SOUTHERN

MEDICAL AND .SURGICAL JOURNAL

EDITED BY

L, A. DUGAS, M D.,

tROFESSOR OF SURGERY I.N THE MEDICAL COLLEGE OF GEORGIA,
AND

HENRY BOSSIGNOL, M. D.

Medical College of Georgia^

Jc prends le bien oicje le troitve*

VOL. XI

185lj--?

NEW SERIES,

AUGUSTA, GA.r

JAMES McCAFPEKTY, PRINTER AND PUBLISHER.

1855,

SOUTHERN

MEDICAL AND SUBGICAL JOURNAL.

Vol. II.] NEW SERIES. JANUARY, 1855. [No. 1.

ORIGINAL AND ECLECTIC.

ARTICLE I.

Typhoid Fever. By R. B. Gardner, M. D., of Barnesville, Ga.

Mr. Editor I propose to give your readers a succinct state-
ment of the opinions I have been led to adopt, relative to Typhoid
fever as it prevails in this section of Georgia, together with a
summary account of the results of my experience in its treatment
with large doses of Quinine. I would not thus submit my pri-
vate views to the inspection of the profession at large, were it not
for the great practical value which the truth, if it be such, possesses
to Southern physicians, that, there are remedies calculated to
shorten the duration of fevers, which run a long and tedious course
under expectant treatment.

But before the practitioner can fully appreciate the promptness
and efficacy of the invaluable agent employed to curtail the exist-
ence of continued or typhoid fever, it is indispensably necessary
that he possess a sound and an accurate understanding of the na-
ture and causes of this disease, as it prevails in his own climate
or arises in his own locality. Without this knowledge, as far as
it may be in his power to obtain it, he cannot be considered many
removes in the practice of his profession from the hideous deformi-
ties of empiricism and charlatanry. With it he may dispense the
blessings of an intelligent physician throughout his community,
and reflect the light of philosophy upon every action of his life.

After examining carefully the various accessible sources of
information, and after a close enquiry into the subject, and

N. 8. VOL. XI. NO. I. 1

g *ij \ X8 Gardner, on Typhoid Fever. [January,

some observation of the disease, no theory seems more rational
than that which locates the seat of the fever essentially in the
cerebro-spinal system. The deficiency of nervons power, and the
amount of morbid innervation observed in the course of this mala-
dy, show clearly that this hypothesis is not entirely destitute of
foundation.

IIow the nervous system becomes implicated, is a question, an
enquiry into which may somewhat gratify curiosity, notwithstand-
ing the vague uncertainty of the conclusions at which the mind
may arrive. An serial poison, which in compliance with usage I
will denominate Malaria, effects its entrance into the blood by
imbibition through the cutaneous surface and the walls of the pul-
monary air vesicles, and is transported upon the bosom of a thou-
sand currents to every portion of the body, coming in contact
with every particle of the same, and exerting its malign influence
in some degree throughout the entire organism. This being the
case, it is not surprising when the cerebro-spinal system the
centre and origin of all vitality, whether of sensation, voluntary
or involuntary motion, and presiding over the various functions
of health is found giving evidence by its sufferings of the pre-
sence of this poison, so extremely attenuated as readily to be
diffused throughout its entire mass, and penetrate to its utmost
ramifications. The action of this noxious material, however, I do
not pretend to have ascertained ; yet I do feel fully persuaded,
that in some unknown way, it perverts innervation, either re-
ducing it below its healthy standard, exalting it above, or in some
other manner rendering it morbid. ' The various organs of the
body, then, that have any concern in the processes of health, be-
ing entirely dependent on the nervous system for that supply of
energy indispensable to the performance of their physiological
functions, are necessarily deranged and disqualified for the proper
discharge of their duty, and disease is the inevitable result.

Such are some of the leading views I entertain of the origin of
Typhoid no less than Periodic fever; and their probability, I may
here remark, is favored by the success which follews its treatment
with large doses of quinine.

I will now consider what I believe to be the essential cause of
Typhoid fever, and to which I have already incidentally alluded,
as it has occurred to me in my field of practice.

In this latitude, our warm weather is not confined exclusively
to the summer months, but is often experienced early in the spring

1855.] Gaedxer, on Typhoid Fever. 7

and late in the fall, being no stranger even during the winter.
That portion of the year, in which the temperature is sufficiently
high for vegetation to put forth, cannot be estimated at less than
nine months, during much of which time the solar heat is intense.
Heavy floods of rain occur in connection with this protracted state
of warm and often hot weather. Our rivers, creeks, and smaller
streams ; our marshes, broad flats, and extended bottoms all are
surcharged at various times, and in repeated instances, with water
from the clouds. The low lands are overflowed, the hills satura-
ted, and the plains steeped in the same element. The vegetable
products of a fruitful soil live out their " brief span of existence,"
and perish under obedience to the laws of nature. Animal life
soon, too, becomes extinct, and putrefaction ensues. Here we
have combined, protracted heat, great moisture, and an immense
quantity of decaying animal and vegetable matter.

Now, whatever other agencies may share in the origin or
modification of our febrile diseases, it is exceedingly difficult to
understand how, under the circumstances, a case of continued or
typhoid fever can arise uninfluenced by the all-pervading malaria.
Notwithstanding its s}*mptoms be often precisely the same as are
observed in the typhoid fever of France and New England, as
well as others of our Northern states ; still I must contend for the
existence and it intimately associated with the nature and con-
cerned in the origin of this disease as it occurs in Southern lati-
tudes of another and an important element, fundamentally allied
to, if not constituting part and parcel of miasm itself, that invisi-
ble sentinel of darkness breathing its deadly poison upon the still
bosom of the serene night air. This material, too, may be evolved
not only in low damp situations, but also from the surface of
plains and elevated table lands ; and although possessed of a spe-
cific gravity greater than that of the atmosphere, and having a
tendency to collect in bodies and flow in currents after the manner
of streams; still, under the full persuasion of its light aerial nature,
I must believe, with the evidence before me, that it abounds in the
air at varying distances from the earth's surface. The facility,
too, of its transportation for short distances by means of winds is
.clearly shown in the books. The conclusion, then, forces itself
with almost resistless power upon the mind of the philosophic
physician, that typhoid fever can rarely occur in so low a latitude
as ours, altogether free from malarial influence. The theorv, too
which I believe to be the most probable respecting the origin of

8 Gaedxee, on Typhoid Fever. [January,

all fevers prevailing in this region, goes far in support of this
conclusion. Some of the most eminent observers of disease at the
South maintain likewise, with much plausibility, and no little
showing of truth, the convertible nature of all fevers originating
in Southern localities, indicating how the continued form may-
assume the remittent or intermittent type, and vice versa. Now
to what does all this amount, if it fails to establish the identity of
origin of all our fevers? the intimate relation they bear to one
another ? and the just inferences to be drawn relative to their
therapeutical management ?

Whatever may be said of the lesion of Peyerrs glands, which I
believe to be always secondary, never primary invariably an
effect, in no case a cause of the disease ; still I must contend for
the agency of malaria as the great radical cause, constantly in
operation, and predisposing to an attack of continued as well as
periodic fever.

For the benefit of those who may question the existence of
Typhoid fever in this part of Georgia, I will detail concisely a few
of its leading symptoms.

The prodromic symptoms, of which many may be often absent,
consist of languor and indisposition to exertion, loss or caprice of
appetite, headache, sometimes hebetude, alternations of chlilliness
with flashes of heat, wandering pains, muscular soreness, torpidity
of the bowels, and sometimes epistaxis. These premonitory signs
may continue from a day or two to a week or more, the onset
seldom being abrupt. The attack may commence with or without
a chill ; oftener without any perceptible sensations of coldness, as
far as my observation extends. The pulse now ranges in differ-
ent attacts from 90 to 120, 130, and sometimes as high or even
higher than 140 strokes in the minute, and is nearly continuous,
varying but little until the fever begins to yield. It may possess
considerable force and frequency, but is often feeble and com-
pressible from the commencement. The surface and extremities
may be either warm or hot ; they are sometimes cool or cold, and
somewhat bedewed with perspiration. Some gastric uneasiness is
often present, not unfrequently amounting to vomiting; the stom-
ach, however, is often composed, and when emesis occurs sponta-
neously or is produced by art, the matters discharged are either
viscid and glairy looking, colored with the medicine used, or
tinged with bile. Pain under pressure, sometimes independent of
it, is often felt in some portion of the abdomen, and in the same

*>

1855.] Gardner, on Typhoid Fever. 9

way gurgling may in many instances be produced in the right or
left iliac fossa. Cephalalgia, felt in the frontal region, now be-
comes severe; and the epistaxis may be repeated. Delirium
seldom makes its appearance so early in the attack ; but there
may be a listless inattention from the beginning, sometimes
amounting to stupor. The urine, as in other fevers, is most gen-
erally scanty and highly colored.

These symptoms, under the expectant plan of treatment, con-
tinue in varied degrees of severity or moderation until the fever
runs out its usual course. In mild cases they slowly and gradu-
ally abate, but remain obstinately persistent, or grow even more
formidable in severe attacks.

Usually from the sixth or seventh until towards the fourteenth or
fifteenth day, or later, tympanitis occurs ; and about the same time
the rose- colored eruption, often absent, makes its appearance on
the chest and arms, and occasionally in other localities. Still
later in the disease, close observation will sometimes detect suda-
rnina on the neck. During the second or third week, and not
unfrequently later, where abstinence has been observed towards
cathartics, diarrhoea in most cases sets in, and is sometimes ex-
ceedingly difficult to manage. About the same time, if not earlier,
a low form of delirium supervenes, from which, however, the pa-
tient may be roused, though sometimes with difficulty.

I omit, purposely, a minute description of the symptoms, or to
trace this disease to its termination, as my chief object is simply
to establish the correctness of my diagnosis.

In the treatment of Typhoid fever I shall be brief^ and confine
myself to what I believe to be the best method of forcing the dis-
ease to abort.

About eighteen months or more since, my attention was called
to the articles published by Dr. Fenner, in the New Orleans Medi-
cal and Surgical Journal, and in conversation with one or two
other medical friends, relative to the " abortive treatment," as there
set forth by him, it was thought probable that quinine mioht
abridge the duration of this fever. Determined to give his method
a, trial, I commenced, cautiously, by giving this graat febrifuge in
loses varying from 5 to 8 grains several times in the course of
twenty-four hours. At first I was somewhat bafflled, yet felt
encouraged by the results. Discovering no ill effects from the
remedy, which I had been taught to use in exceedingly small
quantities, I decided to administer larger doses and push the ex-

/

10 Eve, on Chloroform. [January,

periment more boldly ; and thus far I have had every reason to
be satisfied with the competency of quinine to cut short the course
of typhoid fever. I fully endorse the opinion of Dr. Fenner,
however, that the abortive treatment will likely be of little or no
avail after the first few days of the fever, when, in all probability,
some local lesion will be added to the other symptoms.

My usual plan is to begin with an emetic, more especially if
there be any gastric distress ; and, as soon afterwards as the stom-
ach becomes a little composed, to exhibit a large dose of sulphate
of quinia, say from 10 to 20 grains, in solution ; at the same time,
or early after, giving a moderate portion of calomel, to be follow-
ed by castor oil or sulphate of magnesia, if there be any evidence
of bilious disorder. Some mild diaphoretic in connection with
the more important application of cold water, by sponging and
affusion, should be used to moderate the fever when high ; and
an anodyne, when necessary, may be prescribed. My principal
reliance, however, during the first few days of the fever, is on
quinine given in the above doses, at regular intervals, two or three
times a day. In this quantity it acts as a powerful sedative on
the circulation, reducing quickly the force and frequency of the
pulse, and sometimes inducing speedy and copious perspiration.
My opinion, however far-fetched it may seem, is that it produces
this effect by its stimulant and tonic influence on the brain and
spinal system, thus enabling them to impart to the organs and
tissues generally, the ability to eliminate rapidly the noxious
material by which they are infested, and resume the processes of
health.

When the disease is seen early, and before any local lesion is
set up, this treatment, if fearlessly adopted and boldly practiced,
rarely fails of success. And should any rising complication cause
it to fail, no injury is left behind, and recourse may be readily
had to expectant therapeutics.

ARTICLE II.

Report " on Chloroform in Surgical and Obstetric Practice." By
J. A. Eve, M. D., Professor of Obstetrics, &c, in the Medical
College of Georgia.

So much has been written on Chloroform in Surgical and Ob-
stetric Practice, that it may be considered an exhausted subject,

1855.] Eve, on Chloroform. 11

and further remarks upon it may prove uninteresting and tiresome
to many present ; but at the requisition of the Society, and con-
fessedly for the benefit of the junior members of the profession, I
will endeavor to discharge, briefly, the task assigned me.

The question of the morality of the use of anaesthetic agents in
Obstetrics, is too absurd at present ; nor is this the time or place
to consider the philosophy and science of the subject.

The safety of Chloroform in Obstetric practice, and the mode of
its administration will be considered first, and then the cases to
which it is applicable, and the indications to be fulfilled by it.

As Chloroform has almost entirely superseded all other anes-
thetics in Obstetric practice, and is, we believe, preferable, refer-
ence will be made to this article alone.

The safety of Chloroform in all departments of Medicine may
be regarded as established, by the almost perfect impunity with
which it has been of late years, so extensively and indiscriminate-
ly used, or I might, perhaps with more propriety, say abused. It
may be unhesitatingly affirmed, that no remedy, of even half the
power, has ever been so generally and recklessly employed, with
so few fatal results.

In Obstetric practice, although it has been prescribed very free-
ly, often, doubtless unnecessarily, and sometimes immoderately,
there are very few, if any, well authenticated cases of death from
its use.

In many cases of reported death from this agent, which have
been investigated, it has been found that Chloroform has not been
administered, or else that, dissolution might be fairly attributed to
some other cause. A report was circulated last summer that death
had occurred from Chloroform in the practice of my friend, Dr.
Miller : on writing to inquire into the truth of this statement, the
following note was received:

"Home, Oa., April 1st, 1853.

"Dear Sir Yours of the 30th ult. is before me. I know of no
case in which Chloroform in Obstetric practice produced death or
any injurious effects immediately or remotely. I have employed
it in many cases of labor, but have neA~er iound it necessary to
induce the same degree of anesthesia, as in Surgical practice, and
hence, (in part) perhaps its greater exemption from danger.

" I did not attend Mrs. B in her confinement, but have

learned from the attending Physician and from her friends, that
the Chloroform was given only for a short time in the early stage
of labor, and was suspended several hours before the birth of her

12 Eve, on Chloroform. [January,

child, during which time she was perfectly conscious and suffered
in the usual manner. I saw her the first and second days after
her delivery, and never was she more cheerful or her intellect
more unclouded. On the third day, she was attacked with puer-
peral inflammation, of which she died five or six days subsequent-
ly. There was nothing in her case which could justify the sus-
picion that the Chloroform had any agency in her death. I had
myself given it to her in some of her previous labors, and with the
happiest effects, and would most certainly have done so again had
I been present, nor do I know why it was suspended but such is
the history of her case. I am, very Kespectfullv,

"H. V. M. Miller."

All or nearly all the popular reports of death from Chloroform
in Obstetric practice, would, we believe, be found to have no more
foundation in truth than the above.

During the last year or two, there have been reported in the
Northern journals two or three cases, the authenticity of which
we would not call in question, nor would we be understood as
regarding the use of Chloroform in Midwifery entirely free from
danger; it is only contended that it is comparatively safer than in
Surgical or Dental practice.

We would desire most earnestly to impress on our younger
brethren the importance of the greatest care and circumspection in
its administration.

Instead of concealing the fact that fatal cases have occurred, we
would rather point to them as beacons to warn the unwary of the
danger that may result from the careless and indiscriminate use
of this truly potent and valuable agent.

The comparatively greater safety of Chloroform and other anes-
thetics in Obstetrics, than in Surgical or Dental practice, may be
accounted for by the mode of administering it, the circumstances
of the patient at the time, and the nature of the pain it is intended
to relieve.

It ought to be administered slowly, the patient being gradually
brought under its influence. It should be given intermittently
during the pain, and withheld during the interval so that the
patient may recover partially or entirely from its influence, which
can be renewed or deepened whenever the pains return.

Its effect ought seldom if ever to be rendered so profound, or
continued so long as in Surgery. Full anesthesia, except perhaps
in some cases of operative Midwifery, is neither necessary nor
proper ; it is sufficient to obtund sensibility, so as to diminish very

1855.] Eve, on Chloroform. 13

much or annul the perception of pain, without the total abolition
of consciousness. The patient inhales the Chloroform not only
willingly but with great avidity she is in the horizontal position
and therefore less liable to syncope and more easily recovers from
it; her stomach is generally empty, which condition obviates
another source of danger that might result from, vomiting when
that organ is full of food. But perhaps the safety of Chloroform
in this branch of medicine, depends chiefly on the character of the
pain for which it is given. This pain is not altogether morbid,
but is attendant on a natural process, alternately intermitting and
recurring, which has a tendency to arouse the patient and prevent
the anesthesia from becoming as profound and continuous as it
otherwise would be. Unless the administration be carried too far,
the patient will be partially or fully awakened by the occurrence
of each pain. Although very much opposed to the administration
of Chloroform for the extraction of teeth, at the very urgent solici-
tations of a lady of nervous temperament, I allowed her to inhale
a small quantity to prepare her for the removal of a tooth the
effect of which was so sudden, that respiration was suspended
almost immediately, and the pulse rendered nearly, if not- entirely
imperceptible ; for some seconds (which appeared like minutes or
hours) the application of the strongest ammonia to her nostrils,
and dashing cold water in her face produced no effect. Most
serious apprehensions were entertained, that this would be added
to the numerous instances of death from Chloroform given for the
extraction of teeth. Notwithstanding her great fright, some two
years after found the same lady extremely desirous of taking
Chloroform during parturition to which request, I did not object,
feeling perfect confidence in the comparative safety of its use in
Midwifery. Its effects were in all respects most pleasant and satis-
factory. I would not be understood as regarding Chloroform or
any other anesthetic agent, entirely devoid of danger in Obstetric
practice, or that it might be given recklessly and with impunity in
all cases, but I believe in almost any case it may, with proper
care and caution, be safely administered so as to ameliorate to a
considerable degree, the pains of labor, and in many instances to
cause painless parturition.

Chloroform may be administered by a piece of sponge held in a
towel or half a drachm to a drachm at a time may be poured on
a towel or handkerchief held very near but not in immediate con-
tact with the mouth and nostrils, thus preventing excoriation of

14 Eve, on Chloroform. [January,

the lips and nose and admitting a free ingress of atmospheric air to
the lungs along with the Chloroform. Its effects are developed
much more promptly when it is inhaled through the mouth, than
by the nostrils alone. The most economical mode of administration
is by inhalation from a bladder, gas bag, or inhaler, but I believe,
economy as well as safety, will be ensured by pouring a small quan-
tity on a towel thickly folded, holding it alternately to the mouth
and nose daring the pain and withdrawing it during the interval,
the cloth being firmly compressed in order to prevent waste and
evaporation. In protracted cases it is advisable not to administer
at every pain, but sometimes to allow several pains to pass without,
and occasionally to withhold altogether for fifteen or thirty min-
utes, so that the effects may pass off entirely then resume its use
again. Although patients have been kept in a state of uncon-
sciousness for many hours by Prof. Simpson and others, such prac-
tice certainly cannot be safe ; the desirable point is to carry it just
far enough to annul the perception of pain without rendering the,
jDatient unconscious ; it is sometimes extremely difficult, if not im-
possible, to hit this happy point. Its effects on all persons are not
the same; on some, large quantities have very little influence,
while others are affected suddenly and profoundly by a very
minute portion. We might judge from their expressions that
some individuals retain the perception of pain after the loss of
consciousness ; but on awakening, they remember nothing that
has passed, not even the expulsion of the child. It should always
be exhibited cautiously, and never when the patient is excited
her mind should be calm and composed before inhalation is begun
otherwise its effects might prove very unpleasant, if not dangerous

Though a firm believer in the safety of Chloroform in the prao
tice of Obstetrics, when given with proper care, I would not ad
vise its indiscriminate use in all cases. In perfectly natural, and
what are termed by comparison easy labors, it is certainly not
necessary and might be dispensed with. In such cases I withhold
it, unless the patient earnestly solicits it, apprehending that its
general use might lead to its abuse, for it is absurd to suppose that
so powerful a remedy may not produce dangerous results in the
hands of careless practitioners. But in the more difficult and
painful cases it is of inestimable value. Its introduction into
Obstetric practice is surely one of the greatest blessings ever con-
ferred on suffering humanity.

As it is not always convenient to have another physician pres-

Eve, on Chloroform. 15

ent, tie accoucheur may himself administer the Chloroform when
not particularly engaged in obstetric services to the patient, and
even when thus employed, he may direct and superintend its ad-
ministration by the nurse or any intelligent person present.

The accoucheur should observe the patient attentively while
under its influence, especially in reference to the state of her pulse
and respiration. Whenever the former becomes much depressed,
or the latter stertorous, the Chloroform should be suspended until
they become more natural. When the effects of the anesthetic
seem to be more profound than may be considered desirable or
safe, it is advisable to dash cold water on the patient's face and
heart, and apply strong aqua ammonia to the nostrils. When
respiration is suspended, insufflation is advised either by the mouth
of another person or by means of a bellows. Galvanism might
succeed well if it could be brought to bear on the case in time.

It is seldom proper to administer Chloroform early in the first
stage of labor. It is best, generally, to defer its exhibition until
this stage is considerably advanced, or the second commenced,
lest if the labor be protracted, you may be compelled to keep the
patient too long in the anesthetic state, for when once its use is
begun, it is very difficult to induce her to suspend it while the
labor is progressing. But to this general rule there are some ex-
ceptions. At times, the nervous system is so affected that the
sensation of pain is morbidly acute ; the patient suffers excrucia-
ting agony from very moderate uterine contraction. This state
we sometimes find in patients who have usually borne the pains
of parturition with exemplary fortitude and patience. This con-
dition of the nervous system is generally most happily corrected
by Chloroform, and- the same patient is often willing to dispense
with its use in the second stage, bearing the more violent actions
of the uterus, with comparatively little or no complaint. Chloro-
form is said to exercise a decidedly relaxing influence in cases of
rigidity of the os uteri. While I am willing to believe it may
have this effect, I am not prepared to testify to the fact from my
own experience, for in my practice this cause of impeded labor
seldom occurs which I think will accord with the observation of
all Southern practitioners. When, from irregular or spasmodic
action of the womb, the patient suffers inordinately, while there
is little or no progress in the labor, Chloroform meets most admira-
bly the indications in practice, to relieve the patients sufferings
and correct that state of the nervous system upon which the mor-

16 Eve, on Chloroform. [January,

bid action depends. Whenever, in the first or second stage, rup-
ture of the uterus is threatened by its violent action, it would be
advisable to put the patient more profoundly under the influence
of Chloroform, than in ordinary circumstances, for the purpose of
diminishing uterine action, until measures can be taken to avert
the danger ; rupture, however, is rarely threatened in this stage,
except in cases of rigidity, in which it would also act beneficially
lay virtue of its relaxing influence. In the whole course of ob-
stetric practice, there is perhaps no instance in which Chloroform
evinces more valuable results than in the prevention and subduc-
tion of convulsions, whether occurring before labor, during the
first or second stage, or after the process is over. It is especially
for the fulfilment of this indication that we consider Chloroform
indispensably important, and chiefly on this account that we would
not be willing to attend any case without having it in reach ; the
use of Chloroform in puerperal convulsions is referred to now,
because we believe they occur most frequently in anticipation of
labor or during the first stage. When convulsions are imminently
threatened, this may often be warded off by the sudden induction
of a moderate degree of anesthesia before venesection could be
performed we would not however, propose Chloroform as a sub-
stitute for blood letting in this dangerous affection. When time
is allowed, and especially when there is severe headache, we would
advise venesection first, and then the gentle administration of
Chloroform to compose the nervous system, conjointly with mor-
phine or some other opiate, say, } gr. Morph. or 1 gr. Opii., every
three or four hours. Although we do not think that Chloroform
can obviate the necessity for depletion, we do most firmly believe,
judiciously used, it may prevent the excessive expenditure of
blood, (to which such patients were formerly subjected) to their
very great benefit, thereby rendering their convalescence much
more rapid. By the use of Chloroform, convulsions may not only
be averted when remotely threatened by the usual premonitory
symptoms, but may sometimes be arrested when their immediate
supervention is evinced by spasmodic twitchings of the facial and
orbital muscles ; when actually commenced, their duration may be
curtailed and the succeeding coma rendered less profound.

Were it not transcending our prescribed limits, and digressing
from the subject proposed, cases might be adduced illustrative of
the views advanced. It is true there are some instances in which
all resources fail, in which every effort is unavailing, and we be-

1855.] Eve, on Chloroform. 17

come impotent spectators of destruction we cannot prevent ; but we
consider Chloroform, a most important and valuable addition to
our means for the treatment of this truly terrific disease, in which
it will greatly reduce the number of fatal cases.

It is for the relief of the more violent and exhausting pains of
the second stage, that Chloroform is more particularly appropriate
and requisite. The benefit derived is not simply from its diminish-
ing the patients suffering, but inasmuch as pain itself exhausts the
energies of the nervous system ; in the same proportion as this
remedy lessens pain, it also saves strength. Chloroform, unless
when carried very far, does not diminish the force of the contrac-
tions of the uterus or abdominal muscles it is altogether by
obtunding sensibility, that it thus saves strength and prevents or
lessens the nervous shock attendant on labor; hence it is, that
those who take Chloroform, generally have a much more rapid
and favorable convalescence, than those who are allowed to pass
without relief or mitigation through a violent and protracted la-
bor. It is true, some very eminent obstetricians have objected
to the use of this great remedy, but we think that a careful
analysis of their objections, will satisfy us of the fallacy of their
reasoning. Professor Meigs, obj ects to Chloroform in Midwifery
1st. Because he regards the -pain in parturition as physiological,
and thinks it ought not to be suppressed ; and 2d. Because in the
employment of instruments, he considers it necessary to know
how much the patient suffers, to avoid doing harm.

But even admitting (for the sake of argument) the pain to be
physiological why not relieve the patient, if we can do so, with-
out interference with the process or injury to the patient? In
what are styled easy labors, or whenever the suffering is not intense,
anesthetia is certainly unnecessary ; but pain, when inordinate,
is itself a great source of danger, as it may destroy life, directly or
indirectly, by inducing convulsions or causing exhaustion; it
should therefore be at least abated, whether physiological or pa-
thological.

Professor Meigs' second objection does not appear to me, much
more valid' than the first. The degree of pain actually felt, is not
always in proportion to the injury sustained, and the expression
is a still more fallible criterion. Some complain excessively when
suffering comparatively very little, while others make very little
complaint, however intense their sufferings may be. Nothing can
compensate the accoucheur for a want of a most minute and accu-

18 Eve, on Chloroform. [January,

rate knowledge of the material structures and the positions and
relations to them of the foetal head. He should always operate
by art and not by force, graduating the power employed by his
knowledge of what may be applied and safely borne, and not by
the resistance to be overcome : he should always know that he
is using no destructive violence inflicting no injury, whether the
patient be sensible of it or not. It would certainly be a very un-
certain and unsafe reliance, to depend on the patient to inform us
whether we are applying and using instruments properly.. One
great source of embarrassment and danger in operative midwifery,
is the difficulty often encountered of controlling the voluntary
movements of the patient, which is entirely obviated by the anes-
thetic influence of the Chloroform.

ISir* It is in instrumental deliveries, during the perform-
ance of version and other obstetric operations, that I consider its
administration peculiarly appropriate "and advantageous. In con-
clusion, we do affirm that the discovery of the anesthetic proper-
ties of Chloroform, and its employment in obstetric practice,
constitute a new and glorious era in the history of our science.
Who can contemplate the happy and wonderful effects of this
heaven-blest agent, without the most lively thrill of joy, and the
most profound and heartfelt gratitude to Him, who is the author
and giver of every good. Is it not delightful to behold woman's
primal curse in part annulled, her heavy burden lightened, and
her condition ameliorated? What can be more gratifying to
every humane heart, than to witness the most intense agonies
almost instantly, as by magic, relieved, and to behold the female
who, a moment before, was suffering the most excruciating tor-
tures, now sleeping calmly, or awake and conscious, expressing
her joy and gratitude, while labor is progressing and delivery

ACCOMPLISHED WITHOUT PAIN.

Case I. Called to see a negro woman at Mr. Blackwood's in
Hamburg, S. C, October 30, 1849. She had already passed through
seven convulsions and was now lying in a state of unconsciousness,
with incessant jactitation. On examination the os tincae was
found to be dilated, and the child's head propelled through the
superior strait of the pelvis. In consultation with Doctor Taylor,
of 1ST. C, it was determined to deliver at once with the forceps,
used during anesthesia. It only required half a drachm to a
drachm of Chloroform to put this patient in the condition desired ;
the effect was immediate and profound ; all jactitation ceased in-
stantly. The instruments were readily applied, and while the

1855.] Eve, on Chloroform. 19

mother was lying perfectly motionless, a large and living child
was extracted. Convulsions did not return, and the convalescence
was very favorable. The subsequent death of the child from
Trismus Xascentium, we do not think, in the least attributable to
the mode of delivery. Some writers advance the opinion, that
the children of women who have had convulsions are most liable
to nervous affections ; my experience does not confirm this ; the
only case of Trismus I have known, subsequent either to convul-
sions or instrumental deliver}', is the one just mentioned. In
regard to the cause, as well as to the treatment of this form of
Trismus, our knowledge is very inrperfect. We would only in
addition remark, concerning the case of puerperal convulsions
detailed above. The patient had not intelligence enough to con-
trol her movements voluntarily, and so great was the muscular
action, that even a resort to force would hardly have sufficed to
keep her still and motionless, enough to apply the forceps accurate-
ly. Dr. Taylor and myself were fully convinced that the favora-
ble termination of the delivery, as well as the facility and expedi-
tion with which it was effected, depended very much on the
administration of Chloroform. It is also probable that the Chloro-
form prevented the recurrence of convulsions.

Case II. Mrs. Q. of Graniteville, S. C, primipara, about 30
years of age, was taken with labor, March 28th, 1850, attended by
Dr. James H. Murray. Labor continued during the 28th, 29th
and 30th ; about midnight of the 30th she had a strong convul-
sion, for which she was bled copiously ; three hours after, another
convulsion occurred, and venesection was again resorted to, fol-
lowed by the administration of an opiate, after which she had no
more convulsions. I saw her early Sunday morning : labor was
still active, but her pulse was extremely feeble and frequent, beat-
ing 1-10 strokes per minute. In consultation with Dr. Murray, it
was determined to place her under the influence of Chloroform,
and deliver by the perforator and crotchet, inasmuch as extrac-
tion with the forceps was deemed impracticable, and the child's
death ascertained as satisfactorily as possible, by auscultation.
As soon as anesthesia was completely induced, her pulse became
much less frequent, but increased in fulness and force. Such
great advantage was afforded by the .motionless condition conse-
quent upon the inhalation, that the perforator was pushed through
the foramen magnum, firmly fixed upon the base of the cranium,
and a large fcetus extracted, in a very short time, without the
least injury to the mother.

In this case, the convulsions had ceased some time before the
Chloroform was used, owing, ho doubt, to the copious abstraction
of bloodv and the administration of the opiate a strong proof
of the great and indispensable importance of these remedies
in the treatment of convulsions averting them, when threaten-
ed before actual labor has commenced, and in some cases even

20 Eve, on Chloroform. [January,

arresting them while parturition is progressing and before its ter-
mination.

The value of Chloroform in this case was evinced, in facilitating
and rendering the delivery safer, preventing the further infliction
of pain and exhaustion of strength in a patient already much
prostrated, by the long continuance of labor and the necessary
abstraction of blood.

Case III. Convulsions occurring after Delivery. Eeported by
Dr. S. B. Simmons. Mrs. S., the subject of the following report,
was delivered of adherent foetuses by Dr. Joseph A. Eve, 19th
October, 1851. (See Dr. Eve's Keport in Southern Medical and
Surgical Journal for 1852, February number.)

The patient continued to do well, until about four hours after
delivery, wheu she was seized with a convulsion. Drs. Eve and
Ford met in consultation, bled her copiously, and administered
Chloroform. They remained with her for more than an hour,
during which time she had two other convulsions. Drs. E. and
F. being obliged to leave, sent for, and requested me to remain.

I now watched the patient attentively, intending to administer
Chloroform as soon as the slighest convulsive movement occurred ;
but as the convulsions came on, almost without premonition, I
was unable to get her under the influence of Chloroform in time
to prevent them ; still its use had the effect of lessening their du-
ration and violence. She had had three convulsions since my
arrival, making six in all, when I remarked that each interval, or
from the commencement of one to the commencement of the next,
was exactly forty-five minutes. I therefore determined to antici-
pate the next, by commencing with the Chloroform five minutes
before the expiration of this interval. I did so, and succeeded in
preventing the convulsion.

After having administered Chloroform in this way, three times
with like success, the patient fell into a gentle sleep ; two hours
later, she being still asleep, and having had no symptoms indi-
cating a return of convulsions, I left, after having given directions
for the farther use of Chloroform, were it to become necessary.

Mrs. S. speedily recovered, and has since passed most happily
through two accouchments.

Case TV. Eeported by Dr. S. B. Simmons of Augusta, who
was present and assisted in the delivery. On the 23d of Septem-
ber, 1852, Dr. Joseph A. Eve was called by Dr. Maddox, to a
negro woman belonging to Mrs. L. of Columbia county. The
patient was in labor with her fourth child. On Dr. Eve's arrival,
fifty- four hours after the commencement of active labor, the
shoulder was found presenting, the cord prolapsed and pulseless,
and the uterine pains very feeble and far apart. Taking advan-
tage of this state of things, Dr. Eve attempted version, but his
manipulations, having re-excited the uterine contractions, Chloro-

1855.] Eve, on Chloroform. 21

form was administered. Finding that the head could be brought
down much more readily than the feet, this was done, and the
case left a short time to see if delivery might not be effected with-
out instrumental aid.

As the labor made no progress, and in consideration of the
facts that the child was dead, (as evidenced by the prolapsed and
pulseless cord,) that the patient's strength had already been greatly
taxed, that her pelvis was contracted, and her previous labors
had been very slow and tedious, it was the opinion of all present,
that the perforator and crotchet should be employed.

Extraction was exceedingly difficult, more than an hour being
consumed in this alone.

Two hours after delivery, the patient was doing well, and when
last heard from was in high health.

In this case Chloroform was given, with but, few intermissions
for more than three hours never to such an extent as to cause
stertorous breathing ; still, sufficiently to produce complete insen-
sibility to pain. Notwithstanding this long continued use, the
patient suffered no unpleasant effects, and her recovery was more
speedy than it probably would have been, had Chloroform not
been employed.

Case V. April 6th, 1853. Mrs. J., primipara, aged about
twenty, was seized with convulsions, early in the first stage of la-
bor. I saw her. in consultation with Dr. Dearing of this citv.
She was immediately bled copiously, and on the accession of each
convulsion, was put under the influence of Chloroform, which
appeared not only to shorten the convulsion, but to render the
consequent coma shorter and less profound and the interval longer.
Gentle manual dilation was employed to hasten the termination
of the first stage. Convulsions had now ceased to occur, labor
was progressing fairly and the patient's condition in all respects
so good, that a resort to the forceps was considered unnecessary
and therefore improper. In a shorter time than might have been
expected, a healthy, living child was born. In this case, the con-
vulsions we le arrested by blood-letting and Chloroform sometime
before the termination of labor.

Mrs. J. had several convulsions before Dr. Dearing saw her:
these and the consecutive ones, making in all, about twelve.

Case VI. Con v u Isions after Delivery. April 20th, 1851. I was
called to Mrs. C, primipara, about twenty years of age. On ex-
amination, she was found to be far advanced in labor, and suffer-
ing intensely from headache. Nearly a quart of blood was
promtly abstracted, with immediate relief to her head : in about
three hours labor terminated happily in all respects, but two hours
after the delivery, a strong convulsion came on. The vein was
re-opened and blood allowed to flow to the extent of about sixteen
ounces more. Directions were left to administer Chloroform upon

N. S. VOL. XI. NO. I. 2

22 Eve, on Chloroform. [January,

the slightest indication of a convulsion. In my absence an hour
or two after the first convulsion, another appeared to be coming
on, but was averted by the timely application of Chloroform.
Yery soon after my return, I observed evident premonitory symp-
toms, which were again arrested by the Chloroform. After the
lapse of some time, she did have a convulsion, but its duration was
materially lessened by the anesthetic, and in all probability it
would have been entirely prevented as the others were, had there
not been some delay in the administration of the Chloroform ; this
was the last. Erom one quarter to a third of a grain Morphine was
prescribed, to be taken every three or four hours for several days,
until the patient became convalescent. The effect of the Chloroform
was certainly most happily evinced in this case, although much
ought doubtless to be attributed to the bleeding and Morphine.

It is probable too, that if this patient had been bled previous to
the coming on of labor, or soon after its commencement, convul-
sions would have been entirely averted.

Case VII. Mrs. B., primipara, aged nineteen, was seized with
convulsions, in the eight month of gestation, at 3 o'clock, P. M.,
1st of March, ^ 1854. Chloroform was freely administered, and
blood abstracted to the amount of thirty ounces ; Morphine was
also given, but convulsions continued to recur. Doctors Jones,
H. A. and A. Bignon, Dugas and Ford, were in attendance. All
our remedies apparently failing to have the slightest influence in
arresting the convulsions, and slight dilatation of the os uteri having
commenced, the membranes were ruptured by the introduction of
a steel pen. After the discharge of the liquor amnii, there was a
suspension of the convulsions for three hours ; labor supervened
and the convulsions returned with most frightful rapidity and
violence ; Chloroform was given after each convulsion, Morphine
exhibited by the mouth, as long as deglutition lasted, and then by
enema, and the dilatation of the os was assisted by the fingers; as
soon as this was sufficiently accomplished, but before the whole
circle was fully dilated, the patient was brought more profoundly
under the influence of Chloroform, a very narrow and delicate pair
of forceps were introduced and a living child extracted about 2
o'clock A. M,. March 2d. The convulsions nevertheless continued
at intervals of fifteen to twenty minutes, until late in the afternoon
of this day, notwithstanding the administration of Chloroform,
sinapisms to the spine, cold affusions to the head, blister to back
of neck, calomel and all other means usually considered most
potent, during which time, it is estimated that she had eighty con-
vulsions, and that two pounds of Chloroform were consumed.
Mrs. B. was ill for some time, subsequently ; had an attack of
peritonitis, for which she was blisterd : but after a tedious conva-
lescence, recovered very good health. The child though prema-
ture and feeble, survived. This case is remarkable for the recovery
of the mother, and the safe birth of the child after so many con-

1855.] Eve, on Chloroform. 23

vulsions, and for the continuance of the convulsions after delivery,
as frequent and numerous as before. I have never known, nor
do I remember ever to have read of a similar case. A patient in
my practice, many years ago, survived after having forty-one con-
vulsions.* She was delivered, by the forceps, of a dead child. A
case also occurs to me, in which, after the patient was to appear-
ance, almost in articulo mortis, the number of convulsions she had
had not being known, a living foetus was extracted by the forceps.
The mother rallied after the operation, lived several days, but
afterwards died of peritonitis. +

In the case of Mrs. B., the good effect of Chloroform, as well as
of all other remedies, was not obvious in arresting the convulsions,
for they continued for a long time, apparently uninfluenced by
any means whatsoever, and when they ceased, we did not know
to what mainly to attribute the result. We do not doubt, how-
ever, that it was due in some measure to the powerful agency of
Chloroform, but this anesthetic independent of its direct influence
on the convulsions, was of great value in keeping the patient mo-
tionless and insensible during the application of the forceps, and
the extraction of the foetus.

As this case was so desperate, and the result beyond all reasona-
ble expectation, we think it a fair conclusion, that no one of the
powerful remedies could have been safely omitted.

Case VJJLL Mrs. C. of Edgefield District, S. C, multipara, aged
thirty-two, was seized with convulsions about the commencement
of labor, Aug. 23d, 1850. She was immediately bled and a quar-
ter of a grain of Morphine given Chloroform was administered
on the accession of each convulsion, but they nevertheless con-
tinued to recur through the night, becoming however, less severe
and less frequent. Dr. Creighton of Hamburg, and Dr. Ford of
Augusta, were in attendance with me. As the convulsions had
become comparatively slight, and further apart when the second
stage commenced, and especially as this stage was progressing
very fairly, it was deemed inexpedient to hasten it by the use of
instruments. Mrs. C. was soon delivered safely of a thing child ;
she had eleven convulsions before its birth and one afterwards.
Morphine was then exhibited more freely.

The happy result in this case, is certainly in some degree at
least, attributable to Chloroform. This case is another illustration
of the propriety of trusting to the natural efforts, without resorting
to the forceps whenever labor is advancing fairly. In the excite-
ment, hurry and confusion occasioned by the occurrence of con-
vulsions during labor, it is to be feared, that sometimes instru-
ments are used unnecessarily, and not unfrequently to the injury
of mother or child, perhaps both, when nature herself, if left alone,
would have accomplished the delivery with greater safety, and pro-
bably, in as short a time. [Transactions Med. Soc. Stat

* See S. M. & S. Jour, for 1847, p. 520. t See S. M. & S. Jour, lor 1843, p, 69.

24 Treatment of Mentagra. [January,

TRANSLATIONS AND CONDENSATIONS FROM FRENCH JOURNALS.

A simple, prompt and radical treatment of Mentagra, ( Varus Men-
tagra). By Dr. Kichart, of Soissons.

Whether this affection be acute or chronic, two indications
always present themselves : to subdue the irritation, afterwards
to use resolvents.

For several years, I have fulfilled the first indication successfully
by having the diseased surface washed five or six times daily with
a warm decoction of chervil and laurel leaves, (prunus lauro-
carasus). In order to cause the scabs to fall, I advise my patients
to anoint them every night, on going to bed, with fresh cream, or
with a cerate made of yellow wax and olive oil melted together.
Three or four days' use of the decoction, will ordinarily suffice to
subdue the irritation.

I fulfill the second indication with equal success, by causing the
surface to be washed five or six times a day with the following
solution, using a fine sponge, and allowing the part to dry without
wiping.

ty. Sulphate zinc, - - parts 16.
Sulphate copper, - - " 5.
Distilled water, - - " 500.

Dissolve, filter and add :

Distilled laurel water, grs. 15.

As to internal remedies, believing that mentagra is caused
principally by a chronic suppression of the cutaneous perspiration,
I prescribe two large tumblers of water to be taken every mornirig
before breakfast, at an interval of an hour. I advise also dry
frictions over the whole body every night, and a walk every morn-
ing before breakfast, because I am convinced that the stomach
being empty, perspiration is freely produced by the slightest ex-
ercise. This abundant secretion, I think, is the best purifier of
the blood. During winter, as this secretion is sensibly diminished
and that of urine increased, I use this latter means for purifying
the blood by administering diuretics if they are insufficient, I
have recourse to purgatives.

These simple means are seconded by alkaline baths and a mode-
rate diet, more vegetable than animal. I exclude salted or spiced
food, and also alcoholic drinks. In this way I obtain prompt
cures, even in cases that had been treated for eight or ten years
without success.

1855.] Treatment of Cerebral Congestion- and Apoplexy. 25

I recommend my patients, in order to avoid relapse, not to
pluck out the beard, as was formerly proposed, but on the contrary,
to let it grow at least three or four months after being cured, or
to cut it, not with the razor, but with scissors curved on the side.

[Revue de Tkerap. Medico- Chirurg.

Mational treatment of Cerebral Congestion, and of Apoplexy with the
Alkalies, and particularly icith Bicarbonate of Soda.

Dr. Carriere has just published in the Annates Medico- Physiolo-
ffiques, an interesting work to demonstrate that congestion and
apoplexy may be prevented for a long time by the liquifying
properties of alkalies upon the blood. The following will suffi-
ciently illustrate his ideas and the modus faciendi.

Too strong a diet and a life of inactivity, produce an excess of
nutrition, and consequently too great a richness of the blood.
The system receives a great deal and expends too little. The
sensation of heaviness and of general fullness which result from
it, usually indicate a change in the condition of the humors. If
acid prevails, it is easily known by the manner in which digestion
is performed, by the pains of the stomach, and by the odor of the
eructations. To avoid the congestions which would soon be pro-
duced, if they have not sometimes already taken place, it is neces-
sary to administer alkalies. Bleeding will modify or retard the
accidents ; it does not modify the cause which, remaining always
active, will end by showing itself more or less violently.

The alkaline treatment offers no difficulty. The condition once
known, we must act accordingly; with small doses when the affec-
tion is circumscribed, and with larger ones when more extensive
and serious. The most simple manner of administering the medi-
cine is the best, and the alkali to be preferred to all others is the
bicarbonate of soda. He recommends the mineral alkaline waters,
and believes ammonia useful during the treatment as well as at
the most urgent moment. Having given these general rules, he
passes to .the details.

When the affection is confined to the stomach, a few grranmes
of bicarbonate of soda will suffice from a half to one gramme, at
most, in a tumbler of water sweeten jd with simple syrup. After
twelve or fifteen days, sometimes less, of this treatment, it is rare
if the pains and sluggishness of the digestive faculties have not
pased away. It is often surprising, that a condition which has

26 Tincture of Benzoin in Chapped Nipples. [January,

resisted the series of anti-spasmodics yields as rapidly under the
influence of a treatment which seems to possess so little ac-
tivity.

When the economy presents general symptoms of congestion,
and the danger seems yet far off, the time is favorable for com-
mencing the treatment. It is scarcely necessary to say that it re-
quires time to produce a great change of the blood and other hu-
mors, so that when violent attacks are not to be feared immediately,
a great amelioration may be relied upon, and perhaps, a complete
cure may be effected by means of bicarbonate of soda. The treat-
ment should be commenced with one gramme in a little syrup and
water, and gradually increased to two, and even more, without
increasing the dose too much. By leaving off the medicine after
using it regularly for two or three weeks or a month, its effects can
be better judged of and its action kept up by using moderate doses.

At a more advanced period, that is, on the eve, or at the moment
of a simple or apoplectic congestion, it is to ammonia that recourse
should be had according to M. M. Page and Gavarret. Twenty-
five drops in a half tumbler of water during the attack is enough,
but as this is given at intervals, it should be done according to
the case. After the attack, instead of giving five drops every hour
in a half tumbler of water, it would be better to give two drops
in the same quantity of fluid every half hour. This treatment may
be disapproved, but it cannot be denied that it is rational. If it
does not exclude bleeding, a remedy directed against a secondary
effect of the disease, it controls it, because it directs itself to the
cause, and not to the consecutive phenomena. [Ibid.

Tincture of Benzoin in Chapped Nipples.

M. A. Bourdel, Professor of the Faculty of Medicine of Mont-
pellier, and Inspecting Physician of the Malon, affirms that he has
found the tincture of benzoin to be the best remedy in this disease.
He has used it for ten years without ever having had cause to
change. This tincture is applicable to all fissures of the breast,
whether superficial or deep, large or small, of long standing or
recent, and it causes them to heal rapidly, provided they are sim-
ple, that is to say, if they are not under a syphilitic or other diathesis.

He applies the tincture by means of a soft brush or otherwise,
to the fissures until they are coated with the liquid. He generally
makes the first application himself, because it is the most painful,
and to demonstrate the way in which it should be done ; and he

1855.] Cafeine in Sick Headache. 27

recommends it to be applied every time the child nurses, and
oftener if necessary.

A few days of tins simple treatment suffices to heal the smaller
fissures and render the breast fit to discharge its functions. If the
fissures are more extensive, the treatment must be continued
longer. He never saw a case which required this treatment more
than twelve days.

The first application of the tincture causes a certain pain or
smarting in a majority of cases, which is pretty acute when the
fssures are deep, but it never lasts more than fifteen minutes.
After the first application it is not only no longer painful, but
gives relief, and forms a covering for the surface which it protects.
The child can at any time take the breast without inconvenience
cr repugnance, having seen them nurse even before the tincture
vas dry. After a short time, the child may nurse without
vashing or wiping the breast; and who knows the sufferings
Thich are thus spared the mother! [Gazette Med. de Toulouse,
Hay 1854, and Ibid.

Cafeine in Sick Headache.

We read, in the Allgemeine Medizinische Centralzeitung, that Dr.
Eulenburg has obtained excellent results from cafeine in the treat-
ment of this disease in two cases, one 30 and the other 4-0 years of
ige. The disease returned at intervals of from one to four weeks.
Kany remedies had been resorted to, but without relief. M. Eu-
lenburg began at the first symptom of a return of the attack with
1) centigrammes of cafeine, and repeated this dose every two
lours until three doses had been taken. This treatment quieted
tie pain and lengthened the intervals.

As the price of cafeine is very high, the author suggests in its
pnee the extract of coffee, 20 centigrammes of which are equiva-
leit to 5 centigrammes of cafeine. [Ibid.

Treatment of Hydrocele. By M. Bellucci.
The operation for the radical cure of hydrocele is now one of the
sinplest and most certain in surgery. It is an operation never-
tleless, and as such is not entirely free from accidents; every
neans should therefore be employed to arrive at the same end
w.thout it. M. Bellucci uses an ointment composed of from 4 to 6
g&mmes of powdered digitalis and 30 grammes of lard. Frictions

28 Treatment of Gangrene of the Lungs. [January,

are made with this ointment upon the tumor, being careful to
wash the scrotum every five or six days, to cause the absorption
of the remedy to be more active. Five cases, one acute and four
chronic, reported by the author, are sufficient to show the efficacy
of this treatment, which requires from two to three months to pro-
duce a complete cure. [II. Filiatre Sebezio et Gaz. Med. de Paris ,
and Ibid.

Treatment of Gangrene of the Lungs.

Prof. Skoda, of Vienna, has recently published four cases cf
gangrene of the lungs successfully treated by inhalations of the
vapor of oil of turpentine and internal use of sulphate of quinine.
Under this treatment the cure was rapid, without leaving infiltra-
tion, caverns, or any abnormal sounds ; the vesicular respiration
having re-established itself. The vapor was inhaled every twp
hours, for five or ten minutes, and the quinine given in one grain
doses every two hours. In order to render the turpentine vapo:
less disagreeable, oil of roses may be added, as did M. Skoda in one
of his cases. (Zeitchr. d. K. K. Gesellsch. d. Aerzte.)^[Ibid.

New method of administering Cod-liver Oil. By M. SAUVAN.

Cod-liver oil being so valuable a remedy, particularly with
children, that all means of rendering it less disagreeable is o!
great value. The following formula will entirely mask the taste
and odour of the oil :

#. Yolk of egg,

Sugar, ....
Orange flower water,
Cod-liver oil,
Essence of bitter almonds,

[Ann. Chir. de Montpellier, and Ibid.

1

. 60

gram.

. 30

u

. 90

a

1

drop.

Simple method of administering Iodine Inhalations.

The inhalation of iodated vapor is well known to be inconveii-
ent in consequence of its irritating effect upon the air passages aid
the cough it induces. In order to obviate this difficulty, M. Ba*-
riere has proposed, in the Gazette Medicate de Toulouse, the follor-
ing plan :

He causes his patient to snuff up pulverized camphor saturatd
with iodine vapor. This is done by rubbing together 100 parts >f

1855.] Chorea. 29

pulv. camphor and 1 part of pure iodine, which are wrapped in a
bit of gauze and put into a snuff-box. By shaking the box occa-
sionally and imparting to it the warmth of the hand, the vapori-
zation of the iodine will be produced in a few hours and be
recognized by its peculiar color. This iodated camphor occasions
sneezing, and even some pungency in the nostrils, but as the vapor
reaches the air passages an agreeable sensation is experienced
which induces the patient to take deeper inspirations. Those who
have tried it become very fond of it, and many even prefer it to
snuff. The anaphrodisiac properties of camphor may render it an
useful adjuvant, inasmuch as venereal indulgences are among the
active causes of phthisis.

Chorea.

M. Blache read an essay before the French Academy of Medi-
cine upon the treatment of Chorea by gymnastic exercises. The
author thinks that there are two indications in the treatment of
this disease : 1st, to restore to the will its control of the muscles ;
2d, to change the constitution of the patient. The first of these
indications is the object of the gymnastic exercises.

Of 108 cases of chorea subjected to gymnastic treatnent at the
Hopital des Enfans, only six were unsuccessful, although there
were chronic cases which 3-ielded only in 120 days and 73 exer-
cises. It should be acknowledged, however, that sulphurous baths
have been nearly as successful as gymnastics, for it appears that of
135 cases treated with these baths only 18 were not cured. It
would seem also that the bath treatment is more expeditious than
any other. Yet there are reasons for preferring gymnastics.
These exercises are applicable to all cases not complicated with
cardiac affections ; whereas the quantity of sulphuret of potass.
necessary is so great as sometimes to cause an eruption upon the
skin which forbids the bath any longer; nor can they be used if
the skin is abraided at any point. During the first days of their
use they not unfrequently increase instead of lessening the spas-
modic affection, whereas by passive exercise the muscles at once
become calm. The state of the general system after each of these
plans of treatment, should be considered in estimating their rela-
tive value. The appetite is improved, the circulation invigorated,
and the nutritive process made more perfect by the sulphurous
baths. The muscular power is increased, the skin and mucous
membranes become florid, and the arterial sounds vanish. But

30 Menorrhagia. [January,

these effects, to which we should attribute in a great measure the
cure, are especially worthy of note under the influence of the gym-
nastic treatment. Would it not therefore be advantageous to com-
bine these two modes of treatment ? This question has been settled
affirmatively in a large number of cases.

It is not rare, adds Mr. Blache, to see chorea occurring during
a too rapid growth. Under such circumstances, the patient fre-
quently complains of pains in his wrists and elbows, which are
regarded by Dr. See as rheumatic. This kind of arthralgia is re-
garded by Mr. Blache as dependent merely upon excessive growth
and they disappear very readily by gymnastic exercises. The
gymnastic exercises, which might at first appear hazardous,
especially for children, are in reality without danger. They should,
however, be of two kinds ; first, passive exercises, which alone can
be used when the will has no control over the muscles ; second,
active exercises, which may be executed voluntarily with or with-
out the aid of machines.

Menorrhagia. By Edward Eigby, M. D., etc., Senior Physician
to the General Lying-in Hospital; Examiner in Midwifery at
the University of London.

In selecting cases of menorrhagia coming on at that period of a
woman's life when the menses are either about to cease, or ought
to have done so, and attended with local symptoms and conditions
of the uterus which I have considered to be of a suspicious, if not
dangerous character, let it be understood, that I by no means point
them out as cases of actual malignant disease, but merely as ex-
hibiting more or less of a disposition thereto, although still, in
many instances, admitting of considerable relief by treatment.

If we examine into the history of malignant uterine disease, we
shall, in most instances, find that there has been an early passive
stage of considerable duration ; that the health has become gradu-
ally impaired, the uterine functions deranged ; in women who
have been pregnant several times, their two or three last pregnan-
cies have probably terminated in abortion, which has come on
without any very assignable cause. I am aware that this applies
equally well to non-malignant disease, like fibrous tumor ; but it is
not the less worthy of note, as it often furnishes us with the earliest
data respecting the commencement of the disease, and enables us,
in reviewing the history of the case, to trace it back to an earlier
period than would otherwise have been suspected. That abortion
is not an invariable forerunner of malignant or non-malignant
disease, is proved by the well-known fact of pregnancy being
associated with every form of it, and running its course undisturbed

1855.] Menorrhagia. 31

to a late, or even the full period, even under circumstances where
it could scarcely have been supposed possible. This, however,
must be rather looked upon as an exception to the rule, that preg-
nancy occurring during the two or three years which precede the
outbreak of uterine disease mostly terminates in abortion. I hold,
therefore, that abortion coming on without any very evident cause
in a woman past 40, is a suspicious symptom, and the more worthy
of attention, as the early symptoms of uterine disease are generally
too inappreciable to attract even the notice of the patient, and are
of a nature about which she would not willingly consult a Medical
man if she could possibly avoid it.

In most instances, abortion is rather a retrospective symptom, to
afford some probable clue as to how long the disease has existed,
when the fears of the patient and suspicions of the Medical man
have been excited by attacks of menorrhagia. It is to these attacks
(of menorrhagia) in their earliest stages and slightest degrees, and
more particularly to that group of symptoms which I mentioned
in my last report as chiefly connected with chylo-poietic derange-
ment, and to the anaemic, chlorotic appearance of the patient, that
I am peculiarly anxious to draw the attention of the Profession,
because this is the period when treatment will be of most avail,
and produce the most striking effects.

Mrs. H., aged 50 ; married 21 years ; four children ; aborted in
her last three pregnancies ; short and stout ; pale and flabby.

Dec. 10, 1849. Profuse bloody discharge, coming on irregular-
ly, sometimes bright, at others dark. The periods have varied a
good deal of late, sometimes appearing every fortnight, at others
only once in five weeks. They last more than a week, and are
profuse for the first four or five days ; sometimes preceded for
some hours by rather sharp pain about the hips, which she is in the
habit of relieving by a sedative pill. These attacks are attended
with much nervous depression. Has pain sometimes of one and
sometimes of the other groin. Tongue clean, but sulcated. Bowels
regular.

The catamenia have been gradually becoming profuse during
the last ten years, and first showed this disposition two years after
her last abortion. During the last year she has had a slight
watery discharge, which stiffens her linen.

Examination per vaginam. Os uteri high up, small and soft ;
cervix short ; uterus much enlarged. The uterine sound would
not pass at first beyond one inch, but the dilater passed easily
through the os internum, and then the sound passed 3 a inches.
A quantity of thick, clotty, dark brown fluid came away. The
fundus is inclined to the right side.

$. Pil. hydrarg. gr. iij., ferri sulph. gr. ij., extr. hyoscyami gr.
v. M. ft. pil. ij. o. n. s. Mist, potassae bicarb: et nitratis ter die.
12th. Catemania coming on. Omitt. mist.
$. Acidi gallici, extr. hyoscyami aa. gr. v. M. ft. pil. ij., bis
die sumend.

32 Menorrhagia. [January,

15th.-^-Catamenia came on freely, but not profusely, and without
clots. The discharge was brown and rather thick. Has not felt
weakened by it. Bowels confined.

$. Pil. hydrarg. extr. coloc. co., extra, hyosc. aa. Bj. M. ft.
pil. xij., sumat ij. h. s.

20th. Was seized during the night with severe pain of spas-
modic character in different parts of the abdomen, which feels full
and loaded ; she bears gentle pressure, but vomits occasionally ;
pulse feeble ; looks very ill.

ty. 01. ricini 3 yj. statim ; et repet. si opus sit. Enema magnum.

ty. Hydrarg. c. creta, pulv. ipecac, comp. aa, gr. v., h. ss.

24th. Is much better ; has continued the pills every night, and
'Caster-oil every morning ; large quantities of knotty scybala have
come away daily with very great relief; still, however, the ab-
domen is large and doughy.

$. Ext. hyosc, ext. gentianas aa. gr. v., o. n.

$. Ferri sulph. gr. xvj. ; magnesias sulph. I j. ; acidi sulph. dil.
3j. ; syrupi rhoeados ss. ; aquas menthas pip. Bvijss. M. ft.
mistura, sumat cochl. magn. ij. primo mane.

1852, Dec. 2. Has had no catamenia or discharge of any kind
for a year ; is looking better ; has kept the bowels regular with a
rhubarb draught and an occasional blue pill. Has pains (appa-
rently hepatic) across the middle of the back and right shoulder ;
lies best on the right side ; these pains come on every four or five
weeks, at which time the right hypochondrium is tender.

$. Pil. hydr. ext. hyosc. aa, gr. v. h. s. p. r. n.

It. Acidi hydrochlor. dil., acidi nitrici dil. aa. 3j.; liq. tarax.
5j. ; infusi aurantii comp. 5 vij . M. ft. mistura cuj us sumat cochl.
magna ij., ter die.

^. Sodas potassio tart, manuas opt. aa. 5ss.; pulv. rhosi 3ss. ;
aq. menthas pip. liij. M. ft. haust. sumat demid. primo mane
post pilulas.

1854, April 1. Is suffering from pains of a spasmodic charac-
ter, commencing beneath the right scapula, and extending round
to the left side ; evacuations dark ; urine rather scanty ; no dis-
charge of any kind ; the right hypochondrium is tender during an
attack. Has taken pil. hydr. three times during the week. Kep.
pil. hydr. p. r. n.

$. Liq. taraxaci cochl. min. j. om. nocte ex aqua vel lacte.

$ . Lin. camph. co. 1 iiss. ; tinci. opii 3 ss. M. ft. linimentum
parti dolenti applicand.

In this case, it is worthy of the remark, that her three last preg-
nancies terminated prematurely in abortion, that the catamenia,
in two years after the last abortion, had gradually assumed a
menorrhagic character, and latterly had become irregular as to the
periods, and variable as to the appearance of the discharge ; more-
over, during the last year, she had had in the intervals a watery
discharge, which rendered the linen stiff on becoming dry. The
uterus was larger and more bulky than natural ; the os uteri inter-

1855.] Eclampsia during Pregnancy. 33

num did not admit the sound ; but, as is frequently seen with the
urethra, allowed a larger blunt instrument to pass ; the uterine
cavity was increased in size, and filled with dark-brown, grumous
fluid. The sum of this evidence is decidedly of an unfavorable
character ; it shows that the uterus was much enlarged from pas-
sive congestion, and that the upper part of the canal of the cervix
was sufficiently obstructed by swelling to retain a quantity of the
last catamenial discharge.

The bowels were stated to be regular ; I did not, therefore, ven-
ture to give a purgative in her exhausted state, and even combined
the small dose of a blue pill to a tonic, and as soon as there were
evidences that the catamenia were returning, I gave her the gallic
acid with good effect ; the discharge, although free, did not become
profuse, and she was spared the severe prostration which she had
suffered on previous occasions ; further observation, however, con-
vinced me that the bowels were much loaded ; purgative medi-
cine of mild but effective character was given, and its action still
further assisted by a large enema ; great quantities of scybala were
dislodged with striking relief, and their evacuation was followed
by general improvement of her symptoms. There can be little
doubt but that this intestinal accumulation had tended much to
aggravate the uterine congestion, and thereby the haemorrhage ;
and, vice versa, that the enlarged uterus, thus pressed upon by the
loaded bowels, had much increased the constipation by the pres-
sure which it exerted upon the rectum.

I regret much that I had not the opportunity of making another
examination, that I might ascertain what amount of change had
taken place in the uterus, and especially how far it had diminished
in size ; but her improved state of health rendered it unnecessary.

[Med. Times.

Brazen on Eclampsia during Pregnancy.

This author has recently published a lengthy paper on the above
interesting subject, of which the following is a very brief abstract :

1st. Convulsions may arise, during this period, from hysteria,
epilepsy, cerebral diseases, poisons, or uraemia, resulting from
Bright's disease.

2d. Their most common causes are uraemia and Bright's disease.

3d. The least frequent causes are primary cerebral diseases ; and
when these occur in connection with albuminous nephritis, they
are the results, not the causes, of the convulsions.

4th. Hysteria and epilepsy may exist, during gestation, in a
chronic form, so as to exercise no injurious influence either on
pregnancy or labor, or on the life of the child ; and they may be
quite unconnected with Bright's disease.

5th. Convulsions in every form may occur from these causes in
the unimpregnated female ; and also in men, from all of them, ex-
cept hysteria.

34: Eclampsia during Pregnancy. [January,

6 tli. The altered constitution of the blood, and the detention of
the venous blood in the kidneys by the pressure of the enlarged
uterus, are most commonly the causes of the Morbis Brightii, which
occurs during pregnancy.

7th. Convulsions are caused by the urea, which is uneliminated
from the blood on account of the renal disease, becoming changed
into the carbonate of ammonia.

8th. When, in cases of Bright's disease during pregnancy, we
find carbonate of ammonia in the blood, we may prognosticate the
occurrence of convulsions ; but when, at this time, the urea in the
blood exists merely in small quantities, or chemically unchanged,
we need not dread eclampsia.

9th. Parturition and uterine irritation neither cause this chemi-
cal transformation, nor occasion urapemic eclampsia.

10th. The abortions which so freqently happen during uraemic
convulsions, are the results, not the causes of the eclampsia.

11th. There is no connection between eclampsia and labor-pains.

12th. Albuminuria does not result from convulsions arising from
functional interruptions, and does not generally occur in those of
an epileptical and hysterical character.

13th. Albuminuria continues throughout pregnancy, although
the eclampsia attacks may have ceased ; but when convulsions
cease after labor, it soon disappears, provided the renal disease be
only in the incipient stage.

14th. The disappearance of the albuminuria after parturition, is
principally due to the diminished volume of the uterus.

loth. Morbus Brightii (without convulsion) may be palliated,
but not removed, during pregnancy, although it readily yields to
remedies after parturition.

16th. Albuminuria occurs in all cases of eclampsia which do
not depend upon hysteria, epilepsy, primary cerebral diseases, or
poisons.

17th. Epiliptic convulsions may occur simultaneously with those
from Bright's disease and uraemia.

18th. Uraemic convulsions, when frequently recurring, occasion
the death of the foetus ; but its life is not endangered by those
from hysteria or epilepsy.

19th. During an attack of uraemic eclampsia, reflex sensibility
is almost wholly suspended ; and after it we oftener find sedema
and anaemia of the brain, than hyperemia and consecutive
apoplexy before it.

20th. Venesection (according to Kiwisch, Litzman, Sedgwick,
Blot, and Kink) is injurious in eclampsia; and the author has
found its action very uncertain in uraemia. He considers inhala-
tions of chloroform to be the best and safest means we possess for
subduing and removing uraemic convulsions, both during preg-
nancy and after labor.

21st. The most certain diuretics for removing the uraemia of
Bright's disease are the benzoic, tartaric and citric acids.

1855.] Nasal Irritation in the Treatment of Ozcena. 35

22d. The artificial induction of premature labor diminishes the
danger of uraemic eclampsia alike to the mother and child ; but
this practice should not be universally resorted to in cases of
Bright's disease during pregnancy, but only when necessitated by
the occurrence of convulsions. Braun considers the tampon as
the best method for its induction when necessary.

[The Editor of the Monthly Journal remarks : The treatment
here jDroposed appears to us by no means universally applicable.
Where the convulsions occur during pregnancy, or in an anaemic
patient, or where, as happens in infantile eclampsia, they depend
rather upon a superpolarity of the cerebro-spinal system that on
actual toxaemia, we consider the inhalation of chloroform as un-
questionably the best treatment for arresting the paroxysms. But
when, on the other hand, they occur during parturition, or in the
puerperal state, in a robust, plethoric patient, we should be in-
clined, from all we have seen of the disease, to place more confi-
dence in copious venesection, smart purgatives, and cold to the
head.

Moreover, for the induction of premature labor in such cases,
we should be inclined to prefer the use of sponge-tents and uterine
douches to the clumsier method of the tampon.] Edinburgh Journ.
Mea\ Science.

On the Xa-sal Irritations in the Treatment of Ozcena. By M. Mais-
oxneuve, Hopital Cochin, Paris.

All physiologists are aware that, in the act of deglutition, the pha-
rynx and soft palate close the communication of the fauces with the
nasal fossa?, by a combined movement, so as to prevent the alimen-
tary bolus from regurgitating into the nostrils ; but no one, so far
as I know, has yet mentioned the production of this same phenome-
non under the influence of injections of liquids by the anterior nares,
nor remarked that injections propelled violently into one nostril
invariably escaped by the other, without penetrating into the throat.

This fact, to which I now desire to call the attention of surgeons,
appears to me to be of considerable importance in the treatment of
several serious diseases, and especially in ozaena.

Ozama,* as every one knows, is an infirmity consisting in an ex-
cessive fcetidity of the nasal secretions, depending on the protracted
sojourn of blood, pus, and mucosities, in the recesses of irregular
cavities, where they are subjected to the triple action of air, heat
and moisture.

At each expiration, the air which traverses these cavites, is
charged with putrid emanations, and forms a loathsome atmosphere
around the patient ; so that the victims of this disease become
objects of horror and aversion.

* Ozcena; ulceration ofthe mucous membrane of (be nasal fossae, producing fetidi-
ty oi the air expired by the nostrils, das stinkende Nascngeschuur. (Palmer.) Ed.

36 Humoral Theory of Epilepsy. [January,

Hitherto, our art has possessed only feeble resources against this
appalling disorder. With the exception of syphilitic ozsena, in
which the preparations of mercury and iodine have a direct action,
the graver varieties of the disease have been regarded as nearly
incurable. Cauterizations, insufflations of detersive and astrin-
gent powders, were employed indeed ; patients were advised to
inspire balsamic and emollient liquids, and timid injections were
made with small syringes, but these remedies were but insuffi-
cient applications, and persons who used them, still exhaled the
repulsive odour characteristic of the disease.

ISfo one thought of using free and powerful injections, under the
persuasion that they would penetrate into the throat.

Now numerous experiments have demonstrated to me positively
that this opinion is completely erroneous, and that injections pro-
pelled with great force into one nostril, will always escape by the
other. >

It results from this fact, that we can readily wash out the nares,
and free them from the accumulated crusts, mucus, and pus, which
by their sojourn produce ozama.

Xothing can be simpler than this operation. It suffices to in-
troduce the canula of a large sj'ringe into one nostril, and to push
the piston energetically. A current is presently established, and
foreign matters are washed away, The operation is not disagreea-
ble, and may be executed by the patient himself.

Thus discharges are removed, the fcetor is corrected, and in a
short time the morbid condition of the mucous membrane begins
to amend, and a durable cure is ultimately effected. [Virginia
Medical and Surgical Journal.

The Humoral TJieory of Epilepsy. By Robert B. Todd, M. D.,

Physician to King's College Hospital.

A clinical lecture, on a case of renal epilepsy, delivered by Dr.
Todd at the Hospital of which he is the physician, was made the
occasion of some important and novel suggestions, which we will
present in an abridged form to our readers. The frequency of this
intractable disorder, its distressing symptoms and its destructive
influence on the brain and intellectual faculties of its unfortunate
victim, make it worthy of the closest investigation.

Dr. Todd alludes to the discovery of the frequent association of
epilepsy with renal disease, thus throwing an amount of light on a
class of cases which have heretofore been treated almost entirely
by empirical remedies, but which are now capable of being suc-
cessfully managed on rational and scientific grounds. He proposes
from the information thus derived, to construct a theory of the
cause of epileptic fits generally. He says:

"I hold that the peculiar features of an epileptic disease are due
to the gradual accumulation of a morbid material in the blood,
until it reaches such an amount that it operates upon the brain in,

1855.] Humoral Theory of Epilepsy. 37

as it were, an explosive manner ; in other words, the influence of
this morbid matter, when in sufficient quantity, excites a highly
polarized state of the brain, or of certain parts of it, and these dis-
charge their nervous power upon certain other parts of the cerebro-
spinal centre in such a way as to give rise to the phenomena of
the fit. A very analogous effect produced is that which results
from the administration of strychnine, which is best seen in a cold-
blooded animal, as the frog. You may administer this drug for
sometime, in very minute quantities, without producing any sensi-
ble effects, but when an accumulation has taken place up to a
certain point, the smallest increase of dose will immediately give
rise to the peculiar convulsive phenomena. ll

This, then, may be considered as the humoral theory of epilepsy.
A morbid matter is generated which infects the blood. This mor-
bid matter has a special affinity for the brain, just as the strychnia
has for the spinal centre. The source of this morbid matter may
be in the nervous system, probably in the brain itself.

To give a more definite character to this humoral theory, we
need to discover a morbid matter in the blood in every case of
epilepsy, and this has to a certain extent been accomplished.

The clue to a discovery of this kind was first given by the ob-
servations of Prevost and Dumas upon the effect of excision of the
kidney. They found that a removal of the kidneys was followed
by an accumulation of urea in the blood, resulting in convulsions
and coma, and an epileptic state. The clinical observations of
physicians being directed to this point, soon developed the fact
that disease of the kidney was apt to be followed by epileptic
symptoms, and that in these cases, urea was found in the blood.

11 A connexion was thus clearly established between the pres-
ence of urea in the blood, defective renal secretion, and the epilep-
tic condition ; but whether the active poison is urea, has not been
yet decided. Frenches has lately affirmed that the morbific agent
is carbonate of ammonia, a product of the decomposition of urea.
All that we really know is, that in certain states of diseased kidney
when the secretion falls below a certain point, urea will accumu-
late in the blood, and epileptic seizures will ensue. Should the
patient die, we find no brain lesion to account for the phenomena,
but unequivocal evidence of diseased kidney.

Imperfect as is the present state of our knowledge on this point,
may we not see in the facts thus detailed a gleam upon the horizon
announcing approach of some brilliant discovery which no doubt
the advancing state of organic chemistry will yet develop, and
which will throw great light on the obscurest disease in the whole
range of maladies which affect the human frame. ??

The experiments of Frenches went to show that the comatose and
epileptic symptoms ensuing on kidney disease were attributable to
a development in the blood of carbonate of ammonia, arising from
decomposition of the urea. This carbonate of ammonia is the poi-
sonous matter. Frenches injected this substance into the veins

X. S. VOL. XI. NO. I. 3

liyrxtform Vapour, [January,

. i, a;:.s, and an opil-opiic condition was induced, which passes
a way as soon as the carbonate of ammonia is eliminated from the
system. He also found that when urea was injected into the bloodT
carbonate of ammonia may be detected in the breath of the animals
by holding a rod dipped in hydro-chloric acid under the nose,
when the charcteristic white fumes indicate the presence of an
alkali, and the blood is likewise found to contain it in an appre-
ciable quantity.

Dr. Todd instituted a series of experiments in his hospital for the
purpose of verifying Freriche's conclusions, but though urea was
easily detected in the blood, the tests for carbonate of ammonia
were not satisfactory, [Ibid.

A 'practical inquiry into the advantages derivable from the Vapour of
Chloroform, as a local application to the surface of the Skin and
Mucous Membrane under various conditions. By S. L. Hardy,
M. D., F.R.C.S., Examiner in Midwifery and Diseases of Women
and Children in the Royal College of Surgeons, Ireland ; Ex-
Assistant- Physician, Lying-in Hospital, Rotundo ; Physician to
the Institution for Diseases of Children, &c., &c.

Since the local application of chloroform vapour was first intro-
duced to notice, there has existed considerable discrepancy of
opinion as to its efficacy. In some instances the results obtained
by it have been most satisfactory ; while in others we are told it
was perfectly inert.

By an inquiry into the advantages derivable from its applica-
tion to the surface of the skin and mucous membrane under
various conditions, it seems to me that much of the uncertainty
which at present prevails as to its utility might be removea,
and an amount of knowledge acquired of so practical a nature
as would remove the apathy of some who think little of its
worth, and direct, with more certainty, the efforts of others who
have resorted to it in cases in which it could not have been
expected that its influence should have been exerted with any
decided effect.

In order to prosecute this inquiry, I have collected a number of
cases from various sources, which are, in some instances, accompa-
nied with observations by men whose opportunities for observing
the action of remedies should render their opinions of considera-
ble value.

In applying chloroform vapour to either skin or mucous mem-
brane, it is necessary to attend very particularly to the condition
in which those tissues are at the time, as the effect of this agent
will be more or less marked according to circumstances. The
subject therefore should be considered under the four following
conditions :

1855.] Employment of Chloroform Vapour. 39

1st. the effects produced by the vapour of chloroform
when" applied to the surface of the unbroken skin".

2nd. ditto, when the cuticle is removed.

3rd. ditto, when applied to mucous surfaces unbroken.

4th. ditto, when applied to mucous surfaces in an abraded
condition.

1st. the effects produced by the vapour of chloroform
when applied to the surface of the unbroken skin.
We are naturally led to expect but little effect from the applica-
tion of vapours to the surface of the body, the cuticle being entire.
Nevertheless, however contrary it may appear, there seems to be
sufficient evidence, from the results obtained in many instances, to
prove, that even under such unfavorable circumstances, the vapour
of chloroform exerts very considerable influence. The following
cases are given in illustration :

No. 1. Case of Femoral Hernia. At a meeting of the Surgical
Society, held on the 8th of April last (reported in the Medical
Press, April 19th), Dr. Forrest detailed the following case :

"I was called to a lady, aged 60, who had suffered for several
years from femoral hernia. On the present occasion, the tumor
protruded a good deal, and was so exceedingly painful that the
taxis could not be properly applied. I now directed a stream of
chloroform vapour over the part with the happiest results. It
completely relieved the patient of the distressing sensations caused
by the strangulation, and afforded opportunity for resorting to the
surgical manipulations usual in such cases."

No. 2. Case of letanus. (Under the care of Dr. Kirkpatrick,
Medical Attendant to the North Dublin Union.) , a labour-
er, aetat. 30, was admitted into the North Union Workhouse,
June 7, 1854, sent from Manchester Infirmary, where he had been
a patient, with disease of the right hip. In the workhouse a part
of the treatment consisted in a large caustic issue, made with
potassa cum calce, over the ileum, an inch external to the seat of
pain. On the 12th day the slough came away on the poultice
without any suffering. On the morning of the day following he
was seized with spasms, which commenced at the right side low
down, and rapidly engaged all the muscles of the trunk, both an-
terior and posterior. Before two o'clock p. m., the throat and
jaws were affected, the mouth being opened with pain and diffi-
culty. On the 21st Mr, Eobertson, instrument-maker, spent sev-
eral hours applying the vapour of chloroferm locally.

On the morning of the 22d he lay on his left side, with the right
extremity extended and resting on a stool behind him outside the
bed, as he was quite unable to flex or draw it up to him, nor could
this be done for him owing to its rigidity. He complained of
great pain in the issue, the posterior lower third of the thigh, and

40 Employment of Chloroform Vapour. [January,

in the calf of the leg. Chloroform vapour applied by the vapour
douche to each of those places relieved him in about ten minutes,
and in about twenty he was able to raise and draw his leg into
the bed. He then turned on his back, and afterwards during the
day was able to rise and sit on a chair.

Dr. Kirkpatrick remarks, throughout the course of the disease
(which terminated fatally on the ninth day), chloroform was used
to relieve agon}' by inhalation and local application of the vapour.
The action of the remedy was most satisfactory in producing re-
lief. A few drops on a piece of lint held to his face was sufficient
to cause tranquil sleep.

The local application of the Vapour was of marked service in
relaxing severe spasm of the right lower extiemity, also in causing
some relaxation of the muscles of the jaw, so that the teeth could
be more separated. It also diminished the pain when applied to
the ulcer on the hip and to blistered surfaces on the spine and
epigastrium. It was confined to the affected parts by means of a
glass bell attached to the tube of the douche. It was also caused
to surround the pelvis by the use of air-tight drawers : and lastly,
it was thrown into the rectum.

No. 3. Second Case of Tetanus. (Under the care of Dr. Woods,
Physician to the Killyon and Ballybrit Dispensaries in Parsons-
town and Koscrea Union. A poor man received a lacerated
wound of the thumb and forefinger. On the fifteenth clay after-
wards he felt rigidity of the muscles of the neck, with difficulty of
swallowing ; in fact, trismus had set in. The disease increased for
five days, but with the exception of an occasional spasm, extend-
ing from the diaphragm out through the back and up the back of
the neck, producing slight opisthotonous, the rigidity and spasm
were confined to the neck and jaws. I treated him with Cannabis
InTlica, mercurial and belladonna frictions, occasional enemas of
turpentine and tobacco, croton-oil purgatives, blisters to the hypo-
chondrium, &c; but on Saturday (the day I received the douche)
he was in the following state : Neck and jaws quite rigid; so
much so, that a piece of wood, which the friends had placed be-
tween his teeth, was too firmly held there to be removed; inability
to swallow for thirty-six hours; risus sardonicus very marked;
occasional spasm of diaphragm, producing slight opisthotonous.
Altogether, his state was such that I, as well as another profess-
ional man, said there was no hope of his recovery. Under these
circumstances I applied the douche. I continued forcing the va-
pour of chloroform on the muscles of the neck and jaws for per-
haps half an hour. At length the spasm gave way, the piece of
wood so obstinately fixed between the teeth came out, and he so
far recovered the muscular power as to open his mouth to put out
his tongue, and he managed to drink a cupful of broth. I have
rarely felt more pleasure than when witnessing the almost miracu-
lous effect the douche produced. The rigidity of the jaws and

Employment of Chloroform Vapour. 41

neck has i -Teat at all since the douche was used, now

twenty-four hours.

Pa . igust 6, 1854.

In answer to a letter, inquiring from Dr. Woods whether he
thought the vapour could have been inhaled while he was apply-'
ing to the undtr part of the lower jaw, I received the following
reply :

1 L I have just seen the man with tetanus, and although

not quite free from it, I have no doubt of his recovery. When I
applied the douche to the rigid muscles of his neck, he must have
inhaled some of the chloroform, as*I gave it to him liberally (there
. no appearance of it as to .sleep, kc.) ; but I made
to-day a very satisfactory trial of the douche locally. The spasms
in the back were distressing him very much this morning, causing
slight opisthotonous and intense pain. I stripped and watched the
back for some time, and at every spasm the spine was bent in,
just at the lumbar region, the head slightly thrown back, and a
beautiful radiation of muscular contraction occurred, having its
centre in the lumbar vertebrae, and running up the latissiini dorsi
and down the glutaei on each side. I. immediately applied the
douche assiduously to the loins, and kept up the action for about
a quarter of an hour. He experienced the greatest relief, and
longer duration of ease between the spasms. I showed the friends
how to use the douche, leaving them a bottle of chloroform,- and
this evening, after having it thus applied to the back frequently,
and always with marked relief} he has been for some time entirely
free from pain, and ascribes the relief altogether to the douche. I
asked him particularly about it, and he says he could not be mis-
taken. The pain was always soon mitigated, and he hopes now
nearly entirely removed by the application. I was careful not to
let him get any chloroform by inhalation, in order that the test
might be the stronger, and I have no doubt but that the douche
acted altogether through the integuments, and most beneficially.
The only treatment beside the douche at present adopted is,
croton-oil purgatives, combined with a little opium. I am almost
sure the man will get well : if so. I will ascribe his recovery to
the douche. I remain yours very truly.

Pa . August 10. 1864. <' 'Thomas Woor.v

My . . The man who had tetanus is now quite recov-

ered. I remain, h Thomas Woods.

sonstotmi, August 27. 1854

No. 4. Phthisis. A lady, in the ninth month of pregnane v,
far advanced in phthisis, suffered very much from the frequency
of cough, particularly during the night, which various sedatives
failed to relieve. Over the affected lung, where the skin was un-
broken, but tender, owing to frequent blistering, I had chloroform
vapour applied by the douche, and confined to this part by a bell-

42 Employment of Chloroform' Vapour. [January,

shaped receiver. It had the effect of quieting the cough and of
enabling the patient to sleep much better.

Chloroform manufactured in two different places was used in
the treatment of the case ; that which caused the most soothing
effect felt more pungent on the skin during its application than
the other.

No. 5. Case of Neuralgia. The Medical, Press for June 28,
1854, p. 410 (Mems from our London Correspondent), informs us
i 'that a long discussion has again taken place in Paris relative to
Dr. Hardy's apparatus." M. Bichat says the local action of chlo-
roform is proved by results truly surprising ("les resultats vrai-
ment suprenants "), and gives two cases of his own which had
resisted opiates and quinine : one in particular, of horrible agony
in the arm and shoulder from neuralgia, cured by Dr. Hardy's ap-
paratus.

No. 6. Dysmenorrhea. In the month of July last, I was hastily
summoned to an unmarried patient, aetat. about 26. On my arri-
val she was in bed, tossing about her limbs and grinding her teeth,
her countenance expressive of great suffering, which came on in
paroxysms. At each exacerbation, she pressed firmly with her
hands over the region of the uterus, which led me to suspect the
approach of a menstrual period as being the cause of her distress.
One of her friends afteawards told me she was subject to severe
pain on these occasions. A sinapism laid over the abdomen had
no effect in rousing her, nor was consciousness restored until a
handkerchief, moistened with chloroform vapour, was applied to
the vulva, which immediately caused her to exclaim, owing to the
heat imparted by it. In about five minutes she had no pain
whatever. The secretion soon followed without any more dis-
turbance.

No. 7. Cholera. During the last few months instances of diar-
rhoea have been very prevalent in Dublin. The administration
of chloroform in frequently-repeated doses of from fifteen to twen-
ty-five drops in a little cold water had a most excellent effect in
relieving nausea in those cases, and of imparting a sensation oi
general warmth ; but as the influence exerted by this method oi
exhibiting it was of short duration, a much more decided and per-
manent benefit was obtained by applying the vapour by means oi
a sponge, moistened with chloroform, and placed in a tumbler.
This applied over the epigastrium never failed in giving relief, and
could be kept on constantly without the least inconvenience to
the patients, who very soon became so convinced of its efficacy,
that they anxiously wished for its continuance. (Care was neces-
sary not to allow the fluid chloroform to touch the skin, as it felt
so very hot ; this, however, was easily accomplished by using a
sponge sufficiently large to fill the end of the glass).

1-855.] Employment of Chloroform Vapour. 43

No. 8. Encysted Tumors of the Scalp. My dear Hardy I have
just used your anaesthetic vapour douche with such pleasing result
that I cannot refrain from letting you know, as I am sure it will
gratify you. A patient had four encysted tumors to be removed
from the scalp. With the first and largest, I used the douche.
She expressed the greatest surprise when informed that it was re-
moved. With the second I did not use the douche. With this
she experienced considerable pain during the operation, and sub-
sequently, even after the other two were excised (with which the
chloroform and douche were used, and with equal advantage as
in the first) this continued to give pain. Some months ago Dr.
Montgomery and I removed an eneysted tumour from the scalp,
having previously used the chloroform as you direct ; but as there
was but one tumour, and the patient a particularly good one, we
could not judge from what amount of suffering she had been re-
lieved. Believe me to be yours truly,

Merrion-square, October 18, 1854 J. Smyly.

No. 9. Gout. (Treated by Dr. V. Rexouard.) On the morn-
ing of the 25th the pain was most intense. It increased during
the day, and in the evening wrung cries from the patient, who
writhed upon his bed, biting and tearing the sheets. The night
passed without the least relief, notwithstanding the internal and
external use of narcotics. The foot was cedematous ; the skin was
tense, and of a shining rose-colour. On the morning of the 26th,
having exhausted my resources, and being unable to remain an
inactive spectator of such acute sufferings, I proposed the local ap-
plication of chloroform, which was at once agreed to. Having pro-
cured Hardy's instrument, I commenced at noon the insufflation of
the anaesthetic vapours, directing them chiefly to the most painful
part. After twenty minutes1 application, which was twice or
thrice interrupted, reducing the real duration to sixteen or seven-
teen minutes, the patient felt well enough to request its suspension.
He did not say that he was free from all suffering, but that he was
considerably relieved. The part subjected to the vapour of chlo-
roform had become pale and cold, instead of red and burning, as
it had been before. Moderate pressure could now be made without
exciting the sensibility of the patient, who so short a time before
could not endure the slightest touch. The calm lasted an hour
and a half or two hours ; the pain subsequently appeared to re-
turn, and continued increasing until evening. When I saw the
patient again, between eight and nine o'clock, he was suffering
much, although less than on the preceding evening ; he was par-
ticularly apprehensive about the night. At the same time, the
central point of the pain had changed its place a little ; it was
nearer the internal ankle. The anaesthetic vapours were again
applied uninterruptedly for fifteen minutes. All suffering ceased ;
what had been the principal seat of the pain could now be tolera-
bly strongly leant on without the patient feeling it After a few

44 Employment of Chloroform Vapour. [January,

minutes lie fell into a deep sleep, which lasted two hours. On
awaking, he experienced merely a feeble sensation of pain, some
transitory twitchings returning at shorter or longer intervals,
which did not prevent him from taking several other naps in the
course of the night. From this day he quickly recovered. The
attack was shorter than those of the two preceding years. The
resolution of the congestion appeared to be more rapid than usual.
On the foregoing case, the editor of the Revue Medicate ob-
serves "We cannot, in this case, fail to recognize the beneficial
effects of the vapour of chloroform on the intolerable pain of gout ;
but its influence on the resolution of the oedema, although proba-
ble, does not appear to me to be sufficiently proved." [Gazette
des ffopitaux, 23rd September, 1854, p. 451.

No. 10. Rheumatic Gout. On the 26th of October, a gentleman,
who had suffered severely from frequent attacks of rheumatic gout,
was directed by his medical attendant to have the vapour of chlo-
roform applied to his foot, which was exceedingly painful. Mr.
Robertson (the maker of the instrument), by means of the vapour "
douche, gave a bath of chloroform and warm water vapours com-
bined. In a quarter of an hour he felt perfectly easy. Having
dined with a friend, and partaken of champagne, his distress re-
turned ; and on the 28th of October the bath was repeated. In
three minutes all suffering was removed ; and after its use for a
quarter of an hour, he said he never was more free from pain in
his life. On the 30th he had another bath for a mitigated return
of the pain, and with equally favourable results.

References. See Dublin Journal for Nov., p. 315 : "The effects
of chloroform vapour on the nipple of a female breast." Aso,
Case 6 "Its effects when applied to the surface of a breast affected
with inflammation."

2nd. the effects produced by the vapour of chloroform
when applied to parts denuded of cuticle.

When the cuticle is removed, either by abrasion, vesication,
ulceration, or incision, the vapour of chloroform is enabled to act
with much greater intensity than when the skin is unbroken.
Whenever it is first brought in contact with parts in this condi-
tion, some patients complain of heat, others say it feels cool ; in a
few minutes a sensation is imparted of ease and freedom from
pain, which in some instances is of very considerable duration.
The following cases are given in illustration :

No. 11. Case of Anthrax. (From Dr. Benson, President of
the Eoyal College of Surgeons of Ireland.) An unmarried lady,
setat. about 36 years, highly nervous, and very impatient of pain,
lately consulted me for anthrax, situated on the back of the neck,
which was a little ulcerated and most painful. I proposed the in-
halation of chloroform, to which she strongly objected, but con-

1855.] Employment of Chloroform Vapour. 45

sented gladly to its local application. The vapour was closely
confined to the sore, and first produced a sensation of extreme
heat, which was soon succeeded by perfect relief from suffering.
A free crucial incision was then made, which did not give her the
slightest uneasiness. She said the operation had not hurt her in
the least : everything afterwards went on favourably.

No. 12. Second Case of Anthrax. (Communicated by E. A.
TVhite, Esq., M.R.C.S.I.) A gentleman, aetat. 35, of very excita-
ble temperament, consulted me for an anthrax situated on the
nape of his neck, which was highly inflamed, ulcerated, and ex-
quisitely painful. I applied chloroform vapour by means of the
douche, which at first produced a hot sensation, as if a jet of steam
had come upon it ; this feeling was but momentary. I continued
tne application for about three minutes, then pricked the surface
of the tumour without causing any indication of pain, and finally
laid it open by an incision of an inch and half in length ; the pa-
tient being wholly unconscious of the operation having been per-
formed.

No. 13. Syphilitic Uulcer. Cases illustrating the Effect of Chlo-
roform Vapour when applied to Ulcers. (From Dr. Wilmot. Sur-
geon to Steevens? Hospital.) My dear Hardy: Of the cases in
which we tried the local application of the vapour of chloroform
in Steevens' Hospital, two seem to me more particularly worthy
of notice, as showing not alone its efficacy in producing local
anaesthesia, but the conditions which are necessary for its complete
manifestation. One case is that of a man who suffered from ex-
tensive syphilitic ulceration on the forepart of the right leg, accom-
panied with superficial exfoliation of the tibia, and some periosteal
inflammation along the bone. This ulcer was extremely painful,
and in one spot especially, where the ulcer had cicatrized, the
slightest touch was insupportable. I thought this an excellent
case in which to test the efficacy of the local application of the
vapour of chloroform. Your instrument (the one last invented) was
accordingly called into requisition. After it had been worked for
about two minutes, the patient expressed himself greatly relieved
from pain, and in three minutes more the anaesthesia was so com-
plete that he allowed the part to be handled, and evinced no pain
when firm pressure was made with the fingers along the bone.
This tolerance of pressure was very remarkable at the spot where
the sensibility had been so much exalted. I am certain that had
it been necessary in this case to have made an incision, a little fur-
ther application of the chloroform vapour would have rendered
the operation painless. The patient stated that the anaesthesia
lasted a considerable time.

Xo. 14. Ulcer on die Leg. The second case is that of a woman
who had an extremely painful ulcer on the right leg, a little above

46 Employment of Chloroform Vapour. [January,

the external malleolus. She could not bear it to be touched, and
refused to let it be strapped, owing to the severe pain produced by
the necessary pressure. Your apparatus was resorted to ; and in
a very short time the sensibility of the sore became blunted,
and she permitted it to be handled and firmly pressed with the
fingers.

These two cases strikingly demonstrate the power of the vapour
of chloroform to produce local anaesthesia. The employment of it
in certain ulcers of the leg, will, I feel confident, be found not the
least useful of the purposes to which it may be applied. Every
practical surgeon is acquainted with a small irritable ulcer whicn
shows itself on the leg, generally above either malleolus. This
ulcer is remarkable for being excessively painful, particularly on
pressure, so much so that few patients have fortitude enough to
permit the adoption of the most efficient plan of treatment strap-
ping. Now, in such cases your instrument would prove invalua-
ble. By it the ulcer would be deprived of its sensibility, and the
strapping (which is beneficial nearly in proportion to the tightness
with which the straps are drawn) could be accomplished without
any pain. With respect to the conditions necessary for the produc-
tion of complete local anaesthesia in any of the external surfaces,
it appears to me that the part to which the vapour is applied must
be free from cuticle, or merely covered by a delicate pellicle, as in
a recent cicataix ; or better still, that it should be in a granulating
state. To expect that the agent should act through a thick cuticle,
is unreasonable. How many remedies and plans of treatment have
disappointed expectations simply from a want of due regard to
the conditions essential to their success ? Believe me very truly
yours, Samuel Gr. Wilmot.

Stephen' s-green, August 3, 1854.

No. 15. Chloroform Vapovr in the insertion of an Issue. (By
M. D any an.) "M. Kichet said I shall, finally, allude to the hap-
py effects of the vapor of chloroform when thrown on ulcerated
surfaces, which have been made known to us, by Dr. Hardy of
Dublin, M. Moissenet and my colleague, M. Gosselin.

M. Danyan said Having had to establish an issue on M. Roux,
I made use of Dr. Hardy's apparatus. I employed the Vienna
paste. I directed the vapour of ether for ten minutes on the nape
of the neck, where the issue was to be formed ; the pain was com-
pletely annihilated." [Gazette des Hopitaux, June 13, 1854, p. 280.

No. 16. A painful Stump treated by the Application of Chloro-
form Vapour. (Under the care of M. Larrey.) What appears
certain is, that the vapor of chloroform freely directed to a painful
point, immediately allays the sufferings of the patient. Thus at
Yal-de-Grace, after an amputation of the thigh, the stump having
become excessively painful, M. Larrey made use of Dr. Hardy's
apparatus, and as soon as the vapour of chloroform came in con-

1855.] Employment of Chloroform Vapour. 47

tact with the wound, the pains were soothed. [Journal de Mede-
cine et de Chirurgie Pratiques, March 1854, p. 99.

Reports of three Cases of Carcinoma treated by Local Application of the
Vapour of Chloroform. (From Dr. Geoghegan, Surgeon to
the City of Dublin Hospital and Hospital for Incurables, Profes-
sor of Forensic Medicine, Koyal College of Surgeons, Ireland.)

Dear Sir, The appearance of your important observations on
the local applications of chlroform vapour has led me to direct its
employment in the cases of cancer at present under my care at the
Hospital for Incurables. Although the trials which I have been
as yet enabled to make have not been sufficiently numerous to
furnish a just estimate of the value of your apparatus, I can, how-
ever, state, that the results already arrived at have been for the
most past decidedly encouraging. I, therefore, feel desirous of
submitting some of them to your attention.

No. 17. Ulcerated Cancer of the Axilla. In one case of exten-
sive ulcerated cancer, involving the pectoral region, the axilla,
and lower part of the neck, the application of the vapour (by means
of the perforated ivory jet) was followed by speedy relief of pain,
which the patient assures me continued for three days.

No. 18. Ulcerated Cancer of the Lip. In the second instance,
where the disease has swept away the lower lip and chin, and
which is attended by severe lancinating pain in the vicinity, the
use of the vapour for about a quarter of an hour, was followed (to
use the patient's description) by "a cool and numb feeling," ex-
tending through the affected part. The pain soon began to di-
minish, and in eight minutes had almost disappeared. Belief
continued for several hours, when the pain returned severely. A
subsequent application was followed by nearly similar results.

No. 19. Ulcerated Cancer of the Mamma. Wishing to observe
the action exerted through the unbroken skin, I directed an ap-
plication to the integument below the axilla of a female laboring
under ulcerated cancer of the mamma. In one minute she expe-
rienced a sensation of numbness in the part touched by the vapour ;
in seven minutes this had spread along the whole arm, "as if
streams of water were being poured upon it." The pain by this
time had but very slightly decreased, nor was there any further
diminution of it. On a subsequent occasion, the vapour was ap-
plied to the ulcerated surface ; in one minute a feeling of warmth
had spread down the arm ; in seven, the pain was distinctly less,
and in seventeen was greatly relieved. Like all other remedies,
however, a beneficial action is not uniformly secured. Accord-
ingly, in one case of cancer of the anus, perineum, and thigh, the
patient states that she experienced no relief. I suspect, however,
that in this instance the application was not continued for a sum-

48 Employment of Chloroform Vapour. [January,

cient length of time, nor was the vapour maintained by any appli-
ance in contact with the surface. It strikes me that some arrange-
ment by which the vapour might be effectually secured, and which
would permit such continued pressure as would introduce it into
the capillary circulation of the part-, and hence bring it more inti-
mately in contact with the nervous filaments, would add much to
the value of your apparatus, and render the relief of pain more
durable than I have found it in some cases. A frequent and care-
ful observation of the action of anaesthetics encourages me in this
belief; for in some instances where the anaesthesia produced by
these agents (introduced by inhalation) has been perfect, the action
of the latter would appear to depend exclusively, or nearly so, upon
their direct circulation through the superficial textures,, and their
consequent, though indirect, application to the fibrillae of the sen-
tient nerves of the cutis. This is, I think, sufficiently evidenced
by the singular phenomenon which has attracted the attention of
operators as regards the action of sulphuric ether, and which I
have myself more than once witnessed in a striking manner
namely, the total absence of any disturbance of consciousness and
volition, or indeed of any of the mental faculties, notwithstanding
the completeness of the local effect above alluded to. This result,
according to my experience, is much rarer under the influence of
chloroform ; and as it is precisely that mode of action which is most
desirable, if it can be secured by the local application of the vapour
even in but a proportion of the cases where pain is a prominent
evil, much will have been gained. As facts accumulate, and a
more extended use of local anaesthesia suggests further modifica-
tions of the apparatus, your method will, I doubt not, prove of
permanent benefit in practice. As respects its application to
operative surgery, although the local use of the vapour can scarce-
ly be expected to offer an available substitute for inhalation in the
greater surgical undertakings, yet from the facts that have come
to my knowledge, I cannot doubt its promise of utility in the
various minor operations. I remain faithfully yours,

York-street, July 5, 1854. T. Gr. Geoghegan.

No. 20. Cancerous Tumour in thd Neck. (Under the care of
Dr. Mayne, Physician to the South Dublin Union.) My dear
jSir, The case to which I yesterday alluded in conversation with
you, was that of a lady who lately consulted me for a malignant
tumour situated at the right side of the neck. Several consulta-
tions with Dr. Ireland, Mr. Cussack, and Sir P. Crampton, resulted
in the decision that no operation was justifiable. I have seldom
witnessed more poignant suffering than this lady endured for
several months. Opium afforded her but little relief. Various
other . sedatives and narcotics were also tried in vain, yet I can
confidently assert that the chloroform douche never failed to alle-
viate her sufferings temporarily ; and of this she felt so thoroughly
convinced, that for many weeks before her death she was in the

1855.]

Treatment of Cholera.

49

constant habit of using it herself, by means of one of the instru-
ments sold by Mr. Robertson. This case ran rapidly into open
cancer. Believe me yours very truly, Robert Mayxe.

13, Upper Glocester-street, July 18, 1851.

Xo. 21. Cancerous Ulceration of the Forehead, Orbit, dr. (By
Dr. Moissexet.) The medical journals inform us that a Dublin
practitioner, Dr. Hardy, has just invented an apparatus for the
purpose of injecting the vapour of chloroform into the vagina in
order to allay the violent pain caused by cancer of the uterus, and
that it has completely succeeded. The results obtained by the
Irish physician have led to several trials on the part of others, and
in a note read at the Medical Society of the Hospitals, Dr. Mois-
senet has acquainted us with many very interesting cases, iu which
he has obtained, with Dr. Hardy's apparatus, effects truly unlooked
for. He has succeeded, especially in a case of cancroid ulcer of the
forehead, which had successively invaded the orbit, the eye, and
a portion of the cheek, in instantly and repeatedly allaying dread-
ful sutferings. which had resisted all known remedies. Gazette
des Eopitaux, May 27. 1864, p. 252. [Dublin Medical Press.

[To be concluded in February Number.]

Success of different methods of treating Cholera. By JoHX CRAW-
FORD, M. D., Physician to the Glasgow Cholera Hospital.

The different modes of treatment employed in the various forms
of choleraic disease, with their respective results, are exhibeted in
the following table :

Table shoiving the Residts of Five different modes of Treatment.

1.

Salines
alone.

2

13

5

2.

Salines with
adjuncts.

3.
Calomel.

4.

Stimulants

5.

Astringenis
withopium.

Total.

Diarrhoea,. . ...

Cholera,

Collapse, .

9
53
32

0
13
12

6
24

26

29

0

38

114

73

225

Cured.

Diarrhoea,

Cholera,

Collapse,

Died.

Diarrhoea,

Cholera,

Collapse,

2

13

0

0
0
5

9

46

0

7
1 25

0
7
3

0
6
9

1
I
2

0

5

22

21

24

0

2
5
0

36
91
12

2
23
61

In reference to this table, the following explanations may be
necessary. In the first place, in all, or mostly all cases, counter-
irritation to the epigastrium and abdomen, by means generally of
sinapisms occasionally of turpentine and ammoniacle epithenis,

50 Treatment of Cholera. [January,

and in many cases by blistering was used. It must, therefore, be
understood, that the cases in the first column shared the benefit
of this practice, though "salines alone" were administered as
medicines. The "adjuncts" of the second column were almost
exclusively opiate enemata and stimulants wine, brandy, and
ammonia ; the opiate enemata being generally given in cases of
cholera; and the stimulants though cautiously in collapse, or
cases of cholera verging on that state. In choleraic diarrhoea,
catechu and opium by the mouth were also occasionally used as
adjuncts. The "salines" employed were the following: 1st.
The combination of salts proposed by Dr. Stephens, viz., chlorid.
sodium, 9i; bicarb, sod., 3ss. ; chlorat. potass., gr vii. These
quantities dissolved in water were given every half hour, every
hour, or every two hours. 2nd. The saline enema of the same
writer ; a table spoonful of chloride of sodium dissolved in warm
water employed only in collapse. And here, to avoid recurring
to the subject again, I may mention that, although in several
cases benefit appeared te be derived from its use, the advantage
was only temporary, even when every precaution was taken to
administer it properly. 3rd. The bicarbonate of soda, used as
afterwards described. 4th. The same followed by acidulated
draughts, as afterwards explained. And, lastly (chiefly in cases
of choleraic disease, with irritability of the stomach), the ordinary
effervescing soda-powders.

Calomel was given in various doses in different cases grs. x.
Bi. and upwards, to produce in the first instance a sedative effect
on the patient (a result which it generally failed to accomplish) ;
in smaller doses, gr. i. v., at intervals varying from a quarter of
an hour to three hours ; and in some cases in doses of gr. i. every
five minutes. Upwards of 110 grs. have been continuously exhib-
ited in this way.

Under the head of stimulants, I have also included somewhat
strangely, it may appear the cases in which creasote and hydro-
cyanic acid were given to allay vomiting ; but in almost all these
cases, alcoholic stimulants were also given. That both creasote
an hydrocianic acid are useful in checking the vomiting in cholera
(a combination of the two, 3 drops of the former and 2 of the
latter, probably answers best) is undoubted ; but in this respect
they are far inferior to the bicarbonate of soda, and the creasote
seems frequently to be very nauseous to the patient.

As to the effect of stimulants, the fourth column tells its own tale.
It is however, to be noted, that a number of cases hopelessly ad-
vanced in collapse, and even moribund were admitted, in which
nothing could be done beyond endeavoring to keep up the heat
and administering stimulants. These cases, hopeless under any
treatment, no doubt swell the mortality under this head ; but as a
general rule, alike in choleraic diarrhoea, cholera, and collapse,
the exhibition of alcoholic stimulants, except in a limited number
of cases, and then in small quantities, has not, so far as I have

1855.] Opiate Inhalations and Fumigations. 51

seen, been productive of benefit. They are not even agreeable to
the patient. Even in the prostration of collapse, the habitual
drunkard will be found to turn with loathing from the proffered
wine or spirits, and beg for cold water instead.

The astringents referred to in the fifth column, as conjoined with
opium, were princpially catechu, aromatic sulphuric acid, and
acetate of lead combinations found principally useful in choleraic
diarrhoea and the milder forms of cholera. On the whole, I am
inclined to prefer the acetate of lead and opium in pill (diacetat,
plumb, gr, ii,-iii., op. gr. i.) This was also found very useful in
the diarrhoea which occasionally recurs after a smart attack of
cholera. In collapse, beyond an opiate enema, if the purging still
continued, I would have nothing to do with the opium. [Glasgow
Medical Journal.

Opiate Inhalations and Fumigations. By Dr. Lombard, of Geneva,

I am aware that the attempt has often been made to introduce
opium in the nasal fossae, chiefly for the abortive treatment of
coryza, either by means of injections of water and laudanum or by
making the patient snuff up a powder of sugar and morphine
mixed. But the end I wish to attain to is very different ; the
greater tenuity of the smoke, not less than its warmth, allows it to
penetrate, without pain as without difficulty, into the crevices of
the nasal fossae ; a result which cannot be obtained by a liquid,
still less by a powder, however impalpable. The method that I
am about to submit to your notice, after two years and a-half of
clinical observation, seems to me very different from those of which
I have just spoken, and I can affirm, without the least fear that
experience will contradict my assertion, that the inhalation of
opium smoke into the nasal fossae is a most useful therapeutic
resource. I shall first mention some of the cases in which it has
prospered admirably in my hands. You have, no doubt, met
with, in your practice, cases of coryza, accompanied with lancina-
ting pain in the frontal sinus ; pain which sometimes becomes very
intense. In such cases it is, that I have seen the opium fumiga-
tions produce truly marvelous results ; pain has ceased as if by
enchantment, and an almost intolerable state has been succeeded
promptly by remarkable relief.

In a case of this ' kind that was under my care some eighteen
months ago, the pain was so intense as to make the patient cry outr
and induce him to believe, although of a firm and by no means
pussilanimous disposition, that he was suffering from a dangerous
cerebral affection. These pains came on in the course of a catarrh,
accompanied by intense coryza, produced by a cold blast playing
all night on the face of the patient. Two or three fumigations
were sufficient to remove the pain. Some slight return of the same
suffering yielded promptly to the same remedy, to the exclusion

52 Opiate Inhalations and Fumigations. [January,

of all other treatment. A cure so prompt and easy gave me con-
fidence in a remedy that I then merely experimented with, espe-
cially when my memory recalled a great number of cases in which
other methods of treatment had failed, and the frontal pain had
continued, in spite of the most varied medication.

The opiate fumigations are of use not only in the continued neu-
ralgic pain, as in the patient already alluded to, but also in the
periodic form of that disease ; for this circumstance does not pre-
vent the success of the inhalation of opium. In fact, in the
majority of cases I have had to treat, the frontal, temporal, or
zigomatic pain accompanying catarrhal coryza is met with under
the periodic form ; nevertheless, this method is quite sufficient to
cure the malady, without the assistance of any other medicament.
Two patients, on whom I tried the effect of opiate fumigation in
February, 1852, were both attaked with coryza, complicated with
periodic pain. In one of them the access returned regularly at
eight o'clock in the morning, and lasted till four o'clock in the
afternoon; whilst, in the other, the afternoon was the time at
which the return of the periodic frontal pain took place ; in both
cases the opiate fumigations, without any other treatment, brought
about a prompt recovery. It is not only in the cephalalgia con-
nected with coryza, that I have thus employed opium, but also in
certain cases where the neuralgic pain was symptomatic of some
other morbid affection, or idiopathic. After making mention of a
variety of other cases in which Dr. Lombard had adopted this
mode of treatment, so as either to cure or considerably relieve his
patients, he proceeds to consider the doses of the drug, and the
manner in which it should be used.

I commenced with five centigrammes (about one grain) of pul-
verised opium, mixed with as much sugar, and sometimes an equal
part of gum benzoin; later I orderd ten or fifteen centigrammes
in each fumigation ; but the intermediate doses often centigrammes
seemed to answer all the indications, and produce the desired effect.
I have repeated the fumigations two or three times a day, but
sometimes having had recourse to them oftener, I did not regret it,
having witnessed no bad effect from it.

As regards the mode of administration, it is as simple as possi-
ble: I heat in the fire a thin plate of iron, as a shovel for example,
and I direct the patient to take the powder in small pinches and
throw it on the hot iron, taking care to hold the head over it, so
as to breathe the fumes freely not only through the nostrils but also
through the mouth. I have often employed the smoke of opium,
obtained by another method, which consisted in mixing a solution
of opium with agaric prepared and properly dried. By soaking a
certain quantity of amadou in a known quantity of this tincture,
we can administer a dose as exact as of the powder itself. The
amadou so prepared is lit and burnt under the nose of the patient.
In fine, I do not hesitate to advise the employment of opiate fumi-
gations in all cases of neuralgia occupying the frontal, temporal, or

1855.] Benumbing Cold in Operations. 53

zygomatic regions, either of a continuous or periodic character ;
although it is to be remembered that it is above all in the catar-
rhal neuralgia, often complicating corjza, that the employment of
my method is found to succeed most satisfactorily. [Dublin
Hospital Gazette, from Gaz. Medicale.

Instructions for using Bcnumbir/g Cold in Operations. By James
Arnott, M. D.

Although there are several modes of employing intense cold as
an anaesthetic, I shall here confine myself to the most simple and
generally applicable of these viz., the placing a frigorific mixture
immediately on the part, or with the interposition only of a piece
of thin gauze or tulle containing it.* This piece of gauze (formed
for the sake of convenience, into a small net or bag), the compo-
nents of the frigorific mixture, a canvass bag or coarse cloth, a
mallet or flat iron, a large sheet of paper, a paper-folder, and a
sponge, constitute all the articles required for congelation. The
common frigorific of ice and salt will generally possess sufficient
power ; when greater is required, saltpetre or an ammoniacal salt
may be added. Every systematic work on chemistry contains
tables of frigorific mixtures, as well as instructions for making ice,
which, when but a small quantity is required, may be thus artifi-
cially procured almost at as little expense as from the fishmonger.

A piece of ice the size of an orange, or weighing about a quar-
ter of a pound, will be sufficient for most operations. It is put
into a small canvass bag or a coarse cloth, and beaten, by the
quickly repeated strokes of a mallet or flat iron, into a fine pow-
der. As it is important that the powder should be fine, it is not
ridiculously minute to state, that the bag should be turned in va-
rious directions during the pounding, and that the pounded ice,
squeezed into a cake by the iron, should have its particles again
separated by rubbing the bag between the hands. Instead of
pounding it, the ice may be pulverized by the ice-plane.

The pounded ice having been placed on a large sheet of paper,
any loosely-cohering particles may be separated by a paper-folder,
and the unreduced large bits removed. Beside it, ofl the paper,
about half the quantity of powSered common salt is placed, and
tjbey are then quickly and thoroughly mixed together, either by
the ivory folder while on the paper, or b}< stirring them in a gutta
percha or other non-conducting vessel. If the mixture be not
quickly made, the extreme cold of one part of it may again j;
other parts into lumps.

The mixture is now put into the net (which may be convenient-
ly supported and preserved from coi. placing it in the
mouth of a jar crewer), and as soon as the action of the salt on
the ice appears established by the dropping of the brine, it is readv
for us

In appl\ ing the net, the part which is to be benumbed should

N. S. VOL. XI. NO. I. 4

54 Benumbing Cold in Operations. [January,

be placed in as horizontal a position as possible ; and it is well to
raise the net for a moment every three or four seconds, in order to
secure the equal application of the frigorinc, and watch its effect.
If the part be not horizontal, it may be necessary to hold the
gauze bag containing the frigorinc against it by the hand covered
with a cloth ; and if the net does not cover the whole of the sur-
face to be benumbed, it must be passed to and fro over it. A
moistened sponged placed lower than the net will absorb the fluid
escaping from it, or this, on some occasions, may be allowed to
drop into a basin placed underneath.

The procedure, as now described, may appear not only trouble-
some, but as requiring much time. The truth,, however, is, that
after one or two trials it is unlikely that any mistake will be com-
mitted, and the time occupied by the preparation of the mixture
and its application should rarely exceed five minutes. So simple
is the apparatus required, that, in cases of emergency, I have fre-
quently procured everything but the ice at the house of the patient.
The application of a solid brass ball which has been immersed in
a freezing mixture, or a thin metallic spoon or tube containing
this (with or without ice), is quite as easy.

The effects of this mode of applying intense cold are various,
and their succession is as follows : When a well-prepared frigo-
rinc mixture is brought in contact with the skin, a certain degree
of numbness is immediately produced. The skin is rendered paler
than natural, but there is hardly any disagreeable sensation pro-
duced, not even of cold. In about half a minute, the whole of the
surface in contact with the frigorinc becomes suddenly blanched,
evidently in consequence of the constriction of its bloodvessels.
This change is accompanied with a feeling of pricking or tingling,
such as that produced by mustard. If the application be con-
tinued, a third effect is produced ; the adipose matter under the
skin is solidified, and the part becomes hard as well as white. The
tingling is increased by this ; but, unless in the most sensitive
parts of the body, as the hand or lower part and front of the fore-
arm, it is rarely noticed or complained of. Although this uneasy
sensation soon subsides, there will, if the temperature of the part
be not allowed gradually to return, and if the cold has reached
the stage of congelation, be a renewal of it on the adipose matter
again becoming fluid. This gradual return of the natural heat is
ensured by placing a little powdered ice on the part, or a thin
bladder containing ice and water.

The question how far the refrigeration should be allowed to pro-
ceed, or which of the three stages just described should be reached,
has been answered differently by different operators. In many of
the slighter operations, either of the first stages will be sufficient,
and the measure just mentioned for effecting a gradual return of
heat will then be unnecessaiy. If congelation of the fat is pro-
duced, and the operation is proceeded with before it returns to its
fluid state (which is of advantage when it is important to prevent

1855.] B- ations. 55

bleeding), there may be required, as Mr. Paget has observed, a
modification in the handling of the scalpel ; not only, however,
is there a certainty that the insensibility both in degree and con-
tinuance will be then sufficient, whether the incision is made be-
fore or after the fat again becomes fluid, but (what is of equal
importance) that anti-phlogistic effect is secured, which prevents
those consequences which so often prove fatal under common cir-
cumstances. On other points there have been great differences of
opinion, though probably the results have not been so different as
might have been expected. Dr. Wood, of Cincinnati, and M.
Eichard, of Paris, use frigorifics differing from each other in power,
as much as 30 deg. F. ; and Mr. Ward applies the frigorific for only
one minute, while Dr. Hargrave applies it for five. Perhaps the
longer congelation is continued (and it may be safely continued for
double this period) the deeper and the longer continued the pro-
duced anaesthesia may be ; but it were unreasonable to prolong an
operation inconveniently in order that there shall be absolutely no
feeling. In exhibiting chloroform the surgeon is not authorized to
give a very large and very dangerous dose in order that the insensi-
bility shall be absolute. But if it should appear that a certain con-
tinuance of congelation is necessary to ensure its antiphlogistic pow-
er, this would be a sufficient reason for always so continuing it.
As respects the credit of the two anesthetics in the deeper
operations, not their real character or merit, chloroform has this
advantage over cold, that whereas, from the obscure expression of
pain during the patient's unconsciousness from chloroform, and
his forgetfulness of it afterwards, it is generally supposed that he
suffers none ; so, on the other hand, there may be greater com-
plaint made in such operations under cold than is justified by the
degree of pain felt, owing to the patient's disappointment (if the
: has not been explained to him beforehand) in experiencing
any degree. It is certain that in the majority of operations, or
those only involving the skin, the insensibility produced by cold
is greater than that produced by the ordinary dose of chloroform ;
and on this account Dr. Wood thinks that it ought, in all suitable
to be preferred ; but this is a small advantage compared
with its perfect safety, and the power it jx f preventing

dangerous inflammation. To its superiority in these important
respects must be added the facility with which it may be adminis-
tered, the retention of the patient's consciousness, and the absence
of his dread of -sudden death, as well as of the sickness and head-
ache that generally follow chloroform, the freedom from embar-
rassing haemorrhage, and the assistance which the patient may
give to the operator in ' assuming convenient postures, instead of
its being n . as in using chloroform, to have an assistant to

repress his involuntary movements and struggles.

A few words may be added, in conclusion, on certain misappre-
hensions that have existed in relation to the use of cold as an
anesthetic.

56 Benumbing Cold in Operations. [January,.

Dr. Wood states, that although congelation has, in most in-
stances, fully answered his expectatioms, it has at other times dis-
appointed them. If it be expected that the whole of the pain of
a deep operation, as to the ampution of a limb, or the excision of
a large tumour, is to be thus prevented, the expectation is unrea-
sonable. Unless the frigorific were applied after, as well as before,
the incision of the skin (and it often may be so with advantage),
or unless it were employed of much greater strength, or for a
longer time, than has been usual, and after measures have been
taken to suspend the circulation through the part, this could not
be effected ; and the patient ought himself to decide whether, in
such an operation, he shall endure the comparatively slight degree
of pain caused by cutting the deeper parts, for the advantage of
perfect safety, or undergo the risk of chloroform in order to have
the benefit of that degree of insensibihty (for it is seldom complete)
which the ordinary dose of this substance is capable of producing.
This risk might indeed be lessened were he to have such a mode-
rate dose exhibited as is usually given in midwifery, after the severe
pain from the cutaneous incision has been prevented by cold-; and
this would probably be adequate to the purpose ; but as fatty de-
generation or idiosyncrasy cannot be foretold, there is danger in
every dose. A death from chloroform in midwifery was lately
reported in an American journal ; and in the nearly fatal case, oo-
curring in France, alluded to in a precedidg note, the dose was
small, and was intended, as in midwifery practice, to produce par-
tial insensibility without suspending the consciousness.

Whether chloroform is used or not, I am confident congelation
will soon be considered indispensable in every important operation,
as a preventive of erysipelas .and phlebitis. The fact ascertained
by Dr. Eenwick and other statistical inquirers, that one- third of the
amputations of the limbs prove fatal from inflammation, leaves no
doubt on this point.

Others of Dr. Wood's failures can be. differently accounted for.
When the part to be operated upon is inflamed, or the circulation
through it is vigorous, "a degree of cold only a little above the
freezing point of water" is far from being sufficient. A frigorific
of greater strength than 5 degs. below Zero (the strengh of ice and
salt) may then be required, and it must be kept in contact
with the skin until the desired effect is produced There ought
to be no failures in this respect, as there are in the use of chloro-
form. If the part be sufficiently refrigerated, insensibility of ade-
quate degree and continuance is certainly produced.

It has been mentioned as a disadvantage of cold, that its appli-
cation is painful. In parts which are naturally very- sensitive, or
have become so from disease, there may be considerable smarting
when the third effect, or actual congelation, is suddenly produced;
although even then what the patient feels is little when compared
with the headache and sickness often caused by chloroform. Un-
der these circumstances, congelation should be gradually pro-

Water Strapping in Surgery. 57

duced ; but, ordinarily, there is no occasion for graduation of
temperature.

It is unnecessary to refer again to the notion, at first entertained
by some, that the redness produced by congelation is symptomatic
of inflammation. It arises from a state of the bloodvessels incom-
patible Ti'ith inflammation. So far from causing this condition,
there is little doubt that, however valuable intense cold may be as
an anaesthetic, it is as an antiphlogistic that it will be chiefly
prized, or as a means of preventing or immediately subduing,
with perfect safety to the patient, every inflammation within its
reach. [Medica I Times. .

Water Stropping as a Surgical AppAiance. By C. Holthouse, Esq.

The object of the author of this paper was to direct the attention
of the profession to the superiority of wet-strapping over ordinary
diachylon plaster, in the treatment of ulcers and certain cutaneous
affections of the extremities, as advocated by Mr. Chapman, and to
recommend its adoption in injuries and disease of the joints, and in
dressing stumps after amputation. * The advantages of this appli-
cation over plaster are :-*-l: Its innocuousness, being entirely free
from the irritating effects of the latter, and never producing inflam-
mation of the skin, or the eruption of pustules or vessicles. 2.
The comfort the patient experiences from its application. 3. Its
cleanliness. 4. The ease and quickness with which it is removed,
from its not adhering to the hairs of the part. 5. Its cheapness.
6. It may be made the vehicle for the application of remedies.

The material made use of may consist of linen or calico, bleached,
or unbleached ; and the older it is, provided it be not rotten, the
better it answers the purpose. It must be cut, or torn into strips of
varying length and breadth, according to the part to which it has
to be applied ; the strips must be then immersed in water till
thoroughly saturated, when they are fit for use. If the disease to
be treated be an ulcer of the leg, the strips should be about two
inches in breadth, and of a length exceeding somewhat the cir-
cumference of the limb ; they should then be applied exactly in
the same manner as plaster, each piece overlapping a portion of
the one immediately below it ; in fact, the directions given by Mr.
Baynton for strapping the limb, may be strictly followed in the
application of the water strapping, save and except that his direc-
tions to remove the hair from the part may be dispensed with ; a
roller must afterwards be applied in the ordinary manner.

Four cases in illustration of this method of treatment, and of its
beneficial results, were then given; one being an ulcer of the leg of
fourteen years' standing, that had resisted repeated attempts to heal
at other hospitals ; another, a case of eczema impetiginodes, affec-
ting both lower extremities, and of three years and a half duration ;
a third was a case of a crushed thumb, followed by gangrene and
subsequent amputation ; and the fourth was an amputation of the
thigh, for extensive disease of the knee-joint and upper third of
the leg. [Lancet.

58 Editorial and Miscellaneous. [January,

EDITORIAL AND MISCELLANEOUS.

Our Journal for 1855. By reference to the Publisher's prospectus upon
the cover of this number, it will be seen that by increasing the dimensions
of the page, this volume will contain at least one hundred and twenty pages
more of printed matter than any of its predecessors. It will also be per-
ceived that the valuable assistance of Dr. Henry Rossignol has been secured
for its future editorial supervision. These changes have been made as an
ernest of increased usefulness in return for increased patronage. The char-
acter of the Journal will continue to be essentially practical ; eschewing
theoretical disquisitions as much as possible, avoiding personal controversies,
rejecting anonymous communications, and always giving the preference to
American over European contributions of equal merit. We do not mean
to undervalue foreign medical literature ; but we do mean to foster our own
to the utmost of our ability. Some of our contemporaries seem to have a de-
cided predilection for exotics, and' contain scarcely an allusion to anything
of indigenous origin, while their pages are filled with foreign matter. We
will endeavor not to err in the opposite extreme. [Sr. Ed.

BIBLIOGRAPHICAL.

A Practical Treatise on Foreign Bodies in the Air-passages. By S. D.
Gross, M. D., Professor of Surgery in the University of Louisville, &c,
&c, with illustrations. Philadelphia : Blanchard & Lea, 1854. 8vo.,
pp. 468. (For sale by McKinne & Hall. Trice $2.50.)

The work before us is, we believe, the only complete Treatise in our lan-
guage, upon the subject of which it treats, and it bears the impress of its
learned author's judicious and practical mind. It contains an extensive
collation of facts, with appropriate deductions therefrom, which impart to
it the high value of a clinical monograph. Regarding this work as one of
the most valuable contributions to American Surgical literature, and de-
siring to convey to our readers some idea of its scope, we beg leave to offer
the following general summary in the author's own language :

" From the numerous facts and cases adduced in the preceding pages,
and from the reasoning founded upon them, the following conclusions may
be fairly and legitimately deduced. These conclusions may be arranged
under different heads, according to their respective relations, as diagnostic,
pathological, therapeutic and operative.

I. Diagnostic Signs. Under this division of the subject may be briefly
mentioned the nature and mode of entrance of foreign bodies, their liability
to be arrested in different portions of the air-passages, and the symptoms
commonly induced by their presence.

1. Any substance, whatever may be its form, provided it be not dispro-
portionably large, may enter the larynx, and thence descend into the trachea
and bronchial tubes.

%. The entrance of the foreign body is usually effected during a strong

1855.] Editorial and }Escellaneous. 59

and sudden inspiration, while the epiglottis is off its guard, the glottis ex-
panded, and the larynx quiescent.

3. The extraneous substance may be arrested in any portion of the air-pas-

I .ut not with equal frequency. Thus, in the larynx, it is, perhaps, most
liable to be entrapped in the ventricles of Morgagni ; and, when it descends into
the bronchial tubes, it more frequently selects the right than the left. The tra-
chea, on the contrary, rarely becomes its permanent receptacle ; and the same
is true in respect to the binary and tertiary divisions of the bronchial tubes.

4. The site of the foreign body is materially influenced, not generally, but
frequently, by its size, weight, and configuration. Thus, a shot, ball, pea,
bead, or pebble will be more likely to descend into the bronchial tubes than
a rough, light, sharp, or angular substance.

5. The intruder may shift its place. Thus, it may pass from one bronchial
tube into the other, or from these canals into the trachea, or from the trachea
into the larynx, in direction contrary to that of its entrance. On the other
hand, it may be firmly impacted, either in its first situation, or in some
secondary one.

6. The immediate and invariable effect of the entrance of a foreign body
into the air-passages is a violent, spasmodic, and irresistible cough, with
dyspnoea, and a sense of impending suffocation. The countenance is fre-
quently livid, and the patient sometimes falls down in a state of insensibility.

7. The violence of the first symptoms continues from a few minutes to a
quarter of an hour, half an hour, or even longer, when it is succeeded by
a calm, variable in duration, and again followed by cough and difficulty of
breathing, very much as in the first instance.

8. "When the extraneous substance is arrested in the larynx, there will
generally be more or less change in the voice, sometimes, indeed, total apho-
nia, hoarseness, and croupy cough, with diminished respiratory murmur in
both lungs. The latter symptom will be most conspicuous when the body
is so large as to impede materially the ingress of theair.

9. When the foreign body plays up and down the windpipe, as it often
does when it is light and small, it always excites violent coughing and suf-
focative symptoms, very similar to those produced at the moment of its
entrance. Under such circumstances, the patient can frequently feel the
extraneous substance as it impinges against the trachea and the larynx.
It is not so certain, however, as some have alleged, that the surgeon can
hear and feel it by the application of the ear and fingers to the windpipe.
Such an occurrence, at all events, must be very unfrequent.

10. A bulky body, relatively considered, may entirely fill the bronchial
tube into which it may happen to fall, and thus give rise to complete col-
lapse of the corresponding lung, as occurred in one of my owu cases. A
thin, flat body, as a coin, may produce the same effect, by acting as a son
of valve. In general, however, more or less air will pass by the side of it,
thereby enabling the respiration to go on, although much more feebly than
in the normal state. In both cases, the walls of the chest, on percussion,
will emit a clear sound. The respiration in the opposite lung, after the first
few days, will generally be puerile.

11. The site of the foreign body is occasionally, but not generally, indi-
cated by a fixed pain, soreness, or sense of uneasiness in the Larynx, trachea,
or bronchial tabes.

12. The expectoration may be simply mucous, or it may be tinged with
blood, or mixed with pus, especially in chronic cases, in which there is also
occasionally haemoptysis.

60 Editorial and Miscellaneous. [January,

13. In attempting to establish the diagnosis of a foreign body inihe ait-
passages, the practitioner must take into account, first, the history of the
case ; secondly, he must carefully examine the condition of the respiratory
organs, considering fully the rational and physical signs ; and, thirdly, lie
must hear in mind the fact that the foreign body is liable to change its
situation, thereby inducing corresponding alterations in the symptoms.

II. Pathological Effects. These effects are primary and secondary* the
former relating to what takes place immediately after the occurrence of the
accident, and the latter to the organic alterations induced in the respiratory
apparatus in consequence of the protracted retention of the foreign body.

1. The extraneous substance may destroy life at the moment of its intro-
duction, or death may be induced at a variable period afterwards. In either
case, the fatal effect may be produced by spasm of the larynx, or 'by mere
mechanical occlusion.

2. The foreign body may be expelled immediately after its entrance, in a
violent paroxysm of coughing, or it may be expelled subsequently either
before or after it has induced serious structural lesion "in the air-passages.

8. Xo patient is safe so long as the extraneous substance remains in the
windpipe, whether in the laryngeal, tracheal, or bronchial portion, inasmuch
as he may perish at any moment from suffocation, or, at a more or less
remote period, from inflammation.

4. The danger from suffocation, when the patient escapes from the first
effects of the accident, is generally greatest, all other things being equal,
when the foreign body plays up and down the windpipe. If impacted, it
may lead to the same result by becoming accidentally detached ; but in such
a case it will be more likely to destroy life through inflammatory action.

5. A foreign substance is occasionally comparatively harmless, as when,
for example, it lies in one of the ventricles of the larynx ; but, generally, it
causes serious structural mischief.

6. The danger of severe and fatal inflammation is greater when the sub-
stance is lodged in the bronchial tubes than Vhen it is arrested in the larynx
or the trachea.

7. Violent and even destructive disease may be induced in the lungs,
bronchial tubes, and pleura when the foreign body is situated in the larynx.

8. The most common structural lesion in cases in which the extraneous
substance is retained for any length of time, are inflammation, abscess, and
tubercles of the lungs, inflammation of the pleura, with effusion of serum
and lymph, or sero-purulent matter. In rare instances there is marked
alteration in the conformation of the chest, as happened in one of my own
patients.

III. Therapeutic and Operative Considerations. Under this head may
be mentioned, aphoristic ally, the use of emetics, sternutatories, and other
remedies, as expellents of foreign bodies ; the importance of early recourse
to bronchotomy, with the manner of performing the operation ; and the
various circumstances which should regulate the after-treatment.

1 . Although foreign bodies have occasionally been ejected from the wind-
pipe, under the influence of emetics, errhines, and other means, the num-

i' such cases is too small to justify the practitioner, under any circum-.
stances, in confiding in these different classes of remedies. Generally,
indeed, their effect is to increase the respiratory suffering and the danger
of the patient, by impelling the intruder against the larynx, where its
presence always excites spasm and other unpleasant symptoms.

2. The remarks just made in reference to the use of emetics, sternutato-

1855.] Editorial a 61

re equally applicable to all spont4!ie< a at

expulsion, .whether they occur in the form of coughing, vi

q, sneezing, vomiting, o althoughtl

not
elv hurtful and e\

3. Inversion and >n of the body, with or witho of the
--. are generally hazardo- receded by an

in the windpipe ; for tl that the or ace, if it be

out of its lurking place into the larynx, this portion of the

tube, is inevitably folio? . hing and suffocatn i

thus greatlv endangering the safety of the patient. The only case in which
jlit to be is where' the foreign body is a shot, bullet, or

similar substan

4. Inasmuch, then, as no confidence is to be placed in the use of emetics,
errhines, and other means, inversion and - of the body, and
even in nature's own efforts ; and inasmuch. 1 o patient can
be considered as b o long a- ueous substance remains in
the air-] k follows, as a ut . iiat bronchotomy
affords the best chance of relief, and that, consequently, it should always

early as possible, unless there ' scial contraindication ;

foT example, serious organic disease of the respirat* 3, The

: danger in this accident is spasm of the glottis, which nearly always

promptly disappears the moment the artificial opei bed.

5. In" children, and in young or tim: the operation should
always be preceded and accompanied by the administration of chloroform,
which, while k perfectly calms the patient, greatly facilitates the extrusion
of the foreign body, by rendering the respiratory organs tranquil and |
sive.

. Laryngotomy is always comparatively easy of execution,* and should,
therefore, always be selected when there is a p . tainty that the in-

trad \ -d iu the larynx. In all otkei I also wh- . ient

is very young and the neck very short, tracheotomy, although, in general,
a very difficult procedure, should be i.aryngo-tracheoion.

rarely necessary or proper, except in cases where the ordinary operations
ate found to be inadeqt:

7. The windpipe, as a general rule, should never be opened before there
is a cessation of hemorrhage, lest the blood, by falling into the tube, should
embarrass the operator, if not seriously compromise the safety of the pa-
tient

8. The opening, both in laiyngotomy and in tracheotomy, but especially
the latter, is generally too small to admit of the ready escape of the offend-
ing substance. To answer the purpose effectually, and this is one of the
great oi ' he operation; it shoidd be at least one inch and a quarter
in the adult, and not less than one inch in the child.

9. There is no necessity, in any case, for the removal of an elliptical por-
tion of the trachea, inasmuch as the retraction of the edges of the wound
by means of hooks will generally afford ample space for the ejection of the
foreign body and the introduction of instruments. In laryngotomy, a crucial
incission may sometimes be advantageously made into the crieo-thyroid
membrane.

10. Under no circumstances should bronchotomy be performed without
a thorough axploration of the chest and oesophagus. It should be remem-
bered that mere spasm of the glottis caused by the lodgement of a foreign

62 Editorial and Miscellaneous. [January,

body in the fauaes or gullet, or by derangement of the digestive, respiratory,
and nervous functions, may induce a train of phenomena, closely resembling
those occasioned by the presence of a foreign body in the air-tubes.

11. Bronchotomy is generally inadmissible when there is serious organic
disease of the lungs, attended with marasmus and all the ordinary symp-
toms of pulmonary phthisis.

12. The foreign body, both in laryngotomy and tracheotomy, may escape
either at the artificial opening, or by the glottis. In either case, it may be
thrown to a considerable distance, perhaps the very moment the tube is
pierced ; or it may be intercepted by the edges of the wound ; or it may,
if it take the natural route, lodge in the mouth, or pass into the stomach.

13. Should the foreign substance not be ejected, or appear at the articial
orifice within a few minutes after the tube has been pierced, search should
be made for it with the forceps, or hook, with a view to its extraction ; but
all such attempts should be made in the most gentle manner, nor should
they be prolonged beyond a few seconds at a time ; inasmuch as they almost
invariably excite violent coughing and suffocative feelings. The use of
chloroform will greatly facilitate this step of the procedure.

14. A much better plan than searching for the foreign substance, at least
in the first instance, is to invert the patient's body, and to strike the chest
with the hand, or with a pillow. This procedure should be tried in all cases
of balls, shot, peas, beans, water-melon seeds, plum-stones, cherry-stones,
button-moulds, and other similar articles. Inversion of the body, with pre-
vious opening of the tube, is a comparatively safe operation. Succussion
and percussion are important auxiliaries in such a case.

15. When the extraneous body refuses to escape, or resists our efforts at
removal, the edges of the tracheal wound should be kept apart by means
of blunt hooks, in order to favor extrusion. The outer wound should be
covered, in this case, with a piece of gauze, arranged in the form of a bag,
to prevent the ingress of flies and dirt.

16. Riddance having been effected, the wound is closed with adhesive
strips, aided, if necessary, by a few interrupted sutures, care being taken not
to carry them through the substance of the trachea. Simple water-dressing
is the best application, but even this may, in general, be dispensed with.

17. The after-treatment must be strictly antiphlogistic ; the respiratory
organs be diligently watched ; and the air of the patient's apartment must
be maintained, throughout, at a uniform temperature, that is, at from 65 to
68 of Fahrenheit. It should be remembered that no patient is safe or out
of danger, after this accident, so long as there is inflammation of the respi-
ratory organs, whether the intruder has been expelled or not.

18. Finally, it may be necessary to perform bronchotomy a second or
even a third time. The same circumstances which induce us to perform
it once may compel us to perform it again, at a more or less remote period,
upon the same individual.

A Manual of Pathological Anatomy. By C. H. Joxes, M. B., F. R. S., fec.,
&c, and Edw. H. Sieveking, M. D., F. R. C. P., tfec, &c. 1st American
edition, revised, with 397 illustrations. Philadelphia: Blanchard & Lea.
1854. 8vo., pp. 735. (For Sale by McKinne & Hall. Price $3.50.)

The advances of Pathological Anatomy are so rapid, especially since the
extended application of Microscopy to the study of morbid textures, that
new works upon the subject become necessary to whoever would keep pace

\fisceUartec 63

with them. The work before us appears to have vn up

remarkably well adapted to s The nam I well exe-

cuted illustrations must very materially facilitate its com}
lend to the study an interest which none ell as those who

have not enjoyed these :

' info the Pathological Importance of Ulceration of the Os
Beino; the Croonian Lectures for the West,

M. !:. F. R C. P.. fcc., &c Philadelphia : Blan< - <54. 8vo.,

pp. SS. (For sale by McKinne & Hall. Price, -SI.)

Every medical reader is aware of the i h the lesions of

the os uteri have given rise in the learned bodies of Europe dining tfa

irs. With Bennett on one side and men equally eminent on the
other, the importance of tJ has been very variously estimated,

and practitioners have been found at the two extremes of exaggeration and
depreciation. The object of the author of this work, is a candid inquiry
into the subject. It should therefore be attentively read, and we feel as
that none will rise from its perusal without much practical advantage. It
is only by examining the arguments upon both sides of this mooted qv.
that the truth can b

\ve Medical Agents: being a treatise on the new Alkaloid, Besinoid,

and concentrated preparations of Indigenous and Foreign medical plants.

By authoritv of the American Chemical Institute. New York : B. Keith

& Co. 1854. 8vo., pp. 300.

We are indebted to the publishers for the above-mentioned work, anony-
mous, yet issued " by authority of the American Chemical Ins a body
of whose existence we had not before been apprized. We find at the close
of the work the following advertisement, which will throw some light upon
the object of the book and the end for which the k* Institute"
lished :

,k American Chemical Institute. The preparation of the active and con-
centrated medicinal principles of indigenous and foreign medical plants, in
a pure and reliable form, is the object entertained by the proprietors of the
above institution. B. Keith & : Houston street, Xew York, are pre-

pared to fill all orders on the best terms. They are engaged in the extensive
manufacture of all the agents described in this work, and which are war-
ranted pure in all ca

The work before us is then nothing more than an ingenious device for
bringing before the profession the important fact that B. Keith k Co. are
prepared to fill all orders, <fca We would be doing injustice to the author,
however, were we not to acknowledge that he exhibits no small amount of
artistic skill in the manner in which he has spun his yarn of 300 octavo
aeral considerations, covering 90 pages, interspersed with
Physiological, Psycological, Political, Philanthropic and Christian princi-
-how him to be quite an adept in other matters as well as in the prepa-

6-4 Editorial and Miscellaneous. [January,

ration of Alkaloids and Resinoids. The book then gives us an account of
the physical and medicinal properties of the following concentrated articles :
Geranin, Ilydrastin, Hydrastine, Apocynin, Gelsemiiy Caulophyllin, Capsi-
cin, Asceepin, Cypripedin, Eitpatorin, Rhusin, Myricin, Helonin,Podophyllin,
Lohelin, Sanguinarin, Leptandrin, Euonymin, Irisin, Rumin, Alnuin, ol. Er-
igeron, Senecin, Phytolacin, Scuttellarin, Jalapin, Stillingen, Xanthoxylin,
Veratrin, Corniu, Viburin, Hyosciamin. Lupulin, and Prunin ! ! ! But, we re-
peat, the gist of the work is found at the end of the book, as above quoted.

Report of the' Select Committee of the Senate of the United States on the
Sickness and Mortality on board Emigrant Shirps. 1854. pp. 147.

We thank the author for this very interesting Report, drawn up by
Mr. Hamilton Fish and accompanied with communications from distinguish-
ed gentlemen from different parts of the country. It is full of facts and
valuable suggestions, which will, we trust, lead to enlightened legislation
upon the important subject in question.

Deaths from Chloroform. A man, 29 years of age, was recently submit-
ted to the influence of chloroform, in University College Hospital, London,
for catheterism, rendered necessary by retention of urine. He died, how-
ever, before the operation was commenced, notwithstanding the best endea-
vors of Prof. Erichsen to stay the fatal effects. Another case is reported by
Prof. Dmnreicher, of Vienna, the subject being a youth 19 years of age.

Quinine in Croup. Dr. J. Macfarlan reports, in the New York Journal of
Medicine, for November, several cases in which he succeeded admirably in
relieving croup by the use of quinine, although some of them were very
violent.

Asylum for Inebriates. We are happy to see that a serious effort is
being made in the State of N^ew York to establish an asylum for the treat-
ment of confirmed drunkards. There can be no good reason why such
institutions should not be eminently beneficial.

. A case of Quadruple Birth. Dr. S. Kennerly, of Virginia, reports in
the " Stethoscope " a case of labor which resulted in the delivery of four
children 3 boys and 1 girl all alive, but neither lived more than fifteen
minutes. They were seven months children and weighed in the aggregate
about 8 pounds. " There were two distinct placentas ; one was Very large
and divided into three distinct lobes, each lobe having its respective cord
attached to its centre. The smaller placenta was a little larger than either
lobe of the larger placenta." The mother recovered without accident.

Twins born at 40 days inteo-val. We find in the French Journals, the
following case : A country woman, aged 25, in good health ; menstruation

65

r ; pmnipara ; gave birth to a well developed, though rather delicate
child, which died eight days after birth, from a cold. The placenta came
away natiirally one hour after the child. The subsidence of the abdomen
was incomplete; active movements continued to be felt by the mother;
there was neither secretion of the lochia nor milk. Nothing otL
particular occurred in the condition of the woman until 40 days after the
birth of the first child, when another was born, also feeble, but completely
developed. It was only at this time the lochia and milk a]

Superfastation. Dr. Thielmann relates the following case of superfceta-

tion. it woman, aged 25. had borne, at 20 and 23, girfej In July.

me pregnant the third time: menstruation appeared twice

after conception. On the 2Qth March. 1853, the first pains appeared, and

ivered of .all but living ; the after-birth

came away normally. The lochia ceased in a few hours. The secretion of

milk v. ; i at the child could not be supported by t days

after delivery, the woman returned to her household duties ; but she felt in

her left side the inovemenl orid child. On the 18th May that is.

fterthe birth of the first child pai -birth

oud livii

>u of milk went on so freely, that both children derived sufficient

nourishment. M. Thielmann says this case was officially certified. [Medico-

.

ly found ' According to the

y. Fetter I for bile only once

a positive result. Nitric acid added to the i i only twice an

undoubted reaction of bile. He concludes therefore, that as a rule, unde-
1 bile is not found in faeces.

s in pathological c The following are some of the results

of Ihriag's invesl in the Bri o-Chi-

rurgical Renew :

Hiring has in I the condition pathological -condi-

After taking one ounce of rock-salt, a loo*e acid stool i
which contained 20*8 per cent, of solid constituent-, and among these were
6*6 per cent of rock-salt. There was no sulphuric acid or bile ingredients.
A large portion of the rock-salt passed off by the urine.

Two loose stools, passed by a patient with tuberculosis of the intestines,
had the follow n :

11-8 9-5

hoi extract 28*2 35'9

Water extract 4-30 r

Insoluble salts 5-8 Chlorine . . 7-3

Chloride of sodium .... 9*0 Phosphoric acid

Albumen . . B"4
The stool of an hysterical patient contained a large quantitv of gas. con-
sulphuretted hydrogen and carbonic acid : the stool contained,
also, albumen, and presented under the microscope manv
and muscular fibrillar

66 Editorial and Miscellaneous. [January?

Some other analyses of a similar kind are given, and then the following
conclusions are drawn from all the observations :

The stools may become changed both as to quantity and quality. In
diarrhoea, the water is increased, and compared to the water, the solids are
diminished, but the absolute amount of solids excreted is increased. The
quantity of undigested food is greater than natural. The alcohol-extract,
which includes the biliary constituents, is increased; the water extract and
ts are always increased ; the earthy phosphates, and especially the
magnesia-salts, are always increased. Sulphuric acid is present in bilious
diarrhoea; iron is present when purgatives have been given, and always
when iron has been taken as medicine. Albumen is not present during
purgation by medicine in healthy individuals, but is present in intestinal
tuberculosis, in typhus, cholera, and dysentery.

Quite a Discovery. Dr. W. B. Powell announces in the Boston Medi-
cal and Surgical Journal, " a discovery of the means of determining the
comparative length or duration of human life, and other important physio-
logical facts." Hear him !

" Extend a line, as suggested by Mr. Cox, from the external occipital
protuberance to the most prominent part of the external orbitar pro*
the os front is, and the extent of the space that is found to obtain between
the line and the meatus auditorius externus, will accurately indicate the
comparitive duration of life. From observation I would name an inch, at
the meridian of life, to indicate an existence of 80, 90 or an 100 years, depend-
ing upon the density of the organization. The average, to the best of my
ation, is about half an inch, which may be regarded as corresponding
pretty accurately with the known average of human life, in this country, after
deducting the mortality occasioned by mechanical and chemical causes.
Under the latter I include medical mal-practice.

The first head I measured with a view to the discovery, was that of an old
man who died of phthisis, and the space between the line and the meatus
was but the sixteenth of an inch. The next one I selected was that of a man
who had been executed, and the space was one inch and an eighth. In this
way I ran through my cabinet of crania, consisting of several hundred, and
found nothing but confirmation of the principle here set forth. I then com-
menced testing the law in society, and some of those who possessed a space
of only a fourth of an inch have since died. In fine. I have discovered no ex-
i to the rule.

From what has been stated, it follows that a descending developement of
the cerebellum and of the middle lobes of the cerebrum secures a corres-
ponding duration of life power to resist the usual causes of disease, and
when assailed, to re-act and recover. We can now understand what is
really meant by the common phrase a good constitution, such as we have
illustrated by our octogenarians, who may be of a full habit and in their
usual enjoyments of the good'things of the world, or they may be lean and
shriveled and satisfied with a crust of bread and a glass of water. I desire
that it shall not be supposed that I assign both. vigor and tenacity to the
same cerebral convolutions ; on the contrary, I regard the two functions as
being independent of each other, and as depending upon seperate convolu-
tions, that of tenacity being the inferior."

Another of the Doctor's discoveries is thus stated :

"I have been frequently asked do the vital forces decrease in old age 2

Miscellaneous. 67

I answer affirmatively, more especially the animal : and I know of but one
that does not. and it is the respiratory. During many years. I was unable to
n why consumptives, the phthisic-ally constituted and old
people, should have the medulla oblongata larger than is common to other
people. The fact, to the extent of myflft idin . : been noticed 1

As the forces auxili; iration decline, that upon which it

y depends increase. I refer the in o the foramen magnum of

the crania of those above

ence of the Toison of the Northern Rattlesnake ( Crotalus Bv,
on Plants.* By J. H. Salisbury. M. D. It is a curious and well ki
feet, that some of our most deadly poisons are animal secretions, and that
the very animals the verj ~hese powerful proximate

organic principles, are as susceptible to their deleterious influence, when
introduced into their circulation, as the ~ i>st harmless animal

would be under similar circumstances. It is also well known that many
vegetable products are highly poisonous to animals. But the influence of
animal and vegetable poisons upon plants, has although asubje
\y less interesting in a ph\ - I point of view excited but little atten-

tion. The simplicity* of the plant's structure, renders the field one of
peculiar interest, in the way of studying the general action of medicinal
agents and poisons :iized tissi

On the 18th of June, 1851, a large female rattlesnake, which had

the N. Y. State Cabinet of Natural Histoiy. for about a year, with-
out food, died. On dissection, its stomach and intestinal canal were found
entirely empty. The sac into which the poison is emptied was laid
and the virulent matter (of which there was little), carefully removed and
placed in a poreelain'capsule. About fifteen minutes after its removal, four
young shoots of the lilac Syringa Vulgaris, a small fa nut of one

growth , a.stamum, a corn plant Zea Maize, a sun-

flower plant Holla, and a wild cucumber vin- . erally

ted with it. The vaccination was performed by dipping the point
of a pen-knife into the poisonous matter and then inserting it into the plant
just beneath the inner bark. No visible effect, in either case, of the influence
of the poison was perceptible till about sixty hours after it had been i

- >on after this the leaves above the wound, in each case, began to wilt.
The bark in the vicinity of the incision exhibited scarcely a preemptible
change ; in fact it would have been difficult to have found the points, if they
had not been marked when the poison was inserted. Ninety-six hours after the
operation, nearly all the leaf-blades, in each of the plants, above the wounded
part were wilted, and apparently quite dead. On the fifth day the petioles
and bark above the incisions began to lose their freshness ; and on the sixth,
they were considerably withered. On the seventh day they appeared about
as they did on the sixth. On the tenth, thev began to show slight signs of
recovery. On the fifteenth, new but sickly appearing leaves began to show
themselves on the lilacs, and the < to show slight signs

of recovery in the same way. Neither of the plants were entirely deprived
of life.

It was interesing to mark the progressive influence of the poison. The

* The principal facts in this article were formerly published in the Trans, of
Amer. Scientif. Assoc, but as through this medium they have obtained a limited cir-
culation, especially among medical men, I desire to bring them more directly before
the profession by publication in a medieal periodical.

68 Miscellaneous.

first indication of the derangement of the healthy functions of the plants was
observed in the leaves : these began to wilt and die at their edges and apices;
and this death gradually and uniformly advanced on all sides towards the
midrib and petiole, till the whole or nearly the entire leaf-blade was de-
stroyed. ilJt*A'

It is an interesting fact in physiology, that the plants first exhibited
of death in the leaves ; and still more interesting, that this death commenced
first in the leaves, on the side of the plant, in which the poison was
inserted.*

The facts materially deducible from these experiments are :

1. That the effects of the poison of the rattlesnake upon plants
and animals, when introduced into their circulation, by a wound, are simi-

2. That it requires a much longer time for it to affect the plant, than the
animal .\

3. That the effects were invariably exhibited on the parts above the wound,
and in no case affected the leaves below it.|

4. That it invariably affected first the leaves on the side of the plant
in which the incision was male.

5. That its influences were first rendered visible on the edges and apices
of the leaf-blades. \N. Y. Journal of Medicine.

Poisoning by ike external applica senic. A French peasant who

had had chronic nicer on his face for fifteen years, was persuaded by a
carpenter to allow him to undertake the cure thereof. A plaster was appli-
ed, and on the same day the patient experienced general indisposition ; on
the following day severe headache" and vomiting and purging manifested
themselves; after four days of acute suffering, the patient died. Chemical
analysis proved the presence of arsenic. The carpenter was sentenced to
three months' imprisonment. [Journal de Chimie. Br. and For. Medico-
Cltirurg. Review.

Croup. Trarheotomj/. M. Guersant (L'Union, 3 Juillet) gives tin

>i' tracheotomy in croup at the Hopital des Enfans Malades. tJp to
1850 the mean numbers of operations were ten (annually) ; in 1861, there
were twenty-five ; in 1852, tjiere were thirty ; and in 1853 there were sixty.
Of 1131 children operated on, thirty-six were saved, or one in five, and i
sant believes that this fortunate result would have been still more mi

be operations been performed earlier in the disease than was generally
the case.

Dr. Archambault (L'Union, 8 Juillet) relates two cases of Group, ar-
rived at the last stage, in both of which the operation was ly suc-
'd. M^.

* This shews a less perfect system of Anastomosing vessels than exists in the ani-
mal.

t It is stated on good authority, that the poison of the snake can be taken into the
stomach of.ihe animal with impunity : its dangerous effects bein<? only exhibited when
introduced into the circulation by a wound It would be interesting to note its influ-
ence on the animal when applied externally, to the skin, to see whether its deadly
effects would be modified by the absorbents.

J I[ should be stated, in order to show that animals were readily affected by the
poison of the snake, that a short time previous to its death, a rat bitten by it died iu
two hours.

II This was probably owing to the small quantity of poison inserted in each case.

SOUTHERN

3IEDICAL AID SURGICAL JOURNAL.

Vol. II.] SEW SERIES. FEBRUARY. 1555. [So. i

ORIGINAL AND ECLECTIC.

ARTICLE III.

Remarks on Dysentery. By C. C. Howard, M. D., of Lowndes-
boro', Alabama.

Although in almost every systematic work on the practice of
physic, and often in our periodical journals, we may find a chapter
on dysentery : yet, the subject being an eminently practical one,
some farther remarks may be thought not unworthy an insertion
in your valuable Journal.

It is said, that " inspection of the dead body discloses more or
ulceration, chiefly of the large intestines. The glands that
are scattered over its surface are enlarged and prominent. The
lining membrane is here and there" thickened. The last three or
four inches of the ileum, are generally studded with superficial
ulcerations. The omentum, me and glands are often found,

the first united to the neighboring parts, the latter enlarged."

Having made no post mortem examinations of this disease, these
are facts to which I cannot direct! y But I entertain not

the shadow of a doubt that they are facts nevertheless, and that
they are the results of a previous inflammatory action in those
parts. I come, therefore, confidently to offer some practical re-
marks on an inflammatory disease of the mucous membrane of
the large intestines with or without like disease of other portions
of the alimentary canal.

The results of the inflammatory action in the fatal cases, it
seems, are not the same in each, especially as to locality, and when

BT. 5, VOL. XL >'0. H. 5

70 Howard, on Dysentery. [February,

we take all the cases, from the mildest to the gravest, we must con-
clude, that the extent of actual disease is very variable. All that>
I know of this affection, as already indicated, is that learned from
the books and at the bedside. But, if the post-mortem examina-
tions of others satisfy me, as they do, that the disease is not neces-
sarily confined to one particular part of the intestines ; observa-
tion at the bedside, has entirely convinced me that, in one case,
the inflammatory action is almost confined to the lining of the
rectum or descending colon ; in another, to that of the ccecum and
ascending colon, or the last few inches of the ileum ; yet another,
to modifications of these, and lastly, to the greater part of the
alimentary canal.

Where a disease is thus modified, we should, of course, expect a
corresponding modification of symptoms; but, when an inflamma-
tion affects the same membrane in the same organ or apparatus,
though at different points and to different degrees, we should also
expect some agreement of symptoms. The characteristic symptoms
of dysentery, whether mild or grave, are very correctly stated by
Dr. Watson, in the second paragraph of his seventy-third lecture,
viz : "griping pains in the abdomen, followed by frequent mucus
or bloody stools, straining and tenesmus. * * * The acute
form or stage of the disease is attended with fever." The disease,
perhaps, never exists without these symptoms being present ; but
there is a wide range of modification of them, and thus modified,
they serve as good indices to the locality and extent of the disease
in individual cases.

It will be found, that in inflammation of the mucous tissue,
whether in the intestines, the urinary bladder, the bronchia or
elsewhere, a quantity of mucus, with or without blood, is almost
invariably poured out and this is a law of such tissue. It may
be remarked, then, that although the quantity may be small, owing
to the grade or extent of the inflammation, there is always more
or less with or without blood. And as many substances are received
through the mouth, and find their way into the bowels, and other
secretions beside mucus are poured into the canal, the discharges
are often found to be mixed, and composed of these different
secretions. Those cases in which the rectum is the chief seat of
disease, pour out a much smaller quantity of mucus than when
the greater part of the colon is involved. But, whilst there may
be little secretion, and, it may be added, less tormina or fever, the
tenesmus is almost constant ; and we sometimes see cases, whether

1855.] Howard, on Dysentery. 71

the pathology indicated be correct or not, in which the patient,
for whole days together, has been constantly employed in getting
to and from the chamber-pot ; generally discharging a teaspoonful
of mucous, though frequently a few drops only, or none at all :
yet, at the expiration of two or three days, a reasonable allowance
for the fatigue from so frequently getting up and down, will satis-
factorily account for the difference in his feelings or general symp-
toms. "Where, too, the chief disease is in the last few inches of the
ileum, the evacuations will usually be small, or if large, watery ;
but the other symptoms will be graver, thus, fulness, and upon
pressure pain and gurgling in the right ilia ; fever of a low grade.
Lastly, when the disease involves most of the colon, the secreting
surface being great, it is reasonable that the amount of mucous
should be great also so that in such cases, the discharges are
often sufficiently copious to very much reduce the patient's strength
in a few clays.

In remarking on the discharges, incidental reference has been
made to the other characteristic symptoms. But it should be more
directly stated that the tormina is no less variable than the other
i. e., the discharges ; and in some of the most serious cases it is
by no means prominent. The latter, are those in which the chief
seat of the disease is in the- last few inches of the ileum ; cases in
which the dysenteric symptoms are sufficiently distinct, but not
urgent, and, if we could remove those characteristic symptoms
without entirely removing the disease, no man accustomed to
seeing "typhoid fever" would hesitate to pronounce it such a case.

Tormina is a prominent symptom where the colon is extensively
involved, and still more prominent, when the greater part of the
entire canal is implicated ; or cases in which a green, blue, black,
or prairie-mud-like liquid is poured into it ; accompanied by ex-
treme nausea, and ejected through the mouth and anus most forci-
bly.

It may be said, in relation to the tenesmus, that it is a symptom
dependent on the rectum, and whether there be inflammatory ac-
tion there from the beginning, or the irritation of the liquids
passing over and exciting it to extraordinary action produce it,
where the tenesmus is obstinate and persisting, local disease of the
part is to be very much suspected. Intimately associated with
this symptom, is the dull, heavy pains, about the pelvis, and often
extending to the thighs.

Having noticed the discharges, the tormina and tenesmus ; the

72 Howard, on Dysentery. [February, !

fever accompanying this disease claims attention for a moment.
The division of fever into grades, I regard as being very proper .
and "useful ; and to this remark it is only necessary to add, that in \
dysentery, sometimes we find the synochal grade ; then the typhoid ;
then the intermediate ; again, even modifications of these ; and
lastly, and not unfrequently, there is extremely little febrile action
of any sort. So also, the fever continues, remits or intermits as
the case may be.

When one organ or part suffers, the other organs, or some of
them, sympathize with, the diseased one. This law of man's being \
is so universally recognized, that all would expect, as we shall
find, that with parts having so extensive connections as those in- I
volved in dysentery, there will generally be a great deal of sym-
pathy ; while, indeed, we could scarcely mention any important j
organ that does not at times sympatize with the inflamed mem- |
brane, it is only necessary to name the liver, kidneys, urinary r
bladder, skin and stomach. That the liver, in the amount and I
character of its secretion, soon manifests its sympathy with the j
inflamed membrane, every one knows ; but, that its deviations in I
this respect are often, if ever, the exciting cause of dysentery, I by j
no means believe. I can readily conceive that the chief causes of \
dysentery might directly affect the liver, and my first impressions 8
in the study of physic were with that opinion : but so many cases I
occur in which the functional deviations of this organ are so late I
in making their appearance in the disease, I am satisfied that ordi-
narily, there is no more connection between this glaud and the
inflamed membrane, than between the kidneys and it. Indeed,
these latter organs, -by their diminished, and highly colored and
probably concentrated secretion, usually manifest the earlier sym-
pathy. The urinary bladder, either directly or from the irritation
of this concentrated urine, not unfrequently performs its office reluc-
tantly, and in the most cases strangury often appears comparatively
early. The skin is often dry and preturnaturally hot ; though, in
many of those cases in which the accompanying fever is of a low
grade, it is, particularly of the extremities, cool, and sometimes cold,
moistened with a clammy offensive sweat ; nausea and vomiting are
not confined to those cases heretofore spoken of, in which the
stomach is almost certain early to become involved in actual dis-
ease, but occurs under a variety of circumstances. Thirst, though
often slight or entirely absent in the commencement of the attack,
usually increases very much as the disease progresses.

1855.] Howard, on Dysentery. 73

As yet, no reference has been had to the tongue, as an index in
this disease ; and it is scarcely necessary to say, that in the com-
mencement it is somewhat furred, white or yellow ; having no
more color than is natural to it ; but, in the progress of the disease
becoming red at the tip and edges, with a dry brown crust in the
middle, which crust finally being thrown off, leaves the entire
member very red and often glazed. From the commencement, to
treat a case of dysentery, to the close, I never fail to frequently
examine this organ ; and making very little allowance even for
opium or its preparations ; almost every remedial agent that very
decidedly makes the tongue drier will do no good, and when the
prescription has that effect, to say the least, the question of the
propriety of changing it ought to be considered.

Of the causes of the disease, it may be proper merely to give an
opinion, and it is this, that they are almost entirely atmospheric ;
the simpler and more purely inflammatory being dependent upon
changes in temperature, or perhaps continuance of somewhat ele-
vated temperature, with a certain degree of moisture. Those of
a low or typhoid grade not only upon such changes, but also
changes in the constituents of the atmosphere. That filth about
small negro houses, with decay of the sappy logs of which they
are sometimes constructed, together with certain ingesta ; and I
mention particularly the continued and almost sole use of molasses,
beef and corn bread ; are decided modifiers of the atmospheric in-
fluences, I do not at all doubt.

Having made these remarks upon the nature, symptoms and
cause of the disease, and passing over the points of diagnosis and
prognosis, we come lastly to the treatment. The practice of medi-
cine, as a system, although resting in a great degree upon indi-
vidual experiment, has certainly attained to the respectability of
many well understood general principles. And they ought to
lead us to a reasonably successful practice in this disease, though
we should -see it far less frequently than we do. There are many
remedies and even modes of treatment that have been proposed,
and this is not at all strange, if the pathological views herein pre-
sented approach correctness. Could any one hope to find a reme-
dy, or even a specific mode of treatment for any disease embracing
so wide a range ! Should he seek to do so, in my judgement, he
must from the necessities of the case only be disappointed. " The
only management that can be satisfactory is one based upon gene-
ral principles." (Dunglison.)

74 Howard, on Dysentery. [February,

Such being the fact, it will be proper to remark upon remedies
somewhat in classes and first of bloodletting. This remedy
claims an early consideration, both from its capability of effecting
great good or mischief, and because, when it forms a part of the
treatment, it should be performed early. That it is, in the well
developed, purely inflammatory cases; those attended with a
synochal grade of fever, a proper remedy, few medical men would
dispute. So far from doing so, it appears to me, as not only proper,
but absolutely necessary. And about twelve years ago, whilst
practicing in the county of Chambers, in this State, I rarely saw a
case of dysentery that was not bled in the very commencement of
the treatment, and the impression is with marked benefit. But,
in nearly all the cases that have come under my observation for a
number of years, the grade of the accompanying fever has been
entirely different, viz : of a low or typhoid type. And this is not
only true of dysentery, but other inflammatory affections. The
consequence is, that I seldom bleed in the disease under considera-
tion ; and it may be added, or any other. Still, I am not aware
of any reason for being less satisfied with the success now, than
when the lancet was frequently used. In many, perhaps, most of
the cases of dysentery occurring here, the patient for the first few
days has very little fever ; it then comes on gradually ; his pulse
say eighty or ninety beats per minute ; not at all corded or resist-
ing ; but soft and not fuller than in health. There is a certain
degree of feebleness, and should the patient rise in bed, the pulse
becomes much increased in frequency, and more feeble. Whilst
lying down, as in the purer cases of typhoid fever, feels pretty well.
But, when he rises to the close stool, feels and expresses strong
tendency to syncope, and hurries back to bed. Now, it is asked,
shall such a patient, old or young, male or female, be bled ? I
answer, no ! and for the following reasons : He has a disease that
will not, though he be bled, run its course in a very brief time.
The seat of the disease is intimately associated with the blood-
making department ; to say nothing then of its first impression,
the danger of dying from exhaustion must be very much increased.
"What are the objects of bleeding in inflammation? u Although
the mere loss of blood per se may be of service (when that fluid is
morbidly abundant) by relieving the system from a source of ex-
citement, still the principle good effects in bleeding in inflamma-
tion depend on its sedative effects on the brain, and through the
brain on the heart," (Druitt's Surgery.) It is barely possible

1855.] Howard, on Dysentery. 75

that the case supposed might have a morbid abundance of blood ;
but is a sedative effect on the brain and heart thus called for ?
and if there is not a morbid abundance of blood, would it not
answer as well, for the patient to set up in bed as long as it would
ordinarily take a man with pleuritis to be bled, from a large ori-
fice, to syncope ; and in this case induce an approach to fainting
merely by thus sitting up ?

Again: " The necessity for venesection, and its beneficial effects,
will be great in proportion as the tolerance is greater." (Ibid.)
To apply this rule, which is a correct one, the only conclusion is,
that venesection in these typhoid cases promises little. But here
is another case the patient without heat, pale without thirst ;
pulse 80 or 100 per minute ; feeble ; tending to and actually rapidly
increasing in frequency ; tormina, tenesmus, frequent, and pretty
free evacuations of mucous, blood, and fecal matter; the dis-
charges in a short while becoming more liquid, jprarie-mnd-like ;
deathly nausea; vomiting a green, blue or black fluid. After
continuing thus a few hours, possibly days ; tongue very red and
dry ; thirst inextinguishable ; great abdominal tenderness ; pros-
tration. Are not the indications here clearly against bleeding ?
But this is the disease as we sometimes have it. In such cases as
have the intestinal or mesenteric glands actually diseased, accom-
panied with little fever, or fever of a typhoid type, I never bleed.
But where the disease is more strictly confined to the mucous
membrane, or should the peritoneal coat also be involved in the
first period of the disease, as sometimes happens, and the fever is
of the purely inflammatory grade, we may not hesitate to draw
blood from the arm. Of leeches I know nothing ; but of cups, my
opinion, as compared with that expressed in most of the books, is
not near so favorable.

The next class of remedies to be remarked on is purgatives. And
it may first be said, that those long dreaded balls of hardened feces
(scybala) are less frequently found in this, than in almost any of
the diseases we are he*re called on to treat. It is occasionally the
case that a dysenteric patient has his bowels somewhat loaded with
fecal matter ; and these full bellied cases that have tormina, with
very small discharges, will usually be benefitted by a cathartic,
say of rhubarb and magnesia ; preceeded or not three or four
hours by a small mercurial ; or, if the grade of the fever approaches
the synochal, epsom salts with or without magnesia, or the seidlitz
powders or castor oil will answer a good purpose. Nearly all

76 Howaed, on Dysentery. [February,

the cases I see now-a-days, however, do not seem to at all require
cathartics, and the most of them not the slightest laxative after
the first few days. To the facts as touching this point : in many
cases there is disgust for all kinds of food ; the patient, therefore,
takes nothing of the kind into the stomach ; the bowels frequently
expelling mucous with other liquids, the presumption is that the
small portion of fecal matter is early suspended in the liquids and
thrown off. The abdomen, at the same time, is flaccid and pre-
sents not the slightest appearance of accumulation of fecal matter,
or even the tenth part of the usual quantity. In certain cases in
which the abdomen presents much the same appearance as in
health ; the general symptoms indicating that the disease is con-
fined to the descending colon and rectum, some fever, the combi-
nation of a laxative and opiate will answer a good purpose, as cas-
tor oil. and tr. opii, thus :

$. 01. Eicini !i.

Pulv. Acacia Sacchari. aa 3ij.
Tr. Opii. gtt. xl or lx.
Aqua Cinnamon diluted 3yj.
Dose, a tablespoonful every three or four hours ; or a rhubarb
cordial. But one of the most useful still is the blue mass, opium
and ipecac, thus :

Vf.. Pilulae hydrargyri, grs. xxiv.
Pulv. Ipecac, u iv.

" Opii, " ij. or iij.

Ft. pilulae viij. S. one every three or four hours.
In the commencement of the typhoid variety, and in the more
purely inflammatory form, after the violence of the disease has
been subdued by venesection, a cathartic or emetic, or both, the
above pills will usually do good service. But, though the quanti-
ty of the first ingredient is small, it will often have to be reduced.
Under the circumstances in which the pills have been recommend-
ed, I have rarely seen the following powder fail to make a good
impression :

Vf. Hydrg. cum. oretae, grs, viij.
Cretae. prep. " xx.

Pulv. opii, " iij.

" Ipecac " iv.

Ft. Pulv. viij. S. one every two, three or four hours.
These medicines modify the secretions, allay the tormina and
tenesmus, promote action of the skin, and often the disease in a

1855.] Howard, on Dysentery. 77

few daya entirely yields to them, unaided other than by the warm
bath or fomentations to the abdomen.

Of emetics, particularly of warm water, aided, if necessary, by
ipecac, it may be said that in the commencement of many attacks,
especially such as are distinctly confined to the lower bowels, with
a tolerably full abdomen and a furred, broad, moist tongue, they
will be found useful. A few years ago, the writer was called to a
plantation where the disease had been and was prevailing to a .con-
siderable extent ; a variety of plans had been tried, not satisfacto-
rily successful. During the visit, three or four new cases presented
themselves, to every one of which we gave emetic doses of ipecac,
with a grain of opium, to avoid purgation and, to say the least,
the final issue of the cures was more agreeable. But the remedy
alone did not arrest the disease, by any means. In not a few of
the cases seen in the last few years, however, vomiting, so far
from requiring promotion, is to be combatted with opiates, blisters
and such other means as may be suggested but, after all, and
before all, ice will be the remedy to address to the stomach ; whilst
anodyne and astringent enemata may be repeated as occasion re-
quires. Water, iced and thrown into the bowels, is a remedy well
worthy of trial.

Although mercurials, to a certain extent, are- recommended in
this paper, it ought to be observed, that in the typhoid variety, it
is only in the first stages, and then in fractional doses, if they are
to be repeated, that they should be given ; for, in the advanced
stage of the disease, in almost any quantity, they are often poisonous.

Opium is a remedy eminently calculated to meet the symptoms
of dysentery, if the grade of fever or idiosyncrasy do not forbid
its use. Nearly every case that does not at the time require bleed-
ing or the action of a cathartic, will not only tolerate, but be very
much benefitted by this remedy. That opium and astringents are
indispensable in the treatment of many of the cases occurring
hereabouts, no one, so far as I know, who has been engaged in
their treatment, questions. Though the fever may not be violent,
often the patient in a short time is very much run down by the
tormina, tenesmus and the discharges ; and nothing in the materia
medica promises half so much, or performs the hundredth part so
much as opium and astringents. To relieve the tormina, tenes-
mus and discharges, they are the sine quae non. Though we have
admitted the occasional necessity for cathartics, we read in every
department of animated nature this great law rest forms an im*

78 Howard, on Dysentery. [February,

portant part of the treatment for inflammations. If the limbs have
suffered from external violence, motion is avoided ; if the eye is
inflamed, light is shut out ; if the pleura or lungs, the ribs must
keep still ; if an organ in the abdomen, the diaphragm must cease
its contractions. So, in dysentery, the bowels must be quieted.
Opium is the medicine to do it ; and nothing is more erroneous
than the giving of medicines to excite the bowels to action to throw
off imaginary local irritants, which, if they were present, would not
be at all tolerated. This is clearly shown by the fact, that any
and all irritants taken into the stomach as food, speedily increase
the tormina and discharges. Even the small portions of blue
mass, or mercurial chalk, or rhubarb, or castor oil, or anything of
tb^kind, may have to be avoided. But the opium, with or without
the ipecac and cretae prep., may be given ; or the Hope's mix-
ture will often do well, though the nitric acid in it had better be
left out at times.

The following will prove, in many cases, an admirable anoydyne :
$. Sulph. Morphine, grs. ij. or iij.
Aqua Camphora, 5viij.

S., a tablespoonful every one, two or three hours as occasion
requires.

The last formula, for certain cases, may be improved by the
addition of ess. menth. pip., or the aqua menth. pip. may be substi-
tuted for the aqua camphora.

Of the astringents, the mineral, at least whilst there is fever, is
usually to be preferred ; and of these the acetas plumbi. If the
patient has but little fever ; abdomen soft ; bowels comparatively
empty ; the discharges frequent, with tormina and tenesmus, the
following pills may be expected to do well.

$. Acetas Plumbi, grs. xvj.
Pulv. Opii, u iv.

" Ipecac " iv.
Cons. Kosos or Micas panis q. s.
Ut Fiant pirulae, xvj.

S., one after each discharge, provided they are not required
oftener than every hour.

If they are not sufficient to restrain the bowels and remove the
tormina and tenesmus, an enema of liquid starch or tea of flax
seed or slippery elm, say iij., sulph. morphine, gr. $, with or with-
out the acetas plumbi, grs. ij. a viij., may be given and repeated
according to demand. The lead sometimes nauseates when given

1855.] DuGAS, on Local Anesthesia. 79

by the mouth ; then it is better to give it only in enemata. But
even thus, it will occasionally have that effect; then the tannin,
which stands at the head of vegetable astringents, may be substi-
tuted, and indeed many other astringents. But, when the lead nor
tannin does well, other astringents may be doubted. The best
form decidedly for giving the lead by the mouth, is in pill. It is
scarcely necessary to say, that when the fever is of the synochus
grade, or comes on in distinct paroxysms, the sulph. quinine may
beneficially be given. Blisters, in the latter stage of the disease,
and comparatively early in those cases, attended with tympanitis
and much pain, will do great good, and very few cases of dysen-
tery ought to be permitted to terminate fatally without their
having been used. Fomentations and poultices generally answer
best in the early stage of any form, and should never be removed
for blisters until they have been fairly tried. Of the former, a
flannel bag containing hops, and wrung out of hot water, is light
and soothing. Of the latter, a bran or bread poultice, sprinkled
with mustard does well ; but I think few local applications are so
good, especially in the typhoid variety, as light bran or bread
poultices, which, after being spread, are sprinkled with one or two
drachms of muriate of ammonia, and renewed every few hours.
Though we have written somewhat in detail of the treatment,
we close by repeating the quotation from Dunglison, "the only
management that can be satisfactory is one based upon general
principles."

AETICLE IV.

A Surgical Operation under the influence of " Local Anaesthesia"
induced by cold. By L. A. Dugas, M. D., &c.

About 18 months ago, Mr. J. B., of Greene county, perceived
a warty growth upon his right arm, over the insertion of the del-
toid muscle. Observing that it was increasing in size, he endeav-
ored to destroy it by the application of a silk ligature around its
base. This, however, only aggravated the case, and the growth
was shaved off by his medical adviser, who then applied ineffect-
ually various agents to prevent its return. Every application,
apparently, served only to add to the rapidity with which the
disease extended and assumed the character of an epithelial, car-
cinomatous fungus. The patient subsequently placed himself

80 Dugas, on Local Ancesthesia. [February,

under several individuals, particularly celebrated as "cancer
doctors"; the fungus was repeatedly removed more or less com-
pletely by means of the escharotics in common use ; but would
always return with renewed activity.

On the 2d instant, Mr. B. arrived here, and I found him in the
following condition : The fungous growth was about the size of
two fists, somewhat globular, with a flattened surface and project-
ing a little beyond the circumference of the attachment, so as to
constitute this a neck of about four inches in diameter. The en-
tire surface of the tumor presented the aspect of a ragged, mucous
membrane or ulcer, from which there exuded an abundant dis-
charge of the most fetid sero-purulent matter. The fetor was such
indeed as to infect the whole apartment, to the very great annoy-
ance of the patient and all who came about him. Around the
attachment the skin was swollen, red, and evidently yielding to
farther encroachments. The axillary glands were enlarged and
tender to the touch. The patient's general health was much im-
paired, from incessant pain, despondency, and, above all, the in-
tolerable stench which destroyed his appetite and kept him more
or less nauseated. He urgently solicited the removal of the fungus
and was willing even to suffer amputation, if deemed necessary.

In view of the patient's age, his cachectic condition, the doubt-
ful advantage of the operation, &c, amputation was deemed un-
advisable, and the simple extirpation of the offending mass was
determined upon. From the extent of skin to be necessarily re-
moved, it was evident that the edges of the wound could not be
brought in contact after the operation. Yet there was no alterna-
tive, and this circumstance having been explained to the patient,
as well as the probability that the disease would return soon or
late, he very readily consented to the excision.

This was a case in which the administration of anaesthetics by
inhalation could not have been carried very far without risk, and
it was one remarkably well adapted to the use of a freezing mix-
ture for the production of. local anaesthesia. Prof. Means was
therefore requested to prepare the usual frigoriflc compound of ice
and salt and to superintend its application. This was done in
presence of the Medical Class, and in less than four minutes the
surface was congealed and the operation immediately performed ;
a double eliptical incision being carried through the integuments
from the acromion process to within three inches of the elbow,
and the parts included rapidly dissected away down to the muscles-

1855.] Treatment of Chorea. 81

Under this extensive flaying the patient experienced so little pain
that he now declares that the most unpleasant part of the opera-
tion was the dressing, or rather the application of the adhesive
strips.

The congelation was so complete as to have solidified the adi-
pose matter to such a degree that the knife felt as if passing through
a mass of tallow. Not only was the surface blanched, but we
have reason to believe that the effect of the application very ma-
terially lessened the amount of hemorrhag'e, inasmuch as this did
not exceed a gill, whereas we had expected it to be very profuse.
Ligatures were applied to three small vessels, although they bled
very little, because it was deemed important to prevent even a
small loss of blood under the circumstances. "We regard this
case as fully demonstrating the value of Arnott's plan of inducing
local anaesthesia. It is now seven days since the operation was
performed, and the patient's spirits, as well as general health, have
so much improved as to allow him to return home. The wound
seems to be doing remarkably well.

Augusta, 9th Jan., 1855.

TRANSLATIONS AND CONDENSATIONS FROM FRENCH JOURNALS.

Treatment of Chorea.

The numerous modes of treatment which have been adopted for
the relief of chorea, may be divided into two grand classes, accord-
ing to their method of application and action. First, are the ex-
ternal remedies, viz: 1 Gymnastic exercises; 2 Sulphurous
baths ; 3 Cold baths and others ; 4 Electricity ; 5 Cutaneous
irritants and revulsives. Secondly, the internal remedies, the most
important of which are: 1 Antiphlogistics ; 2 Evacuants
(purgatives and emetics) ; 3 Tonics ; 4 Narcotics ; 5 Excitants
of all kinds (strychnine, preparations of copper, nitrate of silver,
arsenic, iodine and iodide of potassium) ; in short, medicines which
are classed or unclassed under the name of contra-stimulants, anti-
spasmodics, and alteratives.

Before passing in review these various curative methods, it is
important to know whether the patient should be left alone, or
have recourse to art. The expectant plan seems sufficiently
justifiable, by the tendency which the disease has to spontaneous
resolution, and by the resources of nature. But, to a certain point,

82 Treatment of Ohorea. [February,

this question can be settled by comparing the results of this nega-
tive treatment to those furnished by other plans. In two cases,
mentioned by M. Eufz, and four which we saw treated on the ex-
pectant plan, for four, eight, ten and thirty-two days, the disease,
far from diminishing, persisted, or even went on increasing, not-
withstanding rest, regimen and other hygienic means which were
deemed sufficient to effect a cure. Thus the treatment requires
medical art.

EXTERNAL TREATMENT.

1st. Gymnastic exercise. In this division, we must place first
the entirely new plan of treatment by gymnastic exercises, the
result of which we give, after having carefully watched its appli-
cation for more than a year.

Eecommended by Darwin, and later by Mason Good, muscular
exercise was first attempted by Louvet-Lamarre. The patient was
a young girl, who was attacked for the fourth or fifth time. After
an unsuccessful trial of various treatments, rope jumping every
day was advised, at the same time that bleeding was resorted to.
From the sixteenth day the agitation was scarcely perceptible, and
in twenty days the cure was complete. This vague and complex
case proved nothing in favor of the remedy, which remained for-
gotten until the physicians of the Hospital for Children, among
others M. M. Bouneau, Baudelocque, Guersant and Blache, struck
no doubt, as ourself, by the advantages of gymnastics in scrofulous
and the other cachectic conditions, conceived the idea of applying
it to the treatment of nervous diseases, particularly to chorea,
which, besides the perturbations of the nervous system, so fre-
quently induces disorders of nutrition and organic functions.

The treatment must be commenced with simple and harmonious
movements, exercising the larynx at the same time by singing.
The patient, standing up, should flex and extend the knees and
elbows, keeping time with the music. Such are the first steps
necessary to place these movements under the influence of the
will. The rapidity of this result will be in proportion to the at-
tention, intelligence and character of the patient. It is frequently
impossible to do any thing until the patient has been won by
kindness.

After the muscles can be controlled as above, walking at a slow
or quick pace, running, jumping, suspension by the arms, or more
complicated movements should be attempted, graduating them
however, to the state of the disease, and repeating them every

1855.] Treatment of Chorea.

for not more than fifteen or twenty-five minutes, so as to
avoid muscular fatigue and palpitations of the heart, which some-
times occur after too much exercise.

By this treatment, no matter how violent the disease, from the
first lessons sometimes from the very first one but not later than
the fifth or sixth, a manifest change can be seen in the abnormal
movements. At the end of eight days, if the patient cannot stand
erect, walk in a straight line or suspend himself by the arms, it is
doubtful if this plan will succeed ; it is certain, however, that the
treatment will be long or difficult.

In all cases, after the first corrections of the muscular actions.
there is generally a period of arrest, and sometimes eight, and even
fifteen da}~s will pass without progress, after which the movements
become more regular and take on their habitual precision ; the
functions of nutrition are re-established ; children who were thin
and debilitated, recover their appetite, their digestive faculties,
their natural color, their strength and particularly their fleshiness.

This is one of the most remarkable results of this treatment, and
when once produced, it is not long before gayety, good humor,
memory and attention are observed; the countenance alone seems
to remain unchanged, and this condition often still exists even
when all traces of the disease have left the extremities. The arte-
rial and cardiac sounds are the last phenomena to disappear ; but,
unless these depend upon a diseased condition of the endo-cardium,
they yield more readily to this treatment, properly conducted, than
to any other. Save the co-existence of an inflammatory or an
organic affection of the heart, gymnastic exercises can be resorted
to. Of 22 children, 16 were cured completely and rapidly, for
the treatment was on an average 29 days. In two others, the
treatment was interrupted by a febrile condition which hastened
the cure, so that upon the whole, 18 out of 22 cases will recover.

When the exercises were combined with other remedies, the
results were much less satisfactory. Instead of 18 in 22 recover-
ing, the addition of sulphurous baths gave only 8 in 11, and the
addition of tonics 3 in 5 ; and besides, these means, called auxili-
ary, instead of curing the patients in 29 days, succeeded only at
the end of 33 and even 48 days. The most simple means, then,
are the most successful, and whenever the condition of the heart
will allow it, recourse should be had to this plan. In this manner
it will be easy to relieve simple or long standing chorea, cases of
relapse or those just complicated with fever. The natural course

84 Treatment of Chorea. [February, !

of the disease aids powerfully in causing the accidents to disappear ;
and this is so true, that in 29 cases of recovery, 5 were complicated
with fever, 12 relapses, 7 of long standing and 5 recent ; whilst
in 9 cases more or less unsuccessful, there were none but recent
cases. It is therefore impossible to conceal the difficulty to arrest
the disease at its outset, but this difficulty is much greater in the
other plans of treatment.

That which establishes definitely the superiority of this plan, is:
1st, that it relieves constantly cases of relapse and those of long
standing ; 2d, that it shortens very much more the duration of the
disease than most of the other treatments.

2d. Sulphur Baths. In 65 cases treated by M. M. Baudelocque,
Blache, Eufz and Constant, 58 were rapidly and permanently
cured. The baths, which are to be repeated every day, and for at
least an hour, must contain 120 grammes of sulphate of potassium
to every 8 buckets of water at 26 Reaumur.

Generally, from the second or third bath, the patient begins to
improve. Sometimes, however, amelioration is not perceptible
until after 12 or 15 days, when it commences and goes on rapidly,
requiring on an average 22 days to restore the natural functions
of all the muscles excepting those of the face.

After using the bath for sometime, and occasionally after the
first few days, an eruption of little red pimples, sometimes conflu-
ent and in large patches, appears on the abdomen and extremities,
and occasionally upon the whole surface, accompanied by a certain
degree of heat. As soon as this eruption appears, and during its
continuance, all medication must be suspended and simple diet
and rest enjoined. After it has subsided, the treatment may be
continued, but should it appear again, this treatment must be
abandoned. Denuded surfaces, as blisters, &c, will prevent the
treatment, as the constant irritation of these surfaces produced by
the baths counteract their good effects.

Acute irritation of the serous membranes, though rare, contra-
indicates this treatment. Notwithstanding all these accidents, 50
out of 57 cases were cured on an average of 22 days ; showing a
larger number of cures, in a shorter time, by this method, than by
that of gymnastics.

Adjuvants seem only to retard the cure. The bath, combined
with good diet and the use of a little wine, will be sufficient of
themselves.

3d. Cold baths, cold affusions, sea baths, vapour baths and others.

1855.] Iron and Manganese. 85

That which seems the most efficacious of these plans, is the cold
bath, as used at the Hopital des Enfants. Incontestable success is
due to this treatment, 5 out of 6 patients who were bathed in water
at from 18 to 20 degrees were cured.* The efficacy of this remedy,
consequently, does not appear to be much inferior to the sulphur-
ous medication, except in its application, when the latter plan is
superior. Children never take the cold bath without extreme re-
pugnance, and if they are not administered with great care, the
patients may take cold, and the disease, which was until then
simple, becomes complicated with a rheumatic or an inflammatory
tendency. f This plan of treatment was abandoned at the Hopital
des Enfants, in consequence of its disadvantages, the sulphur baths
being so much more prompt in its action curing the patients in
22 days, whilst the cold baths required from 40 to 47 days.

Simple and vapor baths possess no virtue in themselves, neither do
aromatic baths or fumigations. The hydropathic pack and gorging
with cold water is equally valueless. The three first methods, viz :
gymnastic exercises, sulphur baths and cold baths, are all of any
utility that is known of external medication ; but the list is not
yet exhausted, and there still remain to be described the treatment
by electricity and revulsives of all kinds.

4th. Electricity. This plan of treatment was first brought into
notice by de Haen, of Vienna, which had its advocates ; but its
effects are so slow, that they might very well be mistaken for the
natural efforts of nature.

5th. Liniments, ointments and issues. This plan of treatment
has met with such very doubtful success, that it is unnecessary to
give the details.

The methods which should take or preserve their rank in the
external treatment of chorea, are : 1st, gymnastic exercises ; 2d,
sulphur baths ; 3d, cold baths ; and, 4th, electricity, which seems
to be of some utility in certain cases. (Dr. G. See.)

Iron and Manganese.
M. De Larue speaks highly of the combination of iron and man-
ganese in hematic affections, and says he has frequently proved
its good effects at the bed-side. In a certain number of chlorotic

*Of these 5 patients, two were treated at the same time with preparations of sul-
phur, and another owed its cure, perhaps, to the intervention of a febrile condition.

tit is known that a frequent cause of chorea is a sudden immersion in cold water.
Dupuytren cites an example.

N. S. VOL. XI. NO. II. 8

86 Employment of Chloroform Vapour, [Februarys

cases especially -, which had resisted treatment with iron alone,
were relieved, as by enchantment, when manganese was added.

He gives the following case, taken from among similar ones, to
demonstrate the value of this treatment :

Miss X,, aged 16; of a bilioso-nervous temperament; delicate
constitution ; had been affected with well marked chlorosis for
about 20 months ; had not menstruated for two years.

He saw the patient in August, 1853,, and advised the continu-
ance of iron. After a month of fruitless attempts, he prescribed
manganese with the iron, and in less than eight days all the symp-
toms were relieved, and very soon the cure was complete.

The patient was submitted to this treatment but four weeks, and
has continued from that time to enjoy excellent health.

He prefers administering the medicine in pills, generally four
daily ; two morning and night, and as near the time of meals as-
possible. Formula for making the pills :

fy. Sub. Carbonate of iron, 30 grammes,
Sulphate of Manganese, 10 "
Ext. of Licorice, q. s.

Divide into 100 pills 4 to be taken daily.

[Revue de Therap. Medico- Chir.

A practical inquiry into- the advantages derivable from the Vapour of
Chloroform, as a local application to the surface of the Skin and
Mucous Membrane under various conditions. By S. L. HAKDYf
M.D., F.R.C.S.,&c.y&c,

[Concluded from page 4T.J

3d. THE EFFECTS PRUDUCED BY THE VAPOUR OF CHLOROFORM
WHEN APPLIED TO MUCOUS SURFACES UNBROKEN.

Mucous surfaces seem to be particularly eligible for receiving
the influence of chloroform vapour. When its local application
was first brought before the notice of the profession', I alluded to
the sensation of heat which was experienced when those tissues
were subjected to its action. In some instances this is so great
that it is complained of a good deal, but I have never met with
any case in which it was necessary to relinquish its use on that
account. Ceasing to propel the vapour for a few seconds was
quite sufficient to enable the patient to bear it. The relief afford-
e& is in general so agreeable that many would willingly endure a
greater feeling of discomfort rather than be deprived of its efficacy-
The following cases are given in illustration ;

1855.] Employment of Chloroform Vapour. 87

No. 22. Case of Painful Haemorrhoids. At a meeting of the
Surgical Society already alluded to, Dr. Forrest detailed the fol-
lowing case : *

" A gentleman, setat. about 36, who had suffered from piles on
several occasions, sent for me, owing to an attack of his old com-
plaint. I found the mucous membrane of the anus, everted with
several haemorrhoids attached to it. The pain was so very severe,
notwithstanding the use of fomentations which had formerly reliev-
ed him, that no pressure could be borne, nor any attempt be made
to return them. The vapour of chloroform was them applied by
the douche for several minutes, which produced so soothing an
effect that I was able to press them within the sphincter without
causing him any uneasiness."

No. 23. Pain in the Ear. The following case of pain in the
ear shows the necessity of having the vapour propelled for a suf-
ficient length of time :

" A young lady, during the course of an illness, was troubled
with very severe pain in the left ear, running down the side of
her face, for which I directed the application of chloroform vapour.
Next morning she told me it had given her no relief, and she con-
tinued to suffer as before. Supposing that the instrument had
not been properly used, I applied it myself, and in about from
five to ten minutes observed the countenance altering from an
expression of pain to one of ease. Presently the lady said she
was perfectly relieved."

No. 24. Case of Abnormal Sounds in the Ear. The Medical
Times and Gazette for June 17, p. 618, contains the report of a
Case of abnormal sounds in the ear, which had for six weeks re-
sisted various remedies, as syringing, aperients, alteratives, and
blisters. A few applications of the vapour of chloroform com-
pletely removed the complaint.

No. 25. Case of Irritable Bladder. A female patient, aetat. 37,
the mother of one child, had suffered so much from irritation of
the bladder for two years, but particularly during the month of
July last, that her state was most distressing. The calls to mic-
turate were incessant, and always attended with very severe pain.
By means of a catheter attached to the douche, I threw the va-
pour of chloroform into the bladder, occasionally removing the
nozzle of the douche from the end of the catheter, to allow the
vapour to return. Great heat was at first complained of, but (by
ceasing at intervals) the operation was continued for about five
minutes. Next clay the woman informed me that after the applica-
tion of the chloroform, she was able to walk a distance of about two
miles without being under the necessity of relieving the bladder.
When she did pass water, it was in much greater quantity than
it had been for a long time, and attended with less pain. The

88 Employment of Chloroform Vapour. [February,

vapour was used on the second day with like beneficial results.
Afterwards hip-baths and diluents completed the cure.

No. 26. Case of Spasmotic Pain after Delivery. , aetat. 26,

nearly nine years married, had four children and several abor-
tions ; suffered much from great irritability of the uterus, which
was affected frequently with congestion and excoriation. Pre-
vious to, and since marriage, menstruation was always exceed-
ingly painful during the first day of-dts appearance.

On the second day after the birth of her second child, and while
recovering favorably, she was suddenly seized with most excru-
ciating spasmotic pains in the uterine region, recurring in parox-
ysms, which caused her to scream from intense agony. Fomen-
tations, with the internal administration of spt. of turpentine,
opium, &c, at length (in the course of about three hours) quieted
this distress, and her recovery progressed as before. Within an
hour after the birth of her third child, she had similar spasms, in
character somewhat like after-pains, recurring in violent exacer-
bations, which lasted for about an hour, and again on the fifth
day. The inhalation of chloroform was resorted to with good
effect, always relieving her when so attacked.

On the fifth day after her last (the fourth) confinement, and
without anything to account for it, the spasms set in with their
usual violence, the distress felt in the situation of the anus being
particularly severe, owing to the action of the sphincter. Inhala-
tion of chloroform was resorted to, which gave relief so long as
the soporific state existed ; but no sooner did this go off, than the
paroxysms were renewed. The vapour of chloroform was then
thrown into the rectum by means of the douche for about five
minutes, by which the spasms were not only relieved at the time
of its application, but afterwards there was no return of them
whatever, and the recovery was most favorable.

This lady when between seven and eight months pregnant on
the last occasion, suffered greatly from vesical irritation. The
calls to micturate were incessant, depriving her of all comfort by
day and of rest at night ; so much so, that her general health
seemed likely to suffer. The chloroform vapour thrown into the
vagina for a few minutes at bed-time, procured for her so much
relief that she was seldom disturbed, and had quiet sleep.

In my remarks on Cases 2 and 3 {Dublin Journal for Nov. 1853,
p. 311,) I made the following observations :

" It is deserving of notice that, in Case 2, the duration of the
menstrual period was much lengthened, from which circumstance
it may be inferred that the application has not only the effect of
saving the patient from her usual degree of suffering, but by sub-
duing the spasmotic action of the uterus, tends towards the pro-
duction of a more natural secretion. As yet I have not had an
opportunity of testing its efficacy thus in the patient of Case 3.
It is her intention, kowever, to resort to its use when next about

1855.] Employment of Chloroform Vapour, 89

to menstruate, so that at a future time the results may be laid be-
fore the reader."

Of Case 3, it is stated, "menstruation, both before marriage and
to this time, was always very painful, the discharge scanty, and
dysmenorrhceal membrane frequently expelled." Before detailing
the progress of the case, I would beg to direct attention first to the
following remarks on chloroform as an emmenagogue.

On the Emmenagogue Properties of Chloroform. In the Hygeia
for February, 1854, p. 98, Dr. Gibson states "that inhalations of
chloroform have an emmenagogue effect, and he relates five cases
of irregular, insufficient, and wholly suppressed menstruation, in
which this remedy was employed with good results. Van Dye
confirmed this observation in a case of amenorrhcea, in which he
made the patient inhale chloroform on account of spasms accom-
panying the amenorrhcea. The spasmotic symptoms which had
occurred in various organs were removed, and after some time
menstruation set in. Van J)je is therefore also of opinion that
chloroform deserves especial attention as an emmenagoge."

The Journal de Hygeia, Feb., 1854, p. 98, taking it from the Medical
Examiner, adds: "A slightly prolonged inhalation of chloroform
excited, at the end of twenty or thirty minutes, the flow of the
menstrual fluid."

Chloroform is doubtless emmenagogue, like opium, valerian,
ether, &c. ; that is to say, it causes a cessation of the nervous al-
teration which opposes the menstrual flux. Journal de Chimie
Medicate, April, 1854, p. 256. \ %

No. 27. Painful and Scanty Menstruation. When this patient
(Case 3 continued) perceived the catamenial distress commencing,
the application of the vapour was resorted to, and repeated on
each return of uneasiness, by which she menstruated without any
suffering. On the three following occasions it caused similar re-
sults, the secretion taking place in proper quantity, and free from
pain. Her last two menstrual periods" were perfectly natural in
every respect, unaided by the use of chloroform.

No. 28. Case of Painful Menstruation. A patient, aetat 31,
married seven months to her second husband. By her first (with
whom she lived nine years) she became pregnant soon after mar-
riage, and aborted at the second month. Since then she did not
again conceive, and menstruation which, previous to her preg-
nancy, had been healthy, regular in its returns, and without pain
from the time of the miscarriage, had on its approach, and until
after the first day of its appearance, been attended with distressing
sensations in the back, loins, and particularly in her breasts. The
use of chloroform vapour gave her perfect ease, relief on each ap-
plication commencing first in the back and immediately after ex-
tending to the breasts.

90 Employment of Chloroform Vapour. [February,

No. 29. Case in which Menstruation ivas Scanty and Painful,
and finally Ceased. , aetat. 35, enjoyed excellent health; men-
struated regularly for three days, and free from any discomfort
until her marriage, which took place nine years ago. After this
event, she gave birth to a male child, which lived for six months.
During lactation, the catamenia appeared each month as formerly.
From this time her health gradually declined, and in the course
of a year, notwithstanding medical treatment, she was in a very
debilitated state. I first saw her four years after her confinement.
Pregnancy had not taken place ; her menstrual periods in their
approach, and while present, were accompanied with severe pains
occurring at intervals, and the flow continued for scarcely one
day. Ulceration of the os uteri, which I treated her for, soon got
well, her health was restored, and she again concevied, but owing
to an accident aborted at the third month. Although by the mis-
carriage her general health suffered little, yet from this date men-
struation steadily lessened in quantity, but was not attended with
pain, until at length it entirely ceased, without there being any
reason to attribute this circumstance to the existence of pregnancy.
As the secretion diminished, her head and chest became very much
affected with what she described as a " bursting sensation,*' which
was particularly distressing at the time of each expected return of
the catamenia. She was becoming very fat, and had a feeling of
general discomfort. Various remedies had been tried in order to
restore the uterine secretion and to relieve those uncomfortable
sensations, but to no purpose. I now directed the vapour of chlo-
roform fo be thrown into the vagina when the next period was
known to be approaching. On the first occasion menstruation
was established and continued for two days : on the three follow-
ing, the same means having been resorted to, it flowed for three
days in proper quantity, and with the absence of all the uneasy
feelings above described. It now comes naturally and without
the use of chloroform, and in every respect her health is perfect.

No. 30. Case of severe Uterine Pain, with /Suppression of Men-
struation, A lady of strong and healthy appearance, residing in
the country, consulted me in September, 1852. She had given
birth to two children, and had aborted several times. Since her
last miscarriage, which was caused by jumping from a height, she
felt a disagreeable sensation, of a painful nature, in the uterine
region, and menstruation becoming more and more scanty and
irregular, had entirely ceased. She was very languid and incapa-
ble of much exertion. On examination, the os uteri was found
extensively ulcerated and the cervix enlarged. Her health hav-
ing improved, and the uterus being healed, she returned to the
country, where she made use of shower and hip-baths, and took
gentle exercise on horseback, which served her greatly. Again
her health declined, and she consulted a neighboring practitioner,
under whose treatment she continued for a considerable time.

1855.] Employment of Chloroform Vapour. 91

Afterwards she came to town, and informed me that owing to
severe pain in her back and uterus, she was unable to sit for any
length of time in the erect position, particularly in the evenings.
All those symptoms were greatly aggravated periodically, when
menstruation should be present The uterus was rather larger
than natural, but had no abrasion, and the cervical canal was
pervious. I commenced the local application of chloroform va-
pour at the expected catamenial period. The following is the
report given in a letter by the patient herself: "It is with much
pleasure I tell you the result of the chloroform ordered, by you.
While in toAvn it enabled me to walk without pain in my back,
or the very disagreeable internal pain, or gnawing feel, which I
had for some time I may say for years. I had not a change for
the last twenty months; but having used the chloroform for ten
days, it came on, which though scanty, I feel is all right There
was no pain whatever, as (when I began to feel uneasy) I used
the chloroform. It has done wonders for me already."
I lately received the following letter from this lady :
" I am able to take a great deal of exercise without fatigue, and
when I have pain I use the chloroform, which has not in the least
lost its effect, but soothes me at once." It is now five months
since its application was commenced.

No. 31. Violent Vomiting. A patient, setat 20, was attacked
in the month of August last with gastric fever. For the first four
days, irritability of the stomach was very great, nothing whatever
being retained for more than a few minutes. The vomiting was
most severe, and frequently occurred in violent paroxysms. The
remedies usually resorted to in such cases, as ice, creosote, prussic
acid, blistering, &c., were tried in vain. At this time, by means
of the douche, the vapour of chloroform was thrown into the rec-
tum for several minutes. It felt most agreeable to the sufferer,
and in some measure mitigated the violence and frequency of
vomiting. At intervals of an hour, the application was twice re-
peated. After the third exhibition of the vapour, all vomiting
ceased; drinks and medicine were swallowed without exciting
any tendency to it, and for a fortnight it did not return. So
much relief was felt from first using the chloroform that the pa-
tient anxiously requested a repetition of it

No. 32. Painful Flatulent Distension of the Intestines. A woman
in Steevens1 Hospital, under the care of Dr. Croker, in August
last, for flatulent distension of the intestines, suffered so much
from pains and disagreeable sensations that, in addition to the
treatment adopted, the vapour of chloroform was thrown into the
rectum by the douche, for about five minutes, three times daily.
The patient for three hours after each application of the vapour,
said she felt more ease than she had for months past. It was con-
tinued for some time, but whether it had lost its efficacy, or had

92 Employment of Chloroform Vapour. [February,

not been properly used, she said it did not afford as much relief
as at first.

No. 33. Case of Bronchitis in an Infant, attended with Sleepless-
ness. (Under the care of Dr. Kingland.) A child, eight weeks
old, attacked with bronchitis, through great distress from difficulty
of breathing, arising from the enormous accumulation of mucus
in the air-passages, as well as from general irritability during a
period of seventy-two hours, never slept for a single moment, and
was evidently sinking, chiefly from exhaustion from want of sleep.
Many remedies were employed without the least benefit ; at length
a small quantity of chloroform vapour was injected into the rec-
tum by means of Hardy's anaesthetic douche, ranging from six to
nine jets. After an interval of less than fifteen minutes the child
became more tranquil, and shortly fell into an uneasy sleep, which
lasted nearly two hours. When it awoke it took the breast, which
it had previously refused for several hours, having been fed with
breast milk from the spoon. The vapour was again had recourse
to in like manner as before, when the child, after a very brief
space, fell into a quiet and almost natural sleep, which continued
for several hours, and it became necessary to awake it to take nour-
ishment. The chloroform vapour was frequently used in the sub-
sequent progress of the case (which terminated favourably) and
always with equal advantage. Had not rest been procured, the
child must have sunk before there was time for the other remedies
employed to have effect. Medical Press, April 19, 1854.

[Under the 3rd Division "The effect of Chloroform vapour on
Mucous Surfaces Unbroken" the following cases may be referred
to in the Dublin Journal for November: Case 2. "Scanty and
painful menstruation in which the chloroform vapour enabled the
patient to menstruate without pain, and lengthened the duration
of it from one to three days." Case 5. "Violent Uterine Pain."
Page 317, same number "Case of Pruritus Pudendi." Two
Cases of "Pain in the Ear," Medical Press, April 19, p. 242.]

4th. the effects produced by chloroform vapour when
applied to mucous surfaces in an abraded or ulcerated
condition.

The vapour of chloroform when applied to mucous surfaces
abraded or ulcerated, generally causes a good deal of the sensation
of Heat; but although this feeling is more frequent and of longer
duration than where the surface is unbroken, it is not so extreme
as to prevent patients from easily bearing it. The following
cases will serve to illustrate its influence when applied under
these circumstances :

Xo. 34. Case of Ulceration of the Os Uteri. A patient, the
subject of very extensive ulceration of the os uteri, suffered so

Employment of Chloroform Vapour. 93

much from lumbar pain and general distress in the uterine region,
that the vapour of chloroform was applied in the usual manner,
by means of the douche. The heat and scalding sensation wi
great that until after the lapse of half an hour from its application,
no beneficial effect could be perceived. Xo sooner had the un-
easiness caused by the chloroform subsided, than the relief was
complete, and of very considerable duration.

. So. Elongation of the Cervix Uteri. On the 20th October
;:.te in the evening. I was called to a patient who was suffer-
ing from violent expulsive pains, which I found on examination
to depend on an elongated growth from the uterine cervix, so long
that it protruded through the os externum. The mucous mem-
brane of the uterus was abraded, and the vaginal canal felt ex-
tremely painful to the touch. By an opiate suppository and
draught, the pains were quieted, and the woman had a good night's
rest. On the next day I placed a ligature on the tumour, and
until the third day (when I removed it below the ligature by a
curved scissors) the pains were on each return perfectly removed
by the vapour of chloroform thrown into the vagina by the douche.
No complaint whatever was made during its application to the
abraded mucous membrane.

No. So. Cancerous Ulceration oftlie Rectum. The Msdieal Times
and Gazette for August 19, page 195, contains the results obtained
by M. Gonzales Conde. It says: "The Spanish professor has,
after the example of the originator, Dr. Hardy, tested the local
power of the anaesthetic to assuage the pains of cancerous ulcers.
The cases were those of ulceration of the interior of the rectum,
accompanied by most severe suffering, such as ordinary sedatives
were insufficient to calm. M. Conde employed a bottle contain-
ing a sufficient quantity of chloroform. Its mouth was occupied
by a well-fitting cork, through a hole in which a gum-elastic cathe-
ter was passed. The sound was introduced so far, that its aper-
tures were in direct contact with the ulcerated surface. The va-
porization of the chloroform was commenced ; first, by the appli-
cation of the hands to the bottle which contained it, then by bring-
ing near it a heated stove. The patient experienced a slight
pricking sensation, which took the place of the cancerous pains.
This sensation extended upwards towards the colon. From the
rectum some gas escaped, having the odor of chloroform. The
sufferings were quickly appeased, but the most remarkable cir-
cumstance was that the pulse, which at the commencement of the
experiment was accelerated, fell first to its natural rythm, and
then sunk to sixty beats in a minute. The ease, however, be-
stowed by the chloroform, was not limited in its duration by the
effect produced on the pulse. For a week the pains did not re-
turn, nor was it necessary to reapply the anaesthetic for the whole
of that period El Heraldo Medico, June, 1854, page 165.

94 Employment of Chloroform Vapour. [February,

[Under the 4th Division see also, in Dublin Journal for Novem-
ber Case 1. "Cancerous Ulceration of the Uterus." Medical
Press for April 19th " Cancer of the Kectum opening into the

Vagina."]

General Observations. In making a few brief observations on
the cases above detailed, I would direct the reader's attention to
the remarkable influence exerted by chloroform vapour in cancer-
ous ulceration. I may refer to Dr. Mayne's case (No. 19) in which
he says, "opium afforded her but little relief, and various other
sedatives and narcotics were tried in vain ;" and (No. 20) where
we are informed by Dr. Moissenet that "he has succeeded, espe-
cially in a case of cancroid ulcer of the forehead, in instantly and
repeatedly allaying dreadful sufferings, which had resisted all
known remedies." The duration of relief obtained by the appli-
cation of chloroform vapour is very striking, and was one of the
first things in its action that attracted my attention. In the
Dublin Journal for November, p. 308, I stated, "the relief afford-
ed by the local application of the vapour of chloroform is not of
a very transient nature;" as examples, see Case 5 in same journal,
p. 315; No. 13, in Mr. Wilmot's communication; Nos. 16 and
17 in Dr. Geoghegan's; and Nos. 9, 25, 33, and 35.

Although it is stated in No. 32 (Case of Painful Distension) that
the relief was not as much after the application of the vapour had
been continued for some time, I question whether it was properly
applied on each occasion, having never met with another instance
of diminished efficacy in its use. (It was the patient herself who
generally used the douche.)

In the Case of Gout (No. 9) it is stated, "the part subjected to
the vapour of chloroform had become pale and cold, instead of
red and burning, as it had been before." As some might fear on
account of the cold caused by it to resort to its application in gout,
I may inform them that this obstacle can easily be removed by
using the vapour douche, which has a small metalic ball attached,
and by heating this ball by a spirit-lamp, air of any temperature
(most agreeable to the patient) may be transmitted with chloro-
form vapour. If desirable, moist, instead of dry, vapour can be
formed by pouring a little water into the ball, and may be medi-
cated by the addition of extract of belladonna, watery extract of
opium, &c.

The vapour douche is so small that with all its fittings it could
be easily carried in a small dressing case. A chloroform bath can
be given with it instantly, and hot vapour, moist or dry, in about
five minutes (the time required for heating the ball.)

See (No. 10). A similar case treated by the combination of
chloroform and warm water vapours, the affected part being
placed in an air-tight case. As a means of alleviating pain during
operations, the local application of chloroform vapour can be of
6ervice in but a very limited number of cases, and those only be-

1855.] Employment of Chloroform Vapour. 95

longing to the minor operations in surgery, where the disease is
superficial and the cuticle very thin or abraded. No. 8 (Mr. Smy-
ly?s Case) is an example of the first; and Nos. 10 and 11 (Anthrax),
of the second requirement. The same remark is applicable also
to No. 14 (Issue.)

No. 15 (Case of Painful Stump) serves to show of what great
advantage it may be in gunshot wounds, where extraction of the
ball is necessary. A stream of chloroform vapour passed into the
wound might enable the sufferer to undergo the operation without
the least pain.

It was supposed that as the vapour of ether had caused griping
when thrown into the intestines, that of chloroform should have
had a similar effect. Nos. 30, 31, and 32, serves to show that this
is not so, and we are informed by M. Ehrenreich of Germany
(Medical Press, April 12), that "he has found the most marked
benefit from the local action of chloroform, more especially in the
excruciating pains of tenesmus in dysentery." The influence ex-
erted on the uterine system by chloroform in allaying inordinate
contractions, is exhibited by Nos. 25, 26, 27, 28, and 29. From
this knowledge, a very important step might be taken in the treat-
ment of patients who are the subjects of early abortion, and whose
cases are so frequently mistaken for dysmenorrhceal affections.
If, on the approach of a catamenial period, the vapour of chloro-
form be thrown into the vagina, which, acting as an antispas-
modic, has the power of keeping the uterus at rest, the presence
of the ovum may be prevented from exciting the contraction
which otherwise would have caused its expulsion ; or those con-
tractions which, established by habit, have the effect of causing
abortion, might be kept so perfectly controlled that pregnancy
may proceed without interruption. This remedy possesses ad-
vantages in such cases over opium and other narcotics, in that it
exerts, when applied locally, no unpleasant effects ; so that a pa-
tient can enjoy her usual sensations while the uterine system is
alone under its influence. In cases of this nature particular in-
structions should be given to use the douche very gently.

When speaking on the method of applying chloroform vapour
(as reported in the Medical Press for April 19), I made the fol-
lowing remarks : "If the vapour is not confined, either no influ-
ence will be exerted, or to produce an effect, a very unnecessary
waste of material must be the result ; but besides confining it, a
sufficient quantity should be thrown, and with a force propor-
tioned to the extent of surface over which it has to pass." On
referring to No. 2 (Dr. Kirkpatrick's Case of Tetanus), a glass-bell
was attached to the tube of the douche, that the vapour might not
escape. In No. 4 (Phthisis), and in Nos. 12 and 13 (Mr. TVilmot's),
the same precaution was observed. In Dr. Geoghegan's observa-
tions this point is particularly noticed ; and in a Spanish journal
(El Porvenir Medico), it is stated that "M. Figuier, with a view of
favoring the absorption of chloroform, proposes to apply it at a

96 Disease of the Heart. [February,

temperature of 50 (122 deg. Fah.), and to confine it by means of
an impermeable apparatus of gum- elastic."

I have been informed by Mr. Brown, Eesident- Surgeon in Stee-
vens' Hospital, of a case of ulceration of the cartilages of the knee-
joint, in which great relief from pain was obtained by baths of
chloroform and hot water applied by the vapour douche.

The local application of chloroform vapour recommends itself
to our careful attention, not only as a powerfully efficient and rap-
idly active agent, but as a remedy which is as safe as efficacious.
Twelve months have passed since it came into practice, and the
foregoing cases may, in a measure, testify to what extent it has
been tried, both at home and in other countries, during that time ;
but in no instance that has come to my knowledge has its use
been attended or followed by either the slightest accident or
injury. [Dublin Medical Press.

On the tic-tacfelt by the hand as a means of Diagnosis in Disease of
the Heart ; an excerpt from the recent work of M. Eacle on
Diagnosis, with a few comments. By Henry Melville, M.D.,
Edinburgh.

During the year 1852, a letter from a friend, at that time re-
siding in Paris, made me acquainted with this mode of examina-
tion, adopted by M. Bouillaud, in general terms. Since then I
have been in the habit of paying some attention to the phenomena
so presented by healthy and diseased hearts, but without arriving
at any results of diagnostic value. This has arisen, undoubtedly,
from the want of sufficient information as to the points to which
the observations made should be directed, and the connection
between the phenomena observed and their interpretation.

It was therefore with much pleasure and satisfaction that I read,
in M. Kacle's recent admirable work on Diagnosis, the following
account of M. Bouillaud's method ; and believing it to possess
great practical advantages, apart from the interest of its novelty, I
have endeavored to translate it for the pages of the Monthly, in
the hope that" it may be acceptable to its readers.

" M. Bouillaud, who has studied this physiological phenomenon during
six or seven years only, has not as yet published any of his observations on
the subject, and no one else, to our knowledge, has paid any attention to it.
The learned Professor has kindly permitted me to make known in this
work those results, altogether novel and unrecorded, which he has obtained.

" Every one knows that on applying the hand over the precordial re-
gion there is felt, what is called, the beating of the heart ; but hitherto we
have limited ourselves to establish by this means the stroke of the apex,
and to ascertain the force, the extent and the intensity of this stroke ; we
have attempted nothing beyond this.* However, if we feel with attention

* See a on page 98.

1855.] Disease of the Heart. 97

the heart's action, we shall perceive distinctly two beats, two movements
connected one with the other, and which convey a sensation of tic-tac so
like that which we discover by auscultation, that it appears as if we heard
the heart with the hand. This is by no means an acoustic phenomenon, it
is simply the sensation of the double movement of the heart. This percep-
tion obtained by the nerves of general sensibility, and which seems to be
transformed for the observer into a sonorous phenomenon, is altogether
comparable to the perception of vibrating and sonous rales, of the frictions
which occur in the pleura, and which v.e can appreciate by the application
of the hand ;* it resembles, also, the non-sonorous grumbling of the intes-
. we know indeed that it often happens, that on pressing on the abdo-
men we think we hear this grumbling, while in reality we only feel the
displacement and the movements of the contained gas and liquids, and
which other persons do not hear, because they do not feel them. The per-
ception of the beatings of the heart of which we now speak, is a phenomenon
of this kind ; it falls simply under the category of tactile phenomena, as
well as the crepitation of fractured bones, subcutaneous emphysema, <kc

"In some individuals, this double movement is srar.-ely perceptible; in
others it is so strong that it seems as if we held the heart in the hand, and
that we felt it contract and dilate alternately.

" These tAvo movements are closely connected, one with the other, and
are followed by a pause sufficiently long, the great rest -of the heart ; they
correspond to the systole and diastole of the organ, and are synchronous
with the first and second sounds.

" They have, like the sounds of the heart, different characters ; the first
is dull, prolonged, the second is shorter and sharper ; both resemble the
noises (claquements), which we perceive on working a suction and forcing-
pump, and which are due to the alternating movements of its valves. We
attribute them, like the sounds of the heart, to the alternating tension of
the valves, and we retain for them the name claquements of the valves, or
valvular, which has been so properly given to them by M. Bouillaud.

" They have not the same seat ; the first is more particularly perceptible
at the apex of the heart, the second at its base. M. Bouillaud attributes
the first to the tension of the auriculo-ventricular valves during the systole
of the heart, it corresponds also with the stroke of the apex ; the second
has its greatest iutensity at the base of the heart, and on a level with the
ventriculo-arterial orifices ; it occurs indeed in these orifices and results
from the tension or fall of the sigmoid valves of the aorta and pulmonaiy
artery.

" Each of them by its seat and moreover, by its character, is entirely in
accordance with the nature of the valves which produce it. The first
movement is dull, deep, and has something greasy in its character, which
reminds one of the thickness, and greater laxity of the auriculo-ventricular
valves. These characters seem also to be due to the fact, that these valves
are inserted in the thick, soft and fleshy walls. The sharpness, the shock
of the second movement depends upon the thinness, the rigidity of the
sigmoid valves, and we can readily perceive that they occur in superficial
organs with thin parietes and of a certain firmness, (the arterial parietes).

' The characters of these movements vary with the condition of the
valves, and of the parts in which they are inserted ; they become more
marked if the valves are indurated, have become cartilaginous or osseous ;

* See b on page 98.

98 Disease of the Heart. [February,

they are smothered, roughened, if these are thickened, have become soft,
&e. ; finally they disappear more or less completely, sometimes one, some-
times the other, if the valves are destroyed, cease to act freely, &e. We
can derive, in a diagnostic point of view, very valuable information from
the modifications of these movements as perceived by the hand."

To this description M. Eacle adds the following note, furnished
by M. Bouillaud himself:

" If we accustom ourselves, by means of continued and attentive practice,
to the exploration of the different movements of the heart, by the applica-
tion of the hand, (the touch, jjalpation,) it will become easy to distinguish
the ventricular movements of systole and diastole, from the movements of
valvular play, the essential cause of the double sound known under the
name of the tic-tac of the heart, which consequently, more appropriately
deserves the term valvular tic-tac, which we have for a long time bestowed
upon it. In the study of this new phenomenon which engages us, as well
as for that of all the phenomena of observation, nothing, besides, can re-
place personal practice, whether -we have in view that which promotes at
the same time the education of the mind and the intelligence, a double
education so laborious, and therefore so often neglected or unfinished.

" Be this as it may, since our attention has been directed to the explora-
tion of the valvular action, by the method of palpation, we have had ample
opportunity to ascertain, appreciate and determine exactly the modifications
which the movements present, when thus perceived in the principal valvular
lesions, and to apply these modifications in the diagnosis of these lesions.
Every day, in our clinique, we have been able to announce the condition of
the valves, after the application of the hand on the region of the heart, and
afterwards to confirm this diagnosis by means of the signs furnished by
other modes of exploration."

a. The method of examination by touch or palpation is famil-
iar to all diagnosticians, and is successfully employed by many in
determining several conditions or variations of the heart's action,
as well as other physical phenomena exhibited in abnormal states
of the thoracic and abdominal viscera. In hypertrophy of the heart
for instance, it is essentially useful ; although not so stated in the
text, this disease is probably indicated, or intended so to be, by
the enumeration of the characters given.

b. In connection with this point, the following remarks by Dr.
Stokes, contained in his recent work on Diseases of the Heart,
are extremely valuable and full of interest. In treating of Peri-
carditis, he says :

"Phenomena discoverable by touch. When the hand is applied over
the region of the inflamed organ, sensations as of two surfaces rubbing and
grating one on the other are often perceptible. They imply that the
lymph is in a state of unusual consistence or hardness, and probably also
that the surface is but little bedewed with serosity. And hence, as might
be expected, they are generally better developed during the earlier periods
of the disease than when, after the absorption of the serous part of the
effusion, and under the process of cure, the surfaces again come into con-
tact.

" Among the conditions which favor the production of friction signs per-

1855.] Disease of the Heart. 99

ceptible by the band, the resisting nature of the organ covered by the
inflamed membrane occupies a prominent place ; and it is probable that
the greater frequency of these signs in pericarditis, rather than in pleuritis,
is referable to the unyielding nature of the structure of the heart, as com-
pared with that of the lung. Whoever has once grasped the living heart
of an animal, can understand what a hard and solid mass it presents during*
the systole. "We further fiud that in the case of peritoneal friction, the sign
has been principally observed where the inflamed membrane invests some
organic tumour or solid viscus. Can we then explain the rarity of the tac-
tile friction signs in the advanced and resolutive stages of pericarditis, by sup-
posing a weakened state of the heart, which interferes with the vigour of its
contractions, and renders it, during the systole, less hard and resisting?"

Although in the announcement contained in the foregoing arti-
cle from M. IiacleTs work, there is no very detailed statement given
of the extent of the value of the several indications afforded by
this mode of examination , enough is said to guide an intelligent
observer in constructing a scale of phenomena for himself, in de-
termining the amount of valvular disease as well as its special
forms. As a corroborative method of diagnosis, it possesses great
advantages and opens up a large and interesting field of investiga-
tion to the pathologist. JSTor is it without peculiar claims to our
consideration, in those cases in which the formality of a stethescopic
examination becomes irksome or alarming to a patient labouring
under heart disease ; at all times they are anxious, nervous and
easily excited, sometimes prejudicially so, particularly when sus-
picions may have been awakened that the special form of disease
with which they are afflicted is incurable.

In such cases a preparatory examination by touch may pave
the way to the more formidable or repugnant auricular and stethe-
scopic exploration, or may, if we acquire by practice the dexterity
professed by M. Bouillaud, altogether supercede the necessity of
the latter.

Unquestionably the hand will require as much and even more
education than the ear; and with those in whom the sensitiveness
of the hand is impaired, the appreciation of the delicacy of the
phenomena will be very difficult and unsatisfactory. But the latter
objection obtains in some instances to the stethescope : I have
seen many physicians who have failed to recognise or distinguish
the distinctive characterics of cardiac and pulmonic sounds.

I venture to suggest that some little tact is necessary in the mode
of conducting this examination ; it being a matter of no small im-
portance to attend to the position of the patient ; the part of the
hand to be employed the point of touch, and even the choice of
hand.

The position of the patient. This should be in the erect posture ;
standing if practicable as being generally more convenient to the
observer. The body should be slightly inclined forwards, so as
to lean somewhat on the examiner's hand. If from debility, or
other preventing circumstances, the erect position is insupportable

100 Disease of the Heart. [February,

or inconvenient, then the examination being necessarily conducted
with the body recumbent, the prone posture should be assumed,
the examinator slipping the hand under the chest.

The part of the hand to be employed. To those who possess the
advantage of a soft and sensitive hand, this will not be a matter of
much moment, any portion of the palmar aspect will answer equal-
ly well ; but to those not so fortunately endowed, it may become
necessary to select points of contact. It will be found that on
extending the fingers, moderately separated from each other, and
placing the palm of the hand in proper position, that the promi-
nent masses of muscles connected with the thumb and lying along
the outer margin of the palm, will naturally fall on the two points
where the impulse of the base and the apex are most distinctly
perceived, and thus it will be clearly defined. With some it may
be preferable to use the fingers ; the index and middle one will
perhaps be the most convenient, but they are by no means so
useful for the purpose as the whole palm. It may even be advi-
sable to use the left in preference to the right hand, the integu-
ments on the former being generally softer and more sensitive.
According to the hand selected, the examinator's position in re-
lation to the patient, must be on the right or left side.

The points of touch. To determine these with precision, is a
point of much importance to the success of this method of exam-
ination, and not only requires us to be familiar with the normal
relations of the heart to the thoracic parietes, but to bear in mind
that these relations are liable to frequent alterations by disease. I
may therefore be permitted to recite the former and briefly allude
to some of the latter, as prefatory to indicating the best points of
touch.

The heart, then, is placed behind the left half of the sternum
and the sternal attachments of the superior ribs. The base of the
heart, the seat of the second impulse, lies partly under the ster-
num, nearly on a level with the superior margin of the sterno-
costal articulation of the second rib, on the left side extending un-
der the cartilage of this rib and reaching slightly below it. The
axis of the heart is somewhat diagonal ; the apex is found in the
fourth intercostal space, just under the fourth rib. It bears the
same relations to the nipple of the mamma in males and females,
provided that if the latter is not too large, or displaced from its
normal seat. A vertical line dropped from the nipple, will pass
over the spot occupied by the apex. The distance from the nip-
ple to this spot will vary according to the height of the individual.
Here it is that we shall define most clearly the stroke of the apex
against the thoracic parietes. The superior or left border of the
heart will be found to pass on the inside of the nipple from the
inferior border of the second rib to the fourth, where it terminates
in the apex. The inferior or right border is partly under the
sternum, and partly free, lies in contact with the liver and trans-
verse colon, the diaphragm being interposed.

1855.] Difficult Labors and their Treatment 101

From tins description it will be inferred that we should seek for
the phenomena of the second impulse at the seat of the base and
of the ventriculo-arterial valves, or at the articulation of the sec-
ond or third costal cartilages, for those of the first impulse between
the inferior extremity of the sternum and the apex, or even at the
epigastrium. The intimate relations subsisting between the dia-
phragm and posterior surface of the heart render the sounds and
impulses at the auriculo- ventricular valves more appreciable here.

The heart ma}" be misplaced congenitally, or by disease or its
results. Effusion in the left pleural cavity pushing it towards the
right side. Enlargement of the liver pushing up the apex, etc.
It will be necessary to ascertain the existence of these or similar
displacing causes, and to search diligently for the abnormal potei-
tion of the tactile phenomena. [American Medical Monthly.

Prize Essay JRead before the State Medical Society, on Difficult Labors
and their Treatment. By M. B. "Wright, M. D of Cincinnati.

" True things instead of pleasant things."

The eagerness with which the professional mind has engaged in
its search after undiscovered truth, or in its efforts to revive rejected
opinions, has given it often a proclivity to extremes. These ex-
tremes, like opposite promontories of a great continent, are of little
exclusive value. Their importance consists in the facilities and
inducements they may have offered, for the exploration and culti-
vation of the space which lies between.

These remarks apply, not only to the Science of Medicine in
general, but to its obstetrical department. General principles have
been established as lights for our guidance, and the successful ap-
plication of many has stamped them with a true value, but errors
in practice were introduced at an early period, and have descended
in almost every obstetrical work of which we -have any knowledge.
Our object in writing this Essay is to aid in the correction of some
of these errors.

The least appearance of opposition to the announced opinions
of distinguished Medical men, and the practice of their numerous
followers, may give rise to the charge of presumption. But en-
couragement is given in the outset of our present undertaking, by
the reflection, that truth contains as much intrinsic value expressed
by those trudging along the humbler walks of the profession, as
when inculcated by the Professor in his chair, or transferred from
page to page throughout a long line of standard publications.

It will be admitted by those who have had a full share of expe-
rience in the treatment of difficult labors, that a few absolute
rules cannot be applied successfully to every case. Much is neces-
sarily left to the judgment and tact of the practitioner. While,
therefore, nothing will be found in this paper of an arbitrary char-
acter, there will be an independent attempt to correct errors, to

N. S. VOL. XI. ISO. II. 7

102 Difficult Labors and their Treatment. [February,

lessen the perplexities of the accoucheur, to mitigate suffering, and
to save life.

A ready and successful management of difficult labors pre-sup-
poses an intimate knowledge of those which are natural. And if
hy natural labors are understood those which terminate sponta-
neously, and without involving necessarily the safety of either
mother or child, shoulder presentations may be considered the
true type of unnatural or difficult labors, for they almost always
demand extrinsic aid.

The satisfactory termination of difficult labors depends upon
the correct adaptation of art to the principles of science. Traction
is a mechanical act, but to be successful in delivery, it must be
made in conformity with scientific details, with due regard to the
relation of organs and tissues. The convex surface of the foetus,
is correlative with the concave surface of the uterus. If they were
inanimate, rigid bodies, the relations of their several parts could
not be much changed unless the curved lines of the one, were
moved along the curved lines of the other. Their partial flexibility
does not exempt them from the operation of the same principle.

The uterus undergoing gradual distention by the growth of the
fcetus, and by increase in the quantity of liquor amnii, is not from
this cause alone excited to an expulsion of its contents. Let a
strong and sudden mechanical force be applied to the fibres of the
uterus, even to a limited extent, and contraction will speedily fol-
low. If any portion of the foetus should be pushed forcibly against
the fundus of the uterus, by attempts to rectify a mal presentation,
a more than corresponding resistance would soon apprise us of a
want of adroitness, and the probabilities of failure. The hand of
the manipulator in the -vagina, imparts a sense of fulnessy
and induces expulsive efforts on the part of the mother. Pres-
sure on the internal face of the perineum, or along the recto-
vaginal septum, urges the uterus to renewed or more energetic
action. Simple contact of the uterine and foetal surfaces in
turning, does not produce undue contraction of the uterine
walls. The presence of the hand, added to that of the foetusr
within the uterus, is a common cause of irritation and expul-
sive force. But the fact which we most desire to enforce herey
is, that when the foetus, in the operation of turning, is moved in
straight lines, and sensibly displaces the uterine fibres with which
it comes in contact, it is speedily forced back to its orignal mal-
position ;' nor can its displacement be easily rectified, except it
be moved in conformity to the curvatures of the cavity in which
it is contained.

Difficult labor, arising from the presence of either the right or
left shoulder of the foetus, at the brim of the pelvis, is not common.
Indeed, some prominent obstetricians know nothing of it from ex-
perience. He who refuses to examine its nature carefulty, how-
ever, on this account, will find in the hour of trial, that he has
been untrue to himself, and that the lives of confiding and beloved

1855.] Difficult Labors and their Treatment. 103

ones, are in double peril. Difficult labors, in truth, cannot be suc-
cessfully managed without a knowledge of their character, not to
say the possession of tact derived from experience. Without the
one, he cannot exercise the other. In natural, a want of knowl-
edge would be more excusable than in unnatural cases. The
former may terminate favorably, in the midst of inactive ignorance ;
the latter require action, guided by an enlightened judgment. A
man may justly congratulate himself that he has never been en-
trusted with the management of a difficult case of labor, but he
should not cherish the belief, on this account, that his next case
will not require special interference. With the present knowledge
of the profession, it is impossible to determine the nature of a pre-
sentation from external appearance, or from the feelings of the
pregnant woman. And it is hardly to be presumed, that a phy-
sician will examine all his patients during the progress of gestation,
with a view to ascertain the kind of presentation he is to meet ;
admitting, that in some cases, the position of the foetus may be
ascertained by manipulation through the walls of the abdomen,
and by vaginal touch. Hence, the importance of being prepared
to treat every case that may occur, in the best possible manner.

It has been claimed, that nature is adequate to the accomplish-
ment of her own wise designs, and that shoulder presentations
may be left with safety to the spontaneous action of the uterus.
None, among the controlling spirits of our profession, have enforced
this doctrine more strongly than Denman. He contended that by
the alternate contractions of the uterus, the shoulder was moved
from its position, until the head or breach occupied its place and
became the fixed presentation. It may be admitted, indeed, we
know, that the shoulder has receded, and the breech has subse-
quently presented in one case, and the head in the other. Hence
the language of Dr. Denman "spontaneous evolution of the
foetus" may still be retained.

At a subsequent period, Dr. Douglass, of Dublin, gave a differ-
ent explanation of the manner in which spontaneous deliverv was
accomplished in shoulder presentation. The accuracy of his views
have been acknowledged by more recent writers, who have had
opportunities for observation.

Dr. Churchill says, "the head and the shoulder depressed in
the pelvis. mainder of the body doubled up, is

inch by inch forced into the pelvis, and through the external parte,
until all below the arm is expelled, leaving the case to terminate
as a breech or foot presentation. At no part of the process is the
arm at all retracted ; but if moved at all, it is still further protruded ;
the name of "spontaneous expulsion," given by Dr. Dough
therefore more suitable than that of " spontaneous evolution."
Still, the question is not, whetiier spontaneous deliverv is accom-
plished in the s j "evolution," or "expulsion,'' tut whether
the physician should stand idle and hope for delivery by the long
continued agonies of his patient.

104 Difficult Labors and their Treatment. [February,

By reading the following quotation, some faint idea may be ,
formed of the intense and protracted suffering to which a woman
is suject, during "spontaneous expulsion," at full term.

" Immediately after the rupture of the membranes, the parts di-
minish in size by the compression they undergo. The first period
is the analogue of flexion in the presentation of the vertex, of ex-
tension in that of the face, and of the lessening of the parts in the
presentation of the pelvic extremity. Then the shoulder descends
gradually,' and, in proportion as it enters the excavation, it exe-
cutes a movement of rotation, which places the head on the hori-
zontal branch of the left pubis, and thence under the pubic arcade.
After this movement the arm disengages, and passes out of the
vulva ; sometimes the expulsion of the arm takes place before this
period. When the rotation is performed, the period of the descent
of the trunk is complete ; the side of the foetus is pushed into the
excavation by gliding on the right sacro-iliac symphysis, while
the shoulder remains immovable. After the side, the pelvic ex-
tremity descends, which also pursues the same direction. Finally,
the perineum distends, and then successively pass out at the ante-
rior commissure of the perineum, the lateral and superior portion
of the chest, the side properly so called, the hip and pelvic extremi-
ty. In proportion as these parts are delivered, the head and left
arm enter the excavation, but they are soon expelled, and, in most
cases, the head does not undergo its movement of internal rota-
tion. In a word, it presents at parts which have been excessively
dilated, and it is not solicited by them to perform this movement
of rotation. Such is the course pursued, when the dorsal surface
of the foetus corresponds to the surface of the pelvis."

Not only does a labor of this description require unparalleled
voluntary efforts not only does it involve extreme suffering of
body and mind, but many patients have died before, or soon after
delivery ; and, alas, too many of those who may have survived,
have found themselves entailed with incurable injury, or enfeebled
general health.

This is not all. According to M. Velpeau, only twelve children
were alive after "spontaneous expulsion," out of one hundred
and thirty-seven labors.

It is almost certain from the statements of those in whose judg-
ment we are bound to confide, that spontaneous expulsion cannot
take place, even with the hazards already enumerated, except
in cases where the foetus is small, or the pelvis unusually capa-
cious.

That a foetus of full size may pass through the pelvis, the shoul-
der or side continuing as the presenting portion, without necessary
injury to the mother, is proven by the painful details of the follow-
ing case :

The patient was a young German woman, in labor for the first
time. A shoulder presentation was detected at an early period
by the midwife, first called in attendance, who, with uncommon

1855.] Difficult Labors and their Treatment 105

prudence and forethought suggested the necessity of an accoucheur
more experienced and skillful than herself. A messenger was
speedily despatched for a physician of their choice, who, soon
after placing himself at the bedside of the patient decided that the
arm which had prolapsed was a leg. To expedite delivery, the
arm was seized, and was made to sustain for a considerable time
strong traction. Sufficient force, however, could not be applied
by means of the naked hand to withdraw the child. A towel was
interposed, and after repeated efforts and renewed energies, the
arm, together with the clavicle and scapula, were torn from their
attachments. This, to those present was a new mode of proceed-
ing, and not being exactly hi accordance with their feelings or
judgment, the doctor was requested to withdraw.

The physician next called, finding an unpromising state of af-
fairs, invited us 10 share- with him the responsibilities of the case.
On our arrival at the house, we were informed that the foetus had
been expelled by spontaneous action. The midwife, who used
her eyes as well as her hands, assured us, that one shoulder, and
so much of the other as had been left, were born first and at the
same time, and that the head and breech escaped also together.
From an examination of the child, it seemed highly probable that
the statements of the midwife were correct. As the pulling at the
arm was increased, the shoulder descended more and more ; and
the neck of the child was stretched until the face reached the
pelvis, and was compressed in the integuments between the crests
of the ilia. There it remained imbedded, until our examination
of it had been made. The child could not have weighed less than
eight or nine pounds. The mother lived, and, as we understand,
her convalescence was not protracted. We are informed by Dr.
Dewees, that M spontaneous evolution" had never occurred in
his practice, and yet, he says, " I should, therefore, recommend
waiting for this ' spontaneous evolution,' whenever turning for-
bade the hope of saving the child, provided the labor be not com-
plicated by either of the accidents enumerated."

To us, the lesson of Dewees is far from being satisfactory on this
subject. iNotice the language "whenever turning forbade the
hope of saving the child." Are we to allow the woman to suffer
on and on, not because turning is difficult or impracticable, but
because the child is dead ? We cannot suppose this to have been
the meaning of so distinguished a practitioner ; for if it has become
a settled doctrine, that the claims of the mother are paramount to
those of the child, when both are alive, how much stronger are
these claims when the latter is certainly dead.

Perhaps Dr. Dewees entertained, to their full extent, the views
entertained by Denman, viz : that the shoulder receded from the
brim of the pelvis, and that in time the head or breech assumed its
place. Suppose he did believe in this change of position and pre-
sentation, it was simply a belief in a possibility. If a case had
never occurred in the practice of a man of such unhmited experi-

108 Difficult Labors and their Treatment. [February,

ence, what just ground had he to hope that one would soon be
presented ? Would any other man be sustained in waiting thus,
as a compliment to the doctrine of Denman ? While we admit,
with both these distinguished teachers, that " meddlesome mid-
wifery is bad," we greatly fear that tardy action has been followed
by a large amount of evil.

Diagnosis. At an early period of labor, the signs of shoulder
presentation are somewhat negative. The membranes may be felt
within the os uteri, but even when relaxed and admitting consid-
erable pressure, the finger can detect nothing beyond. By and by,
the os undergoing gradual expansion, the membranes protrude in-
to the vagina. Our suspicions of a mal-presentation are increased ;
for, instead of feeling a broad surface of membranes, and through
them, a large, round unresisting body, they are in the shape of a
loose, elongated bag. At length the os tineas is fully dilated, but
the presentation is no less obscure. Up to the present period,
however, all this may frequently be said of the breech presenta-
tions, and occasionally those of the head.

The contractions of the uterus occasion a descent of the presen-
tation, until it can be felt at the superior strait. Now the mind is
led to ask and answer questions. Is this the vertex? No. It is
not hard enough, it has not sufficient circumference, nor has it
sutures nor fontanels. Is it the breech ? No. There is some-
thing that feels like the tuberosity of the ischium ; there is no
fissure, there are no genital organs. Is it a foot ? No. There are
no short toes no malleoli ; there is no heel. It cannot be the
hand, for it is without long ringers, and there is absence of wrist,
or well defined palm. Is it not the face ? If it is, there is neither
chin, mouth, nose, eyes, forehead. We will not say anything about
the elbow, for if that be near, the shoulder cannot be far off. It
must be the shoulder. The shape and size would so indicate
extending the finger upwards, either towards the pubis or sacrum,,
the axilla may be felt ; on one side the clavicle is detected, on the
other, the scapula, and during the exploration, the ribs and inter-
costal spaces will assist in the diagnosis.

These several parts are indistinct, while the membranes remain
unruptured. After their rupture, the presentation descends and is
more readily made out. At this time, also, the arm may be moved,
which will strengthen our opinion still more. When the arm falls
into the vagina, as it may by sudden rupture of the membranes
under uterine contraction, or during an examination, there should
not be left upon the mind a single doubt. It is true, the arm has
been mistaken for a leg, and great mischief has been the result,
but a careful examination of the hand will prevent errors of judg-
ment on this point.

Great care has been enjoined upon us in our examination, lest
the arm should be made to descend into the vagina, and prove an
obstacle to successful turning. We regard it so little in the way,
and so much under our control, that we have not hesitated in a

* 5.] Difncidt Labors and their Treatment 107

case of doubtful presentation, to draw it down from the superior
strait and use it as a means of more certain diagnosis.

Any attempt at a solution of the cause of shoulder
presentation, would result in a mere waste of time. At best, we
could arrive at nothing but conjecture, and our object in writing
this paper is to present our views in as practical a form as possi-
ble. We may venture in passing, however, a few suggestions.

Among the several conditions to which shoulder presentations
have been attributed, are the small size of the foetus, a large accu-
mulation of amniotic fluid, uterine obliquities, pelvic obliquity,
long continued agitation of the body, sudden shocks, violent men-
tal emotion, partial contraction of the uterine fibres. Most of these
so-called causes are daily witnessed, and yet how rare are shoulder
pretentations.

At this point, we are inclined to adopt the language of Cazeaux,
which is: *'If we might be permitted to hazard an opinion, after
so many others, we should unhesitatingly say, they have erred by
seeking only in the foetus, its form and structure, for the causes of
those various positions, exhibited by it in the internal cavity/'
To eDgage earnestly in an examination respecting the cause of
position of the foetus, we should deem it necessary to embrace
both the uterus and its contents.

AY hen the ovum enters the uterine cavity, it is liable to be
moulded to the shape of the cavity, (speaking mechanically) rather
than to expand the uterus. From this moment, (if not before) the
prominent functions of the uterus, are those of growth and devel-
opment ; the fundus, and that portion of the body nearest to it,
remaining, as in the unimpregnated state, larger than the neck
and inferior portion of the body. This is not to be attributed to
a natural tendency in the uterus to uniform expansion only, but
to the fact that the placenta is in the upper portion of the cavity,
and demands that the cavity should be here more expanded, than
where its contents are less.

The embryo is, at the same time, becoming more and more de-
veloped. During the first few weeks it is suspended in the liquor
amnii by means of the umbilical chord. At this period, the ce-
phalic extremity being heavier than the pelvic, (however much
we may agree with M. Dubois when the foetus had become fully
developed,) is most dependent, and until it reaches the bottom of
the membranes, is subject to the laws of gravity. Afterwards, the
uterus will be found to have adapted itself, in all its diameters, to
those of the foetus, which the embryo has now become.

We see, then, how the vertex becomes naturally the presenta-
tion, and it is easy to admit that Madame Boivin had 19,810 vertex,
out of 20,517 presentations, that Madame Lachapelle observed the
same 14,677 times in 15,652 cases, that Dr. Jos. Clarke had 10,387
cases, and out of this number, 9,716 with the head in advance, and
that Collin's record is correct in giving 15,912 head presentations,
in 16,414 labors.

108 Difficult Labors and their Treatment. [February,

Vertex presentations, therefore, may be justly considered as in
accordance with a general law, and all others as violations of this
law, just as placenta previa is a departure from the physiological
principle, that the placenta should be attached near the uterine
extremity of the fallopian tube, and just as utero-gestation is
sometimes earlier, sometimes later than the natural period of 280
days.

in shoulder, and in breech presentations, the transverse is often
so much longer than the vertical diameter of the uterus, that it is
visible, and gives rise to the exclamation, in respect to the woman,
what a singular and ugly shape she has ! May not shoulder pre-
sentations be owing to an early and too rapid expansion of the
neck of the uterus, giving to the foetus much room for motion,
and subjecting it to influences, which in more natural cases, would
have no effect in changing its position ?

In considering shoulder presentations, even to a limited extent,
several questions very naturally arise.

1. In what manner can a change of presentation be accom-
plished most easily and successfully ?

2. What mode of proceeding will prove most favorable for the
mother ?

3. How may the life of the child be best preserved?

4. Can any mode of delivery be relied on exclusively ?

Two modes of delivery, besides those to which we have already
alluded, have been described by obstetrical writers, viz : podalic
version, or turning by the feet, and cephalic version, or turning by
the head. Strictly speaking, however, cephalic version is not per-
formed, i. e. if version and turning be considered as they generally
are, synonymous terms. When to expedite labor, we substitute
the head for the shoulder, we simply remove one part, that the
other may occupy its place. And we should not allow the sudden
impression of a name, to direct our minds into an improper course
of proceeding, or we may say, into an attempt to accomplish that
which is impossible. Podalic version on the contrary, is not only
a change of the presenting part, for the feet, but the actual turning
of the head, most of an entire circle.

We shall endeavor to answer these questions in the order pre-
sented. The first question embraces the general principles of turn-
ing, and may be considered the foundation of the whole subject
before us. It would afford us much pleasure and cause for exul-
tation, if we could refer to American authorities for full and cor-
rect views upon turning, connected with shoulder presentations.
For a moment, however, we must bring them before us.

In "Dewees' Midwifery" we find no instructions upon the
management of shoulder presentation by cephalic version.

After giving a short quotation from one of the early authors,
Prof. Meigs remarks : "It may be that those old practitioners of the
days of Queen Elizabeth may have sometimes succeeded by push-
ing up the presenting shoulder, in getting the head at last to come

1855.] Difficult Labors and their Treatment. 109

to the strait again, but such an event appears to me in any case
most improbable."

Professor Huston, in a note, to be found in u Churchill's Sys-
tem of Midwifery/' says: " The practitioner will experience great
difficulty, and most likely fail in attempting to bring down the
head in a favorable position when the shoulder presents. I am
satisfied from considerable experience that when the arm, shoulder,
breast, back or side is the presenting part, it is better to bring
down the feet at once, Avhile the condition of the uterus is favorable
for turning than to waste time in attempting to restore the head/'

Professor Bedford, who had been induced to translate and edit
"Dr. Chailly's Treatise on Midwifery," is silent upon the subject
of cephalic version in shoulder presentations.

Professor Miller uses the following language : " Cephalic ver-
sion has but few advocates at the present day. and is confessedly
applicable to such a limited number of cases that it is scarcely
worthy of our formal consideration. For this reason, and because
I have no experience of it, I shall confine my observations to pel-
vic version. Again, it is manifest that all attempts forcibly to
pass the hand between a powerfully contracted uterus, and the
foetus, must be extremely painful and may cause fatal rupture of
the organ. The only resort is mutilation of the child, either by
eviscerating its trunk, to enable the operator to extract it doubled
upon itself; in imitation of the natural process of duplication, or
by decapitating it in order that the body and head may be separ-
ately extracted."

We hope to satisfy those who may follow us to the end of our
paper, that evisceration is not the sad alternative to which we
must resort in those cases in which podalic version is impractica-
ble. Some attention, however, must be given to those European
authors, whose opinions and teachings are now before us.

To facilitate turning by the feet, Dr. Churchill recommends the
use of the lancet, tart, antimony, and opium. He then adds,
"should these measures fail, and version be impracticable, we
must open the chest of the child, and eviscerate, after which it
may be extracted by the crotchet."

Three modes of turning are given by Dr. Eamsbotham, viz : by
the feet, the breech and the head. In transverse presentations, he
claims "of these three modes, that of raising the shoulder and
bringing down the head would be the safest for the child, because
there would then be little chance of pressure on the funis umbili-
calis, and it is that pressure which usually destroys the foetus, when
extracted by the breech or the feet, but although safest for the
child, it is the most dangerous to the mother, as well as most dim-
cult to the operator, and the danger, as might be expected, is in
proportion to the difficulty." "And in these attempts," speaking
of the several steps in turning, " which will most likely require to
be repeated, both the uterus and vagina would be seriously endan-
gered."

110 Difficult Labors and their Treatment. [February,

If Kamsbotham expressed these views from experience, his ma-
nipulations must have been singularly defective. How a change
of presentation from the shoulder to the head, accomplished as it
can be, by a force scarcely appreciated by the patient, is to endan-
ger both the uterus and vagina, is to my mind past comprehension.

The opinions of Velpeau are expressed in these words : " Cepha-
lic version may therefore be attempted. 1st. In a well-formed
pelvis, where no other accident has happened except a vicious
position of the foetus, and the head is found in an inclined posi-
tion in the vicinity of the strait. 2d. In presentations of the
shoulder, back or anterior part of the thorax, provided the arm is
not prolapsed, and the uterus not too much contracted. Lastly, it
seems prudent to try it whenever the feet are further removed
from the strait than the head is, and where it is probable the labor
would terminate spontaneously if the head were at the strait."
These views refer to the method adopted by the early obstetrical
writers, of performing cephalic version by manipulations, in part,
through the walls of the abdomen.

Speaking of the same kind of cephalic version, Chailly admits
" that the delivery will be as happy for the infant and mother as
if the vertex had orignally presented." " After the rupture of
the membranes," he continues, " we must not think of cephalic
version; pelvic version is the only resource." Again, "after the
rupture of the membranes, this operation should be resorted to
only when the pelvis is deformed.''''

A few words in passing as a commentary on the above para-
graph. If a change of presentation is safer for mother and child
before the membranes are ruptured, why not afterwards? provided
undue violence be not employed in effecting the changes. Vio-
lence would be as likely to destroy the child, as well in podalic as
in cephalic version. And if the latter can be performed easily
and advantageously when the pelvis is contracted, how can we
reason against it, when no obstacle interposes to the ready use of
the hand in changing the presenting portion of the foetus '?

We have thus given a hasty outline of the views entertained
by a few obstetrical writers on the subject of turning in shoulder
presentation. How far our own experience, which will now be
given, is in accordance with the above, others are at liberty to
determine.

Some years since, we had under our care, at different periods,
two cases of shoulder presentation. In one of these cases, the
membranes gave way under the action of the uterus, before the
os-tincas was fully dilated. As the liquor amnii escaped, the
shoulder descended so as to be easily felt. Being in the country,
and too far to obtain medical advice within a safe period, we de-
termined upon speedy delivery by the feet. The os tineas soon
became sufficiently dilated to admit the necessary manipulations,
and while passing my hand above the superior strait, the shoulder
moved upwards, as if to change its location. A young man, with

1855.] New Meth od of Inducing Premature Delivery. Ill

little experience in turning, but with sufficient knowledge of its
difficulties to occasion a dread of its necessity, can appreciate the
feelings of the moment, and how willingly the suggestions of na-
ture were adopted. The movements of the foetus were facilited,
ting first upon the shoulder, then upon the head ; and after
the latter had been properly adjusted, and had become fairly en-
gaged in the superior strait, the labor progressed and terminated
favorably without further interference.

In the second case, the os-uteri became gradually expanded to
its full size, with the membranes uninjured. Pressure upon them
with a view to reach the obscure presentation, and a strong con-
traction of the uterus at the moment, occasioned their rupture.
Speedily the shoulder came to the superior strait, and being easily
moved as in the above case, was similarly managed.

In both these cases cephalic version was more expeditiously per-
formed, than in the most favorable cases of turning by the feet,
that had fallen under our notice. Eecentiy a case occurred in
our own practice, but as it resembles so closely the above, it is not
deemed necessary to enter into particulars. Cases reported by
others, will doubtless be received as more conclusive testimony.

[To be concluded in March number.]

New Method of inducing Premature Delivery.

Dr. Scanzoni was induced, by observing the active sympathy
between the breasts and the other parts of the sexual apparatus,
to try to produce premature delivery by irritating the nerves of
the mammary glands. The first experiment was made upon a
young woman, aged 24, who, two years ago, had been delivered
by perforation, in consequence of contraction of the pelvis. In
the thirty-second week of utero-gestation, apparatus constructed
of caoutchouc, forming sucking-pumps, were put upon the nipples.
During three days they were used about seven times, the process
going on upon each occasion for two hours. After the third ap-
plication, the neck of the uterus became shortened ; after the sixth,
severe labor-pains came on ; after the seventh, the child was born.

The only danger likely to ensue from this very simple method
of treatment is inflammation of the mamma? ; this can be met with
proper treatment.

A second case, of similar kind, occurred to the author. A young
woman, enceinte for the first time, suffered so severely from dysp-
noea, connected with organic disease of the chest, that premature
delivery was necessary for the preservation of her life. After the
third application of the sucking- pumps, an apparently dead child
was born; respiration, however, was soon re-established. The
author remarks that this case is not quite conclusive, because pre-
mature delivery occurs often in connection with severe dyspnoea,
independent of other influences. [Med. Times and Gazette, from
Yerhandl. der Med. Phys. Ges. zu Wiirtzburg.

112 Operations in Hare-lip. [February,

Advantages of operation in certain cases of Hare-lip at a very early
age. By Henry Smith, Esq.

It is obvious in the first place, that an infant with hare-lip cannot
so readily take in that nourishment which is offered by nature.
If, however, the deformity be remedied, the child will be placed
by the aid of surgery in a much more favorable condition to receive
the nutriment afforded by the mother's breast. It is plain, too,
that the deformity excites most unpleasing and painful sensation in
the mind of the mother and those around her ; and, if the source of
this anxiety can be removed at once, it is of great importance that
it should be accomplished.

A third argument in favor of very early operation for hare-lip
consists in the circumstance, that as the growth of the child is very
rapid in the first period of life, the lip, with other structures of the
body at this time, becomes more fully and fully developed, and thus,
after an operation has been successfully performed, there will be a
much less chance of subsequent deformity in the part. But it is in
those instances where the harelip is complicated with a more or less
extensive fissure in the palate that an early operation for the cure
of the former is so imperative^ demanded, and is attended with
some beneficial results ; and it is to this point especially I wish to
draw attention, because, although in some recent works of surgery
an operation at an early period after birth is recommended, (and I
may especially allude to the Practical Surgery of Professor Fer-
gusson, and to the Surgeon's Vade Mecum, by Dr. Druitt,) the most
important reason for such a proceeding is not alluded to. And I
now refer to the effect which is produced upon the fissure in the
hard palate by the approximation of the edges of the lip. As long
as the hare-lip remains in its primitive state, there can be no pres-
sure upon the hard tissues underneath ; but, if it be united by the
surgeon, a considerable amount of pressure is exerted upon the
edges of the cleft in the palate ; and, in a child aged only a few
days or weeks, the bones are so soft and compressible, that they
are to a great extent influenced by the pressure which constantly
obtains, and in the course of time the fissure becomes either
entirely closed or diminished in size to one-third or one-fourth of
its original extent.

I have had various opportunities of noticing this effect in in-
stances where a very early operation has been performed for hare-
lip, complicated with more or less extensive fissure in the hard
palate ; and so convinced am I of the. importance of performing the
operation as soon after birth as possible, that I invariably recom-
mend it. And it has fallen to my lot to be called upon to perform
the operation very soon after birth, where there has been, at the
same time with the hare-lip considerable malformation of the
palate ; and I have been able to notice the result some length of
time afterwards. More than three years ago I operated upon an
infant only four days old ; here there was an extensive fissure

1855.] Topical Uses of Iodine. 113

extending through the hard palate into the nostril. I had an
opportunity of seeing this child only a few days since, and the
opening in the front portion of the palate was closed up. In this
case the soft palate was extensively cleft, and that still remains
open ; but the parts altogether are in such a condition that, some
years hence, they may be completely closed by staphyloraphv. A
few weeks since, a iittle patient was brought to me, on whom I
operated at a very early age, two years ago. In this instance there
was a fissure in the hard palate, and great deformity of the jaw, a
portion of which I removed at the time. There is now an admira-
bly developed upper lip, and complete closure of the opening which
- in the palate. In another instance, where I operated at an
early period, there was an immense chasm running through both
soft and hard palate into the nostril. I had an opportunity of
seeing this patient a few days since, and found that the anterior
portion of the cleft was much diminished in size. The operation
was done more tl

Mr. Bateman, of Islington, who pays great attention to this
matter, operated, three years since, upon an infant only four hours
after birth. In th i are was an extensive fissure in the palate.

This gentleman kindly showed me this case, and, in reply to my
inquiry regarding the effect which the operation had had upon the
palate, he wrote word the other day that the child had died of
hooping-cough last winter, but that its mother remarked that before
death the fissure, which had at birth been 'so large that she could
put her thumb into it, had contracted so much that it would
scarcely admit the edge of a sheet of writing paper.' About a
month since I operated upon an infant only six days old, with
perfect success. In this case I was partly induced to perform the
operation at this early period because there was a fissure in the
hard palate, extending into the nostril. I have little doubt that, in
time, if the child lives, the fissure will be completely closed.

\ Times and Gaz.

Topical Uses of Iodine.

The value of iodine as a counter-irritant is year by year becom-
ing more generally appreciated, and is yet much less so than it
deserves. The iodine solution will probably, before long, entirely
supersede mustard plasters, being at once more efficient, and much
less disagreeable in its employment. The following notes on its
applications will, perhaps, not be useless ; they are the results of
very extended observations in the hospitals generally, but more
especially in those devoted to the treatment of diseases of the
chest :

1st. In the pleuritic stitches, or aching pains in the chest, so
commonly recurrent in the course of phthisis, the iodine paint,
applied over the affected spot, usually affords, without any expense
to the vital powers, much more relief than either leeches, sinapisms

11 -A Topical Uses of Iodine. [February,

or blisters. It may be used in almost all conditions of the system
with perfect safety.

2nd. In cases of aphonia or hoarseness, depending on inflam-
matory thickening of the parts concerned in the production of
voice, great benefit may be derived from painting the iodine over
the front of the throat externally.

3rd. If the mucous lining of the fauces, etc., be thickened and
congested, the solution may, without risk, be freely applied to the
part itself.

4th. In the treatment of chronic enlargement of the tonsil, the
application of iodine to the gland itself will sometimes effect a
cure, but is much less generally efficient than constitutional treat-
ment.

5th. In cases of chronic pleuritic effusion, or of consolidation of
the lung, the solution should be painted over a large extent of the
diseased side, and is of great service when the period for blister-
ing or leeching has passed.

6th. Applied extensively over the belly, iodine is a useful
counter irritant in the incipient stages of strumous peritonitis.

7th. In strumous ophthalmia, the application of the pharmaco-
poeial tincture to the skin of the lids is often effectual in relieving
intolerance of light ; much benefit may also be derived from like
practice in cases of granular lids. In both instances, frequent
repetition is necessary.

8th. In all forms of periostitis, whether syphilitic, strumous, or
the result of injury, iodine paint is invaluable.

9th. It is needless, perhaps, to mention the employment of
iodine as a local application to bronchocele, to inflamed joints, and
to the enlargements of the absorbent glands ; with regard to the
latter, a point is worthy of being borne in mind, to which Dr.
Budd was, we believe, the first to direct attention, viz : the pro-
priety of applying it to the skin beyond, and not over the affected
gland, so as to allow of its being absorbed and taken through the
gland in the course of the limphatic circulation.

10th. Injections of iodine into the cavities of abscesses, gland-
ular or otherwise, appear most frequently to produce good results,
and to be unattended, except in very exceptional instances, by
any risk. The theory of their use is, that the adhesive and not
suppurative inflammations, as, for instance, in the radical cure of
hydrocele.

11th. In cases of contracted cicatrices after burns, in which
treatment by extension is adopted, the application of iodine, is of
advantage in causing the absorption or softening down of the in-
durated structure. Some cases Illustrative of this have recently
been under care in the Middlesex Hospital. Care must be exer-
cised, or ulceration may be caused.

12th. In cases in which the patient cannot be got to swallow
medicine, as now and then happens in phagedaena of the throat,
the specific influence of iodine may be induced by its endermic

1855.] Nature and Causes of Green Vomiting. 115

application, the best method being to paint over large surfaces of
the skin the pharmacopoeical tincture, choosing a different part
each time.

The reason why, as a counter-irritant in all forms of chronic in-
flammation, iodine appears so superior to other applications, is
doubtless to be found in the fact that it is capable of absorption,
and may thus act beneficially in two distinct methods.

AVe have enumerated above some of the chief uses to which the
iodine solution is daily put in the practice of the London Hospitals,
but do not profess to have mentioned all. These are, however,
enough, we think, to prove its right to a place on the dispensing
table of every Medical practitioner. [Ibid

Nature and causes of Green Vomiting. By Dr. Frazer, of Dublin.

The ejection of green-coloured fluids from the stomach is noticed
in the course of many abdominal diseases ; thus, we meet it during
attacks of peritonitis, puerperal fevers, and continued fevers with
gastric complications, in strangulation, in intussusception of the
bowels, in that rare affection, acute gastritis, and in various enteric
inflammations. Its appearance has been attributed by many to
the presence of bile in the secretions evacuated during protracted
vomiting, and we often find it described as consisting of green
bilious matter. For various reasons, this explanation did not appear
at all satisfactory to me.

I consider this green matter is composed of the blood in an
altered and modified condition, the discharge being altogether of
a hemorrhagic character. Repeated microscopic observations, in
those instances in which I have noticed its occurrence for some
time past, has confirmed my ideas regarding its nature, and ex-
amination shows that the little fragments of which it consists are
various sized clots, containing abundance of blood-globules ; this
alone might decide the inquiry ; however, I am desirous of placing
it _ on other grounds, in addition to such as are afforded by the
microscope. I may, therefore, bring forward the following argu-
ments, which further support the view I have taken. 1st. The
form of vomiting alluded to occurs in diseases where there is much
congestion, and often inflammatory engorgement of tKe vessels of
the stomach or intestines, as in gastritis, and fevers with gastric
complications ; and after death we find patches of softening in
the mucous membrane, or decided marks of excessive vascularity ;
at least such has been the case in those fatal instances where I have
had the opportunity of inspecting the stomach. 2dly. The coin-
cidence of vomiting of ordinary blood, in addition to the green
matter, which sometimes occurs ; besides, I have remarked that,
in many cases of fever which were attended with this peculiar
green discharge, hemorrhagic purpuric eruptions were frequently
seen. 3dly. We have the physical properties of this substance ;

116 Injurious Effects of Chloroform in Parturition. [February,

it forms small green clots in the fluid, in addition to tinging it
with its peculiar hue, as we might expect blood to do. 4thly. We
must consider that a similar green colour occurs in various parts
of the body, and under very dissimilar circumstances. This is,
perhaps, the most interesting branch of our subject, and one on
which medical records afford little information ; as instances of
this change, we have, among other examples, the peculiar green
hue of contusions that are of some standing, and the green colour
of the ecchymoses that occur on the extremities in land scurvy,
many cases of which were noticed in the hospitals, in the late
years of famine. The colour of the great intestine in various
cases of fatal dysentery, and of the mucous tissue of the stomach
in inflammatory gastric affections. The grass-green appearance
of the interior of the bladder, and of the kidneys, after death, in
many acute or sub-acute diseases. The well-known greenish tinge
often seen in moist gangrenous affections. The colour of the body,
as it begins to decay after death. The green hue of coagulable
lymph, and of purulent exudations in bad constitutions, and many
other similar facts in pathology that might be enumerated, which
are as yet unexplained.

If Ave reject all extraneous considerations from the foregoing
class of morbid changes, we have, I conceive, one uniform fact in
them all, namely, the presence of blood undergoing some of its
mysterious changes ; what these are will require additional inves-
tigation ; but I think we may conclude that the death of the blood
is essential that having lost that vital attraction for oxygen which
distinguishes it, and acted on by extraneous sources (probably
deoxidizing ones during decay), it becomes changed in its hue.

With regard to its practical bearings, there is much importance
in the view now brought forward ; it cannot be regarded as a
mere theoretic matter, and, therefore, of secondary value, for those
green discharges being recognized as hemorrhagic, will go far to
account for the collapse, cold extremities, failing circulation, and
other alarming symptoms that attend its presence when ejected in
any quantity ; and with reference to treatment, which is the ulti-
mate aim of medical knowledge, we have a rational explanation
of the benefit that creasote, ice, and other well-known styptics
exert in checking it. [Dublin Hospital Gazette.

Seventeen Cases of Parturition, in which Chloroform was inhaled with
Injurious Effects.

The Medical Times and Gazette, Sept. 9, contains an account, by
Dr. Kobert Lee, of seventeen cases of parturition, in which chloro-
form was inhaled with pernicious effects.

The following is a summary of these cases, with the remarks of
the author :

" In the first and second of these cases, the contractions of the
uterus were arrested by the chloroform, and delivery was com-

1855.] Injurious Effects of Chloroform in Parturition. 117

pleted by craniotomy. Insanity and great disturbance of the
functions of the brain followed its use in cases 3, 4, 5, 10, 14, 15,
and 16. It became necessary to deliver with the forceps in cases
6, 8, 11, 12, and 13. Dangerous or fatal peritonitis, or phlebitis,
ensued after the exhibition of chloroform in cases 7, 8, 11, and 13.
Epilepsy followed in case 14, and dangerous fits of syncope in
17.

"Were I to add those cases which the reports of my medical
friends have confided to me, and the still greater number which
public rumor has brought to my knowledge, I should appal the
Society by the amount of mischief which chloroform, given to
parturient women, has already inflicted on individuals and fami-
lies. The details of unfortunate cases, indeed, are generally
studiously concealed ; but the annals of surgery contain conclu-
sive proofs of the mischievous and dangerous effects of this poison.
However much the disasters of operations performed in private
may be hushed up, the practice of hospitals cannot be concealed ;
and we have now a long list of calamitous cases in which the im-
bibition of a very small quantity of chloroform into the blood was
sufficient to extinguish life in individuals of a robust habit and
perfectly sound constitution. Were our knowledge of chloroform
confined to this fact alone, it would suffice to remove all doubt
from the mind of every intelligent practitioner as to its use in
midwifery.

It might have been expected that a contemplation of the subtle
action of this poison on the nervous system would alone have in-
duced caution in its application to practice, till its influence on
the system was more thoroughly understood. But we have been
compelled, on the contrary, to witness the most reckless levity.
Very soon after the discovery of its physiological effects, I was
confounded by the announcement of its application to midwifery.
It was not difficult for me to foresee that such rashness, as it could
not then at least have a safe foundation, would lead to deplorable
results ; and I regret to say, I have not been mistaken. Yet then,
as now, we were confidently assured of the perfect innocence of
the remedy. The value of the present boasts may be judged of
by the past.

It was not wonderful that women, doomed to bring forth their
offspring in pain and should seek to escape from one of

the troubles of our means of this treacherous poison, par-

ticularly when pre i them with such flattering assurances ;

neither can > I that the instances of women who

were reported to 1 1 ed from the grievous pains of child-

bearing, without bad Lould have for a time re-

duced to silence those unwelcome monitors who pointed to the
possible evils of this n< t, and induced the honest but en-

thusiastic pursuers of novelty to turn away their eyes from the
contemplation of those dropping cases of disaster which soon
showed themselves, and to disturb the general jubilation. But it

N. s. VOL. XI. xo. II. 8

118 Injurious Effects of Chloroform in Parturition. [February,

does seem to me strange, that, amid so wide-spread an experience
as I am convinced now exists of the noxious and dangerous effects
of chloroform, it should be necessary for me to assemble the proofs
of the havoc it has made. Daily reports, however, convince me
that this work is called for ; and I have not shrunk from so sacred
a duty.

Setting aside the mechanical difficulties of labour, the dangers
to which parturient and puerperal women are most exposed may
be said to be fourfold : 1, exhaustion ; 2, hemorrage ; 3, fever and
inflammation ; and 4, cerebral disturbance. The great cause of
flooding is languid or deficient contraction of the uterus. We are
assured by many that the contractility of the womb is in no de-
gree diminished by the action of chloroform. But of this impor-
tant position we have as yet received not a jot of proof ; nay,
there are innumerable proofs to the contrary. It is expected that
we should be satisfied with bare assertion ; and, considering that
it was made at a very early period, when not a score of women
had yet been delivered under the influence of chloroform, and,
moreover, that it is made by those who continue, in the face of the
most painful contradiction of facts, to affirm the perfect innocence
of this poison, we may be permitted to set aside this evidence
without further notice. But I rely not upon d priori reasoning,
but on the direct testimony of my own senses, and maintain, with
this unerring guide, that the action of chloroform does very mani-
festly impede the uterine contractions, and, in some cases, put a
stop to them altogether.

The wise and skilful practitioner will hardly require my evi-
dence to satisfy him that so disturbing an agent must add greatly
to the risks whish arise from inflammation and fever. But they
who doubt will find reason enough, in the cases I have cited, to
pause and reflect ; while the history here given of severe cere oral
affection must surely satisfy the most stolid that all the nervous
accidents which attend the puerperal condition, and complicate
its risks, must be largely increased by this very active poison.

Much reflection on the physiological effects, and observation of
the pathological mischief of chloroform, leave no doubt on my
mind that it ought to be altogether expelled from the practice of
midwifery. There are no circumstances in which it can be with
utility, none in which it can be with safety, employed. I am con-
firmed in this opinion by conversation with the most discreet and
experienced practitioners around me; yet I cannot but entertain
grave doubts of the result of my present appeal to the good sense
of my profession, when I consider the arts used to propagate a
faith in this practice. It has become almost an extra-professional
question, while there is a systematic concealment of truth by phy-
sicians. Appeals are made by others to the natural timidity of
women, and the most fallacious promises of perfect safety are
boldly held out. Conceited and ignorant women of fashion make
a pastime of this, as of other quackeries, especially the speculum,

1855.] Method of Operating upon Polypi. 119

and the cause of science and humanity is placed in the hands of
the most presumptuous and frivolous part of the community, while
young inexperienced mothers are decoyed to their destruction.
It is no unfrequent occurrence that an accoucher should be select-
ed to attend a given woman, but previously told that he must use
chloroform. This grave question of medical science has been pre-
determined by a quorum of old women, instigated, perhaps, by
an itinerant cluchess. There are men to whom such propositions
are not at all insulting. They are quite ready to steal a march
on their wiser and more manly brothers, by the adoption of any
humiliating fashion. Thus, the health and lives of patients are
sacrificed, and medical science is dishonoured.

If I have helped to rescue the medical profession from the do-
minion of a great and dangerous error, if I have placed some re-
straint on ignominious and disgraceful practice, I shall rest satis-
fled that this*essay has not been written in vain." [Amer. Journ.
of Med. Sciences.

Method of Operating upon Naso-pharyngeal Fibrous Polypi. By M.
Nelatox, Hopital des Cliniques.

The true points of origin of these polypi are believed, by the
author, to be the inferior surface of the basilar process ; the infe-
rior surface of the sphenoid bone, and the internal plates of the
pterygoid processes. He states that they never arise from the ver-
tebras, and that when they descend into the pharynx, their course
lies between the muscular and mucous coats.

The complete removal of these tumours is an idea of modern
origin. Flaubert of Eouen in 1849 removed the whole maxillary
bone of one side for this disease. The same . operation has been
since performed by Michaux, of Louvain, Maisonneuve of Paris,
and Huguiers. M. Mane, a surgeon of Avignon, sometime ago
proposed the division of the soft palate, but it was not received
with approbation.

M. Nelaton, however, adopts the suggestion of M. Mane, but also
advises the division of the bony palate also, thus enabling him to
reach more completely the disease. His operation is as follows :

The palatine membrane is first divided and the bony arch ex-
posed. Two openings are then made with a perforator through
the bony palate, and Listoirs forceps being introduced into the
perforations a large portion of bone is removed. The posterior
part of the nasal fossa?, the inferior surface of the sphenoid bone,
and the basilar process will be then exposed, and the polypus
brought well into sight.

The removal of the polypus, under these circumstance, is easy.
M. Nelaton drags the tumour, and severs its connection with the
knife. He has repeatedly been successful, and certainly his meth-
od is preferable, inasmuch as the alveolar border and the teeth are
preserved. [Moniteur des Hop., and Virginia Med. and Surg. Jour.

120 Suture of Tendons, [February,

Suture of Tendons. By M. Chassaignac.

Our readers may recollect a case of successful tenoraphy prac-
ticed by Professor Sedillot of Strasbourg, which was reported in
a late number of this Journal.* In the Compte Rendu de la Societe
de Chirurgie de- Paris, for April, 1854, we rind a second case in
which this operation was successfully performed, and which ap-
pears to us worthy of being brought to the notice of the profession.

It relates to a girl of sixteen years, who, in Nov. 1853, fell on
a piece of broken glass, and received a transverse wound on the
anterior aspect of the lower part of the fore-arm, which, after sup-
purating for a time, cicatrized.

Some months subsequently the patient entered the Hospital St.
Antoine with the inability to flex the index finger. It was found
that the inferior end of the tendon which had been divided was
attached to the cicatrix of the wound already described, and that
when this cicatrix was moved, the index finger moved also. On
the fourth of February, M. Chassaignac laid bare the flexor ten-
dons, by dissecting a rectangular flap of integument from the fore-
arm, and passed a suture through the divided portions of the flexor
of the index finger. The flap was then replaced and secured by
stitches, and the hand was strongly flexed. In a fortnight the
wound had united, and the patient left the hospital with the per-
fect use of her finger. The ends of the tendon were not refreshed.
This fact, when considered in connection with Dr. Mayo's case of
rupture of the ligament of the patella, f and our observations on
tendinous ruptures in the first number of the present volume of
this journal, leads to the conclusion that exact apposition is all
that is necessary for the re-union of divided tendons, even when
separation has existed for a comparatively long period. {Virginia
Med, and Surg. Journal.

Case of Strangulated Femoral Hernia, containing Ovary and Fallo-
pian Tube Operation Recovery. By WlLLAPJ) PARKEE,M.D.r
Prof, of Surgery in the N. Y. Col. of Physicians and Surgeons.

On the 31st of October, 1854, I was called on to visit Miss F r
in consultation with Dr. W.

I obtained the following history of the case : Miss F , aged
69, had always been in perfect health, except at times she had
suffered from dyspepsia, and had been annoyed by a hernia on
the right side. This hernia had existed for many years. She had
attempted to keep the parts in place by means of a truss, but had
failed to accomplish it. The hernia had always been reducible,
and she had usually -succeeded in replacing the protruded mass.
About two years ago, she failed to put the parts back, became sick
at the stomach, and called for her family physician ; who, after a
while, effected a reduction, and she soon became comfortable.

* See Vol. ii, p. 311. + Virginia Med. & Surg. Journal, Vol. i, p. 388.

1S55.] Case of Strangulated Femoral Hernia. 121

The patient had now been suffering for three days ; she had
nausea and vomiting, but without dejections ; the abdomen was
flat, skin cool, tongue moist, pulse small, 90 beats in a minute.
The tumor was hard, the size of an English walnut, and tender at
its neck, under Poupart's ligament. Dr. W. stated, that yesterday
he put the patient under the full influence of chloroform, and
succeeded by firm pressure in reducing the tumor, but no relief
was manifested. On moving or making a slight muscular effort,
the swelling reappeared. I thought of "reduction en masse"

I now tried taxis, but failed with the force she would allow me
to employ. She was then put into a state of profound anesthesia;
and I again made trial of reduction. I could push the whole tu-
mor under Poupart's ligament, but it would seem to bound back.
It was now decided to operate. I cut down, and exposed the fal-
ciform process of the fascia lata, divided it freely, and then at-
tempted to reduce, without opening the sac, but could not succeed
I could push sac and all up. I proceeded to open the sac : it con-
tained some dark fluid and a small loop of intestine, which was
also dark, but not gangrenous. In attempting to explore the
neck of the sac with the finger, it receded: and to prevent it from
slipping back into the abdomen beyond my reach, I passed a ten-
aculum into the sac, and gave it in charge of an assistant. The
neck was very firm around the strangulated parts, and seemed not
more than half an inch in diameter.

I divided it freely, and drew down the intestine that I might
understand the condition of it ; finding all right, the loop was re-
stored. I found something left behind that was dark, shreddy,
and vascular, adherent by a small band to the side of the sac. I
saw it was not omentum, and concluded it might be the product
of some former inflammation.

I concluded to dissect away the mass ; it bled, and I carried a
ligature around the whole. When I drew upon the ligature, there
came into view the ovary: this demonstrated to my mind that the
strange portion I had taken away, was the fimbriated extremity of
the fallopian tube. I pushed back the ovary and the remainder of
the tube, brought the parts together by suture, applied the gradu-
ated compress with the single spica bandage. The patient was
put and kept fully under the influence of morphine. After four
days an enema was administered, and the bowels were moved.
A rapid recover}- ensued.

In consulting authorities in regard to this anomaly, I find no
parallel case; but Dr. Gr. F. Elliot has furnished me with a case
from the Gazette Medicale, for February, 1813, in which the Ces-
arean section was performed upon the uterus, occupying a hernial
sac. " Patient was 4A years old, mother of seven children, had
suffered for many years from a reducible inguinal hernia of right
side, which during her previous pregnancies had caused her great
annoyance. At the sixth month of her eighth pregnancy, the
hernia became strangulated, but by emollient and cold applications

122 The Clamp Suture in Cleft Palate. [February,

it was reduced, followed, however, by severe abdominal pains.
Soon after, the uterus suddenly presented at the inguinal ring, in
the hernial sac, forming a tumor of 8 inches in length by 6 in cir-
cumference. The patient remained in bed, and went on to the
full term. Labor commenced, the os dilated, and the waters es-
ca'ped per vaginam ; the tumor at the time being twenty-five inch-
es in circumference by twenty-three in length. The Cesarean
section was then practiced, dividing the sac and uterine wall ; the
placenta presenting, the operator introduced his hand and deliv-
ered a well-formed living infant. Patient died on the third day
after, of peritonitis or hemorrhage. On postmortem, there was a
large quantity of blood in the abdominal cavity ; the inguinal
canal was so dilated that the open hand could easily be introduced,
and the colon was found detached, and filling the cavity of the
sac." The editor of the Gazette severely censures the conduct of
the operator in not reducing the uterus when it first escaped, as
might have been done ; and also in not waiting longer than three
hours before performing the section a complete hysterocele being
not incompatible with the spontaneous termination of labor. I
find also that Mr. Velpeau, in the second volume of his Traite des
Accouchements, mentions a case by M. Saxtorph, in which the
uterus at term occupied a femoral hernia, and was spontaneously
delivered. In another case by Frank, the uterus protruded through
the linea alba. Flamant cites a case complicating umbilical hernia.

[N. Y. Med. Times.

The Clamp Suture in Cleft Palate.

We recently witnessed an operation for this affection by Dr. J.
Marion Sims, of this city, in which he used this peculiar method
of suture. The case was a bad one ; articulation very indistinct,
and deglutition of fluids frequently attended by regurgitation
through the nostrils. The clamp suture, composed of very fine
silver wire, fastened to small leaden cross-bars, will remain innocu-
ously in the tissues for an almost indefinite period, which consti-
tutes its great superiority over any other suture. In this case the
clamps were removed on the sixth day the cure was perfect.

This is not, by any means, the first case of the sort in which
Dr. Sims has applied this suture with success ; and it is our opin-
ion that the operation of staphyloraphy, by this method, will
never fail, if properly performed.

It is well known that difficult and tedious labor sometimes re-
sults in the most deplorable injuries to the mother: such as lacera-
tion of the perineum, bladder, or bowel, and that these affections
were wholly incurable till the introduction of the clamp suture by
Dr. Sims. It is no wonder, then, that the Profession, both in Eu-
rope and America, unite in according to him the highest praise
for this great boon to science and to suffering humanity. And
now, since he has demonstrated the easy curability of cleft palate

18oS.] Novel mode of Opening an Ovarian Cyst. 123

by the same means, we cannot but hail it with delight as another
triumph of American Surgery. [American Med. MontJily.

Novel Mode of Opening an Ovarian Cyst.

Dr. Sims, of this city, has recently performed this operation in
a mode which is new and which seems to possess several excel-
lencies. A trocar, fifteen inches in length, curved so as to be the
arc of a circle of four and a half inches radius, was, with its canu-
la, inserted at the usual place of tapping in abdominal dropsy.
After a portion of the fluid was drawn off, the point of the trocar
was drawn within the canula, which, after several attempts, was
finally carried to the cul-de sac, between the uterus and rectum;
and when felt there by the finger in the vagina, the trocar was
again protruded, the sac and the vagina perforated, and the ex-
tremity of the canula brought out between the labia majora ; thus,
in fact, transfixing the patient. A self- retaining catheter was then
attached to the canula, and drawn into the ovarian sac, where,
being separated from the canula, it was secured within the sac.
The canula was then withdrawn, and the external opening closed.
In this way the contents of the cyst were allowed to drain entirely
away, and it is hoped that obliteration of the sac and the cure of the
patient, will be the result. At our present writing, nearly three
weeks after the operation, she is going on well. [1 bid.

Treatment of Albuminuria after Scarlatina.

Formerly it was customary to treat this and all other dropsical
affections with diuretics. Prof. Mauthner, however, in the dropsy
which occurs after scarlatina, and is accompanied by bloody and
albuminous urine, sedulously avoids whatever might overstimu-
late the kidneys, as Jikely to cause an acute renal inflammation,
or an attack of Bright's disease. He has seen many cases where
the swelling increased daily in spite of the administration of squills,
digitalis, bitart. potassae, &c, in which a cure was effected by a
simple regulation of the diet. In such cases he advises the exclu-
sive administration of milk, and rice and milk, or at most of decoct,
althea, or of decoct, lini sem. By the exclusive use of milk diet,
he has seen the action of the kidneys so regulated, that a copious
secretion of urine, free from albumen, was established, by means
of which the dropsical condition was removed. When the admin-
istration of milk fails to effect a cure, he endeavours, by means of
alkaline agents, to alter the condition of the urine ; and, for this
purpose, he prefers using the alkali of the urine itself. He accord-
ingly administers urea in small doses (either in the form of pure
urea, or of the nitrate of urea), giving generally fne third of a
grain for a dose, in combination with a little powdered sugar.
After six or eight grs. of the urea had thus been taken, he has

124 Editorial and Miscellaneous. [Febrrilry,

frequently seen profuse diuresis occurring, followed by the speedy
disappearance of the dropsical affection. [Monthly Jour. Med. Sci.}
from Jour, fur Kinderkranlcheiten.

EDITORIAL AND MISCELLANEOUS.

BIBLIOGRAPHICAL.

Manual of Human Microscopical Anatomy. By A. Kolliker, Professcr.
of Anatomy and Physiology in Wurzburg. Translated by Geo. Busk,
F.R.S., and Thos. Huxley, F.R.S. Edited with notes and additions, by
J. Da Costa, M. D. Illustrated by 313 engravings on wood. Phila-
delphia: Lippincott, Grambo & Co., 1854. 8vo., pp. 802. (For sale
by T. Richards & Son.)

It is really a treat to be placed in possession of Kolliker's histology in
plain English. The learned professor's labors in the productive field of
microscopy, have made his name familiar to all enlightened men, and the
American medical profession should feel grateful to those who have ena-
bled them to become more intimately acquainted with his valuable contri-
butions to knowledge. We know of no book that will be found more in-
teresting to the student.

Transactions of the Illinois State Medical Society, for the year 1854.
Chicago.

Although too often resulting in strife, because of their conversion into
police tribunals instead of being devoted exclusively to the promotion of
scientific emulation, the formation of State Medical Societies has, notwith-
standing, been productive of much good. The Transactions of the Illinois
Society for 1854, comprising about 110 pages, will be found one of the most
creditable productions of the kind. It is true that the work contains only
three articles, but they are all papers of decided interesfand indicative of a high
order of talent. The first is the annual address, by Prof. Daniel Brainard,
on the treatment of poisoned wounds by the application of cupping glasses
and the infiltration of solutions of iodine. The second is an elsay by Dr.
E. S. Cooper, entitled "walking rendered the primary element in the cure
of deformities of the lower extremities ; its early adaptation to white swel-
ling and coxalgia, with apparatus for carrying out the designs of the same."
The third is a prize essay on differences in the physiological and pathologi-
cal action of that class of remedies called stimulants, of which alcohol is
the type, and tonics, of which the bitter barks and iron may be considered
as specimens, by H. Parker, M. D. We regret that our limits will not
allow us to notice these papers at present, but we hope to do so hereafter.

We have also to acknowledge the reception of the Transactions of the
College of Physicians of Philadelphia, No. 6 Vol. 2.

1855.] Editorial and Miscellaneous. 125

A lecture introductory to the course of surgical instruction in the Ken-
tucky School of Medicine, 1854-5, by Prof. Joshua B. Flint.

A brief sketch of the history of Lexington, Ky., and of Transylvania Uni-
versity, delivered as an introductory lecture to the winter course in the medi-
cal department of Transylvania University, 6th Nov. 1854, by Rob. Peter,
M.D., Professor of Chemistry, &c.

A new plan of treating ununited fracture by means of artificial limbs,
which combine the principle of Pressure and motion at the seat of fracture
and lead to the formation of an ensheathing callus. Illustrated by the
history of 4 cases of false joint in the femur, 8 in the leg, and 2 in the
humerus. By Henry H. Smith, M. I)., etc., &c.

Elkoplasty, or anaplasty applied to the treatment of old ulcers, (a reply
to Dr. "Watson's reclamation) by Frank H. Hamilton, M. D., &c.

Atlanta Medical College. This institution has been reorganized, and
proposes to deliver a summer course of Lectures during the ensuing season.
The Faculty consists of: M. G. Slaughter, M. I)., Prof, of Anatomy ; J. W.
Jones, M. D., Prof, 'of the Principles and Practice of Medicine ; Jesse
Boring, M. D., Prof, of Obstetrics and Diseases of Women and Children ;
W. F. Westmoreland, M. D., Prof, of the Principles and Practice of Sur-
gery ; J. E. Dubose, M. D., Prof, of Physiology ; G. T. Wilburn, M.D., Prof,
of Surgical and Pathological Anatomy ; J. J. Robertson, M. D., Prof, of
Chemistry and Medical Jurisprudence ; J. G. Westmoreland, M. D., Prof,
of Materia Medica and Therapeutics, and Dean of the Faculty.

Successful Gastrotomy. The Medical Examiner contains the details of an
interesting case of rupture of the uterus, in which the operation of Gastro-
tomy was successfully performed by Dr. John Neill, of Philadelphia. The
child was found lifeless.

The same Journal contains also a Report by W. H. Merinar, of Missis-
sippi, of two cases of successful Cesarean section, which he performed upon
the same person in July, 1852, and May, 1854.

Case of Hydrocephalus, in which the Head was tapped Eight Time*. By
Mr. Brown of Haverfordwest. A child, six months old, with chronic hydro-
cephalus, was placed under my care on July 10, 1852. I enclosed the
head with straps of adhesive plaster, and persevered in this plan for some
time. No good effects were produced. I now proposed tapping, to which
the parents consented. Mr. Rowe was called into consultation, and assisted.

August 6th : We removed six ounces of serum. The child became a
little sick and faint. 7th: The child was apparently much improved; it
looked more intelligent, and took greater notice of the nurse. The head
was tightly strapped up. 18th : The head was as large as ever. It was
tapped to six ounces, with the same results. September 6th : The Ifad
was larger than it had been at all ; and it was tapped to eleven ounces,

126 Editorial and Miscellaneous. [February,

with the same results as on the previous occasions. 28th : The haad was
again larger; and twenty ounces of fluid were removed by tapping, with
the same results. October 8th : The head was tapped to eleven ounces.
18th: Tapping was performed, and sixteen ounces of fluid were remvved.
25th : Twelve ounces of fluid were withdrawn. 30th : We now abandon-
ed tapping as useless, and inserted a seton of silk through ihe membranes
of the brain, running it along the interior for an inch before bringing it
out. No immediate result was produced ; but a great quantity of serum
flowed fiom the orifices through which the seton passed. At the end of
twelve hours, there was no change. At the end of twenty-four hours, there
were vomiting, restlessness, and expressions of pain and distress. In thirty-
six hours, there appeared twitching of the muscles and startings, bordering
on convulsions. In forty-eight hours from the introduction of the seton,
the child refused his food. Moaning and approaching stupor were now
observed. The seton was now removed ; and these symptoms gave way
in a day or two. The head was by this time much decreased in size, and
continued so for several days.

We now flattered ourselves with hopes of a cure ; but in another day or
two, evident signs of secretion manifested themselves, and at the end of
twelve days we tapped again, and again the fluid collected. We now gave
up all hope, and allowed the disease to take its course. The head attained
a frightful size ; and the child died.

Examination of the body. A large washhand basin full of serum was
taken out of the brain. The containing sac was formed by the brain, which
was completely unfolded, and so stretched, that it was no thicker than the
dura mater. This fact, in our opinion, accounted for the failure of the treat-
ment. Had the water been contained in the membranes instead of in the
ventricles, there would have been a better chance of success.

I would never hesitate to make similar attempts at a cure, with the hopes
of the membranes being the investing envelope of the water. In such
cases, a happy termination might be expected. Association Med. Jour.

[The Senior Editor of this Journal tapped the head seven times in a case
of Hydrocephalus in 183*7, with results similar to the above. In this case
a post-mortem examination revealed likewise a complete unfolding of the
cerebrum, which constituted the sac containing the fluid. The case was
reported in the first series of the Southern Medical and Surgical Journal,
p. 440, Vol. i, 1837.]

Treatment of Acne. The cases of acne at the Hospital for Skin Diseases
are usually classified under the heads of A. simplex, A. indurata, and
A. rosacea. The latter, in its best marked examples, often occurs without
appreciable derangement of the general health, and is extremely intractable.
The long-continued use of tonics and alteratives with the local employment
of a mercurial wash or ointment, often effects great improvement, but not
unfrequently the disease resists all measures. When the red spots are very
persistent and disfiguring, they are touched with the solution of the acid
nitrate of mercury, a plan*by which single tubercles may be got rid of, but
which does not prevent others from coming out. It is, therefore, best
adapted to those cases in which the individual tubercles are very hard and
persistent, fresh crops appearing only at long intervals.

1855.] Miscellaneous. 127

Cases of the two other forms of acne almost invariably yield quickly to
treatment. In both, the local measures adopted are the same ; any suppu-
rating tubercles are punctured or opened by means of a minute drop of
nitric acid. The patient is directed never to wash the face with soap ; to
be particular to squeeze out any little black points which become visible,
and to apply every night to the tubercles a small portion of an ointment
of which the chief active ingredient is the ammonio-chloride of mercury,
in the proportion of ten grains to the ounce. The constitutional treatment
consists in rectifying the cachexia, on which these forms of acne almost
always depend. Chalybeates, with aperients, are found the most useful.
In the acne simplex, the sulphate of iron, in combination with the sulphate
of magnesia and an excess of acid is usually employed ; but in the acne
indurata the iodide of iron is preferred. In either case the remedy must
be continued for several months, but the patient may be promised as a
reward for perseverance, that not only will the eruption disappear, but that
the general health will be much improved.

The rarity of the simple form of acne in roamed people, is an observa-
tion quite borne out by the experience of this hospital. [Medical Times
and Gazette.

Ccesarian Section thrice upon the same woman. By Dr. Barjavel. In a
Jewess, at Carpentras, of scrofulous habit and rachitic appearance, the
child presented by the feet at her first confinement. The midwife and two
surgeons who attended pulled so hard, that in their efforts at delivery they
separated the child's body from the head, which remained alone in the
uterus. M. Barjavel (the father of the author) found, when called to the
case, the cavity of the pelvis narrowed throughout by exostosis, so that no
course remained but the Caesarian section, wrhich he performed, as usual, in
the linea alba. In forty days the wound healed. In spite of the danger
to which she exposed herself, she became pregnant again in three years,
when the operation was again performed, and a living child was extracted,
The mother suckled it, and it is now alive. In four years more she be-
came pregnant a third time, when a young surgeon attempted the same
proceeding, but he was not equally fortunate, for the child, a female, was
dead, and the mother sank in a few days from haemorrhage. [Rev. Thir.
du Midi. Dublin Med. Press.

Salt as a Preservative of Dissecting Material. About the first of De-
cember, 1853, a fine muscular subject was injected through the femoral
artery with a solution containing 3lbs. of nitrate of potash. It was then
packed in a solution of common salt. It was dissected during April, and
found to be in excellent preservation ; the muscles being unusually red, a
quality, to obtain which, the injection was used. It kept better on the ta-
ble than any other subject we ever saw, lying for a month of warm weather
without much decay, the muscles drying down instead of softening by pu-
trefaction.

Another subject was packed in the brine about the 1st of January, the
injection being omitted. This subject has stood during the entire summer
in a room lighted by a large window, with a southern exposure, the barrel
in which it was placed being open to the air at the top. After nearly nine
months of this hard usage it is now upon the table in capital preservation.
The advantages of this mode of preservation are these :

1st. It is cheap and certain.

128 Miscellaneous. [February,

2d. The tissues are dryer than when preserved in the usual manner, and
the dissection consequently cleaner and less obscure.

3d. The nitrate of potash gives a lively red to the muscles.

4th. The subject bears exposure upon the table better, and does not com-
municate that extremely offensive smell to the hands, which accompanies
ordinary dissections. A cereful washing removes all smell.

All good things have their drawbacks. The fault in these subjects is a
hardening of the fingers and toes, which renders dissection of those parts
well nigh impossible, as they cannot be softened by water to any extent.
* This hardening is attributed to the presence of an excess of salt in the solu-
tion. If this supposition should prove to be correct, we can conceive of no
better means of preserving material for months, or years, than by common
brine, as subjects thus preserved are (with the exception we have mention-
ed) really more pleasant to dissect than a fresh subject. [Buffalo Medical
Journal.

Quinic Ether. A discovery which has lately been made in Italy, and
which has excited much attention, is illustrative of the results of perseve-
rance and industiy.

In the month of June, 1852, a young man, M. Louis Manetti, a student
of the University of Pavia, happened to witness the death of a patient with
congestive fever, who died apparently from the impossibility of introducing
into the system, in a short time, a sufficient quantity of quinine. Manetti
was struck with the idea that the principle of the bark might be effectually
administered through the medium of pulmonary absorption. Encouraged
by Professor Pignacca, Manetti began a series of investigations, the results
of which are detailed in a letter from Prof. Pignacca to Dr. Stambio of
Milan, a translation of which is found in the " Annales de la Societe Medi-
cale de Grand."

Professor Pignacca has called the new agent for inhalation, Quinic Ether,
probably for want of a better name, for it is not, properly speaking, an ether,
and its positive chemical composition is not known. It is a liquid of a spe-
cial inconstant odor, and is obtained by the distillation of quinate of lime
(quinate de chaux) combined with alcohol ; and is analogous to the etherial
bodies in general, volatilizing like them.

Professor Pignacca states in his letter that he has administered this fluid
by inhalation to eight patients ; seven of them had tertian intermittent fe-
ver, the last neuralgia of the fifth pair. The neuralgia was of an intermit-
tent type. The remedy acted admirably both in the cases of fever and in
the case of neuralgia.

The quantity of the agent given is about a scruple at a time, repeated
three or four times a day. It is administered in the same manner as chlo-
roform, and it produces sensations somewhat similar. \N. 0. Medical News,
and Hospital Gazette.

Effects of Fright on the Unborn Foetus. " I happened, the other day,
to meet a most extraordinary account given by Baron Percy, an eminent
French military surgeon and professor, said to have occurred after the seige
of Landau, in 1*793. If true, it is a most interesting fact, and one well
worthy of deep investigation. He says, that ' in addition to a violent can-
nonading, which kept the women for some time in a constant state of alarm,
the arsenal blew up with a terrific explosion, which few could listen to with
unshaken nerves.' Out of ninety-two children born in the district within

1855.] Miscellaneous. 129

a few moths afterwards, he states, that ' sixteen died at the instant of birth ;
thirty-three languished for from eight to ten months, and then died ; eight
became idiotic, and died before the age of five years ; and two came into
the world with numerous fractures of the bones of the limbs, caused by the
convulsive starts in the mother, excited by the cannonading and explosion !*

" Here, then, is a total of nearly two oat of three actually killed through
the medium of the mother's alarm, and its natural consequence upon her
own organization."

These facts, if such, are indeed interesting; and it is hoped the profession
will improve every opportunity of testing the truth of them. [Lancet.

Delirium Tremens. Tartar Emetic. I>r. Peddie, (Monthly Journal.)
discountenances the treatment by opium, and recommends, from an experi-
ence of 80 cases, the use of tartar emetic, in doses of from one-quarter to
one-half of a grain every two hours. If the bowels are not opened by this
remedy, compound jalap powder is given. The patient is not to be restrain-
ed by mechanical means, and light is freely admitted into the room, as by
its means optical delusions are prevented. [Medico- Chir. Rev.

Dropsy (Ovarian). Iodine. Dr. Simpson (Monthly Journal) refers to
seven or eight cases of ovarian dropsy in which, after tapping, tincture of
iodine (two or three ounces) has been injected into the sac. In two or three
cases the disease seemed arrested, but in the others this was not the case.
No great pain followed the injection, and no febrile symptoms, except in
one case. [Ibid.

Epilepsy. Atropine. Dr. Lange (Schmidt's Jahrb., No. 9, p. 299) has
used atropine in 10 cases of eplilepsy (three men and seven women). The
three men, who had suffered from the disease for many years, were cured
in three, five, and six weeks. Two of the women were not improved, one
died, and three appeared to be cured, as, after from five to eleven months,
they had had no fresh attacks. In the last case, one of epilepsy and com-
mencing idiotcy, the atropine failed. The dose appears to have been about
the 1-1 00th of a grain. M. Delasiauve, in his late treatise on 'Epilepsy'
(p. 369), states that he has experimented with belladonna for many years
at the Bicetre, and that, while he has seen some cases in which the fits
were for the time suspended, he has only seen one instance of cure. [Ibid,

Hydrocele. Collodion. Telpeau (L'Union, Juillet) applies collodion
over the scrotum on the third or fourth day, after the usual operation and
iodine injection. The secondary inflammation and engorgement are much
lessened in severity and duration. Yelpeau intends to apply the collodion
immediately after the operation in the next case he has to treat. [Ibid.

Gonorrhoea. Subrdtrate of Bismuth. Both in acute and chronic gonor-
rhoea Dr. Caby employs, three times daily, an injection, composed of water
mixed with as much trisnitrate of bismuth as can be suspended. It is to be
retained five minutes ; it causes no pain. [Ibid.

Laryngitis. Nitrate of Silver. Dr. Ebert (Annalen des Berlin Char,
Krankheiten,) employs inhalations of nitrate of silver in substance with
great benefit, in all inflammations of the lyryngeal mucous membrane. He
has employed the nitrate of silver also in solution, after the manner of

*30 Miscellaneous. [February,

Green, but has never been able to satisfy himself that the larynx was really
entered. The mode in which the solid caustic is introduced is as follows :
Three grains of the nitrate are mixed with one drachm of sugar ; the pow-
der is placed in a steel pen, which is itself firmly inserted in a quill open at
both ends. The little apparatus is then put into the mouth, so that the end
of the steel pen shall be on the root of the tongue ; then the lips are closed
round the quill, and the patient inspires forcibly. The first attempt is
almost always a failure, and the nitrate is only tasted on the root of the
tongue, but the patient soon learns to manage it very well ; a little cough
and irritation follow, but no great uneasiness. For young children this
method does not answer, and a special apparatus must be used. [Ibid.

German Poison Eaters. Dr. Tschudi has published, in the Wiener
Medizinische Wochenschrift two letters, the translation of which is to be
found in the Journal de Medicine de Bruxelles, containing some curious
details relative to a class of people who are habitual arsenic-eaters.

In some countries of lower Austria and of Styria, especially in the moun-
tains which separate these parts from Hungary, there exists among . the
peasantry the singular habit of eating arsenic. They purchase it under the
name of hedri, (hedri, hedrich, hatterrauch) from wandering herbalists, or
pedlars, who, on their part, obtain it from workers in Hungarian glass,
from veterinary surgeons, from charlatans.

These poison-eaters (toxicophagi) have a double aim ; first, they wish to
give themselves, by this dangerous habit, a fresh and healthy appearance,
and a certain degree of embonpoint. Many of the peasant girls, and even
the men, have recourse to this expedient from coquetry and ( a desire to
please ; and it is remarkable what success they attain, for the young toxico-
phagi are distinguished by the freshness of their complexion and by the
aspect of flourishing health. The following is one of many instances. A
girl who attended cows, in good health, but pale and thin, was employed

at a farm in the parish of H . Having a lover, whom she wished to

attract yet more by her personal charms, she had recourse to the usual
method, and took arsenic several times a week. The desired result was
soon obtained ; and after some months, she became fat, chubby-cheeked,
and, in short, quite to Celadon's taste. To carry the effect further, she in-
creased the dose, and fell a victim to her " coquetterie ;" she died poisoned.
The number of deaths from the abuse of arsenic is by no means inconsidera-
ble, especially among the young people. Every ecclesiastic in those parts
can speak of several victims, and Dr. Tschudi states that his researches
among the clergy were very interesting. He learned that so careful were
the victims of this practice to conceal what they had done, that the secret
was often revealed only on the death-bed.

The second advantage gained by the toxicophagi is, that they become
more " volatile," more free in respiration, and able to ascend high moun-
tains with ease. Upon every long excursion into the mountains they take
a little bit of arsenic, which they let dissolve in the mouth. The effect is
surprising. They ascend without difficulty heights which would have been
almost insurmountable without this practice. The author adds, that upon
this experience, he has advantageously administered Fowler's solution in
cases of asthma.

The toxicophagi commence with a bit of arsenic the size of a lentil-seed,
or about half-a-grain. They keep to this dose, which they swallow several
times a week, morning, and evening, for a long period, to become accus-

1855.] Miscellaneous. 131

tomed to it. Then they increase the quantity insensibly, but with precau-
tion, until the desired effect is produced. A countryman, named R -,

of the commune Ag , a sexagenarian, and in excellent health, was in

the haoit of daily taking four grains. He had followed the habit forty
years, and had transmitted it to his son. There was no trace of arsenical
cachexia in this individual, no symptoms of chronic poisoning. It is to be
remarked, however, that, when the practice is dropped, emaciation gene-
rally ensues from some cause, either from the withdrawal of the stimulus,
or from accidental or acquired disease. The custom does not diminish the
sexual passion, as is the ca?e with the opiophagi oi the East, or with those
who use* the betel in India and Polynesia. On the contrary, the feeling-
becomes more strong.

It may be as wellto bring to mind a general use of arsenic in Vienna,
among the stablemen and coachmen of the great houses. They mix a good
pinch of the powder with corn, put a piece the size of a pea in a linen bag,
and attach it to the bit of the horse. The saliva dissolves the poison. This
produces a blight aspect of the skin, roundness and elegance of form, and
foam at the mouth. The coachmen of the hills adopt the same practice
before commencing a laborious journey ; and horse-dealers carry with them
small balls of arsenic, to be given to those animals which are being led to
market. Should a horse thus treated pass into the hands of a master who
does not employ arsenic, he gets thin, loses his freshness, becomes dull, and
in spite of abundant food does not acquire his former sleekness. [London
Chem is t, from Gaz. des Ho pi ta u x.

0 Variety of the Human Species. Men with Tails. Authentic
De-tails translated from the October Xo. of the Gazette Hebdomadaire,
by John AY. Green, M. D. Dr. Hubsch, Hospital Physician at Constanti-
nople, has addressed a letter on the subject of Men with Tails, which adds
many interesting details to those already received from travellers. We will
briefly lay before our readers the information, more or less positive, which
we possess on the existence of this curious variety of the human species,
and of which the earliest indication dates back as far as 1677.

Mr. Editor At this time when attention seems to be concentrated on
the subject of a tail-bearing race called Xiam-Xiams. it gives me much
pleasure to be able to add some observations which I have had occasion to
make at Constantinople.

In 1852, I saw for the first time one of this race, a negress; struck by
this phenomenon, I interrogated her master, a slave merchant. I was in-
formed by him that there existed, in Xigritia, Africa, a tribe called Xiam-
Tiams ; that all the members of this tribe bear the caudal appendix ; and,
as exaggeration is a necessity to the Oriental imagination, he assured me
that he had seen tails, two feet in length. The one observed by me, was
smooth, and without hair, was two.inches in length and terminated in a
point. The negress was black as ebony; her hair was crisped ; the teeth
were white, thick, and" inserted upon the alveolar processes, strongly in-
clining outwards. The four canines were filed ; her eyes were injected with
blood. She ate raw meat with much relish, clothes were disagreeable to
her ; " son intelligence etait au niveau de celle des gens de son espece.M

Her master had offered her for sale for six months, at an exceedingly low
price, but was unable to sell her. The horror which she inspired not re-
siding in her tail, but in her taste (which she took no pains to conceal) for
human flesh.

132 Miscellaneous.

Her tribe eat the flesh of prisoners taken in battles with the neighboring
nations, with whom they are constantly at war.

When any of them die, the relatives, instead of interring the bock-, eat it;
from this cause there are no cemeteries in the country.

They do not all lead a wandering life, many of them construct huts with
the branches of trees ; they manufacture the implements of war and of
agriculture, cultivating maize, grain, &c. Cattle are also bred by them.

The Niam-Niams have a language which is altogether primitive, it con-
tains many Arabic words. They go entirely naked, and wish for nothing
but to satisfy their sensual appetites. Les fils couch ent avec leures meres,
les freres avec leurs soeurs, etc. ; there is a frightful pellmell. The Jftrongest
among them becomes their chief; he it is who leads them to battle, and it
is he who divides the booty. It is not known whether they have a religion ;
but it is probable they have not, from the very great facility with which
they embrace any that is taught them. It is very difficult to civilize them,
their instinct leading them always to search for human flesh ; there are
examples of slaves who have killed and then devoured the children of their
masters who had been confided to their care.

I saw last year, a man of this same race, having a tail one inch and a
half long, covered with a few hairs. He seemed to be about thirty-five
years of age; was robust, of good constitution, ebony black, and had the
same particular conformation of the lower jaw, spoken of above, i. <?., the
alveoles inclined outwards. Their canines are filed in order to diminish
their masticatory force.

The Niam-Niams are endowed with Herculean strength. The merchants
reject them, as they are so very difficult to subjugate, and the people fear
to confide to them the guard of their houses.

I know, at Constantinople, the son of an apothecary, ten years of age,
who was born with a tail, one inch in length ; he belongs to the white
Caucassian race. One of his ancestors presented the same anomaly.
These phenomena are generally regarded, in the East, as a sign of brute
force.

The Turks have known, for a long time this race of men, and are very
much astonished that scientific Europe seems to ignore their existence at
this late day. Hursch.

To sum up by a scientific view of the case, the exisience of " men with
tails" appears incontestable; and if travellers raise doubts on the subject,
it is probably because they confound the Niam-Niams with a tail, with
other Niams, neighbors of the first, anthropophagi like them, but deprived
of the appendix. [N. T. Med. Times.

Something new. At the New York Hospital, may be daily witnessed the
extraordinary spectacle of seven young and fair looking women, who follow
the physicians and surgeons on their daily rounds, and are at present at all
the operations on males or females. The individuals aforesaid, have been
allowed by the Governors, to take out Hospital Tickets, under the restric-
tion, however, that they are not to visit the male wards reserved for a
certain speciality. Their numbers has also been limited to seven, although
applications have been received from a larger number ; this is in order to
test the yet untried experiment. We understand that these individuals are
attending lectures at a certain Water Cure College (unchartered) in the
upper part of the city. Before expressing our opinion on this innovation,
we await further developments. [N. Y. Med. Times.

*t

a ObjecUe> end,. r Huigc joint .

6 Two gum elastic to6es f Spiral spring.

e Two metallic tides. g tithsti'c movetxSlt spruig.

d Two ivory Knobs ctt outrcU ext/^emities

*

SOUTHERN

MEDICAL AID SURGICAL JOURNAL.

VoiTlL] NEW SERIES MARCH, 1855. [No. S.

ORIGINAL AND ECLECTIC.

ARTICLE V.

Cold Water in Acute Dysentery. By JosiAH Browx, M. D., of
Gaylesville, Cheroke County, Ala.

Case I. J. T. C, Esq., a farmer residing in Cherokee county,
Alabama, aged about 40, was severely attacked with diarrhoea on
the 22d of May last. I visited him on the 25th. His bowel af-
fection had assumed a dysenteric character, as will appear from
the following symptoms, viz : Dejection every half hour, attended
with violent tenesmus and straining ; passing a variable quantity
(from one gill to half-pint) of thick, bloody mucus ; thirst extreme ;
no appetite ; tongue dry, with brown coat ; pulse over 140 in fre-
quency, quick and small ; extremities varying in temperature, the
cold spells being apparently attributable to the depressing influ-
ence of his intense suffering.

Administered: R. Castor oil, 3SS.; turpentine, 40 gtts.

Prescribed, in three hours after, the following anodyne to be
taken every 4 hours: R. Morphine, \ gr.; chloric aether, 3 ij.;
camphor water, sss.; bi. carb. of soda, x. gr. Also, morning and
night: R. Blue mass, v. gr; diet, flour gruel.

26th. Found him somewhat improved in appearance : rested
tolerably well during the night, having had one or two evacua-
tions of the same character; pulse about 125, and rather fuller.

Prescription : Continue anodyne and blue mass.

27th. (morning.) Patient much weaker; represented to have
had evacuations about every two hours during yesterday morning

N. S. VOL. XI. SO. III. 9

134 Beown's Cases of Acute Dysentery. [March,

and much oftener in the evening and night, with considerable in-
crease of fever. Extremities, now, quite cool ) pulse feeble and
about 120; evacuations about every hour, accompanied with
eramp and tenesmus, without change in character, I remained
with him to-day. Prescribed quinine, commencing at 7 o'clock,
A. M., but failed to prevent the exacerbation of fever, which oc-
curred at 10 o'clocky with great aggravation of the dysenteric
symptoms.

1 o'clock, P. M. Prescribed the application of coldr wet towels,,
to the lower zone of the abdomen, frequently repeated, i. e., when-
ever the cloths assumed the temperature of the body also, after
each action , the injection into the rectum of one pint of the coldest
water, which treatment was continued through the night.

28th. Here, I find the first change in the character of the
stools the muco-sanguinolent property being very much dimin-
ished, they consist chiefly of concrete fecal masses, suspended in
the water which had been injected ; and now, does he experience
the first appreciable relief from his dysenteric distress;

Prescription ; Continue the external and internal application
of the cold water, though less frequently, viz., twice or thrice a-
day ; also, continue quinine, blue mass and anodyne,, as before
prescribed.

29th. Find my patient very comfortable f pulse improved in
force and diminished in frequency ; skin of pleasant temperature
and moist ; tongue much cleaner j passages far less frequent, and
fecal, though not entirely so, but attended with little pain.

Prescription : Continue the cold water.

SOth. Patient much better in every respect ; which improve-
ment tended to a speedy recovery, the different phases of which,
it is unnecessary here to detail.

Case II. Mrs. H., of Cherokee county,. Ala., aged 35, of deli-
cate constitution and spare habit, was taken with frequent, pfcinful
and bloody evacuations, on the 10th of July last,

12th. Called to see her7 and find her with high fever, complain-
ing of a continuous dull painT deep seated, in the lower region of
the abdomen, and increasing, to sharp griping at each approach of
her calls to stool, which occur about hourly.

Prescription: ^. Castor oil, 3 i.; turpentine, 3 i. Also, in four
hours after, the anodyne dose prescribed in case 1st, every four
hours.

1855.] Brown's Cases of Acute Dysentery. 135

13th. Patient had had several fecal evacuations from the oil
and turpentine during the night, after which, the bloody mucus
passages returned with severe pain and tenesmus ; fever continues
unabated, and no improvement in any respect.

Prescription : Continue anod^me, and in addition, the repeated
application of cold, wet towels to the hypogastrium, as in No. 1,
Also, blue mass, grs. v., night and morning.

14th. Patient no better. Pulse 145, and rather feeble ; head-
ache ; tongue dry with dark brown fur ; intense thirst with nausea
and vomiting ; evacuations rather more frequent, attended with
painful straining ; extremities cool ; great nervous irritability and
extreme dejection of spirits.

Prescription : Continue anodyne, blue mass and external cold
applications. Also, inject 1 pint of the coldest water into the
rectum after each passage.

15th. Find my patient quite comfortable, having slept pretty
well during last night, in far better spirits free from headache,
nausea, thirst, &c; pulse not much over 100; dejections much
less frequent about 3 hours apart. She had passed during the
night, at different times, a considerable quantity of hardened fecal
lumps, with but little of the bloody matter.

Prescription : Continue treatment ; also, quinine.

16th. She is still improving : no fever; calls to stool greatly
diminished in frequency, &c.

Prescription : The cold injections to be governed by the fre-
quency of the stools. Diet, throughout, flour and milk gruel and
some chicken soup.

Mrs. H. continued to improve and soon resumed her accustom-
ed health.

Case III. Mrs.TT., of the same neighborhood, aged 40, ordina-
rily of plethoric habit, fell sick on the 28th of July last, with that
concomitance of symptoms which would be denominated dysen-
tery. Never having had a physician in her family before, she
exhausted the whole paraphernalia of domestic medicine Upon her
case, without any abatement of its severity, but which, on the
contrary, was steadily enhanced with a corresponding diminution
of her physical strength, to an alarming extremity.

August 7th. Called to see Mrs. W., and find her exceedingly
low very much emaciated, with extreme debility, not being able
to arise to stool ; entire loss of appetite; tongue very dry ; nausea

136 Brown's Cases of Acute Dysentery. [March,

and vomiting; skin hot and dry; pulse quick, small and 130
in frequency; abdomen tumid; alvine discharges small, muco-
sanguinolent, and every half hour with excessive tormina and
tenesmus.

Prescription : The application of cold, wet towels to the abdo-
men, and the injection of 3 pints of the coldest water per anum,
immediately; and 1 pint injections to be continued after each
passage.

This administration was attended with the most marked and
prompt relief, as expressed by the patient. With the water was
expelled a considerable quantity of the muco-sanguinolent, with
some feculent matter.

Prescription: The anodyne mixture above-mentioned every
four hours, and blue mass, grs. v., night and morning.

8th. Find Mrs. W. very weak, but without fever and feeling
much better, having had only three or four evacuations during
the night, and resting well. The distention of the abdomen has
subsided ; her passages recur only about every four hours with
much less suffering.

Prescription : Continue cold enemata, anodyne and blue mass.
Diet, chicken soup, &c.

9th. Patient still better in every respect. Continue treatment
pro re nata.

The improvement of this patient was steady and rapid, and
with the assistance of chalybeate tonics and a generous diet, she
soon arrived at her usual robust condition of health.

Thus, might be multiplied, cases almost ad infinitum , from my
practice of last summer and autumn, if it were necessary ; but the
foregoing will suffice to accomplish the object for which they
were registered, viz : of calling attention to so simple and con-
venient, yet so powerful, safe and reliable a remedy as cold water,
in the treatment of so distressing and dangerous a malady as acute
dysentery, In the locality in which these cases were noted, this
disease appeared with an almost epidemic invasion furnishing
satisfactory opportunity for displaying the respective merits of the
varied, and I may say, antipodal modes of treatment of the pre-
sent day.

I cannot say, that the now, Justly, almost exploded practice of
narcotising the diseased organ, presented no enticements, or had
not its trial ; nor that the recent and rather more rational, purga-

1855.] Brows' s Coses of Acute Dysentery. 137

tive method, was not called into requisition, during my intercourse
with this epidemic, both having to yield to the overwhelming
superiority of a more simple and more rational procedure. Each
of the former modes has its commendatory qualities, as well as its
objections, which furnish each a sufficient plausibleness to cause
them to be selected by some, for the only plan of treatment in this
disease, just as these qualities agree with their conception of the
indications presented therein. The opiate treatment relieves tem-
porary suffering, but its plausibility consists in a suppression of
complaint, without remedying the cause of that complaint. The
purgative method, whether by continued drastic cathartics or
emollient laxatives, may be considered equally objectionable, for
by the former it is attempted (I imagine) to set up an excitement
in one portion of the canal, which will counter-irritate that already
existing in another, or to relieve the turgid condition of the vessels
at the site of the disease by free depletion. And by the latter, the
endeavor probably is, to cleanse the canal, remove ail irritating
substances and prevent their accumulation without furnishing any
additional source of irritation. To answer these indications on
this expensive plan, would occasion difficulty in another quarter,
which I deem of considerable importance, although it may not be
generally so esteemed. In an attack of dysentery, which is usually
protracted, the fatiguing and agonizing concomitants which char-
acterize the disease, being so detrimental to the physical strength
of the patient, it appears unphilosophic to offend the stomach by
nauseating purgatives, besides washing away, or rendering the
absorbent surface incapable of receiving the little nourishment
able to be borne by him, and diminishing his strength, which is of
paramount importance here, by intercepting his nutriment, or
laying it waste by drastic purgation.

I would assign to these two forms of treatment, the place of
mere adjuvants, to be used conditionally, in connexion with what
I consider a more rational plan. Hence, opiates may be given in
accordance with the severity of the suffering, for their anodyne
effect, and not with a view of suppressing the evacuations, which
should be carefully avoided.

It is often best to premise the treatment with the exhibition of
one dose of some laxative, as castor oil, to prepare for the dislodg-
ment of the scybalous accumulation in the large intestines, and if
a more stimulating agent is required to overcome the torpidity of
the bowel, there is none more admirably appropriate than the

138 Cooper's Case of Hydrocephalus. [March,

turpentine, whose stimulation is independent of any drastic mo-
dus operandi.

I will now briefly consider the superior advantages of the Cold
Water Treatment, as pursued in the foregoing cases, and particu-
larly its topical application by enemata. The immediate effect of
its introduction is remarkable the patient generally expressing
entire relief from the pain and burning sensation, which suspen-
sion of suffering lasts for a considerable time. Thus, in its
anodyne effect, surpassing, by promptness and completeness, all
the ordinary means. The nervous irritability which is excited in
these cases, with nausea and intense thirst, especially in females,
and the high febrile excitement, yield equally to its sedative and
cooling effects. The evacuant and cleansing properties of the
measure, are unsurpassed by purgatives, and without the danger
of reducing the patient by hypercatharsis or interference with
nutrition. While hydragogue cathartics may reduce the inflamed
condition, by a draght upon the turgid vessels of the part the
cold application, by a more economical process, would suppress
the inflammatory action, by contracting these distended vessels,
driving out their superabundant-blood and fortifying them against
a continuance of the phlogosis.

In conclusion, I hope it is apparent, that more efficient, univer-
sal and happy qualities, are not to be derived from any other
treatment.

ARTICLE VI.

A Case of Hydrocephalus Spontaneous Tapping Death. By Geo.
F. Cooper, M. D., of Americus, Georgia.

The following case is not reported for any novelty in the treat-
ment, or the presence of any extraordinary symptoms, but, alone,
for the unusual manner in which it terminated ; being so far as I
know, the only case upon record, where nature sought to relieve
herself by the identical operation, not unfrequently practiced by

art.

On the 15th day of May, I was requested to visit the child of
Col. J. J. J., ffit. three months, which had been from its birth re-
markably healthy, and exhibiting a precocity unusual to infants
of its age. It smiled and observed, with as much intelligence at
three and four weeks, as is common to children of as many months.

1855.] Cooper's Case of Hydrocephalus. 139

Its bowels had been habitually constipated, often passing over two,
three, four and sometimes five days, without an evacuation, and
without impairment of its health, at least up to the time of the
attack referred to in this report The mother's attention was first
attracted by the occasional and sudden screams of the child, and
when moved, it often cried out as if in pain, or some tender spot
had been touched. It frequently awoke affrighted, and apparently
upon the eve of con vu* ions.

The child was found in the condition above described, which
had been persistent for two weeks prior to my first visit. The
fever was in irregular exacerbations the surface sometimes in-
tensely hot, and again scarcely appreciable, the skin remaining all
the while pallid, except the checks, and they rarely and very
slightly flushed.

The f)ulse was accelerated, and continued so even when the
heat of surface was normal. There was no delirium, the child,
until very late in the disease, being rational, frequently, even
cheerful. Its bowels were now disordered, with frequent thin
greenish stools, answering perfectly to those often seen in the
disease spinach stools. The thumb was not observed to be flexed
into the palm of the hand as is often mentioned. Its strength
and flesh kept up amazingly ; the failure of both, however, was
slowly progressing. In fifteen or eighteen days after my first
visit, the spleen was noticed to be enlarged: this progressed rapid-
ly until it occupied the left iliac fossa.

In this enlargement of the spleen, we had a beautiful exhibition
of the truth of the doctrine of Eevulsion, the more satisfactory,
because it was developed by nature herself.

Pari passu with enlargement of the spleen, there was a measured
abatement of the cephalic symptoms and troubles, and a hope
that this natural substitution would eventually supersede the
original attack upon the brain. In this hope we were forlorn ; in
from eighteen to twenty days, the spleen slowly receeded, and
commensurate with this diminution was there a rekindling of the
original symptoms with increased violence, and it was evident
that the case was hastening to a speedy termination. Indications
of stupor supervened, its occasional moments of cheerfulness were
no more to be seen ; it refused the breast and soon coma was com-
plete, and death ended the sufferings of the little patient

Six or seven days before dissolution, a sero-sanguinolent matter
was observed to be escaping from a small opening immediately

140 DtTGAS, on Prolapsus of the Rectum. [March,

below the the posterior fontanelle the opening situate in a small
red spot nasvus materni such as is frequently seen upon chil-
dren. The suspicion at once excited was, that there must be some
connection between this opening and the brain, though the idea
was novel to me, that this tapping was nature's operation. There
were no precursors of . inflammation at this point, the first thing
noticed being the escape of the fluid. The quantity of matter dis-
charged daily increased until its death, and1 from the vertex down
to between the scapulas, and around the sides of the neck to al-
most the middle line in front, became cedematous, from, as I sup-
posed, the smallness of the opening, and its being somewhat
valvular.

Eemarks. The cause of the attack in the above case is not
very palpable, though I have always believed that the habit of
constipation which obtained with the child, at least precipitated it.
Nature rarely fails in making some effort to relieve herself; but,
in this particular disease, I do not know that the attempt was ever
made before in a similar way, and had she performed her opera-
tion earlier, and enlarged the opening somewhat, we have no
reason to doubt but that it would have been entirely successful.

ARTICLE VII.

Extraordinary Case of Prolapsus of the Rectum. By L. A. DuGAS,
M.D., &c.

Having been recently consulted in reference to an extraordinary
case of Prolapsus of the Eectum, I deem it of sufficient interest to
record the following notes :

Mr. G., a native of Kentucky, but now a resident of Mississippi,
about 35 years of age, of athletic frame and fine constitution, is,
and has always been in fine health, with the exception of the
infirmity to be described. About twelve years ago, during an
attack of bowel complaint, he experienced for the first time some
prolapsus of the rectum. The bowel affection soon subsided ; but
he was left subject to occasional descent of the intestine, which
gradually grew more frequent, and finally attended each alvine
evacuation. With the increased frequency of the prolapsus, the
extent of the protrusion also became greater, and in a few months
reached the present dimensions.

Mr. Gr.'s state is, now, that of apparently robust health; his

1855.] DUGAS, on Prolapsus of the Rectum. 141

bowels are moved regularly every morning ; his faeces are mould-
ed and otherwise of natural appearance ; but each evacuation is
preceded by expulsory efforts and the protrusion of 8 or 10 inches
in length of the rectum, which is inverted, and so much dilated
as to offer a diameter of from 6 to 7 inches. The protruded mass
is of the shape of a pear, the smaller extremity being at the anus,
which is dilated to from 3 to 4 inches in diameter. In the centre
of the larger extremity may be seen the aperture of the upper por-
tion of the intestine about an inch in diameter, and from which
the faeces issue upon the continuance of expulsory efforts. The
mucous surface of the inverted mass appears health}' and the pro-
trusion is effected without pain.

For some time after the occurrence of this infirmity, the patient
would reduce the prolapsus in the usual way, by pressure with
the hand ; but he has since acquired the faculty of doing so with-
out any mechanical force and by the mere effect of position and
volition. He now can, and has for years been able to do so,
at any time induce this extraordinary prolapsus by expulsory
efforts in a few moments, and reduce it as promptly. For the lat-
ter purpose he places himself upon his knees and face, so as to
bring the pelvis at the summit of an inclined plane formed by the
trunk, and, to use his own expression, draws in the bowel by holding
his breath ; when it promptly re-enters the abdomen with a flap-
ping sound as though a column of air rushed in with it. The anus
then closes, and presents a perfectly natural aspect. I have seen
this feat performed repeatedly, and even at intervals of ten min-
utes, with surprising facility.

The force by which the protrusion is effected is easily under-
stood ; that by which the return is accomplished is probably a
combination of gravitation, by elevating the pelvis, and of atmos-
pheric pressure, by fixing the abdominal muscles at the same time
that an effort is made to elevate the diaphragm, and consequently
to produce a vacuum in the abdominal cavity.

The patient states thaj, unless he has taken some laxative, no
fecal matters -ever issue until the prolapsus be complete. We
might infer frota. this that some stricture exists to a sufficient de-
gree to prevent more consistent matters from reaching the lower
intestine ; but this is negatived by the fact that his discharges are
moulded of the usual size. The orifice seen when the protrusion
is complete, appears normal. Walking, long standing, or any
muscular effort, will induce a partial prolapsus, so as to incapaci-

142 A new Haemostatic Preparation. [March,

tate the patient for the active duties of life, unless when on horse-
back. I proposed to treat his case with the actual cautery,
according to Dupuytren's favorite method; but he was unwilling
to submit to it, and returned home.

TRANSLATIONS AND CONDENSATIONS FROM FRENCH JOURNALS.

A new Hcemostatic Preparation.
Pagliari's solution, which immediately and completely coagu-
lates blood when contained in a vessel, does not act precisely in
the same way when applied to a wound where the blood is con-
tinually flowing and washing away the coagulum. M. Hannon
has been led, from experiments made upon the blood of animals,
to the discovery of the following compound, which possesses
greater coagulating properties than Pagliari's solution.

Benzoic acid, ... 1 part.

Alum, 3 "

Ergotin, 3 "

Water, . . . %. . 25 "

This is to be boiled for thirty minutes in a porcelain vessel, agita-
ting continually, and replacing with warm water that which has
evaporated. This solution is of a deeper color than Pagliari's
solution, of a slightly styptic taste and aromatic odor. If it be
evaporated to the consistence of an extract, agitating the mass all
the while, to prevent the benzoic acid from separating from the
rest of the ingredients, it becomes of a chocolate color, has a
strongly astringent taste, and the odor of ergotin. This extract
is, according to the author, the most energetic hemostatic now
known, either applied to the bleeding surface or administered
internally.

The external application is made by applying a thick layer
of the extract to the seat of hemorrhage. When required to be
administered internally, as M. Hannon did, successfully, in haemop-
tysis, it is not necessary to subject the ingrediente to the above
process. They may be prescribed in the form of pills, as follows :
$. Benzoic acid, ... 1 gramme.
Pulv. alum, ) o

Ergotihe, \ aaS ^mmes-
Mix, and make sixteen pills one to be taken every two hours.

[Presse Med. Beige.

1855.] Actual Cautery. 143

Actual Cautery.
Knowing from long experience the great utility of the actual
cautery, we have endeavored, says M. Sedillot, to do away with
the inconveniencies of the common method, and to substitute one
equally advantageous and more convenient.

The improvement which he suggests, is to substitute for the
moxa and the ordinary heated irons, a pocket-case probe of gold,
silver or steel, heated over a spirit lamp. The diseased parts are
touched very lightly, so as not to produce blisters or escars. The
cuticle alone is affected, presenting a dry, yellowish spot, the size
of a pin's head. The impression is instantaneous and scarcely felt
by the patient, producing ordinarily only a slight pricking sensa-
tion. In by far the greater number of cases this feeling lasts but
a short time. If the pain should persist, the number of cauteriza-
tions should be lessened and the surface covered with wet lint,
which will soon give relief.

The number of contacts with the heated probe should vary ac-
cording to the nature and extent of the disease, as well as the
sensitiveness of the patient, from three or four to thirty, fifty, and
even more, and repeated once or several times during the twenty-
four hours, or only every two or three days, being guided by cir-
cumstances.

This plan has proved of decided advantage where the cautery
was not used as an hemostatic or destructive agent. The effect of
the actual cautery is to draw the arterial blood rapidly into the
parts touched. In a healthy part the redness is uniform. If the
inflammation is unequally disseminated, the redness will be great-
est at those points where the phlogosis is most intense. In those
infectious ulcerations, which sometimes occasion dangerous or fatal
inflammations of the lymphatics or veins, this cautery immediately
modifies the condition of the affected tissues.

In ulcerations of a phagedenic or otherwise bad character, these
cauterizations yield excellent results ; deep inflammations, compli-
cated with affections of the bones, serous swellings and indurations,
are equally modified with great rapidity by this cauterization. A
patient affected with swelling of the tibia, and deprived of sleep,
from excessive pain, for four months, resisting all other treatment,
was immediately relieved, and began to improve from the second
cauterization. This is the most effectual means of cauterizing in
gangrenous affections. [Rev. de Therap. Med. Chir.

144 Iron by Hydrogen. [March,

Iron by Hydrogen.

The following are the results obtained by M. Quevenne, in
the treatment of eight cases of Chlorosis with this preparation :

The doses generally administered were from 20 to 30 centigram-
mes. Below 20 centigrammes, improvement was slow. When
elevated to 40 or 50 centigrammes it was no faster than when
only 30 centigrammes were administered. The patients generally
bore the medicine well, the greater number feeling no inconveni-
ence from it. In one case there were, for several days, cramps of
the stomach, gastralgia, and even vomiting. In another, there
was, at some times, pain in the stomach ; but as these patients
were subject to these accidents, it can scarcely be supposed that
they were caused by the iron. In no case was a tendency to con-
stipation or purging observed during the administration of the'
preparation. The treatment varied in duration from sixteen to
seventy-one days ; but the cases in which it was necessary to con-
tinue the treatment so long, were complicated with organic affec-
tions of the circulating apparatus.

From these results, the following conclusions may be deduced:

1st. Iron by hydrogen is the preparation which furnishes the
most iron to the system from a given weight.

2d. This preparation is particularly remarkable for its activity;
for in average doses of 25 centigrammes the same results are ob-
tained as with doses of 40 or 50 centigrammes of other preparations.

3d. These observations negative the general belief, that insolu-
ble preparations of iron are less active than the salts of this. metal.

4th. It is therefore not true that insoluble preparations of iron
are objectionable, because of their action upon the stomach and
gastric juice.

5th.* When iodide of iron is administered, it is immediately de-
composed ; the iodine passes off rapidly by the kidneys, say in
fifteen minutes whereas the iron is retained in the system and
can scarcely be detected in the urine.' [Ibid.

Blisters applied to the Head in Typhoid Fever.
M. Lebeau, speaks very highly of this plan of treatment in the
coma of tjrphoid fever ; the recoveries being in the proportion of
15 in 20. He attributes the success to the very strong revulsive
action of the blisters, thereby relieving the brain of the mass of
serum which is found in the head of those who die in this condition.
He cites numerous cases in support of this plan of treatment. [Ibid.

1855.] Difficult Labors and their Treatment. 145

Prize Esssay, read before the State Medical Society, on Difficult Labors
and their Treatment. By M. B. Weight, M. D., of Cincinnati.

[Concluded from February No. p. 111.]

In the February No. of the Western Lancet, 1851, Dr. B. F.
Richardson reports as follows :

"I was called to see Mrs. S at 8 o'clock A. M., July 9, 1850,
aged 25 years, medium height, robust and compactly built. Upon
inquiry of the midwife, (who had been in attendance from an early
hour in the night previous) I ascertained that she had been in
hard labor during the night, and that the membranes had ruptured
seven hours prior to my arrival. Her pains being very strong,
with brief intervals, I at once resorted to an examination. I found
the right arm in the vagina, with the palm of the hand presenting*
towards the inner side of the left thigh of the mother. In the
upper portion of the vagina were several folds of the funis, in
which I detected strong and distinct pulsations. After having
remained with the patient about a half an hour, observing during
each pain, whether the child advanced or changed position, (neither
of which occurred,) I determined on an exploration, in order to
determine the practicability of bringing down the feet. After
placing the patient in a convenient position, I slowly passed my
right hand into the uterus. As soon as my hand reached the
axilla of the child, it encountered considerable constriction from
the uterus. After exploring for the neck and head, I directed
my hand in search of the feet passing it up, with the palm ap-
plied to the right side of the child, until it reached the ilium;
beyond this point my hand would not pass, with the degree of
force employed, which was sufficiently great to be compatible with
safety and advantage. The uterus had firmly and persistently
contracted around the pelvis, and over the crest of the ilium. I
retained my hand for some time in its position, hoping to be able
to insinuate my fingers beyond this point of constriction, and gain
the feet, but was compelled to desist and withdraw my hand. and.
give over the attempt. My exploration discovered the position
of the child to be as follows : its right side presented toward the
left iliac fossa inclining somewhat towards the sacrum. The
right side of its neck was projected against the pubic arch, near
its junction with the right ilium, the head occupying the right
iliac fossa anteriorly. In this position it seemed to be firmly and
persistently maintained. The impossibility of the expulsion of the
child (it being evidently above the medium size), without decided
manual interference, the great risk to the motheT from an attempt
to turn, so long after the rupture of the membranes, with the firm
and consistent constriction of the uterus about the child, induced
me at once to propose the advice and co-operation of another
physician. By agreement, Prof. M. B. Wright was sent for, it
then being between 9 and 10 o'clock. Expecting some delay,
(on account of the numerous engagements of physicians generally

146 Difficult Labors and their Treatment. [March,

at that time,) I left the patient for the purpose of visiting some
cases of cholera : with the understanding that word should be left
at my residence, when it would suit Dr. Wright's earliest conveni-
ence to meet me in the case. Unexpectedly to me, the attendance
of Dr. "Wright was secured immediately a contingency provided
for, however, by my request, that should he return with the mes-
senger, and before my return, to accompany my partner, Dr.
Morgan, and do in the case as they thought best for the safety of
the parties concerned. Being absent about one hour and a half
attending to prior professional engagements, I returned by the
house of the patient, and was informed that Drs. Wright and
Morgan had been there aboitt half an hour before, and that Dr.
Wright had interposed in the case, being in too great haste to
await the uncertain period of my return. I at once made an ex-
amination, and found the arm returned and the vertex presenting.
The funis was prolapsed, but without pulsation. Observing the
progress of the head during three or four pains, I found it disposed
to descend, and only delayed by the resistance of the perietal pro-
tuberances. I then ordered secale cornutum in twenty-five grain
doses every twenty minutes (as she seemed very much exhausted,
and the pains inefficient) of which she took two portions. The
pains became more energetic, and in about one hour from the
time of taking the first dose, the child was expelled lifeless. I
judged its weight to be about nine or nine and a half pounds. A
careful external examination gave no clue to the probable cause
of death. It had been dead but a short time prior to delivery.
Mrs. S had a rapid and uninterrupted convalescence.

Dr. Wright's mode of manipulation in the case, was as follows :
The patient being on her back, across the bed (in the usual posi-
tion for turning) he introduced his right hand, passed a couple of
loops of the prolapsed funis around the child's arm, and then re-
turned it converting it into a shoulder presentation. He then
grasped the shoulder and thorax, and pushed the body of the
( child upwards and to the left side, in consequence of which the
head was brought near the axis of the pelvis. He then relinquished
his hold of the body, and grasped the occiput bringing it down
so as to enable the head to engage.

The succeeding number of the same journal contains a case of
shoulder presentation, reported by Dr. Terry. After giving an
account of the first labor of his patient, and of the difficulties en-
countered in consequence of the small size of the pelvis, the doc-
tor proceeds : " On the evening of October 25th, 1850, about 9
o'clock, I was requested to see the above patient, being one year,
three months and eight days from the time of her previous delive-
ry, to attend her in her second accouchment. I learned that she
had been afflicted with erratic pains for the last twenty -four hours,
which at times were quite intense. I found her in bed, lying on
her back, the position she felt most disposed to retain, it affording
her most rest, and enabling her to endure her pains the better. I

1855.'] Difficult Labors and their Treatment. 147

made an examination in the position I found her. The os tineas
was dilated about two inches in diameterT readily yielding to
pressure. The amniotic fluid was escaping in moderate quantities,
showing evidently the rupture of the membranes, I was con-
vinced at once it was not a normal presentation. After waiting
three or four hours, the pains became more intenser I made another
investigation, and found a shoulder presentation. I now made
up my mind that turning must be resorted to the sooner the
better." At this time she had full pulse, flushed face, and spas-
modic contraction in the body of the uterus. I resorted to bleed-
ing, when the intensity of the pains ceased. After waiting a short
time, I proceeded to the process of turning. I gradually and
easily passed my right hand into the uterus, and with little diffi-
culty found the right foot, and brought it down so that the toes
were near the vulva. At this point I found a resistance to any
further progress in that way. I then made search for the other
foot, but did not find it. During this effort, the right hand of the
foetus came down, and on withdrawing my hand, the funis pro-
lapsed, I now attached a strong fillet to the ankle, after which I
passed my left hand into the uterus. I attempted to raise the
child up from its present position, but failed, the head lying in
the right iliac fossa. At this time the pains had ceased, except
when roused by external force. The patient, myself, and attend-
ants were much exhausted, from the severe labor and time devoted
to effect delivery. After an interval of a few hours, I obtained
the able assistance of Professor M, B. Wright. On our arrival
the pains had returned, but they were not severe. Upon an ex-
amination he found the foetus presenting with the right hand, leg
and funis in the cavity of the pelvis, as before described. He at-
tempted to turn by elevating the shoulder and making traction
upon the leg, which he found already down. Failing in this, he
endeavored to introduce his hand into the uterus with a view to
obtain control of both feet, but the uterus had contracted so
thoroughly upon the child as to render it impracticable. The
doctor then decided upon a resort to version by the head. The
leg, arm, and funis, were successively returned into the cavity of
the uterus, and the vertex was brought into the superior strait,,
with the posterior fontanelle behind the left acetabulum. The
patient had been previously put under the influence of chloroform-
Uterine contractions having ceased, it was deemed advisable to
use the forceps, which were adjusted before the hand of the opera-
tor had been withdrawn from the pelvis. It was soon found,
however, that the instrument could not overcome another promi-
nent obstacle to delivery, viz., a disproportion between the head
of the foetus and the brim of the pelvis. The perforator was then
used, the forceps still retaining their hold. As soon as the cranium
was lessened in size sufficient to pass the superior strait, it was
brought forward, and delivery was accomplished by means of the
forceps."

148 Difficult Labors and their Treatment. [March,

In the May number of the Western Lancet, 1851, a case is thus
given by Dr. J. P. Walker :

" I was called Saturday noon, April 12, 1850, to see Mrs. L ,
aged 30, in labor with her third child. The membranes had been
ruptured on Friday morning, nearly thirty-six hours previous to
the time I was called.

" I found her with severe pains, but on examination could not
reach the os uteri. At eight in the evening, I could with difficul-
ty reach the presenting portion. The meconium had been passing
freely, and I had been led to expect a breach presentation, but
upon close examination I found that the shoulder presented. I
sent at once for the assistance of Professor M. B. Wright, who
arrived at eleven o'clock Saturday evening."

At this time the arm was suspended from near the centre of the
superior strait, the fore-arm being partially flexed, and looking
towards the left. Dr. Wright proposed cephalic version, as an easy
and successful mode of treating the case, which was acceded to.
The fore-arm, which could be moved easily by the finger, was
extended, and the hand escaped through the os externum, with
the back of it anteriorly, and the thumb directed to the right thigh.
The arm was brought down with a view to a more satisfactory diag-
nosis, and to indicate the proper manipulations for delivery. The
presentation, and the hand to be used in changing it, being deter-
mined, the Dr. proceeded to the accomplishment of his object.
The patient was placed, as in the ordinary way of turning by the
feet. The arm which was now in the vagina, was returned so as
to ascertain the relative position of the head. It was on the right
side of the pelvis, the occiput in front, the face resting on the pos-
terior surface of the right iliac fossa, and the right cheek against
the promontory of the sacrum. ! The position of the foetus being
thus accurately ascertained, cephalic version was commenced.

The body of the foetus was moved laterally and upwards, by
slight force applied to the presenting shoulder, until the breech
had ascended to the fundus of the uterus. The face, by this move-
ment, was made the presenting portion. It was readily changed
for the vertex, but this change could not be secured without the
constant application of the finger to the occiput. This was not
deemed advisable, as the expulsive efforts had not yet commenced,
and the os tineas was not more than two-thirds dilated. At half-
past ten o'clock A. M., eight hours subsequently, the second stage
of labor commenced, and when the next examination by touch
was made, the face had again presented, and had partially engaged
in the superior strait the chin being directed anteriorly, and to
the left. It was deemed best not to effect any change, either in
presentation or position. As the face, however, passed through
the superior strait, the chin inclined more and more backwards,
until it was placed before the left sacro-iliac symphisis. Before
reaching the inferior strait, the chin had again rotated forwards,
without extrinsic aid, and finally it emerged under the arch of the

1846.] Difficult Labors 149

pubis. Labor was then speedily terminated, the second or expul-

stage occupying about two hours and a half. The fcetiv
dead, and offensive from partial decomposition. It weighed about
nine pounds.

The patient has been doing well since. This case is not only
instructive as to the proper treatment of such cases, but also for
the remarkable efforts of nature to - deliver

Now after all this, are we not justified in declaring,

1. That at an early period in labor, and especially if called be-
fore the uterus has been deprived of its liquid contents, a shoulder
may be converted into a vertex presentation more easily than
turning by the feet is ordinarily performed.

2. That although the membranes may have been long ruptured,
turning by the head can be accomplished with great facility.

3. That delivery by cephalic version may be speedily effected,
after repeated and ineffectual attempts have been made to turn by
the feet.

4. That cephalic version cliouM re prominent, nay, lead-
ing place, as a means of expediting delivery in shoulder presenta-
tions.

The second of the questions already proposed, is, what mode of
proceeding will prove most or the mother ?

In his chapter on podalic version, Churchill ol " On the

other hand its disadvantages are not to be overlooked. From the
distance the head has to traverse, and the difficulty of seizing the
feet, and of turning the child in utero, there must ever be a fear-
ful risk of injury to the mother."

n an examination of the tabular view3 given by Lee, we
find that out of seventy-one cases of shoulder presentations, in
which turning resorted to, "seven women died

from rupture, and three from inflammation of the uteru - . " " Lace-
ration and inflammation of the uterus are, therefore, the conse-
quences chiefly to be L Four of these cases of rupture
red in the practice of c hems, and three in patients
under my own care, and where no great difficulty was experienced
or force employed in turn:

In the hand does not enter the cavity of the

uterus, ai its walls, nor any portion of

them, are : ut. The foetus is moved comparatively

3, the head b near the superior

strait; while i l, the p. :d, is

most remote from 1 through which it must pass. In the

former, the injury to the mother cannol ithout great awk-

wardness on the the obstetrician, while in the other we

pe of injury. In turning
by the feet the ] rably

within th often while it is contracting violently. In

turnii ; little, if any, direct contact of the

hand In the one .ontusionof the uterus

K. S. VOL. XI. NO. III. 10

150 Difficult Labors and their Treatment. [March,

by the hand is to be expected in the other case there is no injury,
because there is no contact. Turning by the feet may occasion a
severe nervous shock. Not so in changing the shoulder for the
head.

How may the life of the child be best preserved ? is the third
enquiry to be briefly answered.

In describing the disadvantages of turning by the feet in all
cases, Churchill sa}Ts: " The mortality amongst the infants thus
brought into the world is very great. As far as our statistics ex-
tend, they yield 171, out of 518 delivered, or 1 in 3."

The mortality in shoulder presentations is, doubtless, greater
than this. In the first place the position of the fcetus weakens its
hold upon life. In the second place the hand is more difficult of
introduction into the uterus in shoulder than in head presentations,,
and whatever force is required is sensibly felt by the fcetus, and
upon that part of the body where pressure is made with least im-
punity.

A timely resort to cepli alic version gives the fcetus almost as
much certainty of life as if the presentation had been originally of
the head. Why not ? The manoeuvre amounts to but little more
than in rectification of deviated head positions.

We are informed by Churchill that, "Bush gave an account in
1826, of fifteen cases, in which / .ere born living. In 1827y

Ritgen collected forty-five successful cases. Riecke has had six-
teen cases." In all the cases treated by myself from the beginning,
the children were born alive. The liability to compression of the
chord and consequent death of the fcetus, is in proportion to the
length of the labor, or rather to the descent of the fcetus in the
cavity of the pelvis. Hence to be wholly successful, cephalic ver-
sion should be performed a short time before, soon after the com-
mencement of the second stage of labor.

Can any mode of treating shoulder presentations be relied on
exclusively? The answer must be in the negative. We are dis-
posed to adopt the language of Cazeaux, "that at the present day
it would be improper to embrace either opinion exclusive'
some cases are better suited to the cephalic version., while there
are others, on the contrary, where the pelvic one is alone practica-
ble ; consequently both operations should be retained in practice,
leaving the judgment of the accoucher to determine the cases,
where the one or the other ought to be preferred." And we will
conclude this part of the subject by stating a few of the cir-
cumstances under which the different modes of turning may be
adopted.

Turning by the feet is to be preferred in cases of inefficient
uterine action, or exhaustion from long continuance of labor ; in
hemorrhage, convulsions, or in any case where there may be a
demand for a speedy delivery.

Turning by the head should be selected in all cases where diffi-
culty arises from mal-position merely ; or in convulsions, hemor-

1855.] Difficult Labors and tJteif Treatment 151

rhage, or prolapsus of the funis, if the uterus should be engaged
in vigorous expulsive efforts. In rupture of the uterus our great
reliance is in artificial delivery ; and the question naturally sug-
gested would be, which will guaranty the greatest safety, podalic
version, or cephalic version aided by the forceps? And we
would be guided in our action by the answer we gave to the
question.

Which shoulder presents? The diagnosis of shoulder presenta-
tions has been already given, but it is still important to ascertain
which shoulder demands our attention, and the relations the foetus
sustains to the pelvis and uterus. Either shoulder may occupy
the brim of the pelvis, with the back in one case looking in front
of the mother, while in the other case it may be directed towards
her spine. The head may be in the right, and again the left iliac
. the breech occupying the opposite fossa, and the feet being
high in the uterine cavity. But how are we to ascertain the actu-
al and relative situation of all these par

It has been stated that the first vertex presentation (the occiput
being behind the left acetabulum) is more frequent than all the
others. If we admit that shoulder presentations are deviations
from those of the vertex, it would be fair to infer that we were
about to adjust the right shoulder with the back in front, and the
head on the left of the pelvis. The direction of the axilla would
indicate the opposite direction of the head, so also of the elbows.
Perhaps the top of the shoulder, the neck, and even the head may
be felt.

The direction of the back may be known by the scapula and
vertebra?, and by the fore-arm lying upon the breast. If the
coccyx, anus and iliac crests can be touched, the location of the
pelvis is rendered certain.

The hand of the foetus being in the vagina, can be used with
advantage to ascertain which shoulder presents. If the palmar
surface be directed upwards towards the symphisis pubis, and the
thumb turns to the right side of the pelvis, we at once pronounce
the right hand, and, consequently, the right shoulder as present-
ing. The reverse obtains with the left shoulder. Again, when
the back of the hand appears in front, and the thumb is nearest
the left thigh, the arm not being twisted, we should prepare to
act upon the right shoulder, the back in front and the head in the
left iliac t

The back of the hand in front, with the thumb near the right
thigh, indicates the presence of the left shoulder, the spine being
in front, and the head on the right side of the pelvis.

So little do we consider the presence of the arm in the vagina
as an obstacle to turning, we do not hesitate to bring it down, to
aid us in our diagnosis if at all doubtful.

In this country, turning is performed, the patient being on her
back. In cephalic version, we have always selected this position.
The hand can be more readily introduced into the uterus, and the

152 Difficult Labors and their Treatment. [March,

feet reached, however, with the patient on her elbows and knees,
than when on the back or sides. There may be cases in which
advantage would be gained, by placing the patient in this posi-
tion, preparatory to cephalic version. This is suggested, how-
ever, on the experience of only one case, which may be briefly so
stated.

We were called to a patient in labor, with shoulder presenta-
tion, when we learned from the medical attendants present that
the arm had descended into the vagina, full sixty hours previously.
From three to five respectable physicians had been lending their
aid, each, in turn, making ineffectual efforts to bring down the
feet. With the patient on her back, we endeavored to pass our
hand above the brim of the pelvis, but failed in this. The arm
was swollen to an immense size, and, as it was much in the way,
it was amputated at the shoulder, the child of course being dead.
Still, the hand could not be extended above the superior strait.
The woman, greatly exhausted, was placed and supported on her
elbows and knees by assistants. With some difficulty, the uterus
was then explored, the feet grasped, and delivery accomplished.
When our hand came in contact with the presenting portion of the
foetus, however, we acted upon it as if to perform the cephalic ver-
sion, and were satisfied of our ability thus to change the presenta-
tion. But, as labor had continued such a long time as uterine
action had, in a great measure, ceased and as every moment of
delay threatened an increase of great danger to the woman, a
preference was given to podalic version.

The hand to be used. The relations of the foetus to the pelvis
having been ascertained, and the patient placed in a proper posi-
tion for turning, the next question is, which hand shall be intro-
duced into the vagina ? We answer, the hand, the palm of which
is directed naturally towards the breach of the foetus. It will be
seen at once, that if the foetus is to be moved in the direction of
the breech, and in correspondence with the right side of the mother,
and the left side of the operator, the right hand could be used with
most success. In cases in which the head occupies the right iliac
fossa, a choice could be given to the left hand.

The prolapsed arm. It is generally conceded that, in turning
by the feet, it is not necessary, nor would it be advantageous, to
return above the brim of the pelvis, the arm, which may have
fallen, or been brought into the vagina. In turning by the head,
on the contrary, its reposition admits of no doubt ; it is impera-
tively demanded. It is not demanded in consequence of any
difficulty in moving the shoulder by its presence, but in the ad-
justment of the head at the superior strait, and its subsequent
descent through the pelvis. By bending the fore-arm of the foetus
until the hand is directed to the upper portion of the vagina, and
then pushing up the arm, the entire member will soon ascend
above the brim of the pelvis, and be no longer an obstacle to com-
plete version.

1855.] Difficult Labors and their Treatment 153

The manner of performing cephalic version. The attention of the
profession is not now directed to cephalic version as a new subject.
- recommended by Hippocrates, and from his days to those
of Pare, was attempted in all cases in which the head did not
originally present. Presentation of the breech and feet, were
not associated with natural labors until a comparatively recent
period.

The practice and influence of Pare led to the adoption of podalic
version, and it has continued the reigning fashion up to the pres-
ent time. Instead of changing the feet for the head, in all cases
where the former presented, as recommended by Hippocrates, it
is now deemed proper, following the example of Pare, to substitute
the feet for the head, in many cases of difficult labor.

The spirit of progress, however, has not been idle, although it
has been slow in making proselytes. Opposing doctrines have
been carefully scrutinized, to a certain extent harmonized, and
adapted to individual cases. Flamand, professor at Strasburg,
recalled the attention of the profession to the utility of cephalic
version, and exerted his influence, by argument and illustration,
to have it reinstated. Some of the German and French writers
have been induced to assign cephalic version a place among
obstetric operations; but they consider it applicable to such a
small number of cases, that they have bestowed upon it little
attention, and have attached to it but a small share of practical
importance.

Although American minds are ever on the alert, and ready to
test the value of suggestions from a practical source, they have not
directed special attention to the subject before ns. Indeed, the
investigation of it has been prevented, by the expressed opposition
of our writers and teachers on the one hand, and their silence on
the other. And here I maj* be allowed to advance an opinion,
which was openly entertained when a teacher myself, that the
mass of the profession think and act too little for themselves. They
too often embrace the doctrine of the teacher as true, to the rejec-
tion of their own experience. We would say to the lecturer, in-
dependence rather than place be a martyr for truth, rather than
be false to your profession to appease local jealousy. And we
would urge, that while the practitioner awards honor where it is
due, he should be true to himself, hy thinking and acting for him-
self.

A few paragraphs from Cazeaux will express the opinions gen-
erally entertained upon cephalic version by European writers :

11 Flamand was also in favor of the performance of cephalic ver-
sion, even after the rupture of the membranes and the discharge of
the amniotic liquid. He has even gone so far as to point out the
particular manceuver for each one of the distinct presentations
admitted by him, for the child's anterior, posterior, and lateral
planes; but we deem it useless to enter into those long details,
more especially since they may all be comprised in this : to grasp

154 Difficult Labors and their Treatment [March,

the preseting part, push it up above the strait, and then carry it
as far as possible towards the side opposite to where the head is
found, and afterwards get hold of. the latter and bring it down, if
the efforts made by the other hand through the abdominal walls,
have not proved sufficient to make it descend into the excavation."

"Flamand himself acknowledges that this operation seldom
succeeds, excepting when some region of the neck or upper part
of the thorax presents at the strait. As for ourselves, we believe
it would be difficult, even under such circumstances ; however, it
is barely possible, especially if there is still some water in the
uterus, and the contractions are not very energetic."

"When a trunk presentation is complicated by the descent of
an arm, the cephalic version, recommended by Kuffius, Ehodion,
and others, should, in my estimation, be wholly rejected."

If we were to be restricted in our manoeuvers by the advice
given in some late obstetrical works, we should certainly fail in
our object, and sooner or later we should be convinced that lessons
given in the absence of experience are liable to errors, even in the
outlines. Churchill tells us that, "if our object be to change the
presentation for example, to substitute the head for a shoulder,
we must gently push up the shoulder, and then seizing the head,
bring it down to the brim, and place it in the most favorable rela-
tion to the pelvis."

A professor representing the difficulties, nay, impossibilities, of
performing cephalic version in shoulder presentations, places the
leather baby m the manikin, raises the shoulder in a line corres-
ponding with the axis of the pelvis, and with an air of triumph
asks, "now, if I withdraw my pressure, or if the uterus should
contract, will not the shoulder return to its original position?"

In reply to the above, let us merely observe, that the expres-
sions "raising the shoulder" and " grasping the head" convey a
very imperfect idea of the manoeuver constituting cephalic version.
And, to shorten discussion, we will present our own mode of pro-
ceeding.

Suppose the patient to have been placed upon her back, across
the bed, and with her hips near its edge the presentation to be
the right shoulder, with the head in the left iliac fossa the right
hand to have been introduced into the vagina, and the arm, if
prolapsed, having been placed, as near as may be, in its original
position across the breast. We now apply our fingers on the top
of the shoulder, and our thumb in the opposite axilla, or on such
part as will give us command of the chest, and enable us to apply
a degree of lateral force. Our left hand is also applied to the ab-
domen of the patient, over the breach of the foetus. Lateral pres-
sure is made upon the shoulders, in such a way as to give the
body of the foetus a curvilinear movement. At the same time,
the left hand, applied as above, makes pressure so as to dislodge
the breech, as it were, and move it towards the centre of the uterine
cavity. The body is thus made to assume its original bent posi-

1855.] Difficult Labors and their Treatment. 155

tion, the points of contact with the uterus are loosened, and per-
haps diminished, and the force of adhesion is in a good degree
overcome. Without any direct action upon the head, it gradually
approaches the superior strait, falls into the opening, and will, in
all probability, adjust itself, as a favorable vertex presentation.
If not, the head may be acted upon as in deviated positions of the
vertex, or it may be grasped, brought into the strait, and placed
in correspondence with one of the oblique diameters.

It will be observed, that we do not act upon the shoulders by
raising them. Perhaps a slight elevation would facilitate the
movement already described or it might be better to depress
them and, again by lateral pressure, without either elevation or
depression, our object might be accomplished. Pushing up the
shoulders, therefore, does not constitute a prominent part of turn-
ing, if by pushing up is meant the mere raising of the shoulders
above the brim of the pelvis.

As the body of the foetus makes its curved movement under the
hand of the operator, it advances upward, as well as laterally, by
a combined, rather than a single action, which would give it only
one direction.

The back of the hand, with which we have been acting upon
the shoulder, is toward the head of the foetus consequently, its
hold upon the head would be apparently slight yet, after the
shoulders have reached the iliac fossa, the vertex may fall upon
the palm of the hand in occupying the strait, and its adjustment
become easy. If, however, there should seem to be a necessity
for grasping the occiput, there could be no reasonable objection to
a speedy change of hands.

The entire process of cephalic version is to be adopted in the
absence of uterine contraction ; or rather, during intervals of ex-
pulsive force. And, as it is now a vertex presentation, we must
be governed, as to time and manner of delivery, by those general
rules applicable to such cases.

In all our cases, except the one which terminated as a face pre-
sentation, the occiput assumed a position corresponding with the
first or second presentations of the vertex. In this case the occiput
was before one of the sacro-iliac symphises, and to this fact we
have attributed the tendency of the occiput to slide above the brim
of the pelvis, and the difficulty in keeping it in place. If there
had been the usual degree of uterine contraction, however, the
head would, in all probability, have become fixed, and the pre-
sentation would have continued as one of the vertex, instead of
changiug for the face.

It will be seen that we lay no claim to the introduction of
cephalic version as a mode of treating wrong presentations, and
expediting delivery. A very brief examination of the subject,
however, may induce some to award to us originality in respect
to the means by which a successful change of presentation may
be accomplished.

156 Difficult Labors and their Treatment. [March,

That cephalic version, by external manipulation by acting
upon the foetus through the parietes of the abdomen and uterus
should have few advocates is not surprising. To be successful, it
confessedly requires a combination of favorable circumstances not
often presented. The tissues both of the abdomen and uterus,
must be thin and yielding the liquor amnii must have been re-
tained, and in considerable quantity and the foetus must be pro-
portionably small.

In all the obstetrical works we have examined, in which cephalic
version is recommended by internal manoeuvre, it is directed to
raise the shoulder as the first necessary impression upon the foetus.
Yiewed anatomically or mechanically, men have not been per-
suaded into the belief, that raising the shoulder can facilitate the
permanent descent of the head into the superior strait. They
claim, what is apparent to the eye in viewing a proper engraving,
and as it can be demonstrated with the manikin, that the eleva-
tion of the shoulder at the brim of the pelvis, tends to increase the
long diameter of the foetus, and the transverse diameter of the
uterus, and without any favorable adjustment of the head after
pressure upon the shoulder has been withdrawn.

Suppose we follow out the directions given by some, and after
the elevation of the shoulder, attempt to force the body of the
foetus in a lateral direction, will not the breach infringe against
the walls of the uterus transversely ? To enable the head to en-
gage in the superior strait, the body must be entirely removed
from it, and this can only be done by raising the breech towards
the fundus of the uterus. Eaising the shoulder, therefore, is very
naturally considered a means to prevent cephalic version. And
we are not surprised that podalic version is almost universally
adopted in the treatment of shoulder presentations.

If our mode of performing cephalic version is sufficiently clear,
in the description already given, it will readily be distinguished
from others. We claim for it great importance, on the ground
that it is easily executed that the mother and foetus receive no
injury that there is little or no danger of subsequent displacement
after the vertex has been fully adjusted that, although it is most
successful in recent cases, delivery may be accomplished after the
membranes have been long ruptured that it may be executed,
after ineffectual efforts to bring down the feet.

Possibly our time might have been more profitably employed
than in writing these pages. If, however, we shall have directed
the minds of our brethren into a new train of observations, and
aided in giving a true value to cephalic version and, especially,
if life shall thereby be preserved we shall consider that an ample
reward has been bestowed on our labor. [Ohio Medical and Sur-
gical Journal.

1855.] On the Spinal System and its Diseases. 157

Three Lectures on the Spinal System and its Diseases. Delivered at
the Chatham-street School of Medicine, Manchester. By Marshall
Hall, M.D., F.E.S. L. k E., Foreign Associate of* the Imperial
Academy of Medicine of Paris, etc.

LECTURE I.

THE ANATOMY, PRINCIPLE OF ACTION, AND PATHOLOGY OF THE

SPINAL SYSTEM.

Gentlemen, I have accepted, with much satisfaction, the invi-
tation of your able teachers, to expound to you the Anatomy,
Physiology, and Pathology of the Spinal System. In doing this,
I shall avail myself of experiment and reference to clinical obser-
vation. I wish to demonstrate to you the immediate and intimate
connexion between physiology and practice. You may indeed
regard these lectures as a specimen of a work which I am preparing
for the press, designed specially for the medical student, to be en-
titled " Physiology in the Laboratory and the Clinical Ward."

I propose, in that work, to effect the separation of mere empiri-
cism from medicine for ever.

Physiology was divided, by the illustrious Bichat, into two sys-
tems, or sub-systems, the animal, and the vegetative.

The nervous system has, in a correlative manner, been divided
into the cerebrospinal and the ganglionic.

Both these divisions are defective. There is a third sub- division
of the nervous system, hitherto undetected, which forms an essen-
tial link with the other two, and which I have designated the
Spinal.

Observe this frog. You are all familiar with its natural move-
ments. I divide what was termed the cerebro-spinal system just
below the occiput.

I stop for a moment to call your attention to a most interesting
phenomenon. I seize one of the toes of a posterior extremity be-
tween my thumb and finger, making a little gentle pressure and
movement. No effect is produced. In a minute, or less, you will
see how different the result will be. The animal is in the state of
shock ; just such a shock as we observed in practice, as the effect
of a violent fall from scaffolding, or a crushing accident from ma-
chinery. I repeated the experiment. You see the manifestation
of returning power in energetic movements.

This experiment, repeated with care, would afford the means of
investigating the phenomena of shock, and of a principle of prac-
tice. For example ; after a violent comminuted fracture, is it bet-
ter to amputate immediately or after the lapse of a certain interval
of time ?

I again call your attention to my experiment. Observe how
energetic the movements of the frog now are on exciting the skin
of the foot; how similar, too, to ordinary voluntary motions!
Who would not be beguiled into the conclusion that in this ani-
mal sensation and volition still exist ?

158 On the Spinal System and, its Diseases. [March,

Nevertheless, if my experiment has accurately divided the cere-
brum and cerrebellum from the medulla oblongata, and if I induce
quiet in the animal by gently controlling its movements, as you
see, it will never move spontaneously more ! Nay, though I place
it in a position which, if sensibility remained, would be the most
painful, yet, quiet once induced, and all external excitation avoided,
it will never move again. It might be left in such a position, and
if so protected from excitement, it would be found the next day
in the same position still.

But again I rub the toe between my thumb and finger, and
again it moves ; it jumps, and it crawls; the latter movement con-
sisting, in fact, in a series of movements induced by the renewed
contact of points of the cutaneous surface with the surface of the
table.

What is the rationale, what the relations, of these singular phe-
nomena ?

Gentlemen, nearly a quarter of a century ago, I was engaged in
the investigation of the circulation of the blood in the batrachian
reptiles ; I had been examining the pneumonic circulation in the
triton ; the animal lay on the table ; I removed the head and the
tail. On touching the latter by the point of a probe, it coiled up !
I asked myself the questions which I have just proposed to you.
From this simple fact and observation have resulted the discovery,
the elaboration, and the application of the spinal system that
system which, as I have said, I am about to expound to you in
these lectures.

I again recur to my question What is the rationale, what the
relation to life, to anatomy, and to physiology, of this phenomenon?
I have removed the cerebrum and cerebellum ; it does not there-
fore depend upon these. But I proceed further; I now remove
the whole of the internal viscera, and, with them the whole of the
ganglionic system. Still the movements continue as lively as ever !

Observe this physiological preparation well. There is not in
the Hunterian Museum a preparation more replete with the deep-
est interest. It is the demonstration that when the centre of the
cerebral system and when the entire ganglionic system are removed,
there still remains a third system, independent of each and of both,
sui generis, autocratic !

Place this specimen of the decapitated, eviscerated frog in your
museum the demonstration of the distinct and independent spinal
system in memory of this day !

Do not be disconcerted that I show you these things in so humble
a creature. All physiology exists in the caterpillar or the butterfly ,
if we could only detect it. The least of God's works is infinite.

I began by stating to you that hitherto anatomists and physiolo-
gists had divided the nervous system into the cerebro-spinal and
the ganglionic. I have analysed these, and I have demonstrated
to you, that in the midst of these two there is a third system. As
the chemist detects, in a mineral hitherto regarded as consisting of

1855.] On the Spinal System and its Diseases. 159

certain elements say silver and gold a new element, platinum,
so I, in the midst of the cerebro- spinal and ganglionic nervous
systems, have detected a new element the spinal; and of how
great moment this is I must proceed, without further delay, to
unfold to you.

I revert once more to this interesting preparation : the cerebral
centres and the ganglionic system are removed ; what remains ?
what is its anatomy, its principle of action, its physiology, its
pathology, its therapeutics ? what its relation to life and death f
questions of the deepest interest.

In the first place, observe me now destroy, in this decapitated,
eviscerated frog, by means of this needle, the spinal marrow. Xow
all is still ! I irritate the toe in vain. I wait in vain for recovery
from shock. All the interesting phenomena formerly manifested
are extinct ! They depend, then, on the spinal marrow, their spi-
nal centre !

In the next place, I take this preparation, which is similar to
the former one viz.. without cerebral, without ganglionic sys-
tems, and I denude the lumbar nerves. The excited movements
in both lower extremities are, as you see, perfect, I divide this
right lumbar nerve ; the excited movements in the right leg, and
in that leg only, are extinct !

The excited reflex movements depend, then, not only on the
spinal centre, but on the nerves connected with that centre.

You observe the phenomena still perfect in the left leg ; I re-
move the skin from the foot ; the excited movements are again
extinct. They depend, then, in this instance, on the integrity of
the integuments of the part to which the excitation is applied. In
these integuments, in fact, resides the origin of those nerves on
which these excited reflex actions depend.

But now, gentlemen, I must beg your best attention whilst I
explain more particularly the nature and forms of that nervous
structure which constitutes the spinal system.

If I either strip off the skin, or destroy the spinal marrow, or
divide the lumbar nerve, the phenomena cease. They depend,
then, on the oHgin and on the course of certain nerves, and on
their spinal centre.

But a little more minutely : If I remove the origin of this struc-
ture, by removing the integument ; or if, within the spinal canal,
I divide the posterior root of the spinal nerves ; or if I destroy the
spinal marrow itself; or, if I divide the anterior roots of the spinal
nerves ; or, if I divide the nerves in any part of their course to or
from the spinal marrow, I annihilate all reflex phenomena.

Here then is a new Demonstration : all reflex actions depend on
an in-going nerve, with its origin in the tissue excited ; on the spi-
nal centre ; and on an out-going nerve, with its termination in the
muscles. These constitute a nervous Arc, consisting of parts essen-
tially linked together ; a new kind of Anatomy, established and
demonstrated for the first time.

160 On the Spinal System and its Diseases. [March,

Each special excited, reflex, or diastaltic action (so I have de-
signated it, because it is excited through the spinal centre), has its
special diastaltic nervous Arc. Of these Arcs there is an extensive
series in the animal economy. Together with their continuous
centres, they constitute the spinal system of connected eisodic (or
in-going) and exodic (or out-going) nerves.

Gentlemen, no facts in chemistry or physics are more demon-
strable than these ; none more valuable in their relations respec-
tively ; whether we contemplate life, disease, or death, the spinal
system becomes now our constant guide.

Let us now, gentlemen, consider what we have within the spinal
theca. The sensations of the hands, feet, &c, imply an uninterrupt-
ed connexion between those parts and the cerebrum, upwards. The
acts of volition of the hands, feet, &c, imply a similar uninterrupt-
ed connexion downwards. There are, then, two nervous conduc-
tors, whether distinct fibres, or whatever they may be, along the
spinal marrow, which, in this sense only, may be viewed as a
spinal Chord of nerves, of sensation, and of volition.

But when the cerebrum is removed, when alb sensation and
volition are extinct, if we excite the skin of the lower extremity
in the frog, the anterior extremity is moved, and vice versa ; phe-
nomena which cease either on removing the spinal marrow, or
dividing the lumbar nerves. How then are we to view these
structures ?

The lumbar nerves convey sensation and the mandates of voli-
tion to and from the cerebral centre, when that remains ; they
convey the eisodic excitor influence, and the exodic excitor influ-
ence, when that centre is removed. The spinal centre is the gene-
ral kej-stone to the diastaltic arcs.

As certainly as the lumbar nerves in the frog convey sensation
and volition, so certainly do they convey these other two influ-
ences. If Sir Charles Bell has proved that such nerves are double,
I have proved them to be quadruple.

The posterior roots of the intra-spinal nerves are not only senti-
ent, but eisodic excito-motor ; their anterior roots are not only
conveyers of the influence of volition, but of exodic excito-motor.
There is precisely the same kind of proof of one of these functions,
as of the other. The spinal marrow ; the lumbar nerve in the
frog ; the sciatic in the human subject ; are each and all quadruple
in their mode of action ; I do not say in their structure.

There is an additional fact or series of facts : the spinal marrow
is the conductor of the 'influence of emotion, and of that of undue
acidity in the stomach, when these affect, the first directly, the
second in a reflected manner, the action of the heart a subject
requiring new and careful investigation.

Enough has been said, then, gentlemen, to convince }^ou that
the spinal marrow is no mere chord of nerves. Enough has been
said to show you that it is intimately connected with the ganglionic
system. And especially, enough has been shown to prove to you

1855.] On the Spinal System and its Diseases. 161

that it is the great centre of a series of actions in the animal
economy.

You will be still more impressed with the importance of the
spinal system, when I tell yon that, besides the phenomena which
I have brought before you, it is the nervous centre and agent in
All the Functi ::stion in the animal econo-

my, in the, ? in pathology, in the

action of a certain Class of -. and in the whole of that de-

partment of medicine denominated 01

Having made these observations, which relate principally to the
Anatomy of the spinal system, I must now call your attention to
its F Hon. This I have proved, by a series of the

clearest experiments, to be th- of Haller. But this

celebrated ph; hat, and Professor J. Muller, all laid it

down as a Law, that this power acts in the direction downwards
only. As long as this idea prevailed, it is obvious that it could
have no application to physwlogj/. For how could the spinal mar-
row or an exodic nerve be irritated physiologically? Its applica-
tion was accordingly limited to

But by a sei ::periments on the turtle, I proved that the

vis nervosa m: wards and inwards as well as outwards and

downwards, and tj.cn its application to physiology became evident.

If you remove the head and viscera in' the turtle, and excite an
eisodic nerve between the upper and lower part of the animal, all
the extremities are moved. The influence of the vis nervosa has
been inw .Is, and in all other directions, and not

downwards c:

It now became easy to explain the various acts of ingestion,
retention, egestion. and exclusion, depending, as they all do, on
an eisodic exciter.

I may now, before entering on this topic, give you a general
idea of the Xervous Systrm as we now view it.

The cerebrum, the cerebellum,, and, in a certain sense, the me-
dulla oblongata, may be regarded as the Centre of the Cerebral
m, of the nerves of special sense, and of volition, of intellect
and of the passions, of pleasure and of pain. By its means we are
placed in relation to all that is i . psychically. By its means

we perceive, by its me; ize and use. external obj

There is good reason to believe that intellect is seated high, the
emotions lower, and the faculty of pleasure and of pain lower still,
in their general cerebral cent

Below the centre of the cerebral system is that of the spinal sys-
tem, and its analogue in the aiticulata, &c. The spinal centre
includes the medulla oblongata and medulla spinalis. It may be
divided into

1. The Medulla Oblongata, the spinal centre principally of the
acts of ingestion and of egestion, by which the preservation of the
individual is effected, and especially those of deglutition, respira-
tion, <kc. With this centre, the pneumogastric, the diaphragmatic,

162 On the Spinal System and its Diseases [March,

&c, of such momentous importance in these acts, are essentially
linked ;

2. The Brachial Enlargement;

3. The Femoral Enlargement ; and,

4. What, I think, may be designated the Lower Medulla Ob-
longata, the analogue with its nerves of the organs of generation,
of the upper with its pneumogastric ; and the spinal centre in the
acts for the perpetuation of the species.

In each of the acts of ingestion and egestion to which I have
alluded, there is the essential agency of a diastaltic spinal arc.
The pharynx and larynx are excited by eisodic and exodic
branches of the pneumogastric; the pneumogastric is the internal
excitor of inspiration, acting through the spinal centre and the
diaphragmatic and intercostals.

Similar diastaltic nervous arcs constitute the nervous media
through which emission, conception, parturition, &c, are effected.
In all these are nervous origins in exciting surfaces, an eisodic
nerve, the spinal centre, an exodic nerve, and muscular termina-
tions. The law of action, the mode of action, the channel of action,
are in all identical or similar. All have the same object or ob-
jects ingestion, retention, egestion, exclusion.

Can anything be more simple and scientifically beautiful ?

All these acts are physical. As the cerebral acts depend on
the immortal ^X^i these depend on the via nervosa ; as those re-
late to external objects psychically viz., to objects without, these
relate to them physically, acting from without to within, and from
within to without.

The spinal centre, with its nervous arcs, and the muscles in
which these terminate, are the dynamic agents which accomplish
that " tourbillon" so eloquently described by Cuvier.

The ganglionic system relates to all that is within, governing the
peristaltic actions, assimilation, the secretions, the excretions, kc.

But of these functions, I must treat as cursorily as I have done
of the cerebral system.

They are greatly under the influence of emotion, and of sympa-
thetic or synergic action through the spinal centre. We have only
to observe the effect of derangement of the stomach, or of eroded
viscera, on the action of the heart, the skin, &c, in connexion with
experiment, to arrive at this conclusion.

The experiments to which I allude are the following : Let the
head be removed in a frog, the spinal marrow remaining, and the
circulation be ready to fail : if we now crush the stomach or a limb
with a hammer, the action of the heart ceases. Let the conditions
be the same in another frog, with the addition that the spinal mar-
row is also removed : in this case, no influence is perceived, on
crushing a limb or the stomach, on the action of the heart. Now,
the difference is the presence of absence of the spinal centre. This
experiment, however, requires careful repetition.

Now, gentlemen, I think I may hope that you have a sound

1855.] On the Spinal System and its Diseases. 163

knowledge of the spinal system, as far as it extends ; for it is
founded on experiments which your own eyes have seen, and
which I think you will not forget. A

As in the present lecture I have brought before you the Anato-
my and Physiology of that system, I propose, to-morrow, to treat
of its Pathology.

You will, if I am not mistaken, find your knowledge of the spi-
nal system the key to the diagnosis of the diseases of the nervous
m. It is to these, in some degree, what the Stethoscope is to
f the heart and lung, the administration of a new kind
of knowledge being as that of a new mode of observation ; and if
to know the disease is not half the cure, it is the whole of the treat-
ment.

-.norrow evening, then, I propose to discuss the subject of the
j.ses of the Spinal SysK .

LECTURE II.

THE PATHOLOGY AND MODES OF DEATH IX DISEASES OF THE SPI-
RAL SYSTEM.

Gentlemen, ted at the close of my former lecture, I now

proceed to "bring before you the Pathology the living Pathology,
the Physiology, of the Diseases of the Spinal System.

Already I h that the spinal system is the source and seat

of the Class of Convulsive D gst these, Infantile Con-

but especially Epilepsy, take the
chief rank.

Epilepsy has received a variety of designations, such as morbus

morbus Herculeus, expressive of its formidable character. It

mg been regarded as the opprobrium medicorum. Even

Esquirol, in his excellent wo. ientales," ex-

rd to it in the following terms :

"Lea synitomes de l%)ilepsie sont tellement extraordin aires.

tellement au-c tion physiologique ; les causes

de cette maladie sont tellement inconnues, que,"

.1 almost afraid, after making these statements, to say what
v own views of this formidable malady, the result of my own
labours. And yet I may not withhold the truth. I will therefore
frankly tell you that I regard this opprobri corum as removed

er. I think no disease is better understood, in its physiolo-
gy or pathology, since the detection and application of the Spixal
-than Epilepsy ! It consists, in fact, of Direct, or Keflex
Action, and dire Effec

I am not blind to the many obscure points in the pathology of
.id the other tormidable diseases of this class. But in what
department of medicine is there not much still left for the phy-
sician to discover ? It is in their comparison with other diseases
that I regard the inexplicable epilepsy as no longer inexplicable.
I must commence my explanation by drawing your attention
to three most important physiological facts:

164: On the Spinal System and its Diseases. [March,

If we puncture or lacerate, or otherwise injure the cerebrum or
cerebellum, or the cerebral nerves of special sense, in every possi-
ble manner, we observe no results, no phenomena, no expression of
pain, no excited movements.

The cerebral system in all its parts is, in this respect, inexplica-

But if we touch any part of the spinal system, and especially
the spinal centre, with the point of a needle, ever so slightly, there
are immediately excited muscular movements, spasm, convulsion.

The spinal system is, in all its parts excitor, excito-motor.

These important facts constitute the foundation of all our knowl-
edge of the diseases of the nervous system, and are the very source
of all diagnosis in regard to them.

For the same facts, as is proved by clinical observation, hold in
regard to the human subject.

By experiment and by observation, then, we are led to these
conclusions :

No lesion of the cerebral system, limited to the cerebrum, can
be attended by spasm or convulsion.

No structural lesion of the spinal system, short of destruction,
can occur without exciting spasm or convulsion.

If, in affections of the cerebral system, we observe spasm or con-
vulsion, it is because it is not limited, in itself or in it* effects, to
the cerebral system. Thus, congestion of the centre of the cere-
bral system may, as in hanging, become extended to that of the
spinal system, and then spasm or convulsion supervenes.

Or affections of the spinal centre may consist in gently applied
pressure, not in lesion of tissue, and then paralysis, and not spasm
or convulsion, will be observed. Or it may consist in sudden or
violent shock, or utter destruction, and then, I need scarcely say,
that paralysis, and not spasm or convulsion, will occur. All this
we have seen demonstrated by experiment ; all this you will see
hereafter in your observation in the clinical, and especially the
surgical, ward.

What a means of diagnosis, then, have we obtained by these
simple physiological facts ! How has physiology become our guide
in practice !

I have thus explained to you, gentlemen, how disease of the
cerebral centre may, by pressure downwards, affect the spinal
centre. But another question arises: How does a disease of the
spinal system, as a pure convulsive malady, affect the cerebral ?
for such is the frequent event, as we observe in epilepsy.

Observe what occurs in the most marked cases of this dire mala-
dy. The head becomes fixed, or there is torticollis, by the action
of the muscles of the Neck, trachelismus ; the jugular and other
veins of the neck are compressed ; the capillary system of the neck,
the face, the intra-cranial structures congested ; the veins start,
the arteries throb ; the cerebral centre becomes implicated. All is
intelligible 1 All is explained !

1855.] On the Spinal System and its Diseases. 165

Affection of the centre of the cerebral system is extended to that
of the spinal system the medulla oblongata by downward pres-
sure : affections of the spinal system are extended to the cerebrum,
by trachelismus 1

That all this is so, is demonstrable. That it is always so, is, per-
haps, what I ought not, however disposed to do so, to assert. And,
gentlemen, does it not constitute a beautiful specimen of the phy-
siology of disease f But such is the whole of our recent views of
epilepsy and of the Class of convulsive diseases, as observed in
the clinical ward, to which I must now recur.

And first, pray observe with me an experiment or two.

I have removed the cerebral centre in this frog. Its spinal sys-
tem is still most lively and energetic. I take and rub the toe be-
tween my thumb and finger ; }-ou observe the almost convulsive
movements produced : I now touch the upper part of the spinal
centre with this needle : the animal is thrown into the most vio-
lent convulsions 1

Gentlemen, these experiments are types of disease ; they are the
types of epilepsy and other convulsive diseases.

The first is the type of ex-centric epilepsy :

The second is the type of centric epilepsy.

For the first was induced by an excitant applied to a part of
the spinal system at a distance from its centre ; the second to that
centre itself.

So it is in epilepsy ; so it is in convulsive diseases generally, in
the human subject ! Do not these simple and illustrative facts
interest you ? They are of the deepest interest.

Do you not now perceive how dentition, and gastric and enteric
and uterine irritatioD, may excite spasm or convulsion, even epi-
lepsy ? And do you not now perceive that ex-centric epilepsy
is no more an opprobrium medicorum than infantile or puerperal
convulsion ; for that it is equally intelligible?

You see again the violent convulsion which I excite by again
touching the spinal centre in this frog by this needle.

Such is the dire state of tilings in centric epilepsy, whether this
be of organic origin, or have become organic in its course ; whether
it be congenital, on one hand, or inveterate on the other.

The cases of epilepsy which occur in private practice are, for
the most part, oft r or ex-eentric kind, and curable; how-

ever, for many . difficult to' cure. The cases which we see

in the lunatic asylum, and especially in the work-house, are gen-
erally centric, and must I not add? too generally incurable.

Allow me t ation to this Table. It has cost me

much labour: ins in a page, a volume. You will find

it in The Lancet for 1850. Procure it. or i . and study it

well. For, allow me to say, I know of no such n of this

most interesting pathology. The chain of events in epilepsy and
other convulsive diseases, is pursued in it, link by The causes

are arranged in this first column, the principles and modes of

2C. 8. -VOL. XI. NO. III. 11

166 On the Spinal System and its Diseases. [March,

treatment in this last ; the rationale, the various stages, forms, and
complications in the intermediate ones. It would occupy us too
long were I to enter into its details. I have only time for a rapid
sketch.

The ex-centric causes act on eisodic nerves, thence on the spinal
centre, and thence along exodic nerves, on the various muscles.
Of these, fewr many, or all may be affected, and the malady may
be the very slightest or the very direst. Amongst the rest I was
about to sayr chief amongst the rest are the muscles of the Neck
and of the Larynx.

By the contraction of the muscles of the neck the veins of the
neck are compressed, as I have already noticed ; and the extra-
cranial and intra-cranial tissues and organs become affected with
venous congestion and all its consequences. Nay, I am disposed
to say that, in every case in which there is such venous congestion
of the necky face, eyes, brain, it arises from this trachelismus, latent
or evident. I do not wish you, however, to adopt this opinion
without examination ; but rather to subject it to a most careful
investigation for yourselves.

By the contraction of the muscles of the larynx in laryngismus
this vital inlet to the respiration T combined, as it usually is, with
breath-struggles, I believe the direst form of epilepsy, with its direst
effects, as coma, mania, dementia, &c.r to be produced.

I do not say that these effects may not arise in cases in which
there is only trachelismus and no laryngismus ; but I am convinced
that they are chiefly the effects of laryngismus ; and hence they
have subsided in cases in which the laryngismus has been disarmed
by tracheotomy, as I shall have to state at length in my next lec-
ture.

And now, gentlemen, you perceive in what sense epilepsy may
be regarded as a cerebral disease. Cerebral in its very origin it
can never be. It may be intra-cranial in its origin, because within
the cranium there are many tissues, as the membranes, from which
eisodic nerves arise, many eisodic nerves, the fifth especially, pur-
suing there a part of their course ; and the medulla oblongata,
all which may be excited by the presence of an exostosis, a tumour,
a variety of diseases. But I repeat that no disease of the cerebral
centre, limited to that centre in itself and its effects, does or can
produce epilepsy. Yet every day we read in medical writings of
affections of the cerebrum inducing epilepsy. Shall I give you
an example of this ? For once I will relinguish the gravity of my
subject, and present you with a specimen of modern pathology, so
called " I hold (I) that the peculiar features of an epileptic seizure
are owing to the gradual accumulation of morbid material in the
blood until it reaches such an amount that it operates on the brain (I)
iny as it were, an explosive (!) manner. In other words, the influ-
ence of this morbid matter, when in sufficient quantity, excites a
highly -polarized (!) state of the brain," &c, &c.

If such feebleness existed alone, I would not add another word.

1855.] On the Spinal System and its Diseases. 167

But I am constrained to add that this feebleness is associated in
the author whom I have quoted with at least an equal degree of
malignity, and in him assuredly the odium medicum is not extinct.

Exciting causes : the Spinal system ; the Neck ; the encephalon ;
such are the links of this chain of pathology. There remains
another to which I must now draw your especial attention : it is
the medulla oblongata, with its pneumogastric nerve.

I have already adverted to laryngismus as giving to epilepsy,
and convulsions generally, its most formidable character. This
form of laryngismus is spasmodic or convulsive, excited through
the spinal system.

But there is another form of laryngismus. After a severe epi-
leptic convulsion, the patient is left in a state of coma, or, as it
may be termed, of simple apoplexy. This condition may prove
fatal. The respiration becomes stertorous that is, there is laryn-
gismus. But this laryngismus is very different from that formerly
described : it is less complete, but more persistent ; it is, indeed,
permanent ; some one said, in rather familiar phrase, " The patient
snores his life away." This laryngismus is not, like the former,
spasmodic, but paralytic. It is owing to compression or conges-
tion an apoplectic state of the medulla oblongata, and paralysis
of the pneumogastric nerve, in which every branch, as well as the
recurrent laryngeal, is implicated.

Apoplexy of the medulla oblongata ; paralysis of the pneumo-
gastric nerve ! Gentlemen, did you ever hear of these expressions
before ? If, then, I demonstrate these things to you, you will not
have assembled here and listened to me in vain.

Legallois the illustrious Legallois divided the pneumogastric
above the origin of the recurrent. The larynx became partially
closed. The breathing was stertorous. In a word, every phe-
nomenon was obscured which I am about to describe to you as
occurring in the coma or simple apoplexy observed after a severe
epileptic seizure.

And what do we observe ? We observe paralytic laryngismus,
impeded respiration, augmented apoplexy ; we also observe or
rather, I have observed a diffused bronchial rattle, the effect of
paralysis of the bronchial and pulmonary branches of the pneu-
mogastric !

Here a most interesting phenomenon presents itself. The cere-
brum is not essential to life. How then does apoplexy, simple,
cerebral apoplexy, destroy life ? It does not do so. Apoplexy
only destroys life when, by its congestion by downward pressure,
it implicates the medulla oblongata and its pneumogastric nerve.
It is by the apoplexy of this medulla and the paralysis of this
nerve, that life is, in effect, destroyed !

Generally the patient dies of paralytic laryngismus, or of laryn-
geal asphyxia. From this danger he is rescued by early trache-
otomy.

But if tracheotomy be performed, but performed too tardily, the

168 On the Spinal System and its Diseases. [March,

patient, however saved from laryngeal asphyxia, dies of bronchial
asphyxia !

But I am anticipating the subject of the lecture of to-morrow.

There are other branches of the pneumogastric nerve the car-
diac and the gastric. The heart and the stomach participate in
the paralysis of the general pneumogastric.

The observant physician will observe palpitation as a symptom
in some cases of epilepsy. This is explained by excitement of the
cardiac branches of the pneumogastric.

In other cases, there are hiccup, eructation, acidity of the stom-
ach ; the effects of the excitement of the gastric branches of this
composite nerve.

As in these cases there is morbid action in the heart and stomach,
so in deep epileptic coma there is failure of the powers of these
organs.

The pneumogastric nerve is not more involved in epilepsy than
in other convulsive diseases. All the phenomena just described
as observe in the former, are again met with in the latter, only, of
course, modified by the exciting causes, and the conditions of age
and sex.

In infants there is the same or similar action of the muscles of
the neck, and of the larynx and respiration. In puerperal con-
vulsions the symptoms are identically those of epilepsy.

There is a form of epilepsy which I have not yet noticed. It is
the epilepsia syncopalis. The patient, instead of turning purple,
turns pale and ghastly. Sometimes this syncope is fatal !

So it is in the laryngismus stridulus of infants. The little pa-
tient not unfrequently dies suddenly too suddenly to be the effect
of asphyxia. The case of cardiac, syncopal.

Both these cases are affections [shocks f] produced through the
medium of the pneumogastric nerve.

But, gentlemen, you remember that I spoke in my lecture of
yesterday, of a lower medulla oblongata, and of a lower analogue
of the pneumogastric. These, too, are influenced by the convul-
sive seizure.

The larvngismus stridulus is frequently excited by enteric irri-
tation. This is also frequently attended by fret of the bladder.

Epilepsy is frequently induced by enteric and uterine irritation,
and is sometimes attended by involuntary evacuations of the blad-
der, rectum, &c.

The urine is frequently morbid in both cases.

There is something in all this analogous to the modes of action
of the medulla oblongata and the pneumogastic nerve.

It is obvious that both these portions of the nervous system
form one. Both are liable to be affected in one and the same
convulsive seizure.

Perhaps the lower portion of this system is most clearly isolated
in what relates to Obstetrics. To excite the cervix uteri is frequent-
ly to excite abortion. To excite the cervix uteri during parturi-

1846.] Reciprocal Influence of the Physical Organization, <c. 169

tion is to excite the uterine efforts. But to excite the cervix uteri
during parturition, is, also, frequently to excite a puerperal con-
vulsion ! These are facts familiar to every experienced pratitioner.
They are proofs that "a meddlesome midwifery is bad.''

Other facts of the same kind are constantly elicited in practice :
to excite the rectum, by the pressure of the fingers backwards,
excites uterine action ; and it is well known that the excitement
of the internal surface of the uterus by the hand, introduced in
certain forms of haemorrhage from inertia, excites the uterus to
energetic contraction.

All this is accomplished through the lower medulla and its ana-
logue of the pneumogastric.

I think that a subject very inscrutable hitherto will receive
elucidation from these studies that of sterility, inertia of the
uterus, kc. &c

The influence of the nerves and passions, with their course of
action, their seat and their destination, their physiological and their
pathological relations, forms also a most interesting subject of in-
quiry a subject however, to which I can only slightly allude on
this occasion.

One point I wish to notice, in conclusion. I have, I trust, in
unravelling the mystery of epilepsy, removed one of the opjyro-
bria noedicorum. I hope, in my lecture to-morrow, to rescue this
malady from the domain of empiricism, whether within or without
the ranks of our profession.

(To be continued.)

Considerations on the Reciprocal Influence of the Physical Organiza-
tion and Mental Manifestations. By A. O. Kellogg. M. D.

ox the importance of a certain amount of physiological,
Pathological and Psychological Knowledge to Parents
and those engaged in the education of youth.
It is only within the last few years that the importance of phy-
siology as a branch of popular education has been duly recognized,
and even now, in most instances, it is assigned a secondarv place,
while others of far less practical importance, and sometimes even
of doubtful utility, sanctioned by the usages and customs of past
years, are clung to with an avidity disproportion ed to their intrin-
sic merits, and incompatible with the progress of the age in which
we live. It is not intended, in these articles, to cast disparagement
upon any branch of popular education now in use in the schools,
but to call the attention, particularly of those engaged in the edu-
cation of youth, to others which have been too much neglected,
and which experience and the present state of science have shown
to be of equal, if not of paramount importance. The great mis-
take into which parents and teachers of the present day are apt to
fall, is to suppose that the chief business of education is the de-

170 Reciprocal Influmce of the Physical Organization, &c. [March,

velopment of mind considered in the abstract, and to disregard
that material medium through which alone it manifests itself. A
system which would lead to the view of mind in the concrete, and
which aims at the development of the whole man, physical, moral
and intellectual, is the only system in harmony with nature, and
the one calculated to bring about the greatest amount of good. It
is somewhat surprising that, while almost all other branches of
physical science have been seized upon with avidity and cultivated
successfully, not only for their practical usefulness in the conduct
of life, but as a means of mental development, that, while meta-
physical science, in all its dark wanderings, has been implicitly
followed as the only guide to a correct understanding of mental
manifestations, so little attention has been given to the physiol-
ogy and pathology of the brain as the organ of these operations,
which, by its varying states of health and disease, its original per-
fection or imperfection is ever influencing them. Gregory Mys-
sen, speaking of the different kinds of dreams, observes, "the
brain may not inappropriately be compared to a stringed instru-
ment, which, while its various keys are properly tuned, vibrates
harmoniously ; but, as soon as they become relaxed, or screwed
down, nothing but discord is produced." Looking upon the brain,
not as a unit, but as a congeries of organs, each subservient to some
faculty of the mind, this comparison becomes particularly appro-
priate. Through these organs mind manifests itself, more or less
powerfully or efficiently, according to their original and innate
perfection, or their present depraved or comparatively perfect con-
dition, as they may have been influenced by disease, education or
other circumstances. In many cases this organism is so defective,
as in congenital idiocy, as to derange entirely all the mental oper-
ations, and but from the partially successful results of the labors
of MM. Yoisins and Valee, of the Bicetre Hospital, Paris, and some
others in the U. States, and elsewhere to preclude all hopes of
ameliorating their unfortunate condition by the cultivation of their
imperfect faculties.

In others the organism is so delicately wrought, so exquisitely
"toned," as to leave us in doubt where the physiological condition
ends and the pathological commences; this state is compatible
with the highest order of mental manifestations, the loftiest nights
of imagination, and the most sublime conceptions of genius.

Dryden's lines, so often quoted, express a pathological fact which
cannot be doubted, when we take into consideration the physical
organization of many a child of genius:

"Great wits to madness closely are allied,
And thin partitions do their realms divide."

Individuals of this order occasionally work and sojourn with us
for a brief space in this our sublunary existence, and their brief
history which consists in being seen, admired and mourned is
soon told ; for the restless spirit that " divinity which stirs within
them " soon frets away its trail and o'erwrought tenement, and

1855.] Reciprocal Influence of tlie Physical Organization, &c. 171

insanity soon casts over their brilliant intellects the shadow of its
dark wing; or scrofula, in some one of its protean forms, lavs their
bodies in the dust, and the spirit passes away unincumbered to a
more congenial communion of the u spirits of the just made perfect"
in the realms of light and life.

Cowper, Keats, Pollock, Kirk White, and many others whose
names might be mentioned, were beings of this order ; but, cer-
tainly, the most remarkable examples of precocious genius, allied
to that extreme delicacy of organization and excitability of the
nervous system which, if not a pathological condition, perse,
passes into it almost imperceptibly have occurred in our own
country within the last few years.

We refer to the two sisters, Lucretia and Margaret Davidson,
whose cases, for various reasons, seem to call for something more
than a passing notice. These young ladies were the daughters of
Dr. Oliver Davidson, of Plattsburgh, New York. The mother,
from whom, undoubtedly, they inherited their delicacy of organi-
zation, is described as a woman of ardent temperament and un-
commonly susceptible feelings. Lucretia was born in 1808, and
died of consumption at the early age of 17, leaving behind her, in
the amount of true poetry she has written, a monument to her
genius seldom equalled and never excelled by one removed at so
early an age. Dr. Southey, in the Quarterly Review, speaking of
her poems, says, u There is enough of originality, enough of aspi-
ration, enough of conscious energy, enough of growing power, to
warrant any expectations, however sanguine, which the patrons
and the friends and parents of the deceased could have ibrmed."
Her susceptibilities were so acute, and her perceptions of beauty
so exquisite, as to cause her to faint when listening to some of her
favorite melodies from Moore. Yet, notwithstanding this serious
impression, she would beg to have them repeated, so delicious were
the sensations produced. Her father, though a medical man, seems
not to have looked upon this as a symptom or manifestation of in-
cipient morbid action ; for we are told, "as soon as she could read,
her books drew her away from the plays of childhood, and she
was constantly found absorbed in the little volumes her father la-
vished upon her. Notwithstanding, as appears from one of her
later poems, she herself seemed conscious how near her mental
condition bordered on insanity. We quote the lines referred to :

" There is something which I dread,

It is a dark and fearful thing,
It steals along with withering tread,

And sweeps on wild destruction's wing

That thought comes o'er me in the hour

Of grief, of sickness, or of sadttess ;
'Tis not "the dread of death 'tis more,

It is the dread of madness.

O may these throbbing pulses pause,

Forgetful of their feverish course!
Mav this hot brain, which burning glow

With all a fiery whirlpool's force,

172 Reciprocal Influence of the Physical Organization. &c. [March,

Be cold, and motionless, and still,

A tenant of its lonely bed;
But let not dark delirium steal"

Here the poem, so expressive of the fearful workings of the spirit
within her, ends abruptly.

The education of this young lady appears to have been of that
character best calculated to develop the intellectual at the expense
of the physical powers, and to bring about the melancholy result
which was so soon realized a system too commonly pursued in
similar cases, it is to be feared, at the present day. Instead of
keeping her at home, and inducing her to forego, in a measure, her
intellectual exercises, to roam the fields and enjoy communion
with nature in the free air of heaven,' to take exercise on horse-
back, and all other means calculated to strengthen her physical
powers, and overcome a scrofulous taint of the system, the parents,
proud of her extraordinary intellectual endowments, readily yield-
ed to the suggestions of a friend, who, like themselves, only saw
in her a mind which needed cultivation to develop the highest or-
der of powers overlooking the delicate physical organization to
which it was linked and placed her in a celebrated female semi-
nary. Here the intellectual exercises she was compelled to under-
go served but too rapidly to develop the germ of disease already
sown, and caused it to grow with fearful rapidity. These and
their deleterious consequences to herself and others similar to her
in delicacy of constitution, are so admirably set forth in her verses
on the "Examination," that we transcribe them:

\ m One has a headache one a cold,

One has her neck in flannel rolled,
Ask the complaint, and you are told,
'Next week's examination !'

One frets and scolds, and laughs and cries,
Another hopes, despairs and sighs,
Ask but the caause, and each replies,
'Next week's examination/'

One bans her books, then grasps them tight,
And studies morning, noon and night,
As though she took some strange delight
In these examinations.

The books are marked, defaced and thumbed,
The brains with midnight tasks benumbed,
Still all in that account is summed,
' Next week's examination !' "

This could not last long, and in less than six months, according
to the memoir, she was taken home in a dying state._ Death, who
loves a shining mark, had already selected his victim ; and con-
sumption, his most faithful ally the insatiable foe, the implacable
enemy of all that is lovely and pure, and beautiful and gifted, had
stolen his march upon her and seized and loosened the silver
cord which bound her to the earth. The skill and kindness of her
father, the affectionate tenderness of her mother, were of no avail.
That kingdom which "cometh without observation" had been

1855.] Reciprocal Influence of the Physical Organization, &c. 173

early set up within her, and she was soon to put off the habili-
ments of her earthly tabernacle, in which she had sojourned but
for a brief space, to be "clothed upon by that which is from
heaven."

Here we draw the curtain over this sad picture of the unequal
struggle between the intellectual and physical powers, to pass to
the consideration of another, no less melancholy, no less interest-
ing.

Margaret Miller Davidson, sister to the above, appears to have
possessed the same delicacy of organization, the same fine- wrought
sensibility of the nervous system, together with that scrofulous
taint of the system which belonged, in so marked a degree to her
sister.

Notwithstanding her education appears to have been more judi-
cious than that of her sister, still it was insufficient to prevent the
early development of the germ of disease she had inherited, favored
as this was by that incontrollable bias towards extraordinary men-
tal exertion, which must have reacted with fearful effect on the
natural delioacy of her organization. In illustration of the won-
derful activity of the child?s mind, we quote the following anecdote
of her : " During a visit to New York, the young poetess, having
engaged herself for a private theatrical scheme, agreed to write a
play. Several days had been spent in preparing dresses, scenery,
and other accessories, when she was called upon to produce the
play. '0!' she replied, ' I have not written it yet. The writing
of the play is the easiest part of the preparation ; it will be ready
before the dresses.' And in two days she produced her drama,
"The Tragedy of Alethea,' which, though not very voluminous,
contained enough of strong character and astounding incident to
furnish a drama of five times its size."

Notwithstanding the ease with which she said this could be
done, still it could not have been accomplished by one so young
without a fearful expenditure of vital power, and a constant repe-
tition of this could but serve to hasten the fatal issue. Consump-
tion, the old enemy, made its appearance, and in spite of all efforts
to ward off the attack, she sank under its blighting stroke in Nov.,
1838, aged 15 years and 8 months. The predisposition to con-
sumption in these young ladies was so strong that it would
undoubtedly have developed itself at some period of life, had the
mental activity been less marked. But instances of death from
this disease at so early an age are comparatively rare, and are in
most instances the result of some marked exciting cause. Had
they even possessed far less mental activity, but been subjected
unwillingly to a severe task- masters, or to the rigid discipline of a
boarding-school, and excited by a laudable ambition to excel at
an examination, possessing at the same time that natural delicacy
of organization and predisposition to disease, the result would, in
all probability, have been the same. Here, however, the innate
love for mental excitement that insanabile cojcowthes scribervdi

174 Reciprocal Influence of 'the Physical Organization, &c. [March,

was a sufficient task-master, and no rigid disciplinarian was re-
quired to goad them on to destruction. But these cases, detailed
above, form an exception to a general rule.

We more frequently meet with youth of the same delicacy of
organization and predisposition to disease, but whose restless
activity and propulsive energy of character manifests itself in a
different way, impelling them to physical rather than mental ex-
ertions ; not that they are incapable, by any means, of extraor-
dinary mental efforts, when urged upon them, for they master the
tasks of their teachers without any apparent effort ; but to them
the only true science is the science of gymnastics, and the only
true poetry the "poetry of motion." Their nervous excitability
and natural buoyancy of feeling must break forth in some way,
and most happy is it for the proper development of their physical
organization, if this is only restrained within due bounds. The
great mistake which parents and teachers of such youth are apt to
commit is to suppose that, without rigid restraint, too much valu-
able time is lost which should be devoted to the cultivation of
the understanding, naturally so active and brilliant. But the
understanding, in these cases, aside from that rigid system of task-
ing and forced development too common, we fear, at the present
day, seems, with proper and judicious direction, to develop itself
almost intuitively. Such a mind, in the expressive language of
Carlyle, "unfolds itself and becomes, in some tolerable degree,
what it is capable of being." Let us not be understood as apply-
ing this to all cases : the peculiar organization, physical and mental,
to which these remarks are intended, we have attempted to point
out ; and teachers, to discriminate correctly, must study the char-
acter and peculiarities, mental and physical, of those committed to
their care, assisted in this by a certain amount of physiological and
pathological knowledge.

There is no disease we more frequently encounter, in connec-
tion with precocious mental manifestations, than scrofula; and it
has been observed by some of the most intelligent and enlightened
physicians of our country, that these affections, whatever form
they assume, become exceedingly intractable, and generally result
in the destruction of some one or other of the physical organs
necessary to life, or so modify their healthy action as to render
them peculiarly susceptible of disease; and when this diseased ac-
tion is once established, their vital energy is so modified that they
readily succumb. The late Dr. Brigham,* in his excellent little

* The personal history of this accomplished writer and eminent philanthropist
furnishes one of the most striking illustrations of the truth of the doctrines he so ably
discussed up to the time of his death, which took place just as he was passing the
meridian of his days, deeply regretted, not only by the profession of which he was a
brilliant ornament, but entire humanity, and particularly that branch of it devoted
to the care and treatment of the insane. His life, from the cradle to the grave, was
emphatically a life of ceaseless activity. During the latter years of it, while con-
nected with the large establishment for the insane at Utica, no duty which he could
discharge himself, and no responsibility he could assume, was ever delegated to

1855.] Reciprocal Influence of 'the Physical Organization, Jrc. 175

work on "The Influence of Mental Excitement and Cultivation
on Health," has some remarks on this head that are so apposite
that we deem no excuse is necessary for transcribing them.

"Dangerous forms of scrofulous disease," says he, "among
children have repeatedly fallen under my observation, for which
I could not account in any other way than by supposing that the
brain had been excited at the expense of other parts of the system,
and at a time of life when nature is endeavoring to perfect ail the
organs of the body ; and, after the disease commenced, I have seen,
with grief, the influence of the same cause in retarding or pre-
venting recovery. I have seen several affecting and melancholy
instances of children, 5 and 6 years of age, lingering awhile with
disease from which those less gifted readily recover, and at last
dying, notwithstanding the utmost efforts to restore them. The
chance for the recovery of such precocioiis children is, in my opin-
ion, small, when attacked by disease ; and several medical men
have informed me that their own observations have led them to
form the same opinion, and have remarked that in two cases of
sickness, if one of the patients was a child of superior and highly
cultivated mental powers, and the other one equally sick, but
whose mind had not been excited by study, they should feel less
confident of the recovery of the former than the latter. This
mental precocity results from an unnatural development of one
organ of the body at the expense of the constitution."

The above is in accordance with my own observations during
an active practice often years. [American Jour, of Insanity.

another: from the investigation of the most intricate of the many hundred cases of
mental alienation which were daily presented to him, down to the construction of
the simplest mechanical contrivance for the benefit of his patients, all must pass
under his own immediate supervision. In answer to a remark of the writer, that
unless he relaxed his exertions, he would, at no distant day, furnish an eminent
illustration of the truth of his doctrines in his own person, he replied that he must
work, and without labor he was unhappy.

This ceaseless activity, mental and physical, reacting upon a constitution natural-
ly delicate, kept him in a constant state of ill health; yet he had no time to be sick,
and the labor he accomplished in this state was truly astonishing. No one knew
better than himself what must be the natural and inevitable result of such an expen-
diture of bodily and mental force, or has more truthfully described it ; yet, to make a
practical application of it to his own case he could not, so absorbed was he in his
labor of love, and the fulfilment of his mission of good to his suffering fellow-crea-
tures.

But he stood
'Gainst that invisible and fellest foe
Who striketh reason throneless, and the world
Beheld him in his meek benevolence
Seeking the lost, and on the broken mind
Graving the name of healer.

And he continued to stand till his physical organization was completely worn out,
and fell with his armor on, doing battle nobly '"gainst the invisible foe " he had
combated so long and so successfully and when the last enemy, dread and invinci-
ble, met him, he was found ready to yield up cheerfully to others that trust he had
kept so faithfully himself into the hands of his Maker, and enter into his everlast-
ing rest.

176 Illustrations of the Treatment of Fractures, &o. [March,

Illustrations of the Treatment of Fractures by the Starched Apparatus,
By John Zachariah Lawrence, Esq., Surgeon to the North-
ern and Farringclon Dispensaries ; late House-Surgeon to the
University College Hospital.

It is not long that a very excellent treatise on this subject eman-
ated from the pen of one of our most distinguished pupils, Mr.
Gamgee. Yet the starched apparatus does not seem to have gained
that ground in the London Hospitals that it so eminently deserves.
The main objection I have invariably found Surgeons raise against
its immediate application to recent fractures, is the danger of mor-
tification that they suppose is incurred in the adaptation of a tight
bandage to a part likely to become the seat of swelling. But
those gentlemen seem to entirely lose sight of the essential differ-
ence that exists between the dead pressure of a bandage applied
directly to a limb, and the same pressure exercised through the
medium of a yielding elastic layer of cotton- wool, as it is in the
starched bandage. That sloughing will, in rare instances, occur
from causes that are often not very appreciable, is perfectly cer-
tain. A remarkable illustration of this occurred to myself. Two
young children were, in the early part of my career as House-
Surgeon, brought on the same day with the same accident, viz.,
fracture of the femur. Both were treated as out-patients, with the
starched apparatus. One made an excellent recovery within a
month ; in the other, extensive sloughing of the foot and anterior
part of the leg followed ; on the separation of the sloughs the ex-
tensor tendons were found laid bare, the ankle joint opened into,
and the first phalanx of the great toe necrosed ; all this while the
child became emaciated to the last degree, got incessant vomiting,
and an attack of bronchitis ; indeed, for some time its life was in
such jeopardy, that I recommended amputation below the knee as
the last resource ; the parents, however, would not consent to this
procedure, and as far as the ultimate result is concerned, proved
themselves the better judges. After a time the child gradually
began to regain flesh, and the wound to cicatrise over, the necrosed
phalanx coming away in the discharge. At the moment I write
the child is strong and hearty. The condition of the leg and foot
is as follows. The only portion of the cicatrix that retains the
character of scar, is a narrow line, extending down the outer side
of the leg to the front of the ankle-joint ; this has recovered the
freest possible mobility. Where the phalanx detached itself, short-
ening of the great toe has occurred, but a perfect false joint has
established itself between the metatarsal bone and the remaining
phalanx. The only permanent deformity is some loss of substance
of the soft parts of the lower half of the leg. The sole of the foot
rests entirely on the ground, when the child stands ; but the whole
of the foot is slightly turned in. No shortening of the limb has
taken place. I have thought proper to publish this case, from the
conviction that it is not by a report of selected cases, intended to

1855.] Illustration of the Treatment of Fracture*. Sd. 177

advocate any particular plan of treatment, that this latter is ad-
vanced, but onlv by a fair and open recital both of the lights and
shadows that it is ever likely to gain confidence. Independent of
anv reference to the subject in question the above case is a very
striking one, illustrating, as it does, in so remarkable a man-
ner, the high amount of reparative power enjoyed by the early
frame.

One of the main advantages this plan of treating fractures of
the lower extremity affords is, that it obviates that long, exhaust-
ing confinement in bed, which the ordinary plans of treatment
imply. This disadvantage is not felt in fractures of the upper
extremity ; here all the starched apparatus has in its favour, is,
that it is' less irksome than wooden splints, and does not involve
that '-taking down" the fracture the latter every now and
then require. I have used it in fractures of the humerus, even
those implicating the elbow-joint, and found it answer welL
did in two or three fractures of the olecranon. But in fractures of
the lower end of the radius, both Mr. Hillier and myself were
obliged to relinquished its use. Our experience leads us to the
conclusion, that it is not adequate to maintain that efficient exten-
sion this class of fracture requires. "Whereas of the many cases I
have treated with the common pistol-splint. I have had only one
attended with considerable stiffness and immobility of the joint
after its removal. Patients express no discomfort from the pistol-
splint, and it would be injudicious to expose them to the chances
of a permanently painful and disabled limb for the sake of apply-
ing an apparatus which really in these cases can possess but little
advantages, or rather, as I am inclined to believe, great disadvan-
tages. At any rate, it should be employed with great caution in
these cases, only in very young subjects, and where there is little
or no tendency to any displacement of the fragments.

If there be any one class of cases in which the applicability of
the starched apparatus might, a priori, be more called into ques-
tion than any other, it is in oblique fractures of the femur, occur-
ring in strong muscular subject.-. A strong middle-aged working-
man was brought into the Hospital with an oblique fracture of
the femur, and the limb shortened to the extent of an inch. The
fracture was at once put up in the starched apparatus, with a tem-
porary long splint to maintain the extension made by assistants
till the apparatus should have dried. On cutting this up, the
shortening was found undiminished. Eesolved to give the starched
bandage a fair trial. I re-applied a new one, enforcing the most
thorough extension during its application, and maintaining that
extension for a while as before by the long splint. Yet, on cutting
up the apparatus, shortening of an inch still existed, and I was
forced to relinquish the starched apparatus, and have recourse to
the long splint. Within a month the fracture had united with a
firm callus, without any shortening; the patient could raise the
limb freely from the bed, but could not bend his knee much with-

178 Illustrations of the Treatment of Fractures, &c. [March,

out considerable pain. The long splint was now thrown aside,
and a starched apparatus applied from above the knee to the groin,
and the man allowed to get about the ward on crutches, and in
another fortnight walked out of the Hospital without any artificial
support whatever, having entirely lost all stiffness of the knee.
This case goes to show, that with no other means of keeping up
the extension than those employed, the starched apparatus will
not answer in a case of this description. It further illustrates the
importance of not maintaining the knee-joint confined longer than
is absolutely necessary. I was formerly in the habit, in all cases
of fracture of the leg, of carrying the paste-board splints some
inches above the knee ; and in cases of fracture of the femur, of
maintaining the apparatus from foot to groin to the end of the
cure. Last June, a woman was re-admitted into the Hospital,
after having previously been treated for a fracture of the femur in
this manner. At the time she came under my observation the
knee was swollen, stiff as cast-iron, and at times excruciatingly
painful. The boy, Thomas Ponfirit {Case IX. of Mr. Gamgee's
work), was an illustration of the same condition, though, no doubt,
here the seat of the fracture was the main cause of the unfortunate
result. I have seen several other instances of the same condition
in a less degree ; but the case of the woman first seriously attracted
my attention to the fact, more than once, however, previously
impressed on me by Mr. Quain ; and since then I have always
been in the habit of curtailing the splints to a little distance be-
low the knee, in about a fortnight after first putting up the frac-
ture in the starched apparatus. By this proceeding the efficiency
of the apparatus will be by no means impaired, and all chance of
a result happening avoided, which cannot but reflect discredit on
the Surgeon, and misery on the patient.

The following case may be taken as illustrating favourably the
application of the starched apparatus :

A woman of dissipated habits had fallen from the parapet of a
house on to some flag-stones from a height of some twenty or
thirty feet. Both femurs were broken, the right transversely, the
left obliquely, and her right shoulder-joint luxated under the
coracoid process. After some difficulty the luxation was reduced,
and both lower limbs put in the starched apparatus, two tempora-
ry long splints being applied. In the evening she began to ex-
hibit very decided symptoms of delirium tremens, which, however,
disappeared under the use of large doses of laudanum. When
the apparatus of either thigh was cut up the limbs were found
symmetrical and of equal length. A month after the accident
both fractures had consolidated with very large, strong, provisional
calli, and the two limbs were of the same length. A month after
the patient left the Hospital, and continued getting about with the
aid of a stick, but died about a year after the accident, from some
inflammation of the chest, aggravated, no doubt, by the unheard
of privations this poor woman suffered. Had she been in a better

1855.] Treatment of Tinea Tarsi. 179

class of life, no doubt she would have lived to walk about with
comfort.

It is in fractures of the leg that the starched bandage finds its
most advantageous application ; indeed, I have no hesitation in
saying, it is unequalled by any other form of retentive apparatus,
A half imbecile old man was brought into the ward with a severe
comminuted fracture of the tibia, and a simple fracture of the fibula.
He was treated successively with three different splints, viz., Mr.
Winchester's, M'Intyre's, and the fracture-box. Not one was
equal to keeping the fragments in quiet apposition ; and from the
continued irritation, the man got into a most dangerous typhoid
condition, when the starched apparatus was applied. Now, be it
mere coincidence or not, he recovered without a bad symptom, and
was discharged with the fragments united by a large firm callus.
In this case there was a great tendency to the protrusion of one
of the fragments of the tibia, through the skin ; and still more so
in another oblique fracture of the tibia that was treated very suc-
cessfully with the starched apparatus. Yet it is in this class of
cases that the greatest prejudice will be found to exist against its
use, " lest the fracture become compound." Now, I maintain,
from wrhat I have seen, that such a result is very much more likely
to happen from the mediate crucifixion of the broken member by
the M'Intyre splint than from the equable support afforded to it
by the uniform casing given by the starched bandage. Of the
many fractures of the leg I treated w^ith the starched bandage, I
may, before concluding, shortly advert to a case of Pott's fracture,
which did exceedingly well. A young man, thrown in wrestling,
got his ankle joint luxated outwards, and his fibula broken loosely
about three niches from the joint, and the lower border of the
inner malleolus splintered off. Two days after the accident he
was about in the wards, and in three weeks made an out-patient.
Fractures of the patella do very well if care be taken not to leave
off the extending back splint too soon. I saw a case which, this
precaution having been neglected, turned out very badly. Two
cases which are detailed in my note-books were attended with ad-
mirable results ; and I may say so with the more confidence from
having seen the patients several months after the receipt of the
injury.

I must state, that I intend the above remarks not as any detailed
clinical expositon, but rather with a view of bringing a plan of
treatment more prominently before the Profession, that they may
feel more universally inclined to test the powers of one of the most
admirable mechanical contrivances Surgery has produced. [Lon-
don Lancet.

Treatment of Tinea Tarsi.

The treatment which is the favourite at the Moorfields Royal
Ophthalmic Hospital in this troublesome diseaseT consists in care-

180 Croup. [March,

fully taking away all scales and crusts, and then rubbing the edge
of the lid with solid lunar caustic. The application must be re-
peated twice a week, and patiently continued. It is absolutely
necessary that all deposit be cleared away, so as to allow the rem-
edy to come in direct contact with the cuticle, the opening of the
hair follicles, orifices of the Meibomian glands, etc. If the treat-
ment be steadily persevered with, the redness subsides, the thick-
ening of the lid is removed, and the hairs previously destroyed
grow again. Mr. Critchett is accustomed to relate a case in which
a fair set of eyelashes were reproduced, after they had been absent
for many years. The disease appears to be much more frequently
secondary to measles than to any other affection, and its subjects
are generally more or less cachectic. It often varies remarkably
with the condition of the patient's health. Tonics are, therefore,
indicated, together with a liberal diet ; but it is well proved that
these, without local treatment, are not competent to cure the dis-
ease. At the Hospital for Skin Diseases, in several cases recently,
the hairs and their bulbs have been examined with the microscope.
It does not appear that any cryptogamic sporules are ever present,
the structure of the hair being healthy. In pulling out an eyelash,
the hair-sheath is generally brought away too, and on its exterior
are numerous pus and exudation-cells, showing that the inflam-
matory action has been external to the hair-sheath. In this res-
pect, the hairs resemble those of sycosis and of impetigo occurring
on hairy parts of the face. Mr. Startin's treatment consists in
smearing the edge of the lid every night with a mild mercurial
ointment, (ammonio- chloride, 10 grains to the ounce), and admin-
istering an arsenical tonic in combination either with iodine or
mercury. [Med. Times and Gaz.

Croup.

The American Medical Monthly for August and September
contains a long and interesting paper by Professor E. E. Peaslee,
on The PatJiology of Croup, as the Basis of its Rational Treatment.
The article gives evidence of much thought and research on the
part of its author, and we are sorry that we can do no more than
give a mere outline of his ideas of the pathology of the disease
and its treatment. This we do in his own words :

1. An inflammation of the larynx, extending into the trachea,
occurs ; offering in its essential nature nothing different from any
other case of inflammation of the same parts, either in the infant
or the adult. It is generally preceded, in both infants and adults,
by congestion and irritation, and therefore by catarrh.

2. An exudation of plasma occurs on the inflamed surface, as
in the adult ; this being most abundant, in the treachea, on the
posterior wall.

3. This exudation may be disposed of in at least two ways, pro-
vided it is not at once removed, as it generally is, in adults but

1855.] Croup. 181

not in infants, by conghing ; reabsorption probably very seldom
occurring in this disease, though it is not impossible.

a. It may become degenerated into pus (purulent matter), and
thus, of course, at once be detached, which is the most common
result.

b. It may become organized into a false membrane. This is
more probable if the blood is rich in fibrin (e. g. in a plethoric
child) ; if there is but little cough (an adult generally expelling it
thus), and if time is allowed for its development (less being re-
quired in the child than in the adult).

4. Croup is, therefore, merely a laryngo-tracheitis in infants and
children, and offers nothing essentially different from the same
inflammation in adults.* The exudation in case of adults is,
however, usually at once ejected by couging, or in the form of
purulent matter ; while the liability to its organization in infants
is greater ; though, after all, a comparatively rare result, consid-
ering the whole number of cases for the reasons before mentioned.f

5. Practically, therefore, as well as pathologically, we cannot
say with Bouchut : " Without a false membrane croup does not exist."
This membrane never exists till the inflammation the essential
element of the disease, as we believe has preceded, and has pro-
duced the exudation of plasma, as before shown. No sooner does
the catarrhal irritation merge into inflammation, than the plastic
lymph is thrown out ; J and this inflammation and its accompany-
ing exudation are the elements always present in croup.

We therefore need not, for any practical purpose, admit an
"inflammatory and a membranous" croup, as some writers have
done, any more than we should make the same distinction in re-
gard to pleuritis or peritonitis. All croup is inflammatory, at any
rate ; and a few cases are also accompanied by the formation of a
false membrane. But the latter should not affect the treatment of
the disease as an inflammation, but merely from its mechanical
effects, and cannot be predicated in any case till it is actually seen ;
and this is not possible in most cases in which it is developed at
the very onset of the disease.

Finally, we would drop the term croup entirely, and use the
term laryngo-tracheitis instead. In a work on the diseases of
children, we would call particular attention to the fact that a false
membrane is formed in about one-sixth of all the cases of this
disease ; while in adults, this is of very rare occurrence. But we
would not make an accident the distinguishing feature of this
disease, more than we do in the case of others, nor allow it to enter
into either our name or our definition of it.

* The idea of Copland and others, that the false membrane in infants is due to
a greater amount of albumen in the biood, is entirely without support.

tin Dr. Ware's " Contributions to the Hisiory and Diagnosis of Croup," false
membrane was found in only 22 cases out of 131, or about one-sixth of the whole.

X Hasse's Diseases of Organs of Circulation and Respiration, p. 277.

Dr. H. Green also holds this idea, though in different terms. See his work on
Croup, p. 13.

N. 8.- VOL. XI. NO. III. 12

182

New Instrument in Orchitis.

[March,

As in all other inflammations, so in this; the distinction of
"sthenic" and u asthenic'7 is important, both in a pathological
and a therapeutical point of view. So far also as laryngismus
enters into any particular case and it does into all cases of true
laryngitis to some extent the case is, of course, spasmodic ; but
this term must not be applied to the exclusion of the idea of in-
flammation. Genuine spasmodic croup, we have already seen, is a
mere laryngismus. There is more or less spasm in all cases of
bronchitis, and still more in whooping-cough ; in the latter case
in the larynx also ; so that infantile laryngitis does not present
any peculiarity in this respect. Catarrhal infantile laryngitis we
regard as a contradiction of terms.

The treatment he recommends for the two forms of the disease
is presented in the following tabular form :

Sthe?iic Laryngo-tracheilis. Asthenic Laryngo -tracheitis.

I. To arrest the inflam-
matory process, and control
the laryngismus.

II. To prevent organiza-
tion of the exuded plasma.

III. For removing1 the
false membrane when form-
ed.

IV. To sustain the

An emetic, followed by a
ull dose of calomel, if re-
quired.

Leeches to throat, or over
the sternum; followed by
cold applied continuously.

Tartrale of antimony,
sedative doses, cautiously
administered.

[nternal application of so-
lution of nitrate of silver.

Inhalation of aqueous and
narcotic vapors.

Opiates, with caution.
Hydrocyanic acid, do. do.

Sponge - probang and
caustic solution.
Expectorants.
( 'a lorn el, in small doses.
Alkalies.

Counter- irritation.
Tracheotomy 1

Continue caustic solution.
Do. expectorants.
Do. counter-irrita-
tion.
Do. alkalies.
No emetics, or calomel.
Tracheotomv, seasonably,
if at all.

Milk-porridge, arrow-
root, broth, &c.
Tonics, if required.

Do. do. j or pil. hydrar-
:yri, instead of calomel.

Leeches doubtful.
Cold continuously ap-
plied.
Nitrate of potassa.

Do. do.
Do. do.
Do. do.

Do. do.

Stimulating expectorant?.

Turpeth mineral.

Do.

Do.

Do. da

Do.
Do.

Stimulant alkalies.
Do. do.
Do. do.

Do. do.; also wine whey,
milk punch, &c.
Tonics and stimulants.

New Instrument for producing Compression in Orchitis. By T. L.
Ogiek, M. D., of Charleston. S. C.

Messrs. Editors : I send you the following description of an
invention of mine, which, if you think worthy, insert in your
journal.

1855.] Self-adjusting Stethoscope of Dr. Cammann. 183

The treatment of orchitis by adhesive straps, applied so as to
exercise a gentle pressure on the gland, is, -I believe considered by
surgeons, a great improvement to the old plan of leeching, fer-
mentations, cold applications, &c. the bandaging giving imme-
diate relief from pain, and reducing the swelling considerably m
a few hours, and this without confining the patient to his bed.

In treating cases of orchitis, I have found the swelling so much
reduced the morning after the straps were applied, that they no
longer gave any support, to the testicle, and therefore, to be effi-
cient, had to be reapplied every ten or twelve hours, or oftener ;
for as soon as the pressure of the plaster is taken off of the gland,
by the latter becoming smaller, the straps no longer act beneficially,
and the curative process is arrested until a fresh support is given
to the swelling by a reapplication of the dressing. Now, this con-
stant reapplication of the straps is troublesome and painful, and if
not attended to as soon as they become loose, no longer give any
support to the enlarged gland, and the cure is protracted.

To remedy this defect, it seemed to me that an elastic pressure
exerted gently on the swelling, would be efficient a pressure that
would be constantly exercised on the swelling, notwithstanding it
became reduced in size. For this object I had made an oval bag,
about the size of a turkey egg, netted of thin india-rubber thread
the body of this bag was netted with pretty coarse meshes, so as
to be open and cool, but the neck was netted much closer and
finer. AYhen this is stretched open and the testicle put into it,
the pressure, on account of the closer work (around the mouth of
the bag) is a little greater than it is elsewhere it therefore remains
on perfectly well, and there is a gradual and gentle pressure ex-
erted over the whole gland, untfl the swelling is completely re-
duced.

I have treated four cases with perfect success, and with little
inconvenience to the patient. In the process of the treatment the
patient can take it off" for a little while to bathe, or for any other
purpose, and reapply it himself without any difficulty. [Charleston
Med. Jour, and Review,

Self-adjusting Stethoscope of Dr. Cammann.

"We have the pleasure of presenting our readers with a description
and an engraving of a double self-adjusting stethoscope, recentlv
invented by George P. Cammann, M. D., of this city. * Dr. C. has
been long known as having devoted himself, with much success,
to the study of affections of the chest. The mode of investigation
of disease under the name of " auscultatory percussion," first made
known by him and Dr. A. Clark, and published in the New York
Journal of Medicine and Surgery, vol. iii. (July, 1840), established
his reputation in this respect.

The stethoscope of Dr. Cammann presents, as will be seen by
the engraving, an objective end, made of ebony, the extremity of

IS-i Self adjusting Stethoscope of Dr. Carnmann. [March,

-which is about two inches in diameter, two tubes composed of
gum-elastic and metallic wire, two metallic tubes of German silver^
two ivory knobs at the aural extremity, and a moveable elastic
spring, so arranged as to adjust it, and keep it in its proper position.

M. Landouzy, of Paris, previous to 1850r formed a stethoscope
having a number of gum-elastic tubes, by means of which several
persons could listen at the same time. Dr. N. B. Marsh, of Cin-
cinnati, in 1851, patented a stethoscope with two gum-elastic
tubes, and a membrane over its objective end. Br. Carnmann
does not, therefore, claim any originality on account of the two
branches of his instrument, but on account of other advantages
which it possesses. The instrument of M. Landouzy was not found
of any practical use. The objections to that of Dr. Marsh are :

1. That the aural extremity is composed of roughly-cut India-
rubber, without anything to adapt it to the ear, which both causes
irritation and does not exclude sounds from without.

2. That it requires both hands to keep it in position.

3. That it gives a loud, muffled, and confused sound, caused by
reverberation within the instrument, in consequence of the drum
at the objective end and the inequality of the diameter of the bore.
These circumstances render it of but little practical value.

The only resemblance between the instrument of Dr. Carnmann
and that of both Drs. Landouzy and Marsh isr that each is com-
posed of more than one tube.

On reference to the engraving of the stethoscope of Dr. Carnmann,,
which represents the instrument of one-third its size, it will be
observed that the bell-like expansion of the objective extremity
will be two inches in diameter, with a convolvulus excavation,,
gently curving outwards, to present a rounded edge to the chest,
in order to prevent causing pain to the patient. The bore of the
instrument is two and a half lines in diameter^ care being taken
to have it made smooth and even.

The tubes are made of German silver, with a double curve to-
wards the aural extremities, which curves require to be constructed
with great care, so that the ivory knobs may rest closely upon the
external openings of the ears.* When applied, it is necessary
that the orihees of the knobs should point upwards. Some of the
instruments are constructed with a spiral, and others with an elas-
tic spring, as shown by the plate. Some of them are so arranged
that they can be disjointed, lo render them more portable.

One point, heretofore sub judice, is settled by this instrument,
viz., that the sound is conducted entirely through the air, and not
at all through die media, as these were, for experiment's sake,.
changed nine or more times, without affecting in the least the in-
tensity of the conducted sound. On making the objective end
solid, "all sound was lost.

* If aoy peculiarity of formation of the head of the observer prevents their thus
resting, so as to exclude ail external sounds, they should be carefully bent to give
the ;equiied curve.

1855.] IformUthn and Displacement of Organs. 185

The advantages claimed for the instrument of Dr. Cammann

are:

1. That being applied, it adjusts itself closely to both cars, ex-
cluding all external sound.

2. It leaves both hands of the examiner free.

3. It gives sounds pure, and greatly increased in intensity,
though differing in quality from those hitherto afforded by auscul-
tation, the pitch being lower. This intensity is produced by both
ears being acted upon at once, by the ear-pieces of the instrument
fitting closely into the meatus of both ears, and by the smoothness
and careful construction of the bore of the stethoscope as to curves,
&c., according to the law of reflected sound.

-1-. Sounds not heard through the instrument in common use
can be detected by this.

5. Sounds which are doubtful by ordinary instruments are made
perfectly certain. Even when disease is seated in the central part
of the lungs, they can be detected, when the ordinary stethoscope
will fail to render them recognizable. The same advantages are
obtained in examining the morbid sounds of the heart.

The great increase of intensity of sound by this instrument ren-
ders it valuable to those with impaired hearing.

In the use of this stethoscope it is necessary that the chest should
be uncovered, to prevent all friction between it and the clothes;
otherwise the sound thus generated is conducted with such inten-
sity as to embarrass the examiner. A short practice may be re-
quired to become familiar with it, in consequence of the increased
intensity of the sounds produced by it, and the difference between
them and those afforded by ordinary auscultation. Many of the
recognized physical signs of thoracic disease will be so modified as
to be new to the examiner, but a short experience will enable him
to appreciate them, and give them their true value.

These stethoscopes are manufactured and sold by Messrs. George
Tieman k Co., No. 63, Chatham street, who pay particular atten-
tion to their construction a point very essential to an instrument
of this kind. [New York Medical Times.

Case of Malformation and Displacement of Organs. Bv Stephen
Wood, M. D.

At 9^- o'clock P. M., on the loth inst., I was called to attend the

wife of J. TT , in labor, at No. 37 M street. The head

presenting favorably, labor was speedily completed. The child, a
female, was of ordinary size, and externally well formed. It cried
for a few moments after birth, made several peculiar, convulsive-
like attempts at respiration, for legitimate respiration it could not
be called; but these soon ceased. On now applying mv hand
over the region of the heart, or rather where pulsation of this or-
gan is usually felt, I could not find any; but, in moving my hand
over different portions of the chest, and placing it on the right

186 Treatment of Prolapsus Ani. [March,

side, I there discovered a strong pulsation a little below, and to
the right of the nipple of that side. This continued for some fif-
teen or twenty minutes. I now thought it best to try artificial
respiration to restore life; and this failing, made use of other
means for that purpose, but all without effect. I then made up
my mind that there was serious derangement of the thoracic or-
gans, on account of the singular location of what appeared to be
the cardiac pulsation, and because of the impossibility of producing
natural respiration.

On post-mortem examination of the body next morning, the
following was the condition of things : The external surface pre-
sented a general livid hue. Internally, I found the heart of usual
size, inclosed in its pericardium, in the right side, directly under
where I had felt the beating, and extending from the third to the
eighth rib. The lunys were very small, and solid, like liver, lying
immediately posterior to the heart, and compressed between it and
the ribs behind, apparently also completely impervious ; these two
organs taking up but a portion of the right side of the thorax.
Commencing at the upper part, and in the order enumerated be-
low, the remaining portion of the right, and the whole of the left
side of the cavity of the chest were occupied by, first, the small
intestines; next, a part of the large intestines ; then, the stomach, the
gall-bladder ; and lastly, the lower lobes of the liver ; this organ,
as well as most of the others mentioned, being in an inverted po-
sition. The remaining part of the liver, and the other portions of
the large intestines containing meconium, nearly filled the cavity
of the abdomen.

The mediastinum and the left half of the diaphragm were want-
ing. It was through the openings caused by these deficiencies,
that the abdominal organs mentioned above passed into the chest,
and produced the displacement of the lungs and heart. The func-
tions of the larynx and trachea, from the remarkable situation of
the other organs, must have been seriously interfered with.

The death of the child, I suppose, was mainly owing to the fact
that respiration could not be properly performed the organs con-
cerned in this act being unfitted for their office. But had the
lungs been pervious to air, it is not probable that, with such gen-
eral displacement and malformation, life would have been much
longer maintained. [New York Med. Times.

Treatment of Prolapsus Ani with the strong Nitric Acid. By J. H.
Broxholm, M. I)., &c.

Having seen several cases of prolapsus ani treated successfully
by the application of the strong nitric acid, it gives us much plea-
sure in being able to testify to its efficacy in cases of that descrip-
tion, having treated several lately with the acid, some of them of
very long standing, accompanied with piles, which at times bled
profusely. If not infringing too much on your valuable columns,

1855.] Treatment of Prolapsus Ani. 187

may I beg the favour of your inserting two eases selected from a
number treated by me ; all of them, I may say, most satisfactorily,
no relapse having occurred in any one case. I was consulted, on
October 6, by Mrs. C, residing in my neighborhood, the mother
of five children, for prolapsus ani, complicated with hemorrhoids,
which at times bled profusely for several days together. She in-
formed me this state of things had existed for the last five years,
obliging her at times to lay up for several days, and compelling
her to reduce the prolapsed parts five or six times daily, the parts
coming down while walking even the least distance, and causing
acute pain until returned. She says she had always enjoyed good
health, and should not have consulted a medical man was it not
for this intolerable nuisance, rendering life, according to her ex-
pression, a misery and burden to her. On examination, I found
the parts very much prolapsed, excessively vascular, and tender
to the touch, the piles being of a purplish red tinge, from conges-
tion, and the mucous membrane very much relaxed. I applied
the acid on the following day, and preparatory to replacing the
parts after applying the acid, I smeared them well with the ung.
cetacei. The pain was trifling, and soon passed off. On examin-
ing the parts, rive days after the application, there was not the
least appearance of prolapse, the parts all being now within the
external sphincter. The piles no longer existed, the inflamma-
tion set up no doubt having produced absorption of their contents,
with obliteration. She informed me that no prolapsus had oc-
curred since the application, either after defecation or walking, as
she was now able to take long walks with ease and comfort.

The next case occurred in a gentleman somewhat advanced in
years, residing in the City. He consulted me on the 18th Octo-
ber, informing me he had been suffering from prolapsus ani for
the last three years, accompanied at times with considerable haemor-
rhage from the relaxed mucous membrane. He had enjoyed very
good health till lately, when, owing to the large size of the pro-
lapsed parts, he had been compelled to remain in- doors ; the pain
being very acute, and compelling him to replace the parts several
times a day, and that considerable force was requisite to reduce
them. Having tried various remedies without relief he fully
made up his mind that his complaint was incurable. On examin-
ing the part I found the mucous membrane enormously protruded,
being exceedingly vascular, of a dark red colour, and highly sen-
sitive ; several piles protruded with the mass. I applied the acid
at once freely to the prolapsed parts and piles. Of course the pain
was very acute for a few minutes, but soon subsided ; and after
smearing the parts with ung. cetacei, I replaced them.

On examining the parts six days after, the effects were truly
surprising. No prolapsus now existed, and he was able now to
walk without the least pain or inconvenience ; and he has re-
mained perfectly well up to the moment of writing this. [London
Lancet.

188 Extra Uterine Foetus., [March,

Case of an Extra Uterine Foetus, Retained Forty Years. Reported
by John A. Cunningham, M. D., Richmond, Virginia.

Among the many remarkable cases of extra uterine pregnancy
found scattered throughout the various works on obstetrics, and
which have been nowhere so well grouped, as in "Dr. Campbell's
memoir on extra uterine pregnancy," published in Edinburgh,
1840, we have never met with any better deserving to be placed
on record than the one occurring in our practice during the past
year, a short description of which we here give.

During the spring of 1853, we were desired to visit an old ne-
gro woman, who had been the cook for one of the largest families
in this city for probably fifty years, and whose office during that
long period of time had certainly been no sinecure. After serving
in this capacity as long as she was able to perform its duties, she
was now at the advanced age of eighty or eighty-five, a superan-
uated dependent on her master. As is common with negroes, she
did not know precisely how old she was, but we think that the
estimate of her age we have made, is correct. Although her mind
was somewhat impaired, yet her health, which had always been
remarkably good, had only given way in the last few months ; and
it was for the purpose of rendering her professional aid that we
were asked to see her.

"We found the old woman's general health quite good, although
she was somewhat enfeebled by a long continued pain in the loins,
accompanied by great irritability of the rectum and anus, with a
constant tendency to stool, and she complained greatly of the tenes-
mus and straining which she had suffered with for some time.

There were no reasons to lead us to suspect what afterwards
turned out to be the true condition of things, and we therefore
treated her for the rectal irritation, and in the usual way, but with-
out giving her any relief. The discharges from the bowels became
offensive and filled with purulent matter, and at last we were as-
tonished to hear one morning from her nurse, that the old woman
had been for some days passing bones of different sizes and shapes,
none of which she had preserved. She was at once instructed to
keep whatever substances of that sort she might evacuate from the
rectum ; and in a day or two she brought us quite a number of
bones, evidently those of a foetus, completely denuded of flesh,
and surrounded by a slimy and purulent material. These bones
which were collected for some time, and some of which we now
have, are mostly the phalanges of the fingers and toes ; others are
evidently the heads of the long bones imperfectly ossified, and
some apparently portions of the pelvis and other of the flat bones.
This poor old creature still lives, but is gradually sinking under the
weight of her infirmities, and continues to discharge at times, bones
of different shapes, but all evidently belonging to the foetal skeleton.

We enquired of the patient whether she had ever thought her-
self pregnant and afterwards believed herself mistaken, but so old

1855.] Editorial 189

was she, and with a mind so impaired, that she remembered nothing
which could be made to bear upon the point. The only fact of
interest was elicited from a fellow servant who had lived with her
many years, and who informed us that the cook had often com-
plained of having a tumour in her belly which troubled her. This
tumour upon examination we found had disappeared. We ascer-
tained however, from her owner, that she had been the mother of
several children.

We think, then, it may be stated beyond dispute, that in this
woman we had a case of extra uterine pregnancy, winch after re-
maining in abeyance not less than /orty years, and interfering but
little, if at all, with her general health, had at last been discharged
by ulceration of the sac which contained it, forming a fistulous
opening into the rectum, and giving rise to all the symptoms to
which we have alluded.

[Dr. Campbell's essay, alluded to above, gives some cases shew-
ing the great length of time that a foetus may remain in the abdo-
men, producing comparatively but little distress, which are equally
remarkable with the one just reported. He has collected from
various sources, seventy-five cases of extra uterine pregnancy,
where the foetus was retained for periods varying from three months
to fifty years ; one case to fifty- two years ; one to fifty-five and
one to fifty-six years.

Denman in his 13th plate delineates an extra uterine foetus that
had been conceived thirty- two years before the death of the mother ;
and in the Hist, d l'Academie Eoyale des Sciences, an instance is
recorded of a woman who conceived at forty-six and lived until
ninety-four, when an ossified foetus was found in her abdomen,
consequently she must have carried it forty- eight years. Editor
Virginia Med. and Surg. Journ.]

EDITORIAL AND MISCELLANEOUS.

Local Anaesthesia in Surgical Operations. Since the case reported in
our last number of this journal, in which a large fungus was removed from
the arm under the anaesthetic influence of a frigorific mixture of salt and
ice, I have had the opportunity of again testing the efficacy of this process
in a number of cases. On the 14th January, a fungous growth occupying a
large portion of the dorsum of Mr. TVs hand, was removed, after freezing
the surface, with very little pain. On the 25th of the same month, the
freezing mixture was placed in a long and narrow bag of gauze and carried
around the neck of a lipoma about the size of a man's head, which hung
from the back of a negress. The solidification of the skin and subcutaneous
adipose tissue was complete in four minutes, and the tumour extirpated
with so little pain that the patient was quite surprised when she heard it
fall to the floor. She declares that she suffered most during the applica-
tion of the stitches and adhesive strips. On the 2d February, another

190 * Editorial. [March,

lipoma the size of a turkey's egg was removed, in like maimer, from the
anterior portion of the thorax. On the 6th of February, a lady presented
herself with a tumor as large as the two fists of a man, attached to the
perineum and side of the vulva. This could not be surrounded by a collar
of freezing mixture, and was therefore removed under the influence of
chloroform inhalation. On the 16th of the same month, the freezing mix-
ture was applied to the face of Mr. E., for the extirpation of an epithelial
tumor of the cheek, the size of a small egg. In consequence of the salt
and ice having been mixed too soon, some delay occurred in the application,
and the freezing was imperfect. The patient therefore suffered much more
in this case than in those above reported.

In all these cases, adhesion by first intention was complete, and in neither
did the patient complain of any pain during or after the application of the
freezing mixture. Yet, I perceive that some of those who have resorted to
this process allege that the reaction which follows such freezing is some-
times quite painful. Such is not my experience.

I cannot close these remarks without again directing attention to this as
an important substitute for the more dangerous inhalation of anaesthetics.
It is applicable to a very large number of the cases requiring surgical in-
tervention, and must therefore correspondingly limit the number of those
in which the surgeon might be justified in resorting to other means. It
lessens the amount of hemorrhage to a remarkable degree ; a very impor-
tant consideration in some cases.

It is not pretended that anaesthesia, thus induced, is complete to the
depth we may have to cut in the removal of large tumors ; but it is nearly
or quite so in the skin, which is the most sensitive tissue we have to divide
in such operations. L. A. Dugas.

Augusta, 2 2d February, 1855.

Dr. Cammann's Stethoscope. We are happy to be able to present our
readers an engraving and description of Dr. Cammann's Stethoscope, inas-
much as we regard it a very important addition to our means of diagnosis.
Dr. C. has for many years been one of the most able and zealous advocates
of auscultation in our country, and published, as far back as 1840, in con-
nexion with Dr. A. Clark, the results of the ingenious combination of auscul-
tation and percussion, by which many obscure questions in diagnosis were
made of easy and certain solution. As no prescription can be safe that is
not based upon correct diagnosis, and as this is by far the most difficult
portion of the study of medicine, any contribution calculated to facilitate
its acquisition must entitle the author to the gratitude of the Profession.
We verily believe that the " auscultatory percussion " of Drs. Cammann
and Clark, and Dr. Cammann's new Stethoscope, constitute the most valua-
ble improvements in the diagnosis of thoracic affections made since the
days of Laennec, in this or any other country.

1856.] Editorial 191

The Chloroform Vapour Douche. Since our publication of Dr. Hardy's
experience in the treatment of various affections by means of tlie chloroform
vapour douche, we have received a number of letters of inquiry in relation
to the process and apparatus used by Dr. Hardy, and we beg leave to pub-
lish the reply to our correspondents for the benefit of such of our readers
as may feel interested in the matter.

We have not seen either of the two instruments recommended by Dr.
H., but have examined the engravings of both as contained in the British
periodicals. One of them is very simple and is that which will therefore
be most generally used. u It consists of a small metallic chamber contain-
ing within it a sponge for holding the chloroform, having at one end a gum-
elastic bottle, and at the other a pipe (containing a valve) for transmitting
the vapour. At the distal end of the chamber is a second valve, to admit
atmospheric air into the gum-elastic bottle. The sponge in the chamber
is charged with chloroform by a screw stopper." It will thus be seen
that this apparatus may be extemporized by interposing a tin box to
receive the sponge between the eanula and bottle of an ordinary gum-
elastic enema bottle of large size. A small mustard box or a 2 oz. vial
with its bottom broken off might answer the purpose of this sponge cham-
ber. The absence of valves and screw stoppers would not materially impair
the usefulness of the instrument, as the chloroform might be poured upon
the sponge through the eanula if this could not be conveniently removed,
and the ingress of air into the bottle through the eanula would only charge
it the more highly with chloroform, by being made to pass twice instead of
once through the sponge chamber, before being brought in contact with
the tissues. But even this might be obviated, by having a small aperture
upon the side of the chamber, which could be closed or not with the
finger, at will.

About a teaspoonful of chloroform is poured upon the sponge just before
using the instrument. The eanula being then directed to the desired sur-
face, the bottle is alternately compressed by the hand and relaxed so as to
drive a current of the air thus charged with chloroform vapour against the
part. This air jet or douche, as the French term it, may be continued two
or more minutes, according to the effect, and be repeated at such invervals
and as often as the case may require.

The other apparatus designed by Dr. H., is much more complicated, and
is calculated to afford a large and continuous supply of vapour, combined
with hot or cold air, or with aqueous vapour.

u The main part of the instrument is a bellows constructed partly of vul-
canized india-rubber. This bellows is furnished with two sponge-chambers
for chloroform, one on the under surface where the air is admitted, and
the other at the mouth where the air is expelled. This second chamber is
provided with the nozzle, to which is affixed, by means of a screw, a cham-
ber, constructed like an harmonicum, and made to react upon the jets of

192 Editorial. [March,

vapour escaping from the bellows, and convert them into a continuous
stream, by means of an India-rubber ring- passed round it. This elastic
chamber is provided with an escape tube, furnished with a stop cock, upon
which tube are screwed conveyance-pipes of various kinds according to the
locality to which the application is to be made. If it is wanted to apply
the vapor of hot water along with the chloroform, the inferior sponge-cham-
ber of the bellows is screwed upon the escape-opening of the jar. This jar
is filled half full of hot water, the temperature being kept up by a spirit-
lamp, if necessary, and regulated by a thermometer suspended from a hook
in the interior. On working the bellows, the air enters this jar through
the entrance-tube, becomes heated in passing through the water, and at the
same time charged with watery vapor ; enters the bellows through the
escape-opening, and so passing out through the elastic chamber, becoming
charged with chloroform in its passage through the sponge-chambers. If
much chloroform is wanted, this jar may be made to hold chloroform in-
stead of water, and so the air may be partly charged with this vapor before
it reaches the sponge-chamber. If it is desirable to apply the chloroform
along with cold air, the inferior sponge-chamber of the bellows is screwed
upon the end of a long coil of tubing, which coil is immersed in a freezing
mixture. The air, entering this coil at its free extremity, becomes cooled
in its passage before it arrives at the bellows."

Our city apothecaries have not yet procured any of these instruments,
but inform me that they will order them for any physican who may request
them to do so. The first or simple instrument described cannot be costly,
but the other must be much more so.

Seventh Volume of the Transactions of the American Medical Association.
New York: C. B. Norton. 8vo., pp. 668.

We have but recently received this volume, and find upon a hasty glance
over its pages, much interesting matter. The paper of Dr. F. P. Porcher,
" On the Medicinal and Toxicological Properties of the Cryptogamic Plants
of the United States, evinces a great deal of research, and is an exceedingly
valuable contribution to science one which reflects much credit upon its
learned author. The Prize Essay of Dr. D. Brainard, " On a new method
of treating Ununited Fractures and certain Deformities of the Osseous Sys-
tem," is also a valuable paper, and bears the impress of an original and
discriminating mind. Dr. B.'s method is ingenious, simple, and will doubtless
be generally adopted hereafter in the management of these difficult cases.
Besides these two papers, which occupy 166 pages, we have 128 pages
devoted to three Reports on the Epidemics of Kentucky and Tennessee, of
Ohio, Indiana and Michigan, and of Louisiana, Mississippi, Arkansas and
Texas, for the year 1853. These are ably drawn up, and may be useful in
History, but we doubt that such documents can ever be worked up into
anything of practical value. The causes of disease are so obscure, and the
types and character of epidemics vary so much, that such histories can
scarcely ever be looked to as guides in the prevention or management of
subsequent visitations.

1855.] Editorial and Miscellaneous. 193

This volume contains another Report, upon the never ending subject of
Medical Education. It reiterates the suggestions and recommendations so
often already and fruitlessly made. We say fruitlessly made, for we feel
assured that the standard of Medical Education is lower now than it was at
the time of the organization of the association. We think it high time that
this learned body desist from attempts to legislate without the power to
enforce, and confine its labors to the simple promotion of contributions to
science. In a country like ours, evils have to work their own cure. We
should not therefore despair.

Deaths from Chloroform. Dr. G. Huff, of Lexington, Ky., reports the
death of a lady from the inhalation of chloroform for the relief of neuralgic
pains. Another death has occurred in Guy's Hospital, (London), the vic-
tim being a female whose leg was to be amputated by Mr. Birkett.

Mortuary Statistics of New York, Philadelphia, Baltimore and Boston
in 1854. We find in the Medical Xews, the following tables :

RATIO OF DEATHS TO POPULATION OF 1850.

Deaths Population Patio of Deaths

in 1854.

0/1850.

to Inhabitants.

Philadelphia,

- 11,811

409,000

1 to 34.63

New York,

28,458

515,000

1 to 18.09

Baltimore, -

5,738

170,000

1 to 29.62

Boston, -

4,418

137,000

1 to 31.00

RATIO

OF DEATHS TO PRESENT ESTIMATED POPULATION.

Deaths

Estimated

Patio of Deaths

in 1854.

Population.

to Inhabitants.

Philadelphia,

- 11,811

500,000

1 to 42.33

New York,

28,458

625,000

1 to 21.95

Baltimore,

- 5,738

210,000

1 to 36.59

Boston,

4,418

160,000

1 to 36.21

Abuse of Chloroform in Midwifery. Dr. Robert Lee has forwarded to
us a letter from Mr. E. Parke, of West Derby, from which we select the fol-
lowing passages: "The profession and the fair sex owe you a deep debt of
gratitude for your manly, able, and convincing paper on the subject of
chloroform and its attendant dangers when administered during parturition.
At one time I used to give it frequently, but latterly I have suspended
it, from careful and unbiased judgment as to its baneful results. I never
had but one nearly fatal case ; but in many I have had to deplore its ef-
fects; and the little amount of good derived in some cases from it, is Badly
out-weighed by its concomitant dangers. As you have given seventeen
cases, I think every medical man is in duty bound to assist you in putting
down its indiscriminate use in midwifery, and entering his most serious
protest against it. In the year 1849. Mrs. M. engaged me to attend her in
her third confinement, and having suffered rather seriously in her previous
ones, she begged of me to administer chloroform. It was a case of twins,
and when the first was born she felt exhausted and fatigued, and finding the

194 Miscellaneous. [March,

arm of the second child was presenting, and turning would be necessary, I
though it probably might be of service. I avoided carrying it to insensi-
bility, and she was perfectly conscious of all that passed during the opera-
tion; and when over, expressed herself most grateful for the ' blessing of
chloroform. She had scarcely given vent to her feelings, when she com-
plained of a violent pain in her head, became delirious, tore the nurse's
gown and the bed-curtains into pieces, and was perfectly maniacal. Flood-
ing came on to a fearful extent, and incessant sickness. I managed to ex-
tract the placenta, and owing to the feeble contraction of the uterus (and
this latter condition I am confident it often produces), I was kept grasping
it for four or five hours. The vomiting continued eight hours without in-
termission, the headache remained for weeks, and her recovery was very
protracted, far more so than on former occasions." [Med. Times and Gaz.

Extraction of Foreign Bodies from the (Esophagus. M. Nelaton has
collected with care the various modes of procedure for the extraction of
foreign bodies arrested in the oesophagus, and he, in particular, examines
the mode of extracting fish-hooks, the removal of which is a matter of great
difficulty. In speaking of cesophagotomy, this skillful surgeon proposes a
proceeding, which, according to him, is simpler than any other operation.
Instead .of making a lateral incision, M. Nelaton divides the integuments
in the median line, as is done in tracheotomy, but making a more extended
incision ; he then separates, to the same extent, the sterno-hyoid muscles,
so that they can be drawn apart by blunt hooks, or, if necessary, divided
transversely, in order to give more space ; that done, the isthmus of the
thyroid body is laid bare ; beneath it is passed a blunt needle, carrying a
double thread, in order that two ligatures may be applied ; between the
two ligatures, the isthmus of the thyroid is divided. The trachea being
thus laid bare, the left lobe of the thyroid is separated from it by a blunt
instrument, keeping, at the same time, close to the trachea ; at the bottom
of this cleft, between the trachea and thyroid, the oesophagus is necessarily
found, and is to be opened in the ordinary way. By acting thus, all risk
of wounding the large vessels of the neck is avoided, and the operation may
be performed without injuring the thyroid arteries. [Elements de Pa-
thologie Chirurgicale. N. Y. Journal of Medicine.

Extraction of a Tobacco-pipe from behind the Ear. Mr. Henry Smith
showed the Medical Society of London, a portion of tobacco-pipe, nearly
two inches in length, which he had extracted from behind the ear of a boy
who, between two and three years previously, had fallen down while holding
a long clay pipe between his teeth. When the child was brought to him,
there was a swelling over the mastoid process, and a small aperture on it,
by which some foreign body was detected, which at first was thought to be
dead bone, as no history of the accident with the pipe had been obtained.
When, however, the foreign body was extracted, the mother of the child
first mentioned it. She stated that after the accident the boy had been
seized with a severe illness, accompanied with a great pain in the head.
These symptoms, together with an inability to open the mouth, continued
for some months, at the end of which they subsided, when the swelling first
appeared behind the ear, and continued there for two years; it had been
thought to be merely an abscess, and treated accordingly. On examining
the interior of the mouth, which could only be opened about half-way, Mr.
Smith could see an opening in the mucous membrane, just at the base and

1855.] Jliscellanec 195

inner side of the ascending ramus of the lower jaw, through which the piece
of pipe had penetrated. It must have passed along the inner and posterior
border of the jaw, amongst the importaD nd nerves, and gradually

made its way towards the suifaee. where it had remained for two years.

[London Lancet.

b in Infantile Enurc*i*. By Dr. Deiters. This author
has found cubebs more effectual than any other remedy in curing the in-
continence of urine so common among children. This complaint may
depend upon atony of the bladder, or on the presence of intestinal worms.
In the former case the cubebs acts as a tonic, in the latter as a valuable
anthelmintic. The medicine requires to be given in considerable doses ;
two pinches [i. e. a few grains or Zwei Messerspitsvolt) for infants, and a
half teaspooni'ul twice or thrice daily for children of a somewhat more ad-
vanced age. Its effect is speedy and permanent ; and although occasion-
ally it happens that daring its administration the incontinence returns at
periodical or irregular intervals, these recurrences gradually become less
frequent, and eventually disappear altogether. To effect a radical cure, the
author has often found it necessary to continue its use for a period of from
three to eight weeks, and he has never observed any injurious effects from
^ministration.
Deiters observes that he has found the same remedy most efficacious in
checking nocturnal emissions in case of spermatorrhea. [Edinburgh
Monthly Journal.

Removal of a. Portion of the Left Lung. By T. B. Hale, M. D.
Editor Medical Examiner:

Dear Doctor The following case has been communicated to me by my
friend, Dr. Hale, of Minersville, Pa. Believing it to be unique, I am de-
sirous of giving it to the profession through the pages of your valuable
journal. The removed portion of lung is now in my possession. It is pyri-
form iu shape, somewhat flattened, and measures about 6 inches long, 2^
inches in diameter at the largest end, and 1 inch in diameter where it was
cut across. It appears quite destitute of blood, except near the small end,
where the capillaries appear quite full. The specimen is somewhat con-
tracted in size from the action of the alcohol in which it is preserved.

Verv respectfully, J. H. \Yythes, M. D.

Port Carbon, Dec. 21. 1854.

C. D.. an Irishman, aged 25 years, rather small in stature, but stoutly
built, with a well developed chest, being engaged in a fight while intoxica-
te.!, received a stab in the left side, parallel with the ribs. The wound was
about \\ inch long, and appeared to have been made with a sharp, clean-
cutting instrument. About fourteen hours after the injury he was visited
by Dr. Hale, who found, upon examination, a portion of the left lung pro-
truding from the thorax. He was sitting up in bed, having the protruded
portion supported by a broad bandage. He complained of no pain, and had
suffered but little from loss of blood. There was no cough or difficulty of
breathing, but on taking a full inspiration the protruded lung became filled
with air, and drops of venous blood oozed from its substance. The protru-
sion was so tightly strangulated at the wound in the thoiax that after an
hour and a half spent in unsuccessful efforts to restore it. Dr. Hale made a

I intei osseous space. Fea

196 Miscellaneous.

however, the effect of a large opening into the cavity of the pleura, he was
induced to desist, and consider the propriety of excision. As the protru-
sion looked extremely unhealthy, from the length of time since the accident
and the efforts made to reduce it, making gangrene not an improbable re-
sult, excision seemed to be the only resource. Dr. H. contemplated apply-
ing a ligature at the base of the protruded lung, but on making two experi-
mental incisions into its substance, and no blood flowing, this was not
judged necessary, but the mass was at once excised, and the remaining
portion pushed back through the wound in the interosseous space, the
orifice of which was then closed with two stitches and strips of adhesive
plaster. The patient was then directed to lie quietly on his back, and a
mixture of two parts syr. prun. virgin., and one part syr. opii. prescribed ; a
table-spoonful to be given every two hours, for the purpose of allaying
irritation in the bronchial tubes. On the second day Dr. Hale found him
in a favorable condition, and on the sixth day he walked five miles to visit
his physician, Buffering in no manner from the loss of the portion of lung.
For the last three months he has labored constantly in the coal mines,
without inconvenience.

The speedy recovery of the patient appears to have been due to adhesive
inflammation between the adjacent walls of the pleura, through the wound
in which the protruded lung was strangulated. In all probability the pul-
monary and costal pleura and the substance of the lung are all connected
in the same cicatrix.

Lumbago. In M. Bonnet's famous work on the affections of the joints,
in treating of diseases of the spine, he mentions incidentally the effiacy of
kneading in cases of lumbago. Recently Professor Nelaton has had occa-
sion to employ this treatment, and has found its results rapid and success-
ful. A man who had fallen on his back experienced the most acute pain
in the common mass of the sacro-lumbalis and longissimus dorsi muscles,
and was unable to execute any movements of torsion or flexion of the trunk.
He was brought to the Hopital des Cliniques. M. Nelaton covered the
lumbar region with cerate, and then with his thumb and fore-finger be
kneaded the muscular mass for five minutes ; he was then relieved by a
pupil, and, at the end of twelve minutes, the patient to his astonishment
was able to move his trunk in every direction without the slightest pain.
[Jour, de Med et dc Chir.. Virginia Med. and Sur. Jour.

Hooping- Cough. Our readers are aware that Dr. Arnold, of Montreal,
attributes great efficacy to nitric acid lemonade, as it is termed, in the
treatment of hooping-cough. An English physician, Dr. Gibbs, has recently
published a monograph on this disease, in which he claims almost specific
virtues for the nitric acid. The mode of preparation is simple. Into water,
sweetened until it is almost of syrup consistence, nitric acid is poured until
the mixture is about the strength of lemon-juice. A child of a year old
should take a dessert-spoonful every hour. To avoid injury to the teeth,
a gargle of carbonate of soda should be used after each dose. [ Virginia
Med. and Surg. Journal.

State Medical Society. The Sixth Annual Meeting of the Medical So-
ciety of the State of Georgia, will be held in the city of Columbus, on
Wednesday, the 11th of April next.

D. C. O'Keefe, M. D., Recording Secretary.

SOUTHERN

MEDICAL AND SURGICAL JOUMAL.

Vol. XL] SEW SERIES. APRIL, 18m. [No. 4.

ORIGINAL AXD ECLECTIC.

AKTICLE Yin.

Disturbances in the Functions of the Human Body from changes in the
condition of the Atmosphere. By "W. L. Joxes. M. D., of Morgan
county, Georgia.

Variations in the atmosphere affect us in two -ways by direct
impressions on the nervous system, and by modifications of some
of the "physical phenomena of living beings." Of the former,
we know little beyond the fact of their existence, as revealed by
sensation ; the latter, coming within the domain of experimental
science, admit of more searching investigation and more definite
results, and it is proposed at this time, briefly, to discuss them in
connection with the functions of the skin and lungs, portions of
the body most directly in relation with the external atmosphere.
The changes in the air with which we are best acquainted and
which most obviously affect us, are of temperature, moisture and
pressure ; those of the first two being oftentimes excessive in the
same locality of the last, small, except in comparing places of
unequal altitudes above the sea.

One of the immediate effects of heat upon the skin, as upon all
other portions of the body, is to cause an influx of blood thereto,
and concomitant with this, or consequent upon it, to increase the
activity of its functions. As relates to our present purpose, its
special function is to regulate the escape of moisture the passing
off of a certain amount of water through the skin, either in the
form of vapour, as in exhalation, or of perspiration, seeming to be

tf . s. VOL. XL NO. iv. 13

198 Jones, on Functional Disturbances. [A$Tilr

of great importance in the animal economy, as appears to be indi-
cated by the fatal results attending the coating over the skins of
rabbits, with a varnish impermeable to moisture, A hot atmos-
phere, increasing the quantity of blood in the skin, and obviously,
therefore, the amount exposed to the drying action of the airr
tends of itself to promote the escape of moisture through the skinr
and if, in addition, it be dry, evaporation necessarily proceed*
with great rapidity ; this reacts again upon the circulation of the
skin, for, as its capillaries are so constantly relieved of their con-
tents, new supplies of blood are as constantly invited,, so to speak,
to refill them; this again increases the amount of evaporation, and
in this manner, these actions and reactions take place, until the
circulation of the skin acquires its maximum. If, besides being
hot and dry, its pressure is diminished as upon the tops of moun-
tains and elevated regions generally, a still greater amount of
evaporation will take place, and the greatest possible activity in
the circulation of the skin will be induced ; for water passes more
readily into the form of vapour under decrease of pressure, as
instanced by the lower temperature at which it boils upon moun-
tain tops. Heat and dryness, combined with a diminution in the
pressure of the air, furnish, therefore, the most favorable condi-
tions for rapid evaporation from the skin, and, consequently, for
great activity in its circulation. They will also produce similar
effects upon the lungs; a larger amount of watery vapour will
escape from its capillaries into the air which is inhaled -T this in-
vites a rapid flow of blood towards them, and a more perfect
aeration of this fluid results from the greater frequency with which
it comes in contact with the air in the lungs.

The capacity of the air for taking up a dose of moisture addi-
tional to that it already contains, is dependent upon the difference
between its actual temperature and that of its dew-point, or that at
which it would give up some of the water it already holds, were
the temperature reduced any lower ; the greater the difference be-
tween these two points, the greater its capacity for receiving a
new supply. Moreover, it is affected by the absolute temperature-
of the air, being always greater cceterus paribus when this is
high than when low, 10 difference between the two points men-
tioned above, not allowing, by any means, so large a quantity of
water to be taken up when the air is at 40 as when at 80 of
temperature. But in its influence upon evaporation from the
body, low temperatures are not so powerful as at first might be

1855.] Jones, on Functional Disturbances. 199

supposed ; for coming in contact with the skin, the cold air re-
ceives a portion of heat from it, and acquires thus an additional
capacity for moisture. Even if already saturated with water,
having its temperature raised by contact with the body, whilst its
dew-point remains the same, it will be in a condition to receive
new supplies of moisture. More particularly is this true of the
air taken into the lungs, as it must, almost of necessity, acquire
the temperature of that organ. If the air is much colder than the
body, therefore, evaporation will take place from the skin and
lungs, even though it be saturated with moisture.

If the air be damp and hot, on the contrary, nearly as warm as
the body itself, evaporation must proceed very slowly ; exhalation
almost ceases, and the water secreted by the perspiratory glands
bathes the skin, unable to assume the form of vapour. How will
this affect the circulation of the skin ? Compared with a dry, hot
atmosphere, it will undoubtedly retard it, all the fluid brought by
the arteries having to traverse the capillaries and find its way
back to the heart ; and in like manner will the circulation of the
lungs be affected. If, now, we conceive the greatest atmospheric
pressure, such as exists at the level of the sea, superadded, the
escape of moisture in the form of vapour will be reduced to its
minimum, and the consequent retardation of the circulation, in
these organs, will reach its maximum.

Let us, in the next place, inquire, what effects these changes in
the circulation of the skin and lungs, dependent on the variations
in the atmosphere, may have upon the general functions of the
body. The escape of a considerable amount of moisture through
these organs* the average, according to the experiments of La-
voisier and Seguin, being about 3^ pounds daily, appears to be a
normal condition of things, and highly favorable to health. It
invites a free supply of blood to the skin, prevents the undue ac-
cumulation of it in the viscera and internal portions of the body
in other words, equalizes the circulation ; it causes the blood to
flow freely through the lungs, bringing it in more complete con-
tact with the air, whence it may derive the life-giving oxygen
with which to stimulate and invigorate the whole system. How
numerous the diseases the plrysician attempts to relieve by ex-
citing the activity of the skin ? how frequently are sinapisms, and
blistering plasters, and frictions prescribed to effect this object?
A similar effect is produced, obviously, by a dry atmosphere, not
so intense perhaps in its action, at any one moment, as the agents

200 JONES, on Functional Disturbances. [April,

mentioned above, but uniform and continuous through any length
of time one may desire. It would seem, therefore, that in cases of
chronic diseases of the internal organs, a dry climate would be
very beneficial, by exciting the circulation of the skin, and thus
abstracting a larger portion of blood from those organs, for peri-
ods of time so extended as to allow them to recover their tone.
Again, it is not uncommon to hear persons, suffering with diseased
lungs, particularly with partially solidified or obliterated lungs,
speak of the invigorating effects of a dry spell of weather upon
them. The explanation of this is obvious, from what has been
said ; increased activity in the circulation of the skin would re-
lieve the lungs of hyperemia, just as any other viscus ; but, in
addition, we have seen that a dry atmosphere increases also the
activity of the true pulmonic circulation ; this causes a more per-
fect aeration of the blood, and removes, therefore, the irritation
which an undue supply of venous blood always produces ; and in
cases of obliteration or solidification, makes up for the deficiency
in the quantity of air cells, where the blood is exposed to the air.

A damp atmosphere on the other hand produces effects quite
the contrary of those described ; in comparison with a dry one, it
drives the blood away from the skin, and it retards the circulation
in the lungs, the former causing a determination of blood to the
viscera and the latter impairing its aeration, the two conditions
pre-eminently favorable to congestion. The brain and nervous
system become depressed through the action of the imperfectly
oxygenated blood, the left ventricle not receiving the stimulus it
is accustomed to from arterial blood, acts with diminished energy,
the capillaries become clogged, and a general stagnation ensues at
the same time that an unusual quantity of the circulatory fluid
driven from the skin is thrown upon the internal organs, and this
is nothing more than what is termed by medical writers " conges-
tion " of those organs. Now, where are those diseases to be found
where these phenomena occur ? Upon the elevated table lands and
mountains where the atmosphere is dry ? Almost never, but in the
neighborhood of the seas and rivers and ponds, either in the tropics
or during the summer in higher latitudes, where the air is damp
and hot. May not also the derangements of the alimentary canal,
so common in these regions, result from an over-activity of the
mucous membranes consequent upon a want of action in the skin,
the two being vicarious in their functions to so great an extent ?

There is another circumstance connected with the escape of

1855.] JONES, on Functional Disturbances. 201

moisture from the skin, which is of high importance. The water
which escapes thence passes off in the form of vapour, rendering
a large quantity of heat latent, and cooling constantly, therefore,
the surface of the body ; the more rapid the evaporation the greater
be reduction of temperature. Every one is aware of the cool-
ing effects of a breeze during a hot sultry day, even though the
thermometer indicates no change in the temperature of the air ;
and this undoubtedly results from the increased facility it affords
for evaporation. Xow, when the temperature of the air is as high
or nearly as high as that of the body (as occurs in the heat of sum-
mer), little or no animal heat is required to maintain the body at
its normal temperature. And if the air be dry. so that evapora-
tion can proceed rapidly, any superfluity of it which may be gene-
rated in the body is readily carried off by this process, and no
inconvenience results. If, on the contrary, the atmosphere is damp,
so that the escape of moisture is retarded, an excess of animal
heat cannot be disposed of in this manner, and must therefore
elevate the temperature of the body above its natural standard.
As this is seldom found to be the case, however, it is more proba-
ble that under such circumstances, the hydrocarbons of the food
which are ordinarily appropriated to the production of heat, escape
combustion, and are thrown in unusual quantity upon the excre-
tory organs for ehmination. May not some of the derangements
of the liver in hot damp climates be connected with this circum-
stance ?

To recapitulate, briefly : A dry atmosphere, by permitting a
rapid escape of moisture from the skin and lungs, increases the
activity of the circulation in those parts, preventing an undue
determination of blood to other portions of the body ; and at the
same time rendering its aeration more perfect : the evaporation of
this moisture also cools the body in hot weather, disposing of any
excess of animal heat which may be generated. A damp atmos-
phere, on the contrary, throws the blood upon the internal por-
tions of the body, retards its oxygenation in the lungs, and, by
preventing the escape of heat, though evaporation from the skin
raises the temperature of the body whenever an excess of animal
heat is generated, or forces the excretory organs to eliminate those
portions of the food which* are ordinarily used up for the genera-
tion of heat

202 Ames, an Phosphorus. [April,

A Reply to Dr. Boiling's Experiments with Phosphorus, and his
remarks upon its dose and action when given in the form of Alco-
holic solution or tincture. By S. Ames, M. D., of Montgomery,
Alabama. (Abridged, by the author, from the Nov. No. of the
New Orleans Medical and Surgical Journal, 1854.)

An account of these experiments was published in the May No.
of the New Orleans Med. and Surg. Journal for 185-4, and in the
Southern Med. and Surg. Journal for July last. They were insti-
tuted, it seems, while Dr. Boling was in search of a 'cardiac
sedative,' equally prompt, powerful and reliable as the veratrum
viride, but without the objections which, in his opinion, pertain
to that remedy. After trying, by experiments on healthy persons,
whether the yellow jessamine would not furnish the kind of seda-
tive required, and being disappointed, he was induced, by my
paper on the Treatment of Pneumonia, published in the January
number of the same journal, to make similar experiments, also,
on well persons, in order to test the sedative properties of phos-
phorus in an alcoholic solution, the remedial operation of which is
there ascribed to a sedative action. The experiments thus prompt-
ed led Dr. Boling to three principal conclusions, namely :

]?irst That Phosphorus is not a Sedative ;

Secondly That it is not a Stimulant ; and,

Thirdly That it is not poisonous when given in an Alcoholic
Solution or Tincture.

These conclusions, it seems, were derived exclusively from these
experiments. Dr. Boling expressly disclaims having had any ex-
perience of the properties of phosphorus in acute diseases. "I
have never," he says, "in any instance, given it in a case of acute
or dangerous disease."

It is important to keep in view the conclusions in the order
here set down, an arrangement not adopted in the paper under
review, as, for the sake of perspicuity, it is required to examine
the experiments and the remarks on them, in reference to each
conclusion, separately.

The first question before us, then, is, as to the proof afforded by
these experiments, that phosphorus is not a sedative.

Dr. Boling selected two subjects for his trials with this medicine:
one a mulatto child, seven years old ; the other an adult black,
under treatment by means of the bandage and a recumbent pos-
ture for an ulcer of the leg, but otherwise in good health. Besides

1855.] Ames, on Phosphorus. 203

these, Dr. Boling submitted himself to some experiments ; but as
they are noticed by him only in a general way, and more in refer-
ence to its poisonous than sedative, their consideration is deferred
for the present.

In all experimental trials of this kind, it is to be remembered
that the state of the pulse is the thing to be observed, and is alone
to be looked to for any indication of the effect of the medicine
given, and consequently that all collateral inducements to changes
in the action of the heart should be carefully avoided Such be-
ing the case, it is not without some surprise that one observes, in
the record of these experiments, an absence of any especial care
to avoid those normal causes affecting the state of the pulse, which,
being common to all persons, of whatever age, are almost con-
stantly in operation during our waking hours. Indeed, their
possible influence seems to have been overlooked, except in the
single instance of the recumbent posture which is mentioned ap-
parently in view of its effect on the pulse, though the difference
between that posture and an erect one, or active muscular exer-
cise, in connexion with such effects, is not alluded to. So, too,
the presence of other causes, as fasting and repletion, sleeping and
waking, are mentioned, but not in this connexion. Yet these are
known to be active sources of perturbation in the heart's action,
which, if not voidable, ought, it would seem, to have been care-
fully noted, and as far as possible taken into the estimate in
counting up the results.

But the influence of these common physiological causes, though
requiring to be noticed as one of the elements of fallacy, is of
much less moment in this discussion than they would otherwise
be, on account of the obvious presence of another cause, operating
more powerfully to disturb the pulse, and, consequently, affecting
more decidedly the results of the experiments. The evidence of
the presence of such a cause, and of its controlling influence in
both subjects, not only over the pulse, but over the action of the
ordinary physiological causes, is found in the record of the experi-
ments ; and to the details necessary to point this out, I wish for a
brief space to call especial attention.

The two first experiments on the little boy, u Sam," are very
significant of the singular fact just referred to :

" On the 25th of February, having kept him (Sam) in a recum-
bent position some time, his pulse being at 102, at one o'clock
P. M., I gave him seven drops of the saturated tincture (of phos-

204 Ames, on Phosphorus. [April,

phorus) ; at two o'clock P. M., pulse variable, from 90 to 108
(eighteen beats while counting it) ; three P. M., (subject asleep,)
pulse 94; the dose of seven drops repeated; four P. M., (subject
asleep,) pulse 104.

" February 26th. Ten o'clock P. M., pulse 100 ; one and a-half
o'clock, pulse 114; two o'clock, pulse 100" (a rise and fall of
fourteen beats at intervals of half an hour.) " No phosphorus
given to day.

" The experiments already given were conducted with the sub-
ject in a recumbent posture. In the following, he was generally
called in from play, when a dose was given or the pulse to be
counted."

In these two experiments the subject appears to have been, more
than in any of the subsequent ones, freed from those ordinary
incidents which operate to derange the action of the heart in
health. For example : He was lying down all the time, so that
no influence could have been exerted by changes of posture, or of
more active muscular exertion. Again, in the first experiment he
was asleep at two consecutive countings the pulse still exhibit-
ing the same tendency to change as when awake ; it being found
at the last counting ten beats quicker than when counted while
asleep, one hour before. Thus, while the tendency of sleep is to
reduce the frequency of the pulse, and give it uniformity, it is
found to be not only faster in this subject, when asleep, at one
time, than another, but faster, by eight beats, when asleep at four
o'clock, than when awake at one o'clock. The cause of these
changes was therefore sufficient to overcome the usual sedative
influence of sleep a very powerful one, too. We are not told
whether "Sam" took any food shortly before or after one o'clock,
on either day, nor is it material here to know ; for, if so, its effect
could have been only to give a uniform acceleration to the pulse
while the process of digestion was going on ; not, certainly, to
produce this kind of vacillation. There is still another apprecia-
ble physiological cause, whose operation would be more likely
than any other to bring about this kind of changes, and that is
mental agitation ; but we have no direct evidence of its presence.
If present, it would probably have shown its presence by other
signs, which could hardly have failed to attract the attention of
Dr. Boling, who does not, however, allude to it. ISTor could the
medicine given have had any influence to derange the pulse in
this way ; for seeing that the changes in these and other experi-

1855.] Ames, on Phosphorus. 205

ments, occurred equally when the phosphorus "was or was not
given, and equally, when given in comparatively small or large
doses. Dr. Boling, himself, very properly excludes it from any
agency in producing them.

Here, then, we find in two experiments one of them occupy-
ing three hours, and the other one hour only an extreme varia-
tion in the pulse, of eighteen beats in the minute in the one, and
of fourteen in the other ; while in both the pulse rose and fell so
suddenly as not to be really the same at any two consecutive
countings ; and this, when all the ordinary incidents affecting the
rythm of the hearts action, were either absent or obviously inop-
erative to produce such effects. Excluding, therefore, all these
ordinary incidents, what other conclusion is left, the subject being
in good health, than that there was in him some inappreciable
peculiarity or idiosyncracy of considerable force, operating to pro-
duce these striking anomalies in the heart's action.

In the subsequent experiments on " Sam," the circumstances
were less favorable for the manifestation of this peculiarity ; one
of the ordinary physiological influences, namely, muscular exer-
tion ; and one extraordinary one, not physiological, namely, large
doses of alcohol, were present in these and absent in the others.
The influence of the alcohol may be estimated with some assurance
of accuracy, for, being the vehicle for the doses of phosphorus,
the time of giving it, and the quantity, are noted ; but we have
no means of estimating the probable effect on the pulse, of the
additional physiological cause for its changeableness. We are not
told, for instance, in which of the experiments he was called in
from play to take the experimental dose, or to have his pulse
counted ; nor whether, when called in from play or at other times ;
the pulse was counted while standing, or in some other position.
All the information we get on these important points, so sure ordi-
narily to derange the pulse, is that he was generally called in from
play. So, too, in the experiments which were partly conducted
while the subject was riding in the buggy with his master, no
especial reference is made to the circumstances in which the state
of the pulse was noted. ]S~or have we any information in this,
any more than in the other experiments, at which time " Sam "
took his meals, nor in which he did or did not take food, though
we are assured that both subjects took their meals as usual, and
with their usual appetite and relish, and, of course, in the usual
quantity and variety ; but, as we do not know the hours of break-

206 Ames, on Phosphorus. [April,

fast, dinner, or supper, we cannot apply this general assurance to
the particular experiments. These incidents, I hardly need say,
are of a kind to have had a decided influence over the pulse ; but
whether they did so in this instance, or when, and to what extent,
.are things that we are not permitted to bring into the estimate for
want of these essential details. Nevertheless, an analysis of the
-experiments as we find them recorded, brings into view, in despite
of all counteracting causes, the manifestation of the same control-
ling powers that is so plainly exhibited in the former experiments.

The first evidence of this that I shall notice is, that the pulse
look a lower range, and was not more variable in these subsequent
experiments, when the pulse should have been accelerated by an
-erect posture, or the mere active muscular exertion of boyish play,
than in the too first, when the subject was lying down all the
time, and asleep a part of the time. Thus, the average of the two
first experiments is respectively, leaving out the fractions, ninety-
nine and one hundred and four beats to the minute ; while the
highest average in the subsequent ones, excluding the effect of
overpowering doses of alcohol, was one hundred, and the lowest
ninety; while the general average in the former subject being at
rest, is one hundred and two. The general average in the latter,
when he was engaged in active exercise, actually falls to ninety-
six. Why did changes of posture, and the alternations of rest and
muscular exercise, fail to have their usual influence in quickening
the pulse ? The pulse ought to have been very much accelerated,
but we find it slow. How could this happen unless there had
been some other cause at work more powerful than they, in its
influence over the action of the heart.

Secondly : The suddenness and extent of the changes in the
pulse. Thus ; March 10th, the pulse at 12 M. was one hundred ;
at 1 P. M., it varied from one hundred, to one hundred and six.
This means, probably, that the variation occurred while the pulse
was being counted at that time. At 2 P. M., pulse one hundred
and four ; 3 P. M., pulse one hundred and eight ; 4| P. M., pulse
ninety-two ; 6 P. M., pulse eighty-eight, a fall of twenty beats
in the minute in three hours ; and five minutes later ninety-six.

Thirdly : Similar changes occurred while the subject was under
the influence of large doses of a powerful stimulant. Thus : March
12th, at 5, and at 5^ o'clock P. M., "Sam" took, at each time,
two hundred drops of anhydrous alcohol, the vehicle for the doses
of phosphorus then given, that is about four drachms of anhy-

1855.] Ames, cm Phosphorus. 207

drous alcohol in the course of half an hour. The result as regards
the pulse is thus noted : 5 P. M., pulse one hundred two hun-
dred drops given ; 5| P. M., pulse one hundred two hundred
drops given ; 6 P. M., pulse one hundred and seven ; 7| P. M.,
pulse ninety-four.

That is to say, the pulse rose seven and fell thirteen beats in
the minute within two hours after taking the last dose of alcohol ;
and of course, while the subject was still under its influence. Now,
it would seem hardly possible that the pulse could have fallen so
much, for it is to be noticed that two hours and a quarter after
the last dose, it was six beats slower in the minute than just before
the doses of alcohol were taken ; or at all, while acted upon by a
quantity of this prompt and powerful stimulant, which is equiva-
lent to about an ounce of good brandy, given to a child seven
years old ; unless there had been some unusual cause of perturba-
tion in the action of the heart.

Another significant fact, leading to the same conclusion, is ex-
hibited in the succeeding experiments. Thus : March 18th, 8 A.
M., pulse ninety-two, five hundred drops (more than half an ounce
of anhydrous alcohol, the menstruum for the dose of one-tenth of a
grain of phosphorus) was given. One hour afterwards, namely,
at 94 A. Ik, the pulse was still at ninety- two ; ten beats below the
average in the other experiments, in which the subject took neither
an artificial stimulant or muscular exercise.

These experiments, if they give us no clue to the nature of the
cause of these singular interruptions to the normal rythm of the
heart's action, afford more decisive evidence of its power. TTe
have seen that the vacillations in the pulse occurred under all
circumstances, with two exceptions, in both of which a large dose
of an active stimulant was operating to control it. The pulse
rose and fell almost equally while under the influence of about
half an ounce of alcohol, as when none was given ; while a larger
dose, more than half an ounce, served only to make the pulse
regular, and apparently to reduce its frequency, for it is found be-
low ninety-two in but three countings in all the other experiments
on this subject. It required a larger dose still to overcome this
physiological tendency, to change so far as to exhibit the usual
effect of a stimulant on the pulse. Thus: March 17th, 4 P. M.,
pulse 104, nine hundred and ten (910) drops, "being," says Dr.
Boling, u exactly one ounce (of anhydrous alcohol, being the men-
struum hi the dose of phosphorus) given at a dose. And here

208 AMES, on Phosphorus. [April,

is the result: half after 4 P. M., pulse 116; 5 P. M., pulse 120 ;
7 P. M., pulse 104, and the subject feels very well.1' The dose of
alcohol, it is seen, is a very large one, if we take into considera-
tion the tender age of this subject. Good brandy contains less
than fifty-three per cent, of alcohol ; the dose, therefore, was nearly
the equivalent of two ounces of brandy. The age of the subject
being seven years, the dose for him should be about one-third of
that for a man of middle age ; so that the quantity of alcohol taken
by Sam, at one dose, was equivalent to nearly six ounces of good
brandy for a man of middle age. Yet the pulse was quickened
only for the space of something over two hours ; at the third hour
it was found to be the same as at the time the dose was given.
The pulse fell sixteen beats in the minutes between the second and
third hour. Was this owing to any narcotic effect from the alco-
hol ? It seems not. " The two hours immediately succeeding the
two last doses," Dr. Boling tells us, " Sam spent riding in my
bugg}', and attending to my horse, at the different stopping places,
and at the end of the experiment, the subject feels very well."

What estimate, then, shall we make of the power of that cause
perturbing the heart's action, in this subject, when half an ounce
(four hundred drops,) of anhydrous alcohol failed to affect it at
all, and five drachms (five hundred drops,) seemed only to steady
it, and, apparently rather to reduce than to augment its frequency,
and a full ounce, equivalent to nearly two ounces of brandy for
the child, or six ounces for an adult, quickened it but for a short
time, something over two hours ? May we not at least conclude
that a cause, so resisting to such active stimulating influences, may
have been sufficient to prevent any manifestation of a sedative
power not absolutely poisonous ?

Abundant evidence of the same peculiarity is exhibited in the
adult subject, in whom this vacillating tendency in the action of
the heart, was not less striking than in the other, if due allowance
be made for the difference in age. For example :

" March 4th. Eleven o'clock A. M., pulse 80 ; half-past twelve
P. M., pulse 72 ; three P. M., pulse 68. No phosphorus given
to-day."

March 7th. Twelve M., pulse 78 ; half-past twelve, pulse 68 ;
eighty drops (of the saturated tincture of phosphorus) given ; two
and a half P. M., pulse 76.

March 10th. Half-past seven A. M., pulse 76 ; half-past eight
A. M., pulse 70 ; ten A. M., pulse 80 ; eleven A. M., pulse 80 ;

1855.] Ames, on Phosphorus. 209

twelve M., pulse 82 ; half-past one P. M., pulse 76 ; two P. M.,
pulse 68 ; three P. M., pulse 74 ; half-past four P. M., pulse 80 ;
six P. M., pulse 82. No phosphorus administered to-day.

March 11th. No phosphorus was given, but the pulse, being
counted at intervals, was found to vary about as it did yesterday.

The extreme range of the pulse is here seen to reach ten, twelve
and fourteen beats to the minute, suddenly, and without any ap-
parent cause. The same thing is true, generally, of the other
experiments on this subject ; the pulse in this, as in the other
subject, being very seldom the same at any two consecutive
countings, no matter how short the time between them. Thus,
the changes occurred equally when the phosphorus was or was
not given ; the man was all the time recumbent, so that neither
posture nor exercise could effect his pulse. There seems to be no
reason to believe that mental agitation operated in this, any more
than in the other subject ; and, finally, the pulse did not, in a sin-
gle instance, exhibit the regular diurnal ebb of the heart's action
from morning to night. The taking of food, by this subject, is
particularly spoken of, in connection with one experiment only,
and in this it is worthy of notice, that the pulse was more steady
on this than on any other day, though we find the usual order of
the diurnal change reversed, the pulse increasing in frequency, in-
stead of diminishing, as the day advanced thus:

March 15th. Nine o'clock A. M., pulse 72 ; 200 drops of the
saturated tincture (of phosphorus, holding in solution about one-
fourth of a grain) given ; ten A. M., pulse 72 ; eleven A. M., pulse
74; one P.M., pulse 76. A short time before he took the 200
drops, he ate a hearty breakfast, and at two P. M., with decided
relish, a substantial dinner of bacon, cabbage, potatoes and corn
bread ; four P. M., pulse 80.

The unusual regularity of the pulse in this instance may have
been accidental ; nevertheless, it is singular as a coincidence, that
this is the only day in which it exhibited a similar regularity in
its variableness; the effects of digestion seeming, like the stimulus
of the alcohol in the other subject, rather to steady the pulse than
to increase its frequency, which is known to be its usual tendency.

Excluding, therefore, in both subjects, all known and apprecia-
ble causes from any agency in producing these remarkable and
peculiar physiological changes in the action of the heart, or making
all proper allowance for their effects, we find remaining a degree
and kind of eccentric action, whose cause it is evident must have

210 Ames, on Phosphorus. [April,

had a predominant influence over the result of these experiments.
In such a condition of the heart's action, so perseveringly and
actively variable, arising from a cause capable of resisting not only
the usual physiological stimuli, when known to be present, but
also the power of a very active medicinal agent, administered in
large doses, may we not suppose, that even a pretty active seda-
tive influence would be as powerless over the pulse of these sub-
jects as the stimulants proved to be? In truth, this source of
fallacy seems to be of that precise kind which would necessarily
preclude any other than the negative results actually obtained by
Dr. Boling in these experiments.

I turn, now, from the fallacies in the experiments to the more
important fallacy in this conclusion from them. The latter is not
dependent on the former, but inheres in the conclusion itself, and
would be the same if there had been no sources of fallacy in the
experiments. The conclusion, which is a general one, as to the
sedative action of phosphorus, is so stated as to cover two distinct
propositions which have no necessary connection: First, that
phosphorus does not act as a sedative on persons in health ; and,
secondly, that it does not act as a sedative in disease. Dr. Boling
infers, from the result of his experiments on well persons, that the
same result must accrue from similar experiments on sick per-
sons, an inference strictly a priori, which Dr. Boling has not
tested the truth of in a single instance of acute or dangerous dis-
ease. The fallacy lies in this inference from the negation of
physiological effects to the negation of therapeutic ones.

Instances illustrating the fallacy of & priori arguments of this
kind are equally numerous and familiar. I select, for illustration
here, two such instances.

Lemon juice, it has recently been discovered, exercises a speedy
and very efficient curative agency in acute rheumatism, an in-
flammatory affection, in which contra-stimulants or sedatives are
necessarily the only effective remedies. Now, is there anything
in the physiological effects of lemon juice which would indicate
this therapeutic action ? I believe not. Certainly it has no con-
siderable power in this respect, if any at all ; and yet it is said to
reduce the force and frequency of the pulse, in this disease, with
a degree of power not equalled by the most active sedatives known
to the Materia Medica. Let us suppose, then, that when this dis-
covery was first announced, physicians, instead of testing its

1855.] Ames, on Phosphorus. 211

value in the circumstances of disease in which its sedative power
was affirmed, had set about to determine whether this was true or
not, by giving it to well persons, to try, in fact, whether it would
cure rheumatism by giving it to persons who had no rheumatism
to cure, what the ekpriori inference from such experiments would
be, as well as its value when made, is obvious enough. Would
they not, in fact, have necessarily come to the same general con-
clusion in regard to the sedative power of lemon juice, that Dr.
Boling was led to by his experiments in regard to phosphorus ?

Again : It is well known to medical men practising in the
Southern and Southwestern States, that quinine acts more effici-
ently as a sedative in a certain class of diseases than any other
medicine. The pulse may be (every one must have seen it) re-
duced by a single dose, but always by a few doses, if the circum-
stances be suitable, twenty, forty, or even fifty beats in the minute
in a very short time. And yet if the same medicine be given to
a person in health in the same doses, or even larger ones, it may be
that the pulse will not be effected at all, and is just as likely to be
made faster as slower. An example in point, remarkable on ac-
count of the unusual size of the doses, has been recently related
to me by Dr. Eeeves, of this city, who gave to a man with chronic-
hypertrophy of the spleen, but without feverT the enormous quan-
tity of an ounce of quinine in the course of four days, in doses of
forty grains, given three times daily. Dr. Eeeves did not observe
any material change in the man's pulse during the whole experi-
ment, for such it was. TThat change there was, indicated an in-
crease rather than a diminution of its frequency. Numberless
other instances of its inaction on the pulse of well persons, as also-
in some forms of febrile disease, will occur to the memory of every
physician who has made much use of it. My own experience
with it as regards its action, when I have taken it, or given it to
others, is to the effect that quinine, like lemon juicer does not so-
effect the pulse in health as to give any intimation of its extraor-
dinary sedative power in some forms of disease. Such, no doubtr
is also the result of the experience of physicians generally,, if not
universally. But if so, how false a guide to the truth would be
experiments made with quinine like those made by Dr. Boling"
with phosphorus ?

But, not to fatigue the reader with further illustrations of an ob-
vious truth, we here close the review of these experiments, so far
as they relate to the sedative action of phosphorus, by summing:

212 Mullein Leaves as an Antiperiodic. [April,

up the conclusions from all that has been said, which, I think, are
embraced in the following propositions :

First : That the fallacies in the experiments were of such a kind
as to preclude any other than the negative results actually obtain-
ed from them, and consequently, that they afford no reliable proof
as to the sedative power of phosphorus in health ; and,

Secondly : That if the experiments had been so conducted as
to insure accurate results, they would furnish us reliable evidence
as to its effects in disease.

[To be concluded in the May No.]

ARTICLE XI.

Decoction of Mullein leaves ( Verbascum Thapsus) as an Antiperiodic.
By E. W. McCrary, M. D., of Clinton Depot, S. C. (Commu-
nicated in a letter to the Editors.)

I have found from experience that a decoction of Mullein leaves
is equal in its effects to sulph. quinine. My method of preparing
it is as follows :

^. Mullein leaves, .... 3ij.
Boiling water, .... oij.
Boil until reduced to one pint. Of this I prescribe four dessert-
spoonsful every two hours, commencing early in the morning.
This is to be repeated on each day that the paroxysm is expected,
for three or four days, when a permanent cure will be effected.

Three Lectures on the Spinal System and its Diseases. Delivered at
the Chatham-street School of Medicine, Manchester. By Marshall
Hall, M.D., F.R.S. L. & E., Foreign Associate of the Imperial
Academy of Medicine of Paris, etc.

LECTURE III.

THE MODES OF DEATH AND THE THERAPEUTICS IN DISEASES OF THE

SPINAL SYSTEM.

Gentlemen, In my lecture of yesterday, I explained to you two
modes in which spinal seizures may issue in death : the first, by
apoplexy of the medulla oblongata and paralysis of the pneumo-
gastric nerve ; the second, by shock on the heart ; the former,
somewhat slowly the latter, suddenly.

There is another mode of death in epilepsy. It is the result of
sheer nervous exhaustion, from the rapid or constant repetition of
severe paroxysms.

1855.] On the Spinal System and its Diseases. 213

This subject will be best illustrated by an experiment :

I divided the cerebral from the spinal centre in this frog, and
then dropped on its surface a few drops of a solution of the acetate
of strychnine. It has become affected by the poison : the least
touch, the least jar of the table thows it into a tetanoid paroxysm.

If I avoid excitement, the animal survives in its state of strych-
nism for a long time. But if I continue to repeat the excitation,
the excitability and life soon become extinct.

I will suppose the frog without injury, but placed under the
' influence of strychnia ; if it be secured from all excitation, it re-
covers ; if it be exposed to repeated excitation, it dies.

So it is in the dog.

Even in tetanus in the human subject, I believe some patients
would recover if preserved absolutely from excitation, who die
under its exhausting influence.

The same event occurs in epilepsy. In a case detailed in the
Lancet, by Dr. Bucknill, in which tracheotomy had been per-
formed, and in which, therefore, laryngismus had lost all its bane-
ful influence, the patient died of pure exhaustion, " distinctly not
of coma."

Death from nervous exhaustion must therefore be added to the
other forms and modes of death in epilepsy.

There is still another source of danger and of death in epilepsy.
It arises out of trachelismus assuming the form of torticollis, and
attended with twisting of the body.

Some time ago a medical student, affected with epilepsy, called
on me, and, whilst we engaged in conversation, uttered a fearful
cry, became affected with twisting of the neck and body, and would
have fallen had I not held him forcibly on his chair.

The next morning he was found dead in bed, with his face
buried in his pillow !

He had doubtless had a fit in the night, which, assuming the
form I had observed and have described, turned him in bed.

In this manner a patient has been suffocated in a fit of epilepsy,
the face being found literally buried in the soft soil of a newly-
ploughed field, or submerged in shallow water.

Such, then, are the principal modes of death in epilepsy.
Another topic which I must discuss briefly before I enter on the
subject of the therapeutics of the spinal system, is, the mode
and degree of recovery from attacks of epileptic or convulsive
affection.

An epileptic fit probably ceases frequently from nervous ex-
haustion of the spinal centre, just as we observe the tetanoid spasm
cease in the frog affected with strychnia.

From this exhaustion reaction usually takes place, and the spi-
nal centre passes into a state of undue excitability, just as reaction
follows repeated attacks of syncope in cases of loss of blood, pass-
ing into excess.

In this condition of excessive excitability, the slighter causes of

N. S. VOL. XI. NO. IV. 14

214 On the Spinal System and its Diseases. [April7

the epileptic seizure are usually but too operative. It constitutes
indeed the continued predisposing cause of epilepsy.

This undue excitability of the spinal centre is by no means in-
compatible with a shattered condition of the general system ; and
therefore we frequently observe the epileptic patient pale, thin,
and feeble, though in other cases there are a florid complexion, a
robust form, and much muscular power.

Besides the spinal centre; the cerebral centre is apt to be affected
in severe epilepsy, and the patient is left comatose, maniacal, or
with loss of memory or intellect. These events appear sometimes
to depend entirely on intra-vascular congestion, and sometimes on
effusion, ecchymosis, softening, or other lesion.

You will not, gentlemen, be surprised, that from any mode of
treatment we look for success, not in cases with organic lesion, or
of inveterate standing, but in the comparatively recent cases of
excentric inorganic origin, and still without organic change.

Now let us consider what may be accomplished in the treatment
of epilepsy or other convulsive disease.

Once more I beg your attention to my Table. Look at this
list of causes. The first part of our treatment depends on carefully
avoiding all these.

The excitements, the irritations must be, as far as possible,
avoided. The morbid conditions of the blood must be remedied.
A low posture and deep sleep must be carefully shunned. The
neck must be cautiously guarded against a tight collar.

One event we must constantly suspect : an undue acidity in the
stomach. Against this, the bicarbonate of potass is the present
remedy, and should be taken on every recurrence of a threateDing
symptom. Many patients have carried about with them a solution
of twenty-five grains of this bicarbonate in two ounces of water,
and taken it in such circumstances with the greatest advantage.

Another event to be suspected is the formation and retention of
scybala in the colon. These are only effectually removed by an
enema of three pints warm water, slowly administered. But in
this manner, too, the threatened attack has been averted.

One patient succeeded in replacing an attack by a fit of vomit-
ing, taking for that purpose, on any threatening, half a drachm of
ipecacuanha. To this I have sometimes added an equal quantity
of the bicarbonate of potass.

The bowels should be kept well relieved daily; but I have
known a dose of purgative medicine constantly to produce a
seizure.

One patient took many remedies empirically. None did good.
But the turpentine acted injuriously.

Of all our remedies, none is more important than a well-regu-
lated, simple, digestible, nutritious diet.

Against the undue excitability of the spinal centre in epilepsy,
well-appointed walking exercise is the specific remedy. But effort
or fatigue adds to the evil.

1855.] On the Spinal System and its Diseases. 215

I think there is as the cause of sleep a latent trachelismus.
The usual posture during sleep is the recumbent. Both these
must conduce to the epileptic seizure. I have constantly re-
commended a posture during sleep at an angle of fifty degrees.
And I think that I have seen advantage from gentle movements
and noises in the patient's room during the first sleep, to prevent
deep sleep.

All empirical remedies may be safely discarded. It is very
improbable that any individual agent should be able to accomplish
all that is required in a case of epilepsy. We may well ask, now
that this malady is somewhat understood, why epilepsy should be
treated empirically more than apoplexy, or than infantile or puer-
peral convulsion ?

It has appeared to me that the hyoscyamus may allay the ner-
vous excitability so frequently observed in epilepsy. As a little
spirit obviously does good in the undue cerebral excitement of
delirium tremens, I have thought that minute doses of strychnia
may be useful in the undue spinal excitability in epilepsy. For
the organic changes induced by epilepsy, mercury is the remedy.

You will observe, in the Table, that after enumerating the reme-
dies which I have briefly noticed, I have asked, is there any spe-
cific remedy in epilepsy ? I am compelled to answer, No ! And
I must add, that the sooner the profession cease from this deroga-
tory mode of prescription the better, and the more honourable.
Zinc, copper, silver, valerian, the cotyledon, the sumbul, are all
given in vain.

We must discard empiricism, and treat epilepsy as we do other
diseases, on rational principles, tracing causes, effects, and, in a
word, every link of the formidable chain, and act on science and
common sense.

I must now, gentlemen, retrace my steps, and take up one of
the topics which I have noticed briefly, and treat it at greater
length. This topic is laryngismus, and its remedy, and the reme-
dy against its effects tracheotomy.

I have already noticed the two kinds of laryngismus which oc-
cur in the first and last stages of a severe epileptic seizure, respec-
tively the first being spasmodic ; the second, paralytic.

The former frequently closes the larynx perfectly, and a breath-
struggle is superadded, or there is simple suspension of respiration ;
the neck, face, eyes, become turgid and purple, the intra-cranial
tissues being equally congested.

In proportion, in some degree, to this congestion is the damage
inflicted on the cerebral faculties, coma, mania, dementia, being
the melancholy effects the lunatic asylum or the workhouse the
melancholy doom.

All these are averted by timely and efficient tracheotomy.

I would strongly urge you to seize some opportunity, during
the period of your studies for I am addressing myself to the
younger part of my audience to witness and write down accu-

216 On the Spinal System and its Diseases, [April,

rately, the phenomena of the epileptic seizure. It is not in any or
every kind of epilepsy that I recommend tracheotomy, but solely
and exclusively in the epilepsia laryngea. It is not for epilepsy,
but for laryngismus, that tracheotomy is proposed.

It is necessary to state this emphatically, for a feeble and male-
volent critic has either misunderstood or misrepresented this mat-
ter.

We must begin, in the administration of this, as in that of all
cases of important remedies, by a most careful and accurate Diag-
nosis:

1. The efficacy of the remedy is precisely proportionate to the
degree of laryngismus and its effects ;

2. The hope from the remedy is proportionate to the earliness
of the period at which it is performed ;

3. By the institution of this remedy, the laryngeal and most
fearful form of the disease is changed into some milder or abortive
form ; or,

4. The seizures may cease, or decline and cease, altogether.
The former was the happy result in the most interesting case of
Mr. Cane.

There are many cases of epilepsy in which tracheotomy would
be inappropriate. It would be inappropriate in cases involving
organic lesion, original or induced, and in cases already become
inveterate. It would be wrong to institute this operation in cases
beyond hope of benefit ; in the cases already deemed incurable ; and
therefore in most of the cases consigned to the lunatic asylum or
the workhouse. In these, all that we ought to expect from this,
or any remedy, is some mitigation of so dire a calamity.

In the cases in which tracheotomy has been performed, this pre-
liminary diagnosis has not always been instituted. The result
has been precisely what ought to have been anticipated ; yet it
has been such, when duly weighed and considered, as to confirm
and raise all my hopes from this important and heroic remedy in
this Herculean malady. In some the fits have been mitigated a
hundredfold ; in several a failing intellect has been greatly restored,
the occupation of the patient, necessarily relinguished, being re-
sumed I

I proceed to notice the second or paralytic laryngismus. This
is the result of a severe attack of epilepsy always, I think, the
epilepsia laryngea. The trachelismus, the laryngismus especially,
the breath-struggles, have congested the cerebrum, and left a deep
coma ; with this, stertor or paralytic laryngismus has been com-
bined an event which reacts on the cerebral centre, augmenting
the coma and the stertor. The patient is frequently seen to be in
hourly jeopardy of his life from asphyxia. The countenance is
livid, the veins of the neck distended, the integuments tumid.
The respiration becomes more and more impaired and stertorous.
A diffused bronchial rattle establishes itself.

The form of the asphyxia is, as I have already stated, twofold,

On the Spinal System and its I 217

laryngeal and bronchial ; at first laryngeal, afterwards both laryn-
geal and bronchial.

If tracheotomy be now efficiently instituted, the laryngismus is
disarmed of its danger. The lividity of the countenance, the dis-
tention of the veins, the tumefaction of the integuments disappear
iL The respiration is free ; the danger from laryngeal
asphxia averted !

I need scarcely re]3eat, that if this tracheotomy be not only
efficiently but timeously performed, the patient's life is saved.
But if the operation be delayed, it will be performed too late : if
the bronchia have become clogged and choked with mucus, it will
dly be performed in vain. The patient, however, rescued
from laryngeal, will succumb to bronchial asphyxia.

These observations do not relate to epileptic coma or apoplexy
alone, but to simple apoplexy in all its forms ; that so well de-
scribed by Abercronibie, the apoplexy of deep intoxication, of
narcotic poisons. <fcc. It is the present remedy, and, if timely in-
stituted, the effectual remedy, tor the laryngeal asphyxia in all
thes-

Gentlemen, do not these views excite a deep interest in you ?
Examine them ; judge them for yourselves : and be not misled by
the ill-natured criticism of any superficial observer or thinker, who
leaves diagnosis and every other just consideration neglected, and
wonders that a fistula, left by a cut-throat, is not a remedy for
laryngismus, and its effects ? Xo ! but for epilet -

Having thus stated in what circumstances tracheotomy may be
available in epilepsy, I will now beg your attention to that which
I finally regard as the simplest, the e ode of performing of it.

I present you with a pair of scissors, so ground at the point as
to leave a notch. I propose that, having selected the point of the
trachea at which the orifice should be made, you take up a fold of
integument over it and, by means of the s: lake a vertical

incision ; that the - turned one-fourth round ; that

their points, brought together, be made to pierce the trachea, and
then be separated, so as to stretch the tissues, and make an orifice
of the proper extent.

The points of a little wire cage, such as I now show you, made
of the proper size and strength, are then to be brought together,
d into the orifice, and allowed to expand to the proper ex-
tent, in their turn ; this being hmited by a thread properly attached
. and placed round it.
: a minute of time, or a drop of blood has been lost, no dan-
ger has been incurred, and yet the operation is performed !

The cage admits of being compressed, and easily removed,
ed, and restored. ISTo veil of viscid mucus will obstruct its
aperture in any part, and the danger arising from such obstruc-
tion, hidden from observation, but detected by Dr. EdAvards, will
actually a veiled a danger which I believe to have existed
in many cases in which the ordinary tube has been long worn.

218 On the Spinal System and its Diseases. [April,

I will now, gentlemen, very briefly revert to the cases of epilepsy
in which tracheotomy has been used. Mr. Cane's was the first,
and the most splendid : life was immediately saved, and the fits
were afterwards averted. Life was saved from a present danger
in Dr. Herrick's and Dr. Williams' cases. The fits were reduced
to a very mild and abortive form in Dr. Edwards' and Dr. Buck-
nill's cases.

Every event occurs to encourage the benevolent inquirer.

There are other applications of tracheotomy.

The patient afflicted with hydrophobia has hitherto fallen a vic-
tim to laryngeal asphyxia and to nervous exhaustion. If tracheoto-
my were performed the instant the diagnosis was made, the pa-
tient would not die, as he has hitherto, of this laryngeal asphyxia.
Query, would he necessarily die ? If the patient were, further,
protected absolutely, like the frog rendered tetanoid by strychnine,
from causes of excitement, he might not die of nervous exhaustion.
Query, is it possible that even the poison of hydrophobia may be,
if life were prolonged, as by tracheotomy and security from excita-
tion, eventually eliminated from the system, and life saved ?

There is still grater hope of good from these measures in certain
cases of laryngeal tetanus. My friend, Dr. Webster, once per-
formed tracheotomy in a case of this kind. The benefit was so
marked as only to lead to a regret that it had not been performed
earlier.

You will find, in a paper which I published in The Lancet
about two years ago, a list of cases in which tracheotomy might
be necessary. It is of considerable extent. It demonstrates the
value of this remedy, and the importance of being prepared to per-
form it ; for almost all the cases requiring it are cases of emergency,
life being in jeopardy. All that is really required is a pair of
pointed scissors and a teaspoon ! The former may keep the orifice
patent horizontally, the latter vertically, until better instruments
are procured and life is spared : indeed, the very issues of life
are in some instances fearfully held, as it were, in our fingers !

Here the lecturer paused, but shortly added, Gentlemen, I
thank your kind invitation to give these lectures, and for your
kind attention to them. I trust the three hours have not been
spent in vain, and especially that the younger part of my audience
will long remember with advantage the principles of medical doc-
trine which I have inculcated.

The lecturer having been invited to take the chair, Mr. Wilson
rose and said that he should propose a vote of thanks to Dr. Mar-
shall Hall for the kindness and courtesy he had shown in coming
amongst them to communicate information, illustrated by experi-
ment, concerning the physiology and pathology of the nervous
system, which it had been the great pursuit of his life to investi-
gate. The students of the Chatham-street School of Medicine
should, indeed, regard the present occasion as red-letter days. As
for himself and the rest of his professional brethren who had at-

1855.] On the Spinal System and its Diseases. 219

tended this course of lectures, he could say with confidence that
they deeply appreciated the philosophic views of Dr. Marshall
Hall; and, when they contemplated the state of nervous physiology
as it was in their own early day, and looked at it now, they must
be greatly impressed with the debt of gratitude due to those emi-
nent men who had so perfected this branch of science ; foremost
amongst whom he had no hesitation in placing their distinguished
visitor. He concluded by moving the cordial thanks of the assem-
blage to Dr. Marshall HalL

Dr. Xoble had great pleasure in seconding the motion so justly
and so appropriately submitted by Mr. Wilson. Thanks, certainly,
were eminently due to their distinguished visitor for his kindness
in coming amongst them, and in thereby giving to the gentlemen
present an important advantage. They had not only had the
gratification of meeting the propounder and discoverer of great
physiological truths, but that also of listening to his own exposi-
tion of them, and of witnessing some of the experiments and
demonstrations by which they are substantiated. And here he
would observe that, however accurately such doctrines might be
learnt from books, by the aid of diagrams, and by repeating the
experiments, there was always an especial benefit in drinking in
knowledge and valuable precepts at their spring. Look at certain
analogies in literary experience. How clear and effective was the
appreciation of history by him who had gone for his knowledge
to the sources, to the old quartos and the big folios, instead of
to modern duodecimos ! He could speak with gratitude of his
own experience. He supposed it was some twenty years since
that he had first applied himself to the physiological discoveries
and practical teachings of Dr. Marshall Hall ; probably he soon
acquired a fair appreciation of their nature and value. Seven or
eight years ago, however, he had had the privilege, through Dr.
Hall's kindness and courtesy, of witnessing at that gentleman's
own house a long series of experiments made by him, and for
several days of conversing with him upon all the allied topics ;
and from this experience he could tell how much more clear and
decided was the apprehension of facts and conclusions learnt in
this wa}\ The brief course of lectures now terminated had, in
some measure, furnished the students, and the numerous practi-
tioners who had attended the course, with a similar advantage.
He was sure that they would feel, as he had felt, in having been
so privileged, delighted to have been taught the physiology, and
much of the pathology, of the Spinal System by the eminent mind
that conceived the same : and to have had demonstrations pre-
sented to them by the hand that first brought them out. For all
these reasons, it was with pleasure, sincerity, and pride, that he
seconded Mr. Wilson's motion.

Dr. Marshall Hall then rose and thanked the mover and seconder
of this vote of thanks ; and, after briefly observing that nearly a
quarter of a century had elapsed since he first began the studies

220 Dislocation of the Femur at the Hip-joint. [April,

which, led to the detection of the Spinal System, urged the students
present to pursue their profession with enthusiasm, and early to
select some special subject for study and investigation. Such a
proceeding was sure, in due time, to bring its reward in reputation
and in practice. [London Lancet.

An account of the Cases of Dislocation of the Femur at the Hip-joint,
treated by Manipulation alone, after the plan proposed by W. W.
Reid, M. D., of Rochester, which have occurred in the N. York Hos-
pital during the past two years. By Thomas M. Markoe, M. D.,
one of the Attending Surgeons.

In the "Transactions of the Medical Society of the State of New
York, during its annual session held at Albany, February 3rd,
1852," is published a paper by m. W. Reid, M. D., of Rochester,
N.York, on "Dislocation of the Femur on the Dorsum Ilii, redu-
cible without pullies or any other mechanical power," in which it
is the object of the writer to show that this displacement can be
remedied " by flexing the leg on the thigh, carrying the thigh
over the sound one, upward over the pelvis, as high as the um-
bilicus, and then by abducting and rotating it."

The fact that luxations of the hip-joint might be reduced by
manipulations, not requiring forcible extension by pullies or other
mechanical contrivance, seems to have presented itself to the mind
of several writers both of ancient and of modern times. The idea
would appear sometimes to have been suggested by accident, and
sometimes to have been the result of reasoning on the mechanism
of the joint, and its displacements. Such a suggestive accidental
reduction occurred in the hands of Dr. Physick, and is related in
Dorsey's Surgery. A patient was the subject "of dislocation of
the femur directly backwards, and after very powerful efforts had
been made to effect the reduction by extension, Prof. Physick,
conjecturing that the head might be confined in a slit in the cap-
sular ligament, discontinued the extending force entirely, and then,
with no more force than that of his own hands, abducted the thigh,
when the bone instantly slipped into its place."

A similar occurrence took place in our hospital, about the time
of the introduction of the use of chloroform, in a patient with dis-
located hip, under the care of Dr. Jno. C. Cheesman. While the
preparations for applying mechanical force were being made, Dr.
C. made some preliminary movements of the joint, while the pa-
tient was fully under the influence of chloroform, and, unexpect-
edly, the head of the bone slipped into its proper place. Dr.
Nathan Smith, Professor of Surgery in Yale College, succeeded in
reducing a luxated femur, by manipulating, with the thigh and
leg used as a lever, after the usual plan had failed. It would seem
from the report of this case, which, however, is made from memory
by his son, Dr. Nathan R. Smith, that it was a deliberate and pre-

1855.] Dislocation of the Femur at the Hip-joint. 221

arranged plan of procedure, though the considerations which led
to its adoption are not mentioned in the record.

Chelius, in his work on Surgery, gives an outline of the views
of four writers, who have proposed to effect the reduction of the
dislocated hip by the hands alone of the surgeon and his assist-
ants, and without the aid of pullies, or, indeed, of any forcible
extension. Three of these gentlemen, Wattman, Kluge and Rust,
have described methods not very different from each other, which
essentially consist of moderate extension with the hand, combined
with movements of rotation of the axis of the limb, adduction,
flexion, etc., but with the addition of force applied by a band
passed around the upper part of the limb, which is committed to
an assistant, and, in the different forms of dislocation, is so applied
as to lift the head of the bone from its unnatural resting-place,
while the other movements made with the shaft of the limb give
an opportunity to the muscles, stretched by the luxation, to draw
the head back into the acetabulum. Another surgeon, referred to
by Chelius, Colombat, speaks of a method which he has always
employed with suceess, in which the patient stands at a table
leaning forward with his chest upon it, and the surgeon, standing
behind, bends the knee with one hand, and makes the various
movements of the hip-joint, while, with the other hand on the
ham, he makes gradual extension by pulling downwards. By
this manoeuvre, he states that he dislodges the head of the bone,
and without any force, accomplishes its reduction. In Casper's
Wochenschrift for Nov., 1849, there is an account given by Dr.
Fischer, of Cologne, of his mode of reducing luxations of the hip,
which consists in flexing the femur on the trunk, and then making
rotation of the limb, conjoined with adduction, or abduction, as
the head of the bone is on one side or the other of the acetabulum.
In the N. Y. Journal of Medicine for March, 1852, a Dr. Mayr is
spoken of as having made use of this procedure of Dr. Fischer,
without being aware of Dr. F.'s published statement.

Dr. Reid, in his paper, gives us an account of his observations
on this subject, which appear to have been made entirely indepen-
dent of any knowledge of the previous opinions of other writers.
He speaks of his early impressions, on seeing the management of
some cases of dislocated hip after the usual method, and gives his
reasonings and reflections and experiments, on the muscular ac-
tions and the mechanical forces which were concerned, or might
be employed, in the production and in the reduction of these dis-
placements. He describes the steps by which he was led to the
adoption of his mode of operation, and, what is most to the pur-
pose, he gives five cases in which the operative procedure, to
which he was led by reasoning, was successfully employed. It is
no part of the object of this communication to criticise or to eulo-
gize Dr. Reid's paper ; but, having tested to some extent the value
of the proposed plan, we feel that we owe to the profession a full
statement of what appears to us to be a most valuable contribution

222 Dislocation of the Femur at the Hip-joint [April,

to the art of healing. It is still less our intention to mete out the
degree of praise which is due to Dr. Eeid as the originator of the
idea upon which the practice is founded. It would seem, from the
little historical sketch given above, that the idea had occurred to
others before it occurred to him, and that, therefore, the barren
honor of being the first suggester of the idea, that luxations of the
hip might be reduced by manipulations alone, does not belong to
him. All who read his paper, however, will acknowledge, that
to him belongs the higher honor, of having caused the idea to as-
sume the shape and value of a fact, and out of the bare suggestion
to have, by patient, ingenious, and long-continued investigation
and experiment, deduced an available, and, as we think, an ex-
ceedingly valuable addition to the resources of Practical Surgery.
Case 1. The first opportunity which presented itself for the
trial of the new method, was in the case of an Irish laborer, who
was brought into the New York Hospital, November 30th, 1852,
with a luxation of the right thigh. He had been struck, a short
time before admission, by the cow-catcher of a passing railway
train, and thrown some distance, and in his fall, probably, the
accident was produced. The symptoms were those of the dislo-
cation on the dorsum ilii, the head lying rather lower down and
nearer the ischiatic notch than usual. The thigh was shortened
about two inches, tended across the other, with the ball of the
great toe of the injured limb touching the instep of the other foot,
fixed in its position, and the head of the femur was felt in the po-
sition above described when the thigh was rotated on its axis. In
addition to this injury, he had received a compound fracture of
the left leg, three inches above the ankle, together with a good
deal of bruising of other parts of his body. The patient was
etherized to the extent of complete relaxation, and Jarvis's Ad-
juster was applied. It broke on the first trial of extension, and
was laid aside. This mischance suggested the trial of Dr. Keid's
plan, which was accordingly adopted. The operator, Dr. Buck,
after bending the leg upon the thigh, gradually adducted the thigh,
while at the same time it was being flexed upon the trunk. Carry-
ing the limb thus bent at the knee, and strongly adducted, over
the sound thigh, by a gradual sweep over the abdomen, and then
slowly and steadily abducting the limb so as to carry the knee
outwards, making at the same time a rocking motion by moving
the leg backward and forward, had the effect of dislodging the
head of the femur from its new position, and making it approach
the acetabulum ; but it did not enter the socket. From the posi-
tion above indicated, the limb was now brought down slowly to-
wards a straight position, still kept in a state of forced adduction.
This last manoeuvre seemed to have a very powerful influence in
forcing the head towards the acetabulum, but the whole proceed-
ing was completed without success. It was observed, however,
that the head had been moved a little higher on the dorsum than
it was before. The same manipulation was now again practiced

1855.] Dislocation of the Femur at the Hip-joint. 223

more deliberately and more carefully than before, and as the limb
was being brought down abducted, we had the satisfaction of see-
ing and hearing the reduction effected, by the head of the bone
slipping into its socket. All deformity had disappeared, and the
motions were free in all directions. The other injuries were pro-
perly attended to, and the recovery from the effects of the luxation
was rapid and satisfactory. He finally recovered from his com-
pound fracture also, and left the hospital with a good leg and a
perfect hip.

Case 2. An Irish laborer, aged 25, received an injury of his
right hip, and a fracture of one of his clavicles, by being thrown
from a railroad car, while it was in motion. He was received into
the New York Hospital, December 8th, 1852, under the care of
Dr. Halsted. On examination, the injury to the hip proved to be
a luxation of the femur upwards and backwards on to the dorsum
ilii. The patient was placed immediately under the influence of
ether, and the reduction was attempted by a procedure nearly the
reverse of that above described, in Case 1. The leg being flexed
upon the thigh, the limb was flexed upon the trunk and carried
up in a state of abduction, then across the abdomen, and being
fully adducted, was, in that state, brought down to the straight po-
sition. The effect of this mode of operating, which is almost pre-
cisely that said to have been employed by Prof. Nathan Smith,
was to throw the head of the bone forwards, under the anterior
superior spine of the ilium, and it was quite evident that a very
little more force in the same direction would have brought it upon
the pubes. This plan was therefore abandoned, and Eeid's mani-
pulation was tried carefully and without the employment of much
force. On the first trial it was successful, the bone being reduced
with an audible snap, as the limb was being brought down in a
state of abduction. The recovery was rapid and perfect, and he
was discharged, cured, January 15, 1853.

Case 3. Charles 0. Merritt, a sailor, thirty-seven years old, of
a stout, vigorous frame, was admitted to the hospital with a luxa-
tion of the femur, of twelve weeks' standing. Attempts had been
made, by an excellent surgeon of this city, to reduce the bone, but
without a satisfactory result, A very careful examination was
given to the limb by all the surgeons of the Hospital who were
present, and all agreed that the head of the femur was thrown
upon the dorsum of the ilium, in the usual situation ; but some
doubt existed whether there might not also be an injury of the
acetabulum itself. The patient being fully etherized, Eeid's mani-
pulation was tried, and, on the first trial, failed, the head seeming
to remain nearly in the position it occupied before the operation
was commenced. Dr. "Watson, under whose care the patient was,
now made a second more careful effort, using more force in making
all the movements, but being particularly careful to make forced
abduction while bringing down the limb from extreme flexion to
the straight position. As the limb was thus descending, slight

224 Dislocation of the Femur at ike Hip-joint. [April,

rocking motions being at the same time employed, the reduction
was suddenly accomplished, the head of the bone being felt, or
heard by a great number of persons, to slip into its socket. The
limbs being laid side by side, all deformity had ceased, and all
present were satisfied that the reduction was complete and perfect.
The patient's knees were bandaged together in the usual manner,
and he was placed in bed with rather more care than usual, but
in less than an hour it seemed as if the joint had lost its natural
appearance again in a slight degree, and the apparatus was tighten-
ed. By next morning, however, it was too evident that the origi-
nal displacement had again occurred, and to its fullest extent.
This had taken jolace in spite of the greatest quietude on the part
of the patient, who was a very intelligent, tractable person, and
fully aware of the importance of keeping the joint unmoved. The
manipulations were again tried several times, but without effect.
The head of the bone seemed to move about freely in all direc-
tions, but could not be brought into the acetabulum. The limb
was put up in the straight apparatus which we usually employ for
fractures of the thigh, and extension, by the adhesive straps, was
kept up so as to keep the parts, as nearly as possible, in proper
position. A good deal of stiffness and swelling of the joint fol-
lowed, which, however, subsided, and he was allowed to go about
on the 30th January. He finally gained about as much use of the
joint as if there had been a fracture of the cervix femoris. I am
informed by Dr. Buck that he has since gained a very excellent
use of the limb.

Case 4. John Kelly, a laboring man, aged twenty-one years,
was admitted May 22d, 1853, having been knocked down by a
horse-car, by which a luxation of the left hip had occurred into
the ischiatic foramen. The limb was shortened about one inch,
toes turned inward, and the head of the bone felt in its new situa-
tion. The reduction was attempted by the mode described above,
the man being fully relaxed by ether. The effect of the first at-
tempt was to throw the head on to the obturator foramen, making
the limb longer than the other, and producing the deformity char-
acteristic of that dislocation. From this point, by a slight altera-
tion of the movement, the head could be made to slip back to its
original position. Between these two points it could be made to
play backwards and forwards, but would not enter its socket.
Dr. Post, in whose charge the patient was, then employed the
usual mode of reduction, from the foramen ovale, viz., extension
of the limb, combined with a lifting of the head of the bone over
the edge of the acetabulum, by the help of a folded sheet passed
round the upper part of the thigh. This proved successful, with-
out resorting to the pullies. In this case the cure was very slow,
and he left the Hospital with some degree of pain and swelling
about the joint. I learned that an abscess formed in or about the
joint, which was opened, and when I saw him a year after, there
was every appearance of seated morbus coxarius.

1855.] Dislocation of the Femvr at the Hip -joint 225-

Case 5. Michael Delany, a boy aged eight years, was admitted
into the house June 29th, 1 853. having received very severe inju-
ries in falling from a ladder,, at the height of the third story of a
house, to the ground. There was found to be a bad compound
fracture of the right thigh, and simple fracture of the left. When
laid upon a bed, and his clothes removed, the right thigh, which
was the seat of compound fracture, was found to be in an extraor-
dinary position. It lay obliquely acroM the abdomen of the boy,
with the leg and foot lying up by the axilla of the left side. On
examination, it was discovered that this singular position was ren-
dered possible by the fact that the head of the femur waa dislocated
backwards and upwards, on the dorsum ilii. The house-surgeon,
to whose care the case fell on admission, took the injured limb in
his hands and very carefully carried it over the abdomen to the
right side, and then abducted it and brought it down towards the
straight position, thereby completing the steps of Eeids manipu-
lation, which accident had already commeneed. In doing this,
the head of the bone slipped into its place, and the hip gave no
further trouble. The fractures of both thighs went on favorably
towards a cure, and he was discharged well, August 23, 1853.

Case 6. John Gallagher, twenty-eight years old, a stout Irish
laborer, was brought into the Hospital about half an hour after he
had fallen from his cart while intoxicated. He was found to have
a dislocation of the left femur upon the dorsum ilii, and was im-
mediately sent to the operating theatre and placed fully under the
influence of ether. I then proceeded to employ the manipulation
above described, but as we were completing it by bringing down
the limb strongly abducted, it became evident that the head of the
femur was about to slip below the acetabulum into the foramen
ovale, as had occurred in Dr. Post's case. No. 1. The movement
was therefore reversed and again more carefully tried, with the
same result. On the third trial, with the view of avoiding this
tendency of the head to be forced below the acetabulum, I brought
,down the limb in a state of very slight instead of very strong ab-
duction, making the movement very deliberately, and accompany-
ing it with the usual rocking motions of the limb on its axis.
This plan was perfectly successful, and the bone slipped easily
into its place, and the cure was rapid and perfect. All the move-
ments in this case were made with the greatest facility,, and with-
out the necessity of employing any more force than the weight of
the limb required.

After the reduction in this case, I made a dissection of the hip-
joint in a recent subject, I had previously made several dissec-
tions with reference to the action of the different muscles and their
condition after luxation. In this instance, however, I removed
all the muscles, leaving the capsular ligament onlyr and then en-
deavored to dislocate the head of the bone. I first tried adductionr
and carried the limb so forcibly over the abdomen that the knee
touched the anterior surface of the thorax, but without producing

226 Dislocation of the Femur at the Hip-joint [April,

luxation. On making more violent efforts in the same direction,
the cervix fractured or rather cracked across within the capsule,
and soon after the ligament itself tore across at its superior and
posterior part, just opposite the point of yielding of the cervix.
The laceration was directly across the ligament, and occupied
about one-half of its circumference. As soon as this took place,
the dislocation was easily effected. The neck of the femur and
the trochanteric portion of it were now seen to be kept in their
place by the untorn portion of the capsular ligament, which acted
as a sort of fulcrum, upon which, by using the limb as the long
arm, we could make the head, as the short arm, move about in
any direction upon the surface of the dorsum of the ilium. On
making the manipulations for its reduction, the head was observed
to pass behind the acetabulum until it reached its lower margin,
and if the thigh was brought down slightly abducted, it slipped
easily over this least elevated part of the margin into its socket.
If, however, it was brought down very strongly abducted, the
head, instead of passing into, went below the acetabulum, and
passed on to the foramen ovale, as it was about to do in Galla-
gher's case, No. 6, and as it did repeatedly do in Kelly's case, No. 4.
Still further, we observed that after we had reduced the bone it
slipped very easily out of place again, and this was explained
by finding that in the reduction, the head had not gone back
through the rent in the capsular ligament, but, remaining outside,
had pressed the capsule before it into the acetabulum. This, of
course, prevented the complete reception of the head of the bone
into the socket, and permitted it to slip out again with the great-
est facility. This entanglement of the head in a button-hole
opening of the capsular ligament is noticed by many surgeons
as an obstacle to complete reduction by the old plan with the
pullies, and I do not perceive that the new method offers any
advantages in this particular. Might not this have been the con-
dition of things in Merritt's hip, Case No. 3 ?

Case 7. Francis Cotbunger, an Irish turner, was admitted to
the N. Y. Hospital, December 12th, 1853, with a dislocation of the
right hip. The accident had occurred about four weeks previous-
ly, and had been treated in the country, as a sprain, by leeches,
etc. The limb was lengthened, the toes everted, and the whole
limb stood off from the body abducted, and slightly flexed, symp-
toms which clearly showed that the head of the bone was upon
the foramen ovale. The patient being fully brought under the
influence of ether, a manipulation the reverse of Eeid's was em-
ployed by Dr. Halsted. The leg being bent upon the thigh, the
thigh was gradually flexed upon the trunk until the knee touched
the thorax. The limb was then brought down, forcibly adducted,
into the straight position. By this the head of the femur was
moved from the foramen ovale on to the dorsum ilii. Being in
this situation, Keid's method was adopted, with the effect, howe-
ver, of bringing back the head to its original position on the fora-

1855,] Dislocation of the Femur at the Hip-joint. 227

men ovale. By a repetition of the first manoeuvre, it was again
thrown on the dorsum, and from there, by Reid's plan, again
thrown back upon the foramen. After repeated attempts, the
bone was finally reduced by the pullies from the dorsum in the
usual way, this being the only instance in which the pullies or
Jarvis's Adjuster have been used, since our attention has been
called to the new plan. It will be noticed, however, that the
limb was every time brought down in a state of forced abduction ;
the moderate abduction found successful in Gallagher's case, No.
6, was not tried. A good deal of swelling and pain in the joint
followed these various operations. He was up and about, how-
ever, by the oth January, and on the 13th, he was discharged,
cured.

Case 8. Hugh Doyle, a sailor, 22 years old, was admitted to
the Hospital, April 22d, 1854, with a dislocation of the left thigh
upon the foramen ovale. The limb was in a position of abduc-
tion, rotated outwards, with the foot resting on its outer edge.
The muscles arising from the pubes and ramus of the ischium were
very tense, adduction was impossible, and the prominence of the
trochanter was gone. From this deformity, the position of the
head, with regard to the acetabulum, was clear. He was also suf-
fering from other severe injuries, which had been produced by
the fall, in which the hip was luxated. He was put fully under
the influence of ether, and the reduction was first attempted in the
usual way, by Dr. Buck, by direct extension of the limb in the di-
rection of its axis, while at the same time the upper part of the
thigh was lifted forcibly outwards by means of a sheet folded
round it This had not the desired effect, and would have
required the pullies to make it effectual. Another manipula-
tion was then tried. The leg was flexed upon the thigh, and
the thigh upon the trunk. The foot was then pressed forcibly
outwards, thus rotating the thigh inwards on its axis, and giving
the head of the bone an inclination outwards towards the ischiatic
notch. The pelvis at the same time was held firm by assistants.
This was repeated twice, each time with the effect of causing the
head to move considerably from its resting-place, but without en-
tering the socket or going over to the notch. On the third time of
making the manipulation, the thigh was brought down from entire
flexion to a little below a right angle, and while in this position
the foot was again forced outward as before. This plan proved
successful, and the head of the bone slipped into its proper place
in the acetabulum. This was accomplished without any consid-
erable force or difficulty. The cure went on favorably, and with-
out unusual symptoms.

Case 9. Fritz Frieze, aged 38, a German sugar refiner, came
into the Hospital, May 23, 1854, with a luxation'of the left thigh,
which had occurred fourteen clays before from a fall. The surgeon
who first saw him pronounced it a mere contusion, and had allow-
ed him to walk about, which he was able to do without much

228 Dislocation of the Femur at the Hip-joint. [April,

pain, though, of course, with a very great halt in his gait, and
with great labor in the movements of the injured hip. As he
stood erect, the left thigh inclined outwards and forwards from its
proper direction, the toe of the injured limb touching the floor
about ten inches from the other foot. The limb was an inch long-
er than its fellow, and the adductor muscles were tense. Adduc-
tion was impossible. The trochanter was fallen in towards the
pelvis and thrown backwards and downwards. On making rota-
tion, the head of the bone could be indistinctly felt moving on the
foramen ovale. After having the patient fully relaxed by ether ;
I made some free movements of the limb in all directions, with a
view of breaking down any adhesions which might exist. I then
took hold of the ankle of the injured limb with the right hand,
while I supported the thigh with the left ; I flexed the knee to a
right angle, and moving the thigh a little forwards, to relax the
tense adductor, I forced the foot inwards, making, at the same
time, a rocking motion of the whole limb on the pelvis. My idea
was, by rotating the thigh outwards, to throw up the head of the
bone towards the acetabulum, from which it could not be distant
more than an inch. This manoeuvre was not successful, though
carefully and repeatedly tried. We then tried the plan adopted
by Dr. Buck, in Hugh Doyle's case, No. 8, with the effect of
throwing the head upon the ischiatic notch. By reversing the
movement, the head was easily thrown back to its previous posi-
tion on the foramen, and the first manipulation was again tried,
combined with a movement of strong adduction in a direction
which carried the knee behind the other one. This, accompanied
with the rocking motion, which we have found useful in all these
replacements, accomplished the reduction on the first trial, and
without the slightest violence or excess of force. The head slipped
in with an audible snap, and the limb assumed its natural shape
and position. The cure was rapid and perfect.

The two last cases were experimental, as we had no knowledge
of any recorded precedent which gave us any assistance in their
management. We were led to adopt the modes of manipulation,
simply from reasoning on the effect which the movements of the
thigh would produce on the position of the head of the femur. An
attentive examination of the skeleton, with the head of the femur
placed on the foramen ovale in the position it assumes when luxa-
ted, will show that, while the head lies upon the foramen, the neck
lies along the side of the pelvis in such a manner as to bring the
trochanter about opposite to, and a little below, the acetabulum.
If, now, we hold the trochanter fixed with one hand, and make
the two movements described in Cases 8 and 9, it will be observed
that the head can be brought into place by both of them ; but, at
the same time, it will be observed that, when the trial is made by
rotating the thigh inwards, thereby causing the head to move out-
wards, the head, in order to reach the socket, has to pass through
a sweep of | of a circle, and then crosses the lip of the acetabulum

1855.] On Skin and Mucous Membrane. 229

at a point where it is very prominent and very difficult to sur*
mount. If, on the contrary, the rotation of the thigh is made out-
wards, so as to throw the head inwards, it has only a space of
about an inch. to pass through in order to slip into place, and the
portion of the brim over which it passes is much less elevated and
prominent. The movement of adduction in a direction a little
backwards, as employed in Case 9. has evidently the effect to lift
the head over the edge of the acetabulum when the rotation has
brought it to that point. It will also be noticed that in the out-
ward sweep of the head, it has, in order to get up to the acetabu-
lum, to pass by the ischiatic notch, into which it is exceedingly
prone to slip, as actually occurred in Case 9, and also in Case 4
For these reasons, I am disposed to consider the manipulation
employed in Case 9 to be the correct and most effectual one in
this form of luxation, and that though in a recent and favorable
case the outward movement of the head might succeed, yet that
in a difficult or long-standing case it would fail entirely, or be
attended, if successful, with a great degree of violence and lacera-
tion. This is a point, however, which can only be settled by more
ample experience and careful experiment. From the comparative
rarity of this form of luxation, this experience can only be slowly
obtained, and we should feel greatly indebted to any gentleman
who may have an opportunity of managing such a case by mani-
pulation, if he would transmit to us the results of his experience,

[To be concluded in May No.]

Normal and Diseased relations of Skin awl Mucous Membrane.
By Alfred Hitchcock, M.D., Fitchburg. Mass.

In the following paper an attempt is made to show the anatomi-
cal identity of the skin and mucous membrane; and also to trace
the Pathological analogy observed in these textures, and there-
from to deduce Therapeutical principles.

The subject naturally divides itself into the Anatomy, Pa-
thology and Therapeutics.

I. The AkatoMT. The skin is a very complex texture. Three
principal layers form its structure the Epidermis, the Papillae,
and the Cutis vera.

The Epidermic layer, which was formerly called an inorganic,
concrete exudation from the cutis vera, is now proved bv the
microscope to consist of epithelial cells of a definite form and vital
character. Xext beneath is the layer of papilla?, which consist
of minute conical or cylindric elevations, which are more promi-
nent on the palms of the hands and soles of the feet than in other
parts; these elevations are highly endowed with blood-vessels and
nerves, and are the medium of the sense of touch. Below this lies
the cutis vera, a dense, tough, highly elastic structure composed

ft & VOL. XL NO* IV. 15

230 On Skin and Mucous Membrane. [April,

of fasciculi of nbro-cellular tissue interwoven in all directions and
forming by their interlacements numerous spaces or areolar. Be-
sides these, anatomists speak of the retemucosum lying next below
the epidermis and giving color to the skin ; this, however, is
proved by the microscope to consist of the last deposited layer of
epitheliel cells. Beneath the cutis vera also is found a layer of
adipose tissue in which lodge the sudoriferous glands, whose open
ducts penetrate all the layers and appear on the surface. These
sweat glands are most numerous in the palms of the hands and
soles of the feet, and are demonstrated to number from four hun-
dred to three thousand on a square inch on different parts of the
body. The sebaceous glands, secreting an uoctuous semi-concrete
fluid, are very abundant in all parts of the body, excepting the
palms of the hands and soles of the feet. They are observed to be
most numerous in the axilla and scalp and around those parts
where the mucous and cutaneous membranes coalesce. The hair
follicles penetrate all the layers of the skin, their origin being in
the fatty tissue beneath the cutis vera. All the hair follicles, the
sudoriferous and sebaceous gland ducts that have so many count-
less outlets on the skin, are all lined with epithelial cells or rather
a thin reflection of the epidermis. The skin carries on the double
function of excretion and absorption, and the importance of these
functions to a healthy state of the animal economy can scarcely be
too highly estimated.

The mucous membranes line all those passages by which inter-
nal parts communicate with the exterior, and by which either mat-
ters are eliminated from the body or foreign substances are taken
into it. They are soft, moist, velvety and extremely vascular.
The externa] or free surface is everywhere lined with one or more
layers of epithelial cells rendering it quite like the epidermis. Be-
neath this lies a basement membrane of firm texture and somewhat
corresponding in structure to the cutis vera next is a stratum of
vascular tissue with outgrowths and depressions in the form of
papilla? and villi, some of which form glands. In difFerents parts
of various tracts of mucous membrane certain structural peculiari-
ties are observed which adapt each part to its peculiar function.
The numerous gland duels which open on the mucous membranes
are all lined with an epithelial membrane.

This is the general anatomical arrangement. In addition it
should be stated that many of the different forms of epithelial cells
have cillia or fine pellucid processes on their free extremities Avhich
are constantly in rapid vibratory motion. These cilliary processes
have an important influence in the function of secretion and pro-
pulsion of fluids in the various membranes and ducts. In the
pulmonary and uterine mucous membranes especially, the cilliary
processes of the epithelial cells are very conspicuous and act an
important part in the functions of these organs. The mucous
membranes are everywhere abundantly supplied with glands
many of them quite corresponding to the sudoriferous and scba-

1855.] On Skin and Mucous Membrane. 231

ceous glands of the skin in structure and like them moistening
and lubricating the surfaces on which they open. The specific
function of the mucous glands is not quite so clearly understood
as the corresponding glands on the skin. In the alimentary canal,
they unquestionably play an important part in the function of di-
gestion. In the small intestines numerous villi exist which play
an important part in the absorption of chyle.

The mucous membranes universally like the skin, perform the
double function of absorbing and exhaling certain fluids and
this function is in addition to the various special functions per-
formed by different sections or parts of each of these tissues. In
this common function of absorption and exhalation they come
under the domain of organic life and in their common sensibility
and impressibility to temperature and the physical properties of
matter applied to their surfaces, the}" are alike related to animal
life, and they consequently are both abundantly supplied with ner-
vous influence from the sympathetic and cerebro-spinal systems.

The parallelism of function in these two membranes is very-
striking, and consequently the sympathies between these two or-
ders of tegumentary tissue is very strong and active. A little
more fully it may be stated that from the skin carbonic acid and
nitrogen are exhaled as they are from the mucous membranes, and
both discharge vapor or sweat charged with salts and effete ani-
mal matter.

The sebaceous glands find a counterpart in the follicular glands
of the mucous membranes. Gaseous and fluid matters find en-
trance into the general system through the skin with a slower but
with as certain a process of absorption as they do through the
mucous membranes. It is also proved that nearly every article of
the materia medica which is absorbed from the surface of mucous
membranes may also with great certainty find entrance through
the skin by absorption, and thus exert their distinctive and spe-
cific effects on the various organs of the body.

II. Pathology. The anatomical identity and reciprocal influ-
ence of the skin and mucous membrane constitutes a most import-
ion in the pathology of cutaneous diseases. Erup-
tive diseases of various kinds are often the result of crude and irri-
tating ingesta and those which are acute are almost invariably

ded by derangement of the mucous membrane of the alimen-
tary canal, and especially of ihe throat and stomach. On the

hand any extensive inflammation of the skin whether from
a burn or a contagious exanthem is quite likely to be accompanied
or followed by mucous irritation or inflammation. If the cutane-
ous inflammation is pustular or eliminates a morbid secretion the

r of the supervention of mucous d itly increased.

- found to be a physiological law of the cutaneous and' mu-
cous i hat if either i& physiologically excited, the func-
tiea at1 the other ki pro^xwrUoaaUjly diauiaslied j aid if eiih.br m

232 On Skin and Mucous Membrane. [iiprfL

pathologically excited, the other takes on identically the same
morbid action. In tins connexion it may be stated, what was
long ago demonstrated by Dr. James Johnsonr editor of the Lon-
don Medico-Chirurgical Review, that the healthy functions of the
skin and liver are always consentaneous, and never vicarious. In
other words when the state of the skin was genial and healthy and
its function easily performed then the function of the liver was in
a correspondingly healthy state, and vice vena.

In studying cutaneous diseases, we find that many causes act
directly on the skin as climate and seasonsT temperature, all
poisons,, friction, artificial heat, uncleanly habits, &c.r and many
of these casual eruptions are well known secondarily or sympa-
thetically to be transmitted to the mucous membranes ; in precisely"
the same way we find diseased action in these membranes from
causes directh^ applied to their surface, producing sympathetically
or secondarily cutaneous eruptions, as for example, roseola, urti-
caria and stropladus from noxious ingesta. Many cutaneous af-
fections are hereditary and then the play of sympathy between
these two membranes is very marked, and the strife for thedomicil
of the disease is often quite eccentric.

Syphilitic eruptions, leprosy and cutaneous tubercles are re-
markable forms of disease dependent on depravation of the blood
sod general constitutional deterioration, and are almost always
strongly marked by corresponding morbid action in the mucous
inembranes.

Nearly all the exanthemata attack both the cutaneous and mu-
cous membranes. Urticaria, Measles, Scarlatina and Variola are
notable examples, In most of this class of diseases the cuticle
desquamates, and the mucous membrane in the affected parts casts
off its epithelium in like manner.

Erythema is also a disease quite as distinctly recognized on the
mucous as the cutaneous surface. Genuine erysipelas in its full
development is not&s distinctly visible on mucous membrane, for
the reason that there is no tissue corresponding in character and
quantity to the sub-cutaneous cellular tissue which is well known
to be the favorite location of that disease.

Some of the bulla? have been observed on the mucous mem-
branes as well as on the skin ; and diphtheritic inflammation has
been shown to occur on the skin as well as the mucous membrane;
Membraneous croup and membraneous dj-sentery are the two
most notable examples of this disease, and both have been shown
to be in some degree contagions. It is also asserted by some Pa-
thologists that contagious or hospital gangrene throws out a diph-
theritic membrane identical in character to those of the two con-
tagious diseases just named. It has often been observed in fevers
of bad type that the skin will throw out the same kind of false
membrane especially if the surface has been abraded by a blister
or other external irritant. This tendency has been thought in
some degree to mark the virulence of the disease

1855.] On Skin and Macous Membrane* 233

There is a form cf diphtheritic inflammation of the mucous
membrane which is frequently observed in this vicinity, especially
towards the end of summer and in autumn. It is sometimes pre-
ceded by slight dysenteric symptoms, mild fever, and great vital
prostration. The fauces and mouth are at first of a violet or scarlet
red. soon becoming spotted and at length entirely covered with a
white pultaceous exudation which sometimes exfoliates and is
several times reproduced. There is feeble capillary action with
tendency to coldness of the parts most remote from the heart ; and
it is common to observe transient red spots on the face, neck, and
sometimes the extremities and in severe cases these spots are
livid and almost always there is a general exfoliation of cuticle
as the patient recovers. Sometimes there is violent delirium but
more frequently the cerebral functions only partake of the general
torpor and prostration. Sometimes sweating occurs, but more
commonly the skin is parched and dry. The pulse is usuallv soft
and never so quick as in true typhoid fever even though "there
is the same apparent degree of vital prostration.

This diphtheritic disease seems occasionally to be epidemic and
contagious, affecting whole families and neighborhoods; and the
duration of the disease may be one week or one month, according
to treatment or accidental influences. This disease is verv often
mistaken for " follicular entente" or true typhoid fever. It is a
very great error in Pathology to confound the two forms of dis-
ease and in a statistical point of view cannot but be very unfor-
tunate to the cause of medical science. The two forms of disease
undoubtedly are occasionally combined in the same individual, and
yet it seems very important that their distinctive pathology should
be duly estimated.

This diphtheritic disease is here alluded to in order to call atten-
tion to its cutaneo-mucous pathology and not to give a detailed
account of its history and character that being of itself well
worthy of a distinct and lengthy paper. The eruptions and gan-
grenous patches of the skin in typhoid and typhus fevers are well
known to be clearly assimilated to the follicular eruptions and
scarlet and gangrenous patches that occur in the course of the in-
testinal canal in those diseases.

Psoriasis of the mucous membranes, exactly like the same dis-
ease on the skin, has been abundantly shown to exist in some
large institutions where microscopic investigations have been
adopted as a means of diagnosis. The eve alone can discover it
at the outlets of mucous canals and the shreds which escape from
the bowels exhibit precisely the same microscopic appearance as
the cutaneous elimination. These subjects invariably show loss
of nutrition, are pale and nervous, and present many anomalous
symptoms. There is great debility but they are not usuallv bene-
fitted by tonics. It is highly probable that other varieties of
squamous disease may likewise be proved to exist on the mucous
membranes. These several forms of cutaneous disease already

234 On Skin and Mucous Membrane. [April,

enumerated and proved to exist on the mucous membranes, are
sufficient to establish a general pathological law ; and analogy
would lead us to infer that many other, if not all the different va-
rieties of eruptive diseases have the same tendency to development
more or less perfect in the mucous membranes. Many Pathologists
are of opinion that nearly all cutaneous diseases are more or less
contagious and that they are strictly Parasitic having an inde-
pendent animalcular or cell vitality and finding an appropriate
nidus in the skin and mucous membranes and possessing a power
of existence and reproduction, limited only by exhausting their
proper pabulum. Variola, Varicella and Rubeola soon exhaust
the pabulum and cease spontaneously, rendering the patient invul-
nerable to another attack, or in other words leaving the soil un-
fitted for another crop.

Some cutaneous diseases seem never to exhaust the soil, and
with age become more tenacious of the domicil, and consequently
require the application of a poison to destroy their vitality hence
the use of Mercury, Arsenic, Sulphur, Tar, Iodine and Antimony
with success in many forms of cutaneous disease.

III. The Therapeutics. On this subject, usually so prolific
of good advice and complicated prescriptions a few general prin-
ciples only, will be briefly alluded to.

It will be well for the practitioner to enquire

1st. Is the disease dependent on some cause that will cease
spontaneously, or that can very easily be avoided ?

2d. Is the disease of specific origin and self-limited, and will it
result in a natural cure ?

3d. Is the disease contagious, with unlimited tendency to in-
crease and consequently requiring the local application of a poison
for its removal ?

4th. Is the disease hereditary or vicarious and would it be safe
to suppress it ?

5th. Is a due estimate placed on the danger of increasing the
same morbid action in the mucous membrane by the internal use
of drugs for curing the cutaneous disease ?

6th. Is the remedy safe and will it best promote the permanent
welfare of the patient ?

The general principles implied in a correct answer to the fore-
going queries are quite sufficient to guide the physician to a safe
and judicious practice in the treatment of cutaneous diseases.

The important Pathological law stated in a former part of this
paper, viz : That in a state of physiological excitement or increased
natural function of the skin or mucous membrane the other is cor-
respondingly diminished in function Whereas, when either is pa-
thologically excited the other is sure to take on the same kind of morbid
action. This principle is fundamental and should never be lost
sight of in prescribing for cutaneous diseases. This principle,
rightly understood, would not diminish confidence in the use of

1855.] On Peritonitis. 235

medicines, but would lead to a more careful investigation of the
Pathology of cutaneo- mucous diseases, and consequently to a more
judicious, safe and successful application of remedies. [Xew
Hampshire Journal of Medicine.

On various rare forms of Peritonitis. By GEORGE Budd, M. D.,
F.R.C. S., Professor of Medicine in King's College Hospital,
London.

Gsntlexsk, I propose to day to bring under your notice a
peculiar form of peritonitis, not often met in practice, but still,
when it does occur, very specific and well marked ; but first we
will recall the more marked symptoms in the case which has led
me to choose this subject; the case will occur to the recollection of
many of you, as having been so near the jaws of death, but is now
quite recovered.

F. P., a poor young man, 18 years of age, you recollect the case
in the last ward we left and which we watched for some time with
no ordinary anxiety. He tells us he has been two years and a
half in London, has lived badly previous to admission, and suffer-
ed a good deal in health; for a full month before coming into the
hospital he has been "out of health and feverish.'' This, perhaps,
in his case, has a more serious signification than it usually has, for
on admission on October 15th, we find him saying he was in every
way worse, and no longer able to stand; his belly is intensely sore
to the touch, he has completely lost his appetite, and is troubled
with vomiting: he has almost all the bad signs of hernia without
that disease at all; in other words, we have here a form of perito-
nitis.

18th: ~\Ve find him still complaining of excessive pain and sore-
ness, percussion is dull all over the abdomen, fluctuation is very
obvious; in fact the peritoneal cavity was full of fluid; another
point, (and one which I would particularly impress on you in
peritonitis,) the belly was quite motionless, the muscles of the abdo-
men, so to speak, lose their function for a time, and the respiration
is entirely carried on by the thorax; on further examination, we
are told the urine is albuminous ; the pulse is only 74 : tbe tongue
is furred, and he sweats at night. Now, in cases of peritonitis of
this kind, you must always look out for tubercles ; there was no
positive evidence in this case of such a morbid deposit, but it look-
ed like it.

One of the best remedies is a blister over the belly, and this was
accordingly ordered: it helps to check the irritation at once. On
his coming in he was ordered calomel and opium, but as we had
reason to fear a tuberculous taint, I left out the calomel. We
gave him, however, a I vi. mixture instead, composed of salines,
nitre, and hyoscyamus, with the opium by itself. Under this plan
you will remember he went on very well ; four days after the

236 On Peritonitis. [April,

veins over the abdomen swelled, more particularly in the hypo-
gastrium. I think I have noticed, when the circulation is very
much impeded in the liver, the veins of the groin and hemor-
rhoidal vessels swell, and as an ordinary rule may be taken as an
indication of such a state of things. About the fifth day, the 23d,
he seemed to be falling back again, and as there were no tuber-
cles, we gave him calomel gr. iss., opii. gr. j, every six hours, and
on the 25th the report states, "percussion is now resonant, there
is also movement of the belly;" in other words, there was a mani-
fest amendment ; appetite is also said to be returning. Again, on
the 30th, we read this report, "the belly is not so tense, the fluid
is becoming absorbed, it is thought better to discontinue the calo-
mel, the mouth is sore," We may now pass over the reports for
a fortnight, as the poor young man has turned the corner, and has
been improving, indeed pulling up wonderfully every day.

13th; Appetite much better; urine has lost its albumen; he is
in every way better. We now ordered him cod-liver oil, with a
mixture containing tincture of hops and hydrocyanic acid. 15th :
Beported quite well.

Now, in speaking of peritonitis, it is a useful clinical distinction,
as we see it every year in the wards, to divide the different kinds
into general and partial, local or constitutional peritonitis; local
or partial peritonitis you will see, perhaps, in surgical wards.

You will find local peritonitis in diseased liver or spleen, dis-
eased ovary or uterus; general peritonitis, on the contrary, is
brought about by a poison in the blood, by puerperal fever, some*
times by erysipelas, or, as we suspected in the present case, by
tubercles. Perforation of the bowel, ulceration of the gall- duct,
&c., also bring on, we need scarcely say, the most fatal forms of
peritonitis. In tuberculous peritonitis, the tubercles are clotted
over the peritoneum; this membrane, in fact, is studied with
them, This disease is slow and chronic, precisely similar to the
case of this young man, I believe the disease we are now con-
sidering in this young man, though true peritonitis, is brought on
by cold, The pain and tenderness in this case was very great ;
the patient cannot stand erect; the legs are drawn up ; he is found
to suffer most severe agony; sometimes from flatulence rolling
along the bowels, or when the bladder is emptied or bowels mov-
edanything, in fact, that prevents them lying at rest, a point
gained by giving opium. A very essential question is this. How
do we know it is not dropsy in place of peritonitis ? but by a little
manipulation you can tell at once. In dropsical effusion there is
lessor no pain, and fluctuation is more marked; in peritonitis,
on the other hand, the fluid, so to speak, is in detached pouches ;
the belly, as we noticed before, is motionless ; there is also vomit-
ing attending this form of disease ; the previous history will also
assist you. In peritonitis there is more or less fever, &c. ISTow,
what is the cause of this form of peritonitis ? Andral says, all
cases of chronic peritonitis above fifteen years of age have tuber-

1855.] Climacteric Disease. 237

cles. I believe this rule, though a good one, yet a little too abso-
lute. (Peritonitis often prevails, epidemically, among lying-in
women, and too much ground exists for believing it is even pro-
pagated by contagion. This is a very terrible and fatal disease,
but rather comes under the subject of obstetrics.) Louis says, he
has never met tubercles in the peritoneum, but they were also to
be found in the lungs; this rule also is not universally true, ac-
cording to Dr. Watson.

I would now wish to direct your attention to treatment. In all
cases of peritonitis in patients of a good frame or habit of body,
you should first put on a large number of leeches. If you think
your patient, as in the case of the boy in the present case, will not
stand depletion, in place of leeches put on a blister. Calomel, in
ordinary peritonitis, is your most valuable medicine ; in tubercular
peritonitis mercury is not advisable, indeed it will aggravate mat-
ters ; in place of it you must order salines, to set the kidneys to
work and act on the skin. Nourishment, especially cod-liver oil,
I find a most valuable adjunct also in this form of tuberculosis;
the remedy of all others, however, which }'ou must not forget, is
counter-irritation on the surface of the belly. You will not, per-
haps, at least in the ill -fed and poor of hospitals, require much
bleeding; blisters must not, however, be forgotten. There is ano-
ther disease of this class, peritoneal inflammation from perforation
of the vermiform appendix; this part you will recollect opening
into the ccecum, whence a cherry-stone or other foreign body
may ulcerate out. I knew two cases die Yerj suddenly from
this; peritonitis is first set up, lymph is thrown out, and glues the
parts together; fever of a puzzling kind sets in ; there is pain, but
probably no constipation : your own knowledge of the parts and
general principles must guide you in treatment.

Another, but rarer disease still, is an affection with peritonitis, and
what may be best described as a fistula of the ccecum, like fistula
in ano of surgeons. Now and again you will meet this, and you
should be prepared for it ; there is very much less pain and ten-
derness ; it is situated in that part of the ccecum deprived of peri-
toneum; leeches, if there be pain, will in all these cases relieve the
want of lone of (he boicel better than purgatives; muscular fibres
are partly paralysed, depletion will do more good than stimu-
lating the bowel, and open the bowels more readily than cathar-
tics. [Jfedical Circular, and Duhlin Med. Press.

Climacteric Disease. By Stephen W. Williams, M. D., Laona,
Winnebago county, 111.

It is the duty of physicians at all times to endeavor to correct
errors in their profession, as well as to communicate facts in rela-
tion to the cure of disease; and on this account I am induced to
make a few remarks on a form of medical superstition which still

238 Climacteric Disease. , [April,

obtains many adherents. There can be but little doubt that the
idea still prevails, to a certain extent, with the people, and even
with the enlightened portions of the community, as well as with
many physicians, that at every seventh year, which is called the
climacteric year, the body undergoes an entire renovation, and
that great and important changes take place at that time. These
are called critical periods, or climacterics, and they are said to
occur at the ages of 7, 14, 21, 28, 35, 42, 49, 56, 63, &c. The age
of 63 is called the grand climacteric, or critical period of great
danger, at which the greatest change in human life is supposed to
occur. The multiplication of 9 by 9, which makes 81, is supposed
to be another grand climacteric.

Dr. Darwin says "Ignorance and credulity have ever been
companions, and have misled and enslaved mankind. Philosophy
has in all ages, endeavored to oppose their progress and to loosen
the shackles they have imposed. Philosophers have on this ac-
count been called unbelievers; unbelievers of what? Of the
fictions of fancy, of witchcraft, hobgoblins, apparitions, vampires,
fairies of the influence of stars on human actions, miracles
wrought by the bones of saints, the flights of ominous birds, the
predictions from the bowels of dying animals, expounders of
dreams, fortune tellers, conjurors, modern prophets, necromancy,
cheiromancy, animal magnetism, with an endless variety of folly."
To which I may add the royal touch, the touch of a dead man's
hand, spiritual intercommunications, eclecticism or Thomsonism
revived, homoeopathy, hydropathy, phrenology, as exclusive sys-
tems of medical practice, and a whole round of empiricism needless
to enumerate, to which the indolent and crafty resort to get rid of
the toil and labor of procuring regular professional knowledge.
These may all be placed on a par with the belief in climacterics.
" These," continues Dr. Darwin, "philosophical physicians have
disbelieved and despised, but have ever bowed their heads to
hoary Truth and Nature."

As it is the subject of individual climacteric years, in which
many intelligent men of the present day express their belief, it
shall be my object to expose the fallacy of such a belief. This
opinion has been prevalent in connection with the subject of vac-
cination. In the early days of inoculation many people expressed
their fears that its efficacy would not extend beyond seven years,
or further than any climacteric year, and that the human body did
not then consist of the same particles of matter as before. True it
is that great changes take place in the system at the age of puber-
ty, which occurs at different periods in this climate ; and also at
the change of life in women, which also occurs at various periods,
from 45 to 55. That the cowpox acts with diminished power, as
the subject advances in life, is now acknowledged by all who have
thorougely examined the subject, and the same is also true in re-
lation to the smallpox, hooping cough, and numerous other con-
tagious diseases ; but it has nothing to do with the climacteric

1855,] Climacteric Disease. 239

disease in question. It however suggests the great importance of
frequent re-vaccination.

The subject of age, however, demands some attention in the
history of the human economy. By the laws of the land, certain
periods are prescribed, before which a child shall not be deemed
guilty of certain crimes. For instance, a male child is supposed
not capable of committing a rape before the age of 14. There are,
however, cases on record of children arriving at puberty at a very
early age. Some cases are recorded of boys attaining it at the age
of 4 and even youDger. But these cases are rare. Others, again,
arrive at that period in from 8 to 10 years. A case occurred at
Paris, where a woman attributed her pregnancy to a boy 10 years
old. It may be a subject of consideration whether the powers of
the individual should not be taken into account, rather than the
age.

The subject of age seems particularly to have attracted the at-
tention of the ancients, who divided the life of man into several
climacterics or periods. They supposed, as I have stated above,
that the human body underwent a radical change once in seven
years ; that is, by the constant absorption going on in the body,
every part was completely taken up in seven years, and carried
off by the absorbents, and a new deposition of animal matter suc-
ceeded to supply the loss or want which it then sustained. Tullius,
King of Kome, divided age into infancy (which was under 7 years) ;
childhood, from 7 to 11 ; youth, from 14 to 21 ; manhood, from
21 to 46 ; old age, from 46 to 70 ; and from that time till death he
called decrepitude. Many of the moderns have adopted this divis-
ion, though most of them vary. After the age of 60, in England
and in some parts of the United States, men are not obliged to
serve on juries. The age of 63 is the first grand climacteric, and
is supposed to be a critical age. It has been abty described by
Sir Henry Halford, with its incidental climacteric disease, some
account of which may be found in Good's Study of Medicine, and
in Copland's Medical Dictionary. This disease occurs between
the ages of 50 and 75, but more frequently about the age of 63.
After 65: men usually cease to procreate, but there are some ex-
ceptions. Seventy years is the scriptural limit of life, though there
are, especially of late, many exceptions, and it is supposed that
the average of old age has increased. Only 1 in 15,000, however,
reaches 100 years ; nor is the age of 81 (the second grand climac-
teric) often attained.

Infancy, in the acceptation above laid down, may comprehend
childhood and youth, though many think that youth extends to
the age of 28. The period allowed to manhood, undoubtedly, in
this climate, is by far too short. The mental faculties are often as
bright at 70, the time at which decrepitude is said to take place, as
at any period of life; and, perhaps, the judgment is not more
matured and perfect at any period, provided a man enjoys good
health, than at 60. After all that has been said upon the subject,

240 Resection of the Right Elbow Joint. [April,

it seems that no other division of age is necessary than that which
is naturally suggested in the rise and decline of life.

I have but few statistics to prove the correctness of my belief
that there are no more deaths in the supposed climacteric years
than in any others, and at present can only give those of the town
of Deerfield, in Massachusetts, accurately kept for a period of
sixty-six years. These statistics commence in 1787, and termin-
ate in 1852. The whole number of deaths there in that time was
1531. Of these, 216 were under 1 year, and 16 were between 90
and 100 years of age. I give a little table from these deaths of
those who have died during their climacteric years, and the years
preceding and succeeding them :

At seven years, 11 At six years, 10 At eight years 5

fourteen 5 thirteen 7 fifteen 5

twenty-one 20 twenty 9 twenty-two 14

twenty-eight 7 twenty-seven 10 twenty-nine 11

thirty-five 9 thirty four 8 thirty-six 8

forty-two 9 forty-one C forty-three 5

forty-nine 3 forty eight 10 fifty 17

fifty-six 5 fifty-five 7 fifty-seven 9

sixty-three 3 sixty-two 10 sixty-four 12

seventy 23 sixty-nine 12 se vent-one 11

seventy-seven 15 seventy-six 16 seventy-eight 17

eighty-one G eighty'. id eighiy-two 10

Total 116 123 124

The above table shows that the climacteric years in Deerfield
have been less fatal than those immediately preceding and succeed-
ing them, and this I think will hold equally true in other places.
So there seems to be but little fear of special danger from these
supposed fatal years. [Boston Med. and Surg. Journal.

Case of Resection of the Right Elbow Joint for the relief of Caries and
Anchylosis of the Joint; cured, with considerable motion at the
Elbow. By Henry H. Smith, M. D., Consulting Surgeon to
the Philadelphia Hospital, Blockiey.

Terence , aged 16 years, entered the Philadelphia Hospital,

Feb. 23d, 1854, in consequence of caries of the right elbow and
anchylosis of the joint, consequent on a fall.

The disorder having existed for 18 months, and the arm been
allowed to become anchylosed in the straight position, he was sent
as a pauper to the Alms House and thence to the Hospital. After
being in the house about eight months, he was presented to me at
the commencement of my term of service in October. At this
time, he was pale, anaemic and enfeebled by long continued dis-
ease and suffering, and exhibited symptoms of hectic fever ; the
elbow -joint was very much swollen, and the skin inflamed and
thickened round the bend of the elbow, several ulcerated spots
and fistulous orifices existing both on the front and back of the
arm. On. introducing a probe into two or three of these orifices,

1855.] Resection of the Rigid Elbow Joint 241

the bones were readily felt in a carious condition ; there was also
perfect inability to move the hand in pronation or supination, the
least attempt at bending the elbow or pronating the hand causing
him severe pain. As his right arm was thus rendered useless, and
there was every prospect of his either dying of hectic fever or
becoming a pauper for life, I decided on attempting to save the
limb by resecting the diseased joint. Accordingly, on the 11th
of October, 1854, after an appropriate preliminary treatment. I
operated as follows, before the medical class in attendance on the
practice of the house.

Operation. The boy being fully etherized by a mixture of chlo-
roform 1 part, ether 3 parts by weight, was laid on his belly with
his face inclined to the side of the table, and a stout, round pillow
placed on the front of the elbow as a support to the portion to be
operated on. as well as with the view of favoring the flexion of
the fore-arm, after the section of the olecranon proc-

The arm being thus steadied, an H incision was made over the
joint on its posterior face ; the flaps turned up, the ulna nerve dis-
sected out of its trochlea, and held on the front side of the internal
condyle, and the artery which accompanied it compressed at a
point where it was wounded. Martin's- circular saw being then
applied to the shaft of the ulna, the olecranon process was soon
removed, and the whole joint being thus laid open and found to
be diseased, both the condyles of the humerus, as well as the epi-
trochlea, were sawed off by the same saw. The head of the radius
being also diseased, it was excised from the neck of the bone by
means of large and strong bone-nippers. So little hemorrhage
ensued on the operation that no ligatures were applied. The flaps
were then loosely united by sutures, supported by a light bandage,
and the boy placed in bed with the arm supported on a pillow in
the semi-rlexed position, the whole elbow being covered by clothsr
wrung out of tepid water. At 8 o'clock, P. M., his pulse" was 90,
and, as he was suffering, 60 drops of laudanum were given to allay
the pain,

Oct. 12th, Slept well, better than for many weeks ; suffers but
little. Ordered chicken -broth and anodyne pro re nata,

Oct. 14th. Removed dressing; suppuration commenced ; order-
ed a light bandage to the part } omit water dressing ; tinct. cin-
chonae compos, f 3iv, per diem ; chicken for dinner.

Oct. 16th. Dressed arm and increased the flexion slightly,

Oct. 18th. Applied an obtuse angular splint to the front of the
arm ; ordered to sit up.

Oct, 20th. Has his clothing on,

Oct. 24th, Applied a splint nearly of a right angle.

After this date, the wound was dressed daily, the agle of the-
splint being gradually changed to a right angle, and then to one
which semi-flexed the arm,

[* Thi> saw may be found figured ia Smith's Operative Surgery, second edition,,
plate 5, fig. I, vol. L Eoito*.}

24:2 Cases of Fracture. [April,

Dec. 5th. Terence is now able to do without the splint, and has
considerable motion at the joint, the wound being healed.

Jan. 15th. Terence can now move his elbow, so that his hand
will traverse an arc of 40 degrees, and can pronate and supinate
the hand quite well.

Remarks. The advantages of the operation of resection in this
case are so apparent as not to require much argument, the saving
of a right arm in one dependant on his daily labor for his support,
being sufficient evidence of its value as a means of treatment in
similar cases.

As a class, few operations are more strikingly illustrative of the
progress of conservative surgery than those of resections, yet the
number of instances reported in the United States of its applica-
tion to the upper extremity are by no means commensurate with
the cases which might have thus escaped amputation. After a
careful examination of a very considerable number of American
medical periodicals, I find only the following: one by Dr. Tlios.
Harris, of Philadelphia, in 1836 ; one by Dr. Gurdon Buck, Jr.,
of New York, in 1841, another in 1843, and a third one in 1846 ;
and one by Dr. J. Pancoast in 1842. These cases, with the pres-
ent one, making only six instances in which this operation has
been published. In every case no serious symptoms supervened
on the operation, and the patient was relieved of the exhaustion
and suffering attendant on the disease, besides obtaining a com-
paratively useful limb.

The entire head of the humerus was resected by Dr. Hunt, of
Washington city, in 1818, and a large portion of the same bone
(its head) was removed by Dr. Pinckney, of the Navy, in 1846.
When we compare this limited number of operations with the
numerous cases of diseased joints that have required it, we must
admit that resections of the bones of the upper extremity have not
received the attention that the benefits conferred by the operation
might naturally lead us to anticipate, and it is with a view of call-
ing professional notice to this useful class of operations that the
present case has now been reported. [Medical Examiner.

Remarks on some Cases of Fracture, in which the Diagnostic Sir/ns
of that Lesion mere absent By David P. Smith, A. At., M. D.,
of Springfield, Massachusetts.

Having met with several cases of fracture which presented un-
usual difficulties in their diagnosis, and being convinced that simi-
lar cases are too often considered to be mere sprains or bruises, I
take the liberty of laying them before your readers.

Case I. May 8th, 1854, I was called to see Mrs. J. D. G., who
had stepped upon a rolling stone, and fallen on the sidewalk. She
was unable to walk, and was carried home, where I saw her about
one half hour after the accident. At her argent solicitation, I
gave her otherj aud proceeded to examine her limb from the kuec

1855.] Cases of Fracture. 243

down, expecting to find a fracture. I could discover none after
the most minute examination. I am confident that I made a
thorough examination, for I was so persuaded by the intense pain,
referred to the shaft of the tibia, that there was a fracture, that it
was some time before I would give over seeking for one. I placed
the leg in a copper half-boot splint, after bandaging it carefully,
and left it for 2 or 3 days. I then called, and finding the leg still
painful, I examined again, and plainly made out a fracture of the
tibia at the junction of the middle with the lower third.

Case II. While talking with a medical gentleman of this place
about the foregoing case, he told me that he had called my late
father in consultation to a similar case, and that they were both of
them unable to discover any fracture. After a few days had
elapsed, the same gentleman easily found a fracture of the tibia.

Case III. Sometime last August, a gentleman from out of town
called upon me walking with crutches. He reported that he had
fallen about three feet, alighting on his heels, and that ever since,
he experienced great pain in one of his limbs whenever he bore
weight upon it. A physician had seen him, and told him that he
could detect no fracture. I spent a longtime in examining his
ankle, and after at least an half an hour. I was enabled to produce
crepitus and diagnose a fracture of the external malleolus.

5E IV. A physician from Enfield in this State, called upon
me a few days since, and, in the course of our conversation, asked
me if I ever found the usual diagnostic marks of fracture to fail
in any case. lie said he had lately had a fracture of the tibia in
which he could by no means produce crepitus, within 24 hours
after the accident.

One or two cases of fractures near and into joints which pre-
sented unusual difficulties in diagnosis, I forbear mentioning, be-
cause, as the}* are always difficult to be found out, any account of
them would not further my present purpose, which is, to show
that ordinary fractures in the shaft of bones may want the usual
symptoms of this injury, and so greatly embarrass, not only the
young, but the more advanced practitioner. I think, indeed lam
sure, that many of these obscure fractures are considered to be and
treated as sprains. I am particular in calling the attention of the
profession to these cases, because I think that, if we would be more
careful, and would not grudge an hours careful examination of
these obscure cas tbould be less troubled by "natural bone-

setters " and should see fewer of those so called braises and sprains
which require months for jcovery.

It is agreed by all authorities, that all the signs of fracture are
equivocal except crepitus, and even that is liable to be confounded
with the grating produced by a thickening or partial absence of
the synovia in some dislocations. What then I wish to impress
upon the reader is this, that he must not suppose that fractures
can in all cases be detected by one, even if it is a careful ex ami na-
tion Let him, if ho is not perfect! v satisfied of the nature of the

244 Placenta Prcevia. [April,

injury, examine again and again. Let him remember that crepi-
tus is the only sure diagnostic mark between bruise or sprain and
fracture, and that this light often fails us, I think it is best to
treat any severe sprain as a fracture; because, if it is indeed only
a sprain, the perfect rest induced by the splints will cure it quicker
than any other means: well, again, if it is found by further ex*
animation to be a fracture, we have employed the means we ought
from the outset. I lately had a case of fracture of the internal
condyle of the humerus in a child, which, apprehensive of a frac-
ture, I examined three or four times without finding what I ex-
pected. Being confident that there was something more than a
bruise, I requested the parent of the boy to allow another exam-
ination. After one fall half hour I was enabled to detect one. I
have no suggestions to offer as to the proper method of examining
fractures ; because each individual case requires a peculiar mani-
pulation.

I know that by the publication of these cases I have laid myself
open to the charge of a want of a tactus eruditus ; but I cannot but
think that, if surgeons would examine their cases more carefully,
they would treat more fractures and fewer bruises and sprains than
they now do. Fergusson, in the last edition of his practical sur-
gery, in speaking of a leg which he examined after death, says
" maceration caused the fragments to separate, but during life there
was no such displacement, and the annoyance did not seem greater
than might have been expected from a violent sprain." The
probable cause or causes of the obscurity of these fractures, I will
not now stop to comment upon ; it is merely the fact that I wish
to establish, [ Virginia Med. and Surg. Jour.

Placenta Prcevia, By M. DepaTJL,

At a recent meeting of the Medico-Chirurgical Society of Paris,
M. Depaul presented a paper upon uterine haemorrhage due to the
attachment of the placenta upon the inferior segment of the uterus.
After showing that in such cases the cause of the haemorrhage was
a defect in the comparative development of this part of the uterus
and the placenta, the author asks what the accoucheur must do to
remedy such a condition of things? That will depend upon the
frequency of the haemorrhages, their amount, the state of the foetus,
the life of which may be compromised, and lastly, upon the exist-
ence or absence of uterine contractions. There are many indica-
tions which the practitioner will have to consider before adopting
any course. He may employ only general means, such as blood-
letting, the use of ergot, the tampon ; and, as a last resource, he
may perforate the membranes, in order to obtain prompt delivery
either by version, or by applying the forceps, according to the pre-
sentation of the child. But when the placenta is implanted over
the very opening of the neck, I believe it best, says M. Depaul, to
apply the tampon, to let the labour advance, and to try to loosen

1855.] Compression of the Arteries in Neuralgia. 245

the placenta laterally, in order to be able to rupture the membranes,-
I am decidedly opposed, adds he, to tearing the placenta from side
to side, in order to reach the child ; such a practice is attended
with too many dangers. After delivery in such cases, it must not
be forgotten that the danger is not over; the haemorrhage may
continue and prove fatal, kept up as it is by the peculiar vascu*
larity of the inferior segment of the organ, and by the slow ten^
dency it has to contract during the first days after parturition.
This contraction ought to be induced by every means in use. the
best of which is unquestionably ergot. [L Union Medicate; Vir-
ginia Med. and Surg. Journal.

On Compression of the Arteries for the cure of Xeuralgia. By M<
Allier.

An individual, aged 48, of nervous temperament, experienced,
during convalescence from a severe malady, the return of a neu-
ralgia of the orbito-frontal nerve, to which he had been subject for
some time. It resisted the employment of the usual measures.
After seven days of severe pain, M. Allier proceeded to compress
the carotid artery of that side, continuing the treatment from one
quarter of an hour to another during the whole morning, intervals
of five minutes only being allowed. A state of somnolence super-
vened, during which the pains disappeared; but they soon after-
wards attacked, suddenly and with violence, the dorsum of the
penis, extending from the pubis to the glans. Pressure upon the
abdominal aorta caused their gradual abatement. This case is in-
teresting in a double point of view^first, as a rare instance of
neuralgia of the superior branch of the pudic nerve supervening
upon a similar affection of the orbito-frontal nerve ; and, in the
second place, as illustrating the efficacy of compression in causing
the cessation of neuralgic pains. \_Gaz. Med. ale Paris < Virginia
Med. and Surg. Jour.

Gum Mezquite as a substitute for Gum Arabic. By George G.
Shumard, M. D., Forth Smith, Arkansas,

The suggestion of Dr. Shumard, (which we notice in the Boston
Medical and Surgical Journal.) that the gum from the mezquite
tree is almost analogous to, and might be easily substituted for,
the gum acacia of the pharmacopoeia, is worthy of notice. The
inexhaustible quantities which might be obtained from Texas,
New Mexico, and the adjacent country, would prove a source of
revenue as well as affording employment to the tribes of Indians
now wandering over those plains, who would be glad to collect
this substance for a very small compensation. Dr. Shumard de-
scribes the character of this growth, and the mode of obtaining the
gum, as follows:

If. S. VOL, XI. NO. IV. 16

246 Editorial and Miscellaneous. [April,

The mezquite tree, from which the gum is obtained, is by far
the most abundant tree of the plains, covering thousands of miles
of surface, and always flourishes most luxuriantly in elevated and
dry regions. The gum exudes spontaneously in a semi-fluid state
from the bark of the trunk and branches, and soon hardens by
exposure to the atmosphere, forming more or less rounded and
variously colored masses, weighing each from a few grains to sev-
eral ounces. These soon bleach and whiten upon exposure to the
light of the sun, finally becoming nearly colorless, semi-transpa-
rent, and often filled with minute fissures. Specimens collected
from the trunks of the trees were generally found to be less pure
and more highly colored than when obtained from the branches.
The gum may be collected during the months of July, August and
September, but the most favorable period for that purpose is in
the latter part of August, when it may be obtained in the greatest
abundance and with but little trouble. The quantity yielded by
each tree varies from one ounce to three pounds, but incisions
made in the bark not only greatly facilitate its exudations, but
cause the tree to yield a much greater amount. As it isr a good
collector would probably he able to gather from ten to twenty
pounds in a day ; were incisions resorted to, probably double the
amount might be obtained. [Virginia Med. and Surg. Jour.

EDITORIAL AND MISCELLANEOUS.

BIBLIOGRAPHICAL.

The Microscopic Anatomy of the Human Body in health and disease.
Illustrated, with numerous drawings in color. By Arthur Hill Has-
sall, M. B., &c, &c. with additions to the Text and Plates, and an
Introduction, containing instructions in Microscopic Manipulations, by
Henry Vanarsdale, M. D. 2 vols. New-York : Samuel S. and William
Wood. 1855. 8vo. (For sale by T. Richards & Son.)

We congratulate the Profession upon the opportunity now afforded by
the liberal and enterprising- house of S. S. & W. Wood, of New- York, of
procuring HassalFs great work. It is magnificently published, and vended
at a reasonable price. It is the only complete work of the kind in the
English language, and reflects high credit upon its learned and indefatiga-
ble author. This edition is, moreover, materially enhanced by the additions
of the American Editor. The second volume is an atlas of plates beauti-
fully drawn from nature. This work ought to be in the hands of every
reading physician.

The Principles and Practice of Obstetric Medicine and Surgery, in reference
to the process of Parturition with 64 Plates and numerous Wood-cuts.
By Francis H. Ramsbotham, M.D., &c, &c. A new American editionr

1855.] Editorial and Miscellaneous. 247

revised by the author, with notes and additions, by Wk. V. Keating,
M.D.. A.M.. (ire. ore. Philadelphia: Blanchard <fe Lea. 1855. Large
8vo., pp. 650. (For sale by McKinne & Hall.)

This work has been so long and favorably known that it can need no
commendation at our hands. It is sufficient for us to say that this edition
is gotten up in splendid style, and that it is justly entitled to extensive
patronage.

The Principles of Physiology ; designed for the use of schools, academies,
colleges, and the general reader. Comprising a familiar explanation of the
structure and functions of the organs of If an. illustrated by comparative
reference to those of the inferior animals. Also, an Essay on the Preser-
vation of Health, with 14 quarto plates, and over 80 engravings on wood,
makinq in all nearly 200 fiaures. Bv J. C. Comstock and B. X. Comings,
M. D. . Xew-York : S. S. <fc W. Wood. 1855. (For sale bv T. Richards
& Son.)

This work is remarkably well adapted to the use of schools for either
sex, being beautifully illustrated, and written in unexceptionable style. If
generally introduced, it is calculated to do much good, as every one ought
to have some knowledge of his own structure and functions.

The Dublin Dissector or Manual of Anatomy ; comprising a description of
the bones, muscles, vessel*, ncrvts. and viscera ; also, the relative anatomy
of the different regions of the human body, together with the elements of
Pathology. By Robert Harrison. A. ML, M. B., T. D. C etc.. Arc 3d
American from the 5th enlarged Dublin edition with additions bv
Robert Watts, jr.. M. D., Professor. <fcc, ore. Xew-York : Samuel S.
and Wm. Wood. 1854. 12mo., pp. 542. (For sale bv T. Richards <fe
Son.)

A Text-Book of Practical Anatomy. By Robert Harrison, M. D., M. R.
J. A.. lVtc. i\rc, with additions by an American physician with numerous
illustrations. 2d edition. Xew-York : S. S. & W. Wood. 1855. 8vo.,
pp. 720. (For sale by T. Richards & Son.)

We have here an old friend of the practical anatomist who now pre-
sents himself to us both under his original title of " Dublin Dissector," and
under that of " A Text-Book of Practical Anatomy." If he has improved,
as he undoubtedly has, without a change of name, what may we not expect
of him when he has thought it necessary to adopt a new cognomen. The
truth is, that we now find our faithful companion so much enlarged and
modernized that we scarcely recognize him ; and although it may be true
in some cases that

Loveliness needs not the foreign aid of ornament,
But is, when unadorned, adorned the most

this is not the fact with regard to such characters as Dissectors. His
livery of fine engravings sets him off admirably, and adds wonderfullv to
his accessibility ; for like all of his clan, it was no easy matter to get ac-

248 Editorial and Miscellaneous. [Aprilf

quainted with him in days gone by. We cheerfully commend him, adorned
or unadorned, as an excellent guide.

What to observe at the Bed-side and after Death in Medical Cases. Pub-
lished under the authority of the London Medical Society of Observation.
2d American from the 2d and enlarged London edition. Philadelphia \
Blanchard & Le-a. 1855. 8vo., pp. 230. (For sale by T. Richards & Son.)

We have already had occasion to notice this work. Its extensive sale
shows that it has met with fever, and its present improved form can only
add to>its popularity.

Essays on Infant Therapeutics: to which are added observations on Ergot ;
a history of the origin of the use of Mercury in inflammatory complaints /
together with the statistics of the deaths from poisoning in Neiu-York in the
years 1841-2-3'. By John B. Beck, M. D., Professor, &c, &c. 2d edi-
tion, enlarged and revised. New-York: S. S. & Win. Wood. 1855.
I2mo., pp."l'70. (For sale by T. Richards k Son.)

These Essays of the lamented Professor Beck, especially those upon the
effects of opium, emetics, mercury, blisters, and bloodletting on children,
are very valuable contributions to practical medicine, and ought to be
studied carefully by young physicians before they undertake to medicate
ehildhood upon principles applicable to adults.

We are indebted to the authors for quite a pile of pamphlets, among-
which are : The twelfth annual Report of the Managers of the State Luna-
tic Asylum of New-York The 1 9th annual Report of the Managers of the

New-York institution for the Blind The Report of the Pennsylvania

Hospital for the Insane, lor the year 1854 The Report of the Trustees-

and Superintendent of the Butler Hospital for the Insane, presented to the

Corporation at their annual meeting, January, 1855, Providence, R. I.

On Injection of the Bronchial tubes and Tubercular cavities of the Lungs,
by Horace Green, M. D., &c, <fcc. New- York. (We expect to refer again

to this.) The Transactions of the New Hampshire Medical Society, 64th

anniversary, Concord Transactions of the Illinois State Medical Society

for 1854, Chicago Oration, delivered before the Phy si co-Medical Society

of New Orleans, at their anniversary meeting in December, 1854, by A.-

Mercier, M. D. A very handsome address Table of Urinary Deposits,

with their microscopical and chemical Tests ; for clinical examinations, by
John King, M. D.. Cincinnati. An excellent Tableau, which would, how-
ever, be more useful if printed in a more convenient form for preservation.

Cases of Inflammation and Ulceration of the Cervix Uteri. By James M.
Green, M. D., of Macon, Ga.

Under this modest title the author has furnished us an exceedingly valu-
able clinical report. As it is not easy to analyse such papers, we subjoin
the author's plan of treatment, the result of considerable experience;

1855.] Editorial and Miscellaneous. 249

" Treatment. There is no treatment whereby confirmed ulceration of
the cervix uteri can be cured, except the local application of cauterizing
agents to the diseased parte.

" The most generally useful of these agents is the nitrate of silver, which
of itself is sufficient for the cure of many cases. In a large number, how-
ever, its alterative effect is not great enough, and we have to substitute the
acid nitrate of mercury. A good general rule is to apply the solid nitrate
to the ulcerated surface every four to seven days, as long as it seems to be
healing. When the healing process stops then make one application of the
acid nitrate of mercury, and notice the result ; if favorable, return to the
weekly touchings with nitrate of silver, until a similar necessity should
arise. In cases of a little greater obstinacy make alternate weekly applicar
tions of the two agents.

" In some cases the eschar is thrown off sooner than in others, and an
earlier re-application of the caustic is consequently required. Again, in
some a longer interval is required tor the production of the best effects.
When the ulceration ceases healing under the periodical cauterizations, it
is advisable to stop treatment for two or three weeks.

" In old chronic cases of indurated hypertrophy, the disease will occa-
sionally be found to resist the influence of those milder remedies. In these
we shall be obliged cautiously to resort to the caustic, lime or soda. The '
resolutive effect of the potential and actual cauteries, in removing chronie
uterine indurations that bid defiance to all other methods of treatment, is
among the most brilliant results of Recamier's discovery.

" The only mode of using these remedies safely is through a speculum.
Among the best and most convenient forms of this instrument is the com-
mon conical glass speculum, covered with amalgam and painted black. If
made tolerably thick there is no danger of their breaking in the vagina,
and they expose the parts very perfectly to view.

" Ulceration of the cervix uteri may be treated with more certainty and
success during the pregnant state, from a disposition in nature to cure the
disease at this time and remove the inflammatory hardening, thus preparing
the way for delivery.

" During pregnancy, where abortion or miscarriage is threatened, we
should not wait a moment for the commencement of treatment, but apply
our caustics immediately to the whole ulcerated surface, clear up to the
internal coarctation. Nitrate of silver is the great sedative of chronic in-
flammation and irritations of the mucous membrane, and prompt treatment
the only thing to prevent the irritation extending through the canal to the
uterine body, and provoking the premature expulsion of its contents.

"In pregnancy these cases will bear stronger applications, and more de-
cided treatment than in the non-pregnant state.

" In treating cases of ulcerated cervix with hypertrophy, we should never
cease treatment until every trace of induration is removed.

"One or two cauterizations frequently produce a very marked improve-
ment in the feelings of the patient, when little apparent change has taken
place in the ulcer itself. Though, of course, some vital changes must have
occurred in the condition modifying the deceased emanations.

" Sometimes during the progress of a case the anterior lip, which mav
have been more inflamed and ulcerated than the posterior, suddenly heals
up, and the posterior lip becomes swollen and inflamed, and vice versa.

" Sometimes when the case is apparently getting well under treatment,
the ulcer will suddenly assume a redder hue and more irritable look, and

250 Editorial and Miscellaneous. [April,

increase in size, with a corresponding increase of the surrounding tumefac-
tion and all the dependant irritations. On careful examination, this may,
at times, be traced to the irritation of rough treatment, or too much exer-
cise.

" Some writers have repudiated the use of vaginal injections, but their
efficient use in washing away the impure collections of acrid secretions,
in the upper part of the canal, must have a healing and healthy influence.
The free contact of cold water with the inflamed and irritable cervix and
vaginal mucous membrane, must exercise a similar influence.

" The writer has not found cases of ulceration associated with any ordina-
ry degree of flexion, backwards or forwards, or prolapsus, to require any
other treatment than that adapted to cure the cervical disease, and to re-
store the contractile power and strength of the vaginal tube.

" In some instances, where the general health and the functional disturb-
ances did not give way from the removal of the local disease, excellent
results have been realized from the use of Hyd. Potass, and Sarsaparilla
Syrup, and still more from that admirable eutrophic Cod Liver Oil.

"In irritable and inflamed conditions of the vagina, which frequently
accompany cervical inflammations, laudanum and morphine injections,
allowed to remain some time in the canal, are very useful.

" In cases attended by much pelvic suffering, a laudanum enema, admin-
istered every night, has the best effect in relieving the local suffering, as
well as the pains in the loins and other parts excited by it.

" Confinement to bed should only be ordered when the ulcer is in a very
irritable condition, and motion seems to aggravate the disease. Continu-
ance in the recumbent posture rapidly impairs the appetite and the general
strength.

"Where the urine is red, scanty and loaded with red deposits, great
improvement will result from the use of alkaline remedies (an excellent
prescription is Carb. Potass, gr. 20 ; Calcined Magnes. gr. 10 ; Pulverized
Rhubarb gr. 5, every night,) followed, after some weeks' use, by some of the
terebinthinate remedies.

"Where the neuralgic pains continue lurking about the loins and pelvic
viscera after the ulceration is cured, they may frequently be entirely re-
moved by one or more decided vesications to the loins.

" When the urinary deposits are white and alkaline, the patient will be
benefitted by the use of the acid alteratives, nitric or muriatic acids in
proper doses.

" When the stomach is very much impaired in tone, and deranged from
the long continuance of the functional irritation, it will be benefitted by one
or more blisters to the epigastrium.

" In closing these remarks upon inflammation and ulceration of the neck
of the womb, the writer thinks proper to observe that although the treat-
ment necessary for the removal of these grave lesions does not require any
peculiar and inscrutable tactus eruditus, yet it does require a great deal of
care and caution, and some experience in the treatment of uterine disease.
The application of strong re-agents to this delicate and important part, ne-
cessarily involves delicacy of touch and discretion, particularly the use of
the potential caustics, for the removal of chronic indurations. The latter
should not be attempted by the tyro in uterine disease,"

1855.] Editorial and Miscellaneous. 251

Report of the Sanitary Commission of New Orleans on the Epidemic Yel-
low Fever of 1853. Published by authority of the City Council of New
Orleans. 1854. 8vo. pp. 542.

We are indebted to a member of the " commission " for this interesting
volume. The committee consisted of Hon. A. D. Crossman, Mayor, and
of Doctors E. H. Barton, A. F. Axson, S. D. McNeil, T. C. Simonds, and
T. L. Riddell. The duties assigned the committee were :

" 1st. To inquire into the origin and mode of transmission or propaga-
tion of the late epidemic yellow fever.

" 2d. To inquire into the subject of sewerage and common drains, their
adaptability to the situation of our city, and their influence on health.

" 3d. To inquire into the subject of quarantine, its uses and applicabili-
ty here, and its influence in protecting the city from epidemic and contagi-
ous maladies, and

" 4th. To make a thorough examination into the sanitary condition of
the city, into all causes influencing it, in present and previous years, and to
suggest the requisite sanitary measures to remove or prevent them and
into the causes of yellow fever in ports and other localities having inter-
course with New Orleans."

These sections were distributed among the several members of the com-
mittee the 1st to Drs. Axson and McNeil ; the 2d to Dr. Riddell ; the 3d
to Dr. Simonds, and the 4th to Dr. Barton. The volume before us con-
tains the separate Reports of each of these sub-committees, with a large
mass of medical testimony obtained from every important point of the yel-
low fever zone of this and other countries. Although these reports are not
printed in the order indicated above, we shall adhere to this for the purpose
of perspicuity.

The report of Drs. Axson and McNeil on the origin and spread of the
epidemic is concise and ably drawn up. Our limits allow us only to note
that they repudiate the idea of contagion, and to furnish their concluding
remarks :

" Looking, then, with singleness of purpose only, at the late epidemic
and what we have been able to garner up of its passing history, we feel
warranted in stating

That it has not been derived from abroad, but is of spontaneous origin :

That there existed here, as attested by our records, very peculiar mete-
orological conditions, known, by general experience, to be capable of pro-
ducing, in co-operation with local causes, fatal and malignant forms of fever :

That these conditions were present in an exaggerated degree, and im-
pressed upon the prevalent type of disease susceptibilities and habits assimi-
lating it to another and distinct form of fever :

That this showed in all those localities within the range of the meteoro-
logical state or influence, an infectiousness not necessary to, or characteris-
tic of the fever, but purely casual and incidental, the result of physical
causes, and which it loses as soon as those causes are changed or disappear."

Dr. Riddell's report on the subjects of city sewerage is an exceedingly
interesting epitome of the plans best adapted to the purpose of carrying off

252 Editorial and Miscellaneous, [April?

the filth of cities, and is characteristic of the learned Doctor's precision and
skill

The report of Dr. Simonds on quarantine is not as complete as he would
have desired it, in consequence of an affection of his eyes which limited
his labors. The Doctor is not very explicit on the subject of contagion,
but we fully concur in the following remarks ;

" Whatever may be thought of the contagiousness or of the transporta-
bility of yellow fever in general, or as it has prevailed here in other years
and in other places at various times, it would appear to admit of no doubt
that the epidemic of 1853 was carried by the regular course of travel to tli6
interior. Its progress was steadily directed to the points of most direct
commercial intercourse throughout the Southwest ; and it appears, more-
over, that having once obtained a foothold in any locality, this served as a
new focus from which it was still further diffused. It does not appear to
have followed any of the known laws of the diffusion of gases, nor to have
exhibited any other law of diffusion than that above indicated. Like a
skillful general in the invasion of the territory of an enemy it took posses-
sion, seriatim, of the most important and prominent points which should
serve as a basis for future operations ,"

And concludes with the following recommendation, which we would
like to see adopted by our city authorities :

<' The Commission therefore recommend that the Common Council me-
morialize the Legislature, requesting that full powers to establish, govern,
supervise, and direct a quarantine for the port of New Orleans, including
therein ah the routes, road passes, bayous and railroads in any and every
direction, be conferred on the corporate authorities of the city, and that

an appropriation of -- - hundred and thousand dollars be set

apart, subject to the order of the proper authorities under proper restric-
tions to defray the expenses thereof."

The Report upon the sanitary condition of New Orleans, by Dr. Barton,
by far the most voluminous, occupying 250 pages, embodies an immense
store of interesting matter, illustrated by tables, charts, &cf It is indicative
of great industry as well as familiarity with the subject on the part of the
learned reporter, and must take place among the most valuable documents
of the kind. Although much of this paper is devoted to considerations still
within the domain of theory, and upon which there must consequently be
diversity of opinion, it is nevertheless but fair to the author to acknowledge
that his arguments are generally sustained by the facts adduced. Others
naight, perhaps, arrive at different conclusions by invoking another class
of facts. The reported for example, dwells at length upon the concurrence
of epidemics of yellow fever with up-turnings or excavations of the earth in
or #bout infected cities ; but many instances may be cited in which
such disturbances of the earth being made, have not occasioned yellow
fever in places subject to this disease, as well as others in which the disease
has prevailed without exposures of this kind. The same may be said with
regard to accumulations of filth. During the whole period of the immense

1855.] Editorial and Miscellaneous. 253

excavations necessary in the completion of the Augusta Canal, when the
animal and vegetable matters, which had accumulated to a great depth
for ages in our Beaver Dam Swamp, were thrown up and exposed to the
action of the summer sun, this city was never more healthy. The year in
which our gas-pipes were laid throughout the city, was equally healthy, and
the city was never more cleanly than in the summer of 1854 when the epi-
demic made its appearance. Very few gas-pipes wTere laid down that season.
This report contains a chart showing the mortuary statistics of Xew Or-
leans for the last fifty years, from which it appears that the annual mor-
tality during that time was 59.63 per 1000 of the population ; whereas the
average annual mortality of the six or eight principal cities of the Union is
a little upwards of 2 per cent. For the last six years preceding 1853
it has averaged in Xew Orleans 6f per cent. The table No. 2 " showing
the life cost of acclimation or liabilities to yellow fever from nativity, as
exhibited by the epidemic of 1853 in Xew Orleans " is very striking. We
learn from it that the ratio of mortality per thousand was with natives of
Louisiana (including Xew Orleans) 3.58 ; of other proximate Southern
States 13.22 ; of the Northern States 32.83 ; of the Western States 44.23 ;
and of British America 50.24. Among foreigners the cost was much great-
er thus: with the Irish 204.97 ; those from Xorthem Europe 163.26 ; from
Germany 132.01 ; from Holland and Belgium 328.94 ; from mountainous
Europe 220.08 ; from Southern Europe 22.06. From these data it would
appear that Southern nativity, both in America and Europe, is singularly
protective or antidotal. This is the converse of what obtains with regard
to the ordinary fevers of this section of country, to which none are so liable
as natives. We are aware that in this announcement, we are in conflict
with both tradition and written authority ; but it is the result of long ob-
servation and of deductions from the mortuary statistics of this city (Augus-
ta). We have long since stated these views in the pages of this Journal,*
and we repeat that they are correct so far as relates to this region of Geor-
gia. Upon the plantations in our sickly counties, the negroes, who are

* In the Bills of Mortality of Augusta for 1833-34-35 and '36, published in the
Southern Medical and Surgical Journal, April 1837, p. 663, we find a table showing
the place of nativity of the whites who died of bilious fever during those years, from
which it appears that of the natives of Slates north of the Potomac, 7 died.
" " " Europe, 10 = 17.

" " " Georgia, 28

" " " other Southern States 18 = 46.

Now if to these 46 an equal number of negroes, who are all natives of the South, be
added, the result will be very remarkable. It should be observed that at that time
our white population was about equally divided between Northerners and South-
erners, and also between whites and blacks. During these four years, there died
413 whites and 468 blacks out of a population of about 7,500, making the annual
average mortality at that time, 1 in 34.10. The average has become much more

favorable since the improvements in the treatment of our autumnal fevers; about
g per cent.

25-i Editorial and Miscellaneous. [April,

mostly natives, suffer attacks of fever more or less violent almost every
autumn. Another striking point of difference between our fevers and yel-
low fever is that one attack, so far from establishing an immunity from
subsequent ones, renders the subject infinitely more liable to them.

We must here beg leave to differ from the Reporter with regard to his 7th
proposition (inserted below). We cannot admit from the mere fact that
other forms of fever prevail when yellow fever does not, that it is demon-
strated that they owe their origin to the same causes as yellow fever, oper-
ating with less intensity. Might we not draw the same inference from the
occurrence of any other disease during the absence of yellow fever ? But
it is urged that our periodic fevers are convertible into yellow fever. If by
this it be meant that by merely increasing in violence or intensity the
bilious (so called) fever becomes yellow fever, we cannot but regard this a
serious error. If a man be affected with phthisis pulmonalis, with pneu-
monia, with diarrhoea or with rheumatism and that he die of black vomit,
will it be insisted that the disease with which he was first attacked has
been converted into yellow fever ? or is the convertibility to be confined to
bilious fever alone because this disease presents some similarity to yellow
fever in its symptomatology ? Believing firmly, as we do, that yellow fever
is a distinct disease ; that it recognizes a distinct cause (or causes, if this
be preferred) ; that this cause, unlike that of our periodic fevers, may be
carried about in ships, steamers and closed rail road cars from place to
place, spreading its infection along thoroughfares ; that the treatment known
to be specific in periodic fevers is of little value in yellow fever ; that one
attack of yellow fever exempts from subsequent ones ; that persons may
become so acclimated as to be protected from yellow fever, but never so
from our periodic fevers ; that negroes are comparatively exempt from yel-
low fever, although as liable to bilious fever as whites ; we cannot admit
their convertibility in the sense in which this term is generally used. We
are willing to grant that an attack of " bilious " fever, or of sundry other
affections, may predispose the patient to the inroads of the yellow fever,
which he might otherwise have escaped.

We have extended this paper so much beyond our original design that
we have space now only for the Reporter's resume.

" 1st. That it is the cause of the high price of everything, and the direct
means of retarding her progress to prosperity, and which will continue to
exist until effective measures are taken to remove it.

2d. That the direct and inevitable change of climate alone, is not the sole
cause of the mortality of immigrants, but the union of the climate with the
terrene conditions under different circumstances, were the efficient agents
in the destructive influence on each class of people as pointed out accord-
ing to nativity ;* that man cannot become acclimated to the second cause,
or terrene (filth, &c.) any where, and that the acclimation to our first cause
(or atmospheric) would be trifling, if the conditions constituting it, were so
modified, as was clearly shown to be, in our power.

1855.] Editorial and Miscellaneous. 255

3d. "We have endeavored to prove what were the constituents of the
epidemic yellow fever of 1853, that they consisted of certain atmospheric
and terrene combinations ; that these causes, so far as we had the means of
ascertaining, were confined to the limits of the fever district ; that it began
with these causes and ended with them, throughout the limits of the epi-
demic region, and that when these ceased, so terminated its influence on
man.

4th. That one of these causes, (the atmospheric,) is more or less present
here every summer, and that when the second (or terrene) exists in suffi-
cient amount, an epidemic is the certain result, so far as near sixty year's
experience will go to prove it ; that this terrene condition is mainly com-
posed of extensive disturbances, or upturning and exposure of the original
soil of the country ; that without this there has been no such epidemic, al-
though, between the occurrence of some of them, long periods have elapsed ;
and that its ravages or malignity appears to have been pretty much in pro-
portion to the extent of that disturbance.

5th. That for the existence of an epidemic, a wide pervading atmospheric
cause being: one of the essential elements, an epidemic disease cannot be im-
ported, and that as a contagious disease cannot depend upon a general
cause for its existence, but must derive its qualities from a specific one ;
epidemic yellow fever is consequently not a contagious disease.

6th. That to constitute an endemic yellow fever, the difference of which
from an epidemic was fully pointed out, that the apparent contagion was
only the extension of the epidemic principle, a lesser degree of the same,
or what was believed to be equivalent, (filth of all kinds, and decomposing
materials) with a lesser degree or intensity of the first or atmospheric con-
stituent, were essential.

7th. That when these causes did not exist in a sufficiently high degree
to produce yellow fever, intermittent, remittent bilious, or other periodic
fevers were the result, demonstrating by the clearest analogy that they pro-
ceeded from the same cause, and that they differed only in degree and in-
tensity, a major amount of the very same materials being required to pro-
duce yellow fever, as a minor one does for bilious or periodic fevers.

8th. That all these fevers are produced from local causes, more or less
extensive, and that the fevers, the result of these, were limited to these
bounds, that these causes are well understood, and were extensively pointed
out in detail, that wherever the epidemic extended, there were causes to
localise it, that where these did not exist, the cases of the epidemic conveyed
there did not extend, and that consequently, that all these fevers arising
from bad air, are no more contagious or infectious the one than the other,
the liability to them is limited to the bad or infected air and personal sus-
ceptibility ; and finally, that these are of the greatest importance in their
practical bearing on sanitary measures. And,

9th. That the temporary epidemic cholera which occurred here early in
December, it was shown, depended also, upon two conditions, an atmos-
pheric and a terrene ; that the first of these was different from that re-
quired to produce epidemic yellow fever, although the second was believed
to be the same.

From all which the following corollaries were deduced ; viz :
1st. That an epidemic yellow fever in New Orleans, if produced by the
causes stated in our third proposition, as believed, being known, is controla-
ble, that is, preventable.

2d. That an endemic yellow fever, arising from the same or equivalent

256 Editorial and Miscellaneous. [April,

-causes, as above, although in a lesser degree, can also, be mainly, if not
entirely control ed.

3d. That the causes of bilious or periodic fevers being known also, to
arise from a smaller amount, or more diluted condition of the same circum-
stances, although more general and extensive, and more dependent on per-
sonal hygiene, it is in the power, as it is the duty of the civil authorities to
mitigate, if they can not entirely control them ; and finally :

4th. That it was demonstrated, that by the proper application of curative
measures, by the establishment of proper sanitary laws and police ordi-
nances, rigidly enforced and effectually carried out, New Orleans can be
made as healthy as any city in America ; and that it was not only the in-
terest of the city to accomplish these important purposes, but that

5th. A penalty could be as much enforced upon the civil authorities for
neglecting the removal of conditions subversive of health and life, as for any
purpose for which society was formed."

We cannot conclude our notice of Dr. Barton's truly able report, without
an expression of profound regret that so respectable a periodical as the
New Orleans Medical and Surgical Journal should have given place to such
a paper as the " Review " of this report signed M. Morton Dowler, M. D.
We are not personally acquainted with either of the parties, nor do we
know their social relations to each other ; but it is very evident that noth-
ing short of the bitterest hostility could have prompted such a display of
malignity, not to say unfairness, on the part of the Reviewer. We cannot
believe that this " Review " was carefully examined by the distinguished
editor, Dr. Bennet Dowler, before its publication, for he would most assured-
ly have rejected it as unworthy of the high design of scientific criticism.
That such personal assaults are permitted and even committed by some of our
editorial fraternity who control certain disgraceful journals, we have repeat-
edly lamented. Periodicals devoted to science should close their columns to
every expression or sentiment calculated in the least degree to engender or
to foster unpleasant feelings among men whose proper calling and whose
sole aim should be to labor harmoniously for the promotion of health and
happiness, D.

The New Orleans Quarterly Journal of Medicine. Such is the title of
a new periodical about to be published under the supervision of Dr. Bennet
Dowler. Price $5 per annum. The learned editor's extended reputation
will doubtless secure to the wrork a liberal patronage. He has our best
wishes for his success.

Medical College of Georgia. On Thursday, the 1st inst., the exercises of
this institution closed for the term. An appropriate prayer having been
made by Rev. Dr. Dumont, the report of the Dean was read, after which
the degree of Doctor of Medicine was conferred by the Hon. A. J. Miller,
President, on fifty-three members of the class.

The Rev. Dr. E. E. Ford was then introduced to the class, to whom he

1855,]

Editorial and Miscellaneous.

257

delivered an address in behalf of the Facnlty, which was responded to by
J. Junius Harris on the part of the class.

It is a source of high gratification to the friends of the College, that this
class, notwithstanding the alarm occasioned by the late epidemic, was
one of the largest ever is attendance at the institution. We subjoin the
report of the Dean :

Augusta, March 1, 1855,

The Faculty report to the Trustees of the Medical College of Georgia,-
that one hundred and seventy-one students were in attendance on the Course*
of Lectures just concluded, of whom

132 were from Georgia,

17

M

u

Alabama.

W

H

u

South Carolina,

2

u

u-

North Carolina,

2

u

u

Texas,

1

u

a

Florida.

1

N

M

Mississippi,

171

That fifty-three of these gentlemen, having complied with all the require-^
ments of the Institution, anoS having undergone satisfactory examinations,-
are now presented by the Faculty to the Trustees as suitable candidates- for
the degree of Doctor of Medicine. That these gentlemen are

FROM GEORGIA,

J. H. Howell, [ R. W. Boston,

M. E. Mcintosh,. ! S. W. Palmer,

E. G. Riley, J. L. Glenn,

J. J. Cartledge, ! W. P. Bond,

M. D. Sanders,. , M. M. Tessier,.

A. J. Vann, V. S. Cooper,

J. R. Harris, J.T.Boyd,

R. B. Jordan, J. M. Greene,

L. C. Rhodes. J. N, Gilbert,

D. A. Newman, : G. T. Snellings,

E. T. Parker, L. M. Pentecost,
A. M. Sabal, J. M. Tullis,
J. F, Haley, L. L. Saundersr
W. H. Doughty,

J. E. Cooke,
S. W. Anton}",
C. W. Smith,
John Hockenhutt,
J. R. Scott,
John Sims,
J. J. Harriss,
C.W. Bedell,
W. B. Rivers,
W. R. King,
AY. A. Mayes,
J. W. Price,
H. A. Urquhart,

E. S. Rawls,
W. D^Cox,

ALABAMA,

James Bates,
J. W. Jones,

SOUTH CAROLINA.

J. G. Davis,

J. C.A.Shaw,

J. J. Shipman North Carolina.

Thomas Tabb Florida.

J, A. Roberts Texas,

; D. W. John stony
G. H. Holcombe,

W. T. Westmoreland
J. C. Cunningham*

258 Editorial and Miscellaneous. [April,

The Faculty also recommend that the Honorary Degree of Doctor of
Medicine be conferred on J. B. Underwood, and that John B. Hendrick,
M. D., be admitted ad eundem gradum in this institution. The Faculty
also recommend that the Honorary Degree of Doctor of Medicine be con-
ferred on the Rev. A. Henry Dumont, D. D., of Newport, Rhode Island.

George M. Newton, Dean.

The Savannah Medical College. We learn that there were fifty students
in attendance upon the session just closed, of whom seventeen were gradu-
ated on the 13th inst.

State Medical Society. We would remind our readers that the Sixth
Annual Meeting of the Medical Society of the State of Georgia, will be
held in the city of Columbus, on Wednesday, the 11th of April, and that
the annual address will be delivered on that day at 12 o'clock M., accord-
ing to a Resolution adopted at the last meeting.

Belladonna for Orchitis. We have received a letter from Dr. Rodney
Burke, of Scriven county, in which he speaks in high terms of the use of the
ointment of Extract of Belladonna applied to the scrotum.

Introduction of a stick or swab-handle more than ten inches long into the
stomach its exit by an abscess cure. By Francisco Garcia y Garcia,
of Daimiel (Mancha baja.) Translated for the Medical Examiner from El
Porvenir Medico of June, 1854. Mateo Sanchez de la Nieta, native of the
town of Daimiel, aged between 45 and 50 years, contracted a syphilitic
disease, which after a time, affected the fauces and posterior part of the
mouth. His attending physician, a distinguished practitioner, directed that
the parts should be cleansed several times daily, and for the purpose con-
structed a swab with which he made the first applications, but not being
sufficiently long the patient had it spliced until the stick was more than
ten inches (una tercia) in length.

One afternoon in the month of September, he was alone in his house and
complying with the directions of the practitioner ; but the presence of the
swab, the stimulus of the medicament, the contraction of the muscles of the
pharynx, a spasmodic movement, the carelessness of the patient, or all
conjoined, caused him to relinquish his grasp of the instrument, which re-
mained in the back part of the mouth. While thus embarrassed, one of
his daughters came in, who perceiving him in distress, and not able to an-
swer questions, gave him water, which he asked for by signs, which not being
able to swallow, was returned by the mouth and nostrils, with suffocating
effect ; some persons in the vicinity seeing him sought a physician ; in the
mean time, which was not long, the stick descended the oesophagus, the
upper extremity fixing itself between the pomum Adami and the anterior
portion of the fork formed by the sterno-cleido mastoideus, producing a
salient angle on the left side, which the patient indicated to the bystanders.
A suffocating condition recurring, caused him to abandon it, and with the
movements it disappeared not only from sight but also from the touch of

1855.] Miscellaneous. 259

the practitioner, who arrived after the patient had recovered from his par-
oxism which followed that state. They gave him some spoonfuls of an
anti-spasmodic mixture, which he swallowed with less difficulty than the
water given him by his daughter. He recovered his speech somewhat, and
complained only of anguish and smarting in the throat, and towards the
left side a little above and front of the nipple of the same side, which gradu-
ally ceased, disappearing on the fourth day. the patient, physician and
friends being left in an unhoped for quiet.

Eight days subsequently the patient felt, deep in the left side of the epi-
gastric region, sharp pains, running towards the last false ribs, increasing
everv hour, accompanied with gastric irritation and febrile symptoms,
which led the physician to suggest a resort to spiritual aid. On the follow-
ing day, (the 14t"h from the ingestion of the stick) the greater part of the
gastro-peritoneal symptoms, which indicated great peril, abated, the patient
remaining almost without fever from the 1 7th to the 20th. Under these cir-
cumstances the practitioner proceeded to a minute examination of the pa-
tient, and ascertaining the existence of the stick in the cavity of the stomach,
proposed to the patient- the operation of gastrotomy, to which he objected
his age, his severe suffering, his present comfortable condition, and finally
that he would not submit, though it would cost him his life.

The practitioner forced unwillingly to yield to the entreaties of the pa-
tient and abandon all operations, directed him to eat, insuring him his
condition was not as flattering as he supposed. At the expiration of ten
days (26th of the accident) the patient presented himself at the house of
the physician, asking him to examine an apostume, as he called it, which
had appeared far below the nipple of the left side. The next day it was
opened by a crucial incision, and a large quantity of pus, both well formed
and bloody, was discharged : with the evacuation the patient grew wonfc,
but four days after the incision, having improved somewhat, and feelings
himself much better, without waiting for the physician, he determined to
remove the dressing and cleanse the wound : a female neighbor, who was
present to assist him, saw with wonder what appeared to be the end of a
black stick in the opening of the : encouraged by the patient, she

seized the foreign body and drew it. and they saw with astonishment four
or five inches of the stick of the swab projecting.

In the midst of the conflict of the two, they thought of and sent for Dr.
Povil, who came at once to the aid of his patient ; he look the stick, and

ted by the exit of pus, contractile movements of the stomach, mi;-
of inspiration and traction of the woman, brought it to the surface, in the
intercostal space formed between the third and fourth false ribs of the left
side, as far as the point where it was spliced : then he seized the stick at
the splice, fearing that the thread which bound it might give way. in con-
sequence of putrefaction, which he presumed might have occurred since its
ingestion: but this fear vanished when the point of the splice passing
through the intercostal space, the thread was found unaltered ; the extrac-
tion was continued until the extremity of the stick, to which threads or a
frayed rag were tied, reached the external wound, where it stuck, causing
new and sharp pains in the stomach, which, although they subsided, were
followed by great distress and a soporose state. Having recovered, the prac-
titioner continued his exertions, and introduced his thumb into the wound,
and by forcibly depressing the inferior rib, succeeded in dislodging and ex-
tracting the entire swab just as it had entered the mouth 28 days before.
It was followed by a flow of pus, considerable blood, and gastric juice

260 Miscellaneous.

through the wound, together with some partially digested alimentary sub-
stances which had been eaten in the morning.

Care was taken in dressing the wound to avoid the introduction of air
into it. He was placed upon his back with head and shoulders elevated,-
ordered a strict diet, being allowed a few spoonsful of acidulated water for
drink. The stick was found to be of black poplar, (Papains nigra), and
more than a tercia (a third of a Spanish yard) or about eleven inches in
length. The patient passed an uncomfortable night, but slept at intervals
in the early part of the next morning. On the 4th day from the removal
of the stick the wound was of a dark color, owing to the presence of some
coagula of blood; these1 came away the next day with the poultice, and
the wound assumed a healthy appearance, and was completely healed in
26 days from the removal of the stick, and 49 from its entrance by the
mouth.

This case occurred at Daimiel in the month of September, 1832, and
was well known among the people. The statement is from the patient be-
fore death and from his children who witnessed it. In 1834 Sanchez had
a light attack of cholera but during; the ten succeeding years he worked
as gardner and laborer without suffering from any serious indisposition ; he
remained fat and healthy until May 1844, when the writer began to prac-
tice in the town. He died in 1849 of an acute attack of pleuro-pneumonia.

[Medical Examiner.

Epilepsy. In a recent work by M. Herpin, which received a prize from
the Institute of France, the prognosis and treatment of epilepsy are ably
discussed. The remedies which M. Herpin found most successful were the
salts of zinc, the ammonio-sulphate of copper, valerian, and an umbelliferous
plant, the Selinum palustre. The oxide of zinc was exclusively employed
in forty-two cases. Thirty-one of these had suffered from less than 100 fits \
26 were cured, and 5 were incurable ; 5 had had less than 500 fits ; 2' were
cured, and 3 were incurable ; 6 had had over 500' fits, and were all incura-
ble. Hie oxide of zinc was commenced in quantities of from six to eight
grains daily, given in divided doses, one hour after each meal. It was
augmented two grains daily until the dose reached forty-five grains. With
regard to the time when the remedy may be supposed to have had a fair
trial, the following rules are laid down by M. Herpin : In children under one
year, seventy-five grains should be administered before the remedy is given
up. In cases over two years, and in which the prognosis is only moderately
favourable, (cases of more than 100 attacks,) as much as four ounces must
have been given during the treatment before another remedy is employed,

[ Virginia Med. and Surg. Jour,

Nickel. Professor Simpson has been experimenting upon the therapeu-
tic properties of nickel, and announces that the sulphate of nickel possesses
tonic properties, and that it may be occasionally employed with advantage
as a substitute for iron or manganeses. In doses of half a grain thrice
daily this salt is found very efficacious. In larger quantities it occasions
nausea and vomiting. Dr. Simpson reports a case of periodical cephalalgia
which yielded to this agent after salts of iron and manganese had failed ;
and he also mentions the cure of a woman who had suffered from amenor-
rhcea for ten years, but who recovered promptly under the administration
of sulphate of nickel. [Ibid.

SOUTHERN

MEDICAL AID SURGICAL JOURNAL

Vol. XI.] 5EW SERIES. HIT, lSji. [So. 5.

ORIGINAL AXD ECLECTIC.

ARTICLE XI.

J. singular Case of Abdominal Abscess. By TV. TV. Broom, M. D.,
of Kingville, Talladega County. Ala.

January 28th, 1855. This evening I was called to visit ''Liz,''
a negro woman, aged seventeen : seven months gone with her first
child : found her in a comparatively helpless condition ; abdomen
intensely swelled, pain on the slightest touch. The lower ex-
tremities could not be moved without the aid of an assistant ;
tongue slightly furred and dry ; pulse 120, small and thready ; skin
over the abdomen very hot ; examination per vaginam proved every
thing to be in its natural position, except an apparent pressure of
the bladder downwards ; introduced a catheter, but only an ounce
of urine escaped, the passage of which had previously been attended
with some difficulty. By inquiry. I found that the girl had been
in this condition, or nearly so, for eight days ; the symptoms above
described were accompanied by costiveness for which frequent
draughts of epsom salts had been given. On my arrival, finding the
bowels a little costive, I gave calomel 15 grs. rhubarb 10 grs., and
ordered a decoction of uva ursi to act upon the urinary organs.

The disease presented more the appearance of rheumatism of
the uterus, as described by Churchill, than any other affection of
that organ, except an excess of the liquor amnii, there being well
marked symptoms of both.

29th. Found my patient pretty much in the same condition, the
medicines had acted finely, but the abdomen was still very much

n. s. VOL. XI. no. rv. 17

262 Broom's Case of Abdominal Abscess. [May,

swollen and very tender ; continued the decoction of iiva ursi, with
phosphate of ammonia, ten grains every four hours, and applied
a plaster of belladonna, cicuta and iodine over the abdomen. I
was here, from some consideration, requested to send medicines
instead of visiting the patient, to which I consented. The plaster,
according to report, measurably relieved the pain in the abdomen,
in so much that the patient got up and walked a few paces. The
viva ursi made the evacuation of urine easy, consequently, I re-
commended it to be continued.

I heard no more from the case until the 5th of Februar}-, I was
again sent for, saying the negro was very ill indeed. Not being at
home, my friend and former colleague, Dr. W. B. Abercrombie,
visited the case and directed calomel 5 grs., James' powder 1 gr.,
every four hours, until four doses were taken ; morphine at night
to allay pain. The tongue was dry and furred through the mid-
dle and slightly red at the tip and edges.

Feb. 6th. To-clay I again visited the case accompanied by Dr.
Abercrombie ; we found the girl in great pain, the abdomen dis-
tended almost to bursting, with considerable heat ; pulse quick and
small ; tongue very dry. The case, indeed, bore a desperate
aspect, and such being the case, we considered the remedies ap-
plied should be equally so to be of any avail, and upon these con-
clusions we resolved to bring on premature labour, with the hope
of perhaps saving one or both, as it is not an uncommon occur-
rence for a seven months child to live. To accomplish this design,
I armed a medium sized gum elastic catheter with a strong wire,
introduced it into the os uteri; then, with a gentle but firm and
rotating pressure, I passed it through the membranes enveloping
the foetus; upon the withdrawal of the instrument there was no
discharge of the liquor amnii, but a slight haemorrhage took place ;
however, being satisfied that the membranes were ruptured, I then
made a decoction of ergot 30 grs. to four ounces boiling water,
and gave an ounce every two hours, about ten o'clock that night
labor pains came on, and in about two hours the child was deliv-
ered alive, but died about noon next day. Much to my chagrin,
I found that the enlargement and soreness of the belly was not
yet removed, but thinking rest would be beneficial to the patient,
I gave her a half grain of opium and allowed her to remain quiet.

7th. This morning I find the patient, so far as the labor is con-
cerned, doing well. The medicines given on the fifth arc acting
well.

1855.] Broom's Case of Abdominal Abscess. 203

8th. This morning I find the abdomen, if possible, more disten-
ded than ever; tongue dry; pulse quick and weak. Entertaining
an opinion that there was possibly an abscess within the walls of
the belly, I this morning confirmed the opinion by tapping, with
an ordinary sized trocar, half an inch to the left of the linea alba,
and two and a half inches below the umbilicus, when a gush of
very fetid and offensive gas made its exit, during which I could
distinctly see the belly sinking down like an inflated bladder when
the air is escaping from it: when this stopped about an ounce of
very fetid pus was discharged. I then applied a poultice to the
abdomen over the seat of the abscess, gave quinine in tonic doses,
with an ounce of whiskey four or five times a day, recommending
a nourishing diet.

9th. To-day the patient appears to be pretty much in the same
condition. Again I used the trocar, but about two inches lower
down upon the right side, with a discharge of eight ounces of pus.
Continue the same treatment. Passing by this evening, I called
and used the trocar again an inch lower down on the right side,
from which a half pint of pus escaped. Upon examination, I find
that the abscess extends from about an inch behind the anterior
superior spinous process of the ilium on the right side, down to the
pubis ; thence across the linea alba, about two inches to the left;
thence upwards as high as the umbilicus; then turning to the right
and ending about two inches above and one inch behind the an-
terior superior spinous process of the ilium. Hence, we discover
that we have a continued abscess over two-thirds of the abdomen.

10th. Found the patient this morning apparently better ; tongue
moist and of the natural colour, with the exception of a dark brown
far along the centre; pulse eight)'. Introduced the trocar an inch
above and behind the anterior superior spinous process of the
ilium, and drew off about eight ounces of very fetid and purulent
matter. I then introduced the trocar on the linea alba, two inches
below the umbilicus, and injected an ounce of tr. iodine of offici-
nal strength into the abscess, and placed tents in the wounds to
keep them open. Prescribed quinine two and a half grains, pipc-
rine half a grain, every three hours with an occasional gl;
toddy.

11th. Found my patient improving; the quantity of pus very
much diminished. Used injections of tr. iodine; continued the
quinine and piperinc; nourishing diet and injections to act upon
the bowels.

264 Broom's Case of Abdominal Abscess. [May,

12th. Patient very much on the decline ; the injections given
had had no effect. Early last night she was seized with a violent
spasm, all symptoms,, however, of the spasm have passed off, ex-
cept a partial paralysis of the right arm. Attributing the spasm to
the costive condition of the bowels, I gave calomel 15 grs., rhubarb
10 grs., and continued the injections to procure a speedy opera-
tion. Directed liquid opodeldoc to the arm, and spts. turpentine
to the spine between the shoulders ; drew off a considerable quan-
tity of pus, and injected one and a half ounces of tr. iodine.

13th. The girl had a spasm last night, but not so severe as be-
fore ; had one copious evacuation during the night, after which
she rested tolerably well : appears somewhat refreshed this morn-
ing, but the arm is perfectly useless ; tongue not so dry as on yes-
terday j pulse one hundred. Withdrew the tents and about four
ounces of pus escaped ; threw in one ounce and a half of tr. iodine
and closed the wounds by tents. Prescribed calomel 2 grs., Do-
vers' powder 2 grs., every four hours, continued the quinine and
pipcrine as before ; liquid opodeldoc to the arm.

14th. Found the patient this morning somewhat depressed : had
a severe spasm last night. Withdrew the tents ; as soon as the dis-
charged ceased a spasm came on, but did not last more than five
minutes. Injected two ounces of tr. iodine into the abscess; di-
rected a decoction of valerian root, a tablespoonful ever four hours
with ten drops vinum colchicum ; bowels moderately open ; pulse
ninety; tongue moist. Continue prescription as before. Saw
the patient again this evening; had had a recurrence of the spasm
at twelve o'clock. Withdrew the tents ; about two ounces of pus
came away. I then introduced a female silver catheter, when about
two ounces more was discharged. I then injected an ounce and a
half of tr. iodine through the catheter, moving it about so as to
spread it as nearly as possible over the whole surface, then closed
the orifice and continued the same prescriptions.

15th. No recurrence of the spasm during the night ; the patient
appears to be improving ; tongue moist ; pulse eighty ; bowels
moderately loose. Withdrew the tents, and by means of a catheter
drew off about four ounces pus. Can feel an indurated ridge
around the margin of the abscess. Inject seven and a half ounces
of warm water into the cavity, and by external manipulation en-
deavored to wash it out. After drawing off the water, inject two
and a half ounces tr, iodine. The patient can make a little use of
the arm this morning. Continue the same prescriptions.

1855.] Broom's Case of Abdominal Abscess. 265

16th. The case appears to be improving gradually; takes nour-
ishment freely ; tongue almost natural ; pulse seventy, and suffi-
ciently full ; the indurations around the abscess very distinctly felt
After drawing off the pus, inject the same quantity of tr. iodine as
before. The arm has some motion to-day. Continue the same
medicines.

17th. The patient appears a little stupid this morning; abscess
appears to be decreasing in dimension ; slight febrile action to-day.
Continue the same prescription.

18th. Patient improving slowly no discharge of pus; intro-
duced a small probe with difficulty; injected a p.p. syringeful
of tr. iodine at the opening on the linea alba, but it was ejected as
soon as the instrument was withdrawn ; allowed the wounds to
close, and continued a tonic treatment.

19th. Called on my patient to-day ; found her doing, appa-
rently, very well; pulse sixty; tongue moist and of the natural
color. Ordered the prec. carb. ferri. in five grain doses three
times a day.

20th. To-day the patient appears somewhat restless. Upon ex-
amination, I found a prominence immediately over the region of
the bladder about the size of a common orange. Here I was again
put to the necessity of using the trocar, after which, I drew off
four ounces of very fetid pus ; injected the cavity full of warm
water, allowed it to run off and threw in one and a half ounces of
tr. iodine ; gave blue pill to operate on the bowels. Other treat-
ment as before.

21st. The blue pill given yesterday has not acted; the abdo-
men a little swollen. Drew out the tent and placed a canula in
the wound, with an escape of four ounces pus of a slight red tin^e.
When the running ceased, introduced a female catheter and in-
jected two ounces of tr. iodine. Prescribed calomel 5 grs., Do-
vers' powder 3 grs., every two hours until three doses were taken ;
one ounce comp. tr. gentian three times a day as a tonic ; directed
the tr. iodine to be used again in the evening.

2 2d. The medicines given yesterday had but slightly moved the
bowels ; the abdomen swollen generally, with some heat over the
surface ; tongue natural ; pulse sixty-five : abscess considerably
distended. Withdrew the tent that the pus might escape, then filled
it with tr. iodine ; gave a dose of rhubarb and aloes ; continued
the tincture of gentian.

23d. The case appears to improve gradually; the medicines

203 Broom's Case of Abdominal Abscess. [May,

given yesterday acted well ; pulse eighty, slightly ptyalized; used
tri iodine for the abscess ; continued the tr. gentian.

24th. The case appears to be progressing well : the discharge
from the abscess very much diminished ; tongue natural; pulse
eighty. Directed five grams quinine with each dose of the gentian.

25th. The patient improving generally; no enlargement of the
belly; abscess diminishing; indurations around the margin very
distinctly felt. Continue the treatment as before.

26th. Very little discharge of pus this morning, but about three
ounces of a white transparent gelatinous matter was discharged.
Used injections of tr. iodine and continued tr. gentian alone.

27th. Little or no difference in the case.

March 1st. Patient considerably better; abscess much dimin-
ished ; discharges about two ounces during the day.

3d. Abscess almost obliterated ; very little discharge ; patient
walked across the house on yesterday; weakness now the promi-
nent feature. Injected half an ounce of tr. iodine, and continued
the tr. gentian alone.

4th. Abscess entirely closed; no pain in or about the region of
the abscess ; order the tincture of gentian to be taken for two or
three weeks.

19th. Patient improving rapidly.

In presenting the above case to the profession, it is not with the
supposition of introducing a novelty or a case treated with extra-
ordinary skill, but owing to the complicated nature of the case.
TVc find that the case was one of very difficult diagnosis, as the
distention of the belly was but a natural consequence of pregnane}^.
The heat and pain indicative of an excess of the liquor amnii, or
rheumatism of the uterus ; the paralysed or immovable condition
of the lower extremities indicative of inordinate pressure in or
upon the pelvic cavity; hence the conclusion of a diseased condi-
tion of the uterus. The course pursued was dictated by the na-
ture of the case; the abortion or premature labor brought on, we
believe was the chief means of saving the life of the patient; for,
had the foetus remained in utero up to the full time, and the ab-
scess have been opened, and the subject reduced to a mere shadow,
as was the case, it would have been a case of unparalled anoma-
lousness for her to have withstood the effects of the labour. But we
would here raise an objection to the probability of her reaching
that period. The size of the uterus, Avith the movements of the

1855.] IIo^ahd's Cases of Varicella Lympliatica. 2G7

child pressing from within against the peritoneum, which we bc-
liveto have been the base of the abscess, would in all probability,
have brought on peritonitis, and under the existing circumstances,
terminated in the death of the patient. The frequent use of the
trocar might with some plausibility be objected to, but it was con-
sidered necessary to puncture in a number of places, to allow the
cavity to be emptied without much manipulation, as well as an-
other very important consideration the more thoroughly spread-
ing the tr. iodine over the surface of the abscess.

ARTICLE XII.

Two Cases of Varicella Lympliatica, in adults, with remarks. By
C. C. Howard, M. D., of Lowndesboro', Alabama.

On the 20 th January last I was requested to see Mr. J , aged

24, overseer on Mr. E. H.'s plantation. He had been unwell at
least one week, and had previously complained to me of lassitude,
anorexia, tinnitus aurium, headache, pains in the back and limbs,
sore throat and occasional chilliness, followed by more or less
fever for which he took quinine.

On the day above mentioned, and especially the night before,
the headache, pains in the limbs, and fever, were much increased;
and now, 10 o'clock A.M., he has an extensive vesicular eruption,
the vesicles being about the size of split peas, and most numerous
about the face, head and breast, (back not examined,) though
many on the abdomen and some on the extremities; no indura-
tion noticed about their bases, or other evidence of inflammatory
action ; face somewhat swollen. He was directed to take Seidlitz
powders. After catharsis he was much relieved from suffering,
so that, on the following day, he was able to give to his employ-
er's business the necessary attention.

The first appearance of the eruption, he stated, was in the night,
and as I saw it, and that was purely vesicular the vesicles pretty
constantly being round, about the size already mentioned, and
filled, apparently to their utmost, with a limpid fluid, which, in
twenty-four or thirty-six hours, became opaque, of a dirty-cream
eolor; in three or four days more they had dried into brown
crusts, and in two or three da}rs more they dropped off, leaving
the skin, as far as the eye could detect, as unaltered as if they had

268 Howard's Cases of Varicella Lymphatica. [May,

never been. Mr. J. has been vaccinated. His immediate family
consists of a wife and child ; there are two or three negroes about
the house. No other case of varicella in the family, except the
child, an infant near eighteen months old for whom I prescribed
a little magnesia, on the 21st ; but the eruption had appeared some
days before, and, perhaps, not the fortieth part as copiously as
upon the father.

On the 7th February, the writer was called to the same planta-
tion to see John, a negro man about twenty -four years old, who
had one week previously been discharged as convalescent from
an attack of pneumonia. Found John with fever, but somewhat
disposed to sweat ; headache ; pains in the back and limbs ; face
and hands a little swollen ; no symptoms specially indicating a
return of pneumonia. He thought he had been steadily improv-
ing until, a few hours before the visit, he had a chill, followed by
fever. Prescription: Quinine and ipecac.

8th. This morning John has the most abundant crop of vesicles
I ever saw. " The body has" (exactly) "the appearance of hav-
ing been exposed to a momentary shower of boiling water, each
drop of which has occasioned a minute blister." Of the parts ex-
amined, these vesicles were most numerous on the face, head and
breast. I think they came out more successively in this case than
in the other, and, certainly, when the most of them had fallen off,
a few were left that I judged not to be more than four or five days
old. The further description given of their maturity, dessication,
&c, in the other case, is sufficiently near correct for this. Of both
it may be said, that there were occasionally vesicles that were
flattened on top, if not actually depressed in the centre. John
had been vaccinated. In the house where he was there were six
beds ; four in the room he was in, and two in the adjoining room,
and the only passway into the latter room was through the for-
mer. These beds negroes slept in every night; and, indeed, day
and night his brother, a younger man, convalescing from pneu-
monia, occupied a bed in six or eight feet of him : besides, several
children were every morning taken to the room he was in, to be
taken care of during the day, by his mother, an old woman. The
number of negroes on the plantation is about seventy, and they
passed and repassed as usual no hint having ever been given out
by myself that the disease might possibly be small-pox. The
weather was cold during much of the time, the doors therefore
were usually closed. It may be proper to state, that the negro

1855.] Howard's Cases of Varicella Lymphatica, 269

man, as well as the overseer, sometime before the eruption, com-
plained of sore-throat, which is not only common at this time on
this plantation, but elsewhere in the neighbourhood. I am very
sorry I did not innoculate some of the little negroes, but so it is.

These cases are interesting because of their infrequency, and
the question of diagnosis involved.

Of their infrequency, it is stated by Watson, "West, Evanson
and Maunsell and others, that the disease is almost peculiar to
infants ; rarely occurring in adults. Indeed, Dr. Gregory, in the
third edition of his practice, says, "lam not aware that vari-
cella in this its vesicular or genuine form has ever been met with
in adult persons. It would appear as if the delicate cuticle of in-
fantile life was indispensable to its development." But Dr. Wat-
son says, "Willan has however described one unambiguous ex-
ample of it in a gentleman thirty years old ; and another genuine
instance of it was seen by Dr. Gregory at the Small-pox Hospital
in the person of an adult female." These are the only cases I
have ever seen, nor have I ever seen variola or varioloid. The
question of diagnosis, however, was presented, and was certainly
a very important one, as well to the physician as to the ne-
groes on the place, their owner and the community at large;
and had there been any small-pox in the country, I confess, I
would probably have felt more anxiety on the subject, or should
if such cases were to present themselves again. I say the question
as it was, was a highly interesting one; for if the disease was
varicella lymphatica, as diagnosticated, then it was a very mild
disease, and nothing was to be apprehended from it ; and the
physician might not have been sustained in the public mind had
he had the cases removed to an out-house, and, in even an un-
certainty of the matter, thrown the plantation, and, indeed, the
whole community, into a panic, with a report that it might be
small-pox. But, on the other hand, had the cases turned out to
be varioloid, and the disease extended, as it had every opportuni-
ty (save innoculation) of doing, the censures of a suffering com-
munity, doubtless, would have been unsparing.

As I desire to be brief in these remarks, it will be taken for
granted that those persons who may feel any particular interest in
the subject, either have or will inquire into the means of distin-
guishing variola and varioloid, from varicella ; and as I desire to
discuss the question somewhat, shall proceed to notice the princi-
pal points of diagnosis, proposed by such authors as I have the

270 HOWARD'S Cases of Varicella Lympliatica. [May,

means of consulting. One remark, however, first, and it is this:
the evidence that has been adduced in the discussion of this long
and still unsettled question leads me to the conclusion, that vario-
loid and varicella do not spring from the same poison, "but that
there is a separate disease called chicken-pox," (varicella lympliati-
ca,) " which springs from a specific poison ;" otherwise, the ques-
tion of diagnosis is only one of words.

It is stated, that "the symptoms are milder in varicella than in
varioloid," but the latter is represented as being a very mild dis-
ease, usually, and sometimes remarkably so ; so that the difference
in this respect, it is submitted, probably would not be apprecia-
ble. Again: " the eruption is more irregular as to the time of its
coming out, as to its formation, and as to its continuance." But
the two cases here reported went to bed at night without any per-
ceptible eruption, and arose in the morning, I am safe in saying,
with many hundreds, if not thousands, of vesicles, that increased
in size very little, if at all. Again: "the vesicle is not so well
defined ;" but, I cannot conceive it possible that a vesicle could
be better defined than hundreds, nay, all in these two cases were.
Again : "it has not the central depression." True, the vesicles in
neither of these two cases had any central depression as the rait,
but occasionally one might be found ilattened on top, and even
somewhat depressed. Dr. Armstrong, after pointing out nine
points of distinction between variola and varicella, says, "yet one
only is to be relied on, which is the presence or absence of the
central depression." To apply this rule rigidly, I should still feel
somewhat doubtful as to the diagnosis of my two cases. J3ut this
central depression is certainly not wholly unimportant. What
is the cause of these depressions in the purely vesicular disease, and
in the pustular? Not the same, I apprehend, in each. In the
vesicular disease, the vesicles are filled to their utmost, and there
is no depression ordinarily ; but if they be partially emptied, as
by absorption, for instance, then the unsupported cuticle may fall,
and as their apices would probably be less supported than other
parts, so, they might be flattened or depressed; or, any accidental
modification of the cuticle in the centre of the vesicle might pre-
vent its rising, only to a limited degree, and thus an occasional
depression exist.

But what is the cause of the depression in the pustular disease?
May it not be owing to the diseased action first occurring in the
" small red point observed on the skin at the commencement of

1855.] AtfES, 07i Phosphorus. 271

the eruption ?" In the common boils tbis central depression may
sometimes be observed : and, doubtless, it would be seen much
oftener, if more frequent!}- their apices were surrounded by vesi-
cation. Is this not so with the pustules in the vaccine disease
viz: their centres depressed by this early action of the disease on
the cuticle, confining it to a certain extent? I suppose, then, that
in variola the detachment of the cuticle at the centre of the pustule,
from like cause, is not so complete as elsewhere, and hence the
depression. Now, if this be an approach to the fact, this central
depression is of no consequence, other than as it helps us to deter-
mine whether we have a pustular disease or a purely vesicular one.
Again: "The eruption is vesicular from the beginning, or at
least from the early part of the first day ; not papular, as vesicular
variola always is at first." If the statement last quoted be correct,
I am brought to this conclusion, viz : that small-pox, in all its
forms, is either a pustular or, at least, a papular disease (the pus-
tulation aborting in the vesicular form); while varicella lymphati-
ca, or chicken-pox. is a purely vesicular one. The diagnosis,
therefore, ought to, and will turn upon the question is the dis-
ease purely vesicular? But if variola or varioloid be sometimes
purely vesicular, or varicella sometimes pustular or papular, then
I am quite sure, that, if these diseases were often to come under
my observation, I should continually be at a loss to determine
from any means of diagnosis proposed, (save innoculation,) whe-
ther the disease be the one or the other.

A Reply to Dr. Bolinfs Experiments with Phosphorus, and his re-
marks upon its dose and action when given in the form of Alcoholic
solution or tincture. By S. Ames, M. D., of Montgomery, Ala-
bama. (Abridged, by the author, from the Nov. Xo. of the
New Orleans Medical and Surgical Journal, 1854.)

[Concluded from page 412, Art. ix.]

The sedative action of phosphorus in health is one question ;
its sedative action in certain forms of disease is another question.
"Whether it is sedative in its action on persons in health I do not
certainly know, and as I have expressed no opinion about it here-
tofore, so neither do I intend to express one now.

A question is raised by Dr. Boling, relative to the proper size
of the medicinal dose of phosphorus, which, being incidentally

272 Ames, on Phosphorus. [May,

connected with its sedative action as a therapeutic agent, may be
more properly discussed here than elsewhere. This question, im-
plied rather than directly expressed, is as to the possible efficacy
of this medicine in the doses recommended by me in the treatment
of pneumonia. The implication is, that given in doses so minute
as they were estimated to be by Dr. Boling, there must have been
some mistake in attributing any efficacy to them ; especially when
it was shown that it could be given in a dose many hundred times
greater to a person in health, without any appreciable effect of
any kind. This last fact, which is dwelt on with some emphasis,
is exhibited in the experiment on Sam, 10th of March, in which
he took at one time nine hundred and ten drops of a diluted
tincture, which held in solution about one-tenth of a grain of
phosphorus. "Here," says Dr. Boling, " a child, seven years old,
took at a single dose, one thousand eight hundred and twenty
(1820) of Dr. Ames' doses for an adult."

The phraseology here is somewhat peculiar ; it is not said that
the child took one-tenth of a grain at one dose, but eighteen hun-
dred and twenty of Dr. Ames' doses ; so that the objection would
seem to be founded more on the relative quantity that could be
given without effect than to the absolute size of the dose. This
supposition is confirmed by a subsequent remark : " Yet not only
did my subjects take it in doses so immeasurably greater than the
doses with which such effects are said by Dr. Ames to have been
produced by it," &c. Now, if such is the meaning, this instance
is not the best that could have been selected for the contrast. A
still stronger one could have been found in the record of cases,
hereafter to be noticed, in which three, six, and even twelve grains
of phosphorus have been given at a dose, with no more sensible
effect than Dr. Boling witnessed from his dose of a tenth of a grain.

Dr. Boling's estimate of the dose is as follows : " In a vial con-
taining an ounce of anhydrous alcohol, I placed four grains of
phosphorus, in another two grains, and in another one grain. At
the end of fourteen days, the time usually necessary for the pre-
paration of tinctures by maceration, the time recommended by a
majority of the pharmacopoeias of the four grains, about one-
fourth or less was dissolved ; of the two grains, about one-half or
less ; and of the single there remained a portion undissolved. It
is fair, I think, then, to say that the saturated alcoholic tincture,
instead of containing four grains to the ounce, contains in reality
but about one grain to the ounce. It may possibly be a little

1855.] Ames, on Phosphorus. 27 '3

more ; it would seem as likely to be a little less." Proceeding on
this assumption, the dose is estimated to be about one sixteen
thousandth part of a grain, a quantity as he remarks, almost in-
conceivably small. Let us see how nearly correct this estimate is.

Seeing that there was one obvious source of fallacy in Dr. Bo-
ling's experiments to ascertain the quantity of phosphorus that
alcohol will dissolve, I requested and obtained the favor of Mr.
Williams, principal assistant in the drug store of Messrs. B. S.
Theiss & Co., a gentleman remarkable for the care and accuracy of
his pharmaceutical manipulations, to institute some experiments,
of which the following is an account :

1 Twenty grains of phosphorus were put into an ounce by
measure of alcohol not anhydrous, sp. grav. 812 (at 70 deg. Fahren-
heit) and allowed to digest nearly twelve days. The phosphorus
was then removed from the vial and weighed. The loss was found
to be three grains. A small part was wasted in transferring the
powder to the scales, which Mr. Williams estimated at about one-
eighth of a grain.

2 Two grains were put into a measured ounce of anhydrous
alcohol (sp. grav. 794 at 60 deg. Fahrenheit) on the 9th of June.
This was all taken up in eleven days.

3 Four grains were put into an ounce of alcohol (sp. grav. as
in the preceding experiment) on the 9th of June. Twenty-one
days afterwards there remained undissolved, according to the esti-
mate of Mr. Williams and others, not more than a quarter of a
grain.

4 Thirty grains were put into a measured ounce of alcohol
(sp. grav. as above) on the 13th of June. Twenty days after,
namely, on the 2d of July, the remainder was carefully removed
from the vial and weighed. The loss was found to be five grains.
There was no perceptible waste in this experiment.

5 Twenty grains were put into a measured ounce of alcohol
(sp. grav. as above) on the 18th of June. On the 2d of July, the
remainder having been carefully transferred from the vial to the
scales, weighed thirteen and seven-eighth grains. The loss, con-
sequently was six and one-eighth grains. There was no percep-
tible waste in this experiment.

The difference in the quantity taken up in the two last experi-
ments, is to be attributed, no doubt, to the circumstance that the
phosphorus used in the last, was more minutely divided. It is
probable that neither solution was a saturated one, the time em-

27-i Ames, on Phosphorus. [May,

ployed being too short to complete it. The pharmacopoeias re-
commend the digestion in either to be continued four weeks ; but
I am satisfied that a solution in alcohol, to be saturated, requires
a much longer time.

The solution or tincture that I first employed medicinally, on
the visible effects of which my opinion of its medicinal action was
founded, was made with all necessary care, to secure a saturated so-
lution of pure phosphorus in absolute alcohol. Both the phosphorus
and alcohol were tested for this purpose. It was allowed to digest
more than four weeks before any part of it was diluted for use ; but
only a small part being used at a time for this purpose, the digestion
of the remainder was continued much longer. Now, if we suppose
the solution made in this way was equivalent in strength to that
obtained by Mr. Williams, after only three weeks digestion, about
which I think there cannot be a reasonable doubt, it must have
contained at least six grains to the ounce, and the diluted tincture
six-tenths of a grain, instead of one-tenth, as estimated by Dr.
Boling ; and, consequently, that the dose recommended by me,
was at least six times larger than his estimate of it.

Still the doss remains a very minute one, so much so that physi-
cians who are in the habit of measuring the curative power of a
remedy, chiefly by its quantity, might find a difficulty in according
any efficacy to one so small as this. The objection to it on this
account occasions no surprise when made by those who have
neither employed the drug medicinally, nor become acquainted
with the peculiar activity of its physiological manifestations, in a
much more minute quantity than is contained in the dose recom-
mended for instance: if eight drops of this diluted tincture (one
grain to ten ounces) be mixed with one drachm, or one hundred
drops of water, a single drop of this mixture, which contains but
the one-hundred thousandth part of a grain, has a taste and smell
of phosphorus strong enough to be easily recognised by those who
are familiar with its sensible qualities.

But if four drops of a diluted tincture containing six-tenths of
a grain to the ounce, which I suppose is the strength of that re-
commended by me, be put into an ounce of water, a teaspoonful
of this mixture, which contains about the twenty-six hundredth
part of a grain, has a taste and smell of phosphorus strong enough
to be disagreeable to most persons; and half a drop of this tinc-
ture, that is, a drop of tincture of half the strength, will give off a
luminous flash if dropped into water in a dark place.

1855.] Ames, on Phosphorus. 275

The inference from these facts is obvious, but still like the op-
posing objection, is merely hypothetical, and the question still
remains unsettled. AVc cannot decide between two opposing
hypothesis neither of which establishes anything more than a pro-
bability. One may answer very well to effect the other, but
neither proves anything unless it be that the other is not true.
Something more then is required on the one side or the other ; and
this is the test of direct observation.

After all, therefore, that may or can be said in arguments of
this kind relating to subjects of physical inquiry, the matter has
always to be brought for settlement to this arbitrament at last.
And consequently the only efficient, perhaps the only proper re-
ply to the h}-pothetical objection under review, as applied to the
doses recommended and employed by me and others, isr that the
point in question had already been tested over and over again by
the actual experience of competent observers; not for a brief peri-
od by a single individual on a few subjects or in the same place ;
but for a series of years, and by a number of physicians, and in a
considerable number of subjects some of them being in places
widely separated from the others ; all tending to give an assurance
as strong as is usually obtained in regard to new remedies or to
old ones introduced under new auspices, that phosphorus in the
doses recommended by me, varied no doubt, by others, and by an
occasional want of proper care in the preparation of the tincture;
but whether in doses larger or smaller, has exhibited medicinal
qualities of the highest value in inflammatory affections of the
lungs, but particularly in pneumonia as they appear in this cli-
mate. Before publishing the results of my own experience with
this remedy, I consulted several physicians as to whether their ex-
perience of its efficacy generally accorded with mine, but especially
as to its sedative action in pneumonia, and found there was no
decrepancy of opinion as regards cither. Some were consulted
verbally, others by letter. Among the answers to the letters there
is one which so well expresses the uniform opinion of those who
have had much experience with it, that I will take the liberty to
extract a portion of it, though I have not asked permission to do
so. The letter was written by physicians associated in practice,
which will account for the recurrence of the plural opinion, and
was dated May, 1853. After saying that "no death from pneu-
monia has occurred in our practice since we adopted this treat-
ment," they add, " as regards the effects of phosphorus in such

276 Ames, on Phosphorus. [May,

doses as recommended in your treatment, so far as our experience
goes, it fully concurs with your own. In almost every case in
which we have administered it, there has been a uniform and
steady diminution of the frequency of the pulse with a marked
quietude of the whole system. At first we were disposed to at-
tribute this sedative influence to the aconite and quinine, but on
suspending these and continuing the phosphorus, we found the
same condition of things continued ; and in no single instance have
we found the pulse increased in frequency, or nervous excitement
produced by the proper administration of this remedy." Among
the other physicians of my acquaintance, some thirteen or four-
teen in all, who have treated this disease by means, partly or
chiefly, of this remedy in similar doses, I believe there is none,
whose experience of its efficacy might not be properly expressed
in the words of the latter paragraph of this letter ; nor do I think
there is one who entertains any more doubt about its curative
power in the doses spoken of, than he does of the curative power
of any other remedy that he may have employed in this disease.
I ought not to omit, in this connection, a reference to the recorded
statistics of the results of the treatment of pneumonia by this as
one of the chief remedies, in which the mortality is found in sixty-
eight consecutive cases, occurring in the course of a little over four
years, reduced to less than three per centum, including one case
in which the patient evidently died of a brain affection, which
complicated the attack from the beginning. The result of the
treatment has been the same or even more favorable, as I have
been informed, in the practice of other physicians.*

2 The second conclusion of Dr. Boling from his experiments,
in the order I have adopted, namely, that phosphorus is not a

* I do not wish to be understood to give an undue importance to this remedy, or
to attribute to it alone the favorable results of the treatment of pneumonia with this
and other remedies; I believe that aconite is equally valuable, and that quinine is
frequently indispensable, while opium and blisters are valuable adjuncts, and tend
very much to secure a favorable result. What I mean to say is that, in the treat-
ment of pneumonia in this climate, it deserves to rank as a leading remedy, and one
more valuable than any other single remedy I have used except aconite. Nor dn I
by any means intend in what I have said in defence of the dose I have been in the
habit of using, to intimate that there is any specific dose which is peculiarly effica-
cious. What I mean to say is that in my opinion, formed after much experience
with larger doses, this is large enough for ordinary purposes in the treatment of
pneumonia, while it is not too large to be perfectly safe. I have to-day, however,
conversed with a physician who doubts the propriety of giving it even in this dose
in cases where there is a gastric complication.

1855.] Ames, on Phosphorus. 277

stimulant, I pass over with a single remark, that my observation
of effects in disease had led me to the same conclusion, as regards
its medicinal action.

3 We come now to the third and last conclusion, from these
experiments, viz : that phosphorus is not poisonous when given
in an alcoholic solution.

This conclusion is derived from several experiments, in which
doses of this medicine, dissolved in alcohol, of various sizes, were
given to the two principal subjects, and were taken by himself.
To Sam, the largest dose given was nine hundred and ten drops
of a tincture, containing less than a tenth of a grain to the ounce ;
the quantity of the tincture given being about one ounce, the dose
was about the tenth of a grain. The largest dose given to other
subjects was two hundred drops of a tincture, containing less than
a grain to the ounce, or about the fourth of a grain. Dr. Boling
took, himself, five drops of this tincture, three times daily ; allow-
ing eight hundred drops to the ounce, each of these doses con-
tained about the one-hundred-and-sixth of a grain. As it is not
material whether these doses are estimated with entire accuracy,
we may leave out of consideration the probable waste in dropping
them out, by the convertion of a part of the phosphorus into
hypo-phosphoric acid, which probably escaped in the form of
vapor, or may have been taken in the place of phosphorus proper.

In reference to the dose of two hundred drops, or one-fourth of
a grain, given to the adult subject, we find the following comment :
u How much further the dose might be augmented with safety,
and without appreciable effect, I am at present unprepared to say ;
but reasons, I think, will appear as we proceed, that will render
it not improbable, that the quantity of alcohol, rather than any
suppositious quantity of phosphorus, the preparations, as pre-
scribed and given, may contain, should form the only necessary
limit to the dose."

It is evident from this, as well as in another instance in which
Dr. Boling has expressed a similar confidence in its harmlessness
dissolved in alcohol, that he had not studied either the medical or
toxicological history of phosphorus very thoroughly. Its medical
history shows that it has been given with a like impunity in either,
or almond oil, and in substance in larger doses and for a longer
time than Dr. Boling gave it to either of his subjects or took it
himself; yet its poisonous properties do not seem to have been
questioned on this account. M. Magendie, for example, quotes a

N. 8. VOL. XI. NO. V. 18

278 Ames, on Phosphorus. 0&*?i

number of authorities showing that at one time the common dose
given by physicians was two or three grains, and upwards even
to twelve grains. But this kind of doses could not be continued
long; and we find accordingly, that the false security engendered
by it was sadly dispelled by the homicides, reported or otherwise
committed in its use, or by its dangerous effects in a less degree,
so that it was soon banished from practice. After a time it was
introduced again in smaller doses, but was soon given up again.
It was introduced a third time only to share the same fate ; and it
is curious to observe in tracing out the medical history of this
potent drug, how the doses grew successively smaller and smaller
as the experience of its pernicious effects, in doses still diminish-
ing, was developed in the two last periods. In the first, the dose
was from two to twelve grains. In the second, it was from the
tenth of a grain to a grain, it fell to a twentieth, fortieth, and even
to the one hundredth of a grain.* In all this time the various sized
doses were not only given with impunity but with the highest
commendations of their success, and yet we find it no more able
to maintain its place in medical practice in the smaller than in the
larger doses. The dose had been reduced from six to twelve hun-
dred times, and was still so much too large that physicians were
compelled to stop prescribing it. Hence the impunity with which
it may be given at times in certain doses, so far from being held
as proof that it may always be given with impunity in the same
or smaller doses, is rather looked to as a warning against trusting
a poison so subtile and treacherous at all ; or at least, in any dose
that had been employed even to the one hundredth of a grain.

What is thus known to be true of phosphorus in any other
mode of giving it may be, and I have no doubt is, true of its solu-
tion in alcohol ; nor does it seem to me that the \ery few experi-
ments of Dr. Boling tend at all to invalidate such a conclusion ;
for it is evident enough, even from the preceding brief abstract of
its history that if they had b3en made with phosphorus in any of
the modes of prescribing it heretofore in use, the results might
have been just the same as they were when made with an alcoholic
solution.

There remains to be said a few words about Dr. Boling's experi-
ments on himself. I copy the greater part of the paragraph con-
taining his comment on them, and the conclusion they led to, as

* From two to five or len drops of a solution in cither or almond oil containing
four grains to the ounce. This it> the officinal preparation oi' thy French codes.

1855.] Ames, on Phosphorus. 279

the best mode of presenting both fully and fairly before the reader.
He says :

11 In connection with this experimental practice on myself, I
will again call attention to the views of Dr. Ames, in regard to
the effects of phosphorus in his doses. Thus, he says, that it cannot
be continued in the smallest quantity mentioned, half a drop, for
any great length of time, without inducing considerable distur-
bance of the stomach, shown by nausea or vomiting, burning heat,
and a feeling of oppression at the epigastrium. Though he admits,
that in a quantity of two drops, a single dose, or perhaps a few
doses, may be given with impunity, yet he would evidently regard
a lengthened use of it, in such a dose, as a very serious matter, and
tells us of one instance in which dangerous effects resulted from
the administration of three doses of two drops each, at intervals of
twenty -four hours. It is most desirable that we should yet be able
to discover and explain the cause of these discrepancies. While Dr.
Ames tells us that doses of half a drop cannot be continued for
any great length of time, without the most serious results, I have
myself taken it in doses of five drops, just ten times the quantity,
a long time, and for eight days, without omission of a single dose,
without effect. While under his observation, for a cumulative ac-
tion, dangerous effects resulted from three doses, of two drops
each, administered at intervals of twenty-four hours, being in all
six drops taken in the course of three days, yet I have taken for
eight successive days, three doses of five drops each, or fifteen
drops per day without effect. Indeed, unless I should discover
something in its action which has never been manifested in any
of my experiments, from my own experience with the article, and
from all the lights at present before me, I should not hesitate, were
it not merely for the trouble of the thing, to continue it in the
same manner for years."

These emphatic antithesis are continued in the succeeding para-
graph, which I also copy.

" In the healthy subject, at least, any effect of the article result-
suiting in nausea and vomiting, could be easily appreciated, and
not readily mistaken ; yet, not only did the subjects of my experi-
ments take it in doses as mentioned, so immeasurably greater than
the doses with which such effects are said by Dr. Ames to have
been produced by it, but they took it under circumstances that
were well calculated to form the production of such an operation.
Thus, while they sometimes took it in the intervals between the
meals, they also took it at times immediately before eating, and at
others immediately after eating. On several occasions, I myself,
having forgotten my dose, which I usually took just before eating,
until I had partly finished my meal, have called for my phial,
taken the dose and proceeded with my meal without disrelish, or
any subsequent manifest effect"

280 Ames, on Phosphorus, [^"aj,

We shall find, I believe, no greater difficulty in discovering
and pointing out the cause of these discrepances, which Dr. Boling
thinks is most desirable, than was found in discovering the dis-
crepancies themselves. The first step in this process is to point
out some errors in these extracts which in themselves go a good
way towards effecting this desideratum.

The first error that I shall mention is, that what I said of two
drop doses is applied, inadvertently of course, to the half drop
doses. The latter is spoken of by me only as liable to produce
considerable disturbance of the stomach when long continued ;
while the former are said, in effect, to be unsafe in Hie treatment
of pneumonia, if continued for any great length of time. The
" most serious consequence,"" therefore, should properly refer to
the effects of the larger doses only.

Another error arises from a wrong construction of the following
passage : u Its effects are cumulative \ that is to say, a dose which
singly is not large enough to produce any sensible effect may be-
come very troublesome or dangerous after several repetitions at
intervals of three or four hours. This quality was developed in one
instance by separating it in a dose of two drops of the strong alco-
holic solution three times at intervals of twenty-four hours." Dr
Boling construes this to mean that dangerous effects resulted from
the three dose3 given at intervals of twenty -four hours ; but the
reader will see that the troublesome or dangerous effects refer only
to the dose repeated every three or four hours, and that the cumu-
lative quality alone is referred to in speaking of its repetition
once a day,

A third error, the source of which is in part explained in the
two preceding paragraphs, is in the comparative estimate of the
quantity of phosphorus taken by Dr. Boling and that given to
my patients, to which the danger of serious consequences was
ascribed, if continued any great length of time. Dr. Boling took
five drops of a tincture containing less than one grain to the ounce
three times a day, supposing it to be a full grain, each dose was
about the one hundred and sixtieth part of a grain j my patients
took two drops of a tincture which, as we have seen, contained at
least six grains to the ounce ; each dose, therefore, allowing as in
the other case, eight hundred drops to an ounce, was about the
sixty -seventh part of a grain, given every three or four hours,
more than double the quantity of the other, and repeated twice as
often. The doses taken by Dr. Boling, therefore, instead of being

1855.] Ames, on Phosphorus. 281

ten times greater, were less than half the size, or more than twenty
times less than the estimate. The aggregate taken by him in twen-
ty-four hours was about the fifty-third part of a grain ; the daily
aggregate given to my patients was from the eighth to the eleventh
of a grain ; that is, nearly from five to seven times greater. The
half drop doses, to which danger of exciting considerable distur-
bance of the stomach was ascribed by me, if continued long, being
of the same tincture, contained, of course, one-fourth the quantity
of phosphorus in the two drop doses, or the two hundred and
sixty-eighth part of a grain ; each of these doses, therefore, is some-
what more than half (as one to one and two-thirds) the size of each
of the doses taken by Dr. Boling, and their daily aggregate in
twenty-four hours, compared with that of Dr. Boling:s doses, is
larger by from a fourth to a third. The largest quantity given to
either of his subjects in one day was two hundred and seventy- two
drops of a tincture having less than a grain to the ounce, or about
the third of a grain of phosphorus. The daily aggregate of the
half drop doses given to my patients, if repeated every four hours,
is about the forty-fifth part of a grain : so that the difference in-
stead of being " so immeasurably " great as supposed by Dr. Bo-
ling, is only as one-third of a grain is to the forty-fifth of a grain ;
and the measure of the difference is almost exactly as fifteen to
one.

But these are minor matters. By far the most important source
of these discrepancies is in the different circumstances in which
the medicine was taken by Dr. Boling and given by me. Dr.
Boling took it in health ; I gave it in disease ; an essential differ-
ence, which in the inception and progress of these experiments
seems to have been entirely overlooked. It must be remembered
that in all I had said of the effects of phosphorus, in the part re-
ferred to by him, I spoke of its effects in the treatment of pneu-
monia only. There is, in fact, with us a peculiar and decided
tendency in this disease to take on gastric or gastro- enteric inflam-
mation from even mild irritants. In this condition, phosphorus,
an irritant poison, whose action as such is always directed especial-
ly to these organs, is much more likely to show its poisonous
effects than in a healthy condition of these organs. Here, then,
was an empty and irritable stomach, prone to take on inflamma-
tion from slight causes, to invite a development of the poisonous
action of phosphorus. On the other hand, Dr. Boling took the
medicine in health and at his meals. The importance of this last

282 Ames, on Phosphorus. pJaj;

circumstance as regards its probable influence over the action of
the medicine is shown by the fact that some authors recommend
it to be taken only on a full stomach, for the purpose of avoiding
its poisonous effects. It is equally true of other irritant poisons, that
a full stomach renders them less active as poisons, cceteris paribus.
Dr. Boling, it is true, did not take his doses, literally, on a full
stomach, but taking a dose just before eating is, practically, or so
far as concerns the irritant action of a poison whose action is slow
in developing itself, the same thing as taking it during or imme-
diately after a meal. Now this was not the only time at which
Dr. Boling took doses of the one hundred and sixtieth part of a
grain, but the time also when he gave to one of his subjects the
largest dose that either of them took, namely, a quarter of a grain.
The influence of health, exercise and the regular meals, in modify-
ing its effects, I have frequently witnessed. In the experiments
made on myself, in whom nearly all such influences were absent,
each dose of three drops of a saturated solution gave rise to dis-
agreeable and soon painful effects on the stomach, as I have seen
it do in smaller doses in the treatment of pneumonia ; the effects
on myself were severe enough to prevent me from carrying the
investigation, as I intended to do, any further than the three ex-
periments mentioned. Nevertheless, I have often prescribed it in
doses of one and two drops in chronic affections of the bladder or
urethra, and in seminal weakness, twice or three times a day when
the patient took his usual meals, and attended to his ordinary bu-
siness, without any such effects, though continued many days. If,
therefore, Dr. Boling took the medicine, as seems to have been the
case, in a condition of the stomach unfavorable to the development
of its local action on this organ, and my patients took it in cir-
cumstances the most favorable for the development of such an
action, we may find in this difference alone a sufficient explana-
tion of the difference in its effects, even if the doses had been
equal.

But, leaving these minute, and probably to the reader, tedious
details, let us sum up, in a general view, the principle sources of
the discrepancies between Dr. Boling's experience and mine; sepa-
rating the apparent from the real. If I have written with suffi-
cient perspicuity, it has been seen in the progress of this paper,
that all the discrepancies are included in, first: the different cir-
cumstances in which the facts have been observed on either side ;
secondly; in the difference between facts observed on one side, and

1S55.] Ames, on Phosphorus. 2 S3

inferred on the other ; in other words, between facts of experience,
and facts obtained by a priori reasoning.

In the first, the discrepancy is apparent, not real, even if wc
admit that the experiments gave accurate results. It may be true,
under this administration, as I have said before, and I think, shown,
that phosphorus does not act as a sadative on healthy persons;
but does so act in certain forms of disease. The difference in the
circumstances, health on the one hand, and disease on the other,
in which the experience was obtained, might alone make all the
difference apparent in its effects. So, too, as regards the poisonous
action of this remedy in certain doses, its eccentricity, and other
circumstances connected with the condition of the subject to whom
it was given, may very well account for the difference in its effects.
So far, then, there is no real discrepancy; a difference in the facts
there is, because both were not looking at the same thing exactly ;
but there is no clashing and incongruity, as might be supposed on
a superiicial view of the matter. Either set of facts might be true,
without in any respect impeaching the integrity of the other.

Not so, however, as regards the second. Here, the difference is
not between facts observed on either side ; but between experi-
mental facts on one side, and a priori inferences on the other.
TVhen Dr. Boling concluded from his experiments, that phospho-
rus dissolved in alcohol neither acts as a sedative nor as a poison,
in certain doses in disease, he overstepped the bounds of legiti-
mate induction, and the real discrepancies began to appear. The
utmost limits to which the experiments permitted him to go, is, that
phosphorus is neither sedative nor poisonous, in the doses in Avhich
he gave it to persons in health. There was no legitimate warrant
for the supposition that it does not so act in certain forms of dis-
ease. Dr. Boling saw correctly, in the circumstances in which he
placed himself; but reasoned incorrectly from what he saw. His
reasoning brought him to conclusions directly opposed to the ex-
perience of others ; and, curiously enough, he supposed that the
former are more reliable in proof of the matters in question than
the latter; and affirms in effect, that the naked inferences shown
of an attempt, even at verification, ai'ethe true facts; and the di-
rect observations of others, made in the very circumstances about
which he reasoned, but did not observe, are the false ones. Here
then, is a real and irreconcilable discrepancy, not, however, diffi-
cult of explanation. The truth is, as we have just seen, Dr. Boling
explored one field of inquiry, and I another ; and seeing nothing

284 New Treatment of Gonorrhoea! Ophthalmia. [May,

where he was, concluded there was nothing to be seen where I was.
He did not come over into my field in order to see with his own
eyes on the spot, but chose rather to look from afar off, and through
an a priori telescope, which hardly ever permits anything to be
seen as it really is. Looking thus from his position, he thought
he saw what was going on where I was better than I did on the
spot ; but in the nature of things this was impossible ; and with
the chances so largely against his seeing right, through this medi-
um, it is no impeachment of the natural accuracy of his vision to
suppose that he saw wrong.

The facts obtained in these different modes are incompatible ;
on one or the other side they must be wrong. The reader, who
has now seen both sides of the argument, must determine the mat-
ter for himself. But if still in doubt as to which are the true and
which the false, and the subject is of sufficient interest to induce
him to take the trouble, let him bring the questions at issue to the
arbitrament of his own direct observations in the circumstances,
in which, only, the sedative and curative, or the poisonous action
of phosphorus in certain doses has been affirmed by me.

TRANSLATIONS AND CONDENSATIONS FROM FRENCH JOURNALS.

New Treatment for Gonorrhoea! Ophthalmia. By M. CHASSAIGNAC,
Surgeon to the Hospital of " La Biboisiere.

Gonorrhoea! ophthalmia may be communicated by having the
muco-pus of gonorrhoea of another person applied to the eyes ; so
that a person suffering from this disease of the eyes is not necessa-
rily obliged to have, or to have had, gonorrhoea.

Observation has shown, beyond doubt, that men suffer more
frequently from this affection than women, because man handles
his organs of generation much more frequently than woman does
hers.

It appears that the majority of the cases of this affection of the
eyes originate by contagion. All that has been advanced in sup-
port of gonorrhoeal ophthalmia, occurring by metastasis or sympa-
thy, is purely hypothetical. These are questions yet to be studied.
We do not say that the disease may not occur in any other way
than by direct contagion, but the manner in which it might occur
is yet involved in darkness.

The disease seems to begin, in almost all cases, very soon after

1855.] New Treatment of Gonorrhoea! Ophthalmia. 285

the application of the poison. Lancinating pains which are sud-
denly felt in the eye or forehead, are sometimes the first symptoms
which attract the attention of the patient. At other times the
disease is only noticed by the great injection of the conjunctiva.
"When the symptoms come on with moderate rapidity, it is in the
following order : Considerable itching at night, or a sensation as
if some foreign body were between the eyelids and globe ; in the
morning the edges of the eyelids are agglutinated by mucus ; ex-
ternal tumefaction of the eyelids ; injection of their inner surfaces ;
the semi-lunar membrane and caruncula lacrymalis much larger
and redder than usual. W^hen the disease becomes established,
the redness of the mucous membrane is of an intensity observed
in no other ophthalmia. It is of the most vivid scarlet. The com
junctival swelling is at its maximum. Chemosis is very marked.
The tumefaction of the eyelid is characteristic, and cannot be
mistaken when once seen. The fluid secreted by the palpebral
conjunctiva is at first mucus, then puriform, becoming rapidly
yellowish, thick and extremely abundant, irritating the skin of
the cheek. Photophobia is rarely absent, but ceases very soon :
its sudden disappearance is regarded as an unfavorable symptom,
because it is presumable that an effusion has taken place within
the eye, thus modifying the sensibility of the retina.

Among the general symptoms may be mentioned, great agita-
tion, wakefulness, sometimes delirium, stupor, fullness and accel-
eration of the pulse, tongue coated.

A distinctive characteristic of gonorrhceal ophthalmia is the
rapidity of its progress six hours being, in some instances, suffi-
cient to destroy the eye ; at other times ten days elapsed before
the organ was lost.

Gonorrhceal ophthalmia may commence very mildly, and con-
tinue so for several days, then suddenly attain its maximum of
intensity, when the eye is inevitably lost. Sometimes the inflam-
mation goes on very slowly and favorably in one eye- even dis-
appears without doing any injury ; then breaks out suddenly in
the other eye and destroys it. The disease terminates, most gen-
erally, in purulent discharge. Ordinarily, only one eye is lost.
It empties itself in several ways. Frequently the cornea is
destroyed by ulceration of its circumference at the points covered
by the swollen conjunctiva. There is then a hernia of the iris at
one or more points. After this accident the cornea appears small
and flattened, the central portion remaining tolerably clear for

2SG New Treatment of Gonorrhoea! Ophthalmia. [^}",

some time; but vision is lost. In other instances, the inflamma-
tion extends over a large surface of the conjunctiva, resulting,
finally, in staphyloma. It has been seen to terminate in hypopy-
um, amaurosis, cataract, ectropium or falling of the iris.

Gonorrhceal ophthalmia is a very grave affection, when it is not
effectually opposed at its onset. In fourteen cases reported by
Lawrence, there was loss of vision in nine ; vision was preserved
in the others, but with partial opacity of the cornea. In two cases
one eye was lost, the other recovering.

Gonorrhceal inflammation does not run its course as other in-
flammations, nor as other specific affections, sui generis, which,
after having gone through the periods of incubation, development
and decline, terminate within a certain time, but this affection
seems, by incessant reinoculation with its characteristic product to re-
produce, or rather to keep up the disease.

The idea just expressed may be thus illustrated; if it were pos-
sible, by means of continuous ablution, to keep the mucous surfaces
completely protected from the gonorrhceal matter, a cure would be
readily effected. This view of the case is fully sustained by ex-
periments, as well as by practice. If, then, this disease can be
thus kept up by reinoculation, it becomes a matter of importance
to determine at what period the pus ceases to be virulent, and also
how long it.would take for the effects of one inoculation to sub-
side.

As it is, therefore, of practical importance to keep the sur-
face entirely free from the contact of the contagious secretion,
my attention has been directed to means for the accomplishment
of this purpose. These consist in continuous irrigations, kept up
until the disease be eradicated. My opinion is, therefore, that the
best treatment for gonorrhceal ophthalmia is that which I have so
successfully used in vaginitis and in the purulent ophthalmia of
new-born infants, viz., continuous affusions of cold water.

In confirmation of these views, I will append the details of a
case of well-marked gonorrhceal ophthalmia, treated by cold affu-
sions alone, with the addition of ice.

Case. On the 10th August, 1849, I was called to see M. B.,
aged 50, for an affection of the eyes, attended with great pain and
general disturbance. I found both eyes considerably tumefied,
with chemosis, at the centre of which, the cornea could be seen
bright and unaffected; the conjunctiva was covered with a white
purulent matter which also filled the eye-lashes; photophobia not

1855.] New Treatment for Prolapsus of the Rectum. 2S7

very great. He had contracted gonorrhoea a week before, and
had been exposed the day previous to the strong light and heat of
a forge. I ordered affusions of cold water, which were at first well
applied, but the patient soon finding them inconvenient substitu-
ted in their stead wet linen. As he seemed to be no better at
night, I ordered the application of ice. This was kept up with
such occasional affusions as were necessary to carry off the pus.

11th Aug. Decided improvement; but as soon as the ice is
omitted the pain returns.

12th Aug. Condition stationary, with less pain and secretion.
Under this treatment the disease gradually yielded, and had sub-
sided by the 26th of August. It manifested, however, a disposi-
tion to return, which was kept down by the same treatment, until
the 10th September, when the case was discharged as cured, and
without leaving any trace of its existence.

In conclusion, I may remark that, by this plan of treatment a
harmless procedure is substituted for the more violent and hazard-
ous remedies in common use in gonorrhceal ophthalmia. [Rev. de
Thsrap. Medico- Qhir.

[Xote. It is evident that the above plan of treatment would be of
very difficult application in children; and as the plan recommended by
Dr. L. A. Dugas, in the Southern Med. and Surg. Journal for 1837. p. 81,
for the treatment of purulent ophthalmia, and since then used by himself
and the writer with uniform success, is attended with so little trouble, and
relieves so much more rapidly than the above treatment, that we give it,
as it might answer equally as well in gonorrhceal ophthalmia.

The eyes are to be bathed every hour or two with tepid diluted chloride
of soda (5ss. to a quart bottle of water). During sleep, a bit of linen to be
placed over each eye, and kept moist with the same solution. Under this
treatment it rarely requires more than eight days to produce a cure. R.]

New Treatment for Prolapsus of Hie Rectum.

Though this disease is mentioned in most of the ancient works,
it is only at the present time that any just idea can be obtained
concerning it. Morgagni complains that the pathological anatomy
of this affection did not fix the attention of his predecessors, nor
of his contemporaries. Boyer did not have a very clear idea of it,
since he thought it was constantly formed by a prolapsus of the
mucous membrane of the rectum. M. Cruveilhier gave it parti-
cular attention. Dupuytren, Blandin and M. Robert endeavored

288 New Treatment for Prolapsus of the Rectum. [May,

to remedy the disease by a rational operation. Since then, and
but recently, it has engaged the attention of M. Duchaussoy.

By prolapsus of the rectum is sometimes meant only a prolap-
sus of the mucous membrane, either simple or complicated with
hemorrhoidal tumors, or sub-mucous fibrous tumors; at other
times, it is the rectum itself which protrudes with all its mem-
branes: in this case there is a real invagination of the rectum,
passing through the anus. Other affections, such as an invagina-
tion of the colon or of the ccecum passing through the anus, may
resemble prolapsus of the rectum. A careful examination, how-
ever, will make the diagnosis clear. It is not intended to call
attention to these various affections, but to the prolapsus of the
rectum, strictly speaking, or, more properly, to the invagination
of the rectum passing through the anus.

In prolapsus of the rectum the intestine becomes invaginated,
resembling the finger of a glove when partially turned inside out.
A more or less considerable extent of the rectal mucous membrane
is thus placed on the outside, red, injected, presenting transverse
folds ; this mucous membrane has the base of the cone formed by
the intestine, and is continuous with the skin around the margin
of the anus. The summit presents an orifice into which the finger
passes with ease; a slight pressure upon this tumor will cause it
to return witjain the anus with facility. After the reduction is
effected, the patient has no power whatever to contract the sphinc-
ter muscle consequently, walking, lifting, going to stool, &c.; will
cause the intestine to protrude. Pathological anatomy has de-
monstrated to M. Cruveilhier that all the intestinal membranes are
dragged out, and that consequently the peritoneum, which covers
the anterior and lateral portions of the rectum, is also drawn out,
an important fact to be remembered in surgery.

A fact well studied by M. Cruveilhier, and since verified by
M. Demarquay, is the atrophy of the sphincter and levator ani
muscles when the disease has continued a certain time.

A means generally adopted for the relief of children, and which
succeeds well, is cauterization with the red-hot iron. A slight
cauterization, then, at opposite points of the anus, will suffice to
relieve the case. The cure cannot be attributed to inflammation
caused by the cautery, because it may be instantaneous. M. De-
marquay thinks that the cure is clue alone to the cauterization.
Dupuytren's plan is to remove four folds, with curved scissors,
radiating from the anus ; the cicatrization of these wounds reliev-

1855.] Sub-maxillary and Sub-lingual Glands. 289

ing the prolapsus. M. M. Blandin and Kobert removed a triangu-
lar portion from the margin of the anus. Blandin not onty cut
through the mucous membrane, but through the sphincter also.
This operation is not without danger ; it exposes to hemorrhage
and to inflammatory accidents, and if it does reduce the size of
the anus, it does not restore the tone and energy of the sphincter
and levator ani muscles. M. Demarquay's operation which is to
remove a triangular portion of the rectal mucous membrane, if not
easier to perform, is at least more efficacious. This operation also
exposes to hemorrhage, but the inflammatory process does not
extend so deep, and therefore acts more properly upon the muscu-
lar tonicity. The mere removal of this mucous portion does not
cure, but only palliates. The contractility of the sphincter and
levator ani muscles can be restored in children with the red-hot
iron. But when the disease has continued for twenty years, and
when there exists no contractility at all, other means must be em-
ployed. In these cases M. Demarquay employs the gal van o-
puncture, passing the needle through the sphincter and levator
ani every morning for twelve or fifteen days.

The following is the operation as performed by M. Demarquay,
upon a woman 59 years of age, with prolapsus of twenty years
standing : The patient being under the influence of chloroform,
a triangular portion of the rectal mucous membrane, -of considera-
ble extent was removed, the fibrous membrane not being included j
the edges of the wound were drawn together by a few sutures.
After the wound was healed, it was plainly perceptible the sphinc-
ter and levator ani muscles were without action. It was to restore
this lost action that M. Demarquay employed the galvano-punc-
ture. A needle was implanted on each side of the anus every
morning, and a current of electricity passed along them, in this-
manner exciting the muscles to contractility, which was perceived
in a few days by passing the finger into the rectum. The patient
was entirely relieved. [Ibid.

Induration of Sub-maxiUary and Sub-lingual Glands.
We find in the Revue de Therap. Medico- Chirurg., the following
treatment of Induration of the Sub-maxillary and Sub-lingual
Glands. It was used in a case which had originated from an in-
flammation of the tongue, but as the disease was of very slow pro-
gress, it was for a long time neglected, then treated successively,
but without success, with mercurial and iodine ointments, M*

290 Camphor in Atonic Ulcers. P^#f>

Pondman prescribed the ointment of Prof. Hoppe de Bales, which
is made as follows :

l . Black oxide of copper, 4 parts,

Lard, 24 "

Mix carefully, and rub the indurated glands twice dail}'.

At the end of a week the tumor was softened and lessened in
size ; six weeks after resolution was complete.

Camphor in Atonic Ulcers.
M. Uytterhoeven is using, with great success, at the "Hopital
Saint-Jean de Bruxelles," the following ointment:

Ointment of Marsh Mallow, 30 parts,

Camphor, 4 "

For atonic and callous nlcers two dressings daily will very soon
produce a favorable change. If there is tendency to gangrene,
powdered cinchona, charcoal and chloride of lime are added.

[Jour, de Med. de Bruxelles.

An account of the Cases of Dislocation of the Femur at the Hip-joint,
treated by Manipulation alone, after the plan proposed by W. W.
Reid, M.D., of Rochester, which have occurred in the N. York Hos-
pital during the past two years. By Thomas M. Markoe, M. D.,
one of the Attending Surgeons.

[Concluded from page 229.]

Case 10. Dr. Dewitt C. Peters, late house-surgeon of the N. Y.
Hospital, now of the U. S. Army, writes from Pawnee Fork Biver,
Kansas Territory, under date of Sept. 24, 1854, " I have have had
one case of dislocation of the head of the femur into the ischiatic
notch, which I reduced immediately after it occurred, by putting
the man under the influence of ether and employing the method
of Dr. Beid." The man had been thrown violently by an unruly
mule he was attempting to harness.

The following letter, from Dr. W. Parker, Professor of Surgery
in the University of the State of New York, adds two more valua-
ble cases to our list.

New York, November 10, 1854.

Dear Sir: In compliance with your request, I send you an
account of two cases of luxation at the hip, which I reduced after
the plan proposed by Dr. Beid, of Rochester, N. Y.

Case 11. July 11, 1853. I was called in the evening, to Mr.

P C , a contractor, hale, muscular and forty years old. I

found him lying on the carpet, complaining of pain. He was
thrown from his carriage, by the running away of his horse. On

1855.] Dislocation of il V the fr:p-jcirt. 291

examination. I found the left limb an inch and a half shorter than
the other, and the foot turned inward. The head of the femur
was in the sacro-ischiatie notch.

I put him fall >/ under the influence of chloroform, and proceeded
to reduce the thigh. In my first attempt, I carried the head of the
bone into the foramen thyroideum. By a slight movement and
without force, the head of the bone passed up to the notch. I at
once made the second trial, and carried the bone into place with
the utmost ease. The patient was soon at his bush

Case 12. November 1. 1854. Mrs. K.. aged forty-four, fell
some eighteen feet, injured the brain and luxated the left thigh,
her at two P. M. Advised to dress the head, get up reac-
tion, and I would be back in a few hours to reduce the limb.
This was a luxation upon the dorsum. She was strong and mus-
cular.

I found her in the evening warm and sensible. I applied chlo-
roform and proceeded to reduce. I accomplished it after the plan
of Dr. lieid, without any violent effort and in a most satisfactory
manner. I am prepared to say, the profession are under great
obligations to Dr. Keid for the plan of treatment which he has
suggested and demonstrated in the reduction of luxations at the
hip-joint. With the aid of an an sssthie the plan is perfect, vr. p.

Case 13. Samuel Gordon, aged thirty-seven, Ireland, laborer,
was brought to the X. Y. Hospital, November, 22, 1854, with a
luxation of the right hip, and a fracture of the right leg. The
accident had occurred immediately before admission, from the
falling of the wall of the Gas-house. The head of the bone was
found on the dorsum ilii, rather low down towards the ischiatic
notch.

Nov. 24. The leg having been dressed firmly with pasteboard
splints, so that it might not receive injury during the reduction of
the hip, the patient was fully etherized and Reid's plan of reduc-
tion was tried by Dr. "Watson, twice or thrice without effect. This
plan was abandoned, and the pullies were faithfully and for a long
time employed. The head descended, but would not pass into its
socket. Thinking that Jarviss Adjuster would give more con-
trol over the movements necessary in replacing the bone, it was
applied, and with it the head of the femur was brought down so
that it seemed ready to slip in, but on cutting the cord it was found
unreduced. It was thoroughly tried until the steel shaft bent, but
without success. Under these discouraging circumstances, the
pullies were again about to be applied, when it was thought best
to give Reid's plan one more trial. The manipulation was per-
formed twice, without success. The third time it was done more
deliberately and more carefully, and when the head of the bone
was brought to the lower edge of the acetabulum, it was retained
there for a time and the rocking motion performed in all directions,
and when all seemed loose and free, the abduction was increased,
without any jerk or sudden motion, and the limb brought down

292 Dislocation cf the Femur at the Hip-joint. [Mav,

thus strongly abducted towards the straight position ; as this was
done, the head of the bone slipped into place with an audible snap,

From the small number of cases here presented, even with the
addition of those recorded in Dr. Reid's paper, I do not consider
that we can obtain data sufficient for the final appreciation of the
new plan of reducing luxations of the hip-joint. Still, they seem
to be sufficient to show us that the plan may be safely, easily and
successfully applied to a certain number, and probably to a very
great proportion of all the cases which occur. The cases which
are related embrace every instance of dislocation of the femur
which has presented itself in the Hospital during the last two years,
and a reduction was always effected without the aid of pullies, ex-
cept in the one case of Dr. Halsted, No. 7, and here a modification
of the manipulation, which had previously proved successful, was
not tried. In Dr. Post's case, No. 4, the reduction was finally
effected from the foramen ovale by the usual mode, though without
the pullies, but it was brought, by the manipulation employed, to
this point from the ischiatic notch, from which it would surely
have required the pullies to displace it on the old plan. It is to
be observed, too, that our experience has been progressive, and
while, at the time Case No. 4 occurred, we did not know how to
reduce the bone from the foramen ovale by manipulation alone,
that we have since learned the true method of doing it, if our ex-
perience, in Cases 8 and 9, can be relied on. Though we have
failed, then, in reducing, by the new plan, two cases out of the
thirteen, yet I think that the record shows good reason for believing
that all might have been so reduced, if we had known at the time
as much as subsequent cases have taught us. The applicability of
the plan to cases of long standing, is well known in Merritt's case.
No. 3, where twelve weeks had elapsed, from the time of the acci-
dent, and in which, though not permanent, the reduction was
effected with comparative facility.

With regard to the rationale of the process, most of those who
have written on this matter are in the main points agreed. The
head of a dislocated femur is retained in its new position by a
mechanism which does not exist in any other joint, and which is pro-
duced by the fact of the muscles not being inserted into the head, but
into the trochanter, nearly three inches from the head, and that from
this point of principal muscular insertion the neck goes off at a large
angle from the axis of the shaft. From this, it happens that when
the head of the femur is thrown out of its socket, the trochanter
no longer stands out more prominent than before, but being held
firmly by the muscles which are inserted into its base, it is pre-
vented from rising any more than enough to let the head out of
the acetabulum, while the head and neck, slipping to the one side
or the other, are found lying in such a manner that the side of the
head, neck and trochanter are in contact with some part of the
outer surface of the pelvis, varying, of course, in the different
forms of luxation. This being borne in mind, it will be clear that

1855.] Dislocation of the Femur at the Hip-joint. 293

any attempt at reduction, which merely brings the head of the
bone to the acetabulum, will not succeed in making it enter that
cavity, because of the lying-down position of the neck and trochan-
ter against the side of the pelvis. TTe need, therefore, not only
to bring the head over the socket, but at the same time to raise up
the trochanter, and neck so as to allow the head to enter. Now,
in the ordinary methods of reduction, this raising up of the tro-
chanter, so as to put the neck in the proper direction for the head
to enter its socket, is done first, by the action of the pullies, and
the approxi/iation of the head to the socket is done second, by the
continuation of the extension. This raising of the trochanter is,
of course, opposed strongly by the muscles inserted into its base,
causing the head to be pressed more and more firmly against the
pelvis, and increasing the friction, and thereby causing, by far, the
greater part of the difficulty in bringing down the head to the level
of the acetabulum. It is in this, principall}', and I am myself dis-
posed to say only, that any active muscular contraction opposes
the reduction of a dislocation of the hip-joint. True, the large
muscles around the joint are thrown into action as soon as exten-
sion is made; but this is an action excited by the extension, and,
that it is a very feeble opposing force, is evidenced by the facility
with which these muscles give way to the force of a single unaided
arm, when a fracture of the neck of the femur is concerned, in
which, of course, none of the friction alluded to can occur. This
comparative action of the muscles, in fracture and in dislocation, is
very strongly and appropriately insisted upon by Dr. Reid.

The process by manipulation avoids this main difficulty, and, as
it were, eludes the opposition of the muscles. The trochanter,
being fixed by the insertion into its base of the pyriformis, the two
obturators, the gemelli, and the upper part of the quadratus, acts
as a fixed point or fulcrum, upon which, by moving the limb, the
head of the bone can be made to describe a circle round the ful-
crum. TThen we remember that this fulcrum is not. strictly speak-
ing, a fixed point, but has a certain degree of motion of its own,
we can easily see how, by means of this moveable fulcrum, the
head of the bone can be placed, by varying the motions of the
limb, on almost any point within two inches around the acetabu-
lum, and, of course, over the acetabulum itself. If this manipula-
tion is made in such a way as not to raise the trochanter from 1 ving
against the pelvis, then, when the head comes over the acetabulum,
a slight rotation, such as is given by the rocking motion employed,
will sufficiently raise the trochanter to let the head slip in without
provoking to opposition the trochanteric muscles, and if the move-
ments be made in such a direction as to relax the stretched mus-
cles, the whole may be accomplished without calling forth the
slightest muscular opposition from the beginning to the end of the
procedure. This principle, in its application to the different forms
of dislocation, presents some variations. In the dislocations on
the dorsum, and on the isciuatic. notch, for their mechanism jg jjgj

294 Dislocation of the Femur at the Hip-joint [May,

our purpose identical, the principle has its best illustration ; and,
if any one will take the skeleton or the dead subject, and go
through the process, he will perceive that, by adduction, the tense
rotators are relaxed, and that, by flexion of the thigh upon the
trunk, the head is caused to pass down behind and below the
acetabulum, and then, by carrying the knee out so as to abduct
the limb, that the head comes toward the lower portion of the
acetabulum where its margin is least prominent. At this point, I
wish it to be observed, that our mode of procedure varies a little
from Dr. field's. He recommends, when the head is brought by
abduction close to the lower edge of the acetabulum, that, by the
rocking movement already described, it be caused to slip in. This
is well, and will probably answer in many cases, but it failed us
so completely from the first, that we were led to add the bringing
down of the thigh to the straight position in a state of abduction,
still keeping up the rocky motion, and it has been uniformly in
the act of thus bringing down the limb, that the reduction has.
been accomplished. On looking at the parts in the dead subject,
it will be seen that this movement of the limb, when the head has
reached the lower margin of the acetabulum, tends directly to roll
the head upwards over the edge and into the socket. The me-
chanism of the reduction from the foramen ovale has already been
alluded to. I do not know of any case of reduction from the
pubes.

If the proposed plan should prove, on further trial, to be as success-
ful and as free from danger as it thus far has been, one most valuable
feature of it, as a surgical resource, will be its availability. Wherever
a surgeon, with his bottle of ether, can go, there the dislocated hip
can be reduced, without instruments, without appliances, without
assistants. I well remember finding myself, in the year 1848, in a
country village in Vermont, in consultation on a case of dislocated
hip of some weeks' standing, in which it was difficult for us to per-
suade the patient's friends that there was anything more than a
sprain of the joint. It was late on a cold autumn day, and we
were about twenty miles from any place where pullies could be
obtained ; but, nevertheless, we made such extempore arrange-
ments as we best: could, and by the help of an old tackle-block and
some bed-cord, with counter-extending bands of hanks of home-
spun yarn, we proceeded to attempt the reduction. If we had
been heartily seconded by the friends and family, we could, I have
no doubt, finally have succeeded, even with our clumsy apparatus ;
but the doubts and hesitations on their minds, and their unwilling-
ness to allow the patient, a stout, muscular young woman, to be
so long and so repeatedly subjected to our unsatisfactory attempts,
finally decided the case against us, and we were dismissed without
thanks or fee, and the poor girl's hip has never been reduced to
to this day. I have often thought since, how different an aspect
matters would have worn, if we could have brought the manipu-
lation to -bear upon the case, and how different a result might

1855.] Dislocation of the Femur at the Hi}) -joint. 295

have been obtained for the unfortunate patient. Xo better illus*
tration, however, could be given of the availability of this opera-
tion than that given in the letter of Dr. Peters, giving an account of
Case 10, in which he says, that the accident occurred in the heart
of Kansas Territory, five hundred miles from the nearest fort. If
the poor man had depended upon pullies for the reduction of Lis
dislocation, how much delay and suffering must he have under-
gone, from which he was saved by the simple fact that Doctor
Peters was familiar, during his hospital course, with the manage-
ment of these cases by manipulation, and was therefore able, on
the spot, to effect with ease a reduction which every day's delay
would have rendered more difficult

Everything in our experience thus far seems to indicate that
this method of reducing luxations is as safe, if not safer, so far as
the integrity of the joint and its after usefulness is concerned,
than the reduction by forcible extension with the pullies. The
method is not however, without its dangers, and these mainlv
arise from the immense amount of force which can be exercised
by acting on the long arm of so powerful a lever as the whole
limb, while the short arm has at most a length of three inches.
By the inconsiderate or misdirected action of this lever force, one
of three accidents might be produced : either the muscles holding
the trochanter, and thereby forming the fulcrum on which the
power is applied, might be torn from their attachments ; or, if they
held fast the tissues, round and among which the head passes in
its movements, may be extensively lacerated or contused; or,
lastly, it seems to me very possible that the neck of the bone might
be broken by too violent abduction, forcing it against the side of
the pelvis. Though happily these dangers are thus far only theo-
retical, yet the anatomy of the part shows that they are real, and
each one of them might have most serious consequences. It would
not be possible to lay down any specific rules wherebv these dan-
gers are to be avoided, except by insisting on that almost univer-
sal law of surgical manipulation, that every thing is to be done
with gentle moderate force, and never with sudden violence. As
far as my recollection serves me, and I myself assisted in almost
every case reported, we never have accomplished any thing by
proceeding in a direction where great force was required to con-
tinue the movement, but have always succeeded by finding a di-
rection in which the mere continuance of the movement, without
force, has brought the head into the proper position. It will be
noticed, by looking over the cases, that in many of them, before
the head went into its socket, it slipped about on the outer surface
of the pelvis, taking sometimes one and sometimes another of the
four positions usually spoken of as the four forms of luxation of
the hip. This in some instances happened several times, and in
the two instances of failure, this change of position was all that
could be accomplished. Now, it cannot be doubted that this ex-
tensive movement of the head of the bone must be attended with

296 Dislocation of the Femur at the Hip-joint [May,

* a corresponding amount of laceration and displacement of the
tissues among which it passes, and although the mischief thus done
may be confined to the areolar tissue in the muscular interspaces,
still it is an injury which may add to the dangers of after-inflam-
mation, and is, if possible, to be avoided. I suppose this can only
be done by defining more accurately the precise method of proce-
dure to be adopted in each case, so that no experimental or ineffec-
tual trials shall have to be made, but the operator shall be able at
once to do exactly what is necessary to bring the head of the bone
to the point desired.

The above account had been prepared for the press, with the
exception of Case 13, which has since occurred, when a case pre-
sented itself which offers some points so important in their bear-
ing upon what has already been said, that I add the history here
by itself, rather than incorporate it with the other cases.

Case 14. Patrick Barry, aged 42, was admitted to the New
York Hospital, Oct. 23, 1854, with a dislocation of the left femur,
which had occurred seven weeks previously, by a fall from a rail-
car while it was in motion. The symptoms were unequivocal, the
limb being shortened If inches, the ball of the great toe resting on
the instep of the sound foot, and the head of the bone being dis-
tinctly felt upon the dorsum of the ilium. The patient was a man
of good muscular development, but the injured limb was somewhat
wasted and flabby from inaction. Two days after admission he
was put under the influence of ether, and Beid's manipulation was
tried. The head descended as usual, until it came opposite to the
lower margin of the acetabulum, but from that point, as the limb
was brought down, it slipped on to the foramen ovale. The mani-
pulation was repeated several times, with all care, varying the
degree of abduction on the various trials, but without success. It
was impossible to make the head rise over the lower border of the
acetabulum so as to slip into its place. After numerous thorough
and careful trials, the manipulation was abandoned and the pul-
lies ordered to be applied. Before this was done, it was thought
best to place the head of the bone on the foramen ovale, and from
that point to try and reduce it by the usual method recommended
by Sir Astley Cooper. The head was accordingly placed on the
foramen, and while the upper part of the thigh was grasped by an
assistant and lifted strongly outwards, I took hold of the ankle
and made extension and adduction. The head seemed not to
move at all under this force, and while making strong adduction
a crack was heard, every thing became loose about the joint, and
on examination it was evident that a fracture of the cervix had
taken place, leaving the head in the foramen ovale. There was
nothing further to be done but to put the limb up in the straight
apparatus, hoping that, if we could obtain union, he would have
as useful a limb as those ordinarily left by fracture of the cervix,
and certainly a better limb than if the dislocation had been un-
touched. Thus far, Nov. 25, every thing has gone well, and

1855.] Malignant Inflammation of the Lips and Face. 297

promises union, with a shortening of about an inch. I am sorry
that we must accept this case as one of failure of the new plan
after what we considered a fair trial ; for mj^self, however, I do
most profoundly believe that it failed simply because we have not
yet learned enough about the manipulation to adapt it to the con-
dition of parts concerned in this particular instance. That we
shall yet acquire that knowledge, I see no reasonable ground to
doubt. With regard to the fracture of the cervix, we were all
surprised at the slight amount of the force which was competent
to produce such a mortifying accident. It adds double force to
the caution given above, when speaking of the possibility of that
accident, and it is not a little remarkable that the paragraph con-
taining that caution was written on the very morning of the day
when tbe production of the fracture verified the necessity of the
warning. Dr. Watson, in a note to me, speaks of a fact which he
says, "I have on undoubted authority, viz: from one of the pro-
fessors in the School of Medicine in Toronto, Ca., that an accident,
similar to that of Case 14, occurred in that city, while the surgeon
was attempting to reduce a luxation of the hip by Reid's method."
Finally, it must be observed that the new plan is entitled to none
of the blame of the fractured cervix. The accident took place
after Reid's manipulation was abandoned, and while we were at-
tempting the reduction according to the old established and classi-
cal method. [New York Journal of Medicine.

On a Peculiar Form of Malignant Inflammation of the Lips and
Face, resembling Malignant Pustule. By W. Pakkeb, M. I)., Pro-
fessor of Surgery in the College of Physicians and Surgeons,
New York.

There have come under my observation, within a recent period,
several cases of a peculiar form of inflammation of the lips and
face, which resembles somewhat phlegmonous erysipelas, but more
strikingly, especially in its commencement, malignant pustule, and,
in its subsequent progress, carbuncle. It, however, differs from
these affections in some essential particulars, which will be noticed
after giving the details of the following cases, which illustrate the
peculiarity of this form of disease.

Case 1. I first saw this patient on the 18th of last December.
He was a young man, aged 23, merchants of good character, tem-
perate habits, and in the previous enjoyment of good health.
About a week before I visited him, a small pustule made its ap-
pearance upon the central portion of the lower lip, just below the
edge of the vermillion border. It became painful, had a livid
areola, gradually but slowly enlarged, and finally broke and be-
gan to discharge. The pain increased, and the swelling extended
downwards upon the chin. At my first visit, about this period,
the tuineftctiQu had reached as low as the os hyoides, and had ex-

298 Malignant Inflammation of the Lips and Face. [May,

tended over the right side of the face to the head ; it was hard to
the feel, of a livid color, insensible, and had now much the appear-
ance of a carbuncle. The lips were greatly tumefied, everted ;
gums swollen, and of the same livid color ; tongue moist ; inside
of mouth unaffected ; ptyalism considerable. The lower lip, about
the seat of the original pustule, appeared gangrenous. The pulse
was 120, rapid and feeble, respiration unaffected. He was able to
get up and sit in the chair, but was suffering from great depres-
sion of the vital powers. The course pursued consisted of deep
scarifications of the lips and yeast poultices to the swelling, and
stimulants to sustain the general system. The swelling continued
to extend, involving successively the neck, face, and finally the
head. He died on the following day, the 19th, late in the evening.

Case 2. I visited on the 15th of January, a patient, aged 45,
merchant, suffering from what appeared to be a carbuncle of the
under lip. He was of a good constitution, temperate habits, and
in the enjoyment of good health, previous to the present attack.
Four days before I saw him, he was supposed to have cut the
lower lip slightly, and applied to it arnica. The inflammation
commenced at this point, the lip swelled largely, became everted,
had a livid color, was tender, hard, and the seat of a burning pain.
At several points there were small sloughy apertures, discharging
thin pus. The constitutional symptoms were considerable, but
not sufficient to confine him to his room. The treatment consisted
of free incision and yeast poultices to the lip, and sustaining reme-
dies for the general system. Portions of the lip sloughed, but
he recovered.

Case 3. Mr, W., aged 26, married, furniture dealer, of good
habits, and hitherto perfect health, discovered a small pustule on
the under lip near the right angle of the mouth, on the second of
April. It was tender on pressure and had a hard base, but at-
tracted no other attention. During night the disease extended
considerably, involving the whole lid, and the right side of the
face in a hard, livid and painful swelling. On the evening of the
second day his physician first saw him, and found the lip greatly
swollen, of a livid color, and the seat of a burning pain. He scari-
fied the parts for the purpose of local depletion, and also applied
leeches. The swelling continued to extend, involving the right
side of the neck and face to a great extent, I saw him on the 7th,
at 11 A. M. His symptoms were then most unfavorable, pulse
130 per minute, intermittent every seventh or eighth beat, weak
and small ; respiration rapid, moaning ; skin warm and moist ;
urine free ; pupils much dilated ; mind clear. He complained of
oppression about the chest, and had not been able to obtain sleep.
Both lips were involved in the swelling ; were hard, livid, and
insensible ; the whole side of the neck and face was similarly af-
fected, the eye being nearly closed. The frontal vein was livid,
red, and prominent, and the vej.ns of the cheek were also visible
as if distended, The treatment consisted of deep scarifications of

1855.] Malignant Inflammation of the Lips and Face. 299

the lips, and yeast poultices to the part, with anoclynes and stimu-
lants. I visted him again at six o'clock, P. M., and found him
rapidly failing ; treatment of no service. He died the same even-
ing.

Case 4. I was called, April 10, to see Miss S., aged 30, occu-
pied as a governess, of good constitution, whom I found laboring
under the same difficulty as in the preceding case. Her history
was almost precisely similar. Five days before, while in the pos-
session of apparently perfect health, she first observed a small pus-
tule on the lower lip, just below the red line of mucous membrane ;
it was regarded as a small boil, and no attention paid to it. On
the following day the pustule had enlarged somewhat, was hard,
and had a livid areola, but she continued about her employment ;
she spent a feverish, restless night, and on the next day called her
physician. The disease gradually extended, assuming the appear-
ances already noticed, and for two days no danger was appre-
hended. Her symptoms now became much more unfavorable,
and at this period I first saw her. She was lying in bed quite
insensible ; deglutition difficult ; respiration laborious ; right side
of body paralyzed ; lips large, everted, and cold ; right side of
face, neck and forehead swollen like the lip, hard and purple ;
right eye protruded ; pupils dilated and insensible. On making
an incision into the lip, the cellular substance was found filled with
small deposits of pus, which were forced out on slight pressure.
As she was moribund, treatment was of no avail.

From the history of the foregoing cases it is evident that this
disease differs from erysipelas, for which it has in several instances
been mistaken in its origin in a pustule, without a chill or other
constitutional disturbance, the hardness of the swelling, its purple
or livid color, insensibility, and absence of much paim It differs
from carbuncle, which in some features it resembles in the class of
individuals which it attacks they being young, temperate, of
sound constitution, and in the previous enjoyment of good health
and in its rapidly fatal course. Carbuncle, on the contrary, oc-
curs by preference in persons enfeebled by age or vicious habits.
It differs again from true malignant pustule, to which in its origin
it seems allied, by attacking persons who have not been affected
by poisonous wounds, or who have been liable to the introduc-
tion of animal poisons into the system.

This disease would therefore seem to be peculiar, having many
points of resemblance to other similar affections, out still not so
closely allied to any one to warrant its classification under the
same head. In every instance which has come under my obser-
vation, the pustule has been seated upon the lower lip, and from
this point the inflammation has spread- In a fatal case related to
me by a physician, in whose practice it recently occurred, the pus-
tule was seated upon the side of the nose.

Although the nature and progress of the disease show a vitiated
state of the system, in no instance have I been able to trace the

300 Physiology of Menstruation and Conception. [May,

attack to the contact of poisonous matter, or its reception into the
system in the food or drink. In every instance the patient has been
in the enjoyment of good health, and the progress of the disease,
though rapid, has excited so little local and general disturbance
as not to excite alarm until a short time before its fatal termina-
tion. The general symtoms are of a typhoid character, the vital
powers being evidently depressed either by the influence of the
disease itself, or, which is more probable, the cause upon which
the development of the disease depends. [Ibid.

The Physiology of Menstruation and Conception. By Prof. Bischoff.

The attention and laborious investigation of the student has
been long directed towards that most interesting and important
point, the physiology of menstruation and conception, and amongst
the many who have labored in this held, we know of none more
distinguished than Prof. Bischoff. We design to give our readers
an abridged sketch of his recent labors, and the results to which he
has arrived.

M. Bischoff gives in detail his examination of the organs of gene-
ration in thirteen women, who had died suddenly whilst menstru-
ating ; the death, in most of the instances, being the result of acci-
dent or violence. These examinations were made with the greatest
accuracy ; and, when taken in connection with the previous histo-
ry of each case, will aid very much in determining the physiologi-
cal facts involved. Our space forbids us from presenting the min-
ute details of each dissection, and we will therefore only give the
deductions derived from them.

Professor Bischoff remarks that these cases confirm the doctrine,
that in woman at every menstruation a follicle ripens, swells, and
bursts, that the ovum escapes, and that a corpus luteum is formed.
The eleventh case seems to prove that the full consequences of
menstruation are not in every instance necessarily carried out, but
that a follicle may swell, and the ovum ripen without the bursting
of the follicle, or the escape of the ovum. Such a condition will
cause sterility, notwithstanding menstruation. Perhaps, also, the
pain of the mentrual period depends upon this incomplete develop-
ment.

A woman may not menstruate, and yet she may conceive; for
the essential condition, the ripening and escape of an ovum, may
proceed, and only the usual outward symptoms of this event, the
secretion of blood, fail. Prof. Bischoff remarks, that he could ne-
ver succeed in finding the ovum, but observes that he does not
believe that it is so soon destroyed. He says there are but two
cases known to him where it was so found, and that only one of
these presents the desired certainty. This is the following obser-
vation of Prof. Hyrtl, of Vienna: Therese Michal, aged 17, died
ou toe 10th of October,. 1844, of Peritonitis, in tho cliai^ueof Pro

1855.] Physiology of Menstruation and Conception. 301

Oppolzer. She had only menstruated twice in her life, and the
last time was two days before her admission into the hospital on
the 8th October. The breasts were tolerably developed ; the pubes
slightly covered with hair. The hymen was uninjured; the ute-
rus of moderate size, compact, its cavity filled with a considerable
quantity of thick blood; the mucous membrane was so loosened
as to resemble a half-liquid plastic exudation. The lining mem-
brane of both Fallopian tubes was suffused, loose, and covered
with mucus. Both ovaries were of fair size, but the left one show-
ed a ruptured follicle of the size of a large hazel-nut, filled with
semi-fluid blood. Prof. Hyrtl submitted the parts to careful in-
spection under the microscope on the same day. Neither in the
vagina, uterus, or tubes, could he find a trace of spermatozoa.
But by a careful examination of the left tube, in that part which
traverses the substance of the uterus, he found an ovulum, with all
its characteristic properties, somewhat dull and turbid indeed, but
fully recognisable. Hyrtl believes he even detected the germinal
vesicle. This is a remarkable anomaly, since the germinal vesicle
of ever}^ ovum, when it has left the ovary, has disappeared. Prof.
Hyrtl had the ovulum immediately drawn by his artist, and ex-
hibited it on the same day in his lecture on physiology. This case
is free from doubt, as there is no room to suspect coitus. Prof.
Bischoff regrets that he cannot admit as much with reference to
the cases of Dr. Letheby, published in the "Philosophical Trans-
actions'' for 1852, but his reasons of dissent do not appear to be
very valid.

Prof. Bischoff takes occasion to discuss the question as to the
differences between the corpus luteum of simple menstruation and
that of conception. In the cow and sow the corpora lutea of the
non -pregnant are altogether similar to those of the pregnant, and
he has made the same observation in the bitch, the cat, and the por-
poise. They disappear more quickly when no conception follows.
In the human female, at the earliest period of the bursting of the
follicle, the filling of it with blood, and the beginning of the de-
velopment of the membrane of the follicle, to the formation of the
corpus luteum, there is no difference at all. But in the further
development of the corpus luteum, the impregnation of the ovum
and gestation bring about a material difference. The corpus lute-
um m simple menstruation never attains the full stage of formation
up to the complete filling up of the follicle and the metamorphosis
of the blood coagulum ; but this substance only developes itself
into a peripheral layer, and soon falls into retrogressive metamor-
phosis. It shrivels up, and only leaves at the next and the suc-
ceeding menstruation a more and more indistinct spot, changing
from 3'ellow to brown and black, and soon there remains nothing
but a scar; which lasts for a time, and gives evidence of the past
process which has at an earlier period taken place on the surface
of the ovary. The corpus luteum of conception, on the other hand,
goes on developing itself throughout the Jkst months of pregnancy,

302 Entrance of the Spermatozoon into the Ovum. [May,

and attains a fullness of size, colour, and texture, which the men-
strual corpora lutea never reach. It lasts throughout the whole
period of pregnancy, and disappears after delivery. It may, how-
ever, be questioned whether it has a great diagnostic value. In
the first period, so long as there are no other signs of pregnancy,
these differences either do not exist, or are very difficult to deter-
mine. After delivery, when the signs of pregnancy in the uterus
have disappeared, it again becomes difficult to distinguish them
from the corpora lutea of fourteen days or three weeks' standing,
resulting from menstruation. And where pregnancy is plain,
from the state of the uterus and other parts, the corpus luteum is
of no value. Prof. Bischoff, therefore, concludes that the corpus
luteum cannot be used in the determination of doubtful cases.

Professor Bischoff holds it to be proved that conception and
pregnancy depend absolutely upon menstruation as the period of
the ripening and expulsion of an ovum. He remarks, however,
that it can scarcely be doubted that the time occupied by the tran-
sit of the ovum from the ovary, the arrest of the ovum, and the
preparatory changes in the uterine mucous membrane, suffer great
differences in individuals, and hence entail a longer or shorter
duration of gestation. [Henle's Zeitschrift, and Monthly Jour. Med.
Science.

The Entrance of the Spermatozoon into the Ovum. By M. Keber.

By the diligence of embryologists, the science of development
continues to make wonderful advances. Martin Barry and Nel-
son had already published observations of the entrance of the sper-
matozoon into the ovulum ; but their observations were not re-
garded as completely satisfactory, till Keber, following in their
footseps, by a careful observation of the process as it takes place
in the fresh water mussel, made out and described the different
stages of this wonderful function. Since Keber's work appeared,
M. Bischoff has been twice in the press ; first of all, with a pamph-
let controverting the views of Keber, and then with one fully con-
firming the same views. Bischoff also takes occasion to make
some amends to Martin Barry, whose uncommon accuracy and
profound research he has occasionally failed to recognize, till forced
by overpowering evidence.

In the fresh water mussel (unio), at the time of conception, the
ovulum, although still small, projects at one part a minute process
which springs from the membrane of the albumen, and perforates
the cortical membrane. This process dehisces, lets escape a little
albumen, and admits one of the spermatozoa which surround it.
This done, the micropyle, as it is called, again closes by constriction
or obliteration.

Afterwards (and sometimes earlier) there is, formed near the
micropyle an adhesion between the membranes of the albumen

1855.] Xitric Acid in Hemorrhoids. 303

and of the yelk, then the yelk-bag dehisces, receives the sperma-
tozoon into its interior and again is closed.

The spermatozoon afterwards sinks deep into the yelk, swells
and becomes ronnded ; after some time a nnclens appears in it,
while its onter membrane thins, and at length disappears.

The nucleus of the spermatozoon splits up into several irregu-
lar divisions which at first lie near one another, and then become
diffused through the yelk, so that before the dissolution of the
germinal vesicle the yelk is filled with particles derived from the
male.

M. Keber has also confirmed the observations of Barry in re-
gard to the small pellucid vesicles not rarely found in the abdomi-
nal cavity of the rabbit, attached to'the ovary, the fimbriae, the ovi-
duct, the' peritonaeum, or the uterus itself; within which are ob-
served vibratory motions over the whole surface and rotary move-
ments of various corpuscles, and of a large mulberry-like body on
its axis, which increases under the eye of the observer by the ap-
position to it of roundish corpuscles, from the fluid of the vesicle.

Barry observed a similar vesicle imbedded in the mucous mem-
brane of the uterus. Those found in this situation, are smaller
than those of the abdominal cavity. In these bodies Keber has
observed changes resembling the formation of the micropyle in the
ovulum, and for that and other reasons regards these vesicles as
ova. But for farther discussion of this subject we refer the reader
to Keber's monograph. [Edinburgh Med. and Surg. Journal.

On the Use of Nitric Acid in Hemorrhoids. By Hexrt Smith,
F. E. C. S.

Several years have now elapsed since the attention of surgeons
was directed by Dr. Houston to the improved treatment of certain
forms of piles by the application of nitric acid, and since the intro-
duction of this plan, it has doubtless been employed by many in
the profession ; but it seems to be necessary even now to direct
further attention to this matter. Most of us may be acquainted
with the fact of a certain improved mode of treatment, or a certain
remedy having been recommended and brought into the category
of surgical means and appliances ; but this may be all ; for many
of us either have no faith in it, or are too much wedded to the use
of those other methods which have been adopted by our teachers
and by the previous generations of surgeons.

These remarks may, I believe, be truly applied to the subject
under present notice. The great advantages of nitric acid in the
treatment of some forms of hemorrhoidal tumors are not yet suffi-
ciently known and acknowledged; and, having had numerous
opportunities of observing them, I deem it right to give the results
of some of this experience, and to make some observation thereon.

In many cases of hemorrhoids, the distress caused by them, per-

304 Nitric Acid in Hemorrhoids. [May,

haps for years, has been such, that many patients are induced to
undergo operations of considerable severity for the purpose of
getting cured. Ligature of the offending part and excision have
been the measures to which surgeons have for the most part
resorted.

When the hemorrhoids are situated within the sphincter ani,
excision is a dangerous remedy. It is true that in many cases the
scissors may be used without much bleeding, and a good cure will
result; but qyqtj now and then such extensive haemorrhage will
follow as to place the life of the patient in jeopardy. I have my-
self been called to two such instances. In the one case of a young
gentleman, some internal piles had been cut off by another sur-
geon. Three hours after the operation I was called to the patient,
and found that he had bled enormously ; in truth, his life had
been seriously periled.

In the second case, the patient was a middle aged female, on
whom I had performed a somewhat complicated operation for the
relief of a prolapsed rectum, conjoined with excessively painful
piles. I snipped off the most prominent part of the swelling
which was protruding externally, and after having returned the
parts within the sphincter, and perceiving no bleeding, left the
patient, but in about a quarter of an hour she suddenly had an
inclination to stool, and passed an immense quantity of blood.
This occurred two or three times, and when I saw her she was in
a very exhausted and restless state ; but I managed to stop the
bleeding, and she happily recovered. In this instance I doubtless
used the scissors more freely than was proper.

It may be stated as a rule, with but few exceptions, that the
scissors or knife should be limited to those excrescences, vascular
or otherwise, which are situated external to the sphincter ; where
there is a prominent swelling, with a more or less narrow neck
growing from the verge of the anus; where there is simply an
enlarged and distended vein containing a coagulum of blood; and
especially where, with a relaxed and haemorrhoidal condition of
the rectum, there is a redundancy of loose skin around the anus
in such latter case the propriety of using the scissors is very ob-
vious.

Ligature of internal piles or of portions of a relaxed state of the
rectum is an operation which is chiefly in favor among surgeons,
and its use is attended with most signal benefit; and, if it were
invariably adopted without producing dangerous or fatal symp-
toms, it would not be expedient to discard the employment of
such a remedy : for, in general, but one operation is required, and,
if this be properly effected, the benefit will be speedy and lasting;
but the advantages of the ligature are, to a certain extent, coun-
terbalanced by certain evil results which are likely to follow its
use. In the first place, the patient must be confined to his bed or
sofa for some days. Secondly, the application of the ligature is
sometimes followed by the most iutense pain. Thirdly, symptoms

1855.] 305

of an alarming and dangerous character may be produced ; and,
fourthly, death itself may. and does occasionally follow its use.

I have had no personal experienc event after the use

of the ligature; but I know of ont- in the practice of a

friend where death did ensue after an operation, and. during a re-
cent d d at the London Medical Society. Mr. II
who . much attention to this subject, stated that he had
examined two individuals where death had been produced by the
ligature. In one instance of a gentleman a most valuable life
who had had a Ik plied for the cure of a bad prolapsus,
most alarming peritoneal symptoms came on, so that I was obliged
tch him most car some time after the oj : and
in others I have s^ re pain and distress produced,
retention of urine is by no means an uncommon sequela.

Under these circumstances it is desirable to employ an agent
which may effect the same good purpose without the attendant
evil results : and, in many instances, this may obtain in the use of
nitric acid. It would be absurd to attempt to discard the use of
the ligature in all; for. where there is considerable prolapsus of
the rectum, or where the hemorrhoidal tumors are large and have
extensive bases, it will be nee - resort to the use of the

ligature : but, in a great majority of instances of internal piles and
of prolapsed condition of the rectum dependent upon the unheal-
thy and vascular state of the mucous membrane, nitric acid will
be found to effect a cure: and this, too, without causing any of
those painful and distressing symptoms which occasionally folio w
the use of the ligature. It has occurred to me to have many op-
portunities of employing it. and I have seen most excellent results
from it. I will briefly relate a few of the most striking cases.

In May last. I was requested to see Mr. R, a gentleman who
had just returned from Australia, in company with his medical
attendant, who told me that he had suffered for several years with
distressing protrusion t>f the rectum after going to stool, and that
he was most anxious to get cured, and would undergo any opera-
tion.

On examination, I discovered that there was a highly congested
and relaxed state of the whole mucous membrane of the rectum,
and just within the sphincter a vascular broad mass, which might
or might not have been termed a pile. However, the pain after
going to stool was always most excessive as the mucous membrane
prolapsed. In addition, there was an external hemorrhoidal ex-
crescence attached to the verge of the anus. I consulted with the
surgeon in attendance, who had not even heard of the use of nitric
acid before he came to England, and it was determined to apply
it freely to the whole congested and relaxed portions of the rec-
tum.

The patient was very anxious that only one operation should
be done; therefore the very strongest acid was applied with free-
dom, and tl*e external pile was cut off.

306 Nitric Acid in Hemorrhoids. [May,

It was not necessary to apply it again. Great pain was pro-
duced by the acid, lasting some time, but when his bowels were
first moved after the operation there was not any prolapsus, and
in a few days he had lost all trace of a complaint which had for
years embittered his life.

While this patient was under my care, Mr. T., a gentleman aged
sixty-live, consulted me about his piles. He had suffered for more
than twenty years, and had consulted various practitioners, and
had used a quantity of remedies. The last person he consulted
was an homoeopath, who took the fees of the old man with an un-
sparing haud, but did not even condescend to examine the rectum.
He stated that his sufferings had been great for the last twenty
years; that the gut came down when he went to stool, which pro-
cess lasted an indefinite period of time, in consequence of his
being compelled to return the protruded part, which at times he
assured me had sometimes filled the hollow of his hand. In ad-
dition to this the gut generally prolapsed when he went out for a
walk, and at times the hemorrhage had been such, that, after leav-
ing his house for a walk, he had been compelled to return hastily
to change his drawers.

On examination, I found a collection of very vascular and
strawberry -colored piles within the sphincter, and a protrusion of
the mucous membrane of the rectum. Around the anus was a
large quantity of relaxed and thickened integument. It was just
the case which was adapted for the treatment by nitric acid, the
action of which I explained to the patient, who readily consent-
ed to its use.

On the following day, his bowels having been cleared out, and
the mucous membrane being protruded as much as possible by the
use of warm vapor, I applied nitric acid lightly to the largest pile.
The effect of this was only to give pain for a few moments, and,
after a few days, there was decided relief, when the acid was re-
peated to others of the tumors. The same* treatment was carried
on until I had applied it on five different occasions, when, with
scarcely giving the patient any amount of pain, all the excrecen-
ces were nearly destroyed. The loose and redundant skin around
the anus was then removed, and in a few days the patient came
to me full of gratitude, stating that he had no further trouble, and
that he had not been in such comfort for twenty years.

In the first of these cases the cure was more rapid and decided
than I could have expected, as it was not one for which the nitric
acid treatment is so well adapted, the disease consisting mainly of
a highly congested state of the veins of the rectum, the hemor-
rhoidal tumor itself being of a deep blue color. It is in the instan-
ces like the second, where the tumors are defined, very vascular,
and of a bright red color resembling a strawberry, that the nitric
acid is so particularly useful.

But it is in cases where there is a great deal of bleeding that it
acts so well ; in the second, there had been most copious hemor-

1855.] Symptoms of Meningitis. 807

rhage, from time to time, but this had been checked before the
patient consulted me, and therefore it would not be fair to give
the acid the credit of curing this as well as other symptoms, be-
cause it did not exist at that precise period of time ; but cases have
occurred to me in which I have seen remarkable effects produced
as regards arrest of bleeding. The last case treated by me was an
instance of this. It occurred only a few weeks ago, in the person
of an elderly woman, who came to me complaining of profuse
bleeding from the rectum, whieh had been going on for several
days. Her countenance betokened loss of blood. On examina-
tion, I discovered, just within the sphincter, a largeT vascular,
bright red pile. I touched it lightly with nitric acid ; this had the
effect of restraining the hemorrhage, and after three other appli-
cations she was cured.

If the remedy is thoroughly applied, and the accessory treatment
properly pursued, the cure will be lasting, a striking instance of
which was presented to my notice a few weeks ago, in the person
of an officer in the Navy, who was under my care in 1850 for the
treatment of very bad piles, from whieh he had suffered greatly
many years, he having been emploi'ed on active service in a hot
climate. Here there were several piles internally, and a large re-
dundancy of loose skin externally. Nitric acid was applied three
or four times to the former, and the loose skin was cut away ; a
good cure resulted. I saw this gentleman the other day on his
return from active service abroad, and he tells me he is quite well.

In many instances of long standing hemorrhoids, the external
skin becomes so thickened and relaxed that there will be a neces-
sity of snipping it all away if a perfect cure be expected. The
contraction which takes place subsequently to the operation braces
up the parts and prevents any further protrusion of the gut whieh
might subsequently take place.

The acid should be quite pure, and should be applied by means
of a stick of wood. The parts should be well oiled afterwards.
It is very important to attend to one thing, namely, to wipe the
part to which the acid is to be applied carefully with a piece of
lint, in order to get rid of the mucus which covers the piles, and
which will prevent the proper action of the acid, [London Lancet,

An Analysis of the Symptoms of ticenty-one cases of Meningitis in
the adult. By J. Lewis Smith, M. I),, Physician to the North-
western Dispensary, New York,

Perhaps there is no inflammatory disease so vaguely written
upon, or so little understood, as inflammation of the arachnoid and
pia mater. This arises chiefly from the fact that this inflammation
usually coexists with that of the dura mater, or cerebral substance,
or with disease elsewhere, modifying and obscuring its symptoms,
and, perhaps, changing its course.

308 Symptoms of Meningitis. [May,

My purpose, in this paper, is to determine whether the books
give a correct account of this disease, and to this end I have col-
lated, as far as possible, records of primary meningitis, and
secondary, where the primary disease seemed so mild as not to
produce any material modification in the patient's condition.

My investigations have been restricted to adults, from the re-
flection that in them the symptoms maj^ be different from those in
childhood ; and in order to avoid those numerous cases of acute
hydrocephalus, which is especially a disease of early life.

The whole number in my collection is only twenty-one, as, for
various reasons, I have rejected most of the recorded cases of this
disease. Of those published in Abercrombie's celebrated treatise,
I employ only one ; the rest, with the exception of a lady, in
whom the disease was combined with inflammation of the ear,
being either children, or else showing, after death, merely a vascu-
lar condition of the membranes. Vascularity, with or without
serous effusion, may indicate, it seems to me, simply a state of
congestion ; and I find that Dr. Watson, of London, objects to
these cases of Abercrombie, on this ground.

The French writers, as Andral, give minute records of menin-
gitis, but most of the cases published by them present such com-
plications, that I have not dared to use them.

Kecords where the patients recovered, and several such are found
in the journals, have also been rejected, in the belief that we can-
not yet make a positive diagnosis of meningeal inflammation from
the symptoms. Only such cases have been employed as showed
after death a lymphy deposit on or under the membranes.

Before proceeding to the analysis, a word should be said of the
so-called cerebro-spinal meningitis, an epidemic disease, which has
prevailed in various parts of Europe, as Gibraltar and Strasburg,
and in our own country. The pathology of this disease is not yet
understood, some considering it a local, others a constitutional
affection ; and there has been a corresponding discrepancy in the
treatment. Whatever may be its nature, it is evidently yery dis-
tinct from the sporadic inflammation, and cannot properly be con-
sidered with it.

In nine of the twenty-one cases, the cause of the disease was
not apparent. Perhaps, in some of these, a more minute autopsy
would have discovered a morbid process, to which the inflamma-
tion was secondary ; for the best pathologists agree that secondary
meningitis is more common than primary. If, in any of them,
such disease were present, it was no doubt mild, to have escaped
detection. Five had tubercles in the membranes, in the midst of
the inflamed surface, and in four there were tubercles in the lungs,
and not elsewhere. Meningeal inflammation has been frequently
noticed to accompany phthisis ; and as post mortem examinations
often reveal the inflammation, without the presence of tubercles
to excite it, the tubercular diathesis has been properly called the
cause of the meningeal disease. When tubercles axe found an, tka

1855.] Symptoms of Meningitis. 809

membranes, they, no doubt, in some instances are deposited dur-
ing the inflammation, just as pneumonia may cause the first tu-
bercular deposition to take place in the central or lower part of
the lung, instead of its usual seat, the apex.

In one case, the meningitis seemed to arise from erysipelas of
the neck and scalp, in one from intemperance, and in one from
reaction after profuse hemorrhage. From the records, it does not
appear that the primary and secondary forms differed in any im-
portant particular. On the average, the symptoms, both in kind
and intensity, seem to have been about the same.

Determining the duration of the disease has been somewhat dim-
cult; but dating from the commencement of well-marked cerebral
symptoms, as headaches or delirium, I find, in fifteen cases, the pe-
riod to vary from one to thirty-three days, with an average of fif-
teen. In one other case, the time seems pretty accurately fixed at
three and a half months, including an interval of improvement.

Symptoms. Headache was one of the most common, generally
severe, but sometimes slight. It is recorded in fourteen cases, in
all of which it began the first day, and continued till the patients
sank into delirium or coma. In no case is its absence recorded.

One only had convulsions. This man was a soldier in the
French army at the time of its retreat from Moscow, subsequently
to which he was subject to epileptic attacks. An autopsy of all
the viscera showed no disease except the meningitis.

How the opinion has become so prevalent, that inflammation of
the meninges gives rise to convulsions I do not know, but pre-
sume it is because this disease is most common in childhood, and
convulsions usually attend this as well as other encephalic diseases
in early life. Perhaps English and American physicians have de-
rived their knowledge of diseases of the brain and membranes
more from Abercrombie5s treatise than any other source ; and, as
we have said, nearly all the cases in his collection were children.
He gives the opinion that " the more common form in which the
attack takes place, is by a sudden and long continued paroxysm
of convulsions/' alluding to an attack of meningitis. On the con-
trary, our analysis clearly shows that convulsions are not a symp-
tom of this disease except in childhood, and this correction should
be made in our standard works.

A rigid and flexed state of the upper extremities was present in
one case, in one trismus, in another paralysis of one side of the
face, in another of an arm, and in four of an entire side.

Delirium was noticed in fourteen cases; in three coming on in
the commencement of the disease, in the others not till near the
close of life. It is not stated whether the remaining seven were
delirious, so that if this symptom were present, it was probably of
the passive kind.

Vomiting, so common in the acute hydrocephalus of childhood,
occurred in only six cases, and in these, with one exception, not
till the disease was well advanced.

N. S. VOL. XI. NO. V. 20

310 Symptoms of Meningitis. [May,

The pupil in six cases was dilated during the comatose state,
and in two others, before the development of coma, it was con-
tracted, the condition during coma not "being mentioned. Besides
these, four exhibited some unnatural appearance of the eye, as
strabismusr occurring, probably, from effusion. In the remaining
cases the condition of this organ is not recorded. In one instance
where the pupils were dilated, thirty leeches were applied to the
neck, and while the bites were still bleeding contraction took
place. This goes to show that simple congestion may cause dilata-
tion, which may not, therefore, be always so grave a symptom as
is usually thought.

Retention of urine was present in six cases, and incontinence
in one.

The pulse in seven was under eighty till near the close of life.
Of these, three were phthisical,, two had headache for two years,
and one for life, one had had pain for a considerable time in the
lumbar region, the cause not being apparent, and in the other the
inflammation appeared to be primary. Three had a pulse varying
from 80 to 100, two were phthisical, in the other the inflammation
was primary. Three had a pulse over 100, of whom two were
consumptives. The thought may occur, whether this discrepancy
in the condition of the pulse may not have been clue to compres-
sion from the effused fluid. A compressed state of the brain, will,
in many instances, prevent acceleration of the pulse, though the
inflammation is intense. But this explanation does not answer,
for the symptoms of compression were generally absent till near
the close of life. It is better to consider this diversity due to a
difference in the grade of inflammation, as is the case in the in-
flammation of other serous membranes.

The mode of death in sixteen cases is given, in all by coma,
varying from a few hours to two or three days. Generally the
effusion of serum and lymph seemed sufficient to cause the coma.

The seat of inflammation in seven cases was the base of the
brain, in four the convexity of one hemisphere, in three the upper
surface of both, and in two the entire meninges. In the remain-
ing cases the seat of disease was not recorded accurately, though
the deposit showed undoubted inflammation.

From this analysis the following conclusions may be drawn :

1st. That a common cause of meningitis is the tubercular dia-
thesis.

2d. That if in any of these cases the inflammation was primary,,
and not dependent on a diathesis, it did not differ materially from
the secondary form either in gravity or duration.

3d. That meningitis usually commences with headache.

4th. That convulsions are not a symptom of it..

5th. That delirium is present in the majority of eases, occasion-
ally early, but generally not till the disease is far advanced.

6th. Vomiting does not occur till a late stage of the inflamma-
tion, and then in only a moderate number of cases..

1855.] Intense Cold as a Local Anaesthetic. 311

7th. The pulse differs in different cases, and is, therefore, the
less reliable as a means of diagnosis.

8th. Paralysis sometimes occurs at a late stage of the disease,
but generally there is no contraction or rigidity of the limbs.

9th. That the mode of death is by coma. It is not our object
to speak of the treatment, as all the cases were fatal, and in no in-
stance did the remedies differ materially from those recommended
in the books. \_JSf. Y. Journal of Medicine.

Intense Cold as a Local Anesthetic Removal of Congenital Koevusi
etc. By J. Mason Warren, M. D.

The patient was a young man having a congenital naevus, of a
black color, and of large size, situated over the inner part of the
knee-joint, below the patella. The tumor had remained of about
the size of a dollar until within two years ; since that time a sup-
plementary tumor had appeared beneath the original, quite hard,
extending into the adjacent cellular membrane, and apparently
attaching itself to the synovial capsule. The whole tumor was
sensitive in the highest degree, and at times so painful as to dis-
able the patient from attending to business ; even the contact of
his clothes producing suffering. It was difficult to make a satis-
factory examination, in consequence of his dread of the necessary
manipulations. He was kept in a horizontal posture for a few
days, dieted, and an evaporating lotion applied, to prepare him
for the operation, which was done in the following manner. Ex-
cision being objectionable on account of the relations of the tumor
to the surrounding organs, equal parts of pounded ice and salt
were enclosed in a small gauze bag, and applied to the tumor for
four minutes, when the whole of it became congealed and of a
white color, crackling under the touch. A narrow-bladed knife
was then introduced beneath the skin, and the tumor freely cut
up in every direction. The operation was entirely painless ; the
patient sitting up, and watching its progress with much interest,
although previously shrinking on the mere approach of the fingers
to the part. The above subcutaneous operation was repeated
once or twice, and resulted in the absorption of a large part of the
tumor, and entire relief from the morbid sensibility.

In a case of fascial paronychia, in which Dr. AV. had recently
employed the same method of anaesthesia, the painful incisions
necessary to give exit to deep-seated pus were borne without
shrinking, and he thought the cure more speedy than under the
ordinary treatment. The same fact was remarked by the patient,
who was a medical man, and an acute observer.

In one or two cases of operation involving vascular tumors,
Dr. W. had found it of much service, during the progress of the
dissection, to apply the freezing mixture, and thus temporarily
arrest the hemorrhage, so as to allow of a more satisfactory prose-
cution of the subsequent steps of the operation.

312 Glycerine as an Internal Remedy. P^y*

In making the incisions in the congealed part, Dr. W. had ob-
served it necessary to be rather more careful to maintain a firm
hold of the knife, and to employ more force than in cutting the
integument in its natural condition ; otherwise the knife would
slip off, and make an incision at some point not intended ; this is,
however, avoided by a little practice.

There are many cases to which the freezing mixture may be
applied, but for more elaborate details reference must be made to
the publications of Dr. Arnott, and other gentlemen abroad. In
Europe this subject is at present attracting great attention, on ac-
count of the continued increase of deaths from chloroform. [Bos-
ton Med. and Surg. Jour.

On the use of Glycerine as an Internal Remedy, By J, L, Craw-
cour, M. D., of New Orleans.

I wish to draw attention, particularly at present, to the special
action of glycerine on the economy, and the perfect safety with
which it can be used as an internal remedy. For the past twelve
months I have used it in every case of disease where formerly I
should have used cod liver oil, and with superior benefit; for
while it seems to possess all the remedial virtues of this latter
agent, it is its superior in taste, in not disordering the digestion,
and in its property of combining with any other remedy.

In several cases of phthisis, of scrofulous disease generally, in
mesenteric disease in children, I have used it largely and success-
fully * and in children, its sweet and agreeable taste gives it a great
advantage over cod liver oil, the only agent I can compare it with,
in its therapeutic action. In addition to its special anti-strumous
property, I find that it materially aids in the assimilation of salts
of iron, especially of the iodide, and I now rarely order either
iodine, or the iodide of iron, without combining them with glyce-
rine. Quinine also, is soluble in it, without the aid of sulphuric
acid, and to some slight extent is divested of its bitterness.

The dose in which I usually administer it is from one to three
drachms three times daily, in an ounce of water ; in from one to
two drachms, it, in a short period, relieves the cough, improves
the digestive powers, and appears to increase the fat-producing
principle in phthisical patients ; in larger doses it has in a few in-
stances produced nausea ; it is, however, essentially necessary to
its successful employment that it be obtained pure, and this is a
matter of some difficulty, for it is ordinarily the result of the pre-
paration of the common lead plaster, and consequently contains
traces of lead, but by the process of Dr, Morfit, who decomposes
lard, or oil, with hydrate of lime, it can be procured chemically
pure, and at a very cheap rate. Should my communication in-
duce other physicians to try it, the purpose of my writing to you
will be answered, as it will be an equal boon to the physician and

1855.] Treatment of Diarrhoea by CJiloric Etiier. 313

patient, if a remedy can be discovered equal in properties to cod
liver oil and without its nauseous taste and smell.

I have recently tried it as a solvent for phosphorus, which latter
we have hitherto hardly been able to use in medicine, as its solu-
tion in oil is so nauseous that we can rarely induce patients to
swallow it, and its solution in ether is so dangerous that I ques-
tion whether any physician of ordinary prudence would prescribe
it. But in glycerine", it is not only nearly as soluble as in oil, but
is miscible with water in all proportions, and is comparatively
tasteless and odorless. About two grains dissolve readily in an
ounce of boiling glycerine, and from experiments on myself, I
consider it a powerful and a valuable stimulant. Of the above
solution, which, after the nomenclature of Messrs. Cap and Garot,
I would call the glycerole of phosphorus, I took one drachm in a
wine-glassful of water, with which it intimately blended; there
was hardly any taste or smell, and it did not produce those gar-
licky eructations said to be the result of the phosphorus in oil. Its
effect on my system was that of a stimulant : in about half an hour
the pulse became quickened, both at the wrist and at the temples,
the cheeks flushed, the skin became warm and suffused with mois-
ture, there was a certain amount of mental excitement, and after a
short time there occurred a feeling of oppression at the praecordia,
accompanied by palpitation of the heart, while after a certain time
the cerebral excitement was followed by a slight feeling of confu-
sion, accompanied by sleeplessness. Each time that it has been
taken in this dose, it has, on myself, produced these same effects.
I therefore look upon this quantity as excessive, and would sug-
gest that if this remedy be used, it should be in doses ranging from
ten to thirty minims. It may be combined with any other drug,
and I look upon it as a valuable addition to our list of therapeutic
agents; not that the use of phosphorus is new, but hitherto it has
been excluded from us from the difficulty of finding a proper solv-
ent this now, I believe, has been discovered in glycerine. [New
Orleans Mea\ News and Hospital Gaz.

Treatment of Diarrhoea by Chloric Ether. By Geo. B. Mead, Esq.

"We often find that many cases of diarrhoea resist all ordinary
treatment, opium amongst the rest. In 1846, 7, and '8, an epi-
demic prevailed at Bradford, Yorkshire, which was attended by a
diarrhoea of an intractable nature.

This diarrhoea was combined in many eases with vomiting and
spasmodic pain of a very distressing character. We had very
little difficulty in treating those cases in which pain was absent
but we found a certain proportion in which the diarrhoea obstin-
ately continued despite the use of a multitude of remedies ; and
the pains, though temporarily relieved by the use of opium, re-
turned directly the narcotism passed off; the opium suspended,

314 Treatment of Diarrhoea by Chloric Ether. [May,

but did not remove, the spasms. At length we adopted the fol-
lowing formula :

ty. JEtheris chlorici 3ij.; speciei pro conf. arom. 3ss. ; misturae
cretce composites ad ?vj. M. Fiat mistura.

The fourth part was directed to be taken directly by an adult,
and repeated every half hour, or at still longer intervals, according
to the severity of the attack, and its effect upon the patient. Oc-
casionally, opium, either in the solid form or the tincture, added
to the mixture, was given ; but this was seldom necessary, and I
think every case would have recovered without its use. The effect
of the ether in every case was marvellous. The spasms and pains
were relieved, as if by a charm ; the diarrhoea ceased ; warmth
returned to the extremities; the pulse, before perhaps nagging,
increased in force and volume : one bottle never failed to relieve,
or two to cure even the worst cases in which all other plans had
failed. The relapses were infrequent, and were generally checked
at once by a single dose. After the introduction of the chloric
ether, we had no further trouble with diarrhoea. The medical
man in whose practice this occurred is since dead ; otherwise I am
sure he would have felt great pleasure in confirming this state-
ment. Often has he expressed to me his high opinion of the
efficacy of the ether in cases of diarrhoea combined with spasmodic
pain. After this, at the time the cholera last visited this country,
I was residing with Dr. Morris, of Spalding. It reached Boston.
Great alarm existed in Spalding, and the public were fully aware
of the importance of checking the premonitory diarrhoea which
began to prevail, and was exceedingly troublesome in many cases
to check. Recollecting the ether, I ventured to suggest its use.
My friend acquiesced. It was tried, and in not one case failed.
As at Bradford, hundreds of cases in which alarming cramps ex-
isted wrere cured like magic ; none ran on into Asiatic cholera,
though many appeared to be on the verge of it, or, at any rate,
were equal to those of English cholera of the severest character.
So prevalent was the diarrhoea, that the surgery was thronged
from morning to night by applicants for medicine ; the policemen
in the streets, sailors in the vessels on the river, travellers upon
the rail, were equally affected : the cause was evidently ubiquitous,
whatever it might be.

At last, one morning early, I was summoned in haste to a pa-
tient, an old woman, residing in one of the most unhealthy locali-
ties in Spalding. I found her presenting unmistakable signs of
labouring under Asiatic cholera in an advanced stage ; she was
blue, almost pulseless, and the cramps were of a violent character.
I had seen English cholera in its worst and most fatal forms, but
never aught like this. I have a vivid recollection of the scene,
and remember well I stood as it were aghast at the sight of her
agonies. Having directed her attendants how to act, I instantly
returned home, and sent a mixture, increasing the dose of ether,
but with very little hope of success. I ordered it to be given at

1855.] Remedies for Stomach Disorders. 315

very short intervals, and, in the course of an hour or two, saw her
again, in company with my friend. We were delighted and sur-
prised to find her greatly improved. We continued the remedies,
and by the evening she was out of danger. Symptoms of relapse
appeared several times during the next day or two, but were at
once checked by the use of the remedy. The patient, though
advanced in years and greatly debilitated, having led a somewhat
irregular life, completely recovered, and died about a year after-
wards, of a totally different complaint. The remedy obtained
quite a notoriety in that locality ; to such an extent was it used,
that we were told by an extensive wholesale druggist he had sold
more to us than to all the rest of his connexion put together.

A gentleman travelling by the Great Northern Railway was
attacked by severe diarrhoea. He got out at Spalding, and con-
sulted Dr. Morris, who prescribed this remedy ; it at once relieved
him. In conversation, he mentioned to him how valuable he had
found it in the treatment of diarrhoea. On his return home, the
gentleman told his usual medical man of the circumstance ; and
he, in consequence, was induced to try it with great success.

In 1850 and 1851, I was again residing in Yorkshire, and there
saw much diarrhoea. I used the ether extensively, and never
found any case in which it was properly administered where it
failed ; indeed, I recollect some equally striking cases with those I
have enumerated, in which it might indeed be said to have acted
like a charm. I could refer 10 many of my medical friends who
have used it upon my recommendation, and whose experience,
after numerous trials, has strongly corroborated my own. Though
I have used it in at least fifteen hundred cases myself, and indeed
I think not improbably three thousand cases, I have never yet
found it fail. [Association Med. Jour., and Braithicaite's Retrosp.

On some Remedies for Stomach Diseases. By Dr. Geo. Budd, F.R.S^
Professor of Medicine in King's College.

In his 8th lecture on disorders of the stomach, Dr. Budd makes
some useful remarks on the use of the mineral acids in various
kinds of indigestion. But these have been so well treated of by
Dr. Prout and others, that we will here only give Dr. Budd's re-
marks on vegetable bitters.

Quinine, and the bitters generally, are especially grateful to
persons who have injured their stomachs by hard drinking. With
such persons they improve the appetite and strengthen digestion,
and have a bracing effect upon the system at large.

In persons exhausted by over-work, or wherever weakness of
the stomach is the result of general debility from other causes,
they often do much good in the same way by improving the appe-
tite and strengthening the digestion.

o o o

They do harm in the organic diseases of the stomach ; in ple-
thoric states of the system ; and generally where there is a furred

316 Remedies in Stomach Disorders. [May,

tongue, or where the urine throws down a sediment of lithic acid,
or of lithate of ammonia. Their most striking effect is, to improve
the appetite, when this has been impaired from hard drinking, or
from over-work, or from nervous exhaustion from other causes ;
and the best time for giving them is from half an hour to an hour
before meals.

The different bitters have not precisely the same effect. Ca
lumba has a sedative influence not possessed by the others, and
probably on this account has had a wider reputation as a remedy
for mere indigestion. Gentian and chiretta (which is of the gen-
tian tribe, and is much employed by practitioners in India) tend
to increase the secretion of the liver, or, at any rate, do not im-
pede the secretion of the liver, which quinine and quassia seem
often to do. They are, therefore, better suited to bilious persons,
and to those cases of indigestion where the secretions of the liver
are defective.

The different preparations of steel are especially useful in the
indigestion that occurs in chlorosis, and generally where weakness
of the stomach results from anaemia.

They do harm in plethoric states of the system, and generally
where there is a furred tongue, or where the urine throws down a
sediment of lithate of ammonia or of lithic acid.

The citrate, or ammonio-citrate, is the most agreeable prepara-
tion to the taste, and generally the most grateful to the stomach.
If there be any disposition to sickness or nausea, or any tendency
to furring of the tongue, it may be given in conjunction with the
bicarbonate of soda or potash. This makes a mixture having much
the same effect as Griffith's mixture, the mistura ferri composi-
ta, and far more agreeable.

The muriated tincture of iron is more astringent than the other
preparations, and may be given in conjunction with dilute muri-
atic acid, in the forms of indigestion suited to this latter medicine,
when these exist in states of anaemia.

The sulphate of iron, like other metalic sulphates, has a tenden-
cy to cause sickness, and should not be given in cases where a
disposition to sickness exists.

Steel medicines do good by improving the quality of the blood
rather than by their immediate action on the coats of the stomach,
and are best given at meal-times. They then are mixed with the
food, and gradually absorbed with the products of digestion, and
are less apt to offend the stomach and to cause headache than at
other times.

Whenever steel medicines are given, it is essential that a regu-
lar action of the bowels be kept up. These medicines tend to
confine the bowels and to cause evolution of sulphuretted hydro-
gen in them ; and unless this tendency be counteracted, they are
apt to fur the tongue and cause headache.

The choice of purgatives is a very important matter in stomach
disorders. The different purgatives exert their chief action on dif

1855.] Chloroform in Tetanus. 317

ferent portions of the intestinal canal : some excite the secretion
or the peristaltic movement of one part, some of another. In dis-
orders of the stomach and bowels, where a purgative is required,
care should, therefore, be taken to select those which are least
prone to irritate the injured or disordered part.

Castor-oil, for example, offends the stomach, but acts very
mildly on the large intestine. It should not be used in stomach
disorders, or where, from any cause, a tendency to vomiting ex-
ists ; but is better than any other purgative in dysentery, or dur-
ing convalescence from typhoid fever, when the intestines are ul-
cerated, and in various other conditions where a speedy and sure
purgative, and one not apt to irritate the large intestine, is re-
quired.

Senna acts chiefly on the small intestine, and, besides exciting
its peristaltic action, increases the secretion from its mucous mem-
brane. It acts, also, on the liver, increasing the secretion of bile.
In conjunction with a few grains of calomel or blue- pill, it is, as
every one knows, one of the best purgatives in bilious states of
the system, or where an evacuant is required ; but in mere disor-
ders of the stomach, it is often objectionable, from the tendency it
has to cause sickness.

The best purgatives in stomach disorders are aloes and colocynth,
which exert their chief action on the large intestine. These medi-
cines may do much harm when the large intestine is ulcerated or
inflamed; but in simple ulcer of the stomach, and in the most se-
vere functional disorders of the stomach, they may generally be
given without causing either paiu of the stomach or sickness. In
some kinds of functional disorder of the stomach, aloes seem, in-
deed, like other bitters, to improve the appetite and strengthen
digestion.

Aloes appear to act more exclusively on the large intestine, and
irritate the stomach less than colocynth, and hence, in stomach
disorders are generally preferable to it.

"Where, from the existence of piles, or from pregnancy, or some
other condition, these medicines are objectionable, the best substi-
tutes for them in stomach disorders are the saline purgatives, which
exert their chief action on the small intestine, and have little ten-
dency to cause pain in the stomach or sickness. [Jfed. 'Times and
Gazette, and Ibid.

On the Use of Chloroform in Tetanus,
In the 'Medical Times and Gazette' will be found a very inter-
esting series of reports of cases of tetanus, forty-three in number,
of which eleven recovered. The editor makes some good remarks
on the use of chloroform as follows :

The following propositions appear to be warranted respecting
it:

1. That, in the great majority of cases, inhalation of chloroform
may be practised with safety as regards immediate consequences,

318 Cancer and Tubercle. [May,

2. That it is always effectual in allaying spasm for the time.

3. That it exerts, however, no preventive influence whatever,
the spasms usually returning, with even increase of severity, very
shortly after its suspension.

4. That its continuous administration over long periods of time
is not to be recommended, since the patients sink at least as fast,
if not faster, than when the disease is allowed to display itself.

5. That it is of great benefit in certain protracted cases simply
<as an alleviant of the pain. In some of these it will procure rest
for periods often of an hour or more after the suspension of the
inhalation, and acts altogether much more favourably than in the
earlier stages.

6. That, in certain protracted cases, it is of the greatest use in
enabling a patient, while in a state of half-insensibility, to take
food, who would otherwise be unable to swallow.

7. That, excepting for the two last-named purposes, its use does
not seem to be attended by any commensurate benefit, while it
may much interfere with the action of other remedies, and, very
possibly, be actively injurious itself.

These conclusions must be understood to apply only to chloro-
form inhalation, since, from the cases published, there appears
reason to believe that the results of that of ether have been more
favourable. As, however, the latter agent has not been, of late
3Tears, used in London, we have no means of judging as to the
proportion of cases in which it did not relieve, or whether in any
it appeared injurious.

It may be worth a thought whether the employment of anes-
thetic vapours externally in cases of tetanus might not promise
some benefit. The spasms are for the most part reflex, and exci-
ted by peripheral irritants. A bath of vapour might be easily
given by covering the bed with an impervious material, and ex-
posing beneath the clothes a sponge saturated with ether. The
patient's head should of course be left out, and the clothes well
tucked in round the neck.

These cases show the relative value of other modes of treatment.
Two cases recovered under the use of belladonna: two cases
showed the uselessness of tracheotomy : one recovered during the
exhibition of sesquioxide of iron and Dover's powder. In several
cases Indian hemp seemed useful. In one case nicotine controlled
the spasm and repressed constitutional disturbance. On the whole,
vegetable sedatives seemed most beneficial. [Medical Times and
Gazette, and Ibid.

An Example of the Concurrent Development of Cancer and Tubercle.
By Septimus Wm. Sibley, Esq., Kegistrar to the Middlesex
Hospital.

There has been a good deal of interest excited of late by the
opinion that cancer and tubercle could not co-exist in the same

1855.] On Htematemesis. 319

subject at the same time. We have seen several cases reported
which made this opinion doubtful, but the following seems con-
clusive. It may, however, be true, generally, that tubercle and
cancer do not co-exist, but it is evident that there are excep-
tions.

This was the case of a woman, aged 48, admitted into the Mid-
dlesex Hospital, with a sloughing cancerous sore in the left breast ;
there was a hard tumour on the inner side of the size of an orange,
and several small nodules of cancer at its edges. In the course of
five days after her admission nearly the whole of the remaining
portion of the tumour sloughed away, leaving a clean looking
surface, which immediately began to cicatrize. Subsequently,
pulmonary symptoms became developed, profuse expectoration
followed, and she sank and died three months after her admission.
On making a section of the structure of the left breast, it was seen
to be an extremely dense form of infiltrating scirrhus, traces of
breast tissue, such as ducts, being very apparent. In the thorax,
large masses of tuberculous lung tissue were observed. Tubercu-
lar cavities existed in the apices of both lungs; a part of the lower
lobe of the right lung was m a state of grey hepatization, and the
bronchial tubes were thickened and dilated. In the left pleura
were numerous crude tubercles. On examining the dates of this
case, positive proof was obtained that a cancerous tumour was
increasing in the breast simultaneously with the increasing of tu-
bercular disease of the lungs, and that for a period of at least six
weeks. The author thought that a single instance of the concur-
rent existence of these diseases was sufficient to destroy the doc-
trine of the absolute incompatibility of tubercle and cancer with
each other. [Lancet, and Ibid.

On H'lymatemesis. By Charles Neate, Esq., Uttoxeter.

In a case of ha?matemesis which resisted the usual remedies of
acetate of lead and opium, sulphuric acid, turpentine, kc, Mr.
Neate was successful, as follows:

I was now induced to try ergot of rye, and commenced by giv-
ing him a drachm and a half of the powder, divided into eight
doses ; one to be taken every four hours ; and to omit the other
medicines.

loth. Better ; has vomited no more blood since taking the se-
cond dose.

16th and 17th. Very much improved; no return of blood, ex-
cept in expectoration, which is rather sanguineous. To continue
ergot.

20th. All the distressing symptoms have entirely disappeared,
and there is no tinge of blood whatever in expectoration ; indeed,
from this time he very rapidly convalesced, and, with the assist-
ance of wine and nutritious diet, gradually recovered strength, and
is now able to do light work.

320 Cicatrization cf Recent Wounds. [May,

Remarks. Now, in this case the ergot has shown itself as pos-
sessing considerable virtues, and evidently of an entirely specific
nature. At any rate there is one recommendation to its use, that
it is neither an excitant nor a stimulant. [Ibid.

Upon the Cicatrization of recent Wounds produced by Caustic. By
Dr. GlROUARD.

Dr. Girouard, of Chartres, read before the Association Medicale
d'Eure et Loire, Feb. 27, 1854, an interesting essay, purporting
to show in what manner recent wounds produced by caustic,
healed, and how unseemly or inconvenient cicatrices might be pre-
vented. Old wounds do not pursue quite the same course as
recent ones.

After the application of caustic (Vienna paste, &c.) to the integu-
ment of a thin subject, the edges of the wound, when burnt per-
pendicular^ from the surface, become thinner from the very day
of the separation of the eschar ; the day following they form an
inclined plane; and a ring of granulations, one line wide and of
deeper red colour than elsewhere, forms a zone on the free margin
of the wound. On the fourth day the zone becomes narrower and
whitens, and forms a cicatrisial membrane ; then a new red zone
is developed within the preceding, and thus the wound becomes
smaller from day to day. In fat subjects, in whom the areolar
tissue is charged with adipose matter, the edges of a similar wound
undergo but little or no thinning; they round themselves; the
adipose membrane swells, becomes covered by granulations ; the
zone then forms, and, rising to the surface of the wound, pursues
the same course as above described. When the edges of the wound
are so burnt or cut as to be oblique, the cicatrisial zone pervades,
it is true, all the phases of the work of healing, but the skin,
loosely connected to the subjacent parts, is dragged towards the
centre of the wound. The cicatrix becomes in time condensed
and contracted.

The daily diminution of the size of the wound always corres-
ponds with the white of the zone namely, two to three millime-
tres, or one line to a line and a half. Centres of cicatrization oc-
cur only in old wounds.

By constantly destroying with caustic the cicatrisial zone, the
process of healing is permanently arrested ; and unseemly con-
tractions may be avoided first, by limiting the cicatrising pro-
cess to situations where the contracting force of the granulation
can exercise no inconvenience; secondly, in so arranging the
shape of a wound that the extremities of the cicatrisial radii ter-
minate in very loose and extensile tissues; thirdly, in so shaping
the edges of the wound that the contracting forces neutralize one
-another. The Mayor of Ponthevrard had on the lip a cancerous
growth, which was removed by caustic. The eschar separated on
the eighth day. By means of escharotics, the cicatrisial zone was

1855.] Live Birth at Four Months. 32l

continually destroyed along the line of wound corresponding
with the external integument : the mucous membrane was, then,
the part furnishing the cicatrisial granulations ; and as contraction
was confined to that side of the wound, the mucous membrane
was drawn outwards, so as to form a very perfect lip. [British
and Foreign Medico- G hi rurgicoX Review.

Live Birth at Four Months.

Mrs. R. menstruated on the 8th February, and quickened 8th
June. On the 17th June a foetus was expelled, which weighed
exactly nine and a half ounces, and measured eight inches in
length ; its placenta weighed six ounces. The eyelids were adhe-
rent, the nose and mouth closed, the membrana pupillaris entire.
The lungs, in colour and volume resembled those of an early foetus,
and, with the exception of one or two ecchymosed spots, no colour
or other evidences of developed air-cells were noticed, all the ap-
pearances indicating that no air whatever had reached the tissue
of the lungs.

The pulsations of cord, which were vigorous, were allowed to
continue for some time, in order that the reflex movements of the
limbs, face, and respiratory muscles might be observed. On touch-
ing the hands or feet, or blowing upon the face, a convulsive
movement of the limbs or respiratory muscles followed. "When
the pulsations of the cord had fallen to ninety beats, it was divided,
and about a drachm of blood suffered to escape; the heart's action
immediately became quicker, and one or two thoracic convulsions-
followed. The rerlex movements gradually became more feeble,
and ceased in about an hour.

Dr. Keiller, who related this case to the Edinburgh Obstetrical
Society, pointed out the medico-legal relations of this case. They
are obviously important. [Edinburgh Monthly Journal.

MISCELLANY.

Saccharized Alcoholic Extract of Ipecacuanha. Mr. A. G. Dunn, in the
*New York Journal of Medical Science,' recommends the employment of a
saccharated extract of ipecacuanha in preference to the usual preparations
of the drug, such as the wine and syrup, which he considers liable to vary
in strength ; and the powder is, he thinks, objectionable, from its insolu-
bility. The following is the formula for preparing the extract :

Rad. ipecac, giv. ; bruise to a coarse powder, and macerate for thirty
days in f fxvi. of diluted alcohol, shaking it occasionally, then filter and
express. Evaporate the tincture thus formed to gii. with which mix pow-
dered white sugar gviij., and triturate them in a mortar until they become
dry.

The extract thus prepared has the peculiar odour and taste of ipecacuan 'r
it is of a brownish yellow colour, and soluble in water, ether, alcohol, mu-
cilage of acacia, and in fact, in all the solutions with which this remedy i

822 Miscellany. L^a}f,

usually combined. The dose required to be exhibited is the same (twice
as much) as the genuine powdered root. From its agreeable taste and
perfect solubility in fluids, it is much preferred to the other preparations of
the drug, by those who ha\re employed it ; more especially in prescribing
for children, for whom its sweet taste renders it an excellent form for com-
bining with other remedies. [Dublin Hospital Gazette.

Inga : a nevj Astringent. 'This substance enjoys a reputation as an astrin-
gent and tonic in some European countries, and also in America. The
bark is compact and heavy, and its fracture presents alternate layers of
white and red. When chewed it is found to be astringent to the taste, and
quickly imparts a red hue to the saliva. It is rich in extractive principles.
The alcoholic extract resembles that of rhatany, both in its color and gene-
ral properties. In America inga is extolled as an astringent tonic in
diarrhcea, in gonorrhoea, in haemoptysis, in incontinence of urine, and in
relaxation of the tissues. As an antiseptic its powder has also been used
in the same instances as cinchona. Some trials already made in Paris
appear to justify its reputation and its claim to take rank in our Materia
Medica. [Ibid.

Iodide of Potassium with Ammonia. An opinion prevails at Guy's Hos-
pital, that the efficiency of the iodide of potassium is very much increased
by combining with it the carbonate of ammonia. The proportions we usu-
ally observe prescribed are, two to three grains of the iodide with four to-
five of the ammonia. Dr. Gull, who strongly advocates the combination,
explains to his class that he believes the ammonia to act in three ways:
1st. As a gentle stimulus to the stomach, preventing the iodide from disa-
greeing. 2d. As a diaphoretic, diffusing the blood, and with it the remedy,
well through the whole system. 3d. By chemical decomposition, itself
being changed into nitric acid, and then by combination with the base of
the salt, liberating the iodine in its free form. [Med. Times and Gax.

JEpilepsy treated by the Bark of Black Elder Tree. The emeto-cathartic
and hydragogue properties of the second bark of black elder (sainbucus
nigra), have long been known, and used in various forms of dropsies; but
no meution has hitherto been made of the employment of this substance
in the treatment of epilepsy. M. Bogetti relates five examples of cure ob-
tained by this remedy alone. In order to prepare it for administration, the
branches of the elder, of one or twro years, are taken ; the grey bark is re-
moved, and the second bark which remains is scraped off. Abont five
ounces of common water, hot or cold, are poured upon two ounces of the
bark, and the infusion is allowed to stand forty-eight hours. The infusion,
properly strained, should be taken at intervals of a quarter of an hour for
certain number of times when the fit is threatening, the patient fasting.
It should be resumed every six or eight days. [Rev. Thcrap., and Ibid.

The Venom of Serpents. Dr. J. Gilman arrives at the following con-
conclusions : 1. That tbe vemon of all serpents acts as a poison in a simi-
lar manner. 2. That the venom of some varieties is far more active than
that of others. 3. That a variety of the coluber, known as the "cotton-
mouth," is the most venomous serpemt in Arkansas. 4. That the vemom
of serpents destroys all forms of organized life, vegetable as well as animal,
5, That alcohol, if brought into contact with the venom, is, to a certairt

1855.J Miscellany. 323

extent, an antidote. 6. That serpents do possess the power of fascinating
small animals. 7. That the blood of small animals destroyed by the venom
of serpents, bears a close resemblance to that of animals destroyed by light-
ning or hydrocyanic acid : ir loses its power of coagulation, and cannot be
kept long from putrefaction. [*S7. Louis Med. Journal.

X- ' Broth for the Sick. Dr. Thudicum exhibited to the Medical Socie-
ty of London, Dec. 9th, a new broth for the sick. To prepare this broth,
half a pound of the flesh of a recently-killed animal (beef, or the flesh of a
fowl) is chopped fine, and well mixed with a pound and an eighth of dis-
tilled water, to which four drops of pure muriatic acid, and from a half to
a drachm of common salt, have teen added. After an hour, the whole is
thrown on a common hair sieve, and the fluid is allowed to run off without
pressure. The first portion, which is turbid, is poured back, until the fluid
runs off quite clear. On to the fleshy residue in the sieve half a pound of
distilled water is thrown in small portions. In this way a pound of fluid
(cold extract of meat) is obtained, of a : . and an agreeable taste of

broth. The sick are allowed to drink a cupful cold at pleasure. It must
not be heated, as it then becomes turbid, and deposits a thick coagulum of
animal albumen and baematin. The broth possesses great advantages over
other preparations of meat, from containing albumen, and being remarka-
bly easy of digestion. [London Lancet

Dropsy Diuretic Wine. M. Grand, phermacien, publishes in the Re-
pertoire de Pharmacie, for June. 1854, the following formula for diuretic
wine : sliced bulbs of squill, eight parts ; powdered digitalis, eight parts ;
canella, twelve parts: acetate of potassa, fifteen parts; Madeira wine, five
hundred parts. Macerate for eight days and strain. The dose is half an
ounce which may be increased to a wine glassful daily. [Fir. Med. and
Surg. Journal.

Herpes Ointment. Dr. Quintanilla announces in the Bulletin de 1
cina, that he lias succeeded in curing a large number of obstinate herpetic
eruptions by the following ointment : R. Of powdered cinnabar, 4 parts ;
sublimed sulphur. 2 parts; laudanum, 2 parts: fresh butter, 32 parts: with
a few drops of essence of mint. The diseased surface should be carefully
cleansed with warm soap water thrice daily, and then covered with oint-
ment. [Ibid.

Nitric Acid in Hooping Cough. Dr. Gibb, in a recent work on this dis-
ease, recommends very highly nitric acid given as follows : R. acid nitric,
dilut. (Lond. Phar.) 5xij; cardam. co.. 5iij; syrup simplex, siijss; aqua,
j. M. Dose, a dessert spoonful every hour or two to a child two years old,

X. Y. Journal of Medicine.

Solidified Milk. This is made by adding to 112 lbs. of fresh milk, 28
lbs. white sugar, and a teaspoonful of bi-carbonate of soda. It is then
evaporated in a water-bath at a moderate temperature, being stirred and
agitated all the while, but so moderately as to avoid churning. In three
hours it assumes a pasty consistency, and by constant manipulation and
wanning, it is reduced to a rich, creamy-looking powder. It is then ex-
posed to the air to cool, weighed into parcels of a pound each, and pressed
into a brick-shaped tablet, which is covered with tin foil. This will keep

324 Miscellany.

for any length of time, and may be grated and dissolved in water for use,
answering all the purposes of ordinary milk, even to the making of butter.
Our ships and steamers will find this solidified milk convenient and econo-
mical, and it may come into general use in cities. It is particularly con-
venient for use in sick-rooms and hospitals. [Memphis Med. Recorder.

Tinnitus Aurium. In cases of this troublesome affection, attended by
itching in the meatus, a scanty secretion of wax, and some degree of deaf-
ness, we have succeeded in affording relief, by the application of the spirit
of nitric ether, a few drops of which may be poured into the ear, or the
meatus may be moistened with it, by the use of a little cotton, or lint, on
the end of a probe. [Ibid.

Podophyllin. This active proximate principle is strongly recommended
in the Boston Journal, by Dr. Bates, of Otsego, New York, as an alterative
and secernent, making it a valuable substitute, in many cases, for mercury.
Obstinate and habitual constipation has yielded to the daily use of one-
eighth of a grain for one to six months, ft. Podophyllin, gr.j.; ipecac*
pulv., ext. colocynth comp., aa grs. iv.; mueilag. q. s. m. ft. pil. viij. One
to be taken every night. ft. Podophyllin, gr. j.; ipecac, pulv. grs. v.; hyos-
ciami ext., q. s. M. ft. pil. xx. One to be taken every night and morning.
ft. Podophyllin, gr. ss.; sach. alb. pulv., 3ij. M. Divide into 24 to 32 pow-
ders. One to be given to an infant every night. [Ibid.

Lactate of Iron with Antispasmodics in some Neuroses. Dr. Marchiandl
has found the following formula very useful in neuroses, dependent upon
onanism gastralgia, epilepsy, etc. ft. Valerianate of zinc 3ij ; lactate of
iron, 3iss; ext. belladonna, 3ss; ext. valerian q.s., to make 60 pills ; patient
takes two for the first two days, and afterwards gradually increases the
dose. [Ibid.

Chronic Papular Eruptions. Dr. Burgess considers them to consist of
disorders of the cutaneous nerves, and prescribes, in severe cases of prurigo,
strychnia and phosphorus ; he has found phosphorated ether, preceded by
repeated doses of hyosciamus for a day or two, succeeded in allaying obsti-
nate pruritus, given internally. [Ibid.

Epilepsy. In a communication to the Medical Times and Gazette, Dr.
Sieveking details seven cases of epilepsy treated with the cotyledon um-
bilicus, and concludes that this medicine seems to possess the power of
mitigating this dreadful disease if it is not able to produce a perfect cure.
He uses the liq. cotyl. umbil. in drachm doses three times a day, but con-
tends that it is impossible to account for the modus operandi, as its effects
on the system are hardly recognizable, though he classes it with digitalis,
producing a slightly diuretic and sedative effect. [Virginia Medical and
Surgical Journal.

Gangrene of the Lung. Dr. Bowditch of the Massachusetts General
Hospital reports a case of gangrene of the lung cured under his treatment.
The patient came in on November 22d and was discharged December 29th.
She had all the symptoms of this usually fatal disease, and was treated
with the liquor soda chlo?-in., in ten drop doses, repeated frequently, and
anodyne inhalations ; a generous diet being superadded. [Ibid.

SOUTHERN

MEDICAL AID SURGICAL JOURNAL.

Vol. XL] NEW SERIES. JD\E, 1855. [No. 6.

ORIGINAL AXD ECLECTIC.

ARTICLE XIII,

Tv:o Cases of Aneurism of the Aorta. Case of Enlargement of the
Bronchia! Glands, simulating Aortic Disease.-^ Case of Wound of
the Aorta. By James Mercer Greex, M, D., of Macon, Ga.

Believing that aneurisms of the aorta verified by dissection, are
sufficiently rare to justify the publication of the following cases,
I have transcribed them from my note-book for insertion in the
chirurgical records of the Society. The wet preparations of the
two cases are still in my possession.

As the third case narrated is also an unusual disease, and one
that causes much anxiety to the patient as well as the medical
practitioner, and is moreover difficult to distinguish from disease
of the aorta itself, I have thought proper to introduce it in con-
nection with the others; and, as a pendant to the whole, have
brought forward a remarkable case of wound of the aorta near
the heart, not only not terminating in death, but attended by
trifling inconvenience.

1. Case of Sacculated Aneurism of the Aorta opening into the (Eso-
phagus. Oily, a mulatto woman, aged 40, died recently of aneur-
ism of the aorta, "When about 15 or 16, she contracted syphilis
and by some accident or mismanagement was salivated so profusely
that she was several months in recovering, and ever after remain-
ed in delicate health ; complaining principally of debility, neural-
gic or rheumatic pains in various parts of the body, and of dys-

N. S. VOL. XL NO. VI. 21

826 Geee^, on Aneurism of the Aorta. [June,

peptic embarrassment of the stomach. She never became pregnant,
I saw her several months preceding her death and found her labor-
ing under the well-marked symptoms of aneurism of the aorta*
She had cough ; dyspnoea, sometimes amounting to complete or-
thopnea ; dysphagia ;. a sense of stuffing up in the chest, and pains
radiating about the chest in different directions. In addition to
these symptoms,, there was a decided enlargement, and a strong
pulsation, visible to the eye as well as perceptible to the touch,,
extending on the right of the sternum, from the cartilage of the
first to that of the fourth rib. The auscultatory indications were
extensive dulness and absence of the natural respiratory murmur
at the upper part and to the right of the sternum, and increased
loudness and development of the first sound of the heart,, diffused
over the same region. This cardiac sound was single, not double,
and louder than over the cardiac region itself. There were no
hruits or other stethoscopic phenomena present, though carefully
listened for ; nor were there any marked differences in the radial
pulsations. Her appetite was almost completely abolished at this
time. For the purpose of relieving her present sufferings,, though
with no expectation of doing any permanent good, morphine
was freely administered and a large blister applied to the chest
in front. After this period her symptoms abated ;. the sufferings
in the chest and the external pulsations of the aneurism diminished
considerably ; and at the time of her death, though feeble,, she was.
pretty comfortable, having a good appetite,, and was able to walk
about with facility in the upper story of the house she occupied.
Nothing particularly worthy of note occurred during the latter
weeks of her life, except that she spat up several pellets of bloody
mucus. At the moment the aneurism burst, she was sitting at &
window, and was suddenly heard to call for assistance. Her mis-
tress, who had been informed of the probable mode of her death,,
immediately ran across the yard and up stairs to her room, and
found her lying on her back, covered with bloodr which still welled
from her mouth. One or two thoracic convulsions were observed,
but she was already pulseless and unconscious. This occurred
about 10 o'clock, A. M., on the 15th of September, 1854.

Necroscopical examination. Six hours after death,, no morbid
appearances were noticed in the thorax or abclomenr except the
aneurism itself and a certain degree of enlargement of the bron-
chial glands,, and the effusion of a layer of fresh blood around
several of these bodies. The heart and large vessels were, with

1855.] GrREEN, on Aneurism of the Aortd* 327

the upper third of the sternum, carefully removed from the thorax,
for more minute examination. In doing so, however, a sacculated
extension of the aneurism above the sternum was accidentally cut
open, The heart was of natural size, and its cavities and the pul-
monary arteries and veins were all of natural size and appearance.
The aneurismal dilatation of the aorta commenced at its very
origin but about half an inch from that point, suddenly and greatly
increased in size, enlarging into a sac capable of holding an ordi-
nary tumblerful of fluid, This enlargement continued as far as
the region of the left subclavian, where it suddenly diminished to
a size about one and a half again as large as the natural calibre of
the aorta, and then tapered down in a fusiform manner for two
and a half inches longer. At this point the vessel resumed its
natural size, elasticity and appearance. The superior third of the
sternum formed the base of an anterior pyramidal extension of the
aneurism, the apex being towards the sac, and was attached to it
with the greatest strength and tenacity. Connected with this
large sacculus were three smaller sacculi, one flat round one, situ-
ated behind the upper margin of the sternum and entirely con-
cealed, and connected with the main one by an orifice i of an inch
in diameter. In this secret pocket of aneurism, the bone was de-
nuded and rough. Originating from the right side by a still smaller
orifice, a large thumbdike sacculus extended upwards along the
right margin of the sternum an inch above the sterno-clavicular
joint. The sternum was denuded in this pocket also; and from
the lower edge proceeded another extension, as large as a walnut,
down the right margin of the sternum. These different sacculi
were separated from the main one by stout diaphragms, in the
centre of which were the above mentioned foramina, and were
not gradual dilatations from these foramina, but separate cells di*
vided by perforated diaphragms. The walls and duplications of
this sternal portion of the aneurism were quite thick and of gutta
percha hardness and toughness. The greater portion of the aneur-
ismal sac itself was thin and in some places translucent, and full
of conchoidal elevations and depressions, The interior lining was
quite smooth and shining, with the exception of being dotted over
with a number of not very prominent atheromatous spots, There
were no long spicoloe or plates deposited under the membrane.
The innominata and left carotid originating from the upper part
of the right subclavian, from the dilated portion of the aorta, were
perfectly normal in size and appearance. There were no coagula

328 Greek, on Aneurism of the Aorta. [Junef

in any part of the aneurism except the secondary sacculi behind
the sternum, all of which were lined with fibrinous layers. Pos-
teriorly, the aneurism, seeking for the fatal outlet, impinged
against and compressed the trachea and oesophagus and was strong-
ly united to the latter on its left side. The opening in the aneur-
ism, which was quite round and not larger than a No, 4 catheter,
communicated with a small sac in the walls of the oesophagus-
{\ inch in diameter) which must have existed for a considerable
time, as the muscular structure was evidently absorbed, I judged
from the appearances that the aneurism must have been restrained
from rupture some time, solely by a portion of the mucous mem-
brane as large as the finger nail. The point of rupture into the
oesophagus- was fully as large as a half dime piece, and a little be-
low the level of the superior margin of the sternum,

2. Case of Sacculated Aneurism of the Aorta opening into the
(Esophagus. In this case the particulars of which I know nothing
more than the appearances presented by the heart and the diseased
vessel the man, who was a convict in our State Penitentiary,
died suddenly with a copious hemorrhage from the mouth while
engaged at his ordinary avocation that of a harness maker. The
Beart is considerably hypertrophied and dilated, and the aorta
itself unusually large at its origin, though completely filled by the
semilunar valves, which are very large and capacious. The aorta
itself, a very short distance from its origin, commences to enlarge
and immediately dilates into a pretty regularly shaped sac, capa-
ble of holding,, probably, a quart of fluid before it was contracted
by long continued maceration in alcohol. The aneurism reaches
its maximum of size in the arched portion of the vessel,, where it
must be four or five inches from the top of the arch to the oppo-
site part of the sac. Prom this point it gradually diminishes to
the place where the aorta was cut (about twelve inches from the
heart, measured over the greater circumference of the sac) and
there it is nearly double the natural size. The whole aneurism is
so thick with ossific plates and spiculas, particularly nearer the
heart, as not to collapse when laid on the table. In the upper and
more distal portions, the ossific plates are intermingled with and
replaced by very thick atheromatous scales. There are no lamela-
ted eoagula attached to any part of the interior of the aneurismal
sac. When the aneurism was connected with the trachea, the
latter had evidently formed a portion of its posterior wall for a

1855.] GrREEX, on Aneurism of the Aorta. 329

length of time, and at one point, as large as a finger nail was con-
siderably eroded, and at another place about an inch above this,
the same process had evidently commenced. The oesophagus had
apparently been attacked by the aneurism subsequently to the
trachea, and pretty much in the same manner as is described in
the preceding case, a sac being formed in its walls an inch in per-
pendicular diameter, but connected with the aneurism by a slit
of the same length, instead of a round orifice. There is no evidence
of muscular absorption, or that the centrifugal force of the aneur-
ism had been resisted by the mucous membrane, only there being
a pretty strong layer of muscular fibre round the point of rupture
which is of the size of a goosequilL

The aneurism, though three times as large as the one previously
recorded, had formed no connection with the sternum or with any
part of the bony walls of the thorax. The arteries which origin ated
from the upper part of the thoracic arc had been shaven off at
their origin, but seem to have been very little, if at all, dilated

I am indebted to my friend Dr. B. A. TThite, of Milledgeville,
for this pathological preparation, but do not know by whom the
post-mortem examination was conducted.

Remarks. In noting the considerations suggested by the struc-
ture of the first of these aneurisms, one is naturally struck with
surprise that no marked bruits were observed in a case where the
fluids had to traverse so many sharp angles and edges, although
they were situated at a distance from the main current of the cir-
culation, and the contents there, no doubt, somewhat in a quiescent
state. The most prominent consideration though, connected with
a study of the sternal portion of this preparation, is, that the sac-
culated prolongations were apparently the result of an active vital
growth, rather than the mere passive dilatation of a diseased vessel
yielding to the centrifugal pressure of the cardiac pulsations.
From their strength, thickness and toughness, as compared with
the resisting power of a healthy aorta, it would seem very impro-
bable that they were the mere result of dilatation. It seems sin-
gular that, while nature is erecting impregnable barriers in one
direction, she should be actively carrying on the destructive pro-
cess in another. In these very sacculi, the process of denudation
and ulceration of bone had commenced. What is the nature of

the influence by which bone is destroyed in aneurismal disease?

can it be the mere passive result of pressure?

830 Green, on Aneurism of the Aorta. [June,

3. Case of Enlargement of the Bronchial Glands, simulating
Aneurism of the Aorta, In narrating the particulars of the follow-
ing case, it is proper to mention the principal antecedents of the
gentleman's medical history, as throwing more or less light upon
the nature of the disease. From the age of ten to twenty-two,
he was the subject of frequent attacks of bilious remittent, ter-
minating in one of extraordinary violence and duration, in which
the patient, during the progress of his case, seemed to have passed
through the entire list of local inflammations that occur in fever.
He had, at one period or another of this protracted attack, the
symptoms of cerebritis, bronchitis, pleuritis, carditis and gastritis,
followed by acute inflammation of the- left shoulder joint, with
abscesses in the left axilla and under the left clavicle, and an im-
mense phlegmon extending down the back from the left scapula
almost to the sacrum. These symptoms were followed by rheu-
matism of the joints for several months, the whole attack lasting
half a year. This dreadful illness seemed to exhaust the liability
to fever in his system, but he became very subject to catarrh,
principally in the form of pharyngitis and bronchitis, and to
chronic rheumatism, of a mild character, in different parts of the
system, This led, finally, in his thirty-second year, to the depo-
sition of a small crop of tubercles in the upper lobe of his right
lung, indicated by a slight hemorrhage, hectic, respiration saccadee,
&c. By prompt change of climate, and other judicious means, he
recovered pretty well from this condition, when he was attacked,
in his thirty-second year, by the following train of symptoms:
Just before retiring to bed one night, he was seized with a marked,
but not very severe, feeling of dyspnoea; this wore off in a couple
of hours, and the next morning, on rising from bed, he was quite
free from it, While actively engaged at his usual avocations, the
same day, the sensation returned with such severity, combined
with a local sense of pressure behind and below the right sterno-
clavicular joint, that he was obliged to go home and assume the
recumbent posture. The affection increased, and became so disa-
greeable that he was confined to bed for several weeks. He des-
cribed the feeling as a local pressure, compressing the bronchus
more particularly, but distending the adjacent parts in every
direction, As his case progressed, however, the direction of great-
est pressure varied at different times ; at one time, it was upwards,
towards the root of the neck at others, downwards ; and then,
again, it returned to the right bronchus ; and at another period,

1855.] Green, on Aneurism of the Aorta. 331

still, it would be most remarkable in the supra-sternal fossa. This
pressure that he complained of was not continuously the same in
degree, but varied very much at different times; it was also al-
most always diminished in the recumbent posture, and increased
in the erect On turning the head briskly, far around, to the right
or left, but particularly the latter, the sensation of a lump, below
and behind the right superior angle of the sternum, was more
marked, and when not present in other positions became immedi-
ately evident, and when developed in this way would remain
present some time. He had a very notable degree of dyspha-
gia, the bolus of food being evidently impeded in passing the
point of greatest pressure ; but he remarked, always, that he al-
ways felt better after swallowing several times in succession, and
he frequently ate an apple, or something of that kind, merely for
that purpose. He also suffered a good deal from pains, radiating
about in different directions from the diseased point, principally
up the right side of the neck, and downwards, from the axilla, and
occasionally along the inner side of the right arm. At one time,
when the pressure was at its greatest height, he had a very evident
degree of cerebral congestion, and this, when he was lying down.
There were no congested veins or oedema perceptible about the
neck, face, arms, or any other part of the body, nor any external
glandular enlargements. On carefully examining the radial pul-
sations, no difference could be detected. There were no modifi-
cations of the sounds given out upon auscultation or percussion,
save the previously existing interrupted or saccadee respiration.

The treatment directed on the supposition that it was a small
aortic aneurism, compressing the right bronchus at its origin, and
impinging against the oesophagus and the adjoining large vessels
was, to assume the recumbent posture exclusively, and to live on
a very low diet, composed entirely of a little milk and dry toast,
three times a day ; also, to avoid mental excitement, and every thing
else calculated to increase the rapidity of the heart's action. Un-
der this regimen, though he emaciated and became very feeble, in
a few weeks the pressure diminished sensibly, and he gradually
gathered courage to walk about a little. Some of his medical
friends, supposing the symptoms might be caused by rheumatism
or neuralgia, blisters were applied repeatedly over the point of
pressure, and morphine was given, from time to time, to alleviate
the disagreeable sensations. From both of these measures he re-
ceived a great deal of relief, and particularly while under the

332 Green, on Aneurism of the Aorta. [June,

influence of a blister, he always felt better. He slowly, but not
regularly, improved in health, and gradually grew so much better
that he would lose sight of the pressure for a few days then for
a longer period then for a month, and at last would only feel it
after considerable exercise, or after a catarrh of some duration.
This increase of symptoms did not accompany every attack of
pharyngitis and bronchial irritation, but was manifestly connected
with them every now and then. During all this period, whatever
might be the degree of swelling of the inflamed glands, he always
felt better, or well, after a profound night's sleep. His general
health and strength, as well as the diseased sensations, were all
very much benefitted by a temporary sojourn in a cooler climate.
It is now over two years since the attack first commenced, and he
is in the possession of a very good degree of health, but still occa-
sionally feels the pressure of his old enemy, and always located
immediately below and behind the right stern o- clavicular joint.
It should be mentioned, as an item in the history of this case, and
probably an element in the diagnosis, that once, in the progress
of his case, he was attacked with a sharp rheumatism of the cellu-
lar substance, and ligaments about the right internal maleolus, and
that while laboring under this, he felt clearer of disagreeable sen-
sations in his chest than he had done for months.

Remarks. After this case had been under my observation for
two or three months, finding that the aneurismal symptoms made
no progress, I came to the conclusion that the disease was local-
ized inflammation and enlargement of the bronchial glands. Pro-
fessional opinions were divided between aneurism of the aorta,
emphysema of the right superior lobe and enlargement of the
bronchial glands. The diagnosis manifestly was confined to these
three.

In considering the disease with reference to aneurism, after the
time above mentioned, an adverse conclusion was arrived at main-
ly on the following grounds :

1st. That no local dulness had made its appearance. On the
contrary, a remarkably clear resonance was elicited on percussing
the upper part of the chest.

2d. The complete intermission that frequently occurred in the
symptoms and the apparent return to health at these times. Al-
though there is no doubt that, in many organic diseases strange
remissions and intermissions are noticed in the symptoms, and

1855.] Green, on Aneurism of the Aorta. 333

Bometimes in aneurism of the aorta, no indications at all of the
disease are observed until the fatal hemorrhage ; yet, it is highly
probable that when dyspnoea, dysphagia, and other evidences of
pressure are produced by an aneurism, they never come and go,
with the frequency and completeness met with in this case.

3d. Its manifest connection in repeated instances with catarrhal
inflammation of the large bronchial tubes, while it would, perhaps,
be a difficult task to point out a part or organ of the human body
that might not fall under the dominion of catarrh ; it may safe-
ly be asserted that aneurismal dilatation of the aorta is as little
liable to its influences as any portion of the organism, diseased
or normal.

Emphysema of the upper lobe of the lung was discountenanced,
by the absence of that persistent dyspnoea and dilatation of the
chest, which are necessary features of that disease. Although the
chest was clear on percussion, instead of there being an elevation,
there was a depression of the right subclavicular region. The
dyspnoea of emphysema is a continuous inflation and turgidity of
the thorax without evidence of any particular local pressure. This
individual could inspire and expire with perfect ease.

Having thus dismissed aneurism and emphysema, we arrive at
the diagnosis of enlargement of the bronchial glands.

As time wore on, this opinion became strengthened, and after a
year or two had elapsed, amounted almost to a certainty.

On the other hand, allowing the disease to be recurrent inflam-
mation and tumefaction of a bunch of the bronchial glands imme-
diately about the bifurcation of the trachea and the right bronchus,
the symptoms tallied very well with this supposition. Its connec-
tion with catarrh was in union with the glandular nature of the
affection, while the existence of pressure, without any dulness on
percussion, also agreed with this idea; the bronchial glands being
much more deeply seated than the aorta, would admit of a great
increase in size without producing an alteration in the natural
resonance of the chest. A very notable relation between catarrh
and tumefaction of these glands is probably an unusual feature of
this rare disease. If we admit that this diseased relationship was
once established between them and the mucous membrane of the
right bronchial tubes, it would always be likely to occur whenever
the patient contracted catarrh. In this person, the bronchitis al-
ways occurred on the right side, and was confined to the larger
tubes, It is highly probable that, in this case, the enlargement was

334 Green, on Aneurism of the Aorta. [June,

not of a tuberculous character, from its progress differing so re-
markably from the same disease in children.

Kheumatism, which comes in as a disturbing element in the
diagnosis and treatment of almost every chronic disease, played its
role here also. The remarkable relief experienced simultaneously
with the appearance of rheumatism near one of the ankle joints,
showed, in my opinion, not that the disease was solely a rheumatic
affection, but that the rheumatism, which, perhaps, is always de-
termined to or near a part, by the presence of a chronic disorder,
was removed for the moment to another locality. I have observed
that chronic disorder of the heart almost always determines rheu-
matism to that organ, and to the intercostal muscles and ribs in
front of it; and it is extremely probable that the tenderness and
pain accompanying tuberculous disease of the apex of the lung is
of the same character. The same may no doubt be said of much
of the pleuritic adhesion seen in tuberculous disease, i. e., that it is
the result of rheumatic inflammation.

In addition to the remedial agents previously mentioned, much
benefit was received from the free use of Scotch ale and cod liver
oil.

4. Case of Wound of the Aorta. I d, a consumptive, in a

drunken rencontre, was stabbed by his opponent in the supra
sternal fossa, with a long narrow bladed knife. The external
wound was small, accompanied by no hemorrhage and soon healed

up. I d, died in something over a month afterwards, of his

internal disease and of the irritation of several other cuts received
in different parts of his body, and a post-mortem was made by
Dr. J. B. Wiley, in presence of Drs. Baber, McGoldrick and Guy-
ton. On elevating the sternum, attention was drawn to a hard
round ball attached to the aorta, in front, at the beginning of the
arch. Upon making a careful examination of this ball, it was
found to be a spherical indurated coagulum, covering a wound in
the aorta itself. The ball was indurated to such a degree as to re-
sist with success all the pressure that could be made between the
thumb and fingers of several of the party present, who tried to
crush it. But the most surprising feature in the whole case, is the
fact, that the wound, which was about one third of an inch in
length and in the longitudinal direction of the vessel, . was, that
no attempt had been made to unite it. The edges were perfectly
smooth and sharp. The contour of the vessel at this point was

1855.] Holt's Letters upon General Pathology. 335

indented, forced inwards by the coagulum, and this may be an
important element in understanding this extraordinary case. No
mistake could have been made in reference to the patulousness of
the slit in the aorta, as its singularity immediately attracted the
attention of all present, and it was repeatedly examined.

These particulars were received from Dr. J. B. Wiley, a very
competent and reliable observer, and quite familiar with necrosco-
pical examinations.

The following is a conjectural modus operandi of this case : The

wound was probably inflicted while I 's head was thrown back

and drawn to one side, and the aorta withdrawn from its proximity
to the sternum ; the effusion of blood took place at this moment,
and the head was then immediately thrown forwards, thus being
converted into a valvular one. The small quantity of blood that
rushed into the cellular meshes of the anterior mediastrinum, was
confined there, forcing the edges of the wound inthe aorta back, and
keeping them in a perfect state of apposition and preventing any
farther hemorrhage. The blood coagulated and eventually as-
sumed the dry, indurated form, in which it was discovered at the
post-mortem. The reason of there being no evidence of an attempt
at union, probably, was, that any effusion ofcoagulable lymph to
effect this purpose, was immediately washed off by the mighty
torrent of arterial blood that swept through the vessel.

ARTICLE XIV.

LETTERS PROM SA3TL. D. HOLT, M. D., UPON SOME POINTS OF GENERAL PATHOLOGY.

LETTER NO. 1.

Montgomery, Ala., April 30th, 1855.
Messrs. Editors : Having promised to furnish you with my views
upon certain medical subjects in the form of "familiar letters," it
is proper to say that I have no motive beyond a desire to add my
testimony to the truth or falsity of the principles and practice of
medicine in the present day ; and whether the opinions which I
entertain, theoretical or practical, are the result of my own ob-
servation, or have been derived from the observation and experi-
ence of others, makes little difference, as I lay no claim to origi-
nality of invention or discovery ; and holding that the written
opinions of men are common property, which may be adopted or
rejected, as they may appear to be sustained by truth and reason,
or otherwise, no exceptions can betaken if "I claim a charter

336 Holt's Letters upon General Pathology. [June,

wide as the winds, to blow on whom I please." It is proper, also,
to say that my subjects will necessarily be desultory ; but I will
-endeavor to preserve as much connection between them, and make
as few digressions as possible. Having said so much by way of
preface, I will call your attention first, to the consideration of
" Congestion." This term, (and its correlatives) which has become
-with the medical profession a house-hold word, has been denned
by Dr. Wood, (who may now justly be regarded as standard
.authority in this country) to be " an unhealthy accumulation of
iblood in any of the bloodvessels of the body." Now, this defini-
tion is perfectly correct and unobjectionable, so far as the term is
used strictly according to its literal signification, in which sense it
matters little in what vessels the accumulation takes place, or what
the condition which produces it. But we, of the South, are in the
habit of regarding what Dr. "Wood describes as " active" conges-
tion, (in which the blood accumulates in the arteries and their
capillaries,) as one of the phenomena of inflammation, the natu-
ral product of excitement, to which condition the idea of congestion
never attaches, and to which the term is never applied. On the
contrary, his "passive" congestion furnishes a true and graphic
description of the opposite condition of depression, and consequent
" unhealthy accumulation of blood in the venous cavities," a con-
dition so often met with in connection with the diseases of the
South, as to have justified a, prefix of the correlative term "conges-
tive," which, if objected to on the ground of its not being expres-
sive of the true pathological condition of depression, it is not less
objectionable, with respect to that of excitement. It must be
remembered that the term congestion, and its correlative, congestive,
are never used in the same sense ; one is used to express the con-
dition of a particular organ ; the other, the condition of the
whole system : thus, when we speak of congestion of the liver
or lungs, we mean that there is an " unheal thy accumulation "
of blood in the vena-portarum or pulmonary artery, without re-
ference to the condition of the general system, which may be in
a state of exaltation or excitement, or in a state of depression.
But when we speak of inflammation of the liver or lungs, we
mean that there is an unhealthy accumulation of blood in the trunk,
branches, or capillaries of the hepatic or bronchial arteries ; and
so of any other organs, for which condition, a more expressive
term may be found in that of engorgement, and thus obviate the
clashing and confusion of terms. When the term congestive is

1855.] HolttS Letters upon General Pathology. 837

used, it does not convey the idea of congestion in any particular
organ, or set of organs, but it conveys the idea of congestion, in
any and all the organs which are liable to congestion, coupled with
a condition of general debility and prostration or depression , and
gives an appellative character to all diseases upon which it is at-
tendant, hence, we speak of congestive fever, congestive pneumonia,
congestive dysentery, kc.

The corollary from what has been said, is, that the definition
given by Dr, Wood to congestion, is, in itself, objectionable, in
as much as it confounds under one term, two diametrically oppo-
site pathological conditions, one having the characteristic phe-
nomena of excitement and irritation or inflammation, with arterial
and capillary u engorgement ;" the other, having the equcdly char-
acteristic phenomena of debility and depression, with venous conges-
tion. The latter condition, which, I believe, has been considered
by systematic writers in a secondary point of view, and treated of
by them, as a temporary and fugitive condition, I now propose to
consider in the light of a primary and essential pathological con-
dition. Before I do so. however, it will be proper for me to give
some reasons explanatory of my motives for so considering it. In
the first place, the doctrine of an exalted nervous excitement and a
corresponding vascular action, has beeu almost universally receiv-
ed as constituting the essential type and characteristic of all febrile
affections, idiopathic or symptomatic, with the exception, perhaps,.
of hectic and typhus ; and the word fever conveys almost as uni-
versal an idea of that condition, as the word fire does that of heat.
I do not pretend to say that fevers have not an essential typical
character ; on the contrary, I maintain that they have, and in that
character they are universal and unchangeable j hence my belief,
that there never has been, uper se" such a thing as congestive or
pernicious fever, an.d that these, and other forms and varieties
which have been described, are but modifications of the one essen-
tial type. In yielding this point, I by no means aequiese in the
idea, that exalted nervous excitement, and increased vascular ac-
tion, constitutes the essential character of fevers; for an intermit-
tent or remittent fever, requiring, from its character, the prefixr
" congestive/7 in which there is neither, is just as much an inter-
mittent or a remittent fever, in its essential type, as if there was^
ever so much excitement and vascular action. Now, the true
essential type of fever belongs to its pathognomonic signs, which
are manifested in its periodic exacerbations and remissions, or tb?

338 Holt's Letters upon General Pathology. [June,

regular rise and fall in nervous excitement) and a corresponding in-
creased or diminished vascular action, as the pathological condition
of the system favors excitement, or depression.

In the second place, the doctrine of exalted excitement and
increased vascular action, has invariably pointed to that condition
as the chief source of danger in febrile affections, and has as inva-
riably suggested a resort to the remedies known as antiphlogistic,
and sedative, which reduce excitement and subdue action for their
cure. But what appears strange to my mind, is, that while South-
ern physicians have been forced (as it were) to discard or abandon,-
one by one, the remedies of that class, as unsuited and even hurt'
ful in the treatment of febrile affections generally, they should
have adhered to the doctrine which sad experience must have
taught them, leads often to disappointment and disaster. This-
inverse proof, alone, ought to be sufficient to establish the fact,
that the essential pathological condition in the febrile affections of
the South generally consists in nervous debility and depression, and
consequent diminished vascular action and "congestion," and
points directly to the source of danger, and the means of cure, to^
be found in that class of remedies known as stimulants and tonics.-
Kearly thirty years of constant observation has served to convince
me that such is the character of our febrile diseases, and acting,
upon this belief, truth and candour prompts me to declare that I
have seldom been at a loss as to the course necessary to be pursu-
ed, or the selection of proper remedial agents to suit the varied
forms and modifications which they assume.

Such being the general character of those affections in Southern-
latitudes, it becomes a matter of much interest to enquire into the
nature of the causes, and the manner in which they operate ta
produce it, which will in due time claim our attention j but, first,
let us look at the condition itself, and see in what it really consists.
I have said, or intended to say, that the condition is not determined
by the local affection, whether of excitement or depression,- nor by
the proximate or exciting cause, but by the remote and predis-
posing causes ; and when the general system is brought under the
influence of those local causes, the phenomena of excitement, or
depression, will be manifested, as one or the other of these condi-
tions may prevail, A perfect model of these two conditions, with
all their characteristic phenomena, is found in a simple intermit-
tent, which I will present, as the most familiar illustration of my
views of the subject.

1855.] Holt's Letters upon General Pathology. 839

Suppose, then, that some cause has operated to throw some
organ, as the liver, stomach, &c, into a condition or state of tem-
porary debility or depression the brain, taking cognizance of the
condition, will rally the vital forces to the assistance of the suffer-
ing organ, where an accumulation of the vital power, or excite-
ment, takes place, at the expense of a proportional loss to all the
other organs. The remote and general capillaries sharing in the
general loss of nervous power, allows the blood to pass freely
through them, into the venous radicles thence, into the large-
venous cavities ; and while this process is going on in the remote,
arterial capillaries, the muscles of respiration participating in the
loss, respiration becomes impeded, the lungs expand imperfectly,,
and the flow of blood is retarded, through the pulmonary capilla-
ries, thus giving rise to an unhealthy accumulation of blood upon
the right side of the heart, constituting the congestion or cold stage,
with all the phenomena consequent upon such a condition of
things. The "congestive," or cold stage, having been fully es-
tablished, the hot stage, or stage of excitement and reaction, may
be supposed to take place in the following manner : The accumu-
lation of vital power in the laboring organ being, now, no longer
necessary for its support, over and above its due and accustomed
supply, is again distributed to the organs whence it was taken.
Among the first to share in the distribution, and to feel and mani-
fest the influence of its return, are the organs of respiration, which,,
regaining their accustomed power of action, the chest and air-cells
become more expanded, allowing of a free transmission of blood
through the pulmonary capillaries, and as the function of respira-
tion is increased, the blood move3 forward through the congested ves-
sels ; the heart, being excited to increased action by a supply of fresh
arterial blood, sends it forward to the remote arterial capillaries,
which, having regained their lost tone, now oppose resistance to
the hitherto too free transmission of blood through them, and the
blood continuing to flow more rapidly and freely through the pul-
monary, than through the remote capillary extremity of the circu-
lation, necessarily accumulates upon the left side of the heartr
giving rise to arterial plethora, and constituting the hot stage, or
stage of excitement and reaction, with ail the phenomena conse-
quent upon the condition.

Such, I think, may be regarded as the process which occurs in
every shade and degree of general depression and congestionr
from the slightest chill, to- the most perfect collapse, on one handy

840 Holt's Letters upon General Pathology. [June,

and from the slightest excitement, to the most violent reaction, on
the other. It is not important, in this connection, to attempt to
trace out, and explain, all the phenomena which characterize and
distinguish these opposite conditions, as the feeble pulse, the cold
skin, the palid countenance, slow breathing, &c, on one hand,
and the hot skin, the flushed countenance, the hurried respiration,
and the full, strong pulse, (to say nothing of the signs of local dis-
order,) on the other. These phenomena, in their full force and
character, stand so wide apart, that there is neither doubt nor
difficulty in determining the true pathological condition from
which they spring, or in applying the proper correctives, one being
recognized as inflammation, the legitimate offspring of excitement
and vigour ; the other, as congestion, the offspring of depression
and debility. But there is an intermediate condition, having no sepa-
rate or independent pathology, which seems to play a part between
the two pathological conditions of excitement and depression,
manifesting sometimes, the phenomena of one and sometimes of
the other, and not unfrequently, indeed I might say very often of
both ; this condition appears to be the product of excitement and
debility, as inflammation is the product of excitement and vigour^
to which it appears to be the stepping-stone, and to which it is so
nearly allied in its general aspects as to have led to an incalculable
amount of abuse, and ultimately to the rejection of the remedies
most appropriate for the reduction of inflammation, namely, the
lancet, emetics, cathartics, diaphoretics, sedatives, &c. This inter-
mediate condition, which is known as " Irritation," occupies all
the ground between excitement and inflammation on one side,
and depression and congestion on the other, and as the excite-
ment rises above "the line of healthy action" up to the point of
inflammation, I would distinguish it as irritant; and as it descends
below that line towards congestion, I would distinguish it as con*
gesto-irritant. (Now if these terms are objected to on the score
that they are arbitrary, I am certain that they are not more so
than others, which have found currency, and which are less ex-
pressive of the true pathology of the diseases which fall under the
condition which lam attempting to describe, such as "adynamic,"
" malignant," " pernicious," &c, terms expressive rather of danger
than of their pathology, with perhaps, the exception of the first,
which conveys the same idea of debility and depression, but not
necessarily of congestion.)

Another distinction which may be advantageously employed

1855.] WilsoX, on Quinine on the Uterus. 341

to express another modification of the two conditions from which
it is derived, namely, " congesto-injiammatory" in which the sys-
tem is pretty well balanced between excitement and depression ;
that is to say, where there is an amount of vigour present, just
sufficient to keep the excitement up to, or a few degrees above the
line of healthy action, but which under the influence of some sud-
den, depressing cause, as a copious bleeding, excessive purging,
&c, would run rapidly into a state of permanent depression and
congestion.

It is no difficult matter to draw the line of demarcation between
the extremes of these conditions, but it is otherwise with respect
to the subdivisions, and I will hazard the assertion that, he who
is able to do so in practice, will receive as the meed of his judg-
ment, a full measure of success.

It is my design to endeavor to point out as clearly as possible
the signs by which these conditions are distinguished, which may
be better done in connection with some particular forms of dis-
ease, and which I will defer to some subsequent communication.
My next letter will be devoted mainly to a consideration of the
causes, and the manner in which they operate, to produce these
opposite pathological conditions and their modification.

Hoping that you may have patience to follow me through this
intricate, but important, subject.

I subscribe myself, your friend, &c.

Saml. D. Holt.

ARTICLE XV.

Action of Sulphate of Quinine on the Uterus. By Jxo. STAINBACK
Wilson, M. D., of Lawrenceville, Georgia, (formerly of Air-
mount, Alabama.)

Having seen several cases in my practice, in which I had reason
to believe that the quinine acted directly on the uterus, increasiDg
the lochial and menstrual discharges, I desire to call the attention
of the profession to this interesting feature, for the purpose of
eliciting further investigation. It will, doubtless, be readily ad-
mitted that quinine may act as an emenagogue, in anemic condi-
tions, by virtue of its tonic and invigorating properties, and by
equalizing the circulation, removing thus those local congestions,

N. s. VOL. XI. no. VI. 22

842 Wilson,, on Quinine on the Uterus.- [June>

which, by depriving the uterus of its quota of blood, interfere with*
the proper performance of the menstrual function. But, in addi-
tion to this mode of action, I am induced, from observation, to en-
tertain the idea that the article which engages our attention, has a
more direct, immediate and specific effect on the uterus -r or at any
rate that its- action on this organ is so prompt in- some cases,,
as to forbid the hypothesis that the result is due to< its tonic pro-
perties. As before intimated, I have been led to this opinion by
observing the effect of quinine in several cases of puerperal dis-
ease, pneumonia, intermittent fever, &c, where this remedy ap-
peared to act decidedly on the uterus when given to fulfil other
indications. One of the most striking of these I will report,,
and others might be adduced, but the details cannot now be re-
collected and recorded with a sufficient degree of accuracy to
bring the same conviction to the mind, of the reader that the actual
facts observed did to my own.

Case. Mrs.. , pregnant with her second child ; has had

occasional attacks of chill and fever ; general health in the inter-
vals pretty goodras the paroxyms were never allowed to continue
any length of time.. On 11th September lastr she was delivered.-
About two- weeks after this time, the lochia having almost disap-
peared, the intermittent returned. She took three five-grain
doses of quinine, which prevented the recurrence of the paroxysm,
and in a Jew hours after taking the medicine, the lochia became pro-
fuse and of a sanguineous appearance. About a week after this last
attack, she had another,, when the same remedy was used with a
like result. Three months or more after her confinement, and
after every vestige of the lochia hadr of course, disappeared, she
again took the quinine for the " chills," and the consequence was,
a uterine discharge of a menstrual character. Now, it may be said,
that this was a return of the catamenia only ; for it is well known
that some women menstruate during lactation. But this objection
may be answeredr by saying that this was not her habit ;. that her
child was young,, and by the fact that there has been nothing like
menstruation from that time to the present month (April)r unless
a very slight "show" in February was an effort of that kind..

Kemakk. The above case may not be considered conclusive-,
by many, still I think it is sufficiently interesting to merit atten-
tion and to invite investigation ; for if the sulphate of quinine, in

1855.]

KossiGtfOL's Statistics of Mortality.

343

addition to its potent general tonic properties, exerts an influence
over the uterine functions, either by equalizing the circulation, or
by a more direct and specific mode of action, it is certainly a most
valuable remedy in anemia, chlorosis, amenorrhcea, dysmenorrhea,
and other grave and complicated affections to which the female
system is subject, on account of the sympathic relations of that
wonderful element of its constitution, the uterus, that mysterious
organ of which it has been truly said, "Propter solum, est mulier,
id quod est.11

ARTICLE XVI.

Statistics of Mortality in Augusta, Georgia, during the years 1853-'54.
Arranged by H. Kossigxol, M. D.

The following Tables are reliable as regards numbers and sexes;
but the books of the City Sexton, from which the tables are made,
are not very correct as relates to ages and the immediate causes of
death :

Table No. 1.
Census of Augusta, taken by order of the City Council, October, 1852*

Whites.

Whites.

H

O

O
g

243

Slaves.

Total*

o

1

Males
between
6 and 16.

Females
between
6 and 15.

a:

oil
2330

g

Grand Total.

2779

2477

770

766

2388

11,753

Transient or temporary resident?
Free negroes and slaves, not ret
Business and suburb normlation

i whites, . .
urned, . * *

400

400

. 1,519

14,072

The above is the last census taken, since which the population
is supposed to have increased several thousand.

Tabli
Deaths in each year

- No. 2.

Still-born included.

Year.

Whites.

Blacks.

Total.

1853.
1854.

195
354

144

147

339
501

su

KossiGiN'Oi/s Statistics of Mortality.

[Jrmcy

Table No. 3.
Deaths in each month Still-born included.

Year.

Months.

Whites.

Blacks.

M. Total.

A. Total.

1853,

January,

15

7

22 *

February.

17

13

30

March,

5

12

17

April,

May,

June,

12
26
13

10

10

9

22
36
22

July,

22

18

40

August,.

September,.

October,

15
18
25

15

21
15

30
39
40

November,

14

4

18

December,

13

10

23

339

1854.

January,

Februaryr

March,

18
13
14

5
4

8

23

17
22

April,

May,

June,

25
23
21

12
13
17

37
36
38

July>

August,
September.
! October,
November,

40
21

62
76

22

15
10
15
W
17

55
31
77
94
39

December,

19

13

32

501

Table No. 4.
Ages of those who died in 1853 and 1854.

Whttes,

d
o

XII

t* SB

-S *

o

o o"

6

O

o

d

O

o

CM

d

o

o

CO

d

o

d
o

o

K3

d

o

o
o

d

oc

o

o

d

00
>

6

2

Total.

1853.

10

82

11

12

19

19

14

12

6

8

l

1

195

1854.

15

102

10

26

62

68

30

23

14

1

3

2

354

25

184

21

38

81

87

44

35

20

9

4

3

594

Blacks.

1853.

10

58

11

G

13

10

9

7

7

6

7

144

1854.

5

54

6

11

13

13

9

6

14

6

9

1

147

15

112

17

17

26

23

18

13

21

12

16

1

291

1855.]

ROSSIGXOL'S Statistics of Mortality.

345

Table Xo. 5.
Causes of Death, as recorded by the City Sexton.

Whites.

Blacks.

Casualties, ....
Mortification, . . .
Old Age, . . . .
Diarrhoea, . . . . .

Dysentery

Inflammation of Bowels,
Cholera Infantum,
Constipation of Bowels,
Pneumonia, . . .
Bronchitis ....
Consumption, . . .
Congestion 0f Lunirs.

Inflammation of Lungs,
Disease of Lungs,
Scarlet Fever, . . .

Typhoid Fever, . . .
Congestive Fever, . .
Bilious Fever, ....
Yellow Fever, ....
Congestive Chills, . .
Peritonitis and Child-bed,
Delirium Tremens, . .
Rheumatism, ....

Neuralgia,

Paralysis

Congestion of Brain, . .

Apoplexy,

Dropsy of Brain, . . .
Inflammation of Brain, .

Suicide,

Murdered,

Affections of Liver, . .
Disease of Heart, . . .
Dropsy of Heart, . . .

Dropsy,

Still-born,

Asthma,

Spasms and Convulsions,

Erysipelas,

Measles,

Cancer,

Epilepsy,

Tetanus

Gangrene,

Thrush

1853.

8

3

5

10

10

9

14

G

1

12

5

1
10
14

7

2
2
1
2
2

3
5

6

11
1

16
3
2
2
1
1
1
1

1S54.

j 1853.

7

4

3

6

13

1

6

7

20

5

7

19

1

17

23

15

4

1

1

1

4

3

15

4

10

1

103

4

8

2

2

4

1

1

3

3

9

1

5

2

2

;|

1

2

3

1

G

9

15

11

4

1

27

13

4

3

2

1

1

1854.

9
2
3

12

1

10
1
9

14

9
5

1
18

1

346 Rossignol's Statistics of Mortality. [June,

Causes of Death, as recorded by the City Sexton continued.

Worms,

Cramp Colic,

Croup,

Affection of Spine,

Catarrh,

Small-pox,

Debility,

Tympanites,

Pertussis,

Marasmus,

Gravel,

Jaundice,

Abortion,

Uterine Hemorrhage, ....
Inflammation of Bladder, . . .

Quinsy,

Putrid Sore Throat,

Dyspepsia,

Hives,

Scrofula,

Tumor of Abdomen,

Hemorrhage of Lungs, ....

Carbuncle,

Intermittent Fever, . . . . ,
Hemorrhage of Bowels, . . . .

Diseases unknown,

Diseases stated,

Whole number of Deaths, . . .

Whites.

1853.

1854.

7
188
195

Blacks.

1853.

13
341
354

2
142
144

1854.

1
2

3

12

1

1
2
1
3

144

147

Table No. 6.
Relative proportion of the Sexes of those who died.

In 1853, died, (whites) Males, 114 Females, 81

" 1854, " " 204 " 150

Females, 85
" 60

In 1853, died, (blacks) Males, 59
M 1854, " " 87

On Keloides. Read before the Boston Society for Medical Obser-
vation, March, 1855. By Daniel D. Slade, M. D.

The term keloid, or keloides, is applied to a singular affection of
the skin, extremely rare, and not even described by many writers
on cutaneous diseases. The origin of the word is involved in
doubt ; some deriving it from chele, a crab's claw while others,

1855.] On Keloides. 347

with more propriety, suppose that it was derived from kelis, a burn,
owing to the resemblance of the affection to the cicatrix left by
such an injury. This disease was first described by Alibert, and
by him termed cancroide, like cancer. Since this writer, we find
observations upon the same affection in the works of Biett, Vel-
peau, Cazenave, AVarren and others.

Dr. Addison, who has recently published an excellent paper
upon keloides, in the Transactions of the London Medico-Chirur-
gical Society, speaks of two forms of this disease under the names
of " keloid "of Alibert/' and "true keloid." The former is the
subject of the present paper. True keloid, he describes as a dis-
ease which has escaped the observation of other writers, and one
which leads to much more serious consequences than the common
form. It occupies the same tissues "and is first indicated by a
white patch or opacity of the integument, of a roundish or oval
shape, varying in size, and very slightly or not at all elevated
.above the surrounding skin," at commencement not attended by
any pain or inconvenience, although a more or less vivid zone or
redness surrounding the whole patch sufficiently attests the vascu-
lar activity going on in the parts beneath. As the disease pro-
ceeds, certain changes take place in the affected parts. Itching,
pains, tightness, or constriction^ are felt at the seat of the disease,
accompanied by " a certain amount of subcutaneous hardness and
rigidity extending beyond the site of the original superficial patch,
although as yet without any necessary change in the appearance
of the superincumbent skin. This hardness and rigidity can be
distinctly felt, and, especially when situated on the extremities,
may sometimes be traced along the course of the neighboring ten-
dons or fasciae, or stretching like a cord along the limb, so as to
bend or shorten it, and even interfere with the natural move-
ments." As the disease advances, the skin, which may have pre-
sented only a slightty drawn or puckered look, now shrinks or
shrivels, undergoing a decided change of color, becoming reddish,
-pinkish or yellowish. The cutis manifests a tendency to super-
ficial ulceration or excoriation ; or ^'hen not excoriated, is occa-
sionally surmounted by obscure tubercular or nodular elevations,
the whole appearance closely resembling the remains of a very
extensive and imperfectly cicatrized burn. The elevated, claw-
like processes extending into the neighboring tissues may also
often be seen, bearing a very exact resemblance to those which
characterize the keloid of Alibert.

Dr. Addison does not enter into any speculation regarding the
origin and nature of this form of disease. He merely states that
this morbid process is allied to inflammation, probably of a stru-
mous character. Neither does he dwell upon the treatment, ex-
cepting to remark that with the exception of iodine, none of the
many remedies tried, seemed to make the slighest impression upon
the progress of the disease.

I am inclined to suppose, on reading Dr. A's description, that

348 On Keloides. [June,

this form of keloides is more properly that form of cancer, which
has its seat in the same tissue, the derma, and which has a tenden-
cy to increase rapidly, constricting and rendering the skin very
tense, the parts becoming hide-bound. Yelpeau calls this form
cancer rayonne, and at his clinique I remember that he mentioned
a case where the skin became so constricted over the chest by the
progress of the disease, as actually to stifle the patient. He never
advises extirpation in this form of cancer.

Warren, in his work on tumors, makes three varieties of this
disease. 1. A white permanent elevation of the skin. 2. The
spider-like pimple of the face. 3. The keloid of Alibert. To the
latter form I wish to call your attention more particularly.

This affection, although rare, has characteristics so well marked
that it would be difficult to confound it with any other disease,
especially when it has attained any considerable growth. It first
appears as a small pimple or tubercle, round or oval in shape,
hard, shining, and generally of a reddish tinge, although the color
may var}r, as we shall presently see. Its growth is slow, and it
may attain the size of an inch to two inches in length, half an inch
in breadth, and an elevation above the surrounding skin of from
several lines to one-fourth of an inch. To the touch it is hard,
elastic, and would convey the idea of a cartilaginous body set in
the skin. I can compare this peculiar feeling, particularly when
the tumor is small, to nothing better than the induration which so
well marks the true or Hunterian chancre, especially when this
latter is seated upon some homogeneous tissue which can be easily
compressed, as upon the prepuce.

In the majority of cases we find only one of these tumors, but
occasionally several. Biett mentions the case of a young woman
who had eight of them upon the sides of the neck and chest. Caze-
nave speaks of having seen more than twenty upon the chest and
arms of a young female. M. Lebert saw, in the wards of Velpeau,
a case where the whole pectoral region of one side was covered
with these tumors, many of which were sufficiently large to have
reddened and eroded the surface of the skin at their borders.
They may be together in the same neighborhood, or occupy parts
remote from each other. Their place of election would appear to
be upon the chest near the sternum, between or upon the mammae,
or upon the arms. They may, however, occupy any portion of
the surface of the body. Observation would seem to show that
females are more prone to the disease than males. These tumors
are generally attended with a pricking or burning sensation, more
severe at certain times than at others. Sometimes it becomes ah
most insupportable, particularly in females while in other cases,
it gives rise to no inconvenience. As these tumors vary in shape,
being sometimes oval, and sometimes elongated, with a convex or
flattened surface, so does their color vary, from a blanched appear-
ance to a light rose, or, as is most common, to a deep red, present-
ing exactly the tint of a cicatrix from a burn, Gazenave says their

1855.] On Keloides. 849

color undergoes changes, according to the temperature, and in fe-
males, at the menstrual period. Their growth, as we have seen,
is gradual and slow, and seems to be effected by the gradual en-
croachment of the claw-like processes from the sides of the tumor
upon the surrounding skin, producing a puckered appearance of
the tissues.

Keloides are developed in the derma, or more particularly, ac-
cording to Dr. Addison, in the subcutaneous areolar tissue, be-
tween the cutis and adipose membrane. This gentleman attributes
the redness and itching attending the growth of these tumors to
the presence of a degree of vascular excitement nearly allied to
inflammation, and which gives rise to a certain amount of adhe-
sion amongst the meshes of areolar tissue around.

As to the causes of this singular affection, we must confess our
almost entire ignorance. Some have attributed it to the influence
of the strumous diathesis. That it really depends upon certain
constitutional conditions, we have reason to infer from the fact of
its almost constant recurrence after extirpation. It would seem
that the presence of the cicatrix of a boil, burn or recent wound,
sometimes acts as an exciting cause, as we find the affection more
frequently developed upon such parts, than upon the sound skin.
In our prognosis we can hardly consider that keloides are a se-
rious or grave disease ; and in those cases where it has assumed a
malignant form, we may, perhaps, attribute such a result rather to
the curative means employed than to the natural progress of the
disease. If abandoned to itself, it makes very slow progress, and
according to some authorities, occasionally disappears spontane-
ously, leaving behind merely a white cicatrix. Cazenave says
that it very rarely terminates by ulceration.

In regard to treatment, we can say but little. Various internal
and external measures have been tried, without satisfactory re-
sults. Extirpation and cauterization have been too often followed
by a return of the malady. Addison says, that when the disease
has been first developed in a cicatrix, the extirpation has proved
more successful, than when it has occurred in the sound skin.
When extirpation is practised, care should be taken to remove a
good portion of the surrounding tissues, in order to be sure of
leaving no apparent traces of the disease behind. Moreover, the
lips of the wound should be brought well together, and secured
by adhesive plaster or collodion, in order that we may obtain
union by first intention. It has been observed that the disease
has returned in the wounds made by sutures. "Warren speaks of
a ease where the disease not only returned in the cicatrix, but also
at each of the points where the needle was passed through, so that
instead of one tumor there were seven. Cazenave says that iodide
of potassium has been administered with some success in cases
where the disease appeared to depend upon a scrofulous diathesis.
As we have before remarked, this affection, like cancer, seems to
depend upon constitutional causes ; therefore it would seem nw

350 On Keloides. [June,

tional to suppose that the only sure method of combating it, is by
general treatment.

The two following cases have come under my own observa-
tion :

Case I. February 7th, 1852. Mrs. P., colored, set. 45. Ke-
ports that about four years ago, being in good health, she first
perceived a small, hard, elastic tumor in the skin, just over upper
third of sternum. Its growth, which was gradual, was accompa-
nied by stinging, darting pains, almost constant, particularly at
night, rendering her very uncomfortable. This tumor was also
somewhat painful when squeezed or compressed. Knows no cause
for the appearance of this tumor ; never received any blow or
barn upon these regions. At the expiration of two years, the tu-
mor having attained the size of a large almond, she sought medi-
cal aid. Extirpation was advised and performed. The disease,
however, returned in a cicatrix ; and at the date when I first saw
her, two years after the operation, the tumor had attained the
same size as before, viz., about half an inch in length by one fourth
in breadth, raised several lines above surrounding skin and con-
vex upon the surface ; quite painful when compressed. As the
patient complained greatly of the annoying, darting and pricking
sensations to which this tumor gave rise, I advised its extirpation
again. This was done. Care was taken to remove a considerable
portion of the surrounding healthy skin, and the wound was
brought together by adhesive plaster. Although a portion of the
wound healed by first intention, the disease returned in the cica-
trix. I lost sight of the patient soon after.

Case II. February 2, 1855. John F., set. 25 ; married. Eng-
land. Tailor. Of decided lymphatic temperament; light com-
plexion and brownish hair. Eeports that, about four years ago,
he first perceived a small, hard, oval pimple or tubercle in the
skin, just over middle of sternum. This continued to grow very
gradually, its growth being accompanied by pricking, darting
pains, much more severe when he became heated. About two
years after, another similar tumor made its appearance, a little
above and to the right of the first one, accompanied with similar
sensations. About six months ago, another appeared to the left
of the first one. Knows no cause for the appearance of these tu-
mors. General health good.

Now, on examination, I find a tumor situated over centre of
sternum, one inch and a quarter in length, half an inch in breadth,
and raised half an inch above the surrounding skin ; convex on
surface. It is of a bright scarlet color, glistening, hard, elastic,
regular in shape, with slightly-marked claw-like processes extend-
ing into surrounding skin from base of tumor. The skin in im-
mediate neighborhood appears natural. Another tumor of similar
character, and of nearly the same size, but not as hard or glisten-
ing, and of a blanched appearance, is seen to the right and just
above the first described. Here the claw-like processes are very

1855.] On Ktloides. 851

distinctly seen. Another, the size of a small pea, is to be seen at
left of first. Suffers no pain on compression of these tumors.

Patient being derious of having the largest of the tumors re-
moved, the operation was performed. The same care was taken
as in the first case to secure an immediate union. The disease
has, however, returned in the cicatrix, and I have thought it use-
less to interfere with the other tumors.

Dr. Shaw made a microscopic examination of the tumor remov-
ed ; this is his report :

The tumor, to the unassisted eye, has a fine, fibroid appearance;
the fluid expressed from it was clear. The disease was apparently
confined to the cutis, and was covered with the epithelial layer.
Its minute structure consisted of fine, wavy, straight and curling
fibres with a few free, oval, fibro-plastic nuclei, such as are com-
monly found in these growths. It resembled the structure of the
condensed cutis, rather than the coarse fibrous structure of fibrous
tumors.

The following cases have been kindly communicated to me by
Dr. J. M. "Warren. One or two of them I had the opportunity of
seeing with him.

Case I. A lady. 25 years old, of very delicate skin, for many
years had a tumor on the back of right fore-arm, which com-
menced first from a scar caused by a burn. The tumor gradually
enlarged to the size of a dollar, was quite elevated above the sur-
rounding skin, of a whitish color, with red streaks through sur-
face of it. It was the seat of severe lancinating pains. It was
carefully removed, with the subjacent cellular tissue, and healed
slowly, but well. It was not possible to approximate the edges
of wound, on account of its size and form. It remained well for
some years, when the disease began to re-appear in the scar, and
extended, so that at the end of nine or ten years it was nearly of
the original size. Last year (185-i) I again removed the disease,
having first congealed the parts with a mixture of ice and salt. It
again healed well. jSTow the place is occupied by a thin cicatrical
tissue, much depressed beneath the level of the surrounding in-
teguments. At one spot, there is a slight thickening and redness,
the size of half a pea, and she imagines that after sewing a great
deal she has a pain in it.

Case II. Healthy girl, 19 years old, with two keloidal tumors
on sternum between mammary glands. Tumors elevated, reddish,
one the size of a ten-cent piece, the other of a pea, and placed
about an inch apart. I removed one, and brought the edges to-
gether with adhesive plaster after a little dissection underneath the
skin to loosen it and allow more easy approximation. Stitches
were avoided, for fear of a return of the disease in the places of
suture. The disease returned in five or six weeks, notwithstand-
ing all the care taken to secure a good union.

Case III. Lady, about -40 years old ; has had a small keloid
tumor on sternum for three years, commencing small and grad-

352 On Kdoides. [June,

ually increasing. I advised removal, as it was becoming painful,
and the patient was apprehensive of cancer. The disease was
removed by a skilful surgeon in a neighboring city, and the
wound brought together by stitches. I understand that the tu-
mor has returned at the original seat, and also in all the places
of suture.

Case IV. I removed a tumor of this nature from a girl 17
years old, about a year since. It was situated on the back, over
the right scapula, and was caused by a burn. The tumor was
elevated above the skin, had the usual lardaceous look, with ves-
sels streaking the surface of it. The dressing was conducted with
much care. The desease, however, re-appeared within two months,
but of less size, less induration, and free from the darting pains
attendant on the former one.

There is a general idea among medical men in regard to these
tumors, that they are of a cancerous nature, and that they termin-
ate in cancerous ulceration. The patients are alarmed by the lan-
cinating pain, described as similar to those belonging to a cancerous
affection. I have seen many cases besides those above described
in the practice of other physicians, both at home and abroad, and
thus far have had no reason to believe that there was anything
malignant in them ; in fact, nearly all the above tumors were ex-
amined by experienced microscopists, and the only prominent
characters of the texture were found to be fibrous never cancer
cells. [Boston Med. and Surg. Jour.

[Note. This affection is quite common in this State, among
Africans or their immediate descendants, showing itself most gen-
erally upon the sternum in the form of one or more transverse
bands of elevated and indurated cutaneous tissue. Although fre-
quently of spontaneous origin, it does sometimes show itself at
the seat of injuries of the skin more or less serious. We have
seen several negroes in whom they resulted from the effects of the
lash upon the shoulders and back ; in others from burns. It is
comparatively rare here in the white race, as we do not remember
having seen more than three whites affected with it, whereas we
must have seen at least fifty blacks thus affected.

According to our observation it is very generally harmless.
"We have seen a few cases, however, in which it terminated in
suppuration and then had very much the appearance of a schir-
rous cancer. Yet the general health seemed unimpaired and the
suppuration was not attended with loss of substance nor extensive
ulceration.

We have usually let them alone ; but in two instances in which
we practiced extirpation, the disease returned. D.

1S55.] Involuntary Seminal Discharges. 353

Involuntary Seminal Discharges. By D. D. Slade.

Since the reading of our paper on Involuntary Seminal Dis-
charges, before the ''Boston Society for Medical Observation,"
and published in the Boston Medical and Surgical Journal, Vol,
XLIX, No. 22, farther experience in many cases has entirely con-
firmed the opinions therein expressed. In addition, Ave have the
satisfaction of knowing that our views upon the subject have been
received with marked approbation by many of the profession. In
a letter communicated to us soon after the publication of the paper
in question, our oldest and most esteemed practitioner says, l< Since
I had experience enough to form an opinion, I have been satisfied
that the alarming statements and consequent anxiety on this sub-
ject were groundless. That there are cases which would ordinari-
ly come under this head of a severe character and really injurious,
is true, but these are very rare. I could almost count all such
cases upon my fingers, after the experience of more than half a
century.

In common cases, I say to the patient that matrimony is the
remedy. Illicit indulgences are not the same thing. They are
usually irregular and often excessive. In quiet, domestic life,
usually, the indulgences are not more than can be borne, after the
early periods."

The importance of this subject, affecting as it does, to a greater
or less extent, the happiness and peace of mind of so many young
men not only in our cities but also in our country towns, who get
erroneous impressions from perusing the publications and adver-
tisements of charlatans so widely circulated, has induced us to ask
the favor of a place in your journal for our paper, with some tri-
fling additions made since its first publication.

We may venture to say that there is not a medical practitioner
among us who is not sometimes consulted by individuals who sup-
pose themselves to be suffering both mental and bodily derange-
ment from involuntary seminal discharges, occurring more or less
frequently. In the great majority of these cases, it is found that
these discharges occur during the night, whilst the individual is
asleep, and that they are preceded by erections excited during
lascivious dreams. Cases of this description are extremely com-
mon, and are generally classed by medical practitioners and wri-
ters under the term spermatorrhoea. Our object in preparing the
present article is to attempt to show that these cases, as they are
commonly presented to our notice, do not merit the importance
which has been given them, and that they should be considered
as entirely separate and distinct from what may be strictlv termed
spermatorrhoea (although they may sometimes lead to this,) an af-
fection, which, as described by medical authors, we conceive to be
extremely rare among us. Sufficient, it is true, has been written
upon spermatorrhoea, but the exaggerated descriptions therein
given do not answer to the cases of simple involuntary seminal

854 Involuntary Seminal Discharges. [June*,

emissions which are so often presented to the notice of the practi-
tioner here, and which he is called upon to treat.

We fully agree with Robley Dunglison, who has written a most
practical and sensible article upon the present subject, in the
Cyclopoedia of Practical Medicine, that there can be no greater
evil to the economy from a flow of semen accompanied by vene-
real desire without sexual intercourse, than with it. There can be
no doubt that an excessive secretion of semen, in whatever way it
may be induced, may have an injurious effect upon the system 1
but we cannot for a moment believe in the long category of com-
plaints which have been attributed to this as a cause.

Involuntary seminal discharges occurring during sleep in young,
robust and continent subjects, constitute a class of cases which are
almost daily presented to our notice. It is very rare, in fact,
judging from our experience, to meet with a young man of vigor-
ous Uealth who does not experience these emissions more or less
frequently, particularly if he be continent. And why, we ask,,
should this be considered as constituting a morbid condition, or
as contrary to the laws of nature ?

The secretion of semen, although it is, like other secretions, very
much under the control of the nervous system, and therefore in-
creased according as the mind is directed towards objects which
awaken sexual feelings, must still in a measure, be constantly go-
ing on under all circumstances. Consequently the presence of an
undue amount of sperm in the vesicular seminales (which are truly
reservoirs according to the best authorities of the present day) if
not got rid of by sexual intercourse, must produce an excitement
in those organs during sleep, which excitement is appreciated by the
brain giving rise to voluptuous dreams, during which the seminal
discharges take place. Even granting the opinions entertained by
many physiologists, that absorption of the semen takes place, and
that it is necessary for the regular maintenance of nearly all our
functions, yet we may easily suppose that this absorption is not the
same under all circumstances, and that the supply may exceed the
demand, particularly in the young, robust and continent individual.

We can scarcely, then, consider moderate involuntary seminal
discharges, occurring during sleep, accompanied by lascivious
dreams and erections, as constituting a morbid condition. In proof
of this, we may say, that there are many individuals who have
had even frequent seminal emissions for a long period without
experiencing the slightest inconvenience from them, and without
ever even giving them a passing thought, until their eyes fell upon
the advertisement of some empiric who has set forth the horrors
and dangers to be expected from a similar condition. But from
this moment there is no more rest for these poor beings, who con-
stitute a class, which, with Ricord, we may term " veritable sper-
matophobist, men who are tormented, hypochondriacal, dejected f
and in whom the cauterization of the neck of the bladder does not
always succeed in curing the brain."

1855.] Involuntary Seminal Discharges. 355*

It may be asked, then, to whal extent these seminal discharges
may take place without actually producing any morbid effects
upon the system. In answer, we must say, that this depends upon
circumstances, upon the peculiar temperament of the individual,
upon his diathesis, &c. In the healthy and continent subject, we
again remark that they exert a beneficial effect upon the economy,
by freeing it from a source of excitement, and that unless they
occur more than once in a niffbt and oftener than once or twiee a .
week, they can scarcely be said to constitute a pathological condi-
tion. We have seen patients who have actually thrived and grown
stout and hearty, in whom these diseharges occurred almost every
night.

What the pathological condition of the vesicufse seminales and
of the ejaculatory ducts may be in this class of cases, we have
comparatively few means of judging. When a patient dies, in
whom these discharges have taken placer the attention at the
autopsy is drawn to some other mo-re serious affection, which has
been the cause of death, so that the examination of the spermatic
organs is almost always neglected. Even in the severest forms of
spermatorrhoea, few observations have been made upon the con-
dition of these organs after death, owing chiefly to the amount of
care and patience necessary, and to the mutilation requisite to ar-
rive at a proper inspection of the parts, which we cannot well
make upon a subject in private practice j and such cases rarely
die in hospitals. Where examinations have been mader however,
more or less sub-acute inflammation has been discovered in the
membranous and prostatic portions of the urethra, and in the ejac-
ulatory ducts the result, generally speaking, of lesions produced
by excessive veneryr or masturbation.. This is what we might
expect.

Involuntary seminal emissions may and do occur in the robust
and continent,, without any decided cause beyond what we have
stated, viz : a certain plethora of the seminal vesicles \ but in the
majority of casesr upon inquiry we do find that their too frequent
occurrence is attributable to masturbation, to excessive sexual in-
dulgence, or to effects produced by gonorrhoea and occasionally
to strictures of the urethra. We are inclined to- doubt the efficacy
of certain other causes which have been supposed to be productive
of these discharges, such as the metastasis of old eutaneous erup-
tions, hemorrhoids, ascarides, horse-exercise, and the use of certain
medicaments, unless there is also present a certain amount of mor-
bid irritability in the urethra.

The general effects ascribed to even moderate involuntary emis-
sions are various, and greatly exaggerated, nay even fabulous^
There is scarce a function in the body which has not been described
as becoming perverted by this cause. However it may be, we
must confess that there seems to be a certain relation between these
discharges and the mental powers, for we find that patients who
experience them are generally more or less misanthropic, hypo-

356 Livolanlary Seminal Discharges. [June,

chondriacal, agitated, and unable to apply themselves to any fixed
pursuit. We know that this cannot be the effect of a moderate
loss of the seminal fluid, however much it may be the result of
excessive losses, and therefore are we not to look for the cause else-
where ; in the perusal of certain books, reputed to be medical
the reading of the advertisements of the charlatan, which disgrace
so many of our daily newspapers and in the fondness for con-
versation upon such topics, always existing in youth? Experi-
ence shows us this ; we never find that one of these patients comes
to us, who, upon inquiry, does not confess that he has read more
or less upon the subject of seminal emissions. In the majority of
these cases relieve the imagination, and the cure is more than lialf
effected.

In our treatment of simple involuntary discharges, such as we
have described, we must act upon the morale of the patient, assur-
ing him that the fears of future impotency and insanity which
have held possession of his brain are without foundation that
what he has read upon the subject is but the artifice of the quack.
To quiet the fears of the " spermatophobist" is to be our first en-
deavor. Advise him to read no more upon the subject of his fan-
cied complaint, to abandon all vicious habits and erotic ideas as
far as possible, and to employ his mind in some engaging pursuit.
Above all, assure him that these discharges do not constitute a
u drain upon the system," but rather depend upon an excess of
sperm, and that if they do occur occasionally they do no serious
harm.

Cold bathing, particularly local, in those cases where a plethoric
condition is not manifest; regular exercise in the open air; atten-
tion to diet, and regularity of the bowels ; in most cases avoidance
of stimulants generally, particularly in the evening, care to empty
the bladder before going to bed ; avoidance of late suppers ; sleep-
ing upon a matrass, with as little clothing as possible to be com-
fortable ; rising at the moment of waking in the morning (for the
emissions occur in almost every case at that time); such constitute
the most important means by which we are to aid the patient in
arresting the too frequent occurrence of these discharges.

With regard to the efficacy of certain drugs in these cases, we
must confess that we put little faith in their virtues. There are
cases where tonics, ferruginous preparations, &c. are no doubt
valuable ; but we think that sedatives are more generally useful.
Benefit has been derived from Lupuline administered either alone
or in combination with ergot, either in pill or powder, at the dose
of from gr. iv, to vj.y two or three times per diem. We have gi ven
a scruple of Lupuline in powder on going to bed with excellent
results. It should be continued for two or three weeks. We
have also derived advantage from ext. byoscyami.

We are inclined to think that some simple medicine should be
given in all cases, even where the discharges occur very rarely.
The "spermatophobist'1 must and will have something for his

1855.] Nitric Acid in Prolapsus Ani. obi

supposed troubles, and if jou gratify his whims, it serves to occu-
py his attention, he feels that he is working out his cure; and that
you take an interest in his particular case. Any more active
treatment than what we have mentioned is rarely necessary in the
class of cases to which we are alluding. Possibly a slight cauteri-
zation might be sometimes admissible, or the simple passage of a
bougie two or three times a week for the purpose of overcoming
any irritability of the urethra. Of course, if stricture should be
the cause of the emissions, it should be overcome.

As to the mechanical contrivances which have latefy been
brought before the public for the cure of seminal emissions, we
must say, after considerable experience, that they have failed to
answer the purpose intended. They cause too much irritation in
the parts and in many cases doubtless augment the evil.

If our patient contemplate entering upon married life, we
should certainly encourage it, and moreover at as early a period
as possible.

Such we consider to be the value and importance of a class of
cases as they are presented to the notice of our practitioners ; cases
which, we repeat, in no wise, answer to the description of sper-
matorrhoea, as given by medical writers, and with which they
should not be classed.

AVe do not deny but that true cases of the milder forms of sper-
matorrhoea may be sometimes met with among us. So much of
our article as relates to spermatorrhoea, we may be induced to
communicate at a future period. [New Hampshire Jour, of Med,

Some observations on Pfolatptus Ani. and suggestions for effecting its
radical cure by the methodical application of strong Nitric Acid.
By Thomas Aickix, M.D., F. R. C. S. I./late Professor of the
Practice of Medicine to the Apothecaries' Hall, Ireland.

The difficulty of effecting a permanent cure of the troublesome
affection for which I venture to propose the line of treatment about
to be described, is admitted by most surgical writers. Previous
to the adoption of the method practised by the late Mr, Hey, no-
thing very effectual appears to have been done for its relief. A
perusal of his cases, as furnished in his Surgical Observations,
shows that they were of an aggravated character, and that certain
structural changes had occurred in the tissues implicated in the
habitually recurring displacement which may have rendered the
excision of a portion of them, as practised by him, indispensable
to their successful treatment. That cases of this description are
occasionally met with, I am quite disposed to admit, having seen
a few such instances myself, which, in other circumstances being
favorable, I would willingly substitute Mr. Hey's method for my
own. It may, however, be observed that the treatment here ad-
vocated as applicable to a large number of cases of prolapsus ani

jr< s, VOL. XI. NO. vi. 23

358 KiLric Acid in Prolapsus Ani. [Jnn'Cr

is based on the same principles as those recognized by Mr. Hey,,
and most subsequent authorities who have adopted his method, or
some modification of it. A prolapsus ani has been compared by
Hunter, Monro, and other surgical pathologists, to an intussuscep-
tion of the bowel, with certain differences which are very apparent,
liokitansky likewise compares it to a u volvulus without a sheath,"
and says that it is characterized by an inversion of the internal
portion of the intestinal tubing, which he describes as follows :
"It represents a sausage- shaped or pyriform tumour, which is
contracted at the anus, so as to form a pedicle, and at the free ex-
tremitj7- there is in trifling cases a round central opening which, in
larger prolapsus^ assumes an eccentric position, and following the
traction exerted upon it by the mesoreetum,. recedes, so as to pre-
sent a mere fissure. The external mucous laj^er is the seat of
inflammation and swelling, which partly proceeds from mechani-
cal hyperemia; partly from irritation produced by the atmosphere.
It is the result of violent and lasting diarrhoea in children, or of
blenorrhoea in adults and old people." It has been doubted whe-
ther all the coats of the rectum are ever protruded in a prolapsus
ani. Such an occurrence, though rare, may, according to the tes-
timony of several intelligent observers,- occasionally happen. The
protrusion beyond the sphincter of the extremity of an intussus-
ception of the colon, or higher portion of the rectum, is alluded to
by different writers, and this grave affection might possibly be
mistaken for a prolapsus ani. Monro (senior) furnishes an inter-
esting case of this description, and similar instances have been
met with and described by others.

Prolapsus ani is, in the majority of cases, easily reducible, sel-
dom demanding any very decided: surgical interference for its tem-
porary relief: indeed it occasionally proves rather unfortunate for
the subjects of this affection that professional assistance is not
invariably deemed necessary on its first occurrence,, because the
facility of its reduction leads to the impression that it is easily
remediable, and therefore no effective measures are employed to
prevent its recurrence. Hence many of these cases date from an
early age, and it is not unusual to meet with persons who have
for several years been subject to a protrusion of the bowel upon
each evacuation. I have met with an instance of it in an old gen-
tleman in his 75th year, when he first began to experience serious
inconvenience from this malady, and who declared that he had
been subject to it from his child hood. Recent cases of this affec-
tion,, owing to the difficulty of their reduction, as also those of
longer standing,, either from their increase f bulk, or the super-
vention of severe haemorrhoidesj or ulceration and consequent
haemorrhage; may suddenly require surgical interference. I have
known the delicate mucous surface of a recent prolapsus in a child,,
as also the tougher and more sensible covering of an habitual one
in an adult, suffer considerable injury from rough and injudicious
attempts at their reduction,, the usual practice amongst nurses and

1855.] Nitric Acid in Prolapsus Ani. 85D

ignorant persons being to place a dry towel over the part, and to
make forcible pressure upon it a method in nowise calculated to
relieve congestion or to overcome the resistance offered by a mor-
bidly excited sphincter. The plan I have usually adopted with
success in such cases, is to place the patient in the prone position,
and if practicable, resting on his knees and elbows, and after
smearing the part with sweet oil, I make gentle lateral pressure
by enclosing it between the thumb and fingers, so as to diminish,
as much as possible, its circumference, and thereby relieve the
congestion, which is usually considerable. The pressure is then
directed upwards in the axis of the bowel, and the reposition of
the part carefully effected by following it with the finger. The
latter practice is indispensable in old cases in which the descend-
ing portion has become more or less thickened and unyielding
from repeated exposure or hemorrhoidal excrescences, Monro
gives some excellent instructions for the reduction of an obstinate
prolapsus, which, as they are worth bearing in mind, I take the
liberty of quoting.

lie observes in his dissertation on "Procidentia Ani, Intussus-
ceptio," &c. : " The bulk of the prolapsed part is often so great
that it is impossible to make it all pass at once through the sphinc-
ter, and a fruitless attempt at reduction generally increases the
swelling. The reduction ought to be made by pressing a small
part of the sides of the orifice with a greasy finger, and when that
part is thrust within the orifice, another finger is applied to what
is then the verge of the orifice, to push it upwards, while the first
finger is withdrawn ; by such an alternate succession of the fingers,
the whole may be introduced in most cases without incisions, so
that this disease is seldom fatal, and for that reason the patient is
generally too much neglected after the reduction, which is some-
times attended with bad consequences." (Monro's works, p. 671.)

Various methods have been devised in order to prevent the re-
currence of the prolapsus, but for the most part without any very
decided results. The older surgeons seem to have placed no great
confidence in the measures they recommend for the cure of this
affection. Thus, Heister, after enumerating several methods of
cure, declares that "to effect a perfect cure in old cases occurring
in persons of a weak or ill habit, is next to impossible. Com-
presses dipped in spirituous or astringent lotions, and retained
in situ by the T. bandage, were chiefly recommended, but they
afforded no protection against the descent of the bowel at the very
time it was sure to occur. Hence certain ingenious mechanical
contrivances were devised in order to obviate the recurrence of the
protrusion during the act of defecation. To these latter it is need-
less to allude here, further than to remark that in surgery, as in
some other sciences, the most ingenious contrivances are not inva-
riably the most practical. Recent cases of prolapsus ani may be
occasionally benefitted by local applications in the form of oint-
ment or lotions, enemata administered for this purpose being

3G0 Nitric Acid in Prolapsus Am. [June,

included under the latter class of remedies. The vegetable astrin-
gents are those usually employed, but Mr. Vincent states that
he has found the injection of a solution of sulphate of iron the
most energetic astringent in such cases. (American Journal of
the Medical Sciences^ new series, vol. sv.) The mere external
application of these remedies cannot confer much benefit,, whilst
their activity as pharmaceutical agents necessarily limits their
solutions, &c, to a strength not well calculated to ensure the de-
sired local effect. I must confess that, after repeated trials of these
remedies, I have not known any of them to confer decided benefit
upon prolapsus ani occurring in the adult. It is indispensable to'
the success of whatever local treatment may be determined on for
the cure of this affection, to- secure a healthy and regular action of
the whole intestinal tube. This may be accomplished in some
cases by a carefully regulated diet, and when the use of cathartic
medicines is indicated,, the mildest should be selected; the elect.,
sennae, either alone or in combination with sulphur, being perhaps
the most suitable. An enema of three or four ounces of cold wa*
ter, administered regularly a short time before bed hour, will be
found to answer extremely well in some cases ; and whilst it usu-
ally solicits peristaltic action, it seems well calculated to allay
local irritation about the anus, and to- induce a healthy tone of the
sphincter.

Mr, Heyrs mode of treating this affection is so well known, that
it is needless to quote his description of it. I shall, however, ad-
duce his reasons for its adoption, as furnished in his own words:
"The relaxed state of the part (he observes), which came down at
everv evacuation, and the want of sufficient stricture in the sphinc-
ter ani, satisfied rne that it was impossible to afford any effectual
relief to mv patient unless I could bring about a more firm adhe-
sion to the surrounding cellular tissue,, and increase the proper
action of the sphincter.- Nothing -seemed to me so likely to effect
these purposes as the removal <>f the pendulous flap and the other
protuberances which surrounded the anus. I hoped that the in-
flammation caused by this operation would produce a more firm
adhesion of the rectum to the surrounding eel hilar substance; and
I could not doubt that the circular wound would bring on a great-
er stricture in the sphincter ani,"" &c, &i\ Subsequent experience
of the results of Mr. Ifeyrs method has demonstrated the correct-
ness of his views, for it is evident that the contraction of the cica-
trices and consolidation of the coats of the bowel with the adjacent
tissues, resulting from a moderate amount of inflammation, accom-
plish the most important part of the cure,

Mr. Abernethy adopted Heyrs method, with some slight modifi-
cation, especially in the treatment of prolapsus caused by hemor-
rhoidal excrescences, for the cure of which he proceeded in the
following manner:- "The bowel being everted to the utmost by
the efforts used in evacuating the feces, and the parts cleased by
bathing, the piles are to be seized with a double hook, of a breadth

1855.] Nktic Acid in Prolapsus AnL CC1

corresponding to the length of the pile, which is to be drawn up-
wards from the bowel, and removed with the scissors. A protruded
and thickened plait of the bowel is to be dealt with in the same
way. The length of the incision should, both for the removal of
piles and that of plaits in the bowel, be longitudinal in the direc-
tion of the bowel. A transverse fold of the bowel is therefore to
be removed by taking away two elliptical portions in the long
axis of the rectum, rather than to attempt its more complete remo-
val by a wound made in another direction. After the operation,
the patient is to remain in the horizontal posture, with the nates
exposed, the parts surrounding the anus being frequently bathed
with cold water, to check haemorrhage or inflammation." (Aber-
nethy's Surgical Works.)

It is certain that the radical cure of a confirmed prolapsus ani,
whether complicated with haemorrhoidal excrescences or otherwise,
must be based upon the principles so clearly explained by Mr.
Hey. Dupuytren's operation for the cure of this disease, is evi-
dently an ingenious modification of Hey's, the requisite contraction
of the orifice being more or less efficiently secured by the eicatri-
cjs following the removal of the marginal folds of integument.

Although the usual result of these methods is in general favour-
able, yet their immediate consequences are occasionally extremely
inconvenient; and there are, no doubt, many patients who wouiel
willingly submit to treatment for this disease^, provided it could
be elected without the use of cutting instruments, but who con-
tinue to endure its many inconveniences rather than submit to an
operation. Having already stated my belief; however, that the
latter may be occasionally indispensable, I shall proceed to de-
scribe a mode of treatment which I believe to be applicable to a
large number of these cases. We are indebted to the late Mr.
Houston for the introduction of the use of strong nitric acid as an
efficient remedy for the destruction of piles. It was observed some
time after this remedy came into general use, that a considerable
amount of constriction of the sphincter ani was not an unfrequent
consequence of its application, which it was inferred might, in
certain cases, induce a troublesome stricture.

Now, in all the cases of old prolapsus ani which I have treated,
there was extreme laxity of the sphincter; and it is quite certain
that unless the latter be stimulated to healthy contraction, the pro-
lapsus must continue to occur. I found that the nitric acid was
calculated to ensure this desirable result, and that its methodical
application accomplished every thing that could be effected by the
excision of a portion of the prolapsed part

The history of the following case will, I trust, sufficiently ex-
plain the manner in which I have employed it. In the beginning
of November, 1854, 1 was requested by a lady to prescribe for an
attack of piles, which then proved troublesome. On inquiry, I
found that this lad}r, who was of middle age and unmarried, had
suffered from prolapsus ani for thirteen years, and that she had

S62 Nitric Acid in Prolapsus Ani. [June,

latterly experienced repeated attacks of hemorrhoidal congestion
and irritation about the anus, along with strangury, and other dis-
tressing symptoms, which I attributed to reflex disturbance of the
pelvic organs. After prescribing some of the usual measures
without conferring much benefit, I proposed to employ a method
for the radical cure of the disease, if, upon examination, such
should be found advisable. I found that, after straining, a fold of
the inner coat of the bowel descended for about an inch, and that
there were three or four old congested hemorrhoidal excrescences,
about the size of small filberts, situated on the verge of the anus.
The prolapsus was returned without any difficulty, but the sphinc-
ter was greatly relaxed, and she was obliged to remain in bed for
some time after each descent of the bowel. The preparatory treat-
ment consisted in effectually unloading the bowels by mild cathar-
tics, after which a few leeches, followed by fomentations, were
applied to the anus, and the patient was directed to remain in bed
for a few days in order to obviate the recurrence of the local irri-
tation, which was subdued by these measures. Having provided
some strong nitric acid and some pieces of ice, I made use of them
in the following manner: the patient was placed on her side, with
the limbs well drawn up ; Weiss' speculum was then introduced
into the rectum, and its blades being divaricated, I dipped a bit of
stick about the size of a common pencil, having a piece of rag
tightly wrapped round one of its extremities for about an inch,
into the nitric acid. This was directly applied between the blades
of the speculum, in a longitudinal manner, so as to cover two
hemorrhoidal excrescences, and extend at right angles to the cir-
cular fibres of the sphincter, for about three-quarters of an inch,
and was pressed firmly against the part for about ten seconds. I
then took a piece of ice about the size of a man's thumb, having
previously rounded off its asperities, and wrapping it in a piece of
lint, introduced it between the blades of the speculum, which was
then withdrawn. The pain, which was intense before the ice was
introdced, ceased in three or four minutes, and the patient expe-
rienced no farther local distress. An anodyne was, however,
given at bedtime, After the lapse of two days there was some
soreness, and a trifling discharge of blood from the part upon
passing a dejection ; otherwise, the ulcer left by the application of
the acid caused but trifling annoyance. About half an ounce of
weak black wash was thrown into the rectum by the vaginal
syringe every night ; and in about ten days a perfect linear cica-
trix had formed. Its effect upon this prolapsus of thirteen years'
duration being already apparent, the same process was now carri-
ed out upon the side immediately opposite to the cicatrix, and,
after the lapse of a fortnight, the contraction of the sphincter not
being quite satisfactory, a third application was made posteriorly,
after which there was no farther descent of the bowel, and the
sphincter acted in the most satisfactory manner.

This patient has, up to this time, experienced no return what*

1855.] Sedative Powers of the Boot of Yellow Jessamine. SG3

ever of the affection, whilst the troublesome reflex symptoms
gradually ceased. My chief reason for employing the ice was to
obviate the great suffering consequent on the use of the acid, and
its anaesthetic efficacy was in this instance fully verified. [Dublin
Medical Press.

Sedative Powers of the Root of Yellow Jessamine. By Dr. Cleave-
laxd, of Cincinnati.

For some time past the profession in the "West and South have
had their attention called to the root of the Gelseminum Semfuvir ens
or Yellow Jessamine, as possessed of very wonderful and valuable
remedial properties ; even those of the most opposite and contra-
dictory nature having been ascribed to it.

The history of the discovery of its power is said to have beeu
as follows: A planter of Mississippi, whose name is not remem-
bered while laboring under a severe attack of billious fever, which
had not yielded to the remedies used, sent a servant into his gar-
den to procure a root and prepare an infusion of it for him to drink.
The servant, by mistake, collected the root of the Yellow Jessa-
mine, made an infusion of it, and gave it his master to drink.
Soon after swallowing some of it, the planter lost his muscular
power, so as to be unable to move a limb or to raise his ej-elids;
while he could hear and feel, and exercise his usual faculties as
well as in health.

His friends became much alarmed at his great prostration, but
after some hours he recovered his muscular powers, and was high-
ly pleased to find himself free from fever. Lie soon learned from
his servant what plant it was from which he obtained the root,
and trying its effects upon the people of his own plantation and
those of his neighbors, he ascertained that he had a valuable reme-
dy for fevers. The use of the article became known to a quack,
who prepared from the Gelseminum a nostrum which he styled
the "Electrical Febrifuge," which was simply the tincture of the
root of the Gelseminum, prepared with dilute alcohol, and disguised
with the essence of winter-green.

After a time the true character of this tincture became known
to the profession, and at the present time it is being used very
frequently by many of this part of the country, who however
seem, from their reports, not to have a very clear idea of its action
on the system, or the class of cases for which it is indicated.

I have tested it uncombined with any other medicine, until I
am satisfied that it is one of the most valuable Sedatives at present
known to the profession and peculiarly valuable, as it expends
its force mainly upon those nerves that are distributed to the mus-
cles of locomotion, leaving entirely unaffected the intellectual fa-
culties, and probably the great ganglionic system of nerves.

We have in the "Aconite a valuable sedative to the nerves of

B6^ Sedative Powers of the Root of Yellow Jessamine. [June,

general sense, or an anaesthetic to those nerves which, when in-
fringed upon, cause the sensation of pain a real pain-destroijer
so far as the superficial sensatory nerves are concerned hence its
value as an external application in all painful conditions.

In ihe'Vei^atrum Viride we have an excellent sedative to the
muscular system and to depress vascular excitement ; but, while
it depresses the Vagus nerve, decreasing the frequency of the con-
tractions of the heart, and deadening the sensibility of the lungs,
and thus relieving them of the sense of a want of breating, it also
sometimes deranges the gastric nerves, producing such an amount
of nausea, and even vomiting, as to preclude the further use of
the remedy. It also not unfrequently induces such free catharsis
as thus to greatly injure the patient if its use is continued.

These objections do not obtain against the Gelseminum, for
while it proves a most powerful sedative to the nerves supplying
the muscles of locomotion, as in the case of the planter who first
took it, it never seems to produce the slightest effect upon the brain,
or in the least degree to derange the stomach or bowels.

It does lessen the pulse and the frequency of respiration, and
while it produces a wonderful relaxation of all the muscles, it re-
lieves all sense of pain by acting upon the nerves of general sense,
in a manner similar to Aconite,

Usually not more than thirty or forty minutes elapse after the
agent is taken into the stomach before the sedative is experienced
and if the dose be not repeated, its influence will continue only
for an hour or two. Many practitioners, however, seem not to be
aware of this, and order doses, in my opinion, unnecessarily large,
and repeat them only once in six or eight hours.

As yet the Gelseminum has been but little used, except in the
form of a tincture prepared with dilute alcohol ; but, as in the in-
stance of its first trial, experience proves that the sedative property
is fully soluble in water; and the experience of some in New Or-
leans, who made use of a tincture prepared with strong alcohol,
would indicate that the root contained a dangerous resinoid sub-
stance, readily soluble in strong alcohol, but not soluble in dilute
liquor or in water. Some deaths even occurred in that city, which
were supposed to be produced by this poisonous resinoid j)rinci-
pie,

The dose of the saturated tincture, with dilute alcohol, is from
three to thirty drops, and I think it much better and safer to give
small doses frequently repeated, than to risk a too large dose of a
powerful sedative medicine,

I need not call the attention of your readers to the great variety
of cases in which sedatives are indicated, and in which those that
act as Lobelia or Veratrum do, on the stomach or boweLs, are con-
tfra-indicated. Perhaps no other class of agents would be more
frequently resorted to than these, did the profession feel sure they
could command the agent which would produce the desired ef-
fect.

1855.] Vapour of CI dor of arm. SC5

From sufficient personal experience, as well as from the obser-
vations of many physicians who have used this preparation, I am
satisfied, that as a sedative to the nerves branching from the spinal
cord, and going to the organs of locomotion or the nerves of
voluntary motion, and in a lesser degree the Vagus and sympa-
thetic branches of nerves that are distributed to the heart and
the lungs, inducing a less powerful and less frequent pulse, and a
more sluggish and feebler respiration, the Gelseminum will prove
highly satisfactory to any who may give it a trial.

It has had ascribed to it tonic, alterative, anti-periodic, anti-
phlogistic, anti-spasmodic, diaphoretic, diuretic, and perhaps
many other anomalous and contradictory properties ; but, like the
laudations of many foolish friends, so much has been said, that
but little, if any, of these statements by many have been believed.

It may be possessed of other powers, but my most careful testing
of the drug has revealed to me only its sedative powers. [Ameri-
can Medical Gazette.

A detailed account of the results obtained from the local application of
the Vapour of Chloroform Ly members of the Surgical Society and
others. By S. L. Hardy, M. D., Examiner in Midwifery and
Diseases of "Women and Children, Koyal College of Surgeons,
Ireland ; Physician to the Institution tor Diseases of Children,

A request having been made by the President on the first night
of the present Session that any person who could give an account
of the action of chloroform vapour as a local remedy would do so,
I propose on the present occasion to show that this agent has been
resorted to in the practice of several members of this Society, and
that in their hands it has proved a valuable and efficient remedy.

I lately detailed in the Medical Press (November 15, 1854) a
large number of cases in order to illustrate the action of chloro-
form vapour as a local application. Since appearing in that peri-
odical, those cases have been published as a pamphlet. When
speaking of the use of chloroform vapor in surgical cases, I made
the following observations: As a means of alleviating pain dur-
ing operations, the application of chloroform vapour can be of
service in but a very limited number of cases, and those only be-
longing to the minor operations of surgery, where the disease is
superficial and the cuticle very thin or abraded."' "With the view
of showing the efficacy of the vapour of chloroform in operative
surgery, I shall first read a case for which I am indebted to the
President. It is one of anthrax, which every practical surgeon
knows to be a most painful affection. A case of a similar nature
was presented to me by Mr. White,* a Licentiate of this College.

* Fi>r a report of these cases, as well as of the others read, see Medical Picss of
November lo, 1854, p. 307.

366 Vapour of Chloroform. [June,

In those cases of anthrax, the cuticle being abraded, the vapour
was enabled to act with much greater intensity than it could have
done where no breach of surface had existed. They are, I think,
most important, as showing that where it is desirable, as in the
President's case, to dispense with inhalation of chloroform, its lo-
cal application may answer all that is necessarj' ; with this no
small recommendation, that in so using it there is no risk of de-
priving the patient of life, no matter whether he be the subject of
fright, or of cardiac, pulmonary or any other form of organic dis-
ease.

That operations in surgery may be performed without suffering
to the patient by the use of chloroform vapour when applied lo-
cally, even where the cuticle is not abraded, cannot be better il-
lustrated than by the following case, for which I have to thank
Mr. Smyly.*

As many surgical dressings are very painful, and require fre-
quently a good deal of tact on the part of the surgeon to overcome
the restlessness or irritability of the patient, it is satisfactory to be
able to quiet those sensations, both for the sake of suffering on the
part of the sick, and for being able the better to resort to the
means necessary for restoring health. Mr. Wilmot has enabled
me to show, both from cases in which he has used chloroform va-
pour with this intention, and from his practical remarks,-)- that
under such circumstances it is most beneficial.

On the Continent, where the local application of the vapour
of chloroform has met with considerable attention, in the hands
of M. Larrey it was also found of much use in surgical dress-
ings4

The Medical Times and Gazette for August 19, 1854, p. 195,
contains the results obtained by M. Conde, copied from a Spanish
journal, also showing the efficacy of the vapour of chloroform in
surgical dressings. The effect of chloroform on the pulse, when
applied locally, as mentioned in this case, I have not observed,
although having particularly attended to it.

Dr. Geoghegan has used chloroform vapour locally in cases of
cancer, and made accurate notes of the effects produced by it.|

Dr. Mayne, in employing it in a cancerous tumour of the neck,
says: " I can confidently assert that the chloroform douche never
failed to alleviate her sufferings temporarily. "If

Very remarkable effects have been obtained by the local appli-
cation of chloroform vapour in tetanus. A case under the care of
Dr. Kirkpatrick occurred in the North Dublin Workhouse, in the
treatment of which chloroform was freely used. It is the more
valuable, as very soon after I had an opportunity of witnessing
the action of chloroform in its treatment ; I had an account of
even a much more important and interesting one under the care
of Dr. Woods of Parsonstown.*"*

* See Medkal Press, Nov. 15, 1854, p. 307. t P. 308. 1 P. 308. P. 311.
ti P. 3J3. IT P. 3vi). ** P. 306.

1855.] Vapour of Chloroform. SG7

I have found chloroform vapour particularly useful in many
neuralgic affections. The rapidity with which relief is obtained
by it in some of those cases will be better understood by the fol-
lowing details.

The first cases that I shall mention are of toothache. Dr. Geo-
ghegan came into my house as I was charging the douche for a
young gentleman who was suffering severely from toothache. I
asked the doctor to witness the result. Not more than half a
dozen jets of vapour had been thrown into the tooth, when I asked
if there was mucn pain ? The gentleman said he was perfectly
well.

One morning in the beginning of this week a girl asked me to
relieve toothache for her. She had suffered a good deal, and was
then in great pain. A few jets of vapour, as in the case just de-
tailed, immediately removed it.

A patient who was taking mercury for a syphilitic affection,
complained to me of very severe pain in his fauces, gums, and
ears. lie was at this time salivated. I directed him to close his
lips on the tube of the douche, and hll his mouth with chloroform
vapour, also to blow it into his ears and on the sides of his face,
lie did so and obtained relief,

A few days ago a lady, during an attack of influenza, com-
plained of pain in the right side of her face, which distressed her
very much. I applied chloroform by the douche, and she was
immediately freed freed it.

I have received the notes of the two following cases from Mr.
Forrest :

An unmarried lady, who had been subject to hysteria from
her 14th year, and had suffered during each month of February
from severe neuralgic pain in the frontal region, was affected
in the present month (February) with violent pain in the globe
of her eye, which was followed by effusion of blood under the
conjunctiva, and the integuments surrounding the orbit appeared
as though a severe blow or contusion had been inflicted upon
them. To relieve the violent pain chloroform vapour was applied.
In fifteen minutes not only was the pain removed, but the con-
gestion was greatly diminished.

The subject of the second case was a professional gentleman of
the bar, aetat. 30, of studious habits, who, about two years ago,
had suffered much from cephalalgia, which was cured by sulphate
of quinine in doses of five grains taken three times a day. Lately
he was seized with most excruciating pain in the globe of the eye,
with profuse lachrymation and inability to separate his eyelids.
The severity of the attack was so great that he hurried to his medi-
cal attendant who applied the vapour of chloroform. In ten min-
utes he could open his eye, and was free from pain. The surprise
of this gentleman was very great at the immediate relief obtained
from the chloroform.

Mr, Smyly has given me the history of a case of neuralgia,

S6S Vapour of Chloroform. [June,

which had resisted various forms of treatment, but readily yielded
to the vapour of chloroform.*

[Dr. Hardy then read the case and a similar one by M. Bichat,
and also a case of crick in the neck by M. Bernardet, for the de-
tails of which see Dr. Hardy's pamphlet " On the Local Applica-
tion of Chloroform Vapour."]

The vapour of chloroform was applied alone in all the cases
now detailed. With the exception of the first that I am next
about to read,f those following were treated by the vapour of
chloroform and warm water combined. The advantages derived
from the combination of warm water vapour with that of chloro-
form, seem to me very important, particularly when the part sub-
jected to treatment is not denuded of cuticle. The warm water
vapour not only has itself a soothing effect, but by softening the
integuments, renders the surface more susceptible to the action of
chloroform.

I had an opportunity of seeing the subject of the second case of
gout when taking a vapour bath. He told me that he had been
for twelve days free from pain, owing to the relief obtained by the
use of the chloroform and warm water vapour bath, and that for
3Tears he had not been so before. He described the sensations
caused by the bath, as being most agreeable and pleasant. He
had frequently applied chloroform on lint to his foot, but it had
not banefited him in the manner that the bath had.

On Thursday last, Mr. Brown, resident-surgeon in Steevens'
Hospital, gave me the history of two cases treated by the vapour
of chloroibrm and warm water.

The iirst was that of a boy, who was under the care of Mr. Wil-
mot for morbus coxas. In the treatment an issue was inserted
behind the trochanter. Erysipelas, which was prevalent in the
ward, attacked the part, and assumed the erratic form. It appear-
ed successively on different parts of the trunk and lower extremi-
ties. In the course of the disease there Avas great pain in the
instep and dorsum of the left foot. By Mr. Wil mot's directions a
bath of chloroform and warm water vapour was given ; the foot
and leg, as far as to the knee, being enclosed in an India-rubber
case. In fifteen minutes the boy expressed himself much relieved,
and shortly after fell into a sound sleep.

The second case was osteo-sarcoma of the thigh, The patient,
a boy, aged 15, suffered from constant pain in the diseased part,
which was at first relieved by poultices, but after a time anodyne
and various applications failed in procuring him ease. The vapours
of chloroform and warm water were resorted to, and he expressed
himself relieved.

In a letter which I had last month from Prof. Simpson, he men-
tions carbonic acid gas which he has found to be locally a stronger
anaesthetic than chloroform vapour, and with a cooling, instead of

* See Dr. Hardy's pamphlet, p. 7. t See Medical Press, Nov. tf , 1864, p. &i7.

1S55.] Wounds of Arteries and their Treatment 350

a burning, effect when applied to mucous membranes and raw-
surfaces; and in concluding his letter, he asks: "Have you tried
it?" I have not tried carbonic acid gas locally as an anaesthetic ;
but from what Dr. Simpson says of its action, it is very desirable
that it should meet with proper attention.

Were it necessary, I might bring before the notice of the Socie-
ty many more cases illustrating the efficacy of chloroform vapour
as a local remedy, but what I have already detailed seem to me
sufficiently convincing, particularly as they are not the results
obtained by one but by many persons, and several of them the
members of this Society, It is not my purpose here to notice the
failures that I from time to time observe reported of the vapour of
chloroform as a local remedy. I am well aware that it has failed,
and will and must do so, and that frequently, until experience has
pointed out the cases to which it is suited, and prejudice has
passed from before the vision of some who can understand noth-
ing but what they themselves have introduced. Any one who
has seen a late number of the Medical Press (December 20th) must
be amused at the report which it contains of experiments made in
London on local anaesthesia. Past experience, however, encour-
ages us to hope that after a little the local application of chloro-
form will be found a valuable remedy by many. It must be well
remembered how long it was before a late improvement which
originated in this place made any way, or was found to answer
the end for which it was applied in any other than in this city.
Case after case was reported of success at home, while failures in
other places were not wanting, until at length the industry, un-
tiring energy, and ingenuity of the members of this Society, estab-
lished beyond all doubt one of the most valuable additions to
modern surgery namelvT the treatment of aneuiisrn by compres-
sion. As it was in the treatment of aneurism, so it is in the local
application of chloroform vapour; time and proper discrimination,
of the cases to which it is applicable will, I doubt not, ultimately
establish this method of using chloroform. In bringing before the
Society the subject of local anaesthesia by the application of chlo-
roform vapour, my object to-night is to induce the members pres-
ent to take a greater interest in it and to investigate it so fully as
will enable us to resort to it and prescribe it with a greater degree
of certainty in our practice. To prove that it deserves our most
careful attention requires but little argument, when it is remem-
bered how immediate are its effects in producing immunity from
pain, how easy of application, and how perfectly free from risk
both to the patient and the operator. [Dublin Medical Press.

Upon Wounds of Arteries, and their Treatment. By Mr. Butcher

The direction given in works on surgery to cut down to a
wounded artery, and to put a ligature above and below the seat*
of injury, is good in itself, but not always practicable. When tW

370 Amputation of the Thigh. [June,

internal carotid artery is wounded by a piece of tobacco pipe thrust
through the mouth, the common carotid must be the vessel tied,
A similar necessity may exist even in wounds of the extremities,
as has been shown by Mr. Butcher, F.R.C.S.I., Surgeon to Mercer's
Hospital. "We find, in the 'Dublin Quarterly Journal of Medi-
cal Science,' an account of a wound of the profunda artery ; liga-
ture of the femoral, below the margin of Poupart's ligament, by a
transverse incision; arrest of the bleeding; death eleven hours
afterwards. It was impossible to tie the artery above and below
the wound, owing to its great depth from the surface; the main
trunk was, therefore, secured by a ligature, the incision through
the skin being made transversely, as previously practised by Mr.
Porter, in consequence of the necessity of putting on the ligature
so close to the crural arch.

The most interesting part of Mr, Butcher's communication is
the narration of those cases in which he commanded haemorrhage
from a large vessel by means of well-adapted pressure. A police-
man was stabbed in the leg : severe arterial haemorrhage, followed
by faintness, ensued. Mr. Butcher concluded, from the nature of
the accident, that the posterior tibial artery was wounded. Gradu-
ated pressure, by means of a roller and compresses (7 or 8 pledgets
over the situation of the would) was carefully exerted ; the foot
was raised ; a compress and roller were applied over the popliteal
artery, and a dose of morphia was administered : the limb was
kept steady by a splint. On the following day, the pressure was
removed from the popliteal artery and applied to the femoral, by
means of an aneurism compress on the groin. The case did well ;
and Mr. Butcher, in commenting upon it, remarks that, as a rule,
the surgeon should not seek for a wounded artery unless it be
bleeding. A case of wound of the ulnar artery above the wrist
was successfully treated by compression of the wound and pres-
sure over the brachial artery ; and profuse haemorrhage from the
hand after excision of the index finger, with removal of the head
of the metacarpal bone, was completely controlled by powerful
flexure of the injured limb, together with gentle pressure over
both the radial and the ulnar arteries. [British and Foreign Medi-
co-Chirurgical Review.

Amputation of the Thigh in Civil and Military Practice. The Com-
parative success of Secondary Amputation. By Eichaed McSheh-
ltY, M. D., of Baltimore.

The great fatality which attends upon amputation of the thigh
after gun shot wounds is evidenced by the fact, that, during the
campaign in Mexico, under Gen'l Scott, there were no recoveries,
so far as Dr. McSherry could learn, after the operation. This
mortality is not peculiar to our country, as Mr, Kibes examined
four thousand invalid soldiers, among all of whom he did not find
one single instance of injury of the femur by shot, nor one who

1855.] Hyposulphite of Soda in Rheumatism, 371

had undergone amputation of the thigh. Malgaigne was equally
unfortunate with all his cases during the Polish campaign. In
civil life, the case is widely different. The statistical tables, pub-
lished by Dr, Norris, state that during a period of ten years, of
sixteen amputations of the thigh, performed in the Pennsylvania
Ilospital, fourteen recovered, and but two died. The two fatal
cases were primary amputations, after fracture of the thigh and
compound and comminuted fracture of the leg, respectively. Of
the fourteen successful cases, seven were fractures (one ununited
fracture of thigh), one tumor on the knee, and six caries of knee-
joint. These results are favorable, Dr, McS, thinks, to secondary
amputations.

In the Parisian hospitals, there were, in ten years, forty-four
amputations of the thigh. Of these, thirty-four died, and ten re-
covered. All of these, however, were amputations after traumatic
lesions. A comparison of these results exhibits. Dr. McSherry
observes, that patients who undergo great operations, in full ro-
bust health, are more liable to perish than those who are subjected
to them for chronic disease. There is abundant proof, also, that
delay is advantageous. Dupnytren,m 1830, treated thirteen cases
of fracture of the thigh witliout amputation ,- of these six recovered
and eight died. Malgaigne reports five cases treated by himself,
without amputation, of whom two recovered and three died. These
results, compared with those in the same hospitals after amputa-
tion, (see ante.) show that the chances of life were greatest where
the operation was not only deferred, but forgone altogether. Dr.
McSherry considers that these facts show that the rule that the
thigh must be amputated immediately upon fracture of the femur
by shot, is a bad one, inasmuch as it requires certain destruction
of the limb, without adding appreciably to the chances of ultimate
recovery. "When there is thorough disorganization of the limb
from injury, the case, of course, is different. The exception, how-
ever, should not be made the rule. [Amor. Jour, of Med. Science.

Hyposulphite of Soda in Inflammatory Rheumatism. By J. II.
WARREN, M. D., of Xewton Upper Falls.

This preparation of soda is worthy of more notice as a remedial
agent than is usually accorded to it by the profession. The fol-
lowing case will illustrate the value of the remedy :

Mr. C. had been ill for three days with inflammatory rheuma-
tism when I first visited him. He had chills once in four hours.
Tongue dry, with a dark, thick coat. Pulse 120, dicrotic ; skin
very dry ; urine high colored and scanty, with brickdust sediment.
All the joints very much swollen, inflamed and exceedingly pain-
ful. The pain was so severe that the walking of any one upon
the carpet caused him to complain most bitterly. Ordered the
following : E. Hyd. chlor. mitis, gr. viij. ; pulv. jalap.,, gr. xi. f

872 Production of Sees< [Juno,

pulv. digitalis, gr. x. Divide into two powders, one to be taken
once in three hours; followed by R Nitrate potassa, gr. xv.;
syrupi simplicis, f I ij. ; vin colchici sem., I ij. ; morphine, gr. ij. M,
Sumat cochleare medium quarter horis. Externally apply R Tr.
aconite, gttxl.; acet plumbi, 3iij. ; tr. opii, f 3j. ; alcohol, 5 vij-
M. Bathe the parts with this mixture freely, applying cotton after
each application.

2J. day. Is no better; skin dry; knees, which are mostly com-
plained of, very painful and badly swollen. Vomited twice through
the night. Pulse 140, full. Passes urine more freely. Super-
added pericardial inflammation. Cannot be moved. Countenance
anxious. Breathing quick. Pain and some oppression about the
cardiac region. K, Hyposulphite soda?, 3j,; acet morphia?, gr,
ij.: gum acacia?, gr. xx. M. Divide into six powders, one to be
taken every two hours. Apply, externally, cloths wet in R Hy-
posulphite soda?, ij., acid, acet dil., Oss. M. Renewed once in
three hours.

3d day. Had a good night's rest Tongue looks better ; pulse
100 ; skin moist ; urine free, not very high colored ; swelling much
diminished. Has but little pain. At his request let him sit up.
Continue the same medicine.

4th day. Pulse 88; swelling nearly gone; no pain ; sits up.
The same medicine continued.

5th day. Tongue clean ; pulse 80 ; walks about the room.
lias some appetite. Give him chicken broth. Medicine continued.
Two comp, cath. pills at night,

6th day. -No pain. Pulse 78. At his request let him go out
Medicine continued, with a little brandy and water.

8th day. Discharged, well.

The fact most worthy of notice is the wonderful power of the
medicine in exciting the secretion of the kidneys, when internally
used. As an antiphlogistic agent, I have found it very powerful,
and have used it externally where lead was objectionable, and
some other agents of this class of remedies were useless. [Baton
Medical and Surg. Journal.

Production of Sexes.
The following are the views of Dr. Silas Hubbard, of New
Hampshire, upon this interesting subject. Will any of our read-
ers verify their correctness?

"In the Sept. No., 1850, of the Buffalo Medical Journal, I ad-
vanced the theory that males are conceived shortly before the time
of the courses, and females shortly after ; and now I propose to
treat of this theory more fully, and to give my reasons therefor.
My theory is, that there is generally a periodical development
and maturation of an ovum near the time of the courses, and that
said maturation usually bears the same relation to the time of the

1855.] Parker's Prize Essay. 373

courses in all women, and thus they are ordinarily more suscepti-
ble of impregnation shortly before and shortly after menstruation :
and also that this susceptibility is nearly equal at both these times.
My theory further is that the same ovum, if fecundated shortly
before the courses, will general^ grow to be a male, while if fe-
cundation is deferred till after the courses, it will generally grow
to be a female. If the maturition of the ovum bears a particular
relation to the time of the courses, then it must be acknowledged
that its condition must be very different before to what it is after
the menses; indeed, a great difference can be seen, at different
ages of its ripeness, with the microscope. It necessarily follows,
then, that if fecundation occurs in one of these cases, the embryo
will grow up to be a very different being to what it would in the
other: that is to say, the ovum which grows to be a male is fecun-
dated as soon as it is sufficiently mature to be impregnated, or
while it is quite recent; but if its fecundation is postponed to a
particular period later, it grows to be a female. I will not say
that this rule relative to the maturition of an ovum near the time
of the courses will always hold true, because rarely it is matured
and fecundated during the intermenstrual period without any re-
ference to the time of the menses, which is an exception to the
general rule."

We find in the " Transactions of the Illinois State Medical So-
ciety," an exceedingly interesting Prize Essay by H. Parker, M. D.,
on the "Differences in the Physiological and Pathological action
of that class of remedies called stimulants, of which alcohol is the
type, and tonics, of which the bitter Barks and Iron may be consid-
ered as specimens." We regret that our limits will not allow us
to reproduce the paper in extenso. The following are, however,
the conclusions of the learned author :

" From a careful consideration of the facts and arguments now
presented, concerning the nature of vital properties, and the
modus operandi and physiological action of stimulants, of which
I have considered alcohol the type, we may deduce in brief the
following conclusions:

1st. That the elementary vital properties or forces of all living
organized bodies, are in no way derived from any connection with
the nervous system, but are inherent, distinct and peculiar. That
they are susceptible to the impression of an agent, and capable of
modification, independent of nervous influence.

2nd. That nervous force is a property or function peculiar to the
nervous system, and like vital force, is susceptible of great modi-
fication.

3rd. That there may exist mental exhileration with increased
nervous force, or excitement, and thereby a sensation of increased

N. S. VOL. XI. NO. VI. 2-i

874 Parker's Prize Essay. [June,.

strength and energy, while the vital forces of the tissues, tonicity
and susceptibility may be simultaneously diminished or depressed ;
and hence,

4th. That increased nervous excitement, or a temporary exalta-
tion of nervous force, is no index of the true condition of the vital-
forces, or any evidence of increased strength or vitality.

5th. That the muscular activity and vigor and the general " har-
diness" of the system, is wholly dependent upon undisturbed
healthy nutrition,, and the due elimination of excretable substances
from the body.

6th. That the popular belief, that the action of alcoholic stimu-
lants is confined to the brain and nervous system alone, simply
inducing mental exhileration and a temporary exaltation of ner-
vous power, is not true ; but that coincident with their action up-
on these structures, they exert in a variable degree, a direct and
deleterious influence upon the component elements of the blood
and tissues, with the ultimate effect of lowering the elementary
vital properties of the body, tonicity and susceptibility.

This they accomplish in the following manner :

1st. By their great affinity for, and absorption of the oxygen
of the blood, thereby interfering with its agency in the formation
of plastic material, and impairing the organizability of those com-
pounds designed for nutrition and reproduction. 2nd. By pre-
venting or retarding that vital change the conversion of venous-
blood into- arterial,, and diminishing the functional activity of the
secreting and excreting structures generally, thus causing a reten-
tion and accumulation in the blood of effete and excrementitious
compounds. 3d. By retarding capillary circulation and the meta-
morphosis of the tissues.

7th. That alcoholic stimulants diminish animal heat, and the
exhalation of carbonic acid.

8th. That the popular notion that alcoholic stimulants promote
healthy digestion and chymincation, is not true, and therefore
should be discountenanced and discouraged by medical men, not
only as failing in this,, but as destroying the natural sensibility of
the stomach, and inducing morbid irritability and diseased action^

9th. That the stimulation and excitement which naturally fol-
lows the use of these substances, tends to destroy that harmony of
action between the different organs and forces of the body, upon
which their functional activity, and the continuance and mainte-
nance of health depends. Finally,

"That alcoholic stimulants are the most unfit, and the least cal-
culated of all other expedients,, to impart strength and vitality to
the human system, or enable it to resist the depressing influences
of cold or hunger, fatigue or disease, or any of the various circum-
stances and events to which it may be exposed.'7

From a careful consideration of the physiological and pathologi-
cal action of tonics,as now presented, I shall deduce the following
conclusions :

1855.] Perchloride of Iron. 375

" 1st. That tonics are haematic medicines, and as such, are res--
torative in their influences ; that, unlike neurotics and stimulants 't
they have no direct or special action upon nerve matter.

2nd. That they are not foreign to the blood, and may therefore
remain in it ; that they improve its quality, and the plasticity or
its organizable material, assisting digestion and promoting assimnV
tion and nutrition. Hence they are slow but permanent in their
effects.

3d. That they exalt the tone of the muscular fibre ; and hence
by their use, " the pulse becomes fuller, stronger, and regular, and
the muscular power increased," that they increase the cohesion
and density of the tissues diminish profuse secretions when de^
pendent upon atony and debility, and finally, augment the vital
forces of the system in general, thereby restoring susceptibility when
defective, and the properties and functions of the nervous system
to their normal condition."

Neutralization of the Syphilitic Virus, by the Perchhride of Iron.

In a report made to the " Administration of Hospitals" at Lyons,
Dr. Eodet has communicated the composition of a liquid which
possesses the property of decomposing the syphilitic virus, and
thus preventing contagion. After numerous experiments made
for the purpose of discovering some substance which would without
cauterization, prevent contagion, this physician has fixed upon
the perchloride of iron, and has deduced the following conclusions
from his varied investigations.

1st. The most suitable dose of perchloride of iron and citric acid,
is 4 grammes of each to 32 grammes of distilled water. By adding
to this solution 1 gramme of hydrochloric acid, preservation from
contagion may generally be secured. With 2 grammes of hydro-
chloric acid, preservation is more secure, and with 4 grammes still
more so. The prescription would therefore be as follows :

Distilled Water, 82 grammes.

Perchloride of Iron, )

Citric Acid, i aa. * 4 "

Hydrochloric Acid, )
A liquid endowed with properties almost identical, maybe found
by leaving out the citric acid, and increasing the quantity of Irp
drochloric acid one third, according to the following prescription :

Distilled Water, 32 grammes,-

Perchloride of Iron, - - - 4 "

Hydrochloric Acid, - - - 6 "

This latter preparation is, however, slightly more irritating than
the former, and therefore not as desirable.

2d. The most simple manner of employing this liquid is by drop^
ping a drop on the part innoculated by the virus, and allowing it
to remain there ten or fifteen minutes, or by placing upon the part
a small piece of lint or charpie previously dipped in the prepara-

376 Perchloride of Iron. [June,

tion. If the liquid remains in contact too short a time the preven-
tion of contagion is incomplete, and an ulcer makes its appearance
which developes itself slowly and which may be regarded as an
imperfect chancre.

The prevention of contagion will be complete if the lint or char-
pie is applied for an hour. Even a shorter time will probably
suffice, but no inconvenience will be experienced if it is allowed
to remain twenty-four hours.

3d. As soon as the liquid is brought into contact with the in-
noculated spot, the patient experiences a burning sensation which
lasts, however, only for an instant. Immediately this spot begins
to rise and assume the form of a papule which gradually extends
from the centre to the circumference, and resembles the bite of a
gnat. At the end of twenty or thirty minutes it ceases to spread ;
in two hours it commences to dry up, and after several hours
no more trace of it remains. This blotch is an infallible sign
that the liquid has penetrated into the point of inoculation, that
it has passed into the meshes of the reticulated tissue of the skin,
and *that the virus which seems to insinuate itself into those parts
more slowly, has been completely destroyed. In order to render
the prevention of contagion certain, it is necessary that the blotch
should acquire a considerable extent, and this is produced by the
absorption of the liquid, hence the necessity of leaving the liquid
in contact with the contaminated part a certain length of time.

4th. The prevention may be secured before the virus has pro-
duced any appreciable effect upon the part. At the expiration of
two, four or six hours, the prevention is as complete as if the ap-
plication were made sooner, provided the liquid has been allowed
to remain sufficiently long in contact with the infected part.

If the inoculation has already produced any sensible effect,
either a pustule or a papule, the liquid is not readity absorbed, the
blotch does not form in a regular manner, and consequently the
prevention remains incomplete. Cauterization with a fragment
of solid nitrate of silver is then more sure and therefore to be pre-
ferred.

5th. The effects of this preventive liquid may be modified, not
only by the quantities of active substances which enter into its
composition, and by the duration of its contact with the parts af-
fected, but also by the activity of the virus, whose effect it is in-
tended to counteract. Weak doses which in some cases act as
complete preventives against contagion, produce in others only an
imperfect result. M. Eodet thinks he can prove that the syphilitic
virus is much more active when it is derived from a recent chan-
cre, than from one in a later stage. He supposes that the virus
may renew itself by a new generation in the chancre ; but that the
soil in which it is implanted may become exhausted, or the chan-
cre itself become so enfeebled that it can produce but. slowly its
first effects, and resist more feebly the neutralizing effects of the
preventive liquid.

1855.] Sub-nitrate of Bismuth in Venereal Diseases. 877

6 tli. This liquid seems to be susceptible of many other applica-
tions.

First. It modifies the simple chancre^ with a rapidity truly re-
markable, destroying sometimes in twenty-four hours their proper-
ty of secreting virulent pus.

Second. Vaccine matter is neutralized by this liquid in the most
complete manner. This considered by itself is a matter of small
importance, but it induces the hope that we may be able to modi-
fy the varioloid irruption and prevent the disfiguring marks which
it sometimes leaves behind it by bathing with this liquid at an
opportune time, the parts of the skin which we wish to preserve.

Lastly. Is not this liquid capable of neutralizing the virus of
hydrophobia as well as that of syphilis and vaccine? If experi-
ence enables us to answer this question affirmatively, science will
have made an important conquest. As this remedy does not cauter-
ize the tissues, even suspected bites may be bathed with it without
fear, while cauterization not only is rejected by a large number of
victims on account of the dread which it inspires, but even when
employed, does not always reach every part of the bite, and is not
always successful in destroying the virus. [Jour, de Medccine et
de Chirurgie. Charleston Med. Journal.

Notice of a New Treatment for Venereal and other Discharges in both
sexes, by the employment of large doses of the sub-nitrate of Bismutlu
By M. E. Caby, Interne of St. Lazare.

The numerous cures, M. Moneret has effected by large doses of
the sub-nitrate of bismuth in cases of diarrhoea, however obstinate,
of dysentery and other maladies, induced me to apply the same
treatment to venereal discharges, and the results, almost unhoped
for, which I have obtained for some time, induce me to bring to
the knowledge of my colleagues this method of cure.

1st. In Gonorrhoea, whether acute or chronic, in male subjects,
I prescribe, three times a day, an injection prepared with a certain,
quantity of water with as much sub-nitrate of bismuth as can be
held in solution. The patient retains it about five minutes. In
no case has it produced the slightest pain ; a result of the insolu-
bility of the sub-nitrate of bismuth. The continuance of the treat-
ment has been from four to ten days. A number of these instances
had resisted every other kind of treatment.

2d. The treatment is different, although not less efficacious in
vaginal discharges, whether acute, or chronic, or simple, or even
connected with ulcerations or chronic inflammation of the os uteri.
It consists in the application, by aid of the speculum and a simple
pledget of lint, of the sub-nitrate of bismuth, dry and in powder.
The only precaution is, to project a large quantity of the powder
upon the osteri, and during the withdrawal of the speculum, upon
the vagina and even on the labia. This application, producing
not the slightest possible pain, should be made at least once a day,

378 Hip Disease or Coxalgia. [June,

taking care to employ an injection to remove from the vagina the
powder more or less moist, which should be replaced by a consid-
erable quantity of dry powder.

This very simple treatment, which requires the concurrence of
no other therapeutic agent, and which occasions not the slightest
pain to the patient, operates, especially among females, with a
promptitude so great, that the next day copious discharges have
almost dried up. Another advantage possessed by the sub-nitrate
consists in the modification, as rapid as inexplicable, of the redness,
and even of the ulcerations on the neck of the uterus.

I hardly venture to say that all discharges, without exception,
can be cured in this way : yet the results, already numerous which
I have collected and purpose soon to publish in a memoir on this
subject, leave no doubt of the efficacy of the treatment. I am,
moreover, convinced that this has been already demonstrated by
the studies of many physicians. [Revue Med, Uhirurg. from Monit.
des Hopitaux, and Ibid.

Early Exercise in Hip Disease or Coxalgia. By E. S. Cooper,
M. D., of Peoria, Illinois.

My attention was first called to the benefits of early exercise in
coxalgia by the following case, two years since.

Case. Master John Fear, aged nine years, was attacked in the
spring of 1852, with pain in the knee, which continued for some
weeks, when it was ascertained that the seat of disease was in the
hip, and his physician had him confined to bed, and kept in this
position from the 1st of May to the 27th of June, when he was ad-
mitted into my institution.

I found him in the following condition : much emaciation ; pain
in the knee and hip ; the foot of the diseased side projected two
inches beyond the other, when they were placed side by side,
Pressure on the heel produced an immediate reference to pain in
the hip ;joint.

Having already witnessed the benefits of early walking in white-
swelling, the great relief from pain which exercise gives in these
cases after the inflammatory symptoms have been principally sub-
dued, and its invigorating influence upon the general health, I
concluded that, inasmuch as keeping the joint quiet was the only
object in confining patients to bed, generally, who have this dis?
ease, an apparatus might be devised which would secure the
quietude of the diseased parts, and, at the same time, permit the
balance of the body to be exercised, and which I was able to ef-
fect by a proper machine.

From the period of its application, the patient was more com?
fortable, particularly during the night. In fact the change was
very striking, so much so, that from the most painful, sleepless
nights, he passed to complete quietude during that period, inter*
rupted by occasional paroxysm of pain, which were readily re

1855.] Differential Diagnosis of Orchitis. 379

lieved by an opiate. With this apparatus I could abduct the
head of the thigh bone to the extent desired, and, by thus securing
"the ulcerating articular surfaces from pressure upon each other,
and keeping the thigh bone from motion, while with the leg held
in a state of flexion, the patient could exercise on crutches without
the least detriment to the diseased limb.

The general health improved very rapidly, and the appetite
became good, while the little fellow began to pass his time quite
happily. About this period, however, his father removed him
from town. I learned subsequently that he continued to improve
after leaving me, and though I am unable to state whether he ever
recovered entirely, I think no case occurring in my practice ever
gave me more satisfaction at the time.

Since that, I have treated several other cases with similar re-
sults, and though some circumstance in each case has prevented
me from witnessing the course throughout, there were none in
which the patient did not begin to improve upon the application
of the abduction splint With one on the third day, he was able
to press the foot of the diseased side upon the ground in walking,
a movement which he had been unable to make for months pre-
viously. This case was Jotham Lyons, of Fulton county, Illinois,
aged fourteen years, who had been attacked about seven months
when he was admitted into my institution. I shall not give a
history of his case in detail. Suffice it to say, that, though the
symptoms progressed slowly, the disease had gradually advanced
from the commencement, until after the application of the splints,
since which he has been steadily improving up to the present pe-
riod, June 16th. [Trans, of Ills. Med. Society. Medical Counsellor.

On the Differential Diagnosis of Syphilitic and Non- Syphilitic Orchi-
tis. By Thos. M. Markoe, M.D., Surgeon to N. Y. Hospital.

In order to contrast the two affections more fully, I will give
the main symptoms in each, so that the data for a differential
diagnosis may be compared at t glance. Thus, the

Non-SypJi iliiicform.

Syphilitic form,

1. Begins in testicle.

2. Smooth and regular.

3. Hard and painless.

4. Scrotum unaffected.

5. Both testicles involved.

6. Hydrocele very common.

7. No suppuration or fungus.

8. No glandular affection.

9. Venereal appetite gone.
10. Treatment successful.

1. Begins in epididymitis.

2. Irregular and knobbecL

3. Less hard and more painful.

4. Scrotum early adherent.

5. Usually one only.

6. Hydrocele rare.

7. Abscess or fungus common.

8. Glands of groin enlarged.

9. Not ascertained.
10. Treatment unsatisfactory.

To complete the differential history of these two diseases, we
may say that the syphilitic testicle tends finally, if not early cured,

SoO Treatment of Chorea. [June,

to produce atrophy of the organ; while in the chronic simple
orchitis, the tendency is to the disorganization of the testicle by
abscesses, sinuses, or its entire protrusion in the shape of the fun-
gous testis. Lastly, the pathological anatomy of the syphilitic
disease is found to be, according to Eicord, an effusion and partial
organization of fibrine on the fibrous surfaces and compartments
of the organ ; while, according to Curling, there is always found
in the simple chronic orchitis, an abundance of the yellow, gelatin-
ous, unorganized material, both within and without the seminifer-
ous tubes, which he considers as the peculiar pathological element
of the disease, and which is undoubtedly fibrine in an aplastic or
unorganizable condition. [N. Y. Medical Times.

Treatment of Chorea.
Sulphate of zinc is undoubtedly the remedy in most general
use for the treatment of the ordinary forms of chorea in the Lon-
don Hospitals. It is usually given in small doses at first (gr. j. to
ij.) and gradually increased if the disease do not jaeld (gr. v. to viii.)
Among other remedies in much esteem must be noticed the vari-
ous preparations of iron, quinine, valerian, the amm on io -sulphate
of copper, the iodide of zinc, and arsenic. In St. Thomas's Hos-
pital Dr. Barker frequently prescribes, in severe cases, the last-
mentioned remedy. He states that he has several times cured
very quickly by its means, cases which had proved obstinate un-
der other treatment. The dose is, of the liquor arsenicalis, three
minims for a child, and from five to six for an adult, given in a
bitter infusion three times daily. Chorea, in its more ordinary
forms, is, as is well known, curable with tolerable certainty by
almost any of the nervine tonics ; hence the number of specifics
which have been boasted against it. [Med. Times and Gaz.

Vinegar in Scabies.
Professor Le Cceur, of Caen, recommends for the cure of itch,
forcible frictions of the parts affected, with a hard sponge, soaked
in good vinegar, performed thrice daily so as to penetrate the skin
and rupture the vesicles. He has tried this treatment with the
most complete success in ten cases. The average length of the
treatment being less than five days. He thinks this treatment
preferable to all others on account of its speedy action its inex-
pensive nature its freedom from unpleasant odours, and its easy
application. He suggests that similar results might probably be
obtained by frictions with the mineral acids dissolved in water.

[Gaz.des Hop. N. Y. Jour, of Med.

Papillce on the Schneiderian Membrane. By Andrew Clark, M.D .

Dr. Andrew Clark exhibited some microscopical sections of the
Schneiderian nervous membrane, demonstrating the presence of

1855.] Congenital Absence of the Pericardium. 381

papillae. The first approach to the discovery of these bodies was
sometime ago made by Mr. Quekett, who, in injecting the mucous
membrane of the nose of a foetus, observed that some of the capil-
laries were looped. Mr. Bowman subsequently observed epithelial
sheaths in the field of the microscope, but could not fincl the pa-
pilla?. Dr. Clark has subsequently ascertained the presence of
papilla?, confined to the upper part of the septum narium, to which
the ramifications of the olfactory nerve are distributed. They
were mostly single, and the epithelium wras imbricated, the points
of the scales overlapping in a direction towards the apex. The
question as to whether they were organs of special or of general
sensation could not yet be determined. [Virginia Med. and Surg.
Journal.

Congenital Absence of the Pericardium. By D. Beistow.

In a paper before the London Pathological Societj-, Dr. Bristow
relates a case of congenital absence of the pericardium in a person
who died with disease of the heart. The left pleura was contigu-
ous with the pericardial sac, the heart lying in the cavity of the
pleura, and adhering to the lung at various points. A slight ru-
dimentary pericardium was connected with the right pleura, and
opened into the left pleura by a small orifice. [Ibid.

Single Kidney. By M. Labe.

In the Comtes Eendus de la Societe de Biologie there is an in-
stance of absence of the left kidney reported by M. Labe. There
was no renal artery or vein on the left side, and there was no trace
of the left ureter to be found. The right kidney was hypertro-
phied and in its normal position. [Ibid.

Sulphate of Quinine in Phthisis.

D. Muntendam, a Dutch physician, has just published a paper
to show that, from his experience in twenty-two cases, sulphate
of quinine, given along with acetate of morphia, or even alone, is
capable of prolonging the life of the patient in many cases of
phthisis, and that it may even effect a cure in those cases in whicli
a tubercular deposition has just commenced, especially in married
women and children. He alleges that, when given continuously
in small doses, it does not cause dyspnoea, diarrhoea, headache, or
any disagreeable effects; and he believes that in very many, but
not in all cases of phthisis, it should be ranked as one of the best
Temedies for the disease. [Month. Jour. Med. Science.

Borax Injections in Infantile Diarrhoza.
M. Bouchut considers infantile diarrhoea to be of two kinds : the
one, symptomatic of lesions of the intestinal mucous membrane ;
the other, idiopathic, a nervous or catarrhal flux from the great

.382 Editorial and Miscellaneous. [June,

intestine, which may occasion death, without leaving any material
morbid appearances. In the latter variety, M. Bouchut recom-
mends clysters containing the bi -borate of soda, as peculiarly
efficacious. This remedy proves as beneficial as it does in aphthae
of the mouth, it acts as a weak astringent on the intestinal mucous
membrane, and as an alkali in neutralizing the acid secretions
poured out by it, which lead secondarily to ulceration of the bow-
els, and especially of the anus.

He uses clysters containing from 10 to 20 grammes of the salt,
in 125 grammes of water.

In cases of infantile diarrhoea symptomatic of intestinal ulcera-
tions, M. Bouchut has found benefit from the use of borax, admin-
istered internally in the dose of 2 grammes, in 80 grammes of a
mucilaginous emulsion, ]_Gaz. des Hopitaux. Stethoscope.

EDITORIAL AND MISCELLANEOUS.

BIBLIOGRAPHICAL.

A Practical Treatise on the Diseases peculiar to Women. Illustrated by
cases derived from Hospital and private practice. By Samuel Ash well,
M. D., &c, &c. 3d American from the 3d and revised London Edition.
Philadelphia : Blanchard & Lea. 1855. 8vo., pp. 525. (For sale by
T. Richards & Son.)

This eminently practical work has passed the ordeal of criticism, and
been received with general approbation by the profession. It is full and
concise, written in good style, and may compare favorably with any work
upon the subject in our language. Practitioners cannot be too well pro-
vided with such works, and should procure this if they have not already
done so.

Surgical Reports and Miscellaneous Papers on Medical Subjects. By
Geo. Hayward, M. D., late Professor of Surgery in Harvard University,
&c, <fcc. Boston : Phillips, Sampson & Co. 1855. pp. 450.
This is a neatly printed volume, containing papers, most of which have
already appeared in the periodicals of our country, but are now revised by
the venerable author and issued in this convenient and permanent form.
They are generally upon topics of interest and constitute valuable contri-
butions to practical knowledge.

An outline of Medical Chemistry, for the use of Students. By B. Howard
Rand, A. M., M. D., Professor of Chemistry in the Philadelphia College
of Medicine. Philadelphia: Lindsay & Blakiston. 1855. 12mo.,pp.259.
(For sale by T. Richards & Son.)

This is strictly speaking, an outline of the science of which it treats, and
we think a very useful one to beginners in the study of medicine. Its pe-
rusal will give such a general idea of the subject as will much facilitate
subsequent study.

1855.] Editorial and Miscellaneous. 383

An Essay to prove the contagious character of Malignant Cholera ; with
brief instructions for its prevention and cure. By Bernard M. Byrne,
M. D., Surgeon U. S. Army. 2d edition with additional notes by the
author. Philadelphia: Childs & Peterson. 1855. 8vo., pp. 160. (For
sale by McKinnie & Hall.)

As cholera seems to be now domiciliated in the United States, we should
neglect no opportunity to have the laws by which it is governed in its pro-
. as well as its curative treatment. The book before us seems to be
conscientiously written by one who has had it in his power to study the dis-
ease, and is therefore entitled to attentive perusal.

Pamphlets Received. We have to acknowledge the reception of the
following pamphlets :
Lectures in reply to the Croonian Lectures for 1854, of Charles West, of

London, on the Pathological Importance of Ulceration of the Os Uteri.

By Henry Miller, M. D., of Louisville, Ky.

Cases of Polvpus of the Womb, with remarks. By Walter Channing,
M. D. Boston.

On the Chemical Analysis of the Tennessee Collection of Urinary Calculi.
By E. B. Haskins. M. D. Tennessee.

Elkoplasty or Anaplasty applied to the Treatment of Old Ulcers, (a Reply
to Dr. Watson's Eeclamation). By Frank H. Hamilton, A. M., M. D.,
Professor of Surgery in the Medical Department of the University of
Buffalo, etc.

Anniversary Discourse, before the New York Academy of Medicine, deliv-
ered in Clinton Hall, Nov. 22d, 1854. By John H. Griscom,M.D.

Address to the Graduating Class of the Memphis Medical College. By
C. T. Quintard, M. D., Professor of Phvsiology and Pathology. Session
of 1854-5.

Atlanta Medical College. We learn that a reorganization of the Faculty
of this Institution has taken place, and that it is now constituted as follows :

A. H. Buchanan, M. D., (of the Nashville University,) Professor of
Anatomy ; W. F. Westmoreland, M. D., Professor of Surgery ; John W.
Jones, M. D., Professor of Practice ; Jesse Boring, M. D., Professor of Ob-
stetrics ; Joseph P. Logan, M. D., Professor of Physiology ; Henry W.
Brown, M. I).. Professor of Chemistry ; J. G. Westmoreland, M. D., Profes-
sor of Materia Medica and Therapeutics ; S. W. Anthony, M. D., Demon-
strator of Anatomy.

Resignations. Prof. Wm. Gibson has resigned the Chair of Surgery in
the LTniversity of Pennsylvania, which he has filled thirty-seven years. It
is not yet known who will be his successor.

Prof. Horace Green has also retired from the New York Medical College.
The Chair of Practice thus vacated has been filled by the election of Dr.
Henry G. Cox.

Dr. B. La Roche has declined the Professorship tendered him by the

-8S4 Editorial and Miscellaneous. [June,

Memphis Medical College. We regret to learn that ill-health is assigned
.as the cause of the learned gentleman's declination.

Dr. Jno. S. Wilson writes us that Cod-liver oil may be deprived of its
unpleasantness as follows: " Wet the spoon with sour wine, then pour in
the oil, and wash the mouth with the wine after taking the oil."

Minutes of the Annual Meeting of the Medical Society of the State of
Georgia, held at Columbus, 11 th April, 1855.

The Society met in the Division room of Temperance Hall, at 11 o'clock,
and was called to order by the President, Dr. R. Q. Dickinson. -The Secre-
tary being absent, Dr. Ellison was appointed Secretary, pro tern. The roll
was called, and the following .members answered to their names:

Drs. Dickinson, of Albany; Dugas, of Augusta; Hammond, of Macon;
Bell, of Houston county ; and Stanford and Flewellen, of Columbus.

The minutes of the last meeting were read, and approved.

On motion of Dr. Flewellen, the regular order of business was suspended,
and the following gentlemen Drs. J. J. Boswell, S. A. Billing, F. A. Bow-
man, T. Stewart, T. W. Grimes, J. E. Bacon, J. A. Urquhart, T. J. Brooks,

R. H. Lockhart, T. S. Tuggle, E. T. Taylor, E. C. Bellamy, Carriger,

B!ackford, T. C. Ellison, all of Columbus, J. S. Wilson, of Laurence-

ville, and J. A. Davis, of Albany, upon written application, were elected
membeis of the Society.

On motion, the election of officers and delegates to the ensuing meeting
of the American Medical Association was postponed until next day.

The Society then adjourned until 3 o'clock P. M.

Afternoon Session.

The Society again assembled. The President, Dr. Dickinson in the
Chair.

An Essay, by Dr. Dugas, upon the Treatment of Strictures of the Urethra,
was read, and ordered to be published.

The reading of an Essay, by Dr. R. C. Mackall, upon the Influence of the
Culinary Art upon Health, was deferred for the present as was also the
Report of Dr. Word, upon Typhoid Fever in the State of Georgia.

The President having called for Reports from Committees, Dr. Ham-
mond, one of the Committee appointed at the last meeting of the Society
to ascertain the quantity of Opium sold and used in the third Congressional
District of the State of Georgia, for non-medical purposes, reported That
he had found no possible means of ascertaining the correct quantity con-
sumed, and begged that the committee be discharged, which, on motion,
was granted.

The following Report, on the Finances of the Society, was read by the
Secretary :

1855.] Miscellaneous. 385

treasurer's report.

C. B. Nottingham, in account with the Medical Society of the State of Ga.

1854-'55. To cash on band 12th April, 18-54 6 29 48

" " from Initiatory Fees for 1853-54, 18 00

Assessment u 1852, 10 00

" M - N 185:3-54, 105 00

$162 48

By cash paid B. Brantiy, and S. Rose & Co.

for Advertising and Printing Circulars, SlO 50

By cash paid Green, Barnes & Co. . . , 62 00

" " " for Envelopes, 1 00

" " " Seals & Blain, 2 00

" M " Columbus Enquirer, 5 00

" " for Postage, 46

880 96 80 96-

" " Balance on hand, $ 81 52

C. B. Nottingham, Treasurer.
The Report was received, and referred to a Finance Committee, consist-
ing of Drs. Hammond, Bell and Lockhart, who report as follow? :

The imdersio-ned, the Committee to whom were referred the accounts of
the Treasurer, respectfully report, that they have examined them and the
accompanying vouchers, and find them correct.

D. W. Hammond, )
T. W. Bell, > Committee.

R. H. Lockhart, )
After the transaction of some other unimportant business, the Society
adjourned until 10 o'clock to-morrow.

April I 2th.
The Society met according to adjournment, Dr. Dickinson in the Chair,
On motion of Dr. Flewellen, a committee of six, consisting of Drs. Dick-
inson, Hammond, Bell, Stewart, Lockhart, and Flewellen, was appointed to
select Essayists and subjects for the next annual meeting. After consulta-
tion, they reported as follows :
1st. On the relation between Remittent and Yellow Fevers. Dr. R. D,

Arnold.
2d. Diseases of the Cervix L'teri. Dr. J. A. Eve.
Sd. On the connection of Pneumonia with Remittent Fever in the South,

Dr. L. D. Ford.
4th. Upon the Diseases of the Spinal Marrow. Dr. C. B. Nottingham.
5th. Relation of Epidemic Dysentery to Remittent and Typhoid Fever,
Dr. D. C. O'Keeffe.

386 Miscellaneous. [Jtlrte,

6th. On the use and abuse of the Speculum Uteri. Dr. G. Harrison.
7th. The value of Diet in the Management of Diseases. Dr. G. F, Cooper,
8th. The Causes of Abortion. Dr. J. M. Green.
9th. Epidemic Diseases. Dr. J. F. Bozeman.

On motion of Dr. Hammond, it was Resolved, That the Medical Socie-
ty elect Honorary members, in or out of the State, at each annual meeting.

The Society then proceeded to the election of officers for the current
year, which resulted as follows :

Dr. L. A. Dugas, President. Dr. D. C. O'Keeffe, Ree'g Sec'ry,

" J.J. Boswell, 1st Vice President* " F. C. Ellison, Correspond'g "
" D. W. Hammond, 2d " " " C. B. Nottingham, Treasurer.

On motion of Dr. Bell, a committee of six weTe appointed to nominate
two delegates from each Congressional district, to represent the State So-
ciety in the American Medical Association. This committee, consisting of
Drs. Dugas, Dickinson, Billing, Bell and Hammond, after consultation,
nominated the following gentlemen, all of whom were duly elected :

1st District, Drs. R. D. Arnold and C. West; 2d District, Drs. W. W,

Flewellen and R. Q. Dickinson ; 3d District, Drs. D. W. Hammond and

/T. W. Bell; 4th District, Drs. G. G. Smith and H. Coe ; 5th District, Drs.

I H. V. M. Miller and R. C. Word; 6th District, Drs. C. W. Long and Jos.

LeConte; 7th District, Drs. D. C. O'Keeffe and J. M. Green; 8th District,

Drs. Juriah Harriss and W. S. Jones.

The following resolutions, offered by Dr. Bell, were adopted :

Resolved, That the publication of the Transactions of this Society, in
separate form, be hereafter dispensed with, and that in lieu thereof, such
matters as it may be desirable to publish be furnished to the Southern
Medical and Surgical Journal, for its pages.

Whereas, the adoption of the last resolution renders any assessment
unnecessary :

Resolved, That none be made, and that all dues from members be con-
sidered cancelled.

A Committee of Publication, consisting of Drs. Boswell, Stewart and
Ellison, were then appointed.

On motion of Dr. Steward, the Corresponding Secretary was instructed
to open a correspondence with the Physicians of the different counties of
the State, for the purpose of eliciting Reports on the history and treatment
of the Epidemics of the present year, to be submitted at the next regular
meeting of the Society.

On motion of Dr. Bell, the Committee on Amendments to the Constitu-
tion, were allowed further time to report.

The Convention then proceeded to elect an Orator for the next regular
meeting of the Society, which resulted in the unanimous choice of Dr. W,
W. Flewellen, of Columbus.

1855.] Miscellaneous. 38T

It was then determined that the next regular meeting of the Society W
held at Macon, on the 12th April, 1856.
On motion, the Society adjourned.

F. C. Ellison, Scch-y pro. tern.

Phthisis Night Sweats of. Give the following draught at bedtime:
R. Acid, gallic, gr. vij. ; morphia* acet. gr. | ; alcohol q. s. (a few drops) ;
syr. tolutan. 3>s. : a.jiiaj. j. The night pill of the Brompton hospital is
as follows: R. Acid, gallic, gr. v. ; morpkiae hydrochlor. gr. \\ mist.-
acacia?, q. s. gtt. pil. ij. (Mr. Hutchinson.) Give gallic or acetic acid.
Dip the night dress in sea-water, or salt and water, and dry it before using.
But the best remedy is four grains of oxide of zinc at bedtime, combined
with a little henbane or hemlock.

Cough of. Mix one part of chloroform with three parts of spirits of
wine, and let the patient inhale when necessary, but with caution, and un-
der medical direction. The inhalation of camphorated spirit is often suffi-
cient, or even the vapor of hot water, or infusion of hops. Sometimes
frequent deglutition as the swallowing a little oil, will relieve the cough.
Sometimes four minims of tincture of aconite is a good palliative.

Profuse Expectoration of. To check this give creasote, pyro-acetic
spirit, infusion of pitch, or balsam of tolu; but by far the best remedy is
petroleum or Barbadoes tar, which often moderates the cough and expec-
toration remarkably. [Braithwaite1 s Retrospect.

Death from Chloroform. In the Medical Times and Gazette, Jan. 13,
1855, the following instance of this is recorded, which occurred in one of
the English Provincial Hospitals ',

A man, aged 18, of ruddy complexion, had chloroform exhibited in order
to the removal of an encysted tumour from under the left eyebrow. Du-
ring the inhalation the breathing became stertorous, and the inhaler was
accordingly removed for a time. On a second application, after about half
a minute's inhalation, a convulsive attack, resembling epilepsy, occurred ;
the man became purple in the face, and almost immediately died. All
attempts to restore animation failed. At the autopsy, great congestion of
the brain was found ; the left ventricle of the heart was tightly contract-
ed. [Medical News.

Fissures of the Anus. The Boston Medical Journal gives the following
as a very valuable application to relieve, and sometimes cure, fissures of the
anus, viz : R. Ext. Belladonna, iii. grs.; Ungt. Rosae., iv. grs. [N. W.
Med. and Surg. Jour.

Scrofulous Intolerance of Light. Prof. Mauthner recommends for this
troublesome affection the application to the lids of the following, viz :

R. Condii. \ gr. : Sweet oil, 3i. Mix, and apply with a hair pencil once
or twice a day. "We have frequently found a simple solution of morphine
(4 grs. to |i. of water) effectual in similar cases. [Ibid.

Nocturnal Seminal Emissions. During the last two years much evi-
dence has accumulated in the medical periodicals in favor of the efficacy of
digitalis and digitaline in the treatment of involuntary seminal emissions^
M. Laroche mentions a case, in the Gazette Medicale, of a very aggravated

3 88 Miscellaneous.

character, which was cured by the digitaline in three weeks. The dose ad-
ministered was equivalent to one grain of the pulverized leaves three times-
a day. We have repeatedly treated the same affections successfully with
a mixture of equal parts of muriated tincture of iron and tincture of ergot,
given in doses of thirty drops, three times a day, in sweetened water. [lb.

How to Test the Genuineness of Cod-liver Oil. We possess in sulphuric
acid a simple re-agent by which genuine cod-liver oil is easily distinguished
from other kinds of oil. A few drops of this acid produce, in olive oil, a
dirty, grey color ; in poppy oil, a deep yellow color, approaching brown ;
and in ordinary fish oil, a deep brown color ; while poured drop by drop
into cod-liver oil, sulphuric acid produces in it a centrifugal movement,
particularly where the drops fall, and, at the same time, a beautiful violet
color, which changes to purple the moment the mixture is agitated, and
ultimately to a rich sienna brown. This color is no doubt due to the ac-
tion of the sulphuric acid on the constituents of the bile contained in the
oil. The action of the re-agent is best seen by adding one or two drops of
concentrated sulphuric acid to about half a teaspoonful of the oil, spread
out upon a white porcelain plate. [Lancet.

Vomiting during Pregnancy. The tincture of Nux "Vomica, in doses of
four drops every two hours, is recommended on the very highest authority,
as an efficient remedy in the distressing and often obstinate vomiting, which
sometimes occurs in the earlier months of pregnancy. It is worthy of
trial. [St. Louis Med. and Surg. Jour.

Nocturnal Emissions. The free use of powdered cubebs is alluded to,
in a paper in the Preuss Verein Zeitung, by Dr. Deiters, as a very valuable
remedy for the nocturnal emissions we meet with in cases of spermatorrhoea.
We suggest a trial of this safe and simple drug under such circumstances.
The same remedy is also highly extolled by him in incontinence of urine of
children, whether caused by atony of the bladder or intestinal worms. We
have recently succeeded in relieving the latter disease of many years stand-
ing in a young lady, by the fluid extract of Uva Ursi it doubtless depended
on atony of the bladder. [Ibid.

Neuralgia. An ointment of two grains of aconitine to the ounce of lard,
lias been employed by Mr. Hilton of Guy's Hospital, to alleviate the pain
of this affection. One of those distressing cases of neuralgia following after
amputation, was much benefitted by this ointment. Its great power should
be always remembered in advising its use, and the patient cautioned as to
the danger of venturing beyond his directions. [ Virginia M. and S. Jour.

New Remedy for Tape Worm. Professor Osborne, of Ireland, recom-
mends tannic acid for tape worm, on account of its known action on albumen
and gelatine; he has seen them curled and contracted, and broken down,
when expelled, after this remedy. [ Western Lancet.

Advertisements. Exceptions having been taken by some that their ad-
vertisements, sent to this Journal, have not been inserted, we beg leave
again to say that this publication is devoted exclusively to scientific pur-
poses, and that it has no advertising sheet appended to it.

SOUTHERN

MEDICAL AND SURGICAL JOuMAL

Vol. XL] NEW SERIES. JULY, lttfc [No. 7.

ORIGINAL AND ECLECTIC.

ARTICLE XVII.

The Influence of the Culinary Art upon Health. By R. C. Mackall,
M. D., of Savannah, Ga. (Published by request of the Medical
Society of the State of Georgia.)

The sum of human life is not made up of great, but of small
things. Man, with all his boasted likeness to the gods, presents
himself to the physician chiefly as a mere animal. In infancy, the
most helpless of all creatures, his manhood is too often stained by
the weaknesses of the first stage, and his old age is the yesterday of
childhood returned. The few who reach " the lean and slippery
pantaloon" are sad satires upon the God-like. The big manly
voice forever gone, the staff and tottering gait are but a mocking
of the first attempts to walk from chair to nurse.

The interlude between the chair and staff is a part of the same
play, in which we witness a continued struggle between strength
and feebleness physical and moral. The single aim of man is
selfish. The gratification of his passions and appetites is the goal
of all his labors. To this end, hero and sage, artisan and serf, work.
And, now,- in the 19th century, the fields from which they cull
their gratifications, present the same varieties to their tastes as were
enjoyed by the classic,- yet mortal ancients. The great of the
past, were only great then, as now, when the world looked on.
Then, as now, poet and orator, statesman and sage,- disdained not
to dwell upon the little affairs of life. Troy's historian could de-
grade the melody of his verse to a description of the vile cookejy

N. S. VOL. XI. NO. VII. 25

390 Mackall, on the Influence of the Culinary Art. [July,

of his countrymen, and the names Lentulus, Fabius, Cicero, assure
us that even the masters of a world never forgot that they had
stomachs. The fame of Cato smells of the kitchen, and Yitellius
could get up a dish that a modern Frenchman would not attempt
to rival.

If, then, the immortal Ancients would stop to tell us how to pre-
pare a feast we moderns who almost eat as well as travel by
steam may well pause and look to our laurels in the regions-
where Toby and mamma preside, notwithstanding a wise man
has written, " put a knife to thy throat if thou be a man given to
appetite," and a wit said in the teeth of the proverb, " qyCun cuisi-
nier est un mortel divin"

Now, although I cannot agree with either the Hebrew sage or
the French poet, I sincerely believe that kitchen lore is too much
neglected by the ultra utilitarians of our day and country. I am
thoroughly satisfied that to this neglect we are indebted for a large
amount of our work, and that if we had in every house in our
broad land if not one of Voltaire's " mortel divins," a well in-
structed cook we might soon lay aside many of our vile com-
pounds, and see disappear from before an unjaundiced public eye,
a hundred quack certificates in favor of liver pills, etc.

American cookery in its influence upon health, bears about the
same relation to the many varied forms of dyspepsia, as malaria*
does to our miasmatic fevers. The poison of the one is brewed
in a pot or frying pan that of the other in a fen or marsh. The
swinish feast with which Penelope's suitors were regaled may
indeed be found with all its classic taste and indigestive vileness
in the modern cuisine, and often so much improved that those
ancient lovers themselves would hardly recognise the noble dish.

Now, although physicians are not cooks, yet, as conservators of
the public health, it is their duty to understand the art of cookery
in its relations to the physiology of digestion. To the almost en-
tire neglect of the kitchen, we have been for generations searching
earth, air, rivers, ponds, marshes, etc., for causes of disease. This
should have been done, but not to the leaving of the other undone.
Unimpaired digestion would greatly assist us in all our labors, as
it certainly would' our unfortunate patients, even in the midst of
malaria or the absence of ozone. And, although sound stomachs
might not deprive epidemics of their subjects, they certainly would
rob them of many victims ; for if the prima via is in good order, the
traveller has a tolerable surety against accident. Thus some of

1855.] Mackall, on the Influence of the Culinary Art. 391

the opprobriums of medicine would be removed, and the now wide
field of quackery considerably narrowed.

In fulfilling the duty imposed upon me by the society, it will
be my endeavor rather to attract laborers to the Augean work of
clearing the kitchen and enlightening cooks, than to attempt the
task myself. My effort will be to give a general view of the art
of preparing food to notice some of the abuses of the art, with
the results which follow them.

Addressing my observations to physicians, it is unneccessary to
enter into an elaborate argument to prove that there is a near con-
nexion between the culinary art and health, or that the influence
of the former upon the latter is not beneath our consideration.
But, in order to exhibit this fact so as to attract special notice, it
may be well first to turn the picture, holding up to your view the
relations between the abuse of the art and disease.

Man being an omnivorous animal, his stomach is by nature
fitted for the digestion of every thing that is good for food indeed,
for many things not food, physiologically considered. From earth,
sea and rivers, he gathers the thousand articles he feeds upon.
Nature has been lavish in her provisions for his wants. But al-
though she thus amply provides for his varied taste and capricious
appetite, she has not for him as for the brute prepared her boun-
ties for his organs or digestion. To reasoning man it is left, either
to be satisfied with a few of the fruits of the earth, or to devise
modes by which to render the animal and vegetable kingdoms
subservient to his desires.

With the gift of superior intelligence, she has made him the cus-
todian of his own powers, subject only to her laws, for the viola-
tion of which she holds him strictly responsible. Yet, ever gener-
ous, she has provided him with more than one sentinel to guard the
approaches to the castle of his health, and in the castle itself, has
placed a faithful keeper. With ever ready wit, corporal smell and
sergeant taste, guard, the one the out post, the other the entrance,
whilst private nausea, even to the wall, strives to cast out every
rude invader. Yet, notwithstanding nature's lavish kindness, and
too often in spite of sentinels and keeper, the castle is entered suc-
cessfully and its walls sadly injured. Thus man becomes a van-
dal to his own stomach, invading it with reckless violence, until
its integrity is destroyed, and, in revenge, it curses him with disease
for the residue of his days.

392 Mackall, on the Influence of the Culinary Art [July,

But, in our own day and country, I believe, more harm is done
to this vital organ through ignorance than through indulgence in
pampered appetites. Particularly is this the ease in our own State.
Almost exclusively an utilitarian people, our masses are too much
"bent upon the acquisition of wealth, to stop to enjoy it, much less
to attend to laws of nature; which education and prejudice have
induced them to believe are only the rules of refined luxury and
effeminate fashion. This is true, not only of the lower and middle
classes,, but of many among the wealthy. In all their gettings they
have not taken SolomonTs advice and gotten wisdom. The anti-
podes of the man of pleasure,, they forget, there is a presentr and live
for an imaginary future. With this classr a life time is not too
long to devote to the acquisition of gold but one hour in twenty-
four is too much to waste upon that, which alone can enable them to
enjoy it. It is ten minutes to a dinner, and hours to a bargain.

Nor does this dinner, thus swallowed, not eaten, cost them a mo-
ment's thought before it is upon the table. The fowl is in the
yard, the mutton in the field in the morning and upon the dish at
noon, Quantity, not quality, is all they demand of their " mortels
divins"" (shades of Yoltaire forgive me). Les cuisiniers of the poet
are as much wanted over our land as schoolmasters, Hardly less to
be feared is the frying pan of old Cato, than the ignorance of the
voter, a rebellion in the prima via being as much to be dreaded
by the individual as a fight at the husting by the body politic.

I now proceed to the consideration of some of the most impor-
tant changes produced in food by different modes of cooking, the
effects of those changes upon the digestibility of various articles
of our ordinary diet, and consequently upon health. Nearly all
our various articles of food having an organized texture, require
the agency of heat to prepare them for digestion. The exceptions
to this rule are oysters and some of the fruits. Dividing, for our
present purpose, the different modes of cooking into boiling, stew-
ing, roasting, broilingr baking and frying, I will take them up as-
named.

Boiling is probably the most common method of preparing food
for the table. If properly conducted, it is a process well calculated
to render both flesh and vegetables digestible. The action of heat
applied through the medium of water, the temperature of which
has been raised to 212 Fahr., upon the fibrous texture of butchersr
meat, fowls, or fish, is to soften the fibre, and separate the fibres
from each other, and from the other tissues. "The albumen of

1855.] Mackall, on the Influence of the Culinary Art 393

meat being partly solid, partly liquid, the latter is coagulated by
boiling water. By the united agency of water and heat, a portion
of albumen, or at least a nitrogenous matter, is rendered soluble,
and is therefore contained in the broth. The hematosin or color-
ing matter of the blood dissolves in, and sometimes communicates
a red color to cold water, but as soon as water becomes sufficient-
ly heated, the hematosin coagulates and forms brown floculi, which
float on the top of the liquor, and constitute part of what is called
the scum. The cellular tissue, the bones, the aponeuroses, and
the tendons, yield by boiling in water, gelatine. The fatty mat-
ters melt, and, except when they are contained in closed cells escap-
ing from the meat^ float on the top of the broth. The nervous or
cerebral fatty matter which principally constitute the pulp of the
nerves, is softened by the heat and is in part carried off during
the process." During the process of boiling several products are
formed by chemical reactions yet unknown to us. We have crea-
tine so called by its discoverer, Chevreul nitrogenous and crys-
talizable, and insoluble in alcohol. Osmazome, an extraction and
highly odorous substance. Ammonia, a sulphurated compound,
a volatile acid, similar to butyric acid. Boiled meat, then, con-
sists of flbrine, coagulated albumen, gelatinous cellular tissue, fat,
nervous matter and water. It has given out to the water, gela-
tine, albuminous matter, creatine, extractive matter, lactic acid,
salts, and a little fatty and saccharine matter. By boiling, there-
fore, meat loses a portion of its nutritive properties, but at the
same time it parts with some of its least digestible components.
If, however, the process is properly managed, the actual loss will
be trifling; for, if the meat is put into the water when it is already
boiling, the albumen upon and near the surface immediately coag-
ulates, thus closing the pores, and in a great measure preventing
the escape of the juices. On the contrary, to make soup, the meat
should be put in the cold water, so that gradual application of heat
will dissolve the soluble matters and extract them from the insolu-
ble fibre, tendons and bones. Again: overboiling is injurious to
some articles of food, rendering them both less digestible and less
nutritious. "When gelatine," says Pereira, "is submitted to
prolonged ebulition, or to a temperature exceeding 220 Fahr., it
undergoes important changes. It evolves ammonia, becomes syr-
upy, loses its characteristic property of forming with water a jelly,
and very speedily undergoes putrefaction. Thus altered, it has a
disagreeable flavor, and its nutritive properties are greatly de-

394 Mackall, on the Influence of the Culinary Art [July,

teriorated, if not altogether destroyed. It is less digestible and
readily deranges the digestive organs." (Food and Diet.) Under-
boiling, of course, fails to effect the main object of the process, viz :
to render the fibrous textures tender and to separate the fibres so
that they may be more easily permeated by the gastric juices.

Stewing is boiling with a small quantity of water. The process
is the same, but the results somewhat different ; for, as stewing is
usually conducted in a closely covered pan, there is little or no
escape of nutritive or other principles of the articles submitted to
it. The albumen and gelatine are dissolved and separated from
the fibres, whilst the latter are thoroughly separated and partially
broken down. A gravy is formed, containing a portion of fat and
osmazome, to which it is indebted for its richness. By stewing,
many wholesome and savory dishes are made, yet it is not a mode
of cooking to be recommended to the dyspeptic.

Eoasting, is probably, of all the various methods of preparing
food, the best, both to preserve its nutritiousness and render it di-
gestible. It is the most ancient as well as the most simple mode
of cooking animal food. " The spit was probably an early cotem-
porary of the altar and sacrifice," says old Frederick Accum,
11 ere the iron age had taught men the use of metals, these roasting
instruments were made of wood, and, as we find in Virgil, slender
branches of the hazel tree were particularly chosen :
" Statit sacer hircus ad aram,

Pinguiaque in verbus torrebimus extra eolurius."
The chemical changes produced in meat by roasting are slight,
but important in a culinary point of view. The watery juices, as
the heat penetrates the fibrous textures are rarified, and escape in
the form of steam. The albumen coagulates. u The gelatine and
the osmazome become detached from the febrine and unite with
the fat which also is liquified by the expansive properties of heat.
The union of these forms a compound not to be found in the meat
previously. This is retained in the interstices of the fibres, where
it is formed, by the brown frothy crust, but flows abundantly from
every pore where a cut is made into the meat with a knife."

Chemistry has demonstrated that roasted meat owes its peculiar
odour and taste to the development of the principle called osma-
zome, a substance distinguished from all other constituents of ani-
mal matter, chemically, in being soluble in alcohol and to the
senses, in being extremely savory and sapid. (Accum.) "Os-
mazome exists in the largest quantity in the fibrous organs, or

1855.] Mack ALL, on the Influence of the Culinary Art 395

combined with fibrin in the muscles, while the tendons and other
gelatinous organs, appear to be destitute of it." But a portion of
the effects produced upon both meat and vegetables b}~ roasting is
entirely mechanical. The expanded juices separate the finest
fibres, cellular tissue, nerves, blood-vessels, etc. The starch grains
of vegetables are split and the meat turned out light and dry.
But roasting, also, must be conducted fairly. If the heat is appli-
ed too quickly the meat will be scorched outside and raw within ;
if too slowly, the rich juices will have time to escape ere the
brown crust is formed. The saddle joint, or fowl, should be rj ei-
ther over, nor underdone ; it should be exactly done.

Broiling differs but little, chemically, from roasting. The meat
being cut into small pieces, and exposed to a quick fire, the albu-
men of the surface is rapidly coagulated thus preventing the
escape of the juices. Hence, broiled meat is extremely savory.
To a delicate stomach, it is somewhat less digestible than roasted
meat Baking is roasting in a closed oven, and is objectionable
on account of the empyreumatic oil which is formed by the decom-
position of fat, and not allowed to make its escape. Baked meats
are apt to be dry and hard, unless the operation is well conducted.
Potatoes, baked, are less nutritious than boiled, as has been demon-
strated by experiment on prisoners in the Glasgow Bridewell.
The fact I am at a loss to explain, unless, by boiling, the starch
cells are more completely broken up.

Lastly, we come to frying, the most decidedly objectionable in-
vention of the cuisinier. " The effect of frying, upon meat, is pecu-
liar and easily distinguished from all other modes of cookery."
The meat is deprived of its own nutritious juices, in part of its
gelatine, albumen, and osmazome, and then saturated with boiling
fat. This boiling fat gives off carbonic acid gas, a little inflamma-
ble vapor, and an acid volatile oil, called acroleine or acroleon,
whilst the fatty acids are in part set free.

I next come to consider the staff of life. Bread making the
true art of which is probably less understood than any other branch
and distressed by salt or sour masses of dough, misnamed bread,
of ordinary cooking ; for so often has my own stomach been shocked
not to have realized this fact, Well would it be for our successors
on the stage of life, if American daughters were as thoroughly
instructed in this branch of housewifery as they are in less useful
arts. An occasional hour might well be spared from the music

396 Mackall, on the Influence of the Culinary Art, [July,

stool, for the study of " Miss Leslie's Complete Cookery ;" and
even Euclid now, I believe a text-book in our female colleges
might be laid aside, with advantage, for the dough- tray and rolling-
pin. The ordinary loaf, or fermented bread, is prepared from
wheaten flour, salt, water, and either yeast or leaven. Bakers
often add potatoes and alum. The yeast or leaven causes the
sugar of the flour to undergo vinous fermentation, the result of
which is the formation of carbonic acid gas and alcohol. The
latter is driven out upon the application of heat; the escape of the
carbonic acid being prevented by the tenacity of the dough, the
latter becomes distended with gas, puffs up, assuming a vesicular
texture, forming, in the language of the bake-house, the sponge.
Now, if this vinous fermentation is suffered to continue over a
certain definite period, the dough becomes sour, owing to the for-
mation of acetic and lactic acids ; if, on the other hand, the sponge
is put into the oven too soon, fermentation is checked before the
loaf is light. It is therefore an important point to arrest the fer-
mentation exactly at the right moment. After baking, bread is
found to weigh from 28 to 32 per cent, more than the flour used
in its preparation. " In the formation of wheaten bread," says
Sir H. Davy, "more than one quarter of the elements of water
combine with the flour ; more water is consolidated in the forma-
tion of bread from barley, and still more in that from oats ; but
gluten in wheat being in much larger quantity than in other
grain, seems to form a combination with starch and water, which
renders wheaten bread more digestible than other species of bread."
Potatoes used in making bread assist fermentation, but containing
less gluten than wheat, are less nutritious, According to Yogel,
wheat bread is composed of starch, dextrine, sugar-gluten, toge*
ther with carbonic acid, chloride of calcium and chloride of mag-
nesium. Leibig states that 100 parts of fresh bread contain, on an
average, 30.15 parts of carbon.

Of unfermented breads, the common buiscuit need only be re-
ferred to, This is made, ordinarily, with milk and water, salt, and
butter or lard. These ingredients, well mixed, form the dough,
which is kneaded or beat, until a gaseous or volatile body is set
free within it. This body being expanded upon the application
of heat, renders the bread light and cellular, If not well kneaded,
buiscuits are heavy and unfit for the table. In England, several
patents have been taken out for unfermented bread. The secret
of the lightness of these patented articles, depends upon the reac*

1855.] Mackall, on the Influence of the Culinary Art. 397

tion between muriatic acid and carbonate of soda chloride of
sodium being formed water and carbonic acid gas. This last
product being set free, distends the dough and lightens the bread.
Over fermented bread, biscuits possess several advantages. They
are less troublesome to make, occupy less time, and are light and
digestible, without the risk of being spoiled by carelessly timed
fermentation, or bad yeast.

But I will not consume the time of the Society by further ^de-
tails, dismissing bread, with the single remark of Dr. Paris: "^11
pastry is an abomination."

Having thus endeavored to give, as concisely as possible, an
outline of the chemistry of cooking, or the changes produced in
food by the agency of heat, I pass to the consideration of a few of
relations between these changes and digestion, and their con-
sequent influence upon health.

Our food being cooked and placed before us, the second step
towards digestion, is mastication. If it is an important matter to
the well-being of man, that his culinary operations should be care-
fully conducted, according to the strictest rules of the art, it is
scarcely less important, that he should give his individual atten-
tion to the agreeable task of mastication. jSow, although the
pleasures of the table are most ungodlike, I do not see why a ne-

-sity should not be made a rational enjoyment, I have already
alluded to the steam-like rapidity with which Americans dispatch
their food. Against this habit, so universal throughout the coun-
try, we, as physicians, should wage a daily, and eternal warfare.
TTe should struggle to convince our patrons, that time is of less
value than health. That teeth are not superadded, but essential
organs ; and that nature has not provided the human species with
the gizzard of the goose, although she may occasionally misplace
the head of Rome's faithful sentinels. But, to return to my sub-
ject: Thorough mastication not only minutely divides, but at the
same time mixes the food with the salivary secretion, an import-
ant adjuvant to the gastric juices, Indeed ptyeline alone pos-
es a certain solvent power over several proteine compounds.
Mixed with saliva we have next to observe the food in the stomach,
presuming it to be scientifically cooked and rationally masticated.
Here for a time it undergoes no change. In the meantime the
gastric juices are being poured out and are slowly penetrating the
yet crude mass. Presently we can see the differences made in the

398 Mackall, on the Influence of the Culinary Art [July,

kitchen. To that lucky chance for science, Beaumont's Canadian,
we will give a choice bit of broiled venson, and watching through
the window accident has made for us we find that in one hour
and thirty-five minutes the steak is ready to pass the pylorus.
Next, we may tempt him with a slice of boiled beef and this we
find digested in two hours and forty five minutes. Again, we give
him fresh beef, fried, and three hours are required for its digestion.
With eggs he is indulged in a variety of forms raw, they digest
in two hours roasted, fifteen minutes longer is necessary ; soft
boiled, in three hours and hard-boiled or fried, in three hours
and a half. Thus I might go on through these valuable tables of
Dr. Beaumont, but they are so well known I need only refer to
them.

Now, this Canadian boy, notwithstanding the misfortune which
made him a martyr to science, was in good health, with unimpair-
ed digestive powers ; otherwise, I doubt not, other and widely
different tables would have been made from Dr. Beaumont's ex-
periments. If, for from twenty to thirty years, he had daily bolted
fried bacon and eggs cabbage half boiled in company with bacon
beef fried in lard, or baked crisp fowls boiled whilst still flut-
tering, etc. I feel well assured that the watches of my old friend
would have been greatly prolonged. Upon how many of our pa-
trons do you suppose like experiments could be made with like
results, supposing their1 stomachs as accessible as was the Canadi-
an's ? But few Americans pass the prime of life without suffering
from impaired digestive organs. Dyspepsia in all its varieties
shortens the average of life. The nutritive properties and diges-
tibility of much of our food is injured before it enters our stom-
achs. After a labored digestion it passes into the small intestines,
probably in company with yet undigested portions. The mucous
membrane is irritated, and cannot continue the process begun in
the stomach. The chyliferous vessels refuse to absorb the mus-
cles of the intestines, irritated, contract and the chyme and chyle
with the crude mass are hurried onward, and the hungry man
eats, but is not satisfied. The stomach of the hardy countryman
is indeed a wonderfully vigorous organ. Long may it resist seri-
ous injury from the daily attacks upon its integrity; but, after a
longer or shorter time, it must complain. The victim of reckless
cookery and telegraphic meals, is slow to realize that he is a dis-
eased man. The robust farmer who can boast "I never knew a
day's sickness" who has only heard of dyspepsia as a city fash-

1855.] Harriss. Surgical Cases. 399

ion can hardly be persuaded that his "heart-burn" is disease,
and his faithiul old cook, assisted by his own habits, the cause of it.
But, gentlemen, it is our duty to teach them the truth, even to
the disgrace of Cato, or the anger of ignorance.

ARTICLE XVIII.

Surgical Cases. By Jueiah Harriss, M. D., of Augusta, Ga.

Case I. Excision of an Atheromatous Tumor. The patient was
a negro man, from Burke county. The tumor was situated on the
right side of the vertebral column, just below the level of the
superior angle of the scapula, and had attained the size of a hen's
egg. The surrounding tissues were considerably indurated, which
made the tumor appear larger than it really was. It had attract-
ed the attention of the patient twelve or eighteen months ; had
ulcerated three months prior to my seeing him, and continued to
discharge pus through a small fistula. The ulceration probably
occurred in this case in consequence of the friction of his clothes
when at work. The tumor was removed by making an incision
over the centre, and dissecting it out with the sac. The wound
soon healed, though the surrounding tissues remained indurated
for some time. This induration was doubtless induced, and pro-
bably kept up, by the irritating friction of the clothes. Anaes-
thetics were deemed unnecessary.

Case II. Injury of the Hand amputation of Finger. An Irish-
man, employed at one of our machine shops, had his hand injured
by a circular saw. The wound extended from the middle of the
dorsum of the hand, down between the middle and ring fingers
to the palmar surface. The metacarpo-phalangeal articulation of
the middle finger was widely opened, the head of the metacarpal
bone being very moveable, showing that it had been severed from
its body. The middle finger was also extensively injured. Its
first phalangeal articulation was cut into, and the bone of the first
phalanx split through its entire length and one half thrown off;
the other half was very loosely attached.

Of course the finger could not be saved, and an amputation was
immediately performed. An incision was made from the angle of
the wound found on the dorsal surface, down between the mid-

4:00 Harriss. Surgical Cases. , [July,

die and index fingers, to meet the wound upon the palmar surface.
The head of the metacarpal bone was next removed, as it was
found completely severed from the body of the bone. The digital
artery cut during the operation was secured, but as the other did
not bleed, it was not tied. The hand was then bandaged, so as to
bring the lateral flaps in apposition, and placed in a sling.

About fourteen hours after, I was called to him in consequence
of hemorrhage from the artery which had not been ligated. This
accident was probably induced by the hand being removed from
the sling while the patient was asleep, or from allowing it to hang.
The bandages were simply applied more tightly, and the hand
placed upon the opposite shoulder, with a broad bandage passed
around the body and over the arm, so as to confine it. There
was no further accident, and the hand was soon well, with but lit-
tle deformity. No anassthetic was administered.

Case III. Hydrocele. A negro man, about 60 years of age,
was sent from an adjoining county to be operated on, if necessary.
The left side of the scrotum was greatly distended, hard and firm,
which state had existed about two years. Fluctuation was very
soon detected by palpation, though the tumor was not at all trans-
lucent when tested with the candle. No shock could be felt by
applying the hand to the tumor and requesting the man to cough.
The enlargement was decided to be hydrocele, for the reasons, that
the tumor had existed for two years; was very gradual in its pro-
gress ; was unattended with pain, until its volume became so great
as to induce this from its weight ; that there was no diminution in
size when in the recumbent posture, and that fluctuation was very
perceptible. In addition, the negative signs were conducive to
that opinion. Such a tumor is most apt to be confounded with
hernia ; but the absence of the shock on coughing, and the fact
that the tumor was no larger at one time than at another, in addi-
tion to the signs already stated, precluded the probability of
hernia. The fact that the tumor, though hydrocele, was not trans-
lucent, was accounted for by the following considerations : that
the inflammation was of two years standing, consequently chronic,
and had induced a considerable thickening of the tunica vaginalis ;
that the negro was very black, and the pigmentary deposit must
have been sufficiently thick to obstruct to a certain extent the
passage of the luminous rays. The tumor was so large as to force
the right testicle very nearly up to the abdominal ring, and made

1855.] Haeriss. Surgical Cases. 401

the penis appear to pass from under the pubis, several inches be-
low the point from which it really did.

At the operation, about a quart of milky fluid was drawn off
through the canula of the trocar. The sac was then injected with
tinct. iodine, 1 part; water. 2 parts. The injection was thrown
into the sac twice at the same sitting, and each time retained three
minutes. The amount of injecting fluid was large, because the
tumor was of great volume, and it was desirable to have enough
to distend the sac, and to come in contact with the whole surface.
The sac was injected twice, and the solution made unusually
strong, in consequence of the fact, that the tunic was altered in
character and very much thickened by the chronic inflammation,
and hence a greater amount of irritation was necessary to cause
adhesion than if it had been of recent origin. M. Velpeau not-
only recommends two injections, but advises the operator to leave
a small portion of the iodine solution in the sac. This, he says, is
to insure the requisite amount of inflammation, and adds that it
does not and cannot produce, any injurious effects.

On the day succeeding the operation the effusion of serum was
very large, greatly distending the sac, and showing that the in-
flammation was, in all probability, sufficient to induce a cure.

The patient was retained here about two weeks, and I have
since learned that he has entirely recovered. No anaesthetic ad-
ministered.

Case IV. Diseased Testicles and Hydrocele. A German, aet. 24
years, called upon me to treat a chancre, which he had contracted.
It was simple, non-indurated in character, and was healed in a
few days, by the application of a diluted solution of chloride of soda.
The patient then requested me to examine his testicles, both of
which were found to be enlarged. The patient had a general
scrofulous appearance, red hair, blue eyes, &c, but without any
sign of this disease existing in an acute form.

The right testicle, he stated, had been enlarged for five years.-
It had never been any larger than a hen's eggj which was its vo-
lume when I first saw it, nor had it been the seat of any pain.
The natural form of this organ was pretty well preserved, with
very slight unevenness, and attended with but little pain on pres-
sure. Previous to the time of his noticing this enlargement,- he-
had never exposed himself to the contraction of syphilis.

The tumor on the left side was considerably larger than the one-

402 HARRISS. Surgical Oases. [July,

on the right. Fluctuation was very manifest, and the upper part
of the tumor was translucent, showing that hydrocele existed on
that side. On further examination, the left testicle was also found
to be enlarged, and the epididymis participating in the swelling.
The patient had never suffered any pain from either tumor. The
disease upon the left side had existed only about five months, and
since then he has worn a suspensory bandage, which added great-
ly to his comfort. The left gland was, very probably, enlarged
sometime before he noticed it, inasmuch as it is probable that the
hydrocele was consecutive to the organic disease of the testicle.
His attention was, doubtless, only drawn to the swelling, when
the hydrocele commenced.

It is usually very difficult, indeed, to determine the nature of
indolent enlargements of the testicles. To form a probable diag-
nosis in this case, it was necessary to adopt the process of exclu-
sion. And first, they were not of syphilitic origin ; for the patient
distinctly states that, prior to his noticing the tumor on the right
side, he had never been exposed. It was not probable that they
were cancerous, as they were not nodulated were unaccompanied
with pain, and exceedingly indolent in their growth. They were
not tubercular enlargements, as there were no pulmonary symp-
toms of tuberculosis, nor any circumstances in the history of the
case to lead to the belief that phthisis was hereditary in the family.
The presumption, then, was, that they were chronic, scrofulous
enlargements, and this opinion was supported by his general ap-
pearance.

Although the hydrocele was considered a mere consequence of
the organic affection of the testicles, it was deemed advisable to get
rid of this complication, in order that applications might be made
directly to the diseased organ : accordingly, the trocar was intro-
duced, and about five ounces of colored liquid drawn off. In
consequence of the gland being diseased, the solution of iodine
injected into the sac was made weak: Iodine, 5iss. ; water, 5iv.
The pain attending the operation was not thought sufficient to
justify chloroform. The next day the tumor had regained its
original size, from the new effusion of serum. The tinct. iodine
was applied twice a-day to the scrotum, to promote the absorption
of the newly effused fluid, wnich was complete on the fourth day.
The testicle on the side operated upon was found to be larger than
before the operation, which was probably owing to the irritating
injection.

1855.] Harriss. Surgical Cases. 403

On the fifth day after the operation, a bandage was drawn
tightly around the left testicle, without inducing any pain. In a
day or two after the application of the bandage, both glands seem-
ed slightly diminished, the left by the direct pressure of the band-
age, and the right by its indirect compression. The bandage be-
ing tightly drawn around the left testicle, drew the scrotum with
considerable force around the right, and by this means pressure
was exercised upon both glands at the same time. The patient
was up, and attending to his occupation, on the seventh day,
though each testicle was alternately bandaged for about three
weeks. He was directed also to wear a suspensory bandage, and
to take syrup sarsaparilla, with hydriodate potash. The recovery
was complete.

Case V. Axillary Tumor. This case was one of tumor, situa-
ted in the left axilla. The patient, a young lady about 23 years
of age, of strictly scrofulous constitution, light sandy hair, light
blue eyes, and phlegmatic fair complexion. Three months pre-
vious to my seeing her, she had measles, which left her with a
constant diarrhoea and amenorrhcea, from both of which she was
relieved before the operation was proposed. About twelve months
previous to the excision of the tumor in the axilla she had an
operation performed upon her left arm, which, from her descrip-
tion, and the appearance of the wound, must have been the remo-
val of a portion of carious radius, just above the wrist. Chloro-
form, she stated, was administered during this operation.

The tumor, dated from her attack of measles, was situated
immediately in the left axilla, and was about the size of a hen's
egg. It gave her intense pain down the side and arm, extending
to the ends of the fingers. The arm, however, frequently felt
benumbed, which was probably due to the pressure of the tumor
on the axillary nerves. In consideration of the history of the
case, the peculiar diathesis of the patient, and the location of the
tumor, it was thought to be an enlarged lymphatic gland.

The great pain it occasioned, and its constant increase in sizer
in spite of external and internal remedial agents, rendered it ad-
visable to remove it.

Chloroform was administered, but with great caution, as she was
of feeble constitution, somewhat hysterical, and frequently com-
plained of violent headaches. After a few inhalations, nervous
twitchings came on, when the chloroform was removed, and again

404 Harriss. Surgical Cases. [July,

applied to the nose after the twitchings had ceased. This was re-
peated several times, until she became accustomed to the agent,
and more composed, when it was given to insensibility, but not
to stertorous breathing. The incision was made parallel with the
long diameter of the axilla, and directly over the tumor. The
integuments were removed from around the tumor with the bis-
toury, and with the grooved director and fingers it was dissected
out. No difficulty was encountered, save at the two points, above
and below,- where it was united to the chain of lymphatics, situa-
ted in this region. These connections were severed, little by little,
with the grooved director and bistoury.

The wound healed very well, except at a small point, which,
at times, discharged pus for several months. The pain of the side
and arm was relieved entirely, but there have been enlargements
of other glands in the same region, which were, however, reduced
by blisters and the internal administration of syrup of iodide of
iron. The microscope confirmed the diagnosis.

Case YI. Fracture of the neck of the Os Femoris. Was called
to see a woman, ast. 43, who had fallen from a window about five
or six feet high. She was thin and emaciated, and presented the
appearance of a woman above fifty. After her fall she was unable
to rise from the ground without assistance. When seen, she com-
plained of pain in the internal and upper part of the thigh, and
over the region of the bladder ; there was no swelling, but great
pain experienced on moving the limb, particularly on abducting
it ; the foot was a little inverted, and the leg about half an inch
shorter than the other. On rotating the limb a crepitation was
felt and heard near the trochanter major, though there was no de-
formity at this point. That there was a fracture admitted of no
doubt, but its exact locality was very uncertain,

On the following day the limb was a little shorter than the day
previous; complained of pain still in the upper and internal ipurt
of the thigh. There was great pain upon rotation ; crepitation
perceptible. The foot; which was on the day of the fracture slight-
ly inverted, was now found to be everted.

The fracture was, then, diagnosticated to be within the capsule,
for the following reasons: 1st. The Very slight shortening of the
limb : this is always less than when the fracture is without the
capsular ligament. 2d. The eversion of the foot. This, it will be
remembered, occurred on the day succeeding the fall, which is not

1855.] Harris^, Surgical Cases. 405

usually the case, but does occasionally happen : indeed, the foot
may remain inverted. (See A. Cooper, &c.) 3d. The small amount
of deformity which followed the accident, If the fracture had
been exterior to the capsule, there would have been a greater
prominence of the trochanter major, particularly in so thin a per-
son. 4th. The locality of the pain, which was situated in the
upper and internal part of the thigh. 5th, The pain being great-
er in abducting the thigh than in any other motion given to it,
6th. The patient being very thin, with indistinct crepitation and
no swelling.

Thus, having satisfied myself as to the nature and locality of the
fracture, the patient was placed upon the back, in bed, and the
leg put upon a double inclined plane. She was informed that
probably she would be confined in that position for six weeks, or
two months, and that she must not be surprised if she continued
more or less lame during the remainder of her life, These pre*
cautions should always be taken, for surgeons are very often cen-
sured for mal-treatment, when really they are not at all to blame
for the lameness. Let your patient be notified of this possible
result, and if it does occur you will not be censured.

The patient did very well during confinement to bed, and was
allowed to get up at the end of six weeks and walk on crutches*
She used these about a month, then a stick, and in about four
months could walk without either. The leg is almost impercepti-
bly shortened.

Case VII, Ulcer of the Knee : amputation. An old inebriate,
With exhausted constitution, had a large and profusely suppurating
ulcer on and around the knee-joint, arising from a burn, The
suppuration from this extensive ulcer, and the patient's excessive
intemperance, had prostrated the strength and energies of the sys-
tem to such a degree that fatal exhaustion was imminent, without
a riddance of the disease, Amputation was proposed only as a
dernier resort. It was the only chance for life. Amputation was
performed above the knee ; the stump yielded a most profuse and
offensive matter, The patient could retain nothing upon his
stomach but whiskey and water. He soon became delirious, and
during his frenzy at night, pulled off the dressing and one of the
ligatures, probably of a small artery, as the hemorrhage was not
great. Died the day succeeding the removal of the dressing ; the
fourth or fifth after amputation. Anesthetic used successfully.

N. S. VOL. XI. NO. VII. 26

40$ Harriss. Surgical Cases. [Julyr

Case VIII.. Disease of the Great Toe: amputation. A negro
man from Elbert county, some six months previous to my seeing
him, cut himself with an axe, leaving a large wound directly across
the proximal joint of the great toe, which could not be healed.
Caries of the bones of the joint and the body of the phalanx, was
detected by probing, and amputation decided upon. The French
mode of operating was adopted as being the most neat and expe-
ditious.. The incision was commenced upon the upper surface of
the rnetatarso-phalyngeal articulation, carried between the great
and next toe, through the joint, and the flap made on the inside,,
without removing the knife.. The head of the metatarsal bone
was found diseased, and was removed with Liston's bone forceps..
The flap was swollen and a little diseased, in consequence of the
inflammation from the old wound, and did not entirely unite for
three or four weeks, when the boy was sent home.- Chloric ether
was given.

Case IX. Injury of Finger : amputation A negro boy from
Jefferson county, was sent up to have his finger amputated. The
finger had been badly crushed with the sash of a saw-mill. An-
attempt had been made by the attending physician to save it, but
necrosis and inflammation of two of its joints supervened,, and
necessitated an operation. The first phalanx was badly crushed,,
two fistulas had formed and discharged unhealthy pus.

The operation was performed at the metacarpo-phalyngeal arti-
culation. The knife was passed from between the middle and
index fingers through the joint, and the flap made upon the inside..
The finger did well, and the boy was sent home a week after the
operation, though the wound had not entirely healed. The flap
was so oedematous and inflamed that it could not heal by the first
intention. No anesthetic was given.

Case X. Tumor of the Lower Jaw: extirpated. A negro wo-
man, set. about 40, was sent from Barnwell, S. C, for the purpose
of having a tumor removed from her jaw. The tumor was hard,.
slightly lobulated, extending from the angle of the lower jaw, and
along the bone to a level with the right commissure of the lips.
It was quite movable, and loosely attached to the surrounding
partsr seemingly situated in the submucous cellular tissue, and
about the size of a guinea egg.

The patient noticed it about eighteen months previous to my

1855.] Harriss. Surgical Cases. 407

seeing her, as a small, hard, round tumor, but causing no pain.
She stated that within a few months past it had grown more ra*
pidly and been the seat of pain.

In order that the patient might not be disfigured with a scar
upon the face, and run no risk of a salivary fistula, it was deemed
advisable to remove the tumor from the inside of the mouth : it
was probably also less painful than making the incision through
the skin.

The tumor was cleanly dissected out, and as there was a little
hemorrhage, a sponge tent was placed in the mouth, with com*
press and bandage upon the outside. This was done only as a
matter of precaution, as the owner desired to take the negro home
in the afternoon. Directions were given to remove the tent the
next day, and to wash the 'mouth three times a day with a weak
solution of chloride soda. No anesthetic was given.

The microscope exhibited a mass, without any element of or-
ganization whatever. The enveloping membrane was of strong
cellular structure.

Case XI* Disease of the Tibia: amputation.- Was called to
Burke county, to amputate the leg of a negro 21 years of age.
The skin of the anterior surface of the leg was diseased, from the
ankle to very near the knee-joint, with numerous and large ulcers
upon it. There was also a very large ulcer upon the upper and
internal surface, extending above the level of the tuberosity of the
tibia. The tibia was enlarged from just above the ankle to within
two inches of the tuberosity, and rough and uneven to the touch.
The disease of the leg had existed for a number of years, during
which it had been several times healed, but always broke out again
in a few months. The ulcers extended too near the knee to am-
putate below this joint.

With the kind and efficient assistance of Drs. Harlow and
Hughes, of Burke county, the leg was amputated above, but as
near the knee-joint as practicable.

Concentrated chloric ether was administered, requiring about
five ounces to produce insensibility. No ill effects resulted. Dr.
Harlow, who took charge of the case, informed me that the boy
did well, and the stump healed rapidly.

Case XII. Fibro-plastic Tumor: extirpation. A mulatto girl,
aet. about 22 years, had a tumor a little larger than a pigeon's egg

408 Hareiss. Surgical Cases. [JulyV

upon the upper and internal part of the breast, near its base. She
noticed it about a year ago, but it has given her very little pain.
It was situated, just beneath the skin; was round, hard and very
movable, being attached only to the adjacent cellular tissue.
Fearing that the tumor might be malignant, she was advised to
have it removed before the gland and surrounding tissues became
implicated.

The freezing mixture was applied, and the tumor removed with
scarcely any pain. There was more pain experienced by the ap-
plication of the sponge to arrest hemorrhage, after the tissues had
regained their natural condition, than during the operation. The
wound healed by first intention.

The microscope exhibited no cancer cells. The tumor was what
Jobert calls fibro -plastic, and which he classes with non-malignant
growths, though very liable to return.

Case XIII. Diseased Nipple : excision. This case occurred in
the person of the young lady upon whom the operation in the
axilla (above related) was performed. The nipple was very red,.
particularly at its base ; not ulcerated, but presented red,, indolent
granulations, very much resembling the lymphatic vegetations
sometimes found upon the glans penis. The affection was thought
to be scrofulous, and the patient was treated constitutionally for
months, and had every variety of local application made to the
nipple. Nothing gave permanent relief; and as the irritation
from these granulations or vegetations caused the neighboring
lymphatic glands to enlarge, inducing incessant pain, and limit-
ing the use of the armr it was deemed advisable to remove the
nipple.

The objection to such an operation is that, in case of child-birth,
mammary abscesses are almost inevitable. They might be pre-
vented, however, by judicious pressure upon the gland before and
after labor. In this case, the objection was not valid, inasmuch
as the state of the nipple was such as to have probably obliterated
the mouths of the milk ducts, and therefore the operation would
not render her more liable to abscesses than without it.

The freezing mixture was successfully applied, and but little
pain experienced during the operation.. The wound is now heal-
ing very well by granulation.

1855.] Holt's Letters upon General Pathology. 409

ARTICLE XIX.
LETTERS FROM SAATL. D. HOLT, IT. D.f UPON S01LE POINTS OF GENERAL PATHOLOGY.

LETTER NO. 2.

Montgomery, Ala., May 4th, 1855.

Messrs. Editors, In my last letter I spoke of a line of healthy
action which separates the two conditions of excitement and de-
pression. This line is supposed to be that condition of the ner-
vous system in which there is an equal distribution of nervous
power, and a corresponding distribution of the circulating fluids,
proportioned to the natural wants of the respective organs, and
stands higher or lower according to the age, sex, constitution and
temperament of each individual, securing health, alike to the feeble
and delicate, and to the strong and robust This equilibrium of
nervous power and vascular action, which is the result of the ope-
ration and agency of the thousand things, both external and inter-
nal, which enter into the means of man's support, is constantly
liable to disturbance, by the influence and the operation of the
thousand causes which tend to his destruction. Among the former
may be enumerated all those agents, known as healthy excitants, as
air, light, food and drink, raiment, exercise, the influence of mod-
erate degrees of heat and cold, &c., &c, and among the latter is to
be found the influence of excessive degrees of heat and cold, and
the influences of bad air, bad food and drink, bad raiment, bad
habits, bad passions, and bad every thing, to say nothing of the
agency of serial, and vegetable and animal poisons, meteorological
and epidemic influences. &c.

In order that I may not be misunderstood in regard to the ob-
jects which I have in view in the discussion of this subject, it is
necessary and proper to state, that it constitutes no part of my
purpose to engage in the investigation of the nature and causes of
diseases with respect to their local character, believing, as I do, that
as local affections, merely, they are nearly the same under all cir-
cumstances, differing only in degrees of intensity, and presenting
phenomena peculiar to the organs in which they are located, and
that they exert little or no influence in determining the character
of the general constitutional symptoms, when the general system
happens to be brought under their influence, these being assigna-
ble to the influence of causes which have operated antecedent to,
and independent of the local affection, and which have operated

410 Holt's Letters upon General Pathology. ['My?

to create and establish the pathological conditions and their modi-
fications spoken of. And here, I may be permitted to reiterate
the necessity which we of the South have for separating the too
intimately associated idea of local excitement, local irritation, and
local inflammation, with excessive general nervous excitement and
excessive general vascular action. The peculiar character of our
diseases requires the separation their appropriate treatment de-
mands it.

Among all the causes, which operate to give origin and support
to the conditions of excitement and depression, the most promi-
nent is the influence of climate, with respect to heat and cold.
The general influence of cold, tends to give strength and vigor to
those nerves which support organic life, while the influence of at-
mospheric heat tends to diminish it, and induce in them a state of
debility and depression, while the reverse of this proposition holds
good with respect to the nerves which support animal life. This
influence of cold, imparts to the inhabitants of northern climates
an amount of vigour of constitution which enables them not only
to resist the ordinary influences which produce depression, to
which indeed they are less exposed, but to sustain a much higher
and more protracted state of excitement. This vigour is supposed
to depend upon a greater degree of density in the moving fibres,
combined with a larger amount of the inherent nervous power which
gives rise to vital motions, and sustains them, to some extent, inde-
pendent of the animal powers, and when an occasional cause oper-
ates to depress the nervous powers below the line of a healthy
excitement, the depression will generally be of short duration, and
the reaction will be prompt and energetic. Hence, most of the
diseases of Northern latitudes are characterized by the evidences
of high nervous excitement and vascular action. It is different
in regard to the influence of atmospheric heat ; for, instead of the
general vigour and inherent nervous power possessed by the inhabit-
ants of cold climates, those of warm climates possess less of den-
sity and a greater degree of elasticity of the moving fibres, which
allows a free exercise and play of the animal poivers, and gives
greater excitability or mobility to the general system, but dimin-
ishes the power of resisting the influence of depressing causes, or of
sustaining, for any great length of time, a state of high excitement ;
thus laying the foundation or predisposition to diseases of depres-
sion and congestion. It is not improbable, too, that the constitution
of the blood plays an important and active part, not only in lay-

1855.] Holt's Letters upon General Pathology. 411

ing the foundation for these states of excitement and depression,
but in sustaining them after they have been established. The dif-
ference in the constitution of the blood, consisting in a greater de-
gree of density, or a larger amount of its solid constituent princi-
ples in the inhabitants of cold climates, while in those of warm
climates the blood is more rare, having a larger amount of the
liquid, and fewer of its solid constituent principles, and while the
former favors the production and continuance of excitement, irri-
tation and inflammation, the latter favours the establishment and
continuance of depression and congestion.

If such be true, with respect to the influence of climate upon
the nervous system, and the constitution of the blood, in laying
the foundation or establishing a predisposition to these opposite
conditions, it is sufficient of itself, in my opinion, to account for
the prevalence of diseases of depression and congestion in South-
ern latitudes, independent of the influence of the many other causes
which combine to produce the same effect. It is upon the truth
of this proposition, that I have based my assumption, that " con-
gestion" constitutes an essential pathological condition, and, as such,
deserves the serious consideration of every Southern practitioner.
It may be urged, that if such be the result from the influence of
climate, why are not all the diseases of warm climates, congestive
in their character, all being subject to the same predisposing in-
fluences? The answer is, that such is the tendency of all; but,
that although the effect of the influence of atmospheric heat is to
diminish the vigour and inherent nervous power, it does not de-
stroy it, and a sufficient amount is left to enable the inhabitants to
resist the influence of the general predisposition, by what is known
as acclimation, and also the influence of occasional depressing
causes ; and while a few have sufficient vigour to sustain a high
degree of excitement and vascular action, and manifest a general
inflammatory diathesis, and many to sustain excitement, almost to
the point of inflammation, a great many sink under the over-
whelming influence of depression and congestion.

If heat and cold, are capable of manifesting such a decided in-
fluence upon the general system as to determine the character of
diseases, with respect to excitement and depression, their influence
is not less manifest upon particular organs, systems and tissues
as exhibited in the prevalence of diseases of the lungs and other
portions of the respiratory apparatus in cold climates ; while disor-
ders of the liver and bilious complications, generally constitutes

412 Holt's Letters upon General Pathology. [July,

the most prominent feature in all the diseases of warm climates a
circumstance which renders the consideration of this subject of
the greatest importance to us, who are not only liable to the dis-
eases peculiar to the influences of atmospheric heat, but also to
those of cold, which, unlike those of the same nature as they pre*
vail in cold climates, scarcely ever fail in being involved in biliary
complications, and these complications are often so prominent as
to overshadow in importance the primary affection, as every
practitioner of any experience must have often observed in pneu-
monia and other kindred affections. The extent and prevalence
of these complications, renders it necessary and important to ex*
amine a little more minutely, into the nature of their causes and
the manner of their production. That these complications result
from an enfeebled condition of the liver, from the influence of long
continued and high ranges of atmospheric heat, will scarcely be
denied; for it is an axiom, that long continued or excessive action
in any organ will be followed, sooner or later, by a corresponding
degree of inactivhVy, torpor or debility, and. the liver, responding to
the impression of spring and early summer heat, pours out its se-
cretion in great abundance, (itself a fruitful source of debility,)
gives rise to those disorders which are indebted mainly for their
character to excessive biliary secretions. But, as the season ad*
vances, the excitability of the organ diminishes by degrees, until
it ceases to be impressed or excited to action by the ordinary de-
grees of heat, which rising still higher, or continuing for a length
of time, it falls into a state of permanent inactivity and debility,
It is to this source that we are enabled to trace the prominent
characteristic differences between vernal and autumnal fevers ; the
former being generally intermittent, with more evident signs of
excitement and vascular action, with redundant biliary secre-
tions ; and the latter, remittent, with evident signs of depression
and congestion, and a deficient secretion of bile. But these
effects of atmospheric heat upon the functions of the liver, do
not terminate with the autumnal diseases; for time and rest
being required to restore its lost tone and accustomed activity, the
same condition is transferred, and ingrafted upon the winter dis*
eases impressing them with the same character, with those which
have preceded, It is in this way that we account for the similarity,
if not the positive identity, of character of our pneumonic and other
symptomatic fevers, with our autumnal idiopatic fevers. I would
not be understood as ascribing the existence of these fevers to

1855.] Holt's Letters upon General Pathology. 413

this enfeebled condition of the liver, but I maintain that the fever
having been excited by those causes which produce local inflamma-
tion will be determined in its character by the identical causes
which determine the character of autumnal fevers, and that the
liver will play about the same part in the one, as the other, which
is never an unimportant one, on account both of its relations to
other organs, and the functions which it has to perform. Kow, to
understand clearly the nature of these relations, both with respect
to these complications and the part which the liver has to sustain
in the general pathological condition of congestion, it is necessary
to keep in mind, that it possesses a peculiar circulation, known as
the " portal circulation,'' consisting of radicles which arise from
most of the abdominal viscera, which, uniting to form a common
trunk, enters the liver, and is again distributed into minute capil-
lary branches, and that its ofhce is, to receive the venous blood from
the abdominal viscera generally, and redistribute it in the liver,
where, and from which, is secreted the biliary fluid, thus present-
ing both the character of artery and vein. The same may be said
of the pulmonary artery, which conveys venous blood to the lungs ;
and while the former vessel is required to receive the blood of all
the principal organs engaged in the repairs and support of the
-:ern; the latter is required to circulate the blood of the entire
system, but what constitutes the great difference between these
vessels and others, is, that their capillaries circulate venous blood,
while the remote or arterial capillaries circulate arterial blood; but
a greater, or at least a much more important difference, upon
which the whole of our theory is built, consists in this, that while
depression or debility in the nerves which sustain or control the
circulation in them, tends to retard the flow of blood through the
former, while it favors a more rapid flow through the latter, and
that excitement, while it accelerates the flow of blood through
the capillaries of the pulmonary artery and vena portarum, it re-
tards its flow through the remote, arterial capillaries ; the one,
giving rise to (the latter) what Dr. Wood has termed M active " and
the other " passive ;' congestion. Kow, let us apply the principle,
to the formation of a condition of general congestion. Suppose
the whole system to be in a state of depression, which means di*
minished exciter/ient, a relaxation to some extent (proportioned to
the degree of depression) takes place in the arterial capillaries,
which allows the blood to escape more freely, and which other-
wise would be retained longer in them, for the performance of the

414 Harris, on Asclepias Verticellala. [July

respective offices for which it is distributed, especially the blood
sent to the organs of digestion, while the venous capillaries,
especially of the vena portarum, which is destined to receive that
blood, sharing in the loss of excitement, which is necessary to sus-
tain the motion of the blood through them, it becomes retarded,
and the consequence is, that the whole portal system soon becomes
congested, and the depression extending to the organs of respira-
tion, and to the capillaries of the pulmonary artery, as before ex-
plained, retarding the flow of blood through them, an undue acca-
mulation of blood takes place throughout the venous cavities,
constituting a general venous congestion. It is scarcely necessary
to say, that general excitement produces exactly the reverse condi-
tion of things, that excitement in the remote capillaries retards,
while it accelerates the flow of blood through the hepatic and pul-
monary capillaries, producing a state of general arterial plethora.

Having so far noticed only one cause, in connection with the
pathological condition in question, namely, atmospheric heat, and
endeavored to trace out that connection, it remains only to say,
that the other causes of depression, (which are almost innumera-
ble,) whether permanent or occasional, whether predisposing or
exciting, serve to give additional force and activity to the one
already mentioned. Some of them will receive, however, more
particular attention, when I come to speak of the condition, in
connection with some particular diseases, and their modifications,
which I shall perhaps do in my next letter, after tracing out the
morbid effects and pathological phenomena growing out of the
general condition of depression and congestion.

Still hoping that you may not become weary of the subject,

I remain, your's truly,

Sam'l D. Holt.

article xx.

A brief history of the introduction of the Asclepias Verticellata, for the
cure of Venomous Snake and Spider bites. By James C. Harris,
M. D., of Wetumpka, Ala.

This plant, more familiarly known in this vicinity as the Indian
snake weed, or Fitzpatrickana, may generally be found growing
in a light-grey or red-soil, upon the uplands throughout the States
of Alabama, Mississippi, Arkansas and Missouri, and in some por-
tions of Georgia, Florida and Louisiana. It flowers throughout

1855.] Harris, on Asclepias Verticellata. 415

the months of July and Augnst, and may be readily found in the
above localities, where the forest growth is scrubby oak and hick-
ory, or in the pine barrens, among the white oak runners. It
has a succession of white flowers, extending from an inch to an
inch and a half along its top, and from the eighth to a quarter of
an inch in length, each one resembling almost exactly the tooth of a
snake. It is perennial and when full grown is from fifteen to
twenty-two inches high, measuring in the largest portion of its
stem, from the sixteenth to the eighth of an inch in diameter, and
terminating in a fibrous root, the fibres extending horizontally in
every direction to the distance of five or six inches from the foot
stalk. The stem is jointed, and from the root to the commence-
ment of the first leaves is from eight to ten inches. The leaves are
acerose (or needle-shaped) of a green color, and from an inch to
an inch and a half long, four appearing at each joint. It is about
the first plant that appears in the spring, and the last that disap-
pears in the fall.

The use of the above plant was first introduced in the cure of
snake bites in Pike county, Alabama, in the year 1824, by Cald-
well Eastis, a white man, who had resided with the Choctaws,
Cherokees and Creek Indians for the last forty years preceding.
The account he gave of the manner in which its virtues were
brought to his notice is as follows : In the year 1801 or 5, when
accompanying a party of the lower Creek Indians upon a trading
expedition to Nashville, Tenn., one of the pack horses, whilst
grazing near the ten Islands upon the Coosa river, was bitten upon
the leg by a rattlesnake. The limb immediately commenced swel-
ling, and the animal exhibiting strong marks of excruciating pain,
whereupon one of the party retired to the woods, and in a short
time returned with a hand full of the above plant, which being
bruised between two smooth stones, was mixed with a bottle of
water and given as a "drench;" two hours afterwards, they re-
sumed their journey, the animal limping slightly for the first two
or three miles, afterwards giving no manifestations whatever of
uneasiness or disease. He also stated that there was a tradition
amongst these tribes, that a knowledge of its virtues being com-
municated to the white man, would most effectually destroy its
remedial powers, as he expressed it, " break the charm ;" he after-
wards frequently witnessed its administration for all kinds of snake
bites to the Indians themselves, and to their domestic animals, and
always with instantaneous relief.

416 Harris, on Asclepias Verticellata. [July*

For the foregoing account of the discovery and introduction of
the remedy in this section of the State, together with a greater
portion of the following, we are indebted to our friend, the Hon.
Benj. Fitzpatrick, who some time in the year 1826, received the
foregoing statement in person from Caldwell Eastis, then in his
eightieth year, and since dead.

The usual manner of preparation and administration is as fol-
lows : Take and slightly bruise five or six of the entire recently
gathered plant, (root, stem and leaves) put them into a pint of
spring water or sweet milk, and boil down to three gills. This is
the ordinary dose for an adult, and is to be diminished propor-
tionably for children, and given three times a day. The first dose
generally gives immediate relief and the others are merely given
by way of precaution. After each dose is swallowed, the remain-
ing bruised and boiled plant is to be applied to the bitten part.

The immediate effects upon the system of the above dose, ap-
pear to be that of a powerful anodyne sudorific, arresting the nausea
and vomiting, and giving instantaneous relief to the pain, to be
speedily succeeded by free perspiration and gentle slumber. Short-
ly after swallowing a dose, an agreeable sensation of warmth is
felt throughout the entire frame, commencing in the region of the
heart, and extending to the surface and extremities. The stomach,
no matter how irritable, scarcely ever rejects the remedy, and if it
does, never more than once or twice.

Since its first introduction in this neighborhood, in the year
1826, it has been used in more than forty cases of snake bite, and
in every instance, as far as we have been able to ascertain, with
the most happy results. Although it does not appear to possess
the power of immediately reducing the oedema of the bitten ex-
tremity or part, it seems to completely destroy the disposition to
any annual or periodic swelling or discoloration of the same. It
has also been tried in several cases of spider bite, and in every
instance has been attended with as complete success as in the cases
of snake bite.

From its tremendous power in arresting and neutralizing the
virus of the viper, the rattle-snake and spider, not only in the hu-
man species, but also in that of the inferior animals, we cannot
entertain the shadow of a doubt but that it will be found upon
trial a complete antidote to any of the animal poisons, even that
of the dreaded "hydrophobia?

In a report on the indigenous botany of Prattville, made to the

1855.] Contrih at ions to Practical Surgery. 417

Alabama State Medical Association in 1852, by Dr. S. P. Smith,
we are informed that the asclepias verticellata, a very popular
remedy in domestic practice for snake bites, had been tried in one
or two cases by himself, but not under such circumstances as ena-
bled him to test its claims satisfactorily.

If we are mistaken in ascribing to the asclepias verticellata in
the cure of snake bite, the extraordinary powers that we have as
it is indigenous throughout the entire Southern and South-western
States we hope the profession will, through their published com-
munications upon the subject, shortly set us right.

Contributions to Practical Surgery. By JoHS" P. AfETTArER, M.D.,
L.L. D., of Virginia.

ico Vaginal Fistula. It is now more than twenty-rive years
since I first operated for the cure of this afflictive infirmity, during
which period many extremely interesting cases have been treated
by me, and most of them successfully. Eecently, several examples
of the disease have come under my care, and, as they resulted for-
tunately, I have thought it might not be unacceptable to the pro-
fession "at large to give them publicity, as well as to describe the
modes of operating I now adopt. Indeed, I think every successful
case should be published ; as it is the increasing number of cures
that will induce surgeons to regard it no longer as an opprobrium
of our noble art, but as a curable disease, in a large majority of
instances ; and such is the opinion that my individual experience
leads me to express in this paper.

Some years since I contributed, through the American Journal,
a short paper on vesico vaginal fistula, with an account of some
cases I had treated successfully, and I expressed the opinion in
that communication, that every example of the disease could be
cured. Since that paper was published, some extremely bad forms
of the infirmity have come under my treatment, which, from their
utter incurability, have induced me to modify the opinion then
entertained ; yet, I believe a very large proportion of the cases are
curable. AVhen the entire basfond of the bladder is destroyed ; or
the urethra and cervix quite into the vesical triangle, such cases
are indeed utterly incurable ; and several of these horrid examples
have been presented to me since the paper referred to was pub-
lished.

In one of these cases it seemed that the entire bladder had
sloughed away, leaving only the orifices of the ureters, into which
I could readily introduce a common probe, and carry it up several
inches into the ureter itself. There was not the least appearance
of the vesical cavity ; and the ureters terminated on each side of

418 Contributions to Practical Surgery. [July*

the contracted vagina in a spongy growth, rather larger than the
extremity of a medium sized finger, and about an inch in length,
There was no ulceration of the parts, but considerable irritation
constantly existed, induced, no doubt,- by the action of the urine
upon them. This woman menstruated regularly, and seemed to
be healthy in all respects, save the irritation and excoriation of the
vagina and vulva, which, occasionally, became very distressing
and troublesome.

The other case differed from the one just described, in presenting
a mere border of the bas-fond of the bladder, upon which the ure-
ters opened by fungous growths of considerable size the greater
part of the floor of the bladder posteriorly and anteriorly nearly
to the meatus urinarius having sloughed away; yet the vesical
cavity above remained partially as a kind of fossa. This subject,
too, enjoyed pretty good general health, menstruated regularly,
but suffered much from occasional vagino- vulval irritation and
excoriation.

Such formidable diseases as these, are to be regarded as necessa-
rily irremidable. Fortunately, however, they are not of frequent
occurrence, as I have only met with two such examples out of
thirty-two cases, that have come under my management, in all.

The following case, which I shall relate in full in order to ex-
plain my method of operating, occurred with a white married
woman, aged about thirty -five years, and followed her first and
only parturition, which was protracted, as I was informed, and
badly managed. The foetus was large, and the head remained
nearly two days in the inferior strait, during which time the blad-
der was so closely compressed as to render urination impractica-
ble, and the introduction of the catheter exceedingly difficult. It
was not known, as I learned from the lady herself, for several
days after delivery four or -five she thinks that there was any
thing wrong about the bladder, or in the passage of the urine, ex-
cept that there was a constant dribbling of it, and totally without
the control of the will.

There was considerable inflammation of the parts at this time,-
and for many days after, which prevented the necessary examina-
tion into the case for nearly three weeks after delivery. Finally,
it was ascertained by the attending physician, that an opening
existed in the vesico- vaginal wall, near the urethral portion of the
vesical triangle, through which every drop of urine escaped from
the bladder into the vagina. The general health of the lady had
materially suffered from constant irritation of the vagino- vulval
surface ; and I believe, if the foetus had not been still born, that
she, in all probability, would have succumbed under her suffer-
ings. From having been a remarkably healthy, robust woman,
she now was emaciated and greatly debilitated ; and such is the
usual effect of this painful affection on the constitutional health.

Some five or six months after this lady's accouchement, I was
called on for the purpose of deciding as to her real condition, and

1855.] Contributions to Practical Surgery. 419

my examination confirmed the report of her family physician. I
found an elliptical opening beyond the sphincter muscle more than
an inch in length in its longest diameter, which was transversely
situated, while its shortest, or antero-posterior, did not exceed half
an inch. Already a tuberculated fungous mass of considerable
size presented through the fistulous opening a common appear-
ance in the disease which caused intense pain of a dragging,,
bearing down description, when the bladder contracted, as it often
will do, when, from any cause, urine accumulates within its cavity
even in small quantity. The borders of the opening were smooth,
rounded, and completely cicatrized, presenting a labiated appear-
ance, and were entirely free from all inflammatory tender.,
was evinced by pretty rude pressure with the probe or finger,
causing very little if any pain.

The case being in all respects favourable for an operation, it
was determined to execute it at once, and the following was the
mode adopted. I had the lady placed on her back, very much in
the position as for lithotomy, on a high bed, with folded blankets
and sheets under her to protect the bed, the parts being exposed
to the strong light of a window immediately opposite to, and on a
level with the perineum. Care was taken that the nates rested
fairly on the edge of the bedstead, so as to render the parts about
to be operated on easy of access. A two-bladed speculum was
employed for the purpose of dilating the os externum and vagina,
which, after being screwed open to the requisite extent, was held
in its proper position by grasping the handle. This instrument
displayed the fistulous opening fully, and caused little or no pain :
it was firmly held in -situ by the lady, with perfect convenience.

The free borders of the fistula were next denuded of their mu-
cous membrane, by the use of delicate hooks to take hold of it,
and scissors curved on their flat surfaces, or delicate knives curved
in like manner, or of the ordinary form, to excise it beneath the
hook. In this manner I removed a narrow but continuous belt
of mucous membrane from the entire border. In denuding in this
operation, the belt should, if possible, be excised in an undivided
manner, for reasons too obvious to be mentioned. I next remov-
ed the mucous lining for half an inch beyond the denuded border,,
commencing at that border, and taking it off, likewise, in an un-
divided continuous belt, using the cutting instruments already
named. During this stage of the operation, for the purpose of
arresting the traumatic bleeding; always exceedingly troublesome
without being profuse, by obscuring the parts, and thus retarding
and protracting the operation ; cold water was freely applied by
injecting it over the denudations with a syringe.

For the purpose of approximating the denuded borders of the
aperture and confining them in contact, metallic threads of pure
lead of moderate size were employed, and they were inserted by
the aid of needles considerably curved.

The metallic thread was employed of the length of five or six

420 Contributions to Practical Surgery. fJtily^

inches, doubled at each extremity upon itself and flattened a little
so as to form, a hook. This hook was then hung in the loop of a
silken or thread ligature previously inserted into the eye of the
needle.

Thus arranged, the needle, held in the grasp of Physic's artery
forceps, with its point deeply inserted into the fistulous opening,
and directed upwards, was made to transfix the upper border from
the vesical cavity to the vaginal surface fully an inch from the
denuded margin, and half an inch on the right side of the urethra.
The needle, with its appendages, the thread and leaden wire, was
now carefully drawn through with a pair of strong forceps, until
the metallic thread was fully one third of its length out beyond the
border.

I next armed the other extremity of the leaden thread, by con-
necting its hook with the loop of the ligature still remaining in the
eye of the needle, to be inserted below. The needle, for the pur-
pose, was held and directed by straight forceps, grooved at the
extremities of the blades, so as to receive and confine it securely,
and somewhat longer than Physic's ; while its point was deeply
inserted into the inferior border through the fistula, from the cavi-
ty of the bladder, and brought out fully an inch from that border
on the vaginal surface. As soon as the point of the needle was
perceptible, it was taken hold of with the traction forceps, already
referred to, and carefully drawn through with the metallic thread
attached to it. This insertion was made directly opposite the one
above, to prevent puckering of the borders when the threads were
tightened.

In like manner, a suture was applied to the right portion of the
fistulous opening, and the blood was now carefully removed by
forcibly injecting cold water over the parts, or by picking away
adhering coagula with the forceps, where they could not be re-
moved by the water,

I next proceeded to approximate the denuded borders, by
making traction on the metallic threads, and then carefully con-
fining them in close and exact contact by twisting their free ends
together, until the loops were sufficiently abridged, to enable them
both to support, and moderately to compress the structures em-
braced by them j and for the purpose of twisting the wires, I
employed a light pair of self-closing forceps, without ring-handles,
having found that instrument far more handy than the ordinary
dressing forceps, or forceps with ring-handles. After securing the
first suture so as to bring the denuded borders well together, I
tightened the second, and was gratified in finding that the fistu-
lous opening was perfectly closed, and that not a drop of urine
escaped between the borders. I was careful in twisting the wires
not to employ undue force, but sufficient to bring the opposing
surfaces into complete and firm contact, without injuriously com-
pressing the unlooped structures ; and I invariably twisted from
left to right, to prevent confusion,

1855.] Contributions to Practical Surgery. 421

After many trials in determining the extent to which the tension
should be carried, I finally adopted as a safe rule, the fixed and
erected state of the twisted extremities of the wires, 'and their bris-
tle-like spring when touched with the probe; and the tightening
of the loops should be executed with extreme caution and gradu-
ally, testing it as we proceed, from time to time, by touching the
wires with a probe or the extremity of the forceps.

After having tightened the wires sufficiently, I found that fully
one half of the surfaces denuded beyond the margin had been
brought completely in contact, thus affording a more extensive
surface for adhesion. The twisted extremities were now cut off
transversely, so as to project a few lines beyond the verge of the
vulva. Again the seat of the operation was carefully washed with
cold water applied with the syringe, and every part critically ex-
amined. A short tube of silver, of the form of a female catheter,
and very light, not more than five inches in length, with a small
ring at its open extremity, was now introduced into the bladder,
to prevent the slightest accumulation of urine in that organ. In
arranging the position of the tube, I was careful to guard, as far
as possible, against the instrument's resting chiefly on the floor of
the urethra, to prevent the incontinence liable to follow in some
cases when it remains long in the bladder.

The lady was now removed, and placed on a bed previously
arranged, as in cases of parturition, on her left side, because it was
at the time most convenient. I directed that the position on the
side should be rigidly maintained, as it would prevent, in a very-
great measure, the draining of urine over the seat of the operation,
which, if not guarded against, might greatly disturb the adhesive
process, and thus defeat the operation. A commanding narcotic
was now given, and every thing arranged to promote slumber as
far as practicable. A diet of tea drained from bread, or rice gruel,
was directed, taken in small quantity and after long intervals.
The application of cold water to the whole vagina with the syringe
was directed to be kept up day and night, care being taken not to
wound or disturb the seat of the operation with the instrument.
The opiate soon quieted the nervous system, and procured very
considerable ease.

Fearing that the bowels might act, as will sometimes be the case
for several hours after the operation, the narcotic was directed to
be repeated in six or seven hours after the dose already given,
and to be continued at like intervals, as long as any marked pain
was felt in the bladder, or the seat of the operation" It was only
necessary to give a second dose of the narcotic, as every thing
went on most favourably. The cold water was faithfully used to
the vagina, and afforded great comfort.

On the third day I tightened the sutures moderatelv, and hav-
ing left the free ends long enough to project above the verge of
the vulva, little difficulty was experienced in reaching them with
the forceps for the purpose. The application of cold water to the

N. s. VOL. XI. HO, VII. 27

422 Contributions to Practical Surgery. [July,-

vagina having soothed the parts so pleasantly, were directed to be
continued.

As yet there had been no action from the bowels, nor was there
any disposition manifested to such action. The urine had flowed
freely through the tube, without the slightest draining over the
seat of the operation. Finding some incrustations about the
threads, and mouth of the tube, I removed the instrument on the
fourth day, and replaced it with a new clean one..

On the eighth day the sutures were removed by snipping with
scissors, one thread just below the twisted portion of each noose,
and drawing it away with the forceps, and I found that perfect
union had taken place between the borders, leaving not a vestige
of the fistulous opening. Some slight bleeding from the orifices
left by the threads followed, but was only momentary.

The seat of the operation presented very slight tumefaction, and
the undue redness was only a shade above what was natural to
the mucous lining of the vagina. I continued the tube in the
bladder two weeks from the time of removing the sutures ; and
directed the lady to keep her bed the same length of time, to allow
the adhesions to become perfectly consolidated, before imposing,
any considerable amount of stress on the vesico- vaginal floor, from
the accumulation of urine in the bladder during an erect posture
of the body. The bowels never acted until the twelfth day after
the operation, and when they did act, the evacuation was natural
and easy. I then permitted a more sustaining and generous diet ;
and from day to dtsj thereafter, the quantity was augmented gradu-
ally, until full meals were taken.

Three weeks after the removal of the sutures, this lady left my
neighborhood perfectly restored to health, except very slight in-
continence of urine (by no means unusual after the operation, but
which generally ameliorates) and some general debility.

The mode of operating which I have just described may be
regarded as the one I now invariably adopt in similar cases. It
is true I have, in certain examples, pursued other methods, but
they have in most cases been unsuccessful. In several instances
I have made trial of the quilled suture as improved by Dr. Sims,
now of New York, but it has not succeeded in my hands. The
cases in which it was employed were, as I supposed, favorable for
its successful application, but I did not succed in them. In each
case, three in number, the operation failed from ulceration of the
denuded borders, both at the margins and where the metalic clamp
rested on them, and by the premature cutting out of the silver
wires. In one case, the clamp induced sufficient ulceration to
form a new opening into the bladder so early as the 5th day after
the operation. Possibly I may have used undue force in the ap-
proximation of the denuded borders in these' cases ; but it seemed
to me that I only carried it to the extent of placing them in com-
plete and firm contact.

This suture, however useful it may have been in the hands of

1855.] Cordributiom to Practical Surgery. 42S

Dr. Sims, is liable to important objections. If applied with too
much force, it will almost certainly cause ulceration or actual
sloughing of the denuded borders ; and it will be very difficult, in
most cases in which it is used, to determine the degree of force
which should be used in applying it. Even when moderate com-
ing force is employed, the circulation of the parts must be
essentially impeded the whole length of the clamps, which cannot
fail to endanger the success of the operation by producing ulcera-
tion or sloughing of the border.

There is another weighty objection to this suture, and I think
it equally as important as the one just named. It is the almost
utter impossibility of increasing or diminishing the approximating
force after the suturization is completed, and the wire threads cut
off, should it be nc to do so ; and, according to my experi-

ence with the leaden suture, used as I have described in the case
already detailed, it will always be necessary to increase that force
on the second or third day after the operation ; which can be most
readily done by simply twisting the wire a few turns, or, until it
is firmly and steadily exerted, as already described.

The liability of the silver wire to cut out prematurely consti-
tutes, likewise, a solid objection to the clamp suture, especially if
the borders are thin, and the mucous membrane delicate.

The interrupted suture, formed of leaden wire, is not liable to
these objections in any material degree. If it causes ulceration or
sloughing of the denuded borders, only the parts immediately
embraced by the metallic loops will suffer, while the structures
between will remain comparatively uncompressed, and their cir-
culation allowed to go on nearly normally, thus favouring adhe-
sion of the denuded surfaces held together by them. This suture,
too, can be applied with measured degress of force, as alreadv ex-
plained, so as to adapt that force with precision and safety. "And
it enables the surgeon to increase its approximating agency at any
time after the operation, should it be found necessary, without
subjecting the parts to disturbance, or the woman to pain.

The strongest objection to this suture is its liability to "cut
out." before firm adhesion takes place between the denuded
borders. But if the thread is deeply inserted, never less than an
inch, and more deeply, if the structures are soft and delicate, and
always beyond the denuded borders, this accident will seldom if
ever defeat the operation. The more effectually to secure the per-
manent agency of this suture in keeping the margins in close and
steady contact, it should be made to include considerable thickness
of the structures anterior to the bladder, as well as width of bor-
der ; and this can be effected by directing the point of the needle
more profoundly into the textures as it is introduced. The
thread, as already intimated, should invariably be carried through
the/ border considerably beyond the denudation. If this precept
is not strictly obeyed, the suture will certainly " cut out " prema-
turely.

424 Contributions to Practical Svrgery. [JulyV

It is the depth of this suture that secures its reparative efficacy
in the cure of vesico-vaginal fistula. That is the point on which
success turns ; and if the denudations are effectually executed, a
failure will seldom follow. This suture can be safely passed
through the vesical wall, and I decidedly prefer it in all cases,
because it secures more effective suturization ; and it is entirely
free from all liability to induce inflammation of the bladder, as my
experience fully testifies.

The possibility of small fistulous openings following suturizing
through the walls of the bladder, is the only danger of importance
that is to be feared ; and if the threads are not permitted to remain
longer than 8 or 9 days, this accident can hardly take place. I
have often suffered them to remain 10 and 12 days without such
an occurrence. In a few hours the ligature openings close. I have
rarely known them discharge urine after a day.

The long continued irritation of the vesical Avails, induced and
kept up by the fistula, seems to render the whole bladder less sus-
ceptible of acute inflammation. It is very certain that rude vio-
lence done to the bladder is seldom or never followed by acute
cystitis when vesico-vaginal fistula exists. I have never yet wit-
nessed a case of it7 and opportunities have often been afforded me
of seeing the bladder violently irritated during operations for vesi-
cal fistula. By transfixing the bladder in the employment of this
suture, besides uniting great security and firmness in its approxi-
mating agency,, it also enables the operator effectually to oppose
a much broader belt of the denuded margins of the fistula, by
reason of the unbridled condition of the borders, and their t
cy to introvert,, in some degree, when brought tog<
ening the wires. And this is an important consul when

the margins are thin, as will often be the case, in favouring ad-
hesion.

The clamp suture necessarily precludes any such widening of
the margins to be united, by reason of the threads of silver wire
basted through them, which compel the margins to approximate
and come into contact only at their borders, when those threads
are tightened, after the clamps are adjuster!. It is evident,, from a
moments reflection, that only very limite 3 : >ortions of the denuded
margins, except the border or edge, can be brought into contact
by the application of this suture. If the silver threads were made
to penetrate the vesical cavity, or even to re-enter the vaginal
passage a few lines before reaching the border, the difficulty just
considered might be obviated, and the utility of the suture greatly
enhanced. Indeed either of these modifications would be, in my
humble opinion, an improvement of the clamp suture, especially
the first one named.

I have been thus particular in considering the comparative
merits of these two methods of suturizing, in the treatment of
vesico-vaginal fistula, because my individual experience with them
enables me, in a degree, to judge of their relative value ; and be-

1855.] Contributions to Practical Surgery. 425

cause, too, I wished the objections to both, as far as I was able to
appreciate theni, fairly placed before the profession.

It has been asserted by some of the journalists of the north, in
support of the safety and infallibility of the clamp suture, that
laceration of the recto- vaginal wall was incurable until that method
of re-uniting the parts was adopted. This is certainly an incorrect
statement, because so early as 1832, 1 treated a case of this lacera-
tion with complete success by the use of the leaden wire inter-
rupted suture, which case was reported in the 25th number of the
American Journal ; and, subsequently, I have reported other cases
of that disgusting affection, treated successfully with the same kind
of suture ; in all having treated and cured twenty-seven cases with
the leaden interrupted suture alone, and without the least difficulty.

In every case of vesicovaginal fistula, the sutures should be
made to act in the direction of the short diameter of the opening,
as will be the case where it is elliptical. It, however, it is circular,
as I have seen in twenty instances, the sutures should be intro-
duced transversely. The transverse direction is most favourable,
both for the approxmv ion of the borders, and adhesion, because
the structures yield and expand readily in that direction; yet if
the disparity of diameter is inconsiderable, it will be best to sutur-
ize transversely. The needles should invariably be as small and
delicately formed as possible, and entirely free from cutting edges
and asperities.

The considerations, which have been presented, relate almost
exclusively to the uncomplicated and simple examples of vesico-
vaginal fistula, and the case detailed may be asstunea as a fair type
of the disease, and my mode of treating it. In the varieties
distinguished by complications, a treatment will be demanded,
adapted to such complications ; but, generally, the mode of sutur-
izing, I have advocated in this paper, will, with these, be also
indispensable.

When the opening is very large and the borders cannot be
brought fully together without the employment of great force, it
would not be safe to rely exclusively on the suture, as it would
almost certainly "cutout" before adhesion could possibly take
place. Nevertheless the suture is the chief agent in approxima-
ting and maintaining the firm contact of the denuded borders.

To prevent premature loosening and "cutting out" of the su-
tures, it will be projDer in these examples to form sloping incisions
of the lips, beyond the points transfixed by the sutures, deeply into
the textures, and longer than the diameter of the fistula, on both
sides, after the marginal denudations have boen formed. These
incisions will generally allow the borders to be easily approximated,
without interfering with the adhesive process in the slightest degree,
and they cause very inconsiderable pain ; they must not extend to
the vesical cavity. Should the margins prove unyielding, after
forming the incisions, it will be proper to deepen and extend them
in an undermining manner in the direction of the fistula, taking

426 Contributions to Practical Surgery. [Juty*

care not to cut into the bladder. If properly executed, this expedi-
ent will seldom fail to render the lips of the fistulous opening easy
of approximation ; and the incisions soon unite, in their new rela-
tions, so as to aid the sutures, in keeping the borders from separating,
or themselves from "cutting out" prematurely.

This mode of operating is applicable to all examples of the in-
firmity, attended with large openings, in which the borders cannot
be drawn together without employing considerable force, as well as
in some cases defying their approximation without such incisions ;
and if properly executed will seldom fail of success, and the incisions
soon heal up.

When the borders are thin and readily approximated, instead of
denuding them, a new surface of considerable width may be formed
around the edge of the opening, by carefully splitting it with a deli-
cate and keen knife two or three lines in depth. The borders being
now carefully drawn together, and the incisions opened with hooks,
or by passing a probe around them as they come in contact, quite
an extensive surface for adhesion is secured, and the union which
results will be proportionally firm. This mode of operating will be
more applicable to cases attended with thick borders, because the
splitting of thin edges is by no means easy of execution, while those
of some thickness can be incised with great convenience.

To perform this section, the lip must be held by long, delicate,
self-closing tenaculum forceps, and slightly everted, so as to bring
the edge of it fairly into view. The incisions can now be formed
in succession, until the whole border is split, taking care that they
shall be directed along the middle of the border.

This operation, for denuding the border, is much more easily per-
formed than that by the removal of the mucous membrane ; and
when properly executed the new surfaces readily approximate and
unite. It is, too, the best mode of rendering the edges raw for the
employment of the clamp, or any form of the quilled suture, espe-
cially if the silver threads are brought out upon the borders through
the middle of the incisions, so as to secure the perfect contact and
fixation of the new surfaces. Upon this plan the thinnest borders
can be made to unite in the firmest manner. Should the first opera-
tion with it, however, fail, the borders will become considerably
thickened by the marginal incisions, and the parts placed in a better
condition for repeating the operation some weeks afterwards, or, as
soon as all inflammatory tenderness of them subsides.

After numerous operations for vesico-vaginal fistula, performed
by myself, and varied in almost every possible manner since 1830, 1
have at last adopted the methods, that have been described in this
paper, as the best for a very large majority of the cases of this in-
firmity, if not for all that are to be regarded as curable; and I
believe it can be so improved, especially in the formation of instru-
ments, as to render it far less difficult of execution than is now the
case. I am confident that I operate now with less difficulty than I
did three years since ; and there cannot be a doubt but this is due

1855.] Contributions to Practical Surgery. 427

chiefly to progressive improvements in my instruments, as well as
to my increasing familiarity, both with the applicability of the in-
struments, and the infirmity itself.

There are certain complications of this affection that, at first
sight, present difficulties well calculated to embarrass inexperienced
operators ; and in some instances give no little trouble to those most
conversant with the disease.

The first to be named is & fungus growth from the mucous mem-
brane of the bladder ; just within the verge of the fistulous opening.
This formation presents a red granular surface, closely resembling
healthy granulations in appearance ; is tuberculated in form ; vary-
ing much in size ; is pedunculated ; often partially filling the fistulous
opening, but chiefly presenting or depending into the vagina, and
when touched with the probe yields blood freely. When of mod-
erate size, it almost invariably recedes into the bladder on placing
the body recumbent. Even when quite large, it often, nay, gener-
ally, re-enters the vesical cavity upon lying down.

This formation causes those distressing bearing down pains, and
strainings, so common in vesico-vaginal fistula ; and they, occa-
sionally, continue to be repeated many days after the fistula is closed,
now and then causing the reopening of the fistula, by cutting, or
tearing out the sutures after partial adhesion had taken place in
some instances. In some cases they involve the orifices of the
ureters, seeming to be an elongation, and hypertrophied enlargement
of these orifices, as the urine can be seen discharging from their
surface by drops or jets.

As long as these bodies remain within the vesical cavity they
cause little if any pain ; but as soon as they protrude from it, the
bearing down and straining commence, and continue until they
re-enter the bladder, or the person is placed recumbent.

In denuding and suturizing the borders, these protrusions are
liable to be wounded, and should be carefully avoided, as they bleed
quite freely, which accident would seriously embarrass and prolong
the operation, but without endangering the bladder from inflamma-
tion in the slightest degree. My custom is to force them back into
the bladder with the index finger before the denudations are com-
menced, and to confine them within the bladder, by temporarily
closing the fistula with a kind of probang, of proper size, resting on
the inner surface of that opening.

After the sutures are applied, and the fistula closed, there will
not be any reason to entertain fears from these tuberculous bodies,
unless they cause strainings, as will sometimes be the case. If
straining follows, narcotics in liberal doses will be demanded. In
eight or ten days after the operation, and frequently as soon as it is
completed, the straining and bearing down uneasiness cease, and it
is exceedingly probable that the spongy bodies are soon dispersed
by the action of the absorbents.

Another complication occasionally to be met with, is the inclusion
of Hie cervix andos uteri by the opening of the bladder ; and firm ad-

428 Contributions to Practical Surgery. [July*

hesion between them, thereby causing the uterine discharges to pass
into the vesical cavity, where, mingling with the urine, they, finally,
are discharged through the fistula.

In these examples the openings in the bladder are large, or the
uterus could not be included by them, to the extent generally met
with ; and although they are firmly united to the uterus, so as to
conceal that organ completely from view, or the touch, they rarely,
if ever, close without leaving an opening to constitute the fistula.

I have only met with a solitary instance of this complication in
the thirty-two cases that have come under my care, and I am in-
duced to believe it is not of frequent occurrence. Dr. Sims, also,
mentions a case treated by him, but in what ratio with his cases is
not stated, or I have not seen the statement if it has been published.

I treated my case as a common example of vesico-vaginal fistula,
without making an effort to disengage the uterus from the bladder;
and I had the satisfaction to find that the woman experienced little
inconvenience from the new relations of these organs in urinating,
or during the menstrual flow. Dr. Sims, I find, treated his case in
like manner. But for the escape of the menstrual discharge from
the urethra, with her urine, my patient would never have supposed
there was any change in her condition as respects urination and
menstruation ; and it was a long time before she discovered that she
menstruated through the meatus urinarius.

It is questionable if an attempt to release the uterus from the
embrace of the bladder would ever be justifiable in these complica-
tions of vesico-vaginal fistula. And, it is probable, this complica-
tion supplies the only means of cure, as the openings of the bladder,
in these cases, are too large to be closed in any other manner.

Calculous formations within the bladder, and around the borders of
the fistula, occasionally complicate this affection.

When a deposition of calculous matter takes place in the vesical
cavity, it causes the usual suffering from stone of the bladder ; and
if a fungus body exists at the same time, its growth will be rapidly
augmented, by reason of the increased bearing down and straining,
caused by the calculus within the bladder. Incrustations, from the
deposition of calculous matter around the borders of the fistula, are,
however, the most frequent form of this complication ; and in some
instances these incrustations become exceedingly thick and bulky if
the case has not been carefully attended to from day to day ; and
they invariably cause much suffering from the local irritation and
excoriation induced by them.

If a calculus exist in the bladder, sounding will readily detect it,
and it should be promptly romoved by extraction through the fistula.

The incrustations can be most readily and painlessly gotten rid
of by picking them away with the forceps, the vagina being pre-
viously dilated with suitable instruments, and exposed to a proper
light. After every particle of the incrustation is removed, the parts
should be freely washed by injecting over them cold water, as
already described, I have only met with a single case complicated

1855.] Contributions to Practical Surgery. 429

with stone of the bladder, which was also attended with axtensive
incrustrations around the fistulous opening ; but nearly every one
was complicated more or less, with incrustations around the opening
and sometimes upon the fungus growth also.

Recto- Vaginal Fistula has, now and then, been observed in con-
nection with the infirmity, and of this complication, too, I have met
with a solitary instance.

In this case the opening into the rectum existed about an inch
and a half from the verge, was elliptical in form, the long diameter
corresponding with the long diameter of the rectum, and readily
admitted the extremity of the index finger. The discharge of faeces
through the opening into the vagina, in this case, greatly aggravated
the irritation caused by the urine ; and the irritation of the fistula
kept up almost constant disorder of the bowels.

This is indeed a most afflictive complication, and one, too, well
calculated to embarrass the surgeon in determining as to its treat-
ment. In the only case that I have ever witnessed, I operated for
both affections at the same time, and was so fortunate as to succeed
by one operation.

The borders of the recto-vaginal fistula were first denuded and
suturized. I next operated for the vesico- vaginal fistula as already
described, and in nine days the leaden threads were cut away, and
both fistulas found to be perfectly closed by firm adhesions ; and this
patient continues well, now six years since the operations were per-
formed having given birth to two children during that period.

I think in all similar cases that both fistulas should be operated for
at the same sitting, as very little more time will be acquired, or pain
experienced. If, however, it should be necessary from any cause
to depart from this rule, and to operate for them at different times,
the vesico-vaginal fistula must invariably be the first to be cured, as
the incessant draining of urine over the rectal fistula, even il closed
in the best possible manner, could hardly fail in defeating the opera-
tion.

Contraction of the vagina is by no means an unusual complication,
because the same agency inducing the fistula, likewise can produce
sloughing and contraction of that passage. In some instances the
contraction nearly or quite closes the vagina.

These contractions, in all of the cases in which I have met with
them (three in number), serve to embarrasss the operation by ren-
dering the fistulas more or less inaccessible. They should, invariably,
be corrected before attempting the operation for the fistula ; and for
the purpose it will generally be sufficient, either to dilate the vagina
with graduated tents of sponge covered with oil silk, commencing
with the smallest: or, by cautiously dividing the bands causing the
contractions, and then dilating with the tents. I have employed
both of these methods with entire success.

It is important not to attempt the operation for closing the fistula
until the tents of the vagina can be dispensed with, as their pre-
eence in that passage, after such an operation, would seriously

430 Contributions to Practical Surgery. [July,

endanger its success, more especially as long as the sutures remain,
and for the first two weeks afterwards.

In some cases, along with the fistulous opening of the vesico-
vaginal wall, there will be laceration, or destruction of the urethra,
partially, or its entire length.

I have met with two examples of this unfortunate complica-
tion, and how they were caused I never was able to ascertain
fully, but I ascribed them to the long continued pressure of the
foetal head upon the parts, during its slow progress through the infe-
rior strait.

In one of these cases the urethra was laid open its whole length,
and it wras difficult to discover a trace of the original canal. But
for the slight projections that remained in the seat of the meatus, I
should never have supposed a urethra had existed. The other case
had suffered only partial destruction, as the meatus, and about half
of the urethra, remained entire.

These complications are always difficult to remedy, besides being
sources of irritation, and, comparatively, barriers to sexual inter-
course, which they render painful as long as they exist. These
cases are amenable to treatment, and, judging from my experience
with them, as far as two cases will enable me to decide, I think they
may always be remedied.

After denuding the imaginary borders, in the case of entire de-
struction, I employed the clamp suture of Dr. Sims, which enabled
me to restore, or, perhaps I should say, to form the urethra, and to
maintain the parts well together. I only employed force enough to
bring and keep the borders well in contact.

After three days I had the mortification to find that the clamps
had become loosened by reason of the wire threads having cut out,
and the borders had separated. I removed the whole apparatus,
and after two months repeated the operation with the interrupted
leaden suture. This was applied deeply, at intervals of four or five
lines. In two days the sutures were tightened, at which time not
the slightest separation of the borders had taken place. A very light
silver tube was kept in the passage from the time of operating until
a week after the sutures were cut away.

On the eighth day I removed the threads, as already described,
and found perfect union had taken place, except a very small por-
tion near the meatus. After six months, I closed this with two
stiches. The subject of this case has entire command of the retain-
ing and expelling powers of the bladder. The case of partial de-
struction was relieved by a single operation with the interrupted
leaden suture, restoring also the retaining and expelling powers of
the bladder.

Incontinence of urine sometimes follows the operation for vesico-
vaginal fistula, either as the result^of injury done to the sphincter
muscle in the formation of the fistulous opening ; or, from continuing
the tube in the bladder too long ; or, using one too heavy, and suf-
fering it to rest entirely on the lower or under segment of the

1855.] Treatment of Vaginitis and Leucorrhcea. 431

urethra. This is a most troublesome and disagreeable infirmity.
It sometimes continues only for a few days or weeks.

When time does not correct this evil, art must be called in. In
some instances injecting the bladder with a solution of nitrate of
silver, of the strength of 4 grains to the ounce of water, and in the
quantity of 4 ounces, to be retained 2, 3, or 4 minutes, will afford
relief, and repeating it once in 2 or 3 days. Now and then, a strong
solution of alum, or a pretty concentrated infusion of green tea, used
in like quantities, and after like intervals, will restore the retaining
power of the bladder.

If these remedies fail, it will be best, either to pass a suture deeply
around the cervix, and so tighten the noose to compress it decidedly,
and to continue it for four or five days ; or, to remove longitudinally
an elliptical piece of the cervix, and then to close the opening with
sutures as already described, keeping a light tube in the urethra as
directed for fistula of the bladder. This last expedient will not fail
to remove the incontinence ; it is not attended with much pain in
its execution, and will seldom be followed by acute inflammation
of the bladder. I know from a trial of it, that it will relieve the
incontinence, and, that the operation can be safely performed.

I have invariably adopted the position on the back, in my opera-
tions for vesico-vaginal fistula, believing it the most easy for the
woman, and quite convenient for the surgeon. And for dilating the
vagina, the two-bladed speculum, with the blades fully an inch and
a half wide, and curved spatulae of the same width I have generally
employed, and found them to answer my purposes very well. I have
used other contrivances also, but the speculum and spatulae I have
found much the most convenient in all respects. I generally em-
ploy a high narrow table, so formed that the lower limbs are sup-
ported above the operator's head, so as to be entirely out of the way,
yet the woman suffers no pain or inconvenience from having them
so disposed. The trunk I invariably secure against motion, by
fixing it to the table, with a cross-bar passing through the uprights
for the support and fixation of the legs, across the hypogastrium with
the nates projecting somewhat beyond the border of the table. In
every case I have the parts exposed to the light of a window on a
level with them. If the window, however, is high, it should be cur-
tained about three feet above the woman's body.

In some of my cases I have operated repeatedly without success,
but the failures were due to undue softness of the parts, from bad
general health, connected with a strumous diathesis, and before I
adopted my present mode of deep suturization. It is not proper to
operate for the infirmity while females are labouring under consti-
tutional scrofula. [ Virginia Medical and Surgical Journal.

On the Treatment of Vaginitis and Leucorrhoza. By MM. Becquerel
and Rodier.

In this paper the authors detail the results of a comparative trial
of various local applications they have made at the Lourcine. The

V

432 Treatment of Vaginitis and Leucorrhcea. [Juty)

following are their conclusions: 1. The application of concentrated
solution of nitrate of silver is very painful, not unfrequently inducing
exacerbations that compel the suspension of the treatment. The
same objection applies, though in a much minor degree, to the solid
nitrate. 2. Tincture of Iodine possesses few advantages ; for, al-
though it causes little pain or exacerbation, its power is feeble. It
is, however, a good means for dissipating either recent or old leu-
corrhoea, when unaccompanied by an inflammatory condition of
the mucous membrane. 3. A solution of tannin in equal parts of
distilled water, and applied directly to the inflamed mucous mem-
brane, is the best means of treatment, exciting neither notable pain
or exacerbation, curing, apparently without fail, and as promptly, as
the solid nitrate of silver. So efficacious and unirritating, indeed,
did the authors find this concentrated solution of tannin, that they
now employ it in all cases, acute or chronic.

During the discussion which ensued upon reading the paper, M.
Becquerel laid down the following marks of distinction between the
varieties of vaginal flux. 1. The discharge consists of a pure, trans-
parent, viscous mucus, composed of mucine, diluted in water, con-
taining very small quantities of saline matters. It is furnished by
the uterus when quite healthy, and sometimes when slightly irrita-
ted, but not to the extent to produce inflammation. 2. Leucorrhceal
mucus is milky and opaline, containing some bubbles of air. It
contains mucine, salts, and fat, especially cholesterine. Under the
microscope, we find abundance of epithelial cells, and some fatty
globules. It is never a product of inflammation, and is often
co-existent with an anaemic condition of the mucous membrane.
3. Jfuco-jms is thick, viscous, and of a light or greenish-yellow
color. It contains mucine and fatty matters in great abundance,
but no soluble albumen. By treating the fluid with a little water,
shaking and filtering it, we obtain a liquid that is not coagulable.
Under the microscope, we find fatty globules, with a few epithelial
cells and pus globules. It is the product of inflammation of the
mucous membrane, but without ulceration. 4. Purulent mucus
consists of a mixture of muco-pus and pus. It infers the existence
of ulceration, and it often presents us with a means of diagnosis
when there is ulceration of the mucous membrane of the interior
of the cervix uteri, inaccessible to the eye. It contains little mu-
cine, abundance of fat, especially cholesterine, and soluble albumen.
The presence of this last is shown by agitating a little of the fluid
with distilled water, the filtered liquid being coagulable by heat.
Thus the fluid that is the product of simple inflammation contains
pus without albumen, whilst the result of inflammation with ulcera-
tion contains pus with albumen. With the microscope, we observe
in purulent mucus numerous pus globules, a few epithelial cells and
fat globules, and protei granulations. [Z7 Union Medicale. London
Med. Times and Gaz.

1855.] Treatment of Scarlatina. 483

Treatment of Scarlatina.

To the Editor of the Medical Times and Gazette :

Sir Having found the dilute nitric acid to be a most efficient
medicine in the treatment of scarlatina, especially in the malignant
form of it, I am induced to send you a few remarks on the subject,
hoping that you will insert them in your columns if you think they
deserve a place there. I know that nitric acid has been made use
of before in this disease, but I do not know that it has ever been
given in the large doses I have found so serviceable, or that it has
been applied generally in the same manner. I am very far from
wishing to have it thought that I look upon nitric acid as a specific
for scarlatina, (indeed, until we find all people so alike in outward
physical conformation that we cannot tell one from another, I think
no one can expect to meet with such similarity of constitution as
will admit of the possibility of curing the same disease in different
persons, by one universal and unmodified remedy.) but only that,
by the treatment with nitric acid, I have attained an amount of
success that has not occurred to me when using other means. I
have taken tolerably full notes of between fifty and sixty cases. A
friend in the neighborhood ofPimlicohas kindly done the same.
The acid was used in every instance. It would be unreasonable
to ask you to give insertion to all these ; but I subjoin a report, in
a condensed form, of twelve consecutive cases of my own, and a
similar number from the note-book of my friend. The report is not
so full and explanatory as to the management of each case from the
commencement to the termination of the treatment as I could wish
it to be, but it will, I think, serve to show the age, sex. character of
the eruption, type of the disease, and that which is of most import-
ance the result. It is proper I should mention, that for the relief
of particular symptoms, and under particular circumstances, I have
not refrained from using other medicines ; but in no case has the
nitric acid been laid aside during the continuance of the fever.
The character of the disease in this neighborhood has been, for the
most part, of the most unfavorable description, yet I can conscien-
tiously assert, that out of fifty-seven cases treated with the acid,
only three have terminated fatally during the fever ; four others died
from one or other of the usual sequelae ; but of these last, three, I
have no hesitation in saying, were lost by premature exposure to
cold, and an entire disregard to both instructions and warnings.
To a child seven or eight years old, I am in the habit of prescribing
a mixture containing three drachms of dilute nitric acid, and eight
ounces of camphor mixture two tablespoonsful to be taken every
four hours. Also a gargle, half an ounce of the acid, with eight
ounces of water, to be used frequently. If the heat of the body be
much above the natural standard, I direct the entire surface to be
sponged with tepid water and the acid an ounce of the latter to
two quarts of the former. When the eruption is very vivid, and
fully developed, so as to render it probable that the desquammation
will be considerable, the acid produces more "smarting" than can

434

Treatment of Scarlatina.

[July,

be well tolerated, and it should therefore be omitted. The only
inconvenience I have found to ensue from the internal administra-
tion of the medicine has been, that in six or seven cases it appeared
to produce a difficulty in voiding the urine ; but well fomenting the
region of the bladder w7ith warm water, an opiate, and diminishing
the frequency of the doses of the acid, invariably afforded the de-
sired relief. With children too young to make use of the gargle, I
apply it with either a syringe or sponge. The distressing nature
of the throat symptoms, in the worst forms of the disease, render
gargling a most necessary proceeding ; but many children, even of
six or seven years old, cannot be got to accomplish it ; they havs
never been asked to do anything of the kind before, and, when at-
tacked with this disease, they are too ill, fretful, and peevish, to
learn, and thus lose the benefit of an essential part of the treatment.
I invariably request all my patients, who are the parents of young
children, to teach their little ones to gargle frequently with water
when cleaning their teeth ; and there are many that now feel thank-
ful they paid attention to the advice.

Name.

Age.

Variety, (a)

Character of
Eruption.

Termination.

1. Jane A

10
5
3
6

H

9

4

3
12

8

6

9
30

1*

4

11
9

3

9
12

1

4
13
11

S. ang.
S. malig.
S. ang.
S. ang.
S. simp.
S. malig.
S. malig.
S. malio:.
S. malig.
S. simp.
S. malig.
S. simp.
S. ang.
S. malig.
S. ang.
S. malig.
S. malig.

S. malig.
S. ang.
S. ang.
S. ang.
S. simp.
S. malig.
S. simp.

Moderate.

Very faint.

Profuse.

Moderate.

Moderate.

Scarcely any.

Very faint.

Faint.

Faint.

Moderate.

Very faint.

Moderate.

Moderate.

Faint.

Moderate.

Faint.

Very faint on

fifth day.
Very faint.
Profuse.
Moderate.
Moderate.
Moderate.
Very faint.
Moderate.

Recovered.

2. \Vm. H

Recovered.

3 Susan B.(b).......

Recovered.

4. George B

Recovered.

5 Mary B

Recovered.

6. Samuel B. (c)

7. Ellen B

Recovered.
Recovered.

8. John R. (d)

Death.

9. Timothy M

10. Edward B

Recovered.
Recovered.

11. Samuel M.(e)

12. James R. (f)

13. Mary L

Death.
Death.
Recovered.

14. Henry L

Recovered.

15. Ann J

Recovered.

16. Win. J

Recovered.

17. Alfred J

Recovered.

18. Emilv J. (a)

Death.

19. Mary Ann W

20. John W

Recovered.
Recovered.

21. Charles W .....

Recovered.

22. Ellen W

Recovered.

23. Mary E. (h)...,

24. John E

Recovered,
Recovered,

(a) The division into scar, simplex., scar, anginosa, and scar, maligna
are used.

(b.) The throat symptoms very severe ; sponging with acid omitted on
account of pain.

1855.] Treatment of Acute Rheumatism. 435

(c) Throat symptoms and coryza most distressing ; breath intolerable,
offensive; recovery very tardy, with symptoms of urajmic poisoning.

(d) This child had been ill four days before I was sent for. Jle was
most unmanageable, and it was only with the greatest difficulty any medi-
cine could be given him.

(e) This child died a month after the fever; gradually wasted away,
there beiug no sign of organic disease of any kind.

(f) No. 12 was the brother of No. S. He was so far convalescent on
the eighth day that the parents requested me not to see him again, unless
sent for. I gave them instructions and cautions, to which they paid no
attention. A fortnight afterwards I was sent for in haste, and found him
dying from uraemic poisoning.

(g) My friend met another medical man on the fifth day, who was anx-
ious to give free chlorine, as he said he had saved three of his children.
It was tried, but the child died on the seventh day.

(h) Tardy recovery. Extensive collections of matter in the cervical
glands.

I fear you will consider my communication inconveniently long;
but at the same time, I trust you will deem the success of the treat-
ment a sufficient excuse for my troubling you with it.

I am, &c, Henry Day, M.R.C.S., and L.A.C.

Stafford, Feb. 20, 1855.

On a successful method of treating Acute Bhematismhy large and fre-
quent doses of the Bicarbonate of Potash. By A. B. Garrod, M.D.,
Physician to University College Hospital.

At a late meeting of the Royal Medical and Chirurgical Society,
Dr. Garrod, after a few preliminary remarks, observed, that he was
induced, in May, 1852, to try a new method of treating acute rheu-
matism; and, finding great success at first, resolved steadilv to
pursue the plan, and has done so up to the present time. The
object of his communication has been to record the method adopted
by him, and also the results obtained in fifty-one cases of rheumatic
fever which have been admitted, under his care, in University Col-
lege Hospital, during the last two years and three-quarters. The
main part of his plan of treatment consists in the administration, in
a diluted form, of two-scruple doses of bicarbonate of potash, every
two hours, day and night, until the patient has been free from all
articular affection and febrile disturbance for two or three days,
using local depletion over the heart's region, if any cardiac disease
is present or threatened. The author then detailed three cases of
rheumatic fever, illustrating this mode of treatment ; the first, a girl,
10 years old, in which the duration under treatment was five days,
the total duration eight ; the second, a young man, aged 20, with a
complication of heart disease, where the duration under treatment
was eight, the total duration fifteen days ; the third, a young woman,
aged 18 years, in the fifth attack, the former ones having always
lasted for a month or five weeks, but which, by the adoption of this

4c36 Treatment of Acute Rheumatism. [Jttly,

plan yielded in nine days : total duration being but thirteen days,
four having elapsed before her admission into the Hospital. He
afterwards gave a table of fifty-one cases of acute rheumatism ; and
of each patient the following particulars are noted : The age, oc-
cupation, hereditary predisposition; the number and causes of at-
tack ; the symptoms before admission ; the symptoms during treat-
ment ; the nature of treatment ; and the duration of the disease.
From these cases the following deductions are made, viz : that in
twenty males the duration of the disease under treatment averaged
between six and seven days, and the total duration between eleven
and twelve days; and, in thirty-one females, the disease under treat-
ment averaged from seven to eight days, and the total duration
between fifteen and sixteen days giving, in all, an average under
treatment of seven days and a half; and, for the total duration about
thirteen days and a half. The author then alluded to the influence
of the bicarbonate of potash, when administered in large and fre-
quent doses, upon the different organs and functions of the body ;
and remarked, that it produces neither nausea, vomiting, nor purg-
ing ; in fact, no symptoms of gastro-intestinal irritation. It now
induces a strongly alkaline condition of the urine, causes it to effer-
vesce freely, with excess of acid, but does not appear to promote an
increase in the quantity of the secretion. It appears to render the
secretion of the skin less acid, sometimes almost neutral. That it
acts as a powerful controller of the heart's action, reducing greatly
the frequency of the pulse, but without causing the faintness often
produced by digitalis, colchicum, etc. That it probably increases
the alkalinity of the serum of the blood, and diminishes the coagu-
lability of the altered fibrin occurring in rheumatic fever ; and
hence, probably, checking or preventing the deposits of lymph on
the endo or peri-cardium. He (Dr. Garrod) stated his opinion, that
the influence of the bicarbonate was felt not only in shortening the
duration of the articular affection, but also in preventing or moder-
ating the cardiac disease. After enumerating many details of the
method adopted, and the value of certain adjuncts, as opium, calo-
mel, and occasional general depletion, he proceeded to recommend
a plan of treatment which, from his experience, he considered cal-
culated to insure the greatest amount of success, and thought it pro-
bable that the total duration of the disease might, on the average,
be reduced to about ten days, provided that the treatment was
adopted early, and no serious complication existed.

The President asked Dr. Garrod if he had employed bicarbonate
of soda, and, if so, with what result. He (the President) had long
ago recommended alkaline treatment for rheumatism ; and, in a
paper read before the Society eighteen months ago, he mentioned
several cases that were successfully treated by carb. of magnesia
and precip. sulphur, about half a drachm of each night and morn-
ing ; with alkalies and bark given every three hours during the
day. He had lately attended a lady who was treated in the same
way, and on the fourth day she was in her drawing-room.

1855.] Treatment of Acute Rheumatism, 437

Dr. Dickson thought it a matter of regret that Dr. Garrod's cases
were those of hospital patients, many of whom were probably dis-
missed before they were really cured, and were lost sight of after-
wards. He could not help thinking that such large doses of alkaline
medicine must ultimately produce a very injurious effect on the
system. He believed that vigorously attacking the disease with
mercurial medicines and other agents which produce a decided
effect on the liver, would do more to abridge the period of the
disease and relieve the sufferings of the patient than any other sys-
tem. He had seen cases in which small doses of alcoholic extract
of aconite had been employed with the best effect.

The President concurred in Dr. Dickson's approval of the occa-
sional use of alcoholic extract of aconite. He wished to ask if Dr.
Garrod had not found anaemia produced in some of his cases, neces-
sitating the use of preparations of bark or steel.

Dr. Garrod, in answer to the President's first question, said he had
not used bicarbonate of soda, his object having been to test the effects
of a simple treatment extending over a long period. He had no
doubt that other remedies than the one he had suggested might often
be useful as adjuncts, such as opiates and extract of aconite, though
he had frequently seen the latter fail. Bicarbonate of soda would
probably be as useful as bicarbonate of potash. He had seen pa-
tients two or three years after they were fully under discipline, and
thev never suffered in the least from the treatment. He believed
that alkaline treatment had no tendency to produce anaemia, but
that rheumatism itself had such a tendency. Mercury, he thought,
was far more likely to produce injurious effects on the system than
alkalies.

Dr. Webster was disposed to doubt the efficacy of new remedies
for rheumatism, which was the subject of greater diversity of opinion
than almost any other complaint. Bicarbonate of potash might
possibly be useful in young subjects of an inflammatory character,
but he should hesitate to employ it in other cases, and especially for
old people. Formerly acids were employed in cases of rheumatism,
and he could hardly believe that both acids and alkalies, could be
efficacious. Opium was considered an excellent remedy, and he
had seen it used with the best effect.

Dr. O'Connor said, the acid referred to by Dr. Webster was
lemon-juice ; and it was now the experience of many Medical men,
that, when given in large doses, it was productive of considerable
prostration. He (Dr. Connor) had lately used bicarbonate of potash
in several cases of acute rheumatism with the best effects, together,
in some instances, with cod-liver oil in combination with quinia.

Mr. Streeter recommended the use of nitrate of potash, with the
addition of bark, on the subsidence of the more inflammatory symp-
toms. Animal food should be taken sparingly, and bleeding* was
sometimes necessary, in order to prevent the pleura or the heart
from becoming implicated.

Dr. Ratcliffe mentioned some experiments made several years

n. s. vol. xi. no. vn. 28

4:88 Employment of Wine as an Enema. [July?

ago in the Military Hospital at Brussels, showing that the natural
course of rheumatism extended over a period often or twelve days.

Dr. Rogers had used lemon-juice without observing the slightest
depression. In cases of phthisis, combined with rheumatism, he
had given it with great benefit.

The President said he had employed bark in conjunction with
alkalies for thirty-two years ; he had occasionally used bicarbonate
of soda. Where there was a threatened exudation of lymph, great
benefit wras derived from biborate of soda. Turpentine might some-
times be usefully employed externally as well as internally.

Dr. Basham said, that the discrepancies of various authors might
be reconciled, if they would pay more attention to the particular
forms of the disease, Cod-liver oil was exclusively useful in cases
of rheumatism allied to syphilis or other causes of disease. The
form to which Dr. Garrod had alluded was acute rheumatism, in
which the fibrous element of the blood was in excess, and the saline
materials were deficient; any plan of treatment, therefore, in which
the saline principle entered, must be the most efficacious. Great
relief might be obtained by exposing the joints to what might be
called saline baths, enveloping them with spongio-piline saturated
with nitre.

The Society then adjourned. [London Med. Times and Gazette*

On the Employment of Wine as an Enema. By M. Akan.

M. Aran observes, that in many cases of dyspepsia, chlorosis,,
phthisis, and convalescence from severe diseases, the use of wine
is strongly indicated whilst the heat and irritation of the digestive,
organs' it induces absolutely prevent its employment. Having
found vinous enemata of great utility in obstinate diarrhoea, he
tried them in various other cases,, and for the last three or four
years he has administered them whenever slow convalescence has
been united with irritability of the digestive organs. He has also
obtained great and unexpected advantages in phthisis,, having at
first administered the wine on account of the accompanying diar-
rhoea. When the disease is advanced, little, or only temporary,
benefit results : but, when given at an earlier period, and associa-
ted with cod-liver oil or other means, the wine does exert a salu-
tary influence that merits attention. In gastralgia, while the gen-
eral debility seems to indicate the use of tonics, yet wine cannot
be given, even in small quantities, without exciting a sensation
of burning ; but in several examples of this the vinous lavements
have not only restored strength, but have so diminished the gas-
tric irritability, as to allow of a little wine being taken with the
food. Another form of dyspepsia alike susceptible of benefit, is
vomiting, with the rejection of alimentary matters the strength
and embonpoint rapidly returning under the use of the enemata.

But the affection, in which M. Aran has been most supprised at
the amount of success obtained was chlorosis. Influenced by the

1855.] Fissure of the Palate. 439

so prevalent opinion, that iron is the specific remedy, he at first
gave it in conjunction; but he afterwards omitted it, only prescribe
ing, besides the wine, general frictions with an ammoniacal lini*
ment, and a powder consisting of bismuth, rhubarb, and valerian,
In a few days the patients seemed to have recovered their normal
health just as if iron had been given, and that even in severe cases.
In their relation to iron, cases of chlorosis may, indeed, be divided
into three categories, In the first and most numerous, iron pro'
perly administered furnishes a durable cure. In others, a rapid
amelioration ensues, which is followed by a relapse on its discon-
tinuance. Temporary amendment attends its resumption, and so
on for years, iron thus becoming a constant necessity. Thirdly,
there are not a few cases in which iron fails altogether, or in which
the amelioration never rises to the dignity of a cure, M. Aran
has also advantageously employed the injections in various other
conditions characterised by debility, and especially in paludal,
syphilitic, or cancerous cachexy, in some cases of anasarca, and in
different circumstances in which alcoholic stimuli are indicated.

The lavements are found to act advantageously, in proportion
as the individuals have been previously unaccustomed to alcoholic
drinks, Thus, they are, in general, more useful in women than
in men, still more in young girls, and more so in the inhabitants
of the country than those of Paris. Until the patient becomes
accustomed to them, they induce a kind of drunkenness, but very
different from that following the swallowing of wine ; and if the
enema be given in the evening, so that the patient may afterwards
remain quietly recumbent, refreshing sleep ensues. It is to be
remarked, that effects are produced by a dose of wine, that, if
swallowed, would induce little effect. It is sufficient, in slight
cases, occurring in impressionable persons, to employ 150 grammes J
but, in obstinate cases, 250 to 350 grammes may be required, In
the chlorotic, it seems much to hasten the cure to divide the dose
into two parts, administering one evening and morning. In
general, from 150 to 250 grammes suffice, and it is better, if the
wine is rich, to commence its use by diluting it with water, Im*
mediately before giving the enema, the rectum should be emptied
by a lukewarm injection, and the wine should be employed tepid,
so as not to induce contraction of the rectum. At first, the patient
should lie down, and endeavor to retain the fluid ; but those who
are accustomed to the treatment, retain it with little trouble in any
position. [Bulletin de Therap) 1855. London Medical Times and
Gazette.

Fissure of the Palate. By Jules Cloquet1.

An interesting memoir on this subject, with an account of six
successful cases, by Dr. Jules Cloquet, is published in the Gazette
Medicate de Paris, for March 3d. The method employed by M.
Cloquet is to cauterize the upper angle of the fissiire for the extent

440 Tincture of Iodine with Cliloroform, [Juty?

of a few lines, by the application of the pernitrate of mercury, the
hot iron, or loop of platina wire, rendered incandescent by means
of the electric current. Not less than seven or eight days ought to
elapse between each operation, in order to allow the parts to con-
tract, and to consolidate the union. In one case after twenty-four
applications of the pernitrate of mercury, with a pointed stick of
soft wood, a fissure of the whole extent of the soft palate, caused by
syphilitic ulceration, was completely united. In another case, in
which the fissure was congenital, the same number of operations b}'
means of the red-hot iron, were sufficient to restore the parts per-
fectly to their normal state. Where the parts are firmly adherent
to the bone, they may be separated by the knife before applying the
caustic, as in the ordinary operation by sutures. The operation
occasions very little pain, is exceedingly simple, and requires no
change in the regimen or habits of the patient. [Virginia Medical
and Surgical Journal.

Tincture of Iodine loith Chloroform. By M. Titon.

This new preparation is a solution of iodine in chloroform ; it
dissolves the iodine even to complete saturation in the proportion of
twenty to one hundred. This solution, containing the fifth part of
its weight of pure iodine, is of sufficient density to preserve it under
water, and is of a deep violet color, with a fine purple reflection. Its
richness in iodine, its form (that of a diffusible stimulant) are all
conditions the most favorable to the perfect action of the iodine ;
on the other hand the dissolution being perfect, the molecules of the
metaloid are, so to speak, imprisoned in the vehicle. And this is
demonstrated by dropping a few drops in a test tube filled with
urine, water or saliva, when the drops fall to the bottom in a sphe-
roidal form ; and whether the liquid previously contained the ap-
propriate reagent, or whether it is subsequently added, there is no
traces of iodide of starch. If, on the other hand, we cover the mouth
of a bottle holding the chloroform tincture of iodine with a starched
paper, upon which, either before or after, a drop of nitric acid has
been placed, a blue tint is immediately, apparent upon that part of
the paper impregnated with the reagents, and this result is more or
less hastened if the bottle is warmed, or otherwise by the heat of the
hand. We have here, consequently, a proof that the vapors of
chloroform, otherwise recognizable by their agreeable odor, are
charged with iodine vapor. This perfect solubility and volatility
which pertajn to the two bodies individually less, however, than
those of the pure chloroform warrant a rapid and complete absorp-
tion ; and the direct proof of this absorption is found in the elimi-
nation of the iodine by the secretions. Ten minutes after an inha-
lation of five minutes, the iodine was detected in the saliva, and in
fifteen miuutes in the urine,

The chloroform solution of iodine may be used by every means
of inhalation. M. Titon generally employs a phial, which is held

1855.] Absence of Chlorides from the Urine. 441

to one of the nostrils for two, four, or ten minutes ; and the evapor-
ation is hastened by shaking the phial or holding it in the hand.
The first inspirations produce a feeling of calmness and ease, with-
out occasioning the suffocative symptoms at times attending the
inhalation of pure chloroform. The respiratory action is carried on
with more freedom. In from four to six minutes, the patient feels
in the nose and throat an extremely pungent sensation, which ra-
pidly disappears the moment the inhalations are discontinued. The
pungency can be obviated in inspiring the vapor in a less concen-
trated form, in breathing from time to time in a little fresh air.
There may be felt after several inhalations a slight degree of pres-
sure about the temporal regions, which disappears rapidly. Follow-
ing the sedative action manifest when the inhalation is commenced,
there is an increase of energy, the vital forces are also increased,
and the quickness of perception and sensation announces that the
absorbed iodine has carried its action to the nervous centres, from
which it reflects a salutary influence upon the whole system.
Iodine, administered in this manner, possesses evidently two advan-
tages ; in the first place the quantity may be graduated ad libitum:
the contact of the portions, intermitting like the inspirations, the
susceptibility of the organs, in allowing the duration of the treat-
ment to be prolonged; and then the absorbing surface is of more
extent certainly than by the gastro-intestinal mucous membrane.

[Bulletin de The rap. Stethoscope.

Absence of Chlorides from the Urine, Diagnostic of the Onward Pro-
gress of Pneu monia.

In the April number of the Monthly Journal of Medical Sci-
ences, Prof. Bennett gave an account of certain facts which con-
firmed the statements of Simon, Kedtenbacher, Beale, and others,
as to the absence of chlorides in the urine during the onward pro-
gress of pneumonia. The professor resumed these enquiries on
returning to the clinical wards of the Edinburg hospital last sum-
mer, and in the number of the above mentioned journal for De-
cember last, he relates three cases of the disease there treated which
confirm the diagnostic value of this change in the urine. In all
these cases the absence of chlorides marked precisely the onward
march of the pneumonia, whilst their presence indicated its cessa-
tion and was generally accompanied by tlie returning crepitation
and commencing absorption of the exudition. [Stethoscope.

Bubo.
It is seldom necessary to open a bubo. Employ counter-irrita-
tion. Take a solution of nitrate of silver (one drachm to two
drachms of water), with the addition of three drops of a strong-
nitric acid. This is to be painted freely into the skin over the in-
flamed gland. It causes great pain ana soreness, which is followed
bj rapid diminution of the gland. This treatment may be ex-

442 Editorial. [July,

tended to other cases in which inflammatory deposits, whether
purulent or fibrinous, require to be absorbed^or diminished. [St.
Louis Med, and Surg. Jour,

EDITORIAL AND MISCELLANEOUS.

State Medical Society. At the late meeting of the Medical Society of
the State of Georgia, it was resolved to discontinue the publication of their
Transactions in pamphlet form, and to furnish such papers as the Society
might desire to publish, for the pages of this Journal. The present number
contains the first of a series of contributions sent to us in accordance with
the above resolution. The others will appear regularly, one per month.
We should add, that the paper of Dr. J. M. Green, contained in our last
issue, was prepared for the Society ; but unavoidable circumstances pre-
vented Dr. G. from attending the meeting, and from having it presented to
the Society.

Compliment to Professor Austin Flint.- We have just received with
the June No. of the Buffalo Medical Journal a fine portrait of its late dis-
tinguished Editor, Austin Flint, M. D., published and distributed by his
professional friends of Buffalo, as a small testimonial of their respect and
attachment. We know but few men upon whom such a manifestation of
good feeling could be so meritoriously bestowed.

Dr. Charles T. Jackson. The Sultan of Turkey has just conferred the
honor of Knighthood upon our worthy countryman, Dr. Jackson of Boston,
in consideration of his discovery of the Anesthetic properties of Ether,
This is the second or third compliment of the kind paid the Doctor by
foreign sovereigns.

Quarantine at JVew Orleans. The Board of Health of Louisiana have
advised the Governor of the State to issue his proclamation declaring as
infected all ports within the torrid zone, thereby subjecting all vessels,
steamers &c, sailing from such ports, to a quarantine of not less than ten
days, but more if found necessary. The quarantine station is 73 miles be-
low New Orleans. This measure will determine, if properly carried out,
the question of the local origin of yellow fever in that city.

Professorial changes, Dr. H. H. Smith has been appointed Professor of
Surgery in the University of Pennsylvania, in place of Prof. Gibson, whose
resignation we announced in pur last, Dr. L. S. Joyner has been appointed

1855.] Editorial and Miscellaneous. 443

Professor of Institutes, &c, in the Medical College at Richmond, Va., in
place of Prof. Brawn. Sequard, resigned ; and Dr. A. E. Petticolas, Pro-
fessor of Anatomy, in lieu of Prof. Johnson, who was lost at sea.

Horse-flesh. M. Jeoffroy-St. Hilaire has been recently delivering Lec-
tures to the good people of Paris, upon the value of Horse-flesh as food,
and recommends it as a good substitute for beef.

Chloroform in Hydrocele. Prof. Lazenbeck, of Prussia, injects a drachm
or two of Chloroform in lieu of the Tr. Iodine in common use, and thinks it
decidedly preferable.

Explanation. A correspondent wishes to know what are the ingredients
referred to in the Recipe upon page 314 of this Journal as "speciei pro
conf. arom." By referring to the U. S. Pharmacopoeia, he will find that
the aromatic confection is made with an " aromatic powder," consisting of
cinnamon and ginger, of each "gij. and of cardamon and nutmeg, of each gj.,
well pulverized and rubbed together. These are, therefore, the articles re-
ferred to in the prescription.

AMERICAN MEDICAL ASSOCIATION.
Proceedings of the Eighth Annual Meeting, held in Philadelphia, Pa.,
May 1 to 4, 1855. (Specially Reported for the New Jersey Medical
RejDorter.)

On the morning of Tuesday, May 1st, at 11 o'clock, the Association as-
sembled in the spacious hall of the Musical Fund building, and at Hi
A. M. was called to order by the President, Dr. C. A. Pope, of St, Louis,
the Vice-Presidents taking their seats on either hand of the President
The ex-Presidents were invited to take seats on the platform.

Dr. Isaac Hays, of Philadelphia, chairman of the Committee of Arrange-
ments, on behalf of the Profession of Philadelphia, extended a cordial greet-
ing to the members of the Association. Dr. Hays then stated that 537
delegates had registered their names.

The President, Dr. Chas. A. Pope, being called upon, delivered the an-
nual address, as follows :

Gentlemen: With feelings of great pleasure, I meet you, and greet you,
on this occasion.

For high and useful purposes, have we assembled from the wide extent
of our beloved country. The elevation of a noble profession the promo-
tion of science the good of humanity these have been, are, and will
continue to be, the objects of our Association. Whether we have, thus tar,
done much or little, our sole aim has been the advancement of the best
interests of our fellow men. I shall not assert that we have done as much
as we might have done, or that the course hitherto pursued by us, is so
perfect, as to admit of no improvement. "Were such the fact, and were the
Association a firmly established institution, I might have experienced more
hesitation in the selection of a theme for the present occasion. And since
we cannot, as yet, I think, urge such a claim, the few suggestions which I

444 Miscellaneous. [July,

shall offer, are made with becoming diffidence, but at the same time with
a deep sense of their importance to the welfare and perpetuity of our As-
sociation.

Some strictures on our proceedings, in medical and other journals, have
appeared within the last year, as well as in previous years. I shall not
here blame the authors of them. They are doubtless, as proud of our noble
profession as we, and equally with us, anxious for the advancement of its
interests and its honor. I thank them for their suggestions. All of us are
ready to hear them and to profit by them. If any more effectual mode of
arriving at truth can be devised, than that which we have heretofore pur-
sued, all of us are ready to follow it, and would rather thank than quarrel
with those who may propose it.

Physicians have an almost superhuman mission to fulfil. The goal of
their ambition, and their hopes, and their duty, stands at the ultima thule
of human capacity nay, rather beyond it. It cannot, indeed, be said,
that their duties are beyond their powers, but their ambition, their hopes,
their wishes certainly are. They would gladly know, not only all the
secrets of organization, but those also of physiology, pathology, and thera-
peutics. To arrive at such knowledge, is perhaps, beyond the attainment
of the human mind. Multiform are the elements which enter into the
problem of health and disease. Health, is, itself, a constant change of
composition diseases are ever-varying changes, supervening on this.

Do we now know, with all our advancement, and after all the toil of our
predecessors for two thousand years, the exact changes in which any disease,
the fevers for instance, consists? And even when we shall have learned
these, so as to understand them as well as the most ordinary chemical
changes, the ever-varying character of most diseases, and the inward dis-
turbing influences upon them, of the mental and moral emotions, would
require to follow them, a continued stretch and power of intellect, of which
it is doubtful if man be capable. This exactness of knowledge is not, I
grant, necessary to the very successful practice of medicine. Our profession
can render great and important services to man without it, but with it, it
would be still more serviceable. To it our ambition tends. To this per-
fect knowledge we aspire. Although we may never reach, we can yet
eternally approach it. In the vast region of our researches, there is no
probability that human genius will ever, Alexander like, weep for the want
of unconquered provinces. Beyond the conquests of the future heroes of
the profession, there will always be a boundless field for the ambitious and
philanthropic explorer. In the language of a western student, " the science
of medicine, like the liver of Promethus, is sufficient to glut the eagles of
all time."

The object of this Association is to do something to advance the profes-
sion towards the far-distant goal of perfection to aid the solution of some
of the problems and enigmas of life and organization to add some material
to the growing temple, whose foundations were so firmly laid by the Coan
sage and to do its part, as best it may, in the cause of humanity. Nor do
I think, that so far, it has altogether failed. Many valuable contributions
to science have been elicited professional ambition has been stimulated
an esprit-de-corps has been successfully evoked and established. The
strength of the profession has acquired additional power by the union of
its members. This Association has been to physicians, what the railroad
and electric wires are to commerce, and the interchange of useful know-
ledge to States and nations. It has made' us one, and as I have just remarked,

1855.] Miscellaneous. 445

in unity there is power. This association has stimulated thought. Chaotic
and void, would forever remain the masses of facts, accumulated by the
observations of ages, but for the co-ordinating and logical power of reason.
It sits in judgment on the silent phenomena, as a "refiner of fire, and a
purifier of silver/' It forces the voiceless facts to mount the tripod of the
oracle, and speak forth words of wisdom. The scalpel, the crucible, the
microscope, may be subsidiary to its purposes and ends, but they cannot
supply its place. Fixed and patient thought in medicine, as in the other
departments of science, is the Aladdin's lamp that lights the footsteps of
the discoverer. To stimulate attention and thought, is to accelerate many
a new discovery to hasten the advent and establishment of important
principles yet in the womb of the future. May not our Association do this
more effectually than it has hitherto done \

Let all the contributions be read and attentively considered. Such a
course would certainly be more encouraging, as well as more respectful, to
their authors. Let the reports be deliberately and fully discussed, and let
them go forth to the world with the sanction or criticisms of the Associa-
tion. This would require time, it is true, but if we have time to meet at all,
surely a tew days would make but little difference. The good that would
be effected would yield a tenfold compensation for the time employd.
Every one must admit that three or four days is too short a time tor the
ciation rightly to fulfil its annual mission.
I would, moreover, respectfully suggest that time be taken for the discus-
sion of some of the leading topics of medical philosophy, j b these,
may be mentioned the nature, causes, and treatment of cholera, yellow
fever, et cetera hygiene, and the laws of health affecting masses of men
quarantine the causes of mortality among children the chemical and
vital doctrines of life. Questions like these, indicated a year in advance for
ion, would excite a carefulness of investigation, and a degree of at-
tention and thought which could not fail to clear away much of the dark-
ness and doubt in which they are yet shrouded. Nothing so sharpens the
intellectual powers as public debate. It fixes attention, and strains to the
utmost every faculty. I have no hesitation in saying that facts enough
have been accumulated to establish great and general principles, of which
the medical world is yet in ignorance or doubt. Nothing would contribute
more to demonstrate these principles than the collision of matured intel-
lects in public debate. What a mass of facts, and argument, and demon-
stration would be brought to bear, on any of the subjects alluded to, if some
of the best minds in the profession were to debate them, after a year's
preparation ! Observed facts are the crude materials of science the in-
tellect is the master builder of its august temple.

I make these suggestions for your consideration. All the scientific meet-
ings in this country and in Europe, employ more time than ours has hither-
to employed. Evidently we must protract our sessions, if we would render
them as serviceable to science as they may be. No member of the A
ation will be required to remain longer than suits his wishes or convenience.
Some fifty or sixty, more or less, would always be found to listen with
eagerness to scientific papers, and engage with pleasure in scientific discus-
sions.

The time has probably arrived, for a change in our plan of organization,
which will admit of the selection of a permanent place for the future
meetings of the Association. There are evident advantages incident to
both the migratory and stationary plans. These might, perhaps, be easily

4-16 Miscellaneous. [July?

reconsiled and secured. A proposition, if I mistake not, was made some
years ago, by the Smithsonian Institution, and I would respectfully suggest,
whether it would not be in accordance with the best interests of the Asso-
ciation, to hold biennial meetings in Washington, and the alternate ones,
as now, at different points of our common country. We might thus secure
all the advantages of a fixed abode, in the way of preserving the archives,
making collections, etc., whilst by meeting in various localities, we could
not fail to excite that wide-spread interest among the profession, and obtain
such accessions of new members as would greatly enhance the high and
useful objects of our Association. Should this proposal meet with your
approbation, I would further intimate that policy would perhaps require
the meetings of the Association at the National Capital, to be held in tne
years of the short sessions of Congress.

I shall say but little of the legislative duties of the Association. I shall
say nothing of the propriety or impropriety of getting laws passed to regu-
late the practice of medicine, and furnish standards for candidates for the
Doctorate. Perhaps the Association can do but little in this respect. Ours
is a popular government, and the people are disposed to allow the largest
freedom in everything pertaining to medicine, medical schools, and physi-
cians. Laws passed against quackery one year, are revoked the next. Our
country is the paradise of quacks. All good things have their attendant
evils, and this unbridled liberty is one of the evils of a popular govern-
ment. May we not hope, however, that even this evil may disappear, as
general education and the cultivation of the masses advance ? At any rate
the people are not yet disposed to put down the quacks, nor to require too
high a degree of qualification for those of the regular profession. After all,
laws can make only mediocre physicians. They can require the candi-
dates to know only so much to be qualified to a certain degree ; and this
degree will always be far lower than that to which the true lovers of
knowledge would attain, without any legislation on the subject. The
greater lights of the profession cannot be manufactured after any process
of legislative enactment. Thirst of knowledge, self-love, philanthropy,
burning ambition these make the great physician and surgeon. These
have made all the worthies of the past not legislation. Legislation can-
not drive the drone to the proud heights of professional eminence. When
these heights are reached, it will be seen that the successful aspirant has
been stimulated by a stronger power.

To him the laurel blossoms of renown and the life-giving mission of his
art, are dearer and more attractive than was the mystic bough of the sibyl,
to the eager iEneas, or, than the golden apples, guarded by sleepless drag-
ons, to the Hesperian daughters.

Whatever course you may think proper to pursue, I am sure that your
objects will be, the advancement of science the good of mankind the
honor and glory of the profession. We have the dignity and character of
a noble calling to sustain of a profession which has numbered, for two
thousand years and more, some of the wisest and best men in all countries
and all times. It is no trivial matter to sustain the rank and respectability
of a vocation which can boast of a Hippocrates, a Harvey, a Hunter, of the
most erudite and beneficent of sages and philanthropists the world ever
saw of a profession which has furnished to every nation its clarum et ven-
erabile nomen.

On the eve of the battle of the pyramids, Napoleon exclaimed, Soldiers !
from the height of yon monuments, forty centuries look down upon you.

1855.] Miscellaneous. 447

Gentlemen, from the heights of past ages, countless worthies of our God-
like profession point and beckon to a goal more elevated than that which
attracts legislators and conquerors, Solons and Caesars.

The Committee on Prize Essays reported through Dr. Rene La Roche.
The committee had received six essays in competition for the prize offered
by the Association. But, although these essays evinced much ability and
extensive learning, but one was decided to possess those qualities, which
deserved the award of the prize. It was entitled " Statistics of Placenta
Prjevta." The name of the author was announced as Dr. James D. Trask,
of White Plains, Westchester County, N. Y. Referred to Committee on
Publication.

Dr. Thos. Reyburn, chairman of Committee on Epidemics of Missouri,
Illinois, Iowa and Wisconsin, read an abstract of the report submitted, which
was, on motion, referred to the Committee on Publication.

At this stage of the proceedings, Dr. White, on behalf of the committee
to whom was referred the resolution and amendments respecting perma-
nent membership, submitted a report, recommending the adoption of the
following resolutions :

Resolved, That no permanent member who is not present at an annual
meeting of this Association, shall be required to pay the usual assessment ;
but no such permanent member shall be entitled to receive a copy of the
printed proceedings of the meeting, unless by paying a sum equal to that
assessed upon those who were present at such meeting ; and that all the
names of permanent members that have been left off the published list, be
re-inserted in the next volume of Transactions.

Resolved, That no assessment whatever shall be made against members
by invitation, but that they also be entitled to a copy of the printed Trans-
actions by paying the sum assessed upon delegates in attendance.

The Chairman of the Committee on Xominations recommended the fol-
lowing officers for the ensuing year :

President Geo. B. Wood, of Pennsylvania.

Vice-Presidents Wm. M. Boling, of Alabama ; Daniel Tilden, of Ohio ;
D. Humphrey Storer, of Massachusetts ; Grafton Tyler, of the District of
Columbia.

Secretaries Francis West, of Pennsylvania ; R. C. Foster, of Tennessee.
Treasurer Caspar Wister, of Pennsylvania.

Committee on Publications Francis G. Smith, of Pennsylvania, Chair-
man ; Francis West, of do.; R. C. Foster, of Tennessee ; Samuel L. Hol-
lingsworth, of Pennsylvania ; H. S. Askew, of Delaware ; Samuel Lewis, of
Pennsylvania.

The vote was taken on the motion of Dr. Palmer, " that the next meet-
ing be held at Detroit," and it was agreed to by a large majority. [Much
applause.]

Dr. Foster, the newly elected Secretary, tendered his resignation, which
was accepted.

Dr. Brodie, of Michigan, was nominated for the office, and elected by
acclamation.

Dr. Hunt, of Buffalo, read an abstract of his report on the Hygromet-
rical state of the Atmosphere in various localities, and its influence on
Health.

During the reading of this valuable pape^a motion was made and unani-
mously adopted, " that the desultory conversation of members be done
down stairs."

448 Miscellaneous. [July*

Dr. Hunt's report was accepted, and referred to the Committee on Pub-
lication.

At the request of Dr. Hamilton, we copy his report from the Buffalo
Medical Journal, as it is more complete.

" Dr. Frank H. Hamilton, of Buffalo, N. Y., then submitted a report on
" Deformities after Fractures." The report was not complete, the author
having only considered fractures of the ossa nasi, septum nasi, superior
maxilla, inferior maxilla and clavicle. Copious statistics accompanied each
fracture.

" Dr. Hamilton said he had a word to say which did not belong to the
report. Prosecutions for malpractice have become so frequent that sur-
geons were alarmed, and not a few were abandoning the profession, or
refusing altogether to undertake the treatment of grave surgical accidents,
and especially of fractures. So frequent were these prosecutions that mem-
bers were no longer surprised at such statements. If they had heard the
speaker say that lawyers were abandoning their profession from this cause,
they would have been startled, but to us the fact is familiar.

" It is proper for us, then, to interrogate ourselves. Why is it that we are
held to an accountability so much more strict than any other professional
men, or than any other artizans ? It is because there are jealous and de-
signing men in our own ranks who instigate these suits ? No doubt such
men may be found, but only as an exception. The fact is that surgeons
have sometimes been mulcted in damages simply because the jury believed,
from the united character of the medical testimony, that it was a con-
spiracy, and the more conclusive the testimony, the more certain, with
some jurors, is the defendant to suffer.

" Is it chargeable to the members of another profession to the lawyers ?
There may be some men in the profession of law, also, who, driven by the
sheer necessity of their circumstances by their extreme poverty, or who,
without any such apology, with only loose notions of right and wrong,
encourage and undertake such suits such are the men who hang about
the tombs in New York, and who may be found, more or less, in every
town but the speaker has reason to believe that honorable and intelligent
lawyers seldom countenance these prosecutions. That eminent jurist of the
State of New York, Joshua Spencer, has told Dr. Hamilton, that for him-
self he does not think he ever commenced a suit of this character, although
he has been frequently retained as counsel, and he believes his brethren,
generally, look upon these complaints with suspicion and refuse to meddle
with them.

" Where, then, must we look for an answer to the question, Why are
these prosecutions against surgeons so frequent ? Let the gentlemen be
assured, the causes are to be found in the very imperfections of our art, and
in our own unwillingness to admit these imperfections. Surgeons have
claimed too much, and it cannot certainly be expected that the world will
demand of them less than they claim for themselves. Again and again
surgeons have said that a fracture of the femur might be generally made
to unite without any shortening, while the fact is not so. Malgaigne, who
is eminently an honest man, says, to make this bone unite in an adult per-
son, where the fracture is sufficiently oblique to prevent the ends from sup-
porting each other, is " simply impossible " (simplement impossible.)

" Let the profession be wiser in future and acknowledge that they cannot
perform impossibilities."

1855.] Miscellaneous. 449-'

The abstract and remarks of Dr. Hamilton excited great interest ; on
motion the report was accepted and referred to the Publishing Committee

Dr. Chas. Hooker, of New Haven, read an abstract of his report on " Diet
for the Sick," which lays down laws for the goverment of diet under
various diseases, and specifies the particular articles which may be given
with benefit.

Dr. Watson offered a resolution providing for the appropriation of $1,000
to pay for the stone for the Washington Monument, which was adopted.

The Secretary read a special report from Dr. Wm. H. Bvford, of Evans--
ville, Indiana, upon the Pathology and Treatment of Scrofula. This paper
gives an account of the nature of the disease, its varieties, causes, effects,
and treatment. Referred to the Committee on Publications.

Dr. N. S. Davis, of Chicago, presented a report on the M Nutritive Quali-
ties of Milk, and the influence produced thereon by Pregnancy and Men-
struation in the Human Female, and by Pregnancy in the Cow; and also
on the question whether there is not some mode by which the nutritive
constituents of milk can be preserved in their purity and sweetness, and
furnished to the inhabitants of cities in such quantities as to supersede the
present defective and often unwholesome modes of supply." The report
says, that when railroads were opened into the interior of the country, it
was said that milk would be furnished to residents of cities in the purity
that it was found on farms; but a sufficient time had elapsed to demon-
strate that such is not the case. The conveyance of the milk from the
farm to the cars, the transit on railway, and the time lost in its delivery
throughout the city, it was clearly shown, had the effect of making it unfit
for the nourishment of a child. During the past half century experiments
had been made with a view of preserving milk in its pure state, yet it was
but recently that a discovery had been made by a gentleman in New York,
which was to evaporate the water, and mix with white sugar, which ren-
dered it what is termed, solidified milk. In his practice he had used this
improved milk for the nourishment of infants with the most gratifying re-
sults, and after having kept it for three months ; and he knew of its having
been kept twelve months without any injury to its qualities.

Dr. Isaac Hays, from the Committee of Arrangements, announced, that
520 delegates were now enrolled.

Dr. Condie, of this city, submitted a voluminous report upon the subject
of Tubercular Disease, accompanied by a vast array of facts, the gathering
of about three years. He stated that the report would make at least 500
printed pages. The opinions advanced, he said, were "very heterodox."

[circular.]
To any Medical Gentleman of the United States or Canada.

Dear Sir : The Committee appointed at the last meeting of the Ameri-
can Medical Association to investigate certain Statistics of Hydrophobia,
bearing upon municipal regulations, have received but six communications
detailing only sixteen cases of Hydrophobia, (some of which, however, are
exceedingly interesting, and for which the Committee desire to make grate-
ful acknowledgments to the gentlemen forwarding them.) Under these
circumstances, the Committee are unwilling to do more at this time than
to report progress and ask to be continued.

The object we have in view is not to enlighten the profession upon the
subject, but to bring the knowledge already in possession of medical men
to bear upon the public mind, and influence our civil authorities in their
municipal regulations regarding Hydrophobia. We believe that facts en-

450 Miscellaneous. [Jul}",

tirely militate against restricting " Dog Laws " to hot weather ; and we
think the advancement of science demands that this remnant of by-gone
superstition should be purged from the statute-book. In Prussia, Poland,
France, Russia, and many other countries in Europe, much attention has
been given to this subject, and it is important in accomplishing our object,
that we should ascertain, as far as practicable, how Hydrophobic Statistics
in our extended country will compare with those in foreign countries, and
may we not hope that, through the facilities afforded by the extensive
ramifications of our cherished Association, the necessary statistics for the
United States and Canada may be obtained ?

The Committee are unwilling to think that want of interest in a subject
so important is the cause of their receiving so few communications, but
rather that the knowledge of what wras wanted was too circumscribed, if
not too indefinite, and the time necessary to obtain it entirely too limited.

In a measure to remove these objections, the Committee have prepared
this Circular, and would respectfully invite communications upon the sub-
ject from Medical gentlemen in any part of the United States or Canada,
who, either in their own practice, or as counsellors in that of others, may
have witnessed cases of hydrophobia in man or brute stating the day and
month of inoculation the period of attack the duration of the disease
and, if in the human species, the name, age, temperament, sex, and residence
of the individual.

The Committee would also request you to state whether in the place of
your residence any " Dog Laws " have been enacted ; if so, to what period
of the year, if any, they are restricted ; and wmat has been the result of
their operation.

An early reply to this circular will enable the Committee to arrange the
facts and prepare a report for the meeting of the Association in 1856.
We remain, &c, Thos. W. Blatchpord, ) n ...

A. D. Spoor, \ Cmttee'

Troy, 2Uh April, 1855.

Communications to be addressed to Dr. Thos. W. Blatchford, Troy, N. Y,

P. S. If the Medical journals and newspapers throughout this country
would call the attention of their readers to this subject, either by publish-
ing this circular or otherwise, it would greatly facilitate the object the
Committee have in charge.

Dr. Mussey, of Ohio, read an interesting report upon the Use of Alcohol
in Health and Disease. It abounded in facts illustrating the effects of
alcohol upon the human system, and evinced extensive reading, and a
laborious collation of medical testimony. Referred to the Committee on
Publications.

A letter was read from Dr. R. J. Breckenridge, of Ky., chairman of
Committee on Medical Literature, announcing that his report was ready,
but that he wras not able to present it himself, and asking its reference to
the Committee on Publications.

A communication was read from Dr. W. H. Anderson, of Mobile, chair-
man of Committee on Medical Education, setting forth that his duties re-
quiring an extensive foreign and domestic correspondence, his report was
incomplete, but would be ready in season for publication in the Transac-
tions.

Dr. Hays stated that the whole number of names registered now, amount-
ed to 523.

The Committee appointed at St. Louis, to whom had been referred the

1855.] Miscellaneous. 451

paper of Dr. Phelps, entitled u Religion an Element of Medicine, or the
duties and obligations of the Profession," reported, through Dr. J. L. Atlee.
who moved that it is inexpedient to publish Dr. IVs paper in connection
with the transactions of the Asso<iation.

Dr. A. J. Scnnnes, of Washington, District Columbia, offered the follow-
ing which was adopted:

Resolved. That a committee of three be appointed to report to the As-
sociation, at its next annual meeting, what measures should be adopted to
remedy the evils existing in the present methods of holding coroners' in-
quests by incompetent persons, by which the lives and liberties of the
innocent may be jeopardized, and the ends of justice frustrated.

Dr. Sonnies, of Washington, Dr. Hyle, of Wilmington, and Dr. Condie,.
of Philadelphia, were appointed.

Dr. Alfred Stille offered the following' resolutions :

Resolved, That a Special Committee of rive be appointed to report at the
next meeting of the Association on the following question : Might not the-
present system of repeating the same lectures to the same classes, during
two successive terms, be usefully modified by extending the lectures of
each chair over two sessions, so as to embrace a systematic and complete-
discussion of each of the following subjects:

1. Special. Regional, and General Anatomy, including illustrative refer-
ences to Morbid Anatomy.

2. Inorganic, Organic, and Pharmaceutical Chemistry, and Toxicology.

3. General and Human Physiology ; Hygiene : Medical Jurisprudence.

4. Medical Botany ; Materia Medics j General Therapeuties.

5. General Pathology ; Morbid Anatomy (Systematic) ; Practice of
Medicine.

6. General Surgical Pathology, or Institutes of Surgery ; Mechanical,
Operative, and Medicinal Surgery.

7. Obstretrics: Diseases of Women ; Diseases of Children.

8. Hospital Clinical Medicine and Surgery.

Resolved, That the Committee, at an early day, address bhe several
Medical Colleges, in regard to the proposed plan of instruction, requesting
from them an official expression of opinion upon its merits and feasibility.

The Chair appointed the following gentlemen as the Committee, to whom
the subject is referred :

Dr. Alfred Stille. of Philadelphia, Chairman, Prof. Samuel Jackson,
Philadelphia, Dr. John Bell, Philadelphia. Dr. John Watson, Xew York,
Dr. J. L. Cabell, Charlottsville, Ya.

Dr. Corson, of New York, read a volunteer report on the Influence of
Lead on the Heart, which was referred to a special committee of three for
examination.

Special Committees. Dr. Lewis H. Steiner, of Washington, D. C, on
Strychnia its chemical and toxicological properties.

Dr. Ashbury Evans, of Covington, Ky., on Tracheotomy in Epilepsy.

Dr. J. Taylor Bradford, of Augusta, Ky.. on the Treatment of Cholera.

Dr. Chas. Q. Chandler, of Roeheport. Mo., on Malignant Periodic Fevers.

Dr. H. A. Johnson, of Chicago, Illinois, on the Excretions as an index to
the Organic Changes in the System.

Dr. Henry J. Bigelow, of Boston, Mass., on Microscopical Investigation
of Malignant Tumors.

Dr. E. H. Davis, of New York, on the Statistics of Calculous Diseases,
and the operations therefor.

452 Miscellaneous.

Dr. J. S. Carpenter, on the Treatment and Curability of Reducible Her-
nia.

Dr. A. J. Fuller, of Maine, on the Best Treatment of Cholera Infantum.

Dr. William B. Page, of Philadelphia, on Injuries of the Joints.

Dr. Wilson Jewell, of Philadelphia, on the Statistics of Mortality in the
United States.

Dr. J. Knight, of New Haven, Conn., on Endemic Fevers.

Dr. P. H. Cabell, of Ala., on the Native Substitutes for Cinchona, indi-
genous to the Southern States.

Dr. James M. Newman, of Buffalo, N. Y., on the Sanitary Police of
Cities.

Dr. L. M. Noble, of Le Roy, 111., on Puerperal Fever and its Communi-
cability.

Dr. J. M. Freer, of Chicago, 111., on the Progress of General and Descrip-
tive Anatomy.

Dr. J. W. Corson, of New York, on the Causes of the Impulse of the
Heart, and the Agencies which influence it in Health and Disease.

Dr. D. Meredith Reese, of New York, on the Causes of Infant Mortality
in large Cities, the Source of its increase, and the Means for its Diminution.

Dr. Mark Stephenson, of Vermont, on the Treatment best adapted to
each Variety of Cataract, with the Method of Operation, Place of Election,
Time, Age, &c.

Dr. J. B. Coleman, of New Jersey, on the Effect of Mercury on the
Living Animal Tissues.

Dr. T. G. Richardson, of Louisville, Ky., on the Diversity of the Vene-
real Poison.

Dr. J. B, Flint, of Louisville, Ky., on the best mode of rendering the
medical patronage of the National Government tributary to the honor and
improvement of the Profession.

Dr. M. M. Latta, of Goshen, Indiana, on whether there are any means
by which the growth of the Foetus in Utero may be controlled without
injury to mother or child.

Dr. Thos. Miller, of Washington, D. C, on Toxicology.

Dr. E. R. Peaslee, of Hanover, N. H., on Inflammation, its Pathology,
and its relation to the Reparative Process.

Dr. D. D. Thompson, of Louisville, Ky., on the Remedial Effects of
Chloroform.

Dr. Wm, Clendennin, of Cincinnati, Ohio, on Epidemic Erysipelas.

Dr. C. G. Comegys, of Cincinati, Ohio, on the State of the Urine in
Tubercular Disease.

Stomachic Pill. The following is the prescription for an excellent din-
ner pill. We copy it from the Pharmacopoeia of Guy's Hospital :

Take of powdered capsicum, 3i.; powdered rhubarb, 3ij. Make into a
mass with treacle, and divide into sixty pills. Two or three to be taken
every day before dinner. [Medical Examiner.

Lotion of the Chlorate of Potash. In the Middlesex Hospital, Mr. Moore,
and also several of his colleagues at his suggestion, have been largely using
a lotion of the chlorate of potash as a dressing for unhealthy sores. It is
considered to have been very successful. The strength has been from two
to three drachms to the pint of water. It has been freely applied on lint.

[Med. Times and Gazette.

SOUTHERN

MEDICAL AND SUBGICAL JOURNAL.

Vol. XL] SEW SERIES. AUGUST, 1S55. [No. 8.

ORIGINAL AND ECLECTIC.

ARTICLE XXI.

Notes on the Epidemic Fever of 1854. By P. M. Kollock, M. D.,
Professor of Obstetrics in " the Savannah Medical College."

Savannah, August 11th, 1854.

The weather during the last month (July) has been intensely
hot I have never suffered so much from heat in my life ; the ther-
mometer, in the shade, rose repeatedly to 94 in my library, where,
in ordinary seasons, it has rarely attained a more elevated point
than 86. During this time we have had very little rain.

Within the last week or ten days there have been cases of coup
de soleiL and we now have cases of fever, terminating in black dis-
charges from the stomach, of a " coffee ground " character.

Up to this time (Aug. 11), some six cases have occurred four of
these in the " Savannah Poor House and Hospital." One case oc-
curred in the female ward, (of which I have charge.) in a young
Irish girl, who came in with fever, for which she was treated with
calomel and quinine, having been purged previous to her entrance.
She complained of headache and thirst ; no tenderness of epigastri-
um ; skin diy ; pulse frequent ; tongue slightly furred. Five or six
grains of quinine (which had been administered on her entrance)
were repeated, combined with two grains of calomel, in twelve
hours. In eighteen hours after, she discharged fc coffee ground "
matter from her stomach, and died before I saw her again. No
autopsy.

Aug. 11. I visited Mr. R ; German; music teacher: has

resided in Savannah for several years ; age years ; married ;

n. s. VOL. XI. NO. VIII. 29

454 "* Kollock, on the Epidemic Fever of 1854. [August,

temperate in his habits ; short in stature, and thin ; dark hair and
black eyes. Has been going about a good deal on foot during the
late hot weather, giving music lessons is generally protected by
an umbrella. His attack commenced with headache and febrile
symptoms to-day. I found him with a hot, but not very dry, skin ;
tongue moist and clean ; pulse frequent and pretty full ; head hot
and painful ; conjunctiva of both eyes very much injected. The
bowels have been opened to-day, and the abdomen free from disten-
sion; slight malaise at epigastrium. $. V. S. until the pulse is
influenced succeeded by vomiting of his dinner. Vomiting pro-
moted by draughts of warm water ; to be followed by administration
of sulph. quinine, calomel aa grs. 6, iced toast water and cold appli-
cations to head.

Aug. 12. Has passed rather a restless night ; head still painful ;
eyes injected ; skin in same condition ; tongue a little furred ; pulse
as before. $. Quinine, gr. 5, calomel gr. 2, toast water and cold
applications to head bowels moved ; stomach quiet.

1 o'clock, P. M. Less fever and headache. Kepeat calomel and
quinine.

Evening. Complains of uneasiness in the bowels, and deafness
from quinine. ty. Enema of flaxseed infus., sinapism to bowels,
#. Sulph. morph., gr. , if restless.

Aug. 13. 7-j- o'clock A. M. Has slept from effects of morphine.
Skin natural ; pulse reduced ; tongue moist and furred ; head easy ;
eyes less injected; bowels moved several times; stools bilious; ab-
domen tympanitic, and pain in descending colon, ty. Flaxseed
enema, which had been omitted ; cold to head ; arrow-root and gum
water. Calomel, gr. j., quinine, gr. 2ss.

1 o'clock P. M. Exacerbation ; head painful ; skin hotter and
more dry; thirst increased ; restlessness; much heat about head and
back of neck; pain at umbilicus; bowels repeatedly moved.

h\ o'clock P. M. Symptoms same. R. Flaxseed enema.

9 o'clock P. M. Same condition. Head hot ; abdominal un-
easiness. #. Scarified cups to nucha. The injection (which had
been neglected) to be given, and if not followed by relief to abdom-
inal uneasiness, a dessert spoonful of castor oil.

Aug 14. Has spent a pretty quiet night. Head still too hot ;.
very much disposed to sleep. Continue cold applications and nour-
ishment.

Evening. No change. $. Epispast. to nucha; mass. ex. hyd.,
gr. 2 ; op. gr. T\, every two hours.

1855.] Kollock, on the Epidemic Fever of 1854. 455

10 o'clock P. M. Improvement. Skin cool and moist ; head cool
and easy; tongue moist; bowels easy blister not perfectly filled,
having been removed too soon. ^. Fer. cyan, quinine, gr. 2, every
two hours. Dress blister with basilicon. Discontinue blue mass.

Aug. 16. Convalescent.

Dr. J. B. Kead, who has been hard at work for a week or two
among fever cases, was attacked himself yesterday (Aug. 15) pretty
severely. On visiting him, I found him with hot, but moist skin,
headache, eyes injected, pulse 120; some uneasiness at praecordia;
pains in his limbs. #. V.S. 5x. Calomel, gr. 10; sulph quinine,
gr. 6.

Saw him again in three or four hours. Very restless ; complains
of increased uneasiness at praecordia. $ . Sinapism to epigastrium ;
ol. ricin. I ss. ; gum water.

Aug. 16, 7 o'clock A. M. Has spent a restless night. Oil has
operated several times; relieved of pain in a great measure; skin
cool and relaxed ; tongue moist and pretty clean still some pain
in the eyes, which are less injected with blood. $. Sulph. quinine,
gr. 5 ; calomel, gr. 2, every three or four hours.

12 o'clock M. Improving. Has taken two powders. $. Con-
tinue.

5 o'clock P. M. Condition same. Complains of uneasiness and
flatulence in bowels. ^. Enema Lini, and continue powders.

Aug. 17. No fever; bowels uneasy. $. 01. ricini. 5ss.

Evening. Oil has operated ; bowels relieved, ty. Quinine, gr. 3.

Aug. 18. Convalescent.

Mr. D. V., aged about 50 years ; married; keeps a clothing store,
to which he is much confined was attacked Aug. 12, after having
been more than usual exposed to the sun. Symptoms: headache,
nausea, hot and dry skin ; pulse rather frequent, but not very full ;
tongue furred, but moist,

I was called to see him in consequence of the absence of his family
physician, to whom I resigned the case, on his return. He was treated
with calomel, quinine and opium, together wTith saline cathartics.

I visited him again, in consultation, on the 15th. His condition
then was as follows: Skin of natural temperature, and relaxed;
pulse 44 in the minute ; tongue furred, and rather dry at the tip ;
head hot ; eyes injected, pupils contracted ; respiration sighing ;
stomach very irritable had been blistered on stomach and legs ;
abdomen soft; no great thirst. $. Cups to nucha; calomel, gr. 2,
every two hours ; ice to head; iced acidulated gum water for drink.

456 Kollock, on the Epidemic Fever of 1854. Augustr

Evening. Much the same. ~fy. Leeches to mastoid processes.
Continue medicine.

Aug. 16. No improvement. $. Wine whey, alternated during
the day with brandy milk toddy, arrow-root and brandy, chicken
water, beef tea most of which were vomited. Flaxseed enemata
brought away dark stools (effects of calomel).

Aug. 17, 7 o'clock A. M. Head cooler, mind more clear; pulse
same ; has retained some brandy and water.

Evening. During the day the irritability of stomach has con-
tinued. Calomel has been suspended, and Cayenne pepper infusion
substituted. This evening he has thrown up dark flocculent mat-
ter, which subsides and adheres with mucus to the bottom of the
vessel. The bilious suffusion of the eyes and skin which has been
present, is increased in intensity stools clay colored. $. Calomel
gr. j., quinine gr. 3, pip. Cayenne gr. 2, in pill, at intervals.

10 o'clock P. M. Has not retained the pill, which accordingly is
discontinued.

Aug. 18. Condition much the same: skin and eyes becoming
more suffused; total suppression of urine. No bile passing from
bowels. All attempts to introduce articles into the stomach aban-
doned. Discharges from stomach small in quantity, but dark and
flocculent : they are brought up by vomiting and retching not
gulped up, as is usual in Yellow fever.

Evening. Stomach a little more quiet; other symptoms the
same. ty. Burnt brandy, 1 table spoonful ; spt. ammon. arom., gtt.
10 ever}7 hour.

Aug. 19. Has retained the remedies, and vomited only once or
twice during the night, ty. Mass ex. hyd. gr. 3, ext. hyos. gr. j-,
every two hours.

Evening. Has retained the pills, and taken five ; pulse 80 ; jaun-
dice increasing; abdomen tympanitic. 3. OL ricini. 3j^ every
hour, with burnt brandy and spt. ammon.

Aug. 20. Death occurred this morning at 6^ o'clock, in great
agony.

Capt. Odson, German ; has been very much exposed to the sun,
on a small sloop. I visited him for the first time August 15th.
Symptoms : Great heat of skin, but some moisture; head painful;
eyes injected ; face very red; pulse full and frequent ; tongue some-
what furred has taken no medicine. $. V.S. Calomel gr. 10,
sulph. quinine gr. 6. M. Ice to head ; iced acidulated gum water.

Aug. 16. Great improvement : head much easier ; medicine has

1855.] Kolloce, an the Epidemic Fever of 1854. 457

acted on the bowels. $. Quinine gr. 5, calomel gr. 2. M. Eve-
three or four hour?.

Evening. Continues to improve has taken two powders. $,
Continue.

Aug. 17. Not so well ; restlessness and thirst during the night;
uneasiness in bowels, and pain in head. $. 01. ricini. ss.

Evening. Feels better ; cathartic has acted twice. Skin moist ;
pulse natural ; tongue prettv clean ; head rather hot. Repeat the
oil.

Aug. 18. Remission. B-. Sulph. quinine; calomel aa gr. 10;
pulv. g. opii. gr. {. M. acidulated gum water.

Evening. Has been very drowsy all day : pulse natural, skin
moist, head hot and painful. $. Epispast. to nucha ; ice to head.

Aug. 19. Has passed a restless night : complains of feeling un-
well and weak ; head cooler ; pulse and skin natural ; tongue pretty
clean at tip, some fur in middle. ^. 01. ricini. Iss. ; gruel.

Evening. Skin, pulse and tongue in same condition ; two stools
from oil ; vomited once after taking gruel. Head still rather hot:
three leeches to each temple.

Aug. 20. Skin moist and natural ; pulse good ; tongue same as
before ; head cool but complains of feeling badly skin and con-
junctiva more jaundiced ; great languor of capillary circulation on
surface ; has had bilious stools from operation of oil ; complains of
burning sensation in throat ; tenderness of epigastrium, ty. Epis-
past. to epigast. Calomel gr. 2, opii. gr. J, every two hours.

Evening. Much the same very drowsy blister has drawn.
$. Blisters to legs ; continue powders; arrow-root .

Aug. 21. Threw up black matter this morning early, and died
shortly after.

The improvement in the symptoms of the case on the dav pre-
ceding death is quite characteristic of this disease.

I was called to Mr. J. R. J., on Thursday, Aug. 17 : he had been
attacked with fever on the evening previous had taken blue mass,
which acted on the bowels. I found him in a remission, with" cool
and moist skin, complaining of a sense of chilliness when the air
blew on him had dressed himself, and was moving about from one
room to the other. I ordered him to bed, and to take 5 grains of
quinine.

After taking several doses of quinine, I was disposed to consider
his disease at an end. Being a native of Savannah, and prettv
thoroughly acclimated, I felt no uneasiness in regard to the result of

458 Kollock, on the Epidemic Fever of 1854. August,

this case. I was much surprised, therefore, to find him on Sunday
(20th) with a hot and dry skin, full and frequent pulse. I accord-
ingly bled him pretty freely from the arm gave him blue mass and
quinine as long as his stomach would bear it which at length be-
came irritated, rendering it necessary to apply a blister to the
epigastrium, and to confine him to gum water and ice.

The stomach at length became quiet ; but a most intense jaundice
set in, which caused me great uneasiness, and I feared that it was
the precursor of " vomito prieto."

Aug. 25. Up to this time, black vomit has not made its appear-
ance; the stomach is quiet, and bears chicken water and arrow-root ;
passes urine freely, but it is loaded with bile ; bowels constipated ;
pulse about 80 ; skin cool and relaxed ; tongue clean; thirst great ;
bilious suffusion of conjunctiva and skin intense. A stimulating
injection brought away a large foecal and bilious stool. He took
blue mass, gr. 10, yesterday, and has had his right hypochondrium
and thighs rubbed for two days with ung. hydrarg. Has enjoyed
effervescing cit. sod. attenuated with chicken water.

Aug. 28. Still very much jaundiced ; but his urine is less bil-
ious, and a stool produced by stimulating enema is large, fecal and
bilious; bowels very torpid ; thirst great; tongue clean ; skin moist ;
pulse increased in frequency.

Aug. 31. For a day or two has exhibited unpleasant symptoms ;
morbid vigilance at night, with delirium ; skin moist ; pulse slow
and sometimes interrupted ; tongue a little furred. Ext. hyosciam.
failed to quiet him, and it became necessary to administer \ grain
of morphia.

To-day (31st) has been pretty liberally plied with porter and beef
tea, and he is more quiet this evening. He takes infus. pum. virg.
and ext. tarax. To night I ordered for him mass. ex. hyd. gr. 5,
ext. hyos. gr. 6. M. Beef tea and porter.

Sept. 1. Bad night: very delirious ; not quieted by pill; fever
during night, ty. Enema, stimulating; \ wine-glassful of infus.
serpentar., and porter, alternately, every heur, with 1 gr. quinine in
each ; beef tea.

Sept. 2. Has been more quiet, sleeping at intervals stomach
revolts at snake-root and quinine : continue beef tea and porter, and
ext. tarax. Complexion clearer, but urine still bilious.

Sept. 3. Not so well : mind more wandering ; much heat of sur-
face.

Evening. Symptoms same. Consultation called. Nit. mur.

1855.] KoLLOCK, on the Epidemic Fever of 1854. 459

acid, internally and externally, recommended. Emp. g. ammoniac,
cum. hydrarg. applied to-night to hypochondrium.

Sept. 5. Death occurred this morning about 6 o'clock.

Jaundice is not an unusual termination of the graver cases of this
epidemic, and when unaccompanied with black vomit, is followed
by recovery. In the case just detailed, as the Jeteric symptoms
began to yield, Typhoid fever was set up, which destroyed the pa-
tient.

The characteristics of this epidemic are a cold stage, followed by
a hot, attended with hot skin (which, however, is very frequently
moist) ; headache ; injection of small vessels of conjunctiva with
blood; bilious suffusion of conjunctiva in cases tending to the ma-
lignant type ; pulse frequent, sometimes full and hard; tongue clean ;
intense pains in back and limbs (like those of Dengue) ; stomach
very frequently irritable, and bowels constipated ; urine suppressed,
partiaily in last stage, totally; stools, in last stage, clay colored.

The confirmed cases of the malignant type have generally ter-
minated fatally, under all kinds of treatment.

When called to a patient with considerable rigour, a full and
chorded pulse, I have generally commenced the treatment with vs.,
followed by calomel and sulph. quinine, aa. gr. 10, or 10 and 5, in
3 hours after, ol. ricin. 3ss, or li. ; iced gum water, toast water, or
acidulated flaxseed infusion.

In some of the first cases I saw, I continued calomel and quinine,
in small doses, gr. 2 and 5, repeated at intervals. From its failure in
late cases, I have not been so much inclined to continue the mercu-
rial, but after giving as much quinine as seems proper, if the case
shows a decided tendency to the yellow fever type, particularlv if
the stomach is irritable, I blister epigastrium and extremities and
content myself with the administration of mucilaginous, iced acidu-
lated drinks; efferveseing cit. sod., &c. injections, demulcent or
stimulating, as may be requisite, sometimes sulph. or acet. morph.
alone are combined with quinine.

Black Vomit, now, as in former years, must be regarded as the
fatal symptom. It is brought up in small quantity, brown, floccu-
lent, like particles of the wings of an insect, settling down in a paste
mixed with mucus at and adherent to the bottom of the vessel into
which it is discharged. When the discharge is profuse, it is thin
and watery like coffee grounds. This last is thrown up with ease;
the former, with much retching. Black Vomit occurs from the 5th
to the 9th day, according to my observation. When about to occur,

460 Kollock, on the Epidemic Fever of 1854. [August,

and during its continuance, the pulse becomes either natural in
strength and frequency, or reduced below the natural standard.
The skin is natural as to temperature and moisture frequently the
patient expresses himself as feeling very comfortable, but sometimes
becomes more restless and uneasy.

I have not found any remedy or course of treatment to be de-
pended upon in this stage. In some rare cases of recovery, the
remedies which have been used, and seem to have been of service,
have failed when tried in others. Brandy, creosote, infus. cayenne,
acet. plumb, and op. have all failed in my hands. There have been
two cases of recovery after black vomit in " Savannah Poor House
and Hospital," under the use of croton oil a drop being placed
upon the tongue produced hypercatharsis and cessation of vomiting.

August 25. I have under treatment an Irish woman, who had
been ill for 5 days, and been actively purged with calomel and jal-
ap. I was called to her in consequence of her having thrown up
a small quantity of dark brown specks, resembling fragments of in-
sects' wings. I blistered her stomach and extremities, and gave her
iced gum water. After blistering, although the stomach continued
irritable, I determined to test the powers of quinine as asserted by
some, Bj. of the sulphate was administered, and repeated in 4 or 5
hours. After the second dose, the vomiting ceased in a great meas-
ure ; but as some irritability remained, effervescing cit. soda, and
10 grs. more of quinine were given. This last dose was succeeded
by great uneasiness, vomiting, deafness, and flushed face. The
pulse became very much lowered, tongue remained clean and moist.
Ice was applied to head ; stimulating enema and soda continued.
She became comatose, and died in a few hours. The cerebral
symptoms I attributed to the quinine.

Beside the decided cases of yellow fever (which very generally
terminate fatally,) there are numerous milder cases of remittent
fever prevailing at this time (August 25 to 28,) and from the com-
mencement of the epidemic, which yield very readily to ordinary
mild treatment, and many cases would doubtless do well without
medicine.

I generally bleed where it seems to be indicated, and where the
skin and tongue are moist, give calomel and quinine in combina-
tion, notwithstanding the presence of considerable cephalalgia.

These are the cases, which the disciples of Hannemann on the one
hand, and the believers in the powers of tr. mur. ferri. on the other,
vaunt as cures of Yellow fever.

1855.] Kollock, on the Epidemic Fever o/1854. 461

It is a great time for humbugging unsophisticated people are
made to believe that they are cured by infinitessimals, while they
are swallowing heroic doses of quinine, and are well roasted with
sinapisms.

August 31. The epidemic continues to advance westward (hav-
ing commenced in the extreme eastern limits of the city.) I think
the hot stage is becoming more protracted, and shows a greater
tendency to return after remission. In a large number of instances
this has not been the case.

I have seen within a day or two, more bilious and furred tongues
which I consider favorable. The bowels are not so irritable as in
the epidemics of former years. Patients bear purging with one or
two teaspoonsful of castor oil. Where the epigastrium is tender and
the stomach irritable leeching proves beneficial although in the
malignant cases, the hemorrhage from the bites is apt to be exces-
sive and difficult to control.

The irritability of stomach before the appearance of black vomit
is frequently allayed by infus. capsici. I think this remedy indi-
cated after disappearance of fever, when the pulse sinks below natu-
ral standard, in force and frequency where there is restlessness,
sighing and epigastric malaise, or where there is no definite sense
of pain. Accompanying such symptoms, the conjunctiva may be-
come tinged yellow, and the countenance bronzed or, on the con-
trary, the eyes and skin may remain perfectly clear and natural.

A very fine looking Irish girl died in the hospital this week the
approach of the mortal stage being alone indicated by the slow de-
pressed pulse, and sighing respiration.

Sept. 2. The welkin is at present ringing with the praises of the
wonderful powers of tr. mur. ferri. in the cure of Yellow fever. One
physician informs the public, through the newspapers, that he has
cured, in a short time, 150 cases with this remedy alone and re-
commends the citizens to take it in anticipation, as a prophylactic.
He says that it medicates the blood, acts as an astringent on the
blood vessels of the stomach, and prevents their pouring out black
vomit another calls it " a refrigerant diaphoretic/' I am assailed
on all sides with the questions, " have you tried it ?" '* why don't
you try it ?"

A trial was made with it by Dr. Bulloch, in the Savannah Poor
House and Hospital, some weeks since, and it was abandoned as of
no service. But to be able to give a satisfactory answer to my
querists, I have determined to give it a fair trial, and accordingly

462 Kollock, on the Epidemic Fever of 1854. [August,

have put some nine or ten cases on the use of it, in different stages
of the disease.

Sept. 3. The immediate effects of the treatment seem favorable:
inflammatory symptoms, instead of being aggravated, appear to be
alleviated ; the dry, hot skin, cephalalgia, thirst, excited pulse, have
all subsided. I begin to think, that either the remedy possesses
qualities which I had never attributed to it, or that there is
this peculiarity in the epidemic disease with which we are con-
tending.

I have found cases within a few days with more protracted par-
oxysms, and it is remarked by physicians that the cases are more
manageable.

Sept. 5. A very few hours have served to prove the fallacy of
appearances in favor of tr. mur. ferri. Its irritating effects on the
stomach have been manifested in every case in which I used it.

Timothy Murphy, (Irish laborer,) middle aged, attacked with
fever Sept. 2d. I found him in bed had just vomited the contents
of his stomach, consisting of his last meal.

Symptoms : Skin hot, but moist ; headache ; eyes injected ; pulse
frequent, not remarkably full, and compressible; tongue pretty clean;
bowels relaxed. Has taken no medicine. $. Tr. mur. ferri. gtt.
25, ever two hours, in a tablespoonful of water. His symptoms im-
proved rapidly, and by the third day he was free from all febrile
appearances ; but he complained of uneasy sensations in the abdo-
men, for which he took some castor oil.

Mrs. F., who had been treated in the ordinary way for fever, and
was nearly cured, I put upon the use of tr. mur. ferri. She took
two doses, each 20 drops : this was followed by such intense heat
and burning in the bowels, that she became alarmed and would take
no more. These sensations continued to annoy her for several days
after the abandonment of the medicine.

N. C. Hopkinson, engineer on the Central Rail Road, native of
New York, has spent several summers in Savannah. He has had
repeated light attacks of fever during this summer while in pursuit
of his business, for which he took quinine without lying up. Pre-
vious to my seeing him, he had taken some cathartic pills, and find-
ing him in a remission, I advised him to take five grains of quinine.
His skin was hot, but moist, pulse frequent, but not very full and
soft ; tongue not much furred ; headache, eyes injected.

In about twelve hours took five grains more of quinine. I then
commenced with tr. mur. ferri gtt. 25, every two hours. He took .

1855.] Kollock, on the Epidemic Fever of 1854. 463

the medicine one day and night, at the end of which time I remark
as follows : Has passed a restless night ; skin dry, not very hot :
pulse 80, having been previously 100; eyes injected; head hot and
uneasy ; abdomen tender ; tongue furred. Has been very much
purged during the night ; stools very thin and blackened by the
iron; thirst excessive. $. Stop the medicine. 12 leeches to
abdomen ; ice to head ; blister to epigastrium ; flaxseed enema ;
gum water for drink.

Evening. Leeches have bled very freely ; necessary to apply
creosote to arrest hemorrhage. Head cooler ; eyes less injected ;
skin cool and moist; purging continues; respiration sighing.

On the morning of the 5th September, I was called up to him,
and found him discharging " black vomit." 3. Strong infusion
capsi. 5 ss. every hour; powerful and continued revulsion to extremi-
ties by sinapisms. In two hours the vomiting ceased, and there
was more action on the surface. The capsicum and ice were con
tinued through the day. In the evening he vomited more black
matter, began to sink rapidly and mind to wander. $. Camphor
juleps and wine freely. He died on the morning of the 6th. If the
black vomiting in this case, was not caused entirely by the use of
tr. mur. ferri., I have very little doubt of its contributing to the
more speedy appearance of that symptom.

Sept. 5. I was desired to prescribe for the child of Mr. H., a
cab-driver. Age of the child 8 or 10 years. It had been subject
to fever for some time ; enlarged spleen and was anaemic. A re-
mission occurring, I prescribed sulph. quinine gr. j , tr. mur. fer. gtt.
3 or 4 every two hours.

At the end of twelve or eighteen hours, fever had entirely disap-
peared, and the child seemed to be convalescent, which opinion I
expressed to its mother. On the morning of the 6th, I found it
vomiting black matter mixed with blood. Death took place in a
few hours.

A mulatto woman, of middle age, after taking some doses of the
medicine, became very uneasy, vomiting of dark, suspicious looking
matter occurred some hours after discontinuing the remedy. She
fortunately recovered.

In the cases wThere tr. mur. fer. manifested effects, least injurious,
I could perceive no advantage obtained by its substitution for other
treatment ordinarily pursued. The result, then, of the experiment
in the cases above detailed, is unfavourable, and it is perfectly clear
to my mind, that this remedy is no specific for the cure of yellow

46-i Kollock, on the Epidemic Fever of 1854. [August,

fever ; but that it is positively injurious, and tends to hasten the
catastrophe.

The cures which have been claimed for it, were doubtless, cases
of mild Remittent and Dengue, which have been mistaken for the
malignant disease by those who have " seen the elephant " for the
first time.

Sept. 8th. I find that the bowels are becoming more irritable, and
doses of cathartic medicine, which were only sufficient to empty
the bowels at the commencement of the epidemic, at this time, pro-
duce hypercatharsis. I also find that patients do not require as much
quinine, nor bear it as well as in ordinary seasons. I am not alto-
gether certain that it is necessary to give quinine at all ; in the
majority of cases, there seems to be no disposition to a repetition of
the paroxysm, even in cases which have no tendency to assume the
Yellow fever type. Those cases which exhibit this disposition, are
rather of a bilious character.

In the cases which show the Yellow fever marks, quinine is cer-
tainly injurious, inducing irritability of stomach, and hastening the
advent of black vomit.

The cases which I see in the western part of the city bordering
on the canal, exhibit more of a bilious character ; the tongue is more
apt to be covered with a bilious fur, and some of them are accom-
panied with dysenteric symptoms. In these cases, and at this stage
of the epidemic, v. s. has to be practiced with great caution leech-
ing and cupping are safer.

I have under treatment, an Irish girl of very full habit, her cheeks
are exceedingly red, as well as her lips. She has had a clean tongue,
hot head, injection of conjunctiva ; pulse frequent, but not very full
nor hard. I purged her first with 10 grs. mass. ex. hyd. and ol.
ricini, 5 ss., and applied six or eight leeches twice to her epigas-
trium, which produced very free bleeding. I feared to bleed her
from the arm, on account of deficiency of force in the pulse, as well
as my conviction that v.s. was not borne as well at this time as at
the commencement of the epidemic. She continued, however, to
have so much general excitement that I yielded to the temptation,
and took from her arm 6 or 8 ounces of blood, which reduced her
pulse with rather alarming suddenness, and produced faintness.
Blisters were applied to her legs.

Fourth day of the disease, no fever ; head still hot, but not pain-
ful ; cheeks and lips still red ; complains of great weakness ; no
irritability of stomach. I feel very anxious lest black vomit should

1855.] KOLLOCK, on the Epidemic Fever of 1854. 4b*5

make its appearance to-morrow (fifth day) ; has no bronze color ot
skin: allowed chicken water. OLricini. 5ss. produced two bilious
passages, which is encouraging.

Sept. 12. She is convalescent.

Within the last three or four days. I have encountered six or
eight of the decidedly malignant cases, and as the expectant treat-
ment has failed in many instances, and ptyalism (when it can be
effected by mercury) is thought to have a controlling influence, I
have adopted the practice. I have given 5 grs. calomel. \ gr. of
opium every two hours ; acidulated flaxseed infusion for drink.
But in the majority of instances, the course of the disease is too
rapid to admit of the induction of the mercurial influence.

At the commencement of the epidemic some of my medical
friends claimed great success for this practice, and pursued it in
every case of fever to which they were called ; but I am strongly
tempted to believe that many of the cases which recovered with
ptyalism, would never have run into the malignant type, and would
have recovered without the mercurial influence. In one of my
cases 3 iss. of calomel was taken before the appearance of black
vomit and of death.

The effects of leeches to the pit of the stomach were very satis-
factory in many cases where there was epigastric tenderness, but
they were not applicable to the hemorrhagic cases, where frequently
profuse hemorrhages occurred spontaneously from the gums, nose
and other mucous membranes.

In the case of a little child of Mr. Farr's, the Hospital Steward,
death occurred with hemorrhage from the gums. I had directed it
to be leeched, but it was omitted. I have no doubt that the hemor-
rhage would have proceeded from the leech bites also.

Sept. 12. I do not think the prevailing fever less malignant, nor
less mortal at this time than previously. I believe that some of the
mortality may be attributed to the use of mur. tr. ferri., a large num-
ber of persons having been induced to use it as a prophylactic. Dr,
Wildman, its warmest advocate, died two days ago and was interred
yesterday.

The deaths for some days have amounted to thirty or forty per
day. To-day (Sept. 12) the number of interments was fifty-one.

It is very difficult to procure coffins to bury the dead or to get
graves dug. Two corpses are put into one hearse, and I am
informed that in the Catholic cemetery, a long trench is dug and
the coffins are dovetailed together so as to occupy the smallest pos-

466 Kollock, on the Epidemic Fever of 1854. [August,

sible space. All business of every description, except that which
relates to attending on the sick and burying the dead, is at an end,
vessels arrive loaded with goods and cannot be discharged for want
of hands.

To complete the ruin and desolation, a gale which commenced
on the 8th inst., and was increased to a hurricane on the 9th, pros-
trated a very large number of trees in the streets, and unroofed many
building which were tinned. In consequence of which, the streets
have been so obstructed by the fallen trees and piles of tin, that it
has been very difficult to pass through them in the day time, and
utterly impossible at night, in consequence of the failure of gas, the
gasometer at the gas house, having been damaged.

This epidemic has been unusually fatal to natives. Many who
have left the city and gone to the upper part of the State and to the
North, to avoid the pestilence, have been attacked and died.
^ Notwithstanding the great malignancy of the disease, however, I
have met with a larger proportion of recoveries after the occurrence
of black vomit than in former seasons.

Sept. 18. A child eight months old, which I have been attending
for some days, threw up black matter this morning. I think this
unusual in so young a subject. Its skin has been very much juan-
diced for some days, for which I have given hydrarg. cum. cret.

Sept. 22. Has ceased vomiting still jaundiced ; but liver has
begun to act, and stools contain green bile. Convalescent.

Sept. 23. The son of Mrs. Ball, a poor woman residing in Rob-
ertsville, (the extreme S. W. part of the city,) about nine years of
age, after having had fever two days, took two doses of quinine
each 2| grains, during the day ; the skin at the same time being
rather hot, but moist tongue moist, pretty clean, pulse frequent.
After taking second dose, he threw up black matter from the stom-
ach during the night of the 21st. I found him on the morning of
the 22d collapsed, almost pulseless ; skin cold and clammy ; deliri-
ous refusing every thing but water, ty. Blisters to extremities.
Calomel, gr. j, every two hours. The stomach having been blistered
before the occurrence of these alarming symptoms.

Evening. Blisters have drawn ; but none of the medicine has
been taken, as he refused it. Delirium continues. Other symp-
toms same. Scarcely any possibility of his living through the
night.

Sept. 24. Condition same. Sinapisms had been applied, accor-
ding to my directions, with the effect of producing some warmth on

1855.] KOLLOCK, on the Epidemic Fever of 1854:. 467

the surface ; but the effect had disappeared. $. 01. terebinth, 3ij. ;
mucil. gum arab. 3vj.; one tablespoonful every hour; sinapisms.

Evening. Skin warm, pulse stronger, more quiet, rational.
Vomiting of black matter, which continued through the night, has
ceased, ft. Continue turpentine mixture, every two hours, alter-
nated with beef tea.

Sept. 26. For the relief of the jaundiced condition, he has been
taking mass. ex. hyd., gr. 3, morning and evening. A secondary
fever has arisen, attended with dry, hot skin, frequent pulse but
mind clear, tongue clean and moist. This secondary fever resem-
bles very much that which succeeds the collapse of cholera. I gave
him 2\ grs. of quinine this morning, which he has borne well; but
it has produced no moisture on the skin.

Sept. 27. Still improving treatment continued recovery.

Cases at this time exhibit more of the hemorrhagic tendency than
at an earlier period.

Charles Ulback, bar-keeper, German : attacked nine days since.
His stomach was very irritable at first ; eyes injected and suppres-
sed ; head-ache ; hot skin ; tongue a little furred, pointed, red at tip;
lips red ; thirst great ; has been blistered on epigast. ; has taken
mild mercurial medicine ; bowels have been principally moved by
enemata ; took \ oz. ol. ricin., after stomach became quiet.

Liver has been very torpid ; urine loaded with bile ; stools clay-
coloured, skin and eyes jaundiced complains of great soreness all
over, at one time confined principally to the left shoulder not re-
lieved by morphia.

Within a few days has exhibited a tendancy to hemorrhage,
slightly from the gums ; but profusely from hemorrhoidal vessels.
R. Cauterize hemorrhoid with nit. argent., apply ung. rhatan. pulv.
matico and dry lint the matico and lint answering best. Sponge
gums frequently with sulph. zinc. 3ss., mel. tr. myrrh, aa. 3ss.r
aq. pur. iv. Port- wine, gallic acid, beef tea, internally.

Sept. 30. Inproving very slowly : skin and urine becoming
clearer under use of ext. tarax. Spirits very much depressed ; com-
plains of great numbness in left arm ; excessive nocturnal vigilance,
which is not influenced by the salts of morphia, porter, Hoff.
anod. and water, in combination.

Oct. 1. Sleep procured last night by 45 drops of acet. opii., ad-
ministered in three doses, at intervals.

Oct. 2. Hemorrhage from nose none from gums or hemor-
rhoidal vessels. $. To snuff the powder of Matico.

468 Kollock, on the Epidemic Fever of 1854. [August,

This treatment was continued, and he recovered after a protracted
convalescence.

J. B. Bacon. First visit, on 25th Sept. I found him in cold stage.
ty. Sinapisms to extremities, and hot mustard foot bath. Stomach
irritable, ft. Epispast. to episgastrium. As soon as stomach is
snfficiently quiet, to take calomel and rhei. aa. gr. x., toast water
for drink. When remission occurs, quinine. Took a very few
grains of quinine. The hot stage lasted forty-eight hours ; after
which, bowels being too much relaxed, I was under the necessity of
giving him Hope's mixture, and arrow-root with Port-wine.

Great restlessness ensued on the night of 27th. On 28th, stom-
ach began to reject his drinks ; looseness of bowels continued, and
he passed one dark stool, resembling coffee grounds ; after which,
his stools became very light colored, ft. Blisters to arms and legs ;
lime water and milk every hour in dose of 1 ounce : no other drink.

Sept. 29. Irritability and restlessness very much diminished ;
diarrhoea continues ; stools like rice water discharges in cholera,
ft. Hope's mixture, 5ss. every two hours ; lime water and milk, as
required ; beef tea and Port-wine.

Sept. 30. Much the same ; vomited dark matter last night. Has
rose coloured spots on his arms, which I have seen in other cases.
They are regarded by Dr. Fickling, of this city, as a favourable
sign.

Oct. 1. Black vomiting ; delirious; pulse good; skin of natural
temperature ; tongue dry, smooth, red at tip, upper part covered with
brown fur. ft. Blister to nucha. Spt. terebinth, gtt. 10, in emul-
sion every hour. Three o'clock, P. M., death occurred.

Oct. 3. I witnessed to-day the autopsical examination of two
cases of Yellow fever at the " Savannah Poor House and Hospi-
tal." The morbid appearances in these, as well as in several other
cases which occurred in August, were precisely the same as those
which I have repeatedly met with in the epidemics of this charac-
ter, in former years, and differ in no respect from those which are
recorded of the great epidemic which prevailed in Savannah in the
summer of 1820.

In one of these cases, the mucous coat of the stomach and duode-
num was of a slate colour, the liver yellowish ; but containing rather
more blood than is usual in such cases. In the other case, the mu-
cous coat of the stomach was of a dark red or mahogany color,
with extravasations of blood here and there, under the mucous coat.
The stomach contained some black matter. The liver in this case

1855.] Kollock, on the Epidemic Fever of 18o4. 469

was more exsanguine than in the other. The intestines, as usual,
were deficient in bilious matters.

Peter O'Kouke, a young Irishman, who was attacked Oct. 1st,
with all the symptoms of the malignant type, threw up black vomit
about the fourth or fifth day. He recovered under the use of tur-
pentine emulsion. An intense juandice remained for many weeks,
from which he slowly recovered. I think I have observed more
uniformly beneficial effects from the use of turpentine in the last
stage of this disease than from any other remedy which I have used.

Oct. G. A miserably poor Irishman, named Powers, died to day,
after struggling for several weeks with the typhoid form of the dis-
ease ; differing in no respect from a genuine typhoid fever.

November 23d. I left the city on the 10th of October; on the
day previous, only two deaths were reported, and as most of the cases
which occurred, were sent by the committees of the " Young Men's
Benevolent Association," to their Infirmary, which they had placed
under the charge of Drs. Redwood and Hamilton, of Mobile, who
had come to our assistance, the other physicians of the city had
comparatively little to do.

I returned to Savannah Nov. 19th. At that time there had
occurred pretty cold weather and smart frost, notwithstanding which,
cases of Yellow fever continued to show themselves, principally in
persons who had come from the North. During the past week
ending Nov. 23d, three or four fatal cases have occurred in " Sa-
vannah Poor House and Hospital." The disease did not entirely
disappear until about the last of November.

On a review of all the facts which have been stated, and summing
up the evidence bearing on the case, I am led to the following con-
clusions :

1st. The epidemic which prevailed in this city during the sum-
mer of 1854, was the same disease wThich the older physicians of
the place have repeatedly witnessed, and with which they are well
acquainted. It prevailed in the year 1820, 1827, 1852, and occa-
sionally in the sporadic character, in other years. It was no stranger
of recent origin, wafted from the coast of Africa to our shores, as
has been asserted by some.

2d. The disease was not imported in any vessel from Cuba, or
some other foreign part in which it happened to prevail at the time.
It originated in our midst under the combined influence of exces-
sive heat and drought, the first acting upon masses of human beino-s
crowded together in cities and towns, in badly ventilated apart-

N. S. VOL. XL NO. IX. 30

470 Kollock, on the Epidemic Fever of 1854. [August,.

merits, filthy in their habits, and breathing an atmosphere tainted
by poisonous exhalations from accumulations of putrid offal, with
which their domicils abound. The latter, exposing to a direct solar
heat, which has never been exceeded., heaps of decomposable com-
post deposited in low grounds, which in ordinary seasons, are cov-
ered with wTater.

3d. The epidemic was composed of a variety of grades, or types,,
which might either preserve to the end, the character with which
they commenced, or be converted into one of a more grave and ma-
lignant kind. But as a general rule, the cases which were destined
to prove serious, very soon displayed the " cloven foot."

4th. No specific or systematic routine of treatment could be en-
joined which would adapt itself to every case or every period of the
epidemic season. Remedies which were safe and beneficial at the
commencement, were not so when the disease had run half its course,,
and those which wrere adapted to this latter period, had to be aband-
oned at a more advanced period. The early cases were treated
safely and effectually by bloodletting, the depressing effects of the
remedy were hazardous after the middle of August, and topical de-
pletion by leeches had to be substituted, while these last were not
admissible towards the close of the season when the hemorrhagic
cases were more rife.

5th. So- far, no specific drug has been discovered for the cure of
Yellow fever, and from the nature of the disease, the inference is
very strong that none will be discovered. The tr. mur. ferri is de-
cidedly not, and its employment either as a prophylactic or curative
agent is unwarrantable.

6th. The nature of the black discharges from the stomach and
bowels is still involved in considerable doubt. The microscope ex-
hibits blood corpuscles, altered, and chemical reagents, and acid. It
differs essentially from the hemorrhages, which proceed from mu-
cous membranes, leechbites, hemorrhoids, and punctured or abraded
cuticle. We know of no remedy on which much reliance can be
placed in the treatment of this symptom ; I think turpentine promises
as much as any which I have tried.

7th. The morbid appearances on dissection are to be found prin-
cipally in the mucous coat of the stomach and duodenum, and in
the liver. The former is either of a slate or mahogany color, or
intensely injected with florid blood ; the latter is pale, bloodless, dry,
and little, or no bite to be found in the intestinal canal.

Sth. No fact has come to my knowledge which will warrant the

1855.] Word, on Typhoid Fever. 471

belief that contagion is an attribute to this disease. I am aware of
more than one instance in which persons left the city to escape the
pestilence and went to the upper part of the State and to the North,
in whom the disease became developed, and who died without in-
fecting others who lodged in the same hotels, or the physicians and
nurses who attended them.

ARTICLE X1IL

Typhoid Fever in the State of Georgia. By T. J. Word, M. D., of
Rome, Ga. (Published by request of the Medical Society of the
State of Georgia.)

In a report on the topography and diseases of the 5th Congres-
sional district, published in Transactions of the Medical Society of
the State of Georgia, April, 1853, 1 had occasion to consider at some
length the subject of Typhoid Fever as it prevails in this section of
the State. I am unable, from subsequent experience or observation,
to add any views of material interest to such as were contained in
that report.

I presume it wras the object of the Society, to obtain a paper con-
taining a correct account of the forms of the disease as it prevails
throughout the entire State, and the comparative results of different
plans of treatment. Although I have faithfully endeavored by
means of circulars sent to different and remote sections of the State,
to comply with the requisition, I am unable to do so with the ma-
terials at my disposal.

The number of communications received has fallen far short of
what w7as necessary to the accomplishment of an object so much
desired. To the few medical brethren, however, who have kindly
responded, I feel it due to present an abstract of their communica-
tions to the Society, and shall proceed to do so in the order in which
they were received. I will here add, that in this section of the
State, for the last two years, the prevalence of the disease appears
to be abating ; cases have not occurred so frequently, nor with such
severity as formerly. So far as I have been able to ascertain, vera-
trum and turpentine are the remedies generally relied upon by the
profession. The former is given upon the plan of Dr. Norwood,
the latter in emulsion, with gum arabic, sugar, &c. In this imme-
diate section, these agents are much used in combination. It is not

472 Word, on Typhoid Fever. [August,

claimed that they will cure th i disease, but when u^ed in conjunc-
tion with opium and such palliative means as the symptoms or pecu-
liarities of each case may suggest, it is believed that the disease
may be accompanied through its regular course with a successful
issue in a large majority of instances. The use of the lancet is con-
fined to the early stages of such cases as appear to be sthenic in
their character. Purgatives are avoided as much as possible, being
administered at long intervals and of the mildest character. Many
rely exclusively upon the use of enemata to open the bowels. Blis-
ters are generally used in the latter stages of the malady, with stimu-
lants, fomentations, &c.

Typhoid Fever in Richmond County, Ga. In a communication
addressed me, by Prof. Dugas, of Augusta, Ga., I learn that Typhoid
fever is not very prevalent there, and was, comparatively, unknown
there until within the last ten years since which time he had occa-
sionally met with a case. It was usually a continued fever, but
within the last two or three years he had seen some instances in
which it was manifestly intermittent, the intermissions being daily,
and always occurring in the evening. With regard to treatment,
our informant had always found the expectant method the best, and
very successful. He never derived any advantage from quinine,
even in the intermittent cases, but did not give it in the enormous
quantities advised by the British authorities. Prof. Dugas states
that he has " the strongest evidence that it is sometimes contagious
in this country," does not think that it is a local disease, confined
to the intestines, nor that it should ever be designated as an exan-
them as some have done. He regards the pathology proposed by
Prof. Campbell, in his late report to the American Medical Associa-
tion, as the most plausible he had seen.

Dr. Henry Gaither, writing from Oxford, Geo., states that in his
section of country, Typhoid fever is a very controlable disease,
as to result, if not as to duration. His treatment is "simple, though
not stereotyped." Emetics in the early stages, and blue mass as
an aperient, or pills of calomel, ipecac and opium, combined, and
given in divided doses, but not continued so as to induce ptyalism.
He remarks, that quinine does not cure Typhoid fever, but is a
valuable auxiliary, uniformly divesting the disease of paroxysmal
complications, (due to malaria,) thereby simplifying it, and facilita-
ting the cure. " Great benefits may be expected from the timely
application of blisters to the abdomen. Neither cups, leeches,
poultices orrubifacients, equal them in the relief of pain, tension and

1855.] Word, on Typhoid Fever. 473

tenderness of the bowels, and no other remedy affords such immu-
nity from the colliquative dianhceas often so formidable. The inju-
ries apprehended from blisters in such cases are all ideal. Save
the surface from being denuded of the cuticle by dressings of soft
cerates on soft old cloths, instead of dock or beet leaves, &c, and
it soon heals, and is ready for a second or third application of the
epispastic, if necessary, which, however, is rarely the case. "I
have often used, with the happiest, effects, cold spongings, and even
cold affusions, continued as long, and repeated as often as is grate-
ful to the patient ; cold acidulated and other drinks are freely al-
lowed. But if, in a system of treatment consisting of many parts,
each essential to its integrity, it can be said that one is of more vital
importance than all the rest, then this is that one : keep Hie patient
as comfortable as possible, and after real debility begins to appear
let the treatment be as much nutritive as medicinal." Under this
treatment, our informant states, nearly all recover, (certainly three
per cent, do not die,) which can not be said of the heroic treatment
within the scope of his observation. He subjoins that opium and
its compounds are very valuable agents in the treatment of the
disease.

Typhoid Fever in Monroe County, Ga. Intelligence from this
county was received from Dr. S. W. Burney, in a communication
of some length. He states, that the disease was a stranger to the
country previous to the winter of 1836 and the spring of 1837. He
regards Typhoid fever as only a mild form of the Typhus fever of
Dr. Armstrong and other English and American writers the
Typhus mitior of Cullen. The symptoms, according to his observa-
tion, present no " characterizing difference." The red, black and
parched tongue, sometimes glazed and fissured ; the constant diar-
rhoea, the jactitation and raging delirium, the great prostration, the
frequent and gaseous pulse, the sordes about the teeth, and the
abdominal tenderness, &c, are common to both affections. The
differences of opinion amongst medical men upon this subject, he
thinks attributable to the fact, that many ascribe a specific origin
to cases of mere inflammation of the bowels. Of the cause of the
disease, he remarks, that he has usually observed that whenever it
prevails to any extent in a community, it appears to originate
amongst those who are crowded in sleeping apartments ; that it
begins in houses built for many years, and in negro cabins, where
a great deal of filth as rags, chips, leather, and dirt, the sweepings
of a quarter of a century, are usually found under the floor. The

474 Word, on Typhoid Fever. [August,

symptoms of cases, occurring under his observation, were not mate-
rially unlike those described of the disease as it prevails elsewhere.
A strong tendency to cerebral congestion he found of frequent
occurrence; the pupils of the eyes were often dilated. At the be-
ginning of the disease, the tongue was generally covered over its
centre with a white fur, and red at the tip and edges. When the
disease was prolonged beyond the ninth day, particularly if the ner-
vous symptoms predominated, the tongue became dry and fissured,
and black as raw beef. The bowels were usually tender, and
attended with diarrhoea, the skin morbidly hot (calor mordax), and
the pulse varying from 95 to 135 beats per minute. All the symp-
toms were indicative of the anemic origin and tendency of the dis-
ease. An experience of eighteen years had convinced him that the
primary impression is always on the nervous tissue. In this con-
viction he was strengthed by the fact, that opium, in the form of
laudanum, is the best and surest remedy in its treatment. The fol-
lowing is the plan of general treatment pursued : Where there is
evidence of inflammation of the illeum, leech the part freely daily,
and in severe cases twice a day, until there is a perceptible change
in the pulse : if there is biliary derangement, give early an emetic
of ipecac: if the bowels are constipated, open them daily with cold
water enemas, never venturing to give even the mildest laxative,
unless the enemas fail : in which event, give a dose of sulphate
magnesia, dissolved in red pepper tea : if there be diarrhoea never
attempt to arrest it in the early stage of the disease, unless there is
evidence of exhaustion. He believes, with Drs. Graves and Stokes,
that this symptom is instituted by nature to overcome the patho-
logical condition of the bowels. He almost invariably meets this
symptom with hydr, cum creta. gr. j., pulvis doveri grs. iij., given
once in four hours, and persevered in, unless the bowels become
too sensitive to allow the remedy. Where there is restlessness,
give sixty drops tine, opii at bed time, to an adult. This remedy
is specially indicated if there is heat of scalp and other evidences
of determination to the brain. " Nothing will so effectually relieve
the engorged brain as the free use of this remedy ; sixty drops are
given every six hours, until the patient falls into a sweet sleep. He
invariably awakes very much refreshed, with his mind perfectly
restored. This, I am aware, is at variance with the directions
found in books, but I have tested its virtues, and speak with confi-
dence in its favor." Corn meal poultices are kept constantly to
the bowels, and mucilaginous drinks used instead of water. Boiled

1855.] Word, on Typlwid Fever. 475

milk and gruel, coffee, &c, constitute the diet. On the accession
of the asthenic or second stage of the malady, a change is demanded
in the treatment, stimulants being loudly called for. Our informant
regards it a matter of great importance to detect the onset of this
stage, and be prepared to meet it " If stimulants are not used
within twenty-four hours after they are indicated, death is sure to
end the scene." When the practitioner is satisfied of the existence
of the second stage, the bowels are to be immediately locked up
with enemas of laudanum, and kept thus for several days. In one
instance he suffered a patient to remain twenty-one days without
an evacuation. The bowels being thus confined, 2 grs. musk and
4 grs. camphor, in mucilage, are given once in two to four hours;
port wine, chicken broth and beef tea are also allowed and a large
blister is applied to the abdomen. The oil of valerian in six drop
doses, once in four hours, is mentioned as a stimulant of great virtue
in the disease. These, with sinapisms to the extremities, are the
stimulants which an experience of eighteen years have proven the
best, and are never attended with disappointment, if properly used.
In cases attended with obstinate diarrhoea and which do not yield
to the laudanum enemas, indicating ulceration of the glands of
Peyer and Bruner, spirits of turpentine is advised. Dr. Burney
claims to be the first man who used this article in the latter stages
of Typhoid fever. He claims also great success in the use ol nitrate
of silver and alum in similar conditions of the intestines. In one
case of ulcerated bowels, he gave the chloride of soda with success,
after the failure of other remedies. In cases where there is an
abiding appetite for a particular article of food or drink, the prac-
tice of our informant is to indulge it. He mentions a case in which
a patient begged several days for brown sugar ; it was allowed him
in large quantities, and seemed much to promote his recovery.
Quinine^ he regards injurious in this affection and in all cases
attended with inflammation of the bowels. He observes, in con-
cluding his communication, "that every thing depends upon the
prompt use of stimulants at the right time, The success attending
my plan has been highly flattering, so much so, as to deprive the
disease of all its terrors ; I have no idea I have lost more than one
case in seventy-five. This, I admit, may look like boasting, but an
appeal to those who know me, will bear me out in the assertion.
Others, who agree with me, have had signal success in overcoming
this scourge, whilst those who persist in purging, puking, &c, lose
a very large per cent, of their cases/'

476 Word, on Typhoid Fever. [August,

Typhoid Fever in Athens, Ga. Dr. W. L. Jones, in a commu-
nication from Madison, Ga., informs me, that having lived in that
vicinity but a short time, he can give no account of Tvphoid fever
as it prevails there, but was familiar with it as it occurred in Athens,
where he formerly resided, having been himself attacked with the
disease in 1849. So far as he had observed, it generally attacked
persons in good health during midsummer. Its duration varied from
three to six or more weeks. It began sometimes with catarrhal
symptoms, oftener with derangement of the alimentary canal, the
latter always supporting the former after a few days. The treat-
ment was cupping over the abdomen, when there were symptoms
of congestion in the early stages, with opiates and small doses of
blue pill at intervals. He was of the opinion that no treatment had
had any decided influence on the disease. Palliation of some un-
pleasant symptoms, and administering to the comfort of patients
being the chief results attained. He knew of no disease where the
treatment is more wholly confined to symptoms. Reference is here
made to the continued fever per se, and not to various other diseases
which sometimes assumed a lingering typhoid form.

Typhoid fever in Walker County, Ga. I am indebted to Dr. A.
L. Barry for information from this county. He "regards Typhoid
fever as continued in its character, but capable of assuming a malig-
nant typhus state. The red, fiery tongue of the Typhoid of the
present day, and the great tendency to inflammation of the glands
and mucous surfaces of the bowels, may appear different from the
continued and Typhus fevers of Good and others of his day ; but
those of us who have been in actual service for twenty years will
give but one opinion, and that is, that Typhoid fever is only a modi-
fication of Typhus. Between 1835 and 1848, Typhus mitior pre-
vailed in all this region of country during the winter season. It
differed but little from that form as described in the authorities, and
was styled winter fever. Since 1845 there has been a gradual
modification in the malady until the present time." Our informant
remarks of the treatment: that coming from a malarious district to
the upper region of Georgia, he at first made free use of quinine,
calomel and Dover's powder. The first he was forced to abandon,
not only as useless, but positively injurious. He afterwards resorted
to the free use of cold water, in the form of bath, wet sheet, &c,
using the lancet occasionally, in conjunction with mild cathartics
and sudorifics. The success of this plan was gratifying, but as time
advanced the malady presented other modifications more difficult

1855.] Word, on Typhoid Fever. 477

to overcome. Amonst these was the red, dry tongue produced by
the mildest cathartics, the diarrhoea which in many cases was at-
tended with bilious discharges., and tympanitis with floculent dejec-
tions, &c. His present plan of" treatment is as follows : i; When
called early in the forming stage of the fever, the pulse quick, the
tongue more slimy than furred, with red edges, or perhaps a red
centre, and the skin dry and hot, I prescribe cold baths Dover's
powder and mustard pediluvium at night. At morning give a small
dose of oil and turpentine. 2nd. If there is any tenderness of the
bowels, mustard poultices to be applied ; Dover's powder in small
doses every three or four hours ; cold bath if skin is hot, repeated
several times in twenty-four hours. The bowels may be opened with
an enema. 3d. 3. Tine. Opii, spts. nitr. dulc, bals. copaiv., tine,
digitalis, aa. 3j; aqua, sjss. Misce. and give to an adult, a teaspoon-
fulonce in four or five hours. When not objectionable to the stom-
ach, a drachm of turpentine is added to the mixture. The pedilu-
vium to be continued at bed time with friction over the body."
The following case he submits, the better to illustr Ian of

treating the disease.

Jan. 28th. Saw, in consultation, Miss M. H., aged seventeen, and
attended the case. Was taken sixteen days zgo pulse 135: tongue
and fauces very dry and red ; sordes on the teeth ; abdomen tender
and tympanitic ; urine scanty and high coloured, and patient dis-
posed all the time to coma; speaks when aroused and mutters a
good deal, especially at niorht. Prescription : Take of the balsamic
mixture above criven, a teaspoonful once in every four hours. At
night, give 3 grs. Dover's powder and repeat if the bowels (already
too loose) should be moved : also, let her be washed with number
six or brandy. 2nd visit Patient rested better through the night ;
bowels quiet : some increase in the quantity of urine. Continue
the mixture with elm tea and brandy in small quantities. 3d visit
Pulse less frequent, but in other respects not much difference. Con-
tinue the mixture with fomentations to the bowels ; if they remain
quiet, give teaspoonful each of castor oil and turpentine at 4 o'clock ;
blister the neck and use frictions over the skin at night withbrandv,
&c., morphine to be iven if purgative acts too strongly. 4th visit
Medicine had acted, causing bloody discharges, which were sup-
pressed by the morphine. Pres. Add 2 grs. acetate plumbi to each
dose of the mixture, and give only two doses with an interval of six
hours. 5th visit Pulse at 115; bowels quiet, urine copious: pa-
tient takes a little broth frequently. Continue mixture, as before.

478 Word, on Typhoid Fever. August,

tfth visit In statu quo. 7 th visit Rather better; has more relish
for food. 8th and 9th visits Patient in much the same condition.
An enema ordered. 10th visit Has been an action of the bowels,
the first since the bloody discharges. No material alteration in the
treatment until the fourteenth visit, when a dose of oil and turpen-
tine was given, which was followed by moderate purgation, the dis-
charges being more consistent and improved. Continue the mix-
ture through the day and give at night and morning a powder
composed of 2 grs. each of hydr. cum. creta and Dover's powder.
This prescription was followed four days, after which she took only
one of the powders and the mixture three times per day until dis-
charged. In this plan it will be perceived that I endeavor to fulfil
two leading indications, to quiet the bowels, and arouse the renal
system. Whenever the cider stools appear, I invariably check the
bowels for several days, at the same time using the balsamic mix-
ture, conjoined with fomentations to the bowels and frictions over
the body." Dr. B. objects to the use of blisters to the bowels, but
blisters to the neck are used when the head is likely to suffer.
When the mixture above mentioned was not tolerated by the
stomach, he substituted a combination of camphor, digitalis, opium
and ipecac. He states that he has used the lancet with advantage
in athletic patients in the early stages of the malady.

Typhoid Fever in Cobb County, Ga. My informant from this
county, is Dr. W. N. King, of Roswell, who writes that Typhoid
fever in its true form, that is, according to Louis, Chomel, Andral,
Petit, and others, prevailed there for the first time in 1848, and
proved very fatal ; since which time it has continued, but not in an
epidemic form, until the last fall, when it assumed the remittent type
chiefly. There were occasionally observed cases of a continued
and also intermittent character. He remarks that " Dr. H. R. Casey,
in his excellent paper read before the State Medical Society, 1852,
mentioned the above peculiarities and reported a number of cases
in the December number of the Southern Medical and Surgical
Journal, 1851." Dr. King states that at first, his treatment was
varied and as unsuccessful as varied. Antimonials and mercurials
combined and alone, were tried, and gradually the whole list of febri-
fuge articles in the materia medica, but without success, until sick-
ened and disgusted, he abandoned all hope of ever effecting anything
in the treatment, in which connection he truly remarks " that num-
bers of others in the profession have passed through much the same
-ordeal with this " opprobrium medicorurn.1 "

1855.] "Word, on Typhoid Fever. 479

To Dr. Norwood, he concedes a debt of gratitude for the intro-
duction of his tine, veratrum viride. u Armed with this, we can say
to the fever 'thus far shalt thou go.' In it we have the controling
agent of Typhoid fever that which has been so long sought after,
the real true arterial sedative. i: I have not arrived hastily at this
conclusion, but mine has been accumulative experience." In his
first trial with it. he states that he began with some misgivings. Be-
lieving, with Dr. Casey, the disease to be one of the most prostra-
ting of our fevers, attended with great nervous depression, &c, and
the veratrum having the power per se, of producing in the human
economy these same demonstrations, being certainly one of the most
depressing agents in the materia medica, he was unwilling to super-
induce upon a pre-existing debility the increased prostration conse-
quent upon the administration of this powerful remedy. This he
remarks, appears to be true in theory. " But, had the Dr. experi-
mented and tested its virtues before publicly banishing it, and pro-
nouncing his anathemas, he would have been advancing the cause,
on a subject which most loudly calls for scientific investigation, and
also rendering to Dr. Norwood that which is justly his due. Is not
the fever the cause of all this nervous depression? remove the cause
and our end is accomplished. This low nervous state passes away,
the pulse comes up round and full ; and by the continued and judi-
cious use of the veratrum, is held at sixty, seventy-five or eighty
beats per minute ; the appetite returns, and the patient passes
through the course of the fever unharmed.

Dr. King contends that Typhoid fever, like the exanthematous
diseases, has its peculiar phases to pass through, and can no more
be stopped than Small pox or Rubeola; but thinks, with the use of
such an agent as we possess in the veratrum, we can control the
fever and thus husband the strength and save the patient. In two
or three cases, he had " continued the use of the veratrum from sixty
to seventy days, without intermission, save a few hours, to see if the
fever had run its course; when the pulse would rise, the tongue
become brown and hard, and all the symptoms attendant before the
use of the veratrum, become speedily manifest. Upon resuming it,
all these symptoms would vanish, like mists before the morning sun,
clearly demonstrating the virtues of this most valuable agent.'*' He
states that his success in the use of the remedy has been most flat-
tering. In some cases, where he found a tendency to diarrhoea, he
used opium for its astringent effects, and where, on the contrary,
there was constipation, a little blue mass, followed by castor oil was

480 Word, on Typhoid Fever. [August,

given, in the meantime continuing the veratrum ; great care being
taken to avoid all purgation of a drastic nature. He states, his
experience in the use of the veratrum, to have been as follows :

1st. I have never found it to increase the action of the bowels,
even where there was a predisposition to it ; its specific action being
an arterial sedative, just what is wanted in Typhoid fever.

2d. In a few cases, I have found the volume of the pulse at first
reduced, but its frequency not affected ; but, by its continued and
careful use, the pulse has been brought down under control both in
volume and frequency.

3d. I have seen it produce hiccough of a most distressing nature,
and had to suspend its use from twelve to twenty-four hours ; but, by
again resuming it in very dilute doses, and at long intervals, its
physiological effects were produced without any untoward circum-
stances.

4th. In some cases, the susceptibility was so great, that two drops
occasioned emesis and prostration ; but I never have seen a case
where, from ^idiosyncrasy, the veratrum was entirety inadmissable,
but with caution and perseverance, the system can be brought under
its influence, and kept under it for any length of time during the
course of an attack of fever.

My mode of administration is as follows : Make a solution of 30
drops veratrum viride to 5j. water and give of this, one teaspoonful
every two and a half, three, four or five hours, beginning at the
longest interval first and gradually decrease the space of time be-
tween each dose, until the patient is brought under its effects taking
great care not to give it too rapidly at first, watching closely
its physiological action ; after that, continue as necessary, never
permitting the patient to lose entirety its effects during the whole
course of the fever. Diet nutritious, but not exciting; soft boiled
eggs ; gelatine with or without wine ; chicken soup, common
starch, &c.

" I am aware that pathological researches, in most diseases, throw
a flood of light upon treatment ; but what, may I ask, has pathology
done for the treatment of Tpphoid fevers ? So I say less of pathology
.and more of treatment, this is what we want."

In concluding, Dr. K. urges the claims "of the veratrum upon the
profession in the following words, " It is our only hope of success and
must work an entire revolution in the treatment. Let each one
for himself test its virtues and report cases : the result will be a
reduction in the bill of mortality more than one half."

1855.] Holt's Letters on General Perfkology. 481

ABTKILE XXIII.
LETTERS PRO?.! SAL D. HOLT, M. D., LP0X SOAIE POINTS OP GENERAL PATHOLOGY-
LETTER NO. 3.

Montgomery, Ala.. June loth, 1855.
Messrs. Editors In order to preserve a proper connection, and
prevent any misunderstanding of my views upon the subject of Con-
gestion, I find it necessary to recapitulate some of the leading points
of the discussion, and I feel disposed to lay more stress upon those
points for the reason that there appears to be, not only a want of
argument in the profession relative to the use of the term proper to
express the condition, but there has existed a contrariety of opinion
with regard to the nature of the condition itself, and what appears
a little strange, is that writers upon this subject have invariably
coupled it with intermittent or, remittent fevers, or as some have main-
tained and laboured to prove, the sui- generic existence of such fevers,
and the profession at large, have scarcely, yet learned to consider it

in anv other light, or connection.

_

Dr. Wood, who stands among the foremost of those writers, ob-
jects to the use of the term Congestion, upon the ground of difficul-
ties which, I think, he himself has created, by the subdivision of
Congestion into ''active and passive" for, in assigning his reasons
for adopting the term "pernicious" he says, "the term Congestive is
still more exceptionable (than Malignant) because, besides belonging
to a vast number of other affections of all possible degrees and of whol-
ly distinct characters, as for example, to cases of arterial or active, as
well as venous or passive Congestion, it is moreover calculated to
lead into erroneous views of the nature of the disease." Now, this
position is not tenable : for, in medical parlance, no disease has re-
ceived the appellative term Congestion, having the characteristic
condition of what Dr. Wood calls "Active Congestion," nor is the
idea ever associated in the minds of those who understand the sub-
ject with " affections of all possible degrees, and of wholly distinct
characters," for Dr. Wood, himself, who understands precisely and
perfectly well what Congestion is, in treating of "pernicious fever,"
the synonyme of " Congestive''* never looses sight of the true patho-
logical condition of nervous depression, or deficient innervation which
he most sedulously urges upon our attention, and says emphatically,
"it is confessedly Venous Congestion that is present in these cases."
And. again, as if summing up all his arguments upon this point, he

482 Holt's Letters on General Pathology. [August,

says, "it appears then that this defect or derangement of innerva-
tion lies at the basis of all the morbid phenomena of the organic
functions, the congestion necessarily follows the prostration of the
active circulating forces, the pulmonary capillaries ; the heart, and
the systemic capillaries are all enfeebled, the blood therefore collects
in the veins, and in the great internal organs, especially in those con-
nected with the portal circulation." Now, if Dr. Wood and others
choose to hold to the term " pernicious" to express a particular mod-
ification of a particular fever, I have no reason to object ; but for my
part, I have a more extensive use for the term Congestive ; and not-
withstanding the weight of authority to the contrary, I must insist
that it is the preferable term to express the condition. I have main-
tained that this condition, which constitutes one of the first links in
the chain of morbid phenomena of almost all febrile affections, often
exists as a permanent one, manifesting signs of its existance to a
greater or less extent throughout their paroxyms, and sometimes to
such a degree as to obliterate all traces of their true typical charac-
ter. I have endeavored to show that this condition is the result of
the operation of such causes as tend directly or indirectly to dimin-
ish nervous power, or impair the tone and vigour of the system,
prominent and foremost among which, stands atmospheric heat,
which, besides its influence upon the general system, exerts a deci-
ded and powerful influence or control over the functions of the
liver, laying a foundation for, and giving rise to numerous trouble-
some and often dangerous complications ; and that the frequent
occurrence of this condition, in connection with our febrile diseases
of all descriptions, together with these complications, renders a
knowledge of their true nature and character, of the utmost impor-
tance, in a theraputic point of view, to every Southern practitioner.
And, having endeavored to show in what the condition consists,
that it is uniformly the same in its essential nature, in whatever light
or connection it may be found to exist, and that it differs only in
degree, according to the intensity or permanency of the causes which
operate singly or conjointly to produce it, I shall proceed to make a
classification of these degrees (for practical purposes) according to
the existing conditions of the system, which I have before suggested,
namely : To all cases of fever, whether idiopathic or symptomatic, in
which the depression and congestion are so complete and perma-
nent as to obscure or obliterate the signs by which the type of the
fever would otherwise be recognised, I would apply the term " Con-
gestive," without qualification. To those cases in which the signs of

1855.] Holt's Letters on General Pathology. 4So

depression and congestion are persistent throughout the paroxysm,
but not so complete as to obliterate their typical character. I would
apply the term " Congesto- inflammatory1'' or 'fr Can ges to- irritant ,r' as
the signs of excitement present might indicate a diathesis favouring
one, or the other, which must necessarily be determined by the
judgment of the practitioner : and very nice discriminations are
often necessary to be made, as in these modifications of fevers, during
their exacerbations, the excitement sometimes rises so high in its
general aspect, as to render a correct diagnosis of those conditions
difficult, even to the most experienced, and however near these con-
ditions may assimilate in appearance, a correct practice and favor-
able results, must depend upon the issue of the judgment.

The terms " inflammatory " and " irritant" (which, though belong-
ing to the same classification, do not properly belong to our present
subject) apply to those conditions in which the excitement ranges
above the line of healthy excitement, during the period allotted to
the paroxysm, according to the type of the disease to which they
belong. Now, I will not quarrel with those who do not choose to
recognise the teim, or adapt the classification, which is here presen-
ted; but this much I will say, that by adopting this classification, I
have found my practice, in such cases, very much simplified, my
labours and anxiety abridged, and my confidence and success in-
creased.

It remains, now, for me to give an outline of the signs and gener-
al symptoms by which these modifications or classes may be known
in order that others may be enabled to apply them to individual
cases; and, for this purpose, I will take Pneumonia, for the reason
that it is an affection of general prevalence, that in the light of a
heal affection, so far as the inflammation in the lungs is concerned,
the shades of difference are slight, (if any.) whatever may be the
condition of the general system, when brought under its influence.
That this condition of the general system, whatever it may be, if
divested of the peculiar phenomena which belong to and distinguish
the local inflammation, as such, would stand in a similar, if not iden-
tical relation in all its phenomena with our ordinary malarial idiopa-
thic fevers, and that it presents all the forms, grades and modifica-
tions of those fevers, from the highest degrees of excitement and
inflammation, to the lowest depths of congestion and collapse.
I wish it to be borne in mind, that if my description of these affec-
tions should appear meagre and incomplete, it is for the reason
that they are used merely for illustration of the subject in hand

45i Holt s Letters on General Pathology. August,

and are not intended to be represented in their full and complete
livery.

We will suppose, then, that cold and wet, a sudden transition of
temperature, or some other cause has operated to kindle up an ir-
ritation in the lungs, or in some part thereof, and some circumstance
occurring to increase the action of the heart and arteries, a current
of blood will be determined to that point, which will accumulate in
the capillaries and arterial ramifications, still further increasing the
irritation and the determination in that direction, until it rises into
inflammation. This action being seated in the nerves and capilla-
ries of the bronchial artery, and parenchymatous structure of the
lungs, constitutes Pneumonia. If there should exist no concurrent
circumstances to produce a state of general depression and conges-
tion, the blood of the general circulation will flow through the Cap-
illaries of the pulmonary artery with an acceleration propor-
tioned to the general excitement, except at the point of inflamma-
tion; where it will be met by the previously engorged capillaries, when
these vessels will become involved in the general results of the in-
flammation, giving rise to Congestion in the pulmonary artery, pro-
portioned to the extent of the inflammation.

I have been thus particular in fixing the precise seat of the disease,
in order to show that the Congestion thus produced, (and which is a
necessary attendant upon the disease, whatever character the gener-
al symptoms may assume,) is altogether different from true conges-
tion of the lungs the former being, as it were, mechanical and the
offspring of excitement, and the latter, pathological, the offspring of
depression, one being local, the other general, with respect to the
lungs. The same remarks will apply to the condition of the liver,
and the portal circulation, as in certain affections, where there is a
high state of general nervous and muscular excitement, in which
that organ participates as in some forms of bilious or remittant fever,
the portal system of veins is often congested, and throwing the
blood back upon the venous radicles, and thus obstructing the free
circulation of the blood in the arterial capillaries, gives rise to irri-
tation or inflammation in the organs, whence the blood of the portal
system is derived. But the congestion thus produced, although the
results may be nearly the same, does not belong to, or constitute
any part of the condition which we are discussing, but must be
viewed in the light of a local affection merely ; so when we speak
of congestion of the liver, or the lungs, or the brain, it expresses the
condition of the organ merely, and not the condition of the general

loooj Holts Letters on General Pathology. 485

system, which I have before said, may be in either a state of exalt*
ed excitement, or of depression. I may remark, however, with
respect to the brain, that it can never be in a state of congestion, on
account of the 'pre- existence of inflammation in that organ, being
dependent for that condition upon congestion of the heart or lungs,
as congestion of the stomach, intestines and other abdominal vis-
cera, is dependent upon congestion of the liver. But it can readily
be perceived, how an inflammation can be kindled up in that organ
from a persistant congestion of the heart, or lungs ; or in the ab-
dominal viscera, from congestion of the portal system. Attention
to this view of the subject will enable us to understand why it is,
that all our diseases are so mixed up with dangerous or troublesome
complications, especially if we will keep in view the fact, that they
depend upon antecedent, or predisposing causes, such as I have
shown the influence of atmospheric heat to be. Hence, in Northern
latitudes, where no such antecedents or predispositions exist, or but
to a limited extent, an attack of Pneumonia will generally run its
course without any material modification of the ordinary inflamma-
tory form of the disease, and without complications, or, if anv should
occur, such as congestion of the brain, liver, &c, they will be re-
ferrible to the inflammation for their cause, and will be curable by
the same means. Not so, however, with us: for it often happens,
that the original affection becomes a matter of secondary considera-
tion, and of minor importance, compared with the complications,
having for their origin a condition of general nervous depression,
and requiring altogether a different mode of treatment. This view
of the subject, too, will enable us better to understand and appreciate
the distinction or classification which I have made, of the degrees
of congestion.

Well, having fixed the seat of the inflammation, and assuming
that the exciting causes, as well as the seat of inflammation are the
same in all cases, without regard to the condition of the general
system, if there should exist no concurrent circumstances to pro-
duce depression and congestion, but circumstances which have
before been mentioned should favour, or predispose to the existence
of the inflammatory diathesis, when the general system is brought
under the influence of the local inflammation, the general excitement
will be kept up, subject, however to the influence of exacerbations
and remissions, according to the type which the fever may assume,
until the vigour of the system is reduced, and the excitement and
inflammation is subdued. Under such circumstances, in addition

X. S. VOL. XL XO. IX. 31

486 Holt's Letters on General Pathology. August,

to the symptoms, which may be considered characteristic of the local
affection, as pain, cough and difficult breathing, (which indeed can
hardly be regarded as such, there being many cases of Pneumonia
in which neither are present) and such signs as may be ascertained
by percussion and auscultation, the disease will be made up of such
symptoms as characterise diseases of excitement, generally, such as
a hot dry skin, and flushed face, a full, strong or hard pulse, often
pain in the head, the tongue usually dry and furred, sometimes nau-
sea, generally constipation, and an interruption or suspension of the
secretions generally. These symptoms being always increased in
violence whenever the investment of the lungs may chance to be
involved in the inflammation. 1 have presented this form of the
disease, not because it falls legitimately within the range of our sub-
ject, but because it represents (though imperfectly) the disease in
what may be regarded its elementary, or true inflammatory charac-
ter, and will serve to show (by contrast) in stronger light the symp-
toms which belong to the disease in its congestive form. Premising,
then, that causes have operated to produce a state of general ner-
vous debility, and especially of the organic nervous system which
will to some extent, modify the characteristic symptoms of the dis-
ease. The pain in the chest will generally be found to be dull an<i
obscure, the cough inconsiderable, and usually attended with ex-
pectoration of brown, bloody or frothy egg-nog looking sputa; the
respiration, generally, slow and frequently interrupted with heavy
sighs, and often rattling in the air passages. The voice feeble and
husky ; the countenance pale and sometimes livid and ghastly, and
the features appear sharpened or shrunken; the skin preternaturally
cool or cold and clammy, with sometimes profuse sweats, and the
extremities cold and shrivelled ; the tongue cold, broad and thick,
and covered wdth a thick moist yellow, cream or ash-coloured fur.
Often, a sense of great oppression and distress about the epigastric
region ; frequently nausea and vomiting, and a strong tendency to
diarrhoea. The head generally free from pain, and the intellect
generally clear, and the pulse small, feeble, generally frequent, irregu-
lar or indistinct. An analysis of the symptoms which characterise
these two opposite conditions, would claim our attention, but I pre-
fer to include those which belong to the minor or sub-divisions,
which, though having no separate or independent origin, are never-
theless important in a practical point of view. I should observe,
that these descriptions are intended to represent each class, or
modification, in its full development, or at the highest point of the

1855.] Holts Letters on General Pathology. 487

exacerbation, and subject, as in all cases, to such changes as belong to
their periodic character. The first of these which I shall describe,
is the " congesto-inflamrnatorv" form. In cases of this class the
characteristic or local symptoms are variable, the pain is often ob-
scure and sometimes severe, especially if the pleura is involved,
which is not unfrequently the case. The cough is sometimes severe,
but most commonly it is inconsiderable, and attended with expecto-
ration more or less abundant of yellowish brown, or bloody mucus,
the respiration variable, sometimes slow, laborious and even ster-
torous, at others hurried, and at times again almost natural. The
countenance, usually, is pale or sallow, with a sad or melancholy
expression. The body and the head are usually hot, and the ex-
tremities preternaturally cool and the skin moist. The tongue gene-
rally looks enlarged) is sometimes dry, but generally moist and cov-
ered to a greater or less extent with along white, yellowish or cream
coloured fur, thicker and darker coloured towards the root and
centre, and thinner or even wanting at the edges Usually there is
epigastric oppression and distress, and sometimes nausea and vomit-
ing. The bowels sometimes constipated, but often there is a strong
tendency to diarrhoea. The head is usually affected, sometimes
with pain, frequently dulness or confusion of intellect, and some-
times stupor, and the pulse, which is sometimes slow, is generally
frequent, sometimes full and bounding, but soft and compressible*
The ;' congesto-irritanr form, which is the last in the order of our
classification, is usually characterized by more acute pain in the
chest, with frequent and troublesome cough, with more or less ex-
pectoration and hurried respiration. The face usually pale, but
sometimes flushed ; the skin hot, and often bathed in perspiration,
which fails to reduce the heat. There is often pain in the head
and cerebral excitement, tending to delirium and convulsions : the
tongue is usually coated with a white or yellowish fur ; nausea and
vomiting of watery or thin bilious matter is common, and often
diarrhoea ; the thirst is often urgent : there is usually a state of gene-
restlessness, and the pulse is usually soft, feeble and compressible ',
and alv;ays freq uen t.

There is yet another form of the disease, which, although it is
frequently attended with local congestion, and in some instances
there are striking similarities in the conditions. (I mean the tvphoid)
yet if they be traced to their origin, or carried to their termination,
the differences will not be less manifest in the evidences of functional
disorder in one, than in structural derangement in the other. This

488 Holtts Letters on General Pathology, [August,.

condition (typhoid) will, perhaps, receive from us hereafter, a sepa-
rate consideration.

With regard to the inflammatory condition, which is generally
so well understood, it is only necessary to say, that in affections of
this sort the excitement usually extends itself to all parts of the ner-
vous system in a greater or less degree, and the symptoms which
distinguished it and the danger attendant upon it, are always deter-
mined by its" location, intensity and duration, and as a local affec-
tion, is characterized by heat, pain, redness and swelling, and as a
general conditionrhy a hot,, dry skin, a full strong pulse, and an inter-
ruption or suspension of the secretions.

In congestion, the depression is confined chiefly to the organic
nerves, in which the cerebral or animal nerves may participate to
some extent, from the influence of the depressing cause ; but, in gene-
ral, the depression which exists in those nerves, results from the
withdrawal of the stimulus of arterial blood. In this condition, as in
inflammation, local congestion has its characteristic signs, as great
restlessness, distress and sense of oppression, when the liver or vena
portarum is congested, lahoured respiration, when the lungs, and
stupor, when the brain is congested, and the general condition is
characterised by coldness and flaccidity of the skin7 and feebleness of
the pulse.

Having pointed out the most ostensive signs by which these
opposite pathological conditions may be recognized, it becomes
necessary to inquire into the manner of their production, and the
relation which they sustain towards these conditions, as cause and
effect. I have stated that it would be an almost endless task to
attempt an investigation into the nature of all the causes which tend,
directly, or indirectly, to produce excitement and depression ; and it
will be sufficient for our present purposes to say, that these causes,
whatever may be their nature and mode of action, do not operate
upon all the organsr systems, and tissues at the same time and in the
same manner, but operate with unequal degrees of force, and that
all diseases are made up of a regular series of cause and effect, and
all under the controlling influences which determine the general
conditions of excitement or depression. Although the brain, as the
great centre and source of nervous power, presides over all the other
organs and systems, they are not all directly dependant upon that
organ for the performance of their respective offices and functions,
such is the case with those organs which derive power from the
ganglea of the great sympathetic ; hence, disordered function in one,

1855.] Holt s Letters on General Pathology. 489

does not necessarily imply disorder in another. The excitability of
one may be increased or diminished without the other; one may be
exalted in excitement, while the other is depressed ; or both may be
exalted or both depressed. I have already endeavored to show the
influence which climate, with respect to heat and cold, exercises upon
these different portions of the nervous system, in the establishment
of a general p :>'on, as well as the production of particular

diseases and complications: and as this matter cannot be too strongly
impressed upon the attention I will repeat that., while cold tends to
give vigour or strength to the nerves which support organic life,
atmospheric heat tends to diminish it, and induce in them a state of
debility. This single proposition will serve to explain why it is,
that in northern climates, diseases often run through a long course
of high febrile excitement, while in southern latitudes, high febrile
action is comparatively of short duration and of rare occurrence,
and the organic powers are first to yield to the influence of depres-
sing causes. If climate alone is sufficient to create these distinc-
tions, there are other causes which operate to make them still more
evident, and produce the modification which I have noticed under the
different forms of pneumonia. These are embraced in the changes
of seasons, atmospheric vicissitudes, character of soil, location, habits
of life, and a thousand other things which operate with more or fess
force to depress nervous energy, the chief of all of which may be
reckoned, malaria. Both heat and cold acquire additional force in
their action upon the system, by the addition of moisture, which is
also regarded as an essential agent in the production of malaria, and
the nature of our climate and soil furnishing abundant material for
its production, as heat, moisture, and vegetable matter, it may well be
regarded as one of the most common and prolific sources of disease.
It is not indispensable to our present purpose to determine in what
manner this morbific agent is introduced into the system, being
sufficient to admit, that in whatever manner it is introduced, or on
whatever system or tissue it makes the first impression, its most evi-
dent and manifest effects are to depress the powers of the organic
nervous system.

Another common source of depression is to be found in the pro-
gress of diseases of regular exacerbations and remissions, in which,
in each successive paroxysm, the system sustains the loss of a por-
tion of its aggregate nervous power, which, progressing to a certain
extent, the depression and congestion become permanent and com-
plete. The progress in the formation of the condition, may be

490 Holt's Letters on General Pathology. [August,

observed in almost all our pyrexial diseases, whether of winter or
summer, but is perhaps more observable in our autumnal intermit-
tent and remittent fevers ; in which, in each successive paroxysm,
the cold, or congestive stage, becomes more protracted, and the hot
or febrile stage less so, until finally all effort at re-action becomes
lost in a state of general depression and congestion. This result
may at any time be accelerated by certain therapeutic agents in
unskilful hands, such as the lancet, drastic and hydragogue cathartics,
and other sedative remedies, used with the view of subduing excite-
ment, which, under the most favorable circumstances, is often not
more than sufficient to sustain the system and defend the vital func-
tions against the consequences of a general depression and conges-
tion. And, I will say, in all sincerity, that with the exception of
such cases as were indebted for their origin and existence to some
powerful epidemic influence, I have never met with a case unquali-
fiedly " congestive," which was not the result of such mismanage-
ment. But of all the causes which operate to produce depression
and congestion, there are none which operate with the force and
rapidity of those which produce epidemic or Asiatic cholera, which
disease, furnishes the most perfect specimens of congestion.

Thus far, I have considered the subject in reference to the condi-
tion of the nervous system only, but it is proper that I should enquire
also, into the part which the blood sustains in relation to the condi-
tion, as well to the constitution of the blood itself, as to its unequal
distribution. It is generally admitted, I believe, that there are par-
ticular conditions, or constitutions of the blood, connected with
diseases of inflammation, congestion and irritation ; but in what rela-
tion, whether of cause or effect, remains to be determined. That
in inflammatory affection, the blood contains an excess of fibrin; in
congestion, both fibrin and albumen are deficient, and that in irri-
tation, the fibrin is deficient and the red corpuscles are in excess.
I have cited these conditions of the blood to show, that whether
they are the cause or the effect of the particular morbid condi-
tion of the system to which they belong, they constitute sufficient
grounds, physiological as well as pathological, for the classifica-
tion which I have made of these disorders, and the presump-
tion is reasonable, that they exert an influence, both in pro-
ducing and maintaining these conditions. There is no doubt that
oft repeated, or long continued accumulations of blood in the venous
cavities, and the slow and imperfect elimination of its natural im-
purities, it becomes in a great measure, unfit for the performance of

1855.] Bozemak. Vesico-vaginal Fistula. 491

the many important offices and functions in which it is employed,
not the least of which is to sustain the energy, and impart life and
activity to the whole nervous system, and failing in this, give rise
to other and greater accumulations. If such changes are wrought
upon the condition of the blood in consequence of its accumulation
and detention in the venous cavities from depression, still greater
and more important consequences follow its accumulation and long
detention in the arterial and capillary system from excitement, which
tends, not only to depravity of the blood from interruption of the
functions of secretion and depuration, but by a species of internal
combustion, to a destruction of the vital solids, also. Under such cir-
cumstances, life will become extinct (as it were) from the rapidity
or the intensity of the combustion, and the destruction of essential
parts of the aparatus employed in the process. While, from accu-
mulations in the venous cavities, life often becomes extinct, from
sheer inanition and enervation, as a lamp will go out for the want
of oil, or oxygen to support combustion. And it is often the case in
pneumonia and other inflammatory affections, that death occurs
when there are no evidences of a sufficient amount of inflammation
to produce such a result. The effects of these unequal distributions
and accumulations of blood, will be further noticed in connexion with
the action of the heart, and the examination of the symptoms which
I have described, as belonging to these separate conditions, which
will compose the substance of my next letter.

I hope you will not consider me too prolix, as it is my desire to
be as concise and comprehensive as the nature and importance of
the subject will permit, and trusting to your patience to hear me
through, 1 subscribe, Your ob't ser'vt.

Sam'l. D. Holt.

ARTICLE XXIV.

Vesico-vaginal Fistula, with laceration of the anterior -lip of the Cervix
Uteri, of nearly six years standing cured, in two iveeks. By
N. Bozeman, M. D. (Report read before the Sydenham Medical
Society, of Montgomery, Alabama.)

The subject of this case was very kindly sent to my Infirm anT,
for treatment, by Dr. W. J. Mitchell, of Tuskegee.

Delphia, (colored woman,) belonging to Dr. Robert Howard, of
Macon county, was admitted on the 4th of April, aet. 25 ; stout, well
formed, and has the appearance of one enjoying good health ; always

492 Bozeman. Vesico-vaginal Fistula. August,

menstruated regularly, &c. In August, 1849, she gave birth to her
second and last child; has had no control over her urine since ; was
in labour nearly four days ; delivery natural ; child of medium size,
strong and vigorous ; did well, and is at present a large and healthy
boy. Presentation was vertex, so far as can be ascertained. First
labour, about a year before, lasted four days the child was still-
born, and of large size ; delivery natural, recovery speedy, &c. In
neither confinement was the patient attended by a physician.

Upon examination, I found the vagina to be very capacious a
circumstance of no little importance., as regards success, in any case,
but especially is it so when the fistulous opening is found in close
proximity to the cervix uteri. The injury sustained by the parts,
seemed, at first view, to be very extensive ; but upon further inspec-
tion, they presented a more favorable appearance. In the anterior
lip of the cervix, was to be seen a deep cleft, presenting on either
side, a considerable prominence ; at its anterior extremity, was
situated the fistula, oval in shape, and large enough to admit the
index finger into the bladder. No effort seemed to have been made
by nature to repair the cervical injury. In a case,* almost identi-
cal, which came under my observation last year, a spontaneous cure
was found to be perfect union seeming to have taken place by the
first intention, only the line of cicatrization remained, showing
very plainly the extent of the injury, and its relation to the fistulous
opening,

This difference in the results of nature to repair injuries, present-
ing the same characters influenced by the same causes, is of no
practical importance in the present instance, yet it is a fact none
the less interesting.

As to the operation, two modes of procedure very naturally sug-
gested themselves : one, was to close the fistula and afterwards the
cleft the other, was to complete the whole under one operation.
The latter, though more difficult of execution, was the one I adopt-
ed, for the reason that the patient would not require to be confined
so long.

A reparation of the cervix, I did not consider essential to the suc-
cess of curing the fistula ; still I determined to effect it, if possible, in
view of the probable results of parturition, should it occur again.
With such a deep fissure existing in the anterior lip of the cervix, it
can very readily be perceived, how much more liable this point
would be to give way under powerful uterine contractions, attended

* Xevr Orleens Med. and Surg. Jour. May No., 1854,

1855.] Bozeman. Vesico-vaginal Fistula. 493

by a reproduction of the fistula, and perhaps laceration of the uterus
itself, with all their dreadful consequences, as dribbling of the urine,
metritis, peritonitis, &c.

On the eighth day after admission, assisted by Dr. Clanton and
Mr. Duncan, a medical student, I proceeded to operate. The me-
thod employed, was that of Dr. J. Marion Sims, (who, be it to the
honor of America yea. of the world, has accomplished more in this
hitherto difficult branch of practice than any surgeon living.)

A detailed account of the different steps of the operation, I shall
purposely omit, as it would be tedious, and perhaps uninteresting ;
therefore, only a single feature of it will be presented the applica-
tion of the suture apparatus. From my description of the injury, it
will now be seen that the clamps had to be applied, with ail the
accuracy observed under ordinary circumstances, to parts totally
different in structure and function, with the view of obtaining, by
a natural and common process, a natural and common result union
by the first intention.

The dense, strong and unyielding tissuse of the cervix, had to be
made to harmonize with the erectile spongy and elastic tissue of the
vagina. In lodging the wire sutures in their respective places,
great care had to be taken that the needle was entered and brought
out at a distance from the fistula and cleft, corresponding to the
extent of elasticity or adaptation of the parts. If too far removed,
there wras danger of the edges becoming everted, and vice versa.
In neither instance, could perfect coaptation be effected a desid-
eratum indispensable to success. The difficulties and perplexities
of such a task, simple as its execution may appear, can scarcely be
realized by one who has never attempted it. Having, then, tho-
roughly freshened and shaped the edges of the injured parts, the first
suture was carried through the cervix in its lower third ; the second
was entered on a line a little exterior to the first carried across the
upper extremity of the fistula, and out at a corresponding point on
the opposite side ; the other two were entered in a similar manner,
at equal distances below. To the ends of the sutures, on the right
side, a clamp was fixed, and made to take its proper place the
upper end resting against the side of the cervix. The one on the
opposite side was arranged in a similar manner, with the proximal
ends of the sutures passing through it. Traction being now made
upon -these ends, the edges of both fistula and cleft were brought in
direct apposition. In this relation, they were maintained by com-
pressing a small shot on each suture, close to the clamp ; after which.

494 Mammary Inflammation and Abscess. [August,

the sutures were cut off close to the shot, and the patient put to bed.
The self-retaining catheter was next introduced into the bladder,
and the operation then completed.

On the day following, menstruation came on, and soon afterwards
I noticed a bloody state of the urine, and slight leakage of the blad-
der. This condition of things continued four or five days, or until
the catamenia ceased, when all unfavorable indications disappeared,
and the patient seemed to do well. That a small opening in the
bladder existed during this period, to allow of leakage and com-
mingling of the two fluids, there can be no doubt. The most re-
markable thing about it, is, that it should have closed after so long
a time.

The explanation of the result, I think, is this : A small groove
remained at the bottom of the cervical cleft, after the application of
the clamps, thus admitting a portion of the catamenia to pass along
to the upper extremity of the fistula, when it entered the bladder.
Owing to the peculiar situation of the opening, and its valve-like
form, only a very slight leakage could take place, and this, I imagine,
as a result of some effort or change of position on the part of the
patient. The urine, then, having little or no tendency to escape
here, and the edges of the opening being still in a freshened state,
union of the parts followed immediately upon the cessation of the
catamenial flow.

On the fifteenth day of the operation, I removed the clamps, when
union at all points seemed to be perfect. A small notch at the ex-
tremity of the anterior lip of the cervix, was the only evidence of
the deep cleft which had existed there. The patient was now
allowed to get up. At first, she could not retain her urine longer
than two or three hours, without experiencing some pain in the re-
gion of the bladder. This difficulty, however, gradually diminished
as the organ regained its natural tone, which it did in a few days.

Montgomery, May 10th, 1855.

On the treatment of Mammary Inflammation and Abscess. By
0. C. GrIBBS, M. D.

Inflammation of the female breast, terminating often in abscess
of a more or less troublesome character, is an affection so common
after pregnancy, as to be familiar to every practitioner. The irri-
tation and congestion which accompanj?- and succeed the secretion
of milk, often exceed the healthy standard, particularly after de-

1855.] Mammary Inflammation and Abscess. 495

liveries with first children ; the breasts become hot, tense, and
painful, to which sj-mptorns inflammation and abscess frequently
succeed. When, in case of absence of the nipple or from any
other cause, the breasts are but imperfectly unloaded mammary
inflammation is a common sequence. When the nipples become
sore, and consequently nursing extremely painful, milk is often
allowed to accumulate in the breasts, until a troublesome and
painful train of symptoms has been commenced, too often leading
to the disease under consideration. Mammary abscess is doubt-
less more common in cities than in the country. Many mothers,
filled with false and nonsensical notions of propriety, refuse to per-
form the pleasurable and sacred duty of nursing their offspring;
and this foolish disregard of a natural obligation and a holy in-
stinct, frequently entails upon the perpetrator the above mention-
ed affection of the breast, accompanied with no small amount of
suffering and pain, and sometimes death.

The suffering and constitutional disturbance, which accompa-
nies inflammation and abscess of the female breast, is by no means
inconsiderable. But few organs are subject to disease more trou-
blesome, pain more excruciating. Many women, suffer more
from diseases of the breast, after confinement, than even during
parturition. If the suffering is not as severe, it is more enduring ;
productive, ordinarily, of more constitutional disturbance, and
often more destructive to life. In view of these facts, mammary
inflammation is worthy, at the hands of physicians, of the highest
consideration, and the utmost therapeutic skill.

Of the causes and symptoms of the disease under consideration,
we do not propose here to speak ; they are sufficiently familiar to
every practitioner. Suffice it to say here, that inflammation and
abscess of the female breast, is by no means a disease peculiar to
the early period of nursing. The worst case of mammary abscess,
that ever came under our observation, occurred in a pregnant fe-
male, several weeks previous to confinement. Another case of
inflammation of both breasts, and abscess in one, that has come
under our observation, came on at the time of weaning, after fif-
teen months of continuous nursing.

In the treatment of inflammation of the breast, a great variety of
plans and remedies have at different times and by different per-
sons been proposed. It is evident that the treatment must vary
with the indications to be fulfilled by the administration of reme-
dies, and the indications are three-fold. First, to prevent inflam-
mation ; second, when inflammation of the gland is present, to effect
resolution ; and third, when suppuration cannot be prevented, or
has already taken place, to promote the rapid cure of the abscess.
1st. In preventing inflammation : simultaneous with the secre-
tion of milk, its abstraction should be commenced, and in no case
should the breasts be allowed to become much distended by re-
tained secretion. The most natural way of accomplishing this, is
by nursing the new-born child. But, in cases where the offspring

496 Mammary Inflammation and Abscess. [August,

is still-born, or in cases where nursing is considered, from good
reasons, injudicious, the breasts must be emptied by artificial
means. Whatever means be employed, the evacuation should be
so perfectly performed, as to prevent any considerable distension
of the mammary glands. In cases of absent nipple, a false one
should be substituted. These nursingrattentions7 always judicious
and appropriate, will but seldom fail in preventing the disease.
But, in case these means are neglected or prove insufficient, and
the irritation and congestion of the gland exceed the healthy stand-
ard, and pain and feverishness supervene, cooling diaphoretics
and saline laxatives, should be administered, unless counterindi-
cated by other symptoms, and the breasts should perseveringly be
kept emptied of the milk secretion, as directed above.

2d. When, from any cause, inflammation of the gland is abso-
lutely present, the treatment detailed under the first indication is
equally appropriate. And in addition, Ave have found nothing so
efficacious as the local application of iodine. We do not now re-
member of making application of this remedy early, or before
suppuration was absolutely and immediately threatened, but that
resolution was accomplished without the formation of pus. This
local remedy is not original with us, and we do not now know to
whom we are indebted for the idea. If, in subsequent cases and
in other hands, the remedy should prove as efficacious as in pre-
vious trials, it will most certainly be a most desirable therapeutic
acquisition, in the treatment of mammary inflammation. We
have thus far made the application in the form of tincture twice a-
day. We advise the whole inflamed surface, to be penciled with
the tincture and then covered with oiled silk. Perhaps the iodine
ointment would be preferable, but we have so far been so well
satisfied with the tincture, as to be reluctant to make a change.

3d. If from the neglect or insufficiency of the above mentioned
treatment, suppuration should be unavoidable, poultices should be
-employed, and when established, the pus should be thoroughly
evacuated. The abscess should never be allow'ed to break of it-
self, for, in this event, pus is apt to borough in the glandular struc-
ture of the organ, sinuses to form, extending the boundaries of the
disease, until the constitution severely suffers from the extent of
the suppurating surface. So soon as matter is detected, the breast
should be opened sufficiently free to effect its complete evacuation.
From a neglect of this direction, suffering is often very much en-
hanced, and the duration of the disease very much protracted.
After the pus is evacuated, the breast should be thoroughly com-
pressed, by the means of adhesive straps, so as to bring the walls
of the abscess into coaptition, prevent the retention of pus, and
facilitate the occlusion of the cavity. These directions are of par-
amount importance. If early opening and proper compression
were universally resorted to, we are of the opinion that bad and
protracted cases of mammary abscess would be extremely uncom-
mon.

1855.] ,%/<>> of II 497

When sinuses do form, they should also be freely opened, and,
in the event of the al ailing to speedily heal, the cavity

should be injected with a solution of iodine, of appropriate strength,
in connection with compression.

Beef-tea and tonics should be employed, when the suppuration
is considerable, depressing materially the powers of the system.

By faithfully fulfilling the first indication, very many cases of
mammary inflammation maybe prevented; by fulfilling the se-
cond, abscess of the breast may be rendered less frequent; and by
attending to the third, much of suffering may be prevented and
convalescence earlier established. [Western Lancet.

f 'Heart Disease.

1. That cases of valvular affection may be divided into two class-
es, in one of which the disease has been produced by inflamma-
tion, while, in the other, it appears to arise independently of this
condition.

2. That in the first class of eases, a period arrives in which, al-
though the disease is progressive, there is no evidence of its being
of an inflammatory nature.

3. That hence it is generally improper to persist in an antiphlo-
gistic treatment of valvular disease beyond a certain period of
time.

4. That the determination of the actual seat and nature of a
Valvular disease is of less importance than that of the vital and
mechanical state of the heart.

5. That a permanently patent state of the orifices is the ordina-
ry result of all valvular diseases. This condition may or may not
be attended with contraction, or the orifices may be dilated.

6. That the period when inadequacy of the valves supervenes,
varies greatly in different cases.

7. That hence, two series of phenomena may occur ; in the first
we have the signs of disorganization without inadequacy : in the
second those of inadequacy are added,

8. That the distinctness of valvular murmur cannot be taken as
being proportionate to the amount of disease.

9. That a complete cessation of murmur may coincide with the
advance of the disease.

10. That the cessation of murmur, under these circumstances,
has been only observed in connexion with contraction of the ori-
fice ; it has not been observed in cases of free regurgitation.

11. That absence of murmur does not necessarily imply absence
of valvular disease, especially if there be symptoms of disease of
the cavities.

12. That the number of cases in which we are warranted in
making a special diagnosis of valvular disease is small.

13. That the number of pathological conditions competent to

498 Signs of Heart Disease. [August,

cause such changes in the valves as will produce murmur is very
great.

14. That in the earlier periods of valvular disease, murmur
may not occur, although the disease be progressive.

15. That even in chronic cases, the development of murmur
may be sudden.

16. That the disorganizing process may advance with great rapi-
dity, or with slowness, and that, in some cases, it appears to be
really arrested.

17. That the irregular action of the heart is much more related
to the state of the cavities than to that of the valves.

18. That we may observe the sudden development of the symp-
toms as well as of the physical signs of chronic disease of the heart,

19. That three conditions of the heart, considered in its vital
relations, may accompany or follow valvular disease : -

1. Increased force of the heart.

2. Diminished force, with rapidity and irregularity of action.
3. Diminished force, with remarkable slowness and compara-
tive regularity of action.

20. That the law which regulates the production of the alteration
of the cavities, which follows on valvular obstruction, with or
withont inadequacy, is still undetermined.

21. That considering the rarity of organic change in the valves
at the right side of the heart, and the difficulty or impossibility of
their special diagnosis, we may in a practical point of view, limit
our considerations to the diseases of the mitral and aortic valves.

22. That in the diseased and permanently patent condition of
the valves of the pulmonary artery, a double murmur at the base
of the heart, not propagated into the aorta, and not attended with
general arterial throbbing, has been observed.

23. That in most cases of organic disease of the valves at the
right side of the heart there is either an open foramen ovale, or a
deficient ventricular septum.

24. That the most frequent result of disease of the right auriculo-
ventricular valves is but the exaggeration of their natural insuffi-
ciency.

25. That we cannot by the ordinary acoustic tactile signs de-
termine the existence of dilatation of the right auriculo-ventricular
orifice.

26. That reflux pulsations in the veins of the neck, and occa-
sionally in those of the upper extremities, indicate regurgitation
into the right auricle.

27. That hence they may be taken as indicating the insufficiency
of the valves, and may have, as their remote cause, morbid condi-
tions of the pulmonary artery, the luug, or the left side of the heart.

28. That of these different lesions the most frequent is contrac-
tion of the mitral orifice.

29. That the venous pulse thus produced may be permanently
present, or only developed during an attack of cardiac asthma.

1855.] Signs of Heart Disease. 49

30. That the pulsations in the jungular veins are synchronous
and isochronous with the ventricular systole.

31. That we must not depend on any acoustic character of the
murmur, nor even on its exact seat, for the diagnosis of valvular
disease. It is requisite to combine with these considerations those
of the history and symptoms of the case, as well as those which
have reference to the state of the pulse, the force of the heart, and
the condition of the lung and liver.

32. That all diagnostics depending solely on the toner character,
and seat of murmur, are more or less doubtful.

33. That although by acoustic signs we may often determine the
insufficiency of a valve, yet there are no means by which, from
the stethescope alone, we can declare the cause of that insuihcien-

34. That the diagnostics between the contraction and dilatation
of any of the orifices, founded on acoustic phenomena, are to be
rejected.

35. That organic and anaamic murmurs may co-exist.

36. That there are no distinctive symptoms of disease of the
mitral valves, when it is uncomplicated with alteration in the vital
or mechanical state of the cavities.

37. That its principal plrysical indication is a murmur which is
systolic, but not propagated into the arteries, and loudest towards
the apex and to the left side. This may or may not be attended
with fremitus.

38. That the most common result of contraction of the mitral
opening is pulmonary congestion, with enlargement of the right
cavities of the heart.

39. That under these circumstances, from the preponderance
of the right ventricle, a globular form of the heart may be produ-
ced.

40. But a globular form of the heart may exist with a dilated
mitral opening, attended with enlargement of the left ventricle,
while the right remains unaffected.

41. That the combination of a contracted state of the mitral
opening, with permanent patency of the aortic valves, is of fre-
quent occurrence.

42. That under these circumstances, we may occasionally ob-
serve both the aortic and the mitral murmurs.

43. But that the absence of a mitral murmur,/ in a case of per-
manent patency of the aortic valves, does not necessarily imply
that the auriculo-ventricular opening is free from disease.

44. That in cases of mitral contraction moveable coagula may
be formed in the left auricle, which may, by occlusion of the open-
ing, become a cause of sudden death.

45. That with the progress of contraction, the mitral murmur
may gradually subside, and ultimately become extinct, so that
with the increase of disease, we may have decrease and cessation
of murmur.

500 Protosulphaie of Iron in Erysipelas. [August,-

46. That this cessation of murmur may coincide with a perma-
nently patent though contracted opening.

47. That inasmuch as most cases of mitral murmur are systolic,
they are to be held as regurgitant. We cannot by acoustic signs,
distinguish between the direct constrictive and the regurgitant
murmur.

_ 48. That the interscapular murmur may attend constriction or
dilatation of the mitral opening, but appears- more allied to the
latter than to the former condition,

49. That the interscapular murmur may be consequent on a
recent and acute disease of the heart.

50. That the existence of a presystolic murmur, which theoret-
ically should imply that it attended the passage of blood from the
auricle into the ventricle, does not justify the diagnosis of absence
of regurgitation through the mitral orifice.^ -[Stokes on Diseases
of the Heart and Aorta. Western Jour, of Med. and Surgery.

On the Application of Protosulphaie of Iron in Erysipelas. By M.
Yelpeau.

M. Yelpeau observes, that true erysipelas is constantly confound-
ed with other inflammations (viz., phlebitis, diffuse phlegmon
of the cellular tissue, and angioleucitis,) which differ from it in
their causes, seat, progress, danger, and treatment. A prolonged
consideration of the nature of the affection has led him to lay
down the following propositions,

1. Erysipelas, taken in its surgical sense, has its predisposing
cause much oftener in external atmospheric, or meteorological,
influences than in the state of health, or general constitution of
the patient. 2. The determining or occasional cause is, almost
always a wound, scabs, or some irritation of the integument. 3,
Its efficient cause is, matter proceeding from without, or altered
tissues, which mingle primarily or secondarily with the fluids of
the part affected. 4. The fluids so affected induce general and lo-
cal phenomena. The first occur before the second when there is,
at the beginning, a passage of the fluids into the general current
of the circulation. The order of occurrence is reversed when the
change only takes place through imbibition. 5.- The fluids in the
inflamed skin, altered by the morbific element, only seem to cir-
culate or advance, by endosmosis the erysipelas still, however,-
spreading itself along the dermis like oil upon a plain surface. 6.
A large proportion of the morbific matter remains to the end un-
der the epidermis, or in the cutaneous tissue, mingled with the
blood in the inflamed part. 7. The totality of the erysipelas is al-
most constantly formed of several small successive erysipelases.
8. An isolated patch of erysipelas ordinarily disappears, of its own
accord, in six or eight days. 9, The duration of the entire dis-
ease is very variable, according to the number of erysipelas patches

1855.] External Use of the Acid Nitrate of Mercury. 501

that may succeed or combine with each other. 10. The remedies
employed, whether external or internal, to be capable of dissipa-
ting such a disease, should especially possess the power of modify-'
ing the condition of the blood.

If. Velpeau furnishes us with the results of the different forms
of treatment he has employed in above 1,000 caseSj in 400 of which
he has kept exact notes. In 25 patients, compression by bandages
was resorted to, with no advantage. In S3 flying blisters were ap-
plied, without diminishing the mean duration of the disease ; these
proving advantageous only in certain cases of phlegmonous erysi-
pelas and angioleucitis. No satisfactory result followed the em-
ployment of nitrate of stiver in 30 cases. In 200 cases, mercurial
ointment was resorted to, with the effect of sometimes diminishing
the duration of the affection by a day or two, and rendering it a
little less painfuL It is, however, very repugnant to the patient,
spoils the linen, and sometimes induces salivation. Lard employed
in 23 cases, although not causing these inconveniences, was found
even less efficacious. A variety of other substances have been
tried by M. Velpeau, but, as he found them useless or injurious,
we need not advert to them.

Calling to mind the modifications which the preparations of iron
produce in the blood, it seemed to him that a disease so supern>
cially placed, and one in which the inflamed tissues are so im-
bibed with altered fluids, was well calculated to be influenced by
by ferruginous preparations. He employed the protosulphate of
iron in the proportion of 30 grammes to the litre of water, (1 drachm
to 5 fluid ounces,) or 8 parts to 30 of lard. In fort}' cases in which
this was tried the erysipelas yielded in from twenty -four to forty-
eight hours. It is, however, remarkable, that when thus extin-
guished at its point of departure, it will still spread beyond this,
along parts already imbibed with the iron. Whether the inflam-
mation, in order to undergo modification, requires to become fully
developed, and whether the remedy is merely curative without
being preventive, further researches must show, More easily em-
ployed to some parts, the ointment would be preferable ;' but it is
somewhat less efficacious than the lotion. When used it should
be applied three times a day to the erysipelatous patch, and some'
way beyond its margin. The lotion should be applied hy means
of compresses, which are to be kept on with bandages, and wetted
every few hours, so as to keep the skin always moistened. Thus
far the remedy has never failed in cutting short the erysipelas;
but it has a disadvantage in iron-moulding the linen. \Bulletin
de Therapeulique. London Medical Times and Gazette*

External Use of the Acid Nitrate of Mercury,

A solution of the nitrate of mercury in strong nitric acicf is in
Very common use at the Hospital for Cutaneous Diseases, and con-
stitutes a very convenient form of caustic, Its formula is -fy. Hy-

N. S. VOL. XI. NO. IX. 32

502 External Use of the Acid Nitrate of Mercury. [August,

drargyri lj, acidi nitrici (specific gravity 1.50) iij; solve. The
solution produced is a clear, colourless fluid. The following may
^be mentioned as some of its chief uses :

In Carbuncle. Mr. Startin usually applies the caustic if the car-
buncle be of not more than moderate size, to but one central spot,,
where it is freely painted for an extent of about a shilling in size.
Its effect is to produce an eschar, from beneath which the core after-
wards escapes.

In Acne. A very minute drop of the acid is placed by means of
a finely-pointed glass brush, on the apex of any indolent tubercles,
whether suppurated or otherwise. It has the effect of opening the
pustule, if matter have formed, and if not, induces the disappear-
ance of the induration. The application is followed only by a little
smarting pain, and if it have been carefully made leaves no scar.

In Boils. There can, we think, be little doubt as to the superior-
ity of the caustic treatment over that by the knife, even in the case
of very large boils. The pain of the incision, the large sore caused,
and the unsightly scar which follows, constitute very formidable
drawbacks to a practice for which there is no real necessity. At
this hospital, where cases of boils are very common, the knife is
never resorted to. The general treatment consists in giving aper-
ients and steel conjointly, and the local in applying to the apex of
the furuncle a full-sized drop of the acid nitrate solution. The
morbid action generally terminates coincidently with the applica-
tion, and the core is thrown off through a comparatively small open-
ing, the resulting cicatrix being insignificant.

In Lupus. The acid nitrate is one of the most efficient and con-
venient forms of caustic in this disease. Mr. Startin does not,
however, employ it solely, but uses also the biniodide of mercury,
and a paste of which arsenic is the principal ingredient. The acid
nitrate is chiefly used in indolent tubercles, and to indurated patch-
es not actually ulcerated. After ulceration has occurred the ar-
senical paste is preferred.

For Sloughing Ulcers. The practice of treating unhealthy ulcer-
ations, wherever situated, by means of caustics, is much pursued at
this hospital, and with excellent results. The pain attending the
application of nitric acid has been much overrated by the profession
generally, and its use has consequently been avoided in many in-
stances in which it wTould have been efficient to completely change
the course of the morbid action and induce healthy processes. Its
powers in cases of phagedena are now widely recognized, and its
use will probably soon extend to various other kinds of ulceration
of somewhat similar nature, but much less severity. The pain
spontaneously caused by an unhealthy sore during a single night is
probably much more than that produced by an application of caus-
tic. In most cases of sloughing or unhealthy ulcers, Mr. Startin
employs either the solution of the acid nitrate or the arsenical paste
just referred to. The rapidity with which the surface granulates
afterwards is often surprising.

1855.] Treatment of Spermatorrhcea. 503

In Moles, Xceui, etc. Small moles on the face, if superficial and
not too thick, may be readily destroyed by the acid nitrate. A
cicatrix of course results, but it is small, and far less unsightly than
the original disease. Small cutaneous nsevi are often treated both
at this and the various other London Hospitals, by means of the
nitric acid. Unless the disease be of very small extent, the em-
ployment of a ligature appears to be a much more certain means of
effecting the end desired. If there be a subcutaneous base to the
morbid structure it often persists in growing, despite frequent appli-
cations of escharotics. There is a mild form of dilated cutaneous
capillaries which produces the marks known as " port-wine stains,"
'spiders,'" etc.. in the treatment of which much benefit may be ob-
tained by the dexterous application of fluid caustics. With a finely
pointed glass brush, charged either with nitric acid or the acid
nitrate of mercury, the tortuous vascular trunks should be severally
painted, a minute streak of the caustic being thus left along the
whole course. In this way, by repeated applications, the whole of
the larger vessels may be destroyed, and the disfigurement, to a
large extent, diminished The "port-wine stain1' is of course very
much more difficult to remove than the less diffused forms of this
condition, such, for instance, as are of frequent occurrence on the
cheeks or nose ; even in it, however, much benefit may by patient
treatment be gained. [Medical Times and Gazette.

Treatment of Spermatorrhaia.

M. Trousseau thinks that the advantages of Lallemand's porte
caustique have been considerably overrated, and that there are only
certain cases in which its use is productive of benefit. It is very
useful where chronic urethritis co-exists with the spermatorrhcea ;
but where that is absent, he thinks we ought to trust to other modes
of treatment more suited to the cause of the disease.

The excessive debility induced by spermatorrhoea demands our
most serious attention. If. in serious cases, we find neither ureth-
ritis nor cystitis present ; if we discover neither calculi nor ascari-
des, nor any other thing which can explain the persistence of the
emissions, we ought to ask ourselves whether the disease does not
depend upon a condition of the vesiculae seminales analogous to the
spasmodic state of the bladder in certain forms of incontinence of
urine. Puerile enuresis is not due to atony of the bladder, or to
any undue accumulation of urine, but to a spasmodic condition of
the bladder. The same phenomenon occurs in the vesiculae semi-
nales; and belladonna, which acts so beneficially in the case of the
bladder, is also very useful in this other spasmodic condition. M.
Trousseau prescribes accordingly, in such cases, powders contain-
ing each 1 centigramme of the powdered root of belladonna, mixed
with sugar. He orders one to be taken daily during the first week
of treatment ; two daily during the second, and so on until the pa-

504 Sleep and Anaesthesia by Compression, Augtrsff

tient experiences a sensation of dryness in the throat. At the same
time, he orders frictions of the perineum with an ointment compo-
sed of 10 grammes of the alcoholic extract of belladonna to 20
grammes of axunge. If necessary, he also uses suppositories con-
taining each 10 centigrammes of the extract belladonnas.

M. Trousseau doubts the utility of cold hip-baths in this affection.
They may do good the first time they are used, but although they
may temporarily arrest venereal excitation in nymphomania and
priapism, this calm disappears on the occurrence of reaction, and
the evil is increased.

Heat acts in an opposite manner. Hence M . Trousseau believes
that, in cases where erotic feelings are conjoined to spasm of the
vesiculae seminales, it is the best sedative which we can employ
simultaneously with belladonna. The form in which he employs it
is that of bags of heated sand, which he applies to the perineum for
a few minutes, morning and evening. The simultaneous adminis-
tration of lupulin may be very beneficial ; but, where we desire de-
cided anaphrodisiac effects, M. Trousseau recommends, on account
of the certainty and efficacy of its action, the bromide of potass, in
doses of from 15 grs. to 3ss. daily. [Monti dy Jour, of Med. Science
from Jour, de Med. et de Chirurg. Prat

Note on the Induction of Sleep and Ancesthesia by Compression of
the Carotids. By Alexander Fleming, M. D., Professor of Ma-
teria Medica, Queen's College, Cork.

While preparing a lecture on the mode of operation of narcotic
medicines, I thought of trying the effect of compressing the carotid
arteries on the functions of the brain. I requested a friend to make
the first experiment on my own person. He compressed the ves-
sels of the upper part of the neck, with the effect of causing imme-
diately deep sleep. This experiment has been frequently repeated
on myself with success, and I have made several cautious but suc-
cessful trials on others. It is sometimes difficult to catch the ves-
sels accurately, but once fairly under the finger, the effect is imme-
diate and decided.

There is felt a soft humming in the ears, a sense of tingling steals
over the body, and in a few seconds, complete unconsciousness and
insensibility supervene, and continue so long as the pressure is main-
tained. On its removal, there is confusion of thought, with return
of the tingling sensation, and in a few seconds consciousness is re-
stored. The operation pales the face slightly, but the pulse is little,
if at all, affected. In profound sleep the breathing is stertorous, but
otherwise free. The inspirations are deeper. The mind dreams
with much activity, and a few seconds appear as hours, from the
number and rapid succession of thoughts passing through the brain.
The experiments have never caused nausea, sickness, or other un
pleasant symptom, except in two or three instances, languor. The

1855.] Fumes of Asphaltum as a Preventive of Cholera. 505

period of profound sleep, in my experiments, has seldom exceeded
fifteen seconds, and never half a minute.

The best mode of operating is to place the thumb of each hand
under the angle of the lower jaw, and, feeling the artery, press back-
wards, and obstruct the circulation through it The recumbent po-
sition is best, and the head of the patient should lie a little forwards,
to relax the skin. There should be no pressure on the windpipe.

The internal jugular vein must be more or less compressed at
the same time with the carotid artery ; and it may be thought that
the phenomenon is due, wholly or in part, to the obstructed return
of blood from the head. I am satisfied that the compression of
the artery, and not of the vein, is the cause. The effect is most de-
cided and rapid when the arterial pulsation is distinctly controlled
by the finger, and the face loses somewhat of its colour ; and, on the
other hand, is manifestly postponed and rendered imperfect when
the compression causes congestion of the countenance.

This mode of inducing anaesthesia is quick and certain. The
effects diminish immediately w7hen the arteries are relieved from
pressure, and are not liable to increase, as happens sometimes from
chloroform and ether, after the patient has ceased to respire the
vapours. So far as my experience goes, it has shown no tendency
to cause faintness ; and usually, after its employment, no unpleasant
feeling whatever remains.

I think it may be found useful as a remedial agent in certain
headaches, tetanus, asthma, and other spasmodic diseases, and to
prevent pain in such small operations as the extraction of a tooth
or the opening of an abscess. Whether the compression can be
continued with safety sufficiently long to make it available in larger
operations, has to be ascertained. But, whatever be the practical
value of this observation, it is at least interesting as a physiological
fact, and may be the means of throwing light on the causes of ordi-
nary, medicinal, and hypnotic sleep, and of coma. Some facts en
courage the supposition that the circulation of the brain is languid
in ordinary slumber, and the etymology of the word carotid shows
the ancient belief in the dependence of deep sleep on some interfer-
ence with the passage of the blood through these vessels; and it is not
an unreasonable conjecture, that hypnotic sleep may be sometimes
caused or promoted by the contracted muscles and constrained po-
sition of the neck compressing the carotid arteries, and diminishing
the supply of blood to, and pressure on, the brain. [British and
Foreign Med. Chir. Review. Charleston Med. Journcd.

Fumes of Asphaltum as a Preventative of Cholera.

Dr. Mitchell, of Trinidad, communicates some singular facts with
reference to the recent visitation of Cholera. "Nearly the whole
island suffered, but the swampy and febrile districts were generally
last attacked, and suffered least. There was one exception ; the
Lake of La Brea (" the pitch lake") escaped altogether, although in-

506 Regeneration of Tendons. [August,

habited by a poor and unhealthy community. In the town of San
Fernando, a quantity of asphaltum had been thrown under and
around a house ; the inmates of that house alone escaped the Cholera.
The badly- ventilated cells of the prison of San Fernando are floored
with asphaltum ; no case of cholera occurred. Is, then, asphaltum
a preventive?"

The asphaltum lake of Trinidad, as most persons are aware, is a
circular basin of about a mile in diameter, situate on high ground
near the sea. In warm weather it is liquid at the top, and exhales
a strong odour ; at other times it is soft and ductile ; sometimes hard
and of conchoidal fracture, like other bitumens. It is considered to
be the true asphaltum bitumen of Linnaeus. .

I well remember that during the first invasion of cholera it was
remarked that the persons employed in all the gas works enjoyed a
remarkable exemption from cholera ; so much so that, as was affirm-
ed, not one of them had been attacked. Is there not here a con-
nection between this observation and the facts stated by Dr. Mitch-
ell ? It seems to me that there is, and of too striking a character to
be overlooked. The coal-tar of the gas works, when evaporated, is
in fact asphaltum.

It is for the consideration of the faculty, may not public fumiga-
tions of infected localities by burning large quantities of coal-tar in
the streets or roads, be an adjuvant to good scavenging? May not
the volatilization of asphaltic fumes from a hot shovel in houses
where cholera exists, assist the efforts of the physician? Tar va-
pour is an old prophylactic, and perhaps is not without its use.
Coal-tar is of a nature not very different.

In so formidable a disease as cholera, the proposal of a new reme-
dy may, it is true, involve a fearful responsibility ; but a suggestion
supported by probability, unattended with danger, and not in the
least interfering vicariously with such means as have been found
efficient (if such there be,) is surely warrantable, and deserving of
consideration. [Dublin Med. Press.

Regeneration of Tendons.

Boner has instituted some experiments on the regeneration of
tendon, for which purpose he made sections of the tendo-Achillis in
the rabbit, and examined the parts at various times after the date of
section. He finds that when a plastic exudation takes place, the
walls of the sheath of the tendon become united, and finally degene-
rate into a thin solid string, the use of the tendon becoming perma-
nently lost. On the other hand, when an effusion of blood takes
place, perfect union of the divided parts is subsequently brought
about. The effused blood coagulates very soon, the blood-corpus-
cles become disintegrated, the fibrin softens, and, after a couple of
davs, the whole presents a homogeneous, here and there granular,
appearance. On the fourth day, the blood-corpuscles have almost
completely disappeared, the whole mass being uniformly red, and

1855.] Particular Method of Applying Cauterization. 507

filled with granules ; round cells, with large indistinctly-bordered
nuclei, begin to be seen, but soon lose their rounded form, and be-
come elongated, the nuclei assuming a spindle shape. In eight to
ten days, the coagulum has become almost completely white, the
cells are very delicate in outline, and thin prolongations are thrown
off from them, which here and there may be traced connecting one
cell with another. The intercellular substance shows a clear longi-
tudinal striation, which is more marked each day. and the whole
coagulum more and more assumes the appearance of a true tendon,
the tendinous tissue being completely organized about the end of the
second week ; it is not, however, tilf the fourth week, or even later,
that the normal strength and consistence of tendon are assumed.

Boner concludes from his investigations that the structure of ten-
don, like that of the cornea, is made up of flat stellate cells, or a
fibrous intercellular substance. [Med. Chlrurg. Rev* from Vtrchow's
Archive. American Jour, of Med. Sciences.

Particular Method of Applying Cauterization for the Reunion of
Anomalous Fissures, and especially those of (lie Palate.

M. Cloquet proposes, in divisions of the velum palati, to take ad-
vantage of the great amount of retraction which occurs in the cica-
trix consequent on burns.

We need not in such cases, says M. Cloquet, cauterize the edges
of the fissure throu^out their whole length, converting them into a
granulating sore, the cicatrization of which must be afterwards as-
sisted bv sutures,' appropriate bandages and the maintenance of
correct adaption. This method, long known to the profession,
sometimes succeeds, but often entirely fails. The one which I pro-
pose, adds M. Cloquet, consists in applying the cautery to the angle
of the fissure, and that only to a limited extent ; leaving the con-
traction of the cicatricial tissue to operate, and then, practising a
similar cauterization, and waiting for some time to renew the appli-
cation in such a way as by repeated operations to bring the edges
of the division towards each other, and to unite them by a succes-
sion of cicatrizations which may be regarded as so many succ
points of suture. The double advantage is thereby gained of being
thus enabled to watch, step by step, the results of the treatment,
and to obtain unions of the most difficult nature by an operation,
simple, scarcely painful, and exempt from all danger. It is especial-
lv in fissure of the palate that M. Cloquet considers the advantages
of this mode of operating as incontestable, and he mentions four
cases in all of which the operation had been attended with equally
successful results. There had been no pain felt, no change in
habits or regimen necessary, and no complications had arisen. The
operation was of the most simple nature, every surgeon could per-
form it. It required the aid of no assistant, an advantage of great
importance in country practice ; anil, lastly, it could be practised
on very young children. One objection urged against this method

508 Mercury taken from the System by Electricity. [August,

was the length of time required for completion of the cure, but the
slowness of its action constituted its safety, and the inconvenience
arising in this way was very small, as the patient experienced no
alteration in his health or habits during its progress.

The cauterization may be effected by two different means ; name-
ly, either by caustics or the actual cautery. M. Cloquet states that
in the first of those cases where he attempted this method, he used,
as the cauterizing agent, the acid nitrate of mercury, and succeed-
ed completely, However, he prefers the actual cautery, its action
being deeper, almost instantaneous and consequently less painful,
while it occasions a more firm cicatrix, and one which becomes
more rapidly organized. The three other patients were treated in
this manner, and the results obtained confirmed his opinion on this
point. An almost insurmountable obstacle to its employment
might be, however, occasionally met with in the terror of the pa-
tient. But, fortunately, science provides us with a means of obvia-
ting this inconvenience ; as a platina wire introduced within the
mouth, before the electric circuit is completed, cannot excite the
patient's alarm, and as it can afterwards by this means be brought
to a white heat, and be kept incandescent for any length of time,
the surgeon is enabled to act with all the calmness and precision
desirable. [Monthly Jour, of 'Med ',, from Gaz. Medicaid

A Great Medical Discovery -^Mercury taken from the System by
Electricity.

The following article is taken from a Western paper :

The following will be received with intense interest in every
community where suffering of any kind is produced by metallic
substances being introduced into the system in the way of mercury,
gold, silver, or lead. If it is practically true, as scarcely any one
can doubt, under the circumstances, it is destined to rank among
the greatest discoveries that science has yet brought to light.

The article which follows, published in the Scientific Bulletin of
Paris, is entitled " The Application of Chemical Electricity to
Therapeutics,', and has been translated for this paper. Though not
literal, the substance of the article is intact. The Bulletin says :

Chemistry is about to drag from an anticipated death thousands
of men, who, in the exercise of their cruel professions gilding,
looking glass plating, white lead manufacturing, &c, and also those
whose systems have been ruined by mercury in its various forms
for these science has raised her right arm and arrests their misery
and destruction. This discovery extracts from their bodies, atom
by atom, every particle of metallic substance from every part of the
human system. Where do we get this great hope ? In a memoir
presented to the French academy of sciences by M. Dumas, which
has for its authors two men, wThose names will strike the ear of the
public for the first time to-day. But if they prove what they pro-

1855.] Mercury taken from the System by Electricity. 509

mise to, they will soon take rank among the greatest benefactors of
humanity. * These authors are Andre Poly of Havana, and Maurice
Vergenes. The invention consists of an application of chemical
electricity to accomplish the above purpose ; and of all the marvel-
lous things that electricity has achieved, this is the boldest and most
triumphant.

The modus operandi is as follows :

A metallic bath is insulated from everything, and partially filled
with acidulated water, to convey more readily the electrical cur-
rents. The patient lies upon a seat in the tub insulated entirely
from the bath. When gold, silver or mercury is in the system,
nitric or hydrochloric acids are employed. When lead is suspected
the acid used is sulphuric. This done, the negative pole of a batte-
ry is put in connection with the bath, while the positive pole is in
the hands of the patient. Now the work of purification commences.
The electricity precipitates itself, hunts, digs, searches, and discov-
ers every particle of metallic substance concealed in the most
profound tissues, bones, joints, and nerves of the patient, resolves
them into their primitive forms, and extracting them entire from the
human organism, deposites them upon the sides of the bath, where
they can be seen with the naked eye.

After the end of one of these operations, a chemist of Havana,
M. Mossand, having analized 912 drachms of the liquid in the bath,
he saw forming a metallic globule of the diameter of nine-tenths of
a milimetre, and this wTas mercury. At another time the same
chemist saw a very light white precipitated substance, which gave
two globules of metallic lead, perfectly visible to the naked eye, and
M, Poly announced that he had taken from the tibia and thigh bone
of a patient, a quantity of mercury that had been there, creating in-
tense suffering for fifteen years.

Providence has had its usual hand in this discovery. One of the
inventors, M. Maurice Vergenes, who was engaged at times in elec-
tric gilding, silvering, &c, where his hands came in continued con-
tact with the nitrate and cyanuret of gold and silver, had them
covered with ulcers, caused by particles of the metal being introdu-
ced into his blood, and no medical skill could eradicate them. One
day he dipped his hands into the bath, taking hold of the positive
pole of the battery, and at the end of fifteen minutes, to the surprise
of the bystanders, a metallic plate of 163 milimetres in length by 109
in width placed in connection with the negative pole of the battery,
was instantly covered with a thick coat of gold and silver extracted
from his hands. The discovery was made. This event took place
April 16, 1852. The inventors use 30 couples or batteries or Bun-
son's and Grove's combined, it being found that a more energetic
current will be evolved by this combination than by the use of
either singly. Each couple is 40 milimetres in diameter by 217 in
height. The number of these couples or batteries used at the com-
mencement of an application, so as not to cause too much suffering
for the patient, depends altogether upon the temperament of the

510 Administration of Chloroform to Children. August,

patient and the nature of the disease. For example, a very nervous
and delicate person would be submitted to the action of ten or
twelve couples at first, the number increased at the rate of five cou-
ples every five minutes. A person of sanguine or lymphatic tem-
perament can endure more. The same ratio applies to the quality
of acid in forming the bath ; for instance it takes less for a nervous
person than for a person with lymphatic or sanguine temperament.
The metallic particles extracted from the body of the patient are
deposited on the whole surface of the bathing tub, although the
metal is formed in larger quantities opposite those parts of the body
in which the metal lay concealed. As to the size of the metallic
spots which are thus formed by the application of this discovery,
they vary in size from that of the head of a pin to the size of a pea,
and some are microscopic.

" I have seen," says M. Poly, " after the first bath of a person who
had been complaining of terrible pains in his arms, caused by mer-
cury, the exact shape of the arm imprinted on the negative plate of
the battery the deposite being formed entirely of mercury drawn
from the arm."

Here ends this important article, which, if true, is destined to
become as much a part of the medical practice as vaccination.

[Stethoscope.

The Administration of Chloroform to Children. By M. Deb out.

While advocating the employment of chloroform in intense chorea,
endangering life itself from the violence of the movements, (cases
of which are not uncommonly met with in the Paris hospitals,) M.
Debout takes occasion to advert to the precautions to be observed
in its administration to children. Having frequently employed it
in considerable quantities, he has never observed any ill effects
result, not even, indeed, the slighter inconveniences that occasion-
ally attend its use in the adult. We must always bear in mind,
however, that at the commencement of the inhalation in chorea. and
other spasmodic diseases, an increase of the muscular movements
takes place, the child sometimes offering very great resistance ; but
by persevering a calm is speedily induced. As a general rule, the
child is soon rendered insensible, and the sleep may continue ten,
fifteen, or even thirty minutes. Such prolongation need give rise
to no uneasiness, as the pulse and respiration will be found quiet and
regular, and the countenance that of a child in a natural sleep.
Usually the child wakes suddenly, looks around it as if astonished,
and then gets up to play or to eat. Headache and the feeling of
stupor which in some adults persist for the entire day, are not met
with in children ; and, indeed, as far as the production of effects of
this kind upon the general system are concerned, children can
inspire larger quantities of chloroform than adults. We hardly
ever find the loss of appetite so frequently met with in the adult,
children often eagerly demanding food, and not rejecting it. Their
power of tolerance is certainly greater.

1855.] Digitalis Pommade in Hydrocele. 511

Before administering it, we should be sure that the stomach is
emptv. in order to prevent the production of nausea or vomiting,
which fatigues the little patient and induces a disgust for the means
employed. We should pay great attention to the pulse and respira-
tion. As a general rule, the pulse, which from the efforts made
during the administration of the chloroform is accelerated, becomes
slower during sleep, to rise again when that ceases. From fifteen
to twenty-five pulsations less may be often noted during sleep. The
disturbed respiration soon becomes as regular as in natural sleep.
Care must be taken that it be not impeded by ligatures or articles
of dress, and if the room is small, fresh air should, as soon as sleep
is secured, be freely admitted. By attending to these rules even
considerable quantities of chloroform may be administered without
fear, if no organic lesion contra-indicates its use.

M. Debout employs merely a compress twisted as a cone, cutting
a small hole in the apex, and' securing in this orifice a piece of fine
sponge. Upon this, from oiiss. to 3 v. of chloroform are poured;
and the base of the cone can be applied to the mouth and nostrils
without alarming the child, or the risk of hurting it in following its
various movements. [Bulletin de Therpeutique. Virginia Medical
and Surgical Journal.

Digitalis Pommade in Hydorcele.

Last spring, an Italian surgeon named Bellucci published ac-
count of five cases of hydrocele cured by the external use of digita-
Little attention was paid by surgeons to these results ; but very
recently M. Laforgue, chief surgeon in the Hopital de la Grave, at
Toulouse, has made trial of the new mode of treatment, and found
it to be as efficacious as was alleged by M. Bellucci. A man set.
60, had a large hydrocele of the right testicle, and being unwilling
to submit to the usual operation, besought M. Laforgue to trv some
other method. Daily friction of the tumour was ordered with the
following ointment : R. Pulv. folior. digitalis, 6 grammes ; axung.
30 grammes; misce. The patient was also ordered to wear a sus-
pensory bandage. In a few days, the man presented himself com-
pletely cured. He had enjoyed excellent health during the process,
and had used, in all, 18 grammes of the powder of digitalis. Gaz. des
Hopitaux. American Jour, of Med. Sciences.

jnent of Vaginitis.

The Union Medicale of Jan. 18th, contains an interesting paper
by MM. Becquerel and Rodier, on the different modes of treatment
employed in vaginitis, founded on observations made at the Hospi-
tal of Lourcine. at Paris. Although no description is given of the
disease, we presume that most of the cases were those of acute and
chronic gonorrhoea, as the hospital is designed exclusively for the
treatment of the venereal diseases of women. The following appli-

512 Treatment of Otorrhoea. [August,

cations were employed for a considerable length of time upon a
large number of patients. I. A concentrated solution of nitrate of
silver. 2. A more diluted solution of the same (16 parts of the salt
to 120 of water.) 3. The solid nitrate of silver. 4. Tincture of
iodine. 5. An ointment composed of lard and alum. 6. A concen-
trated solution of tannin. 7. Benzia, employed internally, as well
as locally. Of all these applications, the writers consider the con-
centrated solution of tannin (equal parts, by weight, of tannin and
distilled water), applied directly upon the inflamed mucus mem-
brane of the vagina, to be the best, as being the least painful, and
least offensive. Of 28 cases treated in this way, all were cured,
the average time being from 20 to 27 days, and the number of appli-
cations from 7 to 8. The tincture of iodine was found to be an
excellent application for chronic and acute vaginal leucorrhoea, not
accompanied by an inflammatory condition of the mucous mem-
brane ; requiring between 12 and 13 days, and 4 or 5 applications.

[Boston Med. and Surg. Jour.

New Method of Treatment for Otorrhoea. By James Yeaesley, Esq.,
Surgeon to the Metropolitan Ear Infirmary, &c.

I come now to mention the manner of applying this remedy.
First of all, the passage of the ear is to be carefully cleansed by gent-
ly syringing it with warm water, and the moisture removed by
means of a porte-sponge. The parts are now to be so clearly dis-
played by the aid of a powerful gas-reflector, that the necessary
manipulations may be readily and accurately accomplished, when I
take a small piece of dry cotton the size of which varies according
to the circumstances of the case and adjust it by gently pressing
down every part of it upon the surface from which the discharge
proceeds, exactly as if dressing an ulcer on any other surface of the
body ; this done, quiet is enjoined, restricting, as much as possible,
every movement of the jaw, such, for instance, as takes place, in
eating and speaking. Twenty-four hours afterwards I remove this,
and apply another dressing of the cotton. The importance of res-
tricting the patient from moving the jaws will be at once manifest,
if the reader will take the trouble to place the point of a finger in
the passage of the ear, and read aloud the present paragraph. It
will then be perceived how easily the cotton, however accurately
adjusted, may be loosened and moved from its state of exact appo-
sition. In eating, this detachment takes place still more readily, yet
the patient cannot be debarred all use of the jaw, seeing he must
have food ; nor if great care be taken to keep the jaws in a state of
motionless apposition, need speech be altogether interdicted ; but
for the same reason the food should be such as to require no masti-
cation.

The successful treatment of external otorrhoea by the same sim-
ple means has been hitherto no less rapid than certain. Moreover,
in nearly every case, relief of the deafness has accompanied the ces-

1855.] Cod-liver Oil and Cocoa*Xut Oil, 513

sation of the discharge a result the reverse of that which follows,
almost invariably, the treatment of external otorrhea by astringent
injections. The arrest of the discharge may,, indeed, by such means,
be accomplished in many instances without any great difficult} : but
when that has been effected, we have no great reason to rejoice at
a cure that has been produced at the expense of the patient's hear-
ing. [London Lancet.

The Changes Produced in the Blood ly the Administration of Cod
Liver Oil and Cocoa-Xut Oil. By Dr. Theofhilus Thompson
F. R. S., Physician to the Consumption Hospital at Brompton.

The author has found, that during the administration of cod-liver
oil to phthisical patients their blood grew richer in red corpuscles,
and he refers to a previous observation of Dr. Franz Simon to the
same effect. The use of almond-oil and of olive-oil was not fol-
lowed by any remedial effort ; but from cocoa-nut oil, results were
obtained almost as decided as from the oil of the liver of the cod,
and the author believes it may turn oat to be a useful substitute.
The oil employed was a pure cocoa oleine, obtained by pressure
from crude cocoa-nut oil. as expressed in Ceylon and on the Mala-
bar coast from the Copperah or dried cocoa-nut kernel, and refined
by being treated with an alkali, and then repeatedly washed with
distilled water. It burns with a faint blue flame, showing a com-
paratively small proportion of carbon, and is undryin^. The
analysis of the blood was conducted by Mr. Dugald Campbell. The
whole quantity abstracted having been weighed, the coagulum was
drained on bibulous paper for four or five hours, weighed, and
divided into two portions. One portion was weighed, and then dried
in a water-oven, to determine the water. The other was macera-
ted in cold water until it became colorless, then moderately dried,
and digested with ether and alcohol, to remove fat ; and, finally,
dried completely, and weighed as fibrin. From the respective
weights of the fibrin, and the dry clot, that of the corpuscles was
calculated. The following were the results observed in seven dif-
ferent individuals affected with phthisis in different stages of ad-
vancement :

Red corpuscles. Fibrin.

First stage, before the use of cod- j Female, 129-26 .... 4*52

liver oil, (Male, 116-55 .... 13-57

First stage, after the use of cod- j Female, 136-47 .... 5-00

liver oil, (Male, 141-53 . , . , 4*70

Third sta^e, after the use of cod- (,ri -, 0 ->, * . -~*

liver OS, jMa,e< 13Si1 2-2

Third stage, after the use of co- j Male, 139-95 . . . . 2-31

coanut oil, ( Male, 144-94 .... 4-6 T

[Virginia Med. and Surg. Jour.

514 Editorial and Miscellaneous. [August,

EDITORIAL AND MISCELLANEOUS.

A Practical Treatise on the Diseases and Injuries of the Urinary Bladder,
the Prostate Gland, and the Urethra. By S. D. Gross, M. D., etc., etc.
2d edition. (For sale by T. Richards & Son.)

WTe are indebted to the publisher for the second edition of Prof. G.'s
valuable Treatise. It contains a considerable amount of new matter, and
is, therefore, still more worthy of the extensive patronage enjoyed by the
first edition. Diseases of this group of organs are so common, as well as
important, that every practitioner ought to be well supplied with books of
reference on the subject, than which none in our language is better than
the one before us.

The Pathology and Treatment of Leucorrhoea. By W. Tyler Smith, M. D.,
<fcc, &c. Philadelphia: Blanchard & Lea. 1855. (For sale by Rich-
ards & Son.)

This is an enlarged edition of the work that first appeared in the Medico-
Chirurgical Transactions, of England. Dr. Smith has devoted more atten-
tion to the interesting subject of which he treats, and, although we may
not be prepared to endorse all his views, we heartily commend the work
to the attentive perusal of the Profession. It is highly instructive, and
well written.

A Pocket Formulary and Physicians Manual, embracing the art of com-
bining and prescribing medicines to the best advantage ; with many
valuable Perils, Tables, dr., adapted to the Profession throughout the
United States. By Thomas S. Powell, M. D., of Sparta, Georgia.
Savannah: AY. Thorne "Williams. 1855.

This work will be found to contain many things of value to the Pro-
fession, particularly to the younger members. The work would have been
more valuable had the author given his authority for each recipe.

Pamphlets received : Thoughts on Yellow Fever. By J. S. McFarlane,
M. D. New Orleans. Pustule Maligne : an Inaugural Essay. By Dan-
iel Wadsworth Wainwright, of New York city. A Paper on Protracted

Valvular Disease of the Heart. Read before the Society of Statistical

Medicine, by John W. Corson, M. D. New York. Lectures on Uterine

Displacements. By B. Fordyce Barker, M. D., Professor of Midwifery and
Diseases of Women in the New York Medical College. Statistics of In-
juries of the Heart : Observations on Wounds of the Heart, and their rela-
tions to Forensic Medicine, with a table of forty-two recorded cases. By

Samuel S. Purple, M. D., etc., etc. Rushton's Treatise on Cod Liver Oil,

giving its curative properties and uses in various diseases. Introductory

Lecture, to the Third Annual Course of the Metropolitan Medical College.
By Henry A. Archer, M. D. The Address, delivered at the Commence-
ment of the Savannah Medical College, March 13th, 1855. By Henry

1855.] Editorial and Miscellaneous. 515

"Williams, Esq. Together with a large number of Catalogues and Circu-
lars.

The Atlanta Medical and Surgical Journal. The first number of this
Journal will be issued on the 1st September next edited by Professors
Joseph P. Logan. M. D., and W. F. Westmoreland, M. D. Terms : |
per annum. We wish the gentlemen much success in their very arduous
enterprise.

Fleming's Hygienic Journal to be published monthly, in Atlanta :
edited by W. R. Fleming, M. D. Terms. 82 00 per annum. The first
number will be issued on the 1st August. This Journal promises to be of
much utility, not only to the Profession, but to the public generally. "We
hope the Editor's labors will be appreciated.

Continued Lactation, of Children by Sick Mothers. Alf. Mercier quotes
the following cases : In one instance, a mother sick of typhus fever con-
tinued to nurse her child, fourteen months old, without injuring it. In
another case, a mother sick with yellow fever continued to nurse her child,
eleven months old, also without bad effect. Presse Med. de Paris.

M. Guillot remarks, that a disease beginning in the last stages of gesta-
tion, or the first after confinement, is no indication for the interruption or
discontinuance of nursing. Presse Med. Beige. [Amer. Med. Monthly.

Formula for the Internal Use of Chloroform. M. Dannecy, pharma-
cien at Bordeaux, recommends the following formula : Pure chloroform,
half a drachm ; oil of sweet almonds, two drachms ; gum arabic, one drachm ;
syrup of orange flowers, one ounce ; distilled water, two ounces ; mix the
chloroform with the oil, and make an ordinary oily draught. The author
also gives a very ready mode of testing the purity of chloroform. Mix the
latter with some oil ; if the chloroform be quite pure, the limpidity of the
oil will not be destroyed ; whereas, any chemical impurity, however small,
will give rise to a cloud. [London Lancet.

Calculus adherent to Bladder by means of a Needle. By J. Simon. Esq.
Mr. Simon, a few days ago. performed the operation of lithotomy on a boy
about 6 years old. After removing the calculus, he felt something in the
bladder, which, on removal, proved to be the head half of a needle. The
other part of the needle was found in the calculus. Mr. Simon supposed
that the needle had been introduced from the rectum, and that the portion
which projected into the bladder had served as a nucleus for the calculus.

[Association Med. Journal.

A Remedy for Animal Parasites. Our readers are probably aware that
benzin or benzole is a clear, colourless fluid, possessed of a pungent ethereal
odour, which is produced by the decomposition of benzoic acid, or other
organic substances, at a light temperature. It was long ago ascertained by
Milne Edwards, that its vapour was very fatal to insects. This property
has led M. Reynal, of the veterinary school at Alfort, to employ it for the

516 Miscellaneous.

treatment of pedicular maladies among* animals. He has found that it
destroys the parasites in these diseases, more surely, and with more safety
to the animal, than tobacco-juice, mercurial ointment, or any other of the
many remedies used. It destroys the epizoa without at all injuring the
skin. It is proposed to use this fluid in the paracitical diseases of tfie hu-
man skin, especially in pityriasis, or morbus pedicularis, and in scabies.

V [Dublin Medical Press.

Formula? for Protosulpfiate of Iron in Erysipelas, Bv M. Debout.
M. Debout, in allusion to the local application of sulphate of iron in erysipe-
las, recommended by MM. Velpeau and Devergie, (see Medical Times and
Gazette for March 10,) states that the following formulae are of approved
value :

The Ointment. Sulphate of iron, - - 5 to 10 parts.
Water, - - - - - 121 " 25 "

Oil, ------ 121 " 25

Lard, - - - - * 70 " 40 "

100 . 100

The Solution. Sulphate of iron, - 10 to 20 or 40 parts.
Water, - - - - 120 " 110 " 90 "
Glycerine, - - - 70 " 70 " 70 "

200 200 200
[Bull, de Therap. Lon. Med. Times and Gaz.

A Radio-Utndr Ligament lately discovered. M. Denuce, in a thesis "on
the luxations of the elbow-joint," lately published, mentions, among other
things, that near the annular ligament, in which plays the head of the
radius, he has, by his dissections, discovered another ligament of about four
inches square, inserted, on the one side upon the neck of the radius, and
on the other, upon the inferior margin of the lesser sigmoid cavity of the
ulna. He calls it ligamentum quadratum radio-ulnare / it is supposed to
limit the movements of pronation and supination. [London Lancet.

Belladonna in Salivation. A woman treated by mercury, internally and
externally, for serous diarrhoea, was affected with profuse salivation. Dr.
Erpenbeck treated this latter complaint with belladonna in divided doses,
of two- grains and a half, taken in emulsion every twenty-four hours. Next
day the salivation had subsided, and the mouth was quite dry. On stop-
ping the belladonna, the salivation returned, and again ceased when it was
resumed. [ Western Med. Journal.

Hare-lip. The " earliest operation for hare-lip is reported by Mr. Doug-
las in the London Lancet. He attended the mother in her labor. The
child having single hare-lip he operated on it two hours after birth, using
fine sewing needles instead of pins. The hemorrhage was trifling. The
child was kept from the breast three days; on the fourth, the needles were
removed, union by the first intention having ensued. He reasons thus on
the propriety of early operation " That infants bear much injury during
birth without fatal results, and they can be made to fast three days after
birth, the secretion of milk not occurring usually for that time." [ Virginia
Medical and Surgical Journal.

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

Vol. XI.] SEW SERIES. SEPTEMBER, 1S55. [No. 9.

ORIGINAL AND ECLECTIC.

ARTICLE XXV.

A glance at the "Reply" of Silas Ames, 31. D., to "Experiments
with Phosphorus,11 &c. By Wm, M. Boling. M.D. (Abridged
by the author, from the New Orleans Medical and Surgical Jour-
nal, for March and May, 1855.)

In the New Orleans Medical and Surgical Journal, for January
1854, is a paper by Silas Ames, M. D., on Pneumonia, in which
phosphorus, in a certain form and mode of administration, is spoken
of as a remedy. In the May number following, of the same jour*
nal, are published some experiments by myself, with the article in
question ; and in the November number, is a Beply by Br, Ames.
(Kepublished in the Southern Med. and Surg. Journal, for April
and May, 1855.) This reply is now under examination in the
course of which it may possibly be deemed proper, to revert to
the paper on Pneumonia.

Doctor Ames commences by saying: "The experiments thus
prompted, led Dr. Boling to three principal conclusions/

*' First. That phosphorus is not a sedative.

11 Second. That it is not a stimulant ; and,

" Third. That it is not poisonous when given in an alcoholic
solution.'7

These conclusions, though it perhaps might not be very unsafe
to admit them, especially the first, are not mine, though so stated
by Dr. Ames, who also says that they are "broadly expressed'' in
my paper ; which, however, I cannot find to be the case. The first
object of my experiments, it will be remembered, was to ascertain
whether phosphorus, given in the form of alcoholic tincture, in

Jf. S. VOL. XI. NO. IX. 33

518 Boling's Reply to Dr. Ames. [September,

certain doses mentioned, and administered in a certain manner, was,
as stated by Dr. Ames, a sedative. In the course of the experi-
ments, it become an object to ascertain whether, second, the
same article, administered in the same manner, and in certain
doses also mentioned, was stimulant,, indirectly however, and
through a local irritant action upon the stomach. In regard to-
phosphorus in no other form than in that of the tinctures spoken
of by Br, Ames, and in his doses, administered as in his prescript
tionf with water, did I feel myself called on to give an opinion ;.
nor yet a to what might be its action when given in a form
to secure the administration of a known definite dose, and one
sufficient to produce an appreciable effect. In view, then, of
the aim with which my experiments were instituted, had I deemed
it proper to have "broadly expressed" the conclusions that I
thought might fairly be deduced from them in the form of propo-
sitions, they would have been somthing like the following :

First. That the alcoholic tinctures of phosphorus, prepared as
those used by Dr. Ames were, and administered in the manner
spoken of by him, and in the doses in which they are asserted by
him to be so, are not sedative-
Second. That the articles, so prepared and administered, are
not stimulant,, indirectly through a local irritant or poisonous ac-
tion upon the stomach,, in the doses in which it is asserted by Dr.
Ames that they are so.

Third, That the alcoholic tinctures used by Dr. AmesTjare not,
probably, the best preparations of phosphorus, " by which to secure
with any certainty its full and peculiar operation, whatever this
may be, upon the system ;" which latter proposition is stated in
my former paper. This opinion is sustained by other, and high
authority. In a note by A, Dechambre, of Paris,, editor of the
" Gazette Hebdomadaire de Medecine et de Chirurgier" to a trans-
lation of my paper on phosphorus, published in that journal, is 1lie
following remark " Ce travail est important comme establissant
a 1'aide d'experiences, ce que la chimie permet d'affirmer d priori.
Le tinture alcoolique de phosphore est une tres mauvaise prepara-
tion, encore moins chargee en principe actif que ne le suppose
l'auteur lui meme." But, to return :

The conclusions, then, not being mine, not made by myself, but
by Dr. Ames for me, the examination might very legitimately be
closed at this point ; but it may not be uninteresting in a cursory
manner to pursue the subject further.

1855.] Bolixg's Reply to Dr. Ames. 519

Doctor Ames objects to my experiments with healthy subjects,
on several grounds ; among others, for the reason, as he says, that
sufficient care was not taken to " avoid those normal causes influ-
encing the state of the pulse, which being common to all persons,
of whatever age, are almost constantly in operation during our
waking hours." Such being the case, it Would be a most difficult
matter, even with reasonable care, to avoid the causes alluded to
entirely, nor does it seem probable that they could have been in
all of my experiments, more actively in operation, than in those of
Dr. Ames. Indeed, on the contrary, it would seem probable that
the disturbing causes were less numerous in some of my expert
ments, than in his. We are not informed, at least, by Dr. Ames,
what were the precautions taken by himself to avoid the causes, in-
fluencing the state of the pulse, so constantly, as he says, in opera-
tion ; and with the sick especially, so calculated to lead to doubtful,
or possibly even erroneous conclusions.

Doctor Ames further objects because, as he concludes, there
was influencing my subjects, some " other cause" than those just
alluded to, "operating more powerfully to disturb the pulse."
It would be curious if such were in reality the case ; that both of
the subjects selected, should have thus been operated on by some
mysterious influence, escaping my observation, different from the
influences generally in operation upon others. Possibly it was
so; and without the evidence of a series of experiments upon
other subjects, exhibiting the condition of the pulse at different
intervals, I would not be willing to give a positive opinion to the
contrary; while in the absence of any such series of experiments,
one could scarcely be certain of being right, in giving a positive
opinion in the affirmative.

This objection of Dr. Ames, it is proper to state, is based upon
certain variations in the pulse in my subjects at different inter-
vals, from unobserved or apparently inappreciable causes. Dr.
Ames does not refer to any authority or experiments to show that
the variations of the pulse to which he objects are unusual, but
merely remarks that physiologists are " universally silent" as to
such changes. His affirmative conclusion, therefore, would seem
to be deduced from a negative premiss. In referring to an in-
stance in which the pulse was found quicker at one time, than it
had been at an earlier hour in the day, Dr. Ames says : " we find
the usual order of the diurnal change reversed, the pulse increas-
ing in frequency, instead of diminishing, as the day advanced,"

520 Bolingts Reply to Dr. Ames. [September,

The time of counting the pulse last, was during the digestion, as
was evident from the report, of a hearty dinner, which may pos-
sibly have had something to do, it would be but reasonable to sup-
pose, with its accumulation at the moment. Professed physiolo-
gists, however,, are by no means unanimous as to this " usual order
of the diurnal change,'7 referred to by Dr. Ames; and with the
reversal of which he is so much dissatisfied. On the contrary,
M. Eochoux, (Die, de Med.) speaking of the pulse, says, "En gene-
ral sa frequence augmente graduellement dhi matin au soir." So,
too, Dr, Bostockr referring to certain experiments upon the pulser
says : "we are however,, scarcely able to draw any conclusion from
them, except that the pulse is less frequent in the morning, and
that it has a general disposition to become more frequent, as the
day advances.'7 In certain experiments performed by Dr.. J. M,
B. Harden, of Georgia, the pulse was generally found to be more
frequent in the afternoon, than late in the evening, at nightr or in
the morning, Now, the hour at which the pulse of my subject
was felt last and found more frequent than at a previous counting,
and from which Dr, Ames sajs the " usual order of the diurnal
change was reversed" was 4 o'clock, P. M. The average range of
the pulse in Dr, HardenTs experiments wasr at 7 a, m., 64, and at
3 p. m.r 79, It would seemf then, that not in my subject, but in
the imagination of Dr, Ames, was the " usual order of the diurnal
change reversed/7 and in view of some of the opinions held by him,
in regard to the manner in which the pulse should act, it would
not by others, probably, be regarded as at all strange,, if at times
he should meet with the record of examples in which it did not
act in accordance with them, or to suit his fancy.

Though there are but few experiments that I can find on record,,
calculated to elucidate the question, physiologists,, it appears, are
not "universally silent" as to very much such changes in the pulse,,
in persons in healthy as were objected to in my subjects by Dr.
Ames. In the experiments of Dr. Harden, very considerable
variations from what would be regarded as its average or more
common standard,, are to be found. On the 8th of November, the
subject being recumbent, the pulse mr at 7 a, m., 6O7 at 1 p. m., 65 ;
at 3 p. mn 72 ; at 7 p. im, 64 ; at 11 p. m., 54. On the 9th, at 7 a
m., 58 at 1 p. m., 70; at 3 p. m., 80; at 11 p. m.r 60. On the
16th, at 7 a. m., 60; at 1 p, m., 72; at 3 p.m., 70; at 7 p.m., 60;
at 11 p. m., 54;, Neither, in all cases, are the usual appreciable
disturbing influences found to produce the variations that might

1855.] Bolikg's Reply to Dr. Ames. 521

be expected Thus, while at 1 p. m.. on the 7th, the pulse is at
64; after a ride of 10 miles, at the same hour on the 9th, it is at 70,
the subject having been at rest While at 3p.nL, of the 4th,
after an ordinary dinner, the pulse is 87, on the 2d, at the same
hour, under apparently similar circumstances, it is 72, and on the
loth, at the same hour, 68, At 7 p. m., on the 7th, the pulse is 72:
at the same hour on the 8th, it is 64, At 3 p. itl, of the 8th, it is 72:
at the same hour on the 9th, it is 80. The want of accordance, too,
in the relative frequency of the pulse, as felt at different times in
these experiment?, in the different positions, is very considerable,
and indicative in itself, of variations, from trivial or inappreciable
causes. Thus, while on the 3d. at 7 a. ra., the pulse is 60 lying,
60 sitting and 68 standing ; on the following day, at the same hour,
it is, in the different positions, 60, 68^ and 80. While at 7 a. m.,
on the 4th, it is 59 lying and 71 sitting ; at 3 p. rm, of the 10th,
it is 74 lying and 72 sitting. While at 11 p. m., on the loth, it is
54 lying and 68 standing: on the 16th, at the same hour, it is 54
lying and 68 standing. While at 7 p. m., of the 16th, it is 60
lying and 70 standing ; at the same hour on the 15th, it is 60 lying
and 80 standing.

As the indications of the presence of this " other cause," what-
ever Dr. Ames may have supposed it to be, appear to be about the
same in these experiments of Dr. Harden, as in my own, and as
there is no little probability that any such mysterious influence
should have been present, in the circumstances under which they
were made, the influence naturally arises, that the thing is alto-
gether a suggestion of the Doctor's own imagination a creature
of his fancy having otherwise no real existence.

Dr. Ames seems to think it very strange that, on one occasion
in my experiments, when the boy Sam took 500 drops of alcohol,
his pulse, counted an hour and a half after, was' not found to be in-
creased in frequency. According to the experience of Dr. Ames, if
very large doses of quinine larger even than may be necessarv,
when given in disease, to reduce the frequency of the pulse twenty,
forty, or even fifty beats in the minute be given in health, " it
may be that the pulse will not be affected at all, and is just as like-
ly to be made faster as slower.'1 Xow, if the pulse may present
such very eccentric variations, as a general thing, under and from
the action of a remedy so powerful as quinine, as it would appear
from the result of Dr. Ames' experience with the article that
it does ; sometimes ruot varying at aU, sortieiimes rising arod sometimes

522 Boling's Reply to Dr. Ames. [September,

falling under its influence, without the presence of this "other
cause," may we not suppose it equally possible, that, as an occa-
sional thing, or in a solitary instance, a moderate dose of a stimu-
lant remedy might fail to be followed by an accelerated action of
the heart.

In instituting my experiments on phosphorus, it was my wish to
ascertain whether the action of the article as recommended by Dr.
Ames, was sedative, as he states it to be, or not, and I conducted
them, as seemed to me at the time, in such a way as was likely to
bring the matter to a fair test On one point I was careful ; to
wit : that the circumstances should be as near as possible the same,
when the experiments with and without the phosphorus were made
. the administration of the latter excepted' and in some of them,
if not all, it will not be doubted, I think, that the causes referred
to, were as certainly and as effectually avoided, as it is probable
they were or could have been, in the experiments of Dr. Ames.
If the sources of fallacy are at times difficult to avoid in experi-
ments on the healthy subject, the sources of doubt must be more
numerous and much more difficult to avoid in the sick, laboring
under violent acute disease, where the real antecedents of any
change are often so uncertain. Here, in addition to most of the
disturbing influences in action upon the healthy subject, there are
many others and important ones in operation, calculated to lead
to doubt. On this account, experiments upon the health}' subject,
where some of these disturbing influences may be avoided, have
been regarded as a legitimate means, not always conclusive, of
course, of confirmation or contradiction in regard to the supposed
operation of articles of the materia medica of new ones more es-
pecially. Such experiments are of course more necessary, and of
more value and importance, in regard to articles, whose influence
upon the s}^stem is not manifested by any very striking or charac-
teristic indications, such as will make the presence of their opera-
tion observable above, and as it were, in spite of other disturbing
influences ; and in some parts, at least, of Dr. Ames last paper, we
are led to think, even as he views them, the evidences of the opera-
tion of his remedy, are neither very striking, conspicuous, nor
characteristic.

Doctor Ames speaks of phosphorus as a sedative, but he gave it,
in his experiments, in conjunction with quinine and aconite, two
very powerful sedatives, under the operation of which, the influ-
ence of another sedative agent, unless of extraordinary power,

1855.] Boling^s Reply to Dr. Ames. 523

would certainly not be very apparent, while a part of the influ-
ence of the former might very readily be ascribed, in mistake, to
the latter, especially by an observer prepossessed with the belief
that this was curative, and through a sedative action. He speaks,
too, of its producing considerable disturbance of the stomach,
shown by u nausea or vomiting, burning heat and a feeling of op-
pression at the epigastrium,'' &c.- which symptoms, as a result of
his remedy, would be easily appreciable under other circumstances,
but less readily in experiments such as he made with it, which
were mainly in a disease in which the symptoms enumerated
are frequently present ; the article being given, too, in conjunction
with another remedy aconite well calculated to develope several
of them, even when not already existing. How, with certainty,
then, discriminate between the " nausea or vomiting," &c, suppo-
sed to be produced by the phosphorus, and the same as produced
by the other agents given in conjunction with it, or as occurring
in connection with or growing out of the disease itself? or be cer-
tain that the part attributed to it, might not belong to other causes?
To determine a question thus rendered doubtful, it would, of
course, greatly aid to administer the remedy under circumstances
in which the causes of doubt should be as much as possible avoid-
ed ; for instance, as in my experiments, to the well. That no
such results as those attributed to phosphorus by Dr. Ames, follow
its use, even in doses so much larger than those used by him, where
the other probable causes of the symptoms mentioned, are not in
operation in conjunction with it, shows, it would seem very clearly,
that they had their origin under other influences, and that, errone-
ously, they were ascribed to it

In the paper of Dr. Ames, on Pneumonia, his estimate was, that
the quantity of phosphorus held in solution to the ounce of his
mother tincture, was about four grains. In the course of my ex-
periments in the administration of phosphorus, I instituted also
some experiments with it with the view of testing its solubility
in alcohoL From these I arrived at the conclusion, that the quan-
tity held in solution in an ounce of the saturated tincture was a-
bout one grain ; which would make the dose recommended by Dr.
Ames, about the one- sixteen-thousandth part of a grain ; suppo-
sing the patient to receive at the time of administration, the full
amount of phosphous contained in the alcohol before its combina-
tion with the water, which, however, there is good reason to believe
is never the case. In his reply, Dr. Ames gives the particulars of

524 Boling's Reply to Dr. Ames. [September,

some experiments performed at his suggestion, from which he ar-
rives at the conclusion that his saturated tincture contains about
six grains to the ounce ; which would make his dose, somewhere
between the one-two-thousandth and the one-three-thousandth part
of a grain, but nearer the latter than the former certainly not itself
a very formidable looking quantity instead of the one-sixteen-
thousandth, at which I had estimated it.

The plan adopted in these experiments by Dr. Ames, was differ-
ent from that pursued in the preparation of the tincture used by
him prior to the publication of his paper on Pneumonia, and was as
follows : a given, known quantity, of phosphorus, previously re-
duced to powder, by the process of Leroy, was placed in several vials,
containing each an ounce of anhydrous alcohol, and after being
digested for some time, the portion remaining in each was again
weighed, and the quantity held in solution, estimated by the loss.
The experiments were performed during the summer season.

There was an obvious, and indeed, as performed, unavoidable
source of fallacy in the experiments of Doctor Ames, growing out
of the impossibility of estimating precisely the loss in weighing the
powder after digestion ; the weight being modified or affected by
the degree of moisture, as also by the quality of the fluid alcohol
or water with which it might be moistened, the loss by combus-
tion &c; for it would be very difficult to collect and weigh all the
remaining powder in a dry state, owing to its combustibility, es-
pecially in the heat of summer. Indeed, the inequality of the re-
sults in the different experiments of Dr. Ames, would seem con-
clusive as to the inaccuracy of the process.

Satisfactory and conclusive as to me were my previously perfor-
med experiments, on the appearance of the reply of Dr. Ames, I
had some others made among them the following and as it will
be seen, in such a manner as to secure any advantages the process
he adopted could possibly have, with the avoidance of the several
sources of fallacy, necessarily pertaining to it. The alcohol used,
which I had considerable difficulty in procuring of such purity, on
being tested, was found of sp. gr. 794, at 60 F.

On the 19th of November, one grain of phosphorus was placed
in a vial, which was afterwards carefully sealed, containing a fluid
ounce of this alcohol. It was then carefully digested several hours
in a water-bath, the temperature of which varied during the time,
from 110 to 150 F., till the solution was complete, and then set
aside to cool On examination, a day or two after, a very apprecia-

1855.] Bolin'g's Reply to Dr. Ames. 525

ble quantity of phosphorus was found precipitated in the form of a
granulated powder.

This, I think, cannot be regarded otherwise than as conclusive,
that the saturated tincture does not contain or hold in solution, a
grain to the ounce, during our usual fall and winter weather. A
portion perhaps of all of the precipitate mentioned, it is but reasona-
ble to suppose, may be redissolved during the warm weather of the
coming summer, but again precipitated in the fall; the quantity
held in solution, depending greatly, of course, upon the tempera-
ture. But, viewing the matter as connected vjith the treatment of Pneu-
monia, which is a disease of the v: inter rather than of the summer
season, the strength of Dr. Ames1 saturated tincture should be es-
timated, not by the quantity of phosphorus that may be dissolved
in the alcohol by digestion or held in solution during the heat of
summer, but by the quantity that it will hold in solution during
the winter season. The estimate made in my former paper, as to
the quantity of phosphorus, as regards the purpose in view, contain-
ed in the ounce of the saturated tincture, then, to- wit, one grain,
from which it follows that Dr. Ames' medicinal dose is the one-
sixteen-thousandth of a grain, is not too low.

The experiment given, enables us, none I think will doubt, to
estimate with as much accuracy as the subject is susceptible of,
the size of Dr. Ames' medicinal dose ; unless we could also fall
upon some method of ascertaining with precision the quantity lost
by evaporation, in the combination of the tincture with water
preparatory to its administration ; when, possibly, it would be dis-
covered that it was reduced to about nothing.

Dr. Ames tells us that prior to the publication of his paper on
Pneumonia, he had not made the size of his dose a subject of in-
quiry. This, even without such an avowal, is the conclusion that
would probably strike almost every person at once, on making an
estimate of his dose ; and with many, if not all, it would be diffi-
cult to resist the impression that, had he made it a subject of in-
quiry before the publication of his paper, he might have been
thereby led to hesitate to hold back awhile to make further in-
stigations and variations of his experiments ; among other things,
perhaps, to have made trial of his dose upon the healthy subject,
where the possibility of mistaking phenomena connected with the
disease, or resulting from the operation of other remedies, for the
effects of the phosphorus, might be avoided ; and in the event of
his so doing, also, that he might have been led to such a modifi-

526 Boling's Reply to Dr. Ames. [September,

cation of his opinions relative to his remedy and its dose, as would
have prevented the promulgation of the " new medical fact."

It would be difficult, I think, after a perusal of the details of my
experiments, notwithstanding the ingenuity of Dr. Ames' objec-
tions to them, to resist the impression that phosphorus, as admin-
istered by him, is not a sedative ; and in the Reply he tells us that
he never said it was much of a sedative. Let us see how this com-
pares with the tenor of what is said on the subject, in his paper on
Pneumonia; first however, presenting what he says in his Reply
on the subject, in his own language.

"By referring to my paper on pneumonia," he says, "it will be
found that I have never spoken of phosphorus as an active sedative
agent over the action of the heart. In all that is there said of the
dose of phosphorus, no mention is made even of its sedative powers;
and this it may be seen, is in striking contrast with what is said of
the saturated tincture of aconite, in speaking of the dose of that
article. As regards the latter, a great deal of pains was taken to
point out that its remedial and poisonous action was the same,
namely, sedative, and that on this account great caution was requi-
red in giving it." He further says, that his references to it as a
sedative, were made, in attempting to account for its curative ac-
tion, and that its sedative is spoken of only in connection with its
medicinal action, which is contrasted with its poisonous action,
which is not sedative.

Now, in the present discussion, it could scarcely be deemed a
material point, whether the sedative action ascribed to phosphorus,
was spoken of by Dr. Ames in connection with the dose or not ;
though he certainly placed it under its more appropriate head, in
treating of it while engaged in his explanation of the modus operandi
of the article. Dr. Ames tells us that he took a great deal of pains
to point out that the remedial and poisonous actions of aconite were
the same, to- wit, sedative, " and that on this account great caution
was required in giving it." Well, he certainly took as much pains
to point out that the remedial and poisonous actions of phosphorus
were not the same; in fact, that they were "antagonistic;" the one
being sedative the other, indirectly stimulant, in consequence of
a local irritant action upon the stomach ; " and that on this account
great caution was required in giving it." But surely there is no
proof in all this presented, that he did not attribute to it a decided
sedative action. The latter he did not speak of as dangerous to be
sure, because it was limited by the former. Thus : "Its sedative

1855.] Boling's Reply to Dr. Ames. 527

or contra-stimulant, is its medicinal or therapeutic effect. Its
poisonous effect is the reverse of this, namely, highly stimulant by
reason of the local inflammation it excites. In this way is brought
about the antagonism between its effects in large and small doses."

Its medicinal or therapeutic effect, Dr. Ames seems to think, is
very considerable a great remedy, " equalled by but one other"
in pneumonia and this is its sedative effect, which, ergo, it follows
as a matter of course, he must also regard, as very considerable.
Again "There is a point at which it ceases to be medicinal or
sedative, and becomes poisonous or stimulant. Thus, it is not pos-
sible to produce by it, the extreme depression which follows large
doses of aconite, for when the dose is enlarged for this purpose be-
yond a certain point, a new and opposite action is immediately set
up, by which the power is lost." " Unlike most other therapeutic
agents, its medicinal and its toxicological actions are in a certain
degree of the development of the latter, antagonistic, so that m pro-
portion as its toxicological powers are brought into exercise, so are
its medicinal virtues diminished, and thus it is found that its cura-
tive effect is not in the ratio of the quantity administered."

That the sedative action of phosphorus, as he claims, was not
represented by Dr. Ames, as existing to a poisonous extent, is
most surely the case ; but for the very good reason that, according
to his explanation of the various effects of the article, and its
modus operandi, a stimulant or poisonous action, counteracting the
sedative action, would be developed before the dangerous point of
sedation could be reached, owing to the very prompt and powerful
local irritant influence upon the stomach, should the dose necessa-
ry to produce the proper manifestation of its sedative action
be moderately exceeded. It would be impossible, therefore, to
sink or be lost in the yawning charybdis of sedation, because the
scylla of stimulation, growing out of the local irritant influence
upon the stomach and bowels, was always rearing its destructive
breakers in the way. But the inference from the remarks of Dr.
Ames, presented fairly, is, that were it possible to so administer it
as to avoid this irritant action upon the stomach in large doses, or
if in any case, from any cause whatever, such action might fail to
occur, the dose being carried beyond the limit of its medicinal
sedative operation, then, under the above explanation, what terri-
ble depression might we not anticipate ! Did any such operation
pertain to the remedy, it ought, of course, to proceed to a poisonous
extent, whenever it being exhibited in large doses this counter-

528 Boling's Reply to Dr. Ames. [September,

acting effect failed to be developed ; and in degree proportionate
with the augmentation of the dose, up to such point. If but mod-
erately manifested under a dose of half a drop, it ought surely to
be very sensibly developed under doses, in this quantity several
hundred times multiplied. But not only in my experiments
though the counteracting or "antagonistic" influence was not de-
veloped, did it fail to manifest a sedative action in any poisonous
degree, but it also failed to manifest any such effect, even to a de-
gree that might be regarded as medicinal, or any effect of any kind
at all.

Dr. Ames, however, in his Reply, admits in one place, that
in his paper on Pneumonia, he did speak of "its sedative influ-
ence over the general circulation;" but a prior remark would
lead to the inference, that he did not mean to say it had any
such action, in a degree sufficient to overcome "any of the
ordinary physiological influences over the pulse;" which it surely
seems, is about equivalent to saying that it was a sedative, and that
it was not a sedative.

Can a medicine, with propriety, be said to have a peculiar
operation, (say, for instance, as a sedative, or as a cathartic, or as
an emetic,) in any given case or condition, otherwise, or for other
reasons, than because it may be capable of overcoming the ordina-
ry physiological influences resisting such operation, in the case or
condition specified ? Is it not mainly, at least, in virtue of such
special powers, that medicines are classified? Is not the possession
of such powers implied in the definitions in any classification
founded upon the effects of medicines upon the system ? Professor
Giacomini, speaking of the class, thus defines sedatives or contra-
stimulants. " Nous regardons comme hyposthenisantes toutes les
substances qui, introduites dans l'assimilation organique, changent
tellement l'organisme vivant que la force vitale reste abaissee
au-dessous du rythme normal du degre ou elle etait avant leur ap-
plication." And of stimulants: " Nous apelons hypersthenisantes
toutes les substances qui etant introduites dans l'assimilation de
nos tissus, changent tellement la maniere d'etre de l'organisme
vivant, que la force vitale s'eleve au-dessus du rythme normal ou
du degre ou elle etait."

Suppose, for instance, one should at one time say that a specified
article was a cathartic in doses named, which, on repeated trial,
failed, not only in such doses, but in much larger ones, to have
any such effect ; and on being reminded of it should answer " Ah,

1855.] Bolixg's Reply to Dr. A 529

yes, I did say say it was a cathartic, but I never said it was capa-
ble of overcoming any of the ordinary physiological influences
resisting a cathartic action ;M and what would be the legitimate
inference ? That it was said to be a cathartic, or that it was asserted,
that it was not a cathartic ?

But let Dr. Ames speak for himself, that we may see what he
really does say in his paper on Pneumonia, in regard to the seda-
tive operation of phosphorus. Speaking of a class of remedies,
useful in inflammation, combining the properties of a " sedative
to the heart's action, and a stimulant to the contractile force
of the capillaries,'7 he says "Phosphorus is put in the class,
solely because of my own experience, and that of a few others, of
its immediate sedative or contra-stimulant influence on the general
circulation, when given in a dose large enough to produce any sen-
sible influence of any kind on the action of the heart, but still not
large enough to excite inflammation or a high state of irritation of
the stomach and bowels. Its sedative or contra-stimulant, is its
medicinal or therapeutic effect."

Indeed, on examining the paper of Dr. Ames on Pneumonia, it
will be found, I think, impossible to arrive at any other conclusion,
than that his "new medical fact," consists mainly, if not exclusively,
in this announcement of a sedative action of phosphorus over the
heart. Repeatedly its operation as a cardiac sedative is spoken of,
and the idea is presented and conveyed in different pointed remarks,
strengthened by incidental allusions, that the limitation of its action
in this direction is found in its secondary or indirect operation as a
stimulant ; and such an inference, so far as I can discover, is not
contradicted by a single assertion or intimation to the contrary.
The idea is not incidentally, merely, it will be seen, presented in a
single instance, or in such a way as to admit of explanation by the
supposition of an oversight ; but the assertion is repeatedly made
in various shapes, distinctly stated, and emphatically dwelt upon.

" My opinion," says Dr. Ames in his Reply, u of the extent and
hind of sedative power it exerts in disease is expressed in the fol-
lowing extract," made from his paper on pneumonia, " its action
on the lungs seems, from its effects, to be especially directed to the
minute bronchial tubes and the air cells ; and in inflammation^ to
the capillary vessels, rather than to the heart."

Let us examine, then, his views, as given in full in his paper on
Pneumonia, in regard to the nature of this action on the " capillary
vessels," that if possible, we may ascertain precisely the uhind of

630 Boling's Reply to Dr. Ames. [September,

sedative power " to which he refers. In pursuance of this object,
it will be necessary to notice certain opinions presented by Dr.
Ames in the paper just mentioned, in regard to the mode of the cu-
rative action of remedies in inflammation. While abbreviating,
nothing essential to the full development of his views will be
omitted. He says :

"It is well known that under certain circumstances, the reme-
dies for inflammation are required to be of a stimulating nature.
* * * * * The pathology of inflammation explains this seem-
ing paradox. The phenomena of inflammation are now known
to be derived from an engorgement, or ' repletion in excess ' of the
capillary vessels carrying blood; the repletion being itself de-
pendent on a deficiency in the organic contractile force, which in
health propels the blood, in part at least, through the vessels,"

According to this view of the proximate cause of inflammation,
he continues, " the remedies for it ought to be stimulants, at least,
in their local action on the part inflamed." This would be true,
he goes on, "of all remedies for inflammation, if the organic force
of the capillary vessels were the only force concerned in circula-
ting the blood." In view, however, of the part which the con-
tractile action of the heart performs in it, some active and efficient
remedies for inflammation are on the list, which are in no sense
stimulant, and which act exclusively by reducing the injecting
force of the heart. These are the pure sedatives, and blood-letting
is the best representative of the class. Leaving these out of con-
sideration, because their action is indirect, he proceeds to divide
the other remedies for inflammation into three classes. The first
are the diffusible stimulants, and alcohol is the best representative
of the class. "They are applicable only in those states of the sys-
tem, where local inflammation co-exists with a depression of vital
powers, a deficient action of the heart and of the nervous force of
the capillaries,"

Those of the second class, stimulate the nervous system gene-
rally, and through it the heart's action also, but moderately, but
at the same time have an especial action on the organic force of
the capillaries ; the latter more than compensating for the slight
additional injecting force of the heart imparted by them.

" The third and last class consists of such medicines as combine
the properties of a sedative to the heart's action, and a stimulant to
the contractile force of the capillaries f and in this class, Dr. Ames
places aconite, antimony, phosphorus and quinine.

1855.J Bolixg's Rsply to Dr. Ames. 531

The action which, according to Dr. Ames, phosphorus exerts
tipon the "capillary vessels," has here been traced out, and the
" kind of sedative power it exerts in disease/' as thus ascertained,
discovered to be a stimulant power. Truly, the Doctor seems, in
this affair, to have very curiously and amusingly involved himself
in his own subtleties.

Dr. Ames speaks of the "facility of doing mischief" with his
preparations, and, alluding to his doses, tells us that the evil of
developing the poisonous influence of the remedy, " am hardly be
avoided, in giving it in much larger ones " than those which he
recommends. After also stating that, in his doses of half a drop
even of the diluted tincture, it ;' occasionally produces some very
sensible effects upon the head and stomach," he further remarks,
alluding to doses of from half a drop to two drops of the saturated
tincture, that it " cannot be continued in the smallest quantity just
mentioned, for any great length of time, without inducing consid-
erable disturbance of the stomach, shown by nausea or vomiting,
burning heat, and a feeling of oppression at the epigastrium and
that in the larger quantities, though a single dose, or perhaps a few
doses may be given with impunity, it cannot be continued for any
great length of time with ordinary, or at least a proper exercise of
prudence."

The consequences of the dose of two drops, given oftener than
M a single dose, or perhaps a few doses," must have seemed awful,
indeed, to Dr. Ames, and, as if language would fail to convey a
sufficiently vivid picture of the terrible mischief and words were
inadequate to its portrayal, he leaves the task to the imaginations
of his readers, after leading them onto the highest state of excited
expectation. He tells us. first, that the medicine cannot be con-
tinued in doses of half a drop for any great length of time without
inducing considerable disturbance of the stomach, as shown by
certain symptoms enumerated, and then, that in the larger quanti-
ty of two drops, though a single dose, or perhaps a few doses, may
be given with impunity, it cannot be continued any great length
of time with "ordinary, or at least a proper exercise of prudence."
He had already told us, that the doses of half a drop could not be
continued any great length of time without inducing considerable
disturbance of the stomach, shown by u nausea or vomiting, burning
heat and, a feeling of oppression at the epigastrium;" which being
the case, they even, of course, could not be so continued, " with
ordinary, or at least a proper exercise of prudence." What, then,.

532 Boling's Reply to Dr. Ames. [September,

must be the dreadful consequences, which we are thus left to
imagine, of the two drop doses, so continued ?

After remarking thus far upon the necessary and uniform
poisonous action of his remedy, given as explained, Dr. Ames
goes on to speak of its other qualities as a poison. " So far in re-
gard to activity merely ; but in estimating the proper dose, several
other things are required to be taken into consideration, having
reference to certain 'peculiarities of its operation. First, the eccen-
tricity of its action as a poison." * * * * * "Secondly, its effects
are cumulative;" and, in the third place, the antagonism, already
referred to, between its medicinal and toxicological operation, is
mentioned.

To this extent it has been deemed proper to present the opin-
ions of Br. Ames, both in regard to the sedative or therapeutic,
and the stimulant or poisonous action of phosporus, as preliminary
to a notice of his arguments against the inferences that appear
fairly cleducible from my experiments, and which I here present,
in shape somewhat different, but in substance the same as formerly
given.

First That not only no sedative effect, but no appreciable effect
of any kind being produced upon the healthy subjects, by the tinc-
ture of phosphorus given in doses many hundred times as large as
those in which Dr. Ames says that in disease it produces a thera-
peutic or sedative, and other "very sensible effects," it is more
probable that he was deceived, than that it does, given as he gave
it, produce any sedative action.

Second. That not only no such poisonous action as is said by
Dr. Ames, to follow its use in doses mentioned by him, when
given to the sick, nor any appreciable effect of any kind resulting
from its administration to the healthy subject, in doses many hun-
dred times larger than his were, it is more probable that he was
deceived than that it rarely does, giving as he gave it, produce
such poisonous effects.

The third, it is unnecessary to repeat.

It is regarded, I think, as a settled point by the profession, that,
as a general rule, the effects of remedies of an active character, and
more especially of poisons, are of the same nature in health as
in disease ; and in experiments in the former state, the actual or
positive powers of medicinal agents can generally be ascertained
correctly. In such experiments, too, the confusion and want of
certainty, necessarily arising from the mingling of the symptoms

1855.] Boling's Reply to Dr. Ames. 533

of disease, or such as are produced by other remedies with those
produced by the medicine under experiment, are avoided ; while
in experiments upon the sick, in which a number of remedies may
be administered at the same time, the actual or positive power of
any one particular medicine, can rarely with certainty be estima-
ted or distinguished. The medicine that will purge or vomit, or
that will depress or exalt the vital actions in disease will be likely
to do the same in health ; and the article that will poison a sick
man, with but a moderate augmentation of the dose at least as
compared to the difference between the medicinal dose of Dr.
Ames, and the doses given by myself will surely poison a well
one.

It is true that the susceptibility to the influence of certain rem-
edies, is in some instances modified by disease. In some cases, the
susceptibility to the influence of a particular remedy, is exalted
by the morbid state, so that the impression of a given dose will
be more marked than it would be in health. On the other hand,
particular morbid states equally also diminish the susceptibility of
the system to the action of certain remedies, and larger doses will
be tolerated than in health. It is true, also, that in some instances
the manifest effects of certain remedies upon the system, are not
precisely the same in health and disease. But there is no exam-
ple, that I can call to mind, of a remedy which, as a general rule,
will produce marked and appreciable effects in disease, and a prompt
curative influence in acute disease in a particular dose1 and yet not
only not manifest any of the peculiar effects said to result from its ac-
tion in disease, ichen given to the healthy subject, even in its, so-called,
medicinal dose several thousand times multiplied, but no effect whate-
ver.

Let us test the reasonableness and probability of such a propo-
sition in regard to phosphorus, by calling to mic d the ^result that
would follow the use upon the healthy subject, of any other active
and dangerous article of the materia medica, in the smallest dose
in which it will produce any "very sensible effects" in disease
augmented in any thing like the position in which my doses of Dr.
Ame's tinctures of phosphorus given to the healthy subject, were
augmented above his medicinal dose.

One drop, or perhaps half a drop say even a quarter of a drop
! of the dilute hydrocyanic acid, is about the smallest dose capa-
ble of producing an appreciable, though not " very sensible effect"
upon an adult subject, laboring under disease, jSow, what would

X. S. VOL. XI. NO. IX, 84

534 Bolietg's Reply to Dr. Ames. [September^

be the inevitable consequence of a dose of this article to the healthy
subject, in the above small dose, even but several hundred, to say
nothng of one several thousand times multiplied? Dr. Ames tells
us that a child six or eight months old, can generally take one-
fourth of a drop, every third or fourth hour,, of a well made satura-
ted tincture of aconite, prepared from root of good quality, without
inconvenience. This is, perhaps, the smallest dose though let
us reduce it to the eighth of a drop with which any very sensi-
ble effects, it is probable, could be produced upon a subject of
the age mentioned. But let us multiply this dose,, say four hun-
dred times, instead of four thousand times, and what would be*
the fate of the healthy infant that might take it ? Death, of course,
instantaneous and inevitable.

It will be remembered that in my experiments with the tinc-
tures of phosphorus, published in the May number for 1854 of
the New Orleans Medical and Surgical Journal, I administered
on several occasions to different subjects, doses from one to four
thousand times as large (and Dr. Baldwin has given much larger
ones still) as Dr. Ames' medicinal dose, from which he says he
has seen produced, when given, to the sick, "-very sensible effects
upon the head and stomach," and my subjects survived. Not
only were they not instantaneously destroyed, but no " sensible
effects" whatever,, were manifested.

Even from the smallest dose,, capable of producing an appreci-
able effect and a prompt curative influence in acute disease, of
remedies not regarded as among the more dangerous,, so multi-
plied and given to the healthy subject, surely there would result
a very manifest effect.

Dr. Ames, speaking in another place of his dose a half a drop
of the diluted tincture says, u it is large enough for ordinary
purposes in the treatment of pneumonia, while it is not too large
to be perfectly safe.17 He further, however, tells usr that another
physician one of course who had had some experience with it
told him he " doubted the propriety of giving it even in this dose,
in cases where there is a gastric complication." Now, in view of
the frequency of gastric complications in pneumonia,, as met with
in the South, in connection with the assertion of Dr. Ames that
his dose is "not too large to be perfectly safe" in this affection,
consistently, of course, he cannot regard the "experience" of his
friend, directly opposed to his own, and according to which his
" perfectly safe" dose, is not perfectly safe, as of any value. It is

1855.] Bolixg's Reply to Dr. Ames. 535

really difficult, too, to reconcile the confidence of Dr. Ames in the
perfect safety of Lis dose in pneumonia, with other statements
made by him in regard to his remedy. Thus he speaks of " the
peculiar activity of its physiological manifestations, in a much more
minute quantity than is contained in" the dose that he recom-
mends, to-wit, a half a drop of the diluted tincture. It is fairly
presumable, that in speaking of its "physiological manifestations,"
he has reference to its action upon the healthy subject. Now, in
pneumonia, Dr. Ames tells us, the susceptibility to the poison*
ous action of his remedy is generally exalted. How, then, can
he feel such confidence in the perfect safety of his dose in this af-
fection, such being the case, consistently with his experience of the
"peculiar activity of its physiological manifestations in a much
more minute quantity" under circumstances where, of course, this
exaltation of the susceptibility to its action could not exist ?

Dr. Ames, after remarking on what he terms fallacies in my
experiments, takes up the first conclusion, as deduced and presen-
ted for me, and says: "the influence" (that phosphorus as given
by himself, does not act as a sedative in disease) " is fallacious,
because there is no necessary connection between it, and the facts
on which it is based. It might be true that phosphorus is not a
sedative in health, and yet it might be true that it is a sedative in
disease. Medical experience has furnished innumerable exam-
ples of the general truth, that negative facts concerning the phy-
siological effects of a medicinal agent, afford no reliable proof as
to its therapeutic action."

But, does medical experience furnish any example of a medicine
which will produce prompt therapeutic and poisonous effects in
disease, in doses many hundred times smaller than doses in which
it will produce no appreciable effect whatever in health ?

"The rule" -continues Dr. Ames "is reversed as regards pos-
itive facts observed in the same way. If, for instance, phospho-
rus had proved to be sedative in these experiments, then the con-
clusion would have been legitimate and proper that it is also se-
dative in disease, and this without any other proof. And why?"

Now, it really does seem difficult to understand how the con-
clusion could be less legitimate and proper, that because a parti-
cular article in a given dose, is without effect on the healthy sub-
ject, therefore it is not sedative in disease, and more especially
in comparatively minute doses, than that because it was sedative
in heaith, therefore it must be sedative in disease. In the one in-

536 Bolikg's Reply to Dr. Ames. [September,

stance, neither less nor more than in the other, the influence as
to the probable effect in disease, would be deduced from the ap-
parent effect or want of effect, which amounts to the same thing
under the circumstances, in health. After the above interrogato-
ry, Dr. Ames proceeds :

"Solely in virtue that experience has long ago established the
general truth of such inferences from positive facts the law, how-
ever, being subject to many exceptions that the manifest effects
of a medicinal agent are generally shown in disease as in health."-

Tell rner would the complete failure of an article to produce any
effect be less a "positive fact/' as regards the legitimacy of deduc-
tion, than the operation of another in a particular manner ? Dr.
Ames continues:.

u But no such law applies to negative facts, and hence it is, that
while in the one case the experience of medical men has furnish-
ed before hand the necessary experimental evidence to- establish
the truth in many instances of such an inference from positive
facts; such an inference from negative factsr lacking this stored
up proof, requires to be supported by an especial and direct ex-
perimental proof,, in every instance. In the one case, the facts
indicate a certain truth ; in the other but a probable one, at least.
To establish, the latter, it is required that the indications from the
facts obtained in experiments on well persons, shall be verified by
experiments on sick ones.'7

Now, fancy one attempting to establish the truth in this in-
stance, by verifying the indication which was a nullity, from my
experiments on the healthy subject, by experiments upon the
sick, and that, too, by giving doses several thousand times smaller
than the doses with which this " indication" was obtained. While
no one surely could doubt the result the certainty of the verifi-
cation and while but few could be found who would not regard
it as an unnecessary waste of time to assure one's self, that a nega-
tive result thus obtained, would be verified by the test proposed y
where is he, even though endowed with all the sober gravity and
solemn dignity of the Great Mogul himself, who could resist a
smile on witnessing the process?

As in my experiments there were no positive effects developed,
the absence or nullity of effect, may, for all practical purposes, be
regarded in this instance as the " manifest effect;" indeed we are
reduced to the necessity of adopting it as such. This being the
case, by the law laid down by Dr. Ames, himself, liable as he

1855.] Bolixg's Reply to Dr, Ames. 537

states to exceptions, but without exception it is probable, in in-
stances precisely parallel to the present, "that the manifest effects
of a medicinal agent are equally shown in disease as in health,"
we are necessarily brought to the conclusion at which I had
already arrived, to-wit : that his doses of phosphorus were without
manifest effect, on thecLiseased subject The inference, then, ap-
pears quite legitimate, according to Dr. Ames' own logic, from the
want of effect in health, to the want of effect (and a fortiori, in
comparatively minute doses) in disease.

Dr. Ames tells us that instances u in which it is shown that de-
cided, and even powerful curative effects, are brought about by
the aid of medicines, which have either no poisonous action at all
on well persons, or are given in doses too small to affect them
sensibly, or in which the curative action is apparently the very
opposite of their sensible physiological action, are equally numer-
ous and familiar."

v, the most of this quotation may be readily admitted, or
rather, allowed to pass without a strict examination, as it has but
little bearing on, or relevancy to the question. That it should
have, or to be fairly appropriate and parallel instead of reading,
u no poisonous action &c., on well persons, n it should read "in-
stances are equally numerous and familiar in which decided
prompt and even powerful curative, as also without great care,
very appreciable poisonous effects are brought about by the aid
of medicines upon the sick, in doses many hundred times smaller
than doses in which it has been ascertained, that not only no such
poisonous action, and no operation similar or analagous to the
one from which the curative effects are said to result, but no ap-
preciable operation of any kind whatever are produced by them
upon well persons."' As presented by Dr. Ames, the parallelism
is deficient in the very points essential to the argument for which
he would use it, though owing to the ingenious obliquity with
which the fallacy is introduced, and managed, it might very read-
ily escape observation.

After the remark quoted above, as to the manifest effects of
medicinal agents in health and disease, Dr. Ames selects two ex-
amples for illustration, and says " Lemon-juice, it has lately been
discovered, exercises a speedy and efficient curative agency in
acute rheumatism, an inflammatory affection in which contra-
stimulants or sedatives are necessarily the only effective remedies.
Now is there any thing in the physiological effects of lemon -juice

638 Boling's Reply to Dr. Ames. [September,

which would indicate this therapeutic effect? Is it a cardiac se-
dative, administered to persons in health ? I believe not. No
mention is made of any sensible physiological effects from it, by
either of the few authorities I have consulted, though among them
is the elaborate work of Dr. Periera, the last edition, where one
might expect to find them, if any where. Certainly it has no con-
siderable power in this respect, if any at all ; and yet it is said to
reduce the force and frequency of the pulse in this disease, with a
degree of power not equalled by the most active sedatives known
to the materia medica. Let us suppose, then, that when this dis-
covery was first announced a discovery of such value that it has
been said, on high authority in England, to mark an era in the
history of practical medicine" (in that case, of almost equal val-
ue to Dr. Ames' discovery, the "new medical fact") "physicians,
instead of testing its value in the circumstances of disease in which
its sedative power was affirmed, had set about to determine
whether this was true or not, by giving it to well persons, to try,
in fact, whether it would cure rheumatism, by giving it to persons
who had no rheumatism to cure, what the a priori inference from
such experiments would be, as well as its value when made, is
obvious enough,"

This seems right strong. But, let us state the case, so that it
shall bear fairly upon the point at issue. The dose of lemon-
juice recommended thus for the cure of rheumatism, is about two
ounces, say three times a day, or six ounces in the 24 hours.
Now, suppose that Dr. Owen Reese, in speaking of it, in this par-
ticular dose, had said that it was sedative ; that the sedative was
its medicinal effect; that this medicinal action was not in the ratio
of the quantity administered, except within narrow limits, because
of a counteracting poisonous operation, should the quantity ne-
cessary for its medicinal action, be slightly exceeded ; that it was
difficult to avoid this poisonous action ; that even his smallest
dose produced "very sensible effects upon the head and stomach,"
&c. ; all in virtue of "its activity merely" independently of certain
eccentricities of action ; and suppose, further, that in his experi-
ments for the cure of rheumatism, with the lemon juice, he had
prescribed it in conjunction with other remedies that were known
to be useful in the cure of this disease; were powerful sedatives ;
produced very sensible effects upon the head and stomach; all such
as he had ascribed to the lemon-juice; and still further, that not
only were the doses of lemon -juice extraordinarily minute, but

1855.] Bolin-g's Reply to Dr. Ames. 539

that the method of administration was such, that of necessity a
-considerable portion and how much, unknown of the active
principle, the citric acid for example, must be lost; and then, sup-
pose that another physician should test the action of lemon -juice,
in such a way as to avoid the possibility of mistaking the effects
of other agents for effects produced by it upon the well, for in-
stance not only in the doses recommended, but in this dose
many hundred times multiplied, and should find that not only
did it not produce any one of the several effects attributed to it by
Dr. Eeese, but had no appreciable action of any kind upon the
system, even in this augmented dose; what the inference a priori,
or a posteriori " would be, as well as its value when made, is
obvious enough," truly, as Dr. Ames remarks. What, under the
circumstances, would be the most reasonable inference ? That Dr.
Eeese had attributed effects to the lemon-juice, that were fairly
attributable to the other agents used in conjunction with it, or
that his lemon-juice, setting at defiance all the experience of the
past, in regard to all other powerful remedies and poisons, and all
natural agencies and influences, all analogy really was capable
of producing all these various effects ascribed to it, when given
to a person who had rheumatism, and yet produce no manifest
effect whatever upon the healthy subjeet in such comparatively
immense doses say from two or three hundred ounces in the day,
to sixty and some odd gallons at a single dose which would bear
the same proportion to the dose of Dr. Eeese, that my doses of
phosphorus bear to that of Dr. Ames. Think, as to the possibili-
ty of giving lemon-juice, even, to the well, without effect, in doses so
vastly augmented above such as, on the sick, it would produce
such various and remarkable results, even were it possible to find
a stomach of sufficient capacity to contain them? It will be ob-
served, too, as we proceed, if I mistake not, that Dr. Ames
strengthens his argument by weakening the lemon-juice. In the
quotation just given, it will be remembered that, speaking of this
article, he asks the question : " is it a cardiac sedative administered
to persons in health?" and states that no sensible physiological ef-
fects are said to arise from it, by authors that he has consulted ;
among others, Periera. Now, for all practical purposes, lemon-juice
may be looked upon, merely as a form of administration, of citric
acid. This is its chief constituent. Merat and Delens say of the
latter, "il est employe en medecine aux meme usages que le sue de
citron." Speaking of lemon -juice, Periera remarks, that on account

0U .boling'S lieply to Vr. Ames. [September,

of the difficulty of preserving it, citric acid may be substituted for
it. Speaking of the physiological effects of the acids, as a class, in-
cluding of course the citric acid or lemon -juice, he says that they,
" in moderate doses, at first allay thirst, sharpen the appetite and
promote digestion, check preternatural heat, reduce the frequency
of the pulse" Professor Giacomini of Padua, speaking of citric
acid in a separate form, and as lemon -juice, classes it among his
hyposthenisants or contrastimulants, and covers nearly half a page
in describing its effects upon the healthy subject. Gal tier, speak-
ing of his "medication temperante ou rafraichissante" says: "Les
changements physiologiques qui forment le principal caractere de
cette medication, consistent dans la diminution de la chaleur, de
la soif, dans le ralentissement de la circulation, &c" " Les medica-
ments temperants ou rafraichissants appartiennent presque exclu-
sivement au regne vegetal ; ce sont ou des acides, tels que les acides
tartrique, citrique" &c.

Foy, referring to the second genus of the second order of his
second class, "temperants," defines them, " medicaments propres
a modifier la trop grande activite des organes en ralentissant la
circulation et en diminuant la production de la chaleur animale."
&c. "Les temperants les plus usites sont, parmi les vegetaux,
l'orange, le citron" &c. It would be unnecessary to consult au-
thorities further on this point.

In further illustration of his argument, Dr. Ames speaks of a
case in which a patient took "the enormous quantity of an ounce
of quinine in the course of four days, in doses of 40 grains, given
three times daily," without " any material change in the pulse,"
though, " what change there was, indicated an increase rather than
a diminution of its frequency ;" and he calls to mind the fact, that
an effect of this remedy in certain febrile affections, is to reduce
the frequency of the pulse. It seems, however, that, in the case
in question, some effect was produced by the doses used ; and had
none been produced, the case would still have to be regarded as
an exceptional one, for it is well known that quinine, even in
very much smaller doses than those mentioned, does, as a general
rule, produce very appreciable effects upon the healthy subject.
An average dose of quinine, among physicians of the South, with
a view to its medicinal sedative action in febrile and inflammatory
diseases, we may say, is about ten grains, given as often as every
eight hours. The quantity taken by the patient, spoken of by
Dr. Ames, was four times as large, and he calls it enormous. To

1855.] Bolixg's Reply to Dr. Ames. 541

deserve the appellation, however, as applicable to the doses of the
tinctures of phosphorus given by myself, as compared to the pre-
ferred medicinal dose of Dr. Ames, the quantity should have been
something larger. Let us see: The quantity given by Dr. Ames
is about three drops of his saturated tincture in the twenty-four
hours. I took, myself, for eight days, fifteen drops of his saturated
tincture, each drop being equal to ten of his diluted tincture,
amounting to fifty times as much per day. His patient, then,
instead of taking 120 grains of quinine per day, should have taken
1,500 grains, or over three ounces ; and instead of 480 grains, or
one ounce, in the four days, 6,000 grains, or a little over twelve
ounces in the same length of time. And in regard to the single
dose: to deserve the term "enormous," as compared to* an aver-
age medicinal sedative dose of quinine, in the same degree that a
dose of the tincture of phosphorus given by myself in one in-
stance to- wit, 200 drops of the saturated tincture, equal to 4,000
of Dr. Ames' doses would deserve to be so called, as compared
to the medicinal dose of Dr. Ames, the patient should have taken,
instead of forty grains, the nice little dose of forty thousand grains,
or eighty -three ounces, and the small fraction of 160 grains over ; or
something more than five pounds ; thus, 1:4000:: 10:40,000.

In my former paper, a remark like this is found : u Here, a child,
seven years old, took, at a single dose, one thousand eight hun-
dred and twenty of Dr. Ames' doses for the adult." In regard to
this, Dr. Ames says: " The phraseology here is somewhat pecu-
liar ; it is not said that the child took one-tenth of a grain at one
dose, but 1820 of Dr. Ames' doses." Although, from my experi-
ments, at the time of writing, it was my impression, that the quan-
tity of the tincture given, (it being Dr. Ames' diluted ticture,)
contained about one- tenth of a grain, owing to the loss by vapor-
ization on mixing it with water for administration, I could not be
certain as to the quantity that the subject actually got of the ac-
tive principle. I knew, of course, that he did not get all of the
tenth of a grain, supposed at the time to be contained in the solu^
tion ; but as to whether he got the half of it, the fourth of it, or
any of it, indeed, I could not be positive. The actual quantity of
the phosphorus that the subject swallowed, then, was, very pro-
erly, a doubtful question, while, as to the relative quanty, I could
entertain no doubt ; and the phraseology, therefore, was such only
as the circumstances would admit of.

Dr. Ames, alluding to the inference, that there must have been

542 BoLixa's Reply to Dr. Ames. [September,

some mistake on his part, in attributing any efficacy to doses so
minute as his were, when it was shown that it could be given in
doses many hundred times greater to persons in health, without
appreciable effect of any kind, says, that stronger instances could
be found in cases in which several grains had been given, without
any sensible effect. There are such cases on record ; but Dr.
Ames, in his paper on Pneumonia, quotes authority to show, and
tells us, that his " own experience of its effects most certainly
leads to the same conclusion," that in all such cases, "the article
had undergone some change, in its chemical state, that rendered it
inert." This is his explanation of the "eccentricity" of the arti-
cle as a poison. But he does not speak more distinctly and
clearly of any action of phosphorus, than he does of certain effects
observable from his medicinal dose, arising from "its activity
merely," and aside from any eccentricity of operation. Certain
consequences are ascribed by him to "the eccentricity of its ac-
tion as a poison;" certain others are spoken of as its common and
ordinary effects, resulting from " its activity merely," and the one
quality, cannot of course be fairly invoked to explain away the
non-occurrence of effects that ought to grow out of the other qual-
ity.

Alluding to the facts that other remedies are also irregular in
their action, and may sometimes be given in doses with safety,
much larger than doses in which they sometimes prove mis-
chievous, Dr. Ames relates the following case, which he says came
within his "own knowledge, when a student of medicine."

" A child between two and three years old, got hold of a vial of
calomel by accident, which she broke while playing with it, and
liking its sweetish taste, ate up a full ounce of it before she was
discovered. But the child showed no sensible effect from this
enormous dose, except that the next day, a single free evacuation
of the bowels took place."

Now, as a matter of course, this was an exceptional case ; the
want of effect resulting from " eccentricity," or some other very
unusual cause ; and therefore such want of effect cannot be fairly
adduced as parallel to the general absence of effect, in experi-
ments on the healthy subject with Dr. Ames' tinctures of phospho-
rus in large doses, and of all the symptoms said by him to result
from its administration in small doses, and arising from its " ac-
tivity merely," aside from its eccentricity." If it were a fact that
calomel might generally thus be given without effect in such large

1855.] Bolixg's Reply to Dr. Ames. 543

doses to the well, known as it is, that in much smaller ones it is
capable of producing very appreciable effects upon the sick, then
the analogy would be such as to entitle the illustration to some
weight.

The ingestion by so young a child of such a meal of calomel,
(and a child of the age would scarcely have eaten a larger quanti-
ty of the most palatable solid food at once) would be likely to be
very alarming to the parents ; and they would also of course be
urgent that measures should be adopted to secure if possible its
evacuation, say by emesis, from the stomach. If this was actually
accomplished, and the calomel subsequently dried and weighed,
of course there could remain no doubt that the child really had
swallowed it ; but the case would be of less value, if possible, then,
than it is as an illustration of the point for which it is adduced ;
and Dr. Ames does not speak of any means having been adopted,
with such an intent.

The case is indeed an extraordinary one. The causes in opera-
tion to develop not only such a remarkable resistance to the ac-
tion of an article known generally to produce appreciable effects
in moderate doses, when taken under any thing like similar cir-
cumstances, but also in consequence of which, actions that the
article usually quickens, (and at the tender age of the child mention-
ed by Dr. Ames, the bowels are extremely susceptible to the oper-
ation of irritants,) should have been, as it were, suspended or
retarded, must have been very peculiar. The child, it will be
remembered, had one loose evacuation from the bowels during the
following day ; none, it would seem, on the day that it ate the meal
of calomel, or at least after it, nor the night following. In a period
then of 24 or 36 hours, after eating a full ounce of calomel a
quantity equal to about half a pound for the adult a child be-
tween two and three years old, and which, it can scarcely be
questioned, would have otherwise that is, without the calomel
had at least two or three, had one loose evacuation from the bow-
els. It is difficult to say what estimate should be placed upon
such causes, and, of course, the case, as stated, is not a suitable one,
with which to illustrate the point under consideration. It would
have been interesting, however, to have traced the progress of
such an " infant phenomenon" from childhood to maturity, and to
have noted the physiological anomalies that it would probably
have exhibited. It would, no doubt, have been found, that to
" eat conger and fennel, and drink off candles' ends for flap-drag-

644 Holt's Letters upon General Pathology. [September,

ods," would be a mere " matter of moonshine" to it. What a
voracious little cormorant it must have been.

Even allowing due weight to the fact, that, in very rare and
exceptional cases, particular medicines fail to produce their usual
effects, or do so with extraordinary violence, owing to individual
peculiarities, the case, in its various details, as related by Dr. Ames,
is truly, as he terms it, an extraordinary one ; so much so, that
were it not that he tells us it came within his own knowledge, doubts
might well be entertained of the reality of its occurrence, as sup-
posed that there might possibly have been some mistake that
the child broke, perhaps, a vial of whiting, or of some other inert
powder or that instead of really eating the full ounce of calomel,
it might have wasted it. If the child was not actually seen to eat
the calomel, (and it is scarcely probable that any one, whose testi-
mony could be considered of any value as to the fact, would have
witnessed the process without interfering to stop it; and, moreo-
ver, the discovery seems not to have been made till after the full
ounce had been eaten,) in view of the termination, many persons
would hesitate to accord full faith to the supposition that it did so.
It is frequently a difficult matter to get a child to take a few grains
of calomel, even in the most tempting vehicle. Certain chemists
and pharmaceutists tell us that calomel is tasteless. Dr. Ames says,
that it is sweetish. Every one to his taste, as a matter of course.
Very few, however, are fond of calomel ; and its sweetness seems of
such a peculiar kind that one would suppose the grossest appetite
would be surfeited by but a very small part of the quantity, said to
have been eaten by this little child. Curiosity might well be
awakened, to know whether it cried for M more."

[To be concluded in October No.]

ARTICLE XXVI.

LETTERS FROM SAML. D. HOLT, M. D., UPON SOME POINTS OF GENERAL PATHOLOGY.

LETTER NO. 4.

Montgomery, Ala., July 20th, 1855.
Messrs. Editors Although it is my desire to avoid as much as
possible an indulgence in theoretical, or hypothetical speculations,
an examination of those phenomena which I have indicated as
characteristic of the opposite conditions of excitement and depress-
ion, or of inflammation and congestion, which are, of the former, a

1855.] Holt's Letters upon General Pathology. 545

hot, dry skin, and a/all. strong pulse, and of the latter, a cold, flaccid
skin, and & feeble pulse, together with such other signs as are usually
connected with these general conditions, will necessarily involve
some delicate points, both in physiology and pathology, I feel
authorized in presenting some gen end views, winch, though they
may be considered as speculative in their character, are, neverthe-
necessary to a satisfactory explanation of those phenomena.
TVe have before stated that the nervous system, including the
great centre, the brain, spine and ganglia, may be disturbed, in
part or in whole, by the causes of excitement or depression, with-
out materially disturbing other parts, and that one organ may be
in a state of depression, while the general system is in a state of
excitement, or that an organ may be in a state of excitement-
while the general system is laboring under depression, as in cases
of congestion of the liver, attended with a hot, dry skin, and &futt,
strong pulse, the characteristics of general excitement and inflam-
mation, or as in cases of inflammation of the lungs, attended with
a cold, flaccid skin7 and a. feeble pulse, the characteristic signs of de-
pression and congestion. But in these cases, as I have stated, the
congestion and the inflammation must both be viewed in the light
of local affections merely7 having little or no agency in determining
the general condition. It may not be so difficult a matter to ac-
count for the production of local affections, and the manner in
which they spread and become general, if we will call to our aid
the principle oi particular and special vital affinities, the existence
of which are sufficiently evident, from the toxicologic and thera-
peutic action of various articles of the materia medica, upon which
principle, indeed, we must rely for an explanation of the existence
of an almost endless variety of local affections. Thus, we may
suppose that a morbid impression is made directly,, or indirectly,
upon the nerves of an organ, or upon that portion of the nei
centre which controls it, where it may be chiefly confined under
the character of a local affection merely, or through sympathy, or
by proximity and intimate relations with other organs, the im-
pression may be communicated to other organs, systems and tissues,
and thus the disease may become general: such, no doubt, is the
case, with respect to the origin and development of most of our
diseases ; but all this does not serve to explain the existence of the
general conditions of excitement and depression, or of inflamma-
tion and congestion, and we are compelled to look beyond the
influence of local causes, or the agency of vital affinities, to those

646 Holt's Letters upon General Pathology. [September,

causes which exert an influence upon the whole nervous system *
such, for instance, as an impoverished state of the blood, from a
watery, poor diet and a feeble digestion, which would predispose
to diseases of depression, by inducing a state of debility throughout
the whole nervous system, while an opposite condition of the
blood, from a rich, nutritious diet and a vigorous digestion, would
give life and energy to the nervous system generally, favoring the
existence of diseases of the opposite character. Or we must look
to those, which, though they do not exert their influence upon the
whole nervous system, as in the case just stated, do, nevertheless,
exert it upon a large portion. Atmospheric heat, for example,
being a natural healthy excitant, to a certain extent, imparts life,
vigour and activity to all the vital functions ; but, beyond this
point, it becomes an unhealthy stimulant, exerting its power, main-
ly, upon the nerves of the cutaneous capillaries, and by sympathy,
upon those of internal organs, and more especially upon those of the
liver, thereby exciting them to undue and continued action, thus
gradually exhausting the aggregate amount of nervous power, but
especially of the organic nervous system, upon which its influence is
particularly exerted, and they all together fall into a state of de-
bility, torpor, and inactivity, proportioned to the intensity and
duration of the cause, and the amount of action thereby induced.

These examples may serve to show the probable manner in
which most of the causes operate, which tend to the production of
the general condition of depression and congestion. Some of them
being direct and general, and others indirect and partial, in their
action some tending directly to the nervous centresr where they
exert their full force and power, bringing all dependent parts, more
or less, under their influence ; while others tend to particular or-
gans, systems and tissues manifesting the signs of local affection
only, or, which may, by sympathy and otherwise, have their influ-
ence transmitted or extended to other organs, systems and tissues,
thus rendering the affection general. But, after all as our know-
ledge and insight into the condition, and the operations of the
nervous system, is, at best, exceedingly limited and imperfect,
except as it is derived from the movements and disturbances in the
circulatory system, and as the action and condition of the heart,
arteries and capillaries afford the best index to the condition of the
system, with respect to the amount of vigor, as well as the degrees
of excitement and depression it is important and necessary that
we should keep constantly in view the circumstances which con-

1855.] Holt's Letters upon General Pathology. 547

trol and influence their action. These are so numerous, and of
such variety, that I cannot venture, at present, upon their enumera-
tion, but will merely suggest, that to render the action of the heart
available in determining upon the general condition of excitement
or depression, it is always necessary to endeavor to ascertain, how
far its action is influenced or control jd by disturbance in the
nervous centres, how far by sympathy with other organs, and how
far by impressions made directly upon the organ itself. Much
stress has been laid upon the action of the heart, and some contro-
versy indulged in by writers upon "pernicious" or congestive
fever. While some of them have represented the pulse (which is-
the general index to the action of the heart) to be "small, frequent
and feeble ," others have represented it as ufull and bounding" and
others, again, as "loud, strong and tumultuous" Now, while some
of these cases show the heart to be decidedly under the influence
of depression, others show it to be evidently under the influence
of excitement, and, as they all attempt to describe the same condi-
tion or modification of disease, how is this conflicting testimony to
be reconciled? I can readily conceive the existence of these appa-
rently discrepant conditions of the pulse, in one or the other of the-
classes which I have made, as, for instance, in the congestive, the
small, frequent and feeble pulse; in the congesto-inflammatory, the
full and bounding pulse, and in the congesto-irritant, the loud and
tumultuous, but not strong pulse, which certainly does not belong
to congestion, in any of its forms or modifications, as a general
pathological condition. But I am not prepared to admit that the
heart plays as active a part in the production and maintainance of
the conditions of excitement and depression as is generally sup-
posed, and allowing the full share which the heart sustains in these
disturbances^ my impression and belief is, that it should be looked
upon, and regarded rather in the light of effect, than of cause ;
that it possesses a sort of counterballancmg or regulating power
between the pulmonary and the capillary extremities of the circu-
lation, and by a wise provision of nature is enabled to maintain a
tolerable degree of regularity and uniformity of action, amidst the
greatest disturbance in other organs, and that its disturbance, by
excitement or depression, is more often sanative than productive
of mischief. Even in eases of high local excitement and inflamma-
tion, in which the heart participates, it will hardly be maintained,
or urged, that the heart has any decided agency in the production
of the inflammation, in electing the points of determination, or in

548 Holt's Letters upon General Pathology. [September,

sustaining its continuance after it has been produced. As cases of
inflammation are often met with, which progress even to a fatal
termination, during the progress of which the action of the heart
is reduced to its lowest perceptible point ; or, perhaps, better evi-
dence of the existence and progress of inflammation, independent
of the heart! s action, may be found in the effects of certain therapeu-
tic agents, as the veratrum viride, for instance, which is said by
those who have fully tested its effects, to possess the power of con-
trolling readily the heart's action, without subduing or arresting
the progress of inflammation. If these views be correct, with re-
gard to the part which the heart sustains in the existence of these
conditions, where are we to look for their true seat, and to what, as-
their true cause ?

I have stated on a former occasion, that while excitement in the
nerves which control and regulate the action of the capillaries, favor-
ed an increased or more rapid flow of blood through the capillaries of
the pulmonary artery, it tended, at the same time, to retard its flow
through the remote or general capillaries, and that depression pro-
duced precisely the opposite condition of things, to the effect, that
while it tends to retard the flow of blood through the pulmonary
capillaries, it facilitates its escape or allows of its easier flow through
the general capillaries, the heart, if undisturbed by other influen-
ces,, rising or falling in excitement and action, as one or the other
of these conditions may prevail. I here, find myself involved
upon a point of pathology, with respect to the action of the capil-
laries directly in opposition to, anel at variance with the highest
authority, upon such subjects ; for Br. Wood, who is sustained by
Dr.. Carpenter and others upon this point, maintains that an enfee-
bled condition of the capillaries, has the effect of retarding the flow
of blood in, or through these vessels. Speaking of the nature of
pernicious fever, and particularly of cases of collapse,, he says r
"This is prominently characterised by a want of action in the ca-
pillaries and extreme arteries.'7 "They collapse simply

because they contain no blood, just as they collapse in death."

"In the pernicious fever, the innervation of the

extreme vessels fails and they cannot, therefore, perform their
part effectively in the circulation. The blood enters them with
difficulty, in their enfeebled state, and is carried through them
very slowly. Hence the paleness, and hence also the lividness o
the surface, owing to the stagnation of the blood."

Now, where I would ask, is the blood which should fill the

1855.] Holt s Letters upon General Pathology. 549

cavities of those vessels which " collapse, because they contain no
blood" if it has not passed them and entered the venous cavities, as
fast or faster than it was sent to them by the action of the heart, or
supplied by the lungs; for if it were not so, the arteries could not
become emptied, and we would find the anomalous condition of a
general arterial plethora or engorgement, with a state of general
venous congestion and collapse. I do not wish to convey the idea
that every disturbance in the circulation necessarily implies an
undue accumulation of blood upon the right, or upon the left side
of the heart, that is, in the venous or arterial cavities or that ex-
citement does not increase, and depression diminish vascular action,
and that the whole current of blood may not be accelerated or re-
tarded in its circuit, without materially disturbing the balance,
between the pulmonary and the general capillary extremities of
the circulation. But what I maintain is, that, for the establish-
ment of the general conditions of venous congestion, or arterial
plethora, it is absolutely necessary that the balance between the
two extremes of the circulation should be broken that is, to empty
the arteries, and fill the veins, the blood must flow faster out of the
arteries than it flows into them; and to fill the arteries, it must flow
faster into, than out of them, whether either be by a slow or rapid
process. And, while I admit the want of blood in these vessels
to be the cause of paleness, in such cases, and the slow movement
of the blood through them to be the cause of the lividness of the
surface, yet stagnation does not take place in them, until the heart
ceases to supply them with blood, unless it should possibly do so
in cases of inflammation. Dr. Wood makes the further remark,
in connection with this subject, which is important to our purpose,
that " this condition of the capillaries (enfeebled) may co-exist with
considerable power in the heart; for the want of innervation is not
necessarily equal in the whole circulation." This principle we
shall have occasion to apply to the explanation of some of the
phenomena of congestion.

In order to present my own views in as clear a light as possible,
which I find apparently in conflict with those of the distinguished
authors just named, I will quote them further upon this subject,
italicising those points, having the greatest bearing upon the sub-
ject at issue:

In treating of "passive congestion," Dr. "Wood says: "The de-
pression giving rise to congestion may be general, or confined to
a particular organ. Nothing is more common than the occurrence

N. s. VOL. XI. NO. ix. 35

550 Holt's Letters upon General Pathology. [September^

of this condition in diseases attended with sudden and great prostra-
tion. The heart , participating in this prostration, is unable to trans-
mit the blood so rapidly as it is conveyed towards it by the continued
action of the capillaries,, and by the forces which move the blood in the-
veins. This fluid, therefore, necessarily accumulates in the right
side of the heart, and the great venous trunks, and, consequently,
in those organs with' which these trunks more immediately com-
municate viz.7 in the brain, liver, and through this latter organ, in
the abdominal viscera in general." The case represents a conges-
tion occurring from the sudden application of a depressing cause,,
directly to the heart itself, which does not presuppose the existence
of depression or debility in the capillaries, and hence it can be re-
garded only as a temporary or fugitive condition ; nothing being
said with regard to the movement, of the blood in the lungs. The
next quotation from the same author, upon the same subject, tal-
lies precisely with my ideas, upon the subject of "Congestion"
" Congestions, frequently also- arise from local depression, affecting
especially the capillaries of the part. From causes, directly or in-
directly operating on these vessels, such as have been already enu-
merated under the head of depression, they become incapable of
performing their usual part, in sustaining the onward movement of
the blood, which therefore accumulates in the vessels behind them,,
especially when these latter vessels happen to be the recipients of
venous blood.. Thus, when the capillaries of the lungs become
depressed, the venous blood carried regularly towards the right
side of the heart and thence sent into the pulmonary arteries, ac-
cumulates in the ramifications of these vessels, distends their trunks,
and even loads the right ventricle so as to produce great venous
engorgement of the lungs and heart so also of the liver. A de-
pression of the capillary circulation in this organ leads to accumu-
lation in the whole portal system' of veins, not only in its hepatic
ramifications, but in the vessels and their radicles, which convey
the venous blood from the abdominal viscera to the vena portarum.
Hence arise congestions of the stomach, bowels, spleen and liver."
Here we have presented not only the true seat of congestion^
which, as I have previously stated, can originate at only two prin-
cipal points, viz., in the capillaries of the pulmonary artery and in
those of the vena portarum, but the true cause,, also to be found in
the enfeebled condition, and depression in those vessels, to which
the action of the heart cannot essentially contribute, though it often
participates.. I will quote a single opinion from "Carpenter's Prin-

1855.] Holt's Letters upon General Pathology. 551

ciples of Human Physiology," for the purpose of showing how con-
gestion may be brought about by a somewhat different process
than those just named, which is this : "It has now been sufficient-
ly proved, both by experiment and by pathological observation,
that the first effect of the non-arterialization of the blood in the
lungs, is the retardation of the fluid in their capillaries, of which
the accumulation in the nervous system and the deficient supply
to the arterial, are the necessary consequences."

The prime cause in this case is defective or imperfect respiration ;
the second step is the non-arterialization of the "blood ; and the
third, its retardation in the capillaries and a general venous conges-
tion. This may serve to account for the production of congestion
in the lungs, but not so well for congestion in the portal circulation,
as that system is sometimes in a state of complete congestion, when
the lungs are comparatively, or entirely free. But, under all cir-
cumstances of congestion, the chief danger arises, (except in ex-
treme and sudden cases of depression) from the want of a sufficient
quantity of well oxj-genized blood in the arteries, for the support
of the great nervous centres, and for giving life and activity to all
the organs and their respective vital functions.

Applying the foregoing principles to an explanation of the phe-
nomena of congestion, under the different forms and modifications, as
I have classed them, and passing by those signs of pneumonia,
which belong to it as a local affection, under whatever form or
modification it may assume, namely, the pain, cough, and expecto-
ration, and, I may add, impeded respiration. The first one which
will claim attention is animal heat: This is the product of the
combination of oxygen with venous blood in the lungs, whereby
it is converted into the character of arterial blood, and fitted for
the offices just mentioned. The process by which it is generated,
whatever share or agency chemistry may 1 sed to have in

if- production, should be regarded as a purely vital process, its
generation, in amount, depending upon the tone of the pulmonary
cap/'llaries, the easy flow of blood through them, and the freedom of
'. The amount of this product serves as an index not
only i idity with which it is generated, or to the rapidity

with which the pulmonary circulation is carried on, but also to
indicate the points of determination and the seats of the greatest
accumulations of blood.

e condition of the pulse, which depends upon the amount of
bl( jd in the arteries, and which is regulated by the action of the

552 Holtts Letters upon General Pathology, [September,

heart, serves also to indicate the activity of the pulmonary circula-
tion, and the amount of action in the heart. Thus, in cases of gen-
eral excitement,, constituting the inflammatory condition,, when the
pulmonary circulation is activer the heart sharing in the general
excitementr and exerted further to action "by the stimulus of
freshly oxygenized blood, the blood is sent forward to the extreme
arterial ramifications and capillaries, which failing to transmit it
as fast as it enters through the pulmonary extremity, necessarily
accumulates in those vessels and in the arterial trunks, giving rise
to the phenomena in question, namely, a hot, dry slcin, and a full,
strong pulse. This accumulation of blood in the arteries and the
excitement in the capillaries, which rises above the secreting point,
gives rise to the dryness of the skin, to its flushedT and turgid ap-
pearance, to dryness of the tongue, to constipation of the bowels,
and to the suspension of the secretions in general. Upon the same
principles, there can be but little difficulty in accounting for the
phenomena which characterise the congestive condition. As the
pulmonary circulation languishes under the influence of debilita-
ting and depressing causes, and the process of oxydizing, and
arterializing7 the blood becomes proportionately diminished, less
heat is generated, and the heart, yielding to the general depression,
and the withdrawal of its accustomed stimulus, becomes diminished
in action, but having the power of acting for a time, independently
of its accustomed stimulus, continues to send the blood forward
through the arteries and capillaries faster than it enters them
through the lungs ; the necessary consequence of which is, that the
arteries and capillaries become measurably emptied of blood, which
accumulates in the venous cavities, where the heat also accumu-
lates, leaving the skin cold and flaccid, and the pulse small, feeble
and frequent ; small from the comparative emptiness of the arteries,
feeble from the diminished action of the heart, and frequent from
the disproportion between the power of the heart and the greatly
reduced, and small quantity of blood in the arteries and capillaries.
In the same manner we may account for the pallor, and lividness
of countenance, the shrivelled condition of the skin, particularly
of the extremities, and such other general signs as grow immediate-
ly out of such a disturbance in the circulation, reserving those
which grow out of disturbance in particular organs, for examination
in connection with the congesto-inflammatory and con gesto irritant
conditions.. It may not be amiss to notice, in this place, the signs
as exhibited in these separate conditions, which grow out of the

#

1855.] Holt1s Letters upon General Pathology, 553

respiratory movement, and which are referable to the same cause,
namely, depression in the respiratory organs, with a like condition
in the pulmonary capillaries ; such as, the feeble, husky voice, cold
tongue, and breath, and slow feeble respiration, in congestive cases ;
frequent sighing, and sometimes stertorous breathing in congesto-
inflammatory, and hurried breathing and often sense of suffocation,
in the congesto-irritant cases. Another set of phenomena, which
serve to mark the difference between these separate conditions,
are the cerebral symptoms, which seem to depend for their existence
upon the action of the heart, in connection with the extent of pul-
monary congestion. Thus, a certain amount of blood being
necessary at all times upon the brain, it is evident that when the
enfeebled action of the heart, from the want of a sufficient supply
of arterial blood, fails to supply the demand, syncope and death
would soon follow, if the want of supply was not, by some means,
compensated for, which is fortunately provided for in two ways
one by atmospheric presure, and the other by the congestion of the
lungs and heart, whereby the blood is prevented from escaping
from the cranial cavity to such an extent as to produce such a
result, which is sometimes the case, from a patient's assuming an
erect posture, in extreme cases of depression and congestion.*
This compensating influence of congestion of the heart and lungs,
for the enfeebled action of the heart, gives rise to the peculiar and
characteristic phenomenon of an undisturbed and almost un-
clouded intellect in the midst of an overwhelming congestion, and

* A remarkable instance of this kind occurred under my observation a few years
ago. I was called to see a patient who load been labouring for two or three days
under an attack of pneumonia, but was not thought to be very ilL I was accompa-
nied in my visit by a non-professsonal friend. We entered the cabin and found an
able-bodied negro man, 25 or 30 years of age, and perfectly healthy otherwise, lying
very quiet and undisturbed, measurably free from pain or distress. A slight ex-
amination of the case satisfied me that he was in great danger; but a different
impression was made upon the mind of my friend, who also examined him, as he sat
up in bed and gave a clear and intelligible history of his case, and of his present
feelings; and he remarked tome that he could see nothing seriously the matter, and
thought the visit rather an unnecessary one, which proved to be true. My friend
had left the room, and stepped into the yard, where I joined him soon after, and
expressed to him my fears as to the result of the case; but he was incredulous, as he
could see no symptoms of a dangerous character, and desired me to point out, and
explain to him the symptoms b\- which I formed my opinion. I told him I arrived
at my conclusion very much as he would recognise an old acquaintance, which is
much easier to do than to describe him so as others might recognise him. And
while I was endeavoring to point out and explain to him the dangerous features of
the case, we were called into the room, and entering hastily, we found our patient
<iead!

556 Miller. Gun-shot Wound. [September,

The following notes of the case taken, at my request, by a
medical friend, will sufficiently detail its further history :

April 1st. Last night the boy suffered some pain, but enjoyed
intervals of interrupted slumber. This morning reaction has
supervened: he has a full pulse, 80 to the minute; bled several
ounces pulse reduced to 75. Cold water dressing, which had been
first applied, was continued. 12 o'clock.' Pulse again full and
frequent, as before ; bled a second time, with like effect. This
afternoon his intellect is perfect; speaks without difficulty, com^
plains but little, and gives a satisfactory account of the way in
which the accident occurred, and of his position when shot in
fact, remembers every circumstance, both before and after the in-
jury. He is unable to move his right arm, or his under jaw ; the
left arm he moves with some difficulty, and the lower extremities
perfectly. Drinks water and gruel, through a quill, with great
ease.

April 2d. Bowels confined. Ordered a mild purgative, and,
subsequently, an enema, which operated freely during the after-
noon. Extremities cold for two hours before the action of the
medicine ; but after it, quickly regained their natural temperature;
pulse 70.

April 3d. Eested well during the night; has very little pain;
takes his gruel with decided relish, and is perfectly rational. Slip-
pery elm poultice applied to favour suppuration ; pulse 68.

April 4th. Slept well ; pulse 66 ; appetite good ; external wound
discharging; boivels moved during the afternoon. 6 o'clock p.m.
No discharge from within the cranium ; pulse 72.

April 5th. Uneasy and sleepless last night. The hole in the
skull found plugged with clotted blood, upon removing which,
pus and broken down cerebral matter escaped freely ; after which,
the uneasiness subsided, and the pulse sank to 66.

April 6th. Slept well ; pulse 65, soft and natural ; wound dis-
charging freely ; appetite good ; perfectly rational.

April 7th. Passed a good night ; sj^mptoms the same as yes-
terday.

April 8th, 9th and 10th. No material change in the treatment
or the symptoms, except that the skin of the upper half of the
body became exceedingly sensitive, the slightest touch of the hand,
or even of the covering, producing exquisite suffering. The par-
alysis of the left arm 'is something greater, though he is still able
to grasp an object with the hand and move the arm slightly.

1855.] Millek. Gun-shot Wound. 557

April 11th. Complains of pain in the head bowels confined
for forty-eight hours. Ordered purgative. 6 o'clock p. m. Medi-
cine has not acted ; pain in the head continues ; pulse 86.

April 12th. Bowels moved during the night. Still complains
of pain in the head, and great tenderness of the surface of the body,
when aroused ; but there is evident tendency to coma ; pulse 90.
6 o'clock p. m. Pulse 108. Since noon to-day he has not spoken,
but seems to recognize those who address him, and to under-
stand what is said to him. The stupor gradually deepened until
midnight, when he died.

The following is the account of the post-mortem examination,
made, twelve hours after death, by Drs. T. J. and E. C. Word :
" The anterior half of the cranium was removed on a level with
the eye-brows. On dissecting the scalp from the cranium, we ob-
served an ecchymosed spot at the upper part of the left temporal
fossa. On removing the cranium, we found that the ball had
passed in an oblique direction downwards and backwards, through
the right anterior lobe of the brain, into, and through the left lobe,
and had lodged against the anterior inferior angle of the parietal
bone, driving in the inner table of it, and fracturing the outer, at
a point corresponding with the ecchymosed spot which we had
observed on the pericranium. The distance traversed by the ball
was, by actual measurement, four inches.

" The surface of the anterior half of the right lobe presented spots
of congestion, but there was not much discoloration of the sub-
stances of it

" The anterior two-thirds of the left lobe, especially the mem-
branes, presented a dark livid appearance. Along the tract of the
ball the substance of the brain was broken down and softened.
The left lateral ventricle contained some semipurulent fluid, tinged
with blood, a very little, was also found, in the right."

The interesting features of the above case, in both a surgical and
physiological point of view, will so readily occur to the reader as
to render unnecessary an extended commentary.

That patients sometimes live for days, and even recover, after
severe injuries and frightful wounds of the brain, is a fact, well
known to the profession. Generally, however, such wounds are
inflicted by cutting instruments, as the sabre, or are made in such
manner as to leave no foreign substance within the cranium or,
if made by a projectile, in all the cases which I can at present
call to mind, only one hemisphere of the brain had been injured.

558 Walker's Cases of Infantile Convulsions. [September,

Barron Larrey relates the case of a soldier, wounded during an
insurrection in Cairo, in which the ball entered the frontal sinus,
passed to the occipital suture, and was extracted from thence by
means of the trephine. This man recovered ; but as it is expressly
stated that the ball pursued the direct course of the longitudinal
sinus, and its position was determined by passing an elastic bougie
along that sinus, the presumption is, that neither hemisphere of
the brain was wounded, at least, to any very great exteut. Many
cases are recorded, in which life was prolonged after gun-shot and
other wounds of a single hemisphere ; but that a man would live
so many days, after both hemispheres of the brain had been tra-
versed four inches by a pistol ball, is a most interesting, if not
unique, surgical fact.

It is not less wonderful, that so extensive a wound, implicating
that portion of the cerebrum which is supposed to be specially
concerned in the intellectual operations, should not have produced
disturbance of some of the mental faculties. Up to the twelfth
day, the mind was as perfect in all its parts as if no injury had
been received, thus setting at defiance both phrenological and
physiological laws.

The peculiarities of the partial paralysis, though not clearly ex-
plicable upon received physiological principles, are infinitely more
so than the exalted nervous sensibility of the surface of the body
which constituted so prominent and troublesome a feature of the
case.

However tempting the occasion, I do not propose to append to
this history any speculations of my own, but simply to submit it
to the consideration of the profession.

ARTICLE XXVIII.

Eccentric Irritation as a cause of Infantile Convulsions. By 1ST. S.
Walker, M. D., of Eatonton, Gra-
in the March No. of the London Lancet, page 216, I find a very
interesting paper, on Eccentric Irritation as a cause of Infantile
Convulsions, by Dr. Molloy.

I wish to add a little of my own observation and experience.
I shall not go into detail, as to the symptoms or causes of this
dreadful malady, but shall add a few cases, relative to the treat-
ment It is generally conceded that the causes are twofold viz ;

1855.] Walker's Cases of Infantile Convulsions. 559

cerebral and gastrointestinal ; but the former cause I believe to
be rare in infants.

The author recommends the injection of warm water, as never
foiling to arrest the paroxysms, and I have met with the same re-
sult in my practice.

Case 1st. Sept. 1853. I was called to see a negro child, set.
16 months, the property of J. M., of Putnam county, and found
the child semi-delirious, and having convulsions every ten or fifteen
minutes. He had taken a large dose of calomel, followed by castor
oil, which had acted tolerably well. I immediately threw up the
rectum about six or seven ounces of warm water, which came
away in a few minutes, and was followed by another paroxysm ;
as soon as that had passed off, I again threw up as much more
water, which gave immediate relief. The child went on to get
well, without another unfavorable symptom. I learned from Mrs.
M. that, about one month after this attack the child contracted a
severe cold, accompanied with disordered bowels; convulsions
followed, which were relieved by warm water injections.

Case 2d. Oct. 1853. Was called to see a negro child, set 18
months, a girl, the property of Eev. M. M. ; she was having severe
convulsions about every twenty minutes had taken castor oil the
night previous, which had acted twice. I bled her, with but little
benefit I now resorted to the warm water, which acted as
promptly, as in case 1st. The child had no other convulsion until
about the same time next day, when the same means relieved her.
I omitted to say that I gave three grains of calomel at my first visit.

Case 3d. April 9th, 1855. Called to see a negro child, set. 5
months, property of F. F. Had been indisposed for several days,
and on the morning of the 9th was seized with convulsions, with
but little intermission- had taken castor oil the day previous, and
a few hours before my visit had taken 1 gr. calomel, and had used
the warm bath frequentty. The calomel had not acted. I im-
mediately gave an injection of warm soap-suds, which moved
the bowels freely, and in thirty minutes another injection was giv-
en. The child had but two slight paroxysms after this, and on the
day following was convalescent.

The last case is not a very marked one, of relief afforded by the
water treatment, as it is likely that the free action of the bowels
might have been followed by relief. I would say, also, in conclu-
sion, that the mother of this last child had lost three of her offspring
at this age with this disease.

560 Chapman's Case of Accidental Impalement [September,

The above cases were not intended for publication, or my notes
would have been more explicit on some points; but I trust that
the above will be the means of calling the profession, generally, to
the therapeutical action of the warm water.

ARTICLE XXIX.

An Accidental Case of Impalement. By B. F. Chapman, M. D.,
of Lithonia, Gra.

On Tuesday, 5th of June last, we were called to see Mr. W. WT
19 years of age weighs 160 lbs. He had climbed up an apple
tree, to gather fruit ; as he came down he fell on a hoe-handle,
about an inch and a quarter in diameter, which was standing un-
der the tree : it entered his body at the anus, and penetrated for
at least twelve inches, without any visible lesion, except the la-
ceration of a small portion of the integument. We found him in
great pain in the umbilical region, and had been vomiting almost
constantly from the time he received the injury, which was two or
three hours before our visit. We kept him on his back, and bled
him copiously, which seemed to relieve him immediately ; he rest-
ed tolerably well through the night. On the 6th, his fever rose
very high, and he continued to have some fever for several days.

The treatment was, very light diet mucilage of slippery elm
forming the greater portion of his nourishment ; sedatives, to allay
pain ; cold sponging, and poultices over the stomach and bowels,
for days and nights ; took three spoonsful, each day, of pulv. carb.
ligni, in water. For dyspnoea and hematuria, we gave nitrous
ether, combined with camphorated tinct. of opium, and uvaursi
tea, with laxatives, to prevent costiveness ; then astringents, when a
diarrhoea set in. With the above treatment, our patient was able
to go about, and labor, in two weeks.

It is but just to say, he had the best of attention during his
illness. Mr. Gr. L. Wood (who is reading with me) remained with
him for nine days.

Hydrophobia.

The following experiments made by Dr. J. H. Geiscom, on a
patient suffering from hydrophobia, at the New York Hospital, are
quoted, as reported by him to one of our city newspapers. [Ameri-
can Medical Monthly.

I found the patient, at the time of my visit, on the bed, to which
lie wasystrapped to prevent injury to himself and others, perfectly

1855.] Hydrophobia. 561

calm to all appearance, intelligent, and entirely submissive to treat-
ment. He conversed freely, though with some confusion of da1
and facts respecting the time when he received the bite (between
four and five weeks previous), and other circumstances connected
therewith, and of his own feelings then. The scar was upon the
lower lip, perfectly healed, and exhibiting no signs of irritation.
As he thus lay and conversed, no one could suppose that he was
laboring under so fatal an influence, unless either the finger were
laid upon the pidse, which now numbered nearly 160, and was full
and bounding, or he complained of the pain in his throat and diffi-
cult v of swallowing. On examining his throat, a degree of redi i
was observed in the fauces, accounting partially for the pain of
deglutition. After giving further directions for his continued
comfort and the prevention of more convulsions, it occurred to me
to test the truth of some of the popular notions respecting this dis-
ease, especially in relation to that peculiar symptom from which
it derives its name, viz : the dread of water. The results of these
investigations, it is hoped, may have the effect not only of correct-
ing some false views on the subject, but, what is more desirable, of
hereafter alleviating the intense suffering of those afflicted with the
disease, if indeed they may not increase the means and probability
of recovery.

The most distressing part of the malady, is undoubtedly the dif-
ficulty and pain in swallowing , arising from sharp spasmodic action
of the muscles concerned in this function, extending sometimes
even to those of the neck and chest, and producing a feeling of
alarming constriction of the organs of respiration, causing almost
complete though temporary suffocation, and thus aggravating, if
not actually exciting, the convulsions, with the more or less violent
contortions and discoloration of the countenance, protrusion of the
eyeballs, and other active and painful symptoms. It is a popular
idea that all these are excited by the sight, and even by the sound,
of water, and although an intense thirst almost universally coex-
ists, the friends, and even the patient himself, anxious as they are
to alleviate it, dread even the presence or sound of water, much,
more its approach to the lips, lest all these horrible symptoms
should ensue. My investigations, simple as they are. show how-
relief may be extended in future in those most distressing symp-
toms thirst and parched and burning throat if the means thus
pointed out, are sufficiently, promptly, and carefully attended to.

That the mere sound of water will not excite the paroxysm, was
proved in this case by the fact that the noise of a stream of water,
in a closet, was continually within reach of his ears, to which he
gave no head whatever while I was by him, though it is said that
when he first heard it he was unpleasantly affected by it. Observ-
ing this, I then desired to try whether its actual taste, without
swallowing, could not be safely borne : and to this end, I induced
the patient to take a mouthful, but to hold it in his mouth without
attempting to swallow. He did so, and after retaining it sufficient-

562 Cutaneous Ntzvi cured by Iodine Paint [September*

ly long to satisfy both him and myself, at my direction he ejected
it from his month, expressing gratification at its cooling effect.

One step further I determined to go, though not without some
fear of producing a paroxysm of pain, and perhaps a convulsion,
I sent for some ice, and with a little persuasion placed a small
piece in his mouth, directing him to allow it simply to trickle
down his throat as it melted, avoiding, as before, every effort at
swallowing. A piece about the size of a thimble was first tried,
the cooling effect of which was exceedingly grateful, and he
willingly accepted a second piece. It was very difficult for him
to avoid deglutition ; he did succeed, however, and all the ice
descended to the stomach, as it melted drop by drop, demonstra-
ting in the most conclusive manner that water per se has no
influence in the causation of the spasms, and that the disease is
improperly named. It is not a hydro-phobia, a dread of wrater; it
is rather a dread of swalloiving, whether of water, or any other
liquid, or even of solid substances, as my patient said to me ; and
if that act can be avoided, as in his case, relief may possibly be
afforded in others by the administration of cooling, and perhaps
even more decidedly palliative remedies. In fact, encouraged by
these observations, I directed the application of a strong solution
of nitrate of silver to the fauces, with the view of allaying the ir-
ritation apparent there, and this he bore with not more difficulty
than is noticed in a majority of the cases in which this astringent
is applied for other diseases.

By these means, and the administration of anodyne and nour-
ishing enemata, the application of cool cloths to his overheated
head, mustard poultices to his extremities, and dry heat to his
general surface, and even by inducing him, a few hours before
death, actually, though slowly and with some difficulty, but not
so as to bring on any general paroxysm, to swallow some ammonia
and brandy, the patient was not a little comforted, and his passage
to the grave made more quiet and less painful. Unhappily, there
is yet no known antidote to this mysterious poison, and the symp-
toms can only be treated on general principles. The ebb of life
was attended writh no unusual phenomena none of the unnatu-
ral sounds, barking or frothing, or biting, popularly ascribed to
this disease being noticed. The vital powers became gradually
exhausted, until at 9f o'clock on the 15th, twentj- hours after
admission, he breathed his last.

Cutaneous Ncevi cured by the application of Iodine paint By S,
Edwards, M. D., Physician-Accoucheur to the Samaritan Hos-
pital for Women, etc.

During the past twelvemonth I have met with two cases of
cutaneous nasvns in infants, which have been most satisfactorily
and completely eradicated by means of the external application
of iodine paint.

1855.] Cutaneous Na I hy Iodine Paint. 563-

The first instance in which I was induced to employ it. was for
a naevus unfortunately situated on the side of the neck of a lernale
infant. At birth it appeared simply as a small, red (shining spot,
which in three months increased to the size of a fourpenny pie
The mother of the child at this time positively refusing to ha
any escharotics employed, fearing that it might give rise to a per-
manent and greater deformity, 1 recommended astringent and cold
applications to be applied constantly, and this was kept up for
some time, but with no good result. The naevus at the end of
ten months had acquired additional size, and was obseryed to
become redder and a little more eleyated, wheneyer the circulation

- increased by crying, etc. The parents still refusing any of
my former suggested remedies, or eyen of yaccination, " until it
got worse,'' I recommended the use of iodine paint, which was
regularly employed by gently painting oyer the surface with a
camel's hair pencil every alternate day, occasionally leaving it off
for three or four days when the skin irritable and rough.

Under this treatment I was pleased to find that the growth of the
naevus was arrested, became smaller and mottled, and finally dis-
appeared ; a speck or two alone being yisible to mark its former
site.

The second case was very similar : it occurred in a little boy
nearly two years of age. The naevns was about the size of a shil-
ling, but slightly eleyated, and situated on the abdomen, and had
gradually but very slowly, increased since birth. Xo treatment
had been employed, the physician who attended the mother of the
child, haying adyised nothing to be done unless it increased. The
tincture was commenced in September. 1854, and was continued
more or less up to last month when the disease had disappeared,
Ieaying scarce a trace of the mischief.

I know not whether other-: may haye made trials of this treat-
ment, but its success in these two cases has induced me to draw
attention to it, as it is a plan so simple in its character that I can
see no objection to its employment. In neither of these cases did
it produce fever, or, in fact, any effect upon the general health.
It is difficult, of course, to decide what might have been the result
had these cases been left to then> :hout treatment. I have

seen several that in the course of time spontaneously disappeared;
but still the fact that each of the above cases had gone on increas-
ing up to the commencement of the treatment,, and then began
shortly to recede, and finally disappeared, must induce the belief
that some considerable merit is due to the iodine, and that it de-
seryes a more extended trial.

The many plans that * haye been proposed and adopted for
producing inflammation in, and consequent destruction of, the
nsevus, are mostly attended with serious objections caustics, by
occasional extensiye ulcerations, serious hemorrhages, and by ex-
citing not unfrequently considerable constitutional irritation. " I
ci nation has, I believe generally failed, and when successful has

564 Sugar and Salt in Chronic Congestion. [September,

the disadvantage of leaving the ordinary cicatrix. The seton,
needles, the injection of fluids, and lastly, and perhaps the best of
all, the knife, have an aspect of seriousness 'to the parents, and are
all fraught with occasional serious consequences. The latest plan
which has been suggested, is that of Mr. J. B. Brown, who has
produced pustules on the cutaneous nasvus by means of tartar
emetic ointment. Besides the almost certainty of a larger or small-
er cicatrix being left, in one of his cases it occasioned very serious,
sloughing of the neighboring parts ; objections to its employment
about the face and neck of a very decided character.

Under these circumstances, I feel desirous of drawing attention
to the above examples, that others may put to the test the value
of iodine in these troublesome malformations of the skin, and
which, if they would kindly give me the result of their trials, I
should esteem it a favor. [Medical Times and Gazette.

Sugar and Salt as a local Solvent in Chronic Congestion of the

Cervix Uteri.
To the Editors of the New York Medical Times:

Gentlemen The following novel method of reducing the con-
gested state of the cervix uteri, which is so commonly met with in
the chronic affections of this organ, accompanied by discharge from
the os and "ulceration" of its mucous surface, has been so success-
ful in my hands, and in the practice of several gentlemen to whom
I suggested its use, that I desire to make it more generally known
through the pages of your journal. The plan of treatment of
which I speak, originated, I believe, with M. Caudmont, of the
Ecole Pratique, Paris ; at any rate, whether original or not with
him, it first came to my knowledge, four years ago, from his prac-
tice at his private clinique, and I have been unable to trace it to
any other source.

The following is the method of its application : The os uteri
having been exposed by means of the speculum, equal parts of
sugar and common table-salt, finely pulverized and mixed, are
impacted around the vaginal portion of the cervix uteri, and re-
tained in place by a pledget of lint or cotton wadding, moulded
into the form of a gddet, or small cup, and having a string attached
to its convex surface to facilitate its subsequent extraction. Thus
applied, it is left in situ, and the patient is directed to withdraw the
plug; by means of the string attached, in the course of twelve or
twenty-four hours.

Its effects are to produce a very copious discharge from the parts
to which it is applied: so much so, indeed, that patients should be
cautioned to take means for the protection of their linen ; and at
the following examination the cervix is found to be greatly re-
lieved of its swollen state due to the products of congestion, and
much reduced in size.

The most obvious explanation of the action of this application

1855.] Ligature of Arteries. 565

would appear to be found in the principle of exosmosis. Its ad-
vantages over the use of leeches, or potassa fusa, to accomplish the
Bame purpose, are obvious. It is exceedingly simple and speedy
in its action ; it is attended with no danger of injury to the neigh-
boring parts or of hemorrhage; it attains the end with but little
pain or inconvenience to the patient. Moreover, the experience
of several gentlemen, enjoying a large field for observation in the
treatment of uterine diseases, whom I induced to make a trial of
Caudmont"s method, confirms the result of my own practice, viz :
that it is even more efficacious as a solvent than the ordinary appli*
cations in chronic congestion of the cervix uteri.

Respectfullv Yours.
July 12, 1855. F. J. BuMSTEAB, M. D

Ligature of Arteries. By TV". J. C, DuHAMEL, M.D.

Having been prompted by some degree of curiosity to investigate
the a] q of various ligatures, and believing that different

material isea different influence upon the artery to which it

is applied, 1 find from inquiry, in experiments made, that those
most applicable in practice are catgut, silk, prepared and crude
flax, hempen threads, and hair.

The catgut, when applied as a ligature, is, doubtless, the most
st ongand homogeneous, Experiments show that even in arteries
all diameter it has sufficient strength to compress and divide
its proper coats, but it liffers from other ligatures, as it does not
always divide the internal wall at the moment the knot is formed.
ne instances, the catgut was thought to have been absorbed,
and in many instances it was found so much softened that little
doubt could be entertained of its progressive absorption.

More experiments have been made with silk than with any other
material, both in the manufactured and crude state, untwisted
threads. &c., applying them not thicker than human hair ; rhe only
difference in the result: was, that manufactured silk, left on an arte-
ry, lost its artificial color, while the unprepared maintain e 1 the
color natural to it. When compared with catgut, silk ligal
produce much more irritaxion, and excite suppuration mor
quently, although in many cases simple adhesive inflamm;
alone was produced.

Like the catgut, they are first covered with plastic lymph, then
connected with the cord remaining between the two extremities of
the artery, or the}" lie bare between the layers of the common cel-
lular tissue, or become encysted. If not thrown off, the silk may
remain inert during life ; yet in some cases it has been demon-
strated that after a long time it becomes softened, and may be ab-
sorbed. Xo difference was found between slender ligatures of
linen or hempen thread ; they have been found no more irritating
than silk. Of experiments made with black horsehair (single or
double), the only difference of such from other ligatures is, that
5. VOL. XL >~o. ix. 36

566

External Pressure in Epistaxis. [September,

they preserve their physical properties unaltered, and still remain
in the body innocuous ; human hair likewise. The following table
will show the result of the application of some 300 various ligatures
and methods, and of the pathological conditions induced by them
in arteries.

1. Quality,
Catgut
Silk .
Thread
Hair .

2. Methods,
Circular ligature .
Loose ditto
Double ditto

3. Animals Experimented upon
Dogs .
Sheep .
Goats .
Calves .
Horses

Rabbits

4. Arteries

Carotids
Subclaviocs .
Brachial

80

120

60

40

140
70
45

65

24

12

2

13

5

8

110
32
14

Iliac .
Femoral

5. Time Left.
1 to 30 days
1 to 3 months
3 to 6 months .
6 to 9 months

1 to 2 years

2 to 3 years

6. Result.

Catgut 80 Jdsappeared.
& \ remained . .

Silk 120jdisaPPe^d-

( remained . .

Thread 60 i disappeared .
( remained . ,
n j disappeared .
( remained . .

19
80

44
61

48
54
29
18

Hair

33
19
10

2

7. Effects in the 236 Ligatures which remained.
1st, Covered by lymphatics cellular subst a nee . .
2d. Attached to the cord between the ends of the artery .

3d. In common cellular tissue

4th. Encysted

5th. Forming abscesses

4T

101

5Q

38

64 236

29
60
67
54
26

Washington, D. C, June 23d, li

236
[N. J. Med. Reporter.

Observations on External Pressure as a means of relieving Excessive
Epistaxis. By L. Shanks, M. D.

A communication, published in the Boston Medical and Surgical
Journal, from Dr. Cartwright, of New Orleans, on the efficacy of
external compression by means of a tourniquet and pad applied
over the alveolar process, in case of hemorrhage from the sockets
whence teeth have been extracted, has induced me to present to
the profession the result of my experience with a similar remedy
in excesssive hemorrhage from the nose, which I have used with
great success for several years, though I have not seen it mention-
ed in any publication on the subject.

The remedy alluded to consists of two compresses, made of old
linen or cotton, firmly rolled, about an inch or an inch and a half

1855.] External Pressure in Epistaxis. 567

in length, and the thickness of an ordinary-sized thumb. These
compresses to be applied on each side of the ahv-nasi, and extend-
ed down to the edge of the lip, and then firmly pressed againstthe
superior maxillary bone and its alveolar process, by means of a
narrow bandage passed over them, and tied on the back part of the
head, or carried round the head, tightly drawn, and secured in its
place by one or two cross turns of the bandage over the vertex and
under the chin, to be pinned at the place of crossing, to keep the
dressing in situ, and preserve the necessary pressure over the naso-
labial compresses.

This dressing, when properly applied, interferes but little either
with respiration or mastication, and therefore may be continued as
long as necessary without inconvenience.

For several years, in obstinate cases of epistaxis, I have used this
remedy for its arrestation, with prompt and uniform success. Its
effect in the entonic or active, and the atonic or passive forms has
been equally successful.

The success of external pressure upon the labial branches of the
external maxillary artery, tends to prove that they supply the
blood to the vascular schneiderian tissue, in cases of profuse and
continuous epistaxis.

Though the supply of blood is attributed by writers on this sub-
ject to the internal maxillary arteries, I was induced to believe
otherwise, from the throbbing in the labial artery, near the alae-
nasi, produced from the temporary suspension of epistaxis, by
plugging up the side of the nares whence the blood issued ; and
the remedy of pressure over that artery was suggested from ob-
serving the increased determination of blood to the nose through
these vessels.

In cases of epistaxis and hemorrhage from the sockets of teeth,
there are two prominent reasons why external pressure succeeds
better than the internal from plugging of the cavities.

First, the extenal pressure cuts off or prevents the increased
determination and chief supply of blood ; and secondly, the cavi-
ties whence the h 'inorrhage proceeds are diminished "by this ex-
ternal pressure, id the vessels and their ruptured and gaping
mouths are diminished and closed.

The expansion of all cavities from which hemorrhagic discharges
of blood proceed, tends to widen the trunks and bleeding mouths
of the ruptured vessels, and to increase the flow, unless sufficient
pressure is made at the proper point to close permanently the patu-
lous opening.

In addition to the greater success of external pressure, demon-
strated by its affording prompt relief in cases where all or most of
the other means recommended in the books had been unsuccessful-
ly tried, there is another thing in its favor of great importance. It
may be used without any serious annoyance or inconvenience to
the patient, and continued until all danger of a return of the
hemorrhage is removed.

568 Alleged Cure of Cancer. [September,.

In illustration of this effect of the external pressure described, I
might report many cases ; but as the object is merely to suggest
this simple remedy for an affection sometimes exceedingly uncon-
trollable, and troublesome to the physician r and annoying and
injurious to the patient, I shall only mention one case.

Last summer I was requested by a gentleman to visit a negro
man who had been reduced very much by a tedious attack of ty-
phoid fever. "When he was considered convalescent, hemorrhage
from the nose commenced, and had continued several days almost
constantly, although most of the ordinary means had been tried to
arrest it. He was so weakened and exhausted, and his blood so
much attenuated by the hemorrhage occurring in his debilitated
state, that his master despaired of his recovery.

I applied the naso- labial compresses, and a strip of soft domestic,
folded so as to be half an inch wider at the part placed over the lip
and compresses under the nose, and tied it tightly on the back part
of the head. Another strip was applied under the lower jaw, car-
ried over the first and tied on the top of the head.

The two strips were then pinned at their crossing, so as to secure
the dressing in situ, and preserve the necessary pressure from the
first, over the compresses.

The hemorrhage was immediately arrestedr and under a course
of tonic treatment he gradually recovered, without having but a
slight return of hemorrhage the next day, from the bandage be-
coming too slack, which was arrested by tightening it. , The band-
age and compresses were kept on several days, and directed to be
tightened if there was any recurrence of hemorrhage.

In this case the hemorrhage was not only permanently arrested
by the simple means adopted, but doubtlessly the life of the patient
was saved by it. No other means could probably have been re-
sorted to, in his extremely debilitated state, that would have arrest-
ed the bleeding, without interfering too much with respiration,
medication, and the nutrient support of the system necessary to his
recovery. [Memphis Medical Recorder.

Alleged Cure of Cancer.

M. Landolfi, chief surgeon of the Neapolitan army, has of late
attracted much attention in Italy and Germany, having seemingly
cured cancer by means of the topical use of chloride of bromine, in
combination with several other chlorides. This success has pro-
duced such sensation as to induce the Emperor of the French to
give the author six beds at the Salpetriere Hospital (where the in-
sane and aged of the female sex are admitted), to afford him a fair
opportunity of proving the efficacy of the remedy. This is the
right, practical, and sensible way of dealing with such questions.
We are in the mean while bound to state that U Union Medicale,
of May 1, 1855, contains a letter from M.. Leriche, of Lyons, who
says that he has strong doubts about the actual bond fide cancer

1855.] Cantharadine Ouumeni in Open Cancer. 569

having ever been cured by the above-named application, as he has
steadily used the chloride of bromine for ten months, in various
-f cancer, without having succeeded in warding off the fatal
issue of this formidable disease.

The formula of the paste used by M. LandoLfi, is the following:
Chloride of bromine, three parts; chloride of zinc, two parts : chlor-
ide of antimony, one part ; chloride of gold, one part ; powder of
liquorice sufficient to make into a paste. The principal agent is
the chloride of bromine, which has lately been used by itself
Cancers of the skin, the epithelial variety, lupus, &c, are treated
by a combination of chloride of bromine with basilicon ointment
M. Landolffs view is to change a malignant ulceration into a sim-
ple one. For this purpose, he formerly left a piece of linen spread
with the paste as long as a fortnight upon the part, but now he
imbricated pieces of lint, similarly spread, and leaves them
only twenty -four hours. The surrounding parts are protected by
an ointment composed of one drachm of chloroform to an ounce
of axunge. The author considers that the chloride of bromine acts
not only topically, but that the specific is absorbed and aids the
cure. Hence he gives, as an adjuvant, a certain number of pills
which contain a minute proportion of the chloride. AVhen the
pledgets spread with the caustic paste are taken off, after the
above-mentioned twenty-four hours, a line of demarcation is ob-
served which separates the altered from the healthy tissues. Bread
poultices are then applied, or else lettuce leaves, or basilicon oint-
ment, which should be changed every three hours, until the eschar
is thrown off, which event takes place from the eighth to the fif-
teenth day.

Numerous experiments have been made in Italy and Germany,
and some successful cases have been recorded. It should be added,
that there is much fairness about the proceedings : M. Landolfi

not choose the cases, is anxious to make the remedy e:
sively known, and publishes the unfavorable as well as the favora-
ble results. The Committee appointed in Paris to report respecting
the experiments at the Salpetriere. is composed of the physicians
of the hospital, Drs. Moissenet. Cazalis, and Manec, assisted by
MM. Mounier, Broca, and Furnari. This report will be an im-
portant document, as the diagnosis will no doubt be very carefully
made ; but the question of recurrence can only be solved by inves-
tigations spreading over several years. [Medical JV-.

Oxntharadine Ointment in Open Cant
Dr. Remv strongly recommends an ointment consisting of 10
parts of powdered cantharides and 30 of larcL It is applied on
charpie night and morning. It rapidly induces temporary cica-
trization of even deep ulcers, and by its palliative employment
cancers may be maintained within moderate limits for a long period
of time, and the exhaustion of the powers of the patient so much
delayed. [Ibid.

570 Iodine, <c, in Cutaneous Inflammations. [September,

Iodine and Nitrate of Silver in Cutaneous Inflammations. By J. H.
Nutting, of Orford, N. H.

The use of these two remedies in erysipelas is too common to
need notice. But, so far as I know, they are not generally used
together, one or the other being applied by itself. It is to the
simultaneous use of both that I wish to call attention.

If the tincture of iodine be applied to the surface, and immedi-
ately after the nitrate, a chemical union of the two takes place, and
the resulting compound is of a dull white. The same takes place
if the solutions are mixed in a phial. Of the chemical change thus
effected and the compound formed, I am not certain.

During the epidemic erysipelas which prevailed some time since
in this region, Dr. Knapp, of Dummerston, Vt first accidentally
applied the tinct. and nitrate together. He found that while the
application was less painful than of the nitrate alone, it was more
efficacious in arresting the ulcerative action. He afterwards fully
tested this mode of applying these remedies during a pretty exten-
sive practice among it for three years. He also used it successful-
ly in the sporadic cases.

On his recommendation, I used the same application in several
cases (of course, with general treatment), and ibund it prompt in
checking the spread of the inflammation, and in restoring the sur-
face to a healthy state. I had an opportunity to compare it with
the effect of blisters in checking this action. In one patient, with
a local manifestation of the disease in the hand, under the advice
of some good old lady, a blister was applied, in my absence, to the
back of the hand. It filled well, and was soon filled with the ex-
tending ulceration. The application of the tinct. and nitrate to the
palm at once checked it, as it also did on the back of the hand.

I was subsequently called to attend a boy with an eruption in
large patches about the loins, and covering about half the circum-
ference of the body. I do not now remember the exact character
of the eruption. There was some constitutional disturbance, which
was treated with salines, and astringent and cooling lotions to the
part. These produced little effect on the eruption. I then applied
the tinct. and nitrate to about half the surface, and the next day
found that drying up, and presenting a better appearance. I then
applied it to the whole, and two clays after, he returned to his
work free from trouble.

About ten days since, a young man in my family passed through
some ivy, and in a few days the whole of the leg, from the nates
to the heel, was a blistered surface, and swollen to double size.
There was considerable disturbance of the sj^stem, and the pain was
so severe as to prevent sleep. After trying the usual applications,
without effect, and the tinct. of iodine, I next tried the nitrate
alone on a part of it. This had little effect besides waking up his
sensibilities for a while. The next day, seeing no amendment, I
had an assistant brush the whole surface over with the tincture,

1855.] Importance of Nourishment in Fever. 571

while I followed with the solid nitrate. The pain from this was
less severe than from the nitrate alon< ; and after the smarting sub-
sided, the pain entirely left him. The next day the surface was
drying up, and there was no progress of the poison, except at one
or two points. These were now touched in the same way, and the
next day he was up and dressed for the first time for a week- The
oedema disappeared from the thigh, and has now wholly left the
leg and foot I have rarely seen so severe a case of poisoning from
this cause. Were I to see another, I should at once try this appli-
cation as the topical treatment.

These cases are not enough to establish the superiority of the
application over others ; but so far as they go, they give it a claim
to attention. My own conclusion is, that used in this mode the
pain is less, and the effect more speedy and certain, than if used
alone. [Boston Med. and Surg. Journal

The Great Importance of Nourishment in Fever. By Dr. Stokes.

I wish also strongly to impress on you the great importance of
the use of other forms of nourishment m this disease; for we must
not only keep up the nervous energy of the s}rstem by wine, but
we must support nature by food. There is no mistake more fatal
in fever, than the withholding of food. I was early taught the
importance of the use of careful r. ourishment in fever, by my
friend and colleague, Dr. Graves. I remember once, Dr. Graves,
when speaking of the necessity of the use of nourishment in fever,
made use of these words: "If you are at a loss for an epitaph to
be placed on my tomb, here is one for you He fed fevers." In
addition to the prejudices with which the inflammatory doctrine
imbued so many minds, with respect to the use of food in fever,
there was a new set of arguments raised against it, in consequence
of the experiments of an American physician. I allude to the
case observed by Dr. Beaumont, and so often quoted since. In
this remarkable case, various medicinal substances and articles of
food were introduced through an exteri 1 fistula into the stomach,
their effects being noted, as also the conditions of temper tture,
vascularity, &e. A set of results were subsequently published in
connection with the action of the stomach upon food. One of
the results stated to have been thus obtained, was that the exist-
ence of the fcLitc of fever altogether suspended the process of
digestion. Here was a statement which had the appearance of
being the result of strict observation. It influenced a number of
young men; but did it influence those who had once been in
charge of a fever hospital? Not at all ; because those men knew
very well that, no matter what Beaumont might say about the
stomach not digesting when the patient had fever, in thousands of
cases patients in fever digested remarkably well, required food, and
derived benefit from it. In a large number of cases of typhus

572 New Method of Introducing Medicine. &c. [September,

fever, the stomach has an excellent power of digestion ; and, I
believe, if we were bold enough, we would find that many articles
of food usually forbidden to fever patients, might be given to them
with safety.- [Banking's Abstract

New method of introducing medicines into the system, more especially
applicable to painful local nervous disease.

Dr. Alexander Wood has been led to introduce solutions of
morphia and Batley's sedative solution into the cellular tissue, as
near as possible to the affected nerve, by means of the small
perforating syringe, constructed by Mr. Furguson of Giltspur
street, for injecting aneurism with perchloride of iron. Dr. "Wood
narrated nine cases in which he had emplo}*ed this method of treat-
ment, in all with perfect safety, in some with complete, in others
with partial success. As to the modus operandi of this method of
t atment, he endeavored to show, from the experiment of Muller
: d others, that the effect of the local application of opium to a
nerve was to destroy its sensibility at the part, and that from this
action of the drug the immediate cessation of the pain arose. He
then pointed out the rapidity with which absorption appeared to
take pi; ce from the cellular tissue, which seemed to account for
the rapidity of the narcotic effect which a small dose of, so intro-
duced, was found to produce. He also pointed out, that other
medicines might be introduced in the same way.

Dr, AY. T. Gairclner mentioned, that a patient in his wards in
the hospital, had been injected the other day in the way recom-
mended by Dr. Wood. The result was not decisive, as the com-
plaint for which the man was under treatment, viz : lumbago, had
been undergoing rapid amendment, and, indeed, the day after ihe
operation, was nearly gone. The experiment, however, was at-
tended with little suffering, and it was noted that some degr e of
giddiness was almost immediately produced. Monthly Jour. Med,
Science,

Common Salt.

Dr. Hutchinson, in the ISTew York Journal of Medicine, ranks
this remedy before arsenic in the treatment of intermittents, and
thinks that in a majority of cases it may be successfully substitu-
ted for quinia. He gives it in combination with slippery elm. in
the proportion of three ounces of the salt and three drachms of the
elm, to eight ounces of boiling wate. ; which forms a saturated so-
lution. The dose is a table-spoonful every two or three hours
during the apyrexia. Besides considerations of economy, its use
is to be preferred in cases where the quinia causes unpleasant con-
stitutional effects. We made some experiments with this remedy
before the medical class, in the Dispensary of the Memphis Medi-
cal College, and in a large majority of cases in which our prescrip-

1855.] Radical Cure of Inguinal Hernia. 573

tion was followed, it proved successful. The plan we pursued
was, to combine with a drachm of salt, a few grains of powdered
bark, or Colombo, and direct such a dose to be taken in a small
cup of water, every two or three hours during all the period of in-
termission. But when it came to be discovered, by the patient's
applying at the Dispensary, what the remedy was, it was imj
ble to continue the treatment in consequence of their want of con-
fidence in it. Some fifty or sixty cases, however, were cured by
this means alone, although in several others it failed, and we had
to resort to the quinia. It can scarcely be doubted that common
salt possesses important antiperiodic power. [Memphis Med. Bee.

A plan for the Radical Cure of some cases of Inguinal Hernia. By
Patrick H. Cabell, aL D., of Selma, Alabama.

Of the different means by which it has been proposed to solve
that difficult surgical problem the cure of reducible inguinal her-
nia, none appears more rational nor offers fairer chances of success
than Dr. Gerdj's method of invaginating a fold of skin into the
inguinal canal. The principle of this operation is certainly cor-
rect. It aims at obstructing the abdominal ring, the insufficiency
of those operations which simply produce ad. in the sac

having long since been tested ; the only difficulty is hi the execu-
tion.

I wish to describe a form of truss which I think calculated to
obliterate the inguinal opening in ordinary cases of oblique hernia.

In place of a pad, the inguinal branch of the ordinary truss is
made longer than usual, and to its extremity is attached a round-
ed cylinder of soft wood, designed to be inserted into the canal,
pushing a fold of the skin of the scrotum before it. This finger-like
projection of wood is kept up by the pressure of the spring, the
displacement is prevented by the circular strap and thigh strap.

When the pouch of skin seems to have adhered in its new situa-
tion, the surface of the "cul-de-sac" is to be denuded of its epithe-
lium, and then its sides brought together by an ordinary truss with
a long pad resting over the invaginated portion.

I do not claim any thing new in this method, and am far from
vaunting it very highly, for the cases in which I have used it have
not been long enough under treatment to enable me to decide on
the permanency of the cure, but I think it cannot be unsafe, and it
is free from some of the objections of the ordinary methods, as the
Lent can walk about during the treatment.

I propose it, then, with much diffidence, hoping that it will be
tried by surgeons if they have nothing better. [Virginia Medical
and Surgical Journal.

Dilatation of the Os Uteri by Chloroform Ointment.

Dr. Ronald succeeded in dilating a hot and rigid os uteri by
means of chloroform ointment. Bleeding to syncope, tartrate of

o7-i Editorial. [September,

antimony and hot bath having failed, Dr. R. prepared an ointment
consisting of a drachm and a half of chloroform, intimately mixed
with an ounce of simple cerate, which was freely applied to the
external surface of the neck of the uterus. It produced a slight
smarting pain, which soon passed off; in 20 minutes dilatation of
the os uteri commenced, and in one hour and 27 minutes, delivery
was .accomplished. [West Jour. Med. and Surg.

EDITORIAL AXD MISCELLANEOUS.

Dr. Wm. J. Holt. We have had the pleasure of perusing a letter re-
ceived from an officer attached to the allied army in the Crimea, who was
wounded at the battle of Balaklava, and taken prisoner by the Russians.
Sent to the Hospital at Simpheropol, this officer was placed under the pro-
fessional care of our esteemed fellow-townsman, Dr. Wm. J. Holt, and
finally recovered from his wounds, which were so severe as to have been at
one time considered fatal. This officer speaks in the highest terms of Dr.
H.'s skill and standing in the army, and states, among other interesting
facts, that the Emperor of Russia has conferred upon Dr. Holt the Knight-
hood of the order of St. Anne, as a testimonial of his high regard. Dr. H.
is now stationed at Eupatoria, and attached to the staff of the commander
at that place, having been compelled to leave Simpheropol in consequence
of the impairment of his health. We are happy to add, that our friend's
health had been entirely restored by the change of air. We sincerely hope
that he may be spared to return to his native land, and to enjoy the con-
gratulations of his numerous relatives and friends in this city.

Savannah Medical College. We have received the Circular of this
Institution, together with the Address delivered at the Commencement in
March last, by Henry Williams, Esq. The Class at the last session num-
bered forty-nine, of whom seventeen were graduated. Mr. W.'s address is
an able and chaste philosophical disquisition upon the intellectual progress
and destiny of mankind, which we read with much pleasure.

Fleming 's Hygienic Journal. We have received the first number of this
periodical, published at Atlanta. It is very creditable to the Editor, and
will doubtless be read with interest by the profession. W"e cheerfully add
it to our list of exchanges.

Necrological. We learn, with regret, the demise of Professor Elisha
Bartlett, the distinguished author of the American work on Fevers, &c.
Also, that of Dr. Martin Barry, celebrated for his researches in Embryolo-
gy and other subjects.

1855.] Editorial and Miscellaneous. 575

Dr. Joliu \Y. Paxton has opened, in Knoxville, Tenn., an Infirmary, under
the name of M Hotel for Invalids." We wish the Doctor success in his
undertaking.

of Double Uterus; both Impregnated. Dr. J. T. Kannon states
(New Orleans Med. and Surg. Journ.. May. 1855) that he was called in
consultation to see a woman who had been delivered early in the morning
of a child. There were still all the external appearances of another child
remaining, the womb being entirely empty, the placenta having come
away. Owing to great prostration consequent upon the birth of the child,
and the womb being empty. Dr. K. supposed that laceration had occurred,
and the fetus had escaped into the cavity of the abdomen.

He passed his hand into the empty womb, and found its walls solid, not
the least appearance of a rupture having occurred. The probability of a
septum with a double womb suggested itself to his mind, and further ex-
amination revealed the correctness of this opinion. Looking upward and
forward, near the e^ge of the symphysis pubis he found the os uteri of
another womb, with the head of the foetus resting directly on the pubis.
There was no effort making on the part of the womb to expel the foetus,
and the usual remedies failing to bring on the pains, an attempt to turn
and deliver was tried : but the peculiar position occupied by this second
womb rendered it very difficult. As by this effort it was discovered that
the foetus was dead, he resorted to the crotchet, and brought away a child
weighing six or seven pounds.

This lady was the mother of five children, but never previously had both
wombs been impregnated at the same time. The septum was horizontal,
with the os tinea? of the lower and posterior womb in the natural position,
the anterior a . y elevated. [American Jour, of Med. Sciences.

Pregnant missions Membri. Dr. Borleben, of Hildesheim, has

placed on record an instance of impregnation without admission of the male
organ. A young woman, about twenty-seven j ears of age, had been in
labour of her first child forty eight hours, v ] n he was called to see her
by the midwife in attendance. Dr. Borleben found the passage of the
child's head obstructed by a strong thick hymen, which on full stretch
only presented an orifice of an inch and a half at its greatest diameter.
An incision having been made, delivery was speedily accomplished.

Dr. Borleben was informed by the husband that he had never been able
to effect penetration. His prepuce covering his glans penis, he suffered
acute pain, consequent on retraction of the prepuce, on every attempt to
consummate sexual union. No defect, as to formation or size of the De-
rated. [Casper's Vicrteljahrsschrift. British and Foreign Med. Chir.
Review.

Prevention of the entrance of air in Paracentesis Thoracis. By Dr. T.
Walker, of Peterborough. Let a piece of quill, fitted to the tube of the
canula, be prepared by wrappinground it and securing with a bit of thread,
a small piece of thin wash-leather, or sheepskin, rendered limp bv wetting
it. Immediately on withdrawing the trocar, this quill is introduced into
the canula : the wet leather forms a pendulous prolongation of the tube, an
inch and a half long, or a little more, through which the fluid will flow
fireely ; but the moment that the slightest act of suction takes place, which,

576 Miscellaneous. [September,

as the chest gets empty, invariably happens, it will act as a valve, and pre-
vent the possibility of any air entering by the tube of the canula.

Of course, the ordinary precautions to prevent the admission of air
through the opening made by the trpcar, either before or after the puncture,
are not neglected [Assoc. Med. Jour.

Recent Chemical Discoveries. A recent chemical discovery proves that
alcohol may be made synthetically from coal-gas (and probably other
carbo-hydrogenes) and water. If the discovery prove remunerative, it
may very much modify the expense of quinine prepared by alcohol, tinc-
tures, and ether of all kinds, and would, we are sure, be a welcome boon
to curators of museums and others. The eminent pharmaceutical chemist
of Dublin, Donovan, lately took advantage of the ice and snow, so plenti-
ful in that city, to examine into the properties of some pharmaceutical
ethers, which would be impossible without large masses of ice and snow;
among the rest chloric ether, now so frequently found in prescriptions.
This able chemist states, that there is no such compound at all as chloric
-ether, and what is known as perchloric ether, detonates violently by even
shaking the bottle. Surgeons prescribe chloric ether, but the patient gets
Dutch oil, more generally, chloroform in an insoluble state, or spirits of
wine ; but the nearest approach to chloric ether is muriatic ether, which
he succeeded in obtaining, or perchloric ether, which he gives a caution
not to use, as it explodes. [London Lancet.

Neiv Treatment of Coryza. In the Journal de Medecine el de Chirurgie
Pratiques for November, 1854, M. Yvyonneau says that he has obtained
great success in coryza by plugging up the external nares by introducing
a plug of lint rolled in collodion. The organ, he says, is protected from
the contact of cold air, and at the same time the disordered surface is
bathed in warm air, and the moisture exhaled in respiration. The remedy
has, in his hands, never failed to produce a cure in twenty-four hours.

[ Western Jour, of Med. and Surgery.

Tasteless Lnfusion of Senna. Dr. Brandeis recommends a cold infusion
of senna for twelve hours in a covered vessel, as especially useful in infan-
tile therapeutics. By this modification of the process usually employed,
the water contains only the cathartic and the coloring matter, leaving the
essential oil, the fatty matter and the irritating resin, which are soluble only
in hot water. Senna waler thus prepared cold, is almost insipid, and its
taste completely disappears when mixed with infusion of coffee or tea.

[Archives Gen. de Med. Peninsular Jour, of Med.

Cupping. Dr. Whitfield, of Gainesville, Ala., suggests, in a letter to the*
editor, that it is an improvement in cupping, to stick with wax in the bot-
tom of the cup a bit of sponge, upon which the alcohol may be dropped.
All risk of burning the patient is obviated by this plan, which is adapted
to all cases in which the cup can be applied vertically. [Memphis Medi-
cal Recorder.

Hiccough. Dr. Upsher, in the Virginia Medical Journal, says, " this
symptom is the result of spasms of the diaphragm, and can be relieved by
a bandage applied tightly around the lower part of the thorax, which re-

1855.] Jf

the diaphragm and causes a cessation of the spasms. This plan has
given relief when every other had failed. It may also prove of much as-
sistance in relieving cases of chronic vomiting, not depending upon organic
disease of the stomach." [SL Louis M >;v. Jour.

Impotence. Dr. Schulz details in th< a number

. which I red successfully by me;

tricitv applied to the pe: : xtiemities of the nerves, on the a

the dorsum penis, tJ . .-. One old gentleman, in panic,

mentioned, who haojnot had an erection for fifteen y
sumed a state of formidable turg tar the disci \ L>r. Schulz*

battery. [St. 1 g. Jour.

Spirits of Turpentine and Nitrate Potash in Snake Bites. Dr. Win.
Hanley. of Xapierville, Illinois, -J and

Surgical Journal some cases of snake bites, one from the rattle snake, which
inks were relieved by 30 drop doses even" half hour of a mixture of
spirits turpentine, saturated with nitrate of | This was also applied

to the wounds and in friction to the liml a [Sash, cille Med. Jour.

Statistics of the Medical P .3 ich, of Wurtz-

burg, has just published tables which would that the mortality is

greater amongst medical men than in other -. The author takes

*e of 15.730 persons belonging to the follow] _ s : Medi-

cal practitioners, Protestant and Catholic ien, professors, schoolmas-

ters, the bar, and those employ Board of Woods and Forests. He

iiat three-fourths of medical men die before the age of fifty, and ten-
elevenths before sixty. Out of 1168 medical men alive in 1852, four only
(8.34 per cent.) were more than eighty years old. The ten oldest practi-
tioners numbered together 792 years, whilst the ten oldest men taken from
any of the above-stated profe- ented much higher figures. Catho-

lic clergymen numbered 872 .oolmasteis 875. and

Protestant clergymen 865. Out of 100 medical men, only twenty-six had
reached fifty years: and it is well known that, according to Casper's statis-
tics, the proporti - favorable in Prussia, as only nineteen per cent.
reach the age of fifty. [London L

Th t J rori. By an Invalid M. D.

With regard to life it has .id by a late writeT, that u we pera

ourselves that it teems wil lights; that it abounds with

high festival days and gala shows, somewhere in happier regious, although
they come not to us." This remark is especially true with regard to the
hopes and expectations of the invalid.

Art may fail him at home, measures which he must feel are well direct-
ed, may disappoint, friends may mournfully walk around him ; still his
mind at times overleaps all, and loves to revel in the idea that somewhere,
in some unknown land, there lives the mind to conceive, and there exist the
remedies which it can direct, for his recovery.

The sweet solace of the mind, Hope, as every one knows, is the constant

attendant on consumption, where it is, indeed, a heavenly visitant. Wasting

day by day. who has not seen the wretched victim letting go the greater

a of yesterday, which may have pointed him to a complete recoverv.

578 Miscellaneous. [September,

but to cling the faster and with as sweet content to those of to-day, although
they promise only a partial convalescence.

I cannot conceive of a more beautiful dispensation of providence than
this. Round and round in a narrowing circle, day by day, but nearer the
end, yet there is always hope that the last thing tried, despite of preceding
failures, will prove just what is wanting. So sweet a comfort the pitying
angel must send for a good purpose. But so much good comes not un-
mixed with evil ; for this very buoyant feeling of hope is taken advantage
of by designing men, whose promises to furnish remedies to suit every
case, are only equalled by the extent of the popular credulity. I believe
that it is in ignorance, that such deceive the afflicted. If there are any
who do it knowingly, who will take advantage of this heaven-born feeling
for .the purpose of money-making ; to them I have but to say with Othello:

Never pray more : abandon all remorse,

*******

For nothing canst thou to damnation add,
Greater than that.

Messrs. Editors, guided by just such feelings as I have attempted to de-
scribe, I directed my footsteps to the great city of New York. I have a
large cavity in the upper part of the left lung, and I had been told with a
sad voice aud a firm aspect, by one whom I loved and had every reason to
respect, that softening had already begun in the apex of the opposite organ ;
and I am emaciated to the last degree. Nevertheless, from the glowing
accounts which I had heard of the wonderful power over the disease, pos-
sessed by numberless men in this great commercial emporium of our Union,
I resolved to proceed thither at all hazards.

My mind was filled with vague, but most embarrassing hopes, shadowy
outlines of superhuman skill, in men, high above their fellows in point of
pure humanity and disinterested devotion to the science of life, flitted be-
fore my morbid vision, giving me strength to endure the journey.

Two great parties I found engaged with equal zeal in this important
work. The one I shall describe as the constitutional class, or those who
adopt a general treatment ; the other the local, or those who adopt a strictly
topical method of cure. I had been educated in the former school, and
did not tarry long with its professors.

Improve the nutrition, cod liver oil good diet much out door exer-
cise, measures which I knew had saved me so far, were all they could tell
me about, but knowing all this before, I w7as not satisfied, and wished to
go farther ; for these I found were not the men who were doing so many
wonders. I diverged a little into the intermediate class a sort of divining
doctor, by spiritual agency who had an immense run, as I learned, among
the clergy. The Dr. was overrun with patients his ante-room was like
the lobby of a theatre on the night of a popular actor's benefit.

I took my seat, and abiding my turn, it came at last. I found behind
the scenes, one having the air of " a most prosperous gentleman," who
looked through my case with an imposing flourish smiled approvingly
received a fee, I thought an enormous one and bade me follow him and
I would be wrell. Conducting me back into the ante-room, he sang out
some words in an unknown tongue to a clerk near the window, who wore
a remarkably stiff standing shirt collar, and then, with a graceful wave of
the hand, withdrew. This latter person at once handed me a package of
medicine, already neatly put up in a handsome paper box. Ah, said I in

1855.] Miscellaneo 57(?

surprise, did you have it ready ? Yea, said the clerk, carelessly, I saw
tou come in, arid whilst you were waiting k, I put it up.

Then, rejoined I with warmth, you knew beforehand what he meant to
give me i

The clerk with a stiff standing collar. thrust his tongue into his left
cheek, drew the lower lid of eye grimly down, with his ring

finger, leered at me significantly, but with much goodnature, and I depart-
ed, I trust, a wiser man.

siting a man who had told me that he had enjoyed the honor
(hitherto unknown to Americans) of being the physician for many years
to her maj- :ia. queen of England, and that he had a book which

he sold for 12| cents, which would tell me how to cure myself of my dis-
ease as well as he could ; and which I did not buy for reasons which must
be obvious ; I became disgusted with this whole class, and having no other
alternative, threw myself into the arms of a Topical party, with hope still
undiminished.

But in this there was some difficulty, for I found two parties, and which
to select perplexed me some. The one I shall characterize as th>
ers. the other the Inhalers:. From what I learned, the history of these
parties i- j >f no little interest.

It appears that the Proband, and its accompanying sponge and caustic,
were not originallv used to cure consumption. In simple throat affections
however it had had an immense run. Clergymen every where had tried it,
and such of their flocks as they could influence had followed suit, and the
whole thing became rapidly much in vogue.

Finding how easily it went down the throats of the people, it bye and
bye took a bolder stand, and stoutly proclaimed its power to cure consump-
tion, in its most common form. Still, it must be remembered, in all this
time it never claimed to go beyond the bifurcation. But we all remember
how popular it was, and what vast sums of money it must have made.

Whether it was the latter, which s a great stimulus to invention, or some
higher motive, it is certain that this thing did not pass unnoticed. Active
minds were at work, and vigorous intellects became engaged in tapping
this rich mine, and in pushing farther the investigation. As the result of
all this, inhalation turned up. The probangers were taken on their own
ground the people were told that if topical treatment, so partially appli-
ed, waa -:ul, how much more were they entitled to expect from a
method making the whole lung accessible to medical agents. The reason-
ing was plausible the thing took Probangdom tottered to its very base,
and inhalatian became the rage.

But our friends were not to be put dov manner ; they were pen-

etrating men, and at onc-e saw that a!1 they had to do was to go a little
deeper. The old idea of the bifurcat'un, being the limit of the probang,
was therefore abandoned, and it was proclaimed that cavities could,
be in vaded and sponged out, and that inhalation could not dare do more
than it.

This was the state of things at the time of my first visit, and it was this
which led to my perplexity already spoken of.

But as I had already (as every body else almost have done in mv situa-
tion) used the probang, as far as the bifurcation, as it was said to have been
applied, I at length decided upon inhalation, and repaired without delav to
its head quarters in the city. The Doctor received and examined my case

680 Miscellaneous.

with exceeding care. At home, my medical friends could perceive at a
glance, as they told me, by the flattenning of the left side of the chest,
and by its quiescence during respiration, the nature of my disease, but
these signs were not sufficient for my new adviser.

He stripped me to the skin, measured, percussed and auscultated, over
and over again every part. I never saw so much pains, and would have
thought some of his manipulations indicative of decided " greenness," but
for the exalted reputation and obviously large experience of the operator.
He found my case a very beautiful one I was, he said, just enough dis-
eased to test the full power of his method. In the course of his remarks,
however, it turned up that this person was not the genuine man so widely
known, and I dressed myself with some show of indignation. He took my
complaints very quietly, and showed me into the next room. The person
who there received me won my heart. He showed me around, examined
my case, predicted " a good time coming " for me soon, but in the midst
of it all, announced himself as only an assistant, and appeared greatly
surprised that I should think any thing of that. I stamped in rage, and
announced that I had come all the way from Virginia just to see the gen-
uine article, and would not be satisfied with any substitute. This gained
me admission into the great man's presence. I found him superb. My
account of my reception amused him much, and we became unreserved
and quite intimate.

The fact was, he told me, that these fellows had come well recommend-
ed to him, the business had prospered in their hands he was no judge
of qualification didn't pretend to it had seen an opening for it, had got
the business up, and managed only the advertising and money department.
In short, said he, I am only the capitalist of the concern. The little fellow
you first saw, he furthermore proceeded, is I think myself, a little too fussy
over the chest, but the other one, I do think, is nice for the throat.

I had one other chance, which was to have my cavity sponged out. The
Doctor told me my case was a beautiful one for the treatment. I admired
his ingenious arguments in favor of his method, and was quite carried away
by his charming description of the rationale of the whole operation. "When
he finished, I announced, with enthusiasm, that I was a convert to his
views, and pronounced myself ready at any moment for the operation. He
examined me again with greater care, and with a faint touch more of grav-
ity in his countenance. It was just the thing for my case, said he, and
would have to be done, but not then. You get back home, he proceeded,
and get a little more strength, and then return, and I'll perform the opera-
tion foT you.

One hour afterwards, feeling as a doomed man, I left the great city of
New York. The consumption curers have taken from me all my bright
hopes, and left me but a mockery. [ Virginia Med. and Surg. jour.

ERRATA. In Professor Kollock's article, published in our last No., on page 453, 18th line from
top, for " attenuated," read " alternated."
On page 45S, 13th line from bottom, for " pum virg." read prun. xirg.

" " 459, 2d " from top,, for " to-night to hypochondrium," read to right hypochondrium.

" " 459, 6th " from top, for ' Jeteric," read Icteric.

" " 459, 16th " from top, for " partiaily," read partially.

" " 459, 9th " from bottom, for " are," read or.

" " 467, 18th " from top, for " suppressed," read suffused.

- " 467 5th " from bottom, for " water " read valer.
Iu Dr. Holt's article, on page 481, 10th line from top, for " argument," read agreement.

SOUTHERN

MEDICAL AND SURGICAL J0UIIATAL.

Fol. XI.] SEW SERIES. OCTOBER, 18ft. [No. 10.

ORIGINAL AXD ECLECTIC.

AKTICLE XXX.

A glance at the " JRejrty11 of Silas Ames, M. D., to "Experiments
vjith Phosphorus" &c. By Wm. M. Bolixg, M. D. (Abridged
by the author, from the New Orleans Medical and Surgical Jour-
nal, for March and May, 1855.)

[Concluded from September No. p. 544.]

In considering the cause of certain discrepancies between the
results from the use of the tinctures of phosphorus in his hands, and
in my own, Dr, Ames makes the following quotation from my pa-
per : "In connection with this experimental practice upon myself,
I will again call attention to the views of Dr. Ames, in regard to
the effects of the tinctures of phosphorus, and their dose, Thus,
he says, speaking of the saturated tincture, that it 'cannot be
continued in the smallest quantity mentioned -half a drop for
any great length of time, without inducing considerable disturb-
ance of the stomach, shown by nausea or vomiting, burning heat,
and a feeling of oppression at the epigastrium/ Though he admits
that, in the quantity of two drops, 'a single dose, or perhaps a few
doses, may be given with impunity,' he would evidently regard
any lengthened use of it in such a dose as a very grave and serious
matter, and tells us of one instance in which dangerous effects re-
sulted from the administration of three doses, of two drops each,
at intervals of twenty-four hours, While Dr. Ames tells us that
doses of half a drop cannot be continued for any great length of
time, without the most serious results, I have myself taken it in
doses of five drops being just ten times the quantity -a lono-

N. S. VOL. XI. NO. X. 37

&o& -DuijiiNijrS xiapiy w ur. jmes. ^^ciooer,

time ; and for eight days, without omission of a single dose, with-
out effect. While under his observation, from a cumulative action,
dangerous effects resulted from three doses of two drops each, ad-
ministered at intervals of twenty -four hours, being in all six drops
taken in the course of three days.. I have taken, for eight succes-
sive days, three doses of five drops each, or fifteen drops per day,
without effect.- Indeedr unless I should discover something in its
action, which has never as yet been manifested in any of my ex-
periments, from, all the lights at present before me, I should not
hesitate,, were it not for the mere trouble of the thing, to continue'
it in the same manner for years."

" In the healthy subject, at leastr any effect of the article result-
ing in nausea and vomiting, could be easily appreciated ; yet, not
only did my subjects take it in doses, as mentioned,. so immeasura-
bly greater than the doses with which Dr. Ames says such effects-
are produced by it, but they took it under circumstances that were
well calculated to favor the production of such an operation.. Thus,,
while they sometimes took it in the middle of the interval between
the meals, they also took it at times immediately before eating.,
and at others immediately after eating. On several occasions, I,.
myself, having forgotten my dose, which I usually took just before
eating,, until I had partly finished my meal, have called for my
vial, taken the doser and proceeded with my meal, without disrel-
ish or any manifest effect,"

In pointing out the cause of the discrepancies, says Dr. Amesr
"the first step in the process is to point out some errors in these
extracts which,, in themselves, go a good way towards effecting this-
desideratum." He continues : " The first error that I shall mention
is, thai what I said of two drop doses is applied, inadvertently, of
course,, to the half drop doses.. The latter are spoken of by me,
only as liable to produce considerable disturbance of the stomach,
when long continued, while the former are said in effect to be un-
safe in the treatment of pneumonia, if continued for any great
length of time.. The 'most serious consequences,.' therefore, should,
properly refer to the effects of the larger doses only."

That a proper estimate may be formed of the extent to which
I have misrepresented the language,, or misconstrued the meaning,
of Dr.. Ames, it will be proper to present again the passage referred
to. Speaking of doses of from half a drop to two drops of the satu-
rated tincture, he says : "It cannot be continued in the smallest
quantity just mentioned for any great length of time, without in-

1855.] Bolixg's Reply to Dr. Ames. 683

ducing considerable disturbance of the stomach, shown by nausea
or vomiting, burning heat and a feeling of oppression at the epigas-
trium."

Let the reader judge are the words, " the most serious results,"
language too strong for such symptoms as the above, (produced, it
will be seen, Dr. Ames says, by the half drop doses,) and more
especially when resulting from an article of which he had such
fearful apprehensions ? If the above are not serious symptoms or
results, when following the supposed administration of so incendia-
ry a poison as phosphorus, what results should we look upon as
serious? Nothing, perhaps, short of the death of the patient.
Dr. Ames proceeds :

" Another error arises from a wrong construction of the follow*
ing passage: 'Its effects are cumulative; that is to say, a dose
which, singly, is not large enough to produce any sensible effect,
may become very troublesome, or dangerous, after several repeti-
tions at intervals of three or four hours. This quality was developed,
in one instance, by repeating it in a dose of two drops of the strong
alcoholic solution three times at intervals of 24 hours.' Dr. Boling
construes this to mean that dangerous effects resulted from the
three doses given at intervals of 24 hours; but the reader will see
that the troublesome or dangerous effects referred only to the dose
repeated every three or four hours, and that the cumulative quali-
ty alone is referred to, in speaking of its repetition once a day."

Xow this is, really, it seems to me, " about as broad as it is long."
The cumulative " quality was developed in one instance," &c., and
how must it, of necessity, have shown itself, according to the defi-
nition of the quality given by Dr. Ames ? Here it is : " Its effects
are cumulative ; that is to say, a dose which, singly, is not large
enough to produce any sensible effect, may become very troublesome
or dangerous after several repetitions at intervals of three or four
hours/' and which quality so characterized, of course was even
in one instance developed by repeating it in a dose of two drops,
three times, at intervals of 24 hours. It was surely not a material
error, if, in my grammatical construction of the sentence, I took
the evidences of the quality the effects indicating, according to
Dr. Ames, its operation or presence for the quality itself. The
Doctor proceeds :

" A third error, the source of which is in part explained in the
two preceding paragraphs, is, in the comparative estimate of the
quantity of phosphorus taken by Dr. Boling and that given to mv

584 Bolingts Reply to Dr. Ames. [October,.

patients, to which the clanger of serious consequences was ascribed,,
if continued any great length of time. Dr. Boling took five drops
of a tincture, containing less than one grain to the ounce, three
times a day. Supposing it to be a full grain, each dose was about
the one-hundred-and-sixtieth part of a grain, My patients took two
drops of a tincture which, as we have seen, there are the best rea-
sons to believe, contained at least six grainy to the ounce."

Proceeding on such data, Dr. Ames shows that his patients took
much larger doses than I did,, in the experiments upon myself.
Now,. I took five drops, three times a day, it will be remembered,
for eight days in succession, without any effect whatever ; while,
in the case alluded to by Dr. Ames, the cumulative quality was de-
veloped by giving three doses of two drops each, at intervals of 24
hours ; that is, in all, six drops, in 72 hours or three days. The
tinctures used by Dr. Ames and myself were the same.

" The doses taken by Dr. Boling, therefore," (remarks Dr. Ames,)
" instead of being ten times greater, were less than half the sizer
or more than 20 times- less than the estimate."

Five drops of the same tincture at a single dose, I surely cannot
be mis-taken in supposing must be just ten times as much as half a
drop at a single dose ; and five drops, three times a day, in like
manner, for the 24 hours, just five times as much as half a drop-
six times a day.

Speaking further, of my experiments, Dr. Ames saj^s, "The
largest quantit}^ given to either of his subjects in one day was 272
drops of a tincture having less than a grain to the ounce, or about
the third of a grain of phosphorus. The daily aggregate of the
half drop doses" (of a tincture, let it be remembered, estimated by
Dr. Antes to contain six grains to the ounce, though we both used
the same tincture) " given to my patients, if repeated every four
hours, is about the 45th part of a grain \ so that the difference, in-
stead of being so 'immeasurably'" great as supposed by Dr. Boling,.
is only as one-third of a grain is to the 45th of a grain ; and the
measure of the difference is almost exactly as fifteen is to one."

"Some explanations, or rather plain matter of fact statements,,
which, however, are unnecessary to any who may have read my
former paper, as to the strength of the tinctures used both by Dr.
Ames and myself, may be deferred for the present, while we pro-
ceed upon the supposition that they were alike, as in reality they
were. The daily aggregate of Dr. Ames' half drop doses, would
be three drops. My subject took, in one instance, 200 drops of

1855.] Boling^s Reply to Dr. Antes. 585

the saturated tincture at a single dose, and on another occasion 272
drops, in the course of about eight hours the latter being just nine-
ty times as much as the aggregate of Dr. Ames' half drop doses in
the ticenty-four hours; and without appreciable effect But this
half drop dose of the saturated tincture under consideration, is not,
be it remembered, the medicinal dose given by Dr. Ames ; but the
latter is half a drop of the diluted tincture, which is only one-tenth
as strong. When my subject, then, took 200 drops of the satura-
ted tincture at a single dose, and without appreciable effect, he took
just four thousand of Dr. Ames' medicinal doses, which, he says,
occasionally produce " some very sensible effects upon the head and
stomach.'' And let it be again called to mind, also, that in his
Reply, Dr. Ames speaks of the " peculiar activity of its physiologi-
cal manifestations in a much more minute quantity " stilL It is to
be regretted, I think, that the Doctor was not a little more explicit
in this instance; say both in the character of the physiological
manifestations, and as to how much more minute the quantity.

Phosphorus, according to what Dr. Ames says of it, is certainly
a very " eccentric" article. One of the most though some might
doubt, perhaps, as to whether it is the most eccentric of all the
eccentricities ascribed to it by him, is that in virtue of which, the
same tincture, prepared by the same apothecary, from the same
materials, and taken out of the same bottle, there can be no reason
to doubt, should, when used in his prescriptions, contain six grains
of phosphorus to the ounce, and when used in my experiments
contain less than one grain to the ounce. There is, in fact, a good
deal of figuring done by Dr. Ames, in which his doses are made to
appear to bear a much nearer proportion to those given by mvself
than in reality they do all based upon this cool and quiet assump-
tion of a difference in the strength of the tinctures. He does not
explain how this curious thing is brought about ; but it can scarce-
ly be questioned that, by the same process, he might have made
the disparity still greater. In my former paper, I made the fol-
lowing pointed statement, in regard to the tincture I used

"The preparation that I at first used in my experiments. I
obtained from the apothecary from whom I am in the habit of
procuring medicines for my own use, and who prepared it at my
request ; but though I had no reason to suppose that it was not of
good quality. I subsequently supplied myself with both the diluted
and saturated tinctures from the apothecary who prepared the tinct-
ures used by Dr. Ames,

586 Boling's Reply to Dr. Ames. [October,

I may here say, what I did not think worth while to mention at
the time and it may seem unnecessary now that all my "pub-
lished experiments were performed with the tinctures obtained from the
latter source. The identity of the tinctures used in my published
experiments, with those used by Dr. Ames, would be taken for
granted, it is but reasonable to suppose, from the care I took to
point out the source from whence I obtained them ; while the mo-
tive for doing so, of course, could not be misunderstood. I must
confess myself puzzled, therefore, to know, by what strange and
mysterious process, the difference on which Dr. Ames' calculations
are based, is brought about. Had the Doctor merely said that the
tincture, when used by himself, was six times as poiuerful as when
used in my experiments, instead of claiming that it contained six
times as much of the active principle, in the absence of a better,
something of an explanation might be found in the supposition,
that he carried it, before using it himself, through a process of
" clynamization " by giving it, say, perhaps, a certain number of
shakes but his phraseology does not authorize the confident
adoption of this method even, of explaining the mystery.

Dr. Ames, in his Reply, it may be remembered, attaches consid-
erable importance to the fact, that my experiments were made
exclusively upon the healthy subject. Between the date of the
publication of my former paper, and the appearance of the reply,
I administered the tincture of phosphorus in two cases of pneumo-
nia, and in several other cases of febrile disease. Although the
length to which the present paper has already reached, and the
extent to which it must still further be prolonged, will prevent
me from giving the details of these cases, it may suffice to say, that
with all the watchfulness I was capable of exerting, I was unable
to discover the least effect of any kind whatever, from its use.
The dose administered in the several cases, varied from one to
three drops of the saturated tincture every hour.

It may be asked, why administer an article from which no bene-
fit was expected? My answer is, that, though I expected no
benefit from it, I did not allow its use to interfere at all with the
administration of such other remedies as I deemed a Ivisablein the
cases ; and that I could not possibly be brought to feel more con-
fident (this confidence based upon many experiments upon the
well, cautiously, and at first step by step made) of any medical fact,
than that in the doses mentioned, it would do no harm. With this
explanation, my real motive for giving it is sufficiently obvious.

1355.] BoListfs Reply to Dr. Ames. 587

Beferring to the circumstances under which my experiments
were performed upon the healthy subject the statement is made
by Dr. Ames, that I, myself took the phosphorus at my meals.
He, further, alludes to the probable difference in the action of a
poison taken upon a full or an empty stomach, and then goes on :
"Dr. Boling, it is true, did not take his dose literally on a full
stomach ; but taking a dose just before eating, is practically, or so
far as concerns the irritant action of a poison, whose .action is slow
in developing itself, the same thing as taking it during or immedi-
ately after a meaL" He also mentions the fact, that it was soon
.after a meal, that the largest dose taken by either of my subjects,
was administered I find, however, on referring to my experi-
ments, that, in one instance^ a dose of a hundred drops of the
saturated tincture was given at five and a half p. m., which must
have been as near giving it upon an empty stomach, so as to in-
sure a considerable interval, prior to the next meal, as could well
be, without the omission of a meaL

In making the experiments upon myself, my reason for taking
the phosphorus before the meals was, that I might not be so likely
to forget it ; -and though it is stated that I took it just before eating,
it was not intended to convey the idea that, designedly, I took it
just at the very instant before the commencement of the meaL
The time at which I took it, in relation to my meals, may have
varied from one minute to thirty miuutes ; and in a few instances
I took the dose during the meal, having forgotten to take it before.
Now, it will be seen that, instead of taking it upon a full, I gener-
ally took it upon a very empty stomach, and therefore under the
most favorable circumstances for the development of the poisonous
action of an article, so far as refers to the stomach itself not very
slow in its operation. It is in a very quiet and matter-of-course
kind of way assumed by Dr. Ames, that phosphorus is slow in its
poisonous action ; but is it probable that such is the fact ? On the
contrary, it would seem that it is very speedy. Writers are unani-
mous (I believe, at least) in the opinion, that it is very prompt in
its stimulant operation. Dr. Ames, it will be remembered, says
that this stimulant action is dependent on, and therefore, of course,
secondary to, its poisonous action. Thus: *f Its poisonous effect is
* # * * # # highly stimulant, by reason of the local in-
flammation it excites." In regard to its stimulant action, Lobestein
says: ''Its action is very prompt, intense, kv." Merat and Delens
(Die. de Matiere Medicale) say, that "le phosphore est un des

588 Boling's Reply to Dr. Ames. [October,

stimulans les plus diffusibles et les phis actifs ; comme tel, Taction
en est a la fois prompte, vive, &c." Galtier says : " Le phosphore
est un excitant tres actif, dont les effets sont prompts, inslantanes,
&c." Dr. Ames, himself, further says speaking of the impossi-
bility of effecting a very powerful sedation with it, and in explana-
tion of the reason "when the dose is enlarged for this purpose,
beyond a certain point, a new and opposite action is immediately
set up;" alluding in this to its poisonous action. Instead, then,
of being slow in its action, as staled by Dr. Ames, it would seem,
upon his own testimony even, to be very prompt ; and, as a matter
of course, any arguments based upon, or inferences deduced from
the assumption that it is slow, are necessarily fallacious, and may
be passed without further notice.

As an argument in favor of the utility of the tincture of phos-
phorus as used by him, Dr. Ames again, in his Reply, reminds us
of the success of his " treatment of pneumonia by this as one of
the chief remedies ; in which the mortality is found in sixty-eight
cases occurring in the course of a little over four years, reduced to
less than three per centum."

Dr. Ramsey, of Georgia, without phosphorus, and relying in a
great measure on two of Dr. Ames' discarded remedies calomel
and tartar-emetic claims to have lost but one out of 170 cases of
pneumonia ; a trifle more than the half of one per cent.

The profession are beginning to regard with an eye, rather of
distrust, the subject of statistics, notwithstanding their several ad-
vantages. At a first glance, it would appear that the results must
of necessity be accurate; but such is by no means the case, and
there are several attendant sources of fallacy some of them per-
haps unavoidable. One, for instance, might grow out of a differ-
ence of diagnosis, pronounced by different physicians may -be
from greater accuracy in one than another ; perhaps from caprice,
or particular views entertained ; and in consequence of which it is
not impossible that where the actual mortality might be equal as
regards some particular disease, the apparent mortality might be
greater in the records of one than another ; and possibly even
greatest, where it was in reality least, For example, let us suppose
the prevalence of some epidemic say pneumonia with a tenden-
cy to the development with it of some severe complications of a
prominent character say, pericarditis, meningitis, enteritis, or
something else. Now, under such circumstances, we may well
conceiye that a different diagnosis might be given in the same, or

1855.] Bolixg's Reply to Dr. Ames. 589

similar cases, by different physicians. One, for instance, might
regard the pneumonia as the primanry disease, and the pericardi-
tis, say, as secondary, and a mere complication ; while the other,
attaching more importance to what the former regarded as a com-
plication merely, and secondary, might set this down as the prima-
ry affection. Under such circumstances, though the mortality
might be equal, the case-book of the one would show a greater
number of fatal cases of pneumonia than that of the other, in con-
sequence of the exclusion from the list by the one, of cases having
a fatal tendency, such as were placed upon it by the other.

On the other hand, it is not impossible, that in reference to cases
of a milder and less dangerous character, the diagnosis might be
such as to make the disparity appear still greater. Thus, for in-
stance, while he who had placed upon his pneumonia list, such
severe and dangerous complicated cases as are above referred to,
might exclude from the same a class of milder cases, such as had
but little tendency to fatality, and set them down as bronchitis or
catarrh, the other, who had excluded from his pneumonia list
the complicated cases having a fatal tendency, might place these
milder ones upon it. Thus, while in the one case, the apparent
fatality, as regards the disease in question, would be augmented in
the practice of one, by including among the number, cases having
a fatal tendency, and excluding others of a milder character, hav-
ing no such tendency, by a reversal of this double process in the
other, it might be diminished by excluding from the list the cases
in question placing them under some other head and including
the milder ones, which were placed under another head by the
former. Such instances of difference in diagnosis are not rare.
A gentleman was taken sick, under somewhat peculiar circumstan-
ces ; his disease, by the physician who was first called to see him,
was pronounced a severe pneumonia. On the fifth day of his sick-
ness, when he was worse than he had at any time previously been,
I was called to see him. After a most careful examination, the
case did not appear to me to be one of pneumonia. A professional
friend gave me the particulars of a somewhat similar case. Now,
here are instances in which a milder form of disease would appear
on the case-book of one physician as pneumonia, and on that of
another physician under a different caption ; augmenting, in one
instance, the apparent success, as regards this particular disease,
and diminishing it in the other. I will mention an instance of an
opposite character. A professional friend informed me that he and

590 Bolixg's Reply to Dr. Ames. [October,

.another medical gentleman had each a patient in the same estab-
lishment, both affected with the same disease, and pronounced by
him pneumonia. The other physician, however, did not call it
pneumonia. Both patients died. On the case-book of one of the
physicians, his case appeared on the pneumonia list, and among
the fatal ones. On the case-book of the other, his would be placed
under some other head " catarrhal fever," I believe, was the name
given it and, of course, his pneumonia list, as regards success,
would gain by its loss.

It will be seen, from references already made to the articles of
Dr. Ames, that he entertains very grave apprehensions, that seri-
ous mischiefs might arise from the use of his tinctures of phosphorus,
even in the small doses in which he speaks of them, and his re-
marks are suggestive of great, very great caution in their adminis-
tration. Speaking of the doses which he says were recommended
by certain authors, he remarks :

" In these doses, small as they may seem, it is spoken of in many
instances as a dangerous and uncontrolable remedy, and cautions
against mischief from it, are everywhere numerous, urgent and
impressive. Dr. Chapman" he goes on "referring to doses of
the one-sixteenth of a grain, says : ' Whatever may have been the
degree of its utility, this appears to be fully balanced by the hazard-
ous nature of the medicine, and the positive mischief which is
acknowledged to result from it.' "

I quote from the article " Phosphorus," in the 2d vol., 2d edition
of the Therapeutics of Dr. Chapman. Before he speaks at all of
the dose, he says : " But whatever may have been the degree of
its utilit}^, it appears nearly balanced by the hazardous nature of
the medicine, and the positive mischief which is acknowledged to
have resulted from it. Even in its moderate operation, phospho-
rus is described as stimulating the whole system, &c." As to the
dose, he refers to a prescription of Hufeland, a seven ounce mix-
ture, regarding which, the directions are " Omni bihor. cochlear
gumendum aut plus pro re nata." What he says, and all he says
of the dose, that I can find, is this: "But whatever mode is se-
lected, the fourth of a grain is the largest dose, and the whole
amount should not exceed two grains in the 24 hours."

Now, how long, according to the dose and method of adminis-
tration pursued by Dr. Ames, would it require for a patient to
take the quantity allowed by Dr. Chapman for the 2-A hours?
There would be in the two grains, thirty-two thousand of Dr.

1855.] Bolixg's Reply to Dr. Aw . 591

Ames' doses. Supposing the dose to be repeated every fourth
hour the interval preferred by Dr. Ames without omission, and
it would take five thousand three hundred and thirty-three and
one-third days, or fourteen years seven months and thirteen and
one-third days, for its consumption. This, too, supposing the arti-
cle were continuously given ; but owing to the cumulative quality
ascribed to it by Dr. Ames, he could not thus, of course, consist-
ently venture to continue it, but would deem it necessary to omit it
much of the time, so that a longer period say a matter of twenty
or twenty -five years would probably be required for its adminis-
tration ; and Dr. Chapman himself, in admitting the quantity men-
tioned, urging the necessity of caution in the use of the remedy.

Again, in urging the dangers of the remedy speaking at the
moment, however, of its eccentricity Dr. Ames remarks :

" While it is said, on good authority, to have been given at times
in doses of several grains without doing serious mischief, at other
times, less than one-tenth of a grain (six milligrammes) has been
known to prove fatal." To this remark, the following paragraph
is appended as a note, referring, it will be seen, to Cazenave, as
authority for the assertion.

"Cazenave. But this author thinks that in all cases in which
such large doses have been given without harm, the article had
undergone some change in its chemical state, which rendered it
inert. Si Ton a pu dire qu'il a ete aclministre avec inocuite a la
dose de 3, -4, 5, 6, decigrammes, on doit croire que dans ces cas il
y avait de composition, et changement dans son etat chimique."
Here is the sentence referred to, and in part quoted by Dr. Ames.

"En effet, a la dose de 6 milligrammes, on Fa vu determiner ties
accidens ; et si Ton peut dire, &c," as above.

Now, it strikes me, that there is nothing in the above sentence
to warrant the assertion of Dr. Ames, that Cazenave says, that in
the dose of six milligrammes (less than the tenth of a grain) it has
been known at times to prove fatal. Where the word " accident"
is used in the French language, as implying death or fatality, as
far as I have observed, and I think that such is invariably the
case, it has associated with it the adjective, "funeste," or "fatal;"
as, for instance, "un accident fatal" uun accident funeste" or
"des accidens funestes," &c. Where it is used without such quali-
fication, it will generally, I think, be found merely to imply, grave,
serious, alarming, or unlooked-for symptoms. I will quote a few
examples for illustration.

592 Boling's Reply to Dr. Ames. [October,

"II est probable qu'en dormant des boissous huileuses dans le
cas ou le phospkore pris a 1'interieiir causait des accidents, on arri-
vait a les calmer." (Merat et Delens. Supplement to Die. de Mat.
Medicale, p. 555.)

The same authors, (vol. 5, p. 274, of the same work,) speaking
of some of the peculiarities of phosphorus, say that they, "exposent
les experimentateurs a des accidens, qui du reste n'ont rien de
specifique, et reclament les memes soins que les brulures graves
ordinaries." In the same volume, page 282, "La conduite atenir
dans cette deniere occurrence, cest-adire, en cas des accidens, con-
sisterait, on le sent bien, a evacuer, au mo^yen d'un vomitif," &c.

"Apres l'ingestion de cette dose considerable, les accidens alloi-
ent en augmentant avec une progression effrayante ; la malade dev-
ient entierement sourde et aveugle ; la respiration s'embarrasse ; son
pouls etait miserable; sa peau se refroidit." (Die. de Med., vol. 26,
page 569.)

" Ces preparations peuvent a elles seules, conjurer des accidens
de la mobilite nerveuse, et quelques formes vaporeueses de l'ordre
le plus elementaire." (Traite de Therapeutique par Trousseau et
Pidoux, Tome 2me., page 252.)

Now some of these passages, at least, appear to be of a precisely
parallel construction with that of Cazenave, referred to by Dr.
Ames; and if in the latter instance, "des accidens" means death,
surely it cannot mean less or more, when found elsewhere, used
in a similar manner. How absurd, then, in these French doctors
to tell us in one instance, to administer oleaginous drinks to a
corpse; in another, to evacuate the stomach of a dead body, by
means of an emetic; in another, to treat "des accidens" as an or-
dinary burn ; or, again, to tell us that a patient become deaf and
blind, had embarrassed respiration, a bad pulse, &c, when she
must of necessity have been already dead.

The smallest fatal dose mentioned by Periera, who has written
so elaborately on every article of the Materia Medica, and whose
examination of authors seems to have been so searching, and cita-
tions so numerous, is one grain and a half. In a careful examina-
tion of the authors in my library, I find a reference to one solitary
case, mentioned by Lcebelstein Lcebel, in which it was supposed
that the eighth of a grain proved fatal ; and another, mentioned by
M. Martin Solon, in which the fourth of a grain is said to have
produced a similar result. Periera, however as in his work,
according to Dr. Ames, "one might expect to find them, if

1855.] Bolixg's Reply to Dr. Ames. 593

any where" it is but reasonable to suppose, regarded them
apocryphal, as lie does not quote them.

Dr. Ames, in the conclusion of his paper, says some right good
things, about my not exploring his field, but preferring " rather to
look from afar off, and through an a priori telescope." It is not
always the case, that he who may be nearest to an object shall
have the most perfect view of it. On the contrary, there are cir-
cumstances under which, another, at a greater distance, might
possibly see it to better advantage. Such, it may be conceived
possible, at least, might be the case in the present instance : and
that another, not having his visual organs dazzled by the prepos-

sions with which Dr. Ames may have been affected, even at a
greater distance, might possibly have a more distinct view of the
object than himself. Such an opinion, is not a mere assumption
of the writer, but is exemplified by actual observation in every-day
life. Sir Gilbert Blane, on this point, remarks: " It is requisite
for the forming of a clear, calm, and impartial judgment, that ob-
jects should be placed at a certain distance, in order that they may
be seen in their relative positions and bearings, which the eye or
mind of a close observer, or of a party concerned, is incapable of
taking in." Moreover, the lights thrown upon a subject by an
observer, might possibly, it can be understood, aid another to a
better view of it, than he himself may have had, as the vision of
the bearer of the torch, is often less assisted by the light he carries,
than that of others who may be near. In the present instance, for
example, the paper of Dr. Ames, from the fact of my having been
led by it to cypher out the size of his dose, which he himself had
not done, may possibly have had some agency, indirectly, in shed-
ding light to me upon the subject, which, from the absence on his
part of any precise investigations in this particular, might possibly
have been lacking to him; and of which, moreover, if he had had
the benefit, many will believe that the perception of the object in
his mind's eye, would have been greatly modified.

It cannot be doubted, however, that the impression received, or
opinion formed of an object, may be influenced or modified, by the
point from, or the media through, which it ma}' be regarded, and
the remarks of Dr. Ames, referred to, are suggestive of the pro-
priety, in all cases, in estimating the degree of importance to be
attached to the views entertained or given on a subject, to bear
this fact in mind. Let us thereforer if possible, or as near as pos-
sible, examine the point from, and the medium through which the

694 BolIng's Reply to Dr. Ames. [October,

curative influence of phosphorus in pneumonia was seen and ex-
amined by Dr. Ames; in doing which, it maybe necessary to
travel somewhat from the written record.

In his article, on Pneumonia, Dr. Ames remarks of phosphorus,-
that it had already been employed in several of the phlegmasia?,
"and among the rest, in pneumonia, but under precisely what
circumstances, and with what success," says he, "I have not been
able to learn."

But very little, indeed, has been said by the regular medical
profession, of the use of this article in pneumonia, so far as I have
been able to learn. It has been used, however, very extensively
in this affection; and with some, therefore, the remark of Dr. Ames,
that, "precisely under what circumstances, and with what degree
of success, he had not been able to learn," will be read with sur-
prise ; seeing that these are very distinctly stated by those who
claim to have long used it, and with great success as great, even,
as that claimed by Dr. Ames. It would seem but probable, that
Dr. Ames, like most other gentlemen of the profession, of exten-
sive reading and investigating habits, had made himself, to some
extent, familiar with the medical literature of the homceopathist,
and he could scarcely glance at a work, at least a practical work,
by any of the followers of Hahnemann, without finding presented
before him, urgent pretensions of the utility of phosphorus in pneu*
rmonia) with the circumstances under which, in their opinion f it
should be administered, given, as also statements of the degree of
success attending its use. Among the symptoms, said by them to
be caused by it in the healthy, are, " accelerated circulation of the
blood," " increased frequency of the pulse," &c. ; and the instances
are numerous in which it is directed by them in disease, where
there is a quick pulse. Aside, then, from any views entertained
by the homoeopathists, of its modus operandi, should others be in-
fluenced in their inference as to its action, from the circumstances
under which it is regarded as indicated by them,, it seems probable
that, so far, they would be led to the belief of its sedative opera-
tion ; for according to their views, interpreted in the language of
legitimate medicine and the regular physicianf they must regard it
as a sedative, quoad an accelerated state of the circulation, as a
morbid condition, By Dr. Flieschmann, of Vienna, a homceopa-
thist, it would seem that it is employed almost exclusively in every
stage of pneumonia ; and there are perhaps few articles more used
by the homoeopathists, or more confidently recommended by them

I8oo.J BoLIXG'S Reply to Dr. Ames. oUcr

in any disease, than phosphorus in this affection. Such being the
case, it will be a matter of regret, of course, to Dr. Ames, from his
own sense of justice, that he was not aware of their claims. It is
not at all probable that these gentlemen will regard with indiffer-
ence, and without reclamation, even an unintentional appropria-
tion of some of their very loudest "thunder;'' and while otb
may think that it would be but right that even " the devil should
have his due,'' however small, they, themselves, will not, it is pro-
bable, be backward in claiming that Dr. Ames' "new medical
fact," was, to them, an old medical fact.

It may not be deemed irrelevant, on the present occasion, while
thus touching, as it were, on the homceopathists and their preten-
sions and claims, to refer to a work on Pneumonia, by J. P. Tessier.
From this, it appears that the author, actuated by motives seem-
ingly identical with those by which Dr. Ames was influenced, by
a somewhat analagous process, the details of which were, as in his
case, step by step, adopted, arrived at very similar conclusions and
results. The circumstances may, with the more propriety be al-
luded to, as affording another instance, gratifying, of course, to Dr.
Ames, of the corroboration of his adopted views, by an observer
at a distant point, and more especially in view of the similarity
in the motives, the means and the results.

Dr. Ames and M. Tessier, both dissatisfied with the results of
the treatment of pneumonia, according to the more generally re-
ceived and approved methods, were, as all should be,, anxious to
improve upon them.

The remedies with which Dr. Ames had become dissatisfied,
were, blood-letting, tartar-emetic and mercury. Those with which
M. Tessier had become dissatisfied, were, blood-letting and tartar-
emetic ; mercury not having been a remedy much, if at all used by
him, prior to his experiments in search of a better treatment. By
Dr. Ames :

uThe method employed was that of occasionally leaving out of

the treatment one or the other remedy." " The first step in

the experimental inquiry encouraging me to proceed, blood-letting

and mercury came to be used only in certain circumstances.''

"Tartar-emetic, by far the most valuable remedy of the three, was

continued longer." "The treatment of pneumonia, then,

which was finally settled down on, somewhat more than four years
ago, consists in discarding the three principal remedies in common
use, and substituting others in their stead," &c. The remedies

oyb BOLING'S Reply to Dr. Ames. [October,

discarded were antimony, blood-letting and mercury; and the
remedies submitted, were aconite and phosphorus, while quinine,
blisters and opium, which, of course, were of the old remedies,
were retained.

"With M, Tessier, after he had discarded blood-letting and tartar-
emetic his former remedies aconite, phosphorus and bryony, were
the articles substituted. He says:

" Apres 1'etude prealable des ecrits de Hahnemann et cle ses dis-
ciples, j'ai lu quelques uns des recueils ou sont consignees les
observations particulieres de malades traites d' apres la nouvelle

methode," "Je me hasardai chez un malade amene a la

remission par les saignees, a substituer le phosphore, au tartre stibie

que j'administrais en pareil cas." "Je resolus alors de di-

minuer peu a peu le nombre des emissions sanguines au debut du
traitement, et de ne point attendre la remission pour recourir a la
methode Hahnemannienne * * * * * Je diminuai done
une, deux, trois, quatre emissions sanguines chez les malades qui
se suivirent, rapprochant toujours du debut l'administration des
nouveaux remedes. Je commencais par une dose dTaconit suivie
d'une dose de begone au bout de douze au de vingt-quatre heures,
et faisant suivre la bryone du phosphore. Moins je saignais et
plus les malades etaient soulages apres l'administration des doses
infinitesimales."

At length the lancet is, as by Dr. Ames, entirely discarded.

" Je me decidai enfin a ne plus saigner et a recourir dremblee a
la medication Hahnemannienne,"

Dr. Ames, alluding to aconite, says: "The best effects of this
remedy in pneumonia are exerted in the first stage." M. Tessier
also, after his adoption of the " nouvelle methode," seems to have
regarded the use of this remedy, as chiefly beneficial in the
early stage j generally, indeed, to have commenced the treatment
with it.

In regard to phosphorus, Dr. Ames tells us : " If the medicinal
qualities of aconite adapt it more especially to the first stage of
pneumonia, so it may be said, those of phosphorus recommend it
more particularly in the second and third stages. M, TessierTs ex-
perience led him to a similar conclusion. He used the phosphorus
only after the aconite, and found it,, in pneumonia, w utile dans les
inflammations locales, menacant de passer a la suppuration,"

Of the cases collected in four years by Dr. Ames, two only
proved fatal. With M. Tessier, " depuis plus de deux ans, un seuly

1855.] Boldtg'S Reply to Dr. Ames. o97

a succombe." Other cases proved fatal, but some how or other, he
does not count them.

Between Dr. Ames and M. Tessier there is also a seeming sym-
pathetic correspondence of thought or sentiment, on other points.
Speaking of his views in regard to the action of phosphorus, Dr.

Ames savs :

/

"And here in alluding to the discrepancy, I wish to say, that I
am fully sensible of the responsibility of uttering as a new medical
fact, that which is opposed to standard authorities in medicine,
and to the established opinions of the great mass of the profession."

M. Tessier, speaking of his newly adopted views, says:

" Ce n'est point, en efTet, une legere responsabilite que celle que
pese sur un medecm alors qu'il va substituer dans le traitement
d'une maladie grave une methode nouvelle a celle qui a pour
sanction l'experienje universelle."

There is, however, a difference, more seeming than real, perhaps,
between the doses of phosphorus recommended by M. Tessier,
and by Dr. Ames; the former giving somewhere from the decil-
lionth to the millionth of a grain at a dose, I believe, and the
latter, as has been shown, as much as the one-sixteen-thousandth
of a grain at a dose ; admitting for the moment, that all the phos-
phorus contained in the half-drop dose of the tincture given by
Dr. Ames, is really received by the patient, and that it is not,
(though in all probability it is,) in a great measure or entirely lost
in vapor, or chemically changed, when the solution is mingled
with the water, preparatory to its administration.

There is also another difference, to which importance may be
attached by some, though it may be regarded as of no importance
by others, between Dr. Ames and M. Tessier. While the latter
makes frequent and open mention of Hahnemann, and his writings
and doctrines, and speaks often of the "nouvelle methode" and
"les doses infinitesimales," the former "never says turkey once."

An incident, apparently connected with the early history of the
use of phosphorus in the practice of certain physicians of our
place, who are not out-and-out homceopathists, (for by the latter
it has been a favorite remedy, as long as any have been among
us) is thus given by a gentleman who claims to know all about
the matter.

Two or three physicians attended in conjunction several cases
of pneumonia, on a plantation about three miles from town. The
result in several instances being unfavorable, the proprietor stated

N. S. VOL. XI. NO. X. 38

598 Felder, on Yellow Fever. [October,

that should another case occur, he would send for a homoeopath-
ist; and another case occurring in a short time, he did so. The
patient recovered. The gentleman inquired of the homoeopathist
what were the remedies he used in such cases, and was answered,
aconite, phosphorus and bryony. This information was commu-
nicated to the physicians previously in attendance, and about this
time, phosphorus is heard of as a remedy for pneumonia, in other
hands than those of the pure homceopathists.

Many cases of pneumonia, it is but reasonable to suppose, would
recover under a purely expectant treatment; and there are but
few in the profession, who would not be disposed to regard the
instance above referred to, as of this kind. But, under all the cir-
cumstances, it is not unreasonable to suppose that Dr. Ames, in
the adoption of the phosphorus practice, may possibly have beer*
influenced to some extent by the incident just related. Viewing,
then, the question with the prepossessions thus it may be deter-
mined regarding it as it were, "through an a priori telescope"
it might be considered "no impeachment of the natural accuracy
of his vision," to admit the possibility that he may have been
wrong, and that he may have ascribed effects to his phosphorus,
that were fairly attributable to other causes. The homoeopathic
construction of the instrument, may fairly account for the "infi-
nitesimal" character of his doses; while in view of certain effects
said by him to result from them, as a visual assistant, its powers
would seem to be such as to develope the degree of perfection im-
plied in the couplet :

" He hath keen optics, well I weenr
"Who sees what is not to be seen."

ARTICLE XXXI.

Observations on the Yellow Fever Epidemic of 1854:, in Augusta, Gar
By W. L. Felder, M..D.

Interminable disputations have always existed, and will continue
to exist, upon the subject of Yellow fever epidemics; nor have
such disputations contributed to establish upon the minds of many
a permanent and fixed opinion as to its cause and origin. Many,
however, are agreed upon the subject of its miasmatic origin, and
among the number, I would record my opinion, as to this mode of
dissemination, and manner of attack ; nevertheless, I would be
liberal, and extend to others any opinions they may have formed

1855.] Felder, on Yellow Fever. 599

upon this subject, in as much as a refutation of opinions, differing
with ours, would not answer my purpose in the present article,
intended briefly to refer to the epidemic of the past year, in Au-
gusta, and especially as it occurred in my practice. The epidemic
made its appearance here several days before I had an opportunity
of seeing a case, such as I believed to be genuine and unmistaka-
ble in its character; although I had several very aggravated
of remitting fever, two of which, especially, were brought from
Savannah during its prevalence and first appearance there, and
while much excitement existed upon the subject of its being in
our city.

I was not satisfied then, nor am I now, of the genuineness of
these cases, in as much as the paroxysms differed in no wise, or
Very little, from those of aggravated bilious fevers in common
practice. The exacerbations and remissions occurred once in every
twenty-four hours, nor were they marked with intensity of vio-
lence, sufficiently, to impress me with the belief that thev were
yellow fever cases. Had the individuals, however, remained in
Savannah, in contact with, and breathing that atmosphere, the
cases might have assumed a yellow fever type ; bnt being removed,
or occurring after they had reached our city, they were differently
masked. A few days only intervened before I had an oppor-
tunity of attending a case, and here began my experience, or
acquaintance, with the epidemic ; nor was it long before I had
many opporl mities of treating the fever, both in its aggravated
and simple o oild forms. The beginning, or initial symptoms of
my first case differed from any other that came under my care, and
materially so, in the obstinate torpor and coldness of the surface.

T\ree days were spent in untiring exertions to rouse the cuta-
neous surface, with but little effect, notwithstanding frictions were
often used with hot brandy, mustard, cayenne, and turpentine, with
the use of mustard sinapisms, frequently and perseveringly applied
literally over nearly all the surface.

Yesicatories, applied to the superior and inferior extremities and
epigastrium, produced vehement febrile reaction, with vomiting;
nor did the vomiting cease for several days, notwithstanding the
blister upon the epigastrium drew finely, and the irritati a was
kept up during the period of innovation and whole attack. Au-
gusta was never visited before, but once, by yellow feyer,
from what I have understood, the cause of its visitation was attr
butable to the immense quantities of Utter and refuse of the

600 Felder, on Yellow Fever. [October,

thrown into the Savannah river, during its ordinary height, and
which became exposed suddenly from continued drought, causing
the river, in part, to dry up, thereby exposing to the daily influence
of a hot sun, a mass of putrifying material, such as would produce
fever of any degree of malignancy. The epidemic of the past year
had not the same point of incubation, or origin, nor was this ne-
cessary for its production, as the internal condition of the city
furnished fertile sources sufficient in itself for its production and
spread. The city of Augusta is situated in a malarial latitude, or
region, and presents many of the characteristics of an unhealthy
location: indeed, where the city now stands was once a dense
swamp, rilled with that peculiar sort of growth common to low and
mucky places.

The land is fertile, and favors the growth of vegetation, which
would spring up in great abundance upon the lots, (public and
private,) but for the vigilance and untiring exertions of the proper
authorities, whose zeal and energy is unparalleled, and entitle
them to our warmest gratitude and highest considerations for their
care and watchfulness over the health of the city. The houses, in
many parts of the town site, are crowded together, in such manner
as to afford but little facilities of free ventilation, and of properly
cleansing, consequently these places were more severely scourged
in the early part of the epidemic than any others. The first case
of fever that occurredy however, was in a sparse and thinly settled
part of the town,, very high up, and far removed from that part
mostly affected, and occurred in the person of a colored servant,
who died of black vomit, with but few days7 illness. The fever re-
garded no right of the acclimated inhabitant to an exemption, but
fell equally heavy and ruthless upon the native born as it did upon
the stranger nor did it respect age or sex.

The season of the past year?s invasion was closely identified
with that of the first occurrence of fever here, although the point
of attack materially differed. The fever of thirty-nine first occur-
red along the margin of the Savannah, and in Bridge-row, while
that of the past year made its appearance high up, and in the op-
posite side of the city.. During the prevalence of the fever, the
weather was hot and uncommonly dry, and with but one excep-
tion,, my recollection at this time furnishes me with but one slight
rain during its continuance.

The thermometer for three days, consecutively, ranged as high
as one hundred and two. This high temperature produced but

1855.] Felder on Yellow Fever, 601

little effect in the severity of some of the cases, although others
were aggravated partially, if not greatly. The number of cases
increased during this period, and spread in portions of the city
where it had not been. They were not, in many respects, of that
genuine character common in the first instance, but bore all of the
characteristic symptoms of a bilious fever; nor do I believe that
many of the cases, according to my conception, could, with strict
propriety, have been denominated yellow fever. The march of the
genuine epidemic was by no means uniform.

In some families its invasion and attack was signally marked,
almost every member of the same family having suffered with it.
The aggravation and violence of the fever thus rnancBuvreing
through families differed materially also.

In some, its grade was mild, remitting in thirty or forty hours,
while in others the first stadia would last four or five days. The
consistency in the same order or set of symptoms varied but little,
save in violence.

In almost every case, the fever was marked by lassitude, loss of
appetite, pain in the head, back, thighs and calves of the legs,
with or without nausea and vomiting. Where nausea early at-
tended the fever, oppression and pain in the epigastrium was
invariably present. Such cases resulted in vomiting, for the most
part. The matter thrown up, was either of a thick, glairy consist-
ency or filled with the bilious secretions of the hepatic system or
structure, and exhibited strong evidences of acidity. The dysp-
noea and restlessness, in many instances, was truly distressing,
and the skin was either hot and dry or bedewed with perspirable
matter, truly disagreeable to the patient, as well as to the friends,
on account of its loathsomeness. The peculiar offensiveness of the
perspiration, on one or two occasions, struck me promptly with
sensations of repugnance, and made me dread its approach from
my worn out and enfeebled condition, in consequence of great
fatigue and loss of sleep. The visceral torpor; in a variety of
cases, at first, was marked with obstinacy, requiring one or two
active cathartics to produce ordinary purgation, after which the
milder cathartics would move, readily, the bowels. The opera-
tions, or stools, at first, were brown, or greenish, after which they
assumed a dark, grumous appearance, very offensive and of adhe-
sive consistency. This state of the bowels lasted but for a short
time, or during only oie first twenty-four or thirty-six hours,
when the evacuations would change and become watery, with

602 Feldek, on Yellow Fever. [October,

flocculi suspended, giving to the whole a dirty, sooty color. In-
crease and change of gastric symptoms produced similar results
upon the bowels, and their contents bore a strong resemblance to
ihat which was thrown from the stomach.

Paucity of urine attended in every instance, save in two : one
of these discharged large quantities, of rather a pinkish appear-
ance; the other, although less in quantity, was sufficient, depositing
at the bottom of the chamber containing it considerable blood,
which had the appearance, through the dark-brown urine, of a co-
agulum, but which could be made to commix readily with the
urine upon the slightest agitation of the vessel having it. The
former patient died ; the latter recovered both threw up black
vomit. I have never heard of a yellow fever epidemic originating
in the country consequently, believe that it properly belongs to
cities, or to such places especially favoring the accumulation of
filth. Pntrescency or decomposition of animal matter, perl taps,
forms a material quality necessary for its production. To what
extent this would operate in producing yellow fever, of itself, I
do not know, but believe that, in itself, it would be insufficient, and
that the admixture of malarial atmosphere is indispensably neces-
sary to its production. Bilious remittent fevers become aggravated
when exposed to the inrluence of hog-pens contiguous or near to
localities where bilious fevers prevail a fact, well established by
past experience, and has occurred more than once in the course
of my country practice. I remember once, especially, and so
noted the fact at the time, that during the prevalence of a bil-
ious fever upon one of the swamp plantations under my profess-
ional care, that a pen containing hogs was thus situated, and that
the weather became very hot and dry, and that suddenly the fevers
then existing became aggravated, and that they spread much more
extensively than they were accustomed to do on former occasions.
The remissions were less marked; the pain in the head, back and
extremities more intense, and the vomit thrown up could not have
been told, by casual observation, from that of genuine black vom-
it. The admixture of it with water, agitated, detected readily its
bilious character; so did chloride of sodium.

I Lave, however, seen this black matter vomited by fever pa-
tients along the course of the Santee, after a freshet, in the months
of August and September, independent of such contingencies. It
should be borne, however, in mind, also, that these freshets
aiford fertile sources for the production of fevers, accompanied

1855.] Felder, on Yellow Fever. 603

with black bilious ejections, independent of such means of aggra-
vation.

These facts have induced some of the ablest, best informed, and
most experienced country physicians, to believe that yellow fever
is nothing more than high bilious fever, caused and aggravated by
a peculiar putrescent effluvia, arising from deposits of much ani-
mal matter daily undergoing decomposition from extreme solar
heat and moisture, mixing with malarial atmosphere, such as that
which arises from poodle holes and trash piles in and upon the
lots and streets of some of our crowded and illy ventilated cities.
The same may be said of a vessel entering one of our sea-port
towns with her holds filled with offensive material : malarial at-
mosphere enters the vessel, displaces the infectious air, drives it
out upon the community, and in turn becomes infectious also.

The same laws here take place again and again, until the place
is filled, in whole or in part, with this deteriorated air, which
causes yellow fever as far as it extends through the community.
This is the only wa}- in which yellow fever is propagated, in my
opinion, humble as it may be, and not from patients carried on
shore while laboring under an attack of fever. Were the disease
communicated by contagion, or persons thrown together while
laboring under fever, innumerable instances could be furnished to
put forever at rest any difference of opinion upon this subject.

Scarcely ever has an epidemic yellow fever prevailed, but that
more or less of the inhabitants residing in the place of its occur-
rence have not sought some place of refuge and safety among the
hills and mountains of our back country, some of whom imbibed
the seeds of yellow fever prior to their leaving the seat of its ori-
gin, and who were afterwards seized with the fever, and died,
having thrown up black vomit. ]So one has ever been known, so
far as I have been informed, to take the fever from such persons.
During the past season's epidemic, two of the most aggravated
cases which 1 saw were persons from Charleston, who took the
fever immediately after the}' arrived here, both of whom died;
and not another case of fever occurred in either of the houses in
which they stayed, notwithstanding there were many inmates be-
longing to both, and who kindly officiated in every act of friend-
ship. Of one of these patients I had the professional care, and was
consulted whether he should not be carried to the hospital, in
consequence of most of the boarders being strangers, and who felt
some scruples of conscience remaining in the same house with

604 Felder, on Yellow Fever. [October,

one who had yellow fever lest they should take the fever and
suffer themselves. The proposal to remove him being negatived,
at the same time giving my reasons, farther fears were not appre-
hended, and they all escaped the fever, although they were in and
out of his sick chamber repeatedly through the day and at night,
and sat up, in turn, with him until his demise.

If, on the contrary, friends from the country visited the sick,
in parts of the town where the fever had its hot bed of origin,
(which did occur several times in the course of and during the
epidemic,) and remained for several hours, or until afternoon
then returning again into the country, without remaining a night
even, in town, they were apt to take the fever : several of whom
did take it, and I have understood one died of black vomit, prov-
ing, conclusively, in my mind, that the fever had been imbibed
and taken in town, by exposure to the same atmospheric influence
which produced it in the case of the friend visited. This latter
circumstance has been selected as an argument, by several of my
friends, to prove the contagiousness of yellow fever, without pro-
perly appreciating its legitimate source and origin, although none
of the members of the family in the country had the fever, or took
it from the patient who visited the sick friend in and at the seat
of its origin.

Eeasoning from analogy, I would suppose that an individual
who had taken the fever from visiting one laboring under yellow
fever in town, where it prevailed as a contagious epidemic or dis-
ease, could, by the same laws of contagion, impart the disease to
others in the country, and that this would be the result invariably
of contagious fevers when and wherever exposed to their influ-
ence. No such results have ever taken place; consequently, I
would suppose, that yellow fever epidemics know no such laws as
contagion, and do not visit such influences upon which yellow fever
origin depends, upon the innocent, who have borne no part in its
production, provided they keep away from the seat of its incuba-
tion, where no right of distinction or exemption is acknowledged.
Many facts have been adduced of a second attack, in the same
individuals who have once had yellow fever; nor do I doubt for
a moment the validity of such statements, but mention as a fact,
also, that since my attack, many years since, as often as I have
been exposed to it, that I have ever since enjoyed a perfect ex-
emption, not only from yellow fever, but from every other of a
malarial origin and hope to enjoy a long continuation of the

1855.] Felder, on Yellow Fever. 806

same'blcssing under Divine Providence and protection. I met
with an individual her the last epidemic, who

had genuine yellow lever with black vomit, taken in one of the
Ltdias some twenty odd years sinee, who mentioned ti act.

He left the place of his attaek and went to the North, where he

remained some ten or twelve years, after which he visited (
during a yellow fever epidemic, remained there during its whole
period, without ever having fever of any description, then returned
North and remained there again as long, if not longer, than he

i done in the first instance, or until last year, when he determ-
ined to visit Augusta, which he did some time in June or July,
and remained here during the whole of the epidemic, escaping also
fever of every description. It may be possible that a second oc-
currence of fever greatly depends upon the genuineness of the
first attack, or upon the condition of the constitution.

The terminations of yellow fever, by no means, depend upon
its violence. I have seen apparently a mild a.ldenly ag-

gravated by an arrest of one or more of the depuratory organs,
that promised nothing unfavorably in its commencement, and I
have sen apparently the most malignant, yield favorably to

the supervention of some critical discharge or other. Epistaaps
was of frequent occurrence, and when not continued for a length
of time, or \erj profuse in quantity, seldom failed to afford ben-
efit by relieving the fullness and tension about the head and pro-
moting the action of the skin. The gums frequently bled, and
in several cases had to be plugged with cotton wetted with kreo-
sote, before the hemorrhage could be arrested; at other times,
there was nothing more than a slight oozing, which would collect
upon the teeth in the form of disagreeable sordes, and could only
with difficulty be washed off. Diarrhoea occurred in several Cf -
and was unfavorable, seldom failing to produce sudden and \
lent collapse, thereby in the danger and occasioning great

loss of strength, from which the patients eould only be roi.
with difficulty; suddenly, profuse and i . iration,

was pathognomonic of great danger. The deep coffee-gzonndfl
urine could be changed suddenly into an int n color, by

the addition of a small quantity of nitric acid, especially after the
icteric condition of the skin made arance. (Edematous

swellings of the extremities would sometimes occur. General or
anasarcous accumulations seldom made tfa ad when

they did occur, the recoveries from them were slow or protracted,

4306 Felder, on Yellow Fever. [October,

unless free diuresis could be produced. Where this was effected
by proper medication, the swellings receded instantly. The yel-
lowness of the skin was absent, or nearly so, in many of the cases,
and I am under the impression that it was not so characteristic in
the past year's epidemic as I have witnessed in former epidemics;
several cases, however, were well marked in this respect, and all
of the genuine forms of the fever partook of this hue slightly.
Obstinate and long-continued hiccough was present in several of
the cases, and especially so in one; its duration was of six or
eight days continuance. There was nothing remarkable about
the pulse, and its frequency and volubility varied but little from
what you find in fevers generally; it would sometimes number
120 or 130 to the minute, but was often much lower, and soft and
compressible. The tongue, at first, was white, with red edges and
tip, but soon grew brown or black, dry, rough and hard, and pre-
sented a swollen appearance very often.

Treatment No particular routine of treatment was pursued by
me. Symptoms were carefully regarded and looked into, and the
treatment adopted accordingly. Most frequently, however, the
treatment was commenced by giving Calomel, Ext. Colocynth
Comp. and Pulv. Ehei.

ty Calomel, grs. 10,

Ext. Colocynth comp. . " Bss.

Pulv. Ead Ehei, ... " 9 ss. Ft. pulv. No. j.
Administered in syrup of any kind. If irritability of the stomach
was present and this dose ejected, warm water was freely given,
so as to vomit and cleanse the stomach, or a simple dose of ipecac
substituted in its stead. The above dose of calomel, colocynth and
rhubarb, followed immediately the administration of the warm
water or ipecac, when the first was thrown up, and if its opera-
tions were insufficient, it was assisted by drinking Epsom salts
dissolved in snake-root tea (Serpentaria Virginiana) every two
hours, until free purgation was produced. If the operations were
not changed in character, becoming more natural, less offensive
and presenting a less bilious appearance, the calomel and colocynth
and rhubarb was given until this state of things were brought
about; after which the chlorate of potash was given and contin-
ued until perfect convalescence took place, which was generally
very rapid under the judicious administration of the potash.
This article (chlorate of potash) seemed to answer every requisi-

1855.] FELDER, on Yellov: Ftcer. 007

tion after the congestive stage of the fever was brok< n down by
cathartics. Patients recovered more rapidly, then the

same amount of debility, so far as I could discern, followil
I am aware of the prejudices of very many of the pi

with regard to the free use of calomel in the treatment of malig-
nant : 'it-rally , and regret to say that 1. did
not confirm the opinions of others in its use in the treatment of
the late epidemic yellow fever. I used it frequently in the

and second stages of the lever witli the happiest results, although
I did not use it to such an extent as to produce ptyalism in a
solitary ease. When the medieine (calomel) was used, after the
first thirty-SUC or forty-eight hours, it was administered in -
and frequently repeated doses, with a view to its operatr.
purgative influence. Seldom, however, was its administration in
ten grain doses necessar}- longer than this period, unless in those
pseudo forms that observed regular exacerbations and remissions
once in every twenty four hours then I used it as long as the
fever continued to run this course, once every day, every other
day or every third day, precisely as I have been in the habit on
all former occasions of using it for the cure of bilious i<
with the same happy effects. The necessity for a further use of
calomel being at an end, the alkaline practice was again taken up
and persisted in to this was added the snake-root tea and spts.
nit. dulc. freely, liq. ammon. acetat, brandy and quinine. If the
bowels grew loose under this course, thirty or forty drops of the
tinct. opii acet. were added either to the alkaline mixture or to the
liq. ammon. acet., which speedily set every tiling to rights. If, on
the contrary, the bowels were constipated, one or two pills, com-
posed of ext. colocynth comp. rhubarb and magnesia, were or-
dered every two or three hours, with enemata, until the b
yielded and one or two operations were produced. A bath, of
warm water with mustard, for the feet, was used repeatedly, and
the extremities, body, and especially along the course of the spine,
were rubbed with strong pepper tea, brandy, mustard and turpen-
tine. To relieve black vomit, which occurred fifteen tin..
of ever}' exertion to the contrary, liq. ammonia aeetat. was r
as follows: # Liq. Ammon. Acet. 5 viij.*

Tinct. Opii. Acet. 3ij. m. s. A* onfnl

was given every hour or two in a w i >ng snak

* The Liq. Ammon. Acet was prepared of pore nj : ->f the

distilled acet acid of the shops, allowing the ammonia to be in excess slightly.

608 Kollock. Case of Hysterical Monomania. [October,

tea, and if a blister had not been previously applied to the epi-
gastrium, one was immediately applied and suffered to remain until
free vesication was produced. I was governed in the application
of the blister to the pit of the stomach, by the condition of the
gums and the appearance of the vomit previous to the discharge
of black vomit, by the normal or abnormal standard of the pulse,
the natural or reduced temperature of the surface, and the appear-
ance or expression of comfort or ease, or of extreme uneasiness
and restlessness. Blisters were also frequently applied to the ex-
tremities, to equalize the circulation and restore general warmth.
The liq. amnion, acet. arrested the vomiting in every instance save
one promptly.

I have, as succinctly as circumstances would allow in an article
like this, detailed my general plan of treatment. It must be re-
membered, however, that other remedies were used in the course
of my practice in many of the cases, that proved highly serviceable,
of which I have not spoken, 'but feel satisfied as to their results.
During the whole course of the epidemic, I treated two hundred
and seventeen cases of fever, of which fifty odd were genuine
yellow fever cases fifteen of whom had black vomit. Of the en-
tire number of the genuine cases, four deaths followed the treat-
ment. No deaths occurred in any of the pseudo forms of the dis-
ease, with the exception of one, who died of pneumonia with dys-
enteric symptoms, from getting wet in the rain alluded to, while
driving a dray some three or four weeks after his attack.

ARTICLE XXXII.

Case of Hysterical Monomania, following Parturition with rem.arhs
on Diseases of the Os Uteri. Eead at a meeting of the Georgia
Medical Society, by P. M. Kollock, M. D., Professor of Ob-
stetrics and Diseases of Women and Children in the Savannah
Medical College.

August 12, 1854. I was called, in consultation with Dr. J. B.

Head, to Mrs. L , an Irish married woman, of very respectable

and comfortable condition in life ; quite youthful ; of healthy ap-
pearance, having a good deal of colour in her cheeks.

She was delivered of her first child about twelve days before I
saw her, by a negro midwife. I was informed that the accouche-
ment was attended with considerable difficulty and hemorrhage, and
resulted in some laceration of the perineum. The child was puny

1855.] Kollock. Case of II

and unhealthy its body being covered with Large bull. Abort
five days after delivery, Mrs. L began to exhibit Bymptoms of
mental alienation, havii much excited and alarmed by

the death of a next door neighbor, from yellow fever, which oc-
curred about this time. Ber mental affection has beer g idually
grown : and at this tin. ly unman-

ageable. She stripe off all her < ] walks about her chamber,

or lies down on the hare floor; imagines that her left side is en-
tirely dead; exposes her naked person, particularly her genital
organs, and insists upon our "taking out" her ''side," which, she
says, is very offensive to the smelL She neither sleeps night nor
day; knows all her acquaintances, and coir, bonally on all

other subjects but the one which is the theme of her hallucinai
The skin is cool, pulse natural, tongue clean ; but there Is a
vous tremor of her limbs, and h b, very much, one

of delirium tremens. Her habits ai Her

bowels have been freely operated 01 . by castor oil, within a day
or tw< >.

The examination of her ease resulted in* the prescription of
camphor emulsion, with laudanum and beef tea, and perfect qui*
etude in bed, in a dark room.

Evening, 5 o'clock. The medicine was given regularly, as di-
rected, until she fell asleep.*

Aug. 13. Has spent a quiet night ; but about 8 o'clock a. m.,
her maniacal symptoms returned.

We visited her at 9 o'clock, and found her lying on the
floor, entirely naked, and labouring under the same delusion in
regard to her side calling upon us to "take it out," at the
time applying her fingers to the labia, and displaying the genitals.
The pulse and skin had undergone no change; the pupils of her
were very much contracted, even when notex] strong

light; and we thought it probable that this might be OC
in some measure, by the laudanum which she had taken in
bination with camphor emulsion. A blister was now prescribed,
to be applied to the nucha: and the camphor mixture to b
tinued, with tr. conii., as a substil Mini, ( 3j. at

dose.)

1 o'clock p. m. We found 1
skin hot, and covered with profuse perspiration, occasioned, in a
great measure, by the intensely hot weather of tb
tinuance of the treatment was directed, according to circumsta

610 Kollock. Case of Hysterical Monomania. [October,

5 o'clock p. m. Very much, the same ; not sleeping. # . 01.
ricin. j.

10 o'clock p. m. Found her quiet ; cathartic had not operated.
$. Stimulant enema into bowels; continue the narcotic, if neces-
sary.

Aug. 14. Cathartic has operated. She is quiet, but still labor-
ing under the idea that her side is dead. ty. Tr. castor, comp. 3j.
every three hours.

Evening. More rational ; admits now that her side is alive and
well ; complains of tooth-ache. ^ . Continue tr. castor.

Aug. 16. Although her mind is not entirely restored to its
healthy condition, she is much more rational, and continues to
improve.

Dr. Eeid being attacked at this time by the prevailing epidemic,
the case was left in my hands.

As she became disgusted with comp. tr. castor, I substituted a
mixture of equal parts of Hoff. anod. and fluid ext. valer., and put
her upon a course of pills of hyd. fer. cyan, ferri.

My regular attendance on her ceased on 24th Aug. I directed
her to continue the use of the pills for some weeks.

I saw no more of her until October 2d, when I was desired to
visit her, and prescribe for pain in the back and lower part of ab-
domen, and for a very profuse and offensive purulent discharge
from the vagina. Her general health at this time was good, and
her mind perfectly rational. I informed her that I presumed that
she was labouring under uterine disease, and suggested an examina-
tion, for the purpose of verifying the diagnosis. To this she sub-
mitted.

The introduction of the finger into the vagina discovered a
granulated feel of the lips of the os uteri, which was confirmed by
the exhibition to the sight, by the speculum, of a pretty extensive
ulcerated surface occupying the anterior lip, which was concealed
by a dense covering of muco-pus, and which prevented a satisfacto-
ry view of the ulcerated surface, until it was wiped away by a
tuft of cotton conveyed to the part by means of the uterine forceps.
This ulcerated surface I immediately cauterized freely and deeply
with "Vienna paste," taking care to confine the action of the caus-
tic to the diseased part, by the application of vinegar, as soon as
I considered myself sure of the full effect of the application in pro-
ducing a slough of sufficient depth.

I examined her again on the 7th, and finding that the cauteriza-

KOLLOCK. ( 611

tion was sufii

vagina, two en ~ j. to

Oj.
I loft Savannah on i r, and did not retain

until the mid
a few

L The purulent
relieved of all tro

The case which 1

be daily met with in practic b would indi-

cate the lesions of organs distant from, and, apparently, totally
disconnected with the uterus, but whose origin is in the uter -
its appendages : and the at: ich the rational s

point, are merely sympath: permanent relief is only to be

effected by remed: - the local uterine afiection. It

is tru ike inr,

become, to in extent, real, and demand a comb

palliative ren. mediately, and a

temporary calm may be effected through their means alone. But
be only temporary, and a :i of theannoying

scene may generally be anticipated.

In the case just described, I have no doubt that the ulcer of the
os uteri was the main cause of the whole train of alarming symp-
toms with which this woman was affected. The cj
ulcerations are. no doul they are difficult labours,

(instrumental, or otherwise,) abuses of sexual intercourse, engorge-
ments of the uterine cervix, ending in inflammation or e.\
of the lips, produced by the numberk- of deranged men-

struation. Then] 1 previous to pregnancy,. or

even coition, and n
sequently applied.

The mental n and hallucination, in on-

doubtless, the

oped by the alarm and depi - ieath.

The palliative treatme

as long as the ulcer of the ained Queued, there con-

tinued to metum

repetition of her i
should be pment.

The- jns of the uterine mouth inon,

612 Kollock. Case of Hysterical Monomania. [October,

and cannot be recognized without the aid of the speculum. Their
most prominent symptoms are usually those of the sympathetic
affections of other distant organs, such as cough, pleurodynia,
headache, backache the whole train of dyspeptic signs ; consti-
pation of bowels, and the varied numerous forms of hysteria. Of
the local symptoms, the most common and constant is leucorrhoea;
sometimes menorrhagia. Menstruation is not always deranged,,
and impregnation is not prevented.

The speculum reveals various grades of morbid affection, from
inflammatory engorgement of the lips of the os uteri, slight abra-
sions, or excoriations of the mucous membrane, to an ulcerated,
granular surface, more or less deeply excavated, or fungoid.

The anterior labium is most frequently affected ;. but often both
are involved in the disease, and the ulcer extends to a greater or
less height into the cavity of the cervix. The cervix is usually
somewhat indurated the os is retroverted, and is with difficulty
engaged in the field of the speculum, so as to obtain a satisfactory
view. The granulated surface is covered with a tenacious muco-
purulent secretion, which is wiped off with difficulty ; and when
the glands of the cavity of the cervix are affected, a semitran spa-
rent and glairy exudation hangs out between the lips of the os
uteri, which is not easily removed. This condition of the os and
cervix is frequently accompanied by congestion of the anterior or
posterior wall of the body singly, or by congestion of both at the
same time, which are tender to the touch; and the patient com-
plains of pain when the point of the finger is thrust up against it..
Some irritation of the neck of the bladder, occasioning either pain-
ful and difficult micturition, or incontinence of urine is not an. un-
common attendant on these uterine affections. And the irritation
may even extend to the rectum, producing troublesome tormina
and tenesmus.

The Treatment of this class of affections consists in a combina-
tion of topical and general measures. The kind and activity of
the first, will depend upon the state of the parts, as evinced by the
vaginal touch, and the speculum. The touch proves the presence
or absence of induration of the labia, cervix and body of the uterus,
as well as the degree of the induration ; also, the existence, or
non-existence of inflammatory tenderness, and the temperature,
whether normal or abnormal of these parts,

A tumefaction of one or both labia, which has been indicated by

1855.] Kollock. Gate of Hysterical ' una. 613

.oh, will also be observed by I
tionofthe speculum, accompanied frequi th inflammat

redness of the mucous membrane c - without any

abn ration.

Fortius condition, I am in the habit of emplo;
with tl: jalpel, tix<^l on a handle tent

length. Where the infiiammator i is Intense, this

du f blood, and depletes the part .

ally; andth Lng is prompted by injections of warm wj

j i i La.

The scariiication is to be repeated at intervals of several d
as may be i subdue the local inflammat

entirely, which is known by the disappearance of redness and tu-
mefaction.

When the inflammatory tenderness and swelling extend into
ix and body, it may be requisite to apply leeches to the
cervix, vulva, or hypogastric region.

When I re applied to the c . must be

introduced through the speculum, in the manner recommended by
Bennet. It lug the os uteri with lint or cotton,

to prevent their making their way into the cavity of the uterus, as
I have known them t ^

The slight al >rasion, or excoriation of the lips of the os uteri,
tended by inflammation, are healed by slight touches of nit. arg

substance, or in solution of proper strength, applied by means of
imel's hair-brush. And these applications are also sufficient
for a granulated surface, provided the granuktioi
healthy in ap;

Where I and fungoid, and the surface

cure will be facilitated, and mor . if

d. I am in the habit of using acid,
nit. of mercury in some cases, and in

The nitn

acid, nitrate not . and Viei n once

a week an sep-

aration i up into tl

ity of th r. While these

applicat. wo

or three tin i

be most i ier feeli:

>\ a. vol. XL 39

614 Kollock, Case of Hysterical Monomania. [October,.

As much rest in the horizontal position, as is consistent with the
general health, is to be enjoined ; as well as abstinence from sexual
intercourse ; after cauterization has been carried to a sufficient
extent, to be decided by the tact and experience of the surgeon in
the treatment of ulcers in general, the cure may be completed by
injections into the vagina of solutions of sulphate of zinc or alum,
(3i. to water Oj.)

The most convenient instrument for the purpose of injection, is
one of the various patterns of injecting pump, provided with flex-
ible tube of sufficient length, served with a terminating bulb, per-
forated with several holes, which enables the patient to inject any
quantity of liquid without withdrawing the tube.

The woman is directed to sit up over a' foot-tub or bidet, insert
the tube as far as possible, and pump in a pint or more of warm
or cold water. She is then to lie down, her hips elevated on a
shovel-shaped bed panr the tube to be introduced as far as possible
into the vagina, and a pint of solution of sulph. zinc or alum, of
the strength indicated,, to be pumped into the vagina from a vessel
standing on the bed, or by the bed-side.. She may either have an
assistant to pump for her, or by a little skill on her part, in manip-
ulating,, combined with practice, she may do it for herself. The
injection is to be used two or three times a day.

After injecting with solution of zinc or alum, it is requisite for
her to remain in the horizontal position for some time, in order to-
retain as much as possible of the solution in contact with the dis-
eased surface.

For the purpose of combatting the sympathetic and constitu-
tional affections which are usually attendant on such cases, it is re-
quisite to employ general, in combination with topical treatment.

The dyspeptic symptoms are to be met by proper diet, antacids,
and those articles which have the power to allay gastralgia such
as nux vomica and bismuth.

Constipation is to be obviated by laxative diet and medicine
of these last, I use comp. ext. colocynth,. conserv. sennas, &c.

Anaemia (which is common)' is to be treated by chalybeates
syr., iod. ferri. is an efficient remedy where the anaemia is conjoined,
with induration of the cervix and corpus uteri.

Hysterical affections require anti-spasmodic and narcotic articles::
tr. castor, comp. gum foetid., Hoff. Anod., and valerian..

Although rest in the horizontal position, as much as possible, is
requisite, moderate exercise in the open air is necessary, in order

1855.] Kollock. Case of Hyst' " 615

to preserve the general health. This h

The- .f uterine die

ing to the patience of both physician and patient Their treatment
y occupies from one month fa

As - rtated, the i rable

to the of distant 01 sympathising with 1 raa

and divert the attentio t and physician from the

principal On this account, this

looked, and if perchanc

mpatheti* mena, in spit

be suggested that probably uteri: from

whence they spring, the difficulty of making t compre-

hend such logic, combined with the aim
of females in i lition of -

investigation of their e

and effectual treatment, productive not only of extra
ment, but frequently total mi)

Although tfa ient in I n$y

important, and in a large number completely : ll; being fol-

lowed by an entire cessation of all annoying ailments, which afflict-
ed the patient, it must be admitted
with, which defy even this id in which manydisi

fter the perfect cure of an olo 3 uteri.

The poor woman continues to be am
stipation of bowels, leucorrhoea, dysmenorrhcea, and occasionally
menorrh;

In such I to extend our investigations be-

yond the mouth of the womb for the source of her malady. It
may chanc a chronic inflammation of the lining membrane

of the uterine cavity, a neuralgic condition of the uterine n
bacote ovarii

If the inflammatory affection of the uterin he cause,

it ma;.

trium. If it b

by a feeling of pain, when the Qui

contiie point of i and

thrust up
thumb in ineum and in

n the thumb and ib;_ Tilt the

per treatment would c .lion of . 5, cupping

616 Holtts Letters upon General Pathology. [October,

and blistering over the region of each ovary, alternately, and fol-
lowed by mercurial friction over the same region, or emp. gum.
amnion, cum. hydrarg. over the same part.

A steady perseverance in such a course, for a sufficient length
of time, may be followed by a cure more or less complete.

If pain should continue to annoy the patient, after such means
have been fully tried and tested, it is probable that it is a purely
neuralgic affection to be cured, or palliated, by narcotics and
chalybeates.

Of the narcotics, I find nothing superior, in certain cases, to
the aconite. It may be taken internally, in the dose of 5 or 10
drops of the tincture, two or three times a day, or applied exter-
nally to the lumbar spine, by compress wet with the tincture and
covered with oiled silk.

I have seen it stated in a periodical, that Jobert, who prefers the
actual cautery to the chemical caustics, in the treatment of the ul-
cers of these parts, also uses it for the cure of the neuralgic affec-
tions, passing the cauterizing iron, at a white heat, through the
cervix into the uterine cavity. His treatment is said to be attend-
ed with success. " C'est possible."

ARTICLE XXXIII.

LETTERS PROM SAME. D. HOLT, M. D., UPON SOME POINTS OP GEXMAL PATHOLOGY

LETTER NO. 5.

Montgomery, Ala., Aug. 23d; 1855.

Messrs. Editors On a former occasion, I stated that congestion
had its origin and seat in two principal points, namely, the cipil-
laries of the pulmonary artery and the capillaries of the portal vein
and that obstruction to the flow of blood and its accumulation in
the veins, from a variety of causes, such a^ pressure from ligatures,
from tumors, from gravitation, &c, which occurs under a variety of
circumstances, and which, in the general acceptation of the term,
constitutes congestion is not embraced in the present view of the
subject as a distinct pathological condition.

Having examined the subject with reference to the origin of con-
gestion in the lungs, I will now proceed to examine it with respect
to its origin in the liver, not separately, however, but as under the
same general pathological condition, having their origin in the
same general causes of depression.

1855.] Holt's Letters upon Gt hohjy. 617

The live ount of the peculiarity of the porta] circulation,

is liable to congestion under a rcar ircumsta] . from

a in die Lungs and heart, and I tnulation oTblood

in the Larg patic vein and its

ated, and tli' -t the flow of blood in the

I capillaries; and no doubt, tl as noil ae

often d in this manner for we ae the

ve pulmonarj without producing

: but the liver thus congested, can lay no claim I

d the c D being but a sequence, or

the effect of pulmonary congestion. The liver may be congi
from a too rapid influx of blood from a excitement, where-

by the hepatic artery and its rami ligations become engorged.
thus obstruct the How of blood in the portal inent

of the bronchial artery and its branches, obstructs the flow of blood
in the pulmonary capillaries, in pneumonia. It may be congested
from obstruction in t) e biliary ducts, from irritation, spasm, &c,
and from accumulations of riseid ()] inspissated bile in those ves-
sels. These different causes of cong f the liver, will receive
their appropriate consideration; but tha which claims our present
attention is congestion, from depression, in the capill ties oi the
venaportaru

Heretofore I have withheld the expression of any opinion, as
to the manner i. which depression produces congestion : upon this
point, I adopt \vh. be the most rational theory advan-

ced by physiologic 9 pathologists, namely that debility and
mon produces relm a n and enlargement of the calibre of the
capillaries, wh od is retarded ' i its flow, and (

quently accun the larger \ jiving ris ^orge-

ment in the ai erial branches, when the BYStemic capillar* j
involved, as ii cases of inflammatio , and to congestion of ti
nous trunks, and even radicles, when the venoc capillars
involved. Apai from the influence which . theluncrg

may exert in establishing or keeping up congestion in the liver,
supposing each to be under the influence of the same causes of
depression, w m in the capillaj

the vena portarum retards the ll<>w of blood in them, which
initiates in all that ion mm

fcion of bile, interrupts ti ...] depurating

functions of the liver, wher blood is& nt to the lungs, in an

unprepwed state, tor the generation of heat, lor its further depura-

618 Holt's Letters upon General Pathology. [October,

tion and its perfect arterialization, and thus giving rise to causes
of still greater depression and congestion. Another more ostensi-
ble effect of portal congestion, and which seems almost to constitute
a part of the condition, is obstruction to the flow of blood in the
systemic capillaries of those organs whence its blood is derived,
producing engorgement in those vessels and the minute arterial
branches ; giving rise for the time to a sense of oppression and
distress in the epigastric, hypochondriac and abdominal regions,
and producing nausea, vomiting and purging, and not unfrequently
hemorrhage. But these effects do not constitute all the inconve-
nience and danger resulting from the engorged state of the capil-
laries in those organs, from portal congestion ; for a continuance
of such a condition of those vessels, will ultimately give rise to
more or less irritation in them, whereby more blood will be sent
to them, still further increasing their engorgement, and finally the
irritation will spring up into inflammation, in some one or more
of those organs most liable to take on such action. These results
which grow out of portal congestion, from whatever cause it may
be produced, is more commonly the result of the operation of
causes acting directly upon the liver, in the manner which has been
explained, and which may not act with sufficient force to bring
the whole system directty under the influence of depression ; hence
the frequent occurrence of those complications which we recognise
as bilious, in all our fevers, symptomatic as well as idiopathic, and
in none are they more often found to exist than in pneumonia.
Although it is one of the chief offices of the lungs to purify the
blood, by relieving it of its carbonaceous impurities, it is the office
of the liver, not only to eliminate the impurities from the blood,
by the secretion of bile, but to elaborate and prepare the blood for
the important changes to be effected in and by the lungs ; and, if
the liver fails to perform its office in this respect, either from the
continuance or the frequent occurrence of portal congestion, the
consequences will be, that the blood will become so much vitiated
and depraved in its constitution, as not only to render it unfit for
the performance of its proper offices, but to render it a positive
poison to the great nervous centres thus increasing and rendering
general the nervous depression and congestion, which before may
have been but local. It is in this manner, and to this cause, that
we would ascribe the fatal termination to so many cases of pneu-
monia, in which there has been no evidence of the existence of a
sufficient amount of inflammation in the lungs to produce such a

1855.] Holt's Letters upon iy. 619

result. It is to this cause that I termination to so

many cases of intermittent and remittent '
the ni in which, in i

the cong< ral and

whelming 001 in which there has been no evidences of

: ice of inflammation, eith ih. It is

to this cause, namely, the vitiated and d teof the blood,

from the suspended functions of the liver and other depur
organs, that we ascribe the terrible effects in yellow fever, in which
a single fever will i I an amount of depression as several

paroxysms of ordinary malarial fever will be required to accom-
plish. I would not be understood as maintainingthat portal conges-
tion (although it is often pr- - i rise to the malignant features
in yellow- fever: yet it would require a longer array of arguments
and facts, than has heretofore been presented, to convince me that
the liver has not an important agency in the production, not only
of the malignant features of that form of fever in its stage ofdepres-

I -ut also many of those which belong to its stage of a
or hot or /- What that agency is, I will probably attempt

to explain hereafter, when I come to speak of the nature of reme-
dies best suited to the condition of this and other important organs
and systems as at present I must confine myself to the general
causes of depression and congestion, and the effects which grow
out of that condition. Among the phenomena, or symptoms,
which. I have described as belonging to the different forms and
modifications of pneumonia, are to be found the appearances of the
tongue and the condition of the stomach and bowels; although
disturbance in I - not furnish symptoms eharact

of pneumonia. - tnt attendance upon that d

well as other forms of fever, and their being modified bv tl.
istence of excitement or depression in the system, entitles th<
special consideration mor have their chief

origin in (1 function of the

livt-r. These symptoms may be d d the

skin and pulse, in

ssion, an that the tongue, in cai

7 or reduced in e v, and that in

those of depression it is enlarg and moist and so of the

bowels, in cases of excitement, the;. \ and

-ion, they
Before I proceed to examine into the different appearand

620 Holt's Letters upon General Pathology. [October,

the tongue in these different conditions, and having just noticed
some of the consequences of portal congestion upon the capillaries
of those organs whence the blood of the portal vein is derived, it
may be further remarked, that those organs which are situated
nearest to, and are in more direct communication with the liver,
will be the first to feel the effects of the portal congestion ; hence,
nausea and vomiting, and a disposition to purge, are often found
amongst the first evidences, or effects, of such a condition of the
liver. I would not contend that these s}~mptoms, or effects, might
not arise from other causes besides portal congestion, but in all
cases of general depression and congestion, I would assign them
to that cause, in the absence of other well known causes, for their
existence. And even in cholera, which seems to be a congestive
diarrltcea, assuming often an epidemic form, I have some doubts,
whether congestion of the portal system does not form one of the
first and most important links in the chain of morbid phenomena,
and that the vomiting and purging are but consequential, though
important results. But, from whatever cause these effects are pro-
duced, there can be no doubt but that the irritated, and often en-
feebled and engorged condition of the capillaries, allows the thiner
and more watery portions of the blood to percolate, and escape
through the stomach and intestines, and in such quantities, some-
times, as seriously to affect the constitution of the blood thus
rendering it thicker, or more viscid, and consequently more diffi-
cult of circulation. Such is often the case in cholera, and other
kindred affections. And not unfrequently is the blood itself al-
lowed to escape through the enfeebled capillaries, giving rise to
hemorrhage from the bowels, particularly in some forms of con-
gestive intermittents. The evil effects of these drains upon the
circulation, are, that the fluids, thus drawn off, come directly from
the arteries, which are already deficient of blood thus increasing
the dangers of congestion, without relieving the congested vessels.
It is sometimes the case, that hemorrhage occurs from an enfeebled
and relaxed state of the capillaries, where there is no sufficient
reason to suppose that congestion of the portal system exists.

An interesting case of this sort occurred in my practice a few
years ago. Dr. J., now a practicing physician in this city, when
a youth, ten or twelve years of age, having been at play, and taken
violent exercise, became highly excited and fatigued, and, la}~ing
down under the shade of a tree, fell asleep ; wrhen he awoke, he
was found to have croup, or something similar, for which I was

1855.] Holt's Letters 621

called to see him. While attempting to relieve him of this, I dis-
cov< hemorrhage from the gums and tongue, which

rapidly increased, until he bled from his m th, bow

bladder, and skin, where" , or

pin this condition oi 'ar-

able action of the

on account of the quantity of blood which he v :id,

acting upon the belief that the hemoi . - dted from an en

bled i condition of the c

acti I opium and sugar of lead pretty ; reduce the

action of the heart and arteries, and applied the c< r to be

lined, freely to the whole - but more particularly to the

head and body. Under this treatme. >on

ent; ared, and the heinorr.

in a few hours entirely ceased, leaving hi: and amematous,

from which he - aally reli of mineral and

vegetabl

I have mentioned t. pie of those

whieh "the want 01 : equal in the whole circula-

tion," and in whieh the power of the heart is not enleebled in pro-
portion to the capillaries a condition most usually to be found in
intermittent and remitfc of the congesto- irritant forms, and

in which, if there is no hemorrhage, there is often profus
and diarrhoea, and the fluids seem to b through the extreme

-els, by the "vis a tergo," rather than to strain or filter through
them, as they do in cony- -es, in which the heart shares alike

in the "defective innervation" Avith the capillaries. This case
ser\ example <s of the capillaries, resulting

from excessive action a condition similar, if not identieal with the
condition of the capillaries, which occurs in typhus and typhoid
fevers. In the I the higher g :.dintlamma-

tory forms of biliou.- :i which a longer time, and a sue

ion of par plish the work; and in

yellow fever, in which X.. w hours' du-

ration, is sufficient t . or

a hemorrhagic I y in all I Although t:

phenomena do not 1 pathological

condition, yet th with, and aggravated

if not directly prod led functi

of the liver.

But as this subject will engage our more particular attention

622 Holt's Letters upon General Pathology. [October,

hereafter, I will proceed to examine the appearance of the tongue,
with reference to the different forms and degrees of congestion.

While those general signs which have been described such as
the condition of the skin, the state of the pulse, &c., serve to indi-
cate the degrees of depression and congestion, the appearance and
condition of the tongue serves, not only to show the degree, but the
permanenc}' or duration of the condition. It is not, however, so
important and valuable a sign, or index, to the general condition
of the system, as it is to the congested state of the liver, and the
deranged and suspended functions of that organ, which, in my very
decided opinion, gives rise to the complications before spoken of,
and constituting the chief danger, not only in pneumonia, but in
all the graver or more malignant forms of fevers in our climate.
It is by no means an easy task to explain satisfactorily the causes
of all the abnormal appearances of the tongue, which is subject to
such a variety of influences. I shall notice it, therefore, in relation
only to its temperature, size, color and/wr.

As a general rule, in cases of excitement with increased vascular
action, the tongue is hot and dry; and in cases of depression and
congestion, it is cool and moist conditions which sufficiently ex-
plain themselves. It h not so with respect to size. In cases of
high excitement and increased vascular action, when the arteries
and the capillaries are in a state of hy peraemia, we would very na-
turally conclude that the tongue would share in the general con-
dition, and consequently present an enlarged appearance ; and that
in cases, of the opposite character, when those vessels are measur-
ably ansematous, the tongue would appear contracted and dimin-
ished in size ; but observation shows exactly the reverse to be the
true state of the case, and that these appearances of the tongue, as to
size, do not depend upon the excess or deficiency of blood, but
upon the tone and the muscular contractility, which, being consid-
erable in cases of general excitement, presents the appearance of
being contracted and diminished in size, being flattened, rounded
and pointed, and being, more or less, red, hot and dry, according
to the degree of excitement, and the nature and seat of the disease.
And in cases of general depression and congestion, the tongue
participates in the depression, loses its ordinary powers of contrac-
tility, and becomes large, broad and thick, and pale, cool and moist.
This enlarged appearance or condition of the tongue, I was for a
long time in the habit of considering as a consequence, and as
one of the phenomena of congestion, from its almost invariable

1855.] Holt's Letters > I jy. 623

attendance upon that condition. It is true, that in extreOD

cially when the jugular veins 1>< i -ue

itli the lips a livid rather than pale ap-

d it may be and often is, enli tion

in the organ itself when, being enlarged, it will generally

be red and turgid, i rally enlarged in cases of salivati

and in acute inflammatory affections of the th]

: but th - do not materially impair the value and im-

portance of its appearas or evidence of general de-

pression and coi rally an easy matter to take

into the account concurrent circuj - and the causes of such

enlargement.

A more important appearance of the tongue as a sign of conges-
tion, and one which seldom fails tp indie; v the condition
of the liver, is to be found in the and color of the
fur upon its surface : and the of the fur upon the
tongue, in connection with its enlargement, furnish the best evi-
dence of the permanence of tl -tion, the sluggish:
of the portal circulation, and the torpor and suspended functions
of the liver. It is often the case that the tongue is enlarged, pale,
and even livid, and at the same time comparatively clean or free
fro i as - of sudden depression and congestion, as in
the cold stage of intermittents in cases of rapid and exhausting
discharges, or as in cholera, &c. ; and if taken in connection with
the condition of the skin and the state of the pulse, as already
described, will serve to indicate the degree of depression and con-
gestion, which, however great, we may infer from the absence of
fur upon the tongue, that it is the result of temporary and fugitive
causes, which will subside with the return of excitement, and that
the condition will not be likely to return without the rem
operation of the same cati

It is veiy different, I . in the congestive forms of our ma-

larial fevers, in pneumonia, &o, in which the t
furred to a greater or less extent, and in proportion to \\
and color, together with its enlai we will

of the permanence of the influence of the causes of th'
and congestion, m- ally so i e liver :

In such cases, the return of on, according to

the type of these d:. ally dispels almost all other

traces of the condition, frequently leaves this condition of the
tongue unchanged, which is very conclus. nee, to my mind,

624 On Sterility. [October,

that it depends upon portal congestion and disordered functions of
the liver, and, of course, removable only with that condition.
This fur, appears to be a depraved secretion by the tongue upon
its upper surface, which vz -., m color, from white to yellow, and
brown or black, according to the condition of the blood, from,
which it is secreted, and the general condition of the depurating
organs, and particularly of the liver. When white, it indicates
that the depression and coDgestion will be temporary, and of easy
removal, and that the functions of the liver will be but temporari-
ly suspended. As it approaches to yellow, it indicates a greater
degree and permanency of congestion the suspension of secretion
of bile, or its reabsorption into the circulation ; and as it approach-
es to brown or black, it indicates a depraved condition of the
blood, and a tendency to the typhoid and hemorrhagic condition,
rather than the congestive.

Having now given an imperfect analysis of the most prominent
signs and symptoms of congestion, as they are exhibited in the dif-
ferent forms of pneumonia, and as they are found to exist in other
fevers of our climate, according to the classification which I have
made of these affections and having endeavored to explain in
what manner they become involved in those bilious complications,
which are so often dangerous to the patient and troublesome to the
practitioner, I propose, after a few more general remarks, upon
some points of pathology, connected with this class of affection, to
make a practical application of the principles which I have been
advocating to individual cases, as they have come under my own
observation with the double purpose, of endeavoring to establish
the truth of my positions, and of vindicating the character of cer-
tain remedial agents, upon which ruthless hands have been laid,
both inside and outside of the profession, and by which some of
them, as calomel and the lancet, have been brought into disrepute,
and opium and quinine are likely to be so.

As ever, yours,

Saml. D. Holt.

On Sterility depending on certain diseased states of the Lining Mem-
brane of the Womb: its treatment and cure. By Wm. GUMMING,
M.D., F.R.C.P., Edinburgh Vice-President of the Edinburgh
Obstetrical Society.

Cases of essential and incurable sterility depending on the female
are extremely rare ; and it is not my purpose to refer to the cause
of this form. But cases of removable sterility are very numerous ;

1855.] On Su-rllUij.

and it may be interesting tu detail some of the can it, the

treatment, and the res

I. ( Ine of tli- Becanses is a diseased state of a portion of the lining
membrane of the uterus in i uial-position, the dia

-ponding with the angle formed by the flexion of the womb
on itself. Ao bo my observation, the displacement of the

womb most frequently accompanying this morbid condition ofthe
mucous membrane, is ante version; but other forms of disj
mentare i pt from disease. I am now dispo lieve

that no mere dis] laa menl i I prevent

impregnation, and that it is only when tins is accompanied by a
isted or ulcerated or otherwise diseased state ofthe lining
membrane that it is a cause of sterility ; and the reason of this
to me to be, th.it the morbid pa valve, which,

while it allows a passage, painful or pain] ay be, to the

menstrual and mucc-purulent discharges from within, refua
trance to any fluid, such as the seminal, from without.

Wh t came under my notice mai

at that time inclined i more importance to mere dis-

placement of the uterus than I now do, I attempted their cure by
the means that were in use for the removal of the i ment.

The chief means employed was the use ofthe intra-uterine pes
on the supposition that there was no disease of the womb ; but the
success of this by no means corresponded to my expectations. It
evident that there was more than mere displacement, and that
recourse must be had to other . 3; and having
some (not certainly in all) a preternatural degree of tenderness
induration at the point offlexio led to the conclusion that

uschiefls L that the treatment should to

to that part Accordingly, instead of inserting the . 1 in-

troduced bougies of different sizes till t, >n that 1 .

at the angle ofthe displaced womb was removed, and fbll<
this up by applying the solid nitrate of silver to the congested or
otherwise diseased surface. The result of this was good. The pain-
ful menstruation v 1, always
menstrual discharge followed, the intra-uterine leucorrh -a was by
successive applications cored, and the patient in due time b
pregnant. To this, of 00 Lded such tre ofthe
general syst m to be r

Of this class, the following may be rei - a not uncommon

specimen :

Mrs Z , married three years, had before marriage been more

or less out of health at the menstrual period, but after that v ent.
had had her uterine symptoms mnc Sfa bad tor the

two years pn 1 consull 'hing,

counter-irritation, &C., but wit:

-ion, had a bougie introduced within tl. I i. but th-

paused was so exquisite that the lady I the operation

was not repeated. When she cam tamed

626 On Sterility. [October.

that there was very decided anteversion, great tenderness at the
curve of the uterus i. e., at the part where it was anteverted on
itself ; and when I introduced a very small bougie for the purpose
of examining the os internum, there was great tenderness and
clearly some constriction. The leucorrhoeal discharge was not very
considerable, but it was intra-uterine, and irritated, and almost ex-
coriated the vagina ; and it was largest in quantity about midway
between the menstrual periods.

It appeared to me that both the lady's illness and consequent
sterility depended on the narrowness of the os internum, and pro-
bably also on a diseased state of the mucous membrane near it.
There was no congestion either of the cervix or body of the womb,
nor could I detect any other functional or organic derangement.

Having explained to the patient the nature of her case, and as-
sured her that I could not undertake the treatment unless I was
allowed to treat her by dilatation, to which, from her previous ex-
perience of the bougie, she had great objection, and having reduced
considerably the tenderness of the diseased part by the inunction
with belladonna ointment before introducing the bougie, I succeed-
ed in dilating the os internum, and ultimately in applying the solid
nitrate of silver. The effect of this was soon perceptible. She
had much less painful menstruation, more of the discharge, and of
a more natural character, and the examination of the affected part
by the finger was much less painful. This was repeated from time
to time for three months, when she left Edinburgh for her own
home. About a year after, she returned, complaining that she
was not yet cured, and proposed a consultation with another prac-
titioner, who, after a careful digital examination, recommended
incision of the os. To this she would not consent, and perhaps
fortunately, for she was then nearly a month pregnant, and in due
time was delivered of a very fine child, since which her health has
been good, and her local symptoms have disappeared. I may add,
that the last time she was in Edinburgh, I mean at the time when
she was a month pregnant, the anteversion was as considerable
as it had ever been ; and except that she voided urine more fre-
quently than natural, I am not aware that she suffered in any de-
gree from the displacement.

This is a fair sample of a large number of cases, in which the
treatment is neither severe nor protracted, and the result is very
successful. The probability is, that the displacement and diseased
condition of the mucous membrane have existed long before mar-
riage, but have been aggravated by it. In such cases, so far as
my experience goes, dilatation by bougies, and the application of
the solid nitrate, effect a cure, and are not liable to produce any
dangerous or severe symptoms. In this respect the latter is much
preferable to an injection of the solution not a few disastrous re-
sults having followed the escape of the injection into the peritone-
al cavity.

II. Another class of cases occurs similar to that now reported,

1855.] lity.

but without displacement of the woi nn I m

flexion of the womb od itself, of so decided a characl r, that turn
or twist it how you may with (he uterine bougie it ah
to the same mal-position, which is with many

of what arc called di- 3 of the womb.)

The essential nature of this class app to consist in

marked constriction of the OS internum, with ulceration of the
lining membrane above the constriction and this ulcer often i

ipaniedwith indurati base, and of part of the neighbor-

ing tissue. Whether the constriction pi the ulceration or

the I 1 do not pretend but 1 have no doubt that the

ulcer in the constriction, and that; sral of the former

is essential to the cure. For this purpose L invariably dilate the
os externum and internum and the cavity of the cervix, andapj
the solid nitrate of silver very freely to the ulcerated or diseas
surface, and with the best results, by which 1 mean removal
the local and general symptoms complained of by the patient, and,
in time, of the sterility 1 say in time, for in mo impreg-

nation does not occur for some time after the apparent cure.

I may mention that this constricted and ulcerated slate of the
lower part of the uterus produces tw< which are calculated

to mislead, and do very often mislead, practitioners. It indue-
hypertrophicd condition of the body, and a considerable enlarge-
ment of the cavity of the uterus; and till I was satisfied of this 1 v
a (comparatively) frequent occurrence of such cases, I was inch:
to regard, and did in reality often regard them as cases of hyper-
trophy, and so employed a treatment that not only failed o\ its
anticipated effect, but weakened the patient, ami greatly increi -
the local symptoms as well as reduced the general health. 1 am
quite confident that no amount of depletion, either by leeches or
scarification, and thatno local application of ointment will remove
the constriction and ulceration, though they may for a time reli<
the congestion, heat, and irritation that generally accompany them,,
but which soon disappear without weakening treatment when
their cause has been removed; and while I cannot help insisting
that the repeated application of leeches in the treatment of uterine
disease is very rarely necessary, I cannot help also declaring that
I have known many cases in which the health of the patient has
been seriously impaired, and life even compromised, by such tn
ment.

Any practitioner who has seen much of uterine disease may
verify what I have said in regard to ulceration within the womb,
by w hat he observes through the speculum in t]
the ulceration is on the i A

tient with an anxious, weary expression of countenance, ande
plaining of the ordinary local and general symptoms of leu-
rhcea from ulceration, conies to consult I xamination.

find the expected ulceration or abrasion, and some congestion.
AVe apply the solid nitrate from time to time till the ulcer c

628 On Sterility, [October,

trizes. We do not deplete nor mercurialize in short, we do not
weaken the patient. She recovers her health, her anxious ex-
pression vanishes, and in course of no long time she becomes
pregnant. This, which we do see, as occurring at the 05 externum,
occurs still more frequently at the os internum, where we can*
not'see it, and precisely the same treatment is applicable to the
one as to the other, with this addition, that before we can apply
the nitrate of silver in the latter case we must dilate, and with this
difference, that while the former or external species of ulceration
almost invariably occurs in those who have had one or more
children, the latter or internal, almost as invariably is found in
virgins and in those who have had none.

^ The following is one of many illustrating this form of the
disease :

Mrs. A has been married for nine months, when she had

what was supposed to be a miscarriage ; but from the menstrua-
tion, though for several months very scanty, having never been
entirely suspended, and from a minute examination of the os and
cervix uteri, I was quite satisfied that she had never been pregnant
When she first consulted me, she believed herself again at about
the end of the third month of pregnancy ; and as I was unwilling
to incur the charge of having induced abortion, I contented my-
self with making a superficial examination, and waiting till time
should put it beyond question one way or the other. She had
however been regularly, though very scantly, menstruating, and
though after a time she increased in size, and her mammae (not the
areola) enlarged and she had morning sickness, and many other
of the signs and symptoms of pregnancy, I was quite confident
that she was not pregnant. Still, she and her friends deprecated
interference, and she went on until she reached the (supposed)
seventh month. At this time I was desirous to begin the treat-
ment that I thought likely to remove both the disease and the
sterility, and requested the opinion of a professional friend, who
agreed with me as to the non-pregnancy. I then examined with
a bougie, and found marked constriction at the os internum, and
very acute pai?i, produced by the passage of the bougie pain des-
cribed as being similar to that produced by the extrusion of a
small clot of blood during the menstrual period. The leucorrhcea
was intra-uterine, and in considerable quantity about midway
between the two periods.

The treatment (local) consisted in dilatation of the passage as far
as the cavity of the body of the womb ; and in affecting this, I
remarked what is, I believe very common in such cases, that after
passing the constriction at the internal os the bougie reaches a
cavity of much larger dimensions than natural, in which it can
be moved about with freedom, and yet containing no polypus or
tumour, and with its walls slightly increased in thickness, as if the
effort to expel the clots at the' menstrual period through the
narrow neck had given rise to this form of hypertrophy with

1855.] On Sterility. 629

dilatation, as is seen in tfc the heart

foil" ion of the solid niti the

dise t, and ibis was repeated till all tenderness

lief from pain during the menstrua] -he

con- . and ultima- patient became pregnant. She

. (which took place at the full time) i
t health.
It were easy to detail s, but they are all more or

like,
III. Another a ladiseaa of the lining

membrane of the cavity ol" th< rily (though not

unfrequently) accompanied by the constricted and olc tate

of the cervix referred to in the pn

The chief symptom of this ie I continuance of uter-

ine leucorrhoea u lerable quantity, attended by the usual

ofbrt, irritability, and despondency, ooserved in
of the womb. The patient feels better at, and
immediately before and alter, the menstrual period, but feels all
her ills heavy on her in the intermediate time.

In thes ter part of the lining membrane

of the won i sail >le that the seminal fluid

nay pass into the womb, i come in contact with the ovum

its way from the ovary ; but it is probable that the ovum (im-

gnated) when itn - te womb does not find a healthy point

and that therefore it passes through and pi In

is frequent impregnation, and as frequent- destruction

of the ovum. The object in view, theref

state of the mucous membrane, and thus at the same time remove
the rod the st Tilitw The process of treatment is similar

to that for the pr 5, with this di; that the

cavity of the body of the womb requires to be cauterized. This
should be done at the end of the first week after the menstrual
period, and I once a month till a heall and action

Qduced.
It is possible that the treatment of this class of cases re-
conducted on different principles wit! the plan
mention - the most simple, direct and b I, and it
this gnat recommendation, that it is quit I apply I
tie to the inside as 1 1 the < outside of the womb. 1 have said nothing
of : aent; but though very important, then- is no-
thing in it very dilfeivnt fnun what has been long and \t
day pursued.

Mrs. M had been married foi Qjqy-

ed good health till her marriage. Prom that her

complaints, all of which pointed to the uterine system. In this
case the prominent Bymptom was the uterine leuc between

the menstrual periods, comi \v days after the d-

pearance of the menstrual fluid, andcontinu rail j for

days. She was comparatively well j ust befbn and after the men
N. S. VOL. XI. NO. X. 40

630 Intermittent Fever treated by Nitric Acid. [October?

but when the white discharge appeared, she felt there was some-
thing wrong,. something that weakened and reduced her; and
though she had undergone treatment of various kinds for it, the
disease still persisted. On examination I could detect lateral dis-
placement of the uterus, but no constriction. The body of the
womb, however, was tender to the touch, and the bougie, when
fully introduced, occasioned unusual pain. It appeared to me that
the disease in this ease lay in the cavity of the body; that the
lining membrane was affected over a considerable surface ;. and
that the treatment should consist in very free and repeated causti-
cation of the whole mucous membrane. Having dilated the cervix
with a sponge tent, I did so, and with a very gratifying result.
The body of the womb became gradually less tender, the leucor-
rhceal discharge diminished,, and lost its muco-purulent character ;
the vagina, which was tender front the acrid character of the dis-
charge, became smooth and soft; the back lost its weakness; the
general health became restored ; and ultimately pregnancy super-
vened, with a favorable result.

In conclusion, I may add, that in connexion with this mode of
treatment,, there is a class of miscarriages in which this cauteriza-
tion of the internal surface of the uterus is very successful I
mean, those in which an abortion has occurred between the second
and third month, followed by general weakness, from which the
patient does not recover, and the other uterine symptoms already
detailed, and where a second pregnancy seems impossible. In
these cases, examination with the uterine bougie generally com-
municates the feeling of its coming in contact with a rough, some-
what hard, uneven surface.. [London Lancet

Result of Six Cases of Intermittent Fever -treated by Nitric Acid.
(under care of Prof. S. Gr. Armok,) Reported by R, L. Rea,
M.D., Resident Physician.

The interest manifested in the success of nitric acid as an anti-
periodic in the treatment of intermittent fever, has recently
attracted much attention, and a confidence has been expressed in
its therapeutic power, from, sources which ought to be regarded as
reliable, which will doubtless lead many to test the remedy. In
order that others maybe benefitted by the experience in the use of
the remedv in the Hospital, I submit the following cases, which I
condense from the Hospital Reports, They possess no peculiar
interest further than as showing what reliance may be placed in
nitric acid as an antijper iodic. We were careful, therefore, in se-
lecting, as far as possible, uncomplicated cases, and such as were
not likely to be prejudiced by the temporary omission of quinine,
and as such, even in a negaloe. point of viewr may be of interest
to the profession.

Case 1st. Thomas B , set. 34, laborer, was admitted April 12. Was

attacked with intermittent fever in July last, of the quotidian type, which

f I by Xitr Wl

nal interruptions of a week or t\\< until doh :
has had a pare ly for two

ill, tongue pale a1'^ '
no nausea or thirst

u. 01. Ricini 5J.: 01. Terebinth. S j. m. sig. now.

1 twice t'.oiii medicine; discharges natural. Hid
chill yesterday at 4 p. m. Ing.

it. N hra

. Baa had a chill - i the continued use

of the but the | growing much lighter.

17th. ' -lit. med.

Had a ; slight chill yesterday. Cont med. From this time
until the 26th, t lie- paroxysms continued to recur every second day, not-
withatanrling the ] _ use <t the remedy.

It. solution are. gtt x.. ter die.

I! had but a - 2 irrence after comn ption, and

May 9th.

trick B . b 2, laborer; - _

temperament; was admitted April 12. Has had intermittent fever
of July last, of the tertian t\ had the paroxysms arrest

rith quinine, but has had them every day for a week

tie, skin hot and dry, b
ix-ii tympanitic, and tender o\ _ >n, very

thirsty, appeti lewhat enlarged and tender upon pressure,

bow< - _ . 2 Physical v

no pain in chest

ft. Calomel, Rhei. pulr., Dover pulv Follow in six

hours fy ft. 01. Ricini %'].
18th. moved fmr times, discharges consistent and bilious, cough

still slight and dry, ap] remains tender; 1

tard applied to epigastrium.

It. Nit. acid, gtt v.; A . ; 1 dist q. a 1
14th. Had eliills yesterday. C'ont.
15th. Had no chill yesterday, cough < ont med.

This patient had no return of the paroxysms, and was dii I 23rd

of April.

William W ,2t22, laborer; bilio-nervous temperament,

was admitted 'April 25. Had intermittent fever n\n months last fall; par-

assumed th<- tertian type
larlv sin

natural.
in action, sometimes constipation and sometimes diarrhoea; puke natural,
sleeps well, e\

ft. [pecac.pt] : Ant tart grs. ii. m. divide into fouj

15 minute- until vomiting is induced.
26th. Hi

ft. Nit acid, gtt v.: Aq. dfst q. a d bra

ii. Pil. Ihd.. gra v. at bed time.
27th. No chill il condition good; some appetite, no

thin

632 Intermittent Fever treated by Nitric Acid. [O'ctofoeiy

May 3d. Had a return of chill to-day.

R. Sul. quinine, grs. v. sig. every 4 hours.
4th. No return of paroxysm ; the patient was discharged 14th.

Case 4th. Joseph R , ret. 26, laborer ; bilio-lymphatic tempera-
ment. Was admitted April 25 ; has had intermittent fever for 9 months,
been occasionally free from it for 2 or 3 weeks.

Present Condition. Tongue coated yellow, moist ; appetite good, pulse
100, thirsty, urine free and natural in color, bowels regular, no perceptible
derangement of the abdominal viscera.

R. Nit. acid, gtt. v. ; Aqua dist. q. s. m. sig. every 4 hours.

26th. Bowels moved ; had chills to-day. Cont. med.

28th to May 5th. Had a chill every day, followed by fever, notwith-
standing the remedy was administered regularly, and the dose gradually
increased. He was then treated with Fowler's solut. ars., which interrupt-
ed the paroxysms, and he was discharged May 19th.

Case 5th. John R , ret. 46, laborer; was admitted March 27. Has

had intermittent fever of quotidian type for nine days.

Present Condition. Extremeties edematous and painful, languid capil-
lary circulation, pulse 84, rather weak, tongue coated dark yellow, bowels
regular ; no manifest enlargement of the liver or spleen ; has some head-
ache; has had no medical attention.

&. Pill hydr. grs. ij. ; Pulv. ipecac, grs. ss. fiat mas. sig. every 3 hours.
28th. Had chill to-day ; bowels moved twice.

&. Nit. acid, gtt. jv. ; Aqua dist. q. s. m. sig. every 3 hours.
30th. No chili since last note; bowels not moved for two days.

B. Cast, oil gj. ; Spts turp. 3'ss.
31st. Bowels moved freely ; pulse, tongue and skin natural, some appe-
tite. Cont. acid,

April 4th. Had a return of chill this morning; bowels moved four times
in 24 hours ; feels quite weak.

Sul. quin. grs. ij. ; Pulv. Doveri. grs. j. m. sig. every 2 hours.
This promptly arrested the paroxysm, and he continued to improve until
11th of April, when he was discharged, cured.

Case 6th. Charles Z , ret. 19, shoemaker; sanguineo-nervons tem-
perament; wa3 admitted March 20; has been sick 14 days. Was attack-
ed with ague*, which has continued uninterruptedly until this time. His
paroxysms occur about midnight, every night. About five days ago his
chill, instead of passing off with fever and sweating, was followed by 5 or 6
copious liquid discharges from the bowels, and but slight fever.

Present Condition. Lower extremities edematous and slightly discolor-
ed ; urine free and high colored, tongue broad, clean and moist, bowels
tender but not tympanitic ; pulse 92, full, soft ; no appetite, sleeps well, no
enlargement of liver or spleen.

B. Sul. quinine grs. ij. ; Pulv. Dover grs. lij. m. every 2- hours.

21st. Had a chill last night, followed by four discharges ; has fever, pulse
132, strong ; tongue coated dark, head feels full and heavy, cheeks flushed.
Cont. med., commencing at 4 o'clock p. m., alternating with neutral
mixture, combined with vin. ipecac.

22d. Had a chill last night, but no diarrhoea ; considerable fever this^
morning, tongue cleaner, no appetite.

1855.] Diagnosis of Tumor * OramtttM, 633

Nit acid gtti pleaaantlj

acid.
23d. Had no chill last night | moved BVc thneaii) 2 1 hours, nose

t clean and moiat : al of akin ;

has headache,

r. Oont meo% with tJ iiH.rj.liiu.- at bed time.

it ; has had no chi 21st; diarrhoea

April 3t>. This patient has had no return of paroxysm since the com-
ment of the ose of the nit. acid. Be iras attacked, however, at the
date of last note, with inflammation of the lymphal
which hek now under treatment in the surgical ward.

May 10, This patient had return of chills to-day; he is still in surgical
ward.

It will be seen by the report of the above i bich are verj

briefly given, that the treatment by nitric acid was uot followed
by tii. 3S which I claimed for itbj itsadvo-

rom a large number in the Hospital,
brding the I 9 therapeutic power, and with the

eariR-st hope that we might be to verify the experience of

others, but careful :ion of it at the bedside has dis-

appointed these hopes. In some combination, h nitric acid

is largi i in the Hospital as a mild and pleasant tonic daring

the period of convalescence of the intermittent and remittent firms;
and especially in those cases in which there is evident
hepatic torpor, and in which, from general anaemia, constitutional
debility, or other causes, mercury is contra-indicated ; but as a re-
liable anti-periodic our observation, thus far, has led us to distrust
its powers. [Western Lancet

On Hie Diagnosis of Tumors within the Cranium.

Dr. Freidereich has recently published a very inte] lono-

graph on this subject, containing ti. i ,{' m-

uial tumors, 11 of which were observed by himself; and on

luable remarks as to the mode of
diagnosis. The following is a brieJ ns on

3 points.

lity occur. One of I
is headache, which is especially frequent in the earlj

ae. The c
jity : it i or intermittent, and it

be accompanied bj
indicate the y
may be affected ; the t

may be
or less. The mini The '

of the interval between the initial
renee of the paralysis, constitute the most characteristic mark of

634 Diagnosis of Tumors within the Cranium. [October,

these intracranial tumors. Convulsions and Spasmodic Conditions
occur in one half of all cases, and the former often assume an epil ptic
type. The mind is always more or less affected; its diseased con-
dition generally commenc.ng with loss of memory. All these symp-
toms are very inconstant and variable; they are also liable to
alternate remissions and exacerbations, which probably are due to
the occurrence of transitory congestions either of the tumor or the
cerebral substance, or perhaps of both together. The course of
intracranial tumors is always chronic. Freidreich never knew a
case to be shorter in duration than 6 weeks, or longer than 14 years.

2i. The Special or Differential Diagnosis of Intracranial Tumors*
(a) Those situated in tne cerebral hemispheres (18) are generally ac-
companied by obstinate headache (14); nausea and vomiting (9);
derangements of the motory functions (14); consisting of more or
less extensive paralysis, and of convulsions which assume an epi-
leptiform character. When hemiplegia occurs it is sometimes
crossed (gekreuzi) and sometimes not: but it constantly occurs on
the affected side. Derangements of the special senses are common
(10), especially of sight (7); and intelligence is often impaired (11).
In a few excepted cases there are no headache or alterations of the
motor functions.

(r/) Tumors of the base of the cranium in the neighborhood of the
pons, occasion tlie following symptoms: (9) headache, (8) almost
always frontal; impairment of vision (7), common!)* also of hear-
ing and taste (5), and in some cases (3) of smell. All these symp-
toms, due to loss of power of the facial nerves, occur on the same
side as the tumor; but paralysis of the extremities, when it occurs,
affects the opposite side of the body. Complete hemiplegia and
paraplegia are not very common ; and convulsions occur less fre-
quently'than with the former class of tumors, and are not epilep-
tiform." An important sign of these tumors is afford< d b}^ the great
multiplicity of the existing sensorial disturbances, and the tenden-
cy of the optical derangement to become bilateral. The mind is
sometimes affected (5).

(cl) Tumors of the Pituitary Region. Freidreich only saw 1 case
of this. There was frequent frontal headache, often with pain in
the orbit, and double amaurosis. There is rarely any disturbance
of the motor functions.

4th. 2 umors of the A nterior part of the Base of the Brain. Two
cases were examined. The symptoms resemble those just men-
tion d.

5th. Tumors of the Peduncles of the Cerebrum and Cerebellum.
Paralysis of the face and extremities, occurring on the side oppo-
site to that on which the tumor was situated, was observed in 3
cases. This makes tumors thus situated resemble those of the
hemispheres. Complicate d derangements of the nerves of special
sense and of the face (as the < c ulo-moJ.or and trif ci. 1), were seen
in two cases. This, on the other hand, approximates these tumors
to those of the base.

1855.] I ' 635

(/)
lent oeph&lalg

id situated i

may i I t d to be patho in the

Pain at the na] neck,

ire, ilia; there were no p cu-

Jiar gym]
luni w ! d.

../ to//7. - I diagnoi re im-

le | E<

0;* tfc t cause of Conua and Insensibility. By Dr. Si

In Dr. Snow's opinion, coma and ility, though met with

under a variety of carcumstano tlie inter-

ruption of the proi vidation of the brain and nerves, which

- I aJJ the oth r

animal functions. Th spiration, which is a process of

oxidation, is very evident on 1

breathe tl. r the imperfect oi tion of the

blood previously eff eted through the placenta. In asphyxia, the
privation i : ability, whilst the heart

still continues to beat far a time. Narcotics produce coma and
ability by diminishing oxidation, through a counter-affinity
which they poss ss foi The following are the chief

which prove that narooti - diminishing oxidation in

the system. The quantity of carbon v given off from the

minished during the influence of chloroform and -
Boeker has found that the quantity of all the constituents of the
urine was diminished by alcoh >me other narcotics. The

temperature of the body, which always bears a direct relation to
the consumption of oxygen in em, is lowered durin.

: of them

vUiati<m out of th tion

is a pi lation in ! nar-

their antiseptic power usually I
direct relation to their riatile

tics also have the pro that kind of oxida-

tion which constil .f the

than
others,
amount of that gas. i int that patients are 1

ibility without dying In pri-
. the fune-
ral hemispheres, and of

-
bilst the
: iue. B) :
ments ceased, from the functions of the medulla oblongata and the

636 Gastric and Enteritic Affections. [October,

nerves of respiration being suspended, whilst the heart continued
to act; showing that the ganglionic system of nerves continue to
perform their functions. Under the influence of narcotics, also,
the action of the heart usually survived that of the muscles of res-
piration, when these agents were not very rapidly introduced into
the circulation. The circulation of the blood is of course necessa-
ry to convey oxygen to any part of the body; and it is by the
interruption of the circulation in the brain that the diminution of
oxidation was produced which caused the coma of apoplexy and
epilepsy. The symptoms of apoplexy arise sometimes from ex-
treme congestion, and sometimes from anaemia of the brain, but in
either case the circulation is much interrupted ; whilst, in effu-
sion, the yielding coats of the vessels were the first to feel the
pressure. \Lancet.

Effects of Position in the Treatment of certain Gastric and Enteric
affections. By Dr. Coale.

At a meeting of the "Boston Society for Medical Improvement,"
Dr. Coale remarked, " that the late frequency of cholera morbus
and other similar affections, had given him an opportunity of
testing, to a considerable extent, the efficacy of a certain practice
of his, based upon observation made some time since, but which
he felt wanted confirmation before suggesting it generally. He is
convinced, from actual experiment, that persons affected with irri-
tability of the stomach are much less liable to vomit if they lie on
the right side than when they- recline in any other position par-
ticular^ on the left side. The explanation is evident. AYhile
lj'ing on the right side, any contraction of the stomach need not
much affect its solid contents; but, when lying on the leftside, the
contents are in the neighborhood of the cardiac orifice, and any
contraction of the organ will force them more or less through this
opening into the oesophagus ; thus, the difference between the two
cases will be a simple eructation in the first, and vomiting in the
second. This, Dr. C. has now tested in ver}^ many enses; and by
many experiments in some of them, varying the position to the
increase or diminution of the nausea and vomitin_:. It may be
urged m objection to the explanation, that a contraction of the
stomach that would force the contents through the a rifice,

would produce vomiting at any rate. But the difference is this :
the same amount of contraction which, when the patient lies on
the right side, throws off gas merely, when he is on the other may
force a small portion of solid or fluid matter into the oesoph^
when reflex action is at once excited, and the whole stomach
stimulated into action.

"In treatment of cases of flatulence, and of what is commonly
called 'cramp colic,' Dr. C. has found reclining on the right side
beneficial. It lessens the vomiting as first saiu a frequent at-
tendant in these cases ; but, besides this, it gives a more ready

1855.] Nt * 0 P 637

escape to gas contained in the tra mple,

suppose the troubl i the trao

ascending colon, were the patient on the Kit side, and a relaxation
of the Bpasm to occur, the gas is still kepi behind the all-
for the distended Into stine is not liable to take upon itself sufl
action to expel it. But, if the patient be on the right aide, t]
then ascends and | to an unaffected part of the in t-

by which its i facilitated." [Amen wnoX

.

AN Operation for Lacerai >. By M. Jobebt.

The peculiarity of thu tion is in the satui r having

pared the of the wound, M. Jobert threads a broad lace

lengthwise through them, and then drawing the lace, he puckers
all thr to a point, rj as the mouth of a tobacco

is closed by drawing the string. M. Jobert appears to have
ated in this way in more than one instance.

31. Eliza Dorvilliers, aymaker. The labor, in

which the perin&um gave way, was her first and only o
curred on ..ild was dead SO far

ed the wretchedness of the local accident, her rec
prompt and satisfactory.
She was admitted into the Hopital de la Clinique, under M. Jo-
gust, 1 854. At this time her general health
. , . strual

the first x. her confinement Sue had no power of retain-

ing flatus, or lares, if at all fluid. The perinadum is completely
lacerated, and the recto-vagina] septum is torn to a certain .
(about 3 centimetres). The b are retracted and

cicatrized. The neighboring skin is red and somewhat tun* :

Having prepared the patient by several baths and a purgative
enema, administered the night before, M. Jobert proceeded to
-: el' Sep;
Having place i the patient in n for lithotomy, the edges

of the wound were pared. This took considerable time, and it was
attended with much hemorrhage. Then three threa taken

and introduced in one through the length of the

Upper border of the wound, the second thr<> the la-

1 permaftum, and the third through the other aid

this, tins.' threads were drawn tight and tied in a double knot.

"fall, incisions were mad Le, to take off the

sion.

The case pr favorably without any remarkable event.

On the 6th, the threads were remi i union i

plete. On the 8th, there havi on up to this time,

d unwise . but without

any ill consequences. On the 15th, a careful examination was
made, when there wis found to be a minute fistulous communica-

638 Inflamed Breasts of Nurses. [October,

tion between the vagina and rectum. This was touched with a
point of lunar caustic. On the 24th, this opening was completely
closed, and the patient had recovered complete power over the
bowel. The perineum is about 3 centimetres broad, and appears
to be very solid. On the 26th October, she left the hospital quite
well. [_Gaz. Hebd. de Med. Ranking 's Abstract.

On the Treatment of the Inflamed Breasts of Nurses. By M. Eeitz-
enbeck, of Prague.

The method here recommended is so simple, that no one need
hesitate to adopt it, provided he is called in before the mischief has
reached a certain degree of development.

It is well known that engorgements of the mammary glands are
frequently caused by chapped nipple. The inflammation of the
skin extends directly into the ducts, exudations take place by
which some of these ducts are plugged up, the milk is pent in, and
hence the engorgement. If now, in such a case, the breast be
surrounded with the hands, and pressure made in the direction of
the nipple, a thin, transparent, whitish vesicle, is caused, by the
milk accumulating behind the closed orifices of the ducts. It is
necessary then, to do this, and having done it, the next thing is to
prick the vesicle with a needle, to remove any epithelial scales
which may be present, and to apply the infant. If time has not
been lost unnecessarily, the relief is almost immediate, and pain
and tumefaction disappear in a few minutes ; but even when it is
otherwise the relief is very marked, and by repeating the process
a few times, the sufferer is relieved altogether. [Gaz. Medicate de
Paris, and Ibid.

Wounds of the Heart.

Samuel S. Pueple, M. D., senior editor of the New York Jour-
nal of Medicine, in the May (1855) No. of that Journal, deduces
from his " Statistical Observations on Wounds of the Heart, and
on their relation to Forensic Medicine, with a table of forty-two
recorded cases," the conclusions which follows:

That wounds of the heart are not in general immediately fatal.

That recovery, after severe gun-shot, incised and punctured
wounds of the heart is possible, and that too, amounting almost to
a probability, provided a careful and judicious treatment is faith-
fully carried out.

That the presence of a leaden ball imbedded in the walls of a
ventricle of the heart does not preclude the possibility of recov-
ery, and is not incompatible with the continuance of life for a
number of years.

That it is possible for an incised wound of the heart to heal by

1855.] Lactic A

th id the p ontinoe

a laborious i

dy, other than a ball,

of considers heart d<

ubility of a continuance of life for a
numl

That t h onfavoT

but that in - pro-

vided th >nstitution be good, be

early

That the pro wounds of the heart is that which

ted to lit aeral; and that the

inflammatory oomp] ca1 - I with the same r

nt of t! sing

from idiopathic cai - s.

That all . the heart are .ally liable to wounds, the

itly inju:
That the cornpar art wounds shows that the

riele be the -
of injurv. This I opinio]

almost all writers on

That th( mds of the heart are im-

I should command th nil attention, in

rd the life of his by timidity

on : on the other. [.'

Dr.C. EakdhsldJoi
Phyj St M ital

Dr. I : lactic acid in dys

a of irrit here

the dig< stion t, and had &

inent in a - thism

aewhat n ployed ii

tw< nty minima, in a b 1 taken

of the 'ably im-

. dys-
Lt may b
improve the t ach. [1

;it little -

bably be

. [AsMOt

640 Editorial [October,

EDITORIAL AND MISCELLANEOUS.

BIBLIOGRAPHICAL.

Clinical Lectures on Paralysis, Disease of the Brain, and other Affections
of the Nervous System. By Robert Bentley Todd, M. D., F. R. S., &c.
Lindsay & Blakiston. Pbilad. 1855.

The work before us comprises a series of lectures delivered at King's
College Hospital during the last ten years. It is not intended as a systema-
tic course, but merely lectures delivered upon such cases as presented
themselves to the author during this period. It is a work of much merit,
and will be read with deep interest by those of the profession who wish to
acquire a knowledge of the diseases of the nervous system.

Letters to a Young Physician just entering upon Practice. By James
Jackson, M. D., LL. D. Phillips, Sampson & Co., Boston. J. C. Derby,
New York. 1855.

These Letters will be read with advantage not only by those just enter-
ing upon the duties of the Profession, but by many in whom the novelty
of the thing has long since worn oft*. The second letter contains some ad-
vice as to the conduct of a physician in the sick room, which it would be
well to bear in mind.

Atlanta Medical Journals and College. We have received the first
number of the " Atlanta Medical and Surgical Journal," edited by Drs.
Logan and Westmoreland, and also the first number of "Fleming's Hygienic
Journal," edited by Dr. Newton R. Fleming. These periodicals are both
to be published monthly, the former at $3 per annum, and the latter at $2
per annum. Their first appearance is highly creditable to the enterprising
conductors, and they will doubtless add considerably to the reputation of
Southern medical literature. That the multiplication of periodicals has
the effect of increasing the number of writers cannot be denied, and many
young men who may be thus induced to venture a contribution will be
emboldened to renewed efforts, and ultimately become eminently useful.
With three medical monthlies now in Georgia alone, there can certainly
be no excuse with the Profession at the South for keeping back any inter-
esting facts or reflections.

The Atlanta Medical College has recently closed its first session, having
had a respectable class of seventy-eight students. The trial of a summer
session has therefore proved to be quite a successful experiment. Its Fa-
culty-deserve much credit for their laudable zeal, and have every reason to
be gratified at the result of their efforts.

Oglethorpe Medical College. We perceive by the newspapers that ano-
ther medical college has been organized in Savannah, bearing the above

.:>.] kd. Ml

name, and tliat its ti:

vembernext The Faculty is constituted ai follows!

II. L Bran, M. P.. (late - aah Medical ( of the

1 ' in - ad Practice of Phj sic
K. Li !, M Dn(of \\ ': ynesh

I fa - of Women an i ( Shildn

i>. M. I >.. (of Cokesbury, s. '..i I
lica and Medical Jurisprudei

'. M. P.. | nv.

John Davis, M. 1.. (of Abbeville, - >r of Vh\

W'm. T. Peat, M. I >.. (d Savannah, and I'har-

Charlu Gahahl, M. I .. (of Savani em. of the Prin-

ciples and Practi i ty.

Demonstrator of Anatomy, II. / S\ ire, M anuah.)

The fees will be $105 for the entin i tores; $10 Demon-

strator's fee ; Graduation |30; Matriculation

This mak I by the 5

gia, besidea the I located at Macon. Surely no

one should be allowed now to practice medicine hi without a
diploma !

The Alumni o/thi Medical ' licalColl<

i. at Augusta, has good reason to be proud of its Alumni. They
hare proved t! llent practitionen throughout the Southern

. and ably sustain the reputation of their alma mat

ral Institutions more recently organized in Savannah and Atlan-
ta. We find two of her Alumni in the Savannah Medical College, one in
rpe Medical < ad four in the Atlanta Medical College.

thorn in what- re they may m<

Trai ' - of Alabama, We

ghth annual issue of the a I k, and find it full of

valuable matter, irhich we hope to be abl read-

ers. Alabama may com] favorably with her tea in point

of medical talent and industry. \\ to find in the midi

interesting contributions to science, the unworthy r upon

Southern Medical Co stained in the -annual ovation." The speak-

er, in advocating the Dent of si

following langui

"Many of our southern states already have medical

and it is natural that they should, for a time at least) leek with a ']
m an\ new rival; but such sentiments will soon pasi
to libera] feelings and noble emulation.
"The palm of medical teaching in the South is vascilating: it do

appear to be centering to any particular point. Kentucky cannot settle it.

642 Editorial and Miscellaneous, [October,

for the University at Louisville is on the wane, and the radiance of Tran-
sylvania lies in the past; Tennessee cannot stay it, for Nashville does not
seem to be so happy a location as some others for maintaining a large pub-
lic school, while Memphis has never claimed more than ordinary facilities
for medical education. New Orleans is objectionable in consequence of
the epidemics which so often scourge that otherwise favored city. The
schools of Virginia and Maryland have not been successful, and are in lit-
tle favor with southern students : the Augusta medical college is entirely
defunct, while the Charleston school is never crowded with numbers."

Such a statement scarcely needs comment, for every one knows that
most of the institutions alluded to are in a highly prosperous condition,,
and most deservedly so. Even the one whose obituary is thus pronounced
had a bona fide class of one hundred and seventy-one students at its session
last winter, and is as well provided with every thing necessary to a most
thorough medical education as any in the Union. It is not surprising
that one who would so far forget the known facts of history as to hail
Dante as " that great Spanish author," should be equally regardless of
accuracy in other matters.

Correction. We are requested to correct a typographical error occur-
ring in the circular of the Medical College of Georgia, appended to the
August number of this Journal. On the fourth line from the bottom of the-
*7th page of the circular, instead of "none but" read more than.

Remarks on the Preparation of Skeletons. By Charles Bell, M. D.-
It is often convenient and economical for students to be able to prepare
skeletons, for themselves, out of the remains of subjects used in dissection.
With a few hints about the mode of procedure, and by the exercise of a
little care and patience, any tolerably good dissector may make for himself,
as good a skeleton as would cost him half a year's tuition, if bought of the-
janitors of any of our medical schools, besides gaining a skill in manipu-
lation, that will be always useful.

To separate the bones of a subject, so as to study their forms and rela-
tions, and afterwards re-adjust them in their places, by mounting the skel-
eton, different modes are adopted. A subject who has died of some linger-
ing disease, such as phthisis or dropsy, should be selected in preference, as
in them the greasy marrow of the bones will be found nearly all absorbed,
and its place supplied merely by a sort of serum. In skeletons prepared
from fleshy subjects, it is almost impossible to get rid of the oil so com-
pletely, that it will not be continually frying out, when the bones are ex-
posed to any degree of warmth, thus soiling and disfiguring the preparation,
besides giving it a disagreeable odour. After the muscles have been remov-
ed by coarse dissection, taking care, however, not to cut the articulating
surfaces, of other parts of the bones, the whole should be boiled in water,
for some hours, to remove the soft parts which remain attached. Pains
should be taken, in the process of cleaning and boiling, not to lose sight
of certain small bones, which might readily pass unnoticed, such as the
sesamoid bones, the little ossicles of the ear, the extreme bones of the pha-
langes, &c. After the boiling, they should be well cleaned, by gently

1855.] 643

craping them with a dull knife, by which tin* remaining
lily detached ; and thru exposed, for several months,
to tli- action of the i and dei :hing,

they may be frequently sprinkled with water, and turn<
a solar heat, however, during the su

and chalk] quently to

crack. After the completion "t* this whitening process, will be

tit for mounting.

A 1- ! for

all the nicer preparal tion. For this pt<

the bones denuded of their flesh, n four or five day* in fresh wa-

ter, which should cover them over completely t<> some depth, bo that the

in them may b< !. In winter, warm water should l<

ployed, and the maceration carried on in a warm room: in summer, w . i t r
at the ordinary temperature will suffice. At the end of that timet!
will have 1" id white. The water is now to b<

and the process continued. After the soft parts have become con;]
decomposed, which will I the bones must be taken out,

scraped with a -hill knife, washed, and returned into another tub of fresh,
luke-warm water, in which they should remain for some 'lav-, to remove
any bad smell, that the d sh may have left npoa them. It is

well to change the water, in which they are macerating, quil
although this retards the decay of the flesh, it render*
and removes the stench. Lastly, the oily matter :-

ing them tor a while in weak ley. If no J may then

sun and wet I: is a bad plan to ose
chloride of lime to whiten them, as it acts upon the bane, and rend
rough and porous. The whole should finally he varnished over with the
white iv dried.

It may he well to remark that care should he taken not to use ditch wa-
water that ha- been colic-ted from the
ofmacerati' enconfervoid matter will be

in it, and stain I ter in the tub should never be a)

porate to guch a deg iny part of ita con;

posure to the air occasions a brownish Btain, whi fficult to be

got rid of.

isturbed, when maceration i> carri
I plan to prevent this, by removing the bones which support
them, and cleaning them befoi As this is very 13 cur in

the costal cartilage, they are osually separated, a i, leav-

ing them joined to the Bternum, so as to prepare them !

If a disarticulated head i- w which

lias not quite reached adult age. To - iparate tie which iht<

upon all sillea, dried peas en employed.

closely tilled with these, from I 3 laid in water, when

the peas, swelling out upon all gradual but powerful pr-

at length affect the disjunction of the ! . frac-

tures are the result of this experiment, ai 1 out in a few hours,

while the 1m.ii,.> softening hut slowly, are broken, I quired

sufficient elasticity to .It i- well, therefore, to ^,-,ik the skull for

days in water, before putting in t! i that the bones may be-

came slightly flexible.

644 Miscellaneous.

Horizontal and vertical sections of the cranium are extremely instructive,
and may be made with a fine saw, care being taken, in the vertical division,
not to go too near the mesial line, for fear of destroying the azygos bone
or vomer. [New Hampshire Journ. of Med.

Preventing Fats and Oil from becoming Rancid. Dr. C. W. "Wright, of
Cincinnati, in the Western Lancet, says that by imitating the practice of
the Indians in mixing the bark of the elm-tree (ulmus fulva) with fats, fixed
oils, butter, &c, they are preserved from rancidity, and have, moreover,
communicated to them an odor resembling the kernel of the hickory-nut.
About a drachm of the bark, either in the fresh or dried state, to a pound
of these articles, is the proportion to be used. This surely deserves a fair
trial, and the principle may be extended, as the Doctor remarks, to cerates,
ointments, oils for machinery &c. [Nashville Journ. Med.

Ointment for Hemorrhoids. Guv's Hospital gives us the following oint-
ment for piles, which happily combines the astringent properties of lead
and galls, with the anodyne influence of opium. A good formula of this
sort will be useful to the country practitioner, who will frequently be con-
sulted with regard to this very common disease, ft. Gallarum. contrit., 3ij.;
Opii (emolliti aquce cum, 3j.) 3ss.; Lig. plumbi. diacet., 3ij.; Adipis, Sj.
ft. ung. [ Virginia Med. & Surg. Journ.

Tic Douloureaux. Dr. Chisholm speaks in the highest terms of the
benefits to be derived from the use of the ointment of veratria in neuralgia.
He directs that it should be used in the proportion of fifteen and twenty
grains to the ounce, and rubbed in until tingling and a peculiar pricking-
sensation is felt. [ Virginia Med. and Surg. Jour.

Who introduced Cod Liver Oil? In the Association Medical Journal of
Great Britain, the question is agitated to who are we indebted for the first
use of Cod Liver Oil. It seems to have early been recommended by the
Manchester physicians, Drs. Percival, Hag. and Bardsley, under the name
of the oleum jecoris aselli. It was consumed there soon after its introduc-
tion in 1776, in quantities of fifty to sixty gallons annually. [Journal of
Med. and Surg.

ERRATA. In the part of Dr. Boling's Paper on Phosphorus, published in our September No.,
the reader will please notice the following corrections :

On page 520, line 4, for " accumulation," read, acceleration.

" 521, "24, * "no little," read, so little.

" 521, "26, " "influence," read, inference.

w 525, " 6-, " "perhaps of all," read, perhaps alT.

" 532, " 32. " " rarely," read, really, and for " giving," read, given.

M 533, " 35, " " position," read, proportion.

" 535, " 18, " " influence," read, inference.

u 536, " 1, " " influence," read, inference.

" 536, ' 21, " " at least," read, at best.

" 539, " 7, " " doses," read, dose.

" 541, " 5, " " saturated," read, diluted.

" 542, " 22, " " facts," read, fact.
And in our present No., on page 596, line 20, for " begone," read, bryone,
" " " 21, " " au," read, oiu,

SOUTHERN

MEDICAL AND SURGICAL JOURNAL.

Vol. Xl.J HOTBMB [No. 11.

ORIGINAL AND ECLECTIC.

ARTICLE XXXIV.

M On the Treatment of I f L A. DrOAS,

M. !>.. & .. & . < Published by request of the Medical Society of
of Georgia.)

In order to be prepared for the st is |>roperthat

W direct our attention to the normal anatomy of the uivthral
canal. BO far Bfl this may be necessary to elucidate
AW- need dwell neither upon the ires nor variable lei._

of this canal, but merely recognize its usual sal i into u,

spongy, a membranous una lie portion, as calculated

facilitate more definite. It is worthy of

ice, that - : ent

diamete f the m

branous portions the bulb'

central prostatic porl

Iml 3 of

diameter more or 1 real

trai not be r

The dilatabilit ; of th

ent point that

the iay be dilate but that

the foss'f

ing; that from this point to the - the canal is

moredil and that its most yielding port

membranous, and prostatic, but

N. S. VOL, XI. NO. XI. 41

64:6 Dugas, on Strictures of the Urethra. [November,

These peculiarities obtain at all a'ges, but the canal is more dilata-
ble in the old than in the young. The same observer ascertain-
ed that when the forced dilatation was carried so far as to produce
a rupture,, this was found to exist alone in the mucous membrane f
that the laceration was longitudinal and upon the inferior surface
of the canal ; and that the spongy tissue was susceptible of a still
much greater degree of dilatation without being torn. The fissure
thus produced in the mucous membrane would therefore be in-
creased in width, according to the force of dilatation, leaving the
spongy tissue uncovered to this extent. It is thus that the canal
may be very considerably dilated after scarifying the mucous
membrane, without impairing the integrity of the other tissues.

The inner surface of the urethra is lined by a very thin mucous
membrane, which, in the flaccid state of the penis, presents slight
longitudinal wrinkles. Eeybard denies ever having found the
transverse wrinkles and valvular arrangements which are affirmed
by some to offer an impediment to catheterism, even though the
penis be pulled so as to efface them. He acknowledges, how-
ever,, that the point of a very fine bougie may be arrested just
beyond the fossa navicularis by the hymenial valve recently dis-
covered there by M. Guerin. Near the vesical extremity of the-
urethra, the posterior or inferior face of the mucous membrane
spreads out and presents on either side of the median line the
orifices of the seminal and prostatic ducts,, in front of which may
also be seen those coming from the glands of Cowper. The lacunae
of Morgagni exist along the mucous surface, but in greater num-
bers about the bulb, and may sometimes arrest very small instru-
ments.

Let us now examine the peculiarities of structure presented by
the other constituents of the urethra in the spongy,, the mem-
branous, and the prostatic portions respectively.

The spongy portion of the urethra is that which extends from
the meatus urinarius externus to the arch of the pubis, and it
derives its name from the circumstance that the mucous membrane
is here surrounded by a peculiar erectile structure denominated
the corpus spongiosum urethra. This corpus spongiosum is con-
tained between two laminae of fibrous structure, the one upon its-
internal and the other upon its external surface, both of which,,
however, coalesce at their anterior and posterior extremities, and
also along the groove formed by the lower junction of the corpora
cavernosa, to which they adhere. We have here, therefore, a

1855.] Di ra.

ted fibro ithin whi tile

ie, which iv abundant mi-

like in. the

portion. The matrix or sheath of th

>m the urethral mucou.
and ilb

inch moi Lull than Vi-

dal. M l he

ur; ttributed to the existe am of eircular m

calar hi th the inner lamina of thifi -

: into the structure ita

be lamina, and are epara

f the urethra] wails, in
:n, but is _ :i later-

ally, we appi . here it

Its maximum. The dilatability of these v. i a

din to their thi- g therefore greater inieriorly

thai] the importance, in catheterism, of din

the instrument towards the superior surface. The
1 with ram the internal pudic

which m he bulb and I

minate in the eells of tli

y fine injections which pass
either e. - into th<

The M the un that int

Lb and I

m that
oft rnally to then; :ane we

I a Btzatum o

of -which - longitudinal. Still

by An.

It IS >r whir]. biofa

surround it hav

deal sphincter." tK<vbard. I
p. 26.)

648 Du 'GAS, on Strictures of 'the Urethra. [Xovemberr

The Prostatic portion of the urethra is that which is imbedded
in the prostate gland and communicates with the bladder. Its
length necessarily varies according to age and the condition of the
prostate. Hence this is stated to be from. 6 to 16 lines. It has
been found in some pathological conditions of the prostate to ex-
ceed its natural length by two inches; a fact which should be
borne in mind.. The same remarks are applicable to the diameter
of this portion of the canal, which is, as already intimated, natu-
rally greater here than elsewhere. The firmness or resistance of
the walls of this portion of the canal must vary according to the
state of the prostate which surrounds them.

Having as briefly as possible directed attention to such portions-
of the anatomical structure of the urethra as may have a bearing
upon the subject before us, let us now advert to some of the pa-
thological states observed in strictures of this canal

The classification of strictures of the urethra varies according to
the peculiar views of authors. Ducanno, after stating that they
are always the product of inflammation, adds that "the mucous
membrane of the urethra, irritated for a length of time, becomes
thickened in one or more points, and terminates in induration."*
(p, 8.) He then studies the effects of this morbid action under the
heads of Induration, Bands, and carnosities.. Amussat says that
they are organic, spasmodier and inflammatory; that "the name
of organic stricture is given to points of engorgement which are
formed upon the mucous membrane of the urethra or in the tis-
sues which surround it." And adds, that there are "four species
of organic strictures: 1st, Frasni ; 2d, valvular strictures; 3dr
strictures produced by a chronic swelling of the mucous membrane ;
and 4thr callous strictures, which comprise the indurations and
nodes found in the subjacent and spongy tissues." (Lectures, p. 17.)
According to Prof, Gross, these strictures are "either transient or
permanent." The former are spasmodic, and therefore paroxys-
mal; but in the latter form the stricture uis- always caused by an
effusion of plastic lymph into the lining membrane and the subja-
cent cellular tissue of the urethra, where a portion of this substance
remains, and is ultimately organized, being thus incorporated as a
constituent element with the pre-existing strictures." " Organic
strictures" (he continues) "are divided into simple and complica-
ted, common and traumatic, soft and callous, dilatable and undi-
latable, permeable and impermeable, recent and old." (p. 615.)
Eeybard remarks, that strictures of the urethra are of four kinds :

1855.] DtTGAS, on Strictures of the Urethra. 049

the spasmodic, the inflammatory, the organic, and those conse-
quent upon the existence of intra or extra-urethral tumo

We consider all strictures of the urethra organic lesions, whe-
ther appreciable or not by post-mortem inspection. Those termed
spasmodic, depend upon a morbid sensibility of the which

usually leaves no visible trace after death, although they may be
attended with marked irritation or phlogosis during life. Indeed
such reflex contractions indicate the existence of irritation at some
point or other of the urinary apparatus, and cannot be supposed
to occur without The strictures dependent upon inflammation,
in the ordinary acceptation of the term, and those attended with
deposits of new matter in the walls of the urethra, may for the
most part be readily detected after death, as they are also the most
unmistakable during life. The study of these various modifica-
tions of organic lesion may, however, be perhaps facilitated by
adopting the classification proposed by EeybarcL

Spo These are, as the term indicates, impedi-

ments offered to the flow of urine or to the passage of instruments
by a contraction of the muscular fibres which enter into the struc-
ture of the urethral parietes; and, like all spasmodic affections,
they must be more or less transitory, or paroxysmal. Theory
alone would teach us, and observation confirms it. that such spasms
must be provoked by irritation, more or less intense, at some point
of the canal As irritations of the mucous surface of the bladder,
stomach, or intestines, will induce contractions of the muscular
coat of these organs, so will the same cause excite similar action in
the urethra Yet, the degree of irritation in the mucous surface
of the urethra may be so slight as to give rise to muscular contrac-
tions only when aggravated by the contact of urine or of an in-
strument ; and hence it is that these contractions may sometimes
be obviated by merely lessening the acrimony of the urine,
have frequently done by the use of alkaline and mucilaginous
beverages. There are cases in which this irritation is so slight as
to be unknown or unfelt, except when, under the influence cf
venereal ex 8, debaucheries, or exposures to cold, it is suffi-
ciently increased to provoke spasmodic contractions. It is then
that we should not only endeavor to lessen the acrimonv of the
urine, but also to diminish the local irritation by means of baths,
leeches, opiates, cathartics.

thing is more unsatisfactory than the conflicting opinions of
writers with regard to the most frequent seat of strictures in gen-

650 Dugas, on Strictures of the Urethra. [November,

eral ; but we may reasonably conclude that spasmodic strictures
must occur most frequently where the muscular fibres are in great-
est number ; and, although they are met along the course of the
spongy portion of the urethra, I think that they are most frequent-
ly found to exist in the membranous or, as Amussat has very
properly styled it, the muscular portion of this canal.

Organic Strictures. By this designation we understand those
diminutions of the calibre of the urethra which are induced by such
vital conditions of the tissues, and such deposits of new matter in
them, as may either impair their normal elasticity or offer a me*
chanical obstruction to the flow of urine. A mere congestion of
the mucous membrane alone, or in common with the subjacent
structures, may impair their elasticity and materially impede the
flow of urine, without being susceptible of detection by passing
the finger along the seat of stricture when an instrument is intro-
duced during life, and without leaving any traces discernible by
post-mortem examination. Such cases are by no means of rare
occurrence.

It must be remembered that the walls of the urethra are habitu-
ally in apposition, or, in other words, that the canal is closed,
except during the temporary distention occasioned by the passage
of urine. ' Hence it is that a mere impairment of the elasticity of
its tissues will impede to a certain degree the flow of urine. This
closure is so complete that the orifice of the urethra is scarcely
perceptible in the stump after amputation of the penis, and it is
very difficult to introduce a catheter under such circumstances.
Every one knows how difficult it is sometimes to catheterize a
patient affected with phymosis, when the meatus externus is hid-
den from view.

The source of obstruction is sometimes referred to a thickening
of the mucous membrane alone; but we apprehend that the de-
gree to which this may be carried has been much exaggerated.
Indeed we know that in other parts this membrane is not suscepti-
ble of much thickening, and that the true extent of this can only
be determined by tearing up slips of it and comparing them with
slips taken from a healthy surface. It is in this manner very rare-
ly found to be more than double its normal thickness, which is
very slight, and could not therefore of itself occasion any very
serious obstruction. The error consists in confounding the mfil*
tration of the subjacent cellular tissue with that of the mucous
membrane itself. Yet, if this thickening be complicated with an

1855.] Dugas, on Strictures of the Urethra. 651

impairment of elasticity, the flow of urine may become very seri-
ously impeded.

Bridle Strictures. This term is applied to strictures characterized
by a duplicature of the mucous membrane which is usually trans-
verse and looks as though this membrane were pinched up or ele-
vated by a thread passed beneath it, so as to constitute something
like a valve. By slitting open the canal in front and behind the
stricture, its valvular shape may be seen ; but tins disappears at
once as the knife is carried through it It is ascribed by some to
an exudation of plastic lymph beneath the mucous membrane,
which becomes organized and agglutinates the external surfaces of
the duplicated membrane, and by others, with a greater semblance
of probability, to the cicatrization of an ulcer. Civiale relates a
case of the kind, which appears to have been caused by the lodg-
ment of a small calculus which was found just behind it, upon
post-mortem inspection. Be their real cause what it may, they are
comparatively rare, and their existence has even been denied by
some, although long ago described by Charles Bell and since by a
number of other authorities.

Excressences. The flow of urine may be more or less impeded
hj granulations, excressences, or carnosities springing up from the
mucous membrane, under the influence of a scrofulous or syphilitic
taint, and sometimes without any other evidence of such a state of
the system. I recollect the case of a boy about 8 years of age,
otherwise quite healthy, who presented a fleshy excressence just
within the orifice of the urethra, which gradually increased until
it protruded sufficiently to be seized with a pair of forceps, drawn
out and clipped off with scissors. A slight hemorrhage ensued ;
but the obstruction never returned.

Indurations. The strictures that most frequently claim the ser-
vices of the surgeon are those which consist of an induration of
one or more of the tissues constituting the urethral walls. There
is very great discrepancy among authors, with regard to the phe-
nomena which precede or induce these indurations, as well as in
relation to the real anatomical condition of the parts thus affected.
The most prevalent opinions are that some of these indurations
are produced by an effusion into the tissues of coagulable or plas-
tic lymph, which becomes organized and thus adds to the thickness
of the tissues that others result from the cicatrization of ulcers
that in some cases the plastic lymph is exuded upon the free sur-
face of the mucous membrane and may even occasion adhesions as

652 DuGAS, on Strictures of the Urethra. [November,

well as indurations. Under all these hypotheses the induration
may exist in one or more of the coats of the urethra ; yet, while
some insist that its seat is most frequently in the mucous mem-
brane, others locate it in most instances in the sub-mucous cellular
tissue. It is more probable that in the great majority of cases, the
induration exists simultaneously in both the mucous and its sub-
jacent coat, and that it extends to the corpus spongiosum only in
extreme cases.

It is not a little singular that notwithstanding the extensive and
minute study of pathological anatomy characteristic of the age, so
little should be positively known or generally admitted with re-
gard to so simple a point as the thickness of the coats thus indurated.
Most writers aver that the obstruction is occasioned by an en-
croachment upon the calibre of the canal, consequent upon the
thickening of its wall or upon the deposit of new matter in these;
whereas Eeybard declares that he has never seen a case in which
there was any thickening whatever, and that the coats are on the
contrary thinner than in the normal state, (p. 116.) It must have
occurred to all who treat inany of these affections, that although
the seat of stricture can generally be felt by carrying the finger
along the course of the urethra containing a bougie, an}- marked
degree of thickening can be very rarely detected. The author
just cited insists that the finger detects the seat of stricture by the
induration and loss of elasticity of the part, and not by any thick-
ening. So far as my observation extends, I think this view correct
in the majority of cases, though not in all.

The intrinsic nature of these indurations is a matter of much
practical importance ; but we here also find conflicting opinions.
That these indurations appear to be fibrous, and even fibro-cartila-
ginous, is admitted by all. Are these mere modifications of exist-
ing tissues, or are they new products heterologous formations ?
According to Cruveilhier, the fibrous element takes the place of
the pre-existing tissues ; the mucous membrane disappears entirely,
and so does the spongy body more or less completely, including,
of course, the intervening cellular tissue. And while he admits
the possibility of this fibrous structure being the result of inflam-
matory action, he is rather disposed to look upon it as consequent
upon ulcerative destruction, in which case it would be an entirely
new product. With Eeybard, the indurated element is heterolo-
gous from the first inception of a stricture up to its most complete
or fibro-cartilaginous development

1855.] Dug AS, on Strictures of Hie Urethra. 653

Now, what are we to infer from such discordant views enter-
tained by men equally distinguished, as faithful observers of dis-
eased structures ? Are we to admit that Hunter, Home, Bell and
Brodie, in England, and Ducamp, Lallemand, Amussat, Civiale,
and Reybard, in France, could be mistaken with regard to the
thickness of the urethral walls in strictures? It is unfortunately
too often the case that even distinguished men walk in the foot-
stepts of 4l their illustrious predecessors " without sufficiently veri-
fying the soundness of the grounds upon which they tread. And
yet it is only by exposing the errors of those who have gone before
us, that progress of any kind can ever be attained. In the present
instance, there has undoubtedly been a lamentable deficiency of
original and unbiassed post-mortem inspections, and, at the same
time, too great a disposition to generalize from a few facts. I be-
lieve, therefore, that organic strictures of the urethra may be found
presenting every gradation, from mere inflammatory effusion into
the tissues, up to the complete substitution of those by a fibro-
cartilaginous and heterologous formation; that the tissues may be
thickened or not. may be indurated, may be destroyed by ulcera-
tion, may be absorbed, and may be replaced by an inelastic fibrous
structure. All this is in accordance with what we see in other
pans of the body, and we know of no reason why the urethral
walls should constitute an exception, due allowance being made
for the irritating effects of the fluid (the urine) which must neces-
sarily so frequently bathe the affected tissues. Thus it is that I
feel disposed to harmonize or conciliate the observations of pa-
thologists who may have been too hasty in deducing general laws
from the few facts studied by each. This will enable us to recon-
cile the dogmatic differences of writers with regard to special plans
of treatment, and to appreciate the value of each under the various
conditions of the disease, instead of blindly advocating any par-
ticular procedure as equally applicable to all cases.

Having in these anatomical and pathological remarks confined
myself to such points as might have a practical bearing upon the
subject under consideration, I may be permitted to omit speaking
of the number of strictures that may be found in the same case, of
the regions in which they most frequently occur, of their remote
and proximate causes, of their symptomatology, tea. Indeed, I do
not know that our object would be promoted by the rehearsal of
the generally received doctrines upon these branches of the ques-
tion, I will therefore at once proceed to the examination of some

*>54 D UG AS, on Strictures of the Urethra. [November,

of the principal plans of treatment in common use. These may
be considered under the three heads of cauterization, dilatation,
and incision.

Cauterization. In use among the ancients, this plan was not
generally resorted to in England until highly extolled by John
Hunter and Sir Everard Home; nor did it become popular in
France until a still later period, when Ducamp and Lallemand be-
came its leading advocates. But, notwithstanding the potent in-
fluence of such high authority, this plan of treatment was on the
wane in England when taken up by the French, and is now very
generally repudiated in both countries by the mass of practitioners.
It was at one time much more resorted to in our country than it is
now, and I think the tendency of the profession is leading gradu-
ally to its abandonment, or rather to its restriction to a small num-
ber of cases. I need scarcely observe that the caustic most gener-
ally used is the nitrate of silver. I will therefore confine my
remarks to this agent. This may be used either as an excitant of
new action, which may terminate in resolution, or as an escharotic
for the purj)ose of destroying the morbid tissues. It is true, that
one of our best authorities denies it to be an escharotic, in the fol-
lowing language :

" Nitrate of silver has been supposed to act as an escharotic. If
this were the case it would be more likely to occasion than to cure
stricture ; for it would lead to ulceration, and the reparative pro-
cess which would follow could hardly fail to cause a narrowing of
the canal. The fact is, the only effect it produces is a detachment
of the epithelium of the lining membrane, and a softening of the
matter which gives rise to the obstruction ; in other words, it acts
mainly as a sorbefacient, rousing the absorbent vessels of the part,
and inciting them to the removal of the adventitious deposit. The
action of this substance is well known upon an exposed mucous
surface. If, for example, it be put in contact with the tongue, lip,
-or palate, it instantly causes coagulation of the natural secretion,
flight, almost imperceptible shrivelling of the epithelial investment,
and increased discharge from the mucous follicles. There is never
any slough, or destruction of the vitality of the part, however large the
quantity of caustic employed" (Gross. Dis. Urin., p. 6-13.)

The italics are mine. It would be out of place here to moot
the physiological question of the susceptibility of the "absorbent
vessels " to be roused or incited to the removal of adventitious de-
posits, But the whole paragraph, and especially the last sentence

1855.] DuGAS, on Strictures of the Urethra, 655

of the above extract, might mislead the juvenile or inexperienced
practitioner into a very mischievous use of the agent in question,
either under the impression that nitrate of silver does not occasion
strictures of the urethra, or that it is comparatively harmless even
in large quantities. The views of Prof. (x. are in direct conflict
with special experiments and post-mortem examinations made on
loAver animals, for the purpose of determining the effects of nitrate
of silver upon the urethra. (Eeybard, 53, et seq.) Lallemand in-
sisted that the caustic should be applied in sufficient quantity and
repeated until the whole morbid structures were destroyed.

Nitrate of silver, I repeat, is used either as an excitant or as an
escharotic : when used as an excitant, it is with the hope that by
converting a chronic into an acute inflammation of a less obsti-
nate character, the injurious effects of the former may be abated.
And it cannot be denied that it has in this way sometimes been
advantageous, in urethral as well as in other affections. But we
should bear in mind that it is here amenable to the same objec-
tions that may be urged against its use in other localities- viz :
that it may aggravate instead of benefitting the case. AVhen used
as an escharotic, according to the recommendation of its most
strenuous advocates, it unquestionably destroys the mucous mem-
brane and sometimes even its subjacent tissue, leaving, as has been
abundantly demonstrated, especially by Eeybard, a cicatrix tend-
ing continually to contraction, and resulting eventually in stric-
tures of an obstinate or of an incurable character. Indeed there
can be no doubt that the use of lunar caustic is one of the most
fruitful causes of strictures of the urethra. I have repeatedly
seen them induced in persons who have never had urethritis, but
who had been subjected to one or more cauterizations for the relief
of spermatorrhoea. This hazardous practice, become so common
in our country upon the authority of Lallemand, should be repro-
bated, or at least restricted to cases that have resisted all other
means; and even then be used with the utmost circumspection.

The observations of Eeybard upon the effects of cauterization
are so strongly corroborative of my own views, that I beg leave
to translate the following passage :

"In the place of the urethral mucous membrane, which the
caustic had destroyed along with the cells of the corpus spongios-
um, the cicatrix may be seen presenting a brighter and more
polished aspect than that of the mucous tissue. It is dense,
compact, very resisting and utterly inextensible, as was proven

65Q T)\j gas, on Strictures of the Urethra. [November,

by our ineffectual attempts to dilate the stricture, before and after
death.

"These experiments demonstrate that the tissue of urethral cica-
trices is very retractile; that its retractility increases as its organ-
ization is completed ; and that the shortening of this tissue cannot
be prevented by attempts at dilatation made during the progress
of cicatrization. I have even observed that the tendency of this
tissue to retract was increased by the use of bougies, and that the
stricture grew more rapidly when catheterism was practiced twice
a day than when this was clone but once in twenty-four hours. It
is therefore true, that cauterization merely destroys one stricture
to substitute in its stead another, often more extensive, more com-
plete and more serious."

"In short, reason, clinical observation, and experiments upon
animals, concur to establish the correctness of our views with re-
gard to the formation of organic strictures as a consequence of the
destruction of the mucous membrane by ulceration, and especially
by cauterization." (Op. cit., p. 61.)

In addition to these objections to the Nitrate of Silver, we may
mention the danger of its falling off the instrument while intro-
duced and lodging in the canal ; also, the risk of such a degree of
tumefaction in the strictured portion of the urethra as to occasion
retention of urine more or less serious. It should therefore be
avoided, especially whenever the stricture is so great as to impede
the introduction of a catheter of medium size.

From what I have said thus far it is evident that I am decidedly
averse to the indiscriminate or even common use of the Nitrate of
Silver in these affections. Yet I freely concede that there are cases
in which the extreme irritability of the mucous surface offers a
serious impediment to the use of bougies, and that in these a judi-
cious resort to gentle cauterization will very happily subdue the
irritability and thus materially facilitate the treatment by dilata-
tion. Cauterization should in fact be regarded rather as an adju-
vant to dilatation than as a special or radical plan of treatment.
With this view, the most convenient instrument for its use is
Lallemand's "porte-caustic," or some of its modifications, charged
in the usual way and carried into the stricture, rotated and imme-
diately withdrawn. This should only be repeated after the sub-
duction of its effects, which usually requires a few days.

Mr. Henry Thompson's conclusions in relation to the use of
caustics are as follows :

1855.] DUGAS, on Strictures of the Urethra. 6o7\

" That these agents are never to be employed for the sake of
their escharotic or caustic powers, properly speaking.

"That the Nitrate of Silver, lightly applied, exerts a salutary
action on the diseased surface of the urethra, relieving inordinate
irritability, and checking undue vascularity and disposition to
hemorrhage, as it does in similar conditions of the skin and mu-
cous membrane in other parts of the body, and thus it becomes a
useful adjuvant to dilatation.

" That the potassa fusa, as a caustic, is considerably more active
than the preceding, and is therefore more dangerous of applica-
tion. If used at all. it should be only in very minute quantities
such as fractional parts of a grain, inasmuch as it is exceedingly
difficult to limit the action of so powerful an escharotic. It may,
perhaps, aid dilatation in the reduction of some strictures, probably
by facilitating the solution of some of their component tissues,*,
when care is taken to employ it in obedience to the condition just
named.'' (Path, and Tr. of Strict, of the Urethra. By H. F. Thomp-
son, F.R.C.S. London : 1854. p. 220.)

Dilatation. The treatment of strictures of the urethra by means
of dilating instruments, is not only one of the most ancient me-
thods, but also that which has most effectually resisted all attempts
to supplant it. It is rational, safe, usually painless, not repugnant
to the patient, and of more general applicability than any other.
The instruments in most common use for this purpose are bougies,
which may be made of various materials, "We need notice, how-
ever, only those made of metal, gum-elastic and waxed linen.
The gutta-percha bougie is apt to break, and should be repudiated.
The cat-gal soon becomes rough and unfit for use.

The waxen bougie is a great favorite with some of the most skil-
ful surgeons, who resort to it for the double purpose of taking an
impression of the stricture and of subsequently dilating this. I
must confess that I think the importance of the explorations made
to obtain an accurate knowledge of the size, shape, &c, of the
strictured portion of the canal, by means of the wax bougie, has
been very much exaggerated, and that the data thus obtained, are
indeed of little or no value in the treatment by dilatation, although
they may perhaps aid us in determining the direction and extent
in which incisions should be made when these are deemed neces-
sary. Any stricture that is permeable may be treated by dilata-
tion, and I do not see how this can be facilitated by a knowledge
of the peculiar shape of the stricture. The waxen bougie is so

#58 Dugas, on Strictures of the Urethra. [November,

inferior to the metallic for dilatation that I never use it for this
purpose.

There are various objections to the gum^elastio, bougie: it is
very difficult to keep during summer, in this climate, however
well made ; it deteriorates very soon by use ; there are very few
cases in which it can be as easily introduced as the metallic in-
strument.

The Leaden bougie is/ 1 think, very decidedly the best in use. It
is durable, may be shaped to suit the views of the operator, is suf-
ficiently dense to exercise advantageous compression upon the
tissues, and is of easier introduction than any other. A very
simple experiment will serve to show the relative facility with
which the different kinds of bougies may be introduced. Let a
waxen bougie be held with a certain degree of force between the
.fingers and thumb of one hand, while an attempt is made with the
other hand to draw the instrument through the grasp. Note the
degree of resistance offered, and then repeat the same experiment
successively with a gum-elastic, a steel, a silver, and a lead bougie.
It will be at once perceived how much more firmly the fingers
adhere to the wax than to the lead, and consequently how much
greater is the force required to move the former than the latter
the resistance diminishes in the order in which Ave have just enu-
merated the materials. The leaden instrument may, therefore,
often be introduced with ease, when those made with other mate-
rials have been tried unsuccessfully. It is so much superior to
any other that I have used it almost exclusively for a good many
years.

It should be remembered that leaden bougies are sometimes
made hollow, and that they are then very easily broken. Having
seen some very ugly accidents resulting from their fracture within
the canal, I think that none but the solid ones should ever be used.
The solid instrument, moreover, retains its shape better, is more
dense, and its weight facilitates its introduction.

The treatment of strictures of the urethra by dilatation may be
either gradual or rapid, but the former method is that in general
use and approved by judicious surgeons, Rapid dilatation, by
means of bougies, may be effected either by using conical instru-
ments carried down with as much force as may be deemed prudent
by the operator, or by the introduction in rapid succession of bou-
gies of increased diameter, as advised by Benique, or, finally, by
the use of instruments invented by Perreve, and variously modifi-

1855.] Dugas, on to/ the Urethra. 650

ed by others, consisting of two blades, which may be separated,
more or less, after having been into the stricture.

If mere dilatation were the sole object of the treatment, the oV
jections to the rapid method would still be very great : but when
we recollect that a stricture thus dilated is by no means cured, that
the indurated tissues or products of morbid action must be remov-
ed by the slow process of absorption, and that the treatment must
be continued sufficiently long to prevent a reproduction of the dis^
ease, it must be conceded that rapid dilatation is entirely inadequate
to these ends. It must be acknowledged that there is something
fascinating in the idea of relieving a strictured patient in a few
days, and sending him home impressed with the belief that an af-
fection, perhaps of years' standing, has been thus so summarily
disposed of. The conscientious practitioner should, however, be-
ware how he be lured by such fair promises : for this practice, like
most others entitled to the designation of heroic, is not without
danger. But let us hear the language of others, lest we be
snspected of prejudice: I quote from Thompson's Prize Es
" Great mischief may very easily be done by rapid dilatation on
any method a proceeding, the exercise of which has been suffi-
ciently reprobated. The semi-elastic constituents of a stricture
must be gradually dilated if an efficient result is to be attained.
Inflammation of the urethra and bladder, which, in patients labor-
ing under chronic disease of the kidneys, may readily extend to
these organs and be followed by fatal consequences, has been not
unfrequently induced by neglecting this rule. Moreover, rupture
of the urethra may be produced by rash treatment, an occasional
consequence of which, even when the lesion is only slight in ex-
tent or degree, is the occurrence of phlebitis and purulent infec-
tion, with collections of pus in different parts of the body. Mr.
Coulson, of St. Mary's Hospital, has recently called the attention
of the profession to the connexion which exists between these
causes and effects, having collected and reported twelve ca-
which laceration of the urethra by sounds and lithotrites has been
so followed. {Lancet. 1852, vol. 1. p. 562.) In these the disease
appeared within a few hours after the - rands or bougies:

in four cases for the dilatation of organic stricture: in four for the
removal of fragments of calculi, chiefly in connexion with lithotri-
ty ; and in the remaining four for various other purposes, as en-
larged prostate, retention in gonorrhoea, kc.

''Three such cases also have come under my own personal

660 Dugas, on Strictures of the Urethra. [November,

observation ; of these, two were due to dilatation of stricture, and
the other followed the operation for lithotrity. It is an instructive
fact, that in almost all these examples the effects in question have
followed efforts to dilate the urethra which have been carried to a
considerable extent, i. e., just as the maximum amount of disten-
tion has been reached, or when an operator has attempted, in the
treatment of an old stricture, to dilate to a degree beyond what
has been his previous habit, although perhaps only to an extent
of one or two sizes of the catheter scale." (The Path, and Tr. of
Strictures of the Urethra, by H.Thompson. Lond., 1854, p. 197.)

Keybard, who advocates the rapid dilatation in some cases, after
stating his plan of procedure, adds: "But it is very rare that we
find strictures sufficiently distensible to yield to as rapid a process
of dilatation as that j ust mentioned. In most cases in which I
have dilated the stricture thus promptly the walls have ^yielded
only after being lacerated, either at the beginning of the operation
or upon the introd action of a bougie of four or five millimetres
diameter. This laceration is produced without much force, and
for the most part without being known ; but if the surgeon have
his attention alive to the fact, he will always recognize its occur-
rence by the peculiar sensation transmitted through the bougie,
by the sharp pain experienced by the patient, who will complain
of a sense of tearing or rupture, and by slight hemorrhage. Sub-
sequently the patient feels a scalding during micturition, larger
instruments are more readily admitted, and a muco-purulent dis-
charge occurs ; all of which symptoms concur in establishing the
fact of laceration.

"Even very distensible strictures can therefore be dilated but
slowly without laceration. Indeed, in most cases the operation of
dilatation can be repeated only at intervals of several clays, with-
out incurring the risk of laceration, of the febrile paroxysms so
common in such cases, of inflammation of the urethra and its at-
tendant blennorrhagic discharge, of inflammation and suppuration
of the sub-mucous tissues, and of uriuary fistula." (Translated
from Traits Prat, des Retrecissen tents da canal de V Uretre. Paris,.
1855. p. 227.)

The treatment by dilatation is of course only applicable to per-
meable strictures. It is true that impermeable strictures may, by
the use of caustics or cutting instruments, be opened so as to admit
a bougie ; but this does not invalidate the position that permea-
bility is a necessary condition of the treatment by dilatation, for

1855.] Du 3 of the Urethra. 661

the bougie must be introduced before it can dilate, The plan I
usually pursue, is to introduce as large a lead bougie as the pas-
sage will admit without violence or pain, and allow it to remain
at first only a quarter of an hour. This operation is repeated only
once a day, morning and night, increasing the size of the instni'
ment as fast as this can be done without pain, and prolonging
its retention to an hour. With a little instruction the patient
is very soon enabled to introduce the bougie himself so as to les-
sen the frequency of professional visits. It is- important, however,
to caution the patient very particularly against the use of too
much force or the infliction of pain, lor I have repeatedly known
accidents produced by their over anxiety to hasten the pi
A safe rule of action is to avoid giving pain by the operation. I
am in the habit of increasing the size of the bougie, until a num-
ber 10 or 12 can be readily admitted, and then of gradually lessen-
ing the frequency of introduction and time of sojourn. It should
be inserted often enough to prevent any tendency whatever to a
return of the contraction, and although this may be at first neces-
sary every q be sufficient to repeat this only every
second, third, or fourth day. and then weekly. But even after all
seems to be perfectly safe, the patient should be fully and freely
apprized of the great liability of such affections to return, and of
the importance of detecting such a tendency as early as possible.
This can only be done by occasional explorations, say once a
month, with the bougie of largest size, when the slightest difficulty
of introduction should be met by a return to the same treatment
as before adopted.

Chills, followed by high fever, are not unfrequently occasioned
by the use of bougies, however carefully managed, and should be
arrested at once by the free use of quinine during the first inter-
mission, lest they prove fatal, as is so often the case in those coun-
tries in which the advantages of quinine are less understood than
in this. These paroxysms constitute what the French designate as
"fievres pernicieuses,'' the synonyme of our " malignant intermit-
tents." It is difficult to understand wh neral dis-

turbances should be induced by so trivial a local irritation, and it
is equally incomprehensible that there should exist such striking
analogy of pathology and treatment between the effects of a cause
purely traumatic and those of one essentially atmospheric. I have
seen patients who had never hadap i of intermittent I

before, suffer most violent attacks of this kind after the introdue-

x. 3. vol. XL NO. XI. 4'2

bb Dugas, on /Strictures of the Urethra. [.November,,

tion of a bougie conducted with the utmost care and without the-
slightest laceration. Arrested by quinine, the attacks would re-
turn upon the repetition of catheterism. The same has doubtless
been the experience of all practitioners. I should remark, how-
ever, that this febrile tendency may be overcome by keeping up
the effect of quinine after the arrest of the paroxysms and until
the system becomes accustomed to the bougie. The administra-
tion of a pill of two or three grains of sulphate of quinine, morn-
ing, noon and night, for eight or ten daysr and the introduction of
the bougie once a day,, for fifteen or twenty minutes during this
time, will usually accomplish the desired toleration. I am under
the impression that gentle cauterization of the affected portion of
the canal with nitrate of silver once or twice, lessens the liability
to constitutional disturbance in such cases, by blunting the sensi-
bility of the affected locality, even though this may not appear to
be unusually developed. I would therefore advise a resort to it
upon the occurrence of a chill or febrile paroxysm,

I need scarcely state that the rapidity with which dilatation
may be safely effected varies exceedingly,, according to the nature
of the stricture itself, as well as the general susceptibilities of the
patient. While some considerable obstructions to the flow of
urine may be abated in even a few days, others, which appear at
first to be comparatively slight,., may prove remarkably refractory,
and consume weeks and even months in the treatment. It is
therefore out of the question to fix upon any rule which should
appty to all cases indiscriminately. The reputation of the surgeon,
as well as the interests of the patient, require that the treatment
be conducted as expeditiously as the circumstances of the case may
permit, with a proper regard to security ; but the judicious aud
conscientious practitioner willr at the same time, avoid the tempta-
tion of reaping laurels at the expense of undue risk to the patient.-
He will feel that he has done his duty when he has removed the
disease without accident,, although he may have subjected himself
to the imputation of timidity or want of energy. We should, of
course,, in all cases, proceed as rapidly as may be safe.

Incisions. The incision of strictures of the urethra may be
made from, within or from without ; that is to say, by reaching, the
obstruction through the canal or through the skin. The internal
incision may, moreover, amount to mere scarification or involve
the tissues to a considerable depth. Internal incisions are advoca-
ted by surgeons under widely different circumstances, for while

1855.J Bugas, on Strictures of 'the Urethra. 663

some think it proper to resort to them in the great majority of
cases, others restrict their use to instances alone in which the pas-
sage of a bougie is very difficult or even impossible. All, how-
ever, agree in the use of bougies afterwards, or, in other words,
make the incisions initiatory to dilatation. The advocates of a
general resort to these incisions as preliminar}r to the use of bou-
gies, insist that they thus economize time and make the cure more
effectual, whereas the opponents of this plan believe that it is less
radical, or permanent, than simple dilatation, and that the disease
is consequently more apt to return. Incisions undoubtedly facili-
tate very materially the use of bougies, and enable us in a few clays
to pass instruments of a calibre such as might have required weeks
of gradual dilatation for their admission ; but I am with those who
think that the disease is much more apt to return when thus treat-
ed, than when the obstruction has been removed by the absorption
provoked by dilating instruments. The use of the cutting in-
struments is, moreover, not always free from difficulty as well as
danger, especially when the stricture is situated about or beyond
the bulb of the urethra. "We have to encounter by this process
the dangers of false passages, and of urinary infiltration as well as
of purulent infection, to say nothing of hemorrhage, which, al-
though very rare, does sometimes become serious. Notwithstand-
ing these objections, however, to incisions as a general practice,
we are free to admit that cases are generally encountered in which
the induration is so extensive or unyielding that it becomes neces-
sary and highly proper to resort to them, even though the stricture
may occupy the membranous portion of the canal. I should observe,
however, that if the stricture be impenetrable, the induration
should be reached from without ; that is to say, by external incis-
ion, as this is both more easy and less hazardous.

Mr. Thompson expresses himself in the following manner upon
this point : M The attempt to perforate an obstruction otherwise im-
passable, by pushing a pointed blade into it without a guide, must
be always somewhat hazardous ; extremely so, if it be attempted
in the curved part of the urethra, for however cautious the opera-
tor may be, the blade may be most readily pushed out of the ure-
thra into surrounding structures, and infinite mischief may result.
Hence I feel bound, unhesitatingly, to discountenance the use of all
curved instruments constructed on this principle, and if it ever be
necessary to apply a 'lancetted stiletto' without a guide (which I
have never had occasion to do), its employment should certainly

664 Du -gas, on Strictures of 'the Urethra. [November,

be limited to that part of the urethra which islamite moveabley and
where its direction can be controlled somewhat by the assistance
of the hand not employed in directing the instrument. Less dan-
gerous is it, as we shall hereafter see, to lay open the perineum
and divide the stricture from without, thus giving free vent to
noxious fluids of all kinds, than to wound the urethra from with-
in, at or behind the bulb, as we run great risk of doingT when
operating at six inches distance from the external meatus, and
thus only make a channel for these matters into the erectile cavi-
ties and other structures around." (Op. cii, p.. 224.)

I have deemed it proper thus to add the weight of Mr. Thomp-
son's authority to my own, because of the less cautious views
advanced by one of the most enlightened surgeons of our own
country. Professor Gross, after advising internal incisions in
"old, firm, and unyielding" strictures, adds: "And why should
there be any hesitation or doubt concerning this operation?
Where are its dangers, or the difficulties of its execution ? I con-
fess I cannot see any ; and in making this remark, let no one
regard me as a visionary enthusiast. What I say is not specula-
tion, but the result of personal observation; not prejudice, but
actual experience at the bedside. It is only when the stricture is
situated far back, in the membranous portion of the urethra, that
the method is obnoxious to objection. Under such circumstances,
especially when the obstruction is nearly impermeable,, or when it
is accompanied by a tortuous condition of the urethra, there may,
I admit, not only be danger in attempting division, but the oper-
ation requires an amount of skill and anatomical knowledge which
few men possess. But even here, the well directed efforts of the
patient and persevering surgeon will generally be crowned with
success. To> the unskilful alone is the operation a stumbling-
block ; to the ignorant, foolishness." (Op. citT p. 790.)

The instruments used for internal incisions, consist of a canula
containing a stylet, with a blade, more or less near its extremity,
which may be projected in front or in the rear of the stricture,
so as to cut from before backward, or from behind forward.
There are various modifications of these "urethrotomes," to suit
the views of the operator. Indeed they are so numerous that it
is not always easy to name the author of any one that may be
presented to us. They are all, however, constructed upon the
same general principles. Some are straight and others curved,
and the blade is so situated as to cut forwards, backwards or lat-

1855.] Dugas, <m Strictures of the Urethra 665

erally. Some are intended merely to scarify, "whereas in others
the blade projects sufficiently to divide the whole thickness of the
urethra, and even the adjacent tissues. Tho.se recommended by
Stafford, Dr. Physick, Thompson, Civiale, and Eicord, will meet
the exigencies of mosl

A catheter of gum-elastic should be introduced into the bladder
immediately after such incisions, and allowed to remain several
days, or until a sufficient organization of plastic lymph has taken
place, to prevent the bad effects of the contact of urine with the
cut surface. Subsequently, it will be necessary to use bougies
(metallic) to maintain the opening effected by the incisions, if not
to increase it.

I have already intimated that even with the aid of such scarifi-
cations or incisions. man}T strictures will be found to return, sooner
or later, after the discontinuance of the treatment M. Eeybard,
however, has of late advanced the opinion that if the incisions be
made sufficiently deep, the disease may be radically cured ; and
inasmuch as his views have been sanctioned by so able a body as
the French Academy of Medicine, I beg leave to present a brief
notice of them. In so doing, I will translate a portion of the Ee-
port made to the Academy by tlft Committee who awarded the
Argenteuil prize to 1L Eeybard, in 1852, for his Treatise on
Strictures of the Urethra. The members of this committee were
MM; Bouvier, Gerdy, Grisolle, Huguier, Larrey, Laugier, Eicord,
Eobert and Eoux.

" Urethrotomy consists, according to M. Eeybard, of an internal
incision extending not only through the stricture, but also through
the whole thickness of the urethral walls. The two bleeding sur-
faces thus produced must be kept asunder so as to be separately
cicatrized, and in this manner a new surface is added to what re-
mains of the circumference of the canal, which increases its diame-
ter, and remains permanent. This operation is therefore very
different from mere scarification. M. Eeybard was led to adopt
this method by a study of the cicatrization which follows lonoi-
tudinal incisions of the urethra in lower animals. He found that
these wounds, when prevented from uniting, terminated in the
formation of a polished, thin, and non-retractile cicatrix, which

added to the parietes of the canal, increased its extent/1

* * -::- * * * .v. ^

" Before practising urethrotomy, the patient should be prepared
for it, by dilating the stricture so that it may admit the introduc-

666 DiTG-AS, on Strictures of the Urethra. [November,

tion of the urethrotome. If dilatation be too tedious or too painful,
scarification should be resorted to.

"The urethrotome used by M. Keybard consists of a canula
with a slit in its whole length, and containing a bladecl stylet, which
may by a simple and ingenious mechanism be projected so as to
divide the urethra from behind forward.

" Whatever be the shape of the stricture, the incision should
always be lateral, because the walls of the canal are here less thick,
and we thus avoid the arteries of the bulb which are situated infe-
riorly. The section should include as already stated, the whole
thickness of the urethral walls ; and even if carried beyond this,
there would be no harm done, as there is no important organ near.
The depth of the incision may be approximatively estimated at
five or six millimetres (from two to three lines), and its length
should be about six centimetres (about two and one-third inches),
the stricture occupying its centre. The longer this incision is
made, the easier will it be to keep its edges separated.

"In order to secure the separate cicatrization of the surfaces of
the wound, M. Keybard merely keeps them apart with dilating
instruments carried into the urethra, but without exercising any
painful compression. For this purpose he uses a double-branched
metallic dilator, or a mercury dilator similar to the air dilator of
Arnolt or of Ducamp. This instrument should not remain in the
canal so as to cause irritation ; but should be daily introduced for
a few minutes during the twenty-five or thirty days usually re-
quired for cicatrization.

" The following are the phenomena observed during this process
of cicatrization. The incision of the urethra is immediately fol-
lowed by a bloody discharge which gradually diminishes during
four or five days, and finally ceases as the inflammatory process
closes up the cells of the divided spongy tissue. This discharge is
followed by an oozing of matter, at first sero-sanguineous, and
subsequently serous and sero-purulent, which continues until com-
plete cicatrization. It is only in exceptional cases that true sup-
puration occurs."

"The edges of the incision, being separated each day, will heal
separately, and if care has been taken to carry the division through
the whole thickness of the canal and to make it sufficiently long,
the cicatrization will occupy not only the edges of the wound, but
also the bottom of this or the space resulting from the separation

55.] DTOAS, on Strictures of the Urethra. 667

of the edges. This portion, which M. Reybard terms 'the inter-
mediate cicatrix,' is formed externally to the canal and rests upon
the subjacent cellular tissue. If the wound does not suppurate,
the cicatrix will be polished, thin, and devoid of the retractility

peculiar to the cicatricial tissue."

* * # # * -a- -* #

" The accidents to be apprehended are, hemorrhage, urinary in-
filtration, febrile paroxysms, inflammation, and death.

"1. Hemorrhage. Urethrotomy is, as we have already said,
always followed by a discharge of blood from the divided spongy
body. This continues for three or four days ; but is rarely abun-
dant enough to constitute real hemorrhage. In a series of thirty-
two cases this accident occurred ten times. It did not take place in
the two cases operated on by your reporter some months since at
the hopital Beaujon ; but in one of these, a slight bloody oozing
persisted upwards of two months whenever the patient made efforts
at stool.

" The hemorrhage does not always occur immediately after the
operation ; it may show itself only at the end of several hours, or
even days, and especially during the night, in consequence of
-erections. In nine cases it ceased spontaneously ; in only one
case did M. Reybard deem it proper to control it by compression
applied along the urethra. AY hen it coincides with paroxysms of
fever (which is most frequently the case), the surgeon should not
interfere too soon, for the bleeding is then advantageous and tends
to prevent inflammation.

" It is not uncommon to see an ecchymosis produced by the
infiltration of blood in the cellular tissue of the penis, scrotum, and
perineum. This phenomenon is unimportant, and will disappear
spontaneously or under the influence of resolvents.

"2. Urinary Infiltration. It would seem that this accident
ought to be the necessary consequence of a deep incision of the
urethra. Observation, however, proves that such is not the fact
If. Reybard has ascertained that the urine flows through the canal
without penetrating the cellular tissue when care is taken to pre-
vent a coagulum of blood from forming in the wound. ThM
done by passing into the urethra for the two or three first days a
bougie or a catheter whenever the patient wishes to urinate. The
danger of such an accident lessens as we recede from the period of
the operation and as the inflammatory action progresses.

11 B. Febrile Paroxysms. Those who are operated on, often ex-

668 Dugas, on Strictures of the Urethra. [November,

perience during the two or three succeeding days, slight febrile
paroxysms, which M. Eeybard thinks may be usually attributed
to the painful contact of the urine with the wound. But some-
times these paroxysms are exceedingly violent and assume a ma-
lignant character, such as may be observed occasionally after other
operations upon the urethra.

"In our summary of thirty-two cases of urethrotomy, febrile
paroxysms occurred in twelve, neither of whom died. The malig-
nant type showed itself twice, and required the sulphate of quinine
in large doses. The same remedy was equally useful in two other
cases less severe ; and in the eight others, the fever being milder,
yielded of itself. The author thinks that this occurrence may
generally be obviated by catheterizing the patient as often as ne-
cessary during two or three days after the operation, and thus pre-
venting the contact of urine with the wound.

"4. Inflammation, The inflammation which follows urethroto-
my is less intense than one might expect from a wound so extensive
and deep ; it is indeed usually less than that which follows scari-
fication. M. Eeybard attributes this difference to the circumstance
that the dilating instruments introduced into the urethra after the
latter operation exert a much more considerable tension of the
divided tissues than they do after urethrotomy.

" 5. Death. It is well known that death may result from the
simplest operations upon the urethra. It has been seen to super-
vene very soon after the mere introduction of a bougie or catheter.
M. Blandin observed it after one single scarification. (See Mem. de
Eeybard, obs. de Joly.) M. Civiale cites (Memoire sur l'Urethroto-
mie, p. 97) another case of death at the Hopital des Yeneriens, the
result of one scarification. It is therefore not surprising that ure-
throtomy should also occasion it. We should, however, observe
that this fatal effect rarely follows this operation, inasmuch as it
occurred only once in thirty-two cases, and that even in this case
extraneous circumstances may be found to account for its fatality."

"Having indicated the accidents that may be occasioned by
urethrotomy, we will now show the final results of this opera-
tion. Among the patients operated on by M. Eeybard, there are
several whose cases could not be followed up, and of whom we can
therefore say nothing. But the last work of this surgeon contains
8 cases in which the condition of the patients was verified a long
time after the treatment by means of explorations with a ball-

1855.] Dugas, an Strictures of the Urethra. 669

headed bougie, the only instrument which enables us to ascertain
with, exactness the relative dimensions of the different portions of
the canal.

" Your committee of 1845 had already seen one of M. Reybard'a
patients ten months after the operation, whose urethra was found
to remain as large as it was after the incision, although he had
ceased to use bougies for six months. (M. Grerdy'a Report) Of
the eight cases reported by M. Key bard, seven were his own, and
one was communicated by M. Yalette, surgeon of the Hotel Dieu
of Lyons. This last is especially remarkable, for the patient had
three strictures with fistulas in the perineum and inguinal region,
and for twelve years the urine passed entirely through these fistu-
lous openings. The persistence of the cure was verified twent}^
months after the treatment, at which time the urethra readily ad-
mitted a bougie of 8 or 9 millimetres. The seven patients opera-
ted on by M. Eej'bard were seen by practitioners of established
scientific reputation, who have testified to the cure of each over
their own signatures."

" Appreciation. What first strikes us in the work of this surgeon
is the boldness and novelty of his operation. Xever indeed, until
now, have intra-urethral incisions been made so extensive and up-
on such sound principles. Another fact, equally certain, is that
this operation has solved the problem of the radical cure of fibrous,
thick strictures, involving sometimes the whole thickness of the
urethral walls, and which have, until now, resisted the most varied
and persevering efforts. By the extent of the incision, which is
carried beyond the indurated tissues, and by the separation of its
edges which is kept up, urethrotomy secures a large, polished and
non-retractile cicatricial surface, formed at the expense of the mor-
bid as well as healthy tissues of the urethra, and which is essen-
tially different from that resulting from the development of fleshy
granulations.

" The authentic facts of which we have given a summary, de-
monstrate that the cures thus obtained may be lasting: yet we do
not think that such happy results should always be looked for.
We regard a relapse as possible or even probable, when high in-
flammation takes place in the wound and renders inevitable the
development of fleshy granulations. In this event, the cicatrix,
instead of being polished, thin and non-retractile, will be similar
to those resulting from suppurating wounds will possess, as these

670 Du G as, on Strictures of the Urethra. [November,

do, more or less retractility, and therefore be capable of reproducing
the urethral obstruction.

" It cannot be denied that urethrotomy is a serious operation,
and that it may occasion grave accidents; but, on the other hand,
let us remember the prognosis of urethral strictures in which this
operation may be used ; let us bear in mind the series of infirmities
and sufferings which embitter and abridge the life of such patients ;
and then let us decide whether, under such circumstances, it is not
proper to resort to an effectual plan, although the cure has to be
purchased at the expense of some danger. For my part, I am far
from wishing to apply M. Reybard's method to all strictures of the
urethra; but there are some of these which I would resolutely
attack with this operation. Moreover, by glancing at the present
practice of some of the English surgeons, it is remarkable to find
that men of distinction, such as Syme, Coulson, &c, have arrived,
by a somewhat different route, to the same results as M. Reybard.
Their method, it is true, is more serious than his, since they add
to the division of the urethral walls, that also of the skin, adipose
tissue, muscular layers, the bulb, and in short of all the thickness
of the perineum. I do not wish here to institute a comparison
between the urethrotomy of our countryman and that of Mr. Syme,
for these operations are very dissimilar in a surgical point of view.
I merely desired to direct attention to the idea by which they were
both guided.

" In conclusion, both experience and reason concur in placing the
operation of M. Reybard among the conquests of modern surgery,
and in reserving it as a precious resource in those cases of stricture
which prove refractory under the methods of treatment hitherto
known." (Op. cit., p. xix. et seq.)

If more extended experience confirm the views of M. Reybard
and of his learned Reporters, then indeed will a vast advance have
been realized in the management of one of the most trying diseases
we are called upon to treat. I trust, therefore, that I will be par-
doned for the lengthy quotation I have thought it necessary to
make in order to bring this new plan of treatment fairly before the
profession. I can say nothing of it from my own observation, but
would certainly not hesitate to give it a fair trial whenever a suit-
able case presents itself.

External Incisions. Cases of strictures of the urethra are occa-
sionally encountered, which resist the usual methods of treatment
and in which it may become proper to resort to an incision of the

1855.] Di ctures of the Urethra.

urethra through the skin. This has been done as a dernier resort
for a long time ; but of late yea: me. of Edinburgh, has

urged with much zeal the adoption of the procedure even in or-
dinary cases," or as a general plan of treatment. Like M. Revbard,
with regard to internal incisions, Mr. Syme u at external

incision is alike prompt, safe and effectual. The profession in
Great Britain has been warmly engaged in ng the merits of

Mr. plan for several . 1 may be considered as still

very much divided in their views of the subject.

Mr. Syme describes his operation thus : " The patient should be
brought to the edge of his bed, and have his limbs supported by
two assistants, one of them standing on each side. A grooved di-
rector, slightly curved, and small enough to pass readily through
the stricture, is next introduced, and confided to one of the ass
ants. The surgeon, sitting, or kneeling upon one knee, now makes
an incision in the middle line of the perineum, or penis, wherever
the stricture is seated. It should be about an inch or inch and a
half in length, and extend through the integuments, together with
the subjacent textures exterior to the urethra. The operator then
taking the handle of the director in his left, and the knife, which
should be a small straight bistoury, in his right hand, feels, with
his fore-finger guarding the blade, for the director, and pushes the
point into the groove behind, or on the bladder side of the stric-
ture, runs the knife forwards so as to divide the whole of the
thickened texture at the contracted part of the canal, and with-
draws the director. Finally, a No. 7 or 8 silver catheter is intro-
duced into the bladder, and retained by a suitable arrangement of
tapes, with a plug to prevent trouble from the discharge of urine.
The process having been thus completed which it may be in less
time than is required for reading its description the patient has
merely to remain quietly in bed for forty-eight hours, when the
catheter should be withdrawn and all restraint removed.1' (Stric-
ture of the Urethra. By J. S 349, p. 41.)

"With regard to the cases in which Mr. Syme advises this opera-
tion, I beg leave again to use his own language : - " There are two
forms of stricture in which mere dilatation has been found inade-
quate to afford relief In one of these the contracted canal is so
extremely irritable that the introduction of an instrument aggra-
vates instead of alleviating the symptoms, and exposes the patient
to various dangers from the local and general disturbance thus
excited. In the other the peculiarity consists in a contractile ten-

672 Dug AS, on Strictures of the Urethra. [November,

dency so strong as quickly to counteract the effect of dilatation,
and thus renders it useless." (Edinburgh Monthly Journal, July,
1852, p. 33.)

From this quotation, as well as from the description of the opera-
tion itself, it is evident that Mr. Syme rejects the old maxim of
making no external incisions unless the stricture be impermeable,
and rather makes permeability a necessary condition for his opera-
tion. However much I am disposed to respect the old axiom just
referred to, I think it would be unwise to make it a fixed rule of
.action, for there are undoubtedly many cases of permeable stric-
tures in which dilatation affords only temporary and very imper-
fect relief, and in which even internal incisions will fail, unless
perhaps made according to the principles of Bej^bard. I have pre-
sent to my mind, very vividly, the history of a case I treated some
ten years ago, which very fully illustrates the correctness of these
remarks. It was that of a gentleman about 40 years of age, whose
urethra presented a series of strictures very near each other, and
extending from half an inch from the meatus externus to the ante-
rior junction of the penis and scrotum ; indeed the whole of this
portion of the urethra was indurated and felt somewhat like a
string of beads closely set. This case was the consequence of gon-
orrhoea, had been of several years' standing when I saw it, and
had been treated by some of the best surgeons in our country-
Dilatation, cauterization, and finally internal incisions, deep and
repeated, had never given more than temporary relief, and the
patient was obliged to keep up the daily use of a bougie in order
to be able to urinate at all. The whole urinary apparatus had be-
come involved, the bladder was very irritable, and the general
health of the patient so much impaired that he was unable to at-
tend to any business. An external incision comprehending the
entire length of the induration not being deemed advisable, I pro-
posed an opening to be made behind the scrotum, but as near it as
possible, and to be kept open; thus simulating the course usually
pursued by nature, in the establishment of a fistulous passage.
The patient readily assented, and a free opening was made down
to the groove of a director introduced into the canal ; a catheter
was then carried through this orifice into the bladder and retained
a few days in order to avoid the danger of urinary infiltration.
After this a bit of a large bougie, about two inches long, was kept
in the opening to prevent its closure, and so secured that it could
not penetrate too deeply. At first we used a bit of gum-elastic

1855.] Dug AS, on Strictures of the '.Urethra. 673

bougie; but this would soon become deteriorated and unfit for
use. We then tried a ,bit of leaden bougie: this did better, but
was apt to slip out from its own weight. Finally, a small ping of
white pine was adopted as the best material: whenever, how
its use was omitted a few days, the tendency of the fistula to close
manifested itself, and the plug had to be replaced. By making a
head to this plug, it could not pass it too deeply, and retentive
means were dispensed with, the pressure of the scrotum
ficient to prevent its escape. I had the satisfaction to see my pa-
tient rapidly regain his health, and resume his occupations 1 was
enabled to watch this e re; and he had no farther

trouble with his strictures, but still had to wear the plug. He finally
died of some other disease. It is remarkable that the portion of the
canal in front of the fistula seemed to have completely closed, for
he could never after the operation pass any urine through it when
attempting to do so with his finger upon the orifice made. The
patient died at a distance, so that I had no opportunity to make a
post-mortem examination.

I may be permitted here to relate another of those extreme cases
in which the surgeon may be justified in resorting to unusual pro-
cedures. A negro man, about 50 years of age, had been man v years
afflicted with stricture to such a degree that he became unable to
attend to any of his duties. The stricture was situated just in front
of the scrotum: had been treated in the usual way \>y several phy-
sicians without success, and the patient could now pass his urine
only by drops and with great effort, His general health was much
impaired,, and he was placed under my charge about fifteen years
ago with the injunction not to undertake the treatment unless I
thought I could make a radical cure. This was one of those cases
which have given rise to so much discussion as to the value of the
term permeable. It would be said by some to be impermeable be-
cause no instrument could pass through it ; yet it was permeable
to urine, for this fluid still made its way. I determined to make
an external incision, to lay open the canal and then to introduce a
catheter. But those alone who have attempted to open the urethra
at a point closed by a thick fibrous texture, without the guide of a
grooved director contained within it, can realize the difficulty of
such an operation. In this instance,, after laying open the indu-
ration, which was half an inch long, I sought in vain for the
channel through which the urine had passed, and finally resolved
to extirpate the whole of the indurated texture, to introduce a

674 Dugas, on Strictures of ihe Urethra. [November,

catheter into the bladder, and to close the external wound by
means of adhesive plaster. The wound healed by first intention,
and the patient continued to keep the catheter in the bladder for
a fortnight, after which he appeared to be perfectly well, but
was advised to introduce a large bougie occasionally. The blad-
der had, however, become implicated, and he remained subject to
attacks of cystitis, which in a few years became attended with very
copious hemorrhages. It was not until then that the operation
revealed one of its inconveniences ; for the newly formed portion of
the canal, not possessing any contractility, small coagula of blood
would lodge in it, and impede the flow of urine until removed by
a bougie. The repeated lodgement of these coagula gradually
distended this portion of the canal, aud converted it into a small
sac, after which it became very difficult to carry a bougie into the
orifice of the natural urethra beyond it, for this being closed by its
own contractility, the point of the bougie would be more apt to
pass to the side of it than to penetrate it. Yet by simply breaking
up the coagula, the Urine would still readily flow. This man lived
ten years after the operation, and finally died from the affection of
the bladder, but never suffered any return of stricture.

But, to return to the consideration of Mr. Syme's operation, I must
avow my decided objection to it as a rule of practice in the generality
of cases. It is but fair, notwithstanding, that I furnish the results
obtained by those who have resorted to this practice, The follow-
ing statement is derived from Mr. Thompson's work, (p. 257.)

" The operation of dividing a permeable stricture upon a grooved
sound as a means of cure has been performed, as far as I have
been able to learn, about 115 or 120 times. Through the kindness
of those gentlemen whose names are given below, from each of
whom I have recently received communications either in person
or by writing, I have obtained the histories of many cases hither-
to unpublished, and have collected more or less of information, the
results of which are annexed in general terms.

By Mr. Synie, above 70 times. No death ;. a large proportion of the eases successful,
Mr. Ferguson 4 . . One death ; two tolerably successful ; one doubtful,

" Outlines of Cases," Nos. 1 to 4.
Mr. Cock . . 5 . . One death y the remainder more or less successful.

See "Outlines of Cases," Nos. 5, 6, 7, 8, and 9.
Mr. Coulson . 8 . . One death ; the remainder more or less successful,

" Outlines of Cases,*' Nos. 10 to 1*7.
Mr. Erichsen . 5 ,, The majority more or less successful. One or two

doubtful. " Outlines of Cases," Nos. 18 to 21-

" Reported Cases," No. 11.

1855.] "WiLSOX, on Laws relating to Medic 6<o

Mr. Haynes "Walton 1 time Successful. "Out!!

Mr. H. Thompson 1 . . Successful. " Reported Cases," No. 11.

Mr. Mackenzie 7 . . One death ; the remainder more or less successful.

"Outlines of Cs 20.

Mr. Dunsmure 3 .. Two, more or less successful, one successful. "Oxifc-

lim-s of O VL

Dr. F. Thompson 2 . . Successful. " Outlines ol Xos. 33, 34.

Dr. Cruickshank 1 .. Successful "Outlii -." No. 35.

Mr. Fiddes . 6 .. Five successful, one doubtful 4* Outlines ot Cases,"

Etas, 36 to 41."

In the present state of our knowledge with regard to the pro-
cedures of both Messrs. Reybard and Thompson, I am disposed to
regard them as valuable contributions to our means of treating
strictures of the urethra, and to adopt them in such cases as may
require them in consequence of having resisted other and simpler
means. We are certainly not yet prepared to give them the pre-
ference over dilatation when this can be made successful.

In conclusion, I have only a word to say with reference to cases
impermeable to instruments. In these, whether resulting from
traumatic or other causes, we should first strive to render them
permeable by the use of leeches, baths, opiates, &c, &c; and if
these means fail, we have no alternative left but external incision,
however difficult this may be without guide.

I have already extended this paper beyond the limits of my
original design, and still feel that I have not done justice to tbe
subject assigned me by this society. An indisposition to tax your
patience beyond endurance, must therefore plead my apology for
the omissions that may be detected in this sketch of the treatment
of an affection so fraught with interest to the profession and vexa-
tion to the patient.

ARTICLE XXXV.

Remarks on the Laics of Georgia relating to the Practice of Medicine
on the Resolutions of the State Medical Society for their Enforce'
ment for the suppression of Quackery. , By Jxo. Staix-

back Wilsox, M. D., of Lawrenceville, Georgia.

Our object in this communication will be to suggest, admonish
and incite, rather than to instruct those who have had such ample
opportunity of informing themselves as to the legal relations of
the Medical Profession in the State of Georgia. All who are con-
versant with the action of the State Medical Society, are familiar

6<6 "Wilson, on Laws relating to Medicine. [November,

with the " Eeport" of Dr. E. Q. Dickinson* In that " Eeport" an
attempt is made to systematize "the glorious uncertainties of the
law ;" and it affords the strongest evidence of the necessity of such
an effort, while it is a striking commentary on the folly, obscurity
and injustice of our legislation on medical subjects. As a proof
of the folly and injustice of our laws, it is only necessary to allude
to the legalizing of the Botanic humbug the removal of all re-
strictions upon the practice of medicine for several years the
passage of an Act rendering it doubtful whether the alumni of
the chartered Medical College of the State could practice without a
license from the State Board the permission of the graduates of
any Medical College to practice and, lastly, the passage of numer-
ous special enactments, permitting certain individuals to practice
Homoeopath}', Hydropathy, the Dutch and Indian practice, &c, &c.
As an evidence of the obscurity of the laws, we will only state that
no less than eleven different, and often contradictory Acts, on the
Practice of Medicine, have been approved by the Legislature with-
in the last thirty years, or since the passage of the first law, in
1825. But one of the most striking evidences of uncertainty is to
be found in the fact that even now, after the careful u Eeview " of
Dr. Quintard,f and the labored "Eeport" of Dr. Dickinson, we
are still not fully satisfied as to who is legally entitled to practice
in this State, The latter gentleman, after giving an able summary
of all the laws relating to this subject, together with a decision of
the Supreme Court, arrives at the following conclusions, viz :
"No person is authorized to practice Medicine or Surgery in
Georgia, 'for fee or reward,' except 1st. The licentiates of the
Medical Board. 2d. The graduates of the Medical College of
Georgia. 3d. Those engaged in the practice in this State, in 1839. rr
And 4th, " The licentiates of the Botanico-Medical Board the
graduates of the Botanic Medical College, and those engaged in
the practice of this exploding humbug in 1847.n

We have examined the laws and the decision referred to in the
" Eeport," carefully, and our conclusion is, that Dr, Dickinson's
list of legal practitioners is not sufficiently comprehensive ; and
that it should embrace those who were engaged in practice, in this
State, prior to the year 1825, or before any restriction was laid
upon the practice of medicine. We have also read the decision of
the Supreme Court, in the case of Coyle vs. Campbell,^ very at-

* Vide Transactions, <fcc. April, 1853.

f "Laws of Georgia relating to the Practice of Medicine."

% 10th Georgia Reports, p. 570.

1855.] Wilson, on Laws relating to Medicine, 677

tentively, and we confess that we are left in doubt, whether all
persons engaged in practice in 1839, the date of the revival of the
Act of 1825, are exempt from the operation of the revised act, by
the proviso, excepting Thompsonians, " or any other practitioners
of medicine in this State ;" or whether the exception extends only
to those " who came into the practice between 1836 and 1839." It
will be seen, by reference to this case, that the counsel for Coyle
endeavored to avail himself of this proviso, by claiming that all
practitioners were exempt from the law of 1839 ; but this was not
allowed by the Court, because such a " construction would defeat
the whole body of the act." The Judge then goes on to say (we
think it best to give his own words) : " But it is not necessary to
make it void. We give it a meaning it means to except such
persons as were, in 1839, in the practice of medicine, and who
came into the practice between 1836 and 1839, whilst the Act of
1825 was repealed persons who were then practitioners of medi-
cine for fee or reward, and who began to practice when there was
no law to prohibit them." We think, although this language is
somewhat ambiguous, the inference is very fair that all persons
engaged in practice in 1839, and not exempt by the proviso to that
act, but that it only extends to the favored Thompsonians, and
those who "began to practice between 1836 and 1839," &e. In
concluding our evidences of the ': uncertainties of the law," we
would remark that we have had two objects in view : 1st. To
show the obscurity of the laws ; and 2d. To ascertain, if possible,
who is legally authorized to practice medicine in Georgia. It is
for the accomplishment of the latter object that we have adduced
the case from the Supreme Court, even at the risk of being tedious.
While we are considering the laws, we should add that the Legis-
lature, at its last session, passed an act authorizing the graduates
of " an}^ Medical College in the United States, to practice physic
within the limits of this State, and charge and collect for the same
without licensi

After a careful review of all the conflicting laws relating to the
practice of medicine, we are of the opinion that the following per-
sons are authorized to practice in Georgia, for "fee or reward;"
and that all who are not embraced 'under one of these heads, are
obnoxious to the penalty affixed to the Act of 1825 :

Legal Practitioners. 1st. The licentiates of the Kegular Board.
2d. The graduates of any Medical College in the United States.

* Session 1853-54, p. 87.
S. S. VOL. XI. NO. XI. 43

b7o W ilson, on Laws relating to Medicine. [November,

3d. Those who began practice, in this Staterbetween 1836 and 1839.-
4th. Those who engaged in practice prior to the year 1825. 5th.
The licentiates of the Botanico-Medical Board the graduates of
the Botanic College, and those engaged in this practice in 1847 ;
and, 6th. A score, or more, of Urine, Dutch and Indian quacks,
who are permitted, by special enactments, to kill and swindle the
credulous and unoffending people of the State.

If we have succeeded in defining the law, the next question for
consideration is the necessity and policy of seeking a change or
repeal of existing laws.

Our allusion,, in the beginning of this article, to the folly and
injustice of those laws, is a sufficient indication of the opinion en-
tertained by us as to the necessity for their modification * and we
flatter ourself that no argument will be required to demonstrate
the correctness of our views,, wrhen it is known that Botanies the
graduates of any thing called a college and a nameless tribe of
individual empirics are allowed to practice under present regula-
tions. But, while we admit that this state of things should not be
tolerated by our Legislature, we are opposed to any attempt, on
the part of the Medical profession, to modify the laws, under exist-
ing circumstances: we therefore concur in the opinion expressed
by Dr. Dickinson, that it would be " inexpedient" and impolitic
to make such an effort; for the simple reason that nothing could
be accomplished in the present state of the public mind. Instead,
then, of striving for the obtainment of impossibilities,, with a cer-
tainty of defeat, and a reaction, fraught with injury to our cause,
let us rather see to it that the existing laws, imperfect as they may
be, are faithfully executed,, and that the horde of illegitimate and
lawless empirics,, who hang like a dark cloud on the skirts of our
profession, are arraigned to answer,, at the bar of the country, for
their offences against the laws of the land, and their unpardonable
outrages upon suffering humanity. And in order to do this suc-
cessfully, it is essential that we do all that we can to enlighten the
people on medical subjects, by publishing in the " popular chan-
nels" of communication, the destructive evils of ignorance and
empiricism, and the elementary principles of scientific medicine.
Let this be doner and we will have no difficulty whatever in exe-
cuting the existing laws, or in procuring a better code, which will
utterly destroy the fungus excrescences which now flourish in such
rank luxuriance upon the medical body, exhausting its vitality
and making it "a by -word and a reproach among all the people."

1855.] Wilson, on Laics relating to Medicine. 679

But if Hippocrates would exert his legitimate influence on the
community, he must look well to his own household : he must see
that those who claim to be his lineal descendants, comply with the
requisitions of the law, and that they are fully armed and equipped
for a contest with the stolid obduracy of ignorance and the artful
wiles of interest: his Temple must be cleared of the "money
changers;" and he must remember that he cannot stand before
his enemies until the "accursed thing" is "taken away" from
his own "midst." For the accomplishment of these things, regu-
lar physicians must disclaim all fellowship with quack-procurers,
nostrum- venders, patent-medicine certifiers and prescribers, by de-
claring all such unworthy of the "rights, privileges and honors of
physicians;" and all Medical Colleges must be put under the ban
of the profession which do not strictly enforce the published rules.*
We are pleased to see, by reference to the Constitution and
Proceedings of the State Medical Society, that a laudable desire
has been manifested by that body to effect the above most desira
ble objects. The Constitution excludes from membership, illegal
immoral and irregular practitioners together with the patentees
certifiers, and dispensers of secret nostrums; and various "Peso
lutions " have been passed, and committees appointed, for the pur
pose of enforcing the existing laws on the practice of medicine
But as we are not aware that any thing has actually been done to
carry out the designs of the Society, we hope we will be excused
for briefly reviewing its "proceedings," for the purpose of remind-
ing members of the duties imposed upon them.

At the meeting in 1851, a resolution was unanimously adopted
requesting auxiliaries, and each physician in the State, to report
the names of persons practicing in violation of the laws ; and also
those practicing in accordance with said laws: at the same time
the Registration committee was "requested to take into consider-
ation the existing laws of the State, which effect the medical pro-
fession, and to propose to the next legislature such amendments as
in their judgment may be expedient. At the meeting before this,
Ave should have stated that a committee was appointed k> consisting
of one from each Congressional district," of which Dr. W. L. Jones
was chairman, whose duty it was "to address the Profession at
large upon the expediency of organizing auxiliary Medical Socie-
ties ; registering the names of all regular practitioners of medi-

* For a more full exposition of our views on professional reform, we would refer
to the Nashville Journal, April, 1854, p. 199.

680 Wilson, on Laivs relating to Medicine, [November,

cine," &c, &c. So much, then, for the laws, and the "resolutions""
of the State Medical Society, for their enforcement.

The question now for serious consideration is this: Will the
Society be satisfied with the passage of idle and ineffective resolu-
tions, which are neither regarded by the members nor the profess-
ion at large ? Or shall they proceed to vindicate the laws to
maintain their own honor and respectability, and to restore the
fallen glories of legitimate medicine, by the elevation and purifica-
tion of their own ranks, and by visiting a righteous retribution on
the vandal host of lawless empirics who have invaded the medical
domain, brought disgrace and reproach on our time-honored pro-
fession, and scattered disease and death throughout the land ?

We trust that this question will receive a hearty affirmation
from every respectable physician in the State, and that each one
will feel under a sacred obligation to respond to the call of the
Society, and to do all that he can, regardless of personal conse-
quences, in the cause of justice, science and humanity. It is true,
that this would be an unenviable task, and those who engage in it
would, in many instances, have their motives impugned,, and be
subjected to public odium and individual animosity ; still, we con-
tend that the magnitude and excellence of the cause justify yea,
demand sacrifices, should they be necessary for the accomplish-
ment of the great work; and we may be permitted to confirm the
sincerity of our opinion by this declaration : Although we live
by our profession although it is our principal dependence for the
support of a family, we had rather suffer immolation in an honor-
able effort to sustain the character of that profession,, than to grow
rich at its expense, by pandering to the clamors of popular igno-
rance and prejudice by supine indifference to its interests or by
a criminal disregard of its high and sacred obligations. If these
be the sentiments of the physicians of the State of Georgia, the
resolutions of the Society vrill be earned out the laws will be exe-
cuted the Temple of Medicine will be purified the character of
the profession will be elevated its usefulness and respectability
will be once more restored; and Scientific Medicine "redeemedr
regenerated and disenthraled," with the gathered honors of
twenty centuries clustering thick upon herr will again command
the esteem,, the admiration, and the confidence of the people. And
do we need any incentives to action? We have every thing enno-
bling and animating to incite us in this great contest. The
warfare is against ignorance and imposture against disease and

1855.] WlLSOX, on Laws relating to Medicine. 681

Buffering and death against Charlatanism and deception: our
aim is, the diffusion of sound, useful, protective knowledge among
the people the establishment of truth and justice the suppress-
ion of frauds the protection of our profession from dishonor
the promotion of the health, happiness, and general interests of
the community: verily, ours is a good cause; it is the cause of
humanity ; it is the cause of God. It must and will prevail.

Having now finished our remarks on the laws relating to the
practice of medicine, &o, Ave will conclude with some suggestions
in reference to the use of patent nostrums.

We fully coincide in the opinion expressed by Dr. Dickinson
on this point, viz: "If legislation is needed in Georgia on any
subject, 'relating to the practice of medicine and the sale of drugs,''
it is in the suppression of the infuriate and wide-spread mania of
gulling and. swindling in the sale and use of quack and secretly
prepared medicines." We also highly commend the plan suggest-
ed by him, that, " our legislature be respectfully and earnestly
memorialized to pass a law prohibiting the sale, within this State,
of any secretly compounded, or any pretended patent medicine,
unless the composition of such mixture shall be plainly printed on
the bottle or paper containing said medicine or mixture, with
heavy penalties for violation or false representation."

In addition - to this, we would propose that the memorial em-
brace a petition that a tax be laid on every patent-medicine
agency in the State. This might be only restrictive, or,- what
would be better, it might be prohibitive. At any rate, it is pro-
bable that it would be a source of considerable revenue, (judging
from the enormous consumption of nostrums by the good people
of the State,) and thus a grievous evil might be made subservient
to good. We may add, that a law of this kind wras, a few 3-ears
since, in operation in Alabama; but the legislature, in its wis-
dom (?) repealed it.

Now, whether we can exclude these vile compounds by law or
not, if we can only make their composition known to the people
by legislative enactment, or otherwise, we will have accomplished
a great deal for their suppression. We would therefore suggest,
in the absence of such legislation, that a Board of Examiners be
appointed by the Society, whose duty it shall be to analyze all
secret medicines imported into the State, and to publish the result
of such analysis extensively "through the popular chaunels of com-
munication:" and also, by means of a work devoted expressly to

082 WlLSOX, on Laws relating to Medicine. [November,

this, and kindred purposes. We think that this would be a good
plan, even admitting that the legislature might be induced to pass
the law recommended by Dr. Dickinson ;> for it would be very de-
sirable to have a board of competent supervisors, to see that the
law was not evaded by false labels, and other devices, to which
the patent adepts in trickery would be likely to resort. But we
confess that we have very little hope of the passage of Dr. Dick-
inson's law by our legislature; and therefore we are the more
inclined to insist on a plan by which, we think, much can be ac-
complished, in spite of our legislators. Another thing which should
commend this suggestion to our favorable consideration is the
fact, that it is perfectly consistent with the "plan" proposed by
Dr. Eobert Campbell, in his "Report on Empirical Remedies,"*
which was adopted by the Society. It will be remembered that
the author of that "Report" advises that a standing committee
should be appointed for the purpose of collecting and publishing
all the " pernicious effects, resulting from the employment of em-
pirical remedies, which may come under the observation of the
Society," &c. We would, then, respectfully urge the propriety of
the appointment of the committee suggested by us, and also that
it be made part of their duty to execute the above recommendation
of Dr. Campbell.

We could say much on this prolific theme, and might multiply
many words in exhorting the profession to action, for the suppres-
sion of the monstrous evil under consideration, but we think it
useless ; if the swindling, humbuggery, disgusting advertisements
and loss of health, and even life itself, which physicians daily wit-
ness as the results of the nostrum trade, will not arouse them
against it, nothing ivill.

One word as to druggists, and we have done. A resolution has
been adopted by the Society, recommending its members, as far
as practicable, to " patronize such druggists and apothecaries as
refuse to vend and puff patent and secretly compounded medi-
cines." Knowing, then, that this class constitutes one of the most
efficient allies of the quack army, we do sincerely hope that re-
spectable physicians generally will act in accordance with this
resolution ; and if no druggists can be found who have not denied
themselves, we suggest that physicians establish houses in the
principal towns, by pledging themselves to support the proprietors
of such, on condition that they deal not in the "unclean thing."
* Vide Transactions State Society, April, 1853,

1S55.] Drake, on Typhous Fevers. 683

ARTICLE XXXVI.

Notice of some of Dr. Drah . as exprei is "Systematic

Treatise, Historical, Etiological and Practical, on the principal
diseases of the interior valley of North Ameri .. dr.

BOOK THE SECOND PART THE THIRD TYPHOUS FEVERS.

As it is not our aim to enter into a critical review of the work
before us, but simply to show that Dr. Drake's facts and reason-
ings tend, rather to establish (at least so far as the interior valley
is concerned) a different conclusion from that to which he appa-
rently arrives; and as it is our desire to present this view of the
subject as briefly as possible, we shall, without any very particular
regard to his arrangement or method, proceed at once to do so.

li Our physicians, (p. 358,) from the Gulf of Mexico to Lake
Superior,, or at least to the northern limits of autumnal fever, are
familiar with the train of what, in their common parlance, are called
nervous or typhoid symptoms, following, now and then, on cases of
that fever; which, beginning with a vomiting, ends with a con-
tinued type. We are all, moreover, witnesses of the fact, that in
some autumns a much greater proportional number of such cases
occur than in others. In these secondary affections, we have the
anti-type, as far at least as symptoms are concerned, of the primary
forms of fever, which we are now about to stui

" These forms known under the names of typhus metior, typhus
gravior, and typhoid fever, which I shall group together under
the term Typhous fevers, are likewise met with from the Gulf to
Hudson's Bay, extending many degrees further north than our
autumnal fevers. Indeed they seem more especially to belong to
the north, than the south : their base line may be said to be in a
high latitude and elevations, as the base line of autumnal fever,
and yellow fever, is in a low latitude and near the level of the sea,
and as we advance to the south. They become rarer, just as the
latter fevers become rarer in advancing to the north. Nevertheless,
they do not appear actually to cease even at the Gulf of Mexico ;
and may be said, therefore, to possess a greater geographical range
than our autumnal endemics or periodical feve

In giving an extended definition of these fevers, we are inform-
ed (p. 360) that,

u Typhous fevers are sometimes sporadic, but more commonly
epidemic: in general the epidemic is local; occasionally extensive.
The forming stage, with a few exceptions, is protracted, and char-
acterized by signs of debility in the crganism at large; the
of reaction shows a continued type, and with evening exac
tions, may continue for forty, sixty, or even ninety days; the
appetite is impaired ; and the bowels, sometimes torpid, are in most

684 Drake, on Typhous Fevers. [November,

cases irritable, with a tendency to diarrhoea the discharges seldom
show increased, often diminished secretion of bile, and are ex-
tremely fetid; the tongue becomes dry, and sordes collect on the
upper front teeth ; the pulse is unnaturally frequent and rarely
tense; the heat of the surface is sometimes burning, and the cheeks
flushed ; the eyes become dull and occasionally bloodshot ; drow-
siness sooner or later supervenes, with wild and muttering deliri-
um; coma is almost universal; subsultus tendinum, especially of
the arms, manifests itself, with efforts to catch and grasp imaginary
objects ; suclamina, petechia, and rose-colored maculae, frequently
appear; borborj^gmus is common; and a tympanitic condition of
the bowels occasional ; early bleeding from the nose may happen,
and there is sometimes copious hemorrhage from the bowels. In
rmmy cases inflammation of the intestines, lungs, or brain, becomes
associated with the fever. When these symptoms, or a majority
of them, are present, the fever is typhus; when no other form of
disease has preceded it, the fever is an original typhus; when the
disease began as an autumnal remittent, an eruptive fever, or a
phlegmasia, the symptoms which have been enumerated indicate
a secondary typhus, or what has long been called the typhoid
stage of the primary disease."

After giving a very interesting history of a general typhus
epidemic atmospheric constitution that prevailed successfully in
different localities throughout the interior valley during the years
1813 and 1815, and which did not entirety cease until 1823, we
are then furnished with the local histories within the United States
and Canadas of some twenty-six sub-epidemic and sporadic visita-
tions of these fevers, all of which, with the exception of the Irish
immigrant fever, are admitted by Dr. Drake to be clearly of do-
mestic origin.

As most of these epidemic and sub-epidemic visitations "have
occurred in the middle latitudes of the settled portions of the inte-
rior valley, between the thirty-fourth and forty-third parallels,"
we are admonished by Dr. Drake (p. 34.3) not to conclude that
these are the latitudes most favorable to their production, as there
is abundant proof to justify the conclusion that in lower Canada,
continued fevers of a typhous type are in reality more prevalent
sporadically, if not epidemically, than in the regions farther south.
Again, on page 369, we are told that remittents, in the Appala-
chian alpine regions of the southern basin, at an elevation of some
3000 feet, tend to the continued form; and that when they do
assume this type, although "the copious secretion of bile, the dis-
tinct remissions, and the occasional transformation into intermit-
tents, which they present in the same latitudes at a lower level, are

1855.] Drake, on Typhous Fevers. 6S5

not so frequent ; vet the season of the year in which they prevail
most, (August, September and October,) mark them as the climatic
equivalents of the remitting fever of the low, warm plains and
vallies between the mountains and the Miee

Along the shores of some of our northern lakes, in the western
portion of upper Canada, and in Montreal, there prevails a con-
tinued fever, described by Doctors Stratton, Hall, and Holmes, as
frequently assuming the remittent type. Dr. Drake, in visiting
the General hospital, at Montreal, on the 1st of September, saw
rnanj- cases of this fever, and unhesitatingly pronounces it (p. 428)
the equivalent of the remittent autumnal fever of more southern
latitudes.

If it be true, then, that the autumnal continued fever of the
more northern portions of the United States frequently assumes
the remittent form, and the southern autumnal remittent fever, oc-
casionally, instead of terminating by a crisis on the second week,
(p. 452,) or assuming an intermittent form, takes on a continued
type) and simulates an original typhous so closely that a diagnostic
distinction between the two is impracticable, "and that this ten-
dency is greater in the higher than the lower latitudes, and much,
stronger in some autumns than others" How is it possible for us
to resist the conviction thus so irresistibly forced upon our mind,
that their difference really consists in nothing more than grade ;
and that they are all the result of similar causes, modified by sea-
son, locality and predisposition?

Under the head of Climatic Eelations, we are informed (p. 414)
that, "in our interior valley, continued fevers have the chief pre-
valence between the S2d and 4Sth parallels ; in western Europe,
between the 44th and 60th ; and that where the mean annual tem-
perature rises above 62, or falls below 40, they prevail but little
on either continent.''

As regards the season of their occurrence and their comparative
prevalence within these latitudes, we are informed that, notwith-
standing, on the whole, they prevail more in cold than in warm
weather, the frequency of their commencement in the interior
valley late in autumn compared with spring and summer, results,
in all probability, from a union of their cause with that of au-
tumnal fever in October and November.

The difference between the annual range of winter and summer
temperature, in the interior valley, is shown by Dr. Drake to be
about twice as great as that of the British isles; and the compara-

^586 Drake, on Typhous Fevers. [November,

tive prevalence of continued fever in these different regions, in-
versely, to the range of their winter and summer heat, being least
in the interior valley, and greatest on the Islands. It is also shown
that typhous and malarial fevers all prevail most where the range
between winter and summer is least. Thus:

" At St. Louis the range is 42, and yellow fever is unknown ;
at Natches it is 29, and the fever prevails occasionally ; at Ha-
vana only 10, and there the yellow fever is as constantly as
typhus fever in Dublin. In the latitude represented by Cincinnat-
ti, the range is 40, and the prevalence of autumnal fever is mod-
erate. In that represented by Baton Rouge, the range is 28, and
the fever prevails every year as certainly as continued fever pre-
vails in Glasgow or Edinburgh."

" It appears, then, that while climates which present but a limit-
ed range between their winter and summer temperatures, may, on
that account, be exempt from some diseases, they are proportiona-
bly more subject to others ; in the lower latitudes to yellow and
periodical fevers in the higher to typhous fevers. But how is it
that the warm winters and cool summers the moderate annual
range of Great Britain and Ireland, favor the production of con-
tinued fevers? This question cannot be answered without the
introduction of another meteorological fact, viz., that where the
range between winter and summer is small, the diurnal range is
correspondingly small. Thus, in those islands it is much less than
in the zone of the interior valley with which we are comparing
them. Now, sudden and violent changes, and extremes of atmos-
pheiic heat, tend directly and powerfully to generate a phlogistic
diathesis, which favors the production of phlegmasial diseases, but
not of typhous fevers. Such a diathesis may, indeed, be regarded as a
preventive of those fevers. On the other hand, those European coun-
tries in which they prevail to the greatest extent, have a humid
atmosphere, as every wind, except those from east to south, (not
of frequent occurrence,) necessarily brings moisture from the At-
lantic ocean, the German sea, the Baltic sea, and the chain of lakes
to its north-east, Ireland, England and Scotland being most ex-
posed to this influence, and from the great prevalence of westerly
winds, Ireland especially. Some of the enlightened medical histo-
rians of those islands have sought for a connexion between these
fevers, and the quantity of rain ; but the latter is not a measure of
the humidity of the air, which can only be ascertained by experi-
ments on the dew-point. That it is at all times very great, is
generally admitted: the absence of extreme cold in winter, and
high heat in -summer, recognized under the last head, contributes
to the same result; for intense cold precipitates the vapour of the
air, and extreme heat raises it far above the point of saturation,
and makes it to our sensations dry, when its absolute quantity of
vapour may be very great. Dr. Ferguson has laid much stress on

1855.] Drake, on Typhous Fevers. . 687

the 'moist cold' of those countries ;se of their fevers; and,

econverso, we may assume that the dry cold of our valley is a cause
of their comparative infrequencv." (p. o-6.)

Admitting the correctness of the foregoing positions, we are with-
out any distortion of facts brought clearly to the conclusion, that
we are never presented above the 32d or below the 43d parallels
of latitude within the interior valley, with any thing more than a
malarial continued fiver, with affinities and resemblances much
stronger marked in favor of our autumnal remittents, than the
supposed primary type, as met with in the cities of Glasgow and
Dublin.

To this conclusion, it is objected by Dr. Drake (p. 557) that,
11 this mingling between continued and typhous fever, has led some
speculative men to assign them a common cause, and to constitute
them a single species. But such a coalition would not be made by
one who had been familiar with both forms, and had the pathog-
nomonic characters of each impressed on his mind by sporadic
cases, when the other was entirely absent.'1 To which we reply
that were we so disposed, or did we even think it necessary to at-
tempt to prove the continued fever of our interior valley, under the
modifying influence of locality and season, of malarial origin, we
do not know where we would look for more or better materials
than are to be found in the work before us. In fact, we are told
by Dr. Drake, on this subject, (p. 558,) that ''in some autumns, in
the high latitude, or latitudes, the type of the fever may be con-
tinued, and yet show its relation to periodical (malarial) fever, by
prevailing chiefly in the latter part of summer and in early au-
tumn,, and terminating [at an earlier period, corresponding, &c.
i?ei\] without the characteristic symptoms of typhous in the second
week, corresponding to the time when remittent fever often ter-
minates by a crisis, or in the intermittent form."

If we assume, then, the British isles as the especial home of ty-
phus fever, with a climate and inhabitants whose social condition
and political relations are such as favor the production of a typhous
diathesis, it is clear that the differences existing, in these respects,
between them and the interior valley of North America, are such
as tend rather to a phlogistic than typhous diathesis. Somewhat
in support of this opinion, we are assured by Dr. Drake that in
Europe, where, on the whole, the cities suffer most from continued
fever, in older settled portions of the valley, notwithstanding, cul-
tivation has diminished the amount of periodical, and increased

688 , Lectures on Hypertrophy. [November,

that of continued fever. The cities and towns of these settlements
are more exempt from typhous fevers, than are the open villages
and country around them.

" Throughout our interior volley, there is an increasing ten-
dency in the profession to refer all cases of continued fever,
which present a striking development of abdominal symptoms,
(especially when the cerebral are mild,) to the head of typhoid
fever. This is generally done without any distinct conception of
the relation between typhus and typhoid. The aim of those who
make the reference is simply to identify our fevers with those of
Paris. I need not here repeat, that the cases which present a
striking display of intestinal symptoms, can, with no propriety, be
erected into a distinct species; and if they could, the term typhoid
would violate every rule of philosophical nomenclature while, if
we regard the cases to which it is applied as constituting a mere
variety, it is equally objectionable, as involving no lrypotheses,
and simply indicating the most formidable localizations of the fe-
ver. The German phrase, abdominal typhus, is every way pre-
ferable." (p. 479.)

From the foregoing extract no less than on account of its not
having been heretofore applied to a fever resembling, but to an
actual typhus fever it appears that the term typhoid, as a dis-
tinctive phrase, is, by Dr. Drake, entirely rejected.

There were other chapters and sections, besides those on treat-
ment and classification, (the latter of which we think decidedly
judicious,) connected with the history of typhous fever, that we had
intended noticing, but on account of the length to which our re-
marks have already extended, we will, at least for the present,
have to deny ourself that pleasure.

Wetumpka, August, 1855. ^H.

Clinical Lectures on Hypertrophy of the Prostate with Retention of
Urine. Delivered at the London Hospital, by John Adams, Esq.,
F.E.C.S., Surgeon of the Hospital.

Gentlemen: These cases of prostatic hypertrophy are of every
day occurrence. Their importance may be approximately estima-
ted by their frequency, and the disastrous consequences to which
they- too often lead. I am therefore glad to have the opportunity
of directing your attention to-day to this subject.

We have received into this hospital, during the last year, 177
cases of retention of urine, from all causes. Of these, only six have
happened to females the rest to males. The reason of this vast
disproportion, is obvious enough. The length of the urethra in

[Sod.] Lectures on Hypertrophy.

the male, the existence of various muscles surrounding it, the po-
sition of the prostate gland at its commencement, the lodgement
sometimes of small calculi in various parts of it, the of

stricture (which is a disease almost exclusive}? of the male ure-
thra), the severe attacks of inflammation to which the urethi
Liable in gonorrhoea, all these causes predispose the male subject to
retention of mine, and explain the important fact alluded to. I
mav also mention the injuries to which the male urethra
all of which lead to a similar result. Now, 1 think I may venture
Tt that, of all these so action, hypertrophy of the

prostate gland is the most common cause of tb <f urine,^

which are brought to this hospital. I regret th,
the hospital do not give us information on this subject; but in
future, a better system of registry, now about to be adopted, will
supply the omission.

This enormous mass of cases, which almost invariably come un-
der your own immediate inspection and treatment, (independent of
the ^surgeon,) gives you such a field of practical experience, as
cannot be obtained any where but at institutions like this. I am
sure you must have remarked, that it is my invariable custom to
habituate the dressers of this hospital to the introduction of the
catheter in all cases : and even in the worst cases of stricture, re-
quiring the nicest manipulation, if I find that a student under my
direction succeeds in the passing of an instrument into thebladderr
I confide the case at once to him, to bring it to a successful termina-
tion. I dare say, you remember my saying to one of the students,
in the beginning of the present session, in allusion to a c:
retention of urine, that the best clinical instruction I could giveT
was to teach him to pass a catheter. The consequence of all this
is, that the surgeon is seldom sent for to cases of retention. The
house-pupils, under the eye of the house-surgeon, have generally
done the business before his usual visit. It is, of course, not always
so. as the present case exemplifies.

Let me now consider the case before us ; here is a case of reten-
tion of urine, occurring in an old man of sixty-seven, who was the
subject of a similar affection, about a fortnight a<ro. He could not
explain the cause, but says that he was called on to pass urine
many times in the night, and at eight in the morning complete re-
tention came on. The very simple fact of the age of the patient
should at once arrest your attention, as it is a most important ele-
ment in estimating the cause of the retention. An old woman
slips upon the pavement, and injures her hip, and cannot walk;
she is brought to the hospital, and, without examination, you at
once infer that she has fractured the neck of the thigh-bone. So
retention of urine, occurring in an old man, leads you to the con-
elusion that the retention arises from enlargement of the pr<
gland, and this is generally the case. Nevertheless, you ought to
inquire into the history of the patient's case, and he will tell vou,
perhaps, that he never had any complaint in these parts, or* any

byU Lectures on Hypertrophy. [November,

difficulty in passing urine, until during the last six months, when
lie has found that he has been called upon more frequently to pass
his urine, especially during the night, and that the stream of urine,
although sufficiently full, perhaps, has lost much of its force.
Sometimes there has been a great deal of pain, accompanying the
efforts at expulsion. Well, with the brief history which you ga-
ther from your patient, your notion or idea is strengthened ; but
to set the question at rest, you pass your finger peranum, and at
once all doubt vanishes, as you feel the gland enlarged, possibly
to the size of your fist. It is a curious fact, that patients seldom
experience any pain during the progress of the enlargement ; but I
have often ascertained that a slight tingling sensation on the dor-
sal aspect of the glans penis, in the course of the dorsal nerve, has
been experienced, but no importance has been attached to it ; in
fact a man will say that he never knew he had any disease about
him of the nature of enlargement at the neck of his bladder, until
informed of it by his surgeon. You have now ascertained the
cause of the disease, and you proceed to act accordingly. There
is no use in wasting your time, and exhausting your patient's
strength, by leeching, purging, warm baths, &c. ; the catheter is
the unicura remedinm, and to this you at once resort. You call for
a prostatic catheter, place your patient at the edge of the bed, or
in the erect position, introduce the instrument secundum artem, and
draw the water off. You then take out the catheter, order the pa-
tient to bed, and anticipate the necessity of a re-introduction of the
instrument in three or four hours. I say in three or four hours,
for you will usually rind that the water begins to pour down rapid-
ly from the kidneys, and the bladder is refilled, and requires, even
more urgently than before, to be emptied ; or possibly the passing
of the catheter has ruptured some of the large veins in the neigh-
borhood of the prostate, and a very considerable quantity of blood
has become mixed with the urine, to the great increase of the con-
tents of the bladder. The bladder should be entirely emptied, at
each introduction of the catheter.

To proceed with the case: there was a difficulty which could not
be overcome, The dresser of the previous week, under whose care
he had been relieved, and who had recognized the case as one of
enlarged prostate, by examination per anum, was foiled. The
prostatic catheter was passed up to the hilt ; and the elastic cathe-
ter was used without effect. No very small instruments were used
in the case. It now became my duty, at the usual visit, to exam-
ine the case myself, and to relieve the patient at all hazards. I
was apprised of the nature of the case, and finding that the ordina-
ry instruments had been unsuccessfully used, I directed the patient
to stand up, and took a full-sized elastic catheter, without stylet,
straightened the instrument, and passed it along the urethra. I
felt it hitch against the prostate; and having withdrawn it about
an inch, I advanced it again, and it entered the bladder at once.
Gentlemen, there is no mistaking the sensation experienced as the

lboo.J Lectures on Hypertrophy. o.l

catheter enters the bladder. It goes in, as the Americans would
sav, stick; and I dare say you know the meaning of that term.

My object, in the present lecture, is to explain the reason why
one instrument succeeds in one case, and another in another.
Mark me; I take no credit for the success of the manoeuvre in tins
case. We are all liable to be foiled in our best endeavors; and I
do not give much credit to those who say they are never foiled in
passing a catheter. An inspection of the preparations preserved
in all our museums, will show why their efforts have been crowned
with success (such as it is). Perforation of the prostate stands in
judgment against them. I cannot help thinking, that alter fumb-
ling about a case for a long time, our fingers get fatigued, and refuse
to obey our will or inclination; and this is a cause of failure.
A iresh surgeon comes forward ; he gains knowledge by the
failing attempts of his predecessors: he takes the very instrument
they have not taken, and, with those advantages, no wonder he suc-
ceeds. If. you will take pains to examine the bodies of patients
who have died of retention of urine, and dissect out the bladder
and urethra, you will find that the prostate enlarges in various
directions. Sometimes it is the left lobe which is enlarged; some-
times it is the right; sometimes both are enlarged together, as is
very generally found to be the case ; but most frequently, the third
or middle lobe is the seat of the enlargement, and by rising up at
the orifice of the urethra, it dams up the bladder; indeed, John
Hunter called it the valve of the urethra and prevents the urine
from escaping. Attention to these varied conditions will, I think,
often explain why one instrument will pass more readily than
another, in particular cases. Thus the middle lobe being the seat
of enlargement, and the cause of retention, if this body rises up
equally, the urethra elongates to a great extent, and it requires
first, a large, long catheter long to traverse the entire length of
the canal and large, to prevent it hitching in the prostatic sinus;
next, that the point of the instrument should be tilted up, either
by depressing the handle, or by inserting the finger per anum, so*
as to carry it well over the projecting third lobe ; a gentle pushing
forward of the catheter is then requisiter and the bladder is entered
at once.

In other cases, the lateral lobes of the gland are unequally en-
larged, the third lobe being free from any extraordinary increase
of size, and the retention is due to the coaptation of the two lateral
lobes, which sometimes dovetail into one another, and the urethra
becomes deviously directed to one side or the other. In this easeT
the large silver prostatic catheter will not answer, and either a
smaller instrument, or one with a small abrupt curve, (such as I
now show you,) or, what I think is much better, a large elastic ca-
theter, without a styletr should be gently pushed along the urethra ;
it will gradually make its way through the winding channel, and
enter the bladder at once. I think, in the case before us, the pros-
tate has been enlarged in this latter method, and hence the facility

692 Physiology of Paralysis. [November,

with which the catheter was introduced. I am almost tempted, in
some cases, to try a long, nearly straight, silver catheter, but of
course this would not answer in cases of hypertrophy of the third
lobe ; but if this be enlarged, and inclined more to one side than
the other, the elastic catheter, introduced as I have just stated, may
make its way more readily and easily than even the large prosta-
tic catheter. Sir Benjamin Brodie generally employs the elastic
catheter ; and there is an obvious advantage in its employment as
a general rule namely, that, independent of other considerations,
it is more easily retained in the bladder, if you wish to keep it in.

Let us further examine the case before us, and apply what we
have just said: it appears, in the report, that the old man passed
his urine himself, after the first day. Now, can we explain this?
you may ask. Where is the enlargement to which the retention
was attributed ? Is it gone so rapidly ? These questions no doubt
suggest themselves, and are pertinent enough, and I offer the fol-
lowing explanation : There has been superadded to the hyper-
trophy of the prostate, vascular congestion, and this having been
relieved by the bleeding, occasioned by the catheter, and by the
rest, purging, &c, the gland has been relieved, and has resumed its
wonted size, (of course still much enlarged,) and the partsT there-
fore, have permitted the urine to escape. I can hardly think that
anything like spasm of the prostate exists, although it is a muscu-
lar organ, or that it can have produced the impediment; and if
spasm of the urethral muscles were the cause, the catheter could
not so readily have been passed. Venous congestion too often,
perhaps, overlooked has, I think, been the immediate cause of the
retention of urine. I know instances of cases, which have led me
to this conclusion. I knew an old gentlemen who always suffered
retention after a nocturnal emission. In this case one can hardly
suspect any sudden increase of size of the gland, except such as
may have resulted from vascular congestion.

I need only say, in conclusion, that the case before us, having
been completely relieved by the use of the catheter, employed
night and morning for several days, is discharged, with the cer-
tainty that at some future time he will return to us, and require a
similar mode of treatment ; and so he will go on until the termina-
tion of his life, the intervals of retention being briefer and briefer,
unless you put him in a way to do something for himself, of which
I shall speak at another lecture. [London Lancet.

The Physiology of the Different Varieties of Paralysis. By MARSHALL
Hall, M.D., F.R.S., London. (Read before the Institute of
France, Academy of Sciences.)

As there are two principal nervous centres, the brain and the
spinal cord, so there are two great classes of paralysis, according
as the influence of the brain or spinal system is intercepted or
annihilated.

1865.] Physiology of Paralysis. 693

I denominate cases belonging to the first class, in which the
palsied parts are deprived of the influence of the brain, cerebral
paralysis. Cases in which the influence of the spinal cord is inter-
cepted from my second class, spinal paralysis. I do not mean to
imply by these terms that there are, in these cases respectively,
lesions of the encephalon or spinal cord, but simply that by some
disease or injury the influence of these organs is abolished, so far
as the muscles of the palsied limbs are concerned. Hemiplegia is
ordinarily a cerebral paralysis; but in some cases, a spinal par-
alysis also ; whereas disease limited to a small part of the dorsal
segment of the cord produces a cerebral paralysis of the lower ex-
tremities ; the influence of the portion of spinal cord below the
seat of disease continuing to reach the palsied limbs. The destruc-
tion of a considerable portion of the spinal cord, or a suspension
or annihilation of the functions of the spinal cord produces a spi-
nal paralysis.

A cerebral paralysis, I repeat, is one in which the muscles are
deprived of the influence of the brain ; a spinal paralysis, one in
which the muscles are deprived of the influence of the spinal cord.

Facial hemiplegia is a cerebral paralysis ; paralysis of the facial
nerve is a spinal paralysis. The distinctive characteristics of these
two classes of palsies are as follows : -

In cerebral paralysis, the influence of the will is alone interrupt-
ed. "When this paralysis is complete, voluntary movements are
abolished. All the functions depending on the medulla oblongata
and spinal cord persist. We have, in different cases :

1. Emotional movements;

2. Movements connected with yawning, coughing, etc. ;

3. Diastolic movements ;

4. Tonic symetrical contractions of the hands ;

5. Comparative increase in the irritability of Haller ;

6. Comparative increase in susceptibility to the action of strych-
nia.

In spinal paralysis, the four species of movements above enu-
merated are not observed, and the Hallerian irritability is compara-
tively less.

I return to cases of hemiplegia. In most cases, shortly after the
attack, there is somewhat of an amelioration, a partial return of
voluntary power; the phenomena I have mentioned are manifest-
ed also. In other cases there is no amelioration : the phenomena
adverted to are absent or scarcely perceptible. There are no tonic
spasms of the hand and arm ; the Hallerian irritability is not aug-
mented. It might be said that such cases were exceptions to the
rules I have laid down. The truth is, it appears to me, that, in
such instances, the shock of the attack has been sufficient to de-
stroy, so to speak, the nervous power of the spinal system. Thus,
when we divide the spinal marrow of the frog from the brain by
an incision, we suspend nervous power, so as to abolish diastolic

N. s. VOL. XI. NO. xi. 44

694' Inflammatory Affections of Bone , [JN ovem Derf

movements. A yet more violent shock, as a stroke of lightnings
would annihilate it altogether.

These phenomena are objects of pure observation, excepting
that relating to irritability. To test this function of the mus-
cular fibre, I have experimented on various occasions, with the
aid of galvanism,, and repeated my experiments with every pre-
caution..

I made use of a simple galvanie current, produced by a Cruik-
shank machine.. I placed a palsied, and a sound hand, for exam-
ple, in the same basin of pure water, and the feet in another, and
carefully observed which was affected by the slightest degree of
galvanism. I found that in cerebral paralysis, the palsied limb is-
most susceptible of galvanic excitation ; whereas in spinal paraly-
sis, the palsied limb is less susceptible than the sound one.

I deduce from these experiments many conclusions of interest
both to the physiologist and the physician.

1. That the brain,, by its acts of volition, tends to exhaust mus-
cular irritability..

2. That the spinal marrow, on the eontrar}^. is the source of
this irritability.

3.. That galvanism, will serve to diagnosticate between cerebral
paralysis and spinal paralysis..

The phenomena I have already enumerated:: yawning, the
effects of emotion, diastolic movements,, sy metrical tonic spasms,,
the effects of strychnia, etc.

Besides cerebral and spinal paralysis,, there are nervous affec-
tions connected with the medulla oblongata and pneumogastric
nerves,, which I propose to discuss on a future occasion, as well as
the diseases of the ganglionic sj-stem.

Lastly, to complete our enumeration of paralysies, there remain
several varieties of palsy that arc exceedingly obscure ; paralysis-
cum agitatione ; paralysies e plumbo, e rheum&tiswo, ex hysteria, e
dentitione, etc. Much labour is requisite before we can form
clear ideas on these diseases.. Emotions, spinal irritation, the ac-
tion of poisons, the influence of pain,, the effect of shock ; what a
field of study I [ Virginia Medical and Surgical Journal.

On some Inflamnnatory Affections of Bone and theiv Treatment. By
Henby Smith.

He stated that there was more interest and more difficulty con-
nected, with the pathology of affections in bone than with the cor-
responding diseases in the soft tissues, and that during the last
few years there had been a great increase in cases of inflammation
in bones, owing either to some peculiarity in the human constitu-
tion or in the conditions of the atmosphere. This inflammation
was produced in two ways first,, from some injury first received
in the neighboring soft parts, and from thence propagated to the

1855.] Inflammatory Affections of Bone.

subjacent bone. As an illustration of this form, he would mention
whitlow, which had been of late extremely frequent, and which
disease was generally the result of some local excitement primarily,
which, being neglected or badly treated, would go on to inflam-
mation of the periosteum and bone, and finally death of that
texture, and probably destruction of a neighboring joint. In the
second way, inflammation of bones, and especially of their shafts,
was produced by a cause acting directly upon the bony I
itself: and, as illustrations of th he would refer to the acute

inflammation which sometimes followed the application of the
saw after excision or amputation, or that which sometimes ensued
upon a fracture of long bone. The author then proceeded to
the consideration of the successive results of inflammation attack-
ing bone, and described the conditions known under the name of
denudation, purulent infiltration, and actual necrosis, which was
the ultimate termination of inflammation. AVith reference to de*
nudation of bone, the author particularly insisted upon the great
importance of not mistaking this condition for actual death of the
is texture, but he believed it frequently occurred, and was
treated as such. In many instances, denudation might occur
even to a considerable extent, and yet no real mischief have in-
volved the bone, for it had only become deprived of its perios-
teum and inflamed, conditions admitting of perfect recovery. He
refers to cases illustrative of this point, and mentioned one in par-
ticular, where a young girl had received an injury to the thigh,
which was followed by rapid inflammation and deep suppuration,
which was not at first detected. The matter was at length
evacuated, and it was then discovered that a large extent of the
femur was denuded. The patient was so excessively worn down
by the suppuration and discharge of matter, that the surgeon in
attendance deemed it necessary to amputate high up in the thigh.
The parents would not consent, and the child was left to the re-
sources of Nature: the consequence was, the health graduallv
improved, the discharge ceased, and the patient quite recovered
her health. In this case the opinion was in all probability, that
the thigh bone had become necrosed, but in reality it was only
denuded, and was capable, as was seen, of recovery. When, how-
ever, inflammation attacked bone, in instances of persons affected
with some constitutional taint, as struma, syphilis, or scurvv,
further changes would take place, and then suppuration would
result, either in the interior of the bone itself, or within its medul-
lary cavity, and subsequently actual death of some portion ; and
such conditions were most formidable enemies to the operating
surgeon, as the}' frequently obtained after direct injury by the
saw. as also from fracture ; and cases in illustration were men-
tioned where, when the inflammation was acute, the changes were
most rapid. One case was alluded to, of a strumous boy, having
received an injury to the elbow, severe disease came on in the
joint, and Mr. Smith was compelled to excise it. The patient

696 Inflammatory Affections of Bone, [November,

recovered from this operation J but in six weeks fell down and
fractured the same arm, just below the shoulder joint, and such
rapid and acute inflammation followed that it was deemed neces-
sary to amputate at the shoulder-joint. On examining the boner
it was found denuded of its periosteum to a great extent, and its-
medullary cavity infiltrated with pus, It was, however, a question
with him whether this extreme measure was absolutely necessary.
Further experience since this case has happened to him had taught
him, that possibly the fracture here might have united, but he
was supported in the opinion of amputating by some very able
surgeons who were present. When the inflammation was of a
more chronic character, it would lead in unhealthy subjects, to*
results as serious and as certain , but more slowly and with less
constitutional disturbance ; still, in time, complete or partial death
of a bone would be brought aboutr and a series of pathological
changes would occur which are very interesting to the surgeon
to watch, and which are so well known as hardly to require des-
cription. As regards the treatment which should be adopted in
these various forms of diseased bone, the author remarked, that
when there was reason to believe that matter was deeply formed
close upon bone, and was producing mischief, very free incisions
should be made, and the matter evacuated. As a precautionary
measure, this treatment would often prevent the bone itself
being affected, as is frequently seen in the cases of whitlow, where
early resort was made to incision ; but where, on the contrary,
the matter has been suffered to accumulate, the further change
mentioned by the author would have taken place, and amputation
of a portion of the finger was required. In cases even where a
large surface of the bone was denuded and inflammed, the free
evacuation of matter, perfect rest, and good support, will frequently
lead to the restoration of the patient ; and on no account should
the surgeou be led to resort to amputation in a hurry, with the idea
that because the bone was bare, death of that structure must ne-
cessarily ensue. Where, however, in acute cases there is proba-
bility that necrosis is occurring, a neighboring joint is perhaps
involved, and the patient's life is in danger, amputation should
be resorted to, but never hastily. In chronic cases resulting in
necrosis, the surgeon must wait until the dead bone is loose, and
then extract if possible. In some he cannot do so ; and a case
was mentioned by the author where he could not succeed in re-
moving a large sequestrum in the femur ; and in another similar
case such an operation was successful, but it took him an hour to
finish. When necrosis involved the extremity of a long bone,
and the joint was otherwise diseased, resection would be applica-
ble, and the author illustrated this by the case where he had lately
performed excision of the knee-joint,, and where, on examination,
a small piece of necrosed bone was found just separating from the
femur, and where the joint was otherwise diseased, a cure had
been effected, and a useful limb was the result. [Western Lancet.

1855.] Hints from a Capper and Leecher. 697

Hints from a Cupper and Leecher. By J. H. Ross.

Having spent many years is cupping and leeching, perhaps I
shall be excused for giving the profession, through your journal,
a few hints in relation to some points which should be observed
in the practice of this branch of therapeuti

And first, let me say, that in the use of leeches, certain errors
are by no means unfrequent, namely, that in leeching adults, the
error in many cases consists in too little depletion; whereas, in
young children, it consists in too much. It should be remembered,
that one leech for a child a year old is, in ordinary circumstances,
fully equal to twenty-live for an adult. A leech bites a child as
though it were a perfect luxury. All the tissues are tender. But
this is not all. It is not only easy for a leech to find bloodves-
sels in a child, but the circulation being more rapid than in adults,
the flow is consequently augmented. Neither is this all. As a
general rule, we can safely bleed a strong man until he faints : but
never an infant. Moreover, two small leeches are always safer
for a child that one large one, it being easier to control the bleed-
ing from six bites of the former than from one of the latter. As a
general rule, leeches should not be applied to the throat of a child,
especially over the trachea. It is safer to select the superior por-
tion of the sternum, which will usually fulfil the indications.
Whenever applied, a young child should never be covered up,
and left for nature to arrest the hemorrhage. I trust your readers
will pardon me for calling their attention, as some of them will
recollect, for the second time, to the importance of a cataplasm
before leeching. It is common to foment the part after the leeches
come off; but if it cannot be done but once, it had better be done
in advance, and I will give a few reasons for such a conclusion.
In the first place, it makes the part very acceptable to the leech,
as it almost never refuses to fasten at once upon the skin thus
prepared, and the time thus saved may be of great importance to
the patient. It also saves much fatigue and anxiety, and enables
the leecher to serve much sooner some other sufferer who counts
the moments of delay as hours. But this is not all. It answers
the end for which the poultice is intended (namely, depletion,)
more perfectly when applied before leeching than subsequently.
It is not an eas}- matter to soften and relax the dermoid tissue so
as to promote the flow of blood to the best advantage in a mo-
ment. It takes time. If the poultice be delayed until after the
leeches fill, it cannot be applied until the last one comes off; and
it often happens that before this occurs, some of the bites have
nearly closed, so that the benefit of the cataplasm, to a great ex-
tent, is lost. When, however, the poultice precedes the leeching,
the moment that one lets go the bite bleeds at once, whether any-
thing is applied or not. To be efficient, the poultice should be
large and hot; and if a little mustard be added, so much the
better. In a large majority of cases, leeches are preferable to cups

698 Hints from a Cupper and Leecher. [November,

for the abdomen, perineum, neck, face, and extremities. For the
thoracic, dorsal, and temporal regions, and especially for pulmona-
ry, renal,'spinal, and ophthalmic affections, cupping is often far
more efficient than leeching. Moreover, the quantity of blood
taken in leeching is always uncertain, there being in one case
much more, and in another case much less depletion than is inten-
ded. It is impossible to tell before the leech is applied how much
blood will flow, there being so many modifying circumstances ;
some of which, perhaps I may mention, though most physicians
may be familiar with them.

Much depends upon the size of the leech; and hence many
physicians, to take advantage of this fact, order large ones. But
this is decidedly wrong ; for in purchasing leeches, we have to
take them as they run, both large and small ; and therefore, if we
select the large ones for those who first call, we cannot supply
those who call subsequent^ with even an average size, and it is
not treating them fairly ; and though we give them the largest
that we have, the doctor is decieved, and perhaps the patient suf-
fers. Not only so, but sometimes we are compelled to purchase
a lot (because we can do no better) which has not a large leech
among them. The proper course seems to be to have the medium
size the criterion, and to modify the number as a deviation from
this standard may demand.

Again, the condition, and also the position of the part, modifies
the bleeding. If the part be inflamed or vascular, the discharge
may be profuse. If it be hard, swollen, oedematous, cold or ex-
sanguineous, little blood may be obtained. The force and the
frequency of the pulse should be taken into consideration. The
position of the part will also, as I said, modify the bleeding. For
example, a leech-bite upon the hand, which bleeds profusely
while it hangs down, will stop at once on raising the hand above
the head. There are other modifying circumstances which I
need not stop to name. The average quantity of blood that a
leech draws is about two drachms, which, with the subsequent
bleeding, amounts to about three-quarters of an ounce. To arrest
the bleeding, I have always found a simple compress sufficient,
though various styptics are used.

Although I intended to say something further on the subject of
cupping, yet as I have already occupied more space in your valua-
ble journal than I have any right to claim, I must omit it, at least
for the present. In regard to sustaining those who make a spe-
cialty of this branch of therapeutics, perhaps I may be permitted
to say a word. It is generally admitted that there should be in
all large cities, competent persons to attend to these applications,
and in cases which require very nice and careful management,
physicians are generally very glad to avail themselves of the ser-
vices of some skilful hand. But it should be remembered that
these cases will by no means sustain him. His principal support
must be derived from the common every-day cases ; and if physi-

1855.] Quinine ui Yellow Fever. 699

cians adopt the practice, as is often the case, of sending to the
nearest apothecary for the leeches, or a leecher, saying anybody
can put them on, he cannot be sustained. The truth is, apotheca-
ries, by each one doing a little, do just enough to spoil the business,
with little or no profit to themselvt- over, if the patient, or

any inexperienced person applies them, he seldom does it to the
best advantage ; frequently cannot make them bite, almost always
produces much fatigue, generally loses time, and gains nothing in
the end. [New York Mea >es.

Quinine in Yelloiv Fever,

"We make the following extract from the record of the Physico-
Medical Society of this city, inasmuch as it contains facts which
will be interesting to the profession : the evidence adduced in
favor of the use of the sulphate of quinine, as administered in the
Oharity Hospital in yellow fever, is so conclusive and so reliable,
that it cannot fail to weaken the prejudice which exists against it
in the minds of many excellent practitioners.

''Dr. Hunt, after adverting to a late discussion on fatty degen-
eration of the liver, and giving his views on that subject, and
the general pathology of yellow fever, said that he had stated at a
previous meeting of the society, when advocating the treatment of
yrellow fever by the use of quinine and opium, that he was confi-
dent that of the patients admitted into the Charity Hospital during
the late epidemic, and during the expiration of the first twenty-
four hours of the attack, not one in fifteen had died ; he was now
prepared to show, by the best authority, that not one in twenty
died of those who entered within the specified time.

t; On an examination of the books of the hospital, he had found
that there had been 565 admittances of patients of yellow fever, who
entered within the first twenty -four hours: only 27 of whom had
died. Of these, fully fifteen-sixteenths had been first seen by the
house surgeon. Dr. Choppin, or his assistant, Dr. Canter, whose al-
most invariable custom was to administer the haustus quiniae of
the house.'1 This, as it is well known, consists essentially of
twenty grains of quinine and forty drops of laudanum.

[New Orleans Medical News and Hospital Gazette.

On the Condition of the Uterus during Menstruation . By M. Judee.

From the examination of the uterus in three women who died
during menstruation, M. Judee concludes that the fluid is not
discharged from its body or the cervix uteri but issues solely from
the highly congested os uteri. The body of the organ was found
somewhat enlarged; its walls being thickened and its interior lined
by reddish gelatinous layer, about two millimetres thick, consis-
ting of a beautiful capillary network enclosed in a mucous-like
membrane. This was easily scraped off, and below it the uterus
was found white and infirm. It terminated at the level of the

700 Copaiba in Blennorrhagia and Blennorrhea. [November,

upper orifice of the cervix. The interior of the cervix was of a
yellowish or greyish colour, and seemed to have undergone no
alteration. The lips of the os uteri were swollen, and of a dull red,
deep blue, or even blackish colour, and in one case they assumed
almost a fungoid appearance. On compressing this, droplets of
blood oozed out from its entire surface, which was not the case
with either the cervix or body of the organ. On making a section
of the uterus, the body and cervix presented the normal fibrous,
lardaceous tissue ; but at the level of the os this was replaced by
a kind of magma, containing some fibres, and much resembling a
portion of apoplectic lung. [Western Lancet.

Local Application of Copaiba in Cases of Blennorrhagia and Blen-
norrhea.

Professor Marchal, of Strasbourg, in a note to the Jour, de Med-
ecine et de Chirurgie, gives the result of several years' experience
in the employment of copaiba, appled topically. At first he in-
jected the liquid copaiba into the urethra of males arid females
affected with blennorrhagia; his success was various, the remedy
sometimes effecting a rapid cure, and again failing altogether. To
obtain more constant results he determined to make a trial of the
copaiba diluted with gum arabic, in the proportion of five parts of
the former to eight of the latter, and to this add an, hundred parts
of distilled water. Injections, with this liquid, succeeded perfect-
ly in a female suffering a urethral blennorrhagia, the discharge
ceasing in a very few days ; the results were equally satisfactory in
the male. To avoid the irritation sometimes caused by the
syringe, he at first used a catheter through which to make the
injections, but subsequently introduced a catheter smeared with
the emulsion, not penetrating to the bladder, and allowed it to
remain, properly secured, thus giving the urethra a copaiba bath.
The success of this treatment has been constant, without internal
medication ; the cure being effected in from five to eight days. In
the majority of cases this treatment was not commenced until the
acute inflammatory symptoms had yielded to the proper means.
The success of this treatment led M. Marchal to employ the same
remedy in vaginal and uterine blennorrhagia, and also to leucor-
rhcea, by means of injections thrown into the vagina and uterus;
also with tampons smeared with the liquid placed in the former,
and with the same invariably good results. Injections thrown
into the uterus, in these cases, have not been followed by the acci-
dents sometimes supervening upon this practice. [iV. Y. Journal
of Medicine.

Slow Poisoning by Copper.

Dr. Corrigan reports {Dub. Hosp. Gaz) several cases of poisoning
by copper, which are remarkable for the extreme slowness of pro-

1855.] Treatment of Vaginitis. 701

gress resulting from the gradual introduction of the poison. In
many instances it was the result of handling old or dirty copper,
on which the carbonate had been formed. It was the carbonate
from which the poisoning proceeded, and in this there is an analo-
gy with the salts of lead, lie notices a peculiar feature in these
cases, viz : an edging of rich purple on the margin of the gums, of
the incisor, canine, and bicuspid teeth of both jaws. This purple
color corresponds, in situation, precisely with the coloring pro-
duced by lead, but the tint of color is so different as to decide at
once whether it has proceeded from copper or from lead, for, while
the color produced from lead is of a pure blue, that from copper is
a well-marked purple, and even, sometimes, a reddish purple. [lb.

Treatment of Vaginitis.

M. Thiry prescribes, in the mild form of vaginitis, first, a bath
and saline purgative; then, removing the vaginal mucus, he sprin-
kles over the inflamed surface finely powdered charcoal or Peru-
vian bark, and completes the dressing by isolating them by means
of a tampon. The tampon is allowed to remain from three to five
hours, and on its removal emollient injections are employed ; usual-
ly, in about six days, the cure is complete. In acute vaginitis he
employs the same treatment, but precedes the application of the
absorbing powder with a rapid cauterization of the inflamed sur-
faces with the* nitrate of silver. A single cauterization usually suf-
fices, and the cure is complete in eight days. He also employs the
cautery and absorbing powder in lolicular vaginal inflammation,
which is ordinarily observed at the neck of the uterus, and is char-
acterized by red conical eminences, and abundant secretion. [lb.

EDITORIAL MD MISCELLANEOUS.

BIBLIOGRAPHICAL.
We have received through the house of Messrs. T. Richards & Son, of
this city, who have them for sale, the following works :

Yelloiv Fever, considered in its Historical, Pathological, Etiological, and
Therapeutical relations. Including a sketch of the disease as it has oc-
curred in Philadelphia from 1669 to 1854. With an examination of the
connections between it and the fevers known under the same name hi other
parts of temperate, as well as in tropical, regions. 1 >v EL La Roche, M.D.,
dzc, <fcc. Id 2 vols. Philadelphia : Blanchard & Lea. 1855.

This is decidedly the great American Medical work of the day a full,
complete, and systematic treatise, unequalled by any other upon the all-
important subject of Yellow fever. The laborious, indefatigable and learn-
ed author has devoted to it many years of arduous research and careful

'02 Editorial, [November,

-stucty, and the result is such as will reflect the highest honor upon the
author and our country. The number of contributions to the history of
Yellow fever was so vast and these were so widely scattered throughout the
medical literature of this and other countries, that their collection, compari-
son and digestion, into an accessible and tangible form, was felt to be a
desideratum by all who had to encounter this fell destroyer. None in our
country was better qualified for the task than Dr. La Roche, and the Pro-
fession must be under lasting obligations to him for the very able manner
in which he has accomplished it.

We hope to be able to notice this work more at length, and to lay before
our readers some of the author's deductions.

The Cause and Prevention of Yellow Fever, contained in the Report of the
Sanitary Commission of New Orleans. By E. H. Bartox, A.M., M.D.,
Chairman, <fcc, <fcc. Philadelphia : Lindsay <fc Blakiston. 1855.

The volume before us is a reprint, with additions, of a portion of the Re-
port of the Sanitary Commission of New Orleans, to which we have here-
tofore directed attention. The additional illustrations and explanations add
considerably to the value of this very interesting document.

A Manual of Pathological Anatomy. By Carl Rokitaxsky, M.D., <fec.,&c.
Translated from the German. In 4 vols., bound in 2. Philadelphia :
Blanchard & Lea. 1855.

The enterprising Publishers deserve the thanks of the Profession in this
country for their fine reprint of Rokitansky's invaluable work. Published
a few years ago in England under the auspices of the Sydenham Society,
but few copies had reached the United States. It is now accessible to all,
and should be attentively perused by whoever wishes to be well informed
upon the subject of morbid anatomy.

The first volume, upon " General Pathological Anatomy," is translated
I>y Win. Edward Swaine, M. D., &c. ; the second, upon the " Abdominal
Viscera," by Edward Sieveking, M.D., &c. ; the third, upon the "Bones, Car-
tilages, Muscles, and Skin, Cellular and Fibrous Tissue, Serous and Mucous
Membrane, and the Nervous System," by Ch. H. Moore ; and the fourth,
upon the " Organs of Respiration and Circulation," by Geo. E. Day, M. D.,
<fcc. The labor of translating this extensive work, has thus been divided
between persons specially qualified for each of its great divisions. A
work so generally known and highly appreciated needs no commendation
from us.

JSlements of Medicine : a compendious view of Pathology and Therapeu tics ;
or the History and Treatment of Diseases. By S. H. Dicksox, M. D.,
LL. D., &c. Philadelphia : Blanchard & Lea. 1855. 8vo., pp. 750.

Indited by one of the most accomplished writers of our country, as well
as by one who has long held a high position among teachers and practi-
tioners of Medicine, this work is entitled to patronage and careful study.

1855.] Editorial and Miscellaneous. 703

The learned author has endeavored to condense in this volume most of the
practical matter contained in his former productions, so as to adapt it to
the use of those who have not time to devote to more extensive works.

The Diseases of the Heart and of the Aorta. By Wm. Btokxs, Regius
Professor. Ao, Ac Philadelphia: Lindsay k Blakiston. 1855. 8vo.,
pp. 710.

What : seven hundred octavo pages upon diseases of the Heart and
Aorta alone ! exclaims a tyro at our elbow. Yes, and not one page too
manv. Dr. Stokes is a practical man, and has furnished us an admirably
practical work. It is only by the aid of such monographs that one can be-
come thoroughly acquainted with his profession.

Cod-Liver Oil with Quinia. The London Lancet says, Mr. Bastick gives
the following account of his mode of preparing this medicine : The oleum
morrhuoe cum quinia is simply a perfect solution of quinine in cod-liver oil.
The quantity of quinine may be varied according to the wish of the pre-
scriber, although it is generally employed in the proportion of two grains
to each ounce of the oil. This preparation is best made in the following
manner: The requisite quantity of bisulphate of quinine is dissolved in
distilled water, with the aid of a little dilute sulphuric acid. The quinine
is precipitated from its solution by means of an alkaline carbonate ; the
precipitate is treated with boiling alcohol ; the resulting alcoholic solution,
after being filtered, is evaporated to dryness. The residue, which is pure
quinine, is then added to the cod-liver oil, and the mixture is heated in a
water-bath until solution is completely effected, which is known by the oil
becoming perfectly transparent. [St. Louis Med. and Surg. Jour a.

Solid Cod Liver Oil. By Dr. Lauxoy. The Greek philosopher used to
say, fci always take the shortest road and the simplest means." We will
apply tliis maxim, says the Bulletin Gen. de Therapeutique, to the solidifi-
cation of cod liver oil. Take of cod liver oil, iv. ; spermacetti, (in the
winter,) 3vj., (in the summer.) 3 v. Mix well, and heat in a close vessel
placed in hot water, then pour into bottles with large mouths, and permit
the contents to cool without shaking. It is also very well to flavor this
preparation with some of the fragrant oils.

The cod liver oil prepared in this way looks like a jelly, and can be swal-
lowed rolled in unleavened bread, moistened with a little gum water or
liquorice.

Dr. Launoy has frequently succeeded in getting patients to take this
preparation, who had been unable to swallow the oil in a liquid state. The
spermacetti is a valuable adjuvant, because it has been long considered as
a gentle and soothing expectorant, and also because it assimilates perfectly
with the oil without much augmenting its volume. [Virginia Medical and
Surgical Journal.

Tin Tumbler taken from a patient, postmortem, and which had been
introduced by him into the rectum, for the purpose of reducing prolapsus
of that intestine. The tumbler was sent to the Boston Society for Medical
Improvement by Dr. John 0. Stone, of New York city, and was presented,
and the account of the case read, by Dr. H. 0. Stone, of Boston. The fol-

70 - Miscellaneous. [November,

lowing is an abstract of the detailed description of the case, read by Dr.
S., and which was published in the Boston Medical and Surgical Journal of
May 14th, 1834.

The patient introduced the tumbler on the 4th of April, 1834, causing its
entrance into the bowel by sitting upon it. The tumbler being drawn up-
wards with the returning intestine, attempts were made by the patient to
extract it, with his fingers, and by means of " shoe-maker's forceps." " With
these he had considerably broken and flattened the e<\ge of the base or rim,
of the tumbler, and forced it beyond the rectum into the colon." It was
found in this situation by the physician who was summoned, Dr. G. Moodie,
of North Andover, Mass. Dr. M. introduced his wt hand and arm into the
rectum, seized" the tumbler and "made a powerful" but unsuccessful
u effort to extract it." The blunt hook was next tried, without extracting
the tumbler, although it was brought down so that " it could be seen."
" Owing to its flattened state, it hitched in the plica? of the intestine."
Several physicians and surgeons were called in consultation ; among others,
Dr. Joseph Kittredge, of Andover, and Dr. Whiting, of Haverhill. No ef-
forts at extraction by the hook or the fingers were of any avail ; although
the tumbler was brought into view and seized, powerful efforts being again
made to disengage it from its situation. One of the practitioners again
introduced his hand, but could not bring the tumbler away. The patient
asked to have his abdomen opened, and the foreign body thus removed.
u He was told that this would produce certain death." A proposition to
divide the levatores ani was negatived by Dr. Kittredge, who feared fatal
haemorrhage. " The patient lived about three days after this. His tongue
sloughed, and there was gangrene of the large intestines. The tumbler
was extracted after death : it measured 3 inches in length, 3^ inches in
width, in the direction of the flattened part, and 2 inches across its base ;
it would hold nearly three gills." It is preserved in the Society's Cab-
inet. [Boston Med. and Surg. Journal.

Palliative in Whooping Cough. Dr. John G. Johnson, of Lockington,
Ohio, in a communication to the Medical Counsellor, states that he has
used with the most decided benefit (in whooping-cough) the prescription
recommended by Dr. Murray of this city, and published in the April No.
of this Journal, for 1848. The prescription is as follows: Potassa Iodide,
gr. vi ; Mucilage Accacia, vii ; Syrup Senega, i ; Tincture Lobelia, 3 i,
mixed ; of which a teaspoonful four times a day may be given to a child
two years old. " I was more than pleased," he says, " to see its great con-
trol over the spasmodic cough." This, we have no doubt, is a useful mix-
ture in this troublesome disease, though we should think that the propor-
tion might be varied with advantage and the quantity of the Iodide in-
creased. [Ibid.

Ergot. A French Journal publishes certain conditions as contraindica-
tions to the use of ergot in labor. 1. Debility from the natural or pathologi-
cal condition of the patient, requiring tonics. 2. An unusual distension of
the uterus, requiring rupture of the membranes. 3. Rigidity of the uterine
fibres from inflammation or congestion, requiring blood-letting. 4. Mental
disturbance may suspend contractions, the cause of which should be re-
moved. 5. Confined and highly-heated apartment, requiring ventilation.
6. Distention of the bladder, to be relieved by the use of the catheter. 1,

1855.] Miscellaneous. 705

Intense pain in the small of the back often interferes with efficient contrac-
tions to be relieved by bleeding and chloroform. 8. Premature rupture
of the membranes. Uterine contractions are oftener impaired by plethora
than debility. Women suffering from the asthenic diathesis are apt tohave
rapid labors; and the tediousness of labor in plethoric habits is relieved 1>y
suitable depletion. Ergot rarely fails to act, and act favorably, upofl the
parturient female, when the system is in a condition favorable to the natu-
ral contractions of the uterus. [Memphis Med. Recorder.

Spigelia Jelly. This elegant formula we find in the Annnairede The-
rapeutique for 1855, taken from the Gazette Med. de Liege. It is recom-
mended by M. Bonnewin as the most agreeable form of administering this
favorite anthelmintic. B. Pulv. spigelia, 3 viij. ; Corsica mow, 3 i v. ; boiled
in 10 ounces of rain water until it is reduced to 10 ounces. The decoction
should then be decanted into a sauce-pan containing 2| ounces of white
sugar, and again boiled down, carefully stirring with a silver spoon, until 4
ounces of jelly are obtained. It then should be strained through a sieve
into a jar containing two drops of the essence of citron or caraway. This
jelly is a very active anthelmintic, and so agreeable that children will seek
for it with avidity. If kept in a cool place it will remain good for some
time, and its flavour may be still more improved, by substituting for the
sugar, either the syrup of gooseberries or mulberries. [ Virginia Medical
and Surgical Journal.

Artificial Eyes. The following scraps of information as to the employ-
ment of artificial eyes, which we have acquired in watching the practice at
the Royal Ophthalmic Hospital, may be welcome to some of our readers :
(a) The success in the deception as to appearance is generally most com-
plete. Several very pleasing cases have fallen under our notice, in which
a glass eye, by hiding a loathsome deformity, and restoring personal ap-
pearance, became the means of effecting a complete revolution in the
worldly prospects of the wearer. (6) In order to complete success, it is
very desirable that the substitute eye should move well. This, however, is
not essential, as should the two eyes not move equally, the only defect sug-
gested to the casual observer is that of a slight squint, (c) To secure the
movements of the artificial organ, the natural globe, in its collapsed state,
should, if possible, be retained in order to serve as a stump. This stump or
cushion, receives the attached muscles and obeys their movements, of course
carrying with it the concave glass eye which has been fitted upon it.
(d) If the entire globe be diseased, and its removal necessary, the operation
should be conducted on the modern plan, viz., by division of the muscles
close to their attachments, nothing whatever excepting the globe itself be-
ing taken away. By this precaution the muscles will be left in their full
length, and, becoming connected, in the course of healing, with the mass of
cellular tissue, fat, etc., which remain's in the orbit, will constitute a cush-
ion possessed of a certain degree of mobility, (e) Qlass eyes will not wear
forever. Even with careful patients the artificial eye generally requires to
be renewed, or, at least, re-enamelled, once a year. It becomes coated
at the back by concretions from the tears, and is then so irritating that its
disuse becomes necessary. To obviate this inconvenience, patients should
always remove them at night, and have them carefully washed ; they
should also, if convenient, lay them aside for a few days whenever the eye

i 06 Miscellaneous. [Kovember,

becomes irritable, or a greater tendency to deposit is observed than usual,
(/) Among the poor this liability to soon become unbearable is a serious
objection to their use. Some surgeons have, indeed, almost ceased to re-
commend them to their Hospital patients on this account, reserving their
employment for cases in which the sufferer appears more than usually in-
telligent, and likely to succeed in the management, (g) Mr. Gray, (of
Goswell-street,) the maker of artificial eyes to the Ophthalmic Hospital,
informed us. in answer to enquiries on this head, that he thought an artifi-
cial eye might, with ordinary care, be kept in a good state at a cost of
about fifteen shillings a year. This estimate, of course, applies onlv to a
pauper patient, to whom cost price only would be charged. [Med. Times
and Gazette.

Exemption of the Jews from Cholera. Whilst reading in the Lancet, Mr,
Huxley's article " On the Treatment of Choleraic Diarrhoea by Olive Oil,"
I was struck with the following passao-e : " And so surely will it yet be
learnt that the remarkable escape of the Jews in seasons of Cholera is at-
tributable to the frequent use of this oil. The fact is so notorious, that I
am surprised the subject has been passed over as little more than the result
*of accident."

Mr. Huxley, like many others whose views have been published in the
Lancet, on the exemption of the Jews from attacks of cholera, attribute
that exemption to the use of olive-oil. For a time I was of the same opin-
ion ; but whilst searching for facts, for a certain purpose on this subject, I
found that the members of the Jewish persuasion made great use of vine-
gar and lemon-juice, as well as of olive-oil, with articles of diet. The in-
formation then obtained, induced me to write, in a paper read by me before
the Epidemiological Society. July 3, 1854, thus : u Perhaps it will be found
upon further inquiry, that the members of the Jewish persuasion of the
present day are somewhat indebted to the use of vinegar and lemon juice,
as well as to olive-oil, for their reported exemption from attacks of cholera,
I possess a statement of the use made of both, with articles of diet, which
seems to throw a light upon the subject. The merit hitherto, as far as I
know, has been given to olive oil, abstinence from spirituous liquors, as
well as to the precautions taken with respect to animal food before cooked,
and to the observance paid to the cleanliness of all cooking utensils."

I believe it is now generally understood that the inhabitants of cider
counties, such as drink cider, are to a very great extent exempt from cho-
lera ; indeed, almost entirely so. Very few persons in cider districts make
use of olive-oil ; but should it be proved that olive oil is the safe-guard as
regards the Jews, perhaps it may be found that butter, cream, lard and
the fat of very fat bacon, is that of those who reside in some cider counties,
where they are plentifully supplied with such, and not to cider. [Dublin
Medical Press, from Mr, , J. H. Tucker in Lancet.

Certificates to the Efficacy of Secret Remedies. There are few ways in
which good-natured people are doing so much harm, while meaning to do
good, as in signing their names to medical certificates, to be distributed all
over the laud in the public newspapers, or thrust upon us, whether we will
or no, at our very doors. This has got to be a crying evil in the land, and
it is time it was corrected. It is doing- much, very much, to impair the
faith in remedies properly given, to shake confidence in the medical pro-

1855.] Miscellaneous.

fession. and thus incidentally to re-act upon the community to their
disadvantage. It is a gross injury to the medical profession. It constant-
ly taunts them with the insinuation. "Look here! what all your b<
science could not do, this man whom y<>u denounce as an Ignoramus, has
done! This medicine has cured me; yours did me do good, and I might
have been in my grave for all you ! From this time forth, fling doctor's
physic to T! nd let me have only the healing drugs of the inspired

natural physician !"" Waiving for a moment all question as to the amount
of real efficacy in the remedies thus vaunted grant
meuts sake, that the nets are as stated, what does it amount to! Only
that a dm g taken at the right moment has wri effect no

more. For this, shall it be emblazoned in every newspaper sheet as the
great eatholicon ? Why, here are two hundred physicians in Boston, do-
ing, with the blessing of Providence, precisely the same tiling every day !
And are they justified in proclaiming their skill and the power of their
remedies for this reason ! No true physician, at any rate, would give an-'
affirmative answer. And yet their patients forsake them, or secretly u-e
while under their care any nostrum their assiduous friends recommend.
Or if they ask the advice of their physician a< to the expediency of trying
the remedy, he has no means of knowing its real character, and of course
cannot recommend it. Still human nature is such that even the mystery
which shrouds it gives it a fascination, particularly if the dose be pleasant
to the taste. Men of respectable position in the community give up their
business to devote themselves to the sale of the article, and untold sums-
are their reward. Grateful patients eagerly subscribe the certificate of its-
real or supposed virtues, while yet in the flush of their enthusiasm at its
efficacy, and the document goes to the world, to add one more to the legion
of medical delusions which are a stigma upon the present generation. Let
any intelligent man go into a public hospital, and he will find numb
patients who will tell even more extraordinary experiences of their own
how they were full of pain, motionless, helpless, but in twenty-four hours
they were changed men. to all intents and purposes, cured. Others will
tell you that for years they had not had the use of their limbs, but now
they walk rejoicing. Happy as these occurrences are, blessed indeed to
the patients, the physician who has been the fortunate instrument in bring-
ing them about does not, or ought not, to claim any exclusive merit ; rather
he most willingly point out to his professional brethren the means he
has used with such success. Thus is the blessing extended beyond his own
immediate sphere, and no selfish thought of personal profit limits the exer-
cise of his professional benevolence. The medical journals are crowded
with reports of just such ca>es. which go forth over the whole world to
bless mankind. Nay, these very remedies are not unfrequently taken up by
shrewd nostrum venders, and after being disguise,] by Bome inert addition,
are sold to the unsuspecting public at a prom of thousands per cent., with-
out the least credit being given to the man who first applied it for such a
purpose. But there is another very important consideration which is en-
tirely overlooked by the patent-medicine-swallowing, or the purYed-medicine-
swallowing community, which is this ivehf < far tire for good

are equally powerful for evil. The knife is a catlin with two edges, let
him who uses it see that he cuts not his own fingers. And this is no ima-
ginary casualty. It is a fact well known to physicians, that cases are
frequently brought under their own observation, of excellent remedies

708 Miscellaneous.

having been taken to great excess when not administered by the direction
of a professional man. It is astonishing to see the recklessness with which
people sometimes do this, taking ad libitum the most powerful medicines-
of the pharmacopoeia, simply because under some circumstances they have
been recommended to them by some respectable physician, who never in-
tended they should be adopted into such promiscuous use. The charity of
these good people is most liberally extended to their friends, inducing them
to take the same, they alone being responsible for the consequences. And
the reason for this not always, but often is to avoid the necessity of pay-
ing the physician the fee which is his due for advice on the subject. Again,
supposing the secret remedy to have been effectual in certain cases, the
cases in which it has failed or done harm far out-number them, and of these
the community hears not. Many of the cases of supposed cure turn out to
be only transiently benefitted, and the deluded sufferer only falls back again
into greater hopelessness. Meanwhile the certificate stands, and money
pours into the pocket of the nostrum- vender what else does he care for ?

We would remark, in conclusion, that medical discoveries should be
the property of the human race; as free for the use of mankind as heaven's
natural gifts of light and air. Only when open to such unrestricted use
can their real value be tested. The noble calling of physician ought not
to be degraded to a mere matter of making money ; the community are as
much interested in this as physicians, perhaps more so. By following the
course which is getting to be so common, they are discouraging and star-
ving those whom they ought to regard as their true friends. [Boston Med.
and Surg. Journal.

Antimoniate of Quinia in Intermittent s. Dr. La Camera, of Naples, in
treating a solution of sulphate of quinia by a solution of antimoniate of
potassa, has obtained a white product crystalized in needles, bitter to the
taste, and soluble in hot water and in alcohol and ether. This antimoniate
of quinia has given excellent results in periodical diseases, both simple and
complicated with rheumatism, in sub-continued fevers of Torti, and in per-
nicious fevers. The dose is 0.4 grm. to 0.6 grin, during the apyrexia, and it
is rarely necessary to be administered a second time. [Journ. of Pharm,

White Indians. Dr. George Lathrop informs the editor of the Peninsu-
lar Journal of Medicine, that north of Washington Territory, there are
Indians of fairer complexion and more Caucasian features than those in the
latitude of Olympia. Some of them have red hair, and all of them are
very high in the natural power of intellect. Their manufactures display
superior mechanical capabilities, specimens of which he has obtained. As-
the neighboring coasts of neither Asia nor America furnish any race which
could have originated this variety by intermarriage, it goes to show that
in spite of Gliddon and Nott, climate and other influences may transform
races. \St. Louis Med. and Surg. Jour.

Dr. John Le Conte, of Athens, has been appointed Professor of Chemistry
in the New York College of Physicians and Surgeons.

SOUTHERN

MEDICAL AID SURGICAL JOUMAL.

Vol. XL] SERIES. DECEMBER, 1555. [No. U.

ORIGIXAL AXD ECLECTIC.

ARTICLE XXXVII.
LETIEES EEOil SAALX. D. HOLT, tf. D., UPOH SOME POUTS OP GEXEEAL PATHOLOGY.

LETTER NO. 6.

ntqomery, Ala., Sept. 25th, 1855.
sro. Editors You will please remember, that in treating of
the subject of congestiou, I have uniformly denied that it had an
existence independent of the existence of some other essential
elementary or typical form of disease, but have maintained that
all diseases with which it may be associated, whether intermittent
or remittent fevers, typhoid, or yellow fever, cholera or dysentery,
rheumatism or pneumonia, measles, scarlatina, small-pox, or any
other disease in which the condition may form a prominent trait
in their character, are alike entitled to receive the appellation of
congestive. This position is sustained by Dr. Bartlett who, in his
Treatise on Fevers, says "The qualifying prefix congestive, like
the term typhoid, is expressive of a pathologieal state or condition
which may exist in different di In this way, most writers

speak of congt." rieties or cases of cholera, of scarlatina, of

yellow fever, and so on : they mean simply those forms of these
3es in which this pathological element, thus designated.

ly, Dr. Bartlett, that is just what we mean.
But we mean something more ; we mean, that all diseases in which
that pathological element predominates, to be treated most su
fully, the treatment must conform to that pathological condition.

I have maintained that congestion, as a pathological condition,
was not dependent upon the causes which produced the diseases

N. s. VOL. XI. NO. XII. 45

710 Holt's Letters upon General Pathology. [December,-

with which it may be associated, for these often appear in their
simple elementary or typical character, free from any of the signs
or phenomena of congestion ; bnt that it depended upon remote
and predisposing causes, which operated antecedently, and some-
times independently of the causes which produced those diseases in
their essential typical character ; and that the same causes which
would make an intermittent fever congestive, would make yellow
fever, pneumonia, or scarlatina, congestive also. It will not be
amiss to repeat here what I said on a former occasion, with re-
spect to the influence of atmospheric heat upon the constitution
of the inhabitants of hot climates, to the effect, that it diminishes
the general vigour and inherent nervous power, diminishes the
density and increases the elasticity of the moving fibres, which
allows of the free exercise and play of the animal powers, and
gives greater excitability or mobility to the general system, but
diminishes the power of resisting the influence of depressing
causes, thus laying the foundation for, or a predisposition to, dis-
eases of depression and congestion. Besides this cause, I have
included all the causes which tend to impair the healthful vigour
of the organic nervous system, the most prominent and important
of which is malaria, which is generally acknowledged to be the
most prolific source of fevers in hot climates, which is not only
engaged in the active production of these diseases, but, like atmos-
pheric heat, with which it acts in conjunction, having the effect of
impairing the general tone and vigour of the system, lays the
foundation or predisposition to congestion. Hence, from a long
residence in malarial regions, the inhabitants often have their
health impaired, giving rise to premature old age to visceral de-
rangements, both functional and structural to nervous disorders,
&c, without their ever having really had an acute attack of mala-
rial disease.. But when this or other causes operate with sufficient
force to excite acute disease, it is but reasonable and natural to
suppose, that such disease will be much more likely to assume in
them, the character of depression and congestion, than in those
who have been but temporarily exposed to its influence.

It is in this way that I would account for the existence and
prevalence of malarial diseases at seasons when malaria has long
ceased to be generated, and when no such atmospheric influence
exists. Not that malaria, as the exciting cause of disease, having
been taken into the system, lies dormant until a favourable oppor-
tunity for the development of its influence but from the fact of

1855.] Holt's Letters upon General Pathology. 711

its having already done its work in and upon the system, in the
establishment of a predisposition to such form of disease. Hence
the almost universal tendency of all diseases in warm and malari-
ous countries, at all seasons, to take on the malarial and periodic
character, whether they be congestive, t}rphoid, or otherwise. I
would not, however, be understood as maintaining that malaria is
the cause of periodicity, nor would I attempt an explanation of
this most important and most mysterious and incomprehensible
phenomenon or feature of disease; yet they appear to be strangely
identified with each other.

I have maintained, also, that congestion of a single organ, which
may occur in a variety of affections, did not constitute the pa-
thological condition of congestion. European writers, however,
(whose example has been followed by some of our own, and who
have adopted their classification of the varieties of "pernicious fe-
ver," which they recognize as synonymous with our congestive
fevers,) have furnished us with a distinct variety for almost every
prominent symptom of the disease. Thus, Alibert, according to
Dr. Bartlett, makes tvsenty varieties; Forti gives us seven ; and
Maillot, whose classification Dr. Bartlett seems to adopt, gives us
four, namely: the "comatose," the "delirious," the "algid," and
the "gastro-enteric." Xow, it must be remembered that these
writers are describing the different forms, varieties and modifica-
tions of a particular disease, and not a general pathological condi-
tion ; and it is proper that they should notice every feature of those
forms, varieties and modifications. But, with the exception of the
"algid" variety, and the "gastro-enteric," as described by Dr.
Parry, and some other American writers, and which corresponds
very nearly with the character of the disease, as I have observed it
in Alabama, which, as I have already shown, is but consequential
of congestion of the liver, which may, and does as often exist
with pneumonia as with "pernicious fever;" not one of the other
varieties are entitled in this connection to separate consideration.
But being based upon the condition of single organs merely, with-
out regard to the general condition of the system, and which may
exist as well without the existence of the pathological condition of
congestion, as with it. Such are the comatose and delirious varie-
ties of Maillot; such of Torti, with the exception of his "algid,"
and such, I dare say, with a majority of Alibert?s; and though
coma and delirium are the usual attendants upon congestion of the
brain, every practitioner of experience and observation in the

712 Holt's Letters upon General Pathology. [December,,

South knows that these conditions of the brain often occur in
intermittent and remittent and other fevers, which are not entitled
to, and do not receive the appellative term congestive.- And Dr.
Bartlett, after describing these varieties, says, in conclusion "It
is proper to mention that the preceding varieties may be more or
less mixed up with each oilier, sometimes one of them prepon-
derating and sometimes another. It is hardly necessary to take
any separate notice of the minor varieties, the cardiac, the icteric,
the syncopalic, and so on," And so I think, for the reason that
such a multiplication of varieties is calculated to create confusion,
without any material practical advantages, and for the better rea-
son, that the foundation upon which many of them have been
made to rest, has no essential relation to the congestive condition,
and those which have may be embraced under one or the other of
the forms, or modifications, according to the classification which I
have made of congestion.

On a former occasion, I stated that I might at some subsequent
period express my views with regard to the typhoid condition,
and finding the present a favorable opportunity, I will do so, for
the reason, that though the two conditions, the congestive, and the
typhoid, are totally different from each other in their charac-
ter and the causes which produce them, yet they are often found
to act reciprocally, or in conjunction with each other, not only to
aggravate the character of the diseases with which they may be
associated, as in the higher grades of our bilious fevers, and such
fevers as Torti, Alibert, and others, have described as "pernicious
fevers," but also to confound and obscure the essential typical
character of those fevers, as well as those more decidedly typhoid
in thftir character, such as yellow fever, typhoid or enteric fever,
&c. Between the causes which produce these two conditions,
(those producing the congestive, belonging to the dynamic, and
those producing the typhoid,, to the zymotic class,) there exists
this material difference that while the former act for an indefi-
nite time, often producing a predisposition only, or if they act
with sufficient force to produce disease, the subsidence or arrest
of that disease does not destroy the predisposition, but leaves
the system subject to a recurrence of the disease under the influ-
ence or operation of the same, or some other slight additional
eauser while the latter or typhoid causes often act at once to pro-
duce disease, without the necessary aid of any predisposition, and
having once acted in the production of disease, their further action

1855.] Holt's Letter* upon General Pathology. 713

ceases, without leaving an}* predisposition to their recurrence, but
on the contrary, their effect is to destroy or weaken the natural or
inherent predisposition to such Between the causes and

the character of the diseases, to which these two conditions usually
belong, there exists also this material and characteristic difference,
that those of a pyrexia! character, of the malarial and dynamic
whether congestive or otherwise, and of whatever type, are
made up of a succession of paroxysms or attacks, each one termin-
ating within a given time, not exceeding twenty-four hours : while
those which belong to the typhoid and zymotic class show no such
signs of periodicity, but are characterized by a single protracted
pyrexia! or febrile stage, seldom terminating within twenty-four
hours, but often continuing longer such are measles, scarlatina,
small-pox, &c, and such, in my opinion, are yellow fever, typhoid
and enteric fever, and other fevers of that class.

Now, while I maintain that congestion has no typical character,
but exists only as a pathological condition, and am willing to ad-
mit that the typhoid condition may exist in the same sense, as is
often observed in certain febrile affections bilious fevers, pneu-
monias, &c. having no typhoid influence for their production,
but during their progress a typhoid condition is generated in the
system, from an accumulation of effete and poisonous matters, in
consequence of defective elimination, which poisonous matters are
incapable of reproducing a like condition in others, but die out
with the disease, of which it is hut the condition ; there are other
typhoid conditions, having an essential typical existence, and sui
is in their character, and being the product of a specific poison,
which, when taken into the system, is capable of being regenera-
ted, and of reproducing a like condition in others, requiring, how-
ever, as a necessary medium for such reproduction, an atmospheric
contamination. That yellow fever belongs to this class, and is not,
as many have supposed, of malarial origin, and a higher grade of
bilious fever, I infer from the fact, that it is not subject to the
laws of periodicity, as malarial fevers are, having one protracted
pyrexia! or hot stage, protracted beyond the limits alloted to the
hot stage of malarial i and that the cause of yellow fever

belongs to the zymotic, and not the malarial and dynamic class,
I infer from the fact, that like other diseases of that class, as mea-
sles, scarlatina and small-pox, whooping-cough. <c, one attack
will measurably destroy the natural or inherent predisposition,
and secure, to some extent, an immunity against another ; while

714 Holt's Letters upon General Pathology. [December,

one attack of malarial or miasmatic fever predisposes to, and fa-
vours the recurrence of another. From the fact, that other zymo-
tic diseases, as scarlatina, measles, &c, have each a specific cause,
operating under and controlled by the laws of elective affinities,
manifest peculiar and characteristic signs of their identity, which
they invariably preserve, however near they may approach in
similitude ; and believing yellow fever and typhoid fever to be-
long to that class, I infer that each of these affections possess a
specific cause, and a specific sui-generic character.

Now, if my views are to have any practical bearing upon this
subject, it is necessary that I should be very explicit in imparting
them, with regard to the nature, the mode of action, and the effects
of the operation of these specific typhoid causes. I assume, there-
fore, that the cause of each is a specific poison, which, when intro-
duced into the circulation in sufficient quantity, a ferment, or the
work of regenerating the poison in the system, commences, which
process will continue under the direct operation and influence of
the poison, constituting the febrile or hot stage of the disease, for
a period of time, according to its typical character, which, if it be
yellow fever, will be not often less than twenty -four hours, and
seldom longer than seventy-two, when its direct poisonous action
will cease, leaving as the effects of the process, or work of regenera-
tion, and of the febrile or hot stage, a depraved and vitiated condi-
tion of the blood, with all the consequences characteristic of, and
constituting the typhoid condition, not however as a consequence
of the direct action of the original poison, but as the consequence
of a rapid accumulation of effete and poisonous matters in the
blood, consequent upon their non-elimination from the interrupted
or suspended function of those organs upon which that duty de-
volves. If this be true, which I think few who have had any
experience will deny, what is the first and most important duty
required of the physician ? Manifestly to endeavour to prevent
the further poisoning, and the breaking down of the healthy con-
stitution of the blood, by aiding the depurating organs in the rapid
elimination, and preventing the accumulation of those poisons
which are generated in the system, and thus preventing the forma-
tion and establishment of the typhoid condition. The means for
accomplishing this will be more appropriately detailed hereafter,
as it is more 'my object at present to examine into the nature of
the typhoid condition, than to suggest means to prevent or to cure
it I may be permitted, however, to say, that if the proper means

1855.] Holt's Letters upon General Pathology. 715

should have been neglected, or should fail of producing their pro-
per effect in this most important stage, all subsequent efforts will
be uncertain and generally fruitless ; for when the healthy consti-
tution of the blood becomes once broken down in these affections,
the nervous system is sure to sink under the depraved condition
of the blood, as is usually the case in the calm or apyrexial stage
of yellow fever, with a development of the characteristic phenome-
na of the typhoid condition, and if life does not become extinct,
the case then becomes a question of time, and of physical or con-
stitutional endurance, for the purification of the blood and the
re-establishment of its healthy constitution, and the reparation of
damage done to the solid tissues.

What I have said of the typhoid condition so far, has been with
reference to its essential, typical and suigeneric character, and, as
it were, of its independent existence; and my object in thus pre-
senting it, divested of all encumbrances, was to demonstrate, as far
as possible, such a character and such an existence, under which
it is seldom, and in some places it is never, known to exist, espe-
cially m connection with yellow fever, which appears only at
malarious seasons, in malarious regions, and which so often has
the malarious influence impressed upon it as to have given rise to
the belief that it was of malarial origin. Indeed so strong some-
times are the influences as to deprive it of all the signs of its essen-
tial typical character, abundant examples of which have been
furnished us by Louis, in his account of }^ellow fever, as it appear-
ed at Gibraltar in 1828 ; but we of the South need not go as far
as Gibraltar for examples of the same sort.

The agency of malarial or miasmatic influences in the produc-
tion of 3'cllow fever (which is the same in its essential typical
character, at all times, and under all circumstances) must be ac-
knowledged ; not, however, that it is necessary for its production
in its essential character, but that it furnishes a nidus and a pabu-
lum, as it were, and gives to it the great diversity of forms and
modifications under which it is observed at different seasons and
in different localities, without destroy ing its essential character,
and a yellow fever, wearing the external livery of an ordinary
intermittent, is as much a yellow fever, in its essential character,
as it would be, divested of all adventitious influences. The want
of a knowledge, or the want of attention to this important fact,
and an effort upon the part of the profession to accommodate and
.adapt their plans of treatment and their remedies to those ever

716 Holt's Letters upon General Pathology. [December,

varying forms and modifications, instead of its uniform and inva-
riable typical or essential character, has been the chief cause, in my
humble opinion, not only of the want of a greater success in its
treatment, but the want of a uniform, systematic, and scientific
plan of treatment, for the want of which we find that in New Or-
leans and other places, where they have the best opportunity for
observing yellow fever, the medical journals, from year to year,
teem with descriptions of the varying forms and modifications of
the disease, effected by malarial and other adventitious influences,
and the various and often heroic plans of treatment founded upon
them ; and members of the profession who have grown gray in the
service, and who for years have followed out those changes, without
having paid sufficient regard to its essential typical character, (which
is alike dangerous, under whatever livery it may appear,) have
found themselves standing as sad commentaries upon the slow
progress and the uncertainties of the healing art ; or what is more,
finding their preconceived and cherished opinions and plans of
operation baffled, and inadequate to the emergency of every change,
they have thrown wide open the doors of the profession to every
species of charlatanism, by publicly proclaiming that one system
of practice in yellow fever is as good as another, or that all are
worthless.

One of the modes of treatment predicated upon the supposition
of the malarial origin of yellow fever and typhoid fever, which at
one time seemed to meet with general favour, and consisted in the
administration of large doses of quinine, and which was known as
the abortive plan, I will notice here, for the purpose of showing, or
at least of expressing my opinion. That while yellow fever and ty-
phoid fever are often complicated with, and even obscured by,
malarial influences, these influences do not materially change or
affect them in their essential typhoid, character ; and while I freely
admit the appropriateness and value of quinine, in controlling the
malarial influences, and the malarial features in these diseases, I
believe it to be totally unfit and inadequate to control them in
their essential typhoid character ; for, having their cause in a spe*
cific poison, which will require time for its elimination from the
system, any other means than those which are calculated to aid in
its elimination, will prove as abortive as would be an effort to
abort scarlatina, measles, or small -pox.

As you may be somewhat at a loss to understand what object I
have in view in departing so far from the subject of congestion,

1855.] Bozemax's Case of broken OcUhei 717

and for saying as much as I have concerning the typhoid condi-
tion, I will explain by saying that it is r the a
plishment of one of the principal ol .Inch I have in view,
and which I intimated in my ]; . namely, the vindication of
certain remedi st popular and professional abuse.
this subject, I shall say something in my next letter which
will be agreeable to some of my readers, and not so much so to
some others. So, until then, I shall remain, as usual,

Yours truly, Saml. D. Holt.

ARTICLE XXXVIII.

Four and a half inches of a silver Catheter broken off in a false
passage; its removal Ly an operation Recovery of the patient.
By X. BOZEMAN, M. D., of Montgomery, Alabama.

On the 2d of July, I received a message to visit an old gentle-
man in Coosa county, who, it was said, had broken a catheter in
his bladder. I did not, however, reach his residence until the next
day some thirty-six hours after the accident occurred I then
met Dr. E. Mason of Wetumpka, in consultation.

Patient set. 72 : tall and spare built; for many years has labored
under hypertrophy of the prostate gland, with all its train of evils.
Dr. M. states that he and his brother, Dr T. TV. Mason, within the
last few years, had been frequently called upon to relieve him of
retention of urine. When attacked this time, a Thomsonian was
called in : he employed the catheter and afforded prompt relief.
After doing this several times, he supposed the patient could cathe-
terize himself, as he had often done before, and therefore discon-
tinued his visits. In a short time the bladder became distended
again and the introduction of the catheter necessary. The one
employed was a No. -i : the patient says that it passed on very
easily until its beak had nearly reached the bladder, then it en-
countered an obstacle; being anxious to get relief, he aj^plied
considerable force, hoping to overcome the difficulty. After per-
sisting for some time, the instrument, all of a sudden, passed on,
as he supposed, into the bladder; no urine escaping, however, he
was induced to withdraw it; but, to his very great astonishment,
only a part of it came, followed by a discharge of blood. At once
he apprised his | q of what had happened: this gentleman,

upon his arrival, found the bladder very much distended, and

718 Bozeman's Case of broken Catheter. [December,

proceeded to introduce another catheter which, he says, he did
with much ease. As to the situation of the broken one, he ex-
pressed his belief that it was in the urethra. I was somewhat
surprised at this statement, having just been told that the second
catheter was passed with so much facility.

To satisfy myself I now introduced a sound, and sure enough
felt a foreign substance far back in the urethra, Notwithstanding
its presence there, the sound passed into the bladder very readily.
To remove all doubts as to the true nature of things, I next intro-
duced my finger into the rectum : here I could feel a hard body
pressing on the left side of the bowel and closely embracing the
prostate gland, which was enormously enlarged ; it extended as
far forward as the bulb of the urethra. The manner in which the
accident occurred now admitted of an easy explanation. The im-
pediment which the catheter met with near the bladder was doubt-
less the prostate gland. The undue force employed by the patient
to overcome it, caused a laceration of the membranous portion of
the urethra thus allowing the instrument to pass down between
the two layers of the deep perineal fascia to the situation just de-
scribed as to the breaking of the catheter. In the first place, it
was an unusually light one, and taking the course it did around
the enlarged prostate gland, it was bent. Upon being straighten-
ed again by the attempt at withdrawal, it broke and separated.
That a catheter can be broken in this way, tany one may satisfy
himself who feels disposed to sacrifice one in such an experiment.

The mode of relieving the patient next claimed our attention.
Although he was comparatively free of pain and had no fever,
yet a condition so favorable could not be expected to exist much
longer, with such a foreign substance imbedded in structures
bearing relations so important to each other. Owing to the immo-
bility of the catheter by any sort of manipulation and the obliqui-
ty of its axis to that of the urethra, it was thought to be almost
impossible to extract it through that canal. At all events, not
being able to make an effort, for want of suitable instruments, we
decided at once to open the urethra and effect its extraction in that
way. The point selected was just in front of the bulb. The pa-
tient was now placed in the usual position for lithotomy, and an
opening made in accordance with Prof. Syme's plan of " perinaeal
section " in the treatment of stricture.

The staff being withdrawn, I next "endeavored to seize the end
of the catheter with a pair of strong forceps and bring it through

1855.] Bozeman's t 'e of broken Catht 719

the opening; but in this I failed, owing to the fact that I could
not get a finger hold on it. Finding this mode of procedure would
not do, I now got a grooved director beneath its end, and alter
many efforts succeeded in lifting it out.

The patient having stood the operation very well, was now put
to bed and a catheter secured in his bladder. Not expecting to
see the case again, instructions were given that the instrument
remain in the bladder three or four days, then, if necessary, to be
removed, cleansed, returned and allowed to remain several days
longer.

I heard nothing more of the case for several weeks. I was then
told that the patient had entirely recovered from the operation, as
well as the false passage.

I have since understood, that shortly after this very favorable
result, an urethral fistula formed just in front of the scrotum or at
the point where the penis hangs off from the pubes, attended with
swelling of the scrotum and one of the testicles. At first, I was
somewhat surprised at this occurrence; but upon learning the
catheter had been worn up to this time. I was satisfied that slough-
ing was caused by the protracted presence of the instrument at
that point. However much this circumstance may have been re-
gretted, it is nevertheless gratifying now to know that the patient
is able to be about, and has the prospect of a speedy and perma-
nent recovery.

Remarks. Thus have I endeavored to give the minute details
of this case, the particulars of the treatment, the result, &c. I
have been induced to do it for the simple reason that I have not
been able to find another just such a case on record. The only
one approaching it in any respect, is the case reported by Fardeau,
to which allusion is made by Gross.* In this instance, an iron
wire, something over seven inches long, pierced the membranous
portion of the urethra and became fixed in the inner edge of the
tuberosity of the ischium. Now, in my case, the false passage,
considered apart from the breaking of the vulnerating body, pos-
sesses comparatively little interest. Such accidents are of rather
frequent occurrence, and some varieties of which are almost ne-
cessarily followed by consequences far more alarming than we
even had any right to expect from the nature and extent of the
injury. For example : when it is made by an instrument leaving

* His work on the Urinary Organs.

'20 W QOD's Case of Fracture of the Cranium. [December,

the natural channel and reaching the bladder through the substance
of the prostate gland, or passing between this gland and the rec-
tum into the bladder, or perforating both the rectum and bladder,
all of these accidents are said to have been met with. There being
a direct communication with the bladder, infiltration of urine, with,
all its evil consequences, would, it seems, be unavoidable in every
instance. Whether the proper course was pursued as regards the
treatment of this case, or not, the result shows for itself. So far
.as the operation is concerned, it was entirety successful. The
urethral fistula was doubtless caused by the protracted and un-
necessary use of the catheter, and therefore should not have any
importance attached to it in estimating the judicious management
of the case.

ARTICLE XXXIX.

Case of Extensive Fracture of the Cranium. Noted by E VAN B.
Wood, M, D., of Dallas, Paulding county, Ga.

Sept. 1st. Was called to see Mr. T. G., who had received a blow on
the left side of the head, with a black-smith's large hand -hammer.
Found him prostrate upon the shop floor ; perfectly insensible ; his
head bathed in blood and the pulse scarcely perceptible. Ordered a
room at the hotel, and directed him to be carried there immedi-
ately. After removing the hair and blood, found the scalp cut
through by the sharp edges of the hammer, and rupture of the
posterior branch of the temporal artery ; but the loss of blood was
small. There was also a semi-circular fracture of the parietal bone,
situate about one and a half inches above the squammous border
of the temporal bone ; the upper portion or apex of which was
driven in upon the brain. There were also two fissures, extend-
ing from the upper portion of the fracture, one in the direction of
the coronal and the other in the direction of the lambdoidal su-
ture. There was effusion into the eye opposite the wound, com-
pletely closing the eye and giving to the lids a dark, shining ap-
pearance. Applied a simple compress, to arrest the hemorhage ;
ordered frictions with warm water and vinegar, and rested for the
period of reaction, without further treatment as it could not be
ascertained to what extent the brain was suffering. During the
first part of the night reaction supervened, accompanied with oc-

1855 J "W OOD 's Case of Fracture of the Cra nix 721

casional spasmodic or disorderly movements of the extremities,
and deep groaning and rest

I should have stated that the subject of this case had drank
brandy to the extent of intoxication before he received the blow.
After reaction was completely established, the brain .-till suffering
from compression, an operation was deemed m .At the

request of friends, Dr. James K. Gotten was sent for in consulta-
tion. There was partial paralysis of the boi ;>erior and in-
ferior extremities, on the side opposite the wound, as is usual. But
what was the more remarkable in thi -.here was
complete paralysis of the nerves of common sensation supplying
the tongue; also, paralysis of the uerves of motion supplying the
side of the tongue opposite the wound, while the nerves of special
sensation of the whole organ remained pcrfeet. There was also
paralysis of the nerves of motion of the superior extremity, while
the nerves of sensation were but little impaired ; and partial par-
alysis of the nerves of sensation of the inferior extremity.

Sept. 2d, 9 A. M. Dr. Gotten having arrived, and the opera-
tion decided upon, it was immediately performed, and was attended
with much pain, but followed by decided improvement in the
spmptoms. Ordered sulph. magnes,, and the application of cold
water to the head and effused eye. 7 P. M. Found him perfectly
quiet; inclined to doze; gave no signs of any pain at all. Ordered
the treatment to be continued.

3d. A.M. Found him very restless: pulse full and strong ; has
some pain in the side of the head, opposite the wound, which he
indicated by signs, for he could not articulate a word ; had slept
but little through the night ; no alvine discharges yet. Ordered
tart. emet. combined with the sulph. inagnes., repeated until free
discharges from the bowels were procured ; and the cold water
applications to be kept np continually. 7, P.M. Pulse full, strong
and bounding; face flushed and temples throbbing; most intolera-
ble pain in the side of the head opposite the wound ; had only
scanty evacuations from the bowels during the day. Bled him
freely from the arm, and ordered the tart. emet. and salts to be
continued, with the cold to the head.

4th. A. M. Found him quiet ; pulse fall, but soft ; had copious
evacuations from the bowels in the early part of the night, and
slept soundly afterwards ; has but little pain in the head ; appears
to be more rational this morning. Ordered Seidlitz powders, and
cold to the head. 7 P. M. Pulse full and strong ; skin dry and

722 Wood's Case of Fracture of the Cranium. [December,

hot; much thirst; great pain in the whole head; countenance
flushed. Bled him again freely from the arm, and ordered tart,
emet. combined with a small portion of calomel, to be repeated
every three hours through the night, and cold to the head.

5th. A.M. Found him perfectly quiet; pulse full, but soft;
but little pain in the head ; rested very well through the night ;
appears quite rational this morning ; makes signs for nourishment;
endeavors to talk, but cannot utter a word. Ordered Seidlitz pow-
der and tart, emet., with cold to the head. 7 P. M. Pulse excited;
pain in the arm and shoulder of the paralyzed side. Took blood
from the arm, and ordered morphine and tart, emet., with the cold
water dressing.

6th. A. M. Much improvement this morning; had a good
night's rest; pulse nearly natural; mind very good, but the par-
alysis remains unimproved. Ordered nothing but the cold water
to the head. 7 P. M. Pulse a little excited ; some pain in the
head, and the shoulder of the paralyzed side. Ordered frictions
with stimulating liniment to the painful shoulder and arm, and
salts and tartar to operate on the bowels, and the cold water con-
tinued.

7th. A.M. Is not so well this morning; had a bad night's rest ;
the pain in the paralyzed shoulder and arm has been most intol-
erable during the night ; pulse a little excited ; considerable pain
yet in the affected shoulder and arm. Ordered the salts and tartar
and the cold water continued. 7 P. M. Pulse yet a little excited;
much pain in the affected shoulder and arm. Took a few ounces
of blood from the arm, and directed a full dose of morphine, and
frictions to the shoulder and arm with strong liniment, and the
cold water to the head.

8th. A. M. Much improved this morning ; pulse very good,
and the appetite decided ; very little pain any where ; makes signs
to be carried home. Ordered nothing but the cold water applica-
tions. From this day the case progressed favorably, without any
other treatment than the application of cold water, and an occa-
sional cooling laxative, and frictions with liniment to the shoulder
and arm.

On the 12th, he began to articulate a few simple words, and to
move the fingers of the paralyzed hand, and on the 15th I dis-
charged and sent him home, a distance of three miles, without any
unfavorable symptom resulting. He recovered completely, save
a difficulty in his articulation.

1855.] SxEED. Medical Properties of Blackberry Root. 723

Remarks upon the Medicinal Properties of the Blackberry Root
(Rubus Villosus). By Cyrus S. Sxeed, M. D., of Culloden,
Georgia.

I propose giving you a brief account of the Rubus Villosus
(Blackberry), a medicinal agent, which, has been employed very
extensively in domestic and popular practice, and with great suc-
cess in a variety of diseases. I am well aware that it has been
long known as an excellent remedy for disorders of the bowels, .
and trust that the profession will not deem it presumption in me
to say, that it is an error to suppose that its usefulness in those
affections depends principally upon the tannin it contains.

According to Dr. Eberle, the root is considered a powerful as-
tringent. The sulphate of iron converts the infusion and decoction
into a dark purple, thereby producing a copious precipitate. Ge-
latin produces a white and opaque precipitate which is insoluble
in water. According to those who have treated of its virtues as a
medicine, its curative effects (in bowel disorders) have been attri-
buted mostly, if not altogether, to the tannin existing in it; but
upon a thorough examination of the matter, from recent experi-
ments, I am fully satisfied that its most powerful effects are attri-
butable, in the above diseases, to the bitter stimulant or tonic
extract, distinct from its astringency, the latter having no more
effect than ordinary vegetable astringents. In order to obtain this
extract separate, the root when taken from the earth should have
its bark immediately grated, and cold water applied to it. Like a
great many other vegetable astringents, in this process tannin is
retained in the bark, whilst the latter principle is extracted by the
water. The fluid changes its colour to a light yellow, and to the
taste it leaves a bitterness, with the slightest degree of roughness,
A small quantity of this fluid, taken into the stomach, increases
the appetite, and at times, I find, produces a glow over the surface
of the body, which induces me to believe that its therapeutic action
is stimulant, rather than tonic, as stated by most authors.

I have found this preparation to produce some of the most ex-
traordinary cures in chronic diarrhoea and dysentery, and even in
cases where all other remedies failed, and in the shortest possible
time. It has a decided advantage over the astringent preparation,
in all chronic cases, which should be used with the greatest cau-
tion, lest, by suddenly checking the discharge from the intestines,
anasarca be produced. The preparation should be given in small

724 Epilepsia Miasmatica. [December,

doses, five or six times a day. There is hardly any danger of its
producing costiveness.

Epilepsia Miasmatica. By E. E. McMeens, M.D., of Sandusky, 0.

Under the above appropriate nomenclature I propose describing
one of the peculiar and protean forms of disease, obviously ema-
nating from, and directly dependent upon, malarious effluvia.
Some doubts have been entertained, by eminent writers, in regard
to the probability of miasmatic exhalations, etiologically engen-
dering or essentially establishing the pathological condition neces-
sary to the production of true epileptic convulsions; implied from
the want of adequate uniformity, in a sufficient number of cases,
to corroborate or confirm the fact.

From a succession of remarkable and interesting instances emi-
nently illustrative of such an innovation, concomitantly occurring,,
under my immediate inspection, exhibiting all the pathognomonic
phenomena of epileptic paroxysms, uncomplicated with other
prominent derangement or subsequent cerebral depravation peri-
odically produced and promptly eradicated by the administration
of anti-periodics ; together with occasional isolated cases of a simi-
lar character, observed in proximit}^ to paludal localities ; strongly
substantiated the practicability of such influences, propagating a
concatenation of functional and sensorial perversion, sufficient for
the consummation and possible perpetuation of an epileptic habit.

During the prevalence of our ordinary autumnal epidemics, a
manifest predisposition or constitutional incorporation of morbiiic
matter is contracted; ostensibly pervading, assimilating with, and
conspicuously characterizing, all succeeding determinations or
developments of disease, however induced or provoked, and fre-
quently subverting or presenting indications of paramount import-
ance in the successful management of the case..

This innate disposition, or malarious diathesis, un dergoes a mark-
ed modification upon the accession and dining the progress of
winter; decreasing in activity and potency, becoming ambiguous
and obscure, and eventually degenerating into an asthenic; latent
and indefinable deterioration of general and local innervation, re-
sulting in occasional exhibitions of anomalous neurotic and func-
tional disorders, difficult of diagnosis and obstinate of cure.

While this constitutional contamination continues a preternatu-
ral susceptibility to the invasion or induction of disease exists, and
any combination of circumstances or particular eligibility, contri-
bute to predilect and promote the subsequent demonstration ; and
accordingly, from the preponderance of cerebral and nervous de-
velopment and impressibility in children, a proportional deter-
mination to that organ and system predominates; and when, from
the presence of this deleterious influence, and undue exaltation or
erethism is already excited ; but little adaptation or concentration

1855.] Epilepsia Jfiasmatica* 725

is necessary to produce a degree of cerebro- meningeal irritation or
:tion, adequate for the full development of an epileptic con-
vulsion. Three* 9 I shall tin elucidation of this
ie same school at the time assailed by this
affliction, when the brain would necessarily be disproportion ally
. and who were considered the most precocious and as-
siduous of the and in whom no hereditary proclivity could
be a 1.

In submitting a detail of the following I shall confine my

remarks to a brief delineation of symptoms and effects, ofas
and recorded at the time.

3E 1. On the second day of March. 1847; while practicing

-tily called, about elc >ck in

the forenoon. a little girl, twelve years of age, who had

suddenly fallen from her seat in hool, and on

reaching the place, found her reclining in the arms of a neighbor-
onian; the violent convulsions having partially subsided,
ilar muscular contractions occasionally occurring, with distor-
tion of features, grinding of the teeth and frothing at the mouth;
perfectly insensible, and apparently comatose; li - and rigid-

thumbs; spasmodic inspirations, and irregular and inter-
mitting pulse. Having ordered an immediate removal to her
nee, the ordinary pal iatives were applied; after which she
sank into a deep and undisturbed slumber of nearly an hour's
continuance, when she suddenly awoke, with the confused and
astonished expression and stare, characteristic of epilepsy, which
I concluded to be the nature of the case, and designed to treat
accordingly. Advising a further repose, I left, with the promise
to return in the evening, at which time I found her quite recover-
ed, having experienced no febrile reaction of any consequence, and
had a warm, profuse perspiration during sleep. Left a mild ca-
thartic, to be taken at bed-time. Next morning found my patient
apparently well, and employed in her usual amusements. En-
joined an from school, and promised a preventive course
of medication : Hit eleven o'clock the next day was hurried-
and informed that my patient was in another paroxysm.
This I found to be pr- milar to the previous attack; and,
upon inquiry, learned that she had been seemingly well until a
short time before seizure, when she complained of a slight sense of
chilliness and uneasiness, and immediately went into a convulsion ;
and, on further investigation, discovered that she had suffered, the
previous autumn, from a persistent intermittent fever.

m this fact, connected with the prominent periodicity and
,profuse perspiration, inferred the affection to depend upon malari-
ous influence. Prescribed a dose of calomel and carbonate of iron,
to be followed, next day, by the continued use of quinine and
strychnine, combined in solution. On visiting her again, at the
period of the anticipated recurrence, found her complaining of cold
toes numbness of the feet and hands, with an uneasy and un-

N. S. VOL. XI. >'0. XII. 46

726 Epilepsia Miasmatica. [December,

pleasant sensation of the lower extremities, closely allied, in des-
cription, to the Aura Epileptica; a slight degree of vertigo, and
an expression of alarm and anxiety : all of which symptoms dis-
appeared without further disturbance, and terminated in a quiet
sleep and perspiration. The same medicine was continued for a
proper length of time, and she never experienced a return of the
paroxysm during the subsequent four years that I remained in the
place enjoying uninterrupted good health, and became a finely
formed and fully developed girl.

Case 2. A handsome, intelligent and active little boy, seven
years of age, attending the same school, on the eleventh day of the
same month, complained of feeling cold, and was permitted to ap-
proach the stove, where he shortly fell upon the floor in a severe
convulsion, creating great consternation among the scholars, who
immediately apprized me of the fact. On examining the case, I
found it resembling in almost every particular the one previously
described, and which disappeared in much the same manner. The
same treatment was accordingly adopted. Upon the second suc-
ceeding day, a like disposition manifesting itself, about the same
hour, I was at once sent for, and found my little patient extremely
excited, vociferously talking, impulsively screaming, and at times,
crying out from an apprehension of some imaginary danger com-
plaining of an exquisite sensitiveness of the hair and scalp, upon
the crown of the head. After the administration of a Dover's pow-
der,, he became quiet slept, and perspired freely, and awakened
feeling comparatively well. The medicine was continued, and
the disease disappeared, without any return, in the same length of
time as stated in the former case,

Case 3, A spare, sallow and sickly looking girl, fourteen years-
of age, complained of a sense of chilliness,, and approaching illness,
while confined in the same school on the 2 1st of the same month,
and was advised by the teacher to return home, the distance being
but a few rods, which she did ; on reaching her house, she was
affected with dizziness and occasional blindness;, repaired to her
bed, and immediately convulsed. I was directly called, and found
her insensible ; teeth rigidly flexed ; eyes staring and distorted ;
fingers firmly flexed ; slow and rattling respiration ; head twisted
to one side -r lips blue and puffed, covered with foam, issuing be-
tween her teeth : directed a stimulating foot-bathr applied ammo-
nias to the nostrils, and a mustard cataplasm to the prascordia.
After a short time she relapsed,, and vomited a quantity of bilious
secretion ; after which I gave her ten grains of calomel, and she
shortly went to sleep, and remained so for some time,, attended
with a free and general perspiration. The same course of treat-
ment was pursued as in the former cases, and she eventually, after
two or three slight periodical returns, entirely recovered; but
owing to the consecutive character displayed by these cases, specu-
lative curiosity was excited in the community, and the school dis-
missed. The house was located directly upon the elevated margin

1855.] Epilepsia Miasmatica, 727

of a shallow swale, which ran diagonally across the commons, to
which I attributed the complaint called into action by the influ*
ence of an advanced season.

Coincidental with the foregoing cases, I visited a child in the
suburbs of the town, similarly afflicted. From this time until the
fall of 1849, when I left that region, I witnessed no more instances
of the kind, but subsequently locating in Sandusky, I met with
throe cases of a similar character, one of which differed in no parti-
cular from those above related. The other two, so closely allied
in nature, yet presenting peculiar features and consequences, de-
mand a faithful relation.

Case 4. In the month of March, 1853, I was called, at an
early hour in the morning, to visit one of our most respectable,
energetic and assiduous attorneys, of a marked nervo-bilious tem-
perament, and was informed that he had passed a harassing and
sleepless night, from an inordinate mental activity and excitement,
and an irresistible disposition to voluble loquacity, which was
continued incessantly the greater part of the night, and ceasing
only upon encroaching exhaustion inducing sleep, which was at-
tended with a profuse and debilitating perspiration. I found him
languid, and tongue slightly furred; pulse soft, but accelerated;
dull headache, and slight pain and uneasiness in the lumbar re-
gion and extremities prescribed the blue mass and hyoscyamus
in pills, and enjoined quiet. AVas re-called about eight o'clock the
same evening: found him extremely excited, vehemently dis-
coursing upon different subjects, but perfectly rational in all his
replies to my interrogatories, attributing his excitement to arduous
duties undergone during a protracted sitting of a court. Inform-
ed me that it had recurred upon the same hour as on the preceding
night, accompanied with a corresponding sensation of chilliness,
in the extremities and back, succeeded by peculiar uneasy numb-
: surface cool, pulse rather frequent, and an increased flow of
saliva. From this intelligence, apparent periodicity, and the fact
of having attended him the previous autumn, in an attack of per-
nicious intermittent fever, I administered a full dose of Dover's
powder for the night, under which he slept and perspired freely,
and ordered regular and free doses of quinine, strychnine and
morphine, in combination, the following day, and he passed the
period of recurrence with only a slight manifestation, after which
he experienced no further effects. This was evidently cerebral
excitation, induced and periodically sustained, by malarious influ-
ences approximating in vigor and effect, the same action as result-
ed in epileptic convulsions with the former

Case 5. A male child about three years of age, the son of one
of our most respectable and influential citizens, apparently healthy,
and robust in conformation, was attacked with an active intermit-
tent fever in the autumn of 1851, which was arrested by ordinary
means, without any difficulty, or unusual appearances, out return-
ed sometime after as a masked intermittent, which was also readily

728 Epilepsia Miasraatica. [December,

relieved, and from that time enjoyed good health until about the
first of April, of the succeeding spring, when he one day complain-
ed of chilliness and other slight symptoms of illness, which was
presumed to result from out door exposure, which had been per-
mitted, but on the second day succeeding, was again affected in the
same manner, which eventuated in a severe convulsion, so closely
resembling epilepsy, as to create great alarm and anxiety in the
parents, from the fact of a brother, on the father's side, being sub-
jected to epileptic attacks, for a number of years. From a know-
ledge of his previous affection the assumed periodicity and
similitude to the cases detailed, the same diagnosis was consequent-
ly deduced, and the same mode of treatment adopted, and like
favorable results obtained. He passed the summer without any
return of the disease, but late in the autumn was again subjected
to chills and paroxysms, attended with prominent gastro-hepatic
derangement at first assuming a tertian type, but subsequently an
erratic and irregular development. I hereupon adopted a methodi-
cal course of treatment, by successfully administering citrate of
quinine and iron, oxide and valerianate of zinc, combinations of
narcotics and restricted dietr and eventually nitrate of silver, cor-
recting visceral derangement by occasional doses of calomel and
carbonate of iron. The paroxysms again subsided during the con-
tinuance of winter, but again reappeared upon the ensuing spring,
premonished by the former gastric disturbances and ejection of
biler but with diminished febrile reaction, and longer protracted
convulsions, and began to manifest some of the appreciable evi-
dences of confirmed epihpsy; as impediment of speech, slight
strabismus, irrascible temper, immoderate activity, and capacious
appetite, but again p issed the summer without a relapse. At this
period he was seen by the late Dr. Dresback, of Tiffin, whose ac-
knowledged experience and practical suggestions I was desirous of
obtaining. He considered the case as one of simulated epilepsy,
depending on and resulting from miasmatic influence and concen-
tration 1 and prognosticated a favorable termination, and entire
exemption by proper treatment and care advised a sojourn to
the sea coast, during the autumnal season, which was complied
with, He also informed me, that he had met with similar cases in
Irs own practice,, and one presenting more untoward indications
than this one, and which eventually entirely recovered. Such
cases possessing a favorable tendencyr instead of the intractable
deterioration of essential epilepsy.

This patient escaped any violent manifestations of relapse du-
ring- the autumn of 1855, which was passed at an eastern resort
upon the coast, and only displayed some occasional vertiginous
disturbance on his return, which were usually excited by erroi
in dietr or under exercise and fatigue. Early in the spring oi
1854, the family removed to Cincinnati, where, through my recom-
mendation, he passed to the professional care of Dr. Mendenhall
to whom I communicated the history of his previous condition

1855.] Treatment for Otorrhoea. 729

and under whose management lie much improved, and I believe
had no relapse of | sma, and who I learned placed him upon

the continued use of stramonium, and regulated diet

In this case there was an evident hereditary predisposition, as
communicated bv the family, two or more instances having occur-
red in their ancestors, but was unquestionably called into action,
sustained, and probably perpetuated, by the direct influences of
miasmatic poison.

I offer the foregoing cases and considerations, without any de-
sire to complicate the causes, or nomenclature of the disease, but
merely to state the fact, of such a character of the disease existing,
having never met with any notice, or account of the affection, in
medical publications; one striking feature as yet unnoticed, is the
fact of the vernal predilection observed by the cases narrated,
which probably depends upon the character of the zymotic ele-
ments, eliminated and set free by the revivifying influences of
spring. [ Wt s cet

On a New Method of Treatment for Otorrhcea. By James Years-
ley. Esq., aLK.CS., Eng., Surgeon to the Metropolitan Ear
Infimary.

To the Editor of The Lancet:

Sir. As the enclosed paper is a continuation of the subject of
papers which appeared in the The Lancet of July, 1848, I shall
esteem it a favour if vou will kindly permit it to have the advan-
tage of the same medium for circulation amongst the profession.
I am, Sir, yours very obediently,

Jas. Yearsley.

It would be contrary to experience, as evinced in the history of
almost eveiy discovery, were the advantages deducible from it to
be at once either fully developed or duly appreciated. When in
1848, so this journal,* it was my good fortune to introduce a mode
of treatment capable of alleviating so materially certain enses of
deafness previously deemed beyond the reach of our art, and that
by one of the simplest of remedies, it could scarcely have occurred
to me that this very practice would, in its turn, lead to an improved
method of treating that very troublesome affection, otorrhcea an
affection which has so frequently baffled the best directed and
most persevering efforts of medical practitioners.

In the present, as in the former case, the agent by which such
results are accomplished is so simple, and seemingly so inadequate
to the end, that nothing short of the most irrefragable and conclu-
sive experience could suffice to convince me of the value of the
method, and the superiority it possesses over the uncertain and

* See The Lancet. July 1848; and "On a Xew Mode of Treating Deafness, ia,"
pamphlet, Churchill, New Burlington-street

730 Treatment for Otorrhoea. [December,

precarious modes of treating otorrhoea by injections hitherto in
use ; nor will it be less surprising when it is added, that it is
neither more nor less than a modification of the remedy already
introduced to the notice of the profession for the alleviation, if not
for the cure, of all those cases of deafness that arise from partial or
entire loss of the membrana tympani namely cotton wool.

But what I have just stated regarding this new mode of treating
otorrhoea, does not comprehend, by any means, the only advan-
tage derivable from its employment, for its value is not limited to
the mere arrest and cure of the discharge; it has this additional
superiority over the usual modes of treatment, that the sense of
hearing so frequently impaired under the use of astringents, is, on
the contrary, not only not diminished, but decidedly and in many
cases immensely improved.

It is not denied that astringent injections containing alum, salts
of lead, zinc, &c., which from time immemorial have formed a
prominent feature in the routine treatment of otorrhoea, have
sometimes been successful in suppressing the discharge ; but how
often have practitioners had reason to regret, in such cases, that
in an exact ratio with their success that is, in exact ratio with
the subsidence of the discharge has there been a corresponding
diminution of the sense of hearing. In my experience this has
been so manifestly the case, that for many years past I have pre-
ferred recommending patients to submit to their malady, rather
than incur the alternative. I have accordingly limited the treat-
ment generally to the mere cleansing and soothing of the ear,
without prescribing the use of such means as might be supposed
capable of suppressing entirely the discharge.

I had not long practised this plan for the relief of deafness
arising from partial or entire loss of the membrana tympani, ere
my attention was arrested by the fact adverted to namely, the-
gradual diminution, followed by the entire cessation, of the dis-
charge, which almost invariably occurs in cases where the wetted
cotton is used for the purpose mentioned, and to the use of which
there can be no doubt such a result is alone attributable. Fre-
quently would some patient exclaim, with no little satisfaction, if
not exultation, " Your remedy has not only improved my hear-
ing, but the discharge, which was so offensive to me, has entirely
ceased." A fact so remarkable could not fail to claim attention ;
and the first cases of chronic discharge from the ear that presented
themselves, irrespective altogether of deafness, were made the sub-
jects of my experiments with the cotton. A few cases, by way of
illustration, will be appended.

I come now to mention the manner of applying this remedy.
First of all, the passage of the ear is to be carefully cleansed by
gently syringing it with warm water, and the moisture removed
by means of a porte-sponge. The parts are now to be so clearly
displayed by the aid of a powerful gas-reflector, that the necessary
manipulations may be readily and accurately accomplished, when

1855.] Treatment for Otorrhoea. 731

I take a small piece of dry cotton the size of which varies accord-
ing to the circumstances of the case and adjust it by gently
:ng down every part of it upon the surface from which the
discharge proceeds, exactly as if dressing an ulcer on any other
surface of the body; this done, quiet is enjoined, restricting, as
much as possible, every movement of the jaw, such, for instance,
as takes place in eating and speaking. Twenty-four hours after-
wards I remove this, and apply another dressing of the cotton.
The importance of restricting the patient from moving the jaws
will be at once manifest, if the reader will take the trouble to place
the point of the finger in the passage of the ear, and read aloud the
present paragraph. It will then be perceived how easily the cot-
ton, however accurate^ adjusted, may be loosened and moved
from its state of exact apposition. In eating, the detachment takes
place still more readily, yet the patient cannot be debarred all use
of the jaw, seeing he must have food; nor, if great care be taken
to keep the jaws in a state of motionless apposition, need speech
be altogether interdicted ; but for the same reason the food should
be such as to require no mastication. Doubtless no one will con-
sider these restrictions as objections to this mode of treatment;
though a more specious, but equally invalid objection to it may be
raised, on the ground that the tympanum being a cavity, such a
degree of accuracy in adapting the cotton to its surface, as descri-
bed, cannot be attained. If the ear be examined with the admira-
ble appliances for its illumination now at the command of the aural
surgeon, it will be found, in cases where the membrana tympani
is destroyed, that the extent of the surface from which the dis-
charge proceeds, is not only exposed to view, but the cavity is
observed to be obliterated. an4 the walls of the tympanum, red
and vascular, are seen thickened and tumid, if not spongy or fun-
goid. I speak here more especially of the worst cases that come
under the notice of aural surgeons, in the great majority of which
not only is the discharge itself cured, but the patient experiences
a great amelioration in the state of his hearing also. Nay, more :
cases can be referred to, in which the great disorganization of the
ear seemed to preclude all hope of effecting any amelioration of
the hearing, yet in which, after persevering in the treatment for
a greater or less period, a change has been accomplished, which
could not have been confined to the fungoid tissues alone, for, in
the cases I speak of, a sensible improvement of hearing has been a
coetaneous result.

The successful treatment of external otorrhoea by the same sim-
ple means has been hitherto no less rapid than certain. Moreover,
in nearly every case, relief of the deafness has accompanied the
cessation of the discharge a result the reverse of that which fol-
lows, almost invariably, the treatment of external otorrhoea by
astringent injections. The arrest of the discharge may, indeed, by-
such means, be accomplished in many instances without any great
difficulty ; but when that has been effected, we have no great rea-

732 Treatment for Otorrhcea. [December,

son to rejoice at a cure that has been produced at the expense
of the patient's hearing.

As already hinted, I foresee the argument, based on the fact of
the tympanum being a cavity with a traversing passage, that may
be adduced against the treatment; but it is contended that in
chronic otorrhcea, of that aggravated form, at least, of which I
speak, no such cavity, for reasons already stated, is found to exist.
The theorist, indeed, as in the case of the treatment of certain
cases of deafness by excision of enlarged tonsils, may contend that
the occlusion of the guttural extremity of the Eustachian tube is a
physical impossibility ; but as in that case, so in the present, facts
that stand forth in bold relief are not to be overthrown by the
laugh of illogical reasoners, how eloquent soever may be their mis-
taken efforts. What fact, in surgical therapeutics, is now better
attested than the cure of deafness by the excision of enlarged ton-
sils? As in that instance, so now in the treatment of otorrhcea
by the simple means so confidently recommended; look at the
facts. It is true, the investigation of this subject is still going for-
ward, and cannot, therefore, be considered as complete ; but if any
modification of what is here stated should become necessary, it
must be sought for in future experience, not in that of the past.

A chronic discharge of mucus or of pus from the passage of the
ear, or of mucus and pus intermingled, is usually denominated
otorrhcea. This affection, which may be confined to the external
meatus, involving chiefly the ceruminous follicles and lining mem-
brane, or which may extend to the internal ear, when it does not
originate therein, is one of the most common as well as the most
troublesome affections to which the ear is liable. And not only
so, but otorrhcea is usually regarded as an affection more intracta-
ble than any other to which the ear is subjeet; and is one, besides,
which it is considered dangerous to cure, and against attempting
to cure which, cautions have been from time to time addressed to
practitioners by almost every writer on diseases of the ear. How
far such cautions, which should have been directed against the
means rather than the end, were necessary, will afterwards be
seen. But otorrhoea, even when neglected, or when unsuccessful-
ly treated, is not always a disease from which the patient experi-
ences much suffering, for pain is by no meaus a necessary attend-
ant; and cases may be met with where the discharge has existed
for years nay, for the greater part of a lifetime, yet unaccompani-
ed all the while by any appreciable measure of pain.

Though otorrhcea may be considered generally as a purely local
disease, yet practitioners there are who seem disposed to regard it
as dependent more on constitutional than on local causes, and
requiring for its successful treatment chiefly constitutional reme-
dies a view too exclusive to require any formal refutation. That
in many cases otorrhcea may be modified by constitutional causes,
is no doubt quite true, and scrofula may be named, especially in
the young, as an undoubted example. But its manifest origin is,

1855.] Treatment for OtorrJ 733

in a great majority of cases, from re local, and that act

directly on the ear itself; the visible, consequent alteration of the
tes that takes place consisting usually in a if not fun-

goid, state of the lining membrane: the readiness with which both
these and the discharge yield, and ai; of th< disease i

appear under the mode of local treatment now advocated, and
without being followed by any of the untoward effects which we
are cautioned to expect these are all reasons which, when com-
bined, are more than sufficient to show how little claim utorrhcea
can have to be considered generally as a disease of constitutional
origin. That an affection so little amenable to the modes of local
treatment usually had recourse to should, in the end, come to be
looked on as one of constitutional rather than of local origin, ad-
mits of a ready explanation ; but beyond constitutional states that
may be coincident with this, as they may be coincident with any
other local d I can see no ground for making any such ex-

clusive admission in favor of otorrhcea.

They who regard otorrhcea as a disease of constitutional origin,
no less than they who consider it a merely local affection, seem
alike imbued with ideas of danger that may arise from attempts to
suppress, by topical applications the discharge. Examples of
danger arising out of such practice are, indeed, not unknoi
and deserve the attentive consideration of all who undertake the
treatment of aural diseases. But the danger, when danger occurs,
arises not from obviating the disease- that is, the morbid altera-
tions of structure, which, indeed, such treatment professedly does
not attempt to do but from the too energetic use of astringents,
through which only the prominent symptom of the disease, rather
than the disease itself; becomes possibly suddenly suppressed. It
is obvious, however, that were the diseased state of the parts to be
first of all remedied by means, simple or complex, no matter what,
but changed from an unhealthy to a healthy condition, then would
the otorrhcea, as a necessary consequence, disappear. But how
have practitioners at least, the more incautious of them attempt-
ed to get rid of the discharge? Not always, certainly, in the
manner we would indicate. On the contrary, every one knows
that injections, containing salts of lead, zinc, and copper, nitrate
of silver, creasote, cv stitute the usual routine in such

cases; and though they may, as has been said, be capable of sud-
denly, and in a dangerous manner, suppressing the discharge, yet
cannot now, after such ample and lengthened experience of their
inefficiency, be supposed capable of removing that morbid state of
the tissues on which the discharge depends. That danger, then,
may arise to the patient under such a treatment is quite conceiva-

* Br. Wilde, also, one of the latest writ* ' the ear, and wt

that "this tedious and difficult," recommends " the various salt*

which eater into the general decomposition of eye collyria" as being "here par-
ticularly applicable, especially those of alum, lead, zinc, and copper." Aural Sur-
gery, p. 410, L

734 Treatment for Otorrhoea. [December,

ble, and it is a source of unfeigned satisfaction and pleasure to me
to be able to make known a mode of treatment as safe in all such
cases as it is efficient, by which the usual mode of treatment, ac-
cused of being so hazardous, must soon, and I hope forever, be
superseded. My treatment will thus do away with all ground for
non-interference with this discharge on the pretext of danger, as
well as remove every reason for counselling submission, on the
part of the patient, to a loathsome discharge a source at all times
not only of disgust, but that renders the subjects thereof, so long
as it is allowed to continue, peculiarly liable to aggravation of
their malady from all those influences that have been mentioned
as occasional causes of this disease.

Miss L , pupil in the establishment of Miss Hurst, St. John's

Wood, became my patient in June, 1854, suffering from a most
disagreeable discharge from the right ear, which was left as one of
the sequeke of scarlatina several years ago. Considerable deafness
attended the case, which varied with the state of the discharge,
being greater when the latter was least abundant. On examina-
tion, a small perforation existed in the membrana tympani, below
the insertion of the malleus ; and the walls of the meatus, near to
the membrane, presented a vascular appearance, approaching to a
state of semi- ulceration. Contenting myself with cleansing the
meatus, by carefully syringing it out with warm water, I directed
her to apply a poultice, enclosed in a linen bag, to the side of the
head, including the ear, for two nights in succession, and then to
visit me again. At the second visit, the irritable appearance of the
meatus had subsided, and I proceeded to adjust and impact a small
piece of dry cotton at the bottom of the meatus. From day to
day the same treatment was employed for upwards of a week, by
which time all discharge had ceased. It was my wish to continue
the application for three or four days longer, but arrangements
had been made for her return to her friends for the holidays, which
could not be overruled. As I feared, the result proved that the
treatment was too early discontinued; for in six weeks she return-
ed as bad as ever. This time she was instructed by her friends to
attend me until the cure was complete; and this was happily ef-
fected in a period of three weeks. The discharge entirety ceased,
and the hearing was perfectly restored. On examination of the
membrane, no appearance of perforation remained.

W. W , foreman in the establishment of Messrs. , be-
came a patient of the Metropolitan Ear Infirmary, January, 1855,
suffering from otorrhoea of some months' continuance, accompani-
ed by a considerable degree of deafness. It appeared to me to be
a very favorable case for the new treatment, and he was desired to
attend me daily for the purpose of trying it. The cotton was ac-
curately adjusted, and from day to day it was replaced by a new
piece. Every application was followed by an improvement, and
the patient invariably spoke of the great "comfort" he experi-
enced from the remedy. In one week all discharge had ceased,

1855.] Treatment far Otorrhea.

and his hearing was better than it had been for In this

case both membranas tympanorum were entirely al ill there

- no appearance of an open cavity. The walla of the tympana
were fuliy exposed to view, and' the patient could "wh
through the ears. Under such circumstances, so rapid a cure
could not have been expected. I had the satisfaction of hearing
from this patient that, many years ago, I had entirely cured his
son of an extreme deafness by excision of exuberant growths from
the tonsils. The lad, now a grown man, had been entirely re-
stored to hearing by the operation.

Miss . the daughter of a surgeon in the Xorth, favoured me

with a visit on the 10th of January, bringing with her an intro-
ductory note from her father, from which I extract the following
brief history of her complaint : ;i When she was about five or six
years of age (she is now twenty) she had a severe attack of scarlet
fever, during which her ears began to discharge ; and, on becom-
ing convalescent. I was grieved to find her hearing affected. E
cept keeping the ears clean by the daily use of warm water (inject-
ed), I did nothing, and scarcely have done anything more ever
since, although occasionally urged to do so by several of my medi-
cal fiiends. You will find the rnembranae tympanorum more or
less gone in both ears. Her general health is uniformly good.
She he. m one side, but very imperfectly on the

other. I have thought the case a favourable one for the cotton
wool, as advised by you some years a ; All this I found

rined, on examination, with the exception of not finding the
membrane perforated on the right side, though it had evidently
suffered damage during the fever. The discharge existed only on
the left side, and to that I directed my attention. The passage of
the ear was tumefied and contracted,' so that the cotton remedy
could not be applied with effect. I therefore set to work to cure
the discharge by my new method, trusting that, if successful, im-
proved hearing also would be experienced by my patient. Day
atter day the dry cotton was applied, with a gradual improvement
certainly, but still with only partial success. The tumefaction,
however, diminished, and the calibre of the passage was propor-
tionately increased. One day mv patient reported to me that she
had experienced a sensible improvement in her hearing, and she
herself suggested another trial of the moistened cotton. This was
done, and with a decided improvement in hearing, so that from
this time the treatment of the discharge was a secondary considera-
tion, and I proceeded to teach her how to apply the moistened
cotton, which is now followed up with daily success, the discharge
ceasing as a matter of course. The great impediment to the sup-
pression of the discharge in this ease, by the impaction of the
dry cotton, arose, I suspect, from the free of the Eustachi-

an tube, along which the discharge in the tympanum freely trav-
elled, of which my patient was frequently and most disagreeably
made sensible.

'36 Trealmont for Otorrhea. [December,

Mr. W- , surgeon in the navy, who had just received orders

to hold himself in readiness to proceed to the Crimea, consulted
me in December last for disease of the left ear, attended by a loath-
some discharge. On examination, I discovered a small fleshy
excrescence growing from the surface of the membrana tympani,
which was very much disorganized, without any apparent per-
foration, though it seemed as if such a condition had at one time
existed. The hearing was greatly deteriorated; but having the
sense perfect on the opposite side, he was but slightly inconveni-
enced. The discharge, and a sense of oppression on the affected
side, were the chief sources of complaint. I explained that it
would be necessary first to remove the fleshy excrescence, and that
then I should proceed to relieve him by my new mode of treating
cases of otorrhoea, and that such treatment would require his daily
attendance for several days in succession.

At that time it was inconvenient to him to remain, and he re-
turned to his duties at the Royal Naval Hospital at Deal, until he
could make arrangements and obtain leave of absence for about a
fortnight in town. In the interval he was one day exposed to a
cold, piercing, easterly wind, and wishing to protect the diseased
ear, he pushed into the passage of it apiece of dry cotton, of which
he took no further notice. On the 10th of January I received a
note from him, to say that he had obtained leave of absence, and
would visit me on the following day, which he did. On examin-
ing the ear, I said, "Why, what have you got in your ear?"
"Nothing; I have done nothing to it." "Oh yes, you have," I
replied, at the same time withdrawing from the ear a dry piece of
coiton, which had evidently been impacted there for several days.
Again applying the speculum, I remarked : " The fleslw excres-
cence has disappeared, and you have unintentionally cured your-
self of the discharge. You have absolutely cured yourself upon
the principle of treatment of which I told you at your last visit.
The piece of cotton I have just extracted has by some good luck
been pushed down upon the seat of disease; its pressure has dissi-
pated the excrescence, and with it the discharge has vanished."
His astonishment was succeeded by an immoderate fit of laughter,
which was thus accounted for: A surgeon had examined his ear
the day previously, and said, "Oh yes, I see the fleshy growth
quite plain : Mr. Yearsley will have no difficulty in removing it!"
So much for the opinion of surgeons unaccustomed to see diseases
of the ear. The gentleman alluded to could only have seen the
pellet of cotton-wool. But more experienced surgeons than he
may be deceived in regard to disease in the passage of the ear. I
remember once to have removed a polypus from the ear of a
young lad}^, the existence of which had been denied by two of the
most eminent surgeons of the day. [London Lancet.

1855.] Practical Remarks on Strabismus.

Practical Remarks on Strabismus; with suggestions re-

specting the Operation. By G. CitfTCHETT, Esq., ] Sur-

geon to the Royal London Ophthalmic Hospital; Lecturer on

Surgery at the London Hospital, etc.

It is now about sixteen years since the first operation for strabis-
mus, so philosophical! >meyer. and so boldly
executed by Dienenbacb, was performed; it was bailed as a great
discovery, and excited an unusual amount oi n the part

of the members of our profession, and persons afflicted with this
deformity became suddenly - of interest and even solicita-

tion. Thousands have been operated upon with various results.
but it still admits of doubt whether t symmetry of

those afflicted with this deformity has been increased, and whether
the impression left upon the public mind, and even on that of the
profession, is not rather unfavorable to this operation. I think it
will be both interesting and instructive to the members of the pro-
fession, to endeavour to point out how far there exists any legiti-
mate ground for these unfavourable impressions, and how far the
present deftcts of the operation admit of improvement. Very soon
after the importation of this novel and ingenious proceeding into
this country, the literature of the profession on this subject was
suddenly and copiously supplied, but it was evident that some
wrote rather for than from practice, and that in every case the
experience was too limited, and the time for observing si
quent results too short, and the mental bias in its favour too strong
to admit of a calm and satisfactory verdict upon the merits of the
:on. Now that many years have elapsed, that vast numbers
have been operated upon, that enthusiasm has cooled down, and
that comparatively few cases remain, we are able to approach the
subject in a more philosophic spirit, and fairly and impartially to
discuss the merits and dements of the operation. As my object
in tins paper is chiefly practical, I do not propose to travel over
the difficult and often discussed question of the pathology of stra-
bismus, but only to glance briefly at a few points that seem to bear
upon treatment.

Much has been said about the importance of determining which
is the defective eye in any given case, and rules have been laid
down for ascertaining this point. The truth is, that in almost
every case both eyes are equally implicated in the abnormal posi-
tion ; for although one may be habitually inverted and the other
straight, yet if the strabismic eye be brought into play, it assumes
a normal condition, and moves in obedience to the will, and the
other eye, if suddenly uncovered, will be found precisely in the
position that the diseased eye usually assumes ; and 1 have proved
over and over again that as favourable result is obtained by oper-
ating upon one as the other. The fact is. that in strabismus the
two eyes start from different points; both respond to the effort
of the will, and each is found, when examined separately, to move

738 Practical Remarks on Strabismus, [December,

equally well in every direction. The disease is, therefore, rather
relative than positive. Practically I endeavor to find out which
is the eye that is habitually inverted, and for this purpose I test
the relative power of vision in the two eyes, and I select for opera-
tion the one presenting this peculiarity. But in the alternating
form of this disease it is quite immaterial which is done, and in
any case the result would be the same as regards the removal of
the deformity ; but the defective eye is selected in the hope of
benefiting its vision simultaneously with its position.
_ The first point that impresses itself upon the mind of an exten-
sive and careful observer is, the extreme variety of causes to which
the disease is attributed; but when these are analyzed and group-
ed, they may be arranged under three heads : first, where the
origin of the nerves is affected through the brain and spinal cord,
as in cases following convulsions, fevers, &c; secondly, where
irritation is propagated from extremities of nerves, as in cases fol-
lowing injuries, ophthalmias, &c. ; thirdly, from morbid volition,
as in cases resulting from irritation, from temporary excitement,
&c. In investigating the causes of strabismus, we find a very
close analogy between this disease and talipes. Another circum-
stance, equally conspicuous and more embarrassing, is the num-
berless shades of difference in the degree of departure from the
normal position, whether it be inversion, or, more rarely, eversion,
or, still more rarely, undue elevation or depression. In extreme
cases, we find that when one eye occupies a central position the
other is so far drawn into the corner, that about half the cornea is
concealed by the folds of the caruncle; in slight cases the depar-
ture from the central axis is from half a line to a line, and between
these two extremes there is every shade of difference. The same
may be said respecting diverging strabismus; but the third varie-
ty viz., that in which either the superior or inferior rectus is
involved, is never found in an extreme degree. Again, we find
that the condition of the sight is very different in cases that are
in other respects apparently simple. The rule certainly is, that
in cases of habitual strabismus of some years' standing the func-
tion of the organ is impaired ; but I have met with several well-
marked cases in which the sight has remained perfectly good, and
with others in which the degree of impairment of vision has vari-
ed considerably, some being able to read large print, others being
scarcely able to distinguish features, or even large objects. In the
alternating form, vision is almost invariably found to be equally
good in both eyes ; and these varieties exist without any obvious
change in the appearance of the eye, either as regards the condi-
tion of the pupil or of any of the transparent media, such as may
generally be observed in amaurotic cases. It is quite possible that
the ophthalmoscope would reveal changes in the retina and choroid
in some of these cases, but I have not as yet had opportunities of
observing a sufficient number to speak with any certainty. It has
been said that the power of the external rectus, and consequently

1855.] Practical Remarks on Slrabisjnus. 7 '69

of eversion, varies considerably, as evinced by t. which

the eye can be acted upon by this muscle; and this may be true
in some cases, but it must be received with much caution, parti-
cularly where the strabismus is extreme, because the limit to ever-
sion of the one eye depends upon the other fa ached its
utmost extent as regards inversion, and consequently the volun-
tary effort as excited in both e;. ached its extreme bound-
ary.

In considering the question of treatment I propose to limit my
remarks exclusively to operative proceedings haying been

able to trace any advantage from any other plan, after the deform-
ity has existed any time. The operation that has usually been
practised for the removal of this deformity h rted in the free

division of those parts attached to the inner surface of the globe,
including conjunctiva, sub-conjunciivial fascia, rectus muscle, and
its sheath ; in fact, it was recommended by one author, that the
inner surface of the sclerotic should be cleansed; if we bear in
mind that this operation has been performed upon some thousands
of cases, of all ages, and presenting the numerous variet:
which I have alreadv alluded, the wonder, is that a greater number
of failures have not occurred, and that a uniform procedure should
have been found so extensively applicable to a condition present-
ing so many degrees of deformity ; nevertheless this is to a certain
extent true. When the eye is free from the muscle it seems, in
many i have an inherent and selective power of assuming

traight position. So that what seems improbable in theory
- in fact. At the same time, untoward results sometimes fol-
low the operation, either imm >r at a subsequent period,
rendering the condition of the patient worse than before. As,
therefore, the motives for recommending such an operation are
mainly based upon considerations respecting personal appearance,
(the improvement to sight being secondary and uncertain.) it be-
comes a matter of great practical moment to consider what are the
defects of this operation, and how far they admit of correction.
The first point that strikes every close observer, even in the most
favorable specimens of the operation, where the eye has assumed
a perfectly normal position, and moves free1. rtain sinking
in and loss of the caruncle, so that the inner part of the globe seems
more exposed than that of the opposite eye, and a fossa exists in
the place of the caruncle: this, so far as my experience goes, is an
invariable result of the operation, and explains the circumstance
that has been often remarked, that those cases are the most suc-
cessful in which it has been necessary to operate on both eyes, the
double defect being less conspicuous than when one only has been
divided, and is brought into competition with the natural state of
the parts. Another unfavourable result that sometimes occurs, is
increased prominence of the globe ; this takes place usually imme-
diately after the muscle is divided, but I have known it occur at a
subsequent period, and gradually increase for a time. This, no

740 Practical Remarks on Strabismus. [Decemberf

doubt, arises from the loss of balance of power between the recti
and obliqui, the latter acting with undue power when one of the
recti is divided; the difficulty is to explain why this occurs in
some cases and not in others, and to indicate any sign by which a
result may be predicated; and this I shall endeavour to do in a
subsequent part of the paper. The most serious and damaging
effect of the operation is the occurrence of eversion : this may be
an immediate or a very remote sequence of the operation; and
when the previous inversion has been slight, and there has been
increased prominence, and an extensive reaction in the outward
direction, the deformity is very great, and almost hideous: the
face seems robbed of all expression "there is no speculation in
those eyes." To the patient it becomes a serious grievance; and
to the operator, a kind of haunting spectral vision. I have met
with cases in my own practice, and in that of others, in which the
two cornea have occupied the outer angles of the lids, particularly
if the eyes have been operated upon, at the same time.

There are some other minor objections to which I may briefly
allude. The extensive wound in the conjunctiva heals very slow-
ly, remains red and swollen for a considerable time, often gives
rise to a fleshy growth that requires removal, and leaves a scar
more or less distinct, and the power of moving the eye in the
direction of the divided muscle is often quite lost, constituting in
itself some deformity. In stating the case, therefore, for the old
operation, there is invariably a sinking and loss of the caruncle,
and a scar, usually a considerable loss of power of inversion, not
unfrequently increased prominence of the globe, and occasionally
eversion more or less complete, either immediately or as a remote
effect, and there may be both prominence and eversion co-existent.
Now, considering that the operation is undertaken and submitted
to almost exclusively with the object of removing a deformity, it
becomes a question whether this deformity is removed to a suffi-
cient extent, and in a sufficient number of cases, to justify the
proceeding, and whether one decided case of eversion does not
outweigh a large number of what are usually deemed successful.
Whatever may be the opinion of the profession on this point, I
think it must be admitted that, with such defects, a wide margin is
left for improvement; and that if a procedure can be suggested, in
which no sinking in of the inner caruncle occurs, nor any per-
ceptible scar remains, in which increased prominence and eversion,
as far as my experience has yet gone, never takes place, and in
which the healing process is complete in a week, and is never at-
tended with the formation of a granulation, I think all must admit
that a very important point is gained. Such a plan I have re-
cently been in the habit of adopting, and it is chiefly with the
view of setting forth the details of this operation that I have been
induced to bring the subject before the notice of the profession.

The essential principle of the operation I am about to describe
consists in the division of the muscle sub-conjunctivally. This, it

1855.J Practical Remarks on Strabismus. l

Will be remarked, is not altogether a novel suggestion; it Las been
recommended by Moris. Guerin, and has been attempted with
more or less success by several; but it has been found difficult and
sometimes impracticable, in consequence of the method adopted.
Thus it is suggested to draw the eye forcibly outwards, so i
render the internal rectus tense; then to introduce a small bistoury
beneath the muscle, and divide it. Any one who has attempted
this operation in this way, will agree with me that it is one of ex-
treme difficulty; the loose capsule round the muscle prevents the
edge of the knife from acting upon the tendon, neither can the
tendon be made sufficiently tense to be thus divided. The diffi-
culty and uncertainty of this operation has resulted in its having
been rarely attempted, more rarely accomplished, and never re-
peated. The method that I propose, and that has been performed
by myself and some of my colleagues at the Ophthalmic Hospital
in a large number of cases, is the following: Having placed the
patient, if nervous or restless, or very young, under the influence
of chloroform, the eye-lids must be fixed open with a spring spec-
ulum, the globe may be now everted by an assistant, and the op-
erator, seizing the conjunctiva at a point corresponding to the
lower border of the internal rectus, makes a small opening with a
pair of rather strong blunt-pointed scissors, he then seizes the sub-
conjunctival fascia, and divides it to the same extent, so as clearly
and cleanly to expose a small surface of sclerotic. The ordinary
strabismus blunt hook, bent at a right angle, must now be swept
round the globe so as to pass beneath the muscle ; this may be
known by the peculiar elastic resistance that is felt; the blades of
the scissors must then be passed in through the opening, and by a
succession of small cuts the tendon may be readily divided between
the hook and the insertion into the sclerotic, and close to the latter.
You may distinctly feel and sometimes hear the creak of the scis-
sors as the tendon is cut through. Some little difficulty is some-
times experienced, when the insertion of the tendon is rather broad
in reaching its upper edge, and when that is the case I make a
small counter-opening in the conjunctiva corresponding to the
upper border of the muscle. I introduce the hook from above,
and, having passed it beneath the remaining slip of tendon, divide
it with the scissors in the same direction. This counter-opening
has the advantage of facilitating the escape of blood that has be-
come infiltrated beneath the conjunctiva, and it does not in any
way interfere with the principle and aim of the operation, which
is to'leave a broad band of conjunctiva between the cornea and the
inner caruncle intact. The advantages of this plan, as contrasted
with the old one, seem to me to be very great. It has, in the iirst
place, the merit enjoyed by all subcutaneous sections, of immunity
from inflammation and suppuration, and makes a very rapid and
certain cure ; no granulation ever forms, and the caruncle main-
tains its natural position, and does not shrink away into a deep
fossa, as is invariably the case when the usual operation has been

N. S. VOL. XL NO. XII. 47

<*4 f radical Jxemarfcs on Strabismus. [.December,

performed \ and as far as my experience yet goes, proptosis or in-
creased prominence of the eye is more rare, and eversion never
occurs, and the natural movements of the eye are more complete.
This I attribute to the fact that the ocular fascia is but little inter-
fered with, and that a good firm union takes place between the
divided muscle and the globe of the eye.

Such seem to me to be the advantages of the mode of operating
that I am now anxious to explain and recommend advantages
that are of so important a nature, that in fairly stating the case to
the patient, if the old operation is contemplated, it certainly admits
of doubt if the personal appearance is much improved, even in the
most favourable results, and there is always a risk of increased
prominence and of eversion, and it admits of a question whether
it can be recommended. If, on the other hand, the mode of pro-
ceeding I am now setting forth be in contemplation, we mav at
least feel assured, that if the deformity is not altogether removed,
it will not be rendered worse, and that in many cases the result
will be so perfect, that the most experienced eye will not detect
any defect, or be aware that any operation has been performed.
But it may be asked if there are any objections to this operation,
and any cases in which the old operation is preferable. It must
be admitted that it is rather more difficult to perform, that there
is a greater liability to leave some portion undivided, and that
sometimes some inversion remains, in consequence of the attach-
ment of the muscle to the fascia after it is divided from the sclero-
tic. This will often rectify itself afterwards, and where this is not
the case, it is better either to operate on the other eye, or, if the
cast is slight, be content to leave the case in that state, rather than
risk eversion by further interference. It is only in cases of long
standing,, and where the strabismus is very extreme, and where
the eye is small and deep-set, and where the sub-conjunctival
operation produces but very little effect, that the old operation is
justifiable.

Before I conclude this paper, I would just briefly glance at two
or three points of some practical interest, having reference to the
age of the patients, and condition of eye at which the operation
should be performed, and to the effect of the operation upon vision..

As regards the first point, my own experience, derived from
many hundred cases, is, that the most favourable results occur in
young adults, as contrasted with children. Cases in which the
relative position of the eyes is not uniform, and is aggravated or
altered by mental or bodily excitement, and in which there is any
oscillary or rotatory movements, are all uncertain in their results,
and very liable to be followed by undue prominence of the globe,
or by eversion, or both. On this account, I do not find operations
on children succeed so well as on young adults. As regards the
effect of the extent of the distortion in influencing the result of the
operation, it is difficult to lay down rules. As far as my own ex-
perience goes, I should say that in most extreme cases of inversion

1855.] Practical Remarks on Strabismus. 743

there is only a partial improvement from dividing one muscle, and
it is a nice point to determine if there be sufficient distortion re-
maining to make it safe to divide the inner rectus of the other eye,
without risking eversion. Unless the eye occupy a position at
least midway between the inner caruncle and the central axis, it is
not safe to operate. The chief causes of eversion, after the opera-
tion, are to be traced to the previous slight degree of the inversion,
to the unsettled state of the disease, or to an undue division and
separation of parts; and if the slightest eversion occur at the time
of the operation, there seems to be a constant tendencj^ to increase,
until it has reached its extreme limits. This arises from the dis-
advantage at which union takes place, the power of the external
rectus muscle, and the loss of the rectifying and controlling power
of vision. Eversion sometimes oocurs weeks and months after the
operation, in consequence of the gradual stretching of the uniting
medium, an analogue of which is to be found sometimes after
fracture of the patella, in which very extensive separation of the
two portions occurs. The very worst cases of eversion that I have
ever seen have resulted from a simultaneous division of the mus-
cles of both eyes, a proceeding that is in no case justifiable. The
effect of the operation upon vision is surrounded with obscurity
-and difficulty. In the first place, much variety exists in the ex-
tent to which vision is impaired by strabismus ; in the alternating
form, both eyes are equally good ; in children but little damage is
done ; but where the deformity has existed several years, there is
almost invariably imperfect vision, differing, however, in degree
in nearly every case.

In several remarkable cases that have come under my notice in
my own practice, in that of Mr. Dixon, and others, a very sudden
and complete restoration of sight has followed the operation. I
should hesitate to assert this curious and almost inexplicable phe-
nomenon, had I not verified the fact over and over again in a
manner that admits of no doubt. Mr. Holthouse has endeavoured
to explain this by supposing that the muscles of the eye-ball focus
the eye, and that the operation restores this power. If this were
the true solution of the riddle we should find something like uni-
formity of result, but this is not the case; the improvement is
sometimes gradual, and sometimes no perceptible change occurs.
These considerations suggest the performance of the operation
during childhood, aud if the result could be made equally favoura-
ble in other respects, this would be the most desirable period for
its performance, and the sub- conjunctival operation will render the
usual objections to an operation at this period of life less obvious.

It will be seen that the chief object of my paper has been to
describe and set forth the advantages of the sub-conjunctival ope-
ration ; and it may be thought by some to have the disadvantage
of difficulty and uncertainty, without sufficient counteracting ad-
vantages, particularly as it is alluded to very briefly and somewhat
disparagingly by the more recent writers on this subject Mr.

744 Practical Remarks on Strabismus. [December,

McKenzie, Mr. H. Walton, and Mr. Holthouse. After having
tried it in above a hundred cases, I never now adopt the old me-
thod, and I am strongly impressed with the uniformity of the
favourable result ; in no case have I had increased prominence or
eversion. In some cases, it is true, some amount of inversion has
remained, but this occurred at least as frequently with the old
operation ; so that the patient is now sure of improvement from
the operation, without risking the occurrence of any of the unfa-
vourable concomitants of the old plan.

As I have mentioned in the foregoing remarks, cases of eversionr
following the operation of dividing the internal rectus muscle,,
sometimes come before our notice. As this is a very distressing
deformity, far worse, in fact, than that for which the operation
was originally performed, patients are very anxious to have some-
thing done for its removal, I have now operated upon five of
these cases with so satisfactory a result that I think it may be in-
teresting to the profession if I describe the mode of proceeding
that I adopted.

I may premise that the operation I am about to describe is
somewhat difficult and tedious, and should be performed under
chloroform, and much of its success depends upon careful atten-
tion to minute details. Having freely exposed the globe by means
of the wire speculum, the parts covering the inner part of the
globe, including conjunctiva, sub-conjunctival fascia, old cicatrix
and muscle, with condensed tissue around it, must be all carefully
dissected off the sclerotic, commencing about two lines from the
inner margin of the cornea, and extending upwards and down-
wards and then inwards, so as to expose the inner third of the
surface of the globe. This dissection must be carefully made so
as to preserve the flap thus raised entire ; it can most readily be
done with a pair of scissors. When this stage of the operation is
completed, the external rectus muscle must be divided. It is bet-
ter to defer this part of the operation until now, because the action
f the external rectus is useful in keeping the globe well fixed
outwards during the first stage of the operation. The next part
of the operation is the most difficult and the most important. It
consists in passing the sutures. For this purpose small semicircu-
lar needles must be used, armed with a piece of fine silk ; the flap
that has been raised from the eye-ball must be firmly held with a
pair of forceps, and drawn forward so as to make it tense ; the.
needle must then be passed through it, as low down- that is, as
near the inner corner as possible. Two or three sutures may be
passed in this way, at intervals of about two lines. The corres-
ponding part of each suture must then be passed through that
small portion of conjunctiva which has been left attached to the
sclerotic near the cornea. This constitutes another difficulty, be-
cause the membrane here is so thin that the fine silk is apt to cut
through : this I found a serious difficulty, in my first operation,
and one that materially interfered with the success. In order to

1855.] On Vomiting during Pregnancy. 745

obviate this. I adopt now the following expedients: I first sepa-
rate this portion upwards towards the cornea; the needle must
then be passed through it, and then back again, so as to include a
portion, which must be tied tightly, so as to prevent it from tearing
out. The next point is to cut away all that portion of the lower
flap that can be sjjared beyond the part where the suture has en-
tered, merely leaving a sufficient margin to hold it. The silks
may be now drawn tightly, and tied to the end that is already
fixed near the cornea. The immediate effect of this proceeding
ought to be to procure some inversion, if the various steps of the
operation are properly performed. The hope and intention are, to
get the parts to unite to the globe in their new position, and thus
retain the eye. This, however, is only partially the case; there
is always some tendency partially to relapse, and in two cases I
had to repeat the operation, with ultimate success. The sutures
may be allowed to remain until they ulcerate through; the subse-
quent inflammation is usually slight. The amount of mobility in
the eye is very limited, but so long as it occupies a central position,
this circumstance is not found practically to occasion much de-
formity, and is an immense improvement upon the facial discord
resulting from extreme e version.

My friend and colleague, Mr. Bowman, has performed this oper-
ation at the Ophthalmic Hospital, with his usual neatness and
dexterity, and the eftect was very perfect. My own experience
would lead me now to undertake such a case with confidence in
the result, if the patient would persevere ; if sufficient effect is not
obtained by the first operation, a second is almost sure to succeed.
I may mention that one favourable effect of the operation is the
drawing forward and restoring the inner caruncle to its natural
place, the deforrnuy being much increased by the sinking in of this
part. [Ibid.

On Vomiting during Pregnancy. By M. M. Pallex. M. D., Prof,
of Obstetrics, &c, in the St Louis Medical College.

Vomiting during pregnancy is most usually a harmless malady.
About the fourth or sixth week, the stomach becomes deranged,
and in the morning the lady makes efforts to vomit, or vomits
sufficiently to evacuate the stomach. After some little time the
feeling of discomfort passes on, and she is as well as usual. These
attacks are renewed every morning for a period, varying from six
to nine weeks, and then gradually subside. Some do not vomit
at all some vomit during the last months of pregnancy, and some
suffer in this way in the first months or latter, months, during the
aight only.

It sometimes happens, however, that vomiting during pregnancy
is a most serious malady, and terminates fatally. In a discussion
in the Academie de Jledecine, Dubois stated that in the course of

746 On Vomiting during Pregnancy. [December,

thirteen years, he had met with twenty fatal cases. Prof. Stoltz, of
Strasburg, states that of four cases which came under his notice,
three died.

A fatal case of vomiting in pregnancy was lately reported by
Dr. Buckingham to the Society for Medical Observation in Boston.
" A young woman, twenty-six years old, was married on the first
of June. On the 10th of the same month she missed her catame-
nia ; on the first of July, she had nausea and vomiting, which con-
tinuing, she sent for Dr. B. on the 7th of August. At that time,
she was unable to retain any food, the vomiting being almost con-
stant. On the 12th, she had yellowness of the skin and conjunc-
tiva. The matter vomited was not bilious, though the urine and
saliva were loaded with bile ; no pain or symptoms of inflamma-
tion about the liver ; for ten days she vomited without cessation.
On the 20th, she was wandering matter vomited, grumous, dejec-
tions involuntary. After this date, she vomited more rarely, and
on the 24th she died. The indications of pregnancy were perfect.
No autopsy was permitted every mode of treatment was made
use of. Dr. John Ware, who was called in consultation, gave an
unfavorable prognosis, and said he had seen two similar cases in
one family." {Boston Med. and Surg. Journal, Yol. LIL, No. 7.)

I could cite other cases which are reported, but these are sufficient
to show the occasional gravity of the affection. Three fatal cases
have occurred under my own observation. The first case occurred
several years ago. The woman had been vomiting during the
two last months of pregnancy she was exceedingly prostrated
when she fell in labor. The pains continued ineffectual for twenty
four hours, when I was sent for I found her with a pulse of 140,
and very feeble I delivered her with the forceps, but she sank in
a few hours.

The second case occurred in the practice of a medical friend. I
saw her in consultation. She died after a month of vomiting.

The third case, was a lady, who commenced vomiting about
the sixth week of her pregnancy. For three weeks she threw up
almost every thing she took in her stomach ; after that period her
pulse increased in frequency, rising up to 100 in a minute ; she
complained of dimness of vision, and was unable to sleep at night.
In the course of a week more, the pulse increased to 120 ; the
dimness of vision increased, there was a ringing noise in her ears ;
mild delirium, and continued insomnolency. During the whole
of this period there was obstinate constipation, no alvine evacua-
tions unless procured by medicines. These symptoms continued
to increase for a fortnight, when she died. During the last two
weeks, however, she was able to retain some food on her stomach.
The treatment pursued, consisted of such mild cathartics as could
be tolerated by the stomach, very small doses of calomel being
best retained, enemata, and counter-irritants to the epigastric re-
gion, with the use of such remedies which sometimes allay vomit-
ing, as the effervescing draught, lime water, creosote, &c, &c.

1855.] On Vomiting during Pregnancy. 747

During the month of October last, a lady from a distance came
to St. Louis, to consult me about her health. She stated that some
two years before, she became pregnant with her third child; that
she had suffered a great deal from nausea and vomiting, from about
the eighth week of pregnane}' to the seventh month, when she
had a miscarriage and was very ill. In a short time after that she
again became pregnant and sulfered in the same way, until the fifth
month, when she miscarried, and was so ill that her life was de-
spaired of. Since which period her health was very bad ; she com-
plained of pain in the lumbar region, pain in the hips, sometimes
radiating down the thighs, a bearing sensation when she walked
about, leucorrhceal discharge, and irritability of the bladder; she
had a feeling of weight in her stomach after taking food ; her skin
was sallow, and she was incapable of much exertion.

Examination per vaginaru, detected an enlargement of the cer-
vix uteri with an abrasion of the epithelium all around the os, and
extending into it, which was fissured, and had the appearance of
being granulated, and was patulent Supposing that her ailments
arose from the inflammation, and its consequences, of the neck of
the womb, I advised her to put herself under the treatment of her
medical attendant at home, but she preferred to return to St. Louis.
In about a month she came back, and I commenced the treatment
of her case. Two weeks after her return she missed her catame-
nial flow, and became very much alarmed lest she should be preg-
nant. In about two weeks more she commenced vomiting, and
her husband and she beeame very desirous that I should produce
an abortion, as they were sure she could not live through her pre-
sent pregnancy. I determined however to wait. In the first in-
stance, I was not sure she was pregnant ; and secondly, if she
were, the urgency of the symptoms then did not require any such
mode of procedure. She missed her catamenia again, and the ap-
pearance of the nipples, and the presence of kiestine in the urine
determined the existence of pregnancy: her vomiting became so
excessive, that she could not retain cold water on her stomach;
she had fever during the greater part of the da}', and was getting
so weak that she could not conveniently set up. Every thing
which I tried to alleviate her suffering did no good, and I deter-
mined to bring on abortion. I tried the douche as recommended
by Kiwisch and Tyler Smith; at the same time using the galvanic
battery. These were persevered in for about a week, without pro-
ducing any effect. I then gradually dilated the os uteri by intro-
ducing a sponge tent into it every day inserting a larger piece
during five days at the expiration of this period I could intro-
duce my index finger into the cavity of the womb. Sixty grains
of ergot in infusion or divided doses were now given, and the
abortion took place without any hemorrhage. The vomiting ceased
immediately, and the treatment for the uterine disease being re-
sumed, she returned home in the latter part of February, quite
restored to health.

748 On Vomiting during Pregnancy. [December,

Vomiting during pregnancy does not depend on any inflamma-
tion of the stomach. It is a reflex action from the irritation in
the uterus ; thus, where death of the ovum takes place, whether it
be expelled immediately or not, the vomiting ceases, clearly show-
ing the connexion between the two. Moreover post-mortem ex-
aminations have failed to detect the morbid appearance of inflam-
mation in the stomach.

In a case quoted by Churchill, from the London Lancet, it is
stated, no morbid appearance was observable in any part of the
body. Two cases are also quoted, which were reported by M.
Dance, Hotel Dieu, in the Reporter. In one, it is stated, "no le-
sion could be detected in the stomach, except a slight reddish
tint in the mucous membrane." The whole of the intestinal canal
was sound. In the other, there was red and softened spots near
the cardiac orifice of the stomach ; but we can readily enough un-
derstand that such spots occur independently of inflammation.

Obstinate vomiting during pregnancy not yielding to medical
treatment, and terminating so often fatally, suggests to us at
once the propriety of inducing abortion. The question arises,
however, in every case when are we justifiable in doing it? or
are we justifiable in doing it at all? I have some friends,
whose opinions I respect, who contend that it should never be
undertaken. They say that the destruction of the ovum is an
evil, and that religion requires that we should not do evil, even
that good should come of it. I think that this is too restricted
a view of the matter. It is better that the nonviable ovum,
or even the viable foetus should perish even by our hand, to save
the life of the mother, than tamely to stand by, and let both
perish. This, I believe, is the voice of the profession in Great
Britain, France, Germany, and in the United States.

Being satisfied then as to its propriety, the question is, when
should it be done, and what is the safest method ? All are agreed
that it should not be performed as long as there is a reasonable
hope that the life of the mother can be saved without a resort to
the operation. The question to determine is, when are we obliged
to give up such a hope.

M. Dubois in the discussion already referred to, laid down the
following rules : Never to perform the operation when the signs
of extreme exhaustion are present, as evidenced by considerable
loss of vision, cephalagia, comatose somnolence, and disorder of
the intellectual faculties; "because," says he, "we should not
save our patient, but perhaps accelerate her death, and bring
discredit on the operation." Of the propriety of this rule, there
can be no doubt, and for this reason I did not bring about abortion
in the third case I have related. Again, he says, " we should
also abstain from operating when the vomiting, though violent
and frequent, still allows of some aliment being retained ; when
the patient, though wasted and feeble, is not obliged to keep her
bed ; when the suffering has not yet induced intense and contin-

1855.] On Vomiting during Pregnancy. 749

uous febrile action ; and when other means still remain untried"
because we should sacrifice a pregnancy which ought to be
saved. According to him, there is an intermediate period that
should be chosen, which is characterized by the following signs:
1st. Almost incessant vomiting, by which all alimentary substan-

. and sometimes the smallest drop of water, are rejected. 2
Wasting and debility, which condemn the patient to absolute r<
3d. Syncope, brought on by the slightest movement, or mental
emotion ; a marked change in the countenance, oth. Severe and
continuous febrile action. 6th. An excessive and penetrating
acidity of the breath. 7th. The failure of all other means.

These rules, although in the main good, are liable to some ob-
jections; sometimes the food is retained in the stomach for a few
days, and then the vomiting returns as bad as ever; sometimes
a portion of the food taken in the day is retained, yet the case
goes on to a fatal termination ; sometimes, although the wasting
and debility show well enough the untractable nature of the
affection, tlie patient can set up a portion of the day, until she is
so extremely exhausted, that she would fall in that situation,
when according to his own rules, the operation would fail to save
her life. There is danger of waiting too long, as then the patient
would die, either from the effects of the previous disease, or be-
cause she would be too feeble to undergo the operation.

The results of M. Dubois' practice seem to prove the truth of
this assertion of four cases, in which he operated, three died.
Professor Stoltz lays great stress upon the operation being per-
formed in good time, because if we wait until the effects of the
sympathetic re-action constitute in themselves a serious disease,
the evacuation of the womb does not induce a cessation of these,
and may in certain cases, even hasten death. It is difficult to lay
down any particular rules to guide the practitioner in undertaking
this most responsible operation. The experienced physician can
generally judge how far he can rely on the efforts of nature and
therapeutic means. But I imagine that when the patient retains
so little food that she becomes daily more feeble and emaciated,
when the pulse permanently increases in frequency, getting up to
100 or more, and when all other means fail to relieve the nausea
and vomiting, we are justifiable in operating, without waiting for
further symptoms.

I now come to the consideration of the best method to procure
abortion when the operation has been decided upon. Various
means have been proposed :

1st. The administration of ergot.

2d. Detachment of the membranes.

3d. Puncturing the membranes.

4th. Electricity.

5th. The uterine douche.

6th. Dilatation of the os and cervix uteri.
Ergot is very uncertain in its operation, although it will, un-

750 On Vomiting during Pregnancy. [December,

doubtedly, sometimes stimulate the gravid uterus at full term to
powerful contractions, yet it often fails at that period. In the
early months it is not to be relied upon at all it would be too
much to deny that it fails altogether in the early months, as the
evidence is sufficient that it has succeeded ; but the success is too
unfrequent to justify our confidence in it as an adjuvant to other
methods it ought to be tried ; that is to say, when other means
have set up uterine action, it will have ^occasionally a decided
effect.

The detachment of the membranes in the first three months is
a method not without danger. Moreover, it is sometimes difficult,
as the womb is not altogether under the command of the instru-
ment. Again, the operation has been performed without effect.

Puncturing the membranes is far more certain, it always brings
on labor in a few days. But in the early months, say in the first
fourteen weeks, it is difficult to perform, and certainly very hazar-
dous. It is true, it is done often, without any risk, but the annals
of medical jurisprudence give many cases of fatal result. The
same has occurred in legitimate practice. Dr. Tyler Smith refers
to a case of a patient who died after the performance of the opera-
tion, in whom, the internal iliac artery was found to be punctu-
red.

Electricity is a safe method, but it totally failed in the case I
have reported. I have on several occasions referred to the power
of electricity in stimulating the uterus in tedious labor, but it does
not seem to have the same effect in bringing on abortion in the
early months; that it has done so there can be no doubt. Dr.
Ashwell relates a case, in which it was used in supposed amenorr-
hcea, and the patient being pregnant, abortion occurred.

The uterine douche was first proposed by Professor Kiewisch
of Wurtzburg. It consists in directing a stream of warm water
from a height by means of a syphon, continuously upon the os
uteri. Dr. Tyler Smith has modified the operation by alternating
warm and cold water. In a case, in which he successfully em-
ployed it, labor being brought on in sixty-four hours, the follow-
ing method was adopted.

A piece of India-rubber tube, above eleven feet long, and half
an inch in diameter, was connected with a straight tube from an
injecting apparatus, five or six inches in length, the latter forming
the uterine extremity of the syphon. A vessel containing two
gallons of water of about 110 Fah. was placed nine or ten feet
from the ground, the patient being placed in an empty hip-bath;
the proper end of the tube was now passed into the vagina, and
directed towards the os uteri, where it was held steadily after
exhausting the tube, the other extremity was placed in the warm
water, the stream immediately began to flow with considerable
force against the os uteri, and continued until the whole contents
of the vessel had been discharged. Two gallons of cold water
were then poured into the vessel and discharged in the same man-

1855.] Differential Diagnosis of Tumors. 751

ner; five applications of the douche were made at intervals; the
patient was within three weeks of full term. I tried this method
in the case already referred to, and it failed. Will it produce
abortion in the early months?

Dilatation oftheos and cervix uteri has been objected to, as
likely to lead to peritonitis; I think on insufficient grounds. It
was the method with which I succeeded : pains were induced, and
then ergot being given, the effect was produced without accident.
I can readily understand that in the latter months of pregnancy
where there is considerable obliquity of the uterus, it would be
difficult to reach theos uteri under such circumstances the douche
might be preferable.

There are cases of such urgency, that it would be proper not to
wait for the slower method of dilatation, or of the douche; the
patient may be seen when it is necessary to arrest the vomiting,
and its co-existing symptoms immediately. If she has passed her
fifth month, the proper method would be to puncture the mem-
branes; by discharging the liquor amnii, it is found, the vomitng
will cease even before the delivery of the foetus.

To sum up. In the early months, if the operation be indicated,
the method I would adopt would be gradual dilatation of the os
and cervix uteri by means of sponge-tents ; if the symptoms were
urgent I would also try the douche, galvanism and ergot. In the
latter months, say after the seventh month, I would rely on the
same means, as by such we are more likely to save the life of the
child, than if we were to puncture the membranes, and discharge
the liquor amnii. If at any time subsequent to the fifth month,
the case required immediate relief, and there was danger in delay,
I would puncture the membrane, and discharge the liquor amnii.

[Weston Lancet.

The Differential Diagnosis of Tumors in the Female Pelvis. By

ElCHARD GUXDRY, M. D.

By the word " Tumors," it is intended, in the following obser-
vations, to express not only those pathological conditions which in
its strict and most limited application are properly so designated,
but also, by an extension of the term, many diseases attended by
increased size of the organs affected the results of exudations in
the various tissues of the pelvis and even physiological changes
taking place therein : all of which must sometimes be considered
in forming a differential diagnosis of a pelvic tumor. Thus, the
existence of pregnancy is not only first suggested by an increased
lower abdomen, but both in its normal position, and occurring out
of its usual habitat, is always an important point to be affirmed
or contradicted. The unpleasant and proportion ably frequent
errors which have arisen on this very point, are too well known to
need any other allusion in this connection. A pelvic abscess often
simulates a true tumor during its progress and by its remains af-

*' 52 Differential Diagnosis of Tumors. [December,

terward. Most, if not all tlie organs and tissues within the pelvis
may become the seat of various tumors, with many of their physi-
cal and rational symptoms identical but very different as to the
prognosis their character suggests, or the treatment they require.
.Nor must we omit, in the consideration of these numerous sources
of difficulty, another class of diseases which will require discrimi-
nation from tumors of the pelvis more rare than those above
mentioned, it is true, but sufficiently frequent in the past to have
caused errors painful to the medical attendants and disastrous to
the patients, and always requiring much care in order to their re-
cognition. I refer to those tumors of the kidney, spleen, and even
the liver, which, by their enormous size, may enter the limits of
the pelvis. A moment's reflection upon these numerous affections
and their common situation in a confined region little accessible
externally, and to be explored internally only with great tact and
delicacy will enable us to appreciate the difficulties and also the
importance of the task I have undertaken. My purpose, there-
fore, is to consider in their relations to one another the tumors met
with in the pelvis, the influence each exerts upon parts therein or
adjacent thereto, and from every available source to gather the
means of arriving at a satisfactory differential diagnosis.

It must especially be remembered that the greatest difficulties
we experience in distinguishing these tumors from each other, do
not generally occur in the well marked or " typical " specimens of
the disease, but in those in which usual and prominent phenomena
are either absent or masked by unusual symptoms. The latter
may sometimes be identical with characteristic signs of other pa-
thological conditions. They naturally mislead, unless the greatest
care is employed in the scrutiny. Moreover, the difference be-
tween reading symptoms in accounts of diseases recorded by au-
thors and reading the same at the bed-side soon discovered by
the least experienced is nowhere more palpable than in these
disorders.

In forming a differential diagnosis of a pelvic tumor, there are
two problems to be solved, viz: To ascertain the organ to which it
belongs and the pathological character of the tumor itself Sometimes
one, sometimes the other of these is the more easily ascertained.
I shall take them up in the order I have stated them, although, in
fact, this is not the invariable mode of arriving at the truth : for
the order of inquiry may be and frequently is the reverse, from
the readiness with which the latter is made out. For instance, in
those cases, somewhat frequent, where the diagnosis is easily made
that the lower abdomen is distended by a considerable quantity of
fluid, and that it fluctuates, much more difficulty is experienced in
order to ascertain whether the effusion is in the general cavity of
the abdomen, or belongs to the ovary, or in some cases to other
organs. Often, therefore, an answer to the former proposition is
all that is necessary, and the inquiry then terminates.

To what Organ does the Tumor belong, or where is its

1855.] Differential Diagnosis of Tumors. 753

seat? I shall notice the different sources of information, and
the results thus obtained, in their regular order. We omit all de-
scription of rational symptoms, though exceedingly useful in many
. more, however, to corroborate than suggest an opinion, and
more available (if the tumor be seen first in its full grown
to denote its character as to malignancy, or the reverse, than the
determination of its origin. To one who watches the tumor from
its first appearance, they are not only useful, but almost sufficient
alone, in many cases, for diagnostic purposes. But this is rarely
the privilege of the surgeon consulted, to whom such cases come
for an elaborate opinion when lapse of time and faded recollections-
have impaired the value of the history derived from the patient or
her friends.

Inspection and external examination furnish us facts as to the po-
sition, extent, shape, resistance and movement of tumors. These
should be carefully noted, because, though an item may seem un-
important per se, it may yet be found an essential link in the whole
chain of evidence formed by all the symptoms.

The enlargement of the abdomen may include not only the low-
er but the upper abdomen also. Tumors of the liver, splejen, kid-
ney, and omentum which descend into the pelvic cavity ascites,
and some ovarian tumors, may so fill the abdomen as to infringe on
the thoracic cavity and interfere with the movements of its viscera.
Pregnancy of the same apparent size does not do so to such an ex-
tent. In these cases, occupying the abdomen more or less, the
principal points made out on external examination, are the margins
of the tumor and their continuity with organs beyond our reach.
The real and apparent continuity differ very often. The examina-
tion requires the utmost possible relaxation of the abdominal muscles
and is best performed when the patient lies on her back, with her
lower limbs flexed thoroughly, if necessary in the position for lithot-
omy. We may thus often detect the true connection of those tumors
which counterfeit the appearance of springing from the pelvis, but
really come from the viscera above. Serious consequences may
result from a failure in this. A case is recorded where an incision
was made in the abdomen to remove a supposed ovarian tumor.
Removal being found impracticable in this manner, and the mass
being solid, it was attempted by suppuration from the introduction
of sponge tents. Death resulted in a few days, and the autopsy
revealed that the morbid growth was an enlarged spleen. In a
case I observed for some months, the lower abdomen appeared
more completely filled than above. To the right, the margin was
more distinct than on the left side, where it was traced with diffi-
culty. On inspection, it appeared continuous with the pelvis; but
on examination in the position described, the continuity of the tu-
mor on the left side upward under the ribs, was apparent The
margin wras crescentric, the concavity upward, crossing about the
umbilicus, leaving a third of the abdomen free at the right upper
portion. Corresponding dullness of course prevailed. Its con-

754 Differential Diagnosis of Tumors. [December, i

nection with the spleen was evident, but it required several exam-
inations to verify the diagnosis, and the whole of the crescentric
margin was only made out on the increasing emaciation of the
patient. To add to the sources of error in these cases, malposition
of the uterus, from pressure^ may be present. Partial prolapse ex-
isted in the case alluded to. Venous and arterial murmurs are
more or less distinctly heard in these cases.

The form and extent of the general enlargement are important
points in the diagnosis of renal tumors. There is generally, not
always, a space between an enlarged kidney, the ribs above, and
the iliac fosa. Where the latter does not exist, it has many of the
external characteristics of an ovarian tumor. It, however, occu-
pies a position behind that of the latter, and fills the lumbar
regions. It also retains its characteristic oval shape. In hydrone-
phrosis cysts and hydatid of the kidney, when the extension is
greatest, the colon passing over it sometimes has the appearance
of another tumor. The pelvic organs are seldom affected in
position. The signs derived from other sources we shall allude to
afterward. The urinary secretions throw great light on theser
somewhat obscure, affections. In extensive pyelitis the rational
symptoms are of much weight. Hepatic tumors rarely occupy so
large a space, and their continuity is usually not very difficult to
make out.

In ascites the enlargement is more uniform than in most other
conditions alluded to it is more diffused throughout the whole
abdominal region, and varies more with the position assumed by
the patient. It is generally globular in form. Unless the abdo-
men be filled to the utmost limits of toleration, the gravitating
ascitic fluid produces appreciable alterations of the surface ; in this
respect differing from ovarian cystic tumors, which move, it is true,
from changes of the position of the patient, but do so, as a whole,
changing its boundaries and form, (as often detected,) and produce
corresponding changes of the exterior, readily suggested by the
altered level of a contained fluid. In ascites, when the patient
lies on the back, there is generally bulging on both sides, so that
the distance between the iliac crest and lower ribs is greater than
in ovarian tumors. In the latter, when the curve thus occurs,
it is more often confined to one side, and is seldom so marked.
The umbilical region is at the same time flatter in the former.
Measurement from the umbilicus to the spinal column, and from
the fourth lumbar vertebrae to the mesial line anteriorly will scarce-
ly differ in ascites. In ovarian tumors, on the contrary, there is
marked disparity. Inspection reveals the veins which ramify-
over the abdominal surface, increased in calibre in ovarian tumors,
but not in ascites. On the other hand, the skin is more distended
in the latter.

Uterine tumors, including pregnancy, occupy the central portion
of the abdomen, and have a globular shape. Even where they
occupy the whole, or nearly so, of the abdomen, their extension

1855.] Differential Diagnosis of Tumors. Ibb

from the maedial line, equally, can often be traced in the hi-
In solid tumors there is a tabulated feeling of the uterine walls.
In pregnancy, of course, there is something to be learnt from a
comparison of size and time, since apparent growth commenced.
Anasarca accompanies pregnancy more often than other tumorsT
though it is found associated with them also.

The resistance of a tumor may sometimes be useful more per-
haps in determining its character than connection. Hardn-
often characteristic of fibrous tumours of uterus, a doughy feel in
pelvic abscess fluctuation in encysted tumors of organs and as-
It is more pronounced in the last named. In hydrometra,
and especially in extensive dropsy of the amnion, it is also very
plainly felt.

Partial enlargement accompanies nearly all pelvic tumors, not
included in the foregoing. External palpation, therefore, gives
but little aid, except conjoined to other modes of exploration.
Attention, however, should be given to the position, its relation to
the mesial line the boundaries of the tumour its evenness or in-
equality hardness and resistance in general.

Percussion confirms many of the observations, by the previous
modes. It also adds to our information as to the limits of tumors.
The tumors of the spleen are of course marked by absence of re-
sonance throughout their extent. In those of the kidney, the sit-
uation of the colon crossing it, is marked by resonance, in contrast
to the utter dullness of the rest of the tumor. The dullness ex-
tends to the spinal column. In tumors of the omentum and pel-
vic abscess of much extent, with modified dullness, there is a boggy
feeling imparted to the fingers. In ascites the resonance of the
intestines, is usually met with anteriorly, when the patient lies
down ; in which position the bowels float on the fluid. Dullness
is evident in the lumbar regions. The contrary result is obtained in
ovarian tumors. Here the anterior abdomen is dull from the inter-
vening body. The bowels behind give a very clear intestinal sound
in the lateral regions. About the umbilicus, perhaps, the dullness
is most evident. These are, therefore, very important points in the
diagnosis of ascites from ovarian tumors. Their value is sometimes
invalidated by the following circumstances: the mesentery may be
very short, naturally, or rendered so by force of disease, and may
thus bind the intestinal canal to the vertebral column ; or, ascites
may be so enormous, and the abdominal covering so expanded, that
a normal mesentery may be insufficient to allow the intestines to
float. Under these circumstances, the intestinal sound will be ab-
sent as high as the epigastrium ; and even the lumbar resonance,
present through this latter, is yet more rarely met with. I have
seen two instances in which these predisposing sources of error
were present. In one case of enormous accumulation of fluid, with
tuberculous exudation of the peritoneum, general dullness prevailed
all over the abdomen. The mesentery was of normal length, and
free. In the other case, an ovarian tumor was diagnosed by several

<ob Differential Diagnosis of Tumors. [December,

capable gentlemen accustomed to such investigation from the dull-
ness of sound, and other symptoms. The effusion was not so great,
and the shape of the tumor, everything, in fact, suggested the
ovary as involved. Yet the result showed a remarkably short mes-
entery co-existing with ascites. F. Yon Kiwisch relates one of these
embarrassing cases, where a still further complication existed by a
displaced and fixed uterus, as if from pressure of an ovarian tumor.
It is not easy to see how an error of diagnosis could be avoided.
After death, the autopsy showed chronic tuberculosis of the peri-
toneum as the cause of the effusion so extensive, and adhesions of
the uterus. The absence of inequality of surface should be ob-
served in these cases, as this is rarely or never the case in ovarian
tumors. From percussion, we therefore conclude that ascites is
present when we find an accumulation of fluid accompanied by
distinct intestinal resonance anteriorly, with dullness laterally.
But the absence of these symptoms does not negative its exist-
ence.

Hydatids occurring near the surface may be detected by a feel-
ing of elasticity imparted to the fingers, on palpation and percus-
sion. Piorry describes a hydatid tremitus like the sensation from
striking a watch when held in the hand. I think the former is
more appreciable, and easily acquired after meeting with such
cases.

Auscultation is especially useful in cases of suspected pregnancy,
even when it happens to be complicated with ascites, dropsy of
the amnion, or other tumors. If the pulsations of the foetal heart
can be distinguished, there can be no doubt of the existence of
pregnancy, and the inquiry is concluded. But this sign may be
wanting during such a condition, for proof of which other signs
must be relied upon. The sounds resulting from the movements
of the foetus, are very obscure at first, as of a body moving under
the stethescope, but later in gestation, the sound is accompanied
by a shock or elevation of the ear of the observer, like a blow on
the parietes of the uterus by some parts of the foetus. But the
foetal heart sounds, and these are with difficulty made out when
dropsy of the amnion is present. To these sounds may be added
the funic usoufflet." There is also another very distinct sound
heard in pregnancy, and formerly believed to be pathognomonic,
and to depend upon the placenta as its cause. It was thus termed
the placental murmur. More acurate observation has shown it to
depend upon the vessels of the enlarged uterus. Although not
peculiar to pregnancy, for it is found in the enlarged uterus from
fibrous tumors, (hypertrophy polypi,) it assists in determining the
uterus as the seat of the tumor. Yenous murmurs are heard in
splenic tumors, very low down sometimes, accompanied by a thrill.
In some faecal tumors, also it is stated by Hennoch that crepita-
tion has been heard. [Ohio Med. and Surg. Journal.

1855.] Treatment of Cancer. 757

On Hie use of Thuya Occidentalism {Arbor Vitce,) in the Treatment of
Cancer. By J. R. Leamixg, If. D., Physician to the Northern
Dispensary, N. Y.

About the 1st of July, 1851, my attention was called to a little
girl, not quite three years old, who had received a slight injury of
the hand, as was supposed from a fall. I directed the application
of cold water, and the swelling and the soreness disappeared. On
the 12th of September I was called to see the child, and found a
purple tumor, not distinctly denned, occupying and complicating
the flexor muscles of the thumb. The veins leading to the tumor
were enlarged and tortuous. The tumor itself was not tender, and
the bone was not implicated. It had the peculiar elastic feel of
erectile tumor. I learned that it commenced growing about two
weeks previously. I informed the parents of my fears respecting
the malignant nature of the disease, and requested a consultation.
Accordingly, the next day, Dr. \Y. H. Van Buren saw the case
with me, and confirmed my diagnosis. On the 20th of September,
Dr. Van Buren met me again, and explored the tumor with a
grooved needle. A glutinous matter was obtained, indicatingthat
the disease was of the colloid variety. The treatment directed was
small doses of hydrarg. bichlor. in tr. cinchon. co., the hand to be
painted every day with tr. iodine and poulticed.

The disease rapidly increased, attacking the carpal and meta-
carpal bones, the back of the hand became thickened, and hard,
and the veins large and tortuous. An abscess formed where the
exploration was made and discharged healthy pus. Still the tu-
mor iucreased in size.

Being informed by a medical friend of the successful employ-
ment of thuya occidentalis in a case of rapidly developed fungus-
haernatodes of the eye the tumor gradually subsiding under its
use, and returning on its intermission, but finally completely dis-
appearing on persisting in the employment of the remedv I
determined to resort to it in this ease. It was of course a forlorne
hope; but the character of the disease warranted any course of
treatment which offered a shadow of success. The child was ac-
cordingly put upon the use of a tincture of the leaves of this tree.
In two weeks the appearance of the hand was changed; the tumor
had not increased in size. In two weeks more, the disease was
evidently subsiding, the tumor was smaller, the back of the hand
was not so thick and hard, and the veins were not so large.

On the 29th of October, the father of the child was attacked with
severe inflammatory rheumatism of the right knee-joint. The dis-
ease resisted the treatment, only partial relief being obtained from
hydrarg. mass andext. conii, tr. colchic. sem., potass, iodid., potass,
nitrat.. etc.. till the 10th of November, when the pain was relieved.
At four o'clock, on the morning of the 11th. 1 was called to see
the patient, and found that he had vomited half a pint of blood ;
soon after I arrived, he vomited more, making in all about a quart

jr. s. vol. xi. no. xii. 48

758 Treatment of Cancer. [December,

of moderately fresh, looking blood. I gave him fifteen drops of
spts. terebinth, aud sent a messenger for Dr. Geo. P. Cammann to
meet me in consultation. Dr. C. soon arrived, and carefully ex-
amined the patient. We agreed upon the following diagnosis:
That there was an old trouble of the liver, most probably cirrhosis,
and that the hemorrhage was from the portal circulation induced
by this biliary trouble.

For a few days the patient took nothing but mulled wine and
beef tea. Altered blood passed from the bowels twenty-four hours.
Forty-eight hours after the first hemorrhage he vomited a small
quantity of blood, and passed altered blood for thirty-six hours
afterward. The bowels were tympanitic, pulse one hundred and
ten, skin moist, tongue furred. The patient presented a yellowish,
waxy appearance. He was directed to take hydrarg. sub. mur.
one grain, and extr. taraxici twenty grains, every day or every
other day, for the purpose of bringing the system gradually under
the influence of the mercurial. Healthy bile was obtained in the
evacuations, but there was no improvement in the patient's health.
At this time, reflecting upon the case, I came to the conclusion
that there was malignant disease connected with the liver. My
reasons wereT the appearance of the patient, the history of the caser
and the history of the patient's family. His mother died when he
was a child. Three years before her death, a purple tumor appear-
ed on her hand. It resisted treatment, and the hand was amputa-
ted. Six months before her death she vomited bloodr and died of
some internal disease. His mother's brother died of cancer of the
lip. His sister vomited blood and died of some internal disease.
His little daughter is under treatment for cancer of the hand.

At my next meeting with Dr. Cammann, I stated my earnest
convictions respecting the malignant nature of the disease connect-
ed with the liver. Dr. Cammann believed the disease was of long
standing and of a very,serious nature, but that we needed further
evidence to warrant us in making up a certain diagnosis.

On the 80th of November, Dr. Valentine Mott saw the patient
with me in consultation. The patient at this time was very tym-
panitic ; there was also a small quantity of fluid in the peritoneal
cavity. The heart was pushed up from its normal position,, so that
the impulse was felt above the nipple. He was weak, tongue
furred, pulse one hundred and ten, skin moist, and urine scanty.

After examining the patient and hearing the history of the case
and of the family from me, Dr. Mott's diagnosis was cirrhosis of
the liver with a suspicion of malignant disease. I commenced
giving the thuya in tinct. made in the following manner: The
leaves and small twigs were crowded into a jar and then covered
with alcohol; half a teaspoonful every three hours. The rheuma-
tism had entirely subsided after the hemorrhage; still there was
no improvement in the patient's health.

On the 6th of December, Dr. Willard Parker saw the patient in
consultation with me. After a careful personal examination, and

1855 .] Treatment of Cancer. 759

hearing the history of the case and of the family from me, his diag-
nosis was scirrhosis of the liver and suspicion of cancerous disease.

The patient seemed to be rapidly sinking. I increased the dose
of the thuya to two teaspoonfuls every three hours, and gave in
addition a mixture composed of hydrochlorate of ammonia and
chlorate of potass, each 3 i, and cinnamon water I vi, a tablespoon-
ful ever}' hour or two. He seemed to improve almost immediate-
ly, his appetite became good, and he gained strength rapidly. A
week after Dr. Parker saw him he was able to walk into an adjoin-
ing room, and sit there most of the day. The 12th of December,
I found a small tumor in the left side on a line with the heart,
just under the ribs. In giving it an impulse it would leave the
hand and return to it, giving the sensation of the foetus in ballot-
ment. The tumor grew rapidly, and I could notice an increase
in size at each examination.

On the 18th of December, Dr. Cammann made a careful exam-
ination of the tumor. It rested upon the kidneys, and evidently
was the cause of the displacement of the heart. It extended over
toward the right side beyond the median line and downward al-
most to the umbilicus.

There was more urine secreted than there had been ; still the
dropsy gradually increased. A great variety of active diuretics
had been used without any beneficial effect; indeed they all seem-
ed to do harm, consequently he was confined to the thuya and
mixture of hydrochlorate of ammonia and chlorate of potash.

On the 4th of January, the dropsy having increased so much, it
was decided to relieve the patient by tapping. On the 6th of Jan-
nary, at the patient's request, Dr. W. H. Van Buren was called,
and drew off thirteen qnarts of amber-colored fluid highly charged
with albumen. In a week he was able to walk about and ride
out, driving an open carriage several miles into the countrv with
enjoyment and benefit. With the exception of the physical in-
convenience of the tumor lying on the kidneys and the portal
veins, the patient seemed to enjoy better health than he had done
for some year.-.

The dropsy rapidly returned, and tapping was necessarv again
in two weeks. Dr. Van Buren performed this operation five times
at intervals of two weeks. After the fifth tapping extensive peri-
toneal inflammation set in, and the patient died on the 5th of
March.

A post-mortem examination was not allowed. This is much to
be regretted, as it would have settled some points of interest the
malignancy of the tumor, its connection with the left lobe of the
liver, and whether the extensive peritoneal inflammation was
caused by the escape of matter from the tumor into the peritoneal
cavity. Of the first two points there can be scarcelv anv doubt;
still it would have been a satisfaction to have had the question set-
tled beyond all cavil. The third point is quite probable from the
sudden onset of the peritonitis.

760 Tumor of the Shin. [December,

The most important fact in the history of this case is the decided
benefit received from the use of the thuya and the mixture of hy-
drochlorate of ammonia and chlorate of polash. Immediately after
commencing the use of these remedies the stomach and liver re-
sumed their natural functions, and the symptoms of scirrhosis
disappeared. The action of the kidneys was also much im-
proved.

During the early part of the father's severe illness, the child was
neglected and the thuya discontinued. The hand became worse,
and the disease again attacked the carpal bones. When the thuya
was prepared for the father, the child again commenced its use,
taking fifteen drops every two or three hours. In a short time its
benefit was quite perceptible. At the present time only a trace of
the disease remains, and the remedy will be persisted in till the
child is well. The hand will remain permanently injured and
probably will be atrophied.

Thuya occidentalis, or arbor vitas, belongs to the pine tribe
(coniferas,) is a native of this country, and is cultivated in our
gardens. The leaves are the parts used medicinal ly. They are
described in the IT. S. Dispensatory as having an agreeable bal-
samic odor, especially when rubbed, and a strong, balsamic, cam-
phorous, bitter taste."

The thuya has long been used for medicinal purposes, but with
ao settled opinions in regard to its therapeutic properties. It has-
thus been employed in intermittent fever, scurvy, rheumatism,
and as a stimulant, diuretic, diaphoretic, and vermifuge. In the
Revue de Therapeut, (Jan. 1st, 1855,) there is a notice of the thuya
having been recently employed by a Hungarian physician in the
treatment of venereal excrescences which had resisted mercury,
cauterization, and excision. He employed the tincture, using"
three pints of the leaves to six of rectified alcohol, applying it from
time to time with a brush. The excrescenses rapidly diminished
in volume, and a radical cure is reported to have been obtained in
five clays.

Thuya occidentalis is a new remedy for cancer. There have
been a great many new remedies for this dreadful disease before,
which upon trial have proved utterly valueless so it may be with
this. Two or three recoveries do not prove the value of a remedy.
These cases are related that it may receive a more extensive trial ;
and if others should find it in a proportion of cases as beneficial
as it has been in the cases I have related, it is one of the greatest
boons conferred upon mankind. [Stethoscope.

Remarks on a peculiar Form of Tumor of the Shin, denominated
"Pachydermatocele" illustrated by Cases. By Yalentine Mott,
M. D., &c.
We are gratified to see our distinguished countryman, Prof,

Mott, honoring his election to a membership of the Royal Medical

1855.] Turner of the Skin, 761

and Chirurgical Society by the contribution to its transactions of
so valuable a surgical paper.

The disease to which Prof. Mott gives the name of 'pachyderma-
tocele is congenital, having its origin in a brown spot or mole, and
increasing with the jears of the individual until they present hid-
eous deformities.

The morbid structures have all- been more brown than the sur-
rounding integuments, with a flabby feel, very like a relaxed and
very emaciated mamma. In several of the cases there were two
or three layers or stories, as in the one upon the neck and shoulder,
resembling the fanciful and successive turns of a tippet, or three
separate folds of a rich maroon velvet curtain. They do not ap-
pear to possess any great degree of vascularity, neither having
veins visible upon the external surface, nor diminishing in size
much after being detached from the body, therein differing essential-
ly from the mevus maternus, or aneurism by anastomosis. * *
* * * On cutting a slice transversely, or making an incision
into these growths, the sub-dermoid structure to the eye seems to
be hypertrophied areolar tissue, with very little evidence of blood
vessels running through it. From their general appearance and
duration, there is no evidence whatever of anything malignant in
their structure or tendency. In one of the cases there was a re-
turn of the same kind of tumor upon the same spot, namely, the
head, though to a less extent, demanding a second excision and
it returned again, and is now of the same shape and character as
at first. In another patient, a boy, the same disposition to return
was observed during the granulating process, but it was complete-
ly conquered by the patient and skillful application of compressed
sponge and the roller bandage. In the other three cases, there
was no disposition whatever to a reproduction of the disease.
The sense of feeling was somewhat diminished below the natural
standard in all of the cases. In only one was there any ulcera-
tive action, and this arose entirely from want of attention to per-
sonal cleanliness. The largest required to be carefully washed
every day with soap and water, then well dried and powdered with
some farinaceous substance. If this was neglected for one day, an
acrid fetid discharge took place, soon leading to excoriation.

Five cases of this disease are reported in the paper, and the dif-
ferent operations necessary to their removal fully described. We
shall have space to introduce but one case, which will afford a
fair illustration of the nature of the tumor, and the operation un-
dertaken for its removal.

Case V. This was truly a monstrous morbid production.
Though disgusting and even frightful, to ordinary beholders, there
was, in its organization and external characters, looking at it as a
morbid growth, something symmetrical and beautiful. From the

mother's statement, it was observed soon after birth. Miss L ,

set. about 45 years, of robust country health came to me from the
western part of the State of New York, as she said, to show me a

762 Tumor of the Shin. [December,

tumor, and to know if it could be removed. From the compact
and regular arrangement of her dress, the impression on my mind
at once was, that it was of no great importance as to size. My
astonishment was not a little excited, as she removed her dress
from the chest and neck, not only from the immense size of the
mass, but that it could all be so completely stowed away, as not to
disturb the apparent symmetry and harmony of her proportions.
The tumor was of a dark brown or copper color, of a soft, elastic
feel, very much resembling a collapsed lung or a placenta. It
hung in beautiful and fantastic folds, like the convolutions of a
tippet over the neck, shoulder and chest. There were five of these
folds or stories, the smallest above, the longest or broadest below.
It was attached to the healthy integuments behind and in front of
the ear directly under its lobe to the entire extent of the side of
the neck from near the nucha to the edge of the larynx and trachea,
to the whole line of the clavicle and middle of the upper bone of
the sternum, over the shoulder, part of the scapula, and reaching
upon the arm to near the insertion of the deltoid muscle over the
entire pectoralis major to the middle of the sternum and ensiform
cartilage, and to the upper part of the rectus abdominis and latissi-
mus dorsi, with a portion of the serratus magnus anticus. The
lowest loose fold hung a little below a line with the umbilicus.
The entire length of the tumor was twenty-one inches, its breadth
eighteen inches. Stating to her that I thought it might be re-
moved, she requested to have the operation performed if there was,
as she said, " any chance of her life." Being made insensible with
chloroform, the operation was performed in the following manner:
An incision was made a little below the tumor, across the lower
part of the deltoid muscle, and the growth was dissected from this
muscle to the top of the shoulder, then from the side of the thorax
and upper part of the abdomen, then from the whole line of the clavi-
cle, the upper part of the sternum, the back of the neck, and from the
trapezius muscle, it was now detached from about the ear, and the
dissection continued towards the front part of the neck, in the di-
rection of the course of the sterno-cleido mastoid muscle, until it
terminated by an incision over the mesial line of the larvnx and
treachea in their entire length. In all this extensive dissection
many arteries required ligatures, and some of them were of consi-
derable size. The most remarkable, and indeed monstrous, were
two veins entering the subclavian, no doubt the external jugular
in its anterior and posterior branches, each apparently separate.
Their size was the greatest I ever saw in any superficial veins,
being each not less than my fore finger. They were running close
together, and were seized successively the instant on being cut
with the foreceps, and were tied to prevent the admission of air,
from which, on one occasion, I had seen frightful and almost fatal
effects. As the tumor originated on the upper part of the neck,
these two enormous superficial veins were probably the principal
channels for returning the blood from the whole abnormal mass.

1855.] Editorial 763

They lay side by side, as the}- went through the deep cervical fascia,
but probably Just on entering the subclavian, they united, as is
usual in the normal sta ;he operation was considerably pro-

tracted, from the extensive superficial on, and the large

number of arteries which required ligatures, some exhaustion fol-
lowed, but she was not alarmingly depressed at any moment, and
quickly rallied when the anaesthesia was allowed to pass off.

With the exception of two attacks of erysipelas, one of which
imminently threatened the life of the patient, the case progi
favorably, and resulted in complete and permanent recovery. The
specimen was submitted to microscopical examination by Prof.
Swett (not Lovett as the English print has it,) who thus reported:
"The specimen appears to me to consist of an hypertrophy of the
skin, and of the sub-cutaneous cellular tissue. Under the micro-
scope I find nothing but an exaggeration of the natural tissues.
There are no evidences of a malignant formation."

The paper is accompanied with two well-executed lithographic
plates representing these tumors. [New York Jour, of Medicirte,

EDITORIAL AXD MISCELLANEOUS.

Our Journal. This number completes the Eleventh volume of the New
Series of the Southern Medtcal and Surgical Journal, We have labor-
ed diligently to make it the expression of the Southern Medical mind,
as well as the repository of whatever may have appeared of practical
importance in the native and foreign periodicals of the day. Three hun-
dred of its pages are occupied by forty original contributions from the
pens of physicians actively engaged in the daily practice of their pro-
fession, and who have consequently no time to devote to theoretical disqui-
sitions. Their papers will accordingly be found to consist principally of
the facts and deductions derived from the bed-side, and in our own section of
countiy. It is true that their name is not always known to fame ; but this
does not lessen the value of their experience, which is much more reliable
than that of the host of closetted book-makers of the age. While we are
fully convinced that Southern practitioners understand better than others
the management of the Southern types of disease, and the peculiarities of
the negro constitution, we have not been sectional in our selections for the
eclectic department of this Journal, but have availed ourselves liberallv of
the contributions to medical knowledge in every portion of our extended
countiy. It will be seen that we have transferred to our pages during the
current year no less than forty valuable American papers culled from our
cotemporaries. Xor have we omitted to do justice to our transatlantic
brethren, whose facilities and industry have accomplished and are still do-
ing so much for the advancement of professional knowledge.

Earnestly hoping that our efforts have not entirely failed to be satisfacto-

764 Editorial. [December,

ry to our readers, we shall enter upon the supervision of the next volume
with that renewal of zeal which a continually increasing list of subscribers
never fails to incite, and with the determination to do our whole duty to the
profession and to the patrons of this work.

CONTRIBUTORS TO THE ORIGINAL DEPARTMENT OF THIS VOLUME.

S. Ames, M. D., of Montgomery, Ala. Saml. D. Holt, M. D., of Montgomery, Ala.

Wra. M. Boling, M. D. do. do. C. C. Howard, M.D., of Lowndesboro', Ala,

K". Bozeman, M. D. do. do. W. L. Jones, M. D., of Morgan Co., Ga.

W. W. Broom, M. D., of Kingsville, Ala. P. M. Kollock, M. D., of Savannah, Ga.

Josiah Brown, M. D., of Gaylesville, Ala. R. C. Mackall, M. D. do. do.

B. F. Chapman, M. D., of Lithonia, Ga. H. V. M. Miller, M. D., of Rome, Ga.

Geo. F. Cooper, M. D., of Americus, Ga. E. W. McCrary, M.D., of Clinton Dep.,S.C.

L. A. Dugas, M. D., of Augusta, Ga. H. Rossignol, M. D., of Augusta, (}a.

Joseph A. Eve, M. D. do. do. C. S. Sneed, M. D., of Culloden, Ga.

W. L. Felder, M. D. do. do. N. S. Walker, M. D., of Eatonton, Ga.

R. B. Gardner, M. D., of Barnesville, Ga. Jno. S.Wilson, M. D., of Lawrenceville, Ga.

James M. Green, M. D., of Macon, Ga. E. B. Wood, M. D., of Paulding Co., Ga.

Juriah Harriss, M. D., of Augusta, Ga. T. J. Word, M. D., of Rome, Ga.
Jas. C. Harris, M. D., of Wetumpka, Ala.

BIBLIOGRAPHICAL.

We are indebted to the publishers for the following works, which are
for sale by Thos. Richards & Son of this city.

A Practical Treatise on the Diseases of the Eye. By Wm. Mackenzie,
M.D., Lecturer on the Eye in the University of Glasgow, &c, &c. ; to
which is prefixed an Anatomical Introduction explanatory of a horizon-
tal section of the human eye-ball. By Thos. Wharton Jones, F. R. S.,
Prof, of Ophthalmic Surgery in University College, London, &c, &c.
with 1*75 illustrations. From the 4th revised and enlarged London edi-
tion. With Notes and additions by A. Hewson, A. M., M. D., Surgeon
to Wills Hospital, Philadelphia, &c, &c. Philadelphia : Blanchard &
Lea. 1855. 8vo., pp. 1027.

To praise a work so extensively and favorably known as is the above
Treatise would seem to be entirely unnecessary. Yet we cannot let the
opportunity pass without commending it to the patronage of those who
have not already procured it. It has been justly said to constitute, "in
respect of learning and research, an encyclopedia unequalled in extent by
any other work of the kind, either English or foreign." The additions of
the American Editor considerably enhance its value to us.

A Treatise on Epidemic Cholera. By Horatio G. Jameson, Jr., M. D.,
&c.,&c. Philadelphia: Lindsay &Blakiston. 1855. 8vo., pp.286.

We can recommend this work to those who desire to learn more than
they already know about the fatal disease of Cholera. It is the last work

1855.] Editorial 765

of one of our most distinguished countrymen, who has since its publication
paid the last debt of nature. Prof. Jameson wai an able surgeon and ac-
complished writer, whose reputation as an observer will acquire new lustre
from his last performance.

A Manual of Clinical Medicine and Physical Diagnosis. By T. H. Tan-
ner. M. L>., Arc. &c. To which is added the code of Ethics of the American
Medical Association. Philadelphia : Blanchard & Lea. 1855. 12m'.,
pp. 2

This is a valuable little manual, full of useful information, especially to
junior members of the profession and to those who have failed to keep
pace with the advances daily made in the important subject of Diagnosis.
The portion devoted to the use of the microscope, test-tray, spirometer,
pleximeter, stethoscope, dynamometer, ophthalmoscope, speculum, <kc. will
be found highly useful.

.

The Physician's Visiting List, Diary, and Book of Engagements for 1856.
Philadelphia : Lindsay & Blakiston.

This little memorandum book has now been annually furnished for sever-
al years, and has been found very convenient by practitioners of medicine,
both in the country and city.

Physiological Chemist)-}/. By Prof. C. G. Lehmaxx. Translated from the
2d edition, by George E. Day, M.D., F. R.S., <fec. Edited by R. E. Ro-
gers, M. D., Prof, of Chemistry in the University of Pennsylvania. With
illustrations selected from Funke's Atlas, and an appendix of Plates. In
2 vols. 8vo. Philadelphia : Blanchard & Lea.

Physiological Chemistry is progressing so rapidly that new works upon
the subject are being continually needed. The one before us is as full and
complete as German labor and American additions could make it and it is
published in the usual excellent style of the enterprising house of Blanch-
ard <k Lea. All teachers must possess it, and every intelligent physician
ought to do likeAvise.

Principles of Human Physiology, with their chief applications to Psycholo-
gy, Pathology. Therapi rutics. Hygiene, and Forensic Medicine. By AVm.
B. Carpenter. M. 1 >., F. R. S.. c\:r.. &c. A new American from the last
London edition. With 261 illustrations. Edited, with additions, by
Fr. G. Smith, M. D., Professor, <tc, <fcc. Philadelphia : Blanchard & Lea.
1855. 8vo., pp. 900.

To eulogise this great work would be superfluous. We should observe,
however, that in this edition the author has remodelled a large portion of
the former, and the Elitor has added much matter of interest, especially in
the form of illustrations. We may confidently recommend it as the most
complete work on Iluman Physiology in our language.

"6$ Editorial. [December,

Synopsis of the Course of Lectures on Materia Medica and Pharmacy
delivered in the University of Pennsylvania, by Joseph Carson, M. D.
2d edition, revised. Philadelphia: Blanchard & Lea. 1855. 8vo. pp. 196.

This is one of those works, the value of which we have never been able
to appreciate. It is designed for students ; but what does it teach them
save the author's classification and the headings of what they should learn ?
As a specimen of the information thus conveyed, we reproduce at random
the whole of the first and the last articles in the book.

" Tannin. The proximate principle of the vegetable astringents. Ob-
tained most conveniently from powdered galls. Mode of obtaining. Form ;
sensible properties ; solubility. Chemical characteristics. Two kinds ; ene
striking a blue-black precipitate with the salts of iron ; the other a green-
black. Source of each.

Incompatibles.

The compounds formed by the union with bases called Tannates. Char-
acter of the precipitate formed by each kind on animal matter. Tests."

" Kooso. The flowers of the Brayera anthelmintica. Grown in Abys-
sinia.

Characters; odor; taste.

Value as an anthelmintic. Mode of administration."

Surely this is an easy way to "make a book."

A Book of Prescriptions : containing 2900 prescriptions, collected from the
practice of the most eminent physicians and surgeons, English and foreign.
Comprising also a compendious history of the Materia Medica of all coun-
tries, alphabetically arranged ; a list of the doses of all officinal or estab-
lished preparations. By Henry Beasley. Philadelphia : Lindsay &
Blakiston. 1855. 12mo., pp. 369.

This is another of those small books designed to aid the junior members
of the profession, or perhaps to be bought by the verdant, who may think
themselves fully equipped for practice with 2900 prescriptions in their
saddle-bags. The compiler, as if conscious that he was laboring for " green
Doctors," is careful to impart some of the rudiments of the supposed un-
known tongue in which the said prescriptions are mystified. We accord-
ingly find among the first pages of the book, not only an explanation of the
"signs and abbreviations," but also "a list of the Latin words and phrases,
more or less frequently met with in prescriptions." The list begins thus :

" Abdomen, the belly ; abdominis, of the belly ; abdomini, to the belly !

Absente febre, is the absence of fever."

We are opposed to humbuggery any where, but especially in scientific
matters ; and we really think that it would be much better for all practi-
tioners to write their prescriptions in plain vernacular, than to adhere to a
custom which no doubt originated at a time when it was deemed a virtue
to keep the masses in ignorance. Is it not preposterous and humiliating to
see a collection of prescriptions, upon the proper use of which the life of the
patient may depend, made up and accompanied with directions, all confess-
edly unintelligible (to many) without reference to the appended glossary.

1855.] Editorial and Miscellaneous. 767

tionary of terms tea licine and the Collateral Sciences. By

K. L>. Hoblyx. A.M., Oxon. A new American from the last London
edition. Revised, with numerous additions. By Isaac Bats, M. 1 1
Philadelphia: Blanchard <fe Lea, 1855. 12mo., pp. 509.

Hoblyn's Dictionary lias long been a favorite with us. It is the best
book of definitions we have, and ought always to be upon the student's
table.

Pronouncing Medical Lexicon: containing the correct pronunciation and
definition of moat of the terms * rs on Medicine

and the collet' -. With addenda. By C. EL Cleayelaxd, M. 1 >..

Cincinnati: Langly Brothers. 1855.

This is a good little book of the kind ; but not to be compared to that of
Hoblyn, which is small enough to be useful.

Scenes in the Practice of a Neut York Surgeon. By Edward H. Dixox,
If, D.. Editor of the Scalpel. With eight illustrations by Darley. New-
York : DeWitt & Davenport. 1855. 12 mo., pp.407. (For sale by

M. G. MrKiune.)

The author of this work is extensively known as a vigorous and racy
writer, and this production fully sustains his reputation as such. The dis-
position too often evinced in the pages of the M Scalpel " to acquire noto-
riety by the abuse of respectable members of the medical profession, and
even of institutions deemed Holy, has very generally alienated the author
from those who might have otherwise applauded some of his positions and
strictures. Yet, in the work before us, we have noticed nothing special-
ly objectionable, and the book will doubtless prove interesting to most
read'

Magendie, the celebrated physiologist, died in Paris early in October,
at quite an advanced age. His disease was an affection of the heart.

Lawrexceyille, Ga., Sept. 19th, 1855.
Prof. Dugas : Dear Sir In looking over some old numbers of Wood's
Quarterly Retrospect, I find an exceedingly interesting account of an oper-
ation performed by the celebrated Dieftenbaeh. The case is such a monu-
ment of his skill and perseverance, and the description of it so graphic, that
I cannot resist the desire to send it to you for publication in your Journal.
For in doing this, I feel that I am not only paying a merited tribute to one
of the brightest ornaments of our profession, (now alas ! no more) but that
I am also engaged in the noble enterprise of heralding the trium]
modern Surgery, and of confirming its claims to the confidence and
tude of mankind. While on this subject, I would remark, that we. in this
day of quackery and humbuggery, have much reason to felicitate oir. -
on the fact that surgical skill cannot be obtained by a patent and that the

768 Miscellaneous. [December,

ignorant mountebanks who infest our country will not be likely to emulate
the deeds of Dieffenbach and others, in Surgery.

Yours, truly, John S. Wilson.

Complicated Plastic and other Operations, successful in removing an ex-
traordinary Case of Deformity of the Face from Scrofula. By Professor
Dieffenbach. Dieffenbach related as follows, one of the most dreadful
deformities that can be imagined :

" It was late one evening that three strangers requested to see me, a man
and two women ; and one of whom, who was closely veiled, wished to speak
to me alone. Her companions having retired, she seemed to cast her eyes
around the room, to ascertain that no one else was present, and then, with
some hesitation, and without uttering a word, she slowly raised the thick
black veil, by which her head and face had been concealed and a great por-
tion of her person enveloped. I had seen much in my life that was shock-
ing, and, as I thought, the most hideous deformities of face and figure
were so familiar to me that I could behold them comparatively unmoved ;
but here I started back, shuddering and horror-struck. A death's head, a
skull with glistening eyes, red and everted eye-lids, and a skeleton face,
stood involuntarily grinning before me. The cheeks and lips were absent,
and in their place a thin red skin covered scantily the almost denuded
bones. In place of a nose was a large triangular hole, through which,
when she gave utterance to sound (speak she could not,) the tongue pro-
truded, for the palate bones were gone, and the oesophagus was freely ex-
posed to view. At the upper portion of this dreadful orifice, through
which three fingers could be introduced, a red and bony process protruded
extending upwards between the remains of the eye-brows, while its lower
margin was the remains of the upper jaw, now reduced to a small and
toothless bony rim ; where cheeks had been, red and indurated cicatrices
crossed each other in all directions, and, as I have said, ectropium existed
to a great degree. This is no exaggerated portrait of a young girl of
eighteen years of age, member of a noble and powerful family, but never-
theless the victim of scrofula.

" I stood late at night and alone with this dreadful apparition a foul
thing, which forcibly reminded me of the prophet Khorassan, when he
raised his veil. Instead of a human voice, hissing and unintelligible sounds
proceeded from the cavity in the face ; and I drew back with horror as she
advanced to place her finger on my nose. Well did I understand the ap-
peal, and deeply did I regret my inability to ameliorate the condition of
this unfortunate lady. Wken I had made her understand by signs that I
could do nothing for her, an exciting scene followed. She cast herself be-
fore me in a state of the deepest mental agony, imploring by signs my
assistance ; and when I summoned her companions (one her brother and
the other her governess) to assist in calming her, she hastily resumed her
veil ; for, for years, she had not allowed her family to behold her deformity.
The governess spoke French, and I told her I could do nothing but recom-
mend a mask ; and then I hastily withdrew from this strange midnight
scene, the recollection of which will never be effaced from my mind.

"The next day I left Berlin for Vienna; and scarcely had I arrived
there than the invalid lady again presented herself before me. She had
heard of my departure, and immediately followed me. Here I called in
the assistance of the great dentist, Carobelli, with whose aid I succeeded

1555.] Miscellaneous. 76^

in procuring a set of teeth and a false palate, which facilitated eatin_
made her speech more intelligible.

''The mora I . the more I felt convinced that I could

do nothing further, and that it was utterly impossible to obtain a not
even a fleshy covering for the hole in the face. Hie bones of the forehead
were nearly naked, and the thin, spare, and cicatrized skin of the t<
was not sufficient for the purpose. A casual examination <t' the arm,
however, showed much loose and thin skin, and as I raised a fold of it
n my fingers, and pressed it into the form of a nose, the idea struck
me that I might transplant a portion of it to a spot near the fm
the right eye-brow, where the skin was not so much . and after-

- remove it by degrees, in the same manner as heavy monuments are
sometimes slowly transplanted from one place to another.'"

[Dieffenbach acted upon this idea, and proceeded to relate the steps of
the operation, or rather series of operations, which extended over a period
of eighteen months, exhibiting as much the skill and perseverance of the
operator as the patience and confidence of the unhappy lady. A nose was
formed from the skin of the upper part of the left arm, and that in a very
novel manner. A triangular piece was marked out, about a third larger
than the supposed size of the required nose; an incision was then made
iid upon the outer and inner thirds of its bane; By sub-
cutanc :ion. this triangular portion of the skin was separated from

the muscle, but still left attached to the arm by its somewhat broad apex
and the middle third of its base. The edges of the wound on the arm
were then brought together as much as possible by straps ; and the sides
of the triangular portion of the skin turned inwards and properly secured.
- three months before the parts had healed ; and then Dieffenbach
had obtained what might be called a triangular loop of flesh, attached by
its base and apex to the arm. This was to form the new nose. The parts
being healed, Dieffenbach proceeded to fix the prepared nose to the inner
edge of the right eye-brow, which, as we have said. Avas thick and puffy.
This he did in the old Taliacotian method, by detaching the apex of the
new nose, or triangular portion of the thickened skin, from the arm, uniting
it in situ with the brow, and fixing it by sutures and appropriate bandages.

He had many doubts a> to the success of the operation : and the great
advantage of this mode of operating is, that if we at first fail in attaching
a new nose to the forehead, we may commei ovo at any rate we

may heal the wouud we have made on the brow, and again attempt to
attach to it the stump which still remains upon the arm. Again, it is pre-
ferable to the common Taliacotian operation, where, even if successful, the
patient's face is deluged with the results of suppuration, as i- not the case
in that performed by Dieffenbach. Contrary to expectation, the stump did
unite to the brow ; in a few days all ligatures were removed : the patient
bore the distressing position of her arm with the greatest fortitude, and
could with difficulty be persuaded at the end of a fortnight to allow the
base of the triangle to be cut away and the arm relaxed from the face.
The case was perfectly successful ; and suffice it to say, that by transplant-
ations, frequent and small incisions, and parings, and gratings, and by the
introduction of tabes and needles, and by compit a, a respectable nose
was at length formed; by appropriate operations the ectropion] of both
eyes was relieved ; the many and hard cicatrices were removed from the
and at the end of eighteen months, the patient was presented to the
Clinique a very different being to what she was when last there ; and she

770 Miscellaneous. [December,

quitted Berlin, with the consciousness that, by her steadfast and enduring
perseverance, she had compelled the professor to an operation he had
deemed impossible, and even by the success of which he had been amply
rewarded.] Banking's Abstract, condensed from the Med. Times.
March 6, 1847.

Epilepsy. Trousseau considers that he has permanently cured twenty
epileptics in one hundred and fifty cases, treated with belladonna. His
mode of giving the remedy, as described in his clinical lectures at Hotel
Dieu, is to make the pills of the extract and the powdered root of belladon-
na, aa l-7th grain. A pill to be taken every night for the first month ; two
pills during the second month ; three on the third month, and four during
the fourth month. If at the end af twelve months the register shews a
diminution of the seizure, the remedy may be persisted in, with great hopes
of a perfect recovery in from two to four years. The dose should not be
increased, after the physiological action of the remedy is manifested. [lb.

Typhoid Fever. Dr. Shute, of the Torbay Infirmary, treated during the
year 1854, forty-eight cases of Typhoid fever in that institution, losing but
one patient. His treatment, as recorded in the Medical Times and Gazette,
was to use brandy and quinine freely, and sustain and nourish the patient.
The doctrine of feeding fevers is becoming very generally approved of, and
the success in the results of the treatment are encouraging. [lb.

A Remarkable Case of Super-Foetation. The following case was related
to us by Dr. Bigelow, of this city, who is cognizant of the facts: Mrs. C,
set. 18, of healthy constitution, accustomed to menstruate every tAvo weeks,
was married Oct. 9, 1854, after which she had three menstrual periods in
regular succession. On the 10th day of July following (nine months and
one day after marriage) she gave birth to a full-sized male child. She did
not, however, regain her former size, the lochia continued for a week ; the
milk was watery and scantily secreted, so that the child had to be fed, and
in about a week she was up. She continued well until the 22d of Sept.,
(72 days after the birth of her first child,) when she was taken sick, as she
supposed, with cholera morbus, but after a short labor she gave birth to a
female child, of about the same size as the former. The lochia continued
longer this time, and the milk was secreted abundantly. Both children are
thriving, and the mother is in perfect health. [N. Y. Jour, of Med.

Sweetened Water as a cure for Opacity of the Cornea, 'produced by
Lime. A man was brought lately to the Hospital after having received
slaked lime in his eye, and Dr. Gosselin saw him ten minutes after the ac-
cident. The cornea, already had a remarkable opacity. No suppuration
occurred, and the transparency of this membrane was restored in a few7 days
under the influence of a mode of treatment discovered by M. Gosselin in the
following experiments. He threw slaked lime on the eyes of animals, and
he saw that, contrary to what is admitted to take place in such a case, there
was no inflammation produced. A sudden opacity appeared, resulting
merely from the introduction of the lime between the elements composing
the tissue of the cornea. M. Gosselin found that a solution of many acids
was able to restore transparency ; but that frequently a suppurative inflam-
mation was the consequence of the irritation produced by the acid. Eau

1855.] Miscellaneous. 771

sucree (sugar and water) gives much more satisfactory results: it dee
the opacity in a very short time, and never causes any inflammation. The
man, above spoken of. had hk eyes trashed with eon sucree. and in three days
the opacity of the cornea had entirely disappeared. I have seen M. I
lin performing with - in presence of the society, the erperim<

restoring to transparency the opaque cornea of a . Med. Time*

and Gazette.

Tinct. F' 'attain Uterine Hemorrhage. Dr. Scbreier, of Ham-

burg, states that, during the last thirteen years, he has found this a most
valuable styptic in severe uterine hemorrhage prior to delivery. He in-
50 or more drops, diluted in 3 or 4 ozs. of water. ( f late he has also
applied it in hemorrhage dependent upon placenta prsevia, when the os is
insufficiently opened to admit of labour being terminated. A sponge tent,
cut to the form ofth< eped in the tincture, and passed as high up as

le. It not only arrests the hemorrhage, but hastens the dilatation.
The tincture has also been found valuable in hemorrhage from cancer uteri,
Monata.fur Geb., and Ibid.

Oxalate of Potassa in Puerperal Diseases. Dr. Ritter von Brenner
strongly recommends this substance in inflammation of the peritoneum,
uterus, or ovary, and especially in the metro-peritonitis of puerperal women.
The formula is,

R. Aq. dest. vi; oxal. pot. gr. vi ; sacch. 3ij. M. A spoonful every
hour. Buchners Repert., and Ibid.

Muriate of Morphia and r<,f\e m Neuralgia. M. Boilean reports t hat-
he has derived great relief in the paroxysms of neuralgia from the admin-
istration of muriate of morphia in a very hot infusion of highly-roasted
coffee. The dose is one centigramme (-^ grain) for an adult, and less in
other ages or in peculiar temperaments. This may be repeated when a
violent paroxysm recurs, and if necessary it may be increased by fractions ;
but If. Boileau has never gone beyond two centigrammes. Gaz. des Hop,
and Ibid.

Opiate Inhalations in Xeuralgic Pains. Take two grains each of pow-
dered opium and sugar, also gum benzoin if desired, which sprinkle upon
a hot shovel held under the patient's nose. It will afford prompt relief in
coryza. with pain in the frontal sinus, as also in the various neuralgic pains
of the frontal, temporal and zygomatic regions, whether of an idiopathic
or symptomatic nature. [St. Louis Med. Journ.

Statistics of Mortality in Norfolk and Portsmouth, during the prevail-
ing Epidemic. It has been estimated that the population of Norfolk, which
is usually about 14,000, has been reduced by flight to not more than 8,000
persons, whilst in Portsmouth, with an average of 8,000 inhabitants, it is
supposed that probably 4,000 have remained. The number of deaths in
Norfolk to the 20th of September have been not far from 1,400, whilst in
Portsmouth it is estimated that 700 have died from the disease. Thus in
12,000 persons, we find a loss of 2,100 from the ravages of this awful
scourge. Yet, even with this fearful exhibit, the disease is not satisfied, for
daily victims are being added to the mournful lie

772

Miscellaneous.

For the sake of comparison, let us turn to the admirable tables of Dr.
La Roche, in his late treatise on Yellow fever, and we see that even this
malignant visitation has been exceeded in the ratio of deaths to popula-
tion. Thus,

In Palma, 1821 The remaining- population being just that we have
allowed to Norfolk and Portsmouth, i. e., 12,000, the number of deaths
were 5,341.

In Gibraltar, 1804 With a population of only 10,000, the mortality
was more than one-half, the number of deaths being 5,946, whilst in the
epidemic of 1821, al Barcelona, of 830 patients entered at the General hos-
pital, all died but 81 ! [ Virginia Med. and Surg. Journal.

THE

MEMORY OF

Sylvester,

Trugien,

Gooch,

Craycroft,

Constable,

Parker,

Howie,

Mierson,

Hal son,

Lovett,

Gelbardt,

Handy,

Sylvester, Jr.,

Walters,

Blow,

Cole, .

Higgins,

Thompson,

Jackson,

Morse,

Briggs,

Fliess,

De Berane,

Riser,

Upshur,

Booth,

Obermuller,

Smith,

Tunstall,

Howe,

De Capry,

Marshall,

Selden,

Bache,

Hunter,

Craven,

Burns,

Dillard,

Schell,

Berry.

At the close of a long and bloody battle, it is the custom to present a
list of the killed and wounded ; that sad record of the lamented dead, who
have gone down to the grave midst the smoke of the conflict ; that glorious
record of the heroic dead, whose gallant deeds are painted on the pages of
history, whose names are cherished in all hearts.

We too, have now to tell of like men with these ; of some who have fallen
at the post of duty ; of others who have died whilst serving as volunteers
in a deadly campaign. With no hope of victory, with no pomp and circum-
stance of war to animate the heart, our brethren in Norfolk and Ports-
mouth have calmly, firmly discharged their duty, and have met their fate.
The slaughter is now over, and we record a mortality unprecedented in
history.

Forty physicians have fallen in the hopeless contest. Exhausted with
fatigue and watchings; dispirited by their want of success ; pressed down
with the weight of responsibility resting on them, they have sunk, easy
victims to an enemy whose ravages they faithfully labored to resist. Many
of these men were residents of the infected cities, and though all was con-
sternation around them, they flinched not at that trying hour ; whilst others
from all parts of our country, ardently rushed to the scene of danger, and
sacrificed their lives in the vain attempt to check the fearful pestilence.

No pompous funeral accompanied our brethren to their silent grave ; no
music, sad and mournful, rings upon the ear. They lie quietly now, but
they have not died in vain. Faithfully have they fulfilled the sacred duties
of their calling, and their memories remain an imperishable legacy to the
profession they have ennobled and adorned. [ Virginia Med and Surg.
Journal.

INDEX TO VOLUME XI.

PAGE.

Abdominal abscess, singular case of 261

Abscess, abdominal 261

Acne, treatment of 126

Acne 602

Actual Cautery 143

Acute rheumatism, large doses of bi-
carbonate of potash in 435

Alkalies in cerebral congestion and

apoplexy 25

Albuminuria after scarlatina, treat-
ment of 123

American Medical Association, trans-
actions of 443, 192

Ames' reply to Dr. Boling's experi-
ments. ., SOS

Amputation of the thigh in civil and

military practice 370

Amputation of finger 399, 406

Do. thigh 405

Do. great toe 406

Do. leg 407

Amesthesia, surgical operation under

local 79, 189

Anaesthesia, instructions for inducing

by cold 53

Anaesthesia by cold operation. . . . 314
Do. by compression of carotid 504

Anthrax, chloroform vapor in 41

Antim. Tart, in delirium tremens. . . 129
Anti periodic properties of Mullein

leaves 212

Anus, fissures of 3S7

Aorta, diseases of the 324

Apoplexy, alkalies in 25

Arbor vitie in cancer 757

Arsenic, poisoning by external use of 68

Arsenic-eaters 130

Arteries, their rounds and treatm't. 369

Do. ligature of 565

Aromatic confection 443

Asylum for inebriates 64

Astringent, Inga a new 322

Ashwell on diseases of women 382

Asclepias verticellata in venomous

bites 414

Atlanta Medical College 125, 3S3

Atlanta Medical and Surg. Journal . . 515
Atlanta Medical Journals and College 640

Atropine in Epilepsy 129

Atmosphere, effects of its condition

on the human body 197

Atheroma 399

PAGE.

Barton on yellow fever 702

Beasley's Book of Prescriptions. . . . 766
Benzoin, Tine, of, in chapped nipples 26

Beck's infant therapeutics 248

Belladonna in orchitis 258

Do. in salivation 510

Birth, a case of quadruple 64

: Do. of twins at 40 days' interval.. 64

; Do. live, at 4 months! 321

Bile not found in healthy fceces. ... 65
Bismuth, subnitrate in Gonorrhoea. . 129
Bites, spirits turpentine and nitrate

potash in snake 577

Bladder, chloroform vapor in irrita-
ble 87

Blenorrhagia, local use of copaiba in 700
Blackberry root, medicinal proper-
ties of 723

Borax, injections in infantile diar-
rhoea 381

Bozeman on Vesico-vaginal fistula. . 491
Bozeman's case of catheter broken

in urethra 717

Boling's Reply to Dr. Ames 517, 5S1

Bone, inflammatory affections of. . . 694
Bronchitis, chloroform vapor in. ... . 92
Brown on the use of cold water in

dysentery 133

Brown's case of abdominal abscess. . 261

Broth for the sick 323

Bubo 441

Byrne on malignant cholera 383

Cafeine in sick headache 27

Cancerous affections, chloroform va-
por in 47

Cancer of rectum, chloroform vapor

in 93

Cancer and tubercle, concurrent de-
velopment of 318

Cancer, alleged cure ot 568

Do. cantharadine ointment in open 569
Do. treated with Thuya occiden-

talis

Camphor in atonic ulcers 290

Cautery, actual 143

Caustic in wounds 320

Cauterization for the reunion of ano-
malous fissures 50*7

Carbuncle 502

Carpenter's Physiology 766

Carson's Synopsis 766

774

INDEX,

PAGE.

Calciilus adherent to Madder 515

Cerebral congestion, alkalies in. . . . 25
Caesarian section thrice upon the

same woman 127

Caesarian section 125

Chorea 29, 81

Do. treatment of 380

Cholera, different methods of treat-
ment 49

Cholera, chloroform vapor in 42

Do. prevented by fumes of as-

phaltum 505

Do, Jews exempted from 106

Chloroform in surgical and obstetric

practice, by Jos, A, Eve, M. D 10

Chloroform, deaths from 64, 193, 387

Do, injurious effects in par-
turition 116

Do. in Tetanus 317

Do, in midwifery, abuse of. 195
Do. with Iodine, tinct. of. ,. 440

Do. in hydrocele . . . 443

Do. administration of it to

children. . . 510

Do. formula for its internal

use 515

Do. ointment, dilatation of

os uteri by 573

Chloroform Vapor, uses by Dr Hardy

Do.
Do.
Do.
Do.
Do.
Do.
Do.
Do.
Do.
Do.
Do.

Do.
Do.

Do.

Do.
Do.

do,
do.
do.
do.
do.
do,
do.
do.
do.
do,
do.

dov
do.

do.

do,
do.

in Hernia 39

in Tetanus 39

in Phthisis 41

in Neuralgia 42

in Dysmenorrhcea 42

in Cholera 42

in Surg, opera'tns 43

in Gout 43

in Anthrax 44

in Ulcers 45

in Cancerous af-
fections 47

in Hemorrhoids..

in affections of the
ear . . ...... .

in irritable blad-
der ......

in Obstetrics

in Morbid men-

87

struation 89

Do. do. in violent vomit-
ing 91

Do. do. in Colic 91

Do. do. in Bronchitis. ... 92
Do. do, in Uterine affec-
tions 92

Do. do. in Cancer of the

rectum. . . 93

Do. do. Douche. 191

Do. do, local application of 365

Chloric ether in diarrhoea 313

Chapman's case of accidental impale-
ment 560

Certificates to the efficacy of secret
remedies ,. . 706

PAGr

Cicatrization of wounds by caustic. 3204
Cleveland's Medical Lexicon. ...... 767

Cleft Palate, clamp suture in 122

Climacteric disease 237

Cod-liver oil, new mode of adminis-
tering 29

Cod-liver oil deprived of unpleasant-

antness . . ..... ...... 384

Do, test of purity 388

Do. its effects on the blood. 513

Do. who introduced it 644

Do. with quinia . , 703

Do. solid.. 703

Cold in operations, instructions for

using .....,, 53

Colic, chloroform vapor in 91

Collodion in hydrocele. . . 129

Coma and insensibility, cause of . . . . 635

Comstock's Physiology 247

Convulsions, a cause of infantile. . . . 558

Conception, physiology of 300, 302

Contributors to this Volume 764

Cooper's case of Hydrocephalus. ... 138

Copper, slow poisoning by 700

Correction 642-

Coryza, new treatment of 576

Cornea^weetened water in opacity of 770
Copaiba in Menorrhagia, local use of 700'

Coxalgia, early exercise in 378-

Croup , 180

do. quinine in 64

do. tracheotomy in. . . , 68

Cubebs in infantile enuresis. 195-

Culinary art, influence of upon health 389

Cupping 576-

Cupper and leecher, hints from a. . . 697

Delirium tremens, tart, emetic in. . . 129-
Delivery, new method of inducing

premature Ill

Diarrhoea treated by chloric ether. . 313
Do. borax injections in infantile 381

Dickson's Elements of Medicine. 702

Dieffenbach's surgical case 768

Digitalis pomade in hydrocele 511

Discovery, quite a 66*

Discoveries, recent chemical . . 576-

Dislocation of Hip reduced by ma-
nipulation alone . . 220, 290^

Dissecting materials preserv'd by salt 1 27

. Diuretic wine for dropsy 323-

Dixon's- Scenes in Surgical Practice . . 767
Drake's views, notice of some of Dr. 683*

Dropsy, diuretic wine in. 323-

Dugas. L. A, Surgical operations un-
der local anaesthesia. . . . 79, 189-

Dugas, L. A., extraordinary case of

prolapsus of Rectum .. rf 140*

Dugas, L. A, Strictures of Urethra . . 645
Dysentery, remarks on, by C. C. How-
ard, M. D. .- 69-

Dysentery, cold water in acute 133-

Dyspepsia, lactic acid in -. . 639

Dysmenorrhea, chloroform vapor in

42.

IXDEX.

775

Ear, chloroform vapor in affections of 87

Eclampsia during pregnancy 33

Editorial our Journal for 1855. 58

Do. our Journal mgrene of the lungs, treatment of

PAGE.

Fracture, neck of os femoris 404

Furuncles 502

Do.

Do.
Do.

local anaesthesia in surgical

operations 189

Dr. Gammann's Stethoscope. 190

the chloroform vapor douche 191

Electricity, mercury taken from the

system by 508

Emigrant ships, sickness and mortal-
ity on 64

Eneuresis. euhebs in infantile 195

Enteric and gastric affections, effects

of position in 636

Epilepsy 260, 324. 77<>

Do. atrophine in 139

Do. treated by black elder bark. . 322

Epilepsia Miasmatiea 724

Epistaxis, external pressure as means

of relieving excessive 566

Erg.t 704

Eruptions, chronic papular 324

Erysipelas, Proto-sulphate of iron

in 500, 516

Errata 580, 644

Eve, Joseph A., on chloroform in sur-
gical and obstetrical practice 10

Extraction of foreign bodies from the

oesophagus 194

Extraction of a tobacco pipe from

behind the ear 194

artificial 7u5

Fats and oil prevented from becom-
ing rancid 644

Feces, bile not found in healthy. ... 65
Do. in pathological conditions. . .

Felder, on the Epidemic of 1854

Fetus, effects of fright upon the un-
born

Fetus, extra-uterine, retained 40 yrs.

Fever, tvphoid, by R. B. Gardner,

Fever, tvphoid, in Georgia 471

Do. * do 110

Do. Kollock on yellow 453

Do. importance of nourishment in 571
Do. blisters to the head in typhoid 144

Do. Felder on yellow 598

Do. intermittent, nitric acid in. . . 630

Do. quinine in yellow 699

Do. antimoniate of quinia in inter-
mittent 708

Fleming's Hygienic Journal 515, 574

Flint, compliment to Professor 442

Foreign bodies in oesophagus, extrac-
tion of . .% 194

Foreign body in the stomach exit

by an abscess 258

Fractures, diagnosis in 242 '

Fracture of the cranium 720

Fractures treated by starched appa-
ratus 176

65
598

128
188

Gardner, R. 13. on typhoid fever... 5

Gastrotomy. successful LSI

.and enteric affections, effects

of position in 636

General pathology, letters on. ..335, 409
481, 544, 616, 709

German Poison Eaters 130

Glands, induration of sub-maxillary

and sub-lingual 289

Glycerine as an internal remedy. . . 312
Gonorrhoeal opthalmia, new treat-
ment of 284

Gonorrhoea sub. nit, bismuth in 129

Gout, chloroform vapor in. 43

Green on diseases of cervix uteri. . . 248

Do. do. do. aorta 325

a on foreign bodies in the air

passages 58

B of the urinary or-
gans 514

Hoemostatic, new 142

Haematemesis 319

Hare-lip, operation in early age 112

Do. early operation in 516

Harriss, 'surgical cases 399

Harris, use of asclepias verticellata

in venomous bites 414

Harrison's Dublin dissector 247

Do. Anatomy 247

Hassall's Microscopic Anatomy 246

Hey ward's Miscellaneous papers... 382

Headache, caffeine in sick 27

Heart, tic-tac in diseases of the 96

Do. signs of diseases of 497

Hemorrhoids, chloroform vapor in. . 89

Do. nitric acid in 303

Do. ointment for 644

Hernia, chloroform vapor in 39

Do. case of strangulated 120

Do. plan for radical cure of in-
guinal 573

Herpes, ointment for 323

Hiccough 576

Hoblyn's Medical Dictionary 767

Holt,' Dr. Win, J 574

Holt's Letters on General Pathology

335, 409. 481, 544, 616, 709

Howard on dysentery 69

Do. on varieella'lymphatica. .. 2b7

ll<>rs<'-fiesh as food 443

Human species, new variety of 131

Hydrocele, treatment of... 27

I>o 400, 401

Do. collodion in 129

Do. chloroform in 443

Do. digitalis pomade in 511

Hydrocephalus, spontaneous tapping 138
Hydrocephalus tapped eight time.-.. 12">
Hydrophobia 560

776

INDEX.

Impotence 5*7*7

Impalement, accidental case of 560

Inga, a new astringent 322

Infantile convulsions, eccentric irri-
tation a cause of 558

Inflammations, iodine and nit. silver

in cutaneous 5*70

Iodine inhalations, simple method of

administering 28

Iodine, topical uses of 113

Do. in ovarian dropsy 129

Do. with chloroform, tinct. of. . . 440

Do. paint in cutaneous nsevi 562

Iodide of potassium with ammonia. 322
Ipecacuanha, saocharized ext. of . . . . 321
Iron, lactate of in some neuroses. . . . 324
Do. per chloride of to neutralize

syphilitic virus 3*75

Do. proto-sulphate of, in erysipelas 500
Do. do do do 516

Do. by hydrogen 144

Do. and manganese 85

Do. muriatcd tinct. in uterine hem-
orrhage 771

Jackson's letters to a young physician 640

Jackson, compliment to Dr. C. T. . . . 442

Jameson on Epidemic cholera 764

Joint, resection of elbow 240

Jones, effect of atmospheric changes

on the human body 197

Jones & Sieveking's Path. Anatomy. 62

Keloides 346

Kidney, single 381

Kollock, on Epidemic of 1854. ..... 453

Do. do Hysterical Monomania. 608

Kolliker's Microscopic Anatomy .... 124

Labors, prize essay on difficult, 101,

Lactation by sick mothers

Laroche on yellow fever

Lacerated perineum, new operation
Laws of Georgia relating to practice

of medicine

Lehmann's Physiological Chemistry.
Leucorrhoea in vaginitis, treatment of

Light, intolerance of

Lips and Face, peculiar malignant

disease of

Lumbago

Lung, gangrene of the

Lungs, treatment of gangrene of the
Lung, removal of portion of the ....
Lupus

Mackall on influence of culinary art
Malformation and displacement of

organs

Malignant disease of lip and face . . .

Mammary inflammation _

Mammae of nurses, treat, of inflamed

Manganese and iron ;

McCrary on mullein leaves as anti-

periodio.

145

515
701
637

675'

765

431

387

297
196
324
28
195
502

389

185
297
494
638
85

212

PAGE.

McKenzie on diseases of the eye. ... 764
Med. College of Georgia, alumnni of 641

Magendie, death of 767

Medical College of Georgia, graduat-
ing class 06-

Medical Society of State of Georgia. 196
258, 384, 442
Medical Association of Ala., trans-
actions of 641

Medical Society of Illinois, transac-
tions of 124, 373

Medicines, new method of introduc-
ing in sjTstem 572

Menorrhagia by Dr. Itigby 30

Mentagra, simple and prompt treat-
ment of 24

Menstruation, chloroform vapor in

morbid 89

Mental manifestations and physical

organization 169

Menstruation and conception, physi-
ology of 300

Meningitis, analysis of 21 cases of. .. 307
Mercury taken from the system by

electricity 508

Mercury, external use of acid nit. of 501
Mezquite gum, a substitute for gum

arabic 245

Milk, solidified 323

Miller's case of gun-shot wound of

head 555

Moles 503

Monomania following parturition,

hysterical case of 608

Mullein leaves an anti-periodic 212

Mucous membrane and skin, relation
to each other 229

Nffivi 503

Do. cutaneous, iodine paint in. . . . 562

Neerological 574

Neuralgia 388

Do. chloroform vapor in 42

Do. treated by compression of ar-
teries 245

Neuroses, lactate of iron in some. . . 324

New Orleans, quarantine act 442

Do. report of sanitary commiss'n of 251

Do. Quarterly Jour, of Medicine 256

New York, consumption cuiers of. . 577

Neuralgia, mur. morph. and coffee in 771

Do. opiate inhalations in 771

Nickel 260

Nitric acid in hemorrhoides 303

Do. " " hooping cough .. 323

Do. " " intermittent fever. . . 630

Do. " " prolapsus ani 186

Nipple, diseased .f 408

Nipples, tr. benzoin in chapped 26

Obituary of Norfolk physicians 772

Obstetrics, chloroform vapor in. .. . 88

Oglethorpe Medical College 640

Opiate inhalations and fumigations. 61

I>~DEX.

777

PAGE.

Orchitis, new compress for 182

Do. belladonna in 258

Do. differential diagnosis of. . .

Otorrhoea, new treatment of. . . .512, 7^'.'

Ovarian cyst, new method of open'g 123

Do. dropsy, iodine io 129

Ozena, nasal irrigations in 35

Palate, fissures of 439, 507

Parturition, injury by chlorofrom in

17 eases of 116

Parasites, a remedy for animal 515

Paralysis, physiology pf

Paxton's, Dr.. bote] for invalids. . . . 575

Perm-sis 196

Do. nitric acid in 323

Do. palliative in 7"i

Peritonitis, rare forms of 235

Pericardium, congenital absence of. 381

Phthisis, chloroform vapor in 41

Do. quinine in 381

Do. .night sweats of 387

Physical organization on mental ma-
nifestations, influence of the 169

Physicians visiting list 765

Placenta Praevia 244

Pneumonia, urine in diagnosis of.. . . 441
Polypi, method of operating for nasal 119

Positive medical aaeuts 63

Podophillin 324

Potash bicarbonate of, in acute rheu-
matism 435

Potass, oxal. in puerperal diseases. . 771

Powel's Pocket Formulary 514

Prolapsus of the rectum, extraordin-
ary case of 140

Prolapsus ani, nitric acid hi 186

Do. u observations on 357

Premature delivery, new method of

inducing Ill

Pregnancy, sine iinmissione membri 575

Prostate, hypertrophy of the 688

IVofesaion, statistics of the medical. 577

Professional changes 442

Do. resignations 383

Paarperal diseases. oxaL potass, in.. 771

Quinine in Croup 64

Do. its action on the uterus. . . . 341

Do. in phthisis 381

Do. in yellow fever 699

Do. with cod-liver oil 7":,

Quinia, antimoniate of, in intermit-

tents 708

Quinic ether 128

Radio ulnar ligament latelydiscov-
ered 516

Rand's Medical Chemistry 382

Bamsbotham's Obstetrics

Rattlesnakes' poison on plants, ef-
fects of 67

Rectum, chloroform vapor in cancer
of the 93

PAGE.

Rectum, prolapsus of the 140

!>.>. tumbler found in T68

Recto-vaginal fistula 429

in of elbow joint 240

Rheumatism, hypo-sulphite of soda

in inflammatory 371

Rokitansky's Path. Anatomy 7"ii

gnoPs Mortuary Statistics of Au-
gusta * 343

Salt, common

Salivation, belladonna in 516

Savannah Medical College 258, 574

Scarlatina, treatment of albuminuria

after 123

Scarlatina, treatment of 433

Scabies; vinegar in 380

Bchneiderian membrane, papillae on

the 380

Scrofulous intolerance of light 387

Serpents, venom of 322

Seminal discfcfcrges, involuntarv 353,

* 387, 388

Sexes, production of 372

Senna, tasteless infusion of 570

Skeletons, preparation of 642

Skin and mucous membrane; rela-
tions to each other

Skin, peculiar diseases of the

Sleep by compression of carotids. . . 504
Smith, pathology and treatment of

leucorrhoea 514

Sneed on properties of blackberry

root 788

Something new 132

Soda, hypo-sulphite in rheumatism. 371
Spinal svstem and its diseases, bv M.

Hall/ .167, 212

Spigelia jelly 705

Spermatozoon, its entrance into the

ovum 302

Spermatorrhoea, treatment of 5< '3

Stethoscope of Dr. Cammann 183

Statistics, mortuary of X.York, drc. . 193
Statistics of mortality in Augusta. . . 343
Stati>ti<-s of mortality in Norfolk and

Port-mouth 771

Stomach stiek 10 inches long in,

exit by abscess 258

Stomach diseases, some remedies for 315

Stomachic pill 452

Strictures of urethra, treatment of. . 645
Stokes on diseases of heart and aorta 7u3
Strabismus, practical remarks on... . 737
Superfoetation, remarkable case. ... 77o

Surgical operation,' cold in 53

al operation, chloroform va-
por in 43

Surgical appliance, water strapping

as a 57

Surgery, contributions to practical. 417

Surgical eases, by .1. Hamas 399

Superfo-tation 64, 65

Syphilitic virus, neutralization of... 375

773

INDEX.

PAGE.

Tanner's Chemical Manual 765

Tape Worm, new remedy for 388

Tendons, suture of 120

Do. regeneration of 506

Tetanus, chloroform vapor in 39

Do. chloroform in 317

Testicle, diseased 401

Thoracis, prevention of entrance of

air in paracentesis 575

Tinea tarsi, treatment of ......... . 179

Tinnitus aurium 324

Tic-doloureux 644

Todd's Lectures on Paralysis, &c . . . 640

Tracheotomy in croup 68

Tumor, axillary 403

Do. lower jaw 406

Do. fibro-plastic 407

Tumors, within the cranium, diagno-
sis of 633

Tumors, diagnosis of pelvio-. 751

Tumor of the skin, peculiar form" of.. 760

Twins born at 40 days interval T>4

Ulcers, chloroform vapor in 45

Do. camphor in atonic 290

Ulcer of the knee 405

Ulcers, chlorate of potash in 452

Ulcers 502

Urine in diagnosis of pneumonia. ... 44l

Urethra, catheter broken in 717

Urethra, strictures of the 645

Uterine affections, vapor in 92

Uteri, ulceration of the cervix 248

Uteri, sugar and salt in diseases of

cervix, . , 564

Uteri, dilatation of os by chloroform

ointment . . . , , 573

Uterine hemorrhage, tr. fer. mur. in. 771

Uterus, action of quinine on the 341

Do. case of double 575

Do. during menstruation, condi-

dition of 699

Vaginitis and leueorrhoea, treat, of.. 431

"Do. treatment of 511, 701

Varicella lymphatic* 267

Venereal discharges, new treat, for.. 377
Venomous bites, asclepias vert. in. . 414

Vesicovaginal fistula 417

Do. do. by Dr. Bozeman 491

Vomiting, chloroform vap. in violent 91

Do. nature and causes of green . . 115

Do. during pregnancy 388

Do. do. do 745

"Walker on infantile convulsions 558

Water-strapping as a surg. appliance 57
West on ulcerations of cervix uteri. 63

What to observe at the Bedside 248

White Indians 708

Wilson, action of quinine on uterus. 341
Wilson on laws of Georgia relating

to practice of medicine 675

Wine as an enema 438

Womb, sterility depending on cer-
tain diseased states of 624

Wood's case of fracture of the cranium 720
Works received.... ..124, 248, 383, 514

Word on typhoid fever 471

Wounds, cicatrization by caustic 320

Wound, remarkable case of gunshot

of head 555

Wounds of the heart 638

Yellow Jessamine, sedative powers
of the root 363

33

Date Due

LIBRARY BUREAU FORM 1137.3

/396 A

Southern Medical and Surgical Journal
M..S. 11 - 1855

: f