Part 3

During the nearly four weeks treatment the patient said that when the eyes were shut she could discern the position of the lighted lamp, but when the eyes were open she could not see the lamp or the slightest object, or even tell daylight from darkness. At various intervals during this time her pastor visited her and offered her his most heartfelt sympathy. Her friends were becoming exceedingly anxious least the sight would never return, although I could assure them that there was not the least danger of permanent blindness. I became satisfied at this time that medication was not going to dispel this peculiar attack of hysteria and that it would need something besides medicine to produce such an impression upon her mind that she could overcome it, so I told her that I was going to do something the next day that would surely make her see before night, and that she should be of good cheer for her sight would return very soon. The next morning I went down about nine o’clock armed with my ophthalmoscope, my case of trial glasses and my Hearteloup’s artificial leech. The patient seemed to be quite confident that she would soon see, and was very hopeful as to the result of what was to be done. I looked into the eyes with my ophthalmoscope, and then applied the cylinder of the artificial leech to the temples without scarifying and used considerable traction, first on one side and then on the other, having previously told her not to open the eyes until I told her to do so. In about half an hour I told her to open the eyes gradually so as not to let the light in too suddenly and then tell me what she could see. The instant she opened them she said I can see the light and the position of the window. I then told her to close the eyes again and I reapplied the cylinder and commenced the suction as before. By this time the temples had become red and so sensitive that she now complained of some pain when the cylinder was reapplied. After twenty minutes she was told to open the eyes again and she said she could see objects about the room distinctly. She was then tried with large letters but she said she could not see to read them, but could see the black objects. Told her glasses would help her and placed a No. 72 convex spherical glass before the eyes when she could see Jaeger No. 20, then told her she needed other glasses and replaced the No. 72. She now saw to read No. 16. I continued taking off and putting on this same No. 72, with good effect and whenever she came to a standstill in reading reapplied the cylinder with uniform benefit until finally after two hours constant work she could read Jaeger No. 1. During all this day she was able to see distinctly. The next day she was again unable to read but a short repetition of the same course brought her vision back again. There was no return of the blindness after that except occasionally for a short time at intervals of two or three days.

In the course of ten days all trace of the difficulty had passed by and since has never returned. This case was diagnosed as one of genuine hysteria and not one of simulating blindness or malingering, and is reported as the most marked case I have ever had illustrating the effect of hokus pokusing (to call it by a mild name) which produced such a strong mental impression that the patient lost sight of her own peculiar mental condition, and by which a perfect cure was effected.

To her the blindness was real, and her friends feel that a remarkable cure has been performed. Such a blindness can occur in any nervous hysterical patient, while simulated blindness usually occurs in those who wish to avoid service in the army or navy, or in the case of lazy young people who do not wish to study at school or college, and in those who have received a slight injury and wish to make it appear more serious for the sake of obtaining large damages, either from private individuals or corporations.

For its detection there are several methods which are usually sufficient to give us positive proof that the blindness is not real. Von Graefe placed a number eight or ten prism in front of the eye, with the base upwards, downwards or sidewise, and if strabismus is present before the removal of the prism there is binocular vision.

Juler places spectacles with an opaque glass in front of the good eye, when, if the patient can read, he must see with both eyes; or he places concave 20 before the good eye, when if the patient can read fine print he must see it with the other eye.

Juval places a ruler before the eye so as to cover part of the page to be read, when, if one eye is blind, not all the page can be read.

Mittendorf puts atropine in the good eye, when if the patient can read fine print he is not blind with the other eye.

Wells places a prism in front of the supposed blind eye, and notices whether the apis of vision of that eye changes when the prism is removed.

Bull bandages the good eye and places a prism in front of the other eye, and holds a lighted candle before the eye, and if the eye turns as the prism is turned, the eye is not blind.

The test with Snellens or other colored letters is also a good one. A word with alternate red and bluish green letters is painted on glass and placed in the window, and the patient is asked to read the letters. If a bluish green glass is held in front of the good eye, he will see only the green letters unless he can see with the other eye, for all but the red rays in the red letters are cut off in the transparency in the window, and the green glass cuts the red off, leaving those letters a perfect blank to the well eye.

Kugel places various colored glasses before each eye and then places an opaque glass in front of the sound eye, and a transparent glass of the same color before the other one, and if the patient sees the object, he is simulating blindness.

Herring has the patient look through a tube large enough to cover both eyes, and then suspends a small ball in front of the tube and drops small objects near this ball, and if the patient can tell whether the balls are dropped in front of or behind the suspended ball, he must see with both eyes.

Lawrence recommends the stereoscope for detecting binocular vision, and places in a covered stereoscope a picture each side of which is different, and yet such as to make a single picture when both sides are seen. A clock dial, for example, with figures in one side only or figures with complemental colors, such that with both eyes the object would appear differently colored from what it would when seen with either eye separately. The distance apart of two objects held up in front of both eyes can be readily told by the patient if he sees with both eyes, no matter how the objects are held with relation to each other. But if there is vision with one eye only, the patient can tell the distant apart with accuracy only when the objects are both held at the same distance from the eye, but not when one is held considerably in front of the other.

One who sees with one eye only always thinks he is nearer to the object than he really is when reaching out for that object. It is always more difficult for him to pour from a pitcher into a cup or glass if held a little distance below it, hence the blind in one eye usually place the nose of the pitcher in contact with the glass before pouring. The old parlor trick of placing two pins in the wall and putting a cent on them and directing the patient to stand across the room and then walk over to the cent and knock it off with the outstretched finger without hitting the pins, may be made use of as a test in simulated blindness, for with one eye the patient always falls short of the mark the first time the experiment is tried. The most simple method of detecting simulated blindness in one eye is by noticing the movement of the pupil under the influence of light. If an eye is blind, the light has little or no effect upon it when the other eye is closed. The pupil is usually dilated. It may be well to mention here that atropine dilatation is generally wider than that due to amaurosis, and also that a cone of light from a strong convex glass thrown upon the sound eye will contract the pupil of the blind eye if the dilatation is not due to atropine. Simulated blindness in both eyes is not likely to be seen, and then the condition of the pupil is of great value in detecting it, and is one of the best guides in connection with the ophthalmoscopic observation.

A CASE OF DOUBLE UTERUS AND VAGINA.

BY S. W. KELLEY, M. D., CLEVELAND, O.

Miss H. E., aged 20, American of Irish parentage: dark brunette, short in stature but apparently quite handsomely formed, and ruddy with health. She has never been sick in her life. Has menstruated normally since her fifteenth year, though scantily during the past year. She feared she had been injured a few days previously by the overturning of a chair upon which she was standing, as she had since felt pain and uneasiness in the lower pelvic and pubic region, for which she sought advice.

Upon examination I found no injury worthy of record, but the malformation here described. Cases of this anomaly have been recorded from time to time, being always of interest to the teratologist, occasionally requiring attention on account of interference with the marital relation or parturition, and being referred to in every discussion on superfœtation.

The external genitalia are well developed. No hymen, nor any remains of one. I have no reason to doubt her virginity. An inch within the introitus vaginæ the finger met a narrowing into which only its tip would pass. Searching to the left another smaller opening was discovered, the two being separated by a strong membrane. Returning to the right or larger passage, was able by careful dilatation for ten or fifteen minutes to insert three-fourths of the length of the index finger and encounter another narrowing, which being patiently overcome, the first joint of the finger found more room and examined uterine cervix and the external os, which is linear antero posteriorly. The neck projects about half an inch into the vagina. The lips are thin, of normal density. Withdrawing the finger and finding the smaller opening, could succeed in penetrating only about an inch. Observed a third, smallest opening in the left vaginal wall, between the ostium vaginæ and the second opening described.

The patient would consent to no interference that could possibly cause even temporary disability for daily housework and care of an invalid mother, but agreed to return daily for a few days. After dilating without anæsthesia fifteen to twenty minutes daily for four days, could pass two fingers or a Fergusson speculum one and one-eighth inches into the right passage, and could pass one finger readily, or speculum seven-eighths of an inch in diameter into the left passage. The septum between the two passages is placed antero posteriorly. It is about an eighth of an inch thick, and has the appearance of any other portion of the vaginal wall. It begins an inch within the introitus, and extends to the uterus, making a right and left vagina of normal length. The third, smallest passage, admits a sound and extends upward an inch in the left lateral vaginal wall and ends in a blind extremity.

The right vagina discloses an uterine os three-eighths inch in length antero posteriorly, the anterior end of the slit inclined toward the median line. The sound passes readily a distance of one and three-eighths inches, entering in a direction upward and inward half that length, and then turning upward and outward. The sound moves freely in the cavity, and the lining membrane evidently contains folds. Secretion of the cervix free.

On the left side the os uteri is smaller, the opening not exceeding a quarter inch, the length being laterally. The lips are in a pouting shape, the anterior, especially, having quite a fold above it. The sound enters freely nearly an inch in a direction upward, outward and slightly backward; lining membrane apparently folded. Very little secretion. By introducing two fingers of the left hand, palm upward, the index into the right vagina and the second finger into the left, the two uterine mouths can be examined simultaneously, and this gives a very vivid impression of the condition. As to the shape of the whole uterus very little can be determined by bimanual examination, the vaginal walls being so tense and abdominal thick. By the rectum the uterus can be felt flat and wide, but no bi-lobing is apparent.

The young lady could not be persuaded to permit an examination during menstruation to determine whether the flow took place on both sides.

MEDICAL SOCIETIES—THEIR BENEFITS TO US AND OUR DUTIES TO THEM.

BY DR. WILLIAM FORSTER, RETIRING PRESIDENT VENANGO COUNTY MEDICAL SOCIETY, PENNSYLVANIA.

Though at best societies in their present form are not very old, medical associations, differing somewhat in their organization and aim, are as old as the science of medicine itself. Even in the fabulous ages it had its heroes, and some rose to the height of deification. In earlier ages those who practiced medicine were looked upon as inspired. They, in addition to belonging to a profession, constituted a class or caste. In some Asiatic nations, and among some of our Indian tribes, it is very much the same at present.

One must belong to the caste, or be able to trace his descent from it, as a necessary qualification to practice medicine.

This is the earliest form of a medical society, and though it may not possess many progressive elements, it has elements of strength.

What few investigations it did make, it kept. Its peculiar organization and position fitted it for being a good conservator; and when the star of empire took its western course, the tide of medical knowledge stored up and held sacred and secret in Asia, Egypt and Greece, flowed out and was diffused over five continents.

Hippocrates, about twenty-five hundred years ago, took the light from under a bushel. About three hundred years later the great Alexandrian school or society—for it was a society as well as a school—trimmed the light and set it higher, but it was so obscured and encompassed with exclusiveness and secrecy as to be a long time in reaching the masses.

The first societies in Germany, France and Great Britain were in connection with their institutions of learning, as they were at an earlier period in Egypt and Greece. In Rome we have reason to believe that they were more independent, as the physicians used a society seal as a label for their medicine. Truly independent society organization and work is comparatively of our own day. Even in the early part of the present century, British authority was the London, Edinburgh and Dublin colleges.

In our own country, previous to the organization of the American Medical Association, about thirty-six years ago, there was very little system in society work. That organization marks a new era in society usefulness. From it sprung the International Medical Congress, making a unit of medical investigation and progress of the world. We point with pride to Philadelphia as the city in which the association was organized, and to the able and determined stand our State has ever taken in sustaining and strengthening it. It has been a power for good to American medicine. It has elevated and is elevating the standard of our American medical colleges.

The progress in society organization, work and usefulness in the last thirty-six years is greater than in all American medical history previous to that time. We had then a few isolated independent medical societies without unity and without influence. We have at present a society in almost every county, a State society in every State, all united in an association and wielding an influence national and world wide.

Great as the benefit has been to the profession at large, it has been greater still to the individual practitioner. It has been to him a post-graduate school.

In our societies A. meets B., B., C. and C., D. They compare their investigations, experiences and theories, and each is benefited.

Our society enables us to know one another better. It is a true saying that, “no man is as good as his best deed nor as bad as his worst.” Our meeting in society aids us in striking the balance and makes us more united, by forming and cementing friendships. They discourage quackery, empiricism and everything that is professionally low and mean. They encourage and stimulate purity, nobility and rectitude. They are a strength to us medically and medico-legally. All that is necessary on our part to secure us these benefits and many more which might be enumerated, is to do our duty to our county, State and national societies. I will now present to you what I believe to constitute at least part of that duty.

_First._ Punctuality and regularity in attendance. This increases our interest and gives the society strength.

_Second._ Support with our intellect. We may not all have an equal number of talents, but he that has five should use them, and he that has one should use it, and the use of that one may be just what the society needs at the time.

If we have anything we think good in theory or practice, or any interesting case, let us report to our society.

I believe everything presented should be in writing, for very few physicians are good extemporaneous speakers, and all members should have such notice of the subject of all papers to be read before the society as will give them time to prepare for intelligent discussion; for unless a man has a clear idea of his subject he is liable to wander off into a labyrinth of side issues.

When appointed for a paper, we should have it ready and be on hand to read it. We should have more papers published, and to better prepare them for publication, each society should have an editor and a publication committee, with ability and power to revise, correct and publish papers and reports of the society.

_Third._ We should support our society with our influence. All have an influence, and there is no neutral ground. It must be for or against.

Never was there a time when there was more need of the support of the good men in the profession. The code of medical ethics has been attacked. The American Medical association has been attacked.

An attempt has been made to make the one obnoxious and destroy the harmony and usefulness of the other.

_Fourth._ We should be prompt in paying our dues and all other necessary demands that may be made on us by our society. Negligence—for it is seldom or never inability—on our part may not only embarrass the society, but tend to destroy our interest in it.

I have a great regard for the Venango County Medical Society. It was the first society I joined after graduating, over twenty years ago, and I have always highly prized the friendships herein formed.

Death has taken some from us, good men and true, but I am pleased to see that we are also adding to our number so many young men, and growing in strength. Let us each do our part to keep up this growth, so that when we are weighed in the balance we may not be found wanting.

I thank you for your kind aid and forbearance throughout the year. May our society live long and prosper.

The Cleveland Medical Gazette.

_A MONTHLY JOURNAL OF MEDICINE AND SURGERY._

ONE DOLLAR PER ANNUM IN ADVANCE.

All letters and communications should be addressed to the CLEVELAND MEDICAL GAZETTE, No. 5 Euclid Avenue, CLEVELAND, OHIO.

A. R. BAKER, M. D., _Editor_. S. W. KELLEY, M. D., _Associate Editor_.

EDITORIAL.

THE LATE DR. ALFRED C. POST.

One of the old land marks of the medical profession is gone! Few men are privileged to continue in actual practice fifty-seven years! Thousands have heard him lecture, seen him operate and read his published papers. He was indeed a remarkable man. At the age of eighty he continued to operate with the freshness of youth. As a lecturer he was terse—direct to the point; as a writer he was lucid and clear; as an operator he was steady, bold and self-reliant; as a man he was a Christian.

If there was one thing more than another more prominent in his well-rounded character, it was his devotion to duty. He was a man of fine religious faith, devout in his behavior and an excellent theologian and Biblical scholar. The two things he is said to have most enjoyed were a surgical operation and a prayer meeting. He was a consistent member of the Presbyterian church, and his example of earnest, unselfish devotion to duty can not help but leave an influence for good which will last long after his brilliant surgical operations are forgotten.

Dr. Post was born in New York city in 1805, graduated from Columbia College in 1822, became a medical student in the office of Dr. Wright Post, his uncle, an eminent surgeon of a former generation. He graduated from the College of Physicians and Surgeons in 1827. After spending two years in the medical schools and hospitals of Paris, Berlin and Edinburgh, he commenced active practice of his profession in New York city, which he continued until the week before his death. He was one of the founders of the Medical Department of the University of New York, taking the chair of surgery and pathological anatomy, and at the time of his death was president of the medical faculty and emeritus professor of the clinical surgery in that institution. His funeral took place Wednesday, February 10, and the Church of the Covenant, of which Dr. Post was a member, was crowded with professional and other friends of the dead man.

ALUMNI ASSOCIATION OF THE MEDICAL DEPARTMENT OF THE WESTERN RESERVE UNIVERSITY.

The annual meeting of the Alumni Association will be held at 2 o’clock, P. M., Wednesday, March 3, in the amphitheatre of the City Hospital corner of Erie and Lake streets.

Dr. E. D. Burton of Collamer, Ohio, will be the orator of the occasion, and Prof. Proctor Thayer, the elected poet.

The president, Prof. G. C. E. Weber, will also deliver an address.

The subjects for discussion are: First, Cholera, the leading speakers being Doctors Thayer, Lowman and Kelley. Second, Diphtheria, its Aetiology and Treatment, with Dr. Knowlton of Brecksville, and Dr. Orwig of Cleveland, as leading speakers. The annual election of officers will be held, and other important business transacted.

The Hon. S. E. Williamson will deliver an address to the graduating class in the evening. The graduating exercises will be held in the First Methodist Church, corner of Euclid avenue and Erie street. There will afterwards be a reception and banquet at the Hollenden.

THE WESTERN PENNSYLVANIA MEDICAL COLLEGE.

The Western Pennsylvania Medical College has been organized and liberally endowed, and will soon assume possession of its new building on Sixth street, Pittsburgh, Pennsylvania. The course of lectures will not begin, however, until October. The faculty will be composed of the following well-known, earnest and hard-working practitioners: Professor of Anatomy, Dr. Heckelman; Professor of Physiology, Dr. Allen; Professor of the Principles of Surgery, Dr. Murdock; Professor of the Practice of Surgery, Dr. McCann; Professor of the Principles of Medicine, Dr. Shively; Professor of Clinical Medicine, Dr. Lane; Professor of Chemistry, Dr. Blank; Professor of Materia Medica, Dr. Gallagher; Professor of Obstetrics, Dr. Duff; Professor of Gynæcology, Dr. Asdale; Lecturer on Dermatology, Dr. Dunn; Lecturer on Nervous Diseases, Dr. Ayers; Lecturer on Orthopædic Surgery, Dr. King; Lecturer on Genito-Urinary Diseases, Dr. Thomas.

SOCIETY PROCEEDINGS.

PROCEEDINGS OF THE NORTHEASTERN UNION MEDICAL SOCIETY.

SIXTIETH QUARTERLY SESSION, HELD AT AKRON, OHIO, TUESDAY, FEBRUARY 2, 1886.

The president, DR. J. E. DOUGHERTY, in the chair.