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at the head of the Innsbruck Surgical Clinic of Professor Hecker from
October, 1898, in which clinic, as is well known, a systematic practice of
the anesthesia by means of ethyl chloride was first undertaken, I had ample
opportunities of observing the application of this anesthetic, as I had as
material for my observations upward of four hundred operations which
were effected there. I was quite amazed to see the rapid eflfect of the anes-
thetic, and the equally rapid recovery of conciousness as soon as the mask
was withdrawn from the face. These advantages gave me the idea of the
possibility of applying this anesthesia to operations on the field of battle.

The publication of this memoir appears to me to be justified by the fact
that the question of anesthesia is always one of the greatest interest to each
surgeon, and it appears to me greatly to be desired that experiments should
be made with this anesthesia by properly qualified army doctors.

Ethyl chloride (chlor-ethyl), monochlorethan, ethylum chloratum C3H5
CI, the kelene of the French house Gaillard, Monnet & Cartier, is an extreme-
ly fluid liquid of a strong, ether like special odor; it boils at the low degree
of 12.5 C, and any particular part of the body can be cooled with it to 35° C.

In regard to the technics and execution of the anesthesia with ethyl
chloride : As the above-cited clinic has employed the term kelene anesthe-
sia, I will use the same term myself. Directions are given in the corre-
sponding papers of this clinic (2) and of certain dentists (3). I will confine
myself here to giving. the results of my own observations: In one half to
two minutes (according to the age of the patient, or whether they have



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The American Practitioner and News. 309

been accustomed to large doses of alcohol) the anesthesia is complete. I
have even heard persons under the influence of the anesthetic answer ques-
tions without having the slightest recollection, on recovering consciousness,
of the conversation they have taken part in. I have observed a period of
excitement only in alcoholic patients, and even then not generally in a high
degree. Only in one case was an anesthesia impossible on account of the
excitement. Never did feebleness of the heart, falling back of the tongue,
diflBcult respiration, with its consequent asphyxia, present themselves.

If a disagreeable awakening of the patient occurred during an operation,
it was always due to the fault of the doctors entrusted with the execution
of the anesthesia. With the withdrawal of the mask consciousness returned
immediately, and I have seen out-patients go home alone unaided after the
completion of the operation. The patients complained of headaches occa-
sionally. I have never known, except in children, a complete diminution
of the muscular reflexes. There is no complete relaxation of the muscles,
and for such operations as require this the anesthesia with kelene is unde-
sirable. Nevertheless, the diminution of the muscular tension is sufl&cient
to arrange even severe luxations, or, in fractures of the patella, to enable
the widely separated parts to be brought together.

In Professor Hecker's clinic the kelene anesthesia is employed for oper-
ations of a short duration, and whenever it does not seem advisable to use
chloroform or ether, as in high degree of interruption of the circulation,
fatty degeneration of the heart, disease of the respiratory organs, cachectic
persons enfeebled by a great loss of blood and suffering from nervous shock.
In these cases it is necessary to work very rapidly, and the Schleich infil-
tration can not therefore be employed. Recently the kelene anesthesia
was employed for operations of a longer duration — as much as fifty minutes
— without any bad effects whatever resulting.

In none of the two hundred cases which came under my own observa-
tion does there appear to have been any bad appearance, accidents, or
results. Vomiting was also very rare. In the same way certain patients
which had been narcotized several times showed no such repugnance to
the kelene anesthesia as is the case with chloroform or ether patients. If
I recapitulate briefly the advantages of the kelene anesthesia, rapid action
of the anesthetic, absence or short duration of the period of excitement,
immediate return to consciousness, and the possibility of employing it for
persons enfeebled by excessive loss of blood or by shock, and put against
these disadvantages absence of complete relaxation of the muscles and
unsuitability for operations of long duration owing to the easy awakening
of the patient from the insensibility, there is a certain balance which speaks
in favor of the kelene and seems to justify its application on the field of
action.

The regulations for the sanitary service of the K. and K. array, Part IV,
says in Article 133: ** In general, the chief task of the ambulance staff" on
the field is to prevent dangerous conditions from developing, and to get the



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wounded ready for transportation as quickly as possible.'* We shall thus
be enabled in the ambulance department, as well as in other places, to
undertake trepanning for fractured skull, tying up bleeding and ruptured
vessels, amputations of crushed limbs, and tracheotomy. Soldiers who are
wounded in this manner can not be kept waiting until they arrive at the
hospital, even if they could be transported in such a condition.

Habart has called attention to the immense importance of rapidly trans-
porting the wounded. He says: *'It is my opinion that the fate of the
wounded to-day is decided not by the first dressing, but by the first trans-
portation.'* The wounded should, therefore, be operated on immediately,
partly on account of the great danger to life in delay, and partly to get them
ready for transportation ; and this should be done, if possible, under anes-
thetic. Now, anesthesia by chloroform requires fifteen minutes for its
accomplishment, and ether even more. The loss of time involved in the
use of these anesthetics is fatal, owing to tjie great affluence of the wounded
who are waiting for treatment, and to the comparatively small number of
doctors at their disposal. We must also remember wounded who are suf-
fering from the efiects of a great loss of blood, or the great fatigue and pri-
vations inseparable from the campaign, and who would probably succumb
under the additional shock of the chloroform. Besides all this, those who
have been under the influence of chloroform or ether are not fit for trans-
port from the field for some hours, as repose and serveillance by the doctor
are absolutely indispensable for them, the reflex only returning later on.

I believe that I have demonstrated that by using the ethyl chloride
anesthetic all these inconveniences are avoided, and that we can save time
and avoid the danger of accidents and bad after-effects, while the wounded
have the great advantage of being ready for transport immediately after the
operation is finished. — New England Medical Monthly,

Unusual Complications of Typhoid Fever.— Dr. E. B. Montgom-
ery, Quincy, 111., presented a paper of considerable interest on "Typhoid
Fever in Very Young Children, with a Report of Three Cases with Unusual
Complications," which was read before the Mississippi Valley Medical
Association, October 4-6, 1899.

After an extensive review of the literature pertaining to typhoid fever
as occurring in infancy and childhood, including a mention of Dr. Stowell's
tabulation of eighty-five cases under three years of age, the author detailed
three cases — two of which happened in his own practice.

In the first, an infant of nine months, the meningeal symptoms were so
marked as, for the time, to make a diagnosis of tubercular meningitis
highly probable. These symptoms began to subside about the twenty-third
day of the fever, and convalescence was fairly established by the thirty- fifth
day.

The second patient, a little girl of three and a half years, suffered from
the development of double suppurative parotitis about the twenty-fifth day



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The American Practitioner and News. 311

of the fever, and aphasia from an earlier period. The fever persisted for
some time after the evacuation and drainage of both abscesses, but conva-
lescence was finally fairly established about the forty-fourth day from the
onset of the illness.

The literature pertaining to meningitis and parotitis as complications
of typhoid fever was reviewed, and many statistics, showing their com-
parative infrequency, were given.

The third case, an unreported case of Pr. C. W. Rook, of Quincy, 111.,
occurred in a boy of three years, and was unusual in the development of
swelling of submaxillary glands of one side on the seventeenth day of the
fever. Later this suppurated and the pus was evacuated ; and one week
following a parotid abscess formed, resulting in the death of the patient on
the thirty-third day of the illness. The author, in an extensive search of
the literature pertaining to typhoid fever, its complications and sequels,
was unable to find but three other cases detailed in which the submaxil-
laries became involved in the course of the disease. — Virginia Medical
Semi-Monthly,

Limits of Ventrofixation of Uterus.— During the session of the
American Association of Obstetricians and Gynecologists, held at Indian-
apolis, Ind., September 19-21, 1899, Dr. X. C. Werder, of Pittsburgh, Pa.,
read a paper entitled " Two Cases of Dystocia Due to Ventro-Fixation :
One Requiring Cesarean Section." In this paper he reported five cases of
firm ventro-fixation followed by delivery at term. In two cases dystocia
followed this operation done for complete prolapse of the uterus with
inversion of the vagina. One case terminated spontaneously; the other
required Cesarean section. The former case had been operated upon by
himself, the latter by another surgeon. In both cases a series of operations
was done at one sitting, including curettement, amputation of cervix,
anterior colporrhaphy, ventro-fixation, and perineorrhaphy. In his own case
very firm fixation of the fundus and posterior wall of the uterus to the
abdominal wall was made in order to be sure of relieving prolapse. In the
other case infection is said to have been the cause of broad attachment and
firm fixation.

He excludes from discussion other procedures intended to hold the
uterus in anterior position, and defines the limits of ventro-fixation as fol-
lows : It is the operation of preference in cases of complete prolapse of the
pelvic organs, and in cases in which a very large heavy uterus, due to
chronic metritis, is habitually retroverted or retroflexed and causes pro-
nounced symptoms. In these cases he thinks less rigid fixation is inefifect-
ive. The fixation should be between the anterior uterine wall — not the
fundus or posterior wall — and lower angle of wound. He attributes the
serious after-results to errors in technique rather than to the procedure
\\st\L—Ibid,



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The American Practitioner and News

"NEC TENUJ PENS A,*'

Vol. 28. OCTOBER 15, 1899. No. 8.

H. A. COTTBLL, M. D., M. P. COOMBS, A. M., M. D., Editors.

A Journal of Medicine and Surgery, pubiislied on the first and fifteentli of eadi
month. Price, $a per year, postage paid.

ThiB Journal is devoted solely to the advancement of medical science and the promotion of the
interests of the whole profession. Essays, reports of cases, and correspondence upon subjects of pro-
fessional interest are solicited. The Editors are not responsible for the views of contributors.

Books for reviews, and all communications relating to the columns of the journal, should be
addressed to the Editors of The American Practitioner and News, Louisville, Ky.

Subscriptions and advertisements received, specimen copies and bound volumes for sale by the
undersigned, to whom remittances may be sent by postal money order, bank check, or registered
letter. Address jqhN P. MORTON & COMPANY, LouUvllle, Ky.

MAN'S RIGHT TO DIE.



Mr. Simeon Baldwin, of the American Bar Association, delivered an
address at its annual meeting in which he claimed that a man had a
right to do as he pleased with his life. The object of the address was
to show that when a person is fatally ill it is humane to hasten death ;
that is, after it is certain that recovery can not take place.

This seems to be a charitable and logical view of the subject, as it
apparently ends a fellow-being's suflferings; but do we know that it
does? We certainly do not, and for that reason, if no other, nature
should be permitted to run her course. A man has no other right to
his body than to use it for the purposes for which it was made, and to
preserve it and sustain it.

From the very beginning of life, which is at the impregnation of the
ovum, until all vitality has left that ovum or its resultant growth —
which may or may not be a mature body — its destruction would be a
violation of the fifth commandment ; it would be murder. The God
that created man's body and placed an immortal soul in it also made
positive conditions as to what the body should do, viz : Love, serve,
honor, and obey its Master and Maker. No man has a right to shorten
or terminate the life of any human being under any circumstances,
hence the argument of Mr. Baldwin is fallacious, and would be unworthy



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The American Practitioner and News. 313

of any consideration were it not for the fact that in our*rapid advances
in civilization some of us at least might retrograde by falling into bar-
baric practices by willfully terminating the lives of those that are
entrusted to our care. The practice of destroying the diseased and
decrepit is an old one among the uncivilized races, and is still prac-
ticed by certain tribes. They have various ways of disposing of those
that are supposed to be useless or not able to recover from an illness.
One way is to neglect them by not giving them any attention, food, or
drink ; another is to bury them alive.

Whether they really wish to see the sufferings o£ their friends ended
and consider their death as humanitarian or not is not certain, nor does
it matter ; the lives of their friends are thus terminated.

The willful administration of a lethal dose of morphia would do the
same thing, and that is virtually what Mr. Baldwin recommended.
There is no difference whatever between the practice of savages referred
to above and that advised, by Mr. Baldwin. It is murder in either case.
Mr. Baldwin stepped over the boundary line and demonstrated very
clearly that his doctrine is unchristian and in every way in defiance
of all of the laws of God.



Hotes an5 Ciueries*



Dr. William H. Howell, professor of physiology at the Johns Hop-
kins University, has been made dean of the medical school. He is not
superintendent of the Johns Hopkins Hospital, as has been reported, but
Dr. Henry M. Hurd continues to hold that position. — Maryland Medical
JournaL

Two Centenarians. — Martha Harlow died in Brooklyn on October
ist at the reputed age of one hundred and four years. She was born in
Plainfield, Conn. Mrs. Ellen Graham Massvel, a cousin of John Lorimer
Graham, who was postmaster of New York City during President Tyler's
administration, died at Lakewood, N. J., on October 3d, aged one hundred
and one years. — Boston Medical and Surgical JournaL

Rev. H. a. Slaughter, two months ago a Baptist preacher in St.
Joseph, Mo., is now president of the National School (Medical) of " Neropa-
thy.** His credentials represent a six weeks' course under the ** celebrated
magnetic healer," Weltmer, of Missouri. The course in neropathy covers
from two to four weeks. Instruction is given during the day, in the even-
ing, or by mail, for $100. A diploma is given, and, according to the laws of

24



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314 The American Practitioner and News.

Missouri, is good and valid. The name of the school is new, the branches
taught are unknown, but the term ** neropathy *' seems not inappropriate
for irregulars.— y<7«r«a/ American Medical Association,

A New Association.— The annual meeting of the National Hay Fever
Association has recently taken place at Bethlehem, N. H. The main
business of the meeting was the narration of the various experiences of the
members, who represented every part of the country. Misery clearly
loves company. — Boston Medical and Surgical Journal,

The University of Chicago has a new and unique branch in the Chicago
Phj'^siological School for the training of nervous and backward children. It
is said to be the first of its kind in the world, and is intended as a home for
boys and girls who are unable to cope with normal children owing to illness
or \VL^xxxs\X.y ,— Maryland Medical JourfiaL

A New Danger. — An affection is said to have appeared in Paris due to
the presence in bakers* bread of salts of lead deposited on the walls of ovens
by the use of old wood as fuel. The Council of Hygiene explains that such
wood is usually impregnated with sulphate of copper or creosote, and is
likely to give oflF poisonous volatile salts. — Boston Medical and Surgical
Journal,

Evangelist D. L. Moody on Physicians. — Mr. Moody has the name
of getting ofi" a lot of good sense in his sermons. He believes in a practical
religion ; in a religion of truth and self-sacrifice; in a religion of noble
aspirations and noble deeds ; in a religion that elevates the individual, the
community, and the nation in every way that is good. During the past
week one of his alleged co-workers acknowledged having endorsed the
notorious Dowie, and not only this, but did not deny that he had allowed
one of his children to die of diphtheria without calling in a physician. In one
of his sermons Mr. Moody took occasion to let this alleged co-worker know
that the saving of souls and the healing of the body were two entirely dif-
ferent propositions, and among other things he said : ** I do not believe
that doctors are devils. The noblest profession outside of the ministry is
that of medicine. Never yet in all my years of work have I called upon an
able doctor, telling him of the sickness and need of some poor friendless
person, that he did not at once go to the rescue, without money and with-
out price. Some of the noblest men I ever knew have gone out as medical
missionaries, devoting their lives to doing good with the skill and healing
medicines the Lord has conferred upon them. And these men are called
devils ! God have mercy upon the man who says so — God forgive the man
who holds such beliefs ! God heals, and God heals through doctors and
through medicines. Do not be carried away by the ravings of fanaticism.
We have a new * ism ' in America about every year — beware of the * isms!*
What would I do if I fell sick? Get the best doctor in Chicago, trust



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The American Practitioner and News. 315

to him, and trust to the Irord to work through him ! The doctors have
done wonders as their knowledge has grown — they have reduced the dan-
gers of death from diseases that once slew all they touched — and the doc-
tors, if God helps them, will yet find a way to stop the ravages of other
terrors ! " — Journal American Medical Association.

Two Cases op Tetanus.— The death of a patient at the Boston City
Hospital is reported. The disease was caused through a penetrating
wound of a foot by a rusty nail. A second patient recovered. Both re-
ceived antitoxin treatment. — Boston Medical and Surgical Journal,

Effect of Emotion on the Liver.— Jonathan Hutchinson says that
it has often struck him that we may perhaps infer from what is so easily
observed in the case of the salivary glands as to what may not improbably
be possible in that of such glands as the pancreas and even the liver itself.
We know how easily certain kinds of emotion may cause the mouth to
become.dry and the salivary glands to cease their secretion for a time. We
know also that in some persons the arrest of secretion may be permanent,
and that probably in many more a partial arrest may become more or less
habitual to the individual. If similar occurrences are possible iti the liver,
we have an easy explanation of the phenomena of bilious disturbances
with or without jaundice. — Medical Record.

Death of a Centenarian.— It is reported that Mrs. Sallie B. Jennings,
of New Fairfield, Conn., died last week, aged one hundred and two years.
She was in excellent health up to a short time before her death. — Boston
Medical and Surgical Journal.

Sudden Changing of Color op Hair.— M. Schmidt, of Frankfort,
reports in Virchow's Archiv., Vol. 156, No. i, 1899, a case of sudden turning
of the hair to gray. The patient was a laborer thirty-six years of age, who
at the time was suflFering from some affection of the neck. His hair showed
two white patches, one in the middle line of the head, the other over the
right ear. Eight years previously the patient had had a severe mental
shock while on a railroad journey, and it was noted by his friends and rela-
tives that these patches appeared almost immediately after. The possibility
of its having been a congenital or gradually acquired defect, covered by
hair dye, as has frequently been shown, seemed remote. — Medical Record.

A Historical Correction in Connection With the Name,
** Koplik's Early Symptoms of Measles." — In the Medical Record of
the year 1898, No. 1431, the well-known American pediatrist, Roplik,
described an early symptom of measles, under the title of "A New Diag-
nostic Sign of Measles." In consists in the appearance of minute bluish-
white specks on a bright red ground. These spots are found on the
mucous membrane of the cheeks and lips twenty-four to forty-eight hours
before the breaking out of the exanthema, and can be seen only with a



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3 16 The American Practitioner and News.

strong light. This symptom was soon verified and confirmed on all sides,
and earned for the author's discovery the name of " Koplik's early symp-
tom." Every one indeed wondered how such a remarkable appearance
could have remained so long undiscovered. I among others was so sur-
prised at its being overlooked that I was led to look through the literature
of the subject, with, in short, the result that in the widely known " Com-
pendium of Pathology and Therapy," written by H. Nothnagel, I found,
under the heading of the "Acute Exanthemata," by Jiirgensen, a descrip-
tion of the early course of the enanthema and exanthema in measles by
the Danish physician, M. Flindt. I extract the following from Jiirgensen's
work:

" The best description is given by Dr. M. Flindt, and deserves to be
exhumed out of the records of the Danish * Sundhedscollegium.'

** Second day of fever : A spotted exanthema may be seen on the
anterior surface of the soft palate, and on the mucous membrane of cheeks
and lips. This shows quite a remarkable appearance due to the numerous
minute, bluish-white, shining, and apparently vesicular points which lie in
the center of small red spots, and are arranged in irregular groups. One
can feel as well as see the small vesicles projecting out above their sur-
roundings. A similar miliary formation is to be seen on the palpebral
conjunctiva.

** Third day of fever: Similarly grouped spots with vesicles are visible
on the buccal mucous membrane, especially on that part of it lying oppo-
site to the space between the upper and lower back teeth. At this stage
the skin eruption first makes its appearance."

The above is a translation of the original. I wish merely to add that
the first writer was more exact in his observations, in that he palpated the
vesicles and described the conjunctival appearances which Koplik,so far as
I am aware, has not mentioned. I may also mention that the time of the
appearance of this symptom, namely, before the rash, was defined by
Flindt in the year 1880. — Dr, Siegfried Weiss, Vienna, in Medical Record,

Tai^lest Children Born in Summer. — According to Combe, boys
born in the months of September, October, November, December, January,
and February are not so tall as those bom in other months. Those bom
in November are the shortest. Those born in July are the tallest. Girls,
according to the same authority, born in December, January, Febmary,
March, April, and May show a less length of body than those bom in the
remaining months. Those born from June to November are taller, but the



Online LibraryUniversidad de Buenos Aires. Facultad de Derecho yThe American practitioner → online text (page 90 of 109)