THE AMERICAN PRACTITIONER AND NEWS "NEC TENUI PENNÂ." VOL. 32. JULY 15, 1901. No. 2. H. A. COTTELL, M. D., M. F. COOMES, A. M., M. D., Editors. A Journal of Medicine and Surgery, published on the first and fifteenth of each month. Price, $2 per year, postage paid. This journal is devoted solely to the advancement of medical science and the promotion of the interests of the whole profession. Essays, reports of cases, and correspondence upon subjects of professional interest are solicited. The Editors are not responsible for the views of contributors. Books for reviews, and all communications relating to the columns of the journal, should be addressed to the Editors of The American PRACTITIONER AND NEWS, Louisville, Ky. Subscriptions and advertisements received, specimen copies and bound volumes for sale by the undersigned, to whom remittances may be sent by postal money order, bank check, or registered letter. Address JOHN P. MORTON & COMPANY, Louisville, Ky. PLASTIC SURGERY. The progress of modern surgery has been such as to enable us at present to do almost any kind of plastic surgery with so much certainty that the careful, expert modern surgeon may now accomplish so many things that he at times seems to possess almost a supernatural power. The rich nerve- and blood-supply to the face makes it the most successful field for the display of plastic surgery. There is scarcely any deformity about the face, neck, or nose, it matters not whether it is congenital or acquired, that may not now be corrected. The saddleback nose is elevated with as much ease and certainty as a fractured limb is put into position; the most hideous hare-lip mouth is shaped up so as to make it “kissable,” and to make it serve all the purposes that any other mouth serves. The "crow-feet" made upon our faces by time may be eradicated and nice smooth surfaces left in their stead. The miss with the exaggerated Roman, Hebrew, or turn-up nose may have it converted into any shape she desires, if she only has the money and will put up with a little privation for a short time. Moles, warts, and other blemishes about the face and neck are now disposed of with no trace left. Recently it has been determined that irregularities may be evened up by injecting sterilized vaseline beneath the skin, where it will remain indefinitely without giving trouble. Many small wounds. of the face can now be closed without stitching, thus reducing the chances of producing a scar to a minimum. The field for plastic surgery in gynecology has a wide area, and the high state of perfection to which the art has been brought by the modern gynecologists goes to show that the workers in this field have not been idle. The reparation of a lacerated perineum or the closure of a vesico-vaginal fistula is accomplished with almost as much certainty as the closure of an incised wound on any other surface of the body. HER ALUMNI HONOR HER. The election of Dr. John A. Wyeth President of the American Medical Association magnifies the established fame of his professional alma mater, the Medical Department of the University of Louisville. This second oldest institution of its kind west of the Alleghanies has contributed in Dr. Wyeth its ninth president to the American Medical Association, a record with which that of no other school can begin to compare. Dr. Wyeth is the third alumnus in the list of American Association presidents, the first being Dr. David W. Yandell and the second Dr. Joseph M. Mathews. There were seven presidents who were members of the University faculty. They were Drs. Henry Miller, Paul F. Eve, S. D. Gross, Austin Flint, T. G. Richardson, and Theophilus Parvin. THE Supreme Court of Ohio has rendered an important decision. which established the right of the Ohio State Board of Medical Registration and Examination to determine when a medical college is in good standing. The board rejected the diplomas of the Hygeia Medical College of Cincinnati, and the college applied for a writ of mandamus compelling such recognition. "The court sustained the board, the decision in effect being that a writ of mandamus will not issue, on the relation of a medical college, to compel the State Board of Medical Registration and Examination to recognize the college as a medical institution in good standing, nor to compel the board to issue certificates to practice medicine in that State to holders of diplomas from such college. Decided March 26, 1901. This decision will establish the Ohio board on a firm foundation, and the precedent thus created will strengthen the hands of boards in other States." Current Surgical and Medical Selections. THE PHYSIOLOGICAL EFFECTS OF EXTRACTS OF DUCTLESS GLANDS.— Dr. Richard E. Cunningham read this paper to the New York Academy of Medicine. He objected to the use of the ordinary desiccated extracts of the ductless glands on the ground that there was good reason for believing that they were mixtures of various substances, and that the determination of the results from their use must necessarily be very unreliable. Much had been anticipated from the administration of the extract of the pituitary body in cases of acromegaly, yet the clinical results had been disappointing. He had personally been unable to observe the remarkable effects on the circulatory system from the ingestion of suprarenal extract, described by several observers. One would expect the best therapeutic results from the administration of suprarenal extract in Addison's disease, yet the cases so far published had not confirmed this belief. Of twenty-four reported cases that he had collected, in which the suprarenal extract had been administered, not a single patient could be said to have been cured, though fourteen had been temporarily improved. Ten had been practically unaffected by the treatment. When the aqueous extract of the suprarenal gland was introduced into the blood-vessels it caused a marked fall in the blood-pressure, but if the colloid preparation of the extract of this gland was injected, this lowering of the blood-pressure was not noted. Thymus Gland.-The thymus gland has been first introduced to the medical profession as a remedial agent in connection with the treatment of a case of pseudo-hypertrophic paralysis. In ten cases of exophthalmic goitre treated by him with dried thymus, only three could be said to have been even temporarily improved. The best results from the use of these extracts had been secured with thyroid extract. If large doses of the desiccated extract were given, the results would often be the development of symptoms apparently indicative of poisoning, with the proteid bodies constituting the impurities of the extract. On the other hand, it would often be found that the same individual could take rather large doses of iodothyrin without experiencing any such toxemia. The iodothyrin did not seem to be nearly so active as the colloid, from which it could be easily obtained.-Medical Record. POISONOUS SNAKEBITES. A description of the various poisonous snakes, together with a detailed consideration of their poison apparatus, is interestingly given in the Medical Record (September 15, 1900) by G. Langmann. The effect of the snakebite, the symptoms produced, and a review of the many methods of treatment that have been used make the article a very valuable one. The object of treatment is fourfold: to prevent absorption of the poison, to destroy or neutralize it, to accelerate its elimination, and to treat symptoms of imminent danger. If the limb affected, as a finger. is not immediately amputated, an Esmarch or other bandage should at once be used and the circulation relieved only to prevent gangrene. Scarification, or better, either excision or destruction of the area by cautery, is advised. Locally supposed specifics have been much used, as carbolic acid or permanganate of potash. A solution of hypochlorite of lime, 1-60, has been found very effective by Calmette, and is probably the best local remedy. Ammonia and strychnine act doubtless merely as general stimulants, but they are certainly of value. The poison exerts both a hemolytic action on the blood and a destructive influence on the cells of the medulla. To neutralize these actions a specific antitoxin must be obtained. Calmette and Fraser have offered to the world an antivenomous serum which experimentally has been shown to have the power of neutralizing lethal doses of the poison injected into animals, and has been used on man successfully in several cases. The antivenene is made by inoculating horses with a mixture of poisons from several species of deadly snakes after the hemolytic agent of the poison has been eliminated by heating to 80° C. It acts as a full protective in a dose of from 5 to 20 cc. when injected even one and a half hours after the introduction of the The action of the intivenene is supposed to be entirely chemical, for a certain amount counteracts a miminal lethal dose when injected at separate points, but 1-1,000 of this quantity is effective when mixed with the venom and injected. Phisalix, of Paris, has recently discovered that in the blood of some animals, as the eels, there is a substance which exerts a decided antitoxin action. Cholesterin, separated from biliary calculi and carrots, has a similar effect. The most commendable treatment is ligature of the part, scarification and injection of the antivenene, or if not at hand, the solution of hypochlorite of lime; stimulation, artificial respiration for hours, if necessary; lavage of the stomach to remove the poison which is there secreted, and encouragement of the victim, for a deep mental prostration accompanies the depression of the nervous centers.-Medical News. venom. ON THE HYPURGIE" OF OBESITY.-Mendelsohn, editor of the Zeitschrift fur Krankenpflege, has devised the term "hypurgie" to denote that special exercise of the physician and nurse which seeks to attain the comfort of the patient upon all occasions. In a number of his journal Mendelsohn extracts from Van Noorden's new work on obesity various practical points which bear upon the questions of nursing and hypurgie. The capacity for exertion on the part of the corpulent patient must first of all be determined for a given time. Those who have a normal tolerance for exertion may be made to work hard, and by following out this principle we avoid excess. The quality of the exercise must be studied. If a patient ascend an elevation 300 meters high he expends the same energy whether he takes 100 minutes or only 60 minutes for the task, but in the latter case he may overtask his heart. Both in walking on a level and in hill-climbing, the effect on the heart and voluntary muscles must be carefully supervised. The better the ventilation of the lungs, the less liability to heart-strain. The introduction of the bicycle into medicine is a great advantage in the management of obesity, but the heart is equally exposed to danger in this form of exercise. The fat bicyclist should never be allowed to bend forward because of the prejudicial effect upon respiration. Rowing, either on the water or with a parlor rowing-machine, is strongly recommended by good authorities, and tests made after this form of exercise show that the pulse and heart are not overtasked. Vigorous obese individuals may play active outdoor games-tennis, football, golf, etc. The principal value of gymnasium exercise lies in the development of certain groups of muscles, and the general strengthening of the entire muscular system. On the other hand, horseback exercise is not recommended. It is good to reduce the horse's weight, but not so good in this respect for the rider. Baths, both for the sake of cleanliness and as hydrotherapy, are of the greatest benefit to the obese. With regard to diet, Van Noorden believes in the expediency of small and somewhat frequent meals. In this way we avoid the profound weakness which comes from an empty stomach (often causing fat women to swoon), as well as the danger of overeating. Wine should never be taken with meals, but between meals it is often grateful. Mineral waters, weak tea, lemonade, etc., may be taken either with or between meals.--Medical Review of Reviews. GUNSHOT WOUNDS AND TETANUS.-The great frequency of tetanus, following wounds from blank cartridges, is well-known. H. Gideon Wells (Philadelphia Medical Journal) has made a study of the blank cartridges on the market with the object of determining whether tetanus spores were present in them or not. Upon inquiry he found that the blank cartridges on the market were manufactured by five different firms in this country and in Canada, and samples of each of these were obtained for examination. In all about two hundred cartridges were examined, but in none of them were tetanus bacilli found. The method of examination was as follows: (1) The wads, powder, and shells were first heated to 85° C. for forty-five minutes, and then cultures on glucose agar and other media were made. Cultures were also made without the preliminary heating. (2) A series of animal inoculations of guinea-pigs and mice were made, in various series, with wads and powder and with agar and bouillon cultures, both with and without heating. Ultimately for the examination of a large number of cartridges the following plan was adopted: Wads from ten cartridges were broken up into fine pieces and placed in bouillon sufficient to cover them; the fluid was then heated to from 80° to 85° C. for forty-five minutes, and grown for one week under anaerobic conditions. The cultures were then inoculated into mice |