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the avenue adopted by malingerers to claim pecuniary reward for
home-manufactured injuries.

Absolute l*est after injury, and mental diversion with light
bodily exercise (especially remunerative exercise) in the secondary
stages, are the best means known for averting chronicity and
warding off incurableness in spinal concussion.

Where the foregoing methods are properly carried out, the
prognosis in this disorder, both as to life and future usefulness,
will be very good. — Dr. Wilkinson in Medical Age, July 25, 1893.



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108 ABSTAACTS.

THREE CASES OF PERTUSSIS TREATED WITH
BROMOFORM.

Three children, aged respectively eight, six, and four years, mem-
bers of the same family, developed pertussis within a few days of
each other. They came under my observation at the Babies*
Hospital at the onset of the disease, — in fact, before the diagnosis
was absolutely positive. Pertussis was strongly suspected, how-
ever, and they were put on the bromoform treatment at once, which
drug has been used in the management of this affection by many
observers with widely varying results. It is claimed by some
that if bromoform is given early, the disease may be aborted ; by
others, that the number and severity of the paroxysms will be
diminished, and the duration of the attack shortened. Equally
good observers, on the other hand, state that after a fair trial the
drug proved itself valueless in their hands.

Concerning the cases in question, the youngest, a decidedly
rachitic girl of four years, was given five drops four times daily,
the other two, fairly healthy boys, each received six drops four
times daily. Under the treatment, the disease developed appar-
ently about equally severe in all. The paroxysms varied from fif-
teen to twenty daily ; vomiting occurred frequently during the
second week, during which time the disease was most severe, the
patients presenting the typical appearance ; the eyes congested and
the faces puffed and swollen. At about the eighteenth day of
treatment, the disease began to subside, the number and severity
of the paroxysms diminished rapidly, the vomiting ceased, and at
the end of the fourth week, greatly to my surprise, they were
practically well as far as the pertussis was concerned.

No other drug was used. Whether the short coarse and sud-
den subsidence of the acute symptoms were accidental or due to
the treatment, I will endeavor to clear up by further trial. — Cliaa.
G, Kerleyy M, 2>., in Archives of Pediatrics,



Scope and Limitations of Cebebbal Subgeby. — Dr. Eirchhoff
has contributed to the Therapeutische Monatshefte an article on
this subject, a summary of which appears in a recent number of
the Memie Midicale, He enumerates the varied conditions for
which operations on the head have been proposed or carried out,
and indicates the reasons for and against operation in each one.
Intra-cranial abscess, for example, is a condition in which the



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BOW-LEGS. lOd

advisability of operative interference is not to be disputed,
whether the abscess be due to traumatism or result from ear dis-
ease, and operation should be carried out as soon as the diagnosis
is made. With regard to intra-cranial growths, it is never easy to
foretell whether a tumor producing certain symptoms is remov-
able or not. Superficial encapsulated growths are naturally those
offering the best opportunities, whilst deeper and more extensive
ones do not present the same chance of recovery afterwards, and,
on account of the destruction of tissue and the risks from hemor-
rhage, the operation itself is a formidable one. Epilepsy, when the
result of localized lesion of the cortex, is practically the only form
of this disease in which a good result is anticipated from opera-
tion. Hernia cerebri, Dr. I^irchhoff thinks, may be removed if
situated anteriorly, as no paralysis appears to follow. It may also
be possible to remove a small one posteriorly. Of course, a condi-
tion such as hemorrhage from the middle meningeal artery, if a
result of injury, must be treated by trephining, and the same is
true of the similar condition associated with pachymeningitis,
although it is not easy of diagnosis. The large serous effusions
associated with tuberculous meningitis, cerebral tumors, etc., have
been evacuated by trephining and puncture, and such an operation
may, at least, temporarily relieve the patient. It is doubtful
whether trephining for cerebral hemorrhage would be practised
even if the difficulty in diagnosticating between that condition and
softening could be overcome. Headache, if the pain be localized
to some distinct tender point, offers a good opportunity for relief
by trephining ; but permanent benefit from operation in mental
disease has yet to be obtained. — Medical Age,



Bow-Legs. — Dr. A. E. Hoadley ( Chicago Clinical Review) says :
Rugged and rapid development produce bow-legs, and more com-
monly straight legs, which will uniformly correct themselves
without assistance.

The severe forms of ordinary bow-legs, especially where the
joint itself partakes largely of the deformity, will require treat-
ment by restraining and corrective force.

The prognosis, in the ordinary forms of bow-legs, is very favor-
able under the influence of mild corrective force.

The prognosis in rachitic bow-legs is unfavorable. When this
condition is of long standing, it is practically not amenable to
treatment by gradual corrective force, and, therefore, should be



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110 ABSTm^CIS.

corrected by osteotomy. The rachitis itself requires the most
careful and comprehensive constitutional treatment.

The anatomical arrangement of muscles favors the sponta n s o i
correction of bow-legs, and the biceps is the most important in the
exercise of this corrective force. In the opposite condition, or
knock-knee, there are no opposing muscles that can act as cor<
rectors of the deformity.

The strong contrast between these two conditions, bow-legs
with a tendency to recovery, and knock-knee with a tendency to
progression and difficulty of correction, is due entirely to the ana-
tomical arrangement of the muscles.



The Action of Glycebine in Nbphbolithiasis. — Besides piper-
azine, which is the best known solvent of concretions of uric acid
and its salts, glycerine has attracted attention in recent literature
as a remedy in nephrolithiasis. Upon the administration of fifty
to one hundred cubic centimeters of glycerine, concrements to the
size of a bean have been observed to pass away with the urine in
patients suffering from nephrolithiasis fourteen to fifteen hours
after taking the drug, the urine also containing a remarkable
amount of mucus. Two or three hours after the drug has been
taken, pains occur with great regularity in the region of the sus.
pected kidney. In order to explain this action of glycerine, A.
Hermann has made experiments, which have been published in the
Ptag. Med. Wochen,^ from which the following may be deducted :
The largest part of the glycerine, taken internally, is secreted
unchanged within the next twenty hours with the urine, and the
latter is neither quantitatively nor qualitatively changed, excepting
that it becomes slippery. The solving power of glycerine for
concrements is extremely small, even at the boiling point. When •
introduced into the ureter of rabbits by abdominal section, no con-
traction of the involuntary muscular fibers of the urinary passages
takes place. When administered to excess, per os, similar symp-
toms occur as are observed when a saturated solution of sodium
chloride is injected into the veins. The action of the drug can,
therefore, only be a mechanical one. Glycerine, after entering the
blood, withdraws a large amount of water from the tissues, which
passes through the kidneys, the mucus in the uriniferous tubules
shrinks in consequence of the withdrawal of water by the glycer-
ine, and is thereby loosened and with the concrements washed
away by the slippery urine. — Medical Meview.



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ADVANCED MEDICAL EDUCATION. Ill

BUFFALO MEDICAL AND SURGICAL JOURNAL

A MONTHLY REVIEW OF MEDICINE AND SURGERY.

EDITORS:

THOMAS LOTHROP. M. D. - - WM. WARREN POTTER, M. D.

All communications, whether of a literary or business character, should be addressed
to the managing editor: 284 Fbanklim Street, Butfalo, K. Y.

Vol- XXXIII. SEPTEMBER, 1893. No. 2.

ADVANCED MEDICAL EDUCATION.

The discassion of the subject of medical education, especially
during the last ten years, in and out of the profession, is at last
bringing forth its fruits. It is a lamentable fact that we have
reason to blush in comparing our standards with those of Europe,
or even of Canada. The defects of the system are too plain to be
denied. We may plead, in extenuation of these depreciated
standards, that the rapid development of our country in its material
wealth has resulted in a demand for material in the profession
that would meet the exigencies of the times. Standards in medi-
cal education, as in other scientific pursuits, have been determined
by the direct and practical demands of our people. We are fast
approaching the epoch in our national life when the science of
medicine here must keep pace with the spirit of research which
inspires the profession abroad.

The latest evidence of the growth of this principle in the pro-
fession is the organization of the Johns Hopkins Medical School,
which opens its first i^ession in October next. We have received the
first annual announcement, and also the excellent address of Prof.
Welch, defining its objects and its aims. Here the difficulty of
fixing the requirements for admission has received the serious con-
sideration the subject demands. " How are we to adapt," writes
Prof. Welch, " to the embarrassing and anomalous development of
American colleges, a system of medical education for which a lib-
eral education is demanded as a prerequisite ? We are not pre-
pared to recognize a High School training as sufficient, and between
this and the training in a college or scientific school there is no
intermediate grade. We must, therefore, endeavor to conform to
the peculiar conditions in our colleges and scientific schools, by
asking that students who are admitted to the medical schools as



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112 BDITOBIAL.

candidates for the doctor's degree shall possess the liberal educa-
tion implied by a degree in arts or in science, and shall also have
a specified amount of knowledge in certain sciences, as physics,
chemistry, and general biology, which are fundamental to the
study of medicine."

These words portray the high aims of this new venture in
medical education in this country. When taken in connection
with the recent advances at Harvard and the prospective advance
to a four-years' course at Columbia College in 1894, with the late
utterances of the vice-president of the faculty of medicine of
Niagara University, who advocates a like advance, it is evident
that the long struggle to remedy the deficiencies of the past is at
last reaching the end the profession has sought.

The announcement of the Johns Hopkins Medical School fur-
nishes the foUoAving requirements for admission : 1. Those who
have satisfactorily completed the chemical biological course which
leads to the degree of A. B. in that university. 2. Graduates of
approved colleges, or scientific [schools, .who can furnish evi-
dence (a) that they have a good reading knowledge of French
and German ; (b) that they have such knowledge of
physics, chemistry, and biology as is imparted by the regular
minor courses given in these subjects in that university. 3. Those
who give evidence, by examination, that they possess the general
education implied by a degree in arts or in science from an
approved college or scientific school, and the knowledge of French,
German, physics, chemistry, and biology already indicated.

These extracts give an idea of the preliminary training required
for admission. They are above the standard of any other medi-
cal school in this country, and in the world. They indicate the
triumph of a principle for which the medical profession has been
fighting, and must stimulate other institutions to like efforts in
the same direction.

Within two or three years, the Legislatures of New York have
established a standard for admission to the medical colleges in this
State which amounts to a mere elementary education. The State
Board of Medical Examiners also has been established, which fur-
nishes an additional safeguard to the profession. We advocate,
in view of the movements already indicated in other States, that
this should be raised to the standard of graduation from the High
Schools, with sufficient knowledge of Latin and Greek to enable
the student to understand the nomenclature of medical terms.



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DIVISION OF THE ABDOMINAL REGIONS. 118

Our State societies should inaugurate a moyement in this direotion
at once. We think the medical schools would cheerfully endorse
the principle. The trend of thought in the profession is in that
direction, and the movement will go on until the £mpire State
acquiesces and adopts an advanced standard fully equal to that of
the most enlightened States.



THE NEED FOR GREATER UNIFORMITY IN THE
DIVISION OF THE ABDOMINAL REGIONS.

It is as true of sciences as of habits, that if we begin with a founda*
tion in which everything about it is not exact and mathematically
accurate, so to say, the superstructure will reveal similar defects.
This is strikingly so in the science of anatomy, in which the size,
position, etc., of the various organs and portions of the organism
vary in each individual case, and, therefore, do not admit of being
described with mathematical precision. Our estimates are only
approximate. The result has been that in their descriptions of
regions or organs authors show a laxity, begotten, it is true, by
the nature of the subject, but in which they have gone much
farther in the approximative than seems justifiable. This is the
more easy in a field of science such as anatomy, where originality
is not easily shown, and the desire to make one's name live by
putting this line in one place and that in another (in the majority ,
of instances but a few millimeters from the place of someone
else), is readily yielded to. Unless by so doing one simplifies
matters and seeks to bring about such a condition as shall lead to
uniformity, it is better to desist. These remarks have been sug«
gested by the lack of uniformity shown by various authors in
marking out the regions of the abdomen. There are over one
dozen methods of placing lines upon the surface of the abdomen,
thus dividing it into regions, so that an organ situated in one
region, according to one author, is found either not at all, or only
in part in the same region according to a second. Confusion is
the natural result, and a science which should supply the neces*
sary to the daily needs of the practitioner does not do so at all.

In a communication to the Anatomical Society of Great
Britain, in May last. Professor Anderson made a strong plea for a
greater uniformity and simplification in setting the limits of the
abdominal regions, and suggested a plan which, to our mind, is a
great improvement upon anything heretofore advanced. His plan



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114 EDITORIAL — TOPICS OF THE MONTH.

is briefly as follows : Draw a line from the symphysis pubis ta
the ensiform appendix, and draw another at right angles to this at
the ievel of the umbilicns. This marks off the abdomen into foar
regions whose boandaries are fairly constant. They can be desig-^
nated as upper and lower, right and left quadrants. Such regions
can be demonstrated upon the dorsum with equal ease, as there
the vertebral column corresponds to the vertical line anteriorly^
and a line drawn between the third and fourth lumbar vertebrae,
if prolonged, would join the anterior horizontal line. When the
term "line" is used, it must be remembered that we are really
speaking of planes of which these " lines " are but the outer bor-
ders. These regions, therefore, are so many compartments
(pigeon-holes, if you will), in which the various abdominal organ&
are stored. Professor Anderson would reduce these from nine to
four, in which the organs found would be as constant as it is pos-
sible to have them. We hope that the Association of American
Anatomists may take this subject into consideration at their next
meeting, and adopt this or some equally simple and excellent
plan.

TOPICS OF THE MONTH.

Mb. £bnest Hart, the distinguished editor of the British Medi-
cal Journaly paid a visit to this country in the early Summer, and
attended the annual meeting of the American Medical Association,
at Milwaukee, in June. During the course of a very able address,
which Mr. Hart delivered at the Medical Editors' meeting on
Monday evening, June 5, 1893, he took occasion to refer to con-
sultations with homeopaths. Whatever may have been the pra^
tice in England with regard to this subject, and upon which Mr.
Hart animadverted, there has never been in this country any
considerable danger of such an admixture of methods that are as
diametrically opposed as the poles.

Somebody must have given Mr. Hart an erroneous view of the
ethical conditions surrounding the American medical profession.
We infer that he has been "coached " with reference to the atti-
tude of the American Medical Association towards the Medical
Society of the State of New York.

Whoever has gratuitously falsified the real situation, will
probably felicitate himself over his cunning. His triumph, how-
ever, will only be of a temporary nature. " Mene, mene, tekel



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TOPICS OP THE MONTH. 115

upharain " was never more plainly written than the handwriting
on the wall with reference to the so-called ethics, of which it
seems that the loudest and most ardent champions are the earliest
to violate either in letter or in spirit.

Dr. Love, the distinguished second vice-president of the Ameri-
can Medical Association, has definitely and intelligently set forth
the proper attitude of the profession to ethics, in his address, pub-
lished in the July number of the Journal, and which we need
not further dilate upon at present. Let all interested read Dr.
Love's address.



The Pan-American Medical Congress, which has excited such uni-
versal interest in medical circles for the past two years, is nearly
at hand. It will be held at Washington, Tuesday, Wednesday,
Thursday, and Friday, September 5, 6, 7, and 8,1893. Let us
again urge all progressive physicians to attend this remarkable
meeting, and to take part in its deliberations.

Rarely has it been the province of the profession to consider in
Medical Congress assembled more important issues than will be
discussed at this meeting. International quarantine, marine sani-
tation, and medical pedagogics, together with all other scientific
medical questions, will be broadly discussed.

We publish in this issue of the Journal the program, in
part, of the Section on Gynecology and Abdominal Surgery. A
number of papers have been announced since this program was
put in type, and it is safe to say that the work to be done by this
Section will take high rank in the literature of the departments of
medicine which is its province to consider.



The Postroffice building in Buffalo is a fair target for the Health
Commissioner in his endeavor to improve the sanitary condition
of this city. Let him visit the basement and there make note of
the environment of the faithful officials who conduct the most
important branch of the postal service. If foul air, superheated
by gas, can ever breed disease, it would seem that here is a favor-
able opportunity.

The New York Board of Health has made an inspection of the
post-office building in that city, where there are 259 persons
employed in the newspaper department in the cellar of the build-
ing, of whom there are on an average of ten on the sick list daily.

While these buildings are under the control of the general



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116 PERSONAL — ACADEMY OP MEDICINE NOTES.

government, it is yet within the province of the local boards of
health to make recommendations looking towards the improve-
ment of the present unsanitary conditions. Let such a report be
made with reference to the Post-office building in Buffalo, and
forward it to Postmaster Gentsch. A copy of such report would,
no doubt, be forwarded by him to the Washington authorities,
and this would, probably, hasten action with reference to the erec-
tion of a post-office building more than any other argument.



The eleventh International Medical Congress, that was to have
convened in Rome in the latter part of September, has been postr
poned until April of next year, on account of the prevalence of
cholera in Italy. This, it seems to us, is a wise solution of the
problem. No doubt there will be much disappointment, in view of
the fact that many of the members of the Pan-American Medical
Congress, which will meet in Washington, September 6tb, bad
arranged for an excursion to Rome by the Werra, to sail from
New York on September 9th ; but this is of too small a moment
as compared with the danger that might grow out of the assem-
bling of the Congress during such an epidemic.



Per<*onaf.

De. Nelson G. Richmond, of Fredonia, was elected president of
the medical society of the county of Chautauqua at its annual
meeting, held at the Chautauqua House, Mayville, N. Y., on Wed-
nesday, July 12, 1893. This is a fitting recognition of the talent
and executive ability of one of the most prominent members of
the society.

Dr. Richmond and Dr. H. J. Dean, of Brocton, were chosen
delegates from the medical society of the county of Chautauqua to
the medical society of the State of New York for three years.



•Kcailem^ o^ MeSicind Flofei*.

The programme of the Section on Medicine, it is stated, will sur-
pass anything that has as yet been attempted in Buffalo medical
circles. A hearty cooperation with the officers is all that is
necessary to insure success.



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COLLEGE NOTES. 117

The next regular meeting of the Academy will be held Tuesday,
September 12, 1893, under the auspices of the Section on Med-
icine.

The annual dues, amounting to $5, are payable in September.



The second year of the Academy should certainly eclipse the first
year's record. There is no reason why the Academy should not
have a membership of 200 at the close of the year.



The Academy rooms have had a forlorn and deserted appearance
during the Summer months. It is expected that this appearance
will improve greatly after the sections are in working order.

The Section on Surgery will hold its first Fall meeting Tuesday^
September 5th. The programme arranged for the evening con-
sists of a paper on Minor Surgical Operations, by Eugene A.
Smith, M. D., and a paper on The Preparation of Suture Material
and Dressings, by F. J. Thornbury, M. D.



e rioted.



The Medical Department of Niagara University opens its doors
Monday, September 25, 1893.

The Medical Department of the University of Buffalo commences
its forty-eighth regular session on Monday, September 25, 1893.



The following changes have been made in the faculty of the Med-
cal Department, University of Buffalo : Dr. S. Y. Howell has
resigned, and Dr. W. H. Bergtold has been appointed Professor
of Pathology ; Dr. J. B. Andrews has been made Emeritus Pro-
fessor of Insanity ; Dr. A. W. Hurd has been appointed Lecturer
on Insanity.

The annual announcements of the Buffalo medical schools are
more tastefully and elaborately gotten up than any that have been
received in many years. They contain a lot of information, are
handsomely illustrated, and reflect credit on their respective
schools. Readers of the Journal desiring copies can obtain them
by addressing Dr. A. A. Hubbell or Dr. John Parmenter.



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118 SOCIBTT HBBTINGS.

^ociel^ Meefingi*.



PROGRAMME OF THE SECTION ON GYNECOLOGY AND
ABDOMINAL SURGERY, PAN-AMERICAN
MEDICAL CONGRESS.

To BE held at the Law Department of the National University,
Thirteenth street, between H and I streets, N. W., Washington,
D. C, September 5, 6, 7, and 8, 1893.

EXECUTIVE OFFICERS.

Dr. W. W. Potter, Buffalo, N. Y., Executive President ; Dr.
Brooks H. Wells, New York, Dr. Ernest W. Cushing, Boston,
Secretaries.

OPENING SESSION, SBPTBMBBB 5TH, 3 P. M.



Online LibraryJ. A. (Joel Asaph) AllenBuffalo medical journal → online text (page 12 of 78)