o'clock, going to bed with one of her sisters. During the night the sister was several times awakened by the extraordinary breathing of the patient, which was very hard and loud. She shook her, and the abnormal breathing ceased. In the morning it was found impossible to awaken her. She was breathing very deeply and slowly, and could not be roused. Physicians were summoned, all of whom pronounced it a case of opium poisoning. The symptoms observed were stertorous breathing, sometimes as slow as four or five per minute, contracted pupils, a suggestion of strabismus, and a rather warm surface. The pulse was remarkably good (about 80), similar to the pulse of a healthy person; the skin was not moist and clammy. The usual measures for opium poisoning were adopted. Mustard was given at once, and as soon as a tube could be procured the stomach was pumped out. Minute doses of atropin were injected hypodermically, the patient receiving about a fortieth of a grain in three injections. The breathing improved very much after these injections, coming up to twelve and fifteen per minute, the pulse also quickened, but suddenly the pulse flickered and went out and breathing stopped. On the following day Drs. Krost and Belfield made a post-mortem examination of the head and abdomen. The brain was not hyperemic, there was no venous congestion; the pupils were widely dilated; the membranes of the brain were adherent to the brain substance, and on stripping close they were found on close examination to be studded with numerous miliary tubercles. On opening the abdominal cavity the intestines bulged out and their surface was thickly studded with miliary tubercles. There was extreme tuberculosis of the peritoneum. The mesenteric glands were large and cheesy. The right ovary contained a rupture cyst about as large as a fist. That the rupture was ante-mortem was evident from the fact that the inner surface of the cyst was intensely congested, and there was a good deal of coagulated blood in its cavity. Dr. Belfield points out that when it is remembered that the pulse was natural, that the surface was not cool and clammy, and that there was a tendency to strabismus, it becomes evident that death resulted from the tuberculosis, aided, perhaps, by rupture of the cyst. No opium could be discovered anywhere around. The patient's general disposition and circumstances were such as to forbid the presumption by her friends that she could have taken poison. The case seems to have been another instance of sudden coma incident to tubercular meningitis. It is of extreme interest as showing how insidious a course miliary tuberculosis of the serous membranes may take. The only abnormal features known to her family was an unusual fullness and hardness of the abdomen developed during the last year of her life. The symptoms hinting at possible tuberculosis were the peculiar breathing (which resembles that described by Trousseau as characteristic of tuberculosis), and the strabismus on which Bristowe lays stress. At the same time it must be remembered that these symptoms exceptionally complicate opium coma. Meningeal tuberculosis in adults is generally secondary to abdominal tuberculosis, and of this there is decided evidence in the peculiar abdominal enlargement observed by the friends long precedent to death. Bacterial tests are certainly of value in these cases, but absence of bacilli does not demonstrate beyond a doubt the absence of tuberculosis, especially since these cases are often ambulant and frequently do not come under observation under circumstances admitting of methods of bacteriologic diagnosis being employed. This was significantly illustrated by the case reported by Dr. Belfield. In view of possible medico-legal complications, it is well, therefore, for the practitioner called to a case of seeming opium poisoning without a clear history to bear in mind the possibility of meningeal tuberculosis. As Dr. Weber indicates, the ptomain of the bacillus tuberculosis plays no small part in determining the symptoms mimicking opium coma. In all probability it is assisted in playing this role by the sudden occurrence of renal inadequacy. Post-Mortems in Medical Teaching. The following is from an embarrassingly fulsome but no doubt truthful appreciation of Prof. Fenger by Dr. Byron Robinson, of Chicago, occuping two full pages of the St. Louis Medical Review. Students who have followed Dr. Fenger in his surgical and pathological work will willingly forgive Dr. Robinson for the warmth of his praise and affection. Autopsy work is receiving due attention in the Medical Colleges in Chicago. Prof. Christian Fenger is the well-recognized systematic instructor in pathological anatomy in America. To his studious efforts hundreds of students for a score of years owe their knowledge of this important subject. No field is richer in undiscovered facts than pathological anatomy. In the general medical college nothing is more defective than its work in post-mortems. In an autopsy twenty years ago Dr. Fenger was seen at his best. He had a peculiar power to hold on to the essentials of a subject, to suggest to students the proper trend of the matter in hand, and to sum up the characteristic features of the fatal illness as shown by the findings in the cadaver. His object was not to fit the autopsic findings to the written clinical history of the patient, but he expressed in a forcible manner the evident and manifest cause of death. He had a very striking characteristic of coming to conclusions analytically, slowly, step by step, until the student at the summation of the autopsy could not be induced to consider the cause of death any other than what Dr. Fenger had pronounced it. All pathologic features of the organs were rapidly scanned, probable errors excluded as quickly as possible, and the chief pathologic characteristics summed up for a final cause of death. In the midst of puzzling autopsic complications he was not easily turned aside by minor details, but held fast to the manifest pathologic anatomy until his diagnosis was reached. He was fearlessly honest as to what he insisted we knew as positive, justifiable conclusions and what was only probable. Dr. Fenger's teachings have produced rational diagnosticians. Autopsic work, i. e., the power to discriminate normal from pathologic anatomy, is the most important factor in a college student's course. The complicated affair seen in the abdomen by a student at an autopsy is apt to inI duce him to perform his first laparotomy with caution. In every department of medicine the student is expected to study and become proficient, but in autopsy work there seems to be an exception. How many scores of young men and women graduate annually without ever having performed a post-mortem, and besides, many graduate without having seen a post-mortem carefully conducted by a competent physician. Such methods cannot produce good diagnosticians. The person who has never done any post-mortem work, and who has not carefully watched while others did it, never rises from his deficiency. Power of Township Trustee to Employ Physician in Indiana. A township trustee is, by Indiana law, made the overseer of the poor of his township. But the power to employ medical and surgical aid for the poor of a township or the county is vested in the Board of County Commissioners. Where there has been an exercise of that power, and suitable provision has been made, the Appellate Court of Indiana points out, in Board of Commissioners v. Galloway, June 2, 1897, it divests the township trustee of power to act, and he has no authority to employ medical aid for the poor of his township, unless the physician employed by the county abandons his contract or refuses to perform it, or is at such a distance that his attendance cannot be readily procured, or an emergency exists, or he lacks the skill and experience necessary to render reasonably efficient services in the case, and the dictates of humanity seem to require immediate action upon the part of the trustee. Even in these exceptional cases a township trustee can only bind the county while he acts within the scope of his authority as the agent of the county. Where a trustee does not act within the scope of his statutory power, and where he has no authority to act at all, he can neither bind his township nor the county. And his agency is of such a character that the court holds all are bound to take notice of its scope and limitations.-Journal American Medical Association, October 9th. By the August 28th number of the Journal of the American Medical Association the medical profession will discover another "puff" of a proprietary article in what should be the representative journal of the profession. The article is by Dr. I. N. Love, of St. Louis, and is credited with having been read before the Section on Materia Medica, Pharmacy and Therapeutics of the American Medical Association. It is somewhat remarkable that the management of the Journal permits matter of this kind to be constantly inserted as original matter. If medical journalism is to maintain a stand at all above mere commercialism, the Journal will have to mend its way materially, as, so long as it prostitutes its pages for cash, it is exceedingly difficult for other journals to do otherwise. The article in question contains much remarkable information, not least among which we may mention the following additions to our nosology: "Obesity diseases" and "stoppage of growth diseases." Of a truth this is fin-desiecle medicine. Cleveland Journal of Medicine, September, 1897. (See also pp. 215-6.) The Journal will publish in its January issue a brief abstract of the inception and history of the Indianapolis City Hospital through the superintendency of Drs. Woolen, Hadley, Marsee, A. W. Davis, McDonald, Van Vorhis, W. H. Davis, W. N. Wishard, J. H. Oliver, Edenharter, C. E. Ferguson, Wright, Nichols, C. E. Ferguson (second term), to the present, with Dr. Poucher in charge. The history of the Hospital is almost the history of medicine in Indianapolis. Dr. Daniel J. Kelly, of Washington, D. C., a graduate of the University of Georgetown in 1875, nearly lost his life, November 10th, from mushroom poisoning. He breakfasted with the Count de Vecchi on these treacherous delicacies. The Count sickened and became unconscious in two hours, and died in fortyeight hours from paralysis of the heart. So rapidly and severely did the poison act that neither of the gentlemen realized the condition or was able to tell the cause of illness. Count Vecchi was a friend of Presidents Lincoln and Harrison, a colonel in the One Hundredth Massachusetts Artillery, and an Italian embassador of wealth and distinction. [There is sufficient danger, it would seem, of mushroom poisoning to prevent their ever becoming a common article of diet in this country. Thousands of bushels are grown in horse manure in the catacombs of Paris and eaten in that city. They are also grown in cellars in Indianapolis. The editor has been regaled with mushrooms, both native and cultivated, by several medical friends who are experts in their preparation, notably Drs. E. F. Hodges and C. I. Fletcher.] An Apparatus for Warming Sprays in Treating The included cut represents a spray-warmer I have had in use for a year. It goes without saying that warm sprays have many advantages over cold, and are without any objecindebted for the tionable features. I am mechanical construction of this spray-warmer to W. A. Heckard, of this city, who worked out the details after my suggestions. It is made of copper, nickel-plated. The lid has six candle-mold tubes projecting into the box to receive the spray bottles. It has two sliding dampers, by which the warmth can be accurately regulated to any degree of heat required, and after once regulated needs no further attention. Ample heat is furnished by a ten or sixteen-candle incandescent lamp. Patients often speak in commendatory terms of the warm as compared with the cold L. C. CLINE. sprays. Willoughby Building. PERSONAL. The "Willoughby," the new office building for physicians and dentists, on Meridian street, between Ohio and New York, erected by Dr. Walling, is now completed and several suites occupied. Dr. George J. Cook, Dr. L. C. Cline, Dr. Marie Haslep, Dr. Lafayette Page, and the dentists, Drs. Hacker and Britton and Blakeman, are already in possession. The building is five stories high, fire-proof, finished in cak and marble. Elevator, steam heat, electric light, hot and cold water, electricity, compressed air, mail boxes, away from street-car racket, restricted to the use of mem'bers of the Marion County Medical Society, rents at twenty-five to fifty dollars a monthit will be the hub of the medical center. Dr. J. R. Jenkins will locate at 20 West Ohio street, Indianapolis, in office with Dr. D. Overly Crist, for the general practice of medicine and surgery. Through the courtesy of Dr. T. A. Mason, of Terre Haute, Ind., the Journal has a copy of the Journal of Osteopathy with its remarkable and mystical cover-page, Vol IV, No. 3, July, 1897. It is amusing, unscientific and mercenary. It is filed among the Journal's curios, with thanks to Dr. Mason, as the Journal does not exchange. Dr. Henry E. Tuley, of Louisville, associate editor of Mathew's Quarterly Journal of Rectal and Gastro-Intestinal Diseases, writes the Journal a note saying that the Nashville meeting of the Mississippi Valley Medical Association will commence the second Tuesday of October, 1898, instead of November, as pre viously announced, so as not to conflict with the date of the regular meeting of the Southern Surgical and Gynecological Association. Dr. Tuley is secretary of the Mississippi Valley Association for 1898. His address is 111 West Kentucky street, Louisville, and not St. Louis, as stated in our November issue. Louisville could not afford to spare Dr. Tuley to St. Louis. Dr. E. L. Larkins, of Terre Haute, has sent the Journal notes of the fifty-first annual meeting of the Esculapian Society of the Wabash Valley, held in Paris, Ill., October 28th of the present year. There were sixty-four present, and they certainly had a good time, as the report shows. The Esculapian is one of the most compact, well-organized and useful district societies in the West. We present most of one of the papers written by a layman, the Hon. E. Callahan, of Robinson, Ill. It is a simply and beautifully written paper on the relations of physicians and lawyers, mainly as regards criminality and the mental capacity of men making wills. It is refreshing to hear a lawyer say that criminals are moved and seduced by the devil. Lombroso and Nordau are not quoted in this paper, as Judge Callahan "was there first." The paper, "Bacteria," by Dr. Barlow, is well worth the attention of our readers. The Denver Meeting of the American Associa tion. The Association Journal, under date of November 20th, says that already the plans of the Committee on Arrangements are more completely developed and farther executed than for any previous meeting at so early a date. Denver is little farther west of the geographical center of population than the coast cities are east. The population is greater than that of Newport, Nashville and Atlanta combined, and accommodations for visitors are ample. Eastern physicians will assemble at Chicago, St. Louis, Kansas City and Omaha, and make the last day's journey over the plains in special trains with cheerful company. There will not be the extensive clinics offered at Philadelphia, but an excellent opportunity will be given for observation of the climate in which tuberculosis is better combated than in any other part of the United States, for there will be excursions to various parts of Colorado and adjacent States. Much depends upon the local committee, and they now claim the meeting will be quite or nearly as large as the Philadelphia meeting. Denver has forty active members of the Association and immediate points enough to make a hundred in number. The number will no doubt be doubled by holding the meeting at Denver; at least such was the effect in California. Colorado has a population of half a million; of these 120,000 are in Denver, and 30,000 in Pueblo, and Colorado Springs 20,000. The State is third in size in the Union, only excelled by Texas and California. Denver has an altitude of 5,200 feet. It is located in in a dry open plain; the rainfall is 15 inches; the sunny days, 340; the average temperature, 49°. The Association meets in Denver, June 7, 1898, and it is none too early for the physicians of Indiana to begin their arrangements for attendance. Indiana has the most perfect medical organization in the United States; it has the largest proportion of members of the Association. The State has been honored twice by the presidency; Dr. Parvin at the first Atlanta meeting, and Dr. Hibberd, of Richmond, at the California meeting. No State has a greater interest or more influence in the Association. Let these facts appear by a large and representative attendance at the Denver meeting. The Ohio Medical Practice Act Sustained by the Supreme Court. Every reputable physician in Indiana will read with interest and gratification the following article from the Columbus Medical Journal of November 9th, as the same questions are involved that will be brought before the Supreme Court of Indiana. This journal has never for a moment doubted that the Indiana Practice Act will stand the final test of State legislation. The Indiana law is the same essentially as that of Ohio and West Virginia. In the latter State the case of Dent versus West Virginia, was carried to the United States Supreme Court (see INDIANA MEDICAL JOURNAL for February, '97, pages 327-8), and this tribunal speaking through Mr. Justice Field, said: The State, in the exercise of its power to provide for the general welfare of its people, may exact from parties, before they can practice medicine, a degree of skill and learning in that profession upon which the community employing their services may confidently rely; and to ascertain whether they have such qualifications require them to obtain a certificate or license from a board or other authority competent to judge in that respect. If the qualifications required are appropriate to the profession and attainable by reasonable study and application, their validity is not subject to objection because of their stringency or difficulty. This decision of Justice Field may be found at length, covering several pages, in 129 U. S., p. 114, and following. It may be found in any law library, and is no doubt familiar to the judges of the Indiana Supreme Court. There is no danger to wise medical legislation as far as the Supreme Court of the United States is concerned The State of Ohio is now safe in the enjoyment of its medical laws. It is to be hoped the Indiana Practice Act may go before our Supreme Court at an early date. The physicians of the State must be on the watch against adverse legislation at the next session. By wise management it may be possible to so amend the present law as to even weed out the advertising charlatans, as has been done in the State of Kentucky. Following is the article in question: The Ohio medical law is constitutional. So the Supreme Court of the State has declared in the case involving the Medical Practice Act, creating the Board of Medical Registration and Examination. This decision was handed down by the court on October 26th. The suit was brought into the Supreme Court on error to the Circuit Court of Sandusky county, and is styled Edson France against the State of Ohio. Dr. France is a resident of Columbus, but was arrested in Sandusky county on the charge of practicing medicine without having been examined or registered by the State Board. He set up the plea that he had been practicing for ten years, which would have made him eligible to continue the practice of medicine under the law. The court found that he had not practiced ten years, and the Supreme Court has affirmed the judgment of the lower court. In the Supreme Court the constitutionality of the law was raised, and the decision of that court sustains the constitutionality of the law. Messrs. Powell, Minahan and Ryan raised the questions: That the law directly prohibits any physician who is a non-resident of Ohio opening an office or practicing his profession within the borders of the State. The act grants special privileges to physi cians who happen to be tipon the borders of some neighboring State by granting them permission to visit patients within the State, but prohibits them from opening an office. All other physicians, non-residents of Ohio, are expressly prohibited from coming into Ohio, practicing their profession, or opening an office, and can only practice when called in consultation with some other physician who is a resident of Ohio. It was also claimed that the law bestowed judicial powers on the Board of Examiners and Registration, and on the Governor and Attorney-General, who are constituted a committee to hear appeals. The syllabi of the court in which the full decision is set forth were handed down on the 29th, and are as follows: 1. The power conferred on the State Board of Medical Registration and Examination, by the act "to regulate the practice of medicine in the State of Ohio" (92 O. L., 44-49,) is administrative in character, and not judicial, within the meaning of Section 1, of Article 4, of the Constitution of the State. 2. The act is prospective in operation, and in no respect obnoxious to Section 10, of Article 1, of the federal constitution, which forbids the enactment of expost facto laws, and bills of attainder, by the States. 3. It is competent for the State, under its power to provide for the welfare of its people, to establish needful regulations, and impose reasonable conditions calculated to insure proper qualifications, both with respect to learning, and moral integrity, of persons desiring to engage in the practice of medicine in the State, and require compliance therewith by such persons before they shall be permitted to practice within the State. The regulations adopted by this statute are of that character, and do not infringe upon those privileges and immunities guaranteed by Section 2, of Article 4, of the federal constitution to citizens in the several States, nor those secured to citizens of the United States by the 14th article of amendment of that constitution. Judgment affirmed. In the argument before the court when the case was presented, October 8th, ex-AttorneyGeneral Richards, as the representative of the Board, made a most able defense of the law, which the court has upheld. The medical profession of Ohio has reason to congratulate itself, as has also the State, as a commonwealth interested in the welfare of its citizens, that the assaults against this law, carried to the court of last resort, have fallen fruitless to the ground. Much quackery has already been driven from the State, and more is to be accomplished in the future. The care that yet remains to us is to see that the enemies of the law shall not succeed in any attempts to annul or emasculate it by amendments introduced in the coming session of the Legislature. |