Case 1st-Foetal, or "Mother's" Marks.-There has long been a variety of opinions among medical writers with regard to the possibility of the child in utero, receiving marks from the mother. Whatever chance there may be for this to happen it is pretty generally supposed that it must be effected, if at all, through the nervous system, and we all know this connection of the mother and child is nearly if not quite deficient. The attempt to account for these changes of structure through the circulatory system also renders the matter very obscure, so that most medical men are inclined to discredit all accounts of the above kind, or at least that portion which refers to the mother for the producing cause. The case here related comes nearer to substantiating the affirmative of this doctrine than any within the personal knowledge of the writer. About January 1st 1870, Mrs. B., a very excellent lady, residing in an interior town in this State, was delivered of a large boy, entirely healthy and natural with the exception of a tumor, or protuberance on its back, between the shoulders, of about the size and general appearance of a scrotum. When this child was about six months of age my attention was called to it by Dr. F. B. Smith, of Owosso, and at that time the tumor was the size of a scrotum, common to a child of that age. The base of this growth, or its attachment to the body, was about one and one-fourth inches in diameter. It had the sacculated or pendulous form of the scrotum and was of the same semi-transparent texture. About its upper margin was to be seen the rudiment of a penis with numerous short hairs. 21-July The mother's explanation of this curious affair was as follows: about the fifth month of her pregnancy her husband was poisoned with Sumach which affected him mainly in the organs of generation, and when those organs were in an inflamed and swollen condition her attention was unexpectedly called to his misfortune. She expressed herself as greatly "shocked" at the unpresentable sight, and moreover that at this particular time she was engaged in arranging her shawl with one hand thrown back between her shoulders, in the same relative position of this growth upon the child. Taking this account for truth, and she is a woman of entire truthfulness, it is quite an interesting case and goes far to confirm the possibility of the unborn child receiving a physical impression, contrary to its natural development, from and through the mother. It need only be said in conclusion that this growth was readily removed by passing a double ligature through its base and tying it in two portions. According to Dr. Smith's report, the strangulation was complete, and it dropped off on the fifth or sixth day. Case 2d-Compound Fracture of the Tibia and Fibula.-In August of last year (1870), I was called in great haste to see a young lad about 14 years of age, who had received a severe injury from getting his leg in a piece of machinery. His condition was as follows: the fibula was fractured near its middle in two places about two inches apart. The tibia was also fractured twice, and the intervening portion one and one-fourth inches in length was so nearly detached that it was easily removed. The flesh wound began over the fibula in front, passed across the tibia and around the inner surface of the leg to the posterior surface, and included full two-thirds of the surface, and the substance the muscles-of the leg. Through this frightful gap the upper portion of the tibia projected over four inches, denuded of the flesh and all but its periosteal covering. A young doctor who was present, and the bystanders were clamorous for immediate amputation. This I objected to for two reasons: first, the boy's parents were not present to give their assent, and, second, if amputation should become necessary a few days delay would not compromise his chances for recovery. Hence the wound was washed and dressed as carefully as possible and further developments were patiently awaited. The limb was placed in a fracture box, suspended from the ceiling, and packed with bran. To the surprise and gratification of all no bad symptoms followed and in seven or eight weeks time the lad was on his feet, and in six months afterwards was running around without crutches or cane and with scarcely a limp. This case is very instructive as demonstrating the value of conservative surgery and the great value of carbolic acil as a dressing in suppurating wounds. The Arnica and Calendula were somewhat useful but incomparably less so than the carbolic lotion. Case 3d-Gun shot wound of the Head.-On the evening of April 3d ult., Mr. H., a young man aged 24 years, committed the mistake of visiting a saloon. While there he had some "words" with the proprietor of the institution and he was requested to depart, and to hasten his exit the latter stepped into an adjoining room to get his gun : Mr. H., had in the meantime gone out and was, as he states, about fifteen feet distant from the door of the saloon, when the proprietor, who was then standing in the doorway with gun in hand, drew up and give him its contents full in the face and head. The charge consisted of buck-shot, three of which struck him in the forehead but fortunately so high up that as they struck the cranium they glanced off, making only scalp wounds. The fourth shot struck about one inch above the right eye and entered the brain. There was free hemorrhage from the wound, and he was soon after removed to his home three or four blocks distant, where I saw him twelve hours afterwards. The last mentioned wound was probed carefully to the depth of two and one half inches directly into the right lobe of the brain. Nothing could be done towards removing the ball and the treatment was confined to warding off unfavorable symptoms. So far, a period of about seven weeks, this has been very successful and there is now great probability that we shall witness the anomalous case of recovery from gun shot wound of the head with the ball remaining in the brain. Prof. Gross in his voluminous work on surgery mentions one such case, but it must be exceedingly rare. Homœopathic literature records no fatal cases but should this eventually prove to be one of that number your readers shall be informed thereof in due The internal use of Aconite, Arnica and Belladonna was very satisfactory. season. Case 4th-Abdominal Fistula.-In the month of September, 1869, a gentleman from the western part of this State, brought to me his little daughter, a child six years of age, with a fistulous abscess situated on the abdomen about midway between the umbilicus and the crest of the ilium, right side. Here was an abscess which had appeared several months before, during which time the child from a strong and hearty condition had become weak and emaciated. The opening extended along under the skin and superficial parts for two inches or more and was discharging freely. I advised the laying of this open throughout its length, but as this was not acceded to by the parents, such remedies as Silicea, Hepar-sulph, Hypophosphite of Lime &c., were prescribed and taken for a period of several months. Two or three times this orifice nearly closed and then would come open again. The parents now finally acted upon the advice first given and the fistulous track was laid open through its entire length, and in it was found a large and much corroded brass pin. On the removal of this the sore soon healed and has remained entirely sound ever since-about one yearand the child has recovered her wonted strength and health. From the history of this case it may be considered as conclusive that this pin was swallowed weeks and probably months before the appearance of the swelling in the abdomen where it finally made its exit. It must have been arrested in its passage through the small intestine near the junction of the latter with the colon, and inflammation of the intestine with adhesion of it to the abdominal walls followed and finally by the ulcerative process it was worked out of the intestine through the abdominal walls to the surface of the body, a rare example of the conservative forces of nature. ON THE USE OF EARTH AS A DRESSING IN SEVERE BURNS. CLINICAL LECTURE BY ADDINELL HEWSON, M.D. * One of the Attending Surgeons to the Pennsylvania Hospital. Gentlemen-Although I have already occupied a considerable portion of the time during which you have been attending my clinics in the exhibition and the discussion of the advantages of earth dressings for various conditions, I do not know that it is necessary for me to apologize to you for my intention to occupy * The Medical Times June 1871. a whole hour to-day in the consideration of the use of earth in severe burns. For, in the first place, the very special interest which you have all displayed in the cases exhibited under such treatment heretofore is certainly sufficient to justify me in the idea that you are not weary of seeing them; and, in the second place, it is only in my wards that such dressings are used, and I wish, therefore, to give you every facility of seeing them and of judging for yourselves of their true value. Furthermore, the very class of cases to which I wish specially to direct your attention to-day, as to the advantages of the earth dressings, is unfortunately terribly on the increase: I refer to burns of the third and fourth degrees, according to Dupuytren's classification, -that is, burns which, involving a greater portion of the thickness of the skin, are certainly the most painful of all such casualties. These, of late years, have increased at an enormous rate, owing, it would seem, to the very general use which is made of coal-oil by the humbler classes as a means of light. This oil produces, when burning on the body, a much deeper destruction than follows the burning of camphene, which was formerly used. The latter is far less tenacious, and very volatile, and therefore usually produces a burn of the first or second degree; whereas you seldom see an injury from burning of coal-oil in which there is not destruction to a much greater depth. I am confident that if our records in this hospital were sufficiently definite this point could be demonstrated beyond all doubt. As it is, they furnish strong presumptive evidence in support of this view. A few years ago was strongly impressed with the idea that the character of burns then admitted to this hospital was much more severe than it was when I first became familiar with its wards, nearly twenty-five years ago; and examining our books of admission and discharges, I ascertained two facts which, I think, may be fairly taken as confirmatory of that impression. These are, first, the great increase of mortality from "burns" there recorded as having occurred in this hospital in the last fifteen years-that is, since coaloil came into general use-over what occurred in the fifteen years previous, the difference being actually such as to double the mortality; and secondly, the increased mortality in the last fifteen years was confined essentially to women and children. The first fact, I would argue, indicates an increased seriousness in the character of such injuries; and the second, that the increase has been in the class most liable to casualties at home. Furthermore, the difference between the two periods is well defined. Up to the time at which we can fix the introduction of coal-oil into use in Philadelphia, the mortality in this hospital from "burns" had been each year about the same, whereas, since then, it has, up to within four years, steadily increased. We have, then, so far as I can see, no other means of explaining these facts. The terrible character of the injuries inflicted by this article, when ignited, you will have a fair opportunity of witnessing in two of the cases |