THE Medical Bulletin. JOHN V. SHOEMAKER, A.M., M.D., Editor. A. L. HUMMEL, M.D., Business Manager. Philadelphia, Jan. 1888. MEDICAL JURISPRUDENCE. are such that giving medical testimony to state what you don't know as what you do know. Do not disgrace science by assuming anything." THE exigencies of the times are dicine art been cat's blood or dog's blood or goats the professions of law and medicine are becoming largely correlative. The responsibility thrust upon the medical practitioner in cases where human life, liberty, and honor are at stake, has become so vital that no man with a conscience can carry it lightly. Daily demands are made for medical authority to decide points which lie in the domain of science, and are accessible only with difficulty. In the first place, law expects too much of medicine. It is with profound surprise, not unmixed with contempt, that the lawyer learns how narrow after all are the limits of exact science. The prosecutor in a murder trial is disappointed, if not disgusted, when he finds. that the most eminent microscopist cannot say whether or not the soiled garments paraded as evidence of guilt, are stained with human blood. It was thought that point could easily be settled by an appeal to science, and the weak-minded physician, summoned as an expert, is mortified when he is obliged to say he doesn't know. He is ashamed of science, and, rather than confess her limits, bearing thereby himself a certain amount of odium from the ignorant, he supplements his exact knowledge with broad statements which by their inaccuracy disgrace him and the science he traduces. In the strained effort to meet the demands of legal inquiry, many socalled medical experts satisfy the law at the expense of conscience and established truth. An eminent microscopist who has attained his high position by devoted and conscientious research, at the expense of worldly advancement, once said to an audience of which the writer was a member: "Never be afraid to say you do not know. It is quite as important in An example of what may be done on both sides was furnished in an episode connected with a certain murder trial in which it was demanded that science prove the blood upon the prisoner's garments to be human blood. The expert who examined the substance ascertained that it was blood, but, being a careful scientific investigator, he knew he could not say whether or not it was human blood. It might have blood, so far as science could ascertain. Nevertheless, he had made the necessary examination and thought himself entitled to his fee, which he named in stating his readiness to travel some distance and appear before the court as an expert. The prosecutor, however, refused to accept his testimony unless it was conclusively on one side, and he was not allowed to appear, since he would not compromise so far as to make the least assumption. The lawyer was searching for proofs of guilt, not for truth. A less learned man, or a weaker man, might have abetted him, but the masters of science are not to be bought or flattered. For this reason it is manifest that not every be a man of conscience and humility. Psyphysician is qualified for an expert, even if he chology is as intimately related to law as pathology is. The medical witness should be a specialist in the departments of legal medicine. If he is well qualified, he must know considerable law, and he attains knowledge commensurate with his duties only by that concentration of power which comes of well-directed study. It would best become the dignity of science and truth if legal medicine were held as a definite and distinct profession in which the emoluments were sufficient to justify a physician in abandoning all other practice in the interest of his special work. Dr. E. Miller Reid's paper on "The Application of Legal Medicine to the Exigencies of the Times," may be read with great advantage. By the o'er-learned (?) in medical jurisprudence, Dr. Reid's conservative suggestions will be received with surprise; but he has certainly presented some forcible thoughts on the sub-suffered from primary or secondary syphilis. ject in question. He points out the weight of Syphilis is not an ineradicable, incurable disevidence lying in the physical conditions of ease. When imperfectly treated, or when the men implicated in fatal assaults, urging that a patient is of a vulnerable diathesis, it may man with an organic weakness has apprehen- linger in the system, and after a lapse of years sive grounds for defending himself with a produce grave, nervous, and visceral lesions, quickness which the occasion may not seem to but when treated early and energetically it can warrant. Dr. Reid also speaks of the frequent in the overwhelming majority of cases be efinadequacy of the fines attached to ordinary faced as completely as an attack of anæmia. assaults where an apparently trifling injury is subsequently followed by a life-long imprisonment or loss of function. He denounces the use of the whipping-post on medical grounds, and speaks, furthermore, of peculiar phases of mania which he considers as subjecting the patient to legal control, phases not ordinarily recognized by the courts, but called by Dr. Reed gynemania and erotomania. A strong point is made of the legal obligation which ought to enforce the disinfecting of money. Dr. Reid thinks that many diseases are contracted by handling coins or script which has passed through diseased fingers. The legal aspects of the phenomenon known as color-blindness are also dwelt upon; and finally Dr. Reed urges the desirability of subjecting engineers, captains of vessels, and all persons on whose skill There is no necessary connection between. the headache, mental hebetude, or osteoscopic pains of middle age, and the indiscretions of youth. The former are usually the result of gastro-intestinal disturbances, and the latter are not infrequently due to gout, lithæmia, rheumatism or even to malaria. Of course in many intricate cases it is well to bear in mind the possibility of the existence of a syphilitic factor, but unless its presence is actively manifested, vigorous specific medication should not be employed until other remedies have proved inefficacious. IMPORTANCE OF ABDOMINAL LABOR. the safety of human life may depend during DR.rent number of THE MEDICAL BUL any length of time, to a medical examination which shall establish the condition of their health and avoid the possible attacks of mental aberration, apoplexy, epilepsy, etc., which might be disastrous to those trusting to their W. S. APPLEGATE'S letter in the current LETIN is an indirect but nevertheless a forcible lesson upon the necessity of the physician endeavoring to elicit the foetal heart-sounds in every case of labor so that he can determine whether the child is living or dead, and base his opinion and action accordingly. In the case reported by Dr. Applegate, the patient's three pregnancies terminated in three still-births, the result being attributed in each instance to prolapse of the cord, followed by its compression during delivery, and conseNo evidence is presented, however, to prove quent interference with the foetal circulation. that any of the children was alive when labor began. It is true that Dr. Applegate claims to have detected pulsation in the cord, but that is a feature which may be simulated by the reflex flow of blood from the placenta during uterine contractions and by a variety of other causes. In a case recorded by Drs. McClintock and Hardy, the attendant was positive that he had observed pulsation in the cord, but when the child was delivered a few minutes later with forceps, it was found to be putrid, and had evidently been dead for many days. We do not mean to imply that prolapse of the cord is to be regarded as a trifling accident. All departures from nature's normal course are to be veiwed with anxiety, but we are convinced that careful observation will show that prolapse of the cord is not as fatal per se as the text-books state, and that a very large proportion of the deaths which are charged to it are the result of constitutional and other causes. In other words, it is more frequently a sign rather than a cause of foetal death, and its presence should point to the necessity of at once ascertaining the presence or absence of the foetal heart-sounds. If they can be heard the prognosis is good whether the cord can be replaced or not. Madame La Chapelle observed cases in which it was prolapsed for hours without any injury to the child. McClintock and Hardy record a series of fortyfour cases which resulted favorably, and yet in only three of them was it possible to return the cord. If the foetal heart-sounds cannot be heard, and this accident has occurred at or near full term, the child may be declared to be almost certainly dead, but as in the great majority of cases no pressure has been exercised upon the cord, the fatal result must be sought for in causes inherent to the mother or the child, and acting before the onset of labor. McClintock and Hardy's statistics show that among the fifty-four cases of prolapsed cord observed by them in which the children were dead when delivered, there was only one in which the foetal heart-sounds were audible at full term. CORRESPONDENCE. DR. AULDE'S LITHIUM BROMIDE MIXTURE. EDITOR MEDICAL BULLETIN : Dear Sir: Having published several papers in your journal on the use of lithium bromide in combination with solution of potassium citrate, more particularly with reference to its value in lithæmic conditions, I have thought it advisable to prepare a final paper, with a view to point out the "Therapeutical indications." Since the pub Mr. Editor: I have had occasion to remark before that THE MEDICAL BULLETIN must circulate widely, and it is only just that it should be appreciated by a large circle of subscribers, for received many letters, asking for information as to the use of orange wine, which, though they might be answered personally, may better be replied to through the columns of THE MEDICAL BULLETIN, and from Virginia comes, "What atomizer do you think the best for spraying the pharynx with in post-nasal catarrh, and how strong do you make the solution?" I have tried many atomizers, and, although any good instrument will do, I prefer that made by H. K. Multhis city. The chief merits of the instrument are ford & Co., of Market and Eighteenth Street, in its being made of glass and rubber only, and this saves it from destruction by any solution which can be employed in the throat or other part of the human body. Next, as it has two bulbs, the spray is continuous-it does not go by jets. The bulbs, also, are so strong that it will not burst under any pressure likely to be applied, and if they did they are cheaply and easily replaced. I have asked the makers to lend me a cut, which it is a welcome visitor to all who take it. I have full weight and with considerable force in an oblique direction against the side of the leg. The displacement was only partial, but even when reduced, the head of the bone was more prominent than that of the other leg. It was treated by the application of a pad and rest. Yours, etc., letter from New York: "Do you find the con- | support of one end broke, and he was thrown tinued use of the wine to induce biliousness?" Not in any case so far, and I have given it for a year at a stretch in persons where such a complication might be expected. I don't find wine to do this when taken alone, and in proper quantity; it is the moderate but steady drinking of malt liquids, and particularly ale, which disturbs the liver. Old ale will ruin any one's digestive tract in time, and it won't take a long time to do it. I hope these remarks will fill out satisfactorily the paper, and my overlooking the first query was accidental, as I had intended to give the points referred to in my article. Very truly yours, W. R. D. BLACKWOOD, M.D. PHILADELPHIA, PA. EDITOR MEDICAL BULLETIN : Dear Doctor: In the earlier part of the summer we had here a number of cases of typhoid fever, scattered cases occurring in all parts of the city, but in one locality the disease was especially fatal, five cases dying within a radius of one block. Some used well water, others cistern water, and still others hydrant water, so nothing can be proved as to the cause in that direction, but the existence of an open sewer a few hundred feet distant may account for the severity of the disease in this locality. What I wished to notice particularly, however, was the temperature in three of the fatal cases, all girls, ranging from fourteen to nineteen years in age. No. I had an average temperature for several days of 102° to 104° Fahr., but Saturday, the morning record was 1060 Fahr., evening 1020 Fahr., and extremities cold. Sunday, morning 103° Fahr.; Monday, 105° Fahr., and patient died Tuesday A.M., at 7.30. No 2 had the same average temperature, but Friday it ran up to 1060 Fahr. Sunday it was subnormal till four in the afternoon, when it ran up to 105° Fahr., and she died at 6.30, Monday, A.M. No. 3 with the same average temperature for ten or twelve days, suddenly had a rise to 106%1⁄2° Fahr. Saturday morning, pulse 200, and respirations 100. Death occurred the same day at 2 P.M. These three cases were in the practice of another physician, but attracted my attention from the fact of the sudden and severe rise of temperature a day or two before death. The only fatal case I had ran along several days with a temperature of 102-104° Fahr., and after two days of improvement of all the symptoms, cerebral congestion suddenly proved fatal. I recently met with a rather unusual dislocation, viz., that of the head of the fibula. A young man was swinging vigorously in a hammock when the LEAVENWORTH, KANSAS. W. D. BIDWELL, M.D. INTRA-UTERINE AMPUTATION. EDITOR Medical Bulletin :— Dear Doctor: On October 13th last I was called into the country, some nine miles, to attend a Mrs. R-, who was in labor with her seventh child. On arrival, I found the woman a blonde, quite fleshy, with a short, thick neck, which gave me some uneasiness, as there were some symptoms of convulsions. As labor progressed there was a partial hip presentation, with the femur crosswise. I thought it best to bring down the feet. I grasped the leg presenting and pulled that down. In reaching for the other it was not to be found. In a few minutes we had a full-developed male, with the exception of one leg (the left one). There was a band, resembling the capsular ligament, passing from where the trochanter ought to have been, back, crossing the spine just above the nates, to within four lines of the right hip. The scrotum was as large as in the adult, measured four inches in length, and contained but one testicle, that resembling a large bell pear. The penis was also very large, being three inches and six lines in length, with two glans penis, with two orifices of the urethra. The two glans extending one inch, then the penis was normal back to the abdomen with the exception of its large size. I asked the mother if she had been frightened during gestation. She answered, "No." If any of my brothers can give any light, I would be plased to hear, per THE MEDICAL Bulletin. J. B. SULLIVAN, M.D. " STANTON, MICH. THREE SUCCESSIVE STILLBIRTHS. Mrs. H, a healthy, well-developed Irish woman of twenty-five, and married three years, has been confined three times at intervals of about a year, in each case prolapse of the cord causing the death of the child. The first labor is said not to have been tedious, nor was there any difficulty excepting the complication mentioned. The second was a foot presentation, but the child was born before a doctor could be obtained. To the last I was called about three hours after the membranes had ruptured, the waters having escaped with something of a gush, at the same time a loop of the cord appearing outside the vulva, a repetition of what had occurred twice before. Strong pains were failing to move the head, which had lodged in the superior strait with the long axis directly across the quite roomy pelvis. MEDICAL APHORISMS.-A correspondent of the Canada Lancet, signing himself "Artz," says that he came across the following professional aphorisms of Amédée Latour, which are sufficiently curious and shrewd to merit reproduction: I. Life is short, patients fastidious and the brethren deceptive. 2. Practice is a field of which tact is the manure. 3. Patients are comparable to flannel, neither can be quilted with Though the loop had lain so for three hours, there was weak pulsation, fatal pressure having been avoided no doubt by the position of the head. In a little time, with the aid of instru-out danger. 4. The physician who absents himments, the position was corrected, and the child quickly delivered, but the delay had been too long. To the question, "Why is it, doctor, that my babies are all born dead?" I could only give an indefinite answer. The woman had always been in excellent health, and during her pregnancy had taken the greatest care to do nothing that might cause any trouble, as both she and her husband were very anxious for a child. The amount of water does not seem to have been excessive. The cord, in the last case-the first two I knew nothing about-was not much longer than cords usually are. The only cause I am able to suggest is a cord perhaps slightly longer than normal, and the too early rupture of rather thin membranes. It is not probable that the attention of a woman to her household duties, or the state of her health during pregnancy, could influence very much the result in a case of this kind. However, both were favorable. If the membranes were ruptured earlier than they should be, it is no more than frequently happens without prolapse. That the constant repetition of conditions so favorable to this complication might be due to some cause exerting the same influence in each labor seems highly probable. FLATBUSH, L. I. W. S. APPLEGATE, M.D. self runs the same risk as the lover who leaves his mistress; he is pretty sure to find himself supplanted. 5. Would you rid yourself of a tiresome patient, present your bill. 6. The patient who pays his attendant is but exacting; he who does not is a despot. 7. The physician who depends on the gratitude of his patient for his fee, is like the traveler who waited on the bank of a river until it finished flowing so that he might cross to the other side. 8. Modesty, simplicity, truthfulness! cleansing virtues, everywhere but at the bedside; there simplicity is construed as hesitation, modesty as want of confidence, truth as impoliteness. 9. To keep within the limits of a dignified assurance without falling into the ridiculous vauntings of a boaster, constitutes the supreme talent of the physician. 10. Remember always to appear to be doing somethingabove all when you are doing nothing. II. With equal and even inferior talent the cleanly and genteelly dressed physician has a great advantage over a dirty or untidy one. SUCTION IN THE REMOVAL OF FOREIGN BODIES FROM THE BLADDER.-The chief difficulty connected with the use of the lithotrite for elon gated bodies is the fact that the foreign body is invariably seized at right angles with its long axis. I have discarded the lithotrite as an extractor, and trusted to a large-eyed evacuating catheter, such as I use for lithotrity, and a rubber wash-bottle connected with it, by means of which MEDICAL NEWS AND MISCELLANY. I can fill and empty the bladder with a stream of NITRATE OF POTASH AS AN ANTI-EMETIC.Dr. V. H. Moore (Medical and Surgical Reporter) says: water of considerable force. When we consider that most foreign bodies introduced into the bladder are of an elongated nature before they become nuclei for stony concretions, this method of removing them at once recommends itself. If a rubber bottle is attached and a stream of water is forced into and out of the bladder, it will be found, as a rule, that the end of the foreign body is sucked into the catheter, and in this way may be withdrawn. Nitrate of potash, properly administered, is one of the surest remedies we have for the relief of vomiting. I have been using it as an antiemetic in my practice, for the past twelve years, with the happiest results. The manner of administering it is as follows: Give one-quarter of a grain, dissolved in a tablespoonful of cold water, One of my recent cases was a curious one, and every four or five minutes until the vomiting is was seen in consultation. A middle-aged healthy relieved, which will usually be in from ten min-man, a month previously, passed a piece of bacon utes to half an hour. I give it in all cases of vomiting, except reflex, and that due to irritant poisons, and have found it to succeed in ninety per cent. of all cases. rind about two inches in length up his urethra ; this disappeared. He introduced a week afterwards, up the same canal, a stiff pig's bristle about five inches in length, which also disap |