Correspondence. YELLOW FEVER AND ITS CAUSES. To the Editor of the CANADA LANCET. This atmosphere must be produced artificially in hot climates, as the chief essential to the recovery of yellow fever patients. A yellow fever climate is exactly opposite to that cold, aqueous, mountain vapor of the Highlands of Scotland, which is so SIR.-The following letter appeared in the conducive to health and to a blooming complexion. Halifax Chronicle, August 9th. "The miserable defect of any clear and consistent view of the causes of this disease induces me to publish an idea formed from an early acquaintance with some of its features in Antigua, in the West Indies. There, certainly, it has arisen as an epidemic among the British troops, at irregular in tervals without being imported. To ignore this certainty is to be ignorant of everything most signal in relation to the disease. But the obscurity which still involves its causes arises, I think, from one prevailing error which always clouds the subject. Everybody knows that it is a disease of hot climates, and that a certain degree of cold checks the prevalence of the disease. But of the two other atmospherical conditions which conduce to generate the disease, one has not been sufficiently appreciated, and the other has been entirely mis taken. Climatic conditions everywhere are always three, at least. 1. The condition of heat or cold is indicated by the thermometer. 2. The condition of density or rarity (weight or lightness) is indicated by the barometer. 3. The condition of humidity is measured by the hygrometer. (The opposite poles of this third axis are dryness and moisture.) Now, with regard to the second condition-viz: the density or rarity of air-it is known in Jamaica that the density of hot air aggravates the danger of yellow fever. A certain elevation-about three thousand feet-is said to be "above the fever level." But as to the third point-of humidity-I write to declare that a constant error has precluded a right view of the concurrent causes which produce the disease. Instead of humidity being a cause of yellow fever, it is the absence of aqueous vapor that causes it. Hot air, dry and condensed, inhaled for any protracted period, is the predisposing cause of this disease, and therefore an atmosphere of cold aqueous vapor is the remedial condition indicated. In connection with a changed atmosphere to act on the patient through the lungs, baths instant upon attack, and frequent afterwards, will be obthe depraved functions, and tending directly and viously beneficial as operating through the skin on indirectly by the aqueous vapor rising from them, to correct the vitiated blood. The fact mentioned by Dr. Read, of the immunity from yellow fever of Salisbury, N.S. To the Editor of the CANADA LANCET. SIR,-I am very much pleased to observe the discussion in reference to the Treasurership of the Medical Council. This is one of those questions that requires to be ventilated in the columns of the LANCET, and you deserve the thanks of the profession for giving it the publicity it merits. However agreeable it may be to the present occupant, and advantageous to the medical school of which he is the president, I can assure you his action is not endorsed by the profession generally in this part of the country. Several medical men who are firm friends of Dr. Aikins, have expressed their surprise that he should hold on to the office, while his position is so open to assault. The officers of with one tenth grain of atropia in similar manner, an institution like the Ontario Medical Council has been successful. Erysipeias. Carbolic acid, three-per cent solution, should be above the suspicion of using their posieight or ten injections at the same time, so as to tion to the advancement of their own private inter-surround and cover the inflamed regions; also saicylic acid in same manner. ests. The affairs of the Medical Council have been frequently the subject of adverse criticism. Nor can this be wondered at, while it retains in office men who place their own private interests before the general good of the profession. It is to be hoped that the new Council, to be elected in June next, will make a clean sweep, and inaugurate a new and better régime. The National Medical Review says: Physicians of the present day carry in a pocket-case more active elements of prompt medication than used to be packed in a good-sized pair of saddlebags of a quarter century ago; and these modern condensed preparations for subcutaneous injection, as we all know, in many respects sepersede the old-fashioned way of administering medicines. In cases of un consciousness, delirium, strangulation, or other condition in which the patient can not or will not swallow, the proper remedy, in nicely-graduated quantity, injected hypodermically answers just as well as if taken in the stomach; and in many cases, even when the patient can take remedies in the usual way, hypodermics respond more promptly and favorably than other plans of treat ment. We give the following list as embodying the principal conditions in which hypodermics have been (mployed : Ununited Fractures. Glacial acetic acid, five to ten minims, between ends of the bones with hypodermic syringe. Iodine has also succeeded, used in same way. Surgical Shock.. Quinine, six grains, hypodermically, with one third grain of morphia. Urticaria. Saturated solution of bisulphite of soda, injected directly into the part affected. Hemoptysis. Sclerotinic acid, substitute for ergotine, five per cent solution injected in the neck or Carcinoma. Acetic acid, one part to three of water, injected into the cancer has proved success, ful in shriveling the tumor and obviating an opera tion. Cerebral Apoplexy has been successfully treated by subcutaneous injections of ergotine in the arm. H.cc.ugh. In an obstinate case, resisting. Il other means, three eighths grain of chlorohydrat of pilocarpin, hypodermically, quickly proved successful. Puerperal Convulsions. Chloral subcutaneously has been pronounced better than when swallowed. Foreign Body in Esophagus. Threatened strangu lation from impaction of gullet has been promptly relieved by inducing vomiting. Apomorplia, one tenth grain, hypodermically. Emetina is also sug gested in same way. Strychnia-poisoning. Caffein, one grain, hypodermic; alcohol in same way is also suggested; chloral injections are also mentioned. Puerperal Eclampsia. Veratrum viride, two to four drops of the tincture, subcutaneously, as required to keep the pulse down to about sixty. Pilocarpin, two-per-cent solution, is also recommended. Trichinosis. Tincture of ergot and ergotine have effected speedy cures, hypodermically, into muscles affected. Skin-diseases caused by Animalulæ. Sulphuric, carbolic, salicylic, or sclerotinic acids, hypodermically, as in erysipelas. Nasal Polypus. Carbolic acid, one part; glycerine, four parts; twenty drops sunk into tumor by means of hypodermic syringe effectually dissipated polypus in case reported. Eczema. Arseniate of soda, hypodermically, in solutions of one fifth, one half, and one per cent, commencing with ten minims of the weaker and gradually increasing is recommended. Nocturnal Enuresis. Two very small doses of the nitrate of strychnia, injected in the vicinity of the rectum at suitable intervals, have proved suc cessful. Croup. Sulphate of atropia, one-per-cent solution, has proved successful in a desperate case, injected in the neck on level with pneumogastric. Three drops, repeated after four hours. Congestive Chills. Ten drops of tinct. belladonna, hypodermically, every fifteen minutes, until the pulse became distinguishable, succeeded where the patient was unconscious and unable to swallow, followed by hypodermics of quinine, brandy, or whiskey. Goitre has been successfully treated by subcut- eight drops beneath the skin. It has cured cases aneeus injections of ergotine, one third, gradually of several years' standing within two months. increased to one grain. Snake bites. Ammonia, brandy, carbolic or saliMembranous Croup. Equal parts of water and cylic acids are all recommended, hypodermically, sol. ferri perchlor, injected into the trachea, pierc-in case of snake-poison, and have been injected ing the needle through just below the thyroid with benefit directly into a vein. cartilage, dissolves the membrane, enables its expectoration, and substitutes tracheotomy. Erectile Tumors have been successfully treated by injections of perchloride of iron and chloride of sodium in solution, the tumor to be surrounded by a ring. Abortion has been caused by hypodermics of pilocarpin. This should insure caution. Hemorrhages. Hemoptysis, hematemesis, and uterine hemorrhages have all been arrested by hypodermics of ergotine. If pain, add morphia. Night-sweats. Atropine has given good results in injections of about one fortieth of a grain at bed time. Tetanus. Chloral hydrate is recommended in conjunction with chloroformization, alternating it with other powerful anodynes and antispasmodics. Infantile Convulsions. Morphia, subcutaneously, with inhalations of five drops of nitrite of amyl immediately following, have proved successful. THE USE OF THE FORCEPS AND ITS The admirable opening address of Dr. Barnes was not followed up with the ability which might have been expected, some of the addresses being prolix and not very ehifying. The opinion of the leading English obstetricians on this subject have much interest, however. Dr. George Kidd, of Dublin, in reference to the "high operation," thought no one would hesitate to apply the forceps when the os is nearly or entirely dilated, and the head lying at the brim and making no progress. The point is, are we to use the forceps when the os is undilated? Dr. Kidd thought not. Even when the os is dilatable, he thought manipulation better. Retention of Urine from paralysis of the bladder, Even, also, when the os was dilated to an inch and accompanying typhus, variola, and hydrocephalus a half, to proceed and introduce the forceps to has been promptly overcome by hypodermics of drag the head down through it, was, he believed, a ergot in the fossa behind the great trochanter. dangerous practice. He preferred the warm bath. Arrest of Perspiration. Pilocarpin, the alkaloid chloral, or chloroform, etc. When, however, there of jaborandi, will cause more or less profuse is some minor disproportion or a malposition, Dr. sweating, according to amount injected beneath | Kidd would use the forceps high up with the os undilated. "But," he concluded, "to let it go the skin. Opium-poisoning. Quite rapid recovery is report-forward as our teaching that we may always use, or ed to have followed warm hypodermics of fluid extract coffee in thirty-minim doses. Caffein citrate and sulphate atropia are also considered antidotes to opium. Suspension of Salivary Secretion. Pilocarpin used as heretofore explained excites salivation. Chorea. Curare, in hypodermics of from one tenth to one twentieth of a grain daily, has been found valuable in this disease. Obstruction of the Bowels. Aloin has been used with success, subcutaneously, to move the bowels. Hydrophobia. Much amelioration of the symptoms has followed hypodermics of curare. Bubo has been aborted by injecting carbolic acid into the centre of the swelling. should always use, the forceps early in the first stage of labor, when there is no urgent demand for it, except the time that has been passed, would I think, be most unfortunate for society, and for our profession." Dr. Thorburn, of Manchester, inveighed against the use of ergot with an undilated os, and urged the more frequent employment of chloroform. Prof. Stevenson, of Aberdeen, and Mr. Newman agreed with Dr. Barnes. Dr. Malins, of Birmingham, maintained that in the majority of cases in which the "high operation" is used the alternative of turning is as efficient as easy, and as safe a practice as the use of the forceps. Dr. Alderson and Mr. Worship followed, urging the frequent employinent of the forceps. Dr. Edis considered the forceps as an aid, to supplement the defective arrangements of nature, and not as a last resort. When evidence of flagging powers showed itself, he would apply outside pressure by the hands or with a binder. He would not use ergot. Dr. Lombe Atthill thought that if any aid was necessary to Epilepsy. Curare, in solution, seven grains in midwifery, the forceps was superior to any other. twenty-five minims water, with two drops hydro-With respect to the use of ergot, this was absolutely chloric acid. About once a week inject about prohibited in the Rotunda Hospital, under his Syphilis has been treated by solutions of some of the mercurials, injected locally. Hernia is more easily reduced by giving a hypodermic of morphine with or without atropia. Dysentery. Morphia, hypodermically, in onethird-grain doses, has been found more rapid in relieving tenesmus than any other opiate. management. The real question at issue, he thought, was whether the use of the forceps was justifiable in cases in which the os was not fully dilated. As to this, Dr. Atthill said, “I avoid the use of the forceps before the os is fully dilated in all cases in which I can do so; but, on the other hand, if a case occurs in my practice in which I believe it imperative to deliver the woman before the os is fully dilated, I unhesitatingly have recourse to the use of the forceps, notwithstanding that the os uteri is not fully dilated. I believe that practice is safer than the practice of version." Dr. Roper himself has only used the forceps eighty times in nine thousand three hundred and eighty-nine cases. Dr. Braxton Hicks spoke of trismus of the uterus, where the foetus is held firmly grasped; and here chloroform may be substituted for the forceps to advantage. This irritable condition of the uterus is sometimes brought on by the too early use of ergot. Occasionally fissures of the cervix occur without the forceps having been used, and occasionally, perhaps, the forceps used high up is blamed for these. The discussion was then adjourned to a later meeting.-Med. Times. PARACENTESIS PERICARDII. Dr. McClintock, of Dublin, could not agree with Dr. Atthill in his denunciation of er ot. He (Dr. McClintock) customarily used it in the later stages of labor, and could see no objection to its employment. He considered it a most valuable remedy, and not likely to do harm. He agreed with Dr. Barnes as to the use of the forceps in the higher operation. Dr. Roper, of the Royal Maternity County Medical Society, (Med. Times), entitled Dr. John B. Roberts read a paper at the PhilaHospital, appeared as the most strenuous opponent of frequent use of the forceps. When used in "Is Paracentesis of the Pericardium Justifiable?" lingering labor due to inertia, he used ergot at the Dr. Wm. Pepper said that this operation is one same time. Although ergot stimulates the uterus of a group which he had always been inclined to to increased action, it does not always succeed in claim for medical men rather than surgeons, as the expelling the child. When the influence of the operation itself is a comparatively trifling one, ergot is expulsive, the forceps is not needed. while the questions of the time for the operation When, however, the uterus under the influence of and its conditionu are of the greatest interest and ergot merely seems to contract upon the child, importance. He agreed with Dr. Roberts in his death will ensue unless the forceps are used to aid reply to the caption of the paper, and thought that expulsion. We cannot expel the child by pressure recorded results were sufficient to authorize an from without on the fundus, as we can the placenta. affirmative answer to the question. Yet these manipulations may excite the uterus to contraction. The forceps may also be used in the opposite variety of cases, where in robust primiparæ the powerfully-acting uterus in the end is unable to overcome the rigidity of the soft parts of the outlet. We are warned by the pains be coming less forcible and frequent, and there is less movement with each pain. Here we should anticipate the occurrence of dead-lock, and supplement the powers of nature before the break-down takes place. From observation of post-mortem examinations in which unsuspected pericardial effusions are sometimes found, he had concluded that such large effusions are not infrequent, but that they may be, and doubtless often are, entirely overlooked during life. And yet the physical diagnosis is, as a rule, very simple and easy, the only possible difficulty being in the case of a dilated heart, where there is a feeble, asystolic action of the ventricles, accompanied by extended area of dulness. That this difficulty exists must be admitted, since cases As to the high operation, Dr. Roper had never have been reported in which paracentesis of a seen a single case of death, either of child or dilated heart has been performed under the immother, or of damage to the maternal structures, pression that there was fluid in the pericardial sac, from a protracted first stage of labor. Of course, and this in the hands of men whose position is it is understood that allusion is made to natural evidence that they were competent to decide. Of labors, with the exception of a rigid state of the os course, the case is different where the physician uteri. A wide distinction must be kept up be- has watched the patient from the beginning, as in tween a head above the brim which does not come a case of acute rheumatism, where frequent exdown, because in the one case it is obstructed by amination of the heart is required. In such cases the brim itself (a bony obstruction) and in the he would detect the early friction in the pericarother by the rigid os aud lower segment of the dium before the effusion of blood in sufficient uterus. In nervous women who bear their pains quantity to separate its layers. The difficulty in badly, the forceps may be used with propriety. diagnosis would only occur where you are called The forceps are used too frequently, and it is in to see a case that is fully developed; but even possible that much of the gynecological work of then there are points that would generally prevent the present day results from this frequent inter- a mistake: these are the altered intensity of the ference with the natural functions in childbirth. | sounds, the relation of the cardiac impulse to the intercostal spaces, and the outline of the percussion dulness; and it would seem that with due attention to these points no mistake can occur. There are complicated cases, however, where some doubt must remain. In a patient operated upon recently, there was a large pleuritic effusion accompanying one in the pericardium. In such a case he would recommend that the pleural effusion should be removed by the aspirator, and, if necessary, the pericardium can be subsequently tapped. This course was adopted in the case referred to; and it was found that after removal of the fluid from the pleural cavity, the effusion in the pericardium was absorbed without further interference, under medical treatment. In regard to the point selected for introducing the needle, he would prefer one that is a little farther from the sternum than Dr. Roberts has recommended, and in the fifth interspace, as being less likely to injure the ventricle; at a site about on a line with the nipple, a little to the outside of the position of the normal apex beat. In performing the operation, a moderately-large aspirating needle is preferable to a small one, since inflammatory effusion in the pericardium is apt to contain shreds of lymph which would clog a sinail needle. It is difficult to introduce a plunger to clean a small tube, and they are also less easily reintroduced if it becomes necessary to remove them to clean them. For this particular operation he had devised an instrument which can be used without danger of scratching the heart, but which he had only tried on the cadaver. In regard to the operation, it has simplicity in its favor. As the results are always brilliant in the marked relief and improvement it affords, and as it frequently prolongs life so as to give time for the action of other remedies, it will compare favorably with any other procedure in the field of legitimate surgical operations. Dr. Roberts stated that he had not intended to recommend a very small aspirating needle, but one of moderate size. He would not use a large one, on account of the injury to the pericardium, and the probability of subsequent leakage into the pleural cavity, and possible pleurisy. As regards the shape of the trocar, he believed that Fitch's dome-shaped trocar was less likely to injure the heart. In regard to the diagnosis, too much stress is laid upon the pyramidal shape of the dulness; the statement in the books is that it is a rude triangle, and it might happen that because it was not more perfect some doubt might exist as to the diagnosis. MARTIN'S OPERATION OF EXTIRPA TION OF THE KIDNEY. Dr. J. Marion Sims (Am. Med. Bi-Weekly, from Med. Record) "It has remained for Dr. Martin, (son of the late Prof. Edward Martin), to open up a new field for and a new method of doing this operation. He has now extirpated the kidney five times-four times successfully. And, strange to say, he has done the operation for what is known as floating kidney. His operation before Listerism would have been wholly unjustifiable. But now it is justified by its simplicity and its success. It is as simple, if not as easy, as ovariotomy, and quite as successful. Certainly so in Martin's hands. I had the satisfaction of assisting at Martin's fifth operation, on the 19th of April. The operation is by abdominal section. of using a single table, five feet long, for his operation, he has two tables, each about two and a half feet long, end to end, one being a little lower than the other. The patient was chloroformed in her own chamber, and then brought into the operating room, and placed on the table, with the head to the window. The head was on the lower table, the pelvis on the higher one. The head was placed low, with the intention of preventing syncope, the chief source of danger in the use of chloroform. Martin's spray apparatus is an enormous affair that will work for hours. It was placed six feet or more from the patient, and the spray passed over the assistants and fell on the patient, not in a dense cloud, but in a sort of mist. It seemed to me to be "too much of a good thing." The operation was begun at ten minutes to 8 a.m,, and was finished in twenty-six minutes. It was done slowly and with great pains-taking. The incision was begun about two inches above the umbilicus, and extended two inches below it. The bleeding from the edges of the abdominal wound was arrested as in ovariotomy, with hemostatic forceps. The peritoneum was then incised. Some folds of small intestine protruded, and were pushed back and retained by a carbolized sponge probang. The kidney was then pushed to the abdominal incision by pressure on the loin behind, where it was seized with a vulsellum and securely held. The peritoneum investing it was then opened longitudinally; and the kidney was enucleated and brought freely into the peritoneal cavity. Some large veins on the surface were ligated, and its attachments (consisting of the renal artery, renal vein, and ureter with cellular investments) were tied in sections, just as we secure a broad pedicle in ovariotomy. The pedicle (so to say) of the kidney, necessarily running longitudinally with the kidney, about three fingers' width long, was transfixed and tied with five separate ligatures. The kidney was then neatly dissected away from the pecicle and removed. The pedicle was dropped back into its proper place behind the peritoneum; the peritoneal cavity was then carefully sponged ary; and the external wound was closed with interrupted sutures. The sutures and ligatures were carbolized silk. Anti |