ECHOES AND NEWS. CORNELL girls have successfully withstood two sessions of vivisection without any marked increase in hysterics or nervous diseases. All students at Cornell are required to dissect during a part of their freshman or sophomore year. the marrow merely, but the periosteum also and part | not draw our affections after us, and lead us to exof the Haversian systems, for his name appears at perience the realization of the old saying, that the foot of articles, at the head of them, in the where our friends are there will our heart be also. middle of case-reports, and even in the ignominious ruck of testimonials from the wilds of Arkansas and the cross-roads of "Injianny." In fact, it seems to be a contest between the Doctor and the food, with the odds in favor of the Doctor; for while he achieves the proud literary feat of mentioning the food by name eight times in a single page of "contribution," yet it gets only a plain capital, while his name looms up majestically in double capitals, with its titles trailing behind it like the lurid tail of a comet, clear across the page. This is by no means the first time that a physician has endeavored to waft himself into prominence on the wings of a proprietary remedy, but it is such a glaring and disgusting instance of the offence that it merits special mention. Its very grossness, however, defeats itself, for it is so palpably overdone that it raises the question, Who pays for the advertisement, the manufacturers or the Doctor? Another amusingly impudent feature of this pamphlet is the insertion of the names of distinguished clinicians, in staring capitals in the middle of pages loaded with resounding praises of the aforementioned food, which names, however, on careful inspection, are found to be simply appended to some trite commonplace as to the value of nutrition, the uses of proteids, etc., with no reference to the food whatever. It reminds one decidedly of the late Artemus Ward's lecture-prospectus, which read somewhat as follows: "MR. WARD HAS DELIVERED THESE LECTURES BEFORE ALL THE CROWNED HEADS OF EUROPE ever thought of delivering lectures." OUR CHANGE OF HEART. THE Medical Record, in commenting upon our removal to New York, interprets it as evincing "a sudden change of heart." We beg to submit that this is not a sudden change of heart, but simply a change of base. To hold the affections subordinate to the reason is recognized as a safe rule of conduct, and it is in obedience to this that this Journal, after a careful consideration of all the factors in the situation, finds itself irresistibly drawn to New York. We are far from admitting, however, that the kindly consideration of our esteemed contemporary may THE foundlings of New York hereafter will be sent directly to Bellevue Hospital. It has been learned that under the present rule, whereby such waifs are first taken to Police Headquarters, at least eighty per cent. die of exposure and hunger. THE pre-trial system, so extensively used by the governments of Germany and France, has been advocated by the chief expert to the New York City District Attorney's office, and its workings are being carefully watched in a series of cases. There will, under the new system, be no convictions of insane men, and fewer sane men will be able to escape on the plea of insanity. A SPECIAL MEETING OF THE NEW YORK ACADEMY OF MEDICINE was called on the 27th ultimo to consider resolutions of censure for the Commissioners of Charities and Correction in their recent action in placing the appointment of physicians and surgeons to the various hospitals in the hands of the three principal medical colleges, together with the fourth division of Bellevue Hospital. After a prolonged discussion the resolutions were not sustained, the vote standing 47 to 108. THE danger of blood-poisoning in piercing the ear is not to be ignored because the operation is supposedly not a dangerous one. There is nothing right about this home surgery. The cleanest person, when it comes to a surgical operation, is, without proper scientific laving, medically unclean. A woman takes a needle, any needle, and threads it with any thread. This thread may have been in her work-basket months and months, lying next to other spools of all colors. She would not think of washing her own hands or washing the ear to be pierced. A cork is taken out of some bottle, any bottle, without thought as to what is in the bottle or how long the cork has been exposed to the dust. This cork is placed under the lobe of the ear for the needle to strike against when it comes through. Inflammation and suppuration naturally result. It is reported that Dr. Cæsar Lombroso has just been convicted in a French court of gross plagiarism, and condemned to pay the man out of whose book he stole the sum of 2500 francs. The plaintiff, M. Crepieux-Jamin, found in La Grafologia, a work by Lombroso, published at Milan, passage after passage which were simply translated from a book by M. Jamin, to whom no credit was given, and whose name was not once mentioned by this soi-disant criminologist. He brought suit at Rouen under the International Convention adopted at Berne, in 1844, and won a verdict without difficulty, the evidence being indubitable. A tendency toward plagiarism, we have been told by both Lombroso and Nordau, is a sign of degeneration. Doubtless it is-degeneration of the | ards, and of ashes or dirt by dogs fed largely from dishes conscience. A successful candidate when recommended for appointment is commissioned by the President of the United States as an Assistant Surgeon. After four years of service, and a second examination, he is entitled to promotion to the grade of Passed Assistant Surgeon, and to the rank of Surgeon, according to priority, on the occurrence of vacancies in that grade. The salary of an Assistant Surgeon is $1600 per annum, together with furnished quarters, light, and fuel; that of a Passed Assistant Surgeon $1800 per annum; and that of Surgeon $2500 per annum. In addition to the above salaries, after five years' service, an additional compensation of ten per cent. of the annual salary for each five years of service is allowed medical officers above the rank of Assistant Surgeons, the maximum rate, however, not to exceed forty per cent. When an officer is on duty at a station where there are no quarters furnished by the government commutation of quarters is allowed at the rate of $30 per month for an Assistant Surgeon, $40 for a Passed Assistant Surgeon, and $50 for a Surgeon. The successful candidates after receiving appointments are usually ordered to one of the larger stations for training in their duties. Full information may be obtained by addressing the Surgeon-General of the Marine-Hospital Service, Washington, D. C. The Remedies oF ANIMALS. From the earliest ages animals have been credited with a considerable knowledge of the medical properties of plants. Legund relates that Esculapius cured a patient by using an herb which he had seen a sick goat search for and eat. In the Middle Ages systems of therapeutics (bestiaries) were founded upon reported animal practice, just as to-day the populace confide implicitly in the sovereign virtues of Indian "blood-medicines," and Chinese, negro, or gypsy "roots" or "herbs." A writer in the London Spectator gives a most elaborate and interesting list of the remedies reported to be used by animals for, either the cure or prevention of disease. Grouse, for instance, during an epidemic of bird-plague, have been known to fly down to the seashore and eat the salt-crystal evaporated upon the rocks. Pheasants scratch up and eat the roots of the wild arum, which are so pungent as to blister the tongue, and also the colchicum-root, presumably as aromatic digestives; at all events pepper and other spices must be added to their food when domesticated. Quite a variety of substances are eaten apparently mainly for their mechanical effect as emetics and purgatives by the carnivora. This is the rationale of the familiar use of grass by dogs and cats, also by lions, tigers, and leop or upon cooked foods. Our author also adduces the fondness of ruminants for salt and of birds for grit and gravel as cases in point, but these come distinctly under the head of diet and normal aids to gizzard-digestion. The same sort of objection applies to the great variety of water, dust, and mud-baths given by him, though, so far as the last two are directed against parasites, they may be regarded as remedies. 66 Indeed, the impression decidedly given by a careful study of the whole list is that the actual amount of really "medical" knowledge possessed by birds and animals is very slight, as would naturally be expected in view of the absence of any form of language adequate to transmit the knowledge of one generation to the next. Disease is such an infrequent and irregular factor in animal welfare, leaves such comparatively slight permanent imprints upon either mind or body when mild, and none at all, of course, when fatal, and is so very seldom inherited, that it is hard to imagine how “ remedial” instincts of any sort could well be transmitted, while the amount of therapeutic knowledge directly acquired during the brief lifetime of an individual must be very limited. Speech is absolutely necessary for the transmission of any but the most rudimentary forms of knowledge. In the realm of surgery and external applications birds and animals make a somewhat better showing, because parasites and wounds or other injuries play a much more frequent and constant part in their experience, and hence some rude idea of their treatment can both be acquired by the individual and transmitted so as to be acted upon by natural selection. And yet even here it seems to be largely a process of using the first application that comes to hand. Nearly all birds and animals use dust-baths or mud-baths of some sort to protect themselves against vermin, and some are said to exercise a choice between different sorts of mineral-laden earths. Sea-birds are said to seek fresh water to bathe in. The dog in particular and carnivora in general cleanse and soften their wounds by licking until a sort of plaster forms over them, composed of saliva, hair, and dust. The elephant blows dust from his trunk over his surface-wounds, or covers them with mud, and even plasters up bullet-wounds with the same materials. He will also cover his sun-scorched back with cool green leaves. Tradition declares that the pig is the original inventor of the mud-bath—which seems tolerably obvious-and that several of the mineralsprings of Europe were discovered by the swine-herds whose pigs resorted to them for the cure of skin erup tions or diseases. The famous waters of Bath are said to have been brought to human notice in this way by the swine of Prince Bladud. Nowadays such things are done by syndicates-which is much better. In fact, animal medicine and surgery are at best extremely primitive and blunted, and most of widespread popular beliefs to the contrary are either superstitions or due to misunderstandings. The fondness of cats for catnip, for instance, is solely due to the similarity of its odor to the feline genital secretions. The mongoose does not depend on an herb to cure him of cobra-bite, but upon his extraordinary agility and skill in avoiding the snake's stroke, and most such "cure" and "antidote" stories have little better foundation. SOCIETY PROCEEDINGS. NEW YORK ACADEMY OF MEDICINE. General Meeting, December 19, 1895. JOSEPH D. BRYANT, M.D., President. VAGINAL VERSUS ABDOMINAL SECTION IN DISEASES OF THE FEMALE PELVIC ORGANS. DR. W. M. POLK read a paper with this title. (See page 2.) DISCUSSION. DR. E. W. CUSHING, of Boston, opened the discussion. He said that there could be no longer any doubt in the minds of those who had studied the evolution of vaginal hysterectomy that the resources of our art had been wonderfully increased by the introduction of morcellation of the uterus, and it was very significant that in the face of opposition the method had steadily increased in popularity, until now it numbered among its advocates some of those who at first had most bitterly opposed it. There were still many, however, who believed with an eminent surgeon in this country that vaginal hysterectomy for pus-tubes was "blind, ignorant, and cowardly." The question at the present time was really between total abdominal and total vaginal removal of the uterus and appendages. By splitting the uterus in half the organ could be brought down much further, and by successively dividing these halves it could be made to descend gradually and rotate anteriorly, thus bringing into view any adhesions that might exist. Clamps were applied to the vessels of the broad ligament under the guidance of both sight and touch. By this method of operating the uterus could be safely and quickly extirpated, even when bound down by firm adhesions, and fibroids up to the size of a cocoanut could be removed with far less shock than by abdominal section. The simplicity of this method and its comparative freedom from danger could hardly be believed by one who had not had the opportunity of seeing it done by an expert. If the tubes are full of pus, they may be opened and washed out without soiling the peritoneal cavity. Want of space between the ischia and a tumor over five inches in diameter are serious contraindications to the vaginal operation, and where there are many adhesions to the intestine one not thoroughly familiar with the vaginal route should not attempt to operate by this method. It was generally accepted, the speaker said, that the vaginal operation was best in the severest cases-those in which there are large purulent accumulations from tubo-ovarian abscesses, or from suppurating hæmatocele where the pus is roofed in by dense adhesions of bowel and omentum. When it is not certain that both appendages are involved the vaginal vault can be opened behind, or, still better, anteriorly, and the question of the removal of the appendages determined by inspection. The advantages of the vaginal operation were diminution of shock, freedom from abdominal wound and scar, and from the liability to hernia. DR. CUSHING then projected on a screen a large number of photographs taken during a vaginal operation, and exhibiting the various steps in the technique, as well as the facility with which the uterus and associated tumors could be brought into view and carefully examined. DR. W. T. LUSK said that it was particularly interesting to hear from Dr. Polk on this subject, as he had been the pioneer in this work in this city. When it had been proposed in Brussels, in 1892, to substitute the vaginal route for the abdominal method in doing much of our work, the speaker said that he had received the suggestion with impatience, but his attention had been called to the method by the great rapidity of convalescence of patients operated upon by the vaginal route, and he had at last become a convert to the vaginal operation. The capabilities of the method had been strikingly demonstrated to him by a personal observation of the work of such surgeons as Péan, Pozzi, Ségond, and Jacobs. Notwithstanding the length of time required for the removal of fibroids by the vaginal route by morcellation, it was worthy of note that the operation had scarcely an appreciable effect on the patient. In cases of double pyosalpinx, in which the uterus was removed first and the tubes afterward, the vaginal method was certainly safer than the abdominal. He had hesitated longest about employing the vaginal route in cases in which it was desired to do conservative surgery on the appendages, and he still thought that the abdominal route was the better for this class of cases except where a free anterior incision was employed. By the latter procedure it was usually possible, if the tubes were not greatly enlarged, to detach the tubes, and bring out first one cornu, then the fundus, then the other cornu, and lastly the tubes. There was no more shock attendant upon this procedure than followed ordinarily an amputation of the cervix. On its merits alone, he would say that the vaginal operation was the coming method, but there was another reason, and that was that the women were beginning to insist that they should be operated upon in this way. In closing, the speaker cautioned those who wished to change to the vaginal method to go slowly, and select for a trial of this method only the simpler cases. He felt sure that these vaginal operations would be followed by much less discomfort to the patient. DR. J. M. BALDY, of Philadelphia, said that he believed he was almost alone here in opposing the vaginal operation. He had no quarrel with the beauties of the vaginal method, nor did he question many of the advantages and results, but he felt that the two routes had not been compared with sufficient care. He was positive that there was as little shock after the abdominal operation as after the vaginal operation, and also that the peritoneal cavity was opened almost as frequently by the vaginal route. He also contended that it was infinitely more reliable to operate through the abdomen with the patient in the Trendelenburg position than to operate by the vaginal route, because in the former one had the aid of both sight and touch, and was in a much better position to determine whether an operation should proceed further or terminate as an exploratory incision. In comparing the two methods of operating, great stress was laid upon the very slight degree of shock observed after the vaginal operation; but in his experience shock was not a great element in pelvic surgery. To be sure, the pulse often became weak after the operation, but this was usually due to the withdrawal of the ether. Another common argument of the advocates of the eral terms. He would like to ask Dr. Polk and Dr. Cushing how many vaginal operations they had done, how many deaths they had had, and how many fistulæ they had met with. DR. POLK replied that his mortality had been 3 in 72, and the fistulæ 2 in 73. DR. CUSHING said that he had had about 75 vaginal hysterectomies, with 5 deaths; and of this number there had been 2 urethral fistulæ and I fistula of the bladder, all of which had been cured. In a recent series of cases there had been 20 vaginal operations, with I death. All his operations had been complete. vaginal operation was that hernia was avoided. Hernia | presented, but everything had been stated in very genafter abdominal operations was now comparatively rare and was perfectly amenable to proper and timely treat- | ment; moreover, a number of cases of hernia following vaginal hernia had already been reported. Any surgeon would agree with him that a vaginal hernia was much more difficult to treat than an abdominal hernia. The bright side of the vaginal method had been very ably presented, but nothing had been said about the alarming proportion of fistulæ following this operation. Most operators by the vaginal route had included fifteen or twenty cases of fistulæ in their lists of these oprations, and many of them had spoken of the difficulty of curing them. Sometimes an abdominal operation was demanded for the relief of this serious complication of the vaginal operation. Injury to the ureters was not at all uncommon, and by the vaginal method the operator was ignorant of the existence of the complication. Three times in his own experience he had injured the ureters in abdominal operations and only discovered it just in time to rectify the difficulty. One of the great objections to the vaginal method was the incompleteness of the operations. He had never seen a vaginal hysterectomist do a complete operation. As an expert operator required nearly twice the time to operate by the vaginal route as by the abdomen, this prolongation of the etherization was a matter for serious consideration. Nor could he accept the statement so persistently made, that convalescence was much quicker after the vaginal operation. The abdominal operator believed that his patient was better off in bed for four weeks after the operation, irrespective of her recovery surgically; the vaginal hysterectomist allowed his patient up as soon as she was surgically well. After considering all these arguments, and duly weighing them, he was free to confess that in his opinion the balance was in favor of the abdominal operation, sentiment not considered. DR. E. B. CRAGIN said that the first vaginal cœliotomy he had ever seen had been done by Dr. Polk, and the more he saw of vaginal work the better was he pleased with it. All surgeons must have noticed a certain depression of the patient after abdominal operations, and without stopping to consider whether or not this was shock, he would say, further, that all must have noticed also that this depression was not so great after the vaginal operation. He could not agree with Dr. Baldy in excluding from the cases suitable for vaginal operation large pelvic intraperitoneal abscesses. These were exactly the cases in which the vaginal operation showed its superiority. Since March 2, 1895, he had performed 55 vaginal cœliotomies, of which 42 were for diseased appendages. According to his experience, therefore, about 75 per cent. of cases of diseased appendages were suitable for the vaginal operation, and the remainder for the abdominal operation. He believed that there was more danger of injuring the rectum in the vaginal operation, yet, as Dr. Baldy had said, the ureters were likely to be injured in abdominal operations. He believed that the vaginal operation gave better results, both immediate and remote, and that vaginal hysterectomy was an operation that had a future. DR. CHARLES P. NOBLE, of Philadelphia, said that the arguments in favor of the vaginal route had been DR. NOBLE said that in comparing the two methods of operating one should consider the mortality, the morbidity, the sequelæ, the mode of convalescence, and the ability to deal with complications. The mortality was very low by both methods, although it was somewhat less by the abdominal method. It depended chiefly upon the operator. The morbidity after abdominal operations was not more than 5 per cent. in his experience. Adhesions occur with both methods. Most operators reported about 10 per cent. of incomplete vaginal operations, which should be contrasted with the small number of infected pedicles in the abdominal method. He thought that there was but little doubt about bowel and bladder fistulæ being more frequent after the vaginal operation. His own cases of vaginal hysterectomy had been in hospital as long as the abdominal hysterectomies; in fact, he thought convalescence was more rapid after the abdominal operation. By the abdominal route, in his opinion, it was far easier to cope with complications arising during the operation, and also to control the hemorrhage. The use of clamps to arrest hemorrhage was at best very crude surgery. As he had recently reported 200 cases in which the abdominal wall had been united with buried silkworm-gut sutures for the relief of hernia, and without a single relapse, the argument that the abdominal operation should be avoided because of the frequency with which it was followed by hernia should have but little force. Where the facilities in a hospital for securing asepsis were poor he would prefer to operate from below. He was prepared to believe that by anterior colpotomy one could remove small fibroids, but for larger tumors he would greatly prefer abdominal section to the vaginal operation with morcellation. He would likewise prefer the abdominal route in dealing with tubal pregnancy, except in the few cases in which there was a suppurating hæmatocele. The operation from below was likely to result in the unnecessary sacrifice of ovaries in this class of cases. He did not wish it to be understood that he was opposed to all operating through the vagina, but he would reserve this method for cases of large pelvic abscess, and where the women were very fat. DR. H. J. BOLDT said that his conclusions regarding the comparative advantages of the two methods had been formulated only after a large experience with both abdominal and vaginal operations. The vaginal operation was applicable to tumors of considerable size, provided the neoplasms were movable, to cases of tubal pregnancy before rupture, or after rupture and cessation of hemorrhage, and to fibroids which did not extend more than three or four fingers above the symphysis. seemed to be a general agreement regarding the greater simplicity of the abdominal route, and although it was a general rule that the easier the operation the better the work done, this proposition did not hold good if in attain The submucous and interstitial fibroids were most successfully treated in this way. For other fibroids, and for neoplasms in virgins, he considered abdominal hysterectomy preferable. It was quite possible to do a complete operation in nearly every case by patient and care-ing this ease of operation it was necessary to do violence ful work. The risk of injuring ureters and bowel was about the same in the two methods. He had never seen a vaginal hernia. While admitting the possibilities of the vaginal method, he felt that a more satisfactory diagnosis could be made by a free abdominal incision. DR. H. N. VINEBERG said that he was among the first to introduce the operation of vaginal incision, which was the forerunner of vaginal section in conservative surgery. He had reported several cases last March. His experience was entirely opposed to the view that the tubes and ovaries could be resected more satisfactorily by the abdominal route. The vaginal operation was particularly appropriate to these cases, because they were often associated with retroversion, a condition which could be readily relieved at the same time by sewing the uterus to the vaginal wall. He could not see that Alexander's operation offered any special advantages over anterior vaginal fixation. DR. PAUL F. MUNDÉ said that the discussion thus far was calculated to convey the impression that all the New York surgeons had been converted to the vaginal procedure, which was far from the truth. He had extirpated the uterus per vaginam for cancer 27 times with 24 recoveries, but as he had secured just as good results, and more easily, by the suprapubic route, he would not care to employ the vaginal method in these cases hereafter. There was certainly no more shock following the abdominal section. As was well known, he was not given to operating frequently on fibroids, but out of the 33 abdominal hysterectomies that he had performed for this condition, 4 had died. The abdominal operation was certainly easier than the vaginal. He had long maintained, and in the face of much opposition, that all fluid accumulations were best operated upon through the vagina, and he was glad that this method now had an increasing number of advocates. He would limit the vaginal operation to cases of pelvic abscesses in which the vagina was roomy and the sacs could be drained or enucleated. to important structures. The peritoneal cavity was just as likely to be opened in the one method as in the other. When the time consumed in suturing the abdomen was considered, it was evident also that there was no very great difference in the time occupied by the two operations in a given case. He had made no mention of cancer in his paper because he was not decided as to which operation was the better one. He was inclined to think, however, that we were justified now in performing abdominal section, and in adding to the old Freund operation the removal of the broad ligament and of infected glands. It so happened that those who had participated in this discussion had not grasped what he considered the great underlying principle, viz., that peritonitis usually originates in the lower part of the pelvis in close relation with the vagina, and that by early incision into this structure it was possible, with little or no risk to the patient, to cut short diseased processes and save important structures in the pelvis. Having once adopted this practice of early operative interference by the vaginal route, he felt confident that all the objections that had proved such stumbling-blocks in this discussion would be forever wiped away. NEW YORK NEUROLOGICAL SOCIETY. Stated Meeting December 3, 1895. EDWARD D. FISHER, M.D., President, in the Chair. GRAVES'S DISEASE-ŒDEMA OF THE eyelids. DR. J. ARTHUR BOOTH presented a case of Graves's disease with the presence of a rather rare symptomoedema of the eyelids. On inspection the diagnosis of Graves's disease had been made, but the examination had revealed no exophthalmos. There was, however, slight enlargement of the thyroid and a rapid pulse. The patient, a girl, aged seventeen years, was very much frightened when quite young. She had some convulsions following this incident. About the time of her first menstruation œdema of the eyelids first appeared. She now complained of palpitation of the heart, profuse sweating, headache, and general weakThis oedema, the speaker said, was not a true oedema, as it did not "pit" on pressure. The movements of the lids were harmonious. On palpation swelling and diffused hardness of the thyroid could be made out. When seen about one month later, i. e., December 2d, there was apparently a slight prominence of one eyeball. Four examinations of the urine had been made, but nothing abnormal discovered. DR. E. E. TULL exhibited a specimen to demonstrate the completeness of the vaginal operation. He had done 50 operations of this kind with 2 deaths. These deaths were due to purely accidental causes. He could not understand why some surgeons used so many ness. He had recently removed a clamps and ligatures. tumor weighing ten pounds, and in this operation had used only one clamp and two ligatures. DR. W. GILL WYLIE said that although he had done about 1500 abdominal sections he had resorted to the vaginal route only 100 times. Out of these 100 vaginal hysterectomies there had been only one fatal case, and he attributed his excellent results largely to the fact that these vaginal operations had been done in a favorable class of cases. The abdominal method was assuredly the one admitting of more general application, and if the great surgeons of France had been as expert in abdominal surgery as the American and German surgeons he was of the opinion that the vaginal method would not have been so strenuously advocated. DR. POLK, in closing the discussion, said that there CEREBRO-SPINAL SYPHILIS. DR. CHRISTIAN HERTER presented a young man, aged twenty-eight years, who gave a history of having had a chancre two years ago, and about one year thereThe after developing various cerebral symptoms. vision was first observed to become diminished in the right eye; then there was ptosis on that side, paralysis |