Contraction of the pupils is one of the early symptoms of tabes dorsalis. It is met with also at the beginning of meningitis, in opium poisoning, and in the first stage of chloral poisoning. Deformation of the pupil, particularly after the injection of atropine, indicates an old iritis, in nine cases out of ten, of syphilitic origin, if not depending on some disease of the neighboring parts. Cataract in subjects under say forty or fifty, is frequently of diabetic origin, and constitutes soft cataract. Finally, the ophthalmoscope enables us to recognize the retinitis of albuminuria in Bright's disease, of simple polyuria, and sometimes in the case of women during pregnancy. Retinal hemorrhages, cedema of the retina, and embol ism of its central artery, are sometimes met with in organic affections of the heart. Optic neuritis and perineuritis and atrophy of the disc are symptoms of syphilis, or of tumors in the neighborhood of the cerebellum or the corpora quadrigemina.-Phil. Med. & Surg. Reporter. ON HERPES FACIALIS. The following extract is from a lecture by Dr. J. M. Finny, published in the Medical Press and Circular : cular complication of fever was ever one of serious import. The most extensive case of facial herpes I ever met with occurred in a patient,aged sixtysix, who was admitted to this hospital in 1879, for pneumonia, as the whole of his right cheek, extending from the zygomatic arch to the nose was one mass of herpetic clusters, which became confluent. He made a rapid and good recovery. Notwithstanding the frequency of the favorable issue of pneumonia attended by herpes, I would not have you lay too much stress upon the value attaching to this symptomatic rash, inasmuch as most cases of sthenic pneumonia have a tendency to recovery, and many cases in which herpetic rashes are absent do equally well. The ordinary cases of facial herpes present no difficulties of diagnosis, but you should remember it may attack the mucous membrane of the mouth and palate. Should it be confined to these places, you may find some diffi culty in recognizing the disease. Within the last couple of months I came across a rather puzzling case of herpes, in consultation with Dr. Wm. Lane, in the person of a well-known clergyman of this city. The whole soft palate, uvula, and arches of the palate were studded with vesicles standing on a reddened base. At first sight scarlatina or diphtheritic inflammation passed through my Herpes facialis-a better name than herpes mind; but the absence of the characteristics labialis-is met with most usually on the lips, of those diseases, and the presence of a most at the muco-cutaneous juncture; but it occurs copious vesicular eruption on the alæ and doralso on cheeks, ears, and nose. Though an sum nasi, the upper lip, and the adjoining suraccompaniment of an ordinary cold or dyspep- faces of the cheeks and chin, made the diagtic attack, herpes facialis is present in pneu-nosis easy.-Phil. Med. & Surg. Reporter. monia, cerebro spinal, intermittent, and scarlet fevers. During the present session you have seen it in both scarlet fever and pneumonia, and you will recollect the different significance which may be attributed to it in these two diseases. In the latter, so usually do the patients who present it recover that some authorities consider it a most favorable prognostic; while in scarlet fever it is an omen of a severe type, in which nasal discharges, arthritic complications, and a prolonged fever may be expected. The late Dr. Stokes used to lay down, as a maxim worthy of note, that a vesi DR. WARBURTON BEGBIE'S prescription for troublesome cough, with copious expectoration in Phthisis : M B Liq. Morphiæ Hydrochlor. Acid. Hydrocyanic. dil. ãã m xviij. Acid. Nitric. dil. Glycerine.... Infus. Quassiæ...... āā 3j. ziij. 3ij. A sixth part to be taken three or four times. a day. In this mixture, Dr. Lauder Brunton says in a letter to the London Lancet: "We find the sedatives, morphia, hydrocyanic acid, and chloroform, to lessen the excitability of the respiratory centres; we find glycerine, which will tend to retain the sedatives for a longer time in contact with the back of the throat, and will also act to some extent as a nutrient. We have combined with these nitric acid and quassia, which have so-called tonic action in the stomach." The nitric acid will diminish the pulmonary secretion and therefore expectoration; but on the other hand, when as under certain circumstances is the case, the cough is very troublesome with insufficient secretion and expectoration, potash has a marked effect in rendering the pulmonary secretion more fluid and abundant. This effect of potash is specially referred to by Dr. Andrew Clark. the iodoform. It is slightly stimulant as well as antiseptic, and must, therefore, be restricted to cases requiring some stimulation. I can well believe that it would be efficacious in impetigo contagiosa, by destroying the micro-organism on which the inoculability of the disease probably depends; but the less unpleasant ammoniated mercury ointment will be preferred by most, as it is so very efficient.-H. Radcliffe Crocker, M.D., 28 Welbeck Street, Physician to the Skin Department, University College Hospital.British Medical Journal. Surgery. IODOFORM IN SKIN DISEASES. The idea of using iodoform in the treatment of skin-diseases other than those due to syphilis has occurred to others as well as to Dr. Balmanno Squire. For some time past, it has been employed at University College Hospital: first by my colleague Mr. Godlee, and subsequently by myself. He had used it, in combination with the oil of eucalyptus, in some cases of eczema, and in lupus after erasion; the formula most used being iodoform gr. x, oil of eucalyptus 3ss to 3j, vaseline 3j. I have used the iodoform without the eucalyptus with success in some cases of subacute eczema, mainly on the back of the hands and forearms; in suitable cases, the result was often very rapid. I have now a boy under my care with eczema of the head, in which there was a profuse sero-purulent discharge, which became offensive in a short time ; to this, an ointment, with ten grains of iodoform to the ounce of lard, was applied, speedily removing all fœtor, and reducing the discharge to serous only. It was, however, rather too stimulating at this stage to be continued long. Its penetrating and disagreeable odour necessarily limits its employment, though the oil of eucalyptus partially obviates this, besides increasing the solubility of Burgundy pitch... 3 x; Gum dammar...... 3 x; 40.00 66 Melt them together and form into sticks from one-fourth to three-fourths inch in diameter, and two to three inches long. The hair having been cropped short, the stick is applied with a slight rotary or twisting motion, and after a few minutes removed by bending it sidewise, by which movement the hair adhering to it will be withdrawn. The hairs thus left on the stick are burned off. In ringworm of the scalp the disease renders the hairs so brittle that they will break before being pulled out, so that the method will not be applicable in this disease. Mr. John Croft has been elected to the recently instituted chair of Clinical Surgery in of Cambridge, has succeeded to Dr. Greenfield, St. Thomas' Hospital, London. Dr. C. S. Roy in the Brown Institution. The rare occurrence of the simultaneous occupancy of the Presidential chairs of the Royal Colleges of Physicians and Surgeons, by members of one hospital and school, was this year celebrated by a banquet given to Sir William Jenner, and Mr. Erichsen, by their colleagues at University College. Midwifery. RUPTURE OF THE FERINEUM. THOS. A. ASHBY, BALTIMore. 1. The question of " support and non-support" must be determined by the condition of the perineum. 2. An attempt to preserve the integrity of the perineum may, under some circumstances, be attended with greater injury to both mother and child than a rupture. The lesion of greatest consequence to both mother and child must be considered. 3. The forceps, if carefully used, are of great aid in preventing lacerations, and should be employed to assist in extending and delivering the head when the condition of the perineum strongly opposes or arrests its passage. 4. The administration of ergot before the head has been brought to bear upon the perineum may give rise to violent expulsive effort and force a rupture of this body. 5. Lacerations play an important part in the induction of bodily and mental disease, and should be recognized at the time of their occurrence with a view of determining the necessity for surgical closure. 6. Perineal lacerations, even when simple in character, ought, as a rule, to be closed by primary union.-Maryland Medical Journal. CHLORAL IN LABOUR. 6. The slight delirium that sometimes occurs is ordinarily removed by a second dose and need cause no alarm. 7. It is rarely necessary to use more than 3j. in any one confinement. 8. It is best given by the rectum, in the form of enemata or suppositories.-St. Louis Courier of Medicine. [Care should be taken that the chloral is pure.—ED.] Correspondence. To the Editor of the CANADIAN JOURNAL OF MEDICAL SCIENCE. DEAR SIR, The Ontario Medical Council in its mightiness has decided that the most “inexpensive method" of licensing homœopaths is to pitchfork them into a quasi-security by a farcical examination. In our profession "good men and true" strive to act up to the motto "Miseris succurrere disco;" but surely the member of the Council and his followers who advocated the "inexpensive method" have (unwittingly of course) misapplied the motto, and placed the would-be licensed in the place of those who may be tempted by the M. C. P. & S. O., to entrust their health to his licensed treatment. Yours, VACUUS VIATOR. Messrs. Wm. Wood & Co., the well-known New York medical publishers, have issued a special edition of their catalogue, beautifully Dr. Kane formulates the following propo- printed and elegantly bound in blue satin with sitions : 1. Chloral may be employed in normal labor for the purpose of blunting sensibility, quieting nervous and hysterical manifestations, shorten ing labor, and destroying pains. gilt edges, containing in addition to a list of their works the daily programme of the International Medical Congress of 1881, and a number of blank pages designed for annotations and memoranda. A copy is presented to each 2. In complicated labour it has three uses, delegate to the Congress. i. e. (a) to relieve pain; (5) to hasten dilatation of the os uteri; and (c) to increase the force of the uterine contractions. 3. Chloral, even when pushed to the production of anesthesia, does not destroy the force of the uterine contractions. Henry A. De Lom, of the Toronto and St. Thomas' Hospital, has passed the Primary Examination of the Royal College of Surgeons. The Bill requiring New York and Brooklyn 4. The alleged danger of post-partum hem- plumbers to be registered, and to subject all orrhage has no foundation in fact. 5. In moderate doses it is never dangerous. their work to the inspection of the City Health Board has become law. PRESIDENTIAL ADDRESS. BY WM. CANNIFF, M.D., M. R. C. S. ENG. Delivered before the CANADA MEDICAL ASSOCIATION, in Halifax, N.S., on 3rd August, 1881. I do GENTLEMEN,—It is customary for the President at each annual meeting to deliver an address upon some topic which he may select, bearing upon the subject of medicine, or matters appertaining to the interests and welfare of the Canada Medical Association. not expect to bring to my task the ability and eloquence which characterized the address of last year with which we were favored by my distinguished predecessor, nor of any of the learned and prominent gentlemen who have graced the chair since the organization of the Association. But it is my duty to meet your expectations on the present occasion so far as may be in my power. Before I proceed I wish to express my thanks for the honor the Association conferred upon me by placing me in the position I occupy to-day, an honor which I feel is greatly enhanced by the fact that I succeed one so eminently gifted, so universally esteemed, and in every way so worthy of the position. Of course, it makes it more difficult for me to follow one thus fitted for the duties of presiding officer; but trusting to your good nature and charity, I will at once proceed to the subject-matter of my address. The Code of Medical Ethics of the Canada Medical Association consist of 1. The duties of physicians to their patients, and the obligations of patients to their physicians. 2. The duties of physicians to each other, and to the profession at large. 3. The duties of the profession to the public, and the obligations of the public to the profession. THE DUTIES OF PHYSICIANS TO THEIR PATIENTS. It is one of the first and almost continual difficulties met with by the medical practitioner in administering to the needs of his patients, to give only the necessary attention a case in practice requires, and secure the approbation of his client. On the one hand he wishes to bestow the requisite time and thought necessary to restore the patient or allay pain, as far as the resources of medical science will enable him. On the other hand, he is often fearful that his attention may be considered unnecessarily diligent or prolonged. It is, therefore, most necessary that the physician should be fully imbued with the responsibilities of his office, consider the necessities of the case, and then unhesitatingly devote such time and energy as he believes the case demands, regardless of any other consideration. At the same time it is not improper for him to exceed what he may think necessary should the patient wish to have extra attention. When two or more cases simultaneously claim the attention of the physician, he is bound to give the most urgent his first consideration, irrespective of the position of the patient, unless relieved of responsibility by another After some consideration, I decided, although it is somewhat a departure from the course hitherto pursued, to bring to the attention of the Association and the profession generally afresh the code of Medical Ethics which this Association adopted at its organization, hoping at the same time that the attention of the public might become engaged in a consideration of the mutual obligations and responsibilities rest-practitioner. ing upon the medical profession and the public at large. Perhaps I could not have done better than simply to have read the Code as it is found in the ransactions of the Association; but there are some facts, some points, and some considerations not referred to in the Code with which it may be desirable to deal. And I shall take the liberty of clothing some of the ideas contained in the Code in fresh language, although it may not possess the same lucidity and conciseness. The response of the physician to a professional call should always be prompt, notwithstanding the fact that he is too often summoned in unnecessary haste and put to great inconvenience, when he might safely have made the required call in his ordinary daily round of duties. Those who have had experience know full well that there are some thoughtless or selfish people who, when they have decided to call in the doctor, desire him to neglect every one else, and come at once with all possible speed, re gardless of his other duties and obligations, or his own convenience. But the physician who feels the duty he owes to those who confide in his care, will charitably make allowance for the natural anxiety which has culminated in his services being sought, and should betray no annoyance because he may have been called with unnecessary haste, and has had his arrangements for the day, perhaps, destroyed. At such times not only the sick, but the sick one's family, may not be quite responsible for their precipitate conduct. Under all circumstances, the demeanour of the physician should be calm and his words tranquil. He must not be gloomy at any time but treat the case with a smile and all the quietness of manner it will permit. The physician should ever come into the sick chamber as a sunbeam, never as a thundercloud. Again, he ought to be natural in his manner. No two are alike, and every one has his peculiarities; and for one physician to try to pattern after another, is to detract from his self-reliance, and diminish his usefulness. I trust it is unnecessary for me to say to the members of the Canada Medical Association that it belongs exclusively to the charlatan to magnify the danger or nature of the disase he is called to treat, so that the recovery which will follow, perhaps would follow without treat ment, may seem to betoken great skill on his part. The most skillful and observant physician is often unable at first to determine the nature of the malady he has to contend with; but it is no disparagement in the minds of the ordinarily enlightened public to honestly state he is as yet unable to say positively what may be the matter. Now and again we have to endure annoyance after expressing our opinion candidly at the bed-side, wishing to conceal nothing from the patient, by a member of the family, in an outer room, or at the gate, or, it may be, by a neighbour on the road, asking the question, "Now what is your opinion? I will not tell any one." But an ever-repeated reply, that you have already given your opinion to the patient, will in time educate the public that you do not tell two stories. Of course there are occasionally cases when you cannot state fully your views in the presence of the patient; but it is a safe and proper rule to conceal nothing from him. He should know the worst as well as the best, especially when you think he is sick unto death. It is wrong to deceive, and a mistaken view that for him to learn and understand the danger, will militate against recovery. To allow one to approach the dark valley, ignorant of the terrible and solemn fact is, in my opinion, inexcusable. On this point I am somewhat at variance with what is laid down in the Code; but I have no hesitation in saying, from experience I believe that the course I have recommended can be pursued without discouraging the patient, depressing his spirits, increasing the danger, or hastening a fatal end. doubt "the life of a sick person can be shortened, not only by the acts, but also by the words, or the manner of a physician," as stated in the Code; but the considerate physician can so blend a true statement of the case with every reasonable ground of hope that no additional element of danger will result. No The relationship between physician and patient is one of confidence and trust. Fidelity and honor as the custodian of secrets connected with the patient, are strictly to be observed. To betray such confidence, or in any way refer to him, so that even an injurious construction can be placed upon your words is a violation of confidence. Yet, at times, it may be difficult to observe so manifest a rule of duty. In illustration, permit me to refer to an instance in my own experience. Not very long ago while in professional attendance upon a respect able employee in a leading hotel I declined to answer all the questions of the manager as to the nature of the illness, (it was not a question of contagion) whereupon I received a threat of expulsion from the building. Moreover, to quote the language of the code, "The obligation to secrecy extends beyond the period of professional services; no circumstance connected with the privacies of personal or domestic life, infirmities of disposition, or stain of character, observed during professional attendance, should ever be divulged by the physician, except when he is imperatively required to do so." |