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On the 12th, with the same treatment, there was still further improvement; beef tea, milk and brandy were continued.

She fully recovered, excepting squinting of the right eye.

J. O., 18th of December, a male child seven years of age, had had two severe chills, and was very restless, complaining with pain in the abdomen and the head; tongue lightly furred, anorexia ; thirsty, constipated, inequality of the pupils, forward movements of the head restrained, pulse 130, temperature 101 deg. F., respiration 38. Applied canthraidal collodion behind each ear, turpentine to the spinal column, calomel one-eighth grain, dry, on the tongue, every two hours; tr. gelsemium eight drops every five hours.

From the 20th to the 28th the following symptoms were noticed : Severe pain either in the head, the epigastrium, or left ingniual region; rose-colored spots upon the chest or the forehead, the left pupil contracted and the right dilated, several light convulsions and rigidity of the muscles of the neck; treatment continued, with cascara to regulate the bowels, and bromide of potassium to control the convulsions.

From the 28th of December to the roth of January, with the same treatment, there was gradual improvement. On the 10th brandy was prescribed, with milk, beef tea, and milk porridge. He made a good recovery, excepting partial paralysis of the right leg.

From January 2 to April 20, I had under care nine cases, from one to six years in age; symptoms, on an average, similar to the cases described. The duration varied from three to nine weeks; recovery in all was good; the treatment was as follows, excepting the regulations in doses according to age, etc:

Tr. gelsemium, calomel, bromide potassium, when necessary to produce rest, or control the convulsions, thorough irritation behind each ear with either cantharidal collodion or cerate cantharides, turpentine to the spinal column, stimulants, and a thorough, nutritious diet.

Early recognition and a thorough knowledge of the natural history of this disease are the essential points for therapeutical management. To meet with success requires comprehensive knowledge, the ability to classify, to regard all the circumstances, and above all to recognize, at once and accurately, the primary course and cause of this disease; yet, after the minutest and the most accurate details are carried out, it is impossible to show up a large percentage of recoveries.

A MALPRACTICE SUIT: VERDICT AGAINST DEFENDANT: SUBSEQUENT AUTOPSY: ALL PARTIES WRONG.

COMPILED BY THE EDITOR.

In the Cincinnati Lancet and Clinic, of December 28, 1878, Dr. I. A. Close, of St. Clairsville, Ohio, made the following report:

"A malpractice suit. Sutton vs. Hollingsworth.-The following is a brief report of a malpractice suit tried in the Court of Common Pleas, Belmont County, Ohio, December 14, 16, 17 and 18, 1878. D. D. Cowan and J. H. Collins, for plaintiff; W. S. Kennon and St. Clair Kelley, for defendant. The case is of peculiar interest in this vicinity, as it brought out very conflicting testimony from a number of prominent medical experts.

"The plaintiff, Samuel Sutton, then about 68 years of age, on the 2d day of August, 1877, received an injury to his right hip by being thrown from a wagon. On the next day, the defendant, George Hollingsworth, M. D., was called to attend to these injuries. After making an examination of the case, he expressed his belief that there was neither a dislocation nor fracture present, and proceeded to treat the injury by cupping. The testimony was somewhat conflicting as to the minuteness of the examination, as well as to the discharge which the defendant claimed to have received; viz., that the plaintiff told him that if he (the plaintiff) needed anything further he would send for the defendant.

"A few weeks afterwards Dr. G. S. Wellons, of Barnesville, while in attendance upon another member of Mr. Sutton's family, had his attention called to the defendant's case, and was led to suspect the presence of a dislocation.

"At his request, the plaintiff was brought to his office, at Barnesville, a few days after, when he and his partner, Dr. O'Brien, made a minute examination and concluded that there was a sacro-ischiatic dislocation. Sometime about the last of September, 1877, the patient was taken to the Columbus Medical College, where, at a clinic, he was examined by Drs. Hamilton, Gay, Kinsman, Wellons, Baldwin

and others, all of whom were of opinion that the head of the femur was in the sacro-ischiatic notch. Both Reed's and Sutton's methods of reduction were employed without effect. Sometime afterward Mr. Sutton brought action against Dr. Hollingsworth for $10,000.

"The medical testimony in this case was very conflicting. Drs. Henry West, J. E. West, Close, and Hewitson, of St. Clairsville; Drs. Judkins, Wellons and O'Brien, of Barnesville; Drs. Lindley, Schooley, of Belmont; Hogue, of Morristown; Estep, of Laydsville, were summoned as experts. An examination of the plaintiff was had, at which the above named physicians were present. Drs. Estep and Scooley, who had previously made an examination, at the request of the defendant's counsel and concluded that there was no dislocation present, pronounced the injury an impacted fracture of the neck of the femur. Drs. Close and Henry West, who had applied Dawson's test and found about three-fourths of an inch difference in the height of the knees, rejected the idea of a dislocation, inclined to the belief in an impacted fracture of the neck of the femur. The same view, substantially, was held by Drs. Hogue and J. E. West. Drs. Judkins and Hewitson believed that there was a dislocation, but that the head of the femur was not in the ischiatic notch, but at some point between that and the acetabulum. Drs. Wellons and O'Brien still held that there was a sacro-ischiatic dislocation.

"The marks upon which they all agreed as being present were slightly restricted motion, inequality of length of the limbs, and anterior projection of the lumbar arch. The toe appeared to be everted at the last examination, while as appeared from the testimony of Drs. Hamilton, Kinsman, and Baldwin, taken by deposition, there had been inversion at the examination at Columbus. This Dr. Judkins accounted for by supposing a rupture of the ilio-femoral ligament by the manipulation at the clinic at Columbus.

"Depositions of Drs. Hamilton, Kinsman and Baldwin, had been taken in behalf of the plaintiff to show the presence of dislocation; and afterwards in behalf of defendant to show the obscurity of the form of dislocation claimed.

"It is the province of the juries to decide when doctors differ. Verdict for plaintiff. Damages $700.00."

Learning, incidentally, that the plaintiff in this case had died several years ago, and that an autopsy had been held, we obtained the following from Dr. G. S. Wellons, of Barnesville :

"In the case of Sutton v. Hollingsworth, which was before the courts of this county, some years ago, a verdict was given for Sutton for $700, which amount was paid. The plaintiff died several years later, and the autopsy resulted in ascertaining that there was an intra-capsular fracture, and a false joint within the capsule. The head of the femur was in its socket, with the teres ligament sound. Neck absorbed. Trochanter resting on the margin of the cotyloid cavity.

"Sutton was before the class of the Columbus Medical College in 1877, when Dr. Hamilton examined him and diagnosed ischiatic dislocation, and attempted to reduce it by manipulating and also the pulley, assisted by Drs. Gay, Baldwin, Kinsman and myself; but after two and one-half hours failed to reduce it.

"Without reflection on any one, I simply call attention to the uncertainty of human diagnosis. The fracture was of long standing-52 days-and of course the symptom of crepitus was lost when he appeared before the class.

"The evidence before the court favored dislocation. All the signs and symptoms of an ischiatic dislocation were manifested in this case: shortening, inversion, arched spine, Symes' symptom, knees perpendicular (Dawson), not increased mobility, etc., yet there was no dislocation.

"This case is of some interest to the profession, as showing clearly the uncertainty of diagnosis in hip joint injuries."

TRINITRIN (NITROGLYCERINE).

BY J. A. LEPER, M. D., COLUMBUS, O.

Read before the Central Ohio Medical Society.

In reviewing the literature of this drug, as to the physiological action and therapeutical uses, and noting the many complimentary articles written in its favor, especially as a cardiac stimulant, diuretic and vascular sedative, I was induced to purchase a bottle of Wyeth's Compressed Triturates, containing gr. 1-100. This was

perhaps a year ago. I carry a small vial constantly with me, and find its use indicated in about the same ratio as I do morphia.

The real physiological action of the drug I do not think is definitely understood. The opinions given are merely hypothetical. Brunton says its action resembles nitrite of amyl and other nitrites, but is more persistent, and that possibly nitrous acid being set free in a nascent condition is more active than it would otherwise be.

Bartholow says it lowers the vascular tension by dilating the arterioles; that it increases the rate of the hearts movements, and lessens that irritability of the nervous system which finds expression in spasm; especially of the nervous system of organic life.

Sajous, in Annual Medical Sciences, says, nitroglycerine is to be used when there is a defect in the equilibrium of the vascular tone, and the blood is irregularly distributed, no matter what the cause may be.

In reflecting on its effects upon the vascular system, we might say that local congestion of the internal organs may be prevented— the medicine acting like a blood letting. For instance, acute congestion of the lungs may be aborted; the extravasation of blood into cerebral tissues by apoplectic strokes hindered; an intense congestion of the kidneys repelled, etc. Dr. Kloman's article, which appeared N. Y. Med. Jour. sometime ago, in which a patient who had been exposed to the fumes of coal gas, was treated successfully with only 1-50 gr., hypodermically, is confirmatory of the above, as is also the case of Dr. Crossland, of Zanesville, in which the patient had been exposed to coal gas almost the entire night and was resuscitated in a few hours, although much larger doses were given; that is, from 15 to 20 minims of a one per cent. solution at intervals varying from thirty minutes to two hours. The disparity in the size of the doses given in these two cases is rather confusing.

At the trial dose the physical condition of the patient is to be noted; the character of the radial pulse, and the peculiar sharp pain in the head, which is always experienced when the physiological effect of the drug is being obtained, constitute the best index, in my opinion, for determining the dose of the drug.

One important test that I have made with the drug was in a case of heart failure, in which, after giving increased doses of digitalis, the amount of urine fell. Nitroglycerine was substituted, and within a few days the urine again arose to normal.

I usually give the drug in all forms of cardiac weakness-vertigo, coldness of the extremities, syncope, dyspnea, cerebral anemia, and in any form of local congestion or extravasation. In the ma jority of these cases the pulse is found slow and of low tension. already mentioned, the condition of the pulse is the best indication for the employment of the drug, and the dose to be given. The na

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