Charles Janet.

American medical monthly and New York review online

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convinced him that there was a living child in utero at any time. If
a child was in utero, he saw no evidence that it was living at the time
Howard performed his first operation.

The water described as passing out on the first operation may be
accounted for by supposing the existence of a hydatid, which was
ruptured by the introduction of an instrument. The bleeding at the
second operation may be accounted for in many ways. It might re-
sult from labor. If there was a foetus in the womb, and labor was
progressing, there would be more or less flowing before delivery.
From such flowing it does not follow that mechanical violence had
been used. If disease existed about the cervix uteri, expulsion of a
putrid foetus, passing over the ulcers, would be likely to make them
worse than before, and might result in slough. Delivery of a dead
foetus would be less likely to irritate the neck of the womb than a
living one.

On the cross-examination, Dr. Phelps said that if called in two or
three days after the death of a woman, an examfhation would at times
enable him to determine conclusively whether she had been delivered
of a child eight or ten days previously; at times he could not so de-
termine. If we were to find portions of the placenta attached to the
uterus, or a portion of the cord within it, there would be no manner
of doubt that there had been a child. Or in another case we might
find a large red mark on the walls of the uterus, corresponding in size
and form to the attachment of the placenta, and the uterine cavity
filled with blood; we could then determine conclusively that delivery
of a child had taken place a few moments before death. It would be
possible to decide with certainty, by post-mortem examination, of a
woman ten or twelve days after delivery, whether she died in conse-
quence of parturition.

In the uterus presented in this case he saw no evidence of hydatids
showing that they certainly were present. Nothing had been given
in court that satisfied him as to the cause of death. He could not
say, from the evidence, that she did not die in consequence of being
delivered of a child. From an examination of the womb, he did not
see evidence that there had been a polypus or a fibrons tumor. In
case of postmortem examination, eight or ten days after delivery, he



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I860.] FOB CRIMINAL ABORTION. 201

would, as a medical man, come to a conclasion whether a child had
been born or not; but if his brethren — six or eight — should all engage
in it, he would certainly expect all would not agree. He would not
expect the evidence to be so conclusive that half a dozen, or even four
men, would agree. This would not be the fact in the majority of
cases, for they would be clear. In an autopsy, undertaken for the
purpose of determining whether delivery of a child had taken place,
it is highly probable that we should meet with appearances which
would not lead several medical men to the same conclusion. For ex-
ample, in a case where we are thrown entirely on the character of the
placental mark, we should have to rely on characteristics with which
we are not familiar. We have read about them, and our imagination
may have misled us. The value of our opinion would depend on our
familiarity and experience with these things. As a general law on
post-mortem examinations, after delivery, there would be evidence of
increased vascularity of the uterus, thickening of its walls, and some
unnatural appearances about its os, and some placental marks in some
degree of perfection. With these conditions, and without finding
fragments of morbid growth, he would have no doubt that it was a
case of pregnancy. Beneath the placental attachment we should find
the vascularity very great. From the vascular condition of the wall
of the uterus, at the point of attachment, he did not think he could
decide whether a placenta or a hydatid had been attached. Did not
think he could distinguish between the two from vascularity alone.
The quantity of blood-vessels necessary to supply blood to the foetus
would be much larger than would be required for the hydatid.

He saw no conclusive evidence of ulceration about the uterus ex-
hibited in this case. He could not say whether sloughing from bruise
or injury would leave such a cavity as is shown in this case, the prep-
aration has been kept so long in alcohol.

In the case described by Drs. N. and F., and the uterus, as here
presented, without having seen its contents, it was impossible for him
to tell what it contained. All the signs of pregnancy derivaUe from
a post-mortem examination of the body, except a perfect placental
mark, may exist from other causes.

S. J. Allen, M.D., of W. R. Junction, Vt., was also examined; hi^
testimony did not differ materially from that of Dr. Phelps.

After a trial, lasting nine days, the jury brought in a verdict o^
guilty on the charge of abortion, and not guilty oif that of manslaugh-
ter. After a hearing before the Supreme Court, on exceptions to the
ruling of the Judge, Howard was sentenced to two years' imprisoa-



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202 CASE OP GUN-SHOT WOUND. [SEPT.,

meat in the State Prison, where he is now serring oat his sentence.
An indictment for criminal abortion and manslaughter in the case of
a jonng woman, who died two days previously to Miss Ashe, was also
found against him.



A Case of Gun- Shot Wound; BulUi found in the Wall of Right Ven-
tricle of the Heart Eighteen Years after the Accident. By G. B.
Balch, M.D.

A short history of the case is as follows: In June, 1842, an Irish
boy, by the name of John Kelly, received an accidental shot in his
right shoulder; the ball passed through three inch-boards before it
strucic him. A surgeon was called, who probed the wonnd, and found
the ball lodged nearly under the inner third of the clavicle. The ball
entered the shoulder through the upper border of the trapezius mus-
cle, about an inch and a half or two inches from the acromion process.
There was not much hemorrhage at the time, and the surgeon did not
deem it prudent to remove the bullet, and in about six weeks the boy
was able to be at work. This accident occurred at Chatham Four
Corners, Columbia Co., N. Y. In 1844 Mr. Kelly came to this
county, (Clinton, ) where he has since resided.

Fourteen years ago he was taken very dangerously ill with pireu-
monia, accompanied with a very severe and iiTegular palpitation of
the heart. Dr. Terry, who attended him at that time, says he did
not expect his recovery. Ever since that sickness his heart has shown
symptoms of organic disease, at times beating in such a tempestuous
manner, that one standing ten or fifteen feet from him could see its
action very distinctly. Ever since he was shot he has had strabismus,
and, at times, inflammation of the right eye.

His last sickness was caused by his going into the water, ten days
before his death, and taking a severe cold; his heart then commenced
its actions with redoubled fury, accompanied with dysphonia, and se-
vere pain in his shoulders and arms. His right arm became purple
and cold before death.

On Friday, June 15th, 1860, I made the post-mortem examina-
tion, by request of Dr. Terry, who was his attending physician. The
autopsy revealed a condition of things I did not expect. The right
subclavian artery was filled with pssific matter at the thyroid axis;
the other arteries were healthy. The right internal jugular and sub-
clavian veins were enlarged; the right external jugular was closed



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I860.] FOOD IN CHINA. 203

near its anion with the internal; I found the remains of the vessel
where it entered the internal jagnlar.

The upper lobe of the right lung was congested. There were no
tubercles in the lungs, but there was considerable pleuritic adhesion.

The heart was enlarged, and undergoing fatty degeneration. The
pericardium was very adherent; so much so that I could not separate
it from the heart, without cutting either one or the other. At the
lower part of the right ventricle I felt a hard lump. I passed my
finger into the right ventricle, and found the lump to be in the wall
of the ventricle, near its lower part. I then cut with my scalpel from
the outside down upon the lump, and found it to be a leaden bullet,
slightly flattened.

Now the query arises, How long had this bullet been in the heart?
I will not advance any theory of mine; I think the facts of the case
tell the story, without any theorizing.



Abstracts and TVanslations from Foreign Journals, Prepared ex-
pressly for the Monthly.

THE UTIUZATION OP EVERYTHING FOR FOOD IN CHINA.
BT m ABSM u wns.

The progress of Chinese civilization cannot be compared with that
of Europe. The Mongolic progress takes place, or rather has taken
place, with a special characteristic of slowness that has been of value.
Agriculture, for example, has so progressed in this immense empire,
through the system of small patriarchal estates, that no country on the
globe can contend now with China in the abundance of its agricultural
products, although this does not prevent, in consequence of the enor-
mous population, (if the census were known, it would probably reach
four hundred millions,) an occasional destruction by famine, which has
reached even to a hundred thousand victims.

The Chinese have long recognized the necessity of losing nothing;
they have conquered natural repugnances, and introduced many natu-
ral products, which we reject, into their ordinary food. The lower
classes, first, have employed substances despised by the rich; for with
the former, children of necessity, all movements of progress take birth,
which are afterwards adopted by every one. * * Dogs' flesh is
considered, in Europe, as the worst kind of meat; it is called unmas-
ticable. The Chinese have decided otherwise; they fatten dogs that
are getting old and eat them; the butchers' stalls are garnished with



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204 UTILIZATION OP BVEBTTHING [SEPT.,

dogs' meat as well as with that of other animals. The farmers breed
a certain race of dogs suitable for fattening, which they call market-
dogs, {chiens de houcherie /) among these may be mentioned a variety
of wolf-dog, with upright ears, remarkable in that the tongue, palate,
and the whole interior of the fauces are of a black color. * * In
certain restaurants of our large cities, cats are sometimes served up
for rabbits; the Chinese use no such deceptions, considering cat's meat
excellent, and at provision stores may be seen enormous cats suspend*
ed with their heads and tails. On all the farms, these animals may
be seen, attached to light chains, undergoing fattening with the refuse
rice that would be thrown away. The cats are large, resembling those
found in our counting-rooms and parlors; the rest imposed on them
facilitates the fattening process.

The rat also occupies a large place in the nutrition of the Chinese;
it is eaten like the meats just described, either fresh or salted; the
salted are chiefly destined for the junks. The farmers, seeing that
this article is profitable, have even devised a plan by which they can
reap some advantage from the fecundity of this animal. They have
Malieries; to establish these rat-lodges, they place in the corners of
walls, that rats frequent, bottles with necks large enough to admit the
hand; the animal, mistaking these bottles, fastened in the walls, for
crevices, makes its nest in them, raises its young, and the farmer goes
from time to time to remove the young rats, just as pigeons are removed
from nests in pigeon-houses.

From rodents, let us pass to batrachians. In some countries the
hind legs of frogs are eaten ; the Chinese eat them entire, looking upon
them only as we do on little birds. Still further, what is to be eaten
must be decided by taste and not by appearance — a very rational
Chinese proverb. The Chinese having tasted the toad and having
found it good, have made it one of their ordinary articles of food, de*
spite its repulsive appearance. In China not a single toad is wantonly
destroyed.

One word as to the mode of preparing these meats so as to remove
all feeling of repugnance. The animals, or quarters of animals, gen-
erally pass through the hands of the roasters, and these are the most
celebrated in the world. They have fire-places so constructed that
the fire is somewhat elevated; below, there is a support, to which are
attached strings with hooks; these carry the article to be roasted, and
the roaster from time to time twists the string above, so that by its
untwisting and twisting the piece may be turned. The meats thus
prepared are minced with a knife, and converted into hash, the form



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I860.] FOB POOD IN CHINA. 205

ID which they are generally eaten. A national sauce, called sania, is
nsaally added, and rice serves for bread. On the tables of the rich,
not less than thirty or forty such hashes are found, differing only in
taste. One does not know what ke eats. Dinner begins with pre-
served fruits, and rice has the honor of being the last mouthful.

The French use nearly all the shell-fish of salt water; the Chinese
also eat those that live in fresh water and on land, such as muscles,
&c They have a species of monstrous snail — voltUo melo~^w\\\ch is a
fovorite dish. * * The Australians devour the glutinous zoophytes
which the sea throws up on their coasts; the Chinesq employ them
also, and, by aid of gastronomic proceedings, make good soups. lu
this class may be mentioned the tre^ang — Holothuria — which are
dried and salted. They delight in everything that is gelatinous, mu-
cilaginous and cartilaginous; sharks' fins, their swimming bladders,
which they call fish-stomachs^ the tendons of all animals, &c. All these
are dried for purposes of alimentation.

Among the fish that are dried are some small ones caught by cor-
morants, which are employed by the Chinese fishermen. They are
brought up with a ring soldered on the neck, which, being retracted,
so closes the cesophagus that they can only swallow gelatinous mate-
rials. The fisherman carries several of the birds in the stern of his
boat — setting them free on the sea, they plunge on the fish, seize and
try to swallow it; but the ring preventing the passage of the fish, the
bird returns to the bo^t to be freed from a body which is suffocating
it, and the fisherman removes the fish.

In China there are some districts where the arachnida are a choice
dish, and consequently the larvae of insects — caterpillars of all kinds —
are a common article of food. One deserves to be noticed — the silk-
worm; the Gliinese hatch more than they have leaves of the mulberry,
ailanthus, oak, &c., to feed until they arrive at maturity, and all that
cannot be fed are cooked and eaten. And here is something still
more strange. The chrysales of the cocoons are not lost; they are
cooked, and form one of the prized aliments of the Mongolic race. A
naval officer, who had eaten them, said lately that they were quite
good, and compared a plate of chrysales to a plate of maroons. They
also eat earth-worms, but only in times of great distress, considering
them poor food.

Hatched eggs must not be omitted, nor confounded with putrid
eggs; the former are eaten fresh, or preserved, cooked, and salted.
They are preferred when they contain the young animal almost ready
to break tl^ shell. Their duck-boats are decorated with cages which



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206 POOD IN CHINA. [Sept.,

serve as a home for the docks daring the night, and with farnaces for
hatching their eggs. As many as five thousand eggs have been
hatched on some of these boats. The dncks are set free daring the
day, feeding on what is found in the rivers, returning to their floating
home at night. A portion of the eggs thus hatched is destined for
reproduction, and another portion is devoted to sale as public food.

A few words are required as to the birds' nests. These are nests of
a swallow which frequents the seashore. It is found somewhat abund-
antly in the islands of Oceanica, Java, the Oelebees, and the Molaccas,
and along the Chinese coasts. Birds' nest soup is a luxury, if we may
judge by its cost. Throughout China aphrodisaic virtues are attrib-
uted to it; in rich society, they endeavor to resuscitate passion by
this food, which of course fails. These birds' nests have no other
merit than that of containing about nine per cent, of nitrogen, which
makes them nutritions and strengthening.

Many errors have prevailed as to the nature of this strange alimen-
tary product. Some have said that the sparrow made it of a mastic
that it prepared from the semen of the whale, obtained in the foam of
the sea; others that it was formed from fish spawn malaxated with
saliva in its beak; others that it extracts this gelatinous substance
from a species of Algse or Lichen which it obtained on the rocks at
ebb-tide. The truth is, that the nest is an immediate animal product
of a peculiar kind — a species of mucus that the bird has the property
of secreting in its beak, at the period of reproduction, in such quantity
that it is able to construct its nest entirely of it. Payen calls this sub-
stance mhilose, from cuhile, because it is produced by the sparrow for
the preparation of a bed for its young. In studying carefully the in-
ternal structure of this white hemisphere glued to the rock, it is found
composed of small filaments adhering together, and one is brought to
the conclusion that the sparrow draws these out with its beak, like
the silk-worm spins its cocoon. On account of this peculiarity in con-
struction, the uest, (which is very hard,) when dissolved in water and
converted into soup, still shows one portion in the form of a very fine
vermicelli, while the remainder has dissolved as a jelly, and furnishes a
soup of the clear brown color of strong beef soup.

The bird first constructs an external envelope out of small yellow
roots, similar to those of the millet that are found in the sands of the
seashore; then it forms the nest proper with its mucus, and it seems
as it it drew out some of its feathers to decorate the interior, so that
its eggs and little ones could rest on a soft and warm bed. These, like
our own swallows, are fond of building their nests together; hence ag-



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I860.] MEDICINE AND SURGERY IN CHINA. 207

glomerations of six, eight or ten are often found so enlaced by their
envelopes as to prevent separation,

In the crevices of rocks and cliffs these nests are built; sometimes
caverns are found which are filled with nests accumulated for ages. A
discovery of this kind is the discovery of a treasury. It is related of
a wealthy Chinaman, who, after having been rained, repaired his for-
tune by means of the discovery of a bird's nest cave, the contents of
which were worth a million of francs. Indeed, the article is so prized
that in the years when most abundant it is sold at 100 francs per
kilogramme.

All the nests are not equally pure. Those that are perfectly white,
after being cleansed, contain only the mucus of the bird. But when
the bird has been disturbed in its first construction, either by enemies,
such as birds of prey, serpents, or man, or by tempests, accidents, Ac,
it has no longer suflBcient of its proper secretion to construct another
nest, and its instinct teaches it to employ the mucus as a species of
mortar to agglomerate other substances, such as algae taken from rocky
banks, and hence the cause of the L)elief that the nests were made from
lichens. These impure nests are used also, but they are cheaper, and
not in demand.

In making the soup, 120 grammes (corresponding in amount to one
nest, or a nest and a half,) are put in a half litre of water, and boiled
for two hours. It is very pleasant to the taste, although having a
peculiar aroma. Soup for one man would cost in China 12 francs.
In Paris they have been sold at one franc a gramme, 100 francs a
kilogramme; and soup for one man would cost 120 francs. — L^ Union
M^dicale. L. H. s.

MEDICINE AND SURGERY IN CHINA.

BT K. G. PAUnUKB.

The practice of medicine and surgery is, in China, a very honorable
profession, at the head of which is an Academy of Medicine, ( 2'ai i
youan,) located at Pekin. The object of the latter is to maintain, in
all its integrity, the science of medical practice, which dates from
3,000 years before our era, and to direct those entering upon such a
career. The members composing this Academy are 115, 15 of whom
are imperial physicians, (Yuij) 30 practitioners, 40 doctors of medi-
cine, and 30 aspirants. The imperial physicians are, in turn, on duty
near the emperor and imperial family. They are often dispatched by
the emperor to attend upon princes, princesses, ministers of State, and
other great functionaries, when his majesty hears that they are sick.



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208 MEDICINE AND SURGERY IN CHINA. [SEPT.,

Chinese medicine divides all diseases in nine great divisions, as fol-
lows: 1, Those aflfecting the pulse violently; 2, Those affecting it mod-
erately; 3, Diseases produced by cold; 4, Diseases peculiar to women;
5, Cutaneous and painful diseases; 6, Diseases needing bleeding; 7.
Diseases of the eye; 8, Diseases of the mouth and teeth; 9, Diseases
of the bones. The physicians seem to have a tolerably good knowl-
edge of anatomy, if we dare judge by the plates contained in their
books. Their physiology rests on the system of two principles, Yang
and Ying, ov the strong 9knd weak principle; the wa/e and /ma/g prin-
ciple, whose equilibrium and harmony constitute the normal state^ and
the predominance of either a diseased condition. Semeiology seems
somewhat advanced with them; the practice of medicine having been,
80 to speak, hereditary in families, observation of diseases has pro-
duced the art of recognizing thom, which has been pushed very far.
I learn from several French missionaries, who have been treated by
Chinese physicians in China, that these exhibited an extraordinary
aptness in recognizing the external signs of disease. Observation of
the movements of the pulse, on which they place four fingers of the
hand, is carried much further than in Europe.

The practice of medicine is called *' the benevolent art," (jen chouj
and is placed second to the profession of literature, which is the first.
The following are the conditions exacted from those wishing to prac-
tice medicine: a celebrated practitioner must be sought out as teacher,
to learn the principles of the science and the properties of remedies;
the best authors that can be secured must be studied. Such works
are common and numerous in China. When the student has accom-
plished the study of the best medical treatises, and has followed for a
sufficient time the practice of his patron, he can practice himself.
There are no public schools in the empire where medical students take
their degrees and are publicly received as doctors; the great college
at Pekin, and the academy alone, require examinations and confer di-
plomas on those who, desiring them, are recognized as worthy. The
Chinese penal code provides for cases where ignorant men practice
medicine with the sole idea of gain, and without the necessary knowl-
edge.

" As for those who shall exercise medicine or surgery, (literally in-
ternal medical practice and external medical practice,) without un-
derstanding them, who shall administer drugs or operate with a pierc-
ing or cutting instrument contrary to practice and established rules,
and, by such a course, shall have caused the death of the patient, the
magistrates shall summon others of the profession to examine into the



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I860.] IfEDICINE AND SUBGEBY IN CHINA. 209

Datore of the remedf employed, or of the operation performed, which
has beea followed bj the death of the patient. If it is manifest that
they can be accused only of having acted through error, and without
the intention of injuring, the physician or surgeon can be freed from
the punishment inflicted on a homicide, in the way adopted in cases of
accidental killing; but they will be obliged to give up the profession
absolutely."

'' If it shall appear that a physician or sui*geon has intentionally not
followed the established rules of practice, and while pretending to con-
quer the disease he really renders it more serious, so that the cure may
bring him in more money, the sum which he shall have gained in this
way will be regarded as stolen, and the punishment will be propor-
tioned to the fees that he has received."



Online LibraryCharles JanetAmerican medical monthly and New York review → online text (page 23 of 54)