State. A copy of each certificate should be upon file in the office of the Commission of Lunacy of the State. Such a law as should be upon the statute books would also bring about the second proposition that all the insane should be properly cared for. The law should establish by an enactment of the legislature State care and would look toward the erection, as rapidly as possible, of structures in which, under State supervision, all of the insane who must be supported at public expense should be cared for and treated in properly regu lated hospitals. The establishment of such hospitals would also bring about the realization "that the friends of individuals who are insane should be able to procure such immediate aid as the case requires." In such hospitals, established under State management, supervised by a board of State commissioners, and upheld by a well educated public sentiment, everything which tends to the advancement of the treatment of the insane in this State and its elevation to the higher standard of scientific care would soon be in operation. "Then all who are in a sound state of mind would feel that in case of becoming afflicted with insanity they would be protected. That every means, medical, moral and mental, will be patiently and THE VITALITY OF THE TURKS.-A Lancet correspondent, in commenting. on the abstemiousness of the Turks and the few drunken of that nation, says that among the many services done to the Turks by Greece in the last few weeks not the least is to have given them an opportunity of showing how and what they can endure. The Times correspondent is much struck with their eagerness to fight and with the difficulty of killing them. He mentions one man whose abdomen was penetrated by a bullet, and who not only kept his place in the ranks till the battle ended but marched ten miles afterwards. Another man with three wounds-two in the legs and one in the shoulder-continued on duty twenty-four hours until an officer noticed his condition and sent em perseveringly and scientifically ployed for their restoration to sound mind." Two citizens of this State have each contributed to the care of the insane more than has ever been given by any other two individuals in the United States, at least, for this purpose. While this will do much toward lifting the burden from the taxpayers of the State, it can not do all and it is your duty and the duty of every citizen to see that private charity does not paralyze public duty. In a year this Faculty celebrates its one-hundredth anniversary. Let us see to it that through the influence of its members working upon an enlightened public sentiment it shall at that time be the established policy of this State that all of the insane supported at public expense are its wards and that laws shall then be upon the statute book making it a misdemeanor to confine any insane person except one under arrest upon criminal charge in any jail, that all of the insane under confinement within our borders shall be subject to regular inspection, shall be carefully registered and that active steps shall be in progress to place all of those supported at public expense in State institutions. him to hospital. Sometimes our alcoholism has been associated with our daring and our endurance as cause and effect, but here are qualities of the same sort in a non-alcoholic nation. Our contemporary's correspondent remarks further on the rapidity with which wounds heal, and says that medical men attribute it to the abstemiousness of the Turks. Here we should scarcely be able to match the race whose soldiers are ill clad, ill fed, and who take no alcoholic stimulants. * * * DR. R. M. TAFEL reports, in the Medical Council, a case of death in a child who had been treated with two hypodermic injections of pilocarpine in close succession. Each dose was of a grain. The depressing action was too great. IODOFORM DERMATITIS CAUSED BY IODOFORM GAUZE. By Moses Savage, M. D., OUR text-books on materia medica often dwell at some length upon the serious constitutional symptoms caused by iodoform poisoning. Thus Dr. Schede of Hamburg describes six classes of cases of iodoform poisoning, but does not mention the cases where a dermatitis may be the only sequela of the use of this drug. Duret, however, assigns to the latter complication an important place by classifying iodoform poisoning into three forms; first, the eruptive, then the cerebral and, third, the syncopal. Whilst iodoform poisoning with grave constitutional disturbance happens, it is rather rare compared with the frequency with which various skin lesions occur, the constitutional symptoms being but insignificant, or entirely absent. Here, too, as in other instances, idiosyncrasy plays an important role. I wish to report a case of severe dermatitis caused by the use of several small pieces of iodoform gauze. A. Z., aged forty years, with a strong constitution and a clear history; occupation, blacksmith. While holding a bar of iron upon which another man was hammering, through carelessness, the latter struck him with the hammer on his left index finger. As a result of this accident the skin of the lower half of this finger, including the nail, was torn off and the last phalanx crushed. The phalanx was amputated and as the flaps were too short, healing by granulation was expected. Within ten days the wound was almost healed up, when a small piece of iodoform gauze was used, as I was short of plain aseptic gauze. On the following day the patient complained of itching and burning, the skin of the whole hand was red and slightly edematous, with a few large inflamed papules on the finger, the wound at the same time looking healthy. Not knowing the cause of the trouble the wound was carefully cleansed and again dressed with iodoform gauze; the same thing was also repeated on the subsequent day, when there was considerable swelling of the hand. The dressings were saturated with a clear liquid which was oozing through the pores of the tis sues and flowing out in large quantities upon slight pressure. The skin in the neighborhood of the wound, which looked healthy, peeled off. The patient also complained of itching of the right hand and of the left side of the face; these parts were likewise erythematous. There were no constitutional symptoms with the exception of a temperature of 99° F. I then became suspicious that iodoform might have been the cause of the trouble. Dr. J. W. Chambers saw the case and verified my suspicion. To relieve tension an incision was made on the dorsal side of the hand and the parts dressed with boracic acid. The fluid gradually diminished in quantity, the skin about the web of the fingers peeled off and the erythema of the other hand and face disappeared. In a few days later the "weeping" ceased entirely, the skin became dry, the epidermis scaled off and the patient recovered. ACUTE DILATATION OF THE HEART FOLLOWING EXERTION. SCHOTT (British Medical Journal) showed in the Verein für Innere Medicin some skiagraphs of acute dilatation occurring in children of twelve to fourteen years old. The position of the nipples was marked by little plates of lead at tached with wax to the children's nipples before the skiagraphs were taken. The dilatation was lost marked in the left ventricle. The children had been allowed to wrestle with each other until dyspnea commenced, in some cases also wearing a belt, which compressed the abdominal blood vessels. Society Reports. MEDICAL AND CHIRURGICAL FACULTY OF THE STATE OF MARYLAND. NINETY-NINTH ANNUAL SESSION, HELD AT THE HALL FIRST DAY, APRIL 27, 1897. Dr. J. C. Clarke said that he thought the insane were very well cared for in Maryland and that the laws were well kept. Dr. I. E. Atkinson thought the discussion was not taking the course it was intended; it is not a charge against any one; he knew that the care of the insane was not perfect, but he was surprised to hear Dr. Hurd say that things were as bad as he stated and can hardly believe that the condition of affairs was so bad. Justice was not done the trustees at Bay View Asylum. He had constantly seen improvements take place there that resulted in the better treatment of the insane, as well as other inmates. The deficiency existing in the care of the insane is only an argument in favor of removing all insane persons to one asylum in the State. Dr. Mary Sherwood said that the fact that insane persons are treated better at Bay View than ever before was no argument that they cannot be treated better than they are. Insane are only in almshouses for detention. No means of cure is provided. At Bay View they are only able to give one or two attendants to a ward containing from forty to sixty patients. They may care for a tramp, but not for the insane. There were 400 in the insane department and also 100 more harmless imbeciles who were scattered throughout the building. Dr. Smart considered the commitments faulty and thought the laws ought to be changed. Dr. Lee: Some said it was very difficult to get the statistics, as if the Board was at fault. It is very hard to get statistics anywhere. The blanks are distributed and sent to the superintendents of each asylum, or to the physician of each almshouse, and if he would attend to his business and It promptly return these blanks filled, the statistics would be very complete. is only the Board's duty to inspect the statistics which they receive from the heads of the different institutions. Most physicians to the almshouses take no interest because they are politically ap pointed and from these he is to get statistics. Dr. Brush said in conclusion of the discussion that he was very sorry that the executive officer of the Lunacy Commission seemed to regard what had been said upon these papers as a personal reflection, that the fault of the lack of care for the insane was not by any means wholly the fault of the Lunacy Commission, but as he had said in his paper, was due to want of education of the people on this subject, who did not understand how the insane ought to be cared for and that it was also largely the fault of the profession, which had been inexcusably negligent in not demanding the proper standard of care. He felt sure that to the agitation which the present discussion had provoked there will be a step forward in this matter and that it was the duty of the State Faculty to see to it that no backward step was permitted. He was surprised to hear any person on the floor argue in favor of county almshouse care. It was the duty of the Lunacy Commission if, as the secretary of the Commission had said in his discussion, it found persons improperly cared for in any institution, to demand the proper care. If such things were done as Dr. Lee referred to in what he termed the best organized hospitals, they were wrong and they certainly were equally wrong in almshouses; the unfortunate insane were without any regular medical supervision and only a standard of nursing which their fellow paupers could give them and with such restraint and seclusion as the caprice of the almshouse superintendent found necessary proper. He was glad that Dr. Sherwood had supported him in regard to Bay View, although that institution las vastly improved over its condition a few years ago. Some four or five years ago, at the request of the Mayor, he or had visited Bay View and had reported to the Mayor the condition of affairs as he had found it and a portion of his report was published in the papers, a part of it was probably too strong an indictment to publish and yet immediately. following this publication in the papers a member of the profession, who from actual observation ought to have known the condition of affairs at Bay View, sent a communication to one of the daily papers from which one might infer that the state of affairs at that institution, especially in the care of the insane, was one of "sweetness and light." Fortunately, the present Board of Trustees do not accept this view and he was gratified to know that it was heartily in favor of State care for all of the insane of the dependent class. Dr. Osler, at the close, remarked that unless the committees of the Faculty and society go in with the politicians, humanity will suffer in the future the same as in the past. There is lots of politics in the little town of Annapolis. Dr. Samuel J. Fort then related a "Case of Habit Spasm." (See page 96.) Dr. A. L. Hodgdon read a paper on "Alcoholic Insanity and Excess, with a Reference to the Opium Habit." (See page 93.) TUESDAY, APRIL 27. FIRST DAY. EVENING SESSION. 8 P. M. Dr. Simon Flexner opened the special subject of discussion by speaking of the "Pathology and Etiology of Peritonitis." He said that the subject was an extensive one and the manner of approaching it was difficult. He spoke of the pathology and etiology. The peritoneum is able to resist a great deal; it can dispose of foreign substances up to a certain limit. Not all parts of it carry on absorption but only a limited. part, that near the central tendon of the diaphragm. Stomata between the endothelial cells do not exist, but fluids may pass through and even solids sometimes escape they are carried through by cells. Some substances interfere with this power of absorption but quite an amount can be absorbed and even bacteriological organisms can be de stroyed as long as the peritoneum is intact. At the Johns Hopkins Hospital he had a careful record of 110 cases of acute peritonitis in man with the bacteriological examination and these cases were divided into certain groups. We must admit first of all an idiopathic or primary peritonitis; twelve idiopathic cases were in this number. In all these cases there were preëxisting conditions predisposing to this peritonitis, such as chronic heart disease, chronic kidney disease, etc. Persons subject to chronic diseases are more liable to bacteriological infection. In several cases the peritoneum was one of several serous surfaces involved in the body. There were thirty-three cases of exogenous peritonitis in which the invasion was from without and in those cases laparotomy had been performed and certain operations had been done. Finally, there is an endogenous form in which the infection is from within; it is an intestinal form. Fifty out of 10 cases which he found recorded were in the intestinal tract, from a perforated appendix or some such cause. In studying the bacteriology of these cases it was interesting to note that in the first group the staphylococcus aureus and the streptococcus were present as mono-infections. In the second group there are some mono-infections and many poly-infections, such as the staphylococcus and the streptococcus and the colon bacillus, etc. In the third group it usually comes from some injury to the intestines; there is a poly-infection such as the streptococcus and the colon bacillus together. Septic and suppurative peritonitis are terms used as if they were distinct conditions. Peritonitis in the absence of the micro-organism is very rare, but it may occur. The fibrinopurulent form is the one more usually met with. The mycotic form is one in which the symptoms run such a rapid course that there is little time for the formation of bacteria and there is very little reaction on the part of the peritoneum. This division, however, is not necessary. Dr. S. C. Chew spoke of the "Diagnosis of Peritonitis.' Dr. Charles M. Ellis of Elkton read a paper on the "Medical Treatment of Peritonitis." Dr. Randolph Winslow made some remarks on the "Surgical Treatment of Peritonitis." Dr. J. M. T. Finney reported several cases from the Johns Hopkins Hospital and also related the results from his experiments on dogs, showing how peritonitis artificially produced could be cured if operation were undertaken before a certain time in the dog. This was six and one-half days. Dr. T. A. Latimer agreed in part with Dr. Ellis and said he did not believe that an operation should be done at the very beginning. Dr. A. K. Bond said that we should not neglect purgation. This paper was further discussed by Drs. Tiffany, Uhler, J. T. Smith and Winslow. THE discussion of the paper of Dr. F. H. Williams, on "An Epidemic of Cerebro-Spinal Meningitis Caused by the Diplococcus Intracellularis Meningitidis (Jaeger)," was continued as follows: Dr. Williams said in regard to the lumbar puncture that it was very valuable in the diagnosis, but the relief was only temporary and about 70 per cent. of the cases died. The fluid was withdrawn gradually. Dr. W. T. Councilman said that the exudation in quite a number of cases had a tendency to extend along the course of the cranial nerves and in one case it was visible to the naked eye along the optic nerve, extending almost to the eye. In some cases that recovered there was loss of both sight and hearing and the eye complication was found to be due to an infection from the meninges. Dr. F. C. Shattuck of Boston said he had seen about fifteen cases and his ex perience had been that not a child died and not an adult recovered. Dr. A. A. Smith of New York then reported "A Case of Levant Fever." He said this disease had a great many names, but this was the one most generally used at the east end of the Mediterranean Sea, where the disease was prevalent. His patient was a woman who lived at Beyrout and her husband was a physician and had seen many cases. She was taken sick on July 4, 1896, and he saw her first in January, 1897. He said the fever would continue for three or four weeks and then there was freedom from fever and then there was a relapse which was more severe than the previous attack, and so on, with intervals of freedom; the temperature sometimes being subnormal. The fever still continued in this case. It was resistant to quinine. He exhibited some beautiful drawings of the blood and of the organisms which he said caused this disease and it was characterized by an absence of pigment. He said the parasite was much like Laveran's organism but was not the same thing. In reply to Dr. Shattuck, who asked if he had used arsenic, he said he had used everything except phenic acid, and in reply to Dr. Dock, who asked if there were many organisms in proportion to the blood, he said that there were a few now, but there had been more formerly. Dr. Dock said one would think this was a form of malarial parasite as described by some of the early Italian writers. The absence of pigmentation and segmentation would do away with the resemblance to the malarial parasite. We do find in some fever bodies which look like the malarial parasite and when Laveran published his observations some German writers said that they could find these bodies in other diseases. They looked too much like the protozoa and the appearance of the colored drawings made him very skeptical. We should be slow in believing that the parasite of Levant fever had been discovered. Dr. A. Jacobi New York then read a paper on "A Case of Adenoma of the Liver with Complications." |