valuable to the busy practitioner, because it is a clinical treatise. In regard to treatment, the author is clear, judicious and practical, and in this respect the work is much more satisfactory than most works upon this class of diseases. REMARKS ON OVARIOTOMY WITH RELATION OF CASES AND PECULIARITIES IN TREATMENT. By NATHAN BOZEMAN, M. D., Surgeon to the Woman's Hospital of the State of New York, etc. New York: William Wood & Co. 1879. Dr. Bozeman gives us an interesting little pamphlet, in which he discusses the various methods of treatment after operation and outlines his own, which consists mainly "in the early and continuous use of quinine and opium per rectum, in conjunction with free and liberal support of the system by oral or rectal alimentation, or both at the same time, as means of preventing or controlling high temperature. Records of the first nine cases operated upon by the author are given, of which eight lived and recovered. THE TREATMENT OF EPITHELIOMA OF THE CERVIX UTERI. By This is another interesting pamphlet, by a distinguished physician and author, which gives the results of his experience in the treatment of a formidable disease. He condemns amputation, and recommends complete exsection of the diseased mass. HISTORY OF THE DISCOVERY OF ANESTHESIA. By J. MARION PRECAUTIONS REQUISITE IN THE ADMINISTRATION OF ERGOT. TRANSACTIONS OF THE MEDICAL AND CHIRUGICAL FACULTY OF THE STATE OF MARYLAND. Eighty-first Annual Session, held at Baltimore, Md., April, 1879. ANNUAL JOURNAL OF THE ECLECTIC AND LIBERAL MEDICAL THE Chicago Medical Times. WILSON H. DAVIS, M. D., Editor and Publisher. VOL. XI. CHICAGO, OCTOBER, 1879. [XLI.] ORIGINAL COMMUNICATIONS. SPINA BIFIDA. BY PROF. S. W. INGRAHAM, M. D. No. 7. Spina bifida is a defect, or, more properly, an opening in the spinal canal, allowing the membranes of the cord to protrude. Surgeons have so little to say about this congenital defect, that little knowledge can be gained from their writings. Gross, Vol. II, page 186, says: "The lesion which is caused by an arrest of ossification and consequent deficiency of the vertebral rings, is generally situated in the lumbar region, but occasionally it affects the dorsal, cervical, or even the sacral. It is frequently associated with hydrocephalus, and is analagous to those malformations which originate from a want of union of the two halves of the foetus during utero-gestation, such as hare-lip, cleft-palate and umbilical hernia." The same surgeon further says that "when the tumor first shows itself, it may not be larger than a pea; but, as the disorder progresses, it gradually increases in size, varying in proportion to the deficiency of the vertebræ ; and that, although the swelling does not usually exceed the size of an orange, it occasionally reaches that of the fist, and even of the child's head." I attended, in the month of May, this year, two cases of spina bifida, complicated with hydrocephalus and atrophy of the inferior extremities. The first child was born of Holland parents, and came under my charge for treatment after a consultation with the physician who was in attendance when it was born. The tumor was in the lumbar region, and presented about the proportion and shape of a medium-sized pear, and was covered with a thin, transparent membrane, through which a thin, serous fluid was oozing. The inferior extremities were in the same condition' as to form and size that they should be in the foetus at five months of utero-gestation, while the trunk and head were rather large, the head showing signs of hydrocephalus. The mother of this child claimed then, and now, that she slipped on the icy pavement at the fifth month, and fell square upon her back, and that she had pain in that region up to the very time the child was born. This fall might have produced dropsy of the arachnoid membrane of the spinal cord, "and the fluid carrying with it the membranes of the cord, have arrested ossification of the bony structure at the point of the rupture," or, it might have caused congestion, followed by dropsy in that particular portion of the soft vertebræ, causing it to part and the membranes to protrude through the opening. Now, it has never been my good fortune to see many of the extraordinary phenomena spoken of by some of the older writers, such as the taking-on of spina bifida after birth, or the closing up and radical cure of these defects, especially where the tumor was large and discharging freely. It is possible that iodine and iodide of potassium, introduced into the sac by subcutaneous injection, has accomplished good results. Indeed, I would not dare to say that it had never produced radical cures in the hands of other surgeons; for it will be remembered that the late lamented Dr. Brainard represented, in the press and to the public, that he cured five out of seven cases by this course of practice. W. Martin Coates, in Braithwaite's Retrospect, January, 1866, says he cured a case by Brainard's method, the tumor being the size of a walnut. In fact, these spinal defects have been treated with marked success by various plans and numerous practitioners (in their minds) all over the civilized world; and if their statements are true, then spina bifida is curable by any of the following methods, viz.: 1. "The withdrawal of a certain quantity of fluid from the tumor, and replacing it by an equal quantity of a solution of iodine, one part, iodide of potassium, three parts, water, one thousand parts. A. Wood's syringe and needle is used instead of a small trocar. By this plan a small puncture is made, “which is not so liable to wound nervous tissue," and has another and very important advantage, of keeping out atmospheric poison. 2. By frequently puncturing the tumor with a very small trocar, then painting it over with collodion, and adjusting a neat-fitting saddle, truss or compress lined with an air-cushion. This was Abernethy's method, and "Sir Astley Cooper, in early life, is said to have treated a case of cleft-spine quite successfully, by compression alone, and another case, soon afterward, by combining repeated punctures with compression.” 3. Tying the base of the sac with a ligature. 4. Repeatedly puncturing the sac, and then closing it up with adhesive straps. 5. Longitudinal incision under an antiseptic veil, and covering the tumor with carbolized lac-plaster, and keeping it in position with adhesive plaster. 6. Nature's own method of radical cure, by adhesion of the arachnoid membrane around the base of the tumor. In all cases of spinal tumors, appropriate remedies should be used to control the over-abundant secretion of the tumor, in order that adhesion may take place, and so that compression of the brain will not follow from a too free discharge of the cephalo-spinal fluid. I am an unbeliever in the doctrine of complete isolation of these larger tumors by any of the varied treatments heretofore recommended; and I still further believe that these larger tumors, complicated with hydrocephalus and atrophy of the inferior extremities, are fatal to life, and that no case can survive many months, even under the most favorable treatment. The case represented in the forepart of this paper is a fair sample of what I class as incurable cases. This child died of convulsions thirty days after birth, notwithstanding all rational plans of treatment applicable to the case had been persistently and faithfully carried into execution. For three days prior to death, the organs of deglutition were paralyzed, so that the child had to be nourished by artificial means. The second child was still-born one week after the first. The tumor was of similar size and situation, but it had ruptured during labor, and the child had died of compression of the brain. Four years ago, a child six weeks old was brought to me, suffering with bifid spine, situated in the lumbar region. The tumor, so far as general appearance and thin membranous covering, was similar to those previously mentioned; but the walls were soft and compressible, and but little fluid appeared to escape, while the child was otherwise well formed, and the various organs seemed to perform their functions well. I had read an article in Braithwaite's Retrospect, of 1872, from the able Dr. John Wilson, physician to the Glasgow University Lying-in Hospital, wherein he represented a case a fortnight old, and the tumor the size of half a billiard ball, and presenting similar conditions to the case I was about to operate upon. I concluded to try his method, which consisted of a free incision under an antiseptic veil, viz.: "tumor first moistened over with carbolized oil (1 in 8), and then opened by free longitudinal incision (about three-quarters of an inch in length), under an antiseptic veil of surgeon's lint, previously soaked in carbolized oil. Simultaneously with the removal of the lint, a large piece of carbolized lac-plaster was applied, and over this another, kept in position by adhesive plaster, leaving one edge comparatively free for the escape of fluid. A soft piece of silk laid over this completed the dressing." I deemed this operation no more hazardous than the various methods previously recommended, especially those advising repeated punctures, and subcutaneous injections. I therefore conducted the treatment of the case after this plan, and have every reason to believe that if I had not been called away out of the city, the treatment would have proved greatly beneficial to the little sufferer; but my going away without notice or consultation, placed the |