lected where the sex is mentioned sixty-seven per cent. were males. The morbid anatomy of the subject is very incomplete, being made up of statistics as to the patency or non-patency of the foetal openings and vessels, the condition of the liver, and the character of the blood, from all of which no satisfactory conclusions can be drawn. The prognosis of umbilical hæmorrhage was stated as excessively grave. A mortality of eightythree per cent. in 230 cases. The fatal termination may occur at any period from one hour to eight weeks from commencement of bleeding. In ninety-four cases where the time of death has been stated forty-seven, or fifty per cent., occurred within first forty-eight hours, twenty-five in the first, and twenty-two in the second, twenty-four hours. The success of therapeutical measures the author believed lies in a proper appreciation of the nature and causes of the disease, and until this is accurately determined umbilical hæmorrhage will continue to resist all well-meant therapeutical resources. In the present state of our knowledge the author believed that that treatment will be the most successful which consists of local styptics, ligature, etc., combined with such internal hæmostatics and tonics as experience has proven of value in kindred hæmorrhagic affectious of adults. DR. CHARLES K. MILLS. I have had one very interesting case of umbilical hæmorrhage, which recovered. The subject was the fourth child of perfectly healthy parents, the other three children being healthy. There was no trouble until the third day after birth, when an oozing was found at umbilicus, and the child vomited blood. The cord was examined, and found not bleeding at the extremity. Subsequently styptics were applied without result. The hematemesis occurred on three occasions during the following twentyfour hours of occasional hæmorrhage. The bleeding was finally controlled by transfixion with needles, and a half drop of aromatic sulphuric acid administered every two hours. The child recovered, and is now perfectly healthy. DR. HANNAH T. CROASDALE. I have had the opportunity of seeing but two cases of umbilical hæmorrhage. The first was from shrinkage of the cord and great amount of gelatinous material. After the ligature was closely reapplied the bleeding began again from the cut extremity. I then applied Pean's hæmostatic forceps and left them in position twenty hours. In the other case the hemorrhage was controlled by tightening the ligatures. DR. MARY WILLITS. To the cases mentioned I would add one seen by myself in hospital. The child was a week or ten days old. After considerable hæmorrhage the bleeding was successfully checked by styptics and a compress. DR. HENRY BEATES, JR. In connection with the hæmatemesis noticed by Dr. Mills, a case seen by myself showed at the autopsy gangrene of the ileum. There was also sloughing at the extremity of the cord. DR. Jos. S. GIBB. I am grateful to the members for the relation of their experience with this troublesome affection. The relation of the hæmorrhagic diathesis to it is yet a question. There seem, however, to be two things intimately connected with it, the hæmorrhagic diathesis and jaundice. The case reported by Dr. Mills would rather support the former theory. DR. ALBERT H. SMITH, in closing the discussion, said: I have seen two cases of the kind referred to by the reader of the paper. The first occurred at the end of twenty-four hours after birth in a healthy child. On attention being called to it the ligature was found loose; this was reapplied carefully. On the following morning the nurse again discovered hæmorrhage, and the child died before I could reach the house. This was not a case of neglect or traumatism. The other instance occurred also in a perfectly healthy child fortyeight hours old. The cord was ligated by myself, but I soon found hæmorrhage occurring freely from the tissue around the cord; a large compress of absorbent cotton was applied by means of Seabury & Johnston's plaster, and a teaspoonful of magnesia given internally. The child was saved. In these two cases there were no hereditary tendencies to this form of trouble; no jaundice; no purpura hæmorrhagica in either the mothers or the infants themselves. We have not, so far, reached any reasonable theory of its etiology. Jaundice seems a coincidence. Great stress has been laid on hæmophylia, but my experience does not bear it out. In a family under my care four out of five died of hæmorrhage, but none showed any tendency to umbilical hæmorrhage. In the autopsies of fatal cases no uniform nor persistent conditions have been found. My cases are somewhat remarkable from the fact that recoveries are rare. In the treatment we could hardly expect a compress to do much, yet I think this application the best that can be made. A laxative would contribute to lessen blood pressure and act as a revulsive. I would suggest that hæmorrhage from non-application of a ligature would rarely occur in health if we are to judge by the fact that in Germany they seldom tie the cord. Difficulty may certainly arise from too early ligation. My practice is not to ligate until the cut extremity has ceased bleeding. It is evident that loosening the ligature would be a dangerous experiment in some of these cases. DR. COLLINS exhibited a bullet that had been removed from the anterior nares of a man. It had remained imbedded in the turbinated bones since 1865. An opening in nasal septum remains, produced at time of reception of wound. Recent Literature. Illustrations of the Influence of Mind upon the Body in Health and Disease, Designed to Elucidate the Action of the Imagination. By DANIEL HACK TUKE, M. D., F. R. C. P., LL. D. Second American from the second English edition. Philadelphia: Henry C. Lea's Son & Co. 1884. The mind acts upon the body through its threefold states of intellect, emotion, volition. The condition of the mind comprising these states exerts an enormous influence, for good or evil, upon the body with which it is associated - including in this term all sensations, movements, and organic functions. Physiologically considered, the illustrations range over the effects produced by the action of the nerve corpuscles of the encephalic centres concerned in intellectual, emotional, and violitional states of mind, upon the sensory and motor ganglia, the centre of the sympathetic, and through the outgoing nerves, upon the whole body. The cases brought together in this volume illustrate the importance of the truth that the mind or brain influences excites, perverts, or depresses the sensory, motor, vaso-motor, and trophic nerves, and through them causes changes in sensation, muscular contraction, nutrition, and secretion. In these words, extracted from the " Introductory portion, is comprehended the scope of Dr. Tuke's book. That the task he has assigned himself is not an easy one may be readily seen, but he faithfully fulfills his promises, as even a cursory glance at the succeeding chapters will show. In the first chapter, which deals with General Psychological and Physiological Principles in reference to the intellect, Dr. Tuke shows that Muzer and Hunter a hundred years ago considered the subject of expectant attention, and later (1838) Johannes Müller. The latter, who agreed with John Hunter in regard to the influence of expectation, said: "It may be stated, as a general fact, that any state of the body, which is conceived to be approaching, and which is expected with certain confidence and certainty of its occurrence, will be very prone to ensue as the mere result of that idea." Elliotson, Laycock, and others investigated the subject of magnetism, and Braid, so familiar to us all of the present day, systematized and repeated on a large scale the experiments which Hunter had previously performed on himself. Dr. Tuke speaks of the importance of Braid's conclusions, and frequently refers to them further on. Dr. Carpenter's exposition of the rationale of the phenomena of mesmerism, so far as they are due to the influence of expectant attention or dominant ideas, is also very valuable. In section three of the second chapter (which is on the Influence of the Mind on Sensation) some interesting cases of what Dr. Tuke calls psychical anæsthesia are given. It is strange, he says (in a foot-note on page 61), "that in all, or nearly all, histories of anaesthetics, psychical anesthetics are not even mentioned. Yet they preceded drug anæsthesia, and to a large extent suggested it. Cloquet removed a woman's breast during the mesmeric sleep, she being able to converse, but insensible to pain, so far back as 1829." The most interesting cases of operation under the influence of magnetism were those of Dr. Esdaile, who in his book called Introduction of Mesmerism (with the sanction of the Government) into the Public Hospitals of India (second edition, 1856), records 261 rendered painless by this influence. Two hundred of the operations were for the removal of large tumors. There were also eighty-four capital operations in another hospital. Out of the 261 there were fourteen deaths, not dependent, however, on the operation. On page 114 the Influence of the Intellect on the Blood-vessels is discussed with special reference to stigmata. The singular phenomena of stigmata, when genuine, arise from the mind's influence on the capillary circulation through the vaso-motor nerves. M. Alfred Maury has treated the subject of stigmatization in the most able manner. He mentions cases in which persons have dreamed that they received blows or wounds, and in the morning have found marks of inflammation on the body; "just so with visionaries," he says, "in them, under the power of the imagination, by the concentration of the attention, the blood is directed to the place where they fancy they are affected." M. Maury regards St. Francis d'Assisi as the ancestor of the stigmatized. The stigmata of Louise Lateau are described, and the conclusions already arrived at in regard to their causation are said to be reaffirmed by M. Warlomont who carefully studied them. "The periodicity of the stigmata is rationally accounted for by the ideas with which they originated having been associated with cer tain days; and by the weekly direction of thought and feeling in the same channel. The profane are not now allowed to study the case of Louise." These few extracts from the book of Dr. Tuke give an idea, in a limited manner, of the interesting matters discussed. They fail, however, to give even a faint idea of the strength of treatment, the rich coloring and clearness and skill of style, with which every subject is elaborated. Dr. Tuke has been known for many years as an able writer, and has of late especially interested himself in trance conditions. The book before us is valuable for what it contains on this subject, which has lately assumed such importance. As physicians we should constantly bear in mind the importance of the expectant treatment of disease. We probably all suppose that we know almost everything about this treatment now, but Dr. Tuke's book, which we should all own and read, will make the modest among us hang our heads. The bibliography and general index at the end of the book are excellent. By A. F. A. KING, M. D. 338 pages. Philadelphia: 1884. A Manual of Obstetrics. the rudiments and essentials of obstetric science as may constitute a good ground-work for the student at the beginning of his obstetric studies." The book is confessedly a compilation, in great part, from the more extensive and classical treatises, such as those of Lusk, Playfair and Leishman. The author has succeeded in producing an epitome, which, if at times concise at the expense of graceful expression, is a reliable and sufficiently comprehensive outline of the subject. Our fear is, however, that manuals like this one will to a great extent displace the large treatises from the student's library: if the knowledge of a manual will enable a student to pass for his degree, he will only exceptionally buy and study the larger works, and will therefore enter his profession with crude and chiefly empirical knowledge, ill-prepared to deal rationally with the problems of medical practice. C. M. G. Ninth Report of the State Board of Health of Minnesota. Minneapolis: 1883. The Reports of Local Boards and officers relative to the prevalence of small-pox in 1881 and 1882 occupy a large portion of the report, and show that the disease was generally prevalent throughout the State in those years. Brief reports follow upon Meteorology, Sanitary Water Survey, Typhoid Fever, Diphtheria, Trichinosis, and Vaccination. An account of the proceedings of a two days' Sanitary Conference at Minneapolis, in which it is notable that seven out of twenty papers presented on sanitary subjects were written by clergymen. Medical and Surgical Journal. meeting of the Medical Association; we refer to the exclusion, not merely from the business meetings but THE DOCTRINE OF EVOLUTION AS APPLIED WASHINGTON is to be this week and next the great centre of medical interest, and no other place in IN Dr. Hughlings Jackson the Spencerian philosothe country to-day offers nearly the same advantages phy has found a strong supporter. The recent Croonand inducements for the annual gatherings of the Na-ian lectures on the Evolution and Dissolution of the tional Associations. It is easy of access by various Nervous System are a rigid application of Mr. Spenlines of railways from all directions; it is central for cer's principles to the explanation of nervous pathola very large proportion of the population of the Un-ogy. ion; it contains almost unrivaled collections both of The nervous system in its development is a strikbooks and specimens of general, scientific, and strictly ing illustration of the general law of evolution, which professional interest; it has grown to be a very beau- it is sought to apply to all orders of natural phetiful city, with environs many of which are charming nomena. This is seen whether we study the nervous and replete with historical associations; and in it all system as an ascending development in the animal American citizens are at home. Moreover, it offers, kingdom, or in the light of human embryology. It is with the vicinity of Baltimore, in common with places an advance from the simple to the complex, from the otherwise less favored and more distracting though relatively undifferentiated to the relatively differenless diverting, sufficient comfortable accommodation tiated, or as Hughlings Jackson expresses it in the for all who choose to resort to it. If more induce- lectures above alluded to, from the most to the least ments were needed the easy and rapid escape from a organized that is to say, from the lowest well organclimate still harsh and uncertain, and the pleasing an-ized centres up to the highest least organized centres, ticipation of a tardy spring, should be a temptation the latter being the most complex, the most heterohard to resist for the medical fraternity of New England. There is the choice between going all the way from Boston by water in a little over forty-eight hours, or directly through by rail in about seventeen hours; the dweller in the interior is likely to wisely choose the former, but we can sympathize with a resident on the coast who might think he had had of late enough east wind. The last days of this week will be occupied by the American Surgical Association, which offers a very large number of papers on a great variety of subjects, aud by the new Climatological Association, for which a vast amount of material is waiting over our many degrees of latitude and longitude. Massachusetts Bay alone offers climate enough for a vigorous Association's attention. Next week will be fully occupied by the American Medical Association's meeting, and those of the Medical Editors, of the Council of the Public Health Association, and of the representatives of the State Boards of Health. We do not doubt these bodies would all find it for their advantage to meet more frequently in Washingtou than they now do, every fourth year being at present the rule with the American Medical Association. There is one regrettable feature this year, which threatens to mar the otherwise fair prospects of the geneous, and the most unstable. The triple conclusion, then, to which Jackson arrives is, "that the highest centres which are the climax of nervous evolution and which make up the organ of mind are the least organized, the most complex, and the most voluntary." One of the most interesting chapters in Dr. Maudsley's recent work, Body and Will, treats of the future probable disintegration and decline of will power in the human race by a reversal of the solar conditions which have evolved it. Without, however, speculating as to any such possible contingencies, we are continually meeting instances of disintegrations in the delicate nervous plexuses which form the substratum of mind by causes which produce local failures of nutrition. Dissolution is treated of by Dr. Jackson as a process of undevelopment, a "taking to pieces" in the order from the least organized, the most complex, and the most voluntary toward the most organized, the most simple, and most automatic. Such "dissolution" (which of course is only partial) is equivalent to the statement," reduced to a lower level of evolution." Dr. Jackson applies this thought to the elucidation of the phenomena of insanity: "Starting with health, the assertion is that each person's normal thought and conduct are or signify survivals of the fit test states of what we may call the topmost layer of his highest centres, the normal highest level of evolution. Now suppose that from disease the normal highest level of evolution the topmost layer is rendered functionless. This is the dissolution, to which answer the negative symptoms of the patient's insanity. His positive mental symptoms are still the survival of bis fittest states, are survivals on the lower but then highest level of evolution. The most extravagant actions and the most absurd mentation in insane people are the survival of their fittest states. We need not then wonder that an insane person believes in what we call his illusions, they are his perceptions. His illusions are not caused by disease, but are the outcome of activity of what is left of him; his illusions are his mind." The above view of abnormal mental action as being a result of suspension or inhibition of the supreme centres and the unchecked activity of the lower is now a favorite view with mental pathologists. Dr. Jackson gives interesting illustrations of his meaning, of which one of the simplest is the effect of alcohol on the brain (and here we take occasion to remark that a similar conception was presented by John Fiske in a work published fifteen years ago): "An injurious agency, say alcohol, taken into the system flows to all parts of it, but the highest centres being least organized 'give out' first and most, the middle centres being more organized resist longer, and the lowest centres being most organized resist longest. Did not the lowest centres for respiration and circulation resist more than the highest do, death by alcohol would be a very common occurrence." After stating that in the progress of chronic alcoholism gradual involvement of the lower centres takes place, he speaks of local dissolution. Disease may occur in any evolutionary level on one side or on both sides; it may affect the sensory elements chiefly, or the motor elements chiefly. There are local dissolutions of the lowest centres and of the highest centres. In every case of insanity the highest centres are affected, and different divisions of these highest centres are affected, corresponding to different kinds and degrees of insanity. As examples of local dissolution, Dr. Jackson cites first progressive muscular atrophy. This is dissolution commencing at the bottom of the central nervous system. Here atrophy begins in the most voluntary limb, the arm, affecting first the most voluntary part of the limb, the hand, and spreading to the trunk (the more automatic parts). The wasting of the muscles of the hand has its causal counterpart in atrophy of the first or second dorsal anterior horn, an atrophy which, as its name intimates, is progressive. He next refers to hemiplegia resulting from destruction of a plexus in mid region of the brain. The arm, the most voluntary limb, suffers the more and longer, and the most voluntary part of the face suffers more than the rest of the face. Although unilateral movements (the voluntary) are lost, the bilateral, which are more automatic, are retained. Hemiplegia is a clear case of dissolution, loss of the most volun tary movements of one side of the body, with persistence of the more automatic movements." His next illustration is paralysis agitans. Here the tremor begins in the hand, affecting the whole arm, finally becoming bilateral. "In an advanced stage paralysis agitans is double hemiplegia with rigidity; is a two-sided dissolution." The same conception is applied to hemilateral epileptiform seizures and to chorea, the great elaborateness of whose movements "points to disease high up, to disease on a high level of evolution." Dr. Jackson's next example is aphasia, which in many ways illustrates the doctrine of dissolution. In complete aphasia, for instance, there is loss of intellectual (the more voluntary) language, with persistence of emotional (the more automatic) language. In other cases the patient has lost all speech with the exception of "yes" and "no," "the most automatic of all verbal utterances." The Speaking of uniform dissolution, dissolution affecting all divisions of the highest centres, Dr. Jackson chooses as an example delirium in acute non-cerebral disease. This, scientifically considered, he says, is a case of insanity. "The patient's condition is partly negative and partly positive. Negatively he ceases to know that he is in the hospital, and ceases to recognize persons about him. In other words, he is lost to his surroundings; he is defectively conscious. We must not say that he does not know where he is because he is defectively conscious; his not knowing where he is is itself defect of consciousness. negative mental state signifies, on the physical side, exhaustion or loss of function, somehow caused, of some highest nervous arrangements of the highest centres. We may conveniently say it shows loss of function of the topmost layer of his highest centres. The other half of his condition is positive. Besides his not knowings there are his wrong knowings. He imagines himself to be at home or at work, and acts as far as practicable as if he were; ceasing to recognize his nurse as a nurse he takes her to be his wife. This, the positive part of his condition, shows activity of the second layer of his highest centres, but which, now that the normal topmost layer is out of function, is the then highest layer. His delirium is the survival of the fittest' states on his then highest evolutionary level. Plainly he is reduced to a more automatic condition. Being (negatively) lost from loss of function of the highest, latest developed, and least organized, to his present 'real' surroundings, he (positively) talks and acts as if adjusted to some former ideal' surroundings, necessarily the more organized." These lectures will be read with interest by all who desire to investigate the great questions of neuro-psychology. THE SUBCUTANEOUS USE OF MORPHINE IN have observed in its use. ELDERLY PERSONS. um. THE fact is generally recognized and taught that the very young and the very old are peculiarly susceptible to the toxic effects of anodynes, especially opiIn the case of children, particularly, we have learned the necessity of reducing materially the dose of opium beyond the proportion to the adult dose which the age of the child would indicate for other drugs. We think, however, that many practitioners do not attach sufficient importance to the necessity for caution in the administration of opium to the aged; and in particular that the hypodermic method, useful as it is under certain circumstances, is capable of greatly increasing the risk of an overdose in such cases. One eighth of a grain of morphia given under the skin has caused alarming symptoms in an elderly subject, and we have seen a similar dose apparently cause death in a hospital patient suffering from pneumonia. Instances have occurred within the knowledge of many where a dose as small as one sixth of a grain repeated once in the course of an hour has proved fatal to a feeble and aged subject. What enhances this danger is the fact that symptoms indicative of narcosis are often entirely wanting until the repetition of the dose has been made, when they supervene with alarming suddenness. It is just here that the risk of the hypodermic method is seen. If the drug is in the stomach and symptoms of an alarming nature present themselves there is at least an opportunity to evacuate the residue of the drug before it becomes absorbed. But with the narcotic circulating within the bloodvessels it is beyond our reach. The very elements which have made the hypodermic syringe such a favorite in the hands of the medical profession are those which constitute its chief danger. True it is that Magendie's solution is convenient to carry about; but so would be morphia granules if we were as accustomed to them. The taste of the latter is no great obstacle to their use; the nausea and other bad after-effects are hardly more frequent after the administration of the drug per os. The desideratum of concealing the dose from the patient is as readily attained by the use of the pill as by that of Magendie's solution. Many physicians finding difficulty in preserving the solution without some antiferment are in the habit of dissolving a weighed powder each time; and surely this is no more convenient than to carry and administer a small pill. The indications which are especially met by the hypodermic method are quickness of action and the retention of the drug against vomiting. When either of these requirements must be met the subcutaneous injection should be practiced. But for a routine method, and above all in that class of patients who are especially liable to suffer from an overdose of the drug, it seems to us unjustifiable to employ a channel of administration which takes it out of our power to evacuate what may prove an excess of the medicament. Some over-conservative physicians of our acquaintance have gone so far as to throw aside the hypodermic syringe altogether in view of the risks which they But while this extreme ground seems to us untenable, and while we recognize the great advantages which in certain special cases may accrue from hypodermic medication, we yet feel impelled to protest against making the subcutaneous tissue a regular channel for the administration of morphia, especially in the debilitated and aged. DR. WILLARD PARKER. THE name of Dr. Willard Parker, who died at his residence in New York on the 25th of April, has long been a household word, and not only in the city where the last forty-five years of his life were spent, but also throughout the country. For eighteen months past he has been suffering from pyelitis and other troubles, but the immediate cause of death was an attack of apoplexy, with aphasia, which occurred April 13th. He was born on the 2d of September, 1800, at Hillsborough, New Hampshire, but when he was five years old his father, who was a farmer of Puritan stock, removed to the family homestead at Chelmsford, Massachusetts; which remained in Dr. Parker's possession up to within a short time before his death. When he was eighteen he began teaching school in order to get the funds necessary to secure a collegiate education, which his parents were unable to provide for him, and four years afterward he entered Harvard; from which he was graduated in 1826. It is related that when he entered college he expected to study for the ministry, but that an incident which occurred in his Freshman year led to a change in his choice of a profession. His room-mate had an attack of strangulated hernia, and he was so much impressed with the skill with which the late Dr. John C. Warren reduced it, thereby affording complete and instantaneous relief, after a local practitioner had failed in the attempt, that he decided to study medicine himself. After graduation he became a student under Dr. Warren, and in 1830 received the degree of M. D. from Harvard; in the meanwhile having served for some time as an interne at the Chelsea United States Marine Hospital. He immediately received the appointment of Professor of Anatomy in the Vermont Medical College, and in the same year (1830) accepted a similar appointment in the Berkshire Medical College, Pittsfield, to which the professorship of surgery was added in 1833. He became Professor of Surgery in the Cincinnati Medical College in 1836, and while still holding this position made a trip abroad, and studied for some time in the London and Paris hospitals. For a period of thirty years, beginning in 1839, he was Professor of Surgery in the College of Physicians and Surgeons in New York; at the expiration of which he resigned this position, and accepted the chair of Clinical Surgery. His success in that city was immediate, both as a teacher and a practical surgeon, and his brilliant operations and distinguished talent as a lecturer soon placed him in the foremost rank of the profession and carried his fame even across the Atlantic. His exalted character also won the esteem and |