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NEW ENGLAND MEDICAL MONTHLY.

NEW ENGLAND
MEDICAL MONTHLY.

W. C. WILE, A. M., M. D., - EDITOR.
Danbury, Conn.

ASSOCIATE EDITORS:

appreciation. To the contributors to the last volume we extend our most cordial thanks, and ask that in the future they will continue to make the MONTHLY, with its large circulation, the medium of presenting their ideas, experiences and discussions to the pro

I. N. LOVE, M. D., St. Louis, Mo.
Junk J. JE, M. D., Portsmouta, NH
L. S. MCMURTRY, M. D., Danville, Ky.ession. They will have as an intelligent
MAX J. STERN, M. D., Philadelphia, Pa.
A. M. OWEN, M. D., Evansve, ind.
ROBERT T. MORRIS, M. D., N. Y. City.
W.F.HUTCHINSON, M.D., Providence, R.I.
GUSTAVUS ELIOT, M. D., New Haven, Ct.

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an audience as does any Medical Journal in the United States, and nearly as large.

To our staff who have so ably seconded us in our efforts, we thank with all our hearts and pronounce our paternal benediction that its ranks may be unbroken during the year and they may enjoy, health and happiness.

To our enemies we would suggest that they subscribe for the MONTHLY, carefully scan its pages and become its friends. Price $2.00 per annum in ad

vance.

The gentlemen who have so liberally extended to us their advertising patronage we thank, and give them credit for using the columns of an active and wide-awake Journal for business purposes. The larger the patronage of these houses the better the evidence of

the value of its large subscription list, its influence and popularity.

COMING

Now

leading topics in a free and easily NOW

digestible form, just the shape for the busy, active doctor. That we are proud of the volume, is quite natural, but the pride is born of an ever increasing interest in the MONTHLY by the profession, especially of the New England States, and constantly enlarging subscription list, which marks that

SESSIONS

IN THE MEDICAL COLLEGES. OW that the medical colleges are about to commence their annual sessions, the profession are scaning closely the catalogues for the necessary information, in order that they may intelligently place their students in those schools which are found to give the best education.

The time has passed when a proceptor will send a young man contemplating

the profession of medicine as his life long vocation, to any college which happens handy or has low fees. His own experience has shown the fallacy of such medical education, and he wants his student to get the very best advantages which the colleges afford regardless of price or location.

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We are glad to note that many of the colleges have raised the standard this year, demanding a preliminary examination, three year's course stricter attendance upon the lectures and clinics. The only way, outside of State Boards of Examination, to force colleges to raise the standard, is for the profession to refuse to send their students to others than those who adopt the highest standards, and in doing this they will put an effectual stop to the usual practice of graduating students who are inadequately educated. A strong pull, a long pull and a pull all together will right the great evil which so severely menaces the practice of medicine.

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URETHRAL ELECTROLYSIS. UR readers will be glad to have so important a matter as the use of electricity in surgery, and especially in the matter of urethral stricture, completely studied and reported upon by consistent observers. It has done so much, and been so uniformly successful in the hands of its friends, especially in those of electrical experts, that surgeons at large have begun to accord the operation of urethral electrolysis a place in the classics. Statistics have been collected, chiefly by Newman of New York, wherein the results of several hundred cases have been formulated, and the outcome is excellent.

Hutchinson, of Providence, whose authority in electro-surgery is undoubted, reports a succession of cures, and our English and French confreres are rapidly endorsing the method.

But so radical a change in time honored surgery must needs meet opposition; exactly what would be calculated to bring it out clearly, provided it was a fair fight; which is what its supporters are quite ready for. Fair play is not what is intended, however, by certain persons who attack it fiercely, and who are quite unqualified by electrical study to do it justly. We predicted a year ago, that this novel operation would find its staunchest supporters among general surgeons who appreciated the uncertainty paning urethral interference by present means, and its most violent enemies among specialists, so called genitourinary surgeons.

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The main difficulties they seem to labor under are lack of knowledge of technique and misapprehension of what a cure of stricture is. We refer, in these remarks, to statements in the number of the "Journal of the American Medical Association for Aug. 11th of this year, pages 194 and 195, where the writer, Dr. Thomas of Pittsburg, speaking for himself and "the most expert genitourinary surgeons," says that they have "failed, after honest work, in deriving any good results from electrolysis" in this connection. But the doctor condemns himself as ignorant of technique when he speaks of treating a patient two months and leaving him with a severe urethral inflammation and unrelieved stricture. Such results never

21

NEW ENGLAND MEDICAL MONTHLY.

follow the use of electrical bougies in expert hands.

As to the question of cure, it is enough when a patient who has long patient who has long been a martyr to difficult and abnormal

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This method now stands so well be

fore the profession at large, that such spiteful attacks as the one to which we have referred, only serve to show the incompetency of the writer to form fair judgement, and perhaps to induce others to investigate the new method who are by no means content with the poor results of the old ones.

We repeat that electro-surgery needs for its highest development an amount of careful training in electrical theory and manual dexterity in practice, that come only to an expert; but this operation is now being successfully performed by general surgeons who did not give it up because they failed with one or two cases. If Dr. Thomas had practiced with electrolytic needles long enough to acquire a competent knowledge of a galvanic battery before attempting urethral work, his enthusiasm might have continued until to-day and have been steadily on the increase. CONGRESS OF AMERICAN PHY

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thing of the past. As our readers will know this Congress is composed of all of the special medical and surgical societies in the United States, and is to

meet in triennial convention in the City of Washington."

Most of these special societies have been organized since the bolt of the New York State Medical Society a few years ago over the Code Question, and it was supposed that they would take the place of the various sections of the American Medical Association. This result was not achieved, owing to the failure of a number of gentlemen on the Atlantic seaboard to control the

International Medical Congress which was so successfully held in Washington. They did all they could to keep prominent members of the profession abroad from coming last year by promising that there should be another congress held this year, and so the programme was carried out. The few gentlemen from abroad, (could be counted on the fingers of the hands) came, and the societies assembled, not in great numbers, but sufficient to make a respectable showing, but nothing like the great attendance at the last International. Dr. Billings, an officer in the Medical Department in the United States Army and chief kicker against the International was elected President and had the poor taste to say in his opening address that, "The prominent characteristic of the great majority of the societies composing this Congress is that their members have, as a rule, been chosen because they have either made some valuable contribution to medical literature, or have, in some way, rendered aid to the profession; in other words, they are supposed to be men whose labor and thought have not been

confined to their own interests, or to those of their own patients. It may, therefore, be assumed 'that you are all interested in medical science, not merely as a means of giving new modes of diagnosis or of treatment, but also for its own sake, for the sake of knowing, for the pleasure of investigation, and in the hope of helping others, and that, while the majority have devoted themselves more or less to special branches, they have not, in so doing, lost interest in what may be for the general good of the whole profession." Thereby by in ference leading his hearers to believe or think that no other society can thus have this "Prominent characteristic." But this Dr. Billings has so often, in his public addresses, insulted the rank and file of the profession of America that

no one notices what he does or does not

in the existence of a phlegmon of the large ligament, and there is no proof of it in medical literature. The symptoms attributed to it are those that belong to what he has for the last ten years called adeno-juxta-pubian phlegmon. If such symptoms have been ascribed to a phlegmon of the large ligament it was because sufficient attention had not been given to the anatomical arrangement of the membranes in general that are destined to protect the internal organs of generation. M. Guerin enters into some anatomical details and shows that

the large ligaments constitute a cell perfectly closed in on all sides by aroneuroses. It is therefore impossible to admit that any pus that might form within it should be able to spread into the neighborhood and attain to the deepest part of the abdominal wall. Besides, this cavity of the large ligaments is so small and contains so little

say. We maintain the assertion, howev-cellular tissue, that were any pus to er, that the "Congress" of to-day will not produce the amount of original and instructive matter which the International did if the reprinted reports are to be relied upon. Besides a banquet at $20 a plate for a select few, there was no social feature at the meeting, and the druggists and instrument makers, the doctors' best friends, and allies were given to understand that none need apply-none need exhibit.

From a scientific point of view the Congress was a snccess, very valuable papers being read and discussion following.

CORRESPONDENCE.

OUR PARIS LETTER. Editor New England Medical Monthly:

PHLEGMON OF LARGE LIGAMENT.

At the meeting, on the 10th of May, of the Academic de Medecine, M. A. Guerin declared that he did not believe

form there, it could be but a very small abscess; the pus would be closely shut in and could not possibly get outside. If such a thing has ever occurred, the pus must have burst through the fibrous barrier and spread out everywhere, above and below, beneath the peritoneum. It is then a sub-peritoneal phlegmon and not a phlegmon of the large ligament. M. Guerin has long since described another malady, that has been mistaken for a phlegmon of the large ligament, and which he calls adeno-justa-pubian phlegmon. The sub-pubian ganglia receive the lymphatics proceeding from the web that cover the neck of the uterus, and it is astonishing that inflammation of these ganglia is not more frequent. Two autopsies have proved that M. Guerin was right in establishing the above distinction. The formation of the tumor may be preceded by the production of simple lymphatic cords surrounded by inflamed cellular tissue.

The tumor

adheres to the side of the matrix. M. Sappey observes that M. Guerin's hypothesis is based on an anatomical error. The discussion is to be continued at another meeting.

On the same occasion M. Panas offered to the academy a bronze medaillion of Jacques Daviel, the inventor of the operation of cataract by extraction, and distributed to the members a biographical memoire of that illustrious surgeon, informing them that a subscription is being raised to erect a monument to his memory at his birth place, La Baare, in Normandy.

M. Dujardin-Beaumetz presents on the part of M. Jacobini, of Naples, an instrument for injecting gases or liquids into different cavities of the system.

M. Haltenhoff, of Geveva, communicates his observations on paralysing vertigo or Gerliers' disease. Since 1884 M. Haltenhoff has observed several patients attacked by paralysis, with cramps starting from the back of neck, accompanied by falling of the eye-lids, with vertigo and paralysis of different parts of the body. Sometimes the patient complains of dysphagia. There is no fever. Sensibility of the skin may be affected at different parts of the body. There is sometimes difficulty of speech, shortening of the field of vision, and color blindness. Change of residence, such as stay in hospital, causes the disappearance of these symptoms; but they often recur when the patients resume their occupations. The cause of paralyzing verito has not been explained. M. Gerlier, who described this malady in 1884, attributed it to the emanations from stables that had been long uninhabited. It is to be remarked that most of the patients observed by M. Haltenhoff lived in stables.

M. Barie published in the Gazette des Hopitaux of May the 17th, an interesting communication on zona in tuberculous patients. The author observes that chronic tuberculous subjects often suffer from various obstinate neuralgias,

sometimes accompanied by trophic disorders, erythemas (Perroud), and muscular atrophies (Landouzy), Zona.

This last affection is very rare, only twenty-five cases having been recorded, from the observation of which may be deduced:

1st. That zona in tuberculosis is extremely rare.

2nd. That it is generally localized on the walls of the thoracic cavity.

M. Barie has observed only three cases, in which the eruption was seated in the perineo-genital region. Zoster herpes supervened without appreciable cause. As usual the lesion was unilateral, occupying one-half of the perineo-anal region, of the perineum, of the scrotum. The eruption was strictly limited to the course of three of the principal collateral branches of the sacrum complex.

By its morphological character and its seat, the eruption may be confounded with other dermopathies of the region; anal herpes, neuralgic herpes of the genital organs and recurring propenital herpes, but these affections are easily distinguishable by the origin and symptoms that characterize them.

After passing in review the different causes more or less uncertain assigned to the nervous affections to which the tuberculous are subject, the author thinks that the origin may be looked for in the nature itself of tuberculosis. These nervous affections have been abserved in another infectious malady, enteric fever, and are evidently connected with modifications of the peripheral nervous system.

M. Barie concluded, from the facts. already published and from his personal observations:

1st, That zona is to be counted among the nervous affections in chronic pulmonary tuberculosis, but that it is a rare complication;

2nd. That it is generally located within the thoracic cavity, but may be met with elsewhere, on the neck, face,

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