Third

ond-That this is owing to the contraction of muscular fibres. That while these substances are passing through the blood on their way to these muscular fibres, their natural chemical tendencies are suspended, "being constrained by various forces;" and, Fourth-That "on the exit by secretion from the blood, they resume their original activity." Can we yield our assent to a doctrine based on such evidence? Certainly not. Although it is true that when astringents are applied to the web of a frog's foot, under the microscope, the capillary vessels are seen to become constringed, and the muscular fibres contracted, it does not follow that they ever act in a similar manner after having been received into the blood. Indeed, if we correctly understand their modus operandi when locally applied, it seems impossible to conclude that they ever can do so, for it seems to be pretty well established that the phenomena they are seen to produce when thus used, are the result of the strong affinity of the astringent substance for water, which it therefore abstracts from the tissues with which it is brought into contact, the constringent effect seen being actually the result of a partial desiccation of the part. It seems legitimate to conclude, that when an astringent substance is taken into the stomach in a case of pulmonary or uterine hemorrhage, this affinity will be gratified long before the medicine reaches the pulmonary or uterine capillaries.

If an appeal is made to clinical experience to substantiate the assumption, that astringents do, despite these theoretical objections, control these hemorrhages by virtue of their astringency, no positive and unequivocal testimony is obtained. If it is maintained that there are many medicines-quinine for instance-whose precise mode of action is unknown, yet whose curative influence is positively established, the truth of the claim will be unquestioned; but to my mind, the same kind of evidence has never been presented in favor of this reputed curative action of astringents as has been in the case of quinine and some other medicines, and I am so fully convinced that careful observation and dispassionate judgment will lead to the conviction that a negative result will follow, when they are administered internally in cases of pulmonary and uterine hemorrhage, in so far as such effect must depend upon their astringency, I am willing to submit the case without further argument, simply stating that I never administer them, in the kind of cases I have been considering, in the hope of obtaining curative results from this power.

CASE OF APHASIA.

BY G. W. H. KEMPER, M. D., MUNCIE, IND.

On January 3d, 1869, I was called to see, in consultation with Drs. Jump and Kerr, Mr. Thomas Stanford, residing near New Burlington, in this county.

Mr. S., at the time of his death, was seventy-four years old. His life had been characterized by extreme vigor of body and mind. For several years he was a member of our State legislature, and at various times has held minor county offices.

During the latter part of last December, he noticed that he had some trouble about taking the proper length of steps in walking. Sometimes he would, contrary to his will, step too far, and at other times not far enough. He noticed this irregularity and spoke of it to his family, but nothing serious was anticipated, until Tuesday, December 29th, when he sat down to breakfast and commenced saying grace, but kept repeating the same word for some little time. Finally, his wife spoke to him and asked what was the matter. He replied, nothing, and exclaimed "how singular," and then proceeded to eat. During all this day, his memory of words would fail him, and he found much dif ficulty in making known his wants. Desiring a younger son to start to school, he said, "Go to-to-to-," and seemed puzzled that he could not finish the sentence. Some one said, "To school, father?" and he replied yes. On Wednesday morning, having some business to transact with a neighbor, he attempted to write a note, but kept writing the same word. He tried for half an hour, but was compelled to give it up, although an excellent penman.

At this period, Dr. Jump was called to see him, and found his condition as follows: No pain in any locality, pulse one hundred, full and regular, tongue furred, pupils unchanged, temperature normal, appetite good as usual, no paralysis nor even numbness. Dr. Jump prescribed a mercurial cathartic, to be followed with oil or a saline cathartic in four hours, if the bowels were not moved, a warm pediluvium with mustard, restricted diet, and potass. iod. in five grain doses three times a day. Dr. Kerr, a son-in-law, who lived some distance, came on Friday and remained with him until his death.

We saw him, in consultation, at twelve M., on Sunday, January 3d. His condition was similar to what it had been since Wednesday. He

seemed cheerful and lively, and desirous of conversing, but forgot so many words that it was impossible, frequently, to understand him. He would smile at his inability to call words, and seemed much perplexed. Pointing to Dr. Kerr, I asked him if he knew him. He replied yes. What is his name? He smiled confusedly, and said, "It's -oh-it's-oh-." I named over several fictitious names, but he would reply no. I then said Kerr. He replied, "That is right." I was shown some of his writing, in which he attempted his own name as follows: "Thos. Thom. Stans." He remained in about the same condition until January 4th, at ten A. M., when he was seized with a convulsive fit, lasting about a minute and a half, and immediately expired. No post-mortem was made.

"PRIORITY IN THE USE OF WEIGHT EXTENSION."

BY GEO. C. BLACKMAN, M. D.,

Professor of Surgery in the Medical College of Ohio; Surgeon to the Samaritan Hospital; etc.

In the April number of the American Journal of the Medical Sciences, Dr. Edward Hartshorne, of Philadelphia, has published an elaborate and interesting paper under the above title, from which we extract the following:

"Some extended researches, in which I have been recently engaged for another purpose, have brought to my notice an interesting effect of second-hand quotation, and of erroneous compilation, in the European history of weight extension, which does not appear to have been noticed either in Edinburgh or London. The fact is, that the first European writer, out of the Continent at least, (italics ours) who definitely speaks of this mode of treating fractured thigh, and gives an unmistakable picture of the weight and its accessories, is John Bell, (Principles of Surgery, 4th edition, Edinburgh, 1801;) and he evidently does so without the slightest idea of suggesting anything new, although what he did present was, so far as the weight is concerned, the product of his own active and brilliant imagination."

Now, the Chirurgical Observations and Cases of William Bromfield, of St. George's Hospital, London, appeared in 1773. In the second volume of this valuable work, at page 111, we find the author extolling the advantages to be derived from the relaxation of the muscles in the reduction of fractures and their treatment. He then proceeds:

"Lately, indeed, I have heard that the practice is adopted by some surgeons of other hospitals in London; nevertheless, this is of as little weight almost as my

instructions were so long since, for even at this time, the advantages of this way are not sufficiently clear to some of the professors of surgery, as short splints and stretched out limbs are, by them, thought the best method of practice; and even a large weight hung from the ankle joint, to keep the muscles of the thigh extended, when the femur is fractured, is not every where exploded."

We have placed in italics, sufficient, we think, to prove that Dr Hartshorne is himself in error in his comments on "the interesting effect of second-hand quotation, and of erroneous compilation, in the European history of weight extension," and it is evident that for many years prior to the publication of Mr. Bromfield's work, the practice which this surgeon condemns, of hanging large weights from the ankle joint in the treatment of fractures of the thigh, had been adopted by the British surgeons.

OPERATION FOR IMPERMEABLE STRICTURE OF THE URETHRA.

BY G. M. BURKE, M. D., SULPHUR SPRINGS, IND.

(Communicated by Prof. Blackman, Cincinnati.)

MR. EDITOR: The operation performed by Dr. Burke is worthy of record, not only on account of its success, but for its variety. The patient was under my care for a few weeks, at the Samaritan Hospital, and I was unable to pass the smallest sized instrument to the bladder. In one instance, the patient being fully under the influence of chloroform, administered by my friend, Dr. Schenck, of Reading, I tried with bougies aud lancetted stilette, for more than an hour, but without success. I then proposed an operation by external incision, but the patient left for home on a temporary visit, and there became so much worse that he availed himself of the services of Dr. Burke, and with what success the report will show.

The only cases in which so extensive an operation has been performed, so far as we have been able to discover, are those in which it was done by Edward Molins in 1652, and by Solingen, also, in the latter part of the seventeenth century. Wiseman assisted in the first operation, and has given the details in the second volume of his Chirurgical Treatises, under the head of "The Ill Consequences of Gonorrhoea." At first, an incision was made in the perineum, but as with "probes and candles," the urethral passage could not be found, at the request of the patient, a few days afterwards, Molin "slit it the

whole length to the incision in perineo." The patient recovered, but a urinary fistula remained in the perineum.

For the notice of Solingen's case, we are indebted to Dr. Aristide Verneuil, who published in the Arch. Gen. de Med., Paris, September, 1857, an interesting paper entitled Note Historique et Critique Sur 'Urethrotomie Externe ou Section des Retrecissements de dehors en dedans, avant CXVIII Siecle. We translate his remarks on the case of Solingen: "Planque, in the article Carnosité, having quoted a successful case of cauterization, adds: 'Van der Wiel approves this method in preference to that adopted by Solingins (Solingen) in the case of a soldier. As the Urethra, according to his report, was full of carnosities, a sonde crénelée, which allowed the urine to pass was used; but all his medications were of no avail. For this reason, he introduced a grooved staff into the bladder, on which he incised the whole canal, even to the glans, and then destroyed with caustic all of the callosities. The lips of the extensive wound were then brought together and retained by means of the hare-lip suture. The operation succeeded so well, that the patient was able to pass his urine, at first through a small flexible catheter, but afterwards a plein canal." It is stated that Solingen had performed a similar operation with success, at the Livourne.

The above extract is quoted by Planque from the Biblioth. de Med., tom viii, page 61, ed. in 8, and he remarks that it is evident that external urethrobomy was performed during the latter part of the seventeenth century in several countries of Europe.

Dr. Verneuil refers to an operation reported by Van Hoorne, and which was performed to relieve a patient affected with hypospadias, the abnormal orifice of the urethra being just in front of the scrotum. The penis was laid open from this point to the end of the glans, a leaden canula introduced, and the whole wound closed with suture. The operation was successful.

One word in conclusion. Although the operation just quoted, like that reported by Dr. Burke, terminated so fortunately, it is probable that the majority of practitioners would, in similar cases of stricture, feel disposed to try, first, the effect of opening the membranous portion of the urethra, relieving the retention of urine, and diverting the channel for a time, in order to give the indurated portion of the urethra an opportunity of becoming softened and more dilatable. Mr. Cock, of Guy's Hospital, Mr. Simon, of St. Thomas', and Mr. Wormald, of St. Bartholomew's, London, and others, have furnished us with much evi