THE AMERICAN PRACTITIONER AND NEWS. Vol. 20. "NEC TENUI PENNÂ.” SATURDAY, NOVEMBER 30, 1893. No. 11. D. W. YANDELL, M. D., LL.D., and H. A. COTTELL, M. D., Editors. A Journal of Medicine and Surgery, published every other Saturday. Price, $3 per year, postage paid. This journal is devoted solely to the advancement of medical science and the promotion of the interests of the whole profession. Essays, reports of cases, and correspondence upon subjects of professional interest are solicited. The editors are not responsible for the views of contributors. Books for review, and all communications relating to the columns of the journal, should be addressed to the Editors of THE AMERICAN PRACTITIONER AND NEWS, Louisville, Ky. Subscriptions and advertisements received, specimen copies and bound volumes for sale by the undersigned, to whom remittances may be sent by postal money order, bank check, or registered letter. Address JOHN P. MORTON & COMPANY, Louisville, Ky. ANESTHESIA STATISTICS. The Medical News of the 23d instant quotes from the Archiv. für Klinische Chirurgie (B. li, H. I. p. 91) the results of a collective investigation, instituted by the members of the German Surgical Society of Berlin, of "the frequency and fatality of anesthesia induced by various agents and combinations." The statistics are compiled by Dr. Gurlt, and extend over a period of five years. The anesthetics employed were chloroform, ether, chloroform and ether in combination, chloroform, ether, and alcohol in combination, ethyl bromide, and pental. The record for chloroform is 201,224 cases with 88 deaths, or I: 2,286. That of ether is 42,141 cases with 7 deaths, or 1 : 6,020. Of the mixtures, chloroform and ether were tested in 10,162 cases with 1 death (1: 10,162). Chloroform, ether, and alcohol have a record of 5,744 cases with 1 death (1: 5,744). Ethyl bromide was used in 8,967 cases with 2 deaths (1: 4,483). Lastly, pental, which was employed in 631 cases, scored 3 deaths (1: 210). According to this showing, ether, uncombined, holds the score against chloroform by about two and a half to one, while ether and chloroform in combination are safer than chloroform alone by a ratio of nearly five to one, and safer than ether alone by about one and a half to one. Ether, alcohol, and chloroform (A. C. E. mixture) beats chloroform by more than two to one, but falls notably behind the record of ether uncombined and ether and chloroform combined. Of the less familiar anesthetics, ethyl bromide makes a clever showing alongside of ether, and beats chloroform nearly two to one. Pental, however, is in disgrace, and we should say ought not to show its face again in aristocratic anesthetic society. It is remarkable, in view of the above and past similar statistical data, that chloroform continues to be the favorite of surgeons in general. The reason is perhaps the ease with which it may be administered, the promptness of its effect, and the almost complete absence of remote ill consequences attending its use. It will be seen by the above data that chloroform is the favorite of the German Surgical Society, and probably of German surgeons generally, since it was preferred to ether in about the proportion of five to one, and to the chloroform and ether mixture in the proportion of about twenty to one. It would seem from such data that the A. C. E. mixture, once so popular in this country, must yield place to the simpler A. C. mixture, and that in choice of an anesthetic ether (except in the face of positive contra-indications) should be preferred to chloroform. But perhaps the figures are misleading. "Nothing," says Carlyle, "lies like figures except facts," and probably not until the falsehoods of the every-day surgeon's facts are more than balanced by the misleading deductions of the statistician's figures will the universal favorite be set at naught. Notes and Queries. INSANITY AND CRIME.-The trial of Robert Allen Coombes, a lad aged thirteen, upon an indictment and coroner's inquisition charging him with the willful murder of his mother, was concluded at the Central Criminal Court in London on September 17th. The jury found that he was guilty of the act charged, but that he was insane at the time he did the act, so as not to be responsible at law for his actions. Whereupon Mr. Justice Kennedy, before whom the case was tried, ordered the youthful matricide to be detained in strict custody as a criminal lunatic until Her Majesty's pleasure should be known. As far as one may rely upon the press reports of the trial the jury could not well have come to any very different conclusion, and, on the whole, the outcome of this sad case is about as well as could have been under the circumstances. Perhaps the necessarily condensed reports of the trial are misleading on the medical aspects of the case, and therefore the little we say is expressed under reserve. The lad had been clever at school and well behaved. "He was a very good boy," was the testimony of his teachers. Complaints of headaches at times, the condition of excitability observed on occasions, the statements that he had heard noises at night, the fondness for sensational literature and for criminal trials-harbingers perhaps of mental disorder, as in some cases, are not necessarily so, and by themselves, as a previous history, are merely suggestive. The defense chiefly rested on the medical officer's observations made on the youth in prison since his arrest for the crime, on which was based evidence to the effect that he was insane, or at all events recurrently so, with lucid intervals. Mental excitability, changeability, and peculiarity were manifested; an erratic letter was written, and to a leading question, whether he heard voices, his reply was that voices at night told him to "kill her, kill her, and run away." Accepting as valid the conclusion that he was insane, one still would like to know how it came about that in prison and on trial for murder a lad of thirteen years and of his station in life hit upon the formula “that he felt an irresistible impulse to kill" his mother. And, in fact, according to his own statements, the murder was premeditated and skillfully planned, as well as cold-blooded and callous in its execution and concealment. Sensational criminal literature is most pernicious in its influence on the weak-minded or the lunatic at large, and there is some evidence that in the present case it was harmful.-British Medical Journal. STATISTICS REGARDING THE FREQUENCY OF INJURY TO THE EYES IN CERTAIN OCCUPATIONS.-Dr. Nieden, of Bochum, living as he does in a mining and foundries district, has had exceptional opportunities of collecting such statistics. Accurate statistics are very desirable from an accident insurance point of view. From 1884 to 1894 he treated for some eye affection 16,987 miners; 4,975 of these were cases of accident-a percentage of 29.3 per cent. Taking the different years separately, the percentage varied from 25.5 to 35.5. No very definite reason could be ascribed for this considerable difference in different years. On the whole, there was a progressive tendency toward diminution, no doubt due to extra care on the part of the men themselves. Of these 4,975 cases the right eye was injured in 51.2 per cent, the left in 48.8 per cent. Here, again, the relative proportion from year to year differed to such an extent that no conclusion could be drawn as to the right eye being on the whole more frequently injured than the left in miners. With regard to iron and foundry workers, the conditions turn out to be different. From 1885 to 1894 there were treated by Nieden 5,443 patients following these occupations, and of these 3,723, or 68.3 per cent, were cases of injury to the eye by accident. It is therefore apparent that iron and foundry workers are much more exposed to accident than miners. Of the 3,723 cases of injury, 2,085 occurred to the left eye, and only 1,638 to the right, the relative proportion being as 56:44. A very similar proportion held good in each separate year, so that the conclusion is arrived at that in these workers the danger to the left eye is greater than that to the right. The proportion was found to be even more marked when the severe cases alone were considered; for instance, the left eye was quite lost in seventeen cases, the right only in seven. Nieden considers, then, that in ironworkers the loss of the right eye should be calculated the more serious, inasmuch as the individual runs then a greater risk of injuring the remaining eye than when he has lost the left.Edinburgh Medical Journal. ANAL FISSURE OR ULCER.-Cripps (British Medical Journal, July 20, 1895.) advises asking the following questions in investigating affections of the rectum : 1. How frequently do you go to the closet? 2. Do you pass any discharge from the bowel, and what does it look like? 3. Do you have any pain, and does it come on immediately after passing a motion? 4. Does any part of the body come down at stool? 5. Do you pass any blood? 6. Is the pan ever sprinkled or splashed with blood as if it had come out in a fine jet? If patients have frequent calls to the closet extending over months, one will almost certainly find either ulceration, cancer, or stricture. If consti pation is present, or if there is only one stool a day, none of these are likely to be present. If discharge comes from inside the bowel, and it is clear, it may be mucous from internal prolapse or piles. If the quantity is considerable, a villous growth or polypus may be suspected. If purulent or coffee-ground in appearance, there may be internal ulceration, fibrous stricture, or cancer. Discharges originating externally and staining the linen generally come from a fistula. Bleeding is common in almost all forms of rectal disorder, but if the pan is sprinkled with blood internal piles are almost certainly present. Any disease situated above an inch from the anus may be free from pain. Treatment. The bowel should be kept open with a teaspoonful of confection of senna, fifteen to thirty drops of fluid extract of cascara, or rhubarb, or colocynth pills. A soothing ointment of six grains of morphine to the ounce of unguentum petrolii may be applied five minutes previous to stool, and an astringent ointment, as subsulphate of iron, ten grains to the ounce of ointment, or tannic acid, twenty grains to ounce, after the stool. Another good ointment is ten grains of camphor or fifteen drops of carbolic acid to the ounce. To prepare for operation give two pills of pil. colocynth. com. gr. iv, pil. rhei com. gr. vi, divided into two pills, taken at bedtime two days preceding the operation. An hour before the operation give enema. are to be laid open and the ulcer cut longitudinally. The incision should be a third of an inch deep. A strip of gauze smeared with eucalyptus ointment is put in the cut and castor oil given to move the bowels on the fifth day. When the patient gets up he may walk, but should sit as little as possible.-University Medical Magazine. BURIED ALIVE.-The subject of the alleged burial of persons who are still alive has recently proved as fruitful as ever of barren correspondence; not one shred of evidence in support of their belief has been proved by those who write so glibly of what would certainly be, if there were any truth in their assertions, an unspeakable horror. We would make an earnest appeal to require from correspondents some sort of proof before inserting letters on this subject. When a man writes: "How often are careless doctors censured by coroners for giving certificates without seeing the body?" and, "In how many cases in ordinary practice is the examination merely perfunctory?" we ask ourselves what can the man who penned such sentences be thinking about? He never can have seen a death certificate or he would know that it is not necessary to see, much less to make any examination, however perfunctory, of the dead body, and we hope that no coroner ever yet censured a doctor for not doing that which he has no obligation to do; of course, if a medical man gives a certificate in the case of a person he has never attended during life he would lay himself open to a censure from which no amount of looking at the body after death could |