Hand Book 
.OF 
THE FIRST 
Pan-American 
Medical Congress 
Washington, D. C., 
U. S. A. 
September 7, 6, 7 and 8, A. D. 1893. NOTICE. 
The position of Chief of the Literary Bureau 
has been assigned to Assistant Secretary-General 
Dr. John Guiteras, whose sudden call to special 
duty in the Marine Hospital Service led to the 
transfer of the Editorial work on the Hand Books 
to Dr. A. M. Fernandes Ybarra, of New York 
City, who has been appointed Executive Assistant 
Secretary-General. 
CHARLES A. L. REED, 
Secretar y-G enera I. GENERAL SESSION 3. 
TUESDAY, SEPTEMBER 5, AT 10 A. M. 
ALBAUQH’S OPERA HOUSE. 
(1) Prayer, by the Rt. Rev. William Paret, D. D., Bishop of Maryland. 
(2) Formal Opening of the Congress, by the President of the United States. 
(3) Address of Welcome, by Hon. John W. Ross, LL.D , President, Board of Commissioners, D. C. 
(4) Informal Remarks, by the President of the Congress, Professor William Pepper, M. D., LL. D., Phila- 
delphia, Pa. 
(5) Response, (five minutes each). 
(A) On Behalf of the European Guests, by Professsor Dr. Fenkler, Germany. 
(B) On Behalf of the Constituent Countries and Colonies, by representatives of 
[a) The Argentine Republic. 
(1b) The British West Indies. 
(c) British North America. 
(</) Chili. 
(e) Costa Rica. 
(f) The Dominican Republic. 
(_£•) Ecuador. 
(6) Report of the Secretary-General, Charles A. L. Reed, M. D., Cincinnati, Ohio. 
(7) Report of the Committee of Arrangements, by Samuel S. Adams, M. D., Chairman, Washington, D. C. 
(8) Address, by Professor Francisco A. Risquez, M. D., Caracas, Venezuela. 
(9) Adjournment. 
WEDNESDAY, SEPTEMBER 6, AT 9 A. M. 
(1) Prayer by Very Rev. P. J. Garrigan, D. D., Vice-Rector of the Catholic University of America. 
(2) Remarks (five minutes each) by representatives of 
[a) Guatemala. 
[b) Haiti. 
[c) Hawaii. 
[J) Honduras. 
(i?) Mexico. 
[/) Nicaragua. 
(g) Paraguay. 
i) Peru. 
(i) The Republic of Colombia. 
(3) Address by Professor Rafael Lavista, M. D., City of Mexico, Mexico. 
(4) Announcement by the Committee of Arrangements, Dr. Samuel S. Adams, Chairman, Washington, D. C. 
(5) Miscellaneous business. 
(6) Adjournment. Session held at Metzerott Hall, Twelfth and F Streets. 
WEDNESDAY, SEPTEMBER 6, AT 8 P. M. 
jt 
(i) Address by the President of the Congress, Professor William Pepper, M. D., LL. D., Philadelphia, Pa. 
THURSDAY, SEPTEMBER 7, AT 9 A. M. 
(1) Prayer by Rev. George Elliott, D. D. 
(2) Remarks (five minutes each) by representatives of 
[a) Salvador. 
(3) Spanish West Indies. 
(c) United States of Brazil. 
(,d) Uruguay. 
(e) Venezuela. 
(3) Report of the Committee of Arrangements, by Samuel S. Adams, M. D., Chairman, Washington, D. C. 
(4) Address by Ernest Hart, Esq., F. R. C. S., London, England. 
(5) Miscellaneous business. 
(6) Adjournment. 
FRIDAY, SEPTEMBER 8, n A. M 
(1) Praytr, by Rev. Byron Sunderland, D. D. 
(2) Address, by Professor J, B. De Lacerda, Rio de Janeiro, U. S. of Brazil. 
(3) Miscellaneous Business upon Reports Emanating from the Sections. 
(4) Report of the International Executive Committee. 
(5) Valedictory. 
(a) On Behalf of the Foreign Members, by Dr. J. C. Phillippo, Kingtston, Jamaica 
{/?) On Behalf of the European Guests, by Professor A. Polttzer, Vienna, Austria. 
(6) Closing Remarks, by the President of the Congress, Professor William Pepper, M. D., LL. D. Phila- 
delphia, Pa. 
(7) Adjournment, sine die. \ ENTERTAINfIENTS. 
A reception at the Arlington from 9to 11. (Admission by card.) 
TUESDAY, SEPTEMBER 5. 
WEDNESDAY, SEPTEMBER 6. 
Reception and Promenade Concert following the delivery of the Presidential Address, by Professor William 
Pepper, M. D., LL. D., at 8 p. m., at Metzerott Hall, southeast corner F and Twelfth streets, N. W. (The 
Metropolitan line of cars pass the door.) 
THURSDAY, SEPTEMBER 7. 
An Excursion on the Potomac river on board the steamer Columbia, which will leave the Seventh street wharf 
at 5-3° P- m- (Cable cars on Pennsylvania avenue and transfer at Seventh street.) / 
FRIDAY, SEPTEMBER 8. 
An Excursion has been arranged for foreign members and the guests of the Congress to Chicago, via Balti- 
more, Philadelphia, New York, Boston, Albany, Saratoga, Niagara Falls, Detroit, Cincinnati and St. Louis, at which 
cities entertainments have been provided. The train will leave the Pennsylvania Railroad Station, Sixth and B 
streets, at 1.30 p. m., Friday, September 8. COMMITTEE OF ARRANGEMENTS. 
WASHINGTON, D. C. 
Samuel S. Adams, M, D., Chairman. 
J. R. Wellington, M. D., Secretary. 
G. L. Magruder, M. D., Treasurer. 
EXECUTIVE COnniTTEE: 
Dr. Samuel S. Adams, Chairman; Surgeon General George M. Sternberg, U. S. A.; Surgeon General J. 
Rufus Tryon, U. S. N.; Supervising Surgeon General Walter Wyman, U. S. M. H. S.; Drs. S. C. Busey, G, Wythe 
Cook, C. H. A. Kleinschmidt, H. L. E. Johnson, Llewellyn Eliot, H. H. Barker, C. W. Richardson, W. Sinclair 
Bowen, George C. Ober, James D. Morgan, G. L. Magruder, J. R. Wellington, and J. Roland Walton, D. D. S. 
SUB=COnniTTEES: 
RECEPTION.—Dr. S. C. Busey, Chairman; Surgeon General George M. Sternberg, U. S. A.; Surgeon 
General J. Rufus Tryon, U. S. N.; Supervising Surgeon General Walter Wyman, U. S. M. H. S.; Drs. J. Ford 
Thompson, Charles E. Hagner, Louis Mackall, J. Taber Johnson, T. Morris Murray, G. Byrd Harrison, and 
Joseph H. Bryan. 
ENTERTAINMENTS.—Dr. G. Wythe Cook, Chairman; Drs. G. N. Acker and Thomas E. McArdle. 
REGISTRATION.—Dr. C. H. A. Kleinschmidt, Chairman; Drs. John S. McLain and Johnson Eliot. 
RAILROADS.—Dr. H. L. E. Johnson, Chairman ; Drs. E. L. Tompkins and J. Foster Scott. 
PRINTING.—Dr. Llewellyn Eliot, Chairman ; Drs. Thomas N. Vincent and F. B. Bishop. 
HALLS AND EXHIBITS. —Dr. H. H. Barker, Chairman; Dr. J. T. Winter and C. M. Buchanan. 
WAYS AND MEANS.—Dr. C. W. Richardson, Chairman; Drs. John Van Rensselaer, William Dillenback, 
Henry B. Deale, and William Compton. 
INFORMATION.—Dr. W. Sinclair Bowen, Chairman; Drs. E. Oliver Belt and F. S, Nash. 
HOTELS.— Dr. George C. Ober, Chairman; Drs, William E. Handy and D. Os Leech. 
CREDENTIALS.—Dr. James D. Morgan, Chairman; Drs. C. W. Franzoni, Elmer Sothoron, C. M. Ham- 
mett, Jr., R. S. Hill, Louis Mackall, Jr., and S. J. Radcliffe. 
DENTAL SURGERY.—J. Roland Walton, D. D. S., Chairman; J. B. Hodgkin, D. D. S., and H. B- 
Noble, D. D. S. Section on Pedagogy 
Place of Meeting, Medical Department, Georgetown University, H St. between 9th and 10th, 
Upper Amphitheatre. 
PROGRAMME. 
At 3P. M.—The President’s Address. “ Medical Education in the United States.” 
At 4P. M.—“ The Importance of Physiological Chemistry as a part of Medical Education.” By R. H. Chitten- 
den, Ph.D., Professor of Physiological Chemistry, The Sheffield Scientific School, New Haven, 
Conn. 
At 5 P.M,—“The Importance of Bacteriological Study to Medical Students, and the Scope of Instruction.” By 
Harold C. Ernst, Assistant Professor of Bacteriology in the Harvard Medical School, Boston, 
Mass. 
Tuesday, September 5. 
Wednesday, September 6. 
At the close of the General Session, 11 A. M.—“ A Demonstration of the Caesarean Section and the Porro Opera- 
tions.” By Gustav Zinke, M. D., Cincinnati, Ohio. 
At 3P. M.—“A Contribution to a Study of Methods of Medical Education in the United States.” By Bayard 
Holmes, M. D., The College of Physicians and Surgeons, Chicago, 111. 
At 4P. M.—“ Methods of Teaching Clinical Medicine.” By F. C. Shattuck, M. I)., Professor of Clinical Medi- 
cine in the Harvard Medical School, Boston, Mass. 
Thursday, September 7. 
At the close of the General Session, II A. M.—“A Demonstration with Colored Crayon, of Methods of Instruc- 
tion in Anatomy and Surgery.” By M. H. Richardson, M. D., Assistant Professor of Anatomy 
in Harvard University. 
At 3P. M.—“ The Methods of Medical Education.” By Victor Vaughan, M. D., Ann Arbor, Michigan. 
At 4P, M.—“The Aims and Methods of Medical Education.” By W. C. Dabney, M. D., University of Virginia. 
At 11 A. M.—“ The Relation of Biology to Medical Education.” By W. T. Sedgwick, Professor of Biology in 
the Massachusetts Institute of Technology, Boston, Mass. 
At 12 A. M.—“A Demonstration of the Physiological Action of the Heart.” By J. P. Sawyer, M. D., Cleve- 
land, Ohio. 
Friday, September 8. 
vii Sectionlon General Medicine. 
Place of Meeting, Albaugh’s Opera House, Fifteenth and E Streets, N. W. 
PROGRAMME. 
Tuesday, September 5. 
Hour. 
3 oo P. M. 43 
3 30 P. M. 2 R. L. Miranda. 
4 00 P. M. 32 Wm. Osier. 
4 30 P. M. 13 C, S. Bond. 
5 00 P. M. 11 J. H. Musser, 
5 30 P. M. 15 Charles G. Stockton. 
6 00 P. M. 38 Eliza M. Mosher. 
Title No. 
Discussion Opened By. 
Wednesday, September 6. 
ii 15 A. M. 37 J. C. Wilson. 
ii 30 A. M. 36 F. A. Risquez. 
11 45 A. M. 10 Judson Daland. 
12 20 P. M. 16 James McAuslen. 
12 40 P. M. 9 D. W. Prentiss. 
1 00 P. M. 52 Karl von Rusk. 
3 00 P. M. 25 Manuel Carmona. 
3 20 P. M. 28 Santiago Hernandez. 
3 40 P. M. 27 George M. Sternberg. 
4 00 P. M. 29 G. Desaussure. 
4 20 P. M. 30 J. W. McLaughlin. 
4 40 P. M. 22 Woods Plutchinson. 
5 00 P. M. 40 F. Pryor Porcher. 
5 30 P. M. 41 Luis Rozetti. 
Thursday, September 7. 
ii 15 A. M. 42 J. B. Lacerda. 
11 35 A. M. 26 Cuthbert Bowers. 
12 00 M. 23 David Lobo. 
12 20 P. M. 34 H. A. West. 
12 40 P. M. 21 Henry Sewall. 
1 00 P. M. 50 Mary G. Day. 
3 00 P. M. 31 S. B. Matteo. 
3 25 P. M. 35 E. L. Shurley. 
viii Hour. 
3 50 P. M. 24 George Dook. 
4 15 P. M. 45 J. E. Graham. 
4 40 P. M. 7 N. S. Davis, Jr. 
5 10 P. M. 8 J. B. Aynoti. 
5 30 P. M. 46 N. Guardia. 
Title No. 
Discussion Opened By. 
Friday, September 8. 
9 30 A. M. 33 D. D. Stewart. 
16 00 A. M. 44 W. K. Vance. 
10 20 A. M. I General. 
10 40 A. M. 47 “ 
11 00 A. M. 48 “ 
11 20 A. M. 5 “ 
11 40 A. M. 6 “ 
12 00 M. 53 “ 
12 20 P, M. 14 “ 
12 40 P. M. 54 “ 
1 00 P. M. 51 “ 
1 20 P. M. 3 “ 
1 40 P. M. 12 “ Section on General and Orthopaedic 
Surgery. 
Place of Meeting, Columbian University, Fifteenth and H Streets, N. W., Large Hall. 
PROGRAMME. 
[The titles for this section of Orthopaedic Surgery were incorporated at the instance of the Executive Presi- 
dent, Dr. Vance, August 8, to the Section on General Surgery, where they appear.] 
[The programme has not been furnished by the officers of this Section.] Section on Military Medicine and Surgery 
Place of Meeting, National Museum, Ninth and B Streets, S. W., Lecture Hall. 
PROGRAMME. 
Tuesday, September 5. 
Hour. Title No. Discussion Opened By. 
3 oo P. M. n8 
Wednesday, September 6. 
ii 15 A. M.. The address of the Executive President 
will first be read. Short addresses by 
the honorary presidents will then be in 
order. 
12 15 P. M. ioi Drs. Nicholas Senn, Hunter McGuire, 
John Homans, Joseph D. Bryant, Albert 
Vander Veer. 
3 oo P. M. 115 
4 00 P. M. 116 
4 30 P. M. 117 Lt. Col. Dallas Bache, Deputy Surgeon 
General, U. S. A. 
Thursday, September 7. ’ 
ii 15 A.M. 106 
11 40 A. M. 108 
12 00 M. 109 
12 30 P. M. IJo 
12 50 P. M. 120 Informal discussion. 
3 00 P, M. 107 
3 30 P. M. 119 Dr. Charles B. Parker. 
4 00 P. M. 105 
4 30 P. M. 114 
5 00 P. M. 121 Dr. A. M. Fernandez de Ybarra. 
xi Section on Obstetrics 
Place of Meeting, Ebbitt House, Parlor D, F and Fourteenth Sts., N. W. 
PROGRAMME. 
Tuesday, September 5. 
PREGNANCY. 
Hour. Title No. Discussion Opened By. 
3 oo P. M, 151 
3 20 P, M. 154 
3 40 P. M. 155 
4 00 P. M. 185 
4 20 P. M. 156 
4 40 P. M. 157 After “ 187,” Drs. Baker, of Mass., Stev- 
500P. M. 187 enson, of 111., Polak, of N. Y. ’ 
Wednesday, September 6. 
ii 15 A. M. 159 
11 35 A. M. 188 
12 00 M. 189 
12 20 P. M. 160 , . . 
12 40 P. M. 161 
1 00 P. M. 162 
3 00 P. M. 164 
3 20 P. M. 165 
3 40 P, M. 190 
4 00 P. M. 186 
4 20 P. M. 183 
4 40 P. M. 184 
5 00 P. M. 152 After “162” and “ 166 ” Drs. Taylor, of 
5 20 P. M. 166 Ohio, Upshur, of Va., Rutherford, of R. I. 
EUTOCIA. 
Thursday, September 7. 
DYSTOCIA. 
ii 15 A. M. 182 
11 35 A. M. 153 After “170” and “173,” Drs. Garcia- 
-12 00 M. 167 diego, of Mex., Berger, of Mo., Gam- 
-12 20 P. M. 168 gues, of N. Y. 
xii 12 40 P. M. 191 
I OO P. M. 170 SPECIAL DISCUSSION. 
3 00 P. M. 192 
3 20 P. M. 171 After “ 171,” Drs. Hirst, of Pa., Jewett, 
3 40 P. M. 172 of N. Y., Haehnlen, of Pa. 
4 00 P. M. 173 
4 20 P, M. GENERAL DISCUSSION. 
5 20 P. M. SPECIAL DISCUSSION. 
Hour. 
Title No. 
Discussion Opened By. 
SPECIAL DISCUSSION. 
Friday, September 8. 
PUERPERIUM. 
9 3° A. M. 174 
10 00 A.M. 175 
10 30 A. M. xBi 
11 00 A. M. 176 After “ 180,” Dr. Jewett, of N. Y., 
11 30 A.M. 177 \ “ Scott, of Wash., D. C. 
12 00 M. 178 “ Opie, of Md. 
12 30 P. M. 193 “ Hirst, of Pa. 
1 00 P. M. 180 
VOLUNTARY PAPERS AND REMARKS, 
AD LIB. Section on Gynecology and Abdominal 
Surgery. 
Place of Meeting, Law Department National University, Thirteenth Street Between H and I. 
PROGRAMME. 
Tuesday, September 5. 
Hour. 
Title No. 
Discussion Opened By. 
201 
3 10 P. M. 224 I George M. Edebohls. 
237 i 
3 50 P. M. 135 Joseph Hoffman. 
4 10 P. M. 210 Charles A. L. Reed. 
4 40 P. M. 215 ■ H. J. Boldt. 
5 00 P. M. 2x4 Robert T. Morris. 
231 J 
5 15 P. M. 207 I James F. W. Ross. 
242 J 
Wednesday, September 6. 
2J4 I 
11 15 A. M. 229 I Joseph Price. 
243 * 
218 -j 
12 15 M. 230 I Joseph Eastman. 
244 J 
236 
I 00 P. M. 216 > J. M. Baldy. 
239 J 
3 00 P. M. 203 M. B. Ward. 
3 20 P. M. 211 L. S. McMurtry. 
3 40 P. M. 202 G. M. Edebohls. 
4 20 P. M. 233 \ Joseph Taber Johnson. 
25o(«) J 
5 00 P. M. 238 Nicholas San Juan. 
5 20 P. M. 228 A. Vander Veer. 
5 40 P. M. 226 Florian Krug. 
xiv Hour. Title No. Discussion Opened By. 
II 15 A. M. 205 I. S. Stone and Charles A. L. Reed. 
11 45 A. M. 209 W. E. B. Davis. 
12 10 P. M. 219 Charles P. Noble. 
12 30 T. M. |l. S. McMurtry. 
1 05 P. M. 247 Joseph Price. 
25° I 
1 25 P. M. 221 r J. B. Murphy. 
252 ' 
3 00 P. M. Joint discussion with Therapeuti 
Hour. 
Thursday, September 7. 
Joint discussion with Therapeutic and 
Surgical Sections. 
4 3° P- M. 245 W. H. Myers. 
4 50 P, M, 240 Edward P. Davis. 
5 10 P. M. 208 George H. Rohe. 
5 30 P. M. 249 A. F. Currier. 
5 45 P. M. 222 Eugene Boise. 
Friday, September 8. 
9 3° M. 2C4 R. B. Maury. 
9 50 A. M. 25c ($) Robert Morris. 
10 20 A. M. 213 
10 40 A. M. 217 
11 10 A. M. 220 
11 30 A. M. 223 [ Titles and abstracts not furnished. 
11 50 A. M. 225 1 
12 10 P. M. 227 
12 30 P. M. 232 J 
R. B. Maury. 
Robert Morris. 
XV Section on Therapeutics. 
Place of Meeting, Riggs’ House, Fourteenth and G Sts., N. W. Parlor No. 32. 
PROGRAMME. 
'Tuesday, September 5. 
262—Address by President. 
Title No 264 
Title No 265 
Title No 267 
Title No 269 
Title No 268 
Title No 273 
Title No 275 
Wednesday, September 6. 
Title No. 252 
Title No 253 
Title No 258 
Title No 259 
Title No 274 
Title No 254 
Title No 256 
Title No 278 
Title No . 251 
Title No. 284 
Discussion on “ The Value of the Bath in the Treatment of Asthenic States, 
more particularly Typhoid Fever,” To be opened by Simon Barruch, of New York. 
Thursday, September 7. 
Title No 271 
Title No 272 
Title No 263 
Title No 257 
Title No 255 
Title No 277 
Title No 270 
Title No 281 
Joint discussion between Sections of Therapeutics, Gynegology and Surgery 
upon “ The Indications governing the Use of the various Anaesthetics.” Referees, H. 
C. Wood, M. D., Philadelphia; E. E. Montgomery, M. D., Philadelphia; George 
Edebohls, M. D., New York; John A. Wyeth, M.D., of New York, and James P\ 
M. Ross, M. D., New York. 
Friday, September 8. 
Title No 282 | 
Title No 283 
xvi Section on Anatomy 
Place of Meeting, Columbian University, Academical Department, Fifteenth and H Ave., Small Hall. 
PROGRAMME. 
Tuesday, September 5, 3 to 6 P. M. 
Call to order at 3 P. M. 
Address of Executive President. 
Miscellaneous Business, 
301.—"Anomalies of the Larynx as seen by the Specialist; ” 20 min. Wm. T. Cathell, M. D., Baltimore, Md. 
306.—“The Diaphragm;” 20 min. H. E. Mclntire, M. D., Hudson, Wis. 
342.—“ Relations of the Heart and Lungs to the Anterior Chest Wall as Determined by Composite Photography;” 
15 min. Irving S. Haynes, M. D., Ph. D., New York. 
Miscellaneous Business. 
Adjournment. 
Wednesday, September 6; 11.15 A. M. to 1.15 P. M. 
Call to order at 11.15 A. M. 
Miscellaneous Business. 
327.—“The Human Hand;” 20 min. Geo. Wm. West, M. D., Washington, D. C. 
308. —“Mallet Finger;” 20 min. Robert T. Morris, M. D., New York. 
338.—“Surgical Anatomy of the Appendix Vermiformis, with some Anatomical Abnormalities Observed;” 
10 min. R. H. Plummer, M. D., San Francisco, Cal. 
309. —“Laws of the Growth of the Cell, applied to Human Anatomy;” 10 min. Robert Reyburn, M. D., 
Washington, D. C. 
Miscellaneous Business. 
Adjournment. 
Wednesday, September 6; 3 to 5 P. M. 
Call to order at 3 P. M. 
Miscellaneous Business. 
323.—“A Part of the Anatomy of the Velum Pendulum Palati; 20 min. Thos. F. Rumbold, M. D., San 
Francisco, Cal. 
345. —“Case of Supernumerary Nipples, with Remarks upon, and the Literature of the Subject;” 20 min. 
Albert Pick, M. D., Manchester, N. H. 
346. —“On the Zona Radiata of the Teleostean Ovum; ” 20 min. Prof. Jacob Reichard, Ann Arbor, Mich. 
313.—“Nerve Anastorosis; 20 min. A. C. Bf.rnays, M. D., St. Louis, Mo. 
Miscellaneous Business. 
Adjournment. 
Thursday, September 7 ; 11.15 A. M. to 1.15 P. M. 
1 Call to order at 11.15 A. M. 
Miscellaneous Business. 
343.—“Bone, an Organized Substance; ” 15 min. George F. Koehler, M. D., Portland, Ore. 
xvii 340-—“ The Dissecting Room;” 20 rain. E. W. Holmes, M, D., Philadelphia, Pa. 
344.—“Craniometric Measurements of 500 Skulls in relation to Aural Topographic Anatomy;” 20 min. 
B. Alexander Randall, M. D., Philadelphia, Pa. 
Miscellaneous Business. 
Adjournment. 
Thursday, September 7; 3 to 5 P. M. 
Call to order at 3 P. M. 
, Miscellaneous Business 
307.—‘*A Note on the occurrance of the Scapuloclavicular Muscle.” Robert S. Moody, M. D., New Haven, Conn. 
311.—-“On the Presence of Finguatula Rhinosia in the United States.” C, W. Stilas, Ph. D., Washington, D.C. 
347,—“In Teaching Comparative Anatomy and Physiology to large classes of medical students.” A. P. Ohl- 
moche, M. D., Chicago, 111. 
Miscellaneous Business. 
Adjournment. 
Friday, September 8; 10 A. M. to i P. M. 
Cali to order at to A. M. 
. i Miscellaneous Business. 
Adjournment. 
Additional papers are expected from the following: 
Dr, Edwin Bentley, U. S. A., Little Rock, Ark. 
Dr. Geo. A. Bingham, Toronto, Can, 
Dr. H, C. Boenning, Philadelphia, Pa. 
Dr. J. D. Bryant, New York. 
Dr. E. F. Clapp, lowa City, la. 
Dr. T. G. Comstock, St. Louis, Mo. 
Dr. E. G. Conklin, Delaware, Ohio. 
Dr. R. B. Gilbert, Louisville, Ky. 
Dr. J. W. Hartigan, Morgantown, W. Va. 
Dr. E. B. Kenner, St. Louis, Mo. 
Dr. Middleton Mjchel, Charleston, S. C. 
Dr. C. S. Minot, Boston, Mass. 
Dr. John C. Monro, Boston, Mass. 
Dr, J. T. Newman, New Orleans, La. 
Dr. J. W. Perkins, Kansas City, Mo. 
Dr. J. B. Prichard, St. Louis, Mo. 
Dr. D, F. Rodgers, Topeka, Kas. 
Dr. E. S. Stevens, Cincinnati, Ohio. 
Dr. Geo. A. Wilcox, Augusta, Ga. 
Dr. W, P. Wilson, Philadelphia, Pa. 
xviii Section on Physiology 
Place j)f Meeting, National University Law Department, Thirteenth St., between H and 1, N. W. 
. . First Hall. 
PROGRAMME. 
Tuesday, September 5. 
Hour, 
3 oo P. M. 351 
4 00 P. M. 362 
4 30 P. M. 361 Dr. Thomas J. Mays, Dr. W. S. Carter. 
5 00 P. M. 358 Informal discussion. 
Title. 
Discussion Opened By. 
Wednesday, September 6. 
11 15 A. M. 355 Dr. C. D. Hodge. 
11 45 A. M. 366 Dr, H. G. Beyer. 
12 15 P. M. 353 Dr. Wesley Mills. 
12 45 P. M. ’372 Dr. A. B. Macallum, 
* * 373 Informal discussion. 
3 00 P. M. 354 Dr. E. T, Reichert. 
3 30 P. M. 357 Dr. J. G. Hernandez. 
4 00 P. M. 356 Dr. W. G. Thompson. 
4 30 P. M. 363 Informal Discussion. 
Thursday, September 7. 
II 15 A. M. 367 Dr. W. A. Thom, Jr. 
11 45 A. M. 369 Dr. Samuel Wolfe. 
12 15 P. M. 370 Dr, A. P. Brubaker. 
3 00 P. M. 371 Informal discussion. 
3. 30 P. M. 360 Dr. R. H. Chittenden. 
4 00 P. M. 359 Informal discussion. 
Friday, September 8. 
9 30 A. M. 368 Dr, E. T. Reichert. 
10 00 A. M. 352 Informal discussion. 
10 30 A. M. 364 “ “ 
to 45 A. M. 374 Section on Diseases of Children 
Place of Meeting, The Arlington, Ladies’ Parlor, No. i. 
PROGRAMME. 
Tuesday, September 5. 
Title No 424 
Title No 401 H. R. Wharton, M. D. 
Title No 4*o W. D. Booker, M. D, 
Title No 419 Discussion on Prevention and Municipal 
Control, opened by E. O. Shakespeare, 
M. D. 
Wednesday, September 6. 
Title No 429 
Title No 411 
Title No 408 
Title No 426 
Title No ..414 
Title No. 4*7 
Thursday, September 7. 
Title No 406 
Title No. , . 421 . . , . . 
Title No 422 
Title No 407 
Title No 402 
Title No 427 
Title No 420 
Title No 415 • • • • • 
Title No 4*3 
Title No 425 
Informal discussion on Gastro-Intestinal Disease. 
Title No . 409 Informal discussion on Local Treatment 
in Gastro-Intestinal Disease. 
Friday, September 8. 
Title No 405 Discussion on the Production and Preser- 
vation of Milk, opened by E. F. 
Brush, M. D. 
Title No 418 
Title No 412 
Title No 403 
Title No 428 
Title No 423 
Informal discussion on Infant Feeding. 
XX Section on Pathology 
Place of Meeting, Medical Department, University of Georgetown, H Street, between Ninth xn4 
Tenth, N. W. 
PROGRAMME. 
Tuesday, September 5. 
Hour. Title No. Discussion Opened By. 
465 Amadeo—Yellow Fever. 
464 Amadeo—Med. Geography of Puerto Rico. 
461 Acosta, on Rabies in Cuba. 
Wednesday, September 6. 
Demonstration Micro Photography, Army 
Medical Museum, by Dr. Gray. 
3 oo P. M. 468 Dr. Matos, on Inflammation. 
3 $o P. M. 463 Dr. Welch, Influence of Rattlesnake poison 
on bactericide power of Wood. 
4 00 P. M. 452 Dickson Bruns, examination of urine and 
sputa. 
455 R. Guiteras, Influenza. 
471 Cattell, Asylums for feeble-minded. 
Thursday, September 7. 
Demonstration of Methods in Histology, by 
Dr. Reeves. 
Demonstration of Methods in Bacteriology, 
by Dr. Kinyoun. 
Friday, September 8. 
462 Smith, on Cancer. 
472 McFarland, on Cancer. 
469 Lacerda, on Beri-beri. 
470 Amadeo, on Malaria 
xxi Section on Ophthalmology. 
. (_, PJac^qf,Meeting, The Arlington, Vermont Avenue and H Street, N. W., Parlor A. 
PROGRAMME. 
[The programme has not been furnished by the officers of this Section.] 
xxii Section on Laryngology and Rhinology. 
Place of Meeting, The Arlington, Parlors D and E. 
PROGRAMME. 
Hour. Title No. Discussion Opened By. 
3 oo P. M. President’s Address. 
3 15 P. M. 552 * Discussion after No. 563. 
3 30 P. M. 582 “ “ 
3 45 P, M. 563 John N. Mackenzie, Baltimore. 
4 40 P. M. 554 Edward O. Clyer, Buenos Ayres. 
5 15 P. M, 580 N, E. Casselberry, Chicago. 
Hour. 
Tuesday, September 5, 
Wednesday, September 6. 
ii 20 A. M. 560 lames E. Newcomb, New York. 
11 50 A. M. 555 Discussion after No. 589. 
12 00 M. 589 S. Solis Cohen, Philadelphia. 
12 30 P. M. 570 Alex. McCay, Philadelphia. 
3 00 P. M. 567 Carron Flemming, Anne Arbor, Mich, 
3 20 P. M. 574 Robert Levy, Denver, Col. 
3 30 P. M. 577 H. Holbrook Curtis, New York. 
400 P. M. 588 D. Bryson Delevan, New York, and 
W. H. Daly, Pittsburg, Pa. 
5 00 P. M. 569 Informal Discussion. 
5 00 P. M. 
Thursday, September 7. 
II 1$ A. M. 586 Informal Discussion. 
11 30 A. M. 573 W. C. Glasgow, St. Louis. 
12 00 M. 575 Discussion following No. 585. 
12 15 P. M. 585 John O. Roe, Rochester, N. Y. 
12 40 P. M. 562 Informal Discussion. 
3 00 P. M. 558 Discussion following No. 584. 
3 10 P. M. 576 “ “ “ 
340 P. M. , 584 C, C. Rice, New York. ' ' ; 
4 00 P. M. 551 Informal Discussion. 
4 15 P. M. 556 “ “ 
4 30 P. M. 587 J. Solis Cohen, Philadelphia, and Arthur 
G. Hobbs, Atlanta, Ga. 
9 3° A. M. 583 J. E. Baylan, Cincinnati, 
lo 00 A. M. 572 C. E. Bean, St. Paul. 
10 35 A. M. 568 W. John Harris, St. Louis 
11 00 A. M. 571 Informal Discussion. 
11 15 A. M. 564 “ “ 
11 30 A. M. 565 “ “ 
11 45 A. M. 559 
Friday, September 8 
xxiii Section on Otology. 
Place of Meeting, The Arlington, Ladies’ Parlor, No. 3. 
PROGRAMME. 
Tuesday, September 5. 
Title No. , noia 
Title No 1115 Informal discussion. 
Title No 1103 “ “ 
Title No 1106 Dr. H. McHatton, Macon, Ga. 
Wednesday, September 6. 
Title No 1102 Informal discussion. 
Title No 1107 Dr. S. S. Bishop, Chicago, 111. 
Title No 1110 Informal discussion. 
Title No 1105 Discussion after No. 1118. 
Title No no 1 “ “ “ « 
Title No 1104 “ “ “ “ 
Title No 1112 « “ “ ** 
Title No 1113 “ “ “ “ 
Title No 11x4 “ “ “ “ 
Title No 1118 Dr. C. R. Holmes, Cincinnati, O 
Thursday, September 7. 
Title No 1116 Informal discussion. 
Title No 1108 “ “ 
Title No 1119 “ “ 
Title No mi “ ‘‘ 
Title No 1109 “ “ 
Title No m 7 “ “ 
xxiv Section on Dermatology and Syphilography. 
Place of Meeting, Riggs’ House, Fifteenth and G Sts., N. W. Parlor No. 27. 
PROGRAMME. 
Hour. Title. Discussion Opened By. 
3 oo P. M. 6oia 
3 45 P. M. 603 
4 30 P. M. 607 Informal discussion. 
Tuesday, September 5. 
Wednesday, September 6. 
11 15 A. M. 608 
12 00 M. 609 Informal discussion. 
300 P. M. 611 • 
3 30 P. M. 614 . . 
4 15 P. M. 610 
5 00 P. M. 618 Informal discussion. 
5 20 P. M. 619 . . . 
Thursday, September 7. 
ii 15 A. M. 602 
11 45 A. M. 605 
12 15 P. M. 613 
1 00 P. M. 616 
I 30 P. M. 612 Informal discussion. 
3 00 P. M. 604 
3 45 P. M. 617 
4 15 P. M. 615 
4 45 P. M. 601 
5 15 P. M. 620 
Friday, September 8. 
9 jo A. M. 621 
10 30 A. M. 622 
xxv Sections of Hygiene, Climatology and Demography, 
• and Marine Hygiene and Quarantine. 
Place of Meeting, Grand Army Hall, 1412 Pennsylvania Avenue, N. W. 
PROGRAMME 
Tuesday, September 5. 
3 15 P- M. 673 
3 45 P- M, 701 
Hour. 
Title No. 
Hour. 
4 ij P. M. 656 
4 45 P. M. 688 
Title No. 
Wednesday, September 6. 
11 20 A. M. 651-654 
ix 50 A. M. 658 
12 10 P. M. 661 
12 30 P. M. • 681 
12 40 P. M. 672 
12 50 P. M. 655 
3 00 P. M. 652 
3 20 P. M. 674 
3 40 P. M. 682 
4 00 P. M. 667-670 
4 30 P. M. 663 
4 40 P. M. 671 
5 00 P. M. 665 
5 20 P. M. 660 
ii 20 A. M. 678 
11 40 A, M. 659 
12 00 M. 675 
12 10 P. M. 653 
12 20 P, M. 657 
12 30 P. M. 669 
4 20 P. M. 
Thursday, September 7. 
3 oo P. M. 679 
3 20 P. M. 680 
3 30 P. M. 712 
3 40 P. M. 701 
4 00 P. M. 702 
4 10 P. M. 703-710 
713 
9 3° -A. M. 662 
9 50 A. M. 666 
10 10 A. M. 683 
11 30 A. M. 
Friday, September 8. 
io 30 A. M. 684 
10 50 A. M. 677 
11 10 A. M. 668 
676 
Through the courtesy of the Surgeon-General of the Navy and the 
Director-ln-charge of the U. S. Naval nuseum of Hygiene, 1707 New 
York Avenue, N. W., this building will be open for inspection by members of the 
Congress from 10 a. m. to 4 p. m. daily, on Wednesday, Thursday and Friday—6th, 
7th and Bth of September, 
xxvi Diseases of the Nervous System and the Mind 
Place of Meeting, The Arlington, New Reception Room. 
PROGRAMME. 
Tuesday, September 5. 
Title No Sola 
Title No 826 Dr. Wm, A. Hammond, Washington, D. C. 
Title No 801 Dr. Manuel Carmona, of Valle, City of Mexico, Mexico. 
Title No 803 Dr. Daniel Guilerrez, Cali, Cauca, Colombia. 
Title No 819 Dr. Chas. R. Mills, Philadelphia. 
Title No 817 Dr. Weir Mitchell, “ 
Title No 805 Dr. H. N. Moyer, Chicago. 
Wednesday, September 6. 
Title No 815 
Title No 827 Dr. E. C. Seguin, New York City. 
Title No. ..... 828 ’ Dr. E. C. Spitzka, “ “ “ 
Title No 807 Dr. L. C. Gray, “ “ “ 
'Eitle No 832 Informal. 
Title No 830 Dr. G. Kierman, Chicago. 
Title No 813 Dr. Wm. A. Hammond, Washington. 
Title No 823 Dr. B. Sachs, New York. 
Title No 8l 1 Dr. M. Allan Stair, New York. 
Title No 822 Dr. Gonzales Echeverria, Key West, Ela. 
Title No 824 Dr. S. G. Webster, Boston. 
Title No 825 Dr. D. R. Brown, Chicago. 
Title No 816 Informal. 
Thursday, September 7. 
Title No 802 Dr. Gracini M. Hammond. 
Title No. . . ... . 809 Dr. J. T. Eskridge, Denver, Col. 
Title No 808 Dr. J. G. Reed, Elmwood Place, Ohio. 
Title No -831 Dr. C. H. Hughes, St. Louis. 
Title No 812 Dr. D. T. Crothers, Hartford, Conn. 
Title No 804 . 
Title No 810 Dr. P. R. Thombs, Pueblo, Colo. 
Title No 820 Dr. Jno. Punton, Kansas City, Mo. 
Title No 806 Dr, Henry M. Hurd, Baltimore. 
Title No 825 Dr. Frank C. Hoyt, Clarinda, Tenn. 
Title No 814 Informal. 
Title No 818 
Title No. ..... 829 Informal. 
xxvii Section on Oral and Dental Surgery 
Place of Meeting, Law Department, National University, i jth Street between H and I Streets, 
N. W., Third Hall. 
PROGRAMME. 
[The programme has not been furnished by the officers of this Section ] 
xxviii Section on Medical Jurisprudence. 
Place of Meeting, Ebbitt House, 14th and F Streets, N. W., Red Parlor. 
PROGRAMME. 
[The programme has not been furnished by the officers of this Section.] 
xxix Section on Railway Surgery 
Place of Meeting, The Cochran, Fourteenth and K Streets, N. W 
PROGRAMME. 
Hour. Title No. 
3 30 P. M. 1001 a 
4 00 P. M. 1001 
5 00 P. M. 1002 
Tuesday, September 5. 
Wednesday, September 6. 
11 3<> A. M. 1003 
12 30 P, M. 1004 
3 30 P. M. 1005 
4 30 P. M. 1006 
Thursday, September 7. 
11 30 A. M. 1007 
12 30 P. M. 1008 
3 30 P. M. 1009 
4 30 P. M. 1010 
5 30 P. M. ion . . , 
Friday, September 8, 
10 oo A.M. ioi2 ....... 
11 oo A. M. 1013 
xxx Section on Pharmacology. 
Place of Meeting, The Arno, Sixteenth Street, between I and K Streets, N. W- 
PROGRAMME. 
£The programme has not been furnished by the officers of this Section.J 
xxxi Office of the Permanent Secretary 
of the American Medical Association, 
Philadelphia, June 4, iBgi. 
To the Medical Profession of the Western Hemisphere: 
At the meeting of the American Medical Association, held at Washington, 
May sth, 1891, Dr. Charles A. L. Reed, of Cincinnati, introduced the following: 
Resolved, That the American Medical Association hereby extends a cordial invitation to the Medical 
Profession of the Western Hemisphere, to assemble in the United States in an Inter-Continental 
American Medical Congress. 
Resolved, That the Committee on Nominations be, and is hereby instructed to nominate one member 
for each State and Territory, and one each from the Army, Navy, and Marine Hospital Service, 
who shall constitute a committee, which is hereby instructed to effect a permanent organization 
of the proposed Inter-Continental American Medical Congress, and to determine the time and 
place at which the same shall be held. 
The resolutions were seconded by Dr. Wm. H. Pancoast and others, and 
unanimously adopted. 
Pursuant to the foregoing, the following Committee was nominated and elected: 
Ala—W. H. Sanders, M. D. 
Ariz.—Henry A. Hughes, M. D. 
Ark.—Ed. Bentley, M. D. 
Cal.—W. R. Cluness, M. D. 
Colo.—Wm. A. Campbell, M. D. 
Conn.—C. A. Lindsley, M, D. 
Del.—C. H. Richards, M. D. 
D. C.—D. W. Prentiss, M. D. 
Fla.—C. R. Oglesby, M. D. 
Ga.—J. McFadden Gaston, M. D. 
Idaho.—Geo. P. Haley, M. D. 
111.-N. S. Davis, M. D. 
Ind.—A. M. Owen, M. D. 
lowa.—B. H. Criley, M. D. 
Kan.—J. E. Minney, M. D. 
Ky.—J. N. McCormack, M. D. 
La.—Stanford E. Chaille, M. D. 
Maine.—Hampton E. Hill, M. D. 
Md.—Geo. H. Rohe, M. D. 
Mass.—Augustus P. Clarke, M. D. 
Mich.—C. Henri Leonard, M. D. 
Minn.—P. H. Millard, M. D. 
Miss.—W. T. Kendall, M. D. 
Mo.—I. N. Love, M. D. 
MONT.—Thos. J. Murray, M. I). 
Neb.—R. C. Moore, M. D. 
Kev.—P. J. Aiken, M. D. 
N. H.—Irving A. Watson, M. D. 
N. J.—E. J. Marsh, M. D. 
New Mex.—C. E. Winslow, M. D. 
N. Y.—John Cronyn, M. D. 
N. C.—H. Longstreet Taylor, M. D. 
N. D.—E. M. Darrow, M. D. 
Ohio.—Charles A. L. Reed. M. D. 
Oregon.—Wm. Boys, M. D. 
Pa.—Wm. Pepper, M. D. 
R. I.—Geo. L. Collins, M. D. 
S. C.—R. A. Kinloch, M. D. 
S. D.—J. W. Freeman, M. D. 
Thnn.—J. R. Buist, M. D. 
Tex.—J. W. Carhart, M. D. 
Utah.—F. S. Bascom, M. D. 
Vt.—H. D. Holton, M. D. 
Va.—J. S. Weliford, M. D. 
Wash.—J. M. Morgan, M. D. 
W. Va.—J. H. Brownfield, M. D. 
Wis.—J. T. Reeve, M. D. 
Wyo.—J. H. Finfrock, M. D. 
U. S. A.— 
U. S. N.— 
U. S. M. H. S. —J. B. Hamilton. M. D. 
WM. T. BRIGGS, M. D., President. 
WILLIAM B. ATKINSON, M, D,, Permanent Secretary. 
1 REPORT. 
To Dr. Hunter McGuire, 
President of the American Medical Association, 
Richmond, Virginia. 
Dear Doctor:—On behalf of the Committee appointed by the American Medical Association, May 
sth, 1891, “to effect a permanent organization of an Inter-Continental American Medical Congress,” I beg 
leave to report that the work has been prosecuted as diligently as possible. A series of regulations, hereby 
submitted, has been adopted and an organization in accordance therewith has been effected, in some degree, 
in all of the constituent countries except Paraguay. In several countries the organization has been 
completed in accordance with the regulations, while in some instances full lists of Secretaries have been 
secured; in others, Honorary Chairmen only have been furnished, while in still others the organization 
has not advanced beyond the appointment of a member of the International Executive Committee. The 
lists of officers are, however, sufficiently complete to furnish channels through which the necessary prelim- 
inary correspondence of the Sections may be inaugurated. In view of this, and the additional fact that a 
considerable time is necessary for the interchange of letters with some of the remoter countries, the 
Committee deems it expedient to submit for promulgation this Preliminary Announcement of the Congress. 
The Committtee entertains the hope that the organization may be completed in each of the constituent 
countries, in accordance with the Regulations, before the meeting of the Congress. 
Respectfully submitted on behalf of the Committee, 
CHARLES A. L. REED, 
Cincinnati, September sth, 1892. 
Chairman of the Committee on Permanent Organization, 
and Secretary-General of the Congress. 
Richmond, Va., October 6tb, 1892. 
Dr. Charles A. L. Reed, 
Chairman of the Committee on Permanent Organization 
of the Pan-American Medical Congress. 
Dear Doctor; 
I am in receipt of the report of the Committee on Organization of the Pan-American Medical Congress 
transmitting the Preliminary Announcement of the Organization. Permit me to state that lam gratified 
to note the completeness of the work which has already been accomplished by your Committee, and that, 
for the reasons stated in your letter, I deem the immediate publication of the preliminary announcement 
imperative to the success of the Congress. 
With the assurance that the American Medical Association will do all in its power to promote the 
interests of the meeting at Washington in September of next year. 
Very sincerely yours, 
President of the American Medical Association. 
Hunter McGuire, $0 iije (&<ntove** of th* llnitefc 
JOINT RESOLUTION 
To authorize the President to invite certain governments to send delegates 
to the Pan-American Medical Congress. 
A Joint Resolution was unanimously adopted by the Senate June 3, 
1892, concurred in by the House of Representatives July 14, 1892, and 
approved July 18, 1892, by which the President was authorized and 
requested to invite the several governments of the Western Hemisphere 
to send official delegates to the meeting of the Pan-American Medical 
Congress to be held in the city of Washington, September fifth sixth, 
seventh and eighth, anno Domini eighteen hundred and ninety-three. 
3 GENERAL REGULATIONS. 
TITLE. 
1. This organization shall he known as The Pan-American Medical Congress, ami shall 
meet once in years. 
2. Members of the Congress shall consist of such members af the medical profession of the 
Western Hemisphere, including the West Indies and Hawaii, as shall comply with the special reg- 
ulations regarding registration, or who shall render service to the Congress in the capacity of Foreign 
Officers. 
MEMBERSHIP. 
3. The Executive Officers of the Congress shall be residents of the country in which the Con- 
gress shall be held, and shall consist of one President, such Vice-Presidents as may be determined 
by special regulations, one Treasurer, one Secretary-General, and one Presiding Officer and neces- 
sary Secretaries for each section, all of whom shall be elected by the Committee on Organization, 
and there shall be such Foreign Vice-Presidents, Secretaries and Auxiliary Committees as are here- 
inafter designated. 
OFFICERS. 
THE COMMITTEE ON ORGANIZATION. 
4. The Committee on Organization shall be appointed by the representative medical association 
of the country in which the Congress shall meet. This committee shall select all domestic officers 
of the Congress, and shall at its discretion confirm all nominations by members of the International 
Executive Committee and in the event that any member of the International Executive Committee 
shall fail to nominate by the time specified by special regulation, the Committee on Organization 
shall elect officers for the country thus delinquent. It may appoint Vice-Presidents and Auxiliary 
Committeemen in foreign countries independently of nominations by the members of the Inter- 
national Executive Committee. It shall appoint Auxiliary Committees, arrange for the meeting, 
and frame special regulations for the session of Congress for which it was appointed. It shall make 
a report of its transactions to the opening session of the Congress. 
5. There shall be an International Executive Committee which shall be appointed by the first 
Committee on Organization and which shall consist of one member for each constituent country. 
This Committee shall hold permanent tenure of office except that when a member shall fail to be 
present at a meeting of the Congress, his office shall be declared vacant and the vacancy be tilled by 
election held by the registered members from the country from which he was accredited. In the 
event of no representation whatever from the country in question, the members of the International 
Executive Committee present, shall determine what disposition shall be made of the office. 
It shall be the duty of each member of the International Executive Committee to nominate 
from the medical profession of his country, one Vice-President for the Congress and one Secretary 
for each Section of the Congress, and to forward the same to the Chairman of the Committee on 
Organization; except that in any country in which the Congress shall meet, it shall be the duty of 
the member of the International Executive Committee for that country to request his representative 
national medical association to appoint a Committee on Organization, which Committee on 
Organization shall discharge the duties designated in Regulation IV. Members of the International 
Executive Committee shall also nominate such Auxiliary Committees, and shall furnish such 
information as the Committee on Organization may request. 
THE INTERNATIONAL EXECUTIVE COMMITTEE. 
6. The Committee on Organization may at its discretion cause the Congress to be incorporated, 
which incorporation shall hold only until the final disbursement of funds for the session held in 
that particular country. In the event of such incorporation such additional officers shall be elected 
and in such manner as may be required by law. 
INCORPORATION. 
4 7. The following shall be considered as the constituent countries of the Pan-American Medical 
Congress: 
Argentine Republic, Bolivia, Brazil, British North America, British West Indies (including B. 
Honduras), Chile, Dominican Republic, Honduras (Sp.), Mexico, Nicaragua, Paraguay, Peru, Salvador, 
Republic of Colombia, Republic of Costa Rica, Ecuador, Guatemala, Haiti, Kingdom of Hawaii, 
Spanish West Indies, United States. Uruguay, Venezuela, Danish, Dutch and French West Indies. 
CONSTITUENT COUNTRIES. 
SECTIONS. 
8. The Sections of the Congress shall be as follows : 
(1) General Medicine, (2) General Surgery, (3) Military Medicine and Surgery, (4) Obstetrics, 
(5) Gynaecology and Abdominal Surgery, (6) Therapeutics, (7) Anatomy, (8) Physiology, (9) Diseases 
of Children, (10) Pathology, (11) Ophthalmology, (12) Laryngology and Rhinology, (13) Otology, 
(14) Dermatology and Syphilography, (15) General Hygiene and Demography, (16) Marine Hygiene 
and Quarantine, (17) Orthopaedic Surgery, (18) Diseases of the Mind and Nervous System, (19) Oral 
and Dental Surgery, (20) Medical Pedagogics, (21) Medical Jurisprudence, (22) Railway Surgery. 
LANGUAGES. 
9. The languages of the Congress shall be Spanish, French, Portuguese and English, 
AUXILIARY COMMITTEES. 
10. The Auxiliary Committee shall consist of one member for each medical society or one for 
each considerable center of population in each of the constituent countries of the Congress. 
Nominations for the Foreign Auxiliary Committee shall be made to the Chairman of the Committee 
on Organization by the members of the International Executive Committee, each for his own country, 
except that in the country in which the Congress is to be held nominations shall be made by the 
Committee on Organization. Appointments on the Auxiliary Committee shall hold only for the 
meeting for which they were made. 
Members of the Auxiliary Committee shall be the official representatives of the Congress in 
their respective localities. It shall be their duty: 
(1) To transmit to the profession of their respective districts all information relative to the 
Congress forwarded to them for that purpose by the General Officers. 
(2) To co-operate with the Officers of Sections in securing desirable contributions to the 
proceedings of the Congress. 
(3) To furnish to the General Officers such information as they may request for the purpose of 
promoting the interests of the Congress. 
(4) To cause such publicity to be given to the development of the organization as will elicit 
the interest of the profession and secure attendance upon the meeting; and they shall discharge 
such other duties as will promote the welfare of the Congress. 
AMENDMENTS. 
11. Amendments to these Regulations can be made only by the International Executive 
Committee, on a majority vote, ten members constituting a quorum, at any meeting of the Congress. 
5 SPECIAL REGULATIONS OF THE FIRST CONGRESS. 
1. The first Pan-American Medical Congress shall be held in the City of Washington, D. C., 
September 5, 6, 7, 8, A. D., 1893. 
TIME AND PLACE OP MEETING. 
2. The Registration fee shall be $lO.OO for each member residing in the United States, but no 
fee shall be charged to foreign members. Each registered member shall receive a card of member- 
ship and be furnished a set of the transactions. 
REGISTRATION. 
ABSTRACTS, PAPERS AND DISCUSSIONS. 
3. Contributors are required to forward abstracts of their papers, not to exceed six hundred 
words each, to be in the hands of the Secretary-General not later than the tenth of July, 1893. 
These abstracts shall be translated into English, French, Spanish and Portuguese, and shall be pub- 
lished in advance of the meeting for the convenience of the Congress, and no paper shall be placed 
upon the programme which has not been thus presented by abstract. Abstracts will be trans- 
lated by the Literary Bureau of the Congress at the request of contributors. Papers to be presented 
to Sections must notconsume more than twenty minutes each in reading, and when of greater length, 
must be read by abstract. Papers read by abstract may be printed in full in the transactions, subject 
to approval by the Editorial Committee. Abstracts shofild be forwarded through the Secretaries of 
Sections. Papers and discussions will be printed in the language in which they may be presented. 
All papers read in the Sections shall be surrendered to the Secretaries of the Sections; all 
addresses read in the General Session shall be surrendered to the Secretary-General as soon as 
read; and all discussions shall be at once reduced to writing by the participants. 
INCORPORATION. 
4. The Chairman of the Committee on Organization shall cause the Congress to be incorporated 
under the laws of Ohio, and fifteen trustees shall be elected in accordance therewith, who by 
by-laws and through the Executive Committee shall supervise all receipts and disbursements by the 
Treasurer in accordance with the laws of Ohio. The President, Secretary-General, Treasurer, the 
member of the International Executive Committee for the United States, and Executive Presidents 
of Sections shall be ex-officio members of the Board of Trustees. 
5. All nominations by the International Executive Committee must be in the hands of the 
Chairman of the Committee on Organization by June Ist, 1892, and in default thereof the Committee 
on Organization shall elect officers for countries thus delinquent. 
FOREIGN NOMINATIONS. 
6. The officers of each section shall consist of Honorary Presidents, who shall be residents 
of the constituent countries of the Congress; one Executive President, who shall organize the 
work of the Section, direct its deliberations, and deliver an inaugural address at its opening session; 
one English-speaking Secretary and one Spanish-speaking Secretary, residents of the United States, 
who shall co-operate with the Executive President in conducting the correspondence of the section; 
and there shall be one Secretary for each section, resident in each additional constituent country of 
the Congress. 
THE ORGANIZATION OP SECTIONS. 
7. The Auxiliary Committee for the United States shall he elected by the Committee on 
Organization and shall consist of one member for each local medical society, or, in the absence of 
medical organization, then one in each considerable center of population, which Auxiliary 
Committee shall co-operate with the Committee on Organization and with the General Officers in 
promoting the welfare of the Congress. Nominations for the Auxiliary Committee shall be made 
by members of the Committee on Organization, each for his own State, except that in the failure of 
any member to make such nomination by January Ist, 1892, or in the inadequacy of the same, the 
Chairman of the Committee on Organization shall supply the deficiency. 
DOMESTIC AUXILIARY COMMITTEE. 
EXECUTIVE COMMITTEE. 
8. The Board of Trustees shall designate seven members, including the President, Treasurer, 
Secretary-General, and member of the International Executive Committee for the United States, 
who shall comprise an Executive Committee which shall transact all business of the Congress, ad 
interim in accordance with By-lav/s adopted by the Board of Trustees. 
6 GENERAL OFFICERS OF THE CONGRESS. 
PRESIDENT: 
WILLIAM PEPPER, M. D., LL. D., Philadelphia, Pa. 
VICE-PRESIDENTS: 
Dr. SAMUEL GACHE, . . i . . . . . Buenos Aires, . . Argentine Republic. 
Dr. JEROME COCHRAN, Montgomery, Alabama. 
Dr. HENRY A. HUGHES, Phoenix, Arizona. 
Dr. P. O. HOOPER, Little Rock, Arkansas. 
Dr. NAPOLEON RANA, La Paz, . . . . ' Bolivia. 
Dr. BAPTISTA DE LACERDA, .... Rio de Janeiro, Brazil. 
Dr. O. O. BURGES, San Francisco, . . . California. 
Dr. J. E. GRAHAM, . . Toronto, Canada. 
Dr. MANUEL BARROS BORGONO . . Santiago, Chili. 
Dr. PIO RENGIFO, New York, U. S. A. (for) Colombia. 
Dr. CHARLES DENISON; Denver, Colorado. 
Dr, \V. A. M. WAINRIGHT, Hartford, . . . . Connecticut. 
Dr. JUAN J. ULLOA, San Jose, Costa Rica. 
Dr. JAMES H. CHANDLER, ..... Centreville, Delaware. 
Dr. S. C. BUSEY, Washington, District of Columbia. 
Dr. J. R. DANIELS, Jacksonville, Florida. 
Dr. R, JvNUNN, Savannah, Georgia. 
Dr. JOSE LLERENA, Guatemala Guatemala. 
Dr. C. R., BOYER, , _ Port au Prince Haiti. 
Dr. JESUS BENDANA Comayagua Plonduras. 
Dr. JOHN S. McGREW, Honolulu, Hawaii. 
Dr. JOHN W. GIVENS, Blackfoot, Idaho. 
Dr. EDMUND ANDREWS, Chicago, Illinois. 
Dr. DONALD McRAE, Council Bluffs, . lowa. 
Dr. WM. B. DEWEES, ........ Salina, Kansas. 
Dr. W. H. WATHEN, Louisville, Kentucky. 
Dr. JOHN B. ELLIOTT, New Orleans, Louisiana. 
Dr. THOMAS A. FOSTER, Portland, Maine. 
Dr. MANUEL CARMONA Y VALLE,. . City of Mexico, Mexico. 
Dr. W. H. WELCH, Baltimore, Maryland. 
Dr. REGINALDO FI. FITZ Boston Massachusetts. 
Dr. H. O. WALKER, Detroit, Michigan. 
Dr. ALEXANDER J. STONE, St. Paul, Minnesota. 
Dr. B. A. DUNCAN, . West Point, Mississippi. 
Dr. YOUNG H. BOND, St. Louis, Missouri. 
Dr, W. M. SCHULTZ, Butte City, Montana. 
Dr. JOHN E. SUMMERS, Omaha, Nebraska. 
Dr. S. BISHOP, Reno, Nevada. 
Dr. GRANVILLE P. CONN, Concord, New Hampshire. 
Dr. EDWARD J. ILL, Newark, New Jersey. 
Dr. FRANCIS H. ATKINS, Las Vegas, New Mexico. 
Dr. SENECA D. POWELL, New York, ; New York. 
Dr. FRANCISCO MATES LACAYO, . . Leon, Nicaragua. 
Dr. WM. T. CHEATHAM, Henderson, North Carolina. 
Dr. LOUIS C. PETIT, Bismarck, North Dakota. 
Dr. s. S. THORN, Toledo, Ohio. 
Tr. E. P. FRAZER, Portland, Oregon. 
7 VICE-PRESIDENTS.—Continued. 
Dr. S. WEIR MITCPIELL Philadelphia, Pennsylvania. 
Dr. LEONARDO VILLAR, Lima, Peru. 
Dr. ELISHA P. CLARK, Hope Valley, Rhode Island. 
Dr. FRANCISCO NUNEZ, St. Tecla, Salvador. 
Dr. J. R. BRATTON, Yorkville, South Carolina. 
Dr. M. WARE, Salem, South Dakota. 
Dr. RICHARD B. MAURY, Memphis, Tennessee. 
Dr. J. T.BELL, Tyler, Texas. 
Dr. PEDRO VISCA, Montevideo, Uruguay. 
Dr. F. S. BASCOM, Salt Lake City, Utah. 
Dr. L. M. BINGHAM, Burlington, Vermont. 
Or. JOSE MANUEL DE LOS RIOS, . . Caracas, Venezuela. 
Dr. HUNTER McGUIRE, Richmond, Virginia. 
Dr. H. C. WILSON, Port Townsend, Washington. 
Dr. FRANCISCO ZAYAS, Habana, (Cuba,) West Indies. 
Dr. J, J. SENIOR, Curacao, West Indies. 
Dr. S. L. CRANE, Surg. Gen’L, .... Trinidad, West Indies. 
Dr. THOS. BOWEN, . . . Bridgetown, (Barbados.) West Indies. 
Dr. The Hon. J- C. PHILLIPPO, . • . Kingston, (Jamaica,) West Indies. 
Dr. J. J. CORNILLIAC St. Pierre . Martinique, F. W. I. 
Dr. C. SHRIVER, Bethany, West Virginia. 
Dr. SOLON MARKS, Milwaukee, Wisconsin. 
Dr. JOHN H. FINFROCK, Laramie City, Wyoming. 
Dr. B. J. D. IRWIN, Ass’t Surg. Gen . . Washington, D. C U. S. Army. 
Dr. J. MILLS BROWNE, Surg. Gen. . . Washington, D. C U. S. Navy. 
Surg. CHAS. S. D. FESSENDEN, . . . Louisville, Ky U. S.,M. H. Service. 
SECRETARY=QENERAL: 
CHARLES A. L. REED, M. D. 
311 Elm St., Cincinnati, O. 
ASSISTANT SECRETARIES-GENERAL: 
1. Dr. J. McFADEN GASTIN, .. . • Edgewood Ave, . . .Atlanta, Georgia 
2. Dr. JOHN GUITERAS, 3914 Samson Street, . . .Philadelphia, . . .Pennsylvania. 
3. Dr. WM. F. HUTCHINSON, ... 159 High Street, .... Providence, .... Rhode Island. 
4. Dr. W, 11, HEATH, 415 Pearl Street, .... Buffalo, New York. 
5. Dr. IRVING A. WATSON, . . . .10 Centre Street, . . . .Concord, New Hampshire, 
6. Dr. J. W. CARHART, Lampasas, . . . .Texas. 
7. Dr. EBRD. C. VALENTINE, . . . 236 W. 51st Street, . . . New York, .... New York. 
8. Dr. A. WALTER SUITER, Herkimer, .... New York. 
9. Dr. ISAAC N. LOVE, Grand Ave St. Louis, .... Missouri. 
TREASURER: 
ABRAHAM M. OWEN, M. D. 
507 Utter First Street, Evansville, Ind. 
CHAIRMAN OF THE COMMITTEE OF ARRANQEHENTS 
Dr. SAMUEL S. ADAMS, 
1632 K Street, Washington, D. C. 
[The full Committee will be announced at as early a date as possible.! 
8 INCORPORATORS. 
Dr. ISAAC N. LOVE St. Louis Missouri. 
Dr. L. S. McMURTRY Louisville Kentucky. 
Dr. RUFUS B. HALL Cincinnati Ohio. 
Dr. T. V. FITZPATRICK Cincinnati Ohio. 
Dr. A. B. RICHARDSON Columbus Ohio. 
Dr. CHARLES A. L. REED Cincinnati Ohio. 
TRUSTEES. 
Dr. FIENRY D. HOLTON, Chairman, .... Brattleboro Vermont. 
Dr. A. WALTER SUITER, Secretary .... Herkimer New York. 
Dr. WILLIAM T. BRIGGS Nashville Tennessee. 
Dr. GEORGE F. SHRADY New York New York. 
Dr. P. O. HOOPER Little Rock Arkansas. 
Dr. S. S. ADAMS Washington Dist. of Columbia. 
Dr. FI. O. MARCY Boston . . Massachusetts. 
Dr. J. F. KENNEDY Des Moines lowa. 
Dr. L. S. McMURTRY Louisville Kentucky. 
Dr. N. S. DAVIS . . . Chicago Illinois. 
Dr. LEVI COOPER LANE San Francisco California. 
Dr. I. N. LOVE St. Louis Missouri. 
Dr. HUNTER McGUIRE Richmond Virginia. 
Dr. CLAUDIUS H. MASTIN Mobile Alabama. 
Dr. J. C. CULBERTSON Chicago Illinois. 
The President, Secretary-General, Treasurer, Members of the International Executive Committee 
for the United States, and Executive Presidents of Sections are ex-officio members of the Board of Trustees. 
EXECUTIVE COMMITTEE. 
Dr. HENRY D. HOLTON, Chairman Brattleboro .... Vermont. 
Dr. L. S. McMURTRY 231 W. Chestnut Street . . Louisville Kentucky. 
Dr. Wm. WARREN POTTER 284 Franklin Street . . . Buffalo New York. 
Dr. WILLIAM PEPPER, (ex-officio) . . . 1811 Spruce Street .... Philadelphia .... Pennsylvania. 
Dr. A. M. OWEN, (ex-officio) 507 Upper First Street . . Evansville Indiana. 
Dr. A. VANDER VEER, (ex-officio) ... 28 Eagle Street Albany New York. 
Dr. CHARLES A. L. REED, (ex-officio) . 311 Elm Street Cincinnati Ohio. 
9 INTERNATIONAL EXECUTIVE COMMITTEE. 
Argentine Republic: 
Dr. PEDRO LAGLEYZE Calle Artes 46 Buenos Aires. 
Bolivia; 
Dr. EMILIO DI TOMASSI Calle Ayacucho 26 La Paz. 
British West Indies: 
Dr. JAMES A. DE WOLF Port of Spain. 
British North America: 
DR- JAMES F. W. ROSS 481 Sherborne St Toronto. 
Chile: 
Dr. MOISES AMARAL Facultad de Medicina Santiago. 
Costa Rica: 
Dr. DANIEL NUNEZ San Jose. 
Dominican Republic: 
Dr. JULIO LEON Santo Domingo* 
Ecuador: 
Dr. RICARDO CUCALON Guayaquil. 
French West Indies: 
Dr. J. J. CORNILLIAC St. Pierre Martinique. 
Dr. J. CARREAU Point a Pitre . Guadeloupe. 
Dr. D. E. GUESDE , Point a Pitre Guadeloupe. 
Guatemala: 
Dr. JOSE MONTEROS Avenida Sur No. 8 Guatemala City. 
Haiti; „ 
Dr. I. LAMOPHE Rue du Centre Port au Prince. 
Hawaii: 
Dr. JOHN S. McGREW Honolulu. 
Honduras (Spanish): 
Dr. GEO. BERNHARDT Tegucigalpa. 
Mexico: / 
Dr. TOMAS NORIEGA . Hospital de Jesus Mexico. 
Nicaragua: 
Dr. J. I. URTECHO Calle Real Granada. 
Paraguay: 
Peru; 
Dr. MANUEL C. BARRIOS I‘acultad de Medicina Lima. 
Republic of Colombia: 
' Dr. P. M. IBANEZ Calle 5a Niiraero 99 Bogota. 
Salvador: 
Dr. DAVID J. GUZMAN San Salvador. 
Spanish West Indies: 
Dr. JUAN SANTOS FERNANDEZ Calle Reina No. 92 Havana. 
United States of America: 
Dr. A. VANDER VEER 28 Eagle Street Albany, N. Y. 
United States of Brazil; 
Dr. CARLOS COSTA Rua Largo da Misericordia 7 . . Rio de Janeiro. 
Uruguay: 
Dr. JACINTO DE LEON Calle de Florida No. 64 Montevideo. 
Venezuela: 
Dr. ELIAS RODRIGUEZ Caracas. COMMITTEE ON WAYS AND MEANS. 
Dr. J. F. A. ADAMS Pittsfield Massachusetts. 
Dr. J. H. ALEXANDER Greensburgh Indiana. 
Dr, J. M. ALLEN Liberty Missouri. 
Dr. D. S. BROCKAWAY Livingston Alabama. 
Dr. DAVID BARROW Lexington Kentucky. 
Dr. JOHN BOWEN Paris Kentucky. 
Dr. SAM’L T. BASSETT *. Richmond Missouri. 
Dr. R. D. BIBBER Bath Maine. 
Dr. W. T. BRIGGS Nashville Tennessee. 
Dr. J. W. CARHART Lampasas Texas. 
Dr. STANFORD E. CHAILLE New Orleans • • • . . Louisiana. 
Dr. J. J. CHISOLM Baltimore Maryland. 
Dr. E. R. CAMPBELL Bellows Falls Vermont. 
Dr. D. W. CROUSE . Waterloo lowa. 
Dr. W. C. CLAUDE Annapolis Maryland. 
Dr. O. B. CARCAWA Sunderland Maryland. 
Dr. Wm. J. CHILDRES Pine Bluff Arkansas. 
Dr. Wm. COMPTON Washington Dist. of Columbia 
Dr. E. D. FREEMAN Osgood Indiana. 
Dr. GEO. H. FULLER Delhi lowa. 
Dr. J. D. FOLSOM St. Johnsburg Vermont. 
Dr, R. S. FULKERSON Lexington Missouri. 
Dr. J. D. FERNANDEZ Jacksonville Florida. 
Dr. ALONZO GARCELON Lewiston Maine. 
Dr. J. McF. GASTON Atlanta Georgia. 
Dr. L. A. GRIFFITH Upper Marlboro Maryland. 
Dr. S. A. GIFFORD Laurel Indiana. 
Dr. W. D. HUNTINGTON Rochester Vermont. 
Dr. JOHN B. HAMILTON Chicago Illinois. 
Dr. JOHN HOUSE Manchester Indiana. 
Dr. C. K. HAGGARD Middlesborough Kentucky. 
Dr. JAMES A. HORNE Mauch Chunk Pennsylvania. 
Dr. GEO. H. HILL Independence lowa. 
Dr. E. P. HURD Newburyport Massachusetts. 
Dr. HOBART A. HARE Philadelphia , Pennsylvania. 
Dr. F. E. HITCHCOCK Rockland Maine. 
Dr. H. D. HOLTON Brattleboro Vermont. 
Dr. C. H. HUGHES St. Louis Missouri. 
Dr. P. O. HOOPER Little Rock Arkansas. 
Dr. H. L. E. JOHNSON Washington * Dist. of Columbia 
Dr. J. M. KELLER Hot Springs Arkansas. 
Dr. D. G. KEMP Montpelier Vermont COMMITTEE ON WAYS AND HEANS.-Continued. 
Dr. WILLIS P. KING Kansas City Missouri. 
Dr. H. LEONARD New Braunfels Texas. 
Dr. F. M. LANCASTER Wayside Maryland. 
Dr. LEVI COOPER LANE San Francisco California. 
Dr. ISAAC N. LOVE St. Louis Missouri. 
Dr. J. M. McLAUGHLIN Springville Alabama. 
Dr. P. H. MILLARD St. Paul Minnesota. 
Dr. J. N. McCORMACK Bowling Green . Kentucky. 
Dr. L. S. McMURTRY •*,... Louisville Kentucky. 
Dr. GEO. MINGES Dubuque lowa. 
Dr. Wm. A. McCOY Madison Indiana. 
Dr. Wm. J. MOODY Plainfield lowa. 
Dr. J. LEE McCOMAS Oakland Maryland. 
Dr. ISAAC OTT Easton Pennsylvania. 
Dr. C. R. OGLESBY Pensacola Florida. 
Dr. A. M. OWEN, ex-officio Evansville Indiana. 
Dr. F. PEYRE PORCHER Charleston South Carolina. 
Dr. Wm. WARREN POTTER Buffalo New York. 
Dr. Wm. PEPPER, ex-officio Philadelphia Pennsylvania. 
Dr. GEO. H. ROHE Catonsville Maryland. 
Dr. CHARLES A. L. REED, ex-officio Cincinnati Ohio. 
Dr. J. T. SIMPSON Holden Missouri. 
Dr. X. C. SCOTT Cleveland Ohio. 
Dr. A. O. STROUT Parkersburgh lowa. 
Dr. J. S. SHIBLEY Paris Arkansas. 
Dr. A. WALTER SUITER Herkimer New York. 
Dr. R. STANSBURY SUTTON Pittsburgh Pennsylvania. 
Dr. A. VANDER VEER Albany New York. 
Dr. E. VAN NOTE Hamilton Missouri 
Dr. J. COLLINS WARREN Boston Massachusetts. 
Dr. HAL. C. WYMAN Detroit Michigan. 
Dr. M. R. WRIGPIT Etowah Alabama. 
Dr. A. WILLIAMS Elk Ridge Maryland. 
Dr. P. R. THOMBS Pueblo Colorado. 
Dr. J. T. ESKRIDGE Denver Colorado. 
12 SECTION ON GENERAL MEDICINE. 
HONORARY PRESIDENTS: 
Dr. Manuel Carmona y Valle, City of Mexico; Dr. Francis Delafield, New York, N. Y.; Dr. 
Israel F. Dunn, Portland, Me.; Dr. Reginald H. Fitz, Boston, Mass.; Dr. J. O. Hirschfelder, San 
Francisco, Cal.; Dr. Henry M. Lyman, Chicago, 111.; Dr. Alfred L. Loomis, New York, N. Y.; Dr. 
Emilio Martinez, Havana, Cuba; Dr. William Osler, Baltimore, Md.; Dr. John A. Ouchterlony, 
Louisville, Ky.; Dr. William Pepper, Philadelphia, Pa.; Dr. F. Peyre Porcher, Charleston, S. C.; 
Dr. G. Isaac Ugarte, Santiago, Chile; Dr. Armando Velez, Lima, Peru; Dr. PL A. West, Galveston, 
Texas; Dr. James C. Wilson, Philadelphia, Pa.; Dr. Carlos E. Bernhard, Tegucigalpa, Honduras. 
Dr. J. J. Cornilliac, St. Pierre, Martinique; Dr. Henry Hun, Albany, N. Y.; Dr.Guzman,Nicaragua. 
EXECUTIVE PRESIDENT: 
Dr. Victor C. Vaughan, 15 South State Street, Ann Arbor, Michigan. 
SECRETARIES: 
Dr. Jxjdson Daland (English-Speaking), Dr. Ramon L. Miranda (Spanish-Speaking), 
317 S. 18th St., Philadelphia, Pa. 439 W. 46th St., New York, N. Y. 
Dr. Guemes, [Lavalle 869.] Buenos Aires, Argentine Republic. 
Dr. A. A. de Azevedo Sodre, Rio de Janeiro U. S. of Brazil. 
Dr. Moorehouse, London, Ontario. 
Dr. A. J. Williams, Georgetown, Br. Guiana. 
Dr. John Fullock, Tobago, Trinidad, W. I. 
Dr. Ignacio Gutierrez Ponce, Paris, France, (for Rep. of Colombia.) 
[2 Rue Pierre Charron 2.] 
Dr. Martin Bonnefille, San Jose, Costa Rica. 
Dr. J. Carreau Point a Pitre Guadeloupe, F. W. I. 
Dr. Samuel Gonzalez, City of Guatemala, Guatemala. 
Dr, Arch. Desert, Port au Prince, Haiti. 
Dr. G. P. Andrews, Honolulu, Hawaii. 
Dr. Rqmulo Colindres, Comayagua, Honduras. 
Dr. Basilio Marin, Leon, Nicaragua. 
Dr. Vicente B. Valdes, [Teniente Rey 104] . . Havana, Cuba. 
Dr. Enrique Figari, [Uruguay 190] Montevideo, Uruguay. 
Dr. Francisco A. Risquez Caracas, Venezuela. 
Dr. Demetrio Mejla [San Andres 12] , City of Mexico, , Mexico. 
Dr. G. E. Pierrez, Antigua . British W. I. 
13 SECTION ON GENERAL MEDICINE. 
TITLES AND ABSTRACTS. 
No. 1. (a) Address by the Executive President of the Section, Victor C. Vaughan, A, M., 
M. D., Ann Arbor, Michigan, 
No. 1. Paper by Manuel Carmona y Valle, M. D., City of Mexico. 
[Neither Title nor Abstract furnished.] 
No. 2, 
FORMS OF MALARIA AND THEIR CHARACTERISTIC 
FEATURES. 
Professor of Medicine in the University of Caracas, and Physician to the Military Hospital in the 
Federal District, Venezuela. 
Dr. Francisco A. Risquez. 
The malarial diseases in Venezuela may be classified as follows: 
I. Intermittent forms, generally quotidian, occasionally tertian. 
11. Continued forms, including the varieties: (a) bilious, (A) icterohematuric. 
111. Pernicious forms, including the varieties: (a) pernicious proper, (6) complicated. 
IV. Larved forms, including the varieties: (a) periodic, (b) continued. 
The fonlls of the first group are easily recognized by the features of the paroxysm and 
by the periodic element. When the access is prolonged, the diagnosis may be difficult. 
The forms of the second group are distinguished by the gastro-hepatic symptoms and 
the indications of the urine. They may be confounded with others, especially the yellow 
fever, and the distinction becomes often a matter of life and death. 
The forms of the third 'group are recognized by the pre-existence of malarial paroxysms. 
It may become almost impossible, however, to distinguish between cholera, pneumonia or 
tetanus and cases of choleriform, dysenteric, tetanic, etc., pernicious fevers. 
The forms of the fourth group present still greater difficulties, especially in the continued 
varieties. They may assume all the appearances of typhoid fever, of cholera, of dysentery, of 
paralysis, of haemorrhage. The malarial cachexia may simulate tuberculosis, hepatic abscess, etc. 
An early diagnosis is indispensable in these cases, because they require the fearless admin- 
istration of quinine; and this drug may be contra-indicated in the non-paludal diseases. 
There is but one unquestionable method of diagnosis: the microscopic examination of 
the blood. 
All malarial manifestations are accompanied with melanoemia; melancemia presents itself 
exclusively in malaria, the sign is, therefore, pathognomonic. 
14 A drop of malarial blood, under tbe microscope, shows the masses of black pigment in 
the plasma. The manipulation requires no special technique; it is simpler than the examina- 
tion of the urine. It does not require, as the parasite of Laveran does, an investigation by an 
expert with high powers. Our method requires only a few slides and covers, and a drop of 
blood obtained from the finger, previously washed. The preparation is tarken to the labora- 
tory and there examined. The strong mineral acids may be used as reagents. 
A search after pigment should be made in all suspected cases. The number and size of the 
pigment masses is proportional with the degree of malarial poisoning. If they are found at all, 
quinine should be given. 
I have found pigment in all forms of malaria. I have found it also in other diseases, but 
only as an evidence of malarial complication. 
Melanoemia is always an indication for the' administration of quinine. The life of the 
patient depends often in these cases upon a prompt diagnosis. 
Caracas, June 13,1893. 
No. 3. Paper by E. L. Shurley, M. D., Detroit, Michigan, U. S. A. 
[Neither Title nor Abstract furnished.] 
No. 4. Paper by J. C. Wilson, M. D,, Philadelphia, Pa., U. S. A. 
[Neither Title nor Abstract furnished.] 
No. 5. Paper by Charles G. Stockton, M. D., Buffalo, N. Y., U. S. A. 
[Neither Title nor Abstract furnished.] 
No. 6. Paper by T. Peyre Poscher, M. D., Charleston, S. C., U. S. A. 
[Neither Title nor Abstract furnished.] 
No. 7. Paper by J. H. Musser, M. D., Philadelphia, Pa., U, S. A. 
[Neither Title nor Abstract furnished.] 
No. 8. Paper by George Dock, M. D., Ann Arbor, Mich., U. S. A. 
[Neither Title nor Abstract furnished.] 
No. 9 
ABSTRACT OF A PAPER ON “COLD STEEL AS AN ANTI-RHEUMATIC.” 
By W. K. Vance, A.M., M.D., 
Bristol, Tenn. 
That the two most frequent venereal diseases are often concerned in the causation of inflam- 
matory rheumatism is a fact that has long been known to the profession. Few, if any, physicians doubt the intimate relationship that exists between syphilis and 
rheumatism, and years after the initial lesion of the former we frequently diagnose rheumatism 
as of syphilitic origin, and generally get good results from instituting a line of treatment based 
upon this theory. 
It is equally well established that gonorrhoea is an important and frequent causative factor 
of rheumatism, but in the absence of a history of a recent attack of the former affection 
physicians rarely entertain the idea that there is any connection between the obstinate cases of 
rheumatism with which they meet and specific urethritis. 
That such cases do sometimes occur, years after the gonorrhoea, which can logically be 
considered sequels of it, the writer is convinced by reason of several cases of that character that 
have come under his observation, two of which he reports. 
They were both cases of two (2) years’ duration, neither had had an attack of gonorrhoea, 
or visible gleety discharge within a year of the first rheumatic manifestation. Both cases 
had been treated for a period of two years by good physicians in the usual way with no bene- 
ficial results, before coming under the writer’s care. 
Exploration of their urethras proved that both were badly strictured, and the victims of 
posterior urethritis, treatment for which with the cold-steel sound soon caused the disappearance 
of all rheumatic symptoms. 
The writer is of the opinion that the term gonorrhoeal rheumatism, as ordinarily used and 
understood by the profession, is too restricted in its significance. 
Adopting the theory that gonorrhoeal rheumatism should be regarded as a reflex trouble, 
“the exciting cause being the irritation of the genital organs that is always present in gonor- 
rhoea, active through some ill understood mechanism,” the writer believes that this “ irritation ” 
long outlives gonorrhoea, and that in strictures, mucous patches, and hypersesthetic conditions 
of the urethra, so frequently sequels of gonorrhoea, we have essentially the same exciting 
cause of rheumatism existing even after an interval of years, and that the rational and only 
successful plan of treating such cases is to restore the integrity of the urethra in the manner 
indicated. 
Bristol, Tenn., May 1, 1893. 
No. 10. 
CHOLERA ASIATICA, 1892. 
J. Drummond Burch, A. M., M. D., 
So long as the mud of the Ganges is sacred, so long will cholera trouble the earth. During 
the Sepoy rebellion native troops were governed by grades of caste. The great difficulty of 
transacting ordinary business on carrying out sanitary laws among a population so resembling 
their sacred river, with its 1500 miles of “variety of phases,” having her source in the nail of 
the great toe of Vishnu’s left foot. This endemic of India was first noticed in Djelalabad, 
Afghanistan, a town largely Hindoo, in December, 1891. Pilgrims carried it to the great Hurd- 
wan Fair, about 250 miles north of Lucknow, by March or April, 1892. Thence, “commerce 
having been engrafted on religion,” it traversed much of the route of 1831, as shown by Surgeon 
General Cornish. Dr, Grebentschikoff affirms the present epidemic is a continuation of a 
pandemic which began its course in 1881. The Golden Horn was frozen over, the first time since 
1849. The coldest winter known in Europe, for years, did not arrest it. Why? The Paris 
Aurora, Texas. 
16 epidemic not believed by some to be directly connected with tins epidemic traveling from India. 
Dr. Prousts’ report suppressed by the Prefect of the Seine : “ Filth does not generate cholera 
nor cleanliness exempt from it.” Most generally accepted theory is that Koch’s comma bacilli 
are the cause. Semraola: “ This doctrine at best is based only on a hypothetical basis ** * 
results that are established solely in the laboratory.” Malignant epidemics of cerebro-spinal 
meningitis, typhoid and typhus fevers have their causes in unhygienic conditions, cholera and the 
eruptive fevers seem to be confederated through a germ theory of which so much and so little 
is known. One may breathe small-pox, he must swallow cholera. Dr. Reiche ascribes the 
explosive type of the Hamburg epidemic to the water of the Elbe. The first case from Baku 
on the Caspian Sea. Timely local disposition, as taught by von Pettenkoffer was there. Pro- 
fessor von Pettenkoffer’s X, Y and Z, discussed in a letter received from M. Hoffkine. 
Pettenkoffer, to destroy Hoffkine’s theory of inoculation,holds that “epidemics of cholera are 
never accompanied by epidemics, etc.” “ What will affect man does not affect lower animals.” 
Man alone of all living creatures is susceptible to the cholera virus, etc.” Discussion. Petten- 
koffer’s mistake, which he covers with the blanket of “ coincidence.” Hoffkine’s demonstrations 
to show the value of anti-cholera vaccine; 400 in India without any untoward symptoms. 
Koch says comma bacilli die quickly when dried. Question. Comma bacilli lately discovered in 
intestines of flies. Bacteria may be carried by paper money. Drs. Acosta and Rossi, on two 
notes of the Bank of Spain, weighing about fifteen grains, estimated 19,000 septic germs of 
various kinds. Dr. Reiche notes the difference in symptoms in the epidemic at Hamburg and 
those already known. Petechke or ecchymosal spots over the bodies of some cases, as seen 
principally over the joints of sufferers in the epidemic of cerebro-spinal meningitis in Texas in 
1890, in which all cases were complicated by articular rheumatism. Enteric fever as a compli- 
cation rarely seen at Hamburg. Opposed to cremation because of peculiar morbid anatomy, 
etc., of cholera. Discovery of Pepper, Jackson, Xeil and Goddard, in 1849 confirmed. Reiche 
thinks Koch’s discovery confirmed at Hamburg. In treatment, Pacini discussed. The hypo- 
dermoclysis and enteroclysis of Cantini. Surgeon Lieutenant-Colonel Lewins, M, D., says his 
father originated the saline rectal and venous injections in 1832, so “new” to some modern 
writers. In discussion Macnamara says, if laudanum must be used to retain comma bacilli in 
intestines of a guinea pig for experimental purposes is it not a good argument against its use 
in treating the disease in man ? Strong argument for inoculation is the fact that persons once 
affected by cholera are somewhat immune. Xote received from Sir Andrew Clark, M. D., on 
treatment. Prevention is the best treatment. Not an Americanism, but a philanthropic desire 
for the spirit of Lord Clive, as health officer, and Lord Bentinck, as'inspector-general of India, 
that cholera might be abolished as sutti and the Thugs. Only English authorities quoted. 
Xo. 11. 
FACTS IX STETHOSCOPIC PERCUSSIOX. 
Henry Sewall, Pit. D., M. I)., 
Denver, Colorado. 
When any homogeneous body is set in vibration, the vibrations gradually decrease in 
amplitude as they depart from the point of impact. When a second homogeneous body is in 
contact with the first, vibrations set up in either may be transmitted to the other, but the ampli- 
tude of the vibrations and the intensity of the sound due to them are suddenly and markedly 
diminished when the line of contact is crossed. When the stethoscope is placed on the human body well over the site of any superficial organ, as the stomach, gentle tapping of the surface 
with the pulp of the middle finger produces in the stethoscope a sound of greater or less 
intensity as the tapping is nearer to or farther from the instrument, though no sound whatever 
is audible to the unaided ear. When the percussing finger is moved in a straight line aw7ay 
from the stethoscope the sound heard through the instrument suffers a marked diminution in 
intensity so soon as the finger has crossed the margin of the stomach and impinges, say, over the 
colon, supposing these organs to be in contact. When the stethoscope is now placed over the 
colon, and percussion carried out from centre to periphery as before, there is a sudden diminu- 
tion in the sound at the spot first marked as on the margin of the stomach. This is the proce- 
dure I call by the name “ Stethoscopic Percussion.” It is obvious that, according to the principle 
stated, adjoining organs may be delimited under all possible conditions, as follows: (1) Both 
organs contain air; (2) both are solid; (3) both contain fluid; (4) one is solid, the other 
contains fluid ; (5) one contains air, the other fluid ; (6) one contains air, the other is solid. I 
have many times assured myself of the practical truth of all these propositions except the 
third, and so frequently has the result of stethoscopic percussion been exactly confirmed both in 
the post mortem room and on the surgical operating table, that the method has won, with me, a 
confidence peculiar to itself. By stethoscopic percussion it is usually easy to outline the 
stomach. The spleen and liver seldom offer any difficulty. The line separating either the 
relative or absolute liver dullness from fluid in the right pleural cavity is readily determined; 
so also is the line between the lower border of the liver and an ascitic accumulation. The 
areas of heart and liver dullness are separable where they are in contact. The level of an 
effusion into abdomen or thorax is easily made out. When to ordinary percussion the note 
over the lower part of the liver is tympanitic, stethoscopic percussion may determine the true 
borders of the organ; and when to ordinary percussion the stomach gives a dull note, indis- 
tinguishable from that of the spleen, it is not difficult by stethoscopic percussion to arrive at 
the true outline of the organ. The cranial sutures can apparently, be accurately determined. 
Of the change in pitch and quality of the stethoscopic percussion note, I am as yet prepared to 
say nothing. Finally, stethoscopic percussion supplants none of the ordinary means of physical 
diagnosis, but is a valuable adjunct to all of them. 
No. 12. Paper by W. C. Christopher, M. D., Chicago, Ills., U. S. A. 
[Neither Title nor Abstract furnished.] 
No. 13, 
A STUDY OF SOME CASES OF CPIRONIC DIABETES. 
Dr. N. S. Davis, Jr., 
Chicago. 
The following headings will illustrate its scope; 
(1) Climatic Relationships of Diabetes. 
(2) Seasonal Relationships of Diabetes. 
(3) Relation of Sugar Excretion to other Symptoms of the Disease. 
No. 14. Paper by C. S. Boxd, M. D., Richmond, Ind., U. S. A. 
[Neither Title nor Abstract furnished.] 
18 No. 15. 
ABSTRACT OF A PARER ON “ TYPHOID FEVER.’ 
Wm. C. Dabney, M. D., 
Professor of Practice of Medicine, University of Virginia. 
This paper is based on a study of fourteen cases of continued fever occurring at the Uni- 
versity of Virginia between January 15 and April 1, 1893. The epidemic, or outbreak, 
presented the following features of interest : 
(1) There had been no typhoid fever in or around the University so far as I could learn 
for several months. 
(2) Between the middle of January and the first of April, 1893, there occurred fourteen 
cases of continued fever among persons living or employed on the University grounds. 
(3) The persons who had this continued fever had rooms at widely separated parts of the 
University grounds but all took their meals at the same hotel. 
(4) The water supply of this hotel was the same as that of the other hotels and of other 
parts of the University and the sanitary condition of the building was good. 
(5) A part of the milk supply was obtained from cows whose teats had been washed in 
waiter contaminated by sewage and probably infected with typhoid fever germs. It was in 
evidence also that at least five of the fourteen persons used milk at every meal. 
(6) Of the fourteen cases of continued fever five (5) presented the typical features of 
typhoid, seven were typical in character, and of the other twro I cannot speak with certainty 
as they were not under my care and I could get no satisfactory history of the cases. 
No. 16 
A CASE OF ACROMEGALY IN A GIANTESS. 
Dr. Woods Hutchinson, 
Des Moines, lowa. 
“ Adma, the French Giantess,” died while on exhibition at a Dime Museum in Des Moines, 
February 27, 1893. Body was secured for lowa State University, and on measurement was 
found to be 6 feet 8i inches in height, age 21, unmarried. 
Hands, feet and face presented characteristic shape and enlargement suggestive of acro- 
megaly, and on autopsy pituitary body found to be greatly enlarged: sella turcica would admit 
small pigeon’s egg. Reported to have died of “ decline ” or “ consumption,” with great and 
increasing bodily weakness and failure of mental powers, but lungs wrere found unimpaired. 
Said to have been almost imbecile before death. Sexual system very imperfectly developed ; 
uterus and vagina very small, mammary glands absent. Organs otherwise normal, except 
smallness in proportion to bodily bulk. 
Suggestions: Analogy or connection between acromegaly and unusual stature. Mental 
and bodily weakness of “giants.” Inquiring into size of Sella Turcica in Infants. 
No. 18. Paper by D. W. Prentiss, M. I)., Washington, D. C., U. S. A. 
[Neither Title nor Abstract furnished.] 
19 No. 19. Paper by R. L. Miranda, M. D., New York City, U. S. A. 
[Neither Title nor Abstract furnished.] 
No, 20. Paper by William Osler, M. D., Baltimore, Md., U. S. A. 
[Neither Title nor Abstract furnished.] 
No. 21. 
THE VALUE OF REST AS A THERAPEUTIC AGENT IN CHRONIC 
PULMONARY TUBERCULOSIS. 
Karl von Ruck, B. S., M. D., 
Asheville, N. C. 
This paper is presented because of a manifest tendency to over-estimate the value of, and 
to recommend rest as a general means for a cure; whereas it is only one aid toward complying 
Avith certain indications which may or may not be present in a given case. 
Prolonged rest in bed is not conducive to the best nutritive processes in health ; on the 
contrary, if persisted in, it leads to diminished appetite and diminished assimilation of food, the 
muscles become soft and decrease in size, anaemia and loss in flesh and strength follow, which 
may, however, be prevented by massage and the use of electricity, thereby substituting necessary 
exercise to keep up a proper circulation and nutrition, and the author’s experience with prolonged 
rest in bed in cases of chronic phthisis who have nothing more than a circumscribed local 
tubercular deposit in the lung, and who are, therefore, in an early stage, is the same as in persons 
having good general health. If such a patient presents nutritive disturbances and is wasting, 
it is not because of the tubercular deposit but because of pre or coexisting complications. 
Apart from the occurrence of pulmonary haemorrhage and acute inflammatory processes 
in the chest, in which the patient naturally takes to his bed, the chief indication for rest treat- 
ment is the presence of Septic fever, but a case in which it is present is no longer one of 
uncomplicated tubercular disease. 
The breaking doivn and suppuration of tubercular deposits are due to additional infection 
with the several pus germs, and without such infections the deposits do not undergo changes of 
softening and breaking doivn, but tend to the development of connective tissue changes and 
fibrosis without the occurrence of fever. If rest treatment could prevent the former and 
induce or favor the latter, it ivould then amount to a remedy against tuberculosis, but so far it 
has not been shown that it can do either. This septic infection engrafted upon the local tuber- 
culosis is practically a ucav disease and for the time controls the entire situation, requiring for its 
arrestment every available means at our command, when once thoroughly established. 
Only one of these means, but a most important one, is rest in the recumbent position, the 
object being to lighten the labor of the heart, with a view of maintaining the best possible 
circulation through the lung, and thus to prevent and relieve local congestion and retarded 
circulation in the affected lung portion. 
The heart, already performing extra labor on account of the obstruction in the lung by the 
tubercular process, is called upon for further increase by the fever itself, which at the same time 
tends to damage the organ by inducing degenerative changes in its muscular fibre. Clinically 
the author finds from an experience with many hundreds of such cases, that under rest in the 
recumbent position, the circulation is better maintained, the cough and expectoration become 
less, and the fever is moderated, and the lighter cases soon reach a normal temperature and 
20 improve in general, when, with the employment of rest, the feeding of the patient and his 
environments and hygienic surroundings are good. 
In severe forms while the good influence of rest is unmistakable, the patient is apt to go 
down, nevertheless, only at a slower pace, and in such cases, hydropathic applications, in con- 
nection with rest, diet and stimulants frequently come to the rescue. 
As the septic fever subsides and is finally and permanently controlled, continous rest in 
bed is no longer indicated, and the patients gain faster and better when they are allowed to sit 
up and go out of doors, for longer or shorter hours during the day, as their strength may permit 
without inducing fatigue. 
No. 22. 
A NEW ANAEROBIC BACILLUS OF MALIGNANT (EDEMA. 
F. G. Novy, Sc. D., M. D., 
In several guinea-pigs which died after injection of an impure milk nuclein solution a 
marked oedematous condition Avas observed resembling, and even more pronounced, than that of 
malignant oedema. In the subcutaneous tissue, peritoneal exudate, heart blood, spleen, liver, 
etc., were found enormous numbers of a long slender bacillus. This organism Avas found to 
be obiigatiATe anaerobic in character and pure cultures possessed marked infections and 
extremely toxic properties, producing death in from tAArelve to thirty-six or forty-eight hours, 
Avith the characteristic oedematous condition. White rats, AAThite mice, rabbits, guinea-pigs and 
pigeons, are all extremely sensitive. 
The organs and tissues of animals that have died after inoculation Avith pure cultures contain 
A-ery feAv germs and often none can be found, shoAving that the normal body is not a very good 
soil for the groAA7th of the germ. By injecting certain chemical substances and cultures of 
common non-pathogenic bacteria at the same time with the virulent germ, this natural resistance 
of the body is altered, and as a resultthe germ develops in enormous numbers throughout die body. 
This neAAT, highly pathogenic, anaerobic bacillus is motile and the flagella can be readily 
demonstrated by Loffler’s method. In some of the cover-glass preparations made from 
animals colorless spirals can be obseiwed. In cultures on certain media and under certain 
conditions are found similar spirals AAThich in reality are giant Avhips. These can be readily 
seen in hanging drops even Avith a dry objective. These abnormal flagella are exactly the same 
as those described by Loftier in connection Avith symptomatic anthrax, and their formation is 
probably due to involution changes. 
The germ is readily stained by simple dyes and also by Gram’s method. Spore forma- 
tion has not been obsexwed but the germ itself is extremely resistant. It can be groAvn in 
vacuum, in hydrogen, carbonic acid, nitrogen, and even in illuminating gas. 
Ann Arbor, Mich. 
No. 23. 
PROGRESSIVE PERNICIOUS ANiEMIA. 
Judson Daland, M. D., 
The- complete absence of any knoAvledge as to the etiology of this disease, and the con- 
sequent unsatisfactory results of all efforts to relieve this condition, are the Avriter’s reasons 
for presenting a detailed report of two interesting cases. 
Philadelphia, Pa. 
21 Case I.—An unmarried woman of 36, with a good family and personal history, was 
in the habit of working hard, eating irregularly, and in great haste. Progressive emaciation 
set in about a year before she came under observation, and at the same time her skin showed 
a peculiar yellow color. On admission to the hospital she complained of intense weakness. 
There was oedema of the upper and lower extremities, and an absence of any positive physical 
signs of disease. 
The blood was of a light pink color, very watery, and showed no tendency to coagulate. 
Microscopical examination demonstrated that many of the red blood corpuscles, were double 
the normal size, and that a large number of microcytes were present. Poikilocytosis was well 
marked. The blood was counted by a Thoma-Zeiss Hremocytometer, and showed a great 
reduction in the red blood corpuscles. In examinations of the blood in such cases it is 
advisable to take a double quantity of the blood ; dissolve it in the water used for dilution, 
and make two estimates of the hsemaglobin; the results divided by two will give a more 
correct estimate than that obtained otherwise. Fleishel’s Hsemometer does not record correctly 
percentages of hsemaglobin down as low as 10 or 15 per cent. Extreme exhaustion continued 
until the death of this patient on the eighth day after admission to the hospital, and three and 
a half months from the appearance of the first symptoms. 
A careful autopsy resulted in a diagnosis of amend a; chronic parenchymatous nephritis ; 
fatty liver; gall-stones and jaundice; pachy-meningitis interna hemorrhagica, and hyperplasia 
of the spleen. Minute examination of the liver under the microscope showed the presence of 
iron around the periphery of the lobules. The case is chiefly interesting from the rapidity 
with which the symptoms developed. 
Case lI.—A man, aged 45, with symptoms somewhat similar. Urine was normal, as 
were the viscera, and repeated physical examinations gave negative results. Patient went 
from bad to worse. The number of red blood corpuscles descended from 2 million to 1} 
million, and the hsemaglobin descended from 46 per cent to 40 per cent. The general condition 
grew rapidly worse, and the patient died of exhaustion. 
The post-mortem examination appearances were similar to those of the preceding case. 
Both were perfectly typical examples of this disease, and the blood conditions precisely what 
would be expected. Urine was found diffused in the liver, spleen and kidneys in unusual 
quantities, thus confirming the observations of Dr. Hunter, of London, in regard to this 
peculiarity of the disease. 
No. 24. 
ON THE OCCURRENCE OF A FORM OF CHRONIC BRIGHT’S DISEASE, 
OTHER THAN TYPICAL FIBROID KIDNEY, WITHOUT ALBUMINURIA. 
Philadelphia, Clinical Lecturer on Medicine, Jefferson Medical College. 
D. D. Stewart, M. D., 
The importance of recognizing that the mere absence of albumin from the urine does not 
exclude renal degeneration is dwelt upon, and the fact deplored that with the non-discovery 
of albumin in a renal suspect, a further inquiry as to abnormalities of the urine, microscopically 
and chemically, is too frequently abandoned. 
It is further pointed out, that even our best text-books on general medicine fail to either 
notice or lay stress upon the fact that Bright’s disease may occur and run its course without 
22 albumin ever being discovered in the urine. Yet the occurrence of such cases was known to 
Wilks, of Guy’s Hospital, in 1852; and Mahaned, in 1879 and 1880, described a number of 
them. These, however, were all cases of red, granular (fibroid) kidney, occurring in middle 
life or old age, and usually associated with such typical symptoms of tins affection as marked 
cardio-vascular changes, and at some time or other in the course of the disease polyuria. The 
symptoms were those now known as common to arteriocapillary fibroid kidney, often rather 
cardiac than renal. 
None, so far as the speaker knows, have described such cases as certain of those whose 
history he relates. In all, albumin is totally absent from the urine, and a tendency to diminution 
rather than any increase in the normal amount of urine has always existed. Nitrogenous 
excretion is lessened, and casts (in all hyaline, in several granular, and in one also waxy) and 
kidney epithelia have been discovered in the urine. In several,—young adults,—cardio- 
vascular changes are absolutely undetectable, though arterial tension is high and the apical 
second sound accentuated. In others,—in middle life,—cardio-vascular changes are slightly 
present, but the apex beat is not displaced. In nearly all some uraemic symptoms have occurred, 
and have drawn attention to the kidney ailment. In several, eye-changes are present. 
In conclusion, these cases reported present symptoms other than those of typical granular 
kidney, and the ease with which the number reported was collected after the first of them 
observed was recognized, indicates that they are of probably common occurrence though 
generally overlooked. 
No. 25 
CLINICAL STUDY OF THE DISEASE KNOWN AS “ LA BUB A.” 
Dus. Luis Razetti y N. Guaedia, Jr., 
University of Caracas. 
La Buba, a contagious, inoculable disease, endemic in some tropical regions, and char- 
acterized by a vesiculo-pustular eruption, followed by fungoid ulcerations. 
Clinical description.—No fever unless there be a secondary infection. No prodromes. 
The eruption begins as a vesicle which, after a period more or less long, becomes an ulcer, 
called the mother huha. This mother buba is not permanent. It may disappear before the 
secondary phenomena present themselves, or may persist during the whole course of the disease, 
and even longer. The mother buba presents itself only in portions of the surfaces of the body 
that are not covered by dress. 
The secondary manifestations consist of a general eruption of ulcerating pustules. These 
become fungoid and covered with a yellowish crust. These pustules are the seat of pain and 
itching. The mother buba alone presents an indurated base and is followed by a scar; whilst 
the other ulcers leave only spots that subsequently disappear. The duration is from nine to 
twenty-four months. Occasionally el clavo (wart?) or osondo remains as a sequela. 
A solution of continuity of the skin is indispensable for the contagion. This may be 
produced by the bite of insects. The buba is then an infectious disease, and must have for its 
cause a micro-organism not yet isolated. The disease is not a syphilitic manifestation. There 
is no hereditary tendency. The buba cannot be confounded with any other disease. The only 
treatment thus far employed consists of mercury, iodide of potassium, and antisepsis of the skin. 
Prophylaxis is of the greatest importance. 
Caracas, Venezuela, June 7, 1893. 
23 No. 26, 
INSANITY IN THE NEGRO 
Dr. J. B. Da Laceeda, 
Rio Janeiro. 
A serious study of the neuro-pathology of the negro can only be undertaken in such 
countries as Brazil, the United States, and some of the Spanish colonies. We have resided a 
few years in a rural district of Brazil, and we have paid attention to this subject. 
We have observed that in the negro race, the psychoses, and the diseases classified under 
the vague denomination of neuroses, are relatively rare. The most prevalent form of insanity 
is the mania of persecutions. It assumes the most varied forms, and is always accompanied 
with hypochondria and hallucinations. Suicide is not a rare termination of such cases. 
The miserable social conditions of the slaves, the cruel treatment to which they were 
subjected, the brutish state in which they were kept, may perhaps explain the dominant features 
of the psychoses of the negro of Brazil. 
Notwithstanding what we read in the recent work of Gilles de la Tourette, we do not 
hesitate to say that hysteria is a rare neurosis in the negro race. We have never seen a negress 
with hysteria major, or with those ill-defined nervous troubles that are considered to-day as 
manifestations of hysteria. All opinions to the contrary are probably founded on simulated 
attacks. 
It is also worthy of note that the nervous system of the negro is less sensitive to the action 
of narcotics. It requires larger doses of opium and chloral to make him sleep. 
May, 1893. 
No. 27 
THE CAUSE OF YELLOW FEVER. 
De. J. B. de Laceeda, 
Rio de Janeiro, Brazil. 
We wish to present to the Congress the conclusions of a book shortly to be published with 
the title of Le Microbe pathogenede la fiebre jaune. 
After a study of the black vomit, the urine, the blood, the tissues of the kidneys, the 
liver, the stomach, and the intestines, I am convinced that the pathogenic microbes of yellow 
fever are not bacteria, but rather a polymorphous fungus. This fungus, cultivated upon a nutri- 
tive medium rich in nitrogenous matter and the hydrocarbons, if supplied with air sufficiently 
and kept at a temperature of 33°-35° C., grows an abundant mycelium, and round or elliptique 
gouidia of a golden color. 
Cultivated in a saccharine medium the fungus assumes the torula form, showing the same 
color. In this shape it acts as a ferment upon the sugar. It is under this form that we 
have found the fungus in the mucous membrane of the stomach, in the vomited matters, in the 
urine, in the kidneys and the liver. In the latter organ the fungus often takes the form of 
hyaline cells with a double contour. It is very rarely found in the blood. The mycelial 
form can be grown, upon the proper media, from the torula. 
After many fruitless attempts we have succeeded in producing some of the symptoms of 
yellow fever, and the lesions of the liver and kidney, in guinea pigs. These results have been 
obtained by injecting into the stomach, previously made acid by tartaric or lactic acid, the 
24 spores of the fungus. Two or three clays later the temperature would rise two degrees, and 
death would follow in five or six days. 
One of the animals presented suppression of urine, and the bladder was found empty 
after death. Microscopical research proved the presence in the kidneys, liver and stomach 
of these animals, of the torula fungus, with hyaline cells of double contour. 
We are convinced to-day that the infection in yellow fever takes place in the stomach. 
The poision or toxine is elaborated there, and it attacks and corrodes the mucous membrane, 
the walls of the capillaries and the blood. 
The anuria is due to obstruction of the venal tubules by masses of fungi mixed with solid 
albumin, and epithelial debris. 
We propose as a basis of treatment the flushing and disinfection of the stomach. A 
few cases with encouraging results are reported. We have found that the oil of eucalyptus 
can be used with advantage as a disinfectant in the stomach, and that the perchloride of 
iron acts as a germicide upon the torula form of the fungus. 
I hope to be able to furnish illustrative plates. 
May, 1893. 
No. 28. 
A NEW DISEASE OF THE WEST INDIES. 
Dr. Cuthbert Bowen, 
Barbados, West Indies. 
(1) During my four years stay in Barbados, I have noticed a peculiar inflammatory 
condition of the buccte mucous membrane and alimentary canal, occurring coincidently with 
a sharply defined pigmentation (symmetrically) on the dorsal aspects of the hands and feet. 
Photographs and colored plates will show these conditions. 
(2) Alimentary disturbances strongly resemble Indian sprue,—called Psilosis, by Dr. Thin, 
of London,—but sprue has not this pigmentation. 
(3) Thrush,—aphtha tropica, and sprue contrasted with my cases. 
(4) Details of cases—futility of treatment. 
(5) Results of post-mortem examination—as far as microscopical appearances go—showing 
Isesion to be in large intestine. 
(6) Rectal and intestinal medication indicated and used with good result temporarily. 
(7) Syphilis and leprosy often accompany this condition, but shown conclusively not to 
be the etiological factors. 
(8) Description of the dermatological manifestations,—showing points of affinity and 
disagreement with Pellagra, la Pellagre alcoholique of the French, etc. etc. 
No. 29. 
THE BACTERIOLOGY OF DENGUE FEVER. 
J. W. McLaughlin, M. D., 
Austin, Texas. 
This paper is a review of original investigations in the bacteriology of dengue fever 
which I made in 1885, during the last epidemic of this disease which visited the Southern 
25 States of North America. To this is added, for the first time, photo-micrographic illustra- 
tions of the micrococcus which I then obtained from the blood of persons having dengue fever. 
A detailed report of my investigations of dengue was read at the meeting of the American 
Medical Association, held in St. Louis, in 1886, and was afterward published in the journal of 
the Association. It is not my purpose now to recapitulate at any length the results of the work 
done at that time, nor to add new facts, as I have had no opportunity since then, of testing my 
results by additional investigations, I desire simply to submit for your examination some photo- 
micrographic illustrations of jelly cultures of the dengue micrococcus, which were made for me 
by Dr. William Gray, of the Army Medical Museum at Washington, D. C., and ask that you 
consider these in connection with the remarks which are needed to intelligibly present the subject. 
An inspection of the photo-micrographs herein reproduced will reveal group-arrangements 
of the micrococcus that are distinctive of this micro-organism, and which so far as I can learn, 
are not found in other pathogenic bacteria. I regard this a matter of importance, and, to a 
large extent, I rest the claim that this microbe is intimately, if not causatively, associated with 
dengue fever, upon the characteristic groupings of this micrococcus. But aside from the prob- 
abilities thus furnished of this being the specific coccus of dengue, its unique group-arrange- 
ments renders this micro-organism a matter of considerable biologic interest; these are clearly 
shown in the photo-micrographs, especially in Fig. 1. A casual inspection of this figure will 
reveal several filaments which, on closer attention, it will be seen, are composed of segments 
which contain a number of cocci, grouped around a central coccus of larger size, perhaps an 
arthrospore; segments and cocci are all imbedded in a matrix-like substance, which is probably 
micro-protein, to form the filaments which, it is seen, are all of the same pattern. 
The next photograph, Fig. 2, represents a different grouping of this coccus which occurs 
in the development cycle of its life history. Here the filaments are seen undergoing dissolution ; 
while the segments, which have become separated, are spread out in circular-shaped masses 
and which form an irregular mosaic in the picture. A further separation of the cocci into 
irregular groupings, with a total disappearance of the filaments, is shown in the next picture, 
Fig. 8. Here the grouping resembles staphylococci, and to a less extent, strepto-cocci in their 
arrangements. 
Now, these three photo-micrographs, representing distinct and different group-forms of the 
same coccus—which, however, bear a relationship to each other,—were obtained from the same 
mounted preparation of jelly culture; and as the same group-forms were constantly found in 
other mounts, the conclusion that they represent development-stages in the biological history 
of this micro-organism seems well taken. And, furthermore, as this grouping has never been 
observed in other pathogenic bacteria, and is characteristic and distinctive of the cultures of the 
micro-organism which I obtained from the blood of dengue fever subjects, I feel justified in 
claiming that it is intimately, if not causatively, associated with this disease. 
The cultures of dengue micrococci from which these photo-micrographs were obtained, 
were made by introducing into test tubes of sterilized Miquel’s lichen-jelly, the small quantity 
of blood from a dengue fever subject that would adhere to the point of a sterilized platinum 
wire. Of course, all necessary precautions against the entrance of other microbes than those 
conveyed from the subject with the blood, were scrupulously taken. That my efforts in this 
direction were successful is testified by expert bacteriologists who have pronounced the cultures 
thus obtained, to be pure. 
The tubes of sterilized jelly, after their inoculation with dengue blood, were kept at 100 
degrees F., in a culture-oven for periods of time varying from three to twenty days, and 
re-inoculations, from one tube containing a culture, to another containing only sterilized jelly, 
were made from time to time during a period of six months. I was fortunate in keeping the 
26 cultures pure during this entire time, and all the tubes which I examined, with a few exception 
only, contained pure cultures of the dengue micrococcus. 
These culture micro-organisms were readily stained by all the aniline dyes to which they 
were submitted, with the exception of the brown colors—vesuvin and Bismark brown—which 
failed to have any selective action whatever; but I obtained the best results from methyl-violet, 
which was found to be of especial value in bringing out the cocci and segments of the filaments. 
When unstained these bodies—filaments—appear as continuous tubular bacilli with highly 
refractive granules distributed within their central cavities, and do not show either cocci or 
segments. But when the cocci which have been separated from the filamentous groupings are 
examined they can be distinctly seen, without any staining whatever, as reddish-browm colored 
bodies in active commotion ; the color is most distinct when the cocci are massed together in 
considerable numbers, less distinct when they are examined separately. 
Blood of dengue fever was microscopically examined by various methods. For example: 
it was examined in the fluid state immediately after its removal from the veins. It was dried 
on cover-glasses, then flamed and submitted to various staining dyes and chemical agents. 
And, finally, blood was aspirated from the veins of a dengue patient into a series of glass 
bulbs blown upon a glass tube (Liebig’s potash bulbs). The end of the tube nearest the arm 
of the donor was then closed by a blow-pipe (the other end having been previously closed by 
packing with sterilized cotton), and the apparatus was put into a culture-oven at 100 degrees F. 
The blood was thus made a culture-medium for the growth of any bacteria it contained. At 
various periods of time a bulb was removed by the blow-pipe, and its contained blood was 
examined by the methods referred to. 
This method of culture proved quite satisfactory, as it furnished a large number of cocci 
in a small quantity of blood; and I think this a valuable means to examine blood in acute 
infectious diseases for bacteria, especially when these are found only in inconsiderable numbers 
in fresh drawn blood. In the instance under consideration the blood in the bulbs, removed at 
various times, was found swarming with micrococci. In a few instances I saw in this blood 
what appeared as filaments, but on this point I cannot be positive, owing to my inability to find 
a selective stain for blood preparations; that is, a stain which the cocci would hold after its 
removal, by washing or decolorizing agents, from the blood cells. lam sure, however, that no 
filaments were ever found in fresh drawn blood from dengue patients—about forty in number 
—whose blood I examined. 
Blood taken from the culture bulbs, if examined in a fluid condition, and without staining 
or other reagents, contained what appeared to be innumerable pigment granules floating in 
the plasma; the cell-elements of the blood were also seen, normal in size, shape and numbers. 
But wdien cover-glass preparations of this blood were stained by Loffler’s solution of methyl- 
blue, or by first submitting them to sulphuric acid for a few seconds, then washing and floating 
them on Lugol’s solution of iodine, that which first appeared as pigment granules is now seen to 
be cocci, variously grouped, and located both within the cells and plasma. Ido not recollect 
to have seen cocci within the cells of fresh drawn dengue blood, but this was constantly found 
in the blood from the bulbs. The difficulty which I encountered in fixing the stain in the cocci 
wuth a degree of permanency that would enable me to resist the washes required to decolorize 
the blood cell, was a source of much annoyance, and interfered with ray efforts to display the 
presence of the cocci in the blood, and their relation to its cell-elements. In fact I succeded 
with but a single aniline stain, and with this imperfectly in accomplishing this result. 
By floating cover-glass preparations of dengue blood on Loffler’s methyl-blue solution for 
twenty-four hours, at 100 degrees F., the cocci were found to retain the blue color after this 
had been removed from the blood cells. This method of staining blood preparations was 
27 found out late in my work, when fresh dengue blood was no longer to be obtained, and was 
used only with the blood taken from the culture bulbs. In these preparations the cocci were 
found both within and without the blood cells, and, what is somewhat singular, they were not 
of uniform size; some were as large again as others, and often a central body of deeper color 
was seen surrounded by a halo of paler color, like a central coccus and surrounding capsule. 
Some months ago I sent the only remaining preparation of this kind I had to a gentleman, 
expert in photo-micography, with a request to photograph it. I had hoped to receive the 
picture in time to reproduce it here, but in this I have been disappointed. 
In place of this, I invite your attention to a picture obtained by first applying sulphuric 
acid for a second or two to cover-glass preparations of blood from the culture bulbs, and 
then staining them with Lugol’s solution of iodine. The appearances obtained by this method 
are well shown in Fig. 4—a photograph prepared for me by Dr. R. Menger, of San Antonio, 
Texas. 
Some remarkable results were obtained by applying glacial acetic acid to cover-glass 
preparations of freshly drawn dengue blood. Several cover-glass preparations of fresh blood, 
taken from the last patient I saw having dengue fever in 1885, were flamed, and then submitted 
to the action of glacial acetic acid. When these were examined with a dry one-sixth, or better, 
with a one-twelfth oil emulsion, numerous ovoid cocci, of a yellow-brown color were seen in 
the blood plasma. The blood cells,—which could be distinctly seen,—were normal in appear- 
ance and numbers, and did not contain any of these ovoid bodies. Unfortunately, the number 
of preparations of blood thus treated, which I examined, were too few, and all coming from 
the same individual, do not furnish sufficient evidence on which to base a positive- opinion. But 
if these results are confirmed by future investigations they will be valuable for diagnostic 
purposes. The difference in shape and size between the cocci seen in these preparations and 
those obtained from jelly and blood cultures is due, I think, to the action of the acid on the 
capsule of the coccus. 
In conclusion, I wish to say, that these investigations were made in 1885,—before very 
little, if any, original work in the bacteriology had been done in this country. All of the 
apparatus used by me was extemporized, and the work was done by a general practitioner 
without technical training, other than can be acquired by any educated physician who will 
give the subject careful investigation and study. I request, therefore, that these facts be 
considered by those who would too closely criticise the imperfections of this work. I admit there 
are many, especially when viewed from the present advanced standpoint of bacteiiology. 
No. 30. 
CULTURE OF ANAEROBIC BACTERIA. 
By F. G. Novy, Sc. D., M. D., 
Ann Harbor, Michigan. 
The first part of this paper contains a brief resume of the principles and methods 
employed in the culture of anaerobic bacteria. The methods are described under five heads; 
(1) Exclusion of oxygen. 
(2) Exhaustion of air. 
28 (3) Absorption of oxygen. 
(4) Displacement of oxygen. 
(5) Cnltui’es in the presence of air. 
The second part is experimental and includes detailed descriptions of a convenient and 
very simple apparatus for the culture of anaerobic bacteria either in vacuum orin an atmosphere 
of some indifferent gas. The apparatus which is described, moreover, does away with the use 
of such special and expensive culture tubes as those of Liborius, permits the making of large 
serial cultures, the use of various culture media, whether solid or liquid, and also enables streak 
cultures on agar and Esmarch roll tubes cultures to be made. The usual sealing in a flame 
is discarded and replaced by a more convenient procedure. 
The culture media employed for the growth of anaerobic bacteria are also discussed and 
the value of peptone, glucose and gelatine additions carefully pointed out. The addition of 
litmus is shown to possess some valuable properties. Pure cultures of anaerobic bacteria can be 
readily obtained even in the presence of air with as much ease as ordinary serobic cultures. 
The common anaerobic bacteria can thus be cultivated without any special apparatus and such 
cultures furthermore possess the advantage of retaining their vitality for a considerable length 
of time. 
No. 31. 
TWO CASES OF ANAEMIA DUE TO THE ANKYLOSTOMA DUODENALE 
Dr. J. B. Agnoli, 
“ Victor Manuel ” Hospital, Lima, Peru. 
Helminthological, clinical and medico-geographical considerations are made from the two 
cases. The most important points are: 
(1) The prevalent opinion that the number of eggs found in the dejecta corresponds with 
the number of parasites is erroneous. (The formula given, that to 1000 ankylostoma, 150-180 
eggs in each centigramme of dejecta should correspond, is found faulty. In one of our cases 
there existed only 378 parasites, and each centigramme of feces yielded 500 eggs. 
(2) The relatively small number of parasites, and the gravity of the symptoms in both 
cases favor the view that there is some toxic influence besides the loss of blood. The large 
number of solutions of continuity in the mucous membrane must favor the absorption of toxic 
materials. 
(3) The blood count by the Thoma Zeiss instrument, and the estimate of hemoglobin by 
the chromo-cytometre of Bizzozero, before and after the anthel-minthic treatment show that 
the loss of hemoglobin far exceeds that of red corpuscles, and that in the process of recovery 
the increase of hemoglobin becomes excessive. 
(4) The two cases reported are the first that have been observed in the Republic of 
Peru. Contradictory opinions have not been substantiated. 
(5) The study of reports concerning the arucmfe of the river districts of Peru, leads the 
author to suspect that the ankyloma play an important part in their production. 
Since the writing of the above a third case has been observed in the same hospital, 
confirming the opinions here expressed. 
Lima, June, 1893. 
29 No. 82, 
A CONTRIBUTION TO THE CLINICAL STUDY OF PROLONGED 
REMITTENT FEVER. 
David Lobo, M. D., 
Formerly Lecturer on Physiology at the Central University, Caracas, Venezuela; Member of the Society of 
Physicians and Surgeons, Caracas. 
It is my purpose to describe a certain form of malarial injection which, I believe, has 
received very little attention from standard writers on tropical diseases. The description is 
based on clinics exclusively, refers to the various individual conditions, and is intended to 
impart my personal views in regard to the malady as it occurs at Caracas. 
ETIOLOGY. 
The normal type of malarial fever, the intermittent form, is rarely met with in said city, 
and its presence, when noticed, can generally be traced to an original exception at some of the 
genuine sources of the injection. Close examination will seldom succeed in detecting any 
marked congestion of the liver and spleen in cases developing within the bounds of the city. 
This congestion can not, therefore, be regarded as a characteristic manifestation of the fever 
under consideration. The aspect and extraordinary course of the pyrexia are probably due to 
corresponding variations in the power and quality of Laveran’s corpuscles, to over-poisoning 
of the blood, or to some distinct element operating simultaneously with the paludal germ. 
Investigations in this direction have not as yet been made. 
Temperature.—Variations in temperature do not respond to any fixed law of recurrence. 
It generally ranges from 38°.5 to 40°. 5 C., and drops or rises unexpectedly. Remissions take 
place at any moment of the day. Intermissions may recur, but they should never be trusted. 
Chills and sweating may be observed, but never as definite stages of the fever. 
GENERAL SYMPTOMS. 
SPECIAL SYMPTOMS. 
Circulation and respiration do not exhibit any deviations, except those induced by the 
reaction of the organism under the influence of abnormal heat. Divergencies between pulse or 
respiration, and temperature, should be looked to and carefully treated. 
Digestion.—Appetite, either very poor or absent. Tongue smooth, clean and moist. 
Bowels generally act well, but diarrhoea or constipation is sometimes present. Intense abdominal 
pain, miteorism, profuse diarrhoea, and obstinate constipation are indicative of some complication 
located in the intestines. Vomiting may occur, but it is never distressing. 
Urine offers no change worth mentioning. The excretion of albumen or blood is never 
observed. 
Liver and Spleen.—ln respect to these organs, reference is made to the preliminary con- 
siderations contained in this abstract. But I desire to lay particular stress on the fact that the 
spleen is seldom enlarged or congested in long remittent fever. 
Nervous System.—Headache and vertigo are not common symptoms. Delirium is never 
present. There is no impairment of sensibility and mobility. COURSE, DURATION. 
The fever frequently runs its entire course free from complications. There are serious 
incidents generally; their gravity depends on the importance of the organ attached. Defer- 
vescence takes place, either gradually or by crisis. The former process is more common. As 
regards duration, remittent fever is not governed by any cyclic law, as typhoid or yellow 
fever are wont to be. The briefest term ranges from fifteen to twenty days; the longest extends 
to three months, seldom more. The average duration can be estimated at thirty-five days. 
It is obvious, from the preceding description, that the whole clinical history of the disease 
may be condensed into two prominent facts, viz., an irregular temperature and a long, weary 
course. 
DIAGNOSIS. 
The main points by which long remittent fever can be discriminated from other malarial 
forms, are its uncommon course, its irregular temperature, the absence of marked stages and 
of hepatic or splenic troubles, and its resistance to quinine. 
Between it and typhoid, there is no possible confusion; typhoid is cyclic in its career, is 
accompanied by intestinal lesions, presents peculiar eruptions and is extremely rare at Caracas. 
The so-called typo-malarial fever exhibits typhoid symptoms, which are never present in 
ordinary remittent. 
Vomiting of black matter and albuminuria are perfectly distinctive of yellow fever* The 
course of this never exceeds ten days. 
Pernicious fevers are sufficiently distinguished by their short duration and characteristic 
aspect. 
PROGNOSIS. 
Where complicating or intercurring processes do not occur, a fatal issue is seldom to be 
feared. High temperature, extreme' weakness, frequent vomiting, copious sweating, and 
diarrhoea, generally impart a serious character to the, disease. 
Prognosis is entirely different, when we have to deal with organic complications. In order 
of gravity, cerebral disorders rank first, and are followed by pulmonary congestion, entero- 
colitis with watery discharges, intestinal ulceration and peritonitis. Congestion of the liver 
recedes under proper treatment. Measles, as an accident, occurred in one of my cases ; this 
is the only intercurring disease I have ever observed. 
COMPLICATION. 
The fever may give rise to a special inflammation of the lung, to which the term pseudo- 
pneumonia can be properly assigned. Crepitant rales are seldom heard. Tube-respiration is 
an early sign. Sputa are viscid, scanty and bloody, but seldom rusty. Pain is generally absent. 
The seat of the fluxion is subject to frequent change. The pleura are sometimes included in 
the process. 
Among nervous complications, none is so terrible as cerebral congestion. It may assume a 
convulsive or a comatose form, but the latter is more common. The convulsive form is probably 
due to meningeal congestion. The issue is fatal in nine cases out of ten. Encephalitis, localized 
lesions, and spinal derangements, I have never seen to complicate the fever. 
Hep>atic congestion is also a possible occurrence, but is not necessarily connected with the 
disease. It yields speedily to remedial agents. Abscess of the liver is very rare. Acute entero colitis, dysentery and choleriform diarrhea are fearful complications, as they 
often lead to a fatal result. Haemorrhage and acute peritonitis are apt to occur as secondary 
phenomena, subsequently to ulceration of the digestive duct. The kidneys generally undergo 
no injury at all. Urine is never albuminous. 
TREATMENT. 
Long remittent fever is very slowly influenced by quinine. There are cases in which the 
drug is absolutely useless, whether it be given in large or small doses. If administered to 
excess, it is apt to cause irritation of the stomach, vomiting, diarrhoea, heart depression and 
collapse. The view that quinine will prevent complications, is merely hypothetic. 
Aconite, arsenic and carbolic acid may be resorted to, in protracted cases. I place very 
little confidence in their action. 
Warburg's fever tincture is a valuable remedy. Salicylate of sodium, antipyrine, antifebrine, 
and similar agents will surely act on temperature, but their effect should be carefully watched. 
Tonics should be ordered larga inarm. 
Chlorate, iodide and bromide of potassium are indicated in very chronic cases. 
Cool baths or lotions are an innocent and efficient means of lowering the temperature. 
They must not be spared. 
A proper diet should be prescribed from the first, including good wine and diluted brandy. 
Complications call for a special treatment, entirely dependent on the nature of each case. 
Washington, D. C. 
No. 33. 
THE NATURE OF THE GERMICIDAL CONSTITUENT OF BLOOD SERUM. 
By Victor C. Vaughan and Charles T. McClintock. 
The germicidal constituent of blood serum is not serum albumin, as has been held by 
German authorities, but is a nuclein. This is demonstrated in the following manner: 
Blood serum is treated with about ten volumes of a mixture of equal portions of absolute 
alcohol and ether. This precipitates all of the protoids present. The precipitated mass after 
eliminating the alcohol and ether, is digested as long as peptones are formed with hydrochlorine 
acid and pepsine. The undigested portion consisting of nuclein, is dissolved in dilute alkali 
and is found to have all the germicidal properties of the original serum. 
No. 34. 
ABSTRACT ON VASOMOTOR ATAXIA. 
Solomon Solis-Cohen, A. M., M. D., 
Professor of Clinical Medicine and Applied Therapeutics in the Philadelphia Polyclinic, one of the Physicians 
to the Philadelphia Hospital, etc. 
(1) By the term vasomotor ataxia it is proposed to designate the condition of instability 
of the mechanism of circulation present in certain persons and characterized by abnormal 
readiness of disturbance with tardiness of restoration, of the equilibrium of the cardio-vascular 
apparatus. The manifestations are most strikingly displayed in the terminal vessels and 
32 occur chiefly under the action of external influences, especially cold ; of textic agents; and 
of emotion. The stimulus may be applied centrally or peripherally but in each case the 
resulting phenomena indicate a defect of central inhibition. 
(2) Vasomotor ataxia is in many cases congenital; in some inherited; the condition is 
not rarely present in several members of a family. 
(3) In some cases the phenomena are of paretic, in others of spasmodic character. 
Usually the two kinds of phenomena are displayed in varying degree in the same patient. 
Whether spasmodic or paretic the symptoms are suggestive of inco-ordination. 
(4) In exophthalmic goitre especially such cases as are produced by emotion or are 
markedly intermittent, is found the extreme type of the paretic variety of vasomotor ataxia. 
(5) The form of Raynaud’s disease, known as “ local syncope ” furnishes an extreme type 
of the spasmodic variety; while “local asphyxia” exhibits both spasmodic and paretic 
phenomena. 
(6) Between these extremes are numberless gradations down to the slightest departure from 
normality; while even the extreme symptom-groups represent merely exaggerations of phe- 
nomena that under certain conditions occur in normal individuals. 
(7) Dermographism is an essential feature of vasomotor ataxia and in most cases, factitious 
urticaria can be readily produced by cold or by pressure or by both; mottlings of the skin, 
certain peculiar markings of the nails, teleangiectases and stigmata are common. 
(8) There is usually a haemorrhagic tendency as shown by ecchymoses, petechise, epistaxis, 
hemoptysis, hsematemesis, hsematuria, and retinal haemorrhage. 
(9) Even in the absence of hematuria, red blood cells are often found in the urine ; uric 
acid, urates and oxalates are likewise common; the presence of albumin, tube casts and 
cylindroids is less common, and is usually intermittent. Glycosuria has been observed. 
(10) In many striking cases there has appeared to be morbid alteration of the thyroid gland. 
(11) The action of the heart is usually rapid, irregular and easily disturbed; palpitation is 
common, and in some cases intermittent tachycardia has been noticed. Hsemic and functional 
murmurs are not uncommon. 
(12) Among other symptoms and morbid associations observed are drugidiosyncrasies, 
urticaria, local oedema, angina pectoris and pseudo-angina, hyperidrosis, asthma, hay fever, 
vertigo, migraine and other forms of headache, transient hemiopia and other visual disturbance, 
persistent mydriaits, astigmatism, myopia, hyperopia, menstrual irregularities, intermittent 
polyuria, rheumatism, chorea, epilepsy, neurasthenia, gastralgia, enteralgia and membraneous 
enteritis; most of which are doubtless related as effects of a common cause, or as secondary 
results. 
(13) The development of pulmonary tuberculosis in some cases, is probably a sequence of 
vascular and trophic disturbance in the lung. 
No. 35. “ Recent Experiences in Croupous Pneumonia with Observations on Treatment by 
Subcutaneous Inspections of Saline Solutions,” by R. F. Cunningham, M. D., 
Birmingham, Ala. 
[Abstract not furnished.] 
No. 36. “ Cholera, its Diagnosis, Prognosis and Treatment,” by J. M. Hurley, M. D., San 
Bernardino, California. 
[Abstract not furnished.] 
33 No. 37 
ASIATIC CHOLERA. 
Major Dr. Santiago Hernandez, 
Of the Spanish Army. 
Cholera has its origin in the delta of the Ganges. From hence the disease traveled in 
1817 to Persia, Egypt and China, over laud and along the course of rivers. It reached Europe 
by the sea route in 1830. 
The second epidemic, 1846, commenced near Salian, in the Gulf of Persia, and extended 
to Bacon, Derbet, Kouva, Tiflis; it crossed the Volga, and invaded Russia, Germany, Italy, 
France and Spain. 
The third epidemic, 1875, made its appearance in Alexandria, extended along the shores 
of the Mediterranean and reached America. 
The fourth epidemic invaded Cochin China, extended into Europe and reached the ports 
of the Mediterranean in 1885. 
The fifth, 1892, coming, like its predecessors from the East, reached Russia, and traveled 
along the Mediterranean to Europe; there it became localized in Hamburg. 
This pahdemic disease is transmitted by merchandise, thus proving that it is eminently 
contagious. 
The germ of the disease may lie dormant for some time, and regain its activity after a 
period of time that has not yet been determined. 
The cholera bacillus assumes different morphological and pathogenic properties according 
to the media where it grows. The best known forms are the granula, the comma, the spirillum 
and spirocheoe. 
The leucomaines of the comma bacillus do not impede their pathogenic action. 
Antiseptic solutions arrest the growth of the bacillus. 
There is no lesion characteristic of cholera. The most marked changes are found in the 
blood. The intestinal diapedesis of the rice-water liquid cannot be accounted for by the 
shedding of the epithelial lining. 
The prophylaxis against cholera depends upon a careful selection of food and drink ; these 
should be sterilized. The infection is not transmitted through the air. 
Attenuated cultures have no prophylactic action. 
There is no specific treatment for cholera. All forms of treatment are symptomatic and 
unreliable. The most reasonable consist in the administration of antiseptics, by the stomach, 
and the hypodermic injection of sterilized saline solutions. 
June, 1893. 
No. 38. 
THE IMPORTANCE OF ELIMINATING PELVIC DISEASES IN GENERAL 
DIAGNOSIS. 
Mary H. McLean, 
St. Louis, Missouri. 
A reference is made to the charge brought against the meddlesome gynaecologist by the 
general practitioner and reasons are stated for making counter charges against the negligent 
practitioner. The intimate relations existing between the pelvic organs and the sympathetic 
34 nervous system should lead one always to recognize the possibility of a causative or complicating 
pelvic disease in fevers and nervous and digestive disorders among women. Chronic invalidism 
and death are the results of ignoring such a possibility. Cases are cited illustrating the 
impotence of general therapeutics extended through weeks of fever or years of invalidism owing 
to unrecognized pelvic troubles which constitute the real pathological condition. 
No. 39. 
THE NEED OF RESEARCH IN PREVENTIVE MEDICINE. 
J. M. Postle, 
Hinckly, Illinois. 
The author makes the following suggestions : 
(1) That the Pan-American Medical Congress petition the general government of the 
United States to establish on a permanent basis a government laboratory in which bacteriological 
research may be prosecuted. 
(2) That the results of the research.done in this laboratory be printed in book form and 
distributed to the physicians of the country at a nominal cost which will pay for the printing. 
(3) That the general government take charge of all examinations of those who wish to 
practice medicine in the United States. 
No. 40. 
ABSTRACT CLINICAL NOTES ON AMCEBIC DYSENTERY 
Professor of Practice of Medicine, University of Texas; Secretary of State Medical Association, 
Galveston, Texas. 
PI. A. West, M. D., 
Practical importance of the subject in consequence of the diversity of opinion in regard 
to the definition, varieties and etiology of dysentery, and especially the non-recognition by, the 
general medical profession of the casual relations of the amoeba colli in the production of 
dysentery and the wide dissemination and frequent occurrence of this form of the disease. 
Attention is called to the following points: 
(1) Importance of a correct definition. Dysentery is not, as is usually taught, a morbid 
entity, consisting of an inflammation of the large intestine essentially the same in all forms 
and climates, varying only according to climatic and other modifying conditions; on the con- 
trary the term dysentery should be used in a general sense to express a group of inflammations 
of the large intestine partly of specific and partly of non-specific origin. 
(2) The adoption of the following classification will do much toward dissipating the 
existing confusion, viz., acute catarrhal, acute diphtheritic, amoebic, and secondary dysentery. 
(3) Amoebic dysentery is more widely disseminated and occurs with greater frequency than 
is generally supposed. 
(4) To emphasize the probable entrance of the amoeba through impure drinking water. 
35 (5) To note the characteristic and uniform symptoms of this form of dysentery. 
(6) The essential chronicity and difficult cure depending upon the character and location of 
the lesions. 
(7) The necessity of combating the excessive anaemia and wasting by the use of a more 
liberal diet than is generally prescribed. 
(8) To urge the importance of cleansing and antiseptic irrigations as a rational method 
of reaching and destroying the amoeba, and stimulating the intestinal ulcers to heal. 
(9) To note the fact that while solutions of quinine are destructive to the amoeba, injections 
of the same fail to exercise any marked curative effect. 
(10) My experience going to show that mild injections of nitrate of silver, 30 grains to a 
quart with occasional administration of salines and large doses of bismuth and salol constitutes 
the best treatment. Details of seven cases illustrative of the above points treated in the John 
Sealy Hospital, Galveston, Texas, from October, 1892, to June 1, 1893, showing the compara- 
tive frequency of this form of dysentery in this locality, there were only two or three cases of 
catarrhal, and none of diphtheritic or. secondary forms admitted during this period. Two of 
them originated upon the same steamship in Yera Cruz, the facts strongly pointing to infection 
through the drinking water. One acquired the disease while traveling through Indian Territory 
and North Texas, one was from Arkansas, having lived for some time in the alluvial bottoms of 
the Mississippi and Red Rivers. These two also drank impure and stagnant water. The other 
three cases originated in Galveston, or its immediate vicinity, and no history of infected water 
could be obtained. The symptoms in these cases were very uniform, though they might begin 
acutely, they would very soon become chronic, and are characterized by irregularity in the flux 
as to character and frequency of the stools, alternating between improvement and relapse. 
The difficult cure and chronicity depending upon the nature of the lesions, viz., ulceration of 
different portions of the large intestine and sometimes of the ileum, with a disposition to infil- 
tration and undermining of the mucous membrane, affording a nidus for the development, 
growth, multiplication and destructive work of the micro-organisms. The nature of the disease 
is such as to produce very rapid anaemia and wasting. It is necessary to combat these results 
by the plentiful use of nitrogenous food—meat, fowls, eggs, rich broths, milk, etc.; if restricted 
to a milk diet these patients will very rapidly fail. 
The character of the lesions gives the key to the most successful treatment, viz., consisting 
of thorough irrigation of the intestine, first with simple warm water for cleansing purposes; 
second, with an antiseptic solution for destroying the organisms, and stimulating the ulcers to 
heal. For the latter purpose, I have tried solutions of quinia, creolin and silver nitrate, the 
latter has given the best results. Quinia, in my experience, failing to accomplish any per- 
manent good. While not attempting to explain mode of action, large doses of bismuth 
subnitrate and salol seem to have had a distinct effect in controlling the excessive frequency 
of the stools. Salines also at times are beneficial, their mode of action probably consisting 
simply of a cleansing effect, in sweeping out irritants of various kinds. 
Galveston, July 20, 1893. 
No. 41. “Some American Ideas about Chronic Diarrhoea,” by Ephkaim Cutter, New York 
City, N. Y. [Abstract received too late for publication.] 
No, 42. “ Tratamento medico del vomito negro,” by Segundo Bellvee Mateo, Havana, Cuba. 
[Abstract received too late for publication.] No 43. “The Principles of Immunity and Cure in the Infectious Diseases,” by Victor C. 
Vaughan, M. D., Ann Arbor, Mich. [Formal Address.] 
No. 44. “ Forced Respiration—Fell Method—A Plea for its General Adoption in Hospital and 
Naval Practice,” by Geo. E. Fell, Buffalo, N. Y., U. S. A. 
[Abstract received too late for publication.] 
No. 45. “Some Medical Facts connected with the Discovery of America,” by A. M. Fernan- 
dez de Ybarra, A. 8., M. D., New York City, N. Y. 
The principal object of this paper on medical history is to state the probable disease that 
caused the death of Christopher Columbus, and his ailments during his voyages of discovery in 
America ; also those of the Pinzones and a few other discoverers of American lands. 
37 SECTION ON GENERAL SURGERY. 
HONORARY PRESIDENTS; 
Dr. E. Andrews, Chicago, 111.; Dr. Manuelßarros Borgono, Santiago, Chile; Dr. Wm. T. Briggs, 
Nashville, Tenn.; Dr. Jos. D. Bryant, New York, N.Y.; Dr. P. S. Conner, Cincinnati, O.; Dr. N. P. 
Dandridge, Cincinnati, O.; Dr. E. 11. Gregory, St. Louis, Mo.; Dr. W. T. Halstead, Baltimore, Md.; 
Dr. W. W. Keen, Philadelphia, Pa.; Dr. Levi Cooper Lane, San Francisco, Cal.; Dr. Rafael Lavista, 
City of Mexico, Mexico; Dr. Samuel Logan, New Orleans, La.; Dr. Claudius H. Mastin, Mobile, Ala.; 
Dr. E. M. Moore, Rochester, N.Y.; Dr. Julius Mundt, Comayagua, Honduras; Dr. Wm. H. Pancoast, 
Philadelphia, Pa.; Dr. John B. Roberts, Philadelphia, Pa.; Dr. Louis A. Sayre, New York, N. Y.; Dr. 
Casimiro Saez, Havana, Cuba; Dr. N. Senn, Chicago, 111.; Dr. Belasario Sosa, Lima, Peru; Dr. J. 
Ford Thompson, Washington, D. C.; Dr. J. Collins Warren, Boston, Mass.; Dr. John A, Wyeth, 
New York, N. Y.; Dr. D. W. Yandell, Louisville, Ky. Dr. Rudolph Mates, New Orleans, La. 
Dr. John B. Hamilton, 20 Custom House, Chicago, 111. 
EXECUTIVE PRESIDENT: 
Dr. Joseph Ransohoff (English-Speaking), Dr. W. H. Heath (Spanish-Speaking), 
296 Walnut Street, Cincinnati, O. 415 Pearl Street, Buffalo, N. Y. 
Dr. PIROVANO, [Florida 251,] Buenos Aires, Argentine Republic. 
Dr. Ricardo Guzman, La Paz, Bolivia. 
Dr. A. P. Boon St. Kitts, ... . Er. West Indies. 
Dr. T. G. Roddick, Montreal, Canada. 
Dr. Rafael Rocha Castilla [Carrera 6 No. 285] Bogota, Rep. of Colombia. 
Dr. Panfilio J. Valverde, San Jose, Costa Rica. 
Dr. Raimundo Menocal, [Dragones 2] . . . . Havana, Cuba. 
Dr. Erichsen, St. Thomas, Danish West Indies. 
Dr. D. E. Guesde . i ••.... Point a Pitre Guadeloupe, F. W. I. 
Dr. Juan Padilla Matute, Guatemala City, Guatemala. 
Dr. Leon Audain, . . • Port au Prince, Haiti. 
Dr. G. P. Andrews, Honolulu, Hawaii. 
Dr. R. Pineda, Tegucigalpa, Honduras. 
Dr. Regino Gonzalez, [Cordovanes No. 4,] . . City of Mexico, Mexico. 
Dr. Velasquez, . . Managua, Nicaragua. 
Dr. Lucas A. de O. Catta Preta, ...... Rio de Janeiro, U. S. of Brazil. 
Dr. Jose Pugnalin, [Mercedes 280,] Montevideo, Uruguay. 
Dr. David Lobo, Caracas, Venezuela. 
SECRETARIES: 
38 SECTION ON GENERAL SURGERY. 
Section of Orthopedic Surgery has been incorporated in this Section. 
No. 51. 
THE TREATMENT OF POTT’S DISEASE OF THE SPINE 
A. B. Judson, M, D., 
New York City. 
Articular osteitis in the middle region of the spine is more intractable than in the 
regions above and below, for mechanical reasons. The vertebrae here are exposed to 
disturbance by the respiratory movements. Below the vertebral bodies are so large that 
they do not soon give up their relations of mutual support, and above the superincumbent 
weight is less. We cannot cut short the disease by operative or other interference, but 
must expect with confidence the intervention of the natural reparative procest-es. A brace 
should be applied with the purpose of transferring the weight so far as is practicable from 
the bodies of the vertebrae, in which the disease is found, to the processes which remain 
sound. It does not take much experience to convince one that efficient pressure applied 
in this manner is productive of good. It may not at once arrest morbid action and induce 
repair of the carious bone. For these events we must wait for the natural reaction; but 
it is not difficult to believe that nature will the more promptly intervene if our mechanical 
applications relieve pain and substitute a feeling of strength for weakness and apprehen- 
sion. The brace should be made chiefly of mild steel, which gives the surgeon the power 
to modify the degree and direction of pressure to the changing shape and to meet the 
increasing tolerance of pressure. The details of treatment require patient and minute 
attention. 
No. 52. 
THE PROBABLE CAUSE OF THE LIMP OF THE FIRST AND SECOND 
STAGES OF HIP DISEASE. 
Harry M. Sherman, A. M., M. D., 
San Francisco, Cal. 
It is noted in almost all the descriptions of the invasion of the ordinary form of hip- 
joint disease—osteo-arthritic tuberculosis—that the initial symptom is the limp; that the 
limp lasts a variable time and increases, and then follow night-cri.es and complaints of 
pain in the day time. These are the classical symptoms of the first stage of the disease, 
the s.age before the development of deformity. 
39 In the second stage the symptoms are often not much changed except in intensity, but 
examination shows the motions of the joint more or less checked in one or more or all 
directions. Still, within the range of permitted motion this is free and painless, and it is 
within this range that the joint is used in the act of walking, and evidently used pain- 
lessly. 
In this second stage, with joint motions crippled by muscular rigidity, it is incon- 
ceivable that the gait should be even and smooth, but what causes the limp in the first stage, 
when there can be found but the slightest amount of checked motion, or none at all? And 
what causes the limp of the second stage beyond that due to the checked motion? 
The chief characteristic of the hip limp is a lateral sway of the body toward the 
affected side, while the body weight is supported by the diseased joint. 
The usual site of the initial infection is in the neck of the femur on the diaphyseal 
side of the epiphyseal cartilage. From this point the process extends downward into 
the trochanter and, by a subperiosteal route, it passes around the epiphyseal cartilage and 
involves the epiphysis. Under the stimulus of the bacillary product the cancelli of the 
bone become crowded with a round cell infiltration, the trabeculae waste, circulation is cut 
off and cheesy or fatty change of the pathological product follows. 
The inevitable result of the wasting of the trabeculae is a structural weakness of the 
bone. Its resistance to strain is lessened directly as its substance is lessened. 
The suggestion is here made that it is this structural weakening that is the cause of 
the painless limp of the hip-joint disease in the first stage, and of that portion of the 
limp, also painless, of the second stage that is not due to checked motion. 
It is argued that in the absence of pain, and in the absence of any change in the form 
of the bone, or of the opposing articular surfaces, or of any suspension of the function 
of the muscles around the joint, the structural weakness that must result from the thin- 
ning, and even complete disappearance, of the trabeculae in the neck and head of the 
femur, is the most probable cause of the limp. 
No. 53. 
THE MECHANICAL TREATMENT OF OSTEO-ARTHRITIS OF THE 
KNEE. 
Henry Ling M. D., 
New York. 
Osteo-arthritis of the knee, or “ white swelling,” is usually a tubercular process, 
beginning in an adjacent epiphysis or in the synovial membrane, and, if unchecked, finally 
involves most of the joint structures. It is accompanied by the usual symptoms of chronic 
joint inflammation, of which spasm and atrophy of the muscles acting upon the joint 
are practically the most important, as indicating most exactly the degree of joint irrita- 
tion ; and, also, by certain characteristic deformities at the knee, namely flexion, eversion, 
abduction (genu valgum), and subluxation backwards of the head of the tibia. The 
deformities are due to the mechanical conditions under which the spasmodically irritated 
thigh muscles act. 
40 The general indication for treatment is to improve the nutrition of the patient, and 
tHs insure a blood supply of good quality to the diseased area, facilitating the reparative 
process. One of the most gratifying results of proper mechanical treatment is the marked 
and speedy gain in general health and vigor. 
The local indications for treatment are to inaugurate and promote the process of 
repair at the site of disease, and to prevent or correct deformity, in order to restore, so far 
as possible, the functions of the joint. These local indications are met by mechanically 
providing conditions favoring the relaxation of the spasmodically contracted muscles, a 
normal local circulation, gradual correction of the deformity and, later, the protected use of 
the joint. In the stage of irritation and disintegration strict local rest is enforced by the 
use of an apparatus giving counter-extension and fixation, and for a month or two the 
patient is kept recumbent. When the local circulation and position of the limb has suffi- 
ciently improved, locomotion is permitted first with, later without, crutches, but always pro- 
tected by the apparatus. After a considerable period of such enforced rest, during which 
the reparative process is completed, the neuro-muscular apparatus should be regulated and 
strengthened by allowing limited motion at the joint; last of all, the joint may be gradu- 
ually trained to bear weight, as a preparation for discarding all treatment. 
The Dowr’s supporting and protective apparatus with a lock-joint at the knee, as 
described in the paper, may be used to meet all these varied indications ; the aim of the 
author, however, is not to advocate the use of any particular apparatus, but to point out 
the varying indications presented by the disease in its different stages, and that the ele- 
ments of protection artificially supplied should vary to correspond. Protection from 
external and internal trauma with progressive replacement of distorted parts should be 
furnished at all stages, at first with enforced disuse, later with protected use, limited by the 
operator to meet the conditions present. 
No. 54. Paper by Dr. Beenando Herrera, Caracas, Venezuela. 
[Neither Title nor Abstract furnished.] 
No. 55. Paper by Dr. Juan M. Escolana, Caracas, Venezuela. 
[Neither Title nor Abstract furnished.] 
No. 56. UNUNITED FRACTURE. 
By Leweleyn Eliot, A. M., INI. D., 
Washington, D. C. 
Definition.—Pseudarthosis or unuuited fracture is non-union of broken fragments of 
bone, after the expiration of six or more weeks. This non-union may be temporary or 
permanent. 
Causes.—The causes of this non-union may be either constitutional or local. 
Diagnosis.—The diagnosis in cases of non-union is not a difficult matter, as the 
condition is generally apparent. 
41 Treatment.—The treatment of cases of ununited fracture must be in accord with the 
cause, whether it be constitutional or local. The constitutional treatment is embraced in 
all measures which improve nutrition and hasten bone repair. The local treatment con- 
sists in such measures as will produce an irritation at the ends of the fragments; 
resection and wiring the freshened ends, and in some cases, amputation of the member. 
He favors the open method after resection and wiring. The details of four cases are 
appended. 
No. 57. 
SOME POINTS IN THE SURGICAL TREATMENT OF APPENDICITIS. 
Augustus P. Clarke, A. M., M. D,, 
Cambridge, Mass., U. S. A. 
From a careful study of the histories of cases coming under the writer’s observation 
during a number of years past, and also from learning in many instances the final results 
of those eases, the author remarks that it is not unsafe to say that in every case in which 
there is reason to believe that the vermiform appendix is involved, though the symptoms at 
first may be mild or transient, the surgeon or medical attendant should be ready to insti- 
tute measures against the occurrences of sudden surprises and umisal results. There is 
great probability in almost any event that the appendix, during an attack of inflammation, 
will become adherent to other parts in the immediate vicinity. In many ckses, if not in 
the most, incision should be made over the point of greatest tenderness; this corresponds 
to the Mcßurney point, which is midway between the umbilicus and the superior spinous 
process of the ilium, and is in the right liuea semilunaris. Such an incision will afford 
an opportunity for free drainage and for flushing the parts with warm carbolized water or 
with water of the temperature of 115° to 120° containing boracic acid or other antiseptic 
agents that can safely be introduced into an abscess cavity. A liberal incision when timely 
made over the tender part has always yielded in the cases occurring in the author’s practice 
an immediate and permanent result. In all cases after the incision has been made the 
parts should be thoroughly explored ; if the appendix is within easy reach it should be 
brought forward and then sewed off by means of sutures of aseptic kangaroo tendon. 
The cordwainer’s stitch will be most convenient for accomplishing this. If, however, 
the appendix is bound down by firm adhesions, or if it cannot be found without much 
difficulty or without doing excessive violence to the caecum or to other parts, it will be 
far better to allow it to remain, for its presence, when thus left, will not seriously interfere 
with the patient’s recovery. In most cases when the mesentery •or other parts have been 
sufficiently detached the appendix should not be tied but should be clamped, and then 
sewed off by means of carbolized animal sutures ; as soon as all hemorrhage has been con- 
trolled the appendix may be incised about two centimeters from the caeca! tissue. In order 
to prevent adhesions of the stump or base of the pedicle to other structures the peritoneal 
tissue in immediate vicinity of the margin of the incision should be closely approximated 
by a subperitoneal suture. The smaller sized kangaroo tendon rendered aseptic should 
preferably be the material for such use. A thorough closure of the peritoneal surface of 
the wound thus effected will not only obviate the occurrence of agglutination of the parts 
42 but will also help to prevent the escape into the peritoneum of aseptic matter that may 
gravitate toward this point, and thus to preclude the occurrence of a fistulous tract. The 
entire wound should as far as possible be kept in an aseptic condition. Aristol and iodo- 
form will be found to be excellent adjuvants in maintaining this condition of the tissues. 
The danger of the subsequent occurrence of hernia may be overcome by paying strict 
attention to the closure of the severed layers that have been divided in the operation; the 
peritoneum, the muscular tissue, the fascia and the external integument should each be 
brought together separately. Carbolized animal sutures should be used for this purpose. 
Entire closure of the wound by the first intension can be effected only in those cases in 
which the operation has been undertaken in the early stage of the attack. After the 
formation of an abscess complete union at first cannot be expected to follow because some 
method for facilitating drainage for a while will have to be employed. The different steps 
of an operation are much complicated when there is present an unusual abdominal disten- 
sion ; so also it will be in cases in which there is excessive or marked obesity. Trendelen- 
burg’s posture in this as in all cases of abdominal section for intestinal affections cannot be 
overestimated. In those cases in which some means for drainage become necessary every 
detail in the treatment should receive the strictest attention, for if there should occur any 
hindrance to a free discharge of the exudation a risk of a dangerous sepsis to the organ- 
ism will be incurred. In every such case of abdominal section when a drainage tube has 
been employed, the possibility of the occurrence of hernia should not be overlooked. In 
all cases, whether the drainage tube has been required or not, a firm binder or a thorough 
bandaging should be employed ; the patient for some weeks should be kept for the most 
part in the horizontal position. The question often arises—Should the surgeon when called 
upon in the later stages of a case advise operative interference? In answer to this it may 
be remarked that our experience in such cases is favorable to the adoption of an explora- 
tory incision. When an operation is undertaken in the later stages the patient must of 
course assume more risks, for the chances of recovery are much less than when an opera- 
tion is attempted much earlier though surgical measures at such lata date may prevent the 
rupturing of an abscess into the peritoneal cavity ; when there has been such a rupture, 
removal of the pus, and cleausing of the parts may afford an opportunity for a retrograde 
process of the disease to take place. Nothing, therefore, but the occurrence of extreme collapse 
should weigh against the employment of operative measures. In those cases of appendi- 
citis, which have gone on to suppuration before operative measures have been undertaken 
there may occur secondary abscess in other portions of the abdominal cavity. An ope. a- 
tion to insure relief must therefore embrace a course of procedure which will afford a free 
discharge to all accumulation of purulent exudation ; it will sometimes be necessary to 
make a prolonged dissection at different parts and also to overcome adhesions of an 
unusual extent. Great care will also have to be exercised lest an opening be made into an 
adherent intestinal mass. In some instances portions of the epiploon may have become 
gangrenous; there may occur in the veins of the abdomen an inflammation that may 
extend outward to the other vascular tissue. In carrying out, for these complications, 
the necessary surgical treatment, much judgment will have to be exercised and much pre- 
caution taken that the dissection or search be not prolonged beyond what may afterward 
prove to be a beneficial or safe proceeding. 
43 No. 58. 
A BRIEF SPLINT-TECHNOLOGY FOR SURGEONS, 
By Edward A. Tracey, M. D., 
Boston, Mass, 
The objects of this paper are: to treat in detail of a new material and method used 
in surgical splint making,—to urge the surgeon to become the maker of suitable splints 
for cases occurring in practice,—and to indicate lines of procedure in apparatus making, 
which promise rich results in general and orthopedic surgery. 
Material.—The basis of the material employed is wood-pulp, made preferably from 
the crashed fibre of the poplar tree. This is rolled into sheets in such wise that the fibres 
intertwine in every direction, and loosely, thus giving an increased ductility to the 
product. These sheets are farther strengthened by having a fabric introduced between 
the layers of the pulp, or by interweaving with the short, crushed wood-fibres, a long jute 
or other tough fibre. 
These sheets are made of several thicknesses ; for convenience I shall designate them 
by number—each figure representing one millimetre. Thus, Sheet 1 has a thickness ot 
one millimetre,-Sheet 2, of two millimetres, and so on. 
The characteristics of this material are stiffness or rigidity when dry, and plasticity 
with toughness when moist. Its rigidity can be increased ad libitum by the use of a silicate 
solution as a moistener. 
Moisteners.—Water, or a stiffening solution, can be used to moisted the material 
previous to molding. The advantage of water is its omnipresence. With its aid a 
serviceable splint can be made. Such a splint, however, is liable to be softened by the 
absorption of perspiration, or, on children, of urine; and for this reason it should be 
protected by a covering of oiled paper or silk, or mackintosh, or best of all, by a coat of 
varnish. 
A solution of potassium silicate has several qualities which render it the best of the 
stiffening solutions experimented with. (Sodium silicate and a mixture of potassium and 
sodium silicates have nearly the same qualities.) 
Any desired degree of rigidity up to brittleness can be given the splint by using a 
silicate solution as a moistener—the stronger the solution, the more rigid the splint. 
A splint rendered rigid in this wise is not affected by perspiration, nor indeed by 
momentary contact with fluids, as in washing. Another quality, of exceptional advan- 
tages in cases of compound fractures, is that this solution has strong antiseptic properties. 
The manner of moistening the blank deserves mention. It is most satisfactorily 
done by applying by means of a flat paste-brush, the fluid used, on both sides, alternately, 
of the splint-bank, and repeating until the proper amount of the fluid is absorbed. 
Practice enables us to judge the precise amount of moisture suited for our purpose. 
Having thus treated of the materials used in this method of splinting, I shall briefly 
consider their application to the human body, under the headings of 
(1) Head splints. 
(2) Trunk splints. 
(3) Upper limb splints. 
(4) Lower limb splints. 
44 This simplicity of classification will be necessarily violated in specific cases where 
compound splints, embracing parts of different systems are constructed. 
There follows a systematic description of splints and apparatus, mostly original, for 
the various parts of the body, and the author’s technique for the same. 
No. 59 
RECONSTRUCTIVE SURGERY. 
Thomas Maghee, A. M., M. D 
Rawlins, Wyoming, U. S. 
Patient, Englishman, George W ■, set. fifty-three, sheepherder, attempt at 
suicide. Gunshot wound of face and neck, extending from pomum Adami to nasal 
bones, with almost entire destruction of lower maxilla, alveolar portion of upper maxilla, 
chin, mouth and nose. 
Patient transported thirty miles in farm wagon. 
Thirty-nine operations in five months. 
Result, complete reproduction of lower maxilla. 
Restoration of injured portion of upper maxilla. 
Construction of new chin, mouth and nose with natural appearance of tissues, also 
new mustache and beard. 
No. 60 
URETHRAL MALE POLYPUS. 
R. Menoral, M. D., 
Havana, Cuba. 
The case which I have the honor to bring before you is extremely rare. It is well- 
known that the male urethra is rarely affected by morbid growth, and only after the use 
of perfected apparatus for exploring the canal, its existence is admitted. The following 
case which we have seen is a good example, obscure in its cause, but I think effectively 
treated. 
Mr. W. M., is a man of twenty-eight years old, bachelor, book agent. I saw him at 
my office, on the fifth of June, 1892. No history could be obtained of gleet or syphilis. 
The patient said that he had observed that the morbid growths of the meatus had been 
developing for about three months at left side, growing slow. He told me that no careful 
attempt had been made to remedy this swelling, because he has no dsciomfort in making 
water ; no pain, no smarting, and only at times a little blood is lost at end of micturition, 
the blood being moldered into long worm-like clots. 
When I saw him, I observed at left side of the meatis two little growths, olive- 
shaped, flattened, pale, smooth. By expanding the sides of the urethra with the fingers, 
we have not found another tumor, but exploring the rest of the canal by means of the 
Griienfeld endoscope, the existence of four more polypi, located immediately before the 
bulbous portion, is revealed, the canal is enlarged. One of the tumors is pediculated, 
45 the mucous membrane is soft, red around the polypus. Upon examination by the 
urethral endoscope is found a puffed appearance one inch in extent, in a state of granular 
degeneration ; the pediculated polypus was situated at the right side; the rest of the 
canal had a normal appearance. 
On the same day of the consultation, I performed the operation. A weak boracic 
solution was injected followed by another cocaine solution at one per cent. By means of a 
small Sim’s curette, I scraped the supposed site of the growths, turning the instrument 
and extracting the four polypi. The removal of these tumors and the scraping of the 
mucous membrane are not attended with any serious hemorrhage. 
With a small curved eye scissors I excised the tumors of the meatus, applying after 
the excision sutures with fine silk thread. 
Injections of permanganate of kpotash are recommended. This topical treatment was 
repeated four times a day. 
Sutures are removed at seventh day, the wound of the meatus healed per primam. 
At eighteenth day endoscopic examination of the canal shows its normal appearance. 
On microscopical examination a fine interlacing thread of connective tissue and 
blood vessels, covered with an attenuated layer of urethral epithelium, were seen. 
No, 61. 
SIMPLICITY IN SURGERY. 
By Robert W. Johnson, M. D., Principal and Practitioner of Surgery, 
Baltimore Medical College. 
I. Introduction. 
Repetition of axioms not always useless. 
Simplicity, the termini of a science. Evolution, the process of elimination. Theo- 
retically desirable. Practically often neglected. Immortality of a discovery often 
proportionate to its simplicity. 
11. Nature, complex as she is, one factor in all treatment; hence simplicity here 
refers to man’s assistance. 
111. Reasons for aiming at simplicity : 
(1) Greater applicability in place and time. 
(2) More easily comprehended and retained in mediocre minds. 
(3) Fewer avenues for error. 
* IV. Comparison of complex and simple methods of treating. 
(1) Inflammation; (2) hemorrhage; (3) drainage; (4) sutures and ligatures; (5) 
antiseptics; (6) fractures; (7) heruise, etc. 
V. Simplicity in prescribing drugs. No shot-gun prescriptions. 
VI. Value of simplicity in nomenclature, and with laity, jury, etc. 
VII. Conclusion. 
46 No. 62 
A REPORT OF'FOUR CASES OF BRAIN SURGERY. 
Attending Surgeon Presbyterian Hospital, New York, Professor of Surgery, New York Polyclinic. 
Andrew J. McCosh, M. I). 
The surgical treatment of epilepsy has been unsatisfactory. Very few cases have 
been permanently cured as the result of operation. 
Report of four cases operated on by the author, no general conclusions can be drawn 
from these cases, but each one has points of special interest. 
Case I. Age seventeen; extra dural hemorrhage. Convulsions on tenth day. 
Trephining. Removal of clot. Recovery. 
Case 11. Aged six. Extra-dural hemorrhage. Paralysis and convulsions. Tre- 
phining on eighth day. Removal of clot. Recovery. 
Case 111. General epileptiform convulsions, stupor and delirium. Trephining in 
right occipital region. (Edema of brain. Aspiration and drainage (for two days) of 
light lateral ventricle. Recovery. No convulsions since operation and patient perfectly 
well (five mouths). 
Case IV. Age seven. General convulsions and partial paralysis of right arm and 
leg. Trephining over motor area of left side. Dura mater opened. Thin membrane, 
old organized blood-clot found over motor area. Removal. Recovery. Paralysis 
improving, no change in convulsions (four months). 
No. 63. “ Soudas y Bujras Gercas del Dr. Castano,” by Dr. Alberto Castano, Buenos Aires, 
Argentine Republic. 
[Abstract and Specimens not furnished.] 
No. 64. Paper by Ignacio Placencia, M. D., Havana, Cuba. 
[Title and Abstract not furnished.] 
No. 65. Paper by Ignacio Placencia, M. D., Havana, Cuba. 
[Title and Abstract not furnished.] 
No. 66. “ Tratamiento quirurgico de la fiebre amarila,” by Segundo B. Mateo, M. D., 
Havana, Cuba. 
[Abstract not furnished.] 
No, 67. “In what Class of Cases is Drainage Required?”, by H. 0. Marcy, M.D., Boston, 
Mass. [Abstract not furnished.] 
47 No. 68. “Causation, Pathology and Treatment of Carbuncle,” by David W. Graham, M. D. 
Chicago, 111. [Abstract not furnished.] 
No. 69. Paper by Dr. Martin Herrera, Caracas, Venezuela. 
[Neither Title nor Abstract furnished.] 
No. 70. Paper by Dr. Miguel A. Lego, Caracas, Venezuela. 
[Neither Title nor Abstract furnished.] 
No. 71. 
DEMONSTRATION OF IMPROVED LONG TRACTION HIP-SPLINT WITH 
PROPER METHOD OF APPLYING ADHESIVE PLASTER FOR 
COUNTER EXTENSION. 
Henry Ling Taylor, M. D., 
The splint consists in a hollow shank, firmly attached at its upper end to a side plate, 
from which strong curved steel horns spring to carry the perineal strap. 
In the hollow shank plays a notched bar, which is worked by a key; this bar is 
bent under the foot at a right angle to give attachment to a strap which is buckled to 
adhesive plasters ending just above the malleoli. The plasters consist in two strips of 
diachylon plaster, each ending in a buckle; they are one and one-half inches wide and 
long enough to reach from just below the level of the groin to two inches above the 
malleoli, on the outer and inner aspects of the limb, respectively. To each plaster are 
sewed two tails of three quarters of an inch rubber plaster, above the knee and at the 
lower end. With both long strips in position, the narrow strips are to be evenly wound 
in a spiral direction upward around the limb, beginning with the upper pair. They 
should be held in place by a bandage or laced legging. Plasters applied in this manner 
pull from the thigh, so that the knee is protected, and give a firm basis for continued 
traction. The improvement in the apparatus described, over the original Taylor hip- 
splint, consists mainly in the substitution of the strong curved steel horns of peculiar 
shape, for the horizontal hip-band formerly used. The change was made on account of 
the greater comfort and convenience of the new arrangement, but chiefly to give greater 
rigidity to the apparatus. 
New York City. 
No. 72. IMPROVED APPARATUS FOR POTT’S DISEASE. 
Henry Ling Taylor, M. D., 
New York. 
The apparatus devised by Dr. C. Fayette Taylor, over thirty years ago, for the treat- 
ment of Pott’s disease, and figured and described (often incorrectly) in surgical works, has 
in the last twenty years undergone considerable modification and improvement in the way 
of definiteness and precision of action, though the principle of antero-posterior leverage 
remains unchanged. 
48 The apparatus {Figs. 3 and 4) 'm the form shown has been in use for eighteen years 
or more. It differs from the apparatus shown to the New York State Medical Society in 
1863 in the following points: (1) The parallel vertical bars have been lengthened, and 
end in hooked pieces passing well over the shoulders near the neck. (2) The hinges differ 
somewhat in construction (see detail Fig. 4) and are screwed to the bars, being retained 
solely for the purpose of facilitating the modification of the apparatus corresponding to 
the varying indications of the case. (3) The horizontal hip-band is discarded, and 
replaced by a rigid steel bar or vertical hip-band having the shape of an inverted U: to 
the upper part of this band the lower ends of the vertical bars are firmly attached. The 
ends of the pp-shaped band are fitted into the post-trochanteric sulcus on either side, and 
together with the hooked pieces at the root of the neck fix the apparatus laterally, besides 
assisting in antero-posterior and vertical fixation. The lower ends, beiqg points of con- 
tact with the skin, are protected by hard-rubber piates. (4) Hard-rubber pads are used 
instead of the soft pads formerly employed, to transmit the leverage of the apparatus to 
the region of the spine which it is desired to protect. (5) Instead of the straps encircling 
the arm formerly used to get a fixed point for counter force in front, a “chest-piece” is 
employed, consisting of two ear-shaped or triangular hard-rubber pads, fitted under the 
clavicles and resting on the pectoral muscles, and joined by a stiff steel bar, curved forward 
to escape the chest, and so contrived that the distance between the plates may be increased 
or diminished at will. The chest-piece being in position, is buckled to straps coming from 
the ends of the shoulder hooks above, and below it is strapped to a buckle at the angle of 
the pphip-band on either side, thus leaving the arm free and the axilla untouched. (See 
upper part of Fig. 4-) (6) The apron which holds the whole apparatus forward reaches 
to the posterior border of the axilla on either side, and from the trochanter to the arm lat- 
erally, and is secured by straps and buckles to the apparatus. (7) Perineal straps pass 
from the lower border of the apron in front, under the thighs to the ends of the vertical 
hip-band. 
It is to be understood that appropriate modifications of the form of the apparatus 
are made to correspond with the indications presented by disease in the different regions 
of the spine, and by the character and amount of the deformity. Most cases above the 
eighth dorsal, will require, in addition, Dr. Taylor’s circular pivoted head-support or chin- 
rest, Avhich is easily fitted to this apparatus. 
No. 73 
APPARATUS FOR THE CORRECTION OF TALIPES EQUINO-VARUS 
AND FOR THE RETENTION OF THE CORRECTED FOOT. 
Henry Ling Taylor, M. D., 
New York. 
This apparatus, devised by Dr. C. Fayette Taylor, is used for the gradual reduction 
of the deformity by continuous leverage applied to the inner side of the foot and leg. 
As the deformity yields, the leverage is increased by bending the shank of the instrument 
49 The splint, always acting from the inner side and never attached to the shoe, is used 
and modified to meet the requirements of particular cases, and has been substantially as 
shown for eighteen years. It consists, in its commonest form {Figs. 1, 2, and 4), in a steel 
shank with guarded leg and ankle-bands pivoted to a foot-piece of thin steel. The foot- 
piece has a sole-plate, and a side-plate fitted to the inside of the foot; there is a screw stop 
at the ankle-joint to flex the ankle, and there are straps across the instep which are 
guarded by a small steel bar. The shank is not usually pivoted directly to the foot-plate 
but to a steel H-piece which makes an offset from the ankle. The shank of this instru- 
ment is easily bent by the hand or by wrenches according to the requirements of the case. 
About 1874 a three-tailed adhesive plaster was applied to the leg {Fig. 3), and a 
jpiece of webbing attached to the plaster was buckled to the heel of the apparatus {Fig. J). 
This kept the heel from leaving the sole-plate when force was applied, and greatly 
increased precision of action. 
The essential points in the method are : 
(1) The preservation of the heel cord as an aid in unfolding the foot. 
(2) The gradual reduction of the varus deformity first, afterward of the equiuus. 
(3) Exact prehension of the foot by means of an apparatus not attached to the shoe, 
and by adhesive plaster applied to the leg. 
(4) The application of leverage to the inner side of the foot and leg. 
(5) Thorough mechanical after-treatment. 
No. 74. “Practical Orthopedics,” by Dr. Noble Smith, London, England. 
[Abstract not furnished.] 
No. 75. 
OBSERVATIONS ON THE ROTARY-LATERAL CURVATURE OF THE 
SPINE, WITH SPECIAL REFERENCE TO ETIOLOGY AND 
TREATMENT. 
Jacob Teschner, M.D., 
New York City, 
'General results of treatment. 
Time of life when curvatures occur. 
Sex as a factor. 
Pathological and anatomical causes. 
Factors in the etiology of the disease, which are regarded by the author of special 
importance, viz: 
(1) Hereditary tendency. 
(2) General temperament, and the condition of the mind and nervous systems. 
(3) Lack of development of the muscular system and general physical condition. (4) Habitual faulty position with super-imposed weight, especially considering the 
school habits of children. 
Treatment of classes of curvatures, viz; 
(1) Habitual scolioses which can be obliterated by the voluntary muscular efforts of 
the patients. 
(2) Scolioses which are not affected by muscular efforts, but which can be reduced or 
obliterated by suspension of the patients. 
(3) Scoliosis which are not affected by muscular efforts or by suspension, the deform- 
ities being fixed. 
No. 76. 
RECUMBENCY IN THE TREATMENT OF POTT’S DISEASE. 
John C. Schapps, M. D., 
Brooklyn, N. Y. 
Ii is not alone the collapse of a cavity produced by disintegration which is the local 
determining condition of the deformity of Pott’s disease. The softened bone which sur- 
rounds for some distance and merges into the seat of actual destruction is squeezed out by 
longitudinal pressure, bent out by antero-posterior leverage and pushed out by direct 
backward pressure. To directly antagonize these deforming forces it is necessary to have 
a passive spine. Portative apparatus are limited in their efficiency by reason of the dis- 
tmce and heterogeneous character and mobility of the parts which intervene between their 
points of application and the lesion sought to be controlled, and are usually applied with 
a view to maintaining the activity of the spine, as a support and a base for muscular exer- 
tion. Recumbency means more than simply putting a patient to bed. It implies the 
retention of the whole spine in the best possible position so that the separate parts remain 
unchanged or subject to such changes only as the surgeon may make. When the patient 
is horizontal, the force of gravity which had acted when upright as a deforming agent can 
be converted into a reforming force. Direct backward pressure can be accurately antag- 
onized. Muscular action and consequent interosseous pressure, now greatly reduced by the 
general condition of rest, can be overcome by fixation and by less traction than would be 
required to raise the weight of what were superincumbent parts. The spine thus relieved 
of the performance of all its active functions, and saved from all traumatisms except that 
of respiration, is placed in the best possible condition for repair. And, what is of great 
importance, fever and the drain of muscular spasm, pain and perverted nutrition are met 
by a state of systemic rest. Clinical experience has demonstrated the truth of these 
theoretical considerations. When the proper conditions are maintained, patients are usu- 
ally relieved of pain, sleep and eat well, and soon lose the drawn, old, tired expression so 
familiar upon the faces of those suffering from prolonged muscular spasm. The improve- 
ment in general health which they commonly make is, to those who have been burdened 
by the traditional fear of confinement, surprising. I believe that by systematic recum- 
bency the course of the disease is materially shortened, much destruction is avoided and much deformity prevented. Another merit of this therapeutic measure is that its employ- 
ment does not demand the mechanical skill and experience necessary to the successful con- 
struction and use of a portative apparatus. When a spinal brace cannot be readily 
obtained, recumbency may, if the mechanical conditions are carefully studied, be safely 
resorted to, until other arrangements can be made. Patients may be removed long dis- 
tances with comfort and safety upon a frame. 
The indications for recumbency are : (1.) As a routine measure as soon as a diagnosis 
of spondylitis has been made or even when it is probable. (2.) In cases of patients wear- 
ing braces, persistent pressure sores, progressive deformity, psoas contraction, acute or 
increasing abscess, loss of power, pain, night-cries, grunting respiration, inclination to lean 
on chairs, etc., or any other suggestion by face, attitude or gait that the proper degree of 
support has not been secured. For the fulfillment of all the indications a wheeled couch 
is recommended, consisting of a canvas support laced to an iron frame which is adjustable 
at any convenient height or incline. The canvas is provided with the necessary aperture, 
closed by a flap. Straps, pads and weights are added for support, fixation and traction. 
Adjustable pressure to antagonize the kyphotic projection is produced by means of straps. 
The patient need rarely be moved for any purpose whatever. When not in use the appa- 
ratus can be folded up. 
When acute symptoms have been absent for several months, the patient may gradu- 
ually and tentatively be allowed greater liberty under the protection of a brace carefully 
adapted to the needs of the case. 
No. 77. “ Causes Contributing to Failure in the Treatment of Hip Joint Disease,” by A. M. 
Phelps, M. D., New York, N. Y. 
[Abstract not furnished.] 
No. 78. “Some Thomas’ Splints with Demonstrations of Principles,” by John Ridlon, M. D., 
Chicago, 111. 
[Demonstration not furnished.] 
No. 79. “Orthopedic Work done at the Vanderbilt Clinic of New York, from January, 1889, 
to June, 1893,” by John Ridlon, M. D., Chicago, 111, 
[Abstract not furnished.] 
No. 80 
A CASE OF ACUTE ARTHRITIS OF THE HIP OF INFANTS, WITH 
SOME REMARKS ON THE ETIOLOGY OF THE AFFECTION. 
By Augustus Thohndike, M. D,, 
Boston, Mass. 
W. C., a boy aged seventeen months, had been ill for three days, although fur ter! days 
previous he had occasional cramps in the stomach. He was much emaciated, with pinched 
52 and anxious expression of face, and was in great pain, which was made worse by any move- 
ment. The Jeff ♦■.high was semiflexed, swollen to twice its natural size, fluctuating and very 
tender. Swelh g involved the entire thigh to iliac crest behind, and also the lower half 
of the abdomen. Temperature 104.6 (rectal). Pulse 160. Operation at the West End 
Infant Hospital on heated table under light etherization ; the abscess was opened, irrigated 
with corrosive sublimate solution, and washed out with boiled water, drainage tubes 
inserted and sterilized gauze dressings, and a Cabot wire frame applied. The hip was dis- 
located on the dorsum, the acetabulum was very shallow and probably perforated ; hip 
replaced, came out, replaced again in threedays under ether, but would not remain in place. 
Good recovery otherwise; the frequency of dislocation persisting in cases which recover 
explained. 
Etiologically the affection is an acute septic affec'ion of great virulence, characterized 
by rapid and extensive suppuration and destruction of the bone and sofc parts, and by 
general sepsis ; it occurs chiefly in small babies. Trauma has but little to do with its 
production. Syphilis may cause it and so may tuberculosis, but pathological data are 
wanting to prove this, and it is usua.ly regarded as a simple acute septic inflammation of 
the upper epiphysis of tl - femur. Bacteriological examinations show the pyogenic organ- 
isms found in the pus to be staphylococci, especially s. aureus and occasionally, as in this 
case, streptococci are also present. 
INo. 81. 
THE THERAPEUTIC TREATMENT OF INFANTILE PARALYSIS. 
L, A. Weigel, M. D., 
Rochester, N. Y. 
The prevention of deformity in the early stages. 
Differentiation between malpositions due to muscular fixation and contraction, by the 
use of anaesthetics. 
The use of anaesthetics in the treatment of paralytic deformities. 
Description of a method for correcting malpositions of the hip, with report of a 
case illustrating the same. 
Operative treatment of paralytic deformities. 
No. 82. “ Gymnastic Apparatus for Scoliosis,” by L. A. Weigel, M. D., Rochester, N. Y. 
[Abstract not furnished.] 
To. 83. “Practical Points in the Treatment of Hip Disease,” by A. B. Judson, M. D., New 
York, N. Y. 
[Abstract not furnished.] 
53 No. 84. “The Technique of the Piaster Jacket,” by Reginald H. Sayre, M. D., New 
York, N. Y. 
[Demonstration not furnished.] 
No. 85. “Club Hand,” by Reginald H. Sayre, M. D., New York, N. Y. 
[Abstract not furnished.] 
No. 86. “ Gastrostomy for Relief of Oesophageal Stricture,” by Ernest Laplace, M. D.,. 
Philadelphia, Pa. 
[Abstract not furnished.] 
No. 92, 
HYPERTROPHY OF THE PROSTATE, 
G. Frank Lydston, M. D., 
Chicago, 111. 
Among other points made by the author in this paper were the following: It is 
claimed by writers upon the subject that the prostate is absent in children, Mansell 
Moullin basing his arguments anent the function of the prostate largely upon this supposed 
fact. Dr. Lydston himself, in a recent paper, presented similar arguments regarding the 
function of the prostate. He now, however, renounces his views in this direction and 
asserts that a well-developed prostate body is found in children. He presented two draw- 
ings of the bladder and prostate in a new-born child, and in a child of four years of age 
in support of his assertion. 
Regarding the function of the prostate, the author has modified his views somewhat,, 
he having hitherto believed that the prostate as regards the function of both its glandular 
and muscular structure was distinctively a sexual organ. From post-mortem and clinical 
studies, however, he concludes that it has both a sexual and urinary function, perturbation 
of either of which may lead to disease. Once pathological conditions have beeU excited, 
the perturbation of both sexual and urinary function is likely to follow. As an illustra- 
tion of the importance of the prostate from the sphincteric standpoint, is mentioned the 
that a thorough splitting of the membranous urethra back of the apex of the prostate 
is not followed by incontinence of urine, providing the prostatic urethra proper and the 
prostato-vesical sphincter are not completely paralyzed by over-dilatation. This is exem- 
plified in many cases of perineal section for organic stricture. The author further claims 
that residual urine per se, is not the cause of the early symptoms of prostatic disease. It 
has an important bearing, to be sure, upon the symptomatology of this affection, but it is, 
when taken alone, a minor factor in the pathological and symptomatic tout ensemble. 
Residual urine, the author claims, is by no means infrequent, in patients who are not 
supposed to be the subjects of prostatic disease. He does not believe in the majority of 
individuals the bladder is ever thoroughly emptied in the physiological performance of 
54 micturition. This defect in evacuation increases as the subject grows older and the elas- 
ticity of the bladder walls becomes impaired. When the elasticity is pathologically 
impaired, a proportionate increase in the quantity of residual urine results. A condition 
of extreme irritability of the prostatic urethra associated with a diminution and rigidity of 
its lumen has more to do with the early symptoms of prostatic disease than has residual 
urine. Once a cystitis has occurred, then the existence of residual urine becomes of rela- 
tively great importance. 
Dr. Lydston does not believe that the beneficial action of the catheter in prostatiques 
is due to evacuation of the residual urine, nor does he believe that catheterization alone 
will evacuate the residual urine completely in these patients. He believes that the rest 
secured to the prostate and bladder by the systematic introduction of the catheter, asso- 
ciated with the blunting of hyperasthesia by the pressure of the catheter, has more to do 
with the relief of the symptoms than the simple evacuation of residual urine. Once the 
residual urine has become pathological, then its removal is urgently necessary, but this, 
cannot be evacuated by the catheter alone, irrigation being necessary for this purpose. 
Regarding the etiology of prostatic disease, Dr. Lydston claims that senility per se is 
not a logical explanation of prostatic hypertrophy. He has found by post mortem exami- 
nations, incipient posterior median lobes in subjects under forty years of age with perfectly 
healthy bladders. He thinks the disease is laid down before middle life. Excesses of 
various kinds, particularly in the way of sexual indulgence, masturbation, etc., being 
responsible for it in a large proportion of cases, collateral causes entering into play how- 
ever. He collectively embraces the causes of prostatic hypertrophy as beginning in early 
life under the term prostatic overstrain. He believes that in patients presenting the first 
symptoms of the disease late in life, the changes in the prostate had their point of depar- 
ture many years before. Dr. Lydston divides the various pathological conditions 
embraced under the omnibus hypertrophy of the prostate essentially as follows: (1) 
Hyperplasia of the periprostatic glandular and interstitial tissues. (2) Hyperplasia of the 
prostatic muscular tissue proper, with or without a corresponding periprostatic and glandu- 
lar hyperplasia. (3) Circumscribed enlargement of tin lateral or posterior median portion, 
singly or combined. This may be associated or not with a bar at the neck of the bladder. 
(4) A bar at the neck of the bladder. (5) Fibro-rayoraatous neoplasms. 
Lastly, the author calls attention to the fact that drainage of the bladder produces its 
beneficial effects by promoting rest of the prostate and vesical neck and surrounding 
tissues. He claims, if performed at an early period, this operation will alone very 
frequently restore the normal function of micturition by inducing resolution in hyper- 
plastic tissue. 
55 SECTION ON MILITARY MEDICINE AND SURGERY. 
HONORARY PRESIDENTS; 
Brig. Genl. Chas. Sutherland, M. D., Surgeon General U. S. Army; Surgeon General J. Mills 
Browne, M. D., Chief of Bureau of Medicine and Surgery, U. S. Navy; William A. Hammond, M. D., 
Surgeon General U. S. Army, (Retired); Robert Murray, M. D., Surgeon General U. S. Army, (Retired); 
John Moore, M. D., Surgeon General U. S. Army, (Retired); Col. Fernando Lopez, M. D., Mexican 
Army; Col. Tomas Casas, Medical Sub-inspector of the First class, Spanish Army, Havana; Robert 
Grieve, M. D., Surgeon General, Georgetown, B. G.; Joseph D. Bryant, M. D., Surgeon General, State 
of New York; Nicholas Senn, Surgeon General, Wisconsin National Guard; Walter Wyman, M. D., 
Surgeon General U. S. Marine Hospital Service; Philip S. Wales, M. D., Medical Director U. S. Navy; 
Thomas A. McParlin, M. D,, Brev’t Brig. Gen’l U. S. A., (Retired); Edw. P. Vollum, M. D., Colonel and 
Chief Medical Purveyor, U. S. Army, (Retired); Jos. R. Smith, M. D., Colonel and Ass’t Surgeon General 
U. S. A., Medical Director Dep’t of Col’d U. S. Army; Albert 1.. Gihon, M. D., Medical Director U. 
S. Navy; John H. Brinton, M. D., Philadephia, Ex-Surgeon U. S. Volunteers; Hunter McGuire, M. 
D., Richmond, Va., Ex-Surgeon Volunteers, C. S. A.; Robert Weir, M. D., New York, formerly Ass’t 
Surgeon U. S. A.; P. S. Conner, M. D., Cincinnati, formerly Ass’t Surgeon U. S. A,; D. Bergin, M. D., 
Surgeon General Canadian. Militia; Dr. Frederick W. Strange, Surgeon Canadian Regiment of Infantry. 
EXECUTIVE PRESIDENT: 
Lieut. Col. Geo. M. Sternberg, Surgeon General U. S. Army, War Dep’t, Army Bldg., New York City. 
SECRETARIES: 
John Van R. Hoff, M. I)., Sur. U. S. A. (Eng.-Speaking), Dr. D. M. G liter as, U. S. N. (Span.-Speaking),, 
Governor’s Island, N. V. 133 E. 117 th St., N. Y. 
Dr. Mallo [Piedad 1259] Buenos Aires, Argentine Republic. 
Dr. Hernandez, La Paz, . . Bolivia. 
Dr. Carlos Frederico S. X. Azevedo, Rio de Janeiro, U. S. of Brazil. 
Dr. Abraham Aparicio [Carrera 8] Bogota, Rep. of Colombia. 
Dr. Juan J. Ulloa, San Jose, Costa Rica. 
Dr. Eduardo Semprun [San Jose 10] Havana, Cuba. 
Dr. D. E. Guesdk Point a Pitre Guadeloupe, F. W. I. 
Dr. Juan J. Ortega, Guatemala City, Guatemala. 
Dr. A. Comean, . Port au Prince, Haiti. 
Dr. G. P. Andrews, Honolulu, Hawaii. 
Dr. Jos6 Gayqn [Hospital Mill tar] City of Mexico, Mexico. 
Dr. J. Martinez, Granada, Nicaragua. 
Dr. Gabriel Honore [Gaboto 151] Montevideo, Uruguay. 
Dr. N. Guardia, Caracas, Venezuela. \ 
56 SECTION OF MILITARY MEDICINE AND SURGERY. 
No. 101. “ Laparotomy in Gun-shot Wounds of the Abdomen,” by P. S. Conner, M. D., Cin- 
cinnati, Ohio. 
[Abstract not furnished.] 
No. 105. “Paper by Wm. A. Hammond, 51. D., Washington, D. C. 
[Neither Title nor Abstract furnished.] 
No. 106, 
ARE PROJECTILES FROM PORTABLE HAND WEAPONS STERILIZED BY 
THE ACT OF FIRING? 
CAN A SEPTIC BULLET INFECT A GUN-SHOT WOUND? 
By Louis A. LaGarde, 
U. S. A. Hospital, Chicago. 
[From the Laboratory of the Johns Hopkins University and Hospital,] 
As a preliminary to the work of noting the effects of firing bullets that had been previously 
contaminated it was considered proper to ascertain the condition, bacteriologically speaking, of 
bulUts in their original packages. After a number of observations it was found that fifty-three 
per cent of all cartridges in their original packages were absolutely free from germs. This is 
to be ascribed to the cleanly methods, which are necessary in their manufacture. 
The literature of gun-shot wounds shows that the majority of surgeons of the past and 
present times believe that the act of firing destroys any infection that might have been accident- 
ally or otherwise placed upon the projectile. 
In order to ascertain the facts in the matter I fired projectiles after they had been sterilized 
by heat from revolvers that had been similarly sterilized. The projectiles were recovered from 
sterilized cotton and dropped into gelatine tubes. The latter revealed no growth. 
Projectiles covered with dust were then fired from sterilized revolvers into sterilized cotton. 
As each projectile was recovered it was dropped into a gelatine tube. Colonies appeared in 
every instance. 
In a series of experiments with the .22 and .38 calibre revolvers, the .45 calibre Springfield 
rifle, as well as the .30 calibre Experimental Springfield rifle, whose projectile is made of a core 
of lead enveloped in a mantle of German silver, and whose ballistic qualities correspond to the 
Maennlicher, Improved Mauser, Lebel, etc., the projectiles were in all instances infected with 
the germs of anthrax and fired into sterilized materials and into animals. 
57 The tables of results show that anthrax bacilli or spores are seldom, if ever, destroyed by 
the act of firing. 
Bullets infected with the streptococcus of erysipelas, with some of the same culture of 
tetanus mentioned below, and with the bacillus pyogenes soli of Bolton, were fired through the 
ears of rabbits with a .45 calibre Colt’s revolver. The erysipelas coccus was communicated to 
one animal, and the bacillus pyogenes soli was recovered from the wound of another; tetanus 
was not communicated. 
A bullet infected with a culture of the bacilli of tetanus was fired into a horse with the 
Modified Springfield rifle with negative results ; rabbits inoculated with some of the same cul- 
ture died promptly. At the suggestion of Professor Meade Bolton, of the Johns Hopkins Hos- 
pital, a bag of tetanus earth was placed against the hip of another horse-and the projectile of 
the .30 calibre Experimental Springfield rifle was fired through the earth into the fleshy part of 
the ham without result. 
The following conclusions may be formulated from the foregoing: 
(1) The majority of cartridges in original packages are sterile and free from septic germs. 
(2) The sterile condition of cartridges is due to the thorough disinfection and absolute 
cleanliness observed in the process of manufacture. 
(3) The majority of gun-shot wounds are aseptic because the vast majority of the projectiles 
inflicting them are either sterile or free from septic germs. 
(4) Anthrax spores or bacilli when applied to the projectile of a portable hand weapon 
are seldom, if ever, entirely destroyed by the act of firing. 
(5) When a gun-shot wound is inflicted upon a susceptible animal by a projectile infected 
with anthrax bacilli the animal becomes infected with anthrax and dies in the vast majority of 
instances from said infection. 
(6) The streptococcus of erysipelas and the bacillus pyogenes soli when placed upon the 
projectile of the .45 calibre Colt’s revolver, are not always at least destroyed by the act of 
firing, and they are liable to cause infection. 
(7) Projectiles from portable hand weapons are not sterilized by the act of firing. 
(8) A septic bullet can infect a gun-shot wound. 
U. S. Army Hospital, Jackson Park, Chicago, 111. 
April 20, 1893. 
No. 107. “The Point of Election in Amputations Below the Knee with Reference to the Ser- 
viceableness of Artificial Appliances,” by Stephen Smith, M, I)., New York. 
[Abstract not furnished.] 
No. 108. 
THE AVOIDANCE OF INTESTINAL DISORDERS IN THE FIELD. 
By Brevet Lt.-Col. Alfred A. Woodhull, Surgeon United States Army, 
Intestinal diseases a large part of the morbidity in the field. 
Due to: (1) Indigestion. From change of food; from altered cooking ; from indiscretion 
in going beyond the ration. Instruction in field cooking required. 
(2) Drinking water. From contained malarial cause ; hardness ; irritation by suspended 
mud. Modes of correction. 
Hot Springs, Ark. 
58 (3) Variations of temperature. Cold ; value of waterproof blanket. Heat; action on 
abdominal vessels; importance of abdominal protection. 
(4) Enteric fever. Its prevalence in all armies. Whatever the actual etiological condi- 
tion necessary for the propagation of this disease, all 'non-paroxysmal fevers should be looked 
upon as possibly enteric. Scrupulous precautions against fouling camps by dejecta, and 
extreme care of sinks are n cessary to prevent the introduction and spread of intestinal diseases. 
No. 109. 
PERSONAL EXPERIENCE OF NEARLY FOUR YEARS IN OBSERVING THE 
RESULTS OF GOOD AND BAD SANITATION IN THE 
CONFEDERATE STATES ARMY. 
Bedford Brown, M. D., 
Alexandria, Va. President of the Southern Surgical and Gynecological Association; Ex-President of the 
Medical Society of Virginia ; Member of Medical Board of Virginia ; Member of American 
Medical Association. 
The design of this paper is to show the fluctuations in the health of the Confederate States 
Army, the results of the observance or non-observance of the laws of hygiene as witnessed by 
the author from time to time. v 
First example shows an army, Generals Lee and Floyd, of West Virginia, 1861, located 
on summit of AJleghanies, under most favorable circumstances for health, salubrious air, 
abundance of clear water, bracing climate, yet decimated by sickness caused by utter negli- 
gence of sanitation. 
The second example is that of an army under the rhost unfavorable circumstances, located 
near Drury’s Bluff, in the hot season of 1862, made a model of health and the camp a model 
of neatness by strict attention to the laws of hygiene. 
Treats of the best methods found for the hygiene of armies and camps; treats of the 
importance of giving daily mental and physical employment to soldiers while stationary ; shows 
the difference in the health of armies in active motion and when stationary. 
Yeats of the importance of proper disposition of human and animal excreta of camps. 
Di ■teases of new recruits.—Homesickness in certain instances amounts to actual disease, 
mental and physical. Means used to control it. 
Measles and its disastrous effects on the Confederate Army. How these evil effects were 
prevented. 
Cerebrospinal meningitis.—The epidemic as it appeared in the camps of instruction of 
North C°” i:ua. Its origin and great fatality, and extinction by means of rigid quarantine 
and isolation. Its history established‘its contagious properties. 
Hygiene of contagious diseases as gangrene, erysipelas, pyaemia, septicaemia, as adopted 
by the writer. 
The effects of bad cooking on the health of the Confederate Army discussed. 
The comparative capacity of educated, cultivated volunteers and that of the ignorant and 
illiterate to resist both the contraction and ravages of the diseases of army life. 
The necessity of proper hygiene to the force, efficiency and vigor of an army. 
Methods resorted to by the writer to protect the water supply of his command against 
pollution, and to preserve it in a state of purity. 
The difficulties of protecting the water supply of stationary armies pure. 
59 The surface drainage of camps is discussed. 
The prevention of the accumulation of camp debris of all kinds, and the means resorted to 
for that purpose. 
Cleanliness in all things was made an inflexible rule. 
On the principle that moving armies are more healthy than stationary armies by reason of 
the protection of water from camp-surface drainage, ami the non-accumulation of excreta and 
camp debris as a hygienic measure, the writer caused the command with which he was con- 
nected, while stationed in camp, to pursue a course in imitation as near as possible of an army in 
motion. 
This was accomplished by having all privy sinks excavated at a point below the level of 
the water supply, and by establishing a regular system of changing the location of every 
tent every second day, sweeping thoroughly the old locations, and then burning the debris 
and exposing the entire surface, formerly covered by the tents to the action of solar heat and 
light, and the oxygen of the atmosphere. In this connection the chemical action of solar 
heat and light is discussed as hygienic agents. 
The remarkable absorbing properties of the surface of the earth when shaded by tracts of 
either vegetable, animal, excrementitial substances, and all exhalations from the human body are 
also discussed, and the action of light and heat as chemical correctives. 
No. 110. 
THE CAUSES AND ORIGIN OF CONTINUED FEVERS IN NAVAL 
SERVICES. 
C. A. Siegfried, Surgeon U. S. Navy, 
Newport, R. I. 
In the study of the phenomena as a whole, and their influence on mortality rates, the 
varieties of typhoid and continued fevers furnish the type for an analytic study, and of a 
morbidity that impels our earnest attention ; and a better appreciation of the causes, manage- 
ment and possible prevention and extinction of this type of disease is obviously desirable and 
attainable. 
It is not the present purpose to consider relapsing fever, or particularly typhus fever—the 
class of plagues born directly of misery and famine—yet these in their etiology indicate a 
similarity of origin and conditions related to saprophytism, specialization of common forms of 
micro-organisms, and human invasion due to diminished power of resistance and a lowered 
immunity. 
True typhoid and related forms of continued fever are essentially diseases of aggregated, 
well-conditioned humanity in all grades of society, civil and military, notwithstanding the arts 
and sciences of modern civilization; and no one factor of origin is fixed upon. 
They much affect the crews of ships in the older harbors of the world, and the-troops in 
garrisons, and at this time these fevers are the paramount cause of loss in all national forces. 
Pyrexia (from increased metabolism, derangement of heat balance, or by the action of the 
chemical products and alkaloids on the heat centres—thermogenetic, thermotaxic and thermo- 
lytic) is not necessarily always present; the same of the sometimes present enteric lesion. 
Typhus exanthematicus still lacks the thorough work long given to typhus abdominalis. 
Here is an overwhelming intoxication, rapid progress and rapid defervescence. The morbid 
lesions most noted are deposits of luematin, congestions of mucous membranes of the alimentary 
60 tube ami muscle degeneration. In typhoid the enteric lesion lias given a name and typifies a 
large class of cases, but the hyperplasia of the lymph follicles of the intestine and parenchy- 
matous change of the spleen signify sequence more than cause. 
Since 1880 the Eberth bacillus has taken the chief part, but it is not proved that this 
organism produces typhoid fever in man or in animals, nor has it been shown to exist as such 
outside the human body unconnected with recent typhoid disease. It is clearly indicated by 
Roux, Rodet, Yaughan and by Babes that the Eberth-Geffky germ is a specialized form of a 
commonly present bacillus in the intestines. Klebs, Babes, Letzerich and others describe 
different forms as the bacillus typhosus. Rodet and Roux very positively as-sert that it is the 
altered and virulent form of bac. coli commune of Escherich. The constant association of the 
germ with typhoid is undoubted, and pure cultures have even been found in cases of typhoid 
at such unusual seats as the ribs. (Welsh.-) 
The work of Dr. Pasquale, of Italy, entitled “Studio Etiologico delle Malattie Febbrile 
piu comuni a Massaua,” has cleared up the Italian Red Sea littoral regarding a class of low 
febrde disorders very common there. They are not of paludal or climatic origin, but partake 
of the typhic etiology; and he compares them to the fevers common to. Crete, Malta and 
Gibraltar. 
The admirable researches of Doctor G. H. Milnes, Doctor Gipps, R. N., and Doctors Bruce 
and Hughes, R. A., among Englishmen, has done much toward elucidating the Mediterranean 
fevers. The lesions may and may not resemble those of true enteric fever, but the spleen is 
usually found enlarged, and changes in the epithelial linings of the digestive tube are common. 
The germ which has been isolated and which produces a similar fever- in monkeys, and which 
has in all respects fulfilled the postulates of Koch, is a minute coccus, ovoid, of fapid movement, 
stains easily, tends to chains, and is found in the blood and spleen. The fever may last for 
months, and the wave-like exacerbations, the thick white tongue, and long persisting muscular 
soreness are pathognomonic. The types observed are not exactly alike as noted in Gibraltar, 
Malta, Cyprus and the Red Sea coasts. There is, however, the same relation as in the varieties 
of typhoid in temperate zones. These fevers, in the basins of the Red Sea and the Mediterra- 
nean, cause enormous losses in men, time, and money. Without exception, and as in the case 
of typhic disease everywhere, all observers are agreed regarding the etiological relation of 
crowded environment, and organic putrescence—fecal pollution of soil and supplies. 
The argument is, than continued fevers, excepting Murchison’s classification, and including 
Mediterranean fevers, most tropical fevers and the “simple continued” fevers, are all of similar 
origin in the first place, differentiating finally, and becoming types only when the specialized micro- 
phytic elements have gained the characteristic virulent properties and power of transmission as 
such. The morbid lesions of typhoid, and the association of certain germs in the blood, intestines, 
and other tissues does not necessarily oppose this view in the light of recent knowledge of the 
natural ’ ’ tory of micro-organisms, the varying chemical products under their constantly 
changing conditions of subject and environment. 
It is impossible to find specific differences in the majority of cases of continued fevers, and 
particularly on occasions of beginning and of declining epidemics of typhus, typhoid and related 
forms, either in the mortality symptoms or morbid lesions. Once differentiated and specialized, 
by reason of predominance of the particulate class of germs involved, the types persist according 
to the conditions present. The lesions most noted are unusual fluidity of the blood and degen- 
erations of muscle fibre. Eruptions and all other phenomena are inconstant. 
Experience in naval service has impressed upon me that continued fevers originate spon- 
taneously in foul crowded ships; that, with improving hygiene they are overcome and cease. 
On the land I have found cesspools under residences in the same relation Avith Avell-conditioned 
61 human beings; and, in one instance, where for twenty two years these fevers—including some 
enteric—annually occurred, by diligent search and exhaustive analysis, the cause lay in long 
fecal-fouled subsoil and permeable basement doors and walls. Numberless instances are 
recorded, and it is becoming apparent that the “ typhic ” fevers are indubitably connected*, 
with iusanitation and fouled supplies; that the microbic elements common to the body attain 
changed and virulent properties, with the formation of new bodies which, absorbed, induence 
the nerve centres controlling metabolism and the heat balance ; that we see before us a slowly 
consuming phenomenon—a mixed infection, not a single micro-organism in the drst place nor a 
single chemical product circulating in the blood stream, but several in association. The changes 
in blood, epithelium, spleen, and muscle, and the selective affinity of the poisons for the proteid 
elements of the nerve cell—the ataxia—-are obvious. 
In my humble estimation, the great and classic work of Murchison on continued fevers, 
and his belief regarding the origin of the “fevers of putrescence,” mark the direction of their 
true etiology-putrescence the hot-bed of the class of saprophytic micro-organisms. 
No. 111. 
A CONTRIBUTION TO RECTAL SURGERY AND BLOODLESS OPERATION 
OF MEMBRANEOUS AND LAX TISSUES BY MEANS OF AN ELASTIC 
QUILLED, OR WELTED SUTURE. 
H. M. Bishop, M.D., 
Los Angeles, California. 
For the removal of the larger hsemorrhoidal tumors, and of the complete or partial prolapse 
of the rectum, all past methods have failed in obtaining one or both of the desiderata of sur- 
gery, prevention of haemorrhage and primary union ; the ligature, the ecraseur, the clamp and 
cautery, and Whitehead’s operation, are either liable to a waste of blood, primarily or secondarily, 
or leave a granulating wound whose prolonged i healing may become affected with septicsema 
or other unpleasant complications. 
After seeking for many years to obviate these disadvantages, and to devise some means of 
harmlessly controlling haemorrhage while excising the tumors and redundant folds of the rectum, 
and likewise to hold in perfect and undisturbed coaptation the edges of the incisions, my endeavors 
have finally been satisfactorily rewarded. 
It is now my custom after dilating the sphincter, to raise the hsemorrhoidal projection or 
prolapsed membrane with vulsellum, to gently clamp its base so as to parallel the approximated 
tissues and free them from plications; then, having left room between the clamp and adjacent 
healthy tissues, I apply on either side a sufficient length of rubber tubing five millimetres in 
diameter, having a central orifice of one millimetre ; these are secured with catgut after the 
usual manner of the quilled suture, the clamp removed and the tissues divided close to the 
tubing. This makes a bloodless operation, plastic exudation soon unites the edges, the catgut 
softens in due time and permits the tubing to pass away, while the flexibility of the latter has 
adapted itself to its environment with the minimum of annoyance to the patient. 
In eases of complete prolapsus, or where any considerable section of the rectum is to be 
removed, after properly bringing down the folds, the same plan can be followed, by uniting 
internal and external circles of the tubing, applied just above and below the section to be 
excised, the elastic pressure sufficiently occluding the divided vessels without interfering with 
62 reparative processes, and leaving a smooth line of union. This, although resembling somewhat 
the modern enterorraphy, differs from it in the less rigidity and more suppleness of the supporting 
rings of union. 
Other and more extended uses of this combined ligature and suture have suggested them- 
selves. The cceleotomist might find it more eligible than the sectional tyings of the broad 
ligament now in vogue, with its puckerings of folds and crowding into condensed distorted 
masses structures that are normally expanded, and whose severed edges would manifest less 
disposition to necrosis if kept unfolded and smoothly approximated while at the same time freed 
from the rigidity of the clamp. After a few days when the tubes had accomplished their object 
they could be slipped away from the softened catgut loops by a thread of silk left attached for 
that purpose, and drawn out through the vault of the vagina or other convenient locality. 
Should it be necessary in any emergency to make use of more firmness than the simple 
tubing supplies, it can be furnished by passing a wire along the small aperture of the rubber tube. 
For .the closing of the abdominal incision and other long and deep wounds, it may prove 
to be more advantageous than the usual interrupted suture, for it provides a more uniform and 
steady joining of the severed parts, deep as well as superficial, which accommodates itself to 
the various necessary bodily movements without permitting any variation of the relation 
between the parts engaged in the process of reuniting, and which must consequently result in a 
firmer line of union. 
No. 114. “ Aprestos de Campamento de uso en Cuba por los Medicos Militares,” by Dr. Felix 
Estrada y Catoyba, Havana, 
[Abstract not furnished.] 
No. 115. Hospital Corps Drill by Detachment, under the command of Major Van R. Hoff, 
Surgeon, U. S. A. 
[Abstract not furnished.] 
No. 116. Exhibition of a Field Hospital Complete with Equipment now in use in the U. S. 
Army. 
[Abstract not furnished.] 
No. 117. “First Aid to the Wounded and transportation of the Wounded from the Battle- 
field and Field Hospitals.” 
[Open Discussion,] 
No. 118. Visit to the Army Medical Museum. 
(a) Inspection of Collection, 
(b) Inspection of Library of the Surgeon General’s Office, 
[lnformal Session.] 
63 No. 119. “ Amputations Prothetically Considered,” by Geo. E. Marks, A. M., New York City. 
[Abstract not furnished.] 
No. 120. “The Laws of Growth of Bacteria Applied to Antiseptic Surgery,” by Egbert 
Reyburn, M. D., Washington, 
[Abstract not furnished.] 
No. 121. “ The Wounds of the Mannlicher Rifle in the recent Civil War in Chili,” by A. M. 
Fernandez de Ybara, A. 8., M. D., New York City, N. Y. 
[Abstract not furnished.] SECTION ON ORTHOPAEDIC SURGERY. 
HONORARY PRESIDENTS: 
Dr. E. H. Bradford, Boston; Dr. E. Ventura Carvallo, Santiago, Chile; Dr. A. B. Judson, New 
York; Benj. Lee, Philadelphia; Dr. Julio Leon, Santo Domingo, Dominican Republic; Dr. James E. 
Moore, Minneapolis, Minn ; Dr. Ernesto Odriozola, Lima, Peru; Dr. Roswell Park, Buffalo; Dr. 
A. M. Phelps, New York; Dr. John Ridlon, Chicago; Dr. Geo. W. Ryan, Cincinnati; Dr. Reginald 
H. Sayre, New York; Dr. A. J. Steele, St. Louis ; Dr. Newton M. Shaffer, New York; Dr. Harry 
M. Sherman, San Francisco; Dr. Henry Ling Taylor, New York; Dr. W. R. Townsend, New York; 
Dr. DeForrest Willard, Philadelphia. 
EXECUTIVE PRESIDENT: 
Dr. Ap. Morgan Vance, 218 W. Chestnut St., Louisville, Ky. 
SECRETARIES: 
Dr. Robert W. Lovett (English-Speaking), Dr. Jose R. de Armona (Spanish-Speaking), 
Boston, Mass. Key West, Fla. 
Dr. Alejandro Castro [Reconquista 342] Buenos Aires Argentine Republic. 
Dr. Viscarra Heredia La Paz Bolivia. 
Dr. Pinto Portella Rio de Janeiro U. S. of Brazil. 
Dr. B E. McKenie Toronto Canada. 
Dr. Ignacio Remirez [San Nicolas 60] Havana Cuba. 
Dr. Juan E. Manrique [Calle 16, num. 57] .... Bogota Republic of Colombia. 
Dr. Carlos Duran San Jose Costa Rica. 
Dr. Mariano Fernandez Padilla Guatemala City Guatemala. 
Dr. Henry Goulden McGrew Honolulu Hawaii. 
Dr. J. Midence Leon Nicaragua. 
Dr. Diego Perez [Jefatura Politica] Montevideo . Uruguay. 
Dr. Pedro V. Vivas Merida Venezuela. 
65 SECTION ON OBSTETRICS. 
HONORARY PRESIDENTS: 
Dr. William H. Baker, Boston, Mass.; Dr. Rafael Benavides, Lima, Peru; Dr. Lyman A. 
Berger, Kansas City, Mo.; Dr. James Peter Boyd, Albany, N. Y.; Dr. Pedro M. Cartaya, Matanzas, 
Cuba; Dr. Geo. J. Engelman, St. Louis, Mo.; Dr. Henry Gibbons, San Francisco, Gal.; Dr. Manuel 
■Guiterrez, City of Mexico; Dr. Robert P. Harris, Philadelphia, Penn.; Dr. Barton Cooke Hirst, 
Philadelphia, Penn.; Dr. Edward W. Jenks, Detroit, Mich.; Dr. W. W. Jaggard, Chicago, 111.; Dr. 
Charles Jewett, Brooklyn, N. Y.; Dr. Richmond Kelley, Portland, Oregon ; Dr. A. F. A. King, 
Washington City, D. C.; Dr. William T. Lusk, New York, N. Y.; Dr. Matthew D. Mann, Buffalo, 
N. Y.; Dr. James W. McLane, New York, N. Y.; Dr. Adolfo Murillo, Santiago, Chile; Dr. 
Theophilus Parvin, Philadelphia, Pa.; Dr. Thad. A. Reamy, Cincinnati, O.; Dr. Sarah Hackett 
Stevenson, Chicago, Hi.; Dr. Wm. H. Taylor, Cincinnati, O.; Dr. Adam H. Wright, Toronto, Canada. 
Dr. Giles S. Mitchell, 277 West Eighth Street, Cincinnati, O 
EXECUTIVE PRESIDENT: 
SECRETARIES; 
Dr. Hugh Hamilton (English-Speaking), Dr. John J. Castellanos (Spanish-Speaking), 
Harrisburgh, Penn. 70 Orleans St., New Orleans, La. 
Dr. J. B. Fernandez, .... [San Martin 678] Buenos Aires, Argentine Republic. 
Dr. Claudio Aliaga, La Paz, Bolivia. 
Dr. Erico Coelho, Rio de Janeiro, . . . . U. S. of Brazil. 
Dr. J. C. Cameron, Montreal, Canada. 
Dr. Rafael Weiss, [lndustria 115,] Havana, Cuba. 
Dr. Joaquin Maldonado, . . [Calle 13, No. 64,] .... Bogota, Rep. of Colombia. 
Dr. Tomas M. Calneck, ... Cartago, Costa Rica. 
Dr. Mariano Fernandez Padilla, Guatemala City, .... Guatemala. 
Dr. SeREMIE, Port au Prince, .... Haiti. 
Dr. G. P. Andrews, ■ Honolulu, Hawaii. 
Dr. Andres Lopez Martinez, Tegucigalpa, Honduras. 
Dr. Fernando ZoRRAGA, . . . [Arco de San Agustin 12,] . City of Mexico, .... Mexico. 
Dr. Velasquez, Managua Nicaragua. 
Dr. Isabelino Bosch, . .■ . . [lB de Julio 299,] Montevideo, Uruguay. 
Dr. Angel Rivas Baldwin, Caracas, Venezuela. 
66 SECTION ON OBSTETRICS. 
No, 151. Address, by Giles S. Mitchell, M. D., Executive President, Cincinnati, Ohio. 
No, 152. “ Maternity Hospitals and their Results,” by Joseph Price, M. D., Philadelphia, Pa. 
[Abstract not furnished.] 
No. 153. “The Axis Traction Principle in Obstetrics,” by Joseph Hoffman, M. D., Phila- 
delphia, Pa. 
[Abstract not furnished.] 
No. 154. “ The Care of the Pregnant Woman in the First Half of Utero-Gestation,” by W. H. 
Baker, M. D., Boston, Mass. 
[Abstract not furnished.] 
No. i" 5 
THE HEMORRHAGES OF PREGNANCY. THEIR MANAGEMENT. 
John O. Polak. M. D., 
Instructor in Obstetrics at the New York Post-Graduate Medical School, and the Long Island College Hospital, 
Brooklyn. 
The hemorrhages occurring ante-partum are: 
(1) Bleeding as a symptom of miscarriage. 
(2) Placenta prsevia. 
(3) Accidental hemorrhage from the partial separation of a normally placed placenta 
and ectopic gestation. While post-partum bleeding from atonicity of the uterus and lace- 
rations in the cervix, vagina and vulva. 
Hemorrhage as a sign of miscarriage, when very slight, may be controlled by rest in 
bed, suppositories of morphia and atropia si. doses fid. ext. of viburnum, or gr. iv. 
pill of solid extract. 
67 The more severe cases with abortion inevitable, cervical softening, dilatation, and the 
ovum separated, everything being aseptic, the cervical and vaginal tampon is to be recom- 
mended, to empty the uterus and secure firm retraction. 
Method—Empty bladder and rectum. Sims’ position douche, Creolin two per cent. 
Through a Sims’ speculum with anterior lip of cervix fixed carry strips of iodoform 
gauze into the cervical canal through the internal os, then pack anteriorly, posteriorly, 
laterally, and finally against the cervix, filling whole vagina with gauze. 
Divulse if necessary by the rapid method. 
Placenta Prsevia. Clinically a pservia is where the placenta has an attachment in 
the lower zone and the cervix, from which it is detached during canalization. 
Before viability, diagnosis made, with the foetus dead. Implantation central, or hem- 
orrhage whether copious or moderate, empty the uterus. 
After viability. Act with the occurrence of the first hemorrhage. It is not good 
obstetrics to allow her strength to become exhausted by repeated or continued bleeding, 
not to speak of the nervous strain she sustains. 
Diagnosis made, hemorrhage occurring, cervix closed ; tampon with iodoform gauze, at 
the end of eight to ten hours, when gauze is removed, douche with an antiseptic. The cer- 
vix in most cases will admit one or two fingers. With this amount of dilatation turn by the 
Braxton-Hicks method, and bring down a foot, which acts as a most efficient tampon. 
This method, in my opinion, is superior to either the method of Barnes, or the use of 
internal version. 
Accidental hemorrhage from partial separation of a normally placed placenta. 
Management—Rapid dilatation of cervix is indicated manually, or if the portio- 
vaginalis be effaced, the bloody method ; then rupture the membranes, and deliver rapidly 
either by forceps or version. Remove the placenta immediately and tampon the uterus 
with iodoform gauze to control bleeding. Craniotomy may be resorted to if the foetus be 
dead or non-viable. 
I condemn ergot in these cases before delivery, causing spasmodic action and tendency 
to the formation of stricture at lower segment. (Case-History.) 
ECTOPIC GESTATION. 
Post-partum hemorrhage from uterine atonicity. 
Cervical hemorrhages from lacerations. 
Suture ligatures will control the bleeding from tears in the vagina and perineum. 
Acute anaemia, lower head—auto-transfusion, subcutaneous injections. 
No. 156. “ A Study of Placenta Prsevia, Especially the Causes of the Hemorrhages,” by 
Sarah Hackett Stevenson, M. D.. Chicago, 111. 
[Neither Title nor Abstract furnished.] 
68 No. 157 
THE FEASIBILITY OF IMMEDIATE REMOVAL OF THE PLACENTA 
IN OPERATIONS FOR ECTOPIC GESTATION. 
D. Tod Gilliam, M. D., *. 
Columbus, Ohio, 
The distinguishing characteristic of operations for advanced .ectopic gestation is the 
presence of the placenta and the necessity of dealing with the same. 
I start out with the proposition that the blood supply of such placentas is derived from 
one source, viz: the tubal vessels, and as these are centralized and usually accessible, 
hemostasis is at command. 
That such was the original source of blood supply is self-evident, because all extra- 
uterine pregnancies are at the outset tubal. As the ovum never starts life in extratubal 
structures, because they are incapable of those changes in response to its presence which 
renders life and development possible, such structures surely cannot be expected to receive 
and provide life-giving lodgment to an ovum suddenly thrust upon them after violent 
displacement. After implantation of the villi, such a change is inconceivable. The 
transplantation of a bunch of hair from one part of the scalp to another would be as 
rational as to expect these villi to adjust themselves to alien tissues. Death from inani- 
tion would be the inevitable result. That the placenta grows away from the tubal struc- 
tures and forms new attachments, is not sustained by reason or analogy. It is much more 
reasonable to suppose that the structure that first gave bed and board to the ovum—the 
only structure capable of responding to its presence—should follow it up providing a 
matrix for the growing placenta, than that others under the dominance of a different set 
of vessels and nerves should do so. Such wTe find often in morbid growths, and every 
abdominal surgeon knows that the quickest and most effectual way to stop the hemorrhage 
of adhesions is to clamp the pedicle. Indeed, close observation has demonstrated that in 
exti -uterine pregnances the hemorrhage comes from the sac and not from the structures to 
which it is attached. As further evidence of this important fact, it has long been known 
that a ligature applied to the tube at the angle of the. uterus will control the hemorrhage 
of an ectopic gestation. Why ? Because in this situation the tubal circulation is con- 
trolled. The key to the situation lies in our ability to get at and shut off the circulation 
of the tube, whereby we also control the blood supply of the ovum and placenta. 
No. 159. 
THE STATUS OF OBSTETRICS IN GENERAL PRACTICE. 
Professor Hygiene and Medical Jurisprudence, Northwestern University Woman’s Medical School, and Professor 
Clinical Obstetrics, at the Chicago Hospital for Women and Children. 
Eliza H. Root, 
Why is the physiological and perfectly natural function of child-bearing so frequently 
followed by health-ruining results ? 
69 The conditions which prompt the patient to seek advice of the gynecologist belong 
to one of two classes of causes or to both combined. 
I. Traumatisms, 
11. Inflammations. {A) Due largely to septic infection at or during the lying-in period. 
The causes which produce these conditions may be traced to ignorant and careless 
practice. (A) Of the accoucheru, physician or midwife. (B) Of the patient herself, 
and (C) in the care of the lying-in patient. 
{A) The physician assumes the responsibility of the lying-in chamber without suffi- 
cient clinical training and experience. 
(.B) Carelessness and ignorance on the part of the patient frequently puts the skill of 
the physician to a severe test. The physician will know nothing of a case of nephritis 
with albuminuria until called to a case of eclampsia, that with treatment and care might 
have been saved. Constipation during gestation is a frequent source of danger to the lying- 
in period. A case proved to me how serious the consequences, when the ignorance of the 
patient combined with the ignorance and carelessness of the physician. It is the phy- 
sician’s duty to teach his patients the importance of seeking timely advice and to duly 
warn them of the consequences of not doing so; for in no branch of medicine will an 
accident or fatal outcome prove more disastrous to the physician. 
(C) The surroundings land the nursing of the patient should not be left out of the 
physician’s code of duty. The practice of paying one visit after delivery that prevails in 
some sections of our country is reprehensible. 
No. 160. 
THE MECHANISM OF LABOR. 
Jacob Chase Rutherford, M. D., 
Providence, R. I. 
The theory of the mechanism of labor, as advanced by all ancient and many modern 
obstetrical writers, is entirely without foundation. The ground taken that the parturient 
canal is curved cannot be maintained for a moment when we consider the anatomy of 
the parts, the changes which take place during pregnancy and the phenomena of 
labor. * * * The mechanism of labor, briefly, is as follows : In head presentations, 
occipito-anterior, the head descends in the axis of the uterus in a straight line, until it 
reaches the trough of the levator-ani muscle, when rotation begins; continuing to descend 
in the same line, it reaches the bottom of the trough, which is the floor of the pelvis. By 
this time rotation is completed, and now begins the hardest part of the labor, for the head 
having reached the floor of the pelvis cannot go any further, but must change its direction 
and pursue a course at right angles with the one it has been following. This change in 
direction is brought about by extension of the head into the vaginal canal. As the head 
extends, the body descends, and by the time the head is fully extended it has passed the 
vaginal orifice, and the shoulders are at the utero-vaginal angle. They pass the angle by 
a lateral bending of the body and are followed by the hips and legs. 
70 In occipito-posterior cases labor is prolonged by the impossibility of farther flexing 
an already fully flexed head, and the perineum has to be enormously distended before the 
head can be delivered. 
In face cases mento-posterior delivery is impossible because the head cannot be further 
extended, and the stiff, straight fetal body cannot be bent around the angle. 
A knowledge of the mechanism of head cases embraces a knowledge of the mechanism 
of other presentations. 
The deductions to be drawn from the above theory are; first, the parturient canal is 
angular, not curved; second, when the presenting part has reached the bottom of the 
trough in the pelvic floor rotation is complete; third, flexion and extension take place at 
the utero-vaginal angle; fourth, in the high forceps delivery traction should be made in 
the line of the uterine axis, and in the low forceps delivery in the line of the vaginal 
axis. 
No. 161. 
THE INDUCTION FOR PREMATURE LABOR, 
J. 11. W. Chestnut, M. D., 
Philadelphia, Pa. 
The groups of cases whose circumstances may call for the operation for the induction 
of premature labor include ; First, cases of contracted pelves which would render labor at 
term dangerously difficult to the mother, to the child or to both; second, cases of maternal 
disease which progressively endanger the life of the mother ; third, cases in which in 
previous pregnancies the child has died in the latter weeks of gestation ; fourth, cases of 
hopeless disease of the mother, for the sake of the child ; fifth, cases in which the child is 
known to be dead, and, sixth, cases complicated by the presence of ovarian, bony or 
mab'o-nant tumors, or by atresia of any part of the normally distensible canal. 
The relative number of markedly contracted deformed pelves is very small; in a 
private obstetrical practice of more than twenty years, averaging from sixteen to twenty 
cases per month for many years, the writer has met but one case with a conjugate diameter 
at the brim of less than two and one-half inches ; but cases of lesser contraction where the 
same diameter measured from three to three and three-fourths inches, or where there 
appeared to be a slight degree of lessening in all diameters were not so uncommon. 
In view of considerations set forth in the paper, and of the results of cases therein 
reported, the writer believes that in cases of deformed pelves where the anterio-posterior 
diameter at the brim is from two and three-fourths inches to three and one-fourth inches, 
and in cases of jusso-minor pelves where the same diameter is three and one-half inches— 
labor should be induced before term, when the conditions described are recognized in due 
time. The difficulty of diagnosis at the proper time is the obstacle to the more frequent 
employment of the operation in these cases. The means used to reach a correct diagnosis 
include the history of the patient, inspection and various external and internal measure- 
ments as set forth in the paper. 
71 Xu the other groups of cases submitted, uo difficulty of diagnosis is supposed; aud 
the decision as to the advisability of the operation depends on a comparison of the possible 
results of prospective conditions and measures; these circumstances are discussed in the 
paper. 
No. 162. 
AIDS TO EASY PARTURITION. 
A. J. C. Saunter, A.M., M.D., 
Professor of Gynaecology Clinical College of Medicine, Chicago. 
A.—Aids to easy parturition should be considered and their application begun early 
in life. 
B,—Care to be exercised in young women at time of menstruation to prevent undue 
congestion and to secure free catamenial flow. 
After impregnation, diet may influence the amount of suffering undergone at the 
time of childbirth. 
C. —All pelvic troubles, especially inflammations, to be corrected during the period 
of gestation. 
D. —Abridge the first stage of labor by securing frequent and strong uterine contrac- 
tions, by means of massage of the abdomen and digital assistance at dilitatiou of the os 
uteri. 
No. 164. “ Occipito-posterioi; Positions and their Management,” by F. C. Furgeson, M. D., 
Indianapolis, Ind. 
[Neither Title nor Abstract received.] 
No. 165, 
THE THERAPEUTIC APPLICATION OF CHLOROFORM IN LABOR. 
By John N. Upshur, M.D., 
Professor of Materia Medica and Therapeutics in the Medical College of Virginia, Honorary Fellow of the Medi- 
cal Society of West Virginia, etc., Richmond, Va. 
Chloroform.-^-As therapeutically applied, as a causative factor, predisposing or active 
in transforming the physiological function into a condition of some form of dystocia. 
The question is resolved into this problem. In what cases should chloroform be 
administered ; at what stage of labor; what dangers arise in consequence ; at what stage 
do these complications arise; the best means of combating them; and finally, if these 
propositions are true, is it justifiable to administer chloroform in natural labor, progress- 
ing with satisfactory rapidity ? , 
No. 166. “The Management of SomeCasesof Difficult Labor,” by Wm. H. Taylor, M. D., 
Cincinnati, Ohio. , 
[Abstract not furnished.] 
72 N0.J167. “Forceps Delivery,” by James Campbell, M. D., Hartford, Conn. 
[Abstract not furnished.] 
No. 168. “The More Frequent Use of Forceps in the Multipara,” by Lyman A. Berger, 
. M. D., Kansas City. Mo. 
[Abstract not furnished.] 
No. 170. “The Use and Abuse of the Forceps,” by W. Frank Haehanlen, M. D., Phila- 
delphia, Pa. 
[Abstract not furnished.] 
No 171. 
SYMPHYSEOTOMY. 
Henry J. Garrigues, A. M., M. D., 
Professor of Obstetrics at the New York Postgraduate Medical School and Hospital; Consulting Obstetric Surgeon 
to the New York Maternity Hospital; Gyneacologist to St. Mark’s Hospital, etc. 
Symphyseotomy was invented and performed by the Frenchman Jean Rene Sigault 
in 1877. After having fallen into discredit everywhere else, it was kept alive in Italy, 
and was dying out there when Marisani revived it in 1866, but without finding imitators 
elsewhere, until in 1891, his pupil, Spinelli, demonstrated it to Piuard. Thus brought 
back to Paris, it has spread over the world with such rapidity that it has become 
•impossible to keep accurate account of the statistics. 
When the symphysis and subjective ligaments are cut, the limbs bent, and the iliac 
bones pulled apart, a separation of 7 cm. (two and three-quarter inches) between the 
ends of the pubic bones is easily obtained without injury to the ilia-sacral joints. The 
hea'1 enters into this gap, and all diameters of the pelvis are considerably increased. The 
distance between the centre of the promontory and the end of the pubic bones, at the safe 
distance of 7 cm. (two and three-quarter inches), gains 14 ram. (over one half inch), the 
other diameters from 17-35 mra. (three-quarters to one and one-half inches). 
Symphyseotomy is indicated in a flat pelvis with a true conjugate ranging between 
67 and 88 mm. (two and five-eighths to three and one-half inches), but it is difficult below 
7 cm. (two and three-quarter inches). In a generally contracted pelvis the upper limit 
may be extended to 10 cm. (four inches), and we should cautiously approach the lower 
limit. 
Other indications, with which it has been performed, are pelvic tumor, mento-posterior 
face presentations if the chin cannot be rotated forward, occipito-posterior vertex presen- 
tation with impacted head ; and it has been proposed in cases of absolute coarctation of 
the pelvis (7. e., below 5 cm.—two inches) with dead child, in order to facilitate 
craniotomy and embryotomy. 
The sacro-iliac articulations must be movable. There are two chief methods, 
the sul cutaneous (Morisani’s) and the open (Piuard’s). 
73 The child may be left to be expelled by uterine contractions, or removed with 
forceps, or turned and extracted. 
Considerable lesions of the soft parts have occurred even in the hands of first-class 
operators. In many cases the hemorrhage has been profuse and sometimes difficult to 
check. Most children are born more or less asphyctic, £fud in some there has been fracture 
of the skull. 
Symphyseotomy has come to stay and deserves a large place in the practice of skillful 
Operators, but should not be attempted by the average accoucheur. 
In lying-in hospitals and private practice of specialists it should take the place of 
craniotomy on the living child and induction of premature labor, in which the infantile 
mortality is over forty-three per cent. 
Caesarean section should be limited to cases that lie beyond the domain of symphyse- 
otomy. Symphyseotomy has several times been successfully performed twice on the 
same woman. 
No. 172. “Whathas Surgery done for Modern Obstetrics,” by Thomas Opie, M, D., Balti- 
more, Md. 
[Abstract not furnished.] 
No. 173 
RECENT SURGICAL ADVANCES AND THEIR RELATION TO CON- 
SERVATIVE OBSTETRICS. 
By W. Reynolds Wilson, M. D., 
Visiting Physician to the Philadelphia Lying-in Charity; Physician to the Out-patient Department for Diseases of 
Women, German Hospital, Philadelphia., etc. 
In view of the fact that the science of obstetrics is the most stable of medical sciences 
in which fixed mechanical laws largely determine both the event and the conduct of 
parturition, the influence of modern surgery in modifying obstetrical practice is unexpected. 
This influence is observed in the present treatment of abortion, ectopic gestation, 
dystocia, in contracted and deformed pelves, septicemia. 
The operations which have become recognized obstetrical procedures in these conditions 
are: in abortion, curetting in order to remove every trace of decidual tissue, irrespective of 
symptoms of retention ; in ectopic gestation, the removal of the gestation sac as soon as 
the diagnosis has been established, irrespective of the viability of the foetus ; in impeded 
labor, Caesarean section and symphyseotomy ; in septic infection, curetting and drainage 
by means of gauze ; cceliotomy for peritonitis, and supravaginal hysterectomy for lym- 
phatic infection of the mucosa. 
Surgery deserves the lasting praise of the profession for the scientific treatment of 
tubal pregnancy, no surgical procedure being too radical for this condition, but of all these 
procedures the active treatment in abortion and in septicaemia and the substitution of 
74 symphyseotomy for the forms of treatment formerly recognized in dystocia from contracted 
pelvis, are to be questioned. 
The conservative treatment with exact indications is illustrated in the following five 
hundred cases from the records of the Philadelphia Lying-in Charity, and deductions are 
drawn from these cases showing instances where surgical treatment in cases of abortion, 
septicaemia and dystocia was replaced by expectant treatment, with results favorable to the 
latter method. 
Analysis of cases. Statistics. 
No. 174. “Puerperal Peri-uterine Inflammations; their Pathology and Treatment,” by J. 
Foster Scott, M. D., Washington, D. C. 
[Abstract not furnished.] 
No. 175 
PUERPERAL INFECTION. 
Edward A. Ayers, M. D., 
New York City. 
Our views to-day as to the treatment of puerperal infection are in a great state of 
confusion. A dozen years ago the main line of treatment was that of general, systemic 
remedies, such as alcohol, morphine, cathartics, and external applications. In a short 
while a recognition of the germ character of the disease led to the use of iutra-uterine and 
vaginal irrigation. The extent to which this method of treatment has been carried is 
a marvel, not to say a terror. Few doctors refused its aid, most doctors employed it to 
arrest the disease on suspicion, and many considered their cases neglected if an intra- 
uterine douche was not administered after delivery in every case. 
Following in the train of this method is a list of failures to prevent or cure infec- 
tion and a startling number of deaths from mercuric poisoning that have developed a 
strong opposition to local douching. 
The efforts to find something better than the old opium and whisky treatment has 
given laparotoraists an excuse for testing the merits of abdominal drainage, or exsections 
of purulent tissues in some form of this disease’s varied pathology. 
There is a grave fault in most of the discussions of this subject, namely, the lack 
of pathological classification, by which we find in various cases of puerperal infection 
much greater differences than in many distinct diseases. 
Puerperal infection, caused by unclean manipulation of the “ examiner,” or by 
abscess in the labia, or the vagina, or uterus, or tubes; or by germs present in the genital 
tract at the time of labor, as in gonorrhea and possibly in purulent leucorrhea, or a slough- 
ing fibroid, or decomposing foetus, or placenta, or partially organized blood-clot, or pla- 
centa succenturiata, or uterine rupture, etc., finds a footing somewhere along the genital 
tract from the vulva to the fundus uteri. 
Let us surgically consider the question of local treatment. If a wound can be thor- 
oughly irrigated and efficient drainage and protection secured, in the great majority of 
75 cases it will progress uninterruptedly to complete healing. If the first requisite “ thorough 
irrigation ” can be had in puerperal infection, and it must be secured promptly, we may 
expect, and clinical work endorses the statement, a prompt and satisfactory cessation of 
the infectious character of the inflammation. 
Bur we do not secure this “ thorough irrigation” in many cases, and this is why the 
irrigation treatment is falling into disrepute. 
Where is the cause of failure located ? If infection starts at some site of abrasion 
in the vagina, and prompt irrigation is employed, the infection will disappear in the 
great majority of cases. It can at least be kept from reaching the uterus. Likewise an 
infection starting on the surface of the endometrium, where but a slight superficial abrasion 
exists, will respond satisfactorily to irrigation. 
But suppose the labor has been long and severe; that the head of the child remained 
long in one place, pressing the uterine wall against the bony structure of the pelvis, with 
the consequent death of a portion of tissue en masse, if infection has obtained a place it 
will be present at the base of this loosening slough ere the dead mass has separated. 
Would you expect irrigation to cleanse the tissue beneath this slough? 
Or suppose, the labor was very “ laborious,” followed by great muscular exhaustion 
of the uterus, mild relaxations occurring following the completion of the patient’s toilet, 
with the formation of blood-clot in the uterine cavity. 
This mass may be retained for days, I have so observed it, and become soft and foul- 
smelling, in short, decomposed. Irrigation will not render this mass, which may be as 
large as an orange, innocuous. 
Or suppose following an exhausting labor, with threatened or supervened post-partum 
hemorrhage, cessation of bleeding is secured by the formation of thrombi in the sinuses 
of the uterus, nature’s resource when the doctor fails to make efficient use of bi-manual 
compression, if the germs have made their bed in these germ inns, how is irrigation 
going to kill them or drive them out? 
The thrombi penetrate the wall of the uterus. The antiseptic fluid flowing over the 
surface will not touch the inner mass. 
The presence of a placenta succenturiata will also, if unremoved, put an undeserved 
failure upon irrigation. 
Let me briefly outline the indications for these various methods of local treatment. 
First.—A normal labor with steady and easy advance of the child, with complete 
removal of the placenta, followed by good contraction and retraction of the uterus, with 
no indication of a previously existing purulent condition, or of fibroids, but yet with in- 
fection, indicates that simple irrigation should do all possible, with perhaps the introduc- 
tion of iodoform gauze, though I would prefer not to use it unless the discharge became 
purulent. 
Use a fountain syringe held not more than a foot or two above the patient’s hips, 
with the patient lying on her back. A solution of bi-chloride, 1-4000 at a temperature 
of 105 degrees, one to two quarts should be used, followed by a pint or quart of freshly 
boiled water cooled sufficiently. I think my tube, which you see has a groove along the 
under side for exit of the fluid, is made of hard rubber and has a hole at the end as well 
as sides, permitting the stream to reach all parts at the fundus and without danger of 
76 forcing fluid through the tubes of the uterus while the force is made so slight by keeping 
the syringe bag low, and cannot possibly break, is preferable to Chamberlain’s glass tube. 
The indication for repeated irrigation must be the rise of temperature. If the 
symptoms do not promptly subside I would use iodoform gauze following irrigation. 
Second.—A labor history that indicated prolonged pressure of the head would sug- 
gest possible gangrenous sloughing, and would call for the use of iodoform gauze from 
the start, to aid drainage, stimulate repair and lessen decomposition. 
Third.—A history of post-partum hemorrhage, or of torn placenta, with the pres- 
ence of unusually large shreds of tissue in the lochial discharge, would call for an explo- 
ration of the uterine cavity. Putting the patient in Sim’s position, a large blunt curette 
should be used in conjunction with irrigation, and the question answered, “ Is debris 
present?” A thorough curettement followed'by the introduction of iodoform gauze 
would be indicated. 
Fourth.—A case where, on examination, the uterus is found to be relaxed, soft, 
“ doughy,” pitting on pressure, with a very offensive discharge, very purulent in char- 
acter, and with general symptoms of high fever, profuse sweats and great prostration, 
indicates purulent infiltration of the body of the uterus. From a theoretical standpoint 
it may be said with assurance that intra-uterine irrigation will do nothing but possibly 
lower the temperature a little for a half hour. Pus is present throughout the connective 
and muscular tissues of the body of the uterus. 
Irrigation of the cavity cannot possibly reach it. 
As well expect a stream of water flowing over the mammary gland, the seat of many 
abscesses, to wash away the pus within. 
Post-mortem examination of such cases shows pockets of pus dispersed throughout 
the muscular tissue that have no outlet into the uterine cavity. 
What resources have we in such cases for cure ? 
General supportive treatment through the, long weeks of struggle, or, may we not 
declare in favor of abdominal hysterectomy ? In any other part of the body we would 
employ in such a condition, multiple incisions with the introduction of drainage tubes. 
We cannot do that here; it is possible to remove the diseased mass altogether. 
No. 176. “Infection of the Kidneys after Labor/’ by Barton Cooke Hirst, M. D., Phila- 
delphia, Pa. 
[Abstract not furnished.] 
No. 177. “Puerperal Eclampsia,” by J. G. Cecil, M. D., Louisville, Ky. 
[Abstract not furnished.] 
77 No. 178. 
“ Puerperal Eclampsia,” by Theophilas Parvix, M. D., Philadelphia, Pa. 
[Abstract not furnished.] 
No. 180. 
INDUCTION OF LABOR AND ACCOUCHEMENT FORCE IN THE 
PROPHYLAXIS OF ECLAMPSIA. 
Charles Jewett, A. M., M. D., 
Brooklyn, N. Y. 
Whatever room there may be for difference of opinion with reference to the etiology 
of child-bed eclampsia and the nephritis of pregnancy, it is impossible to lose sight of the 
fact that the ultimate cause of the trouble is the presence of the child in utero. So long 
as the cause remains our resources either for the treatment or prevention of puerperal con- 
vulsions are at most an uncertain reliance, and too often prove wholly futile. A pregnancy 
nephritis once established the kidneys never regain their normal condition while the 
pregnancy continues. Dietetic, diaphoretic and cathartic measures are of great value as 
temporary expedients, but they do not cure. 
The extra tax upon the crippled kidneys increases rapidly in the later weeks of 
gestation and the danger grows with the growth of the child. The woman is never free 
from the possibility of a sudden explosion of uraemic symptoms. On the occurrence of 
convulsions the gravity of the condition is enormously increased, and with each succeeding 
attack it becomes less and less amenable to treatment. After labor, on the other hand, 
the nephritic symptoms subside and prompt recovery is the rule. Convulsions in most 
cases cease with the birth, the attacks seldom begin in the post-partum period, and in any 
event they yield more easily to ordinary remedial measures in the puerperal than in the 
pregnant or parturient woman. 
The chief desideratum, therefore, in the prophylaxis of*puerperal eclampsia is the 
evacuation of the uterus. The writer believes that under modern methods a more aggres- 
sive policy is justifiable in the prevention of eclampsia than is generally pursued. It is 
difficult to formulate definite rules, but in general after the full period of viability little 
reliance should be placed on other than obstetric measures. In the presence of any but 
the milder forms of nephritis, immediate and rapid termination of the pregnancy offers 
the best prospect for both mother and child. The indication is especially urgent in the 
last month of gestation, when the child has little to gain and the mother frequently much 
to lose by delay. 
Under the .methods formerly employed the induction of labor was a difficult and 
tedious undertaking. With the intra-uterine injection of glycerine, recently introduced by 
Pelzer, uterine contractions may be set up at will and the birth terminated with rapidity 
and safety. 
78 Labor begins immediately as a rule and is actively established within two hours. 
The intra-uterine injection of glycerine acts not only to inaugurate the pains, but in greater 
or less degree to maintain them. Its effect in many cases seems to persist to the close of 
the third stage if well retained. To act at best advantage the glycerine must be carried 
high up toward the fundus, must be widely diffused between the membranes and the 
uterine wall by gradual injection and its too rapid escape prevented by keeping the 
patient in the latero-prone position. In many cases no further interference is called for. 
In imminent danger of convulsions, if the labor is not promptly terminated, it should be 
completed by manual dilatation of the cervix under chloroform and resort to forceps or 
version. Under a rigid asepsis and with avoidance of lacerations, accouchement force is a 
safe and conservative procedure. Manual dilatation should not be undertaken before the 
supra-vaginal portion of the cervix is obliterated. In simple cases it is a harmless inter- 
ference which may save hours of labor and continued danger. In difficult cases with a rigid 
cervix the operation is even more urgently indicated and is safe, provided sufficient care is 
used. From ten minutes to two hours will usually suffice to complete the dilatation and 
terminate the birth. The total length of labor will seldom exceed twelve hours; in 
emergency, may be reduced to five or six. 
Illustrative cases. 
No. 181. 
CONTRIBUTIONS TO THE STUDY OF PUERPERAL SEPTICAEMIA. 
Antonio Jose Amadeo, M.D., 
Maunabo, Porto Rico. 
This paper contains a resume of the twenty years of obstetrical experience of the 
author in the town of Maunabo, island of Porto Rico. He says that until lately a phy- 
sician was there very seldom called to attend a case of confinement, and that puerperal 
infection is much more frequent in the towns, on account of their bad hygienic conditions, 
than in the country. He holds the opinion that women of a lymphatic temperament are 
more liable ; chronic metritis and leucorrhea are]talso contributing factors; anaemia, and 
all the manifestations of lymphatic cachexia are unfavorable signs for the prognosis. 
In regard to diagnosis, he says that paludal fevers sometimes make their appearance 
immediately after parturition, but sulphate of quinine settles the doubt. Sleeplessness, 
nervous disquiet, and ill-smelling discharges are alarming symptoms. 
His plan of treatment consists in local antisepsis to reduce the hyperthermia, to open 
and disinfect abscesses, sustain the vital forces, and combat peritonitis should it make its 
appearance. 
He complains of the custom that prevails in Porto Rico, of receiving the visit of 
many friends in the lying-in room. 
79 No. 182. “A Study of Dystocia,” by Dr. Salvador Garciadiego, Guadalajara, Mexico. 
[Abstract not furnished.] 
No. 183. 
A METHOD OF PERFORMING RAPID MANUAL DILATATION OF THE 
OS UTERI, AND ITS ADVANTAGES IN THE TREATMENT OF 
PLACENTA PRiEVIA. 
Philander A. Harris, M. D., 
Paterson, N. J. 
History of eight successful cases embracing the author’s entire experience in the 
management of Placenta Praevia. The method of dilatation to be shown at reading, and 
to be illustrated in published report by the aid of ten photo-engravings, claiming that the 
undilated os in placenta praevia, can, under chloroform or ether anaesthesia, be enlarged 
to a circumference of ten to eleven inches in from fifteen to twenty-five minutes; thus 
rendering it easily possible to effect rapid delivery of child without waiting for the develop- 
ment of labor, or of employing more tardy and inefficient methods of dilatation to any 
degree desired by the operator. 
Photographs of which are herewith forwarded. 
No. 184. 
EXPRESSION OF THE BLADDER IN POST-PARTUM RETENTION OF 
URINE. 
Sebastian Cuervo Serrano, M. D., 
Sancti-Spiritus, Cuba. 
This article is formed of eighteen clinical notes, and constitutes the second part of a 
former paper by the author on the post-partum treatment of retention of urine. He 
believes that the retention is directly conn acted with the degree and time of pressure of 
the head of the foetus against the symphis, which may be so great as to give rise to a 
vexico-vaginal fistula. He does not believe that the use of forceps produces retention of 
urine. 
The manner of procedure is very much like the expression of the placenta by Crede’s 
method, taking especial care to exert pressure in the fundus of the bladder to force the 
urine out and not backward. 
80 The usual employment ©f the catheter Dr. Cuervo thinks produces cystitis, and is 
disagreeable to many women, besides the risk of infection. He puts in practice his com- 
pression method of emptying the bladder whenever it becomes necessary to do so, and says 
that at the end of the third or fourth day the bladder recovers its contractile function. 
His opinion is that the post-parturn retention of urine is due to vesical paresis caused 
by compression. 
No. 185. 
THE APPLICATION OF GRAPH IES TO THE FCETAL HEART 
SOUNDS. 
Hugh Hamilton, M. Sc., M. D., 
Harrisburg, Pa. 
I. The securing of these tones by a special instrument. 
11. The transmission of these notes to the human ear. 
111. A recording of them so that they may be permanent and compared on the 
tablet with those of the mother made at the same instant. 
IV. Its practical application in doubtful pregnancy, whether synchronous or other- 
wise. 
Demonstration—Time twelve minutes. 
No. 186. 
UTERINE COMPRESSION. 
Jose Maria de Ita, M. D., 
Pueblo, Mexico. 
The author, who for the last ten years has been in charge of the Maternity Hospital 
of the city of Pueblo, gives credit to Dr. Juan Maria Rodriguez for having first 
introduced and practiced uterine compression in Mexico. He is perfectly satisfied of its 
great utility as an aid in the production of uterine contraction. He practices the operation 
in the following manner ; 
The woman lies flat on her back, the operator stands by her side, extends his arms 
and presses the hands with the two thumbs together over the abdomen immediately above 
the fundus uteri; at first only slight digital compression is made, slowly increasing the 
force, imitating the rhythmical contraction of the uterus. It is necessary sometimes, he 
says, to continue the pressure steadily, in order to terminate the delivery at'once. 
The indications for uterine compression he groups thus : 
(1) In all cases of uterine inertia. 
(2) To help the traction made with the forceps. 
81 (3) To expel the trunk when the head of the child has already been born, either by 
nature’s forces or by traction; in this last event, with the uterine compression one avoids 
the necessity for further traction on the head, or inserting the finger in the axilla to draw 
out the rest of the body. 
(4) To hold the head bent after the expulsion of the trunk, and thus helping to its 
ibirth, in a case of feet presentation. 
(5) To overcome the resistance of the perineum and avoid the application of forceps. 
(6) To fix the head in the superior strait in cases where the application of delivery 
forceps are necessary, or when the use of craniotomy forceps becomes a necessity. 
(7) To facilitate the expulsion of the placenta in cases of hemorrhage. ' 
(8) To aid the uterus in throwing out the clots retained in its cavity, should a 
secondary hemorrhage take place. 
The author says that in case the uterus loses the power to contract, this mechanical 
compression will take its place. 
When the accoucheur has no assistant with him, he ought to practice the operation 
with only one hand aided by the forearm, and the other hand is used to support the 
perineum. 
No. 187. “ Prolapsus Uteri,” by E. F. Tucker, M. D., Portland, Oregon. 
[Abstract not furnished.] 
No. 188. “ Neurotic Effect of Perverted Dancing, Observations and Statistics made upon 
the Three Races, Asiatic, Ethiopian, and Caucasian,” by E. J. Chopin-Minard, 
M. D., Brooklyn, N. Y. 
[Abstract not furnished.] 
No. 189. “A Study of Gestation and the Phenomena at Term from the Standpoint of the 
Doctrine of the Conservation of Energy,” by Geo. F. Hurlburt, M. D., St. 
Louis, Mo. 
[Abstract not furnished.] 
No. 190. “Obstetrics among the Negroes of South Carolina,” by P. Gourdin De Saussure, 
M. D., Charleston, S. C. 
[Abstract not furnished.] 
No. 191. “The Use and Abuse of the Obstetric Forceps,” by J. Postman Chesney, M. D., 
St. Joseph, Mo. 
[Abstract not furnished.] 
82 No. 192. “The Modern Caesarian Section with Demonstration upon a Mannikin,” by Gustav 
A. Zuicke, M. D., Cincinnati, Ohio. 
[Abstract not furnished.] 
No. 193. “ Puerperal Convulsions,” by Richmond Kelly, M. D., Portland, Oregon. 
[Abstract not furnished.] 
83 SECTION ON GYNECOLOGY AND ABDOMINAL SURGERY. 
HONORARY PRESIDENTS; 
Dr. Rafael Benavides, Lima, Peru; Dr. Young H. Bond, St. Louis; Dr. Domingo F. Cueas, 
Havana, Cuba; Dr. Clinton Cushing, San Francisco ; Dr, Wm, E. B. Davis, Birmingham, Ala.; Dr. 
Christian Fenger, Chicago, 111.; Dr. Frank P. Foster, New York; Dr. Thos. H. Hawkins, Denver; 
Dr. Wm. D. Haggard, Nashville; Dr. Edward W. Jenks, Detroit; Dr. Joseph Taber Johnson, 
Washington; Dr. Ernst S Lewis, New Orleans; Dr. Andres Lopez Martinez, Tegucigalpa, Hon- 
duras; Dr. Richard B. Maury, Memphis; Dr. Thomas E. McArdle, Washington; Dr. Lewis S. 
McMurtry, Louisville; Dr. Roberto Moericke, Santiago, Chile; Dr. Robt. T. Morris, New York City; 
Dr. Paul F. Munde, New York; Dr. Joseph Price, Philadelphia; Dr. Charles A. L. Reed, Cincinnati; 
Dr. John C. Reeve, Dayton, O.; Dr. Jose Manuel de los Rios, Caracas, Venezuela; Dr. George H. 
Rohe, Catonsville, Md.; Dr. James F W. Ross, Toronto, Canada; Dr. Albert Vander Veer, Albany; 
Dr. Milo B. Ward, Topeka; Dr. Henry P. C. Wilson, Baltimore- Dr. NicolAs San Juan, City of 
Mexico, Mexico; Dr. F. Henrotin, Chicago, 111. , 
EXECUTIVE "PRESIDENT ; 
Dr. Wm. Warren Potter, 284 Franklin Street, Buffalo, N. Y. 
Dr. Brooks H. Wells (English-Speaking), Dr. Ernest W. Cushing (Spanish-Speaking), 
71 W. 45th St., New York, N. Y. 168 Newbury St., Boston, Mass 
Dr. Maglioni L.C. Llobet [Victoria 737] .... Buenos Aires . Argentine Republic. 
Dr. Manuel Cuellar (hijo) Sucre Bolivia. 
Dr. Luiz da CunhaFeijo Rio de Janeiro U. S. of Brazil. 
Dr. Gabriel Casuso [Virtudes 37] Havana Cuba. 
Dr. C. E. Gooding Bridgetown Barbados, W. I. 
Dr. Jose M. Buendia [Calle 10, nhm. 212] Bogota Republic of Colombia. 
Dr. Moises L. Castro Cartago Costa Rica. 
Dr. Mariano Fernandez Padilla Guatemala City Guatemala 
Dr. Ribaul Port au Prince Haiti. 
Dr. G. P. Andrews Honolulu Hawaii. 
Dr. Jose Maria Ochoa Velasquez Comayagua Honduras. 
Dr. Saunders ’ Kingston Jamaica, W. I. 
Dr. RicardoFuEßTES[calleDonJuanManuelnum.4]City of Mexico Mexico. 
Dr. M. J. Barrios Rivas Nicaragua. 
Dr. Enrique Pou£y, [Uruguay 371] Montevideo Uruguay. 
Dr. Ezequiel Jelamei Caracas Venezuela. 
SECRETARIES : 
84 SECTION ON GYNECOLOGY AND ABDOMINAL SURGERY. 
No. 201. 
ON THE VALUE OF CERTAIN METHODS OF SURGICAL TREATMENT 
FOR CHRONIC PROCIDENTIA UTERI. 
Augustus P. Claeke, A. M., M. D., 
Cambridge, Mass. 
The operation for shortening the round ligaments will often prove of service. 
These ligaments undoubtedly act as moderators to any excessive muscular action which 
may interfere with the normal equipoise of the uterine tissue. In chronic prolapse 
the ligaments will be found to have lost their power for contractility. In those 
cases in which they may respond to the presence of stimulus they will in great measure 
prove powerless in preventing the occurrence of prolapse, for their function is rather 
to preserve the uterus from a backward displacement than to overcome the factors 
that enter into the causation of its descent. Much success has been obtained in those 
cases in which high posterior colporrhaphy and high perinorrhaphy have been under- 
taken. Though much relief follows in some cases and most favorable results 
in others, there is nevertheless a class of cases which rarely improve under such 
measures of procedure. 
In that class of cases in which only one ovary has been removed and the menopause 
has not been reached, the uterus may still carry on its normal functional activity. In 
those cases in which both ovaries and tubes have become seriously affected, and in which 
there has been an intractable prolapse, resort to hysterectomy appears to afford the best 
chances for permanent success. The favorable results achieved by resort to vaginal 
hysterectomy as carried out by many distinguished operators for relief of malignant 
disease are, at some length, considered. The chief danger to be encountered in the opera- 
tion for any cause is that arising from hemorrhage. By the strict observance, however, 
of antiseptic precautions and by the careful suturing of the tissues before excising them, 
the danger will be reduced to a minimum. The author reports, as occurring in his prac- 
tice, cases of intractable prolapse, in each of which after other operative measures had 
been undertaken without success he was finally compelled to resort to vaginal hysterectomy. 
The author’s experience in these and in other cases leads him to say that the opera- 
tion is not a difficult one; that it does not expose the patient to so many dangers as are 
incident for the most part to other methods of procedure, especially to those of abdominal 
section. A resort to hysterectomy effects a permanent cure. The author refers to 
Goodell, Irish, Krug and to others as among the pioneers in the work of vaginal 
hysterectomy for relief of such severe cases of procidentia. 
85 No. 202. 
“ Hysterectomy for Fibroids: Methods and Results,” by Josefh Price, M. D., 
Philadelphia, Pa. 
[Abstract not furnished.] 
No. 203, 
THE TREATMENT OF SUPPURATIVE DISEASES OF THE FEMALE 
PELVIC ORGANS. 
H. J. Boldt, 
New York City. 
• These conditions can be treated only one way, if we intend to do justice to the patient 
and are conscientious enough to take no hazardous risks. Numerous voices have been 
heard during the past two years putting forth doctrines as to the management of pyo-sal- 
pinx, other than surgical, that I feel called upon to make some remarks. 
In addition to (1) pyo-salpinx, I shall refer to (2) ovarian abscess; (3) suppurative 
para-metritis and (4) suppurative perimetritis. There may be ground to differ as to the 
method of operation, even in the same patient, but there certainly should not be a differ- 
ence on the principle. 
No. 204. “ The Significance of Endometritis and the Necessity for its Early Cure,” by Joseph 
Tabor Johnson, M. D., Washington, D. C. 
[Abstract not furnished.] 
No. 205. 
AN INQUIRY INTO THE ETIOLOGY OF MENTAL DISTURBANCES 
FOLLOWING OPERATIONS UPON THE PELVIC ORGANS IN 
WOMEN. 
George H. Rohe, M. D., 
Catonsville, Md. 
The author claims that an analysis of the evidence available shows that a large pro- 
portion, perhaps the majority of cases, of mental disturbance following operations upon 
the pelvic organs, is due to the same causes that produce insanity subsequent to surgical 
operations generally. 
These causes are in some cases shock; in others, sepsis; in others, intoxication from 
drugs or antiseptics used during or after the operation. 
86 In a certain proportion 'of cases of insanity following operations upon the pelvic 
organs in women, the mental disturbance is due to the artificial induction of the meno- 
pause. 
In a minority of cases, the mental disturbance is probably due to the shock of the 
operation in a person hereditarily disposed to insanity. 
No. 206. 
ONE HUNDRED OPERATIONS FOR SEVERE STRUCTURAL DISEASE 
OF ABDOMINAL AND PELVIC ORGANS OF WOMEN. 
I. S. Stone, M, D., 
Washington, D C, 
Summary, 
Pelvic Abscess 17 5 
Extra Peritoneal Abscess 1 1 
Pysemic Intra Abdominal Abscess 1 1 
Tubo-ovarian Abscess 21 1 
Pyo-salpinx ' 6 0 
Hydro-salpinx 2 0 
Cystic Ovary (Pysemic uterm) . 1 1 
Cystic Ovaries. Result of infection 3 0 
Ovarian Tumor 6 0 
Myoma Uteri 11 3 
Hysterorrhaphy 7 1 
Exploratory Section 5 0 
Inguinal Hernia 1 0 
Vaginal Hysterectomy 4 0 
Oophorectomy for Uterine Myoma 2 0 
Old Sinus 1 0 
Cholelithotomy 1 0 
Cyst of Kidney 1 0 
Nephrotomy 1 0 
Extra-uterine Pregnancy 1 1 
Abdominal Hemorrhage 1 0 
Battey’s Operation 5 0 
Tubercular Peritonitis 1 1 
100 15 
CASES. 
DEATHS. 
87 No. 207. 
“Two Cases of Ectopic Gestation with Unusual Complications, Laparotomy and 
Recovery,” by T. H. Hawkins, Denver, Colo. 
[Abstract not furnished.] 
No. 208. “ Ought Craniotomy to be Abolished,” by W. H. Myers, M. D., Fort Wayne, Ind. 
[Abstract not furnished.] 
No. 209. “ What I have Learned in the Surgery of the Gall-bladder,” by Joseph Eastman, 
M. D., Indianapolis, Ind. 
[Abstract not furnished.] 
No 210, 
THE CAUSES OF STERILITY IN WOMAN AND TREATMENT, WITH 
CASES. 
By De Saussuee Foed, M. D., 
Professor, Practitioner of Practical Surgery, Medical College of Georgia, Medical Department University of 
Georgia. 
I. The vulvo-vaginal gland, analogue to Cooper’s gland in the male, its secretion 
discharged into fossa navicularis, may be abnormal; if so, may deteriorate spermatozoal 
life, to be impotent to fecundate ovule. 
11. Uterine and fallopian muscular coats, if in irritation, may affect migration of 
spermatozoids, and ovules. 
111. Excretion from mucous, open-mouthed follicles of uterus must be normal for 
conception, and any uterine trouble may vitiate it—e. g,, interruption of circulation, 
either arterial or venous. 
IV. Abnormality of raucous of fallopian tubes, will militate against fecundation. 
Y. If ovaries are in chronic inflammation, fecundation will he aborted. 
VI. Mechanical interruption, preventing migration of either spermatozoids or ovules, 
is a bar to conception. 
VII. Masturbation and excessive coition are factors causing ill iteration in vagina 
and uterine functions by congestions and these may invite flexions, which are mechanical 
barriers. 
VIII. All passages must be bathed with normal mucous excretion. 
IX. Position, during coitus, or immediately thereafter may be important, especially 
in multipar, with an old and extensive laceration of perineum. 
TREATMENT. 
I. Correct flexions by rapid dilatations, and relieve any atresia of any of the 
passages. 
88 11. Relieve congestions and inflammations by local venesection, and especially by 
applications of undiluted spirits of turpentine. 
111. The therapeutic value of turpentine in all inflammations of mucous membranes. 
IV. Retain the uterus in its intrinsic natural form, and in its relation with its 
surroundings, by pessary, or tamponades. 
No. 211. 
DRAINAGE OF OVARIAN CYSTS WHERE THE ADHESIONS ARE SUCH 
THAT IT IS IMPOSSIBLE TO REMOVE THE SAC. 
A. Vandeeyeer, M. D., 
Review of the symptoms and diagnosis of severe adhesions: The fallacy of always 
being able to tell definitely and with certainty the nature and extent of such adhesions. 
Some valuable time lost, some additional nerve strain given the patient by too frequent 
and too severe a manner exhibited in the examination when adhesions are suspected. 
Some considerations as to the rapidity in which adhesions will at times form. 
Careful study of previous history of patient as to traumatisms that may have 
occurred in the case, with or without any marked evidence of local or general peritonitis 
having supervened. Brief consideration of the subject of exploratory incision. Discus- 
sion of the necessary, careful procedure in the care of the adjacent parts, when loosening 
and breaking up strong adhesions. 
Presentation of the subject, to what extent shall we resect portions of the intestinal 
tract, when implicated with the tumor, by reason of the adhesions. What course to pur- 
sue when portions of the large intestines are seriously implicated. When is it judicious 
to cease to regard the strength of the patient, length of operation, and if drainage of the 
whole or part of the sac or sacs is considered the safest course to pursue as to the recovery 
of the patient. 
Some considerations as to the manner and way in which the drainage shall be carried 
out. 
Albany, N. Y. 
Careful discussion as to the relative danger between pelvic and abdominal adhesions. 
To what extent do we now make use of the preparations of iron and the thermo-cautery 
in controlling hemorrhage resulting from adhesions. The use of the glass tube or other 
forms of drainage for the same purpose. The dangers of sapraemia and septic conditions 
in cases of incomplete removal of the sac. General treatment of such cases as where, of 
necessity, drainage becomes the only method of procedure. 
No. 213. Paper by H. A. Kelly, M. D., Baltimore, Md. 
[Neither Title nor Abstract furnished.] 
89 No. 214 
THE RELATION OF URINARY CONDITIONS TO GYNECOLOGICAL 
SURGERY. 
Charles P. Noble, M. D., 
Surgeon-in-Chief to the Kensington Hospital for Women, Philadelphia. 
(1) That albumen is often observed in the urine of gynecological patients. 
(2) That the presence of albumen often is not significant of serious disease. 
(3) That tube casts are not always significant. 
(4) The secretion of urine is diminished after operation for several days. 
(5) Albumen and tube casts are present in the urine with greater frequency after 
than before operation. 
(6) The question of ether versus chloroform in relation to suppression of urine after 
operation. 
(7) Illustrative cases. 
(8) Conclusions. 
No. 215. “Shortening of the Round Ligaments in Retro-position of the Uterus,” by T. 
Johnson Alloway, M. D., Montreal, Canada. 
[Abstract not furnished.] 
No. 216. “Total Extirpation of the Fibroid Uterus,” by Floeian Krug, M. D., New York 
City, N. Y. 
[Abstract not furnished.] 
No. 217. Paper by J. Algernon Temple, M. D., Toronto, Canada. 
[Neither Title nor Abstract furnished.] 
No. 218 
VAGINAL HYSTERECTOMY. 
E. E, Montgomery, M. D., 
Philadelphia, Pa. 
This is now an accepted operation. Under improved methods the greatly reduced 
mortality, with the increased immunity against relapse, renders it the effective operation 
in malignant disease where confined to the uterus. In uterine fibroids of small size, 
whether involving the cavity of the uterus or its walls, it is preferable to dilatation and 
enucleation for their removal. It may be done in some cases of prolapsus of the uterus, 
90 particularly when accompanied with extensive ulceration of the cervix. Its performance 
for pelvic inflammations demanding removal of the ovaries and tubes, may be questioned. 
The use of the clamps greatly expedites the operation and saves the patient from the effects 
of shock resulting from a prolonged operation and long continued anaesthesia. In twenty- 
one cases in which the writer has performed vaginal hysterectomy, sixteen were done for 
undoubted malignant disease, in one of which there was epithelioma of the cervix and a 
number of fibroids in the body of the uterus; three for fibroids, and two in which the 
diagnosis was doubtful. In twenty-one cases there was one death from tetanus on the 
fourteenth day. 
No. 219. 
SURGICAL TREATMENT OF PERITONITIS. 
M. B. Ward, M. D., 
Topeka, Kan. 
It is not my purpose to attempt to enlighten the distinguished gynecologists whom I 
now have the pleasure and honor to address, by presenting this brief essay, but rather 
that I may add my “ mite” relative to the importance of early surgical treatment of 
peritonitis. It is, indeed, very essential that well-established surgical procedures should 
be constantly kept plainly engraved on the sign-boards so as to guide the members of our 
profession. 
Human life is dear to the possessor and fondly cherished by loved ones, therefore, we 
need the wisdom of all who have had experience—even though it be limited—to guide us 
when brought face to face with conditions which seem to demand surgical interference in 
order to save life, when, perhaps, the patient might recover without an operation, and does 
succumb on account of the operation. So long as time shall last, the profession will have 
to deal with such uncertain problems. Almost every week, and right under our personal 
observation, men and women are dying of peritonitis, caused by appendicitis or disease of 
pelvic organs, and nothing is done to save their lives, except it be to administer opium or 
salines, with the vain hope that each hour will show improvement. But, alas, nothing 
can be done, the last opportunity for surgical interference is past, our hands are folded on 
our breasts and we exclaim, “ The Lord’s will, and not ours, be done.” 
Those who recover from peritonitis without an operation, or, rather, are symptomati- 
cally cured, are almost certain to suffer from recurring attacks which are more serious and 
dangerous than the first onslaught. 
When called upon to treat this character of cases, we all are inclined to be timid and 
hesitate. Is it not the experience of all surgeons that an operation is only recommended 
after every other known remedy has been tried and an operation is the only source of 
relief? 
This paper is written especially that I may record the statement that surgical inter- 
ference, when properly done, should never increase the mortality. I do not wish to 
91 convey the impression th it I would operate on every case of acute obstruction of the 
bowels. Peritonitis and intestinal obstructions are essentially different. The symptoms 
of peritonitis are usually rather apparent. An important landmark to the diagnosis of 
peritonitis is the fact that while the bowels are usually locked, they will act after the 
persistent use of laxatives and enemas, but the evacuation of the intestinal tract does not 
relieve the distention or tenderness. In other words, when the patient seems to be doing 
well they often are in the greatest danger. I call attention to this feature of the subject 
in order to emphasize the importance of watching, most carefully, patients who have symp- 
toms of peritonitis and claim they feel relieved after having a movement of the bowels. 
I also think the profession should be warned against the delusion that, because the 
patient’s bowels have moved, there is no more danger. I have myself been led astray in 
this direction, and have told patients that they were getting along nicely, when, afterward, 
I found myself mistaken. I would, therefore, urge the propriety of operating on all 
cases whose history points to recurring attacks, where other conditions give promise of 
success. I would also urge the necessity of early surgery in all acute attacks where the 
gravity of the onslaught indicates that the appendix vermiformis is the cause of the 
inflammation, or even when it is found to be a leaking pus tube or ovarian abscess. 
Perhaps it is not necessary that I should add in this connection that we cannot with pro- 
priety rush into every abdomen with the knife that seems to demand operative procedure, 
for often it is essential to success that certain preparations be first made by way of getting 
the patient in the best possible condition for operating. The preparation of patients can 
only be carried out to perfection in elective cases. 
It was my intention to report some cases, but perhaps a brief reference to two bad 
cases will suffice the purpose. 
In April of this year 1 was summoned by telegram to a distant part of this State to 
operate on Mr. W., for appendicitis. The summons came from the attending physicians, 
and was not authorized by the patient or friends. I arrived at the patient’s residence at 
five o’clock in the morning, and was at once informed by the friends that they were sorry 
that I had been sent for, because the patient was greatly improved, having had no 
morphine for the last twenty hours. Prior to this time large doses of morphine had been 
given to partly control the intense suffering, After an examination, I, too, was led to 
think the patient was doing quite well; his temperature was 101 and pulse 120. The 
abdomen was moderately distended and very tender, the most sensitive point being over 
the cecum. I watched the patient carefully for four hours before I operated. The first 
two hours of this watching I felt certain that an operation would not be necessary and so 
informed the friends, but later it wTas noticeable that the patient was failing, and failed 
so rapidly it seemed that he could not live but a few hours at the longest. Upon opening 
the abdomen, the odor was that of fecal matter. The intestines were in a condition akin 
to gangrene ; the adhesions were so profound and universal that it was impossible to move 
a single coil of intestines without tearing it loose from its moorings. The cecum was so 
nearly gangrenous that my finger perforated the gut wffiilecarefully examining the condition. 
The opening in the intestine was was about one inch in length. This I closed by the use of 
fine silk sutures. The adhesions were broken up until the patient began to show signs of 
shock. Although I had apparently accomplished but little, yet I had succeeded in 
92 separating the intestines so as to be able to flush the cavity most thoroughly. Several 
gallons of warm sterilized water were used. The abdominal opening was packed with 
iodoform gauze and the patient placed in bed. In one hour after the operation the 
patient’s symptoms were decidedly better and he expressed himself as greatly relieved. I 
informed the friends that the patient could not recover, that the inflammation had gone to 
the very verge of suppuration or breaking down of the tissues, and I thought it impossi- 
ble for the intestines to resume their natural functious. However, after twelve hours, I 
felt hopeful, but remained with the patient twenty-four hours after the operation, leaving 
him in the care of two bright and experienced physicians. On two or three occasions the 
patient had considerable pain, and on one occasion suffered very greatly for a few hours, 
during the course of his convalescence, but, aside from these slight disturbances, he made a 
rapid and uneventful recovery, and is now an entirely well man, and attending to his 
avocation as superintendent of a large stock ranch. 
Another case, quite as interesting on account of its history, but in no way as grave 
as the case just referred to: Mr. A., who resides in this city, consulted me about two 
months ago to obtain my opinion regarding the necessity for an operation upon him- 
self for appendicitis. He gave a history of having had several attacks, some of them 
quite severe, and the last one, from which he was just recovering, kept him in bed about 
ten days with a high temperature and rapid pulse. Two physicians had recommended an 
operation to be done at once, but 1 found him in so comfortable a condition, with tempera- 
ture only and pulse 90, a good appetite, bowels regular and not very tender; I 
thought it best that he should wait developments, and in case he should suffer from another 
attack it wrould be plenty of time to operate. My advice was heeded and for a time it 
seemed to have been wise counsel. About one month after I had first been consulted I 
received a telephone message to come at once prepared to operate on Mr. A. 
The operation was done as promptly as preparation could be made. Upon opening 
the abdominal cavity we were shocked, because we were certain from the odor that the 
intestines were perforated. However, it was found upon examination that it was not a 
perforated intestine but the broken down condition of the tissues. The cecum was buried 
in adhesions, and I was obliged to carve my way, so to speak, in order that I might 
remove the large intestine to examine it. There was no vestige of the appendix 
remaining. The inflammation in this case did not extend to the small intestines but 
involved the cecum and ascending colon and a small proportion of the ilium. After 
thoroughly separating the adhesions and loosening the diseased intestines I flushed the 
abdomen with a large quantity of sterilized water, drained and packed as in the case above 
mentioned. The patient recovered so rapidly that it did not seem there had been any- 
thing the matter with him. His temperature fell one degree and a half in less than one- 
half hour, and never got higher than 100 after the operation. • 
The brief reference to the above cases is quite sufficient in my judgment to illustrate 
the purpose of this paper, because one could not find graver cases than these two, and yet 
have such uneventful recoveries. In the case first mentioned, life must have been saved 
by the operation. The second case, in my judgment, would have gotten up without an 
operation, and yet it is possible he could not have lived. 
93 No. 220. Paper, by B. E. Hadra, M. D,, Galveston, Texas. 
[Neither Title nor Abstract furnished.] 
No. 221. “ A Last Resort in the Operative Treatment of Hernia,” by Robert T. Morris, 
M. D., New York City, N. Y. 
[Abstract not furnished.] 
No. 222. 
WHEN OPERATION IS REFUSED—WHAT THEN ? 
Geo. R. Dean, M.D., 
Spartanburg, S. C. 
The object of this paper is not to throw light upon the subjects referred to, but to 
obtain the expression of sentiment from such a learned body as the Pan-American 
Congress. 
There are two points to consider in this question—First, shall a doctor withdraw from 
a patient if she refuses his advice as to au operation. Second. If the doctor remains after 
he is refused permission to operate, what line of treatment should he adopt on general 
principles for the various diseases to which women are subject, herein named, taking it 
for granted .that a patient may retain her doctor even though she refuse operation ? I have 
not discussed the ethical side of this subject but have confined my remarks to the second 
part of the subject. 
First as to cancerous growths on womb and appendages. Does operation present the 
only means of giving relief? This Ido not answer but leave it for discussion. 
Then fibroma and cystoma are discussed. Here operations are generally, though 
not universally, advised; certain conditions militate against operation. But when recom- 
mended and refused what can be done to mitigate the suffering and discomfort of a patient 
and prolong her life % 
Then pus tubes, ovarian abscess, puerperal sepsis, septic peritonitis and ectopic preg- 
nancy. The desire of the writer is to bring out a full and comprehensive discussion upon 
the subjects, viz : The results of operation, present and remote. The ratio of mortality 
from operation and non-interference, the prognosis of those left without operation but 
kept under skilled hands. 
The treatment and expectancy of life. 
The result, present and remote, of those who do recover without operation. 
94 No. 223. Paper, by W. E. B. Davis, M. D., Birmingham, Ala. 
[Neither Title nor Abstract furnished.] 
No. 224. “ Perineo-Yaginal Restoration,” by Edward W. Jenks, M. D., Detroit, Mich. 
[Abstract not furnished.] 
No. 225. Paper, by W. Gardner, M. D., Montreal, Canada. 
[Neither Title nor Abstract furnished.] 
No. 226, 
PRESENT STATUS OF OUR KNOWLEDGE OF THE PATHOLOGY OF 
PELVIC INFLAMMATION, WITH SPECIAL REFERENCE TO 
THE ANATOMY AND TREATMENT OF PELVIC 
ABSCESS. 
R. B. Maury, M. D., 
Memphis, Tenn. 
The term “ pelvic abscess ” applied to any collection of pus in the pelvis, no matter 
what its anatomical relations. 
Views of pelvic inflammation ten years ago, compared with accepted doctrines of the 
present time. 
Pelvic cellulitis known to be an acute inflammation, occurring as one of the features of 
a puerperal septicemia. 
It also occurs as a result of tHe infection of surgical injuries upon the uterus or vagina. 
To the extent of producing appreciable exudations it is of infrequent occurrence even 
in the puerperal inflammations. 
Death following septic infection of surgical operations is usually due to peritonitis ; 
cellulitis is seldom found. 
The dissecting room proves that pelvic cellulitis to a minor extent frequently occurs in 
association with a major peritonitis. 
In such cases the cellulitis would be incapable of recognition at the bedside. 
Chronic pelvic cellulitis as a distinct pathological condition, believed to be a mis- 
nomer, and is of doubtful existence. Clinically, it is impossible of recognition. 
Pelvic peritonitis associated with diseased uterine appendages is regarded to-day just 
as it was taught thirty years ago by Bernutz, the keystone of pelvic pathology in women. 
The collections of pus, here to be considered, are those which follow inflammation of 
the pelvic cellular tissue, and those which result from salpingitis, ovaritis and pelvic peri- 
tonitis. 
95 Abscesses of the cellular tissue are rare. Broad ligament abscesses are very infre- 
quent. Lack of scientific accuracy in the anatomical reports of them. 
The overwhelming majority of pelvic abscesses are intra-peritoneal. 
As long as pelvic cellulitis dominated pelvic pathology all the surgical methods tor 
the evacuation of pus were based upon operations through the vagina, or through the 
anterior abdominal wall. 
Such methods are applicable to a very small number of cases. 
Methods of treatment of pelvic abscesses. 
(1) Of abscesses extra-peritoneal. 
(2) Of intra-peritoneal abscesses. 
Abdominal section the natural method of approaching intra-peritoneal abscesses. It 
offers advantages which no other possesses. 
It should be essayed in cases when the exact nature of the abscess is in doubt. 
No. 227. Paper, by John R. Haynes, M. D., Los Angeles, Cal. 
[Neither Title nor Abstract furnished.] 
No. 228. “The Omentum, and the Role it plays in Operative Work upon the Abdomen,’’ by 
James F. W. Ross, M. D., Toronto, Canada. 
[Abstract not furnished.] 
No. 229 
HYSTERECTOMY. INDICATIONS AND TECHNIQUE. 
Professor of Gynaecology in the Philadelphia Polyclinic. Surgeon to the Gynecean Hospital. 
J. M. Baldy, M. D., 
It is not proposed to discuss in this paper the etiology or symptomatology of the 
various conditions for which this operation is performed. 
It is not always safe in forming conclusions to draw our inspiration from a promis- 
cuous collection of statistics, therefore whatever deductions are drawn will be entirely from 
the author’s personal experience, which has reached the number of seven-seven hysterec- 
tomies. 
The indications as taught by this expeuei ce are absolute and relative. They ate : 
(1) Malignant degenerations. 
(2) Fibroid tumors. 
(3) Pelvic inflammations. 
(4) Prolapse. 
(5) Inversion. 
96 The indications in malignancy are absolute, both as to the advisability of operation 
and as to the complete removal of the uterus. However small the number of cases cured 
may be, yet it is an undisputed fact that a certain proportion regain permanent good 
health. Should only one or two in a hundred be so fortunate, yet would the operation be 
justified in view of . the absolutely certain end of all without it. The operation is com- 
paratively safe. Twenty-five operations have been performed by the writer for primary 
cancer or sarcoma of the uterus, and of this number three have died from the operation; 
all three deaths were due to preventable causes, and with added experience and a more per- 
fect technique would not be likely to occur again. 
The indications for surgical treatment of fibroid tumor are relative. Surgical treat- 
ment having been once decided upon, hysterectomy is the proper procedure. Ovariotomy 
is excluded for the reason that it equally renders the patient sterile ; it allows the tumor 
to remain in situ with the added chance of its not producing a cure; it often leaves a 
uterus diseased in its cavity as well as its walls; it is as difficult as hysterectomy often ; and 
at times is impossible. Hysterectomy as the operation of choice depends upon its mortal- 
ity. Forty-one fibroid uteri were removed by this means with four deaths. Three of these 
deaths were from preventable causes, or accidents which would not be likely to occur again. 
The indications for pelvic inflammation are relative. Four such operations have 
been successfully performed : two subsequent to a primary ovariotomy ; two primarily. 
-Patients in whom the endometrium is badly diseased, the uterine walls infiltrated, espe- 
cially with pus corpuscles, and the whole uterus enlarged, are proper subjects for their 
treatment. 
The indications for uterine prolapse are relative, when the ordinary procedures have 
failed, when the patient is near, or past, the menopause, and when there is the slightest 
suspicion of malignancy. The operation should be performed with catgut ligatures, the 
stump stitched into the vaginal opening and subsequent plastic operations performed upon 
the anterior and posterior vaginal walls. The operatiqn has been performed six times, 
always with success. 
A chronic inverted uterus should be removed wherever a short trial at taxis and 
elastic pressure has failed. The operation has been performed once successfully. 
The methods of performing hysterectomy are abdominal, vaginal and the combined 
method. The combined method is superfluous and more dangerous than either of the 
other two alone. 
Abdominal hysterectomy is performed by: 
{a. Treatment of the by the extra-peritoneal 
method. 
b. Dropping the stump. 
(2) Extirpation. 
Vaginal hysterectomy is performed by : 
f a. Single clamps. 
(1) Clamp operation. | k Muftiple c]aFmps. 
(2) Ligature operation. - 
All cases of prolapse and inversion, all cases of malignancy sufficiently small, and 
very small fibroid tumors are proper subjects for the vaginal operation. 
97 Fibroid tumors, large malignant uteri, pelvic inflammatory cases, should all be sub- 
jected to the abdominal operation. 
The writer has performed each operation as follows : 
Vaginal hysterectomy. 
Single clamps : three, with two deaths. 
Multiple clamps : one, with no death. 
Catgut ligature; twenty-seven, with one death. 
Abdominal hysterectomy. 
Extirpation : five, with one death. 
Extra-peritoneal treatment of stump : twenty-eight, with two deaths. 
Dropping the pedicle : thirteen, with one death. 
The vaginal operation performed with catgut ligature and the abdominal operation 
performed by supra-vaginal amputation and dropping the stump are the procedures of 
choice. 
Vo. 230. “Observations on Total Extirpation of the Uterus for Cancer Based upon a Personal 
Experience with Thirty-two Cases,” by Charles A. L. Reed, M. D., Cincin- 
nati, Ohio. 
[Abstract not furnished.] 
Vo. 231. “Ectopic Pregnancy,” by Joseph Hoffman, M. D., Philadelphia, Pa, 
[Abstract not furnished.] 
Vo. 232. Paper, by E. W. Davis, M. D., Philadelphia, Pa, 
[Neither Title nor Abstract furnished.] 
Vo. 223. “After-treatment of Abdominal Section,” by L. S. McMurtry, M. D., Louis- 
ville, Ky. 
[Abstract not furnished.] 
Vo. 234 
THE TECHNIQUE OF TOTAL EXTIRPATION OF THE/FIBROMATOUS 
UTERUS. 
George M. Edebohls, A. M., M. D. 
New York. 
Place the patient in the lithotomy position. 
Thoroughly disinfect the vagina. 
98 Disinfect the uterine cavity, as far as possible in each individual case, by means of 
superficial curetting and irrigation with 1-2000 sublimate solution. 
Pack the uterine cavity moderately full of sublimate gauze, 1-100. 
Pack the vagina tightly with sublimate gauze 1-1000. 
Make no vaginal incisions; do none of the cutting from below. 
Now place the patient in the Trendeleburg posture. 
Open the abdomen above the pubis by an incision just large enough to permit of 
delivery of the entire tumor. 
Given a tumor weighing not above four kilogrammes, with healthy tubes and 
ovaries, proceed as follows : * 
Eventrate the tumor. 
Circumscribe two peritoneal flaps by two transverse incisions of the peritoneum, one 
on the anterior, the other on the posterior surface of the tumor mass, each incision extend- 
ing from one broad ligament across to the other. These peritoneal flaps should be large 
enough to easily cover the defect in the pelvic floor left after removal of the uterus. 
Strip the peritoneal flaps from the surface of the uterus, carrying the bladder and 
ureters forward, out of harm’s way, with the anterior flap. 
Tie the uterine arteries on either side by a subperitoneal mass ligature of catgut, 
carried well down to, but not into the vagina. The distention of the vagina by the gauze 
packing makes this an easy matter. 
Tie off the broad ligaments, outside of the tubes and ovaries, by two further catgut 
ligatures on either side. 
Cut out the entire uterus, tubes and ovaries, in one piece, between the ligatures. 
Cut short the six ligatures. 
Unite the peritoneal flaps by a transverse, running Lembert suture of catgut, extend- 
ing from the stump of one infuudibulo-pelvic ligament to that of the other, carefully 
applied so as to securely close the peritoneal cavity and turn all ligatures down into the 
vagina. 
Close the abdominal wound. 
Again place the patient in the lithotomy position. 
Remove the gauze packing from the vagina and apply a loose dressing of gauze in 
such a manner as to drain the supravaginal subperitoneal space. 
If the ovaries or tubes present evidences or suspicion of containing infectious mate- 
rial, tie off and remove them the first thing after opening the abdomen. 
If the tumor extend above the umbilicus, weighing more than about four kilo- 
grammes, pass a rubber ligature around the cervical part, after stripping back the 
peritoneal flaps, and amputate the bulk of the tumor. Cauterize the cervical canal with 
the Pacquelin or a tablet of corrosive sublimate, and remove the cervix in the manner 
described above. 
If multiple fibromata, or intra-ligamentary fibromata, fill the pelvis, make room by 
enucleating the fibromata most in the way, and proceed as above. 
The technique advocated is believed to possess the following advantages : 
The danger of infection from the uterus or vagina is entirely avoided or at least min- 
imized. 
99 The uterine arteries are secured with ease and certainty. 
The operation is practically bloodless. 
The closure of the peritoneum is as perfect as it can be made and no foreign body is 
left in its cavity. 
The after treatment required is practically nil. 
No. 235. 
THE INTRA-UTERINE TAMPON. 
Andrew F. Currier, M. D., 
New York. 
The vast experience in gynecology which has accumulated particularly during the 
past fifteen years has educated us to accept measures which would have been regarded as 
inexcusably rash in pre-antiseptic days. The freedom with which the curette is now 
used within the uterus is an illustration in point. The usefulness of instruments for the 
dilatation of the uterus has been generally appreciated only during the era in question, 
and the same is true concerning the principle of drainage in its application to the same 
organ. Dilatation, curettage and drainage are the three principal foundation stones upon 
which intra-uterine treatment may be said to rest. From the propriety of dilating the 
uterus to that of packing it with a tampon is a logical step. The vaginal tampon is an 
indirect and often unsatisfactory means of relieving uterine trouble. The intra-uterine 
tampon goes directly to the source of the trouble and has opened a new field in intra- 
uterine therapeutics. Sterilized gauze is the material which offers the greatest number of 
advantages for such a tampon. 
In the impregnated and puerperal uterus it may be used : 
(1) During the period of gestation. 
(2) During parturition. 
(3) Post-partum, whether the labor occur at term or prior to it. 
In the unimpregnated uterus its use is for— 
(1) Exploratory and operative purposes in connection with disease of the uterus and 
its appendages. 
(2) Hemorrhage. 
(3) Endometritis. 
(4) Stenosis. 
(5) Accumulations within the tubes. 
No. 236. 
A PLEA FOR THE EARLY DIAGNOSIS AND PROMPT ELECTRICAL 
TREATMENT OF FIBROID GROWTHS OF THE UTERUS. 
G. Betton Massey, M. D., 
Philadelphia, Pa. 
The questions briefly considered in this paper are : the nature and symptoms of the 
early manifestations of uterine fibrosis and myomatous new growths; the duties of the 
100 profession in making a prompt diagnosis and instituting early treatment for the condition; 
and a consideration of the value of the Apostoli methods in these cases. 
Conclusions. (1) The early signsof uterine fibrosisare quite similar to those of a number 
of more common disorders, and are consequently mistaken for them in many instances. 
Whenever metritis, displacements, or persistent sensations of pain and weight are found, 
the physician should bear in mind the possibility of the cause being an incipient fibroid 
development, and if found to be so, he should place the patient at once under treatment. 
(2) The most recent views of the etiology of fibrosis indicates that the mode of 
action of electricity is most likely by a stimulation of the trophic and sorberacieut func- 
tions of the uterus, rather than by an electrolytic destruction of the growth. 
(3) The expectant policy in dealing with fibroids is too prevalent, resulting in many 
cases losing the decided advantage to be derived from early treatment. 
(4) The early diagnosis of fibroid growths has the advantage of placing all cases 
within the list of those that are amenable to electrical treatment, while delay permits of 
some becoming unsuitable for it. 
(5) All forms of fibrosis and fibroid neoplasms of the uterus are suitable for electrical 
treatment except those that have undergone cystic changes, or that are accompanied by 
purulent accumulations in the uterine adnexa. 
No. 237. 
THE CO-ORDINATION OF THE MUSCLES CLOSING THE URETHRA, 
VAGINA AND RECTUM, AND ITS APPLICATION TO THE 
PRECISE DIAGNOSIS AND SURGICAL TREATMENT OF 
INJURIES TO THE PELVIC FLOOR. 
A. W. Abbott, M. D., 
That the perineum completes the outer layer of pelvic supports, that it perfects the 
valvular closure of the vaginal opening, that it performs an important function in copu- 
lation and conception, are sufficient reasons for its restoration after rupture. 
When the sphincter ani is made to contract voluntarily, the entire levator ani as well 
as the perineal muscles proper contract at the same time, and can therefore at all times be 
influenced by the control of the sphincter ani. 
To ascertain what muscle or muscles of the perineum are torn, place the patient in 
the dorsal position, with the perineum exposed; if now the patient alternately contracts 
and relaxes the sphincter ani, all the other muscles involved contracting and relaxing, as 
before stated, at the same instant, it will be immediately apparent by touching the normal 
positions of the various muscles, which ones contract throughout their full extent, and are 
therefore intact, and as positively, those that are torn, by the total or partial loss of 
contractile hardening at the point of rupture. Indeed, the exact site of injury may often 
be made out by sight alone, the sound side drawing up, while the tissues of the injured 
Minneapolis, Minn. 
101 side are carried toward the uninjured side instead of counteracting the effect of the 
latter, as they normally should. 
In brief, the principles of repairing a lacerated perineum are, first, to definitely 
locate the lesion; second, to confine the operation to the injured muscles and fasciae only; 
third, to place the sutures just as would be done in like injuries in any other part of thebody. 
The results have been certainly gratifying, the perineum not only being restored to its 
nulliparious form, but what is of more importance, the control is perfect. 
No. 238, “ Estudio Clinico Sobre las Heridas Penetrantes del Abdomen i Pecho,” by Du. Juan 
Manual Escalana, Caracas, Venezuela. 
[Abstract not furnished.] 
No. 239 
CAVERNOUS ANGEIOMA OF THE UTERUS REMOVED PER HYSTER- 
ECTOMIAM VAGINALIS, WITH REMARKS UPON THE 
METHOD OF DOING VAGINAL HYSTERECTOMY. 
(With specimen presented.) 
H. J. Boldt, M. D., 
New York. 
The specimen is presented because it is unique; it was obtained from a woman thirty- 
seven years old, who had been troubled with irregular uterine hemorrhages for nearly a 
year, and despite of all treatment adopted, had gradually become worse; several curettings 
with a sharp curette and subsequent local applications had but temporary effect. The 
products of curetting only showed by perplastic endometritis under the microscope, but 
notwithstanding that no evidence of malignant disease could be found, extirpation of the 
uterus was resorted to in preference to castration, because of its equal safety, and its 
more certain cure. 
For the histological details, I must refer to the original article, and here tabs the 
opportunity to again express my opinion on a practical issue, namely, the proper way to 
do the operation. For explicit details I refer to my article on vaginal hysterectomy for 
cancer of the uterus in the ".Transactions of the American Gynecological Society for 
1892. 
No fixed rule can be laid down, each case must be managed according to the circumst ices 
presenting themselves at the time. We will, however, take an ordinary case, such a the 
one from whom the uterus presented was removed. It is immaterial whether it be m. lig- 
nant or non-malignant disease for which the operation is done, as far as the one feature is 
concerned, viz: the closing of the wound completely and to have the broad ligament 
stumps entirely extra-peritoneal. The portio having been grasped by vulsella and the 
uterus pulled down as much as possible, a transverse incision is made anteriorly and the 
102 bladder stripped off the cervix ; if it cannot be completely done yet, only so much is 
separated as is convenient. The same course is pursued posteriorly, and the cul-de-sac of 
Douglas is opened. The peritoneum is now attached to the vaginal mucosa by a con- 
tinuous cat-gut suture. The base of the parametria are next ligated and cut on either 
side. Should the bladder not have already been entirely separated, it will be found to be 
easily accomplished after severance of the base of the parametria. The broad ligaments 
are now ligated in sections and cut as we proceed, taking care that the needle enters the 
vaginal mucosa, and after taking in its grasp as much of the broad ligament as is desired, 
it emerges again in the vaginal mucosa. The index-finger of either hand is used as a 
guide, by way of the posterior opening. After tying the ligature, the ligated portion of 
the broad ligament is cut. The adnexa are brought down and ligated off if possible in 
the same manner. It is obvious that by following this technique of introducing sutures 
that our stumps are practically already secured in the vagina. The terminal ends of the 
stumps are now grasped with bullet forceps and an assistant makes traction sufficient to 
bring them completely into the vagina, when another suture is passed on the same 
principle as the previous ones, enveloping all the stumps. This done on either side, the 
centre gap can now be closed completely, after removing the sponge or gauze tampon, 
from the pelvic cavity, if one has been inserted to prevent the intestines from prolapsing 
during operation. 
Full curved sharp needles of suitable size are used, and nothing but cat-gut for liga- 
tures. Silk delays convalescence too much and it cannot be made more aseptic nor tied 
more securely than animal ligature. The needle holder is also preferable without catch or 
spring. There is no necessity for drainage in ordinary cases, so that the practice of putting 
a strip of gauze into the pelvic cavity for this purpose in every instance, had better be 
abandoned. It is only desirable when extensive perimetrial adhesions are present. In 
malignant disease the operation must be done as far away as possible from the diseased 
structure, and sufficient vagina must also be resected if the portio is the seat of the 
neoplasm. Clamps should never be used if ligatures are applicable. 
The operation should be done with the patient in the lithotomy position, and not in 
the side position. 
No. 240. 
THE DORSAL DECUBITUS AFTER CONFINEMENTS AND MISCAR 
RIAGES IS THE COMMONEST CAUSE OF RETROVERSION 
WITH FIXATION. 
A, Lapthorxe Smith, M. D., 
Montreal, Canada. 
(1) After confinement or miscarriage the uterus is unusually heavy, and is therefore 
especially subject to the law of gravitation. 
103 (2) During the process of enlargement during pregnancy the ligaments, especially 
the round ones, become lengthened and probably weakened because they are not used, the 
uterus being held in position by other means at that time. 
(3) By allowing the patient to remain on her back for ten days after delivery or 
miscarriage, the heavy and unsupported fundus gravitates onto the spine, and as it invol- 
utes it gradually sinks into the hollow of the sacrum, where it receives the intra-abdominal 
pressure on its anterior surface, and where it obstructs the passage of the rectum like a 
valve; the more the patient strains the tighter it closes the canal. 
(4) The uterus is then in the position of a bottle with the mouth up, and the lochial 
discharge accumulates in it; if germs have been introduced the conditions for fermentation 
are very favorable. The bottle, however, has two holes in it, through which the 
fermenting liquid leaks into the cavity of the pelvic peritoneum, setting up an attack of 
local peritonitis. If the patient recovers from this, as she usually does, the ovaries, tubes 
and fundus uteri will be found firmly glued together in Douglas’ cul-de-sac, from which 
no manipulation short of 'abdominal section will generally remove them, 
(5) Such a condition of the uterus and appendages generally renders the woman a 
life-long sufferer. 
(6) This condition is absolutely preventable by keeping the patient on her face or 
partly on her side after miscarriage and confinement, and by allowing her to sit up on a 
chamber, leaning forward when possible, when evacuating the bladder and bowels. 
The dorsal decubitus, while having this great objection, has nothing to recommend 
it. There is no foundation for the dread that hemorrhage will come on if the patient 
turns on her side or face. 
No. 242. “ Observaciones Sobre un caso de Prenez extra-uterina (Tubaria Derecha) Operada 
en el Hospital de San Salvador por el Dr. Jose Antonio Delgado,” by Dr. J. 
Antonio Delgado, Guatemala City, Guatemala. 
[Abstract not furnished.] 
No. 243. “ Notes Pour L’Histoire Des Fibro Miomes Uterine,” by Dr. Nicolas San Juan, 
City of Mexico, Mexico. 
[Abstract not furnished.] 
No. 244 
THE RESULTS OF VAGINAL HYSTERECTOMY. 
Andrew J. McCosh, M. D., 
Attending Surgeon to Presbyterian Hospital, New York; Professor of Surgery in New York Polyclinic. 
The object of the paper is to record the personal results of the author. No new 
methods or instruments are proposed. All the cases of vaginal hysterectomy operated on 
by the author are reported and classed as (1) for cancer, (2) for prolapse. 
104 First, for cancer. Ligatures are preferred, but clamps are used without hesitation 
provided they can be applied with greater ease or safety. Silk has been employed for 
ligatures. All specimens were examined microscopically. 
Thirteen operations are reported. No deaths. There are in perfect health, without 
sign of return, / 
At end of 5 years 1 patient. 
uuu4 « 2 a 
u u « 2 (i 1 « 
» » (t ji « 2 a 
“ “ “ 1 “ 2 patients. 
“ “ “ 4 months 2 “ 
There have died from return of the disease 
At end of 38 months 1 patient. 
auu 7 « a 
There are still alive, but with return of the cancer— 
At end of 3 years 1 patient. 
<< u « -j « 2 u 
Disappeared from observation one patient. 
Second, for prolapsus uteri. For ordinary cases of prolapse hysterectomy is unjusti- 
fiable. Milder measures are sufficient. In certain cases, however, of complete prolapse 
of a very large uterus and of an enormously- hypertrophied vagina the ordinary plastic 
operations (perineorrhaphy and colporrhaphy) are apt to be failures as a means of perma- 
nent support. In such cases hysterectomy is a justifiable operation. 
Report of five cases, (four of the author’s) no deaths. 
Complete success 1 case. 
Partial success 2 cases. 
Failure 2 cases. 
It is doubtful if we can expect perfectly satisfactory results from this operation even 
when followed by a perineorrhaphy. 
The operation is rather tedious and bloody. 
No. 245. “ Apuntamientos Para el Estudio Comparativo de la Pelvis Mexicana y Europea y 
Consecuencias Practicas ague da Lugar la Especial Conformacion de la Primera,” 
by Dr. Manuel Gutierrez y Tomas Noriega, City of Mexico, Mexico. 
[Abstract not furnished.] 
No. 247. “Analysis and Deduction from my first one hundred and ten Laparotomies for 
Appendicitis, with Report of Experimental Investigation,” by J. B. Murphy, 
M. D., Chicago, 111. 
[Abstract not furnished.] 
105 No. 248. “ A Study based upon one hundred Consecutive Cases of Removal of Diseased Uterine 
Appendages with two Deaths,” by R. Stanbury Sutton, M. D., Allegheny, Pa. 
[Abstract not furnished.] 
No. 249. 
DOES THE CATAMENIA INVARIABLY APPEAR EARLIER IN HOT 
THAN IN COLD CLIMATES? 
J. H. O’Donnell, M.D., 
Winnipeg, Manitoba, Canada. 
I have various reasons for selecting this subject, foremost among these is the desire 
to place before you some of the conclusions I have drawn from an experience of over 
1100 cases that have come under my own notice during twenty-three years’ practice in the 
northwestern portion of the continent. The subject is too wide to allow of its compression 
into a brief paper. I shall therefore select those points which seem to have an important 
bearing upon, and in many respects opposed to, existing theories as to the age menstruation 
appears in northern latitudes. 
The text-books tell us that the average age at which the first menstruation occurs has 
been the object of many statistical researches, that it is influenced by mode of life, race, 
climate and other conditions, but most observers agree as to climate, that the outset of 
menstruation is earlier in hot than in temperate regions, and in temperate than in cold. 
I shall endeavor to show that such is not an invariable rule, at least in so far as my 
observation extends, ana a few words on the early history of the location where my collec- 
tions have been made will make the figures more rapidly understood. The place is situ- 
ate at the junction of the Red and Assiniboine Rivers, at the fiftieth parallel of latitude, 
and was settled about the beginning of the century, now the Province of Manitoba. 
There were few white women, and the servants of the Hudson Bay Company and 
other settlers took Indian women for wives, and the result, a large population of “ metis 
or half-caste, pure, and many others more or less intimately co-mixed ” with aboriginal 
blood. The white people were French, Scotch, English and Irish, and within the past 
ten or fifteen years the Icelander. The following table which I have prepared will show 
the percentage of persons of the different races who have menstruated between ten and 
thirteen years of age. 
Nationality. Number, Menst'd. Per Cent. 
French 150 81 54.00 
Scotch 75 45 60.00 
English 53 19 35.84 
Irish 26 10 38.46 
French Half-breeds 300 180 60.00 
Scotch “ 210 102 48.57 
English “ 116 45 38.79 
Irish “ 60 20 33.33 
Icelanders 120 64 53.33 
Total, 1110 566 50.99 
106 I hope to be able to show at the congress the history of a number who have borne 
children at an age hitherto not thought possible in a northern climate, as well as other 
climatic affects not yet written upon so far as I know. 
No. 250. “ Curs Radical de las Hernias,” by Dr. Luis C. Maglioni, Buenos Ayres, Argentine 
Republic. 
[Abstract not furnished.] 
No. 250 a. 
THE AFTER-TREATMENT OF COELIOTOMY CASES WITH ESPECIAL 
REFERENCE TO SHOCK AND SEPTIC PERITONITIS. 
Eugene Boise, M. D., 
Gynecologist to St. Mark’s Hospital; Fellow of the American Association of Obstetrician and Gynecologists. 
Grand Rapids, Mich. 
There are three post-operative conditions which call for prompt intelligent action : 
Secondary hemorrhage; shock, and septic peritonitis. 
Shock is some form of paresis of the sympathetic nervous system. I believe that it is 
primarily hyper-irritation of the entire sympathetic system. 
The primary condition in shock—severe stimulation of the entire sympathetic system, 
with consequent cardiac and arterial spasm. The second stage of shock may be a so- 
called paresis by reason of the exhaustion of the heart. The remedies, therefore, would 
be for the first stage, free hypodermics of codine, nitrite of amyl and nitro-glycerine, with 
copious injections of hot water into the colon. 
For the second stage, strychnia, digitalis, and cardiac stimulants, with, if necessary, 
intra-venous transfusion of hot saline solution. 
All operators have an instinctive feeling that prevention of sepsis prevents peritonitis, 
and, therefore, the efforts are directed to prevent the entrance of septic material into the 
cavity—or if the material removed is of septic nature, to cleanse the cavity as thoroughly 
as possible and to remove the fluid which would otherwise invite infection. The two 
post-operative measures relied on for this purpose are drainage and free catharsis. Drain- 
age may be accomplished by tube or gauze, and if used must be thorough and cleanly. 
In the production of catharsis several factors are to be kept in mind. First, after 
every coeliotomy there is a flow of serum from the blood vessels into the peritoneal cavity, 
thus depleting the vessels. Second, during the first few hours after a coeliotomy of any 
considerable severity there is more or less paroxysmal abdominal pain, sometimes very 
severe. This is caused by irregular and spasmodic peristalsis, the muscular coat of the 
intestines contracting unequally, and it may be tonically obstructing the bowels. Third, 
by reason of the withholding of fluids, the intra-peritoneal serous effusion, and, it may be, 
profuse perspiration, the blood vessels of the intestines are greatly depleted. For the 
107 easy production of catharsis the current should have ceased to flow from the blood vessels 
toward the peritoneal cavity. The spasmodic contraction of the intestines should have 
been overcome, and the blood vessels should have been replenished. 
The serous effusion will cease after a few hours. The spasmodic contraction of the 
intestinal muscles should be overcome by a hypodermic injection of a free dose of codeine, 
and the blood vessels should be filled by means of hot water thrown into the colon. 
Then catharsis may be produced with comparative ease. 
No. 2506. 
HABITS OF POSTURE A CAUSE OF DEFORMITY AND DISPLACE- 
MENT OF THE UTERUS. 
Eliza M. Mosher, M. D., 
Brooklyn, N. Y. 
To present the subject clearly it will be necessary to glance at the body from the 
standpoint of its mechanics. * * * What is the normal position of the pelvis? 
Evidently it is that position in which the uterus balances evenly upon the supports, but 
with its fundus so placed that it would drop forward rather than backward if suddenly 
deprived of support. 
Results of measurements with the author’s “ Pelvic Obliquiraeter.” 
The influence upon the uterus of habits of posture which shorten the distance between 
the sternum and pubis. (A common posture among school girls.) 
Of habits which shorten the lateral line of the trunk on one side (elevation of hip 
and drooping of shoulder) by habitually standing on one and the same leg, sitting on one 
ischium, etc. 
The effect upon the position of the uterus of sitting and standing with the pelvic 
brim approaching the horizontal:—the oblique. 
Causes which tend to lessen the normal obliquity of the pelvis. * * * Import- 
ance of early and frequent measurement of pelvic obliquity. * * * Suggestions in 
reference to the best methods of correcting habits of posture which tend to produce 
deformities and displacements. 
Note :—A method of measuring accurately the obliquity of the pelvis will be shown. 
Correct and incorrect postures will be shown by means of the author’s “ Postura 
Model,” and by plates. 
108 SECTION ON THERAPEUTICS. 
Dr. I. E. Atkinson, Baltimore; Dr. A. D. Blackader, Montreal; Dr. Simon Baruch, New York; 
Dr. Norman Bridge, Los Angeles; Dr.W. E. Casselberry, Chicago; Dr. M. C. Caldwell, Chicago; 
Dr. Charles Cary, Buffalo; Dr. F. D. McDaniel, Mobile ; Dr. Manuel Dominguez, City of Mexico, 
Mexico; Dr. Antonio A. Ramirez F. Fontecha, Tegucigalpa, Honduras; Dr. J. Milton Bigelow; 
Albany; Dr. J. H. Kimball, Denver ; Dr. John A. Larrabee, Louisville; Dr. Justin Steer, St. Louis; 
Dr. A. B. Miles, New Orleans; Dr. Francisco R. Martinez, Santiago, Chile; Dr. Ramon Mazaeredo, 
Cienfuegos, Cuba; Dr. Geo. L. Peabody, New York; Dr. J. C. Mackenzie, Cincinnati; Dr. A. D. 
Rockwell, New York; Dr. Tomas Salazer, Lima, Peru; Dr. A. A, Smith, New York; Dr. James 
Tyson, Philadelphia; Dr. H. C. Wood, Phiiadelphia; Dr. James T. Whittaker, Cincinnati; Dr. James 
C. Wilson, Philadelphia. 
HONORARY PRESIDENTS: 
EXECUTIVE PRESIDENT: 
Dr. Hobart Amory Hare, 222 S. 15th St., Philadelphia. Pa. 
SECRETARIES: 
Dr. Edward Randall (English-Speaking), Dr. David Cerna (Spanish-Speaking), 
Galveston, Texas. Galveston, Texas. 
Dr. Del Arca [Paraguay 840] Buenos Aires Argentine Republic. 
Dr. Manuel B. Mariaca . La Paz Bolivia. 
Dr. Alvaro Alberto da Silva Rio de Janeiro U. S. of Brazil. 
Dr. J. L. Davidson Toronto Canada. 
Dr. Manuel Plata Azuero Guaduas Republic of Colombia. 
Dr. Domingo L. Madan [Contreras 13] Matanzas • Cuba. 
Dr. J. Luis Estrada Guatemala City Guatemala, 
Dr F. L. Miner Honolulu Hawaii. 
Dr. Ramon Midence Tegucigalpa Honduras. 
Dr. Fernando Altamirano [lnstitute Medico] . . City of Mexico Mexico. 
Dr. Alvarez Granada Nicaragua. 
Dr. Amerigo Ricaldoni Montevideo . Uruguay. 
Dr. Vicente G, Guanchez ........... Caracas Venezuela. 
109 SECTION OF THERAPEUTICS. 
No. 251, Paper, by Edward Randall, M. D., Galveston, Texas. 
[Neither Title nor Abstract furnished.] 
No. 252. 
THE TREATMENT OF SCARLET FEVER BY CHLORAL HYDRATE, 
James C. Wilson, M. D, 
Philadelphia. 
Previous methods of treatment unsatisfactory; a purely expectant method, justifiable only 
in the mildest forms of the disease ; specific methods have led to disappointment. The general 
drift of opinion is at present in the direction of an expectant—symptomatic plan, a plan based 
largely upon knowledge of the general pathology of the disease and its liability to special 
complications. 
Under this plan of treatment, almost all recent authorities refer to the use of chloral 
hydrate for the control of the nervous symptoms. Over this group of symptoms, partly the 
result of the infectious toxaemia, partly the result of the tegumentary efflorescence, chloral 
unquestionably exercises a powerful influence. 
Given thus continuously throughout the attack, in appropriate doses, it is also to a high 
degree diuretic. It destroys low organisms and inhibits the decomposition to which they give 
rise. It is, therefore, to some extent, an antiseptic. 
Chloral as such is excreted in the urine so long as the urine remains acid. It tends to 
diminish blood pressure and to lower temperature. 
Theoretically, then, chloral fulfills in scarlet fever a larger number of causal and sympto- 
matic indications than any other single drug. 
Practically, the writer of this paper, has found the treatment of scarlet fever by chloral to 
yield more satisfactory results in the course of individual cases and in the reduction of the 
mortality, than any treatment previously used. He has now employed chloral in accordance 
with the following plan in the management of all cases of scarlet fever for a period covering 
epidemics and cases of every grade of intensity, and extending over ten years, with the most 
satisfactory results as compared with any other method of treatment known to him: 
So soon as the patient is suspected or known to be developing scarlatina, a laxative dose 
of calomel, proportionate to the age and general condition, is administered. Shortly thereafter 
chloral is given, in moderate doses, at intervals of two or three hours, or longer, throughout the 
attack. The dose varies with the age of the child; the frequency of its administration depends 
largely upon its effect. To infants of two or three years, a dose of from one to two grains may be given, the dosage being gradually increased with older children; that for adolescents 
reaching five grains. The tranquilizing and sleep-producing effects of the drug are in most 
instances promptly realized, the patient falling into a condition of quietude or somnolence, in 
striking contrast to the discomfort and jactitation which are so distressing in the well-developed 
disease. 
The repetition of the dose should not be more frequent than is necessary to maintain this 
condition of quietude, a condition from which the patient may be easily aroused, and into which he 
quickly relapses when disturbed. It is neither necessary nor desirable to push the drug to the 
establishment of a deeper sleep. Profound narcotism is, of course, to be avoided. The patient 
may thus be kept in a condition of light repose throughout the whole duration of the fever. 
By this means, not only is there obtained relief from the restlessness and distress of the active 
period of the disease, but much wear and tear of the nervous system and some exhaustion from 
muscular effort are prevented. Delirium is controlled ; the itching and burning of the skin due 
to the eruption are allayed; in a word, the greater number of the distressing symptoms of the 
disease are favorably influenced by the cautious and prolonged administration of chloral 
hydrate in efficient doses. 
As a rule, the drug is easy of administration and well borne by the stomach. I have found 
its acrid after-taste best masked by the administration in Aubergier’s syrup of lactucarium 
diluted, thus: 
R Chloralis . . - gr. xxx 
Syrup, lactucarii (Aubergier) "t „ . 
Aqua f aa 5 jss.—M. 
Sig. A teaspoonful in iced water every two, three 
or four hours. 
The administration of nourishment immediately after the medicine is desirable. The 
sleep-producing properties of the drug manifest themselves rapidly, but are not prolonged; 
therefore, its repetition at intervals of two or three hours is called for. 
Systematic inunctions of goose-grease or washed lard are practiced at intervals of four or 
six hours throughout the attack. The throat and nasal passages are sprayed with some 
antiseptic detergent fluid at regular intervals, varying according to the degree of disturbance 
of the naso-pharyngeal mucous membrane. 
In the way of medicines chloral only is employed. As a stimulant alcohol is given rather 
freely in the form of milk punch, wine whey, champagne, etc. Except in response to special 
indications no other drugs are administered until the defervescence is complete. After this 
period small doses of quinine and iron in some appropriate form are employed. 
No. 253. 
A PLEA FOR PHYSIOLOGICAL REMEDIES. 
Simon Baruch, M. D., 
New York City. 
Physiological rentedies may be defined as those agents which contribute to the maintenance 
of health. It is proposed to show the value of methodical applications, and their superiority 
to medicinal agents. Antagonism to the latter is not intended. The present status of 
therapeutics is unsatisfactory; we have only one positive medicinal curative agent—quinine. 
111 Medicinal agents are symplematic; they often are injurious, because they hide the real 
essence of disease and give us a false sense of security. Nil nocere should be our aim. 
The chief direction of therapeutic effort is in the following of the natural tendencies 
of disease. In acute disease, rest is as plainly the chief factor of cure as it is in the more 
patent traumatic conditions. In chronic conditions a judicious alternation of restand exercise 
is more valuable. 
Typhoid fever may be offered as an illustration of the effect of medicinal as contrasted with 
physiological remedies. It is characterized by depreciation of nerve centres and consequent 
enfeeblement of all organs dependent upon the latter. The modern physician tries to conserve 
vital forces; the expectant plan succeeded the spoliative. High temperature, brought 
permanently forward by Liebermaster, as the chief lethal agent is proven secondary, since we 
have positive antithermics. It is now proven that not to his (medicinal) quinine but to his 
(physiological) baths was due his success. The coal tar antipyretics must go just as veratrum 
went, and as internal antiseptics will go. Absolute reduction of pulse and temperature by 
veratrum and anti pyrin e, have not only failed, but are proven dangerous. 
We must depend in acute depressing diseases entirely on the vis medicatrix, which is 
aided by the physiological remedies if crippled by medicinal remedies. While air, rest and 
diet are well applied, the various methods of bathing are still a terra incognita to many who 
either satisfy themselves with some kind of sponging or adopt the other extreme of using it 
severely and injudiciously. 
The Brand method has proved the most successful treatment; hence, only the closest 
approximations to it will produce similar results. The rationale of cold bathing is simple, it is 
a stimulus conveyed to the nerve centres from the cutaneous sensory nerve endings, and 
reflected upon all the vital organs, and it is followed by moderate reduction of temperature. 
All the manifestations of disease are favorably influenced, because its aim is to imitate and 
approach the normal standard. 
This illustration may be applied to other acute diseases, to show that while medicinal 
remedies, though agreeable, tend to cripple the vital forces, physiological remedies, though 
unpleasant, tend to sustain them. 
This difference may be illustrated in chronic diseases. In the latter we are not forced, as 
in the acute, to remove the patient from the etiological factors. Hence, medicinal agents are 
more depended on than in the acute. Chlorosis may be cited as an example, because curable. 
Removal from unfavorable environments, a judicious diet, exercise, rest, fresh air and certain 
baths accomplish quickly what prolonged administrations of iron fail to do. Other examples 
may be brought forward to demonstrate, that physiological remedies, though much neglected, 
are our most powerful weapons ; they should be studied and applied with the same care which 
is devoted to medicines. Hasty judgment must be avoided, so that a firm basis for a sound 
therapeutic structure may be built. 
With this view attention requires to be called to water, as perhaps the most active 
“physiological remedy.” Its use is now taught in many of our schools in acute diseases, but 
its great value in many chronic diseases is still unappreciated in America. This is not the case 
in Europe; for in Italy the talented Seminola; in Germany, Ziemnessen and Eib and 
Nothnagel; in France, Dryrodin, Braumcity and Charcot, have given a powerful impetus to 
hydrotherapy by their own successes. In this country Draper and Peterson are teaching the 
methodical use of baths in chronic diseases. In the Montefiore Home for Chronic Invalids, of 
New York, hydrotherapy has demonstrated its value in intractable chronic diseases; we need 
no longer depend upon the statements of empirics on this subject. 
112 Water fulfills every demand required of a remedy. Its action is explicable on rational- 
principles ; its effect may be accurately modified to suit individual conditions and its clinical 
results are undeniable. If used in conjunction with other physiological remedies, its powers for 
good are readily ascertained. 
I plead for a more thorough study and application of wafer as a remedy in acute and. 
chronic diseases, because it is the least understood of all physiological remedies. 
No. 254. 
TREATMENT OF CHRONIC GASTRIC CATARRH AND ALLIED CONDITIONS 
OF LOWERED HYDROCHLORIC ACIDITY. 
D. D. Stewart, M. D., 
Clinical Lecturer on Medicine in the Jefferson Medical College, Philadelphia. 
The paper deals with the measured effects of certain therapeutic agents, such as lavage, 
strychnia, and intra-gastric electricity; hydrochloric acid and other digestive agents, upon the 
secretory and motor functions of the stomach, but especially the secretory, in several cases of 
chronic gastric catarrh in which hydrochloric acidity was originally absent. Concise histories 
of these cases are cited and the general and special therapeusis, measured by frequent 
examinations of the gastric contents, employed in cases of subacidity, are detailed. 
No. 255. 
THE PHYSIOLOGICAL ACTIONS OF ALCOHOL. 
David Cerna, M. D., Ph. D., 
Galveston, Texas. 
Conclusions.—1. Alcohol in small amounts excites, and in large doses depresses the 
peripheral and sensory nerves. 2. Excessive quantities cause degeneration of the axis-cylinder 
of nerve-fibres. 3. Reflex action is at first increased, and afterwards diminished under the 
action of alcohol. 4. In small amounts the drug stimulates the cerebral functions, afterwards 
depressing, and finally abolishing them. 5. Alcohol causes lack of co-ordination by depressing 
both the brain and the spinal cord. 6. In toxic doses alcohol produces hyperiemia of both 
brain and spinal cord, especially of the lumbar enlargement of the latter. 7. Small doses of 
alcohol produce increased rapidity of the cardiac beat; large amounts a depression of the 
same. In either case the effect is brought about mainly through a direct cardiac action. 8. 
The drug in small quantities causes a rise of the arterial pressure by a direct action upon the 
heart; in large amounts it depresses the pressure similarly through a cardiac influence. 9. In 
large doses alcohol enhances coagulation of the blood; in toxic quantities it destroys the 
ozonizing power of this fluid causing a separation of the haemoglobin from the corpuscles. 10. 
Alcohol has little or no effect on the respiratory function. In large amounts it produces a 
depression of both depth and rate of the respiration through a direct liction on the centres in 
the medulla oblongata. 11. The drug kills by failure of the respiration. 12. On the 
elimination of carbon dioxide alcohol exercises a varying action, sometimes increasing, sometimes decreasing such elimination. 13. The action of alcohol on the amount of oxygen 
absorbed also varies, and may be said to be practically unknown. 14. The drug lessens the 
excretion of tissue-waste, both in health and disease. 15. In small amounts alcohol increases 
the bodily temperature; in large doses it diminishes the same. The fall of bodily temperature 
Is due mainly to an excess of heat dissipation caused by the drug. 16. Alcohol has a decided 
•antipyretic action. 17. In moderate amounts alcohol aids the digestive processes. 18. Alcohol 
exercises a varying action on the amount of urine secreted; but it probably increases the 
activity of the kidneys. 19. Alcohol is mainly burnt up in the system. When ingested in 
excessive quantities it is eliminated by the breath, the kidneys and the intestines. 20. Alcohol 
is a conservator of tissue, a generator of vital force; and may, therefore, be considered as a 
fool. 
Galveston, June 22, 1893. 
No. 256. “The Treatment of Neurasthenia with Special Reference to the Best Cure,” by F. 
X. Dercum, M. D., Philadelphia, Pa. 
[Abstract.] 
No. 257. 
THE ADVANTAGES OF AMORPHOUS PHOSPHORUS OVER THE 
OFFICIAL FORM. 
E. Q. Thornton, M. D., 
Demonstrator of Therapeutics, Jefferson Medical College, Philadelphia, Pa. 
The investigations of Wegner, Bradley, Broadbent, Thompson and others should 
leave little doubt as to the value of phosphorus as a stimulant to bone growth, and in the 
treatment of disorders, due to exhaustion or wasting of the nervous tissues. The 
remedy while undoubtedly possessing powers so potent for good, has the great disadvan- 
tage of not being entirely safe, as disorders of digestion, nephritis and fatty degeneration 
are not infrequently attributed to its administration. On account of these untoward 
effects, many authors have wisely insisted upon the utmost precaution in its use. As is 
well known, the form of phosphorus exclusively employed in medicine is the vitreous 
variety, from which both of the official preparations are made. Both of these prepara- 
tions are open to the objections named above, and on account of the readiness of phosphorus 
to undergo change wffien exposed to the air, the pills are necessarily made by a com- 
plicated process which renders their extemporaneous manufacture difficult. As to phos- 
phorated oil the other official preparation, its taste is extremely nauseous as may be 
inferred from its combination (phosphorus, ether and oil). It is on account of these dis- 
advantages of the vitreous phosphorus I am led to suggest the employment of the 
114 amorphous or red variety. The amorphous phosphorus is made by heating the vitreous 
variety to 250° C. in the absence of air, and possesses the following advantages over the 
official variety : it does not readily undergo change at ordinary temperature, is almost 
entirely without taste or odor, therefore, it can readily be made into pills at a moment’s 
notice ; it is free from irritant or caustic effect, consequently it is far less liable to give rise 
to irritation or inflammation of the gastro-intestinal and genito-urinary tract, but its 
greatest advantage lies in the fact that it is non-toxic, and therefore far safer. 
That it has the same physiological effect as ordinary phosphorus seems to be proven 
beyond doubt by Kelly, who, while experimenting upon himself to determine if it was 
toxic, experienced the full physiological effects of vitreous phosphorus. The following brief 
extracts are made from Kelly’s essay, which has never been published : 
Experiment No. 1, 
For the first three days one-tenth grain amorphous phosphorus was taken every two 
hours, nine doses being taken each day. On the fourth day each dose was increased to 
two-tenths grains, and from the tenth until the twenty-fifth day three-tenth grains every 
two hours, nine doses a day being taken. 
Effect, Mental excitement, headache, vertigo, priapism, nocturnal emissions of semen, 
followed, about the twentieth day, by nervous exhaustion. Return to his normal, healthy 
condition in about two weeks after discontinuing the drug. 
Experiment No. 2. 
About two weeks after completing experiment No, 1, he again began taking 
amorphous phosphorus in doses of one one-hundredth grains, increased on the fifth day 
to two one-hundredth, and on the tenth day to four-one hundredth grains, nine doses 
being taken each day. 
Priapism and noctural seminal emissions were among the most pronounced effects. 
The drug was discontinued on the seventeenth day, and he soon returned to his normal 
condition. 
Experiment No, 3. 
About six weeks after completing experiment No. 2, he took at a single dose twenty 
grains of amorphous phosphorus. The physiological effects came on promptly. 
Priapism, vertigo, nausea, followed by muscular tremors, cold, clammy skin, great 
exhaustion and seminal emissions while asleep were the most pronounced effects. For 
some weeks he was in a state of nervous exhaustion, from which he gradually returned to 
his normal condition. He is now in good health and shows no ill effect of this rather 
vigorous medication. 
‘ Reese publishes a case in which thirty grains of amorphous phosphorus was taken, 
by a young woman, with suicidal intent, no toxic symptoms having been manifested. 
My own experiments upon animals are in accord with those who assert that the sub- 
stance in large quantities is non-toxic. My investigations as to the effect of long con- 
tinued doses is as yet incomplete. 
These records would seem to indicate that amorphous phosphorus, while having the 
same physiological action of the vitreous variety, is to be preferred as it is much easier to 
administer, less irritating, and above all is a far safer remedy. 
115 No. 258 
THE USE OF NITRO-GLYCERINE IN ARTERIO SCLEROSIS. . 
Demonstrator of Clinical Medicine in the Jefferson Medical College and Chief of the Out-Patient Medical Depart- 
ment in the Jefferson Medical College Hospital. 
Thomas G. Ashton, M. D., 
To appreciate the reasons advanced for the use of nitro-glycerine in arterio-sclerosis 
it is necessary to have a clear understanding of the lesion of the disease and its mode of 
progress. 
Thoma places the origin of the lesion in the media which, from some unknown cause, 
has lost its elasticity. Resulting from this loss of elasticity the artery dilates and the 
blood stream flows more slowly than normal. This produces a hypersemia of the vasa 
vasorum and a new growth of connective tissue in the intiraa, the media and adventitia 
subsequently sharing in the morbid process. So soon as this new growth, in any situation, 
reaches such dimensions that the normal rapidity of the blood-stream is re-established, 
these changes cease. 
From these observations Thoma deduces the following law:— 
A slowing of the blood-current in an artery that is not at once and completely coun- 
teracted by a proportionate contraction of the media, leads to a new growth of connective 
tissue in the intima which lessens the lumen of the affected vessel and thus restores the 
normal swiftness of the blood-current more or less completely. 
These changes in the blood-vessel cause a thickening of its wall with narrowing both 
of its lumen and its opening at its point of departure from the main vessel. Consequently 
the various organs and tissues, including the arteries themselves, receive an amount of 
blood insufficient for their nutrition. 
Upon this fact is based the usefulness of nitro-glycerine in arterio-sclerosis. This 
drug, acting upon either of the muscular Avails of the arterioles, or upon the vaso-motor 
ganglia in or near them, causes a dilitation of the arterioles (Brunton). Thus do we ha\Te 
not only a lessening of the arterial tension, which is such a constant accompaniment of 
arterio-sclerosis, but the tissues generally are made to receive a larger quantity of arterial 
blood; this increases their nutrition and tends to prevent the secondary degenerations 
dependent upon the lessening of the blood supply to the tissues which is character- 
istic of the disease. Therefore, such cerebral symptoms as vertigo, headache, or impairment 
of memory, which result from insufficient blood-supply to the brain, disappear under the 
use of nitro-glycerine. By lessening arterial tension and by removing the inhibition of 
the vagus from the heart (Bartholow), the hypertrophy of that organ is modified. So also 
by its action upon the vessels renal changes are often arrested and these organs brought 
back to a fair condition of health. 
As there is a wide difference in individual susceptibility to the action ot nitro-glyce- 
rine it is well to begin with 1-100 of a grain, gradually increasing this until the physio- 
logical effects are produced and maintained. 
The effects of the drug are transient, being observed for less than half an hour upon 
the sphygmogram, and the interval between the doses, therefore, should not be more than 
two or three hours. 
116 Nitroglycerine tends to arrest the oxygeu-earrying function of the red blood- 
corpuscle, and it is therefore important not to give it in doses larger than necessary to pro- 
duce the desired effects; and during long-continued courses of the drug to interpose 
frequent periods of abstinence from its use. 
Arterio-sclerosis is a progressive disease and it is not claimed, therefore, that nitro- 
glycerine will effect a cure. It is claimed for the drug, however, that it will retard the 
progress of the affection and alleviate many of its most distressing and serious manifesta- 
tions. 
No. 259. 
VENESECTION IN THE TREATMENT OF ENGORGEMENT AND 
DILATATION OF THE RIGHT SIDE OF THE HEART. 
I. E. Atkinson, M. D., 
Baltimore, Md. 
The object of this short paper is to insist upon the remarkable therapeutic value of 
general blood-letting in the dangerous engorgement and dilatation of the right side of the 
heart that has its origin in obstruction to the onward passage of blood through the pulmo- 
nary circulation and left side of the heart, whether arising from emphysema, mitral sten- 
oses or insufficiency or otherwise. Though venesection has long and often been advocated 
and practiced as the most efficient remedy we have with which to combat this frequent 
morbid condition, it has failed to receive the general recognition and adoption it deserves. 
A brief description of the pathological sequence and of its symptomatology is given. The 
method and degree of blood-letting necessary to secure the required mechanical relief is 
described in abstract and an illustrative case showing the life-saving character of the 
measure is related. 
No. 262. Formal Address, by Hobart A. Hark, M. D., Executive President, Philadelphia, Pa. 
No. 263, 
THE PHILOSOPHY OF THERAPEUTICS. 
L. B. Anderson, M.D., 
Norfolk, Va. 
The philosophical and scientific application of remedial agencies to the relief of suffering 
humanity involves a comprehensive view of the mental and physical constitution of the 
patient, as well as an accurate acquaintance with the vital functions, their relationship to each 
other, and the indications of their aberration from a normal, healthy condition. On 
117 this foundation must rest, and from it-must spring, every indication for the use of remedial 
agents, whether for the restoration of impaired functions or the removal of organic 
derangement. 
IMPORTANCE AND DIFFICULTIES. 
First.—As health is an expression of the harmony and unity of the vital functions, 
so disease is-but a suspension or aberration of those functions. The phases of functional 
derangement are often so obscure as to render it difficult to decide whether the trouble is 
local or reflex, specific or sympathetic. It is, also, often difficult to decide whether the 
remedial effect of an agent has been exerted upon the organ ostensibly affected, or 
reflectively through some other organ or organs. 
Second.—Another difficulty which confronts the therapeutist is the want of reliability 
in the agents which are prepared for his use. Some agents are only valuable when pre- 
pared from the green herb, and yet they are prepared from the dry ; some only in tincture 
or syrup, and yet they are given in powder. 
Third.—Another difficulty arises from the want of unity and harmony among therapeu- 
tists as to the true physiological action of certain widely used medicinal agents. This is illus- 
trated in the vegetable kingdom by sanguinaria canadensis, and in the mineral kingdom by 
calomel. The contrariety of opinion in regard to the physiological action of these import- 
ant medicinal agents, demonstrates the difficulties which environ the student of medicine 
in reaching a reliable conclusion in regard to the factors which constitute his armamentarium. 
PHILOSOPHY. 
One fact has been clearly demonstrated in the progress of therapeutics which consti- 
tutes a reliable basis for substantial progress, viz., certain agents exert a specific action on 
certain organs and tissues. This action must be clearly defined before any practical result 
can follow its application. The pathological condition of the organ to be acted on must 
be clearly defined in order to prevent exciting therein a more formidable trouble than 
already exists. Thus, cathartics and diuretics are of great range and physiological diverg- 
ence ; some harsh, others mild—the remedy must therefore be used to accomplish a certain 
physiological effect, only as the pathological state will justify. Pathology constitutes, then, 
the basis principle of all reliable therapeutics. 
To treat a disease from the standpoint of its supposed cause is to substitute empiricism 
for philosophy, and hypothetical factors for clearly-defined scientific indications. It matters 
not from what cause a fever springs, we know that so soon as all the functions are 
restored to a normal condition, the fever disappears. 
The boldness with which men proclaim themselves allopaths, homeopaths, hydro- 
paths, etc., is a demonstration of the brazen effrontery with which they can boast of their 
ignorance and stupidity. In either case the nature and extent of disease is measured by 
the ostensible symptoms which may spring from as many different causes and pathological 
conditions. 
Any medicinal agent may produce various effects by increasing or diminishing the 
dose. And yet a careful analysis will demonstrate that the legitimate physiological action 
has been preserved, and the varying effects are the result of well-defined physiological 
118 laws. The legitimate and proper sanative effect, of any remedy, is that in which its 
physiological action on an organ is attained with the least disturbance of the functions of 
other organs. 
The assumption, declaration or ipse dixit of no one in the medical profession is 
entitled to be esteemed as authoritative, no matter how high the position or world-wide 
the reputation of the author, which is not sustained by well-established physiological results 
of remedial agents in well-defined pathological conditions. The indiscriminate use in 
fevers, of so-called antipyretics, especially of the coal-oil family, is a clear demonstration 
of this. The first impression of these agents is to allay pain when it exists, or to pro- 
duce a state of repose and quietude. Fever heat springs from the evolution of acrid, 
exciting and ptomainic products of retained secretions, or the products of retrogressive 
metabolism, under the action of chemical laws; vital laws having ceased to operate. 
So long as these chemical changes are progressing, the temperature rises in propor- 
tion to the aberration of function, and the violence of the chemical changes. The indica- 
tions are to restore the secretions, eliminate the vitiated accumulations, re-establish the vital 
laws, and restore the lost balance. Should antipyretics be given in this state, the sensi- 
bility of the nervous centres, both animal and organic, is obtunded, and the tissues no longer 
responding to the irritating and exciting products of chemical forces, sink into a state of 
comparative repose, and all the heat-producing agencies are, for the time, kept in abeyance. 
As, however, no chemical changes are wrought within, no vital forces are awakened, and 
no secretions are aroused, thereby vitiated matters are eliminated, so soon as the analgesic 
effect of the antipyretic is expended, the febrile re-action becomes as high or higher than 
at first, rendering the last state worse than the first. 
As disease is the result of suspended or perverted functions, to re-establish and restore 
their normal operations is the province of the therapeutist. To do this rationally and 
scientifically is to fullfil the demands of Therapeqtical Philosophy. 
No. 264. 
THE ANTIPYRETIC ACTION OF CALOMEL. 
Drs. R. J, Nunn and A. B. Simmons, 
Savannah, Ga. 
From the use of calomel in these twenty-five cases of typhoid and continued fever 
cases we have drawn the following conclusions : 
First.—Calomel is a sure and safe antipyretic, reducing the temperature from two to 
three degrees in a few hours. 
Second.—Small doses will prove of no avail. 
Third.—The ingestion of large doses was followed by no untoward event, no ptyalism 
no hyper-catharsis. This is contrary to the usual opinion. 
Fourth.—Diarrhea, hemorrhage, albuminuria, tympanites have not been contra-indica- 
tions to the use of the remedy. 
Fifth.—The reduction of temperature occurs without cathartic action on the bowels. 
119 Sixth.—The calomel acts best in combination with soda, bismuth and pepsin. 
Seventh.—-That in some instances the remedy appeared to cut short an attack, and in 
others, while having no influence on its duration, it modified all symptoms, and by keeping 
temperature in check aided materially in the management of the case. 
No. 265. “ Some Views Eegarding the Philosophy of Drug Action,” by J. W. McLaughlin, 
M. D., Austin, Texas. x 
[Abstract] 
No. 266. 
THE EFFECT OF ADVANCED CIVILIZATION ON DISEASE. 
W. J. Moody, M. D., 
Plainfield, Iowa; Member Auxiliary Committee of lowa. 
A traveler having ascended Vesuvius to witness the phenomena of an approaching 
eclipse, depicts the awful appearance of the enormous shadow as it darted with lightning 
speed across the Campagna and the Bay of Naples; in like manner we are bewildered by 
the astounding increase of insanity and kindred affections accompanying the phenomenal 
centralization of population characterizing in so marked a degree the present times. 
Taken in connection with the established fact that extermination awaits the third 
generation in large towns, without the infusion of “ fresh blood,” this tendency is a cloud 
looming from the future with datk and portentous aspect; however, threatened evil well 
understood is half remedied, and it may not be expecting too much to hope that with our 
advancing therapy and hygiene, we shall be able ultimately to stem the tide of deleterious 
influences which produce this one. 
Another decade will probably enhance our knowledge and means of combating some 
of those types of disease, which, like ataxia, increase through the generations in a sort of 
arithmetical ratio till the affected stock is finally exterminated. 
It is of vital interest to learn to what extent our developing means of prevention and 
cure are adequate to contend with these untoward tendencies which have acquired the 
impetus of a tidal wave. 
It is seemingly reasonable to hope that the science of medicine will, like other 
branches, develop almost incredible resources; in which case, as in that of electricity and 
mechanics, these may be of so astounding a nature as to utterly shatter the cautious 
predictions of preceding decades. 
Wonderful reduction of death rates has been affected in former ages, even with the 
imperfect means and appliances which our ancestors could command. After the great 
fire which nearly annihilated Loudon in 1666, future ravages of the plague which had up 
to that period decimated Europe, were rendered impossible by improved hygienic 
methods. More recently the same scourge has been stamped out in Upper Egypt by the 
interdiction of the casting dead bodies into the Nile, where they accumulated in its delta 
and produced pestilential exhalations. 
120 It is not unreasonable to expect that like restrictive measures will be put in force at 
the sources of the Ganges and the Indus. It is this region which furnishes the nursery- 
stock of Asiatic cholera, where it prevails every season, ever ready to spring like a tiger 
from his lair and devastate the earth; in this case the obstacles to be overcome are 
apparently insurmountable, from the myriad population who are fanatically attached to the 
religious rite of casting their dead into the bosom of the holy river; however civilization 
delights in overcoming seemingly insurmountable obstacles, and the mitigation of this 
stupendous nuisance would result in an almost incalculable saving of human lives. 
La grippe, a disease naturally of a harmless nature, has a terrible virulence given to 
it by the inconceivable filthiness of the people of Southwestern Russia, among whom its 
lethal germs fester and seethe till they overflow and contaminate the whole earth. With 
the autocratic power invested in the Russian government this pest is certainly amenable 
to control, and if this were effective it would result in the prevention of death rate 
compared with which that even of the cholera is insignificant. 
No. 267. “ The Treatment of Leprosy,” by Richard H. L. Bibb, M. D., Satillo, Mexico. 
[Abstract not furnished.] 
No. 268. Paper, by Fernando Altamirano, M. D., City of Mexico, Mexico. 
[Neither Title nor Abstract furnished.] 
No. 269. “ The Clinical Import of Koumyss,” by J. Mount Bleyer, M. D?, New York, N. Y. 
[Abstract.] 
No. 270, 
TREATMENT OF EXOPHTHALMIC GOITRE, BASED ON FORTY'-FIYE 
CONSECUTIVE CASES. 
By A. D. Rockwell, A. M., M. D., 
New York City. 
Basing my judgment upon the results that have been observed in these forty-five 
cases, I hold that the prognosis in exophthalmic goitre is better than is generally believed. 
If these results are more encouraging than those usually recorded, I attribute them to a 
more rational use of electricity—the remedy that has been my main reliance, and to a 
greater thoroughness and persistency in its application. 
Among drugs I have found a combination of iron, ergot, digitalis or strophanthus and 
bromide of zinc to be distinctly valuable and to more nearly fulfill the indications in the 
121 majority of cases, than any other single remedy or combination of remedies. Under 
certain conditions, both iron and digitalis are contra-indicated. In sthenic cases 
where the excitability of the heart is great without enfeeblement, digitalis may do harm. 
Very frequently, however, there is enfeeblement of the myocardium, and digitalis is use- 
ful in slowing the rapid systole associated with it. The condition of the heart thus 
becomes improved by the physiological rest it obtains through prolongation of the 
diastole. 
Strophanthus has received high commendation, and on theoretical grounds it is recom- 
mended in preference to digitalis. While both tend to lengthen the interval between the 
contractions of the heart, strophanthus is supposed to contract the calibre of the arterioles 
in less degree than digitalis, and is to be preferred as not increasing the work of the heart 
to the same degree as the latter. In reference to the observations of Gowers, Eulenberg, 
Gutman, Vigoroux, Charcot and others, on the electrical treatment of exophthalmic goitre, 
I wmuld call attention to the utter inadequacy of the strength of current used and the 
incomplete and hap-hazard way in which the applications are usually administered. 
These authorities, in recommending constant currents of very slight tension, seem not to 
appreciate the fact that in the therapeutic use of electricity, we are dealing with a hide- 
bound body which offers such a resistance to the passage of the current, that our ingenuity 
is taxed to the utmost in order to overcome this resistance without pain, and get into the 
body a sufficient quantity of electricity to affect the cerebro-spinal system and the nervous 
system of vegatitive life. Again, efforts should not be confined alone to drugs and the 
galvanic current, but the faradic current, after the method of general faradization, is 
useful. While the method of Eulenberg and Gutman in using simple localized faradiza- 
tion in the vain attempt to directly affect the sympathetic, and the faradization of the 
praecordial region by Charcot may possibly do some good, they cannot compare in 
efficiency with general faradization—a method that has been abundantly tested and 
which rests upon a sound physiological basis. Fur the cases which are detailed I am 
mostly indebted to various members of the profession—who have with me watched their 
progress, noting both the successes and failures. Out of these forty-five cases, three 
received no benefit whatever. Twenty-seven were benefited, some of them greatly, others 
slightly. Fourteen cases either fully or approximately recovered. 
No. 271. “Etude sur un Moyen d’assurer 1 efficacite du copaiba dans la medication suppressive 
de la blererrhage urethrale,” by L. T. C. Lamothe, M. D., Port au Prince, 
Haiti. 
[Abstract.] 
No. 272. “Action physiologique de quelques plantes bresiliennes de la famille des Menesper- 
macies,” by J. B. Da Lacerda, M. D,, Riode Janeiro, Brazil. 
[Abstract.] 
122 No. 273 
“Une plante Convulsevante du Bresil,” by J. B. Da*Lacerda, M. D., Bio de 
Janeiro, Brazil. 
[Abstract.] 
No. 274 
“ Pathology and Treatment of Gout,” by James Tyson, M. D., Philadelphia, Pa. 
[Abstract.] 
No. 275, 
“ Contribution to the Therapeutics of Yellow Fever,” by Pedro Penuelas, M. D., 
Havana, Cuba. 
[Abstract.] 
No. 277, 
“ Some Points in the Treatment of Uric Acid Diathesis,” by F.E. Stewart, M. D., 
Watkins, N. Y. 
[Abstract.] 
No. 278. 
“A Contribution to the Treatment of Diabetes Mellitus,” by Solomon Solis Cohen, 
M. D., Philadelphia, Pa. 
[Abstract.] 
No. 279 
Discussion on “The Value of the Bath in some Sthenic Conditions, Particularly 
Typhoid Fever.” 
[Abstract.] 
No. 280. 
Joint Discussion on “ The Indications which should Govern the Employment of the 
Several Anaesthetics.” 
[Abstract not furnished.] 
No. 281. 
“Electricity, its Use in Medicine,” by F. Schavoir, M. D., Stamford, Conn. 
[Abstract.] 
No. 282. 
“ The Use of Phenocoll in Malaria,” by David Cerne, M. D., Galveston Texas. 
No. 283. 
“ The Effect of Advanced Civilization on Disease and the Treatment of Disease,” 
by W. J. Moody, Plainfield, lowa. 
No. 284. “ Orexin in Anorexia,” by James T. Whittaker, M. D., Cincinnati, Ohio. 
123 SECTION ON ANATOMY. 
Dr. Harrison Allen, Philadelphia; Dr. Frank Baker, Washington; Dr. Jos. D. Bryant, New 
York; Dr. Celso Bamberen, Lima, Peru; Dr. P. S. Conner, Cincinnati; Dr. Miguel Cordero y 
Gomez, City of Mexico, Mexico; Dr. Corydon L. Ford, Ann Arbor, Mich.; Dr. Enrique Horstman, 
Puerto Principe, Cuba; Dr. Hunter McGuire, Richmond; Dr. L. Augusto Orrego, Santiago, Chile; 
Dr. John E. Owens, Chicago; Dr. L. S. Pilcher, Brooklyn; Dr. F. D. Weisse, New York; Dr. Bert. 
G. Wilder, Ithaca, N. Y. 
HONORARY PRESIDENTS: 
EXECUTIVE PRESIDENT: 
Dr. John B. Roberts, 1627 Walnut St., Philadelphia, Pa. 
SECRETARIES: 
Dr. D. S. Lamb (English-Speaking), Dr. A. M. Fernandez (Spanish-Speaking), 
800 10th St., N. W., Washington, D. C. 209 W. 10th St., New York, N. Y. 
Dk. Justo [Victoria 1778] Buenos Aires Argentine Republic. 
Dr. Manuel B. Mariaca La Paz Bolivia. 
Dr. Ernesto Crissiuma Rio de Janeiro U. S. of Brazil. 
Dr. F. J. Shepherd Montreal Canada. 
Dr. Federico Hortsman [Prado 109] Havana Cuba. 
Dr. Juan D. Herrera [Carrena i», Nu. 272] .... Bogota Rep. of Colombia. 
Dr. Juan J. Ortega Guatemala City Guatemala. 
Dr. F. L. Miner Plonolulu Hawaii. 
Dr. Valquez Tegucigalpa Honduras. 
Dr. Miguel Zuniga [Botica de Santa Catarina] . . . City of Mexico Mexico. 
Dr. E. Solorzano Masaya Nicaragua. 
Dr. Jose M. Carafi [Facultad de Medicina] .... Montevideo Uruguay. 
Dr. Domingo Hernandez Bello . % Merida Venezuela. 
124 SECTION ON ANATOHY. 
No. 301. “Anomalies of the Larynx as seen by the Specialist,” by Wm. T. Cathell, M. D., 
Baltimore, Md. 
[Abstract.] 
No. 302. Paper, by T. Griswold Comstock, M. D., St. Louis, Mo. 
[Neither Title nor Abstract furnished.] 
No. 303. Paper, by R. B. Gilbert, M. D., Louisville, Ky. 
[Neither Title nor Abstract furnished.] 
No. 306. “ The Diaphragm,” by H. E. Mclntire, M. D., Hudson, Wis. 
[Abstract not furnished.] 
No. 307. 
A NOTE ON THE OCCURRENCE OF THE SCAPULO-CLAYICULAR 
MUSCLE. 
Robert O. Moody, B. S., 
New Haven, Conn. 
The existence of this muscle, which is described by Wood and Gruber and noted by 
Destut, MacWhennie, Hallet and Luschka, is said by Testutin his book, “ Les Anomalies 
Musculaires chez L’Hommc,” to be very rare. 
Last January, in the dissecting room of Yale Medical School, I found this muscle on 
the left shoulder of a male subject. It arose from the superior border of the scapula and 
was attached to the inferior surface of the clavicle. 
The note giving a more detailed description of the muscle which I found would 
occupy not more than three or four minutes’ time. 
125 No. 308. 
“MALLET FINGER.” 
Robert T. Morris, M. D., 
New York. 
The deformity here described is not uncommon among men who engage in athletic 
sports. 
When the extensor tendons of the fingers are tense a blow upon the end of the finger 
transmitting force in a direction which would ordinarily flex the finger, results in injury to an 
extensor tendon in the vicinity of its attachment to the dorsal surface of the last phalanx. 
The injury consists, not in a bodily separation of the tendon from its points of attachment, 
but rather in a thinning of the tendon cephalad from the principal point of attachment to 
the phalanx, and from the fibres which form the posterior ligament of the last phalangeal 
articulation. A few fibres of the tendon are undoubtedly ruptured, but most of them 
slide away from each other very much as the threads of a textile fabric separate when the 
fabric is violently stretched but not torn. 
Immediately after the occurrence of the injury to the tendon the last phalanx of the 
finger assumes a semi-flexed position, and this deformity is usually permanent; the extensor 
tendon then having little or no influence upon the phalanx. 
The tendon is repaired surgically by making a longitudinal incision about two centi- 
metres in length over the site of the injury, dividing the thinned tendon longitudinally 
into the two principal fasciculi into which it naturally separates, dividing the tendon 
transversely cephalad from the thinned point, and advancing each fasciculus to a point 
upon its own side of the finger, near the base of the finger nail. At this point the fasci- 
culus is sutured to the under surface of the skin with a suture which passes through the 
skin and is tied upon the outside. The fasciculi are sutured to skin rather than to 
periosteum and tendinous remains, because the former structure gives the firmer hold and the 
cut end of tendon makes a good union with the phalanx as it would if sutured directly to 
periosteum. A perfect finger results from the operation. 
Four cuts illustrate the paper. 
No. 309. 
LAWS OF THE GROWTH OF THE CELL APPLIED TO HUMAN 
ANATOMY. 
Robert Reyburn, M, D., 
Washington,. D. C. 
The living cell the unit of structure from which all living bodies, vegetable as well 
as animal, are built up. 
Error of studying human anatomy in the adult human body, and in not commencing 
the study by tracing the development of the human ovum, through its successive stages to 
the completed organism. 
126 Structure of the human body as a whole. 
Differences between the growth of inorganic bodies and the growth of living bodies. 
Shapes of organic and inorganic bodies. 
Conditions modifying and changing the shapes of organic forms. 
Shapes of organic forms modified by type of parent cell. Vaccine virus. 
Shapes of organic forms modified by pressure. 
Shapes of organic forms modified by heat. 
Shapes of organic bodies modified by the supply of nutriment in certain directions. 
Growth of the abdominal and other cavities of the human body. 
Growth of the stomach and intestinal tube. Growth of the blood-vessels and all the 
hollow viscera of the body. 
Growth of the human body as a whole. Youth, maturity and old age of the body. 
The laws of growth of the cell correspond to the laws of growth of the human body. 
No. 810. Paper by E. G. Conklin, M. D., Delaware, Ohio. 
[Neither Title nor Abstract furnished.] 
No. 311. 
THE PRESENCE OF LINGUATULA RHINARIA (L. SERRATA, 
PENTASTOMA TAENIOIDES) IN THE UNITED STATES. 
Medical Zoologist, Bureau of Animal Industry, United States Department of Agriculture. 
C. W. Stiles, Ph. D., 
Record of three cases of this parasite in domesticated animals in the District of 
Columbia. Short review of life-history of parasite. Its occurrence in man. Possible 
modes of infection. Account of experiments now in progress. Exhibition of specimens. 
Time, ten minutes. 
No. 313. “ Nerve Anastomosis,” by A. C. Beenays, M. D., St. Louis, Mo. 
[Abstract not furnished.] 
No. 314. Paper by Geo. A. Bingham, M. D., Toronto, Canada. 
No. 315. Paper by E. B. Kenner, M. D., St. Louis, Mo. 
No. 316. Paper by Jos. D. Bryant, New York, N. Y, 
127 No. 318. Paper, by Ciias. S. Minot, M, D., Boston, Mass. 
No. 319. Paper, by John C. Munro, M. D., Boston, Mass. 
No. 320. Paper, by J. T. Newman, M. D., New Orleans, La. 
No. 321. Paper, by Geo. A. Piersol, M. D., Philadelphia, Pa. 
No. 322. Paper, by James B. Prichard, M. D., St. Louis, Mo. 
[Neither Title nor Abstract furnished for 314 to 322 inclusive.] 
No. 323, 
A PART OF THE ANATOMY OF THE VELUM PENDULUM PALATI, 
Thomas F. Rumbold, M. D., 
San Francisco, Cal. 
Some time ago, as I was discussing the ridge that extends up and down the posterior 
surface of the velum pendulum palati, I discovered that the muscles forming this eleva- 
tion, that are called the azygos uvulae muscles in all works on anatomy, were two pairs of 
muscles : an upper and lower pair. 
The upper pair, or, as I have named them, the elevator palati muscles, arise from the 
posterior nasal spine of the palate bone, and from the contiguous tendinous aponurosis of the 
velum pendulum palati, and are inserted at about the junction of the lower third of the 
velum palati with the middle third, interlacing with the fibres of the lower pair of muscles. 
The lower pair, or, as I have named them, the elevator uvulae muscles, arise at the 
place of insertion of the elevator palati muscles—their fibres interlacing with them—pass 
downward and are inserted into the connective tissues of the lower extremity of the uvula 
and form this organ. 
The four muscles form the ridge on the back of the palatum molle, which may be 
seen by a pharyngeal reflector. This ridge I have named the Azygos Prominence. 
The action of these two pairs of muscles can be plainly seen on inspection of the 
anterior surface of the velum palati while the mouth is open and the tongue is slightly 
depressed. 
On some persons the effect of the contractions of the elevator palati are more marked 
than on others. Upon asking the person examined to move the velum palati upward and 
downward, after a number of efforts, a dimple will be seen on the under side of the velum 
a little below the centre. This dimple or indrawing of the under surface of the velum 
128 indicates the location of the insertion of the elevator palati on the upper or posterior sur- 
face of the velum palati. It is seen to be two-thirds—or nearly that—of the way down 
the central line of the velum pendulum palati. 
Some say that this is the action of the elevator palati, another and very different pair 
of muscles, but these muscles are inserted into the whole width of the velum palati from 
the base of the uvula to the nasal spine of the palate bone; so that their contraction 
could not raise one spot so as to form a dimple on the underside of the velum pendulum 
palati. 
It will be seen that this action of the elevator palati has no effect upon the uvula. 
During the efforts of the person examined to elevate and depress the velum palati, the 
uvula will be noticed to be elevated, both with and without the dimple on the under side 
of the velum, showing that there are two distinct sets of muscles, one to elevate the velum 
pendulum palati, and the other to elevate the uvula. 
Another method of demonstrating the action of these two pairs of muscles, is by 
means of a gentle faradic current. A metal probe insolated, except at the point, which is 
slightly bent, is passed into one of the nasal passages and made to rest upon the azygos 
prominence. A gentle current of electricity is now turned on while inspection is made 
upon the velum palati through the open mouth. As the probe is slowly passed down the 
posterior wall of the palatum molle, the effect of the contraction of the muscles occasioned 
by the electricity is plainly seen when the probe is over the centre of the elevator palati 
muscles, producing the dimple on the under surface of the velum pendulum palati. As 
soon as the probe is passed still lower, so as to be over the elevator uvulae muscles, the 
uvula is at once elevated so as to be, many times, out of sight, showing plainly the action 
of the two pairs of muscles. 
No, 324. Paper, by D. F. Rodgers, M. D., Topeka, Kan. 
[Neither Title nor Abstract furnished.] 
No. 325. Paper, by Middleton Michel, M. D., Charleston, S. C. 
[Neither Title nor Abstract furnished.] 
No. 326. Paper, by E. S. Stevens, M. D., Cincinnati, Ohio. 
[Neither Title nor Abstract furnished.] 
No. 327. “The Human Hand,” by Geo. W. West, M. D., Washington, D. C. 
[Abstract not furnished.] 
No. 328. Paper, by Geo. A. Wilcox, M. D., Augusta, Ga. 
129 No. 329. Paper, by W. P. Wilson, M. D,, Philadelphia, Pa. 
No. 330. Paper, by Edwin Bentley, M. D., Little Rock, Ark. 
No. 331. Paper, by Henry C. Boenning, M. D., Philadelphia, Pa. 
No. 333. Paper, by E. F. Clapp, M. D., lowa City, lowa. 
No. 334. Paper, by J. W. Hartigan, M. D., Morgantown, W. Ya. 
No. 337. Paper, by J. W. Perkins, M. D., Kansas City, Mo. 
[Neither Title nor Abstract furnished for 328 to 338 inclusive.] 
No. 338. “ Surgical Anatomy of the Appendix Vermiformis with some Anatomical abnormali- 
ties observed,” by R. H. Plummer, M. D., San Francisco, Cal. 
[Abstract not furnished.] 
No. 339. Paper, by E. S. Herns, M. D., Lebanon, Ohio. 
[Neither Title nor Abstract furnished.] 
No 340 
THE DISSECTING ROOM. 
E. W. Holmes, M.D., 
Philadelphia, Pa. 
The writer originally intended to discuss all the various problems which present 
themselves in the practical management of the dissecting room, and thereby to benefit from 
the discussion thus evoked, but the necessities of time and space compel the omission of 
some. 
The equally important motive is to call attention to the neglect of the practical work 
into many of our schools. 
The distaste for the work is inherent in its very nature. 
Dissection should be legalized and public opinion educated. 
130 Chloride of zinc, upon the whole is the best preservative, in this climate where bodies 
are to be kept for a considerable period. 
With proper precautions the demonstrator of anatomy may attend to obstetrics and 
operative surgical work with safety. 
Didactic lecturing is peculiarly ill fitted for the teaching of anatomy. Its the eye 
and hand, not the ear, that needs the careful training here. This is recognized theoretically 
but not practically in the great majority of our schools. 
The difficulties are: 
(1) The isolation of the rooms and the difficulty of access. 
(2) The scarcity of bodies which in many States prevents the selection of only fit 
material. 
(3) The minimizing of the practical work. 
(4) The irregularity of the methods of work, 
(5) It is a paradox that we only know our anatomy through our dissecting. Yet we 
must know the structures in order to dissect intelligently. 
The remedy is: 
(1) The minimizing of the didactic and the increase of the practical work upon the 
cadaver. 
(2) Frequent demonstrations (rather than lectures) to small sections. 
(3) The division of the classes into sections for work here as in other laboratories, 
for the stated periods and hours. 
(4) The supply to the rooms of numerous dissected specimens kept in alcohol, which 
shall be frequently examined by the students, before, during and after the course of dis- 
section. The ideal would be a demonstration upon the cadaver to a class, each of whom 
had a similar specimen at least upon which to fpllow the speaker. 
(5) Personal supervision of each of the tables by a special assistant. 
(6) Frequent examinations in practical rather than theoretical data. 
(7) The rooms should be easy of access and should be conducted in as orderly a 
manner as in any other laboratory. 
(8) Scientific records of anamolies and pathological appearances should be carefully made 
(9) The student should be stimulated to spend his spare time in the anatomical room 
by the arrangement to this end in the roster of the medical school, by the undivided and 
enthusiastic personal supervision of the teachers, of which there should be many, and by 
the emphasis laid upon the practical rather than upon the theoretical in the examiner’s room 
No. 342. 
THE RELATIONS OF THE HEART AND LUNGS TO THE ANTERIOR 
CHEST WALL AS DETERMINED BY COMPOSITE PHOTOGRAPHY. 
Irving S. Haynes, Ph. D., M. D,, 
New York City. 
(1) Description of the method of composite photography when applied to the 
purpose of determining visceral relations. 
131 (2) Relations ascertained by this method in two subjects. 
(3) Summary of relations as given by various authors. 
(4) Photographs and drawings illustrating the paper. 
No. 343. 
BONE AND ORGANIZED SUBSTANCE. 
By George Frederick Koehler, M. D,, 
Adj. Professor and Lecturer on Anatomy, Medical Department, Oregon State University, Portland, Ore. 
The bones, the organs of support of the animal frame, wmuld appear to the 
superficial observer to be merely inorganic compounds—resisting for ages the influence of 
time, impressive factors, the emblems of the decay of past generations—but this is not 
true, for by minute examination we are able to trace the numerous vessels, and study the 
internal structure of bone, and to demonstrate that the bones are supplied with blood like 
the softer parts, and that, similar to other structures of the human economy, they have 
their periods of growth and decay, and are quite as susceptible as are other organs of the 
body to disease and derangement from external influences. 
No. 344. 
CRANIOMETRIC MEASUREMENT OF 500 SKULLS IN RELATION TO 
AURAL TOPOGRAPHIC ANATOMY. 
B. Alex. Raxdall, M.A., M. D., 
Philadelphia, Pa. 
The limited endeavors previously made to thus gain light for aural surgery having 
proved insufficient and contradictory, a wider research seemed to be requisite; and a 
method has been employed applicable to any intact skill). Calipers introduced through 
the foramen magnum gave the minimum distance of the sigmoid sinus from the mastoid 
surface and the position of this thinnest point behind the spina supra meatum. The 
separation of the sulcus from the back-wall of the meatus and from an “ operation-point ” 
5 mm. behind the spina, were measured in the same way. Inside calipers gave the 
extreme separation of the sulcus from its fellow of the opposite side; while external 
measurement furnished the distances apart of the spina, and of the operation-points, as 
well as the maximum length and parietal breadth of the skull. This breadth divided by 
the length gave the index, in accordance with which the crania were grouped as raeso- 
cephalic (.777 to .799) and dolichocephalic or brachycephalic when longer or shorter, 
respectively. Separate groups were made of sixty skulls at each extreme of the opposite 
types—over .860 or under .720. 
Another specially-constructed caliper gave the height of the floor of the middle 
cerebral fossa above the upper margin of the external meatus and the lateral position of 
132 this lowest point within or beyond the spina. The relative size of the sigmoid sulcus and 
of the jugular foramen on the two sides was also noted, as bearing upon the vulnerability 
of the lateral sinus in case of operation. 
In the 500 skulls the thinnest point averaged 6.1 mm. (max. 20,' rain. 0) on the 
right, 6.6 mm. (18 to 9) on the left; being greater on the right in 151, on the left in 231; 
it was located behind the spina 17.8 mm. (40 to 0.5) right, 17 mm. (85 to 1) left. 
From the meatus to the sulcus the distance averaged 12.1 mm. (21 to 0) right, 12.5 (18 
to 0) left; being greater on the right in 153, on the left in 201. The “operation- 
room” (distance of the sulcus from a point 5 mm. back of the spina) averaged 11.3 mm. 
(20 to 0.3) right, 11.8 (25 to 0) left; the right being larger 159 times, the left 206. 
The sigmoid sulcus was found larger on the right in 225 (+ 53?); larger left in 128 
(4- 47 ?), equal in 47. The jugular fossa and foramen often differed : it was larger right 
in 277 (4- 29?), left in 125 (+ 18?) and equal in 51. The long and short skulls each 
showed nearly the same averages and maxima and minima as the whole 500 ; but in the 
extreme types, the brachycephalic showed less operation-room (10.4: 12.1 right, 11.2 : 
12.6 left), a less meatus to sulcus distance (11.2 : 12.7 right, 12.4: 12.5 left) and a more 
superficial sinus (6.4: 6.8 right, 6.8 : 7.4 left). 
The floor of the middle cerebral fossa averaged 6.6 mm. (15 to 0) right, 5.6 (15 to 0) 
left, above the upper margin of the external meatus, being lower on the left in 287 and 
on the right in 102—the brachycephalic skull, even of the extreme type, showing no 
noteworthy difference from the extreme dolichocephalic or the general average of the 
entire 500. 
While not sufficiently extensive to be conclusive, this study certainly shows that the 
cranial index gives little pointing as to the anatomical relations likely to be met by the 
operator; and it proves that maximal or minimal dimensions may be encountered in any 
type of skull. 
No. 345. “ A Case of Supernumerary Nipples, with Remarks upon and Literature of the 
Subject,” by Albert Pick, M. D., Manchester, N. H. 
[Abstract not furnished.] 
No. 346, “On the Zona Radiata of the Telostean Ovum,” by Jacob Reichard, M. D., 
Ann Arbor, Mich. 
[Abstract.] 
No. 347. “On Teaching Comparative Anatomy and Embryology to Large Classes of Medical 
Students,” by A. P. Ohlmacher, M. D., Chicago, 111. 
[Abstract not furnished.] 
133 SECTION ON PHYSIOLOGY. 
HONORARY PRESIDENTS: 
Dr. Josi: M. Bandera, City of Mexico, Mexico; Dr. James Blake, San Francisco; Dr. R. H. Chit- 
tenden, New Haven; Dr. Austin Flint, New York; Dr. C. Heinemann, Vera Cruz, Mexico; Dr. Joseph 
Jones, New Orleans; Dr. J. B. De Lacerda, Rio de Janeiro; Dr. H. N. Martin, Baltimore; Dr. Wesley 
Mills, Montreal, Canada; Dr. S. Weir Mitchell, Philadelphia; Dr. E. T. Reichert, Philadelphia; 
Dr. Antonio Perez Roca, Lima, Peru; Dr. Magln Sagarka, Santiago de Cuba, Cuba; Dr. Carlos 
Schonlein, Santiago, Chile. 
EXECUTIVE PRESIDENT: 
Dr. Isaac Ott, Easton, Pennsylvania. 
Dr. A. P. Brubaker (English-Speaking), Dr. Wm. A. Thom (Spanish-Speaking), 
40 N. 19th St., Philadelphia, Pa. 128 Main St., Norfolk, Va. 
Dr. SeSorans [Defensa 293] Buenos Aires Argentine Republic. 
Dr. Enrique Hertzog La Paz Bolivia. 
Dr. J. Paulo de Carvalho . Rio de Janeiro U. S. of Brazil. 
Dr. A. B. MacAllum Toronto . . Canada. 
Dr. Julio San Martin [Dragones 94] Havana Cuba. 
Dr. Antonio Vargas Vega [Calle 10, Num. 305] . . Bogota Republic of Colombia. 
Dr. Carlos Duran San Jose Costa Rica. 
Dr. Carlos Padilla Guatemala City Guatemala. 
Dr. F. L. Miner Honolulu Hawaii. 
Dr. Esteban Ferran Tegucigalpa Honduras. 
Dr. Manuel Toussaint [San Jose de Gracia 12] . . City of Mexico ..... Mexico. 
Dr. Guerra Rivas . Nicaragua. 
Dr. Juan Morelli (hijo) [Arapey 192] Montevideo Uruguay. 
Dr. Ramon Porra Pic6n Merida Venezuela. 
SECRETARIES: 
134 SECTION ON PHYSIOLOGY. 
No. 351. “American Physiology—Past, Present and Future,” by Isaac Ott, M. D., Execu- 
tive President of Section, Easton, Pa. 
[Formal Address.] 
No. 362. 
A TABULAR VIEW OF THE PATHOLOGICAL ANATOMY OF YELLOW 
FEVER AND MALARIAL FEVER. 
Joseph Jones, M. D., 
New Orleans, La. 
Yellow Fever, 
Exterior. 
Malarial Fever. 
Exterior. 
Cerebro-spinal. Nervous system. 
Sympathetic nervous system. 
Heart Yellow and softened. 
Cerebrospinal. Nervous. 
System, Sympathetic. Nervous system. 
Heart, Normal, no change in color or struc- 
ture. 
No fatty degeneration. 
Lungs. Dependent portions congested, other- 
wise healthy. 
Stomach. No uniform condition. 
State of fatty degeneration. 
Lungs. Dependent portions congested, other- 
wise normal. 
Stomach. Congested and filled with black 
vomit. 
Intestines. Congested and filled with gas. 
Liver, yellow color. Liver cells and liver 
structure generally filled with oil globules. 
Gall bladder. Small, contracted. Contains 
about 300 grains of yellow bile. 
Spleen. Slightly enlarged and softened. 
Intestines. No uniform condition. 
Liver, slate color on exterior and bronze 
within. The portal capillaries filled with 
black pigmentary and melanotic matter. 
Gall bladder, distended with 1500 grains of 
dark greenish, black bile. 
Spleen, more or less enlarged. Sometimes 
attains a size larger than that of the liver, 
weighing several pounds. 
Supra-renal bodies. 
No change. 
Kidneys. Generally normal, sometimes slate 
colored in patches. In malarial hema- 
turia bright red from effused blood. 
Urinary bladder. Normal with relatively 
abundant excretions. 
Bupra-renal bodies. 
Fatty degeneration. 
Kidneys. Brownish yellow and softened, 
disquamation of excretory cells of the 
tubuli-uriniferi. 
Urinary bladder contains albuminous urine 
with excretory cells and granular casts. 
135 No. 353, 
THE EFFECTS OF LESIONS OF CERTAIN PARTS OF THE BRAIN UPON 
THE HEAT PROCESSES. 
Edward T, Reichert, 
Professor of Physiology, University of Pennsylvania. 
The object of the research was to determine the effects of transverse sections of certain parts 
of the base of the brain upon heat phenomena. The experiments were made on dogs. In 
some merely temperature records were taken; in others, the method was calorimetrical; in 
others, observations of the alterations in temperature, circulation and respiration were simul- 
taneously made. 
The parts studied were, the white matter just anterior to the caudate nuclei, the striated 
bodies, the optic thalami, the crura cerebri and the pons Yarolti. 
The technique of the operations was in nearly all cases the same. The animals were anaes- 
thetized with ether, chloroform or a mixture of both ; a small trephine opening was made in the 
side of the skull opposite to and on a level with the upper surface of the structure to be cut; 
the membranes were punctured ; a slightly bent probe (one millimetre thick and two millimetres 
wide) was inserted horizontally and pushed across the brain until the skull on the opposite side 
was reached, and then with a downward, sweeping movement all of the cerebral mass below the 
probe was severed. 
In two experiments in which section was made of the white matter within one millimetre 
of the heads of the caudate nuclei the temperature fell in both. 
Twelve experiments were made in which the striated bodies were cut, six of which were 
calorimetrical. In every one a rise of temperature was recorded. The increase was due to an 
increase of heat production. 
In three experiments in the optic thalami, in which the sections did not involve the corpora 
striata, there occurred an immediate, slight and transient rise of temperature, which was followed 
by a decided and lasting fall. 
Section of the crura cerebri was made in twenty experiments in which the temperature 
was specially studied. The temperature increased in sixteen and fell in four. In eight addi- 
tional experiments made with the calorimeter, in four a slight and transient rise was noted which 
was followed by a fall; in the other four a marked fall was recorded. 
The pons Varolii was cut in seven experiments. In six the temperature was increased and 
in one diminished. 
Comparisons made between the effects on temperature and those on the circulation and 
respiration show that the former are practically entirely independent of the latter; and calorimet- 
rical experiments prove that the increase of temperature is due essentially to increased heat 
production, and the fall of temperature to diminished heat production. The increase of heat 
production is owing to excitation of accellerator thermogenetic centres or fibres and not to a 
loss of thermo-inhibitory influence. 
No. 354. “The Relation of the Mogenesis to the Yoso-motorSystem,” by Dr.Bartolemeo 
Baculo, Naples, Italy. 
[Abstract.] 
136 No. 355. 
THE GLOBULICIDAL ACTION OF BLOOD SERUMS. 
William S. Carter, M. D., 
Assistant Demonstrator of Pathology, University of Pennsylvania. 
It is well known that if you inject into the veins of some animals the blood serum of cer- 
tain other species of animals, there is produced an hsemaglobinuria and albuminuria. The 
destruction of red blood corpuscles has been watched under the field of the microscope, by 
mixing the blood of some animals with the clear serum of others. This paper will give a 
study of the number and kinds of corpuscles of animals injected with the blood serums of 
other species. The number of corpuscles were estimated by the Thoma hsematocytometer, 
although in a few instances Gower’s was employed. The leucocytes were also examined in 
fixed preparations and divided for the purpose of studying into the following classes: (1) 
symphocytes ; (2) large mononuclear; (8) transitional; (4) multinuclear ; (5) eosinophiles. 
The recent investigations on immunity and prominence given to blood serum therapeutics 
make it important to know what change occurs in the blood of animals under these circum- 
stances and also to know something of the toxicity of blood serums. 
The serum was obtained by bleeding animals with all antiseptic precautions into sterilized 
flasks and then standing the blood in an ice chest and allowing the serum to separate from the 
clot. The experiments were chiefly on rabbits and dogs, as the blood can be easily obtained 
from these animals by sticking their ears. The injections were made both subcutaneously and 
intravenously, all the apparatus used being very carefully sterilized. 
It was found that the rapid introduction of a small quantity of serum of a healthy man, 
into the vein of a rabbit caused death in a very few minutes, and that there was also a marked 
diminution in the number of red blood corpuscles. When the injection was made slowly there 
was a much greater destruction of red blood corpuscles, a larger quantity of serum was used 
and death came on much later. Death always occurred by respiratory failure, the heart 
beating after respiration ceased. There were no symptoms of dyspnoea. In the cavities of the 
heart there were sometimes found soft, non-adherent currant-jelly clots. The subcutaneous 
injection of larger quantities caused a diminution in the red blood corpuscles, but produced no 
symptoms. 
When serum of man is injected int(f the veins of dogs, rapidly and in large quantities, 
there were no symptoms, no destruction of red blood corpuscles, no haemaglobinuria, but there 
was some albuminuria. 
Dog’s serum in small quantities injected rapidly into the veins of rabbits caused death in 
very short time by respiratory failure. When injected slowly they were able to withstand large 
quantities, some recovering with no symptoms, others dying several hours later in convulsions. 
In none were there found any ante-mortem clots in the heart. Most of the cases did not show 
any marked change in the number of corpuscles. Even some of the fatal cases did not show 
any change in the corpuscles. In a few instances there was produced a destruction of red 
blood corpuscles and haemaglobinuria. Albuminuria always follows. The subcutaneous injec- 
tion produced no symptoms and, only once produced marked destruction of red blood corpuscles 
with hseraaglobinuria. 
Horse’s serum did not seem toxic even when introduced rapidly and in large quantities 
into the veins of rabbits. There was a slight diminution of red blood corpuscles with 
albuminuria. 
137 From these experiments it would seem that the toxicity of blood serums is not dependent 
on their globulicidal action. 
There was no constant alteration either in the number or kind of leucocytes. The varia- 
tions following the injections were no greater than can occur in health. When there was a 
diminution in the number of leucocytes there was a great reduction in the multinuclear 
form giving rise to a relative increase in the number of lymphocytes. This was seen in rabbits 
injected with serum of the dog. 
When an increase in the number of leucocytes occurred it was caused by an increase in 
the multinuclear form. 
Laboratory of Experimental Pathology, 
University op Pennsylvania. 
No. 356. 
THE ABSORPTION OF IRON IN THE ANIMAL BODY. 
A. B. Macallum, 
Professor of Physiology, University of Toronto. 
The author’s observations on the distribution of iron in the animal and vegetable cell have 
resulted in determinings that the chromatin of every species of cell is an iron-holding com- 
pound, and that this substance gives origin to the haemoglobin in the animal body. It follows 
from this that the iron of inorganic preparations in the food, if it is assimilated at all, must go 
directly to the formation, not of haemoglobin, but of chromatin—a conclusion which necessi- 
tates a revision of the commonly accepted views as to the physiological relations of iron, and 
which at the same time suggests two interdependent questions: (1) Is chromatin formed in the 
animal body, or is it formed in vegetable organisms only ? (2) What is the true explanation 
of the beneficial effects of the administration of iron salts ? 
In an attempt to answer these questions, various compounds of iron have been adminis- 
tered to animals (guinea pig, rabbit) in order to determine by micro-chemical and histological 
methods their action in the intestine. The investigation has yielded results which may be 
summarized thus: 
(1) The chloride, phosphate and sulphate of iron and certain organic preparations of iron 
are absorbed by the epithelial cells of the villi and by the siderophilous cells surrounding the 
lacteal vessels. 
(2) When given in large doses, certain preparations of iron have, upon the absorbing 
elements, especially the siderophilous cells, an effect similar to chemotaxis. 
(3) The absorption of iron compounds occurs chiefly in the upper and middle portions of 
the small intestine. 
The beneficial effects of the administration of iron in anaemia may, in large part, be 
explained on the view that iron salts increase the absorptive activity of the intestinal mucosa. 
Other investigations on the absorption of chromatin tend to support this view, and to indicate 
that inorganic and albuminate compounds of iron are not assimilated in the animal body, or, 
in other words, iron-holding nucleo-albumins are products of vegetable metabolism only. 
The bearings of these observations on the pathology of simple anaemia and chlorosis and 
on the subject of nutrition is discussed at length in the original paper. 
138 No. 357. 
FUNCTIONAL DISTURBANCES CAUSED BY HEAT. 
Dr. J. B. de Lacerda, 
Rio Janeiro, Brazil, 
Experiments commenced some years ago with the lamented Dr. Couty. The experiments 
of Cl. Bernard were too artificial. We have not made use of stoves, but have been in a 
position to employ natural heat. In Rio, during the summer, we often have temperatures 
varying between 30° and 36° C. The action of the heat is increased by the hygrometric 
saturation and the prevailing calm of the air. 
Under these circumstances there is a considerable exhaustion of muscular energy; the 
nerve energy is in abeyance; the secretions of the skin are enormously increased; the kidneys 
are slow, and the brain slumbers. 
Experimenting on the lower animals between the temperatures of 30° and 35° C., we have 
always found the arterial tension very low, varying between 12 and 15 c. c. of mercury, while 
in winter it reached 19 and 21. We have thought that the fall was due to two factors, namely, 
a dilatation of the vessels, and cardiac weakness. 
The nerves were found not to respond after a few electrical excitations unless a sufficient 
time of rest was allowed. 
Dogs exposed directly to the sun, if kept immovable, perish in fifty minutes. At first 
there are signs of excitation, cardiac and respiratory acceleration, contracted pupils, salivation. 
This condition lasted about fifteen minutes, and was followed by cardiac weakness, dilated 
pupils, dryness of the mouth, and arrest of respiration at times. When the rectal temperature 
reached 44° C., death Avas imminent, and was the result of arrest of respiration, the heart 
continuing to beat for a few seconds.. 
Immediately after death we could demonstrate the loss of muscular contractility, at least 
in the respiratory muscles and the heart. The blood was dark, rather fluid. There were 
hiemorrhages into the endocardium and in the lungs. There were minute petcchhe of the 
skin, and at times considerable suffusion. 
The circulatory changes above mentioned must bring about, as secondary results, a slowing 
of the processes of absorption and of metabolism. 
It is easy to perceive how these secondary conditions may concur to aggravate certain 
pathological states in the warm climates, and how they may give rise to a slow absorption of 
medicinal agents. 
No. 358. 
AUTOMATISM IN NERVE CENTRES. 
Samuel Wolfe, A. M., M. D., 
Clinical Professor of Nervous Diseases in Medico-Chirurgical College, Philadelphia (formerly Professor ol 
Physiology). * 
The so-called stage of rest in any physiological unit should be considered when regarding 
its total functional activity. 
This stage in the nerve cell must be continually influenced by impressions on the peripheral 
nerve endings sending impulses over fibres, which impressions arise in the external world, 
within the body from similar causes, and as the result of metabolic processes in the various 
tissues. 
139 The intimate connection by fibres, of all the nerve cells, make it probable that no function 
of the cell is independent of impressions arising outside of the immediate cell concerned, hence 
not automatic in any absolute sense. 
A stability which prevents activity independent of excitation transmitted through a fibre is 
essential to the normal condition of most of these cells, and most probably of all of them. 
No. 359. 
THE PROTEOLYSIS OF CRYSTALLIZED PHYTO-GLOBULIN OR 
VITELLIN. 
Dr. R. H. Chittenden, 
In,any exact study of the relationship between the various products resulting from ordinary 
proteolytic action and the proteid undergoing digestion, the purity of the mother-proteid must 
first be assured. Obviously, the colloidal or amorphous character of ordinary proteids is 
a great obstacle to chemical purity. In crystallized phyto-globulin, however, we have a form 
of proteid matter, the crystalline character of which offers a comparatively easy means of in- 
suring reasonable purity. Hitherto, the great difficulty attending the preparation of large 
quantities of these crystalline proteids has been a barrier to their wide-spread use in digestion 
experiments.* 
The present series of experiments has been made with the crystallized globulin or vitellin 
from hemp-seed, which can be readily prepared in large quantities and in the form of beautiful 
octahedra, with well-defined edges. The globulin is readily digestible in artificial gastric juice 
(pepsin-HCI), yielding the ordinary forms of proteose and peptone, and it has been the main 
object of the present study to ascertain as fully as possible the characters and chemical compo- 
sition of the various products resulting from the digestion of this pure proteid with carefully 
purified pepsin-hydrochloric acid. This has seemed especially important in view of the fact 
that a still more exact method of separating the last traces of deuteroproteose from true peptone 
has recently been devisedf, thus making it very desirable to again study the properties and 
composition of a true and pure peptone, entirely free from adherent proteose. 
In one digestion with pepsin-hydrochloric acid (seventy-two hours at 40° C.) products ot 
the following composition 1' were separated: 
New Haven, Conn. 
C. H. N. S. O. ASH, 
Phytoglobulin or vitellin . 51.63 6.90 18.78 0.90 21.79 0.56 
Protovitellose 51.55 6.73 18.90 1.09 21.7 3 0.17 
Mixed vitelloses 50.85 6.68 18.94 1.10 22.43 0 49 
Deuterovitellose 49.78 6.73 17.97 1.08 24,44 1.26 
fPeptone . 49.40 6.77 18.40 0.49 24.94 258 
|Andvitellid -50.18 6.50 14-74 2.41 
While the reactions of a given vitellose are essentially the same under all circumstances, 
its composition is liable to vary somewhat with the length and intensity of the proeolytic action, 
This adds weight to the theory that there may be two or more proto or deuteroproteoses or vitel- 
*Two series of experiments have, however, been previously made ; Ueber Vitellosen, R. Neurneister, Zeitschr. y Biol., Bd. 23, 
p. 402, and Crystalline globulin and globuloses or vitelloses, Chittenden and Hartwell. Journ. Physiol., vol. 2, p. 435. 
fZeitschr. / Biol., Bd. 29, p. 2. 
ash free. 
\ Mixed products from two distinct digestions. 
140 loses, representing different stages of hydration, possessed of essentially the same general reactions, 
but variable in composition. In any event, we have in the above table a confirmation of the 
many results obtained in the digestion of animal proteids, all of which point to the conclusion 
that the proteolytic process, considered from a chemical standpoint, consists of a series of succes- 
sive changes mostly hydrolytic in their nature. The most marked evidence of the gradual 
chemical change accompanying long-continued proteolysis is the pronounced diminution in the 
content of carbon of the successive products; thus, peptone always contains, as in this case, two 
to three per cent less carbon than the original proteid from which it is derived, tvhile the prim- 
ary and secondary proteoses usually show7 a content of carbon midway between the tw70, propor- 
tional to the extent of the proteolytic change from which they have resulted. 
The specific rotation of the original globulin dissolved in a ten per cent solution of sodium 
chloride is (a)D—53.8°. The vitelloses, however, are as a rule possessed of a somewhat higher 
rotary power, although the pure peptone has a rotation of only (a)D—47.3°. 
Vitelloses and peptone were also prepared by the action of alkaline trypsin solutions, 
although the globulin proved considerably more resistant to the action of this ferment than to 
pepsin. 
For further details of the work, together with a fuller description of the result obtained 
reference must be made to the complete paper. 
No. 360. 
INNERVATION OF THE VENA PORTAE. 
Franklin P, Mall, M. D., 
It has been known for a long time that when the splanchnic nerve or cervical spinal cord 
is irritated the arterial pressure rises. During the irritation of these nerves it has also been 
noticed that the smaller arteries of the mesentery as well as others contract. The mechanical 
explanation of the rise of the arterial pressure was therefore quite simple. 
When the volume of the blood in the arteries as well as that thrown from the ventricle is 
taken into consideration it is at once seen that the simple contraction of some of the smaller arteries 
is not sufficient to explain the rise of arterial pressure after splanchnic irritation. It has been 
found that when the aorta is tied just below the left subclavian artery (and the femoral artery 
opened to prove that the arterial pressure is reduced to zero) irritation of the splanchnic nerve 
causes a decided rise of pressure in the carotid artery. Moreover, it is found that with the 
aorta open or closed splanchnic irritation causes an increase flow of blood to and from the heart, 
thus showing us that the real cause of arterial pressure is due to an increased amount of blood 
being thrown into the aorta. A similar rise of pressure can be produced by injecting a 
quantity of fresh blood either into the jugular vein or into the carotid artery. In a dog of 
average size splanchnic irritation causes an increase of about 100 c. c. of blood to be thrown into 
the aorta. Transfusion of the same quantity from another animal causes an identical arterial 
curve. 
Chicago, 111. 
The first and most important experiment is the proof that when the splanchnic or the cord 
is irritated, the vena port contracts, often completely emptying its lumen altogether. That 
this is not primarily due to a contraction of the smaller raesenterie arteries is proved by the 
fact that the contraction of the vein is most marked when the pressure in the abdominal aorta is reduced to zero. Moreover, with the aorta open and the vena portae closed, it is quite easv 
to cause the portal pressure to exceed that of the arterial by splanchnic irritations. We, there- 
fore, conclude that the rise of arterial pressure, after splanchnic irritation, is due in great part 
to an increased quantity of blood being thrown from the heart; this in turn is caused by the 
contraction of the veins, and especially the vena portae and its branches. (See Archiv. fur 
Anat, und Physiol., Paynol, Abt, 1892.) 
In the demonstration to be made a ligature staff is applied to the aorta just below the 
origin of the left subclavian, and on the splanchnic is armed with an electrode. The portal 
vein is exposed and after the artery is closed the splanchnic is irritated. The portal vein will 
contract and the arterial blood pressure will rise. 
No. 361. 
THE PHYSIOLOGICAL BASIS OF THERAPEUTIC ACTION. AN EXPERI- 
MENTAL INQUIRY. 
Thomas J. Mays, M. D., 
Philadelphia, Pa. 
Every phenomenon in nature becomes intelligible only when considered in the light of 
force. Any scientific system of therapeutics must, therefore, be built on a broader basis than 
that of the mere drug action on the animal economy. The fireman looks upon the coal with which 
he feeds his engine as the ultimate source of heat, while the philosopher regards the same 
material as a store-house of force which has been gathered by the sun, and is but a part of the 
force which pervades the universe. Heat affects the body differently in accordance with the 
quantity which is applied. In small quantity it enhances, and in large quantity it suppresses 
organic action, and in excessive quantity it destroys tissue. A disconnected view of the effects 
would seem to show three different properties in heat, while really these three different phe- 
nomena are varying effects of one property or one force applied in varying quantities. 
Experiment shows that many of our therapeutic agents have a similar action in small and 
large doses—in the former they exalt, and in the latter they depress vital action. Further 
experimentation shows that small doses are directly antagonistic to large doses, i. e., small 
doses will overcome the depressant action of large doses. If, instead of large drug doses, we 
substitute the action of morbid forces, we have a picture before us as to the manner in which 
drugs combat disease, viz., by interference. 
Figures. Showing the action of small and large drug doses, and the antagonism of the 
same. 
To comprehend this principle of interference we must realize that all the textures of the 
animal body are in a state of continual molecular motion, and that so long as the molecular 
motion of each texture harmonizes with that of every other health is the resultant. Disease 
arises when a perturbation occurs among these. This molecular motion is maintained first, by 
substances, like food, which undergoes chemical change in the body ; and, second, by force, like 
heat, friction, which act aggressively. Drug action falls under the latter classification. The 
idea that our drugs are like forces also explains their elective affinity. The fundamental princi- 
ples of drug action, therefore, resolve themselves into (1) stimulant effects of small doses; (2) 
depressant effects of large doses, and (3) elective affinity. From this it follows that we have 
stimulants and depressants of every special organ and function; as of the general nervous 
142 system, and of special parts of the same, of the heart, lungs, intestines, liver, kidneys, skin, etc., 
which demonstrates that the old grouping of the action of drugs into stimulants, tonics, 
narcotics, expectorants, emetics, cathartics, cholagogues, diuretics, diaphoretics, etc., is the only 
scientific and natural classification. 
No. 362. 
SOME OBSERVATIONS ON THE NORMAL GROWTH AND MUSCULAR 
DEVELOPMENT OF THE HUMAN BODY UNDER 
SYSTEMATICAL EXERCISES. 
By H. G. Beyer, M. D., 
Annapolis, Md. 
This paper discusses some of the results of gymnastic exercises, as obtained by two successive 
measurements from a number of naval cadets. The items forming subjects for special consid- 
eration are the height, weight, lung capacity, vital capacity and total strength, and the change 
observed in these after a course of six months training in the gymnasium. 
No. 363, 
NOTES ON METHODS OF TEACHING PHYSIOLOGY IN 
THE LECTURE-ROOM. 
By W. Gilman Thompson, M. D., 
Professor of Physiology, Medical Department of the University of the City of New York. 
In the larger medical schools physiology is mainly taught in the lecture-room, before 
audiences of several hundred students whom it is neither practicable nor desirable to admit to 
wholesale individual experimentation upon the lower animals. The object of this paper is to 
emphasize the usefulness of such demonstrations as may be adapted to exhibition before large 
audiences and to invite discussion upon the methods suggested. The subject is divided under 
the headings: 
I. Animal experimentation in the class-room, its value, limitations, etc. 
11, Models and apparatus; description of new materials used; construction and employ- 
ment of “working” models to illustrate mechanism, etc. 
No. 364 
HIBERNATION AND ALLIED STATES IN ANIMALS. 
By Wesley Mills, M. A., M. D., 
Professor of Physiology in McGill University, Montreal, Canada. 
I. After citing the views usually held in regard to hibernation in the cold-blooded animaL 
and in certain vertebrates, an account is given of the study of two specimens of the American 
marmot or woodchuck (Arctomys monox), for a period of five years. From these investigations the following conclusions relating to this creature in confinement 
are drawn: 
(1) There was annually in its life a period characterized by drowsiness, sleep or profound 
torpor, at different times, and lasting from about November to April. 
(2) A period of perfect wakefulness immediately following, during which the animal was 
emaciated, in poor coat and with a generally low vital capital, lasting some weeks. 
(3) A period of improving condition, with good health and a desire to get free, which 
latter was also noticeable in the preceding period but to a less degree. 
(4) A period of maximum weight and vigor, with perfect coat and an abundance of fat. 
The marmot on a study of which these conclusions were based was under observation 
continuously for four years. Another specimen has been kept under similar conditions for two 
years, and has shown no tendency to hibernate. 
Then follows an account of certain cases of human hibernation or allied condition, one of 
which is reported with minute details. 
11. The second part of the paper is occupied with a discussion of the nature of the 
phenomena reported in the first part. *• 
It appears that all forms of profound winter (or summer) sleep are protective, and that 
this alone has prevented the extinction of several groups of animals. 
All study thus far given to sleep, hibernation, etc., seems to justify the conclusion that 
every degree of diminution of functional activity will be found represented from the normal 
sleep of man and other animals to the lowest degree of activity consistent with the actual 
maintenance of life. 
No. 366. 
THE NUMBER OF THE RED GLOBULES. 
By Dr. Jose G. Hernandez, 
Profesor de la Universidad de Caracas. 
The classical works on physiology fail to mention the influence of latitude upon the 
number of red corpuscles. The author has endeavored to study this question in the tropics. 
He started to find the physiological mean of the number of red corpuscles in the inhabitants of 
Caracas. The latitude of the city and elevation above sea level are given. Healthy individ- 
uals, medical students between the ages of sixteen and twenty years, were chosen. Twenty-five 
counts were made with the apparatus of Nachet. The mean obtained per cubic millimetre was 
of 3,247,000. The minimum was 1,900,000, and the maximum 3,840,000. 
The amount of urea secreted in twenty-four hours was also investigated in six cases, 
obtaining a mean of twenty-one grammes, with extremes of fifteen and twenty-five grammes. 
This olygocythoemia is explained by the theory that the function of the red blood cells is 
respiratory, and that the process of oxidation is necessary to keep up the bodily temperature, a 
function that must be less active where the surrounding temperature is uniformly high. The 
diminished oxidation of the tissues results in a diminished secretion of urea. 
The statement, often repeated, that the climate of the tropics is a producer of anosemia, is 
thus confirmed. 
144 No. 367. 
MUSCULAR FORCE OF THE INDIAN. 
Dr. J. B. Lacerda, 
Rio Janeiro, Brazil. 
It is generally admitted that the Indians are possessed of great muscular force. During 
the anthropological exposition at Rio Janeiro, in 1882, we had representatives of the different 
tribes in the National Museum. Experiments made with the Botocudos and the Cherentes 
show that they possess a mean of muscular strength inferior to that of the white or the negro 
race. The strongest Indians never reached above 120 in Mathieu’s dynamometer. 
As to muscular development, the superiority of the negro is at once apparent. As to the 
agility, we find the Indians to be slow, if we except certain habitual movements, such as the 
handling of the bow and arrows. We have no doubt that the other races would easily outrun 
the Indians, Their musical ear is very dull. They are lazy even when in danger, and trust 
more to acuteness than to their courage. 
No. 368. 
THE RESPIRATORY CENTRE IN THE MEDULLA OBLONGATA. 
Physiological Institute, Berlin, Germany. 
J. Gad, M. D., 
In 1891 and 1892 I was able to show, in collaboration with Marinescu, that the formatio 
reticularis of the medulla oblongata in rabbits, dogs and cats is endowed with functions such 
as we should expect in a respiratory centre sending out rhythmical inspiratory impulses. 
The region in question cannot be one of the narrowly circumscribed areas mentioned by 
Gierke, Mislawsky and Hohn, for after very slow alid cautious destruction of all these spots 
with nitrate of silver or hot glass beads the respiration is only temporarily suspended (inhibition 
stimulus). On the contrary, the respiration was permanently stopped when a sufficiently large 
portion of the formatio reticularis or the noeud vital of Flourens was destroyed. Circum- 
scribed electrical stimulation with fine needle electrodes, varnished to near the point, caused, 
when the needles were thrust in the noeud vital, only an increase of the tonus of the diaphragm, 
while the same stimulus, applied to the formatio reticularis, quickened and deepened the 
respiration. These observations show: (1) That the noeud vital (in the historical sense of the 
phrase) is only a point in the nerve path from the respiratory centre to the spinal centres for 
the muscles of respiration; and (2) that the nerve cells which automatically govern the respira- 
tory rhythm are themselves placed in the formatio reticularis. 
The above results were laid before the Physiological Society in Berlin, October 23, 1892. 
Since then, in co-operation with Arnheim, I have been able to determine that the respiratory 
centre in the formatio reticularis of the rabbit is a pre-ordinating centre, by which is meant 
that the co-ordination of the individual muscles of respiration is not accomplished through 
paths which carry the stimulus of one motor centre directly to another (as Exner and Gross- 
mann think), but, on the contrary, the collaboration between the nucleus facialis and the spinal 
centres for muscles of respiration is brought about only through the intervention of the pre- 
ordinating centre in tire formatio reticularis. The circumscribed electrical stimulation of the 
latter causes an alteration in the rhythm and depth of thoracic and nasal breathing, and the 
changes are both of the same character, as simultaneous registration shows. On stimulating in the region between the nucleus facialis and the formatio reticularis, an 
alteration of the nasal breathing alone is seen, while on stimulating distal to the formatio 
reticularis only an alteration in the thoracic breathing (excepting a general sensory reaction) 
is observed. Unilateral stimulation of the areas in the mid-brain, which Martin, Booker and 
Christiani have called respiratory centres, gives an alteration of the same character in the 
■respiratory movements of the thorax and the opposite half of the nose, and this alteration 
ceases when an incision is made between the nucleus facialis and the formatio reticularis; from 
which it follows that the path to the nucleus facialis turns out of its direct course and runs 
through the formatio reticularis. 
No. 369. 
THE ANALYSIS OF THE GASTRIC JUICE FOR SOME DISEASES 
OF THE STOMACH. 
Hugh Hamilton, M. Sc., M. D 
Harrisburg, Pennsylvania 
I. A method of analysis. 
11. Made at different periods after meals. 
111. What it teaches. 
IV. Its practical results. 
Illustrated with diagrams. 
Time, twelve minutes. 
No. 370. 
A MICROSCOPICAL STUDY OF THE LIVING NERVE CELL 
DURING STIMULATION. 
C. F. Hodge, Ph.D., 
Assistant Professor, Physiology and Neurology, Clark University. 
Up to the present series of experiments my work upon the nerve cell has been confined to 
observing the changes due to electrical stimulation or to daily fatigue in the cell after it has 
undergone the usual methods of preparation for the microscope. From the beginning it has 
been my desire to study the nerve cell continuously during the process of fatigue. 
METHOD. 
Of a pair of spinal or sympathetic ganglia quickly excised from a freshly pithed frog the 
right is placed in a drop of salt solution upon one of the “ stimulating stages ” to be presently 
described, the left, upon the other. The “ stimulating stages ” are made by looping up the 
two fine platinum wires, which serve as tips to electrodes of an ordinary Dußois-Reymond coil, 
through needle holes in a thin piece of glass so that about two millimetres of each wire is 
exposed upon the upper surface of the glass and the wires lie about two millimetres apart. 
This glass plate is mounted over a hole in a hard rubber disc of such size as to be conveniently 
clipped to the stage of a microscope. The ganglia are arranged so that the nerve of each lies 
on the electrodes and, the specimens being placed each under a microscope, a cell, or group of 
146 cells in each, which can be plainly seen, is found and brought to the centre of the field. Cells 
as near alike as possible are of course sought out. Now with the microscopes side by side, with 
similar nerve cells of the same animal under each, electrical stimulation is applied to one, while 
the other remains at rest; and both are observed, measured and drawn (with the camera) from 
time to time. A flow of sterilized salt solution was maintained under the cover-slips by means of 
capillary glass syphons supplied from the same reservoir. Stimulation was interrupted, fifteen 
seconds’ work alternating with forty-five seconds’ rest, the primary current being made and 
broken by a “ Lombard clock interrupter.” Four Daniels’ cells, supplying current of .5 ampere 
were used throughout. At the end of desired time both control and stimulated ganglia were 
hardened in osmic acid and teased in glycerine for further study. 
RESULTS. 
It has been planned to have the experiments fall into two series, a summer and a winter 
series. The winter series, consisting of ten experiments, was completed between November 24 
and December 24, 1892. Of the summer series four experiments have been completed at the 
writing of this abstract. It is intended to add about fourteen more during the summer. 
The chief result of the experiments so far is that the nucleus shrinks when stimulated 
under these conditions more rapidly than when the ganglion remains in the animal’s body. 
This decrease in size is rapid at first, then slower and more rapid again, as observed in a 
previous set of experiments; but the slowing up at no time amounts to a stand-still or to partial 
recovery. The controls shrink a very little, 3to 8 per cent, as compared to 60 to 73.7 per cent 
in the nuclei of the stimulated ganglia. 
Granules and oil droplets have been seen to disappear from the cell-protoplasm during 
stimulation. 
Stimulation has been continued as long as six days and nights, but active changes cease to 
be visible after the first five to six hours. 
With too severe stimulation the cells may show little or no change. The most definite 
results were obtained with the secondary of a Kriiger coil (10305 u.) at from 10 to 13 cm. 
With the secondary coil at 0, no change in the cells was visible. Motile protozoa, vorticella 
and paramoecium, were almost instantly killed with this strength of current; whereas they 
were apparently uninjured when the secondary coil was removed to 10 cm. 
No. 371. 
CHANGES IN GANGLION CELLS FROM BIRTH TO DEATH FROM 
OLD AGE. 
Assistant Professor Physiology and Neurology, Clark University. 
C. F. Hodge, Pie D., 
In previous experiments, where it has been necessary to compare ganglion cells of one 
animal with those of another, special care has been taken to use animals of as nearly the same 
age as possible. This has been done under the supposition that age might materially influence 
the appearance of the cells. 
Certain histological features have been observed to occur quite frequently in nerve, tissue 
taken from the aged. The most common of these is sclerosis. For the ganglion cell itself 
increase of pigment has also been noted. Both of these characteristics, together with the 
147 numerous forms of degeneration which have been described for nerve tissue, are often met with 
in various pathological conditions. It is with special reference to age changes within the nerve 
cell itself that the present research is begun. 
The material which has been of most service, so far, is the first cervical ganglia of a foetus 
of full term, male, and of a man dying of old age at ninety-two. The death of the foetus was 
due to an accident during birth; that of the man Avas caused by gradual decay accompanying 
old age, and not complicated by disease of any sort. The ganglia were hardened, one of each 
pair, in osmic acid and corrosive sublimate, embedded side by side in paraffine, cut together 
and stained together on the slide. We thus have, side by side, and prepared in the same way, 
similar cells at birth and at ninety-two years of age. And the question now is—What changes 
have the ninety-two years of life and activity wrought in the cells? 
The first difference to be noted between the ganglia is one of size, the ganglion of the old 
man being, by measurement, 105 times larger in bulk than that of the foetus. This increase in 
size is seen from the sections to be due chiefly to sclerosis, the old ganglion consisting practically 
of a knot of connective tissue, in which are sparsely scattered small groups of nerve cells 
and fibres. 
In the cells themselves the most striking difference is the almost complete absence of 
nucleoli from the ganglion cells of the old man. Coupled with this is the extremely shrunken 
condition of the nuclei. The cells in this instance are largely filled with pigment and fat, both 
substances showing black in osmic acid specimens, the pigment being yellow and the fatty 
masses being represented by large vacuoles in sections by the corrosive sublimate method. 
Careful measurements and estimates of pigment are given in tables. Similar changes are 
not found in the brain cells. 
No. 372, 
IN WHAT WAY DOES ATROPIN ELEVATE THE TEMPERATURE? 
Isaac Ott, M. D., 
Easton, Pa. 
In this paper I shall show that the elevation of temperature is not spinal but cerebral in 
origin and probably partly due to an action upon the medulla oblongata. 
THE RELATION OF THE NERVOUS SYSTEM TO HEAT PRODUCTION. 
Isaac Ott, M. D., 
Easton, Pa. 
The aim of this paper will be to show by experiment, both thermometric and calorimetric, 
that the action of the nervous system is mainly thermotoxic. 
148 PRELIMINARY REPORT UPON THE ACTION OF SOME METALLIC SALTS. 
Isaac Ott, M. D., 
Easton, Pa. 
This paper consists of a series of experiments upon the circulatory apparatus with lantha- 
num, thorium, ittrium, neodymium, praeseodymium and zirconium. It will try to show that 
they are all cardiac depressants. 
No. 873. How does Atropin Elevate the Temperature,” by Isaac Ott, M. D., Easton, Pa. 
[Abstract.] 
No. 374. “The Physiological Action of Lanthanum, Thorium, Ittrium, Praseo-digmium, Neo- 
digraium and Zirconium. Preliminary note. By Isaac Ott, M. D., Easton, Pa. 
[Abstract.] 
149 SECTION ON DISEASES OF CHILDREN. 
HONORARY PRESIDENTS 
Dr. S. S. Adams, Washington; Dr. A. D. Blackader, Montreal, Canada; Dr. Sam’l C. Busey, 
Washington; Dr. Charles Warrington Earle, Chicago; Dr. F. Forchheimer, Cincinnati; Dr. L. 
Emmet Holt, New York; Dr. A. V. Meigs, Philadelphia; Dr. W. P. Northrop, New York; Dr. J. 
O’Dwyer, New York; Dr. C. I. Putnam, Boston; Dr. T. M. Rotch, Boston; Dr. J. Lewis Smith, 
New York; Dr. Louis Starr, Philadelphia; Dr. J. E. Winters, New York; Dr. Jesus Valenzuela, 
City of Mexico, Mexico; Dr. I. N. Love, St. Louis, Missouri, 
Dr. John M. Keating, Colorado Springs, Colorado. 
EXECUTIVE PRESIDENT : 
SECRETARIES: 
Dr. F. M. Crandall (English-Speaking), Dr. Damaso Laine (Spanish-Speaking), 
No. 113 W. 95th St., New York, N. Y. Media, P*. 
Dr. Larguia [Viamont 332] Buenos Aires Argentine Republic. 
Dr. Enrique Hertzog . La Paz Bolivia. 
Dr. Carlos A. Moncorvo deFigueredo ...... Rio de Janeiro U. S. of Brazil. 
Dr. Antonino Gomez Calvo [Carrera 5 Num. 92] . . Bogota Republic of Colombia. 
Dr. Joaquin L. Duenas [San Miguel 75] Havana Cuba. 
Dr. Domingo Alvarez Guatemala City Guatemala. 
Dr, Saint Leger-Perrier Port au Prince Haiti. 
Dr. F. L. Miner Honolulu Hawaii. 
Dr. Andres Lopez Martinez Tegucigalpa Honduras. 
Dr. Ramon Icaza [Ratas 9] City of Mexico Mexico. 
Dr. Carmen Bengochea Managua Nicaragua. 
Dr. Pedro Castro [lB de Julio 422] Montevideo Uruguay. 
Dr. Luis A. Ibarra Caracas Venezuela. 
150 SECTION ON DISEASES OF CHILDREN. 
No. 401. “ The most Successful Method of Treating Croup,” by Joseph O’Dwyer, M. D., 
New York City, N, Y. 
[Abstract not furnished.] 
No 402. “The Teaching of Hygiene in Colleges and Public Schools,” by F. Forchheimer, 
M. D., Cincinnati, O. * 
[Abstract not furnished. 
No. 408. “ Clinical Aspects of Infant Feeding,” by E. P. Davis, M. D., Philadelphia Fa. 
[Abstract not furnished.] 
No. 405. “ General Principles Underlying all Methods of Infant Feeding,” by T. M. Hutch, 
M. D., Boston, Mass. 
[Abstract not furnished.] 
No. 406. “The Time and Mode of the Introduction of the Exotic Diseases of Children into 
America,” by J, Lewis Smith, M. D., New York City, N. Y. 
[Abstract not furnished.] 
No. 407 
PHYSICAL TRAINING OF PUBLIC SCHOOL CHILDREN. 
J, Gardner Smith, M, D., 
New York City. 
The training of the body and mind by mechanical means is emphasized by the 
university, the college, the seminary, and the prison, but the public school children till 
quite recently have been allowed to grow up with little or no attention to bodily develop- 
ment. 
Need.—The need of such training is apparent, both as a hygienic and a pedagogic 
measure. 
Pedagogic.—The voluntary muscles contain perhaps one-quarter of the blood in the 
body and through their activity a large proportion of the potential energy of the body is 
151 changed into work and heat. This energy stimulates the growth of both mind and 
muscle. As a result we have quicker perception, better judgment of external objects and 
distances, better co-ordination of muscles, and a brighter mind. 
Hygienic.—From an examination of upwards of 2000 children during the past two 
years we note faulty sitting and standing position, lack of control of thoracic muscles; a 
chest expansion of boys, 1.1 inches; of girls, .9 inch, with a small amount of comple- 
mental air and reserve; scoliosis in boys, 10 per cent; in girls, 10 per cent. After eight 
months’ exercise, boys’ chest expansion was 1.9 inches ; in girls, 1.8 ; scoliosis improved 
except in two eases. 
System.—The system pursued should meet the demands, hygienic, educative and 
recreative. It should be a broad system comprising the physiological and progressive 
arrangement of Professor Ling, the grace and beauty of expression of Delsarte and the 
interest and recreative element of the German work. 
Teacher.—The teacher should be familiar with all the so-called systems, but more 
than this, with the human body in health and disease, being able to examine the scholars 
and adapt the exercises to their needs. 
Method.—Exercises permissible in school may be classified as follows : 
Training in sitting position ; training in standing position ; training in breath- 
ing, upper thoracic, lower thoracic and diaphragmatic; marching, running, hopping, 
skipping and jumping; calisthenic exercises (without apparatus); light gymnastic exer- 
cises (with apparatus) ; dumb-bells, wands, bar-bells, rings, Indian clubs, etc.; heavy 
gymnastics—horse, buck, parallel and horizontal bars, vaulting, ladder, rings, etc.; games 
—innumerable games, especially in spring and fall, with much of the other exercise 
should be done out of doors. 
Hoorn.—Assuming that we have a gymnasium or a room well ventilated with 200 
cubic feet of air space for each individual, and most modern adjustable desks and seats, 
there are innumerable groups of exercises which may be done by the scholars as often as 
every half hour at least. 
Position.—Motion is one of the means of rest to the growing child. He should not 
be restrained in any one position more than five or ten minutes, or allowed to assume 
attitudes tending to deformity. 
Calisthenics,—Exercises in a sitting position may be alternated with risings, facings, 
marchings, and calisthenics at intervals, from one to five minutes at a time. Much 
attention should be given to the “ position of the soldier,” and to the training of the chest 
and the various breathing exercises. 
Gymnastics.—As Dr. Lincoln remarks, in Dr. Keating’s Cyclopedia “ Calisthenics 
lack one essential element, they do not call for exertion to overcome resistance,” neither 
do they furnish the desired recreation that is enjoyed in light and heavy gymnastic 
exercise. 
Games.—Of course the element of fun is greatest in the so-called u games.” They 
should not, however, be carried to fatigue during study hours, but are extremely profit- 
able as recreation and exercise. 
Graded drills.—The following is a classification of the graded drills used iu the New 
York City schools to June 80, 1893. 
152 la the grammar departments : 
First Grade, advance Indian club drill, No. 1. 
Second Grade, advanced bell-bar drill, No. I. 
Third Grade, wood dumb-bell drill, No. 1. 
Fourth Grade, bell-bar drill, No. 2. 
Fifth Grade, wood dumb-bell drill, No. 2. 
Sixth Grade, short wand drill, No. 1. 
Seventh Grade, wood dumb-bell drill, No. 3. 
Eighth Grade, calisthenic dumb-bell drill, No. 4. 
For the primary departments : 
First Grade, Indian club drill, No. 2. 
Second Grade, anvil chorus dumb-bell drill. 
Third Grade, short wand drill, No. 2. 
Fourth Grade, wood dumb-bell drill, No. 5. 
Fifth Grade, ring drill, No. 1. 
Sixth Grade, calisthenic drills, Nos. 1 and 2. 
How taught,—The director of physical training should visit each school at intervals, 
reviewing the past and explaining some new exercise. The plan has worked well in 
New York, each teacher instructing his or her own class. There is a great demand for 
physical training, and members of this congress can do much to make the introduction 
and progress successful and beneficial. 
With printed and illustrated drills. 
No. 408. “ Palmus,” by Landon Carter Gray, M. D., New York City, N. Y. 
[Abstract not furnished.] 
No. 409. “ Enteroclysis in Intestinal Diseases of Children,” by Edwin E. Graham, M. D., 
Philadelphia, Pa. 
[Abstract not furnished.] 
No. 410, 
BACTERIOLOGICAL DIAGNOSIS OF DIPHTHERIA. 
Harold C. Ernst, M. D., 
(1) A brief consideration of our present knowledge of the etiology of the disease. 
(2) The necessity for'a distinction between the diphtheria produced by the Klebs-Loffer 
bacillus and pseudo-diphtherias, the result of the activity of other bacteria and closely 
resembling it clinically. 
(3) Emphasizing the fact than a differential diagnosis can only be made by bacterio- 
logical examination. 
(4) Showing how this may be done. 
Boston, Mass. 
153 No. 411. “Aphasia in Children,” by Frederick Peterson, M. D., New York City, N. Y. 
[Abstract not furnished.] 
No. 412. “Studies in Infant Feeding,” by Henry Dwight Chapin, M. D., New York.N. Y 
[Abstract not furnished.] 
No. 413. 
THE RACE FACTOR IN DISEASE. 
J. Wellington Byers, M. D., 
Investigation in regard to the nature and influence of the contributory or predisposing 
conditions of disease demonstrate the fact that race with its concomitants and peculiarities 
of tissue and structure possesses and exercises an important modifying effect upon both the 
advent and type of morbid phenomena. 
A gross comparison of the physiological characteristics of the white, yellow and 
black races suggests a higher and a lower form of organization, though variatious in skin, 
hair, size and shape of skull and face do not afford an explanation of these diversities of 
disease and we must pass beyond these to still finer and more subtle peculiarities of tissues 
or ceils as the ultimate causes. Recent developments in relation to the questions of immu- 
nity demonstrates that the vulnerable state is our partaking largely of cell incompetence, 
and exemption from infectious agencies depends upon cell actions and products. Such 
being true we must conclude that the factor of race carries with it certain inherent peculiari- 
ties of cell powers which control and modify disease processes. In saying this we must 
not be understood as implying that these conditions are themselves incapable of modifica- 
tion, for we know that climate, class, occupation, habitation and mode of life will each and 
all cause a fluctuation in these inherent conditions; still these qualities which exist by virtue 
of race are always more or less evident, and no amount of perturbing influences will 
completely and entirely suppress them. Hence it is the Anglo-Saxon people show unusual 
tendency to scrofula and consumption and to diseases allied to these in character; the negro 
is exempt largely from malaria, scarlet fever and yellow fever, and the Semitic people are 
prone to cancer and melancholia, though exempt from contagious disease to a degree war- 
ranting the idea that they possess a charmed life. 
Charlotte, N. C. 
No 414. 
THE TREATMENT OF EMPYAEMA IN EARLY LIFE, 
H. Brothers, M.D., 
New York. 
The structural differences in the chest walls of children and those of adults are 
sufficiently distinct to justify the separate consideration of empyaema as it occurs in child- 
hood, especially in regard to treatment. From the standpoint of bacteriology new 
light has been cast on the pathology of empyaema, but its treatment has remained 
unaffected. Clinically the disease is divided into two groups of cases: (1) Acute or 
primary empyaema; (2) subacute or secondary empyaema. Regarding diagnosis, reliance 
154 is chiefly laid on two signs: (1) The percussion note; (2) exploratory puncture. The 
prognosis of simple empyaema not operated upon is bad, one-third of the cases dying in 
eleven to sixteen days. Therefore operative interference is urgently indicated. A 
description of the various methods of treatment follows. Statistics by other operators are 
quoted. 
Next follows a study of seventy-one operated cases of empyaema—twenty-one of 
which were done by the author and the remaining fifty gathered from the practice of a 
few friends. 
The next table refers to the mortality at different ages. 
Regarding sex, the disease occurred (in forty-nine cases) thirty-one times in male 
children and eighteen times in female children—nearly double as often in males. Both 
sides of the chest were equally affected. 
The diagnosis was made as early as the third day or as late as six mouths. The 
youngest case operated in the list was seven months old. 
The results of aspiration were unfortunate. Of eighteen cases, seven died, two 
recovered, and nine required subsequent operations (incision and drainage). Personally 
the author has only once resorted to aspiration in empyaema and that case died. 
After simple incision with drainage, in forty-six cases in which the point was noted, 
the healing process required on the average a little less than seven weeks. The extremes 
varied between thirteen days and three months. 
The complications noted embraced ; lobar pneumonia of the same or opposite side, 
diphtheria, scarlet fever, measles, influenza, nephritis, laryngitis, post-pharyngeal adenitis, 
tuberculosis, scrofulosis, pyaemia, pulmonary oedema or empyaema of the opposite side. 
The dangers attending operative interference include collapse during anaesthesia and 
emphysema about the wound; after the operation may follow uncontrollable coughing 
(due to pressure of tube), incessant vomiting, hyperpyrexia, erysipelas, sepsis, pyaemia. 
Among the causes of death were shock, pneumonia of opposite lung, nephritis, 
exhaustion, acute gastro-intestinal catarrh, erysipelas, sepsis and pyaemia. 
Preventive treatment consists in avoiding overcrowding in the tenements and observ- 
ance of personal hygiene. 
Regarding medicinal treatment, resort must be had to free stimulation and general 
symptomatic treatment. . . . 
The best operative treatment in the empyaemas of childhood consists in the method 
of simple incision with drainage. Under certain circumstances treatment by aspiration or 
rib-exsection is also indicated. 
No. 415. 
A CONTRIBUTION TO THE KNOWLEDGE OF ACUTE PRIMITIVE 
ENTERO-COLITIS DURING LOW INFANCY. 
By Joaquin L. Duenas, M.D., 
Havana, Cuba. 
Clinic and demography show that in Havana, morbidity and mortality due to 
enteritis is as great as in any other city. Thirty-three per cent of children dead before 
their second year are the victims of acute diarrhea. 
155 The etiological conditions that provoke them are : 
(1) Infected condition, soil, air and water. 
(2) Altered state of cow’s milk. 
The fermentation of milk is dependent on many a different cause : adulterations, 
heat, etc. 
Clinical forms can be limited to two types, viz,, cholera infantum and entero-colitis. 
No relation is to be detected between morbid and etiological especificity, the same 
infectious agent, such as milk alterations, B. coli-commuue, impaludism, etc., can provoke 
the same clinical type. 
Etiological and clinical diagnosis will only be concordant when supported by ample 
and sufficient information, which are some of the resorts of clinical investigation, others 
consisting of laboratory researches, and anatomo-pathological considerations. 
Infection of the intestine is the cause of entero-colitis of children. The analogies 
observed in termical evolution, symptoms and results of therapeutics, induce me to claim 
their identical nature. Comparative mortality observed in the sketches during the years 
1888-92 is well adapted to maintain this position. 
The principal forms of entero-colitis occurring in Havana are—the common form 
quoted by the authors, the gastric, the thoracic (severtre) aud the cerebral; the remittent 
typhoidic and choleric varieties are also very frequent. Treatment is based in four capital 
indications : (1) Delivering the intestinal duct of matters residing in it. (2) Securing its 
antisepsy aud the functional repose of the organ. (3) Reparation of organic waste. (4) 
Attacking of the symptoms aud complications. 
It is very important to find out the genesis of the disease from the beginning. 
The medications which have afforded the best results are the following: first of all, 
calomel; secondly, antisepsy of the intestine, watery diet, alimentary hygiene ; if paludism 
is to be supposed present, quinine may be administered ; also, opium, alcohol, tonics, 
caphein, acids, alkalines, etc. 
Baths, frictions, revulsions and other resources, whose application has great influence 
in the ultimate results, are not to be forgotten. 
SYNOPSIS. 
Male 93 
Female 62 
CASES. MORTALITY. 
Lactated by their mother 41 7.32 per cent. 
Artificially nourished 114 21.93 “ 
./ Cholera infantum 12 66.00 “ 
orms [ Entero-colitis 143 13.99 “ 
No. 417. “The Surgical Treatment of Empyema in Children,” by John B. Deaver, M. D., 
Philadelphia, Pa. 
[Abstract.] 
156 No. 418. 
“ The Production of Cow’s Milk Designed for Infant Feeding,” by Henry L.Coit, 
M. D., Newark, N. J. 
[Abstract.] 
No. 419. “ The Proper Mode of Preventing and Treating Diphtheria, Based on Recent Dis- 
coveries Relating to its Etiology and Pathology,” by J. Lewis Smith, M. D., 
New York City, N. Y. 
[Abstract not furnished.] 
No. 420 
THE NORMAL PRAECORDIA IN INFANCY AND CHILDHOOD. 
H. B. Whitney, A. 8., M. D., 
It is is with great surprise that one finds how little careful attention has been paid to 
the normal praecordial dullness in infants and children. Weil says that up to the age of 
twelve or fifteen the praecordial dullness extends somewhat beyond the right sternal 
margin. Rotch states in his article in Keating that in infancy the praecordia has the 
same boundaries as in the adult, while from the second or third up to the eighth or ninth 
year there is frequently some dullness over the lower half of the sternum. Other authors 
are silent. 
Denver, Col. 
The subject is important, no less in children than in adults. A cardiac enlargement 
can only be determined when the normal limits at different ages are known. The diagnosis 
also of slight cardiac displacement, one of the most valuable signs of pleuritic effusion, 
depends upon an exact knowledge of normal conditions. 
From a somewhat extended series of observations the writer has reached the follow- 
ing conclusions:— 
In children up to the beginning of the sixth year, the relative dullness of the normal 
heart has practically the same limits as in the adult, namely, (vid. Fig. 1), above and to 
the left, a curved line extending from the junction of the third rib and sternum outward 
and downward to the apex of the heart in the fourth and fifth interspace at or a little 
within the mammary line. The right boundary (the most important as being the most 
variable in pathological conditions) is a perpendicular line corresponding very nearly with 
the left border of the sternum from the third to the sixth costal attachment. The lower 
half of the sternum is therefore of the same resonance as the upper half in children under 
six years of age. 
From the fifth to the ninth year the praecordial dullness varies in different cases of 
the same age. In a few even at six years some slight dullness will be found over the 
lower half of the sternum. A considerable proportion, however, of children between five 
and nine have still the praecordia of infancy, this number diminishing as the end of the 
eighth year is approached. 
In children over eight years and up to about the age of puberty the praecordia. differs 
widely from that of infancy and adult life. The upper boundary is usually higher (Vide 
157 Fig. 2), it is often found at the second interspace and occasionally at the second rib. The 
apex is generally one-quarter to one-half inch outside the mammary line. The chief 
difference is in the right border. Instead of a perpendicular it is now a curved line which 
meets the line of liver dullness at a point one and a quarter to one and a half inches to the 
right of the median line. There is, therefore, relative dullness over the lower half or 
two-thirds of the sternum. 
In the percussion of the heart, both in children and adults, the following points de- 
serve attention: First, only light percussion should be used ; second, marking the changes 
of resonance upon the chest wall is extremely serviceable; Third, to determine the reson- 
ance of the lower portion of the sternum comparison should be made, not with the full 
pulmonary resonance along its right border, nor with the cardiac flatness along its left, 
but with the resonance of its upper half. Percussion should therefore be made from 
above downward, and if an oblique line of dullness is reached above the line of hepatic 
dullness at the level of the sixth rib, it may safely be ascribed, except in the second half of 
childhood, to an enlargement of the right heart or to cardiac displacement. 
No. 421. 
INTESTINAL PARASITES FOUND IN PORTO RICO. 
Antonio I. Amadeo, M. D., 
Maunabo, Porto Rico. 
They constitute the most frequent trouble among the children of the island, and some 
adults also suffer the same malady. The ascarides lumbricoides is the parasite generally 
found, with the usual symptoms. It is surprising to see the number of lumbricoides 
passed by children when sick, not only through the rectum but also by the mouth. 
Enteritis caused by these parasites has been observed by the author in calves, which 
had sanguinolent discharges and died exhausted, none of them passing any worm, but 
when opened after death the intestines were full of ascarides lumbricoides. 
The fever, gastro-intestinal disturbances, nervous symptoms, etc., shown by sick 
children in consequence of the presence of these parasites in the intestinal tubes, are very often 
attributed in Porto Rico to malaria, which seems to be the refugiura peccatorum of many 
practitioners who do not see anything else about them but the haemato-parasite of Laveran. 
Taenia, oxyurus vermiculares, and several other intestinal parasites are also met with. 
Extract of male fern, calomel, aloes, and castor-oil are generally the remedial agents 
employed. 
No. 422. “Immediate Percussion among Children,” by Dr. Olinto, Porto Algre, Brazil. 
[Abstract.] 
158 No. 423 
NOTES ON THE FEEDING OF INFANTS IN THE ISLAND OF CUBA. 
Joaquin L. Duenas, M. D., 
The most usual way of feeding a child during its first infancy in the Island of Cuba 
is by maternal lactation. As a general rule, it can safely be said that the Cuban woman 
is a fit subject for the suckling of her children, the conditions necessary for a good nurse 
being of course better in the country than in the cities. There is a general tendency to 
discontinue lactation too soon, the city woman under the pretext of debility, and the 
country woman adopting a bad mixed system, sometimes suckling her child off and on 
for two whole years, while her citizen-sister prefers an artificial mixed system or sharing 
her maternal duties with a wet nurse. 
Havana, Cuba. 
The milk ordinarily chosen in the city is cow’s milk, because it is cheap (five cents a 
pint), next ass’s milk is given when a physician so orders, and, lastly, goat’s milk and 
mare’s milk. 
Since 1890 sterilized milk has been employed, which sells at Havana at ten cents for 
a half pint, and about 10,000 bottles a month are now sold. 
In the Maternity Hospital, of Havana, only wet nurses are employed, one for each 
child; its cost (salary, board, etc.) is forty-five dollars a month each, and the number of 
children usually admitted about twenty-seven or twenty-eight. 
In the country cow’s milk is given from the third or fourth month, or at the same 
time that the mother suckles her child, and in places where cow’s milk is not easily got, 
goat’s or mare’s or ass’s milk is substituted for it. 
The first cooked food given to the child in the city is a mixed powder made up of 
sago and wheat flour, sugar and pulverized crackers, which the mother puts into milk or 
stirs it in a little bouillon. Crumbs of bread fried in a pan, bananina, light bread soup, 
and latter on vermicelli soup, tapioca, etc., are also given. In the country paps of sago 
or wheat flour are used, but more frequently corn flour or fried green plantain powdered 
in a mortar is employed. 
Sometimes before the third or fourth month very imprudently the child is given 
sweet potato, rice, malanga (a farinaceous root of great consumption in Cuba, the arum 
sagitse folium). 
The bad (the author calls it “ vicious ”) mixed system to which reference has been 
previously made, as adopted by the Cuban country woman, consists in letting the child 
eat every thing. From that source the frequent dyspepsias, the ventre gros of Bauinel, 
the successive attacks of enteritis, and secondary infection of the intestines arise. 
No. 424. “ Pertussis as it Exists in the Rocky Mountains,” by John hi. Keating, M. D., 
Colorado Springs, Col. 
[Abstract not furnished.] No. 425 
TYPES OF GASTRO-INTESTINAL DISEASE PREVALENT IN NEW YORK. 
Floyd M. Crandall, M. D., 
The gastro-iutestinal diseases common to young children are especially prevalent in 
large cities, where all the conditions exist which are active in their production. In New 
York over 30,000 children die of diarrheal diseases during each decade. Diarrheal 
diseases occur daring every mouth of the year, but they do not become seriously prevalent 
until the middle of June, During the last ten days of June these diseases usually begin 
to develop in large numbers. They are most prevalent during the first twenty days of 
July. At that date the number of new cases decidedly diminishes. During the six weeks 
between July 20th and September Ist the development of new cases is quite uniform, 
being less than half that of early July. During the latter part of September there is 
again a decided increase in new cases. These variations are represented by a chart based 
upon a study of diarrhea during four years. Numerous factors contribute to the results 
shown by this chart, heat being one of them. 
The prevailing type of the disease changes with the season. During June and early 
July the prevailing type is that of acute dyspeptic diarrhea. The diarrhea at this 
period is largely of the serous type. In August the prevailing disease is marked by less 
watery stools, much less frequent in number; and entero-colitis is common. During the 
latter part of September a prevailing type of disease develops of which but little is seen 
earlier in the season, the so-called dysenteric diarrhea. 
Study of these variations shows that, although age is an active etiological factor it 
has but slight influence upon the type of disease. 
Observations are reported upon various symptoms of diarrhea. In a large number 
of cases disordered digestion in some form preceded the actual attack of diarrhea. In 
72 per cent of the dyspeptic cases, the onset was definite or sudden ; and in the dysenteric 
form the onset was sudden in a much larger proportion. The number of stools per day 
varied in dyspeptic diarrhea from two or three to twenty or thirty, the common range 
being from six to fifteen; in entero-colitis the common range was from eight to twelve ; 
and in dysenteric diarrhea twelve to twenty. 
The fact that diarrhea is, accurately speaking, a symptom, not a disease, is demon- 
strated by the study of certain types. Observations are reported upon other symptoms— 
number and color of the stools, the occurrence of vomiting, pain and fever. From these 
studies several types of diarrhea are described, no claim being made, however, that they 
are sufficiently distinctive to be characterized as classes worthy of a specific name. 
New York City. 
No. 426. 
THE INSANE DISORDERS OF CHILDHOOD. 
John Madison Taylor, A. M., M. D., 
Insanity arising from the same sources as in the adult is rare in childhood, but 
mental defects are common and grow rapidly worse unless wisely bandied. 
Philadelphia, Pa. 
160 The causes of these states are numerous. Some result from depressed physical 
powers, but more are the result of careless usages and vice. There is danger in certain 
parental tendencies and vitiated appetites from the use of alcohol, opium and tobacco. Tuber- 
culous families and those with notable unstably nervous equilibrium are subject to numerous 
mental disorders. The childish brain is vulnerable at all times, and is readily affected by 
conditions which would have no effect upon the adult. Moral causes, as shock, fright, or 
dread, are active factors in disturbing the mind, as are also religious teachings of a lurid 
hyperbolic type. Acute febrile diseases, want and exposure, are also causes of mental 
derangement. Medicines are often quite useless, but moral control and tactful domination 
must be ever forthcoming. It is rare to find a mother capable of training a child of this 
tyPe- 
The insane disorders, as the term is used here, include not only insanity but that 
mixture of hysteria and insanity which is often almost indistinguishably blended. 
Hysteria in the larger significance of the word must not be excluded. It imitates all 
neuroses but never presents a picture faithful in essential details. While pre-eminently an 
imitation it is not all true simulation. In children it is rarely suspected, but it is possible as 
soon as the receptive faculties and power to form concepts are fairly established. Acute 
hysteria and organic brain disease may co-exist, but it is rare in childhood. 
Mental perversions are hard to distinguish from merely evil and vicious tendencies. 
A large familiarity with hysterical states increases respect for the difficulties of 
diagnosis. In the management of these children of hysterical and maniacal tendencies 
the most important step to be gained by the physician is to gain the confidence of the child. 
It is best to show and preserve a frank, quiet, but persistently friendly demeanor. It is 
well to efface as far as possible the difference in age or position between the physician and 
patient. Corporal punishment is sometimes needed. Some children of low tone or 
vicious hysteroidal character are amenable to no other argument. More often gentle 
admonition or kindly encouragement will suffice. A jocose bantering tone is always to 
be avoided. Children of pauper and criminal classes need most careful watching and 
unusual training in the fundamental principles of morality. Instead of this, they 
usually get too much liberty and religious teaching. The latter tends to foster an 
exaggerated emotion. Moral instruction should always precede the religious. 
A detailed history of several cases illustrating the points brought out in the paper is 
appended. 
No. 427. 
CIRRHOSIS OF THE LIVER INT CHILDHOOD. 
(Second communication.) 
By William A. Edwards, M. D., 
[Microscopic report by William M. Gray, M. D., Microscopist Army Medical Museum, Washington, D. C.] 
San Diego, Cal. 
In the present communication it is our desire to further study the case which formed 
the basis of a paper on the subject of hepatic cirrhosis in children, that appeared in the 
161 Archives of Pediatrics, July, 1890, and to present the results of the post-mortem 
examination in this case, together with the microscopic studies and photomicrographs of 
Dr. Gray. 
The disease pursued the usual course as seen in the adult. Gastric disturbances, 
coated tongue and foul breath, occasional nose bleed, constipation alternating with 
diarrhea, headache, dry harsh skin, jaundice, stigmata, some side pain, lassitude, languor 
-and drowsiness. 
Thirty days before death ascites arose, in twenty days the belly became enormously 
(distended with serum, the legs were cedematous, the veins of the breast and abdomen 
greatly distended. The pulse 120, respiration 30, temperature 100 F. Total quantity 
of urine passed in twenty-four hours, sixteen ounces, small amount of albumen and a few 
granular tube casts. 
On September 13,1890, assisted by Dr. Le Fevre, I performed paracentesis abdominis 
and withdrew one and one-half gallons of clear fluid. For twenty-four hours there 
was a free drainage of clear serum from the puncture, the next day it decreased to almost 
nothing. The child became drowsy and complained of abdominal distress and pain ; the 
original puncture in the abdominal wall was enlarged and a rubber drain inserted, and at 
once two pints of fluid drained away. This fluid was, however, no longer clear but 
contained some pus. Slight improvement was noted in the child’s general condition. 
The temperature remained lower, the pulse below 100 and the respirations below twenty, 
but this gain was of short duration. The urine became scant, high colored and bile 
stained, and was voided with difficulty. The child grew progressively weaker, and 
weaker, hiccough arose, the temperature became subnormal and the pulse extremely 
irregular. The urinary secretion was almost suppressed, and finally, on the evening of 
September 23, convulsions arose which persisted until death on the 24th. These 
convulsions were most severe, clonie in nature and lasted for fifteen or twenty minutes, 
with only short intervals between. Death occurred in one of these spasms. 
Post-mortem.—Six hours after death, assisted by Drs. Le Fevre and T. A Davis. 
Child much emaciated. Several petechial spots over thighs, legs and chest. 
Thorax.—Heart small, cavities dilated and contained clots. Valves normal. Aorta 
healthy; muscle slightly fibroid ; lungs and pleurae healthy. 
Abdomen.—Peritoneum thickened and venous channels greatly dilated. Stomach.— 
Mucous membrane thickened and slightly ecchymotic. Spleen weighed nine ounces and 
appeared to be normal, except that it was intensely congested. The liver is well repre- 
sented in the accompanying photograph. It weighed twenty-six ounces and is a 
remarkable example of atrophic cirrhosis. Its microscopic changes are most graphically 
and accurately presented in the photomicrographs of Dr. Gray. 
It is somewhat remarkable that life could be sustained with such an important organ 
as the liver in the advanced state of disease shown by the specimen; the organ was 
practically converted into a mass of fibrous tissue. 
The gall-bladder was comparatively normal, its mucous membrane slightly thickened. 
Contained a small amount of thin bile. No calculi. 
The kidneys were large, swollen, congested and hyperaemic; they could be classed 
as examples of parenchymatous nephritis. The intestines were normal with the exception 
162 of the vermiform appendix, which was gangrenous from its terminal extremity almost to its 
origin in the caecum. There was, however, no perforation. It contained no concretions 
or faecal matter. I was unable to determine why this gangrenous condition existed ; 
had the child survived a few days longer perforation would undoubtedly have occurred. 
The rectum and bladder were not diseased. Brain and spinal cord not examined. 
A review of the literature and deductions from the microscopic studies complete the 
paper. 
No. 428. “ The Feeding of Children in Mexico,” by Dr. J. Ramon Icasa, City of 
Mexico, Mexico. 
[Abstract.] 
No. 429 Address, by W. S. Christopher, M. D., Chicago, 111. 
163 SECTION ON PATHOLOGY. 
I>R. ANTONIO J. Amadeo, Maunabo, Puerto Rico; Dr. Francis Delafield, New York ; Dr. George 
Duffield, Detroit; Dr. John Guitkras, Philadelphia; Dr. F. S. Johnson, Chicago; Dr. Morris Long- 
streth, Philadelphia; Dr. Alfred L. Loomis, New York; Dr. L. D. Mignault, Montreal; Dr.T. Francisco 
Puelma, Santiago, Chili; Dr. Jose M. Quirooa, Lima, Peru; Deputy Surgeon General Geo. M. 
Sternberg, U. S. Army ; Dr. Clark Stewart, Minneapolis, Minn.; Dr. Joshua M. Van Cott, Brooklyn, 
N.Y.; Dr. Joaquin V£rtiz, City of Mexico; Dr. William H. Welch, Baltimore; Dr. J. J. Cornilliac, 
St. Pierre, Martinique; Dr. W. T. Councilman, Boston, Mass.; Dr. Juan Landkta, Havana, Cuba; Dr. 
John ij. MysSER, Philadelphia, Pa.; Dr.E. O. Shakespear, Philadelphia, Pa. 
HONORARY PRESIDENTS: 
Dr. John Guixfeßas, 4914 Sansom Street, Philadelphia, Pa. 
EXECUTIVE PRESIDENT; 
SECRETARIES: 
Dr. David Inglis (English-Speaking), Dr. Louis F. Criado (Spanish-Speaking), 
21 State St., Detroit, Mich. 147 Ft. Greene PL, Brooklyn, N. Y 
Dr. Wernicke [Victoria 1194] Buenos Aires Argentine Republic. 
Dr. Enrique Hertzog La Paz Bolivia. 
Dr. Leopoldo Mendes Costa Riode Jancrio U. S. of Brazil. 
Dr. John Caren Toronto Canada. 
Dr. Raimundo de Castro [Salud esq. a Gervasio] . . Havana Cuba. 
Dr. Nicolas Osorio [Calle 13 niim. 181} Bogota Republic of Colombia. 
Dr. J. Carreau Point a, Pitre Guadeloupe, F. W. 1. 
Dr. Samuel Gonzalez Guatemala City Guatemala. 
Dr. F. L. Miner Honolulu Hawaii. 
Dr. Rafael FIALLOS Tegucigalpa Honduras. 
Dr. Francisco Hurtado [Leon 9] ........ City of Mexico Mexico. 
Dr. J. MARTINEZ Granada Nicaragua. 
Dr. David Matto [Facultad de Medicina] Lima Peru. 
Dr. Alfredo Vidal Y Fuentes [Sierra 8] Montevideo ...... .Uruguay. 
Dr. M. M. Ponte , , , , , , Caracas Venezuela. 
164 SECTION ON PATHOLOGY. 
[Abstracts received too late for publication.] 
No. 451. “ Abscess of the Liver,” by James E. Reeves, M. D., Chattanooga, Tenn. 
No. 452. “ Notes on Three Years’ Work in the Pathological Laboratory of the Charity Hos- 
pital of New Orleans,” by Henry Dickson Bruns, M. D., New Orleans, La. 
No. 453. Paper, by Wm. Henry Welch, M. D., Baltimore, Md. 
No. 454. Paper, by W. T. Councilman, M. D., Boston, Mass. 
No. 455. “ Influenza,” by Ramon Guiteras, New York City, N. Y. 
No. 456. “A Bacteriological Observation on the Waters of the Harbor of Havana,” by Drs. 
Acosta and Grande, Havana, Cuba. 
No. 457. “ Pathological Histology of Yellow Fever,” by Drs. Acosta and Grande, Havana, 
Cuba. 
No. 458. “ Investigations Concerning Malaria,” by Drs. Coronada and Madau, Havana, 
Cuba. 
No. 459. “ Bacteriological Studies in Havana,” by Dr. Davalos, Havana, Cuba. 
No. 460. “ Investigations upon the Carbuncle in Cuba,” by Dr. Coronado, Havana, Cuba. 
No. 461. “Observations on the Anti-Rabic Treatment of Pasteur,” by Dr. Acosta, Havana., 
Cuba. 
No. 462. “ Aetiology of Cancer with Especial Regard to the Protozoa Parasites of Cancer,” by 
Allen J. Smith, M. D., Galveston, Texas. 
No. 463. “Contribution to the Study of Cancer,” by Dr. Wernicke, Buenos Ayres, Argen- 
tine Republic. 
No. 465. “ Yellow Fever of the Creoles and the Negroes,” by Dr, A. J. Amadeo, Maunabo , 
Porto Rico. 
No. 466. Paper, by E. O. Shakespeare, M. D., Philadelphia, Pa. 
No. 467. Paper on Yellow Fever (definite title not yet furnished), by Dr. C. Heineman, 
Yera Cruz, Mexico. 
No. 468. “ Theories of Inflammation,” by Dr. Jose Torres Matos, Havana, Cuba. 
No. 469. “ L’etat de Hyperexcitabilite du nerf Phrenique Daus le Beriberi,” by Dr. J. B. 
Da Lacerda, Rio de Janeiro, Brazil. 
165 No. 470. “ Paludismo,” by Dr. Antonio Jose Amadeo, Maunabo, Poi’to Rico. 
No. 471. “ Pathology at the Institution for Feeble-minded Children, at Elwyn, Pa.” by Henry 
W. Cattell, M. D., Philadelphia, Pa. 
No. 472. “The Epithelio-genetic Origin of Cancer,” by Joseph McFarland, M. D., Phila- 
delphia, Pa. 
No. 473. “ Cancer,” by Dr. Wernicke, Buenos Ayres, Argentine Republic. * 
[Formal Discussion, with Professor Allen J. Smith as Co-referee.] 
No. 474. “ Cancer,” by Joshua M. Van Cott, M. D., Brooklyn, N. Y. 
No. 475. “Cancer,” by Joseph McFarland, M. D., Philadelphia, Pa. 
[Formal Discussion.] 
No. 476. “ Yellow Fever,” by Drs. Acosta and Grande, Havana, Cuba. 
[Formal Discussion, with Dr. A. J. Amadeo, of Porto Rico, as Co-referee.] 
No. 477. “ Practical Demonstration of the Methods in Pathological Histology,” by James E. 
Reeve, M. D., Chattanooga, Tenn. 
[Demonstration,] 
No. 478. “Practical Demonstration of the Methods in Photography Applied to Pathology,” 
by Wm. M. Gray, M. D., Army Medical Museum, Washington, D. C. 
[Demonstration.] 
N0*479. “Practical Demonstration of Methods in Bacteriology,” by J. J. Kinyoun, M.D., 
U. S. Marine Hospital Service, Washington, D. C. 
[Demonstration.] 
No. 480. “ The Third Blood Corpuscle as a Pathological Product,” by R. L. Watkins, M. D., 
New York City, N. Y. 
No. 481. “On Cholera,” by Herman M. Briggs, M. D., New York City, N. Y. 
No. 482. “ Pathology of Pelvic Inflammatory Trouble,” by Joseph Price, M. D., Philadelphia, 
Pa. 
No. 483. Paper, by G. F. H. Nuttall, M. D., Baltimore, Md. 
No. 484. Paper, by Wm. Hughes, M. D., Philadelphia, Pa. 
No. 485. Paper, by W. J. Carter, M. D., Philadelphia, Pa. 
166 SECTION ON OPHTHALMOLOGY. 
HONORARY PRESIDENTS: 
Dr. Aurelio Alarco, Lima, Peru; Dr. Stephen C. Ayres, Cincinnati; Dr. Abner W. Calhoun, 
Atlanta, Ga.; Dr. Maximo Cienfuegos, Santiago, Chile; Dr. Carlos Finlay, Havana, Cuba; Dr. 
Herbert Harlan, Baltimore; Dr. Ferdinand C. Hotz, Chicago; Dr. Herman Knapp, New York; Dr. 
Charles W. Kollock, Charleston, S. C.; Dr. Chas. E. Michel, St. Louis; Dr. Dudley S. Reynolds, 
Louisville; Dr. Stephen O. Richey, Washington; Dr. Sam’l D. Risley, Philadelphia; Dr. Eugene 
Smith, Detroit; Dr. Jose Ramos, City of Mexico, Mexico; Dr. R. H. Lewis, Raleigh, N. C.; Dr. G. 
C. Savage, Nashville, Tenn.; Dr. Hasket Derby, Boston, Mass.; Dr. T. E. Murrell, Little Rock, 
Ark.; Dr. James L. Thompson, Indianapolis, Ind.; Dr. John E. Minney, Topeka, Kansas; Dr. E. C. 
Rivers, Denver, Colo.; Dr. C. J. Kipp, Newark, N. J.; Dr. C. M. Shield, Richmond, Va.; Dr. B. J. 
Baldwin, Montgomery, Ala.; Dr. J. F. Fulton, St. Paul, Minn.; Dr. H. L. Hilgartner, Austin, Texas; 
P)r. X. C. Scott, Cleveland, O.; Dr. E. J. Gardiner, Chicago, 111.; Dr. John F. Fulton, St. Paul, Minn. 
Dr. Julian J. Chisolm, 114 W. Franklin St., Baltimore, Md. 
EXECUTIVE PRESIDENT: 
SECRETARIES r 
Dr. Geo. M. Gould (English-Speaking), Dr. J. Harris Pierpont (Spanish-Speaking), 
119 S. 17th St., Philadelphia, Pa. Pensacola, Fla. 
Dr. Barraza [Cordoba 1471] Buenos Aires Argentine Republic. 
Dr. Cuthbert Bowen Bridgetown Barbados, W. I. 
Dr. Ernesto Mazzei La Paz Bolivia. 
Dr. Hilario de Gouvea Rio de Janeiro U. S. of Brazil. 
Dr. G. H. Burnham Toronto Canada. 
Dr. Proto Gomez [Carrera 8, num. 370] Bogota Republic of Colombia. 
Dr. Juan J. Ortega . . Guatemala City Guatemala. 
Dr. H. G. McGrew Honolulu Hawaii. 
Dr. Augustin Chacon [Escuela de Medicina] . . . City of Mexico Mexico. 
Dr. Rodlfo F. Herdocia Leon Nicaragua. 
Dr. Joaquin de Salterain [Canelones 8] ..... Montevideo Uruguay. 
Dr. Miguel Castilla Merida . Venezuela. 
167 SECTION ON OPHTHAUTOLOGY. 
No. 501(a). Formal Address by Julian J. Chisolm, M. D., Executive President of Section, 
Baltimore, Md. 
No. 501. 
SKIN GRAFTING AS A THERAPEUTICAL AGENT IN MALIGNANT 
GROWTHS OF THE EYELIDS AND OF THE ORBIT. 
F. B. Tiffany, M. D., 
Kansas City, Mo. 
In making these plastic operations much care should be taken to secure as good 
health as possible before operating, as the life of the plant depends much upon the general 
health of the patient. From one-fifth to one-fourth larger plant than the dimensions of 
the space it is to occupy should be secured, only the true skin, free, from fats, and no 
subcutaneous tissue is taken. Also the bed as well as the plant must be entirely free from 
hemorrhage, as blood in the cavity might give rise to suppuration and sloughing. The 
graft is secured by delicate silk or cat-gut, and the parts then carefully covered by gauze 
(antiseptic). Ido not use the isinglass plaster and collodion, nor do I ever use iodoform. 
I dress the parts daily, but do not disturb the plants for seven or eight days, usually 
leaving the sutures for this length of time. At first the graft is of a white, deathly, 
cadaverous appearance, but soon it takes on a red granular look and after a few days 
becomes normal; occasionally the epidermis turns black and may exfoliate, but there is 
not sloughing and soon perfect skin will assert itself. Cases in which I have resorted to 
plastic surgery with a view of indemnifying the parts against a return of malignancy are 
those of the orbit and of the eyelids. 
I have used it quite a number of times and as yet where I have employed it there 
has been no return of the cancerous growth. It has been my experience that these grafts 
are more sure to live without a pedicle than with. Care should be taken to select them 
from the part of the body where the skin is thin and free from hairs as possible. 
No. 502. “ Further Experiences in Graduated Tenotomy,” by Charles Hermon Thomas, 
M. D., Philadelphia, Pa. 
No. 503. “ A Case of Cysticercus of the Vitreus,” by William Cheatham, M. D., Louis- 
ville, Ky. 
[Abstract not furnished.] 
168 No. 504 
SPONTANEOUS REPLACEMENT OF A DETACHED RETINA. 
James Wallace, M. D., 
The origin of the trouble was in a traumatic episcleritis, produced by a small piece 
of hot brass, which was thrown off from a lathe and struck the right eye in the ciliary 
region. Date of injury, November, 1888. The inflammation seems to have spread at once 
to the deeper structures, producing haziness of the vitreous and inflammation of the retina. 
Five months after the trouble the patient noticed a dark stream, starting from the lower 
part of the eye and spreading upwards (actuallv from above downwards). May, 1889, 
O. D. counts fingers, iris discolored greenish, large floating masses in the vitreous of a 
dark reddish color, no view of fundus. 6-9-89, Fingers only seen in outer field. 
7-13—89, No perception of hand, retina can be seen by oblique illumination floating 
forwards, its vessels plainly visible and some red spots near the centre. Treatment to 
this time, potass, sod. sixty grains per diem. Treatment abandoned. 8-11-89, Patient 
sees hand when held in lower outer field. The detached retina can now be seen limited 
to temporal side. 9-8-89, Retina has replaced itself still more. The nasal portion of 
the retina is now visible by the direct ophthalmoscopic method, and to the temporal side 
can be seen the hemorrhages. 12-1-89., V. in lower temporal field . 1-19-90, V. 
direct vision. From this time on V. rapidly increased and field of vision spread suddenly 
out (see chart). 3-16-90 with -flo+.socy. ax. 180 7-16-90, -f 750+.75 cy. ax.180f. 
This was the best vision obtained and no change has since taken place. The lesion con- 
sisted in the rupture of one of the branches of the upper temporal vein of the right eye. 
The downward gush of blood was visible to the patient as an ascending dark stream. 
From the source of the hemorrhage above to the pool of blood below, a coagulation pro- 
ceeding to partial organization took place. The subsequent contraction of the clot pulled 
the retina from the choroid. The co-existing disease of the vitreous rendered this all the 
more easy. On the first view of the fundus after replacement of the retina, a structure 
like the strings of a harp was seen to extend from the upper to the lower clot. Some of 
these had snapped in the middle and some had parted at their upper or lower extremities. 
The mechanism of the detachment is thus easily shown. A small detachment still remains 
above and below. In the vicinity of the macula is seen a white crescentic line caused by 
the stretched and distorted retina. Acunous metamorphopsia of a straight line appearing 
curved to the patient corresponds exactly with this defect, and the curve as drawn in my 
book, is exactly the shape of the retinal lesion. 
Assistant Ophthalmic Surgeon to the University Hospital, Philadelphia, Pa. 
No. 505. 
A CLINICAL STUDY OF HETEROPHORIA. 
Hiram Wood, M. D., 
Baltimore, Md. 
This question will be the basis of the paper: “What Importance Should Be 
Attached to the Presence of Heterophoria ? ” Observations in office practice will be the 
foundation of what is said. 
169 Attention will be called to the association of particular refraction and muscular 
errors : to the symptoms—if there be such—which, when both refraction and muscular 
errors are present, point to the latter as the cause of asthenopia or reflex disturbances. 
The following points will be discussed : 
(1) The correction of a refraction error will often cause asthenopia although there 
may be demonstrable grave forms of heterophoria. 
(2) Heterophoria may result from uncorrected refraction error; either disappearing 
after glasses, correcting the latter, have been worn for a time, or, if demonstrable, not 
causing any trouble. 
(3) On the other hand, with practically the same conditions, no permanent good will 
be done till the heterophoria has been taken into account. In the first class the hetero- 
phoria seems to be secondary, in the latter the most important factor. What means have 
we, short of waiting for time to decide with which class we are dealing ? The answer to 
this lies not so much in either the nature or degree of heterophoria, as revealed by 
equilibrium tests, as in the symptoms; the relative equilibrium error for distance and 
near ; the relative power of the S. R. and I, R. when the vertical muscles are at fault; 
abduction, when esophoria is demonstrated, the power of convergence and behavior on 
exclusion being more important guides in exaphoria than adduction; the degree and 
nature of the associated refraction error. The above muscular conditions do not always 
confirm the findings of the equilibrium tests. What should this lead us to look for ? 
As regards the treatment of heterophoria, attention will be called to the possibility 
of using prisms too soon ; of the usefulness of exercise—specially for troubles in the 
internal rectus—and the results of some tenotomies. 
No. 506. 
TREATMENT IN SIX CASES OF TRAUMATIC CATARACT WITH IRIDO- 
CYCLITIS. 
Robert L. Randolph, M. D., 
Baltimore, Md. 
In six cases of traumatic irido-cyclitis cataract was also produced by the injury. 
The lens swelled up as is usual and acted as a violent irritant pressing against the ciliary 
body and iris and almost causing the obliteration of the anterior chamber. 
The treatment consisted in simply removing the crystalline lens. 
The best vision obtained was counting fingers in twenty feet. In two cases enucea- 
tion had been advised by a prominent oculist, and in one of these cases, the vision 
mounted up to counting fingers in fifteen feet, and the other to counting fingers in two 
feet. 
I operate in such cases just as soon as I see the patient. I think it unwise to wait 
even a day. It is surprising to see how quickly all inflammatory symptoms subside. Of 
course such an operation should be done in as absolutely cleanly manner as possible. 
170 No. 507 
HOMEOCHRONOUS* HEREDITARY OPTIC NERVE ATROPHY. 
Opthalmologist to the Philadelphia Hospital, Philadelphia, Pa. 
George M. Gould, A. M., M. D., 
Dr. Gould reported some thirteen cases of hereditary optic-nerve atrophy extending 
through six generations. The affection came on during adult manhood, usually at from 
twenty-eight to thirty-four years of age. Other members of the family only required 
slight traumatism to induce partial or complete blindness, showing a lack of strength or 
delicate equilibrium of the visual mechanism. The striking peculiarity of the family 
history consists in the fact that after the second generation the disease is only transmitted 
by unaffected women. Passing the line through a male, even though he be blind, at once 
stops the appearance of the disease. No woman of the family has been affected. In one 
group the inheritance is passed through three unaffected females. Following out the law 
thus discovered it is found that so far as can be learned, there are only three young males 
living who are liable to the disease, i. e., who are the sons of women of the family when 
the line has not been passed through a male since the second generation. Of these three 
brothers, the elder is nearly blind at twenty-eight, and his two younger brothers who 
have not yet reached the ominous age, have chronic retinitis, with degenerative changes 
already observable. In the later generations there is a remarkable predominance of males, 
and a rapid decrease of prolific females, thus fortunately bringing the vicious inheritance 
to a sharp ending. If the law holds good, there will be no danger of a reappearance of 
the atrophy after this present (sixth) generation, as there will be no male children of the 
family whose ancestral line has not been passed through a male of the family. 
No. 508. 
FURTHER STUDIES OF THE CYCLOPLEGIC VALUE OF HOMATRO- 
PINE AND COCAINE DISKS AS ATROPINE, DUBOISINE AND 
HYOSCIN SUBSTITUTES. 
Casey A. Wood, C. M., M. D., 
Opthalmic Surgeon Alexian Hospital ; Oculist and Aurist Cook County Hospital and to the Emergency Hospital* 
Chicago; Professor of Ophthalmology, Chicago Post- Graduate Medical School, 
The results of these investigations (which now number several hundred) are chiefly 
these: (1) all the cycloplegics fail upon occasions to paralyze the accommodation, and 
this fact must always be kept uppermost in comparing their merits as cyclopegics. I 
have numerous cases on my note books where a one per cent solution of atropine, instilled 
six times in forty-eight hours, revealed (e.g.) a much higher degree of hyperopia or 
astigmatism a couple of weeks after a first trial. In comparing homatropine plus cocaine 
* Homoios, similar ; Chronos, time. Applied to a hereditary trait or disease, appearing at a similar age or time of life in a line 
of descendants 
171 disks, (3) as I have chiefly done in ray later investigations, with atropine sulphate (1 per 
cent solution) and hyoscine hydrobroraate (single instillations of a 1 per cent solution, 
examination an hour afterward) I have begun sometimes with one agent, sometimes with 
the other, so that the assistance obtained by the previous use of another cycloplegic might 
not only assist the one under observation. (2) Hyoscin hydrobromate, as well as its near 
relatives, duboisin sulphate and hyoscyamino sulphate appear, in my hands at least, to be 
too toxic, too uncertain, and even too dangerous to be used by the patient as atropine can 
be, and in none of the cases where I have employed all three agents were better results 
obtained than with atropine—quoad the ciliary paresis. Even with the patient under 
observation in ray office or under my assistant’s care in hospital, they all impressed me— 
take what precautions I would—as dangerous and unreliable agents. Small doses of them 
are inefficient, and large doses may prove toxic. In many instances one is reduced to the 
choice between poisoning one’s patient and not relaxing his accommodative spasm. (3) 
With the foregoing modification, I found little or no difference between the cyclo- 
plegic effects of the four named alkaloidal salts and disks of gelatine containing the 
grain each of homatropine (alkaloid, Merck) and cocam (alkaloid, Merck). (4). I used, 
however, young subjects, and in cases of suspected accommodative spasm, one disk of the 
latter every twenty minutes until three had been put into each eye, and made the exami- 
nation between 80 and 110 minutes after introducing the first disk. (5) That the 
personal equation should not disturb the accuracy of the observations, every case was first 
worked out by the retinoscopy method, and under similar conditions, by my painstaking 
assistant, Dr. T. A. Woodruff, and afterward reviewed by myself. The retinoscopy 
result was accepted as the refractive condition, and no reliance was placed upon the 
patient’s statements. (6) Tables giving the result in every case form part of this paper, 
and are in line with the statements just made. 
No. 510. 
AN ANALYSIS OF FIFTY (50) CASES OF CONVERGENT STRABISMUS. 
Howard F. Mansell, M. 1)., 
Philadelphia, Pa. 
A comparison with 200 cases (400 eyes) of hypermetropia without squint. 
My purpose in this comparative analysis is to endeavor to prove clinically, that, 
(1) H. is found in nearly all cases of convergent squint. 
(2) H. is not essential to convergent squint. 
(3) Congenial amblyopia is almost uniformly present in constant internal squint. 
(4) Amblyopia is not essential to squint either constant or alternating, 
(5) Amblyopia is found in it without squint. 
(6) Amblyopia is not a condition of alternating squint. 
(7) Amblyopia precedes the appearance of abnormal convergence and is not the result 
of non use. 
(8) The degree of it does not determine the squinting eye. 
172 (9) The degree of it does not determine amblyopia. 
(10) H. may be the determining cause of squint. 
(11) H. as must be considered equally with it, as a refractive cause of squint, and 
may be, in some cases, the more important factor in determining the squinting eye. 
(12) A considerable difference in the refraction of the two eyes may not cause squint, 
(13) Amblyopia determines which eye shall squint and in its absence either eye fixes 
indifferently without regard to the degree of H. 
No. 511. “Gouty and Rheumatic Affections of the Eve,” by W. Oliver Moore, M. D. 
New York City, N. Y. 
[Abstract not furnished.] 
No. 612. 
HEMORRHAGIC GLAUCOMA. 
B. D. Risley, M. D., 
Internally potassium iodide, or better still small doses of corrosive sublimate, fre- 
quently repeated, and long continued, with occasional doses of pilocarpine, were commended 
as useful in the predomol stage. Locally eserine in very weak solutions were often bene- 
ficial, even before the onset of the glaucomatous stage of the disease, but stronger solutions 
should be employed in the presence of increased tension. 
After the onset of the glaucoma no form of treatment promised much hope of perma- 
nent relief except enucleaieus of the ball. Among operative precedures of a less radical 
character, posterior sclerotomy to relieve the tension and pain, to be followed in twenty-four 
hours or longer by anterior sclerotomy or in some cases by iridistomy seemed to promise 
most. 
Philadelphia, Pa. 
No. 513. “Suppurative Processes of the Vitrious,” by J. F. Fulton, M. D., St. Paul, Minn. 
[Abstract not furnished.] 
No. 515. 
THE LOCAL USE OF MERCURY IN THE DEEPER-SEATED DISEASES 
OF THE EYE. 
D. Mittendorf, M. D., 
New York City, N. Y. 
The author’s attention being called to the rapid improvement of an eye affected with 
diffuse or parenchymatous disease of the cornea, which had become at the same time the 
seat of granular conjunctivitis, for which a solution of the bichloride of mercury 1 : 6000 
173 was used, extended the use of this remedy to cases of serous choroiditis with numerous punc- 
tate deposits of the membrane of Descemet and to cases of sympathetic ophthalmia, and 
encouraged by his results and the writings of several European authors who recommended 
the use of this remedy in the shape of hypodermic injections to the subconjunctival and 
even deeper tissues of the eye ball, applied it in cases of plastic irido-choroiditis, old pos- 
terior synechiae and exudations into the vitreous humor with considerable success. 
The results have been especially gratifying in cases of keratitis due to congenital 
syphilis, in keratitis punctata accompanying serous irido-choroiditis and in cases of sym- 
pathetic ophthalmia. 
No, 516. 
A CLINICAL STUDY OF THE VISUAL FIELDS IN HEMIANOPSIA. 
Charles A. Oliver, M.D., 
Philadelphia, Pa. 
This paper comprises a series of investigations based upon an unselected successive 
number of personal examples of the various forms of symmetrical defect in the fields of 
vision—especially of the hemianopic type,—which seem to prove that, first, the macular 
fibres of each retina have a special, individual and crossed connection with the right and 
the left cuneal regions ; second, the circum-macular fibres of each retina have connection 
both with certain related parts of the occipital cortex of their own side and the opposite 
side, the preponderant number of these fibres being situated in the temporal region of each 
retina and passing uncrossedly to the occipital cortex of their own side. 
No. 517. “ Glaucoma from Traumatic Causes,” by Dr. E. Lopez, Havana, Cuba. 
[Abstract not furnished.] 
No. 518. “ Nomenclature of Blepheritis,” by Dudley S, Reynolds, M. D., Louisville, Ky. 
[Abstract not furnished.] 
No, 520. 
A COMPARISON OF THE EYES OF WHITE WITH COLORED PUPILS 
IN THE PUBLIC SCHOOLS OF WASHINGTON CITY. 
E. O. Belt, M. D., 
Washington, D. C. 
The fact of the increase of myopia during school life being established, the impor- 
tant point for the physician to consider is its cause and its prevention, v 
That heredity and older civilization have much to do with it, would seem to be 
indicated from comparisons made between pupils iu Europe and in this country, and I 
174 have thought a comparison between the eyes of white and colored pupils would throw 
additional light upon this point. 
The few cases of abnormal eyes found among the colored pupils, as compared with 
the white, indicate the influence of heredity, and the more advanced civilization in the 
causation of defective eyes. Especially is this so of astigmatism, which was found in 
twenty-five per cent of the white and in only ten per cent of the colored pupils. That 
hypermatropic eyes are unhealthy ones, and tend to become myopic after passing through 
the stage of emmetropia, seems also to be indicated. 
No. 521. 
THE HYGIENIC AND SCIENTIFIC VALUE OF EXAMINATIONS OF 
THE EYES IN THE SCHOOLS. 
B. Alexander Randall, M. D., 
Accuracy and thoroughness are the prime factors. Too many questions face the examiner 
to admit of his answering all; so a wise choice of methods is requisite, that the most 
important points shall be determined with economy of time and all possible precision. 
The examiner can record the name, age, class, general health and ocular comfort of the 
pupil, the vision, accommodation and color-sense of each eye, with its eye-ground condition 
and refraction as determined by ophthalmoscope and retinoscopy in about three minutes. 
Lens-tests and ophthalmometer measurements may be added if time permits. The value 
of such determinations is unquestionable. Wide divergence of findings will be rare under 
such conditions ; and while rigid discrimination is needful in studying the results of past 
work, the correlation of data may be easy in the future. Ophthalmology can then rest on 
facts, instead of assumptions : and can have indisputable answers to the questions: 
Is emmetropia common or rare ? 
Can hypermetropia be healthfull outgrown ? 
Is myopia inherited, evolved, or pathologically produced ? 
Is astigmatism the rule or the exception ? or the all embracing query : 
What is the usual and normal refraction of the human eye? 
Philadelphia, Pa. 
No. 522 
ON CROUPOUS IRITIS. 
Adolf Alt, M. D., 
St. Louis, Mo. 
Croupous iritis is a separate form of inflammation of the iris which is probably due 
to a specific microbic invasion of the iris tissue. 
The same form of inflammation may extend backwards into the ciliary body and 
choroid and produce croupous irido-choroiditis. 
175 Clinical histories. 
Anatomical examination proves the existence of a croupous exudation in the tissues 
of the tract in the aqueous and vitreous humors, and contained in it numerous 
bacteria resembling the staphylococcus aureus. 
Treatment. 
No. 523. “ Tratamiento del Triquiasis y Distiquiasis por Adelanta-miento del Parpado Supe- 
rior,” by Dr. J. Santos Fernandez, Havana, Cuba. 
No. 524. 
REMARKS ON THE TREATMENT OF HETEROPHORIA. 
E. J. Gardiner, M. D., 
Chicago, 111. 
The time for purely theoretical discussions on the subject of muscular anomalies is 
past. 
Reports of cases reciting experiences with the different methods of treatment, and 
the results, now necessary in order to study the subject from a clinical standpoint. 
The majority of investigators agree; 
(1) That anomalies of the muscular apparatus of the eye produce certain forms of 
disturbances. 
(2) That these disturbances may be local, and general. 
(3) That the correction of the muscular anomalies is usually followed by relief from 
the disturbances. 
Method used for detecting and measuring the different forms Of heterophoria. 
Particular attention given to the elimination of other causes of disturbance by anomalies 
of refraction, diseases of other organs, etc. 
The subject so extensive that one form only of heterophoria will be considered in this 
paper—hyperphoria. 
Report of cases selected so that the various forms of errors of refraction combined 
with heterophoria will be considered, and the method of treatment, with results noted. 
No. 525. 
EXTRA OCULAR MELANO-SARCOMA OF THE ORBIT. 
S. C. Ayres, M. D,, 
Cincinnati, Ohio. 
Melano-sarcoma of the orbit most generally originates in the choroid, perforates the 
salera and then invades the orbital tissues. Is melano-sarcoma of the choroid more 
frequently primary or secondary ? What operation is most advisable for its relief and is 
there any constitutional treatment which will arrestor retard its progress? What internal 
organs are most frequently implicated with sarcoma of the choroid ? 
176 •No. 526 
ORBITAL TUMORS. 
Walter B. Johnson, M. D., 
Paterson, N. J. 
In advising operation, the most important considerations are: If the tumor is 
benign ; is it endangering the integrity and vision of the eye? Will it possibly disappear 
without operation? May it be a benign tumor which presents the symptoms and char- 
acter of a malignant growth and is possibly a (Lymphoma?) and non-malignant? 
If the tumor is decidedly malignant the important question is the probability of its 
complete removal, for if not likely to succeed in the entire evisceration of an orbital 
tumor, and if some of the malignant tissue may remain within the orbital or surrounding- 
cavities, and cannot be removed or destroyed, it is almost certain that the growth will 
recur with marked rapidity and much more extensively than if it never had been 
operated upon, and that the patient will succumb much sooner than would otherwise have 
been the case. 
The tumor, even if malignant, if confined by the presence of the eye-ball and the 
surrounding tissues, will be of comparatively slow growth. 
Even though there is progressive profusion, loss of motion and sight, irritation, 
inflammation, oedema, strangulation, and perhaps subsequent disintegration, a tumor 
which cannot be entirely removed should not be operated unless the unbearable paiu, 
distressing discharge and bleeding compel it; for the condition is generally much worse 
very shortly after the operation has been performed, and the death of the patient is 
hastened without compensating benefits. 
No. 527. “ The Treatment of Opacities of the Vitreous Humor by Hypodermic Injections of 
Pilocarpine,” by T, J. Tyner, M. D, Austin, Texas. 
[Abstract not furnished.] 
No. 528. “ Relacioues de la Oftalmometria con la Skiascopia,” by Dr. Pedro Lagleyze, 
Buenos Ayres, Argentine. 
No. 529. “Etiology and Early Management of Glaucoma,” by G. E. Dean, M. D., Scranton, 
Pa. 
[Abstract not furnished.] 
No. 530. “ Acute Monocular Neuro-Retinitis, with Cases,” by B. L. Milliktn, M. D., 
Cleveland, Ohio, U. S. A. 
[Abstract not furnished.] 
177 No. 531. “A Contribution to Refractive Errors,” by J. C. Morgan, M. D., Philadelphia. 
Pa., U. S. A. 
[Abstract not furnished.] 
No. 532. “ The Necessity for Complete Suspension of Accommodation by Mydriatics in the 
Adjustment of Glasses,” by C. C. Savage, M. D., Nashville, Tenn,, U.S. A. 
[Abstract not furnished.] 
No. 533. 
THE RELATION OF SKIASCOPY TO OTHER TESTS FOR THE 
DETERMINATION OF THE OCULAR REFRACTION. 
By H. V. WUEDMANN, M. D., 
Milwaukee, Wis. 
This paper deals with the method of using the shadow test to best advantage, gives 
author’s valuation of the method. Exhibits convenient skiascope. Tabulated results in 
comparison to other tests. 
No. 534. “ A Few Thoughts about Opthalmometry, as to what the Javal Instrument will do, 
and what it will not,” by Louis L. Lautenback, M. D., Philadelphia, Pa., 
U. S. A. 
[Abstract not furnished.] 
No. 535. 
ASTIGMATISM FOLLOWING CATARACT EXTRACTION AND OTHER 
SECTIONS OF THE CORNEA. 
Edward Jackson, A. M., M. D., 
Philadelphia, Pa. 
This condition, though generally recognized, has heretofore received little careful 
study. A series of cases is reported with reference to its degree; the direction of its 
principal meridians ; the changes undergone; the time at which a permanent condition was 
reached, and the final amount of it. 
Consideration of the cases observed shows it to be due to the bulging of the cornea, 
brought about by normal intra-ocular pressure at the point weakened by the section. 
Conclusions of practical importance are reached as to the choice of the form of corneal 
section, its location, and the proper time to adjust correcting lenses. 
178 No. 586. “Refraction Anomalies of Artists,” by J. C. Morgan, M. D., Philadelphia, Pa. 
U.S. A. 
[Abstract not furnished.] 
No. 587. “Further Observations on the Eye of the ‘Negro/” by C. W. Kollock, M. D., 
Charleston, S. C., U. S. A. 
[Abstract not furnished.] 
No. 538. “Exophthalmos Traumaticus,” by L. F. Love, M. D., Philadelphia, Pa., U. S. A. 
[Abstract not furnished.] 
No. 539. • 
GRADUATED AND COMPLETE TENOTOMY FOR THE RELIEF OF 
HETEROPHORIA, WITH A NEW OBJECTIVE TEST 
FOR USE DURING OPERATION. 
Ophthalmic Surgeon to St. Joseph’s Hospital; Assistant Surgeon, Wills Eye Hospital, Philadelphia, Pa. 
S. Lewis Ziegler, M. D., 
I have, therefore, devised a test object which will always stand out with great clear- 
ness, when used with a red glass and the displacingiprism. It consists of a Greek cross cut 
out of blackened metal and placed over a thin strip of porcelain, behind which is a gas lamp 
or electric light. The cross is held in place by a blackened metal hood, which serves to 
conceal the light. 
My satisfaction in using this test for operative cases has led me to adopt it for all my 
heterophoria work. I have also devised a smaller Greek cross, printed in black on card- 
board, for use as a near test instead of the Graefe line and ball. I have found the 
following advantages to accrue from these tests: 
(1) The Greek cross test object is easily recognized by the patient, even under 
partial blurring of vision during tenotomy. 
(2) The four arms of the cross attract the attention of the eye separately, causing 
complete dissociation of the two images, with muscular relaxation. Hence, the tendency 
to fuse is almost nil, and the deviating error is as great, if not greater, than that shown 
by any other test. 
(3) It is easy for the patient to line up the vertical deviation by the horizontal arms 
of the cross, and the horizontal deviation by the vertical arms. 
(4) The test for near, by the small black cross, is likewise more accurate than any 
other method, and the error more manifest, for the same reasons that apply to the distance 
test. 
A number of cases of graduated and complete tenotomy for the relief of heterophoria 
are related, and in conclusion some observations are recorded based on the histories of 
these cases. 
179 SECTION ON LARYNGOLOGY AND RHINOLOGY. 
Dr, Harrison Allen, Philadelphia; Dr. Francke H. Bosworth, New York; Dr. J. Solis Cohen, 
Philadelphia, Pa.; Dr. [D. Bryson Delavan, New York; Dr. J. F. Dickson,Portland, Oregon; Dr. 
Stephen Dodge, Halifax, Nova Scotia; Dr, W. C. Glasgow, St, Louis,; Dr. Frederick I, Knight, 
Boston; Dr. Geo. M. Lefferts, New York; Dr. Alvaro Ledan, Villa Clara, Cuba; Dr. John N. 
Mackenzie, Baltimore; Dr. David Matto, Lima, Peru; Dr. P. Emelio Petit, Santiago, Chile; Dr. 
John O. Roe, Rochester, N. Y.; Dr. Federico Semeleder, City of Mexico, Mexico; Dr. Chas. J. Sajous, 
Paris, France. 
HONORARY PRESIDENTS: 
Dr. E. Fletcher Ingals, 34 & 36 Washington St., Chicago, 111. 
EXECUTIVE PRESIDENT: 
Dr. T. Morris Murray (English-Speaking), Dr. F. Marron y Alonso (Spanish-Speaking), 
Washington, D. C. Las Vegas, N. M, 
Dr. Ovejero [Piedad 22] Beunos Aires . . . . . . Argentine Republic. 
Dr. H. Guedes de Mello Rio de Janeiro U. S. of Brazil. 
Dr. G. W. Major Montreal Canada. 
Dr. Felix Campuzano [Virtudes 33]) Havana Cuba. 
Dr. Luis Fonnegra [Calle 10, numero 263] Bogota Republic of Colombia. 
Dr. Fabricio Uribe Guatemala City Guatemala. 
Dr. Henri Goulden McGrew Honolulu Hawaii. 
Dr. Angel GAVifjo [Cocheros 15] City of Mexico . . .... Mexico. 
Dr. J. Midence Leon . Nicaragua. 
Dr. Eugenio S. Cassanello [San Jose 119] . . . .Montevideo Uruguay. 
Dr. Napoleon F. Cordero Merida Venezuela. 
SECRETARIES: 
180 SECTION ON LARYNGOLOGY AND RHINOLOGY. 
No. 551. Paper by Robert Levy, M. D., Denver, Colo. 
[Neither Title nor Abstract furnished.] 
No. 552 
THE RELATION OF DISEASES OF THE RECTUM TO NASAL 
CATARRH. 
W. John Harris, M. D,, 
St. Louis, Mo. 
Will present facts going to show the intimate relation of the mucous membrane of 
the alimentary canal, and especially of the rectum, with the mucous membrane of the 
respiratory organs. 
Will give illustrations going to prove that there is a direct sympathy between the 
sphincter ani and the act of respiration. 
Will give illustrative cases to prove that in the majority of cases of chronic nasal 
catarrh there will be found some abnormal condition of the rectum. 
Cases reported going to show that until papillae, pockets and hemorrhoidal tumors 
had been removed it was impossible to cure the local nasal disease. 
That by curing the disease of the rectum, removing any obstruction to the circulation 
there, it will be found much more easy to remove the attending chronic nasal compli- 
cation. 
No. 554. 
MYCOSIS OF THE PHARYNX. 
By William C. Glasgon, M. D. 
Mycosis of the pharynx has been recorded by all writers as a rare form of disease. Since 
the advent of the pandemic of influenza, or grippe, it has been seen more frequently. Between 
the years 1870 and 1890 only two cases of mycosis came under the observation of the writer; 
since 1890 the number of cases has been increased to eight. 
The affection consists essentially in a growth and development of the leptatrix buccalis. 
The spores of the organism become fixed in certain parts of the fauces, and finding a suitable 
soil, they grow and multiply, forming masses of such size that they are visible to the eye. In 
the beginning they appear as minute white specks; these enlarge their area until they form 
masses the size of bird-shot. The spots of mycosis do not coalesce; each point remains isolated 
with normal membrane between. The spots present different appearances in different cases; 
some are soft and friable, and when raised above the surface can readily be removed. In other 
181 cases they assume the form of horny filaments, which become deeply looted in the mucous 
membrane, and can only be removed by forcible extraction. They are found most frequently 
on the tonsils. The small whitish projections may be limited in number or they may largely 
cover the tonsil. However numerous they may be, each spot is isolated, and they never form a 
continuous mass. The glandular tissue at the base of the tongue is the next most frequent site; 
the growth here may be very exuberant, the masses attaining the size of a pea. The posterior 
pharyngeal wall is the least frequent site of its occurrence. Here it presents the appearance 
of minute white points, rarely forming masses. In some cases the mycosis involves all parts 
of the pharynx, distributed over the tonsils, the base of the tongue and the posterior pharynx. 
The symptoms of pharyngeal mycosis are often negative. In many cases the spots are 
accidentally discovered through insjiection, and in others the symptoms are vague and trifling. 
The most common symptom observed by the writer has been a feeling of stiffness of the fauces, 
very appreciable in swallowing. In one case there was a paroxysmal violent cough, but this 
was evidently caused by laryngeal irritation, as it soon disappeared, while the spots of mycosis 
remained unchanged. 
The causes of mycosis pharyngia are still uncertain. The constant pressure of the lep- 
tatrix in the mouth and the comparative rarity of the mycotic spots in the fauces leads the 
writer to think that some peculiar condition of the mucous membrane is a necessary factor in 
its development, and that it only exists when the membrane presents a soil which favors its 
growth and development. The great increase in the number of cases since the advent of the 
influenza seems to indicate that the peculiar condition of the mucous membrane in influenza 
has largely favored its development. Some writers have claimed that a condition of mal- 
nutrition with an impaired state of health may be considered as a provoking cause. Others 
have claimed causative relation, between disturbances of digestion and mycosis. These views 
are not in accordance with the experience of the writer. Each of the eight cases seen were in 
good health and perfect bodily vigor; there were no symptoms of impaired digestion or mal- 
assimilation. Four of these cases were females between the ages of seventeen and thirty-five; 
four were males between the ages of sixteen and forty-five. It is a noticeable fact only two of 
the eight cases occurred in hospital practice, among which class of patients conditions of 
mal-nutrition are more apt to be found. 
Mycosis of the pharnyx can only be confounded with cheesy masses in the crypts of the 
tonsils and follicular disease of the throat. The ease with which the cheesy masses may be 
expressed from the crypts of the tonsils is in striking contrast to the fixation of mycotic masses. 
Certain cases of follicular disease of the throat show a similarity to mycosis. This is especially 
the case when the follicles of the posterior and lateral pharynx are involved. The constant 
presence of inflammation of the mucous membrane in follicular disease and an entire absence 
of inflammation in mycosis are distinctive of the two diseases. The exudation of follicular 
tonsilitis is a yellowish white; it frequently becomes confluent, and upon the application of the 
salts of iron it is readily disintegrated and may be largely removed. 
The treatment of mycosis of the pharynx consists in the destruction of the organism either 
by the galvano-cautery, or the acid-cautery, or forcible extraction with the forceps, where the 
growth has assumed a horny, thread-like character. In some cases the spots must be well 
scraped with a sharp curette and the caustic, either tri-chloracetic acid or chromic acid freely 
applied to the surface; in others, the galvano-cautery point may be pushed deep into the spot 
after the soft superficial portion has been rubbed off. In case the horny filaments are present 
in the growth, forcible extraction with the forceps is an effectual but painful measure. 
According to the writer’s experience, constitutional treatment has been of little value. 
Some writers have advised cigarette smoking as a remedy. One of the cases seen by the writer 
182 was aii inveterate smoker; nevertheless, extensive mycosis on the tongue and tonsils was 
developed. The use of antiseptic washes has seemed to the writer to be of use in preventing 
the spread of the organisms. A saturated solution of boracic acid has given best results. The 
treatment is always tedious, with a tendency to recurrence until all evidences of the disease 
have been eradicated. 
The following cases came under the observation of the writer: 
Case I. A negro coachman, aged thirty, in good health. Mycosis confined to one tonsil. 
Came under observation on account of an attack of acute pharyngitis. Was under observation 
only a few days, then disappeared. 
Case 11. A lady of twenty-one years, in good general health. She complained of sore- 
ness and stiffness of the throat. Mycosis was confined to the right tonsil. Applications of 
iron and iodine preparations gave no relief. Solutions of nitrate of silver were also used 
without avail. 
Case 111. A lady, aged thirty-five, in perfect physical condition. There were no symp- 
toms, and the white spots had been accidentally discovered. The mycosis was confined to one 
tonsil, which was the size of a small almond. The tonsil was sharply curetted and tri- 
chloracetic acid applied. The treatment was effectual, and there has been no recurrence of the 
mycosis. 
Case IV. A laboring man, aged twenty, complained of soreness of the throat. Each 
tonsil was sprinkled with mycotic spots. After the tonsils had been curetted, chromic acid was 
applied, causing an entire disappearance of the spots. 
Case V. Man, forty-eight years, complained of a slight uneasy feeling in the throat. 
Being a very nervous person, the presence of the white spots gave him great anxiety. His 
general physical condition was perfect, and there were no symptoms of indigestion. He 
indulged freely in tobacco, both cigars and cigarettes. In this case the mycotic spots were 
situated on each tonsil, in the follicles at the base of the tongue, with a few scattered on the 
lateral wall of the pharynx. The organism on the tongue was exuberant and of soft con- 
sistency. On the tonsils there was a mixed variety; some portions soft, and others tough and 
homy, protruding from the surface in distinct filaments. In this case chromic acid, the chlora- 
cetic acid and iodine was applied, without result; afterwards the horny masses were extracted 
with forceps, and the galvano-cautery point applied to the remaining spots. After the greater 
number had disappeared, a sharp attack of pharyngitis seemed to cause a second growth. 
They were again removed in a similar manner, and so far there has been no recurrence. 
Case VI. A lady, thirty years old, noticed the spots in her throat, but experienced no 
distress. The mycosis was confined to the tonsils. The horny growths were extracted with the 
forceps, and the remaining growths were touched with the galvano-cautery. 
Case VII. A young lady, seventeen years of age. Mycosis confined to the tonsils. Each 
tonsil was curetted and the chloracetic acid applied. In this case a constant tendency to 
recurrence has been observed. 
Case VIII. A boy, sixteen years of age, sought advice on account of a paroxysmal 
cough. He was not conscious of anything abnormal in his throat. On laryngoscopic inspec- 
tion, a sub-acute laryngitis Avas discovered, and in the fauces numerous spots of mycosis were 
discovered. They Avere thickly sprinkled on the posterior and lateral Avails of the pharynx; a 
few Avere found on the tonsils ; a number on the base of the tongue. Under appropriate treat- 
ment the cough and laryngeal irritation disappeared. The spots of mycosis, hoAvever, proved 
very obstinate to treatment, and it Avas only after several months that they disappeared, from 
frequent application of the galvano-cautery, chromic and the chloracetic acid. 
183 No. 555 
THE EASIEST AND MOST PRACTICAL MEANS OF MAKING GALYANO- 
CAUTERIES, ESPECIALLY TO TURBINATE HYPERTROPHIES. 
Arthur G. Hobbs, M. D., 
Member of American Medical Association, Ex-President of the American Rhinological Association, Member of 
the Georgia State Medical Association, and Fellow of the Atlanta Society of Medicine, etc., Atlanta, Georgia. 
The little apparatus that I ara using for galvano-cautery and magnet operations is the only 
perfect instrument in my knowledge for these purposes. 
It is contained in a rosewood box eight inches long, four inches thick and lour inches deep 
and is secured to the wall at a convenient distance from the operator’s chair. The wires from an 
alternating current of fifty-two volts, the most generally used circuit, particularly in the medium 
and smaller-sized cities, are brought into the operating room from the street and attached to one 
end of this little box. 
The conducting wires are similarly attached to the other end. The apparatus is now 
ready for the cautery operation, and more than this it remains always and ever ready, in no 
way requiring the attention of the operator at any time. When the proper cautery point is 
attached, through the handle of the conducting wire, it is necessary only to turn a screw project- 
ing from the nearer service, with the left hand, to use any number of volts, or to raise the cautery 
point to any degree of heat desired. In short, the little apparatus is simply a gauge for 
measuring out the exact quantity of electro-motor force in the form of heat that may be needed 
for each particular case. 
I have used these instruments in my own and assistants’ rooms, perhaps a thousand times 
during the year that I have had them, and in no instance have they failed me or caused me any 
care or trouble. 
The needle and a very narrow blade are the only cautery points ever used in my office and 
in all cases they are made to enter at the most prominent point of the hypertrophied tissue, pen- 
etrate to the bone when a white heat is reached, then withdrawn through the same puncture 
while the point is still hot. In no case is a wholesale destruction of mucous membrane ever 
produced by applying the flat surface of a blade to the protruding part. 
When an application of a twenty per cent solution of cocaine has been applied on a cotton 
tampon ten minutes before the operation, there is but little painjand indeed, in many instances, 
none. 
No. 556. Paper by W. H. Daly, M. D., Pittsburg, Pa. 
[Neither Title nor Abstract furnished.] 
No. 558, “Formate Soda in Laryngeal Disease,” by E. L. Shurly, M. D., Detroit, Mich. 
[Abstract not furnished.] 
No. 559. Paper by G. B, Lawrason, M. D., New Orleans, La. 
[Neither Title nor Abstract furnished.] 
184 No. 560. 
THE UTILITY OF THE ELECTRO-CAUTERY SNARE. 
Hanau W. Loeb, M.D., 
St. Lows, Mo. 
In certain operations upon tlie nose and throat, the writer insists that the electro-cautery 
snare is vastly superior to any other instrument, especially where the following are desired ; 
(1) No hemorrhage. 
(2) Celerity of operation. 
(3) Accuracy in removal. 
The electro-cautery snare is therefore of utility in the following: 
(1) Removal of nasal polypi. 
(2) Removal of redundant nasal mucous membrane. 
(3) Removal of tonsils. 
(4) Removal of the uvula. 
(1) The advantages of this instrument over the cold snare so generally in use for the pur- 
pose of removing nasal polypi may be summed up as follows: It is just as easy to engage the 
electro-cautery snare as the cold snare; the removal is accomplished with far greater rapidity ; 
there is no haemorrhage; the after effects are no more severe ; more polypi can be removed at 
one sitting; there is less pain, as before the effect of the primary application of cocaine has worn 
off the operation may be completed. 
Compare with the advice, found in so many books, to the effect that from fifteen to thirty 
minutes should be consumed in the removal of a polyp, the fact that the electro-cautery opera- 
tion is instantaneous. One should not lose sight of the good effect of cauterizing the base of 
the polyp incident upon the use of the electric snare. 
(2) In regard to the removal of redundant mucous membrane, a similar condition of things 
prevails. The greater liability to luemorrhage and the greater tediousness of the cold snare 
operation render the use of the galvano-cautery snare all the more imperative. 
(3) Tonsillar hemorrhages are rare but they are not so infrequent as to cause those who 
operate often to lose sight of their possibility. All operations with the tonsillotome permit, 
without restraint, any bleeding, capillary, arterial or diathetic. The electro-cautery snare is the 
only instrument which can prevent these hemorrhages, be they trivial or serious. This same 
instrument offers in tonsillotomy greater precision ; the operator may engage in the snare as 
much as he wishes and therefore can be exact in so far as removal of tissue is concerned. After 
effects are no more severe than with other instruments. 
(4) In uvulotomy the electro-cautery snare is convenient of application—the uvula being 
permitted to fall into the loop and removal soon accomplished—no slipping, no pulling down 
of the mucous membrane, no accidental cutting the uvula where it was not intended. Patients 
seem to get along better after this than after cutting operations. They are able to eat with 
greater ease, healing is more rapid and a good stump always remains. 
The electro-cautery snares which have been in use are open to objection on the score of 
lack of cleanliness and by reason of the great amount of wire required to form the loop. The 
writer presents his own electro-cautery snare which he exhibited before the Laryngological Section 
of the American Medical Association, in 1892, and which negatives these objections. Every por- 
tion of the instrument is separable, the canulse, the copper wires, the ivory tip and the rubber 
insulation. 
By means of two stout copper wires, which pass through the canulae and which are sup- 
plied with an eyelet in the end, a substantial loop may be made out of a small piece of steel 
185 wire. As the instrument may be entirely taken apart and cleaned before and after every oper- 
ation, it fulfills the requirements of modern antiseptic surgery. The rubber insulation is a great 
advantage over the silk and cotton used in other snares. 
Objections, which are valid, have been urged against batteries of all kinds—they are 
seldom reliable for more than a year. In view of this fact, an instrument should be used which 
makes the ordinary street current available for cautery work. Such an instrument is the Aloes 
(St. Louis) Converter, which, in the writer’s experience, has never failed a single time to act 
properly and happily in any cautery operation. 
No. 561. Paper by Jonathan Wright, M. D., Brooklyn, N. Y. 
[Neither Title nor Abstract furnished.] 
No. 562. Paper by John N. McKensie, M. D., Baltimore, Md. 
[Neither Title nor Abstract furnished.] 
No. 563. 
KEFLEX EPILEPSY FROM INTRA-NASAL DISEASE. 
Dr. John O. Roe, 
Rochester, N. Y. 
(1) That epilepsy is a frequent result of peripheral irritation, which may be excited by a 
local disturbance affecting the peripheral nerves in any portion of the body. 
(2) That the susceptibility to peripheral irritation varies greatly in different persons, as 
is shown by the fact that irritation of the same kind or degree will not always cause the 
same amount of central disturbance, or may develop reflex disturbance of an entirely different 
character. 
Resume 
(3) That the nose is frequently the seat of sufficient irritation to excite a variety of reflex 
manifestations ; that these disturbances may be confined to the brain centres, manifested in 
epileptic convulsions, or they may be reflected to other peripheral organs, giving rise to mani- 
festations of an entirely different character. 
(4) That in the nose there are well-defined sensitive areas, which are more readily stimu- 
lated by diseased conditions or by irritants introduced from without, than other portions of the 
nasal cavity. 
(5) That these areas are rendered inordinately sensitive to irritation by abnormal condi- 
tions in the nose, frequently independent of “neurotic habit.” 
(6) That the undue susceptibility of these sensitive areas and the production of reflected 
disturbances—and especially those of epilepsy—is more often excited by intra-nasal pressure 
than by any other local condition. 
(7) That the frequency with which epilepsy has been found to result from intra-nasal dis- 
ease emphasizes the importance of interrogating the nose in all cases of epilepsy, and especially 
in those in which the cause is in any manner obscure. 
(8) Citation of illustrative cases. 
186 No. 564. Paper by Charles H. Knight, M. D., New York City, N. Y. 
[Neither Title nor Abstract furnished.] 
No. 665. Paper by Alexander Mac Coy, M. D., Philadelphia, Pa. 
[Neither Title nor Abstract furnished.] 
No. 667 
A CASE OF ANGIOMA OF THE NASAL SEPTUM. 
F. C. Cobb, 
Boston, Mass. 
The patient, a girl of fifteen years, was examined at the Massachusetts Hospital in October, 
1892. She complained of obstruction of, and bleeding from, the right nostril, with a duration of 
six months. There had been no sneezing, and only occasionally a yellow, thick discharge from 
that nostril. 
Her general condition was anaemic; she was subject to headache, and exhausted by slight 
exertion. 
Examination showed a small growth attached by a thin pedicle inserted into the septum 
of the right nostril, above the end of the lower turbinated bone near the junction of the skin 
and mucus membrane. The growth was soft, its base dotted with a few small blood clots. It 
moved backwards and forwards with respiration, but did not pulsate. 
The right nostril was slightly atrophic, otherwise the upper air passages were normal. 
The growth was removed, with very slight haemorrhage, with the aid of the Hooper snare 
and ecraseur. 
The base was not cauterized, and the site was completely healed in a few days. 
In June, 1893, she reported that there had been no recurrence. 
The growth was submitted to Dr. Whitney, pathologist to the hospital, from whom the 
following report was received : 
“ Growth with large vascular sinuses with more or less round cells about—cavernous 
angioma.” 
In looking up the literature of Nasal Angiomata, one is struck by the lack of pathological 
accuracy shown by the reporters of cases. 
Sutton, Ziegler, Birch-Hirchfeld and other pathologists agree that angioma may be defined 
as a new growth of blood vessels held together by a slight reticulum of connective tissue. 
The cases reported are those of Yerneuil, Wagner, Steinbriigge, Seiler, Bichet, Hoe, 
Jarvis, Vanderpoel, Burckhardt, Nelaton, Huguier, Panas, Guyon, Dumenil, Delavan, Boef 
and Luc. 
There were in all nineteen cases. 
There was no microscopical examination in six cases, viz., those reported by Dumenil, 
Verneuil, Seiler, Panas, Guyon and Vanderpoel. 
. In five cases the growths contain myxomatous tissue, and are not therefore pure angiomata. 
These cases, were reported, two by Wagner, two by Luc and one by Delavan. 
Three cases, those of Bichet, Hnguier and Boef, were probably fibromata rather than 
angiomata. 
187 We have, then, left the cases of Richet (reported by Bazg), Steinbriigge and Burckhardt 
(which I could not find), Roe, Jarvis and Nelatou. 
Richet’s case contained embryonal and fusiform cells in large quantities. 
It was therefore probably an angio-sarcoraa. 
Roe’s case was, by microscopical examination, an angioma, but it subsequently degenerated 
into an angio-sarcoma. 
Nelaton’s pathological description is not characteristic enough to class this tumor among 
the angiomata; while in the case of Jarvis no pathological description, but only the diagnosis, 
was given by the microscopist. 
As a further proof of the rarity of this affection, I would say that, in an examination of 
7429 cases in the Massachusetts General Hospital records, I have found no other case. 
With regard to the symptoms, the only two of importance are haemorrhage from and 
occlusion of one nostril. 
In all the reported cases a mere examination of the growth with probe or finger caused 
extensive haemorrhage. 
As regards prognosis, it is evident from Roe’s case that a pure angioma may degenerate 
into a malignant growth. 
The diagnosis of pure angiomata can only be made by careful microscopical examination. 
In the treatment of these growths we are met with less difficulty, since all the recent 
authors seem to consider the snare, if used slowly, as the safest instrument. 
The length of time to be consumed in removal should depend upon the thickness of the 
pedicle. 
In Roe’s case three hours were consumed in removal of the growth, the haemorrhage being 
very slight. 
Jarvis and Luc got no haemorrhage with slow snaring, but considerable from more rapid 
use of the instrument. The former used his own snare and ecraseur; the latter, the galvano- 
cautery wire. 
In my own case, I attribute the slight haemorrhage to the thinness of the pedicle. 
No. 568. 
A CASE OF ELONGATION OF THE EPIGLOTTIS, REDUCED BY OPERA- 
TIVE MEASURES. 
Dr. Price-Beowx, 
Toronto. 
On February 27, 1893, Miss W„ aet. 23 years, tall and slight, presented herself for treat- 
ment. Father’s family tuberculous. Father and mother both living and healthy. Two 
brothers died of consumption between the ages of twenty and thirty years. Patient had been 
delicate from infancy. Family physician affirms that the apex of left lung had been diseased 
twice. During childhood respiration was always whistling. Throughout life patient has been 
subject to throat colds, always attended by hoarseness, and sometimes by complete aphonia, lasting 
from one to two weeks at a time. There has, likewise, always been great difficulty in freeing 
the throat from mucous. 
Two years ago her physician sent her to Colorado Springs for six months. She returned im- 
proved in general health, but without material change in throat symptoms. 
188 When she came to me she had been free from cold for several weeks. On examining the 
throat with the laryngoscope, what could be seen of the larynx appeared perfectly healthy. 
The epiglottis, however, which was long and narrow, with the end turned up, lay in a horizontal 
position, the whole of the free end pressing against the posterior wall of the phalynx, during 
ordinary respiration the air passing up and down through the open sides. At forcible respira- 
tion the epiglottis was varied slightly, seemingly enough to admit the passage of a knife blade. 
The whole of the larynx was deeply seated and the vocal cords quite invisible. It required two 
and a quarter inches, from the right angle of a probe, to reach the tip of the epiglottis. 
As the patient was tractable, and a good view of the parts could be obtained, I considered 
the case a good one for operation, always using a fifteen per cent solution of cocaine. On March 
1, the first tentative touch with galvano-cautery was made. There was but slight reaction. 
On March 4, during forcible breathing, I slipped the galvano-cautery blade between the epi- 
glottis and post-pharyngeal wall. Then drawing the former forward, so as to free the calter, I 
cauterized the central portion and left side of the tip. The operation was followed by limited 
sloughing and acute congestion of a mild type. There were two subsequent cauterizations, one 
on the eighteenth and the other on the twenty-ninth; and the patient was allowed to return to 
her home, 100 miles away on April 1. Throughout the treatment albolene sprays were used to 
the throat several times a day. 
The shortening of the epiglottis amounted to about one-fourth inch ; and there was a perpetual 
niche of one-eighth inch. As there was, however, still a protruding corner, and the finish was not as 
aesthetic as one would like, I desired the patient to recuperate tor a couple of mouths and then 
return. She accordingly came back for treatment on June 6. The epiglottis had entirely 
healed and she had been quite free from hoarseness. At two sittings, with an interval of three 
days, I touched the remaining projections with the galvano-cautery. The healing was more 
rapid than formerly, and in ten days the patient was well enough to return home. The sloughs 
had separated; the epiglottis was uniform in length and regular in outline; and although the 
organ was still horizontal, the vocal cords could for the first time both be seen. 
No. 569. Paper by Dr. Edward O. Clyer, Buenos Ayres, Argentine Republic. 
[Neither Title nor Abstract received.] 
No. 570, 
SOME OF THE THROAT CONDITIONS OBSERVED IN GOUTY SUBJECTS. 
Solomon Solis-Cohen, A. M., M. D., 
Professor of Clinical Medicine and Applied Therapeutics in the Philadelphia Polyclinic, etc. 
The term “ gouty subjects ” as used in this paper applies not only to those who have had 
attacks of acute gout, or those who exhibit the characteristic deposits of chronic gout, but also 
to the much larger number who suffer with the varied and often obscure symptoms of “ lithemia,” 
with a more or less constant tendency to excess of oxalates, phosphates, urates and uric acid in 
the urine. In both classes of patients the upper air passages are frequently affected ; and while 
the gouty diathesis cannot be affirmed to be the sole cause of the local manifestations, it doubt- 
less acts both as a predisposing and modifying influence. A large number of cases by different 
observers would have to be recorded in detail and carefully analyzed before characteristic signs 
of throat-gout could be laid down. In most, if not in all, cases, the condition is a chronic one, 
189 with tendency to paroxysmal exacerbation. Attention being first directed to it during a period 
of intensification, it may be mistaken for an ordinary form of acute inflammation, and the 
diathetic origin overlooked. Inflammation, however, is not a necessary feature of the case. 
In the author’s experience, the most prominent symptoms are sensory; pains and perverted 
sensations of various kinds being referred to circumscribed regions, often described as “ spots,” 
in which no adequate structural alteration is obvious. These spots are often, but not invariable, 
painfully sensitive to the touch, and can be accurately localized; in some cases pain is referred 
to a part apparently unrelated with the one touched ; but the association is constant. 
Sometimes, more especially during an acute paroxysm, these spots are characterized by the 
junction of several dilated blood vessels; sometimes a single blood vessel is prominent; some- 
times there is a dusky coloration of the mucous membrane; sometimes an enlarged and 
reddened follicle, but often there is no apparent difference from the surrounding membrane. In 
the larynx the epiglottis and the arytenoid eminences seem the favorite seats of morbid sensa- 
tion ; the former usually exhibiting a network of dilated vessels, resembling a veil; the latter a 
slight tumefaction and reddening. In some cases during the more acute stage there is a diffuse 
laryngitis with characteristic coloration and tumefaction—a “ corned-beef” appearance. In 
the pharynx, the tonsillar and peritonsillar structures, and the angles of junction of the postero- 
lateral walls have seemed to be most frequently affected. There may be enlarged glands. The 
tongue and its glands are often involved. The buccal mucous membrane sometimes presents 
whitish patches. When the distressing sensations are referred to the rhinopharynx, Luschka’s 
tonsil may be tumefied and reddened. Noises and peculiar sensations in the ear are usually to 
be explained by tubul catarrh and gouty changes in the drum membrane. 
In young patients, the pharynx and larynx are often covered with a grayish tenacious 
mucus; in those past middle life the pharyngeal membrane is more often dry and pale, 
exhibiting a network of enlarged and tortuous vessels, or mottled with livid patches. 
Spasmodic obstruction to nasal respiration with or without accompanying coryza, spasmodic 
choking in swallowing and spasmodic obstruction to voice and to laryngeal or bronchial 
respiration have been observed in a few cases. 
The diagnosis depends on urinalysis and associated symptoms of gout or lithemia. Local 
treatment must be of the mildest character, and is palliative only; for permanent relief of 
greater or less degree, dependence must be placed on dietetic, hygienic and medicinal measures 
appropriate to the gouty state. 
No. 571. 
Paper by C. E. Bean, M. D., St. Paul, Minn. 
[Neither Title nor Abstract furnished.] 
No. 572. 
“ Effects of Improper Tone-Production on the Vocal Cords of Singers,” by H. Hol- 
brook Curtis, M.D., New York City, N. Y. 
[Neither Title nor Abstract furnished.] 
No. 573 
THE ULTIMATE PROGNOSIS IN NEGLECTED ADENOID HYPERTROPHY. 
D. Bryson Delavan, M. D., 
New York. 
Synopsis.—Does adenoid hypertrophy, if left to itself, disappear, leaving the pharyngeal 
vault in a normal, healthy condition ? 
190 Generally speaking, it does not, but remains under some pathological state, which may 
continue throughout the life of the patient. 
(1) The enlargement may not entirely subside, and a degree of hypertrophy sufficient to 
cause serious injury and annoyance may continue to exist for many years. 
(2) The so-called “ Thorn waldt’s Disease ” appears to be nothing more than neglected 
adenoid hypertrophy. 
(8) Disappearance of the hypertrophy may be attended with an atrophic condition of the 
vault of the pharynx, the result of which is a pathological state, detrimental to the patient and 
difficult to cure. 
The above conditions may influence not only the locality in which they arise, but may 
have far-reaching and disastrous effects upon other organs. The ultimate prognosis as to the 
local condition, therefore, in cases of neglected adenoid hypertrophy is unfavorable. 
No. 574, 
REPORT OF A CASE OF MYXO-SARCOMA OF THE NASAL CAVITY. 
Professor of Laryngology and Otology, Medical Department, Columbia University. 
C. W. Richardson, M. D., 
The interesting features in the case are numerous. The development of the growth, as 
noticed by the parents, was from early infancy. The age of the child at the time of operation 
interference, was only four years and nine months. The enormous size of growth, filling out as 
it did, the nasal and pharyngeal cavities. The complete absence of hemorrhage previous to, 
and the small amount at the first removal of the growth. The rapid reproduction of growth— 
it filling out the left nasal cavity within four days after a most searching and thorough removal. 
From a pathological point of view it presents an interesting feature in the presence of single 
fibres of striated muscular tissues here and there disseminated throughout the growth. The 
growth was first removed by snare but on its rapid reproduction a more radical procedure was 
adopted. The second operation was that of Billroth’s for resection of the superior maxilla. 
Recovery wTas complete. Recurrent followed in four months in the pharynx and lymphatic 
glands of the neck. Result death. 
No. 575. “Surgical Treatment of Empyema of the Maxillary Sinus,” by Dr. Edward 
Obejero, Buenos Ayres, Argentine Republic. 
[Abstract not furnished.] 
No. 576. 
REPORT OF A CASE OF TUBERCULAR LARYNGITIS TREATED IN 
COLORADO SPRINGS. 
S. E. Solly, M. D. 
The author reports the cases of tubercular laryngitis which he has treated, and been able 
to follow out so as to report definitely concerning results, while practicing in Colorado Springs. 
191 Forty-five cases showed decided evidence of tubercular laryngeal affection, among a con- 
tinuous series of 250 cases of phthisis. Many other cases were seen and treated but were 
not seen for a sufficient length of time or often enough to give results. In order to give sufficient 
time for results no cases have been taken of phthisis or laryngitis that were seen for the first 
time less than two years ago. A comparison of the general symptoms, history, and results of 
the 250 cases, with those reported on in this climate and in the Swiss Alps at a similar elevation, 
show them to be average cases. Also a like comparison of the laryngeal cases with those of 
well-known observers, with the exception of results, indicates a common natural history. No 
statistics of results could be obtained, though occasional cures are referred to, and the disease is 
supposed to be necessarily fatal with a few striking exceptions. 
Among the 250 cases of phthisis there were forty-five with tubercular laryngitis’ twenty- 
eight per cent, twenty-five with infiltration without ulceration and twenty with both, that is eight 
per cent. 
The average duration of the twenty-five cases without ulceration from their first symptoms 
up to the time of this report or death was six years, while of eight of these who got worse it was 
three years and ten months. Of the twenty cases with ulcers the average duration was three 
years and two months. While of fifteen of them that got worse it was two years. 
After taking all the laryngeal cases that deteriorated, the average duration of life was two 
years and seven months. Bosworth says the average duration of all cases with laryngeal 
tuberculosis is about two years. Forty-eight per cent of all the laryngeal cases improved. There 
was sixty-eight per cent of improvement among the non-ulcerated cases and twenty-five per cent 
among the ulcerated cases. 
In considering the improvement in the throat alone, in 64.2 per cent of the whole forty- 
five laryngeal cases there was local permanent arrest and besides in five more cases there was 
well-marked temporary improvement. 
Among the non-ulcerated alone the local improvement was sixty-eight per cent. 
Among the twenty ulcerated cases fifty per cent healed and remained healed while three 
additional cases healed temporarily. Of these twenty cases in twenty per cent the lungs' were in 
the last stage of tuberculosis, fifty per cent of whom were generally improved, and in seventy- 
five per cent there was local arrest of the laryngeal disease. Thirty per cent were in the 
second stage of pulmonary tuberculosis, of whom 16.6 per cent were generally improved, 66.6 
per cent having arrest of throat disease. 
Fifty per cent were in the third stage as regards their lungs and showed twenty per cent of 
general improvement, while in thirty per cent of them there was arrest of the laryngeal compli- 
cation. 
The ulceration in thirty per cent was found in the commissure, of whom 33.3 per cent 
improved. 
Upon the arytenoids in forty-five per cent with none improved. 
Upon the false chords in twenty per cent none improved. 
Upon the epiglottis in thirty per cent seventeen per cent improved and upon the true chords in 
fifty per cent of whom thirty per cent improved. In the majority the ulceration was not limited to 
any one of those parts. The author believes these cases would not have shown such good 
results even in the Colorado climate without careful local treatment though it was shown that 
similar treatment had been skillfully applied in a low climate and had failed in most cases. As 
a general principle stimulation is preferred to sedation, while cleanliness is of the utmost 
importance and a variety of drugs and methods are called for and useful in their turn. 
192 No. 577 
SARCOMA OF NASOPHARYNX, WITH REPORT OF CASE. 
Db. James E. Logan, 
Kansas City, Mo. 
J. N. T., age forty-four, school teacher, consulted me June, 1888, presenting the following 
history. Up to the age of forty was very robust; was then taken with typhoid fever. Shortly 
after recovery, he noticed what he called a “ fullness in the upper part of throat,” accompanied 
by considerable secretion of saliva. This condition grew steadily worse, and in a few months 
he was unable to breathe through the nose, could scarcely speak, and often felt on the point of 
suffocation. His general health was much impaired, and the discharges had become excessive 
and fetid. 
He applied to a local practitioner, who found a tumor in the throat projecting into the 
pharynx below. Not wishing to operate himself, he referred the patient to a surgeon in our 
city. This gentleman, as I understand, pronounced the growth a fibroid tumor. He removed 
it and dismissed the, case as cured. There was a temporary improvement in the patient’s 
general health; but he soon lost appetite, became emaciated, and his former symptoms returned 
with frequent haemorrhages, and, for the first time, some pain, not acute, referable principally to 
the left ear. The surgeon again examined him, and discovered that the tumor had returned. 
This time he diagnosed it as sarcomatous in nature. He prescribed a tonic treatment, hoping 
to build up the general health before attempting a second operation; but the tumor grew so 
rapidly that he was forced to remove it while the patient was still very weak. There were no 
glandular complications, and but little pain. This second growth was removed by means of a 
wire ecraseur. The patient reports the operation as very bloody, the haemorrhages continuing 
for several days. He rallied slowly, but for five months enjoyed comparative immunity from 
his trouble. Then the symptoms again returned, and another operation took place. This went 
on until he had submitted to nine such operations. He then concluded to apply to a throat 
specialist. 
I examined him and found a tumor, perhaps twice as large as a partridge egg, situated 
partly upon the roof of the pharynx and extending down a quarter of an inch along the 
posterior wall of the uaso-pharynx. It appeared slightly lobulated, and was firmly attached 
to a large base. Patient’s general condition was much below par. He was somewhat cachectic, 
and suffered considerable pain in the ear and in the back of head. Digital examination of 
tumor provoked profuse haemorrhage. 
I tied back the soft palate, applied a ten per cent solution of cocaine, and divided the 
growth into three sections. One of these I removed at once with the galvano-cautery. Very 
little haemorrhage followed. I applied per-sulphate of iron to the cauterized surface and sent 
the patient back to the hospital. 
I saw him daily, but applied no treatment except a spray of wrarm Dobell’s solution. No 
extensive suppuration followed. In a week he came to my office, and I then removed the 
remaining sections, which by this time were much reduced in size. The surface healed 
readily. The tumor was examined by several pathologists, who all pronounced it a round-cell 
sarcoma. 
The growth has not returned, and the man is to-day in perfect health. 
193 No. 580. 
Alumnol in Diseases of the Throat and Nose,” by J. Mount Bleyer, M. D.,- 
New York City, N. Y. 
JSk>. 582. 
SOME FORMS OF NASAL REFLEXES, AND REPORT OF CASES. 
Professor of Diseases of the Nose, Throat and Chest, Baltimore Medical College. 
S. K. Merrick, M. D. 
While a few medical men are somewhat skeptical as to the connection between the treat- 
ment of certain intra-nasal conditions and the cure of so-called reflex affections in some more 
or less remote portion of the body, so many cases have been reported, covering such a wide 
field, by so many trustworthy observers, that I take it that the great body of intelligent 
physicians, among throat specialists at least, are a unit practically in believing the connection 
very close. 
Until within a comparatively recent date, few cases of nasal reflex disease were recorded 
in medical literature. It would carry us far beyond the limits of this paper to refer to the 
names of all who have done good work in this field of investigation, yet it may not be amiss to 
mention those of a few whose labors have thrown special light upon this interesting subject. 
Voltalini seems to have been one of the first writers to call attention to the nasal reflex, 
in 1872, when he reported a case of spasmodic asthma, dependent on a nasal polypus, the 
removal of which effected a cure. This observation has since been abundantly verified. 
Seiler, Hack and Jno. Mackenzie subsequently brought out the fact that reflex cough was 
present in a certain per cent of nasal diseases. Ocular disturbances, due to intra-nasal disease, 
were forcibly set forth by Dr. Grueining, of New York, in a paper read before the Academy 
of Medicine, April, 1886. Beverly Robinson, Cheatham, and Bettman have also reported 
similar cases of eye troubles of nasal origin. 
Hack, in his well-known monograph, reports a large number of nasal reflexes, such as 
gastralgia, dyspepsia, cardiac palpitation, salivation, neuralgia, cephalalgia, migraine, ciliary 
neuralgia, photophobia, vertigo, and some others. 
Bosworth reports cases of salivation, chorea and epilepsy cured by treatment of intra-nasal 
diseases, of which they were reflexes. Salinger and Fincke also report cases of epilepsy. F. 
A. Mcßride reports a case of psychical epilepsy, and Tesin a case of nocturnal enuresis. 
Many others have reported nasal reflexes covering a wide field, but the foregoing names 
and cases are sufficient to emphasize the reliability of the observations, and the fact that a great 
variety of affections may be due to intra-nasal disease. 
Dr. Mcßride, of Edinburgh, has raised the question, “ whether the cure of the local con- 
dition within the nose or the counter-irritant action of the application ” controls the reflex. 
Bosworth cites Bourchard, as quoted by Rualt (in support of the counter-irritant action), who 
cured a case of sciatica by cauterizing the lobe of the ear. 
The question of “ moral effect ” has very naturally been invoked to explain many of these 
cures, yet I believe, with Bosworth, that while it may have some force, it is secondary in most 
cases, but may be, I think, the chief factor in a small per cent of cases. 
The cure of intra-nasal disease is responsible, undoubtedly, for most of the successful 
results. 
There are, then, three chief views held as to just how these reflexes are cured, viz. ; 
(1) By cure of intra-nasal disease. 
194 (2) By counter-irritation. 
(3) By moral effect. . 1 
That none of these is wholly true or entirely false I firmly believe, as the following cases 
will verify: 
Cases I. and 11. show that reflex eye troubles were relieved, not suddenly, but when the 
local intra-nasal condition was cured. 
Case 111. A case of reflex headache and vertigo was relieved by the counter-irritant 
action of the cautery before the local disease of nose was favorably affected. 
Case IV. A case of sciatica, cured almost immediately on cauterization of the turbinates, 
was doubtless relieved by the “ moral effect.” 
No. 583. 
HYSTERICAL APHONIA AND DEAFNESS. 
E. Fletcher Ingals, A. M., M. D., 
Chicago, Illinois. 
Hysterical aphonia is so common that little of interest can be said concerning it. But 
hysterical deafness is comparatively rare, I find repoits of a few cases, but have never met 
with it myself excepting in a single instance, a brief history of which I think will be of interest 
to this Congress. The case is that of Miss P. A. J., aged twenty-three years, and a teacher by 
profession, who recently came to America from Ceylon. She had been annoyed for three years 
by weakness of the voice, and sometimes by complete aphonia. About two years ago, while 
making an ocean voyage, she was greatly alarmed by a rat springing upon her. Immediately 
thereafter she lost the sense of hearing, and since that time has been so deaf that she could not 
hear ordinary conversation, and could only understand when addressed in very loud tones with 
the person’s lips close to her ear. She had been slightly deaf before the fright, but the symptom 
was greatly increased immediately afterwards. 
When she came to see me in the early part of July, 1893, she was still extremely nervous, 
and complained of dryness of the throat, inability to speak excepting in a whisper, and deaf- 
ness so great as to require shouting to enable her to hear. Her general health was good; there 
was no history of predisposition to disease; pulse 100, temperature 100; no cough nor expecto- 
ration ; appetite fair and digestion normal. The hearing tested by an ordinary watch showed 
that no sounds whatever were appreciated even when the watch was placed in contact with the 
ear or temporal bones. The left membrana tympani was considerably thickened; the right 
normal. There was no congestion of the larynx and the cords were well approximated on 
attempted phonation, but this position could not be maintained. She talked only in a whisper, 
but upon directing her to sound the letter a, while examining her larynx I found that she could 
easily produce loud sounds. I applied a mild astringent spray to the larynx and a spray of 
menthol, five grains to the ounce, to the Eustachian tubes through the naso-pharynx, the appli- 
cation being made by a long-tipped Davidson’s No. 59 atomizer, which was introduced back of 
the palate, the spray being driven in with an air pressure of fifteen pounds, while the nostrils 
were tightly held. 
She was given internally berberin muriate gr. i, ext. of valerian gr. ii, and sulphate of 
strychnine in doses of 1-20 of a gr,, which I proposed to increase rapidly to 1-10 or even 1-8 of 
a grain. 
Three days later it was noted that she felt something better, stating there was a “softening” 
in the ears, and seven days after the first treatment her friends stated that she occasionally 
195 spoke aloud, though in a low voice, and that her hearing was decidedly improved. At this time 
the dose of strychnine was increased to gr. 1-10, which produced no appreciable physiological 
effects. Large doses of strychnine have proven most beneficial in hysterical aphonia, and 
therefore I feel very confident of benefit in this case. 
No. 584. 
CLINICAL NOTES OF CASES OF TUBERCULAR ULCERATION OF THE 
LARYNX TREATED BY THE KRAUSE METHOD AT THE THROAT 
AND CHEST CLINIC OF THE EMERGENCY HOSPITAL. 
T. Morris Murray, M. D., 
Washington, D. C. 
Statistics of results obtained by this method in Krause’s practice. 
Report of cases. These include tubercular ulceration occurring on the soft palate, 
uvula, walls of pharynx and in the larynx. 
Conclusions. Whenever lactic acid can be applied directly to the granulating surface 
of a tubercular ulcer the pain accompanying such ulcer is promptly relieved, and the 
ulcer soon heals. These results are obtained whether great debility be present or not. 
The relief afforded the patient by these applications warrants their use even in cases 
where there is no hope of prolonging life. 
No. 685. “ Indications and Opportunity for Opening the Mastoid Process,” by Dr. Edward 
Obejero, Buenos Ayres, Argentine Republic. 
[Abstract not furnished.] 
No. 586. 
ON THE TREATMENT OF EMPYEMA WITH DUE REGARD TO NORMAL 
PULMONARY CON TRACTIBILITY. 
Dan Milliken, M. D., 
Hamilton, Ohio. 
I. The author lays down the proposition that though, in the act of expiration, air 
rushes across from lung to lung and slightly expands one lung even when its pleural 
cavity has been opened, yet this law is applicable only to persons of fair vigor with deep 
and slow respiration, and to a lung which has not lost its expansibility by disease or 
compression. 
11. The surgeons ignore the tendency of collapsed lungs to remain collapsed, or, 
admitting it, they aim, by the destruction of ribs, to bring the chest-wall down to the 
shrunken lung. This, at best, gives a cure with deformity and diminished lung capacity. 
196 111. The method of treatment by continuous siphonage must be excepted from this 
criticism. Considered as a matter of physics, it is the ideally perfect method ; but it is 
objectionable because it enforces great quietude upon patients who ought to be moving 
about. 
IV. The author therefore commends a method of his own devising. It much ante- 
dates the method of continuous siphonage, and accomplishes its results in the way of 
re-expansion, by an intermittent treatment. 
V. The initial operation, demanding no surgical skill, requires that the aspirator 
needle, passed close to the upper margin of a rib, shall find pus. To tap the lower level 
of the pleural sack is not required. Having found pus, the aspiration ceases and the 
operator thrusts a cataract-knife beside the needle and strictly parallel to it. He makes 
but a tiny wound and seeks to cut the thick pleura rather than the skin. Then a grooved 
director is passed into the wound and the knife is withdrawn. A strong probe is forced 
along the groove, dilating the little wound until a soft small catheter can be passed into the 
chest, leaving about two inches projecting outward. The catheter having been selected to 
fit the metal on the aspirator, and the proper attachment having been made, pus is aspir- 
ated through the catheter until the patient suffers some slight discomfort, or, perhaps, 
begins to cough. Then a perfectly flat pincette is applied to the end of the catheter ; it 
is laid upon the chest in some upward direction; and it is secured in position by plaster 
applied by moisture. 
VI. In later treatment the operator washes away the plaster strips, attaches the aspira- 
tor, removes the pincette, and then aspirates fluid or gases until the patient is slightly dis- 
tressed. This may be profitably done twice a day, but good results have been attained by 
one treatment each day. Warm antiseptic fluids may be thrown into the chest and may 
be returned and replaced, again and again, until they come into the aspirator almost 
limpid. In every case the fluid thrown in should measure less than that abstracted. 
Forming adhesions must not be stretched by the injection of solutions. The patient 
should be left, at the end of each sitting, with some slight discomfort to indicate that there 
is a partial vacuum in the chest. All of this manipulation is made possible by the fact 
that the catheter (after a few days’ granulation and absorption), forms a valvular, air- 
tight joint with the chest-wall. The aspirator is not only able to withdraw pus from the 
cavity, but it sometimes produces such a vacuum as to suck blood from the granulations on 
the pleura. As the pus cavity grows less, the catheter may be gradually shortened. 
VII. In all of the treatment the catheter should be either firmly held by the pincette 
forceps or should be firmly attached to the aspirator, to avoid the possibility of its slipping 
into the chest. 
VIII. The author insists that, having this sort of active drainage, one may ignore 
gravity. Gently pressed by the expanding lung at each aspiration, pus will flow up or 
down or laterally to find the point of least pressure. It will find it at the point of the 
catheter. 
IX. The author observes that his method involves no formidable surgery, no 
general anaesthesia in adults, no pain, inconvenience or enforced quietude in the later 
treatment. It invokes physical principles to expand the lung, and by a systematic move- 
ment cure it teaches the lung to resume its full activity in a full-sized pleural cavity. No 
197 imperfect result has been observed in a large group of cases treated by this method, by a 
number of practitioners, in cases ranging from infancy upward. All have been cured 
quickly and without deformity. 
X. As to priority in calling attention to the need and the method of induced re- 
expansion of the lung, the author refers to his paper in the report of the Ohio State 
Medical Society for the year. 
Xo. 587. Discussion of Injudicious Operative Interference in Nasal Maladies. Opened by J. 
Solis Cohen, Philadelphia, and Arthur G. Hobbs, Atlanta, Ga., followed by 
informal discussion. 
No. 588. Discussion of Local and General Treatment of Hay Fever. Opened by D. Bryson 
Delev an, New York, and W. H. Daly, Pittsburg, followed by informal 
discussion. 
No. 589. “ After Treatment of Nasal Cauterization,” by J. W. Gleitzman, New York. 
198 SECTION ON OTOLOGY. 
HONORARY PRESIDENTS: 
Dr. Adolph Alt, St. Louis, Mo.; Dr. Albert H. Buck, New York; Dr. Gorham Bacon, New 
York; Dr. Wm. Cheatham, Louisville, Ky.; Dr. Francisco de P. Chacon, City of Mexico; Dr. 
Sebastian Cuervo ySerrano, Sancti Spiritu, Cuba; Dr. J. C. Connel, Toronto, Canada; Dr. Stephen 
Dodge, Halifax, Nova Scotia; Dr. J. B. Eaton, Portland, Oregon; Dr. A. A. Foucher, Montreal; Dr. 
John F. Fulton, St. Paul; Dr. J. Wilford Goon, Winnipeg, Manitoba; Dr. Francis B. Loring, 
Washington. D. C.; Dr. Henry D. Noyes, New York; Dr. Arturo Costa Pruneda, Santiago, Chile 
Dr. Charles Inslee Pardee, New York; Dr. G. Sterling Ryerson, Toronto, Canada; Dr. D. B. St. 
John Roosa, New York ; Dr. W. IT. Sanders, Mobile, Ala.; Dr. Belisario Sosa, Lima, Peru; Dr. G. 
C. Savage, Nashville, Tenn.; Dr. J. J. B. Vermyne, New Bedford, Mass. 
EXECUTIVE PRESIDENT. 
Dr. C. M. Hobby, lowa City, lowa. 
SECRETARIES: 
Dr. Max Thokner (Englisn-Speaking), Dr. H. McHatton (Spanish-Speaking), 
Cincinnati, O. Macon, Ga. 
Dr. Fernando Perez [Juncal SO9J liuenos Aires Argentine Republic. 
Dr. Ernesto Mazize La Paz Bolivia. 
Dr. Theodoro Peckolt, (Jok) . Rio de Janeiro U. S. of Brazil. 
Dr. J. H. WISHART Toronto Canada. 
Dr. Carlos Desvernine [Cuba 52] Havana Cuba. 
Dr. Carlos Esguerra Bogota Republic of Colombia. 
I)R. Demetrio OranTES Guatemala City ..... Guatemala. 
Dr. H. G. McGrew Honolulu Hawaii. 
Dr. Antonio PeSafiel [Escuela de Medicina] . . City of Mexico Mexico. 
Dr. Montenegro Leon Nicaragua. 
Dr. N. Surh [lturaingo 265] Montevideo Uruguay. 
Dr. Focion F. Cordero F Merida . Venezuela. 
199 SECTION ON OTOLOGY. 
No. 1101 a. “Prevention of Deaf Mutism,” by C. M. Hobby, M. D., Executive President of 
the Section, lowa City, lowa. 
[Formal Address.] 
No, 1101. 
CHRONIC DISEASE OF THE MIDDLE EAR—ITS PROGNOSIS AND 
SURGICAL TREATMENT. 
Albert H. Tuttle, B. S., M. D., 
Cambridge, Mass. 
The early history of operations for the relief of chronic deafness; and also the 
brilliant success achieved in some cases and to the total failures in others. The different 
individual results obtained by a resort to surgical measures undertaken for pathological 
conditions of apparently similar character; also the great difficulty to be overcome in 
arriving at even an approximate prognosis of such chronic disease. The method intro- 
duced for excision of the membrana tympani, and the method for the removal of the 
larger ossicles for the relief of chronic suppuration. Fixed conditions which give indica- 
tion for operative treatment. Cases for operation into two classes, the first division is for 
the relief of deafness generally ; the second class embraces measures for overcoming the 
suppuration altogether. The causes of deafness, either accompanied with suppuration or 
not, are touched upon ; so also deafness as a result of a former attack of suppurating 
otitis media, and deafness as a result of dry catarrh with hypertrophy of the tissues and 
in other cases when the disease processes have progressed further and produced an atrophy. 
Otitis media suppurativa chronica with complications of caries of the ossicles and mastoid 
disease are also considered as well as the pathological conditions giving rise to tinnitus 
aurium and to vertigo. The special treatment of the membrana tympani with reference 
to its reproduction or prevention after operations is mentioned, and also the dangers of the 
operations and of continued middle ear disease. A choice in the methods of operating 
and a consideration of the cases that yield the best results after the employment of surgi- 
cal measures. Cases. 
200 No. 1102. 
OTACOUSTIC TREATMENT—ITS HISTORY AND RESULTS UPON THE 
DEAF AND DEAF MUTES. 
J. A. Maloney, M. D., 
Washington, D. C. 
Prior to the year 1886, I devoted a great deal of time to experiment in physics, and 
principally to its branch, acoustics, the result of which was the development of the instru- 
ment, since known as the otophone, which differed in construction from anything used for 
that purpose prior thereto. It had two chief characteristics : 
(1) It did not enter the meatus auditorius externus. 
(2) It was a tube closed at one end by a flexible membrane, and thereby confined a 
column of air. 
Its advantages having reached the ears of Drs. S. Wier Mitchell and C. H. Burnett, 
of Philadelphia, and through them, I was requested by the College of Physicians, of that 
city, to lay the matter before them, and demonstrate its advantages. This was done on 
April 6, 1887. (See transactions of the College of Physicians, Third Series, Yol. IX., 
Philadelphia, 1887.) 
Subsequently I was invited to make tests upon deaf mutes at the “ Pennsylvania 
Institution for the Deaf and Dumb,” and (a confirmatory test) at the “ National Deaf 
Mute College, Washington, D. C.” The results were laid before the American Otological 
Society, July 19, 1887, New London, Conn. (See transactions American Otological 
Society, Yol. IY., Part I. 
Then it was that the thought of a new field of treatment in chronic deafness 
occurred to me, I turned to physiological acoustics for light and knowledge, but I found 
the path had been traversed only partially, until the portals of this domain of science had 
been opened by Weber, Lucac, Helmholtz, Politzer, Rieman, Henke, and in our own 
country by Blake, Burnett and Sexton, but the literature upon this subject was sparse, 
and then not special. 
A great deal then was dependent upon tentative deduction. Up to this time, 
otology depended upon “ Politzer Inflation,” local application, Siegel’s Otoscope, and 
later Delstanche’s improvement upon same. In the use of Politzer Inflation slight 
benefit was conferred by equalizing the pressure upon each side of the “ membrana 
tympani.” In the use of otoscope, success was rare, why ? because it produced noise, and 
the ear in the higher or lower animal shrinks from the same. 
Then I directed ray attention to a system of aural massage, which had for its chief 
feature, sound arbitrarily applied, as a therapeutic agent in chronic deafness, and desig- 
nated by me as “ otacoustic treatment ” (meaning any sounds to the ear), and has since 
been known by that title. Much time was required in formulating the method of treat- 
ment, classified, as well as individual cases during the first two years, the work being 
empirical, because I had no rule of procedure based upon experience of others for my 
guidance. The partial anchylosis or fixation of the ossicular auditus could be relaxed by 
201 this form of passive motion was accepted by some of the most eminent otologists of our 
day, and I was encouraged by them to persevere. There were two leading otologists, 
however, who ascribed my success to education of the perceptive tract, and this alone 
* * * * * * 
No. 1103. 
THE PHONOGRAPH IN THE TREATMENT OF DEAFNESS. 
Johnson Eliot, A. M., M. D. 
Washington, D. C. 
He reviews the theories of the phonograph, of massage, of hearing and the’practical 
utility of the phonograph as a means of applying massage. 
He recites the histories of several cases and concludes that, as far as his experience 
shows, the phonograph has proven a failure in the treatment of deafness. 
No. 1104 
SOME INTERESTING CASES OF MASTOID DISEASE 
S. McCuen Smith, M. D., 
Philadelphia, Pa. 
It is now generally conceded that intra-cranial complications arising from aural dis- 
ease are usually the result of the chronic form ; and yet we should not overlook the fact 
that these serious complications sometimes take their origin from an acute suppurative 
otitis media. The cases cited in the paper forcibly illustrate this view. As a rule, how- 
ever, we need not fear cerebral complications from the acute form of the disease, unless 
they should arise from the transmission of infectious matter through the blood-vessels. 
As this probably explains how intra-cranial sepsis may occur, the subject demands our 
most serious consideration and investigation. 
The danger from an acute suppurative otitis media by direct communication is slight 
when the lining tympanus mucous membrane is intact; but if by neglect this inflamma- 
tion should become chronic, the erosion and consequent caries of the tympanic walls may 
give rise to a cerebral or mastoid abscess, through direct communication. 
The other cases are unique, because arising from the acute suppurative form of tym- 
panic disease. 
Our object in calling attention to these cases is to bring prominently before the pro- 
fession the assertion that septic cerebral inflammation and abscess arising from acute sup- 
purative disease of the tympanic cavity occurs with far greater frequency than was hereto- 
fore suspected. All of which facts strongly emphasize the necessity for the early recogni- 
tion and treatment of all primary aural diseases, no matter how insignificant they may 
appear. 
202 No. 1105. 
OPENING THE MASTOID CELLS IN ACUTE INFLAMMATORY MID- 
DLE EAR DISEASES. 
L. D. Brose, M. D., Ph. D., 
Evansville, Ind. 
Although the indications as laid down in the text-books for opening the mastoid 
cells in acute middle ear diseases seem well defined, it has nevertheless been my experience 
to have met with cases where, notwithstanding the symptoms present indicated mastotomy, 
and because of failure to get the patient’s consent, or because the operation through other 
causes was delayed, the patients eventually recovered solely through local treatment. 
Otorrhoea accompanied by pain, oedema over mastoid, and fever, resisting antiphlo- 
gistic treatment for eight days (Schwartze) is an indication for mastotomy, especially if 
the posterior wall of external hearing canal is swollen and bulging and deep-seated 
furuncolosis is excluded. In acute suppurative middle ear inflammation, without mastoid 
involvement or pus retention resisting usual treatment two to three weeks, mastotomy is 
indicated (Dr. Heiman, of Warsaw). Also as a prophylactic measure when the ear 
drainage is insufficient, because of swelling of the middle ear lining membrane, or size or 
location of drum perforation or stenosis of auditory canal. Cerebral abscess, suppurative 
phlebitis with sinus thombosis, extra-dural suppuration and meningitis, even with the 
presence of pyaemic or septic symptoms, indicate mastotomy. Otherwise incurable and 
recurrent mastoid neuralgias indicate opening the mastoid. 
No. 1106. 
ARTICLE ADENOIDS, A CONTRIBUTEDE FACTOR IN AURAL 
AFFECTIONS. 
M. D. Lederman, M. D., 
The recurrence of the suppurative process in middle ear disease observed in children 
is so evidently due to the presence of these growths, that their thorough removal should 
be our first effort. If the patient is suffering from acute symptoms, we must delay such 
surgical interference until same have subsided. It matters not if this obstructing mass 
produces the inflammatory state by direct continuity or by inhibiting the action of the 
levator palati muscles, thus interfering with the proper aeration of the eustachian tube and 
middle ear, or whether the circulatory apparatus is influenced by the pressure exerted 
upon the pharyngeal veins. The knowledge that these growths are an exciting factor is 
sufficient evidence to urge their prompt removal. The usual method of treating the 
incessant discharge by irrigation and insufflations of boracic acid, thus allowing the 
possible absorption of the tympanic membrane and ossicles, is, to say the least, a most 
faulty practice. If we would introduce our finger into the pharyngeal vault of young 
New York. 
203 patients, suffering from these frequent purulent attacks, in the large majority of cases it 
would not be necessary to seek further for their origin. When a child suffering from ear 
disease, be it of the catarrhal or purulent variety, is the subject of adenoids, we may 
safely offer a favorable prognosis, providing the removal of the hypertrophied tissue can 
be thoroughly performed. Unless all the lymphatic tissue is ablated (and this can be 
readily ascertained by the introduction of the finger into the pharyngeal space), the 
desired results are not forthcoming. By ridding the patient of this overgrown tonsil, we 
not only benefit the aural complication, but materially influence the general system as 
well. The symptoms of mouth-breathing, restlessness at night, dull expression of face, 
nocturnal enuresis, are all relieved by abstracting the exciting lesion. We must not 
anticipate an immediate cessation of the offensive aural discharge, as it takes a few days 
and sometimes weeks for its final disappearance. However, some cases respond so quickly 
to the treatment that we are at times agreeably surprised. The instrument which has 
given me most satisfaction in their removal is the modified heart-shaped Gottstein 
curette, together with the Lowenberg’s post-nasal forceps improved by Dr. Gleitsmann. 
No. 1107. “Compressed Air, Vapors and Sprays in the Treatment of the Middle Ear, and 
Eustachian Tubes,” by H. V. Wuedeman, M. D., Milwaukee, Wis. 
No. 1108. “The Present Condition of Otology in Europe,” by Lawrence Tuenbull, M. D., 
Philadelphia, Pa. 
No. 1109. “Pathological Conditions following Piercing of the Lobules of the Ear,” by Max 
Thornee, M. D., Secretary of the Section, Cincinnati, O. 
[Abstract not furnished.] 
No. 1110. “ Craniometric Measurement of 500 Skulls in Relation to Aural Topographic 
•Anatomy,” by B. Alex. Randall, M, D., Philadelphia, Pa. 
No. 1111. “Description of Focussing Ear Trumpet,” by Edmund D. Spear, M.D., Boston, 
Mass. 
[Abstract in hands of Literary Bureau.] 
No. 1112. “The Modern Non-Surgical Treatment of Chronic Purulent Inflammation of the 
Middle Ear, with Indications for Surgical Interference,” by R. C. Heflebower, 
M. D., Cincinnati, Ohio. 
[Abstract in hands of Literary Bureau.] 
No. 1113. “The Treatment of Suppurative Processes of the Attic,” by J. F. Fulton, M. D., 
St. Paul, Minn. 
204 No. 1114. “The Non-Surgical Treatment of Attic-Neurosis,” by W. Cheatham, M. D. 
Louisville, Ky. 
No. 1115. “ Preventable Deafness,” by Chas. S. Turnbull, M. D., Philadelphia, Pa. 
No. 1116. “Contribution to the Study of Aural Syphilis,” by Max Toeplitz, M. D., New 
York City, N. Y. 
No. 1117. “On Localization of Sound,” by C. Barck, M. D., St. Louis, Mo. 
No. 1118. “Indications for the Mastoid Operations and the Preferable Methods,” by S. S. 
Bishop, M. D., Chicago, 111. 
No. 1119. “Description of a Middle Ear Powder Blower,” by R. D. Barret, M. D., St. 
Louis, Mo. 
[Abstract not furnished for 1113 to 1119 inclusive.] 
205 SECTION ON DERMATOLOGY AND SYPHILOGRAPHY. 
Dr. Silva Aranjo, Rio de Janeiro, U. S. of Brazil; Dr. L. Duncan Bulkley, New York; Dr. Juan 
C. Castillo, Lima, Peru; Dr. Louis A. Duhring, Philadelphia; Dr. Le Grand N. Denslow, St. Paul; 
Dr, Maximiliano Golan, City of Mexico, Mexico; Dr. Jas. Nevins Hyde, Chicago; Dr. Prince A. 
Morrow, New York; Dr. R. B. Morison, Baltimore; Dr. D. W. Montgomery, San Francisco; Dr. A. 
Ravogli, Cincinnati; Dr. A. R. Robinson, New York; Dr. Antonio Rubio, Pinar del Rio, Cuba; Dr. 
M. Lucas Sierra, Santiago, Chile; Dr. R. W. Taylor, New York; Dr. A. Van Harlinger, Philadel- 
phia; Dr. J. C. White, Boston, Mass.; Dr. Edw. Wigglesworth, Boston, Mass. 
HONORARY PRESIDENTS; 
EXECUTIVE PRESIDENT: 
Dr. A. H. Ohmann-Dumesnil, No. 5 South Broadway, St. Louis, Mo. 
Dr. Wm. S. Gottheil (English-Speaking), Dr. John Forrest (Spanish-Speaking), 
25 W. 53rd St., New York, N. Y. Charleston, S. C. 
Dr. Carlos Lloveras [Piedad 944] Buenos Aires Argentine Republic. 
Dr. Viscarra Heredia La Paz Bolivia. 
Dr. W. S. Barnes [Leper Llospital] Mahaica British Guiana. 
Dr. Joan P. Gabiza Rio de Janeiro U. S. of Brazil. 
Dr. J. E. Graham Toronto Canada. 
Dr. Enrique Robelin, [Jesus Maria 91] Havana Cuba. 
Dr. Daniel E. Coronado [Calle 13, num. 120] . . Bogota Republic of Colombia. 
Dr. Daniel NuSez San Jose Costa Rica. 
Dr. Angel Rivera Paz Guatemala City Guatemala. 
Dr. HENRY G. McGrf.w, Honolulu Hawaii. 
Dr. Strachan Kingston Jamaica, W. I. 
Dr. P. Numa Rat Antigua Leeward Islands, W.I 
Dr. Francisco Bernaldez [Escuela de Medicina] . . City of Mexico Mexico. 
Dr. Bevan N. Rake Port of Spain Trinidad, W. I. 
Dr. Manuel Bonasso [Arapey Esquina Colonia] . . Montevideo Uruguay. 
Dr, Adolfo BriceSo Picon Merida Venezuela. 
SECRETARIES: 
206 SECTION ON DERMATOLOGY AND SYPHJLOQRAPHY. 
No. 601 a. “American Dermatology,” by A. H. Ohmann-Dumesnil, M. D., Executive Presi- 
dent of the Section, St. Louis, Mo. 
[Formal Address.] 
No. 601. 
LUPUS, ITS EXTIRPATION AND REPORTS OF CASES. 
B. Mereil Ricketts, M. D., 
Cincinnati, Ohio. 
The ravages that lupus in any form produces, and its persistent character, have made 
not only the sufferer, but the surgeon desperate in his endeavor to give relief. Whether 
or not the future treatment and consequent good results are to be obtained by following up 
Koch's principles, is yet a question. When a lesion is cured that has been diagnosticated 
lupus, the preponderance of evidence is that it was a mistaken diagnosis, that it was not 
lupus. However this may be, we must necessarily depend to a great degree upon the 
clinical history and appearance of the lesion. I was convinced early in my practice that 
treatment of any kind availed but little. This naturally led me to resort to more desperate 
means than was usually employed by those with whom I was associated. All treat- 
ments convinced me that the disease, when possible, should be excised. Unfortunately, 
the disease occurs mostly about the face, eye-lids, nose, ears and lips, places where extirpa- 
tion is made with the greatest difficulty, and where the greatest deformity is the result. I 
believe that the extirpation of lupus is about as certain, when done in its earliest stages, 
as some of the forms of epithelioma and sarcoma. The question arises, When does it 
become constitutional and to what degree may it become constitutional when extirpation 
would be useless? It is also important to determine that degree in any of the malignant 
growths. 
If lupus is found upon the finger we would not hesitate to amputate it; if lupus 
were to appear upon the hand, we would naturally resort to all means of treatment to save 
the hand. Would it not be better to remove the hand early in the progress of the disease? 
We know that the removal of a finger affected with lupus has cut short the disease, and 
that the patient has lived for years without any recurrence. Now, if this be so, why is it 
not rational surgery to extirpate any diseased lesion that may appear upon any part of 
the body ? The means that we now have at our command in restoring parts with both 
single and double pedunculated grafts, as suggested by Thiersch, should encourage both 
the operator and the patient in resorting to early surgical interference, no difference upon 
207 what part of the face the disease may be found. The dread of suffering, taking an 
anaesthetic, and being deformed, I might say, is the occasion of so much procrastination, 
not only in the treatment of lupus, but all other diseases. 
I have treated the two forms of lupus in the same manner, having seen sixty-five 
oases. 
(1) Lupus vulgaris 42 
(2) Lupus erythematosus ~ . . .23 
No. 602. 
GLYCOSURIA AS AN ADDITIONAL SYMPTOM INDICATING THE 
NEUROTIC ORIGIN OF DERMATITIS HERPETIFORMIS. 
James McF. Winfield, M. D., 
Attending Dermatologist to the Kings County Hospital, Brooklyn, N. Y. 
Many cases of dermatitis herpetiformis have been reported by Elliot, Brocq, and 
other dermatologists, pointing to severe nervous shock as the essential etiological factor in 
the production of this much discussed cutaneous disease; but no mention is made in their 
writings of any change in the urinary secretion. 
The author gives a number of clinical cases occurring both in his practice and that of 
Doctor Sherwell, in which glycosuria was present to a greater or less extent, and in all of 
them the recurrent attacks followed some unusual mental exertion or severe nervous shock, 
showing, therefore, an intimate relationship between the presence of the eruption and the 
reception of the nervous shock. 
It is not the object of the paper to consider in extenso the other clinical facts. Refer- 
ence is made to the investigations of Claude Bernard in regard to the now recognized 
existence of a sugar centre in the medulla oblongata, by direct puncture of this centre, 
but also in some cases of general brain shock and sudden lesions in distant parts of the 
brain. Suggestion is made to the possible influence of the higher nervous centres radiat- 
ing the shock to the medulla oblongata. 
No. 603. 
A STATISTICAL RECORD OF 5000 CASES OF SMALL-POX 
William M. Welch, M. D., 
Physician in Charge of the Municipal Hospital for Contagious and Infectious Diseases, Philadelphia, Pa, 
It is my purpose to present for consideration a statistical tabulation of 5000 cases of 
small-pox, all having come under my personal observation in hospital service. These 
cases will be so divided and classified as to show the influence of sex, color and age, 
over the disease. More especially will be shown the power of vaccination as a protec- 
tive agent. 
208 In order to facilitate and simplify the presentation of these important facts printed, 
tables will be hung up for inspection, showing the number of cases, the deaths, and 
the death rates of each sex and of each color, white and black. Both the vaccinated 
and unvaccinated cases will be divided according to the age of the patients, showing 
the death rates of those under one year, one to live years, five to ten, ten to fifteen, 
and fifteen years and upwards. A classification will also be made of the cases, accord- 
ing to the nationality of the patients, showing the death rates of the unvaccinated and 
the vaccinated under each of these divisions. The vaccinated cases will be divided in 
each table, according to the character of the vaccine cicatrices, three divisions being 
made, and characterized by the terms, good, fair, and poor. All those who alleged to 
have been vaccinated, but showed no visible mark, will be classified accordingly. The 
vaccinated cases will still further be classified according to the number, as well as the 
character of the vaccine cicatrices in each case. 
The paper will show what proportion of these 5000 cases had been, or alleged 
to have been, revaccinated. 
The question of the frequency and severity of recurrent or second attacks of 
small-pox, will also be considered. 
No. 604. 
TKEATMENT OF DISEASES OF THE NAILS. 
John V. Shoemaker, A.M., M.D., 
Philadelphia, Pa. 
In all the systematic diseases to which allusion has been made loss or change of nail 
structure is but one of many signs of disordered nutrition. In serious maladies, which 
tend to a fatal issue, the local treatment of the nails is scarcely likely to engage any one’s 
attention. But in many of the conditions named, especially when the patient is a female, 
it is desirable to take measures for improving the appearance of the nails. The therapy 
will obviously be chiefly directed to the constitutional disorder. Of constitutional 
remedies I will only mention sulphur as one which is especially useful in improving the 
nutrition of the nails. Sulphur is a normal ingredient of nail-tissue, in which it exists in 
a comparatively large proportion. It is consequently an excellent remedy in cases where 
the nutrition of the nail is perverted. 
In addition to sulphur, of which I have already spoken, arsenic and iron are also of 
value in debilitated subjects. They improve the nutrition of the nails and assist the 
action of the local measures. When the nail is simply thickened or lengthened the 
redundant portion can be removed by means of the knife, scissors, cutting-pliers or saw. 
If the hypertrophy is but moderate in degree, paring the free end of the nail and pushing 
back the free margin of skin at the side and base of the nail will often arrest the faulty 
growth. Early in the case a cure can generally be effected by carefully inserting a small 
HYPERTROPHY OF THE NAIL. 
209 piece of absorbent cotton between the nail and the adjacent fold of skin. Tn this manner 
the horny plate is gradually raised when the soft parts can be readily removed without pro- 
ducing much pain. 
ATROPHY. 
The treatment of atrophy of the nails depends upon its cause. As the affection 
occurs in connection with many constitutional diseases constitutional treatment is requisite 
in most cases. If atrophy of the nails takes place in syphilis anti-syphilitic remedies 
should be given according to the stage of the disease and the condition of the patient, not 
forgetting that iron is often needed in syphilis in order to combat the specific anaemia. If 
the atrophy develops consecutive to an attack of fever, reconstituent remedies are 
demanded and as the general health improves the nutrition of the nails is favorably 
influenced. If the atrophy has been caused by tuberculosis we must employ those remedies 
which may modify the progress of the general malady. When we are able to trace a 
connection between the malnutrition of the nails and a serious disease of the nervous 
system, such as ataxia, we must make use of such means and remedies as are most likely to 
favorably modify the course of the general malady. 
The local applications which we may employ in case of unusual atrophy consist 
principally of oils or fats and protectives. The office of the latter is, of course, to guard 
a painful nail-bed from direct contact with irritant substances. The latter is a point of 
considerable importance when the occupation of the patient exposes the finger ends to 
injury. A layer of wax or gum over the affected nails will add to the comfort of the 
patient. Among medicinal agents which exert a favorable influence in atrophy of the 
nail are the oleates of lead and zinc, made into an ointment with lanolin. These oleates are 
of especial service in painful conditions. 
The growth of a healthy nail may also be stimulated by the use of mercurial 
ointments or plasters, which are of particular value if the disease of the nail depends upon 
syphilis. 
No. 605. “ Primary Dystrophies of tie Skin,” by E. Preble, M. D., Cleveland, Ohio. 
No. 607. Paper, by Geo. Holster, M. D., Brooklyn, N. Y. 
[Neither Title nor Abstract furnished.] 
No. 608. “ Rhinophyma,” by Wm, Gottiieil, M. D., New York City, N. Y. 
[Abstract not furnished.] 
No. 609. 
RHINOPHYMA.—A NEW PATHOLOGICAL CONDITION FOUND. 
A. H. Ohmarr-Dumesril, M.D., 
St. Louis, Mo. 
In this paper a case of the trouble is described wherein the tumor weighed about two 
pounds. An operation procured complete relief of the deformity which had existed 
210 some years, the subject having been a hard drinker for a number of years. The operation 
was a purely cosmetic one which terminated in a very favorable result. 
Upon making microscopical sections of the tumor it was found to consist mainly of 
fibrous tissue as is generally the case in growths of this nature. Large vacuoles were 
also found, but the interesting condition is the finding of isolated fat cells disseminated in 
the fibrous tissue. Their origin was no doubt due to a shrinking process by which por- 
tions of the columnae adiposae were cut off by the formation of the fibrous tissue and, in 
this manner the fat cells discovered were disseminated in a totally different tissue. 
No. 610. 
FRAMBOESIA OR YAWS. 
Honorable Secretary “Leeward Island’s Branch of the British Medical Association;’.’ Government Medical Officer, 
St. Philip’s, Antiqua, British West Indies. 
By George Edmund Pierez, M. D., and C. M., Edin. Univ., 
Introduction :—The disease little known in Europe. Widely diffused throughout the 
tropics, under various names. Statistics of cases in some of the British West Indies. 
Definition :—A specific contagious disease, endemic in many tropical countries, char- 
acterized by eruptions of solid tubercles on certain parts of the body, the tubercles covered 
by a brownish-yellow crust, and exhibiting a raspberry-like appearance, on removal of 
the crust. The disease runs in more or less chronic course. 
Synonyms :—“ Framboesia,” “ Rian,” “ Yaws,” “ toboe,” parangi,” etc. 
Geographical Distribution :—West Africa; Senegambia to Angola; interior of 
Africa; Westerly Soudan ; Nile Valley; Timbuctoo; Northern and North-eastern coasts 
of Africa; Madagascar; Mozambique; Java; Sumatra; Ceylon; Fiji Isles; Brazil; 
British, Spanish and French West Indies; Guiana; Central America. 
History :—Various waiters have described the disease from 1648 to present time. 
(Wm. Pison, Bontius, Dazille, Schilling, Alibert, Gavin Milroy, etc.) 
Symptoms:—(A) Stage of incubation, two to ten weeks. (R) Stage of invasion, very 
little to be noticed in mild cases. In severe ones the eruption may be ushered in by fever 
and joint pains. (C) Results, recovery in mild cases. Severer cases end (i) either fatally 
from dropsy, dysentery or some other intercurrent disease, or (ii) in permanent deformities 
from destruction of muscle and tendon (through deep and extensive ulcerations) and con- 
traction of joints. 
Varieties of eruptions:—(A) “Pian dartre,” a furfuraceous condition of the skin. 
(R) “ Pian gratelle,” the tubercles are small, have no distinct crust, and have a* watery 
appearance. (C) “ Crab yaws,” a name applied to the disease, when it attacks the soles of 
the feet. (D) “ Ringworm yaws,” so called from the appearance presented by the 
tubercles. {E) “ Tubercles,” the characteristic eruption, they are covered by brownish- 
yellow crusts. A, R, C, D, are not true varieties, but only steps in the evolution of the 
true tubercles. 
Duration;— Two weeks to four or six months in mild cases, one or more years in 
severe cases. 
211 Distribution of Eruption :—Upper and lower extremities, but chiefly the latter, next 
the face, then the genitals and perineum. 
Age :—Most common between one and five years; next, between five and ten years; 
least seen in very young children and old people. 
Sex :—Both equally affected. 
Diagnosis:—(A) Between “Psoriasis” and “Plan dartre.” (B) Between “Eczema 
squamosum” and “ Pian dartre.” (0) Between “yaws” and syphilis. 
Prognosis :—Not dangerous in healthy, well-fed and cleanly children or adults. May 
end fatally in those of debilitated constitutions, or may cause permanent deformities. 
Etiology :—(A) Predisposing causes, (i) race, most common in black races, but due 
to accidental circumstances, (ii) Bad hygienic conditions and unwholesome food. (B) 
True cause, a “ con tagi urn vivum,” the “micrococcus Framboesial,” so named and de- 
scribed by the author in 1890, in a graduation thesis submitted to the medical faculty of 
Edinburgh University. 
Pathology:—A yaws “ tubercle ” consists of an aggregation of overgrown papillae, 
the overgrowth being due to the irritation caused by the “ micrococcus Framboesial. 
Bacteriology :—From old crusts exposed to the air, the author isolated a “ bacillus ” 
which has been shown to be the ordinary “B. subtilis.” Not found in crusts protected 
from external contamination. The “ micrococcus Framboesial ” was isolated from the 
blood of a yaws patient. 
Treatment:—Wholesome food and cleanliness, quiet sufficient in mild cases. More 
Severe cases need external application of some germicide (tinct. of iodine, etc.). Bad cases 
need, beside outward applications, internal remedies (Fowler’s Solution alone or with iron, 
etc.). 
Classification :—Not a “ cachexia,” but one of the “ exanthemata.” 
Fowl yaws :—Very similar to the disease in the human subject, in the microscopic 
characters of the “ tubercle,” distribution of the eruption, and age at which infection most 
frequent. A micrococcus, isolated from the blood here also, is apparently identical with 
that of human yaws. 
x\ppendix:—Consists of a list of 152 cases of yaws, seen and treated by the author, 
in Antigua up to the end of February 1893. 
No. 611. 
THE QUESTION OF THE COMMUNICABILITY OF LEPROSY. 
Beaven Rake, M. D., London, 
Medical Superintendent of the Trinidad Leper Asylum; late Senior Member of the Indian Leprosy Commission 
Port of Spain, Trinidad. 
Modern evidence does not bear out the ancient opinion as to the communicability of 
leprosy. 
212 Subject to be considered under six headings : 
(1) Bacteriological evidence. 
Discovery of leprosy bacillus’! by Hansen, confirmed by Neisser. Leprosy not 
necessarily contagious because associated with a bacillus. 
Cultivation experiments of Hansen, Neisser, Rake in the Trinidad Asylum, Bordoni, 
Uffreduzzi, Gianturco, Campana, Buckmaster, Thomson and Rake at Almosa and Simla. 
No undoubted culture of leprosy bacilli yet obtained, though some of the bacilli cultivated 
have presented points of resemblance to those in the tissues. Inoculation of cultures in 
animals have always failed. Of Koch’s four postulates, only the first has been proved in 
the case of leprosy. 
(2) Inoculations of animals. 
1. With cultures. 
2. With tubercles or other leprous products. 
Culture inoculations always negative. 
Results with tubercles or other leprous products doubtful. Neisse described a local 
nodule. Damseh got local infiltration of iris, ciliary body aid Descemet’s membrane. 
Vossius got similar results. Adverse criticism of Wesener, Leloir and Campana. Simi- 
lar results with leprous material hardened for years in alcohol. Experiments of Campana 
in fowls, and Kobner and Hansen in monkeys. Failure of Thin, Kannis, Arming, Bor- 
dinis, Uffreduzzi, Leloir and Rake to inoculate animals. Negative experiments of Hil- 
laiset and Gaucher and Vidal in pigs. 
Melcher and Ortmann obtained dissemination of nodules in viscera of rabbits after 
inoculation of anteria chamber with leprous tubercle. Avining and Ruffer believe these 
nodules to be leprous. Wesener and Huppe think they are tuberculous. 
Recent experiments of Rake in Trinidad Asylum. Guinea pigs developed visceral 
nodules after inoculation with fragments of phthisical lung from lepers. Bearing of 
these experiments on those of Melcher and Ortmann. Besiner’s view that leprosy is an 
essentially human disease. 
(3) Inoculations in the human subject. 
(1) With cultures. 
(2) With tubercles or other products. 
Injections of anesthetic lepers with cultures in the Trinidad Asylum. Two out of 
twelve developed leprous tubercles afterwards, but this may have been a coincidence. 
Rarity of appearance of cutaneous tubercles in a pure anesthetic leper. 
Aviniug’s case of inoculation of a criminal with leprous tubercle. Fallacies sub- 
sequently discovered. 
Failure of Profeta, Danielssen, Holst and Jitsch to inoculate healthy individuals, 
and of Hansen to inoculate anesthetic lepers. Thirty-three anesthetic lepers inoculated 
with pieces of leprous tubercle in the Trinidad Asylum. Results negative, except in one 
who had also been injected with culture. 
Sum of evidence under this head practically negative. 
213 (4) Vaccination. 
Cases reported by Gairdner, Daubler and Chew. Obvious fallacies. Pringle’s 
experience of twenty years’ vaccination in British Gashune and the plains between Ganges 
and Jumna. Opposed to statements of anti-vaccinationists. 
Microscopic examination of vaccine lymph from leper. Avining and Simpson re- 
ported bacilli. Rake in Trinidad found none. Animals vaccinated with leprous lymph 
did not develop leprosy. Buckmaster, Thomson and Rake in Almont made ninety-three 
examinations of vaccine lymph from lepers. Doubtful rods in two cases. Practically 
no damage from vaccination. 
(5) Practical experience. 
Fallacy of concomitant variations in all cases of alleged contagion occurring in 
countries where leprosy is epidemic. Typical case of the kind cited, which recently came 
under the writer’s notice. Experience of the leprosy commission in India. Only one 
case which did not break down on cross-examination. Discrepancies even in this case, 
that of an asylum attendant at Calicut. Hawtrey Benson’s public case, the only one 
apparently free from objection. Was the diagnosis correct? 
(6) Alleged increase of leprosy. 
Apparently great increase in Hawaii. Recent appearance and increase in Memel. 
Present state of the disease in Trinidad, India, Norway, Iceland, and Northwestern 
States of North America. In Trinidad proportion of lepers to population about the same. 
In other countries absolute decrease. 
No. Gl2. 
SOME OF THE RARER TROPHIC LESIONS IN LEPROSY. 
f By Beaven Rake, M. D., London, 
Medical Superintendent of the Trinidad Leper Asylum ; Late Senior Member of the Indian Leprosy Commission, 
Port of Spain, Trinidad. 
Peripheral nerves always infiltrated more or less with new growth associated with 
leprosy bacilli if patient lives long enough. Classification of leprosy into tuberculated, 
anesthetic and mixed purely arbitrary. Recent dissections by Gerlach show that in 
anesthetic leprosy primary growth takes place in skin around nerve endings. 
Existence of trophic nerves not satisfactorily proved. Term “ trophic,” used as a 
convenient one for working purposes. 
More common trophic lesions such as anesthesia, ulceration, gangrene and necrosis 
are well known. Proposed to discuss some of the rarer conditions. 
(1) Raymond's phenomena. 
Raymond’s original definition. Local asphyxia and symmetrical gangrene. Case 
of local asphyxia occurring in Trinidad Leper Asylum quoted. Associated with anes- 
thetic leprosy. Post-mortem appearances. Bacilli in superior cervical sympathetic 
ganglion. 
214 (2) Charcot’s Joint Disease. 
Two cases in lepers in Trinidad Asylum quoted. Points mentioned by Charcot 
as characteristic of tabetic arthrites. Hutchinson’s criticism that changes are due to free 
movement of an anesthetic rheumatically inflamed joint is peculiarly applicable to 
leprosy. Possibly the two patients had tabes as well as leprosy. Three possible theories. 
(3) Symmetrical Bed-sores. 
Two cases in lepers quoted. Close resemblance to Charcot’s acute decubitus, 
Position of sores in centre of buttocks rendered it unlikely they were due to pressure. 
(i) Perforating Ulcers. 
Far commoner in lepers than in other subjects. Very similar to those in locomotor 
ataxia and other diseases, but sometimes there is intense pain. Methods of treatment: 
Nerve stretching sometimes successful for a time. Best results from splitting open foot 
forward between toes and stuffing with lint. Twenty-four patients thus operated on. 
Illustrated case quoted. 
(-5) A Condition Resembling Ainhum. 
Crombie’s description of ainhum. Only occurs in negroes and Hindoos, Has been 
seen in fourth toe, great toe and a finger. Histology studied by Eyles. His theory, though 
applicable to little toe, not satisfactory when disease occurs elsewhere. 
Notes of nine cases resembling ainhum, occurring at Trinidad Leper Asylum. Con- 
striction occurred in various fingers and toes. Possible explanation offered. Difficulty of 
obtaining post-mortem evidence in cases of ainhum, as the disease is not a fatal one. 
(6) Ophthalmic Lesions. 
Ophthalmia most frequent. Ulcer of cornea not uncommon. Sometimes followed 
by onyx, hypopym, or other varieties of abscess, by perforation, or iritis with synechia. 
Occasionally panophthalmistic and destruction of eye occurs. 
Same difficulty here as in the old experiments on changes in nutrition of the eye 
after division of trigemiums in rabbit. Snellen’s results. 
Condition in leprosy closely resembles effect of section of trigeminus. Sometimes 
absolute anaesthesia of cornea, so that cataract can be extracted without artificial 
anesthetic. 
Question thus becomes the same as that discussed with reference to Charcot’s joint 
disease. 
Changes in tuberculated leprosy due to growth of tubercles in conjunctiva or cornea, 
and do not concern present inquiry. 
(7) Zona. 
Observed seven times in six years at Trinidad Asylum. Radcliffe Crocker describes 
cases in groups and suggests atmospheric influence. Patients in adjoining-beds attacked 
in Trinidad Asylum. Groups of cases also occur outside the asylum in non-lepers 
occasionally. 
215 No. 613. “ Beriberi en el Cauca,” by De. Eyaeisto Gaecia, Cali, Cauca, Colombia. 
No. 614. “ Lepra en el Cauca,” by Des. Eyaeisto Gaecta, and Adolfo Tenoeis, Cali, 
Cauca, Colombia. 
Intestinal neuritis, the commonest lesion in zona, hence it is not surprising that zona 
occurs in lepers, Charcot specially mentions zona in locomotor ataxia. 
These notes help to show that many of the most interesting lesions in leprosy have 
their prototypes in diseases already described in Europe oE elsewhere. Great complexity 
of question of trophic lesions. 
No. 615. “El Caratea,” Des. Juan N. Wallis 0., and Alfeedo Gaeces y Domingo, 
Arboleda, Colombia. 
No. 616 
A CASE OF RECURRENT PRURITUS. 
A. H. Ohmann-Dumesnil, M. D., 
St. Louis, Mo. 
A woman who is now twenty-nine years old had a child twelve years ago. Her 
cervix was lacerated but she did not suffer in any particular manner from this. March 
6, 1889, she took Siij of laudanum and did not recover from the effects for several days. 
The woman is well nourished, has a good physique and is inclined to be “ nervous.” 
Her menstruation has always been normal and regular. The pecular pruritus first 
showed itself April 16, 1889, when her menstrual period came on. Ever since that time 
it occurs a day before, during, or a day after menstruation. It is universal and very dis- 
tressing, nothing, in the way of scratching, brushing or the mechanical means, allaying it. 
The attacks last from twelve to twenty-four hours. 
Latterly, however, the attacks are not so severe, nor do they last for such a long period 
of time. 
A peculiarity in connection with such attack is that the face becomes of an intense red 
color, and the pupil contracts to one-third its normal diameter. This would seem to point 
to a central origin limited to the base of the brain. 
No. 617. 
THE ETIOLOGY OF ECZEMA. 
A. Ravoglia M. D., 
Cincinnati, Ohio. 
The experiment of Hebra, consisting in painting the skin with croton oil, can no 
more pass as an example of eczema. The action of the croton oil on the skin is an inflam- 
matory one, and the result is a dermatitis. Dermatitis is not eczema, but dermatitis often 
is the starting point of eczema. Both affections recognize as their ground an inflamraa- 
216 Tory process, but they must be separated by their clinical and pathological characters. 
Chronic course not tendency to relapse are the characteristics of eczematous affections. 
Observations show that the presence of pus or purulent discharge on an irritated skin 
are liable to produce eczema. Catarrhal rinitis, chronic otorrhea often are the starting point 
of eczema, and yet in cases of seborrhea eczema is produced when purulent matter is 
formed underneath the sebaceous crusts. Nurses and surgeons having to handle puru- 
lent secretions, when the epidermis was not entirely wholesome, have got eczema of the 
hands and of the fingers. Impetigo has often been communicated from the mother to the 
child and vice versa, and often from one point of the skin eczema has been communicated to 
other parts of the body only by contact of the surface of the skin, or by the nails in the act of 
scratching. 
Conclusion is that pus is the most effective cause of eczema. To prove this assertion 
experiments were done, 
A rabbit was prepared by shaving its ears, and after having them washed and cleansed 
with a solution of carbolic acid, the ears were rubbed with a pure culture of staphylococcus 
pyogenes albus. No result however was obtained. The ears were after a while painted with 
croton oil until a strong dermatitis was produced. The left ear was then inoculated with 
the pure culture of staphylococcus pyogenes albus; nothing was done to the other ear, leav- 
ing it for comparison. In a few days the symptoms of dermatitis subsided, but one week 
after, the left ear which had been inoculated showed pustules, and vesicles, which soon 
were covered with yellow thick coats resembling eczema, while the other ear which had 
not been inoculated, but only irritated with croton oil, had returned to its normal condi- 
tion. The eczema produced on the inoculated ear lasted for over four weeks before the 
skin could return to the normal condition, and showed a remarkable alopecia. 
This was a proof that staphylococcus pyogenes albus is a cause of eczema. 
It will not affect an epidermis when completely healthy, but it needs to find the cells 
of the horny layer disconnected so as to find its entrance underneath them. 
This explains the easy relapse of eczema when some of the cocci remain under the 
epidermic cells, after some days they develop again and new plagues of eczema show up again. 
The quality of the skin of the different individuals and their general condition has 
something to do with the production of eczema, but never has it been inherited from the 
offspring as eczema. All the cases referred to as nervous eczema were more dermatitis 
than true eczema. 
The cocci produce taxalbumen which has a local irritant action upon the epidermis 
causing at times an acidizatiou of eczema. Stophilococci are found abundantly on the 
epidermis cells scraping an eczematous plague. Stophylococcus aureus and citreus seems 
to produce more deep inflammations in the skin in form of pustules, furunceles and 
carbuncles. 
The conclusions are that: 
(1) Eczema is a local affection of the skin. 
(2) Of chronic inflammatory nature affecting the epidermis. 
(3) Contagious under favorable circumstances. 
(4) Produced by micro-organisms contained in the pus. 
(5) Aroused from a previous irritative or inflammatory condition of the skin. 
217 No. 618. Is leprosy contagious or inoculable? If so, what is the manner in which such con- 
tagion or inoculation is effected ? 
No. 619. What are the relations of psorospermosis to malignant processes (epithelioma, 
Paget’s disease of the nipple, etc.) ? 
No. 620. Is impetigo a disease sui generis? If so, what is the explanation of the different 
varieties observed ? 
No. 621. Are the lesions of tertiary syphilis dependent on the process, or]are they secondarily 
caused by the result of a changed condition of tissues ? ”If so, what is the 
explanation ? 
No. 622. The diagnosis of skin diseases in the colored races. 
218 SECTION ON HYGIENE, CLIMATOLOGY AND DEMOGRAPHY, 
HONORARY PRESIDENTS: 
Dr. A. Nelson Bell, Brooklyn, N. Y.; Dr. Federico Puca Borne, Santiago, Chile; Dr. Emelio R. 
Coni, Buenos Aires, Argentine Republic ; Dr. J. J. Cornilliac, St. Pierre, Martinique, F. W. I.; Dr. 
Roland G. Curtin, Philadelphia, Pa.; Dr. Charles Denison, Denver, Col.; Dr. Martin Dulante, 
Lima, Peru; Dr. Samuel H. Durgin, Boston, Mass.; Dr. Justin E. Emerson, Detroit, Mich.; Dr. Carlos 
Finlay, Havana, Cuba; Dr. Felix Formento, New Orleans, La.; Dr. Aranjo Goes, Rio de Janeiro, 
U. S. of Brazil; Dr. Henry R. Hopkins, Buffalo, N. Y.; Dr. E. P. Lachapelle, Montreal, Canada; 
Dr. Eduardo Liceaga, City of Mexico, Mexico; Dr. Frederick Montizambert, Quebec, Canada; Dr. 
John S. McGrew, Honolulu, Hawaii; Dr. John H. Rauch, Chicago, 111.; Dr. E. L. Shurley, Detroit, 
Mich.; Dr. Stephen Smith, New York City; Deputy Surgeon General George M. Sternberg, U. S. 
Array; Dr. John Sundberg, San Francisco, California; Dr. Henry P. Walcott, Boston, Mass.; Dr. 
Irving A. Watson, Concord, N. H. 
Medical Director Albert L. Gihon, M. D., United States Navy. 
EXECUTIVE PRESIDENT : 
SECRETARIES: 
Dr. Peter 11. Bryce (English-Speaking), Dr. Pedro Jose Salicrup (Spanish-Speaking), 
Toronto, Canada. 129 E. 17th St., New York City. 
Dr. Pedro N. Arata [25 de Mayo 273] .... Buenos Aires Argentine Republic. 
Dr. Luis Pierola La Paz Bolivia. 
Dr. Pacifico Pereira Bahia U. S. of Brazil. 
Dr. E. J. Rowland New Amsterdam British Guiana. 
Dr. Gabriel Durango Borda Bogota Republic of Colombia. 
Dr. Juan J. Flores Heredia Costa Rica. 
Dr. Manuel Delfin Havana Cuba. 
Dr. J. B. De Houx . Port au Prince Haiti. 
Dr. George Trousseau Honolulu Hawaii. 
Dr. Clarke Santa Cruz Jamaica. 
Dr. Kalmer St. Croix Leeward Islands, W. I. 
Dr. J. Carreau Point a Pitre Guadeloupe, F. W. I. 
Dr. Enecon Mora Quezaltenango Guatemala. 
Dr. Domingo Orvaßanos City of Mexico [Chavarria 25] . Mexico. 
Dr. Montenegro Leon Nicaragua. 
Dr. Jose Arechavaleta Montevideo Uruguay. 
Dr. Calixto GonzAles Caracas Venezuek 
219 SECTION ON HYGIENE, CLIiTATOLOGY AND DEMO= 
GRAPHY. 
[Abstracts received too late for publication.) 
No. 651 “ The Climate of Jamaica,” by Dr. J. C. Phillippo, Kingston, Jamaica. 
No. 652. “ Les Mesures Prophylactiques Centre les Epidemics, ”by Dr. J. B. Da Lacerda, 
Rio de Janeiro, Brazil. 
No. 653. “ Practical Measures in the Prevention of Tuberculosis,” by Lawrence F. Flick, 
M. D., Philadelphia, Pa. 
No. 655. “ Apuntes Sobre la Patologia del Departmento Fluvial de Loreto,” by Dr. Leonidas 
Arendaho, Lima, Peru. 
No. 656. “ Ojeada Retrospectiva Sobre la Organizacion de la Sanidad en los Ejercitos Espa- 
holes,” by Dr. Felix Estrada y Catoyra, Havana, Cuba. 
No. 657. “ The Climate of Western North Carolina, with a Consideration of the Relative 
Value of High and Medium Altitudes in the Treatment of Pulmonary Tubercu- 
losis,” by Karl von Ruck, M. D., Asheville, N. C. 
No. 658. “ The Climate of the Santa Cruz Mountains,” by James Henry Clark, M. D., 
Jamaica, W. I. 
No. 659. “On the Early Detection and Seasonable Climatic and other Treatment of Phthisis,” 
by Charles Denison, M. D., Denver, Col. 
No. 660. “ The Distribution of Disease by Isthmian Practice, or the Direct Responsibility 
of the Republic of Colombia, S. A., in the Burial and Disinterring of the Dead 
on the Isthmus of Panama,” by Wolfred Nelson, M. D., New York City, N. Y. 
No. 661. “ The Three Climates of Jamaica, B. W. 1., Its Coast or Tropical—Temperate and 
Mountain Climates. Jamaica, considered as a Winter Island for Health,” by 
Wolfred Nelson, M. D., New York City, N. Y. 
No. 662. “ A Brief Consideration of Elephantiasis Arabum, as observed in the Samoan 
Islands,” by John C. Wise, M. D., Washington, D. C. 
No. 663. “On the Climatology of Egypt,” by Dr. Grant (Bey), Cairo, Egypt. 
220 No. 664. “ Hygiene and Demography of Jamaica,” by Dr. James Cecil Phillippo, Kingston, 
Jamaica. 
No. 665. “ The Need of Research in Preventive Medicine,” by J. M. Postle, M. D. 
Hinckley, 111. 
No. 666. “ The Effect of Advanced Civilization on Disease,” by W. J. Moody, M. D., 
Plainfield, lowa. 
No. 667. “ Necessary Laws that Should be Enacted by the Several States by which Munic- 
ipal Health Authorities may be enabled to Control Infectious Diseases.” 
[Discussion.] 
No. 668. “The Cause and Prevention of Diphtheria.” 
[Discussion.] 
No. 669. “ The Limitation and Prophylaxis of Tuberculosis.” 
[Discussion.] 
No. 670. “The Role of Municipal Sanitation in the Limitation and Eradication of Yellow 
Fever.” 
[Discussion.] 
No 671. “On the Climatology of Mesopotamia,” by John Sundberg, M. D., United States 
Consul, Bagdad, Asiatic Turkey. 
No. 672. “On the Climatology of Puerto Rico,” by Pedro Jose Salicrup, Secretary of the 
Section, New York City, N. Y. 
No. 673. Formal Address, by Albert L. Gihon, M. D., Medical Director United States Navy, 
Navy Hospital, Washington, D. C. SECTION ON MARINE HYGIENE AND QUARANTINE. 
HONORARY PRESIDENTS: 
Dr. Lino Alarco, Lima, Peru; Dr. Henry B. Baker, Lansing, Mich.; Dr. CardeSas, Managua, 
Nicaragua; Dr. J. J. Cornilliac, St. Pierre, Martinique, F. W. I.; Dr. Felix Formento, New Orleans; 
Dr. H. B. Horlbeck, Charleston, S. C.; Lieut. Col. Amalio Lorenz, Sub-inspector of 2nd class Spanish 
Navy, Havana; Dr. F. Montizambert, Quebec, Canada; Dr. Francisco Nunez, St. Tecla, Salvador; 
Dr. Juan Ortego, Guatemala City, Guatemala; Dr. Joseph Y. Porter, Jacksonville, Fla.; Dr. John 
Pringle, Kingston, Jamaica; Dr. Juan J, Unoa, San Jose, Costa Rica; Dr. O. Paquin, Lebanon 
Springs, Mo. 
EXECUTIVE PRESIDENT: 
Dr. Walter Wyman, Surgeon General U. S. Marine Hospital Service, Washington, D. C. 
Dr. S. T. Armstrong (English-Speaking), Dr. G. M. Guiteras (Spanish-Speaking), 
166 W. 54th St., New York, N. Y. U. S. M. H. S., Washington D. C. 
Dr. Emelio R. Coni [Tacuari 252] Buenos Aires Argentine Republic. 
Dr. Luis Pierola La Paz Bolivia. 
Dr. Jose L. de Magalha.es Rio de Janeiro, U. S. of Brazil. 
Dr. J. J. Cassidy Toronto Canada. 
Dr. Manuel Delfln [Maloja 4] Plavana Cuba. 
Dr. Gabriel I. Castenado [Calle 13, num. 181] . . Bogota Republic of Colombia. 
Dr. Jose M. Castr.o Limon Costa Rica. 
Dr. D. E. Guesde Point a, Pitn . . . Guadeloupe, F. W. I, 
Dr. Carlos Padilla Guatemala City Guatemala. 
Dr. George Herbert Wailuku Maui Plawaii. 
Dr. E. Flint Rivas Nicaragua. 
Dr. A. E. Edwards Antigua Leeward Islands, W. I. 
Dr. Elias Regules . Mentevideo Uruguay. 
Dr, Geronimo A. Blanco Caracas Venezuela 
SECRETARIES: 
222 SECTION ON ITARINE HYGIENE AND QUARANTINE. 
[Abstracts received too late for publication.] 
No. 701. Formal Address, by Walter Wyman, M. D., Executive President of the Section 
Surgeon General of the United States Marine Hospital Service, Washing- 
ton, D. c. 
No. 701 a. The Hygiene of Vessels, Commercial and Naval, including the Question of 
Ventilation, Heating, Sanitary Arrangements, the Disposal of Cargo so as 
to Facilitate Disinfection, Steam Disinfection, Food Supply, etc. 
(Discussion Opened by Dr. John J. Cassidy, Ontario, Canada.) 
No. 702. “Epidemic and Exotic Diseases Propagated by Shipping. What Diseases 
Should be Quarantined. Responsibility of Nations for Epidemics ; India 
for Cholera, South America for Yellow Fever. Can a Feasible Plan be 
Devised to Totally Exterminate Cholera ? International Intervention to 
Prevent the Propagation of Cholera or other Epidemic Diseases by Pil- 
grimages or Immigration.” 
(Discussion Opened by Wolfred Nelson, M. D., New York City, N. Y.) 
No. 703. “International Uniformity in Quarantine Regulations.” 
(Discussion Opened by Dr. Juan J. Ulloa, San Jose, Costa Rica.) 
No. 704. “The Medical Officers of Passenger Vessels; Methods for their Selection, 
Duties, etc.” 
[Discussion,] 
No. 705. “ The Vital Statistics of Seamen and Firemen. The Question of the Medical 
Examination of Crews Preparatory to Shipping. 
[Discussion.] 
No. 706, “ The Supervision of Vessels by Government Medical Inspectors at Ports of 
Arrival and Departure. Code of Rules for Handling an Epidemic Disease 
that Breaks out on Shipboard. Disinfection of Passengers and Crew 
During a Voyage. Location and Arrangement of Ship’s Hospitals.” 
[Discussion.] 
223 No. 707. “ Arrangement of Detail and Equipment of Quarantine Stations: a, Inspec- 
tion Stations; b, Local Quarantine Stations; c, Refuge Stations. Methods 
for Handling Infected or Suspected Vessels. Interstate and Inland Quar- 
antine. Sanitary Cordons; Camps of Refuge; Camps of Probation. 
Recent Improvements in Hospitals for Infectious Diseases. Railroad 
Inspection and Quarantine. Length of Time Vessels Should be Held in 
Quarantine. Conditions that Should Determine Proclamation of Quar- 
antine Against a Country.” 
[Discussion.] 
No. 708. “ Under what Requirements may Passenger Traffic be Carried on Between a 
Port Infected with Yellow Fever and a Southern Port of the United States 
During the Summer with the Least Obstruction to Such Traffic.” 
[Discussion.] 
No. 709. “ What Merchandise Should be Considered as Requiring Treatment if 
Shipped from a Port or Place infected with Cholera, Yellow Fever or 
Small-pox ? ” 
[Discussion.] 
No, 710. “Methods of Disinfection: a, Persons; b, Baggage; c, Cargoes; d, Vessels. 
Recent Improvements in Quarantine Appliances; Steam Chambers; 
Sulphur Furnaces. Liquid Sulphur Dioxide as a Disinfectant. Treatment 
of I3allast Water; Solid. What Time Should an Infected Vessel be 
Detained in Quarantine? a, For the Cholera ; b, For Small-pox ; c, For 
Typhus Fever; d, For Plague ; e, For Yellow Fever. Methods of the 
Disposal of the Bodies of those that Die While in Quarantine.” 
[Discussion.] 
Papers 701 to 710, inclusive, transferred to 674 et. sej. 
224 SECTION ON DISEASES OF THE MIND AND NERVOUS SYSTEM. 
HONORARY PRESIDENTS: 
Dr, Jorge Diaz Albertina, Havana, Cuba; Dk. Juan C. Castillo, Lima, Peru; Dr. C. G. 
Comegys, Cincinnati; Dr. F. X. Dercum, Philadelphia; Dr. J. T.r Eskridge, Denver; Dr. Orpheus 
Everts, College Hill, Ohio; Dr. Juan N. Govantes, City of Mexico, Mexico; Dr. Allen McLane 
Hamilton, New York ; Dr. Wm. A. Hammond, Washington ; Dr. P. O. Hooper, Little Rock, Ark.: Dr 
Henry M. Hurd, Baltimore; Dr. J. G. Kiernan, Chicago; Dr. J. A. Mcßride, Wauwatosa, Wis.- 
Dr. Chas. K. Mills, Philadelphia; Dr. S. Weir Mitchell, Philadelphia; Dr. Moncorvo, Rio de 
Janerio, U. S. Brazil; Dr. J. J. Putnam, Boston; Dr. E. C. Seguin, New York ; Dr. E. C. SPITZKA, 
New York, Dr. G. Isaac Ugarte, Santiago, Chile; Dr. Sam’l Weber, Boston; Dr. D. R. Brower 
Chicago; Dr. Barney Sachs, New York City ; Dr. Graeme M. Hammond, New York City; Dr. M. 
Allen Star, New York; Dr. Landon Carter Gray, New York City; Dr. Harold N. Moyer, Chicago; 
Dr. J. B. Andrews, Sup’t Buffalo State Hospital, Buffalo, N. Y.; Dr. Chas. L. Dana, 50 W. 46th Street,' 
New York City; Dr. P. R. Thombs, Sup’t State Hospital for Insane, Pueblo, Colo.; Dr. H. C, Wood 
1925 Chestnut St., Philadelphia, Pa. 
EXECUTIVE PRESIDENT: 
Dr. C. H. Hughes, 500 N. Jefferson Avenue, St. Louis, Mo. 
SECRETARIES: 
A. B. Richardson' (English-Speaking), Dr. M. G. Echeverria (Spanish-Speaking), 
Columbus, Ohio. Key West, Fla. 
Dr. Melendezy Cabrea [HospicioSan Buenaventura] Buenos Aires Argentine Republic. 
Dr. Nicolas Hortiz Da Paz Bolivia. 
Dr. Carlos Eires Rio de Janeiro U. S. of Brazil. 
Dr. Stephen Lett .... Guelph Canada. 
Dr. Plaido Kingston Jamaica, W. I. 
Dr. Pablo Garcia Medina [carrera 8, nura. 277] . . Bogota Republic of Colombia. 
Dr. Emiliano NuSez [Galiano 19] Havana Cuba. 
Dr. Jose Azurdia Guatemala City Guatemala. 
Dr. George Herbert Wailuku Maui Hawaii. 
Dr. SECUNDINO E. Sosa [Hospital de Mujeres Dementes] City of Mexico ...■>. Mexico. 
Dr. Pellais . . Leon Nicaragua. 
Dr. Francisco Soca [Florida 90] Montevideo Uruguay. 
Dr. Hemiterio Formez Merida Venezuela. 
225 SECTION ON DISEASES OF THE HIND AND NERVOUS 
SYSTEM, 
[Abstract received too late for publication,] 
No. 801<x. Formal Address, by C. H. Hughes, M. D., Executive President of the 
Section, St. Louis, Mo. 
No. 801. u The Gangliated Nervous System and Some of it’s Diseases,” by Chas. K 
Mills, M. D., Philadelphia, Pa. 
No. 802. Paper, by William A. Hammond, M. D., Washington D. C. 
No. 803. “ The Traumatic Psychoneurosis, its Relations to Paronoia, Epilepsy and 
Paretic Dementia,” by J. G. Kiernan, M. D., Chicago, 111. 
No. 804. Paper, by Theo. Diller, M. D., Pittsburg, Pa. 
No, 805. Paper, by E. C. Seguin, M. D., New York City. 
No. 806. “ The Urine in Sexual Neurasthenia,” by Chas. L. Dana, M. D,, New York 
City. 
No. 807. “ Suppurative Meningitis and Myelitis with Exhibition of Specimens,” by 
Graeme M. Hammond, M. D., New York City. 
No, 808, “ The Disease of Inebriety and its Treatment,” by T. D. Crothers, M. D., 
Hartford, Conn. 
No. 809. “Chorea,” by Charles Henry Brown, M. D., New York City, 
No. 810. “ Study of the Temperature in Twenty-five Cases of General Paralysis of 
the Insane,” by Frederick Peterson, M, D., New York City. 
No. 811. “ The Present Status of Infantile Cerebral Palsies,” by Frederick Peterson, 
M. D., New York City. 
No. 812. “ The Successful Management of Inebriety without Secrecy in Therapeutics,” 
by C. H. Hughes, M. D., St. Louis, Mo, 
226 No, 813. “ Erotopathia, Morbid Erotism/’ by C. H. Hughes, M. D., St. Louis, Mo. 
No. 814. “ The Medical Treatment of Insanity,” by Edward C. Mann, Brooklyn, N. Y. 
No. 815. “Address of Welcome,” (in Spanish), by Wm. A. Hammond, M. D., Washing- 
ton, D. C. 
No. 816. “ Where the New-born Baby Learned to Suck,” by C. A. F, Lindorme, M.D., 
Atlanta, Ga. 
No, 817. “ The Treatment of Nervous Diseases in Sanitariums,” by Jas. K. King, M.D. 
Watkins, N. Y. 
No. 818. “The Influence of Alcohol upon the Human Powers and Constitution,” by T. 
L. Wright, M. D., Bellefontaine, Ohio. 
No. 819. “ The Treatment of Cerebral Hemorrhage,” by D. R. Brower, M. D., 
Chicago, 111. 
No. 820. “ Neuro-Angio Paralysis and its Relation to Paretic Dementia,” by Prank C. 
Hoyt, M. D., Clarinda, la. 
No. 822, Paper by S. Weir Mitchell, M. D., Philadelphia, Pa. 
N0.’823. Paper by E. C, Spitzka, M. D., New York City, N. Y. 
No. 824. Paper by O. T. Sherman, M. D., Boston, Mass. 
No. 825, “ Civil Service in American Hospitals for the Insane,” by S. V. Clevenger, 
M. D., Chicago, 111. 
No. 826, “La Renguera,” by Dr. Daniel Guiterrez y Arango, Call, Cauca, Columbia. 
No. 827, “ Paralisis Espastica Cerebral de los Adultos,” by Dr. Manuel Carmona y Yalle, 
City of Mexico, Mexico. 
No, 828. “On the Prognosis of * Railway Spine,’ ”byF. X. Dercum, M. D., Philadel- 
phia, Pa. 
No. 829. “ The Nervous Symptoms of Storms,” by Curran Pope, M. D., Louisville, Ky. 
No. 830. “ A Peculiar Type of Vase-motor Neurasthenia (The Pulsating Disease) with 
Report of and Operation for the Same,” by Chas. L. Dana, M. D., New 
York City, N. Y. 
No. 831. “ Curability of Inebriety,” by J. G. Reed, M, D., Elmwood Place, Ohio. 
No. 832. “ Nutrition Against Stimulation,” by W. H. Maxon, M. D., St. Louis, Mo. 
227 SECTION ON ORAL AND DENTAL SURGERY. 
Dr. Jose Joaquin Aguirre, Santiago, Chile; Dr. R. R. Andrews, Boston; Dr. E. A. Baldwin, 
Chicago; Dr. George Beers, Montreal, Canada; Dr. S. B. Brown, Fort Wayne; Dr. EmegdioCarillo, 
City of Mexico, Mexico; Dr. Wm. Carr, New York; Dr. H. B. Catching, Atlanta; Dr. Geo. J. Fred- 
ericks, New Orleans; Dr. Ricardo Gordon, Matanzas, Cuba ; Dr. J. H. Hatch, San Francisco; Dr. 
A. O. Hunt, lowa City; Dr. Louis Jack, Philadelphia; Dr. H. J. McKellops, St. Louis; Dr. Francis 
Peabody, Louisville; Dr. J. C. Storey, Dallas; Dr. J. Taft, Cincinnati; Dr. J. B. Willmot, Toronto, 
Canada. 
HONORARY PRESIDENTS ; 
M. H. FIetCHKH, M. D., D. D. S., 65 W. 7th St., Cincinnati, O. 
EXECUTIVE PRESIDENT ; 
Dr. E. S. Talbot (English-Speaking), I>R. Ramon Campuzano (Spanish-Speaking), 
125 State St., Chicago, Illinois. 822 N. 25th Street, Philadelphia, Pa 
Dr. N. Etchepareborda [Tacuari 355] Buenos Aires Argentine Republic. 
Dr. Wilson La Paz Bolivia. 
Dr. Benicio DE Sa Rio de Janeiro . . . . ; . U. S. of Brazil. 
Dr. LukeTeskey Toronto Canada. 
Dr.Guillermo Vargas Parades [Carrera 7, num.63B] Bogota Republic of Colombia. 
Dr. J. Luis Estrada Guatemala City Guatemala. 
Dr. George Herbert Wailuku Maui Hawaii. 
Dr. Rafael Rico [Escuela de Med.] City of Mexico Mexico. 
Dr. A. Lacayo Granada Nicaragua. 
Dr. Andres G. Weber [Corrales 1] Havana Cuba. 
Dr, Angel Guerra Montevideo Uruguay. 
SECRETARIES: SECTION ON ORAL AND DENTAL SURGERY. 
[No abstracts furnished.] 
No. 0. Dr. Fletcher’s address. 
No. 1. “ Pulpless Teeth,” by Dr. George Evans, New York City, N. Y. 
No. 2. “ Preparatory Knowledge for the Study and Qualifying Education for the Prac- 
tice of Specialties in Medicine and Surgery,” by Dr. J. L. Willie ms, 
Boston, Mass. 
No. 3, “ Teeth in Evolution as Related to Human Degeneracy,” by Dr. Jas. Kiernan, 
Chicago, Illinois. 
No. 4, “ The Relations of Spyhilis to Dentistry,” by Dr. G. Frank Lydston, Chicago, 
Illinois. 
No, 5, “ Hygiene of the Mouth,” by Dr. Charles F. Francis, New York. 
No. 6. “ The Discovery of the Anaesthetic Power of Ether,” by Dr. William H. Potter, 
Boston, Mass. 
No. 7. “ Principles Underlying the Regulating of the Human Teeth,” by Dr. E. A. 
Bogin, New York. 
No, 8. “ Dental Medication and Experiments with Cases,” by Dr. Vida A. Latham. 
No. 9. “A Method of Making Photo-Micrographs with the Higher Powers of the 
Microscope by an Instantaneous Process and Demonstrating with Slides 
made by this Method the Process of Calcification of the Dentine,” by Dr. 
R. R. Andrews. 
No. 10. “ History of the Surgical Engine and its Demonstration,” by Dr. Bonwell. 
No. 11. “ Development of the Vault,” by Dr. Eugene S. Talbot. 
No. 12. “ The Relation of Certain Neuroses to the Teeth,” by Dr. Harrold Moyer. 
No. 13. “ Hair Lip,” by Dr. A. Wilks Smith, Richmond Ky. 
No, 14. “ Pyorrhoea Alviolaris,” Dr. Williams Donnelly, D. D. S., Washington, D. C. 
No. 15. “ Hereditary Stamp,” by Prof. J. B. Hodgkin, D. D.S., Washington, D. C. 
229 SECTION ON MEDICAL PEDAGOGICS. 
Dr. Wm. C. Dabney, University of Virginia, Va.; Dr. L. B. Durochek, Montreal, Canada; Dr. 
Fife Fowler, Toronto, Canada; Dr. Walter B. Geike, Toronto, Canada; Dr. J. W. Holland, Phila- 
delphia; Dr. Felipe Hartman, Santiago, Cuba; Dr. Geo. A. Ketchum, Mobile; Dr. Fernando 
Lataste, Santiago, Chile; Dr. Jos. M. Mathews, Louisville; Dr. Thos. Menees, Nashville; Dr. 
Jas. H. Ethridge, Chicago; Dr. James W. McLane, New York; Dr. Thos. Opie, Baltimore; Dr. Charles 
inslee Pardee, New York; Dr. John Parmenter, Buffalo; Dr. R. C. Stockton Reed, Cincinnati; 
Dr. Dudley S. Reynolds, Louisville; Dr. Juan M. Rodriguez, City of Mexico, Mexico ; Dr. Francisco 
Rosas, lima, Peru; Dr. Geo. L. Sinclair, Halifax, Nova Scotia; Dr. Victor C. Vaughan, Ann Arbor, 
Mich.; Dr. Adam H. Wright, Toronto, Canada. 
HONORARY PRESIDENTS; 
EXECUTIVE PRESIDENT: 
Dr. J. Collins Warren, 58 Beacon Street, Boston, Mass. 
SECRETARIES: 
Dr. Charles L. Scudder (English-Speaking), Dr. Wm. F. Hutchinson (Spanish-Speaking), 
94 Charles Street, Boston, Mass. 159 High St., Providence, R. I 
Dr. Susini [Piedad 10x2] Buenos Aires Argentine Republic. 
Dr. Francisco Hurri La Paz Bolivia. 
Dr. Carlos de Vasconellos . Rio de Janeiro U. S. of Brazil. 
Dr. T. S. Wallbridge Georgetown British Guiana. 
Dr. Fernando Gonzalez del Valle Havana Cuba. 
Dr, Jorge Vargas [Calle 13, num. 109 ...... Bogota Republic of Colombia. 
Dr. Carlos Duran .. . .. . .... . . . . San Jose Costa Rica. 
Dr. Samuel Gonzalez Guatemala City Guatemala. 
Dr. Walters Lehui Kaui ■. . Hawaii. 
Dr. Luis E. Ruiz [San Pedro y S. Pablo 14] .... City of Mexico Mexico. 
Dr. Alejandro Bolasos Masaya Nicaragua. 
Dr. Angel Conaveris [lBde Julio] . Montevideo Uruguay 
Dr. Caracciolo Parra Merida Venezuela. 
230 SECTION ON MEDICAL PEDAGOGICS. 
No. 901(a) 
MEDICAL EDUCATION IN THE UNITED STATES. 
J. Collins Warren M. D., 
Early history of the condition of teaching previous to reform; the changes in the 
past twenty-five years; the new system; medical practice acts; preliminary education; 
laboratory work: study of pathology; clinical instruction; control of hospitals by the 
faculty endowments. 
Boston, Mass. 
No. 901. “ A Consideration of the Position of Bacteriology in a Course of Medical 
Study; its Importance and Growth of Late Years, together with some 
Account of the Development of the Department in Harvard Medical 
School,” by Harold C. Ernst, M. D., Boston, Mass. 
No. 902 
THE IMPORTANCE OF PHYSIOLOGICAL CHEMISTRY" AS A PART OF 
MEDICAL EDUCATION. 
R. H. Chittenden, M. D., 
New Haven, Conn. 
By physiological chemistry is meant something more than the mere application of 
chemical analysis to a determination of composition. This, to be sure, is important, but 
more valuable still is a proper understanding of the processes or lines of functional 
activity going on in the organs and fluids of the body. There is hardly a question either 
in physiology or in the science or practice of medicine which does not draw to a greater 
or less extent upon physiological chemistry for its solution. We must remember that our 
knowledge of the composition of the tissues, organs and fluids of the body is derived 
entirely from chemical study and investigation. 
The great progress made of late years in our knowledge of the various digestive 
juices of the body, of their mode of action, of the character of the products resulting from 
231 the digestion of the various classes of food-stuffs, of the conditions favorable and 
unfavorable to ferment action, these and many other things connected with the study of 
digestion in its broadest sense have all been accomplished by long continued experimenta- 
tion in the domain of physiological chemistry; results that have not only helped to give 
us broader and clearer ideas of the physiology of digestion, but have made possible much 
of the advance in the diagnosis and treatment of disorders of the alimentary tract. 
Take from us our knowledge of the chemical composition of muscle and nerve tissue 
and of the characteristics of the various substances entering into their structure and what 
a blank would remain. Consider the importance of our ever-growing knowledge 
regarding the chemical changes going on in the two master tissues of the body with their 
influence on heat production and on proteid and other forms of metabolism. Then, too, 
the whole broad question of nutrition in general with its bearing on health and disease, 
the study of the urine and faeces, with the rich results such study affords as a means of 
diagnosis, the study of the liver and its secretion, the bile, all are in great part chemical 
problems, partial solution of which has already afforded results of inestimable value. 
Then consider the part physiological chemistry has played in bringing about our 
present understanding of the manner in which micro-organisms act in the animal body, 
with its bearing upon the whole question of infectious diseases. These few illustrations 
give us some idea of the important position physiological chemistry holds with reference 
to medicine, and lends emphasis to the statement that in every medical school of the land 
there should be a well-appointed laboratory for the practice and study of physiological 
chemistry in every direction bearing on medical science. 
No. 903. 
A CONTRIBUTION TO THE STUDY OF MEDICAL EDUCATION IN THE 
UNITED STATES. 
Bayard Holmes, B. S., M. D., 
Chicago, 111. 
An attempt is made to give a brief review of the origin of the American medical 
colleges, showing that they sprang from a desire on the part of ambitious medical men to 
advance in this way their own financial interests. This is shown to have been the case 
especially in a great number of the more recent schools. 
The medical schools of the United States are divided into three classes : (I) Those 
that are under the exclusive control and support of State universities; (2) those that are 
under the control of university corporations or that maintain a nominal connection with 
such corporations, and (3) those that maintain no relations whatever to other educational 
organizations. The advantages and disadvantages of each class are considered separately. 
Illustrative examples of courses of study and a diagram showing the amount of instruc- 
tion, are presented. 
The tendencies of development are shown to have been as follows: (1) Medical 
theories; (2) medical theories plus demonstration of practice in hospitals, dispensaries and 
232 clinics; (3) the application of the best educational methods in studying the theories of 
medicine and the same methods in the study of clinical material. The schools of the 
United States are now undergoing development in this last particular by the adoption of 
laboratory methods of study in all departments of anatomy, pathology and clinical 
investigation. 
The needs of medical schools are shown to lie in improved methods of teaching 
rather than in better facilities for clinical demonstration ; in new laboratories for individual 
and class instruction rather than in hospitals or laboratories for original research ; in paid 
teachers of physiology, pathology and clinical chemistry rather than in the extension of 
surgery, medicine and obstetrics. Suggestions are made by means of model courses of 
study, and by means of rules designed to govern examinations and methods of measuring 
work. The possibilities and limitations of some of these methods are illustrated by the 
exhibition of class work actually accomplished. 
The relation of medical schools to hospitals is shown to be less intimate than the 
requirements of education and the needs of the patients demand. 
The position of medical courses in all but a few universities where the control of the 
medical school is absolutely in the hands of the university, is shown to be less intimate 
and less rational than that of other departments in the following respects: 
(1) Admission to the medical school is allowed to the untrained and uncultured. 
(2) The courses in the medical school do not count in the elective courses for the 
bachelor’s degree or the doctor’s degree, save in a few schools, 
(3) There are no fellowships and no scholarships offered in medicine. 
(4) The relation of the professors in the medical schools to the trustees and to the 
treasury of the university are not upon the same basis as that of professors in other post- 
graduate departments. 
Relief is to be expected only in the endowment of medical schools either by private 
individuals or by the State. It is urged that the State should manifest as much interest in 
the health and food of man as in the health and food of hogs and cattle. Attention is 
called to the fact that at least $750,000 is annually expended by the general government 
on the agricultural experiment stations alone, while not a dollar is spent in medical 
education. Attention is called to the advantages of State university medical schools in 
their ability to co-operate with free hospitals supported by the state, the county, and the 
city, with state boards of health and experiment stations, with the administration of 
charities, with the administration of tenement and factory inspection, with the reformatory 
and penal institutions, and with all the many other varied activities of the general and 
local governments. 
No. 904 
METHODS OF MEDICAL EDUCATION. 
Victor C. Vaughan, M, D., 
Medical education should consist largely of laboratory demonstration and clinical 
teaching. The course should extend through not less than four years. The first two 
Ann Arbor, Mich. 
233 years should be given to the sciences of chemistry, anatomy, bacteriology, physiology, 
physiological chemistry, electro-therapeutics, materia medica and hectology. These 
subjects should be taught by laboratory methods. The students should do, and not be 
content with seeing and hearing. 
The third year should be devoted to demonstration courses in surgery, ausculta- 
tion, percussion and other means of diagnosis, obstetrics, gynecology, ophthalmology, 
otology, laryngeology and the medical uses of electricity. The student should not only 
have practice in bandaging and fracture dressing, but should make amputations on the 
cadaver and laparotomies, and other operations on the lower animals. The third year 
student should also attend clinics. 
The fourth year should be devoted to clinical and hospital work. 
No. 906 
THE AIMS AND METHODS OF MEDICAL EDUCATION. 
By WiM. C. Dabney, M. D., 
University of Virginia, Va. 
The subject will be considered under the following headings: 
First. The requisites for persons entering upon the study and practice of medicine: 
(1) A sufficient development of the faculty of observation and the reasoning faculty, 
to enable the person to judge of cause and effect and to draw proper conclusions from 
ascertained facts. 
(2) A knowledge of the work done by others directly or indirectly connected with 
medical matters. 
(3) The ability and willingness to work. 
(4) A just appreciation of the extent and character of the work which they under- 
take and the responsibility which they assume. 
Second. The best means of allowing these requisites : 
(1) The preliminary studies calculated to develop the faculty of observation. 
(2) The preliminary studies calculated to develop the reasoning faculties. 
(3) The order in which the various branches of medicine should be studied. 
(4) The time which should be given to laboratory work and lectures each day. 
(5) The value and importance of the didactic lectures and of daily recitations. 
(6) The objects and methods of clinical instruction. 
(7) The importance of a high standard graduation in medical colleges with especial 
reference to the character of the work done by the graduate in after life. 
No. 907. “ Methods of Instruction in Clinical Medicine,” by F. C. Shattuck, M. D., 
Boston, Mass. 
(Abstract not furnished.) 
234 No. 908. LATENT POWER OF SOME AMERICAN MEDICAL IDEAS. 
Dr. Ephraim Cutter, 
New York City. 
REALIZED. 
(1) Anaesthena. 
UNREi LIZED, 
(2) Food as a cause of disease. 
(3) Treatment of sclerosis. 
(4) Treatment of fatty fibroid degenerations. 
(5) Treatment of gravelly diseases. 
(6) New physical sign of the pretubercular state. 
No. 909. 
“ How to Teach the Caesarian and Porro Operations in the Class-room,” by 
E. Gustav Zinke, M. D., Cincinnati, O. 
(Demonstration.) 
u Demonstration of the Physiological Action of the|Heart,” by J. P. Sawyer, 
M. D., Cleveland, O. 
(Abstract not furnished.) 
No. 910, 
No. 911 
“ Demonstration of Methods of Teaching Surgery and Anatomy by Free-hand 
Drawing with Colored Crayons,” by M. H. Richardson, M. D., Boston, 
Mass. 
(Abstract not furnished.) 
No. 913 
“ Relation of Biology to Medical Education,by W. T. Sedgwick, M. D. 
Boston, Mass. 
(Abstract not furnished.) 
No. 914 
“ The Status of the 1 Preceptor ’ in Modern Medical Education.” 
(Informal Discussion.) 
No. 916. 
“ Which of the Collateral Sciences Ought to be Eliminated from the Medical 
Curriculum and which of Them ought to be Embraced in the Required 
Preliminary Studies?” 
(Informal Discussion.) 
No. 917. 
“ On the Feasibility of Arranging a Practically Uniform Course of Medical 
Instruction and Requirements in the Various American Countries and 
Colonies.” 
(Informal Discussion to be Participated in more Particularly by the Official Delegates of 
the various Governments and of the various Medical Schools.) 
235 SECTION ON MEDICAL JURISPRUDENCE. 
HONORARY PRESIDENTS ; 
Dr. Juan Jose R. deArrellano, City of Mexico, Mexico; Dr. Manuel C. Barrios, Lima, Peru; 
Hon. Wilder L.Burnap, Burlington, Vt.; Dr. Chas. F. Chandler, New York; Hon. J. D. B. Deßow, 
Nashville, 'fenn.; Dr. Wenceslao Diaz, Santiago, Chile; Dr. R. Ogden Doremus, New York; Hon. 
Lucelius A. Emery, Brunswick, Me.; Hon. M. C. George, Portland, Oregon ; Dr. Alexander E. Mc- 
Donald, New York; Dr. Perry H. Millard, St. Paul, Minn.; Hon. Calvin E. Pratt, Brooklyn, N. 
Y.j Dr. Joaquin Quiles, Havana, Cuba; Dr. 11. J. Launders, Toronto, Canada; Dr. A. N. Bell, 
Brooklyn, N. Y.; Dr. Hon. Clark Bell, New York, N. Y.; Dr. Maurice J. Lewi, New York. 
EXECUTIVE PRESIDENT : 
Dr. Alonzo Garcelon, Lewiston, Maine. 
SECRETARIES; 
Dr. Harold N. Moyer (English-Speaking), Dr. Plutarco Ornelas, 
834 Chicago Opera House, Chicago, Ills. San Antonio, Texas. 
Dr. Podesta [Cuyo 424] Beunos Aires Argentine Republic. 
Dr. Francisco Harri La Paz Bolivia. 
Dr. A. J. de Lonza Lima Rio de Janeiro U. S. of Brazil. 
Dr. N. A. Powell Toronto Canada. 
Dr. Eduardo, Fla [Reina 105] . Havana . . Cuba. 
Dr. Leoncio Barrets [carrera 7, nhm. 397] . . . Bogota Republic of Columbia, 
Dr. Alberta Molina Gautemala City Gautemala. 
Dr. Walters Lehui Kaui Hawaii. 
Dr. Nicolas R. de Avellan [consejo de salubridad] City of Mexico Mexico. 
Dr. M. J. Barrios Rivas Nicaragua. 
Dr. Jose R. Romen [Plaza de Cogancha 38] .... Montevideo Uruguay. 
Dr. Francisco Choparro Merida Venezuela. 
236 SECTION ON MEDICAL JURISPRUDENCE. 
[Abstracts received too late for publication.] 
No. 961 
“ Medical Jurisprudence in its Relations to Dipsomania,” by Edward C. Mann 
M. D., Brooklyn, N. Y. 
No/952 
“ La Antropologia Criminal de Puerto Rico,” by Dr. Jose Rodriquez Castro 
Puerto Rico. 
N0.!953 
“ Present Status of Criminal Anthropology,” by G. Frank Lydson, M D 
Chicago, 111. ’’ 
No. 954 
Hypnotism : Does it Menace Public Weal?” by Fred. C. Valentine, M. D 
New York City, N. Y. 
No. 956. 
‘ The Doctor in Court,” by D. R. Wallace, M. D., Terrell, Texas. 
No. 956. 
“ The Medico-Legal Aspect of Hypnotism.” 
[Discussion.] 
No. 967. 
“ The Question of Responsibility in the Extirpation of the Uterine Appendages 
in the Insane and in Minors.” 
[Discussion.] 
No. 958. 
“The Legal Aspect of Abdominal Section for Penetrating Wounds of the 
Abdomen.” 
[Discussion.] 
No. 959. 
“Medical Jurisprudence; its Aims, Importance, Status and Demands for 
Higher Recognition and Increased Facilities for Instruction by our Insti- 
tutions of Learning devoted to fitting our Young Men for the Professions 
of Law and Medicine,” by A. Garcelon, M. D., Executive President, 
Lewiston, Me. 
[Formal address.] 
237 SECTION ON RAILWAY SURGERY. 
HONORARY PRESIDENTS: 
Dr. F. K. Ainsworth, Los Angeles Cal.; Dr. DeWitt C. Bryant, Omaha, Neb.; Dr. J. M. Dinnen, 
Ft. Wayne, Ind.; Dr. W. G. Galbraith, Omaha, Neb.; Dr. G. L. Hoege, Fostoria, Ohio; Dr. JabezN. 
Jackson, Kansas City, Mo.; Dr. Willis P. King, Kansas City, Mo.; Dr. J. B. Murdoch, Pittsburgh, Pa.; 
Dr. J. B. Murphy, Chicago, 111.; Dr. A. J. Mullen, Michigan City, Ind.; Dr. G. J. Northrop, Mar- 
quette, Mich.; Dr. W. R. Nugent, Oskaloosa, Iowa; Dr. J. W. O’Conner, Denver, Col.; Dr. W. B. 
Outten, St. Louis, Mo.; Dr. R. Harvey Reed, Mansfield, O.; Dr. C. B. Stemen, Ft. Wayne, Ind.; Dr. 
A. A. Thompson, Waxahatchie, Texas; Dr. S. S. Thorn, Toledo, O.; Dr. W, S. Weissinger, Hernando, 
Miss.; Dr. B. F. Wilson, Slater, Mo.; Dr. Geo. W. Griffith, Louisville, Ky. 
EXECUTIVE PRESIDENT : 
Dr. C. W. P. Brock, Richmond, Virginia 
Dr. E. R. Lewis (English-Speaking), Dr. H. McHatton (Spanish-Speaking), 
P. O. Box 255, Kansas City, Missouri. Macon, Ga, 
Dk. PIROVANO . Buenos Aires Argentine Republic. 
Dr. T. G. Roddick Montreal Canada. 
Dr. Hernandez La Paz Bolivia. 
Ur. Francisco C. Guzman- Santiago Chile. 
Dr. Regino Gonzalez, [Cordovanes No. 4,] ... City of Mexico Mexico. 
Dr. Juan J. Ortega Guatemala City Guatemala. 
Dr. Abraham Aparico Bogota Republic of Columbia. 
Dr. Lucas A. de O. Catta Preta Rio de Janeiro U. S. of Brazil. 
Dr. Lino Alarco Lima Peru, 
Dr. Josfe Pugnalin Montevideo Uruguay. 
Dr. Pedro Maria Garcia Caracas Venezuela. 
SECRETARIES: 
238 SECTION ON RAILWAY SURGERY. 
No. 1001 a, 
Formal address by C. W. P. Brock, M. D., Executive President of the 
Section, Richmond, Va. 
No. 1001. 
“ Railway Surgery, as a Branch of the Surgical Art,” by E. R. Lewis, M. D., 
Kansas City, Mo. 
No. 1003. 
“ The History of Railway Surgical Organization,” by C. B. Stemen, M. D., 
Ft. Wayne, Ind. 
No. 1004. 
“ Hot Water in Contusion of the Bones of the Foot and Ankle,” by Geo 
Chaffee, M. D., Brooklyn, N. Y. 
No. 1005. 
“ Excision of Shaft of Femur following Pathological Fracture,” by Alex. J. 
Mullen, Jr., M. D., Michigan City, Ind. 
No. 1006. 
“ Implantation of Senn’s De-Calcified Bone. Recovery,” by B. F. Wilson, 
M. D., Slater, Mo. 
No, 1006 a. 
“The Essential Elements of Ideal Surgery,” by B. F. Wilson, M.D., 
Slater, Mo, 
No. 1007. 
Paper, by T. C. Kennedy, M. D., Shelbyville, lud 
No. 1008. 
Paper, by J. N. Warren, M. D., Sioux City, lowa 
No. 1009. 
“ The Torsion of Arteries for the Arrest of Hemorrhage,” by J. B. 
Murdoch, M. D,, Pittsburg, Pa. 
239 Hand Book 
OF 
THE FIRST 
Pan-American 
Medical Congress 
Washington, D. C., 
U. S. A. 
September 7, 6, 7 and 8, A. D. 1893. 
AVIL PRINTING CO., PHILADA.