inent medical men, sectional prejudices are more likely to be worn away, and a feeling of personal sympathy between the members established, hence giving each one a greater interest in the works of the others. Let us hope that the interest shown in our own American Medical Association will continue so to increase that it may some day be to us what the similar congresses are to the medical profession in Europe. V. Y. B. LEIPZIG, January 20, 1880.

THE PROPOSED MEDICAL ACT.

MR. EDITOR,- In the report of the Suffolk District Medical Society in your issue of February 19th, I find an abridgment of some remarks of mine so reported as to appear ridiculous. I did not simply state that the proposed law "was ridiculous and unwise," but after a somewhat extended argument I did reach what seemed to me a logical conclusion, that the law was both ridiculous and unwise. I did state that the law was opposed to the reasonings of Adam Smith and Herbert Spencer, and compared their authority with that of the individuals from whom Drs. Cushing and Wigglesworth exhibited numerous certificates of approval of the law.

One word in regard to Dr. Wigglesworth's answer that the "Social Science Association had not inaugurated this reform as philosophers, but as public-spirited citizens." No one will dispute his statement; but let me ask if, considering the legislative enactments of the Massachusetts legislature, it would not have been better if a greater number of laws had been proposed by "philosophers" and fewer by public-spirited citizens, who have crowded our statute-books with nonsensical statutes (dead and alive) until the lawyers cannot tell us the law. If Dr. Wigglesworth thinks that our profession will figure better in this company of public-spirited citizens than in that of philosophers, I can only deprecate his taste.

Respectfully yours,

THE CODE OF ETHICS.

D. HUNT.

MR. EDITOR, Does the acceptance of a code of ethics by the council of the Massachusetts Medical Society make it binding upon the Fellows, unless it is accepted at the annual meeting of the Fellows?

From the account of the action of the council in the JOURNAL it is not clear, I think, whether the vote is to be discussed by the society next summer or not.

I cannot find in the prescribed duties of the councilors (By-Laws XVII., XVIII., XIX.; Digest of Acts of Commonwealth, relating to Massachusetts Medical Society, XVI., XVII., XVIII.) that the enactment of a code is included. Although the council may assume this power, it is certainly desirable that the style of legislation exhibited by the council in regard to the admission of women be not continued. The council decreed last autumn that women should be admitted to the Massachusetts Medical Society. This was accepted by the community, was quoted in the daily press and by President Eliot in his annual report. The council have since practically admitted that they had no legal right to enact such a decree, a fact which should have been thought of before placing themselves and the society in a ridiculous position before the public.

If, hereafter, a Fellow be expelled from the society for non-observance of the code, can he not claim that it is doubtful whether the vote of the council in this matter binds the Fellows of the society unless the code is adopted by the society? A FELLOW.

THE ADMISSION OF WOMEN TO THE MASSACHUSETTS MEDICAL SOCIETY.

MR. EDITOR, In your comments in the last number on the action taken by the last meeting of the councilors upon the woman question, you justly say "that the question stands at the present moment precisely as it did before any action was taken." It is interesting to recall the fact that in 1873, "before any action was taken," the councilors appointed a committee to obtain legal advice upon the very question now at issue, and that at the annual meeting, June 3, 1873, this committee presented to the councilors the written opinion of Messrs. Hoar and Putnam.

As the full text of this opinion has never been printed, so far as I know, its publication in your widely read columns would be useful at the present time. A copy is inclosed. Very truly yours, G. E. FRANCIS.

WORCESTER, February 14, 1880.

BOSTON, March 11, 1873.

CHARLES E. BUCKINGHAM:— DEAR SIR, We have carefully examined the question raised by your communication of February 20th in relation to the application of Miss Susan Dimmock to the Massachusetts Medical Society, and we are of opinion:

(1.) That the society may, if it see fit, prescribe as a qualification for membership or license that the candidate shall be of the male sex.

(2.) That it has not yet done so, by its by-laws submitted to us (edition of 1861).

(3.) That in the absence of any such regulation by the society it rests with the examiners or censors to whom the application is made whether they will approve the licensing of a woman to practice, and that it is competent for them to reject an applicant on the ground of her sex, if in their judgment that is a disqualification for the practice of medicine or surgery.

(4.) That in the absence of any by-law of the society excluding women from examination, if any woman shall be licensed to practice by the proper officers of the society, she will thereupon be entitled to membership of the society. Very respectfully yours, E. R. HOAR. GEORGE PUTNAM, JR.

(Signed) (Signed)

MR. EDITOR, -In your issue of February 12th, page 157, in reporting the discussion pending the referring of the question of admission of women to the general society for ratification, I think your reporter misapprehended one element in the discussion, namely the relation of he to the question of sex as applied to our charter and by-laws. In this discussion of February 4th, Dr. Millet suggested that it might be necessary to invoke legislative authority before women could be admitted. I then suggested that to the mind of a former council that question had been settled, namely, that of sex, which I understood Dr. Millet to refer to. Permit me here briefly to review this point. When the

of men.

question of the admission of women to the society was first agitated, it was urged that they were ineligible by reason of the spirit and language of our charter, which contemplated the association and incorporation only Digest, Sections XI., XXVII., and XXVIII. were quoted to sustain this view, the pronoun he always being used in referring to person. On the other hand, it was contended that the scope of both charter and by-laws was ample to cover both sexes, and Digest XXIII. and By-Law I. were quoted in defense of that view. Finally, it was voted to refer the question of woman's eligibility by reason of sex to Judge Hoar, then senior counsel of the society, who decided her eligible. It was this decision to which I referred in speaking to the question February 4th.

ATTLEBORO, February 17, 1880.

J. R. BRONSON.

SCANZONI IN RHYME.

A SMALL 12mo of forty-two pages has recently (1879) been published in Bern and Leipzig, as written by "Campolongo," and entitled "Der Kleine Scanzoni. Repetitorium Gynækologicum Hysteropoeticum." This gives in pleasing verse the lessons taught by Scanzoni on the diseases of women, and is not in ridicule, but conveys the sense of the lessons very agreeably. A few extracts will show the style quite well:

SPECULA.

Für Seitenlage praktikabel

Ist Sims' einarm'ger Entenschnabel;
Und geht's an's Operiren scharf,
Man Simon's Speculum bedarf.
In England und Amerika
Gibt's täglich neue Specula;
Doch bleibt es stets die alte Leier:
Was complicirt, das ist auch theuer;
Auch denkt ein Practicus, ein echter:
Je complicirter, desto schlechter!

Und müsst ihr schlitzen auch ein Hymen,
So denkt gelassen: non est crimen!
Nur übet Mass und Billigkeit,

Und treibt die Spannung nicht zu weit;
Der Heilkunst Segen wird zum Fluch,
Bedenkt man nicht den alten Spruch:
Was du nicht willst, das man dir thu,
Das füg' auch keinem Andern zu!

in Paris in 1878, and entitled L'Instrument de Molière; Traduction du Traité de Clysteribus de Regnier de Graaf (1668). In paper, type, and illustrations, this work is an edition de luxe of a translation, as its name implies, of the treatise on injections, or clysters, as the old term puts it, by that De Graaf whose name comes down to us in connection with the Graafian follicle. A handsome portrait of De Graaf forms the frontispiece, while interspersed through the work are little cupids, who furnish the head and tail pieces in a manner at once very Frenchy and suggestive of the matter contained within the text. The object of the work, which is prefaced by a full notice of the life and writings of De Graaf, and filled with copious and interesting notes, seems to be to introduce the use of a long and flexible tube, invented by the author as an aid in giving and receiving injections without expos ure of person. But the part of most interest here is

the assertion that a number of cases have demonstrated that, contrary to the nature of things, the valve of Bauhin (ileo-cæcal valve) is found relaxed during an anti-peristaltic action of the intestines, so that clysters pass out by the mouth, and that this fact is mentioned by Galien, Sennert, Paré, Bartholin, and many others, of whom some affirm that suppositories have been ejected in the same way. Sennert is quoted as giving a case of a young girl of twelve years, "souffrant de la passion iliaque," who could not only retain nothing by the rectum, but also vomited violently the clysters almost as soon as received. This state of things lasting for three days, a long suppository was introduced, and in the time which it took to recite a Pater Noster and an Ave Maria, to quote the quaint language used, it was rejected by the mouth; a second, retained by a thread, was vomited, the thread being broken; a third, attached by four stronger threads, took the same course; a fourth produced so violent a movement (of the intes tine?) that the mother removed it in fear that it would follow the others. The girl was finally relieved through the use of very fat bouillon, which triumphed over the excitability of the organs.

W. L.

ANESTHESIA BY ETHYL BROMIDE. MR. EDITOR,

--

-The following case, in which the above named-drug was used, is of interest to the profession:

The patient, under the care of Dr. C. J. Blake, at the Massachusetts Charitable Eye and Ear Infirmary, a ship's cook, aged thirty-five years, was suffering from chronic otitis media purulenta, right ear. Four weeks exposure at sea. ago there was an acute exacerbation of the disease after appetite. Considerable oedema and erythema below There was sleeplessness and loss of and behind the auricle. Great tenderness on pressure, with a sense of fluctuation over the mastoid process. Wilde's incision was advised.

The operation was done at 2.10 P. M. on February 4, 1880, by the house interne, assisted by the writer; patient reclining with head raised. Pulse 92.

About sixteen cubic centimetres (half a fluid ounce) of ethyl bromide were poured on a small folded towel, and held to the nose of the patient for two and a half minutes, the breathing continuing regular. At the end of this time anesthesia with relaxation of the muscles was produced. The incision, two centimetres (three

quarters of an inch) in length, was then made vertically, about one and a half centimetres behind the auricle (over the mastoid process of the temporal bone) through the integument to the bone.

During the time that the incision was being made there was no movement of the patient.

Voluntary motion with an apparent restoration of consciousness succeeded, in two minutes, the making of the incision. In seven minutes after the first inhalation of the ethyl the patient talked rationally about the operation, and said that he felt the knife, as if it were the pressure of a finger drawn over the skin,

but that there was no pain. The window near by having been opened and cold, fresh air supplied, the patient soon became chilly and trembled, saying that he felt weak. The window was then closed, ammonia given by inhalation, and blankets were placed over the patient. He said at the end of fifteen minutes, the trembling having entirely ceased, that he felt easy and able to recline comfortably, which he had not done for many hours previous to the operation, on account of the extreme tenderness in the neck. There was no nausea. E. D. SPEAR, JR.

BOSTON, February 12, 1880.

Two thousand five hundred and twenty-two deaths were reported; 810 under five years of age: principal "zymotic diseases (small-pox, measles, diphtheria and croup, diarrhoeal diseases, whooping-cough, erysipelas, and fevers) 470, consumption 396, lung diseases 366, diphtheria and croup 201, scarlet fever 75, typhoid fever 50, measles 44, whooping-cough 27, diarrhoeal diseases 26, malarial fevers 17, erysipelas 11, small-pox seven, cerebro-spinal meningitis six, typhus fever six. From measles, New York 21, Philadelphia six, Brooklyn and Chicago five, St. Louis and New Haven three, Lowell one. From whooping-cough, Pittsburgh five, New York three, Philadelphia, Brooklyn, New Orleans, and District of Columbia two, Chicago, St. Louis, Baltimore, Boston, Cleveland, New Haven, Charleston, Somerville, Gloucester, Marblehead, and Palmer one. From malarial fevers, New York eight, St. Louis and New Orleans three, Chicago two, Brooklyn one. From erysipelas, Brooklyn three, New York and Philadelphia two, St. Louis, Cincinnati, Nashville, and Newburyport one. From small-pox, Philadelphia three, District of Columbia and Worcester two. From cerebro

spinal meningitis, Philadelphia two, New York, Chicago, Lynn, and Marblehead one. From typhus fever, Chicago four, Philadelphia and Baltimore one. One hundred and sixty-four cases of measles, 58 of diphtheria, nine of whooping-cough, and three of typhoid fever were reported in Brooklyn; diphtheria 48, scarlet fever six, in Boston; diphtheria 13 in Milwaukee; diphtheria seven, scarlet fever six, in New Bedford. Philadelphia, Washington, and Worcester continue to report deaths from small-pox; one case was reported in Cleveland. Systematic vaccination was begun in Worcester on the 15th inst.

The total number of deaths reported shows a considerable increase over the previous week; of deaths under five as large a decrease. Diarrhoeal diseases were less fatal, and to a less degree also scarlet fever and diphtheria. Lung diseases, consumption, typhoid fever, measles, and small-pox caused more deaths. In 37 cities and towns of Massachusetts, with an estimated population of 958,060 (population of the State about 1,690,000), the death-rate was 21.82 against 20.41 and 20.17 of the previous

two weeks.

Lectures.

CLINICAL LECTURE

र

BY HENRY J. BIGELOW, M, D., ~ Professor of Surgery in Harvard University. [Reported for the JOURNAL.]

LITHOLAPAXY.

GENTLEMEN, Within ten days we have had two cases of rapid litholapaxy, one of which you saw. After both, the temperature rose from 98° to above 100° F. On the third day it fell to 99° F., and now, three days later, it is normal. This reaction is like that from the effect of a bougie, and the temperature like that of urethral fever. A patient readily recovers from the operation of litholapaxy if we remove from the bladder all the fragments of the stone. In fact, the new method has succeeded beyond expectation.

Small stones are easily ground up, especially if soft, and then come away of themselves. Serious consequences may follow if fragments are left in the bladder. In former times cases that did not admit of lithotrity had to be cut; likewise those in which, from any reason, lithotrity was hazardous. A recent number of the London Lancet reports a case in which Mr. Smith, of St. Bartholomew, removed four ounces of stone from the bladder of an elderly man, who left the hospital in a week. This is the largest quantity of débris ever removed by litholapaxy.

The operation, of course, is purely mechanical, and any reference to it is chiefly to its mechanics. The principles of litholapaxy and of complete evacuation are pretty well settled and accepted. It is now mainly a question of certain minor details of convenience in the apparatus. I am satisfied that one point which contributes as much as, if not more than, any other to rapid and complete evacuation is the power of regulating and of frequently varying the quantity of water in the bladder. You require just enough water to prevent the thud of the slack walls when they are drawn into the eye of the catheter. When you feel that, the bladder must have a little more water to distend it. Too little water crowds the fragments together. When there is too much you may have to chase a single fragment a long time.

The arrangement of hose I show you here is the only one that allows the operator to diminish the quantity of water in the bladder without disturbing the apparatus. If one end of this hose which is not much larger than a pipe-stem be kept in a tumbler of water it does not in the least interfere with the convenience of the operator. But, on the other hand, it does enable him, by turning the cocks, to vary from one minute to another, if he please, the amount of water in the bladder. There can be no doubt of the advantage of being able to do so.

Another point relates to the size of the tubes. The smallest tube used in litholapaxy is larger than the largest tube that was used for evacuation in previous operations. But you will find that the largest tubes I use are sometimes not preferred by other surgeons. They are in the habit of using a No. 28 or 29 tube, and these often serve the purpose. The fact is this: a stone after evacuation is found to have been mostly reduced to powder and minute fragments. Large fragments are rather the exception. Now, the fine débris may be evacuated through a 28 or 29 tube, though perhaps not

quite so rapidly as if the tube had a calibre of 30 or 31. It then remains only to crush the larger fragments and repeat the process. I prefer a larger tube, when there is no objection to its introduction, because it not only evacuates the dust more rapidly, but at the same time allows me to remove the large fragments without having to crush them.

I am sure that in the end operators will all use a stand to support the weight of the bulb, because it is very inconvenient to hold it through a long operation. But there should be a device (as in the stand I show you here) for supporting the bulb at different heights, which can be varied during the progress of evacuation. I also think surgeons will connect the bulb with the evacuating catheter by means of an elastic tube, so that one can be moved without the other. This to me is a sine qua non.

RUPTURE OF A TENDON.

You have seen this man in the ward. He came to the hospital with a rupture of the long tendon of the biceps muscle of the arm. It is a rare accident, and is well worth examination. The man fell upon his shoulder and disabled it. More than this he does not know. He has been unable to bend the arm freely, but is now recovering the use of it. There is a noticeable difference between the biceps muscles of the two arms. On the affected side, the outer belly, never long, has contracted into an almost spherical mass. You can see how this arm differs from the other by its curiously irregular outline. Flexion is accomplished chiefly by the brachialis anticus muscle. The biceps here shows one tendon running to the coracoid process, but there Just is a hollow where the outer belly should be. above this depression is a little tendinous mass, which seems to consist of the fibres remaining about the outer tendon. When the man entered he felt pain about the shoulder, and when he contracts the biceps there is very decided pain there now. There can be no doubt as to the character of the lesion. I have had a cast made of the arm. The case is rare. I never happened to see one before.

TUMORS UPON THE STternum.

Nine months ago a tumor appeared on the upper segment of this man's sternum. When he works he suffers pain. He is employed in a paper store, and his work is mostly lifting heavy bundles. He has never been sick. While taking down a package of paper from a shelf he struck the sternum. At night it felt a little sore. A tumor soon appeared, and has grown slowly. It is not tender, although he feels it when he first begins to work.

Here is a second case. This man is a stocking knitter, and of sedentary habits. In May or June last he first noticed an inflammatory swelling which extended over a part of the sternum. A second swelling came on later at the top of the bone.

In these two cases we have two exceptional and different tumors of the upper part of the sternum. The inflammatory growth is the more common of the two. Coming on about six months ago, it became tender, was opened, and has been discharging ever since. Within a few weeks the upper swelling appeared on the same patient. It fluctuates a little, but is still firm, and is indolent in progress. It is a case of caries of the sternum with abscess, occurring in a man of weak habit-and somewhat run down. Its progress has been