sound than in the judicious and discriminating views which they have promulgated upon the subject of bleeding. Nothing can be more accurate and clear than their counsel upon this subject, and the careful discrimination which they make between the types and forms of disease, and the remedies adapted thereto.

The reviewer relies very much upon evidence furnished by reports of the success of bleeding and tartar emetic in the treatment of pneumonia in certain large European hospitals in 1835 and 1839. I do not give much weight to these reports, first, because in 1835 and 1839 the adynamic type of disease was rapidly gaining ground in large cities especially, (witness Mr. Watson,) and the more so in large hospitals, and secondly, because the treatment of disease in large hospitals is often too much of a perfunctory character.

That modern physicians should deny the correctness of the practice in inflammatory diseases of those able and talented men that have preceded them, because the cases that they now see do not bear the same treatment, reminds me of David Hume's argument against the truth of the miracles of the Bible. He argued that they were utterly incredible, because they were contrary to human experience. That is, they were contrary to his experience; he had not witnessed them; but were they contrary to the experience of the generations that lived in the days of their alleged performance?

It is said that the forests of this part of the country were formerly inhabited by panthers, bears, wolves, deer, and rattlesnakes. But now we have nothing of the kind; nothing larger nor more ferocious than foxes, coons, and opossums. Shall we say that our fathers were mistaken in this matter? that nothing larger nor more ferocious than a fox ever did inhabit them?

During the transition period in the type of disease above alluded to, I experienced some most mortifying failures (as many others have done, and will ever do), from mistaking cases of high irritative fever for inflammatory cases. They mostly consisted of violent attacks of malignant scarlet fever without eruption. Bleeding proved immediately fatal. I will venture this prophecy,

viz., that some time in the future (it may be in twenty, or fifty, or one hundred, or two hundred years) diseases of the purely inflammatory or sthenic type will again become the order of the day. When that time comes, woe be to the practitioner that abhors the lancet!

Post Script.-Let me beg that the reader, in justice to the writers and practitioners above alluded to, will consider carefully the following passages of a few of them. Hundreds of others of a similar character might be pointed out, but let these suffice.

1st. Eberle's Practice of Medicine, Philadelphia, edition 1831, pp. 104 to 107, vol. 1, on treatment of remitting fever, and pp. 139 to 144, on treatment of common continued fever, or synocha and synochus; also, last paragraph, p. 150; and pp. 289 to 291, on treatment of pleurisy and pneumonia.

2d. Watson's Practice, Philadelphia, 1855, pp. 143 to 149, and 970 to 971.

3d. Wood's Practice, Philadelphia, 1850, vol. 1, pp. 224 to 227, and 292 to 293, and 355 to 357.

Now, I state with all the solemnity of one sworn on the Holy Evangelists, that in a thousand instances or more, I have witnessed the perfect accuracy of these writers, both in their descriptions of disease and the correctness of the practice prescribed.

I offer this to the candid consideration of the reader as some offset to the sweeping, most reckless, and irreverent denunciation by the reviewer when he says, "The ancient worthies butchered their victims; modern physicians heal and bless them." I will guarantee that the author of that remark had no acquaintance personally with diseases previous to the year 1840, and probably not before 1850 or -'55.

These ancient worthies testified to what they saw, and modern physicians testify to what they have seen; and doubless the testimony of both, as a general thing, is worthy of all regard. That the science of medicine has made immense strides in the

last forty years, we all know; but let not the modern physician plume himself too much on that, for I do not doubt that if the diseases of former days were suddenly to come upon us the modern would find himself as much at a loss as the ancient worthy would be, who might suddenly awake from a Rip Van Winkle slumber.

ART. III.-OVARIOTOMY IN ENGLAND. READ BEFORE THE LOUISVILLE OBSTETRICAL SOCIETY February 18, 1871, by S. BRANDEIS, M. D., Louisville, Ky.

Dr. Paul Grenser, who is highly distinguished by his publishing the latest and most improved edition of Professor Naegle's Hand-book on Midwifery, has made a trip to England for the purpose of studying the radical treatment of ovarian cyst, and from his report we abstract the following interesting facts:

During a sojourn of six months in England, Dr. G. has witnessed 20 operations for ovarian tumors, of which 16 were completed, while 4 remained uncompleted. Of that number 5 were made by Thomas Keith, 1 by James Simpson, Spencer Wells 12 (6 in Samaritan Hospital and 6 in private practice), Murray 1, Graily Hewitt, 1. From the 16 completed cases 4 died; from the non-completed cases 2 died.

Keith and Wells work both very systematically; they use Spencer Well's note-book on ovarian and abdominal tumors, and report their cases with the greatest accuracy. In this little note-book, twelve pages are devoted to the anamnesis (or previous history), the present state, and diagnosis; four pages to the report of the operation, and the balance to the history of the after treatment. The anamnesis embraces besides the usual questions, hereditary disposition, the earliest signs of the disease, the mode of life, and the influence of habitation upon the

development of the disease, its subjective and objective symptoms; by it is also investigated whether signs of inflammation, suppuration, or rupture of the cyst, have become manifest. For the investigation of the present state of the patient particular attention is paid to the general condition of the catamenia, intestinal canal, the urinary organs, and nervous system; upon which follows the real objective examination. This comprises, first, the measurement around the umbilicus, then its distance from the symphysis pubis, the zyphoid cartilage, and the right and left antero-superior spine of the ilium. Next follows the inspection of the abdomen, and finally percussion and auscultation.

In

Percussion is specially important for the differential diagnosis between free ascites and encysted tumor. Not speaking of the change of posture, Grenser calls attention to a special deception. One will meet with cases with a great collection of free fluid, in which percussion will furnish the appearances of encysted fluid, while the presence of a cyst cannot be distinctly established. such cases, of which Grenser has seen two cases in Mathew Duncan's clinic, in Edinburgh, the so-called profound percussion removes all doubt. If, namely, the plessimeter is pressed down deeply, we will meet with a distinct tympanitic sound, where, previously, the sound was flat and dull, which former will disappear as soon as one percusses superficially. This phenomenon is explained by the shortness of the mesentery, which does not permit the intestines to float upon the surface of the fluid, by which arrangement a portion of the fluid intervenes between the intestines and the abdominal walls; this will give a dull sound on percussion, disappearing forthwith upon depression of the plessimeter, the intestines being then percussed. The shortening of the mesentery can either be natural or pathological, as the result of previous inflammation, in which case the intestines are drawn towards the spine.

Palpation and the discovery of fluctuation by succussion throw light upon existing irritations of the peritoneum, and likewise upon the consistency of the contents of the tumor. The sensa

1

tion of crepitus belong likewise under this heading. If crepitus is felt over various places, it shows that the tumor can be moved and shifted, and is consequently not adherent. Altogether crepitus, or rather friction sound, has lost its great importance as a diagnastic, as the existence of adhesions to the abdominal wall are of no great influence upon the operation.

The discovery of fluctuation throws light upon the nature of the contents and the structure of the tumor (as to its being unilocular or multilocular), but for the diagnosis of an ovarian cyst, it is of only subordinate importance, if other conditions are confirmative; such is the case with tumors with semi-liquid (jelly) contents and multilocular tumors.

Auscultation furnishes results of little importance, even though crepitation, or friction sound can be heard. In order to establish the mobility of the tumor the patient is made to take a long breath-if the tumor is not adherent, the abdominal muscles can be seen gliding over the tumor, while if it is adherent, it will either interfere with the movement of the muscles or will move simultaneously with them. If the patient is made to sit up, the abdominal muscles bulge forward if the tumor is free, which will not be the case if the tumor is adherent. But again, there are instances in which the cyst may have very thin walls and very fluid contents, and if adherent may be pulled upward with the abdominal muscles; the last test is therefore not very reliable.

For the distinction between an ovarian and uterine tumor the sound is used.

In regard to the length of the pedicle, the high standing of the tumor and its mobility is decisive, on the contrary, if it is deepseated and immovable, it is presumed that the pedicle is short, and the tumor adherent to the pelvis. Keith believes that he is able to decide as to the length of the pedicle by introducing one finger into the vagina, while the others are placed over the symphysis, and moving the uterus from the outside.

To determine which ovary is diseased, whether the right or left, is thought to be of little importance. As the puncture is