Dr Anstie, during the examination of a septic corpse from the Royal Victoria Patriotic Asylum for Girls, received the puncture which killed him at the age of 41 years. The day after the puncture the writer of this article had a long conversation with him on the state of things which Dr Anstie had observed at this asylum. He made no reference to the wound he had received, and which must then have been beginning to work out its fatal consequences; and the writer left him impressed with the enthusiasm with which he had entered upon a difficult task. His death, a related consequence of the neglect against which he protested, gives a melancholy interest to this his last teaching in sanitary work.

Formerly, if Englishmen or Englishwomen had a certain amount of pain, or worry, or sleeplessness, they endured it, and hoped for better times – an opiate being considered a serious matter by most persons. At present the list of available soothers of pain and restlessness has become much larger; and from time to time fresh substances are discovered to possess the required power, and are at first stated to be also ‘quite harmless’. This was especially the case with chloral; but that drug has proved itself a wolf in sheep’s clothing with a vengeance.

The material of raving thought is chiefly the objects upon which the mind ordinarily dwells: the bricklayer’s mind wanders amidst bricks; the medical man commonly wishes to visit his patients. But maidens do not mutter their lovers’ names nor men their liaisons in preference to anything else. Delirium is but a modification of our ordinary thought; frequently it is little more than incoherent thought.The unstable brain is easily perturbed; and if the eye sees but imperfectly, then a flood of erroneous ideas is inaugurated.

This instrument, of which we append a woodcut, is a very ingenious and useful invention. The object of the inventor has been to make it possible for persons suffering from intense pain or insomnia to avail themselves of the benefits of those smaller doses (“stimulant” doses, we should call them) of chloroform which will produce sleep without producing coma.

As starvation had had much to do with the precipitation, at least, of the chorea, so did generous food in hospital very quickly produce an impression both upon the choreic state and upon the mental condition. But she went back to her poverty-stricken home for two years, and at the end of that time was prematurely forced into the slavish toil of a maid-of-all-work in a small tradesman’s family. The consequence was very remarkable: she was observed to become somewhat fidgety in her movements and sly and furtive in her gestures; and before she was sixteen she had passed (without any full re-development of the choreic affection) successively through the stages of prostitution and of religious melancholia, in which latter she settled down: the youngest of such patients that I have seen.

Painful impressions made upon the skin cause contraction of the blood vessels. Medical students occasionally prevent themselves from fainting, when witnessing an operation, by biting their lips or pinching their fingers. Its beneficial action in shock is very great. My friend Dr Fayrer has succeeded in recovering a patient from a state of collapse by thrashing his feet and the calves of his legs with switches after other means had failed. Mustard plasters are often applied for a similar purpose.

The patient, a lady aged about 25, had suffered more or less from sick-headache or migraine from girlhood. After her marriage she had children rapidly, and being weakened in consequence, the attacks had become more frequent and violent, and had changed somewhat in character, having assumed more the character of distinct neuralgia of the first division of the fifth nerve, a common transformation. Change of air afforded relief from the attacks for a while, but as soon as she had been a short time in any place in England they began to return. She enjoyed a more complete immunity when at sea or abroad,  and during two or three journeys to the Orkneys, and on one to Malta, Egypt, and other parts of the Mediterranean, and for some time after her return she had not a single attack.

Dr Ballard’s inquiry showed that of the 68 houses attacked 51, including that of the milk-seller, were supplied with milk by the dairyman in question; 13 were supplied by various other milk-sellers; one had no milk from anybody, and the source of milk supply to three was doubted or unknown. Of the 449 houses in the defined district, 132 were supplied by the dairyman who had been ill, and 317 obtained their supply from 18 other milk-sellers. Altogether, 37.8 per cent of the families the dairyman supplied with milk, after he himself had been attacked with enteric fever, were invaded by the same disease, while only 5.3 per cent of the families supplied by other milk-sellers, or not taking milk at all, suffered from the fever.

I shall never forget the incredible results of such a “counsel of despair” which I gave a migrainous young lady who had nearly reduced herself to the state of the horse who lived upon one bean a day. She was sent to an out-of-the-way part of Germany, where she lived among pleasant people, but where her necessary daily food consisted of  black bread, sausages, sauerkraut, and very oily salads. Mirabile dictu! She was soon energetically devouring these astounding aliments, and in twelve months her migraine was a thing of the past.

“ Then gentlemen,” I said “I am about to try the experiment of transfusing milk into his veins. “If you do, you will kill him,” was the reply. Thereupon I invited them to be present at the operation, but three out of the four left the building; the fourth remained, but would not assist. Everything being ready, I ordered a cow to be driven up to the shed.

Sometimes the effect of prolonged and lavish use of chloroform on the class of subjects to whom we have just referred is even more mischievous. It has been known to take the form, especially in women who are at or near the menopause, of violent erotic excitement, to which no doubt there was a tendency resulting from the physiological state, but which was definitely aggravated by the injudicious use of chloroform; the proof being that it diminished, or even practically ceased immediately that the drug was discontinued.

A man aged 26 came under my care at the Hulme Dispensary on the 26 September, with severe haemoptysis, which had lasted  continuously for two days, although he was under medical treatment all the time. ... Injected five grains of ergotin in watery solution. Not a single bloody sputum followed the injection till the 28th, when, after a severe fit of coughing, he again began to spit blood. The injection was repeated, with the same result, viz. the abrupt cessation of the haemoptysis, which, however, probably owing to domestic inquietude, recurred on the night of the 29th, as I afterward learned, when his wife insisted on his leaving Manchester.

I cannot too strongly protest against the therapeutic doctrine of ‘rest’ being so caricatured as to imprison a joint in splints for weeks or months at a time; the last hope of rescuing it from permanent uselessness may thus be destroyed. Intercurrent attacks of inflammation may peremptorily require a joint to be rested; to be placed for a few days on a back splint, to be poulticed, or even mildly blistered; but this is quite a different thing from putting it, whether inflamed or not, into a splint-case or box, and condemning it to a chronic fixed position.

Mrs T. T…………… suffered from dilated hypertrophy of both ventricles, the dilation being in excess, accompanied by a very feeble circulation, and anasarca to an extreme degree extending upwards to the abdomen, slight pulmonary oedema, some lividity of face, but not much shortness of breath. I proceeded one evening to cup the loins. Two glasses were applied, one over each kidney. The blood flowed slowly, and when there was about a wine glass full in each glass it ceased to run. At that moment it occurred to me that it would be interesting to watch just then the effects of nitrite of amyl upon her. I applied ten drops on some lint to her nostrils. Soon the radial pulse throbbed, then the face became flushed, and at the same instant blood flowed freely into the cupping-glasses. The experiment was most striking, and clearly showed the influence of amyl on the circulation.

Mr Weston is an extraordinary man. He has accomplished the most wonderful feats of endurance, always without having gone through a regular system of training. He walked, a few days ago from Portland to Chicago, a distance of about 1,200 miles in thirty consecutive days, resting four Sundays, and this in the early winter, through mud, rain, and snow; and he is apparently as well after such efforts as before. Mr Weston has an ill-judged contempt for training. He takes no regular exercise, and does not restrict his diet before his greatest efforts. About a week after a hundred mile walk, he walked fifty miles in less than 10 hours. The night before the attempt, at 2 A.M., he was eating pork and beans preparatory to going to bed.

This was a very sad case; there can be no doubt that a naturally clever, well conducted, capable, I might say talented female, was utterly degraded and ruined by succumbing to the fatal craving for stimulants induced by the debility and anxiety, the bodily and mental strain, which her condition in life rendered unavoidable.  

Her brother, a seaman, had small-pox when he was four years of age; he had not been vaccinated. A brother-in-law had small-pox three months ago – i.e. at the same time as Rosina T. and died of it. He was said to have been ‘stone-blind’ three days before he died. .... The case illustrates well the protracted  nature of keratitis following small-pox; and the family history is extremely interesting as a proof of the danger of neglecting vaccination and of the protective qualities of the operation, should any further proof be wanting of so well-established a fact in therapeutics.

M.B. ... labours under the distressing idea that her children and relations have been the victims of a foul plot, have been chopped into mincemeat by the officers of the asylum, and that their mutilated remains, tied up in canvas bags, are concealed in the cellars beneath the ward which she inhabits, whence they hourly cry aloud for vengeance.

Book review: Fleetwood Churchill, M.D.. The diseases of children. Third Edition. Dublin: Fannin and Co. London: Longmans, 1870

That Dr Churchill is a learned man, in the sense of  having read pretty nearly everything by writers on children’s diseases who flourished not later than twenty or twenty-five years ago we do not deny. But of the larger part of recent pathology and therapeutics he is apparently ignorant; and he has thought fit to republish his work as a text-book applicable to the present time. It is certainly the duty of a reviewer to show how little it possesses any claim to be so regarded. We have seldom seen a book more unfit to be taken as a guide for practice.

A clergyman, aged 40, has been a drunkard for years, but worse since his marriage three and a half years ago to a woman beneath him in station, and with whom he does not seem to have got on well.  He has been in the habit of taking all kinds of drinks and has had delirium tremens several times, the last bad attack being a little more than a year ago. Sometimes he has gone for six months without taking any drink. His father died of paralysis from disease of the brain. The history of insanity is uncertain.

A maid servant who fell downstairs with a child in her arms was supposed to be hysterical from fear. He found her suffering from violent convulsions, recovering every few minutes. She was unconscious, respiration appearing to be suspended; eyes shut, with dilated pupils; face much suffused; pulse very frequent and full

Extraction of a pin from the urethra: M. Ticier reports a case in which a boy, aged 7,  introduced, at the encouragement of a school-fellow, a pin into his urethra. It slipped from his hand, and as usual retreated along the passage. 

A plan for reducing dislocation of the shoulder by Mr Lowe. 

On the therapeutic value of gastric juice: Signor Arturo Menzel supports the experiments and results of older experimenters in regard  to the value of gastric juice in cancerous tumours, and has collected a considerable number of cases in which it has been employed with advantage, either in true cancer or in lymphoma

Louisa M., aged 17 years, and living as servant in a gentleman’s family, at Wandsworth, where the mistress and a young child  had died from scarlatina, fell ill with the same complaint on December 27th, 1869. All were treated homoeopathically by the family attendant, and one week from commencement of fever Louisa M. was ordered out of bed, and, four days later, requested to take outdoor exercise. January 24th Awoke at 3 a.m. with violent fit of vomiting in the midst of which the sight of both eyes was entirely lost; nothing abnormal in external appearance of eye, except that the conjunctiva was congested; the pupils were slightly dilated, but acted well. Applied mustard poultices to nape of neck and behind both ears, applied blisters to both temples and slightly darkened the room.

Jane is nominally a laundress, and by practice a prostitute. She is evidently worn down by excesses and irregularities, and will soon be worn out. Her face is sallow and wan, her frame is wasted, her voice is hoarse, her hearing is dull. She has enlarged hard glands in her neck and groin, scars at the angles of her nose and mouth, coppery tubercles about the forehead and eyebrows, a lump of  gummous matter in the calf of the right leg, nodes on her tibiae and open ulcers on her face and upon her legs. These ulcers are large, numerous, indolent, and characteristic. She makes no secret of her disease, and dates its origin several years ago. She “has had mercury”, and her gums bear the traces of it; her irritable tongue and stomach, her anorexia, and her wasting seem to warn us against the iodides. She took sarsaparilla, beginning with half a pint a day, and increased the dose to one pint daily.

IN 83 OF THE LAST 100 cases in my case book for the asylum, whose disease was under six months’ duration, there were symptoms of bodily disorder that could be directly connected with the psychical symptoms. One bodily disorder accompanying insanity I call ‘general debility’(13 of the 100 cases). There is great emaciation, no vigour or ability for bodily exertion, languor, and a sense of prostration. The mental symptoms in these cases are generally those of melancholy and depression of mind. There is often a sluggishness in the performance of even the organic bodily functions – a slow pulse, costive bowels, a weak circulation in the extremities, with cold feet, blue hands, and pinched features. This is without organic disease of any kind.

I have reported cases in The Practitioner of several old persons who have died while labouring under senile delirium, all of which were attended by excessive talking that would continue hour after hour, and day after day, exhausting themselves such that they effectually talked themselves to death. It occurred to me to consider whether the cerebral symptoms of senile delirium could be traceable to a derangement of liver function. I had not long to wait before testing the value of this idea on a case. I confess to having some anxiety as to the result.

PETER O'C AGED 18, a compositor in the office of the Evening Post, was admitted into Sir P. Dun’s Hospital on the morning of the 14th December in 1870 with all the symptoms of well-marked enteric fever. He had the rose-coloured spots, caecal gurgling, with tympany and diarrhoea; when comparatively late in the fever, convulsions and other cerebrospinal symptoms manifested themselves. As far as we could learn he was about eleven days in fever.  He was rather inclined to sleep, and for several days seemed to be getting on favourably, and the diarrhoea ceased, receiving eight ounces of wine.  On Saturday night, about half-past ten o’clock, the patient was noticed to be lying on his back, low down in the bed, with his arms folded over his chest; his breathing was rapid and irregular, a circumstance noted during the afternoon, without any chest complication to account for it. When spoken to he made no reply, nor did he stir, but when turned on his side he spoke a few words and swallowed some whiskey in milk. A blister was applied to the nape of the neck.

IN CASES OF DISLOCATED BONES of difficult reduction vagal pressure presents several advantages possessed by no other means with which I am acquainted, as it is unattended with any kind of danger, and is always at hand in any emergency, however sudden. 

THE SUBCUTANEOUS INJECTION of morphia has become a comparatively common household remedy among certain classes of society for some years past. More especially among the very numerous persons, chiefly women, who suffer either from neuralgia, or even from attacks of nervous depression and sleeplessness without positive pain, it has become a too common practice to inject themselves, or to get injected by their servants, whenever they feel symptoms.

THE TERRIBLE SEAMING and pitting of the face, neck and other exposed parts of the body so often consequent on bad attacks of small-pox are universally known. Reference, however, is seldom made to the total exemption of the scalp from marking of any kind, after even the severest form of this disease. It recently occurred to me, from watching a photographer using cotton-wool to shut out light in the process of ‘vignetting’ photographs, that this material, if applied to the face and neck of small-pox patients, might give a protecting influence somewhat similar to that afforded to the scalp by the hair, and thereby prevent or modify the subsequent pitting.

E.S, A GIRL OF 16 YEARS of age, suffering from epileptic mania, and never having menstruated, was admitted into the Brookwood Asylum in October 1868, being unable to use either of her legs, and having in consequence to be carried into the ward on her arrival. A few days after her admission the use of Browning’s electro-magnetic machine was commenced About the end of December she was enabled to crawl about, and employ herself a little in cleaning the floors of the infirmary in which she was placed. She gradually improved, and during the second week in March she had her first catamenial period. In the beginning of April she suddenly discarded her crutches, which she had used for two or three months; and at the ball given to the patients the following week, danced several times, appearing to have quite recovered both sensation and motion. 

THE CAESAREAN OPERATION still remains an almost sacrificial one, reversing from necessity the teaching of British obstetrics; for the children thus preserved are comparatively many, the mothers disastrously few. Eighty-five per cent of deaths has been stated by an accurate writer as the probable results in our days. Probably as much, or more, may be learned from failure as from success. Here is such a failure from the obstetric ward of the Westminster Hospital. It can only be from the faithful record of cases and careful observance of facts that any better rules for guidance can be elicited. 

AT TWELVE O’CLOCK ON THE NIGHT of October 23, 1870, a woman begged I would instantly go and see her daughter, who, she said, ‘was in a dying state.’ On entering her bedroom, I saw the patient, a young married woman, half undressed, sitting on the corner of the bed and holding on to the bed-post. There was a dusky leaden hue about her face, neck, chest, and hands, and a cold damp sweat clung to her. Her body generally was cold, but her feet and legs were of an icy coldness. Her pulse could scarcely be felt. She was making violent efforts to breathe, and each inspiration was accompanied with marked recession of the supra-clavicular and the intercostal spaces. Loud sibilant rales with sonorous rhonchus could be heard over the greater part of the chest.  She tried to speak, but could only make faint gasps.

An old widow woman, living in a retired village, came one day to the parson of the parish in a state of great despondency. She said she had had 'a signal warning,' and she was sure she would soon be in her grave, for she was continually haunted by 'a skeleton'. The parson having in vain tried to convince her that she was under a delusion, set about a systematic examination of her eyes.

The beneficial effects of ergot in certain forms of mental disease are to be attributed to its controlling power over the intracranial vessels. In 200 cases of insanity in which I have employed ergot, I have found it useful in none in which the theory of its action which I have suggested was not available; while in all those in which it has proved most advantageous, this theory was vindicated in various ways.

During the Siege of Paris wounds were of exceptional gravity. Older surgeons, who had had much experience in wars, admitted that the wounds during the siege were of unexampled and unprecedented fatality. In cases I had observed a violent contusion of the marrow extending very high up; it was obvious to me that this marked injury was of immediate origin. At the same time, the bones themselves presented the most serious lesions; there was splitting and splintering of the bone, extending as high up as the great trochanter, for instance, in cases of fractured femur. Amputation was, at the beginning, universally employed. The results were disastrous, the mortality was absolute and general. Most strenuous exertions were made by Paris surgeons, and were much insisted on by myself, in the direction of conservative surgery in wounds which engaged the bones, and particularly the femur.

MANY GIRLS WHO LIVE AMONG RICH (especially nouveau riche) and gay society are in the habit, during six months out of the twelve, of taking a daily average of  2, 2½ or 3 ounces of absolute alcohol, a quantity which, if expressed in cheap beer, would be equal to six or seven pints.

IT WOULD BE IMPOSSIBLE, in any case, to pass without notice so striking an event as the appearance of the inaugural treatise of the first lady - an English lady, moreover - who has ever passed through the formidable ordeal of the examination for the Paris doctorate of medicine. It is not the province of this journal to discuss medical politics, and we shall not pronounce any opinion as to the probability of lady doctors, in any considerable numbers, acquiring such a genuine knowledge of medical science as is displayed in Dr Garrett’s inaugural treatise; but we may at least say that we should personally be delighted to welcome as colleagues any number of ladies who should prove themselves to have mastered their profession as she has done.

THE LONG LEGAL CAREER of Sir Frederick Pollock was combined especially with a large amount of  scientific reading.  Favoured with an almost unbroken health, Sir F Pollock FRS has reached the great age of 86, yet still retains his mental energy and activity; while as regards physical status, with the exception of the inevitable decline of muscular energy, he at present scarcely betrays his age in any noticeable manner. About six years ago, however, he was led to adopt ether-inhalation by the occurrence of symptoms which were annoying, and had a chronic depressing tendency. Besides a certain  indefinable nervous malaise, he suffered specifically from gastric flatulence and painful spasm, occurring almost constantly during meals.

The greater number of recipients did not come under the notice of the regular practitioner at all, but were dealt with by the midwife, a canny friend, or the father, or mother, armed with clasp-knife or darning needle. I remember one amateur vaccinator of great local repute, a “surgeon to old shoes,” the weapon of whose anti-varioloid warfare was his awl. Matter belonging to any stage of vaccinia, or even the scrapings from the moistened under-surface of the effete crust, after it had dropped off from the arm, served the purpose; and when the produce of this rude husbandry was a pimple or sore of any description, it sufficed. In not a few cases, protection from small-pox was never involved in any way.

“Can it be seriously maintained that the low diet in the first case, that the loss of six ounces of blood in the second or the six leeches and other treatment in the two others, benefitted the pneumonia and hastened its resolution?”

We add here a few words in correction of a statement which occurs in a former paper, and which, by ambiguity of phraseology, has led to misunderstanding and consequent cavil. We did not intend, when recommending the “hard-working student” to allow himself a bottle per diem of weak Bordeaux wine, to give that recommendation to young lads. We were thinking of “hard working students” of middle age; and we would state our very firm conviction, that for youths (say under 25) whose bodily frame is yet not fully consolidated, the proper rule is either no alcohol or very little indeed.

THE UNAIDED EFFECTS OF FOOD may not have had the trial it deserves in the relief of nervous weakness. Patients are told to live well and adopt a generous diet, but this is usually judged by the amount of port wine or other alcoholic stimulant, rather than by bread, mutton or beef. If we inquire into the past history of nervous patients, we often find that for a considerable time the supply of food has been inadequate. 

CERTAIN WRITERS HINT DOUBTS of the value of the so-called non-restraint system in  English asylums, while others  advocate openly the use of the strait-waistcoat. They would have us give up a system of treatment which has been considered by English alienists to be the great merit of English asylums, has hitherto been zealously defended by them against the attacks of foreigners, and has now become so general, that there is hardly an asylum in this country in which a strait-waistcoat would be found. Henry Maudsley, M.D.

IT IS ESTABLISHED by custom and by the most recent physiological research that alcohol, as such, has its legitimate place in the sustentation both of the healthy and of the diseased organism. However, there is grave danger of excess from the multiplication of alcoholic drinks taken by the richer classes. In this paper, we put the question of the absolute alcoholic allowance for healthy adults in a somewhat crude and abstract form. We do this to compel the upper and middle classes, and their medical advisers, to look the facts of alcoholic consumption honestly in the face.  FE Anstie, Editor of The Practitioner (1868-1874)

When admitted he was perspiring freely; his face and eyes were congested; his tongue moist, and coated with creamy fur; his pulse was slow, full, but very compressible, and his hands were tremulous.  For the last twenty years he had led an intemperate life, ‘and having become a tavern-keeper,’ he drank night and day for about six months, and had not ceased up to the time of his admission. He was treated successively by means of capsicum, tartar-emetic with opium every second hour, a stream of water directed from a height of some feet on his head, and an enema containing tincture of opium and tincture of bella donna. All the remedies tried have proved of no avail. ...

Pancreatic emulsion is  now widely used in the wasting diseases of adults, but is not even referred to in the latest works on the diseases of children. Yet scarcely a week now passes but some general practitioner relates to me cases of the successful use in his own practice of pancreatic emulsion in the wasting of delicate children; showing that in this respect the rank and file of our professional army are in advance of some of their generals.

From inquiries made at several of the large dispensing houses in Liverpool, I find that the demand for leeches has dwindled down to a mere tithe of what it was ten years ago. At most of the hospitals and dispensaries they are so rarely required, that they are not kept in stock at all, but sent for when ordered. As for cupping and bleeding from the arm, they are never heard of now. The following cases show the mistake which will be made if  blood-letting is altogether lost sight of or omitted from our therapeutics.

On expressing my satisfaction at the improvement in her health and the increased range of foods that she was able to use with impunity, I found that she had been in the habit of applying vagal compression herself. Whenever any considerable irritation of the stomach was felt after eating, instead of waiting until the symptoms became severe, she immediately applied slight pressure on the vagus, thus arresting the symptoms at their début, and digestion was completed without further inconvenience.

I was sent for early in the morning, and was told she had not had any sleep during the night, but had been talking incessantly. When I saw her she was sitting up in the bed and was rambling incoherently, but everything she uttered was in rhyme, and the ingenuity she displayed in promptly finding the rhyme was very remarkable. During the whole of her illness, which lasted a week, I never once found her at fault in this respect, and she never was more at a loss to give utterance to her thoughts in rhyme than if she had expressed them in the ordinary mode of conversation. She gradually sank, apparently from exhaustion and having talked herself to death.

WHILE OCCUPIED some few days ago in preparing an electromagnetic machine for application to a patient, an old servant (upwards of 80 years), who had long been subject to violent spasmodic tremblings of both arms, chanced to enter the room. More, in the spirit of levity than either philanthropy or philosophy, I asked her to take hold of the electrodes of the machine, at the same time pressing the bundle of soft wires some distance into the centre of the helix, so as to give a pretty sharp shock.

The child was lying, with head bent, hanging by its own weight, so incapable was the wasted neck of sustaining it. But when I was going to take his arm to take the pulse, he sprang up like a lion, open-mouthed, to bite my hand. “What is that for?” I asked the mother. “Ah, sir,” said she, “he thought you were going to dress his blisters. He always does that when we go to dress them, and we are obliged to hold him.”