own private laboratory, could be restored to the practice of his profession at the present day and have at his command the variety of medical preparations, in concentrated and palatable form, that the enterprise and skill of pharmacists have introduced, he must feel as if his occupation were gone, or certainly that portion of it which had to do with the preparation of medicines. The improvements in pharmacy have been so many and so important that we doubt if there are many physicians to-day who have kept pace with them, and who are fully informed regarding the preparation of drugs and methods of administering them acceptably to patients, and yet given equal opportunities and equal medical acquirements that physician who applies in his practice the improved methods pharmacy has provided, and is constantly adding to, reaps the largest share of pecuniary

success.

Since the discovery of the subcutaneous method of medication many drugs have been prepared in forms which admit of their being administered hypodermically. The convenience and accuracy of this method must grow to be more generally appreciated, and we doubt not it will in time supersede, in many cases, the exhibition of medicine per os. The improvements in hypodermic syringes and the manufacture of a sufficient variety of tablets to meet the requirements of practice has given a further impetus to the hypodermic method. It will be gratifying to our readers, therefore, to learn that Messrs Parke, Davis & Co., with their characteristic prompt recognition of the demands of the profession, now offer a very complete line of hypodermic tablets, which they supply in small glass tubes, convenient for carrying in the pocket or medicine case, each tube containing 25 tablets. For the convenience of physicians, they have also devised a pocket-case, containing an improved hypodermic syringe especially adapted for the use of these tablets and six tubes of tablets. Any formulæ which physicians may desire, and which can be made into tablets, will be manu. factured to order. We believe this method of medication cannot fail to become more and more popular as its advantages grow to be appreciated.-Southern Med. Record, Sept., 1886.

DEEP INJECTIONS OF YELLOW OXIDE OF MERCURY IN SYPHILIS.-DR. SHAPEK gives in the Proceedings of the Kieff Medical Society, an account of some observations made in PROF. STUKOVENKOFF'S clinic on the employment of yellow oxide of mercury injections, in the condylomatous stage of syphilis. The solution used was prepared by rubbing up sixteen grains of the oxide with twenty of gum arabic, and an ounce of water. The injections were made not hypodermically into the subcutaneous tissue, but, according to a plan recommended by PROF. SMIRNOFF, of Helsingfors, the needle, which was four or five centimetres in length, being plunged almost vertically into the gluteal muscles. In three cases five injections were given; in one case, four; in one, six; and in one case, ten injections were administered at intervals generally of a fortnight; a grain of the yellow oxide being introduced each time by means of two separate punctures on opposite

sides of the middle line. In some cases, however, half a grain was injected weekly. The writer found these injections well borne by patients, only very slight local signs of irritation being induced, and in many cases none at all. In one case there was a hard swelling as large as a nut, but it was not painful, and soon passed away. The mercury, too, was always very quickly absorbed, being detected in the urine in four of the cases after the lapse of twenty-four hours from the first injection, and at the end of forty-eight hours in the other two cases. DR. SHAPEK remarks that this method is inexpensive, simple, and efficacious, and will probably be found particularly useful in what in this country would be described as club, union, and dispensary practice. -The London Lancet.

CONTRIBUTION TO THE STUDY OF THE FERRUGINOUS PREPARATIONS EMPLOYED HYPODERMATICALLY.-DR. HIRCHSFELD has made hypodermatic injection of iron preparations the subject of an elaborate essay, historical, physiological, and therapeutical (Bull. Gen. de Thérap., July 15, 1886). In his historical summary, which is quite complete, he has not overlooked the contributions of Americans, and has referred to the paper of DA COSTA. The first experience in his practice was that of ROSENTHAL, of Vienna, which was made in 1872. Since that time numerous observations and experiments have been reported, on the whole favorable to the practice. But HIRCHSFELD says: "Our results and conclusions do not coincide with those of the partisans of the hypodermatic method. We entered into the investigation without preconceived ideas, and we publish our conclusions as they were reached." The most important fact disclosed in the investigation thus far published, is the following:

"On examination of the blood, the number of red globules had sensibly diminished-a fact which had previously been observed both in men and in animals as a result of the hypodermatic injection of iron."

No conclusion has been reached as to the preparation most suitable for administration subcutaneously. The preparation of ROSENTHAL has been used more frequently, probably, than any other. This is obtained by dissolving the pyrophosphate in a solution of citrate of soda. In a half hour after the injection of this salt, iron may be detected in the urine.-Amer. Jour. of Med. Sci., Oct., 1886.

5. Should spots of trachoma be left after the first application of the powder, it can be reapplied in from six to ten days, thus localizing its action.

6. Its permanent effects are the same as those produced by the solution.

7. It appears to be much the safer remedy, for it does not seem necessary to limit its use to old trachomas with pannus.

8. Attention is especially directed to the fact that great caution is necessary in using this remedy, in any form, on account of the unexpected and somewhat alarming constitutional effects sometimes produced.—Pacific Med. and Surg. Journal, October, 1886.

in sulphur. It is applied, after careful wash ing and drying of the affected part, either in the crude form or as a compound sulphate of ichthyol and soda or ammonia, and at the same time is given internally in the form of drops or pills, the dose being from 15 to 25 drops of the sulphate of ichthyol and ammonia, or a similar quantity made up into from six to twelve pills In all cases the pain was relieved, but the swell ing was not affected, so that the author think that the drug must only be used in the expec | tation of relieving pain. He warns his readers too, that where the external applications are carried on for a long time, or without the necessary precautions of washing, a pustular erup tion is liable to occur.-Lancet, Oct., 1886.

TROUVE'S ELECTRIC SOUND FOR FOREIGN BODIES.-M. POLLAILON gave an account before the Académie de Médecine of an operation which he performed on a man who swallowed a tablefork. There was some difficulty in detecting the exact position of the foreign body; palpation and the introduction of an œsophagean sound gave but little result, but the sound of M. TROUVE, to which is attacted an electric bell, solved the difficulty. An incision was

then made from the ninth rib of the left side, a quarter of an inch from the costal cartilage down towards the umbilicus for three inches; the peritoneum was opened, and the anterior wall of the stomach was drawn to the abdominal opening and incised to the extent of an inch, the fork was seized with a forceps and easily withdrawn, the wound was ligatured with catgut, and the stomach abandoned, the external incision was treated in the ordinary way, and the patient did well.-Med. Press and Circular.

SEVENTY CASES OF RHEUMATISM TREATED BY ANTIPYRINE. DR. JOLEBIEWSKI, while attached to the military forces in Dresden, has observed the effect of antipyrine in 70 cases of rheumatism. He places its action on an equal with acid salicylic. The action was in general very prompt. The average duration of the disease in the above recorded cases was three to four days. He thinks it best to begin with large doses-60 grains night and morning. This dosage was not strictly adhered to when the patients were very weak and thin, or when there were complications with other diseasesa much smaller amount then being given.

Antipyrine proved as much a specific as salicylic acid in chronic as well as acute cases. There was no case of collapse. In only two of the 70 was there urticaria. The amount of perspiration varied extremely with different individuals. Nausea was quite often observed, especially when taken near meal times.- Va. Med. Monthly.

COTOINE IN DIARRHOEA.-In the Thera peutic Society, July 21, M. HUCHARD read note on the therapeutic properties of cotoine or the extract of coto, a plant found in Bolivia It is exhibited in the dose of two to three grain for adults in various forms of diarrhoea. I may be given in powder, in the form of an alexholic extract or as a tincture. The wine of cote may also be made by macerating for six day an ounce of coto bark in a liter of Malaga wine.

M. HUCHARD gives the coto in powder, pre ferably in doses of three grains, with marked favorable results in tuberculous and various other forms of diarrhoea.-Le Progrès Médicale

PISCIDIA ERYTHRINA IN OBSTETRICS.-LES SONA (Gazetta delle cliniche, February, 1887 reports upward of 100 cases in which he admi istered this drug, either in threatening abo tion or during the first stage of labor. Promp relief of excessive pain was experienced in per cent. of the cases. For the sake of compar ison, opium was given to 96 other patients, wit a similar result in 80 per cent. of the number.N. Y. Med. Journal.

NAPHTHALIN AS AN ANTHELMINTIC.-DR CORIANDER, of Samarkand, recommends naph thalin as a valuable and economical remedy especially in country and military practice, for worms, both tænia and ascarides. He give children of from one to three years of age twe or three grains twice a day. In the case o adults he gives from 20 to 80 grains a day in powder with sugar.

ICHTHYOL IN RHEUMATISM.-DR. BUBELIR has been using ichthyol in the Moscow Military Hospital in rheumatic cases, both of an acute and chronic type, with success. This substance is obtained from mineral oil, and is rich

MENTHOL IN NASAL REFLEX NEUROSESDR. ROSENBERG, of Berlin, recommends the application of gelatin_bougies containing one sixth grain of menthol, for the relief of refle neuroses due to nasal disease.-Pacific Recor of Med. and Phar., Oct., 1886.

́ol. IV.

Original Articles.

WOUNDS OF THE HEART.*

I HAL C. WYMAN, M. D., SURGEON DETROIT POLYCLINIC, ETC.

A

For the purpose of ascertaining how long an imal might live after a penetrating wound of e heart, and also for the purpose of studying e mechanism of death resulting from such ›unds, I made the following experiments on æsthetized dogs and cats: The instruments ed were of two kinds, about the length an ordinary knitting needle, and meased a sixteenth of an inch in diameter. One d a tapering, sharp, round point; the other d a cutting point flattened on each side. The e instrument makes a perfect punctured und-crowding the tissues one side and laceting them as they roll up to resist advance of e instrument. The other instrument makes a all incised wound, which was slightly dilated the rounded part of the instrument. edium-sized dog had the cutting instrument, st mentioned, thrust through his left side in Hirection to insure its passage through the art. The hand on the handle of the instruent felt plainly the violent movements of the paled heart. The needle was now quickly thdrawn and the time noted when the expition was made. Respiratory movements eedily became rapid, a convulsion soon ran rough the muscles of the animal, and three nutes after the wound was inflicted the acn of the heart could not be detected. An topsy (?) was now begun. The chest was ickly opened. The pericardium was foumd derately distended with blood, which, on ening the sac, was found to proceed from a und of the right coronary artery An effort s made to reach the cavity of the right venele by passing a probe along the wound made the needle, but failed because the different ers of muscle fibres, contracting in different ections, had distorted the channel of the und. During this attempt to pass the probe heart muscle was observed to contract spasdically, showing that the vital energy had no means left the heart, although too little mained to carry on the circulation of the

A paper read before the meeting of the Wayne County ical Society, Nov. 17, 1886.

No. 22.

blood. Further examination showed that the needle had transfixed the right ventricle and the left auricle and had advanced into the left lung in which a small amount of free hemorrhage was found in the larger bronchi. This animal lived three minutes after receiving the wound of the heart. Death resulted from two conditions, shock, and hemorrhage from the right coronary artery, which so weakened the power of the ventricles that they failed to send the blood into the lungs and brain.

A second medium-sized dog was experimented upon in the same way as the one just described, with this exception, that the instrument used to puncture and transfix the heart had the round, tapering point. Time was noted. Sharp cry, and rapid breathing followed the withdrawal of the needle, notwithstanding the anæsthesia. The dog was released from his fastenings while the heart's action rapidly increased in frequency. (I forgot to say that I felt the beating of the heart unmistakably while the needle was transfixing it.) As the anaesthesia passed away his movements became more sudden and incoördinate than I had noticed before in animals coming from under the influence of an anæsthetic. There was a peculiar quickness in the way he moved his head in attempting to walk, which I attributed to the shock of the punctured wound and which, reminded me of the case related by SIR ASTLEY COOPER of the young lady who suffered a punctured wound of the finger and in consequence screamed, fainted and died; only my patient did not die. Twenty minutes after the wound was made the dog appeared as well as any dog so soon after anæsthesia. Two hours later he was frisky and drank some water. The following day he ate and seemed well, and twenty hours after the experiment, through some carelessness of the keeper, he escaped from my laboratory. The man said he ran down the street and out of sound and sight with the swiftness of a deer.

A third dog, a little smaller than those mentioned, was punctured through the heart in as nearly the same direction as possible. He yelped and moaned piteously almost immediately after the instrument was withdrawn. His heart beat violently; his mouth and tongue grew pale. His respiration was asthmatic. It appeared that he must soon die. After half an hour he was much easier, and was disposed to be quiet, giving little attention to his surroundings. I thought best to kill him to ascertain how

far the wound through the heart could account for the smyptoms, and thrust an awl into the medulla oblongata, causing immediate arrest of the heart and respiratory movements. On opening the chest, I was surprised to find only a small amount of coagulated blood in the pericardium. The right pleural cavity contained some blood, and there was some pneumo-thorax. The presence of coagula in the pericardium, doubtless, embarrassed the heart's action, and made it beat more vigorously. In a few hours more this cause would probably have induced pericarditis.

Two cats now became the subject for research. The pointed needle was forced through the heart of one and quickly withdrawn, the animal expiring almost instantly. The wound was examined, but revealed only a mere trace of blood in the pericardium. It is possible that the sudden death in this case may have been caused in part by the action of the anesthetic. I could find no wound of nerves or cardiac ganglia. The needle had transfixed both ventricles near their apex. Shock from the wound was probably the main factor in this death:

Cat No. 2 was wounded through the heart with the instrument having the cutting point. She immediately uttered a cry, and tried to escape from her fastenings. The respiration and heart struggled violently. On releasing her she jumped furiously about the room, biting at objects and occasionally vomiting. This violent agitation continued for twenty-five minutes, when she gradually became quiet, and at the end of one hour and eight minutes after the wound was made, the heart's action had ceased. I now opened the chest and neck, exposing the trachea and thoracic viscera. The pericardium was filled with blood, which had coagulated, making a firm clot around the heart. There was, however, no such relative distention of the pericardium, pushing the lung up into the apex of the chest, as we often see in cases of dropsy of the pericardium. There was not enough blood to have caused death by its mere abstraction from the circulation. Nor was the pericardium so distended as compared with what we see in hydrops pericardii as to stop the action of the heart by force of compression. I think the firm resistance offered by the coagula was the cause of arrest of the heart's action, acting on the peripheral branches of the cardiac division of the pneumogastric to increase its inhibitory action, as galvanism or blows increase it. The clots were quickly turned out by laying open the pericardium. An opening was made into the trachea, and through this artificial respiration was carried on, and, notwithstanding the fact that the heart had been apparently dead for five minutes, I succeeded in re-establishing its action by first grasping the heart in my hand and imitating the action of the ventricles by

giving them about five short squeezes for every time the lungs were distended by the bellows used in carrying on artificial respiration.

I could not have made a nicer illustration of the ability of art to establish an artificial cir culation of the blood.

These are not all the experiments which I have made concerning the tolerance of the heart for trauma. Some of them suggest already the propriety of emptying the human pericardium of clots by surgical procedures. when we find that the heart resists the first shock of the wound inflicted upon it, and the wound in the walls of the heart is not too large to admit of being closed by muscular action.

It is interesting to observe what a few surgical writers say upon the subject of heart wounds before making any further deductions from the experiments which I have aimed merely to describe. DR. JOHN A. LIDELI says, in the Encyclopædia of Surgery, by ASHHURST: The traumatic lesions of the heart consist of punctured and incised wounds; contusions, lacerations, and ruptures; and gurshot wounds. Formerly, punctured and incised wounds were most frequently met with at present, however, the lesions from firearms are much more common. Death occurs instantaneously in some of the cases, but in most instances, a brief interval elapses before life is extinguished. A farm hand, aged 18, was ac cidentally shot in the left breast, July 7, 1878. with a small revolver (calibre, inch). In

less than a fortnight he was again at work, ap parently well. He continued in good health. performing the ordinary labor of a farm-hand without inconvenience, until August 30, when he was found dead at his work behind a plough, fifty-four days after the accident. The autopsy showed that death had resulted from extravasation of blood into the pericardium and left pleura. The missile was found to have passed through the pericardium, the righ: ventricle, and the septum, together with the semilumar valve next the septum into the aorta. The explanation of the lodg ment of the ball is, that it encountered a well-filled left auricle, and, being spent, it dropped down through the left auriculo-ven tricular opening to the place where it was found. The wound through the right ventricle was valvular, and the pericardium, healing quickly here, prevented the escape of blood. This, finally rupturing, from over-distension. death ensued. With needful rest for a time instead of labor, no reason appears why this young man should not have in reality recov ered.

VELPEAU mentions the history of a man who was stabbed in the left side. The symptom which ensued were such that at the time the heart was supposed to have been pierced

Nine years afterward he died from other causes. The autopsy established the truth of the former diagnosis, as the cicatrix of the wound was found in the right auricle as well as in the pericardium.

DR. FISCHER has collected 452 cases of heart wound, of which 380 ended in death, and 72 in recovery. Death was immediate in 104 cases, while in 370 it occurred after intervals varying from one hour to nine months. There were 44 punctured wounds, with ten recoveries; 260 punctured and incised wounds, with 43 recoveries; 72 gunshot wounds, with 12 recoveries, 76 contusions and traumatic ruptures, with 7 recoveries. In 36, or exactly one-half of the 72 recoveries, the diagnoses were verified by postmortem examinations held long after the original injuries: and this circumstance affords good ground for supposing that the remaining 36 cases were likewise correctly diagnosed. FISCHER also notes the relative frequency with which different parts of the heart were wounded. In 123 cases it was the right ventricle; in 101 the left ventricle; in 28, the right auricle; in 13, the left auricle; and in 17 the apex of the organ. The right ventricle and the right auricle are wounded much oftener than the left ventricle and the left auricle because they occupy by far the larger share of the front or exposed portion of the heart. The statistics collected by M. OLLIVIER and by M. JAMAIN support FISCHER'S conclusions.

Additional examples of recovery from wounds of the heart, which have appeared during the last twelve years, may be found reported as follows: In the London Lancet a case is recorded of the removal of a needle from the heart on the ninth day, recovery ensuing. DR. C. L. FORD reports a case of heart-wound from a buck-shot, which was successfully treated. In the British and Foreign Medico-Chirurgical Review there is related a case of bullet wound of the heart with recovery; on the twentieth day the external wound was already healed and the cicatrix moved synchronously with the systole of the heart.

Additional examples of long survival after wounds of the heart, which have been noted during the last twelve years, may be found reported as follows: MR. WEST in an article on wounds of the heart gives a summary of twenty cases. In one of them the patient lived nineteen years and seven months, after both ventricles had been wounded with a kuife.

DR. S. P. CONNER reports a case of a gunshot wound of the heart, wherein both ventricles and the right auricle were involved, and yet the patient survived 3 years, 2 months and 13 days. STENDENER, Halle, is quoted as reporting a case of pistol-shot wound of the heart with survival for fifteen weeks. On autopsy a cicatrix was found at the apex of the left ventricle, corresponding to the wound of

the pericardium; grains of powder were also found embedded in the substance of the heart. SIR JAMES FAYRER mentions a case of bulletwound of the heart, with survival for 72 days. The missile was found in the apex of the left ventricle. TILLAUX is quoted as having exhibited at the Société de Chirurgie, the heart of a woman who had survived two gunshot wounds for eighteen days, one missile lodging in the left ventricle of the heart. DR. H. W. BOONE relates a case of gunshot heart wound, with survival of thirteen days. A case of stabwound of the right ventricle of the heart is reported, in which the patient lived five days. DR. G. F. DUDLEY reports a case of pistol ball in the heart, in which the patient lived four days.

The symptoms of heart wounds are often very obscure. There may be present in cases of wounds which penetrate the region of the heart, great prostration of the strength with swooning or syncope, a thready, weak, irregular pulse, a feeble and tumultuous action of the heart, præcordial distress and anxiety, with dyspnoea and other signs of hemorrhage into the pericardial and pleural sacs, pallor, cold sweats, a husky voice and excessive thirst, together with a systolic bellows murmur or other abnormal sounds, without establishing anything more than a strong presumption that the heart itself is wounded. But although the traumatic lesions of the heart are not attended by any symptoms that are peculiar to, or characteristic of them, the occurrence or coincidence of most of the phenomena just mentioned, in a case where a patient is wounded in the cardiac region, will render the diagnosis of a cardiac wound highly probable. According to DR. FISCHER'S statistics the phenomena which usually predominate in cases of sudden death from this lesion are those of sudden syncope, or collapse; not unfrequently a hurried exclamation or a convulsive gasping occurs; but the popular notion that persons spring into the air when shot or stabbed through the heart, is not supported by the facts.

In the causation of sudden death from traumatic lesions of the heart, there are three important factors: (1), shock; (2), anæmia of the brain and lungs, directly caused by the escape of blood from the chambers of the heart; (3), arrest of the cardiac movement by compression resulting from distension of the pericardium with extravasated blood. Oftentimes in such cases, a necropsy shows the heart firmly contracted and empty, with much extravasation of blood in the pericardial and pleural

sacs.

BELL'S Surgery, 1804, vol. I., p. 266:

Wounds of the heart and large vessels connected with it, are at all times attended with much danger, nor is the greatest exertion of of practitioners able to lessen it. Of such a