The

mal-practice by which he alleges to have lost the use of an arm. Damages are claimed of $5,000.--Small pox is prevalent at Albany.-Dr. G. A. Dayton of Oswego, has died recently. -Dr. E. J. Schoonmaker of Magee's Corner, has died-Dr. B. E Osborne of Auburn, has been elected medical examiner of Cayuga Lodge Order of Tonti.—Dr. Otto Ritzman of Albany, was drowned while fishing in Lake Champlain.-A fatal case of toad-stool poisoning is reported at New City, Rockland connty.-New York City-Dr R. H. Duncan was married to Miss M. M. Thompson, July 24.-Dr. C. M. Woolford died recently.-Dr. A. B. Mott died August 12.-Dr. J. G Johnston of Brooklyn was arrested under charges of criminal assault. girl making the charge is in all probability a nymphomaniac The Cancer Hospital at One Hundred and Sixth street is receiving additions, costing $175,000. -Charges of neglect have been made against the officers of the quarantine hospital. Dr Gilson Dayton died in Brooklyn recently aged 68 yeats.— Dr. O. D. Pomeroy has been appointed consulting surgeon to the Eye and Ear Clinic at St. Joseph Riverside Hospital at Yonkers.-Dr. James M. Duncan died recently.-Dr. Wm. A. Ewing has been appointed sanitary superintendent by the Board of Health.-On account of continued illness Dr. W. DeForest Day has resigned his position as sanitary superintendent.-Dr. Alex B. Mott, the wellknown surgeon, died August 12.-Brooklyn. Dr. T. J. Corcoran was recently called to see a patient with cardiac disease The man died suddenly while being examined whereupon the friends mobbed Dr. Corcoran -Dr. R. N. Brickner was recently arrested for trying to get rid of an obstrepalous servant girl.

OHIO.-Dr. C. M. Monroe of Minerva, was thrown from a carriage August 8 and had two ribs broken. The office of Dr. Moore, of Norwalk, was recently destroyed by an incendiary fire-Dr. J. P. Robison of Mentor, died recently at the age of 78 -Dr. F. H. Rewhenkle of Chillicothe died of apoplexy recently.-Thirty-one persons were re cently poisoned at Findlay by eating corned beef. -Dr. Beck of Dayton has been removed as pension examiner and Dr. Lee Conklin of Vandalia appointed in his place.-Dr. R E. Scott of Bowerston, has sold out to E. E. McPeck.-Dr. A. C. Yengling of Salem, has been appointed pension examiner Dr. A. E. Jones of Cincinnati, was murdered July 27.-Dr. A G. White of Norfolk died August 23 at the age of 79.

PENNSYLVANIA.-Dr. S Wolfe of Skippack, has been elected professor of physiolgy in the Philadelphia Medico-Chirurgical College.-Dr. W. B. Roberts of Titusville, died July 30 --Dr. W. S. Welch of Franklin, died August 9--J. M. Harding of Oil City has been arrested for criminal abortion. -Dr. Stoneroad of Meadville has gone into the patent midicine trade -Dr F. J. Richards and Ida M. Watkins were married at Williamsport

August 20.-The wife of Dr. W. J. Mowry of Masonville died from lockjaw recently.-Dr. J E. Shaffer died at Elizabeth recently.-Dr. Howard A. Kelly has been elected Professor of Gynaecology in the Johns Hopkins University.-Dr. Emanuel Melhorn died at Newchester August 12 aged 65 years. Dr. W. W. Wythe has been stricken with paralysis Drs. D. H. Strickland of Erie, S. F. Chapin of Wattsburg, and O'Logan of Girard have been appointed as a new pension hoard -Phiadelphia.-Dr. C. Shaeffer was recently married to Miss M. T. Sharpless.-"Dr." Abraham Hahn has been arrested for crimininal abortion.-"Dr "F. Mesterfeld has been arrested for criminal abortion.

RHODE ISLAND.-Dr. T. P. Knox of Providence died recently at the age of 65.-Dr. Ecroyd suc ceeds Dr. Sears at the Marine hospital, Newport.— Dr. J. L Ashton of Pawtucket, who recently married an actress is now suing for divorce -Dr. A C Dedrick died at Centreville recently.-Dr. Job Kenyon, of Providence, died August 5.

SOUTH CAROLINA.--Charleston. -Dr. J. Schlegrell has gone to Germany. -Dr. F. B. Kendall has been expelled from the Columbia Medical Society. --The State Medical Society have expelled Dr. McDow.

TENNESSEE.-Dr. West, city physician of Knoxville, was killed by a railroad accident August 22.The Vanderbilt Medical College at Nashville has opened a free dispensary.

TEXAS. Dr. Joslin of Grand Saline, was recently killed.-Dr. John Collins of Athens has gone to New York.

VIRGINIA -Dr. T. P Mayo died at Richmond recently-D. J. P. Moore recently died at Richmond of pneumonia.- Dr. J. B. Worthem of Winchester, committed suicide August 12, by shooting himself through the head.-Dr. James A. Cabel, senior member of the facu'ty of the University of Virginia died recently at Overton.

WISCONSIN-Dr. Henry Palmer, of Janesville, was recently acquitted of the charge of unlawfully performing an autopsy. -Dr A. Reher of Howards Grove committed suicide July 31.-Dr. A B. Lynde of Milwaukee, recently committed suicide-There is an extensive epidemic of small pox at Menominee. -Dr. Saul T. Brown, one of the oldest physicians of Milwaukee, died August 13, aged 67 years.-There are prospects of the Emergency Hospital at Milwaukee soon going into the hands of the city.—Dr. J. English of Baraboo, has been sued for malpractice in treating an injury to the shoulder-Dr. F. A. Rickard of Chippewa Falls, died August 1.Dr. J. Oettiker of Plattsville, has been appointed pension examiner.-A band of traveling doctors were arrested recently at La Crosse and the head of the concern placed under $200 bail-Dr. Jenkins of Elsie Junction has disappeared.-Dr. A. B. Lind of Milwaukee, committed suicide at Duluth, Minn., August 18, by cutting his throat with a penknife.

In 1870 I began the treatment of typhoid fever by a systematic application of cold baths and the administration of antipyretic doses of quinine after the German method, keeping a careful record of my cases, and the result was communicated to the profession in December, 1878. This paper was the first one published in the United States giving a detailed account of this treatment in any considerable number of cases, and it met with a great deal of adverse criticism.

In 1883 I presented a supplemental paper upon the same subject, in which I tabulated one hundred and fifty-seven cases treated upon this plan, by myself and two or three professional friends, with three deaths-a mortality of 1.9 per cent.

This plan of treatment has never been popular with the profession. It has not been regarded with that degree of favor or received the attention which its importance demands. I expect to be able in this discussion to convince the most skeptical that the hydro-therapeutic treatment of typhoid fever is the most rational, as well as the most successful, of any that has ever been proposed.

Brand, although not the originator of this plan of treatment, is certainly entitled to the honor of its revival. After the publication of his successes, in 1861, several theories were advanced in explanation of its modus operandi. Brand never claimed for this treatment that it owed its beneficial results to the abstraction of heat exclusively, but that it derived its benefits from the powerful and healthy reaction which followed the cold bath; that the over-burdened and stupefied nervous system was stimulated into action, and that by lowering the temperature and restoring the secretions, the brokendown products caused by the oxidation of the tissues were eliminated from the system, and parenchymatous and fatty degenerations which are known to be so fatal in this disease— were prevented.

Liebermeister advanced the plausible theory, based upon the success of Brand in the treatment of typhoid fever by the abstraction of heat, that the secondary lesions of this fever, which Indiana Medical Society Trans. Condensed.

consist of congestions, inflammations and degenerations of important organs, were caused by the persistent elevation of temperature, which is a characteristic of this fever. This view of the matter advocated by Liebermeister has resulted disastrously in 'the extreme, and has been the cause of many deaths from this disease. Nervous and timid doctors have abandoned the cold bath and resorted to antipyretic medicines, which, although they will lower the temperature, lack the essential element of exciting a booming reaction, and the patient is lost. Yet even this is better than the purely expectant plan.

No one has any right to oppose the hydrotherapeutic treatment upon purely theoretical grounds. He who does so, and refuses to adopt it, signs the death warrant of twenty individuals out of every hundred with this disease which he treats, and a discriminating public will find him responsible. This treatment is not an idle tale, to be whistled down by a breath of wind, It is a genuine Banquo's ghost, which will not down at anybody's bidding. The "antipyretic craze," as it is called, has come to stay. This treatment prevents death from hyperpyrexia by a sudden failure of the heart's action or paralysis of the brain, including the respiratory centers. It prevents death from the secondary lesions, from whatever cause they may arisethus reducing and confining the fatal cases to those caused by the specific lesions, which statistics show to be less than three per cent. even this small per cent. may be further reduced, for Brand has shown conclusively that the lesion in the bowel does not proceed farther than the infiltration, when this treatment is begun early. All observers are agreed that to get the best results from this treatment it must be begun early, before the secondary lesions have been developed, or the primary lesions have progressed farther than that of infiltration. After the group of symptoms known as the typhoid condition has appeared-which is contemporaneous with the secondary lesions—it is too late for the treatment to achieve the brilliant results which follow its early administration. It matters not how the modus operandi of this treatment is explained, whether its benefits are derived from the abstraction of heat or from the reaction

But

which follows the shock of the bath, the fact remains the same, that it is the most successful treatment which has ever been proposed for typhoid fever, and is equally successful in all forms of fever. Dr. Currie demonstrated clearly, over one hundred years ago, that typhus fever could be aborted by it, that smallpox and scarlet fever were rendered mild and tractable diseases by its early adoption. His method of using cold water was by affusion. Five or six gallons of cold water (44°) were dashed upon the body of the patient, while seated in the bath tub. Brand, Liebermeister, and others immerse the patient in cold water the temperature of which is not less than 65° F., repeating it as often as the temperature reaches 103°. Ziemssen uses water the temperature of which is at first about ten degrees lower than the temperature of the patient's body, cold water added until it is gradually cooled to the required degree. This does not shock the patient, as does the strictly cold bath. But Ziemssen's statistics are not so favorable as Brand's, he having lost 9.6 per cent. in 2,000 cases.

It has been customary to supplement the cold bath treatment, in recent years, with antipyretic medicines, consisting of quinine, antipyrine, etc., under the supposition that the benefits derived from the treatment are due to abstraction of heat, and gradually the attempt has been made to substitute the antipyretic medicines for the baths. Brand opposes the use of this class of medicines, and claims that they reduce the mortality but little from the expectant plan. Quinine stands at the head of the list of antipyretic medicines, but neither quinine, antipyrine, antifebrin, nor any other medicine should be used to the exclusion of the bath. For, while they can be used as supplemental to bathing, having the effect of prolonging the intermission produced thereby, they cannot be used successfully alone. All cases coming under treatment early

say before the close of the first week-should have two or three cathartic doses of calomel administered, consisting of eight or ten grains each, and if perfect results are to be expected from cold baths, they must be begun at once. As soon as the temperature reaches 103°, water should be applied, either by immersion in the cold bath of 65° or 70°, or the graduated bath of Ziemssen, or by Currie's method of affusion. I have used Kibbie's cot with good results. The application must be repeated as often as the temperature rises to 103°, until all danger is passed. Quinine administered in doses of from 25 to 45 grains, in the evening, will prolong the remission so that few baths will be required on the succeeding day. Antipyrine and antifebrin lower the temperature more rapidly than quinine, but the remission is much shorter, and they certainly have no influence in shortening the disease. Besides, they are not free from danger, for by their long-continued use they are said to destroy the red corpuscles of the blood. No deleterious effect, however, can be charged to the use of the quinine. Unpleasant cinchonism is not produced as often by large doses as is common in smaller doses, where it is continued from day to day. It should not be administered in antipyretic doses oftener than each alternate day.

This plan of treatment has been so successful in my hands that I shall continue its use at least until something better is offered. Let us hope that some specific germicide may be discovered soon. Since publishing my last report I have treated 51 additional cases, with two deaths, which, added to the 157 already reported, with three deaths, give a total of 208 cases, with five deaths. Of the two deaths reported in this series, both were treated by antipyretic medicines and no baths. In every case where the bathing was energetically used, the patient recovered.

The victim of this myoma was a 38-year old multipara,who had been exsanguinated from long continued frequent uterine hæmorrhages. The tumor was ovoid and extended from a point near the umbilicus to the vulva, filling the pelvis minor so as to prevent an examination from revealing its relations to the uterus. The fact that the tumor presented at the vulva decided me, in accordance with the old rule, to attack it through the vagina, knowing that if it became impossible Chicago Gyn. Soc. Trans. Condensed.

to enucleate the entire tumor in this way the remainder might be removed through the abdominal cavity.

The patient being in Sims' position and the parts exposed by Sims' speculum, the capsule was incised, and with some difficulty peeled back, and piece after piece of the tumor was cut off with the scissors, all the time making traction with vulsellum forceps. Presently a cavity in the tumor was entered which contained something like a quart of purulent fluid. I continued

It was now apparent that furthur enucleation in this manner would consume more time than the patient could endure, and might be impossible without rupture of the capsule into the peritoneal cavity and all the dangers consequent upon such an accident. Accordingly I placed the patient upon the back and opened the abdomen by an incision perhaps five inches in length. The patient was so weak as to necessitate the most rapid manipulation. The abdominal portion of the tumor was found to be free from adhesions. I incised the capsule parallel to the abdominal incision, and with considerable difficulty, in about ten minutes, enucleated it. The empty capsule was then intact with the exception of its two openings, below in the vagina and above in the abdominal cavity. The uterus was of about normal size. My first impulse was to remove the capsule together with the uterus, in order to secure absolute hæmostasis. This might have been done by means of the lock forceps in the vagina, as in an ordinary vaginal hysterectomy. Instead, however, I stitched up the abdominal opening of the capsule, including a wide margin of peritoneum, with interrupted catgut sutures, leaving an opening in the summit of the capsule about an inch long. This was stitched into the central part of the abdominal wound, and the remainder of the wound was closed in the usual way, except that the sutures closing the abdominal wound were passed also through the seam in the capsule. The capsule was then irrigated with hot water, which readily passed out through the vagina. A glass drainage tube was introduced through the abdominal wound into the capsule, and antiseptic dressings applied over the abdomen and vulva. Very little blood was lost in the operation.

The patient did remarkably well until about the fourth day, when drainage at the vulva ceased from obliteration of that end of the capsule. Temperature rose to 103.5°; no chill. Capsule irrigated with corrosive sublimate solution, 1:10,000. Temperature remained high. I then forced a flexible sound from above

downward through the capsule into the vagina, breaking up the adhesions between the walls of the capsule. The sound was then withdrawn with a thread which had been tightly tied around

103.

its end. A large, perforated rubber drainage tube was now drawn down by means of this thread through the abdominal wound into the vagina, and perfect drainage was thereby secured. Temperature has been much lower, quite within bounds. It is now two weeks since the operation, and the indications are all most favorable.2

Whenever a myoma can be peeled out of the capsule, the latter may be repaired by means of interrupted catgut sutures and stitched into the wound, as above described. If its inner surface bleeds considerably, an iodoform gauze packing after the method of Mikulicz would be a perfect hæmostatic. In this case, a long rubber drainage tube reaching to the vagina should have been used instead of a glass tube, to begin with. I regret that I did not simply invert the capsule into the vagina and hold it there by means of lock forceps, precisely as the broad ligaments are held after severing the uterus in vaginal hysterectomy.

Occasionally the operator will encounter a case in which he has enucleated a myoma on the abdominal side, the myoma having developed so far down toward the vagina as to permit an opening to be made into the vagina through which the capsule could be inverted.

In the discussion Dr. Etheridge said the tumor should have been removed entirely through the abdominal cavity. Dr. Dudley ran a great risk in getting it out piecemeal from below, knowing nothing about when he was going to cut across a large yessel. In regard to the possibility of hæmorrhage, it seems to me the operation is uhjustifiably dangerous. When there is a movable tumor, a very much better way of proceeding is to remove tumor, capsule, and all, and then close the abdominal wound and make free drainage through the vagina, and wash it out as often as necessary. Dr. Byford's suggestion would be better than the one of Dr. Dudly's, for this reason: In turning the capsule down and fastening it with forceps beneath, there is a point at which this tnin tissue turned over upon itself will strangle the blood vessels, so that no circulation can take place through the part of the capsule that is inverted, consequently all that is inverted will stand a good chance of necrosing, and being a source of sepsis.

THE New Hampshire Supreme Court recently decided in the case of the State vs. C. D. Hinman and D. D. Pennoyer, that the law regulating the practice of medicine was uncon

stitutional.

2Three weeks after operation the patient was convalescent. 31 have since used the iodoform gauze packing.

The case I am about to describe is that of two children born in Kokomo, Indiana, June 24. The mother was in fair health, and had scrubbed the floor the day the babies were born. The "waters broke" before she had gone to bed, and a messenger was quickly dispatched for the doctor. Labor was so rapid that the woman was in need of immediate assistance. A midwife was hastily summoned. When she arrived at the bedside the head of the first child was already born. The pains were intense and close together, and the labor progressed rapidly until the pelvis was reached, when it was obstructed for a short time. The pains were soon vigorously renewed, however, and with a little assistance the labor was completed. Each head was born with the face to the back of the mother. The two legs in advance were born outstretched, while the other two were flexed on the body of the second child. The first child cried before the second

Their bodies as they lie upon their backs are in the same plane, and in a straight line, and literally placed end to end, the place of union being the pelvis. There are four well developed feet and legs opposite or to the side of the point of union, and located at right angles with the bodies. Both are females. The genital organs and ani are situated at the side of the bodies, but occupy the normal position with reference to the legs on the same side. There was a common umbilical cord which entered the bodies at the center of the point of union. Both bodies down to the iliac crests are as well developed as babies ordinarily are at the same age. Every part of them seems quite well formed, and the symmetrical arrangement of the pelves and lower extremities makes it an almost perfect monster of the ischiopagus variety. When the legs are outstretched the bodies with the legs make a complete cross. The digestive systems, kidneys and bladders

38

was born. She further stated that there were two "afterbirths," but firmly united together, and one cord, which was very long and nodular, or as she expressed it, "full of knots." The perineum was lacerated, but to what extent I could not learn; not enough, however, to prevent her making good recovery. The mother is a well developed, pleasant faced woman, 19 years old, of medium size, with very dark hair and eyes. The father is a finely formed man, height about five feet nine or ten inches, and sandy complexion. There is nothing in the previous history of either parent that throws any light on this peculiar product.

The babies are the result of a second gestation, the first being a well formed child two years old. They constitute a perfect symmetrical ischiopagus monster, following completely the law that "when two or more individuals are united in composition of a monster, double or more than double, the union takes place between homologous surfaces of the bodies."

1 Chicago Medical Society Trans. Condensed.

seem to act independently. Their weight at birth was about twelve pounds, and their length twenty-two inches.

A case of ischiopagus dipygus lately reported was still living at the age of 42. The parents were healthy. The mother's labor was an easy one. At birth the following appearances were present: There was an umbilical hernia below the umbilicus, and to the right and left of the medial line were two distinct penes, each as large as the penis of a child six months old. Their direction is normal. Water passes from both organs at the same moment. Each penis is provided with a scrotum, the outer half of each scrotum containing one testicle; the inner half of the scrotum is far removed from the outer, and the two inner halves appear like another scrotum between the two penes. Between and behind the legs of the child are two lower extremities uniting together in their whole length. The upper part of this compound limb is attached to the rami 2Annals of Gyn. Vol. II, No. 2