that this power, like all others, must have a limit, and when it is over-exerted must reveal its weakness by failing to accomplish what it undertook. Were the mind-cure practiced within its limits, and without the miserable attempt to shield itself under a Christian garb, its results would be of unquestionable ben

efit.

But when it claims to grasp within its capacious bounds the length and breadth of all diseases, curing nasal catarrh equally with hysteria, its fallacy must be apparent, and its life, as such, of short duration.

THE COURAGE OF CONVICTION.

How easy in medicine to have conviction, how difficult to have the courage to stick to it. Absolute conviction in medicine may be said to be almost unattainable in any of its details, so that in speaking of the ease with which it is acquired, it is not the conviction which is conveyed to the mind by multiplying two by two with the indisputable result of four, but that approach to certainty which is arrived at by logical processes, any of the details of which may be incorrect. A physician meets with an obscure condition of affairs in the human body, and by carefully bringing into use all the observed or attainable data, and rationally drawing his conclusions; there fore, may feel to a high degree the certainty of correctness, but there have been many chances for error along the route which he traveled to attain that probable certainty, (if such a mutually-destructive couplet of words can be used), which renders it frequently a matter of the greatest difficulty to hold to his belief in the face of strong opposition from prejudice or other source.

A case illustrative is that of one Seymour, who, having been told that a little girl had fallen into the canal, procured a boat hook and recovered the body, which he removed to a neighboring inn. Had he attempted to hang up the inanimate child by the heels, or to make it swallow half a pint of brandy, his efforts would doubtless have been rewarded with the sympathy and approval of the bystanders; as it was, after sending for medical aid, he endeavored to the best of his ability to perform

artificial respiration, and was roundly abused for "knocking about the dead." Fortunately he had the "courage of his convictions," and persevered so successfully that, in spite of many attempts at interference, the child recovered animation, though it died the next day from the effects of prolonged immersion.

How often it is that a physician, logically convinced that he is in the right, yet knowing how uncertain the result is even if he is correct, will allow himself to be led from the course which he is inclined to pursue. It is here that the courage of conviction has its opportunity of making itself felt, and it is here that that courage is often found wanting. The old saying: "Be sure you are right,then go ahead," fails to come into play, and fear of the result leads to dilatory measures devoid of effect.

THE ACTION OF THE EPIGLOTTIS.

Carmalt Jones, M. D., London, Eng., in his paper on the action of the epiglottis in swallowing, said that the old idea, and perhaps the one which is even now most prevalent, is that the epiglottis acts like a lid hinged to the base of the tongue, and by a simple backward movement covering the larynx and directing the food into the esophagus. The author does not believe that it has any such simple action as that. There is always a slight regurgitation of food and liquids as they are grasped by the middle and inferior constrictors, which would be apt to lift up the epiglottis and pass beneath it. As a result of personal experiments, he finds that the epiglottis on irritation folds the sides together so as to grasp the upper part of the larynx. When this spasm occurs one must wait until it relaxes before trying to pass a brush into the larynx, or it will glide over the epiglottis into the esophagus. He thinks that the backward movement of the tongue in swallowing is, for the most part, theoretical. One can swallow well with the tongue held between the teeth or firmly grasped by the fingers. There is only a slight effort to draw it back. We swallow more through the action of the pha

ryngeal muscles. The larynx is raised toward the base of the tongue, and the constrictor muscles do much toward closing it. The epiglottis is drawn down by muscular action and moulds itself about the upper part of the larynx instead of acting like a simple lid.

THE KYMOGRAPHION.

A feature of the course in physiology at the St. Louis Medical College during the approaching winter session, will be the use of the kymographion in demonstrating to the classes the phenomena of muscle and nerve, and the laws that govern the rise and fall of blood-pressure, etc.

The kymographion to be used in these experiments consists of a narrow table, about four feet long, and ten inches high; upon this rest two brass cylinders, supported by a frame of brass rods. Connecting the cylinders and passing around them, is a strip of blackened paper, eight feet long and eight inches wide. When one cylinder revolves the other cylinder turns also, by reason of the friction of the encircling band of paper. The motion is communicated to the first cylinder by a gearing connected with a spring motor, a recent invention admirably adapted to furnish light power.

At one end of the table upon which the cylinders revolve, is placed a mercurial manometer-a U tube partly filled with mercury. In one limb of this U tube is a float which bears an upright rod, carrying a style so arranged that its point writes on the blackened paper as it passes over one of the cylinders. Obviously, every movement of the mercury must be recorded by this floating pencil. The other limb of the manometer is connected with an artery of the animal to be experimented upon. The connection is made by means of a rubber tube filled with a saturated solution of sodic carbonate (to keep the blood fluid) and provided with a glass cannula for insertion in the artery.

With this instrument many interesting and instructive experiments can be most graphically shown.

THE VAGINAL TOTAL EXTIRPATION OF THE UTERUS FOR CANCER.

BY DR. AUGUST MARTIN, BERLIN, GERMANY.

[From advance sheets of the Medical Record.] Freund inaugurated the extirpation of the cancerous uterus ten years ago. Sufficient material is now at hand to decide the two fol

lowing questions, which may legitimately be asked concerning every new method of sur gical treatment:

1. Is this operation practicable with such immediate success that it promises good results in the hands of others than a few specially successful operators?

2. Does the extirpation of the cancerous uterus give permanent results which force us to recognize that this method is superior to any other treatment of cancer employed up to the present time?

In seeking an answer to the first, if we examine the literature, we are struck with the fact that only meager and isolated reports about this operation can be found in English and German medical journals. Vaginal ex tirpation has obtained decided recognition in Germany. In this country the purely vaginal operation of Czerny and Billroth and Schroeder has been adopted instead of the procedure of Freund, which was a combination of abdominal and vaginal operations. The results of the same have improved noticeably with increasing exercise and experience.

In 1881 Olshausen collected 41 cases with twenty-nine per cent mortality. In 1883 Sanger, 133 cases, twenty-eight per cent mortality. In 1884 Engstrom, 157 cases, twentynine per cent mortality. nine per cent mortality. In 1886 Hegar, 257 cases, twenty-eight per cent mortality.

Through the courtesy of these operators, who to my knowledge commanded the greatest amount of material, and, at my request, placed at my disposal the results up to the end of the year 1886, I am able to present the following:

Up to the end of 1886 these total extirpations have been performed on account of carcinoma uteri: Fritsch, 60 times with 7 deaths;

Leopold, 42 times, 4 deaths; Olshausen, 47 times, 12 deaths; Staude, 22 times, 1 death; A. Martin, 66 times, 11 deaths. Total, 311 cases with 47 deaths, or 15.1 per cent.

Are we not justified in assuming that this rate of mortality will decrease, with more experience, as shown by the published tabular results of each of these operators? Already the total extirpation of the uterus for cancer shows better results, so far as immediate mortality is concerned, than removal of the breast for cancer.

For the latter, Kuster, at the Twelfth Meeting of the German Surgical Society, in 1883, published 778 cases with a mortality of 15.6 per cent. Who would hesitate to propose to perform the amputation of the cancerous breast as soon as the diagnosis is established?

I do not hesitate to answer my first question in the affirmative, and to claim for this operation of the vaginal total extirpation of the uterus a full and equal rank among all methods for the treatment of cancer of this organ.

For an answer to the second we will make use of the relatively small, but very accurately reported cases of Schroeder, collected by Hofmeir, and those of Fritsch, Leopold and myself.

Table II. shows that the permanent results of vaginal total extirpation in this relatively short period of observation are, no doubt, equal to the best results of carcinoma operations of other organs.

The author up to the end of 1885 operated on 44 cases. Of these relapsed 18, or 29.7 per cent.; recovered 31, or 70.3 per cent.

Is there any other method of treating cancer which with so small mortality can show equally good results? There is no other mode of treating cancer of the fundus and those forms of diseases of the cervix in which the mucous lining of the cervical canal is the point of origin, or in which there are carcinomatous nodules in the tissues of the neck. There is no room for discussion except in the epithelioma of the portio vaginalis arising from the surface of the cervix, that is, from a

surface covered with flat epithelium and containing very few glands.

I agree with Fritsch that the observation of cases of progress of the disease in isolated nodules in the mucous membrane up to the fundus, in cases of carcinoma colli, is sufflcient in itself to show it is erroneous to claim that in carcinoma of the cervix we should try to save the body of the uterus. Biswanger and P. Ruge have described such well-marked

cases.

The possibility of a subsequent pregnancy is not excluded in cases of high excision; but Hofmeir himself declares that pregnancy is a very serious danger in carcinoma. Therefore, I am convinced that it is much better to immediately perform vaginal total extirpation in these forms of epithelioma of the cervix. The sooner we operate the more surely we may hope to save our patients from the sad fate of death by cancer. The greater the experience with vaginal total extirpations the more has the rule been proved that we shall perform the operation only when the vicinity of the uterus is free from carcinomatous infiltration. All attempts to enlarge the boundaries of the operation in this direction have failed.

The technique of the operation has undergone only immaterial changes, as is shown by the results of operators using different methods. It is irrelevant whether the uterus be removed by an incision made in front of, or at the side of the neck, or at the side of the neck, or behind it. It is of little importance whether hemorrhages be prevented by stitches introduced before the incision, or whether each separate vessel be seized and tied as it bleeds. It is immaterial whether the uterus be turned over or removed by drawing it down and freeing it, whether the opening in the floor of the pelvis remain open or be closed, or be drained either with the iodoform gauze or with a tube.

If it be easily practicable I advise that the ovaries and tubes be also removed. It is immaterial whether the wound be sutured or not. It is wonderful what little impression the operation makes on the patient. One can liken her very much to a puerperal woman.

Bleeding must be stopped at all events during convalescence; the parts as much as possible kept at rest. Washing out the peritoneal cavity does not work favorably.

THE ETIOLOGY AND TREATMENT OF TETANUS,

BY DR. CHAS. W. BROWN, OF ELMIRA, N. Y.

The author began by saying that the cause of the disease is still enshrouded in doubt, but was more probably due to ascending neuritis than to the irritation of peripheral nerves. He considers the disease a specific, contagious, and infectious one, which, according to Rosenbach, is caused by a bacillus, his experiments having shown that rabbits and mice inoculated with material from a case of tetanus died of the disease. The author adverted to some experiments made by various observers upon the horse, and proceeded to compare a true case of the disease with one of cerebro-spinal meningitis, which, he thought, had often been mistaken for idiopathic tetanus; in fact, his experience and observation had cast a doubt in his mind as to the existence of such a disease as idiopathic tetanus, which was always the result of some wound, however slight. After an interesting account of a case met with in his practice he approached the subject of treatment, which he characterized, as a rule, as very unsatisfactory. The wound should be, if necessary, freely opened and cleansed with some antiseptic fluid, and dressed in accordance with the methods of modern asepsis. Isolation and rest in a dark room, free from air-currents, were of great importance. The removal of wounded parts has not given good results in traumatic tetanus. Supporting measures are indicated in the disease, and the intelligent use of stimulants. The use of concentrated foods was not to be overlooked.

Quinine had been in some cases apparently, used to advantage, in enormous doses, some giving as much as two hundred and sixty grains in one dose. He had himself administered it in doses of one hundred grains every hour for some time; this case recovered,

bad

results followed from the injection of such a large quantity of the drug. Fowler's solution, cannabis indica, morphia, cocaine, the bromides, had in turn been tried in vain, although the latter, particularly bromide of po tassium had been strongly recommended by Dr. McCord, of Kentucky, in twenty grain doses, every hour. The use of pounded ice. and the ether spray along the spine should always be resorted to.

GALVANISM OF UTERINE FIBROIDS,

BY DR. EPHRAIM CUTTER, OF NEW YORK.

The paper was divided into Expectations, Realizations, Answers to Critics, Conclusions. EXPECTATIONS.--August 21, 1886, the first American operation was performed, simply to arrest development of the fibroid. It was participated in by Dr. W. S. Stoveham, of Massachusetts (see American Journal of Obstetrics, New York, February, 1887, p. 120).

Dr. Gilman Kimball was present, August 29, 1887, and operated the second time. "So far as the priority is concerned, I am willing to give it to him, for I will have no question of honor between him and me."

The idea of using common needles was scouted at once by their unsatisfactory per formance. Dr. Kimball said he would have nothing to do with the operation unless better needles were provided. I invented one plated with gold and shaped like a corkscrew, which proved a useless device. The so-called Cutter needles were then produced. Whatever has been or may be said of them, they were satisfactory.

batteries, in the duration of the application, in the kinds of electrodes, in the discovery of instruments for mensuration; 7, the operation has been widely published and has become pretty well known; 8, uterine fibroids are no longer opprobia medicine.

When the first operation was done there were no amperemeters; only voltameters, which are measures of electro-motive force. It is not claimed that the milliamperemeter cures; it only measures. I only object to the doctrine that no operation can be done without measurement, not to measurement itself. APOSTOLI'S CRITICISMS.--I distinguish be tween him and his sayings; I know him for the work he has done, and reply to him in no spirit of malice.

CONCLUSIONS.-1. When an untried operation is purposed, it is not wise for those whose opinion is asked as experts to say it cannot be done.

2. Best to give all due credit for what they do.

3. In performing this operation use common sense, and not blindly follow anyone's method unless indicated by the strongest signs.

4. Hereafter any physician who says uterine fibroids are hopelessly incurable is not sustained by the facts and evidence.

IODOL IN SURGERY.

BY DR. GEORGE ASSAKY, OF BUCHAREST, ROUMANIA.

The conclusions arrived at were: (1) Wounds unite under l'iodol by first intention. This union, however, being the result of various and complex conditions attending operation, it is not possible to attribute to l'iodol alone the absence of suppuration and inflammatory conditions. In wounds which gape and suppurate l'iodol is an excellent antiseptic. It rapidly retards suppuration, renders it inodorous, reduces the frequency of dressing, and hastens considerably cicatrization. In ulcerating or gangrenous wounds l'iodol aids to resist the destructive process, and changes the

wound, after a variable time, to a healthy, granulating condition. This action of l'iodol extends itself to hard chancres. In case of soft chancres the result is variable. Sometimes it transforms them into a simple wound with brief delay; at others it is insufficient for this purpose, and it becomes necessary to employ in addition locally, antiseptic lotions. The same is true with reference to open venereal bubos of the groin. The powdered l'iodol has this advantage over iodoform, that it is free from odor and is not toxic in its effects.

(2) Doses of l'iodol of from 0.40 centigrammes to 2.0 grammes, daily, produce no functional trouble, even if continued a long time.

These doses give marvellous results in tertiary syphilis and in scofulous affections. In the secondary stage of syphilis, taken internally, it rapidly destroys the syphilitic manifestations. L'iodol seems to aid the general nutrition and increase strength and flesh. It is indicated in all cases of specific malnutrition.

L'iodol is an antipyretic. In acute infectious diseases, such as erysipelas, etc., it causes a rapid fall of temperature.

"DOES FUNCTION CONTROL THE EVOLUTION OF STRUCTURE ?"

The following is a portion of the remarks of Dr. H. H. Thompson, in his paper:

Some time since, Dr. C. N. Pierce discussed a subject similar to that at the head of this paper. After noticing the mechanical forces involved in and influencing the evolution of the teeth, he says: "Those cumulative forces are utilized through heredity, and while so potent in tooth-evolution, exert a similar influence in the development and modification of all other structures and organs. All departments of biology recognize the fact that heredity, adaptation, and growth, being of special importance in the evolution of the organic body, must therefore be regarded as especially formative functions. Adaptation to environment might be called the ancestor of