AN UNNOTICED FEATURE OF THE New Code.-The Chicago Medical Journal and Examiner points out a very important clause in the New York Code, which, strangely enough, has hitherto escaped the notice of the many wondering eyes which have perused that now famous document. The Chicago Journal points out that "the third deviation from the National Code is embraced in the following paragraph: 'In case of acute, dangerous, or obscure illness, the consulting physician should continue his visits at such intervals as may be deemed necessary by the patient or his friends, by him, or by the attending physician.' Here is a latitude given for the continued attendance of a consulting physician after having once been called, which should certainly satisfy the most aggressive consultant in New York, or elsewhere. WHAT IS SAID OF THE NEW YORK CODE OF ETHICS. We are enjoying the proud distinction of being the only journal that has assumed the responsibility of being outspoken on this question. We are consequently more than ever emboldened to say that, despite the adverse comments of medical journals, despite the denunciatory resolutions of State societies, despite the anathemas of medical orators, the Medical Society of the State of New York is perfectly right in the stand it has taken, and that it must not back down in any particular. The Medical Record, April 22, 1882. Most unwise, ill-timed, and injurious both to the interests of the profession and of the community. . . . Untenable in every aspect in which it can be viewed, and is not sustained by the action of any other respectable body of medical men in Europe or America.The Chicago Medical Journal and Examiner. Practically, it gathers all medical adventurers and medical pretenders into its arms, and calls this liberality. The Detroit Lancet. From the profession of almost every State and section, as reflected by the medical journals, come the earnest protests against the attempted innovation of the New York State Medical Society upon the code of ethics. Some of the comments are extremely vigorous and some even caustic. The unanimity of opinion, however, is remarkable. ... It gives us renewed faith in the honor and integrity of the profession.-Atlanta Medical Register. Yesterday homeopathy was a delusion. It was a gigantic fraud-in short, a lie. All the big noodles of the allopathic school swore by the big horn spoon, and all the little noodles repeated the oath, that the system called homœopathy was a monstrous lie. . . . To-day has come, bringing with it a remarkable change. Homœopathy is no longer a lie. .. To-day homeopathy in the main is true enough, and there is no objection to any one practising it if they see fit.-The Medical Advance (Homœopathic). DEATH OF THE SUBJECT OF THE FIRST PORROCÆSAREAN OPERATION IN EUROPE.-Giulia Cavallini, upon whom Prof. Porro, of Pavia, performed the initial operation which bears his name, on May 21, 1876, died of typhoid fever after nine days' sickness at Gambolo, on September 25, 1881. Although but a few miles distant, no word was sent of her sickness to Prof. Porro ; and he was not aware of her death until too late to secure an autopsy, which would have been of great interest to the medical profession throughout the world. Giulia was thirty years old at the time of her death: she was a comely little woman of four feet ten and onequarter inches in height; and her pelvis which was deformed by rickets was computed to have a conjugate of one nine-sixteenth inches. The favorable result in her case was largely due to the fact that she was less than seven hours in labor, and had been in hospital prior to its commencement, where steps had been taken in anticipation of the event. THE SOCIETY OF THE WHITE CROSS.-A society has been formed in Austria, called the Society of the White Cross, to aid in the labors of the Red Cross Society by providing and superintending convalescent homes in healthy places for invalided and wounded soldiers. OBITUARY. DIED, on April 20, CHARLES ROBERT DARWIN, LL.D., F.R.S., the celebrated English scientist and philosopher. Mr. Darwin was one of the most distinguished students and scholars of the day, and his name is probably more widely known, and his opinions more generally studied, than those of any other English-speaking scholar. He was born at Shrewsbury, England, February 12, 1809, his father being Dr. Robert Waring Darwin, F.R.S., and his grandfather the celebrated Dr. Erasmus Darwin, F.R.S., the author of "Zoönomia," the "Botanic Garden," "Temple of Nature," etc. Mr. Charles Darwin was educated first at the Shrewsbury Grammar School, then at the University of Edinburg in 1825 and 1826, and next at Christ College, Cambridge, where he received the degree of B. A. in 1832, and M.A. in 1837. His reputation as a naturalist was first obtained by his report on the scientific expedition of the "Adventure and "Beagle," in 1826-30, and again in 1831-36. In addition to numerous papers on scientific subjects, Mr. Darwin wrote "The Structure and Distribution of Coral Reefs," which passed through two editions,; Geological Observations on Volcanic Islands," and "Geological Observations on South America." The most important of all his writings is his "Origin of Species by Means of Natural Selection," published in 1859, in which the outline of the now famous doctrine of evolution, or as it is familiarly termed, “Darwinism," was established. It is only recently that the controversy awakened by his bold and ingenious arguments has ceased, while their effects on the whole line of scientific thought is unparalleled. His " Origin of Species" has passed through several editions in England, and been translated into French, German, Spanish, Italian, and other European languages. Mr. Darwin's more recent works had for their object the supplying of data on which he founded his conclusions. A "Treatise on the Fertilization of Orchids," was published in 1862, and was followed in 1867 by 'Domesticated Animals and Cultivated Plants, or the Principles of Inheritance," etc. In 1871, he published his "Descent of Man and Selection in Relation to Sex;" in 1872, The Expression of the Emotions in Man and Animals," "Movements and Habits of Climbing Plants," second edition, 1875; "Insectivorous Plants,' 1875; "Cross- and Self-fertilization in the Vegetable Kingdom," 1876; and "Different Forms of Flowers, in Plants of the Same Species," 1877. Mr. Darwin, who had been elected a member of various English and efficiency, assure us they are not spurious mixtures, as some interested parties have represented them to be. We have visited, from time to time, the establishments of the N. E. Vaccine Co., to keep ourselves fully acquainted with their mode of propagating and collecting virus, and are satisfied no more skill or care can be exercised than they use. Respectfully, H. C. BLAIR'S SONS. PHILADELPHIA, April 24. [The statements made in the article referred to, so far as Messrs. Henry C. Blair's Sons are concerned, were simply that they are the agents of the "New England Vaccine Company," and that they sold us the cone which we examined, neither of which they deny; so that their grievance is not evident. The specific matters upon which their letter dwells relate to the "N. E. V. Co." and not to them. In reply to these, however, it is proper to say that: 1. We did not imply that the "N. E. V. Co." does not deal in points, on the contrary we distinctly said that it is stated that Dr. Cutler manages to charge three or four times more points from a single heifer than any other propagator. en 2. The cones are advertised as "consolidated lymph tirely free from any trace of pus, débris, or epidermis," which does not correspond with the characteristics of a and other scientific bodies, had received from the Royal | At his residence in New Orleans, on March 20, BENJAMIN STILLÉ, M.D., formerly of Philadelphia, in the 68th year of his age. NOTES AND QUERIES. PRACTICAL NOTES. To the Editor of THE MEDICAL NEWS. Sir: You will oblige me very much if you will answer me the following questions in the next issue of your paper: In the treatment of syphilis by hypodermic injections of albuminate of mercury, as mentioned in your paper of to-day, how many times a week ought the injections to be made? A patient with the opium habit, takes from two to two and onehalf grains of morphia, hypodermically, per day. Is it safe for him to leave the nabit off all at once, and what symptoms would follow in that case? Will solutions of muriate of apomorphia or muriate of pilocarpina keep for any length of time? Which American work, or foreign work adapted to American practice, is the best authority on skin diseases? In answering these questions you will very much oblige, Yours, truly, A SUBSCRIBER. [1. The mercurial injections are given daily, on alternate days, and twice a week, according to case. 2. The habit can be discontinued at once, but great depression, almost callapse, ensues. 3. Both undergo change rapidly, and should be made when required. 4. Duhring, American, and Fox, English.—ED.] HYPODERMIC INJECTIONS FOR CURE OF SCROFULOUS CERVICAL Subscriber asks: What is the latest experience in using hypodermic injections for the radical cure of scrofulous glands in the neck? What injection is the best? What percentage of cases has been benefited? Billroth and Czerny both report cures of lymphadenoma by injections of Fowler's solution into enlarged glands-from five to twenty drops daily. The usual material for strumous glands is the tincture of iodine. Cures are certainly constantly effected, but we do not know of any exact statistics bearing on the question of the relative number. VACCINE CONES. To the Editor of THE MEDICAL NEWS. Sir: Seeing our name mentioned in special article "On Vaccine" in the issue of THE MEDICAL NEWS of April 22, 1882, and as it does not justly state the facts as far as we are concerned, we respectfully request that you will permit us to explain. 1. The article alludes only to the cones made by the N. E. V. Co., creating the impression (with those not familiar with their virus) that they make it in no other form. This is an error, as they make and sell more on ivory points than any other way, and these are considered the purest form of vaccine, and are equal to the best that can be produced, and better than most in the market, as is proven by the great satisfaction they have given the medical profession. We have sold nearly 100,000 ourselves during the past winter. 2. The cones have never been spoken of by ourselves, nor do the N. E. Vaccine Co. recommend them as equal to points, but have always represented them as a pure form of crust, and are preferred by many practitioners to the points. We have sold hundreds of these cones during the past winter, and the many unsolicited letters of recommendation received by us of their reliability crust. The letters of recommendation which were shown to us by Mr. Blair, were in response to their own notes of inquiry, and most of them spoke of the points and not of the cones. Mr. Blair can scarcely expect the public to accept as unbiassed his opinion of the management of a business of which he is a commercial agent, particularly in the face of the impressions given by a peremptory refusal to permit an inspection of the company's premises by a competent and properly accredited physician.-ED.] OFFICIAL LIST OF CHANGES OF STATIONS AND DUTIES OF OFFICERS OF THE MEDICAL DEPARTMENT, U. S. ARMY, FROM APRIL 18 TO APRIL 24, 1882. GREENLEAF, CHAS. B., Major and Surgeon.-In accordance with par. 12, S. O. 78, C. S., from Headquarters of the Army, relieved from duty in this department.-S. O. 57, Department of Dakota, April 11, 1882. GARDNER, W. H., Captain and Assistant Surgeon.-His assignment to duty at Fort McKavett, to relieve Surgeon Waters, revoked, and to report to the commanding officer Fort Davies, Texas, for duty as Post Surgeon.-S. O. 38, Department of Texas, April 14, 1882. LAUDERDALE, J. V., Captain and Assistant Surgeon.-Par. 1, S. O. 47. C. S., from these headquarters, in regard to him, revoked, and he will proceed to Fort Sully, Dakota Territory, and report to the commanding officer of that post for duty.-S. O. 59, Department of Dakota, April 13, 1882. BROWN, P. R., Captain and Assistant Surgeon.-To be relieved from duty in Department of Texas, on receipt of this order, to proceed to New York City, and, on arrival, report by letter to the Surgeon-General.-S. O. 88, A. G. O., April 17, 1882. FINLEY, J. A., Captain and Assistant Surgeon.-Relieved from duty at Fort Concho, Texas, and assigned to duty as Post Surgeon at Fort McKavett, Texas, relieving Surgeon Waters.-S. O. 38, C. S., Department of Texas. KILBOURNE, H. S., Captain and Assistant Surgeon.-Having reported in person at these headquarters, will proceed to Fort Shaw, Montana Territory, and report to the commanding officer of that post for duty.-S. O. 60, Department of Dakota, April 14, 1882. SHUFELDT, R. W., Captain and Assistant Surgeon.-Granted leave of absence for three months from May 1, 1882, and relieved from duty in Surgeon-General's Office from May 1, 1882, and, upon expiration of leave, to report by letter to Surgeon-General.— S. O. 92, A. G. O., April 21, 1882. DAVIS, WM. B., Captain and Assistant Surgeon.-So much of par. 12, S. O. 78, April 5, 1882, from A. G. O., as directs him to report for duty to the commanding general Department of the Platte, is amended as to direct him to report in person for duty to the commanding general Department of Dakota.—S. O. 87, A. G. O., April 15, 1882. THE MEDICAL NEWS will be pleased to receive early intelligence of local events of general medical interest, or which it is desirable to bring to the notice of the profession. Local papers containing reports or news items should be marked. Letters, whether written for publication or private information, must be authenticated by the names and addresses of their writers— of course not necessarily for publication. All communications relating to the editorial department of the NEWS should be addressed to No. 1004 Walnut Street, Philadelphia. VOL. XL. A WEEKLY JOURNAL OF MEDICAL SCIENCE. SATURDAY, MAY 6, 1882. ORIGINAL LECTURES. MÜTTER LECTURES. ON THE HISTOLOGY OF INFLAMMATION. Delivered before the College of Physicians of Philadelphia, April 24 to May 2, 1882. BY E. O. SHAKESPEARE, M.D. GENTLEMEN: Having been appointed to deliver here a series of ten lectures upon some subject relating to surgical pathology, I have chosen that of the "Histology of Inflammation" for two reasons. 1. Because of its importance, if we would learn the changes which actually occur in inflamed tissues; 2. Because, notwithstanding the researches of many distinguished investigators, there is still much to learn concerning the minute processes of inflammation. The great champion of the activities and functions of the white blood-corpuscle, Cohnheim, in one of his monographs on inflammation of the cornea, very truly says that "too little is known of the anatomy of the cornea to permit of a final settlement of this question." In taking up, again, inflammation of the cornea, it is useless to proceed with the pathological histology of this tissue, before first knowing something of its real normal histology, and the same remark applies to the pathological histology of every other type of living tissue. Hence the necessity of prefacing what I shall have to say of inflammation in the different tissues to which I shall invite your attention, by a short account of my understanding of their normal structure. doing so, I shall dwell only upon points where a divergence exists from views generally accepted. In With regard to the cornea, I am compelled to dissent, in many respects, from prevalent opinions concerning the simplicity of its structure. Taking up the subject seriatim, I have nought to say concerning the anterior epithelium, except that this layer rests upon a layer of flat endothelial cell-plates which separates it from the basement membrane of Bowman, which latter, I am inclined to suspect, like other basement membranes beneath epithelial investments, is constituted in part, at least, of old elastic endothelial cell-plates. This basement membrane is separated from the substantia propria of the cornea by another endothelial layer, more or less complete, which in some places seems to be double, thus constituting lymph passages which assume the outline of a network. With regard to the nerves I have nothing to state, except that their lymphsheath is occasionally in communication with adjoining lymph-spaces in the substance of the cornea, nor have I anything to say concerning the membrane of Descemet. As to the structure of the substance of the cornea, included between the anterior membrane of Bowman and the posterior membrane of Descemet, my investigations lead me to coincide in many respects with Thin, and in consequence to depart from the teachings of Rollet, Klein, Cohnheim, Stricker, and others, in some important particulars. I admit the fibrous nature of the substantia propria as a condition existing in life and health, but I see three usual arrangements of the fibres. Rollet speaks of the possibility, after the action of the permanganate of potash, of resolving the bundles of No. 18. fibres ordinarily seen, into their ultimate fibrillæ; and others, as well as he, speak of the arrangement of the bundles of fibres side by side so as to form sheets, which are familiarly known as the lamellæ of the cornea, of which the whole thickness of the cornea affords a considerable number. I have been able to satisfy myself of the existence of an intermediate arrangement of the ultimate fibrillæ into small bundles or bands having a thickness from one-tenth to one-quarter that of the bundles ordinarily seen; they have a breadth about equal to the diameter of a red blood-corpuscle of man. Fig. 1 indicates such a constitution of an ordinary bundle, and shows most distinctly the existence of small intermediate bundles in the cornea of a kitten. The same arrangement exists in other cornea. FIG. I. X 600 Furthermore, as to the arrangement of the ordinary bundles side by side to form a lamella or fibrous membrane. I have repeatedly seen both in the young and adult cornea, when normal as when slightly irritated, proof that there is frequently an intermediate arrangement between the ordinary bundles and the broad continuous lamellæ. There are bands or ribbons formed by ordinary bundles placed side by side. It is these bands or bundles which form the lamellæ. Sometimes they pass from one lamella to another, and often are composed of three or more thicknesses of lamellæ. Now, as to the cells of the cornea. The prevalent belief is that they are of two kinds: the fixed cell, or stellate corneal corpuscle; and the wandering cell, or lymph corpuscle. I am convinced that there are at least four forms of cellular elements, and perhaps a fifth, which are constantly met with in the normal cornea, if proper methods are used for their demon stration. One of which elementary forms is the leucocyte or lymph corpuscle, and need not be further discussed, except to say that these cells are met with in the lymph channels. We return to the intermediate bundles, above mentioned as constituting the ordinary bundle of fibres. Upon and partly enwrapping these intermediate bundles, from point to point, in their course, are delicate cells, which, when seen in profile, appear like small spindles applied to the surface of the small_bundle; some of them are actual spindles, while others are somewhat broadened plates which partly envelop the bundle (see Fig. 1). The existence of these cells has escaped the observation of nearly all investigators. Thin, I think, was perhaps the first to appreciate their significance. The direction of the spindles is, of course, parallel with that of the fibres. The ordinary bundles are, at intervals, partially invested with a form of flat cell, which much resembles the tendon cell of Ranvier, and experiences analogous modifications in advancing from young to adult tissue. I recognize these cells as one form of the so-called corneal corpuscle; and there is strong reason to believe that the bands or ribbons of bundles are covered with a more or less complete investment of a single layer of endothelial plates, like that which limits the secondary bundles of tendon. Fig. 2 represents an endothelial covering of a lamella in the cornea of a young kitten. I have been able, under favorable circumstances, to demonstrate the existence of similar endothelial layers between lamellæ in the normal adult cornea. FIG. 2. X 250 Fig. 3 shows, upon a lamella in the depth of the cornea of an ox, the effect of a solution of caustic potash in revealing the existence of the endothelial cells which line the sheath of a nerve (a), as also that of the endothelial cells covering the adjacent fibrous substance, and of the spindle cells above described. FIG. 3. a X 200 As to the corneal corpuscle, so called, I have nothing to advance beyond the statement that it seems to be a living, contractile entity, of the nature and somewhat of the form of the ordinary connective tissue corpuscle, and to more or less completely fill a lymph space, which is necessarily more or less stellate, and in some instances seems to be a channel hollowed out of the semifluid, interfibrous cement substance; in other instances, merely a space left by imperfect apposition of bundles of fibres, whether they be those formed by the ordinary bundles constituting the bands, or by the bands and lamellæ themselves. We now come to the consideration of the effects of inflammation in this structure. I shall ask your atten tion only to what takes place in a healthy reparatory inflammation, after a slight traumatism. Whether the animal selected for experiment be a frog, a cat, or a rabbit, the phenomena to be observed in a few hours are much the same. The method of exciting inflammation chiefly used was that of gently touching the centre of the exposed cornea with the point of a crayon of caustic potash or soda, and afterwards washing the eye. I should state in the beginning that most of the experiments were made in winter. The stick of lunar caustic was sometimes used, as also the white-hot needle, to produce the wound. At the end of three, twelve, twenty-four, forty-eight, or seventy-two hours, the cornea was treated with lunar caustic, either mitigated or of full strength, during the life of the animal; after the lapse of twenty minutes to three-quarters of an hour, the animal was killed, and the eye immediately removed and placed in slightly acidulated water, and exposed to light. At the end of one or two days, it was removed, the cornea excised, and split into thin lamellæ, or cut into thin sections, or otherwise treated. The sections were mounted in glycerine, and again exposed to light. Some pieces were teased with needles and stained in carmine. Other preparations were made with osmic acid, with gold, and with various reagents. Examination of the earlier preparations showed, in the neighborhood of the injury, the presence of numbers of spindle cells, quite distinct, most of which had no visible connection with the so-called corneal corpuscles, which latter could be demonstrated at the same time as showing no other change other than that of multiplication of the nucleus and thickening of the processes. These spindle cells followed the course of the ordinary bundles of fibres, and frequently two, three, four, or more nuclei were visible in them, and they corresponded in position to the locations of the spindle cells existing in normal tissue. Those intermediate bundles, which were not separated from each other by spindle cells, were, nevertheless, for the most part quite distinct and well shown. The number of lymph corpuscles was not yet abnormal in this region, and the periphery of the cornea was not invaded by them, nor did this portion of it show signs of inflammation other than the slightest ædema (see Figs. 4 and 5). FIG. 4. X 600 At the end of forty-eight hours the appearances first noted were more marked; the spindle cells were more numerous, a long spindle had sometimes divided once or twice, and the stellate corpuscles in some places were still visible as before, and in much the same condition, except the number of their nuclei was greater, and sometimes the whole body of the corpuscle appeared to have divided into two. In other places, however, the location of the corpuscle was occupied by a more or less broad network in the place of the corpuscle, formed by polygonal, flat, endothelioid cells, with multiplying nuclei, and in some of these nets at the nodal point the remains of the stellate corpuscle could still be recognized upon or beneath the flat cells. In other spots more or less broad areas of the field were occu pied by similar endothelioid cells in a state of proliferation, but no networks, and still the remains of the corneal corpuscles were even now sometimes visible in addition, and were undoubtedly multiplying. Besides these elements, lymph corpuscles were intermingled with all in numbers considerably increased beyond normal, but yet far from constituting an abundant purulent infiltration. At the same time, in some preparations, especially those which showed but few of the endothelial cells, the limb of the cornea offered scarcely any more signs of inflammation than the first example. In some older preparations, the inflammatory process gradually subsided, without an infiltration from the border of the cornea taking place. In others the injury had been sufficient to cause, when the animal lived long enough, a very abundant cell formation, and purulent infiltration, producing a mass of embryonal cells, in which neither the stellate corpuscles, nor the spindle cells, nor the endothelial cells, could be recognized as such. From a study of these preparations in the light of the above advanced normal structure of the cornea, I am of the opinion that a slight injury of the cornea can be, and frequently is, repaired by the agency of the cellular elements normally in the tissue near the place of injury, and without any other assistance from the adjacent blood vessels than an additional supply of blood plasma, and that the repair takes place by slight inflammation, through the stimulated activity of the spindle cells and the endothelium, as well as of the few lymph corpuscles normally present, as also of the stellate cells. I, therefore, most positively believe in the activity of the fixed cells of this tissue in the processes of destruction and repair, and at the same time admit as much for the lymphatic. INFLAMMATION IN CARTILAGE. Still pursuing the plan of introducing the pathological histology of the tissues in inflammation by a study of their normal constitution, I invite your attention to my understanding of the minute structure of the cartilages. These tissues have usually been described as presenting three main types, differing from one another in several particulars hyaline cartilage, elastic or reticular cartilage, and fibro-cartilage. I will not review present opinions concerning the structure of the cartilages, further than by saying that hyaline cartilage is believed to consist of the usual more or less globular cartilage cell enveloped by a capsule, and imbedded in a ground substance or intercellular matrix, which is commonly homogeneous or structureless; that in reticular cartilage there is the addition in the intercellular matrix of branching fibres, which resemble more or less closely elastic fibres in other locations; and that in the fibrocartilages the intercellular matrix is occupied by bundles of common white fibrous tissue. Returning to the hyaline cartilages, I desire to say to you that some of the writers of the last century entertained more correct ideas of the minute structure of this variety of cartilage when it covers the articulations, than do most authors of this day and generation, notwithstanding their improved microscopes and methods of study. I wish to say in the most positive terms that the hyaline cartilages covering the diarthrodial joints, as well as in most other locations, possess a ground substance or intercellular matrix, which in health is as decidedly fibrous in constitution as is that of the lamellæ between the bone-corpuscles of the osseous tissues. The fibrous structure of the matrix of hyaline cartilage is ordinarily masked by an inter-fibrous cement substance, which has such a consistence as to ordinarily prevent the separation of the fibrillæ by mechanical means, and which in health possesses an index of refraction so nearly approaching that of the fibres as to cause it to be nearly impossible to distinguish the outlines of the fibres. But there are certain methods of examination by which healthy hyaline cartilage can be shown to present the structure of fibrous tissue as it is found in other locations in the animal economy. Various substances which have the power, by maceration, to soften and dissolve the interfibrillar cement of other fibrous tissues, and resolve the larger fibrous bundles into their ultimate fibrillæ, have the same potency when acting upon cartilage, although in a much lessened degree. With cartilage, more time, more patience, more perseverance, are required than with other tissues, if we would succeed in unravelling its intimate structure. Maceration in lime water, in baryta water, in permanganate of potash, in salt solution, will frequently demonstrate the fibrous nature of the intercellular matrix of cartilage. Treatment of thin sections of fresh cartilage by solutions of osmic acid, of chromic acid, will sometimes succeed in revealing, more or less completely, their fibrous structure. Spina recommends one of the most certain means of caus FIG. 6. X 400 ing it to appear: The cartilage is to be plunged, when perfectly fresh, into very strong alcohol, where it is to remain for three or four days. At the end of this time thin sections are to be made while the tissue is still wet with the alcohol, and are to be examined under the |