ARE OPERATIONS UPON THE MAM MARY REGION SPECIALLY APT TO CAUSE RESPIRATORY FAILURE DURING ANESTHESIA? mammary tumor. An almost fatal ending tc chloroform anæsthesia the other day set the writer thinking, as it usually does the man in whose case the cat hesitates as to which side of the fence to jump. The patient was a strong, well-developed young man, in whose case one would least expect trouble. The operation to be done was the excision of a small The circumstances need not be noted except that though the conjunctival reflex was completely abolished, the patient winced perceptibly on the incision being made, but was not aware of having done so, when consciousness had returned, the knife being drawn outwards towards the axilla from a point 11 inches or so to the inner side of the nipple, past it for the same distance. Previously to this the heart had slowed too quickly and become somewhat irregular, but not alarmingly so. Now the respiration began to go wrong, each successive cycle being more shallow than the last, till it ceased altogether. Amyl nitrite, ether subcutaneously, depression of the head and vigorous artificial respiration induced the respiratory centre to resume its control of the situation in a few moments. Had the sensory impression made by the knife anything to do with the failure of respiration? The nervous mechanism involved is as follows:-The region of the incision is supplied in the male by the 4th intercostal nerve, with the 3rd and 5th, the nipple in the male being constantly in the 4th interspace. The twelve intercostal nerves communicate at the root of the ribs, on the inner or juxta-vertical end of the internal intercostal muscles, with the dorsal ganglia, usually twelve in number, of the sympathetic nervous system. These dorsal ganglia have two sets of branches in addition to that set, which strings them together into a chain, an external set communicating with the intercostal nerves, and an internal set. This internal set, usually twelve in number, is divided into two sets of six, the lower six going to form the three splanchnic nerves, and the upper six, which are very much smaller, going to communicate freely with the anterior and posterior pulmonary branches of the pneumo-gas trics, the two sets of interlacing fibres forming the anterior and posterior pulmonary plexuses. In particular, the internal branches from the Brd and 4th ganglia go to the posterior pulmonary plexus. The sympathetic ganglia reflexly affected by an incision at the nipple, would thus be the 3rd, 4th and 5th, probably all three, the pneumogastric nerves complete the nervous chain necessary for the transmission of impressions to the floor of the fourth ventricle, where the respiratory centre lies in close proximity to the pneumogastric nuclei, and between them. The vagi throughout their whole course contain both motor and sensory fibres, and though not essential to respiratory movements, have decided influence upon them through the nervous mechanism already indicated, as, for instance, is shown by the convulsive inspiratory effort produced by cold affusion of the abdominal or thoracic parietes (though it is reasonable to suppose that that reflex muscular act is partially due to impulses arising from motor ganglion cells other than those of the respiratory centre). I am of the impression that I have seen it stated as the result of clinical observation, that operations in the mammary region are specially liable to be reflexly injurious to the respiratory centre, as are those upon the rectum. The ordinary and well-understood danger of beginning an operation before anesthesia is sufficiently profound, for fear of the paralysis of the vasomotor system which allows of " bleeding into the veins," is, of course, operative as well in mammary wounds as in any other, and all the more directly as filaments from some of the upper six sympathetic ganglia supply the thoracic aorta and its branches, which could very promptly and seriously affect arterial tension, especially in the vessels entering the neck, and so interfere to such an extent with the nutrition of the medullary centres as to leave them quite at the mercy of the poisonous anesthetic. THE SHURLY GIBBES TREATMENT OF PHTHISIS. The old search for the philosopher's stone was all in vain, and there are many pessimistic observers at the present day, who affirm that the search after a cure for tuberculosis will be equally in vain. As long, however, as this dire disease can claim to be the cause of one death out of every seven that occur over the globe, just so long will men, eager to solve the problems which its history presents, devise one means after another to stay its ravages. The last few years have seen the birth and death of several "cures" for phthisis. a certain treatment, if closely investigated, will be found to result from climatic change, tonics, and cod liver oil, so that it becomes difficult to analyze the final product, and to assign to each factor its proper place. In the Therapeutic Gazette, (Dec. 15th), Dr. H L. Taylor, of Ashvide, N.C., reports his results The sulphur gas enemata made many hopeful, with the Shurly-Gibbes method. The results may but were soon relegated to the past. Weigert's hot-air treatment, after deceiving many, was shown to have made claims physiologically impossible. Tuberculin caused Berlin to be the "Mecca" of one of the greatest of modern pilgrimages. Yet without avail. It is characteristic of most of the modern suggestions regarding the cure of phthisis, that they try to assist nature. They are not so much antagonistic to the germs of disease, as devices to act as aids to nature in her untiring efforts to lessen pathological processes. What this conservatism is, we have learned from the post-mortem table. It is to attempt to It is to attempt to surround the infecting nidus by a zone of tissue of such a nature that the former will be circumscribed in its effects and either obliterated or cicatrized. To effect this, various drugs have been introduced into the system. Chloride of zinc and cantharidinate of potash are among the most recent suggestions. Still more recently have come the experiments by Drs. Gibbes and Shurly with chlorine inhalations, together with the hypodermic injections of iodine and the chloride of gold and sodium. It is based, its advocates assert, upon scientific principles. It is capable of being used by all physicians. Under these circumstances, it is worthy of more than passing notice. In a very able article upon the treatment of tubercular disease, Dr. N. B. Shade, of Washington, D.C., sums up the indications as follows: 1. Remove the cause. That is, break up the soil in which the germs develop. 2. Restore the power of assimilating food, thereby increasing the volume and improving the quality of the blood. 3. Repair damaged lung and throat tissue. On these points doubtless all will agree, but when we come to judge the method by which these results may best be obtained we have almost as many opinions as advocates. Frequently the good results said to be due to be summarized as follows: Total cases twenty-two. Advanced cases with no improvement in their condition, six, or twenty-seven per cent. of the whole number. Advanced cases with improvement, eight, or thirty-six per cent. of the whole number. Cases which have shown very great improvement, including advanced and incipient cases, eight, or thirty-six per cent. of the total. It is impossible to compare these results with those obtained (without the injections), in those cases in which reliance was placed entirely upon climatic and tonic treatment, with attention to symptoms as they arose, for two reasons. The first is, that many cases are so far advanced that euthanasia is the one object of all treatment. They cannot oftentimes reach their homes alive. Such cases would throw the balance at once to the side of the Shurly-Gibbes treatment, and evidently unjustly. The second reason is, that, in parallel cases, the comparison could only be made with those who have refused the Shurly-Gibbes remedies, patients who have not had the courage to undergo the treatment. The temperament of such cases is against them in their battle for health. Time alone will tell whether this treatment is of any real value, its greatest drawback is the severe pain caused by the iodine injections, and the tendency to the formation of abscesses at the site of puncture. Vice-Presidents-For Ontario, Surgeon V. H. Moore, 41st Battalion Brockville Rifles; for Quebec, Surgeon-Major F. W. Campbell, I.S.C., Montreal; for New Brunswick, Surgeon Stephen Smith, Woodstock Field Battery; for Nova Scotia, Surgeon Curry, 66th Princess Louise Fusiliers, Halifax, N.S.; for Prince Edward Island, Surgeon J. Warburton, 82nd Battalion, Charlottetown, P.E.I.; for Manitoba, Surgeon Codd, Canadian Mounted Rifles, Fort Osborne, Man.; for British Columbia, Surgeon Matthews, Garrison Artillery. Hon. Secretary-Surgeon G. S. Ryerson, Royal Grenadiers, Toronto. PERSONAL. To the Editor of the CANADA LANCET. SIR, There having appeared in the Templar of March 31st, a paper published in Hamilton and the organ of the Royal Templars in Canada, a portrait and laudatory notice of myself, containing statements that are a gross violation of good taste and professional ethics, I am required by the Council of the Toronto Medical Society, to repudiate through the Medical Journals of Toronto, all connection with the parts of the article which deal with me in a professional capacity. Having been one of the organizers of the Order in this country, and having held office continuHon. Treasurer-Surgeon Halliday, 57th Bat- ously for seven years, the editor of the paper had talion, Peterboro'. Executive Committee-Drs. Lesslie, Paull, Hilliary, Osborne, Griffin, Lynch, Grasett, McCrimmon, Mitchell, Holmes, Harris and Elliot. Business Committee-Drs. Stewart, Rennie, Nattress, King and Henderson. The first annual meeting will be held June 2nd at the Canadian Military Institute, when an interesting programme will be presented. So far as we can learn the following are the papers which will be read. A paper on "The Experiences of a Surgeon during the American War," by Dr. Canniff, late Royal Artillery; Surgery during the Franco-Prussian War, 1870-71," by Dr. Warren 2nd Dragoons; "Hygiene of Camps," by Dr. McCrimmon, 20th Halton Rifles; "Gunshot Injuries of the Brain," by Dr. Daniel Clark, late surgeon U.S. A. A discussion will take place upon "The present condition of the Militia Medical Service, and what should be done to render it more efficient." In the evening the ambulance corps of the Royal Grenadiers under Assistant Surgeon King, will practically illustrate the ambulance drill and handling of the wounded in war. At the same time the competition for the prizes offered by Surgeon Ryerson for the best and smartest detachment of the corps will take place. An invitation will be sent to the executive of the Association of Surgeons of the National Guard of the U.S. to attend the annual meeting in June. Such an organization cannot but be productive of good, and from the names of the officers we augur for it a useful future. often asked permission to publish my portrait, accompanied by a short biographical sketch. This permission I had refused until a few months ago, when the editor urged it, reminding me that a similar course had been taken with nearly all the officers of the Society. I unadvisedly consented, and did not take the precaution to see the before it was published. biographical sketch before it Having worked with and been known to the editor during those years, he was quite conversant with my history, and penned the exaggerated statement on his own responsibility. In reply to a note from me, complaining of the statements made, he sent me the following: HAMILTON, APRIL 28th, 1892. DR. B. E. MCKENZIE, Toronto, Ont. Dear Sir and Brother,-Replying to yours of the 26th April, I desire to express my sincere sorrow if any blunder or mistake of mine has placed you in an unfavorable position before the profession. I am very sorry now that I did not consult you with regard to the brief sketch before it was published. Newspaper men easily fall into a hurried, reckless way of slashing off matter of this kind without any thought of the technical etiquette of any society or profession. I make herewith the emphatic statement that you had no knowledge whatever of the character of text which accompanied your portrait, and that it was written without any consultation whatever with you. We took the liberty to deal with you as we did with other officers of our Association, looking at the matter purely from a society standbrethern in the most favorable light. point, with the desire of presenting you to your Yours fraternally, W. W. BUCHANAN. To the Editor of the CANADA LANCET. SIR, I have been favored with a communication from Mr. Pyne, the Registrar of the College of Physicians and Surgeons, Ontario, threatening to "strike my name off the roll," unless I immediately paid the annual subscriptions due to the College. Now, I would willingly pay up if I saw any chance of getting value received. I submit that we Canadian graduates practicing in England, have a very substantial grievance against the College authorities. It is this :— Why is not some effort made to procure the registration of the diploma in England? By the last Medical Act (1889), the British Medical Council were empowered by Parliament, with the sanction of the Privy Council, to establish in the British Medical Registrar what it was proposed to call the "Colonial List," in order that respectable Colonial degrees might register, but up to the present nothing has been done in that direction. I maintain that the M. C. P. & S., Ontario, is such a diploma, and worthy of such recognition, for this reason, that the College requires a test in both primary and final subjects; and the candidate having usually taken his degree at one of the Universities, has reviewed again the subjects of the whole medical curiculum, and is therefore likely to be fairly well up. Now, I imagine that a little judicious presure on the part of the Colonial authorities, with the British Medical Council, would convince them of the reasonableness of our claim. It does seem a disgraceful anomaly that a graduate of one of the largest Universities, of one of the most extensive and important British possessions, and M. C. P. & S., Ontario as well, should have to play second fiddle here, to a Brussels M.D. who is allowed to register it. Let your College do its duty, and extend its sheltering arm to its members abroad; let it be a privilege as well as an honor to remain a member; this is the best way to obviate the necessity of your Registrar touting for subs. Yours, DOUBLY QUALIFIED IN ENGLAND AND CANADA. London, Eng., March 26th, 1892. TORONTO GENERAL HOSPITAL. ANNUAL REPORT OF MEDICAL SUPERINTENDENT FOR YEAR 1891. The following notice appeared in the May number of the Buffalo Medical and Surgical Journal"The Toronto General Hospital has lately issued its annual report for the year ending September 30th, 1891. It is a handsome brochure of 107 pages, illustrated with lithographs and woodcuts of the hospital buildings as they formerly appeared, and as they now look with the improvements recently made. Besides the ordinary record of cases treated and their several classifications, there are divisions of the report relating to medical education, history of the hospital, description of the hospital buildings, and a roster of the trustees from 1853 to the present. The ambulance service is given in detail with illustrations, and, finally, the annual report of the training school for nurses is added. Taken all together, this is one of the most complete and useful hospital reports that we have seen, and reflects much credit upon all concerned in that institution, and especially upon the medical superintendent, Dr. Chas. O'Reilly, who has held the position for more than sixteen years. "It seems to us that this is the proper way to govern a hospital, in order that its patients may receive the full benefit of the most skilful attention. A medical superintendent who is fitted for the work will be obeyed and respected, when others will not, and thus insure perfect subordination in all the various departments." We are glad to endorse the above, and are pleased that our brethren across the line take so active an interest in our institution. The report contains very full and valuable statistical tables, and reflects great credit upon Dr. O'Reilly, the able and efficient superintendent. GOLDEN RULES OF SURGICAL PRACTICE.-Con tinued.—(Times and Reg.) :— BURNS.-Do not neglect opium for the shock of burns in children, but use it cautiously; afterwards do not stint fresh air, food or warmth. Never give a hypodermic in burns of children; you cannot recall it. Give it by the mouth, Beware of strong application of carbolic oil in burns, and if it be used at all, watch the urine for absorption signs. interfering greatly with nutrition and sleep. Nearly all the different antispasmodics had been recommended without success. Dr. Leloir then Do not dress too often; but never let the dress- thought of strongly compressing the left phrenic ings foul. nerve between the two sterno-clavicular attachNever uncover the entire wound at once; do it ments of the sterno-mastoid muscle. Digital compiecemeal. pression, which was very painful, was used for Never omit chloroform or opium in the first three minutes, after which the hiccough comdressing of extensive burns. pletely disappeared, and has never recurred. During the last five years he has used this method several times in acute and chronic cases of hiccough, compressing the nerve for a few minutes, with complete success. DISLOCATION.-Never attempt to reduce a dislocation of humerus in an old person without first examining the state of the arteries to inspire you with caution and gentleness. Never put a booted foot in the axilla to reduce dislocation. MORPHINE PARTIES IN PARIS.-The Paris cor Always reduce by some other method if ribs are respondent of the Tribune in a recent letter wrote broken on the same side. Remember that injuries to the elbow joint are often very difficult to diagnose, if much swelling co-exists; but: Never give a positive opinion of an elbow joint until you have carefully examined the relations of the olecranon, internal and external condyles, and head of radius. that he had just come from a lecture on morphine mania by Dr. Durand-Fardel. The lecturer spoke of this kind of intoxication as having stolen first on the wealthy, and now as spreading so fast to the less rich classes as to threaten to bring France to the level of China and Turkey. He showed a hypodermic syringe which was really an article of jewelry. One end was a pencil to note down Remember that in dislocation at the elbow the dance engagements on ivory tablets, and the other joint becomes rapidly irreducible. Never forget that a faulty diagnosis may cause loss of motion in the joint. Never be ashamed to say you "do not know" until the swelling has subsided, and you are able to be certain of the character of the injury. Do not forget in dislocation of the carpal bones that the great point is to see that the motions of the fingers are early restored. EAR. Never forget that rupture of the mem. brana tympani, or even fatal consequences, may ensue from roughness. Never forget that vegetable substances swell in the auditory canal on the application of water. Remember no foreign body in ear, except living insects or vegetable substances, can do harm. Syringe gently, unless the foreign body is likely to swell. A NEW TREATMENT FOR HICCOUGH.-Dr. Leloir, of Paris,, describes a new treatment for hiccough, which he first applied some years ago. He had been called to treat a girl aged twelve, who had suffered for a year from incessant hiccoughing, which occured about every half minute, end a hypodermic injector. The case was enriched with brilliants, and the tablets were attached to a ring, jewelled also, which was to be worn on the finger of the person intending to use the little instrument. He found in many instances that the initiation began at social meetings where a select company gathered to make experiments and to relate sensations. WE HOPE IT Is.-Donovan's solution of iodide of arsenic and mercury is said (Med. Rec.) to be of material service in the treatment of gleet. It is given for this purpose in the dose of ten minims, three times a day. A correspondent writes that he feels justified, so uniform has been his success in controlling a chronic urethral discharge by Donovan's solution, in calling the remedy almost a specific for gleet. PHYSICIANS AS FREIGHT.-The Ohio Legislature has recently passed a law providing that physicians in the discharge of professional duties shall be permitted to ride, at their own risk, upon freight trains between stations where such trains stop, paying therefore the regular passenger fare. |