of hospitals and camps. But in any event, it will be the duty of American physicians to be fully prepared for any exigencies that may arise. Already the New York and other Hospital Boards in this city have proffered their gratuitous services to the State authorities, offering to go to any point and to undertake any duty in the organization of Army Hospitals, when required. The five Hospital Boards have also cordially united in giving full effect to a plan for the practical training of a class of approved women to serve as Nurses in the Army Hospitals—an enterprise that is being nobly sustained by the Ladies' Central Association of Relief. This work has received the approval of the proper authorities at Washington, and will doubtless constitute one of the first elements for the improved organization and management of our Army Hospitals.

From information already received, we are assured that so far as any "civil element" or any voluntary aid is needed, or can properly be introduced, the military authorities will encourage its introduction under suitable regulations. In view of this fact, and also in anticipation of what we believe to be the earnest desire of our readers, we shall continue the consideration of this subject in the next number.

THE WEEK.

THE AMERICAN MEDICAL ASSOCIATION has postponed its meeting for one year. Though the fraternal bonds of our profession are indissoluble, the entire North is so truly united in the support of the Federal Government that all men seem to be unconscious of any other duty, and in this devotion to country no class of citizens are more hearty than physicians. The million of citizens now impatiently demanding the privilege of rushing to the rescue, also demand that their physicians go with them. "For," say they, "let Death make no reprisals except upon the battlefield. Medical science and the physician's skill must guard our camps." When next our Medical Congress convenes, we trust that not only the fraternity of States, but the unity and power of our life-saving profession, will be abundantly confirmed, by the record of experiences and works of a war in which no needless inhumanities and no preventible sacrifice of life were allowed.

LINT and Bandages have become staple articles of domestic manufacture from Maine to Iowa. This was well for the brief period when volunteer regiments in their haste could not wait for Government orders and supplies. But the time has now arrived when other wants of the soldier should receive most attention. Let light flannel garments both for the sick and the active soldiery be accumulated. They will be required.

MEDICAL men and army surgeons are admitted to be brave men; and when occasion requires, their terrible intrepidity, like that of the surgeon-gunner of FORT SUMTER, dares any danger. But inasmuch as the mission of the physician and surgeon in armies and at the battle-field, is to save life and not to destroy, ought not the medical corps of contending armies to be, as far as practicable, shielded from the enemy's fire? It was the glory of the renowned LARREY, that in all his campaigns with BONAPARTE, he devoted his matchless skill as freely for the benefit of wounded and suffering foes as for the troops to which he belonged. And more than once, when inevitable death

awaited him, as an officer of rank in the Army, a timely recognition of his name and duties at once made him an object of protection by the enemy. Let such an honorable recognition of the claims of humanity in scenes of carnage characterize the acts of the immense armies now on the eve of conflict. In order to insure a ready recognition of members of the Surgical Staff when moving on errands of mercy in the theatre of battle, let the proper Medical and Military Bureaux of the contending armies agree upon and direct a distinctive and easily recognised uniform that shall be worn in common by the medical corps of both armies. ARMY SURGEONS.-In answer to the numerous correspondents who have addressed us with reference to the best mode of obtaining commissions as Regimental Surgeons, we would suggest, as the most proper course, that they join some local regiment, and afterwards present themselves for examination before the Surgeon-General and his Board of Examiners.

THE following order from the Surgeon-General's office will give the reader an idea of the responsibility and importance attached to the office of medical inspector of army volunteers at the New York City Depot:

-

GENERAL HEAD QUARTERS, STATE OF NEW YORK, SURGEON GENERAL'S OFFICE, Albany, April 22, 1861.

SPECIAL ORDERS, No. 5.

Surgeon ALEX. B. MOTT is hereby detailed as Inspecting Surgeon to the depôt at New York. He will carefully inspect the troops on their arrival at the depôt, in relation to the following points: First, whether there is any evidence of pulmonary disease; Second, any organic disease of the heart; Third, hernia; Fourth, any marked physical imperfections or any infirmity unfitting a man for the active duties of a soldier. He will also daily inspect the quarters and attend to all matters pertaining to the hygiene of the depôt. It is particularly requested that he cause to be enforced perfect cleanliness of quarters and men. He will report to this office on Saturday of each week the number of men inspected in each company, the number accepted, together with the name of the officer commanding each company. By order of the Commander-in-Chief,

S. OAKLEY VANDERPOEL, Surgeon-General.

MIAMI VALLEY MEDICAL ASSOCIATION.-We learn from reliable authority that this Association is made up of a band of eclectics, persons who consequently have no claim for countenance by the profession. We make this announcement that any of our contemporaries who may have heretofore sent their journals to these pretenders may cease to do so, for the reason stated. The transparency of the trick on the part of this pseudo-scientific body is only equalled by the impudent solicitation made by them a short time since for medical literature free of expense!

DR. A. CLARK's lectures on Diphtheria will be continued after a lapse of two or three weeks.

SMALL-POX in military depôts and encampments is one of the direst calamities to which an army can be exposed. Will not the Surgeons-General of the State troops issue orders to the Medical Inspectors at the various military depôts to provide officially for the immediate vaccination of every regiment? Upon inquiry, we learn that the Eastern Dispensary, alone, in this city, is prepared to supply fresh virus for the vaccination of a thousand or more every day for the next six weeks. The inconvenience of the vesicle and soreness is but trifling, and need not prevent soldiers from drilling and other duties.

sleeping in this position from infancy to old age, affords very conclusive proof, that if commenced in early life, it is the healthiest for a general posture, that can be adopted.

"It is very evident that the back of the head should never be allowed, in sleep, to fall to a level with the spine; but should be supported by a small pillow, to elevate it a little, without raising the shoulders or bending the back, which should always be kept straight.

"The Savages with their pillows, like the birds in the building of their nests, make no improvements during the lapse of ages, and seem to care little if they are blocks of wood or of stone, provided they elevate the head to the required position.

"With the civilized races, where everything is progressive, and luxuries especially so, pillows have increased in longitudinal dimensions until they too often form a support for the shoulders as well as the head, thereby annulling the object for which they were originally intended, and for which, alone, they should be used.

sleeping hours, in the heated exhalation of her body, places it at her arm's length from her, and compels it to breathe the fresh air, the coldness of which generally prompts it to shut the mouth, in default of which, she presses its lips together in the manner that has been stated, until she fixes the habit which is to last it through life; and the contrast to this, which is too often practised by mothers in the civilized world, in the mistaken belief that warmth is the essential thing for their darling babes, I believe to be the innocent foundation of the principal, and as yet unexplained cause of the deadly diseases so frightfully swelling the Bills of Mortality in civilized communities.

"All animals lower the head in sleep; and mankind, with a

"All Savage infants among the various native tribes of America, are reared in cribs (or cradles) with the back lashed to a straight board; and by the aid of a circular, concave cushion placed under the head, the head is bowed a little forward when they

sleep, which prevents the mouth from falling open; thus establishing the early habit of breathing through the nostrils. The results of this habit are, that Indian adults invariably walk erect and straight, have healthy spines, and sleep upon their backs, with their robes wrapped around them; with the head supported by some rest, which inclines it a little forward, or upon their faces, with the forehead resting on the arms, which are folded underneath it, in both of which cases there is a tendency to the closing of the mouth; and their sleep is therefore always unattended with the nightmare or snoring.

"Lying on the back is thought by many to be an unhealthy practice; and a long habit of sleeping in a different position may even make it so; but the general custom of the Savage races, of

small support under it, inclining it a little forward, assume for it a similar position.

"This elderly and excellent gentleman, from a long (and therefore necessary) habit, takes his nap after dinner, in the attitude which he is contented to believe is the most luxurious that can be devised; whilst any one can discover that he is very far from the actual enjoyment which he might feel, and the more agreeableness of aspect which he might present to his surrounding friends, if his invention had carried him a little farther, and suggested the introduction of a small cushion behind his head, advancing it a little forward, above the level of his spine. The gastric juices commence their work upon the fresh contents of a stomach, on the arrival of a good dinner, with a much slighter jar upon the digestive and nervous systems, when the soothing and delectable compound is not shocked by the unwelcome inhalations of chilling atmosphere.

"And this tender and affectionate mother, blessing herself and her flock of little ones with the pleasures of sleep! how much might she increase her own enjoyment with her pillow under her head, instead of having it under her shoulders; and that of her little gasping innocents, if she had placed them in cribs, and with pillows under their heads, from which they could not escape. "The contrast between the expression of these two groups will be striking to all; and every mother may find a lesson in them worth her studying; either for improvements in her own nursery, or for teaching those who may stand more in need of nursery reform than herself.

"So far back as the starting point in life, I believe man seldomlooks for the causes of the pangs and pains which beset and torture him in advanced life; but in which, far back as it may be, they may have had their origin.

"Little does he think that his aching, deformed, and decaying teeth were tortured out of their natural arrangement and

has been caused by the same habit; and that habit was the result of the actual tenderness, but oversight, of his affectionate mother, when he slept in her arms, or in the cradle."

We cannot dismiss this quaint production without a word of commendation. However much in the medical theory advanced by the author may be questioned, it is certain that the work aims to correct a habit, which, to say the least, is disgusting. We trust it may be introduced into every family, and every Sabbath and public school in the country. There are few children who will soon forget its apt illustrations, and every one will be led insensibly to correct the tendency to this habit. The author closes with the following appeal:

"And if I were to endeavour to bequeathe to posterity the most important Motto which human language can convey, it should be in three words

Shut-your-Mouth.

"In the social transactions of life, this might have its beneficial results, as the most friendly, cautionary advice, or be received as the grossest of insults; but where I would point and engrave it, in every nursery, and on every bed-post in the Universe, its meaning could not be mistaken; and if obeyed, its importance would soon be realized."

Reports of Societies.

NEW YORK ACADEMY OF MEDICINE.
STATED MEETING, April 3, 1861.

DR. JAMES Anderson, PRESIDENT, IN THE CHAIR.

DISCUSSION ON MORBUS COXARIUS.
(Continued from page 298.)

DR. WATSON.-There is no disease in surgery which requires more attention from the surgeon than this. From almost the earliest period of my professional life this subject has been one of great importance to me, and consequently I have paid a great deal of attention to it. I remember as long ago as 1835 and '36, I happened to be in London, and during that time my attention was particularly called to this disease by a conversation with Mr Liston. And at that time there was a very spirited discussion between him and Mr. Brodie on the pathology of the disease, and particularly in reference to the dislocation that was said to occur in the latter stage. Mr. Brodie had taken the ground that there was a secondary dislocation, that the head of the bone was lodged upon the dorsum of the ilium. Mr. Liston took issue with him on that ground, and I believe if the journals of that date be consulted, their discourses will be found. These subjects were thoroughly discussed, and it was the talk of all the medical public of Great Britain. Liston took the ground that luxation never occurred. As I was going up to Edinburgh, Mr. Liston told me to look into the large museums of that city for secondary luxations. I spent a day or two in looking over those specimens, which amounted to several hundreds, and I could not succeed in finding any where this accident had taken place. The disease was not, therefore, one of the secondary dislocation, but one of absorption. The true

luxation that occurs is a very rare affection. That it sometimes does occur, the following case will prove. I remember some years ago a child was brought into the New York Hospital with a large ulceration over each hip; the heads of both the femurs were projecting through these openings, and were dislocated. The specimen is now in the museum, and an account of it may be found in Dr. Ray's Catalogue of the Pathological Cabinet of that institution. This luxation took place in consequence of the openings which formed. There is another mode in which the luxation will occur; now and then, as has been remarked by some of the gentlemen, the disease affects the bottom of the cavity of the acetabulum, which is swept away, and the head of the bone is thrown into the cavity of the pelvis. That I have seen. So there are two ways in which dislocation can occur; one by destruction of the capsular ligament, and the other by perforation of the acetabulum. One word in regard to the origin of this disease. I cannot but admire the order and neatness with which Dr. Post opened this discussion, but in the point of pathology, I think he was rather limited in his views. He states as his belief that the disease originates in the bone. I take issue with him on that point; the disease, I believe, may commence in the cartilage, and also in the ligaments. In the latter instances there is acute pain and effusion early, but when in the bone there may be no pain at all. You may see cases that have gone many months without pain, in which the first thing that calls the attention of the parents is a shortening of the limb. This last variety has called forth most attention, and is most easily cured. When the disease begins in the synovial tissue, it has the same form as pleuritis. In this form of disease, the progress is next to the cartilages; they become eroded, and will appear as if they had been rubbed off by sandpaper, by piecemeal. If the disease commences in the bone, they turn yellow and brown, they become soft, elastic, and loose, and finally become disinte

grated. In the former variety, the cartilage remains attached to the bone until it has entirely disappeared by piecemeal. Now, with regard to the treatment of this disease. If you see one of those cases that begin with severe pain, you may be very much alarmed, but if you see them early you can generally manage them very well. Extension is of very great use in these cases.

As long ago as 1840, when I just took charge of one of the departments of the New York Hospital, I had occasion to treat patients in this way by extension, and I founded my treatment of those cases upon Dr. Harris's paper as published in the Philadelphia Medical Examiner in 1839, and subsequently referred to by Dr. J. G. Adams in a paper which he published in July, 1839, in the New York Journal of Medicine. I merely make this statement to counteract the impression that this treatment has fallen into disuse. From the very hour I read Harris's paper, I have always looked upon it as the best plan of treatment until the new mode introduced by Dr. Davis came into use, which I highly approve. I remember the first case which I treated upon this plan. She was brought into the Hospital suffering agonizing pain, scarcely allowing any one to touch her. I remember telling Dr. Kearny Rodgers that I intended to treat the patient upon a new plan. Well," ," said he, "let us see how it will work." I placed her upon the straight apparatus as if she had a fracture of the thigh. I had hardly put on the counter-extension before the girl was entirely free from pain. It operated beautifully and instantly. I have always used it since.

66

With regard to some of the other points that have been discussed in reference to the different forms of apparatus, I cannot say much, because I have had very little experience in their use. It is not necessary in every acute stage to use extension, for if you sometimes purge a child freely you will not unfrequently put a stop to the disease at once, to your utter astonishment. I can refer to a case of this sort which occurred within the last two months. A child for several days complained of severe pain in its knee and hip. I found a great deal of tenderness on pressure over the hip. This child I purged with a little pulvis purgans; applied leeches freely behind the trochanter; kept it at rest, and used some stimulating embrocation, and in two weeks the patient was about. This I look upon as one of the cases in which the disease begins in the synovial membrane. I think that a great many cases of this sort can be treated without the necessity of extension; when, however, that necessity does exist, the instrument which I believe was invented by Dr. Davis, and modified by Dr. Sayre, is an improvement on the old plan, and will be adopted by the profession generally; and as I understand Dr. Sayre is now willing to do justice to Dr. Davis, there need be no further discussion upon the subject.

DR. SAYRE.-I would ask Dr. Watson if he has read my report?

DR. WATSON.-I have not.

DR. SAYRE.-I presumed not, or you would not have made that last remark, in which you state, you learn that I am now willing to do justice to Dr. Davis, thereby inferring that hitherto I have been unwilling to do so. (Cries of order!)

CHAIR. The gentleman will confine himself to the subject, which is the treatment of the disease.

DR. SAYRE.-I will, sir; but I have been openly charged in this Academy, during my absence, as dishonorably claiming ideas which belong to Dr. Davis. And Drs. Parker, Post, and Buck, have signed their names to a report testifying to the same. (Cries of Order!) I claim, sir, the right of correcting this false statement. If my report were in the hands of the whole profession, it would need no correction from me; but as it is not, and only the few who obtain the Transactions* will ever know the truth, hundreds of other young men in the profession will hear the slander and never hear the correction. I therefore claim the privilege

*Trans. Amer. Med. Asso., Vol. XIII. 1861.

of reading from my report what I have said in relation to this matter, and then leave it with the profession for their honest judgment. I have been in the habit of applying motion with extension for eight years or more, and have had frequent discussions with Dr. Bauer on this subject, as he can testify. Several cases of anchylosis occurred, one of which in a particular friend of mine in Kentucky, made a lasting impression on my mind. This subject, sir, was a topic of discussion every time we met, because from him I could learn more than was in our standard works upon the subject, he was in advance of the age; and he can testify whether or not I am indebted to Dr. Davis for any of the principles laid down in my report. The construction of Dr. Davis's instrument being the first to embody this principle of motion with extension, I fully acknowledge. Have I not stated this in my report? I will read the paragraph in which I refer to him.

"This was a desideratum I had tried long to accomplish, but never succeeded to my satisfaction until Dr. H. G. Davis, of this city, applied to him one of his instruments, which answered the purpose admirably, and in its construction embraced the very principles I had so long sought to obtain. As Dr. Davis is, I believe, the first person who has constructed an instrument embracing these important advantages, extension with motion, I have taken the liberty of presenting a plate of the same, and his own remarks in regard to its method of application. I have made, as I think, some very important improvements and modifications of this instrument, which I will describe more fully hereafter." Here, sir, follows a plate of his instrument, and two pages of his own remarks; and then the succeeding paragraph in which I state: "This instrument of Dr. Davis was applied in this case with the happiest results for a few days, but it soon began to excoriate the groin, and the method of extension was not satisfactory, and could not be controlled at will; but would be either too feeble or too severe, and I therefore constructed an instrument embracing all the principles in this, but much more effectual in its application, more comfortable to the patient, and entirely under the control of the surgeon."

Can any man write the English language more clearly? I appeal to the profession! Am I then to be traduced for being wanting in honor in not making proper mention of Dr. Davis, as these gentlemen have charged me?

The best proof that the modification is an improvement, is the fact that Dr. Davis has now adopted it in his own instrument. Pardon me, Mr. President, if in these remarks I have overstepped the bounds of prudence; but justice to myself demanded they should be made. And now, sir, so far as I am concerned, this is the last of this subject, and I hope for ever.

I will now proceed to discuss the subject under consideration. Dr. Post has given to the Academy a very excellent exposé of the subject, and I can clearly recognise the chief features of my report in his statement. But the learned gentleman has signally failed to appreciate the pathology of hip-disease, which I think is indispensable, since it, and it only, furnishes us with the scientific basis for rational therapeutic action. In part, Drs. Watson and Bauer have already supplied this deficiency, and but little is left for me to add to their remarks on this part of the subject. DR. SAYRE then proceeded to enlarge on the subject pathologically in its various stages. We omit, however, this portion of his remarks, as his views on this particular point are already before the profession in his report.

What the report, however, did not contain, was the treatment of the sequelæ, or effects of the disease, when left to itself, and its spontaneous relief, viz: permanent impediment of the joint, and deformity. I am anxious, said he, to supply this deficiency at my earliest leisure, and I embrace this opportunity only for the purpose of referring to this very important branch of the subject under consideration.

There can be no further doubt as to the efficiency of

surgical aid in these cases; and I may be permitted to relate one or two cases in confirmation. In November last, I was called to Hartford, Conn., by Dr. Curtis, to advise in a case of anchylosis of the hip-joint with very great deformity. The patient was a young lady, aged 14. When three years old, she was attacked with what was thought hip-disease, from which she suffered four years, at last resulting in perfect immobility, and acute angular flexion, and adduction of the thigh. The flexion was so great that the anterior surface of the thigh was in close contact with the abdomen, producing constant excoriation. The heel was placed on the opposite thigh, two inches above the knee-joint. It may easily be imagined how much this deformity interfered with the bodily requirements. Most physicians who had seen the patient, pronounced it dislocation into the ischiatic notch, and declared it on that account irremediable. Not knowing whether the joint itself was anchylosed, or whether the fixed position of the joint depended on osteophytes, I decided on the following plan: first to divide all the contracted flexor and adductor muscles, then to try a moderate force, sufficient to fracture off the osteophytes, and in case of failure, then to perform Rhea Barton's operation. This procedure required necessarily great discretion, on account of the possibility of producing diastasis of the head of the femur. After putting the patient fully under chloroform, and dividing all the contracted muscles, and a portion of the vagina-femoris which was very short and tense, I succeeded with a moderate amount of force, in freeing the head of the femur from its fixed position. Every one in the room distinctly heard the breaking of bony substance, which could have been but osteophytes around the joint; for immediately afterwards the joint itself moved tolerably smoothly. I suggested to follow up this result by constant extension over a pulley, and rest, with such local antiphlogistic applications as might be necessary, until all inflammation had subsided; and at a proper time, to apply the hip-splint, and encourage exercise. Since this time I have not seen this patient, but I have received a letter from Dr. Curtis, dated the 5th of March, in which he states, "Her limb is entirely down upon the floor, and of equal length with the other. She has free motion of the joint, and there is no pain whatever on pressure. She walks with a cane only, having left off the instrument for more than two weeks; and I think she will not be obliged to resort to it again.' From the fact that osteophytes caused the impediment of the joint in this case, and the fact that the limb is now of the same length as the other, I infer that the original difficulty was periostitis only.

I could refer also to another case sent to me by Dr. Gunn of this city, of genuine morbus coxarius of seven years' standing, resulting in permanent anchylosis in the straight position with four inches shortening, caused partly by the twisting of the pelvis, and partly from absorption of the bone, and arrest of development in the limb. In this case the contracted muscles were divided, and the adhesions broken up with equally satisfactory results, with the exception of the length of the limb, which of course cannot be restored. But motion has been given to the joint, and the limb is rendered useful, so that she can walk without a cane or crutch, I could narrate many more similar cases; but merely mention these as type cases of the different diseases which result in deformities of this joint.

Dr. Sayre, in conclusion, exhibited a hip-splint he was now using, which allowed free motion of the knee-joint; and another apparatus for the extension in the diseases of the knee-joint, which enabled the patient to take exercise in the open air. He had used this instrument for some months, in quite a number of cases, with the greatest benefit, and could therefore confidently commend it to the attention of the members.

DR. PARKER: I wish to ask Dr. Sayre if I understood him to say that the case treated by him in this neighborhood was complete anchylosis. I am surprised if it should

he means by the expression used in his report that "motion is as essential to the joint as light to the eye." I now wish to know whether the object of that splint first suggested by Dr. Davis, and afterwards adopted by Dr. Sayre, is to give motion to the diseased joint or to the whole body. My own conviction is, that the great law which obtains everywhere in inflammation, obtains also in the joint; light is for the eye in a healthy state, but in disease light should be excluded. The treatment of inflammation in the early stage is rest. We get our extension and counter-extension by the application of this splint, and thereby we accomplish everything in the joint. Our patient gets the air, but that joint is still at rest. The great advantage of Davis's splint is, not that it enables us to give motion to the joint, but that it allows the patient the opportunity to exercise, to lift him up to the getting-well point. The time at length arrives when the activity of the inflammation subsiding, the great doctrine of passive motion comes in, which with this splint can be commenced earlier than by the use of any other means. In conclusion, I repeat the question, does he use the expression already cited as applying to the diseased or to the healthy joints?

DR. SAYRE, in answer to the question, stated that in the case already quoted, he should not say that the anchylosis was complete, but he supposed it to be one of those cases where osteophytes shot out around the joint like stalactites, and thus riveted the parts together; certain it was that when he broke up the adhesion there was a sensation as if such a state of things existed. In relation to the second question, he stated that the principle upon which the instrument was applied was to permit motion in order to take exercise before the disease was entirely cured, and prevent the return of the disease by pressure, and the crowding of the two synovial surfaces against one another.

DR. WATSON then moved that the subject for discussion be continued the next meeting.

The Academy then adjourned.

Recent Inventions.

THE following wood-engravings represent an apparatus for the application of gases, vapors, and chloroform, invented by Mr. S. E. Smith, Surgeon to the National Ear Institution, London, editor of the "London Medical Review:"

This instrument has been most successfully used by Mr. Smith in the treatment of chronic inflammatory diseases of the middle ear, by means of the application of gases, vapors, etc., to the tympanum through the Eustachian tube; more No. I.