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conditions found at operation clearly proving this to be the case.

The essay of the evening, " Dislocation of the Cervical Vertebrae,
followed by Mania and Death : Report of a Case,'* was read by Thomas
L. Butler, M. D. [See p. 329.]

Discussion. Dr. A. M. Vance: I have seen several broken necks
and injuries about the neck in my experience. I have operated upon
but one, an old man who was paralyzed, both sensation and motion,
from his neck downward. He was removed to his home, and for eight
days lay there without pain or suffering, perfectly paralyzed both as to
motion and sensation. At the end of eight days he allowed me to
operate upon him. When I cut down over the cervical region I found
a fracture of the fourth cervical vertebra, exposing the dura over quite
an area. Upon lifting up this broken bone, he being perfectly conscious,
he remarked that he believed he could move his foot and arm, which
he proceeded to do then and there. I sciaped the dura and pressed
upon it first one side then the other, and he said he could feel sensation
upon the side opposite to where my manipulations were made. He
lived fourteen days afterward, the wound healing perfectly, and he
improved progressively as to motion. He could empty his bladder
normally, and also had control of the bowel. He died of hypostatic
pneumonia, being a man sixty-five years of age.

These cases are very unpromising ones to operate upon. In my
case there was no suppuration. I think Dr. Butler's patient died
either from hemorrhages or from a septic condition from the wound.

Dr. Louis Frank : In regard to the flushing of the face mentioned
by Dr. Butler : I would like for some of the physiologists or Dr. Butler
to make plain the cause of this. Was it not due to paralysis of the
cervical sympathetic ? I remember a case seen several years ago where
there was paralysis of the cervical sympathetic, in which this was a
marked symptom.

Dr. H. A. Cottell : It seems to me that the explanation offered by
Doctor Frank is the correct one. The anatomical features of the case
reported are extremely interesting. I hardly see how any displace-
ment could occur between the axis and the atlas without serious injury
to the cord. The case is very remarkable in this respect. We know



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The American Practitioner and News. 347

in nearly all cases of real or supposed dislocation of the vertebrae, even
when the vertebrae show no sign of dislocation, that the bones have
slipped out of place and then slipped in again, at the time, however,
seriously lacerating the cord.

Dr. S. G. Dabney: The pupillary symtoms would rather indicate
an irritation of the sympathetic. An inequality of the pupils, so
long as response to light and convergence is perfect, is not very unusual
in health.

Dr. T. S. Bullock: I can not understand the symptoms which
occurred in this case, but I can testify to the great diflSculty which was
experienced in placing the ligature, and there was certainly some sep-
aration of the vertebrae. Dr. Roberts, who was assisting Dr. Butler,
had to go away before the operation was completed, and I was the
assistant from this time on. It was an extremely difficult matter to
get the ligature properly placed.

I also coincide with the opinion expressed by Dr. Frank that the
cervical sympathetic must have been injured.

Dr. W. O. Roberts : I, like the other gentlemen, can not understand
why, with this dislocation, paralysis should have been confined to one
arm and one leg. I felt satisfied at the time that there must be some
intra-cranial injury. I have only met with two other cases of disloca-
tion of the cervical vertebrae, and in both of these there was paralysis
below, both arms and both legs, and both patients died of hypostatic
pneumonia weeks after the accident occurred.

The dislocation in the case reported was easily recognized with the
finger in the mouth pressed against the vertebrae before the opei^ation,
and we did not make out any fracture.

Dr. T. ly. Butler : I do not agree with Dr. Vance that this man died
of sepsis. There was free drainage, and the wound was carefully
dressed every day, so there was no pent-up pus. The man's tempera-
ture remained practically normal for the greater part of the time for
nearly six weeks after the operation. I really think the man died from
exhaustion. To what the mania was due I do not know, unless there
was some meningeal trouble ; possibly alcohol acted as a predisposing
cause.

In regard to the symptoms : The most interesting symptom was
that he had paralysis of one leg and incomplete paralysis of one arm.
Naturally it would be supposed that there would be complete paralysis
from the point of injury down.



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348 The American Practitioner and News.

Since seeing this case I have read a report of a case quite similar to
this by some English surgeon, in which there was a fracture in about
the same location. No operation was done, and the man lived for
eleven years with considerable deformity. He had paralysis of the
right arm and right leg, just as occurred in my case. The diagnosis was
verified eleven years after the injury by a post-mortem examination.

LOUIS FRANK, M. D., Secretary,



.foreign (Eorresponbencc.



LONDON LETTER.

[FROM OUR SPBCLAX CORRESPONDBNT.]

New School of Medicine; The Army Medical Report; The Use of Tuber-
culine; Effects of the New Vaccination Act ; Adrenal Disease in Lunacy;
Biliary Calculi in Children ; The Anti-vaccination League ; Centenary of
the Royal College of Surgeons.

Lord Lister has opened the Henry Thompson Ward set apart at the
Royal Southern Hospital, Liverpool, in connection with the school for the
special treatment of tropical diseases. Lord Lister said he felt sure that
Liverpool was doing work of the greatest importance for the welfare of
mankind.

In the Army Medical Report for 1897, recently issued, it is stated that
enteric fever caused 2,050 admissions to hospital among the European
troops serving in India, 556 deaths, and a constant sickness of 296.85 men,
being in the ratios of 31.8, 8.62, and 4.60 per thousand. Cholera caused one
hundred and sixteen admissions and eighty deaths; at one station there
were sixty-five cases and forty deaths during seven days, and it is noted
that most of the sufferers were members of the Army Temperance Associa-
tion, and the cholera microbe was detected in several articles of food and
drink found in the room used by this Association on the morning after the
outbreak. Examination failed to detect the poison in the drinking-water
of the station.

The Medical Officer for Sunderland has just read a paper upon the Use
of Tuberculin before the members of the Newcastle Farmers* Club; Dr.
Scarfield suggested that mere inspection of cows by a veterinary surgeon
was not of much use, as an animal might be seriously affected by tubercle
and give no outward sign, and that the services of the veterinary surgeon
and the tuberculin should be offered free of charge to any breeder or farmer
who would agree to isolate the sound from the reacting animals. It was



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The American Practitioner and News. 34.9

also suggested that five years after the introduction of a new law on the
subject no compensation for condemned carcasses is to be given, no milk
from a tuberculous cow is to be sold, local authorities may test any animal*
and if reacting may be sold and fattened for killing without compensation,
and all cattle are to be sold with an implied warranty that they are free from
tuberculosis.

In the course of a lecture delivered at St. George's Hospital it was stated
that the lecturer knew of two cases in which the mind had effect upon dis-
ease ; in each the increased growth of a humor appeared to follow the con-
tinued concentration of the patient's attention upon the part, and further
that it has occasionally happened that a physician or surgeon who has paid
particular attention to the diseases of some organ or region of the body has
ultimately, as a result, it is assumed, suffered from an affection of the same
part.

The President of the Local Government Board has stated that the
effects of the new vaccination act have proved the opposite of those antici-
pated, vaccination being considerably on the increase, and the step taken by
the Government in creating the " conscientious objector " more than jus-
tified. In a number of cases the actual statistics recorded show the increase
in the number of certificates of successful vaccination to range from an
increase from twenty-five to one hundred per cent. The increase is attrib-
uted to the system of domiciliary vaccination and the provision of a better
and purer kind of lymph, which has relieved the apprehensions of a great
many people who were formerly opposed to vaccination.

Dr. Beadles has drawn attention to four cases of extensive hemorrhage
into one or both adrenals which have appeared in the necropsy records of
Colney Hatch Asylum. He found that these organs were not uncommonly
the seats of atrophy or inflammatory processes in the insane. These
changes were, however, unaccompanied by symptoms. Addison's disease
was rare among the insane, as also was malignant disease of the adrenals.

At the meeting of the Pathological Society Dr. Still gave details of three
cases which he had seen within six months at the Great Ormond Street
Hospital for Children of instances of biliary calculi in children. The first
was the case of a child, aged nine months, that had suffered from vomiting,
day -colored stools, but with neither jaundice nor colic. At the post-mortem
examination there were found eleven small, black, friable calculi of pigment,
three being impacted in the common bile duct. Another patient was a
female child, aged eight months ; in this case also there was neither jaundice
nor abdominal pain ; the patient died of tuberculous meningitis. Three
minute calculi of pigment were discovered in the gall-bladder. The last
case, a boy, had vomiting with abdominal pain, but no jaundice ; several
calculi were discovered. Dr. Still remarked upon the rarity of such cases,
but said he had been able to discover twenty published cases, of which ten
were quite infants. He considered that biliary calculi might be formed
during intra-uterine life, the viscosity of the bile in infancy, which led to a



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350 The American Practitioner and News'.

secondary stagnation, probably giving rise to the formation of such concre-
tions.

Upon the occasion of Dr. Sophia Jex-Blake retiring from active practice
of her profession a farewell reception was given her in Edinburgh. Pro-
fessor Masson remarked that not many years ago the people of Scotland
thought the foundation of society would be shaken if women began to
study medicine, and now, while free dispensaries stood open on all sides,
many working women were willing to pay a relatively considerable sum in
order to be attended by doctors of their own sex.

The Anti-Vaccination League at the annual meeting announced that
they intend to establish a ** Woman's Anti-Vaccination league." It
appeared that the income of between ;^8oo and ;^900 per annum is not suf-
ficient, and it was decided to raise a special fund of ;^5,ooo for the purpose
of carrying on the campaign against vaccination and to increase the num-
ber of their paid lecturers.

It has been decided to celebrate the centenary of the charter of the
Royal College of Surgeons of England next year before the termination of
the college year on June 30, 1900. The charter of incorporation is dated
March 22, 1800. The committee, however, consider that, although the actual
day of the year on which the charter was granted would be the most suitable
date for the function, March is not a desirable month.

Dr. Parker, of Liverpool, has recently successfully performed pyloro-
plasty on a man aged twenty-one years. The pylorus was found narrowed
to three eighths of an inch in diameter outside. Upon opening this a small
circular ulcer was discovered inside the stomach. Upon performing the
operation over a Mayo Robson's decalcified bone button the diameter of the
pylorus increased to one and a half inches outside. At the end of five
weeks the patient ate ordinary meat diet and quickly regained good health.

London, April, 1899.



MaUch'5 Materia Medica— New (7th) Edition. A Manual of Organic Materia
Medica : Being a Guide to Materia Medica of the Vegetable and Animal King-
doms. For the Use of Students, Druggists, Pharmacists, and Physicians. By
John M. Maisch, Phar. D., Professor of Materia Medica and Botany in the Phila-
delphia College of Pharmacy. New (7th) edition, thoroughly revised by H. C
C. Maisch, Ph. G., Ph. D., Professor of Materia Medica and Botany in the Medico-
Chirurgical College of Philadelphia, Department of Pharmacy. In one ver^
handsome i2mo volume of 512 pages, with 285 engravings. Cloth, $2.50, net Lea
Brothers & Co., publishers, Philadelphia and New York.

The name of Maisch in the department of materia medica carries with
it a special force among physicians from the fact that the author of this
work was for so long a time associated in the production of authoritative
works on materia medica.



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The American Practitioner and News. 351

It need not be said that the very best to be obtained was aflForded in the
previous editions of this work as they successively came from the press.
In this edition the son has taken up the work and added to it such facts of
value as have transpired since the father laid down his pen, and he has
done it in such a way as to satisfy the high expectations the profession had
a right to indulge on account of the reputation of the father. The press-
work is not the least of the book's attractions, the illustrations being
especially artistic. d. t. s.

Retinoscopy (or Shadow Test) in the Determination of Refraction at One Meter
Distance with the Plane Mirror. By JameS Thorington, M. D., Adjunct Pro-
fessor of Diseases of the Eye in the Philadelphia Polyclinic and College for
Graduates in Medicine, etc. Third edition, revised and enlarged. Forty-three
illustrations, twelve of which are colored. 86 pp. Price, $i.oo. Philadelphia :
P. Blaki&ton's Son & Co. 1899.

Retinoscopy is defined by the author as the method of estimating
the refraction of the eye by reflecting into it rays of light from a plane
or concave mirror and observing the movement which the retinal illumi-
nation makes by rotating the mirror, a definition that we hardly think will
be adopted into the next edition of Webster's International without shaping
it into meaning. The author's statement of an axiom on page 21 is
another illustration that his training has been rather in the medical clinic
than in the preparation of dictionaries. His axiom is, " That with an eye
otherwise normal except for its refractive error, and being under the
influence of a reliable cycloplegic, there is no more accurate objective
method of obtaining its exact correction than by retinoscopy." This may
be a fact, and may possibly come to be an aphorism, but an axiom it cer-
tainly is not, at all events not in Philadelphia. Upon the technical merits
of the work we will not venture to pass. The fact that it has gone to the
third edition argues a not unfavorable reception. d. t. s.

The Principles of Bacteriology. A Practical Manual for Students and Physicians.
By A. C. Abbott, M. D., Professor of Hygiene and Director of the Laboratory
of Hygiene, University of Pennsylvania, Philadelphia. New (5th) edition, enlarged
and thoroughly revised. Handsome i2mo, 585 pages; 109 illustrations, of which
26 are colored. Cloth, $2.75, net Philadelphia and New York : Lea Brothers & Co.

In previous reviews of this work we pointed out as one of its distin-
guishing merits its clearness and impressiveness of description. The
author seems to write as if asking himself at the end of every sentence,
** Have I made myself understood?" In a field where there are so many
contestants for public favor this is not a small merit. Anybody can get
enough facts together now to make a large book on bacteriology, and
methods of staining and illustration are common property. What we all
want is the man who selects the most profitable information and offers it
in such language and style as make the study a pleasure and a pastime
rather than a labor.



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352 The American Practitioner and News.

A call for a fifth edition of this work is its sufficient commendation,
which is enhanced by the fact that this even is a j^eat improvement over
former ones. d. t. s.

The International Medical Annual and Practitioner's Index. A work of reference
for medical practitioners. Contributors : Prof. A. H. Carter, M. A., F. R. C P.;
Prof. H. A. Chapen, M. A., M. D.; C. W. Daniels, M. B., M. R. C. S.; E. Harry Fen-
wick, F. R. C. S.; W. Soltan Fenwick, M. D., M. R. C. P.; T. Colcott Fox, B. A.,
F. R. C. P.; H. Bellamy Gardner, M. R. C. S., L. R. C P.; A. E. Giles, B. Sc, M. D.,
F. R. C. S.; J. Dundas Grant, M. A., M. D.; F. de Haviland HaU, M. D., F. R. C. P.;
Prof. G. M. Hammond, A. M., M. D.; David Hardie, M. D.; Robert Jones, F. R. C. S.;
Prof. Charles Boyd Kelsey, M. D.; Richard Lake, F. R. C. S.; Priestly Leech, M. D.,
F. R. C. S.; Keith W. Monsarrat, F. R. C. S.; Prof. W. Oliver Moore. M. D.; Wm.
Murrell, M. D., F. R. C. P.; Stephen Paget, M:. A., F. R. C. S.; Prof. Seneca D.
Powell, M. D.; James Priestly, B. A, M. D., D. P. H.; Wm. -A. Purrington, A. B.,
LL. M.; Prof. A. W. Mayo Robson, F. R. C. S.; A. D. Rockwell, A. M., M. D.; Prof.
Robert Saundby, M. D., F. R. C. P.; Samuel G. Shattock, F. R. C. S.; Prof. W. Gil-
man Thompson, M. D.; Wm. Thorburn, B. Sc, F. R. C. S.; A. H. Tubby, M. S.,
M. B.; R. Norris Wolfenden, B. A, M. D.; Eugene S. Gouge, M. D., C. M. 1899.
Seventeenth year. 700 pp. Price, $3.00, net E. B. Treat & Co., New York.

A large amount of practical work is indicated for the year by the con-
tributions in this volume, in almost every department of medicine and sur-
gery. The list of authors here given, many of them known wherever
medicine is known as leaders in medical authorship, is of itself a guarantee
of the high excellence of the work, without invoking the flattering history
of the years through which it has continued. There is no waste to it ; it
is all meat and marrow, while the range is as wide as medicine and surgery.

Gerrish's forthcoming Anatomy by American Authors promises to be
the work for which teachers and students have long been looking. Its
editor, Prof. F. H. Gerrish, of Portland, has selected as his fellow-contribu-
tois leading anatomists throughout the country, wisely restricting their
number to accord with the best division of the subject, gaining thereby
unity in result, joined with the highest authority. The list includes Profes-
sors Bevan of Rush in Chicago, Keiller of the University of Texas,
McMurrich of the University of Michigan, Stewart of the University-Bel-
levue College in New York, Woolsey of Cornell Medical College likewise
in New York, and Gerrish himself, who is not only editor, but perhaps the
largest contributor.

The plan of the work judiciously avoids the unimportant and excep-
tional, reserving its space for those portions of anatomical knowledge which
are necessary to the intelligent study of physiology, surgery, and internal
medicine. The authors have endeavored to stand in the place of a living
teacher to the student, selecting such portions as will be of actual service
to the pupil in his study and to the practitioner in his subsequent clinical
work, clarifying obscurities, giving most help in the most difficult parts, and
illustrating every thing by all available methods. Pictorially Gerrish's



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The American Practitioner and News. 353

Anatomy will be by far the most lavish work ever offered on a subject
which can already boast of many elaborately illustrated text-books. The
engravings number about one thousand, their size is large enough to make
visible every detail, colors have been employed more liberally than ever
before, anid lastly the labels of the parts have been conspicuously engraved
upon them, whereby a glance gives not only their names but also their
position, extent, and relations, obviating entirely the slow, toilsome, and
wasteful mental processes necessitated where only reference letters are
employed. In an early issue we shall give our readers a review of the
book itself.



dbstracts an5 Selections.



Report of Seventy-eight Cases of Pulmonary Tuberculosis
Treated with Watery Extract of Tubercle Bacilli.— A report of
seventy-eight cases of pulmonary tuberculosis treated at the Winyah
Sanitarium, at Asheville, N. C, in 1898, with watery extract of tubercle
bacilli, by Dr. Karl von Ruck, appears in the February number of the
Therapeutic Gazette.

The author giving due credit to the advantages of the favorable climate
of the Asheville plateau as well as to the systematic employment of hygienic
and dietetic methods, in a special institution, shows nevertheless by his
results the unmistakable favorable influence of this preparation, which he
perfected in his laboratory in February, 1896.

He with many others, notably Professor Koch, have long realized that
the bodies of tubercle bacilli contain a soluble substance, a proteid upon
which the curative action of all tuberculin preparations and modifications
must depend, small and variable quantities of which were thought to enter
into the culture fluid from which the tuberculin preparations are made.

Experiments upon animals have shown that the injection of dead
tubercle bacilli produces both curative and immunizing effects, but they
have always produced abscesses at the point where they were injected and
often spurious tubercle in the animals experimented upon, conditions
which seemed to preclude their use in the treatment of human tuber-
culosis.

A solution of the tubercle bacilli without injury to the curative pro-
teids was therefore naturally sought for, and in April, 1897, Professor Koch
announced that he had accomplished this in the production of Tuberculin
R., which was then given to the profession.

Several weeks later Dr. von Ruck announced his success in also mak-
ing the desired solution, and communicated his experiments and methods
in a paper read before the American Climatological Association and



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354 3^4^ American Practitioner and News.

published in its transactions for 1897, and also in the Therapeutic Gazette
for June, 1897. His method of preparation diflfers from that published by
Professor Koch, and is briefly as follows :

The tubercle bacilli are filtered out of the rapidly growing and highly
virulent culture. After washing with distilled water for the removal of
the remains of the culture fluid, they are dried in a vacuum desiccator.
Next they are powdered in an agate mortar and then extracted with sul-
phuric ether. This extraction removes the fats. They are again dried
and powdered as before, and their further extraction takes place in steril-
ized distilled water over a water bath with a temperature of 120** F. .
The proteids becoming dissolved in the distilled water, the fluid is then
decanted and filtered through porcelain, when finally the amount of pro-
teids is determiiied and the preparation, standardized to a certain per cent.

Prof. Koch simply triturated his tubercle bacilli and then put them
into distilled water and separated the undissolved germs with a centrifugal
machine. His preparation, however, did not pass through a porcelain
filter, and it was subsequently shown that when an attempt of filtering
through porcelain was made, a residue collected in the filter consisting of
tubercle bacilli.

Virulent infection followed the injection of this residue in animals, and
for this reason Professor Koch was obliged to withdraw his Tuberculin R., it
being an emulsion of tubercle bacilli and fragments of such, rather than a
true solution.

Koch's claim that in a true solution of the tubercle bacilli the final per-
fection of a specific remedy was attained, would appear to, be verified by
the results which Dr. von Ruck reports.

He treated with his watery extract twenty cases in the early stages, all
of which recovered, with an average gain of eleven pounds in weight,
and subsidence of all symptoms.

Of thirty-seven cases in a more advanced stage, twenty-seven recov-
ered, seven were greatly improved, three improved, and none grew worse,
gaining on an average nearly thirteen pounds each.



Online LibraryUniversidad de Buenos Aires. Facultad de Derecho yThe American practitioner → online text (page 40 of 109)