THE MEDICAL RECORD. allied occupation of the Crimea. The organization of our army medical corps, especially in its official posture towards the rest of the service, whereby the sick 3 Semi-Mouthly Journal of Medicine and Surgery. ened or wounded soldier was severed, during treat ment, from his purely military relations, and guarded and protected in a self-governing and appropriate medical sphere, has been imitated by more than one nation across the seas. An unrivalled system of medical and surgical reports and records has secured to science the immense professional fruits of our war, which, it is confidently hoped and expected, some enlightened and liberal Congress will make available to the world by further appropriations of money for their publication. And that sombre succursale of our national battle-fields and hospitals, the Army Medical Museum at Washington, contains a collection of scientific treasures' that promises speedily to become, if it be not indeed already, more interesting and valuable than any of its THE CONSTRUCTION OF ARMY HOS- kind in the world. PITALS. But the crowning medico-military lesson of our late UPON European observers, who attentively and criti- rebellion, like that of every protracted war, was the one cally watch from abroad the progress of our new taught by the inexorable laws of hygiene: a science eivilization in this country, the favorable impressions which sometimes dwarfs and thwarts the arbitrament ereated by our humanity, our bounteous liberality, and of arms, and is co-ordinate in importance with military our extraordinary skill and success in providing for the strategy and state policy. While the public, and even comfort, and the medical and surgical alleviation of the the members of our profession in civil life, allow their sick and wounded in the late war of the rebellion, are appreciation of the value of hygienic rules, as applied to the source of just pride to Americans. The well-being the soldier, to lie dormant in time of peace, and to be of the soldier-in hospital, camp, and field-was the pivo- roused into activity only by the actual pressure of war, tal centre towards which gravitated all hearts and hands, it is gratifying to learn, as we do, from a recent publifrom every corner of our wide land, during that trying cation by the Surgeon-General's office, that we have, period of our nation's life. It opened a field of noblest in the medical corps of the army, a silent and unobtrueffort to patriotic men and devoted women. Such sive, yet most intelligent and able body of workers, prolific lavishment of money and means has never be- constantly engaged, under the inspiration and guidance fore, nor since, gilded with redeeming rays the suffer- of their chief, in testing old or solving new problems ings of war. And the rapidity and efficiency with in hygiene, with view to their profitable application to which our army medical department expanded, from a the improvement of the soldier's physical as well as condition appropriate to profound peace, to meet the mental and moral condition. tremendous requirements of the war, attested an intelligence among its officers, and a national aptitude and zealous co-operation on the part of their professional brethren from civil life, unequalled, in beneficent effects, even by that clothing of the old army with new military hosts, which ultimately won such worldfamed results. Stupendous military hospitals almost magically appeared, which, in means of comfort, in skill of professional succor, and in successful remedial results, challenged comparison with the best ever instituted in the Old World; where, indeed, the American pavilion hospital is now generally commended and followed as a model. An ambulance system, whose essential features have received the honorable seal of foreign approbation and adoption, rose into existence, and grew into perfection, under our national flag. Our admirably-arranged and comfortably-equipped hospital transport ships shared not in that wail of woe and dirge of death that spread from the Black Sea during the memorable years of the We have before us "Circular No. 4, War Department, Surgeon-General's Office, December 5, 1870. A Report on Barracks and Hospitals, with Descriptions of Military Posts." It is issued from the Government Printing Office; comprises 527 handsome quarto pages; is unexceptionable in paper and typography; and is illustrated with numerous diagrams and plates. Quantitatively, this interesting volume owes four hundred and ninety-two pages of its dimensions to local reports, and descriptions of posts, contributed by the medical officers of the army stationed at the various military posts of the United States, extending from Eastport to Fort Yuma, and from Key West to Bellingham Bay. Qualitatively, we are disposed to think that its value to professional readers, outside of the army, will be found to inhere principally in the thirty-three succinct, but pregnant, pages comprised in the exceedingly intelligent, reliable, and instructive Report on Barracks and Hospitals, by Assistant-Surgeon John S. Billings, U. S. A. officer has discussed his theme with marked ability This in its hygienic as well as in its purely military relations ology of their respective localities, evinces a degree of -and therefore its careful perusal will profitably repay the sanitary student and hygienist in civil life. To officers of the army, and especially to military commanders and representatives of the Quartermaster's Department, charged, under the existing army system, with the construction and repairs of barracks and hospitals, we hail this offer of hygienic advice with hopeful pleasure. Such a perspicuous and perfectly trustworthy résumé of the hygiene of barracks, guardrooms, and hospitals as Dr. Billings has placed within the portée of his non-professional brothers in the army, will prove to them an able and reliable guide, if observed in the performance of their responsible duties; and may we trust that it will also serve as a groundwork of harmonious understanding between them and the post medical officers, and help to smoothe away those differences which have oftentimes so strongly militated against the true interests of the service and the best welfare of the soldier. Three tables of statistics, collected and presented by Dr. Billings in his report, are mainly new, and are unusually interesting and valuable from a medical point of view. The first table shows the ratio, per 1,000, of mean strength, of sickness and mortality (accidents and injuries excluded), occurring in the United States Army for the calendar years 1868 and 1869; the second table gives the ratio of mortality in the U. S. Army as compared with the U. S. Navy, and the military services of other countries, and with civil life; and the third table shows the ratio, per 1,000, of total mortality (exclusive of deaths from epidemics, accidents, and wounds), due to various classes of diseases, in the United States army and navy, the English army and navy, the French army, the Italian army, and in civil life. The statistics for the U. S. navy we do not remember to have seen published before; while those for civil life are here given to the public in advance of the U. S. census reports. scientific knowledge on the part of the writers which it is rare for the busy practitioners of our profession, at least in civil life, to carry much beyond the curriculum of their pupilage. All of the members of the commissioned medical staff of the army received their appointments only after rigid competitive examinations for their positions, and, fortunately, without the aid of political preference. Most of them have been submitted, during the last decade, to the most varied and trying military and professional experience; and after examining their reports upon sanitary and kindred professional topics, contained in the present volume, we feel confirmed in our confidence in their ample preparation for all national contingencies. We must return to Dr. Billings' report with a confession of surprise that on so seemingly appropriate an occasion, and from so well-informed a source, there should have come no strong protest, or even moderate recommendation, looking to the disenthralment, from the annual Congressional appropriation of funds for the use of the Quartermaster's Department, of that portion intended for the construction and repairs of hospitals. It may be that by reason of Dr. Billings' official position there may exist some good reason, unappreciable to us, which would render such protest or recommendation ungracious, or not permissible, in his report; or, possibly, the efforts of the Surgeon-General, in his uniformly right and humane direction, have been temporarily checked by his success in obtaining the promulgation of War Department Order No. 118, of November 23, 1870, which was really a great step in advance, and which provided that the medical department, though not permitted to disburse a definite appropriation in its own best way, shall at least prevent such pittance as may be doled out to it from an appropriation made for associated purposes, from being expended in erecting hospitals upon any other than the SurgeonGeneral's approved plan. And, after all, this order, instead of giving the medical department authority to do all that is right, simply enables it to prevent another department from doing what is wrong! Does it even accomplish this? Is there anything in it to prevent the Quartermaster's Department from trenching on and absorbing the portion of the common appropriation urgently required by, and undoubtedly intended by the legislators for, the medical department? So long as the appropriation for hospitals is mixed up, as it now is, with that for barracks and stables, so long will the To Dr. Billings, also, was committed, by the Surgeon-General, the duty of collating for publication the reports by army medical officers above referred to as embraced in this volume. These reports, based upon an excellent system, prescribed by the Surgeon-General in 1868, of preserving the medical histories of military posts, furnish, by their present publication, in addition to a large array of facts bearing upon the hygiene of posts, upon their atmospheric and telluric characteristics, and upon a great variety of conditions and causes affecting the sanitary state of their occupants, much other information which will, doubt-building of hospitals be a secondary matter. Barracks, less, prove interesting and valuable to officers of the army, and to persons to whom the archives of the Surgeon-General's Office may not be conveniently accessible. The historical reminiscences of many military posts, preserved in these reports, are interesting; and the information given, in nearly all of them, concerning the fauna and flora, geology, mineralogy, and meteor stables, and hospitals being clubbed, and included in the same grant, whenever the barracks and stables require a greater expenditure of money, the hospitals necessarily suffer, under the present system. Unquestionably, there should be an analysis, and proper division of the common appropriation. There should be a certain amount of money allotted every year for hos Two numbers of the series are already published, containing the more common medicinal plants of the Northern States; rarer specimens from home and abroad are promised in the later fasciculi, which may tains ten specimens. number twenty or twenty-five. Each fasciculus con Reports of Societies. pitals only, and that fund should exist and remain solely titioners, especially those residing in rural districts, for hospital purposes. It should be a separate item, and would find both pleasure and profit by availing thembe placed under the Surgeon-General, for his disburse-selves of this means to become familiar with medicinal plants growing in their neighborhood. ments, through the officers of his own department. But, say the opponents of this reform, would not a medical officer be going out of his line if he had to superintend the erection of a hospital, and to judge whether the repairs were properly done, or of good material? But suppose that medical officers, for the double purpose of protecting the integrity of the hospital appropriation, and of securing, by their personal supervision of the construction and the repairs, the best hygienic conveniences for their patients, elect to per- NEW form these extra-professional duties. Is there any conceivable obstacle in the way of their successful execution of them? Are they destitute of intelligence, or of principles of wise economy? Are their garments any more susceptible to dishonest sully than those of army quartermasters? But we are so apt to lose our patience, when reflecting upon the degree to which the efficiency and usefulness of our army medical depart-ing of the Academy, illustrated very forcibly what is ment are impaired by this neglect to give it an independent appropriation for its hospitals,-the same as it now has for medicines and hospital supplies,-that we summarily suspend the subject for the present. The concluding recommendation in Dr. Billings' report, relating to post and barrack construction, is a point inviting more earnest comment than we have at present the space to give it. In consideration of the great importance of this subject, and in order to consult the interests of the different arms of service involved, Dr. Billings suggests the expediency of its reference to a competent board, consisting of engineer, quartermaster, medical and line officers, for the preparation of plans and regulations, for the approval of the Secretary of War. To this focus of intelligent solution and settlement do we believe that the subject should be promptly brought; for so long as individual ignorance or caprice is allowed to control the erection of barracks, so long shall we probably continue to have the best fed and best doctored, but the worst sheltered, army in the world. Reviews and Notices of Books. THE MEDICAL HERBARIUM; A COLLECTION OF DRIED YORK ACADEMY OF MEDICINE. DR. E. R. PEASLEE in the Chair. DR. WM. H. DRAPER opened the "Discussion of Dia- The elaborate historical review of the pathology of diabetes which was read by Dr. Smith at the last meet true of so many problems in disease, that what we substitution of one theory for another, a change of base sometimes falsely call progress in pathology is only a which often involves us in greater difficulties than the one we abandoned. When Bernard announced in 1849, that diabetes irritation of the floor of the fourth ventricle, the new mellitus may be artificially produced in animals by pathology took definite shape, and diabetes became a functional disease of the liver, the consequence of irritation, central or peripheral, of the vaso-motor nerves that supply this organ. The experiments of Harley and others, demonstrating that liver-glycogenesis could be excited by reflex as weil as central irritation, seemed to confirm this view. In stating the serious objections to the exclusive adoption of this theory of glycosuria, we desire to suggest some reasons for the belief that glycosuria is a symptom, not of one, but of numerous morbid conditions. The principal objection to the exclusive adoption of the theory of diabetes which is based upon liver-glycogenesis, is a clinical one. It is well known that certain times entirely cured by restriction to animal diet. cases of glycosuria are always controlled and someThese cases, and they are by no means infrequent, neither require nor admit the glycogenic function of the liver for their explanation. They are explained satisfactorily by that defect in the assimilative process by which the conversion of amylaceous and saccharine food is checked-and the series of changes by which the non-nitrogenous elements of our food are ultimately converted into CO, and water is interrupted at the formation of glucose. This is the old chemical theory of Bouchardat, and one which is certainly in accordance with the facts observed in the class of cases to which we have alluded. Again, if glycosuria was the necessary result of the excessive formation of animal sugar by the liver, is it not strange that morbid anatoThe undertaking could not have fallen into better my should not present us with some constant lesion of hands than those of Dr. Allen, whom we have long the liver as the result of the long-continued hyperæmia known as one of our most accomplished amateur bot- to which the organ must have been subjected? It is anists. The specimens have been carefully selected, well known that the most diverse lesions have been found thoroughly poisoned from the attack of insects, and in this disease in the lungs, liver, kidneys, and alimenglued to stout paper, so that they will last indefinitely. tary canal, and that, excepting the nerve-lesions which To instructors of Materia Medica, and to pharmaceu- have been found in a few cases, pathological anatomy tists, this collection will prove invaluable; and all prac- I has furnished no clue to the seat of the disease. Publishers. SEVERAL Collections of dried samples of medicinal plants have been issued abroad in the form of a serial publication, but this is the first instance of the kind of which we are aware in America. of the most dangerous collapse, prompt clearing out of the tube, and liberal administration of hot whiskey and water, prevented that occurrence from ending fatally. CASE 2.-On the 30th of December, 1870, I was called to see John Conway, residing at 126 East 51st street. I found a delicate boy, aged eight years, of a strumous diathesis, with a suspiciously ringing cough and hoarse articulation, slight fever, fair appetite, and no general or local distress. I cautioned the father and friends of the child as to the possibility of the appearance of more urgent symptoms, prescribed expectant remedies, and took my leave. On the day but one after I called and found a full efflorescence of measles and an almost complete disappearance of the croupous symptoms. I renewed my previous cautions, with the injunction to give immediate notice of any change in the patient. On the 4th of January, at 3 P.M., I was summoned in extreme haste, and found the patient with fully-developed membranous croup. The paroxysms of breathlessness had commenced early in the afternoon. The return of cough and hoarseness was coincident with the subsidence of the eruption the day before. I estimated at this time that the patient without relief would live from twelve to fifteen hours. Having explained the circumstances, which were intelligently apprehended, I advised consultation and immediate operation. Consent was given at once, and I proceeded with all possible speed to make the necessary preparations and obtain the advice and assistance of my friend and colleague Dr. Erskine Mason. Dr. Mason sustained the diagnosis and opinion, and at 6 P.M., with the aid of gas-light, we proceeded to perform the operation. Ether was given, the subcutaneous divisions made with a blunted scalpel, the trachea laid bare without bleeding, opened, and a double tube inserted. Complete relief immediately followed. The child, still sleeping, was placed in bed; the temperature of the apartment regulated to stand permanently at 80°, and a croup kettle placed in operation at the bedside with the steam directed towards the mouth of the tube. The following excellent formula of Dr. Leaming was directed, a teaspoonful every two hours :*B Ammonia Muriat., 3 ss. Potas. Chlorat., 3 j. Syr. Senegæ, Pruni Virgin., aa iss. Steady and systematic nutrition by beef tea and milk punch was likewise advised as of the utmost impor tance. This case progressed exceptionally well. No untoward event of any kind marred its course. On the third day I began to interrupt respiration through the tube, and on the seventh removed it altogether. On the thirteenth day from the operation, the opening was completely closed; and on the twenty-first the voice had begun to recover its natural clearness and force. At the present date the boy is perfectly well. These two cases happening at a widely distant interval, and under diverse circumstances, illustrate some of the most important points ir regard to a surgical procedure, concerning which there is much uncertainty and diversity of opinion. The conclusion which I desire to draw, and the one I am disposed to adopt till better instructed by the knowledge of others or my own experience, is to advise tracheotomy in every case of impending suffocation, whether from diphtheria or fibrous croup; and secondly, to insist upon the operation at the earliest moment at which the condition is recognized with certainty; before the brain is poisoned by unoxygenated blood, and the unstriped fibres paralyzed by interruption, diminution, and pravity of nervous force. REMOVAL OF A PORTION OF A NEEDLE FROM THE By E. G. JANEWAY, M.D. NEW YORK. ON Sunday, the 7th of November, 1870, a gentleman brought his daughter, four years of age, to my office with a piece of thread hanging from an opening in the skin over the outer side of the right knee. Her father stated that a short time before, while she was playing on the floor, a needle had run into her knee, leaving the thread hanging out, as above described. A short examination convinced me that the threaded needle had entered the joint, and was imbedded in the bone-the head of the tibia, I supposed; and that traction on the thread was useless. I sent the child home, giving the father directions to apply ice to the joint, till I could arrange for a consultation with a view to the extraction of the needle. Dr. Gouley and Dr. Loomis met me three hours later, and we decided that the proper course would be to follow the thread by careful dissection; and to open the capsule of the joint, if that procedure should be found indispensable to the removal of the needle. The child was placed under ether, and Dr. Gouley followed the thread by careful and delicate dissection. Occasional traction was made on the thread, but the needle was so firmly imbedded in its lodgingplace, that this only served to move the leg; and this was desisted from for fear of breaking the thread and thus losing the guide to the needle. Finding it necessary, Dr. Gouley opened the capsule of the joint an inch to the outside of, and partly below the patella, to the extent of an inch. On strongly flexing the knee a portion of the needle was seen to protrude from the cartilaginous surface of the outer condyle of the femur thread and the eye portion of the needle were hidden near its centre at a right angle, whilst the end of the forceps. The portion thus removed was less than an in its substance. This was easily removed by a pair of inch long. Not knowing what had become of the remainder, a search of the floor where the child had been playing was ordered; and a larger piece, evidently This we supposed had broken off in the floor, when the of the same needle, was soon found minus the point. eye portion entered the knee. The lips of the wound were then brought together by fine silk sutures. and the continued application of cold. I secured the The after-treatment consisted of two elements-rest, first, by placing the child on her back, and tying the leg in a small pillow, for two days afterwards, by means of a plaster of Paris splint reaching from the A thin layer of upper third of the thigh to the toes. cotton and a flannel bandage were applied before the pe-joint was left bare. plaster bandages; and the anterior half of the knee The first was the most unfavorable possible, in its nature and conditions; the second, with allowance for a naturally delicate constitution, very happily situated as to comfort, care, nutrition, temperature, and the riod selected for operation. *This prescription frequently requires to be diluted with syrup and to be given in diminished doses. The cold was obtained by the use of bags filled with ice. For the first two days the child was restless, and would complain of her knee on the least movement of her leg; but no complaint of this kind was made after the application of the plaster apparatus. The sutures were removed at the end of the third day, as slight suppuration had then commenced in their course, and a portion of the wound had healed by the first intention. Their place was supplied by strips of adhesive plaster, so applied as to cover the wound and protect it. The use of the ice was continued uninterruptedly for two weeks, the joint having become somewhat swollen at first, and remaining so for ten days, and being also painful on pressure. To prevent the effects of reaction, on suddenly discontinuing the ice, I ordered gradually increasing thicknesses of cloth to be interposed between the icebag and the joint. No granulations formed in the ununited portion of the wound till the removal of the ice, but in one week later the healing process was completed. The splint was removed at the end of four weeks, and a slight membranous adhesion found on bending the knee to a right angle. I made no attempt to break this up, but allowed the child for a few days to move the leg, and then to run around. She soon made an apparently complete recovery. Two points in connection with the use of ice in disease were apparent here: First. It prevented the granulations from springing up in the wound after the sutures were removed, but previously the presence of an irritant, in the form of sutures, sufficed as usual to produce suppuration. Secondly. Whenever the ice was suddenly removed, the effects of reaction threatened to prove injurious; and hence I adopted the procedure above described, with happy results. I ought to state, that the child was descended from healthy parents; and that her father's wounds always healed readily. She had enjoyed good health. · 249 WEST TWENTY-THIRD STREET. Progress of Medical Science. NOVEL MODE OF CONTROLLING HEMORRHAGE.-Dr. J. H. H. Burge (N. Y. Med. Jour.) contributes the history of a case of Placenta Prævia attended with profuse hemorrhage. He found a small margin of the placenta presenting. The liquor amnii had completely drained away, so that the outline of the child could be made out through the abdominal walls. The examination excited some pain and caused considerable hemorrhage. Observing that during the pain the pressure of the child's head upon the placenta controlled the flow, he in the intermission grasped the uterine tumor and pressed steadily in the direction of the os. This was continued with perfect success for two and a half hours, when a living child was born, and the placenta followed without loss of time. During all this time, if the pressure was relaxed while the uterus was inactive, hemorrhage was sure to follow. CASTRATION FOR EPILEPTIC INSANITY.-Dr. Mackenzie Bacon, in the Practitioner, cites a case of removal of the testes in a lad who had brought on epilepsy and insanity by self-abuse. The result was an improvement in every way, including a marked increase of intelligence. He thinks the operation would be useful to many insane epileptics. ed all the symptoms attending that disease. Dr. N. determined to use chloral thoroughly, and accordingly administered twenty grains. He was a little calmer, but no sleep; gave thirty grains half an hour after. The patient went to sleep in five minutes. Ordered the dose to be repeated when patient waked: he waked quietly in two hours. After the medicine he again slept for seven hours, when he was awaked to take essence of beef, which he took unconsciously. Was then ordered to be put in a warm bath every three hours, and every four hours to have the chloral, if required, and to have the essence of beef. Between the baths the wound was dressed with warm flax-seed poultices, made up with equal parts of tincture of opium and arnica. The patient was kept more or less under the influence of the chloral for four days. In a week he was well. SHOULDER.-Dr. Samuel Logan, of New Orleans, describes his method. The patient is placed on the back, while the surgeon, having removed his boots, seats himself so that his legs shall be nearly at right angles to the patient's body, but pointing rather upwards. He places the heel of one foot in the armpit, against the ribs, so as to press a little crosswise; the base of the great toe of the other foot is placed against the acromion process, and the surgeon pushes with moderate force while traction is made upon the arm.-Transactions Am. Med. Assoc. NEW METHOD OF REDUCING DISLOCATIONS OF THE HICCOUGH CURED BY CHLORAL.-Dr. P. F. Whitehead has recently prescribed for a patient with hiccough, which had continued for thirty-six hours. Various remedies were used with but little good effect, save a temporary cessation by the use of morphine hypodermically. Thirty grains of chloral gave immediate and permanent relief. TOBACCO AS AN ANTIDOTE TO MALARIA.-Dr. S. P. Crawford, on this subject, says: "The only assurance of freedom from all the ills of miasmatic poison, while it continues in force, is to constantly use some antidote. I do not say that tobacco is the best; but I do say, in my opinion, that it is capable of warding off oftentimes periodic diseases, by in some way counteracting the causes that produce them. I do not say that it will hold good in all cases, nor do I believe it would be of much service where miasm is concentrated and holds its deadliest carnivals. It is only in those habituated to the use of tobacco, who appear to enjoy the usual health of those who use it, that I have noticed this immunity. I cannot say there is any difference between the smoker and the chewer."-Nashville Journal of Medicine and Surgery. IMPOTENCE RESULTING FROM ONANISM; CURED BY ELECTRO-MAGNETISM.-Dr. Finstein, of Ohio, reports a case of this in a man aged 26, who, from the age of 15 to 19, was addicted to onanism, but which was relinquished after the latter period. At the age of 23 he found himself impotent. Various remedies failing, electro-magnetism was resorted to, and after 52 applications, twice a day, continued from 10 to 30 minutes, his powers were restored.-Medical News. Dr. Bradley, of St. Mary's, Ohio, reports that when a INCOMPATIBILITY OF QUININE And Veratrum VIRIDE. patient is under the influence of veratrum viride, it is highly dangerous to administer quinine. The effects are most alarming: immediate sinking of the pulse, which, in some instances, reaches collapse. He ran great risk of losing three patients before he became aware of the actual cause.— Cincinnati Lancet and Ob HYDROPHOBIA CURED BY HYDRATE OF CHLORAL.-Dr Thomas Nicholson (N. O. Times) was called to attend a patient, 12 years old, with hydrophobia. He present-server. |