1881.]

dent, Dr. S. Lilienthal of New York; Vice-President, Dr. W. B. Chamberlain, of Worcester, Mass.; Secretary and Treasurer; Dr. W. P. Armstrong, Lafayette, Ind.; Censors; Drs. George F. Foote, Stamford, Conn.; T. C. Duncan, Chicago; M. Deschere, New York; E. W. Jones, Taunton, Mass.; and D. Foss, Newburyport, Mass.

On motion, the society adjourned to meet again the next year, during the annual session of the American Institute of Homœopathy, and at some place convenient to the same.

W. P. ARMSTRONG, M.D.

THE ETIOLOGY OF GANGRENE OF THE MOUTH (NOMA).—Dr. Krasine (La France Medicale, 1881, p. 657; from Vratchebniya Vaidomosti) gives the case of two persons-a mother and daughter, aged respectively 48 and 8 years who, following the endurance of great hardship, were attacked with gangrene of the face. Examined in the hospital two weeks after the beginning of the disease, for which neither treatment nor attention had been previously obtained, the greater part of the right cheek was found in both cases to have been destroyed by gangrene. The patients died after a fortnight's stay in the hospital, the disease having run course of a month, which is rare in fatal cases. Krasine, in reporting the cases, discusses the pathogeny of noma in general. It is rarely found in adults, usually in children of ten or twelve years, following eruptive or intermittent fevers. Its occurrence is favored by bad alimentation, damp dwellings, and the abuse of mercury. It is more frequent among girls than among boys.

Noma generally begins by the appearance of a patch of induration sit

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uated on the mucous surface of the cheek near the labial commissure, and which is quickly surrounded by minute phlyctenulæ. The neighboring parts swell, the patch becomes black, it spreads on the surface and deeply, the soft tissues become involved, and even the bone is affected. After the removal of the sphacelated portions a hideous hole remains in the side of the cheek. Death occurs in seventy cases out of one hundred. In case of cure, extreme disfigurement, with adherent cicatrices, is apt to ensue.

This disease has sometimes been considered to originate in some disorder of the nervous system, particularly the vaso-motors of the face. Krasine, however, is inclined to think. that it is due to a cutting off of the blood-supply in an anæmic and broken-down person by the exercise

of pressure. This pressure may in some cases be the result of lying on one side or the other during a prolonged illness, and is thus nothing more than a gangrene from decubitus.

Noma is generally limited to one side of the face: it rarely attacks the other side. Above, it may reach to the border of the under eyelid and to the ear. It rarely passes beyond the border of the lower jaw. The tongue and the eye of the affected side remain untouched. Noma attacks children because, in Krasine's opinion, the amount of blood in the body is relatively smaller than in adults, nutrition changes are active, and anæmia is quickly produced and has grave consequences. Why the disease should attack little girls by preference is as yet inexplicable.

The treatment of noma has hitherto been by means of local remedies. Krasine, however, speaking from his point of view of the origin of the disease, urges improved nutritio tonics, stimulants, etc., with simple antiseptic dressing.

THE

AMERICAN HOMEOPATH.

tion and an oratorical feat. It is no possible here to give an adequate idea

and Sanitary Science.

GRESS (OLD SCHOOL). Never before in the history of medicine has a more learned and august body of medical men assembled together for purposes of scientific discussion than that which gathered in London in the early part of August last. There were to be seen men whose names have become famous, not only in their own country, but throughout the civilized world, for the power and brilliancy of their original researches.

Royal patronage was lavished upon the Assembly, the opening exercises. being favored by the presence of His Royal Highness the Prince of Wales and the Crown Prince of Germany. The opening address was made by the President, Sir James Paget, and was remarkable as a scientific produc

should be read by every physician in the land. The work of the Association was done in sections, a method which it seems advisable to follow in large gatherings of this kind. The Presidents of the various bureaus delivered addresses before their respective departments, all of which were models of learning and careful research. Professor Volkmann's address. on "The Change which Surgery has Undergone During the Last Ten Years" was read by us with great interest. The antiseptic method is placed by him in the front rank of modern improvements, and as a resultant factor surgery is elevated to the position of the latest experimental science. In evidence he refers to two examples: the results of treatment in compound fractures and major amputations. He says, "The mortality after compound fracture had, during the long labors of my predecessor, as well as during my own, reached the sad height of forty per cent. When I adopted the antiseptic treatment of wounds, my last twelve patients with compound fracture of the leg had all died of pyæmia or septicemia. From that time to the present day I have treated one after another 135 compound fractures, and not a single patient has succumbed to either of those accidental wound diseases; 133 men were cured, two died, one of fat embolism of the lungs during the first four

hours, and one, a drunkard, of delirium tremens."

"The number of amputations of the larger limbs which I have undertaken during the last few years amounts to more than 400. If I subtract those cases where death did certainly not result in consequence of the operation, but independently of this from some other serious complication, there results a mortality of four to five per cent., and the same number, as far as I can discover from the communication before me, was obtained in the other German hospitals in which antiseptic surgery is practised in full strength"

The plenitude of scientific material supplied to each section, and the character of the discussions which ensued, were alike noticeable and worthy of the highest praise. We could not fail to observe, however, the the dearth of material supplied to the section on Materia Medica and Pharmacology. Considering the large number and character of the delegates, and that the gathering was one of world-wide significance, the paucity of the productions in this department is astonishing. It would seem as if skepticism in medicine, which was the theme of one of the addresses, had crept in here, and rendered the work of the laborers fruitless in results. There was nothing worthy of note presented in this section.

In sharp contrast to this is the work of the Homœopathic International Congress, which assembled one month earlier in the same city. The

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treatment of disease, the study of drugs and drug action, seemed paramount in the minds of our brethren. In fact, we have become as a school, specialists in Materia Medica; we have penetrated deep into that storehouse of nature's treasures, from whence richest gems have come to us. In this field we are still advanced workers, and though our friends. on the opposite side may not agree with us in the solution of that all-absorbing problem-the theory of drug action-they are fast recognizing the value of many of the remedies whose therapeutic application we have clearly defined.

Our brethren of the old school have made great strides in surgery, pathological and physiological research, and in many other departments of investigation pertaining to medicine. Nevertheless, as truth will prevail, so shall we some day witness the acknowledgment of our principle of drug action; and though now wide. apart from our friends, the world will see that we have all been working toward one common end-the amelioration of the physical woes of mankind. L. L. D.

ABSTRACTS.

LONG VERSUS SHORT MIDWIFERY FORCEPS.-The long double-curved forceps stands prominently forward, as the instrument of all others, scientifically fitted to meet the requirements of the obstetric surgeon. (Braithwaite's Retrospect.) To compare the long and short forceps together is to compare things com

pletely incongruous; the one being an instrument almost perfect in its power of scientific adaptation; the other being essentially useless. Again, though so small and handy looking, the short instrument is really not of so easy application, for ordinary cases, as the long double-curved forceps. The pelvic curve in the long instrument makes its application, even in the middle of the bed. a matter of little or no difficulty. This pelvic curve also does away with the necessity of paying such strict attention to the position of the head, for the blades, of course, must be placed in one or other of the oblique diameters, and nearly parallel with the sides of the pelvis. It is in this position the blades have most room, and they naturally and easily glide into these spaces in the ordinary presentation. A purely lateral grasp of the head is still taught and practiced by some, but the oblique grasp of head was long ago pointed out by Smellie, insisted on by Simpson, and is still taught by Barnes, Playfair and other leaders in the art.

An apparent exception to this rule is, of course, found in cases where the head is quite down on the perineum, and in the ordinary position of face looking directly backward to the sacrum. Here, the grasp, as a rule, is more on the lateral aspects of the head, one blade being before one ear, the other behind th: opposite one. Like others I have applied the blades transversely-i. e.. over the ears of the childin order to rotate in cases of occipitoposterior position where, for some cause, natural rotation into occipitoanterior position had been arrested. This I now believe to be seldom necessary, as the pelvic curve in Simpson's long forceps (the instrument I chiefly use) is so slight, that traction alone with the oblique grasp will bring the head into its proper position.

SYMPTOMS IN DIFFERENT DISEASES. Dr. Gorecke, as quoted in the Glasgow Medical Journal has tabulated his views as follows:

Blepharoptosis, or the falling of the upper eyelid, indicates paralysis, complete or incomplete, of the third pair.

Lagophthalmos, or inability to close completely the palpebral fissure, is a sign of facial hemiplegia, idiopathic or a symptom of cerebral disease.

Strabismus occurring suddenly, and accompanied by diplopia, is most frequently the result of some cerebral affection. Xanthelasma (a yellow lamina sometimes met with in the skin) of the eyelids, occurs in certain alterations of the liver.

Sub-conjunctival ecchymoses are frequent in whooping-cough, and may sometimes, at the beginning of the complaint, clear up a difficult diag

nosis.

Redness of the conjunctiva, watering of the eye, etc., indicate in the child the outbreak of some eruptive fever, particularly measles. The prognosis is favorable if the tears come when the child cries, but fatal if the secretion of the tears is arrested.

Spots on the cornea are often the indication of a strumous constitution.

Dilatationof the pupil, or mydriasis, indicates excessive fatigue, the exist ence of intestinal worms, meningitis in the second stage, or a true amaurosis. The dilatation is most frequently connected with atrophy of the optic nerve. It is seen also during an attack of epilepsy, on coming out of chloroform, after belladonna poisoning, etc.

Unequal dilatation of the two pupils points to the onset of general progressive paralysis.

Contraction of the pupil is one of the early symptoms of tabes dorsalis. It is met with also at the beginning of

meningitis, in opium poisoning, and in the first stage of chloral poisoning.

Deformation of the pupil, particularly after the injection of atropine, indicates an old iritis, in nine cases out of ten, of syphilitic origin, if not depending on some disease of the neighboring parts.

Cataract in subjects under say forty or fifty, is frequently of diabetic origin, and constitutes soft cataract.

Finally, the opthalmoscope enables us to recognize the retinitis of albuminuria in Bright's disease, of simple polyuria, and sometimes in the case of women during pregi ancy. Retinal hemorrhages, cedema of the retina, and embolism of its central artery, are sometimes met with in organic affections of the heart. Optic neuritis and perineuritis and atrophy of the disc are symptoms of syphilis, or of tumors in the neighborhood of the cerebellum or the corpora quadrige

mina.

PURPURA HÆMORRHAGICA AS A NEUROSIS. The nervous origin of certain cutaneous affections, says Dr. H. Leloir in Le Progres Medical, is a question of great interest at the present time. Recent observations tend to confirm the opinion of Drs. Stieldorf, Wagner, Henoch, Couty, and others as to the nervous origin of some cases of purpura. Rigal and Cornil (Soc. Med. des Hôp., Fèv. et Mars, 1879), in discussing a case of acute purpura hemorrhagica of which they made an autopsy, propose the following conclusions: 1. Severe purpura hemorrhagica is a group of symptoms constituted essentially by hemorrhages in the skin and mucous membranes and by progressive weakness resulting in nervous exhaustion not always commensurate with the amount of hemorrhage. 2. Whatever are the other morbid conditions which may

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have been concerned in the production of a given case of purpura hemorrhagica, it is necessary to include some trouble with the vascular innervation if we are to understand the causation of the hemorrhages. This nervous disturbance may be either excitation of the sympathetics or diminution in the action of the vaso-motor centres. 3. The alterations in the blood and the lesions of the vascular walls appear to be variable and inconstant. While admitting their importance, they appear insufficient to produce purpura hemorrhagica without some nervous perturbation.

Mackenzie (Medical Times and Gazette, March, 1877), referring to a case of purpura occurring in a young girl, and disappearing under the influence of treatment, only to reappear anew at the menstrual period, and giving rise to fatal symptoms, seems to think the affection due to an intracranial lesion. He does not, however, in the opinion of Dr. Leloir, bring forward sufficient proof to sustain this view.

Maiocchi Lo Sperimentale, February, 1877) thinks that purpura rheumatica belongs neither to a diathesis nor to a dyscrasia nor to an infection. He makes it out an affection of the

vaso-motor system. Cavalier (Bull. Gen. de Therap., 1879) reports a case of purpura hemorrhagica alternating with paralytic symptoms. Finally, Shand (Lancet, July, 1876) has obtained good results in purpura hemorrhagica by the use of electricity.

The attention of surgeons has long been drawn to certain scarlatiniform eruptions showing themselves after wounds and injuries. Authors are, however, far from being in accord in their views on the nature of these eruptions.

Stirling (St. George's Hospital Reports, vol. x., 1879), in an important and judicious memoir based on thirty