Sections, is ample to fully occupy the time set apart for Chauliac or Ambroise Pare Bacteriology has added our deliberations. much to our knowledge of tuberculosis, and given more The rapid evolution of surgical knowledge is one of precision to its treatment, but that knowledge is still the wonders of this remarkable age, and surgeons may imperfect, and its treatment far from satisfactory. Much fairly claim that their own branch of medicine has kept less has bacteriology added to our knowledge of the equal pace with the stupendous advance made by the carcinomata, which still remain one of the mysteries of collateral sciences. A review of the surgical progress medicine. We have for years studied the varying de of the last decade, alone constitutes one of the most partures of tissues from the normal to the abnormal brilliant pages of the history of medicine. And yet type, and bacteriologists have in vain sought to connect one must remember that all scientific progress is based the atypical structure of carcinoma with some bacterial on antecedent fundamental facts, discovered by slow, development, but no Pasteur or Harvey has yet dawned laborious and painful steps. upon our horizon to pich the lock of a mystery to which Heaven seems to have allowed our generation no key. Looking to the future we can not doubt that the solu tion of the formation of the carcinomata will yet be discovered, but it will necessarily be through the influence of some now totally unknown factor. The study of embryology and atavism seems at present the most probable avenue to the truth. The labors of Darwin, Huxley, Herbert Spencer, Pasteur and Lister, in the last decade, have made possible the practical successes in the present decade. There is at this time no diseased organ or tissue of the body that escapes the remedial scalpel, and an examination of the discussions of this time shows that the questions presented are rather those of method,than those of original discovery. We no longer question the propriety of surgical interference, in hitherto dark portions of human anatomy, but we are concerned in the technique of that interference; and to the improvement of surgical technique the ablest minds of the pres ent decade have been directed. What may we hope for the future of surgery? It seems likely at this day that improvements in technique will continue to occupy the surgical mind until some epoch making discovery in physiology shall have been made. It is not likely that the present generation of surgeons will witness another discovery as far reachThe subject of surgical bacteriology, which includes ing as that of Pasteur. We must digest and fully asthe chemical study of microbic products, has still much similate the discoveries of the bacteriological epoch; to disclose, but we already base our practice on the im that process will probably fully occupy our time and mortal discovery of Pasteur. The success of modern that of our immediate successors. · It is true that we surgical treatment, even with the imperfect knowledge may have some help from advances in the collateral of the bacteria that we now possess, is such that no sur sciences; transillumination of the body, for example, geon thinks for a moment of comparing the results of may be yet fully developed in our time, instruments of any given operation with those obtained in the pre-mi-precision as aids to hearing and vision may greatly as crobic epoch. This comparison, however, only relates sist us in making our present knowledge useful, but the to the age of gunpowder, for history tells us with great outlets to human life such as carcinoma, in all abundant detail, that the ancient treatment of wounds probability will have their genesis understood only by correspond very closely with our own. The vulnerary the surgeons yet unborn. When that time shall come, compounds of the ancients were largely composed of carcinoma and tuberculosis will be classed among the what we know as antiseptics; the teribinthinate and me- preventable diseases. These two affections have cost tallic dressings of the Alexandrian period we can ac can ac mose human lives annually than cholera or yellow fever, cept to-day as true anti bacillary agents; and even the and yet no government has ever set on foot any system. boiling oil and the red hot iron, we could now admit as atic and regular inquiry into their causation or propa forming an eschar, or impermeable wall against the engation. It is true that the study of cattle tuberculosis trance of microbes. It was aseptic surgery of which has been the subject of much study by the Bureau the ancients knew nothing. The empirical results of of Animal Industry, but so far as the human race is the boiling oil, of the actual cautery, were enough for concerned little has been done in the direction indithe ancient masters; like the heroes of Balaklava: cated. "Theirs not to reason why;" Colleagues! I feel that I have two long detained you they only knew results were satisfactory, wounds healed with these speculations, when we have before us a proquickly and without sepsis; what matter if the theory gram so rich and so varied, but I cannot refrain from quickly and without sepsis; what matter if the theory expressing by heartfelt congratulations on the success of this meeting, my thanks for your generous response to the call for papers, and as an American surgeon to bid you welcome. Welcome, thrice welcome, foreign colleagues, to our hearts and homes. We pray you to kindly join us in warmest fraternal greetings to our European guests, and let us remember the saying of Livy that true friendships are immortal. on which their treatment was based-that of arrest of hemorrhage was faulty, the result satisfied them. Like the blind man of the New Testament the logic was simple: "Whereas I was blind, now I see;" therefore the touch was adequate. All medical science seems to have run in cycles, and there was less medical superstition in the Alexandrian period, than in medieval medicine less in the Hindoo charaka than in the pages of Guy de Dr. Sachs expressed the opinion that akromegaly and gigantism are related. Gigantism is a form of physiolo We gic excess, while akromegaly is a distinct morbid con American Neurological Association.-The Dr. C. L. Dana, of New York, read a paper entitled dition. One Dr. Weber, of New York, had seen two cases. had symptoms of myxedema. He was inclined to believe gigantism to be excessive physiologic growth. Dr. Mills related that he has, after death, found a tumor destroying the pituary gland in a case in which during life there has been no akromegaly. Dr. J. J. Putnam, of Boston, read a paper entitled He related the history of a case of akromegaly with autopsy, and that of a case of gigantism or soma. tomegaly with some symptoms of akromegaly. The giant had a unilateral facial hypertrophy. The first After calling attention to the fact that this procedure case was in a full-blooded Bolivian Indian who was ex- has been carried out some forty times, mainly by Gerhibited as a giant. He was thirty years old, 6 feet 7 man surgeons, with but two deaths and a very large inches high, and weighed 300 pounds. The malar and percentage of cures or improvements, he narrated the frontal bones were enormously developed. The thorax case of a young woman suffering from a typical form of measured 50 inches in circumference. Death took place Graves' disease, of nine months' standing and with a suddenly. On autopsy, the brain was found normal, rather large goiter. The right lobe and most of the weighing 55 ounces. The pituitary gland was greatly isthmus were removed. During and after the operation enlarged, measuring 1 inch in diameter. The thyroid the patient's pulse ran up very high, and for several gland weighed 4 ounces. The feet and hands had in creased in circumferential measurements. The brain presented interesting peculiarities of fissuration. The second case was in a professional giant, nineteen years old, 7 feet 5 inches tall, and weighing 350 pounds, whose muscular development was feeble and who pre sented several symptoms resembling those of akromegaly. A most curious condition was a progressive unilateral facial hypertrophy, due mainly to osseous growth. It suggested akromegaly attacking only half of one extremity. Only eleven cases of this affection are on record. Dr. Dana said that akromegaly is sometimes associated with gigantism. He held that many so-called giants are instances of pathologic growth rather than excessive physiologic development. There is much evidence to show that the pituitary gland has some relation to these disorders. Among twelve autopsies, this gland was enlarged in ten. Dr. Dercum said that akromegaly is not associated with increase in the length of bones but in their width. He regarded Dr. Dana's case as one of gigantism with akromegaly superadded. Dr. Gray said that it is a question whether akrome galy and gigantism are not identical. The pathology of akromegaly is not yet clear. days she lay in an extremely prostrated, and apparently critical condition. She then rallied, and at the end of six months her condition was decidedly better than before the operation, though far from being cured. The remaining portion of the tumor did not shrink and showed a marked tendency to vascular enlargement. The voice was reduced to a whisper immediately after the operation, but subsequently nearly recovered its natural tone. The reasonableness of the operation lies in the fact that in Graves' disease certain nervous centers are in a state of extreme irritability. Any means that will cut off a considerable number of excitations from reaching the unstable centers is likely to be beneficial by securing for them a partial physiologic rest. There are various means, such as complete rest, the treatment of the nasopharynx, etc., that may do this in a measure, but no one means is so effectual as thyroidectomy. The operation is, however, attended with a slight risk of death, and with a greater risk of considerable temporary prostration and laryngeal paresis. Dr. Weber said that he has noted recovery in a patient possessing all of the characteristic symptoms, under the persistent use of potassium iodid. The dose was gradually increased to three drams daily. Dr. B. Sachs, of New York, read a paper entitled Dr. Collins held that akromegaly and gigantism are two separate diseases. In gantism the changes are in the cellular structure of the diaphyses and epiphyses, In support of the close relationship between syphilis principally the former In akromegaly the changes are and tabes he pointed out the frequent occurrence of confined to the epiphyses. Probably the disease of the general paresis in association with tabes, and of tabes pituitary gland stands in a causative relation to akrome- in the course of general paresis; the occurrence of galy. Giants may suffer from akromegaly, which is a symptoms in the course of tabes that are often due to degenerative disease. syphilis; the ocular palsies; the loss of pupillary reflexes and even the lightning-pains; the effect of treatment with mercurials and iodids upon many of the symp toms of tabes. Dr. Putnam said that he has seen temporary improvement in one case from the administration of thyroid extract. A clinical differentiation of cases of tabes which are the left abducens, double optic neuritis, hemianopsia, due to an active syphilitic process was attempted. word-blindness, aphasia, and word deafness. An operaAmong such cases were included those that exhibit tion was attempted, but the tumor proved too large and complete loss of reflex contractility of one or both diffuse for removal, extending into the temporal, occipupils, and ocular palsies. A case of typical tabes was pital, and parietal regions. The patient lived two reported in extenso, in which on post-mortem examina- months, with comparative relief from pressure symption a more recent syphilitic process was found super- toms, including the abducens paralysis. Toward the imposed upon an old typical sclerosis. It was pointed end the right hand and arm became somewhat paretic. out that the spinal sclerosis may result from degenera Examination showed the growth to be a glioma. tion brought about by syphilitic disease of the bloodvessels of the cord. Altered states of the blood may be the prime cause of changes in the blood vessels. Dr. Preston maintained that the syphilitic process is an arterio-sclerosis. Rarely is there hyperplasia of neuroglia without changes in the cells or nerve-fibers. The tabetic process probably begins in the blood vessels. Traumatism seems to be an important etiologic factor. Improvement and relief of pain have followed the use of nitro glycerin. Dr. Seguin suggested that the ocular symptoms were probably not due so much to lesion of the angular gyrus as to involvement of the fibers of the fasciculus opticus which lie immediately under it. Dr. James H. Lloyd and Dr. David Riesman, of Philadelphia, presented a joint communication entitled INFECTIOUS ENDOCARDITIS with GENERAL SEPTICEMIA, COMPLICATED WITH MULTIPLE Neuritis, founded upon the report of two cases. The first occurred in a man with a typhoid type of Dr. Mills stated that preceding the development of the sclerosis there may be leptomeningitis and disease of the vessels, which if attacked early might be relieved fever which had continued for three months, and was or removed, but the sclerosis once established, recovery becomes impossible. Posterior sclerosis often advances at intervals by jumps, and these may sometimes be coincident with or may follow the revival of active syphi litic processes. Dr. Parsons referred to two cases of syphilis, followed by insanity and the subsequent development of spinal symptoms. Dr. Seguin stated that he still adheres to the idea that syphilis is only a predisposing cause for the ground. work of tabes. Certain cases occur that are undoubtedly free from any history or evidence of syphilis. Dr. Knapp mentioned a case of primary syphilis superadded to tabes of two or three year's standing. Dr. Wm. C. Krauss, of Buffalo, exhibited a new pedodynamometer. The apparatus consisted of a wide, heavy belt, with its inner surface padded, so that its adjust ment around the waist will not be uncomfortable. A heavy webbing is looped through the belt, passing over the shoulders and helping to retain the belt in position. A common dynamometer is connected with the belt by means of a strong adjustable strap, permitting it to be lengthened or shortened, according to the stature of the patient. Connected with the dynamometer is a stirrup, the base of which is padded for receiving the foot. Pressure exerted upon the stirrup will be registered upon the dial of the dynamometer and the exact strength of the extensors of the leg can thus be ascer tained. The apparatus can be applied either in the standing or in the recumbent posture. The leg should be flexed at the knee at an angle of about 90°. To determine the strength of the calf muscles the strap should be lengthened and the foot flexed upon the leg. Dr. C. L. Walton, of Boston, read a paper entitled TUMOR OF THE ANGULAR GYRUS, in which he detailed the history of a case presenting temporal and occipital headache, vomiting, paralysis of complicated with multiple neuritis. The diagnosis of typhoid fever was excluded. The neuritis was irreg ularly distributed. The patient gradually developed an aortic regurgitant murmur, with a water hammer pulse. Later, a purpuric eruption appeared. A diagnosis was made of infectious endocarditis, with secondary septic neuritis. At the post-mortem examination immense vegetations were found on the aortic valves, with infarcts in the spleen and in one kidney. Sections of the spinal cord and nerves were shown, exhibiting slight posterior sclerosis of the cord and extensive inflammation of the nerves. The second case, also in a man, simulated typhoid fever, with yellow colored stools. At the post-mortem examination multiple abscesses in the brain, a large embolus in the left brachial artery, and an infarct in one kidney were found, together with a giant growth of vegetations as large as a pullet's egg attached to the inuer coat of the aorta, overhanging the orifices of the innominate, carotid, and subclavian arteries. Dr. E. D. Fisher, of New York, read a paper entitled CONGENITAL CEREBRAL HEMIPLEGIA, WITH AUTOPSY. He detailed the history of a case presenting complete right hemiplegia, with marked atrophy, exaggerated reflexes, epilepsy, and imbecility. The cranial measurements showed morbid deficiency in the binauricular diameter and facial length. At the autopsy the left central hemisphere was found much atrophied. The right cerebellar hemisphere was also atrophied. The microscopic specimens showed a decrease in the number of cortical cells, but those present were not much dimi nished in size. There was some loss of acuteness of the angles of the cells, but little pigmentary or granular changes. The cord was but slightly affected. Dr. Charles K. Mills, of Philadelphia, read a paper entitled LESION OF THE THALAMUS AND INTERNAL CAPSULE. duce somnolence in a case of cerebro-spinal meningitis. Dr. Sinkler added that in his case the somnolence diminished after the administration of the iodid, THE LOCALIZING VALUE OF APHASIA. The pationt had an apoplectic attack in 1877, and died in 1892. The symptomatology of the case included hemianesthesia; paresis with contractures not marked; inability to recognize the position of the affected limbs. Hemianopsia and all affections of the special senses were absent, as were also athetoid and choreoid move He related two cases of hemianopsia, one with autopsy, ments. The autopsy disclosed a hemorrhagic cyst, in which there was no word-blindness, as might have which had destroyed about two thirds of the substance of the thalamus, including the entire external tubercle and a large portion of the pulvinar. The anterior extremity and the internal and inferior surfaces of the thalamus were intact. The lesion had to a slight extent invaded the posterior arm of the capsule. Dr. Wharton Sinkler, of Philadelphia, read a paper entitled TUMOR OF THE OPTIC THALAMUS, and presented a specimen. He reported the case of an unmarried woman, forty six years old, who, previously in excellent health, first noticed somnolence and loss of mental vigor. Her manner became indifferent and listless A little later there was some aphasia, and later still paresis of the right side of the face, unsteadiness of gait, and awkwardness in the use of the right hand. When first seen there was marked paralysis and partial anesthesia of the right side of the face, but no impairment of sensation of the arm or leg. There was decided mental hebetude, but no loss of memory. The woman could not walk on account of unsteadiness. The knee jerks were exaggerated. The temperature was subnormal and the pulse varied from 48 to 60. The pupils reacted to light and in accommodation. There was no nys tagnus or hemianopsia, and no change in the fundus oculi. The symptoms increased in severity, the temperature rose rapidly, and the patient died. There had been no convulsions. The post-mortem showed the left optic thalamus to be the seat of a growth as large as a ben's egg, which encroached upon the corpus striatum and posterior part of the internal capsule. The tumor has not been ex amined microscopically, but is probably a fibroma. The points of interest are the hysterical symptoms that were present at the onset; the fact that the anesthesia was confined to the face; and the question that arose as to the possibility of operation. been expected. A case of mixed aphasia was related and the brain exhibited. The case showed absolute motor aphasia, together with word blindness, and yet the lesion was confined to the third frontal convolution, the occipital cortex showing no disease. A case was reported in which there was a general disturbance of speech, with distinct mental symptoms; the patient at times being maniacal. Upon the strength of the general disturbance of the speech processes the skull was trephined over Broca's region, and the under surface of the dura found covered with blood. Dr. Leonard Weber, of New York, presented a paper entitled Dr. Wm. C. Krause, of Buffalo, read a paper entitled He reported a case of myxedema in a woman, fifty- Dr. Dana referred to two cases, one with tumor and another with softening in the thalamic region, in both of which somnolence was a prominent symptom. This tremities became swollen, her hair suddenly disphenomenon is characteristic when the posterior portion of the optic thalamus and the neighborhood of the cor pora quadrigemina are involved. appeared from all parts of the body, and she suffered with severe pains, especially through the temples, and a tired feeling incapacitating her for all kinds of manual. Dr. Seguin reported a case with a probable tumor in labor. She further complained of a feeling of coldness, the thalamic region, with somnolence, which was in- even in midsummer. Her hands were dry, harsh, and creased by the use of potassium iodid, scaly, her face waxy, and her eyes puffy and swollen. Dr. Dana said that he is familiar with a case in Her temperature ranged from 95.4° F. to 97.4° F. Her which the iodid acted as a hypnotic. pulse, soft, regular, and uniform, varied from 81 to 88 Dr. Gray said that he has noticed the iodid to pro- per minute. The edema-like swelling did not pit on pressure. The urine was normal and did not contain albumin at any time. The only drug that acted benefi. cially was ferric chlorid. THE MICROBIC ORIGIN OF CHOREA, WITH A Case. He reported the case of a man, twenty-six years old, who had had chorea from the age of fifteen, the attacks Thyroid glands of sheep were given for six weeks, but appearing exactly like those of ordinary chorea. At no improvement whatever appeared to follow. Another first there were intermissions, but the disease finally be. case, seen in consultation, treated with desiccated thy-came chronic. The spasmodic movements were general roids, also manifested no improvement. and violent. There was no heart-disease or rheumatism. Dr. Philip Coombs Knapp, of Boston, read a paper entitled SIMULATION IN TRAUMATIC NERVOUS DISEASES. He said that although many persons will simulate disease if it be to their advantage, successful simulation of the various traumatic nervous affections is rare. Non-traumatic hysteria and neurasthenia present many symptoms that appear counterfeit, the victims of these diseases often being accused of pretending to be ill, when really the malady is a serious one. Contraction of the visual field, anesthesia, tremor, disturbances of the reflexes, circulatory disturbances, and Mannkopf's symptoms are to be regarded as important objective signs. Few simulators have intelligence enough to withstand a searching examination by a skilled neurologist. Furthermore, a person can keep his attention fixed on any subject only for a very brief time, and if he must be prepared to defend his simulation of half a dozen different symptoms he will inevitably be tripped up by unexpected tests applied when his attention is diverted. Three cases were cited in which the defence claimed that there was simulation, but in every case objective evidence proved the reality of the disease. Of fifty cases in which claims for damages had been made, only two could be regarded as simulating, and few as exaggerating, and in most of these there was little reason to suspect any deliberate attempt at fraud. Dr. Mills maintained that absolute simulation is very infrequent. The cumulative exaggeration of symptoms however, is comparatively frequent. A few persons can simulate a type of insanity or a traumatic neurosis, but cannot easily simulate all of the symptoms and signs. Dr. Gray said that many cases supposed to be simu lating are simply offering to the trained eye symptoms indicative of possible simulation. He related a case of traumatic neurasthenia cured by 1/125 grain of atropine taken for two days. Dr. Lloyd held that the symptoms of traumatic neurasthenia are nothing but the inter-paroxysmal symptoms of hysteria. Because a person develops hysteria after an accident there is no reason to believe that he must be a simulator. The patient died from exhaustion. The post mortem examination showed microscopically a conspicuous chronic lepto meningitis involving the vertex of the brain. Microscopically this was found to be mainly infiltration a proliferation process, without exudation or much cellinfiltration In the superficial layer of the cortex there were cellular infiltration and degenerative changes. At this point diplococci were found. The microorganisms were found only in the deep layer of the pia and the superficial part of the cortex. In addition, there were found peculiar hyaline bodies in the three outer layers of the cortex and less numer. ously in the basal ganglia. There were evidences of meningeal irritation, vascular disease (arteritis), and nerve-root irritation in the medulla and upper part of the cord. The lower part of the cord was not examined. The following named gentlemen were elected to active membership: Dr. Brower, of Chicago; Dr. Burr, of Philadelphia; and Dr. Diller, of Pittsburg. Dr. Arnold Pick, of Prague, was elected an associate member. The following papers were read by title: "The Genesis of Hallucination, Illusion, and Delusion," by Dr. H. A. Tomlinson, of St. Peter, Minn. "The Diagnosis of General Paresis," by Dr. L. C. Gray, of New York. "A Report of Two Cases of Friedreich's Disease," by Dr. Frank R. Fry, of St. Louis. "The Metapore or Foramen of Magendie in Man and in the Orang," by Dr. Burt G. Wilder, of Ithaca. "Observations on the Relation of Chorea to Rheumatism," by Dr. Eugene Riggs, of St. Paul. "Experiences in the Use of Testic ulin and Cerebrin," by Dr. J. J. Putnam, of Boston. "Peripheral Paralysis after Surgical Operations," by Plexus Paralysis in Infants," by Dr. Wm. M. LeszynDr. V. P. Gibney, of New York. "Traumatic Brachial sky, of New York. The officers elected for the ensuing year were: Secretary and Treasurer-Dr. G. M. Hammond, of Councillors, Dr. E. C. Seguin, of New York, and Dr. J. H. Lloyd, of Philadelphia. Illumination of the Eyes from Behind.When an incandescent lamp is introduced into the mouth for the purpose of ascertaining, by trans-illumination, the condition of the maxillary antra, the pupils are seen as blood red apertures. Mr. N. Stevenson calls attention to the curious fact that when the light is thus introduced, as it were, by a back door, the pupils do not contract (Med. Press). This observation may Dr. C. L. Dana, of New York, read a paper entitled prove to possess considerable importance. Dr. Seguin exhibited a specimen stained with a 1 to 2000 solution of nigrosin, a method that he used many years ago, but neglected to publish. One of the advantages is that specimens may be safely left in the solution for twenty-four hours. |