally qualified practitioner of
medicine, of the city, town, or district, in which the
parents of the infant reside.
Sec. 'i. — Any failure to comply with the provisions
of this act, shall be punishable by a fine not to exceed
one hundred dollars or imprisonment not to exceed six
months, or both.
Sec. 3. — This act shall take effect on the 1st of Sep-
tember, 1890.
Although this law was modified the following year,
its provisions are virtually the same to-day, as found
in Chapter 325 of the laws of New York for 1892, and
it has been deemed so beneficial that, with sUght changes
in the first wording, it exists now in Maine, Rhode
Island, Connecticut, Minnesota, Ohio, Xew Jersey, Mary-
land, Iowa, Missouri, Pennsylvania, Illinois, and Michi-
gan, covering a population of about thirty-four million.
That came from action beginning in this society. The
real fact is, however, that this law is still partly inopera-
tive, because physicians do not like to report negligent
nurses as often as they should, and because judges are
apt to be too lenient to these women, as frequently
neither judge nor nurse appreciate the importance of
the question. But the few convictions obtained, and ar-
rests made, have undoubtedly^ exerted a wholesome effect
in bringing nurses to a sense of their responsibilities and
duties.
Now there are manv who believe that children in
public institutions or, in general, in the cities, should be
subjected to the inconvenience of Crede's method, and
also that the law concerning nurses should be strictly
enforced there, but honestly believe also that any such
precautions are unnecessary in private practice, especial-
ly in country practice. But when we look at the dis-
tribution of the blind in the counties of New York we
find, to our surprise, that there are more thus afflicted in
the country than in the cities, and it is but natural to
infer that ophthalmia neonatorum fm-nishes at least its
usual large quota of victims here as elsewhere.
Thus the United States Census for 1890 showed, as
before stated, that we had -1,389 blind persons in this
State — namely, 73.2 for every 100,000 persons. When
we look at the distribution of those persons according
to counties a curious fact attracts attention. We notice
that there are in the county of St. Lawrence 122 to the
100,000; Franklin. 89 to the 100,000; CHnton, 144 to the
100,000; Essex, 122 to the 100,000. These give an aver-
age of 119 to the 100,000. On the other hand, we find
in the county of New York 50 to the 100.000; Kings,
32 to the 100,000; Richmond, 54 to the 100,000; West-
chester, 56 to the 100,000. Average, 48 to the 100,000.
We notice that there are also in Erie 53 to the 100,000;
Monroe, 57 to the 100.000; Rensselaer, 83 to the 100,-
000; Albany, 87 to the 100,000 — or the average of these
four counties in the northern corner of the State is 119,
as contrasted with an average of 48 in and about New
York.
While statistics are often deceptive, and there are
marked exceptions to the rule, this peculiar distribution
of the blind is too regular to be a coincidence, and we
notice that, in general, the proportion of blind is less
near the centres of population than in the counties where
the area is large and the population scanty.
As a rule, easy transportation and good roads are in
direct proportion to a low rate of blindness, while bad
roads mean a higher ratio.
It is unnatural to suppose that this disease or any
other is more common in the country than among an
urban population. It probably is not. But it is true that
more precautions are taken in the cities than in the
country against this principal cause of blindness, and
that this and other diseases of the eyes are, in general,
more promptly and regularly treated. This is not the
fault of one class of practitioners as much as it is the
result of the environment of others, for in the vicinity
of large cities it is possible for nurses or friends to take
a child at once to a physician without much inconvenience
or exposure, and where the facilities for travel are great
the mother herself can very soon attend to this. This
undoubtedly lessens the proportion of blind in and near
the cities. On the other hand, where the distances are
great and the roads are poor the patients are usually seen
late, and often only at intervals. That is why bad roads
mean a high percentage of blindness.
Finally, as to the third cause of blindness, supposing
872
PEIOLEAU: PAQUIX'S ANTITUBEECLE SERUM IX TUBERCULOSIS. [N Y. Mkd. Joor.,
Crede's method were made obligatory in every ease, leav-
ing only half of one per cent, of the children to contract
this disease, and supposing nurses were invariably prompt
in taking this small number of cases promptly to the
physician, the question arises of how many of these chil-
dren would still become blind from the ignorance of the
practitioner or from the general lack of knowledge con-
cerning the proper methods of treatment. This point has
been carefully investigated by Cohn and others, and the
results obtained from many different sources, especially
from the statistics of large ophthalmic hospitals, show
that on the average only about five per cent, of these chil-
dren become bUnd when suitable treatment is instituted
at an early stage. These figures need no comment. To
recapitulate briefly, it maj' be said that if Crede's method
were invariably used the number of blind from this dis-
ease would be only about twenty-seven instead of about
four hundred and thirt3'-eight in this entire State. And,
further, if these twenty-seven had been treated early by
present methods, only five per cent, of therd would have
lost both eyes. That is, with Crede's plan invariably fol-
lowed, and with treatment invariably prompt, we should
have only one, or, at most, two cases of such blindness
in each generation. We should soon practically end this
terrible disease, and save the State each year over fifty
thousand dollars.
The truth has been well stated recently by Professor
Cohn, of Breslau, in a careful and exhaustive study of
fresh data relating to blindness from this cause. He
concludes thus with a quotation from Professor Dimmer:
" Ophthalmia of infancy can and must be wiped otit of
every civilized country."
That is the lesson which this arithmetic and geogra-
phy has to teach us. Shall it be forgotten, and shall one
generation of blind after another result from our neg-
lect? Or shall the Empire State take the lead in whole-
some legislation again as it has before? The answer to
that question depends largely on the medical profession
of the State, and the consequent honor or dishonor will
be theirs.
DR. PAUL PAQUIN'S
ANTITUBERCLE SERUM IN TUBERCULOSIS.*
By WILLIAM HUTSOX PRIOLEAU, A.M., M. D.,
SFJIMERVILLE, S. 0.
Seeothekapt is yet in its infancy, and any light
■which can be shed on tliis topic will be of value to all
of us. In an experience with Dr. Paquin's antitubercle
serum extending over a period of sixteen months I can
safely say that nothing has ever given me such good re-
sults as this serum. I do not state that it is a specific
for tuberculosis, but I do say that there are few cases of
unmixed tuberculosis that can not be benefited by it.
This applies not only to tuberculosis of the lungs, but
* Read before the South Carolina Medical AsBociation at Union,
S. C, April 29, 1897.
also to tuberculosis of the larynx and joints. I presume
that all of you gentlemen have heard of tliis serum, and
probably some of you may have tried it. ilanufactured
in St. Louis, as you are aware, under the supervision of
the State Board of Health of ilissouri, and under the
personal direction of Dr. Paquin, it is quite evident that
it must be unattainted of any fraud. Dr. Paquin was
himself a student of that renowned benefactor of man-
kind, the late Louis Pasteur, a fact which in itself must
necessarily lend great weight to any theory or treatment
that he approves. The antitubercle serum is obtained
from the horse, and is made on the theory that a toxine
produces an antitoxine when introduced into the blood
of an animal. It is the old immunity theory. The re-
lation that diphtheria antitoxine bears to diphtheria is
the same that the antitubercle serum bears to tubercu-
losis. These two serums depend upon the same prin-
ciple, and both have rendered remarkable and unex-
pected results. I feel quite sure that after having
learned the results of my experience many of you will re-
turn home with a new drug in your pharmacopoeia, and
that in the near future you will all find its use absolutely
necessary in order to give the poor consumptive the long-
desired relief which he has so frequently sought for in
vain. In using this serum I have only twice noticed any
dangerous symptoms, both times in the same patient.
He had been taking the injections daily for two months,
when suddenly, one afternoon, just after the serum had
been injected, he became flushed and gasped for breath.
His pulse grew very weak. I did not do an}d;hing at that
time because liis condition was not sutRciently alarming,
and for the further reason that I wished to observe what
would be the probable result. In the course of a brief
time he came to again. This same condition existed at
the time of the next injection. What was the cause of
these alarniing symptoms I am unable to state; but it is
a fact worthy of observation that in no case has death
occurred from an injection of this serum. In all, I have
treated thirteen patients with this serum. Very often,
under its influence, I have seen many of the worst sjonp-
toms disappear. As if by magic, fever, night sweats, loss
of appetite, hfemorrhage, etc., all \-ield to it. Many of
the most desperate cases have received temporary reUef,
while the incipient cases have received permanent bene-
fit. Some patients can not take the injections h}T)oder-
mically because of the tissttes in the back becoming
swollen and painful; for these patients I order rectal in-
jections of double the hypodermic dose. I shall not pro-
long this discussion by relating in detail each and every
case that came under my treatment, but shall take up
four only, leading the remainder unmentioned except in
so far as they possess points of especial importance con-
nected with the subject.
Case I. — An Englishman, aged thirty-one years.
Familv history negative. Contracted phthisis pulmonalis
in the spring of 1895. In the summer of the same year
he caught a cold which settled on his larvnx. He came
June 26, 1897.] PRIOLEAU: PAQUIN'S ANTITUBERCLE SERUM IN TUBERCULOSIS.
»73
to me in December, 1896. Ou examination I found the
npper lobe of the left lung breaking clown. The larynx
showed inflammation. lie could not speak above a whis-
per and could hardly walk. He had lost flesh and was
also sufl'ering from indigestion. I advised the serum
treatment. After three months' use of this serum my pa-
tient had gained so much strength that he was al)le to
walk briskly; his voice also was considerably stronger.
His appetite became greatly improved, and consequently
he felt better than he had for some time. Unfortunately
for the patient, he was unable to continue the serum treat-
ment; but the effects lasted about six months, when the
grip, attacking him, lowered his vitality to such an ex-
tent that the old trouble returned. It is my firm belief
that had this patient been able to keep up the treatment
he would have been restored to health again. In fact,
he admitted this much to a friend; for once he remarked
that if it ever became possible for him to stand the ex-
pense of the serum treatment he would undoubtedly
begin its use again.
Case II. — Charlestonian, aged twenty-eight years.
Family history good. Contracted phthisis pulmonalis in
February, 1895, after having been weakened by two suc-
cessive attacks of the grip. Physical examination showed
one spot on apex of right Ivmg, and another in lovv-er part
of upper lobe of left lung posteriorly. It was a typical
case, with fever, cough, night sweats, hfemorrhage, etc.
The patient was ordered, in May, 1895, to the mountains
of North Carolina, where he passed the summer with little
or no benefit. He then came to Summerville in the
autumn and remained for two months, when, tuberculosis
of the hip and testes developing, he was advised to go to
Charleston for the purpose of having an operation per-
formed. There his testes were operated on, but he refused
to have his Mp joint opened. The pain in his hip had
become so intense that the slightest movement in bed
would cause extreme agony. At my earnest request
the physician in charge kindly consented to treat him
with Dr. Paquin's serum, and it was not very long before
his hip became much improved. So great \^'as this im-
provement that in a few months the patient was enabled
to walk without the help of crutches and with absolute-
ly no pain. In every respect he continued to improve,
and finally, in March, 1890, he returned to Summerville.
There I continued the serum treatment until the hot
weather set in, at which time, for numerous reasons, I
stopped it. Not three weeks after its discontinuance
the patient developed tuberculosis of the brain, which
in the short space of two weeks caused his death.
This case is interesting in many points. First, the
development of tubercles in the lungs, followed by tuber-
cles in the testes, hip, and brain; also because of the
marked and immediate relief furnished him by Dr.
Paquin's serum. And lastly, because it was the only
case in which I have observed alarming symptoms caused
by an injection of the serum.
Case III. — Virginian, woman, aged thirty-five years.
Family history negative. Patient had suffered from re-
peated attacks of the grip. In the last four years it was
her custom to come South for the winter season. An ex-
amination revealed a lesion in tlie upper part of the right
lung. I could not say whether it was tubercular or not.
A careful examination of the sputa did not show tubercle
bacilli. There had been no improvement in health dur-
ing the last three winters, so this year I placed her under
the serum treatment. Immediately after using tliis
scrum improvement became quite noticeable, and after
three months' treatment I allowed her to return home;
not, however, without cautioning her to be extremely
careful witli herself, and for the next year to use twice
a week rectal injections of Dr. Paipiin's serum, forty
minims at a dose.
Case IV. — Summervillian, man, aged twenty-five
years. Family history poor. Father and sister had died
of phthisis piilnionalis. Patient has had a cough all liis
life. In June, 1896, he had several hemorrhages; also fe-
ver, night sweats, cough, etc. On examination, I found
consolidation in upper part of lower lobe of left lung. I
immediately put him under the serum treatment with no
other medicines. Very soon his htemorrhages ceased,
his night sweats were arrested, and his fever left him.
His appetite was restored and his strength renewed.
Improvement continued until the summer, when the
injections of serum were discontinued because of the
great difficulty in keeping the serum fresh. In the fall
I commenced" to inject him again, and since that time
he has steadily improved. His gain in weight is eleven
pounds, and he coughs only when the atmosphere is
damp and moist. I advised him that he could return to
his work, but that for the next year he must use the
serum by rectal injections twice a week.
This case is worthy of observation, because of such
a brilliant and successful result in one who so strongly
inherited a predisposition to tuberculosis.
So far I have discussed, in detail, the history and
treatment in four cases, and now I propose merely to
make brief mention of the remaining nine which have
come under my notice, giving only the most important
points connected with them.
Report of Cases.
No.
Sex.
M.
Age.
29
Family history.
Disease.
1
Good.
Phthisis pulmonalis.
9.
F.
39
Not good.
Phthisis pulmonalis with cavities.
3
F.
17
Very pooi'.
Phthisis pulmonalis with pernicious anae-
mia.
4
M.
35
Unknown.
Phthisis pulmonalis with frequent hiem-
orrhaj^es.
7
F.
40
Unknown.
Cavity in left lung.
5, 6, 8, and 9 already reported in detail
10
M.
29
11
F.
38
12
F.
40
13
F.
23
Unknown.
Unknown.
Good.
Good.
Phthisis pulmonalis five years and laryn-
geal tuberculosis one year.
Acute pulmonary tuberculosis.
Laryngeal tuberculosis.
Acute pulmonary tuberculosis.
1. The patient was in a dying condition when first
seen. Daily injections of serum gave him relief and pro-
longed his life.
3. All distressing symptoms disappeared under the
serum treatment. The patient was too far gone for any-
thing to benefit her permanently.
3. Tuberculosis was checked, but death resulted from
anaemia.
4. Haemorrhages checked, and patient's condition im-
proved. Ordered home when hot weather began. Re-
sult unknown.
7. I could see no improvement in this case, although
the patient stated she was better. As she was unable to
874
THERAPEUTICAL NOTES.— LEADING ARTICLES.
[N. Y. Med. Jodb.,
stand our warm weather in the summer I sent her home
in ■May. Result not known.
10. This case was that of a physician who took the
serum treatment having no faith in it. but died con-
vinced of its merits.
11. The patient when tirst seen had a large cavity in
the left hmg. The right lung was consolidated. I did
not use the serum expecting a cure, but simply to give
her strength enough to return home. She died three
months after I first saw her.
12. Marked improvement. Left for her home with
instructions to continue treatment.
13. Too far gone for serum to accomplish any good
results. Used it for about a month, and then discontin-
ued it, or rather told her father to take her home.
Two of my patients, you will observe, have been dis-
missed practically cured, an unusual result in tubercu-
losis. Of the remaining eleven, all but one were bene-
fited. In using this serum I did not, as a rule, give up
other medication — hygiene, diet, etc. — because diet and
hygiene are of vast importance, and proper medication
is also quite advantageous. There is no medical routine
that I know of, but my method is to use, along with the
serum, strychnine, arsenauro (Charles Roome Parmele
Company), protonuclein (Reed & Carnrick), and Gude's
peptomangan. Before concluding, I must add that
many of these cases were exceedingly desperate, and
while some may argue, perhaps rightly, that the climate
of Summerville was largely instrumental in producing
these good results, still I must maintain that the primary
cause was Dr. Paquin's great discovery.
Cbtrapeutiral flotts.
Birch Leaves as a Diuretic. — Winternitz (Central'
hlaii fiir die ijesammte Therapie; Journal des praticiens,
June 5, 1897) reports that an infusion of the leaves of
the birch (species not mentioned) is a powerful diuretic.
He says the leaves should be gathered in the spring and
well dried before they are used. From twenty-five to
thirty parts of the leaves are added to from a "hundred
and fifty to two hundred parts of hot water, the water is
then made to boil for an instant, and the leaves are
allowed to macerate for an hour or two. The dose is
not stated.
The Treatment of After-Pains.— Dr. J. L. Audebert
of the obstetrical clinic of the Faculty of Medicine of
Bordeaux (Gazette liet)doinadaire de medecine et de chi-
rnrgie, June 3, 1897), recommends an enema of fifteen
grains of antipyrine in four ounces of boiled water ; also
the following :
R Fluid extract of viburnum ")
prunifolium, I , , ri
Fluid extract of hydrastis ( ®^°^' i ^- ""^'^^^
canadensis, J
M. S. : Twentydropsevery two hours, in a hot drink.
NEW YORK MEDICAL JOURNAL,
A IVee/cly Review of Medicine.
Published by
D. Appleton & Co.
Edited by
Frank P. Foster, M. D.
NEW YORK, SATURDAY, JUNE 26, 1897.
THE CONCOURS IN FRANCE.
Some of our brethren in France seem to have lost
confidence in the concours system as a bar to intrigue
and favoritism. In the Journal de clinique et de thera-
peutique infantiles Dr. Variot lately gave his opinion
concerning the nomination of three hospital physicians
in Paris. He asserts that the tests are no longer any-
thing more than lamentable shams intended to cover
up an election prearranged among a majority of the
judges. As regards the particular concours which re-
sulted in the appointment of these three physicians, he
declares that as soon as the jury had been constituted
and before the examination was begun everybody knew
who would be appointed. There were no fewer than
seventy-five candidates, and thirty-five sittings of three
hours each were held, and M. Variot, who was one of the
judges, but one of the minority, asks if it can be con-
scientiously admitted that out of so large a number only
three met all the requirements, while all the others, men
of worth as they were, tumbled over each other in con-
fusion (" culbutaient indistinctement les uns sur les
autres "). He thinks it would have been better if the
vote had been taken at once after the first meeting, for
then the candidates' feelings would have been spared as
well as a useless expenditure of the judges' time.
The Gazette medicale de Nantes, which cites M.
Variot's criticism, recognizes that the state of things re-
vealed is deplorable and ealcvdated to discourage work-
ers. Nevertheless, it still believes that for France the
concours will long remain the best guarantee against
intrigue. It has its weak points that can not be over-
looked, the Gazette is unable to deny, but it sees many
others in anj' plan that might be substituted for it.
What is called a concours sur titres has been demanded
by some of the journals. This seems to be a competition
based on what the candidates can show that they have
accomplished, especially by their contributions to litera-
ture. As regards a concours of this sort, the Gazette
cites the case of Dejerine, who, it suggests, was made an
agrege in spite of his works, rather than on account of
them, for as titles Charcot regarded them as titles to
nothing better than ostracism. Our contemporai-y goes
on to say that Charcot, although a competent judge.
June 26, 1897.]
MINOR PARA0RAPH8.— ITEMS.
875
unfortunately allowed himself to be led by \\ii intimates
and by an inclination to nepotism, as is generally done
in France, particularly in Paris. Charcot, powerful as
he was, adds the Gazette, was forced in Dejerine's case
by the threat of great scandals, such as the noisy with-
drawal of certain members of the jury who, fortu-
nately, supported the candidate.
Our Nantes contemporary gives other reasons for still
relying on the concours. The French people, it says, are
so constituted that they would not work if they were
not stimulated by the prospect of tests to be submitted
to publicly. Peoples, it remarks, have their tempera-
ments as well as individuals, and the French are nei-
ther Germans, nor Eussians,nor Englishmen. It concedes
that a candidate's original works should go far in his
favor, but that, it insists, is no reason for tampering
vrith the concours. To the objection that the super-
annuated system now in force favors the good talkers
at the expense of the others it answers that that is doubt-
less a danger to be avoided, but it must not be forgotten
that, when a professor is to be chosen, a mute will not
answer, no matter how scientific he may be. As to this
point, the Gazette quotes from the Progres medical, which
said, apropos of Maisonneuve's death: " If he did not
succeed in the concours, it was undoubtedly because he
was a very poor speaker and because, in our country, to be
a surgeon one must know how to talk! " To this the
Gazette retorts that to practise surgery and to teach it are
two different things; to teach it to students, and do it
well, one must certainly be able to expound and explain
it in words.
MINOR PARAGRAPHS.
ICHTHYOSIS IN THE ISLAND OF MELEDA.
At a recent meeting of the Imperial-royal Society
of Physicians of Vienna (Wiener medizinisrhe BUiiter,
June 10, 1897) Dr. Neumann mentioned a rare skin
disease observed among the inhabitants of the island of
Meleda. The soles of the feet were beset with callosities
more than half an inch thick, separated by furrows, so
that the surface had a honeycomb appearance. There
were also callosities on the dorsum of the foot, each sur-
rounded by a red, hyperfemic area. Similar appearances
were found on the palms of the hands, on the wrists, and
on the extensor surfaces of the knees and elbows. For
years the disease had been hereditary in a family. The
speaker defined it as a hyperkeratosis which had first
been described in 1826 as a partial ichthyosis.
ITEMS.
The Twelfth International Medical Congress.— Dr. A.
Jacobi, chairman of the American national comniittee.
which was established at the request and under the author-
ity of the general committee of the congress, desires to in-
form the numerous gentlemen who are constantly applying
for information concerning certificates, trip, fares, hotels
etc., that lie has none to give, not having heard from th^
general committee foi' two mouths.
Yale University.— The annual address in medicine will
be given liy Dr. William M. Polk, of New York, in College
Street Hall, on Tuesday, June 29th. at noon, on the subject
of How to Work.
Infectious Diseases in New York.— We are indebted to
the Sanitary Bureau of the Health Depai'tment for the fol-
lowing statement of cases and deaths reported during the
two weeks ending June 22, 1897:
DISEASES.
Tvphoid fever
Scarlet fever
Cerebro-spinal meningitis
Measles
Diphtheria
Croup
Tuberculosis
Week ending June 15.
Caees. l Deaths.
6
158
1
192
255
10
160
6
1
11
40
5
94
Week ending Jtme 22.
Cases. Deaths.
9
179
4
228
261
11
140
4
14
8
41
4
113
Marine-Hospital Service Health Reports.— The follow-
ing statistics concerning small-pox, yellow fever, cholera,
and plague have been received in the office of the super-
vising surgeon-general :
Small-pox — United Stales.
Toledo, Ohio May 1-31 11 cases, 2 deaths.
St. Louis, Mo May 1-31 3 " 3 "
NewYork, N. T June 5-12 4 "
Small-pox — Foreign,
Calcutta, India May 1-8 15 deaths.
Matanzas, Cuba Purchase Trental June 2-9 1 death.
Trieste, Austria May 22-29 1 "
Alexandria, Egypt May 6-13 1 "
Cairo, Egypt . .' May 6-13 2 deaths.
Rotterdam, Holland May 29-June 5 1 case.
Madrid, Spain Miiy 26- June 2 2 "
St. Petersburg, Russia May 22-29 8 cases, 4 "
Rotterdam, Holland May 29-June 5 1 case.
Habana, Cuba June 3-10 8 cases, 1 death.
Cardenas, Cuba May 29-June 6 3 " 1 "
Sagua la Grande, Cuba May 29-June 5 17 " 3 deaths
Habana. Cuba June 5-12 1 death.
Cardenas, Cuba May 29-June 5 1 "
Cholei-a.
Calcutta, India May 1-8. . . ,
Bombay, India May 11-18.
70 deaths.
1 death.
Yellow Fever.
Bahia, Brazil May 12-19 3 deaths.
Matanzas, Cuba June 2-9 3 "
Rio de Janeiro, Brazil May 8-15 3 "
Habana, Cuba June 3-10 170 cases, 37 "
Cardenas, Cuba May 29-June 5 2 cases.
Sagua la Grande, Cuba May 29-June 5 24 "
Santiago de Cuba May 22-June 5 6 "
Habana, Cuba ...June5-r2 37 "
Panama, Col May 24-June 3 20 " 14 "
Bombay, India
Plague.
May 11-18..
67 deaths.
Marine-Hospital Service.— O^cia? List of the Changes
of Stations and Duties of Commissioned Officers of the
United States Marine-Hospital Service for the Fire Weeks
ending June 19, 1S97 :
Murray, R. D., Surgeon. Granted leave of absence for
four days from June 1, 1897.
Pettus, W. J., Passed Assistant Surgeon. Granted leave
of absence for twenty-three days from May 18, 1897.
Stewart. W. J. S., Passed Assistant Surgeon. Granted
leave of absence for thr.ee days from May 2(), 1897.
Greene, Joseph B., Assistant Surgeon. To rejoin station,
Deti'oit, Mich., on return to Evansville, Ind.. of Passed
Assistant Surgeon P. M. Carrington. June 9, 1897.
Grubbs. S. B., Assistant Surgeon. To proceed to Boston,
Mass. and report to medical officer in command of
876
ITEMS.— MARRIAGES AND DEATHS.— PROCEEDINGS OF SOCIETIES. |N. Y. Med. jodb..
service for duty on return to Detroit, Mich., of Assistant
Surgeon Joseph B. Greene. June 9, 1897.
Hastings, Hill, Assistant Surgeon. Granted leave of ab-
sence for seven days from June 7, 1897. Leave of ab-
sence e.xtended for seven days from June 14, 1897.
Banks, C. E., Surgeon. To inspect service at Memphis,
Tenn.. St. Louis, Mo., Cairo, 111., Evansville, Ind., Louis-
ville, Ky.. and Pittsburgh. Pa.. June 5. 1897.
Peckhaji, C. T.. Passed Assistant Surgeon, and ELalloch,
P. C. Pa.ssed Assistant Surgeon. To report June 22.
1897, at bureau for examination for promotion. June
15, 1897.
Glennan, a. H.. Passed Assistant Surgeon. To inspect
Cape Charles Quarantine and vessels connected there-
with. June 14, 1897.
W.ASDIN. Eugene, Passed Assistant Surgeon. To proceed
to Detroit. Mich., for temporary duty. June 15, 1897.
Cobb. J. O.. Pa.ssed Assistant Surgeon. To proceed to St.
Louis. Mo., and assume temporary command of service.
June 19. 1897.
Stoner, J. B., Passed Assistant Surgeon. Granted leave
of absence for seven days from June 17. 1897.
Brown. B. W., Passed Assistant Surgeon. Granted leave
of absence for twenty days from June 28, 1897.
Boards Convened.
Board convened to meet in Washington. D. C. for physical
examination of Assistant Surgeon Emil Prochazka : Sur-
geon C. E. Banks (chairman) : Passed Assistant Surgeon
G. T. Vaughan; E. K. Spragce (recorder).
Board convened to meet in Washington. D. C. June 22,
1897, at 10 o'clock, .\. M.. for examination of ofRcei-s of
the service for promotion: Surgeon P. H. Bailhache
(chairman) ; Surgeon G. W. Stoner and Surgeon C. E.
Banks (recorder).
Death.
Surgeon W. H. H. HrTTON died at Detroit, Mich., June 14
1897.
Society Meetings for the Coming Week :
Monday. June JSth : Medical Society of the County of New
York; Cambridge. Massachusetts. Society for Medical
Improvement: Baltimore Medical Association.
Wednesd.^Y. t7»?ie SOtli : Auburn. N. Y.. City Medical As-
sociation ; Berkshire. Ma.ssachusetts, Distinct Medical
Society (PittsHeld).
Thtrsday. ./!(/(/ L'if : Brooklyn Surgical Society; Society
of Physicians of the Village of Canandaigua, N. Y. ;
Washington. Vermont. County Medical Society.
Friday. July 2d : Clinical Society of the New York Post-
gi-aduate Medical School and Hospital.
Satueday. July M : Miller's River, Massachusetts, Medical
Society.
girths, Slarriages, anb Beatbs.
Mai-ried.
Bill— Seabury.— In New York, on Wednesday. June
16th, Dr. Edmund Walleu Bill and Miss Susan Saltoustall
Seaburv.
Brennan— MOTT.— In New York, on Tuesday. June
15th. Mr. Isaac Bell Brennan and Miss Genevieve MoflPet
Mott, granddaughter of the late Dr. Valentine Mott.
Echols— Harrison.— In New Yoi-k. on Tuesday. June
15th, Professor William H. Echols, of the University of
Virginia, and Miss Elizabeth M. Harrison, daughter of Dr.
George Tucker Harrison.
Magltre— Bosset. — In Detroit, on Wednesday. June
16th. Dr. Francis J. W. Maguire and Miss Mignon E. Bos-
set.
Monks— Gardner. — In Boston, on Tuesday, June 15th,
Dr. George H. Monks and Miss Olga Gardner.
OPPENHEni— Elsberg. — In New York, on Tuesday,
June 15th, Dr. Nathan Oppenheim and Miss Bertha A.
Elsberg.
Severn — Tunison. — In Townsendville, N. Y.. on
Wednesday. June 16th. Dr. Frank W. Severn, of Farmer,
N. Y., and Miss Bertha Mae Tunison.
Tlrck — Paine.— In Dixon, Illinois, on Tlmrsday, June
10th. Dr. Fenton Benedict Turck, of Chicago, and Miss
Avis Paine, daughter of Dr. Henry E. Paine.
Died.
SETTLES. — In Grangeville, Louisiana, on Saturday,
e 12th, Dr. Silas S. Nettles, aged sixty-eight years.
Ni
June
Potter. — In Lancaster, N. Y., on Saturday, June 12th,
Dr. Samuel Potter.
IProftftthtgs of Sorittics.
NEW YOEK ACADEMY OF MEDICINE.
SECTIOSr in obstetrics and GTNJiCOLOGT.
Meeting of May S7, 1897.
Dr. Simon Mahx, Chairman.
Uterine Fihroma with Beginning Sarcomatous
Change. — Dr. M.\ky PrxxAii Jacob: presented a fibro-
ma removed by operation. ^licroscopical examination
showed beginning .sarcomatous degeneration. The pa-
tient had been eonscious of its presence for about a j'ear
previously, but it had caused little inconvenience until
last January, when she had had a profuse uterine haemor-
rhage. This had been controlled at first by tamponing
and curetting, and afterward by galvanism. Just before
this there had been slight fever. The current had been
applied within the uterus, and of a strength of fifty
milliamperes. Shortly after this there had been an-
other severe hfemorrhage, which had led to the removal
of the tumor by Dr. Polk. On section of the tumor after
its removal, a large area of softening had been discovered
in it. The mucosa of the uterine cavity was perfectly
smooth and free from necrosis, showing that the intra-
uterine use of galvanism had had nothing to do with the
necrosis of the tumor.
Malignant Disease of the Cervix Uteri; Vaginal
Hysterectomy with the Paquelin Cautery. — Dr. Her-
MAXX J. EoLDX presented a uterus that he had removed
by the vaginal route. It was the seat of a myoma, as well
as of a carcinoma: yet he thought it had been removed
radically and completely. Having separated the bladder
from the anterior surface of the uterus as far up as possi-
ble, lie had packed gauze in so as to keep the ureters out
of the way of injury. After two or three days, it had
been found that there was a leakage of urine. He felt
satisfied that there had been no injury of the bladder,
and that the left ureter had been injured by the heat of
the cautery. The specimen showed how completely the
carcinomatous uterus could be removed with the Paque-
lin cautery \vithout resort to ligatures or clamps. The
speaker was inclined to believe that this method offered
special advantages in cases, not of malignant disease of
the body, but of the cervix, and that the ultimate results
would ]U'ove to be far better from it.
Dr. W. Gill Wyi^ie said that he certainly would not
resort to the use of the cautery in cases of malignant dis-
ease of the uterus until every other method had been ex-
hausted. His objection was that one could never be
sure just how far-reaching would be the effect of the
cautery. This had been well exemplified in the ease
just reported by Dr. Boldt, in which the ureter had been
injured without the operator knowing it at the time.
June 26, 1897.1
PROCEEDINGS OF SOCIETIES.
877
The great secret of success in the treatment of cancer
was not to be found in the particular mode of operating,
but in operating early and radically. The use of the
cautery he considered a step backward. He would pre-
fer a saturated solution of chloride of zinc to the use of
the hot iron, if cauterization seemed to be indicated.
Dr. BoLDT said that it had been shown that in many
instances infection occurred during an operation, and
this was one reason for using the cautery. The usual
methods of operating for cancer of the cervix gave al-
most uniformly bad ultimate results, although undoubt-
edly the immediate results were fairly good. Chloride of
zinc was a useful application in " inoperable " cases,
but he doubted very much whether Trental Online as much could be ac-
complished with it as with the hot iron.
Malignant Adenoma of the Uterus. — Dr. Henrt C.
COK presented a uterus removed by operation from a
woman, forty years of age, who had enjoyed good gen-
eral health up to about eight months before. At this
time she had begun to have metrorrhagia, and soon after-
ward an irregular bloody discharge. He had curetted
her last January, and because of the soft, brainlike mate-
rial that had been removed he had insisted upon the
diagnosis of malignant disease. Microscopical examina-
tions on two different occasions had resulted in the re-
port that the growth was not malignant. Nevertheless,
on removing the uterus he had found a malignant
growth. Dr. Coe said that he had seen several of these
cases, all presenting a similar clinical history, and had
described them imder the name of "malignant adenoma."
He had found that the microscopical report was totally
unreliable in these cases. The prognosis was especially
favorable, and a prompt operation, in what might be
called the " pre-cancerous stage," gave very good results.
The occurrence of irregular hismorrhage, without foul
discharge, pain, or impairment of the general health,
should arouse suspicion, and when, on curetting, soft,
brainlike material was removed, the diagnosis was almost
certain.
A Calcareous Fibroid. — Dr. W. Gill Wylie pre-
sented a uterus and tumor that had been removed from
a woman, over sixty years of age, about a month before.
The chief symptom had been uterine haemorrhage. Ex-
amination of the tumor had revealed the presence of an
unusually large mass of firm, calcareous matter. She
had made a good recovery from the operation.
A Fibroid Undergoing Carcinomatous Degeneration.
— Dr. Wylie also presented a tumor, removed from a
woman, thirty-seven years of age, who had had scanty
and irregular menstruation, but no pain. The usual
rule was to let alone cases of fibromata if there were no
symptoms produced by the tumor, but he felt that if the
tumor was large — e. g., of the size of a cocoanut- — it was
better to remove it on account of the danger of its under-
going malignant degeneration. The condition of this
tumor showed the wisdom of this course, as it had already
undergone extensive carcinomatous change.
A Staflf for Packing Gauze into Cavities. — Dr. Phi-
lander A. Harris, of Paterson, N. J., exliibited a curved
metallic staff bearing some resemblance to a urethral
sound, but terminating at its distal end in a V-shaped ex-
tremity. This toothed extremity served to catch the
gauze and carry it easily into the cavity. It had proved
very useful in his hands, and had been termed by his as-
sistants a " packing staff."
Dr. BoLDT said that his experience with cases of
malignant adenoma was that, although at first they might
not give the picture of malignant disease under the mi-
croscope, they invariably did so subsequently, and the
patients always died in about eighteen months after
the occurrence of the hajmorrhages, unless operated
upon early. Personally, he would always rely more upon
the clinical than the microscopical diagnosis in cases in
which the bleeding recurred after a curetting.
Dr. A. E. Gallant spoke of three cases in which
haemorrhage had recurred after curetting. In these eases
the hemorrhage had been best controlled by the admin-
istration of iodide of potassium. Each of these patients
had given a more or less distinct history of syphilis. A
microscopist had diagnosticated one of the cases as ma-
lignant, and the uterus had been removed on the strength
of this, but no malignant disease had been found in it.
Dr. Coe said that malignant disease of the uterus
gave rise to one especially suspicious symptom — irregular
metrorrhagia — not menorrhagia.
Symphysiotomy. — Dr. Edward A. Ayers read a
paper on this subject. He said that as the mortality to
the mother was about one per cent, greater in selected
symphysiotomy cases than in those of induced premature
labor, and for the child, about twice as great, the decision
as to which operation should be done might well be left
to the parents. Last year he had reported five cases of
symphysiotomy, in four of which there had been no disa-
bility whatever following the operation. In the other
case, the division of a cicatricial ring in the vagina had
been followed by sloughing, communication with the
rectum, and infection of the operation wound. As a re-
sult of this, the patient had died from septic pneumonia.
He then reported three additional cases.
Dr. Ayers said that it was his custom to leave a strip
of gauze in the wound for drainage, and to retain a soft-
rubber catheter in the bladder for several days. Four
advantages were alleged for this method of operating —
viz.: 1. The hsemorrhage was readily controlled with the
thumb. 2. The integrity of the integument over the
joint allowed of greater stretching over the pubes with-
out laceration. 3. There was no exposure of the wound
to the air after the patient had been placed in bed, for
the labia closed the wound completely. 4. Drainage was
perfect, as the wound was at the base of the symphysis.
If the pelvis was left to itself after the operation, it tend-
ed to widen to the extent of about an inch. In two
cases he had used a device for conveniently holding the
pelvis and patient firmly, to which he had given the
name of " the symphysiotomy hammock."
Dr. Ayers closed his paper with a report of the record-
ed cases of traumatic separation of the pubes occurring
spontaneously, during labor, or in connection with vio-
lent efforts at extraction of the child.
Dr. W. Gill Wylie believed that to-day there shoidd
be very little risk from the induction of premature labor;
hence the comparison of symphysiotomy with the old
statistics of induced labor was hardly fair. The induc-
tion of premature labor was a very simple matter; the risk
was very slight to the mother and much less to the child
than formerly. For these reasons it seemed to him that
the selection between symphysiotomy and the induction
of premature labor should not be left to the parents. He
had met with two cases in which there had been trau-
matic separation of the symphysis. He had found the
symphysiotomy hammock exceedingly useful in the treat-
ment of these patients.
Dr. A. B. Tucker said that he had had two cases of
symphysiotomy, both in tenement houses. One patient
was an exceedingly fleshy woman, in whom the head had
not engaged after she had been in labor for twenty-four
878
MISCELLANY.
[N. T. Mkd. Joub.,
hours. He had done subcutaueoiis symphysiotomy on
her, and she had been able to do all her hard housework
since then. The second patient had been in labor from
Sunday to Thursday before he had seen her, and the
uterus was firmly contracted from the effects of ergot.
A good result had been obtained in this case also.
Dr. J. Alexander Brown, of Paterson, N. J., said
that he had had an opportunity of examining the pubic
joint in one case two years after the operation, and had
been able to satisfy himself that in tliis instance at least
true bony union had taken place. In this case there
had been no free htemorrhage from the venous plexus
behind the symphysis at the first symphysiotomy, but at
the second one the haemorrhage had been profuse. This
he explained by supposing that the plexus had been
caught in the firm, unyielding cicatricial tissue. The
speaker said that, so far as he knew, all operators had
secured fairly good fibrous union, no matter what method
of dressing or after-treatment they had employed.
Dr. CoE said that he had not been impressed very
favorably with symphysiotomy as an operation suitable
for private practice. As the object of symphysiotomy
was to secure a living child, he would prefer to take the
chances with a Cajsarean section. He had lost with
symphysiotomy one child out of three. It was to be in-
ferred that symphysiotomy was practically without mor-
tality, and that, as a rule, no great disability would fol-
low, but we could not hold out a very good prospect of a
living child, especially if the child was a large one.
Dr. C. A. VON Eamdohr said that symphysiotomy
was an excellent operation if performed by an expert,
but with an operator of less experience elective Caesarcan
section would probably be safer.
Dr. P. A. Harris said that symphysiotomy was cer-
tainly an operation for experts only. The os should be
fully dilated before it was done. He believed that many
children were born through an osseous birth canal whose
internal conjugate was three inches or less. The " ham-
mock " seemed to be an admirable device.
Dr. Robert A. Murray said that it was essential
that the cervix should be fully dilated, and it was not
necessary to wait long for this, as it could be readily
accomplished artificially. Having done this, it seemed
to him eminently proper that the obstetrician should in-
troduce his hand into the uterus and explore the pelvis
carefully, and so determine the degree of disproportion
existing between the maternal and foetal parts and the
method best suited for delivery.
Dr. Ayers said that it was only in a very small per-
centage of cases that one had an opportunity to elect
premature labor. The latest statistics seemed to show an
infantile mortality from induced premature labor nearly
double that of symphysiotomy, and a mortality for the
mother slightly in favor of symphysiotomy. While with
the various methods of after-treatment fair union of the
symphysis could be secured, it could be obtained with the
least discomfort by the use of his hammock. As regard-
ed the choice of the Cesarean section, he said that as the
maternal mortality was far better with Trental Indications symphysiotomy
than with the Cresarean section, he could not under-
stand Dr. Coe's preference.
Results from the Administration of Iron in a
readily Assimilated Form after Gynaecological Opera-
tions. — Dr. C. A. Von Eamdohr read a paper with this
title. (See page 858.)
Dr. W. Gill Wylie said that he had recently been
studying the effect of preparing the patients for opera-
tion by giving them meat juice and other concentrated
and partially digested foods, with a view to increasing
the quantity and quality of the blood. He was confident
that iron was also a useful remedy for such a purpose,
and he had for many years past been accustomed to use
it in combination with glycerin, as this seemed to act bet-
ter than the iron alone.
Dr. William Henry Porter said Buy Trental Online that there could
be no question about the utility of iron, both before and
after an operation. It certainly had a very decided
tendency to augment the quantity of haemoglobin and to
increase the number of the red blood-corpuscles. He had
come to believe that it mattered little what preparation
of iron we used, provided it was well tolerated by the
stomach. He believed that they all acted in the same
way — viz., they were acted upon by the acid of the gas-
tric juice and converted into the chloride, and this chlo-
ride was decomposed by the sulphur compounds. He had
been informed that there would soon be placed on the
market a concentrated solution of nucleo-albumin which
acted in the same way as the iron — i. e., the nucleo-albu-
min was decomposed, with the formation of a chloride.
It helped to satisfy the sulphur compounds which are
decomposing the natural nucleo-albumin of the food.
Dr. Mary Putnam Jacobi agreed with the last
speaker that all preparations of iron acted in the same
way. The effect of manganese did not seem to have been
exactly determined, and the action of pepto-mangan was
rather remarkable. With regard to the use of glycerin
preparations of iron, she had noticed that if patients
were given remedies made up with glycerin, they would
often suffer from a burning sensation in the stomach,
which rendered it necessary sometimes to suspend the
administration of the remedy. This was due to the os-
motic action of the glycerin on the miicosa. It should
teach us the importance of sufficiently diluting such a
preparation at the time of its ingestion.
Dr. R. A. Murray said that, while it might be ad-
vantageous to give iron in some cases prior to an opera-
tion, he certainly would not consider it good practice to
do so in cases of fibroma, for example, in which there
was the liability to much haemorrhage, for the iron would
certainly increase this liability. Another point in the
administration of iron was that it should always be given
largely diluted, in small doses, and at short intervals.
Dr. H. L. CoLLYER said that he had used iron a great
deal after operations. The particular preparation de-
scribed in the paper appeared to have a special action as a
blood-maker, apparently due to the manganese which it
contained.
Dr. VON Eamdohr said that one out of "twelve cases
had been a check case, the patient not being given any
iron after the operation. The blood counts in the check
patient had been about fifteen per cent, less than in the
others.
isf illang.
The Immorality of the Antivivisection' Movement. —
To the June number of the Open Court Dr. Paul Carus
contributes an article in which he states his views of the
subject as follows: It is not to be doubted, he says, that
the antivivisectionists are noble men and women pos-
sessed of the noblest of all virtues, compassion for the
suffering; but they lack the most essential of all virtues — -
namely, thought, discrimination, consideration of conse-
June 26, 1897.]
MISCELLANY.
870-
quences, a surveying of the situation, and a weighing
of the implications of the question as well as of the
results to which it leads.
The author wishes it understood that he sanctions all
aspirations which tend to alleviate suffering, in man
and in animals, not excluding even the insects and ver-
min which molest life. He condemns all contrivances
which involve unnecessary pain or produce suffering,
but, he says, for that reason, he would not demand that
we should not resist those creatures that are pestiferous
and obnoxious. There is no merit, he continues, in
sparing the life either of a tiger or of a louse; but it is
a vice to take delight in torturing a wild beast or in
prolonging the death-struggle of a fly.
Morality, says Dr. Carus, religiously speaking, con-
sists in doing the will of God, or simply in performing
the duties of life — that is to sa}', in achieving that which,
according to the nature of the universe in which we
live, raises us higher, renders us nobler, and extends the
sphere of our power. Immorality is all that which an-
tagonizes morality, and there can be no question that
self-indulgence is the main if not the sole cause of going
astray. It should be borne in mind, he continues, that
the moral man should never yield Trental Injection without previous de-
liberation to a sentiment or a passion of any kind, not
even to the gentlest or noblest, such as charity, compas-
sion, and love, for the former may be misplaced and the
latter may do more harm than good. Guard against
yielding to sentiment, he says, for that is self-indulgence
and will be productive of good only by haphazard.
The author feels that the antivivisection movement
is such a thoughtless yielding to sentiment. It is a noble
one, he says, and shows a gentle disposition of the heart,
but he doubts whether it is moral, whether it is right,
whether it leads mankind upward.
As to vivisection, he says, we all know that it is not
a pleasant duty of the physiologist, but it is an indis-
pensable task that must be done for the sake of investiga-
tion. It falls within the same category with all sacrifices.
Should science neglect to search for light in this most
important domain, the domain of life, its representatives
would be guilty of a gross neglect of duty. They would
be like generals who retreated before the enemy because
the enemy's bullets endangered the lives of their soldiers.
They would be like an officer in the fire department who,
inspired by the idea of not causing pain to anybody,
would recall his men from the burning building when
they ought to rescue its inmates, because the firemen
might blister their hands.
Vivisection may truly have, and frequently will have,
he thinks, a tendency to blunt the sentiments of the vivi-
sector; but so does dissection. Shall we, he asks, surren-
der dissection as an obligatory part of medical instruction
lest the moral sense of the student be shocked? Dr.
Carus states that there are a few quack schools of medi-
cine in this country which undertake to educate physi-
cians, but their degrees should not be recognized, for
they leave their graduates ignorant on one, perhaps on
several, most Order Trental important subjects. It is true enough, he
says, that the human body in its wretched nakedness is
subjected on the dissection table to most undignified
treatment, which is likely to make the student vulgar
and rude; but for that reason we can not abandon clis-
section. The right thing to do is to teach the student the
moral aspect of dissection and put him on his guard
against the demoralizing influence of the dissection table.
Do not cut him oft' from one of the best sources of in-
formation, but so strengthen his moral nerve that he may
hear the view of the Medusa without having his heart
petrified by the sight of her terribly ugly features.
The antivivisection movement might be excusable,
the author continues, if there were any valid arguments
to prove that vivisection was useless. But the very
opposite is the case. Innumerable discoveries of the
most beneficent kind have been made in experiments on
animals.
An antivivisectionist writes, the author goes on to
say, that he would rather die than purchase the pro-
longation of Ms life with the sacrifice of an innocent
animal, and he thinks the sentiment seems noble and
generous. But, he asks, should we not be ready to kill
a milUon rabbits if we can thereby save the life of one
child attacked with diphtheria? The question, he adds,
is not that of one child against a million rabbits, but
that of many millions of children of all the generations
to come against a few hundred rabbits; and not man
alone but the whole animal creation, too, is the gainer
by every progress of science.
Dr. Carus does not enter into a detailed discussion of
the antivivisection movement, but he says that many
publications of the antivivisectionists contain gross ex-
aggerations as to the number of the victims of vivisec-
tion and the cruelties to which the animals are exposed.
The truth is, he says, that all the great men who are
famous as clever vivisectors are as considerate as possible
and avoid all unnecessary suffering. It is of course not
exactly impossible that there are among the minor lights
of science men ruthless enough to delight in the cruelty
of their work, but it is very improbable. He believes
that it is painful to vivisectors to be reminded of the
fact that their subject is a living being; but whenever
they think of it, they can not help being touched by a
sentiment of compassion.
There is a great field, he says, for the humane societies,
and they can do a noble work by elevating mankind and
refining its sentiments, and also by protecting the dumb
creatures against savage masters; but, he adds, when they
begin to meddle with science and forbid the physiologist
to investigate life in the living animal, it is time to pro-
nounce the quousque.
Vivisection, Dr. Carus continues, if kept strictly
within the limits of its important purpose, is a moral ob-
ligation, and he who would hinder the physiologist in
the performance of his duties makes himself guilty of
immoral conduct; but any cruelty to animals — namely,
every lack of respect for life, every thoughtless or willful
infliction of pain, every delight taken in torturing, in-
juring, or destroying sentient beings — is a crime that
should be denounced and reprimanded and, if necessary,
checked by the power of law.
"Painful Paralysis of Young Children." — Dr. A.
Halipre {Normandie medicale, June 1, 1897) employs
this term as the title of a case which he himself seems to
have come to look upon as one of subluxation of the
head of the radius. He was called to see a girl baby,
sixteen months old, that had been attacked with " pa-
ralysis" of the right arm. The child was health)^ and
played with older children, who, on one occasion, han-
dled it rather roughly, for it began to cry. The mother
picked it up, thinking it was tired. However, on the
following morning it cried again on awakening, and
when the child was taken up it was noticed that the
right arm hung along the body. When the arm was
moved the child gave a sharp cry. Nothing peculiar
was observed in the other limbs.
880
MISCELLANY.
[N. Y. Med. Joue.,
On examining the child, M. Halipre found the arm
inert and slightly bent, and passive movements of the
arm seemed to cause great pain. There was no swelling
or any apparent deformity.
An examination of the articulations soon enabled
him to ascertain that the seat of the injury was the elbow.
All movements were made without any resistance being
perceptible, and they seemed to increase the pain singu-
larly. The condyles of the humerus were intact. The
relations of the articular surfaces were then examined,
and the movements of pronation and supination caused
the child to cry violently. The head of the radius was
easily felt, although the child was very fat. But sud-
denly, while he was executing these movements, a creak-
ing in the articulation was distinctly heard. From this
moment the child stopped crying and was able to use
the right arm as easily as the left. The creaking was
reproduced at different times, although the physician
was not able to ascertain its situation exactly.
It is probable, M. Halipre thinks, that the head of the
radius was slightly out of place. However, it did not
seem to have lost its gross relations; it did not protrude
behind, neither was it manifestly prominent in front.
Nevertheless, what led the author to think it was at
fault was the fact that at the moment when he tried to
determine its precise relations the creaking was produced
and recovery took place.
The author thinks that, in the presence of a case of
this kind, a diagnosis of " painful paralysis of young
children " is warranted, and it seems that the term is
used by some French writers to cover cases of sudden
loss of power in a hmb, with pain on passive motion


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