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 Another Random Document on
Scribd Without Any Related Topics
 From this case I learned that the removal of foreign substances by
forceps or other instruments, except they are metallic substances is
seldom necessary, there would be much more difficulty in retaining
them or preventing their escape. As soon as the windpipe is cut into
there is a rush of wind that follows, that moves the substance by the
double ability or means of respiration, caused or provided by the
operation, and the next we know the substance is expelled. Certain it
is, it is not going to stay there, if there is room for its escape and the
patient is rightly attended to. When certain that all has come away,
apply adhesive plaster drawing the parts together, a stitch or two
might be necessary in some cases, it soon gets well.
My next case was the woman alluded to, the wife of Mr. Amos
Wooten, of New Hanover county. A piece of beef gristle got into the
wrong passage. After several spasms, and vain attempts to get it out
she sent for me. I got to her as soon as possible—the distance being
sixteen or seventeen miles. On enquiry I learned the particulars of
her case. I found her composed. I told her it might not be in the
windpipe, and we had better be certain about it. I passed a probang
down the œsophagus and found that it was not there. After waiting a
little longer, she had a violent spasm that hurried and increased her
determination to have it out. So violent was the spasm, that it created
doubts on her mind as to her chances of living, or of being able to
bear up under the operation. She next turned her head toward me
and remarked that she was ready. I had no medical assistant with
me. I operated without chloroform—the woman fainted. There was
camphorated spirits close by, and I sprinkled it heavily and forcibly
in her face and over her chest, and rubbed some in her mouth. She
revives with a vim and sends the gristle forcibly, not only out of her
mouth, but nearly out of doors, rejoicing all hands around.
I applied sticking plaster and left; saw her in a few days; she was
well.
My next operation was on the child of Mr. Enoch Foy, who had the
misfortune to get a watermelon seed in his windpipe. The usual
symptoms occurring, he came on with his little boy and had him
relieved—the seed coming out several hours after the operation.
The next was a child of Mr. Marshall, (another fine boy), another
case of watermelon seed, which was operated on with like success.
 My last case was a child 8 or 9 months old, a very pretty and fine
little girl, the daughter of a Mr. Padjet of this county. She had been
playing with an ear of corn, given to amuse her; some of the grains
coming off and one and a half getting into the windpipe, as shown by
the sequel. She was operated on, assisted by Drs. Cox and Nicholson.
The foreign substance did not come out as soon after the operation
as the other cases. The wound was not kept open by the attendants,
and in consequence I had to re-visit, reöpen and somewhat enlarge
the incision which was attended with the usual good results. The
child was very fat, and the space for operating in so young a child,
was necessarily very limited. One grain of corn and the part of
another was expelled. I will next give my “modus operandi,” or
rather my imperfect manner of operating.
The patient being laid on a suitable table, with the chest elevated,
by placing a pillow or folds of cloth underneath. The head is next laid
back neatly observing the direction of the mesial line strictly, and
throughout the operation. The instruments previously got ready, and
those which I prefer, are a scalpel with a sharp handle, a director and
probe, two bistouries, one sharp and the other button pointed, a
forceps, tenacula, sponge and ligatures. But so far I have never
needed the ligatures. I have always stopped any little bleeding that
occurred by applying a pencil of nitrate of silver. All these ready, also
a basin of cold water, standing on the right of my patient, I place the
finger and thumb of my left hand, one on each side of the thyroid
cartilage, and commence my first incision from its lower third if a
child, and from its lower edge if an adult, for obvious reasons,
namely: In the child we want room, and if necessary can enlarge the
incision in that direction, with but little difficulty, the cartilage
affording no resistance. In the adult we have more room, and the
cartilage is often found hard, and unyielding in persons of advanced
life, and it is therefore necessary when enlargement is required in the
adult, to cut an additional ring or more of the trachea. I continue my
incision below the cricoid cartilage, so far as one or more of the rings
of the trachea. The track of the operation being now laid off, I
proceed cautiously, an assistant sponging, and applying caustic, as
may be necessary to arrest any little bleeding that may ensue, whilst
I, with the handle of my knife, push aside any vessel likely to bleed—
cricoid artery or otherwise. I next lay hold on the cellular sheath of
the trachea, at the lower edge of the track of my operation, and at
this point I enter with a sharp pointed bistoury, holding it close to
the point, and cutting upward not more than one-eighth of an inch
and withdraw it in favor of the button pointed bistoury, with which I
slit upward the windpipe, as far as the starting point of the first
incision—not moving the instrument back and forth, but holding it
perfectly steady, carrying it or rather pushing it, aided by the other
hand from below upward, with the handle of the knife inclined
downward. The operation now done, is made known by a whizzing
which it is necessary to look after, and as all-important. I consider it
the safety valve of the patient.
This operation may also be performed from above, downwards,
with a sharp pointed bistoury, holding it not far from the point; the
forefinger on the back of the knife—taking care to help the cricoid
artery out of the way, which I have always been able to control when
cut, by the application of nitrate of silver. The patient may be, if
necessary, turned on the side to prevent blood from passing into the
windpipe.
I begin close by the lower edge of the thyroid cartilage, and carry it
so far as the second ring of the trachea; but in either case, whether I
open upward or downward, the tenaculum can materially assist in
the operation, by drawing down the tube when cutting upward, or by
drawing upward when cutting downward—the hook to enter behind
the knife in either case.
The use of the hook is most necessary when operating on young
children. The object in pushing the knife, holding it steadily, is from
knowing that it long since has been found, that an artery will give
way before a knife when carried in this way that might otherwise
have been cut immediately by a “see-saw” motion.
After the operation is performed, I direct the attendants to keep
the opening clear of obstruction—bloody froth, &c., or anything that
may make its appearance in the wound. Artificial respiration must be
kept up until the foreign substance is expelled or removed. A probe
or knitting needle will suffice for that purpose, one or the other must
be used several times a day and night, in fact as often as needed; I
use no gauze, it might get sucked to, or drawn into the opening, and
thereby defeat the intent of the operation. In cases needing the use of
the canula I make no reference.
 I prefer laryngo-tracheotomy, sometimes denominated circo-
tracheotomy, which I have been endeavoring to describe, to any
other, for all ordinary purposes. We have less risk, and more room,
and it is more adapted to the relief of children and might with
propriety be called the higher operation to distinguish it from
tracheotomy, which rightly speaking is the lower operation. This
would draw a distinction between the two, and it is necessary that
line should be observed, and that when these operations are spoken
of, we should know what importance to attach in either case, and
give to either operation the degree of approbation it may deserve.
I cannot close this subject without giving the opinion of a very able
anatomist regarding it, Harrison, of Dublin. In the first place he
speaks of an irregular artery, which he has seen running along the
front of the trachea to the thyroid gland and cellular membranes
beneath it. He had seen this so frequently in this situation, that he
describes it under the name of the middle thyroid artery. “This is” he
says “so common an occurrence that it should be remembered by the
practitioner of tracheotomy.” He further goes on to say, “in children
the space for tracheotomy is very limited,” and directly that
“particular attention be paid to the inconsiderable portion of the
trachea that can be exposed between the thyroid gland above, the
arteria innominata, the left carotid artery, the remainder of the
thymus gland below. The deep thyroid veins also descending to the
vena innominata obscure the trachea very much, these together with
the great mobility of this tube, add to the danger and difficulty of this
operation.” Pancoast says: “The checking of hemorrhage from the
veins and arteries divided in tracheotomy requires particular
attention; from six to eight ligatures are usually employed. They
should be applied in general as the vessels are cut and before the
opening of the trachea as there must be blood drawn by respiration
into the trachea and thereby endanger life.”
These dangers constitute shoals and quicksands to the anatomist
and surgeon, that has made many a one shudder at their approach.
The six or eight vessels to tie, before daring to open the trachea,
causes delay dangerous to life, as well as to the success of the
operation, and brings into question the propriety of the operation,
and sometimes the skill of the physician. In the upper operation,
laryngo-tracheotomy, you can enlarge the opening upward whenever
necessary, with but little risk, by cutting through the thyroid
cartilage. In fact, it may be opened above or below, one or both, with
but little risk; whereas in the lower operation it is almost impossible
to do so. When it becomes necessary, the safest plan is to enlarge the
opening upward, as much as is practicable, and downward as little as
we are able to get along with. The space taken up by the lower
operation on children is very limited, and the operator must
necessarily be cramped for want of room. The cervical portion of the
adult trachea is laid down at from two to two and one half inches
long. It is composed 18 or 20 fibro cartilages, this makes the space
between each ring 1–8th of an inch. According to that measurement,
allowing the 20 rings for 2½ inches makes the space taken up by
cutting three rings 3–8ths of an inch long in the adult, if no more is
divided, and proportionately less in the child. We can readily
understand that those operating in this region do as little cutting as
possible, and although the operation so far as the outside incision,
may begin at the cricoid cartilage, and terminate as at a little
distance from the fossa at the top of the sternum. I have no idea that
the trachea is often laid open to that extent. Pancoast directs, “that
after separating the two sterno-thyroid muscles, partly with the point
and partly with the handle of the knife, and finding no large vessels
in the way, pushes up, or if necessary divides the isthmus of the
thyroid gland.” The next cutting he speaks of, is, “that of the third,
fourth and fifth rings, puncturing the tube, with the point of the knife
below the fifth ring.” He then speaks of running the scalpel upwards
with the handle inclined to the sternum, so as to avoid injuring the
posterior wall of the trachea. It is easy to perceive in the practice of
the present day, that this operation is done for, and best suited to the
insertion of the canula, and that the opening of the third, fourth and
fifth rings of the trachea can, when divided, answer by binding the
canula, a much better purpose than a larger opening, which would
allow it to move about, thereby incurring the danger of displacement.
The word tracheotomy as a general term does harm. We ought
rather to particularize, and make known on what part of that tube we
operate, and not speak of tracheotomy as though it were of little
moment in the performance, and that one part of the windpipe cut
into, was as much a tracheotomy as another; not by any means
should this be thought. I consider that tracheotomy strictly, and
according to the definitions of anatomy and surgery, is one of the
most dangerous that come within the province of the surgeon; and,
on the contrary, I consider laryngo-tracheotomy, or crico-
tracheotomy as it is sometimes denominated, a very simple
operation, and only requiring ordinary tact in the performance.

Since the above article was written, this operation has been
successfully performed by Dr. J. L. Nicholson, assisted by myself and
Dr. C. Thompson.
MR. GRANT GIVES THE FOLLOWING RULES
ABOUT FOREIGN BODIES IN THE
EXTERNAL EAR.
1. Be sure that the foreign body is seen. To attempt to extract a
foreign body without first seeing it is highly dangerous.
2. Determine what the body is, and, if possible, obtain a sample of
the body supposed to be in the ear.
3. Remember that a body which will not swell, and has no cutting
edge, will generally remain without causing any urgent symptoms.
4. Seeing the body, determine with a probe if it be movable. If
easily movable, concussion with a downward position of ear will
often remove it.
5. Warm water injection is the best of all methods of removing
foreign bodies.
6. If it be a vegetable substance, do not inject fluid unless you have
time to extract the body either at one operation, or shortly
afterwards.
7. Injection failing, which is very exceptional, a surgeon, with the
necessary appliances, ought to be at once consulted, or should urgent
symptoms arise from the irritation in the attempted extraction, the
extraction by the incisions, galvano-cautery, boring out by trephine
or conical file the centre of substance, and so causing its collapse; or
even detachment of the auricle may be necessary.—The Medical
Press and Circular.
SELECTED PAPERS.
 THE YELLOW FEVER AT HAVANA—ITS
NATURE AND TREATMENT.
By Charles Belot.

(Concluded from page 165).

It is at the moment even, of this remission, that sulphate of
quinine must be administered in a dose of thirty-six grains taken at
once in a half cup of black coffee without sugar. When the
intermission is complete, its action is marvellous, the disease is
immediately moderated; but if there is no remission, it is necessary
to be prudent, for sulphate of quinine, because of its powerful action,
can do much harm, if it is not indicated. When the disease
commences with chills, followed by abundant sweats after the emetic
and purgative, there is assurance, that there will be another
remission, and then the sulphate of quinine is preëminently the
remedy. But when there are no chills in the commencement of the
disease, when the prominent symptoms are heat and dryness of the
skin, and the fever continues, the exacerbation will not be long
delayed, and no propitious moment can be found to administer the
anti-periodic.
In cases where sulphate of quinine cannot be employed, calomel is
an excellent remedy, especially when in the absence of remission, the
tongue shows itself humid, loaded, white, large, the gums engorged,
the stools difficult, or when there is bilious diarrhœa. Under these
circumstances, calomel taken in purgative doses every half hour,
until the characteristic stools of this remedy appear. Very often, after
the administration of calomel, remission of the fever and of the
congestive symptoms takes place; the skin becomes moist, and
sulphate of quinine, the effect of which will be more sure in
proportion to the distinctness of the remission, may then be
appropriately used. Its effect is assisted by oil and by emollient
injections. If there was no chill in the commencement, aconite and
tincture of digitalis will be pressed. These are ordinarily sufficient to
bring the patient into full convalescence.
 The action of calomel and of sulphate of quinine has led some
medical men to employ these remedies, united in the same formula. I
have never understood the effect expected from this, and my
experience has not proved the result satisfactory. When one is
fortunate enough to have determined an intermission, frictions of
sulphate of quinine produce a good effect. Calomel is not indicated,
when the disease following its course, the alterations of the coat of
the stomach become more observable, the epigastric pain more
violent. In this case recourse may be had to the treatment heretofore
recommended.
We have seen already, that there are three kinds of black vomit—
that formed by bile, that formed by decomposed blood, and finally,
that which is a mixture of these substances. The most numerous
cases of cure are those, in which the black substance is formed by
bile, and in these bicarbonate of soda and nux vomica will ordinarily
triumph. But if the black vomit is formed from decomposed blood,
there is no treatment which can result in positive action.
When cerebral symptoms predominate, with delirium,
restlessness, etc., recourse should be had to blisters, to compresses
upon the forehead of cold water and of brandy with belladonna, and
to the administration internally of calomel alone, or combined with
opium. This combination is valuable—it calms the cerebral
excitement. When the delirium is violent, it is dissipated or quieted
by an infusion of valerian.
Hiccough may be arrested by compressing with the fingers the
phrenic nerve on the level of the os hyoid. In other instances, it yields
to the application of cold water on the stomach to opium, to
belladonna in small doses, to ice swallowed in small pieces.
When hemorrhages occur, the most appropriate remedies are
acids, astringents, and iron. Local, such as buccal hemorrhages, yield
to lotions of diluted sulphuric acid every half hour, or to gargles of
borax. The best means of resisting epistaxis is by application of ice to
the forehead; at the same time, by acid injections into the nostrils.
Plugging of the anterior openings of the nostrils would be
insufficient, because the hemorrhage is passive, and comes from the
whole surface of the nasal mucous membrane. For anal
hemorrhages, acid injections, the application of cold to the abdomen,
and tannin given internally, are prescribed.
 General hemorrhage, that is to say decomposition of the blood, is
combatted with tannin or perchloride of iron administered every two
hours, with lotions of vinegar or of wine of cinchona, applied over the
whole body.
Hematuria is combatted with weak sulphuric lemonade.
It is during the period of hemorrhages, that the parotids become
swollen—a frequent indication of amelioration of the general
condition. When pain or swelling appears, I apply tincture of iodine
three times a day externally, loco dolenti. During the epidemic of
1862, I had twenty-nine cases of inflammation of one parotid, and
seven of both parotids, and lost but one patient. I attribute this
success to iodine. When suppuration does not invade the whole
gland, premature incisions must be avoided. They would produce the
serious inconvenience of retarding the cure, of making the patient
suffer uselessly, and of occasioning hemorrhages difficult to arrest.
The tumors which show themselves on different parts of the body
ought to be treated with topical tonics. Compresses soaked in wine of
cinchona, facilitate resolution. It is not necessary to open these
tumors; this would expose them to hemorrhage.
During the first period, slightly acidulated drinks are prescribed,
warmed to promote diaphoresis; in the second, the patient takes cool
beverages; in the third, tonics are preferable.
During the whole course of the disease, absolute diet is essential.
There must be no indulgence on this point. Often a little broth, given
before the period of remission, is enough to bring on indigestion,
then reäction, and finally death. In the second period, there is
sometimes a sensation of false hunger, which deceives the patient;
but the least compliance on the part of the physician might be fatal.
To be more exact, we now proceed to examine singly each one of
the recognized therapeutic remedies against yellow fever:
Bleeding.—I consider general bleeding injurious, except with
individuals of apoplectic temperament, presenting symptoms of
inflammatory fever. I repeat that cupping is preferable to leeches. I
have already so insisted on this mode of application, that it is useless
to allude to it again. I will say only, that it is necessary to employ the
spring scarificator, and never the lancet or bistoury.
 Pediluvia.—Foot-baths are perfectly associated with cuppings, to
diminish local congestions. They ought to be given in the manner
following: The patient lying on the back, draws his thighs upon the
stomach, the legs upon the thighs. In this position the feet and legs
are placed in a vessel filled with warm water, the temperature of
which is gradually increased, until it becomes unendurable. The bath
ought to last from fifteen to twenty minutes. Its effect will be
increased by the addition of powdered mustard. When taken from
the water, the feet should be carefully dried, and mustard plasters
applied to the thighs and allowed to remain as long as the patient can
bear them, when they will be removed, and placed on the calves of
the legs.
Emetics.—Emesis is one of the most important remedies in the
first, but becomes injurious in the second period. Black vomit often
comes soon after the administration of an ill-judged emetic. The
principle indication are these—the tongue humid, saburral, charged
with whitish mucous deposits, nausea, disposition to vomit, bad taste
in the mouth, the temperament bilious, constitution lymphatic,
atmosphere damp, etc. Administered under these circumstances in
the first period of the invasion, the emetic is a heroic remedy. I
prescribe thirty grains of ipecac, dissolved in six ounces of distilled
water, taken in one draught. Nausea soon occurs, and as soon as the
patient begins to vomit, the effect of the medicine is assisted by
drinks of warm water. The food contents of the stomach are first
ejected, then bile. The drinks of warm water should be continued,
until the liquid ejected is as clear as the water that is swallowed.
After the vomiting, the patient takes one or two cups of tilia.
Ordinarily, the congestive symptoms of the brain increase, by reason
of these efforts, but after a short repose and a little sleep, the skin
becomes covered with sweat, and on awaking, the pain in the head is
sensibly diminished.
I prefer ipecac to tartar emetic, because the action of the former is
more gentle and more constant, and because tartar emetic irritates
the mucous membrane of the stomach. After ipecac, the patient
remains calm, whilst after tartar emetic, the nausea continues, and is
very often followed by diarrhœa. I insist strongly on patiently
awaiting the effect of the ipecac before giving warm water, because
prematurely swallowed, this embarrasses instead of promoting the
effect of the medicine.
Let us, however, observe, that ipecac, if useful when clearly
indicated, may produce deplorable consequences, if administered
despite counter-indications. In my experience, it is counter-
indicated, whenever the period of invasion is passed, and even
during the period of invasion, when the patient has not been
attacked immediately after a meal, when the disease has not
commenced with chills, when the individual is plethoric and is
subject to cerebral congestions, or when he complains of pains in the
stomach, even when fasting.
The first twenty-four hours of the invasion passed, the emetic can
have fatal effects. At this period, indeed, the stomach and abdominal
organs suffer in a manner more direct, and the efforts of vomiting
increasing, these local congestions may determine a condition as
much more difficult to encounter, as the period of the disease is
advanced. How often have I seen black vomit appear after an emetic
improperly given! I have seen under the same circumstances
epistaxis which could not be arrested, and such irritability of the
stomach, that it could not bear anything.
Purgatives.—Purgatives are of as great importance as emetics in
the treatment of yellow fever.
After the administration of the emetic and a repose of twelve to
twenty-four hours, the purgative may be used to induce action by the
intestines. It slightly excites the secretion of mucus, and facilitates
the circulation and the passing of bile by the stools. Drastics should
be absolutely excluded, their too violent action producing injurious
irritation. Among the purgatives I recommend, above all, castor oil
alone, or associated with oil of sweet almonds. When judged proper
to be administered alone, two ounces at least should be given at
once. When mixed with oil of sweet almonds, three ounces of the
first, and two ounces of the second, adding some drops of lemon
juice, unless it is preferred to give the patient a slice of lemon, after
the potion, to prevent vomiting.
The action of castor oil is a little slow, but it should be assisted
with injections of olive oil and warm water.
 If the patient has an antipathy to castor oil, sulphate of magnesia is
administered, in a dose of one ounce in a half tumbler of fresh water,
with the addition of six grains of nitrate of potash. The mixture of
these two remedies produces secretion of intestinal mucus, acts upon
the kidneys, augments the secretion of urine, and at the same time
excites diaphoresis.
This mixture ought to be given in small doses, every half hour, as
the stomach will bear it better. Given in this way it is sometimes
vomited in part, so that there should be no attempt to give the
remainder. If its action is delayed, it should be assisted with
injections slightly purgative, warm sea water, or sulphate of
magnesia, mixed with olive oil. During the action of the purgatives,
especially of sulphate of magnesia, the patient may drink as much
fresh water as he wishes.
Obstinate constipation, indicating a congestive state of the brain,
will be combatted with Seidlitz water. The different purgatives
generally bring on a calm, and marked relief.
Other purgative substances are employed, among which I would
cite rhubarb and Seidlitz powder, or Seidlitz water. They are
particularly indicated in the jaundice of the second, and in the
commencement of the third period.
The counter-indications of purgatives are colliquative diarrhœa,
the third period of the disease, hemorrhages, especially those of the
anus. Feeble and lymphatic temperaments do not endure them well.
They should be given to women and children with caution, and in
small doses frequently repeated.
Calomel.—We have spoken of calomel, the action of which, so
different according to the dose, is here formally indicated, either as a
purgative, or as an alterative, or as a derivative. We have seen, that
emetics were counter-indicated with persons too robust and
disposed to cerebral congestion. It is in these cases, that calomel
should be employed, at least, when there are no symptoms of local
irritation or inflammation of the stomach. But if the tongue is
loaded, humid, large and saburral, without redness of its borders, if
the region of the liver is painful, the indication for calomel is more
precise.
 For a purgative dose there will be given every half hour from three
to six grains, until the patient has taken eighteen. If, after having
obtained the purgative action, it is necessary to continue the
medicine for a certain time in smaller doses, as a derivative, it is
given in doses of two grains every hour, until the characteristic
greenish stools are obtained.
Calomel is still applicable, when constipation persists, despite the
employment of sulphate of magnesia. Administered then, every hour,
in grain doses up to twelve, it works marvellous effects. I have seen
convulsive symptoms disappear after the administration of this
remedy. One of its inconveniences is ptyalism, but this is obviated
with the aid of Seidlitz powder. Very often when it has been given
after the emetic and sulphate of magnesia, calomel is sufficient to
produce a remission, when there has been none.
Sudorifics.—When the remedies, of which we have spoken
heretofore, do not bring on a remission of the symptoms, it is well to
look to sudorifics, which, facilitating the peripheric circulation,
produce a general relaxation, and with this an abatement of the
pulse. Among the sudorifics, I commonly select Dover’s powder, and
the liquid acetate of ammonia or spirit of mindererus.
The latter administered in doses of twenty drops, in four ounces of
flower of elder, acts as an antiseptic and sudorific. It is indicated,
when the skin is dry, with the sharp heat so common in yellow fever
of the continued acute type, without remission. I have often seen
individuals stubborn to sweat, despite the purgative, transpire
abundantly after some doses of this medicine.
Dover’s powder suits, when the patient has dry skin, is restless,
and turns over in his bed uttering deep sighs. I give for the dose,
every two hours, from three to four grains in two or three spoonfuls
of infusion of tilia, warm or hot. After the second or third dose, the
patient becomes more calm, sleeps, and wakes covered with sweat.
The effect of sudorifics will always be assisted by a mustard foot-
bath.
Some medical men have considered the transpiration so useful,
that they have made it the basis of their treatment. In the outset, they
prescribe a steam bath. I have tried this but without advantageous
results.
 When transpiration is determined, the pulse remains full and
strong, diuretics are indicated, and among these powder of digitalis
associated with nitre.
Sulphate of Quinine.—Sulphate of quinine is one of the most
powerful and most useful remedies in the treatment of this disease;
but it must be well indicated, well administered, and in a suitable
dose. What are the indications of sulphate of quinine in yellow fever?
There must be at least remission, if there is not complete
intermission of the fever. Its application is then excluded from the
continued type. When the fever has yielded, by the use of the
medicines of which we have spoken, or when, with sweat or moisture
of the skin, the pulse has sensibly lowered, the employment of
quinine is always good. Its effect will be shown, for the strongest
reason, in the intermittent type. In this last case, it acts with the
same precision and the same success, as in simple intermittent fever.
As sulphate of quinine has a prompt and durable action, the
mucous membrane of the stomach ought to be in the best possible
condition for absorption. It must, therefore, be empty. An emetic and
a purgative, at least the latter, should precede the administration of
sulphate of quinine. I know that there are medical men, who
administer quinine in the height of the fever, regardless of the state
of the stomach and of the mucous membrane. If they have found this
treatment beneficial, it is by chance; for it is illogical, and its effects
are commonly deplorable.
As for the dose in which sulphate of quinine ought to be
prescribed, it depends on the age, sex, and temperament of the
patients. For adults and men, the average is twenty grains in a single
dose, in about three ounces of black coffee, without sugar. If it is
feared, that the irritated stomach cannot bear so strong a dose, it
should be dissolved in a few ounces of distilled water with a
sufficient quantity of sulphuric acid, and given every hour by the
large spoonful. If the stomach cannot bear this, give an injection of a
double dose, with the precaution, not to inject more than one ounce
of liquid at once, every hour. The action of the medicine will be
assisted by friction of quinine ointment along the vertebral column,
on the articulations of the wrist, knees, and under the arm-pits, etc.
Some enthusiasts consider sulphate of quinine, as a preventive,
and direct it to be taken in a perfect state of health, or administer it
in the outset of the fever. I have tried this without having felicitated
myself. I will say as much of the association of calomel with sulphate
of quinine. This combination should be rejected.
I have nothing to add to what I have already said as to blisters.
Bicarbonate of Soda—Nux Vomica.—When the patient complains
of nausea, disposition to vomit, of eructations warm and acid, that he
feels in the throat and liver a burning sensation, bicarbonate of soda
is the remedy indicated. I give it in doses of one gramme in six
ounces of distilled water, taken by the spoonful every hour.
I have stated before, how and under what circumstances nux
vomica ought to be given. The effect of these two last remedies is
often much more sure, if their action is assisted by cold fomentations
upon the abdomen, perhaps with cold water alone, or with
camphorated alcohol and belladonna.
Belladonna—Camphor.—Compresses of camphorated alcohol and
belladonna, placed upon the epigastric region, diminish the beating
of the cœliac trunk, the epigastric pain, and the vomiting. Laid at the
bottom of the abdomen, they quiet the colic pains and facilitate the
passage of urine. Camphor alternated with belladonna, finds its use
internally, in combatting hiccough, and camphor alone is especially
useful in the typhoid period of the disease.
Tannin.—Tannin diminishes the excitement of the stomach. I
recommend its employment, where nitric acid reveals the
commencement of albuminous deposit in the urine. Its use must be
suspended, if the albumen persists or increases. Tannin is
administered every hour, in grain doses in a spoonful of water. When
the twelfth grain has been given, and it works no favorable change, it
is replaced by arsenic.
Arsenic.—Towards the end of the second period, when the
vomiting cannot be arrested, when the patient has continual nausea,
when the vomit contains bile or mucosities filled with blackish or
sanguinolent streaks, in a word when the characteristic signs of
pronounced yellow fever are developed, there is no better remedy
than arsenic. It is given as arsenious acid dissolved in water, and
prepared in the following manner: Boil for an hour a grain of
arsenious acid in a porcelain cup, containing a half pint of distilled
water; then replace the evaporated liquid with an equal volume of
boiling water, let it cool, and give this solution by the teaspoonful
every half hour, until the nausea and vomiting cease. The
administration of this remedy is continued for two days, at longer
intervals, that is every hour, then every two hours, finally every four
hours. Prescribed under fitting circumstances, arsenic often brings
unhoped for amelioration.
There are some medicines, whose action, though certain, is
inexplicable. Such is arsenic, the influence of which must be accepted
as a fact, without considering theories more or less satisfactory. I
should add, that arsenic often determines a deceptive hunger, to
which there should be no concession, because at this period of the
disease, the lightest broth might cause fatal indigestion.
I have tried every possible remedy for black vomit, and there is not
one, which has constantly given the same result. I have had
extraordinary success with agents, which at other times produced no
effect; and I affirm, that there is no therapeutic agent, which can
always be employed with entire confidence. Black vomit is the
symptom of alteration, more or less profound, of the bile and of the
blood. If it is alteration of the bile, presenting solely the black color of
jet, hope remains; but when the vomited matter is of the color and
consistency of coffee grounds, the patient is irretrievably lost. This
truth rests on an experience of forty years.
It is not surprising then, that under a great number of
circumstances, the most heroic agents are absolutely ineffective.
Iron.—It is not necessary to give iron in too large doses. The two
best ferruginous preparations are iron reduced by hydrogen, and the
muriatic tincture of perchloride of iron. Small doses, often repeated,
are much more easily absorbed than large doses. A quarter of a grain
of powder of iron every hour, or a drop of perchloride of iron in three
ounces of water, taken by the spoonful, every hour, is all that the
stomach can bear; more is rejected by the stool or by vomiting. The
reconstructive action of this remedy will be assisted by cold
lemonades, and by ice in small quantities. Cold vinegar lotions over
the whole body, frictions, enveloping the patient in sheets wet with
cool vinegared water, compresses of cold vinegared water on the
abdomen, changed as soon as they become warm, are adjuncts,
which should not be neglected, and which will always be found good.
 Ice.—Ice is one of the agents greatly abused, especially in the first
and second period. It is an excellent tonic; but I am not well assured
of its employment in the third period.
Drinks.—During the first period, the diet drinks ought to be warm
or hot, to facilitate the diaphoresis so necessary at this time. But in
the second and third period, there is used only cool water, slightly
acidulated, and sweetened ad gratam saporem. In the great majority
of cases the patient prefers simple water.
Regimen.—Absolute diet is demanded, rigorously, while the fever
lasts. But when the febrile symptoms have disappeared entirely, and
at the same time local congestions dissipated, a little thin broth may
be allowed.
A certain sensation of hunger is felt, especially towards the end of
the first period; but the desire of the patient must be resisted,
although the pulse maybe less frequent and less full. Often at the first
touch, the pulse seems regular, but the attentive physician will find
something abnormal, and he will soon be assured, that the
improvement is more apparent than real.
Convalescence.—The greatest care should be given to
convalescents, because relapse is often fatal. The nourishment ought
to be select and the patient should not be exposed to the sun or to the
influence of the moon. When the disease does not go beyond the first
period, convalescence is much shorter, if there is no leading organ
assailed; but if it reaches the second and third period, especially that
of hemorrhages and profound alterations of the blood, convalescence
is long and painful, and often leaves its traces during the whole life.
When restoration is complete, wine of cinchona, wine of iron, cold
baths, and sea baths are prescribed. In cases of swollen parotids,
convalescence is prolonged during many months.
Is it possible to prevent a disease, which makes such ravages? Its
entire destruction seems to me an unrealizable utopia, because we
have seen, that one of the causes of its existence is in the
atmosphere: but it is certainly possible to diminish its effects, and to
avoid it, when it exists. A well observed hygiene would give the best
results, and the government, which would attach its name to this
undertaking, would deserve well of mankind.
 Besides the causes of the disease, described in the commencement
of this memoir, there is one important cause, in the collection of
persons living together under the same roof, especially in barracks.
These establishments are designed to shelter, day and night,
strangers, who expose themselves without precaution to sun and to
damp, and who drink, and eat, as if they had nothing to fear. These
barracks ought to be built on elevated places, far from the city, and
from the seashore, and especially, be well ventilated. The surgeon of
the regiment, should have a roll-call three times a day, and, on his
responsibility, put in the infirmary, and on diet, any one, who
complains of the least headache.
Instead of sending to one hospital only, the sick coming from
garrison and from government ships, several military hospitals ought
to be established. Every barrack should have its infirmary, with
medical service, and the sick should not have to cross the city to
obtain treatment. There is no disease which develops contagious
miasm more suddenly than yellow fever. A large accumulation of sick
in the same place, is a certain source of disease and contagion.
On board of vessels, a good hygienic system would greatly
diminish the number of the sick. In ordinary times, government
vessels should not have full crews. The men will then have a
sufficient quantity of air to breathe. They should not be drilled in the
fierce heat of the sun, or in rain, and they should be required to go to
the surgeon, for the least pain in the head.
We have observed, that the incubation of yellow fever, is from ten
to twelve days. It will be prudent then, in the heated term, not to
remain in port more than six days. English vessels have the habit of
not remaining more than three days, but they cruise in the vicinity,
or go to Jamaica, so that they are always exposed. The best plan
would be to leave the waters of the Gulf, which is the true centre of
infection. When, despite every precaution, there are sick men on
board, and their condition inspires apprehension, they should be put
ashore at once, the vessel whitewashed, and sail set for other
latitudes to the north.
Commercial are not under the same conditions as government
vessels. On the former all is sacrificed to speculation. The crew is
lodged as closely as possible, and ten or twelve men are often seen in
a space, where four men can scarcely lie down. The government
should require the lodgment of the crew to be on deck, so as to allow
free circulation of air. Their food should be wholesome, and well
chosen, and instead of giving the crew fresh meat every day, it is
better to continue giving them salt meat which is more wholesome,
and more nourishing. Let us add, that the meat of the country,
bought by merchantmen, is not of first quality.
There are some captains, who, to shun the invasion of the disease,
engage blacks to load and unload their vessels, and during this time,
leave their crews inactive. This plan is of no avail. The crew is
generally composed of strong men, habituated to bodily exercise,
which facilitates transpiration. They require, therefore, moderate
labor.
The water of the country is bad, and it would be good to add to it a
little brandy or rum. This drink is better than wine, or beer, which
are adulterated and often give colic.
Prophylactic remedies have been much recommended. In latter
times, chlorine on board ships was extolled, and has fallen into
disuse, like others I have tried without satisfaction. I have seen a
captain, who, convinced of possessing the universal panacea,
neglected his sailors, and they became gravely sick. Prophylactics can
not have any action on a disease which is in the air. Hygienic
precautions and cleanliness, are worth more than these pretended
preventives.
Inoculation.—At one time, it was attempted at Havana to prevent
yellow fever by inoculation of the poison of a snake, supposed to be
the crotalus horridus. A German adventurer assumed the
respectable name of Humboldt to sustain his theory. This man had
observed that the Indian prisoners, lead from Mexico to Vera Cruz,
exhibited, when they were bitten by a viper, symptoms analogous to
those of yellow fever. He then made some experiments with the
inoculation of this substance at Vera Cruz, and at New Orleans. He
came afterwards to Havana, and obtained from General Concha,
then Governor of the Island, permission to make some trials at the
military hospital. He proceeded in this wise: He made, said he (no
one saw it), the snake bite the liver of an animal, and kept it to
putrefaction. He inoculated with this substance, and gave at the
same time, internally, a syrup composed of mikiana-guaco and
rhubarb, with the addition of iodide of potassium and gutta-gamba.
 The symptoms appeared in the following order: at the moment of
inoculation, the subject was taken with a transient vertigo, at other
times, with a nervous trembling, which lasted a longer time. Seven
hours after, the pulse was modified in a permanent manner, more
frequent or slower, stronger or weaker. Eleven hours after, he had
febrile heat. At the end of fourteen hours, he had headache,
inappetence, thirst; sixteen hours after, the face red, the conjunctiva
injected. From the outset, the gums were swollen and the patient
suffered from colic. Eighteen hours after, the gums were painful, and
their borders became red, with pains in the salivary glands, and in
the nerves of the face and teeth. Nineteen hours after, pain in the
lower jaw, in the direction of the submaxillary nerve. At the
twentieth hour, bad taste in the mouth, coryza, and œdema of the
face; at the expiration of twenty-two hours, a sensation of
contraction of the throat, without visible change. At the twenty-third
hour, jaundice; at the twenty-fourth, gingival hemorrhage; at the
twenty-eighth, conjunctiva injected, chills; at the twenty-ninth,
tonsillary angina; at the thirtieth, pains in the loins; at the thirty-
eighth, pain in the joints; at the seventy-second, swelling of the lower
lip. During convalescence, prurience of the skin, with cutaneous
eruptions. These symptoms are far from being those of yellow fever.
They belong in part to those produced by the mixture of guaco and
iodide of potassium, and in part to those, which putrifying
substances produce, when they are absorbed.
M. Humboldt would not yield to the desire of the Commission, to
try solely the inoculation and the syrup of guaco. The conclusions of
the report were absolutely unfavorable to the experimentalist. The
epidemic of yellow fever continuing its course, the proportion of
mortality was the same among the inoculated, as among other
subjects, and if the statistical tables, presented by M. Humboldt,
disagree with the conclusions of the Commission, it is because he
had among the inoculated, not only a great number of acclimated
persons, but of individuals who had already had the disease. These
ideas of inoculation, inspiring a false security, might produce the
saddest results. I think, however, that this interesting question might
deserve to be studied anew.
I here terminate my effort. I have proposed to make yellow fever
known, as I have observed it at Havana for some twenty years. The
reflections, which I have presented on the nature and the causes of
this terrible disease, the details into which I have entered, in order
that all that relates to its symptoms, its progress, and its treatment,
may be clearly estimated, make this work a monograph, the utility
and opportuneness of which, will, I hope, be appreciated by those
medical men, who are called to practice in tropical regions.

The Elastic Bandage in the Treatment of Aneurisms.—It seems

likely that Esmarch’s bandage will add very greatly to our means of
treating aneurism. Dr. Weir has collected twenty-one cases of
iliofemoral, femoral, and popliteal aneurisms, mostly the latter,
treated in this way. Twelve of these were successful, while the others
failed, owing chiefly to the fact that obstruction to the arterial
current was not kept up after the removal of the elastic bandage.
Upon this point Dr. Weir lays great stress, and states that in it is the
gist of the treatment.

In connection with the study of this matter, the question of how long a limb can
be kept desanguinated is of importance. In the lower animals the time is six or
eight hours. In man the time is longer than has been heretofore supposed.
Ischæmia has been enforced for four, five, and in one case fourteen hours without
injury. During the compression it is important to remember that the arterial
tension elsewhere is increased.
Autopsies have made it probable that coägulation begins in the tumor and
extends up several inches into the artery. The arterial clot then becomes organized
into fibrous tissue, and for this organization a healthy state of the wall is necessary.
Aneurisms with large mouths are perhaps more easily cured by Esmarch’s
bandage.
As the result of a study of the cases collected, including his own, Dr. Weir
recommends a plan of treatment like the following: the limb should be bandaged
up to the tumor and above it, but not over it. The patient should stand erect before
the upper bandage is put on. Tubing should be applied in the usual manner. The
elastic compression may be kept on for two hours, followed by the application of a
tourniquet for two hours. If pulsation is still apparent, the elastic and mechanical
compression should be repeated until pulsation has ceased. After consolidation of
the tumor is secured it is well to moderate current above the tumor for twelve or
twenty-four hours by a bag containing seven or ten pounds of shot.—Amer. Jour.
Med. Sciences, Jan., 1879.
 EDITORIAL.

NORTH CAROLINA MEDICAL JOURNAL.

A MONTHLY JOURNAL OF MEDICINE AND SURGERY,

PUBLISHED
IN WILMINGTON, N. C.

M. J. DeRosset, M. D., New York City,

Editors.
Thomas F. Wood, M. D., Wilmington, N. C.

☞ Original communications are solicited from all parts of the

country, and especially from the medical profession of The
Carolinas. Articles requiring illustrations can be promptly supplied
by previous arrangement with the Editors. Any subscriber can have
a specimen number sent free of cost to a friend whose attention he
desires to call to our Journal, by sending the address to this office.
Prompt remittances from subscribers are absolutely necessary to
enable us to maintain our work with vigor and acceptability. All
remittances must be made payable to DeRosset & Wood, P. O. Box
535, Wilmington, N. C.
 THE APPROACHING MAY MEETINGS.
We ask the attention of the members of the North Carolina
Medical Society, at the request of Dr. Charles Duffy, Jr., President, to
their obligation as Chairmen and members of Committees and
Sections.
The sections as instituted at the last meeting of the Society are as
follows:

Surgery and Anatomy.—Dr. Charles J. O’Hagan, Greenville.

Obstetrics Gynæcology.—Dr. H. Otis Hyatt, Kinston.
Practice of Medicine.—Dr. W. A. B. Norcom, Edenton.
Materia Medica and Therapeutics.—Dr. G. G. Smith, Mill Hill.
Microscopy and Pathology.—Dr. G. G. Thomas, Wilmington.

It will be remembered that the resolution creating the Sections

offered by Dr. Shaffner, of Salem, designed that all papers coming
under the above heads should be presented to the Chairman of that
section, and through him papers are to be presented to the Society. It
is highly desirable, therefore, that papers intended to be presented
should be sent forward to their proper chairman, that they may get
early attention. The ultimate design of this method is to promote a
systematic and orderly presentation of papers, and to induce every
contributor to the literature of the Society to put his paper in a way
to be properly shaped before being read to the Society. Sometimes
papers are too long to be read during the session, and still are too
important to be neglected. These papers should be passed upon by
the Section to which they belong, and given to the publication
committee.
As desirable as this plan is, it must not be understood to exclude
papers prepared too late to be reviewed by the section, for literary
laziness and procrastination is the prominent failing of members of
our State Medical Society. (We are now speaking as editors).
 With the additional work now devolving upon our State Society,
every effort will have to be made to economize time. It is desirable
that the Board of Medical Examiners meet a day in advance of the
Society, in order that candidates passing the Board can at once enter
into the duties of full membership, and enable the members of the
Board also, to take active part in the proceedings. This we
understand to be the plan agreed upon by the Board, and it may be
officially announced in this Journal.
All these matters should be thought over before the meeting is
right upon us, if we intend to make the best use of the opportunities
presented, and not embarrass the presiding officer by a jumble of ill-
digested work, or bring disrepute upon the Society by presenting
papers put together without due study.
Another matter of vital importance should be carefully considered
by every member of the Society. It is the amendment proposed by Dr.
T. D. Haigh, of Fayetteville. He proposes to amend the Constitution
(Art. IV, Sec. 2,) so that the officers are elected by ballot. This is not a
new feature. It has been tried before in the Society but was found to
consume a great deal of time. This is the only objection we have
heard against it, and this should not be considered insuperable, if the
amendment corrects abuses of which we have heard complaints.
We would like to see the office of President filled for a longer term
than one year. A good presiding officer is not so easy to get that we
ought to be willing to let him go out of office as soon as he has shown
his capacity, and this remark applies with peculiar force to the
present incumbent. To affect this change though, there must be a
further amendment of the Constitution.
 YELLOW FEVER POISON SURVIVES A
WINTER.

“The U. S. Steamer Plymouth, Captain Hanning, which left Boston March 15th,
for a cruise to the West Indies, returned to Vineyard Sound on account of two cases
of yellow fever occurring on board when about 80 miles south-east of Bermuda
Islands.
“The ship had been in Boston during the winter, and as she had come from the
West Indies last autumn with yellow fever on board she had been frozen out and
fumigated. As she had not called into any port since leaving Boston, this
development showed that the germs of yellow fever still existed in her, and she was
headed north, being deemed, under the circumstances, unfit for cruising in the
tropics. On the 31st of March, Peter Eagan, the boatswain’s mate, was buried,
having died from yellow fever on the previous day.”—Wilmington Sun’s associated
press telegram.

The above dispatch has since been verified and the minute details
will no doubt be investigated most thoroughly. Notwithstanding this
case is not without a parallel, it comes in uncomfortable collision
with the theories we cherish of the killing power of low temperature
on the yellow fever poison.
In the most dismal times of a ravaging epidemic the heart turned
with anxious longings for the arrival of frost! This was the line of
demarcation between the pestilence and recovery from it! But in this
case we are informed that the Plymouth spent the winter in Boston
harbor with open hatches, the cold being intense enough to freeze
the water in the boilers. Every means for thorough disinfection had
been applied that could suggest itself to the minds of the well
educated medical officers in the service of a government lavish in its
supplies. With all this, a short cruise develops the fever in a form
intense enough to cause the death of one of the two seized with the
disease.
We will await the detailed accounts of the investigation which is to
follow with peculiar interest. It is a starting point for the National
Board of Health, and a difficult one.
 We append the following from the Surgeon-General of the Navy,
received through the Bulletin of the Public Health, from Surgeon
General Hamilton, U. S. M. H. S.:
“The Surgeon-General of the U. S. Navy has furnished the
following facts in regard to the recent outbreak of yellow fever on the
U. S. Steamer ‘Plymouth:’ On November 7th last, four cases of yellow
fever occurred on board the vessel while lying in the harbor of Santa
Cruz; these were removed to hospital on shore and the ship sailed for
Norfolk. Three mild cases occurred during the voyage and the
‘Plymouth’ was ordered to Portsmouth, N. H., thence to Boston. At
the latter port everything was removed from the ship and all parts of
the interior freely exposed to a temperature which frequently fell
below zero, the exposure continuing for more than a month. During
this time the water in the tanks, bilges, and in vessels placed in the
store rooms was frozen, 100 pounds of sulphur was burned below
decks, this fumigation continuing for two days, and the berth-decks,
holds and store rooms were thoroughly whitewashed. On March
15th, the ship sailed from Boston southward; on the 19th, during a
severe gale, the hatches had to be battened down, and the berth deck
became very close and damp. On the 23d two men showed decided
symptoms of yellow fever, and on the recommendation of the
Surgeon, the vessel headed northward. The sick men were isolated,
and measures adopted for improving the hygienic condition of the
vessel and crew. The surgeon reported that he believed the infection
to be confined to the hull of the ship, especially to the unsound wood
about the berth deck, all the cases but one having occurred within a
limited area, and that while the ‘Plymouth’ is in good sanitary
condition for service in temperate climates, should she be sent to a
tropical station, probably no precautionary measures whatever,
would avail to prevent an outbreak of yellow fever.”

Charcoal for Burns.—A retired foundryman claims that powdered

pine charcoal thickly dusted over a burn is a never-failing and speedy
remedy.
 THE NATIONAL BOARD OF HEALTH.
This body as now composed includes fairly representative men. As
far as we can learn it is as follows:

Dr. James L. Cabell, University of Virginia, President.

Dr. John S. Billings, U. S. A., Washington, Vice-President.
Dr. Henry J. Bowditch, Boston, Mass.
Dr. Henry A. Johnson, Chicago, Illinois.
Solicitor-General, Samuel Phillips, North Carolina.
Dr. S. M. Bemiss, New Orleans.
Dr. Th. Turner, Surgeon U. S. N., Washington, Secretary.
Dr. P. H. Bailhache, U. S. Marine Hospital.
Dr. Robert W. Mitchell, Memphis, Tenn.

A committee of experts has been sent to Havana to study the

disease where it is endemic, and where it can be seen for many
months in the year.
“The system [adopted by the new National Health bill]
contemplates a national sanitary supervision of all vessels engaged in
the transportation of goods or persons from any foreign port where
any contagious or infectious disease exists, to any port of the United
States. All such vessels shall be required to obtain from the consul,
vice-consul, or other consular officer of the United States at the port
of departure, a certificate in duplicate, setting forth that said vessel
has complied with all the necessary regulations and possesses a clean
bill of health. This provision applies with particular and special force
to vessels from Havana, a clause in the bill defining in detail the
duties of the medical officer in charge of the port. The said inspector
must issue a certificate setting forth ‘that he has personally inspected
said vessel, her cargo, crew, and passengers; that the rules and
regulations prescribed by the National Board of Health in respect
thereto have been fully complied with, and that in his opinion the
said vessel may be allowed to enter any port of the United States and
land its cargo and passengers without danger to the health thereof on
account of any contagious or infectious disease.’ Any vessels from
such port entering any port of the United States without such
certificate shall in each instance forfeit the sum of five hundred
dollars. The execution of these provisions is entrusted to the
National Board of Health. The latter is also charged with the duty of
obtaining information of the sanitary condition of foreign ports and
places from which contagious diseases are or may be imported into
the United States, and also similar information from home ports. It
is also provided that the National Board of Health ‘shall correspond
with similar local officers, boards and authorities acting under laws
of the States in sanitary matters, to prevent the introduction and
spread of contagious and infectious diseases from foreign countries
into the United States and from one State into any other State by
means of commercial intercourse, or upon and along the lines of
inter-State trade and travel.’ To such an end it shall be lawful in
times of emergency for said board of health to confer upon any such
local officer or board within or near the locality where his provisions
of this act, and any rules or regulations made in pursuance
thereof.”—Medical Record.
 SYMES ON THYMOL AND THYMOL-
CAMPHOR.
Dr. Symes, in the Pharmaceutical Journal of January 10,
publishes the results of his researches on the combination of thymol,
chloral-hydrate, and camphor, acting as an antiseptic. The two
former drugs are rubbed together in a mortar, and an equal quantity
of camphor added, which liquefies the whole, and produces a
powerful antiseptic. Its virtues were immediately tested on some
urine containing pus, and which was already beginning to
decompose. Two drops of the compound being added to it, the
putrefaction was arrested. If thymol and camphor alone are rubbed
together, they also become liquid, and this a convenient form from
which to prepare the ointment. Thymol-camphor can be mixed in
almost any proportion with vaseline, ung. petrolei, or ozokerine, and
the thymol will not separate, as in crystals, when thymol alone is
used. A solution of thymol in water (1 in 1000) is sufficiently strong
for the spray in surgical operations. If used for the throat, milk and
glacial acetic acid will be found to be good solvents for it.—London
Medical Record.
 REVIEWS AND BOOK NOTICES.

Modern Surgical Therapeutics: A Compendium of Current

Formulæ, Approved Dressings, and Specific Methods for the
Treatment of Surgical Diseases and Injuries. By George H.
Napheys, A. M., M. D., etc. Sixth Edition. Revised to the most
recent date. Philadelphia: D. G. Brinton, 115 South Seventh
Street. 1879. Pp. 605. Price $4.00, in cloth.
This is a companion volume to Napheys’ Medical Therapeutics
which we noticed in our January issue.
The design of this work is to give a careful digest of surgical
therapeutics up to the latest date, and the author has succeeded in
carrying it out. As a work of ready reference it may be compared
favorably with any of a similar character. Discrimination in
selections, however, does not seem to be the aim of the author, but
rather to bring all matters under their heads, leaving the reader to
select those best suited to his needs.
In divesting surgery of its operative procedures, it leaves a
comparatively indifferent number of resources, but the therapeutical
branch is by no means at a stand still.
We are pleased to see that under the head of anæsthetics,
chloroform has been allowed its proper place at the head of the list.
Chloroform “is the most potent of all anæsthetics,” he says, “and
its use is still advocated by many eminent surgeons. Only the alleged
dangers attending it, prevent its exclusive employment. Many of
these arise from its ignorant or heedless administration.” The
directions for its use are given, as also the means of combatting
dangers arising from it. Dr. Napheys might have added with a great
deal of truth, that chloroform should not be administered by any
surgeon who is not habitually on his guard as to the dangers of the
anæsthetic state.
The dressing of wounds after the new processes of antiseptic
practice receives a great deal of attention. To one familiar with the
dressings during our civil war, on examination of the present
multitudinous plans to exclude “germs” would bring back the days of
our grand-fathers in surgery with their balms and balsams and
salves; and some of the dressing is not more rational. According to
Esmarch (p. 151 and 152) the dressing of gun-shot wounds should be
purely antiseptic. “Do not examine the wound at all, rather than
examine it with unclean fingers—and everything is unclean, in the
strict sense that is not antiseptic.
“* * * * To avoid pernicious putrefactive influences the wounds
must not be touched by the hands, but closed rapidly by antiseptic
plugs, in order to preserve them from the contact of putrefactive
agents until they can undergo the Lister treatment in the hospitals if
necessary. He proposes that every soldier should carry in the lining
of his uniform two balls of salicylated jute wrapped in gauze.”
We make this particular quotation to show to what old-maidish
precision the antiseptic idea is leading good surgeons. This ever-
present inextinguishable “germ” is the evil spirit hovering over every
wound. Nets of gauze are set to protect it; strong odors from the
witches cauldron are summoned to stifle and destroy the malicious
fiend.
We are thankful though that the civil surgeon still sees “union by
adhesion,” and “first intention,” and “granulation,” in regions so far
remote from Listerism that there is little hope it will enter there, and
if it does it will hardly captivate the even-minded country surgeon.
When the days of probationary Listerism have ended, we will not be
surprised if the verdict is against it.
But we have digressed from our book. It is the XVIth chapter on
“Diseases of the Skin” that will be often consulted by the busy doctor.
Having made his diagnosis, here is a goodly array of remedial agents,
from the most eminent teachers to help him out of difficulties. We
miss chrysophanic acid in the composition of his formulæ for the
treatment of psoriasis. It certainly has made as much headway in the
favor of the general practitioner as any of the more recent agents.
 But why say anything about a book which has made its way
through the world, and has now come to its sixth edition? The
hundreds of medical men who will read it, will traverse a field of
surgical treatment far beyond the facilities of those possessed of the
best private libraries. As long as the author keeps up with the current
of surgical treatment, his book will be sought after. We congratulate
the author, and Dr. Brinton, on the success of this book, and advise
our friends to buy it.

A Clinical Treatise on Diseases of the Liver. By Fried-Theod.

Frerichs. Prof. of Clin. Med. Uni. of Berlin, &c., &c. In three
volumes. Translated by Charles Murchison, M. D., F. R. C. P.
Physician to the London Fever Hospital. New York: Wm. Wood &
Co. 27 Great Jones Street. 1879. 8vo. Pp. 224.
This is the third volume of Wood’s Library of Standard Medical
Authors.
For many years this work of Frerich’s has been a classic, although
only known popularly to the American profession by the large
number of quotations made from it by writers on diseases of the
liver. Although the word “Clinical” appears on the title page, it is
nevertheless a systematic treatise which traverses the entire field of
clinical pathology, and embraces also lucid historical accounts of the
phases of change which medical men have passed through on their
way to the knowledge of the present day.
This book, more than any we have been called upon to review,
shows how much German authors rely upon the authority of their
own people. References everywhere abound, but for the most part to
German works. We do not mention this as a fault, but to make the
contrast with American authors who seem to glory in going far away
from home for authority among the unspeakable names of the
Russian and German gentry.
Prof. Frerich’s work for this reason will be more valuable to
American students who wish to know the state of pathology in
Germany in regard to “the great gland.”
As, of course, no American physician can now forego the pleasure
and duty of making Frerich’s on the Liver one of his working tools,
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