for the past twenty years, and I am constrained to speak of the vast improvement manifest in every department of that important institution. The order and cleanliness of the wards, the efficiency of the attendants, the skill and faithfulness of the physicians, and the courtesy of all concerned, are fit subjects for praise and pride. But above all the admirable work of the trained nurses should be recognized and commended. These refined ladies, full of enthusiasm and devotion, and ably prepared for their responsible duties, are angels of mercy to the sick and suffering, and their tender regard for the patients is itself a healing balm. . . There was a time when thoughts of Bellevue were not savory, but now I know no place where I should rather be an invalid to receive the wise and gentle attention of experienced and sympathetic guard

ians.

Correspondence.

THE TREATMENT OF HIP-JOINT DISEASE. EXTENSION BETTER THAN EXCISION.

-

MR. EDITOR, I was much interested in the discussion in your journal upon excision of the head of the femur in hip-joint disease. I must acknowledge, however, that I was somewhat surprised to find that the operation was advocated and so often practiced as was represented during the discussion.

I had supposed that since my introduction of the treatment of diseases of the joints by elastic or continued extension that there had been no occasion for excision of the head of the femur.

As to the frequency of this disease of the hip proving fatal, at the present time, it was entirely new to me. It certainly is at variance with my experience in the treatment of such cases, so much so as to render it difficult for me to realize its possibility, taking it for granted that the treatment was by the present received mode, both in this country and in Europe.

Some thirty years since I began the treatment of joint diseases by continued extension, and between the years 1850 and 1860 published in the medical journals many papers upon the subject, endeavoring to so bring my method of treatment before the profession that they could understand its principles, and thus be enabled to apply the treatment correctly, and obtain the favorable results that had followed it in my hands.

In giving the results of the treatment of hip disease, as practiced by me for so many years, I am embarrassed by the feeling that my statements will be distrusted by the gentlemen engaged in the discussion, when they compare them with their experience. I can say, without equivocation, that among the vast numbers that have been under my care, not one has succumbed to the disease; and that in those cases that came under my care in the early stages they recovered without deformity or lameness. After the head of the bone has been partially destroyed, it cannot be expected that the treatment will restore it, although the disease was arrested at once by the treatment.

This mode was so fully described in my work entitled Conservative Surgery, that it would seem superfluous to describe it here, yet there are some points that appear not well understood, or at least not fully appreciated, that are essential to good success.

Again there is an important, I may say an all important, difference in the perineal band used by me and other instruments. In all the splints that have come under my observation, they are made with only one band, and that for extension alone, whereas in my instruments there is an outside inelastic band, which, after the extension is made and the outside inelastic band is buckled tight, prevents the retraction or shortening of the limb either by the contraction of the muscles or by the weight of the body. When the short splint is used the recovery, as a rule, is very much like that without treatment, except, perhaps, the position of the limb and the freedom from suffering.

Now if you want a speedy, and at the same time a perfect recovery, perfect considering the freedom from the loss of parts when the treatment commences, you must not allow the head of the bone to impinge upon the upper part of the acetabulum, as this contact is liable, if it remains for any length of time, to destroy all that has been gained before. The bony parts involved can never heal so long as they come in contact, as it is this pressure that keeps up the destruction of the parts. Some of the speakers advised free opening of the abscesses.

Before the adoption of my treatment I had seen abscesses opened, followed by hectic fever, night sweats, and death. Since the adoption of my plan of treatment there has never been an unpleasant symptom following the opening of an abscess, however reduced the patient or unpromising the constitution.

After opening the abscess and discharging the contents I have washed it out with warm water, syringing it two or three times, then injecting chlorine water two or three times according to the sensibility of the sac. I introduce a small tent to keep an opening, and apply a compress. In this way the walls of the sac unite, leaving only a sinus for the discharge of the pus from the diseased bone. This reduces the discharge to a very small quantity, so small as not to affect the health or retard the recovery.

In this connection allow me to ask what will destroy the patient? He can eat, drink, and sleep well, and have not enough discharge to affect his health.

Some spoke of auchylosis being the most favorable result, and the one to be sought for in treatment.

So far as my experience goes this never takes place between ulcerated surfaces of bone. A fixed state of the joint caused by a shortening of all the soft parts connected with the femur at the joint is what is generally termed anchylosis. I have yet to see a case

That the decreased frequency of typhoid was entirely independent of the malarial invasion now is quite

clear.

The return of typhoid is also not dependent upon the decrease of malarial diseases, as we see it side by side with all varieties of ague, not only where the latter has longest remained as one of the regular diseases of the region, but also where malarial diseases are entering territory hitherto never occupied, so far as human knowledge can determine, by any form of ague; and also where having existed quietly for several years malarial diseases become epidemic, leaving but a small percentage of the people unaffected. The subject is too complicated to discuss here, but the increased frequency of both malarial diseases and typhoid fever are interesting features.

HALLUCINATIONS FROM SALICINE.

A WRITER in the Australasian Medical Gazette (November, 1883) gives an account of some mental phenomena following large doses of salicine, which, though not entirely unknown heretofore, are sufficiently unusual to be interesting, and were, moreover, recorded as the observations of a medical man on his own person. A peculiarity of this case was the perception of a number of musical airs, in a regularly recurring order, but having no objective reality. The writer says:

"On July 9th I took to my bed with, as I thought, a slight attack of acute rheumatism. I treated myself (not liking to trouble Dr. -) with alkalies, lemons, and entire abstinence from alcohol. I remained in bed for all the week, and, not getting much better, commenced to get very anxious about my practice, and determined to try salicine in large doses, such as I have frequently seen mentioned in the Lancet, although I had never given it quite so heroically to patients. Accordingly, on Sunday, July 15th, I took four doses, at intervals of only two hours, of forty grains of salicine in each dose. It made me drowsy, and I slept most of the afternoon. Just after dark I awoke, and found myself apparently mad, and yet conscious of my own madness. There seemed to be all sorts of people about me and in the room, and yet I was conscious that they were fanciful creations of the mind, and had no fear or dread of them. They were all, so far as I can recollect, human in appearance, and all strangers to me. The music had now commenced, and it was so natural that I said to my wife that I had never heard (it was Sunday night) the church music so far off before. The music gradually got louder and more defined, until it settled down to one perpetual repetition in regular order- much after the fashion of a musical box of a certain six airs, one of which had a choral accompaniment, the human voices being perfectly distinct and audible. Only one of the airs was known to me, namely, Scenes that are Brightest,' from Maritana. All the others were strange. I am not a musician, but I know enough to be sure that the time kept was perfect. This lasted for forty-eight hours, and I was nearly mad in reality at the end of that time from the constant apparent noise and din. The chloral did me some good, but immediately on awakening from a deep chloral sleep my band, as I got to call it, would begin again. It gradually wore away on the third day, but for some days afterwards I occasionally heard one

of the tunes, and perhaps part of another. I was, throughout, much interested in all the symptoms, and recognized from the first what had happened, and that the salicine was to blame, but I was uncertain how the case might end. I have had a long and slow convalescence, suffering a great deal from occasional pains and great weakness, and am now slowly coming round."

PAROVARIAN CYSTS.

DR. GOODELL recently exhibited two cysts of the parovarium before the Obstetrical Society of Philadelphia (Medical and Surgical Reporter, January 5th). Both patients got well; he indeed had never lost a patient from whom he had removed a parovarian cyst. In both cases a correct diagnosis was made previous to the operation. Regarding the differences between this tumor and the cyst of the ovary, he remarked that one interesting diagnostic point was the complete absence of the facies ovariana. The color in the cheeks was good, and the countenance was free from the anxious expression present in cases of ovarian tumor. One tumor had existed for ten years, the other for one. Another important point in the differential diagnosis is not only the flaccidity of the tumor but its variable degrees of flaccidity. Upon inspection, it is seen to reach to the sternum, aud seems to occupy a large portion of the abdominal cavity, but where the hands are placed upon its sternal edge it can be compressed to the level of the umbilicus. An ovarian cyst, on the contrary, is hard and uncompressible. Exceptions to this rule are very rare, that is, either a tense parovarian cyst or a flaccid ovarian one. A third important distinguishing point is the long time ten years in one case - which the tumor existed, and further, without marked deterioration of health. After being tapped these tumors usually refill, but occasionally they do not, and a cure is thus brought about. The fluid withdrawn has been in every case limpid and generally colorless, but it has sometimes had in his experience an emerald tint. These tumors are generally free from serious adhesions, but if, in an operation for the removal of one, adhesions should exist where for any reason their forcible separation would be unadvisable, or the cyst were intra-ligamentous, he would not hesitate to leave the adherent portion of the cyst wall, or the whole cyst itself, after making a big hole in it, as the fluid it secretes is bland and unirritating to the peritonæum.

Any one examining one of these cysts for the first time would consider it to be of ovarian origin, for it is only by patient search that the ovary can be found spread out over the cyst wall. The microscope will decide with certainty in any otherwise doubtful case. The tumor is covered with a beautiful net-work of veins.

When a cyst of the parovarium exists on one side, the ovary of the opposite side is usually found to be diseased and should be removed. In these cases the remaining ovary was seen to be enlarged, and the site of a small ruptured cyst was pointed out. The Fallopian tube was also enlarged, and the terminal vesicle of the Fallopian tube, or the hydatid of Morgagni, was enlarged and cystic. This hydatid sometimes attains the size of an orange, and often ruptures spontaneously without any bad effects. A few years ago one of these small cysts ruptured while he was making an examination of the patient to ascertain its character.

Deaths reported 2574 (no reports from Cincinnati and Buffalo) under five years of age, 840: principal infectious diseases (small-pox, measles, diphtheria and croup, whoopingcough, erysipelas, fevers, and diarrhoeal diseases) 430, consumption 432, lung diseases 407, diphtheria and croup 164, scarlet fever 66, typhoid fever 40, measles 38, diarrhoeal diseases 34, malarial fever 25, whooping-cough 21, puerperal fever 19, cerebro-spinal meningitis 11, erysipelas nine, small-pox two, yellow fever one. From measles, District of Columbia 13, Baltimore 11, New York five, Pittsburg three, Brooklyn and Chicago two each, Charleston and Nashville one each. From diarrheal diseases, New York eight, Boston six, New Orleans five, Philadelphia four, Baltimore and Charleston two each, Brooklyn, District of Columbia, Providence, New Haven, Cambridge, Lynn, Springfield, and North Adams one each. From malarial fever, New York and St. Louis seven each, New Orleans five, Brooklyn, Chicago, and Baltimore two each. From whooping-cough, New York six, District of Columbia three, Brooklyn, New Orleans, and Cambridge two each, Philadelphia, Chicago,__Boston, Gloucester, North Adams, and Arlington one each. From puerperal fever, Boston and Milwaukee four each, St. Louis three, Philadelphia, Chicago, Baltimore, and Charleston two each, New York one. From cerebro-spinal meningitis, New York three, Chicago and District of Columbia two each, Philadelphia, Boston, Milwaukee, North Adams, and Dedham one each. From erysipelas, New York three, Philadelphia two, Brooklyn, Chicago, Boston, and Gloucester one each. From small-pox, Philadelphia and St. Louis one each. From yellow fever, New York

one.

One case of small-pox was reported in Holyoke; scarlet fever 41, diphtheria 30, typhoid fever 14, and measles three in Boston.

In 92 cities and towns of Massachusetts, with an estimated population of 1,285,557 (estimated population of the State

1,922,530), the total death-rate for the week was 20.00 against 18.00 and 17.41 for the previous two weeks.

In the 28 greater towns of England and Wales, with an estimated population of 8,620,975, for the week ending January 5th, the death-rate was 22.2. Deaths reported 3731 acute diseases of the respiratory organs (London) 387, scarlet fever 112, measles 100, whooping-cough 103, fever 51, diphtheria 30, smallpox (Birmingham eight, Sunderland seven, London and Liverpool six each, Manchester one) 28. The death-rates ranged from 12.1 in Norwich to 31.3 in Cardiff; Bradford 17.7; Nottingham 19.1; London 21.6; Birmingham 21.9; Sheffield 23.8; Liverpool 23.9; Leeds 26.5; Manchester 29.1. In Edinburgh 21.8; Glasgow 29; Dublin 28.7.

For the week ending December 29th, in 162 German cities and towns, with an estimated population of 8,472,338, the death rate was 24. Deaths reported 3912; under five years of age, 1812; consumption 542, lung diseases 447, diphtheria and croup 281, diarrhoeal diseases 118, scarlet fever 66, whooping-cough 60, measles and rötheln 58, typhoid fever 53, puerperal fever 25, small-pox (Schwerin one) one. The death-rates ranged from 12.8 in Wiesbaden to 32.1 in Leipzig; Königsberg 26.6; Breslau 30.4; Munich 25.8; Dresden 22; Berlin 23.5; Hamburg 29.5; Cologne 18.9; Frankfort a. M. 15.2; Strasburg 29.7.

For the week ending January 5th, in the Swiss towns, there were 26 deaths from lung diseases, consumption 25, diphtheria and croup 13, diarrhoeal diseases seven, whooping cough four, typhoid fever four, scarlet fever three, puerperal fever three, measles one, erysipelas one. The death-rates were, at Geneva 19.5; Zurich 22; Basle 16.7; Berne 29.4.

The meteorological record for the week ending January 19th, in Boston, was as follows, according to observations furnished by Sergeant O. B. Cole, of the United States Signal Corps: