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Dr. E. B. Stevens states, in Obstet. Gazette, August, 1888, that, uniformly, women who have been for some time-say one to two or three years in the morphine habit, have an entire ARREST OF MENSTRUATION, which function is reëstablished under treatment for the habit.

Another external application for NEURALGIA is the following (Med. Record): Eau de Cologne, ether and chloroform, fz iij of each, poured on a handkerchief previously wetted with cold water, and placed on the seat of pain, is said to give instantaneous relief. In nervous headache it is also efficacious.

In the treatment of CONGESTED AND IRRITATED BRONCHIAL MUCOUS MEMBRANES, Dr. Wm. Murrell, of England, employs ipecacuanha spray, the wine of ipecacuanha, either pure or diluted with an equal quantity of water, being applied either by a steam vaporizer or the ordinary hand-ball spray apparatus.

Oxalate of cerium is stated, in the Med. Press and Circ., to be of benefit in SEA SICKNESS, in doses of two to three grains every three hours. Its principal application hitherto has been in the treatment of functional sickness. It is also useful in subduing the OBSTINATE COUGH of pulmonary or laryngeal phthisis, asthma, etc., in doses of from one to one and a half grains daily; but the dose may be raised to fifteen grains without inconvenience.

In ABDOMINAL PAIN, Dr. Lauder Brunton (Brit. Med. Journal, June 2d) recommends codeine in doses of half a grain three times a day, increased to a grain if the patient is not relieved. It does not cause drowsiness nor does it interfere with the digestion. In longcontinued enteralgia, not due to organic disease, it has continued to relieve pain for months together.

Professor Jaccoud (Brit. Med. Journal) recommends a copious diluent draught and an exclusive milk diet in the treatment of GOUT; in cases in which there is considerable fever he gives a small quantity of hydrate of bromal. Preparations of colchicine and of salicylate of soda, though excellent as anæsthetics, are to be avoided. In patients affected with interstitial nephritis these substances produce most serious toxic symptoms.

The oil of turpentine is recommended as an application to all cases involving a SOLUTION OF SURFACE CONTINUITY FROM INJURY. (Med. Press.) In severe wounds of the hand or other parts, involving extensive laceration, the oil is said to prevent suppuration and sepsis, and so conduce to rapid recovery. In such cases the parts are well cleansed with hot water, and pledgets of lint steeped in the oil are applied. The dressing is kept saturated with a mixture of two parts of the oil of turpentine and one of linseed oil.

PAMPHLETS RECEIVED. 'Section of Contractured Tissues Essential before Mechanical Treatment can be Effected.' By Lewis A. Sayre, M. D., New York.

'On the Deleterious Results of a Narrow Prepuce and Preputial Adhesions.' By Lewis A. Sayre, M. D., New York.

'Observations on Yellow Fever.' By John P. Wall, M. D., Tampa, Fla.

'Relation of the Diseases of the Kidney, especially the Bright's Diseases, to Diseases of the Heart.' The Middleton Goldsmith Lecture. By J. M. Da Costa, M. D., LL. D. Philadelphia, 1888.

News and Miscellany.

DEATH BY ELECTRICITY.-Dr. Richardson writes on this subject, in the Asclepiad, as follows: "In some researches on the application of the electric discharge for the painless extinction of the lives of

side, and if his highness the Nizam had not taken him into his service he would have been there still or died of starvation."

SICK-DIET KITCHENS.—The sick poor of Philadelphia are to be congratulated on the fact that the Philadelphia Protestant Episcopal City Mission have organized and arranged, and now maintain, five Sick-Diet Kitchens in different districts of the city, which are open every week-day throughout the year at convenient hours, for dispensing nourishing diet to those for whom it is requested by any physician. To all who are sick and poor, soup, milk, beef tea, stewed fruits, puddings, oat-meal, farina, bread, jellies and many other delicacies suitable for sick people, are freely given. These Sick-Diet Kitchens are supported entirely by voluntary contributions, and it is ear

animals to be used as food, the details of which I recorded in the Medical Times and Gazette for the year 1869, this mode of death was anything but certain in its effects. Sheep stricken apparently into instant and irrevocable death by electricity, after a few minutes showed signs of life, and if they had not been dispatched in the ordinary way by the knife would have been restored to consciousness. The same fact has been observed in attempts to kill dogs by the electric shock, and I once published an instance in which a large dog, struck into perfect unconsciousness by the stroke from a powerful battery, was submitted to a surgi-nestly hoped that all interested in such benevolent cal operation while lying, to all appearances, dead, and was yet so little affected as to make an easy and sound recovery. It need not be inferred from such facts as these that the electric shock will not kill at one discharge-in most cases it will—but, exceptionally, instead of killing outright it will simply stun, and may induce the semblance of death instead of the real event. It will be only common humanity, therefore, for the authorities of New York, when they begin to give the coup de grace by the electric shock, to supplement the process by a post-mortem examination of the victims, so that the act may not be crowned by burying the victims alive."

PREJUDICE AGAINST AMPUTATION. -SurgeonMajor E. Lawrie, in his report on medical administration in the dominions of the Nizam, during 1887, says the British Medical Journal, gives a curious instance of the strength of the prejudice against amputation of a limb which survives among semicivilized people. A native was severely bitten in the foot by a tiger, and after an attempt to save the foot had been made, the patient consented to amputation, but his friends objected that he would be of no use without a foot, and that they would rather he should die. "As the patient was old enough," writes Dr. Lawrie, "to judge for himself, I turned the friends out of the hospital and took the foot off. They returned, armed to the teeth, after the operation had been completed, and if it had not been for a very strong guard, would certainly have attacked us. Being foiled in this, they entirely deserted the man whose foot had been amputated. We were obliged to keep him in the hospital for months, as he could get no food out

work will contribute toward their maintenance, either in money or in suitable articles of food, viz., meat, groceries, provisions and delicacies of every kind. Samuel Durborow, 411 Spruce Street, is the Superintendent.

WHAT COCAINe to Use.-Dr. Dudley S. Reynolds, editor of Progress, in the July, 1888, number states that the medical profession has about settled its estimate of the therapeutical value of muriate of cocaine, but it is, unhappily, no easy matter to decide upon the most uniformly reliable source of supply. He had about concluded Merck's was the only reliable product, when recently he was induced to make trial of that produced by Parke, Davis & Co. A fresh sample of ten grains was dis solved in five drachms ofdistilled water, to which was added one drop of liquid carbolic acid. One drop of this instilled into the eye of a man from whose cornea a foreign body was to be removed, produced complete anesthesia in three minutes, so that incision of the inflamed cornea, and turning out of the piece of offending metal, was not felt by the patient. Twenty other similar experiments yielded similar results.

VACCINATION IN THE HAREM.-A writer in the Indian Medical Gazette states that the women in the Sultan's seraglio, at Constantinople, have just been vaccinated, to the number of 150. The operation took place in a large hall, under the superintendence of four gigantic eunuchs. The Italian surgeon to whom the task was confided was stationed in front of a huge screen, and the women were concealed behind it. A hole had been made in the centre of the screen, just large enough to allow an arm to pass through; and in this manner the arms,

of various colors and sizes, were presented to the operator in rapid succession. It was utterly impossible for the surgeon to get a glimpse of his patients; but, in order to guard against the chance of his being able to see through the screen, two eunuchs, who stood by the operator, threw a shawl over his face the instant an operation was concluded, and did not remove it till the next arm had been placed in position.

WOMEN AND OBSCENE LITERATURE.-A certain class of very good and well-meaning folk, says the London Hospital Gazette, never tire of declaiming from the platform of the corrupt and licentious conduct of men, but from a recent discussion in Parliament respecting the rapid spread of corrupt literature in this country, it would appear that the male sex are not alone to blame in this matter. Indeed, were the corrupt literature business to depend on the patronage of men alone, it would die a natural death. The chief customers of the vile traders in obscene publications and indecent prints and photographs are said to be women. In some parts of London there are reading rooms and lending libraries open to females only, where young girls can have the use of private rooms, and a supply of indecent books and prints at a small charge. This is a matter which might well engage the attention of the Social Purity Association.

THE VENEREAL WARDS OF THE VIENNA HOSPITAL.—A correspondent of the Maryland Medical Journal states that it makes a strange impression on an American to go, for the first time, through the syphilis wards with the professor. Arranged in long rows, upon their backs, in bed, with nothing covering them from their knees to their navels, lie the men, ready for examination. Standing around with various implements and dressings are five or six active women, awaiting orders from their lord and master, the professor. The men are not allowed to touch themselves, so with their hands under their heads they lie there with anxious faces awaiting the next development in the treatment. Truly, it is a comical sight, this mixture of the sexes under the circumstances.

-In the biography of Dr. Marshall Hall, by his widow, we find the following anecdote (quoted in Medical Classics): "Dr. Wilkins lent Dr. Hall a well-worn book, 'Body and Soul.' The book being retained, he sent a note: 'Dear Dr. Hall— Do send back my body and soul; I cannot exist any longer without them.' The servant who received the note was able, by pressing the sides, to

read it. He was quite horror-stricken, and rushed into the kitchen saying, 'Cook, I can't live any longer with the doctor!' 'Why, what's the matter?' Matter enough,' replied the man; 'our master has got Dr. Wilkins' body and soul, and I have too much regard for character to stay where there are such things going on.'"

-Dr. J. M. DaCosta, the Middleton Goldsmith lecturer for the present year, declined to receive any compensation for his lecture, and requested the New York Pathological Society to apply the amount ($100) to any purpose which might seem desirable. The matter was referred to the trustees, and they decided that the most fitting tribute to Dr. DaCosta's generosity would be to purchase some microscopes for the use of the Society, and requested the speaker to procure them. He has succeeded in getting two microscopes, one having an Abbé condenser and a objective, the other having no condenser and being of a low power. The microscopes will be engraved with an inscription to the effect that they were the gift of Dr. DaCosta.

CHINESE SUPERSTITION.-The Lancet states that a medical missionary nearly lost his life through an outburst of fanaticism at Foochow, China. It seems that the doctor, who was attending a patient with hemorrhage, immediately proceeded to check the latter, in disregard of a native superstition according to which delay should have been made until the patient's friends had finished consulting the gods in the joss-house. The patient died, and the Chinese would have boiled the doctor in oil, but for the courage of some of the

converts.

INCREASE OF BEER DRINKING.-In the year 1886, 642,967,720 gallons of malt liquor were consumed in the United States, being 11.18 gallons to each man, woman and child in the country. In 1840, there were only 1.36 gallons to each. In Great Britain 32.79 gallons per capita were consumed in 1886; in Germany, 23.78. It seems, however, that the malt liquors have been driving out the distilled, reducing the per capita rate from 2.52 gallons to 1.24

-Merck's Bulletin, published monthly, contains much valuable information in regard to new remedies. Its publishers claim that it is not an advertising or business medium in any sense whatever; that no advertisements or business notices of any nature are received in its pages, and that its method of discussing its matters is purely scientific, statistic and neutral.

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-In answer to a correspondent, we would state that the Valedictory Poem delivered at the annual commencement of the Jefferson Medical College, March, 1879, by Prof. James Aitken Meigs, M. D., may still be procured from Wm. F. Fell & Co., 1220-24 Sansom Street, Philadelphia. Price, postpaid, 20 cents.

-The name of The Canada Medical and Surgical Journal has been changed to The Montreal Medical Journal. It has been enlarged from sixtyfour to eighty pages, and the subscription reduced to $2.00 per annum. We congratulate its esteemed editors on these evidences of its continued success.

-The annual meeting of the Southern Surgical and Gynecological Association will be held at Birmingham, Alabama, September 11th, 12th, 13th, 1888. Dr. W. D. Haggard is President, and Dr. W. E. B. Davis, Secretary.

-The Mississippi Valley Medical Association will meet at St. Louis, September 25th, 26th and 27th, 1888. Dudley S. Reynolds, A.M., M.D., of Louisville, Ky., is President, and John L. Gray, M.D., of Chicago, Ill., Secretary. These meetings are always eminently successful, whether regarded from a scientific or a social point of view.

PERSONAL.-Prof. Parvin has removed to 1636 Spruce street, Philadelphia.

Dr. M. L. Emrick (J. M. C., 1888), is at 135 N. 15th St., Phila.

Dr. George H. Flett (J. M. C. 1884) has removed to Sisson, California.

Dr. E. L. Dawson (J. M. C., 1888) has removed to Buena Vista, Arkansas.

Dr. A. P. Jacoby (J. M. C., 1887) has removed to Phillipsburg, New Jersey.

Dr. J. B. Loos (J. M. C., 1888) has removed from Bethlehem to Scranton, Pa.

Dr. Harry B. Ely (J. M. C., 1886) has removed from Laceyville to Ariel, Penna.

Dr. J. H. O'Connor (J. M. C., 1888) has located at 1216 South Tenth Street, Philadelphia.

Dr. Calvin DeWitt, Major and Surgeon, U. S. A. (J. M. C., 1865), has been ordered to duty at Fort Missaula, Montana.

Dr. Daniel G. Caldwell, Major and Surgeon, U. S. A. (J. M. C., 1864), has been ordered to duty at Jefferson barracks, Mo.

Dr. D. M. Appel, Captain and Assistant Surgeon, U. S. A., has been ordered to Fort Bliss, Texas, for temporary duty.

Dr. Henry Leffmann (J. M. C., 1869) has been elected Lecturer on Chemistry, at the Woman's Medical College, Philadelphia.

Dr. J. R. Maxwell (J. M. C., 1888) has located at Parkesburg, Penna.; and Dr. F. Horace S. Ritter (J. M. C., 1888), at Elkland, Pa.

Dr. James E. Reeves, of Chattanooga, Tennessee, has accepted a commission from the State Board of Health of that State, to go all along the Southern line, to examine the quarantines, State and municipal, in order to perfect its own. The selection is an excellent one, and will doubtless result in very valuable service to the State and its people.

Marriages.

COMSTOCK-CULLINAR.-On July 18th, 1888, A. J. Comstock, Jr., M.D. (J. M. C., 1884), and Elizabeth W. Cullinar, both of San Buenaventura, California.

COPE-WALLACE.-On July 25th, 1888, A. B. Cope, м.D. (J. M. C., 1883), of Mount Union, Ohio, and Lizzie Wallace.

FLETT-COCHRAN.-At Dunsmuir, California, August 15th, 1888, George H. Flett, M. D. (J. M. C. 1884), and Georgiena Cochran.

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Vol. IX.

No. 10.

October, 1888.

THE COLLEGE AND CLINICAL RECORD.

Clinical Lecture.

AORTIC ANEURISM AND EMPHY

SEMA.

A Clinical Lecture delivered at the Philadelphia Hospital, BY JOSEPH S. NEFF, M. D.,

Physician to the Hospital and to the Jefferson Medical College Hospital, etc.

Reported by WILLIAM H. MORRISON, M. D.

Gentlemen:-You will probably recall a case which I brought before you in the early part of the session, that of a colored man in whom there was considerable difficulty in arriving at a satisfactory diagnosis. After a thorough study of the case we diagnosticated aneurism of the ascending arch of the aorta. The patient died some six weeks ago, from compression of the trachea, and the post-mortem examination verifies the diagnosis. I have here the specimens, which I shall exhibit to you.

In speaking of thoracic aneurism, I told you that sometimes the diagnosis is extremely easy, while at other times it is impossible to express a positive opinion. Thoracic aneurism of large size may exist and not be discovered. I have seen many instances in which such aneurisms were found post-mortem in cases where there was no suspicion that such a condition existed. In the present case, there was at the time that the patient was before you dullness in the second and third intercostal spaces extending one inch to the right of the sternum, and in this region there was also slight prominence. On palpation, there was a pulsation detected over this part, but it was not of an expansile character. As you know, an expansile pulsation is characteristic of aneurism. If you have that you have an aneurism, if you do not have it, you cannot be positive that an aneurism is present. In this instance there was merely the impulse which might be transmitted to any solid growth overlying the artery. The diagnosis lay between aneurism, a solid growth lying over the aorta and solidified lung over the artery. The latter condition was eliminated without difficulty, for the pressure signs were too marked to be due

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to solidification of the lung. There was pressure on the trachea and on the recurrent laryngeal nerve, causing stridor and sometimes aphonia. It is interesting to note that a mass of this size (four inches in diameter) did not cause other pressure symptoms.

On auscultation no abnormal sounds were heard over the cardiac area and no murmur was heard over the tumor. The heart sounds were, however, if anything, more distinctly. heard over the area of dullness than over the heart. There was no bruit and no murmur either systolic or diastolic. One of the great points in the distinction between disease of the aorta with no dilatation of the vessel and aneurism in this location, is that in the former there is almost always a large amount of compensatory hypertrophy of the left ventricle. Although this may be present in aneurism, it is not so constant. In this case there was no marked hypertrophy of the walls of the left ventricle; neither was there dilatation of its cavity. This is also verified by looking at the specimen. There was found no disease of any of the valves that would produce a

murmur.

Aneurism of the innominate was excluded by the fact that pressure on the subclavian and carotid arteries did not affect the impulse. If the innominate artery had been the seat of the aneurism, this pressure would have stopped the impulse.

One symptom presented by this patient was pain. He was placed on the use of iodide of potassium in large doses, and in the course of two or three weeks the pain ceased, and the impulse over the tumor also disappeared. Later on bronchial breathing was found at the posterior part of the chest, indicating that the lung was being pressed upon by a solid

mass.

Turning now to an examination of the specimen, we find a large aneurism of the ascending arch of the aorta. We find that there has been a rupture of the inner coat of the artery about three-fourths of an inch above the valve. This point of rupture is of some importance. A true aneurism is a dilatation of the vessel without a rupture of

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