Sciatica.—Bryant.

Antipyrine Hypodermically for Sciatica.-.

233

From the beginning the hæmorrhage yielded to the treatment, consisting of the following:

Misce. Sig. To be given in teaspoonful doses every time the bowels moved, provided this did not occur oftener than once an hour at any time, and at least once in three hours.

Within the first month nearly all hæmorrhage had ceased, but an occasional blood-staining occurred for about six weeks.

She returned to her home about May first, and is regularly attending to her household duties with no return of her old difficulties, but is still suffering from an old chronic endometritis with anteflexion.

ANTIPYRINE HYPODERMICALLY FOR SCIATICA.

BY JOHN W. BRYANT, M. D., SPRINGFIELD, ILLS.
[House Surgeon Wabash Railway Hospital.]

On the 20th day of March, 1888, John H. Swords, of Custar Park, Ills., aged 32 years, presented himself at the Springfield, Ills., Wabash Hospital, suffering from sciatic pains which extended from the gluteal to the posterior tibial region.

Several months previous to this date he had been under treatment at our hospital for the same trouble, when we relied upon hypodermic injections of sulphate of morphine (guarded with atropia) to cover the pain, but under this treatment the patient lost his appetite, and also suffered from intense nausea.

Upon Mr. Swords's readmission, Dr. Bulkley, the surgeon in charge, instructed me to make a daily hypodermic injection (into the thigh, along the course of the sciatic nerve) of a solution five-grains of antipyrine.

There was almost immediate cessation of pain, after the first application of the needle. The patient was comfortable for fifteen to twenty hours; and his appetite, which was not good, rapidly improved. His rest at night became refreshing. The treatment was kept up for four or five days, when the patient made complaint that there was soreness from the punctures of the needle. Fearing abscesses, we omitted the operation for a day or two, when the cause of fear disappeared.

The nervous pain became more pronounced in the posterior-tibial region, which we followed up and brought under control by our line of treatment.

The third point of attack was in the gluteal region. We got less favorable results from our injections here; owing, it must be, to the thick muscular padding under which the pain was seated.

It was noticed that the deeper the needle was put, the more readily ease was brought about. Upon one or two occasions I directed the needle downreach the muscular tissue on account of the thickness of

ward, and failed to

I

the integument and fascia-scarcely any effect of the drug was perceptible.
was fortunate not to produce an abscess from the fact that I took great care
that the drug was thoroughly dissolved before making an injection.

After remaining under treatment for four weeks, the patient returned to his duties, not well, but much improved. We heard no more from him until he had been absent from the hospital for three weeks. At that time he wrote to us that he was getting along comfortably, and that he did not suffer any great pain-in fact, was almost well.

It might be well for me to say that I took no other precaution than to avoid puncturing the larger blood-vessels and bone-coverings when using the hypodermic needle.

DISLOCATION OF THE SPINE.

BY W. D. BIDWELL, A. M., M. D., (HARV) LEAVENWORTH, KANSAS.

April 30th, Mr. B—, aged 72 years and in good health, attempted to trim the branches of a tree, but stepped on one that was too weak to hold him, and fell eight feet, striking on his head and right shoulder and rolled over in a heap. A neighbor who was standing close by went to him and found him perfectly conscious, but unable to move his legs, and complaining of more or less numbness over the whole body. Half an hour after the accident he was carefully examined, with the following results:

Sensation of numbness everywhere, motion of arms impaired but not lost, pupils normal, tongue protruded all right, mucous râles audible throughout the room, pulse 81 intermitting every 20th beat, inability to move legs, does not feel severe pinching there, but Faradic current causes contractions of muscles of leg and the pain caused by it was accurately localized, lower end of last lumbar vertebra projecting one-half inch beyond sacrum.

May 1st the hands began to twitch, and temperature rose till at 5 P. M. the temperature was 104, respiration 40, and pulse 104; by 7 o'clock he was completely unconscious and died at 10:20 P. M.

An autopsy revealed a dislocation of the last lumbar vertebra from the sacrum, though the spinal cord was undoubtedly affected higher up by the violence of the fall.

ANTIPYRINE FOR GONORRHEA.-Thomas Linn, M. D., the Paris correspondent of the Philadelphia Medical Times, says that another proof of the extent to which antipyrine is invading medical practice is shown in the following solution which has been used in the Paris clinics with the greatest success in the treatment of both acute and chronic gonorrhoeas:

CORRESPONDENCE.

FOREIGN LETTER.

TRENTO, Austria, April 1, 1888. DEAR DR. LANPHEAR:-This Sunday evening finds us in the little Alpine town of Trent; the ancient stronghold of the Etruscans with its ruins of castle and towers. We are to spend the night here on our way over the mountains from Verona to Munich, so I will devote a part of the evening to writing of what I saw in ophthalmology after leaving Berlin.

Our last evening before leaving Berlin was pleasantly spent with Professor and Mrs. Hirschberg at their home in Karl Strasse. It was on the 8th of February that we took train for Halle, where we were again very pleasantly received by Prof. Alfred C. Graefe, the originator of antiseptic ophthalmology, and cousin to the celebrated Von Graefe. Mr. Alfred C. Graefe is Professor of Ophthalmology in the University of Halle. He has one of the finest ophthalmic cliniques in the world, and is one of the cleverest ophthalmologists I have ever met. Three days are most profitably and pleasantly spent with him. We see here many interesting cases, and even some new ones, two cases of diphtheritic conjunctivitis, a disease quite rare in America, one tuberculosis of conjunctiva, inoculated by the sputum of a husband dying of tuberculosis. This patient was a woman of about thirty-five, rosy, and, apart from the conjunctival affection, seemingly in perfect health. That it was tubercular conjunctivitis could not be doubted, the tubercular bacillus being present.

A peculiar kind of nystagmus, "Collier's," is seen here, caused from looking up while mining. Prof. Graefe is a pains-taking and careful observer, making drawings of almost every case. He and his assistant are at the present time using oyster shells for drawing the fundus of the eye, when they also have the prepared red paper for making similar drawings. A case of a piece of steel entering the eye, piercing cornea and lens and lodging in the macula lutea, was quite interesting from the fact that the piece could be easily seen sticking in the retina, and becoming encysted without giving rise to any inflammation, nor had it produced more than a slight opacity of cornea and lens although three weeks had elapsed since the injury. Prof. Graefe makes extraction of cataract with iridectomy "999 times out of a thousand;" he makes both his cut and iridectomy from below; his assistant usually cuts the iris. In making this operation he does not employ a speculum or fixation forcep; he has the lids held open by elevators and steadies the eye with a short, three-tined fork. He uses corrosive sublimate, one to five thousand, constantly poured over the eye during the entire operation. He tells me that out of 479 cases of extraction of cataract he has had but one case of suppuration. Prof. Graefe is the author of quite a clear, simple demonstrating ophthalmoscope. We also saw a case of suppuration, choroidal, of both eyes, total blindness, in a young woman of 29 years, from puerperal fever, seventh child. Prof. Graefe and his

assistant are giving considerable attention to bacteriology of the eye as well as to histological research. One wishing to make sections and study the normal histological structures as well as the pathological would do well to come here.

From Halle we take train for Leipzig, where I meet again my friend Dr. Otto Swartz, whom I first saw in London at Moorfield's and then again in Paris. Dr. Swartz is now located as oculist in Leipzig, and is making some very interesting experiments on the eyes of rabbits at the university here. He has now seven rabbits upon which he has made excision of the optic nerve for the purpose of studying the nerve-fibers of the retina. He wishes to demonstrate if there be more than one fibre to each nerve-cell of the ganglion. Dr. Swartz excises the optic nerve, then treats the eye antiseptically, one part to five thousand sublimate, twice a day. Some of the eyes are enucleated on the second, some on the third and others on the fourth day, and then sectious are made and fatty degenerations of fibers looked for. If there be some degenerations of fibers, he concludes that such fibers do not go to the cells. It is already known that there are more fibers than cells, but whether one cell has more than one fiber is a question. Dr. Swartz is a very conscientious, close observer, and we may expect something of some value from his investigations.

Prof. Coccius, of the Leipzig University, does not seem to fully appreciate the good from asepsis, much less antisepsis. For cataract he makes his cut downward and nearly always makes iridectomy, which he also makes from below.

From Leipzig we go on to Dresden. Here ophthalmology is at a discount and art reigns supreme; three days are delightfully spent in looking at the works of the old masters in one of the finest galleries of the world. The quaint city of Prague, with its many Dutch houses, is our next stopping-place. Here we find another shining light in ophthalmology, viz.: Prof. Sattler, of the Prague University. I find him at his private clinique, 49 Kurngasse. He gives me a hearty welcome, and says that he will have plenty to show me on the morrow, and that I should stay at least one week with him; but our time is limited and will only admit of a few days stay.

Prof. Sattler is doing considerable in bacteriology of the eye. He treats about five thousand patients a year, and makes about 190 cataract extractions annually. He usually extracts with iridectomy, and only makes the operation without in selected cases. He tells me that he occasionally washes out the anterior chamber with a borated solution after extraction. He says that many of his patients come from the country, and only come for the more important troubles of the eye, which accounts for the large number of operations to the number of patients treated. He makes about eight hundred operations a year. The two mornings that I was with him he made ten operations-seven for cataract. He removes the anterior capsule with the capsule forcep of his pattern. It is scarcely ever that he misses getting the capsule, which is a decided gain in the prevention of secondary cataract or capsular opacity, which so frequently results when decission only is made. He and the Professor of Physiology here are getting out a new test for color-blindness which they are to bring before the Heidelberg Congress this summer, and do not wish any publication made regarding the method until after the Congress; but I am sure that as soon as it is

generally known it will be introduced in the office of every oculist who appreciates the importance of making this test. The massage for the ripening of cataract is considerably used in Prof. Sattler's clinique.

Leaving Prague, we come on to Vienna where a week is apent with Profs. Fuchs and Stelwag. Prof. Fuchs was assistant here when I was in Vienna ten years ago. He now takes Prof. Arlt's place. He and Prof. Stelwag both make iridectomy in the extraction of cataract. Prof. S. gives little attention to antisepsis. In his operation of extraction of cataract I noticed that in some cases he left blood in the anterior chamber, and scarcely ever gave any attention to the clearing of any shreds or clots from the lips of the wound. I saw several of the cases in the wards after the operations, and the results were about what one might expect.

Professor Pulitzer tells me that he is now injecting pilocarpine in the middle ear for some forms of tympanitis, sclerosis, etc., with good results. He and Prof. Graefe both give private courses in otology. Vienna is undoubtedly the best place in the world to study affections of the ear, if not also of the throat and eye. We meet here in Vienna Dr. Color, the first to introduce cocaine. He tells me that he expects soon to locate in Chicago or Milwaukee, as oculist. But we must not tarry longer in Vienna. Our week being up, we start for Venice, where we glide about the old city for a few days, and then on to Sicily, visiting the many old ruins of basilicas and temples antedating the Christian era by more than six hundred years, and finally we wend our way back through Italy to the Alps, where we are now spending the night. To-morrow we are to go on to Munich and thence to Paris, stopping at several towns in Germany on our way, where I expect to see several of the more celebrated oculists of Europe.

We are to sail from Havre on the ship "Companye," French Line, April 21, and expect to reach Kansas City about the 1st of May.

Yours Very Truly,

FLAVEL B. TIFFANY.

SOCIETY PROCEEDINGS.

MISSOURI STATE MEDICAL ASSOCIATION.

The most successful meeting of the Medical Association of Missouri occurred April 17, 18 and 19, in Kansas City. There were nearly three hundred members in in attendance, those entitled to seats being as follows:

President, F. J. Lutz, St. Louis; Secretary, J. C. Mulhall, St. Louis; Vice-Presidents, T. C. Boulware, of Butler, T. B. Jackson, of Kansas City, J. R. Hall, of Marshall, W. B. Adams, of Montgomery City, and J. W. Heddens, of St. Joseph; Recording Secretary, John H. Duncan, of Kansas City; Corresponding Secretary, W. B. Evans, of Boonville; Treasurer, C. A. Thompson, of Jefferson City, and Drs. Z. T. Stanley, Laclede; J. L. Burke, Laclede; W. F. Gart, Knoxville; J. O. Wilkerson, Titusville; W. M. Lenox, Lake Springs; B. F. Wilson, Salisbury; L. J. Matthews, Carthage; Woodson Moss, Columbia; J B. Winn, Macon; A. Rhodes, Carthage; R. D Haire, Schell City; U. S. Wright, Fayette; W. W. Dougherty, Liberty; H. T. Garrett, Keytesville; C. T. Holland, Keytesville; R. B. Gladden, Purdy; R. L. John