Medical Items and News. prudence having been established by the judgment of the criminal court, condemned the defendant to pay 4,000 francs damages, 1,000 to go to the husband and 3,000 to be put out at interest for the son until he attained his majority.- Union Méd., December 11. ALUMNI ASSOCIATION OF THE ALBANY MEDICAL COLLEGE. We have received a circular addressed to the Alumni of the Albany Medical College, together with a copy of the Constitution and By-Laws of the Alumni Association. The circular requests all gradu out delay, their present addresses, and also those of other graduates with whom they may be acquainted, especially of those in their immediate vicinity." It is proposed making a complete catalogue of the Alumni. CREMATION. The cause of cremation (writes a German correspondent of the British Med. Jour.) appears to be rapidly gaining ground. The merits of the new system of disposing of dead bodies are shortly to be tested by practical experiment in Saxony, the two principal towns of which, Dresden and Leipzig, have offered to legalize it, as an optional course, supposing its ad-ates to send to the Secretary, Willis G. Tucker,withvocates can practically make good their assertions in its favor. A furnace for cremation is now actually in process of construction by Herr Friedrich Dremens, a Civil Engineer. Its cost is estimated at 5,000 marks, or £250; and it is calculated that the complete combustion of a human corpse will take about an hour. The number of persons who have enrolled themselves as members of the Cremation Society in Zürich amounts to at least four hundred. Professor Weith has gone to Italy, to consult with the professors there who are engaged in studying the practical methods of burning the body. A Philadelphia paper of the 19th inst. contains a long account of an instance of cremation in that city. A physician, whose son died on the Tuesday previous, erected a furnace in the cellar of his house, and reduced the body to ashes. DR. B. W. MCCREADY.—(Extract from minutes of Medical Board of Bellevue Hospital.)—Dr. Clark, Chair man of the Committee on the resignation of Dr. McCready, presented the following report:— The Medical Board of Bellevue Hospital cannot part with their long-tried and so worthy associate, Dr. Benj. McCready, without expressing their regret that he has found himself compelled by resignation to sunder official relations which have been in a high degree agreeable and profitable to all its members. In twenty-five years of associated labor they have learned to aprpeciate him as a scholar, a learned and skilful physician and a gentleman. The example of his punctuality in duty, the application of his large stores of medical knowledge to the relief of the sick, his wise counsels in the management of the hospital, his uniform courtesy to all his colleagues, his kindness and devotion to the sick under his charge, the climical instruction by which he has greatly aided in forming and storing the minds of the hospital pupils and his professional eminence are the prosperity of the institution, and make up part of its history. In his retirement from hospital duties he takes with him the highest respects and the best wishes of this Board. ACTION AT LAW FOR A DEATH FROM CHLOROFORM. -A Madame Caron some months since was taken by her husband to a dentist at Lille, to have a tooth drawn. Chloroform was administered in his presence, and his unfortunate wife died. The dentist was condemned by the Criminal Tribunal at Lille to a month's imprisonment and 500 francs fine for "homicide by imprudence." On appeal, the imprisonment was struck out of the sentence. Thereupon the husband, although he had completely authorized the use of the chloroform, brought a civil action for damages, demanding 20,000 francs in his own interest and that of a son, a minor. The tribunal, considering the fact of homicide by im HOSPITAL APPOINTMENTS.--The following is a list of the recent appointments to the resident staff of Bellevue and Charity Hospitals: Assistant; Geo. F. Bates, M.D., G.M. Stoeckel, M.D. Charity: Dr. M. A. Alvarez, J. R. Joininez, Nicholas C. Jobs, Francis Hustase, Wm. D. Spencer, James J. Delancy, Edward T. Ely and Edward M. Hill. RETIREMENT OF PROF. HYRTL.-Dr. Hyrtl, the eminent professor of anatomy in the University of Vienna, delivered his final lecture on the morning of the 16th of March, and in the afternoon of the same day met an assemblage of over three thousand pupils and friends, who presented him with addresses and other evidences of esteem. He was the recipient also of over fifty congratulatory telegrams from various parts of the world, and on the following day the municipal council of the city conferred upon him honorary citizenship. New Publications. BOOKS RECEIVED. MANUAL OF TOXICOLOGY, including the Consideration of the Nature, Properties, Effects, and Means of Detection of Poisons, more especially in their medico-legal relations. By JOHN J. REESE, M.D., Prof. Med. Jurisprudence and Toxicology in University of Pa., Phila. : J. B. Lippincott & Co., 1874. EMERGENCIES AND HOW TO TREAT THEM: Etiology, FIGHTY-FIFTH ANNIVERSARY OF THE REGENTS' UNI- LECTURES ON THE DISEASES OF INFANCY AND Child- CATALOUGE OF THE LIBRARY OF THE SURGEON-GEN- Original Communications. Dec. 15. Pulse 104; temperature 974. Vomiting has ceased. I saw him to-day for the first time since the limb was submerged. The water in the bath has been USE OF WARM AND HOT WATER IN changed twice daily. The patient seems cheerful; SURGERY. says he sleeps very well, has no pain in the limb, nor is it particularly tender upon pressure above the line of gangrene. I cannot see that the gangrene las ex BY PROF. FRANK HASTINGS HAMILTON, M.D., tended at all since the present treatment was adopted. NEW YORK. IN the January number for 1873, of the Richmond and Louisville Medical Journal, I have published a paper, originally read before the New York ReadingRoom Association, on the subject of warm water in surgery, and which was summarized in THE MEDICAL RECORD. The paper includes an account of ten cases of surgical accidents and operations, treated mainly by submersion in warm or hot water, with allusion to many other minor examples treated in the same manner at St. Francis' Hospital, the Reception Hospitals, and Bellevue; all occurring under my immediate observation. The practice was first introduced (from the German hospitals) at St. Francis' Hospital of this city by my colleagues and predecessors, all German physicians. The results have proved so remarkable that I felt constrained to place them before the profession. I am now able to add several other cases, and although they include one in which death has resulted, yet my confidence in the plan has not diminished. CASE II.-Traumatic gangrene arrested by hot-water submersion; spontaneous separation of foot and leg on the ninth day after submersion; recovery. Hugh Quigley, æt. 26; admitted to 99th Street Reception Hospital, Dec. 8, 1873, with a fracture of the right leg, caused by the fall of a heavy stone upon the leg about one hour before admission. The bones were broken near the junction of the lower and middle thirds. There was a slight laceration on the inside of the leg; the posterior tibial artery pulsated distinctly. Dr. Delgado, the house-surgeon, applied a roller and placed the limb in a box padded with oakum. Dec. 9. A padded leather splint was applied to the outside of the leg and secured by a roller. Dec. 10. 4.30 P.M., foot found to be cold, congested, and edematous; pulse 130; splint and bandage removed, and limb wrapped in cotton batting, with hot bottles. Dec. 11, I was summoned. There was then no sensation below the point of fracture; the pulsation of the posterior tibiæ had ceased; the leg was swollen and erysipelatous to a point some inches above the knee, and gangrene had extended in patches to about the middle of the leg. it was apparent that the condition of the limb and of the patient were in the highest degree unfavorable for an amputation, which, in case it were made, must be above the knee. Surgeons need not be reminded how seldom an amputation at this period (intermediate), and under these circumstances, is successful. Dr. Delgado, at my suggestion, made several incisions through the gangrenous tissues, and at once placed the limb in a water-bath at a temperature of about 110° Fahrenheit. No medicine. Dec. 12. Pulse 112; temperature 1034. Dec. 13. Pulse 119; temperature 994. Dec. 14. Pulse 114; temperature 1014. Swelling of limb above the fracture increasing. Permanganate of potassa and chloride of zinc put in the water as disinfectants. Stomach rejects food; bowels are constipated; appetite poor. Bicarbonate of bismuth 3i. ter die. Dec. 16. Pulse 90; temperature 98. Dec. 19. The erysipelas has disappeared, and the line of demarcation is formed near the junction of the lower and middle portions of the leg. This is the eleventh day since the injury was received, and the eighth since submersion was employed. With my forceps and scissors I proceeded to trace the separation, and soon found that all the dead tissues were separated, except a portion of the gastrocnemius and soleus, which latter I divided with a knife, low down, and the limb fell off at the point of fracture; the incision of these muscles causing only a moderate hemorrhage from very small vessels. These I tied; neither anaesthetics nor the tourniquet were employed. The stump was then covered with warm-water dressings, supported by a snug roller. Dec. 21. Pulse 92; temperature 100°. Leg again immersed in warm water. Dec. 25. Limb removed from bath. Granulations abundant. Dec. 28. Balsam of Peru substituted for | the water as a dressing. Dec. 30, a small abscess was opened which had formed near the knee; discharged about three ounces of pus. Jan. 24, 1874, I removed the projecting and exfoliated portion of the tibia with my fingers. Jan. 31. Patient sits up in his chair two hours daily, and the stump is closing rapidly. It is quite probable, however, that at some future time it will be necessary to resect portions of both the tibia and fibula, in order to give a proper shape to the stump. I have since made resection, and the stump is nearly well. CASE XII.-Lacerated and contused wound of foot, with fracture of bones, caused by a car-wheel; gangrene and recovery.-Bernard Monahan, æt. 45, admitted to 99th St. Reception Hospital, Jan. 11, 1874, with a compound fracture of the left foot, caused by its having been traversed by a street-car a short time previous to admission. The foot below the tarsus was much lacerated, and several of the bones were broken, The right foot was also slightly injured. On the following day I was summoned to decide the question of amputation. It was determined to employ submersion, in the case of the left foot, with water at a temperature of 100° Fahrenheit. The right foot was enclosed in water-dressings and placed in bed. Jan. 19. Left foot ædematous, but not tender or painful. The second and third phalanges of the second toe have dropped off. Jan. 20. The second and third phalanges of the second toe dropped off. Patient ordered extras, as food and tonics. Foot taken from bath at night. Jan. 31. Right foot is well; left foot granulating and cicatrizing; water-dressings discontinued and balsam of Peru substituted. The condition of the pulse has been recorded each day, and at no time during the progress of the case has it exceeded 80 in the minute. There has been no fever. CASE XIII.-Excision of head of metatarsal bone of great toe for valgus hallux.—Adult male. St. Francis' Hospital. Operation.--February 2, 1874. The patient having been placed under the influence of ether, Dr. Schar lau applied Esmarch's bandage from the toes to the middle of the leg. I then made a crucial incision over the lower portion of the metatarsal bone, rather upon its inner and dorsal aspect. In attempting to pass the chain-saw it was broken, and the section of the bone was made with the bone-cutter; in consequence of which the bone was divided irregularly. After disarticulation of the head the bursa was found to communicate with the joint, and the joint-surfaces were slightly carious. During the operation not one drop of blood appeared in the wound; but there was a slight oozing of serum, which required to be removed once or twice by the sponge. The ligature remained upon the leg about twenty minutes, and when it was removed, quite a free bleeding occurred; which was, however, promptly arrested by the application of carbolic-acid water-ten drops of the saturated solution to an ounce of water. In order to avoid secondary hemorrhage the foot was treated with cool-water dressings until the following morning, when submersion in warm water was sub stituted, and this was continued about two weeks. One small abscess formed and opened upon the top of the foot, about two inches from the wound. In all other respects the progress of the recovery was uninterrupted. March 20, the wound was healed. CASE XIV.-Valgus hallux-Excision of head of metatarsal bone of great toe.-Male, æt. 18, admitted to St. Francis' Hospital, Feb., 1874, with valgus hallux in both feet, which had existed several years. The right foot troubled him most, the integument over the articulation being almost constantly inflamed. It was decided to practise excision only upon this foot. Operation, Feb. 9, 1874, assisted by Drs. Rose and Scharlau. The patient was anæsthetized and Esmarch's bandage applied. The incisions were the same as in the preceding case; but the section of the bone was made with the chain-saw. No blood appeared in the wound until the Esmarch band was removed. The blood then flowed quite freely, but in a few minutes it ceased spontaneously, the total amount of blood lost not exceeding two or three ounces. The wound was treated with cool-water dressings until the following morning, when the warm-water bath was substituted. The bath was used about fourteen days, and warm-water fomentations were then substituted. March 20, the wound was closed and patient was walking about, the progress of the case toward recovery having been from the first uninterrupted. On warm-water submersion. We subsequently learned Jan. 19th. "Hand begins to look a little better; Jan. 22d. Opening made above the wrist to let out pus. 23d. Explored again for pus, but none found. 24th. For the first time the submersion has been continued all night. Jan. 25th. At 5 P.M. the night watchman, in making his rounds, discovered that the hand was bleeding, "which was arrested by the orderly before the acting house-surgeon could arrive (which was in two minutes). Patient had lost very little blood (water in bath hardly tinged), but was terribly frightened." He was informed that he had lost very little blood, but from this moment he failed rapidly and died about three hours later. Remarks. The records of the autopsy cannot be found, but it is understood that there was no evidence of pyæmic infection. The period at which submersion was commenced-the sixth day--renders it apparent that the water treatment had little or no responsibility for the final result. It is my opinion, founded upon my experience in similar cases, that submersion, practised fron the first or second day after the accident, would have saved his life. The following is the record of temperature and heart's action from and after the fourth day: Jan. 16th. (Day of consultation) P.M. Temperature 106°; pulse 120. Jan. 17th. (Fomentations commenced) P.M. Temperature 1064° pulse 108. Jan. 18th. (Slight chill.) Jan. 19th. (Submersion commenced to-day) P.M. Jan. 20th. Temperature 1034°; pulse 112. Jan. 23d. (Explored for pus, none found.) Temperature 100°; pulse 112. Jan. 24th. (In bath all night.) himself at my office with a very large bursa on the back of his hand and forearm-probably seven inches in length by three in breadth, and by which he was completely disabled. CASE XV.-Lacerated wound of hand-Submersion on the seventh day-Death on the thirteenth day.— CASE XVI.-Large bursa of wrist-Incision and subAndrew Bedhman, æt. 27, admitted to Bellevue Hos-mersion-Results negative.-A blacksmith presented pital, Dr. Wood's service, Jan. 12, 1874. His left hand had been caught in a "moulding machine" a few hours before admission, and was "terribly lacerated -in short, all torn to pieces." By advice of Dr. Wood, the acting house-surgeon proceeded at once to amputate the first and third fingers, through the middle of the metacarpal bones, and the second finger at the second joint. Only one or two vessels required the ligature. The hand was then laid upon a splint and dressed with carbolic-acid solution and lint. In February of this year I opened the bursa at two points (at Bellevue Hospital) and had the arm at once submerged in warm water. The openings did not prove to be sufficiently free to allow of easy ingress and egress of water, and the consequence was that when suppuration took place the matter made an exit at two or three other points; but at no time was the inflammatory reaction violent. Jan. 16th. A consultation was called by Dr. Wood, at which I was present. Hand greatly swollen and wounds gaping, foul, and gangrenous; redness and March 25th. The wounds are nearly closed, and it is swelling extending above the wrist; pulse, in the morn-apparent that a cure may be promised. In order to ing of this day, 100; in the afternoon, 120; tempera- compare the results in this case with other similar ture, 106; respiration, 20; patient very despondent. cases, I will mention that about the same time a The period and condition seemed peculiarly unfavor- similar bursa of the arm was opened by one of my able for amputation, and it was decided to employ colleagues at Bellevue, and treated by injection of tinct. of iodine. A very smart inflammatory reaction resulted, with suppuration, and several openings formed for the discharge of pus. A few days since a patient was brought to me by Dr. Cox, of Harlem, with a similar bursa, which had opened spontaneously at various points, and was accompanied with purulent infiltrations between the metacarpal bones. Remarks. On the whole, I am satisfied that of these three examples the case treated by submersion did the best, yet the value of this plan can only be demonstrated when the water has perfectly free ingress and egress. In a like case I would hereafter lay open the whole length of the bursa. Method of Using the Warm- Water Bath. For the arm and hand we have an oblong zinc bath, 23 inches long by 8 inches wide and 8 in depth, with somewhat flaring margins where the arm is to enter, supplied with a movable cover, which leaves an opening for the arm, and provided with a stop-cock to enable us to draw off and renew the water. Along Bath for arm, forearm, and hand. the upper and outer margin of the bath are arranged small wire-pins, upon which pieces of cloth may be fastened for the purpose of suspending the limb. Care must be taken not to allow the limb to rest against the edge of the bath, so as to interfere with the circulation, and it must be carefully adjusted upon a shelf, beside the bed, in such a position as will be most comfortable to the patient. For the lower extremity a zinc bath is used also, somewhat larger, the floor being in the form of an inverted roof, the apex of which is below; the base being represented by the open top of the bath; this latter is provided also with a movable cover. The apex is supported by a wooden frame and horizontal board. This bath is, like the arm-bath, provided with pins for suspension of the limb, and a stop-cock. In the case of the foot-bath, when it is found uncomfortable to project the foot from the side of the bed, the portion of the bed upon which the body reposes is elevated by mattresses, and the bath is placed on the floor of the bedstead. We have not thought it necessary to keep the water at an absolutely uniform temperature, so that its management is left very much to the judgment of the patient or of his attendant; but usually it has been kept at such a temperature as to feel warm to the hand of the attendant-and this is found to be about 95° Fahrenheit. Sufficient uniformity has been attained generally by changing the water three times daily. In case of a recent wound, where secondary hemorrhage is at all liable to occur, the limb is dressed for a few hours with either warm or cold fomentations, and is left reposing in bed; but neither sutures, adhesive plasters, nor bandages are applied. At the expiration of this time either the bath or the warm-water fomentations are commenced, and thereafter employed to lift the limb from the bath, and he generally does systematically. The patient is at liberty at any time this pretty often, to see how it is progressing. The baths in use by us are constructed by Otto & Reynders, surgical instrument-makers, No. 64 Chatham street. In using the fomentations we envelop the wound and limb in several folds of sheet lint or soft old muslin, saturated with warm water, the whole being enclosed in oiled silk or vulcanized rubber. This is changed about once in four or six hours. SUMMARY OF CONCLUSIONS. Effect of Submersion in Warm and Hot Water. No treatment hitherto adopted, under our observation, has been attended with equally favorable results. Under this plan the area of acute inflammation is exceedingly limited; erysipelatous inflammation has been almost uniformly arrested or restrained, when it has actually commenced, and it has never originated after submersion; gangrene has in no instance extended beyond the parts originally injured, and when progressing it has in most cases been speedily arrested (in gangrene hot water, or water at a temperature of from 100° to 110° Fahrenheit, is to be preferred). Septicæmia and pyæmia have not ensued in any case in which submersion has been practised from the first day of the accident. Purulent infiltrations and consecutive abscesses have been infrequent, and always limited to the neighborhood of the parts injured, and of small extent. Traumatic fever, usually present after grave accidents, when other plans of treatment have been pursued, as early as the third or fourth day, has seldom been present when this plan has been adopted, and in no case has the fever been intense or alarming. The phenomena usually observed in cases of recent lacerated or incised wounds, when submerged, are, a sense of comfort, yet not absolute relief from pain; on the second or third day the parts adjacent are swollen, but not much reddened; the integument generally assumes a white and sodden appearance, and with only slight tenderness. On the fifth, sixth, or seventh day the swelling is greater than usually accompanies other plans of treatment; and, with the inexperienced, is likely to excite alarm, but it is found not to be attended with increased tenderness, and it pits under pressure, showing that it is a condition of edema chiefly. At this time the granulations are generally covered with lymph, or some exudate of a whitish color, and which might easily be mistaken for a diphtheritic deposit. At the end of fourteen days, or thereabouts (the period at which, in most cases, we substitute fomentation for submersion), the limb is still oedematous, the granulations are abundant, sometimes presenting a fresh, red appearance, and at others covered with the white exudate.. Effects Ensuing from the Substitution of Fomentation occasionally they have progressed toward recovery in for Submersion. Pursuing the clinical history of these cases, we find that after fomentations are commenced, the oedema - gradually lessens, but its final disappearance is delayed sometimes to a period beyond the complete cicatrization, so that the cicatrix, not unfrequently, is considerably depressed below the level of the sound parts; and we have seen this condition of the parts continue for many months. We observe, also, that the granulations are red and abundant, and that cicatrization progresses as rapidly as under any other plan of treatment; indeed, we are inclined to think that it progresses more rapidly than we are accustomed to see where other plans, considered appropriate, have been adopted. We speak especially of the vigorous appearance of the granulations, and of the cicatrization, because our opinion was, before observing these cases, that warm-water fomentations and warm baths would render granulations weak, pale, and sodden, and retard cicatrization. If such effects have resulted, they must have been presented as rare exceptions, since we have not observed them. After Erysipelas has actually Commenced. We have had very few opportunities of testing warm-water submersion after erysipelas has actually invaded a limb, since at St. Francis', where most of these observations have been made, erysipelas is generally prevented; but in two or three examples, imperfectly managed, at Bellevue Hospital, the results have at least furnished no testimony which would deter us from a further trial. In explanation of this latter statement, relating to Bellevue Hospital, it is necessary to say that, with one exception, the bathingtubs employed were improvised and were imperfect, the amount of attendance during the night is too limited to insure faithful attention to the temperature of the water, the heat of the wards is greatly lowered, and none of the nurses have experience in the management of the baths. Value of Hot Water in Traumatic Gangrene. The power of hot-water baths, or water at or above the normal temperature of the blood, to arrest traumatic gangrene is remarkable; and the writer entertains a hope that its efficiency may not be limited to traumatic gangrene alone, yet this remains to be proven. To what Class of Cases Submersion is especially Applicable. Position of injury. The lower extremities can only be completely and permanently submerged to a point three or four inches below the knee, and the upper extremities to a point a few inches above the elbow; consequently, submersion is limited to those portions of the extremities which are below the points mentioned. Character of injury.-Submersion in warm water demonstrates its superiority over other plans, especially in the case of a laceration or contusion of the hand or of the foot, when the integument and flesh are extensively torn--provided the limb is submerged without closing the wound-that is, without sutures or bandages; indeed, sutures are inadmissible when this plan is adopted, since the oedema which almost inevitably ensues would break away the sutures. Mere contusions, without external lesions, have been treated almost constantly at St. Francis' by this method; and the results have been in all cases satisfactory, and a manner to excite surprise. intention. Simple incised wounds have seldom been subjected to immersion, since it inevitably defeats union by first been treated in this manner, partly for the reason just Nor have wounds caused by amputation given, and partly because of certain apprehensions to the dangers of a secondary hemorrhage where large that the depending position might expose the patient arteries have been severed and are exposed in the wound. always second in value to submersion in the prevenWarm-water fomentations are regarded by us as tion and cure of inflammation, and they are reserved, therefore, for those examples in which submersion for one or another of the reasons already given, cannot properly be employed. fourteenth day in all those cases in which we employ Fomentations are employed by us after about the submersion at first-occasionally, when the patient is weary of the confinement of the bath, the limb is taken out and fomented during the night. We employ fomentations in amputations and other incised wounds when union by first intent is desired; in lacerated and contused wounds which cannot be subjected to immersion; in most examples of old ulcers; in many syphilitic and cancerous sores; in some simple contusions and sprains. In short, to repeat what has been already intimated, with warm water, either in the form of the bath or fomentation, we treat nearly all surgical accidents. Carbolic acid, the chlorinate of soda or lime, and other antiseptics being reserved for very rare and exceptional cases. Unguents, and poultices are almost unknown at St. Francis'. THE USE AND COMPARATIVE MERITS BY BENJ. F. DAWSON, M.D., ETC., NEW YORK. April 17th, 1874.) (Read before the New York Medical Library and Journal Association, WHILE in London during June, 1872, I had the pleasure of being invited by Mr. T. Spencer Wells to assist him in a case of ovariotomy, in which he wished to test the merits of my clamp for the pedicle. Aside from the great skill of this distinguished surgeon, I was much attracted by the appearance and behavior of the patient under the anaesthetic, as well as by the manner in which the latter was administered. In appearance the patient seemed to be in a natural sleep; neither her color nor respiration indicating that she was in a state of unnatural unconsciousness. At the conclusion of the operation I was still more surprised to see how rapidly she recovered consciousness, not more than two minutes elapsing from the painless introduction of the last stitch and complete consciousness, shown by her opening her eyes and addressing Mr. Wells. There was no complaint of either nausea or headache. On inquiry, Mr. Wells informed me that the anæsthetic used was the bichloride of methylene, or chloromethyl, as it is commonly called, and that he had used it for some time in preference to all other anæsthetics, for the reasons I will hereafter mention. On my return home I brought with me a supply of chloromethyl, and the apparatus by which it is gener |