Then having spoken of the labors of John Curry in the latter part of the last century in connection with the external use of cold water in fevers, and the recent revival of the practice by Brandt, of Stetin, he proceeded to give some statistics showing the decreased mortality since the cold bathing had come into use. At the Berlin Hospital from 1848 to 1867 there were treated 2228 cases of typhoid fever, with a mortality of eighteen per cent.; while from 1868 to 1881 there were 2000 cases and 267 deaths, a mortality of thirteen per cent. If from the number of fatal cases there were deducted sixty-four which died very shortly after admission, the mortality was only 10.5 per cent. In the Prussian army the mortality among typhoid fever patients from 1868 to 1874 amounted to fifteen per cent.; while during the last seven years, when the antipyretic treatment was practiced, it was only 9.7 per cent. At Basle the mortality had been reduced from 27.3 to 8.8 per cent., at Kiel from 15.4 to 3.1 per cent., and at Stetin from 25.6 to four per cent. Brandt had reported no less than 211 successive cases without a single death. Brandt's rule was to commence the full cold bath (the temperature of the water being at from 67° F. to 70° F.) as soon as the patient's temperature, taken in the rectum, went up to 102.2° F., and Dr. Peabody thought that the adoption of this practice could not be too strongly urged. At the New York Hospital he had had a rubber bath-tub placed on wheels for use in the wards, and his own results had been quite satisfactory, although his experience was limited. He had found the cold bath useful not only in reducing the temperature but in relieving stupor, insomnia, and failure of the heart's action, and in one instance he had seen well-marked pulmonary edema dissipated like magic by it. There was, perhaps, a greater tendency to relapse when the cold bath was used, but the relapses were not often of a serious character. It was contraindicated when there was intestinal hemorrhage, aphonia from ulceration of the glottis, and venous congestion from chronic bronchitis or emphysema. Cold sponging in many cases, he believed, was wholly inefficient in reducing the temperature. As to the use of drugs for this purpose, he was not an advocate of the measure, since he believed that the large and frequently repeated doses of such agents as quinine, kairin, and salicylic acid which were required would have an injurious effect upon the patient if maintained for any length of time. In regard to the various complications of typhoid fever he said that he would not have time to speak, but he was convinced that they would very rarely occur in cases where the patient was systematically subjected to the cold water bath.

DR. A. FLINT, JR., advocated, on theoretical grounds, the administration of fatty substances (such as cream and cod-liver oil), farinaceous articles, alcohol, and saccharine matters, especially glucose. After speaking at some length on the causation of animal heat, and expressing the opinion (derived particularly from experiments on the pedestrian, Weston, and on his own person) that the formation of water in the body from the union of oxygen and hydrogen was a most important factor in its production, he went on to say that in fevers there was an exaggeration of the normal process Since the fever fed on the tissues of the body, it followed that these tissues must suffer very greatly unless some other fuel could be furnished to feed the flames, and the question arose, how could this be sup

plied? The answer, he thought, was found in the administration to the patient of the class of articles of diet which have been mentioned, and in regard to alcohol, at least, it was already well known, he said, that the temperature in fevers was reduced by it. The President, DR. DETMOLD, remarked that in proposing, as a physiologist, to administer these hydrocarbons to typhoid - fever patients, Dr. Flint forgot that simply introducing them into the alimentary canal did not introduce them into the tissues. He had presupposed normal digestion, while in this disease, as was well known, digestion, assimilation, and nutrition were very greatly impaired, and, consequently, the fuel which was designed to feed the flames of the fever would lie inert in the intestinal tract and be discharged inert from it.

DR. E. G. JANEWAY said he feared that an erroneous impression might be derived from the statistics which Dr. Peabody had quoted in support of the advantages of the refrigeration treatment, since in Europe it was the practice to leave out of such statistics the records of all cases which proved fatal within a few hours after admission to the hospital; while this was not the case in this country. Again, in considering the high deathrate noted in the United States army, it was worthy of note that many of the cases were transported for a very long distance; it being a very common thing to bring patients in the second and third week of the disease all the way from Virginia to New York. Such circumstances as these ought always to be taken into consideration in the study of hospital statistics. Still another point. Liebermeister and others in their statistics made no reference whatever to the age of patients, while age, it was not to be forgotten, made an extremely great difference in the rate of mortality from typhoid fever. In the young the result was almost invariably favorable, but in the old, and, indeed, in all persons above the age of twenty, the disease was very much more serious. In the Mount Sinai Hospital, in which it had been noted by Dr. Peabody that the mortality was the smallest of any of the New York hospitals, the comparatively low death-rate was due, he believed, to the fact, which he had ascertained, that an unusually large proportion of children with the disease had been treated there. During an outbreak of typhoid fever a number of years ago at the Deaf and Dumb Asylum, he had treated fifty cases with only two deaths, a mortality of four per cent., and in another institution he had obtained about the same results. In these instances the small mortality was due, not to the treatment adopted, but to the fact that the disease prevailed among young subjects. At the same time he was himself a believer in the antipyretic treatment, though he thought that the mode of applying the cold water should be modified according to the circumstances and character of each particular case. In the division of Bellevue Hospital to which both he and Professor Flint were attached this had been the practice for a number of years. Dr. Janeway concluded with a few remarks on the subject of diet, in the course of which he said that he thought that the return to the use of solid food should be made with great care.

DR. A. FLINT, SR., said that there was only one point, and that not a very important one, in regard to which he differed from the author of the paper. This was as to the value of cold sponging. His observation had led him to believe that if properly carried out it was a very efficient method of reducing temperature,

though if it was not thoroughly performed it was of little use. He had also gone through the experience of Dr. Peabody with a portable bath-tub, but he had found the method extremely inconvenient, and also that, as a rule, all the advantages of the full bath could be obtained by sponging. In any case where sponging did not reduce the temperature as completely as was desired the end, he felt certain, could be attained by the use of the cold pack, the patient being wrapped in a sheet and kept thoroughly sprinkled. For several years he had pursued this plan with advantage in Bellevue Hospital, and consequently had long since dispensed with the cumbersome bath-tub. He agreed with Dr. Peabody in regard to the desirability of an early resort to the use of solid food, and thought that it was a good rule to allow the patient to have it as soon as he felt a desire for it. He did not believe that there was any specific for typhoid fever, and thought that each case ought to be treated according to the special characteristics which it manifested. In regard to the administration of alcohol, he said that he had passed through three different phases of opinion on the subject. When he first commenced the practice of medicine it was customary to starve fever patients as far as possible, and no alcohol whatever was allowed. Afterwards medical opinion went to the opposite extreme, and alcohol was given to excess, but still more recently there seemed to be a tendency, he thought, not to appreciate the advantages of the free use of alcohol in appropriate cases.

In bringing the discussion to a close DR. PEABODY said that there was an additional objection to the suggestion of Dr. Flint, Jr., and that was the difficulty that there would be in getting typhoid-fever patients to take sweet or greasy substances, since it was well known how hard it was to secure the taking of sufficient nourishment of a kind that was more agreeable to the sick. After replying to the criticisms of Dr. Janeway he remarked, in conclusion, that he did not doubt the efficacy of cold sponging if it was properly carried out, but the trouble was, according to his observation, that this was not done practically, as a rule, and hence he was still inclined to urge the use of the full cold bath as the most efficient means of reducing temperature in the average case of typhoid fever.

RHODE ISLAND MEDICAL SOCIETY.

QUARTERLY MEETING.

MARCH 20, 1884. Lyceum Hall, Providence. DR. N. O'D. PARKS read a paper on TOPICAL CARDIAC BLISTERING IN THE TREATMENT OF ACUTE RHEUMATISM,

and recited several illustrative cases.

CASE I. Mr. B. was treated for acute rheumatism by the administration of salicin, in scruple doses, with five grains of ammonia carbonate every three hours. Under this treatment he rapidly improved, and in ten days appeared to be convalescent, and resumed his ordinary pursuits. In a few days, however, a relapse was threatened, indicated by pain and swelling of the knee and tarsal joints and an endocardial murmur. A blister, five by six inches, was applied over the heart, with the happy effect of aborting the threatened relapse, all symptoms of which, including the endocardial

murmur, quickly disappeared. Urine and saliva became alkaline. No return of the malady.

CASE II. An old lady who, every winter, is a victim to so-called "rheumatic gout," which usually attacks each great toe in succession. On this occasion most of the joints of each foot and some joints of the upper extremities, including the metacarpo-phalangeal and phalangeal joints of both hands, were involved, with the usual accompaniment of great pain, swelling, and high fever. A blister was ordered over the heart, and the affected joints anointed with ol. gaultheria, which was also exhibited internally, in fifteen-drop doses, every two hours. In three days she was able to sit up, and in less than a fortnight was out driving in her buggy, handling the reins herself. No symptom of relapse. CASE III. Mrs. M., aged forty. Right toe and ankle-joints swollen and painful. Urine and saliva highly acid. Ordered ten grains of salicin and two and a half grains of ammonia carbonate, to be repeated hourly. Fly blister, four by five inches, over the heart. On the next day the left foot was attacked. Ordered salicin, fifteen grains, and ammonia carbonate, five grains, every two hours. Dressed the blistered surface with unguentum sabinæ. She did well for five days, when the right instep became swollen and painful. Blister over the heart repeated. The following day she felt much better. No pain. From this time convalescence was uninterrupted.

The history of several similar cases of acute rheumatism was given, the cure in each case being rapid and complete. The writer had tried all the modern methods of treating rheumatism, but none yielded such satisfactory results as followed the action of a blister over the heart combined with the administration of salicin or some of the salicyl compounds.

DR. ARIEL BALLOU had suffered from three attacks of rheumatic fever, and had found that a blister over the heart gave relief when the fever threatened to be high. He recommended the opium treatment in muscular rheumatism, as in his experience it tended to prevent a metastasis of the disease to the heart. The treatment of this disease has hitherto been largely empirical. The speaker had gathered eighty "sure cures" for rheumatism.

DR. HERBERT TERRY read a paper on

The

THE TREATMENT OF PUERPERAL FEVER, founded on personal observation of eleven cases. prevention of puerperal fever was briefly discussed. One of the most valuable prophylactic measures yet advocated is the production of a firm and continuous contraction of the uterus after the placenta is expelled. Ergot should be given in every case as soon as the after-birth is delivered, and for half an hour, at least, the hand should remain over the uterus, and any relaxation should be met by gently rubbing the uterus, cold to the abdomen, etc. After tonic contraction of the uterus is insured, and the patient thoroughly cleansed, a firm binder should be applied from the ensiform cartilage to the pubes. Ergot should be continued in smaller doses at least until the color has left the lochia.

Against vaginal douches during labor there is at least one theoretical objection. They wash away the mucus secreted during labor to aid in the passage of the head. A single injection, however, as labor begins may be advantageous.

Vaginal douches after confinement are unnecessary unless the lochia are offensive, and then only for the

sake of cleanliness. More attention might well be paid to the condition of the napkin, as offensive discharges appear to be often due to retaining a soiled napkin. In this connection favorable reference was made to Dr. Garrigues' recent paper advocating the use of a bandage composed of lint wrung out of a one to two thousand solution, of bichloride of mercury and covered with oiled muslin. Three times a day the bandage is renewed and genitals washed.

The indications for treatment in puerperal septicæmia are to keep the patient alive until the morbid process ends, and also to prevent any further absorption. For the latter purpose antiseptic intra-uterine douches are the most effectual means. When in doubt as to whether the disease is puerperal fever or milk fever, or as to the location of the point of absorption, it is a good rule to wash out the uterus without delay. If carefully done, the intra-uterine douche is as safe as the vaginal injection. The Davidson was preferred to the fountain syringe, because the direction and force of the stream are under more perfect control. The choice of a tube has to do with some of the dangers alleged against this treatment. It should be large enough to avoid entering a sinus or the Fallopian tubes, yet should not block up the os, and should be about twice the length of the ordinary vaginal nozzle. Some of the tubes used for this purpose are closed at the end, with several openings in the side directed outward and backward so that not only is the force of the stream diminished but it always flows towards the mouth of the womb. It seems important, however, that the fundus of the uterus as well as other portions should be well washed, and, to accomplish this, the hole in the end of the tube should be retained. As to antiseptics, carbolic acid may be employed in a strength of one to sixty, or even one to forty. A permaganate of potash solution of four grains to the ounce is valuable. Corrosive sublimate may be used in a solution of one to two thousand.

Alcohol, opium, quinine, digitalis, and the bromides are invaluable; but without the use of some germicide intra-uterine wash they do not promptly reduce the temperature or shorten the disease.

DR. H. G. MILLER read a brief paper on

BLEPHAROSPASM.

Although usually divided into three stages according to its degree, four varieties may more properly be recognized. The first is one of the slightest and least significant of the eye troubles for which patients seek advice. A simple spasmodic contraction of a few fibres of either the upper or lower portion of the orbicularis, and which the patient often refers to the eye-ball itself. It seems to occur most frequently in near-sighted per

sons.

The second form, nictitation, affects the muscles of both sides at the same time and consists in too frequent or too violent winking. This is most common in children, and is frequently thought to be a manifestation of chorea. Oftenest caused by hyperæmia of the lids or chronic papillary conjunctivitis. It seems to be frequently a reflex expression of fatigue, either of the eyes themselves or of some other portion of the organism. The excessive use of tea, coffee, and tobacco not unfrequently seem to be the exciting cause.

The third form is an exaggeration of the natural effort of the lids to protect the eyes from external in

jury. Photophobia, whether from hyperesthesia of the retina or more commonly from conjunctival and corneal affections, is the most common cause of this form. What at first is a mere voluntary or instinctive effort to shield the eye from harm becomes a spasmodic contraction of surprising force and indefinite duration. It even aggravates and increases the original disease, as well as interferes seriously with its proper treatment. The practiced fingers of the surgeon can almost always successfully cope with it; but to the friends to whom the details of treatment must generally be confided it presents an almost insuperable obstacle. Even when the diseased condition causing it is cured, the palpebral opening for a louger or shorter period is left smaller and narrower than before.

The fourth form is spasm of the orbicularis, usually on one side only, clonic in its character, sometimes un-complicated but often extending to all the muscles supplied by the facialis. In its slighter degrees, occurring frequently during conversation, it gives the patient the appearance of voluntarily adding a mysterious significance to his words, often mortifying to those so affected. In a higher degree the whole side of the face is drawn and distorted. This form is sometimes associated with tic douloureux and adds terror to an already terrible malady. Unlike the other forms which are reflex in character, this one may be of central origin. Cases were given illustrating each of the forms of the disease.

LOSS OF SIGHT FROM INJURY OF FACIAL NERVE.

DR. O'LEARY reported a case in which the sight of one eye was completely obliterated by injury of the facial nerve. The patient, while on picket duty, received a bullet wound over the eye, barely grazing the skin. DR. MILLER thought the loss of sight was a reflex effect from shock of the facialis.

DR. W. J. BURGE reported a case of

MALIGNANT DISEASE OF THE BLADDER,

and DR. CASWELL exhibited the specimen. There had been symptoms of vesical calculus, for which he was sounded without detecting a stone, though he passed a small one soon after leaving Dr. Caswell's office. The evacuating tube and a current of water would probably detect a stone in such a case better than an ordinary searcher. There was entire suppression of urine for four days before death. The growth extended across the bladder so as to close both ureters. The right kidney was atrophied, and the left with its ureter dilated. The tumor had the appearance of fibro-sarcoma.

EXHIBITION OF VARIOUS SPECIMENS.

DR. CASWELL exhibited six small calculi weighing together twenty-five grains, which he removed from the roof of a urinary fistula. They seemed to have formed in the passage.

DR. KEMP, of Lonsdale, exhibited a specimen of Aneurism of the Aorta with Cardiac Hypertrophy. DR. LLOYD MORTON reported a case of Oblique Fracture of the Femur through the trochanteric portion, and exhibited the specimen. There was only a ligamentous union, but the patient was able to walk.

DEATHS.

The President announced the death of DRS. T. W. PERRY and OTIS BULLOCK. A committee consisting