The Project Gutenberg eBook of The Cleveland Medical Gazette, Vol. 1, No. 5, March 1886
    
This ebook is for the use of anyone anywhere in the United States and
most other parts of the world at no cost and with almost no restrictions
whatsoever. You may copy it, give it away or re-use it under the terms
of the Project Gutenberg License included with this ebook or online
at www.gutenberg.org. If you are not located in the United States,
you will have to check the laws of the country where you are located
before using this eBook.

Title: The Cleveland Medical Gazette, Vol. 1, No. 5, March 1886

Author: Various

Editor: Albert Rufus Baker
        Samuel Walter Kelley

Release date: October 19, 2016 [eBook #53325]

Language: English

Credits: Produced by Richard Tonsing, The Online Distributed
        Proofreading Team at http://www.pgdp.net (This file was
        produced from images generously made available by The
        Internet Archive)


*** START OF THE PROJECT GUTENBERG EBOOK THE CLEVELAND MEDICAL GAZETTE, VOL. 1, NO. 5, MARCH 1886 ***




Produced by Richard Tonsing, The Online Distributed
Proofreading Team at http://www.pgdp.net (This file was
produced from images generously made available by The
Internet Archive)






[Illustration]

                         DESCRIPTION OF PLATE.

 Powers used.     Figs. 7 and 9, Gundlach’s objective, III, ocular III,
                    magn. about 175 diam. All the rest Gundlach’s
                    objective V, ocular III, magn. about 500 diam.

 Fig. 1.          Part of alveolus, submaxillary cat, compressed
                    Carmine.

                  _m._ Nuclei of memb. propr.

                  _g._ Nuclei of gland cells.

 Fig. 2.          Part of alveolus submaxillary cat; membr. propr. torn
                    Carmine.

                  _n._ Nuclei of membr. prop. either rolled up or seen
                    edgewise.

                  _m._ Similar nucleus flattened out.

 Fig. 3.          Nucleus of membr. propr.

                  _a._ Viewed edgewise.

                  _c._ Viewed from surface.

                  _b._ Viewed in position between both.

 Fig. 4.          Group of gland cells with nucleus and portion of
                    membr. propr. resembling a connective tissue
                    corpuscle with processes.

 Figs. 5 and 6.   Fragments of membrana propria with nuclei. Cat.

 Fig. 7.          Nerve trunk with branches, accompanying a small duct.
                    Carmine. In the main trunk the individual fibrils
                    cannot be distinguished. Aniline blue might have
                    made them distinct.

 Fig 8.           Small nerve trunk containing two naked fibrils in
                    sheath. Aniline blue.

 Fig. 9.          Single naked nerve fibril found passing on to an
                    alveolus. It seemed to pass on to the capillary
                    figured but a small break, where the fibre might
                    have been torn, or where from the underlying cells
                    it could not be distinguished—allows doubt if the
                    fibre seen along-side of the capillary is the
                    continuation of the fibre. Carmine and aniline blue.

 Figs. 10 and 11. Capillaries with nerve fibrils accompanying the same.
                    Carmine and aniline blue.

------------------------------------------------------------------------

[Illustration]




                                  THE
                       Cleveland Medical Gazette

 _VOL. I._                   _MARCH, 1886._                     _No. 5._




                           ORIGINAL ARTICLES.


TWO DISPUTED POINTS IN THE HISTOLOGY OF THE SUBMAXILLARY GLAND. MEMBRANA
                 PROPRIA—NERVE-ENDINGS (WITH PLATE.)[1]

            BY CHR. SIHLER, M. D., PH. D., CLEVELAND, OHIO.

            Formerly Fellow of the Johns Hopkins University.

The submaxillary gland is of importance not only for its own sake, but
because its anatomical connections and situation are such that it can be
subjected to physiological experiment, and a number of important results
have been reached which I may discuss at some future time.

Footnote 1:

  Read before the Cuyahoga County Medical Society, January 7, 1886.

The results of my work are not only contradictory to the authorities in
histology, but also do not harmonize with the requirements of prevailing
physiological theories. Bringing this before you does not mean that I
ask you to accept either facts or conclusions. I am fully aware of the
difficulty of such work, the doubtfulness of the facts and the liability
to error in the conclusion. But it is just possible that some of the
younger members may fare as I did—have not all their time occupied by
practice—and if I enlist the interest of any in this most important
region I shall feel happy.

A number of years have passed since I undertook this question, and the
work on the nerve-endings on muscle, which I had the pleasure to
communicate to this society a few months ago, was undertaken more as a
study, to make myself familiar with analogous structures, than that I
expected to find anything new.


                                METHOD.

In the investigations on the nerve-endings I used the submaxillary of
the half-grown cat, the calf, the ox and the puppy. The method followed
was in the main that of Beale. In the case of the cat I injected the
whole animal from the aorta with Turnbull’s blue, dissected out the
gland, duct, and the nerves entering it. After breaking up the gland
into pieces by aid of a needle, from the size of a bean to a pea, I
placed it in a dish with a light cover, containing Beale’s carmine
(carmine dissolved in ammonia and glycerine). I am in the habit of using
a stronger solution than Beale’s. I suspect that the carmine I used in
some of these stainings was adulterated with eosin, and that possibly
this may have been of advantage. In some of my stainings I used a fluid
prepared from cochineal; used ammonia in dissolving the coloring matter,
and then added carmine besides. It is of the utmost importance to have
no excess of ammonia present, otherwise the staining will be slow and
imperfect. I have been staining with this method for years, yet I cannot
say why the results differ so much. Some time ago I stained a frog for
the nerve-endings in muscle and obtained the most beautiful results, but
in the number of stainings I have made since (trying to follow the same
method) I have not been by far as successful as then. In breaking up the
gland I do not always separate all the pieces, but try to remove the
connective tissue holding together the small lobules with the dull end
of a needle, and then throw the coherent mass into the stain. In this
way I procured a very perfectly injected and beautifully stained
submaxillary of a half-grown cat, from which I made a number of valuable
specimens. The material may remain in the staining fluid for weeks, and
may be examined every two or three days to note how the staining is
advancing. When the masses stained are large, or the whole gland is
subjected to staining, of course the outer parts are more deeply stained
than the inner ones, but it is at times convenient to have material of
different depths of staining. After the process has continued long
enough—the nuclei at least should be very distinctly colored—the
material is transferred into a fluid containing glycerine five parts,
water and alcohol each two parts, acetic acid one part. Here it may
remain about twenty-four hours, and finally it is to be preserved in a
similar mixture containing but a trace of acetic acid. I hold acetic
acid of varying strength diluted with glycerine in high esteem in such
investigation. It does two things, removes the superfluous stain and
softens and clears up the connective tissue. Thus treated, the material
is ready for examination.

The tissues thus prepared may be hardened in alcohol and sections cut,
but this will not aid much in the investigation of the questions that
interest us. For this purpose teasing and compression with the cover
glass are mainly to be relied upon. It is to be commended to isolate one
of the little lobules the gland is composed of, because thus we
certainly have ready for examination all the elements making up the
gland. The little root which connects the lobule with the rest of the
gland will consist of the duct, vessel and nerves supplying the lobule.
Such a lobule is broken up with needles and by compression between
slides. All these manipulations are to be carried on in glycerine. When
the fragments are small enough they are examined with lower powers. The
ducts in well injected specimens can be recognized by the rich supply of
vessels, the nerve-trunks by the arrangement of the nuclei.

After examining larger fragments with lower powers, smaller ones are
selected, subjected to pressure with cover glass, and examined with
higher powers. By compression with cover glass, pushing from side to
side, one can isolate almost any structure. One can also then make sure
whether a fine fibre is really in connection with any other structure,
or only lying above or beneath the same.

The staining with the carmine will generally not attack the fine nerve
fibres. To show these up I have used aniline blue dissolved in water. By
these means I have brought out very plainly the nerve fibres, in nerve
trunks, of considerable size, as well as those along vessels. I took the
material prepared as described, broke up a little piece in fragments of
the size of mustard seeds, and left them twelve hours in the blue fluid
in a watch glass. Glycerine, if necessary, slightly acidulated, will
remove the superfluous stain. I was very much pleased with the action of
the aniline blue.

Notwithstanding its physiological importance there is among the
authorities as yet no uniformity of opinion on the histology of this
gland, save that it belongs to the racemose glands, and is made up of
epithelial cells.

The question whether there is present a special membrana propria,
enveloping the glandular epithelium, as Pflüger teaches, or a network of
partly coalesced connective tissue cells, as Kölliker supposes, may not
seem very important, but certainly such points must be cleared up before
such questions as to how the nerves end can satisfactorily be answered.

This question, the importance of which will be admitted by all, is also
a disputed one. In Stricker’s handbook Pflüger has, in the article on
the submaxillary gland, given a detailed account of the mode of
nerve-ending in this gland. According to his investigations it is of
various kinds.

(1.) The medullary fibre approaches an alveolus penetrates this
membrane, the axis cylinder breaks up into innumerable fine fibres, and
these pass into the body of the gland cell. (2) Or the nerve passes into
a pale cell provided with numerous processes, which in their turn form
connections with the secreting cells.

These results of Pflüger have, however, not been accepted by all
investigators. Thus Kölliker says on this question:

“The investigations on the nerve-endings in the salivary glands are
evidently far from being concluded, nevertheless so much can be gathered
from the work done that the nerve fibres are in more intimate relations
with the glandular elements than has been surmised heretofore. What
these relations may be I cannot say, for notwithstanding a very careful
investigation of this gland it has not been possible for me to reach
views definite and not open to doubt, although frequently enough I have
seen fibres and threads of various kinds apparently come in contact with
salivary cells. Further, regarding the drawings and descriptions of
Pflüger, I must confess, having at the same time nothing but the highest
esteem of this investigator, as well as of the care and accuracy he
employed in this question, that these do not seem altogether convincing
to me.”


                           MEMBRANA PROPRIA.

I find that the gland cells are enclosed by a membrane (agreeing
altogether with Pflüger) which I look upon as decidedly homogeneous
(histologically speaking, of course), not showing any structure; by no
means being merely a reticulum of connective tissue corpuscles, as
Kölliker suggests.

Further: This membrane is provided with nuclei of an oval form
(generally), reminding me of the nuclei supplying the nerve sheaths.

Finally: This membrana propria sends out from the alveolar walls,
processes, ensheathing—how complete I cannot say—the gland cells. I
cannot otherwise explain the glistening lines, which we see in examining
sections VI extending from the alveolar wall between the cells,
resembling altogether the sections of the alveolar walls. To investigate
this matter more accurately, I have stained sections with carmine, also
with log-wood, and have found that the alveolar wall and these lines
stain the same way. Further breaking up such a section by manipulation
with cover-glass, one can obtain fragments of these processes, thus
demonstrating that these lines are not merely optical illusions.

The nuclei of this membrana propria are situated on its inner surface
and could be distinguished in the gland of the cat, mentioned above, not
only by their more oval, oblong or elliptical form, from the more
roundish nuclei of the gland cells, but just as plainly by the lighter
red or pinkish staining which they take on the nuclei of the gland cells
being stained a deeper red.

Compressing very small fragments of gland-substance (always of course in
glycerine), by means of the cover-glass, beating and pushing it from
side to side, thus bursting the alveolus and tearing the membrane and
isolating it from the contained gland cells, one can prepare for
examination greater or smaller pieces of this membrane. There are by
such means obtainable fragments with all sorts of processes and fringes,
short and long, many and few, which undoubtedly may remind one of
“connective tissue cells.” (See fig. 4.) More convincing than these are
membraneous pieces, which may be obtained of various sizes. (See figs.
5, 6.) I have a drawing of such a fragment, which, if enlarged as figs.
1 and 2, would cover over one-quarter of the page, and to which a number
of nuclei, more than six, are attached. As a rule, this membrane will,
by the manipulations with the cover-glass, not be spread out, but rather
folded up, huddled together inclosing some of the gland cells, forming
an indescribable nest.

I do not know if it will be necessary to mention in this connection that
I consider these nuclei identical with the half-moon cells of Gianuzzi,
and cannot help expressing my surprise at the physiological importance
assigned to them; for they have been considered playing the role of
mother cells, giving origin to glandular epithelium formed to take the
place of cells used up in the process of secretion. The dark staining,
which in section they seem to assume as well as the semilunar form, will
be discussed later. Of course I look upon these nuclei as belonging to
flat epithelial cells, as we find them lining nerve sheaths, and serous
membranes, and consider them of the same physiological importance as the
nuclei of such endothelial cells. A similar ensheathing membrane, or
membrana propria, I find in the ducts; but here I have not been able to
distinguish processes passing in between the cells. If present they must
be exceedingly delicate, for it is not difficult to press out groups of
cells from the ducts so that empty pieces (short ones of course) of such
can be examined.

While the membrana propria of the ducts can be separated rather easily
from the inclosed cells, it is different from the surrounding network of
capillaries. It seems impossible to remove the capillaries from the
duct-walls; while, in the gland-structure proper, among the alveoli, the
separation of the capillary from an alveolus, can with little difficulty
often be accomplished, so that a piece of capillary can be examined
without any other structures lying above or beneath it.


                             BLOODVESSELS.

It was somewhat surprising to me, and not a little interesting, to find
that the ducts have a decidedly richer blood supply than the gland
substance proper, the meshes of the capillaries covering the ducts very
closely indeed.

I will also call attention to the fact that, along the terminal portions
of the ducts, no arteries or veins can be seen; and what is still more
important, no free nerve-fibres can be discovered. Following the ducts
outwards, as these attain larger dimensions, and especially where they
give off side branches, we find arteries and veins accompanying them,
and there will also be found along-side of them fine nerve-branches. So
much is certain, that in that region, where arteries and veins are not
to be seen, there are also no separate nerve twigs, and that here the
union or coalescence of nerve and tissue which the nerves are to
influence must have taken place. If one considers the fine meshes of the
capillary network enveloping the ducts, and keeps in mind the abundance
of nuclei belonging to the capillary, the membrana propria and the duct
cells proper, he can imagine how difficult it must be to follow the
course of the nerves through and among all these structures. That it has
been impossible for me to separate capillary and membrana propria, has
been mentioned.


                                NERVES.

If one were to ask the physiologist: What do you expect us to find in
our anatomical investigations on the nerve-endings in the submaxillary
gland, he would undoubtedly answer: “You will find an arrangement
analogous, if not similar, to that in the striped muscle; the
nerve-fibre will be seen to approach the alveolus, penetrate its
covering, and the protoplasm of the nerve and the gland-cell will be
found to come in contact, if not to coalesce.” And that is what has been
found by Pflüger.

It has been my endeavor for some time to find something similar to the
descriptions of Pflüger, but so far in vain, although many an alveolus
has been carefully examined, flattened out and slowly crushed, so that
each nucleus could be diagnosed, but never have I found anything which
would remind me of the drawings by Pflüger in Stricker’s ‘Histological
Handbook.’

In this matter I reasoned thus: If there are any such structures as
specialized nerve-endings present in the glandular elements, we might
look for an analogy either to the striped muscle fibres or to the
capillaries, in both of which nerve-endings are known to be present. In
the former case we have the so-called end-plate—the nerve fibre ends in
a multi-nucleated mass—but as the muscle fibre, standing for a number of
cells, is so different a structure from the gland-cells, we might, with
greater probability, expect some such arrangement as we see on the
capillaries. Here we see fine fibrils, provided with nuclei, exceeding
the fibres two to four times in thickness, entwining the capillary, thus
coming in contact with each of the cells composing the capillary wall.
In the (submaxillary) gland there are similar structures to be
influenced; at least in the capillary as well as in the gland, we have
cells lying side by side to be influenced by nerves—hence we might
expect similar structures.

Although the books in general have very little to say about the nerve
supply of the capillaries, yet it is a fact, and can well be
demonstrated, _e. g._, in the frog’s muscle, that such is the
arrangement. As a rule, the fibril cannot so readily be detected, but
the nuclei belonging to it are not difficult to recognize. A still more
convenient and instructive locality is the base of the frog’s mouth,
where everything is one plane, and where the nerve fibres can be
followed to their ultimate ramifications.

Let us now see what evidence of nerve-endings we find in or on the
alveoli of the gland, examining one, or more accurately, a part of one
(the round eminence). We shall see what fig. 1 presents. We see there
two sets of nuclei; one kind oval, longish, stained lighter than the
rest, of a pink hue (fig. 1, _m_), and these a further examination will
demonstrate to be the nuclei belonging to the membrana propria, which
have also been described before. Besides these nuclei, fewer in number,
there is another kind, making up the bulk of the nuclei, more rounded in
form (fig. 1, _g_), and of a deep-red color, which, in their turn, will
prove to be the nuclei of the gland-cells; and these two are the only
elements or structures that I have been able to demonstrate in a
glandular alveolus.

At one time I thought I had found in or on the alveoli the evidence of a
network of fine nerves. Quite frequently one can observe longish, even
spindle-shaped, often deeply stained, nuclei, which resemble very much
those belonging to the fine nerve fibres. (Fig. 2, _n_, such nuclei are
figured.) But so far, whenever I examined such a spindle-shaped nucleus
more carefully, I found that it proved to be one of the nuclei belonging
to the membrana propria, already described, and the form, as well as its
dark color, was due to the fact that it had been examined edgewise. If,
by manipulation, such a nucleus was turned over and compressed to
present a flat surface, it would have an oval outline and be of a
light-red color. Fig. 3 (_a_, _b_, _c_), shows the same nucleus as it
appeared when seen edgewise, when seen from the flat and when seen in a
position midway between these. Thus is also to be explained the
demilune: If the section would strike a nucleus so that it would be seen
only edgewise—especially if the membrana propria has a chance to roll up
slightly—we should then have a deeply stained body, somewhat
half-moon-shaped, the demilunes of the books.

So far, nothing but the nuclei have been mentioned, and the observation
might very appropriately be made, that there might exist some
exceedingly fine and delicate nerve fibrils without nuclei. Such a
system of structures would, of course, be almost impossible to
demonstrate with any degree of certainty. I have not, of course,
sufficient reason to deny such an arrangement, and would not consider it
improbable if we had not, in the capillaries of the frog’s muscle (and
other structures) evidence certainly not in favor of such an assumption.
The fine nerve fibrils supplying the capillaries are richly supplied
with nuclei, although the cells which build up the walls of the
capillary are by far more insignificant elements than the secreting
cells of the gland. Certain it is that as yet there is no evidence of
the existence of such fine non-nucleated fibrils, arranged either in the
form of a network or a bundle of fine branches.

The examination of the alveoli not leading to any results as to
nerve-endings—no structures being discovered there that might be called
nervous—I attacked the problem from the other side. I took up the nerve
trunks accompanying the ducts, and tried how far I could follow their
divisions and branches, and can say that I have spent a great deal of
time on this point. In speakings of the bloodvessels, the fact was
mentioned that, where arteries and veins of any size run along-side of
the duct, these are accompanied by nerve branches, _i. e._, bundles of
nerve fibres, inclosed in a sheath, and these—at least in the cat, the
calf and the ox—are made up (excepting, possibly, the very large trunks)
of fine nerve fibres. Thicker or medullary nerves I have not been able
to discover, even in branches of considerable size, consisting of, say
six or eight fibres, and giving off smaller twigs containing one to
three fibres. Fig. 7 shows such a nerve-trunk with side branches;
neither in the main stem nor in the offshoots are there any medullary
nerves discoverable.

If this observation is correct, we see that what has to be traced
further, is not the more easily recognized medullary fibre, but
exceedingly fine fibrils carrying in certain intervals nuclei, the only
distinguishing feature. It will be admitted also (first) that it must be
a matter of considerable difficulty to follow such indifferent looking
structures, as delicate fibres. And (secondly), one cannot expect to
find medullary nerves approach the alveoli, penetrate the membrane, come
in connection with the secretory cells, etc., etc, as has been done by
Pflüger. If the question should be asked how far I have been able to
follow these nerves, I should say: Small twigs consisting of one to
three fine fibrils, enclosed in a sheath branch off from a trunk, not
much larger, and apply themselves to the membrana propria of the duct;
their sheaths in all probability coalescing with that membrane. Here
they have been seen to apply themselves to some bloodvessel and are now
lost out of sight, being hid by all the many structures mentioned above,
the nuclei of membrane, capillary, duct cells, and the fibre cannot so
readily be distinguished from the membrana propria of the duct upon
which it rests. But I do not wish to be understood that because the
nerves have been lost out of sight, along-side of vessels, that they
have their “ending” there, inasmuch as the network of bloodvessels is
such a close one that the nerves cannot but help coming in contact with
them. Fig. 8 shows such a fine nerve-trunk. By the aid of aniline blue
the fine fibrils have been made quite plain. Such fine fibrils can by
the same means be demonstrated in much larger trunks, as shown in fig.
7, and it can be shown that even such large trunks consist of nothing
but these fine fibrils.

I have also seen, exceptionally however, fine nerve twigs run into the
alveoli directly, but the nerves here were of the same nature as the
ones described going to the duct. Fig. 9 shows a fine fibril passing on
to an alveolus and running probably on to a vessel; the nerve fibre
resting upon gland cells, also stained, could not with absolute
certainty be traced to the vessel. There is a small break shown in the
drawing.

As intimated, especially if the cells of the duct are still _in situ_,
it is impossible to follow the fine nerve-fibres any further. By
pressing out the cells from the ducts, one can obtain portion of the
duct, with the capillaries belonging to them, but they are short pieces,
and the nerve fibril is not easily discoverable.

But there remains one fact to be mentioned, which may throw light on the
question, as to how the nerves end and which in my opinion might and
does clear up the difficulty.

Examining the capillaries supplying the gland alveoli, one is able to
find nuclei, not belonging to the capillaries themselves. This statement
can be made for two reasons. In the first place, the majority of these
nuclei have not the form of the nuclei of the capillary, and in the
second place these nuclei are situated on the outside of the capillary
wall. Whoever has examined the capillaries of the frog’s muscle knows
that just such or the same nuclei belong to nerve-fibres, supplying the
capillary wall. In the mammal of course these nuclei are smaller and not
so conspicuous, nor can we procure pieces of capilliary of any length
(the structures under examination here, not being in one plane.) Thus we
cannot expect to have matters so plain here and easy of demonstration.
After finding these nuclei, it was of course my desire to find if they
were united by fibres. It must in this matter be kept in mind, that if
there are such fibres present to which these nuclei belong, these may be
expected to be in the most intimate relation with the capilliary wall,
if one is to influence the other—and therefore not of ready and easy
demonstration.

I have, however, succeeded in showing in a number of instances that such
fibres exist. Figs. 10 and 11 show such a fibre uniting several nuclei.
The shortness of these fragments makes a more perfect demonstration
almost impossible.

If this observation is correct, we find on the capillaries the same
(only finer) fibres provided with nuclei, which we have lost out of
sight following the branching out of the nerves.

There is also some evidence of fine fibres in the membrana propria of
the ducts, inasmuch as we find here nuclei along-side of the
capillaries, these not being the nuclei of the membrane, but resembling
altogether the nuclei of the nerve fibres.

Again, as stated above, I have not been able to find any such evidence
of nerves in connection with the gland cells themselves. In case,
however, such an arrangement or something similar existed, why should it
have been impossible for me to find evidences of such as well here on
the gland cells as on the capillaries; and should they not be more
readily found in the gland than in the capillary, inasmuch as we have
larger structures to deal with here in the gland.

The conclusion then regarding the nerve-endings to which my work has led
me are these:

There were no special nerve-endings found in connection with the gland
cells themselves. _We find, however, upon the capillaries evidence of
the same kind of fine nucleated fibrils, which we find to be present in
the fine nerve twigs_, as far as we can follow them in their course
towards their final distribution. To explain the action of nerves on the
process of secretion we would have to assume either that the nerves
accompanying the capillaries also influence the gland cells, or that the
glands are stimulated to activity by some changes in the condition of
the capillary wall furnishing a greater amount of oxygen and nutritive
fluids.

The results are partly negative, partly positive. The latter I wish to
emphasize, believing it worthy of attention, as it may throw light on
the physiology of the capillary wall, which seems to be altogether too
much neglected. The negative I have offered, knowing well enough that
such negative results must be accepted as final with much hesitation.

To any one feeling inclined to undertake investigation on this gland, I
would make a few suggestions:

    (1) Make sections through gland hardened in bichromate of potash,
    or alcohol, and stain with staining fluids.

    (2) Compare in material prepared as above described, the vascular
    supply of duct and gland substance proper.

    (3) Compare gland and duct cells.

    (4) Find the nuclei of the membrana propria and compare the same
    with the nuclei of the gland cells.

    (5) See if you can examine the same nucleus from different sides.
    Do you think that the demilune of books and the nucleus of the
    membrana propria might be the same thing?

    (6) Prepare pieces of the membrana propria covering the alveoli.
    What is your opinion—is there a membrane or only a reticulum of
    connective tissue cells?

    (7) Prepare pieces of membrana propria of duct.

    (8) Can you find the nuclei of the duct, and other nuclei on the
    exterior of the capillaries?

    (9) Can you find pieces of capillaries belonging to the alveoli,
    and do you find any nuclei on them?

    (10) Examine the wall of the duct in injected and uninjected
    material, both stained.

    (11) Follow the bloodvessels—can you find nerves on the walls of
    arteries?

    (12) Of what structure do you find the root of a little lobule to
    consist?

    (13) How do the nerve trunks differ from the fibrous envelope
    holding together all these structures?

    (14) Differentiate between the nuclei of the nerve fibres and the
    nuclei of the nerve sheath.

    (15) Examine nerve branches of various thicknesses—what do you
    find the nature of the nerve fibres to be? Do not forget the
    aniline blue and try other staining fluids.

    (16) Can you find evidence in the alveoli of other structures
    besides capillary, membrana propria and salivary cells?

    (17) How far have you succeeded in following the fine nerve twigs?

    (18) By all means try different methods, different tissue, and
    compare the results. See what you can discover by simply teasing
    material treated with Muller’s fluid, and other stained and
    treated as I have described.

    (19) Follow the course of the arteries, and note where the larger
    vessels pass into the capillaries.


                         A HISTORY OF MEDICINE.

                        BY JOHN BENNITT, M. D.,

    Professor of Principles and Practice of Medicine in the Medical
     Department of the Western Reserve University, Cleveland, Ohio.

                      [_Continued from page 103._]

But the contributions to medicine of all his predecessors dwarf into
insignificance when compared to those of Galen—who lived and wrote in
the middle of the second century—and whose writings were ultimate
authority, until they were attacked and publicly burned in the 16th
century by the arch-quack Paracelsus. Galen, although born in Pergamus,
in Mysia and living there, was called by the Emperors M. Aurelius, and
L. Verus to attend them in the northeastern frontier of Italy, and was
for a considerable period of time physician to the emperor, spending a
considerable portion of the last half of his life at Rome. He died in
Sicily in 201 aet 71 (?) There are ascribed to him 83 treatises on
medicine about which there is no question as to their genuineness, 19
that are questionable, 45 undoubtedly spurious, 19 fragments, 15
commentaries on Hippocrates’ works. Besides these, he wrote a great
number of works (not all on medicine) whose titles only are preserved,
so that altogether it is believed that the number of distinct treatises
cannot have been less than 500. These were, on (1) Anatomy and
Physiology, (2) Dietetics and Hygiene, (3) Pathology, (4) Semiology and
Diagnosis, (5) Materia Medica and Pharmacy, (6) Therapeutics including
Surgery, (7) Commentaries on Hippocrates, (8) Philosophical and
Miscellaneous. Most of these works are still extant in Greek (in which
they were originally written). They have been translated into many
modern languages. His works on anatomy and physiology are most valuable.
But it is not certain that he ever dissected human bodies. His knowledge
he derived from dissecting apes, bears, goats, etc., and his knowledge
of physiology from experiments on these animals. His pathology was
speculative.

In diagnosis and prognosis he laid great stress upon the pulse, on which
subject he may be considered as the first and greatest authority, for
subsequent writers adopted his system without alteration. He placed
great confidence in the doctrine of “critical days,” which he believed
to be influenced by the moon.

In materia medica he was not considered as good authority as
Dioscorides. He was prone to making prescriptions containing many
ingredients, some of which were entirely _inert_. He seems to have
placed more faith in amulets than in medicine, and is supposed to be the
author of the anodyne necklace, which was for a long time famous in
England. He was an allopathist in his notions, _i. e._, he believed that
disease is something contrary to nature, and is to be overcome by that
which is contrary to the disease itself. At the same time he taught that
nature is to be preserved by that which has relations to nature, in
accord. Hence his two indications, “Overcome Disease,” “Sustain Nature.”

Before this time, as already intimated, the medical profession was
divided into several sects, who were always disputing with one another.
After him, all these sects seem to have merged into his followers. The
subsequent Greek and Roman medical writers were compilers from his
writings, and being translated into Arabic, Galen’s works became
authority in the East as well as in Europe, and continued to be so for
fourteen hundred years. In 1559, Dr. Geynes was cited before the college
of physicians for impugning the infallibility of Galen. On his
acknowledgment of his error and humble recantation, signed with his own
hand, he was received into the college.

The great mass of Galen’s _works_, together with modern improvements and
researches, have now in great measure consigned them to neglect, but his
_fame_ can only perish with the science itself. As in the case of
Hippocrates, his immeasurable superiority over his contemporaries seems
to have acted as a check to all attempts at further improvement.

The first names of any renown that occur subsequent to Galen are those
of Oribasius, Alexander of Tralles, Ætius and Paulus Egineta, who
flourished between the fourth and seventh centuries. They were all
jealous Galenists, and those of their writings which are still extant
are, for the most part, compilations from the predecessors, especially
from their great master, Galen.

The writings of Paulus seem to be the last of any written in the Greek
language, which had been the language of medical science for more than a
thousand years. At about this time the Arabian school was beginning to
rise into notice. The earliest Arabian writers on medicine of whom we
have any notice or certain account, is Ahrum, who was contemporary with
Paulus. The most celebrated physicians of this school were Rhazes, (who
flourished in the ninth century, and was the first to describe
small-pox) and Avicenna who flourished early in the eleventh century,
and whose ‘Canon Medicina’ may be regarded as a cyclopaedia of all that
was known of medicine at that time (as well as collateral sciences).
This was a compilation from Greek writers, whose writings had been
translated into Arabic, (for Avicenna was not a Greek scholar himself).
Avenzoar, and Averrhoes flourished in the twelfth century. The last was
a celebrated philosopher as well as physician. The works of Hippocrates
and Galen, which, together with the works of Aristotle, Plato and
Euclid, were translated into Arabic in the ninth century, formed the
basis of their medical knowledge; but the Arabian physicians did good
service to medicine, introducing new articles from the East into
European materia medica, as for example, rhubarb, cassia, senna,
camphor, and in making known what may be termed the first elements of
pharmaceutical chemistry, such as a knowledge of distillation, and of
the means of obtaining various metallic oxides and salts.

Upon the decline of the Saracenic universities in Spain, which was about
the time of the death of Averrhoes, the only medical knowledge that
remained was to be found in Italy, where the School of Salerno acquired
considerable celebrity, which it maintained for some time, till it was
gradually eclipsed by the rising fame of other medical schools at
Bologna—where Mondino or Mundinus de Leozza publicly dissected two human
bodies in 1315.

Contemporary with Mondini, lived Gilbert, the first English writer on
medicine who acquired any repute; and the next century gave birth to
Linacre, who after studying at Oxford spent a considerable time at
Bologna, Florence, Rome, Venice and Padua, and subsequently became the
founder of the London College of Physicians. It was in this fifteenth
century that the sect of chemical physicians arose, who claimed that all
the phenomena of the living body could be explained by the same chemical
laws as those that rule inorganic matters. Although the illustrations
and proofs which they adduced were completely unsatisfactory, yet the
tendency at the present time is in the same direction, since chemistry
and physiology are better known.

This seems to be a period prolific of new diseases. In the thirteenth,
fourteenth and fifteenth centuries we hear most of leprosy, and of the
visitation of the plague in Europe. Whooping-cough and scurvy were never
described by any writer anterior to the fifteenth century. Syphilis was
first recognized in Italy in the fifteenth century, from which country
it spread rapidly over the whole of Europe.

In the sixteenth century the study of human anatomy may be said to have
been fairly established by the zeal and labors of Vesalius, and in this
and the succeeding centuries we meet with the names of many physicians
whose anatomical and physiological investigations tended either directly
or indirectly to advance the science of medicine. This was the epoch of
Eustachius, Fallopius, Asellius, Harvey, Rudbeck, Bartholini, Malpighi,
Glisson, Sylvius, Willis, Bellini, etc., names preserved in anatomy.

Chemistry was now being separated from alchemy, and advancing to a
science, and a combination formed between its principles and those of
physiology, which gave rise to a new sect of chemical physicians, quite
distinct from the sect represented two centuries before by Paracelsus.
The chemical school was succeeded by the mathematical school, of which
Borelli, Sauvages, Heill, Jurin, Mead and Freind were amongst the most
celebrated. While at the same time the old Galenists were fast
disappearing. To the rival sects of this period must be added the
Vitalists, which originated with Von Helmont, and with some
modifications was adopted by Stahl and Hoffman. The greatest physician
of the seventeenth century was, however, Sydenham, who, though inclining
to the chemical school, did not allow his speculative opinions regarding
the nature of disease to interfere with a careful consideration of the
indications for treatment, as derived from the symptoms, and from
experience.

Boerhaave, a Dutch physician and philosopher, occupied special
prominence in last part of the seventeenth and the early part of the
eighteenth centuries. He engaged in the practice of medicine at Leyden
in 1693, and became professor of theory and practice of medicine in the
university of that city in 1701. He was erudite, exact, simple and
eloquent, and hence as a lecturer very popular. He specially advocated
simplicity in practice of medicine. Professor of botany was added to his
duties in 1709. He wrote a treatise in 1703 (in Latin) advocating
mechanical and chemical hypotheses in medicine. In 1708 his institutes
of medicine extended his reputation; and in 1709 appeared his famous
‘Aphorisms’ on the diagnosis and cure of disease. In this was a well
defined classification of diseases, including their causes, nature and
treatment, which was adopted by his contemporaries. He was distinguished
as a botanist and chemist. He published a description of plants at
Leyden in 1710, and became professor of chemistry in 1718 in addition to
his other duties. He made chemistry popular by presenting it in a clear
and attractive style, in his lectures and in his ‘Elements of Chemistry’
(1724).

On account of his attack of gout he was constrained to give up the
teaching of botany and chemistry in 1727. He was elected a Fellow of the
Royal Society of London in 1730. His fame extended over the world. A
Chinese mandarin hearing of his fame addressed a letter to Boerhaave,
physician in Europe, which reached him in due time. His practice was
lucrative, and he spent money freely in the interest of science and
benevolence, yet such was his success that it is said that at his death
(in 1738) he left an estate of nearly a million dollars.

Cullen, who was born in 1710 and died in 1790, was undoubtedly the
greatest medical man of his age. It is especially interesting to read
the biographies of such men as Cullen and of Hunter his contemporary,
and of Jenner of the last half of the eighteenth century, and of John
Brown the quack—though much quoted.

The present century may be considered as the epoch of physiological
experiment and clinical observation. The efficient laborers of the last
eighty years in the field of medicine have been so numerous that it
would be impossible to notice at this time even those deemed most
celebrated, while it would be invidious to attempt such a selection.

In this time our materia medica has received a large number of most
important additions, amongst which may be noticed, morphia, quinia,
strychnia, iodine and the iodides, bromides, cyanohydric acid, cod-liver
oil, chloroform, chloral, nitrite, amyl and a long list of preparations
from the vegetable kingdom and from the hydrocarbon series.

The physical diagnosis of disease has been facilitated to an extent far
beyond what the most sanguine physician of the last century could have
deemed possible, by the discovery and practical application of the
stethoscope, the pleximeter, the speculum in various forms, the
ophthalmoscope, the laryngoscope and the thermometer; while chemistry
and the microscopy have been applied successfully to the investigation
of the various excretions, and especially of the urine, bile, and in the
study of digestion where the process could be observed in its various
stages in the person of Alexis St. Martin.

But the field for the medical historian broadens immensely and can best
be appreciated by study of a catalogue of medical books and periodicals
of the present century.


                     CASE OF HYSTERICAL BLINDNESS.

                         BY D. B. SMITH, M. D.

 Professor of Diseases of the Eye and Ear in the Medical Department of
                                Western
                          Reserve University.

On the fourth day of June I was called to see Miss C. R., aged nineteen
years, a clerk, who told me that she had gone to bed the night before
perfectly well, and that when she awoke in the morning she found herself
totally blind, and had remained so up to the time of my visit, about
eleven o’clock. This blindness she said had come on without the least
pain or bad feeling, and the eyes were not in the least degree
uncomfortable, nor had they been during the morning. No cause on the
part of the patient could be assigned for the attack, and nothing of the
kind had ever happened to any member of the family before. The external
examination gave not the slightest evidence of any disease of the
eyeballs or lids. The conjunctiva was perfectly normal, as were also the
cornea iris and pupil. The ophthalmoscope revealed a perfectly healthy
retina and optic nerve and clear media. The tension of the eyeball was
normal. There was not the least constitutional disturbance, if we except
a marked nervousness caused by the fear that she would be permanently
blind. The patient declared most positively that she could not see the
lamp even when held close to the eyes. From the fact that the pupils
were perfectly normal and moveable under the influence of light, and
that the patient put out her hand to shake hands with me in a way that I
felt she could not do if she did not see, I diagnosed a case of
hysterical blindness. It was more than a simulated blindness, for all
the anxiety and mental distress of actual blindness were present; and I
am satisfied the patient was honest in her belief that she could not
see. The ordinary remedies for hysteria were given and were taken
faithfully and regularly, and although for several days she took large
doses of the bromide, valerianate of ammonia, hyoscyamus, assafœtida,
and kindred drugs, there was not the slightest improvement in her
vision. These remedies were continued from the fourth to the fourteenth
without any perceptible effect. After ten days I began to give her
tonics instead, and although she took the elixir cinchona with dilute
hydrochloric acid, tincture of nux vomica, quinine, iron oxid of zinc,
and finally stimulants, there was no improvement and the patient said
she remained in total darkness. This tonic course was continued up to
the twenty-ninth, and had been followed out thoroughly for two full
weeks without effect.

During the nearly four weeks treatment the patient said that when the
eyes were shut she could discern the position of the lighted lamp, but
when the eyes were open she could not see the lamp or the slightest
object, or even tell daylight from darkness. At various intervals during
this time her pastor visited her and offered her his most heartfelt
sympathy. Her friends were becoming exceedingly anxious least the sight
would never return, although I could assure them that there was not the
least danger of permanent blindness. I became satisfied at this time
that medication was not going to dispel this peculiar attack of hysteria
and that it would need something besides medicine to produce such an
impression upon her mind that she could overcome it, so I told her that
I was going to do something the next day that would surely make her see
before night, and that she should be of good cheer for her sight would
return very soon. The next morning I went down about nine o’clock armed
with my ophthalmoscope, my case of trial glasses and my Hearteloup’s
artificial leech. The patient seemed to be quite confident that she
would soon see, and was very hopeful as to the result of what was to be
done. I looked into the eyes with my ophthalmoscope, and then applied
the cylinder of the artificial leech to the temples without scarifying
and used considerable traction, first on one side and then on the other,
having previously told her not to open the eyes until I told her to do
so. In about half an hour I told her to open the eyes gradually so as
not to let the light in too suddenly and then tell me what she could
see. The instant she opened them she said I can see the light and the
position of the window. I then told her to close the eyes again and I
reapplied the cylinder and commenced the suction as before. By this time
the temples had become red and so sensitive that she now complained of
some pain when the cylinder was reapplied. After twenty minutes she was
told to open the eyes again and she said she could see objects about the
room distinctly. She was then tried with large letters but she said she
could not see to read them, but could see the black objects. Told her
glasses would help her and placed a No. 72 convex spherical glass before
the eyes when she could see Jaeger No. 20, then told her she needed
other glasses and replaced the No. 72. She now saw to read No. 16. I
continued taking off and putting on this same No. 72, with good effect
and whenever she came to a standstill in reading reapplied the cylinder
with uniform benefit until finally after two hours constant work she
could read Jaeger No. 1. During all this day she was able to see
distinctly. The next day she was again unable to read but a short
repetition of the same course brought her vision back again. There was
no return of the blindness after that except occasionally for a short
time at intervals of two or three days.

In the course of ten days all trace of the difficulty had passed by and
since has never returned. This case was diagnosed as one of genuine
hysteria and not one of simulating blindness or malingering, and is
reported as the most marked case I have ever had illustrating the effect
of hokus pokusing (to call it by a mild name) which produced such a
strong mental impression that the patient lost sight of her own peculiar
mental condition, and by which a perfect cure was effected.

To her the blindness was real, and her friends feel that a remarkable
cure has been performed. Such a blindness can occur in any nervous
hysterical patient, while simulated blindness usually occurs in those
who wish to avoid service in the army or navy, or in the case of lazy
young people who do not wish to study at school or college, and in those
who have received a slight injury and wish to make it appear more
serious for the sake of obtaining large damages, either from private
individuals or corporations.

For its detection there are several methods which are usually sufficient
to give us positive proof that the blindness is not real. Von Graefe
placed a number eight or ten prism in front of the eye, with the base
upwards, downwards or sidewise, and if strabismus is present before the
removal of the prism there is binocular vision.

Juler places spectacles with an opaque glass in front of the good eye,
when, if the patient can read, he must see with both eyes; or he places
concave 20 before the good eye, when if the patient can read fine print
he must see it with the other eye.

Juval places a ruler before the eye so as to cover part of the page to
be read, when, if one eye is blind, not all the page can be read.

Mittendorf puts atropine in the good eye, when if the patient can read
fine print he is not blind with the other eye.

Wells places a prism in front of the supposed blind eye, and notices
whether the apis of vision of that eye changes when the prism is
removed.

Bull bandages the good eye and places a prism in front of the other eye,
and holds a lighted candle before the eye, and if the eye turns as the
prism is turned, the eye is not blind.

The test with Snellens or other colored letters is also a good one. A
word with alternate red and bluish green letters is painted on glass and
placed in the window, and the patient is asked to read the letters. If a
bluish green glass is held in front of the good eye, he will see only
the green letters unless he can see with the other eye, for all but the
red rays in the red letters are cut off in the transparency in the
window, and the green glass cuts the red off, leaving those letters a
perfect blank to the well eye.

Kugel places various colored glasses before each eye and then places an
opaque glass in front of the sound eye, and a transparent glass of the
same color before the other one, and if the patient sees the object, he
is simulating blindness.

Herring has the patient look through a tube large enough to cover both
eyes, and then suspends a small ball in front of the tube and drops
small objects near this ball, and if the patient can tell whether the
balls are dropped in front of or behind the suspended ball, he must see
with both eyes.

Lawrence recommends the stereoscope for detecting binocular vision, and
places in a covered stereoscope a picture each side of which is
different, and yet such as to make a single picture when both sides are
seen. A clock dial, for example, with figures in one side only or
figures with complemental colors, such that with both eyes the object
would appear differently colored from what it would when seen with
either eye separately. The distance apart of two objects held up in
front of both eyes can be readily told by the patient if he sees with
both eyes, no matter how the objects are held with relation to each
other. But if there is vision with one eye only, the patient can tell
the distant apart with accuracy only when the objects are both held at
the same distance from the eye, but not when one is held considerably in
front of the other.

One who sees with one eye only always thinks he is nearer to the object
than he really is when reaching out for that object. It is always more
difficult for him to pour from a pitcher into a cup or glass if held a
little distance below it, hence the blind in one eye usually place the
nose of the pitcher in contact with the glass before pouring. The old
parlor trick of placing two pins in the wall and putting a cent on them
and directing the patient to stand across the room and then walk over to
the cent and knock it off with the outstretched finger without hitting
the pins, may be made use of as a test in simulated blindness, for with
one eye the patient always falls short of the mark the first time the
experiment is tried. The most simple method of detecting simulated
blindness in one eye is by noticing the movement of the pupil under the
influence of light. If an eye is blind, the light has little or no
effect upon it when the other eye is closed. The pupil is usually
dilated. It may be well to mention here that atropine dilatation is
generally wider than that due to amaurosis, and also that a cone of
light from a strong convex glass thrown upon the sound eye will contract
the pupil of the blind eye if the dilatation is not due to atropine.
Simulated blindness in both eyes is not likely to be seen, and then the
condition of the pupil is of great value in detecting it, and is one of
the best guides in connection with the ophthalmoscopic observation.


                  A CASE OF DOUBLE UTERUS AND VAGINA.

                 BY S. W. KELLEY, M. D., CLEVELAND, O.

Miss H. E., aged 20, American of Irish parentage: dark brunette, short
in stature but apparently quite handsomely formed, and ruddy with
health. She has never been sick in her life. Has menstruated normally
since her fifteenth year, though scantily during the past year. She
feared she had been injured a few days previously by the overturning of
a chair upon which she was standing, as she had since felt pain and
uneasiness in the lower pelvic and pubic region, for which she sought
advice.

Upon examination I found no injury worthy of record, but the
malformation here described. Cases of this anomaly have been recorded
from time to time, being always of interest to the teratologist,
occasionally requiring attention on account of interference with the
marital relation or parturition, and being referred to in every
discussion on superfœtation.

The external genitalia are well developed. No hymen, nor any remains of
one. I have no reason to doubt her virginity. An inch within the
introitus vaginæ the finger met a narrowing into which only its tip
would pass. Searching to the left another smaller opening was
discovered, the two being separated by a strong membrane. Returning to
the right or larger passage, was able by careful dilatation for ten or
fifteen minutes to insert three-fourths of the length of the index
finger and encounter another narrowing, which being patiently overcome,
the first joint of the finger found more room and examined uterine
cervix and the external os, which is linear antero posteriorly. The neck
projects about half an inch into the vagina. The lips are thin, of
normal density. Withdrawing the finger and finding the smaller opening,
could succeed in penetrating only about an inch. Observed a third,
smallest opening in the left vaginal wall, between the ostium vaginæ and
the second opening described.

[Illustration]

The patient would consent to no interference that could possibly cause
even temporary disability for daily housework and care of an invalid
mother, but agreed to return daily for a few days. After dilating
without anæsthesia fifteen to twenty minutes daily for four days, could
pass two fingers or a Fergusson speculum one and one-eighth inches into
the right passage, and could pass one finger readily, or speculum
seven-eighths of an inch in diameter into the left passage. The septum
between the two passages is placed antero posteriorly. It is about an
eighth of an inch thick, and has the appearance of any other portion of
the vaginal wall. It begins an inch within the introitus, and extends to
the uterus, making a right and left vagina of normal length. The third,
smallest passage, admits a sound and extends upward an inch in the left
lateral vaginal wall and ends in a blind extremity.

The right vagina discloses an uterine os three-eighths inch in length
antero posteriorly, the anterior end of the slit inclined toward the
median line. The sound passes readily a distance of one and
three-eighths inches, entering in a direction upward and inward half
that length, and then turning upward and outward. The sound moves freely
in the cavity, and the lining membrane evidently contains folds.
Secretion of the cervix free.

On the left side the os uteri is smaller, the opening not exceeding a
quarter inch, the length being laterally. The lips are in a pouting
shape, the anterior, especially, having quite a fold above it. The sound
enters freely nearly an inch in a direction upward, outward and slightly
backward; lining membrane apparently folded. Very little secretion. By
introducing two fingers of the left hand, palm upward, the index into
the right vagina and the second finger into the left, the two uterine
mouths can be examined simultaneously, and this gives a very vivid
impression of the condition. As to the shape of the whole uterus very
little can be determined by bimanual examination, the vaginal walls
being so tense and abdominal thick. By the rectum the uterus can be felt
flat and wide, but no bi-lobing is apparent.

The young lady could not be persuaded to permit an examination during
menstruation to determine whether the flow took place on both sides.


     MEDICAL SOCIETIES—THEIR BENEFITS TO US AND OUR DUTIES TO THEM.

   BY DR. WILLIAM FORSTER, RETIRING PRESIDENT VENANGO COUNTY MEDICAL
                         SOCIETY, PENNSYLVANIA.

Though at best societies in their present form are not very old, medical
associations, differing somewhat in their organization and aim, are as
old as the science of medicine itself. Even in the fabulous ages it had
its heroes, and some rose to the height of deification. In earlier ages
those who practiced medicine were looked upon as inspired. They, in
addition to belonging to a profession, constituted a class or caste. In
some Asiatic nations, and among some of our Indian tribes, it is very
much the same at present.

One must belong to the caste, or be able to trace his descent from it,
as a necessary qualification to practice medicine.

This is the earliest form of a medical society, and though it may not
possess many progressive elements, it has elements of strength.

What few investigations it did make, it kept. Its peculiar organization
and position fitted it for being a good conservator; and when the star
of empire took its western course, the tide of medical knowledge stored
up and held sacred and secret in Asia, Egypt and Greece, flowed out and
was diffused over five continents.

Hippocrates, about twenty-five hundred years ago, took the light from
under a bushel. About three hundred years later the great Alexandrian
school or society—for it was a society as well as a school—trimmed the
light and set it higher, but it was so obscured and encompassed with
exclusiveness and secrecy as to be a long time in reaching the masses.

The first societies in Germany, France and Great Britain were in
connection with their institutions of learning, as they were at an
earlier period in Egypt and Greece. In Rome we have reason to believe
that they were more independent, as the physicians used a society seal
as a label for their medicine. Truly independent society organization
and work is comparatively of our own day. Even in the early part of the
present century, British authority was the London, Edinburgh and Dublin
colleges.

In our own country, previous to the organization of the American Medical
Association, about thirty-six years ago, there was very little system in
society work. That organization marks a new era in society usefulness.
From it sprung the International Medical Congress, making a unit of
medical investigation and progress of the world. We point with pride to
Philadelphia as the city in which the association was organized, and to
the able and determined stand our State has ever taken in sustaining and
strengthening it. It has been a power for good to American medicine. It
has elevated and is elevating the standard of our American medical
colleges.

The progress in society organization, work and usefulness in the last
thirty-six years is greater than in all American medical history
previous to that time. We had then a few isolated independent medical
societies without unity and without influence. We have at present a
society in almost every county, a State society in every State, all
united in an association and wielding an influence national and world
wide.

Great as the benefit has been to the profession at large, it has been
greater still to the individual practitioner. It has been to him a
post-graduate school.

In our societies A. meets B., B., C. and C., D. They compare their
investigations, experiences and theories, and each is benefited.

Our society enables us to know one another better. It is a true saying
that, “no man is as good as his best deed nor as bad as his worst.” Our
meeting in society aids us in striking the balance and makes us more
united, by forming and cementing friendships. They discourage quackery,
empiricism and everything that is professionally low and mean. They
encourage and stimulate purity, nobility and rectitude. They are a
strength to us medically and medico-legally. All that is necessary on
our part to secure us these benefits and many more which might be
enumerated, is to do our duty to our county, State and national
societies. I will now present to you what I believe to constitute at
least part of that duty.

_First._ Punctuality and regularity in attendance. This increases our
interest and gives the society strength.

_Second._ Support with our intellect. We may not all have an equal
number of talents, but he that has five should use them, and he that has
one should use it, and the use of that one may be just what the society
needs at the time.

If we have anything we think good in theory or practice, or any
interesting case, let us report to our society.

I believe everything presented should be in writing, for very few
physicians are good extemporaneous speakers, and all members should have
such notice of the subject of all papers to be read before the society
as will give them time to prepare for intelligent discussion; for unless
a man has a clear idea of his subject he is liable to wander off into a
labyrinth of side issues.

When appointed for a paper, we should have it ready and be on hand to
read it. We should have more papers published, and to better prepare
them for publication, each society should have an editor and a
publication committee, with ability and power to revise, correct and
publish papers and reports of the society.

_Third._ We should support our society with our influence. All have an
influence, and there is no neutral ground. It must be for or against.

Never was there a time when there was more need of the support of the
good men in the profession. The code of medical ethics has been
attacked. The American Medical association has been attacked.

An attempt has been made to make the one obnoxious and destroy the
harmony and usefulness of the other.

_Fourth._ We should be prompt in paying our dues and all other necessary
demands that may be made on us by our society. Negligence—for it is
seldom or never inability—on our part may not only embarrass the
society, but tend to destroy our interest in it.

I have a great regard for the Venango County Medical Society. It was the
first society I joined after graduating, over twenty years ago, and I
have always highly prized the friendships herein formed.

Death has taken some from us, good men and true, but I am pleased to see
that we are also adding to our number so many young men, and growing in
strength. Let us each do our part to keep up this growth, so that when
we are weighed in the balance we may not be found wanting.

I thank you for your kind aid and forbearance throughout the year. May
our society live long and prosper.




                     The Cleveland Medical Gazette.

              _A MONTHLY JOURNAL OF MEDICINE AND SURGERY._


                    ONE DOLLAR PER ANNUM IN ADVANCE.

  All letters and communications should be addressed to the CLEVELAND
         MEDICAL GAZETTE, No. 5 Euclid Avenue, CLEVELAND, OHIO.

 A. R. BAKER, M. D., _Editor_.  S. W. KELLEY, M. D., _Associate Editor_.




                               EDITORIAL.


                      THE LATE DR. ALFRED C. POST.

One of the old land marks of the medical profession is gone! Few men are
privileged to continue in actual practice fifty-seven years! Thousands
have heard him lecture, seen him operate and read his published papers.
He was indeed a remarkable man. At the age of eighty he continued to
operate with the freshness of youth. As a lecturer he was terse—direct
to the point; as a writer he was lucid and clear; as an operator he was
steady, bold and self-reliant; as a man he was a Christian.

If there was one thing more than another more prominent in his
well-rounded character, it was his devotion to duty. He was a man of
fine religious faith, devout in his behavior and an excellent theologian
and Biblical scholar. The two things he is said to have most enjoyed
were a surgical operation and a prayer meeting. He was a consistent
member of the Presbyterian church, and his example of earnest, unselfish
devotion to duty can not help but leave an influence for good which will
last long after his brilliant surgical operations are forgotten.

Dr. Post was born in New York city in 1805, graduated from Columbia
College in 1822, became a medical student in the office of Dr. Wright
Post, his uncle, an eminent surgeon of a former generation. He graduated
from the College of Physicians and Surgeons in 1827. After spending two
years in the medical schools and hospitals of Paris, Berlin and
Edinburgh, he commenced active practice of his profession in New York
city, which he continued until the week before his death. He was one of
the founders of the Medical Department of the University of New York,
taking the chair of surgery and pathological anatomy, and at the time of
his death was president of the medical faculty and emeritus professor of
the clinical surgery in that institution. His funeral took place
Wednesday, February 10, and the Church of the Covenant, of which Dr.
Post was a member, was crowded with professional and other friends of
the dead man.


  ALUMNI ASSOCIATION OF THE MEDICAL DEPARTMENT OF THE WESTERN RESERVE
                              UNIVERSITY.

The annual meeting of the Alumni Association will be held at 2 o’clock,
P. M., Wednesday, March 3, in the amphitheatre of the City Hospital
corner of Erie and Lake streets.

Dr. E. D. Burton of Collamer, Ohio, will be the orator of the occasion,
and Prof. Proctor Thayer, the elected poet.

The president, Prof. G. C. E. Weber, will also deliver an address.

The subjects for discussion are: First, Cholera, the leading speakers
being Doctors Thayer, Lowman and Kelley. Second, Diphtheria, its
Aetiology and Treatment, with Dr. Knowlton of Brecksville, and Dr. Orwig
of Cleveland, as leading speakers. The annual election of officers will
be held, and other important business transacted.

The Hon. S. E. Williamson will deliver an address to the graduating
class in the evening. The graduating exercises will be held in the First
Methodist Church, corner of Euclid avenue and Erie street. There will
afterwards be a reception and banquet at the Hollenden.


               THE WESTERN PENNSYLVANIA MEDICAL COLLEGE.

The Western Pennsylvania Medical College has been organized and
liberally endowed, and will soon assume possession of its new building
on Sixth street, Pittsburgh, Pennsylvania. The course of lectures will
not begin, however, until October. The faculty will be composed of the
following well-known, earnest and hard-working practitioners: Professor
of Anatomy, Dr. Heckelman; Professor of Physiology, Dr. Allen; Professor
of the Principles of Surgery, Dr. Murdock; Professor of the Practice of
Surgery, Dr. McCann; Professor of the Principles of Medicine, Dr.
Shively; Professor of Clinical Medicine, Dr. Lane; Professor of
Chemistry, Dr. Blank; Professor of Materia Medica, Dr. Gallagher;
Professor of Obstetrics, Dr. Duff; Professor of Gynæcology, Dr. Asdale;
Lecturer on Dermatology, Dr. Dunn; Lecturer on Nervous Diseases, Dr.
Ayers; Lecturer on Orthopædic Surgery, Dr. King; Lecturer on
Genito-Urinary Diseases, Dr. Thomas.




                          SOCIETY PROCEEDINGS.


         PROCEEDINGS OF THE NORTHEASTERN UNION MEDICAL SOCIETY.

 SIXTIETH QUARTERLY SESSION, HELD AT AKRON, OHIO, TUESDAY, FEBRUARY 2,
                                 1886.

The president, DR. J. E. DOUGHERTY, in the chair.

DR. BAUER, of the Committee on Obituaries, was instructed to prepare a
fitting memorial to be read at the next meeting upon the death of Dr. J.
C. Ferguson of Mogadore.

DR. PIERSON read a history of a clinical case. The clinical committee,
consisting of Drs. Hitchcock, Bauer and Rowe, after examination,
reported the case to be one of chronic pleuritis with adhesions and
effusion, and recommended alterative treatment.

DR. FISHER read a report of a case of puerperal convulsions, in which
venesection had been resorted to with favorable results.

In the discussion which followed, DR. SHIVELY said he did not believe in
blood-letting, but would rely upon _drastic cathartics_ and anæsthetics.

DR. WRIGHT, in a practice of fifty years, had employed blood-letting in
a few cases with good results.

DR. EVERHARD had seen several cases, and favored the use of anæsthetics,
but objected to the use of morphine on the ground of the supposed uræmic
pathology of puerperal convulsions.

DR. HOWARD thought Dr. Fisher’s treatment of the case good, and believed
emphatically in blood-letting, and also in the use of arterial
sedatives, such as verat., vir., etc.

DR. T. C. MILLER believed in thorough narcosis, giving morphine
hypodermically until the effects were noticeable on the respiration.
Anæsthetics are good, but can not be given continuously. The physician
giving the anæsthetic, when the convulsions cease will not crowd the
anæsthetic, and almost before he is aware of it the convulsions will
return. We have much to learn about the pathology of puerperal
convulsions. The speaker does not believe it to be uræmic. All of his
cases in which he gave narcotics thoroughly from the first recovered;
cases in which he used blood-letting died.

DR. VANCE believed that the treatment advised by Dr. Miller would result
disastrously in many cases, and spoke at some length, showing that the
latest authorities believed the true pathology of the trouble to be
uræmic.

DR. PIXLEY asked, after hearing so many opinions from so many
distinguished speakers: “What is Dr. Pixley going to do to-night if he
meets a case of puerperal convulsions? One speaker swears, if you bleed,
your patient will die; another swears, if you don’t bleed, your patient
will die; a third says, you must give opium; another says, you must not;
another says, you must give anæsthetics; another veratrum, another
cathartics.” Now, after all of this light upon the subject, he would do
as he always has done—apply cold to the head, warmth to the extremities,
maybe give a little opium, possibly bleed a little, equalize the
circulation, and deliver as soon as possible. Some of his patients will
live and some will die.

DR. HOWARD submitted to the society, for signatures, a petition to the
State Legislature in the interests of what is known as the “Sharpe
bill,” for the creation of a State Board of Health and a State Board of
Medical Examiners.

Adjourned to 1:30 P. M.


                           AFTERNOON SESSION.

On motion of DR. VANCE it was decided to hold the next meeting in
Cleveland, and on motion of DR. SCOTT the Cuyahoga County Medical
Society was invited to meet with this society.

It was also decided that, because of the session of the American Medical
Association occurring in May, the meeting of this association be held on
the first Tuesday in April.

Drs. A. R. Baker and W. T. Corlett were appointed a committee on
arrangements for the meeting in Cleveland.

An election of officers for the ensuing year was held, with the
following result: President, Dr. J. W. Shively of Kent; first
vice-president, Dr. A. C. Belden of Akron; second vice-president, Dr. T.
C. Miller of Massillon; recording secretary, Dr. L. S. Ebright of Akron;
corresponding secretary, Dr. A. K. Fouser of Akron; treasurer, Dr. E. W.
Howard of Akron.

DR. DOUGHERTY at once relinquished the chair to his successor, and in so
doing begged to be excused from the customary valedictory address
because of his having lately given up the practice of medicine and being
now very busily engaged in the duties of a county office.

DR. SHIVELY, the president-elect, after thanking the members for the
honor conferred upon him and commending the society upon its active
prosperity and scientific advancement, entered upon the duties of the
office.

The recording secretary and treasurer submitted their annual reports,
which, on motion, were referred to the finance committee. The committee,
after making a thorough examination of the accounts of the secretary and
treasurer, reported them as correct, but at the same time recommending a
more accurate system of book-keeping in the future, as well as the
passage of a resolution providing for an annual due from each member.

DR. MCEBRIGHT gave notice of his intention to introduce such a
resolution at the next meeting.

DR. LOUGHEAD, the appointed essayist, read an interesting paper upon the
Metric System, reviewing the many advantages which might be gained by
its adoption by the medical profession.

DR. D. B. SMITH read a report of a case of hysterical blindness (see
page 212 of this number), and followed with a verbal report of a very
peculiar case of exfoliation of the epidermis.

Remarks on the cases reported were made by Dr. Corlett and others.

DR. HITCHCOCK reported a case of malpresentation, in which, by
manipulation and the slight aid of forceps, delivery was accomplished
with safety to both mother and child.

DR. CORLETT spoke on the method of prescribing the bromide of arsenic.
He said the most trustworthy way was the alcoholic solution, which he
had been in the habit of diluting it in the strength of one grain to
eight ounces of simple elixirs without precipitation. Care must be taken
that no water be added before the bromide of arsenic is dissolved in
alcohol. Spoke favorably of its use in the class of skin diseases known
as _nenrose cutanae_.

DR. EBRIGHT reported the case of a man who had swallowed a silver
dollar. DR. PIXLEY told of a similar disposition of a five franc piece,
and DR. EVERHARD related a recent attempt by a lady to swallow the gauge
of a sewing machine. The three cases terminated favorably, though the
last mentioned required the aid of a surgeon.

The chair announced the following as the standing committees for the
ensuing year:

Admissions—Drs. D. B. Smith, E. Hitchcock, S. Pixley.

Publication—Drs. B. B. Brashear, T. H. Phillips, H. M. Fisher.

Finance—Drs. T. McEbright, M. M. Bauer, L. P. Proehl.

Ethics—Drs. X. C. Scott, A. M. Sherman, E. Conn.

Obituaries—Drs. W. C. Jacobs, N. S. Everhard, E. K. Nash.

The appointments for the next meeting are as follows: Essayist, Dr. A.
C. Brant; alternate, Dr. W. T. Corlett. Lecturer, Dr. E. W. Howard;
alternate, Dr. B. B. Loughead. Reports of cases, Drs. McEbright,
Phillips, Peck, Vance and Starr. Topic for discussion: “Functions of the
Cerebellum,” to be opened by Dr. Brashear.

After tendering a vote of thanks to the city council for the use of the
council chamber, and voting two dollars to the janitor of the building,
the society adjourned to meet in Cleveland on the sixth of April.

                                    A. K. FOUSER, _Recording Secretary_.




                               NEW BOOKS.


  ‘AN ESSAY ON THE PATHOLOGY OF THE ŒSOPHAGUS.’ By John F. Knott.
    Dublin: Fannin & Co.

  ‘THE OPERATIVE TREATMENT OF INTRA-THORACIC EFFUSION.’ By Norman
    Porritt, L. R. C. P., Lond., M. R. C. S., Eng. London: J. & A.
    Churchill.

  ‘ON THE PATHOLOGY OF BRONCHITIS, CATARRHAL PNEUMONIA, TUBERCLE, AND
    ALLIED LESIONS OF THE HUMAN LUNG.’ By D. J. Hamilton. London:
    Macmillan & Co.

We can well imagine the interest with which some practitioner in a
comparatively isolated locality—in the sense of being far from some one
of the great Atlantic cities where all new medical and surgical works
are kept in stock—reads over the titles of forthcoming works in the
particular department in which he is most concerned, and the eagerness
with which he anticipates their arrival after he has gone so far as to
order them. It may be, in this catarrhal land of ours, that it is throat
and chest diseases he is studying, and that the above works excited his
interest and drew from his pocket his hard earned dollars. If so, who
can doubt that emotions of pleasure warmed his heart as he contemplated
the instruction to be gained and the information to be acquired from
their perusal? For who would dare write on the pathology of the
œsophagus, if he had nothing to say? or descant on the operative
treatment of intra-thoracic effusion, if he was not qualified by
learning and experience to speak on the subject? But, lest the doubter
be abroad in the land, look further to the vouchers of the title page or
the preface. The first work on our list is “the Essay to which was
awarded the Gold Medal of the Pathological Society at the close of the
Session, 1876-77.” The second, “the Essay to which the Medical Society
of London awarded the Fothergillian Gold Medal, 1883.” Can anything be
more satisfactory? It is true that our last work boasts no such
authoritative endorsement, but then as the author is a professor of
pathological anatomy at Aberdeen, its other imperfections—from this
standpoint—we can imagine passed by, and the book, not without
misgivings, may be ultimately ordered with the rest.

What is the consequence? Two of the books will prove extremely
unsatisfactory, and but one will be found to fulfill in any way the
anticipations of the purchaser. The work on the œsophagus is the
production of an undergraduate—a creditable performance for a student,
but by no means the work any practitioner, not a friend of the writer,
would care to purchase. Mr. Porritt’s treatise is good to that degree
that one feels aggrieved that his friends permitted him to publish
anything until he had produced something first-class—for he is evidently
a young man of ability. Practical surgeons who have arrived at years of
maturity, not infrequently have occasion to notice that young men of
brilliant parts who enter upon the practice of that art, seem to think
they are unjustly kept in the background because no notice is taken of
their efforts to gain position in their profession by the arts of the
rhetorician or the tricks of the essayist. Nevertheless, no man can
become a surgeon, save by surgical works, or be entitled to speak as one
except he be a man of learning or experience—or both.

After so much that is unpleasant, it is a pleasure to turn to a work of
a radically different kind. In ‘Hamilton’s Bronchitis,’ the reader will
find a treatise that is a mine of pathological lore; a work every page
of which is suggestive and instructive. It possesses the rare quality of
being interesting to an unusual degree, and its perusal will be a
substantial pleasure to all its readers.

                  *       *       *       *       *

  ‘THE PHYSICIAN HIMSELF.’ By D. W. CATHELL, M. D. Fifth edition.
    Baltimore: Cushings & Bailey.

It is rather humiliating to the physician who is interested in equipping
his brain to successfully combat disease to find himself distanced by
the individual who rides into a paying practice in a fine carriage. But
we must take the world as we find it, and so long as people are judged
by what they seem and not by what they are, such books as the ‘Physician
Himself’ will be demanded. What shall we eat, and where shall we sleep,
and how shall we be clothed withal, are, like the poor, always with the
doctor.

Dr. Cathell has succeeded quite well in showing the importance of
business tact and sagacity in promoting the welfare of the physician. He
gives rules as to the best methods to pursue toward patients both in the
office and out, so as to line the doctor’s pocket-book. He tells him how
to dress, how to walk, how to sleep and how to eat, what kind of signs
to display, gives hints as to the selection of an office, together with
suitable furniture, etc., etc.

                  *       *       *       *       *

  ‘POST-MORTEM EXAMINATION.’ By Professor Rudolph Virchow. Translated
    by T. P. SMITH, M. D., from the fourth German edition.
    Philadelphia: P. Blackson, Son & Co.

In this admirable little work, Prof. Virchow gives a brief account of
his early experience as Prosector in the dead-house of the Berlin
Charity Hospital, and traces under his auspices the development of a
systematic method of conducting post-mortem examinations. He also
criticises, explains and illustrates the regulations which have been
promulgated throughout Germany for the guidance of medical jurists in
performing autopsies and drawing up reports.

He also gives three interesting cases in which the post-mortem
examinations were performed by himself, the order of sequence enjoined
by the regulations being closely adhered to. They may be taken as
examples of the way in which all post-mortem examinations for
medico-legal purposes should be conducted. It is much to be wished that
a method similar to the one which has received the high sanction of
Prof. Virchow were adopted in this country. One hundred and thirty-eight
pages, neatly bound in cloth, with a number of plates. Price $1.50.

                  *       *       *       *       *

THE SEVENTH ANNUAL REPORT (1885) OF THE OHIO STATE PHARMACEUTICAL
ASSOCIATION contains, besides the constitution and by-laws and history
of the organization, a number of interesting articles. One of them, by
S. J. Nicolay, M. D., of Hamilton, Ohio, is in reply to Query No. 1—“Do
the Various Fluid Extracts of Hydrastis Canadensis, Made Without
Alcohol, Contain all of the Active Principles of the Drug?” The writer
says that, properly, this extract “should not contain alcohol, since the
alcoholic extractive essentially contains resin, which, being an
irritant to inflamed mucous surfaces, is a detriment in a large majority
of cases to which it is otherwise applicable.” As to whether the various
fluid extracts of this drug, made without alcohol, contain _all_ the
active principles of the crude article, he concludes, after an
examination of six specimens from different manufacturers, that “each
specimen was found to contain portions of the two known
alkaloids—berberine and hydrastine—in their varying proportions.” “As to
whether these samples contained the alkaloids in as large quantities as
the respective samples of the crude drug from which they were made, was
not determined, but probably they did.” If this is true, the fluid
extract, without alcohol, will be as effective as that made with
alcohol, beside being quite miscible with water for topical application,
injections, etc., without becoming turbid and depositing resin.

Query 24—“_What_ is the Most Effective and Pleasant Disinfectant?”—is
answered by L. Sollman of Canton in an essay in which he treats: 1. “As
to what is that something which disinfectants are intended to
counteract.” 2. “What articles are disinfectants, and what is the way in
which they effect disinfection.” 3. “Which of them is practically
useful, and which is the most practical way of using them under various
conditions.”

A copy of the report can be had by forwarding fifty cents to the
secretary, Lewis C. Hopp, Cleveland, O.




                          NOTES AND COMMENTS.


_The Graubuch of the General Hospital of Vienna._—From this very
interesting report for 1884 we learn the following: At the end of ‘83
there remained in the hospital 1,672 patients; of these 1,037 were males
and 635 females. In ‘84, 23,937 patients were admitted, 14,801 males and
9,136 females. Discharged as cured, 12,532; improved, 4,485; uncured,
2,857. At the end of December, 1884, the number of patients remaining in
the hospital was 1,742.

The maximum of sickness among males was reached in January (1,179);
among females in May (740). The minimum among males in the month of
August (842); among females in September (588).

It is somewhat interesting to note among the victims of pulmonary
tuberculosis, the proportion furnished by various occupations. Two
hundred and four day laborers, 113 shoemakers, 90 blacksmiths, 76
cabinetmakers, 71 turners, 30 coachmen, 19 butlers, 19 waiters, 8
landlords, 6 musicians, 6 servants, 4 conductors, 2 janitors, 1
stenographer, 1 chorister, 1 turnkey, etc. The proportion of deaths from
tuberculosis expressed in percentage of the whole number of deaths was
as follows: June, 5.6; April, 4.7; March, 4.4; August, 4.3; May, 4.2;
February, 4.1; January, 3.9; October, 3.6; July, 3.2; November, 2.9;
September and December, 2.8.

The most rheumatism occurred in May (84), most typhus in September (19),
most bronchitis in March (210), the most pneumonitis in April (78), the
most catarrh of the digestive organs in July (81).

                  *       *       *       *       *

WINTER PRURIGO, says Dr. Corlett in a clinical lecture, a common and
most annoying disease of the skin in this climate, must be regarded as a
_local neurosis_. In its treatment internal medication avails but
little, excepting in severe cases where the paroxysms of itching occur
several times during the four and twenty hours, when hydrobromic acid
may be used with marked benefit. It is in local measures, however, that
we are effectually able to control it.

At the outset of a paroxysm apply caustic potash in strength varying
from x to xxx grains to the ounce of water, to which a drachm of
glycerine may be added, after which the following should be added:

                       ℞ Menthol          ℨss.
                         Acidi carbolici  ℨss.
                         Sodii benzoati   ℨij.
                         Ung. aquae rosae ℥iij.
                         Cerae alba q. s. Misce.

In mild cases, by omitting the caustic potash, the following lotions
will be sufficient:

                        ℞ Menthol         ℨj.
                          Alcoholis       ℥ij.
                          Acidi carbolici ℨss.
                          Sodae benzoati  ℥j.
                          Aquae rosae     ℥vj.
                                          Misce.

                  *       *       *       *       *

Dr. G. E. Paget of Cambridge is to have a K. C. B. bestowed on him, and
Dr. William Roberts of Manchester is to be knighted. Dr. Paget is Regius
Professor of Physic in the University of Cambridge, and a brother of Sir
James Paget, the eminent London surgeon. Dr. Wm. Roberts is Professor of
Clinical Medicine in the Victoria University. In neither case can the
title of “Sir” enhance the distinguished professional reputation already
enjoyed by each of these gentlemen.—_London Correspondence N. Y. Medical
Record._

                  *       *       *       *       *

At the end of November the Curatorium of the General Polyclinic of
Vienna held its first meeting according to its new constitution.
President Bezecny and Vice-Presidents Dompropst, Marshall and
Neumann-Spallart were unanimously reëlected. The chairman, Baron
Bezecny, next greeted the new curators, and stated that the object of
the meeting was to raise a large sum of money to erect a small hospital
for emergency cases. Upon request of the chair, Prof. Schnitzler gave a
brief report of the work of the Polyclinic from January 1 to November
25, 1885. Over thirty-two thousand patients were treated. The number of
hearers, almost entirely doctors, during the semester year of ‘84-5,
reached the height of four hundred and fifty-four. Among these were one
hundred from Austria and Hungary, and almost as many out of the German
empire. Then follow from other European States—Russia, England, Sweden
and Norway, Belgium and Holland, Italy and Greece. America was
represented by more than one hundred attendants; but also Asia, Africa
and Australia furnished hearers to the Polyclinic. Prof. Schnitzler then
left the subject of the report and moved that it be made the ambition of
the Polyclinic to erect a Polyclinical hospital. This motion, after a
very brief debate, was unanimously adopted.

                  *       *       *       *       *

On account of the death of Prof. Geo. Hunert, A. M., M. D., the chair of
Theory and Practice of Medicine is vacant in the Medical Department of
Wooster University in this city. As yet a successor has not been decided
upon.

                  *       *       *       *       *

_Third Annual Meeting of the Ohio State Sanitary Association._—We regret
that the programme of this meeting, which was held in Columbus, O., Feb.
25-26, was not received in time for publication in our last number. A
number of practical papers were read, some of which we shall present to
our readers.

                  *       *       *       *       *

Drs. Scott, Ashmun and Herrick, of Cleveland, presented papers at the
meeting of the State Sanitary Association.

                  *       *       *       *       *

Dr. J. H. Gleeson of 87 Bond street met a sudden death on the evening of
February 22, at Gerling & Haber’s drug store, No. 283 St. Clair street.
It is reported that Mr. Haber handed him by mistake a couple of ounces
of a mixture of carbolic acid and glycerine, which the doctor swallowed
and expired in a few minutes. The inquest will bring out the facts.

                  *       *       *       *       *

Dr. Geo. F. Leick is in New York City, where he expects to remain
several months.

                  *       *       *       *       *

Dr. A. B. Carpenter, who has been abroad in the hospitals of London and
Berlin during the past year, has returned to Cleveland.

                  *       *       *       *       *

Dr. H. G. Sherman, owing to ill health, has gone south for the winter.


    HOW DOES AMERICAN JOURNALISM AID THE DEVELOPMENT OF THE MEDICAL
                              PROFESSION?

The New York _Medical Journal_ says that “it regards the great
distinctive service of American medical journalism as shown mainly in
its counteracting influence in removing the pedantry shown in the
medical colleges, and encouraging the expression of original thought in
young men.” Surely, it were a great thing to remove the stupidity
engendered by medical schools, and to draw forth the powers of original
thought which are dormant in the young doctor. Of the truth of this view
we have no question, nor can any editor of any experience or success
fail to have many personal experiences in this sort of work. In the very
best sense of that term, the medical editor is a teacher; and this, too,
in causing others to work for the common good. The education follows
from the efforts of the young doctor to learn something of profit or
interest to the profession, and then place this before the profession in
the most attractive shape. The medical editor, in order to make his
journal a success, is compelled to get the best work expressed in the
best way. Most of the older members of the profession have never learned
to write, and as they become burdened with the cares of a large
business, it becomes impossible for them to learn the art of writing.
Much they possess of positive value to the profession, but from the
defect of not being able to write with comfort, their knowledge dies
with them. The medical editor can get little help from them. There are a
considerable number of the members of the medical profession who could
not write a decent article, if they had any distinct ideas to put in it.
Obviously, the medical editor can do nothing with this class. But there
is another class of doctors, who have the general culture and the
brains, but are too modest to think of writing for the benefit of their
seniors. From this class the medical editor draws most of his working
colaborers. By encouragement, by personal solicitation, by aid in
matters of reference, by stimuli of ambition, of professional pride, by
appealing to the sense of his obligations to do for the general
profession that which lies in his power, many of this class are brought
into active service in medical journalism. Having encouraged to habit of
expression, the editor stimulates the habit of original research. Of
course, different individuals will be stimulated in different
directions. So, at last, the editor will have writers in every portion
of the field of the art and science of medical surgery. Hence, it comes
about that the editor sends men to work with the microscope, in the
chemical laboratory, in the pharmaceutical laboratory, in the
physiological laboratory, in the anatomical room, in the hospital, in
the dispensary, in the tomes of medical literature of every language and
of every age. In short, he has these men at work in every field
congenial to them, and such that they can reach it.

In a very real sense, an editor is like a captain of a ship—he shows his
abilities not so much in what he does himself, as in what he can get
others to do. That there are not more really good medical journals, is
due to the fact that there are really few medical men having the power
of getting others to work in the fields leading to medical journalism.

When a young doctor has begun to realize that he can talk to the entire
medical profession, life and study takes an entirely new aspect. The day
of small things is past, and the day of an enlarged and enlarging
manhood has come to him. One who does realize this truth will never
write a poor article for publication. The poor articles come from quite
a different sort of men. These the medical editor gradually weeds out.

Of this direct and indirect influence upon the conduct of medical
colleges, and upon medical societies and medical publishers, writers of
medical books, and the relations of medical men, we have not time to
speak. But in all these things the medical journal is the means by which
the process of both good and bad education goes forward. Out of all
these educational processes the medical profession is slowly rising
higher in its development.

To every young man who would make the most of his powers, we say: think,
observe, and write for the medical press constantly. It may be that one
article a year is all that any particular person can produce. It may be
that longer time will be required, but whether the time be long or
short, be sure to begin and keep up the habit of correct thinking,
constant study and correct and frequent writing.—_Detroit Lancet._

------------------------------------------------------------------------




                          TRANSCRIBER'S NOTES


 1. Corrected yours to hours on p. 195.
 2. Corrected Aurelinsto Aurelius on p. 206.
 3. Silently corrected typographical errors.
 4. Retained anachronistic and non-standard spellings as printed.
 5. Enclosed italics font in _underscores_.







*** END OF THE PROJECT GUTENBERG EBOOK THE CLEVELAND MEDICAL GAZETTE, VOL. 1, NO. 5, MARCH 1886 ***


    

Updated editions will replace the previous one—the old editions will
be renamed.

Creating the works from print editions not protected by U.S. copyright
law means that no one owns a United States copyright in these works,
so the Foundation (and you!) can copy and distribute it in the United
States without permission and without paying copyright
royalties. Special rules, set forth in the General Terms of Use part
of this license, apply to copying and distributing Project
Gutenberg™ electronic works to protect the PROJECT GUTENBERG™
concept and trademark. Project Gutenberg is a registered trademark,
and may not be used if you charge for an eBook, except by following
the terms of the trademark license, including paying royalties for use
of the Project Gutenberg trademark. If you do not charge anything for
copies of this eBook, complying with the trademark license is very
easy. You may use this eBook for nearly any purpose such as creation
of derivative works, reports, performances and research. Project
Gutenberg eBooks may be modified and printed and given away—you may
do practically ANYTHING in the United States with eBooks not protected
by U.S. copyright law. Redistribution is subject to the trademark
license, especially commercial redistribution.


START: FULL LICENSE

THE FULL PROJECT GUTENBERG LICENSE

PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK

To protect the Project Gutenberg™ mission of promoting the free
distribution of electronic works, by using or distributing this work
(or any other work associated in any way with the phrase “Project
Gutenberg”), you agree to comply with all the terms of the Full
Project Gutenberg™ License available with this file or online at
www.gutenberg.org/license.

Section 1. General Terms of Use and Redistributing Project Gutenberg™
electronic works

1.A. By reading or using any part of this Project Gutenberg™
electronic work, you indicate that you have read, understand, agree to
and accept all the terms of this license and intellectual property
(trademark/copyright) agreement. If you do not agree to abide by all
the terms of this agreement, you must cease using and return or
destroy all copies of Project Gutenberg™ electronic works in your
possession. If you paid a fee for obtaining a copy of or access to a
Project Gutenberg™ electronic work and you do not agree to be bound
by the terms of this agreement, you may obtain a refund from the person
or entity to whom you paid the fee as set forth in paragraph 1.E.8.

1.B. “Project Gutenberg” is a registered trademark. It may only be
used on or associated in any way with an electronic work by people who
agree to be bound by the terms of this agreement. There are a few
things that you can do with most Project Gutenberg™ electronic works
even without complying with the full terms of this agreement. See
paragraph 1.C below. There are a lot of things you can do with Project
Gutenberg™ electronic works if you follow the terms of this
agreement and help preserve free future access to Project Gutenberg™
electronic works. See paragraph 1.E below.

1.C. The Project Gutenberg Literary Archive Foundation (“the
Foundation” or PGLAF), owns a compilation copyright in the collection
of Project Gutenberg™ electronic works. Nearly all the individual
works in the collection are in the public domain in the United
States. If an individual work is unprotected by copyright law in the
United States and you are located in the United States, we do not
claim a right to prevent you from copying, distributing, performing,
displaying or creating derivative works based on the work as long as
all references to Project Gutenberg are removed. Of course, we hope
that you will support the Project Gutenberg™ mission of promoting
free access to electronic works by freely sharing Project Gutenberg™
works in compliance with the terms of this agreement for keeping the
Project Gutenberg™ name associated with the work. You can easily
comply with the terms of this agreement by keeping this work in the
same format with its attached full Project Gutenberg™ License when
you share it without charge with others.

1.D. The copyright laws of the place where you are located also govern
what you can do with this work. Copyright laws in most countries are
in a constant state of change. If you are outside the United States,
check the laws of your country in addition to the terms of this
agreement before downloading, copying, displaying, performing,
distributing or creating derivative works based on this work or any
other Project Gutenberg™ work. The Foundation makes no
representations concerning the copyright status of any work in any
country other than the United States.

1.E. Unless you have removed all references to Project Gutenberg:

1.E.1. The following sentence, with active links to, or other
immediate access to, the full Project Gutenberg™ License must appear
prominently whenever any copy of a Project Gutenberg™ work (any work
on which the phrase “Project Gutenberg” appears, or with which the
phrase “Project Gutenberg” is associated) is accessed, displayed,
performed, viewed, copied or distributed:

    This eBook is for the use of anyone anywhere in the United States and most
    other parts of the world at no cost and with almost no restrictions
    whatsoever. You may copy it, give it away or re-use it under the terms
    of the Project Gutenberg License included with this eBook or online
    at www.gutenberg.org. If you
    are not located in the United States, you will have to check the laws
    of the country where you are located before using this eBook.
  
1.E.2. If an individual Project Gutenberg™ electronic work is
derived from texts not protected by U.S. copyright law (does not
contain a notice indicating that it is posted with permission of the
copyright holder), the work can be copied and distributed to anyone in
the United States without paying any fees or charges. If you are
redistributing or providing access to a work with the phrase “Project
Gutenberg” associated with or appearing on the work, you must comply
either with the requirements of paragraphs 1.E.1 through 1.E.7 or
obtain permission for the use of the work and the Project Gutenberg™
trademark as set forth in paragraphs 1.E.8 or 1.E.9.

1.E.3. If an individual Project Gutenberg™ electronic work is posted
with the permission of the copyright holder, your use and distribution
must comply with both paragraphs 1.E.1 through 1.E.7 and any
additional terms imposed by the copyright holder. Additional terms
will be linked to the Project Gutenberg™ License for all works
posted with the permission of the copyright holder found at the
beginning of this work.

1.E.4. Do not unlink or detach or remove the full Project Gutenberg™
License terms from this work, or any files containing a part of this
work or any other work associated with Project Gutenberg™.

1.E.5. Do not copy, display, perform, distribute or redistribute this
electronic work, or any part of this electronic work, without
prominently displaying the sentence set forth in paragraph 1.E.1 with
active links or immediate access to the full terms of the Project
Gutenberg™ License.

1.E.6. You may convert to and distribute this work in any binary,
compressed, marked up, nonproprietary or proprietary form, including
any word processing or hypertext form. However, if you provide access
to or distribute copies of a Project Gutenberg™ work in a format
other than “Plain Vanilla ASCII” or other format used in the official
version posted on the official Project Gutenberg™ website
(www.gutenberg.org), you must, at no additional cost, fee or expense
to the user, provide a copy, a means of exporting a copy, or a means
of obtaining a copy upon request, of the work in its original “Plain
Vanilla ASCII” or other form. Any alternate format must include the
full Project Gutenberg™ License as specified in paragraph 1.E.1.

1.E.7. Do not charge a fee for access to, viewing, displaying,
performing, copying or distributing any Project Gutenberg™ works
unless you comply with paragraph 1.E.8 or 1.E.9.

1.E.8. You may charge a reasonable fee for copies of or providing
access to or distributing Project Gutenberg™ electronic works
provided that:

    • You pay a royalty fee of 20% of the gross profits you derive from
        the use of Project Gutenberg™ works calculated using the method
        you already use to calculate your applicable taxes. The fee is owed
        to the owner of the Project Gutenberg™ trademark, but he has
        agreed to donate royalties under this paragraph to the Project
        Gutenberg Literary Archive Foundation. Royalty payments must be paid
        within 60 days following each date on which you prepare (or are
        legally required to prepare) your periodic tax returns. Royalty
        payments should be clearly marked as such and sent to the Project
        Gutenberg Literary Archive Foundation at the address specified in
        Section 4, “Information about donations to the Project Gutenberg
        Literary Archive Foundation.”
    
    • You provide a full refund of any money paid by a user who notifies
        you in writing (or by e-mail) within 30 days of receipt that s/he
        does not agree to the terms of the full Project Gutenberg™
        License. You must require such a user to return or destroy all
        copies of the works possessed in a physical medium and discontinue
        all use of and all access to other copies of Project Gutenberg™
        works.
    
    • You provide, in accordance with paragraph 1.F.3, a full refund of
        any money paid for a work or a replacement copy, if a defect in the
        electronic work is discovered and reported to you within 90 days of
        receipt of the work.
    
    • You comply with all other terms of this agreement for free
        distribution of Project Gutenberg™ works.
    

1.E.9. If you wish to charge a fee or distribute a Project
Gutenberg™ electronic work or group of works on different terms than
are set forth in this agreement, you must obtain permission in writing
from the Project Gutenberg Literary Archive Foundation, the manager of
the Project Gutenberg™ trademark. Contact the Foundation as set
forth in Section 3 below.

1.F.

1.F.1. Project Gutenberg volunteers and employees expend considerable
effort to identify, do copyright research on, transcribe and proofread
works not protected by U.S. copyright law in creating the Project
Gutenberg™ collection. Despite these efforts, Project Gutenberg™
electronic works, and the medium on which they may be stored, may
contain “Defects,” such as, but not limited to, incomplete, inaccurate
or corrupt data, transcription errors, a copyright or other
intellectual property infringement, a defective or damaged disk or
other medium, a computer virus, or computer codes that damage or
cannot be read by your equipment.

1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except for the “Right
of Replacement or Refund” described in paragraph 1.F.3, the Project
Gutenberg Literary Archive Foundation, the owner of the Project
Gutenberg™ trademark, and any other party distributing a Project
Gutenberg™ electronic work under this agreement, disclaim all
liability to you for damages, costs and expenses, including legal
fees. YOU AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT
LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE
PROVIDED IN PARAGRAPH 1.F.3. YOU AGREE THAT THE FOUNDATION, THE
TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE
LIABLE TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE OR
INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF THE POSSIBILITY OF SUCH
DAMAGE.

1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you discover a
defect in this electronic work within 90 days of receiving it, you can
receive a refund of the money (if any) you paid for it by sending a
written explanation to the person you received the work from. If you
received the work on a physical medium, you must return the medium
with your written explanation. The person or entity that provided you
with the defective work may elect to provide a replacement copy in
lieu of a refund. If you received the work electronically, the person
or entity providing it to you may choose to give you a second
opportunity to receive the work electronically in lieu of a refund. If
the second copy is also defective, you may demand a refund in writing
without further opportunities to fix the problem.

1.F.4. Except for the limited right of replacement or refund set forth
in paragraph 1.F.3, this work is provided to you ‘AS-IS’, WITH NO
OTHER WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT
LIMITED TO WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PURPOSE.

1.F.5. Some states do not allow disclaimers of certain implied
warranties or the exclusion or limitation of certain types of
damages. If any disclaimer or limitation set forth in this agreement
violates the law of the state applicable to this agreement, the
agreement shall be interpreted to make the maximum disclaimer or
limitation permitted by the applicable state law. The invalidity or
unenforceability of any provision of this agreement shall not void the
remaining provisions.

1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation, the
trademark owner, any agent or employee of the Foundation, anyone
providing copies of Project Gutenberg™ electronic works in
accordance with this agreement, and any volunteers associated with the
production, promotion and distribution of Project Gutenberg™
electronic works, harmless from all liability, costs and expenses,
including legal fees, that arise directly or indirectly from any of
the following which you do or cause to occur: (a) distribution of this
or any Project Gutenberg™ work, (b) alteration, modification, or
additions or deletions to any Project Gutenberg™ work, and (c) any
Defect you cause.

Section 2. Information about the Mission of Project Gutenberg™

Project Gutenberg™ is synonymous with the free distribution of
electronic works in formats readable by the widest variety of
computers including obsolete, old, middle-aged and new computers. It
exists because of the efforts of hundreds of volunteers and donations
from people in all walks of life.

Volunteers and financial support to provide volunteers with the
assistance they need are critical to reaching Project Gutenberg™’s
goals and ensuring that the Project Gutenberg™ collection will
remain freely available for generations to come. In 2001, the Project
Gutenberg Literary Archive Foundation was created to provide a secure
and permanent future for Project Gutenberg™ and future
generations. To learn more about the Project Gutenberg Literary
Archive Foundation and how your efforts and donations can help, see
Sections 3 and 4 and the Foundation information page at www.gutenberg.org.

Section 3. Information about the Project Gutenberg Literary Archive Foundation

The Project Gutenberg Literary Archive Foundation is a non-profit
501(c)(3) educational corporation organized under the laws of the
state of Mississippi and granted tax exempt status by the Internal
Revenue Service. The Foundation’s EIN or federal tax identification
number is 64-6221541. Contributions to the Project Gutenberg Literary
Archive Foundation are tax deductible to the full extent permitted by
U.S. federal laws and your state’s laws.

The Foundation’s business office is located at 809 North 1500 West,
Salt Lake City, UT 84116, (801) 596-1887. Email contact links and up
to date contact information can be found at the Foundation’s website
and official page at www.gutenberg.org/contact

Section 4. Information about Donations to the Project Gutenberg
Literary Archive Foundation

Project Gutenberg™ depends upon and cannot survive without widespread
public support and donations to carry out its mission of
increasing the number of public domain and licensed works that can be
freely distributed in machine-readable form accessible by the widest
array of equipment including outdated equipment. Many small donations
($1 to $5,000) are particularly important to maintaining tax exempt
status with the IRS.

The Foundation is committed to complying with the laws regulating
charities and charitable donations in all 50 states of the United
States. Compliance requirements are not uniform and it takes a
considerable effort, much paperwork and many fees to meet and keep up
with these requirements. We do not solicit donations in locations
where we have not received written confirmation of compliance. To SEND
DONATIONS or determine the status of compliance for any particular state
visit www.gutenberg.org/donate.

While we cannot and do not solicit contributions from states where we
have not met the solicitation requirements, we know of no prohibition
against accepting unsolicited donations from donors in such states who
approach us with offers to donate.

International donations are gratefully accepted, but we cannot make
any statements concerning tax treatment of donations received from
outside the United States. U.S. laws alone swamp our small staff.

Please check the Project Gutenberg web pages for current donation
methods and addresses. Donations are accepted in a number of other
ways including checks, online payments and credit card donations. To
donate, please visit: www.gutenberg.org/donate.

Section 5. General Information About Project Gutenberg™ electronic works

Professor Michael S. Hart was the originator of the Project
Gutenberg™ concept of a library of electronic works that could be
freely shared with anyone. For forty years, he produced and
distributed Project Gutenberg™ eBooks with only a loose network of
volunteer support.

Project Gutenberg™ eBooks are often created from several printed
editions, all of which are confirmed as not protected by copyright in
the U.S. unless a copyright notice is included. Thus, we do not
necessarily keep eBooks in compliance with any particular paper
edition.

Most people start at our website which has the main PG search
facility: www.gutenberg.org.

This website includes information about Project Gutenberg™,
including how to make donations to the Project Gutenberg Literary
Archive Foundation, how to help produce our new eBooks, and how to
subscribe to our email newsletter to hear about new eBooks.