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THE MEDICAL NEWS. all countries; it must give prompt and reliable in

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IN entering upon the fortieth year of its publication, and prompted by the desire of more fully meeting the requirements of the medical literature of to-day, and of furnishing the profession with a medium of more frequent intercommunication, The Medical News begins its weekly issue under most encouraging circumstances, and with the cordial commendation of a very large number of the foremost and ablest workers in the profession in all parts of the country, who have also assured its high standard of excellence by specifically promising to enrich its pages by their contributions.

The plan of the weekly News is so fully and faithfully set forth in the Publisher's prospectus, and in this first number, that it seems unnecessary to dwell further upon it, beyond saying that we shall especially endeavor to cultivate the vast field of clinical observation, embracing the scope of all the specialties, and to stimulate the publication in our pages, for the benefit of the whole profession, of the rich stores of clinical experience, the lessons of which heretofore have been for the most part confined to single observers. At the same time we shall assiduously labor to render every department of the News worthy of the entire profession which it aims to represent.

The functions of a weekly medical journal are multifarious: it must be the medium of transmitting the earliest intelligence of medical discoveries and progress; it must, in its editorial columns, represent the living thought of the day, and, while holding positive views, fully, fairly and forcibly discuss all current topics which interest the profession scientifically, socially, or politically; it must present a faithful record of the progress of medical science in

formation concerning all matters, wherever they may be, which are of general medical interest; it must, in fine, fulfil the rôle of a professional newspaper. To enable it to attain this aim, the News will have the advantage of a large, carefully selected, and experienced editorial staff, of a corps of collaborators, embracing the most prominent workers in the medical profession of this continent, of special correspondents in all the principal cities of the world, and of a large reportorial staff, which will furnish. full and accurate reports of the meetings of the principal medical societies in the United States and Canada which are available. With the ample resources and abundant experience of the publishers the profession are too well acquainted to render necessary any assurances as to the manner in which their portion of the work will be performed.

The columns of the News are open to the whole profession. Communications to every department are invited, and liberal compensation will be made for all original articles when published.

In developing so comprehensive a plan, which in its accomplishment will make a periodical that shall be absolutely indispensable to every physician who would keep himself abreast the professional thought and action of the day, and in its execution will require unremitting labor and involve weighty responsibility and a very large pecuniary expenditure, the News is encouraged by the belief that the profession want only the best, and that a periodical conducted on so broad and liberal a basis as is proposed will receive their unqualified and generous support, without which such enterprise becomes impossible.

In its management, the News will always be conducted for the advancement of the interests of the whole profession, and it shall be absolutely uninfluenced by any personal, school, or local interest; modelled on the highest type of weekly medical journalism, its scope shall be cosmopolitan and its character national.

With such a plan, and in the hope of its meriting their approbation and support, the first number of the weekly issue of The Medical News is presented to the profession.

LOCAL TREATMENT OF LUNG CAVITIES.

IN the number of the American Journal of the Medical Sciences for October, 1881, we find a notable paper by Drs. Fenger and Hollister, of Chicago, on the "Opening and Drainage of Cavities in the Lungs." Our attention is thus invited to an extremely interesting, if not altogether new, practice. During the present century there have been numerous attempts to reach, by more direct means, the cavities excavated by tuberculous ulcerations, not to

speak of pleural effusions. The subject has been revived anew, and a more practical direction given to the operative procedures, by Professor Mosler, of Greifswald. On the 23d of September, 1873, Professor Mosler read a paper before the Society of Naturalists and Physicians, assembled at Wiesbaden, which subsequently appeared in the Berliner Klinische Wochenschrift for October 27, 1873, under the title-Ueber lokale Behandlung von Lungenkavernen. Mosler's scheme included the opening and drainage of pulmonary cavities by suitable drainagetubes, and the application to the walls of the cavities of appropriate topical agents.

Prof. William Pepper, of Philadelphia, was engaged in a similar plan of treating lung cavities, at or about the same time, his preliminary publication appearing in The Philadelphia Medical Times for March 14, 1874.' Pepper's paper was "On the Local Treatment of Pulmonary Cavities by Injections through the Chest Wall."

Very recently drainage of the pericardium has been successfully carried on by Rosenstein, of Leyden. It is true, paracentesis of the pericardium has been frequently performed, and but a few months ago a very meritorious treatise on this topic appeared from the pen of Dr. J. B. Roberts, of Philadelphia. Rosenstein's case of drainage is, however, novel; for although puncture of the sac and fistulous openings externally are comparatively common, no one has before this deliberately opened the pericardium and inserted drainage-tubes to secure prompt removal of purulent fluid. The success of this case justifies the belief that the principles of treatment now established for empyema are equally applicable to the suppurating pericardium. It has been clearly established that in empyema, the main point is to secure a ready and complete evacuation of the pus; if necessary, exsecting a rib for that purpose. Can the same methods be applied to suppurating cavities of the lungs? To render the local conditions the same, it is necessary that the cavity be single, and that complete adhesions with the walls of the thorax exist. Let us see how far this declaration is sustained by the facts before us.

Of the six cases (five from various sources, and one their own) narrated by Drs. Fenger and Hollister, five proved fatal and one was cured. The fatal cases were examples of pulmonary disease, either inflammatory or tubercular; the successful case was one of echinococcus of the lungs. Davaine (Traité des Entozoaires, etc., Deux, Éd., Paris, 1877,) reports two cases of echinococcus of the lungs, in which operative procedures were successful. So long ago. as January, 1812, Fréteau opened a cavity (Opération de l'empyeme) and discharged 500 hydatids, the

1 Dr. Pepper's detailed publication appeared in the American Journal of the Medical Sciences for October, 1874.

rest being expectorated. In 1855, Dr. Vigla made an exploratory puncture with a trocar, in a suspected case of this kind, and injected into the hydatid cavity about 8 ounces (250 grammes) of a compound solution of iodine. (Arch. Gen. de Médecine, 5e Serie, tome vi., p. 282.) This case proved entirely successful,

Can the results of experience in the treatment of echinococcus cysts of the lungs be applied to phthisical cavities? We think not, and for the following reasons:

An echinococcus cyst is a purely local lesion, and the tissue of the lungs beyond the seat of deposit is healthy. The presence of an echinococcus cyst in the lungs does not involve any necessary change in the structure or function of the other organs of the body. When entirely and successfully removed, the local disturbance caused by their presence subsides, and the status in quo is restored.

In the case of pulmonary cavities caused by the usual conditions producing them, it is extremely rare to find a single cavity without adjacent lesions. Besides the more or less extensive pulmonary disease, complications exist in various organs which exercise a marked influence over the fortunes of the case. It is certainly true that when a cavity exists suitable for the treatment by drainage, more or less extensive caseous and tubercular deposits, dilated bronchi, interstitial pneumonia, etc., coexist. The successful drainage of a cavity, under such circumstances, can effect but a temporary alleviation of the symptoms.

Before the drainage of a cavity can be attempted, the exact position of it must be ascertained. It may be affirmed in the most positive manner that no considerable depth of healthy pulmonary tissue can be with propriety penetrated. There must be complete adhesion between the pulmonary and costal pleura at the site of the cavity. The cases conforming to these requirements are examples of advanced disease in which extensive excavations have formed in the upper or middle lobe, the anterior boundary being composed of the pleura, much thickened by organized exudations. It is difficult to conceive of any advantage to be derived from drainage of such a cavity, if, as is usual, extensive lesions coexist, and if the cavity has free communication with a bronchus. On the other hand, if the cavity occupy the major part of the diseased area, and is not satisfactorily drained, the general condition being fairly good, certainly results may be achieved by drainage sufficient to justify the procedure.

The questions concerned in dealing with hydatid cavities in the lungs are, as has been stated, very different. Without entering too much into detail, it will suffice to say that there are two modes of dealing with them, determined by the local conditions.

When there is a solitary echinococcus cyst, which has | render it subject to contamination from the main merely displaced the pulmonary tissue without ex-soil-pipe and from other sources; want of ventilation citing a limiting inflammation, as in the case of Dr. of two of the water-closet compartments, and the Vigla, before mentioned, it suffices to inject some use, in one case, of the pan closet, which is now iodine solution, which causes the death of the para- generally condemned as one of the worst of that site, after which it undergoes a fatty metamorphosis class of sanitary appliances. and disappears. If, on the other hand, the conditions are as in the case of Drs. Fenger and Hollister, and in the case of Dr. Fréteau—that is, a limiting inflammation, suppuration, and vast numbers of daughter and granddaughter vesicles-the proper practice consists in the evacuation of the cavity, in thorough drainage, and washing out with carbolized water, etc.

The injection of pulmonary cavities is a more generally available expedient. Although no distinctly curative results have been thus far obtained, there is promise in the method. The remedy thus employed has been iodine in some form. It is not essential to the success of this expedient that the cavity injected be situated superficially, or fixed by adhesions to the thoracic wall. If the diagnosis be accurate, the cavity can be readily reached by a suitable needle, even although somewhat deeply placed. This method may, in the future, be utilized for a different purpose. It may be possible to remove extensive caseous or tubercular deposits, by injecting into them medicaments which will exert a solvent action on the morbid materials, leaving the proper anatomical elements unharmed.

DRAINAGE OF THE WHITE HOUSE.

AN examination of the sanitary condition of the Executive Mansion at Washington, with especial reference to the plumbing and drainage, was made necessary by the repeated complaints of its insalubrity, to which unusual prominence has been given by events occurring within the past few months. This investigation has been made by Mr. George E. Waring, Jr., who transmitted to Col. Rockwell, in charge of public buildings and grounds, a preliminary report containing the results of his observations. It is gratifying to learn that the defects were less serious than general rumor would lead us to expect. He found the quality of the plumbing reasonably good, but the system of drainage antiquated and defective, and in part radically wrong. This is what might have been expected from alterations and additions made from time to time by different persons, in lieu of a radical reconstruction in accordance with our present knowledge of the necessary sanitary requirements.

The authorities have doubtless been familiar with these faults, and their recommendations, if reported upon, have shared the fate which is inevitable when the necessary funds to defray the expense of reconstruction are withheld. It is humiliating that a great national calamity should be required as the occasion of which advantage must needs be taken. to compel a thorough overhauling of the drainage arrangements of the White House, which should. not, under any circumstances, have been permitted to remain in so unsatisfactory and neglected a condition.. We are informed that the temporary modifications suggested by the report have been car-ried into effect, and that safety is now ensured.

When Col. Waring makes his final report, it is to be hoped that the recommendations for reconstructing the sanitary arrangements of the ExecutiveMansion in accordance with the requirements of the best practice of sanitary science will at once receive proper consideration, and that Congress will promptly make the necessary appropriation, so that in the future we shall hear no more about the insalubrity of the White House, from this cause, at least.

ONE SYMPTOM TREATMENT OF LOCOMOTOR ATAXIA.

THE hygienic treatment of the ataxia of posterior spinal sclerosis, oscillates between absolute rest and active exercise. Now comes Dr. Mortimer Granvillewith an expedient, which is opposed to the "rest cure," and which he says in less than three months, if his results are trustworthy, not only will the symptom which was regarded as conclusively indicating the existence of an incurable disease, beeliminated from the case, but other symptoms will disappear with it, and the general state of the patient be sensibly improved. We give the plan in his own words (The Practitioner, November, 1881, p. 336.)

"The patient is directed to stand with his eyesclosed in his bath, after pouring a small can of cold. water down the spine, and to persevere in the attempt to do this steadily for, at first a quarter of an hour, and as his state improves, for half an hour every morning. He is to be furnished with a chair or rail at hand, to which he can cling in case of need; but instructed to avoid using it except in actual danger of falling. When he commences the daily exercise, he will probably for some two or three weeks make little progress, but after this he

Among the defects discovered may be mentioned, the want of proper ventilation of the soil-pipes, in one or more cases its entire absence; an arrangement of the tank for supplying a considerable por-will begin to be able to stand,” etc. tion of the house with water in such a manner as to

Dr. Granville recommends in sthenic cases the

application of a mustard plaster at night, the full | may properly correct flagrant irregularities by aplength of the spine, until redness is produced, in addition to the cold douche in the morning.

"FREE TRADE IN MEDICINE."

OUR valued contemporary, The Medical Times and Gazette of London, in a recent issue (November 12, 1881), discusses the subject of "Medical Education and Registration in America." In this article the regulations in the various States are commented on with fairness and candor. We refer to it, however, not to discuss the subject of medical education, per se, but whether this were better left to the medical profession and its legitimate institu- | tions, or be made the subject of political and civic regulation. As our contemporary states it, "the conditions under which men should be allowed to practise medicine, the amount and kind of knowledge which they should be obliged to show, the way in which their possession of that knowledge can best be tested, the length of the preliminary training which they ought to be required to undergo, the extent to which the details of that training should be regulated by compulsory rules or left to individual option, these are questions upon which there are wide differences of opinion in this country."

In England and on the Continent of Europe, the system of "compulsory rules," of entire governmental control, obtains; in this country, there is, as our contemporary well expresses it, "free trade in medicine," and "the provision of competent medical advisers is left, so far as the central authority is concerned, to the unhampered operation of the law of supply and demand." Which is the better system? In England, it appears, there are wide differences of opinion on this question. They are not altogether satisfied that their plan is the better one. There is a large and influential minority who hold that the American system, notwithstanding the abuses to which it is subject, is, on the whole, the better. They observe that the profession of medicine, left to its own resources, and untrammelled by obstructive legislation, is remarkably successful in the development of its powers. In the same article from which we have quoted, we learn that "American medical literature is very voluminous, and characterized by great originality, inventive genius, industry, and practicality." Now, as all the world knows, our medical literature is the growth of this century, of, indeed, the last thirty or forty years, and it is already being reproduced in European languages. It is also well known that certain departments of our art have been created in this -country, and others notably improved. Free trade in medicine seems to work well here. Ought we not continue, as heretofore, to permit the law of supply and demand to regulate our growth? We

propriate legislation, but ought we not refrain from such interference in our organizations and methods by authority of the government, as would hinder that free development and successful progress which we owe to our system of free trade in medicine?

THE THORACIC DUCT IN THE PRESIDENT'S CASE.

In another column we print an excellent letter from Mr. H. A. Kelly, a medical student at the University of Pennsylvania, who, with praiseworthy zeal, has carefully dissected the thoracic duct, with a view to determining whether it could have been injured, as has been inferred, in the case of the late President Garfield. His conclusion is adverse to any such opinion. It may interest our readers to know that the ball (calibre 44) is of an inch in diameter, and that the track of the ball (supposing it to be no wider than the ball itself) passed in the middle line, within about to of an inch of the anterior surface of the wounded vertebra. Posteriorly between the track and the spinal canal a slightly greater thickness of bone intervened.

Whether the thoracic duct was injured primarily, may be doubtful. But the drawings of the specimen show that the body of the vertebra was almost wholly eroded at several points anteriorly as well as posteriorly; and it is not at all unlikely that the duct may have become involved in the later inflammatory action, and have disturbed the processes of nutrition to such an extent as to account for the subsequent rapid emaciation.

It is remarkable that the aorta escaped injury, for the ball must have almost grazed it; and it is no less remarkable that the spinal cord was not involved by the secondary erosion; and that in lifting the President so frequently the weakened spine did not give way and produce pressure on the cord.

Our correspondent has done good service in his careful investigation of the facts anatomically.

THE NATIONAL BOARD OF HEALTH.

THIS Board has just issued its annual report. We venture to say that in scarcely any of the many reports presented to Congress will there be found more important matters compressed into briefer space than in this one of three and a half quarto pages.

We have only space at this time to call attention to the excellent and valuable special scientific investigations which the Board has directed to be made by eminent scientists in various departments, such as Wood, Sternberg, Remsen, Martin, Hering, Pumpelly, Mallet, Bowditch, Stephen Smith, G. A. Smyth, and others. The subjects are national in importance, and include diphtheria, malaria, air and water currents in soils, potable water, the sanitary condition of summer resorts, arsenical papers, etc.

We hope to allude hereafter in detail to the results sometimes led to atrophy of the testis, and has beers pretty nearly abandoned," p. 183, he lays himself open already obtained. to criticism from those who upon any or all of these

The expenditures of the Board have been-mirabile dictu-far less than the appropriation. The special sum of $100,000, set apart for use in case of an epidemic, has fortunately not been needed.

REVIEWS.

THE STUDENT S MANUAL OF VENEREAL DISEASES. By F. R. STURGIS, M. D. 12m0, pp. 196. New York: G. P. Putnam's Sons, 1880.

This little book is a condensation of much practical information concerning the venereal diseases, arranged in the form of lectures. Beginning with the simple venereal ulcer, the author describes in accurate terms the clinical history, the customary treatment, and the sequelae of chancroid, syphilis, and gonorrhoea, formulating and emphasizing in italicized paragraphs the general truths which underlie the received methods of diagnosis and treatment of these maladies.

We cannot better give an idea of its general plan and scope than by quoting a few of these paragraphs: "The initial lesion of syphilis is usually indurated; when present, this is of great value; but its absence, which sometimes happens, does not change the nature of the lesion; it still remains syphilis. When the induration is absent, the diagnosis has to be made from other characteristics."

"Syphilis always begins by an initial lesion, seated at the point where the virus gained entrance, never in any other way."

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Paralysis of single muscles, or sets of muscles, are (sic) nine times in ten syphilitic."

"The average case of syphilis runs its course in from eighteen to twenty-four months. Under proper and careful treatment the graver forms of the disease seldom occur. After the disease has apparently run its course, and anti-syphilitic treatment has been suspended, the patients should be kept under occasional observation for another eighteen months, and if in that time no symptoms make their appearance, they may make their minds easy about the future."

Nothing could be better adapted to fix fundamental principles in the mind of the student than these and many similar axioms which might be cited if space perinitted.

Teaching intended for students must necessarily be dogmatic, and it cannot be expected that in a manual" the author should give prominence to or should even mention theories opposed to those he himself holds. He should, however, for obvious reasons, endeavor to avoid disputed questions, and to state in the clearest and most unequivocal language those propositions which have received universal acceptance.

This has, as a rule, been well done. Paragraphs similar to those above quoted, and embodying in a concise and intelligible form, much information, familiar of course to specialists, but not so well known or understood by the general practitioner or by the student, are frequent throughout the book, and are generally admirable in their terseness and comprehensive

ness.

When, however, he says that “" urethritis in the female is always due to some venereal affection," p. 154; doubts the existence of "vesicular and bullous [sic] syphilides," p. 60; asserts without qualification that “a chancroid becomes worse under a mercurial course, which is poison to it," p. 59; that when complicated with phimosis, "the initial lesion does not ulcerate," p. 38; and that strapping of the testicle in epididymitis "has

points venture to disagree with him.

There is a granular urethritis of females often following parturition, and becoming chronic, a traumatic urethritis, due to local irritation, sometimes, for example, to a vulvitis caused by rude and excessive copulation, and a urethritis which may appear consecutively to affections of the bladder, in any of which a suspicion, much more a dogmatic assertion, of the existence of venereal disease would be a great injustice to the pa

tient.

The existence of vesicular and bullous eruptions as rare forms of syphilodermata, although also questioned by other syphilographers, has been, we believe, demonstrated beyond reasonable doubt; Dr. Sturgis does not distinctly say so, but of course refers only to acquired syphilis, as, a little later, in describing infantile syphilis, he remarks, p. 122: "The body is usually covered with large bulla."

That a simple contagious venereal ulcer—a chancroid -is not commonly benefited by a mercurial course every one will allow, but that it necessarily becomes worse under it, or that there is any essential antagonism between the disease and the drug cannot be admitted. How seldom it becomes necessary to interrupt a mercurial course in the treatment of syphilis to permit of the cure of an intercurrent chancroid.

When phimosis comes on as a complication of the initial lesion, there is always more or less ulceration; indeed, it is in just these cases that the sore approximates most closely in its characters to the simple venereal ulcer.

In asserting that strapping the testicle has fallen into disuse, Dr. Sturgis undoubtedly represents the teachings of Cullerier, Bumstead, and others; but the cases in which atrophy has been attributed to it are, to say the least, open to doubt; no other bad results are even claimed to have been produced; and in this city the dressing is still very commonly employed. A procedure which, practised at the proper stage of this painful affection, will give rapid, safe, and certain relief, should not be discredited or discarded on such vague grounds. No other method of treatment except that by puncturewhich is not adapted to exactly the same stage, is more repugnant to the patient, and has certainly been followed by herniæ testis-will compare with it in giving comfort and enabling the patient to resume his usual avocation. We are pleased to see that he objects to the term 'mixed sore;" but regret that, while discarding this title of that purely hypothetical lesion, he immediately. alludes to it by a still more objectionable name, as a "double sore," and proceeds to speak of the simultaneous inoculation of two poisons, and their subsequent course and development-a view not by any means generally accepted even by dualists, and in many respects opposed to sound pathology.

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Dr. Sturgis's assertion, already quoted, that in infecting chancre the induration is sometimes absent, might have been construed into an admission that syphilis sometimes follows the sore known as a chancroid" or "soft chancre;" but he forestalls this by substituting for the latter the term "simple venereal ulcer," which he contrasts with the "specific venereal ulcer" or initial lesion. Now if by this Dr. Sturgis means that there are two venereal ulcers, one which is specific and one which is not, we heartily agree with him; but, as he subsequently proceeds to speak of "two poisons," of "two kinds of virus," of "double infection," etc., we perceive that in dividing these sores into "simple" and specific," he has unintentionally misrepresented himself, as, according to these views, the simple sore is just as truly specific as the specific sore. We are the more

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