ble to refuse the patients the possibility of relief by an the case may require, he irrigates the wound with sterloperation, all four were completely cured. He was also ized water, drying the surface with sterilized gauze. successful with several cases of non-cancerous stenosis He then applies glutol in the same manner that iodo of the pylorus. He advocates closing the stomach com form is used, covering the wound with sterile gauze, pletely, and then making an anastomosis with some cotton and bandage. For the treatment of any variety loop of the intestine near by (gastro duodenostomy), in of an uninfected wound, this method, in Dr. Hoyt's cases where it is necessary to remove a very large amount opinion, comes nearer being an ideal than any other he of substance on account of the extent of the cancerous has employed. Under its influence septic wounds rapidly growth. Intervention is always possible when the upper become uninfected. The author has been particularly part of the duodenum alone is affected and a small, pleased with glutol in cases of extensive laceration of even very small, portion of the stomach near the cardia the tissues of the fingers sustained by brake or switchcan be retained. He has performed fourteen gastro men, and often complicated by fracture of the phalanges. enterostomies, and uses the Murphy button. Doyen After cleansing the wound, reducing the fracture, and reports a total of ninety four operations on the stomach, inserting a stitch if necessary, he applies glutol, gauze, including fifty five for non-cancerous lesions, ulcers, cotton and bandage, and extends the hand on a splint. dilatation or severe dyspepsia with advanced cachexia, In a week or ten days, if the wound is uninfected, on cases abandoned by the physicians. He attributes his removal of the dressing there will be no pain or inflamma. surprising success in these latter cases to the fact that tion. The scab that has formed is so firm that no splint the dyspepsia is caused by some constriction of the is further required, and after the second dressing of pylorus, and disappears when normal communication is non-infected wound nothing need be done than to prore-established between the stomach and the intestines. tect the injured member with a clean roller bandage He has never used an anastomotic button, which he until recovery is complete. In conclusion Dr. Hoyt considers a step backward in surgery. He requires only states that glutol is inexpensive in view of the small twenty five minutes at the outside to complete the opera- quantity required, and that its application is entirely tion. Roux has twelve successes to report with one painless. failure. He makes a Y-shaped incision (gastro-enterostomy), to avoid "elbows," which are liable to occur with a lateral operation. He prefers a button to a poor suture, but considers a well made suture far preferable to any button, as the patient can begin to take nourish ment at once, a most important factor in rapid recovery. -Bulletin Med.; J. A. M. A.

OBSTETRICS AND GYNECOLOGY.

Congenital Prolapsus Uteri.-F. L. Neugebauer, of Warsaw, in a paper treating of the abnormal

A New Method of Wound Treatment.-developments of the hair (Gazeta Lekarska; Brit. Med. Some time ago, says the International Journal of Sur Jour.) describes and figures a case of congenital prolapgery, we called attention to the fact that Dr. C. L. sus uteri. According to the midwife the prolapse was Schleich, of Berlin, to whom surgery is indebted for a present at birth, but Neugebauer thinks it did not occur number of ingenious discoveries-notably infiltration till the infant began to cry. In addition to the genital an esthesia-had introduced a new antiseptic dressing malformation there was a spina bifida (myelo-meningo for wounds which promised to be a valuable acquisition cele) in the lumbar region with two tufts of black hair to the resources of the surgeon. Glutol, as the new com- below it in the middle line of the sacral region. There pound has since been called,is a whitish, granular powder, was also a marked development of the hair of the head. odorless, non-irritating and non-toxic, which is formed Along with the prolapsus uteri there was complete in by dissolving gelatine in water and drying the solution version of the vagina, commencing inversion of the in the vapors of formaline. The advantages claimed urethra, and a certain degree of anal ectropion. The for it were that when applied to the surface of a wound prolapse was ascribed to the crying of the infant and to the gelatine is slowly absorbed, with the continuous paretic relaxation of the muscles of the perineum and liberation of a small amount of formaline-a powerful, vuiva. Kraase, in whose practice the case occurred, reyet innocuous antiseptic. Despite the short time that has elapsed since the introduction of glutol, it has been submitted to extensive experimentation, and the high Tympania Uteri. Ahlfeld (Zeit. f. Geburt claims of its value made by Schleich have been fully shulfe u. Gynak.; Brit Med. Jour.) condemns the prin corroborated. From the numerous reports that have ciple of performing Porro's operation for tympania appeared on the new antiseptic we select that of Dr. H. uteri. Fritsch's doctrine that it not only stops the sepF. Hoyt, Ohief Surgeon, G. N. and C. B. and N. Rail- tic changes, but also prevents the patient from becoming ways, as well illustrating its utility in general surgical pregnant again,and running the same risks is hardly to be practice. It is his custom to employ it as follows: After accepted. The prognosis when the uterine cavity consterilizing with either bichloride,boricacid, permanganate tains fetid air during labor is far from certain, and of potash, peroxide of hydrogen, as the contingency of death is not invariable, and the rational treatment is to

moved the spina bifida sac but the infant died.

deliver the child speedily and to wash out the uterus. He boldly uses a 50 per cent solution of alcohol,and freely washes out the uterine cavity with it, in fever after delivery and septic endometritis. He finds that the pa tient suffers no pain, and no bad consequences ensue; on the contrary, all fever disappears. When blood poisoning has become general removal of the uterus can be of no avail.

NOTES: AND ITEMS

The Vienna Academy of Sciences has just opened a contest with a prize of 10,000 florins for the best work on ultra-violet light. The decision will be made in 1899.

Infected Milk.-The investigations of the New York Health Board extending into the annexed district

have shown that more than sixteen per cent of the cows are unfit for milk production.

Skiagraphic Outfit. Through the efforts of Prof. Fessenden and the Academy of Science and Art of Pittsburg, Pa., a complete skiagraphic outfit of the most approved kind will be placed in Carnegie Hall for the use of all reputable medical men.

The Germ of Yellow Fever.-A dispatch sent from Rome to a London publication states that Dr. Gaccarelli has discovered the germ of yellow fever. So many scientific researches have been made in Italy says the Medical Record which have borne fruit that we can only hope that the above report will be productive of something more definite.

Small-Pox and Yellow Fever in Cuba.Dr. D. M. Burgess, U.S.M H.S., in his recent report, states that during the week ending December 17 there were 306 deaths in Havana, 57 of these caused by small pox, with about 500 new cases, and 55 caused by yellow fever, with 150 new cases. Fifty-two of the 55 deaths from yellow fever were among Spanish soldiers.

Scribner's for February.-One of the most novel things in this issue is the appearance of C. D. Gibson as the writer of the notes which accompany his first series of sketches portraying "London as Seen by C. D. Gibson." As a writer he sees things with that fresh eye for what is significant and picturesque in character that marks his drawings. He is intensely interested in the pageant of the "London Street," and he tells you why. His drawings (made during his residence in London) are studies from real people, and suggest entirely new types. These articles, which will continue for six months, add a new Gibson gallery to the Paris and New York types already famous.

The Bubonic Plague in India and the St. Louis Board of Health.-At a meeting of the St. Louis Board of Health January 25, Health Commissioner Dr. Starkloff, submitted a communication containing recommendations for the treatment of the bubonic plague now raging in India, in the event of a case reaching St. Louis. He recommends that the Hospital Commission include in its report to the Mayor a plan for the erection of two wards with suitable out building, in which patients with this disease can be treated. The wards are to be inexpensive, and are to be torn down when there is no longer any need of them. The communication was approved.

To the Members of the American Medical Association.-Dr. C. H. Hughes, 3857 Olive Street, St. Louis, Secretary of the Section of Neurology and Medical Jurisprudence of the American Medical Association, sends out the following request:

DEAR DOCTOR-The Section of Neurology and Medical Jurisprudence of the American Medical Association, which meets with the Association at Philadelphia, June 1-4, would be pleased to be honored with a paper from you at the forthcoming meeting, and I should myself take it as a personal favor if you would so favor the Section. Please designate any subject you would. like to see discussed before the Section, yourself taking part therein. Yours very truly,

C. H. HUGHES, M.D., Secretary.

Review of Reviews.-The public seems never to grow weary of hearing about Rudyard Kipling and his achievements, though much of what is said in print about him is sorry stuff indeed. It is refreshing to find The St. Louis Death-Rate and That of in the February number of the Review of Reviews a Other Cities.-The death rate in St. Louis is smaller candid and unpretentious, but not the less exhaustive, than that of any one of the nine cities which have al-critique of Kipling which really does justice to the ways been used for purposes of comparison. Mr. Mor author's personality without "gush" and without the ris Jacks, of the Health Department, recently tabulated senseless exaggeration so common in articles of this the official returns for the first quarter of 1896, showing kind. The writer, Mr. Charles D. Lanier, has given us that the rate in St. Louis was 10.7 per thousand; in an interpretation of Kipling which is frankly sympaChicago counting city and country, 17; Baltimore, 17.9; thetic and at the same time irresistibly attractive. San Francisco, 18; Cincinnati, 20; Brooklyn, 21; Philadelphia, 22.3; New York and Boston, 23, and New Orleans, 31.

East St. Louis Medical Society.-The physicians of East St. Louis held a meeting in the office of

The document was approved by the Board in the fol matic type are commonly met and 'Antikamnia and lowing resolution:

MEDICAL REVIEW.

VOL. XXXV.

A WEEKLY JOURNAL OF MEDICINE AND SURGERY.

ST. LOUIS, MO., FEBRUARY 6, 1897.

ORIGINAL ARTICLES

Neurasthenia.'

BY JOHN A. HALE, M.D., ALTO PASS, ILL.

In presenting for your consideration this contribution to the study of neurasthenia, I feel my inability to do justice to a subject so fraught with importance to the many who have been called upon to relieve this distressing condition so frequently met with in daily practice of our professional duties among the artificial lives of modern society.

Believing that good results from essays read at society meetings, are not brought about by a conglomeration of statistics and their concomitant reference, but by the personal experience related by the intelligent physician concerning the impressions he has received at the bedside of his patients, I shall not, in the limited time I have allotted to me, indulge in the abstruse theories or bewildering hypotheses, and the specializations of the etiological factors of neurasthenia.

I only wish by this paper to place before this Asso ciation the subject of neurasthenia in the light of an important condition from the standpoint of the general practitioner, and to further inspire observation in this direction, until the subject be illumined on all sides by the broad consideration of the man of general practice, and not left to the specialists to be considered as a field of their own.

My presentation of this subject may seem crude and rather bold, but in the category of nervous affections no other disease or condition, it seems to me, has been so clearly ignored by many great teachers and authorities of the past and present.

In considering the subject, for convenience, I shall classify it under two heads-Organic and Psychological, each presenting certain clinical phenomena which distinctly separates it from the other.

NO. 6.

The first matter to determine in any case of neurasthenia is, whether or not there be any localized pathological affection-organic neurasthenia; or whether or not the symptoms expressed and characterized by the patient be merely a simulation of a true lesion or path. ological condition-psychological neurasthenia. And, now, let me impress upon my hearers the importance of this discrimination, and let it not be forgotten that underneath the mental peculiarities of anthrophobia, agarophobia and thanatophobia there may be sown and well rooted the seeds of a more serious malady than simple neurasthenia.

In thus generalizing the clinical characteristics of the two distinct forms of this malady, its differentiation from the hysterical or hypochondrical condition must not be lost sight of, for by a close inspection of the relative symptoms of each, they may be readily distinguished, although a patient may at the same time or at different periods show symptoms of hysteria and neurasthenia.

The symptoms, like the condition, may be, and are, classified by our best authorities into two distinct divisions, namely: the negative and the positive.

The most common negative symptom is neuralgia, although anesthesia may, and sometimes does, exist without apparent cause; while the most prominent posi tive symptoms are nervous outbreaks or signs of excessive weakness, both mentally and physically.

Individual cases of neurasthenia may present a variety of symptoms, but invariably the foregoing will be found predominating. After arriving at a definite classification and grouping of the symptoms expressed, we may the more easily determine the etiological factors in the case.

Assuming that we have arrived at a definite diagnosis and classification of the symptoms and conditions, we have for solution, before treatment begins, the question of origin and seat of the disturbing factor.

Organic neurasthenia, we may find upon investiga. tion, is due, in a great number of instances, to malnutrition of the nerve cells, instability of the circulation in the form of anemia, hyperemia and chlorosis, all of which in their turn arise from, or may be complicated with digestive disorders, productive of a train of symptoms, principle of which is insomnia; and as reported in some case, an entire absence of knee jerk. with Rom

Read before the Southern Illinois Medical Association, November berg's symptom, tremor, paralysis of special sensation, 19 and 20, 1896.

paresthesia, nervous cough, palpitation and cardiac ir

Be it organic or psychical, the treatment of the case must primarily be addressed to the morale for the control of the mental symptoms, and the confidence of the patient is absolutely necessary. The orders of the phy

regularity. While each or all of these symptoms may be found in a purely organic neurasthenia, I must but reiterate that herein lies the great difficulty in ascertaining whether or not they be due to pathological affections-organic neurasthenia, or merely simulation—sician must be carried out with firmness, but discriminpsychical neurasthenia.

One of the differential points between neurasthenia and hysteria is the former's prevalence among males nearly or quite as great as among females.

Let me give you a note of warning in advance, and that is, that neurasthenic symptoms in an overworked business or professional man are sometimes but the forernners of an approaching mental disease. Again, in neurasthenia among females, it is well to pay strict attention to the ever-present ovarian aud uterine symp toms, be they organic or functional in their nature.

Catarrh and all other local inflammations of the upper air passages must not for a moment be lost sight of, as at least, in a manner, aggravating the condition, if not, as assumed by some, to be the instigator of this malady.

The question of the heredity of this disease is con ceded by all the late authorities, who teach that it may be transmitted, not alone from parents suffering from one of the many neuroses, but also from those suffering from such constitutional diseases, as gout, phthisis and lithemia, may be found the starting point of the neu rasthenic predisposition.

ate and gentle persuasion must be used in so doing; and in the case of ladies, no allusion to the hysteria should be made. Appropriate general treatment for nutrition, proper hygienic measures, regular hours of work and rest, with general symptomatic treatment as may be indicated, will do much toward reaching a happy termination of the trouble and ultimate recovery of the pa tient. Acquired neurasthenia will pass away with a cessation of the cause.

In conclusion allow me to give a note of warning, that in the treatment of this trouble I have found patients of both sexes easily affected by stimulants, and often they feel a desire for such, and in our desire to benefit the patient let us not be too careless and create a condition far more serious than the disease itself. Let us use stimulants when necessary, but use them judic iously, and when so used, let us keep prominently in our minds the one expressive word of warning, "Beware."

Some Complications in Abdominal and
Pelvic Surgery.1

BY JOHN H. M'INTYRE, A.M, M.D., ST. LOUIS

The operation of laparotomy seems to be a peculiarly fascinating one, for there is as eager and ambitious a throng attempting to perform it as ever fought in serried ranks for fame upon the bloodiest battle field.

I feel loth to leave this subject without referring to what, in my mind, is but another of the many manifes tations of this neurosis, namely, neuromimesis, first recognized and defined by Sir James Paget, "to designate a class of cases characterized by many, or all, of the symptoms of a real or pathological condition, but where there is only a simulation of a true lesion or deformity." Thus, it may be seen that Sir James Paget's definition It is probably a fact that but few counties in any of neuromimesis and a definition of neurasthenia, clas- State in all this broad land is without at least one man sified as I have it, are nearly identical. While neuras who has not either attempted it or has the "bee buzzing thenia applies more properly to a systemic or bodily ail in his bonnet," urging him onward to try it if the opment, not confined to any particular locality, neuromi- portunity is offered. This craze to open the abdomen mesis applies more directly to what has been considered when at least a reasonably certain diagnosis can not be by various writers under the appellation of "hysterical approximated, and then call it an exploratory laparotomy, joints, and spine" "hysterical contractions," "pseudoarthropathy," "mock diseases" and "joint neurosis."

Before considering the treatment of neurasthnia, or neuromimesis and their accompanying disorders, it is well to observe that with the exception of extreme in fancy and, perhaps, old age, no period in life is exempt from an attack, and that while luxurious living and dissipation are certainly predisposing causes, the opposite condition of poverty, by its unhygienic surroundings and want of proper nourishment may produce as severe a type of this disease.

Volumes might be writen upon the treatment of this disease, but when the matter is sifted through the seive of common sense, there remains but little to be said, and without much ado, I shall in a few words give you the conclusions I have arrived at in the treatment of this most prevalent of disorders.

is probably caused by successful specialists who have at their command the best appliances and surroundings for obtaining the most brilliant results, being too prone to report only the successes, and not pointing out the difficulties and complications that so often arise. Hence the opinion is extant that the operation is an easy one, and many rush rashly into it who would not think of attempting to cut down upon and ligate the carotid artery, when in point of fact many abdominal and pelvic operations are vastly more difficult. The unexpected is always what happens in pelvic work, and an acquaintance with the complications which may arise is the very best means of avoiding them, thus it follows that suc cess may be measured by the ability of the operator. It

'Read before the Southern Illinois Medical Association, November, 19 and 20, 1896.