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subject, it is really a scientific prose poem, which, even had it no scientific
value, would deserve to be treasured as a literary production. Throughout
the work is a very interesting one, dealing as it does with questions that
have engaged the best minds for centuries.



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The American Practitioner and News. 363

Denver Republican : These titles show a wide field of research. They
are all deductive as to reasoning and radical in tone, the author not follow-
ing blindly the generally accepted theories of science, as do so many.

Salt Lake Tribune : Enough certainly for one volume, and containing
a vast deal of interesting matter.

Wilmington Morning News : " The Philosophy of Memory." by D. T.
Smith, M. D., is a serious work on interesting problems that will appeal to
students in a particular line of thought. The writer reveals that he has
given the several subjects deep consideration, and what he has to say will
appeal to readers who are in search of information upon the several subjects
discussed.

lyouisville Courier-Journal : The essayist not only shows that by care-
ful reading he has mastered the literature of these questions, but develops
original research and thought to a striking degree.

Louisville Commercial : A book which belongs to high-grade and lasting
literature, and which carries the valuable qualities of research, thought,
and noteworthy theory. These essays use no waste words, and every
thought belongs just where it is, and can not be eliminated for the sake of
brevity or any other cause. The reader who is interested in the themes
will follow the lines from cover to cover.

Lactophenin as a Hypnotic.-^A Cristiani (// Manicamio Moderno,
1898, No. 2) recommends the use of lactophenin as a hypnotic. He gives
it in doses of from 15 to 45 gr. suspended in sweetened mucilage in the
evening one hour after food. He has employed it in over two hundred
cases of insanity accompanied by insomnia, and concludes that it has a hyp-
notic action which is certain, rapid, intense, prolonged, and harmless. The
sleep which it produces is deep, calm, and restorative, and lasts generally
from four to nine hours. Its use is not followed by any unpleasant phe-
nomena, such as headache and malaise. The drug has no cumulative
action. It may be safely used even when the patient's physical condition
is weak. Like other hypnotics, it has failed to act in certain cases, and in
some, in which at first it was successful, it has after a time entirely lost its
power. He considers that it is the hypnotic par excellence in the insomnia
of the insane accompanied by serious involvement of the physical health
in any form. — British Medical Journal,

Antipyrin Intoxication.— Immerwahr (-5^. ir/r«. ^F<?^^., August 22,
1898) relates a remarkable case in a woman, aged twenty-eight, who had
syphilis in 1894, for which she was thoroughly treated. Nearly three years
later syphilitic manifestations appeared, consisting of mucous patches in
the mouth and vulva, and also chronic induration of glands. These symp-
toms again disappeared under treatment. In April, 1898, she took 0.5 g.
of antipyrin on account of headache, and on the following day she had a
crop of vesicles in the mouth, which soon disappeared. A few days later



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364 The American Practitioner and News.

she took another dose of 0.5 g. of antipyrin. In the same evening she
shivered, and was feverish, and had an urticarial eruption over the body.
On the next d^ay there were numerous vesicles on the mucous membrane
of the cheek, soft and hard palate, upper and lower lips, and also on the
vaginal mucous membrane. The patient thought that this was a relapse
of the syphilis. In four days the vesicles began to dry up, but food was
taken with much difficulty. The urticaria-like rash had now disappeared.
Immerwahr thought that this eruption of vesicles must be due to antipyrin,
and therefore made use of nothing but simple treatment. In a few days the
eruption entirely disappeared. The importance of the diflFerential diag-
nosis in this case is obvious. The author remarks that it is necessary to
put these cases on record, considering the frequency with which antipyrin,
salipyrin, and migranin are xxs^.-^Ibid.

Dr. Bransford's Heroism Recognized. — Passed Assistant Surgeon
John W. Bransford, UnitecJ States Navy, was advanced three numbers by
the last Congress for heroism in the naval battle of Santiago. Surgeon
Bransford was attached to the converted yacht Gloucester, which destroyed
the Spanish torpedo boat destroyers, and having no wounded to demand
his care he took charge of one of the rapid-fire guns with marked eflFect, his
conduct eliciting the official praise of his commanding officer. Dr. Brans-
ford had served eighteen years as an assistant surgeon in the navy, but had
afterward resigned and was in civil practice when the war broke out. He
promptly offered his services and was given a volunteer commission. A
bill to appoint him an assistant surgeon in the navy and place him on the
retired list passed the Senate but failed to receive action by the House
during the more pressing matters which occupied the latter part of its
session. — Boston Medical and Surgical Journal,

Pregnancy and Heart Disease.— Jess (Miinch, med. Woch., October
II, 1898) has during the last few years collected from his own clinic, and
also from those of others, all the material bearing on this question.
He says the family doctor is often asked whether a girl should be allowed
to marry who is the subject of heart disease. The author^s advice in these
cases depends upon whether there is a compensation or not. A heart with
healthy muscle walls will bear pregnancy and parturition fairly well, pro-
vided the patient is still young. Another point to be considered before
giving a prognosis is the social position of the patient. The rest, both
before and after parturition, is more readily obtained amongst the upper
classes. The question erf premature delivery in these cases is very difficult
to decide. Schlazer brought on abortion in three out of twenty-five cases
of pregnancy and heart disease; all three patients died. An abortion
usually takes longer than a normal delivery, and this is probably the reason
of the fatal terihination. Advice is frequently asked during the last months
of pregnancy, when it is too late to bring on abortion. Special instruction



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The American Practitioner and News. 365

is given in Schlazer's clinic in the management of labor in cases of heart
disease. The main object in treatment is to deliver as soon as possible
with the forceps or turning. As the fetus is passing through the pelvis a
sand-bag, weighing from eight to ten pounds, is placed on the abdomen in
such a manner that it rests on the fundus uteri ; the constant pressure of
the sand-bag insures the complete contraction of the uterus ; no blood-clots
remain behind, which saves the patient from subsequent pains. Alcoholic
stimulants are given immediately after delivery. The patient is kept in
bed for three or four weeks at least. — British Medical Journal,

The Dbath Sbntenck and Criminal Abortion.— Mr. Justice Dar-
ling, on Monday last, in charging the grand jury at Chester Assizes, referred
at length to the case of William Upton, who is alleged to have killed a woman
named Mary Murray, at Macclesfield, by means of an illegal operation. The
learned judge referred to the notorious cases which have recently been tried,
and pointed out that where the death sentence had been pronounced every-
body in court knew that it would not be carried out. Such a state of the
law, he considered, put judges in an undignified and absurd position. It
was not well that the highest penalty which man had it in his power to
inflict should be gravely decreed against criminals with the full knowledge
that the whole proceeding was nothing but a sham from the beginning.
He advised the jury upon his own initiative, and until some concensus of
opinion had been arrived at in the matter, not to return a true bill for mur-
der if they thought that the wound, though inflicted for an unlawful pur-
pose, was not intended to kill, and only to find a true bill for murder when
it was intended to kill the woman, or, at any rate, when those who per-
formed the operation did not care if the woman died or not. The grand
jury adopted Mr. Justice Darling's suggestion when they came to deal with
the matter, and we are glad that they did so, for his lordship's advice runs
with our own expressed opinion, that the Treasury (the almost inevitable
prosecutor) should always indict for manslaughter only, unless, of course,
suspicion is present that a deliberate attempt has been made to take life
by a uterine wound. — Lancet,

School Education and Needless Injury to Children. — We
have received a copy of an address on the above subject, delivered by
Dr. Clement Dukes before the meeting of headmasters, held in London
on January 13th and 14th of the present year. It is a powerful indictment
of the abominable cast-iron system of present education. It is not the
great public schools such as Westminster, Winchester, and Eaton which
are so much at fault as board schools and so-called voluntary schools.
*' This," says Dr. Dukes, *' is what prevails. In the * infant schools,' where
the ages range from three to seven years, the morning hours of work occupy
from 9 to 12, with a break of a quarter of an hour, and the afternoon lesson
from 2 to 4. . . . Children of three years of age are kept at lessons indoors



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366 The American Practitioner and News.

five hours a day for five days a week.'* Attendance is not compulsory before
the age of five years, but yet ** school-room and teacher are provided . . .
and attendance is courted for the sake of the government grant." We have
no hesitation in saying that the system is extravagant, cruel, ineflScient,
and hurtful to the health of the coming generation. In addition, far too
many subjects are taught. Years ago Kingsley wrote as follows concern-
ing the turnip in the Examination Island : '^Can you tell me any thing at
all about any thing you like?" "About what?" says Tom. "About any
thing you like, for as fast as I learn things I forget them again, so my
mamma says that my intellect is not adapted for methodic science, and says
that I must go in for general information." We commend this passage to
the education department. — Laruet,

How Quinine May Favor Post-Partum Hbmorrhagk. — Dr. Bar-
ton C. Hirst, in his article in the American Text-book of Obstetrics, men-
tions that quinine given as an oxytocic increases the liability to post-partum
hemorrhage, but offers no explanation as to why it should have this effect.
It is well known that the presence of white blood-corpuscles is essential to
the formation of a blood-clot. Possibly this liability to post-partum hemor-
rhage after the administration of quinine is due to the fact that quinine
interferes with the activity of the white blood-corpuscles, and, if given in
sufiicient quantities, may do so to such an extent that the coagulation of
the blood in the uterine vessels after labor is imperfect. — H, D, Fwniss,
M. D.y in New York Medical Journal.

The Regulation op Marriage in North Dakota. — According to
the Philadelphia Medical Journal, the so-called *' Creel Bill " to regulate
marriage has passed the North Dakota Senate. If it becomes law, no mar-
riage license can be granted in that State unless applicants present a
certificate from a legally established Board of Examiners showing that
they are free from certain diseases, such as tuberculosis and hereditary
insanity.

Gigantism and Femininity.— At a recent meeting of the Paris Society
of Biology ( Gazette hebdomadaire de mkdecine et de chirurgie^ February i6th)
M. Hallopeau showed a male giant who had no beard, whose mammary
glands were considerably developed, and whose genitals were extremely
small. On the lower part of the abdomen there were enormoub varices,
and M. Hallopeau suggested that these might have so pressed upon the
vasa deferentia or the nerves of the testicles as to have caused their atrophy
and consequently the femininity. — New York Medical Journal,

Liability of Master for Attendance on Servant. — It is a well-
settled doctrine that the master is not by reason of his relation to the
servant liable for medical attendance upon such servant. If, however, a
physician is called by a master to attend a servant in his employ, such



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The American Practitioner and News. 367

engagement has been held to amount to a direct undertaking by the master
to pay ; but if he is called by the master's wife, even with an express agree-
ment-that her husband will pay, the husband is not bound unless it can be
shown that the agreement is made with his knowledge and consent, or that
he subsequently ratified the hiring. The reason for this rule may be
readily perceived ; the husband is never bound by the contracts of his wife
except for necessaries furnished to her or to her children ; therefore a con-
tract imposing a liability upon him for medical attendance upon a servant,
which he is not primarily liable to pay, is beyond the scope of her authority.
Arthur N, Taylor, LL^ B,, in the New York Medical Journal.

A Law Enforcing Professional Secrecy. — Governor Roosevelt has
signed an amendment to the Civil Code which prohibits absolutely a phy-
sician from divulging any information concerning one of his patients, either
before or after the death of the latter. Up to the present time the insurance
law has permitted the physician to testify concerning the physical condition
of a policy-holder.

Dr. Flexner Goes to University of Pennsylvania. — Dr. Simon
Flexner, formerly Professor of Pathological Anatomy in the Johns Hopkins
University, is now Professor of Pathology in the University of Pennsyl-
vania. He has just been appointed to this chair, which was left vacant by
the resignation of Dr. John Guiteras, who has gone to Cuba. Professor
Flexner will enter upon his new duties on the ist of next September.

Grave Syphilis in Physicians. — Von Brandis {Deutsche medicinische
Wochenschrifty 1898, No. 21 ; Monatshefte fur praktische Dennatologie, Feb.
i5i 1899) has met with a number of grave cases of syphilis among medical
men. The initial lesion was on the finger, and the diagnosis was always a
late one, and this fact probably serves to explain the gravity of the course
pursued by the disease.

A Use For Exhausted Drugs. — In the March number of the Amer-
ican Journal of Pharmacy the editor of that journal, remarking upon the
immunity of certain of the domestic animals against particular poisons,
suggests that medicinal roots, rhizomes, fruits, and seeds, being rich in nutri-
tive material, may economically be turned to account as food for animals
instead of being thrown away as of no value,[after their medicinal constit-
uents have been extracted.

Tuberculous Perforation of the Velum Palati.— At the Societe
medicate des hopitaux, M. Barbier {Pr ogres medical, January 28th) recently
described a case of tuberculous perforation of the velum palati with tuber-
culosis of the tonsil and consequent glandular affections. Syphilis, it was
asserted, had no part in the affiection, and antisyphilitic treatment only
aggravated the malady, which was ameliorated by applications of ten-per-
cent lactic-acid solution and by overfeeding. — New York Medical Journal,



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368 The American Practitioner and News.



Special ZTotices.



The usefulness of good Hypophosphites in Pulmonary and Strumous affections
is generally agreed upon by the Profession.

We commend to the notice of our readers the advertisement in this number of
** Robinson's Hypophosphites/' also " Robinson's Hypophosphites with Wild Cherry
Bark" (this is a new combination and will be found very valuable) which are elegant
and uniformly active preparations; the presence in them of Quinine, Strychnine,
Iron, etc., adding highly to their tonic value.

Sanmetto and Imitations. — I have used Sanmetto extensively for the last five^
or six years in both old and young, male and female, in all forms of irritation of the
urinary organs, from nocturnal enuresis in the young to cystitis in the aged, and have
been disappointed in but few cases in obtaining good results. Have tried imitations
(owing to their cheapness). The results were unsatisfactory. Have returned to the
use of Sanmetto as a sheet-anchor in both acute and chronic conditions of the uri-
nary tract. I obtain speedier and more satisfactory results when given four times a
day in dram doses in hot water. T. B. Gui^i^EFER, M. D.,

Green sburg, Ind. Coroner.

Malarial Fevers. — Prof. G. Scognamiglio [Die Heilkunde) presents reports of
his own experience, as well as that of Drs. Loti and Colotti, with quinalgen in the
treatment of the various forms of malaria, in which quinine was not tolerated, or was
otherwise objectionable. Up to the present time they have employed the remedy in
40 cases, comprising intermittent fever, 11 cases; tertain, 7; quartan, 7; masked
forms, 10; pernicious malarial fever, 3 ; and atypical, 2 cases. The results were remark-
ably favorable in the first class, from 7 to 22 grains being administered three times
daily. Equally satisfactory effects were obtained in tertain and quartan fevers, doses
of 15 to 22 grains being given eight or ten hours before the occurrence of the attack,
until 30 to 60 grains had been taken. In all these cases, as well as the masked forms,
the attacks were either aborted or much reduced in intensity, and a permanent cure
rapidly obtained. In pernicious types of fever it was usually found desirable to give
an initial dose of 30 grains, followed by smaller doses. In the majority of these cases
a cure was brought about after ten to twelve days' treatment

LABOR SAVING : The American Medical Publishers' Association is prepared to
furnish carefully revised lists, set by the Mergenthaler Linotype Machine, as follows:

List No. I contains the name and address of all reputable advertisers in the
United States who use medical and pharmaceutical publications, including many new
customers just entering the field. In book form, 50 cents.

List No. a contains the address of all publications devoted to Medicine, Surgery,
Pharmacy, Microscopy, and allied sciences, throughout the United States and Canada,
revised and corrected to date. Price, $1.25 per dozen gummed sheets.

List No. 2 is furnished in gummed sheets, for use on your mailer, and will be
found a great convenience in sending out reprints and exchanges. If you do not
use a mailing machine, these lists can readily be cut apart and applied as quickly as
postage stamps, insuring accuracy in delivery and saving your ofiice help valuable time.

These lists are furnished free of charge to members of the Association. Address
Chari^es Wood Fassett, Secretary, cor. Sixth and Charles streets, St. Joseph, Mo.



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THE



American Practitioner and News.



NEC TENUI PENNA.'



Vol, XXVII. lyOuisviLLE, Ky., May 15, 1899. No. 10

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the
fewest possible words, or his reader is sure to skip them ; and in the plainest possible words, or his
reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain
way ; and we want downright facts at present more than any thing else.— RusriN.



©riginal Clrticles.



MALIGNANT. DISEASE OP THE SIQMOID.'f'

BY JOHN A. OUCHTERLONY, A. M., M. D., LL. D.

Professor of the Science aud Practice of Medicine and Clinical Medicine in the University <if Louisville,

Very little has been written on malignant disease of the sigmoid
flexure of the colon, and the literature of the subject must be gathered
from what has been written on the general subject of intestinal cancer.

In this paper I have endeavored to embody the results of my own
observations of the disease, in connection with what seems to me to
have been settled by the investigations of others. The etiology of sig-
moidal cancer is as completely unknown as of cancer in general.

Even the predisposing causes which have been mentioned, viz:
previous inflammation and habitual constipation, are hardly more than
conjectures. Baillie expressed the belief that the main cause of the
disease, and of its frequency at the flexures, lies in the more marked
development of the glands in the lower part of the large intestine, and
in the greater susceptibility to injury by the passage of hard bodies at
the point where the colon becomes contracted ; that is, at the sigmoid
flexure. These hard bodies, he says, " by their irritation may excite
the disease of scirrhus in a part which was predisposed to it. What
we have now said, however, is merely conjecture."

Some interesting facts bearing on the frequency of cancer of the
alimentary tract have been related by Dechamp. The gates of entrance
and of exit — the stomach and the rectum — ^are particularly liable to

«Read before the I^onisville Medico-Chirurg^cal Society, March 24,1899. For discussion see p. 385.

28



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370 The American Practitioner and News.

cancerous localization, the stomach more frequently than all other
intestinal cancers together.

Cancer of the rectum is four times more frequent than cancer of
other parts of the intestine. Leaving out the rectum, one finds the
other parts aflfected in the following order of decreasing frequency, viz :
the sigmoid flexure, the descending colon, transverse colon, the ascend-
ing colon, and finally the cecum. The small intestine is most rarely
aflfected, especially the jejunum. In 280 cases of intestinal cancer col-
lected by Haussmann, only four were of the jejunum. Duodenal cancer
is much more frequent but generally consecutive to cancer of the
stomach.

In cancer of all parts, one out of every five will be of the intestine.
As Leube states that eighty per cent of intestinal cancers are found
below the sigmoid and five per cent in the small intestine, the remain-
ing fifteen per cent must be distributed among other parts of the large
intestine. It follows that cancer of the sigmoid flexure must be of com-
paratively rare occurrence. In my own cases it was always primary,
and this, I believe, accords with the experience of others.

It is said not to occur until the age of forty. Every case seen by
myself was over fifty years of age. Dechamp mentions that cases have
been cited as occurring in adolescents, and even in children. It is sup-
posed to be equally common in both sexes, but it happened that in my
cases the proportion was three females to one male. It is possible that
a larger experience might change this proportion.

Pathological Anatomy. My opportunities for studying the morbid
anatomy of sigmoidal cancer in the dead-house have been very limited,
and certainly would not justify any eflFort at generalization. It occurs
as scirrhus, encephaloid and colloid. Sarcoma of the sigmoid must be
exceedingly rare.

Beginning in the glandular structure of the mucosa, the morbid
process soon invades the other coats of the intestine. For some time
it seems like a hard ring surrounding the intestine, increasing in volume
on the periphery, while it al^o encroaches upon the lumen, which steadily,
though gradually, becomes narrower until all but impassible stricture
is formed. In some cases the neoplasm is lateral instead of annular,
when the intestinal wall opposite to it may bulge out quite considerably,
and in this way obstruction may be delayed.

In the annular form the bowel above the seat of constriction becomes
distended and even thickened, while below the neoplasm the intestine



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The American Practitioner and News. 371

is found empty, flaccid, and atrophied. In one of my cases an abscess
formed at the seat of the stricture which finally ruptured into the
rectum.

The growth rarely, if ever, attains very large dimensions. It cer-
tainly never did so in any of my cases. Save in exceptional cases, it
remains quite movable. The tendency to form firm and extensive
adhesions to contiguous parts, which is so conspicuous in cancer of the
kidney, for instance, is but feeble and slight in cancer of the sigmoid.
Although malignant disease of this part runs a rather protracted course,
it but seldom shows much disposition to invade other organs and



Online LibraryUniversidad de Buenos Aires. Facultad de Derecho yThe American practitioner → online text (page 42 of 109)