of four to six week courses. A list of these will be found to announce teaching that takes up as specialities the various departments through the whole range of surgery, from classes to teach the uses of surgical instruments and the dressing of injuries, to courses on the finest and most difficult surgery of the eye, ear and genitals. The short duration of these practical courses enable a man to have a handto-hand struggle with the leading difficulties in any special department without expending an unreasonable amount either of time or money. My space warns me that I must postpone the discussion of Vienna's teachers to another time. J. H. DUNCAN. To the Editor of the CANADIAN PRACTITIONER. VIENNA CORRESPONDENCE. The great reputation enjoyed by the Vienna medical faculty has, during the past few years, caused such an increase in the number of students, that all matriculated in the University are unable to participate in the lectures and private courses in a satisfactory manner. The faculty, seeing that the success of demonstrative instruction, which forms the basis of medical study here, was suffering some damage, petitioned the Government to endeavor to abolish the defect. Accordingly, two years ago, a pathological institution was erected and a new building for descriptive anatomy is now in course of construction. Even with these added facilities all cannot be accommodated, and the Government, not wishing to expend any more money, and fearing the present increase of students will not continue, has requested the faculty to limit the number, considering that those students who are not among the elect can as well find some other school where they may begin or continue their studies. The faculty will no doubt deliberate upon the question, and, it is expected, answer the Government by tabling its request. There were last year in attendance at the University about 6,000 students, 2,407 being matriculated in medicine. These crowded the laboratories, lecture-rooms and hospital wards, and it is scarcely probable that the powers who have control in this matter will close the door in the face of those eager for ad mission. Other universities have attached to them earnest thinkers and original investigators, and numerous cities outside of Germany have many leaders in the profession, but in Vienna there is such a grouping of great and lesser lights, forming a constellation unequalled in splendor by any other city on the Continent. The hospital may be divided into twelve clinics. One, known as internal medicine, has in connection with it twelve professors, ten private teachers and a large staff of assistants. Professor Bamberger has his clinic for medical pathology and therapeutics from seven until nine during the summer session, but during the winter session the lectures commence at eight in the morning. He has been in his present position since 1872, and is well known for his valuable treatise on Affections of the Heart, and for a more recent and also classical standard work, Diseases of the Chylopoietic system. A graceful and prolific writer, he has contributed many monograms to enrich the current literature of the day; as a diagnostician, he is unequalled by even Gehrhart, of Berlin; a man of vast erudition, he devotes himself less to private practice than to clinical teaching in which he is so eminent, and is the last of the second renowned Vienna school, whose chief representatives were Rokitansky, Skoda and Hebra. His assistants are Dr. Musser and Dr. Hugo Ritter von Frisch, who give private courses, lasting for five weeks, on the diagnosis, pathology and treatment of medical diseases. Professor Nothnagel, renowned for his work on Therapeutics, was called to Vienna from Jena four years ago. His lectures, fluently delivered, are well calculated to instruct students, and are so popular that in order to secure a desirable seat one is forced to be at the lectureroom some time before the hour. The lectures are practical demonstrations with a patient always before the class; object teaching in the study of symptoms. His assistants, Dr. Jaschks and Dr. E. Bamberger- son of the professorgive excellent private courses on internal medicine. A part of the work in the wards for the clinical clerks is the examination of sputa for the bacilli in suspected cases of phthisis. It is considered when found, to be of positive diagnostic value; but when not discovered, it is no In the Obituaries. DR. MCBRIDE. on the Book Notices. Surgical Lesions of the Brain and its En- velopes. proof that the disease does not exist. offices of the best clinicians here it is as common to see the test materials for examining sputa as it is to find the solutions for testing urine in other places. Perhaps there is a special reason It is with deep regret that we announce the for this, for phthisis is of such frequent occur- death of Dr. McBride, of New York. He had rence as to be known by the name of morbus been suffering for some time from Bright's Viennensis a term at times embarrassing disease, and spent the greater part of the sumto new-comers. In this clinic, Dr. Jaschks mer at Carlsbad, where he received temporary has on several occasions removed, by hypo- benefit. On his return home he died of dermic needle, materials from the spleen in uræmic coma, when ocean. Dr. typhoid fever and from the lung inpneu- McBride was one of the rising physicians of monia to be examined for the bacteria peculiar | New York, and would have occupied one of the to these diseases. Whether this procedure is most distinguished positions on the continent if expedient, or even justifiable, is open to ques- he had been spared. tion, yet it may be said that in two cases where the disease terminated fatally no trace of the small punctures were to be found at the autopsies. In Nothnagel's wards is used a new test for the detection of sugar in the urine, recently introduced by Fischer; it is extremely delicate and easily made. Take two parts of phenylhydrazin and three parts of the acetate of sodium, and dissolve, gently heating over a spirit flame, in a test tube filled one-fourth with water, then add an equal quantity of urine and place the test tube in a water bath for fifteen minutes; then put into cold water, and if sugar be present crystals are deposited, which, on microscopic examination, will be found to have the form of small rosettes of a yellowish color. Dr. Heitler's class on physical diagnosis is very popular with the doctors visiting this city. It is held late in the afternoon, five times a week during the session; each course lasting for six weeks. Dr. Heitler is now the only private teacher in connection with the hospital who was a student under Skoda and Rokitansky, and has adopted, so far as possible, the style of teaching of his preceptors. He has the renown of a good diagnostician, making his chief effort at the bedside lecture, towards a clear cut diagnosis, and to give a concise outline of the disease. W. H. B. AIKINS. DOUBLE EMBRYO IN A SINGLE BLASTODERM. -Prof. Legge, in a communication made to the Eustachian Society of Camerire, states that he has had the fortune of meeting with, in a fowl's egg, at about the third day of incubation, two embryos in a single blastoderm, joined together at the summit.-Revista Clinica. Some Recent Experiences in Clinical Surgery. By DONALD MACLEAN, M.D. Reprinted from the transactions of the Michigan State Medical Society. Operations on the Drum-head for Impaired Hearing, with fourteen cases. By LETH S. BISHOP, M.D., of Chicago. Reprinted from the Journal of the American Medical Association. Galvano-Cautery in Diseases of the Prostate Bladder and Urethra. By ROBERT NEWMAN, of New York. Read in the surgical section at the 37th annual meeting of the American Medical Association. Reprinted from the Journal of the American Medical Association. Electrolysis in Gynaecology, with a Report of three cases of Fibroid Tumor successfully treated by the Method. By FRANKLIN H. MARTIN, of Chicago. Read at meeting of American Medical Association, with discussion; also supplementary paper citing two cases of Fibroid Tumor treated by Electrolysis. By J. N. FreeMAN, M.D., Brooklyn. Reprinted from the Journal of the American Association. Dr. J. H. Duncan, who has been spending a few months in Vienna, will resume his practice in Thamesville, Ont., on his return early in January. BIBLIOGRAPHICAL NOTE. The following extracts from the preface to the forthcoming (sixth) edition of "The Principles and Practice of Medicine," by the late Dr. Austin Flint, will be read with interest, as evincing alike the enormous personal experience upon which the author founded his opinions, and the very complete manner in which he has presented to the fellow-members of his profession the matured results of his life's labors. own hand. "The basis of the work is an unbroken series of records of cases in private practice and in hospitals, begun in 1833 and continued for more than half a century, covering sixteen thousand nine hundred and twenty-two folio pages of manuscript, written with the author's These records embrace carefullywritten histories of cases in all departments of practical medicine, observed under varied conditions of life, climate, and general surroundings. Soldiers in camp and barracks; the rich and the poor; those affected with diseases incident to lives of ease and luxury, and paupers in hospitals; the pioneers of Western New York, and the inhabitants of the metropolis; patients in the wards of the almshouse and hospitals of Buffalo; of the Marine Hospital in Louisville, Kentucky; the great Charity Hospital in New Orleans, Louisiana; the Bellevue Hospital, the Charity Hospital, the Dispensaries, and similar institutions in the city of New York. Cases observed in the experience of a quarter of a century as a general practitioner, and of more than another quarter of a century as a consulthave occurred in this country within the last ing physician, including the epidemics which fifty years the experience derived from these various sources of observation, carefully recorded, studied, and analyzed, was finally used in the composition of this treatise. that the eliminations, substitutions, and addi"The claim in the preface to the fifth edition, tions, rendered it essentially a new work,' can with equal propriety be made for the present edition as compared with the edition issued in 1881. Among the entirely new articles, special attention may be called to the following: Infectious Tumors, Syphilitic Disease of the Lungs, Cerebral Syphilis, General Considerations relating to Inflammatory and Structural Diseases of the Spinal Cord, Spastic Cerebral Paralysis of Children, Hereditary Ataxia, Myxedema, Multiple Neuritis, General Pathology of Fever, and Milk Sickness. In addition to these new features, many articles have been entirely rewritten; and in nearly every article changes and additions, some of them very important, have been made." Miscellaneous. The following, taken from one of our dailies, shows the false position in which the profession may be placed by one of its unscrupulous members: "Good morning, gentlemen," said the doctor, as he walked into the newspaper office, "is the city editor in? Ah, yes, I see. Mr. Huntemup, there was an accident on Fremont avenue this afternoon that I thought you would like to hear of. Mrs. John Peduncle was thrown out of her carriage and sustained a compound fracture of the right clavicle. She was taken home and medical aid summoned. Her injuries were skilfully attended to, and she is now resting easily. You might say that I was called and have charge of the case." "By the way, doctor," said the advertising manager, looking up from his books, "I would like to insert an advertisement for you in the I'll let you have it a year for $30 an inch, payable Banner. "Sir," interrupted the doctor with a scowl, "I never advertise. It is contrary to medical ethics. Good day, gentlemen." THE Canadian Practitioner FORMERLY "THE CANADIAN JOURNAL OF MEDICAL SCIENCE." Literary Communications may be addressed to any of the Editors. All Exchanges and Business Communications should be addressed to DR. ADAM WRIGHT, 20 Gerrard Street East. TORONTO, NOVEMBER, 1886. Original Communications. SECONDARY PUERPERAL HEMORRHAGE. BY A. H. WRIGHT, M.B. TORONTO. (Read before the Ontario Medical Association, June, 1886.) membranes by pressure on uterus without traction on cord. Examined placenta carefully and thought it all expelled; everything seemed favorable; rather less than average amount of hemorrhage; lochial discharge normal, gradually growing lighter in colour-quite pale by sixth day; uterus diminished in size from day to day; no after-pains requiring treatment. On tenth day after delivery, without any It is hard to draw a definite line between apparent cause, a sudden hemorrhage comordinary post-partum and secondary puerperal menced, sufficiently copious to be rather alarmhemorrhage, but we will probably be safe in ing. Uterus slightly enlarged as compared accepting the following rule which is generally with previous day; introduced fingers and endorsed by the profession: Post-partum hem- found clots in vagina, cervical canal, and orrhage occurs within twenty-four hours after uterus, which I removed. In order to accomdelivery; secondary puerperal hemorrhage may plish this I was compelled to introduce hand occur at any time after the lapse of twenty- into vagina, and was able, without much four hours and up to the end of one month trouble, to get two fingers into uterus. Could after delivery, i.e., after the process of involu- find no solid substance in clots removed. Pretion of the uterus has commenced. This sec- scribed a mixture containing ergot, quinine, ondary form has been designated by some and dilute sulphuric acid. Very little hemorwriters "remote or delayed puerperal hemorrhage that night, but next day (eleventh after rhage." It frequently happens that profuse hemorrhage commences quite suddenly after the ordinary lochial discharges have ceased to be sanguineous. The following two cases which recently came under my observation are good examples of this: CASE I. Mrs. A., healthy, secondipera, confined March 23rd, 1886; labor normal, lasting altogether about ten hours; followed my usual custom of keeping hand over uterus during expulsion of child, and after a delay of a few minutes assisted delivery of placenta and delivery) it became again copious. Introduced hand into vagina as before, and cleared uterus of clots. I then explored interior of uterus carefully and found a small mass, which I scratched away with some difficulty. It was a piece of placenta, free from offensive odor, about the size of a large bean. There was no hemorrhage after this. Patient made a good recovery. CASE II. Mrs. B.; labour normal. Expulsion of placenta assisted by slight pressure over uterus, as in Case I. On examination it seemed entire; uterus contracted well; very little hemorrhage; doing well on second day. I was attending this lady for Dr. Graham, who was away from home. On his return he took charge of the case after the second day. I learned from him that everything went on well until the ninth day, when a serious hemorrhage commenced without apparent cause. Dr. Graham then introduced fingers and removed from uterine cavity a good-sized piece of membrane with a small piece of placenta attached to one corner. Hemorrhage ceased after this, and patient had no further unfavorable symptoms. statics, local means are resorted to, and the so-called fibrinous polypi are removed by the curette and a cure is effected; but after all the original retention of the little bit of placenta has been the source of the whole trouble. Thomas, in an excellent paper on this subject, read before the New York Obstetrical Society in April, 1884, reports a case where hemorrhage occurred on the ninth day after delivery. Ergot, tannic acid, dilute sulphuric acid, etc., were used, but about three weeks after delivery the patient was seized with a still more profuse Such cases as these are comparatively rare, hemorrhage, when Dr. Thomas was called in but not sufficiently so, in my opinion, to entitle consultation. He at once had her etherized, them to the scant notices accorded to them dilated cervical canal, removed three small by most of our obstetric authors. Barnes, how-pieces of placenta, and thereby at once effected ever, in the compendious, multum in parvo a cure. This case was sufficiently tedious, but style which he has seen fit to adopt in his might have been indefinitely protracted if this recent work on Obstetrics, treats the subject in vigorous treatment had not been instituted. a somewhat elaborate manner, giving nineteen I am supposing that the hemorrhage was not causes which, with their numerous subdivisions, sufficiently severe to cause death. are about as likely to perplex as instruct. Others treat it in a brief and unsatisfactory way, Gallabin's short description of causes and treatment being one of the best. What are the causes of these remote puerperal hemorrhages? I believe there is one, and only one, cause in the vast majority of cases, i.e., the retention of a portion of the placenta, or membranes, or both. I do not deny that other conditions, such as tumors, displacements of uterus, constitutional dyscrasia, and the like may be occasional causes; but I believe they are simply exceptions and not the rule. That a very small mass may cause a very serious hemorrhage is well shown by my first case. Why that insignificant-looking thing should be apparently harmless for ten days, and then suddenly set up such a commotion, I cannot explain. It is quite possible these cases are not so rare as is generally supposed. Protracted hemorrhages are not uncommon, but are frequently so slight as to attract little notice. After a time they cease temporarily, but reappear from some apparently slight accidents. Among such accidents we may include Barnes' nineteen causes. It frequently happens that after long courses of treatment by an infinitude of hemo We may, therefore, look upon the dangers arising from retention of uterine secundines in two aspects: 1st. Immediate danger from hemorrhage.That this is very grave is proved by the fact that deaths from this kind of hemorrhage have been reported by various writers, such as McClintock, Collins, and others. These sad results are fortunately rare, but leaving such extreme cases out of the question, it is impossible to estimate the injury which a puerperal woman may sustain from such hemorrhages. It is the time when it is most important for her to conserve all her vital forces for the sake of herself as well as the child who lives through her. Who can tell how often a hemorrhage has been sufficient to turn the balance in a constitution which, up to that time, has been able to battle successfully against the approach of some fatal disease such as phthisis, and give the body over to the dread enemy? 2nd. More remote and secondary dangers.— The masses of placenta or membranes retained may be so small as to cause only slight hemorrhage-a mere oozing so trifling as to be scarcely noticed, or at all events mentioned; but this continued for any length of time must produce very serious effects. Again, they may lead |