Part 5

The dressing of wounds after the new processes of antiseptic practice receives a great deal of attention. To one familiar with the dressings during our civil war, on examination of the present multitudinous plans to exclude “germs” would bring back the days of our grand-fathers in surgery with their balms and balsams and salves; and some of the dressing is not more rational. According to Esmarch (p. 151 and 152) the dressing of gun-shot wounds should be purely antiseptic. “Do not examine the wound at all, rather than examine it with unclean fingers—and everything is unclean, in the strict sense that is not antiseptic.

“* * * * To avoid pernicious putrefactive influences the wounds must not be touched by the hands, but closed rapidly by antiseptic plugs, in order to preserve them from the contact of putrefactive agents until they can undergo the Lister treatment in the hospitals if necessary. He proposes that every soldier should carry in the lining of his uniform two balls of _salicylated jute_ wrapped in gauze.”

We make this particular quotation to show to what old-maidish precision the antiseptic idea is leading good surgeons. This ever-present inextinguishable “germ” is the evil spirit hovering over every wound. Nets of gauze are set to protect it; strong odors from the witches cauldron are summoned to stifle and destroy the malicious fiend.

We are thankful though that the civil surgeon still sees “union by adhesion,” and “first intention,” and “granulation,” in regions so far remote from Listerism that there is little hope it will enter there, and if it does it will hardly captivate the even-minded country surgeon. When the days of probationary Listerism have ended, we will not be surprised if the verdict is against it.

But we have digressed from our book. It is the XVIth chapter on “Diseases of the Skin” that will be often consulted by the busy doctor. Having made his diagnosis, here is a goodly array of remedial agents, from the most eminent teachers to help him out of difficulties. We miss chrysophanic acid in the composition of his formulæ for the treatment of psoriasis. It certainly has made as much headway in the favor of the general practitioner as any of the more recent agents.

But why say anything about a book which has made its way through the world, and has now come to its sixth edition? The hundreds of medical men who will read it, will traverse a field of surgical treatment far beyond the facilities of those possessed of the best private libraries. As long as the author keeps up with the current of surgical treatment, his book will be sought after. We congratulate the author, and Dr. Brinton, on the success of this book, and advise our friends to buy it.

A CLINICAL TREATISE ON DISEASES OF THE LIVER. By Fried-Theod. Frerichs. Prof. of Clin. Med. Uni. of Berlin, &c., &c. In three volumes. Translated by Charles Murchison, M. D., F. R. C. P. Physician to the London Fever Hospital. New York: Wm. Wood & Co. 27 Great Jones Street. 1879. 8vo. Pp. 224.

This is the third volume of Wood’s Library of Standard Medical Authors.

For many years this work of Frerich’s has been a classic, although only known popularly to the American profession by the large number of quotations made from it by writers on diseases of the liver. Although the word “Clinical” appears on the title page, it is nevertheless a systematic treatise which traverses the entire field of clinical pathology, and embraces also lucid historical accounts of the phases of change which medical men have passed through on their way to the knowledge of the present day.

This book, more than any we have been called upon to review, shows how much German authors rely upon the authority of their own people. References everywhere abound, but for the most part to German works. We do not mention this as a fault, but to make the contrast with American authors who seem to glory in going far away from home for authority among the unspeakable names of the Russian and German gentry.

Prof. Frerich’s work for this reason will be more valuable to American students who wish to know the state of pathology in Germany in regard to “the great gland.”

As, of course, no American physician can now forego the pleasure and duty of making Frerich’s on the Liver one of his working tools, we leave them to judge if we are mistaken in saying that it is a master-piece.

Dr. Charles Murchison is the translator, and his preface serves to elucidate many points, and to bring the work up to the present advanced state of pathological and physiological knowledge. It is not necessary to say anything commendatory of the author of Functional Diseases of the Liver, as every Southern physician will have found a good friend and counsellor in this volume already.

To subscribers this work is sold at $1.00, a very low price!

THE DISEASES OF LIVE STOCK and their most efficient remedies: Including Horses, Cattle, Sheep and Swine. By Lloyd V. Tellor, M. D. Philadelphia: D. G. Brinton, 115 South Seventh St. 1879. Pp. 469. Price $2.50.

Diseases of the domestic animals deserve more study from the medical profession than they receive. Medical men even now submit their horses to the treatment of the neighborhood blacksmith and farrier, whose ignorance and brutality is all but universal, rather than inform themselves of the phenomena of brute diseases; in fact, some medical men hold it as beneath their dignified calling to give their attention to such affairs. Fortunately now a better day is dawning, and books like this will do a great deal towards enticing physicians into this neglected field. There is no practice that promises such profitable returns as the educated and skillful management of diseases of domestic animals.

We advise our friends in the country to put this volume side by side on their book-shelves with Youatt, and soon the latter would be but a shelf-keeper alongside their new acquaintance.

The point of view from which the study of the diseases of domestic animals is growing in importance, is the relation of their diseases to ours.

To be able to detect measly beef and mutton is an accomplishment that every physician should acquire, now that we know that tape-worm has its origin there. And we should also be stimulated to earnest enquiry when we remember what great results JENNER brought out of the study of cow-pox.

BIENNIAL REPORT OF THE NORTH CAROLINA INSTITUTION FOR THE DEAF AND DUMB AND THE BLIND. From January 1st, 1877 to January 1879. 32d and 33d Sessions. Raleigh: Published by order of the Board of Trustees.

The last Legislature was famous for fault-finding, but had nothing but praise for the Institution presided over by Mr. Gudger. His report shows good work done, and common sense ideas of the theories of the methods of teaching of those unfortunates under his care.

Mr. Gudger reviews the arguments of the advocates of the Manual method, and the Articulation method, of instructing deaf mutes as follows:

“There is a ground, however, upon which the advocates of each system can meet and agree. In most of the larger institutions articulation has been introduced and is a success, when the class to be instructed consists of those who, having heard in childhood and learnt to speak, have become deaf (and so are in danger of losing what speech they have) or of those who are partly deaf and consequently not able to catch the delicate shades of sound in different words similar to each other. As these persons have some language to build upon, and an idea of sound, it is comparatively easy, by means of the skillful methods in use, to improve and advance their knowledge in this particular, especially as the teacher may use the _known_ in getting at the _unknown_; but to attempt to teach articulation to an ordinary congenital deaf-mute, is to spend valuable time in that which gives promise of little fruit. In other words, as our matter-of-fact American people would express it, ‘_It does not pay._’”

The entire report shows that the management is in the hands of a courageous and enthusiastic worker,—one not too much engrossed with the beautiful theories of his profession—who shows practical results instead of learned dissertations.

LECTURES ON PRACTICAL SURGERY. By H. H. Toland, M. D. Professor of the Principles and Practice of Surgery, &c., &c., in the University of California. Second Edition. Illustrated. Philadelphia: Lindsay & Blakiston. 1879.

This is a handsome volume of 520 pages, written by a teacher of surgery of great celebrity on the Pacific slope. It consists of lectures as delivered in the Medical College of the University of California, reported by a stenographer. The first edition of this book, although it was treated rather severely by the critics has found ready sale, the present being the second edition.

It is not difficult to see that Dr. Toland is an original teacher of merit, bound down by no school, nor easily captivated by innovations. He is confident of his powers and does not speak with uncertain meaning.

Under the head of fractures of the thigh, the apparatus in favor with the author is the double inclined plane with some modifications, and with which he has had admirable results.

“When you engage in practice,” he says p. 284, “you will soon be convinced that the double inclined plane and short splints are generally better than a more complicated apparatus.”

Again—“If physicians relied more on their common sense than on the rules of authorities in the treatment of fractures, there would not be so many cases of deformity resulting from such injuries as are daily presented. I would as soon think of committing suicide as of placing an oblique fracture of the tibia in an ordinary fracture-box, filled with either sand, sawdust, or any of the other substances used for that purpose,” p. 279.

A case of aneurism of the left iliac artery is given and illustrated, (p. 515). “In aneurism of the external iliac artery” the author says “I never open the sheath, and consequently apply a single ligature; the sheath of the vessel not being disturbed, there is scarcely a possibility of the occurrence of secondary hemorrhages. I have ligated the external iliac nine times, and my success is the best evidence of the correctness of the theory upon which it is based. One patient died from gangrene of the extremity, and the other from internal hemorrhage which proceeded from the small vessels that were lacerated when the peritoneum was detached from the iliac fossa,” p. 516.

The volume is well illustrated by fresh designs,—all of them original—a matter of sincere congratulation to the author and publishers.

A book possessed of so much originality and individuality as this, will be sure to find a large number of readers among the former students of the author, and will also make its way into favor with the student of American surgery.

* * * * *

_Syphilis by Vaccination with Human Virus._—The virus was taken from the arm of a child aged seven months, apparently in perfect health. Twenty-five girls were vaccinated from this infant. At the end of six weeks, twelve of the girls were taken with symptoms of syphilis, ulcerations at point of inoculation followed by exanthema, ulcerations in mouth and pharynx, condylomata of anus, syphilitic ozœena, etc.; three others of the group suffered from suspicious ulceration near the vaccine sore, which failed to be followed by constitutional symptoms. Later it was discovered that the mother of the child was suffering from syphilis.—_Hosp. Med. Gazette._—_Louisville Med. News._

NEW JOURNALS.

INDEX MEDICUS.—We hardly know which to admire most in this new journal—its typographical excellence, or its editorial management. It is no surprise to the medical public that it begins its existence as an accomplished success, as Dr. Billings had long ago shown his capacity in his official position as librarian, and has shown his taste also in the typographical selections in the specimen fasciculus of the catalogue of the National Medical Library.

The two numbers now before us demonstrate as it could be done in no other way, the necessity for some guide to the medical literature of the world. The student will be helped in pursuing any special research, and the general reader will be able to know what is going on in the medical world, and be saved very much irksome reading by following his inclinations. The careless and uninformed “discoverer” of new things, may be saved the trouble of re-discovering, by looking out into the field upon what others are doing.

Twice we have written notices of this periodical, and each time it was overlooked. Our notice though tardy is none the less earnest.

The subscription price is $3.00 a year, and intending subscribers should commence at once with the first number. Address, F. Leypoldt, 37 Park Row, N. Y.

THE COURIER OF MEDICINE AND COLLATERAL SCIENCES is the title of a new monthly journal of exceptional excellence, commencing its career with the January number, in St. Louis. This city had already in the field a brilliant array of medical journals, and while we cannot think any less of our old friends we welcome the new one.

The printer’s art has cleverly served up the literary matter in a style which will commend itself to all readers, and especially those who are beginning to hold their books at arm’s length. The effigy of John Hunter on the outside cover is a faithful copy of the celebrated Sharpe engraving, and is in good taste.

What a clever faculty there must be in St. Louis to sustain so many good journals by purse and pen! We wish for the journal a most hearty appreciation.

NORTH CAROLINA FARMER.—An examination of the April number of this periodical was a pleasant surprise. It abounds in practical matters suited to the necessity of our farmers, and should be read and supported by the pen and pockets of the entire agricultural community.

We make one suggestion to the editors, and that is, that if they are to have a column for diseases and remedies (a questionable matter for all non-medical publications), that it should be in the hands of a competent medical man. We congratulate the publishers that they have no nostrum advertisements. Large quarto of 18 pp. at $1.00 a year. Jas. H. Enniss, Editor and Publisher, Raleigh, N. C.

GROSS ON THE TREATMENT OF CYSTIC GOITRE.

In a clinical lecture delivered by M. Gross, of Nancy, reported in the _Revue Médicale de l’Est_, of November 15, he describes the treatment of cystic goitre, known as Michel’s “mixed method,” as extremely useful, and furnishes a case illustrating its advantages. Giving a rather extended review of the various modes hitherto proposed for removal of these growths, he points out their drawbacks, and the superiority of Michel’s method over them. Briefly the latter consists in making a vertical incision in the skin over the most prominent cyst, and then dissecting carefully down through the various structures, until the wall of the cavity is reached. A very fine trocar is then pushed into the cavity with a canula, and through the latter the fluid is withdrawn. After this a plaque of pâte de Canquoin, about three centimètres broad, is applied to the cyst, the sides of the wound being protected by a circular piece of diachylon. This is left on a day or two until an eschar is formed, which soon after comes away, leaving a free opening through, which the cyst can discharge, until it shrinks up, after suppurating for a time.

It is claimed for this method that it is less likely to give rise to dangerous hemorrhage than several others, while, the caustic only being applied to the surface of the cyst, severe inflammation of the tissues around is avoided. Other cysts, if present, are similarly treated through the aperture of the first.—ARTHUR E. BARKER, in _London Medical Record_.

CURRENT LITERATURE.

REMEDIAL AND FATAL EFFECTS OF CHLORATE OF POTASSA.

In a paper read before the Medical Society of the State of New York, (_Medical Record_, March 5th), Dr. Jacobi reviews in a very careful manner the remedial effects of chlorate of potash, and calls attention also to what he considers the dangers of large dosages so commonly employed by physicians and patients.

Sir James Y. Simpson, introduced chlorate of potash on the theoretical ground of its employment in chemistry to develop oxygen, to supply oxygen to the blood on the part of the fœtus in cases of placentitis.

Many years ago, Isambert and Honie, found chlorate of potash eliminated without any change, and in large quantities, even as much as 95 or 99 per cent. of the amount administered, in the various secretions of the body; that is in the urine, the saliva, the tears, the perspiration, the bile, and now and then even in the milk; no oxygen was developed at all. The theory of Simpson was long ago given up, because it was found out that the same redness was produced in the blood by other alkalies.

Its principle value consists in its effect upon catarrhal and follicular stomatitis; further, in mercurial stomatitis, the former being a frequent and the latter a rare disease in infancy and childhood.

“In regard to [the employment of chlorate of potash] diphtheria, I can give [my position] in a few words. It is this: that chlorate of potassa is a valuable remedy in diphtheria, but that it is not _the_ remedy for diphtheria. There are very few cases of diphtheria which do not exhibit larger surfaces of either pharyngitis or stomatitis than of diphtheritic exudation.”

There are also a number of cases of stomatitis and pharyngitis, during every epidemic of diphtheria, which must be referred to the epidemic, perhaps as introductory stages, but which still do not show the characteristic symptoms of the disease. * * * *

The dose of chlorate of potassa for a child two or three years old should not be larger than half a drachm in twenty-four hours. A baby of one year or less should not take more than one scruple a day. The dose for an adult should not be more than a drachm and one-half, or at most two drachms, in the course of twenty-four hours.

The general effect might be obtained by the use of occasional larger doses; but it is best not to strain the eliminating powers of the system. The local effect cannot be obtained with occasional doses, but only by doses so frequently repeated that the remedy is in almost constant contact with the diseased surface. Thus the dose, to produce the local effect should be very small and frequently administered. It is better that the daily quantity of twenty grains should be given in fifty or sixty doses than in eight or ten: that is, the solution should be weak, and a drachm or a half-drachm of such solution can be given every hour or every half hour, or every fifteen or twenty minutes, care being taken that no water is given soon after the remedy has been administered for obvious reasons. He referred to these facts with so much emphasis because of late an attempt has been made to introduce chlorate of potassa as the main remedy in bad cases of diphtheria—and, what is worst, in large doses.

As early as 1860, Dr. Jacobi advised strongly against the use of large doses of chlorate of potassa. * * * * The treatment is dangerous and because of the largeness of the dose of the chlorate given.

After reviewing the opinions of several writers who have extolled chlorate of potassa in large doses, and having pointed out the real solution of so many having succumbed to nephritis or similar symptoms, he concludes:

“The practical point I wish to make is this, that chlorate of potassa is by no means an indifferent remedy; that it can prove and has proved dangerous and fatal in a number of instances, producing one of the most dangerous diseases—acute nephritis. We are not very careful in regard to doses of alkalies in general, but in regard to the chlorate we ought to be very particular. The more so as the drug, from its well-known either authentic or alleged effects, has arisen or descended into the ranks of popular medicines. Chlorate of potassa or soda is used perhaps more than any other drug I am aware of. Its doses in domestic administration are not weighed but estimated; it is not bought by the drachm or ounce; but the ten or twenty cents worth. It is given indiscriminately to young and old, for days or even weeks, for the public are more given to _taking hold_ of a remedy than to _heed warnings_, and the profession are no better in many respects. Besides, it has appeared to me, acute nephritis is a much more frequent occurrence now than it was twenty years ago. Chronic nephritis is certainly met with much oftener than formerly, and I know that many a death certificate ought to bear the inscription of nephritis instead of meningitis, convulsions or acute pulmonary œdema. Why is that? Partly, assuredly, because for twenty years past diphtheria has given rise to numerous cases of nephritis; partly however, I am afraid, because of the recklessness with which chlorate of potassa has become a popular remedy. Having often met medical men unaware of the possible dangers connected with the indiscriminate use of chlorate of potassa or soda, I thought this Society would excuse my bringing up this subject. It may appear trifling, but you who deal with individual lives, which often are lost or recovered by trifles, will understand that I was anxious to impress the dangers of an important and popular drug on my colleagues, and through them on the public.”

DEMANGE ON AZOTURIA.

The importance of the study of urology has of late been more fully realized by Medical practitioners, and M. Demange in his thesis (_Thése de Paris_, 1878) has undertaken to give a full account of the progress of this branch of medical science, being also fortunate enough to be able to enrich it by several new or very little known observations on azoturia. The latter seem the most interesting part of his thesis; we give them here briefly. The normal quantity of urea which must be contained in the urine in the space of twenty-four hours is from nineteen to fourteen grammes. If more or less is excreted, this is caused either by some local or general affection. Some years ago, Bouchard, in studying the causes of loss of flesh in patients suffering from diabetes insipidus, discovered that a large number among them lost an enormous quantity of urea. Having thoroughly examined their symptoms he thought himself fully justified in describing azoturia as a special disease, having peculiar clinical symptoms. The affection begins with a sensation of ravenous hunger, polydipsia or profuse sweating. The thirst is excessive, and the urine passed is generally in proportion with the quantity of drink swallowed by the patient. Its density is from 1000 to 1002. In order to be able to calculate justly the amount of urea lost in twenty-four hours, all the urine passed in twenty-four hours, all the urine passed in this time must be kept and mixed. In some cases it has reached the amount of eighty-seven grammes, a most enormous quantity, which proves that nutrition is very much impaired. Senator Kien and M. Bouchard have shown that what is called extractive matter is eliminated, corresponding to urea in such cases, and that chlorates and phosphates are ejected in a similar proportion. We must, therefore, not be astonished if the patients present general symptoms which are analogous to those of diabetic patients, with the exception of the visual troubles of the latter. Both the crystalline lens and the retina remain intact, and the sight is only influenced by the anæmic state of the brain, which is caused by the dyscrasia, and which in certain cases produces a torpor of the intellect verging on imbecility. As in cases of diabetes mellitus and albuminuria, sometimes the quantity of urea decreases, and even falls below the normal amount.