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the boat before Providence, a small boat came off telling us we could not and should not land. They would have no intercourse with New York. We protested, but in yain. Various messages passed between us and the town authorities. Whilst the latter were deliberating, a crowd of excited citizens surrounded the building, and declared that none should land. Finally, it was told to us that the coach would be allowed to take us up at Seekonk, on the other side of the river. Seekonk is in Massachusetts, and that State might take care of itself; but none coming from New York should traverse Rhode Island. We retreated to Seekonk, and got back to Boston about midnight. The next day we reported to the city council. Our report was so unfavorable that its worst parts were not allowed to appear in print, for fear of exciting a panic in Boston.'
“I referred again to the memorable fact that, while all else were flying from the pestilence, the physicians stood bravely at their posts. He added this noble tribute to our profession. During my life, I never have seen a medical man refuse to attend upon any case, however dangerous, when he alone was concerned. Where he would be liable to carry contagion to any other patient, he would of course decline, and thereby resign virtually his practice. Then, as if thinking that, as a general rule, no physicians ever regard personal danger when called to one sick, he added: 'I can truly say that, while in New York, the thought of danger to myself never once occurred to me.'
"I spoke of the modern ideas involved in the expression State or Preventive Medicine.'
• Epidemics usually,' he said, “have been short, though at times severe, and when finished the people feel relieved, but have taken no measures of prevention for the future.' To the thought of state or preventive medicine, as at present understood, his mind had evidently not been led. Probably this was natural, because his life-work had been simply to destroy our sovereign faith in drugs, and to fasten the belief that diseases once produced would in many, perhaps in most, instances run their course, and that the most that physic (using the term in its widest sense) could do would be to relieve and palliate the more prominent symptoms. In other words, his labors, after resiguing bis professorship of materia medica were, first, utterly to break down what little confidence he had given us in the materia medica; and, second, to inculcate in us a love of nature as the curer of disease by self-limitation.
" Thus about twenty-five years after listening to Rush did Dr. Bigelow propound opinions precisely the reverse of those of his great master upon the relative merits of nature and of art, as handmaids to the physician. Neither Rush nor Bigelow seized the modern idea of state preventive medicine. In our conversation, I thought I recognized that fact, and I tried to unravel before him my views of the matter. I spoke earnestly, because I believed warmly in the future success of that idea, now just beginning to germinate in this country and in Europe. He listened attentively, and when I had described how much I hoped from the study, under the power of the State, of the causes of disease and for the prevention of them, he chuckled as he lay in bed, and looked like his old self, when enjoying a quiet joke. I said nothing, but expected something racy from his clear head. His assertions had been, at times, B0 pungent, so precise, and generally so true that I thought, from his manner while listening to my remarks, I should get some reply a little grotesque, perhaps ; but I did not expect so much of genuine good sense as is contained in the following sentences, which were poured forth with the greatest deliberation, but without the least change or hesitancy of speech:
"* Preventive medicine! Well, doctor, you lay out a wide field! You will have to prevent intemperance! How can you prevent the imprudent exposare of inen and women ? You will have to teach them what common sense calls prudence. For example, suppose a public ball or public dinner; how prerent men and women from running into that fire ? You will need almost despotic power to do that. Then, if you should attempt to use your power, you would have fifty thousand opponents to rise up against you to prevent your orders from being carried out.' Here he remained silent, and then quietly brought out the following most wise culmination of all our talk : “All that can be done will be to try to open the eyes of the people to the dangers which surround them, by a candid exposition of the facts and of their consequences.' And perhaps that is really all that can be done, but even that is a rastly nobler, if a heavier, task than to carry on contests like those of preceding ages for the support of many theories, set up by one great leader after another, each and all to be knocked down by their successors.
“I left Dr. Bigelow after a two hours' conversation with him, deeply impressed with his really very able mind, which at the age of ninety was so clear, $0 sagacious, so witty, and so precise in thought and in the choice of words to express those thoughts. I had spent a most delightful morning, away from the turmoil of the hour, in the presence of a representative of the past, of one capable of comparing from his own experience the thoughts of almost the beginning and end of our centennial period. After bidding him good-by I talked, a little while, with members of his family. As I had been led to respect him by what I had previously known of him as a physician and a man, and as I saw him on his bed of helplessness, so I was led to hold him in still higher honor when I learned the following facts: He began to be blind in 1870, and he had been totally blind for more than two years.
In 1873 he had a slight hemiplegia, and though previously able to walk about under the guidance of an attendant, be had, since that time, been wholly confined to his bed. And he was becoming still more helpless every year. He made no complaints, though he said jokingly to Dr. Storer a few months since, • To live till one is ninety is not what it is cracked up to be.' He never gave any expression of unhappiness in the presence of others. He had some one to read to him daily, and thus had not allowed his mind to become dull, morose, or stupid by feeding upon its own lot. In fact, as one of his family expressed herself very graphically and charmingly, his deportment is so sweet and gentle on all occasions that his friends almost forget that he is so helpless and so permanent an invalid. He sleeps often in the day, and quietly like a child at night. I asked what he said of his thoughts of a hereafter. The reply was: 'He rarely speaks upon the subject, and dislikes to talk of theological doctrines, even of Christianity. But his faith in God is unbounded. He says, “ I believe; help thou my unbelief.” He believes in and hopes for immortal life.'”
At the conclusion of Dr. Bowditch's remarks the resolutions were unanimously adopted, and the society then adjourned.
PROCEEDINGS OF THE BOSTON SOCIETY FOR MEDICAL
A. M. SUMNER, M. D., SECRETARY.
MAY 6, 1878. Chest Expansion in Pleurisy.--DR. CALVIN ELLIS showed
, an instrument for testing the expansion of the chest which proved the fallacy of the non-expansion theory in cases of pleurisy with effusion. He said that in obserring a certain number of cases the diminution of motion so generally described was not seen. But for the purpose of measuring the exact amount of expansion, he arranged an apparatus which showed upon a scale the relative expansion of various parts of the chest. The application of this in a case of pleurisy, where the effusion rose as high as the second rib, gave the following results : In the axillary region, about midway, over the pectoral muscles and under the clavicles, on both sides the expansion was the same. With the aid of this, or some siinilar instrument, in a sufficient number of cases, the exact amount of movement could be easily ascertained.
Dr. Bowditch asked if he had ever tried the instrument on the lower angle of the scapula, because, from what he had seen in cases of pleurisy with large effusion, there seemed to be a decided difference between the expansion of the two sides at this point.
Dr. Ellis stated that he did not apply it there in the present case, as the patient was lying on his back in bed.
Dr. BOWDITCH spoke of a case he had seen with Dr. J. G. Blake. The patient, a male, had come from one of the New York hospitals, wbere he had been told that there was fluid in his chest, but the physicians did not approve of tapping. He had been sick for some months, and the fluid seemed to be in small quantily, the flatness being below the angle of the scapula. Dr. Bowditch did not examine in reference to the pleuritic line, which is one of the most striking diagnostic points in pleurisy. There was fine crepitation in various parts of the lung, front and back; very little expectoration, with great dyspnea. He considered it a case of inflammatory action of a chronic character, the lung as well as the pleura being involved. The chest was tapped May 30, between the eighth and ninth ribs below the angle of the scapula, where crepitus could be heard. Three pints of fluid were drawn off, with great relief, and there has been no return of the fluid. Dr. Bowditch spoke of another case, where there was gurgling and what seemed to be a cavity. The chest was tapped, and a quantity of pus was withdrawn, with relief. Dr. Bow. ditch wished to lay particular stress on the importance of tapping in that class of cases in wliich oftentimes one would think that he was pushing the needle into the lung instead of fluid, but in these cases there have always been the dead flatness of pleuritic effusion, orthopnea, and perhaps other severe general symptoms.
DR. TARBELL wished to ask Dr. Ellis if, in the case he spoke of, he believed, by other evidence than the instrument, that the affected side expanded as much as the well one. He asked this question on account of the many inaccuracies which might creep into the investigation on account of the patient's back not
being supported, or by too great pressure by the patient on the instrument. He stated that he was not a believer in the inmobility of the chest in pleurisy.
Dr. Ellis replied that he had other evidence. He considered it very important that the patient's back should be kept immovable by support. He first arranged an ordinary syringe in such a manner that the expansion of the chest acted upon a column of water, and showed upon a scale the amount of variation. He then tried two india-rubber bulbs, like those of the Davidson's syringe, without any effect upon the column of water ; this failure was found to be owing to the fact that the ovoid bulbs changed their form under pressure without a change of capacity. And, finally, the apparatus shown was found to be the most efficient.
Typhoid Fever. — The regular reader for the evening, Dr. C. E. STEDMAN, then read a paper entitled One Hundred and Fifty Cases of Typhoid Fever, which is reserved for publication.
Dr. H. W. Williams spoke of patients' distaste for alcohol, on the recovery from typhoid fever, having taken large quantities during the illness. He mentioned a case that came under his observation, where the patient had been in the habit of taking half a bottle of brandy a day for a long time without any unpleasant effects, but on recovery not even a drachm could be borne.
Dr. Stedman, in reply to Dr. Ingalls, said that the youngest patient that had come under his care last summer sick with typhoid fever was two years old. Small children almost always did well. In the list of cases which he had just read, all children recovered, except one, who died from perforation of the gall-bladder.
Dr. Bowditch wished to ask about the case reported where death ensued from rupture of the gall-bladder, and yet the case was set down as typhoid fever. At the autopsy, were the characteristic lesions due to typhoid fever found ?
DR. STEDJAN replied that they were not, except some enlargement of Peyer's patches, but that there was elevated temperature.
Dr. Bowditch remarked that rupture of the gall-bladder in typhoid fever was of very rare occurrence.
Dr. STEDMAN said that all the other members of the same family were brought into the liospital sick with typhoid fever, and so he classed this case as
Ten Cases of Melancholia. DR. J. B. Ayer read a paper entitled Ten Typical Cases of Melancholia.
Nine were seen at the McLean Asylum and one in private practice. All were married men. Insanity manifested itself at a late period in these cases, — it appeared between the ages of thirty-one and sixty-two. Four of the cases were between fifty and sixty. Five had out-of-door pursuits, and five were sedentary in their babits and business. All were industrions when well. In most of the cases the invasion was gradual. The exciting causes were, in order of frequency: (1.) Worry lest accounts were not kept properly. (2.) Loss of property. (3.) Partial sunstroke. (4.) Overwork in counting-room. (5.) Inability to find employment. (6.) Inability to work on account of failing cyesight. (7.) Worry on account of wife's drunkenness.
In five of the cases there was hereditary tendency, and the patients had previously been more or less peculiar. In six cases out of eight the symptoms appeared between May Ist and September 1st.
Three were suicidal or homicidal cases, and threo of the others were suspected. Probably hallucinations and delusions existed in every case, but the patients rarely revealed them. Occasionally, when thrown off their guard, they would admit that they were guided by voices which directed them to do penance, abstain from food, etc. One patient who was pressed very hard to tell why he would not eat without compulsion, although he was very hungry, finally said, " It's God's food; I must not eat it.” These patients were invariably worse in the morning. As far as I know, all their attempts at suicide or homicide were made early in the day, sometimes on waking out of a sound sleep. Two of the patients have apparently recovered, and have attended to business for upwards of a year. In two there were relapses. One, who was removed from the asylum after five months there, continued to improve for a while, but in four months became dull, despondent, and irritable again, and was returned. He is now improving. The other patient was taken ill in 1864, and recovered in twenty-one months. He attended to business, and was considered well for ten and a half years, then became suddenly depressed, was brought back to the asylum, and died a year later in an attack of angina pectoris. With one remarkable exception the cases of long standing became gradually demented, the physical condition at the same time often improving. The patient referred to is a typical case of melancholia ; but while avoiding companionship he reads incessantly, is thoroughly well informed, and retains full possession of his faculties. A recent contributor to the British Medical Journal asserts that the “insane lose the power of weeping, and only with returning reason can unloose the fountain of their tears." This is entirely opposed to my experience. Three of the cases mentioned have frequently shed tears, although at the time their prospect of recovery was extremely small.
As to treatment, tonics were always indicated, generally citrate of quinine and iron with lime; frequently dilute phosphoric acid, twenty or thirty minims, or Horsford's acid phosphate, from half a drachm to a drachm, was added to cach dose, with doubtful benefit. It was often necessary to add fluid extract of rhubarb or fluid extract of senna to each dose of the tonic.
In cases of subacute melancholia, where the patient was not in a condition of stupor, morphia in doses of one sixth to one third of a grain thrice daily, and a double dose at bed. rime, for months often acted as a nervous tonic without manifesting to any great degree the usual disagrecable effects. For excitement combined with sleeplessness, chloral with bromide of potash, of each ten to twenty grains cvery hour and a half to two hours, worked well. Except when cerebral congestion existed, bromide of potash did not benefit. Dr. Jelly states that bromide of potash given to patients suffering from melancholia for a length of time often has a very injurious and depressing effect. When patients began to improve they would still remain restless at night. It was necessary to change the sedatives, or to give them in new combination. Hyoscyamus often did well for a few nights. In one convales cent case a bottle of lager at bedtime was better than medicine. The patients were required to take sufficient food. The danger from inanition was seen to be so great that they were compelled to take three full meals daily, and at times they were fed through the stomach tube. I made repeated efforts to get them interested in matters apart from themselves, It was hard to make them ride or walk outside the hospital grounds. They did not wish to sce relatives or friends, and took no pleasure in social entertainments. I induced one pa. tient - a professional gardener - to try light work in the garden, but after working a couple of hours he declined to do more.
Another said he had been fond of sawing wood; so I took him to the wood-pile and invited him to work. In a few moments he laid down his saw, and said that he had had enough. As he was a farmer we next tried to interest him in cattle, etc., but without success.
Only one of the cases was treated outside of the asyium. Ile was advised to enter, but his friends refused. It was then recommended that he should buy a farm and become a farmer. This experiment was carried out, and was completely successful. In three or four months he seemed entirely well. Still it was a somewhat dangerous course to try, as he had shown symptoms of a suicidal tendency.