[Physicians should be on the outlook for these cases, for though only a few have been reported by Charcot, Gray, Massei, Lefferts and others, yet it is believed that attacks of dizziness after cough are comparatively frequent, and temporary unconsciousness less rare than has been supposed. In a contribution to the Allgemeine Wiener Med. Zeitung, June 22, 1886, upon laryngospasmus, Prof. Widerhoffer says that in nursing children, epilepsy begins as a spasm of the larynx, continuing at intervals for weeks or months and becoming true epilepsy after the second or third year. These researches indicate a close relationship between laryngeal spasm and epilepsy, using the latter term as HughlingsJackson does when referring to all "sudden actions of nerve-cells."] TUBERCULOSIS IN CHILDREN AND THE QUES TION OF CONGENITAL TUBERCULOSIS. It is generally asserted that chronic tuberculosis is a disease which is rare in early years, but progressively increases in frequency. M. Jules Simon in his "Conference Therapeutiques et Cliniques sur les Maladies des Enfants," states that tuberculosis is rare in the first year of life; from the age of one to three it affects by preference the abdominal cavity, while from the age of three to ten one finds it oftenest in the cranial cavity; after the latter age pulmonary tuberculosis predominates, increasing its frequency with years, and attaining its maximum between the ages of twenty and thirty; or, as more recent writers have it, increasing in relative frequency even up to the later years of life. With regard to tuberculosis in infants, and especially the question of congenital tuberculosis, Dr. W. Schwer, of Kiel, has recently (Allgemeine Med. Central Zeitung, 1886, No. 6.) contributed some interesting facts. His statistics include 123 autopsies on tuberculous children made between the years 1879 and 1883, and are a continuation of Simmond's statistics which covered the years 1873-1879. Basing his opinion on the fact that no tu berculosis was found post-mortem in children under nine weeks of age, Dr. Schwer concludes that tuberculosis is never a congenital or connate disease. From his figures the author concludes that tuberculosis is very prevalent in the first years of life and then gradually diminishes up to the time of puberty. Against this there will be very little dissent, but Dr. Schwer's view, that tuberculosis is never congenital, is not borne out either by his own statistics or those of others. It is only probable, and not certain, that the infants who died of tuberculosis at the age of nine weeks were not born with the disease. However this may be, a year ago Jahne (Fortschritte der Medicin) reported a case of undoubted fetal tuberculosis, and Dr. Haupt, of Soden, affirms that veterinarians have often observed fetal tuberculosis in animals. We cannot but think that tuberculosis exists more frequently among the children of the lower class of Europe than among those of America. On this point, however, there are unfortunately no very trustworthy statistics, so far as we are aware. Schwer's per cent of tuberculosis among 160 children dying between the age of six and twelve months, was 17.5.-Med. Record, June 19, 1886. [The practical point is that however physi cians may conclude regarding the question of inherited tuberculosis, there can be no doubt but that the conditions which form a tubercu lar invasion are inherited. The frequency of its occurrence in early life suggests this, and careful examination proves it. A rare case of tuberculosis of the larynx in a child five years old is reported by Voltolini in the Deutsche Med. Wochenschrift, Feb., 1886. The objective and subjective symptoms were those ordinarily found in adults so affected, and tubercles were found iu the sputa]. HEMOFTYSIS AND APEX PNEUMONIA. Dr. Frederick C. Shattuck, of Boston, in his report on progress in thoracic disease (Boston Med. and Surg. Journ., Aug. 19, 1886), refers to Dr. Hood's paper (Lancet), which emphasizes the fact that in certain pneumonic conditions a sharp hemorrhage at the initial stage is symptomatic of the attack, and is, as he believes, directly caused by the inflammatory hyperemia. "In such cases, where a severe hemorrhage ushers in the attack, we shall find the inflammatory focus very frequently at one or the other apex, and the physical symptoms of such a pneumonia are often more easily demonstrated at the posterior than at the anterior region of the chest. Such Such pneumonia, complicated with severe hemorrhage, is peculiarly connected with lung tissue, already the seat of chronic change, whether such change be due to deposition of tubercle or to chronic inflammatory changes. * * Ia the cases of apex pneumonia I have referred to, the progress which was rapid as compared with an ordinary lobar pneumonia, the patients were not so severely ill. May not the severity of the attack have been mitigated by the local blood-let?" diuretic; (3) that its indications are the same as for digitalis; (4) that it works much more quickly than digitalis, but that there is no stimulative effect; (5) that it acts frequently in cases where digitalis fails; (6) that it is best given in small doses, to keep the heart continually under its influence. A disagreeable quality of caffeine is its bad solubility in water. It is dissolved only in eighty parts. Its salts are very easily spoiled, being dissolved in water or exposed to the air. [In the very annoying cases of so-called irritable heart, and for the cardiac pain often found with reflex stimulation, I have found caffeine with bromide of potassium most useful. The caffeine is better given alone when the rapidity of heart action depends upon muscular or valvular change. The fact that caffeine requires so much water to dissolve is no objection. A better effect is produced when a good quantity of menstrum is used.] -Biliousness, Bacteria and Billings are probably the three topics most discussed by our contemporaries, but we would advise more attention to the latter, as the bacteria and biliousness give promise of being always with you; while (for obvious reasons) you may never get another crack at Billings.--"Dakota Medical Brief." Our active and enterprising neighbor we fear overlooks Bartholow. These four busy bees are attracting considerable attention and we are inclined to think they are very properly classed together. Yes, we doubt whether we can ever "get another crack at Billings" for the reason that he is too shrewd and able a man to ever make more than one blunder as serious as his "malarial map." But this remark doesn't apply to Bartholow. The record he has made in Jefferson College, preceded by the one left behind him in Ohio (if reports are true) makes him as certain and definite a quantity as his associates, Biliousness and Bacteria. This constant association may be explained by the old saw "birds of a feather flock together." We would recall to the mind of the Jefferson College B., the modification of Lord Dundreary"B-birds of a f-f-feather,-g-g-gather no moss, "and Jefferson College may soon be in need of moss if it continues its efforts toward the discomfiture of the A. M. A., and its contempt of the West and South. ORIGINAL ARTICLES. spray of steam was kept over the wound for twelve hours. His head was kept in a flexed A CASE OF CUT THROAT INVOLVING position by means of pillows. No food was THE LARYNX. BY W. W. FRENCH, M. S., M. D., given by mouth, but a soft rubber cather was passed through the nose into the esophagus, and through this by means of a Davidson Surgeon to Out-Door Department Bellevue Hospital, syringe, was given every six hours: New York The case of cut throat admitted to Bellevue Hospital during my house service, and which the attending surgeon, Dr. Wm. F. Fluhrer, kindly allowed me to treat, is of interest as it offers some suggestions regarding the treatment of cut throat when involving the larynx. Geo. S., German, 49 years old, was admitted to Bellevue Hospital, Jan. 15, 8 P. M. Without any known cause, he attempted suicide by cutting his throat with a razor. He lay five hours before he was brought to the hospital, and during that time blood constantly oozed from the cut. Upon examination, I found a horizontal incised wound extending from 14 inches to the left of median line to 34 inches to the right. The thyroid cartilage was divided nearly to the posterior border at about the junction of upper one third with lower two-thirds. The vocal cords could be clearly seen, and he breathed through the cut. The superficial and deep fascia of the neck were divided, and on the right side the superior thyroid artery could be seen pulsating at the bottom of the wound. The wound was filled with a firm clot of blood. He was quite weak from the shock, was unable to swallow, part of the liquid passing out through the incision, part passing into the larynx causing violent fits of coughing. TREATMENT.-The clots were all removed. There was no bleeding as all of the larger vessels of the neck had escaped injury. The wound was disinfected by irrigation with a solution of hydrag. bichlor. 1-2500. Sutures of silver were threaded in a straight surgical needle, two in number, were passed from without inward through lower segment of each ale, then from within outward through upper segment about one-eighth of an inch from cut edge. When twisted, they brought the cut edges into apposition. In the median In the median line the alæ had separated and gaping, left an opening through which sputa were constantly coughed. This gaping was relieved a little by a silk suture, but the edges could not be exactly approximated. The wound in the neck was packed with iodoform gauze. Over this was laid a layer of carbolized gauze and then a layer of borated cotton. A steady R Milk Oj. རྩོss. j. gtt. vi. The egg and milk were whipped together, then the other ingredients added. January 18. Upon removing the dressings the upper sequents of cartilages were found to be displaced backwards, the wire having cut through. The alæ were also separated in the median line, leaving an opening about onehalf inch in diameter in the larynx, through which he expectorated. Dressed as before, except over larynx a layer of borated cotton was laid, which was changed whenever soiled by_sputa. January 31. The wound in neck had filled with granulation even with the skin. The cut edges of the cartilages had necrosed for about one-eighth of an inch. February 13. The necrosed cartilages have separated and granulations have filled in the space between the cut edges of the alæ, with exception of a small opening in the median line and to-day he was able to swallow without escape of fluid through the larynx. The use of the catheter was discontinued and he was fed by mouth with soft food. On each side of the median line there are two small healthy ulcers. February 18. Upon forcible expiration, mouth and nose being closed, no air escaped through wound. There is still a small ulcer to right of median line. March 2. Wound is entirely healed. The lower segment of thyroid cartilage projects one half an inch anteriorly beyond upper segment, but this does not interfere with deglutition, and voice is normal. The most constitutional disturbance occurred January 17, when he had temperature 102° (per rectum), pulse 112, respiration 24, but these fell the next day, and after January 27, the vital signs were normal. During the first aud second weeks he had some bronchitis which would account for his temperature. In this case the cutting of the wire suture was due to the patient's restlessness and inability to keep his head in one place. If called upon to treat another case where the thyroid cartilage was cut, I should wire the cartilage and render the head immovable by passing a plaster of Paris bandage around head and neck, the head being flexed, should prohibit all attempts to swallow, allay any cough by opiates, and by so doing the cutting of the suture, I think, would be obviated. The indication of wiring the cartilages is two-fold: First, the danger of edema glottids is lessened. Secondly, we lessen the deformity, although, as in this case, the wound in the larynx will heal without suture, yet it is desirable to avoid deformity when we can. As a matter of experience the wounds in the neck do better if allowed to heal by granulation, for they are seldom clean cut, usually they are more or less lacerated, and they are very apt to develop cellulitis due to the difficulty in establishing perfect drainage, and should therefore be packed with antiseptic material after thoroughly disinfecting. -A country doctor once sent his stable boy to carry medicine to a patient several miles away. Arriving at his destination, the simple people greeted the youth as "doctor," which inflated his self-importance considerably. A boy in the family having a sore toe, the "doctor" was requested to examine it. After surveying the wounded member attentively, he gravely called for a chisel and mallet. These being procured, he proceeded to amputate the toe with a single blow, assuring the astonished family that the boy would never suffer with that toe again. Respectfully submitted to the ovariotomistswe beg their pardon-gynecologists.-"Medical World." It is certainly a radical way to relieve a diseased member to remove it in toto. WEEKLY MEDICAL REVIEW, EDITED BY THE MEDICAL PRESS AND LIBRARY ASSOCIATION Contributions for publication should be sent to Dr. I. N. Love, Secretary Executive Committee, Cor. Grand and Lindell Aves. All remittances and communications pertaining to Advertisements or Subscriptions should be addressed to J. H. CHAMBERS, 914 LOCUST STREET, ST. LOUIS, MO. SATURDAY, OCTOBER 23, 1886. STRANGE CONDUCT OF A RELIGIOUS JOURNAL. In our issue of September 18, we gave editorial attention to the St. Louis Evangelist, which had given a fulsome advertising notice to a book with the title of "Tokology." We gave several extracts from the book, which indicated its character, and referred to the fact that the "Evangelist" presented the book to its readers as "the very best book to put into the hands of a girl or a woman,"in spite of its filthiness, and a tone so vile as to render it disgusting even to a man to read. Marked copies of this issue were mailed to the"Evangelist," and, notwithstanding this, in its weekly issues of the past month the advertisement of the book has appeared, along with others pre -The "Dakota Medical Brief," a monthly jour-senting specifics for spermatorrhea, cancer nal of medicine and the allied sciences under the control of Doctors F. Andros and H. S. Sevey, editors and proprietors, comes to us from Mitchell, Dakota, full of good matter,original and selected. A very practical and valuable paper appears from the pointed and accomplished pen of Dr. E. A. Fisher, of Long Prairie, Minn., on the Treatment of Fevers. We extend greetings to the "Brief, "and bespeak for it and its talented workers the success they merit. Nothing so aids the profession in a community as a first-class medical journal, working for the development and organization of its interests. -Members of the Missouri State Medical Asso ciation for 1886, who have not received a copy of this year's transactions will please notify the Secretary, Dr. J. C. Mulhall, 2305 Olive St. and consumption, stomach bitters and uterine regulators. In the last number of the "Evangelist" (the fourth issue since its attention has been called to the matter), the disgusting thing is presented as "the very best book to put into the hands of a girl or woman," upon the same page where appears the Sunday school lesson with "Jesus crucified" as the subject, and the columns devoted to Sunday reading matter under the heading "Sunday at home" evidencing the shrewdness of the agent of the book in the placing of his advertisements, as it is the page to which Sunday school teachers and scholars, and the home folks generally, are most apt to turn their at tention. In the same paper appears an editorial endorsement of the "Western Society for the Suppression of Vice", and its energetic and active general agent, Rev. W. McAfee, of St. Louis, in the course of which it says: "The check upon the foul work of circulating indecent and corrupting literature and photographic matter by this agency is an important consideration in estimating its importance, even when no arrests are made. The fact that there is a vigilant and fearless supervision is repressive, and deters many from participating in the demoralizing business; and the influence of this society in securing better legislation entitles it to the confidence and support of all who desire the purity of society. Mr. McAfee's long experience and habits of close observation give him superior qualifications for his position." We respectfully suggest that general agent McAfee read this book so lauded on the "family page" of the St. Louis Evangelist, and then direct his repressive energies in the proper direction. THE HISTORY OF MEDICINE. of the ceremony, and the invitation they have extended to you to be witnesses. But we must not be unmindful of the real nature of this occasion. This is no time for mere speculation, for stage whispers among ourselves, as to the character and physical peculiarities of our neophytes. This lecture is introductory to the general course of lectures for this thirty-eighth annual session, and in order to comply with the ante-nuptial contract it must have some connection, direct or indirect, with the subject matter of the course, or consist of preliminary hints for their future guidance. During courtship they frequently need guidance, for not every one that signs the betrothal papers finally wins the bride. She is a bit of a jade at times, and if the young lover devote the passing hour to pool rooms and billiards and politics, instead of paying her his undivided attention, the wedding may never take place." Dr. Hamilton then traced the history of medicine from the time of the expedition of the Argonauts 1273, B. C.,when the first signs of medicine among the Greeks appeared down through the various periods of the Alexandrian and the Methodist schools to about A. D. 500, when all science was at the The introductory lecture of the thirtyeighth annual course of Georgetown Med-point of greatest decay. ical College, at Washington, D. C., was delivered Monday evening, Oct. 4, by SurgeonGen. John B. Hamilton, the Professor of Surgery, to a large audience. The subject chosen by Dr. Hamilton was, "The History of Medicine," and was handled in an unusually able and interesting manner. After referring to Dr. Holmes' comparison of the commencement exercises of a medical college with a wedding ceremony, he suggested that "the public exercises connected with the introductory course of lectures to a class of medical students could well be compared to a public betrothal. You see here the young men full of love for their chosen profession, burning with laudable sentiments of faith in mankind, hope for the future, and boundless enthusiasm. They here in your presence formally plight their troth. That they are in earnest is manifest from the public character Coincident with the Crusades in the tenth and eleventh centuries Arabic medicine predominated, until the time of Martin Luther, in the sixteenth century when reform was the order of the day and Greek medicine and anatomy was again established. "Rational medicine" being now dominant the progress was constant, ever and anon being obstructed by quacks and mistaken enthusiasts, the most prominent brake upon the wheel being the arch quack Paracelsus, of Germany, who burnt the books of Avicenna and Galen and said his own "shoe buckles were more learned than they." Passing through the thirty years' war in the seventeenth century when the immortal Harvey demonstrated his knowledge of the cir culation of the blood, and produced the key that locked many hidden mysteries, on to the reign of Frederick the Great early in the |